Magnetic resonance imaging and tractography of sensorimotor tracts in fetuses with intraventricular hemorrhage: feasibility and added prognostic value.

OBJECTIVES: To assess the feasibility, characteristics and prognostic value of prenatal visualization of the corticospinal tracts (CSTs) using diffusion-weighted magnetic resonance imaging (MRI)-based tractography in fetuses with intraventricular hemorrhage (IVH). METHODS: This was a retrospective single-center cohort study of singleton fetuses diagnosed with IVH on MRI from January 2011 to December 2018. The left and right CSTs were reconstructed according to an in-utero diffusion tensor imaging sequence using a multi-region of interest (ROI) deterministic tractography approach. The CSTs were segmented by two polygonal ROI: at the level of the posterior limb of the internal capsule and the crus cerebri. The morphology and integrity of the CSTs were assessed visually. Internal capsule and crus cerebri apparent diffusion coefficient and fractional anisotropy values were measured. Postnatal motor function data were obtained from the parents using the functional status scale. RESULTS: A total of 35 fetuses with IVH (mean ± SD gestational age, 29.1 ± 5.1 (range, 19.9-38.9) weeks) were included in the analysis. Parenchymal involvement on T2-weighted sequences was demonstrated in 19 (54%) of the cohort. CST involvement correlated significantly with the presence of parenchymal damage on T2-weighted imaging (P = 0.02). Among liveborn cases, the rate of motor impairment was 14% (1/7) in children with intact CSTs compared with 100% (5/5) in cases in which the CSTs were impaired (P = 0.015). CONCLUSIONS: Fetal corticospinal tractography is feasible technically and offers valuable prognostic information. It enhances parental counseling by providing insights into potential motor outcome, underscoring its utility in complementing fetal neurosonography in cases of prenatal IVH. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ovarian follicular function is not altered by SARS-CoV-2 infection or BNT162b2 mRNA COVID-19 vaccination.

STUDY QUESTION: Does the immune response to coronavirus disease 2019 (COVID-19) infection or the BNT162b2 mRNA vaccine involve the ovarian follicle, and does it affect its function? SUMMARY ANSWER: We were able to demonstrate anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG in follicular fluid (FF) from both infected and vaccinated IVF patients, with no evidence for compromised follicular function. WHAT IS KNOWN ALREADY: No research data are available yet. STUDY DESIGN, SIZE, DURATION: This is a cohort study, composed of 32 consecutive IVF patients, either infected with COVID-19, vaccinated or non-exposed, conducted between 1 February and 10 March 2021 in a single university hospital-based IVF clinic. PARTICIPANTS/MATERIALS, SETTING, METHODS: A consecutive sample of female consenting patients undergoing oocyte retrieval was recruited and assigned to one of the three study groups: recovering from confirmed COVID-19 (n = 9); vaccinated (n = 9); and uninfected, non-vaccinated controls (n = 14). Serum and FF samples were taken and analyzed for anti-COVID IgG as well as estrogen, progesterone and heparan sulfate proteoglycan 2 concentration, as well as the number and maturity of aspirated oocytes and day of trigger estrogen and progesterone measurements. Main outcome measures were follicular function, including steroidogenesis, follicular response to the LH/hCG trigger, and oocyte quality biomarkers. MAIN RESULTS AND THE ROLE OF CHANCE: Both COVID-19 and the vaccine elicited anti-COVID IgG antibodies that were detected in the FF at levels proportional to the IgG serum concentration. No differences between the three groups were detected in any of the surrogate parameters for ovarian follicle quality. LIMITATIONS, REASONS FOR CAUTION: This is a small study, comprising a mixed fertile and infertile population, and its conclusions should be supported and validated by larger studies. WIDER IMPLICATIONS OF THE FINDINGS: This is the first study to examine the impact of SARS-Cov-2 infection and COVID-19 vaccination on ovarian function and these early findings suggest no measurable detrimental effect on function of the ovarian follicle. STUDY FUNDING/COMPETING INTEREST(S): The study was funded out of an internal budget. There are no conflicts of interest for any of the authors. TRIAL REGISTRATION NUMBER: CinicalTrials.gov registry number NCT04822012.

Impact of Left Ventricular Diastolic Dysfunction on Lung Transplantation Outcome in Patients With Pulmonary Arterial Hypertension.

Diastolic dysfunction may influence perioperative outcome, early graft function, and long-term survival. We compared the outcomes of double lung transplantation (DLTx) for patients with pulmonary arterial hypertension (PAH) with preoperative left ventricular (LV) diastolic dysfunction with the outcomes of patients without diastolic dysfunction. Of 116 consecutive patients with PAH (who underwent transplantation between January 1995 and December 2013), 44 met our inclusion and exclusion criteria. Fourteen (31.8%) patients with diastolic dysfunction pretransplantation had a higher body mass index (29 [IQR 21.5-32.6] vs 22.4 [IQR 19.9-25.3] kg/m2 ) and mean pulmonary arterial pressure (54.6 ± 10 mmHg vs 47 ± 11.3 mmHg) and right atrial pressure (16.5 ± 5.2 mmHg vs 10.6 ± 5.2 mmHg). The patients received extracorporeal life support more frequently (33% vs 7% [p = 0.02]), had worse APACHE II scores (21.7 ± 7.4 vs 15.3 ± 5.3 [p = 0.02]), and a trend toward worse ventilator-free days (2.5 [IQR 6.5-32.5] vs 17 [IQR 3-23] [p = 0.08]). There was no effect on development of primary graft dysfunction or intensive care unit/hospital survival. One-year survival was worse (hazard ratio [HR] 4.45, 95% confidence interval [CI] 1.3-22, p = 0.02). Diastolic dysfunction was the only variable that correlated with overall survival (HR 5.4, 95% CI 1.3-22, p = 0.02). Diastolic dysfunction leads to early postoperative morbidity and worse survival in patients with PAH after DLTx.

What is the best treatment for women with polycystic ovarian syndrome and high LH/FSH ratio? A comparison among in vitro fertilization with GnRH agonist, GnRH antagonist and in vitro maturation.

PURPOSE: To evaluate whether high LH/FSH ratio has a clinical impact on patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) with GnRH-agonist/antagonist protocols or in vitro maturation (IVM) treatments. METHODS: We retrospectively reviewed all PCOS patients with day 3 LH/FSH ratio ≥1.5 who underwent IVF or IVM. The main outcomes measures were embryo quality and pregnancy rate. RESULTS: A total of 75 cycles were included. Among these, 44 patients underwent long agonist protocol, 16 antagonist protocol and 15 IVM. Age, basal LH and FSH levels, as well as duration of infertility were comparable for all groups. The LH level on the day of hCG administration was significantly lower in the antagonist group (0.9 IU/ml) compared to the long agonist group (1.4 IU/ml, p = 0.01). There was no difference in pregnancy rates among the groups: 27.2 % in the long agonist group, 37.5 % in the antagonist group and 26.6 % among the IVM patients. CONCLUSIONS: High LH/FSH ratio had no adverse effect on pregnancy rates in all three treatment modes.

[What Should (Future) GPs Learn in Surgery?]. / Was sollten (zukünftige) Allgemeinärzte in der Chirurgie lernen?

BACKGROUND: Surgical diseases are often primarily seen and initially treated as well as further patient care is organised in clinical practice by a general practitioner (GP). During postoperative time periods, GPs do have to i) ensure the surgical treatment success, ii) support reintegration of surgically pretreated patients within their daily and professional life as well as iii) coordinate follow-up care. Therefore, it is indicated for residents in general practice/family medicine to spend a certain time period of approximately 6 months at a surgical department of an outpatient clinic and/or hospital. METHODS: A selective literature search was undertaken on the required surgical knowledge, abilities, skills and expertise that need to be achieved by residents of general practice/family medicine or, respectively, future GPs and that are listed within national regulations on further education, recommendations of professional groups as well as documents and data for preparation of exams. RESULTS AND CONCLUSIONS: Surgical contents during residency in general practice/family medicine comprise far more than "small surgery" only. Requirements of regulations on specialised medical training for a temporary surgical mentor/supervisor and "trainees" provide orientation for the development of an "ideal" surgical rotation for future GPs.

[What should a surgeon know about family medicine?]. / Was muss der Chirurg über Allgemeinmedizin wissen?

BACKGROUND: Surgeons have only limited options from case-specific contacts to generate a comprehensive picture about family medicine as a discipline and the family practitioner with its specific issues and characteristics. Thus, the typical function of the family practitioner is often not sufficiently taken into account while aiming for a better cooperation: the primary care of "unselected reasons for encounter" with integration of bio-psycho-social aspects, long-term care, close distance contacts and low-threshold access. In addition, family practitioners and surgeons have different expectations regarding their cooperation, which are important to know and handle. METHODS: A selective literature search was undertaken on the self-conception and professional functioning of family medicine as well as on mutual expectations to improve cooperation at the outpatient-inpatient interface. RESULTS/CONCLUSION: Surgeons benefit from the knowledge on self-conception and functioning of family practitioners by using options and potentials for the reduction of problems at the outpatient-inpatient interface and for an optimised network.

["Without any practical relevance?": 3 years of student evaluation of an interdisciplinary curriculum for prevention and health promotion in undergraduate medical education]. / "Ohne jede Relevanz für die Praxis?": Studentische Evaluation des Querschnittsfaches Prävention und Gesundheitsförderung im Medizinstudium über 3 Jahre.

BACKGROUND: The topic "prevention and health promotion" (Q10) was introduced into the medical training in Germany by the new medical licensing regulations in 2004. For the conception of an effective curriculum in the context of quality assurance, a continuous evaluation by the target group is necessary. Of importance are particularly the subjective success in learning and its interdependence to invested time, achievement expenditure and perceived relevance of the topics. METHODS: Medical students (N=660) of the fifth academic years of 2007-2009 at the Martin-Luther-University Halle-Wittenberg were asked about their opinion after completing their Q10 curriculums by means of a standardised questionnaires. Emphasis of the questioning was placed on self estimates about success in learning, expenditure of time, evaluation of instruction elements, perceived relevance of prevention topics and the motivation for further occupation with the topic field. The collection instruments covered multiple choice questions, decimal number data and 5-point Likert scales. RESULTS: 510 questionnaires (77% return) could be evaluated. The curriculum "prevention and health promotion" was continuously evaluated over 3 years with increasingly indicated performance requirements and expenditure of time regarding instruction elements and success in learning. The invested time in lecture visits correlated positively with relevance-attribution (r=0.16, p<0.01) and subjective success in learning (r=0.29, p<0.001). The strongest correlations regarding subjective success in learning were shown in the evaluation of the instruction elements (r=0.65, p<0.001), perceived relevance of the topic (r=0.42, p<0.001) and motivation (r=0.45, p<0.001). CONCLUSIONS: Self-estimated success in learning within the interdisciplinary field of prevention and health promotion can be fostered by elucidating the relevance of the topic. Increasing requirements and expenditure of time for the preparation of performance records seem to be a less effective stimulus for successes in learning as the promotion of the lecture visit. The selection of suitable teaching and testing formats for prevention and health should orient itself - apart from objective success measurement - also on student evaluations.

[Perioperative management of polymedication in geriatric patients: risk reduction and coordination with the family practitioner]. / Perioperatives Management von Polymedikation bei geriatrischen Patienten: Risikoreduktion und Abstimmung mit dem Hausarzt.

The increasing proportion of older and polymorbid people in the population also means an increase in polymedication and its risks. This places new and complex demands on the interdisciplinary and transsectoral collaboration. The preoperative, perioperative and postoperative management of polymedication is described in the article with respect to frequent risks and the chances of a systematic exchange of information. The establishment of an interdisciplinary admission routine in departments of surgery and communication with the family practitioner is crucial for patient safety.

Intracytoplasmic morphologically selected sperm injection and congenital birth defects: a retrospective cohort study.

Our objective was to study the birth defect rates in intracytoplasmic morphologically selected sperm injection (IMSI) pregnancies. A cohort of couples presenting male factor infertility between January 2006 and January 2014 was retrospectively analyzed. Discharge letters and a telephone interview were performed for assessing pregnancy outcome. All clinical data were reviewed by a board certified medical geneticist. Main outcomes were fetal/birth defect and chromosomal abnormality rates. Two thousand two hundred and fifty-eight pregnancies were available for analysis, of them, 1669 (73.9%) resulting from ICSI and 2258 (26.1%) achieved by IMSI. Pregnancy outcome distribution did not show a significant difference. For the fresh embryo transfer cohort, fetal/birth defect rate was 4.5%, chromosomal aberration rate was 1.0%, and structural malformation rate was 3.5%. IMSI vs. ICSI pregnancies were less likely to involve a fetal/birth defect: 3.5% vs. 4.8%, respectively, but did not reach a statistical significance OR 0.71 (95% CI 0.39-1.22). Split by multiplicity, this trend existed only for singleton pregnancies; 1.4% structural malformations rate vs. 3.8%, respectively, OR 0.35 (95% CI 0.11-0.9). The frozen cohort demonstrated a significantly lower birth defect rate (OR 0.25, 95% CI 0.09-0.58). We conclude that IMSI procedure does not involve an increased malformation rate and may offer a reduced anomaly incidence. Further studies are required.

[Sports and leisure injuries in summer]. / Sportverletzungen, Beinaheertrinken, Hundebisse. Erste Hilfe bei Sommerunfällen.

In the first days of summer, there is an increase in the number of summer-related accidents and injuries. Typical for the types of sports practiced in summer, such as ball games, cycling or skating are injuries to the wrist and ankle, knee, head and shoulder. The most frequent victims of swimming accidents are children under four years of age, and adolescents aged between 15 and 19 years. During grilling, burns often occur, most of which, however, are superficial and can be treated in the doctor's office. The incidence of dog bites also increases in summer. In such cases consideration must be given not only to tetanus boosters, but also to the possibility of an infection with rabies.

[Remote results of surgical treatment of post-thrombophlebitic disease of the lower limbs]. / Otdalennye rezul'taty operativnogo lecheniia posttromboflebiticheskoi bolezni nizhnikh konechnostei

An analysis of late results of surgery for thrombophlebitic affection is reported. 55 patients were examined in different terms (up to 7 years after reconstructive operative procedures). Favourable and satisfactory issues were gained in 44 of them Control phlebograms proved the patency of anastomosed and free grafted veins. The following operations are recommended for a wider clinical application: croos shunting, the femoral vein plasty with a free venous autograft, the construction of anastomoses between v. saphena magna and profound veins of the extremity. The need for reconstructive procedures that would be associated with the removal of pathologically changed subcutaneous veins and ligation of insufficient communicant veins of the leg and foot is emphasized.

[Clinico-roentgenological characteristics of renal hemorrhage in hemophilia]. / Kliniko-rentgenologicheskie osobennosti pochechnykh krovotechenii u bol'nykh gemofiliei.

The observation over 20 cases of hemophilia with severe renal bleedings proved the possibility of rendering an effective surgical aid to these patients. Besides, on the grounds of the observations the authors concluded that in all the cases of hematuria and microhematuria constitute indications for x-ray examination of the kidneys and the urinary tract.

[Role of drugs with disaggregative effect in the prevention of thrombosis in reconstructive operations on the veins of the limbs]. / O roli preparatov dezagregiruiushchego deistviia v preduprezhdenii trombozov pri rekonstruktivnykh operatsiiakh na venakh konechnostei

With the aim of prophylaxis of early postoperative thrombosis in reparative operations on veins of the lower extremities acetyl salicylic acid (aspirin) was used. Diminishing of adhesion and aggregation of thrombocytes, a reduced fibrinase activity and lessening of clot density were noted.