Atherogenic Index of Plasma (AIP) is a reliable predictor of coronary artery disease. There is paucity of data on AIP and its correlates among patients with type 2 diabetes (T2D) in Uganda.To assess the profile of AIP and its cardiovascular risk factor correlates among patients with T2D in Uganda.This was a cross-sectional study conducted in 8 health facilities with established T2D clinics in Central-Uganda. The study enrolled 500 patients aged 40 to 79 years. Data was collected on socio-demographic characteristics, lipid profile and glycated haemoglobin (HbA1c). The AIP was derived using log (triglycerides/high-density cholesterol) and further categorised as low cardiovascular disease (CVD) risk if the AIP was <0.1, intermediate risk (0.1-0.24) and high risk (≥0.24). Cardiovascular risk factors were defined according to international guidelines.Stata version 14 was used to analyse data, Pearson correlation analyses were conducted. Statistical significance was set at p<0.05.There were 389(77.4%) females with a mean age of 55.07±8. 979 years. Low-risk was found in 43.6%, intermediate risk in 20.2% and high risk in 36.2% of the participants. AIP significantly correlated with waist circumference , waist-hip ratio , Casteri Risk Index I , Casteri Risk Index II  and atherogenic coefficient . Insignificant correlation was observed between AIP and fasting blood sugar , HBA1C  and diabetes duration AIP is significantly elevated and correlated with cardiovascular risk factors in patients with T2D. In clinical management, this may be a useful tool in risk stratifying patients with T2D. Diabetes mellitus (DM) is an established risk factor for cardiovascular disease (CVD)It can be easily derived from the usual lipid profile which is done widely among T2D patients in Uganda at no added cost. AIP can be used to stratify T2D patients so that those at high CVD risk can be started on drugs with proven cardiovascular benefitWhereas the statin dose intensity and use of ant platelet agents is clear for those who have had a CVD eventKnowledge of the profile of AIP and its cardiovascular risk factor correlates is key for CVD risk stratificationAdditionally, markers of obesity such as body mass index, waist circumference, waist hip ratio and atherogenic indices have been shown to correlate with a high CVD riskThis was a cross-sectional study conducted in eight (8) diabetes clinics in Central-Uganda namely; Entebbe grade B hospital, Mengo Hospital, Naguru Hospital, Kasangati Health Center IV, Wakiso Health Center IV, Mpigi Health Center IV, Mityana Hospital and Kawolo Hospital. Detailed description of the methodology has been published elsewhereData was collected from 500 patients with T2D aged between 40 and 79 years who were consecutively selected from the diabetes registers. Eligible patients were given unique identification numbers derived from the health facility code and registration number.Socio-demographic data on age, sex, level of education, employment status and smoking were collected by trained study nurses through face-to-face interviews.Anthropometric, clinical and laboratory measurements were conducted. Details of these measurements have been published elsewhere.16Atherogenic Index of Plasma (AIP) was calculated from Log10(TG/HDLc) ratio. Low CAD risk was when AIP was -0.3-<0.1, medium risk 0.1 -<0.24 and high CAD risk ≥0.24.17Cardiovascular risk factors in T2D were defined according to W.H.O Smoking was defined as daily cigarette smoking, family history of premature coronary heart disease was defined as history of CHD in first degree relatives aged < 55 years for males and <65 years for femalesCastelli Risk Index 1(CRI-1) was estimated as: TC/HDLc ratio, A low risk was defined as <3.5The data collected was checked for completeness, coded and entered into EpiData manager version 4.6 and exported to STATA version 14. Continuous variables were described using the mean and standard deviation. Categorical variables were expressed as frequencies and percentages and were compared using Chi-square tests. The correlation between AIP and cardiovascular risk factors was determined by Pearson chi-square correlation analyses. A p-value of less than 0.05 was considered statistically significant.Out of the 500 study participants, 389 (77.4%) were females and the mean age of the participants was 55.07years±8.979. One hundred eight seven (37.4%) were aged between 50 and 59 years. Three hundred twenty-three (64.6%) of the study participants were urban residents. About 442(88.4%) did not have history of premature coronary heart disease death in the family. The majority 448(89.6%) did not take alcohol and 491(98.2%) did not smoke. Thirty-five (7%) of the participants were on lipid lowering medications by the time of our study. About three hundred and sixty-seven (73.4%) of the participants had had DM for less than 10 years while 364(72.8%) were taking ant hypertensive medications. Details are shown in Out of 500 participants,218(43.6%) had low, 101(20.2%) moderate and 181(36.2%) high AIP. The mean AIP was 0.177±0.413. There was no significant gender difference across all categories of AIP as shown in Three hundred and seventy-nine (75.8%) of the study participants had a BMI ≥25Kg/m2 with a mean of 29.78 Kg/m2 ±5. 778. Two hundred and eighty-four (56.8%) had elevated waist-hip ratio though there was no significant difference in mean waist circumference between females and males though men had a higher mean waist-hip ratio 0.942±0. 106. Elevated systolic blood pressure and diastolic blood pressure was found among 211(42.2%) and 158(31.6%) of participants respectively. However, the mean combined blood pressure across all the study participants, was 137.53/85.62mmhg.Elevated total cholesterol was found among 290(58%) of the study participants with a mean value of 5.405mmol±1.319 while 393 (78.6%) had elevated LDL with a mean of 3.502mmol/l±1. 181.Seventy-two percent (72%) of the participants had elevated glycated Hemoglobin (HbA1C≥7%). About two thirds had fasting hyperglycemia (fasting blood sugar ≥ 7mmol/l). The mean DM duration was 6.952 ±6.383 years.Regarding cardiovascular indices,357(71.4%) of the participants had an elevated CRI I and there was no significant gender difference(p=0.818). Two hundred eighty-one (56.2%) of the participants had their A.C raised. Similarly, there was no gender difference noted in this parameter(p=0.524). More details about the CVD risk factors are shown in We performed Pearson's correlation analysis to investigate the correlation between AIP and cardiovascular risk factors. AIP positively and significantly correlated with waist circumference , waist-hip ratio , CRI I , CRI II  and A.C. Furthermore, weak and insignificant correlation was noted between AIP and sex , BMI , total cholesterol , fasting blood sugar , glycated haemoglobin , LDL . Details are depicted in In this cross-sectional study, we determined the profile of atherogenic index of plasma and its cardiovascular risk factor correlates among patients with T2D in 8 rural and urban clinics in Central Uganda. Our study showed 56.4% of the participants had intermediate and high AIP (atherogenic risk) with no significant difference in distribution across gender. The current study showed that a significant proportion of our patients with T2D had poorly controlled cardiovascular disease risk factors.Our study showed that AIP was positively and significantly correlated with waist circumference, waist- hip ratio, CRI-I, CRI-II and A.C. Weak and insignificant correlation was noted between AIP and sex, BMI, total cholesterol, fasting blood sugar, glycated haemoglobin and duration of diabetes.Similar results were shown in one study among adult Africans living with HIV infection by Steve Raul Noumegni et al where 52.4% had intermediate and high atherogenic risk In a large population-based survey conducted over 7000 subjects in rural Uganda,42% of the individuals had high and intermediate atherogenic risk (20). The differences in study design, population sample, nature of patients studied and specimen collected could explain the differences in the findings between the two studies.In a study conducted by S. Bhardwaj et al, AIP, CRI 1, CRI II and AC were significantly elevated in angiographically confirmed cases of CAD and contributed significantly to the CAD risk with AIP contributing 31% followed by CRI 1 with 20%, AC 17% and CRI IIOur findings are consistent with a study done in Nigeria by Bolarinwa et al that found a high AIP in 31.4% of diabetic and hypertensive patients attending a tertiary hospital Consistent with earlier studies In our study population, more than 50% had diabetic dyslipidaemia characterised by a high LDL (mean 3.502mmol/l±1.181), high triglyceride (mean 2.078mmol/l±1.24) and low HDL (mean 1.33mmol/l±0.372), this type of dyslipidaemia typical of diabetes is highly atherogenic and is not surprising that 56.4% of our study participants had a high plasma atherogenicity as determined by the AIP. This is in tandem with several other studies Contrary to other studiesWe have earlier shown that 65.8% of patients with T2D have a high 10 year predicted ASCVD risk13In our study, AIP was not significantly correlated with systolic and diastolic blood pressure which was in tandem with a study done by Manoj Kumar et al assessing the association of AIP with haemodynamic variables in normotensive and never treated hypertensive subjects. In that study, AIP didn't correlate with arterial Blood pressure but correlated directly and indirectly with arterial stiffness28Contrary to our study, Zhang H et al in a large prospective population-based cohort study among 10060 Chinese, showed that an HbA1C of 7-8% was significantly associated with a high CVD risk in patients with baseline ASCVD risk score≥10%While hyperglycemia is evidently associated with microvascular complications, its role in the causation of large vessel atherosclerosis is controversialDespite the fact that our patients' mean glycated hemoglobin was 8.919±2.818% which is strongly related to CVDThe major strength of this study is that it assessed atherogenic AIP and its cardiovascular risk factor correlates among patients with T2D for the first time in Uganda. Secondly, the study was conducted in one region of the country with limited ethnic variation. However, there are some limitations. The cross-sectional design does not allow to infer a causal-effect relationship between AIP and other cardiovascular risk factors. This needs a longitudinal study. We did single measurements of the laboratory parameters that could have affected accuracy of the results. The study enrolled only those patients present at the clinic during the study period and this could have caused a selection bias. We did not screen our patients for HIV and this could have affected our results.The present study showed that AIP was significantly elevated and correlated significantly with waist-hip ratio and atherocardiovascular indices among T2D patients in Uganda. AIP at no added cost can be used to stratify patients in a poor resource setting so that those at high risk can be started on primary CVD management with appropriate medications and life style programs.


In pursuit of a consistent diagnosis, treatment, and prevention of uterine diseases in dairy cattle, researchers have focused their efforts on identifying bacteria present in the uterus, the so-called uterine microbiota. Bacteria frequently populate the uterus but an optimal balance in type and number of bacteria is important for reproductive health. In this study, the uterine microbiota from healthy, pregnant, and diseased cattle have been analyzed from samples taken in the slaughterhouse. Interestingly, the bacterial composition in the uterus of healthy and pregnant cattle was more similar, compared to diseased animals who had a different bacterial composition in their uterus.Streptococcus, Pseudomonas, Fusobacterium, Lactococcus and Bacteroides. Compared to pregnant and clinically healthy cows, the uterine bacterial community of endometritis cows was significantly decreased in species diversity (p < 0.05), reflecting uneven community composition in different patterns with either dominance of Escherichia-Shigella, Histophilus, Bacteroides and Porphyromonas or Actinobacteria.Endometritis is one of the most important causes of infertility in dairy cows, resulting in high economic losses in the dairy industry. Though the presence of a commensal uterine microbiota is now well established, the complex role of these bacteria in genital health, fertility, and susceptibility to uterine diseases remains unclear. In this study, we explore the endometrial microbiota through 16S rRNA gene profiling from cytobrush samples taken ex vivo from healthy, pregnant, and endometritis cows. There were no significant differences between healthy and pregnant cows, whose uterine microbiota were dominated by  Bovine postpartum uterine diseases (PPUDs) are a common problem in dairy herds and a major concern for dairy farmers . They arEscherichia coli, Trueperella pyogenes, Fusobacterium necrophorum, Bacteroides spp., and Prevotella spp.  SDS (sodium dodecyl sulphate) and 20 µL of 20 mg/mL proteinase K were added to each sample tube and vortexed for 5 s and incubated at 45 °C for 1 h in a water bath. After 1 h, 100 µL of 5 M NaCl, 80 µL of CTAB/NaCl (10% [w/v] Cetyl trimethylammonium bromide/0.7 M NaCl) solution was added to each sample and vortexed and incubated for 10 min at 65 °C. After 10 min, an equal volume of phenol chloroform (Sigma–Aldrich) was added to each sample, vortexed, and centrifuged at 10,000 rpm for 5 min. After centrifugation, the aqueous phase was transferred to a fresh 2 mL Lo-bind Eppendorf tube and an equal volume of phenol chloroform isoamyl alcohol  was added, vortexed, and centrifuged at 10,000× g for 10 min and then the aqueous phase was once again transferred to a fresh 2 mL Lo-bind Eppendorf tube.The brush tips were removed and placed into a filtered homogenizer bag. Ten milliliters of phosphate buffered saline  was added to each bag containing the brush tips and homogenized for 3 min. After homogenization, each sample was transferred to a 50 mL Falcon tube and centrifuged at 10,000× v/v] alcohol and centrifuged at 10,000 rpm for 5 min and dried in a vacuum dryer. The dried DNA pellet was dissolved in 100 µL of 1X TE buffer. The concentration and purity of the DNA was determined on a Nano Drop™ spectrophotometer measuring absorbance at 260 nm and the ratio of absorbance at A260/A280.DNA was precipitated by adding 0.6× volume of isopropanol and stored at −20 °C overnight, which was followed by centrifugation at 10,000 rpm for 5 min. The DNA pellet was washed finally with 1 mL of 70% [g for 1 min. Amplification was performed in a thermal cycler using the following conditions: 95 °C for 3 min and 25 cycles of 95 °C for 30 s, 55 °C for 30 s, 72 °C for 30 s, followed by annealing at 72 °C for 5 min. Each amplicon was assessed on the Agilent 2200 TapeStation using Agilent D1000 reagents and ScreenTape  to verify size, the expected size being ~550 bp. After the size had been verified, each amplicon underwent purification using AMPure XP beads to purify the V3 and V4 amplicon from primers and primer dimers. Once the amplicons were purified, dual indices and Illumina sequencing adaptors were added using the Nextera XT index kit. In a lo-bind 96 well plate, 5 µL of amplicon DNA, 5 µL Nextera XT index primer 1 (N7), 5 µL Nextera XT index primer 2 (S5), 25 µL 2 × 5 KAPA HiFi HotStart ReadyMix, and 10 µL of PCR grade water were added, gently mixed, and centrifuged for 1000× g for 1 min. PCR was performed in a thermal cycler using the following conditions: 95 °C for 3 min and 8 cycles of 95 °C for 30 s, 55 °C for 30 s, 72 °C for 30 s, followed by annealing at 72 °C for 5 min. The Indexed PCR samples were then purified as before and 1:10 dilution of each library preparation was assessed once again on the Agilent 2200 TapeStation using Agilent D1000 reagents and ScreenTape  to verify the fragment size (expected fragment size ~630 bp). DNA concentration of each sample library preparation was determined using the Qubit dsDNA Assay Kit .Libraries were prepared for all 26 samples as outlined in the 16S Metagenomic Sequencing Library preparation for the Illumina MiSeq system (Part # 15044223 Rev. B). The 16S rRNA V3–V4 hypervariable regions were amplified using the S-D-Bact-0341-b-S-17 (5′-CCTACGGGNGGCWGCAG-3′) and S-D-Bact-0785-a-A-21 (5′-GACTACHVGGGTATCTAATCC-3′) primers . Amplico® Reagent Kit v3 to a final concentration of 20 pM. The 20 pM library was further diluted by adding 300 µL of this library to 300 µL of HT1 buffer and mixed to give a library with a final concentration of 10 pM. Denatured PhiX with a concentration of 20 pM (30 µL) was added to 570 µL of the denatured 10 pM library to give a final spike of 5% of the library. The library was subsequently incubated at 95 °C for two min and placed on ice. After five min, 600 μL of the 20 pM library was loaded onto a reagent cartridge from the MiSeq® Reagent Kit v3, which was loaded onto the Illumina® MiSeq Instrument for 600 cycles of paired-end sequencing.The average fragment lengths and Qubit DNA concentration were used to normalize the DNA to a final concentration of 4 nM. All 20 of the 4 nM normalized samples were then pooled by combining 5 µL of each. From this normalized pooled, a volume of 5 µL was denatured by adding it to 5 µL 0.2 M NaOH and incubating for five minutes. After denaturation, 0.2 M Tris-HCl (pH 8.0) was added to neutralize the NaOH and subsequently diluted using 985 µL HT1 buffer from the MiSeqThe quality of the generated reads was assessed using FastQC (version 0.11.8). Raw sequencing reads were then demultiplexed, quality-filtered, and analyzed using Mothur (version v.1.43.0) . Sequencp-value adjusted by FDR < 0.1) between healthy cows, endometritic, and pregnant cows were determined using the Wald test for significance of GLM terms.Downstream analyses were carried out in RStudio  using tn = 9), pregnant (n = 10), and endometritis (n = 5) animals .Of the 26 animals sampled, two were excluded from further analysis based on poor-quality sequences, leaving ten healthy, ten pregnant, and four endometritis based on clinical evaluation. Pregnancy of the animals was early gestation (less than 42–56 days) since the placenta had not yet developed . After cAfter filtering out low quality reads, a total of 2,275,115 reads were obtained with 94,796 ± 86,440 reads per sample on average. The average read length was 288 bp . High-quality reads were sorted into 7740 operational taxonomic units (OTUs) using a 97% sequence identity cut off. Singletons were removed for analyses, resulting in a dataset totalling 3188 OTUs. On average, we detected 355 ± 252 OTUs per sample.From the nine healthy animals, a total of 2157 OTUs were retrieved, with an average Shannon index of 4.41 ± 0.40 and 290 ± 122 OTUs per animal. Phyla, whose relative abundance was less than 1% of total reads, were grouped as “Other”, resulting in five phyla that comprised 97.09% of the total dataset. Proteobacteria (45.91%), Firmicutes (33.02%), and Bacteroidetes (12.11%) were predominant, followed by a minority of Actinobacteria (4.23%) and Fusobacteria (1.82%) .Escherichia-Shigella (12.21%) and a group of unclassified Enterobacteriaceae (83.77%), followed by the Pseudomonadaeae (13.74%) with Pseudomonas as the main genus. Other families included Neisseriaceae (9.29%), Pasteurellaceae (8.31%), Burkholderiaceae (5.40%), and Moraxellaceae (3.95%).Within the predominant phylum Proteobacteria, a little more than half of the reads were assigned to the Enterobacteriaceae (51.32%), largely represented by the genera Streptococcus, belonging to Streptococcaceae , which was the predominant family (30.48%). The Lachnospiraceae  were the second most abundant family (22.60%) in this phylum, largely represented by the genus Blautia (8.42%) and Acetitomaculum (2.82%). Another fourth of the reads were assigned to Ruminococcaceae (7.93%), Bacillaceae (5.85%), Veillonellaceae (4.34%), Erysipelotrichaceae (3.84%), and Staphylococcaceae (3.30%).Within the phylum Firmicutes, approximately a quarter (26.24%) of the reads were assigned to the genus Within the phylum Bacteroidetes, Prevotellaceae (30.37%) and Bacteroidaceae (30.24%) accounted for more than half of the reads, followed by Porphyromonadaceae (22.24%). The phylum Actinobacteria was represented by different families at comparable relative abundances, such as Microbacteriaceae (20.26%), Micrococcaceae (15.79%), Corynebacteriaceae (14.35%), Actinomycetaceae (13.88%), and Propionibacteriaceae (12.46%). Finally, the phylum Fusobacteria comprised two families, Fusobacteriaceae (74.54%), represented by the genus Fusobacterium and Leptotrichiaceae (25.46%).Streptococcus, Pseudomonas, Fusobacterium, Lactococcus, and Bacteroides , Bacteroidetes (8.65%), and Firmicutes (7.00%). However, taxonomic profiles of the samples were markedly different between the five diseased animals .Histophilus  prevailed in the subclinical diseased animal SM03, with a relative abundance of 99.66%. In contrast, Proteobacteria only contributed marginally to the taxonomic profile of the other two diseased animals SM21 and SM24, at a relative abundance of 5.83% and 0.09%, respectively. The taxonomic profile for animal SM21 was dominated by Actinobacteria (82.21%), with 90% of reads assigned to unclassified Microbacteriaceae and only a small contribution of Firmicutes (9.04%) and Bacteroidetes (1.99%). However, for animal SM24, Bacteroidetes dominated the taxonomic profile with a relative abundance of 47.08%, represented mainly by the genera Porphyromonas  and Bacteroides . Actinobacteria contributed for 12.25% whereas 30.59% belonged to other phyla. Among those, the genus Fusobacterium belonging to the phylum Fusobacteria accounted for 89.67%.In three animals, Proteobacteria dominated with Escherichia-Shigella  accounting for a relative abundance of 87.13% and 95.20%, respectively, in animals SM22 and SM23, both showing clinical signs. In contrast, the genus From 10 endometrial cytobrush samples from pregnant cows, a total of 1274 OTUs were retrieved, with an average Shannon index of 4.39 ± 0.40 and 285 ± 118 OTUs per animal. Phyla whose relative abundance was less than 1% of total reads were grouped as “Other”, resulting in five phyla that comprised 97.85% of the total dataset. Firmicutes (52.50%) and Proteobacteria (29.63%) were predominant, followed by a minority of Bacteroidetes (6.36%), Actinobacteria (5.24%), and Fusobacteria (4.12%) .Streptococcus (71.09%) and Lactococcus (28.91%). Other families included Lachnospiraceae (12.45%), Bacillaceae (8.30%), Lactobacillaceae (7.95%), Erysipelotrichaceae (7.85%), and Ruminococcaceae (5.26%). The Proteobacteria were largely represented by Pseudomonadaceae (23.17%), Enterobacteriaceae (19.02%), Moraxellaceae (16.93%), Sphingomonadaceae (7.28%), Pasteurellaceae (7.21%), and Neisseriaceae (5.20%). Within the Bacteroidetes, the relative abundance of Prevotellaceae accounted for 22.13%, followed by Weeksellaceae (6.57%) and Bacteroidaceae (5.68%). The Actinobacteria were largely composed of Propionibacteriaceae (31.51%), Micrococcaceae (25.70%), and Corynebacteriaceae (18.96%).Within the Firmicutes, Streptococcaceae (41.21%) were dominant and represented by the genera 2 = 8.932, p < 0.05), though no significant differences were found among groups in species richness (measured by the number of OTUs)  . The Venof OTUs) .p = 0.003, R2 = 0.23) and pregnant animals , respectively. Three OTUs assigned to the genus Escherichia-Shigella  were significantly more abundant in endometritic cows whereas one OTU assigned to the genus Acetitomaculum  was significantly reduced (Padj < 0.1). Between healthy and pregnant cows, 47 OTUs were found to be differentially abundant. Of these, only one OTU assigned to Anaerobacillus  was significantly more abundant in pregnant cows (Padj < 0.1)  .In the present study, we investigated the bovine uterine microbiota following endometrial cytobrush sampling ex vivo in healthy dairy cattle, cattle with endometritis, and cattle in early stages of pregnancy. The animals were sampled at slaughter as to be able to collect the samples without animal welfare issues. Unlike other transcervical sampling approaches, we used samples directly taken from the uterus. This allowed us to take samples without the risk of vaginal or cervical contamination, as well as taking samples from pregnant animals. The latter would otherwise not be possible without abortion of the fetus. A similar study assessing the microbiome of the uterus of pregnant animals used the uteri post slaughter, though the sample taken was different. Unlike our study, they had to disinfect the outside of the uterus and as they took a full thickness uterine sample . HoweverMicrobial communities are typically more diverse in healthy endometria. In line with mounting evidence of commensal uterine colonization in the bovine reproductive tract, we also found that the uterus is not sterile even during pregnancy. However, few studies have been performed on the endometrial microbiome during pregnancy. Similar to those previous studies, the same—though with minor variations—microbial families are abundant in the bovine endometrium ,31,32.From the current results and also those found by other researchers, we have a more diverse microbiome in the healthy uterus, indicating that the diversity of species is necessary to have a healthy microbiome and maintain a healthy status. Disturbing factors, of which partus is one, may disturb this healthy microbiome and lead to the overgrowth of a pathogenic species. The ecological concept of species diversity in a healthy system has been demonstrated before . More stIt was previously shown that different microbial populations are present in the non-pregnant endometrium compared to the embryo stage of pregnancy, though this was not found by all researchers and was only evident in the very early stages of pregnancy, close to the timepoint of insemination . In our Differences between studies on healthy microbiomes thus show a large diversity; however, it has been shown in many different ecosystems that these differences in microbiomes are not related to the metabolic pathways they represent as a total. While the microbiomes may be different, the metabolic pathways may be the same . This stIn postpartum animals, the microbiome shows an evolution starting with an alteration of the microbiome, then returning to normal after 5 weeks . It is cTrueperella pyogenes (Actinobacteria), Escherichia coli/Klebsiella pneumoniae (Proteobacteria), and an infection with anaerobes which could be Fusobacterium necrophorum and Bacteriodes spp., as well as Prevotella species.We found major differences between endometrial microbiomes of healthy and diseased cattle, even with a small sample. Both the alpha- and beta-diversity measures are very different. Presence of pathogenic bacteria becomes evident as some OTUs, which were identified to genus level, become dominant. There is also a major shift in the ‘normal’ microbiome. This is in line with earlier findings ,38. FromPeptostreptococcus spp.; Sneathia spp.; Prevotella spp.; Arcanobacterium spp.; Corynebacterium spp.; Fusobacteriaceae, Mycoplasmataceae, and Ureaplasma spp.; and Bacteroidaceae, Porphyromonadaceae, and Pasteurellaceae families was shown [Histophilus, a typical genital-mucosa-dwelling bacterium which is a facultative pathogen in cattle. It is evident that cows, from different locations, with different types of endometritis need to be investigated to see patterns of infection. The uterine microbial signatures detected could ultimately lead to new diagnostic methods that allow more targeted treatments. However, given the sample size here, there is a need for more detailed studies comparing uterine microbial communities retrieved from endometritic animals, so potential microbial indicators for etiology, dysbiosis, and inflammation can be well defined and associated with a certain treatment and prevention program for PPUD.Using deep-level 16S rRNA amplicon-based gene sequencing several studies showed the involvement of different bacterial families and genera. The involvement of the as shown ,41,42, wBacterioidetes were found, while there was a negative association found for Fusobacteria and Treuperella [In addition, metagenomic studies have been applied for studying the differences in uterine microbial composition between healthy and diseased animals. Here, the most prevalent species in diseased animals differed between the different studies and mostly members of the uperella . Metagenuperella , also inWe also detected a subclinical case of PPUD in this study for which the microbial alterations were already present. However, other studies, using different methodologies, could not find any association of subclinical metritis with certain pathogens ,45. StudWhile there is an overrepresentation of pathogenic bacteria in diseased animals, there remains a part of the core genome that is important for recovery. Comparing this pathogen-associated ′residual core′ with the ′healthy core′ may lead to new insights in the role of the endometrial microbiome in preserving uterine health and lead to the development of probiotics and prebiotics that may fortify the core microbiome at partus and, as such, prevent the pathogen to get established.It is thus important to know the details of the microbiome to be able to determine the health status of the animals, as well as to develop scientific based pre- and probiotics. Knowing the microbiome will help in the identification of animals at risk and will aid in the treatment. For the practitioner and farmer, it is also of interest to know that the uterus has its own microbiome and disturbances by any action may lead to metritis. Any manipulation  induce changes to this microbiome and may cause endometritis. The endometrial microbiome thus plays a very important role in uterine health by helping to control infection. We noticed reduced diversity with increased abundance of bacteria from genera that have been correlated with postpartum endometritis. It will also allow the farm veterinarian, farmer, or farm staff, to identify at risk animals and will allow use of pre- and/or probiotics, and therefore reduce use of antibiotic treatments.Our data have shown that the uterine microbial communities are seemingly not influenced by pregnancy, though they form a separate group overlapping the healthy animals. Compared to the healthy microbiome, we noticed a reduced abundance and increase of certain bacterial genera, which is typical for postpartum endometritis microbiomes. These pattern-like changes may offer the possibility for developing new diagnostic tools that may allow a more targeted treatment of uterine disease. Further studies are necessary to confirm this. Comparison of microbial communities of the total genital tract, as well as analyzing in detail the microbial communities of cows with endometritis, may bring insights in the dynamics of disease. Through additional studies, also including culture-based methods, may offer opportunities to develop probiotics and/or prebiotics that may change these dynamics into a healthy direction.


BackgroundHemorrhoids refer to the abnormal enlargement of the anal cushions. They are a common anorectal problem with a prevalence of 5% in the general population aged greater than 40 years. The objective of this study was to compare Milligan-Morgan open hemorrhoidectomy with pedicle ligation with LigaSure  in terms of postoperative pain on day 1 and day 7. It is important to assess the technique that is associated with lower postoperative pain because both of these techniques are still practiced in the developing world.MethodsIt was a randomized controlled trial conducted in the Department of Surgery, Rawalpindi, Pakistan. A total of 100 patients were selected and were allotted into the two groups by lottery method. Patients aged from 15 to 60 years who presented with symptomatic third and fourth-degree hemorrhoids were included after taking informed consent. Patients who had a previous or concomitant anorectal disease, patients who had undergone previous surgery for hemorrhoids, and those who were anesthetically unfit for surgery (American Society of Anesthesiologists (ASA) class 3 or above) were excluded from the study. Pain was assessed using the Visual Analogue scale (VAS). Data was entered and analyzed using SPSS v. 23.0 . Chi-square tests were applied. P-value <0.05 was taken as statistically significant.ResultsOut of 100 patients, 68 (68%) were males while 32 (32%) were females. The mean age was 40.56±9.24 years. Postoperative pain at day 1 was 9.24±0.51 in the Milligan-Morgan group while that in the LigaSure group was 8.44±0.64 (p<0.0001). Postoperative pain at day 7 was 5.00±0.85 in the Milligan-Morgan group while it was 3.04±1.08 in the LigaSure group (p<0.0001).ConclusionLigaSure is a newer technique that helps to reduce complications as compared to other traditional hemorrhoidectomy procedures. Many patients avoid hemorrhoidectomy as it is associated with painful postoperative recovery. Pedicle coagulation with LigaSure was better than conventional Milligan-Morgan hemorrhoidectomy in terms of reducing the mean postoperative pain on 1st day and 7th day. Reducing the postoperative pain helps in greater patient satisfaction and lesser requirement of analgesia among patients of 3rd and 4th-degree hemorrhoids undergoing hemorrhoidectomy.  Hemorrhoids are normally found in the human body -3. InterSymptoms of hemorrhoids include bright red painless per rectal bleed, mucus discharge, and prolapsed anal mucosa. If left untreated, they may lead to complications like strangulation, thrombosis, ulceration, gangrene, fibrosis, or portal pyemia . A hemorThe LigaSure  is a novel device consisting of a bipolar electro-thermal device with an optimized combination of pressure and radiofrequency, with the ability to seal blood vessels up to 7mm in diameter and associated with a collateral thermal injury confined to 2mm over the surgical field. This confined spread decreases reflex anal spasm and a bloodless hemorrhoidectomy is possible with reduced postoperative pain and rapid healing. Thus, this operation can be advocated as the ideal technique because of the potentially decreased collateral tissue trauma . Among tThe aim of this study is to evaluate the LigaSure pedicle coagulation in comparison with conventional Milligan-Morgan hemorrhoidectomy pedicle ligation and if proven effective it will result in less postoperative pain, more patient satisfaction, and less requirement of analgesia.Study setting and durationThis study was a randomized controlled trial conducted at the Department of Surgery Holy Family Hospital, Rawalpindi from 10th October 2021 to 10th April 2022.Ethical approvalThis randomized controlled trial was approved by the Ethical Review Board of Rawalpindi Medical University. The reference number is SUR-96-46-23.RandomizationA total of 100 patients were divided into two groups of 50 each and were randomly allotted into one of the two groups by lottery method. Group A comprised of patients undergoing Milligan-Morgan open hemorrhoidectomy and group B comprised of patients who underwent pedicle coagulation by LigaSure. Randomization was single-blinded meaning that the patient did not know about the one procedure that was going to be used among the two procedures.Eligibility criteriaBoth male and female patients aged 15 to 60 years, who presented with symptomatic third, and fourth-degree hemorrhoids were included after taking informed consent. Patients who had a previous or concomitant anorectal disease, patients who had undergone previous surgery for hemorrhoids, and those who were anaesthetically unfit for surgery (ASA class 3 or above) were excluded from the study.The procedure of pedicle coagulation hemorrhoidectomyAfter administering standardized spinal or general anesthesia the procedure was carried out with the patient in the lithotomy position. After examination under anesthesia, hemorrhoids were delivered with the help of artery forceps. One of the artery forceps was applied at the mucocutaneous junction of the hemorrhoid and the other at the apex of the hemorrhoidal tissue. A skin incision was given at the base of the hemorrhoids and dissection was done to separate the hemorrhoidal tissue from the internal anal sphincters. After this, in Milligan-Morgan’s open technique, the hemorrhoid pedicle was transfixed with zero number Vicryl suture while in the other group, the hemorrhoid pedicle was coagulated with the help of LigaSure.Postoperative procedurePostoperatively patient was given a ketorolac injection of 30 mg 8 hourly and pain was recorded on a visual analog pain score ranging from 0 to 10 after 24 hours. Follow-up was done on the seventh postoperative day in the surgical outpatient department. Mean post-operative pain was calculated. This randomized controlled trial was done in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines as shown in Figure Data analysis150 subjects were initially enrolled in the study. 50 patients were excluded and a total of 100 patients were divided into two groups of 50 each. The collected data was entered in the SPSS Statistics v. 20.0 . Qualitative variables like gender, ASA grade, and grade of hemorrhoids were measured as frequencies and percentages. The quantitative variables like age and postoperative pain were measured as mean ± SD. Independent samples t-test was used to compare postoperative pain in both groups. Effect modifiers like age, gender ASA class, and grade of hemorrhoids were controlled by stratification. Post-stratification chi-square test was applied. P-value ≤ 0.05 was significant.A total of 100 patients were included in the study out of which 68 (68%) were males whereas 32 (32%) were females. Both genders were equally distributed within the study groups. There were 34 males and 16 females in each of the two groups. The mean age of the study participants was 40.56±9.24 years. The mean age of the patients in group A (Milligan-Morgan open hemorrhoidectomy) was 43.84±9.98 years and that in group B (pedicle coagulation by LigaSure) was 37.28±7.15 years. Out of 100 patients, 82 (82%) belonged to ASA class I while the rest 18 (18%) were of ASA class II. Thirty-six out of 82 (43.9%) in ASA class I and 14/18 (77.78%) in class II were in study group A. Forty-six out of 82 (56.1%) in class I and 4/18 (22.22%) in class II were in study group B.Eighty-four out of 100 (84%) patients had grade 3 hemorrhoids while 16/100 (16%) had grade 4 hemorrhoids. Out of 84 patients with grade 3 hemorrhoids, 38 45.24%) were in study group A while 46 (54.76%) were in study group B. Similarly, out of 16 patients with grade 4 hemorrhoids 12 (75%) were in group A while 4 (25%) were in group B. postoperative pain on day 1 was 9.24±0.51 in the Milligan-Morgan group while that in the LigaSure group was 8.44±0.64. This difference in mean postoperative pain at day 1 was statistically significant between the two groups (p<0.0001). postoperative pain on day 7 was 5.00±0.85 in the Milligan-Morgan group while it was 3.04±1.08 in the LigaSure group. Mean postoperative pain at day 7 was also statistically significant between the two groups (p<0.0001). postoperative pain on both day 1 and day 7 was significantly lesser in the LigaSure group which means that the LigaSure procedure is associated with better postoperative clinical outcomes as compared to the Milligan-Morgan procedure. A comparison of mean postoperative pain in both study groups is shown in Figure 4% were iThe results of stratification for postoperative pain at day 1 and day 7 with regards to age, gender, ASA class, and hemorrhoids grades are shown in Table Hemorrhoidectomy is an effective treatment for 3rd and 4th-degree hemorrhoids . HoweverIn our study, the mean age of the patients with hemorrhoids was 40.56 years. This is consistent with the study by Ravindranath and Rahul, where the mean age was below 40 years of age . Ali andThe results of stratification showed that postoperative pain at day 1 was higher in the age group 26-60 years (8.88) as compared to the age group 15-25 years (8.00) in the Milligan-Morgan group. Similarly, postoperative pain at day 7 was also higher in the age group 26-60 years as compared to 15-25 years in both the study groups Postoperative pain at day 1 was higher in grade 4 hemorrhoids (9.25) as compared to grade 3 hemorrhoids (8.76) in the Milligan-Morgan group. Whereas postoperative pain at day 7 was more in grade 3 (7.12) as compared to grade 4 hemorrhoids (6.02) in the LigaSure group. LigaSure is a newer technique that helps to reduce complications as compared to other traditional hemorrhoidectomy procedures. Many patients avoid hemorrhoidectomy as it is associated with painful postoperative recovery. This study concluded that pedicle coagulation with LigaSure was better than conventional Milligan-Morgan hemorrhoidectomy in terms of reducing the mean postoperative pain on 1st day and 7th day. Reducing the postoperative pain helps in greater patient satisfaction and lesser requirement of analgesia among patients of 3rd and 4th-degree hemorrhoids undergoing hemorrhoidectomy.


Asthma is a common worldwide, chronic respiratory disease. It has been shown to impair a person’s health-related quality of life (HR-QoL), but the core influencing factors are not fully understood.We aimed in this study to evaluate QoL of asthmatic patients and its main determinants.A prospective single center study was held with asthmatics consulting in the Pulmonology Department a public hospital in Tunisia. A complete structured questionnaire concerning socio-demographic and clinical characteristics were determined. The assessment of asthma control during the last 4 weeks was based on the GINA 2022 report criteria. The quality of life was assessed by the Asthma Quality of Life Questionnaire (AQLQ) scale in its validated Arabic version.A total of 109 asthmatic patients was included. Most of them were female . Twelve (11%) were current or ex-smokers. The majority of patients  were active. Thirty-nine patients (35.7%) had comordidities. Asthma were controlled in 40.4% of cases.The average of AQLQ was4.9±1.2. The most affected domains were environmental stimuli and symptoms with a mean value of 4.6 ± 1.3 and 5.0± 1.3 respectively.Allergic and uncontrolled asthma and severe disease were significantly associated with the average of AQLQ in the study population with p respectively 0.001, <0.000 and <0.000.Multivariate analysis demonstrated that factors independently associated with the HR-QoL were : the severity of asthma  and uncontrolled disease .These results suggest that uncontrolled and severe asthma significantly affect health asthma-related quality of life.None Declared


Psychiatric symptoms of children and adolescents’ people whose families have joined the Islamic State of Iraq and Syria (ISIS) for various reasons, lived under the threat of terrorism in or outside Turkey, lost their parents or were separated for various reasons, are not clearly known.This research aims to psychiatrically evaluate children and adolescents who are victims of various reasons due to their families joining the ISIS.31 children and adolescents living with or without parents in Turkey, whose parents had joined ISIS, were included in the study. The sociodemographic data of the participants, the country they were in during their time in ISIS, the current situation of their parents, their exposure to terror attacks, their stay in prison were determined. Psychiatric diagnoses of the participants were determined according to DSM-5. Afterwards, the participants and caregivers were asked to fill out the Revised Child Anxiety and Depression Scale Child and Parent Form , Child Post Traumatic Stress Disorder Reaction Index Scale (CPTS-RI), Child and Youth Resilience Measure (CYRM) and Conners Parental Rating Scale Revised Short Form (CPRS-SF)14 (45.2%) of the participants were boy and 17 (54.8%) were girl. The mean age of the participants was 10.55±3.79. The average age of the participants’ families at the time they joined ISIS was 4.81±3.37 years. The average age of the participants to return to our country was 8.87±3.99. All of the participants remained in Iraq. 25 (80.6%) of the participants stayed at home and 6 (19.4%) of them stayed in the camp. 19 (61.3%) of the participants were exposed to at least one conflict, 12 (38.7%) witnessed at least one terror attack, 5 (16.1%) were injured, 26 (83.9%) were not injured. It was found that 28 (90.3%) of the participants remained in prison and 3 (9.7%) did not. Participants’ RCADS-C scores were 23.42±15.96, RCADS-P total scores were 16.25±16.12, CPTS-RI scores 20.3±14.56. CYRM total scores were 46.65±9.04, and CPRS-SF total scores were 19.74±16.55.It has been revealed that there are various psychiatric problems of varying severity in children and adolescents who are victims of ISIS in Turkey.None Declared


Background and Objectives: Relapsed or refractory acute myeloid leukemia (r/r AML) is a disease with a poor prognosis. Limited treatment options are available in r/r AML. Here, we administered gemtuzumab ozogamicin (GO) as salvage therapy in twenty-four patients with r/r AML. The aim of the study was to determine the role of GO in r/r AML in real life. Material and Methods: This retrospective observational study recruited 24 adult patients with diagnosed r/r AML from 2018 to 2022. Twenty-four patients with r/r AML were treated with GO. GO treatment was used as monotherapy in 23 patients and in combination with cytarabine in 1 patient. At the time of diagnosis, the risk status of all patients was determined as favorable, intermediate, or adverse according to the 2017 ELN AML guidelines. Results: The median follow-up was 44.3 (13–144) months. Fifteen (62.5%) of the twenty-four patients were in the intermediate-risk cytogenetics group and nine (37.5%) were in the favorable cytogenetics group. The most common adverse events included nausea/vomiting in 79.17% (n = 19) of patients, headache in 62.50% (n = 15), elevated LFTs in 37.50% (n = 9), febrile neutropenia in 25% (n = 6), and bleeding in 25% (n = 6). The most common cause of death was infection. The most common causes of mortality were septic shock, accounting for 33.3% (n = 8) of deaths, and opportunistic lung infection, accounting for 12.5% (n = 3) of deaths. Acute infusion-related toxicities associated with GO were usually transient and, in most cases, responded to the standard of care treatment. After treatment with GO, 16.6% (n = 4) of patients achieved MLFS and 37.5% (n = 9) achieved CR. The overall response rate was 54.1%. The median overall survival time of the patients was 44 months (37.8–50.2 months). Disease-free survival was 22 months (0–48.6 months). The 5-year survival rate was 33%. Conclusions: A low dose of GO improved the overall survival and disease-free survival in r/r AML patients. GO treatment had a positive safety profile in terms of toxicity. Acute myeloid leukemia (AML), which is characterized by the clonal expansion and differentiation arrest of myeloid progenitor cells, is the most common form of acute leukemia in adults ,2. It isThe main goals in the treatment of AML are to keep the disease under control and, if possible, to eliminate the disease. The European LeukemiaNet (ELN) 2017 report has led to significant advances in the diagnosis and management of AML treatment. Since the ELN 2017 report, cytogenetics, molecular markers, and minimal residual disease (MRD) have become very important in both prognosis and treatment planning . StandarThe recurrence of AML after complete remission (CR), despite intensive therapy, is a major obstacle in approximately 60% of younger patients and 80–90% of elderly patients . There iThe aim of this study is to explore the clinical outcomes in patients with r/r AML who received GO as salvage therapy and to assess the mean disease-free survival rate.FLT3-ITD, which may be associated with AML, were performed from bone marrow aspiration samples. At the time of diagnosis, the risk status of all patients was determined as favorable, intermediate, or adverse according to the 2017 ELN AML guidelines. Those with a CD33 positivity above 20% in immunophenotyping by flow cytometry were considered CD33(+). Patients under the age of 18 years who were diagnosed with APL and those who did not receive GO were excluded.This was a retrospective, single-center, observational study. Data were analyzed from 24 patients with r/r AML, who were older than 18 years of age, treated with GO as salvage therapy for multiple r/r, and diagnosed according to the WHO 2016 Acute Leukemia Diagnostic Criteria in the Hematology Service of the Department of Internal Medicine, Faculty of Medicine, Çukurova University between 2018 and 2022. Morphology, immunophenotyping by flow cytometry, conventional cytogenetic analysis, and gene mutation studies such as 2 over 3 h for days 1, 3, and 5) in one patient. All patients were administered GO treatment at a dose of 3 mg/m2/day on days 1, 4, and 7.In this retrospective study, GO treatment was administered as monotherapy in 23 patients and in combination with cytarabine  or the Mann–Whitney test ; p < 0.05 was taken as statistically significant. The Kaplan–Meier survival curves were plotted to compare the intergroup survival rates. The data were expressed as the mean ± SD (standard deviation) and the numbers as %. The McNemar test was used to compare the survey data.The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS), Windows v22.0 . The continuous variables were summarized using the mean and standard deviation in the event of normal distribution and using the median and interquartile range in the event of a non-normal distribution. The Kolmogorov–Smirnov test was used to assess the normality assumption. The continuous variables were analyzed using an independent This retrospective study included a total of 24 patients with AML, older than 18 years of age, who were diagnosed and classified according to the WHO 2008 diagnostic criteria and treated with GO as salvage therapy for multiple r/r AML between 2018 and 2022. The mean follow-up was 44.3 (13–144) months.p = 0.57). The demographic characteristics of the patients are shown in Of these 24 patients, 8 (33.3%) were female and 16 (66.7%) were male. The mean age of the patients at diagnosis was 47.63 ± 16.93 (18–74) years; the mean age was 50.75 ± 15.68 years in females and 46.06 ± 18.33 years in males. There was no statistically significant difference in the mean ages at diagnosis between male and female patients (The number of patients with pre-transplant relapsed AML and primary refractory AML was 22 (91.6%) and 2 (8.4%), respectively.2, which was administered on days 1, 4, and 7. GO was used in combination with cytarabine  in one patient. Other concomitant medicines used were pheniramine hydrogen maleate, dexamethasone, and paracetamol.The dose of GO was 3 mg/mn = 7) of patients, cytomegalovirus in 16.67% (n = 4), and pneumonia in 8.33% (n = 4). The comorbid diseases included diabetes, hypertension, chronic renal failure, and chronic obstructive pulmonary disease (COPD) in 29.17% (n = 7), 25% (n = 6), 8.33% (n = 2) and 8.33% (n = 2) of patients, respectively. Microscopic hematuria and proteinuria were common in 41.67% (n = 10) of patients in the urinalysis samples before treatment with GO. The PA chest X-ray showed bilateral infiltration (pneumonia) and opportunistic lung infection in 37.5% (n = 9) of patients, and the ECG demonstrated inferior MI and atrial fibrillation in 8.33% (n = 2) of patients.The history of prior infections included herpes infections in 29.17% .The physical examination findings and The biochemical outcomes of patients before and after GO treatment are shown in The median overall survival time of the patients was 44 months (37.8–50.2 months). The 5-year survival rate was 33%. The disease-free survival was 22 months (0–48.6 months). The two-year disease-free survival rate was 45% .n = 4) of patients achieved a morphologic leukemia-free state (MLFS), 37.5% (n = 9) achieved CR (complete remission), while 45.83% (n = 11) had progressive disease (PD). The overall response rate was 54.1%. Two of the patients who achieved a response later relapsed. Twelve (50%) patients underwent HSCT. The most common causes of death were infections. The causes of mortality are shown in The mean time from diagnosis to relapse was 21 months. After treatment with GO, 16.67% (FLT3-ITD. The most common molecular mutations in the cases were DNMT3A 3 (12.5%), biallelic CEBPA 2 (8.3%), and NPM1 2 (8.3%). The immune phenotyping and cytogenetics are shown in The cytogenetic analysis showed that 24 patients had a normal karyotype (46 XX or 46 XY). Overall, fifteen (62.5%) were in the intermediate-risk cytogenetic group and nine (37.5%) were in the favorable cytogenetic group. Six (25%) female patients had intermediate risk while two (8.3%) had favorable risk; nine (37.5%) male patients had intermediate risk and seven (29.2%) had favorable risk. In our patient population, there were no cases with poor prognostic factors such as The adverse events that occurred during the study period are shown in AML is the most common form of aggressive leukemia and multiple treatment options are available to treat the disease. Although there are many intensive salvage treatment options for the treatment of AML, high mortality remains a major problem in patients with r/r AML who have an increased risk of toxicity due to multiple exposures to intensive chemotherapy. Low-dose GO has an acceptable toxicity profile in patients with r/r AML, which has resulted in its increased use, particularly in frail patients who have already received intensive therapy . Acute iGO is an immuno-conjugate that combines an anti-CD33 monoclonal antibody with a highly cytotoxic antibiotic, calicheamicin. It was first developed as a single agent for adults with recurrent AML, and then evaluated in combination with chemotherapy in newly diagnosed patients .A recent meta-analysis confirmed that adding GO to chemotherapy may offer a survival benefit in patients who did not have adverse-risk cytogenetics . Howeverp < 0.05) , hematocrit (%), erythrocytes (M/µL), and AST (IU/L) were statistically significantly higher ( < 0.05) . A compaCD45, CD34, or CD117 are used to determine the blast rate in immunophenotypic studies . The preThe median overall survival time in patients after treatment with GO was 44 months (37.8–50.2 months). The 5-year survival rate was 33%. The disease-free survival time was 22 months (0–48.6 months). The 2-year disease-free survival rate was 45% . In anotp = 0.000). The median (min.–max.) bone marrow—blast (%) level was 80.0 (20–100.0) before GO treatment versus 8.0 (1.0–95.0) after treatment with GO (p = 0.000).According to the WHO classification, a blast rate above 20% is required for the diagnosis of AML (WHO). When peripheral smear and bone marrow blast percentages were considered, a statistically significant reduction occurred after treatment with GO. The median (min.–max.) value of the peripheral smear blast (%) was 55.00 (8–100) before GO treatment versus 0.5 (0.0–90.0) after treatment with GO (p = 0.715).In this study, the median platelet count (µ/uL) was 47,500  before treatment with GO versus 46,000  after treatment with GO. As for thrombocytopenia, there was no statistically significant difference between the pre- and post-treatment levels (n = 15) were in the intermediate-risk group while 37.5% (n = 9) were in the favorable-risk group.Considering the cytogenetic risk assessment of the patients, 62.5% (n = 19) of patients, headache in 62.50% (n = 15), elevated LFT in 37.50% (n = 9), febrile neutropenia in 25% (n = 6), and bleeding in 25% (n = 6). The most common causes of mortality were septic shock in 33.3% (n = 8) of patients and opportunistic lung infection in 12.5% (n = 3).The most common adverse events included nausea/vomiting in 79.17%  or combination treatment . As most patients had a history of multiple courses of intensive chemotherapy, GO was administered at a low dose (3 mg/m2) and intermittently  to avoid possible toxicities and to avoid increased risk of VOD.The administration of GO in patients who received multiple intensive treatment before or in combination with other agents at high doses resulted in increases in the toxic effects and the incidence of hepatic veno-occlusive disease (VOD) . In thisIn conclusion, a low dose of GO improved the overall survival and disease-free survival in r/r AML patients. In this study, GO was used as salvage therapy, and it appeared to have a positive safety profile in terms of toxicity. Considering that GO was a bridge therapy for allo-HSCT in half of the patients, it seems highly impressive that it offered a median survival of 44 months for patients with r/r AML. We believe that studies on the use of GO in the first-line treatments will further prolong the overall survival and the disease-free survival. In addition, it may be beneficial to conduct prospective studies with more patients in the future.


Young age, abstinence, earlier stage and laryngeal tumor site might predict a better prognosis. The age distribution and the high prevalence of traditional risk factors among the young patients as well as the predominance of oral cavity tumor localization suggest that the early onset of tumor development could be originated from the premature failure of the intrinsic protective mechanisms.We aimed to characterize clinical and prognostical factors of primary head and neck squamous cell carcinoma (HNSCC) in 85 young patients  in comparison with 140 institutional general HNSCC patients (median age: 61.5 years). The patient’s medical records were collected from the institutional database. The prevalence of smoking and alcohol consumption (65.8% and 48.1%) in the young group exceeded the regional population average but was below the institutional (86.4% and 55%) general HNSCC patient population. Primary tumor sites in the group of young patients were as follows: oral cavity (56.4%), oropharynx (17.6%), hypopharynx (11.7%), and larynx (14.1%). Cumulative five-year overall survival was 44.2% in the young group, but significantly better with early T (T1-2 vs. T3-4: 52.6% vs. 26.7%;  Head and neck squamous cell carcinoma (HNSCC) was estimated as the sixth most common cancer with approximately 800,000 new cases yearly worldwide based on the GLOBOCAN database . The annNational Institute of Oncology, Budapest, Hungary. Patients diagnosed under 40 years (≤39) of age were accepted as young, according to National Comprehensive Cancer Network (NCCN) Adolescent and Young Adult (AYA) Oncology’s guideline . According to the 10th revision of International Classification of Diseases (ICD-10) lip (C00), oral cavity (C01-C06), pharynx  and larynx (C32), with histologically verified squamous cell cancer morphology codes were included in our study  medium risk category , which constitutes approximately a bottle of beer or >2–3 dL of wine on a daily basis (INK4a antigen with Roche CINtec® p16 (E6H4TM) antibody for detection of this antigen  in the Center of Tumor Pathology Department of National Institute of Oncology. The clinicopathological data of our study population were compared with an institutional group of 140 consecutive general HNSCC patients from year 2014.We summarized and analyzed the medical records of 85 young patients with histologically verified HNSCC between 2000 and 2018 based on the institutional medical database of uideline . We involy basis  and WHO The study was conducted under the ethical permission of the Scientific and Research Ethics Committee of the Medical Research Council  in accordance with the Helsinki Declaration of 1975, as revised in 2008.Recurrence was defined as the local or regional return of cancer after the patient was declared disease-free. Residual tumor was defined as histologically positive resection margins after surgical therapy, or tumor suspect soft tissue detected by radiological imaging  within 3 months from the end of the radio(chemo)therapy or other conservative treatment . We also diagnosed locoregional residual disease if the locoregional recurrence occurred within 3 months after the first surgical treatment regardless of the surgical margin status. Overall survival (OS) was determined as months between the date of initial diagnosis and the last follow-up or death.p-value < 0.05 was accepted as statistically significant. KyPlot 5.0  and Statistica 14.0.1.25  were used for statistical analysis.Chi-square test (CS) was used to compare the composition of groups. Fisher’s exact test (FE) with Bonferroni correction of the alpha values was used as a post-hoc test for multiple comparisons. Kolmogorov-Smirnov test was used to assess the normality of distributions. Student’s t-test or Mann-Whitney U-test (MWU-test) was used to compare independent variables with normal or non-normal distribution, respectively. Survival curves were depicted according to the Kaplan-Meier method (KM), significance was analyzed by log-rank statistics (LR). Univariate and multivariate analyses of prognostic factors were done using the Cox’s regression model. A p < 0.001, CS). The most common subsite was the tongue in contrast to the oral cavity tumors of the general HNSCC patients . In the oral cavity subgroup 6 of 48 young patients (12.5%) and 3 of 27 general HNSCC patients (11.1%) presented with lip cancer, the difference was none-significant . Fifty-seven of 85 young patients had early (T1-T2) primary tumor status at the time of the diagnosis, which is significantly different from the control group . Fifty-four (63.5%) had cervical lymph node involvement (N+) according to the physical examination and radiological imaging . Lymph nodes were seldom involved in laryngeal cancer . None of the patients had distant metastasis (M) at the time of the diagnosis. Well-differentiated tumors are significantly more common among young patients than in the control group . Detailed characteristics of all study groups are reported in Among young patients male predominance  was found. The median age at the time of the diagnosis was 37 years (range 21–39) and two-third of the patients were 35–39 years old. For comparison we involved an institutional general HNSCC group . The most common primary tumor locations were the lip and the oral cavity in contrast to the general patient population . In contrast, the alcohol consumption was similar in the young and the general HNSCC group  (n = 13) and 11.1% (n = 4) respectively, no significant difference was shown between the two groups .Data on smoking and alcohol consumption could be found in the medical records of 79 young patients. Fifty-two (65.8%) of them were (current or previous) smokers, 38 (48.1%) consumed alcohol and 33 (41.7%) enjoyed both risk factors. However, smoking was significantly less prevalent in the young group than in the general HNSCC patient population  . The p16n = 17) of patients R1 resection was performed.Fifty-seven of the 85 patients (67%) underwent surgical therapy, 85.4% of those with lip and oral cavity cancer, 75% with laryngeal cancer, 40% with hypopharynx, 20% with mesopharynx cancer. Forty (70.2%) of the 57 patients underwent R0 resection, among them 10 patients with close R0 resection (the free margin is < 5 mm). In 29.8%  received adjuvant therapy after the surgical therapy (Two patients (20%) with close R0 resection, and 6 patients (35.2%) with R1 resection underwent a follow-up operation. The indications for postoperative irradiation were pT3 or pT4 stage, perineural spreading, vascular invasion, extranodal extension and close or positive surgical resection margins. Altogether 42 patients , 58.3% for oropharynx (n = 15), 0% for hypopharynx (n = 10) and 62.8% for larynx (n = 12) carcinoma. Only the subgroup with hypopharynx carcinoma differed significantly from all others (The median follow-up time since the diagnosis of cancer was 28.5 months (range 3–228). Cumulative five-year OS for all head and neck sites was 44.2% , 44.9% fl others .p = 0.0297). The 5-year OS was significantly better in patients with early, than in advanced T status  (p = 0.0013)   and in p 0.0013) .p = 0.005).The cumulative 5-year survival for all tumor sites was significantly better in the young than in the control group  of the 85 patients. The histological analysis of the surgical materials showed positive margins in 17 cases, and residual disease was also detected in 15 cases after the completion of other treatment modalities therapy, induction chemotherapy+ radio(chemo)therapy) by radiological imaging. We also considered four further cases of locoregional recurrences to constitute residual disease, as recurrence occured within 3 months  after surgical treatment with tumor-free margin (R0) status.Residual disease was reported in 42.3% (n = 21) of the 85 patients  after that the patient was defined as disease free, and occurred within an average of 24 months after the diagnosis . The incidence of second primary cancers  was 4.7% (n = 4).Recurrent disease was observed in 24.7%  but they might rather show an exceeded susceptibility to classical risk factors.Although the etiological factors might be similar, young patients do have a better prognosis according to our results. Given that the most common tumor site was the oral cavity in young patients we should highlight the importance and feasibility of screening.


To explore the outcomes and related factors in children without cholangitis after Kasai portoenterostomy (KPE).We retrospectively analyzed the data of infants with type III BA who underwent KPE from June 2016 to December 2021. We compared and analyzed the difference in native liver survival (NLS) rates in different types of cholangitis. We also investigated the relationship between the absence of cholangitis and the effect of early bile drainage (EBD) as well as the related factors affecting EBD efficacy.P < 0.05). The NLS rate in recurrent cholangitis was significantly lower than that in occasional cholangitis (P < 0.01). Compared with the EBD-poor group, the NLS rate in the EBD-good group of infants was significantly increased (P < 0.001). EBD was significantly correlated with the occurrence and frequency of cholangitis (P < 0.05).A total of 145 children were included in this study. Among these children, 82  had cholangitis, including 40  with early cholangitis and 33  with recurrent cholangitis. The median follow-up period was 29 months . The NLS rates were 67.6%, 51.7%, 45.5% and 43.4% at 6 months, 1 year, 2 years and 5 years following KPE, while the NLS rates for infants without cholangitis after KPE were 68.3%, 50.8%, 46.0% and 46.0%, respectively. Higher gamma-glutamyl transferase (γ- GT) and total bile acid (TBA) before KPE were risk factors for cholangitis (Recurrent cholangitis was an important factor affecting NLS. For children without cholangitis after KPE, early bile drainage was better, and the NLS was longer. If left untreated, most patients will die before the age of 2 . AlthougCholangitis is the most common complication of BA after KPE and is also an important factor that seriously affects native liver survival (NLS) . The occ2.2.1.This study retrospectively analyzed the data of 145 infants with type III BA who underwent KPE in the Guangzhou Women and Children's Medical Center from June 2016 to December 2021. All the children underwent KPE performed by the same surgeons. The inclusion criteria of this study included the following: (1) All patients were diagnosed with BA by laparoscopic biliary exploration and postoperative pathology and were classified as type III . (2) The2.2.Cholangitis was defined as the presence of systemic inflammation , with evidence of cholestasis  , 12. To 2.3.Postoperative follow-ups were conducted for all patients at 1, 2, 3 and 6 months after surgery completion and every 6 months thereafter. Each visit consisted of a physical examination, abdominal ultrasound and liver function tests. Telephone follow-up was conducted every six months after surgery. The end point of follow-up was death or liver transplantation, and the follow-ups occurred until September 2022.2.4.t-test was used for comparisons between two groups with measurement data, and the χ2 test or Fisher's exact test was used for categorical variables. The Mann‒Whitney U test was used for grade data. A Cox regression test was used to compare the NLS rate. A value of P < 0.05 indicated that the difference was statistically significant.SPSS 21.0 software was used for statistical analysis. Student's 3.3.1.n = 145), 82 had cholangitis , of which 40 had early cholangitis  and 33 had recurrent cholangitis . The median follow-up period was 29 months . The NLS rates were 67.6%, 51.7%, 45.5% and 43.4% at 6 months, 1 year, 2 years and 5 years following KPE  Type I and II BA; (2) incomplete case data; and (3) lost to follow-up. Finally, 145 infants were included in the study , includiwing KPE , while twing KPE , respect3.2.P = 0.034, P = 0.014), while other preoperative indexes were not significantly different (The preoperative γ-GT and TBA levels were significantly higher in the cholangitis (Cho) group than in the noncholangitis (Noncho) group (ifferent .3.3.P = 0.003) (P = 0.829)  . However= 0.829) .3.4.P = 0.000)  .3.5.P = 0.018) (P = 0.03) (P = 0.055) (The EBD was significantly related to the occurrence of cholangitis (= 0.018) , which s = 0.03) , which s= 0.055) .4.BA is still a leading cause of liver transplantation in children, although great progress has been made in the diagnosis and treatment of BA in recent years , 16. AppCholangitis not only seriously affects the quality of life of BA children after KPE but also places great economic and psychological burdens on their parents . The effCholangitis may be related to microbiota migration and the immune inflammatory response. Gut microbiota is also closely related to feeding practice and delivery modes , 21. RecThe frequency and onset time of cholangitis were significantly related to postoperative quality of life . RamachaChildren without cholangitis have totally different NLS according to the different EBDs 1 month after KPE. In our study, we found that only the EBD-G group had a good NLS rate. In contrast, in the EBD-P group, the NLS rate was significantly reduced. Serum bilirubin rapidly decreases to very low levels after KPE, which can prolong the NLS time by delaying the process of liver fibrosis . SundaraBile drainage was closely related to the occurrence and frequency of cholangitis. The incidence of cholangitis was significantly higher in children who cleared jaundice than in those who did not . Good biThis study is limited by several factors. First, our study only included 145 children with BA, and all of them were Type III and came from one center. Second, although this study found that the effect of early biliary drainage significantly affected the NLS rate in children without cholangitis after KPE, this result still needs to be verified in large-sample and multicenter studies. Finally, whether the effect of early bile drainage can be given different scores according to clinical manifestations and laboratory test results as an indicator to predict long-term NLS requires more detailed work in the future.5.Recurrent cholangitis was an important factor affecting NLS after KPE. For children who did not have cholangitis after KPE, only early bile drainage was better and the NLS time was longer, thereby providing a theoretical basis for clinical practice.


Correcting retinal nerve fiber layer thickness (RNFLT) artifacts in glaucoma with deep learning and evaluate its clinical usefulness.We included 24,257 patients with optical coherence tomography and reliable visual field (VF) measurements within 30 days and 3,233 patients with reliable VF series of at least five measurements over ≥4 years. The artifacts are defined as RNFLT less than the known floor value of 50 µm. We selected 27,319 high-quality RNFLT maps with an artifact ratio (AR) of <2% as the ground truth. We created pseudo-artifacts from 21,722 low-quality RNFLT maps with AR of >5% and superimposed them on high-quality RNFLT maps to predict the artifact-free ground truth. We evaluated the impact of artifact correction on the structure–function relationship and progression forecasting.P < 0.001), respectively. Artifact correction improved R2 for VF prediction in RNFLT maps with AR of >10% and AR of >20% up to 0.03 and 0.04 (P < 0.001), respectively. Artifact correction improved (P < 0.05) the AUC for progression prediction in RNFLT maps with AR of ≤10%, >10%, and >20%: (1) total deviation pointwise progression: 0.68 to 0.69, 0.62 to 0.63, and 0.62 to 0.64; and (2) mean deviation fast progression: 0.67 to 0.68, 0.54 to 0.60, and 0.45 to 0.56.The mean absolute error and Pearson correlation of the artifact correction were 9.89 µm and 0.90 (Artifact correction for RNFLTs improves VF and progression prediction in glaucoma.Our model improves clinical usability of RNFLT maps with artifacts. For instance, studies have reported that artifacts were found in 58.5% and 19.9% of circumpapillary RNFL B-scans, 35.4% of optic disc volume RNFL B-scans,–,Currently, there are no good solutions to correct the RNFLT artifacts, except excluding scans with significant artifacts.This study was approved by the Massachusetts Eye and Ear Institutional Review Board and adhered to the tenets of the Declaration of Helsinki. Given the retrospective nature of the study, the need for informed consent was waived.,,,The dataset used in this study consists of 111,966 RNFLT maps from 24,257 patients tested with available VFs tested within 30 days from the Massachusetts Eye and Ear glaucoma service between 2010 and 2022. Each RNFLT map consisted of 200 × 200 thickness values and was obtained from a spectral domain OCT device . Because this study was designed for artifact correction, we included all OCT scans, regardless of signal strength. We defined artifacts as RNFLT values below the clinically known floor value of 50 µm.overall = Lcorrect + wcontrast × Lcontrast + wconsistency × LconsistencyL. The weight parameters contrastw and consistencyw scale the impact of contrast loss and consistency loss and were optimized in our model development.We developed a deep learning model RNFLTCorrect  using a 2 and mean absolute errors (MAEs) were used to measure the artifact correction accuracy.To establish the ground truth, we selected 27,319 high-quality RNFLT maps from 16,669 patients with an AR of <2%. We then created pseudo-artifacts by sampling artifacts from the low-quality RNFLT maps with an AR of >5% and superimposed them onto the high-quality RNFLT maps as model inputs to predict the artifact-free ground truth. The dataset was split into two parts at the patient level, where 70% and 30% of the total data were used for training and testing, respectively. Hence, for each patient , their images are either in the training or testing set, but not both. To evaluate the artifact correction accuracy, we compared the predicted and original RNFLTs in the regions of pseudo-artifacts in the test set. We further assessed the artifact correction accuracy in the artifact region with different ARs including ≤10%, >10%, and >20% for the entire RNFLT map as well as for RNFLTs on the 3.46-mm diameter circle centered on the optic disc.We conducted two sets of data analyses to demonstrate the clinical usefulness of artifact correction, including VF prediction and progression forecasting.2 and MAE were used for assessing prediction accuracy. In addition, we trained a linear regression model to predict VF MD and TDs using RNFLTs on the standard scan circle.First, to evaluate the impact of artifact correction on VF prediction, we separately used original and corrected RNFLT maps to predict the accompanying reliable 24-2 VFs tested within 30 days of the OCT scan. For this task, no artifacts were artificially added to the original RNFLT maps. Rather, we used our deep learning model to correct the native artifacts in the original RNFLT maps. Specifically, we trained a VGG-16P value of <0.05P value of <0.05P value of <0.05P value of <0.05.Furthermore, we assessed if artifact correction improves progression and fast progression prediction in glaucoma. We selected original RNFLT maps from patients with at least 5 reliable follow-up VFs across ≥4 years. We used four different progression criteria documented in the literature: (1) MD progression defined as MD slope of <0 and a t-test combined with three-fold cross-validation. For the three-fold cross-validation, the data were split into three equal subsets, where each subset was iteratively used for model evaluation and the remaining two subsets were combined for model training. The bootstrapping technique was used to compare the prediction accuracy between the models using original and corrected RNFLT maps. All statistical analyses were performed using Python 3.8.For VF prediction and progression forecasting tasks, we used the We included 111,966 OCT scans with VFs tested within 30 days from 42,765 eyes of 24,257 patients in this study. The mean age of participants at the time of imaging was 60.5 ± 16.9 years, and 57.0% were female. Of the 24,257 patients included, 65.4% identified as White . Of the Additional demographic information and ophthalmic characteristics are shown in When stratified by ARs, artifact correction accuracy in the artifact region decreased with increasing ARs in the RNFLT map. The artifact correction accuracy had MAE of 10.0 µm (R = 0.92) among scans with an AR of ≤10%, MAE of 8.0 µm (R = 0.93) at an AR of >10%, and MAE of 11.1 µm (R = 0.86) at an AR of >20% . SimilarWe used 111,966 pairs of RNFLT maps and VFs tested within 30 days to study the impact of artifact correction on structure–function relationships. Of all RNFLT maps used, 89.8% of the RNFLT maps had AR of ≤10%, 10.2% of the RNFLT maps had an AR of >10%, and 4.1% of the RNFLT maps had an AR of >20% .P = 0.87; R2 0.42 vs R2 0.42 with correction, P = 0.28) . For RNFLT maps with an AR of >20%, there was a significant improvement in both MAE and R2 after artifact correction . When using only data from the circle scan, artifact correction demonstrated improvements in MD prediction compared to without correction regardless of ARs (P < 0.001) and the R2 from 0.10 to 0.17 (P < 0.001). For RNFLT maps with an AR of >20%, artifact correction improved MAE from 5.0 dB to 4.7 dB (P < 0.001) and the R2 from 0.01 to 0.11 (P < 0.001).Overall, MD prediction did not significantly improve with artifact correction  . The MD s of ARs . MAE imp2 performance on predicting 52 TD values using original RNFLT maps versus corrected RNFLT maps. Overall, artifact correction significantly improved TD prediction for 11 VF locations with a ≤0.01 R2 improvement, which were mainly in the inferior hemifield. When stratified by ARs, the improvement in R2 with artifact correction increased with increasing ARs  with 10 locations improved. For the MAE performance improvement, see sing ARs . For RNFP < 0.05) the areas under the receiver operating characteristic curve for progression forecasting in RNFLT maps with an AR of ≤10%, >10%, and >20%  MD To the best of our knowledge, this research is the first work in the literature to correct RNFLT artifacts with deep learning. RNFLT measurement is an important tool for glaucoma diagnosis and monitoring. We demonstrated that our artifact correction model RNFLTCorrect was able to predict the true RNFLTs in the artifact region with high accuracy, evidenced by correlations of 0.90 and 0.92 for the artifact region over the entire map and the scan circle, respectively . We have,,–High-quality OCT imaging is critical in clinical care for glaucoma. Imaging artifacts can impede effective clinical interpretation and progression detection, especially when the artifact is large so that the structural measurement is therefore not assessable by clinicians.,–,Using deep learning to assess structure–function associations has been extensively studied in prior work.–More important, prior works have attempted to predict glaucoma progression by deep learning.There are some limitations to this study. First, we selected high-quality RNFLT maps to train the RNFLTCorrect model, but these maps may also contain minor artifacts around the peripheral regions, which are not perfect ground truth for training our artifact correction model.The performance in VF prediction and glaucoma progression forecasting typically improves with a reduced AR. This result is attributed to the availability of more RNFLT information when the AR is smaller. Conversely, the enhancements in VF prediction and progression forecasting are more pronounced with a higher AR, as seen in In conclusion, the prevalence of artifacts in a large proportion of RNFLT maps remains a significant clinical challenge for effectively using OCT measurements to diagnose and prognose glaucoma. We have developed a novel deep learning framework termed RNFLTCorrect to address OCT artifacts, consisting of an artifact correction backbone together with a contrastive learning module and a consistency learning component. RNFLTCorrect has achieved high accuracy on artifact correction, which improves the VF prediction and progression forecasting in glaucoma.


The mean CF achieved in the ICE/CFS group was 7.52 ± 3.31 g. Less X-ray time was used in the combination group . An acute success rate of 100% was achieved for the ICE/CFS group (n = 22) and 66.67% for the no ICE/CFS group (n = 8). VA recurrence at the 11.21 ± 7.21-month follow-up was 14.2% for the ICE/CFS group and 50% for the no ICE/CFS group (p = 0.04). No severe complications occurred in all patients. Conclusions: The combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) could provide precise geometries of cardiac endocavitary structures and accurate contact information for the catheter during ablation, which improved acute and long-term ablation outcomes. The routine adoption of this strategy should be considered to improve the outcomes of LV PM VA ablation.Objectives: The catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular (LV) papillary muscles (PMs) is challenging. This study sought to address whether the combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can improve the acute and long-term ablation outcomes of left ventricular papillary muscle arrhythmias. Methods and Results: From May 2015 to August 2022, a total of thirty-three patients underwent catheter ablation for LV PM arrhythmias: VAs were located in anterolateral PMs in 11 and posteromedial PMs in 22. A combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) was used in 21 of the 33 procedures. A mean of 6.93 ± 4.91 for lesions was used per patient, comparable between the CFS/ICE and no ICE/CFS (4.90 ± 2.23 vs. 10.17 ± 5.89;  The left ventricular (LV) papillary muscle (PM) is increasingly being recognized as a source of ventricular arrhythmias (VAs) in patients with or without structural heart diseases ,2. PremaAlthough catheter ablation is increasingly being used for treating LV PM VAs, it is still challenging for a variety of reasons; anatomically, the PM originates from the mid or apical one-third of the LV, and protrudes like fingers into the LV cavity . RecentlThirty-three patients with LV PM arrhythmias were identified from a retrospective review of 578 consecutive patients with symptomatically sustained ventricular tachycardia (VT), nonsustained VT or PVC in the Qilu Hospital of Shandong University from May 2015 to August 2022. All patients underwent electrophysiological studies and ablation, following institutional practice . Patients with right ventricular (RV) PM VAs were excluded from the study . The stuThe patients were divided into two groups according to whether the combination of ICE and CFS was used during the ablation. The mapping of the no ICE/CFS group was performed using a 3.5 mm open-irrigation-tip catheter . The ablation technique was selected according to the operators’ preferences and available technologies. The clinical data of the samples were obtained from the database of the Qilu Hospital and provided by the patients themselves. All transthoracic echocardiograms, electrocardiograms (ECG) and 24 h Holter laboratory test result recordings at baseline and throughout the follow-up were reviewed. The research samples and data included in this study were reviewed and approved by the ethical audit committee of the Qilu Hospital of Shandong University (no. KYLL-202111-041). All methods were carried out in accordance with relevant guidelines and regulations.Antiarrhythmic medications were discontinued at least 5 half-lives before the procedure, and the electrophysiology study was conducted under minimal sedation. Intravenous heparin was used to maintain an activated clotting time greater than 300 s during the LV mapping and ablation.® Catheter, Biosense-Webster) was advanced through the femoral vein and positioned in the RV to model the different LV structures, as previously described [An ICE catheter  A–C.Radiofrequency ablation was delivered at the site of earliest activation and/or with the best pace map. Efforts were devoted to achieving at least 5 g of contact force at the site of energy delivery. Power was initiated at 30 W and then increased to a maximum of 45 W to achieve an impedance drop of 10 Ω with a temperature limit of 43 °C. When an acceleration or reduction in the incidence of PVC was observed, RF delivery was continued for 60 s, and a second application of RF was delivered; if there was no change in VA behavior after <30 s of RF delivery, then the lesion was terminated and the catheter was repositioned. During several ablations around the site of earliest activation, alternative contact directions were attempted with vector orientations of the catheter tip. Additionally, the trans-septal approach was adopted if the ablation contact force was not sufficient with the retroaortic access D–F.Acute success was defined as a targeted clinical VA elimination and noninduction for at least 30 min after ablation with isoproterenol infusion and ventricular pacing agitation. A postprocedural follow-up was based on symptom recurrence and Holter monitoring. Patients were evaluated 2 months after the procedure in the outpatient clinic, and contacted us in time if clinical symptoms reoccurred. Holter and/or mobile cardiac outpatient telemetry monitors were performed 6 and 12 months after the procedure. For patients who were not followed-up with at our facility, the referring cardiologist or the patients were contacted to obtain information on any devices (ECG/Holter), including clinic visits and telephone calls. A successful long-term catheter ablation was defined as a significant reduction  or absence of clinical arrhythmia during the follow-up. In our study, no ICDs or implantable Holter devices were implanted after the ablation.t-test (parametric) or Mann–Whitney U-test (nonparametric). Kaplan–Meier curves were generated and a comparison between the two groups was performed using the log-rank test. The categorical variables were compared using the chi-square test or Fisher exact test. Statistical analyses were performed by using IBM SPSS version 24.0 , and statistical significance was defined as a 2-sided p value of <0.05.Continuous data were expressed as mean ± SD, and categorical data were expressed as the number (%). Categorical variables were expressed as numbers and percentages. Continuous variables were compared using the unpaired Student’s A total of thirty-three patients were included in our study. Overall, the mean age was 49 ± 15 years and 69.7% were male. Twenty-five patients (75.7%) manifested isolated premature ventricular complexes (PVCs), eight (24.2%) had nonsustained VTs and the mean duration of symptoms was 19.91 ± 42.68 months. Eight patients (24.2%) had hypertension and thirteen patients (39.4%) had a history of smoking. Structural heart disease was present in 12 patients (36.4%) and the mean ejection fraction for the entire cohort was 58 ± 8%. The mean left ventricular diameter (LVD) overall was 51.00 ± 5.33 mm, and the mean left atrial diameter (LAD) was 38.38 ± 5.96 mm. No patients had an MV prolapse. In addition, we recorded the myocardial enzyme profile before the patients underwent the ablation, including the mean creatine kinase-MB (CK-MB) 2.29 ± 6.25 ng/dL, creatine kinase (CK) 110.45 ± 180.88 ng/dL, NT-proBNP 449.73 ± 753.40 ng/mL and cardiac troponin I (CTNI) 1.82 ± 1.66 ng/dL. Twenty-four patients took AADs preoperatively and twenty-five postoperatively. No significant differences in baseline characteristics were noted between both study groups .p = 0.618). During the RF energy delivery, the mean CF achieved in the ICE/CFS group were 7.52 ± 3.31 g. The total amount and distribution of lesions are described in p = 0.002). The mean procedure time was 157.64 ± 55.75 min  and mean RF application time was 274.45 ± 138.96 S . On average, 247.5 ± 160.75 s total X-ray time was used per ablation .ICE/CFS ablation catheters were used in 21 (63.6%) cases, whereas non-CFS/ICE catheters were used in 12 (36.3%). Overall, VAs were targeted at the posteromedial PM (PPM) in 22 patients (66.7%) and at the anterolateral PM (APM) in 11 patients (33.3%), with VAs originating from the PM body in 11/21 (52.38%) patients in the ICE/CFS group. The retrograde aortic access approach was undertaken in 22 patients (66.7%) and combined access in 11 (33.3%) patients. At the site of a successful ablation, the earliest ventricular activation preQRS was achieved with an average of 35.10 ± 5.08 ms for the ICE/CFS group and 34.25 ± 4.35 ms for the no ICE/CFS group (p = 0.012) at a mean follow-up of 11.21 ± 7.21 months, whereas the clinical success rate was 24/33 (72.72%) in all cases  (p < 0.001).The acute success rate was 29/33 (87.87%), with a tendency for a higher success rate in patients whose first procedure was performed with compared to without ICE/CFS  . Figure Catheter ablation is increasingly being used for treating LV PM VAs, but it can be challenging to perform for a variety of reasons, including due to anatomic complexities of the PM, variable locations of the VA sites and changing exits during ablation. A lot of effort has been contributed through technological innovations, as well as methodological improvements. Catheter ablation is an effective and safe strategy for the treatment of PM VAs, with an acute success rate of 88.1%, a long-term success rate of 69.2% and a relatively low procedural complication rate of 1.7% . The salp = 0.14) [Ultrasound imaging can be integrated with electroanatomic mapping, and has been used in the catheter ablation of atrial fibrillation . Echofac = 0.14) .A further challenge for PM VA ablation is that consistent favorable contact is difficult to achieve for the duration of lesion application on highly mobile endocavitary structures such as the PM. Although ICE could monitor the contact between the catheter tip and the PM, contact force sensing, which has been proved to be effective in achieving durable chronic pulmonary vein isolation in atrial fibrillation ablation, is still in debate for use in PM arrhythmias. Aung N. Lin et al. reported that the use of CFS technology did not influence acute and long-term outcomes in an observational study, and inferred that the lack of benefits from CFS may be related to the consistent use of ICE guidance, which was used in all catheter ablations; however, it was noted that the average CF achieved during the catheter ablation of LV PM VAs was ~11 g; therefore, it was reasonable to speculate that the satisfactory ablation outcomes also benefited from contact force sensing . In our Often, several RF lesions on different parts of the PM are required to completely eliminate the VT/PVC, with ablation outcomes likely enhanced through the use of more sophisticated methods for optimizing lesion efficacy, incorporating metrics beyond CF. A previous study by Wo et al. reported that if the first one or two shots of RFCA at the initial targeted site failed, they would adopt a circumferential approach with multiple ablations applied to the base of the PMs to eliminate all VAs completely . In an eAs this was a single-center retrospective study of the catheter ablation of PM-related arrhythmias, the catheter ablation strategy used here may not be generalizable to all patients with LV PM arrhythmias. A prospective validation cohort study, ideally with multicenter participation, could validate our findings. Furthermore, the small number of patients in our report did not allow for an exhaustive statistical assessment. This was partly due to the fact that patients with PM arrhythmias represent a small subset of subjects referred for ablation, making them less suitable for larger studies. This was not a randomized trial; thus, the conclusions were only hypothesis-generating, and related to the feasibility rather than the efficacy of the proposed strategy; therefore, larger studies and randomized experiences are needed.A highly mobile endocavitary structure makes PM arrhythmias a unique clinical entity with peculiar features; ideal ablation requirements often relate to precise activation mapping, best pace mapping, stable contact and multiple lesions around the site all together. The combination of intracardiac echocardiography and contact force sensing may overcome the specific difficulties. Furthermore, an integrated approach using ICE and CFS may increase the success rate of PM VA ablation.


Post-traumatic stress disorder, following stress of a particular intensity, is often related to the perception of childbirth as a traumatic event requiring the optimization of follow-up and the interest of early detection.To determine the factors associated with post-traumatic stress disorder related to childbirth.This is a longitudinal prospective analytical study carried out in the obstetrics gynecology department of the Tahar Sfar Mahdia hospital. The study population was women who gave birth during the study period from March 15, 2020 to September 15, 2020. We used a pre-established questionnaire including sociodemographic and clinical characteristics as well as a psychometric part containing the psychiatric scale for screening for post-traumatic stress disorder.Our sample included 120 women. The average age was 28.2±5.3.Five participants (4.2%) had a psychiatric history .Thirty-five patients (29.1%) had a pathological obstetric history. However, fifteen patients (12.5%) were hospitalized during their pregnancies. Psychometric assessment revealed a prevalence of PTSD at 5.8% with PTSD symptomatology in 18.4% of women.Twenty-two patients (18.3%) described the childbirth as painful and traumatic.The frequency of PTSD was higher in women with a history of abortion (6.9%)Postpartum PTSD was statistically associated with a low level of education (p=0.02), postpartum complications (p=0.05) and sex of the newborn (p=0.01)The detection of factors associated with postpartum posttraumatic stress disorder seems to be essential for comprehensive and multidisciplinary management of women at risk.None Declared