АНАЛІЗ СТАНУ ПРОФІЛАКТИКИ ПЕРЕДАЧІ ВІЛ ВІД МАТЕРІ ДО ДИТИНИ

Purpose: to define of the system condition of prevention of HIV transmission from mother to child, implementation of family planning for HIV-infected women.         Material and methods. In this study are used: statistical, analytical, organizational and conceptual methods from medical documents and official information.Results. The study determined that the major problems of HIV transmission from mother to child in Ukraine is unplanned pregnancy of HIV-infected women and associated with this low commitment to their timely HIV testing, prenatal surveillance, ARVP during pregnancy, timely hospitalization for childbirth, examination of newborn and optimal care by him; late stages of HIV infection in pregnant women; injecting drug taking; risk sexual behavior during pregnancy.Conclusions. Prevention of HIV transmission from mother to child in Ukraine may essential improving due to optimization of family planning service and improvement of health and social care for HIV-infected women.Мета: визначити стан системи профілактики передачі ВІЛ від матері до дитини, заходів з планування сім’ї для ВІЛ-інфікованих жінок.Матеріали і методи. У дослідженні вивчалися матеріали медичної та статистичної документації, використані статистичний, аналітичний, організаційний та концептуальний методи.Результати. Встановлено, що основними проблемами передачі ВІЛ від матері до дитини в Україні є непланованість вагітності та пов'язана з цим низька прихильність до своєчасного обстеження на ВІЛ, допологового нагляду, АРВ-профілактики під час вагітності, своєчасної госпіталізації на пологи, обстеження новонародженого та оптимального догляду за ним; пізні стадії ВІЛ-інфекції у вагітних; споживання ін'єкційних наркотиків; ризикована статева поведінка під час вагітності.Висновки. Профілактику вертикальної передачі ВІЛ в Україні можливо суттєво покращити за рахунок оптимізації діяльності служби планування сім’ї та покращення надання медико-соціальної допомоги ВІЛ-інфікованим жінкам

clDice -- a Novel Topology-Preserving Loss Function for Tubular Structure Segmentation

Accurate segmentation of tubular, network-like structures, such as vessels, neurons, or roads, is relevant to many fields of research. For such structures, the topology is their most important characteristic; particularly preserving connectedness: in the case of vascular networks, missing a connected vessel entirely alters the blood-flow dynamics. We introduce a novel similarity measure termed centerlineDice (short clDice), which is calculated on the intersection of the segmentation masks and their (morphological) skeleta. We theoretically prove that clDice guarantees topology preservation up to homotopy equivalence for binary 2D and 3D segmentation. Extending this, we propose a computationally efficient, differentiable loss function (soft-clDice) for training arbitrary neural segmentation networks. We benchmark the soft-clDice loss on five public datasets, including vessels, roads and neurons (2D and 3D). Training on soft-clDice leads to segmentation with more accurate connectivity information, higher graph similarity, and better volumetric scores.Comment: * The authors Suprosanna Shit and Johannes C. Paetzold contributed equally to the wor

Reconstruction of the Corticospinal Tract in Patients with Motor-Eloquent High-Grade Gliomas Using Multilevel Fiber Tractography Combined with Functional Motor Cortex Mapping

BACKGROUND AND PURPOSE: Tractography of the corticospinal tract is paramount to presurgical planning and guidance of intraoperative resection in patients with motor-eloquent gliomas. It is well-known that DTI-based tractography as the most frequently used technique has relevant shortcomings, particularly for resolving complex fiber architecture. The purpose of this study was to evaluate multilevel fiber tractography combined with functional motor cortex mapping in comparison with conventional deterministic tractography algorithms. MATERIALS AND METHODS: Thirty-one patients (mean age, 61.5 [SD, 12.2] years) with motor-eloquent high-grade gliomas underwent MR imaging with DWI (TR/TE ¼ 5000/78 ms, voxel size ¼ 2 × 2 × 2 mm3, 1 volume at b ¼ 0 s/mm2, 32 volumes at b ¼ 1000 s/mm2). DTI, constrained spherical deconvolution, and multilevel fiber tractography–based reconstruction of the corticospinal tract within the tumor-affected hemispheres were performed. The functional motor cortex was enclosed by navigated transcranial magnetic stimulation motor mapping before tumor resection and used for seeding. A range of angular deviation and fractional anisotropy thresholds (for DTI) was tested. RESULTS: For all investigated thresholds, multilevel fiber tractography achieved the highest mean coverage of the motor maps (eg, angular threshold = 60°; multilevel/constrained spherical deconvolution/DTI, 25% anisotropy threshold ¼ 71.8%, 22.6%, and 11.7%) and the most extensive corticospinal tract reconstructions (eg, angular threshold ¼ 60°; multilevel/constrained spherical deconvolution/DTI, 25% anisotropy threshold ¼ 26,485 mm3, 6308 mm3, and 4270 mm3). CONCLUSIONS: Multilevel fiber tractography may improve the coverage of the motor cortex by corticospinal tract fibers compared with conventional deterministic algorithms. Thus, it could provide a more detailed and complete visualization of corticospinal tract architecture, particularly by visualizing fiber trajectories with acute angles that might be of high relevance in patients with gliomas and distorted anatomy.</p

Cross-scanner and cross-protocol multi-shell diffusion MRI data harmonization: algorithms and result

Cross-scanner and cross-protocol variability of diffusion magnetic resonance imaging (dMRI) data are known to be major obstacles in multi-site clinical studies since they limit the ability to aggregate dMRI data and derived measures. Computational algorithms that harmonize the data and minimize such variability are critical to reliably combine datasets acquired from different scanners and/or protocols, thus improving the statistical power and sensitivity of multi-site studies. Different computational approaches have been proposed to harmonize diffusion MRI data or remove scanner-specific differences. To date, these methods have mostly been developed for or evaluated on single b-value diffusion MRI data. In this work, we present the evaluation results of 19 algorithms that are developed to harmonize the cross-scanner and cross-protocol variability of multi-shell diffusion MRI using a benchmark database. The proposed algorithms rely on various signal representation approaches and computational tools, such as rotational invariant spherical harmonics, deep neural networks and hybrid biophysical and statistical approaches. The benchmark database consists of data acquired from the same subjects on two scanners with different maximum gradient strength (80 and 300 ​mT/m) and with two protocols. We evaluated the performance of these algorithms for mapping multi-shell diffusion MRI data across scanners and across protocols using several state-of-the-art imaging measures. The results show that data harmonization algorithms can reduce the cross-scanner and cross-protocol variabilities to a similar level as scan-rescan variability using the same scanner and protocol. In particular, the LinearRISH algorithm based on adaptive linear mapping of rotational invariant spherical harmonics features yields the lowest variability for our data in predicting the fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK) and the rotationally invariant spherical harmonic (RISH) features. But other algorithms, such as DIAMOND, SHResNet, DIQT, CMResNet show further improvement in harmonizing the return-to-origin probability (RTOP). The performance of different approaches provides useful guidelines on data harmonization in future multi-site studies

Uterine bleedings and quality of woman's life

12 березня 2019 р. у Києві відбулося засідання Експертної ради з питань впливу маткових кровотеч на якість життя жінки, до роботи якої були залучені провідні вітчизняні та європейські фахівці. Згідно з думкою міжнародних експертів (клінічні рекомендації Національного інституту здоров'я і якості медичної допомоги Великобританії та Міжнародної федерації гінекології та акушерства від 2018 р.), вибір тактики ведення пацієнтки визначається не результатом вимірювання крововтрати, а самопочуттям жінки (дистрес, зниження працездатності, сексуальної активності та якості життя). Менструальні симптоми зазвичай є легкими і незначними або взагалі відсутні за умови, якщо менструальне запалення відповідає наступним трьом критеріям: «завершується» (відновлюється нормальна цитоархітектура тканини, перш за все ендометрія); обмежене в часі; адекватне і достатнє за інтенсивністю для завершення відновлення гістологічних та функціональних характеристик залучених тканин. Однак якщо локальне і системне запалення, асоційоване з менструацією, є надмірним за інтенсивністю і тривалістю, воно викликає різні патологічні симптоми. Тяжкі менструальні симптоми клінічно корелюють з місцевим та системним запаленням, яке не завершується (менструація є надмірною за тривалістю та інтенсивністю). Тому пригнічення менструального запалення є важливим для зменшення частоти проявів та інтенсивності менструальних симптомів і покращення якості життя жінок репродуктивного віку. Для оптимізації фізичного та психічного здоров`я жінкам необхідні належні стабільні рівнів естрогенів та прогестерону. При виборі комбінованих оральних контрацептивів для здорових жінок доцільно віддавати перевагу препаратам із коротким безгормональним інтервалом (24+4, 26+2) у порівнянні з традиційним режимом (21+7). Скорочення цього інтервалу забезпечує більш стабільний рівень естрадіолу, знижує ризик випадкової овуляції в разі пропуску таблеток, підвищує резерв контрацептивної надійності в порівнянні з традиційним режимом, а також дозволяє зменшити частоту появи симптомів, асоційованих з відміною гормонів.On March 12, 2019, an Advisory Board on impact of uterine bleedings on the quality of life of a woman was held in Kyiv, with participation of leading Ukrainian and European experts.According to opinion of international experts (guidelines of the UK National Institute for Health and Care Excellence and the International Federation of Gynecology and Obstetrics from 2018), the choice of patient management tactics is notdetermined by measuring blood loss, but by the patient’s well-being (distress, decrease of work ability, sexual activity and quality of life).Menstrual inflammation is phisiological and menstrual symptoms are usually mild/minor or absent when three criteria are fulfilled: resolving (normal cytoarchitecture of the tissue is reconstructed, endometrium first); limited in time; adequateand sufficient by intensity to finalize the reconstruction to the histological and functional characteristics of the different tissues involved. At the same time, if local and systemic inflammation associated with menstruation is On March 12, 2019, an Advisory Board on impact of uterine bleedings on the quality of life of a woman was held in Kyiv, with participation of leading Ukrainian and European experts.According to opinion of international experts (guidelines of the UK National Institute for Health and Care Excellence and the International Federation of Gynecology and Obstetrics from 2018), the choice of patient management tactics is notdetermined by measuring blood loss, but by the patient’s well-being (distress, decrease of work ability, sexual activity and quality of life).Menstrual inflammation is phisiological and menstrual symptoms are usually mild/minor or absent when three criteria are fulfilled: resolving (normal cytoarchitecture of the tissue is reconstructed, endometrium first); limited in time; adequateand sufficient by intensity to finalize the reconstruction to the histological and functional characteristics of the different tissues involved. At the same time, if local and systemic inflammation associated with menstruation is excessive byintensity and duration, it can cause different pathological symptoms. Severe menstrual symptoms are clinically correlated with local and systemic inflammation, which is not resolving (menstruation is excessive in duration and intensity).Therefore, reducing menstrual inflammation is important to reduce the frequency and intensity of menstrual symptoms and improve the quality of life of women of reproductive age.Women need appropriate stable levels of estrogen and progesterone to optimize their physical and mental health. During combined oral contraceptives selection for healthy women it is reasonable to give preference to contraceptives with shorthormonal free interval (24+4, 26+2) compared to the traditional regimen (21+7), since the reduction of this interval provides a more stable level of estradiol, reduces the risk of casual ovulation in case of missed pill, increases contraceptiveefficacy in comparison with the traditional regimen and reduce the incidence of hormone-withdrawal associated symptoms

Biological data on the Danube ruffe, Gymnocephalus baloni Holčík et Hensel, 1974, in the Desna River, Ukraine

Background. The Danube ruffe, Gymnocephalus baloni Holčík et Hensel, 1974, is a little-known species from the middle and lower Danube River. The relevant information on its habitat, maturity, fecundity, spawning season, maximum size and age, as well as its growth and length–weight relation are provided herewith from the Desna River, Ukraine. The estimation of fecundity ranged from 5072 to 15 730 eggs within the length range of 8.6 to 10.4 cm SL and the gonado-somatic index was 0.12–0.14 respectively. The length–weight relation was determined as W = 0.0345SL2.8

SITUATIONAL ANALYSIS OF THE PROBLEM OF MATERNAL MORTALITY IN UKRAINE AND WAYS TO SOLVE IT

&lt;p&gt;The maternal mortality (MM) rate is considered an integrated indicator of women's reproductive health, which reflects not only the state of general health, including reproductive one, the quality of medical care for pregnant women and the level of organizational work of maternity institutions, but also the combined interaction of these factors with economic, ecological, sanitary-cultural, social-hygienic and other ones.&lt;br&gt;&lt;strong&gt;The objective:&lt;/strong&gt; to highlight the current problem of MM in Ukraine and the world, finding its main factors and ways to solve it.&lt;br&gt;&lt;strong&gt;Materials and methods.&lt;/strong&gt; Bibliosemantic, analytical, statistical and conceptual methods were used. The research period is 2010–2022.&lt;br&gt;&lt;strong&gt;Results.&lt;/strong&gt; The MM rate is currently an extreme problem worldwide. The World Health Organization (WHO) emphasizes that MM is unacceptably high. In 2020, almost 287,000 women died during and after pregnancy and childbirth. Almost 95% of all maternal deaths in 2020 occurred in low-income and lower-middle-income countries, and most of them were preventable.&lt;br&gt;&lt;strong&gt;Conclusions.&lt;/strong&gt; In Ukraine, there is a negative wave-like situation with the MM indicator, that is fluctuations from decrease to increase. And even the decrease in the MM indicator does not reach its level in developed countries. In 2022, 19.3 per 100,000 live births were registered. The main reasons for the high rates of MM in Ukraine are: the imperfection of the health care system in relation to the formation of reproductive health in adolescents, the loss of the potential of the family planning system, the insufficient level of accessibility of Ukrainian women to reproductive health care services, the low level of organization of perinatal assistance and its effectiveness, lack of a monitoring system for compliance with quality criteria of clinical protocols, as well as an insufficient level of socio-economic support of the population.&lt;br&gt;The implementation of measures of the WHO Global Strategy and goals for the prevention of maternal mortality by 2030 will contribute to the reduction of the MM indicator, namely, the increase in the availability and quality of medical and sanitary services in the health care system of adolescents, mothers and newborns, in reproductive health, for the prevention of maternal mortality, improving the efficiency of the health care system.&lt;/p&gt;&lt;p&gt;&lt;a href="https://repro-health.com.ua/article/view/285759"&gt;https://repro-health.com.ua/article/view/285759&lt;/a&gt;&lt;/p&gt

Anatomically informed multi-level fiber tractography for targeted virtual dissection

Objectives: Diffusion-weighted MRI can assist preoperative planning by reconstructing the trajectory of eloquent fiber pathways, such as the corticospinal tract (CST). However, accurate reconstruction of the full extent of the CST remains challenging with existing tractography methods. We suggest a novel tractography algorithm exploiting unused fiber orientations to produce more complete and reliable results. Methods: Our novel approach, referred to as multi-level fiber tractography (MLFT), reconstructs fiber pathways by progressively considering previously unused fiber orientations at multiple levels of tract propagation. Anatomical priors are used to minimize the number of false-positive pathways. The MLFT method was evaluated on synthetic data and in vivo data by reconstructing the CST while compared to conventional tractography approaches. Results: The radial extent of MLFT reconstructions is comparable to that of probabilistic reconstruction: p= 0.21 for the left and p= 0.53 for the right hemisphere according to Wilcoxon test, while achieving significantly higher topography preservation compared to probabilistic tractography: p< 0.01. Discussion: MLFT provides a novel way to reconstruct fiber pathways by adding the capability of including branching pathways in fiber tractography. Thanks to its robustness, feasible reconstruction extent and topography preservation, our approach may assist in clinical practice as well as in virtual dissection studies