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Introduction: Coordinated medical evacuations represent an important strategy for emergency response when healthcare systems are impaired by armed conflict, particularly for patients diagnosed with life-threatening conditions such as cancer. In this study, we compare the experiences of two parallel medical evacuation systems developed to meet the medical needs of Ukrainians affected by war., Methods: This retrospective study compared outcomes of two medical evacuation systems, developed by the European Union Emergency Response Coordination Centre (ERCC) and Supporting Action for Emergency Response in Ukraine (SAFER Ukraine) collaborative, in the first 10 months after the war's intensification in Ukraine (February 24 to December 21, 2022). Each groups' respective registries served as data sources. Patient demographics and allocation data were summarized descriptively. Median time for patient referral were analyzed statistically., Results: The ERCC pathway evacuated 1385 patients (median age: 36 [0 - 85] years) to 16 European countries; 78.7 % (n = 1091) suffered from trauma-related injuries and 13.4 % (n = 185) from cancer. SAFER Ukraine evacuated 550 patients (median age: 9 [0 - 22] years) to 14 European and North American countries; 97.1 % (n = 534) were children diagnosed with cancer or blood disorders. The median evacuation time for the SAFER Ukraine cohort was shorter than the ERCC cohort (p < 0.001), though comparable (six versus seven days)., Conclusion: The ERCC and SAFER Ukraine collaborative successfully developed medical evacuation pathways to meet the needs of Ukrainian patients impacted by war. System comparison provides opportunity to identify strategies for parallel system harmonization and a pragmatic example of how to anticipate support of these patients in future armed conflicts., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Worldwide neonatal screening for congenital hypothyroidism (CH) is a gold standard of active surveillance in newborns. Prompt diagnosis, subsequent timely treatment implementation, and proper dosage of levothyroxine (L-T4) are crucial for normal growth and development, especially of the central nervous system. However, overtreatment may have a potential negative impact on further neurodevelopment. We retrospectively analysed data of 99 newborns with CH diagnosis, referred to the Endocrinology Outpatient Clinic of the Institute of Mother and Child in Warsaw, Poland from the CH screening program from 2017 to 2021. We evaluated the diagnostic process and treatment up to the age of 3 years. We compared groups of children from the first and the second screening groups (FSG, SSG) in the neonatal screening with an evaluation of ultrasound examination (thyroid dysgenesis vs. gland in situ , GIS). The overtreatment and undertreatment risks were assessed and an analysis of the new TSH thresholds was performed. Treatment was implemented at a median of 9 days of life (3 - 27); 8 days (3 - 17) in FSG and 19 (6 - 27) in SSG. The dose of L-T4 differed between FSG and SSG at all three analysed time points (start of the therapy, 12 months, and 3 years) with significantly higher doses in FSG. The same was observed for the patients with thyroid dysgenesis vs. GIS. Screening TSH level was ≥ 28mIU/l in 91.7% of patients with thyroid dysgenesis in comparison to 74.0% of patients with GIS (p= 0.038). The optimally treated group (fT4 in the upper half of the reference range, according to the guidelines) was up to 58.0% of the children during the follow-up. The risk for overtreatment was present in 1/5 of the study group after 12 months and 1/4 after 3 years of L-T4 therapy. Analysis of new TSH thresholds showed an increased prevalence of mild hypothyroidism, GIS, and either euthyroid state or overtreatment while treating with lower L-T4 doses in comparison to the rest of the cohort. The study confirmed the general efficacy of the CH diagnostic pathway and the timely implemented L-T4 therapy. The suspected overtreatment after the first 12 months of L-T4 therapy requires consideration of the earlier diagnosis re-evaluation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lipska, Lecka-Ambroziak, Witkowski, Szamotulska, Mierzejewska and Ołtarzewski.)

The revised international health regulations offer a framework that can be used by host countries to organise public health activities for mass gatherings. From June 8, to July 1, 2012, Poland and Ukraine jointly hosted the Union of European Football Associations European Football Championship Finals (Euro 2012). More than 8 million people from around the world congregated to watch the games. Host countries and international public health agencies planned extensively to assess and build capacity in the host countries and to develop effective strategies for dissemination of public health messages. The effectiveness of public health services was maximised through rapid sharing of information between parties, early use of networks of experienced individuals, and the momentum of existing national health programmes. Organisers of future mass gatherings for sporting events should share best practice and their experiences through the WHO International Observer Program. Research about behaviour of large crowds is needed for crowd management and the evidence base translated into practice. A framework to measure and evaluate the legacy of Euro 2012 is needed based on the experiences and the medium-term and long-term benefits of the tournament., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: The aim of the present study was to characterise and compare alterations in the ultrastructure of the functionally identified isolated twitch skeletal muscle fibres of the frog after repeated tetanic stimulation and under experimental conditions which modified their fatigability., Methods: Single isolated twitch muscle fibres of m. iliofibularis of adult frogs Rana temporaria were subjected to intermittent tetanic stimulation. Fibres at specified degree of fatigue were processed for electron microscopic observation and ultrastructural examination., Results: The fatigue-resistant (FR) fibres that developed 90% of the control tetanic tension after 10 min stimulation in ordinary Ringer's solution showed regions with dilated intermyofibrillar spaces containing small vesicles and swollen mitochondria. In addition to the changes observed in FR fibres, the easily fatigued (EF) fibres that produced 50% of the original tension after 3 min stimulation showed small vacuoles in the sarcoplasm. In EF fibres that preserved 10% of the control tension after 10 min stimulation and showed swelling of the longitudinal sarcoplasmic reticulum, the central element of triads and mitochondria, large vacuoles were present. FR fibres exposed to low Ca2+ medium containing 0.02 mmol/l verapamil, lost their resistance to fatigue. Their contractile responses fell down to 20 % within 0.5 min of stimulation. Those fibres displayed large vacuoles and changes in mitochondria as observed in EF fibres after 10 min stimulation., Conclusion: These results suggest that morphological changes accompanying reduction of the contractile force (i) appear earlier than the reduction of the contractile ability, (ii) correlate with the degree of reduction of the contractile capacity but not with the duration of contractile activity, (iii) are not specific for the fatigue fibre type.

Distribution of ribonuclease (RNAase), acid phosphatase (acid Ph-ase) and beta glucuronidase (BGU) between the granule, cytosol-soluble and post-granule fractions in normal human granulocytes and in granulocytes of chronic granulocytic leukemia (CGL) was studied. CGL granulocytes were found to display relative RNAase activity 1.2 times higher, relative acid Ph-ase activity 2.5 times higher than normal granulocytes. The granule fraction of CGL granulocytes showed 1.4 times higher relative RNAase activity but 0.87 times lower acid Ph-ase activity and the same BGU activity as normal granulocytes. On the other hand, the supernatant soluble fraction of CGL granulocytes showed 4.4 times higher relative RNAase activity, 1.2 times higher relative acid Ph-ase activity and BGU 2.2 times higher than in cytosol soluble fraction of normal granulocytes. Thus, cytosol soluble fraction of CGL granulocytes show a relative activity of the lysosomal enzymes studied which is remarkably higher than in normal granulocytes. The percentage distribution of RNAase, acid Ph-ase and BGU showed that CGL granulocytes contain only 36% of total RNAase activity versus 46% of that in normal ones. On the other hand, CGL granulocytes in cytosol soluble fraction will contain 48% of total RNAase versus 29% of total RNAase in cytosol of normal granulocytes. The isoenzyme profiles of RNAase of granule fractions were similar in normal and CGL granulocytes, while the RNAase isoenzyme profiles of cytosol fractions were different for normal and CGL granulocytes, indicating that some essential part of CGL granulocyte cytosol RNAase differs from RNAase contained in granules and in cytosol of normal granulocytes.