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Abstract: This paper deals with the following fractional $(p,q)$-Choquard equation with exponential growth of the form: $\varepsilon^{p s} (-\Delta)^{s}_{p} u + \varepsilon^{q s} (-\Delta)^{s}_{q} u + Z(x) ( |u|^{p-2} u + |u|^{q-2} u)$ $=\varepsilon^{\mu - N} [ |x|^{-\mu} * F(u) ] f(u)$ in $\mathbb{R}^N,$ where $s \in (0,1)$, $\varepsilon > 0$ is a parameter, $2 \leq p = \frac{N}{s} < q$, and $0 < \mu < N$. The nonlinear function $f$ has exponential growth at infinity, and the continuous potential function $Z$ satisfies suitable natural conditions. Using Ljusternik–Schnirelmann category theory and variational methods, the multiplicity and concentration of positive solutions are obtained for $\varepsilon > 0$ small enough. In a certain sense, we generalize some previously known results.
Keywords: fractional double phase operator, critical exponential growth, mountain pass theorem, Trudinger–Moser inequality, variational method
Published in DiRROS: 09.03.2026; Views: 61; Downloads: 29
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Abstract: The distinctive effects of maintaining the upper- (0–2) versus lower-normal (−2–0) range of IGF-1 SDS in adult growth hormone deficiency (AGHD) remain understudied. We conducted a cross-sectional study on 31 patients with AGHD receiving growth hormone replacement therapy (GHRT) with daily GH for >5 years, with a 2-year mean IGF-1 SDS ranging between −2 and +2. Patients were categorized into the upper- or lower-normal range IGF-1 SDS groups according to their 2-year mean. Associations of clinical characteristics, anthropometric parameters, laboratory tests, and vascular markers of subclinical atherosclerosis with the 2-year IGF-1 SDS range and 5-year mean IGF-1 SDS were explored. Long-term maintenance of upper-normal IGF-1 SDSs was more common in men and in patients with a longer duration of GHRT. Patients with tumor-related AGHD had a lower 5-year mean IGF-1 SDS. Long-term maintenance of IGF-1 SDS in the upper-normal range was associated with lower high-sensitivity C-reactive protein (hs-CRP) levels (median (25–75% range): 0.8 (0.6–1.1) vs. 1.8 (0.8–4.6); p = 0.005). Moreover, a negative correlation was identified between a hs-CRP and the 5-year mean IGF-1 SDS. The association between the upper-normal IGF-1 SDS range and lower body fat percentage lost significance after adjusting for sex, due to the higher proportion of male patients in the upper-normal IGF-1 SDS group. In conclusion, long-term maintenance of upper-normal IGF-1 SDSs was associated with male sex and reduced low-grade inflammation. Randomized controlled studies are needed to evaluate the long-term and sex-specific effects of targeting the upper- vs. lower-normal IGF-1 range in AGHD.
Keywords: adult growth hormone deficiency, growth hormone replacement therapy, IGF-1 range
Published in DiRROS: 26.02.2026; Views: 163; Downloads: 55
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Abstract: Introduction: Maternal abdominal decompression during pregnancy could be used in an attempt to improve utero-placental blood flow. We utilized Doppler ultrasonography to investigate the effects of this procedure on blood flow in the umbilical artery and fetal middle cerebral artery. Methods: Women (n = 23) with singleton pregnancies attending antenatal abdominal decompression were enrolled in the study. Doppler velocity waveforms were obtained from umbilical artery and fetal middle cerebral artery before and after a 30-minute decompression session. Resistance indices were compared using the Student's t - test (p < 0.05 significant). Results: 23 healthy pregnant women were included at an average gestational age of 36+1 weeks. The mean resistance index before decompression in the umbilical artery was 0.58 (s = 0.10) and after decompression 0.54 (s = 0.07, p = 0.06). In the middle cerebral artery the values were 0.72 (s = 0.11) and 0.77 (s = 0.08), respectively (p = 0.01). Discussion and conclusion: Significantly increased resistance index in the middle cerebral artery implies a higher fetal brain oxygenation after decompression. This is further corroborated by the trend towards a decrease in umbilical artery resistance index. The effects of decompression could be beneficial in pregnancies complicated by IUGR or hypertensive disorders of pregnancy.
Keywords: Doppler ultrasound, resistance index, fetus, intrauterine growth restriction
Published in DiRROS: 28.01.2026; Views: 157; Downloads: 53
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Abstract: Aims: To assess the prevalence of endocrine/metabolic disorders among pediatric Duchenne muscular dystrophy (DMD) patients and identify individuals who would benefit from the new corticosteroid treatment available, vamorolone. Methods: A national pediatric cohort of DMD patients followed at University Children’s Hospital, University Medical Center Ljubljana in June 2025 was included in the study. The presence of endocrine/metabolic disorders was determined by clinical examination, laboratory data, and imaging at the last annual multidisciplinary evaluation. Results: A total of 21 patients (average age 11.1, range 4.6-16.7 yrs) were included in the study. Two patients were corticosteroid-naive, the rest treated with deflazacort (average treatment duration 5.4, range 1.1-11.3 yrs). At the time of final follow-up, 90% were diagnosed with an endocrine and/or metabolic disorder. Short stature was present in 67% of patients, a decline in height standard deviation score (SDS) since the initiation of corticosteroid therapy was observed, -2.37 SDS on average. Based on body composition data (fat % SDS), 57% were classified as obese. Lipid abnormalities were detected in 76% of patients. Insulin resistance (determined by HOMA-IR) was increased in 9.5% of patients; type 2 diabetes was not detected. Conclusion: Our findings demonstrate a high prevalence of endocrine and metabolic disturbances among patients with DMD. In light of emerging evidence on the potential benefits of vamorolone - particularly regarding bone health and growth - we identified a subgroup of patients most likely to benefit from its use. We propose that ambulatory, non-corticosteroid naive patients with pathological fractures, markedly reduced bone density, short stature, or significant growth deceleration could be considered for the therapeutic transition. Accordingly, we established national clinical criteria to guide individualized therapeutic transitions, aimed at optimizing clinical outcomes and ensuring efficient allocation of healthcare resources.
Keywords: Duchenne muscular dystrophy, corticosteroid treatment, vamorolone, bone health, linear growth
Published in DiRROS: 05.01.2026; Views: 251; Downloads: 128
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Abstract: BACKGROUND: Classic bladder exstrophy (CBE) is a rare congenital condition affecting multiple organs, primarily the urinary and musculoskeletal systems. Management involves multiple reconstructive surgical procedures and aims to maintain renal function, achieve urinary continence, and support normal reproductive health. Pregnancies in women with CBE can be complicated by recurrent urinary tract infections, pelvic prolapse, and a higher risk of preterm birth. CASE REPORT: We report the case of a 33-year-old woman with a history of CBE, admitted at 32 weeks of pregnancy with fever and symptoms of a urinary tract infection. Her medical history included multiple surgeries, including formation of neovesica from the cecum with appendicovesicostomy to the abdominal wall. The pregnancy was complicated by recurrent urinary tract infections, anemia, gestational diabetes, and stage IV uterine prolapse. A multidisciplinary team managed her care, with imaging revealing altered abdominal anatomy and breech fetal presentation. At 37 weeks, due to concerns about fetal growth restriction, breech position, and potential prolapse exacerbation, an elective cesarean delivery with median relaparotomy and vertical uterine fundal incision was performed to avoid emergency intervention. Both the delivery and postpartum recovery were uneventful despite the complexity of the case. CONCLUSIONS: Managing pregnancy in patients with CBE requires close, multidisciplinary collaboration to address potential complications. Detailed delivery planning and vigilant monitoring are crucial to ensure maternal and fetal safety.
Keywords: bladder exstrophy, cesarean section, congenital abnormalities, fetal growth retardation, urinary tract infections
Published in DiRROS: 03.12.2025; Views: 413; Downloads: 149
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