2-year Period Research Articles

Increasing prevalence of bacteriocin carriage in a 6-year hospital cohort of E. faecium.

Vancomycin-resistant enterococci (VRE) are important pathogens in hospitalized patients; however, the factors involved in VRE colonization of hospitalized patients are not well characterized. Bacteriocins provide a competitive advantage to enterococci in experimental models of colonization, but little is known about bacteriocin content in samples derived from humans and even less is known about their dynamics in the clinical setting. To identify bacteriocins which may be relevant in the transmission of VRE, we present a systematic analysis of bacteriocin content in the genomes of 2,248 patient-derived E. faecium isolates collected over a 6-year period from a single hospital system. We used computational methods to broadly search for bacteriocin structural genes and a functional assay to look for phenotypes consistent with bacteriocin expression. We identified homology to 15 different bacteriocins, with 2 having a high presence in this clinical cohort. Bacteriocin 43 (bac43) was found in a total of 58% of isolates, increasing from 8% to 91% presence over the 6-year collection period. There was little genetic variation in the bac43 structural or immunity genes across isolates. The enterocin A structural gene was found in 98% of isolates, but only 0.3% of isolates had an intact enterocin A gene cluster and displayed a bacteriocin-producing phenotype. This study presents a wide survey of bacteriocins from hospital isolates and identified bac43 as highly conserved, increasing in prevalence, and phenotypically functional. This makes bac43 an interesting target for future investigation for a potential role in E. faecium transmission.IMPORTANCEWhile enterococci are a normal inhabitant of the human gut, vancomycin-resistant E. faecalis and E. faecium are urgent public health threats responsible for hospital-associated infections. Bacteriocins are ribosomally synthesized antimicrobial proteins and are commonly used by bacteria to provide a competitive advantage in polymicrobial environments. Bacteriocins have the potential to be used by E. faecium to invade and dominate the human gut leading to a greater propensity for transmission. In this work, we explore bacteriocin content in a defined clinically derived population of E. faecium using both genetic and phenotypic studies. We show that one highly active bacteriocin is increasing in prevalence over time and demonstrates great potential relevance to E. faecium transmission.

Menvironmental impacts of crop production systems in subtropical plateau regions: case study of Yunnan, China

Excessive fertilisation, improper nutrient management, and specific climatic factors are the main reasons for the high environmental risks associated with agricultural production in subtropical plateau regions. However, quantitative data of environmental impacts and emission reduction potential remain unclear. The development potential of such systems is likely to be significant. In that context, we conducted a case study in Yunnan Province, China, to quantify the environmental impact of crop production from 2002 to 2021. A life cycle assessment method was employed to identify the factors driving environmental impacts, and potential mitigation strategies were proposed. The yield and total nutrient input of grain crops in Yunnan Province increased over the 20-year period, and the environmental footprint of crop production in Yunnan Province was higher than that in other regions. The average annual mean greenhouse gas (GHG) emissions, soil acidification potential (AP), and water eutrophication potential (EP) of crop production from 2002 to 2021 were 837 kg CO2-eq·Mg−1, 15.7 kg SO2-eq·Mg−1, and 2.71 kg PO4-eq Mg−1, respectively. Environmental emissions from crops mainly originate from the application of agricultural inputs (including fertilisers (N, P, and K), pesticides, seed, diesel fuels, and plastic film) during the crop life cycle. There was a significant correlation between surplus nitrogen and environmental impacts. Scenario testing showed that optimised nutrient management practices could increase crop yield and reduce environmental costs. GHG emissions, AP, and EP from the production of rice, wheat, and maize are expected to decrease by 43.0–59.5%, 51.5–64.5%, and 57.4–71.5%, respectively (scenario 4, S4). Based on these findings, we propose that com-prehensive agricultural management measures can reduce the negative impacts of crop production on the environment in subtropical plateau areas and help achieve sustainable agricultural development.

Physiologic specialization of Puccinia triticina, the causal agent of wheat leaf rust, in Canada in 2020–2023

Wheat nurseries and fields throughout Canada were surveyed annually, from 2020 to 2023, for the presence of leaf rust, caused by Puccinia triticina Erikss. Infected leaves were collected, then single pustule isolates were analyzed for virulence on a set of 16 differential lines. In 2020 there were 29 unique virulence phenotypes found among 230 isolates, in 2021 there were 37 unique virulence phenotypes found from 153 isolates, in 2022, 47 unique phenotypes were found among 246 isolates, and there were 69 unique phenotypes among 384 isolates in 2023. The most common virulence phenotypes over this 4-year period from Manitoba and Saskatchewan were MNPS, TNBJ, MBDS and MLPS. In Ontario these were TCTS, MBTN and TBRD, while in Quebec these were MBTN, TCTS, MBPS and TBSJ. The smaller samples from Ontario and Quebec were more diverse than the larger samples from Manitoba and Saskatchewan. There were only 25 isolates analyzed from British Columbia, but four of the five unique virulence phenotypes found there, LBDS, LCDS, CCPN and NBDS, were not found in the rest of Canada during this period. Only eight isolates from Alberta were analyzed and they were similar to virulence phenotypes found in Manitoba and Saskatchewan. The frequencies of virulence to Lr9, Lr24 and Lr21 were higher in Manitoba and Saskatchewan than in Ontario and Quebec, though the reverse was true for Lr2a, Lr2c and Lr18. When representative isolates were tested on additional differential lines there was no virulence detected to Lr19, Lr29, Lr32, Lr52 and Lr22a.

Risk of hypertension in patients with multiple sclerosis treated with teriflunomide compared to dimethyl fumarate: A nationwide cohort study in Denmark.

Teriflunomide has been associated with an increased risk of hypertension. Real-world studies including adequate control groups are lacking. We hypothesized that patients with multiple sclerosis (MS) treated with teriflunomide would be at higher risk of developing hypertension than those treated with dimethyl fumarate. We conducted a cohort study linking the Danish Multiple Sclerosis Registry with national health registries during a 10-year period. Teriflunomide (N = 2656) and dimethyl fumarate (N = 2237) exposure was defined by the first treatment record lasting ⩾ 3 months, at which time follow-up started. We included 4893 adult patients without hypertension at baseline. Hypertension was defined as an International Classification of Diseases 10th Revision code for hypertension and by dispensed prescription drugs identified by the respective Anatomical Therapeutic Chemical codes. We used multivariable-adjusted Cox regression. We found 40.6 (teriflunomide) and 13.1 (dimethyl fumarate) hypertension events per 1000 person-years. Compared to dimethyl fumarate-treated patients, patients treated with teriflunomide had a higher risk of developing hypertension (adjusted hazard ratio = 2.80; 95% confidence interval = 2.19-3.56). The number needed to harm was 16 and 9 at 3 and 5 years of follow-up, respectively. We found an increased risk of hypertension in adult patients with MS treated with teriflunomide.

The Distribution and Therapeutic Effectiveness of Clinical Unilateral Ménière's Disease Phenotypes.

The first purpose of this study was to ascertain the distribution of unilateral Ménière's disease (MD) clinical subgroups in China and compare with the population reported in Europe and the United States. The second purpose was to investigate the effectiveness in different clinical phenotypes. Participants were categorised into one of five subtypes using a previously reported classification scheme based on cluster analysis. The distribution and clinical characteristics were analysed and compared with the two cohorts reported in Europe and the United States. Participants were followed up to observe the therapeutic effectiveness over a 2-year period. A total of 245 patients diagnosed with UMD were enrolled in the study, with 84 of these participants providing complete and detailed follow-up data. All of the unilateral MD patients were accurately classified: 58.0% were classic MD, 25.7% were delayed MD, 1.2% was familial MD, 12.7% were sporadic MD with migraine and 2.4% were autoimmune MD. Our findings revealed a significant difference in the distribution between this cohort and the European cohort. Follow-up assessments revealed worse vertigo control rate in the patients with migraine compared to the classical MD (50.0% vs. 82.6%, p = 0.034). The distribution of unilateral MD subtypes in this Chinese population differs from that in the European population, and the therapeutic effectiveness varies across subtypes in this cohort. Our study highlights the importance of the clinical heterogeneity in unilateral MD, and further studies are needed to identify the optimal interventions for specific subgroups.

Challenges in management of abnormal thyroid function tests in unwell infants: A tertiary centre real-world experience.

Abnormal thyroid function tests (TFTs) are found in a wide range of settings in hospitalised infants. This retrospective descriptive study reviewed management decisions and outcomes of these infants, identifying factors influencing clinicians' decision to treat with thyroxine. Data were collected for all infants referred to the on-call endocrinology service at a tertiary Australian centre for thyroid dysfunction between 1 July 2019 and 30 June 2021. Electronic medical records were reviewed for birth and neonatal factors, TFTs, relevant investigations, treatment and disposition. Of 124 infants referred to the service over a 2-year period, 43% (52 out of 120) were premature, with a high rate of comorbidities, including jaundice, hypoglycaemia, respiratory distress and cardiac anomalies. About 57% (69 out of 121) of referrals to the service were from neonatal intensive care units. Investigations to evaluate hypothyroidism included nuclear thyroid scans in 40% (46 out of 114) and ultrasound in 37% (41 out of 112). Levothyroxine treatment was initiated in 66% (77 out of 117) of infants, with 63% (73 out of 117) assigned a presumptive diagnosis of transient congenital hypothyroidism. At the end of the study period, 70% (54 out of 77) remained on thyroid replacement. Our study demonstrates the challenge clinicians face when deciding whether to treat premature and medically unwell infants with abnormal TFTs. Further prospective studies are required to determine predictors of permanent CH in this complex population.

Obesity Impacts the Likelihood of Symptom Resolution in Patients with Esophagogastric Junction Outflow Obstruction.

Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterised by an elevated integrated relaxation pressure (IRP) with preserved peristalsis. Most functional EGJOO symptoms are self-limiting. This study aimed to evaluate the risk factors associated with non-resolution of symptoms for functional EGJOO. A retrospective single institution cohort study was performed on patients diagnosed with functional EGJOO on high-resolution manometry (HRM). Clinical, demographic, endoscopic and imaging parameters were recorded. Univariate and multivariate analyses were performed to identify factors associated with reduced likelihood of symptom resolution. Time to symptom resolution was then plotted on a Kaplan-Meier survival analysis. Over a 5-year period, 53 patients (41.5% male, 58.5% female) were diagnosed with functional EGJOO. The median age, body mass index and IRP at 4s were 47.0years (interquartile range (IQR): 36.0-58.0), 23.3kg/m2 (IQR: 20.9-26.5) and 39.9mmHg (IQR: 28.6-52.3) respectively. Dysphagia and atypical chest pain accounted for 36.5% and 21.2% of symptoms respectively. On the univariate analysis, obesity (p = 0.002), heartburn (p = 0.098) and lack of epigastric pain (p = 0.090) were potentially correlated with failure of symptom resolution. In the multivariate analysis, only obesity (OR 0.11, 95% CI: 0.02-0.77; p = 0.026) was significantly associated with reduced likelihood of symptom resolution for EGJOO. On the survival analysis, 87.2% of non-obese patients, in contrast 37.5% of obese patients reported symptom resolution at up to 41-month follow-up period (p = 0.039). Patients with obesity are at an increased likelihood of having persistent symptoms. This association appeared to persist for patients with both manometric and clinically relevant EGJOO.

Equity-Focused Interventions Improve Interpreter Use in the Pediatric Intensive Care Unit.

Federal guidelines and equitable care mandate that patients who use a language other than English receive interpretation in their preferred language. Substantial variability exists in interpreter use in intensive care settings. We aimed to increase the rate of interpretations in our pediatric intensive care unit (PICU) through a series of targeted interventions. A multidisciplinary team developed a key driver diagram to identify areas for focused intervention. Each plan-do-study-act cycle informed the next cycle of interventions, targeting increasing interpreter (video, phone, and in-person) use. Interventions included standardizing technology, standardizing placement of interpretation devices in patient rooms, provider education, and creating accountability systems of interpreter use by care providers. We reviewed data from PICU encounters between January 2018 and January 2022 and used summary statistics and statistical process control methods to measure the impact of our interventions. We analyzed 882 patient encounters over the 4-year study period. Demographic characteristics were similar in the preintervention and postintervention periods. The total interpretation rate increased to 2.7 interpretations per patient per day from a baseline rate of 1.4. Each individual interpretation modality demonstrated increases in use. Average time spent interpreting via phone increased from 8 to 10.5 minutes per patient per day, and average time spent interpreting via video went from 9.5 to 22 minutes per patient per day. Iterative quality improvement methodology effectively identified barriers to equitable care, guided development of focused interventions, and improved interpreter use among pediatric patients who were critically ill.

Secondary nummular headache: Are they more common thanwe thought?

To provide a detailed description of symptomatic nummular headache (NH) and to compare them with primary cases in a large series. While most published cases of NH are primary headache, some 'secondary' cases have been reported since its initial description. It remains uncertain why identical clinical presentations can result from primary and 'secondary' etiologies. Thanks to the possibility of offering specific treatments for symptomatic NH, it is crucial to be able to distinguish between them effectively. This monocentric retrospective study included a cohort of patients diagnosed with NH according to the International Classification of Headache Disorders, Second (ICHD-2) and Third Editions (ICHD-3), and the Pareja etal. first description, over a 20-year period (2002 to 2022). Established ICHD-3 diagnoses were used for each symptomatic case. Causality was attributed if (i) headache had developed in close temporal relation to other symptoms and/or clinical signs, or had led to its diagnosis, and (ii) either the headache had significantly worsened in parallel with other symptoms or clinical or radiological signs of worsening of the underlying disease, or the headache had resolved after treatment of the presumed causative disorder. Symptomatic NH were divided into two groups: "definite" or "probable." A comparison between the "primary" and "secondary" groups is presented. A total of 131 patients (88, 67.2% females) were included in the study. The median (interquartile range) age at onset of symptoms was 52 (36-63.2) years. In all, 34 patients (25.9%) were diagnosed as symptomatic NH (nine post-traumatic, seven attributed to a disorder of the cranial bones, six due to intracranial neoplasia, five attributed to arachnoid cysts, three attributed to vascular malformations, two due to cutaneous disturbances, and two attributed to hypertension). Eight patients were classified as "definite symptomatic NH" and 26 as "probable symptomatic NH." Neuroimaging was performed in all cases. Any previous headache (52.9% vs. 29.9%; p = 0.016), a remote head trauma (26.5% vs. 9.3%; p = 0.015), and a longer disease duration (18 vs. 12 months; p = 0.036) were more likely in patients with symptomatic NH. Preventive treatment was more effective (achieved >50% reduction in monthly headache days) in patients with symptomatic NH (72.2% vs. 30.3%; p = 0.002) due to a cause-specific treatment. Symptomatic NH are frequent. The presence of any previous headache or remote head trauma may suggest a diagnosis of symptomatic NH; however, as certain NH might be an early symptom of intracranial mass lesions, neuroimaging is necessary. Finding the cause of NH is essential to offer the most effective targeted treatment.

Surgical and Oncologic Outcomes of Primary Tumor Resection in Patients with Small Intestinal Neuroendocrine Tumors: Results from a Single-Center Series Over a 15-Year Period.

The role of prophylactic primary tumor resection (PTR) in patients with small intestinal neuroendocrine tumors (SI-NETs) and unresectable liver metastases is a matter of debate. We aimed to evaluate outcomes in patients with SI-NETs who underwent PTR, according to the presence of metastasis and symptoms from primary. Data from patients who underwent PTR for SI-NETs from a single referral center (2007-2023) were prospectively collected. Patients were divided into three groups: non-metastatic (M0) and metastatic with primary tumor-related symptoms (MS) or metastatic asymptomatic (MA). Kaplan-Meier curves for overall survival (OS) and event-free survival (EFS) were generated and compared by group. Univariate and multivariable Cox regression analyses were performed to assess the significance of risk factors. Of 147 patients, 53 were M0, 23 were MS, and 71 were MA. Median follow-up was 26 months. The 5- and 10-year OS estimates were 100% and 100% in M0 patients, 82 and 21% in MS patients, and 89 and 80% in MA patients, respectively (p<0.001). Median EFS was 91 months overall and 43,126 months and not reached for the MS, MA, and M0 groups, respectively (p<0.001). In multivariable analysis, MS (hazard ratio [HR] 3.92, 95% confidence interval [CI] 1.71-9.52), functioning tumors (HR 1.98, 95% CI 1.03-3.81), and G2 grade (HR 3.20, 95% CI 1.64-6.85) were associated with a shorter EFS. In this large retrospective series, the MS group had a significantly worse OS and EFS compared with M0 and MA. This finding suggests that prophylactic PTR might benefit SI-NET patients with unresectable liver metastases, as symptom development could impair long-term prognosis after surgery.

Assessing climate-driven glacial retreat, snow-cover reduction and GLOF risks: implications for water resource management amid rising global temperatures and CO2

Context The consequences of climate change, including alterations in snow and glacier patterns and rising temperatures, pose a risk of glacial lake outburst floods (GLOFs), which can have cross-border impacts, leading to the loss of life and property downstream. Aims This research focused on the assessment of changes in snow cover within Chitral district imposed by temperature increase. Methods ArcGIS and Origin programs were used in this research to study the glacier pattern of Chitral. Results Therer was a significant increase of 266.7% in urban development and an expansion of 135.9 km2 in agricultural areas within this remote mountainous region. The findings of the study show that in the year 2000, &gt;51.6% of Chitral district’s total land was covered by snow during early winter. However, this coverage drastically declined to ~6.8% by 2008. Across the initial two 4-year periods, ~44.7% (5694.6 km2) of the glaciated area transitioned to barren rock, whereas the overall reduction in snow-covered areas accounted for ~43.3% (5514.6 km2). Conclusion Owing to the increasing stress on freshwater resources, it is essential to conduct thorough analyses and monitoring of snow patterns to ensure sustainable freshwater availability and effective environmental risk management. Implications This study emphasises the critical consequences of climate-driven glacial retreat, waning snow cover and increased risks of glacial lake outburst floods (GLOFs) for the management of water resources with the rise in global CO2 and temperatures levels. These changes threaten the timing and availability of water supply, with impacts on agriculture, ecosystem and hydropower. Effective adaptation measures and sustainable management practices are crucial to alleviate these risks and ensure water security in a warming world.

Pregnancy and Pregnancy Outcomes in a National Population Cohort of Patients Treated for Substance Use Disorders.

The objectives of this study were to i) provide population-level prevalence rates of pregnancy, birth, elective termination, and miscarriage among females treated for SUDs and their demographic counterparts and ii) examine associations between SUD treatment and pregnancy and elective terminations. Data were analyzed from a prospective registry-linkage study of all females (15-45 years) recorded as treated for SUDs in the Norwegian Patient Registry over a 2-year period (n = 6470) and a non-treated frequency-matched cohort of females from the general population (n = 6286). Pregnancy and pregnancy outcomes over a 4-year follow-up were retrieved from the Norwegian Patient Registry. Multivariable logistic regression models tested for associations of SUD treatment with pregnancy and with elective termination among pregnant females. Annual pregnancy and elective termination rates per 1000 females were significantly higher for the SUD cohort than the non-treated cohort (94.2 vs 71.3 for pregnancy, P < 0.001; 54.7 vs 17.8 for elective termination, P < 0.001), the annual birth rate was lower for the SUD cohort (25.3 vs 41.8, P < 0.001), and the rate of miscarriage did not differ across cohorts. Multivariable analysis showed that SUD treatment was associated with a significant increase in the odds of pregnancy (adjusted Odds Ratio 1.34, Confidence Interval [1.18-1.54]) and the odds of an elective termination, conditional on pregnancy (aOR 2.55, Confidence Interval [1.97-3.29]). Females treated for SUDs had substantially higher odds of pregnancy and elective terminations than the non-treated cohort. To improve their reproductive health, targeted interventions such as free long-acting contraception and integration of family planning guidance into substance use treatment should be considered.

Choroidal Response to Intravitreal Bevacizumab Injections in Treatment-Naïve Macular Neovascularization Secondary to Chronic Central Serous Chorioretinopathy

Background/Objectives: To evaluate the impact of intravitreal bevacizumab (IVB) therapy on anatomical and visual outcomes in patients with macular neovascularization (MNV) secondary to chronic central serous chorioretinopathy (cCSC). Methods: This retrospective observational study reviewed the medical records of treatment-naïve patients diagnosed with cCSC complicated by MNV and treated with IVB injections over a 5-year period. The presence of MNV was confirmed using optical coherence tomography angiography (OCTA). Best-corrected visual acuity (BCVA), subfoveal choroidal thickness (SFCT), and subretinal fluid (SRF) were recorded pre- and post-IVB treatment. Results: Twenty-two eyes of 22 patients (mean age, 68 ± 11 years) were included. After a mean follow-up of 21.0 ± 14.6 months, SRF significantly decreased from baseline (176.86 ± 115.62 µm) to the final follow-up (80.95 ± 87.32 µm, p = 0.003). A greater SRF reduction was associated with more injections (&gt;7) (p = 0.047). However, no significant changes were observed in BCVA (p &gt; 0.05) or SFCT (p &gt; 0.05), irrespective of follow-up duration or injection frequency. Complete resolution of SRF was achieved in nine patients (40.9%), and a significantly greater reduction in SFCT was observed in complete responders compared to non-responders (p = 0.03). Conclusions: IVB therapy significantly reduced SRF in cCSC patients with secondary MNV, though it did not lead to visual improvement or significant changes in SFCT. However, greater choroidal thinning in patients with complete fluid resorption may suggest distinct underlying mechanisms or alternative sources of subretinal fluid beyond the MNV itself.

The impact of a dedicated checklist on the quality of onsite management of critically buried avalanche victims in cardiac arrest in a Swiss helicopter emergency medical service

BackgroundThe management of avalanche victims in cardiac arrest (CA) is a challenging situation for rescuers. Despite existing specific management algorithms, previous studies have reported poor compliance with international guidelines and incomplete documentation and transmission of the information required for patient management. The Avalanche Victim Resuscitation Checklist (AVRC) was developed in 2014 in response by the International Commission for Mountain Emergency Medicine. Our aim was to assess the impact of the AVRC on the quality of onsite management of critically buried avalanche victims in CA, i.e. the compliance of management with international guidelines and the completeness of documentation of avalanche specific information.MethodsWe assessed compliance and documentation in a Swiss helicopter emergency medical service (HEMS) between January 2010 and April 2020. Victims buried for more than 24 h were excluded.ResultsIn the 10-year study period, 87 critically buried avalanche victims in CA were treated by the HEMS, 44 of them after the introduction of the AVRC. Enough information was available to assess management compliance in over 90% of cases (n = 79). Inadequate management (n = 25, 32%) and incomplete documentation occurred more often in patients with a long burial duration. After the introduction of the AVRC, the compliance of patient management with the guidelines increased by 36% (from 59 to 95%, p < 0.05) and led to complete documentation of the required information for patient management.ConclusionsThe use of the AVRC improves the quality of management of critically buried avalanche victims in CA and ensures complete documentation of avalanche specific information. Quality improvement efforts should focus on the management of avalanche victims with a long burial duration. The use of the AVRC enables identification and appropriate treatment of patients with hypothermic cardiac arrest.

Primary Intraosseous Solitary Fibrous Tumor of the Mandible: Report of a Diagnostically Challenging Case with NAB2::STAT6 Fusion and Review of the Literature.

Solitary fibrous tumor (SFT) represents an uncommon mesenchymal neoplasm affecting primarily the extremities and deep soft tissues with, overall, benign but locally aggressive biologic behavior and an underlying pathognomonic NAB2::STAT6 fusion. Intraosseous SFTs are infrequent, and involvement of the jawbones is exceedingly rare. A 54-year-old woman presented with an asymptomatic, well-demarcated, multilocular radiolucency of the left posterior mandible featuring focally irregular borders, root resorption and lingual cortex perforation. The lesion had shown progressive growth over a 6-year period. Microscopically, a proliferation of predominantly ovoid and spindle-shaped cells with indistinct cell membrane borders, elongated, plump or tapered, hyperchromatic nuclei, and lightly eosinophilic cytoplasm was noted. Marked cytologic atypia, pleomorphism and mitoses were absent. A secondary population of epithelioid cells exhibiting ovoid or elongated vesicular nuclei, and abundant, pale eosinophilic or vacuolated cytoplasm was also present. The supporting stroma was densely fibrous with areas of marked hyalinization and variably-sized, ramifying, thin-walled vessels. By immunohistochemistry, lesional cells were strongly and diffusely positive for STAT6 and CD99, and focally immunoreactive for MDM2 and SATB2. Ki-67 was expressed in less than 5% of lesional cells, while most interspersed epithelioid cells were positive for the histiocyte marker, CD163. Molecular analysis disclosed a NAB2::STAT6 fusion confirming the diagnosis of SFT. The patient underwent segmental mandibulectomy. Herein, we report the first case of primary intraosseous SFT of the mandible with complete documentation of its characteristic immunohistochemical and molecular features. Diagnosis of such unusual presentations may be further complicated by the challenging histomorphologic diversity of SFT.

Результаты эпидемиологического мониторинга заболеваемости, смертности, распространенности злокачественных новообразований на основе действующего государственного ракового регистра.

Today, the cancer registry is an information and analytical system for collecting, storing and analyzing information about malignant neoplasms throughout the Russian Federation, as well as about the state of specialized oncological care. The value of the cancer registry is that its information can and should be analyzed: the registry allows for a statistical assessment of the disease, to see differences in morbidity, including depending on the region. Purpose of the study is to analyze the morbidity, mortality and prevalence of malignant neoplasms in the Russian Federation for the period 2012–2022. Materials and methods. Calculation and analysis of indicators were carried out in accordance with the recommendations of the International Agency for Research on Cancer for calculating indicators. The calculation of indicators was carried out with a 95% confidence interval. To calculate standardized morbidity and mortality rates, the world standard for the age distribution of the population was used. The calculation of the increase/decrease of indicators over a 10-year period was carried out with preliminary alignment of the time series. Results. Indicators of morbidity, mortality and prevalence of malignant neoplasms in the Russian Federation for the period 2012–2022 were analyzed, general trends in changes in indicators were determined for all cancers and several of the most common localizations that make the greatest contribution to the morbidity and mortality from cancer, the male and female population of the Russian Federation. Findings. Based on the results obtained, it is necessary to expand the implementation of the developed screening measures and strengthen control over existing programs for the early detection of cancer.

Outcomes for older patients with subarachnoid haemorrhage who require admission to an Australian intensive care unit.

Advanced age is an independent risk factor for poor outcomes following aneurysmal subarachnoid haemorrhage (SAH). However, Australian data are lacking. Our aim was to evaluate outcomes for older patients admitted to an Australian intensive care unit for management of aneurysmal SAH. We conducted a single centre retrospective observational study looking at adult patients admitted with aneurysmal SAH to an Intensive Care Unit (ICU) over a 10-year period. Patients were grouped by age; <70 years, 70-79 years, ⩾80 years, and were of sufficient complexity to be unsuitable for our neurosurgical high-dependency unit. The primary outcome was in-hospital mortality. Secondary outcomes were ICU and hospital length of stay, and discharge destination. Of 372 patients admitted to ICU with aneurysmal SAH, 302 (82%) were younger (<70 years), 46 (12%) were septuagenarians and 24 (6%) were octogenarians. There were no differences between clinical or radiological grade of aneurysmal SAH between age cohorts. When compared to the patients younger than 70 years, there was increased odds of dying for those 70-79 and ⩾80 years (70-79: OR 1.98, 95% CI 0.93, 4.20 p = 0.077; ⩾80: OR 4.01, 95% CI 1.55, 10.35 p = 0.004). There were no associations between age and duration of admission. Only 6% of patients aged ⩾70 years were discharged home alive. It was uncommon for patients over 70 years of age who present with a SAH to be discharged home from hospital, and those aged ⩾80 are four times more likely to die in hospital than younger patients.

Hindi-Urdu through COVID-19: A Three-year Account at UBC

As the impact of COVID 19 is waning and life is coming back to normal, many universities, after weighing the advantages and disadvantages of online teaching, have started experimenting with various teaching methods. A 3-year long period of COVID-impacted teaching has changed the way instruction of foreign language in general and of Hindi-Urdu in particular is delivered. From the initial haste in transitioning the remaining part of the academic year 2019-20 to online teaching, then through full online teaching of 2020-21 and on and off-online teaching in 2021-22, to the returning to normalcy in 2022-23, the three-year period has kept the teachers on their toes to be ready for any sudden changes and adjusting to the changes to the teaching modes. In this paper, I aim to provide a comprehensive overview of the 3-year period how the Hindi-Urdu language program at the University of British Columbia (UBC) adapted its teaching method in response to the evolving challenges posed by the COVID-19 pandemic.

Impact of alcohol use disorder on inpatient hospitalizations: A comparison of outcomes between urban and rural Veterans Affairs hospitals.

Alcohol use disorder (AUD) is a leading cause of morbidity and mortality that disproportionately affects rural residents and Veterans. To evaluate the burden of AUD in admissions at rural and urban hospitals within the Veterans Health Administration (VHA) comparing patient characteristics, clinical outcomes, and 1-, 3-, and 5-year mortality rates. Retrospective cross-sectional study of patients admitted to VHA hospitals from 2016 to 2020, with a primary or secondary diagnosis related to AUD. Follow-up mortality data was collected through September 30, 2023. From 2.9 million qualifying admissions, AUD-related diagnoses were present in 14.3% of admitted patients (427,375 admissions among 190,152 unique patients in 129 facilities). Rural hospitals (n = 22) had a significantly higher overall admission rate for AUD-related diagnoses (21.6% vs. 14.8%, p = .011), higher 30-day readmission rates (17.8% vs. 15.3%, p < .001), but lower hospital-level average length of stay (median = 4.3 vs. 5.6, p < .001). Mortality in rural hospitals was lower than urban at 1 year (9.6% vs. 11.4%, p < .001), 3 years (20.7% vs. 23.1%, p < .001), and 5 years (30.4% vs. 32.9%, p < .001). Rural VHA hospitals have a higher proportion of patients admitted with AUD-related diagnoses and higher readmission rates, but lower mortality rates. Approximately, one in three patients admitted with an AUD-related diagnosis died within the 5-year follow-up period. The mortality rates observed are extraordinary and deserve urgent attention. A comprehensive plan to address AUD in the Veteran population, including how we approach and engage patients in treatment during hospitalizations with any primary or secondary AUD diagnoses, is needed.

Prevalence and Incidence of Peutz-Jeghers Syndrome and Juvenile Polyposis Syndrome in Japan: A Nationwide Epidemiological Survey in 2022.

Peutz-Jeghers syndrome (PJS) and juvenile polyposis syndrome (JPS) are autosomal dominant diseases associated with high cancer risk. In Japan, knowledge about the prevalence and incidence of PJS and JPS is lacking despite being crucial for providing appropriate medical support. We aimed to determine the prevalence and incidence of these diseases. In 2022, a nationwide questionnaire survey was conducted to determine the number of patients with PJS or JPS by sex and the number of newly confirmed cases from 2019 to 2021. The target facilities included gastroenterology, pediatrics, and pediatric surgery departments, which were stratified into seven classes on the basis of the total number of beds. We randomly selected target facilities using different extraction rates in each class, resulting in 1748/2912 facilities (extraction rate: 60%) as the final sample. We calculated the estimated number of patients using the response and extraction rates. A total of 1077 facilities responded to the survey. The estimated numbers of patients with PJS and JPS were 701 (95% confidence interval [CI]: 581-820) and 188 (95% CI: 147-230), respectively. The 3-year period prevalences of PJS and JPS were 0.6/100000 and 0.15/100000, whereas the incidences in 2021 were 0.07/100000 and 0.02/100000, respectively. Male patients constituted 53.5% and 59.6% in the PJS and JPS groups, respectively. We determined the prevalence and incidence of PJS and JPS in Japan for the first time. Further research is needed to obtain more detailed information, including the clinical differences and outcomes in Japan.