Common Anatomic Location Research Articles

Pain and Discomfort Among Mohs Surgeons: An Ergonomic Model of Procedural Dermatologists

Background: Dermatologic surgeons are at risk for work-related injuries and chronic pain. Objectives: To investigate the prevalence and characteristics of pain and discomfort among fellowship trained Mohs surgeons across the United States Methods: A cross-sectional survey study was conducted of members of the American College of Mohs Surgery (ACMS).Participants reported the continuous variables of hours spent working, standing versus sitting while operating, typing to the electronic medical record, and exercising per week. Results: 107 male and female respondents participated. 88.7% of respondents reported chronic pain; the most common anatomic locations for pain were the neck (54.2%), upper back (38.2%), and lower back (33.6%). At these anatomic locations, male respondents less frequently complained of upper back pain (odds ratio (OR) 0.349, 95% confidence interval (CI) 0.155 to 0.787; P = 0.010) but more frequently complained of lower back pain (OR 2.462, 95% CI 1.606 to 13.320; P = 0.044), than female respondents. Respondents were significantly more likely to report regular pain-relieving medication use when suffering from pain at the neck (OR 4.665, 95% CI 1.450 to 15.007; P = 0.006) or upper back (OR 3.366, 95% CI 1.251 to 9.054; P = 0.013). Respondents regularly using sit-stand stools were less likely to report neck pain (OR 0.326, 95% CI 0.105 to 1.015; P = 0.046). Conclusions: Pain is prevalent among Mohs surgeons. Adopting and training in an ergonomically-friendly environment and incorporating an ergonomically aware mindset early in a surgeon’s career may decrease one’s risk for job-related injury and pain.

Elder Mistreatment Documentation by Prehospital Clinicians: An Analysis of the National Emergency Medical Services Information System Database

Objectives Elder mistreatment (EM), encompassing abuse and neglect, is a significant public health issue, affecting up to 10% of community-dwelling older adults annually. Elder mistreatment is a growing concern with a higher prevalence in institutional settings and substantial associated healthcare costs. Prehospital clinicians (PHCs) such as emergency medical technicians and paramedics are uniquely positioned to detect and report EM during their interactions with older adults in their homes. The objective of the study is to describe the rate and characteristics of EM documented by PHCs using the National Emergency Medical Services Information System (NEMSIS) database. Methods This study analyzed data from NEMSIS, which includes standardized information about PHC emergency response encounters across the United States. In 2018, 22,532,890 activations were included from 9,599 agencies in 43 states and US territories. Elder mistreatment was identified using specific International Classification of Diseases (ICD) codes related to EM. Demographic data, injury location, and associated physical findings were also examined. Results Out of 9,605,522 EMS encounters for patients aged ≥60, EM was coded in 1,765 encounters (0.02%). Most EM cases were listed as the cause of injury (64%), followed by the clinician’s first impression (25.4%). Physical abuse was the most common type of mistreatment reported (20.8%), followed by sexual abuse (18.2%), neglect (9.7%), and psychological/emotional abuse (0.34%). The median age of patients with documented EM was 72, and 62.3% were female. The most common anatomic locations of injuries were the lower extremities, head, and upper extremities. Conclusions Despite the high prevalence of EM, PHCs infrequently document EM in their encounters with older adults. Additional training and comprehensive protocols are needed to improve the identification and reporting of EM, mainly elder neglect. Empowering PHCs through education and protocol development can significantly impact the detection and intervention of EM.

Outcome of treatment with a 10-week COP protocol in cats with intermediate or large cell lymphoma: 27 cases (2014-2023).

The aim of this retrospective clinical study was to evaluate and report response to treatment with a 10-week maintenance-free COP (COP-10) protocol in a cohort of 27 cats with intermediate or large cell lymphoma. Additionally, to identify any potential prognostic factors for predicting the treatment response. The medical records of cats diagnosed with intermediate or large cell lymphoma in a single institution in the period 2014 to 2023 and treated with COP-10 as first-line treatment were reviewed. Twenty-seven cats were included in the study. The median age was 10 years, 67% of the cats were in stages I to II and the most common anatomical location was alimentary (37%). The overall response rate was 65%, with 38% of cats achieving complete remission and 27% partial remission. For cats achieving complete remission, the median progression-free interval and the median lymphoma-specific survival time were both 1,139 days. For cats in partial remission, the median progression-free interval and the median lymphoma-specific survival time were 53 and 210 days, respectively. Clinical stage was significantly related to treatment response and survival time. Treatment with the short protocol COP-10 resulted in remission rates and durable first remissions for cats achieving complete remission comparable to responses seen with longer-duration chemotherapy protocols. The results from this study may impact economic and logistic decisions for owners, as well as the quality of life for patients in the future.

Representation of Skin Color, Disease Severity, and Anatomic Location in Hidradenitis Suppurativa Images

Introduction: Hidradenitis suppurativa (HS) is an inflammatory dermatosis disproportionately affecting patients of color. We evaluated characteristics of HS images in dermatology online image resources and textbooks. Methods: Images of HS were collected in December 2021 from online and textbook sources. Data regarding anatomic region, Hurley stage, and Fitzpatrick skin tone (FST) were collected and analyzed. Results: 318 images remained after exclusion criteria. VisualDx contained the highest number of dark skin (FST V-VI) images (59%, 47/79), followed by Google (4%, 2/52) and DermNetNZ (4%, 4/100). In textbook sources, dark skin represented 25% (4/16) of images. Across sources, 47% (151/318) of images represented Hurley stage 2, followed by 32% (101/318) stage 3, and 21% (66/318) stage 1. The axilla (49%, 156/318) was the most common anatomic location featured, followed by the groin (18%, 58/318) and breast/chest (9%, 28/318). Involvement of non-classic locations was represented in 3% (8/318) of images. There was a positive correlation between higher Hurley stage and darker skin (r=0.26, p<0.05). Discussion/Conclusion: Overall there is underrepresentation of dark skin tones, “non-classic” anatomic locations, and mild HS which may lead to missed opportunities for patient education and dermatology training. Dermatologists should take the lead to improve image diversity across educational resources.

The use of hyperbaric oxygen for avascular necrosis of the femoral head and femoral condyle: a single centre's experience over 30 years.

Avascular necrosis (AVN) is a rare progressive degenerative disease leading to bone and joint destruction. Patients often require surgical intervention. Femoral AVN is the most common anatomical location. Hyperbaric oxygen treatment (HBOT) has been shown to be effective in AVN. We present data collected from one centre over a 30-year period and compare the results with other published data. A retrospective chart review of all patients receiving HBOT for AVN at Fremantle and Fiona Stanley Hospitals since 1989 was performed. The primary outcome was radiological appearance using the Steinberg score, with secondary outcomes being subjective improvement, the need for joint replacement surgery and rates of complications. Twenty-one joints in 14 patients (14 femoral heads and seven femoral condyles) were treated with HBOT since 1989. Two patients were excluded. Within the femoral head group, nine of the 14 joints (64%) had stable or improved magnetic resonance imaging (MRI) scans post treatment and at six months (minimum); 10 joints (71%) had good outcomes subjectively, three joints required surgical intervention, and three patients developed mild aural barotrauma. Within the femoral condyle group, all five joints had stable or improved post-treatment MRI scans (four had visible improvement in oedema and/or chondral stability), four joints reported good outcomes subjectively, none of the patients required surgical intervention (follow-up > six months). This single centre retrospective study observed prevention of disease progression in femoral AVN with the use of HBOT, comparable to other published studies. This adds to the body of evidence that HBOT may have a significant role in the treatment of femoral AVN.

The Role of Routine Pathologic Assessment After Pediatric Osteochondroma Excision.

Osteochondromas are benign osseous lesions often excised for pain, growth abnormalities, and aesthetic concerns. While characteristic clinical and radiographic features leave little diagnostic ambiguity in most cases of osteochondroma, pathologic analysis to confirm the diagnosis and screen for malignancy is routinely performed following surgical excision. The purpose of this study was to determine the clinical and economic value of routine pathologic analysis after osteochondroma excision in a pediatric population. A retrospective review of clinical records from 2 pediatric orthopaedic hospitals (St. Louis Children's Hospital and Shriner's Hospital for Children, St. Louis) identified 426 osteochondroma lesions surgically resected from 201 patients. Patients with solitary and multiple lesions were included. Clinical, radiographic, and surgical data were recorded for each resection surgery. Pathologic reports were evaluated. Costs incurred for routine pathologic assessment was also noted. Totally, 132 patients were treated with surgical resection of a solitary osteochondroma lesion, while an additional 291 lesions were resected from 69 patients with multiple lesions. Average age at the time of surgical resection was 13.0 years (2.1 to 17.9). The most common anatomic locations of excised lesions included the distal femur (110, 25.8%), proximal tibia/fibula (95, 22.3%), and distal radius/ulna (58, 13.6%). All resected specimens were sent for pathologic analysis. The average size of the resected lesions was 19.9 mm 3 (0.02 to 385.0mm 3 ). In all cases, the histologic diagnosis confirmed benign osteochondroma. The total charges of pathologic analysis including processing and interpretation fees was ∼$755.00 for each lesion assessed, for a total cohort charge of $321,630. We propose that in most cases of pediatric osteochondroma excision procedures, postoperative histologic analysis is not strictly indicated as it rarely, if ever, alters diagnosis or management. We suggest using a "gross only" analysis in these cases. However, we do believe that with preoperative diagnostic ambiguity, or if patients present with concerning features such as rapidly expansile lesions or cortical destruction, have axial skeleton or pelvic involvement, or enlarged cartilaginous caps, full histologic evaluation of the excised lesions will continue to be prudent. Level IV-case series.

Second opinion for pulmonary and pleural cytology is valuable for patient care

IntroductionThoracic cytology can be challenging due to limited procured material or overlapping morphology between benign and malignant entities. In such cases, expert consultation might be sought. This study aimed to characterize all pulmonary and pleural cytology consult cases submitted to our practice and provide recommendations on approaching difficult cases. Materials and MethodsAll thoracic (pulmonary and pleural) cytology cases submitted for expert consultation to the University of Michigan (MLabs) from 2013 to mid-2022 were reviewed. Cases where cytology was only part of a hematopathology or surgical pathology consult were excluded. Patient demographics, specimen location, procedure performed, referring diagnosis, and our diagnoses were recorded for each case. Diagnoses were categorized according to the Papanicolaou Society of Cytopathology recommendations for pulmonary and effusion cytology. Discordant diagnoses were stratified as major or minor. Data was analyzed using Chi-Square analysis and logistic models. ResultsWe received 784 thoracic cytology consult cases, including 530 exfoliative samples and 307 fine needle aspirations (FNAs). The most common anatomic locations sampled were the bronchial wall (n=194, 23%), lung nodule (n=322, 38%), and pleura (n=296, 35%). 413 cases had a diagnostic discrepancy (48.3%), with 274 (66%) minor and 139 (34%) major discrepancies. By location, pleural effusion specimens had the highest probability of a discrepant diagnosis (p=0.003). By specimen type, FNA samples were significantly more likely to have a discrepant diagnosis (p=0.06). ConclusionNearly half of the thoracic cytology cases submitted for expert second opinion had diagnostic discrepancies. Consequently, consulting a tertiary medical care center with cytopathology expertise for challenging thoracic cytology diagnoses is beneficial.

Pediatric patients with facial fractures: a retrospective study.

Epidemiology of maxillofacial injuries vary depending on geographic location, culture and socioeconomic condition. This study assessed etiology and pattern of facial fractures in children reported at Burdwan Dental College and Hospital, Burdwan, West Bengal, India. Clinical files of 206 children with facial fractures were evaluated retrospectively. Diagnosis of fractures were confirmed by radiographic examination. Study period was from July 2018 to June 2022. Data collected were age and sex of the patient, site of fracture, and etiology of trauma. Descriptive statistics were used for statistical analysis with a P-value less than 0.05. There were 127 (61.7%) males and 79 (38.3%) females with a male to female ratio of 1.6:1. Within the study sample, the majority of facial fractures (n= 146, 70.9%) belonged to 6-to-9-year age group. Overall, falls (44.2%) and motor vehicles accidents (31.5%) were the two leading causes of trauma. Mandible fracture was the most common, accounting for 72.8% of cases. 74 patients (35.9%) with facial fracture had dental injuries. Male predominance in facial fracture is seen. With age, frequency of facial fractures tends to increase. Falls are the main cause of facial fracture and mandible is the most common anatomic location.

Patellar osteochondritis dissecans:maturation-dependent patellofemoral joint characteristics.

The likelihood of healing of osteochondritis dissecans decreases with skeletal maturity and there are theories that abnormal biomechanical forces contribute to the development and progression of these lesions. To characterize, according to regional skeletal maturity, the morphology and alignment indices of the patellofemoral joint on MRI in patients with patellar osteochondritis dissecans. MRI examinations of patients with patellar osteochondritis dissecans obtained between January 2008 and May 2023 were retrospectively reviewed to determine regional skeletal maturity, osteochondritis dissecans lesion size and location, patellar and trochlear morphology (Wiberg/Dejour classifications), and to calculate trochlear sulcus angles, trochlear depth index, lateral trochlear inclination, Insall-Salvati index, Caton-Deschamps index, patellar tendon-lateral trochlear ridge, and tibial tubercle-trochlear groove distances. Values were compared between skeletally immature and mature groups. Sixty-eight children (22 girls, 46 boys, age: 14.0 ± 1.7 years) yielded 74 knees with patellar osteochondritis dissecans lesions, 14 (19%) of which were skeletally mature. The most common anatomic location was over the central patella [median ridge (34/74 - 46%) on the axial images and over the middle third (45/74 - 61%) on the sagittal images]. Overall, mean trochlear sulcus angle (high, 151 ± 11°), trochlear depth index (low, 2.8 ± 1.4mm), and Insall-Salvati index (borderline, 1.3 ± 0.1) were abnormal for the entire sample. Skeletally mature knees were significantly more likely to have higher (more dysplastic) Dejour types whencompared to skeletally immature knees (p < 0.01). Knees in the mature group, compared to immature, had significantly more abnormal mean lateral trochlear inclination (15 ± 8° vs. 19 ± 6°, p = 0.03) and patellar tendon-lateral trochlear ridge distance (5.55 ± 4.31mm vs. 2.89 ± 4.69mm, p = 0.04). Half of the knees had ≥ 4 abnormal features that predispose to patellofemoral maltracking; mature knees weresignificantly (p = 0.02) more likely to have a higher number of abnormal features (> 6 features, 7/14, 50.0%) versus immature knees (0-3 features, 33/60, 55.0%). In children with patellar osteochondritis dissecans, abnormal patellofemoral morphology and alignment indices were common in all patients and more severe in mature knees.

A 12-year follow up survey of childhood blindness at schools for the blind in Cambodia

BackgroundCambodia is a low-income country in South East Asia with a population of 15.5 million people of whom 4.9 million (38%) are under the age of 16. The causes of childhood blindness in Cambodia have not been investigated since the first survey of schools for the blind done in 2009 by our group. Given the large demographic and economic shifts in Cambodia since 2009 it is important to determine if these causes have changed in order to ensure intervention programmes are appropriately targeted. The purpose of the present study is to investigate the prevalence of causes of childhood blindness at schools for the blind in Cambodia.MethodsStudents between the ages of 5 and 16 years who were attending schools for the blind in Cambodia were examined by a consultant paediatric ophthalmologist and had clinical photographs taken. Distance visual acuity was measured using a logMAR tumbling E chart and the WHO definitions of blindness and severe visual impairment were used. The examining ophthalmologist recorded the anatomical site and aetiology of vision loss using the WHO Prevention of Blindness eye examination record for children. Collected data were compared to a previous survey from 2009.ResultsData from 73 students were included for analysis. The most common anatomical location of abnormality causing vision loss was the cornea (n = 20, 33.9%) followed by the lens and retina (n = 11, 18.64% each). Hereditary factors (n = 29, 49.15%) and childhood diseases (n = 27, 45.76%) were the most common aetiological causes of childhood blindness. The majority (71.19%) of childhood blindness was avoidable. The present study did not demonstrate 0a significant difference in the causes of childhood blindness compared to 2009.ConclusionsCorneal pathologies continue to represent the most common cause of vision loss amongst the surveyed population and the majority of causes of childhood blindness continue to be avoidable. These findings will facilitate the development of evidence-based targeted interventional programmes in Cambodia.

Subgemmal neurogenous plaque: a series of six cases and a literature overview.

The study aims to describe six subgemmal neurogenous plaque (SNP) cases and compile the previously available data on SNP. Searches on PubMed, Web of Science, Embase, Scopus, and a two-step study selection were performed to compile data from case reports/series of SNP published in English literature. Our six patients (range 29-63years) had SNP in the posterior lateral border of the tongue. Four of them were associated with lymphoepithelial cysts. A total of 15 studies, comprising 116 patients, were included in this overview. There was a slight predilection for female patients (56.0%) in the 5th (22.4%) and the 7th (23.9%) decades. The lateral border of the tongue (66.4%) was the most common anatomical location. The major manifestation was nodule/papule. Histologically, the presence of taste buds (n = 40/ 34.5%), superficial neural plexus (n = 32/ 27.6%), deep nerve fascicles (n = 32/ 27.6%), ganglion cells (n = 41/ 35.3%), and lymphoid tissue (n = 22/ 19.0%) was mainly reported. Surgical removal was the primary approach, with a low recurrence rate. Although largely unknown, SNP is a regular and likely frequent structure located in the tongue. The findings emphasize the importance of describing clinicopathological patterns of SNP as a differential diagnosis of neural lesions that affect the tongue.

A novel classification of small bowel adenocarcinoma based on a hidden genome classifier: A multi-institutional study.

724 Background: Small bowel adenocarcinoma (SBA) is a rare malignancy with poor prognosis. Data describing the clinical and pathologic characteristics of this disease are sparse, and few studies examine the genetic footprint of SBAs within the continuum of the gastrointestinal tract. Methods: All patients with small bowel adenocarcinoma for whom primary tumor tissue was available from 1993 to 2021 at six institutions were included. A hidden genome classifier (HGC) was developed based on genomic features from 286 gastroesophageal cancers (foregut) and 286 colorectal cancers (hindgut) using targeted tumor sequencing. The SBA samples were run through the HGC to obtain the predicted probability of either foregut or hindgut lineage. For patients submitted to curative intent resection, overall survival (OS) was calculated from 90 days post resection until date of last follow up. Cox regression was used to examine factors associated with OS and to construct the multivariable model. Results: Of a total of 243 patients with SBA, 60% were male. The most common anatomic locations were duodenum (53%), jejunum (28%), and ileum (12%). HGC prediction of foregut lineage was higher for duodenal (55%) and intestinal-type periampullary (64%) tumors, while prediction of hindgut lineage was higher for ileal (68%) and jejunal (54%) tumors. Patients were then divided into three HGC prediction groups based on the lowest-, highest-, and inter-quartile ranges: foregut (n=61), characterized by gene amplification of CDK12, CD3, EGFR, and KRAS and cytoband segmentation of chromosomes 8-p21.1 and 15-q26.3; hindgut (n=61), characterized by APC and KRAS mutations; and mixed-type (n=121) with elements of both. Among those undergoing curative-intent surgery (n=160), median OS was 73 months. On multivariable analysis, HGC prediction group (hindgut vs mixed-type, HR 3.22, 95%CI 1.54-6.73), age (HR 1.03, 95%CI 1.01-1.05) and positive lymph node status (HR 1.96, 95%CI 1.02-3.76) were associated with decreased survival (Table). Neither anatomic site nor the presence of other driver mutations was associated with survival. Conclusions: Small bowel adenocarcinomas display genomic heterogeneity. A novel hidden genome classifier that stratifies SBAs based on homology to foregut or hindgut genomic alterations may be superior to anatomic location for characterizing disease biology. Additional studies are needed to validate and further explore these findings. [Table: see text]

A scoping review of E-scooter safety: Delightful urban slalom or injury epidemic?

IntroductionE-scooters are a convenient, relatively inexpensive and fun new mode of transportation with rapidly increased use in cities throughout the world. Despite the popularity of e-scooters, increases in rider injuries and fatalities have become a public health concern. Objective. To characterize the types of safety issues associated with e-scooter use. Methods. Scoping review methods focused on any safety issues associated with the use of dockless, stand-up, motorized, electric kick scooters from companies offering short-term rentals or through private ownership, published in English between January 2017 and March 2022. Databases included Academic Search Complete, Business Source Complete, Google Scholar, PsychINFO, PubMed, Scopus, SocINDEX, TRID Database, and Web of Science databases. After abstract screening and full text review, a total of 81 studies were included in the scoping review. Results. Few e-scooter riders wear helmets except where legally required. Alcohol impairment is a primary contributor to e-scooter injuries. Younger males, underage riding, double riding, speeding and rider distraction were also identified as behavioural contributors to e-scooter injury crashes. Environmental contributors included crash locations (e.g., sidewalks, bike paths, roads) parking issues (e.g., tripping hazard), fixed object collisions (e.g., lampposts, parked cars), road surface and slope (e.g., uneven, curbs, downhills) and insufficient nighttime visibility. E-scooter reliability was affected by brake failures and design limitations (e.g., stability over rough terrain). Injury patterns included mechanism of injury (loss of balance and/or control, fall) and moving object collisions (e.g., vehicles, pedestrians, bicyclists). The head, face, upper and lower extremities were the most common anatomical locations injured. Fractures, contusions, concussions, lacerations, and sprains were the most frequent injury types. Discussion. Policies, regulations and interventions that address helmet requirements, alcohol and drug use, rider skill and knowledge acquisition, restrictive speed limits, education and enforcement are discussed with respect to evidence-based safety guidance for transportation policy and decision makers. Conclusion. Behavioural, environmental and device design safety issues associated with e-scooter use require effective interventions to reduce the frequency and severity of rider injuries.

Routine Computed Tomography before Pediatric Hematopoietic Stem Cell Transplantation and Association with Length of Stay and Early Non-Relapse Mortality

Introduction: Computerized tomography (CT) scans of the sinus, chest, abdomen, and pelvis are often performed in children prior to hematopoietic stem cell transplantation (HSCT) to evaluate for occult infections. Identification of infectious abnormalities could allow for pre- or post-HSCT infection prophylaxis to reduce morbidity or mortality. However, the association of abnormal pre-HSCT and adverse outcomes post-HSCT has not been previously examined. Additionally, routine imaging may identify incidental non-infectious findings, potentially necessitating additional diagnostic workup and unnecessary radiation exposure. In this study, we sought to investigate the prevalence of abnormal findings on CT scans in children undergoing HSCT and their association with post-HSCT length of stay (LOS) and early non-relapse mortality (NRM). Methods:We constructed a retrospective cohort of children, adolescents, and young adults (0-26y) who received a HSCT at Children's of Alabama between 2003 and 2019. Institutional Review Board approval was obtained prior to data collection. Eligibility included availability of pre-HSCT CT reports which were abstracted by the study team from medical records and were coded as either normal, infectious, or non-infectious abnormalities. Demographic (age at HSCT, sex, race/ethnicity) and HSCT characteristics (indication [primary diagnosis], type of HSCT [allogeneic, autologous], cell source, donor type) were abstracted from medical records. Vital status at day +100 was ascertained and causes of death were classified as relapse-related mortality and NRM. Post-HSCT outcomes of interest included length of stay (using day of HSCT as day 0) and day +100 NRM. Association between abnormal pre-HSCT CT and LOS was modelled using linear regression after adjusting for age at HSCT, sex, race/ethnicity, primary diagnosis, type of HSCT, cell source and donor type. Stratified analyses for patients with infectious abnormalities and those who received allogeneic HSCT were performed. Association between pre-HSCT abnormal CT and early (day +100) NRM was examined using logistic regression after adjusting for above covariates. Results: Overall, 236 patients met eligibility for inclusion. Cohort characteristics are included in Table. Median age at HSCT was 5.8y (range, 0.1-26), 54.7% were male and 57.6% were non-Hispanic white. Most patients received an allogeneic HSCT (66.1%); most common source of stem cells was bone marrow (60.3%), and most common donor was matched unrelated (40.7%). The most common anatomic location imaged using CT scan was chest (91%) followed by abdomen (89%), pelvis (87%), sinus (57%), head (46%) and neck (8.5%). An abnormal pre-HSCT CT scan was identified in 99 patients (41.9%). Infectious abnormalities were identified in 73 (31%) and a non-infectious abnormality was identified in 26 (11%). Sinus CT was most likely to demonstrate any abnormality. Compared to no abnormality, infectious abnormality was more commonly noted in patients with acute lymphoblastic leukemia (20.4% vs 27.4%, P=0.01) and acute myeloid leukemia (8.0% vs 23.3%, P=0.01). Abnormalities noted on CT scans are shown in Figure. The most commonly identified infectious abnormalities were sinusitis (58.9%), lung densities (20.5%), and enteritis (8.2%). The most common non-infectious abnormality noted was active primary disease (15.4%). No association between an abnormal pre-HSCT CT scan and LOS was noted after adjusting for covariates ( b=1.0, 95% confidence interval [CI]= -6.2-8.3, P=0.8). Similarly, there was no association between infectious abnormalities noted on pre-HSCT CT and LOS ( b= -0.4, 95% CI=-5.8-5.1, P=0.9) or among patients undergoing an allogenic HSCT ( b=1.0; 95% CI=-6.2-7.4, P=0.8). Five patients died by day +100 due to NRM (respiratory failure=2, graft-vs-host disease=1, intracranial bleed=1, multi-organ failure=1). However, this was not significantly associated with abnormal pre-HSCT CT scan (odds ratio=1.9, 95%CI=0.1-87.8, P=0.7) Discussion: We show that routine pre-HSCT CT scans identify abnormalities in over 40% of children, adolescent and young adults undergoing HSCT, however, these are not associated with greater length of stay post-HSCT or early mortality. Future research is needed to understand the utility of pre-HSCT CT scans in identifying patients at risk of post-HSCT adverse events.

The curative effect of fire needling combined with filiform needling on tension-type headache and its effect on the tenderness of pericranial muscles.

To observe the curative effect of fire needling pricking pericranial tender points combined with filiform needling on tension-type headache (TTH) and its effect on pericranial muscle tenderness, and explore the correlation between changes of headache symptoms and pericranial muscle tenderness in TTH, to analyze the influence of pericranial muscle tenderness on TTH. A total of 41 TTH patients in the treatment group and 38 TTH patients in the control group completed the study. The patients in the treatment group were treated with fire needling at pericranial tender points combined with filiform needling at Baihui (GV20), Sishencong (EX-HN1), Shenting (GV24), Touwei (ST8) and Fengchi (GB20). The patients in the control group were only treated with the same filiform needling as the treatment group. Patients in the two groups were treated twice a week for 8 weeks. Before and after treatment, the days of headache onset, the number and distribution of pericranial muscle tender points were recorded, the degree of headache was evaluated by visual analogue scale and the threshold of pericranial muscle tender points were measured. The correlations between the changes of the days and degree of headache onset and the changes of the number and threshold of pericranial muscle tender points were analyzed. The effective rates in the two groups were calculated. Compared with those before treatment, the days of headache onset and the degree of headache were decreased (P<0.05) in the two groups；the number of pericranial muscle tender points was decreased (P<0.05) and the tenderness threshold was increased (P<0.05) in the treatment group. After treatment, compared with the control group, the days of headache onset, the degree of headache, and the number of pericranial muscle tender points were decreased (P<0.05), and the tenderness threshold was increased (P<0.05) in the treatment group. The decrease of the days and degree of headache was positively correlated with the decrease of number and the increase of tenderness threshold of pericranial muscle tender points (P<0.05). The effective rate in the treatment group was 87.80% (36/41), which was higher than 57.89% (22/38) in the control group (P<0.05). The most common anatomic location of tender points in baseline was superior trapezius muscle, followed by sternocleidomastoid muscle, superior nuchal line, temporal muscle, masseter muscle, etc. The fire needling at the pericranial muscle tender points combined with filiform needling on TTH patients can significantly improve the clinical symptoms and reduce the pericranial muscle tenderness. The pericranial muscle tenderness is an important factor in the pathogenesis of TTH.

Comprehensive Characterization of Coagulation Parameters in Venous Malformations

Introduction: Localized intravascular coagulopathy (LIC) is a well-recognized, though poorly characterized complication of venous malformations (VM) that can lead to bleeding, thrombosis, and phlebolith formation. While LIC has classically been characterized by elevations in D-dimer and reductions in fibrinogen, no comprehensive studies of coagulation parameters in VM have been performed to date. Since 2021, all patients with VM undergoing evaluation for LIC in the Yale Vascular Malformations Program (VaMP) and the Yale Classical Hematology clinic have been subjected to an extensive set of coagulation tests to fully analyze LIC. Our aim was to use these laboratory test results to comprehensively characterize LIC in this population. Methods: We conducted a retrospective chart review of all VM patients presenting to the Yale VaMP and the Yale Classical Hematology clinic for assessment of LIC from 2021 to 2023. All included patients were evaluated for LIC using the following coagulation parameters: von Willebrand Factor (VWF) antigen, VWF activity, factor VIII (FVIII), alpha-2 antiplasmin (A2AP), plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex (TAT), D-dimer (DD), fibrinogen, prothrombin time (PT), international normalized ratio (INR), and partial thromboplastin time (PTT). Measurements of VWF antigen, VWF activity, FVIII and A2AP were performed using an ACL TOP system (Instrumentation Laboratory; Bedford, MA, USA), while D-dimer and fibrinogen were measured using a BCS XP System (Siemens; Malvern, PA, USA) at our institution's clinical laboratory. PAI-1 and TAT were processed at national Clinical Laboratory Improvement Amendment-certified reference laboratories using ELISA-based assays. Baseline patient characteristics and coagulation test results were extracted via manual chart review. Data analysis was done using IBM SPSS statistics software and GraphPad Prism 9 software. Categorical variables were described using frequency and percentages, while quantitative variables were described using central tendency and dispersion measures. We performed univariate analysis using the Chi-square test. We also analyzed the coagulation tests using a correlation matrix. Statistical significance was set at p&amp;lt;0.05. This project was approved by our Institutional Review Board. Results: A total of 23 patients with VM were included in the analysis (Table 1). The mean age was 38 ± 16 years; the majority (82.6%) were female. The most common anatomic location was the head and neck (52.2%), while the most frequent extent of tissue involvement was muscle (54.5%), with most patients having a single lesion (59.1%) rather than multiple ones. No patients had venous thromboembolism. Normal DD and high TAT levels were observed in most patients (68.2% and 69.6%, respectively). VWF activity, VWF antigen, FVIII, PAI-1, and fibrinogen all were positively correlated (Figure 1). TAT was positively correlated with PAI-1 and inverselycorrelated withPT and INR. DD was positively correlated only with vWF activity. TAT and DD had a poor correlation; among patients with a normal TAT (n=7), 85.7% had a normal DD, while among patients with a normal DD (n=15), only 40% had a normal TAT. Three out of 4 (75%) patients with skin involvement had a high TAT with normal DD, while 2 out of 3 (66.7%) patients with visceral involvement had both high TAT and DD, although these patternswere not statistically significant (P=0.42 and 0.31, respectively). Among patients with muscle involvement (n=11), 45.5% had a high TAT and normal DD while 36.3% had both high TAT and DD. Conclusions: In this first comprehensive hematologic study of VM, we demonstrate that VM-related LIC is characterized by derangements of multiple coagulation parameters. Due to this, measurements of DD and fibrinogen alone may be inadequate for assessing LIC, and the addition of TAT and multiple other coagulation tests may yield a more complete picture of hemostatic derangements in LIC. A lack of correlation between DD and TAT is unexpected and merits further study. Differences in the depth of the VM tissue involvement and TAT/DD correlation may indicate a progression of coagulopathy related to the extent of VM but require further investigation in a larger study.

Subcutaneous Leiomyosarcoma: An Aggressive Malignancy Portending a Significant Risk of Metastasis and Death.

Subcutaneous leiomyosarcoma (LMS) is a rare, poorly understood variant. The current literature on the subject is sparse, consisting of isolated case reports and small clinicopathologic studies compromised by the inclusion of both its more common and indolent counterpart, cutaneous LMS (atypical intradermal smooth muscle neoplasm), as well as highly aggressive deep-seated tumors. Thus, precise clinicopathologic characterization is limited. Cases of subcutaneous LMS reviewed at the University of Michigan and Cleveland Clinic from 1994 to 2022 were included in this retrospective study. A total of 39 cases were identified. The mean age was 61 years, and the cohort was predominantly male (23/39; 59%). Tumors averaged 4.2cm and most commonly arose on the extremities (32/39; 82%). The majority (38/39; 97%) were diagnosed at an early pathologic stage (pT1 or pT2). Histopathologically, most tumors were well-circumscribed and were assigned a Fédération Nationale des Centers de Lutte Contre le Cancer grade of either 1 or 2 (24/39; 62%). The majority (22/39; 56%) appeared to arise in association with a blood vessel. Of the 36 cases with accessible clinical data and follow-up (mean 34mo, range 0 to 94mo), 12 (33%) were noted to have metastasized, with the lung representing the most common anatomic location. One case recurred locally. Six of 36 patients (17%) died from the disease at an average of 47 months after diagnosis (range 16 to 94mo). Metastasis or death from disease was significantly associated with the Fédération Nationale des Centers de Lutte Contre le Cancer grade ( P =0.0015), the presence of necrosis ( P =0.032), tumor size ( P =0.049), and AJCC tumor stage ( P =0.036). These data demonstrate that subcutaneous LMS are more aggressive than dermal-based tumors and have a prognosis akin to that of deep-seated LMS.

Outcomes of N-butyl-2-Cyanoacrylate Tissue Adhesive Application in Corneal Perforation Disorders: Consecutive Case Series.

The purpose of this study was to report the success and long-term outcomes of cyanoacrylate tissue adhesive (CTA) application in the management of corneal perforation disorders. This retrospective case series describes the profile and outcomes of eyes that underwent CTA for corneal perforation over an 11-year period from January 2009 until January 2020 at a tertiary eye centre in the United Kingdom. In total, 25 eyes underwent CTA application during the study period. Non-traumatic sterile corneal melt was responsible in more than half of the cases (56.0%; n = 14) followed by infection (32.0%; n = 8) and trauma (12.0%; n = 3). Median size of perforation was 2.0mm (interquartile range, IQR 1.0-3.0). The most common anatomical location of corneal perforation was central (56.0%; n = 14). Ocular surface disease was seen in almost all eyes except two (92.0%; n = 23) with dry eye disease being the most common (48.0%; n = 12). Amongst 23 eyes that completed follow-up (median 27months; IQR 9.5-46.5), single CTA application was successful in achieving intact globe in 13 (56.5%) eyes and repeat gluing sealed total of 20 (86.9%) eyes. Survival analysis showed cumulative success of 71.0% and 51.2% at 90 and 250days, respectively. The CTA was retained in the eyes for median of 94.0days (IQR 30.0-140.5). A total of five patients developed adverse events, including endophthalmitis (n = 2), following CTA application. CTA was highly effective in sealing corneal perforations in acute setting and showed moderate long-term success. However, multiple applications are often required.

Clinicopathological characteristics and treatment outcomes of oesophageal cancer patients in Uganda.

Oesophageal cancer is the seventh most common cancer and the sixth leading cause of cancer death worldwide, and its incidence varies globally. In Uganda, the incidence and trend are on the increase. However, there is a paucity of published data regarding this population's oesophageal cancer clinicopathologic characterisation and treatment outcomes. To study the patients' clinicopathologic characteristics and treatment outcomes of oesophageal cancer over 10 years at the Uganda Cancer Institute. Patients' charts with histologically confirmed diagnoses of oesophageal cancer for 2009-2019 were identified. Case information, which included patient demographics, history of alcohol use or smoking, tumour location, histological type, tumour grade, clinical TNM (Tumour, Node, Metastasis) staging treatment exposure and treatment outcomes, was evaluated retrospectively. The median survival time was estimated with the Kaplan-Meier method and the median follow-up period was estimated using the reverse Kaplan-Meier. 1,965 oesophageal cancer patients were identified; 1,380(70.23%) were males and 585(29.77 %) females, their mean age was 60.20 years (±12.66). Most males had a history of both alcohol consumption and smoking 640(46.38%). The lower third of the oesophagus was the most common anatomical location 771(39.24%). The majority had squamous cell carcinoma histological type 1,783(90.74%) followed by adenocarcinomas 182(9.26%) in the distal oesophagus. Poorly differentiated tumour grade 743(37.81%) was predominant. The majority of the patients were in stage IVB, 733(37.30%), and most patients were planned for the best supportive care, 731(37.20%). Radiation alone was offered to 621(31.60%) and feeding gastrostomy to 249(12.70%). Treatment outcomes: at the time of the current analysis, 58.68% had died, 1.48% were alive and 39.84% were lost to follow-up. The median follow-up period was 65 months (IQR:35.83-83.30) with a median survival time of 4.47 months (95% CI: 4.17-4.80). Treatment outcomes of Ugandan oesophageal cancer patients seeking care are poor as most patients present with advanced disease. There is a significant loss of follow-up after treatment initiation. Therefore, reduction in exposure to known modifiable risk factors, early detection and timely referral for treatment strategies are needed to improve outcomes of these patients in our population. Designing interventions to improve treatment adherence is necessary.

Infection-Associated Mortality During Induction Chemotherapy in Group B Intermediate-Risk Pediatric Burkitt's Lymphoma.

Background Burkitt's lymphoma (BL) in the pediatric population has significantburden in developing countries. Infection-related complications during the induction chemotherapy phase pose a major challenge and contribute to high mortality rates due to a severely immunocompromised state. However, there is scarcedata on the etiologies and optimal management strategies for infection-related mortality in pediatric BL patients, especially in developing countries like Pakistan. Methods This is across-sectional study that included a total of 116 pediatric patients with intermediate-risk BL. All patients were treated based on theChildren's Cancer and Leukaemia Group (CCLG) 2020 guidelines. Data on patientdemographics, presenting symptoms, diagnosis, infectious etiologies, and outcomes were collected. Infection-related complications and mortality were monitored during the induction chemotherapy period. The results of relevant culture reports were tabulated and data were analyzed. Results Among the 116 included patients, 61.1% were males with a mean age of 4.83 ± 2.12 years. Abdominal BL was the most common anatomical location. During the induction period, 66 patients (56.9%) had culture-proven infections, resulting in 33 deaths (28.4%). Fever was the predominant presenting symptom in all patients, followed by vomiting (57.6%), loose stools (42.4%), and cough (18.2%). Neutropenic colitis, sepsis, pneumonia, and meningitis were among the diagnosed infections. Hospital-acquired bacterial infections, including multi-drug resistantgram-negative and gram-positive organisms, were the main cause of mortality, with fungal infections and cytomegalovirus viremia also identified in a few patients. Conclusions This study highlights the urgent need for improved management strategies in pediatric BL patients in Pakistan to reduce infection-related complications and mortality rates, emphasizing the importance of context-specific approaches for infection prevention and management.