Definitive Evaluation Research Articles

Retrospective analysis in in situ ductal carcinoma; 11 years of experience

Objective: To describe our experience in the diagnosis, treatment and follow up of patients with ductal carcinoma in situ (DCIS). Materials and methods: 953 breast carcinomas treated in the Mastology service of the Department of Gynecology and Obstetrics of the Hospital Aleman of Buenos Aires, between January 2004 and December 2014, are retrospectively analyzed. 206 biopsies (BRQ 25-mammotome 151-core biopsy 30) of ductal carcinomas in situ were identified, resulting after definitive pathological evaluation in 172 (18%) pure ductal carcinomas in situ of the total of 953 patients analyzed. Results: 206 biopsies (BRQ 25-mammotome 151-core biopsy 30) of ductal carcinomas in situ were identified, resulting after definitive pathological evaluation in 172 (18%) pure ductal carcinomas in situ of the total of 953 patients analyzed. The imaging report in the total of the 206 patients showed microcalcifications in 80.1%. The diagnosis of carcinoma in situ was made in 181 (87%) patients by preoperative microinvasive procedures and in the remaining 25 (13%) patients by radiosurgical biopsy (BRQ). There was evidence of 18.8% underdiagnosis after microinvasive procedures. In our case series, 84.3% were GH3/GH2 while 15.7% were GH 1. When comparing the size of the surgical specimens and correlating it with the 34 cases of invasive and microinvasive carcinoma, it showed that 54.8% of invasion in those tumors greater than 30 mm, 50.4% in those that exceeded 21 mm and in no case in those less than 10 mm. 20% of multicentric lesions were associated with invasive tumor. Sentinel lymph node technique was performed in 23.8% patients in the first surgery, resulting negative in all cases. When evaluating radiation and hormonal treatment, radiotherapy was performed in 131 patients (85.6%) and hormonal treatment was performed in 75% of the patients. In the follow-up until December 2014, 11 relapses (5.23%) were recorded. Conclusion: Our results are consistent with the international indexed literature in reference to diagnosis, treatment and recurrence rate pure of DCIS.

The data layer: the importance of sources critical appraisal

Abstract One of the main purposes of public health institute is to tracking the health status of its citizens and understanding its evolution over time. Given the absence of a singular, comprehensive data source, we developed a framework to select databases specific to each disease and outcome of interest. This process includes a thorough evaluation of the operational case definitions, as well as the strengths and weaknesses of each database, with a particular focus on their sensitivity and specificity. These qualities are appraised following a dedicated scoring form into different categories (i.e., high, medium, low). The selection criteria for data sources hinge on several key questions: Is the database exhaustive or merely a sample? Does the case definition rely on direct medical diagnoses or proxies? Does the source capture all cases? Is the data collected at regional or national level? Are there mechanisms for yearly or periodic updates? To establish the most accurate national prevalence estimates for each outcome, we often need to adjust for data misclassification-applying corrections for biases such as self-reported data and interpolating for missing entries. In some instances, a pooled estimate from multiple data sources is developed. A specific case will be presented to illustrate our approach in practice. This critical evaluation is pivotal, as the quality of data underpins the entire health information pyramid. The integrity of our data directly influences our ability to convert data into actionable health wisdom, ultimately affecting public health decision-making and policy formulation.

Evaluation and Revision of Historical ESSENCE Syndromic Surveillance Definition Used to Identify Work-Related Emergency Department Visits.

Occupational health surveillance programs have rarely incorporated syndromic surveillance. We documented a process for evaluating and revising syndromic surveillance definitions, using the example of work-related emergency department (ED) visits. Of 140 331 481 ED visits in the National Syndromic Surveillance Program from May 15, 2016, through October 31, 2017, we extracted 391 827 records for phase 1 that met the previously unevaluated original work-related definition or included a work-related employment status ICD-10-CM code (Y99.0/Y99.1; International Classification of Diseases, Tenth Revision, Clinical Modification). Also for phase 1, we evaluated the performance of the original work-related definition using ICD-10-CM work-related employment status codes as a reference standard. In phase 2, we extracted 99 109 records containing candidate work-related keywords. Finally, in phase 3, we examined individual keywords and developed and evaluated a revised definition. The revised work-related definition identified 259 153 visits by keyword alone, 104 342 visits by ICD-10-CM work-related employment status codes alone, and 16 385 ED visits by both methods. Sensitivity (13.6% vs 11.3%) and positive predictive value (5.9% vs 4.8%) were higher for the revised definition than for the original work-related definition. Manual review indicated that 91.3% (95% CI, 89.6%-93.0%) of visits identified by the revised definition keywords met the study criteria for work-related visits as compared with 75.5% (95% CI, 73.0%-78.4%) of visits for the original work-related definition. The original work-related definition performed suboptimally because keywords were not sufficiently specific. The revised definition is an improvement but requires testing in real-world scenarios. The presented methods for developing a syndromic surveillance definition are useful, not only for occupational health, but for identification of other subpopulations treated in the ED.

Implementing Schwartz Rounds in children's social care: Enablers and barriers

Summary Children's social care services can be a challenging place to work, with staff regularly reporting higher stress levels relative to the general population and other public sector settings. Thus, it is important to provide staff with good support. Previously, we completed a randomised controlled trial (RCT) of Schwartz Rounds (SRs) and reported a series of non-statistically significant differences between intervention and comparison groups. We also undertook a process evaluation, to identify enablers and barriers to the successful implementation of SRs in children's social care. Findings Compared with studies of SRs in healthcare settings, we identified several similar enablers, such as senior management buy-in and effective administrative support, and some similar barriers, such as high workloads and poor publicity. We also identified specific enablers and barriers for social care settings, including the synergy between existing practice models and SRs, the nature of trauma in social care compared with healthcare, and some related to the different nature of organisational and workload pressures. Applications Understanding the differences between SRs in healthcare and social care will be useful for local authorities who may want to support their staff via the provision of SRs. They should also be useful in any future definitive evaluation of SRs for social care by helping to maximise the possibility for a successful implementation.

Evaluation and Application of the Work-Related Asthma Screening Questionnaire—Long Version (WRASQ-L)

BackgroundThe Work-related Asthma (WRA) Screening Questionnaire (Long-Version)(WRASQ-L)TM is a screening questionnaire that could improve recognition of WRA. ObjectiveTo conduct a definitive evaluation of the WRASQ-LTM to justify its implementation in clinical settings. MethodsEmployed adults aged 18-75 years with asthma confirmed by objective measures and the ability to take time off work were eligible. Participants completed the WRASQ-LTM then monitored their peak expiratory flow at and away from work or completed a specific inhalation challenge test. Data were classified as WRA or non-WRA by two asthma specialists, blinded to WRASQ-LTM answers. Sensitivity (SN), specificity (SP), positive and negative predictive values (PPV and NPV, respectively) and Youden’s index were calculated for cut-offs of a positive screen. ResultsOf 106 participants (47.1±7.1 years (mean ± SD); 60 (57%) female), 14 (17%) were classified as WRA and were significantly younger in age than non-WRA participants (p=0.043). The questionnaire has high SN and NPV (90.9% and 93.1%, respectively), but low PPV and SP (32.1% and 26.0%, respectively). ConclusionsThe WRASQ-LTM has high SN and NPV. High SN is of primary interest to ensure that few false negative screens are missed and those with potential WRA are identified and continue to specialist care. The SN indicates utility of the questionnaire in clinical settings. Further benefits of the tool include its potential to prompt for education on the symptom-workplace relationship, workplace exposures, personal protective equipment use, and collect exposure and occupational history.

Pulse oximetry for the prediction of acute mountain sickness: A systematic review.

Acute mountain sickness (AMS) causes serious illness for many individuals ascending to high altitude (HA), although preventable with appropriate acclimatisation. AMS is a clinical diagnosis, with symptom severity evaluated using the Lake Louise Score (LLS). Reliable methods of predicting which individuals will develop AMS have not been developed. This systematic review evaluates whether a predictive relationship exists between oxygen saturation and subsequent development of AMS. PubMed, PubMed Central, MEDLINE, Semantic Scholar, Cochrane Library, University of Birmingham Library and clinicaltrials.gov databases were systematically searched from inception to 15 June 2023. Human studies involving collection of peripheral blood oxygen saturation ( ) from healthy lowlanders during ascent to HA that evaluated any relationship between and AMS severity were considered for eligibility. Risk of bias was assessed using a modified Newcastle-Ottawa Tool for cohort studies (PROPSPERO CRD42023423542). Seven of 980 total identified studies were ultimately included for data extraction. These studies evaluated and AMS (via LLS) in 1406 individuals during ascent to HA (3952-6300m). Risk of bias was 'low' for six and 'moderate' for one of the included studies. Ascent profiles and measurement methodology varied widely, as did the statistical methods for AMS prediction. Decreasing oxygen saturation measured with pulse oximetry during ascent shows a positive predictive relationship for individuals who develop AMS. Studies have high heterogeneity in ascent profile and oximetry measurement protocols. Further studies with homogeneous methodology are required to enable statistical analysis for more definitive evaluation of AMS predictability by pulse oximetry.

Endoscopic Evaluation and Management of Superficial Esophageal Squamous Cell Carcinoma

AbstractEsophageal squamous cell carcinoma (SCC) is the seventh most common malignancy and the sixth leading cause of cancer-related deaths globally, demanding precise diagnostic and individualized therapeutic interventions. This case study describes the diagnosis and treatment of esophageal SCC in a 54-year-old man initially detected during an upper gastrointestinal endoscopy. The lesion was identified using narrow-band imaging and magnifying endoscopy; after imaging studies, it was treated with endoscopic submucosal dissection (ESD). ESD is known for its minimal invasiveness and the definitive histopathological evaluation it facilitates.The management strategy described in this paper reiterates the criticality of extensive pretreatment evaluations, the indication of the application of ESD, and the importance of a multidisciplinary team. It underscores the significance of careful posttreatment monitoring and the informed selection of adjuvant therapies, particularly in areas like India, where such advanced endoscopic techniques are still on the rise.

Advancing continual lifelong learning in neural information retrieval: Definition, dataset, framework, and empirical evaluation

Continual learning refers to the capability of a machine learning model to learn and adapt to new information, without compromising its performance on previously learned tasks. Although several studies have investigated continual learning methods for neural information retrieval (NIR) tasks, a well-defined task definition is still lacking, and it is unclear how typical learning strategies perform in this context. To address this challenge, a systematic task definition of continual NIR is presented, along with a multiple-topic dataset that simulates continuous information retrieval. A comprehensive continual neural information retrieval framework consisting of typical retrieval models and continual learning strategies is then proposed. Empirical evaluations illustrate that the proposed framework can successfully prevent catastrophic forgetting in neural information retrieval and enhance performance on previously learned tasks. The results also indicate that embedding-based retrieval models experience a decline in their continual learning performance as the topic shift distance and dataset volume of new tasks increase. In contrast, pretraining-based models do not show any such correlation. Adopting suitable learning strategies can mitigate the effects of topic shift and data augmentation in continual neural information retrieval.

Redefining Intercultural Competence Using the Delphi Method

This study employs the Delphi method to ascertain intercultural scholars’ current consensus on a definition, specific components, and key evaluation criteria of intercultural competence. Sixty-eight leading intercultural scholars from Euro-American and East-Asian countries participated in this study. The results are largely congruent with the previous study, nonetheless some new elements emerge from this study. Based on the findings, intercultural competence is redefined and a multicultural model is proposed.

Current Advances in Radioactive Iodine-Refractory Differentiated Thyroid Cancer.

Differentiated thyroid cancer (DTC) patients have an outstanding overall long-term survival rate, and certain subsets of DTC patients have a very high likelihood of disease recurrence. Radioactive iodine (RAI) therapy is a cornerstone in DTC management, but cancer cells can eventually develop resistance to RAI. Radioactive iodine-refractory DTC (RAIR-DTC) is a condition defined by ATA 2015 guidelines when DTC cannot concentrate RAI ab initio or loses RAI uptake ability after the initial therapy. The RAIR condition implies that RAI cannot reveal new met-astatic foci, so RAIR-DTC metabolic imaging needs new tracers. 18F-FDG PET/CT has been widely used and has demonstrated prognostic value, but 18F-FDG DTC avidity may remain low. Fibroblast activation protein inhibitors (FA-Pi)s, prostatic-specific membrane antigen (PSMA), and somatostatin receptor (SSTR) tracers have been proposed as theragnostic agents in experimental settings and Arg-Gly-Asp (RGD) peptides in the diagnostic trial field. Multi-targeted tyrosine kinase inhibitors are relatively new drugs approved in RAIR-DTC therapy. Despite the promising targeted setting, they relate to frequent adverse-event onset. Sorafenib and trametinib have been included in re-differentiation protocols aimed at re-inducing RAI accumulation in DTC cells. Results appear promising, but not excellent. RAIR-DTC remains a challenging nosological entity. There are still controversies on RAIR-DTC definition and post-RAI therapy evaluation, with post-therapy whole-body scan (PT-WBS) the only validated criterion of response. The recent introduction of multiple diagnostic and therapeutic agents obliges physicians to pursue a multidisciplinary approach aiming to correct drug introduction and timing choice.

Processes and principles for producing credible climate change attribution messages: lessons from Australia and New Zealand

Extreme event attribution (EEA) information is increasingly in demand from climate services. EEA messages can: raise awareness about the effect climate change has already imposed, inform climate change liability conversations, and be combined with climate projections to inform adaptation. However, due to limitations in observations, models and methods, there are barriers towards operationalising EEA in practice. Operational services will need EEA to be done transparently and using preset formats. Here we review recent experience and practice in EEA in Australia and New Zealand with a view to inform the design of an EEA component of climate services. We present a flow chart of the processes involved, noting particular care is needed on the trigger, event definition, and climate model evaluation, with effective stage gates. We also promote the use of tailored causal network diagrams as a standard tool to inform an EEA study and communicate results, with particular care needed for messages on events with lower confidence or complex sets of influences, including tropical cyclones and extratropical cyclones. We suggest that extending EEA to impact attribution is essential for making EEA messages salient but requires an uplift in forming interdisciplinary teams and in granular exposure and vulnerability datasets and is likely to raise new interdisciplinary methodological questions. Finally, we suggest communication of EEA messages can learn more from its origins in medical epidemiology.

A Framework for Developing and Assessing Custom Case Definitions: A Demonstration Applied to Opioid Overdose in Maryland.

Public health epidemiologists monitor data sources for disease outbreaks and other events of public health concern, but manual review of records to identify cases of interest is slow and labor-intensive and may not reflect evolving data practices. To automatically identify cases from electronic data sources, epidemiologists must use "case definitions" or formal logic that captures the criteria used to identify a record as a case of interest. To establish a methodology for development and evaluation of case definitions. A logical evaluation framework to approach case definitions will allow jurisdictions the flexibility to implement a case definition tailored to their goals and available data. Case definition development is explained as a process with multiple logical components combining free-text and categorical data fields. The process is illustrated with the development of a case definition to identify emergency medical services (EMS) call records related to opioid overdoses in Maryland. The Maryland Department of Health (MDH) installation of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE), which began capturing EMS call records in ESSENCE in 2019 to improve statewide coverage of all-hazards health issues. We describe a case definition evaluation framework and demonstrate its application through development of an opioid overdose case definition to be used in MDH ESSENCE. We show the iterative process of development, from defining how a case can be identified conceptually to examining each component of the conceptual definition and then exploring how to capture that component using available data. We present a framework for developing and qualitatively assessing case definitions and demonstrate an application of the framework to identifying opioid overdose incidents from MDH EMS data. We discuss guidelines to support jurisdictions in applying this framework to their own data and public health challenges to improve local surveillance capability.

Accurate analytical evaluation of the generalized logarithmic and double Fermi–Dirac and Bose–Einstein functions

AbstractThe accurate definition and powerful evaluation modeling of the various generalized Fermi–Dirac and Bose–Einstein functions remain a challenging problem in various areas of physics. In this study, we develop a general analytical technique for accurately calculating logarithmic and double Fermi–Dirac and Bose–Einstein functions. The obtaining analytical formulae are established by considering the binomial expansion theorem. The obtained expressions are valid in chemical potential values between ‐∞ <μ <0 and have been designated as explicit form features, high precision, and less computing time. The calculation results are tabularly illustrated to show the consistency of the analytical relations analysis under the effect of parameters. Based on a comprehensive analysis of the results, they are potentially useful in applications to evaluate thermionic emission and astrophysics problems.

Rehabilitative outcomes with preparatory suction prostheses following traumatic Gritti-Stokes amputation: A case series.

Gritti-Stokes amputation (GSA) is a knee disarticulation variant, where the femur is transected at the level of the epicondyle and the patella is fixated to the distal end. GSA results in a long residual limb with little postoperative swelling and less potential for muscular atrophy, so stable limb volume may allow the use of seal-in suction for suspension for preparatory prostheses. The purpose of this case series was to report on the efficacy of seal-in suction preparatory prostheses for 2 adults with traumatic GSA. Between October and December of 2021, 2 participants with unilateral traumatic Gritti-Stokes amputation, who had received seal-in suction suspension for their preparatory prostheses, were recruited. Information was extracted from medical charts regarding prosthetic care and mobility at preparatory and definitive prosthesis evaluation, and participants underwent standardized measurement of their residual limb and prosthesis. Duration of preparatory prosthesis use was >6 months; neither participant reported loss of suspension nor significant complications with socket fit. Participant 1 required socket replacement because of residual limb pain secondary to osteophyte formation, and Participant 2 required component replacement because of weight gain. At definitive prosthesis evaluations, both participants were unlimited community ambulators; both successfully returned to work before provision of their definitive prostheses. Results indicate that seal-in suction suspension may be viable for preparatory prostheses among adults with traumatic GSA, but knee center height discrepancies persist. GSA may yield highly functional outcomes for adults with traumatic amputation. Further research is required to substantiate these findings.

Posterior Communicating Artery / Posterior Cerebral Artery

Thorough understanding of the vascular anatomy, including embryological development of vessels is important to safely perform endovascular procedures. The posterior cerebral and anterior choroidal arteries are embryologically complementary, which suggests a potential network. Numerous perforators originate from the posterior communicating and posterior cerebral arteries. The tuberothalamic artery arising from the posterior communicating artery and the thalamoperforating artery, which originates from the P1 segment of the posterior cerebral artery are clinically important because occlusion of these vessels can precipitate severe infarction. It is clinically important to be aware that the branching pattern of perforators differs based on the fusion type of the basilar tip. The balloon occlusion and Allcock test are useful to predict ischemic tolerance in cases of intentional artery occlusion. However, accurate prediction remains challenging, and a definitive evaluation method is unavailable. Flow disturbances in the cortical territory and local perforator impairment require close attention in cases of intentional artery occlusion.

Adverse effects of tamoxifen treatment on bone mineral density in premenopausal patients with breast cancer: a systematic review and meta-analysis.

It is well known that adjuvant tamoxifen treatment for breast cancer in postmenopausal women decreased bone loss. However, the effects of adjuvant tamoxifen therapy on bone mineral density (BMD) in premenopausal patients with breast cancer remains uncertain. Tamoxifen would have a potential impact of premenopausal BMD on health. The aim of this meta-analysis was to assess this in premenopausal women with primary breast cancer. Through April 2020, studies reporting BMD changes of lumbar spine or hip in premenopausal women with primary breast cancer treated with adjuvant tamoxifen and tamoxifen plus chemotherapy or ovarian function suppression (OFS) were collected from EMBASE and PubMed. The meta-analysis was performed using random effects model of the standardized mean difference (SMD) of BMD in patients. A total of 1432 premenopausal patients were enrolled in eight studies, involving 198 patients treated with tamoxifen alone in three studies. After a 3-year median follow-up, adjuvant tamoxifen decreased the lumbar spinal and hip BMD by as much as an SMD of -1.17 [95% confidence interval (CI); -1.58 to -0.76)] and -0.66 (95% CI, -1.55 to 0.23), respectively. In subgroup analysis in patients treated adjuvant tamoxifen and tamoxifen plus chemotherapy or OFS according to follow-up duration, the bone change of < 3years follow-up group was -0.03 SMD (95% CI, -0.47 to 0.41) and that of ≥ 3years follow-up group was -1.06 SMD (95% CI, -1.48 to -0.64). Compared with patients who received tamoxifen alone, patients who received combination therapy with chemotherapy or OFS showed lesser bone loss at the lumbar spine. Our meta-analysis demonstrated that adjuvant tamoxifen therapy in premenopausal patients caused bone loss after 3years of follow-up, especially at the lumbar spines. For a definite evaluation of the adverse effects of tamoxifen on bone, it is necessary to accumulate more relevant studies.

Stepwise analysis of thyroid diagnostic modalities with genomic imprinting detection.

The current preoperative malignancy risk evaluation for thyroid nodules involves stepwise diagnostic modalities including ultrasonography, thyroid function serology and fine-needle aspiration (FNA) cytopathology, respectively. We aimed to substantiate the stepwise contributions of each diagnostic step and additionally investigate the diagnostic significance of quantitative chromogenic imprinted gene in-situ hybridization (QCIGISH)-an adjunctive molecular test based on epigenetic imprinting alterations. A total of 114 cytopathologically-diagnosed and histopathologically-confirmed thyroid nodules with complete ultrasonographic and serological examination records were evaluated using QCIGISH in the study. Logistic regression models for thyroid malignancy prediction were developed with the stepwise addition of each diagnostic modality and the contribution of each step evaluated in terms of discrimination performance and goodness-of-fit. From the baseline model using ultrasonography [area under the receiver operating characteristics curve (AUROC): 0.79; 95% confidence interval (CI): 0.71-0.86], significant improvements in thyroid malignancy discrimination were observed with the stepwise addition of thyroid function serology (AUROC: 0.82; 95% CI: 0.74-0.90; P=0.23) and FNA cytopathology (AUROC: 0.88; 95% CI: 0.81-0.94; P=0.02), respectively. The inclusion of QCIGISH as an adjunctive molecular test further advanced the preceding model's diagnostic performance (AUROC: 0.95; 95% CI: 0.91-1.00, P=0.007). Our study demonstrated the significant stepwise diagnostic contributions of standard clinical assessments in the malignancy risk stratification of thyroid nodules. However, the addition of molecular imprinting detection further enabled a more accurate and definitive preoperative evaluation especially for morphologically indeterminate thyroid nodules and cases with potentially discordant results among standard modalities.

An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis

IntroductionExpert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. MethodsWe conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. ResultsIndividual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. ConclusionWhile the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions.

Glucagon-Like Peptide-1 Receptor Agonists and Thyroid Cancer: A Narrative Review.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are highly effective medications for the treatment of type 2 diabetes and obesity. Pharmacological studies in rodents support an association between the use of GLP-1 RAs and the development of medullary thyroid cancer (MTC) resulting in a black box warning for these agents in patients at risk for this condition. Yet, the association between GLP-1 RAs and non-MTC remains controversial. Excessive worry about unproven thyroid cancer risk might lead to underutilizing GLP-1 RAs in patients who could otherwise experience substantial benefits. Unwarranted concerns about thyroid cancer could lead to unnecessary thyroid cancer screening and harms from overdiagnosis. Summary: The body of evidence assessing the association between GLP-1 RA use and thyroid cancer spans a wide range of methodologies, including basic and translational research investigating biological plausibility; randomized trials assessing clinical efficacy and providing the strongest evidence for causality; observational studies providing real-life outcome evaluation in larger populations but with limited evaluation of covariates or dependable outcome definitions; and pharmacovigilance studies that provide postmarketing assessments of a safety signal but do not address causality. There is biological plausibility supporting an association between GLP-1 RA and MTC in rodents, which is less clear for non-MTC in humans. Clinical evidence from randomized trials and associated meta-analysis suggest thyroid cancer as a rare event making effect estimates imprecise but without conclusive and consistent evidence of increase risk in those receiving GLP-1 RA. Observational studies at higher risk of bias also show low event rates for thyroid cancer, with effect estimates that are inconsistent among different studies. Pharmacovigilance studies consistently show a signal of increased reporting of thyroid cancer in patients treated with GLP-1 RA. Conclusions: Evidence from randomized controlled trials indicates occurrence of thyroid cancer is infrequent in individuals exposed to GLP-1 RA. Observational studies at higher risk of bias yield inconsistent results. Overall there is no conclusive evidence of elevated thyroid cancer risk. These findings can help clinicians when addressing patient's concerns about a potential yet unproven link between GLP-1 RA therapy and thyroid cancer.

Correlation of anterior segment optical coherence tomography and ultrasound biomicroscopy in congenital corneal opacity

To investigate the correlation between swept-source anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) in congenital corneal opacity (CCO). All children with unilateral or bilateral congenital corneal opacities who underwent examination under anesthesia (EUA) and anterior segment optical coherence tomography (AS-OCT) imaging from January 1, 2022, to December 31, 2022, were included. Main outcome measures were corneal and anterior segment evaluation and correlation of UBM and AS-OCT findings. A total of 22 eyes of 15 patients were imaged using both technologies. The age at first EUA ranged from 11 days to 4 years. Different phenotypes were classified based on the clinical examination, UBM, and AS-OCT findings. Fourteen eyes were diagnosed with Peters anomaly, congenital corneal staphyloma was observed in 4 eyes, 2 eyes had coloboma, 1 eye had peripheral sclerocornea, and 1 eye was diagnosed with congenital primary aphakia. AS-OCT and UBM findings were closely correlated in 18 of 22 eyes (82%) but AS-OCT failed to provide detailed information in 4 eyes (18%) where UBM revealed more details. Although AS-OCT offers valuable preliminary data for initial assessment and counseling, it may not consistently provide precise assessments in all cases. Therefore, UBM should be considered for definitive evaluation.