High-risk Sites Research Articles

Local Morphologic and Hemodynamic Analyses for the Prediction of Abdominal Aortic Aneurysm Rupture Based on Patient-Specific CTA and Computational Modeling.

Extensive research has focused on the evaluation of rupture risks in abdominal aortic aneurysms (AAAs) through comprehensive morphologic and hemodynamic analyses, primarily considering the AAA as a whole entity. This study tried to identify the high-risk rupture sites of AAAs more precisely before the fatal process based on morphologic and hemodynamic analyses at the local segment. Computed tomography angiography of a specific AAA patient was conducted at the follow-up 4 months before rupture, 1 day before rupture, the day of the rupture, and 15 days after endovascular aortic repair. The evolution of local morphology and the hemodynamic characteristics at these critical timepoints were investigated based on patient-specific reconstructions and computational fluid dynamics. The morphologic and hemodynamic parameters of the rupture region vary continuously in the process of AAA development and rupture. The surface area and volume of the rupture segment were gradually enlarged at the follow-up 4 months before rupture (47.33 cm2; 67.35 mL), 1 day before rupture (57.23 cm2; 85.24 mL), and on the day of the rupture (62.41cm2; 104.73ml). A prominent decrease in time-averaged wall shear stress and velocity for the rupture segment is observed. The percentages of the lowest time-averaged wall shear stress (<0.1 Pa) area are increased in the AAA region (20.42%, 33.85%, and 53.00%, separately). The results based on precisely rebuilt geometries for the complete follow-ups of patient-specific computed tomography angiography demonstrate that notable morphologic and hemodynamic evolutions have occurred in the local segment of the AAA, which was further proved at the rupture site. The significant changes occurring at the local segment may provide valuable information for the evaluation of aneurysm rupture risk and locate the most probable site of rupture. Capturing the entire process of AAA rupture through CTA imaging is a rare occurrence in clinical practice. The evolution of morphology and hemodynamic characteristics observed in the illustrated results provides valuable insights for clinicians to monitor the state of AAA from a different perspective. These findings suggest that variations in morphology and hemodynamics within the local segment of the AAA might serve as an alternative approach for predicting the rupture risk of AAA.

Best Management Practices to Mitigate Contamination of Karstic Aquifers from Emergency Fire-Control Runoff

We propose best management practices to increase karstic aquifer drinking water supplies’ resilience to potential hazardous material impacts where first responders and public safety officials suspect emergency firefighting runoff has entered the subsurface in the aquifer recharge zone. Karstic aquifers are unique because of their direct openings to the land’s surface, which allows contaminants in runoff or other surface waters to rapidly enter the subsurface and impact aquifer water quality. In the United States, 20% of the land surface is karst, and about a third of the groundwater used for drinking comes from karstic aquifers. Proposed best management practices emphasize on-site, real-time evaluation of the transport and fate of HAZMAT that may enter the subsurface and focus on water quality sampling, runoff and groundwater flow modeling, nontoxic dye tracing, and related studies for use in planning before and during an event and after emergency response has ended. We recommend best management practices for evidence-based screening of high-risk sites to facilitate placement of hazardous material sampling devices and emergency responder deployment. The best management practices, tools, curricula, and training described combine with earlier work by the authors to provide a comprehensive menu of actions to (1) help first responders prevent or limit flushing of hazardous material into a karstic aquifer; (2) help emergency management officials understand the consequences of contamination and issue data-driven geographically focused health and safety risk communications; and (3) help provide health and safety officials with relevant science- and data-based information that can help mitigate human and environmental health risks.

A Rose by Any Other Name: The Long Intricate History of Localized Aggressive Periodontitis.

This review addresses the recent World Workshop Consensus Conference (WWCC) decision to eliminate Localized Aggressive Periodontitis (LAgP) in young adults as a distinct form of periodontitis. A "Consensus" implies widespread, if not unanimous, agreement among participants. However, a significant number of attendees were opposed to the elimination of the LAgP classification. The substantial evidence supporting a unique diagnosis for LAgP includes the (1) incisor/molar pattern of disease, (2) young age of onset, (3) rapid progression of attachment and bone loss, (4) familial aggregation across multiple generations, and (5) defined consortium of microbiological risk factors including Aggregatibacter actinomycetemcomitans. Distinctive clinical signs and symptoms of LAgP are presented, and the microbial subgingival consortia that precede the onset of signs and symptoms are described. Using Bradford-Hill guidelines to assess causation, well-defined longitudinal studies support the unique microbial consortia, including A. actinomycetemcomitans as causative for LAgP. To determine the effects of the WWCC elimination of LAgP on research, we searched three publication databases and discovered a clear decrease in the number of new publications addressing LAgP since the new WWCC classification. The negative effects of the WWCC guidelines on both diagnosis and treatment success are presented. For example, due to the localized nature of LAgP, the practice of averaging mean pocket depth reduction or attachment gain across all teeth masks major changes in disease recovery at high-risk tooth sites. Reinstating LAgP as a distinct disease entity is proposed, and an alternative or additional way of measuring treatment success is recommended based on an assessment of the extension of the time to relapse of subgingival re-infection. The consequences of the translocation of oral microbes to distant anatomical sites due to ignoring relapse frequency are also discussed. Additional questions and future directions are also presented.

A Large Percentage of Excision Specimens Show Residual Basal Cell Carcinoma: A Retrospective Chart Review.

Treatment of basal cell carcinoma (BCC) is recommended. However, patients often note that the biopsy site appears resolved and inquire about the need for additional treatment. This study aims to determine the rate of residual BCC on excision specimens after initial shave biopsy to aid in decision-making on the necessity of further treatment. A retrospective chart review was conducted that reviewed excision specimen pathology reports of previously biopsy-proven basal cell carcinomas for the presence of residual tumor between 2012 and 2022 at a single institution. Two thousand one hundred seventeen cases met inclusion criteria. Overall, 39.4% of patients had residual BCC after an initial shave biopsy. Using an odds ratio and 95% confidence interval, a significant relationship was found between larger lesions, longer time between biopsy and excision, and lesions on high-risk body sites with increased odds of residual BCC. A significant relationship was found between negative or not specified margins on shave biopsy with decreased odds of residual BCC. The results show that a large percentage of patients have residual BCC following initial biopsies. These results should be included in physician-patient discussions about treatment options for BCC.

A case controlled study of risk factors for metastatic squamous cell carcinoma in organ transplant recipients: single academic medical center.

Solid organ transplant recipients (SOTRs) are at high risk of cutaneous squamous cell carcinoma (cSCC) metastasis. Despite prior studies identifying risk factors, mortality remains high. Understanding additional risk factors may aid in reducing mortality in this population. This study aimed to investigate risk factors and predictive variables for metastatic cSCC in SOTRs. The primary goal was to accurately identify transplant patients at increased risk of metastatic cSCC. A retrospective case-control study in a single institution of 3576 cases of organ transplants were identified from January 1991 to July 2022. A cohort of metastatic cancer patients and two randomly generated age and organ matched control cohorts were identified. 16 SOTR patients developed metastatic cSCC. The majority were male, with high-risk tumor sites. Tumor depth varied and half exhibited perineural invasion. Cylex® (p = 0.05) and white blood cell counts (p = 0.04) were significantly lower in these patients compared to control. Lung transplants were at highest risk relative to other solid organ transplants. Voriconazole exposure was also associated with increased metastatic risk (p = 0.04). Small sample size at a single institution. Close monitoring of SOTR, especially those with lung transplants given their increased risk, reducing immunosuppression, and limiting exposure to voriconazole can improve outcomes in SOTRs with metastatic cSCC.

Clinicopathological risk factors of oral second primary tumours

BackgroundOral second primary tumours (SPTs) have a poor prognosis due to late-stage diagnosis. This study evaluates the demographic and clinicopathological risk predictors of SPTs. MethodsPatients with oral squamous cell carcinoma, carcinoma in situ, or severe dysplasia were accrued into the Oral Cancer Prediction Longitudinal study within one year post-curative treatment. Data on demographics, risk habits, and primary tumour characteristics were collected. Clinical follow-up included assessing the presence of second oral premalignant lesions (SOPLs), clinicopathological features, and the results from toluidine blue staining and fluorescence visualization. ResultsAmong 296 patients, 23 (8 %) developed SPTs. Older age at primary cancer diagnosis (P = 0.008) and a history of chewing tobacco or betel nut (P = 0.043) increased the risk of SPTs. Patients with primary tumours located at low-risk sites had an increased risk of SPTs (P = 0.004), which often presented at high-risk sites. The presence of SOPLs (P < 0.001), and multiple lesions (P = 0.017) significantly increased the risk of SPTs. Positive toluidine blue staining indicated a trend toward higher risk of SPTs, whereas fluorescence visualization did not. The median time to SPT diagnosis was 3.25 years post-treatment. ConclusionsIdentifying second or multiple oral premalignant lesions is critical for predicting the risk of SPTs regardless of their clinical or histological characteristics. Routine biopsy of these lesions should be prioritized to ensure timely diagnosis. Incorporating these risk predictors into clinical follow-up can enhance early cancer detection and improve patient outcomes.

Dose-Dependent Effects of Botulinum Toxin Type A on Prevention of Postoperative Scars in Various Regions in the Body: A Prospective, Double-Blind Randomized Controlled Trial.

Botulinum toxin type A (BTXA) can improve wound healing and reduce scar formation; however, the exact dose required to prevent postoperative scarring across various anatomical sites remains unclear. This study aimed to investigate the effectiveness and optimal concentrations of BTXA for preventing postoperative scarring across various common surgical sites throughout the body. In this prospective randomized controlled trial, 46 patients with benign skin tumors received injections of 1, 2.5, or 5U/0.1mL of BTXA or 0.9% saline immediately following surgical tumor excision on both sides of the incisions. Follow-ups were conducted at 7days, 15days, and 1, 3, and 6months postoperatively. Patient-reported adverse events and standardized digital photographs were collected. Scar formation was assessed using the modified Stony Brook Scar Evaluation Scale (mSBSES). All 46 patients completed the trial without severe complications. The mSBSES scores were higher in the experimental groups at all follow-ups. The 5U/0.1mL BTXA dose group demonstrated optimal scar prevention at all high-risk sites for scar hyperplasia. No significant difference was observed between the 2.5U/0.1mL and 5U/0.1mL doses for intermediate-risk sites, while 1U/0.1mL dose was sufficient for low-risk sites. Overall, 86.5% of patients were satisfied with their treatments, with 16.3% being very satisfied. Early postoperative BTXA injection can reduce or prevent hypertrophic scarring, with optimal doses ranging from 1 to 5U/0.1mL depending on the surgical site, supporting broader clinical application of BTXA. The effectiveness of different concentrations of botulinum toxin type A (BTXA) in preventing postoperative scarring was compared, expanding the scope of previous research, which focused only on the head, face, and neck regions, to include the trunk and extremity areas. Different optimal injection strategies were determined based on different surgical sites and their risks of developing hypertrophic scars. The study demonstrates that BTXA not only reduces scar formation but also enhances patient satisfaction and reduces postoperative itching and pain, contributing to overall better postoperative outcomes. By establishing the efficacy and optimal dosing of BTXA for various surgical sites, this research supports the potential for broader clinical application of BTXA in aesthetic and reconstructive surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The efficacy and safety of computed tomography-guided percutaneous cryoablation for malignant liver tumors at high-risk sites

Objective: To assess the efficacy and safety of computed tomography (CT)-guided percutaneous cryoablation in treating malignant liver tumors located explicitly at high-risk sites. Methods: Data were collected retrospectively from patients with malignant liver tumors undergoing percutaneous cryoablation at Tianjin Medical University Cancer Hospital between January 2018 and December 2021. In all, 46 patients with malignant liver tumors at non-high-risk sites were matched 1∶1 according to the maximum tumor diameter. Technical success rate, complete ablation rate, and complications at 12 and 24 months post-surgery were evaluated. A statistical analysis of the ablation effect difference between the high-risk site and non-high-risk site groups was conducted. Univariate and multivariate logistic regression analyses were performed to identify risk factors. Results: Both groups demonstrated a 100% intraoperative technical success rate, and no major complications related to cryoablation were observed. The complete ablation rate was 82.6% (38/46) and 71.7% (33/46) in the high-risk group and 84.8% (39/46) and 73.9% (34/46) in the non-high-risk group at 12 and 24 months, respectively. There was no significant difference in complete ablation rates between the two groups (P>0.05). Multivariate analysis identified the distance between the tumor edge and high-risk site ≤5 mm and preoperative trans-arterial chemoembolization (TACE) treatment as independent risk factors for cryoablation effect. Conclusion: CT-guided percutaneous cryoablation is a safe and effective approach for patients with malignant liver tumor at high-risk sites. Our results emphasize the importance of proper preoperative planning and intraoperative manipulation.

Factors associated with residual tumor at time of Mohs micrographic surgery for basal cell and squamous cell carcinomas

BackgroundResidual tumor is not always clinically apparent following biopsy of cutaneous carcinomas, which may prompt patients to question the need for definitive treatment. ObjectiveWe investigated the percentage of cases in which residual tumor was histologically present at the time of Mohs micrographic surgery (MMS) for basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) and investigated factors associated with residual tumor. MethodsWe examined 483 MMS cases performed for biopsy-proven BCC (n=287) and SCC (n=196) between October 2022 and April 2023. Single-stage MMS specimens were step-sectioned en face to exhaust the block. Univariate and multivariable logistic regression models were created. ResultsResidual tumor was identified in 83.3% of BCC and 66.8% of SCC at time of MMS (p=0.01). In patients clinically appearing tumor-free following biopsy, residual histologic tumor was identified in 68.2% of BCC and 41.5% of SCC. Residual tumor was significantly more likely in men (p=0.04), high-risk sites (p=0.002), smaller biopsy sizes (p=0.0003), and larger pre-operative sizes (p<0.0001). LimitationsSingle center, retrospective cohort ConclusionThe majority of patients with BCC and SCC have residual histologic tumor at the time of MMS, oftentimes even when tumor is not clinically apparent. Multiple factors impact the presence/absence of residual tumor.

Occurrence of contaminants of emerging concern in surface and waste water from the Yangtze River chemical contiguous zone, China: Distribution, sources and ecological risk assessment

Limited knowledge exists regarding the occurrence, potential sources, and risks of contaminants of emerging concern (CECs) in surface and waste water from chemical contiguous zones. A total of 136 CECs were detected at 32 sampling sites along the Yangtze River, with concentrations ranging from 0.55 to 4.21 × 104 ng/L. Hydrocortisonacetate, cortisone, prednisone, enalapril and medroxyprogesterone were detected across all sampling sites. Hierarchical cluster analysis based on 47 core CECs yielded similar results compared with principal components analysis and identified two major clusters: wastewater sites and surface water sites. Distinct patterns of CECs were observed in wastewater from three industrial parks owing to variations in the industrial facilities and products within each park. Nineteen CECs were initially classified as presenting a high or medium risk to aquatic organisms. Further quantitative probabilistic risk assessment revealed that caffeine, trenbolone and norethindrone posed a threat to the most vulnerable aquatic species while high-risk sites mainly occurred downstream of the chemical industrial park. The joint ecological risk of high-risk CECs was evaluated using potentially affected fractions, which ranged from 0.44 % to 47.9 % with concentration addition and 0.33 % to 45.1 % with response addition. This suggests the need to consider the joint ecological risk of the detected compounds in future studies.

Evaluation of the sentinel yellow fever surveillance system in Uganda, 2017–2022: strengths and weaknesses

BackgroundUganda has a sentinel surveillance system in seven high-risk sites to monitor yellow fever (YF) patterns and detect outbreaks. We evaluated the performance of this system from 2017 to 2022.MethodsWe evaluated selected attributes, including timeliness (lags between different critical time points), external completeness (proportion of expected sentinel sites reporting ≥ 1 suspect case in the system annually), and internal completeness (proportion of reports with the minimum required data elements filled), using secondary data in the YF surveillance database from January 2017–July 2022. We conducted key informant interviews with stakeholders at health facility and national level to assess usefulness, flexibility, simplicity, and acceptability of the surveillance system.ResultsIn total, 3,073 suspected and 15 confirmed YF cases were reported. The median time lag from sample collection to laboratory shipment was 37 days (IQR:21–54). External completeness was 76%; internal completeness was 65%. Stakeholders felt that the surveillance system was simple and acceptable, but were uncertain about flexibility. Most (71%) YF cases in previous outbreaks were detected through the sentinel surveillance system; data were used to inform interventions such as intensified YF vaccination.ConclusionThe YF sentinel surveillance system was useful in detecting outbreaks and informing public health action. Delays in case confirmation and incomplete data compromised its overall effectiveness and efficiency.

Distance of Biopsy-Confirmed High-Risk Breast Lesion from Concurrently Identified Breast Malignancy Associated with Risk of Carcinoma at the High-Risk Lesion Site.

High-risk breast lesions including incidental intraductal papilloma without atypia (IPA), lobular hyperplasia (LCIS or ALH), flat epithelial atypia (FEA) and complex sclerosing lesion (CSL) are not routinely excised due to low upgrade rates to carcinoma. We aim to identify features of these lesions predictive of upgrade when identified concurrently with invasive disease. Methods: A single-center retrospective cohort study was performed for patients who underwent multi-site lumpectomies with invasive disease at one site and a high-risk lesion at another site between 2006 and 2021. A multinomial logistic regression was performed. Results: Sixty-five patients met the inclusion criteria. Four patients (6.2%) had an upgrade to in situ disease (DCIS) and one (1.5%) to invasive carcinoma. Three upgraded high-risk lesions were ipsilateral to the concurrent carcinoma and two were contralateral. In the multivariate model, a high-risk lesion within 5 cm of an ipsilateral malignancy was associated with increased risk of upgrade. The 3.8% upgrade rate for high-risk lesions located greater than 5 cm from ipsilateral malignancy or in the contralateral breast suggests that omission of excisional biopsy may be considered. Excisional biopsy of lesions within 5 cm of ipsilateral malignancy is recommended given the 25% upgrade risk in our series.

A comparative analysis of risk prevention policy tools and governance structures in Normandy (France) and Victoria (Australia): Assessing policies for high-risk sites

High-risk industrial sites are classified as the most dangerous sites for their risk of inducing damage in case of an accident, even if it is rare. Risk policies are one way to prevent damage while balancing other trade-offs. How can public authorities assess “risk policy systems” of high-risk sites in specific administrative regimes for an effective decision process taking into consideration different jurisdictions? This paper investigates the Normandy and Victorian risk policy system in France and Australia, respectively, based on qualitative approaches. By investigating two cases and fostering conceptual thinking, two assessment criteria are highlighted by different stakeholders to determine an effective risk policy. For instance, beyond the common focus on the efficiency and efficacy of risk policies, findings revealed the importance of “dialogue, participation, and cooperation” between actors and “adaptivity, flexibility, relevance, and coherence” of different tools and legal texts. Limitations and further work include testing and iterating on other assessment criteria to propose an adapted assessment framework for high-risk policies.

Exploring the Nature of Arhopalus ferus (Coleoptera: Cerambycidae: Spondylidinae) Pheromone Attraction.

Cerambycid species of the Spondylidinae subfamily are distributed worldwide and are known for being prolific invaders that infest conifers. In New Zealand, Arhopalus ferus (Mulsant), the burnt pine longhorn beetle, is well-established and requires monitoring at high-risk sites such as ports, airports, and sawmills as part of the requirements to meet pine log export standards set by the New Zealand Ministry of Primary Industries (MPI). Currently, its surveillance relies on traps baited with host volatiles (i.e., ethanol and α-pinene). We used volatile collections from adult beetles, electroantennograms, and field trapping bioassays to identify the pheromones emitted by the burnt pine longhorn beetle A. ferus and their effects on its behaviour. We show that A. ferus males emit mainly (E)-fuscumol and geranylacetone, as well as the minor components, α-terpinene and p-mentha-1,3,8-triene, and that all four compounds elicit a dose-dependent response in antennae of both sexes. Traps baited with the binary combination of geranylacetone plus fuscumol captured significantly more female A. ferus than did unbaited traps in two of three field experiments. α-Terpinene did not affect A. ferus trap catches and effects of p-mentha-1,3,8-triene on trap catch were not determined. Our findings provide further evidence of the use of fuscumol and geranylacetone as aggregation-sex pheromones by longhorn beetles in the Spondylidinae subfamily, and suggest that their deployment in survey traps may improve the efficacy of A. ferus monitoring in New Zealand and elsewhere.

Stratified Treatment in Pediatric Anaplastic Large Cell Lymphoma: Result of a Prospective Open-Label Multiple-Institution Study.

The risk stratification of pediatric anaplastic large cell lymphoma (ALCL) has not been standardized. In this study, new risk factors were included to establish a new risk stratification system for ALCL, and its feasibility in clinical practice was explored. On the basis of the non-Hodgkin's lymphoma Berlin-Frankfurt-Munster 95 (NHL-BFM-95) protocol, patients with minimal disseminated disease (MDD), high-risk tumor site (multiple bone, skin, liver, and lung involvement), and small cell/lymphohistiocytic (SC/LH) pathological subtype were enrolled in risk stratification. Patients were treated with a modified NHL-BFM-95 protocol combined with an anaplastic lymphoma kinase inhibitor or vinblastine (VBL). A total of 136 patients were enrolled in this study. The median age was 8.8 years. The 3-year event-free survival (EFS) and overall survival of the entire cohort were 77.7% (95% confidence interval [CI], 69.0% to 83.9%) and 92.3% (95% CI, 86.1% to 95.8%), respectively. The 3-year EFS rates of low-risk group (R1), intermediate-risk group (R2), and high-risk group (R3) patients were 100%, 89.5% (95% CI, 76.5% to 95.5%), and 67.9% (95% CI, 55.4% to 77.6%), respectively. The prognosis of patients with MDD (+), stage IV cancer, SC/LH lymphoma, and high-risk sites was poor, and the 3-year EFS rates were 45.3% (95% CI, 68.6% to 19.0%), 65.7% (95% CI, 47.6% to 78.9%), 55.7% (95% CI, 26.2% to 77.5%), and 70.7% (95% CI, 48.6% to 84.6%), respectively. At the end of follow-up, one of the five patients who received maintenance therapy with VBL relapsed, and seven patients receiving anaplastic lymphoma kinase inhibitor maintenance therapy did not experience relapse. This study has confirmed the poor prognostic of MDD (+), high-risk site and SC/LH, but patients with SC/LH lymphoma and MDD (+) at diagnosis still need to receive better treatment (ClinicalTrials.gov number, NCT03971305).

An analysis of the social, cultural, and ecological factors that affect the implementation of biosecurity measures on smallholder commercial swine farms in Italy in the context of an emerging African Swine Fever outbreak

African Swine Fever (ASF) is a contagious viral disease that infects wild and domesticated swine. In early 2022, the virus was found in wild boar in the Apennine mountains of mainland Italy.22https://storymaps.arcgis.com/stories/9fe6aa3980ca438cb9c7e8d656358f35 Since then, it has spread from wild boar to domesticated swine. To control the spread of ASF, an effective surveillance system and the implementation of strict biosecurity measures on farms are required yet are unevenly implemented across husbandry systems. Smallholder farms in particular are known to have low levels of biosecurity. In the Apennine mountains of Italy, small commercial farms have been found to have low levels of biosecurity despite being located in areas with high densities of wild boar, and, hence, being high-risk sites for potential ASF incursion and subsequent diffusion. To address the question as to why the level of biosecurity is low, interviews and participant observation were conducted with smallholder commercial farmers. The interviews identified the social, cultural, and ecological factors that affect the implementation of biosecurity measures in small commercial swine farms in the Apennines. Farmers expressed knowledge of priority biosecurity measures and an overall willingness to follow rules and regulations; however, the application of the measures in practice was uneven across farms. Economic, political, and ecological factors as well as farmer beliefs about biosecurity emerged as important factors affecting the implementation of biosecurity measures. These include economic constraints, challenges posed by the mountain environment, a shifting regulatory environment, and ideas about animal welfare. Other important factors include cultural factors such as the use of traditional agricultural methods and norms about customer access to animals, time constraints and the perceived hassle of implementing the measures, farmer age, farmer relationships with government officials and veterinarians, and the role of pigs in reducing farm waste. The study confirmed that wild boar are present in high numbers and in close proximity to smallholder commercial farms in the Apennines.

Endocrine Disorders in Childhood Brain Tumour Survivors: A Single-Centre Study.

The study aims to determine the prevalence and risk factors for endocrine disorders in childhood brain tumour survivors. Included in the study were 124 childhood brain tumour survivors aged 18 years old or younger with either stable disease or in remission, and had survived for at least 2 years after diagnosis. Demographic data (age at diagnosis, gender, ethnicity, socioeconomic status), clinical clues for endocrine disorders, anthropometrics (weight, height, midparental height), pubertal staging, tumour-related characteristics, treatment modalities and endocrine laboratory measurements at diagnosis and during follow up were obtained. Logistic regression was applied to evaluate risk factors for endocrine disorders in childhood brain tumour survivors. The prevalence of endocrine disorders in childhood brain tumour survivors was 62.1%. The risk factors were high BMI [adjusted odds ratio (OR) 1.29, 95% CI: 1.12 to 1.5], high-risk site [adjusted odds ratio (OR) 7.15, 95% CI: 1.41 to 36.3] and chemotherapy [adjusted odds ratio (OR) 0.18, 95% CI: 0.05 to 0.62]. The prevalence of endocrine disorders in childhood brain tumour survivors in our centre was 62.1%. The significant risk factors were high BMI, tumour location (suprasellar and intrasellar) and chemotherapy.

Clinical implications of CSF-ctDNA positivity in newly diagnosed diffuse large B cell lymphoma.

The clinical implications of CSF-ctDNA positivity in newly diagnosed diffuse large B cell lymphoma (ND-DLBCL) remains largely unexplored. One hundredND-DLBCL patients were consecutively enrolled as training cohort and another 26 ND-DLBCL patients were prospectively enrolled in validation cohort. CSF-ctDNA positivity (CSF(+)) was identified in 25 patients (25.0%) in the training cohort and 7 patients (26.9%) in the validation cohort, extremely higher than CNS involvement rate detected by conventional methods. Patients with mutations of CARD11, JAK2, ID3, and PLCG2 were more predominant with CSF(+) while FAT4 mutations were negatively correlated with CSF(+). The downregulation of PI3K-AKT signaling, focal adhesion, actin cytoskeleton, and tight junction pathways were enriched in CSF(+) ND-DLBCL. Furthermore, pretreatment CSF(+) was significantly associated with poor outcomes. Three risk factors, including high CSF protein level, high plasma ctDNA burden, and involvement of high-risk sites were used to predict the risk of CSF(+) in ND-DLBCL. The sensitivity and specificity of pretreatment CSF-ctDNA to predict CNS relapse were 100% and 77.3%. Taken together, we firstly present the prevalence and the genomic and transcriptomic landscape for CSF-ctDNA(+) DLBCL and highlight the importance of CSF-ctDNA as a noninvasive biomarker in detecting and monitoring of CSF infiltration and predicting CNS relapse in DLBCL.

Estimating Landfill Landslide Probability Using SAR Satellite Products: A Novel Approach

This article presents a methodology for evaluating the susceptibility of landfill areas to develop landslides by analyzing Synthetic Aperture Radar (SAR) satellite products. The deformation velocity of the landfills is computed through the Persistent Scatterer Method on SAR imagery. These data, combined with a deformation model based on the shallow water equations (SWE), form the foundation for a Monte Carlo experiment that extrapolates the current state of the landfill into the future. The results of this simulation are then employed to determine the probability of a landslide occurrence. In order to validate the methodology effectiveness, a case study is conducted on a landfill in Zaldibar, Spain, revealing its effectiveness in estimating the probability of landfill landslides. This innovative approach emerges as an asset in large landfill management, acting as a proactive tool for identifying high-risk sites and preventing potential landslides, ultimately safeguarding human life and the environment. By providing insights into landslide probabilities, this study enhances decision-making processes and facilitates the development of intervention strategies in the domain of landfill risk assessment and management.

Insights into the risk of COVID-19 infection in urban neighborhood and its environmental influence factors:A novel approach

Many studies have dealt with the relationship between the built environment and COVID-19 infection in isolation. However, the research approaches were often inadequate in accurately reflecting the risk of COVID-19 infection. Therefore, we aim to develop a novel approach to study the risk of COVID-19 infection and its Environmental Influence Factors (EIFs) at the neighborhood scale. We constructed a multi-agent model of the spatial environment of residential quarters, including models of behavior and COVID-19 infection dynamics, and established 24 experimental schemes based on the Prevention and Control Measures (PCMs) of zonal control, mask-wearing, and outing frequency to simulate and assess the infection risk. The results show that the areas of accessible wood, hard surfaces, and seating are high-risk sites for infection. Zonal control and mask-wearing are effective PCMs, and the EIFs we set all play significant roles in influencing infection risk. Our study provides insight into the effects of PCMs and EIFs related to COVID-19 infection and highlights that the novel approach not only reveals the levels of infection risk and its mechanisms but also detects the spatio-temporal characteristics of behaviors and infection. This novel approach, dealing with individuals, space, environment, behavior, PCMs, and COVID-19 infection dynamics in integration, overcomes the limitations of traditional methods that overlook the influences of the spatio-temporal dynamics of individual behaviors and their environmental factors. It offers theoretical support for designing healthy outdoor built environments and technical support for the PCMs of the epidemic.