Local Incidence Research Articles

An inventory of greenhouse gas emissions due to natural gas pipeline incidents in the United States and Canada from 1980s to 2021

Natural gas is believed to be a critical transitional energy source. However, natural gas pipelines, once failed, will contribute to a large amount of greenhouse gas (GHG) emissions, including methane from uncontrolled natural gas venting and carbon dioxide from flared natural gas. However, the GHG emissions caused by pipeline incidents are not included in the regular inventories, making the counted GHG amount deviate from the reality. This study, for the first time, establishes an inventory framework for GHG emissions including all natural gas pipeline incidents in the two of the largest gas producers and consumers in North America (United States and Canada) from 1980s to 2021. The inventory comprises GHG emissions resulting from gathering and transmission pipeline incidents in a total of 24 states or regions in the United States between 1970 and 2021, local distribution pipeline incidents in 22 states or regions between 1970 and 2021, as well as natural gas pipeline incidents in a total of 7 provinces or regions in Canada between 1979 and 2021. These datasets can improve the accuracy of regular emission inventories by covering more emission sources in the United States and Canada and provide essential information for climate-oriented pipeline integrity management.

Brown carbon absorption in the Mediterranean basin from local and long-range transported biomass burning air masses

This study examines the impact of light absorption from biomass burning (BB) brown carbon (BrC) in the Mediterranean basin from local and distant fire incidents during a typical fire season in August 2019 and under severe fire activity in August 2021. The approaches of Saleh et al. (2014) and Wang et al. (2018) are used to describe the BrC absorption within the WRF-Chem model. Focusing on three regions in the Mediterranean (around the islands of Sicily, Malta, and Crete) that are most affected by BB activity, BrC absorption approximates 5 Mm−1 in OC concentrations up to 3 μg m−3 and can approach 15 Mm−1 in extreme conditions (up to 10 μg m−3). When photochemical bleaching is considered, BrC undergoes almost immediate bleaching upon emission due to high levels of OH radical in the Mediterranean atmosphere during summertime, decreasing light absorption between 56% and 75% under both average and extreme BB conditions. Cloud formation is facilitated above the PBL due to moisture increase induced by BrC at the area of fire events, while transported drier and warmer air masses tend to dissipate cloud formation further away from the BB source. The impact of BrC absorption on irradiances is small (up to −6 W m−2 in extreme conditions) and is often overlapped by the absorption from water vapour variations. BrC direct radiative effect (DRE) is estimated at 0.04 W m−2 (∼10% of BC) in average and 0.18 W m−2 in extreme BB activity under clear sky. Under all sky, low-level clouds dissipation in 2019 with average BB emissions enhances DRE (at 0.15 W m−2), while the higher clouds dissipation in 2021 limits DRE (at 0.11 W m−2) resulting in lower DRE despite the extreme BB conditions.

Spatial Internet Spillovers in Manufacturing

Does local internet diffusion spur manufacturing performance in developing countries? To answer this question, we conduct instrumental variable estimations, using repeated cross-section data on 44,073 manufacturing firms from 109 developing and transition economies, and find large positive spillover effects of local email incidence on manufacturing firms sales and sales per worker. This evidence is driven by the local dissemination of email technology within industries rather than across industries. However, further analysis stresses that inter-industry spillovers are actually U-shaped, that is, negative at low email incidence rates but turning positive once incidence reaches approximately 50% of the local universe of firms. This suggests that local internet spillovers across industries are subject to network effects. Last, these threshold effects seem related to the presence of outward-oriented firms, which are known to exhibit higher digital absorptive capacity. Overall, this paper shows that local industrialisation paces may strongly diverge between poorly and highly digitalised environments.

The COVID-19 shock and consumer credit: Evidence from credit card data

We study the dynamic effect of the COVID-19 shock on credit card use in 2020. Local case incidence had a strong negative effect on credit card spending in the early months of the pandemic, which diminished over time. This time-varying pattern was driven by the fear of the virus, rather than government support programs, consistent with the “pandemic fatigue” of consumers. Local pandemic severity also had a strong effect on credit card repayments. These spending and repayment effects offset each other, resulting in no effect on credit card borrowing, consistent with credit-smoothing behavior. The local stringency of nonpharmaceutical interventions also had a negative effect on spending and repayments, albeit smaller in magnitude. We conclude that the pandemic itself was a more important driver of changes in credit card use than the public health policy response.

Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan Africa.

The Global AIDS Strategy 2021-2026 identifies adolescent girls and young women (AGYW) as a priority population for HIV prevention, and recommends differentiating intervention portfolios geographically based on local HIV incidence and individual risk behaviours. We estimated prevalence of HIV risk behaviours and associated HIV incidence at health district level among AGYW living in 13 countries in sub-Saharan Africa. We analysed 46 geospatially-referenced national household surveys conducted between 1999-2018 across 13 high HIV burden countries in sub-Saharan Africa. Female survey respondents aged 15-29 years were classified into four risk groups (not sexually active, cohabiting, non-regular or multiple partner[s] and female sex workers [FSW]) based on reported sexual behaviour. We used a Bayesian spatio-temporal multinomial regression model to estimate the proportion of AGYW in each risk group stratified by district, year, and five-year age group. Using subnational estimates of HIV prevalence and incidence produced by countries with support from UNAIDS, we estimated new HIV infections in each risk group by district and age group. We then assessed the efficiency of prioritising interventions according to risk group. Data consisted of 274,970 female survey respondents aged 15-29. Among women aged 20-29, cohabiting (63.1%) was more common in eastern Africa than non-regular or multiple partner(s) (21.3%), while in southern countries non-regular or multiple partner(s) (58.9%) were more common than cohabiting (23.4%). Risk group proportions varied substantially across age groups (65.9% of total variation explained), countries (20.9%), and between districts within each country (11.3%), but changed little over time (0.9%). Prioritisation based on behavioural risk, in combination with location- and age-based prioritisation, reduced the proportion of population required to be reached in order to find half of all expected new infections from 19.4% to 10.6%. FSW were 1.3% of the population but 10.6% of all expected new infections. Our risk group estimates provide data for HIV programmes to set targets and implement differentiated prevention strategies outlined in the Global AIDS Strategy. Successfully implementing this approach would result in more efficiently reaching substantially more of those at risk for infections.

Preparing for future cyber crises: lessons from governance of the coronavirus pandemic

The SARS-CoV-2 pandemic has had an immense impact on public policy and the management of risks that threaten critical systems, such as national health services. Drawing on perspectives from multiple disciplines, this article considers lessons-learned with respect to mitigating the threats to critical systems and societal harms presented by the proliferation of malware. The article dovetails crisis management with cyber resilience, for the purpose of analyzing transferable good-practices and areas-for-improvement, drawing on preparedness and response strategies deployed in public policymaking in the United Kingdom during the pandemic. Reflecting on key national and local ransomware incidents that have impacted key services, the article offers a post-SARS-CoV-2 review of recent British strategic outputs with respect to cyber resilience; most notably the National Cyber Security Strategy and the Government Cyber Security Strategy. The article focuses on lessons that may be learned with respect to communications strategies. The article argues that although the recent British cyber-security strategies hold significant promise in terms of improving preparedness, response and recovery in relation to future cyber crisis, nuanced, dynamic and empathetic multi-stakeholder engagement will be required in order to meaningfully implement the measures outlined in the strategy documents.

Disaster Psychiatry Needs You: How to Get Involved

Disaster Psychiatry Needs You: How to Get Involved

Similar local recurrence and survival in patients with T1 radial growth phase melanoma on head and neck treated with 5 or 10 mm margins: A retrospective study.

Melanoma guidelines recommend surgical excision with 10 mm margins for T1 melanomas (invasive melanomas with Breslow thickness ≤1 mm), including those in radial growth phase, which are without metastatic potential; however, such margins may be problematic on head-and-neck. We compared outcomes of wide (10 mm margins) versus narrow (5 mm margins) excisions in patients with radial growth phase T1 melanoma on head-and-neck including face. We retrospectively examined 610 consecutive patients excised with wide versus narrow margins, from 2001 to 2018, at six European centres. In all cases, radial growth phase, and clear margins with 5 or 10 mm of clearance, were ascertained histologically. Multivariable models investigated associations of margins and other factors with overall survival and local recurrence. Three hundred and sixteen (51.8%) patients received wide excision, 219 (69.3%) with primary wound closure, 97 (30.7%) with reconstruction; 294 (48.2%) patients received narrow excision, 264 (89.8%) with primary wound closure, 30 (10.2%) with reconstruction (p < 0.001). Median follow-ups were 88 months (wide) and 187 months (narrow) (inter-quartile ranges 43-133 and 79-206, respectively). Ten-year overall survival (95% confidence interval) was 96.7% (94.2%-99.3%) in wide and 98.2% (96.4%-100%) in narrow patients. Ten-year local recurrence incidence was 6.4% (4.1%-10.1%) in wide and 7.8% (5.3%-11.6%) in narrow groups. Lentigo maligna melanoma subtype appeared associated with increased risk of local recurrence in narrow versus wide patients (15.0% vs. 7.5%; p=0.190). Narrower excision margins for T1 radial growth phase melanoma are not associated with worse overall survival (hazard ratio 0.97, p=0.996) or increased local recurrence (subdistribution hazard ratio: 0.87; p=0.751) compared to wider margins, and may be safely applied to such lesions, although caution may be required in the presence of lentigo maligna melanoma.

Horse and Cattle-Related Trauma: A Retrospective Review of Injuries and Management in a Regional Queensland Hospital.

Horse and cattle-related trauma is a common presentation to regional hospitals in Australia. We review local incidence and patterns of injuries relating to horse and cattle trauma over a three-year period at the Toowoomba Base Hospital within the Darling Downs region in Queensland, an area rich in cattle farming and equestrian recreation. We conducted a single-centre retrospective cohort study. The inclusion criteria were all patients presenting with injuries following cattle or horse-related incidents between January 2018 and April 2021. Primary outcomes were the mechanism of trauma, confirmed injuries, and the need for admission, operative intervention, or inter-hospital transfer. A total of 1002 individuals (55% female; mean age 34 years; median Injury Severity Score (ISS) 2) were identified during the study period. Presentations relating to horses (81%) were more frequent than cattle (19%). The most common mechanism of injury was "falling" for horse incidents (68%)and "trampling" for cattle incidents (40%). Horse incidents often resulted in soft tissue injury (55%), upper limb fracture (19%), or lower limb fracture (9%). Cattle incidents often resulted in soft tissue injury (57%), upper limb fracture (15%), and rib fracture (15%). Overall, 14% required admission, 13% required operative intervention, and 1% required inter-hospital transfer. This local series demonstrates a high volume of cattle and horse-related trauma in our region. Whilst most patients are managed locally without operative intervention, the high frequency of injuries observed necessitates further development of preventative measures and safety advocacy.

Current scenario of recently rising up cases of invasive group A streptococcal (iGAS) infections in younger children in many European nations: clinical management and prospective counteracting measures – an update

Current scenario of recently rising up cases of invasive group A streptococcal (iGAS) infections in younger children in many European nations: clinical management and prospective counteracting measures – an update

Abstract PD6-10: PD6-10 The impact of post mastectomy radiation therapy on clinical outcomes of male breast cancer: A meta-analysis of comparative studies

Abstract Background/Rationale: Male breast cancer accounts for less than 1 percent of all cancer diagnoses in men. Because it is rare, it does not lend itself to large, randomized trials. In general, the approach to the treatment of early, non-metastatic male breast cancer has largely been extrapolated from female breast cancer trials. Specifically, the data on early-stage post mastectomy radiation therapy (PMRT) is limited, and its benefits remain unclear. Objectives: We conducted this meta-analysis to determine the impact of PMRT on clinical outcomes of men with breast cancer. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language, diagnosis of invasive non-metastatic male breast cancer (MBC), comparative studies of PMRT versus none, and studies that reported the incidence of local and distant recurrences as well as survival data in the compared arms. A meta-analysis using the Mantel-Haenszel method for calculating the weighted pooled relative risk (RR) under the fixed effects model. Subsequently, the heterogeneity statistic gets incorporated to calculate the summary RR under the random effects model. Results: Ten retrospective comparative studies with 3912 patients were included and analyzed. Eight studies reported survival data. Six and three studies reported local and distant recurrence incidence, respectively. PMRT did not have an impact on overall survival or distant recurrences. However, PMRT significantly lowered the RR of locoregional recurrences (RR=0.53, 95%CI 0.31-0.92). In addition, when survival was analyzed by TNM stage and N status, PMRT was found to have a significant reduction in RR of death in stage III (RR=0.85, 95%CI 0.75-0.97), N1 (RR=0.77, 95%CI 0.61-0.98), and N2 (RR=0.61, 95%CI 0.49-0.78) disease. Conclusions: This is the first meta-analysis to show that PMRT is associated with a lower relative risk of death in stage III MBC as well as N1 and N2 disease. It also demonstrates a significant reduction in RR of locoregional recurrences. In the absence of randomized clinical trials, it represents the most compelling data supporting the use of PMRT in this MBC patient population. Citation Format: Philip A. Haddad, Usman Zaheer. PD6-10 The impact of post mastectomy radiation therapy on clinical outcomes of male breast cancer: A meta-analysis of comparative studies [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD6-10.

A regionally adapted HRM-based technique to screen MMACHC carriers for methylmalonic acidemia with homocystinuria in Shandong Province, China.

Methylmalonic acidemia with homocystinuria (MMA-cblC) is an autosomal recessive genetic disorder of organic acid metabolism. Shandong, a northern province of China, has a significantly high incidence of about 1/4,000, suggesting a high carrying rate among the local population. The current study established a PCR technique involving high-resolution melting (HRM) to screen for carriers based on hotspot mutation analysis to further develop a preventive strategy to reduce the local incidence of this rare disease. Whole-exome sequencing of 22 families with MMA-cblC and a comprehensive literature review were used to identify MMACHC hotspot mutations in Shandong Province. Subsequently, a PCR-HRM assay based on the selected mutations was established and optimized for large-scale hotspot mutation screening. The accuracy and efficiency of the screening technique was validated using samples from 69 individuals with MMA-cblC and 1,000 healthy volunteers. Six hotspot mutations in the MMACHC gene (c.609G>A, c.658_660delAAG, c.80A>G, c.217C>T, c.567dupT and c.482G>A), which account for 74% of the alleles associated with MMA-cblC, were used to establish a screening technique. The established PCR-HRM assay detected 88 MMACHC mutation alleles in a validation study with 100% accuracy. In the general population in Shandong, the carrying rate of 6 MMACHC hotspot mutations was 3.4%. In conclusion, the 6 hotspots identified cover the majority of the MMACHC mutation spectrum, and the Shandong population has a particularly high carrying rate of MMACHC mutations. The PCR-HRM assay is highly accurate, cost-effective, and easy to use, making it an ideal choice for mass carrier screening.

Nurses' attitudes and barriers to incident reporting in Malta's acute general hospital

Although the science of patient safety has been developed and implemented widely, there remains a large gap in the understanding of the chain of events that lead to safety incidents, as well as their cost to patients, healthcare staff and the organisation as a whole. The aim of the study was to evaluate nurses' knowledge and awareness of the local incident reporting system at Malta's acute general hospital. A quantitative, descriptive cross-sectional design was used and data were collected from nurses through an online survey. A total of 323 questionnaires were received with a response rate of 23%. Various shortages within the local setting were identified, including lack of feedback and awareness of the system. Therefore, it is suggested that incident reporting should be given a higher profile on the organisation's agenda and incorporate employed members of staff rather than volunteers.

Cardiovascular Imaging in Women with Heart Diseases, A local Clinical Practice Guidelines for Pakistani Population

This is the first time that a local preliminary document on gender differences in CVDs has been initiated in Pakistan. International forum has been highlighting significant gender and ethnicity in CVDs. So different countries from world took the initiative to develop their local guideline or clinical scientific statements on gender differences with different socio-cultural and educational background for their own countries. GRFW in collaboration with Scientific Council of Women with Heart Disease PCS Pakistan floated this idea to develop a local guideline in various aspects CVDs for our own women population. In this regard different topics were assigned to different groups including mostly female cardiologists, senior gynecologists/obstetricians and radiologist from all over Pakistan. Primary objectives of this write up on Cardiac Imaging in Women is to provide a local clinical practice guideline for the assessment and management of CVD that will improve and standardize the physicians’ decision making for Pakistani women population. In the setting of growing awareness of providing personalized precision medicine, addressing sex differences in CVD is a key goal. The intention is to inform cardiologists, non-cardiologist physicians’, general practitioners, and, obstetrician/gynecologists about the reasonable use and understanding of technologies to help in proper approach to their treating women with HDs and when to send them for cardiac specialist diagnostic center. As we could not find our own local data on cardiac imaging to report at present, most recommendations on cardiac imaging used has been taken from international literatures (which we have found feasible, readily available, and some cost effective approach in our money constraint society which can be followed in our population) and also which were published within the past decade were given priority. In this document, we discuss the role of using different cardiac imaging modalities, with a focus on diseases which are unique/or occur more in women. So, five women specific topics more commonly seen in our population were selected currently, which are (stable/unstable angina and ACS, MINOCA), non-ischemic CMP, HD during pregnancy, cardio-oncology, and connective tissue diseases (CTD). In these topics we have tried to used our own local incidences and prevalence of these diseases in our community/internationally on gender basis and have highlighted the availability/limitations of cardiac imaging in our society. The updated recommendations in women have been taken from international guidelines. Graphs and tables layout has been taken from abroad literatures and made some few changes according to its use in our population. You will find this a preliminary review document which will be simple to read, have updated approach in evaluating the diagnosis of HD in women easily. For current cost effectiveness issues for our population will be taken up by PCS to Health ministries of Pakistan for its making it easily availability with cheap cost so to benefit our female (very neglected and ill informed) with CVD population.

Radiosurgery of limited brain metastases from primary solid tumor: results of the randomized phase III trial (NCT02355613) comparing treatments executed with a specialized or a C-arm linac-based platform

BackgroundComparative prospective data regarding different radiosurgery (SRS) modalities for treating brain metastases (BMs) from solid tumors are not available. To investigate with a single institute phase III randomized trial whether SRS executed with linac (Arm-B) is superior to a dedicated multi-source gamma-ray stereotactic platform (Arm-A).MethodsAdults patients with 1–4 BMs from solid tumors up to 30 mm in maximum diameter were randomly assigned to arms A and B. The primary endpoint was cumulative incidence of symptomatic (grade 2–3) radionecrosis (CIRN). Secondary endpoints were local progression cumulative incidence (CILP), distant brain failure, disease-free survival (DFS), and overall survival (OS).ResultsA total of 251 patients were randomly assigned to Arm-A (121) or Arm-B (130). The 1-year RN cumulative incidence was 6.7% in whole cohort, 3.8% (95% CI 1.9–7.4%) in Arm-B, and 9.3% (95% CI 6.2–13.8%) in the Arm-A (p = 0.43). CIRN was influenced by target volume irradiated only for the Arm-A (p << 0.001; HR 1.36 [95% CI 1.25–1.48]). Symptomatic RN occurred in 56 cases at a median time of 10.3 months (range 1.15–54.8 months), 27 in the Arm-B at a median time of 15.9 months (range 4.9–54.8 months), and 29 in the Arm-A at a median time of 6.9 months (1.2–32.3 months), without statistically significant differences between the two arms. No statistically significant differences were recorded between the two arms in CILP, BDF, DFS or OS. The mean beam-on time to deliver SRS was 49.0 ± 36.2 min in Arm-A, and 3.1 ± 1.6 min in Arm-B.ConclusionsGiven the technical differences between the treatment platforms investigated in this single-institution study, linac-based SRS (Arm-B) did not lead to significantly lower grade 2–3 RN rates versus the multi-source gamma-ray system (Arm-A) in a population of patients with limited brain metastases of small volume. No significant difference in local control was observed between both arms. For Arm-B, the treatment delivery time was significantly lower than for Arm-A.Trial registration: ClinicalTrials.gov Identifier NCT02355613.

Fast Nonlinear Static Aeroelasticity Method for High-Aspect-Ratio Wings at Different Mach Regimes

A low-computational-cost method is proposed in this paper to predict steady-state nonlinear aeroelastic response for high-aspect-ratio wings. This fast nonlinear static aeroelasticity method relies on a simple but robust mathematical approach. The work presented in this paper evaluates the accuracy of a nonlinear aerodynamic method on a large range of Mach numbers for a geometry representative of a typical industrial high-aspect-ratio-wing aircraft. The robustness of the method relies on the accurate estimation of the local pressure field based on an aerodynamic database using a local incidence estimated with a vortex lattice method. The database can be filled with flight test, wind tunnel test, or high-fidelity numerical simulation. The structural deformation is provided by a coupled aeroelastic high-fidelity numerical simulation, and so this paper focuses mainly on the development and validation of the aerodynamic model. Then, the flexible coefficients of the wing are compared to the high-fidelity aeroelastic numerical simulations for a set of Mach numbers ranging from subsonic to transonic conditions. The results presented in this paper show that the present method is very accurate for low-Mach-number regimes (error is lower than 1% on lift), and it is also adapted to transonic flow regimes because the error on lift is lower than 5%. For high Mach numbers, the current solution commits larger errors on drag and pitching moment coefficients.

Local infectious disease experience influences vaccine refusal rates: a natural experiment.

Vaccination has been critical to the decline in infectious disease prevalence in recent centuries. Nonetheless, vaccine refusal has increased in recent years, with complacency associated with reductions in disease prevalence highlighted as an important contributor. We exploit a natural experiment in Glasgow at the beginning of the twentieth century to investigate whether prior local experience of an infectious disease matters for vaccination decisions. Our study is based on smallpox surveillance data and administrative records of parental refusal to vaccinate their infants. We analyse variation between administrative units of Glasgow in cases and deaths from smallpox during two epidemics over the period 1900-1904, and vaccine refusal following its legalization in Scotland in 1907 after a long period of compulsory vaccination. We find that lower local disease incidence and mortality during the epidemics were associated with higher rates of subsequent vaccine refusal. This finding indicates that complacency influenced vaccination decisions in periods of higher infectious disease risk, responding to local prior experience of the relevant disease, and has not emerged solely in the context of the generally low levels of infectious disease risk of recent decades. These results suggest that vaccine delivery strategies may benefit from information on local variation in incidence.

Sodium nitrite ingestion in Singapore – a case report

Sodium nitrite is a strong oxidising agent with multiple industrial uses. Ingestion of a small dose can cause death rapidly through the formation of methaemoglobin and nitric oxide. Globally, while deaths due to sodium nitrite ingestion have been sporadic and tended to be accidental, the frequency of deaths due to purposeful ingestions is increasing. Local incidences of sodium nitrite ingestion in Singapore remain rare. We present a case report of a death due to sodium nitrite ingestion in Singapore, the challenges faced, and the various diagnostic approaches to sodium nitrite toxicity.

Prophylaxis of Invasive Fungal Infection in Neonates: A Narrative Review for Practical Purposes

Candida albicans is the most frequent cause of invasive fungal disease in preterm and/or low birth weight neonates, followed by Candida parapsilosis, whilst infections from other species are rare. Considering the severity of the disease, associated with poor clinical signs and diagnostic difficulties, primary prophylaxis becomes relevant. This paper summarizes the pathogenesis and clinical presentation of invasive candidiasis in neonates, focusing on prophylaxis. For late onset invasive disease, e.g., those occurring after the 3rd (or 7th according to some definitions) day of life possible approaches are the use of fluconazole, recommended in case of weight <1000 g or <1500 g if the local incidence of invasive candidiasis is higher than 2%, or the use of nystatin (for patients < 1500 g). Micafungin must be used in case of colonization by Candida auris, or in centers with a high prevalence of this pathogen. Concurrently, correct management of the central venous catheter and isolation procedures, with special regard to patients colonized by resistant strains, are fundamental. Other approaches such as reduced use of H2 blockers and broad-spectrum antibiotics (e.g., 3rd generation cephalosporins or carbapenems) and promotion of breast feeding proved useful. Reduction of early-onset infections (those occurring in the first 3 days of life) can also be obtained by treating maternal vulvo-vaginal candidiasis, which can represent a fastidious problem during pregnancy. In this case, topic azoles (the only recommendable treatment) can represent a kind of "prophylaxis" of early neonatal candidiasis. However, it must always be remembered that prophylaxis reduces the risk of invasive candidiasis but can not completely eliminate its occurrence, with the parallel risk of selecting for antifungal-resistant strains. Clinicians must maintain a high level of suspicion to start an appropriate therapy and strict epidemiological surveillance to identify the occurrence of clusters and the appearance of strains resistant to prophylaxis.

Comparison of endovenous laser ablation and conservative treatment in acute thrombophlebitis of the varicose great saphenous vein: rationale, design and first results of clinical trial

Thrombophlebitis of the superficial lower limb veins is one of the most common complications of chronic vein disease. Nowadays a long-term (at least 45 days) subcutaneous injection of fondaparinux sodium or heparin in combination with elastic compression of the limb is recommended for treatment of superficial vein thrombosis with a moderate risk of thrombus propagation to deep venous system. However, long-term use of anticoagulants is not always possible and sometimes contraindicated. Endovenous laser ablation (EVLA) around thrombus-free junction of great or small saphenous veins without subsequent long-term use of anticoagulants seems to be a promising intervention for treatment of acute thrombophlebitis of varicose superficial veins.The prospective single-center randomized open-label clinical trial was dedicated for comparison the efficacy and safety of three following treatments options for patients with acute thrombosis of the varicose great saphenous vein and location of thrombi in the trunk and/ or its large inflows: EVLA close to saphenous vein junction without anticoagulation, EVLA and 7 days of anticoagulation and noninvasive treatment with anticoagulation for 45 days (subcutaneous injections of the fondaparinux 2,5 mg). Class 2 compression stockings are used in all patients. Adverse outcomes are recorded at 7, 45 and 90 days after randomization. These include the progression of superficial vein thrombosis, recurrent superficial vein thrombosis, thrombosis involvement of the superficial segment of the perforating vein up to the fascia, deep vein thrombosis according to compression ultrasound, and pulmonary embolism with symptoms. Bleedings according to the World Society of Thrombosis and Hemostasis and the Academic Research Consortium classification as well other complications are also recorded. The first 30 patients included in the study have a low incidence of venous thrombosis risk factors and localization of the thrombus relatively far from the saphenofemoral junction. EVLA resulted in persistent cessation of venous blood flow at the intervention site. New episodes of venous thrombosis were noted only in the group of medical treatment — deep vein thrombosis of the contralateral tibia 5 days after stopping of 45-day treatment with fondaparinux and thrombus in the recanalized inflow of the great saphenous vein without involving its trunk at the 21st day after stopping of 45-day injection of fondaparinux. There were no complications in the area of intervention and bleedings.