Low-risk Sites Research Articles

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 .

Clinical versus Histological Assessment of Basal Cell Carcinoma Subtype and Thickness of Tumours Selected for Photodynamic Therapy.

Photodynamic therapy is an approved treatment for primary, superficial, and small nodular basal cell carcinomas with a thickness of < 2 mm located on low-risk sites. Histologically verified basal cell carcinomas clinically assessed as suited for photodynamic therapy were included. The study aimed to investigate the agreement between clinical and histological assessments of basal cell carcinoma subtypes and thickness of tumours selected for photodynamic therapy with histopathological evaluation as a reference. A total of 343 tumours were included. The agreement between clinical and histological diagnosis of basal cell carcinoma subtype was 72% (p < 0.001). Clinical assessment of subtype had a sensitivity of 93% and specificity of 55% for superficial tumours and a sensitivity of 55% and specificity of 85% for nodular tumours. The mean ± SD thickness values by clinical and histological assessments were 0.95 ± 0.53 and 0.86 ± 0.75. The difference of 0.09 mm was statistically significant (p = 0.017), but not considered to be clinically relevant, although the differences between specific subgroups could be relevant. Among basal cell carcinomas clinically diagnosed as superficial, 91% were histologically consistent with the current photodynamic therapy criteria. The main results suggest that histopathological evaluation should precede photodynamic therapy to ensure selection of suitable basal cell carcinomas. In selected cases, the clinical diagnosis alone may be adequate before proceeding with photodynamic therapy.

Large ulcerated hemangioma treated with topical timolol drops

Infantile hemangiomas (IH) are the most common benign tumors of infancy and undergo spontaneous remission by about four to five years of age. Usually, only superficial and uncomplicated hemangiomas are treated by topical timolol while larger and complicated hemangiomas require oral propranolol or corticosteroids. Uncommonly reported in the literature is that even larger complicated IHs on low-risk sites can be treated with timolol drops locally. Our case is unique, as we treated a large ulcerated IH with oral and topical antibiotics and only topical timolol drops with rapid and complete resolution of symptoms.

Ecological Suitability Assessment Methods of Waste Pile-Up along Railway Routes Based on Machine Learning Algorithms

Waste pile-up along railway routes poses an important threat to the regional ecological environment. However, there is a lack of methods that assess the ecological suitability of waste pile-up (ESWP) at a macro scale, which is crucial for informed decision-making. We define the ESWP and propose a methodology to measure the level of ESWP along railway routes. Specifically, we focus on the Ya’an to Nyingchi section of the railway, selecting a 30-km buffer zone on either side as the study area. To develop ESWP maps, we employed Landsat 8, digital elevation model (DEM), soil database, land use, and meteorological data. We tested 3 machine learning methods—random forest (RF), deep neural network (DNN), and extreme gradient boosting (XGBoost)—using 7 key indicators as input parameters. The performance of these models was evaluated using overall accuracy and the Kappa index. Additionally, we analyzed the relative importance of each indicator on the results. The study reached the following results: Firstly, the combination of selected indicators with machine learning methods effectively assesses the ESWP along railways. Secondly, among the tested methods, DNN demonstrated superior performance, achieving an accuracy of 86.49%, outperforming RF (80.31%) and XGBoost (79.54%). Thirdly, the indicators with the greatest impact on the assessment were biological richness (weight is 0.23), vegetation coverage (weight is 0.20), and soil nutrients (weight is 0.16). These findings provide a novel approach to assessing the ecological suitability and identifying low-risk sites for waste pile-up along railway routes.

Preoperative predictors for recurrence sites associated with poor post-recurrence survival after surgery of non-small cell lung cancer: a multicenter study

BackgroundThe recurrence site that influences post-recurrence survival (PRS) in patients with non-small cell lung cancer (NSCLC) undergoing surgery and the preoperative predictors of recurrence remain unclear.MethodsCohorts 1 and 2 had 4520 (who underwent complete resection for p-stage 0-IIIA NSCLC) and 727 (who experienced recurrence after surgery) patients, respectively. The initial sites of recurrence were the lungs (309 cases), thoracic lymph nodes (225 cases), pleura (112 cases), bone (110 cases), central nervous system (86 cases), adrenal gland (25 cases), abdomen (60 cases), cervical and axillary lymph nodes (38 cases), chest wall (13 cases), skin (5 cases), and eye and tongue (3 cases). For cohort 2 analysis, the initial recurrence site that resulted in poor PRS was analyzed by multivariable analysis using a Cox proportional hazard model. For cohort 1 analysis, the preoperative predictors of recurrence patterns with poor PRS were analyzed by multivariable analysis using a logistic regression model.ResultsIn cohort 2 analysis, recurrence in the central nervous system (hazard ratio [HR], 1.70; p < 0.001), bone (HR, 1.75; p < 0.001), abdomen (HR, 2.39; p < 0.001), and pleura (HR, 1.69; p < 0.001) were independent poor prognostic recurrent sites for PRS and they were high-risk sites (HRS). Intrathoracic lymph nodes, cervical and axillary lymph nodes, lungs, chest wall, adrenal gland, eye and tongue, and skin were low-risk sites (LRS) that did not affect PRS. Patients with multiple LRS without HRS recurrence had a worse prognosis than those with a single LRS without HRS recurrence (5-year PRS 20.2% vs. 37.7%, p < 0.001) and were comparable to those with HRS recurrence (p = 1.000). In cohort 1 analysis, preoperative predictors for HRS and multiple LRS recurrences were positron emission tomography (PET) maximum standardized uptake value (maxSUV) ≥ 3.2 (HR, 5.09; p < 0.001), clinical nodal metastasis (HR, 2.00; p < 0.001), tumor size ≥ 2.4 cm (HR, 1.96; p < 0.001) and carcinoembryonic antigen (CEA) ≥ 5 ng/ml (HR, 1.41; p = 0.004). The cumulative incidence rates of HRS and multiple LRS recurrences within 5 years were 55.9%, 40.9%, 26.3%, 11.1%, and 3.5% (p < 0.001) in patients with 4, 3, 2, 1 and 0 of the above risks, respectively.ConclusionsHRS and multiple LRS were vital recurrences associated with poor PRS. Preoperative PET maxSUV, clinical nodal metastasis, tumor size, and CEA level predicted the incidence of vital recurrence.

Mortality among persons with epilepsy in onchocerciasis-endemic and non-endemic areas of sub-Saharan Africa: A systematic review and meta-analysis

To document epilepsy-related mortality in sub-Saharan Africa (SSA) and investigate possible associations with onchocerciasis endemicity. Systematic review with meta-analysis. Searches were performed in PubMed and Google Scholar (search terms: 'epilepsy'; 'mortality/death'; 'sub-Saharan Africa'). Included studies were classified as high-risk or low-risk for onchocerciasis based on documented endemicity data. Pooled mortality rates and annual case fatality rates (CFR) were calculated, and risk factors for mortality among persons with epilepsy (PWE) were investigated using meta-regression analysis. The 28 eligible studies reported 30 epilepsy surveys, of which 9 (30.0%) were conducted in onchocerciasis high-risk sites. The pooled epilepsy mortality rate was 20.9 (95% CI: 5.9-74.4) per 100,000 person-years, and the pooled CFR was 36.2 (95% CI: 23.9-54.4) per 1,000 PWE per year, albeit with substantial between-study heterogeneity. Compared to onchocerciasis low-risk sites, high-risk sites had higher pooled mortality (342.9 versus 10.0 per 100,000 PY; p<0.001) and CFR (57.0 versus 26.6 per 1,000 PWE per year; p=0.001). Mortality of PWE was almost five-fold that of people without epilepsy (mortality risk ratio: 4.9; 95% CI: 3.5-6.8). Studies in onchocerciasis high-risk sites and the study which recruited only PWE with nodding syndrome were associated with higher CFR (p=0.044 and p=0.002, respectively). The leading causes of epilepsy-related death were status epilepticus (58.5%), drowning (15.7%), and sudden unexpected death in epilepsy (10.1%). Epilepsy mortality remains high in SSA. Most reported causes of death among PWE might be averted by improving seizure control. Better epilepsy prevention and care are urgently needed, particularly in onchocerciasis-endemic settings.

Incidence, risk factors, and burden of incisional hernia repair after abdominal surgery in France: a nationwide study

PurposeIncisional hernias are common after laparotomies. The aims of this study were to assess the rate of incisional hernia repair after abdominal surgery, recurrence rate, hospital costs, and risk factors, in France.MethodsThis national, retrospective, longitudinal, observational study was based on the exhaustive hospital discharge database (PMSI). All adult patients (≥ 18 years old) hospitalised for an abdominal surgical procedure between 01-01-2013 and 31-12-2014 and hospitalised for incisional hernia repair within five years were included. Descriptive analyses and cost analyses from the National Health Insurance (NHI) viewpoint (hospital care for the hernia repair) were performed. To identify risk factors for hernia repair a multivariable Cox model and a machine learning analysis were performed.ResultsIn 2013–2014, 710074 patients underwent abdominal surgery, of which 32633 (4.6%) and 5117 (0.7%) had ≥ 1 and ≥ 2 incisional hernia repair(s) within five years, respectively. Mean hospital costs amounted to €4153/hernia repair, representing nearly €67.7 million/year. Some surgical sites exposed patients at high risk of incisional hernia repair: colon and rectum (hazard ratio [HR] 1.2), and other sites on the small bowel and the peritoneum (HR 1.4). Laparotomy procedure and being ≥ 40 years old put patients at high risk of incisional hernia repair even when operated on low-risk sites such as stomach, duodenum, and hepatobiliary.ConclusionThe burden of incisional hernia repair is high and most patients are at risk either due to age ≥ 40 or the surgery site. New approaches to prevent the onset of incisional hernia are warranted.

BT06 Using artificial intelligence to triage skin cancer referrals: outcomes from a pilot study

Abstract Artificial intelligence (AI) is a rapidly emerging field in dermatology, aimed at delivering efficient and effective patient care. To date, there is a lack of substantial evidence for the use of this technology in a clinical setting. However, the pandemic era has placed significant pressures on dermatology services, specifically the skin cancer clinics at our trust, which has experienced a 30% increase in demand compared with prepandemic levels. A novel solution for urgent referrals was to test the use of AI teledermatology software using a UK Conformity Assessed marked Class IIa Medical Device (and therefore regulated by the Medicines and Healthcare products Regulatory Agency). Appropriate cases are selected and booked for a teledermatology appointment at one of our four community-based hubs. Clinical and dermoscopic images, together with a short questionnaire, are uploaded to the software by a healthcare assistant. The AI immediately assesses the dermoscopic images of the lesion, and those cases identified as benign are discharged back to the general practitioner (GP), following a safety check by a consultant dermatologist employed by the AI provider. The trust dermatology consultants have chosen to further triage all cases suspected to be nonbenign. Patients with suitable small lesions at low-risk sites receive a telephone appointment to discuss surgery and obtain consent. Those with precancerous lesions can be discharged back to the GP with management advice. Low-risk basal cell carcinomas case are transferred to a routine pathway. Selected cases may be referred directly to other teams. The pilot started in March 2022 and now processes 5–600 cases per month at four photography hubs. To date, 19% of cases have been discharged back to the GP with a benign diagnosis. A further 15% of cases have been discharged back to the GP by the trust dermatologists, giving an overall discharge rate of 34%. Ten per cent of patients have received a telephone call to take consent for biopsy, and 2% have been referred directly to another speciality. Thirteen per cent of cases have been triaged to a routine pathway, and 38% of patients have required an urgent face-to-face appointment with a dermatologist. The trust has seen &amp;gt; 90% 2-week wait referrals within 2 weeks in the last two quarters. Since the introduction of this AI teledermatology service, we have seen a 62% reduction in the number of patients requiring an urgent face-to-face appointment with a dermatologist. Ongoing audit work is focused on the safety, acceptability and cost-effectiveness of this pathway, and will shape decision-making in the ongoing use of this technology both locally and across the UK.

Survey Study Reveals High Prevalence of Heterobasidion Root Rot Infection in Scots Pine (Pinus sylvestris) Stands Established on Seemingly Low-Risk Sites

Heterobasidion spp. are among the most destructive root rot pathogens, causing severe economic losses to conifer forestry. High infection frequency has been observed in Scots pine stands growing on dry sandy soils with low organic matter or former agricultural soils. In this study, we investigated the incidence of Heterobasidion spp. infection in Scots pine forests established on low-risk sites where the trees looked healthy and unlikely to be infected. In total, 135 healthy-looking pine trees from nine different stands were examined for Heterobasidion spp. presence. Heterobasidion spp. was detected in six stands and infection frequency was 13%–33%. There was a significant correlation between site index and infection frequency, which was higher in pine stands established on more fertile soils. There was no correlation between disease incidence and defoliation level, diameter of tree at breast height, root diameter, tree volume, or stand age. Overall, our results showed that, regardless of the soil type, Scots pine can be intensively infected by Heterobasidion pathogens while showing no outward signs. Therefore, the risk of Heterobasidion disease should be taken into consideration in management of pine forests growing on both low- and high-risk sites for more productive and sustainable forests.

Exploring potential drivers of brain size variation in the electric fish Brachyhypopomus occidentalis

Characterizing the factors that shape variation in brain size in natural populations is crucial to understanding the evolution of brain size in animals. Here, we explore how relative brain size and brain allometry vary with drainage, predation risk and sex in natural populations of the electric knifefish Brachyhypopomus occidentalis. Fish were sampled from high and low predation risk sites within two independent river drainages in eastern and central Panamá. Overall, we observed low variation in brain-body size allometric slopes associated with drainage, predation risk and sex category. However, we observed significant differences in allometric intercepts between predation risk sites. We also found significant differences in relative brain mass associated with drainage, as well as significant differences in absolute brain mass associated with drainage, predation risk and sex category. Our results suggest potential constraints in brain-body allometry across populations of B. occidentalis. However, both drainage and predation risk may be playing a role in brain mass variation among populations. We suggest that variation in brain mass in electric fishes is affected by multiple extrinsic and intrinsic factors, including geography, environmental complexity, social interaction and developmental or functional constraints.

Stress fractures.

Stress fractures (SF) represent 10%-20% of all injuries in sport medicine. An SF occurs when abnormal and repetitive loading is applied on normal bone: The body cannot adapt quickly enough, leading to microdamage and fracture. The etiology is multifactorial with numerous risk factors involved. Diagnosis of SF can be achieved by identifying intrinsic and extrinsic factors, obtaining a good history, performing a physical exam, and ordering laboratory and imaging studies (magnetic resonance imaging is the current gold standard). Relative energy deficiency in sport (RED-S) is a known risk factor. In addition, for women, it is very important know the menstrual status to identify long periods of amenorrhea in the past and the present. Early detection is important to improve the chance of symptom resolution with conservative treatment. Common presentation involves complaints of localized pain, with or without swelling, and tenderness on palpation of bony structures that begins earlier in training and progressively worsens with activity over a 2- to 3-week period. Appropriate classification of SF based on type, location, grading, and low or high risk is critical in guiding treatment strategies and influencing the time to return to sport. Stress injuries at low-risk sites are typically managed conservatively. Studies have suggested that calcium and vitamin D supplementation might be helpful. Moreover, other treatment regimens are not well established. Understanding better the pathophysiology of SFs and the potential utility of current and future bone-active therapeutics may well yield approaches that could treat SFs more effectively.

Nuclear challenges

The demand for the reduced use of fossil fuels has stimulated calls for increased nuclear power. However, that enthusiasm does not extend to managing the growing volume of spent nuclear fuel – the inevitable result of generating carbon-free nuclear energy. The search for a low-risk permanent disposal site for spent nuclear fuel remains one of […]

Bone stress injuries.

Bone stress injuries, including stress fractures, are overuse injuries that lead to substantial morbidity in active individuals. These injuries occur when excessive repetitive loads are introduced to a generally normal skeleton. Although the precise mechanisms for bone stress injuries are not completely understood, the prevailing theory is that an imbalance in bone metabolism favours microdamage accumulation over its removal and replacement with new bone via targeted remodelling. Diagnosis is achieved by a combination of patient history and physical examination, with imaging used for confirmation. Management of bone stress injuries is guided by their location and consequent risk of healing complications. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading and return to activity. Additional treatment approaches include non-weight-bearing immobilization, medications or surgery, but these approaches are usually limited to managing bone stress injuries that occur at high-risk sites. A comprehensive strategy that integrates anatomical, biomechanical and biological risk factors has the potential to improve the understanding of these injuries and aid in their prevention and management.

Qualitative analysis of a diffusive SEIR epidemic model with linear external source and asymptomatic infection in heterogeneous environment

&lt;p style='text-indent:20px;'&gt;This paper is devoted to an SEIR epidemic model with variable recruitment and both exposed and infected populations having infectious in a spatially heterogeneous environment. The basic reproduction number is defined and the existence of endemic equilibrium is obtained, and the relationship between the basic reproduction number and diffusion coefficients is established. Then the global stability of the endemic equilibrium in a homogeneous environment is investigated. Finally, the asymptotic profiles of endemic equilibrium are discussed, when the diffusion rates of susceptible, exposed and infected individuals tend to zero or infinity. The theoretical results show that limiting the movement of exposed, infected and recovered individuals can eliminate the disease in low-risk sites, while the disease is still persistent in high-risk sites. Therefore, the presence of exposed individuals with infectious greatly increases the difficulty of disease prevention and control.&lt;/p&gt;

The history, etiology, and management of ginseng replant disease: a Canadian perspective in review

Ginseng replant disease (GRD) has had a major impact on the American ginseng (Panax quinquefolius L.) industry in Canada and is a threat to its survival. With only 150 yr of domestic ginseng cultivation, GRD and its effect on the industry in North America is well documented compared with replant diseases in other crops. However, minimal research has been published on the etiology and management of GRD. Research and observations of replant diseases of the major commercial Panax species worldwide are presented to propose mechanisms of GRD and potential management options. The available evidence suggests the specific involvement of the soil-borne fungus Ilyonectria mors-panacis (A.A. Hildebr.) A. Cabral &amp; Crous combined with an unknown host-related factor as the ultimate cause of GRD, since other proposed mechanisms seem unlikely to have occurred in the diversity of regions where GRD is reported. Other abiotic and biotic factors influencing the severity of the disease are also likely to be involved. Given the lack of clarity in the scientific literature between problems associated with continuous cultivation of ginseng and true replant disease, a definition of GRD is proposed. The development of an effective and economical management regime will require a better understanding of the mechanisms of GRD. Potential management options include reducing ginseng debris after harvest of the first crop, preplant testing to identify low-risk sites for replanting, fumigation, alternative disinfestation techniques, and fungicides (including biofungicides) targeting I. mors-panacis.

Significance of molecular detection in diagnosis of benign and malignant thyroid nodules in China.

e15028 Background: Ultrasound and ultrasound-guided fine needle aspiration (US-FNA) are a preferred method for judging benign and malignant thyroid nodules. For thyroid nodules that can’t be determined by FNA, molecular markers of thyroid cancer can be detected as assistant method. This study aim to verify the significance of molecular detection in diagnosis of benign and malignant thyroid nodules in China. Methods: We carried out a prospective study of 383 FNA samples of thyroid nodules, and performed targeted multi-gene NGS on most samples with FSZ-Thyroid NGS Panel V1, the result of which would be incorporated into the reference index for clinicians to decide whether a patient should undergo surgery. And postoperative pathology were followed up. The NGS targets were divided into three categories: high risk (BRAF V600E, TP53, PIK3CA, AKT1, CTNNB1, RET, KRAS with VAF≥30%, HRAS with VAF≥30%, NRAS with VAF≥30%, RET fusion, NTRK1 fusion, NTRK3 fusion, ALK fusion, BRAF fusion), low risk (BRAF non-V600E, EIF1AX, GNAS, TSHR, TERT, KRAS with VAF &lt; 30%, HRAS with VAF &lt; 30%, HRAS with VAF &lt; 30%, PPARG fusion, THADA fusion), benign like (EZH1, SPOP, ZNF148 or no mutations). Results: Among the 383 FNA samples, 333 of them were sequenced with FSZ-Thyroid NGS Panel V1, and 211 thyroid nodules were resected. Finally, postoperative pathology showed that 180 nodules was malignant and 31 was benign. Among the 180 malignant tumors, BRAF V600E (71.1%), RET fusion (7.8%), and TERT mutation (2.8%) were the top three most mutated genes; and there were also significant differences in frequency of some mutations between malignant tumors in different BSRTC class, including more BRAF V600E (83.6%) in class VI malignant tumors, more gene fusions (26.1%) in class V malignant tumors which was significantly higher than that in class VI (7%). And, the frequency of RAS mutations (8.3%) in class III and IV malignant tumors was higher than that of class V and VI. Here a test was considered as positive if a genetic alteration was annotated with High-Risk, and negative if Low-Risk or Benign-Like, the sensitivity and specificity for detecting malignant tumors in BSRTC class III-IV were 66.7% and 100%, respectively, and the total sensitivity and specificity for BSRTC class I-VI malignant tumors were 85.6% and 100%. In addition, 21 of 383 patients underwent Re-FNA. Among these 21 patients, 11 patients detected high risk mutations and 90.9% (10/11) underwent upgrade of BSRTC class on Re-FNA. As a comparation, among the remaining 10 patients who detected low risk or benign like sites, only 30% (3/10) underwent upgrade of BSRTC class on Re-FNA which suggested that the detection of high risk sites might predict the upgrade of BSRTC class on Re-FNA. Conclusions: Molecular testing can distinguish between benign and malignant thyroid nodules and predict the upgrade of BSRTC class on Re-FNA which could provide the reference for treatment decision-making of thyroid nodules in China.

Win \u2013 and stay, but not too long: cavity selection by Boreal Owls to minimize nest predation by Pine Marten

Site fidelity after successful nesting and site shift after nest predation (win–stay, lose–shift) is a well-documented adaptation to spatially heterogeneous and temporally auto-correlated predation risk. However, site shift even after a successful nesting (win–shift) may become a better tactic than site fidelity (win–stay), if a successful nest site becomes more risky until the next nesting opportunity, and if new low-risk nest sites regularly appear. Correspondingly, selecting a new non-used nest site may become a better tactic than selecting one previously used successfully by a conspecific. I studied this dynamic by focusing on nest cavities that may be available for many years, and using nest boxes to allow an experimental design. At localities where Boreal Owls (Aegolius funereus) had nested successfully, a dyad of nest boxes was made available each year, one box in the original nest tree and one in a new tree for the season, each containing either old nest material from the successful nesting or new wood shavings. Boreal owls were more likely to select the box in the new tree when more years had elapsed since the successful nesting and since a box was installed in the original nest tree, independent of box content. The pattern of selection differed between young and old individuals for males, but not females. Young males based their selection of nest tree mainly on box content, while old males based it on time elapsed since the successful nesting in the original nest tree and how long a box had been present there. The probability of depredation of Boreal Owl nests by Pine Marten (Martes martes) has previously been found to increase with cavity age and number of nesting seasons elapsed since the previous successful nesting. This pattern of nest predation thus predicted the pattern of nest site selection found.

Salivary microbiome and periodontal status of patients with periodontitis during the initial stage of orthodontic treatment

Patients with severe periodontitis typically present with pathologic tooth migration. To improve esthetics and masticatory function, orthodontic treatment is required. Research on periodontal orthodontic treatment has been sparse, particularly from the microbial perspective. Hence, we analyzed the microbial and clinical changes in patients with well-controlled periodontitis in the early stage of orthodontic treatment. Ten patients with well-controlled periodontitis were asked to collect saliva before and 1 and 3months after appliance placement (T0, T1, and T2, respectively) and underwent clinical examinations before and 1, 3, and 6months after appliance placement (T0, T1, T2, and T3, respectively). The microbial community of saliva was analyzed by 16S rRNA gene sequencing. Gingival index, the plaque index, and the probing pocket depth were clinically assessed. The plaque index significantly increased from T0 to T1 and decreased at T2 and T3. The probing pocket depth and gingival index increased slightly at T2, but not significantly, in both the high-risk site and low-risk site. The alpha and beta diversity increased at T1. The microbial community structure was similar at T0 and T2. The relative abundance of core genera and periodontal pathogens was stable during the initial 3months of orthodontic treatment. The orthodontic appliance promoted plaque accumulation and altered the microbial community of patients with well-controlled periodontitis during the first month of orthodontic treatment. The microbial community returned to the basal composition at 3months after appliance placement, and the periodontal inflammation during the 6-months orthodontic treatment was under control.

Selection of Oncogenic Mutant Clones in Normal Human Skin Varies with Body Site.

Skin cancer risk varies substantially across the body, yet how this relates to the mutations found in normal skin is unknown. Here we mapped mutant clones in skin from high- and low-risk sites. The density of mutations varied by location. The prevalence of NOTCH1 and FAT1 mutations in forearm, trunk, and leg skin was similar to that in keratinocyte cancers. Most mutations were caused by ultraviolet light, but mutational signature analysis suggested differences in DNA-repair processes between sites. Eleven mutant genes were under positive selection, with TP53 preferentially selected in the head and FAT1 in the leg. Fine-scale mapping revealed 10% of clones had copy-number alterations. Analysis of hair follicles showed mutations in the upper follicle resembled adjacent skin, but the lower follicle was sparsely mutated. Normal skin is a dense patchwork of mutant clones arising from competitive selection that varies by location. SIGNIFICANCE: Mapping mutant clones across the body reveals normal skin is a dense patchwork of mutant cells. The variation in cancer risk between sites substantially exceeds that in mutant clone density. More generally, mutant genes cannot be assigned as cancer drivers until their prevalence in normal tissue is known.See related commentary by De Dominici and DeGregori, p. 227.This article is highlighted in the In This Issue feature, p. 211.