Central Register Research Articles

The Barriers to Cardiothoracic Surgery Training in Nigeria: Key Insights From Trainees.

Aim Cardiothoracic surgery has the potential to improve care in resource-deprived countries like Nigeria. This study analyzes the barriers to training in cardiothoracic surgery and gaps in the existing curriculum from a cardiothoracic surgery trainee perspective. Methods An online nationwide mixed-method cross-sectional survey was conducted. The participants were from a pool of senior residents in cardiothoracic surgery. A five-point Likert scale was utilized to rate and evaluate their training experiences. The motivations for choosing cardiothoracic surgery, gaps in the training curriculum, perceived barriers, and facilitators in their training programs were also assessed. The survey included closed and open-ended questions to capture quantitative data and qualitative insights. Thequantitative data were analyzed using SPSS21 (Armonk, NY: IBM Corp), while the qualitative data were analyzed using MAXQDA 24 (Berlin, Germany: VERBI Software). Results Sixteen senior cardiothoracic surgery residents completed the survey. Thematic grouping identified several key barriers, such as low case volume, lack of infrastructure and equipment, and reduced trainee autonomy during cases. The significant deficiencies in the existing curriculum are the absence of clear minimum competencies, lack of local and international collaboration, and robust cardiac training. In low-resource settings like Nigeria, government participation and improved funding, increased collaboration between local and international programs, and establishment of regional centers may offer solutions and successful implementation of cardiothoracic surgery training and improve access to surgical care. Conclusion Cardiothoracic trainees are highly interested in their training despite several barriers. Increased funding, collaboration, and infrastructure development will help improve the training experience.

Regional perspective on prospects and risks of the renewable energy in Russia

AbstractThe expansion of renewable energy (RE) relies on both natural factors and socioeconomic conditions fostered at the regional level. This paper examines the key factors influencing RE development in selected Russian regions. We conducted a literature review, surveyed 250 industry experts, and analyzed reports from energy and rating agencies, along with natural resource maps, to identify specific risks and indicators. Our expert survey revealed that the most significant technical risks are low resource potential (68%), energy system surplus (68%), and the absence of transport logistics with neighboring regions (58%). Politically, the lack of additional sector initiatives (6%) was noted. Economically, the high cost of RE (56%) and insufficient experience with “green” investments (54%) were highlighted. Social factors included low unemployment rates (74%), and the absence of remote areas without power supply (72%). Environmentally, the lack of enterprises for energy unit utilization (84%), low greenhouse gas emissions (60%), and insufficient accessible territories for facilities (58%) were significant concerns. We developed risk profiles for nine Russian regions, categorizing them into leaders, intermediates, and nascent stages of RE market formation. Our findings indicate that the most impactful factors include resource potential, space limitations for energy facilities, proximity to equipment manufacturers, regional support measures, and the development of “green” investment instruments. Conversely, regional investment attractiveness had a lesser influence. On the basis of these insights, we recommend enhancing RE development through refined federal and regional support programs. We propose additional criteria for project selection: (1) minimum construction costs covered by “green” investments and (2) quantitative restrictions on new capacities, considering regional energy system status. Practical recommendations also include developing regional centers for servicing generating facilities and increasing the sector's investment attractiveness to stimulate private investment.

Effect of Body Weight on Glycaemic Indices in People with Type 1 Diabetes Using Continuous Glucose Monitoring.

Background/Objectives: Obesity and overweight have become increasingly prevalent in different populations of people with type 1 diabetes (PwT1D). This study aimed to assess the effect of body weight on glycaemic indices in PwT1D. Methods: Adult PwT1D using continuous glucose monitoring (CGM) and followed up at a regional academic diabetes centre were included. Body weight, body mass index (BMI), waist circumference, glycated haemoglobin (HbA1c), and standard CGM glycaemic indices were recorded. Glycaemic indices were compared according to BMI, and correlation and linear regression analysis were performed to estimate the association between measures of adiposity and glycaemic indices. Results: A total of 73 PwT1D were included (48% normal weight, 33% overweight, and 19% obese). HbA1c was 7.2% (5.6-10), glucose management indicator (GMI) 6.9% (5.7-8.9), coefficient of variation (CV) for glucose 39.5% ± 6.4, mean glucose 148 (101-235) mg/dL, TIR (time in range, glucose 70-180 mg/dL) 66% (25-94), TBR70 (time below range, 54-69 mg/dL) 4% (0-16), TBR54 (<54 mg/dL) 1% (0-11), TAR180 (time above range, 181-250 mg/dL) 20% ± 7, and TAR250 (>250 mg/dL) 6% (0-40). Glycaemic indices and achievement (%) of optimal glycaemic targets were similar between normal weight, overweight, and obese patients. BMI was associated negatively with GMI, mean glucose, TAR180, and TAR250 and positively with TIR; waist circumference was negatively associated with TAR250. Conclusions: CGM-derived glycaemic indices were similar in overweight/obese and normal weight PwT1D. Body weight and BMI were positively associated with better glycaemic control. PwT1D should receive appropriate ongoing support to achieve optimal glycaemic targets whilst maintaining a healthy body weight.

SPATIAL DISTRIBUTION AND ASSESSMENT OF PUBLIC GREEN SPACES IN AN URBAN SETTLEMENT

The article examines the current land use of green spaces as an integral part of the urban economy through the example of a city in central Ukraine, Kropyvnytskyi. It analyses the regulatory framework for the functioning of green spaces. The study also includes an analysis of the geospatial distribution of public green spaces and their structure by number and area in the regional centre. The authors estimate the green areas covered with tree plantations based on vegetative indicators using remote sensing data. The Normalised Difference Vegetation Index (NDVI) allowed for clarifying the boundaries of green areas, their area, and the density of green mass of vegetation. This index helps to identify the spatial-temporal trends of vegetation, which are necessary to support scientific-grounded management decisions for city governance. The results of determining the NDVI are presented in the example of the park-monument of landscape art ‘Dendropark’. For vegetation in good condition, its value exceeds 0.7, corresponding to 58 % of the area. The Shannon Diversity Index has been used to assess the distribution of land use types in the green areas of general use. We identified six types of green area land use in Kropyvnytskyi city and performed the index calculations according to these types of land use. The calculation of the provision of public green spaces for city residents confirmed its low value compared to the standards. The research’s results determined that Kropyvnytskyi city needs to create new green zones, preserve existing ones, inventory, and develop a database of all green areas. Planting areas of new residential buildings and applying the experience of other countries to increase green areas due to alternative landscaping types (vertical landscaping, green roofs, and others) will allow for an expansion in the green areas of settlements, especially in large cities. The practical importance of the research results is their potential use for creating a strategy to develop and preserve green plantings in the city of Kropyvnytskyi for future years. Keywords: vegetation index, land use, diversity index, green areas, parks.

Cancer Unveiling: A Profile of Incidence and Trends in Bam City, Southeast Iran

Background Cancer is one of the leading causes of mortality and morbidity worldwide. According to the report from the Iranian Ministry of Health, cancer ranks as the third most common cause of death in Iran. Consequently, acquiring information about cancer statistics and their trends is crucial for cancer prevention and control. In this study, we examined the trends and epidemiology of cancer in Bam City, Iran, from 2014 to 2019. Material and Methods This cross-sectional study was conducted using cancer registry data spanning from 2014 to 2019 in Bam, located in Kerman Province. Common cancers were determined based on the reported number of cancer cases and age-standardized rates. Data analysis was performed using SPSS (version 22) and GraphPad Prism (version 9). Results In this study, we examined 1,290 cases of cancer registered in Bam City, Kerman Province, from 2014 to 2019. Of our study population, 42.8% (552 cases) were women. The sex ratio (male to female) for all cancers during the 6-year study period was 1.34. The highest number of cancer cases among men occurred in 2016, while among women, it was in 2017. The age-standardized incidence rate did not display a clear increasing or decreasing trend; instead, we observed fluctuations over the 6-year period for both sexes. Notably, the age-standardized incidence rate trend for males consistently remained higher than that for females. Conclusion Fluctuations of the trend in our study can be attributed to reasons such as referral of cases to other cities with better medical facilities and weakness in the cancer registration system of deprived areas such as Bam. Nevertheless, to reduce the burden of cancer, each individual should be aware of the most preventable risk factors, such as an unhealthy lifestyle and occupational exposure. To achieve this goal, the government should prioritize improving the accuracy and completeness of cancer registry centers.

Incidence and pattern of second primary cancer in patients diagnosed with primary cancer.

The long survival of patients with primary cancer increases the chance of such patients developing second primary cancer (SPC). The development of SPC in cancer survivors exerts a large psychological, social and economic burden on patients and their families. The aim of the present study was to assess the risk of cancer survivors developing SPC. The study included patients who had been diagnosed with a first primary cancer in five organs (stomach, colorectum, lung, breast and thyroid), which are the five most common sites of cancer in patients from Korea, at the regional cancer center in Jeonbuk National University Hospital between January 2007 and December 2009. The standardized incidence ratio (SIR) of SPC according to sex and site was calculated from 5,209 patients who were followed up to September 2017. General incidence was acquired from the National Cancer Registry of Republic of Korea. SPC occurred in 6.2% (323/5,209) of patients, and the incidence of SPC among the five major types of cancer was in the order of breast (8.8%, 46/524), colorectum (8.6%, 86/1,003), gastric (6.6%, 89/1,358), thyroid (4.7%, 67/1,437) and lung cancer (3.9%, 35/887). When all SPC sites were included, the SIRs of SPC in patients with colorectal cancer and breast cancer were >1.0 (1.21 and 1.66, respectively). Breast cancer and thyroid cancer exhibited a high site relationship (P<0.05), and colorectal cancer had a high site relationship with gastric cancer (P<0.05). The present study analyzed the incidence and pattern of SPC in patients with cancer who were diagnosed with primary carcinoma in five organs. The results of the study may be useful for effective follow-up and early detection of SPC in patients with cancer.

Contributions of the ELENA Cohort to Study Autism Spectrum Disorder in Children and Adolescents from a Biopsychosocial Framework.

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition influenced by a myriad of developmental, biological, psychological, and socio-demographic factors. The ELENA cohort seeks to delineate the intricate interplay of these factors, facilitating the identification of risk factors and the development of targeted interventions. This paper emphasizes the clinical profiles of children and outlines key findings from a biopsychosocial perspective. The ELENA cohort, a multicenter initiative across French regional centers, conducted a systematic prospective analysis on children newly diagnosed with DSM-5 ASD between 2012 and 2019. This encompassed direct assessments and parent-reported questionnaires covering a broad spectrum of developmental, biological, psychological and socio-demographic measures. Embedded case-control studies further examined risk and protective factors, alongside specific environmental and psychosocial influences during pregnancy and early childhood. A subset of participants also contributed biospecimens, with data enhancement via linkage to French National Administrative Healthcare Databases. The study unveils baseline clinical characteristics for 876 children, average age 6 (SD ± 3.3) previously unreported in protocol descriptions. It highlights the study's developmental biopsychosocial approach and its novel findings on children's socio-adaptive functioning, ASD severity, comorbidities, quality of life and interventions. Employing developmental biopsychosocial insights offers a promising pathway to integrating health, social care, and experiential insights, ultimately aiming to enhance the future well-being and outcomes for children with ASD. This approach underscores the need of a holistic, interdisciplinary strategy in encouraging and supporting the ASD community.

A two-stage stochastic programming framework for blood product inventory management with ABO substitution and lateral transshipment

This work proposes a two-stage stochastic optimization model for managing the inventory of a two-echelon blood supply chain comprised of a blood center and a network of hospitals and transfusion points. The proposed model identifies optimal distribution quantities across the supply chain, considering demand stochasticity and product perishability. Furthermore, the model utilizes redistribution policies, such as lateral transshipment and product substitution based on ABO compatibility, as corrective actions to minimize outdates (i.e., expired product) and shortages across the network. Using a computational experiment that includes a network with one regional blood center and twenty hospitals, we show that inventory management policies that include both ABO substitution and transshipment can significantly decrease the expected total network costs. Similarly, we see corresponding reductions in the expected number of outdated units and emergency requests to external networks for additional supply to satisfy unmet demand.

Сравнительная характеристика затрат рабочего времени врача-челюстно-лицевого хирурга, оказывающего помощь в стационарных условиях, в условиях организационного эксперимента.

In the system of organization of provision of specialized medical care on the profile of maxillofacial surgery there are significant changes in connection with the digitalization processes, the introduction of new medical-diagnostic technologies, the development of surgical interventions, that has a significant effect on the working time of the doctor – maxillofacial surgeon. Purpose of the study is to study the working time of the doctor-maxillofacial surgeon, who provides assistance in stationary conditions with the help of photochronometric measurements in dynamics before and after the introduction of organizational measures. Materials and methods. The study was carried out in 2018 and 2023, before and after the introduction of organizational measures, on the basis of the department of maxillofacial surgery of the Penza regional clinical hospital. N. N. Burdenko». Doctors-maxillofacial surgeons took part in the study. The following methods were used: analytical, photo-time, organizational experiment, statistical. In the course of the photo chronometric research, all activities were studied: main activity, document processing, support activities, work, other activities, personal time required, unencumbered time. Results and Discussion. Analysis of the data obtained showed that doctors-facial surgeons in 2018 conducted an average of 9.75+0.1 hours at the workplace, which is 1.95 hours above the norm. According to the results of the study the article reveals an imbalance of working time expenditure, significant time spent on unusual functions (provision of medical assistance in the reception department, completion of medical documentation)There’s a lot going on. Problems in the regulation of work of doctors-maxillofacial surgeons, as well as shortcomings in the organization of medical care on the profile of «maxillofacial surgery» were revealed as a result of the photochronometric researchIt was possible to identify the main directions for improving the provision of specialized assistance in the field of PF. After the behavior of organizational arrangements (change of localization of the department, staffing, new patient routing, strengthening of continuity) The results of a repeated photochromic study conducted in 2023 showed that the structure of the working time expenditure has changed significantly: the share of main activities has decreased from 61,46% in 2018 to 59.7% in 2023, the duration of work with medical documents increased from 16.3% to 20.1%, costs for support activities decreased from 14,63% to 7.6%, The cost of performance increased from 4.59% to 5.6%, personal time required increased from 0.86% to 2.0% respectively. In 2023 there is no open time (late to work). The organizational changes made have had a positive impact on the quantity of quality of the bed. The average duration of treatment in 2018 was 7.92 days, and in 2023–5.53 days. In 2018, the pre-operative bed day was 1.05 days, and in 2023–0.17 days, decreased by 6.2 times. Conclusions. It was found that the organizational changes, directly related to the opening of the regional center of maxillofacial surgery, allowed to change the routing of patients, improve the continuity with specialists of dental, traumatological, oncological, pediatric profile, rational use of personnel resources, provide assistance to children. The optimization of doctors’ activities has had a positive impact on the quantity and quality of the bed. A comparative description of the work time spent before and after the organizational experiment shows that the activity of the surgeonmaxillofacial round-the-clock hospital has changed significantly due to the reduction of the cost of performing unusual functions.

Topical Anti-Inflammatory Treatments for Eczema: A Cochrane Systematic Review and Network Meta-Analysis.

Eczema is the most burdensome skin condition worldwide and topical anti-inflammatory treatments are commonly used to control symptoms. The relative effectiveness and safety of different topical anti-inflammatory treatments is uncertain. Network meta-analysis performed within a Cochrane systematic review to compare and statistically rank efficacy and safety of topical anti-inflammatory eczema treatments. Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to June 2023. Included trials were within-participant or between-participant randomised controlled trials. Participants had eczema that was not clinically infected and was not contact dermatitis, seborrheic eczema or hand eczema. Interventions were topical anti-inflammatory treatments but not complementary treatments, antibiotics alone, wet wraps, phototherapy or systemic treatments. Comparators were no treatment/vehicle or another topical anti-inflammatory. We identified 291 trials (45,846 participants), mainly in high-income countries. Most were industry-funded with median 3 weeks treatment duration. Risk of bias assessed using the Cochrane Risk of Bias 2.0 tool was high in 89% of trials, mainly due to risk of selective reporting. Network meta-analysis of binary outcomes ranked potent and/or very potent topical steroids, tacrolimus 0.1% and ruxolitinib 1.5% among the most effective treatments for improving patient-reported symptoms (40 trials, all low confidence) and clinician-reported signs (32 trials, all moderate confidence). For investigator global assessment, the Janus kinas inhibitors ruxolitinib 1.5%, delgocitinib 0.5% or 0.25%, very potent/potent topical steroids and tacrolimus 0.1% were ranked as most effective (140 trials, all moderate confidence). Continuous outcome data were mixed. Local application site reactions were most common with tacrolimus 0.1% (moderate confidence) and crisaborole 2% (high confidence) and least common with topical steroids (moderate confidence). Skin thinning was not increased with short-term use of any topical steroid potency (low confidence) but skin thinning was reported in 6/2044 (0.3%) participants treated with longer-term (6-60 months) topical steroids. Potent topical steroids, Janus kinase inhibitors and tacrolimus 0.1% were consistently ranked as among the most effective topical anti-inflammatory treatments for eczema.

Association of office blood pressure with ischemic and bleeding events in patients undergoing percutaneous coronary intervention

Optimal blood pressure (BP) for patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. This study aims to identify the optimal BP by investigating the association between average office BP and future clinical events in patients undergoing PCI. Consecutive patients undergoing PCI from 2012 to 2016 were included. They were divided into five groups according to the average follow-up BP after discharge. The co-primary outcomes were net adverse clinical events (NACE) and major adverse cardiac and cerebrovascular events (MACCE) up to 5 years. NACE was defined as a composite of MACCE (all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, or any revascularization) or major bleeding. A total of 2845 patients were included, and among them, 787 (27.7%) experienced the NACE during the follow-up period. Patients in the highest SBP group (adjusted hazard ratio [HR] 1.495, confidence interval [CI] 1.189–1.880) and lowest SBP group (adjusted HR 1.625, CI 1.214–2.176) had a significantly higher risk of 5-year NACE. Similar associations were observed between SBP and the risk of MACCE, and similar results based on DBP categories were also observed. There was a J-curve relationship between SBP and DBP with respect to 5-year NACE and MACCE. The nadir point of risk for NACE and MACCE was found at 121.4/74.8 and 120.4/73.7 mmHg. In patients underwent PCI, there is a significant correlation between office BP level and clinical events, indicates the importance of efforts for optimal BP control to reduce ischemic and bleeding events.Trial registration: HanYang University Medical Center (HYUMC) Registry, NCT05935397.

Pediatric Hospital Admissions with Concern for Neglect: Correlations Between Neglect Types and Other Clinical and Environmental Risk Factors.

Child neglect is a public health concern with negative consequences that impact children, families, and society. While neglect is involved with many pediatric hospitalizations, few studies explore characteristics associated with neglect types, social needs, and post-discharge care. Data on neglect type, sociodemographics, social needs, inpatient consultations, and post-discharge care were collected from the electronic medical record for children aged 0-5years who were hospitalized with concern for neglect during 2016-2020. Frequencies and percentages were calculated to determine sample characteristics. The Chi-square Test for Independence was used to evaluate associations between neglect type and other variables. The most common neglect types were inadequate nutrition (40%), inability to provide basic care (37%), intrauterine substance exposure (25%), combined types (23%), and inadequate medical care (10%). Common characteristics among neglect types included age less than 1year, male sex, Hispanic ethnicity, public insurance, past involvement with Child Protective Services, and inpatient consultation services (social work, physical therapy, and occupational therapy), and post-discharge recommendations (primary care, physical therapy, and regional center). Neglect type groups varied by child medical history, social needs, and discharge recommendations. Statistically significant associations supported differences per neglect type. Our findings highlight five specific types of neglect seen in an impoverished and ethnically diverse geographic region. Post-discharge care needs should focus on removing social barriers and optimizing resources, in particular mental health, to mitigate the risk of continued neglect. Future studies should focus on prevention strategies, tailored interventions, and improved resource allocations per neglect type and discharge location.

Evaluating cancer rehabilitation services: Insight from Australia and New Zealand

Background: Despite evidence supporting the benefits of rehabilitation for cancer survivors, the nature of cancer rehabilitation programs is inadequately described in Australia and New Zealand. This study provides insight into current service delivery and challenges for healthcare systems in implementation of cancer rehabilitation programs. Methods: A cross-sectional survey of directors of public and private rehabilitation services in hospital and ambulatory settings across Australia and New Zealand using the Australasian Rehabilitation Outcomes Centre (AROC) registry evaluated the current delivery of cancer rehabilitation programs, health professional workforce, core care components delivered, barriers and facilitators to service delivery, and unit/organisation-wide cancer rehabilitation activities. Descriptive statistics analyzed quantitative data, and qualitative analyses interpreted item responses. Results: Of the 300 services, 102 (34%) participants completed the survey. Most services provide non-dedicated cancer rehabilitation programs (n=63), led by rehabilitation physicians, followed by allied health. The common tumour streams referred included central nervous system (67%, n=56), haematological (59%, n=49), prostate (58%, n=48), and lung cancers (58%, n=48). Patients were frequently referred during post-treatment (87%, n=72) and treatment phases (66%, n=55). Core program components were multimodal exercises, fatigue management strategies, and management of medical complications and medications. The main barriers and facilitators toward the uptake of cancer rehabilitation programs were identified. Key activities in education, research, advocacy, and clinical practice improvement were also highlighted. Conclusions: The survey identified key barriers and facilitators for the implementation of cancer rehabilitation programs. Collaborative efforts of relevant stakeholders, clinicians, consumers, and policymakers need to address barriers to broader implementation of cancer rehabilitation services.

169 Strategies for recruitment of adolescent girls into physical activity programmes: a systematic review

Abstract Purpose Physical activity is essential for youth physical and mental health, yet just 15% of adolescent girls worldwide meet the World Health Organization guideline of 60 minutes of moderate-to-vigorous physical activity per day. A persistent challenge faced by physical activity providers, however, is recruiting adolescent girls into their programmes. This review aims to provide quantitative evidence-based recommendations for optimal recruitment practices for this cohort. Methods Five electronic databases were searched (Embase, Medline, CINAHL, Web of Science, and Cochrane Library – Central Trial Registry) including database-specific terms, truncations, and synonyms combining ‘adolescent females’, ‘recruitment’, and ‘physical activity’ to identify randomised controlled trials of physical activity interventions for adolescent girls worldwide. Hand searches of references were also conducted. Data was extracted regarding study, participant, and intervention characteristics, pre-determined recruitment goals, recruitment strategies employed, and the number of participants screened, eligible, approached, randomised, and retained. Outcomes included whether recruitment goals were met, recruitment rate, and any revised recruitment measures implemented mid-study. Results After removal of duplicates (n = 71), 5460 articles were screened by title and abstract independently by two reviewers. 70 full-text articles were screened by two reviewers, resulting in 26 included studies. Preliminary analysis showed that most physical activity programmes were school-based (76.4%), multicomponent (65.4%), and designed based on behaviour change theories (80.8%). All studies employed multiple recruitment strategies such as distributing information to eligible students in schools (14 studies), researchers presenting directly to eligible students at their school (10), teachers assisting with recruitment (6), providing small gifts, vouchers, or the ability to earn awards for participation (5 each), and posting flyers in schools (4). The mean recruitment rate for adolescent girls into physical activity randomised controlled trials was 60.4% (SD = 26.94), with high variability (23.6%-99.2%). Ongoing analysis will provide regression results regarding the effectiveness of recruitment strategies employed and their impact on recruitment outcomes. Conclusions Application of the findings of this review by physical activity programme providers may enhance their recruitment processes, potentially increasing teenage girls’ physical activity enrolment worldwide. Funding This research was funded by the Irish Research Council and the Dublin City Sport &amp; Wellbeing Partnership through the Enterprise Partnership Scheme.

Treatment Patterns and Health Care Resource Utilization of Patients With Non-Small Cell Lung Cancer in Puerto Rico: The TREATLINES-ONCOLUNG Study.

Lung cancer remains one of the leading causes of cancer-related mortality worldwide. It is the third cause of death among patients with cancer in Puerto Rico (PR) and non-small cell lung cancer (NSCLC) is the most prevalent. This study aims to describe the first-line treatment (1LT) and health care resource utilization (HCRU) among patients with NSCLC in PR. A retrospective cohort study was conducted using the PR Central Cancer Registry Health Insurance Linkage Database to describe patients with NSCLC from 2012 to 2016. It describes sociodemographic and clinical characteristics on the basis of stage and histology and includes 1LT patterns and HCRU. A total of 1,011 patients met the inclusion criteria. Most were male (57.1%), married (54.1%), and had no comorbidities (55.8%). A significant proportion of patients (71.1%) were diagnosed at stages III and IV, with nonsquamous cell carcinoma being the most prevalent histology group (75.9%). About 61.7% received systemic therapy, 36.7% received radiotherapy, and 21.9% underwent surgery. Platinum (Pt)-based combinations were the most common 1LT (82.9%). On average, patients had 4.7 emergency room visits, nearly six hospitalizations, and 22.4 outpatient visits annually. The mean frequencies of positron emission tomography, ultrasounds, computerized tomography scans, and magnetic resonance imaging were 0.95, 0.11, 4.88, and 0.91, respectively. To our knowledge, this study provides the first description of 1LT patterns, HCRU, and sociodemographic information among patients with NSCLC in PR. A significant number of patients were diagnosed at stage III or higher and received Pt-based systemic therapy as their 1LT. More research is required to investigate treatment patterns beyond the 1LT and to gain a comprehensive understanding of optimal care interventions and factors associated with early NSCLC diagnosis.

The Texas Landscape: Accounting for Migrant Mortality and the Challenges of a Justice of the Peace Medicolegal System

Executive Summary This paper details the structural and resource challenges in Texas related to identifying migrant decedents, investigating their deaths, repatriating them, and adhering to legal and ethical requirements in addressing this humanitarian tragedy. While actors working on migrant decedent investigations in Arizona can map and provide accurate counts of migrant deaths, this is not yet possible for Texas cases. Texas’ mixed Medical Examiner/Justice of the Peace medicolegal system suffers from fragmentation across county jurisdictions, lack of resources, and minimal access to investigative tools for transnational families. These challenges produce a landscape where unidentified presumed migrants may structurally disappear (e.g., buried in temporarily marked graves as unidentified persons with no investigation or case tracking). The article highlights the work of Operation Identification (OpID), a humanitarian project formed to assist border counties with recovering, identifying, and repatriating migrant decedents. OpID’s extensive community outreach and collaboration with governmental and nongovernmental partners in the United States and Latin America have improved practices in some Texas counties. However, systemic change is still needed to address this humanitarian disaster. The article proposes that presumed migrant decedents be managed using a disaster victim identification (DVI) approach, which prioritizes identification, rather than how and why someone dies. It also proposes the establishment of regional Migrant Identification Centers (MICs) to streamline identification and repatriation efforts, while ensuring compliance with Texas law by Justices of the Peace (JPs). Centralization, the article argues, can lead to more accurate counts of migrant deaths and lay the groundwork for greater resources. The article also supports increased access to national databases including the National Combined DNA Indexing System (CODIS) and the National Missing and Unidentified Persons System (NamUs). It argues that transnational families of missing persons be afforded expanded access to investigative tools (e.g., NamUs)

Clinical experience of pulmonary vein isolation via single transseptal puncture in atrial fibrillation patients: Comprehensive characterization and follow-up

BackgroundAtrial fibrillation is the most commonly observed cardiac rhythm disorder. Pulmonary vein isolation (PVI) is an effective treatment option to maintain sinus rhythm. This study evaluates the safety, efficacy, clinical outcomes and radiation exposures using a standardized single transseptal puncture (STP)-strategy. MethodsWe analyzed data from patients who underwent our STP-ablation technique with transesophageal echocardiography (TEE) guidance at a university hospital and a regional tertiary health center in Switzerland between January 1, 2017, and May 30, 2022. Collected data included demographics, symptoms, echocardiography results, procedural details, complications and outcomes. Mean follow-up time was 21.4 ± 16 months. ResultsThe study population included 304 patients with a median age of 67 years, who had at least one ablation using our STP-approach. Among these, 248 (82 %) patients underwent de novo PVI with this technique. Ablation was successful in all patients with isolation of all pulmonary veins, with an average procedure duration of 120 min and an average fluoroscopy time of 3 min, resulting in a mean X-ray dose of 252 cGy × cm2. TEE guidance was performed in 235 (95 %) patients. During the first intervention, 17 complications occurred in 13 patients (5 %). After the first PVI, 135 (54 %) patients experienced no recurrence during the follow-up period. The one-year recurrence rate for atrial fibrillation requiring therapy was 30 %. ConclusionOur STP- approach demonstrated comparable success rates to traditional methods, with similar procedural durations, low radiation exposure and a low complication rate. Therefore, this method may offer procedural, economic and safety benefits without compromising efficacy or safety.

Scientific evidence of acupuncture for post-stroke motor impairment: protocol for an overview of systematic reviews and meta-analyses

IntroductionSeveral systematic reviews and meta-analyses (SRs/MAs) of clinical trials showed the efficacy of acupuncture for post-stroke motor impairment. To systematically estimate and synthesise these results, we aimed to conduct an...

791. ONLY HALF OF THE PATIENTS TREATED ENDOSCOPICALLY FOR EARLY BARRETT RELATED NEOPLASIA IS DETECTED DURING BARRETT SURVEILLANCE

Abstract Background Barrett’s esophagus (BE) with early neoplasia is an indication for endoscopic treatment. Patients with non-dysplastic BE are typically enrolled in an endoscopic surveillance program to enable early detection, and treatment, of BE related neoplasia. In contrast, a subset of patients with early BE neoplasia is concurrently diagnosed with BE and early neoplasia. Our goal was to distinguish cases detected through endoscopic surveillance programs (i.e. initial detection of non-dysplastic BE with progression to neoplasia later in time (metachronous neoplasia)) from cases where BE and neoplasia were diagnosed simultaneously (synchronous neoplasia). Methods We obtained data from the Dutch Barrett Expert Center Registry, a comprehensive nationwide registry encompassing data from all BE patients who underwent endoscopic treatment in Barrett expert Centers in the Netherlands. To enhance data completeness, we supplemented the registry with pathology reports sourced from the national pathology registry (PALGA). Primary endpoint was the proportion of patients diagnosed with BE and neoplasia simultaneously (synchronous neoplasia). Enrollment in an endoscopic surveillance program was defined as the presence of at least one endoscopy with non-dysplastic BE ≥12 months prior to endoscopic treatment initiation. Results A total of 2,091 patients were identified from the registry with a mean age of 66 years (SD±10) and 81% of the cohort being male. Median BE length was C2M5 (IQR 0-6; 3-8) and treatment indication encompassed low-grade dysplasia (LGD; 23%), high-grade dysplasia (HGD; 25%), or cancer (52%). Overall, 1149/2,091 patients (55%) underwent an endoscopy that revealed a new diagnosis of BE with synchronous neoplasia. Conversely, the remaining 942/2,091 patients (45%) were enrolled in endoscopic surveillance programs at the moment neoplasia was diagnosed, with a median duration of endoscopic surveillance prior to neoplasia detection of 8 years (IQR 4-13). The proportion of patients with new BE and synchronous neoplasia increased along with more severe histology at the moment of neoplasia detection. Specifically, the proportion of patients with synchronous neoplasia was 42% (198/475) for a treatment indication of LGD, 50% (260/520) for HGD and 63% (690/1096) for cancer (P &amp;lt;0.01). There was no significant difference observed concerning varying lengths of BE. Conclusions Remarkably, less than half of the patients with early Barrett’s neoplasia and neoplasia, receive a neoplasia diagnosis following enrollment in endoscopic surveillance programs, while the remaining patients present with de novo diagnosis of BE containing synchronous neoplasia. Notably, for patients with more severe histologic changes at the moment of neoplasia detection, the proportion of de novo BE with synchronous neoplasia is even higher. These findings support further critical view regarding the benefits of BE surveillance.

Placental mosaicism for autosomal trisomies: comprehensive follow-up of 528 Danish cases (1983–2021)

BackgroundMosaicism, characterized by the presence of two or more chromosomally distinct cell lines, is detected in 2% to 4% of chorionic villus samples (CVSs). In these cases, the aberration may be confined to the placenta or additionally present in the fetus. Fetal involvement may manifest as fetal malformations, while confined placental mosaicism (CPM) poses risks such as preterm birth and low birth weight. Differentiating between true fetal mosaicism and CPM at the time of the chorionic villus sampling is challenging and requires follow-up by an amniocentesis and ultrasonography. ObjectiveTo estimate the risk of fetal involvement or adverse pregnancy outcomes for specific chromosomes after detecting mosaicism for an autosomal trisomy in a CVS and identify high (red), intermediate (yellow), and low (green) risk chromosomes. Further, to explore possible associations with level of mosaicism and screening parameters. Study DesignA retrospective descriptive study of all singleton pregnancies with mosaicism detected in CVSs from 1983 to 2021 identified in the Danish Cytogenetic Central Registry and the Danish Fetal Medicine Database. ResultsOf 90,973 CVSs, 528 cases had mosaicism involving an autosomal trisomy and where genetic follow-up had been performed. The overall risk of fetal involvement was 13% (69/528) with extensive variations depending on which chromosome was involved (eg, trisomy 7: 0% [0/55] or trisomy 21: 46% [19/41]). Higher levels of mosaicism in the CVS suggested fetal involvement as mean mosaic level was 55% in true fetal mosaics vs 28% in cases confined to the placenta (P=.0002). In cases with CPM (459/528), the risk of delivering small-for-gestational-age neonates was 14% (48/341). The risk of preterm birth (before 37 weeks) was 15% (51/343). The collective risk of adverse outcome was 22% (76/343) in pregnancies that continued and where information on birth weight and gestational age at birth was available. Adverse outcomes varied substantially between chromosomes. Also, multiple-of-the-median (MoM) values of pregnancy-associated plasma protein A was predictive of these issues as it was significantly lower in cases with adverse outcome compared to cases with a normal outcome (small for gestational age: 0.23 MoM vs 0.47 MoM, P<.0001) or preterm birth: 0.25 MoM vs 0.47 MoM, P<.0001). After the introduction of combined first-trimester screening (cFTS) in 2004, the detection of cases with fetal involvement seemed to increase as the risk before 2004 was 9% (16/174) compared to 15% (53/354) after 2004 (risk ratio: 1.7 [95% CI: 1.0; 2.8]). The risk of adverse outcome in CPM pregnancies increased from 16% (22/139) before 2004 to 27% (55/204) after 2004 (risk ratio 1.7 [95% CI: 1.1; 2.7]). ConclusionIntroducing cFTS increased the detection of placental mosaicism with fetal involvement and CPM with adverse outcome. In cases of mosaicism in CVSs, the risk of fetal involvement and adverse outcomes varied considerably between chromosomes. Importantly, adverse outcomes were seen in CPM for many trisomies besides trisomy 16.