Risk Of Reoccurrence Research Articles

8409 Thyroid Nodules A to V: A Discussion on Thyroid Nodules and a Case Report of a Rare Thyroid Arteriovenous Malformation

Abstract Disclosure: M. Townsend: None. M. Brennan: None. C. Kazmierczak: None. P. Czako: None. Introduction: Thyroid nodules are an increasingly common finding on imaging, and the differential is broad. Arteriovenous malformations (AVMs) are a very rare cause of thyroid lesions, with only 6 reported cases to date. Given their scarcity, there is a lack of information regarding these lesions and how they are diagnosed and managed. Our case aims to address these gaps in information. Case: A 58-yo female with a history of hypertension was found by her PCP to have an enlarged left thyroid lobe with a new left sided bruit and palpable thrill. She had undergone prior thyroid ultrasonography for the enlarged left thyroid lobe which noted dilated and tortuous vascular structures at the posterior aspect of the left thyroid consistent with varices. These were being monitored clinically. Thyroid function tests were all normal. Due to concern for atherosclerotic disease, carotid ultrasound was obtained and showed patent carotid arteries with a large left sided thyroid mass. CTA of the neck revealed the mass to be a large (6.0 x 3.0 x 2.4 cm) AVM centered at the left thyroid gland. She underwent diagnostic angiography that confirmed the size of the mass and showed predominant arterial supply from the left superior thyroidal artery as well as bilateral inferior thyroidal arteries. Since the patient was asymptomatic with no reported neck pain, dysphagia or dyspnea, non-operative management with angioembolization was pursued given the risk of significant blood loss with surgical intervention. Following angioembolization, the results and adequacy of treatment are to be followed with repeat imaging given the high risk of reoccurrence. Discussion: AVMs of the thyroid are a very rare but clinically significant cause of thyroid lesions. Left untreated, they can grow in size and lead to compression of the esophagus or trachea, serious bleeding and high output heart failure. Their presentation is often non-specific and on routine thyroid imaging they can be difficult to differentiate from malignant tumors or varices, as in the case of our patient. Management prioritizes embolization, either alone or in conjunction with surgery, depending on the clinical scenario. Regardless of the treatment modality, reoccurrence rates remain high. Conclusion: Our case aims to add to the available information about thyroid AVMs and discuss the clinical presentation, challenges in diagnosis, imaging findings and treatment modalities available to manage these lesions. Presentation: 6/2/2024

Breaking Down SCAD: A Deep Dive into Spontaneous Coronary Artery Dissection (SCAD)

Spontaneous Coronary Artery Dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, mainly seen in females with non-traditional cardiovascular risk factors. This case report follows a 44-year-old female who experienced a sudden onset of severe chest pain, which was attributed to SCAD following a coronary angiogram. This case emphasizes the importance of recognizing such presentations within the emergency department, particularly regarding differential diagnosis of chest pain following emotional or physical stressors. It also highlights the need for a multidisciplinary approach in terms of proper management with cardiology, emergency medicine, and mental health care to reduce the risk of reoccurrence. This case report aids in underscoring SCAD’s significance as a potential cause of ST Elevation Myocardial Infarction in what is noted as a low-risk population and the critical role of awareness and education in terms of its diagnosis and management.

Overview of the Mechanism of Action of Gentiana Scabra in the Treatment of Rheumatoid Arthritis

Objective: To provide a comprehensive review of the research on the analgesic, anti-inflammatory, anti-swelling and analgesic effects of Radix Gentiana Macrophylla. Methods: Gentiana macrocephala has an analgesic effect in modern research, commonly used in various rheumatism and paralysis, numbness, contracture and soreness of the muscles and bones and other diseases of the pain treatment, can be extracted from the sterol glycoside salts and other medicinal components, its anti-inflammatory and analgesic and treatment of acute arthritis episodes of the clinical effect of the performance of the particularly unique and significant. The results can make the joint swelling, pain and other symptoms can be reduced, and the risk of reoccurrence can also be reduced after the introduction of the drug. Conclusion: In the treatment of rheumatoid arthritis, Gentiana Macrophyllae alone and in combination can improve joint symptoms such as stiffness, swelling, pain, distension and deformity as well as other systemic symptoms of rheumatoid arthritis.

Plasmonic nanophotothermal therapy: Destruction of 500 mm3 subcutaneous human basal cell carcinoma with gold nanoparticles and near infrared laser.

Multilesional basal cell carcinoma (BCC) are spread on sun exposed skin areas, including arms, face and back. The first-line treatment remains the surgical resection or Mohs surgery. Despite its high complexity, Mohs surgery is well practiced in USA and Germany and presents very good results both in esthetic and in carcinology point of view. Large lesions more than 2cm remain challenging to remove by topical cream used in photodynamic therapy (PDT). If these larger lesions are not treated in less than 1 month, they could grow deeply in the skin, thus enhancing the risk of reoccurrence and the severity of the disease. Despite this model herein studied, that is non melanoma skin cancer is a good prognostic cancer, the therapy aims to be applied to more aggressive melanoma skin cancers. Total regression of large cutaneous lesions less than 1 month with no reoccurrence. Tumor induction on murine model bearing a 500 mm3 subcutaneous lesion. Increasing dose of gold nanoparticles at fixed initial concentration C0=0.3mg/mL, infused into the tumor then exposition of the region of interest to NIR medical laser to assess the therapy. One or two intratumoral administration(s) were compared to surgery and control, that is no treatment, laser alone or nanoparticles alone. Gold nanoparticles alone or the NIR laser alone did not induce the tumor regression. The combination of laser and nanoparticles called plasmonic nanophotothermal therapy induced apoptosis. Derma and hypoderm do not show any visible gold nanoparticles and demonstrated a good cicatrization process. Plasmonic nanophotothermal therapy using two doses of gold nanoparticles was the only protocol that proved its efficacy on large lesions in 14 days, that is 500 mm3 on a murine model bearing human basal cell carcinoma.

Monetary Policy Between Stability and Growth

Abstract The global financial crisis and the coronavirus pandemic were marked by expansionary policies of key central banks in an attempt to stop the recession. The degree of expansiveness of monetary policy was unprecedented. As a result of expansionary policies, global inflation has been present since 2021. The change in the macroeconomic environment has led to a turnaround in monetary policy pursuits and a rapid rise in reference interest rates. The FED reacted much faster than the ECB and that is why inflation was lower in the USA compared to the euro area. All announcements for 2023 point to the continuation of contractionary policies. The subject of the paper’s analysis is the monetary policy of key central banks, as well as expectations for the next period. The paper raises the question of whether central banks have gone from one extreme of overly expansionary monetary policy to the other extreme of overly contractionary monetary policy and whether such policies carry the risk of reoccurrence of recession. The paper also contains recommendations for improving existing monetary policy regimes, as well as for creating a completely new monetary policy regime which will be based on two nominal anchors.

Implant replacement and anaplastic large cell lymphoma associated with breast implants: a quantitative analysis

IntroductionBreast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma associated with breast reconstruction post-mastectomy or cosmetic-additive mammoplasty. The increasing use of implants for cosmetic purposes is expected to lead to an increase in BIA-ALCL cases. This study investigated the main characteristics of the disease and the factors predicting BIA-ALCL onset in patients with and without an implant replacement.MethodsA quantitative analysis was performed by two independent researchers on cases extracted from 52 primary studies (case report, case series, and systematic review) published until April 2022 and searched in PubMed, Scopus, and Google-Scholar databases using “Breast-Implant” AND/OR “Associated” AND/OR “Anaplastic-Large-Cell-Lymphoma”. The statistical significance was verified by Student’s t-test for continuous variables, while Fisher’s exact test was applied for qualitative variables. Cox model with time-dependent covariates was used to estimate BIA-ALCL’s onset time. The Kaplan–Meier model allowed the estimation of the probability of survival after therapy according to breast implant exposure time.ResultsOverall, 232 patients with BIA-ALCL were extracted. The mean age at diagnosis was 55 years old, with a mean time to disease onset from the first implant of 10.3 years. The hazard of developing BIA-ALCL in a shorter time resulted significantly higher for patients not having an implant replacement (hazard ratio = 0.03; 95%CI: 0.005–0.19; p-value < 0.01). Patients with implant replacement were significantly older than patients without previous replacement at diagnosis, having a median time to diagnosis since the first implant of 13 years (7 years in patients without replacement); anyway, the median time to BIA-ALCL occurrence since the last implantation was equal to 5 years.DiscussionOur findings suggest that, in BIA-ALCL patients, the implant substitution and/or capsulectomy may delay the disease’s onset. However, the risk of reoccurrence in an earlier time should be considered in these patients. Moreover, the time to BIA-ALCL onset slightly increased with age. Selection bias, lack of awareness, misdiagnosis, and limited data availability could be identified as limits of our study. An implant replacement should be considered according to a risk stratification approach to delay the BIA-ALCL occurrence in asymptomatic patients, although a stricter follow-up after the implant substitution should be recommended.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier: CRD42023446726.

Prevalence, incidence, and re-occurrence risk of musculoskeletal pain in older adults in the United Kingdom: a population-based study.

Throughout the literature, pain burden has been assessed by asking different questions, often cross-sectionally, different populations of interest. We know little about pain re-occurrence and how to translate knowledge between pain questions within the population of interest. We aimed to estimate the burden of musculoskeletal pain by estimating prevalence, incidence rates, and re-occurrence risk of back, hand, hip, knee, and foot pain using different questions from UK population-based samples and predict the number of affected individuals in the UK in 2030. We used two UK population-representative studies, with two eight-year-apart follow-ups and two pain questions assessing recent pain episodes and often troubled pain when walking. We estimated prevalence, 8-year incidence rates, and 8-year pain re-occurrence risk for women and men aged 50 years and older and the relation between the two pain questions. Among UK individuals older than 50 years, the prevalence of musculoskeletal pain episode was 20%-50%, and the incidence was 20-40/1,000 person-years, while the prevalence of pain when walking was 10%-25%, and the incidence was 6-12/1,000 person-years. The most prevalent musculoskeletal pain types were back and knee pain; of five women experiencing back or knee pain episodes, three are expected to be often troubled by pain. Hip and foot pain had similar estimates in both questions. Hand pain peaked in women aged 50-65 years. Women had higher prevalence and incidence rates, but men had higher 8-year re-occurrence risk of all types of musculoskeletal pain. Reporting a pain episode was associated with two times higher risk, but often troubled by pain when walking was associated with four to seven times times higher risk of the same pain in 8 years. Women and men with a body mass index (BMI) of ≥27 kg/m2 were twice as likely to experience musculoskeletal pain than those with BMI<27 kg/m2. In 2030, we expect 2-7 million people older than 50 years in the United Kingdom to seek site-specific musculoskeletal pain-focused healthcare. In individuals older than 50 years, the experience of musculoskeletal pain at least doubles the chance of experiencing it again. Women report musculoskeletal pain more often, but men report more persistent pain. Musculoskeletal pain presents a significant burden to public health.

Spontaneous Pneumomediastinum Secondary to Undiagnosed Asthma inMilitary Adult.

Spontaneous pneumomediastinum (SPM) is a rare but described complication of exercise-induced bronchoconstriction (EIB), more commonly observed in children with asthma. We present a 23-year-old active duty military male and avid distance runner who developed progressive radiating retrosternal chest pain preceded by wheezing and coughing paroxysm. A chest computed tomography revealed extensive pneumomediastinum. SPM results from increased intrathoracic pressure with alveolar rupture and subsequent tracking of air between fascial planes. Like most cases of SPM, our patient remained hemodynamically stable and responded well to conservative therapies with complete resolution. After thorough evaluation, undiagnosed asthma was determined to be the inciting etiology. The patient is now well controlled and symptom free on a daily low-dose inhaled corticosteroid without SPM reoccurrence. In young adult patients presenting with SPM, EIB and asthma should be considered on the differential diagnosis as appropriate medical therapy will improve symptoms and reduce risk of reoccurrence.

ABO Incompatible Kidney Transplant in a Patient With Atypical Hemolytic Uremic Syndrome: Case Report

Kidney transplant (KT) or renal transplant is 1 of the preferred treatment options for patients with end-stage renal disease, but the presence of atypical hemolytic uremic syndrome (aHUS) further increases the risk of reoccurrence with graft rejection, and poor outcomes. ABO incompatibility further adds to the rejection risk. Here, we present a case of a young adult with a history of aHUS undergoing a successful ABO-incompatible (ABOi) renal transplant. ABO incompatibility desensitization was carried out, and the antibody titer was reduced to nullify the risk of rejection. Graft acceptance was facilitated by triple immunosuppression (steroid, tacrolimus, and mycophenolate mofetil), and 4-month serum creatinine follow-up indicated the absence of antibody-mediated rejection and recurrence of aHUS. This case demonstrates that in patients with aHUS, ABOi renal transplant can be performed successfully.

Combining portable cone penetration test and electrical resistivity tomography to assess residual risks after shallow landslides: a case at the Hokkaido Eastern Iburi earthquake in 2018 in Japan

Landscapes disturbed by shallow landslides present several residual risks. For example, residual soils on sliding surfaces may lead to the re-occurrence of shallow landslides, and landslide deposits on valley floors may introduce multiple hazards associated with river blocking or landslide damming. Despite such risks, few studies have investigated the residual risks following shallow landslides, and thus, no methodology has been established for assessing such risks. In this study, we combined portable cone penetration test (PCPT) and electrical resistivity tomography (ERT) to investigate the post-event risks associated with a landslide scar resulting from the 2018 Hokkaido Eastern Iburi earthquake (HEIE) in Japan. The multi-point PCPT identified the interface between a weak volcanic soil layer and underlying weathered sedimentary rocks. This interface exhibited an abrupt spatial change in resistivity, ranging from 20 to 100 Ωm. The thickness of the residual soil layer was 0.3–3.2 m and that of the landslide deposit exceeded 2.0 m. An infinite-slope stability analysis was performed to predict the re-occurrence of shallow landslides due to a lower intensity earthquake than that of HEIE in this region. Considering the area affected by the HEIE and the physical properties of soil layers, our findings imply a widespread risk of re-occurrence of shallow landslides over an area of 20 km × 20 km. Although the areal coverage of the combined ERT/PCPT method needs to be extended, it is effective for assessing the residual risks associated with shallow landslides.

International Perspectives on Modifications to the Surgical Safety Checklist

Modification of the World Health Organization's Surgical Safety Checklist (SSC) is a critical component of its implementation. To facilitate the SSC's use, it is important to know how surgical teams modify their SSCs, their reasons for making modifications, and the opportunities and challenges teams face in SSC tailoring. To study SSC modifications in high-income hospital settings in 5 countries: Australia, Canada, New Zealand, the United States, and the United Kingdom. This qualitative study used semistructured interviews based on the survey used in the quantitative study. Each interviewee was asked a core set of questions and various follow-up questions based on their survey responses. Interviews were conducted from July 2019 to February 2020 in person and online using teleconferencing software. Surgeons, anesthesiologists, nurses, and hospital administrators from the 5 countries were recruited through a survey and snowball sampling. Interviewees' attitudes and perceptions on SSC modifications and their perceived impact on operating rooms. A total of 51 surgical team members and hospital administrators from the 5 countries were interviewed (37 [75%] with >10 years of service; 28 [55%] women). There were 15 (29%) surgeons, 13 (26%) nurses, 15 (29%) anesthesiologists, and 8 (16%) health administrators. Five themes emerged concerning the awareness and involvement in SSC modifications; reasons for modifications; types of modifications; the outcomes of modifications; and perceived barriers to SSC modifications. Based on the interviews, some SSCs may go many years without being revisited or modified. SSCs are modified to ensure they address local issues and standards of practice and that they are fit for purpose. Modifications are also made following adverse events to reduce the risk of reoccurrence. Interviewees described adding, moving, and removing elements from their SSCs, which increased their sense of ownership in their SSC and participation in its performance. Some barriers to modification included leadership and the SSC's inclusion in hospitals' electronic medical record. In this qualitative study of surgical team members and administrators, interviewees described addressing contemporary surgical issues through various SSC modifications. The process of SSC modification may improve team cohesion and buy-in in addition to providing opportunities for teams to improve patient safety.

Investigation of Spotty Liver Disease and Campylobacter hepaticus in Layer Flocks-A Field Study.

Campylobacter hepaticus (C. hepaticus) was recently discovered as the causative agent of Spotty Liver Disease (SLD). SLD affects laying hens and causes significant economic losses in egg production in several countries throughout the world. Field observations reveal that cases of SLD appear with a high risk of reoccurrence, specifically in free-range and organic brown-feathered layer lines. Possible factors contributing to the development of SLD still have to be elucidated. In this field study, one free range (Flock 1) and one organic flock (Flock 2) of brown laying hens kept on farms with a history of clinical SLD were monitored for C. hepaticus colonization, clinical signs, and egg production from 16 to 79 wk of age on the first farm and from 17 to 83 wk of age on the other. The flocks showed a significant drop in egg production at 32 to 39 or 56 wk of age, respectively, which was associated with macroscopically visible liver lesions typical for SLD. Interestingly, in both cases observed clinical disease was linked to a stressful event: heat stress for Flock 1 and respiratory symptoms for Flock 2. C. hepaticus was detected by PCR during the acute phase of the disease in Flock 1. At 50 wk after the initial clinical outbreak had waned, C. hepaticus was still able to be isolated by culture in this flock. This clearly demonstrates that C. hepaticus persists either in the birds or their environment. We speculate that this long persistence may favor chronic SLD in affected flocks and the reoccurrence of SLD in subsequent flocks. Clinically less severe SLD outbreaks may be observed after re-exposure of clinically recovered flocks.

At long-term follow-up many first-time male traumatic shoulder dislocators remain symptomatic.

To assess the status at 13 to 17 years follow-up of a cohort of young male traumatic shoulder dislocators. Prospective cohort study. A prospective study of first-time young male traumatic shoulder dislocators, began in 2004. Subjects were evaluated by the apprehension test after completing rehabilitation 6 to 9 weeks post dislocation. Between March 2021 and July 2022, a telephone questionnaire was administered to ascertain their current shoulder status. Subjects were questioned about avoidance of activities of daily living and sport, participation in sports, current instability, and self-assessed shoulder function by the SANE score. 50/53 (94.3%) of the study subjects, mean age 20.4 years, completed a mean follow-up of 181.8 ± 12 months. The non-redislocation survival was 13% for those with a positive apprehension test and 49% for those with a negative test (p = 0.007). SANE scores were 64.3 ± 23.7 for those with a positive apprehension test and 83.7 ± 19.7 for those with a negative test (p = 0.001). In the year before the follow-up, 33.3% of those treated conservatively and 42.9% treated surgically experienced subluxation (p = 0.5). Fifty-seven percent of those who were treated conservatively and 56% of those who underwent surgery avoided some ADL or sports because of their shoulder. For young male first time traumatic shoulder dislocators a positive apprehension test after rehabilitation is associated with a high risk for reoccurrence and poorer long-term results. Most subjects were still dealing with shoulder symptoms at long-term follow-up.

Preferences of cancer patients as a guide to cancer prevention: a retrospective willingness to pay study in Nepal

ObjectiveIn developing countries, like Nepal, with no population-based cancer registry and low level of awareness, it is difficult to communicate the significance of cancer preventative measures to the general population. Only patients, who have faced or facing the economic and mental burden of cancer, can better understand the importance of early diagnosis. This led us to study the retrospective preference of cancer patients in valuing an annual comprehensive cancer screening program in Nepal. Study designThis is a primary survey-based study of 600 diagnosed cancer patients (aged 18+ years) randomly sampled from five hospitals of Nepal during December 2015–February 2016. MethodsUsing the contingent valuation estimation methods, we modelled patients’ willingness to pay (WTP) for early cancer screening through the Structural Equation Modelling framework. ResultsAbout 59% of our sampled patients did not receive education and 65% earned below $100/month. Among other findings, we saw that the Risk of re-occurrence impacted WTP through two opposing channels. The direct effect of Risk of re-occurrence on WTP was positive (β = 0.20; p < 0.05), but higher the risk of cancer relapses, the higher was the Pessimism among patients, which indirectly impacted WTP negatively (β = −0.16; p < 0.1). In addition, we found the effect of Income on WTP to be positive (β = 0.15; p < 0.05), whereas, one belonging to the Dalit section of the society had lower WTP for screening. ConclusionCancer patients value the importance of early diagnosis with multiple psychosocial factors impacting this preference. This direct account of patients could be used as evidence in policymaking.

Leveraging Telehealth for the Management of Breast Cancer: A Systematic Review.

Background: Breast cancer affects 2.3 million women and kills 685,000 globally, making it the most prevalent cancer. The telemedicine modality has been used to treat the symptoms associated with breast cancer recovery. Objectives: To analyze the effectiveness of telemedicine to help women recover from the treatment-associated effects and promote overall recovery from breast cancer. Methods: Four databases were queried for published literature from the last 10 years. The systematic literature review was conducted in accordance with the Kruse Protocol and reported in accordance with PRISMA 2020. Results: Five interventions were identified in the literature, with the most dominant being eHealth and mHealth. The other interventions were telephone, video teleconference, and a combination of eHealth and mHealth. There were positive effects of these telemedicine interventions in 88% of the studies analyzed. Telemedicine is shown to positively affect physical and mental health, sleep outcomes, quality of life, and body image. The largest barriers to the adoption of telemedicine interventions are training, cost, workflow, time of providers, and low reimbursement. Conclusion: Telemedicine offers promise to both providers and breast cancer survivors to improve the physical and mental health detriments of both cancer and its associated treatments. It also helps women develop healthy habits to reduce the risk of reoccurrence.

Postoperative Atrial Fibrillation and Risk for Reoccurrence at Long-Term in Adults with Obstructive Sleep Apnea Undergoing Coronary Artery Bypass Grafting in the RICCADSA Cohort

Postoperative Atrial Fibrillation and Risk for Reoccurrence at Long-Term in Adults with Obstructive Sleep Apnea Undergoing Coronary Artery Bypass Grafting in the RICCADSA Cohort

P-753 Pregnancy complications and placental histology following embryo transfer with a thinner endometrium

Abstract Study question Our objective was to assess perinatal outcomes and placental findings following in vitro fertilization (IVF) with a thinner endometrium. Summary answer Live births following IVF with a thinner endometrium were associated with placental mediated obstetric complications and lower birthweight, yet with no differences in placental histology. What is known already A lower average birth weight and higher rate of small for gestational age infants have been demonstrated in both fresh transfer and frozen transfer cycles with thinner endometrial thicknesses. Additional adverse outcomes associated with thin endometrium included hypertensive disorders of pregnancy, placenta previa, cesarean section and overall obstetric complications. Yet, no study has explored placental histology in such cases. Study design, size, duration This was a retrospective cohort study of 1057 deliveries following IVF, between 2009 and 2017. All placentas were sent to pathology irrelevant of pregnancy complication status, per protocol at our institution. Participants/materials, setting, methods Data was from a university-affiliated tertiary hospital. Included were live singleton births after IVF, compared according to maximum endometrial thickness prior to transfer: thinner endometrium group, defined as &amp;lt; 9-millimeters, as compared to controls, defined as ≥ 9-millimeters. Outcomes were placental findings, including anatomic, inflammatory, vascular malperfusion and villous maturation lesions and obstetric and perinatal outcomes. Continuous and categorial variables were compared as appropriate, and logistic and linear regression analyses employed.to control for confounders. Main results and the role of chance A total 292 deliveries in the thinner endometrium group, and 765 in the control (thicker) group were compared. Maternal demographics were similar between the groups, except for main treatment indication, which was more commonly diminished reserve in patients with a thinner endometrium – 17.8% vs. 9.4%, and less commonly male factor – 27.0% vs. 35.6%, p = 0.003. Live births following fresh transfer were more common in the control group, while the thinner endometrium group was notable for a higher rate of single blastocyst transfers. When controlling for confounding effects, thinner endometrium was associated with an increased rate of obstetric complications (preterm delivery, preeclampsia, low birth weight or placental abruption) - 26.0% vs. 17.5%, p = 0.001, while placental histological examination demonstrated no differences in anatomical, inflammatory or vascular lesions. In a linear regression analysis, after adjustment for confounders, thinner endometrium was associated with lower birthweights – β -101.3 grams, 95% CI (-185.0 to -17.6 grams), p = 0.01. Limitations, reasons for caution The study was limited by sample size. Missing historical information included obstetric complications in previous deliveries, which would increase the risk of reoccurrence in subsequent pregnancies and data regarding endometrial trauma (curettage for example). Wider implications of the findings Transfer with a thinner endometrium was associated with placental mediated complications and lower birthweights, despite similar placental histology. This may result from functional placental changes throughout implantation and placentation. Preventive measures for adverse obstetric outcomes, such as Micropirin, in cases in which endometrial thicknesses are suboptimal are to be determined. Trial registration number Not applicable

The influence of COVID-19 pandemic on biomedical waste management, the impact beyond infection

Excessive population outbursts and associated xenobiotic interventions contribute overproduction of waste materials across the world. Among these waste materials biomedical wastes (BMW) make a significant contribution. The huge accumulation of BMW is not only meant for successive environmental pollution but increases health hazards by cross-contamination and reoccurrence of different fatal infections. The management of BMW gaining continuous attention to the scientific communities for their intriguing potentiality towards public health concerns. Although, world health organization (WHO) and other public health and environmental societies formulate different guidelines for the disposal machinery of BMW but the proper implementation of those rules in public sectors in developing countries is very difficult. In this situation, the sudden prevalence of pandemic like, COVID-19 further worsen such conditions. Huge disposition of medical wastes during COVID-19 detection, treatment, and precautionary measures not only increases the risk of reoccurrence of infection but puts us also in front of a huge challenge of efficient management of these BMW. In this respect, the present review focus on an overview of BMW, existing BMW management, probable consequences of COVID-19 pandemic on the waste management system, and future perspectives.

Critical incident reporting over time: a retrospective, descriptive analysis of 5493 cases.

As recommended by the WHO and many national healthcare authorities, health care institutions of most industrialised countries have employed a critical incident reporting system (CIRS). However, little is known about differences in critical incidents across clinical specialties, the use of CIRSs amongst different professional groups, the types, severity and risk of reoccurrence of critical incidents, their contributing factors and the preventive actions taken in response. In this retrospective, descriptive study we critically reviewed all reports filed in the CIRS of our institution between 2013 and 2019 and analysed characteristics over time. Of the 5493 analysed incidents, the main types were related to medications (32.8%), clinical procedures (32.6%) or behaviour of employees (23.3%). Only 21.6% of reports were made by physicians, 51.3% were rated at least "high risk". Major contributing factors were personal factors (44.0%), lack of training and knowledge (43.7%) and communication errors (36.1%). Most actions taken to prevent similar events aimed at improving communications (23.6%); in 46.3% no actions whatsoever were taken. Longitudinal analysis revealed that reporting increased in internal medicine and obstetrics but collapsed in laboratory medicine / microbiology. Steady increases in medication-type incidents as well as lack of training and knowledge as contributing factors were observed. This study revealed that the efferent loop (feedback, preventive actions taken) was the weakest part of the CIRS in our institution, indicating that no learning may have resulted from a large number of reports. In particular, the actions taken appeared to not adequately address the major contributing factors. This highlights that special attention must be paid to the efferent loop of a CIRS to fulfil the purpose of such a reporting system and ultimately to improve patient safety.

Proteomics analysis of tissue small extracellular vesicles reveals protein panels for the reoccurrence prediction of colorectal cancer

Many stage II/III colorectal cancer (CRC) patients might relapse after routine treatment and there is a great need of reliable biomarkers for predicting its reoccurrence risk. Small extracellular vesicles (sEVs) could regulate many pathophysiological processes of diseases, which are promising source for biomarker discovery. In this study, we implemented a MS-based workflow that utilizes data-dependent acquisition (DDA) for discovery and parallel reaction monitoring (PRM) for validation of high relapse risk related biomarkers. We compared the protein profiling of sEVs from CRC tissues and paired adjacent tissues in relapsed group (n = 5) and non-relapsed group (n = 5). 417 and 1140 proteins were differentially expressed between the tumor tissues and adjacent tissues in relapsed group and non-relapsed group, respectively. Bioinformatics analysis showed that immunity of the relapsed patients (Z-score − 0.69) was relatively poorer than the non-relapsed patients (Z-score 2.59), while chronic inflammatory response was activated (Z-score 3.0), which might enhance the reoccurrence risk. Four proteins (HLA-DPA1, S100P, NUP205, PCNA) showed significant expressions in the adjacent tissues of the relapsed group by PRM validation. ROC analysis of HLA-DPA1 (AUC = 0.96) achieved the best classification accuracy in separating the relapsed group and the non-relapsed group. Our data demonstrate that tissue-derived sEVs harbor prognostic proteomic signatures of CRC. SignificanceIn this research, our proteomics analysis of tissue sEVs revealed that poor immunity as well as chronic inflammatory of the CRC relapsed patient likely lead to poor prognosis and high risk of reoccurrence. The significant expression levels of four proteins (HLA-DPA1, S100P, NUP205, PCNA) in the adjacent tissues of the relapsed group might be used to predict the risk of relapse in postoperative follow-ups.