Specific Risk Research Articles

Pediatric tuberculosis in Mexico and the COVID-19 phenomenon: Past and present.

In endemic regions, tuberculosis in children constitutes a bigger fraction of total cases as compared to those in low endemic regions, regardless of the implications, this phenomenon has been historically neglected. Pediatric tuberculosis has an insidious onset and quickly develops into disseminated disease and the young are at a special risk for dissemination. Some studies suggest that measures to contain adult tuberculosis are not enough to manage tuberculosis in children, meaning that pediatric tuberculosis needs dedicated attention. Children are harder to diagnose than adults, because collecting samples is difficult, and their bacterial yield is low. In endemic countries, such as Mexico, where contact with Mycobacterium tuberculosis is common, immunological tests are inconsistent, especially in immunocompromised children. With the disruption of Mexican healthcare services by the COVID-19 pandemic, there is an uncertainty of how the situation has evolved, current data about tuberculosis indicates a drop in the national report of cases: 15.4 per 100,000 persons in 2021, compared with pre-COVID 2019 17.7 per 100,000 persons, a small increase in mortality: 1.7 per 100,000 in 2021 compared with 2019 1.6 per 100,000, a drop in treatment success: 80.4% in 2021 compared with 85.4% in 2019, and a decrease in national vaccination rates: an estimate of 86.6% children between 1 and 2 years-old were vaccinated in 2021 compared with 97.3% reported national rate in 2018-2019. There is a need for new research on regions with high tuberculosis incidence, to clarify the current situation of pediatric tuberculosis and improve epidemiological surveillance.

Early development of infants born prematurely who were conceived through assisted reproductive technologies

ObjectiveThis study aims to determine physical and psychomotor development characteristics during the first 24 months of life in prematurely born children conceived with assistive reproductive technologies and to determine specific risk factors for deviation from typical development. Patients and methodsThe study included 308 prematurely born children (154 conceived with assistive reproductive technologies – ART group and 154 conceived naturally – NC group) hospitalized at the Institute for the Health Care of Children and Adolescents of Vojvodina in Serbia. The physical and psychomotor development was monitored during the first two years of life. ResultsBirth weight was statistically significantly higher in the NC group than in the ART group, and IUGR was more often present in the ART group than in the NC group of newborns. The mean values of body weight, length, and head circumference of children from both groups did not differ statistically significantly at 18 months. At 12 and 18 months, children from the ART group significantly more often had below-average scores on the test for assessment of psychomotor development (corrected GDQ <90) than children from the NC group, but not at 24 months. Logistic regression analysis has shown that at 12 and 18 months, multiple pregnancy is an independent risk factor for lower GDQ. ConclusionAt the age of 12 months, prematurely born children conceived with ART do not differ in physical development from prematurely born children after natural conception. At 12 and 18 months, prematurely born children conceived with ART achieve lower global developmental scores than children conceived naturally, but not at 24 months of age. Multiple pregnancies are an independent risk factor for lower achievement on the test for assessment of psychomotor development in prematurely born children.

A Comprehensive Risk Factor Exploration: Korean Nationwide Cross-Sectional Study of Sarcopenia Obesity in Young-Old Males-Investigating the Prevalence, Somatometric, Biochemical, and Behavioral Traits.

Sarcopenic obesity refers to the coexistence of sarcopenia and obesity. This study assessed the prevalence of and risk factors for sarcopenic obesity in community-dwelling older males in Korea. This cross-sectional study analyzed data from 1060 community-dwelling participants. The participants were screened for sarcopenia and obesity. This study examined various risk factors, composed of somatometric, biochemical, and behavioral traits, including age; height; weight; body mass index; waist circumference; skeletal muscle mass index; fasting glucose, triglycerides, and cholesterol levels; systolic and diastolic blood pressure; and smoking and drinking traits. The prevalence of sarcopenic obesity in men had a weighted value of 9.09% (95% CI: 7.20-11.41). The clinical risk factors included short height, as well as high weight, body mass index, waist circumference, skeletal muscle mass index, triglyceride levels, systolic blood pressure, and diastolic blood pressure. Specific prevalence and clinical risk factors for sarcopenic obesity were found among community-dwelling older men. These findings may be beneficial for primary care clinicians and healthcare professionals for identifying individuals with sarcopenic obesity and referring them for early detection and treatment.

Assessment of psychosocial risks at work in supervisors of clothing stores during the pandemic context

The main objective of this paper is to demonstrate how to carry out a structured, sustained and objective assessment of psychosocial risks at work. Several studies in the literature on this topic are presented as risk assessments, when in fact they reflect the results from worker consultation procedures and/or surveys about the psychosocial work climate. As relevant as these studies are, many are not professional risk assessments. This assessment obeys a set of assumptions that must be strictly respected and performed by duly qualified professionals, as national and European legislation determine. Using a practical case with supervisors of clothing stores evaluated during the pandemic context, it is explained and applied an approach to perform this kind of risk assessment. The data presented show the effectiveness of the methodology applied. Regarding the results obtained in the practical case mobilized, a positive psychosocial work environment, even taking into account the pandemic context, with most risk factors showing acceptable or moderate incidences. It is possible to conclude that the pandemic period, despite creating contextual constraints, was not consider a specific risk factor in these stores and the supervisors felt safe in their workplace, because there was a robust system of preventive measures implemented. However, it is important to underline that exist also dissatisfaction with working conditions in some segments of supervisors, as well as a high level of risk of professional exhaustion, interpersonal conflicts at work and interference of work with personal/family life. For this reason, intervention measures were proposed to the company.

Testing Cancer Patients for HIV: Just Do It

Who do we test for HIV? In a perfect world, the answer to this question is, “Everyone.” The United States Centers for Disease Control and Prevention (CDC) recommends that anyone between the age of 13 to 64 years old should have at least one HIV test as part of routine healthcare. 1 In addition, they recommend that anyone who comes into contact with the healthcare system be tested, along with all pregnant women. The main justification for these recommendations is that 40% of new HIV infections in the United States are transmitted by people who do not know their HIV status, which is about 10% of their people living with HIV (PLHIV). 2&#x0D; In the Philippines, the testing gap is even wider. Out of an estimated 160,000 PLHIV in 2022, only 102,931 PLHIV were tested and diagnosed. This translates to nearly 40% of all Filipino PLHIV remaining undiagnosed and potentially infecting others. 3 The testing coverage for the most-at-risk populations in the Philippines remains dismal at 67% for female sex workers (FSW), 28% for men who have sex with men (MSM), and 27% for persons who inject drugs (PWID). Successfully addressing the HIV epidemic begins at diagnosis, and so improving testing is of paramount importance.&#x0D; There are two major compelling public health reasons to test people for HIV. First is to start life-saving antiretroviral therapy (ART) as soon as possible. The sooner a PLHIV starts ART and stays on it, the more life years are recovered up to nearly restoring life expectancy. 4 The second reason is to eliminate the risk of transmission to other people. Starting ART and achieving a suppressed viral load renders a PLHIV virtually unable to transmit. 5&#x0D; In this issue of the journal, Poblete and his colleagues6 try to make the case for universal HIV screening of Filipino cancer patients. While they did not find any HIV cases among the 124 patients they screened, they did note that risk factors among the study population were low. They still encouraged physicians to offer HIV screening to all cancer patients given the overwhelming benefits of treatment.&#x0D; Targeted versus universal HIV screening has been a long ongoing academic debate and there are pros and cons supporting each approach. 7 A low overall prevalence like in the Philippines will be associated with higher costs per case detected with universal screening, but this could potentially be offset by the cost of missed cases in targeted screening. The CDC in past guidance has asserted that universal HIV screening in a specific risk population with an HIV prevalence of at least 0.1% is cost-effective. However, it eventually updated this guidance, urging universal screening regardless of risk factors or prevalence due to the clear benefits of early antiretroviral therapy both from an improved survival and decreased transmission standpoint. 1 In 2010, we did a study doing universal screening on cervical cancer patients and found no cases of HIV among 394 subjects at the Philippine General Hospital (PGH). 8 However, we do have several PLHIV with cervical cancer in the SAGIP clinic in PGH. The failure to capture these patients in the study could be due to several reasons, including an underpowered sample size, poor random sampling, or those with higher risk factors declined to participate due to stigma. In a parallel study, we found no HIV cases in 400 pregnant women. 9 Despite this finding, universal screening among pregnant women continues to be recommended and is needed to eliminate maternal to child transmission of HIV.&#x0D; There are more aspects to consider in recommending an HIV test beyond cost-effectiveness, underlying prevalence, and risk factors. Many infectious diseases physicians, including myself, recommend universal HIV screening for all cancer patients, especially those who are going to undergo chemotherapy regardless of risk factors. Given the severe immunosuppression that results from chemotherapy, the presence of an undetected HIV diagnosis can result in catastrophic medical consequences. Furthermore, certain AIDS-defining illness such as Kaposi’s sarcoma and lymphomas respond to treatment much better once antiretrovirals have been started.&#x0D; Studies like Poblete et al. 6 are ultimately useful for periodic surveillance to check whether the prevalence of HIV in special populations is increasing, but negative findings from these studies should not be seen as a reason to defer HIV testing in this population. The benefits of HIV screening in cancer patients far outweigh any drawbacks, given the tremendous public health benefits of early diagnosis. We still have a long way to go in finding all the PLHIV in our country, and any opportunity to test is an opportunity to save a life.

First-In-Human Safety, Tolerability, and Pharmacokinetics of Single and Multiple Doses of AZP2006, A Synthetic Compound for the Treatment of Alzheimer's Disease and Related Diseases.

Alzheimer's disease (AD) and progressive supranuclear palsy (PSP) are major neurodegenerative conditions with tau pathology in common but distinct symptoms-AD involves cognitive decline while PSP affects balance and eye movement. Progranulin (PGRN) is a growth factor implicated in neurodegenerative diseases, including AD and PSP. AZP2006, a synthetic compound, targets tauopathies by stabilizing PGRN levels and reducing tau aggregation and neuroinflammation. Evaluate the safety, tolerability, and pharmacokinetics of AZP2006. A first-in-Human phase 1 study comprised a single ascending dose (SAD) and a multiple ascending dose study (MAD). The SAD study included 64 healthy male volunteers and tested singles oral doses of 3 to 500 mg of AZP2006 free base equivalent or placebo. In the MAD study, 24 healthy male volunteers were administered oral doses of 30, 60, and 120 mg per day of AZP2006 or placebo for 10 days. No serious adverse events were observed. Clinical, biological, and electrocardiogram findings were non-relevant. Nineteen minor adverse events resolved before study completion. The safety profile indicated no specific risks. The multiple ascending dose study was halted, and the optional dose level of 180 mg was not performed due to high levels of M2 metabolite in plasma that necessitated additional preclinical evaluation of M2. Both AZP2006 and its M2 metabolite were quickly absorbed and widely distributed in tissues. Exposure increased more than proportionally with dose. AZP2006 had a favorable safety profile and was rapidly absorbed. Elevated M2 metabolite levels necessitated further studies to clarify excretion and metabolism mechanisms.

Gambling Operators’ Use of Advertising Strategies on Social Media and Their Effects: A Systematic Review

Abstract Purpose of Review Social media offer gambling operators an attractive channel for connecting with gamblers and promoting their products. The aim of the present study is to review the recent literature to summarise the latest findings on marketing strategies of gambling operators, and their effects, with particular focus on social media. Recent Findings A systematic review on gambling advertising in social media has been conducted, taking into account English-language journal articles from 2021 onwards, which include primary data collection. Searching three data bases, a total number of 12 studies from peer-reviewed journals were identified. Gambling advertising has an enormous reach, including esports sponsorship and a surge in popularity on streaming platforms, which raises concerns about the protection of gamblers in general and of vulnerable groups in particular. The studies identify individual advertising strategies and investigate the influence of incentives and tips on gambling behaviour. Gaps in the current literature include evidence from certain regions or countries, research into communication strategies on individual social media platforms, and questions about the effectiveness of regulatory measures regarding gambling advertising. Summary Gambling operators flexibly adapt their advertising strategies to the surrounding conditions. This appears to be problematic, as the intensity and complexity of gambling advertising increases at the same time as the boundaries between advertising and seemingly neutral content blur. Vulnerable groups, especially children and adolescents, are at special risk, because advertising on social media is particularly attractive for them, while protection mechanisms such as age limits are often missing or being ignored.

Pain sensitivity as a state marker and predictor for adolescent non-suicidal self-injury.

The pain analgesia hypothesis suggests that reduced pain sensitivity (PS) is a specific risk factor for the engagement in non-suicidal self-injury (NSSI). Consistent with this, several studies found reduced PS in adults as well as adolescents with NSSI. Cross-sectional studies in adults with borderline personality disorder (BPD) suggest that PS may (partially) normalize after remission or reduction of BPD symptoms. The objective of the present study was to investigate the development of PS over 1 year in a sample of adolescents with NSSI and to investigate whether PS at baseline predicts longitudinal change in NSSI. N = 66 adolescents who underwent specialized treatment for NSSI disorder participated in baseline and 1-year follow-up assessments, including heat pain stimulation for the measurement of pain threshold and tolerance. Associations between PS and NSSI as well as BPD and depressive symptoms were examined using negative binomial, logistic, and linear regression analyses. We found that a decrease in pain threshold over time was associated with reduced NSSI (incident rate ratio = 2.04, p = 0.047) and that higher pain tolerance at baseline predicted lower probability for NSSI (odds ratio = 0.42, p = 0.016) 1 year later. However, the latter effect did not survive Holm correction (p = 0.059). No associations between PS and BPD or depressive symptoms were observed. Our findings suggest that pain threshold might normalize with a decrease in NSSI frequency and could thus serve as a state marker for NSSI.

Challenges and promising practices in background check systems for firearm purchases

AbstractAimThe U.S. prohibits firearm purchase among individuals with specific risk factors. These prohibitions are operationalized using background checks for firearm purchase. Despite these restrictions, prohibited persons have obtained firearms after passing background checks, sometimes with devastating effects.Materials and MethodsWe conducted a mixed‐methods, descriptive study of the records and record‐keeping practices that underpin background checks for firearm transfers. Sources included key informant interviews with individuals working in a leadership capacity with state record‐keeping systems as well as data from state surveys and administrative records. We analyzed quantitative data using descriptive statistics and qualitative data using a thematic analysis approach to code the data and identify themes. Three investigators coded each interview. We returned to all data sources to develop key findings in an iterative process.ResultsKey informants described major improvements in the collection of specific record types that were previously a “black hole” (e.g. criminal history records housed in military justice systems, and records relating to involuntary commitments for mental illness) and advances in the automation of record transfer across agencies, themes corroborated by administrative data. Key informants also identified potential causes and solutions for challenges relating to missing or incomplete information and delays in resolving ambiguous background check results. Examples include manual processes for confirming relationship status in misdemeanor crimes of domestic violence and discordant practices for processing arrest and court records that result in dispositions that cannot be entered or arrests with no disposition.ConclusionBackground checks are the backbone of many policies designed to prevent firearm harm in the United States. This study highlights actionable ways in which states could make background check practices and policies more robust.

External validation of the PC-ECMO score in postcardiotomy veno-arterial extracorporeal membrane oxygenation.

Reliable stratification of the risk of early mortality after postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) remains elusive. In this study, we externally validated the PC-ECMO score, a specific risk scoring method for prediction of in-hospital mortality after postcardiotomy V-A-ECMO. Overall, 614 patients who required V-A-ECMO after adult cardiac surgery were gathered from an individual patient data meta-analysis of nine studies on this topic. The AUC of the logistic PC-ECMO score in predicting in-hospital mortality was 0.678 (95%CI 0.630-0.726; p < 0.0001). The AUC of the logistic PC-ECMO score in predicting on V-A-ECMO mortality was 0.652 (95%CI 0.609-0.695; p < 0.0001). The Brier score of the logistic PC-ECMO score for in-hospital mortality was 0.193, the slope 0.909, the calibration-in-the-large 0.074 and the expected/observed mortality ratio 0.979. 95%CIs of the calibration belt of fit relationship between observed and predicted in-hospital mortality were never above or below the bisector (p = 0.072). The present findings suggest that the PC-ECMO score may be a valuable tool in clinical research for stratification of the risk of patients requiring postcardiotomy V-A-ECMO.

Firearm ownership and storage among US college students: results from the healthy minds study, 2021-2022.

The purpose of this study is to address a significant gap in knowledge on firearm ownership rates and storage characteristics in a national sample of college students. We used 2021-2022 survey data from the Healthy Minds Study, which included approximately 88,500 students at over 100 US colleges and universities. We conducted analyses using descriptive statistics and two-sample proportion tests. About 4% of respondents reported having a firearm on or around campus. Among firearm owners, 68.8% reported storing firearms at their permanent address within an hour's drive from campus, and 43.1% reported storing their firearms unloaded and locked. Firearm ownership rates were significantly higher for respondents who were positive for specific risk factors (i.e., in a relationship, suicide ideation, recent binge drinking, and having been physically assaulted) versus those who were negative. These findings support the need for targeted messaging and firearm safety training for college students to reduce firearm-related risks.

Comparison of patient demographics and patient-specific risk factors for readmissions following open reduction and internal fixation for acetabular fractures.

Acetabular fractures are highly complex injuries often resulting from high-energy trauma. The gold standard treatment for these injuries has become open reduction internal fixation (ORIF). The purpose of this study is to further this understanding and investigate how (1) patient demographics and (2) patient-specific risk factors affect 90-day readmission rates. A retrospective, nationwide query of private insurance database from January 1st, 2010 to October 31st, 2020 was performed using ICD-9, ICD-10, and CPT codes. Patients who underwent acetabular ORIF and were readmitted within 90days following index procedure were included, patients who were not readmitted served as controls. Patients were divided by demographics and specific risk factors associated with readmission. The query yielded a total of 3942 patients. Age and sex were found to be non-significant contributing risk factors to 90-day readmissions. Data also showed that statistically significant comorbidities included arrhythmia, cerebrovascular disease, coagulopathy, fluid and electrolyte abnormalities, and pathologic weight loss. This study illustrated how several patient-specific risk factors may contribute to increased 90-day readmission risk following acetabular ORIF. A heightened awareness of these comorbidities in patients requiring acetabular ORIF is required to improve patient outcomes and minimize rates of readmission. Further investigation is needed to improve patient outcomes, and increase awareness of potential post-operative complications in these higher-risk patient populations.

Occurrence and fate of pharmaceuticals and personal care products in a wastewater treatment plant with Bacillus bio-reactor treatment

Pharmaceuticals and personal care products (PPCPs) have attracted wide attention due to their environmental impacts and health risks. PPCPs released through wastewater treatment plants (WWTPs) are estimated to be 80 %. Nevertheless, the occurrence of PPCPs in the WWTPs equipped with Bacillus spec.-based bioreactors (BBR) treatment system remains unclear. In this study, sludge and waste water samples were collected during separate winter and summer sampling campaigns from a typical BBR treatment system. The results indicate that out of 58 target PPCPs, 27 compounds were detected in the waste water (0.06–1900 ng/L), and 23 were found in the sludge (0.6–7755 ng/g dw). Paraxanthine was the chemical of the highest abundance in the influent due to the high consumption of the parent compounds caffeine and theobromine. The profile for PPCPs in the wastewater and sludge exhibited no seasonal variation. Overall, the removal of target PPCPs in summer is more effective than the winter. In the BBR bio-reactor, it was found that selected PPCPs (at ng/L level) can be completely removed. The efficiency for individual PPCP removal was increased from 1.0 % to 50 % in this unit, after target specific adjustments of the process. The effective removal of selected PPCPs by the BBR treatment system is explained by combined sorption and biodegradation processing. The re-occurrence of PPCPs in the wastewater was monitored. Negative removal efficiency was explained by the cleavage of Phase II metabolites after the biotransformation process, and the lack of equilibrium for PPCPs in the sludge of the second clarifier. A compound specific risk quotient (RQ) was calculated and applied for studying the potential environmental risks. Diphenhydramine is found with the highest environmental risk in wastewater, and 15 other PPCPs show negligible risks in sewage sludge.

A short-term price prediction-based trading strategy.

Quantitative investment theory has emerged as a prominent and widely researched domain within the financial markets, where investors predominantly focus on discerning the intricate influences of market dynamics. In this paper, we proposed a short-term prediction-based trading strategy, which can equiponderate between return and risk, considerations while accounting for investor risk preferences. This strategy employs GM(1,1) to capture nuanced features of price dynamics in short-term intervals and update the GM(1,1) model with the latest data. Subsequently, a multi-objective planning equation is formulated to optimize asset allocations by determining the optimal holding that strikes between specific returns and risk mitigation. In the end, this work conducts a case study and sensitivity analysis using five years of gold and bitcoin price data spanning from 2016 to 2021. This empirical examination serves to affirm the efficacy and resilience of the proposed trading strategy. The case study reveals that proficient short-term price forecasting serves as a potent means to proactively mitigate risk, facilitating, judicious and objective trading practices. Moreover, it underscores the strategy's tangible utility as a guide for real-world investment decisions.

The audit of banks in the USA: Has it changed since the financial crisis?

AbstractThe most recent financial crisis exposed to the auditors the risk associated with the audit engagement of their banking clients. Because many banking clients failed and investors suffered trillions of dollars in losses, auditors are now defendants in numerous shareholder and regulatory lawsuits. There is consensus that the financial crisis was created by an abundance of credit, excessive risk taking through complex financial instruments, weak corporate structures, and ineffective regulatory mechanisms. In this study, we examine how the financial crisis has affected the audit engagements of banking clients. We examine audit fees, audit report lag, and auditor changes before and after the financial crisis with respect to specific bank risks like credit risk, interest rate risk, and liquidity. Overall, we find that auditors are more responsive to bank risks in the post-financial crisis period compared to the pre-financial crisis period.

IMPACT OF THE COVID-19 PANDEMIC ON BRUXISM AND THE DAILY LIFE OF CHILDREN AGED 7-10

Introduction: In 2020, the global pandemic of COVID-19 significantly affected our daily lives. The youngest students were most affected due to the establishment of distance education, which is associated with social isolation and increased screen time. Aim:To investigate the prevalence and specific risk factors for sleep bruxism associated with the COVID-19 pandemic in children aged 7-10 years, their eating habits and physical activity. Materials and methods: The object of the study are 267 children aged 7-10 years. The examined children underwent a clinical examination, during which the following were registered: dental status and attrition, oral hygiene and orthodontic status. Anamnestic data on nocturnal bruxism, physical activity, dietary habits, and screen exposure were obtained from 241 parents via a questionnaire. The results were statistically processed with SPSS-19. Results: The frequency of bruxism in children aged 7-10 is 21.4% (p&lt;0.05). No increase in its frequency or intensity was found during the pandemic in the studied groups. The average increase in screen exposure during the pandemic was more than 60 minutes per day (p&lt;0.05). In 1/4 of the children, physical activity during the pandemic decreased (p&lt;0.05). In 21.6% of the examined children, the intake of simple carbohydrates increased (p&lt;0.05). Conclusions: Bruxism is a common condition in school-aged children. The restrictive measures during the COVID-19 pandemic have led to a rise in some risk factors for bruxism oral and general health of children aged 7-10 years by increasing their screen exposure, consumption of simple carbohydrates and decreasing their physical activity.

An observational study of olfactory functions in total laryngectomees.

To evaluate the olfactory acuity and quality of life in patients who have undergone total laryngectomy. The study also aims to identify any specific patient-related risk factors linked to worse olfactory outcomes. This is a prospective cross-sectional study conducted at the University Malaya Medical Centre. A total of 30 patients who have undergone total laryngectomy were assessed objectively using the Sniffin' Sticks test and compared against normal age-matched Malaysians. Subsequently, they also filled out the modified Questionnaire on Olfactory Disorders. Correlations of patient demographics, disease and treatment variables against olfactory outcomes were conducted. All subjects suffered olfactory impairment, with 66.7% of them being anosmic after total laryngectomy. The Sniffin' Sticks test demonstrated a statistically significant difference between laryngectomees and the normal age-matched Malaysian population in all three subtests for odor threshold, discrimination and identification. 37% of patients developed olfactory adaptive methods, which resulted in higher olfactory scores and a better quality of life. There were no patient demographics, disease or treatment variables associated with a poorer olfactory outcome identified. Olfactory impairment should not be overlooked among patients after total laryngectomy. Although as many as a third of patients developed some sort of olfactory adaptive behavior, early rehabilitation should be integrated into the multidisciplinary rehabilitation program after total laryngectomy.

Complication Rates of Central Venous Catheters

Central venous catheters (CVCs) are commonly used but are associated with complications. Quantifying complication rates is essential for guiding CVC utilization decisions. To summarize current rates of CVC-associated complications. MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for observational studies and randomized clinical trials published between 2015 to 2023. This study included English-language observational studies and randomized clinical trials of adult patients that reported complication rates of short-term centrally inserted CVCs and data for 1 or more outcomes of interest. Studies that evaluated long-term intravascular devices, focused on dialysis catheters not typically used for medication administration, or studied catheters placed by radiologists were excluded. Two reviewers independently extracted data and assessed risk of bias. Bayesian random-effects meta-analysis was applied to summarize event rates. Rates of placement complications (events/1000 catheters with 95% credible interval [CrI]) and use complications (events/1000 catheter-days with 95% CrI) were estimated. Ten prespecified complications associated with CVC placement (placement failure, arterial puncture, arterial cannulation, pneumothorax, bleeding events requiring action, nerve injury, arteriovenous fistula, cardiac tamponade, arrhythmia, and delay of ≥1 hour in vasopressor administration) and 5 prespecified complications associated with CVC use (malfunction, infection, deep vein thrombosis [DVT], thrombophlebitis, and venous stenosis) were assessed. The composite of 4 serious complications (arterial cannulation, pneumothorax, infection, or DVT) after CVC exposure for 3 days was also assessed. Of 11 722 screened studies, 130 were included in the analyses. Seven of 15 prespecified complications were meta-analyzed. Placement failure occurred at 20.4 (95% CrI, 10.9-34.4) events per 1000 catheters placed. Other rates of CVC placement complications (per 1000 catheters) were arterial canulation (2.8; 95% CrI, 0.1-10), arterial puncture (16.2; 95% CrI, 11.5-22), and pneumothorax (4.4; 95% CrI, 2.7-6.5). Rates of CVC use complications (per 1000 catheter-days) were malfunction (5.5; 95% CrI, 0.6-38), infection (4.8; 95% CrI, 3.4-6.6), and DVT (2.7; 95% CrI, 1.0-6.2). It was estimated that 30.2 (95% CrI, 21.8-43.0) in 1000 patients with a CVC for 3 days would develop 1 or more serious complication (arterial cannulation, pneumothorax, infection, or DVT). Use of ultrasonography was associated with lower rates of arterial puncture (risk ratio [RR], 0.20; 95% CrI, 0.09-0.44; 13.5 events vs 68.8 events/1000 catheters) and pneumothorax (RR, 0.25; 95% CrI, 0.08-0.80; 2.4 events vs 9.9 events/1000 catheters). Approximately 3% of CVC placements were associated with major complications. Use of ultrasonography guidance may reduce specific risks including arterial puncture and pneumothorax.

Portal vein thrombosis and liver transplantation: management, matching, and outcomes: a retrospective multicenter cohort study.

Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients. Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600min, estimated blood loss greater than 5000ml, more than 20 ICU days, 90 days mortality, 90 days retransplant. Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT (P<0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present. Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3-4.

Lymph Node Dissection in Testicular Cancer: The State of the Art and Future Perspectives.

This narrative review provides a comprehensive overview of the evolving role of retroperitoneal lymph node dissection (RPLND) in the management of testicular cancer (TC). It explores the significance of RPLND as both a diagnostic and therapeutic tool, highlighting its contribution to accurate staging, its impact on oncological outcomes, and its influence on subsequent treatment decisions. RPLND serves as an essential diagnostic procedure, aiding in the precise assessment of lymph node involvement and guiding personalized treatment strategies. It has demonstrated therapeutic value, particularly in patients with specific risk factors and disease stages, contributing to improved oncological outcomes and survival rates. Recent studies have emphasized the importance of meticulous patient selection and nerve-sparing techniques to mitigate complications while optimizing outcomes. Additionally, modern imaging and surgical approaches have expanded the potential applications of RPLND. In the context of TC management, RPLND remains a valuable and evolving tool. Its dual role in staging and therapy underscores its relevance in contemporary urological practice. This review highlights the critical role of RPLND in enhancing patient care and shaping treatment strategies, emphasizing the need for further research to refine patient selection and surgical techniques.