Basal cell carcinomas without histological confirmation and their treatment : an audit in four European regions

Summary- Background: Limited data are available on how often basal cell carcinomas (BCCs) are clinically diagnosed without histological confirmation and how they are treated. Objectives Within the framework of the EPIDERM project, an audit was conducted in four European countries to study the occurrence of clinically diagnosed BCCs without histological confirmation and to investigate how these are treated. Methods: In the Netherlands, Scotland, Finland and Malta studies were performed within different timeframes. Patients with one or more BCC(s) were selected and the number of clinically diagnosed BCCs without histological confirmation and their treatment was investigated by (manually) reviewing the (electronic) patient records and checking the (hospital) pathology databases to find evidence of histological confirmation. Results: In the Netherlands, 1089 patients with a first histologically confirmed BCC developed 1974 BCCs of which 1833 (92.9%) were histologically confirmed and 141 (7.1%) were not. A 4-month retrospective study conducted in Scotland selected 294 patients with 344 BCCs; 306 (89.0%) were histologically confirmed and 38 (11.0%) were not. A 3-month prospective study performed at the same centre in Scotland identified 44 patients who developed 58 BCCs; 44 (75.9%) of these were histologically confirmed and 14 (24.1%) were not. In Finland, there were 701 patients who developed 977 BCCs, of which 807 (82.6%) were histologically and 170 (17.4%) nonhistologically confirmed. In Malta, there were 420 patients with 477 BCCs. Only three (0.7%) of them were clinically diagnosed without histological confirmation. In the Netherlands and Finland, clinically diagnosed BCCs without histological confirmation were most often treated with cryotherapy, whereas in Scotland 5% imiquimod cream was the preferred treatment modality. Conclusions: Although the frequency of clinically diagnosed BCCs without histological confirmation differed between the four European regions (range 0.7-24.1%), this confirms that the burden of BCC in Europe is underestimated when based on data from pathology and/or cancer registries.peer-reviewe

Active degassing across the Maltese Islands (Mediterranean Sea) and implications for its neotectonics

The Maltese Islands, located in the central Mediterranean Sea, are intersected by two normal fault systems associated with continental rifting to the south. Due to a lack of evidence for offshore displacement and insignificant historical seismicity, the systems are thought to be inactive and the rift-related deformation is believed to have ceased. In this study we integrate aerial, marine and onshore geological, geophysical and geochemical data from the Maltese Islands to demonstrate that the majority of faults offshore the archipelago underwent extensional to transtensional deformation during the last 20 ka. We also document an active fluid flow system responsible for degassing of CH4 and CO2. The gases migrate through carbonate bedrock and overlying sedimentary layers via focused pathways, such as faults and pipe structures, and possibly via diffuse pathways, such as fractures. Where the gases seep offshore, they form pockmarks and rise through the water column into the atmosphere. Gas migration and seepage implies that the onshore and offshore faults systems are permeable and that they were active recently and simultaneously. The latter can be explained by a transtensional system involving two right-stepping, right-lateral NW-SE trending faults, either binding a pull-apart basin between the islands of Malta and Gozo or associated with minor connecting antitethic structures. Such a configuration may be responsible for the generation or reactivation of faults onshore and offshore the Maltese Islands, and fits into the modern divergent strain-stress regime inferred from geodetic data

Rare thyroid malignancies in Europe : data from the information network on rare cancers in Europe (RARECAREnet)

Data will be made available on requestPeer reviewedPostprin

Active faulting offshore the Maltese Islands revealed by geophysical and geochemical observations

The Maltese Islands (central Mediterranean Sea) are intersected by two normal fault systems associated with continental rifting to the south. Because of a lack of evidence for offshore displacement and insignificant historical seismicity, the systems have been considered to be inactive. Here we integrate aerial and marine geological, geophysical and geochemical data to demonstrate that: (i) the majority of faults offshore the Maltese Islands underwent extensional to transtensional deformation during the last 20 ka, (ii) active degassing of CH4 and CO2 occurs via these faults. The gases migrate through Miocene carbonate bedrock and the overlying Plio-Pleistocene sedimentary layers to generate pockmarks at the muddy seafloor and rise through the water column into the atmosphere. We infer that the offshore faults systems are permeable and that they were active recently and simultaneously. The latter can be explained by a transtensional system involving two right-stepping, right-lateral NW-SE trending faults, either binding a pull-apart basin between the islands of Malta and Gozo or associated with minor connecting antitethic structures. Such a configuration may be responsible for the generation or reactivation of faults onshore and offshore the Maltese Islands, and fits into the modern divergent strain-stress regime inferred from geodetic data.peer-reviewe

Crowdsourcing for information visualization: promises and pitfalls

Crowdsourcing offers great potential to overcome the limitations of controlled lab studies. To guide future designs of crowdsourcing-based studies for visualization, we review visualization research that has attempted to leverage crowdsourcing for empirical evaluations of visualizations. We discuss six core aspects for successful employment of crowdsourcing in empirical studies for visualization - participants, study design, study procedure, data, tasks, and metrics & measures. We then present four case studies, discussing potential mechanisms to overcome common pitfalls. This chapter will help the visualization community understand how to effectively and efficiently take advantage of the exciting potential crowdsourcing has to offer to support empirical visualization research

Rare thyroid malignancies in Europe: Data from the information network on rare cancers in Europe (RARECAREnet).

Limited information is available on the incidence of rare thyroid cancer (TC) subtypes: anaplastic (ATC) and medullary (MTC). The aim of this study was to describe incidence variations and trends across European countries of all TC subtypes. We used the RARECAREnet database including 80721 TC incident cases in the period 2000-2007 from 77 population-based cancer registries (CRs) in Europe. In the trend analyses, we included 68890 TC cases from 53 CRs with at least 6 years of incidence data in the years 2000-2007. In Europe age-standardised incidence rates (ASR) in women were The huge increase and heterogeneity between countries of PTC incidence has a small influence on the trends and variations of MTC and ATC in Europe. Large-scale epidemiological and clinical registry-based studies are warranted to increase knowledge about the rarest TC subtypes. This information would be fundamental for the design of new clinical trials and for inference

Skin cancer risk in outdoor workers: A European multicenter case-control study

Background Exposure to ultraviolet radiation (UVR) is the most important external risk factor for skin cancer. Outdoor workers, who are exposed to high ambient UVR levels are at increased risk. Objective To compare outdoor with indoor workers in terms of: (i) skin cancer risk factors, and (ii) risk of developing skin cancer. Methods Using descriptive methods and a large multicenter European case-control study, we compared risk factor patterns between outdoor (N = 1416) and indoor workers (N = 1863). Risk of developing basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma and actinic keratosis (AK) were analysed by type of work using multivariate logistic regression models, for three categories of work: indoor; farming/construction; other outdoor work. Results Although skin phototype was equally distributed by type of work, significantly less outdoor than indoor workers used sunscreen in their own country (44.3% vs. 60.2%), but had more outdoor hobbies (66.2% vs. 58.2%). Outdoor workers had lower educational levels, and felt less confident in understanding medical information and filling medical forms (all P < 0.001). Outdoor workers had more signs of photodamage (78.1% vs. 65.5%) and among the skin cancer patients, 37.7% of outdoor workers vs. 28.6% of indoor workers had ≥2 skin cancers diagnosed during their lifetime. Multivariate logistic regression models showed significantly increased risk of outdoor vs. indoor work for AK (ORother outdoor = 1.55, ORfarming/construction = 2.58), SCC (ORother outdoor = 1.32, ORfarming/construction = 2.77) and BCC (ORother outdoor = 1.53, ORfarming/construction = 1.83). No significant associations were found for melanoma. The risk of all types of skin cancer and AK was significantly increased for workers with ≥5 years of outdoor work. Conclusions Outdoor workers had more risk behaviour with similar constitutional skin cancer risk factors: more UV exposure (both occupational and leisure) and less sunscreen use and lower health literacy. This results in higher exposure, more photodamage and an increased risk of developing AK, BCC and SCC.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

Procalcitonin algorithm in critically ill adults with undifferentiated infection or suspected sepsis : a randomized controlled trial

Rationale: The role of procalcitonin (PCT), a widely used sepsis biomarker, in critically ill patients with sepsis is undetermined. Objectives: To investigate the effect of a low PCT cut-off on antibiotic prescription and to describe the relationships between PCT plasma concentration and sepsis severity and mortality. Methods: This was a multicenter (11 Australian intensive care units [ICUs]), prospective, single-blind, randomized controlled trial involving 400 patients with suspected bacterial infection/sepsis and expected to receive antibiotics and stay in ICU longer than 24 hours. The primary outcome was the cumulative number of antibiotics treatment days at Day 28. Measurements and Main Results: PCT was measured daily while in the ICU. A PCT algorithm, including 0.1 ng/ml cut-off, determined antibiotic cessation. Published guidelines and antimicrobial stewardship were used in all patients. Primary analysis included 196 (PCT) versus 198 standard care patients. Ninety-three patients in each group had septic shock. The overall median (interquartile range) number of antibiotic treatment days were 9 (6–21) versus 11 (6–22), P = 0.58; in patients with positive pulmonary culture, 11 (7–27) versus 15 (8–27), P = 0.33; and in patients with septic shock, 9 (6–22) versus 11 (6–24), P = 0.64; with an overall 90-day all-cause mortality of 35 (18%) versus 31 (16%), P = 0.54 in the PCT versus standard care, respectively. Using logistic regression, adjusted for age, ventilation status, and positive culture, the decline rate in log(PCT) over the first 72 hours independently predicted hospital and 90-day mortality (odds ratio [95% confidence interval], 2.76 [1.10–6.96], P = 0.03; 3.20 [1.30–7.89], P = 0.01, respectively). Conclusions: In critically ill adults with undifferentiated infections, a PCT algorithm including 0.1 ng/ml cut-off did not achieve 25% reduction in duration of antibiotic treatment.9 page(s