Comparison of the prevalence and sonographic features of thyroid nodules accompanying autoimmune thyroid diseases

Introduction: The coexistence of thyroid nodules and autoimmune thyroid disease (ATD) has been widely reported. The aim of our study was to retrospectively evaluate the prevalence and sonographic features of malignancy of thyroid nodules in ATD patients. Material and methods: We retrospectively analysed data from 500 patients with ATD in our hospital. We recorded ultrasonographic, histopathological and laboratory features of these patients. Thyroid ultrasonography was performed on all the patients, as well as fine needle aspiration biopsy (FNAB) of the thyroid nodule, when required. Patients underwent operations depending on the result of the FNAB. Results: Of the 500 with ATD (400 female and 100 male; mean age = 42.4 years), 300 (60%) had Hashimoto&#8217;s thyroiditis (HT) and 200 (40%) presented with Graves&#8217; disease (GD). The frequency of thyroid nodules was statistically significantly higher in those with GD (37.8%) than in those with HT (24.3%) (p < 0.001). One hundred and forty-nine nodules underwent FNAB (37.8%, 76 out of 200 had GD and 24.3%; 73 out of 300 had HT). The results of the cytological examination were: non-diagnostic cytology, benign, malignant and indeterminate in 19.4%, 73.8%, 2% and 4.5% of the nodules, respectively. When 55 GD and 32 HT patients, on whom total thyroidectomy had been carried out, were evaluated, the incidence of thyroid carcinoma was similar between patients with GD (n = 3, 5.5%) and HT (n = 2, 6.3%) (p > 0.05). Conclusions: We observed that the prevalence of thyroid nodules in patients with GD was higher than patients with HT. However, in general, the characteristics of the nodules and FNAB results were similar in both ATDs. (Pol J Endocrinol 2010; 61 (6): 658-664)Wstęp: W licznych doniesieniach stwierdza się współwystępowanie guzków tarczycy i autoimmunologicznych chorób tarczycy. Celem pracy była retrospektywna ocena występowania i sonograficznych cech złośliwości guzków tarczycy u pajcentów z autoimmunologicznymi chorobami tarczycy (ATD, autoimmune thyroid disease). Materiał i metody: Analizie retrospektywnej poddano dane 500 pacjentów z ATD, u których przeprowadzono badania ultrasonograficzne, histopatologiczne i laboratoryjne. U wszystkich pacjentów wykonano badanie ultrasonograficzne oraz, w zależności od wymagań, biopsję aspiracyjną cienkoigłową (BAC). Pacjentów poddano operacji w zależności od wyniku BAC. Wyniki: Spośród 500 pacjentów z ATD (400 kobiet i 100 mężczyzn, średnia wieku: 42,4 lat), u 300 (60%) stwierdzono zapalenie tarczycy Hashimoto (HT, Hashimoto thyroids), a u 200 (40%) chorobę Gravesa (GD, Graves disease). U pacjentów z GD stwierdzono statystycznie wyższą częstość występowania guzków tarczycy (37%) w porównaniu z pacjentami z HT (24,3%) (p < 0,001). Wykonano BAC 149 guzków, w 37,8% (76 z 200) przypadków z GD i w 24,3% ( 73 z 300) z HT. Wyniki badania cytologicznego: cytologia niediagnostyczna (19,4%), guzki łagodne (73,8%), guzki złośliwe (2%) i guzki o pośredniej złośliwości (4,5%). Spośród 55 pacjentów z GD i 32 z HT, u których wykonano tyroidektomię totalną, stwierdzono podobną częstość występowania raka tarczycy - u pacjentów z GD (n = 3, 5,5%), a u pacjentów z HT (n = 2, 6,3%) (p > 0,05). Wnioski: Zaobserwowano wyższą częstość występowania guzków tarczycy u pacjentów z GD w porównaniu z pacjentami z HT. Natomiast charakterystyka guzków i wyniki BAC nie różniły sie w obu typach ATD. (Endokrynol Pol 2010; 61 (6): 658-664

Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members

Background: In contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world. Methods: A web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021-03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients´ age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis. Results: A total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (&gt; 500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children ≤ 10 and ≤ 5&nbsp;years of age (p = 0.0014). This situation is aggravated in participants from smaller hospitals (p &lt; 0.01). With regard to hospital size (≤ 500 versus &gt; 500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p &lt; 0.0001), treated children at all ages more frequently (p = 0.0938) and have higher case-loads of severely injured children &lt; 12&nbsp;years of age (p = 0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p &lt; 0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively). Conclusions: Multi-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Azimuthal separation in nearly back-to-back jet topologies in inclusive 2-and 3-jet events in pp collisions at root s=13TeV

A measurement for inclusive 2- and 3-jet events of the azimuthal correlation between the two jets with the largest transverse momenta, Delta phi(12), is presented. The measurement considers events where the two leading jets are nearly collinear ("back-to-back") in the transverse plane and is performed for several ranges of the leading jet transverse momentum. Proton-proton collision data collected with the CMS experiment at a center-of-mass energy of 13 TeV and corresponding to an integrated luminosity of 35.9 fb(-1) are used. Predictions based on calculations using matrix elements at leading-order and next-to-leading-order accuracy in perturbative quantum chromodynamics supplemented with leading-log parton showers and hadronization are generally in agreement with themeasurements. Discrepancies between the measurement and theoretical predictions are as large as 15%, mainly in the region 177 degrees <Delta phi(12) <180 degrees. The 2- and 3-jet measurements are not simultaneously described by any of models.Peer reviewe

Observation of the χb1(3P)\chi_{b1}(3P) and χb2(3P)\chi_{b2}(3P) and measurement of their masses

The $\chi_{b1}(3P)$ and $\chi_{b2}(3P)$ states are observed through their $\gamma(3S)_\gamma$ decays, using an event sample of proton-proton collisions collected by the CMS experiment at the CERN LHC. The data were collected at a center-of-mass energy of 13 TeV and correspond to an integrated luminosity of $80.0  fb^{−1}$. The$\gamma(3S)$ mesons are identified through their dimuon decay channel, while the low-energy photons are detected after converting to $e^+e ^−$ pairs in the silicon tracker, leading to a $\chi_{b1}(3P)$ mass resolution of 2.2 MeV. This is the first time that the J=1 and 2 states are well resolved and their masses individually measured: $10513.42±0.41(stat)±0.18(syst)  MeV$ and $10524.02±0.57(stat)±0.18(syst)  MeV$; they are determined with respect to the world-average value of the $\gamma(3S)$ mass, which has an uncertainty of 0.5 MeV. The mass splitting is measured to be $10.60±0.64(stat)±0.17(syst)  MeV$

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Relationship Between Economic Freedoms and the Informal Economy: An Application on the Member States of the Organization of Islamic Cooperation

11th RSEP International Multidisciplinary Conference -- APR 09-11, 2019 -- Vienna, AUSTRIAWOS: 000471906200007The reduction and ultimately the elimination of the informal economy emerges as an important problem for the countries in terms of effectively collecting tax revenues, preventing unfair competition and increasing confidence for the state. Increasing economic freedoms contributes to the reduction of such economic activities. The aim of the study is to determine the effect of economic freedoms on informal economy for the member states of Organization of Islamic Cooperation (OIC). It covers annual panel data of 44 countries from 1999 to 2015. In the study, Fixed Effects and Random Effects Models are applied. The findings of the study point out that there was statistically significant and negative relationship between economic freedoms and informal economy. According to the results, one-point increase in Economic Freedom Index led to a nearly 0.13% reduction in the size of informal economy.Review Socio Econ Perspec

Technical Aspects and Difficulties in the Management of Head and Neck Cutaneous Malignancies in Xeroderma Pigmentosum.

Xeroderma pigmentosum (XP) is an autosomal recessive disorder characterized by xerosis, ultraviolet light sensitivity, and cutaneous dyspigmentation. Due to defects in their DNA repair mechanism, genetic mutations and carcinogenesis inevitably occurs in almost all patients. In these patients, reconstruction of cutaneous malignancies in the head and neck area is associated with some challenges such as likelihood of recurrence and an aggressive clinical course. The aim of this study is to discuss the therapeutic options and challenges commonly seen during the course of treatment

Neurofibromatosis Type 1 with Bladder Involvement

Neurofibromatosis type 1 is an autosomal dominant transmitted disease with various clinical manifestations. The bladder is the most commonly affected organ in the genitourinary system. The malignant transformation of the disease is rare, and unlike malign tumors, the treatment option for benign disease is usually conservative. The size and localization of the mass determine the symptoms, most of which are usually not specific. In this paper, we aim to present a 15-year-old patient with neurofibromatosis type 1 with bladder involvement. The clinical presentation and treatment options of this disease are discussed in the light of the literature