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To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years.Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered.A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46-70 years) were included. Nodule volume was significantly reduced at all time points (p 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small ( 10 mL) (74%), medium (49%), or large ( 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment.Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN.• Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.

Background: Percutaneous ethanol injection (PEI) is used for the treatment of benign cystic thyroid nodules. This systematic review and meta-analysis aimed to obtain strong evidence of its long-term efficacy and safety. Methods: PubMed, CENTRAL, Scopus and Web of Science databases were searched until November 2020 for studies reporting data on volume reduction rate (VRR), compressive symptoms and cosmetic concerns. Associated complications were assessed. A random-effects model was designed to pool the data. Results: Out of 385 papers, nine studies evaluating 1667 nodules were finally included. Overall, VRR at 6, 12, 24, 36, 60 and 120 months was 77%, 81%, 72%, 68%, 74% and 69%, respectively. Significant reductions in the compressive symptoms and cosmetic concerns were observed. No permanent complications were observed. Conclusions: The present meta-analysis showed that PEI could significantly reduce the volume of benign cystic thyroid nodules. This reduction was already effective at 6 months post-treatment, and the effect was stable over time.

Background A number of ultrasound risk stratification systems (RSSs) of thyroid nodule, often labeled as TIRADS (Thyroid Imaging Reporting and Data System), have been proposed. As a consequence, an increasing number of studies have been published on this topic. This systematic review was undertaken to answer specific questions in this field: how many articles and what type of studies have been published, which TIRADSs/RSSs have preferably been discussed, and what is the geographic distribution of the publications. Methods The study was conducted according to PRISMA. A specific search algorithm was used. Defined selection criteria were applied. Results 502 studies were finally included. The number of publications about TIRADSs/RSSs has increased over the time, being the Horvath TIRADS the most evaluated one. The first author of the article was from China in one fourth of cases. Conclusions The number of scientific articles focused on TIRADSs/RSSs is high and it has been importantly increased over the time.

Background Women with aesthetic prostheses must be included in the target population of mammography screening programmes. Breast implants are radiopaque and partially obscure the breast tissue. This can be avoided with the use of the Eklund technique, which causes an increased radiation exposure. In this study, augmented women undergoing a dedicated protocol within a population-based screening programme were compared according to selected indicators with the standard screening population. Essential dosimetric parameters and their time trend were also assessed. Materials and methods The study was conducted in a screening centre in Milan in the years 2009–2016. The screening protocol for women with breast implants included a double-read mammography with the Eklund views, ultrasound and clinical breast examination. Results A total of 28,794 women were enrolled, including 588 (2%) women with breast implants and 28,206 (98%) undergoing the standard screening protocol. The invasive assessment rate was 9.0‰ for women with breast implants vs. 15‰ in the standard cohort. The surgical referral rate was 2.2% vs. 0.9%. The detection rate was similar in the two groups (4.0 and 4.5‰, respectively). There were significant differences in the average glandular dose according to the mammography equipment. The use of the Eklund views increased over time. Conclusions Screening of augmented women according to a specific protocol in the contexts of population-based programmes is feasible. Observed differences in screening indicators relative to the standard screening population require further research. The increasing use of Eklund views probably results from quality assurance measures associated with screening programmes.

Lockdown and social distancing, as well as testing and contact tracing, are the main measures assumed by the governments to control and limit the spread of COVID-19 infection. In reason of that, special attention was recently paid by the scientific community to the mathematical modeling of infection spreading by including in classical models the effects of the distribution of contacts between individuals. Among other approaches, the coupling of the classical SIR model with a statistical study of the distribution of social contacts among the population, led some of the present authors to build a Social SIR model, able to accurately follow the effect of the decrease in contacts resulting from the lockdown measures adopted in various European countries in the first phase of the epidemic. The Social SIR has been recently tested and improved through a fruitful collaboration with the Health Protection Agency (ATS) of the province of Pavia (Italy), that made it possible to have at disposal all the relevant data relative to the spreading of COVID-19 infection in the province (half a million of people), starting from February 2020. The statistical analysis of the data was relevant to fit at best the parameters of the mathematical model, and to make short-term predictions of the spreading evolution in order to optimize the response of the local health system.

Background: The role of minimal extrathyroidal extension (mETE) as a risk factor for persistent papillary thyroid carcinoma (PTC) is still debated. The aim of this study was to assess the clinical impact of mETE as a predictor of worse initial treatment response in PTC patients and to verify the impact of radioiodine therapy after surgery in patients with mETE. Methods: We reviewed all records in the Italian Thyroid Cancer Observatory (ITCO) database and selected 2237 consecutive patients with PTC who satisfied the inclusion criteria (PTC with no lymph node metastases and at least 1 year of follow-up). For each case, we considered initial surgery, histological variant of PTC, tumor diameter, recurrence risk class according to the American Thyroid Association (ATA) risk stratification system, use of radioiodine therapy, and initial therapy response, as suggested by ATA guidelines. Results: At 1-year follow-up, 1831 patients (81.8%) had an excellent response, 296 (13.2%) had an indeterminate response, 55 (2.5%) had a biochemical incomplete response, and 55 (2.5%) had a structural incomplete response. Statistical analysis suggested that mETE (odds ratio [OR] 1.16, p=0.65), tumor size >2 cm (OR 1.45, p=0.34), aggressive PTC histology (OR 0.55, p=0.15), and age at diagnosis (OR 0.90, p=0.32) were not significant risk factors for a worse initial therapy response. When evaluating the combination of mETE, tumor size, and aggressive PTC histology, the presence of mETE with a >2 cm tumor was significantly associated with a worse outcome (OR 5.27, 95% CI, p=0.014). The role of radioiodine ablation in patients with mETE was also evaluated. When considering radioiodine treatment, propensity score-based matching was performed, and no significant differences were found between treated and non-treated patients (p=0.24). Conclusions: This study failed to show the prognostic value of mETE in predicting initial therapy response in a large cohort of PTC patients without lymph node metastases. The study suggests that the combination of tumor diameter and mETE can be used as a reliable prognostic factor for persistence and could be easily applied in clinical practice to manage PTC patients with low-to-intermediate risk of recurrent/persistent disease.

Background The evaluation of participant experience is an essential part of monitoring the quality of breast cancer screening services. Satisfaction of services can lead to good adherence and hence affect health outcomes. Methods We performed a systematic review to assess how satisfied women were with organized breast cancer screening programs. A literature search in Medline, CINAHL, Embase and PsycINFO from 1965 to October 2019 was performed. Articles reporting a quantitative measure of satisfaction collected via questionnaires in programs using mammography as a screening test were selected. We narratively synthesized the data and used tabulated summaries. Results Out of 4310 individual citations, 3099 abstracts were reviewed by two independent researchers, and 126 articles were selected for full-text reading. Finally, 48 studies, published between 1990 and 2018, were included in analysis, reporting 54 surveys in the context of an organized screening program, 37 on satisfaction with screening mammography, 14 on satisfaction with further assessments and 3 with counseling. Most studies reported a high level of satisfaction for both mammography and further assessments. Despite commonly reported temporary pain, discomfort and anxiety, the willingness to be re-screened was very high. Effective information transfer, the staff's interpersonal skills and quick delivery of results correlated with high satisfaction. Only 7 out of 54 surveys used recognized satisfaction instruments or their modifications. Conclusions In general, satisfaction with breast cancer screening is high, but its evaluation is mainly performed using non-validated instruments. Emphasis should be put on effective communication, the staff´s interpersonal skills and quick delivery of results.

Glucocorticoids (GCs) and external radiotherapy (RT) are used for treating moderate-to-severe Graves’ orbitopathy (GO). We aimed to assess whether GCs and RT were more effective when administered concomitantly or sequentially. We retrospectively analyzed clinical outcomes [assessed by Clinical Activity Score (CAS) and NOSPECS classification] in 73 patients treated with both i.v. GCs and RT. The patients were divided in two groups: In group A (53 patients), RT was delivered concomitantly with GCs, and in group B (20 patients) RT was administered subsequently to the end of methylprednisolone. At baseline, CAS (median 4.0) and the percentage of patients encompassing the various grades of the classes 2, 3 and 4 of the NOSPECS score were similar in both groups. Six months after RT, CAS decreased to 2 in both groups (p = 0.0003 vs baseline) as well as NOSPECS class 4 (p

Background Improving the quality of information and communication is a priority in organised breast cancer screening and an ethical duty. Programmes must offer the information each woman is looking for, promoting informed decision-making. This study aimed to develop and evaluate a web-based dynamic decision aid (DA). Methods A pragmatic randomised trial carried out in six regional organised screening programmes recruited women at the first invitation receiving DA or a web-based standard brochure (SB). The primary outcome was informed choice measured on knowledge, attitudes, and intentions. Follow-up period: 7–10 days. Secondary outcomes included participation rate, satisfaction, decisional conflict, and acceptability of DA. Results Two thousand one hundred and nineteen women were randomised and 1001 completed the study. Respectively, 43.9% and 36.9% in the DA and SB reached the informed choice. The DA gave a 13-point higher proportion of women aware about overdiagnosis compared to SB (38.3% versus 25.2%, p Conclusion DA increases informed choice. Complete information including the pros, cons, controversies, and overdiagnosis–overtreatment issues boost a woman’s knowledge without reducing the rate of actual screening participation. Clinical trial registration ClinicalTrials.gov number NCT 03097653.

Radiofrequency ablation (RFA) was proven as effective in reducing thyroid nodules’ volume. However, whether technical procedure aspects could influence the volume reduction rate (VRR) has not been clarified. This retrospective pilot study aimed to analyze the correlation of RFA power, duration, and energy with VRR. During the period from June to December 2018 two primary-care centers treated benign thyroid nodules of adult outpatients according to the same RFA procedure. Technical parameters to be investigated were the following: median power (Pmedian), effective time of treatment (Teff), energy calculated as Pmedian × Teff (Ecalc), and energy delivered per mL as Kcal × 4184 × nodule’s volume (Edel). Continuous variables were analyzed by the Mann–Whitney test. Data of 1-year posttreatment follow-up were collected on December 2019 and the correlation of the above parameters with VRR was analyzed by linear regression. Forty-one nodules were included and their 1-year VRR was 66.6%. RFA was performed with a Pmedian of 55 W, Teff 10.24 min, Ecalc 31,380 J, and Edel 1473 J/mL. Edel was significantly correlated with VRR (p = 0.014) while Pmedian, Teff, and Ecalc not. A strong correlation of Edel with VRR was found in nodules 10 mL. This study showed that the energy delivered with RFA is the only technical parameter significantly correlated with the VRR of thyroid nodules.

Abstract. Online contexts are becoming a widely available space to disseminate health information and target specific populations for health campaigns. Limited evidence for health message engagement in these contexts exists. This study draws on the elaboration likelihood model and construal-level theory to predict processing time and recall when individuals are presented with messages for or against electronic cigarette use from socially close or distant sources. Participants ( N = 159) were shown messages about electronic cigarettes, designed to look like tweets, from socially close and socially distant message senders. Processing times were highest for pro-attitudinal messages while messages from socially close sources were more likely to be recalled, and furthering social distance increased the difference in processing times for pro- and counter-attitudinal messages. We demonstrate the applicability of behavioral measures in online studies, while finding that attitudes, social distance, and their interaction affect measures of message processing. These findings suggest further exploration may be needed to differentiate between processing time and counterarguing. From our findings, we offer applied practitioners guidance on how to develop messages that target audiences will spend more time considering and are more likely to remember.

Key Points Question Could transparent masks help to overcome communication barriers associated with widespread mask use among the general population, general health care workers, and health care workers who are deaf or hard of hearing in the United States? Findings In this survey study of 1000 members of the general public, 123 general health care workers, and 45 health care workers who are deaf or hard of hearing, participants perceived mask wearing as potentially impairing communication. Respondents reported an improved ability to read emotion with transparent mask use, and transparent masks were generally accepted across all 3 populations surveyed. Meaning These findings suggest that transparent masks have the potential to overcome barriers in communication brought on by universal mask wearing during the COVID-19 pandemic., This survey study assesses communication barriers in patient-clinician interactions and among individuals who are deaf and hard of hearing when wearing standard vs transparent masks., Importance Adoption of mask wearing in response to the COVID-19 pandemic alters daily communication. Objective To assess communication barriers associated with mask wearing in patient-clinician interactions and individuals who are deaf and hard of hearing. Design, Setting, and Participants This pilot cross-sectional survey study included the general population, health care workers, and health care workers who are deaf or hard of hearing in the United States. Volunteers were sampled via an opt-in survey panel and nonrandomized convenience sampling. The general population survey was conducted between January 5 and January 8, 2021. The health care worker surveys were conducted between December 3, 2020, and January 3, 2021. Respondents viewed 2 short videos of a study author wearing both a standard and transparent N95 mask and answered questions regarding mask use, communication, preference, and fit. Surveys took 15 to 20 minutes to complete. Main Outcomes and Measures Participants’ perceptions were assessed surrounding the use of both mask types related to communication and the ability to express emotions. Results The national survey consisted of 1000 participants (mean [SD] age, 48.7 [18.5] years; 496 [49.6%] women) with a response rate of 92.25%. The survey of general health care workers consisted of 123 participants (mean [SD] age, 49.5 [9.0] years; 84 [68.3%] women), with a response rate of 11.14%. The survey of health care workers who are deaf or hard of hearing consisted of 45 participants (mean [SD] age, 54.5 [9.0] years; 30 [66.7%] women) with a response rate of 23.95%. After viewing a video demonstrating a study author wearing a transparent N95 mask, 781 (78.1%) in the general population, 109 general health care workers (88.6%), and 38 health care workers who are deaf or hard of hearing (84.4%) were able to identify the emotion being expressed, in contrast with 201 (20.1%), 25 (20.5%), and 11 (24.4%) for the standard opaque N95 mask. In the general population, 450 (45.0%) felt positively about interacting with a health care worker wearing a transparent mask; 76 general health care workers (61.8%) and 37 health care workers who are deaf or hard of hearing (82.2%) felt positively about wearing a transparent mask to communicate with patients. Conclusions and Relevance The findings of this study suggest that transparent masks could help improve communication during the COVID-19 pandemic, particularly for individuals who are deaf and hard of hearing.

Background: One of the most widely used risk stratification systems for estimating individual patients' risk of persistent or recurrent differentiated thyroid cancer (DTC) is the American Thyroid Association (ATA) guidelines. The 2015 ATA version, which has increased the number of patients considered at low or intermediate risk, has been validated in several retrospective, single-center studies. The aims of this study were to evaluate the real-world performance of the 2015 ATA risk stratification system in predicting the response to treatment 12 months after the initial treatment and to determine the extent to which this performance is affected by the treatment center in which it is used. Methods: A prospective cohort of DTC patients collected by the Italian Thyroid Cancer Observatory web-based database was analyzed. We reviewed all records present in the database and selected consecutive cases that satisfied inclusion criteria: (i) histological diagnosis of DTC, with the exclusion of noninvasive follicular thyroid neoplasm with papillary-like nuclear features; (ii) complete data of the initial treatment and pathological features; and (iii) results of 1-year follow-up visit (6-18 months after the initial treatment), including all data needed to classify the estimated response to treatment. Results: The final cohort was composed of 2071 patients from 40 centers. The ATA risk of persistent/recurrent disease was classified as low in 1109 patients (53.6%), intermediate in 796 (38.4%), and high in 166 (8.0%). Structural incomplete responses were documented in only 86 (4.2%) patients: 1.5% in the low-risk, 5.7% in the intermediate-risk, and 14.5% in the high-risk group. The baseline ATA risk class proved to be a significant predictor of structural persistent disease, both for intermediate-risk (odds ratio [OR] 4.67; 95% confidence interval [CI] 2.59-8.43) and high-risk groups (OR 16.48; CI 7.87-34.5). Individual center did not significantly influence the prediction of the 1-year disease status. Conclusions: The ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC in real-world clinical settings characterized by center heterogeneity in terms of size, location, level of care, local management strategies, and resource availability.

This online experiment examines how partisan cues interact with features of newer media to affect how people evaluate political messages online. Specifically, we examine the degree to which obscuring the political affiliations of different online sources can influence how viewers evaluate the political messages they share through social media. We also examine how viewers evaluate political organizations that appear to strategically suppress comments that accompany their political posts. The results indicate that viewers were more trusting and more likely to endorse political messages, the less they perceived that political organizations were strategically controlling comments and the less they believed that the commenters were affiliated with a political organization; notably, these effects were robust across the political spectrum. Theoretical implications for warranting theory and practical implications for evaluating messages shared online are discussed.

The COVID-19 pandemic affects mortality and morbidity, with disruptions expected to continue for some time, with access to timely cancer-related services a concern. For breast cancer, early detection and treatment is key to improved survival and longer-term quality of life. Health services generally have been strained and in many settings with population breast mammography screening, efforts to diagnose and treat breast cancers earlier have been paused or have had reduced capacity. The resulting delays to diagnosis and treatment may lead to more intensive treatment requirements and, potentially, increased mortality. Modelled evaluations can support responses to the pandemic by estimating short- and long-term outcomes for various scenarios. Multiple calibrated and validated models exist for breast cancer screening, and some have been applied in 2020 to estimate the impact of breast screening disruptions and compare options for recovery, in a range of international settings. On behalf of the Covid and Cancer Modelling Consortium (CCGMC) Working Group 2 (Breast Cancer), we summarize and provide examples of such in a range of settings internationally, and propose priorities for future modelling exercises. International expert collaborations from the CCGMC Working Group 2 (Breast Cancer) will conduct analyses and modelling studies needed to inform key stakeholders recovery efforts in order to mitigate the impact of the pandemic on early diagnosis and treatment of breast cancer.

Orbitopathy is the main extra thyroidal manifestation of Graves' disease. It is a very challenging condition, which requires a cooperation between many specialists (endocrinologists, ophthalmologists, radiologists, radiotherapeutic, orbital surgeons) for an optimal clinical management. An accurate diagnostic assessment is required, in order to plan an adequate treatment of Graves' orbitopathy. Medical therapy, radiotherapy or surgery may be necessary to control the disease. In this review, the authors analyze the various therapeutic strategies, as well the more recent therapies based on pharmacologic immunomodulation.

The coronavirus outbreak in the United States continues to pose a serious threat to human lives. Public health measures to slow down the spread of the virus involve using a face mask, social-distancing, and frequent hand washing. Since the beginning of the pandemic, there has been a global campaign on the use of non-pharmaceutical interventions (NPIs) to curtail the spread of the virus. However, the number of cases, mortality, and hospitalization continue to rise globally, including in the United States. We developed a mathematical model to assess the impact of a public health education program on the coronavirus outbreak in the US. Our simulation showed the prospect of an effective public health education program in reducing both the cumulative and daily mortality of the novel coronavirus. Finally, our result suggests the need to obey public health measures as loss of willingness would increase the cumulative and daily mortality in the US.

Benign thyroid nodules are a common clinical occurrence and usually do not require treatment unless symptomatic. During the last years, ultrasound-guided minimally invasive treatments (MIT) gained an increasing role in the management of nodules causing local symptoms. In February 2018, the Italian MIT Thyroid Group was founded to create a permanent cooperation between Italian and international physicians dedicated to clinical research and assistance on MIT for thyroid nodules. The group drafted this list of statements based on literature review and consensus opinion of interdisciplinary experts to facilitate the diffusion and the appropriate use of MIT of thyroid nodules in clinical practice. (#1) Predominantly cystic/cystic symptomatic nodules should first undergo US-guided aspiration; ethanol injection should be performed if relapsing (level of evidence [LoE]: ethanol is superior to simple aspiration = 2); (#2) In symptomatic cystic nodules, thermal ablation is an option when symptoms persist after ethanol ablation (LoE = 4); (#3) Double cytological benignity confirmation is needed before thermal ablation (LoE = 2); (#4) Single cytological sample is adequate in ultrasound low risk (EU-TIRADS ≤3) and in autonomously functioning nodules (LoE = 2); (#5) Thermal ablation may be proposed as first-line treatment for solid, symptomatic, nonfunctioning, benign nodules (LoE = 2); (#6) Thermal ablation may be used for dominant lesions in nonfunctioning multinodular goiter in patients refusing/not eligible for surgery (LoE = 5); (#7) Clinical and ultrasound follow-up is appropriate after thermal ablation (LoE = 2); (#8) Nodule re-treatment can be considered when symptoms relapse or partially resolve (LoE = 2); (#9) In case of nodule regrowth, a new cytological assessment is suggested before second ablation (LoE = 5); (#10) Thermal ablation is an option for autonomously functioning nodules in patients refusing/not eligible for radioiodine or surgery (LoE = 2); (#11) Small autonomously functioning nodules can be treated with thermal ablation when thyroid tissue sparing is a priority and ≥80% nodule volume ablation is expected (LoE = 3).

Radiofrequency and laser ablation (RFA and LA) are effective treatments for benign thyroid nodules. Due to their relatively recent introduction into clinical practice, there are limited long-term follow-up studies. This study aimed to evaluate technique efficacy, rate of regrowth and retreatment over 5 years following RFA or LA and to identify predictive factors of outcome.

Background In the night of February 20, 2020, the first epidemic of the novel coronavirus disease (COVID-19) outside Asia was uncovered by the identification of its first patient in Lombardy region, Italy. In the following weeks, Lombardy experienced a sudden increase in the number of ascertained infections and strict measures were imposed to contain the epidemic spread. Methods We analyzed official records of cases occurred in Lombardy to characterize the epidemiology of SARS-CoV-2 during the early phase of the outbreak. A line list of laboratory-confirmed cases was set up and later retrospectively consolidated, using standardized interviews to ascertained cases and their close contacts. We provide estimates of the serial interval, of the basic reproduction number, and of the temporal variation of the net reproduction number of SARS-CoV-2. Results Epidemiological investigations detected over 500 cases (median age: 69, IQR: 57–78) before the first COVID-19 diagnosed patient (February 20, 2020), and suggested that SARS-CoV-2 was already circulating in at least 222 out of 1506 (14.7%) municipalities with sustained transmission across all the Lombardy provinces. We estimated the mean serial interval to be 6.6 days (95% CrI, 0.7–19). Our estimates of the basic reproduction number range from 2.6 in Pavia (95% CI, 2.1–3.2) to 3.3 in Milan (95% CI, 2.9–3.8). A decreasing trend in the net reproduction number was observed following the detection of the first case. Conclusions At the time of first case notification, COVID-19 was already widespread in the entire Lombardy region. This may explain the large number of critical cases experienced by this region in a very short timeframe. The slight decrease of the reproduction number observed in the early days after February 20, 2020 might be due to increased population awareness and early interventions implemented before the regional lockdown imposed on March 8, 2020.

We performed a pilot trial investigating the effect of a steroid taper on adrenal function and safety measures after acute MS relapses. Twenty-five patients were randomized to either prednisone taper (n=12) or placebo (n=13) after 3 days of intravenous methylprednisolone. No patient showed signs of adrenal insufficiency at any time by cortisol response to ACTH. This significantly increased between baseline and 6 months in both groups. Patients remained clinically and radiologically stable, but those under prednisone taper experienced more frequently mood disorders, hyperglycaemia and weight increase. If confirmed by sufficiently powered studies, these results would question the need of a steroid taper following short-term intravenous methylprednisolone.

Issue In many countries the organized screening programs have been in the frontline in developing and implementing the evaluation of the quality of screening and of the entire process of care following a positive test. Over the years, the three Italian Screening Groups (GIS) have separately published indicators and standards concerning the programs for breast, cervical and colorectal cancers they were responsible for, thus hampering coherence, homogeneity. In addition, at local level, an increasing number of indicators have been observed with difficult to monitor all of them. Description of the Problem The Screening Indicators Manual, prepared by a multidisciplinary working group, represents the guidance agreed upon by the Italian Screening Network (ONS) and the three GIS on how to develop, implement, communicate and maintain a set of quality indicators for the evaluation of cancer screening programs. Results The Manual indicates that the three GIS must first constitute, with ONS, the common steering committee made of six-nine experts. The involvement of the public and the management of the conflicts of interests are foreseen. The conceptual framework distinguishes indicators of context, coverage and process. It is based on six dimensions: efficacy, efficiency, security, appropriateness, person centeredness, equity. There are four macro-processes: invitation; test, further assessment and diagnosis; treatment and follow-up; evaluation. The methods include: a survey of the existent indicators, their selection with the Delphi method, the evaluation of the completeness of the resulting indicators set, its integration, when needed, by means of a public call, and finally a new Delphi round. Appropriate standards, empirical or evidence based, are then identified. Last, indicators are assigned to core or library list based on priority. Lessons Select, define and measure an indicator is a way to understand what we are aiming at even more than provide the measure of how we do it. Key messages The creation of the Manual allows to build a coherent evaluation framework for the three screening programs. The Manual promotes the adoption of rigorous methods and make feasible the monitoring activity according to its purpose, level of observation and detail of information needed.

Radiofrequency ablation (RFA) is effective in reducing the volume of benign thyroid nodules. However, what parameters can influence the response to RFA is still unclear. The present study aimed to (1) investigate which ultrasound and technical parameters are potential determinants of the volumetric reduction; (2) develop a dose-response model, and (3) analyze the effects of RFA on ultrasound features.In this retrospective study, three institutions treated patients with benign thyroid nodules according to the same protocol. The technical parameters were power and energy. The 1-year volume reduction ratio (VRR) was the reference standard of the response. The correlations of different parameters with VRR were analyzed and the association between several parameters and a VRR above 50% studied by uni- and multivariate analyses. The probit regression estimated the probability to achieve an effective response.One hundred fifteen patients were enrolled. The median power was 50 W and median total delivered energy 27,531 J. At 1-year follow-up, the median VRR was 64.0% and 87 (75.7%) nodules showed a VRR above 50%. Among all parameters, only baseline volume, total energy, and energy per volume were independently associated to a VRR50% (p = 0.001, p = 0.0178, p0.001 respectively). The probit regression analysis demonstrated that delivering 756 J/ml and 2670 J/ml gave a probability of VRR50% in 50% and 99% of patients, respectively.Considering the baseline nodular volume and delivering the adequate energy per volume allow optimizing technical and clinical success.• The effectiveness of radiofrequency ablation in treating benign thyroid nodules is negatively correlated to the volume of the nodule and positively correlated to the energy delivered per volume. • When planning the treatment, the total energy to deliver can be calculated by using a simple formula: nodular volume × 2670 J.

Organoaxial gastric volvulus occurs when the stomach rotates on its longitudinal axis connecting the gastroesophageal junction to the pylorus. With that, the antrum of the stomach usually rotates in the opposite direction in rela-tion to its fundus (1). This phenomenon has often been known to be associated with diaphragmatic defects (2) Importantly, abnormal rotation of the stomach of more than 180° is a life threatening emergency that may create a closed loop ob- struction which may result in incarceration leading to strangulation, and hence, a surgical emergency. We present the case of a middle-aged female who presented with organoaxial gastric volvulus and had an associated Type IV paraesophageal hiatal hernia that was treated electively. Normally an emergent gastric volvulus is diagnosed via Borchardt’s classic triad (epigastric pain, unproductive vomiting and diffculty inserting a nasogastric tube); however in this patient the nasogastric tube (NGT) was passed into the antrum which allowed additional time for resusci-tation with fuids and other symptomatic relief.

The LHC BSM Reinterpretation Forum: et al., We report on the status of efforts to improve the reinterpretation of searches and measurements at the LHC in terms of models for new physics, in the context of the LHC Reinterpretation Forum. We detail current experimental offerings in direct searches for new particles, measurements, technical implementations and Open Data, and provide a set of recommendations for further improving the presentation of LHC results in order to better enable reinterpretation in the future. We also provide a brief description of existing software reinterpretation frameworks and recent global analyses of new physics that make use of the current data., The editors of this report were supported in part by the European Union as part of the Marie Sklodowska-Curie Innovative Training Network MCnetITN3 (grant agreement no. 722104), by the IN2P3/CNRS under the project “LHC-iTools”, by STFC grants ST/P000681/1, ST/K00414X/1, ST/N000838/1, ST/P000762/1, ST/N003985/1, ST/M005437/1, and by FAPESP under the project grant 2015/20570-1. We acknowledge moreover partial support by The Royal Society, University Research Fellowship grant UF160548 (AB); the F.R.S.-FNRS (JH); the DFG Emmy Noether Grant No. KA 4662/1-1 (FK). the Austrian Science Fund, EliseRichter grant V592-N27 (SuK); and the National Research Foundation of Korea, NRF, contract NRF-2008-00460 (SS).

The Centers for Disease Control and Prevention (CDC), Division of State and Local Readiness (DSLR), Public Health Emergency Preparedness(PHEP) program funds 62 recipients to strengthen capability standards to prepare for and respond to public health emergencies. Recipients use these PHEP resources in addition to CDC’s administrative and scientific guidance to support preparedness and response program planning and requirements. It is expected that public health agencies develop and maintain comprehensive emergency preparedness and response plans in preparation for disasters such as hurricanes. The 2017 historic hurricane season highlighted how emergency planning and collaborative operational execution is important for public health agencies to effectively prepare for and respond to both the immediate and long-term population health consequences of these disasters. In 2017, the southeastern United States (US) and US Caribbean territories experienced 3 Category 4 or higher Atlantic hurricanes (Harvey, Irma, and Maria) within a 5-week period. This paper highlights selected case studies that illustrate the contributions and impact of jurisdictional emergency management planning and operational capacity supported by capability standards during the 2017 hurricane season. Although the magnitude of the 2017 hurricanes required public health officials to seek additional assistance, the following case studies describe the use of public health preparedness systems and recovery resources supported by the PHEP program.

Background and aim: Cystic thyroid nodules (CNs), although generally benign, can cause compressive or aesthetic problems. Percutaneous ethanol injection (PEI) can represent an alternative to surgery. The present retrospective study evaluates: (i) the long-term outcome of CNs after PEI; (ii) the differences between two different PEI protocols; (iii) the CNs response according to the liquid component. Materials and methods: The study comprises 358 nodules post-PEI followed for at least 2 years. PEI was performed according to two different treatment protocols with a single (Foggia) or double (Turin) alcohol injection. CNs were divided according to their composition: cystic (CYS) >90%, mainly cystic (M-CYS) 75–90%, mixed (MIX) 50–75%, solid-mixed (S-MIX) 35-50%. The volume reduction rate (VRR) was defined as nodule volume (mL) after PEI/nodule volume (mL) before PEI x 100. Results: The 1-year VRR was significantly higher than that at 6 months (89.5% vs 72.9%, P = 0.0005), no differences were observed after 1 year. A significant difference between Turin and Foggia was observed only in VRR at early visit (79% vs 86%, respectively, P = 0.002) and recurrence rate (14% vs 24%, respectively, P = 0.001). Minor side-effects were infrequent. In 192 nodules with a 10-year follow-up CYS showed higher VRR than MIX and S-MIX nodules (P < 0.001). Conclusion: Our study reported that the long-term outcome of CNs treated with PEI is excellent regardless of the PEI technique utilized; the larger the cystic amount, the higher the VRR. Based on present results, PEI can be considered as the first-line choice for treating thyroid CNs.

Introduction: We previously reported that markers of coagulation and hemostatic activation (MOCHA) have been associated with malignancy, venous thromboembolism (VTE) and hypercoagulable states in embolic stroke of undetermined source (ESUS) patients. The objective of our study was to identify independent predictors of these endpoints. Methods: Consecutive ESUS patients seen at the Emory Clinic from January 1, 2017 to June 30, 2019 underwent a MOCHA profile (d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) and were followed prospectively for new diagnoses of malignancy, VTE, other defined hypercoagulable states and the composite outcome. Abnormal MOCHA was defined as ≥ 2 elevated markers. Multivariable analyses were performed to identify predictors of the composite outcome. Results: Of 188 patients (mean age 63 ±16 years, 59% female, 50% Caucasian) included in the study period, 25 (13%) had the composite outcome. The median time between ESUS to MOCHA testing was 45 days (IQR 23-88). Abnormal MOCHA profile was the only independent predictor of the composite outcome (OR 2.34, 1.64-3.32, p Conclusions: This study confirms that a normal MOCHA profile in the post-acute time period can rule out ESUS patients with malignancy, VTE or other underlying hypercoagulable states.

Introduction: Left atrial enlargement (LAE) and markers of coagulation and hemostatic activation (MOCHA) have previously been shown to identify ESUS patients who are more likely to have subsequent diagnosis of atrial fibrillation (AF), malignancy or recurrent strokes. The objective of this study was to evaluate if anticoagulation therapy reduces recurrent stroke in ESUS patients with LAE or abnormal MOCHA. Methods: Consecutive ESUS patients seen in the Emory Clinic from January 1, 2017, to June 30, 2019, underwent outpatient cardiac monitoring and the MOCHA profile (serum d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex and fibrin monomer) obtained ≥ 2 weeks after the index stroke. All patients were on antiplatelet therapy at the time of testing. Anticoagulation was offered to patients with an abnormal MOCHA (≥ 2 elevated markers) or severe LAE (LA volume index >40 ml/m 2 ). Patients were evaluated for AF, malignancy, recurrent stroke or hemorrhage at routine clinical follow-up. We compared this patient cohort (cohort 2) to a historical cohort (cohort 1) who underwent the same protocol but remained on antiplatelet therapy during follow-up. Results: Baseline characteristics and endpoints are shown in the Table. Overall 46 (23%) patients in Cohort 2 initiated anticoagulation based on abnormal MOCHA or severe LAE. Cohort 2 had significantly lower rates of recurrent stroke than cohort 1 (14% vs. 3%, p=0.008) with no major hemorrhages. Conclusion: Anticoagulation therapy in a subgroup of ESUS patients with abnormal MOCHA or severe LAE may be associated with a reduced rate of recurrent stroke. A prospective, multicenter study is warranted to validate these results.

Employees can provide invaluable input to organizations when they can freely express their opinions at work. Employees, however, may not believe that it is safe or efficacious to voice their concerns. How features of communication channels affect employees’ safety and efficacy perceptions is largely ignored in existing voice models. Therefore, this study seeks to understand how the anonymity and visibility affordances of a communication channel influence employees’ safety and efficacy perceptions, and, thus, their intention to engage in prohibitive voice at work. Two between-subjects experiments were conducted to test how these channel affordances affect voicing behavior in organizations. The results indicate that the more anonymous and less visible participants perceive a voicing channel to be, the safer and the more efficacious they evaluate the channel. Theoretical and practical implications, limitations, and future research directions are discussed.

While hope is repeatedly present in Shelley’s The Revolt of Islam, two centuries later global politics seems stifled by a domination of terror, war and liberticidal power structures, echoing the poem’s ‘brotherhood of ill’. This article reflects on Revolt’s continuing relevance for the sustenance of hope amongst contemporary progressive movements. It focuses on the strategies to re-kindle hope and utopian visions that Shelley’s imagery hints at, and relates them to some aspects of the Arab Springs: these strategies are identified as Godwinian liberating truth, underground forces, symbolic locations and the endurance of culture and education.

Purpose To perform a comparative quantitative analysis of Power Doppler ultrasound (PDUS) and Contrast-Enhancement ultrasound (CEUS) for the quantification of thyroid nodules vascularity patterns, with the goal of identifying biomarkers correlated with the malignancy of the nodule with both imaging techniques. Methods We propose a novel method to reconstruct the vascular architecture from 3-D PDUS and CEUS images of thyroid nodules, and to automatically extract seven quantitative features related to the morphology and distribution of vascular network. Features include three tortuosity metrics, the number of vascular trees and branches, the vascular volume density, and the main spatial vascularity pattern. Feature extraction was performed on 20 thyroid lesions (ten benign and ten malignant), of which we acquired both PDUS and CEUS. MANOVA (multivariate analysis of variance) was used to differentiate benign and malignant lesions based on the most significant features. Results The analysis of the extracted features showed a significant difference between the benign and malignant nodules for both PDUS and CEUS techniques for all the features. Furthermore, by using a linear classifier on the significant features identified by the MANOVA, benign nodules could be entirely separated from the malignant ones. Conclusions Our early results confirm the correlation between the morphology and distribution of blood vessels and the malignancy of the lesion, and also show (at least for the dataset used in this study) a considerable similarity in terms of findings of PDUS and CEUS imaging for thyroid nodules diagnosis and classification.

The ultrasound risk stratification system of the American Thyroid Association (ATA) is frequently adopted in clinical practice. Here, we evaluated its performance in a series of nodules with indeterminate fine-needle aspiration cytology (FNAC) report.Indeterminate thyroid nodules diagnosed at 2 medical centers were retrospectively screened, ultrasound images were reevaluated, and lesions were classified according to the ATA. Single ultrasound parameters were also analyzed.One hundred seventy-three indeterminate lesions were included with 24.8% of malignancy. The high suspicion class showed a cancer rate (75%) significantly (P.001) higher than that recorded in the other categories (16.8%). Between ultrasound parameters, halo and microcalcifications were the most sensitive and specific ones. The most accurate receiver operating characteristic (ROC)-derived cutoff of nodule's diameter was4.1 cm. At multivariate analysis, only the ATA class of high suspicion and size4.1 cm were significantly associated with cancer (odds ratios [ORs] 19.4 and 5.4, respectively).The ATA ultrasound system is reliable in the risk stratification of indeterminate thyroid lesions.

Objectives. To demonstrate how inclusion of the Centers for Disease Control and Prevention’s Community Assessment for Public Health Emergency Response (CASPER) as a tool in Public Health Preparedness Capabilities: National Standards for State and Local Planning can increase public health capacity for emergency response. Methods. We reviewed all domestic CASPER activities (i.e., trainings and assessments) between fiscal years 2012 and 2016. Data from these CASPER activities were compared with respect to differences in geographic distribution, type, actions, efficacy, and usefulness of training. Results. During the study period, the Centers for Disease Control and Prevention conducted 24 domestic in-person CASPER trainings for 1057 staff in 38 states. On average, there was a marked increase in knowledge of CASPER. Ninety-nine CASPERs were conducted in the United States, approximately half of which (53.5%) assessed preparedness; the others were categorized as response or recovery (27.2%) or were unrelated to a disaster (19.2%). Conclusions. CASPER trainings are successful in increasing disaster epidemiology skills. CASPER can be used by Public Health Emergency Preparedness program awardees to help build and sustain preparedness and response capabilities.

To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules.Institutional review board approval was obtained, and patients' consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57 ± 14 years) with LA and 152 (107 females, age 57 ± 14 years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12 months and complications were evaluated.No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12 months was -67 ± 19% vs. -57 ± 21% (p 0.001) - 70 ± 19% vs. -62 ± 22% (p = 0.001) in LA group and in RFA group, respectively. Nodules with volume 30 mL had significantly higher percentage volume reduction at 6 and 12 months (-69 ± 19 vs. -50 ± 21, p = 0.001) and (-73 ± 18 vs. -54 ± 23 8, p = 0.001) in the LA group than in the RFA group, respectively. In both groups, operator's skills affected the results. Major complications occurred in 4 cases in each group (p = 0.116) Conclusions: LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator's skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique.

Background Studies have evaluated various strategies to prevent venous thromboembolism (VTE) in neuro-oncology patients, without consensus. Objective To perform a systematic review with cost-effectiveness analysis (CEA) of various prophylaxis strategies in tumor patients undergoing craniotomy to determine the safest and most cost-effective prophylaxis regimen. Methods A literature search was conducted for VTE prophylaxis in brain tumor patients. Articles reporting the type of surgery, choice of VTE prophylaxis, and outcomes were included. Safety of prophylaxis strategies was determined by measuring rates of VTE and intracranial hemorrhage. Cost estimates were collected based on institutional data and existing literature. CEA was performed at 30 d after craniotomy, comparing the following strategies: mechanical prophylaxis (MP), low molecular weight heparin with MP (MP+LMWH), and unfractionated heparin with MP (MP+UFH) to prevent symptomatic VTE. All costs were reported in 2016 US dollars. Results A total of 34 studies were reviewed (8 studies evaluated LMWH, 12 for MP, and 7 for UFH individually or in combination; 4 studies used LMWH and UFH preoperatively). Overall probability of VTE was 1.49% (95% confidence interval (CI) 0.42-3.72) for MP+UFH, 2.72% [95% CI 1.23-5.15] for MP+LMWH, and 2.59% (95% CI 1.31-4.58) for MP, which were not statistically significant. Compared to a control of MP alone, the number needed to treat for MP+UFH is 91 and 769 for MP+LMWH. The risk of intracranial hemorrhage was 0.26% (95% CI 0.01-1.34) for MP, 0.74% (95% CI 0.09-2.61) for MP+UFH, and 2.72% (95% CI 1.23-5.15) for MP+LMWH, which were also not statistically significant. Compared to MP, the number needed to harm for MP+UFH was 208 and for MP+LMWH was 41. Fifteen studies were included in the final CEA. The estimated cost of treatment was $127.47 for MP, $142.20 for MP+UFH, and $169.40 for MP+LMWH. The average cost per quality-adjusted life-year for different strategies was $284.14 for MP+UFH, $338.39 for MP, and $722.87 for MP+LMWH. Conclusion Although MP+LMWH is frequently considered the optimal prophylaxis for VTE risk reduction, our model suggests that MP+UFH is the safest and most cost-effective measure to balance VTE and hemorrhage risks in brain tumor patients at lower risk of hemorrhage. MP+LMWH may be more effective for patients at higher risk of VTE.

Improved communication clarity is needed in the presentation and critical evaluation of proposed theory advancements in the field of communication. We encourage communication scholars to be more explicit in detailing the nature of their theoretical pursuits and to utilize with greater frequency established criteria for the assessment of theory. Engaging in these practices will foster more reasoned debate between scholars, produce better informed judgments concerning publication worthiness, allow weaker work to be discarded with less error, and provide an efficient means for the building of stronger, more cogent lines of research.

La radiofrequenza tiroidea rappresenta una valida opzione terapeutica per il trattamento di riduzione volumetrica dei nodi tiroidei benigni. L’efficacia a lungo termine di questa metodica e ormai consolidata, come la bassa incidenza di complicanze, se la tecnica viene eseguita da operatori specializzati con adeguata esperienza. Non si esclude l’applicazione di questa metodica, in un prossimo futuro, nel trattamento del microcarcinoma papillare della tiroide.

Objective: Several thyroid imaging reporting and data systems (TIRADS) have been proposed to stratify the malignancy risk of thyroid nodule by ultrasound. The TIRADS by the European Thyroid Association, namely EU-TIRADS, was the last one to be published. Design: We conducted a meta-analysis to assess the prevalence of malignancy in each EU-TIRADS class and the performance of EU-TIRADS class 5 vs 2, 3 and 4 in detecting malignant lesions. Methods: Four databases were searched until December 2019. Original articles reporting the performance of EU-TIRADS and adopting histology as reference standard were included. The number of malignant nodules in each class and the number of nodules classified as true/false positive/negative were extracted. A random-effects model was used for pooling data. Results: Seven studies were included, evaluating 5672 thyroid nodules. The prevalence of malignancy in each EU-TIRADS class was 0.5% (95% CI: 0.0–1.3), 5.9% (95% CI: 2.6–9.2), 21.4% (95% CI: 11.1–31.7), and 76.1% (95% CI: 63.7–88.5). Sensitivity, specificity, PPV, NPV, LR+, LR− and DOR of EU-TIRADS class 5 were 83.5% (95% CI: 74.5–89.8), 84.3% (95% CI: 66.2–93.7), 76.1% (95% CI: 63.7–88.5), 85.4% (95% CI: 79.1–91.8), 4.9 (95% CI: 2.9–8.2), 0.2 (95% CI: 0.1–0.3), and 24.5 (95% CI: 11.7–51.0), respectively. A further improved performance was found after excluding two studies because of limited sample size and low prevalence of malignancy in class 5. Conclusions: A limited number of studies generally conducted using a retrospective design was found. Acknowledging this limitation, the performance of EU-TIRADS in stratifying the risk of thyroid nodules was high. Also, EU-TIRADS class 5 showed moderate evidence of detecting malignant lesions.

In spring 2011, the Centers for Disease Control and Prevention (CDC) released Public Health Preparedness Capabilities: National Standards for State and Local Planning. The capability standards provide a framework that supports state, local, tribal, and territorial public health agency preparedness planning and response to public health threats and emergencies. In 2017, a project team at the CDC Division of State and Local Readiness incorporated input from subject matter experts, national partners, and stakeholders to update the 2011 capability standards. As a result, CDC released the updated capability standards in October 2018, which were amended in January 2019. The original structure of the 15 capability standards remained unchanged, but updates were made to capability functions, tasks, and resource elements to reflect advances in public health emergency preparedness and response practices since 2011. When the number of functions and tasks in the 2018 capability standards were compared to those in the 2011 capabilities, only 20% (3/15) of the capabilities had a decrease in function number. The majority of changes were at the task level (task numbers changed in 80%, or 12/15, capabilities) in the 2018 version. The capability standards provide public health agencies with a practical framework, informed by updated science and tools, which can guide prioritization of limited resources to strengthen public health agency emergency preparedness and response capacities.

Background: Radiofrequency (RF) is a therapeutic modality for reducing the volume of large benign thyroid nodules. If thermal therapies are interpreted as an alternative strategy to surgery, critical issues in their use are represented by the extent of nodule reduction and by the durability of nodule reduction over a long period of time. Objective: To assess the ability of machine learning to discriminate nodules with volume reduction rate (VRR) < or ≥50% at 12 months following RF treatment. Methods: A machine learning model was trained with a dataset of 402 cytologically benign thyroid nodules subjected to RF at six Italian Institutions. The model was trained with the following variables: baseline nodule volume, echostructure, macrocalcalcifications, vascularity, and 12-month VRR. Results: After training, the model could distinguish between nodules having VRR

Italian cytology system for thyroid fine-needle aspiration (FNA) includes indeterminate lesions at low- (Tir 3A) and high-risk (Tir 3B). The present retrospective multicenter study was undertaken to compare the histological type of cancers and disease-free survival in these two groups. Eight institutions participated. Thyroid cancer patients diagnosed and followed-up after Tir 3A or Tir 3B were reviewed. Histological diagnosis was adopted as the gold standard. Patients were defined with cancer recurrence or no evidence of disease. Disease-free survival (DFS) was calculated. A non-parametric statistical analysis was used. DFS was estimated by Kaplan–Meier method and Hazard Ratio (HR) defined the slope of curves. Two hundred and nine patients (median DFS 24 months) were enrolled and a 6.3% of these recurred. Tir 3B group had higher age (p = 0.014), larger cancer size (p = 0.0002), shorter DFS (p = 0.003), higher number of aggressive cancers (p = 0.006), and relapse frequency double than Tir 3A. At survival curves analysis, Tir 3B group had HR of 2.37 with respect to Tir 3A. At Cox’s proportional hazard regression analysis histology was the only significant predictor of relapse. While patients with thyroid FNA of Tir 3B should be addressed to surgery due to high likelihood of more aggressive cancer, a diagnostic surgery could be avoided in patients with Tir 3A if concurrent unsuspicious clinical features are found.

Introduction: Markers of coagulation and hemostatic activation (MOCHA) have previously been shown to identify ESUS patients who are more likely to have subsequent diagnosis of atrial fibrillation (AF), malignancy, venous thromboembolism (VTE) or other defined hypercoagulable disorders. The objective of this study was to evaluate whether anticoagulation therapy reduces recurrent stroke in ESUS patients with an abnormal MOCHA profile. Methods: Consecutive ESUS patients seen in the Emory Clinic from January 1, 2017 to June 30, 2018 underwent outpatient cardiac monitoring and the MOCHA profile including serum d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex and fibrin monomer obtained ≥ 2 weeks after the index stroke. All patients were on antiplatelet therapy at the time of MOCHA testing and an abnormal MOCHA profile was defined as ≥ 2 elevated markers. Anticoagulation was offered to patients with an abnormal MOCHA and patients were evaluated for recurrent stroke or hemorrhage at routine clinical follow-up. We compared this patient cohort (cohort 2) to a historical cohort (cohort 1) who underwent the same protocol but remained on antiplatelet therapy during follow-up. Results: Baseline characteristics were similar between cohorts except that cohort 2 was less likely to have diabetes (43% vs 23%, p=0.004), less likely to have an abnormal MOCHA profile (55% vs 36%, p=0.008) and had a shorter duration of follow-up (mean months 13 vs 7, p=0.0001). Cohorts had similar rates of the composite endpoint of AF, malignancy, VTE or other defined hypercoagulable disorder (33% vs 26%, p=0.43). MOCHA profile was obtained a median of 33 (IQR 15-57) days after index stroke in cohort 2; 41 (36%) patients were offered the option of anticoagulation therapy due to an abnormal MOCHA profile of which 32 (78%) chose anticoagulation. Cohort 2 had significantly lower rates of recurrent stroke than cohort 1 (14% vs. 0.9%, IRR 0.14, p=0.01) with no major hemorrhages seen in either group. Conclusion: This study suggests that anticoagulation therapy in a subgroup of ESUS patients with abnormal MOCHA profile may be associated with a reduced rate of recurrent stroke. A prospective, randomized study is needed to confirm these findings.

Potential causes of embolic stroke of undetermined source (ESUS) include occult malignancy, venous thrombosis (VTE) with paradoxical embolism, and hypercoagulable disorders. Given the association of markers of coagulation and hemostatic activation (MOCHA) with these causes, the objective of this study was to validate the utility of the MOCHA profile in identifying the underlying cause of stroke.We prospectively identified ESUS patients from January 1, 2017 to December 1, 2019 who underwent MOCHA profile (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) testing. Abnormal MOCHA profile was defined as ≥ 2 abnormal markers. New diagnoses of malignancy, VTE, hypercoagulable disorders and recurrent stroke were identified during routine clinical follow-up.Of 236 ESUS patients, 104 (44%) patients had an abnormal MOCHA profile. In multivariable analyses the number of MOCHA abnormalities was significantly associated with malignancy, VTE, and hypercoagulable disorders (OR 2.59, CI 95% 1.78-3.76, p0.001). Sensitivity, specificity, positive predictive value, and negative predictive value of an abnormal MOCHA profile for the combined outcome of malignancy, VTE, and hypercoagulability was 96%, 62%, 23%, and 99% respectively.The MOCHA profile was able to identify ESUS patients more likely to have malignancy, VTE, and hypercoagulable disorders during follow-up. Our results show that a normal MOCHA profile in ESUS patients can effectively rule out these potential causes of ESUS.

The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population- based breast cancer screening programmes based on mammography every other year for women aged 50 to 69 years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population- based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population- based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged. (C) 2016 The Authors. Published by Elsevier Inc.

Background: There is some evidence that dietary habits may influence the risk of endometrial cancer independently of body mass, although the role of diet on endometrial carcinogenesis is unclear. Patients and methods: We carried out a multicenter case-control study from 1992 to 2006 in Italy on 454 women with incident, histologically confirmed endometrial cancer (age range 18-79 years) and 908 controls (age range 19-79 years) admitted to hospitals for acute, non-neoplastic diseases. A validated food-frequency questionnaire was used to estimate macronutrients, fatty acids and cholesterol intake. Logistic regression models, conditioned on age and study centre, and adjusted for major known risk factor of endometrial cancer and residual of energy intake were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Significant direct associations were observed with intake of energy (OR = 1.7 for the highest versus the lowest quintile, 95% CI = 1.1-2.5), and cholesterol (OR = 2.1, 95% CI = 1.4-3.2), while a direct borderline association emerged with saturated fatty acids (OR = 1.3, 95% CI = 0.9-2.0). There was no association with proteins, sugars, starch, total fat and other selected fatty acids. Conclusion: Energy and cholesterol intake were associated with endometrial cancer. RI Parpinel, Maria/B-1605-2012

The objective of this trial is to determine the safety, tolerability, and toxicity of DNX-2401 in newly diagnosed DIPG patients (NCT03178032) followed by radiotherapy. Secondary endpoints are overall survival at 12 months, percentage of responses and induced immune response against tumor. Tumor biopsy was performed through the cerebellar peduncle, followed by intratumoral injection of DNX-2401 (N=12). Three patients were treated with 1x1010vp and given the lack of toxicity we escalated to 5x1010vp. The procedure was well tolerated and reduced tumor volume was demonstrated in all patients after combined treatment (virus + radiotherapy). We performed molecular studies (RNAseq and the Oncomine Childhood Research Panel from Thermo Fisher). The immune cell composition of the biopsies pre-virus injection was assessed using multiplexed quantitative immunofluorescence. T cells were hardly detectable in these tumors while macrophages were abundant. Using a multiplexed TCR-sequencing mRNA-based assay to analyze 18 available paired pre- and post-treatment samples from the trial, we detected increased clonal T cell diversity following treatment with the virus. We also measured pre and post treatment neutralizing antibodies and their relationship with survival. Finally, we performed functional studies using 2 cell lines isolated from patients included in this trial to assess the response to the virus (infectivity, viability, T-cell recognition). In summary, the virus has shown safety and efficacy in some patients. The information obtained in this clinical study would aid understanding the response of DIPG patients to viral therapies and, therefore, to better tailor this strategy to improve the survival of these patients.

Context Radiofrequency ablation (RFA) of benign thyroid nodules has been gaining consensus. However, no solid information on its long-term efficacy is available. Objective To analyze the long-term results of single-session RFA. Design Retrospective longitudinal observational study. Setting Primary care center. Patients or Other Participants Adult outpatients who underwent a single-session RFA and posttreatment follow-up of least 3 years. Intervention Ultrasound-guided RFA was performed after local anesthesia by “moving-shot” technique. RFA was performed with a median power of 55W and a median time of 14 minutes with an internally cooled 18-gauge electrode with an active 10-mm tip. Main Outcome Measures Objective (trend of nodule volume) and subjective (compressive and cosmetic concerns) response to RFA were evaluated. Continuous variables were analyzed by the Wilcoxon and ANOVA test and their correlations by using the Spearman test. Categorical variables were compared by Pearson χ2 test. Results Two hundred and fifteen patients were included. An early significant reduction of nodule volume was found at 1 year, lasting up to 5 years. A 67% nodule shrinkage was observed at the end of the observation period. The best response was recorded in nodules below 10 mL (79% reduction early and 81% at 5 years). Patients’ symptoms were significantly reduced. Conclusions This study, by demonstrating a durable shrinkage of benign thyroid nodules treated by RFA with an improvement of subjective symptoms, establishes the reliability of RFA as alternative to surgery in the management of thyroid nodules, thus representing a remarkable novelty for clinical practice.