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Activated protein C resistance (APCR) is a common thrombophilia, caused mainly by a mutation. The impact of APCR on the efficacy of In Vitro Fertilization (IVF) are still unclear, and no solid recommendations for its management were published. To investigate the effect of APCR on IVF outcomes and assess the efficacy of our management protocol, we retrospectively scanned the medical records of women who were tested with APCR assay in 2019 at our fertility centre. The 66 women (12%) positive for APCR had lower odds of reaching clinical pregnancies after IVF 0.18 [95% CI: 0.07–0.47] and fewer live births. The administration of low-molecular-weight heparin and aspirin associated with more implantation in treated compared to untreated APCR-positive women with an odds ratio of 43.2 [7.51–248.6]. In conclusion, APCR negatively affects the number of clinical pregnancies after IVF, but anticoagulation therapy can mitigate this effect and significantly increase clinical pregnancies.Impact StatementWhat is already known on this subject? The evidence about the impact of APCR on IVF outcomes is still inconclusive. According to the Canadian guideline, routine screening for thrombophilia in patients with recurrent pregnancy loss is not recommended. No clear recommendations regarding the management of APCR in the planning for IVF are yet available.What do the results of this study add? APCR significantly increases implantation failure among infertile women who conduct IVF. Management of APCR using LMWH and aspirin was effective in mitigating this effect and increasing successful implantation.What are the implications of these findings for clinical practice and/or further research? Our findings can support the recommendation to include APCR assay in the routine tests for infertile women conducting IVF, and suggest the combination between LMWH and aspirin as an effective therapy to increase successful implantation in APCR positive candidates. However, more controlled clinical trials are still needed to confirm our results. What is already known on this subject? The evidence about the impact of APCR on IVF outcomes is still inconclusive. According to the Canadian guideline, routine screening for thrombophilia in patients with recurrent pregnancy loss is not recommended. No clear recommendations regarding the management of APCR in the planning for IVF are yet available. What do the results of this study add? APCR significantly increases implantation failure among infertile women who conduct IVF. Management of APCR using LMWH and aspirin was effective in mitigating this effect and increasing successful implantation. What are the implications of these findings for clinical practice and/or further research? Our findings can support the recommendation to include APCR assay in the routine tests for infertile women conducting IVF, and suggest the combination between LMWH and aspirin as an effective therapy to increase successful implantation in APCR positive candidates. However, more controlled clinical trials are still needed to confirm our results.

Introduction:Syrian medical research synthesis is marginal compared to neighboring countries and faces numerous obstacles that have been intensified by the Syrian armed conflict. Perceived research barriers include the lack of mentorship and academic writing skills. We evaluate the outcomes of a peer-run academic writing and publishing workshop, and contrast training synchronicity and its supplementary peer-reviewed assignments. Methods:This randomized controlled trial studied an online workshop that targeted under- and post-graduate medical and paramedical students at all Syrian universities. Blinded participants were randomized into four arms; Two arms attended the workshop synchronously, and the others asynchronously. One arm in each group undertook peer-reviewed scientific writing exercises (active), while the other two self-reviewed the same exercises (passive). Objective knowledge and subjective confidence in the learnt skills were assessed before the workshop, and one month and one year after it.Results: One-hundred-twenty-one participants completed the workshop, which was effective in improving their knowledge (PPP=0.005) and confidence (P=0.003) only in the active groups. Moreover, participants who joined the peer-review process gained higher knowledge (P

Introduction Multiple primary cancers (MPC) are defined as the occurrence of two or more non-related cancers. The acquiring of male breast cancer (MBC) as secondary cancer in a sequence of MPC is extremely rare. Only one case of breast cancer following liposarcoma (LP) was previously reported in a female patient. We report the first case of MBC following LP. Case presentation A non-smoker male patient with a history of a well-differentiated liposarcoma was treated surgically and with radiotherapy 14 years ago with no signs of recurrence. The patient presented with a left breast mass; The excisional biopsy showed poorly differentiated grade III invasive ductal carcinoma. The patient underwent a mastectomy with axillary node resection and the final diagnosis was invasive ductal carcinoma stage IIA [T:2, N:0, M:0]. The tumor markers reported; Positive Estrogen Receptor (ER+), negative Progesterone Receptor (PR-), and negative Human Epidermal Receptor (HER-). He received eight sessions of chemotherapy with Docetaxel and 16 fractions of radiotherapy. The follow-up showed no signs of recurrence. Discussion Despite the rarity of diagnosis MBC as a second primary. Studies have found a relation between different types of breast cancer in male patients, and further, a relation was also found between MBC and lymphoma. While no studies that link MBC and LP were previously reported. Conclusion We found that acquiring a treated LP would not affect the MBC prognosis or its response to treatment, yet further studies are needed to confirm this outcome., Highlights • Multiple primary cancers occur in 2.4–17% of all people. • The diagnosis of male breast cancer as a second primary is rare. • Having male breast cancer following liposarcoma is even rarer. • Well treated liposarcoma would not affect male breast cancer prognosis.

Traumatic diaphragmatic hernias (TDHs) are uncommon, and they mostly occur following blunt or penetrating traumatic injury and rarely as a complication of Iatrogenic procedure. The management of TDHs is through surgical repair. In this article, we present the case of a diaphragmatic herniation presenting 1 year after thoracic surgery in a 16-year-old male. The patient presented with gastrointestinal obstruction symptoms and later developed a hypovolemic shock due to stomach bleeding. Immediate exploratory thoracotomy was performed, and the patient reached a full recovery afterward.

Traditional cellular network infrastructure provide fixed radio coverage. The temporal changes in user distribution throughout the day and from day to day leads to inefficient use of radio resources. Our position is to create an adaptive radio coverage to match the radio resources and user demand. The main approach for creating flexible radio coverage (in our view) is to replace large cells with many small cells that can be switched ON and OFF as needed. The small cells have the added crucial advantage of supporting the very high data rates expected in future networks. The proposed approach will rely on developing advanced Self Organizing Network (SON) techniques to deploy, monitor and manage radio resources in the small cells. This paper discusses requirements for this approach and how it can be implemented within the SON.