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Mean minimal ablation margin was 5.51 mm. The mean actual ablation zone volume was -21.4% compared to predicted, likely due to significant tissue contraction ranging from 0-43%. There was no significant heat sink effect. Mean hospital stay was 1.73 days, and only 1 patient stayed for more than 3 days. Complications included pain (13.3%), pneumothorax requiring drainage (6.67%), post-ablation reaction (6.67%), pleural effusion (3.33%) and hemoptysis (3.33%). After median follow up of 12 months, none of the nodules had evidence of progression.

Bronchoscopic transbronchial microwave ablation is safe and feasible for treatment of malignant lung nodules. Prospective study on clinical application of this novel technique is warranted.

Bronchoscopic transbronchial microwave ablation is safe and feasible for treatment of malignant lung nodules. Prospective study on clinical application of this novel technique is warranted.

Programmed cell death 1/programmed death ligand 1 (PD-1/PD-L1) immune-checkpoint blockade is a promising new therapeutic strategy in cancer. However, expression patterns and prognostic significance of PD-L1 and PD-1 are still controversial in human malignant pleural mesothelioma (MPM).

Formalin-fixed paraffin-embedded (FFPE) tumor samples from 203 MPM patients receiving standard treatment without immunotherapy were collected from 5 European centers. PD-L1 and PD-1 expression of tumor cells (TCs) and tumor-infiltrating lymphocytes (TILs) were measured by immunohistochemistry and correlated with clinical parameters and long-term outcome.

High (>10%) PD-L1 TC and PD-1 TILs expressions were found in 18 (8%) and 39 (24%) patients, respectively. PD-L1 was rarely expressed by TILs [≥1%, n=13 (8%); >10%, n=1]. No significant associations were found between the PD-L1 or PD-1 expression of TCs or TILs and clinicopathological parameters such as stage or histological subtype. Notably, patients with high (>10%) TC-specific PD-L1 expression exhibited significantly worse median overall survival (OS) (6.3

15.1 months of those with low TC PD-L1 expression; HR 2.51, P<0.001). In multivariate cox regression analysis adjusted for clinical parameters, high TC PD-L1 expression (>10%) proved to be an independent negative prognostic factor for OS (HR 2.486, P=0.005). There was no significant correlation between PD-L1 or PD-1 expression of TILs and OS.

In this multicenter cohort study, we demonstrate that high (>10%) PD-L1 expression of TCs independently predicts worse OS in MPM. Further studies are warranted to investigate the value of PD-L1/PD-1 expression as a marker for treatment response in MPM patients receiving immunotherapy.

10%) PD-L1 expression of TCs independently predicts worse OS in MPM. Further studies are warranted to investigate the value of PD-L1/PD-1 expression as a marker for treatment response in MPM patients receiving immunotherapy.Massive ovarian edema (MOE) is a rare non-neoplastic clinicopathologic disease that is characterized by stromal edema and is caused by the partial or intermittent obstruction of venous and lymphatic drainage. The literature on MOE contains approximately 200 cases, but only 12 cases of MOE during pregnancy have been reported to date. We report a case of MOE at 22 weeks of gestation that was diagnosed preoperatively, and the patient underwent laparoscopic surgery. Accurate preoperative diagnosis of MOE is important because it enables the selection of a therapeutic option, such as fundamental surgery, including adnexectomy; conservative surgery, including the release of torsion and ovarian biopsy; and conservative treatment without surgery. MOE should be considered as a differential diagnosis for an enlarged ovary during pregnancy. Laparoscopic surgery may be a useful therapeutic option for MOE, especially during pregnancy.Emphysematous pyelonephritis (EPN) on a single kidney is an extremely uncommon necrosing infection of renal parenchyma due often to infection by a gas-producing bacteria in a patient with uncontrolled diabetes mellitus. The management associate aggressive fluid and electrolyte resuscitation with several dialysis sessions, control of blood sugar levels, and broad-spectrum antibiotics with an urgent drainage. This paper aims to describe a case of a 68-year-old diabetic male patient who presented with EPN on a single kidney managed by conservative treatment.Rhodococcosis is a serious infection specially affecting immunocompromised populations. We report a case of disseminated infection by Rhodococcus equi in a renal transplant patient, that was initially diagnosed as histoplasmosis, highlighting the potential for confusion between rhodococcosis and other infections. Clinicians and pathologists should correlate histopathology findings with the clinical and microbiological data.This is a case of disseminated cryptococcosis with gastrointestinal and thyroid involvement. This case illustrates that gastrointestinal and thyroid involvement may be an under-recognized phenomenon. Suspicion should be high in an immunocompromised patient with odynophagia and a thyroid nodule and warrants further investigation by endoscopy and fine needle aspiration biopsy.Fusobacterium necrophorum infection is known to cause Lemierre’s syndrome, not pelvic peritonitis. Herein, we report a case of Fusobacterium necrophorum pelvic peritonitis and bacteremia, without Lemierre’s syndrome, mimicking intestinal necrosis. A 28-year-old woman with peritoneal irritation and shock was suspected of having intestinal necrosis due to the presence of hepatoportal venous gas and pneumatosis intestinalis. Intestinal necrosis was ruled out by emergency laparotomy. However, massive opaque ascites and inflammatory changes in the uterus and fallopian tubes were observed. Fusobacterium necrophorum and Gardnerella vaginalis were found in ascetic fluid cultures. Moreover, Fusobacterium necrophorum was also found in blood culture. Systemic management of septic shock and antibiotic treatment improved the patient’s general condition and abnormal gas on imaging. The patient had untreated bacterial vaginosis prior to admission. Pelvic peritonitis caused by Fusobacterium necrophorum is extremely rare. However, it must be recognized to avoid its rapid development into severe onset mimicking intestinal necrosis.

Some of the most vulnerable groups of teens choose to delay driving licensure (DDL). We assessed longitudinal associations between state-level Graduated Driver Licensing (GDL) restrictions and DDL among U.S. SMI-4a high school students.

Data from seven waves of the NEXT Generation Health Study (starting 10

-grade (2009-2010)), were analyzed in 2020 using Poisson regression. The outcome was DDL (delay vs. no-delay). Independent variables were driving restrictions (at learner and intermediate phases of licensure), sex, race/ethnicity, family affluence, parent education, family structure, and urbanicity.

Of 2525 eligible for licensure, 887 (38.9%), 1078 (30.4%), 560 (30.7%) reported DDL 1-2 years, >2 years, no DDL, respectively. Interactions between GDL restrictions during the learner permit period and covariates were found. In states requiring ≥30 hours of supervised practice driving, Latinos (Adjusted relative risk ratio [aRRR]=1.55, p<.001) and Blacks (aRRR=1.38, p<.01) were more likely to DDL than Wstricter GDL driving restrictions.

Our findings heighten concerns about increased crash risk among older teens who age out of state GDL policies thereby circumventing driver safety related restrictions. Significant disparities in DDL exist among more vulnerable teens in states with stricter GDL driving restrictions.

Proximal femoral extracapsular fractures with associated ipsilateral hip dislocation is an extremely rare pattern of injury. These fractures may be associated with a spectrum of severity from isolated trochanteric fractures to comminuted intertrochanteric and subtrochanteric fractures with hip dislocation. To date, this pattern of injury is not described in any injury classification system and no clear cut guidelines for the same are available. The aim of this review is to provide an evidence based pooled analysis of the existing literature and develop guidelines that help surgeons tackle this rare injury pattern.

A comprehensive review of the literature was undertaken using the PRISMA. Case reports and series of Extracapsular proximal femoral fracture dislocations published in PubMed, EMBASE, Springer, OvidSP, ScienceDirect, Web of Science and Google scholar between inception of journals to May 2020 were included in the review. A pooled analysis comparing the demography, pattern of the fracture, mode andorthopaedics should be followed in unstable patients with this rare fracture dislocation. Percutaneous Schanz screw reduction manoeuvre can be attempted gently with a low threshold to perform an open reduction. Every attempt at salvaging the fractured hip must be performed in young individuals with an arthroplasty standby for comminuted and unreconstructable cases.The rotator cuff has an important role in the stability and function of the glenohumeral joint. It is a complex anatomic structure commonly affected by injury such as tendinopathy and cuff tears. The rotator cuff helps to provide a stabilising effect to the shoulder joint by compressing the humeral head against the glenoid cavity via the concavity compression mechanism. To appreciate the function of the cuff it is imperative to understand the normal biomechanics of the cuff as well as the mechanisms involved in the pathogenesis of cuff disease. The shoulder joint offers a wide range of motion due to the variety of rotational moments the cuff muscles are able to provide. In order for the joint to remain stable, the cuff creates a force couple around the glenohumeral joint with coordinated activation of adjacent muscles, which work together to contain the otherwise intrinsically unstable glenohumeral joint and prevent proximal migration of the humerus. Once this muscular balance is lost, increased translations or subluxation of the humeral head may result, leading to changes in the magnitude and direction of the joint reaction forces at the glenohumeral joint. These mechanical changes may then result in a number of clinical presentations of shoulder dysfunction, disease and pain. This narrative review aims to highlight the importance of functional rotator cuff biomechanics whilst assessing the kinetics and kinematics of the shoulder joint, as well as exploring the various factors involved in cuff disease.Trichophyton bullosum is a zoophilic dermatophyte that has been rarely isolated from horses and humans in Africa and Europe. This is the first reported isolation of T. bullosum from a horse with dermatophytosis in Japan. The isolate from a skin lesion formed a cream-colored and waxy colony that was slightly elevated in the center. Sequencing of the internal transcribe spacer region of the isolate revealed that it was 100% identical to that of T. bullosum.

The World Health Organization’s (WHO’s) Basic Emergency Care (BEC) course was developed to address training gaps in low- and middle-income countries (LMICs). Simultaneously, LMICs have experienced an unprecedented increase in the number of cell phone and internet users. We developed a mobile application adjunct to the BEC course (BEC app) and sought to assess the reach of the BEC app.

Forty-six BEC course participants, made up of doctors and nurses from three hospital sites in Tanzania, were given access to the BEC app with download instructions. Moderators tracked mobile access characteristics and barriers. This is a descriptive study outlining the implementation of the BEC app and associated findings from the process.

Fewer than 10% of participants were able to independently download and use the application. The download process revealed three key barrier areas accessibility (no smartphone, smartphone without charge, no access to data/WiFi to download app, increased cost of data), technical (outdated operating system, inconsistent access to data/WiFi to run the app, insufficient phone storage), and participant-related characteristics (variability in smartphone literary, language discordance, smartphone turnover).