Implementation of O-RADS Ultrasound Reporting System: A Quality Improvement Initiative.

To determine the feasibility of implementing Ovarian-Adnexal Reporting & Data System (O-RADS) ultrasound (US) for reporting of adnexal masses at our institution, with a specific goal of increasing the use of O-RADS from a baseline of <5% to at least 75% over a 16-month period. A prospective interrupted time series quality improvement study was undertaken over a 16-month period. Plan, do, study, act cycles included: (1) Engagement of interested parties, (2) Targeted educational sessions, (3) Development of reporting templates, (4) Weekly audit-feedback.

Traumatic Hyphema with Commotio Retinae in a Special Operations Environment.

Traumatic ocular injuries from both combat- and noncombat-related activity remain a significant burden in active duty Ser- vicemembers and present a diagnostic and therapeutic challenge to Special Operations medics with limited resources in far forward and remote areas. Blunt ocular injury, whether from sports or battlefield engagement, can result in a variety of eyesight-threatening injuries, including hyphema, commotio retinae, iritis, uveitis, and open globe injury. The management of these conditions often requires teleconsultation with ophthalmology and potential evacuation, which is tailored to the resources available for the Special Operations Forces medic.

Specifics of spinal neuropathology in the molecular age.

Tumors located in the spinal cord and its coverings can be diagnostically challenging and require special consideration regarding treatment options. During the last decade, important advances regarding the molecular characterization of central and peripheral nervous system tumors were achieved, resulting in improved diagnostic precision, and understanding of the tumor spectrum of this compartment. In particular, array-based global DNA methylation profiling has emerged as a valuable tool to delineate biologically and clinically relevant tumor subgroups and has been incorporated in the current WHO classification for central nervous system tumors of 2021.

Clinically relevant molecular hallmarks of PFA ependymomas display intratumoral heterogeneity and correlate with tumor morphology.

Posterior fossa type A (PF-EPN-A, PFA) ependymoma are aggressive tumors that mainly affect children and have a poor prognosis. Histopathology shows significant intratumoral heterogeneity, ranging from loose tissue to often sharply demarcated, extremely cell-dense tumor areas. To determine molecular differences in morphologically different areas and to understand their clinical significance, we analyzed 113 PF-EPN-A samples, including 40 corresponding relapse samples.

Nivolumab Plus Ipilimumab in Patients With Solid Tumors With Mutations: Results From the Targeted Agent and Profiling Utilization Registry (TAPUR) Study.

Purpose: The Targeted Agent and Profiling Utilization Registry Study is a phase II basket study evaluating the antitumor activity of commercially available targeted agents in patients with advanced cancers with genomic alterations known to be drug targets. Results of a cohort of patients with solid tumors with mutations treated with nivolumab plus ipilimumab are reported.

Methods: Eligible patients had measurable disease (RECIST v.

Cervical assessment certification and its impact on performance quality in the context of universal cervical screening.

Objective: To assess the impact of the introduction of universal transvaginal cervical screening and certification on the quality of cervical length ultrasound images.

Methods: The present study included a retrospective cohort of singleton pregnancies that underwent transvaginal cervical length measurement at the anatomical scan (18 and 23 weeks) before (period A, 2015-2017) and after (period B, 2017-2019) the introduction of universal transvaginal cervical length screening. Independent observers blindly evaluated the images obtained for cervical length using a qualitative scoring method based on five criteria, according to the Fetal Medicine Foundation.

Surgical complications in pregnancy after bariatric surgery; a case series.

Background: Obesity is a rising world-wide problem and bariatric surgery, also in the reproductive age, is increasingly performed. Bariatric procedures are associated with surgical complications during pregnancy, such as internal herniation.

Cases: In this case series three cases with severe surgical complications after Roux-Y gastric bypass are described.

Gestational trophoblastic disease: an update.

Gestational trophoblastic diseases (GTD) encompass a spectrum of rare pre-malignant and malignant entities originating from trophoblastic tissue. This updated review will highlight important radiological features, pathology and classification, and provide insight into the clinical management of these uncommon disorders. There is a wide geographic variation with the incidence of hydatidiform mole varying between 0.

Establishing consensus-based high-acuity low-occurrence skills for EMS physicians: A pilot survey of EMS fellowship faculty.

Background: The specialty of emergency medical services (EMS) medicine focuses on providing out-of-hospital patient care, including initial stabilization, treatment, and transport in specially equipped vehicles including ambulances and airframe platforms to hospitals and better-resourced destinations. The Core Content of EMS Medicine outlines the knowledge, procedures, and psychomotor skills relevant to prehospital patient care. However, this document does not specify the high-consequence skills that are infrequently performed and that carry high levels of complexity as well as potential morbidity.

Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis.

Objective: First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies.

Data Sources: A search of MEDLINE, EMBASE, ClinicalTrials.

External Validation of O-RADS US Risk Stratification and Management System.

Background The Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification and management system (O-RADS US) was designed to improve risk assessment and management of ovarian and adnexal lesions. Validation studies including both surgical and nonsurgical treatment as the reference standard remain lacking. Purpose To externally validate O-RADS US in women who underwent either surgical or nonsurgical treatment and to determine if incorporating acoustic shadowing as a benign finding improves diagnostic performance.

Thermodynamic description of metastable fcc/liquid phase equilibria and solidification kinetics in Al-Cu alloys.

The thermodynamic description of the fcc phase in the Al-Cu system has been revised, allowing for the prediction of metastable fcc/liquid phase equilibria to undercoolings of Δ = 421 K below the eutectic temperature. Hypoeutectic Al-Cu alloys that are prone to pronounced microsegregation were solidified containerlessly in electromagnetic levitation. Solidus and liquidus concentrations were experimentally determined from highly undercooled samples employing energy-dispersive X-ray analysis.

Resolidification of a mushy-zone and directional solidification: a method for efficient alloy development demonstrated using the example of Cu-Ga-Sn.

An experimental method for alloy development that allows to systematically scan multicomponent alloy systems is presented using the Cu-Ga-Sn system as an example. Rods with homogeneous concentration distribution of different initial compositions are annealed in a steep temperature gradient with temperatures in the range from above liquidus to below solidus temperature. During resolidification of the initially formed mushy-zone, a continuously varying composition over the length of the rods develops.

Neonatal Morbidity of Monoamniotic Twin Pregnancies: A Systematic Review and Meta-analysis.

Objective: This study was aimed to report the incidence of neonatal morbidity in monochorionic monoamniotic (MCMA) twin pregnancies according to gestational age at birth and type of management adopted (inpatient or outpatient).

Study Design: Medline and Embase databases were searched. Inclusion criteria were nonanomalous MCMA twins.

The Abnormal Ovary: Evolving Concepts in Diagnosis and Management.

Ovarian lesions are common and require a consistent approach to diagnosis and management for best patient outcomes. In the past 20 years, there has been an evolution in the approach to abnormal ovarian lesions, with increasing emphasis on reducing surgery for benign disease, standardizing terminology, assessing risk of malignancy through use of evidence-based scoring systems, and triaging suspicious abnormalities to dedicated oncology centers. This article provides an evidence-based review of how these changes in diagnosis and management of ultrasound-detected abnormal ovarian lesions have occurred.

Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta-analysis.

Objectives: To explore the outcome of monochorionic monoamniotic (MCMA) twin pregnancies affected by twin-to-twin transfusion syndrome (TTTS).

Methods: MEDLINE and EMBASE databases were searched for studies reporting the outcome of MCMA twin pregnancies complicated by TTTS. The primary outcome was intrauterine death (IUD); secondary outcomes were miscarriage, single IUD, double IUD, neonatal death (NND), perinatal death (PND), survival of at least one twin, survival of both twins and preterm birth (PTB) before 32 weeks' gestation.

Delivering Precision Oncology in a Community Cancer Program: Results From a Prospective Observational Study.

Introduction: Precision oncology (PO) is a growing treatment approach in the era of next-generation sequencing (NGS) and matched therapies. Effective delivery of PO in the community has not been extensively studied. Our program developed a virtual molecular tumor board (MTB) strategy to help guide PO care.

Rapid MRI of the breast in evaluating lesions discovered on screening.

Background: In Canada, breast MRI has traditionally been reserved for evaluation of disease extent in patients with known breast malignancy. More recently, MRI has been emerging as an instrument for breast screening. However, its utilization is limited by increased relative cost and increased reader time.

Perinatal mortality, timing of delivery and prenatal management of monoamniotic twin pregnancy: systematic review and meta-analysis.

Objective: To quantify the rate of perinatal mortality in monochorionic monoamniotic (MCMA) twin pregnancies, according to gestational age, and to ascertain the incidence of mortality in pregnancies managed as inpatients compared with those managed as outpatients.

Methods: MEDLINE, EMBASE and CINAHL databases were searched for studies on monoamniotic twin pregnancy. The primary outcomes explored were the incidence of intrauterine death (IUD), neonatal death (NND) and perinatal death (PND) in MCMA twins at different gestational-age windows (24-30, 31-32, 33-34, 35-36 and ≥ 37 weeks of gestation).

Perinatal outcome of monochorionic and dichorionic twins after spontaneous and assisted conception: a retrospective cohort study.

Introduction: The aim of this study was to compare pregnancy outcomes in twin pregnancies after assisted conception and spontaneous conception, according to chorionicity.

Material And Methods: Retrospective cohort study of 1305 twin pregnancies between 1995 and 2015. All spontaneous (n = 731) and assisted conception conceived (n = 574) twin pregnancies with antenatal care and delivery in University Medical Center Utrecht, the Netherlands, a tertiary obstetric care center were studied according to chorionicity.