Search

Aims: Areas of gland crowding that do not fulfil diagnostic criteria of endometrioid intra‐epithelial neoplasia (EIN) are often encountered in endometrial biopsies. In this study, we document the prevalence of neoplastic outcome in patients with these subdiagnostic lesions (SL) and assess the utility of morphological features and a three‐marker immunohistochemistry panel (PAX2, PTEN, beta‐catenin) to predict outcome. Methods and results: Of 430 women with SL on endometrial sampling at Brigham and Women's Hospital between 2001 and 2021 with available follow‐up biopsy, 72 (17%) had a neoplastic outcome (EIN or endometrioid carcinoma). Multilayered epithelium and mitoses in SL were statistically associated with a neoplastic outcome. Abnormal three‐marker staining was observed in 93% (53 of 57) of SL with neoplastic outcome and 60% (37 of 62) of a control group with benign outcome. Among the 72 patients with neoplastic outcome, EIN/carcinoma tissue was available in 33; of these, 30 (91%) showed abnormal staining for one or more markers. Remarkably, in 84% of these cases the EIN/carcinoma had the aberrant expression seen in the preceding SL. Based on a prevalence of 17%, the positive and negative predictive values of abnormal staining in one or more markers were 24 and 97%, respectively. Conclusions: The presence of SL warrants clinical surveillance and repeat sampling because it is followed by endometrioid neoplasia in a significant subset of patients. Normal three‐marker staining identifies women with a very low risk of neoplastic outcome. Conversely, abnormal staining is frequent in SL with benign outcome leading to poor specificity and positive predictive value. [ABSTRACT FROM AUTHOR]

Duodenal ulcer (DU) causes various symptoms in children. The prevalence of Helicobacter pylori (Hp)-associated DU has been reducing in some regions, yet the updated trend in Taiwan is unknown. Risk factors of DU recurrence have not been comprehensively investigated in children. This retrospective study included children diagnosed with DU to evaluate the demographics, symptoms, diagnostics, treatment, and outcomes. Specific populations (infant, surgery required) were sorted for subgroup analysis. Predictors of DU recurrence was analyzed in patients who received endoscopic follow-ups. A total of 488 children were included. Most patients were male (72.5%), school-aged (11.3 ± 4.8 years old), and with varied underlying diseases in one-fifth. The annual incidences were around 3–5%, with a declining trend of case numbers and the Hp-positive proportion. Hp infection, concurrent gastric ulcer, perforation, and mortality were noted in 32.7%, 16%, 1.6%, and 1% of patients. Patients with or without Hp infection showed different clinical features but similar outcomes. The characteristics of subpopulations were depicted respectively. Male sex, lower Hb level, and perforation were independent risk factors associated with recurrence. Hp-positive DU seems to wane. Patients with male sex, lower Hb level, or perforation at diagnosis carried a higher risk of recurrence, which may warrant active surveillance and endoscopic follow-up. [ABSTRACT FROM AUTHOR]

On August 8 2022, the Federal Bureau of Investigation executed a search warrant at former President Donald Trump's Mar-a-Lago Resort. The search uncovered hundreds of documents bearing various classification and governmental markings. On June 8, 2023, Trump was indicted in the Southern District of Florida on thirty-seven counts of unlawful retention of national defense information. Almost immediately after the search, the former President and his allies advanced a theory that Trump's retention of classified documents was permissible because he had declassified the documents before leaving office on January 20, 2021. The former President has repeatedly mentioned these arguments in both civil and criminal litigation following the search, but has provided no evidentiary support for his contentions that he declassified the documents. While other aspects of the search warrant and criminal case have been adjudicated by the Eleventh Circuit and Supreme Court, no court has yet addressed the merits of the declassification defense. This note will examine the propriety of former President Trump's claims that he cannot be criminally charged with unlawful retention of national defense information because the information was declassified. First, it will examine the historical and Constitutional background of the executive classification system, including judicial precedents interpreting the scope of the power. Next, it will introduce parallel statutory frameworks that Congress has enacted to criminalize the retention of classified information, automatically classify certain types of information, and establish guidelines for the handling of Presidential records. Considering the concurrent authorities of the Executive and Legislative branches over classified information and government records, the note will then analyze the merits of former President Trump's claimed powers to declassify and retain classified documents as of right. It will conclude that a President does not have the plenary power to declassify all types of classified documents, and that any declassification must comply with established procedures to be effective. Lastly, the note will conclude that based upon publicly available information, former President Trump did not follow any such procedures that would have led to the documents being properly declassified before he left office. [ABSTRACT FROM AUTHOR]

Presumptive drug screening enables timely procurement of search and arrest warrants and represents a crucial first step in crime scene analysis. Screening also reduces the burden on forensic laboratories which often face insurmountable backlogs. In most scenarios, on-site presumptive drug screening relies on chemical field tests for initial identification. However, even when used appropriately, these test kits remain limited to subjective colorimetric analysis, produce false positive or negative results with excessive sample quantities, and are known to cross-react with numerous innocuous substances. Previous efforts to develop microfluidic devices that incorporate these chromogenic indicator reagents address only a few of the many challenges associated with these kits. This is especially true for samples where the drug of interest is present as a lacing agent. This work describes the development of a centrifugal microfluidic device capable of integrating facile sample preparation, by way of a 3D printed snap-on cartridge amenable to microwave assisted extraction, followed by chromatographic separation and chromogenic detection on-disc. As cannabis is among the most widely used controlled substance worldwide, and displays strong interference with these indicator reagents, mock samples of laced marijuana are used for a proof-of-concept demonstration. Post extraction, the microdevice completes high throughput metering just prior to simultaneous reaction with four of the most commonly employed microchemical tests, followed by objective image analysis in CIELAB (a device-independent color model). Separation and recovery of a representative controlled substance with 93% efficiency is achieved. Correct identification, according to hierarchical cluster analysis, of three illicit drugs (e.g., heroin, phencyclidine, and cocaine) in artificially laced samples is also demonstrated on-disc. The cost effective microdevice is capable of complete automation post-extraction, with a total analysis time (including extraction) of <8 min. Finally, sample consumption is minimized, thereby preventing the complete destruction of forensic evidence. [ABSTRACT FROM AUTHOR]

Search warrants, subpoenas, and other forms of compulsory legal process are essential for legal parties to gather evidence. Internet technology companies increasingly control wide-ranging forms of evidence, yet little is known about how these companies fulfill their compulsory legal obligations. This Article presents an original study of internet technology companies as evidence intermediaries: third-party organizations that control access to evidence routinely sought by legal parties. Drawing on in-depth qualitative interviews with companies' legal and compliance staff and with law enforcement agents, I show how company processes for responding to search warrants cannot be neatly categorized within the existing literature's dichotomy of cooperation or resistance. Rather, the responses consist of makeshift measures that companies have developed to manage predicaments arising from the imprecise or impracticable wording of warrants. These measures can affect the evidence that is ultimately available for use in legal proceedings. They can also untether the scope of searches--as they are carried out--from the procedures of the Fourth Amendment. This Article contends that, because judicial officers are likely ill-equipped to oversee problematic company practices, a variety of institutional interventions to supplement existing court oversight of search procedure should be considered. [ABSTRACT FROM AUTHOR]

Aims: The aim of this work is to describe opioid initiation and long‐term use after emergency department (ED) visits or hospitalizations in New South Wales, Australia, by patient, admission and clinical characteristics. Methods: This is a population‐based cohort study, including all hospitalizations and ED visits between 2014 and 2020, linked to medicine dispensings, deaths and cancer registrations (Medicines Intelligence Data Platform), among adults with no opioid dispensings in the previous year. Outcome measures were opioid initiations (dispensed within 7 days of discharge) and long‐term use (90 days of continuous exposure, 90–270 days after initiation). Results: The cohort included 16 153 096 admissions by 4.2 million opioid‐naïve adults; 39.0% were ED presentations without hospital admission, 16.8% hospital admissions via ED and 44.2% direct hospital admissions. Opioids were initiated post‐discharge for 6.2% of ED, 8.3% of hospital via ED and 10.0% of direct hospital admissions; of these 1.0%, 2.5% and 0.5% progressed to long‐term opioid use, respectively. Initiation was lowest in obstetric admissions without surgery (1.0%), and highest among trauma admissions (25.4%), obstetric admissions with surgical intervention (19.8%) and non‐trauma surgical admissions (12.0%). Long‐term use was highest among medical admissions via ED (3.5%), trauma admissions (2.3%) and ED alone (1.0%). From 2014 to 2020, overall opioid initiations decreased 16% from 8.7% to 7.2%, and long‐term opioid use decreased 33% from 1.3% to 0.8%. Conclusions: Both opioid initiation and long‐term use decreased over time; however, the higher rates of long‐term use following trauma, and medical admissions via ED, warrant further surveillance. Strategies supporting appropriate prescribing and access to multidisciplinary pain services will facilitate best practice care. [ABSTRACT FROM AUTHOR]

U.S. law enforcement agencies are increasingly relying on advanced mobile device forensic tools (MDFTs) when conducting digital searches of cellphones and other devices. MDFTs are powerful tools built and sold by third-party vendors, which allow law enforcement to (a) circumvent security features to access locked cellphones, (b) access data stored on the device, cloud-based backups, and online accounts, and (c) utilize enhanced cellphone data analytics, sorting, and querying capabilities. Although some 2,000 law enforcement agencies in almost every U.S. state are using MDFTs, there is little public transparency into the technology. This is particularly concerning considering police often use MDFTs in consent searches, even if the person subject to the search is unaware that the tool enables police to conduct a full download ("extraction") of the data on their device for subsequent parsing. Even with a warrant, as the U.S. Supreme Court's ruling in Riley intended to require absent an exigency, lower courts' unpredictable application of the plain view doctrine in digital search cases can and indeed has permitted authorities to "rummage" through a mobile device until evidence of some crime is discovered. Even in the rare instances where courts have deemed cellphone warrants illegally overbroad, they have been quick to apply the good faith exception to the exclusionary rule, removing any incentive for police to narrow the scope of future affidavits. The broad, unchecked digital searches enabled by MDFTs are even more concerning today as many states criminalize abortions or restrict access to gender-affirming medical care, among other repressive laws. This Note analyzes existing case law related to digital searches of hard drives and cellphones, to pinpoint the primary legal and policy problems with MDFT use: a lack of transparency, insufficiently informed consent searches, insufficiently scoped search warrants, and inadequate auditing and record-keeping. Further, this Note discusses an aspect overlooked in the current literature--that MDFTs, if used with the appropriate restrictions in place, could help limit rather than expand the scope of cellphone searches. Machine learning algorithms enable features that can auto-detect certain images and text, allowing officers to view only material flagged within the scope of their search. Similarly, MDFTs can generate audit reports allowing greater transparency into and repeatability of searches, allowing courts and defense attorneys to verify that a cellphone search stayed within lawful scope. Finally, because using MDFTs in these beneficial ways won't happen organically, the Note concludes by proposing enforcement of such requirements through a federal statute that would require (1) restricting consent searches, the plain view exception, and types of crimes for which MDFT-enabled searches are allowed; (2) more narrowly scoped search warrants; and (3) record-keeping and reporting requirements to increase transparency and accountability. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to identify impediments, discuss impediments and make recommendations for the impediments during the execution of a search and seizure warrant for digital evidence in South African criminal cases. Design/methodology/approach: The discussion of this article, the second article of two, focuses on a literature review of international and local impediments identified in case law and published research literature and how it is approached in various jurisdictions. Findings: This study found that impediments identified and addressed internationally during the execution of a search and seizure warrant for digital evidence are relevant to South African criminal cases and still need to be addressed during the execution of a search and seizure warrant for digital evidence in South African criminal cases. Research limitations/implications: Although searches and seizures for digital evidence are relevant to civil, regulatory and criminal investigations, this study focuses on the search and seizure for digital evidence in criminal matters with an emphasis on the provisions of the Criminal Procedure Act 51 of 1977 and the Cybercrimes Act 19 of 2020. Originality/value: The originality of this paper lies in the procedures followed during the physical search and seizure of digital information during the execution of search and seizure warrants for digital information in South Africa. If the South African Police Service follows the recommended procedures, it will contribute to the success of the South African Police Service, which would result in the improved quality of investigations and successful prosecution of crime in South Africa. [ABSTRACT FROM AUTHOR]

It is indicated that in the early days of June 2024, the judges of the Supreme Court appealed to the members of the Scientific Advisory Council with a request to provide scientific conclusions regarding case No. 466/525/22 (the case concerned the application of the provisions of Part 3 of Article 233 of the Criminal Procedure Code). It emerged from the appeal that the criminal proceedings based on the cassation appeal of the prosecutor against the decision of the Lviv Court of Appeals dated Octobe 2, 2023 were referred to the joint chamber of the Criminal Court of Cassation as part of the Supreme Court. In this scientific publication, the authors attempted to examine the situation that arises during searches in emergency cases within the framework of the problem of prioritizing the protection of human rights. It is argued that given the legal nature and content of the above constitutional provisions, it should be concluded that part three of Article 30 of the Basic Law of Ukraine should be interpreted as a direct effect provision. This means that it prevents a participant in criminal proceedings on the side of the prosecution (prosecutor, investigator, inquirer) from making a decision to enter a person's home or other property unless the case is urgent and the purpose does not comply with the provisions of the said provision of the Constitution of Ukraine, taking into account an individual assessment of the circumstances of a particular case. It is summarized that in the absence of a clear definition of the term «urgent» in the criminal procedure legislation, it is advisable to apply the principle of in dubio pro tributario (priority with the most favorable interpretation of the rule of law)). Given that we are talking about an exceptional case of restriction of the constitutional right to inviolability of the home outside of judicial control, it is important to apply a literal (not extended) interpretation of the content of part three of Article 30 of the Constitution of Ukraine. Therefore, the authorized participants in criminal proceedings, when deciding on an urgent search, are obliged to find out whether the delay during the reasonably foreseeable time required to apply to the investigating judge, obtain a search warrant and conduct it in the normal course of events will inevitably lead to the consequences provided for in Article 30 of the Constitution of Ukraine; what specific circumstances of the case indicate the urgency of the entry into the home or other property, which must be in direct causal connection with the loss (destruction, etc.) of property. [ABSTRACT FROM AUTHOR]

Today, the Fourth Amendment Warrant Clause governs arrest warrants and search warrants only. But in the founding era, the Warrant Clause governed a third type of warrant: the "warrant of commitment." Judges issued these warrants to jail defendants pending trial. This Article argues that the Fourth Amendment Warrant Clause, with its oath and probable cause standard, should be understood today to apply to this third type of warrant. That means the Warrant Clause would govern any initial appearance where a judge first commits a defendant--a process that currently falls far short of fulfilling its constitutional and historical function. History supports this understanding. For example, in two Supreme Court cases in 1806 and 1807, lawyers and the Justices applied, either expressly or implicitly, the Fourth Amendment Warrant Clause to the warrant of commitment. Moreover, Chief Justice Marshall did so expressly in a different case, riding circuit, in 1807. Leading lawyers of that era, as well as nineteenth-century treatises, likewise understood that the Warrant Clause applied to the commitment warrant separate from any arrest warrant. The commitment warrant, often called a mittimus, therefore required its own probable cause supported by oath or affirmation. Remarkably, this history has largely been lost. Neither courts nor scholars today recognize that the Fourth Amendment applies to this third, important type of warrant--even though judges still use such warrants to commit. But applying the Warrant Clause directly to commitment warrants would restore to defendants some of the surprisingly robust pretrial rights they enjoyed in the founding era and help reduce the mass incarceration of defendants pending trial. [ABSTRACT FROM AUTHOR]

Background The incidence of colonic adenomas and colorectal cancer has been on the rise among young patients. In this study, we aimed to describe the characteristics of young patients (<50 years) with adenomatous polyps and to characterize those polyps. We also aimed to determine appropriate surveillance intervals for young patients. Methods We performed a retrospective chart review of patients <50 years of age who had polypectomy of 1 or more adenomatous polyps on colonoscopy between 2008 and 2021. Patient demographics, colonoscopy indication and polyp characteristics were obtained from the chart. Timing and findings on surveillance colonoscopies were recorded. Results A total of 610 patients were included: mean age 42.9±5.9 years, 61% males, body mass index 27.5±4.7 kg/m², and over 50% smokers. The most common indications were abdominal pain (23.3%), rectal bleeding (22.3%), and change in bowel habits (17.6%). Almost half of the patients who had adenomas (299) were younger than 45 years. Tubular adenoma was the most frequently encountered type of polyp (571; 93.6%). Mean polyp size was 1.1±0.9 cm. The most common location of adenomas was the sigmoid colon (41%). Of patients with adenomas, 156 (26%) had surveillance colonoscopy within 2.9±2.3 years; 74 patients (47.4%) were found to have new adenomas. Conclusions Patients aged <50 years with colonic adenomas were mostly males, overweight, and smokers. Further adenomas were found in 47% of surveillance colonoscopies, and most were encountered within 5 years. High rates of recurrent adenomas in people ˂50 years of age may warrant frequent surveillance. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to identify and discuss impediments in the compilation of an application for a search and seizure warrant for digital evidence and the structure of such a warrant in South African criminal cases. Design/methodology/approach: This paper provides a brief overview of international and local impediments, followed by a detailed discussion of the implications of these impediments and how it is approached in various jurisdictions. The methodology of this paper consists of a literature review. Findings: Addressing the impediments in the compilation of the application and the warrant will be beneficial for forensic investigators, the South African Police Service (SAPS) and the administration of justice in South Africa. Research limitations/implications: Search and seizures for digital evidence form part of civil, regulatory and criminal search and seizures. This study focuses on the search and seizure of digital evidence in criminal matters pursuant to mainly the provisions of the Criminal Procedure Act 51 of 1977 and the Cybercrimes Act 19 of 2020. Originality/value: The originality of this paper lies in the approach to the drafting of applications for search and seizure warrants for digital information in South Africa. The contribution of the study is that, by using this approach, the SAPS can address the impediments during the application and compilation of the warrants, which would enhance the quality of investigations and contribute to the successful investigation and prosecution of crime in South Africa. [ABSTRACT FROM AUTHOR]

Triple-negative breast cancer (TNBC) patients are more likely to have BRCA1/2 mutations, with a prevalence rate of about 10–20%. Although several studies have analyzed the oncologic outcomes between BRCA1/2 carriers and non-carriers, the impact on breast cancer patients is still unclear. A retrospective review was performed to determine the long-term outcomes of TNBC patients, focusing on the impact of BRCA1/2 mutations. A total of 953 TNBC patients who underwent primary breast cancer surgery from June 2008 to January 2016 were included. We examined long-term outcomes, including contralateral breast cancer (CBC) incidence, recurrence patterns, and survival rates over a median follow-up of 80.9 months (range 3–152 months). 122 patients (12.8%) had BRCA1/2 mutations. BRCA1/2 mutation carriers were significantly younger at diagnosis and more likely to have a family history of breast/ovarian cancer. CBC incidence at 60, 120, and 150 months was significantly higher in BRCA1/2 mutation carriers compared to non-carriers (P = 0.0250, 0.0063, and 0.0184, respectively). However, there were no significant differences in disease-free survival, overall survival, breast cancer-specific survival, or distant-metastasis-free survival between the two groups. BRCA1/2 mutation status was a significant risk factor for CBC (HR = 6.242, P < 0.0001). Interestingly, among 29 patients with CBC recurrence, 24 patients (82.8%) had recurring TNBC subtype and among the CBC recurrence patients, 19 patients (65.5%) resumed chemotherapy. In the TNBC subtype, appropriate genetic testing and counseling are pivotal for surgical decisions like risk-reducing mastectomy (RRM). Furthermore, long-term surveillance is warranted, especially in BRCA1/2 carriers who did not receive RRM. [ABSTRACT FROM AUTHOR]

Background: Cluster headache (CH) is a debilitating condition, but current therapies leave CH patients in pain. The extent of this problem in Sweden is unknown. Methods: An anonymized questionnaire was sent to 479 Swedish CH patients to investigate patterns and perceived effects of treatments. Results: Three hundred fourteen answers were analyzed. The population was representative regarding age of onset and sex. Less than half (46%) were satisfied with their abortive treatments, 19% terminated functioning abortive treatments due to side effects. Additionally, 17% of chronic CH patients had not tried the first-line preventive drug verapamil. A small subset had tried illicit substances to treat their CH (0–8% depending on substance). Notably, psilocybin was reported effective as an abortive treatment by 100% (n = 8), and with some level of effect as a preventive treatment by 92% (n = 12). For verapamil, some level of preventive effect was reported among 68% (n = 85). Conclusions: Our descriptive data illustrate that many Swedish CH patients are undertreated, lack functional therapies, and experience side effects. Further studies are warranted to search for new treatment strategies as well as a revision of current treatment guidelines with the aim of reducing patient disease burden to the greatest extent possible. [ABSTRACT FROM AUTHOR]

Academic literature in England and Wales and New Zealand does not consider the protection of legal professional privilege where digital material is seized under a search warrant. Academic literature in the United States does engage with this subject but is not informed by a comparative approach. This article fills both gaps. It examines practices that have been developed by investigative teams and prosecuting authorities in all three comparator jurisdictions in their attempts to provide safeguards necessary to preserve privilege. Such practices involve the use of technology to increase the speed, cost effectiveness and/or efficiency of identifying privileged documents. The process of developing these practices has been informed by judicial guidance, where they have been challenged before the courts, and by guidance from government departments, Bar Associations or Law Commissions. Following comparative analysis, the article recommends measures that should be included in legislation, codes of practice or guidance in any jurisdictions where there is potential for legal professional privilege or an equivalent concept to be undermined when digital material is seized under a search warrant. [ABSTRACT FROM AUTHOR]

That Loch Ness Monsters, "Nessies", might exist has been argued by many people on the basis of films, sonar contacts, photos, and eyewitness accounts. At the same time, some observers have insisted that these are not real creatures, nothing but misperceptions of natural phenomena or known animals. Their arguments typically address the weakest evidence (eyewitness accounts) rather than the strongest objective evidence of sonar and film. Such evasion or avoidance constitutes a strategy of misdirection, as does the insistence that, since Nessies are not recognized by "science," therefore taking their possible existence seriously amounts to doing pseudo-science. Debunkers are arguably irrational and go beyond the evidence in declaring that Nessies are definitely non-existent. Although Nessie fans do believe that they exist, most will admit that final proof requires a specimen or detailed close-up of unequivocally valid photography and insist only that enough evidence exists to warrant further searches: that is not pseudo-science. [ABSTRACT FROM AUTHOR]

Human alveolar echinococcosis is increasingly documented in Alberta, Canada. Its causative agent, Echinococcus multilocularis (Em), can be transmitted to humans by infected dogs. We assessed the prevalence and associated risk factors for Em infections in domestic dogs in Calgary, Alberta, Canada. In this cross-sectional study that coupled collection and assessment of dog feces with a survey on potential risk factors, 13 of 696 (Bayesian true prevalence, 2.4%; 95% CrI: 1.3–4.0%) individual dogs' feces collected during August and September 2012 were qPCR positive for Em. Sequencing two of these cases indicated that both were from the same Em European strain responsible for human infections in Alberta. Likelihood of intestinal Em was 5.6-times higher in hounds than other breeds, 4.6-times higher in dogs leashed at dog parks than those allowed off-leash, 3.1-times higher in dogs often kept in the backyard during spring and summer months than those rarely in the yard, and 3.3-times higher in dogs living in neighbourhoods bordering Bowmont park than those in other areas of Calgary. This situation warrants surveillance of dog infections as a preventative measure to reduce infections in North America. [ABSTRACT FROM AUTHOR]

Background and Aim: Patients with inflammatory bowel disease have an increased risk of developing colorectal cancer as compared with the general population. Endoscopic surveillance to detect early dysplastic changes is advised by several published clinical guidelines, which provide recommendations as to the timing and performance of surveillance procedures. There is a paucity of data as to adherence with these guidelines in clinical practice. Methods: A longitudinal inception cohort study of all new patients diagnosed with inflammatory bowel disease across a service network of Australian hospitals between January 2005 and June 2014, with continuous follow‐up in a gastroenterology clinic until December 31, 2022. Patients were included if they warranted surveillance according to the Australian guidelines. Adherence to guidelines and technical and quality measures were reported. Results: A total of 136 patients were included, and a total of 263 surveillance procedures were performed. Ninety‐five patients (70%) had their first surveillance colonoscopy within the correct time interval. Fifty patients (37%) were completely adherent to guidelines with respect to timing of all surveillance procedure. The overall dysplasia detection rate for surveillance procedures was 10%. Chromoendoscopy was only performed in 16% of procedures. Conclusions: Adherence to endoscopic surveillance guidelines with regard to timing of procedures and the utilization of chromoendoscopy is poor. Further clinician education, promotion of the surveillance guidelines and incorporation of chromoendoscopy training as part of the national colonoscopy training program may improve adherence to guidelines. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hepatitis B virus (HBV) genotypes (A–H) have a distinct geographic distribution and are highly associated with the country of birth. Canada has experienced increased immigration over the past decade, primarily from regions where HBV is endemic. This study investigated the proportions and trends of HBV genotypes within blood donor and clinical populations of Canada over the period 2016–2021. Materials and Methods: Study samples involved two cohorts: (1) Canadian blood donors (n = 246) deferred from donation due to HBV test positivity and (2) chronic HBV patients from across Canada (clinically referred population, n = 3539). Plasma or serum was extracted, and the surface antigen and/or polymerase‐coding region was amplified and sequenced to determine genotype by phylogenetic analysis. Results: Six (A–E, G) and eight (A–H) HBV genotypes were detected among deferred blood donors and the clinically referred population, respectively. Differences in HBV genotype proportions between the two cohorts were observed across Canada. Males comprised most of the referred population among genotypes A–E (p < 0.0001), except for genotypes B and C. The median age was younger among blood donors (36 years [range 17–72]) compared with the referred population (41 years [range 0–99]). Distinct trends of increasing (E, referred; B, blood donor) and decreasing genotype prevalence were observed over the study period. Conclusion: HBV genotypes in Canada are highly diverse, suggesting a large immigrant population. Observed trends in genotype prevalence and proportional differences among cohorts imply shifts among the HBV‐infected population of Canada, which warrants continued surveillance. [ABSTRACT FROM AUTHOR]

Background: Leprosy remains a significant public health concern in many regions, including India, with multibacillary forms posing unique challenges in diagnosis and management. This study aimed to comprehensively assess the spectrum of disease in multibacillary leprosy patients at a tertiary care center in Chennai. Methods: A prospective study was conducted over one and a half years, involving 38 newly diagnosed and untreated multibacillary leprosy patients. Clinical, bacteriological, and treatment response parameters were evaluated using standardized methods. Statistical analysis was performed using SPSS version 26. Results: The study analyzed 38 multibacillary leprosy patients. The study cohort exhibited a mean age of 40.2 years, with a notable male predominance (79%) aged 30-39. Coolies (28.9%) were the most affected occupation group. Borderline lepromatous leprosy (66%) was prevalent. Clinical assessments showed trophic ulcers (13%) and grade 2 deformities like claw hand (5.3%) and lagophthalmos (2.6%). Bacteriological evaluation post-MDT revealed significant BI reduction at 6 months (p < 0.001). While most patients attained negative smears, some remained positive at 12 months, warranting continued surveillance for sustained clearance. Conclusion: This study provides comprehensive insights into the epidemiological, clinical, and bacteriological characteristics of multibacillary leprosy, highlighting the efficacy of multidrug therapy in achieving favorable treatment outcomes. [ABSTRACT FROM AUTHOR]

There is a lack of large-scale data on outcomes of cirrhotic patients undergoing trauma laparotomy. We aimed to compare outcomes of cirrhotic versus noncirrhotic trauma patients undergoing laparotomy. We analyzed 2018 American College of Surgeons Trauma Quality Improvement Program. We included blunt trauma patients (≥18 y) who underwent a laparotomy. Patients who were transferred, dead on arrival, or had penetrating injuries were excluded. Patients were matched in a 1:2 ratio (cirrhotic and noncirrhotic). Outcomes included mortality, complications, failure to rescue, transfusion requirements, and hospital and intensive care unit (ICU) lengths of stay. Multivariable backward stepwise regression analysis was performed. Four hundred and seventy-one patients (cirrhotic, 157; noncirrhotic, 314) were matched. Mean age was 57 ± 15 y, 78% were male, and median injury severity score was 24. Cirrhotic patients had higher rates of mortality (60% versus 30%, P value <0.001), complications (49% versus 37%; P value = 0.01), failure to rescue (66% versus 36%, P value<0.001), and pRBC (units, median, 11 [7-18] versus 7 [4-11], P value <0.001) transfusion requirements. There were no significant differences in hospital and intensive care unit (ICU) lengths of stay (P value ≥0.05). On multivariate analysis, increasing age (adjusted odds ratio [aOR] 1.02, P value <0.001), Glasgow Coma Scale score ≤8 at presentation (aOR 3.3, P value <0.001), and total splenectomy (aOR 5.7, P value <0.001) were associated with higher odds of mortality. Platelet transfusion was associated with lower odds of mortality (aOR 0.84, P value = 0.044). On a national scale, mortality following trauma laparotomy is twice as high for cirrhotic patients compared to noncirrhotic patients with higher rates of major complications and failure to rescue. Our finding of a protective effect of platelet transfusion may be explained by the platelet dysfunction associated with cirrhosis. Liver cirrhosis among trauma patients warrants heightened surveillance. [ABSTRACT FROM AUTHOR]

Background: Rapid diagnostic tests (RDTs) that detect Plasmodium falciparum histidine-rich protein-2 (PfHRP2) are exclusively deployed in Uganda, but deletion of the pfhrp2/3 target gene threatens their usefulness as malaria diagnosis and surveillance tools. Methods: A cross-sectional survey was conducted at 40 sites across four regions of Uganda in Acholi, Lango, W. Nile and Karamoja from March 2021 to June 2023. Symptomatic malaria suspected patients were recruited and screened with both HRP2 and pan lactate dehydrogenase (pLDH) detecting RDTs. Dried blood spots (DBS) were collected from all patients and a random subset were used for genomic analysis to confirm parasite species and pfhrp2 and pfhrp3 gene status. Plasmodium species was determined using a conventional multiplex PCR while pfhrp2 and pfhrp3 gene deletions were determined using a real-time multiplex qPCR. Expression of the HRP2 protein antigen in a subset of samples was further assessed using a ELISA. Results: Out of 2435 symptomatic patients tested for malaria, 1504 (61.8%) were positive on pLDH RDT. Overall, qPCR confirmed single pfhrp2 gene deletion in 1 out of 416 (0.2%) randomly selected samples that were confirmed of P. falciparum mono-infections. Conclusion: These findings show limited threat of pfhrp2/3 gene deletions in the survey areas suggesting that HRP2 RDTs are still useful diagnostic tools for surveillance and diagnosis of P. falciparum malaria infections in symptomatic patients in this setting. Periodic genomic surveillance is warranted to monitor the frequency and trend of gene deletions and its effect on RDTs. [ABSTRACT FROM AUTHOR]

Background Because of increased access to kidney transplantation in elderly subjects, the prevalence of monoclonal gammopathies of unknown significance (MGUS) in kidney transplantation (KT) is growing. However, little is known about the consequences of MGUS on long-term outcomes. Methods We identified 70 recipients with MGUS present at transplantation (KTMG) and 114 patients with MGUS occurring after KT (DNMG), among 3059 patients who underwent a KT in two French kidney transplantation centers. We compared outcomes of KTMG with those of matched controls. Results Baseline characteristics were similar except for an older age in KTMG compared with the DNMG group (62 vs 57 years, P  = .03). Transient MGUS occurred more frequently in DNMG patients (45% vs 24%, P  = .007). When compared with matched controls without MGUS, KTMG patients showed higher frequency and earlier post-transplant solid cancers (15% vs 5%, P  = .04) and a trend for more bacterial infections (63% vs 48%, P  = .08), without difference regarding patient and graft survival, rejection episodes or hematological complications. KTMG patients with an abnormal kappa/lambda ratio and/or severe hypogammaglobulinemia at the time of KT experienced shorter overall survival. Conclusions MGUS detection at the time of KT is neither associated with a higher occurrence of graft rejection, nor adversely affects graft or overall survival. MGUS should not contraindicate KT. However, MGUS at the time of KT may be associated with higher risk of early neoplastic and infectious complications and warrants prolonged surveillance. Measurement of serum free light chain should be performed before transplant to refine the risk evaluation of KTMG patients and propose personalized follow-up and immunosuppression. [ABSTRACT FROM AUTHOR]

Introduction: Medicinal cannabis is now legal in 44 US jurisdictions. Between 2020 and 2021 alone, four US jurisdictions legalised medicinal cannabis. The aim of this study is to identify themes in medicinal cannabis tweets from US jurisdictions with different legal statuses of cannabis from January to June 2021. Methods: A total of 25,099 historical tweets from 51 US jurisdictions were collected using Python. Content analysis was performed on a random sample of tweets accounting for the population size of each US jurisdictions (n = 750). Results were presented separately by tweets posted from jurisdictions where all cannabis use (non‐medicinal and medicinal) is 'fully legalised', 'illegal' and legal for 'medical‐only' use. Results: Four themes were identified: 'Policy', 'Therapeutic value', 'Sales and industry opportunities' and 'Adverse effects'. Most of the tweets were posted by the public. The most common theme was related to 'Policy' (32.5%–61.5% of the tweets). Tweets on 'Therapeutic value' were prevalent in all jurisdictions and accounted for 23.8%–32.1% of the tweets. Sales and promotional activities were prominent even in illegal jurisdictions (12.1%–26.5% of the tweets). Fewer than 10% of tweets were about intoxication and withdrawal symptoms. Discussion and Conclusion: This study has explored if content themes of medicinal cannabis tweets differed by cannabis legal status. Most tweets were pro‐cannabis and they were related to policy, therapeutic value, and sales and industry opportunities. Tweets on unsubstantiated health claims, adverse effects and crime warrants continued surveillance as these conversations could allow us to estimate cannabis‐related harms to inform health surveillance. [ABSTRACT FROM AUTHOR]

The article discusses the powers and duties of fish and wildlife conservation officers in different U.S. states and at the federal level and their possible ramifications on the Fourth Amendment of the Constitution. Other topics include probable cause and search warrants during search activities of said officers and the exceptions and limitations to probable cause requirement for such searches.

Cutaneous T cell lymphoma (CTCL) is a varied group of neoplasms that affects the skin. Acquired resistance against chemotherapeutic drugs and associated toxic side effects are limitations that warrant search for novel drugs against CTCL. Embelin (EMB) is a naturally occurring benzoquinone derivative that has gained attention owing to its anticancer pharmacological actions and nontoxic nature. We assessed the anticancer activity of EMB against CTCL cell lines, HuT78, and H9. EMB inhibited viability of CTCL cells in a dose-dependent manner. EMB activated extrinsic and intrinsic pathways of apoptosis as shown by the activation of initiator and executioner caspases. EMB-induced apoptosis also involved suppression of inhibitors of apoptosis, XIAP, cIAP1, and cIAP2. PARP cleavage and upregulation of pH2AX indicated DNA damage induced by EMB. In conclusion, we characterized a novel apoptosis-inducing activity of EMB against CTCL cells, implicating EMB as a potential therapeutic agent against CTCL. [ABSTRACT FROM AUTHOR]

Sister Mary Joseph's nodule is an umbilical nodule found in patients with metastatic abdominal cancers. It is quite rare finding and needs a high index of suspicion for diagnosis. Detection of Sister Mary Joseph's nodule should warrant widespread search for abdominal carcinoma and it universally carries quite poor clinical prognosis. Here, we describe the case of a 28-year-old patient who presented with Sister Mary Joseph's Nodule and was found to have metastatic signet ring cell gastric carcinoma on investigation. A brief discussion about this rare condition is also presented. [ABSTRACT FROM AUTHOR]

To investigate the association of molecular subtype with progesterone response in patients with endometrial cancer (EC) or atypical endometrial hyperplasia (AEH). Premenopausal patients aged ≤48 years with tumor-normal sequencing data who received progesterone for EC/AEH from 1/1/2010–6/30/2021 were identified. Tumors were classified as POLE -ultramutated, microsatellite instability-high (MSI-H), copy number-high (CN-H), or copy number-low (CN-L) molecular subtype. Best response to progesterone was compared by subtype. Appropriate statistical tests were performed. Of 20 patients, 7 (35%) had AEH and 13 (65%) had EC. Sixteen tumors (80%) were CN-L, 3 (15%) were MSI-H, and 1 (5%) was POLE -ultramutated. Median time on progesterone was 22 months (range, 3–115). Ten patients (50%) had complete response (CR); median time to CR was 9 months (range, 3–32). Four patients (20%) had stable disease (SD) and 6 (30%) had progressive disease (PD). For CN-L tumors, 10 patients (62%) had CR, 3 (19%) had SD, and 3 (19%) had PD. For MSI-H tumors, 1 patient (33%) had SD and 2 (66%) had PD. For POLE -ultramutated tumors, 1 patient had PD. Median follow-up was 48 months (range, 12–123). Four of 10 patients (40%) with CR recurred; median time from CR to recurrence was 16 months (range, 5–102). Molecular subtype may be associated with progesterone response in patients with EC/AEH. CN-L tumors had the best response, and MSI-H tumors had the poorest. Recurrence after CR is common, and close surveillance is warranted. Larger studies investigating the role of molecular classification in medical management of EC/AEH are needed. • In endometrial cancer/atypical endometrial hyperplasia (AEH), molecular subtype may be associated with progesterone response. • Molecular classification may help guide selection for progestin-based treatments in patients with endometrial cancer/AEH. • Response to progestin varied among molecular subtypes of endometrial cancer. • Copy number-low tumors showed the highest response rate to progestin-based treatments. • Close follow-up is warranted for patients with complete response due to high risk of recurrence. [ABSTRACT FROM AUTHOR]

Cervical spine metastasis from primary intracranial solitary fibrous tumors (SFTs) is an extremely rare clinical entity. This report focuses on its metastatic tendency, radiological imaging, management plan, and follow-up strategies in view of its long latency period for metastasis. A 35-year-old female presented with right-side cervical radiculopathy. Magnetic resonance imaging spine showed C7 vertebral body collapse with retropulsion and neural compression. Two years ago, the patient had surgical resection of intracranial SFT (World Health Organization grade 3) with no evidence of recurrence on follow-up imaging. Cervical C7 metastasis has been decompressed and fused by the anterior cervical approach. Histopathology confirmed SFT metastasis to the spine, and the patient received adjuvant radiotherapy. Cervical metastasis from well-controlled primary intracranial SFT poses a significant challenge for its diagnostic and management planning. Serial pre-emptive surveillance is warranted with regular imaging and appropriate patient counseling. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Malignancy is the leading cause of late mortality after orthotopic heart transplantation (OHT), and the burden of post-transplantation cancer is expected to rise in proportion to increased case volume following the 2018 heart allocation score change. In this report, we evaluated factors associated with de novo malignancy after OHT with a focus on skin and solid organ cancers. METHODS Patients who underwent OHT at our institution between 1999 and 2018 were retrospectively reviewed (n  = 488). Terminal outcomes of death and development of skin and/or solid organ malignancy were assessed as competing risks. Fine–Gray subdistribution hazards regression was used to evaluate the association between perioperative patient and donor characteristics and late-term malignancy outcomes. RESULTS By 1, 5 and 10 years, an estimated 2%, 17% and 27% of patients developed skin malignancy, while 1%, 5% and 12% of patients developed solid organ malignancy. On multivariable Fine–Gray regression, age [1.05 (1.03–1.08); P  <   0.001], government payer insurance [1.77 (1.20–2.59); P  =   0.006], family history of malignancy [1.66 (1.15–2.38); P  =   0.007] and metformin use [1.73 (1.15–2.59); P  =   0.008] were associated with increased risk of melanoma and basal or squamous cell carcinoma. Age [1.08 (1.04–1.12); P  <   0.001] and family history of malignancy [2.55 (1.43–4.56); P  =   0.002] were associated with an increased risk of solid organ cancer, most commonly prostate and lung cancer. CONCLUSIONS Vigilant cancer and immunosuppression surveillance is warranted in OHT recipients at late-term follow-up. The cumulative incidence of skin and solid organ malignancies increases temporally after transplantation, and key risk factors for the development of post-OHT malignancy warrant identification and routine monitoring. [ABSTRACT FROM AUTHOR]

Producing or sharing Child Sexual Exploitation Material (CSEM) is a severe crime that Law Enforcement Agencies (LEAs) fight daily. When the LEA seizes a computer from a potential producer or consumer of the CSEM, it analyzes the storage devices of the suspect looking for evidence. Manual inspection of CSEM is time-consuming given the limited time available for Spanish police to use a search warrant. Our approach to speeding up the identification of CSEM-related files is to analyze only the file names and their absolute paths rather than their content. The main challenge lies in handling short and sparse texts that are deliberately distorted by file owners using obfuscated words and user-defined naming patterns. We present two approaches to CSEM identification. The first employs two independent classifiers, one for the file name and the other for the file path, and their outputs are then combined. Conversely, the second approach uses only the file name classifier to iterate over an absolute path. Both operate at the character n-gram level, whereas novel binary and orthographic features are presented to enrich the text representation. We benchmarked six classification models based on machine learning and convolutional neural networks. The proposed classifier has an F1 score of 0.988, which can be a promising tool for LEAs. [ABSTRACT FROM AUTHOR]

The introduction of new materials for the production of various types of constructs that can connect directly to tissues has enabled the development of such fields of science as medicine, tissue, and regenerative engineering. The implementation of these types of materials, called biomaterials, has contributed to a significant improvement in the quality of human life in terms of health. This is due to the constantly growing availability of new implants, prostheses, tools, and surgical equipment, which, thanks to their specific features such as biocompatibility, appropriate mechanical properties, ease of sterilization, and high porosity, ensure an improvement of living. Biodegradation ensures, among other things, the ideal rate of development for regenerated tissue. Current tissue engineering and regenerative medicine strategies aim to restore the function of damaged tissues. The current gold standard is autografts (using the patient's tissue to accelerate healing), but limitations such as limited procurement of certain tissues, long operative time, and donor site morbidity have warranted the search for alternative options. The use of biomaterials for this purpose is an attractive option and the number of biomaterials being developed and tested is growing rapidly. [ABSTRACT FROM AUTHOR]