Ultrasound-guided core biopsy in the diagnosis of parotid neoplasia: an overview and update with a review of the literature

Objective: Accurate diagnosis of parotid neoplasia is a key to determine the most appropriate patient management choice, including the need for surgery. This review provides an update of the literature on current practice and outcomes of parotid tissue sampling techniques, with an emphasis on ultrasound-guided core biopsy (USCB) and comparison with fine needle aspiration cytology (FNAC). Methods: A literature review of EMBASE, Medline, PubMed and Google Scholar was conducted. Results: USCB has higher sensitivity, specificity and lower non-diagnostic rates than optimized FNAC. It also has a significantly higher sensitivity for the detection of malignancy. Significant complications post-USCB are uncommon, with only one reported case of tumour seeding and no cases of permanent facial nerve dysfunction. The technique is less operator-dependent than FNAC, with less reported variation in results between institutions. Conclusions: USCB can be considered as the optimum tool of choice for the diagnosis of parotid neoplasia. This would particularly be the case in centres utilizing FNAC with high non-diagnostic rates or reduced diagnostic accuracy when compared to USCB published data, or in centres establishing a new service. Advances in knowledge: An update of the role and outcomes of USCB in the diagnosis of parotid gland pathologies. Research shows that USCB preforms better than FNAC, in terms of sensitivity and specificity, particularly in the case of malignant neoplasia. Complications following USCB were found to be higher than that of FNAC; however, no long-term major complications following either method have been reported in the literature.

Dairy Buffalo Life Cycle Assessment (LCA) Affected by a Management Choice: The Production of Wheat Crop

Life cycle assessment (LCA) was performed in dairy buffalo farms representative of Southern Italian farming systems, similar due to several characteristics, with the exception of wheat production. This work evaluated the impacts derived from this management choice, comparing farms with wheat crop (WWC) or not (NWC). In agreement with the literature, economic allocation was chosen as a useful strategy to attribute equivalents to by-products, i.e., culled animals; the same criterion was also adopted to assign pollutants to wheat grain, limited to WWC farms. Environmental impacts in terms of Global Warming Potential (GWP, kg CO2 eq), Acidification Potential (AC, g SO2 eq), Eutrophication Potential (EU, g PO43-eq), Agricultural Land Occupation (ALO, m2y) and Water Depletion (WD, m3) were estimated. The production of wheat crop significantly affected (p < 0.05) the Agricultural Land Occupation (ALO) category as WWC farms need adequate land. WWC farms could allow a significant reduction in eutrophication (EU) compared to NWC farms (p < 0.05).

Canadian consensus forum of key controversial areas in the management of advanced prostate cancer

Introduction: Rapid progress in diagnostics and therapeutics for the management of prostate cancer (PCa) have created areas where high-level evidence to guide practice is lacking. The Genitourinary Research Consortium (GURC) conducted its second Canadian consensus forum to address areas of controversy in the management of PCa and provide recommendations to guide treatment. Methods: A panel of PCa specialists discussed topics related to the management of PCa. The core scientific committee finalized the design, questions and the analysis of the consensus results. Attendees then voted to indicate their management choice regarding each statement/topic. Questions for voting were adapted from the 2019 Advanced Prostate Cancer Consensus Conference. The thresholds for agreement were set at ≥ 75% for ‘consensus agreement’, > 50% for “near-consensus”, and ≤ 50% for “no consensus”. Results: The panel was comprised of 29 PCa experts including urologists (n=12), medical oncologists (n= 12), and radiation oncologists (n= 5). Voting took place for 65 pre-determined questions and three ad hoc questions. Consensus was reached for 34 questions, spanning a variety of areas including biochemical recurrence, treatment of metastatic castration-sensitive PCa, management of non-metastatic and metastatic castration-resistant PCa, bone health, and molecular profiling. Conclusions: The consensus forum identified areas of consensus or near-consensus in more than half of the questions discussed. Areas of consensus typically aligned with available evidence, and areas of variability may indicate a lack of high-quality evidence and point to future opportunities for further research and education.

Management Trend and Attitude Regarding Osteoporotic Vertebral Compression Fracture: A Comparative Study Between Surgeons and Internists

Background: Osteoporotic vertebral compression fracture (OVCF) is the most common form of osteoporotic fracture, both surgeons and internists included in the management of that. This study aimed to identify whether a discrepancy exists between spinal surgeons and internists in the diagnosis and management of OVCF.Method: This comparative study included 124 spinal surgeons and 47 internists in the WeChat group of the Society of Osteoporosis and Bone Mineral Research. They were sent a self-administered electronic questionnaire that asked about practice pattern, diagnosis trend, and management choice in OVCF management. The validity of the survey was examined in advance.Results: A significantly higher percentage of surgeons obtained T2-weighted images scan with fat suppression than internists. A significantly higher proportion of spinal surgeons provided surgical treatment as first-line treatment and considered fracture as the most important aspect in OVCF management than internist. No significant difference was observed in the use of dual-energy X-ray absorptiometry scan, in performing laboratory examination, or in the collaboration rate between the two groups.Conclusion: Differences exist between internists and spinal surgeons in imaging diagnosis, choice of therapeutic schedule, and attitude to osteoporosis treatment in the management of OVCF.

CRISIS AND DISASTER MANAGEMENT CHOICE STRATEGY

Predicting the occurrence of a crisis is indeed difficult, where insensitivity picks up signals from existingsymptoms, causing it to only realize when the crisis situation. If you are not able to handle it will have badconsequences, and even the impact can not be predicted when it ends. Therefore, optimal efforts to reduce risksand uncertainties are carried out during a crisis, so that crisis management is needed to quickly return to normal.Risk conditions are conditions that have an impact on a situation such that it can cause a crisis or even a disaster.Crisis is a situation of very high potential towards disaster in a short span of time. While disasters are events thatthreaten and disrupt life and livelihoods caused by natural factors and / or factors not natural or human factors,causing casualties, environmental damage, property losses, and psychological impacts. So, crises and disastersrequire proper management. Accordingly, comparative advantage as a strategy can be a choice for crisis anddisaster management.

Nonsurgical Management of an Exposed Deep Brain Stimulation Lead

Erosion of the skin overlying a deep brain stimulator (DBS) lead can occur in between 1 and 10% of cases. This complication increases the risk for subsequent infection, and full explantation of the lead is almost always necessary. In some specific cases, however, nonoperative management may be possible. This chapter describes a case of a patient with Parkinson disease (PD) and implantation of bilateral subthalamic nuclei (STN) DBS leads with a complicated postoperative course, requiring lead revision and extensive reprogramming to achieve therapeutic benefit. The patient later developed a skin erosion and eventual exposure of his brain lead, which recurred after skin graft placement. Because of the sterile appearance of his erosion and his willingness to be closely monitored, he was managed nonsurgically with only topical antibiotics. After 3 years of DBS therapy with an exposed lead, the erosion site became infected, requiring surgical movement of the system, but the patient experienced improved quality of life with DBS up until this point in time. Temporary nonoperative management of some low-infection-risk chronic lead erosions may be well-tolerated and allow for continued benefit from DBS. This conservative and controversial management choice may be helpful in rare cases in which a patient is benefiting greatly from DBS and would not be considered a candidate for DBS reimplantation.

Beating the Record: 157 Days of Delayed Delivery of The Second Fetus in a Twin Pregnancy

Case Report: We present the case of a diamniotic-dichorionic twin pregnancy of 14+4 weeks with obstetric history of cervical incompetence. The premature delivery of the first twin took place, with unfortunate outcome. The second twin was left in utero. The management, at first, included combination of expectant attitude with a close monitoring of maternal constants and analysis, and administration of antibiotics; in a second step, after discarding intraamniotic infection, a McDonald cerclage was performed with success. At 37 weeks the cerclage was removed and after Oxytocin induction, a healthy baby was born. Conclusion: Delayed delivery of the second fetus in a twin pregnancy is an effective management choice. The use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. The behaviour in these unusual cases should be assessed individually, due to the scarce literature on the matter and the lack of unanimous protocols. But, always considering the maternal and fetal status, trying to improve perinatal results with a strict maternal surveillance to discard the appearance of a possible intraamniotic infection.

Presentation and Communication of Financial Information for Investment Decision: Synthesis of the Literature

The focus of investment failure is seen as consequential to investors’ irrational decision. Capital structure and classical theories, by literature, informed the investor in making their portfolio choices. Currently behavioural finance positslack of cognitive and psychological capacity of the investor in the use of complex information to make a rational investment decision. The rationality of information, how presented and communicated by management is not on the radar of experts and analysts. Literature is reviewed, addressing the presentation and communication of financial information in proactive market orientation for rational investment decision.The studyposits the relevance of communicating financial information in proactive market orientation as againstthe linearone‐step modelapproach. Management should be responsible for any investment and corporate failure dependent on relevant financial information and how rationally communicated. Capital structure is a response of investors to management behaviour and not management choice.