/library/oar/handle/123456789/144 2026-05-26T07:51:42Z /library/oar/handle/123456789/146720 Title: Prescribing patterns and clinician preferences for direct oral anticoagulant use in unusual site venous thromboembolism : a cross-sectional analysis from the Direct oral anticoagulants in Unusual Site venous Thromboembolism (DUST) study Authors: Riva, Nicoletta; Bertoletti, Laurent; Chistolini, Antonio; De Stefano, Valerio; Barbar, Sofia; Donadini, Marco Paolo; Sartori, Maria Teresa; Couturaud, Francis; Sartori, Michelangelo; Gatt, Alexander; Cohen, Omri; Fantoni, Chiara; Kaatz, Scott; Mavri, Alenka; Mahé, Isabelle; Catella, Judith; Ruiz-Artacho, Pedro; Ghigliotti, Giorgio; Jara-Palomares, Luis; Podda, Gian Marco; Squizzato, Alessandro; Rojnuckarin, Ponlapat; Leentjens, Jenneke; Sevestre, Marie Antoinette; Ageno, Walter Abstract: Background: Unusual site venous thromboembolism (USVTE) presents therapeutic challenges. Direct oral anticoagulants (DOACs) are increasingly prescribed despite limited evidence from clinical trials. Objectives: This cross-sectional analysis aimed to describe DOAC prescription patterns and rationale for choosing DOACs for USVTE treatment in real-life clinical practice. Methods: The Direct oral anticoagulants in Unusual Site venous Thromboembolism study (NCT03778502) is an international, multicenter, prospective, observational registry. Adult patients with objectively diagnosed USVTE (years 2018-2023) treated with DOACs were included. ¸£ÀûÔÚÏßÃâ·Ñ was collected on patient characteristics, USVTE location, anticoagulant treatment, and rationale for starting DOACs. Results: In total, 349 patients were included from 23 centers in 9 countries. The most common USVTE were splanchnic vein thrombosis (n = 219, 62.8%) and cerebral vein thrombosis (n = 103, 29.5%). The most prescribed DOACs were apixaban (n = 186, 53.3%) and rivaroxaban (n = 101, 28.9%). The median delay between USVTE diagnosis and DOAC initiation was 24 days, with 219 patients (62.8%) starting DOACs >14 days after diagnosis. Indeed, 320 (91.7%) patients received other anticoagulants before switching to DOACs (mainly low-molecular-weight heparin, n = 217, 67.8%). The main reasons for prescribing DOACs were oral administration (145/336, 43.2%), no need for blood monitoring (131/336, 39.0%), favorable safety profile (116/336, 34.5%), and prescriber-reported patient's preference (96/336, 28.6%). Apixaban was the most prescribed DOAC in splanchnic vein thrombosis (133/219, 60.7%), while dabigatran was the most prescribed DOAC in cerebral vein thrombosis (38/103, 36.9%). Conclusion: DOACs are increasingly prescribed for USVTE owing to their ease of use and perceived safety, but mainly after initial treatment with parenteral anticoagulation. Further evidence is still needed to support their use in the acute phase. 2026-01-01T00:00:00Z /library/oar/handle/123456789/146571 Title: Epidemiology, databases, and cancer registries Authors: Calleja, Neville; Gatta, Gemma Abstract: Rare diseases are defined by their low prevalence. In Europe, a disease is considered rare if it affects fewer than 1 in 2000 people. A more specific definition exists for rare tumours, which are classified as malignancies with an incidence of fewer than 6 per 100,000 per year. This classification, established through EU-funded projects and the Joint Action on Rare Cancers (JARC). Population- based cancer registries provide essential epidemiological indicators—incidence, prevalence, survival, and mortality—allowing continuous assessment of the cancer burden in defined populations. Projects such as RARECARE, RARECAREnet and EUROCARE have contributed to understand ing rare cancer epidemiology across Europe. Rare gynaecological cancers, including non-epithelial ovarian tumours, epithelial tumours of the fallopian tube, and placental choriocarcinoma, exhibit varying incidence and survival figures, with older women often more affected and five-year survival generally lower than common gynaecologic cancers. 2026-01-01T00:00:00Z /library/oar/handle/123456789/146551 Title: Smartphones and social media are harming youth health : a comprehensive public health response is overdue Authors: Gannon, John; Kosola, Silja; Boode, Karin; Calleja-Agius, Jean; Elias, Cecilia; Saxena, Sonia Abstract: The impact of smartphones and social media on child and adolescent health is profound, with evidence increasingly highlighting negative outcomes such as impaired cognitive and social development, mental health issues, and addiction. Excessive screen time and problematic social media use are linked to poor academic performance, disrupted sleep, depression, anxiety, and exposure to harmful content such as misinformation and cyberbullying. Adolescents are particularly vulnerable due to the developmental imbalance between heightened reward-seeking and still-maturing impulse control in their brains. Addressing these risks requires a comprehensive public health approach involving four key domains: education, support services, user-focused legislation, and corporate regulation. Educational initiatives should promote digital literacy and online safety while campaigns can encourage behaviour change among children, parents, and educators. Support services for those struggling with addiction and mental health issues are crucial. User-focused legislation is needed to reduce screen time and restrict social media access for minors, including the use of age verification tools. Regulatory measures targeting tech companies, such as the EU Digital ¸£ÀûÔÚÏßÃâ·Ñ Act, are necessary to hold corporations accountable for their role in public health harms. To protect children’s well-being, a multifaceted strategy that combines education, supports, legal action, and corporate regulation is essential in mitigating the negative effects of technology use. 2026-01-01T00:00:00Z /library/oar/handle/123456789/146548 Title: Fertility preservation in rare and uncommon gynaecological cancers Authors: Khattak, Hajra; Hussey, Thomas; Wattar, Bassel; Calleja-Agius, Jean Abstract: Fertility preservation has become an essential component of comprehensive cancer care for young women, reflecting a growing recognition that survival must be accompanied by quality of life and the possibility of future parenthood. While fertility-sparing strategies are well established for certain common gynaecological cancers, their application in rare and uncommon malignancies remains complex. These tumours include rare histological subtypes of ovarian, cervical, uterine, vaginal and vulval cancers. They are often characterised by aggressive biology, diagnostic uncertainty and a limited evidence base, which creates unique challenges in balancing oncological safety with reproductive potential. This chapter provides an in-depth review of current fertility preservation approaches in this context, including conservative surgical techniques, ovarian tissue cryopreservation, ovarian transposition, embryo and oocyte cryopreservation, in vitro maturation, and selected medical strategies. Tumour-specific considerations for germ cell tumours, sex-cord stromal tumours, uterine sarcomas, neuroendocrine carcinomas, and paediatric and adolescent presentations are discussed. Emerging and experimental avenues such as artificial ovaries, uterus transplantation, and in vitro gametogenesis are examined for their potential to expand reproductive options in the future. Central to effective care is a multidisciplinary, individualised approach that incorporates gynaecologic oncology, reproductive medicine, pathology, radiology, nursing, and psychological support, underpinned by clear communication and informed consent. Embedding fertility considerations early in the cancer care pathway enables clinicians to align oncological management with patients’ reproductive goals, ensuring a more holistic approach to treatment. 2026-01-01T00:00:00Z