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International Journal of Radiation... Jun 2024Metaplastic breast cancer (MBC) is a rare and heterogeneous breast cancer subtype, and there are critical gaps in our understanding of its long-term outcomes. This...
BACKGROUND
Metaplastic breast cancer (MBC) is a rare and heterogeneous breast cancer subtype, and there are critical gaps in our understanding of its long-term outcomes. This retrospective cohort study aimed to address these gaps by scrutinizing the pathological and clinical aspects of MBC to enhance clinical decision-making and refine patient care strategies.
METHODS
This registry-based retrospective cohort study included females aged ≥21 years diagnosed with MBC or matrix-producing carcinoma. The data were obtained from January 2001-August 2020 from the XXXX Registry of XXXX, which included 23,935 patients. Demographic and clinicopathological characteristics, neoadjuvant chemotherapy responses, and survival outcomes were analyzed. Statistical assessments involved univariate and multivariate Cox proportional hazards models and Kaplan-Meier survival analyses.
RESULTS
This study enrolled 170 patients; 87.1% had non-metastatic disease and 12.9% had metastatic disease. The age of patients at diagnosis ranged from 46 to 65 years (median, 56 years). The cohort's predominant characteristics were advanced clinical stage (77.6%), node negativity (67.6%), and grade 3 disease (74.1%). In patients receiving curative intent treatment, neoadjuvant chemotherapy yielded a pathological complete response of 19.2% and a disease progression rate of 46.2%. Multivariate analysis showed that adjuvant radiation therapy significantly improved overall survival (OS) and disease-free survival (DFS), with hazard ratios (HRs) of 0.29 (95% confidence interval [CI], 0.13 - 0.62; p < 0.005) and 0.23 (95% CI, 0.10-0.50; p < 0.005), respectively. Clinical T3 and T4 stages, and nodal involvement were associated with poor outcomes. Stable disease after neoadjuvant chemotherapy was associated with poor OS and DFS.
CONCLUSION(S)
This study sheds light on the complex landscape of MBC and emphasizes the pivotal role of adjuvant radiotherapy in enhancing patient outcomes. Despite advancements, challenges persist that warrant continued research to refine neoadjuvant chemotherapy strategies and delve into the nuanced factors that influence treatment responses.
PubMed: 38950711
DOI: 10.1016/j.ijrobp.2024.06.016 -
International Journal of Pharmaceutics Jun 2024High shear wet granulation (HSWG) is widely used in tablet manufacturing mainly because of its advantages in improving flowability, powder handling, process run time,...
High shear wet granulation (HSWG) is widely used in tablet manufacturing mainly because of its advantages in improving flowability, powder handling, process run time, size distribution, and preventing segregation. In line process analytical technology measurements are essential in capturing detailed particle dynamics and presenting real-time data to uncover the complexity of the HSWG process and ultimately for process control. This study presents an opportunity to predict the properties of the granules and tablets through torque measurement of the granulation bowl and the force exerted on a novel force probe within the powder bed. Inline force measurements are found to be more sensitive than torque measurements to the granulation process. The characteristic force profiles present the overall fingerprint of the high shear wet granulation, in which the evolution of the granule formation can improve our understanding of the granulation process. This provides rich information relating to the properties of the granules, identification of the even distribution of the binder liquid, and potential granulation end point. Data were obtained from an experimental high shear mixer across a range of key process parameters using a face-centred surface response design of experiment (DoE). A closed-form analytical model was developed from the DOE matrix using the discovery of evolutionary equations. The model is able to provide a strong predictive indication of the expected tablet tensile strength based only on the data in-line. The use of a closed form mathematical equation carries notable advantages over other AI methodologies such as artificial neural networks, notably improved interpretability/interrogability, and minimal inference costs, thus allowing the model to be used for real-time decision making and process control. The capability of accurately predicting, in real time, the required compaction force required to achieve the desired tablet tensile strength from upstream data carries the potential to ensure compression machine settings rapidly reach and are maintained at optimal values, thus maximising efficiency and minimising waste.
PubMed: 38950660
DOI: 10.1016/j.ijpharm.2024.124405 -
Klinische Padiatrie Jul 2024We sought to investigate adherence to the current pediatric syncope guideline in the emergency department and its impact on the frequency of missed or unnecessary...
BACKGROUND
We sought to investigate adherence to the current pediatric syncope guideline in the emergency department and its impact on the frequency of missed or unnecessary diagnostic measures. For the first time, in 2014 updated guideline defines indispensable basic diagnostic measures and a consecutive algorithm for safe clinical decision making.
PATIENTS AND METHOD
We analyzed retrospectively 314 pediatric patients, 166 were presented before and 148 after publication of this guideline update.
RESULTS
After guideline publication, 54 patients (36.5%) were not treated in accordance with the guideline and 2 (0.63%) cases caused by epileptic seizures were initially misdiagnosed as reflex syncope. Among these 54 patients, 32 (59.3%) inpatient admissions were inappropriate, as well as 11 (20.4%) electroencephalographies, 4 (7.4%) sleep-deprivation EEGs, 2 (3.7%) magnetic resonance imaging, 5 (9.3%) urine diagnostics and 32 (59.3%) blood tests. In 21 cases (38.9%), the medical history was insufficient. ECG was missed in 42 patients (77.8%). There was no significant difference between the pre- and post-guideline groups concerning diagnostic work-up (p=0,12).
DISCUSSION
This non-compliance with the guideline did not cause a large number of misdiagnosed epileptic seizures (1.4%) or adverse outcomes but led to waste of resources in healthcare system and undue burdens on patients and their families.
CONCLUSION
In addition to establishment of clinical guidelines, the need for additional measures and strategies to promote their implementation seems obvious.
PubMed: 38950601
DOI: 10.1055/a-2345-3343 -
Seminars in Thrombosis and Hemostasis Jul 2024Inherited disorders of primary hemostasis, such as von Willebrand disease and congenital platelet disorders, can cause extensive, typically mucocutaneous bleeding....
Inherited disorders of primary hemostasis, such as von Willebrand disease and congenital platelet disorders, can cause extensive, typically mucocutaneous bleeding. Assays to diagnose and monitor these disorders, such as von Willebrand factor activity assays and light transmission aggregometry, are performed in specialized hemostasis laboratories but are commonly not available in local hospitals. Due to the complexity and relative scarcity of these conventional assays, point-of-care tests (POCT) might be an attractive alternative in patients with hereditary bleeding disorders. POCTs, such as thromboelastography, are increasingly used to assess hemostasis in patients with acquired hemostatic defects, aiding clinical decision-making in critical situations, such as during surgery or childbirth. In comparison, the use of these assays in patients with hereditary hemostasis defects remains relatively unexplored. This review aims to give an overview of point-of-care hemostasis tests in patients with hereditary disorders of primary hemostasis. A summary of the literature reporting on the performance of currently available and experimental POCTs in these disorders is given, and the potential utility of the assays in various use scenarios is discussed. Altogether, the studies included in this review reveal that several POCTs are capable of identifying and monitoring severe defects in the primary hemostasis, while a POCT that can reliably detect milder defects of primary hemostasis is currently lacking. A better understanding of the strengths and limitations of POCTs in assessing hereditary defects of primary hemostasis is needed, after which these tests may become available for clinical practice, potentially targeting a large group of patients with milder defects of primary hemostasis.
PubMed: 38950596
DOI: 10.1055/s-0044-1787976 -
Deutsche Medizinische Wochenschrift... Jul 2024Artificial intelligence (AI) is increasingly finding its way into medicine, and it is not yet clear how it will change the practice of medicine and the way doctors see...
Artificial intelligence (AI) is increasingly finding its way into medicine, and it is not yet clear how it will change the practice of medicine and the way doctors see themselves. This article explores the ethical limits of AI by (1) discussing the reductionistic elements inherent in AI, (2) working out the problematic implications of algorithmisation and (3) highlighting the lack of human control as an ethical problem of AI. The conclusion is that although AI is a useful tool to support medical judgement, it is absolutely dependent on human decision-making authority in order to actually prove beneficial for medicine.
Topics: Artificial Intelligence; Humans; Ethics, Medical; Algorithms
PubMed: 38950550
DOI: 10.1055/a-2302-8919 -
Deutsche Medizinische Wochenschrift... Jul 2024When elder individuals develop chronic kidney failure, doctors, patients, and family members are faced with the decision: Should dialysis (still) be initiated, or should...
When elder individuals develop chronic kidney failure, doctors, patients, and family members are faced with the decision: Should dialysis (still) be initiated, or should a conservative-palliative therapy strategy be chosen? A prerequisite for shared decision-making is structured education about the various options, ensuring all necessary information and consequences are communicated. This article outlines the advantages and disadvantages of haemodialysis and peritoneal dialysis, as well as conservative-palliative therapy. Additionally, it discusses the option of a trial dialysis and the choice to discontinue ongoing dialysis.
Topics: Humans; Kidney Failure, Chronic; Conservative Treatment; Aged; Palliative Care; Renal Dialysis; Aged, 80 and over; Renal Replacement Therapy; Peritoneal Dialysis
PubMed: 38950545
DOI: 10.1055/a-2157-5626 -
Facts, Views & Vision in ObGyn Jun 2024Port-site hernia (PSH) of less than 10 mm is an exceptionally rare complication of minimally invasive surgery (MIS). To date, there have been no cases in the literature...
Port-site hernia (PSH) of less than 10 mm is an exceptionally rare complication of minimally invasive surgery (MIS). To date, there have been no cases in the literature reporting recurrence of PSH from a 5 mm incision. We present the first case of PSH recurrence in a woman who underwent surgery for benign gynaecological pathology via a MIS approach. Her post-operative course was complicated by an episode of symptomatic hernia arising from a 5 mm accessory trocar which was surgically managed. A few months later she re-presented with the same symptoms and had a PSH recurrence of the same port-site. Two corrective surgeries employing different techniques were performed. The first episode was managed laparoscopically using interrupted stitches. On the other hand, the PSH recurrence was managed by placement of a mesh. Ultrasound played a crucial role in diagnostics, especially in the recurrent setting. Due to the complete absence of similar cases in the literature, the decision making around the management of a PSH recurrence from a 5 mm trocar site proved to be challenging. As MIS is the current standard of care, more cases are likely to occur, however despite the increasing number of surgical procedures performed via MIS, no established guidelines for managing such complications have been proposed. Trying to bridge this gap, we present the case report of the first case of PSH recurrence from a 5 mm accessory port and a review of the most significant literature available to date. We finally summarise the reported cases of PSH and the types of surgical repair conducted to highlight the absence of a standard of care.
PubMed: 38950540
DOI: 10.52054/FVVO.16.2.013 -
International Immunopharmacology Jun 2024Hepatic arterial infusionchemotherapy (HAIC) is a promising option for large unresectable hepatocellular carcinoma (HCC). Identifying patients who could benefit from...
BACKGROUND
Hepatic arterial infusionchemotherapy (HAIC) is a promising option for large unresectable hepatocellular carcinoma (HCC). Identifying patients who could benefit from continuous HAIC remains a challenge. We aimed to establish an objective model to guide the decision for retreatment with HAIC.
METHODS
Between 2015 and 2020, the data of patients with large unresectable HCC without macrovascular invasion or extrahepatic spread undergoing multiple HAIC cycles from 3 different centers were retrieved. We investigated the basic tumor parameters and the effect of HAIC on liver function and tumor response, and their impact on overall survival (OS). A point score (ARH, Assessment for Retreatment with HAIC) was built by using a stepwise Cox regression model in the training cohort (n = 112) and was validated in an independent validation cohort (n = 71).
RESULTS
The high α-fetoprotein before the second cycle of HAIC, an increase in Child-Pugh score, and undesirable radiologic tumor responses remained independent negative prognostic factors and were used to create the ARH score. The prognosis of HCC patients deteriorated significantly with the increase in ARH score. The median OS of patients with ARH score 0-2 points and ≥ 2.5 points were 19.37 months and 11.60 months (P < 0.001). All of these results had been confirmed in the external validation cohort and demonstrated significance across multiple subgroups.
CONCLUSIONS
The ARH score makes an excellent prediction of the prognosis of HCC patients who received retreatment of HAIC. Patients with an ARH score ≥ 2.5 prior to the second cycle of HAIC may not profit from further sessions.
PubMed: 38950459
DOI: 10.1016/j.intimp.2024.112551 -
Neurosurgical Focus Jul 2024Concussions are self-limited forms of mild traumatic brain injury (TBI). Gradual return to play (RTP) is crucial to minimizing the risk of second impact syndrome. Online...
OBJECTIVE
Concussions are self-limited forms of mild traumatic brain injury (TBI). Gradual return to play (RTP) is crucial to minimizing the risk of second impact syndrome. Online patient educational materials (OPEM) are often used to guide decision-making. Previous literature has reported that grade-level readability of OPEM is higher than recommended by the American Medical Association and the National Institutes of Health. The authors evaluated the readability of OPEM on concussion and RTP.
METHODS
An online search engine was used to identify websites providing OPEM on concussion and RTP. Text specific to concussion and RTP was extracted from each website and readability was assessed using the following six standardized indices: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. One-way ANOVA and Tukey's post hoc test were used to compare readability across sources of information.
RESULTS
There were 59 concussion and RTP articles, and readability levels exceeded the recommended 6th grade level, irrespective of the source of information. Academic institutions published OPEM at simpler readability levels (higher FRE scores). Private organizations published OPEM at more complex (higher) grade-level readability levels in comparison with academic and nonprofit institutions (p < 0.05).
CONCLUSIONS
The readability of OPEM on RTP after concussions exceeds the literacy of the average American. There is a critical need to modify the concussion and RTP OPEM to improve comprehension by a broad audience.
Topics: Brain Concussion; Humans; Comprehension; Patient Education as Topic; Internet; Return to Sport; Reading
PubMed: 38950429
DOI: 10.3171/2024.4.FOCUS24128 -
Journal of Public Health Management and... Jun 2024A qualitative study was conducted using semi-structured interviews leaders in community-based organizations, health care, and local public health to understand...
A qualitative study was conducted using semi-structured interviews leaders in community-based organizations, health care, and local public health to understand organizational perspectives of collaboration for health equity and identify opportunities to improve collaboration. Twelve leaders were interviewed from March through May 2023 in Kent County, Michigan. All leaders saw collaboration as valuable for advancing health equity. Key themes that affected collaboration and could be a facilitator or barrier to advancing health equity in the community were inclusion, power, relationships, resources, and organizational traits. Leaders articulated the following factors as those that support collaboration for health equity: authentic inclusion, shared decision-making, taking time to foster trusting relationships, adequate resources to support the infrastructure needed for collaborations, organizational flexibility, and individual commitment. Building partnerships with these facilitators in mind may result in more robust, sustainable, and resilient collaboratives.
PubMed: 38950426
DOI: 10.1097/PHH.0000000000002013