Machine learning-based classification of varicocoele grading: A promising approach for diagnosis and treatment optimization.

BACKGROUND: Varicocoele is a correctable cause of male infertility. Although physical examination is still being used in diagnosis and grading, it gives conflicting results when compared to ultrasonography-based varicocoele grading. OBJECTIVES: We aimed to develop a multi-class machine learning model for the grading of varicocoeles based on ultrasonographic measurements. METHOD: Between January and May 2024, we enrolled unilateral varicocoele patients at an infertility clinic, assessing their varicocoele stages using the Dubin and Amelar system. We measured vascular diameter and reflux time at the testicular apex and the subinguinal region ultrasonography in both the supine and standing positions. Using these measurements, we developed four multi-class machine learning models, evaluating their performance metrics and determining which patient position and projection were most influential in varicocoele grading. RESULTS: We included 248 patients with unilateral varicocoele in the study, their average age was 26.61 ± 4.95 years old. Of these, 212 had left-sided and 36 had right-sided varicocoeles. According to the Dubin and Amelar system, there were 66 grade I, 96 grade II, and 86 grade III varicocoeles. Among the models we created, the random forest (RF) model performed best, with an overall accuracy of 0.81 ± 0.06, an F1 score of 0.79 ± 0.02, a sensitivity of 0.69 ± 0.02, and a specificity of 0.8 ± 0.03. Vascular diameter measurement at the testicular apex in the supine position had the most impact on grading across all models. In support vector machine and multi-layer perceptron models, reflux time measurements from the subinguinal projection in the standing position contributed the most, while in RF and k-nearest neighbors models, measurements from the subinguinal projection in the supine position were the most influential. CONCLUSIONS: Machine learning methods have demonstrated superior accuracy in predicting disease compared to traditional statistical regressions and nomograms. These advancements hold promise for clinically automated prediction of varicocoele grades in patients. Tailored varicocoele grading for individuals has the potential to enhance treatment effectiveness and overall quality of life.

Impact of blastocyst grading and blastocyst biopsy dates on the clinical outcomes of patients undergoing preimplantation genetic testing.

Background: Preimplantation genetic testing (PGT) allows for the evaluation of embryo genetic information prior to implantation, enabling the selection of normal embryos for transfer and ultimately leading to better pregnancy outcomes. In this study, we explored factors that influence clinical outcomes of patients undergoing PGT. The effects of blastocyst grading and biopsy dates on clinical outcomes were also analyzed. Methods: The clinical data and pregnancy outcomes of 428 PGT cycles performed in the Reproductive Medicine Department of the Northern Theater General Hospital between January 2017 and December 2022 were retrospectively analyzed. Multifactorial logistic regression analysis and nomograms were used to determine factors influencing pregnancy outcomes. The impact of D5 blastocysts (290 cycles) and D6 blastocysts (138 cycles) with different quality levels on clinical outcomes was also compared. Results: Multifactorial logistic regression analysis showed that age, BMI, endometrial thickness, and embryo quality of women affected PGT clinical outcomes. Women aged <40 years or with a body mass index (BMI) >18.5 and endometrial thickness>1.0 cm had a significantly higher pregnancy success rate. Compared to that of D6 blastocyst biopsy, D5 blastocyst biopsy was associated with a higher pregnancy success rate but a similar live birth rate. No significant differences were observed in the pregnancy and live birth rates of D5 and D6 high-quality blastocysts. Conclusion: To achieve better pregnancy outcomes after PGT, considering blastocyst grading and biopsy dates when transferring embryos is essential for improving pregnancy outcomes. Furthermore, patients should adjust their BMI, endometrial receptivity, and endometrial thickness and pattern.

The correlation of neurosurgery motor examinations with ISNCSCI motor examinations in patients with spinal cord injury: a multicenter TRACK-SCI study.

OBJECTIVE: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessment is the gold standard for evaluation of neurological function after spinal cord injury (SCI). Although it is an invaluable tool for diagnostic and research purposes, it is time consuming and can be impractical in acute injury settings. Clinical neurosurgery motor examinations (NMEs) could serve as an expeditious surrogate for SCI research when ISNCSCI motor examinations are not feasible. The aim of this study was to evaluate the agreement between motor examinations performed by the neurosurgery clinical team and ISNCSCI examiners. METHODS: The multicenter prospective Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) registry was queried to identify patients with recorded neurosurgery and research motor examinations within 24 hours of each other. Pearson correlations and modified Bland-Altman analyses were performed using data from matching upper-extremity, lower-extremity, and combined examinations. Kappa analysis was used to test interrater reliability with respect to determination of American Spinal Injury Association Impairment Scale (AIS) grade. RESULTS: There were 72 pairs of matching clinical and research examinations in 63 patients. NME scores were strongly correlated with ISNCSCI motor scores (R = 0.962, p < 0.001). Both upper- and lower-extremity NME scores were strongly correlated with upper- and lower-extremity ISNCSCI motor scores, respectively (R = 0.939, p < 0.001; and R = 0.959, p < 0.001, respectively). In modified Bland-Altman analyses, total, upper-extremity, and lower-extremity NME scores and ISNCSCI motor scores showed low systematic bias and high agreeability (total: bias = 0.3, limit of agreement [LoA] = 36.6; upper extremity: bias = -0.5, LoA = 17.6; lower extremity: bias = 0.8, LoA = 24.0). There were 66 pairs of examinations that had thorough sensory and rectal examinations for AIS grade calculation. Using kappa analysis to test the interrater reliability of AIS grade calculation using NME versus ISNCSCI motor scores, the authors found a weighted kappa of 0.883 (SE 0.061, 95% CI 0.736-0.976), indicating strong agreement. CONCLUSIONS: Overall, this study suggests that ISNCSCI motor scores and NME scores are strongly correlated and highly agreeable. When conducting SCI research, a thorough clinical motor examination may be a useful surrogate when ISNCSCI examinations are missing.

A Comparative Study of Laparoscopic Versus Robotic Cholecystectomies Based on the Parkland Grading Scale.

Background Cholecystectomy, the surgical removal of the gallbladder, is a common procedure performed to treat conditions like gallstone disease and cholecystitis. Among the various techniques available, laparoscopic cholecystectomy (LC) and robotic cholecystectomy (RC) are minimally invasive methods, while open cholecystectomy (OC) involves a more extensive incision and is reserved for cases where less invasive options are unsuitable. This study focuses on evaluating and comparing the safety and efficacy of LC and RC across different grades of cholecystitis, categorized by the Parkland Grading Scale. The goal is to determine whether RC provides significant benefits over LC, particularly in cases of higher-grade cholecystitis. Methodology This ambispective observational case-control study was conducted from January to June 2024 at Manipal Hospitals, Vijayawada, India. It included patients aged 18 or older with acute cholecystitis who underwent LC or OC. Exclusions were made for chronic cholecystitis, prior surgeries affecting the procedure, incomplete records, or severe complications. Data, including demographics, preoperative symptoms, intraoperative details, and postoperative outcomes, were extracted from electronic medical records. Laparoscopic procedures used standard techniques, while robotic procedures employed the da Vinci surgical system. Outcomes measured included operative time, complications, conversion rates, length of stay, and readmission rates. Results There was no significant difference in pre-operative parameters like age, white blood cell (WBC) count, total bilirubin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), or history of previous surgery according to the Parkland Grading Scale. However, differences were noted in the Parkland Grading Scale regarding the thickness of the gallbladder wall, incidence of pericholecystic collection, and history of acute cholecystitis (p < 0.05). The most common complication was bleeding during the operation, which was more frequent in LC and was significant. Other complications, such as bile duct injury and vascular injury, were not observed in either procedure. Conclusion This study highlights that RC provides notable benefits compared to LC, especially for higher grades of cholecystitis, as per the Parkland Grading Scale. Although robotic procedures have longer operative times, they result in fewer intraoperative and postoperative complications, reduced conversion rates, and lower readmission rates. These advantages make RC a promising choice for treating complex cases of cholecystitis.

Describing the current landscape of pass/fail grading schemes within skills-based pharmacy curricula.

INTRODUCTION: Optimal methods for grading students in skills-based courses within pharmacy education have not been fully explored. This research aimed to assess the current landscape of pass/fail grading schemes within pharmacy skills-based courses and explore faculty perceptions of pass/fail grading schemes. METHODS: A 29-item, cross-sectional survey was electronically distributed to the American Association of Colleges of Pharmacy Laboratory Special Interest Group. The survey collected demographics, course grading schemes, faculty perceptions of student performance, and impact of implementing pass/fail grading schemes. Survey respondents were also invited to participate in semi-structured interviews, which were summarized due to limited participation. Descriptive statistics were used for analysis of survey data. RESULTS: Fifty-five participants responded to the survey, representing 23 pharmacy institutions. Most respondents (82 %) used a traditional grading system for final course grades in skills-based courses. Some respondents (40 %) used specification grading for skills assessment, and 64 % of respondents used pass/fail grading to assess specific skills. Most respondents perceived that the change to pass/fail grading either improved or made no difference in faculty workload, wellbeing, general faculty creativity, quality of feedback, timeliness of grading, grade grievances, and faculty preparation time. The main concern was decreased student motivation and engagement. Semi-structured interviews identified a need for specific, validated rubrics, importance of faculty buy-in, and lack of impact on faculty workload as a result of the change. Concerns about residency placement and student motivation were also identified. CONCLUSION: There is variability in grading schemes used within skills-based pharmacy curricula. Faculty perceptions of pass/fail grading schemes are positive overall. Considering the limited number of institutions utilizing this grading scheme, additional research is needed.

Image quality assessments in abdominal CT: Relative importance of dose, iterative reconstruction strength and slice thickness.

INTRODUCTION: Low contrast resolution in abdominal computed tomography (CT) may be negatively affected by attempts to lower patient doses. Iterative reconstruction (IR) algorithms play a key role in mitigating this problem. The reconstructed slice thickness also influences image quality. The aim was to assess the interaction and influence of patient dose, slice thickness, and IR strength on image quality in abdominal CT. METHOD: With a simultaneous acquisition, images at 42 and 98 mAs were obtained in 25 patients. Multiplanar images with slice thicknesses of 1, 2, and 3 mm and advanced modeled iterative reconstruction (ADMIRE) strengths of 3 (AD3) and 5 (AD5) were reconstructed. Four radiologists evaluated the images in a pairwise manner based on five image criteria. Ordinal logistic regression with mixed effects was used to evaluate the effect of tube load, ADMIRE strength, and slice thickness using the visual grading regression technique. RESULTS: For all assessed image criteria, the regression analysis showed significantly (p < 0.001) higher image quality for AD5, but lower for tube load 42 mAs, and slice thicknesses of 1 mm and 2 mm, compared to the reference categories of AD3, 98 mAs, and 3 mm, respectively. AD5 at 2 mm was superior to AD3 at 3 mm for all image criteria studied. AD5 1 mm produced inferior image quality for liver parenchyma and overall image quality compared to AD3 3 mm. Interobserver agreement (ICC) ranged from 0.874 to 0.920. CONCLUSION: ADMIRE 5 at 2 mm slice thickness may allow for further dose reductions due to its superiority when compared to ADMIRE 3 at 3 mm slice thickness. IMPLICATIONS FOR PRACTICE: Combination of thinner slices and higher ADMIRE strength facilitates imaging at low dose.

Automatic Acne Severity Grading with a Small and Imbalanced Data Set of Low-Resolution Images.

INTRODUCTION: Developing automatic acne vulgaris grading systems based on machine learning is an expensive endeavor in terms of data acquisition. A machine learning practitioner will need to gather high-resolution pictures from a considerable number of different patients, with a well-balanced distribution between acne severity grades and potentially very tedious labeling. We developed a deep learning model to grade acne severity with respect to the Investigator's Global Assessment (IGA) scale that can be trained on low-resolution images, with pictures from a small number of different patients, a strongly imbalanced severity grade distribution and minimal labeling. METHODS: A total of 1374 triplets of images (frontal and lateral views) from 391 different patients suffering from acne labeled with the IGA severity grade by an expert dermatologist were used to train and validate a deep learning model that predicts the IGA severity grade. RESULTS: On the test set we obtained 66.67% accuracy with an equivalent performance for all grades despite the highly imbalanced severity grade distribution of our database. Importantly, we obtained performance on par with more tedious methods in terms of data acquisition which have the same simple labeling as ours but require either a more balanced severity grade distribution or large numbers of high-resolution images. CONCLUSIONS: Our deep learning model demonstrated promising accuracy despite the limited data set on which it was trained, indicating its potential for further development both as an assistance tool for medical practitioners and as a way to provide patients with an immediately available and standardized acne grading tool. TRIAL REGISTRATION: chinadrugtrials.org.cn identifier CTR20211314.

Magnetic resonance imaging classification in a percutaneous needle injury rat model of intervertebral disc degeneration.

BACKGROUND: During the development of disease-modifying intervertebral disc degeneration (IDD) drugs, the rat model of IDD is frequently used for disease progression assessment. The aim of this study was to describe a magnetic resonance (MRI) scoring system for the assessment of different disc conditions in puncture-induced IDD, allowing standardization and comparison of results obtained by different investigators. METHODS: A total of 36 Sprague-Dawley rats were utilized in the present study. The animals were divided into two groups: a sham group and an IDD group caused by puncture. The rats in the IDD group were subsequently divided into six categories based on time frames, with five rats in each category. The sham group was divided into two sub-groups (n = 3) for 28 and 56 days, respectively. T2-weighted images of rats consecutively studied with MRI of the coccygeal discs were classified according to the time course using the corresponding histological data. Additional scoring of the micro-CT was employed to identify the progression of bone destruction of the rat model of IDD. RESULTS: A comparison of the MRI results between the sham group and the IDD group revealed a significant reduction in NP height, area, T2WI value, and DHI in the latter group (P < 0.05). The micro-CT results demonstrated that following acupuncture, there was a notable decline in the BV, Tb.N, and height of the coccygeal vertebra, while the BS/BV and Tb.Sp exhibited a significant increase (P < 0.05). The histological results were analogous to the MRI results, indicating a progressive exacerbation of IDD and a corresponding increase in NP score (P < 0.05). The results of the MRI were found to be consistent with those of the micro-CT and histological analyses (P < 0.05). The results of the study demonstrate a robust correlation between MRI analysis and histological findings. Live animals are employed for MRI analysis to improve experiment comparability. The reliability of the MRI scoring system ensures assessment of disease progression in live animals, while promoting cost savings and animal welfare by avoiding the sacrifice of animals at different times. CONCLUSIONS: The described scoring paradigm has quantitatively been found to differentiate IDD disease progression in an in vivo rat model. Hence, we suggest employing it to evaluate the rat IDD model and assess the effects of treatments in this model.

Histopathological features of subcutaneous and cutaneous mast cell tumors in dogs.

BACKGROUND: Mast cell tumors (MCTs) are the most common malignant skin neoplasms in dogs. In the past, the distinction between cutaneous MCTs (cMCTs), originating from the dermis, and subcutaneous MCTs (scMCTs), originating from the subcutaneous tissue, was not made. Histopathological differentiation, including grading, is important for prognosis. However, the Patnaik and Kiupel grading systems were proposed for cMCTs only. The objective of our study was to describe and compare the signalment of dogs with scMCTs and cMCTs and histopathological features, anticipating similarities in both groups. Data of dogs histologically diagnosed with scMCTs or cMCTs between September 2020 and July 2023 were analyzed retrospectively. Signalment, tumor location, histopathological features, completeness of removal and lymph node status were recorded. RESULTS: Data on 305 scMCTs and 1291 cMCTs were collected. Breed distribution was different between scMCTs and cMCTs (P < 0.0001). Mitotic count (MC) was not different between scMCTs (1.63) and cMCTs (1.58) (P = 0.8490). Compared to cMCTs, scMCTs more often had anisokaryosis, bizarre nuclei and multinucleation. Kiupel high grade was more often assigned to scMCTs (51/292, 17.5%) than cMCTs (154/1291, 11.9%) (P = 0.009). The odds of MCTs being assigned a high grade in scMCT was 1.578 higher than in cMCTs (95% confidence interval [1.116-2.232]). CONCLUSIONS: Histopathological differences between scMCTs and cMCTs were observed. A Kiupel high grade was more often assigned to scMCTs than cMCTs. Whether these histopathological findings correlate with clinical outcome has to be established in additional studies.

Altered Brain Structure in Hemifacial Spasm Patients: A Multimodal Brain Structure Study.

Objective: Hemifacial spasm (HFS) is a clinical neurosurgical disease, which brain structural alterations caused by HFS remain a topic of debate. We evaluated changes in brain microstructure associated with HFS and observed their relevance to clinical characteristics. Methods: We enrolled 72 participants. T1-weighted structural and diffusion tensor images were collected from all participants using 3.0T magnetic resonance equipment. Voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) were used to identify changes in gray matter volume (GMV) and disruptions in white matter (WM) integrity. The severity of the spasms was graded using the Cohn scale. Results: VBM analysis revealed that the GMV was significantly reduced in the left Thalamus and increased GMV in the right Cerebellum IV-V of the HFS group. TBSS analysis showed that FA in the left superior longitudinal fasciculus (SLF) of the HFS group was significantly increased. GMV in the thalamus showed a negative correlation with disease duration and Cohn grade, while FA in the left SLF had a positive correlation with both the disease duration and Cohn grade. Conclusion: We identified regions with altered GMV in HFS patients. Additionally, we determined that FA in the left SLF might serve as a significant neural indicator of HFS.

Development and external validation of a nomogram for predicting lymph node metastasis in 1-3 cm lung adenocarcinoma.

Aim: This study aimed to investigate the risk factors for lymph node metastasis in 1-3 cm adenocarcinoma and develop a new nomogram to predict the probability of lymph node metastasis.Materials & methods: This study collected clinical data from 1656 patients for risk factor analysis and an additional 500 patients for external validation. The logistic regression analyses were employed for risk factor analysis. The least absolute shrinkage and selection operator regression was used to select variables, and important variables were used to construct the nomogram and an online calculator.Results: The nomogram for predicting lymph node metastasis comprises six variables: tumor size (mediastinal window), consolidation tumor ratio, tumor location, lymphadenopathy, preoperative serum carcinoembryonic antigen level and pathological grade. According to the predicted results, the risk of lymph node metastasis was divided into low-risk group and high-risk group. We confirmed the exceptional clinical efficacy of the model through multiple evaluation methods.Conclusion: The importance of intraoperative frozen section is increasing. We discussed the risk factors for lymph node metastasis and developed a nomogram to predict the probability of lymph node metastasis in 1-3 cm adenocarcinomas, which can guide lymph node resection strategies during surgery.

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Comparative Study of Gleason 7 (3+4) and (4+3) Prostatic Adenocarcinomas with Prog-nostic Criteria and Immunohistochemical Profiles of AMACR, PSA and Ki-67.

BACKGROUND: To compare Gleason 7 (3+4) and (4+3) prostatic adenocarcinoma (PC) with different prognostic criteria through immunohistochemical analysis with anti-PSA, anti-Ki 67 and anti-AMARC antibodies. METHODS: We analyzed 221 surgical specimens from patients between 40 and 86 years-old (mean=63) with PC. The immunohistochemical study was performed with anti-PSA, anti-Ki 67 and anti-AMARC. The microscopic fields were photographed with an Olympus DP70 digital camera coupled to an Olympus BX51 microscope and archived in TIFF. Proportion and intensity criteria were used to quantify the anti-PSA antibody and for the anti-Ki 67 antibody, the quantification by similarity of this antibody in breast carcinomas. Anti-AMACR protein expression was based on four scores: negative, weak, moderate and strong. The statistical analysis was performed with the Graph Pad Prism 5 program. RESULTS: In the Gleason score 7 (3+4) we had 91.72% in pT2 and 8.27% in the pT3 group; 8.27% recurrences, of which 90.90% in the pT2 group. In the Gleason score 7 (4+3) we had 77.27% in the pT2 group and 22.72% in the pT3 group and 10.22% of relapses, of which 66.66% in the pT2 group and 33.33% in the pT3 group. In 6.81% of cases there was an increase in the anti-Ki 67 index and in 2.27% of the cases, there was an increase in the immunoexpression of anti-p53 when comparing Gleason score 7 (3+4) with Gleason score 7 (4+3). CONCLUSION: Our study confirmed differences in the Gleason score 7 (3+4) and Gleason score 7 (4+3) of PC when comparing prognostic criteria. Anti-Ki 67 and anti-PSA antibody immunostaining showed a positive correlation as the Gleason score 7 increased from (3+4) to (4+3).

Comparison between OCT B-scan and En Face Imaging for the Diagnosis of Early Macular Atrophy in Age-Related Macular Degeneration.

PURPOSE: The gradings of complete retinal pigment epithelium and outer retinal atrophy (cRORA) and incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) on spectral domain optical coherence tomography (SD-OCT) B-scans were compared with the grading of persistent choroidal hypertransmission defects (hyperTDs) on swept-source OCT angiography (SS-OCTA) en face images. DESIGN: Comparative diagnostic analysis of prospective study data METHODS: Patients with late nonexudative AMD underwent same day 6 × 6 mm macular scans using both SD-OCT (Spectralis® Heidelberg, 512 × 97, ART:9) and SS-OCTA (PLEX® Elite 9000, Carl Zeiss Meditec, 500 × 500 angio pattern) instruments. SS-OCTA and SD-OCT en face images were generated from a sub-retinal pigment epithelium slab positioned 64-400 µm below Bruch's membrane. SD-OCT B-scan gradings, which included an inspection of neighboring B-scans for the diagnosis of cRORA and iRORA, were performed at the Moran Eye Center, while gradings of en face images to identify persistent choroidal hyperTDs were performed at the Bascom Palmer Eye Institute and Tel Aviv Medical Center. RESULTS: There was a high degree of agreement (99.6%) between the gradings of cRORA lesions and persistent hyperTDs. However, 27.4% of iRORA lesions were found to be contained within persistent hyperTDs. This discrepancy was due to the finding that 27.5% of iRORA lesions were diagnosed as having a greatest linear horizontal dimension of < 250 µm on B-scans, but on en face images, these B-scan defined iRORA lesions were found to have a greatest linear dimensions in the non-horizontal dimension that were ≥ 250 µm. CONCLUSION: This report demonstrates the benefits of using en face OCT imaging to identify cRORA lesions and highlights the need to acquire dense raster B-scans with the grading neighboring B-scans when identifying iRORA lesions to assess the full extent of the iRORA lesions in the non-horizontal dimension. Even though neighboring B-scans were inspected, 27.5% of iRORA lesions were actually part of larger cRORA lesions when graded using an en face strategy.

Grading Histopathology Features of Graft-versus-host Disease in Animal Models; A Systematic Review.

Graft-versus-host disease (GvHD), a frequent and severe complication following allogeneic hematopoietic stem cell transplantation, presents substantial morbidity and mortality risks. The crucial role of histopathological examination in diagnosing and grading GvHD, particularly within animal models, is pivotal for elucidating disease mechanisms and assessing emerging therapies. This systematic review aims to critically evaluate the various grading systems for GvHD in animal models, emphasizing histopathological characteristics. In this endeavor, we meticulously examined original research articles sourced from PubMed, Scopus, Web of Science, and Google Scholar. Our findings reveal a diverse array of grading systems, each differing in the tissues examined, criteria evaluated, severity scoring scales, and the granularity of the information provided. Predominantly, skin, liver, and gut tissues are assessed, though some systems also incorporate lung and thymus evaluations. This review will delve into the alignment between clinical and histological grading in animal models of GvHD, also casting light on prospective advancements and the impact of technological progress. In conclusion, our analysis underscores the imperative need for uniform criteria and consistent application of grading systems. Such standardization is essential to foster comparability across studies and enhance the translation of preclinical discoveries into clinical applications.

How Morphology Shapes Survival in Invasive Squamous Cell Carcinoma of the Lung.

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma (SQCC) represents a significant proportion of human malignancies affecting various anatomical sites, including the lung. Understanding the prognostic factors is crucial for establishing effective risk stratification in these patients, as multiple critical aspects significantly impact overall survival. MATERIALS AND METHODS: A retrospective study was conducted on 99 patients with operable lung SQCC treated at a tertiary center. The exclusion criteria included patients under 18, those with in situ or metastatic SQCC, and those who received neoadjuvant therapy. The surgical specimens were re-analyzed, and data were collected on multiple variables, including pTNM staging, tumor characteristics, and overall survival (OS). The Kaplan-Meier survival analysis and Cox regression models were used to identify significant prognostic factors. RESULTS: The Kaplan-Meier analysis showed a median survival of 36 months with a 65.65% mortality rate. Significant factors influencing survival included keratinization, histological grading, tumor size and stage, pleural invasion, tumor cell arrangement, tumor budding, spread through air space (STAS), and mitotic index. A multiple Cox regression highlighted the nonkeratinizing tumors, advanced pT stages, single-cell invasion, and high mitotic index as key predictors of poorer outcomes. The nonkeratinizing tumors showed higher mortality and shorter median survival rates compared to keratinizing tumors. The tumor staging, cell arrangement, and tumor budding significantly impacted the survival curves. CONCLUSIONS: The study underscores the importance of detailed histopathological evaluations in lung SQCC. The nonkeratinizing tumors, advanced pT stage, single-cell invasion, and high mitotic index were associated with higher hazard rates, emphasizing the need for a comprehensive grading system incorporating these factors to improve prognostic accuracy and guide treatment strategies.

Expression of Ki-67 in Invasive Breast Carcinoma and Its Correlation With Different Clinicopathological Features.

Introduction Worldwide, breast cancer is still the most common cancer that affects women. Breast cancer prognosis is based on a number of clinical and pathological indicators. Further features are needed to predict early metastasis and prognosis of patients with breast carcinoma, as the current pathological characteristics, such as tumor differentiation, vascular infiltration, and TNM (tumor, node, and metastasis) staging, cannot fully describe the early metastatic biological behavior in breast carcinoma. High Ki-67 expression is seen to be associated with worse survival in cancer patients. Hence, this study was conducted to study the utility of Ki-67 as a prognostic marker in invasive breast carcinoma and its association with known clinicopathological factors. Methodology The study was a hospital-based cross-sectional study carried out in the Histopathology Section of the Department of Pathology, Shri BM Patil Medical College Hospital and Research Centre, Bijapur Lingayat District Education (BLDE) (Deemed to be University), Vijayapura. The study was conducted between September 1, 2022, and April 30, 2024. The study population consisted of 55 cases of mastectomy specimens of primary breast cancer admitted to our hospital. Data regarding the patient's age, tumor size, histological type, histological grade, lymph node status, and vascular invasion were noted from medical records. Immunohistochemical staining for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2/neu (HER2/neu) proto-oncogene, and Ki-67 markers was performed according to standard protocol. The relationship of Ki-67 with these clinicopathological parameters was analyzed statistically. Results In the current study, high-grade Ki-67 nuclear positivity was seen in 30 cases out of 55 cases, and low-grade Ki-67 was seen in the remaining 25 cases. The association of Ki-67 with tumor size and histological grade showed statistical significance with a p-value of less than 0.05 and 0.001, respectively. However, no statistical significance was seen with lymph node status, vascular invasion, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2/neu (HER2/neu) proto-oncogene status with p-values greater than 0.05. Conclusion The expression of Ki-67 was statistically significant with histological grading and tumor size in our study. Immunohistochemical determination of the Ki-67 proliferation index should be performed in routine cases of breast cancer to obtain clinically useful information on tumor aggressiveness as reflected in their proliferative rate. Hence, Ki-67 can be used as a predictive and prognostic marker in managing breast cancer patients.

The prevalence of intervertebral disc degeneration in the cervical, thoracic, and lumbar spine in asymptomatic cats.

OBJECTIVE: To investigate the prevalence and severity of intervertebral disc (IVD) degeneration (IVDD) throughout the spine of young, middle-aged, and old asymptomatic cats; identify differences between the cervical, thoracic, and lumbar spine; and investigate the influence of sex and neuter status on the prevalence of feline IVDD. METHODS: 60 cadavers were collected from asymptomatic cats and subdivided into 3 age groups: young (≥ 1 to < 6 years), middle aged (≥ 6 to < 12 years), and old (≥ 12 years). T2 weighted sagittal MRI studies of the spine were obtained. Each IVD was graded according to the modified Pfirrmann grading for feline IVDD. Cumulative link mixed models were used to analyze the significance of spinal region, age, sex, and neuter status on the degenerative state of the IVDs. RESULTS: A total of 1,544 IVDs were evaluated; 884 (57.3%), 425 (27.5%), 147 (9.5%), 82 (5.3%), and 6 (0.4%) were graded Pfirrmann 1, 2, 3, 4, and 5, respectively. Irrespective of spinal region, middle-aged cats (OR, 4.03; P < .01) and old cats (OR, 12.5; P < .01) had significantly higher odds for IVDD compared to young cats. For old cats, thoracic (OR, 4.44; P < .01) and cervical IVDs (OR, 2.76; P < .01) had significantly higher odds of degenerating compared to lumbar IVDs. No significant effect of sex (P = .81) and neuter status (P = .61) was found. CLINICAL RELEVANCE: The prevalence of feline IVDD significantly increases with progressive age, with the thoracic and cervical IVDs showing the highest odds for degeneration. However, extreme stages of IVDD were only occasionally observed.

Expression and diagnostic value of abnormal prothrombin and osteopontin in hepatocellular carcinoma with cirrhosis.

OBJECTIVE: To investigate the expression levels of prothrombin induced by vitamin K absence-II (PIVKA-II) and osteopontin (OPN) in patients with hepatocellular carcinoma (HCC) and cirrhosis, and to evaluate their potential as markers for cirrhosis severity. METHODS: This retrospective study included 84 patients with HCC and cirrhosis treated at the Liver Disease Center of the 904th Hospital from January 2021 to December 2023, forming the cirrhosis group. Fifty healthy individuals undergoing routine physical examinations during the same period comprised the control group. We compared cirrhosis-related indicators and serum levels of PIVKA-II and OPN between the two groups and analyzed the relationships between these biomarkers, liver cancer-related indicators, Child-Pugh grades, tumor size, and their diagnostic value using receiver operating characteristic (ROC) curve analysis. RESULTS: The cirrhosis group showed significantly higher levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), total bilirubin (TBIL), alpha-fetoprotein (AFP), OPN, and PIVKA-II compared to the control group (all P < 0.05). Conversely, levels of hemoglobin (Hb), white blood cells (WBC), platelets (PLT), and albumin (ALB) were significantly lower (all P < 0.05). Serum levels of OPN, PIVKA-II, AFP, TBIL, PT, and Child-Pugh scores were positively correlated, with correlation coefficients (r values) of 0.678, 0.634, 0.529, 0.617, 0.479, 0.551, 0.620, and 0.054, respectively (all P < 0.05). These markers were negatively correlated with ALB levels, with r values of -0.480 and -0.533 (both P < 0.05). Additionally, higher PIVKA-II and OPN levels were associated with larger tumors (> 3 cm) and more advanced cirrhosis stages (P < 0.05). Over a two-year follow-up, 12 patient deaths were recorded, with deceased patients showing higher levels of PIVKA-II, OPN, and AFP than those in the control group. ROC curve analysis revealed that AFP had a sensitivity of 98.8% and specificity of 82.0% in diagnosing HCC with cirrhosis. OPN achieved a sensitivity of 93.82% and a specificity of 88.0% for diagnosing cirrhosis, while PIVKA-II showed a sensitivity of 98.8% and a specificity of 80.0%. CONCLUSION: Serum levels of PIVKA-II and OPN correlate significantly with HCC presence, cirrhosis severity, Child-Pugh grading, and patient prognosis. Their combined diagnostic use enhances detection rates of HCC with cirrhosis and holds substantial clinical value, recommending their incorporation into clinical practice.

Clinical Profile of Leg Symptoms and Reflux in the Legs From Varicose Veins Disease Reported at a Tertiary Healthcare Institute in Jharkhand, India.

Background Varicose veins, affecting 8-10% of the population, are categorized as primary or secondary, depending on the etiology. The aim of the study is to assess the clinical profile of leg symptoms and reflux in the legs of varicose veins disease among patients reported in a tertiary hospital. Patients and methods An institution-based cross-sectional exploratory study comprising 56 patients with reflux in legs of varicose veins disease selected through purposive sampling, conducted in the OPD (outpatient department), general surgery, AIIMS (All India Institute of Medical Sciences) Deoghar. The standardized study instrument includes the Aberdeen varicose veins questionnaire, and patients' symptoms and concerns questionnaire, followed by a brief clinical examination based on CEAP (clinical, etiological, anatomical, and pathophysiological) classification and VCSS (venous clinical severity score) for C5/6 and color-flow duplex imaging of both lower limbs. Descriptive and inferential statistics were used for data analysis using IBM SPSS Statistics for Windows, Version 23 (IBM Corp., Armonk, NY). Results Bilateral presentation of the disease had been seen in 57.1% (n=32) participants, and the common history of present illness reported by participants included swelling along the veins (n=55, 98.2%), pain (n=51, 91.1%), and discoloration (n=33, 58.9%). The clinical grading revealed that most participants, i.e., 87.5% (n=49) had C2 and 75% (n=42) had C3 disease. The majority of participants 96.4% (n=54) suffered from primary varicose veins. Furthermore, all subjects exhibited superficial vein involvement, along with one individual having deep vein involvement and a few participants (n=35, 62.5%) having perforators. With this, the majority of participants (n=55, 98.2%) showed reflux pathology. Conclusion Varicose veins typically afflict men in their 40s and 50s who work in positions of extended standing. Limited awareness in the Santhal Pargana division, Jharkhand state, India may result in poor healthcare outcomes. Improving public awareness may help lessen disease-related consequences.

Comparison Between Conventional and Variable-Angle Locking Compression Plates in Complex Proximal Tibia Fractures.

BACKGROUND: Proximal tibial fractures, particularly those involving the tibial plateau, are complex injuries that require careful management to restore knee function and prevent long-term disability. Recent advancements have introduced variable-angle locking compression plates (VALCP) as a potential alternative to the widely used fixed-angle locking plating techniques. These plates allow for more precise screw placement, potentially improving fixation and clinical outcomes. The goal of this study was to find out how well conventional locking plates and VALCP treat Schatzker's type I, II, and III tibial plateau fractures in terms of clinical, functional, and radiological outcomes. We evaluated the outcomes using the Rasmussen functional and radiological grading systems, as well as the Oxford Knee Score (OKS). METHODS: This prospective study was undertaken by a tertiary care medical institute from January 2020 to August 2021. The study included a total of 60 patients with Schatzker's type I, II, and III tibial plateau fractures. These patients were randomly assigned to two groups, with each group consisting of 30 patients. Conventional locking compression plates (CLCP) treated one group, while VALCP treated the other. Clinical, functional, and radiological outcomes of patients were evaluated using the OKS, Rasmussen's functional grading system, and Rasmussen's radiological grading system. Additionally, the study documented and examined the duration of the surgical procedure, the stability of the fixation, and any complications that occurred in the postoperative phase over a span of six months. RESULTS: The study included 52 males and eight females, aged 19 to 65 years. The mean age was 42.66 years for the conventional LCP group and 35.6 years for the VALCP group. Road traffic accidents were the most common cause of injury, with 86.67% in the VALCP group and 70% in the conventional group. In both groups, the majority of fractures were Schatzker type II. At the six-month follow-up, 60% of VALCP patients had excellent functional outcomes compared to 50% in the conventional group. Radiologically, 80% of VALCP patients had excellent results versus 73.33% in the conventional group. The OKS showed that 86.67% of VALCP patients had excellent results, compared to 73.33% in the conventional group. While VALCP showed slightly better outcomes, the differences were not statistically significant. Complications were minimal, with 90% of VALCP and 86.67% of conventional LCP patients experiencing no complications. CONCLUSION: The small number of patients, short-term study, and heterogeneity of fractures constitute a limitation of this study. VALCP plating in tibial plateau fractures is a good treatment modality because it seems to improve fixation, provides early mobilization, and has excellent to good functional and radiological outcomes. However, no significant difference in functional and radiological outcomes was found between the conventional and VALCP groups.