Artificial intelligence-based recurrence prediction outperforms classical histopathological methods in pulmonary adenocarcinoma biopsies.

INTRODUCTION: Between 10 and 50% of early-stage lung adenocarcinoma patients experience local or distant recurrence. Histological parameters such as a solid or micropapillary growth pattern are well-described risk factors for recurrence. However, not every patient presenting with such a pattern will develop recurrence. Designing a model which can more accurately predict recurrence on small biopsy samples can aid the stratification of patients for surgery, (neo-)adjuvant therapy, and follow-up. MATERIAL AND METHODS: In this study, a statistical model on biopsies fed with histological data from early and advanced-stage lung adenocarcinomas was developed to predict recurrence after surgical resection. Additionally, a convolutional neural network (CNN)-based artificial intelligence (AI) classification model, named AI-based Lung Adenocarcinoma Recurrence Predictor (AILARP), was trained to predict recurrence, with an ImageNet pre-trained EfficientNet that was fine-tuned on lung adenocarcinoma biopsies using transfer learning. Both models were validated using the same biopsy dataset to ensure that an accurate comparison was demonstrated. RESULTS: The statistical model had an accuracy of 0.49 for all patients when using histology data only. The AI classification model yielded a test accuracy of 0.70 and 0.82 and an area under the curve (AUC) of 0.74 and 0.87 on patch-wise and patient-wise hematoxylin and eosin (H&E) stained whole slide images (WSIs), respectively. CONCLUSION: AI classification outperformed the traditional clinical approach for recurrence prediction on biopsies by a fair margin. The AI classifier may stratify patients according to their recurrence risk, based only on small biopsies. This model warrants validation in a larger lung biopsy cohort.

Surface Characterization of Stainless Steel 316L Coated with Various Nanoparticle Types.

Background: Material tribology has widely expanded in scope and depth and is extended from the mechanical field to the biomedical field. The present study aimed to characterize the nanocoating of highly pure (99.9%) niobium (Nb), tantalum (Ta), and vanadium (V) deposited on 316L stainless steel (SS) substrates which considered the most widely used alloys in the manufacturing of SS orthodontic components. To date, the coating of SS orthodontic archwires with Nb, Ta, and V using a plasma sputtering method has never been reported. Nanodeposition was performed using a DC plasma sputtering system with three different sputtering times (1, 2, and 3 hours). Results: Structural and elemental analyses were conducted on the deposited coatings using XRD, FESEM, and EDS showing a unique phase of coating metals over their substrates with obvious homogeneous even deposition. A highly significant positive correlation was found between sputtering time and thickness of the achieved coatings. AFM revealed a reduction in the surface roughness of 316L SS substrates sputtered with all coating materials, significantly seen in V coatings. Conclusions: Sputtering time and coating material play a significant role in terms of microstructure and topography of the achieved coatings being the best in the Ta group; moreover, surface roughness was significantly improved by V coatings. Likewise, it is found to be sputtering time independent for all used coatings.

The value of prognostic and predictive parameters in early-stage lung adenocarcinomas: A comparison between biopsies and resections.

INTRODUCTION: Since lung adenocarcinoma (LUAD) biopsies are usually small, it is questionable if their prognostic and predictive information is comparable to what is offered by large resection specimens. This study compares LUAD biopsies and resection specimens for their ability to provide prognostic and predictive parameters. METHODS: We selected 187 biopsy specimens with stage I and II LUAD. In 123 cases, subsequent resection specimens were also available. All specimens were evaluated for growth pattern, nuclear grade, fibrosis, inflammation, and genomic alterations. Findings were compared using non-parametric testing for categorical variables. Model performance was assessed using the area under the curve for both biopsies and resection specimens, and overall (OS) and disease-free survival (DFS) was calculated. RESULTS: The overall growth pattern concordance between biopsies and resections was 73.9%. The dominant growth pattern correlated with OS and DFS in resected adenocarcinomas and for high-grade growth pattern in biopsies. Multivariate analysis of biopsy specimens revealed that T2-tumors, N1-status, KRAS mutations and a lack of other driver mutations were associated with poorer survival. Model performance using clinical, histological and genetic data from biopsy specimens for predicting OS and DSF demonstrated an AUC of 0.72 and 0.69, respectively. CONCLUSIONS: Our data demonstrated the prognostic relevance of a high-grade growth pattern in biopsy specimens of LUAD. Combining clinical, histological and genetic information in one model demonstrated a suboptimal performance for DFS prediction and good performance for OS prediction. However, for daily practice, more robust (bio)markers are required to predict prognosis and stratify patients for therapy and follow-up.

Aortic arch thrombosis complicated by an embolic stroke in a patient with COVID-19: A case report.

INTRODUCTION: Aortic thrombosis is an uncommon condition with serious embolic complications. COVID-19 is currently recognized to be associated with both venous and arterial thrombosis. However, only a limited number of COVID-19 cases associated with aortic thrombosis have been reported in the literature since the beginning of the pandemic. CASE PRESENTATION: A 66-year-old lady was admitted to our hospital with acute ischemic stroke. Floating aortic arch thrombus was detected incidentally on CT imaging. Interestingly, the patient reported a history of fever and cough and was found to have COVID-19 pneumonia based on nasopharyngeal polymerase chain reaction (PCR) and imaging. The patient received three months of anticoagulant therapy, and repeated imaging study did not reveal any aortic thrombus. CLINICAL DISCUSSION: COVID-19 related aortic thrombosis has been reported chiefly in severe cases. The SARS-CoV-2 can directly infect the endothelium of the vessels, which might explain the occurrence of arterial thrombosis in milder COVID-19 cases with the absence of the hyperinflammatory state. The management guideline for aortic thrombosis is scarce and based only on case reports and series. CONCLUSION: Aortic thrombosis is a devastating condition that can be easily missed without clinical suspicion. Our patient developed acute ischemic stroke, most likely embolic originating from the aortic thrombus. The clinician should consider this condition in any COVID-19 patient presenting with thromboembolic events, such as stroke or acute limb ischemia. Further study is required to explain the pathophysiology of arterial/venous thrombosis in mild-moderate COVID-19 cases.

An Incidental Finding of Scalp Angiosarcoma: A Case Report.

Scalp angiosarcoma is a malignant tumor of the vascular endothelial cells. We present the case of an elderly male patient with a history of urinary bladder transitional cell cancer and trauma (falling on his head) who came to the emergency department with scalp swelling, which was found on brain imaging to infiltrate into the skull, reaching the dural matter. A biopsy was done, which showed angiosarcoma, which is rare for that area. Further studies are recommended to establish if there is a possible genetic association between both cancers (urinary bladder transitional cell cancer and scalp angiosarcoma) as both arise from endothelial cells.

An assessment of Pakistani pharmacy and medical students’ knowledge of black box warnings / Una evaluación del conocimiento de estudiantes de medicina y de farmacia en Pakistán sobre alertas de medicamentos / Uma avaliação sobre o acesso de estudantes paquistaneses de medicina e farmácia ao conhecimento das advertências das caixas de tarja preta

Food and Drug Administration delivers the black box warnings (BBW) which should appear on the leaflets of medicines for patient awareness and the prescription of drugs indicating its highly fatal adverse effects to human body. The aim of this study was to assess the knowledge of Pakistani pharmacy and medical students about BBW. A questionnaire containing contents about BBW was given to the 1st, 2nd and 3rd professional year pharmacy and medical students from different pharmacy and medical institutes. A 76 percent survey response rate was observed. It was observed that student’s knowledge about BBW improves in association with the promotion in professional years of pharmacy and medical education. The results indicate that student’s knowledge about black box increases with the study level. Training in black box warnings should be implemented in pharmacy and medical institutions influencing the meaningful ways to educate and train pharmacy and medical students, and help these students to get recent knowledge about black box warnings so that, in future, they may perform an ethical practice in their respective fields.

La Agencia Reguladora de Alimentos y Medicamentos comunica alertas sobre medicamentos (AM), que debieran aparecer en los prospectos de medicinas, para el conocimiento de los pacientes y la prescripción de medicamentos, indicando sus efectos adversos fatales para el cuerpo humano. El objetivo de este estudio es averiguar el conocimiento de estudiantes de medicina y de farmacia sobre AM. Se entregó un cuestionario con contenidos sobre AM a estudiantes de farmacia y de medicina de primero a tercer año de diferentes institutos médicos y farmacéuticos. Se obtuvo un 76 por ciento de respuesta. Se observó que el conocimiento de los estudiantes sobre AM mejora asociado a la promoción en años profesionales de medicina y farmacia. Los resultados indican que el conocimiento de los estudiantes sobre alerta de medicamentos aumenta con el nivel de estudio. Debería implementarse la formación sobre alerta de medicamentos en farmacia y medicina y ayudar a los estudiantes a tener conocimiento actual sobre alerta de medicamentos de forma que, en el futuro, puedan realizar prácticas éticas en sus campos respectivos.

A Food and Drug Administration disponibiliza as advertências das caixas de tarja preta (BBW) que devem aparecer em bulas de medicamentos para conscientização de pacientes e a prescrição de drogas, indicando seus efeitos adversos altamente fatais para o corpo humano. O propósito deste estudo foi o de de inteirar a cerca do conhecimento de estudantes de medicina e farmácia sobre BBW. Um questionário com conteúdos sobre BBW foi dado a estudantes de farmácia e medicina, do 1º, 2º e 3º ano de diferentes instituições de ensino em farmácia e medicina. Foi observada uma taxa de 76 por cento de resposta dos pesquisados. Observou-se que o conhecimento de estudantes sobre BBW melhora quando se associa à promoção para anos seguintes da educação nas faculdades de farmácia e medicina. Os resultados indicam que o conhecimento dos estudantes sobre as caixas de tarja preta aumenta com o nível de estudo. Treinamento com caixas de tarja preta pode ser implementado em instituições de ensino de farmácia e medicina, influenciando de modo significativo as formas de educação e treinamento de estudantes de farmácia e medicina, e,assim, ajudar estes estudantes a obter conhecimentos recentes sobre medicamentos de tarja preta de modo que, no futuro, elas possam exercer uma prática ética em seus respectivos campos de atuação profissional.

Prevention of oral mucositis in children receiving cancer therapy: a systematic review and evidence-based analysis.

This systematic review investigated, critically appraised, and rated the evidence on agents used to prevent oral mucositis in children. A comprehensive search of the relevant literature was performed up to December 2011. Articles were included according to the inclusion/exclusion criteria and were critically appraised for validation and quality assessment using a checklist consisting of 18 categories. Each article was then rated for its strength of evidence. 16,471 articles were retrieved from 19 different databases and then reduced to 27 articles that fit the inclusion criteria. Five articles on oral care protocols supported their use to prevent oral mucositis in children. Seven articles on chlorhexidine mouthwash and three on laser therapy had conflicting evidence of its use. The preventative agents that were supported by one or two articles included: benzydamine mouthwash, iseganan mouthwash, granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash, oral/enteral glutamine, oral propantheline and cryotherapy, oral cryotherapy, oral sucralfate suspension, prostaglandin E2 tablets, and chewing gum. The reduction in the rates of occurrence of oral mucositis when using agents of fair (B) to good (A) evidence ranged from 22% to 52%. In conclusion, this review suggests the use of oral care protocols to prevent oral mucositis in children because of their strength of evidence (fair to good). The authors suggest avoiding agents with fair to good evidence against their use (oral sucralfate suspension, prostaglandin E2 tablets, and GM-CSF mouthwash). Agents with conflicting evidence (chlorhexidine mouthwash (used solely), laser therapy, and glutamine) should also be avoided until further research confirms their efficacy.

Implementation of a hospital oral care protocol and recording of oral mucositis in children receiving cancer treatment : a retrospective and a prospective study.

PURPOSE: This retrospective/prospective study was carried out to implement a standardized hospital oral care protocol and record the incidence of oral mucositis for inpatients with childhood cancer. METHODS: The implementation process included stages of collaboration, consultation, education, and evaluation. The retrospective part of the study documented the existing hospital oral care protocol and audited medical records of all pediatric patients diagnosed with cancer over a 12-month period. The frequency of recorded oral mucositis and the rate of referral to the pediatric dentistry department were assessed. Following evaluation of the retrospective study, the literature was searched to create a new hospital oral care protocol. Referral to the dental department was standardized and frequent in-service presentations were given to staff. The oral mucositis scale was recorded daily for all inpatients, and compliance rates were assessed. RESULTS: Fifty-nine patients' medical records were audited during the retrospective study. Oral mucositis prevalence was clearly documented at 34%, while an additional 20% lacked a definitive diagnosis. During the prospective study, 38 patients were followed and had a verified incidence of oral mucositis of 33%. The rate of compliance of implementing the oral mucositis scale improved from 41% during the first 4 months to 87% during last 3 months. Referral rates to the dental department increased from 53% during the retrospective study to 100% during the prospective study. CONCLUSIONS: Mutual understanding and collaboration between the oncology and dental departments in hospitals is crucial for standardizing patient care and for improving oral care standards.

A comparative study of the health care systems of Canada and Saudi Arabia: lessons and insights.

INTRODUCTION: Understanding the structure of a health care system is essential in improving public health policies and health outcomes. OBJECTIVES: To describe and compare the health care systems of Canada and Saudi Arabia; to discuss possible lessons that could be learned from both for policy-making purposes. METHODS: A comprehensive method was used to describe the national health care systems of both countries. For each country, the system is described by: context, ownership, delivery, financing, organisational structure, target groups, and comprehensiveness of services. RESULTS: In Canada, the Medicare system provides comprehensive medical services except for dental, optometric, chiropractic, pharmacologic and home care services. The dental care system is financed privately (94%) and is owned and delivered by private for-profit dental practitioners. In Saudi Arabia, the government sector is owned, delivered, and financed by the government and provides free comprehensive medical and dental services. The same services are provided by the private sector, but under governmental supervision. Among the relevant lessons: access to care, accountability, quality assurance, mix and reimbursement of providers. CONCLUSIONS: Canada can learn about different approaches to socialising the dental care system. Saudi Arabia can improve the implementation of quality assurance practices and management.