Artificial intelligence-powered optimization of KI-67 assessment in breast cancer: enhancing precision and workflow efficiency. a literature review.

Breast Cancer (BC) has evolved from traditional morphological analysis to molecular profiling, identifying new subtypes. Ki-67, a prognostic biomarker, helps classify subtypes and guide chemotherapy decisions. This review explores how artificial intelligence (AI) can optimize Ki-67 assessment, improving precision and workflow efficiency in BC management. The study presents a critical analysis of the current state of AI-powered Ki-67 assessment. Results demonstrate high agreement between AI and standard Ki-67 assessment methods highlighting AI's potential as an auxiliary tool for pathologists. Despite these advancements, the review acknowledges limitations such as the restricted timeframe and diverse study designs, emphasizing the need for further research to address these concerns. In conclusion, AI holds promise in enhancing Ki-67 assessment's precision and workflow efficiency in BC diagnosis. While challenges persist, the integration of AI can revolutionize BC care, making it more accessible and precise, even in resource-limited settings.

Mechanical Performance of Polymeric ARGF-Based Fly Ash-Concrete Composites: A Study for Eco-Friendly Circular Economy Application.

At present, low tensile mechanical properties and a high carbon footprint are considered the chief drawbacks of plain cement concrete (PCC). At the same time, the combination of supplementary cementitious material (SCM) and reinforcement of fiber filaments is an innovative and eco-friendly approach to overcome the tensile and environmental drawbacks of plain cement concrete (PCC). The combined and individual effect of fly ash (FA) and Alkali resistance glass fiber (ARGF) with several contents on the mechanical characteristics of M20 grade plain cement concrete was investigated in this study. A total of 20 concrete mix proportions were prepared with numerous contents of FA (i.e., 0, 10, 20, 30 and 40%) and ARGF (i.e., 0, 0.5, 1 and 1.5%). The curing of these concrete specimens was carried out for 7 and 28 days. For the analysis of concrete mechanical characteristics, the following flexural, split tensile, and compressive strength tests were applied to these casted specimens. The outcomes reveal that the mechanical properties increase with the addition of fibers and decrease at 30 and 40% replacement of cement with fly ash. Replacement of cement at higher percentages (i.e., 30 and 40) negatively affects the mechanical properties of concrete. On the other hand, the addition of fibers positively enhanced the flexural and tensile strength of concrete mixes with and without FA in contrast to compressive strength. In the end, it was concluded that the combined addition of these two materials enhances the strength and toughness of plain cement concrete, supportive of the application of an eco-friendly circular economy. The relationship among the mechanical properties of fiber-reinforced concrete was successfully generated at each percentage of fly ash. The R-square for general relationships varied from (0.48-0.90) to (0.68-0.96) for each percentage of FA fiber reinforced concrete. Additionally, the accumulation of fibers effectively boosts the mechanical properties of all concrete mixes.

Revisiting the Reliability of the Endoscopy and Sedation-Assisted High-Resolution Esophageal Motility Assessment.

BACKGROUND: Esophageal high-resolution manometry (HRM) is performed for evaluation of dysphagia or the pre-operative evaluation before esophageal surgery. The esophageal manometry parameters, interpreted as per the Chicago classification (CC), are meant to be acquired in an awake state. At times, the patient intolerance or inability to traverse the manometry catheter across the esophagogastric junction (EGJ) renders incomplete esophageal motility evaluation; hence, sedation or endoscopy assistance is required. There have been concerns raised regarding the use of sedation and resultant alteration of the manometry parameters. The aims were to study the effects of intravenous sedation on esophageal motility parameters and analyze its impact on outcomes of patients with dysphagia who are intolerant to awake manometry procedure. METHODS: The study population comprised patients who had sedation or the endoscopy assistance for the HRM. The indication for HRM, necessity for the sedation, manometry findings, barium esophagogram results, procedural timings and patient outcomes were reviewed. The diagnostic impact of the 10% correction in integrated relaxation pressure (IRP) was also studied. RESULTS: There were 14 patients from 179 awake manometry procedures that required the sedation or the endoscopy assistance. The mean age was 60.7 years and there was equal gender distribution. Dysphagia (n = 9) remained the predominant indication for the HRM, followed by the pre-operative evaluation for the esophageal surgery (n = 5). In eight patients, awake manometry failed due to the coiling of the catheter above the EGJ and six patients were intolerant to awake catheter insertion technique. Six patients were diagnosed with achalasia and two with EGJ obstruction. The correction of the possible 10% inflation of the IRP did not alter the final diagnosis in majority except one patient with the EGJ obstruction. The findings of the barium esophagogram corroborated the manometry diagnosis. CONCLUSION: Esophageal HRM should be done in awake state as much as possible. Sedation may be a feasible option as against aborting the further workup in patients who fail with current techniques involving awake catheter insertion. However, one needs to be mindful of sedation effects on manometry parameters and interpret results carefully.

Predicting the presence of adenomatous polyps during colonoscopy with National Cancer Institute Colorectal Cancer Risk-Assessment Tool.

AIM: To evaluate the National Cancer Institute (NCI) Colorectal Cancer (CRC) Risk Assessment Tool as a predictor for the presence of adenomatous polyps (AP) found during screening or surveillance colonoscopy. METHODS: This is a retrospective single center observational study. We collected data of adenomatous polyps in each colonoscopy and then evaluated the lifetime CRC risk. We calculated the AP prevalence across risk score quintiles, odds ratios of the prevalence of AP across risk score quintiles, area under curves (AUCs) and Youden's indexes to assess the optimal risk score cut off value for AP prevalence status. RESULTS: The prevalence of AP gradually increased throughout the five risk score quintiles: i.e., 27.63% in the first and 51.35% in the fifth quintile. The odd ratios of AP prevalence in the fifth quintile compared to the first and second quintile were 2.76 [confidence interval (CI): 1.71-4.47] and 2.09 (CI: 1.32-3.30). The AUC for all patients was 0.62 (CI: 0.58-0.66). Youden's Index indicated the optimal risk score cutoff value discriminating AP prevalence status was 3.60. CONCLUSION: Patients with the higher NCI risk score have higher risk of AP and subsequent CRC; therefore, measures to increase the effectiveness of CRC detection in these patients include longer withdrawal time, early surveillance colonoscopy, and choosing flexible colonoscopy over other CRC screening modalities.

Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic.

Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care. Although there are several constraints in the development of PAT clinics, with increasing awareness about the usefulness of pre-operative risk assessments, growing bodies of literature, and evidence-based guidelines, these clinics are becoming a medical necessity for the improvement of perioperative care.