An annotated clinical image dataset for AI classification of malignant and potentially malignant oral lesions.

INTRODUCTION – Breast cancer remains the most frequent tumor in the female population and the fourth in mortality in the world population (GLOBOCAN 2020). With the aim of reducing mortality and at the same time de-escalating treatment, avoiding overtreatment, individualized therapy is increasingly being applied. The genomic signature of 70-genes, when stratifying patients into high and low risk of relapse, makes it possible to withdraw part of the cases of high clinical risk from chemotherapy treatment. However, the MINDACT study, which validated this signature, was carried out only in the European population, with no data on performance and outcomes in other populations with greater miscegenation. OBJECTIVE – To study the performance and outcomes of the 70-gene genomic signature (MammaPrint™) in a Brazilian population with a high ethnic miscegenation. METHODOLOGY – A retrospective cohort study was conducted in 953 women with breast cancer at high clinical risk, who underwent genomic analysis with the 70-gene platform (MammaPrint™), from January 2016 to December 2020. For the statistical evaluation, a descriptive analysis of the data with absolute and relative frequencies of the variables was performed. To verify the association between qualitative variables, the chi-square test was used. All analyzes were performed in the R 4.1.0 environment (R Core Team, 2021). Study approved by the Research Ethics Committee of the State University of Ponta Grossa (PR) - (CAAE: 12194219.4.0000.0105). RESULTS – The analysis of 955 cases from the AGEMABRA cohort (all at high clinical risk) showed 546 cases (57.2%) with low genomic risk and 409 cases (42.8%) with high genomic risk to MammaPrint™ (MP); when compared with data from the MINDACT study (46.2% low risk and 53.8% high risk) a significant difference was observed in the distribution for high and low risk in the two populations (p.< 0.001). After excluding patients with missing data, 409 cases of low- and high-risk MP were studied. The variables regarding age group, tumor diameter, number of affected lymph nodes, hormone receptors and HER2 overexpression showed no significant difference; within this same analysis, the tumor grade showed a higher incidence of grade 1 in the population with low genomic risk (6.6%) compared to high risk (2.9%) and grade 3 in high risk (13%) compared to low risk (5%) with p.< 0.001 (table 1). With an average follow-up of 40 months, the DMFS (disease metastatic free survival) found was 97.2%, being 97.8% for low risk and 96.2% for high risk (p.0.54). All patients with high-risk MP who progressed had used adjuvant chemotherapy, and all patients with low-risk MP who relapsed received only endocrine therapy. When compared to the MINDACT population, the AGEMA-BRA has more elderly patients, and smaller tumors with a lower histological grade (p.=< 0.001). CONCLUSION – The analysis of the Brazilian population submitted to the 70-gene genomic signature showed a greater proportional number of tumors with low genomic risk than in the test approval study, favoring its application with the aim of de-escalating systemic treatment in this population. Despite the low rate of disease progression in the AGEMA-BRA study, probably determined by the population with the best prognosis disease and the short follow-up, recurrence was similar in the high and low genomic risk groups, demonstrating the adequate selection of systemic therapy following the results of the MP. An increase in the sample size and longer follow-up are necessary to confirm the results found. Table 1. Characteristics of patients and tumor according to risk (AGEMA-BRA) Citation Format: Fabio Mansani, Ruffo Freitas-Junior. PERFORMANCE AND OUTCOMES OF THE 70-GENES SIGNATURE (MAMMAPRINT™) IN A POPULATION WITH MIDDLE INCOME – REAL WORLD STUDY (AGEMA-BRA) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-17-10.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.

European guidelines on cardiovascular disease prevention in clinical practice<SBT>Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts)

In response to escalating rates of cesarean section, the Norwegian Parliament in 2001 decreed that maternity units should be organized into separate units to differentiate between low and high risk deliveries. This action was based on the assumption that low risk patients were being subjected to unnecessary and possibly harmful interventions when treated together with high risk patients. Moreover, it was suggested that the calmer environment for low risk women and less need for medical interventions would achieve a better outcome for mother and child. Accordingly, a number of obstetrical departments were reorganized by physical separation of perceived high and low risk patients. However, the benefit of separate maternity units for low risk patients is questionable. A Cochrane review reported that births in home-like settings appeared to have only a marginally lower rate of cesarean births. No studies have examined the effect of separating low and high risk pregnancies on frequency of cesarean deliveries. This hospital-based registry study investigated whether assignment of women with low risk births to special maternity units reduced emergency cesarean section rates compared with giving birth in a unit with mixed cases. The patient population was comprised of women with intended vaginal delivery during 2001-2003 at 2 urban university hospitals in Norway. There were a total of 11,686 low and high risk deliveries. Data were obtained from standardized prenatal and perinatal health charts. The primary study outcome measure was the risk of emergency cesarean section. The risk of emergency cesarean section was higher in the low risk maternity unit compared with a maternity unit with both high and low risk women; the adjusted odds ratio was 1.4, with a 95% confidence interval of 1.2 to 1.6. These findings provide no support for the separation of maternity wards into high and low risk units. Lower rates of emergency cesarean section among the mixed cases may be due to the better maternity care of low risk women by personnel who are trained to manage high risk pregnancies.

3520 Background: Duration of adjuvant FOLFOX or CAPOX for stage III CC is being guided by pt stratification into low (T1-3N1) and high (T4 or N2) risk groups based on the IDEA study. We determined the relative contributions of clinical and molecular features for prediction of time-to-recurrence (TTR) and survival after recurrence (SAR) within each risk group. Methods: Stage III CC (N=5,430) from 2 trials of adjuvant FOLFOX ± cetuximab with similar outcome by study arm [NCCTG N0147 (Alliance), PETACC-8] were used. Tumors were analyzed for mismatch repair (dMMR vs pMMR), mutations in KRAS (exon 2) and BRAFV600E. Median pt follow-up was 83.4 months. Relative contributions to predicting outcome were assessed using χ2 (Harrell’s rms) based on multivariable (MV) Cox models. Results: N (50.8%) and T (31.8%) stage were the top two contributors to prediction of TTR which supports risk grouping. High risk (n=2566) vs low risk (n=2774) pts had poorer TTR (HR 2.7, 95% CI, 2.4-3.0) and SAR [HR 1.6 (1.4-1.9)], both p&lt;.0001. TTR: KRAS contributed the most to predicting TTR among high (58.6%) and low (51.1%) risk pts (Table). Contribution of MMR (16%) to predicting TTR was limited to low risk pts. Contribution of BRAFV600E to TTR was nearly 3-fold increased in high vs low risk pts. SAR: BRAFV600E contributed the most to predicting SAR, especially in high vs low risk pts (2-fold increase). Tumor sidedness and performance status (PS) were key contributors to SAR, but not TTR. MV associations: TTR: low risk, KRAS [HR 1.7 (1.4-2.3], MMR [HR 0.55 (.35-.87), gender (M/F) [HR 1.3 (1.0-1.5)], all p&lt;.04]; high risk: BRAF [HR 1.3 (1.1-1.7)], sidedness (R vs L) [HR 1.14 (1.0-1.3)], KRAS [HR 1.4 (1.2-1.6)], all p&lt;.04]. SAR: BRAF, sidedness, PS (all p&lt;.05). Conclusions: KRAS mutation was the strongest predictor of shorter TTR in both risk groups whereas BRAFV600E was the primary driver of SAR, especially in high risk pts. Support: U10CA180821, U10CA180882, U24CA196171; BMS, Pfizer, Sanofi. NCT00079274.[Table: see text]

The long-term cardiovascular outcomes of a population-based cohort presenting to the emergency department (ED) with chest pain and classified with a clinical risk stratification algorithm are not well documented. The Olmsted County Chest Pain Study is a community-based study that included all consecutive patients presenting with chest pain consistent with unstable angina presenting to all EDs in Olmsted County, Minnesota. Patients were classified according to the Agency for Health Care Policy and Research (AHCPR) criteria. Patients with ST elevation myocardial infarction and chest pain of noncardiac origin were excluded. Main outcome measures were major adverse cardiovascular and cerebrovascular events (MACCE) at 30 days and at a median follow-up of 7.3 years, and mortality through a median of 16.6 years.The 2271 patients were classified as follows: 436 (19.2%) as high risk, 1557 (68.6%) as intermediate risk, and 278 (12.2%) as low risk. Thirty-day MACCE occurred in 11.5% in the high-risk group, 6.2% in the intermediate-risk group, and 2.5% in the low-risk group (p < 0.001). At 7.3 years, significantly more MACCE were recorded in the intermediate-risk (hazard ratio [HR], 1.91; 95% confidence intervals [CI], 1.33-2.75) and high-risk groups (HR, 2.45; 95% CI, 1.67-3.58). Intermediate- and high-risk patients demonstrated a 1.38-fold (95% CI, 0.95-2.01; p = 0.09) and a 1.68-fold (95% CI, 1.13-2.50; p = 0.011) higher mortality, respectively, compared to low-risk patients at 16.6 years. At 7.3 and at 16.6 years of follow-up, biomarkers were not incrementally predictive of cardiovascular risk.In conclusion, a widely applicable rapid clinical algorithm using AHCPR criteria can reliably predict long-term mortality and cardiovascular outcomes. This algorithm, when applied in the ED, affords an excellent opportunity to identify patients who might benefit from a more aggressive cardiovascular risk factor management strategy.

534 Robotically assisted MIDCAB surgery may have similarly favourable outcomes in high risk and low risk patients

Improved prediction of early post-discharge death or rehospitalization after admission for acute heart failure is a major unmet need. We evaluated the value of biomarkers to predict either low or high risk for early post-discharge events. A total of 1653 patients enrolled in the PROTECT trial who were discharged alive and with available blood samples were included. Forty-seven biomarkers were serially evaluated in these patients. Measurement closest to discharge was used to evaluate the predictive value of biomarkers for low and high post-discharge risk. Patients were classified as 'low risk' if post-discharge 30-day risk of death or heart failure rehospitalization was <5% while risk >20% was used to define 'high risk'. Cut-off values that yielded a 95% negative predictive value and a 20% positive predictive value were identified for each biomarker. Partial area under the receiver operating characteristic curve (pAUC) in the high-sensitivity and high-specificity regions was calculated to compare low-risk and high-risk predictive values. Of patients analysed, 193 (11.7%) patients reached the 30-day death or heart failure rehospitalization outcome. We found marked differences between low-risk and high-risk predictors. Cardiac-specific troponin I was the strongest biomarker for low-risk prediction (pAUC = 0.552, 95% confidence interval 0.52-0.58) while endothelin-1 showed better performance for high-risk prediction (pAUC = 0.560, 95% confidence interval 0.53-0.59). Several biomarkers (individually and in combination) provided added predictive value, on top of a clinical model, in both low-risk and high-risk regions. Different biomarkers predicted low risk vs. high risk of early post-discharge death or heart failure readmission in patients hospitalized for acute heart failure.

Robotic aortic valve replacement

Scientific and Standardization Committee Communication: Guidance document on the periprocedural management of patients on chronic oral anticoagulant therapy: Recommendations for standardized reporting of procedural/surgical bleed risk and patient‐specific thromboembolic risk

Preeclampsia and associated hypertensive disorders of pregnancy represent a leading cause of global maternal and neonatal morbidity and mortality. Identification of women at high risk for developing preterm-preeclampsia and prophylaxis with low-dose aspirin has the potential to significantly reduce the rate of preterm-preeclampsia. In addition, risk assessment and monitoring of women in the second and third trimester of pregnancy, to aid in early detection of evolving disease, timely referral to specialist care, and active monitoring of women with confirmed or suspected preeclampsia is essential for improving maternal and neonatal outcomes. The angiogenesis-related biomarkers sFlt-1 and PlGF have been shown to have clinical value to aid in the prediction, diagnosis, and risk stratification of preeclampsia when used either alone or in combination with other risk factors. However, currently there is no consensus on the optimum strategy to link first trimester screening for preterm-preeclampsia with appropriate second and third trimester risk assessment strategies. This opinion paper will outline the current evidence for first trimester preeclampsia screening and prevention, as well as the evidence for various risk stratification approaches for detection of evolving preeclampsia through the second and third trimesters of pregnancy, and proposes a potential model integrating these tools. This article is protected by copyright. All rights reserved.

The Framingham Heart Study has contributed importantly to understanding of the causes of coronary heart disease (CHD), stroke, and other cardiovascular diseases. Framingham research has helped define the quantitative and additive nature of these causes or, as they are now called, “cardiovascular risk factors.”1 The National Cholesterol Education Program (NCEP)2 3 has made extensive use of Framingham data in developing its strategy for preventing CHD by controlling high cholesterol levels. The NCEP guidelines2 3 adjust the intensity of cholesterol-lowering therapy with absolute risk as determined by summation of risk factors. The National High Blood Pressure Education Program (NHBPEP) has set forth a parallel approach for blood pressure control. In contrast to the NCEP,2 however, earlier NHBPEP reports issued through the Joint National Committee4 did not match the intensity of therapy to absolute risk for CHD. “Normalization” of blood pressure is the essential goal of therapy regardless of risk status. Blood pressure–lowering therapy is carried out as much for prevention of stroke and other cardiovascular complications as for reduction of CHD risk. Nonetheless, risk assessment could be important for making decisions about type and intensity of therapy for hypertension. Thus, the most recent Joint National Committee report5 gives more attention to risk stratification for adjustment of therapy for hypertension. Although Framingham data have already been influential in the development of national guidelines for risk factor management, the opportunity may exist for both cholesterol and blood pressure programs to draw more extensively from Framingham results when formulating improved risk assessment guidelines and recommending more specific strategies for risk factor modification. The American Heart Association has previously used Framingham risk factor data to prepare charts for estimating CHD risk. Framingham investigators of the National Heart, Lung, and Blood Institute prepared the original charts and have now revised …

Dear Editor, Oral lesions may be as a manifestation of mucocutaneous or systemic disease or a side effect of treatment [1] including laceration, erosion, vesicle, traumatic lesions (such as cheek biting, denture induced lesions), infections (candidiasis, warts,..), chemical or heat burn lesions, drug complications, radiotherapy effects and specific lesions in pemphigus vulgaris, lichen planus and aphtus stomatitis.[1][2][3][4][5] Drug-induced lesions are very different and compromise xerostomy, stomatitis, erosions, bullous lesions similar to pemphigus, candidial or bacterial infections.[5][6][7] Oral lesions after chemotherapy were noticed in12-80% of patients. Good hygiene of oral cavity and teeth has important preventive role for these lesions. Oral mucositis is seen in 1/3 of patients with solid tumors. Leucopenia, fever and long duration chemotherapy are risk factors in induction of oral mucositis. Antifungal treatment with incomplete or complete gastrointestinal absorption can prevent oral candidiasis and reduce clinical features of the infection.[4][5][6][7] Oral candidiasis is one of the causes of morbidity in patients with acute leukemia after chemotherapy. It also increases the risk of esophagus candidiasis.[7] Oral lesions after chemotherapy such as mucositis, oral bleeding, infections and xerostomy may be very severe and lead to interruption of chemotherapy. Mucositis is one important factor in limitation of upper limit of drug doses and commonest cause of morbidity in post-chemotherapy patients. [3] Dental decay, previous history of oral lesions, smoking, bad oral hygiene and some drug consumptions were shown as risk factors of mucositis. Antifungal drugs and ice chips have significant effects in prevention of mucositis after chemotherapy.[5][6] This descriptive-analytical study was performed on 130 patients who underwent chemotherapy in Babol University of Medical Science, Northern Iran. A questionnaire was provided including information about sex, age and type of lesions before and after chemotherapy completed for every patient. Data were analyzed by SPSS software (version 11, Chicago, IL, USA) using t and Chi-Square tests. Sixty six (50.8%) did not have any lesions at admission time or after chemotherapy. Thirty three (25.4%) cases at the admission time and after chemotherapy had oral lesions and 31 (23.8%) cases after chemotherapy experienced oral lesions. Types of oral lesions before and after chemotherapy are depicted in Table 1. Table 1 Prevalence and percent of oral lesions in patients undergoing chemotherapy in Babol Medical Science University, Iran. One of the important points in our study was the significant correlation between age and oral complications before and after chemotherapy. Mean age of patients without oral lesions before and after chemotherapy was 48.7±17.6 years and mean age of cases that had oral lesions after chemotherapy was 58.8±11.7 years (p=0.005). Old age was one of the important risk factor for oral lesions after chemotherapy. Type of cancer did not have a significant correlation with oral lesions. Before chemotherapy, 22.8% of cases of hematological cancers, 22.9% of gastrointestinal carcinoma and 45.5% patients with other carcinomas had oral lesions. After chemotherapy, 50% of patients with hematological cancers, 44.4% with gastrointestinal carcinoma and 54.5% with other cancers had oral lesions (p=0.82). Oral lesions are one of the most common complications of chemotherapy. So every chemotherapy center needs trained medical staffs for diagnosis, prevention and control of oral cavity lesions and careful attention to age of patients under chemotherapeutic courses could prevent severe oral complications.

Clinical Outcomes of Alternative Uses for Stereotactic Body Radiation Therapy in Non-Small Cell Lung Cancer: Thinking Beyond Definitive Treatment for Early Disease

Effectiveness in Predicting the Response and Outcome with Three Prognostic Scoring Systems in Pediatric CML CP on Upfront Imatinib