Oregon Health Sciences University Research Articles

Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline

The purpose of this guideline is to provide a useful reference on the effective evidence-based diagnoses and management of non-metastatic upper tract urothelial carcinoma (UTUC). The Pacific Northwest Evidence-based Practice Center of Oregon Health & Science University (OHSU) team conducted searches in Ovid MEDLINE (1946 to March 3rd, 2022), Cochrane Central Register of Controlled Trials (through January 2022), and Cochrane Database of Systematic Reviews (through January 2022). The searches were updated August 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (Table 1).[Table: see text]Results:This Guideline provides updated, evidence-based recommendations regarding diagnosis and management of non-metastatic UTUC including risk stratification, surveillance and survivorship. Treatments discussed include kidney sparing management, surgical management, lymph node dissection (LND), neoadjuvant/adjuvant chemotherapy and immunotherapy. This standardized guideline seeks to improve clinicians' ability to evaluate and treat patients with UTUC based on available evidence. Future studies will be essential to further support these statements for improving patient care. Updates will occur as the knowledge regarding disease biology, clinical behavior and new therapeutic options develop.

The Psychiatric Evaluation and Treatment of Refugees. Edited by J. David Kinzie and George A. Keepers.

It is universally acknowledged that due to factors including war, starvation, collapsed civil societies, genocide, religious cleansing, and many other unbearable stressors, asylum seekers regularly experience mental disorders and Post-Traumatic Stress Disorder (PTSD) in one way or another even prior to their forced migration. Worse still, protracted detention and screening before they are granted entry, and overwhelming hatred, discrimination, stigmatization, hostility, as well as xenophobic reactions from natives in the host country, can then further traumatize these individuals. It is in this context that Kinzie and Keepers’ edited collection The Psychiatric Evaluation and Treatment of Refugees is published, which brings together scholars and psychotherapists to draw worldwide attention to the ongoing psychological struggles of this population. What gives this volume an urgency often lacking in literature on psychiatric interventions with refugees is its emphasis on assessing and treating refugees’ psychiatric problems from a socio-cultural perspective instead of amplifying psychopharmacological remedies. Based on the belief that ‘culture has an important role in the presentation of illness, and cultural differences impact upon the diagnosis and treatment of migrant populations in part due to linguistic, religious and social variation from the clinician providing care’ (Bhugar and Becker 2005: 18), chapters in this volume focus on symptoms, diagnosis, and therapies of patients’ psychosis from cross-cultural perspectives within the framework of the Intercultural Psychiatric Program (IPP) launched at the Oregon Health & Science University (OHSU) in Portland, Oregon. Through this program, the authors have had the opportunity to learn more about the psychological plight of specific refugee populations, including children and adolescents, geriatric patients, and immigrants at the US-Mexico Border. The abundant clinical case examples illustrate the cultural barriers these displaced groups are confronted with when seeking psychiatric help.

Editorial introductions.

Editorial introductions.

Implementation and expansion of inpatient and ambulatory pharmacist credentialing and privileging at an academic medical center.

This article highlights one academic medical center's effort to implement a complete credentialing and privileging (C&P) process for both inpatient and ambulatory clinical pharmacists. The C&P process offers a recognized method to advance pharmacy practice. Credentialing is defined as a process whereby an individual is deemed qualified in a specific subject matter area. Privileging is the process whereby an institution grants authority to an individual to perform services based on credentials. Federal guidelines permit pharmacists to obtain the same level of privileges as professional medical staff, such as physicians, if relevant state laws allow for the corresponding pharmacist scope of practice. States establish laws and regulations that specify the scope of practice for various types of licensed healthcare professionals, including pharmacists. Many health systems have attempted pharmacist C&P practices in both the inpatient and ambulatory care setting with varying degrees of success and reach. Privileged pharmacists provide established benefits and value to other members of the healthcare team. Oregon Health & Science University (OHSU) pursued C&P for both inpatient and ambulatory clinical pharmacists. Initiation and implementation processes were complex and accompanied by a variety of challenges. OHSU operates with advanced pharmacy practice integrated into the interdisciplinary patient care team. Pharmacist C&P allows pharmacists to demonstrate significant clinical benefits and quality improvement in patient care delivery in both inpatient and ambulatory settings.

Innovative growth and development of a neurological surgery residency cadaveric skull base simulation training program: A single institution experience

ObjectiveNeurosurgical cadaveric and simulation training is a valuable opportunity for residents and fellows to develop as neurosurgeons, further neuroanatomy knowledge, and develop decision-making and technical expertise. The authors describe the growth and development of Oregon Health & Science University (OHSU) Department of Neurological Surgery (NSG) resident hands-on simulation skull base course and provide details of course layout and setup. MethodsA three-part surgical simulation series was created to provide training in cadaveric skull base procedures. Course objectives were outlined for participants. Residents participated in NSG hands-on simulation courses (years 2015–2020) and completed annual course curriculum and anonymous course evaluations, which included free text reviews. Courses were evaluated by Likert scale analysis within Python, and free text was quantified using Valence Aware Dictionary for sEntiment Reasoning (VADER). Descriptive statistics were calculated and plotted using Python’s Seaborn and Matplotlib library modules. ResultsAnalysis included 162 skull base (anterior fossa, middle fossa and lateral, and endoscopic endonasal-based) simulation course evaluations. Resident responses were overwhelmingly positive. Likert responses demonstrated high average responses for each question (4.62 ± 0.56 and above). A positive attitude about simulation courses is supported by an average compound sentiment value of 0.558 ± 0.285. ConclusionThis is the first time Likert responses and sentiment analysis have been used to demonstrate how neurosurgical residents view a comprehensive, multi-year hands-on simulation training program. We hope the information presented serves as a guide for other institutions to develop their own residency educational curriculum in cadaveric skull base procedures.

Transgender and Gender Nonbinary Patient Experiences in the Emergency Department: A Regional Study.

Transgender people experience discrimination in health care, including reports of avoiding or delaying emergency department (ED) care due to prior negative experiences, fear of discrimination, poor accommodations, and inappropriate staff behavior. Emergency physicians receive minimal training on transgender care. This study sought to understand the experience of transgender patients when visiting EDs in the Portland metro area, and the knowledge and training experience of Oregon Health & Science University (OHSU) ED staff. Two populations were examined via survey: (1) Transgender people who accessed, or felt they should access, ED care in Portland, Oregon, in the past 5 years; and (2) OHSU ED patient-facing staff. Data were analyzed to identify trends in ED experiences, and predictors of positive experiences. Potential relationships between self-reported proficiency in transgender care and formal training experience, professional role, and duration of practice were also assessed. Of the predictors assessed, only the opportunity to provide pronouns at check-in was associated with better perceived experiences (p<0.01). The differences between reported best and worst ED experiences were significant in all domains of perceived experiences but one (p<0.01). ED providers who had formal training were more likely to rate themselves as proficient (p<0.01). There was no relationship found between self-reported proficiency and length of practice. This study demonstrated that there are significant differences between reported best and worst ED experiences by transgender patients, and thus areas for ED improvement. It is our recommendation that EDs provide the opportunity for patients to supply their pronouns, and offer trainings in transgender health care for employees.

Simulating for Quality: A Centralized Quality Improvement and Patient Safety Simulation Curriculum for Residents and Fellows.

Requirements for experiential education in quality improvement and patient safety (QI/PS) in graduate medical education (GME) have recently expanded. Major challenges to meeting these requirements include a lack of faculty with the needed expertise, paucity of standardized curricular models allowing for skill demonstration, and inconsistent access to data for iterative improvement. In October 2017, the authors began development of a centralized QI/PS flipped-classroom simulation-based medical education (SBME) curriculum for GME trainees across multiple disciplines at Oregon Health & Science University (OHSU). The curriculum development team included OHSU and Veterans Affairs faculty with experience in QI/PS and SBME, as well as house officers. The curriculum consisted of a preassessment and prework readings and videos (sent 3 weeks before the simulation day) and an 8-hour simulation day, with introductory activities, 4 linked simulation sessions, and concluding activities. The 4 linked sessions followed the same medication error from disclosure and reporting to root cause analysis, iterative implementation of an action plan, and consolidation of lessons learned into routine operations with Lean huddles. In academic year 2018-2019, 71 residents and fellows of various postgraduate years from 23 training programs enrolled in 2 pilot sessions. Learners reacted favorably to the simulation curriculum. Learner attitudes, confidence, knowledge, and skills significantly increased across all QI/PS domains studied. This approach focuses a small cadre of educators toward the creation of a centralized resource that, owing to its experiential SBME foundation, can accommodate many learners with data-driven practice-based learning and improvement cycles in a shorter time frame than traditional QI initiatives. Next steps include the addition of a control group, assessment of the sustainability of learner outcomes, translation of learning to behavior change and improvements in patient and health system outcomes, and adapting the materials to include learners from different professions and levels.

Endosomal phosphatidylinositol 3-phosphate controls synaptic vesicle cycling and neurotransmission.

Neural circuit function requires mechanisms for controlling neurotransmitter release and the activity of neuronal networks, including modulation by synaptic contacts, synaptic plasticity, and homeostatic scaling. However, how neurons intrinsically monitor and feedback control presynaptic neurotransmitter release and synaptic vesicle (SV) recycling to restrict neuronal network activity remains poorly understood at the molecular level. Here, we investigated the reciprocal interplay between neuronal endosomes, organelles of central importance for the function of synapses, and synaptic activity. We show that elevated neuronal activity represses the synthesis of endosomal lipid phosphatidylinositol 3‐phosphate [PI(3)P] by the lipid kinase VPS34. Neuronal activity in turn is regulated by endosomal PI(3)P, the depletion of which reduces neurotransmission as a consequence of perturbed SV endocytosis. We find that this mechanism involves Calpain 2‐mediated hyperactivation of Cdk5 downstream of receptor‐ and activity‐dependent calcium influx. Our results unravel an unexpected function for PI(3)P‐containing neuronal endosomes in the control of presynaptic vesicle cycling and neurotransmission, which may explain the involvement of the PI(3)P‐producing VPS34 kinase in neurological disease and neurodegeneration.

Guardians of the eye: new tales about retinal microglia and other ocular macrophages.

Guardians of the eye: new tales about retinal microglia and other ocular macrophages.

OHSU Employees’ Opinions of Receipt of Clinical Care and Participation in Clinical Research at Place of Employment

ABSTRACT Academic medical centers conduct clinical research and provide patient care to the community and their workforce. Conflict may exist, as employees might expect benefits or feel pressured or coerced to participate in research studies or receive clinical care. Without evidence, some universities consider employees to be part of a vulnerable population for research consent at their institution, potentially restricting opportunities for employees to participate in clinical trials. At the same time, these universities encourage employees to receive health care at the same institution. We hypothesized that attitudes toward voluntary research participation and receipt of health care services at the site of employment are similar and favorable. To study this, we conducted a survey of employees at Oregon Health & Science University (OHSU) that asked parallel questions focusing on attitudes regarding concerns with participation in research and receipt of clinical care. We found the majority of respondents reported favorable and similar attitudes regarding employee participation in clinical care 596/688 (87%) or research 605/639 (95%) and personally comfortable with the idea (614/688 (90%) for clinical care, 582/639 (92%) for research participation). Our findings support efforts to remove barriers that restrict participation in clinical research by employees at academic medical centers.

Prognostic models for stage I-III esophageal cancer: a comparison between existing calculators.

Determining the best approach for esophageal cancer and predicting accurate prognosis are critical. Multiple studies evaluated characteristics associated with overall survival, and several prediction models have been developed. This study aimed to evaluate existing models and perform external validation of selected models. A retrospective investigation of a multi-site institutional enterprise for patients with a diagnosis of esophageal cancer between 2013-2014 was performed. Selected survival prediction models included the Roswell Park Comprehensive Cancer Center (RPCCC) calculator, Oregon Health & Science University (OHSU) calculator, and two nomograms published by Shapiro et al. and Sun et al. One-year overall survival, level of agreement, and performance for each model were evaluated. A total of 104 patients were included and used to assess the prediction models. One-year overall survival was 0.76. Different calculators tended to rank patients similarly; however, they did not agree on predicted overall survival. The least disparity in correlation was observed between OHSU and Shapiro calculators. Shapiro's model achieved the highest performance [area under the curve (AUC) =0.63]. Selected models showed fair results in estimating individual overall survival, although none achieved a high performance. While these tools may support the decision-making process for esophageal cancer patients, their implementation in clinical practice requires improved refinement to optimize their clinical utility.

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients.

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients.

Addressing Food Insecurity Among Graduate-Level Health Professional Students

Describe a program aimed at reducing graduate-level health professional student (GHPS) food insecurity during the COVID-19 pandemic. Food insecurity is inversely correlated with academic success, time to completion, graduation rates, and wellness. In 2018, 28.5% of graduate level health professional students (GHPS) (n=1,133) at Oregon Health & Science University (OHSU), reported food insecurity. Barriers to food security included limited availability, high food costs on campus, and lack of time for preparation. A student-initiated Grocery-Box Distribution Program (GBDP) was launched in May 2020 in response to food insecurity during the COVID 19 pandemic and reduced access to on-campus food resources. Initial funding was provided by the Provost and Student Health & Wellness, volunteers were recruited, space was identified in a convenient and safe location, and a university website was used to market and post a weekly-updated food request form. Food was purchased from local farmers and grocery stores and donations were received from the local food bank, food distributers, and OHSU Food and Nutrition Services. Food requests were filled and delivered by student volunteers and information was summarized to evaluate GBDP use. Over 40-weeks, 50 volunteers filled over 1000 orders placed by 299 unique users enrolled in a variety of OHSU programs. Foods offered included grains, canned fruits, vegetables, meat and beans, soups, milk and plant-based dairy alternatives, snacks, beverages, and hygiene products. The GBDP is an innovative initiative to address food insecurity experienced by OHSU students that could be applied to other institutions and modified for different populations.

Behaviorally and environmentally induced non-24-hour sleep-wake rhythm disorder in sighted patients.

To determine whether there was evidence of circadian or sleep-regulatory dysfunction in sighted individuals with non-24-hour sleep-wake rhythm disorder. Three sighted individuals with signs and/or symptoms of non-24-hour sleep-wake rhythm disorder were studied. Thirty-five- to 332-day laboratory and home-based assessments of sleep-wake and circadian timing, endogenous circadian period, photic input to the circadian pacemaker, and/or circadian and sleep-wake-dependent regulation of sleep were conducted. No evidence of circadian dysfunction was found in these individuals. Instead, sleep-wake timing appeared to dissociate from the circadian timing system, and/or self-selected sleep-wake and associated light/dark timing shifted the circadian pacemaker later, rather than the circadian pacemaker determining sleep-wake timing. These findings suggest that the etiology of this disorder may be light- and/or behaviorally induced in some sighted people, which has implications for the successful treatment of this disorder. Emens JS, St Hilaire MA, Klerman EB, etal. Behaviorally and environmentally induced non-24-hour sleep-wake rhythm disorder in sighted patients. J Clin Sleep Med. 2022;18(2):453-459.

Opioid crisis remains critical national problem.

Lisa Hines Oregon Health & Science University (OHSU) pharmacist Emily Skogrand remembers the event that awoke her compassion for patients with substance use disorders. Skogrand was reviewing the chart of a young woman who had been admitted multiple times for serious complications of substance use. The patient had been near death from endocarditis about a month before but recovered. Now, she was back in the intensive care unit. Skogrand initially looked down on the patient for repeating the behavior that had nearly killed her just weeks before. But after reading a brief chart note about a traumatic experience in the patient’s past, Skogrand started to see how that incident shaped the young woman’s life. “This young lady was my age, she had a seemingly similar upbringing to me . . . and then this 1 horrific thing occurred to her, and she has to live with that every day,” Skogrand explained. “And I just thought, what I would do if I were in a similar situation; could I have gone down the same path? And that humanized the disease to me.”

Effects of Chronic Secondhand Smoke (SHS) Exposure on Cognitive Performance and Metabolic Pathways in the Hippocampus of Wild-Type and Human Tau Mice.

Background:Exposure to secondhand smoke (SHS) is a risk factor for developing sporadic forms of sporadic dementia. A human tau (htau) mouse model is available that exhibits age-dependent tau dysregulation, neurofibrillary tangles, neuronal loss, neuroinflammation, and oxidative stress starting at an early age (3–4 months) and in which tau dysregulation and neuronal loss correlate with synaptic dysfunction and cognitive decline.Objective:The goal of this study was to assess the effects of chronic SHS exposure (10 months’ exposure to ) on behavioral and cognitive function, metabolism, and neuropathology in mice.Methods:Wild-type (WT) and htau female and male mice were exposed to SHS (90% side stream, 10% main stream) using the SCIREQ® inExpose™ system or air control for 168 min per day, for 312 d, 7 d per week. The exposures continued during the days of behavioral and cognitive testing. In addition to behavioral and cognitive performance and neuropathology, the lungs of mice were examined for pathology and alterations in gene expression.Results:Mice exposed to chronic SHS exposure showed the following genotype-dependent responses: a) lower body weights in WT, but not htau, mice; b) less spontaneous alternation in WT, but not htau, mice in the Y maze; c) faster swim speeds of WT, but not htau, mice in the water maze; d) lower activity levels of WT and htau mice in the open field; e) lower expression of brain PHF1, TTCM1, , and HSP90 protein levels in WT male, but not female, mice; and f) more profound effects on hippocampal metabolic pathways in WT male than female mice and more profound effects in WT than htau mice.Discussion:The brain of WT mice, in particular WT male mice, might be especially susceptible to the effects of chronic SHS exposure. In WT males, independent pathways involving ascorbate, flavin adenine dinucleotide, or palmitoleic acid might contribute to the hippocampal injury following chronic SHS exposure. https://doi.org/10.1289/EHP8428

Ruth Matarazzo (1926–2020).

Presents the obituary of Ruth Matarazzo (1926-2020). She was Professor Emeritus of Behavioral Neuroscience at Oregon Health Sciences University (OHSU). Matarazzo went to Pembroke College for women at Brown University graduating in 1948 in psychology and stayed on for a year in graduate studies. There she met Joseph (Joe) Matarazzo, also in graduate psychology, and married him in 1949. She earned her Ph.D. from Washington University in 1955 and became the first woman admitted to the St. Louis Department of Veterans Affairs Medical Center Clinical Psychology Internship Program. She later joined Harvard Medical School as a research fellow and staff psychologist at Massachusetts General Hospital. As an educator, Ruth taught and supervised psychology interns and residents in medical psychology, residents in psychiatry, mentored female medical students, and published widely. Some of her greatest achievements was her leadership in helping women in medicine and science. She arrived at the Portland Medical School eight months pregnant and worked until she gave birth to her first child. Her example helped to change policy for working women at the school, particularly nurses, allowing them to work longer during their pregnancies if they chose to do so. She also was a founding member of the Portland Opera. In 2007 she received the Presidential Award of the American Psychological Association for her lifetime of professional contributions and public service. In her spare time, she was active in civic affairs and clubs. She is survived by her husband Joe, son Harris, daughters Elizabeth and Sara, and five grandchildren. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introductory Medical Spanish Elective: Creating and Evaluating a Case-Based Course Compatible with an 18-Month Pre-Clinical Medical Curriculum.

Limited English proficiency patients experience high rates of medical errors and receive lower quality of care. To better prepare the healthcare workforce, Latino Medical Student Association (LMSA) members at Oregon Health & Science University (OHSU) developed an Introductory Medical Spanish course to complement an 18-month pre-clinical curriculum. This 10-week elective course consisted of 2 h of weekly instruction, two Cafecito cultural sessions, and one clinical standardized assessment (CSA). The authors used Bloom's taxonomy as a theoretical framework to design course components. Pre- and post-course surveys captured comfort scores with performing a history and physical (H&P) and building rapport in Spanish. Change in comfort was analyzed via paired T-test in STATA. The authors performed a content analysis of CSA feedback and a thematic analysis of Cafecito reflections. Fifteen preclinical medical students in cohort 1 and sixteen in cohort 2 completed the 10-week course. Comfort scores significantly (p < 0.05) increased by 2.87 and 1 point(s) for cohorts 1 and 2, respectively. There were differences between cohorts 1 and 2, including self-reported language fluency (93% vs 47% "beginner" level) and value of the cultural sessions (73% vs 50%), respectively. Qualitative content analysis of CSA feedback and thematic analysis of Cafecito reflections revealed students successfully applied learned material to a new case and developed a newfound appreciation for Latinx public health issues. This course effectively increased students' comfort using medical Spanish which successfullytranslated into simulated patient environments. It also provided a space to discuss nuances of health and Latinx cultures with peers. Ultimately, this course's feasible, effective structure can serve as a model to complement condensed pre-clinical undergraduate medical education (UME) curricula.

Rate of neuropathic progression in hereditary transthyretin amyloidosis with polyneuropathy and other peripheral neuropathies: a systematic review and meta-analysis

BackgroundWe aimed to compare neuropathic progression rate between hereditary transthyretin amyloidosis with polyneuropathy (ATTRv-PN) and other peripheral neuropathies, including diabetic peripheral neuropathy (DPN) and Charcot-Marie-Tooth disease (CMT).MethodsLiterature searches identified studies reporting neuropathic progression, measured by Neuropathy Impairment Score (NIS) or NIS-Lower Limbs (NIS-LL). Our study also included unpublished data from a clinical registry of patients who were diagnosed with different peripheral neuropathies and seen at the Oregon Health & Science University (OHSU) during 2016–2020. Meta-analysis and meta-regression models examined and compared annual progression rates, calculated from extracted data, between studies of ATTRv-PN and other peripheral neuropathies.ResultsData were synthesized from 15 studies in which NIS and/or NIS-LL total scores were assessed at least twice, with ≥12 weeks between assessments, among untreated patients with ATTRv-PN or other peripheral neuropathies. Meta-analysis models yielded that the annual progression rate in NIS total scores was significantly different from zero for studies in ATTRv-PN and CMT (11.77 and 1.41; both P < 0.001), but not DPN (− 1.96; P = 0.147). Meta-regression models showed significantly faster annual progression in studies in ATTRv-PN, which statistically exceeded that in other peripheral neuropathies by 12.45 points/year for NIS, and 6.96 for NIS-LL (both P < 0.001).ConclusionsPeripheral nervous function deteriorates more rapidly in patients with ATTRv-PN than for other peripheral neuropathies. These findings may improve understanding of the natural history of neuropathy in ATTRv-PN, facilitate early diagnosis, and guide the development of assessment tools and therapies specifically targeting neuropathic progression in this debilitating disease.

A Novel 85-Gene Expression Signature Predicts Unfavorable Prognosis in Acute Myeloid Leukemia.

Aim:Acute myeloid leukemia (AML) is a heterogeneous disorder with complex genetic basis and adverse prognosis. Cytogenetics risk, somatic mutations and gene expression profiles are important prognostic factors for AML patients. However, accurate stratification of patient prognosis remains an unsolved problem in AML. This study was to to develop a novel gene profile to accurately classify AML patients into subgroups with different survival probabilities.Methods:Survival-related genes were determined by Kaplan–Meier survival analysis and multivariate analysis using the expression and clinical data of 405 AML patients from Oregon Health & Science University (OHSU) dataset and validated in The Cancer Genome Atlas (TCGA) database. Feature selection was performed by using the Least Absolute Shrinkage and Selection Operator (LASSO) method. With the LASSO model, a prognostic 85-gene score was established and compared with 2 known gene-expression risk scores. The stratification of AML patients was performed by unsupervised hierarchical clustering of 85 gene expression levels to identify clusters of AML patients with different survival probabilities.Results:The LASSO model comprising 85 genes was considered as the optimal model based on relatively high area under curve value (0.83) and the minimum mean squared error. The 85-gene score was associated with increased mortality in AML patients. Hierarchical clustering analysis of the 85 genes revealed 3 subgroups of AML patients in the OHSU dataset. The cluster1 AML patients were associated with more female cases, higher percent of bone marrow blast cells, 85-gene score, cytogenetics risk, more frequent FLT3-ITD, DNMT3A, NP1 mutations, less frequent TP53, RUNX1 mutations, poorer overall survival than cluster2 tumors. The 85-gene score had higher AUC (0.75) than the 5-gene risk score and LSC17 score (0.74 and 0.65).Conclusions:The 85-gene score is superior to the 2 established prognostic gene signatures in the prediction of prognosis of AML patients.