Significant Increase In Grade Research Articles

Postoperative Outcomes of Pre-Pectoral Versus Sub-Pectoral Implant Immediate Breast Reconstruction.

Immediate breast reconstruction (IBR) techniques are rapidly evolving. We compared the results from a single-center implant IBR cohort between subpectoral and prepectoral implants with and without a mesh. We analyzed all complications and grade 2-3 complications, the implant loss rate, the surgery time, the length of stay (LOS), patient satisfaction, the interval time to adjuvant therapy and cost, with a comparison between subpectoral and prepectoral implant IBR. Subpectoral implant IBR was carried out in 529 mastectomies (62.0%) and prepectoral in 324, with a significant increase in prepectoral placement in recent years. Mesh was used in 176 prepectoral placements (54.3%). Any grade of complication was reported in 147 mastectomies (17.2%), with a significantly higher rate for prepectoral implant IBR (p = 0.036). Regression analysis showed that prepectoral implant was not significantly associated with any grade of complication or with grade 2-3 complications. Prepectoral implant IBR was associated with a significantly shorter operative time and lower LOS. Grade 2-3 complications were significantly associated with lower satisfaction. Higher costs were significantly associated with the subpectoral placement and mesh. A complication rate predictive score identified five groups with a significant increase in grade 2-3 complications. Prepectoral-M-IBR increased over time with no difference in complication rates compared to subpectoral-M-IBR. Prepectoral implant placement can be considered a safe technique.

Understanding university failure: zero-fails, COVID-19 and commencing student outcomes at an Australian university

ABSTRACT Universities actively promote themselves to potential students, control admissions and deliver programs of study. For most students globally, there are financial costs to attending university. At the extreme end of failure are students who receive ‘zero-fails’: they enrol, do not submit any assessments, and receive a mark of 0 out of 100. A quantitative descriptive analysis was performed and provides student performance details for bachelor-level students enrolled in a large, regional Australian university from 2019–2021. At a unit level, zero-fails accounted for 20% of all failing grades. There was a significant increase in zero-fail grades in 2020 and 2021 compared to 2019. However, zero-fails are not entirely a COVID-19 phenomenon. Only 8% of students who received any zero-fail grade in their commencing semester of study continued onto their second semester and passed most of their units. We argue universities operating in countries with deferred payment schemes such as Australia and the United Kingdom have a responsibility to track unit failure in finer detail and consider ways to mitigate debt associated with students who are clearly not receiving value from their educational experience. This must be done as we continue to expand higher education opportunities to students from non-traditional backgrounds.

Outcomes of Haplo-Cord and Dual-Cord Transplants: A Single-Center Retrospective Analysis

Background: Despite the concurrent use of tandem haploidentical-umbilical cord (haplo-cord) and dual-umbilical cord (dual-cord) allogeneic hematopoietic stem cell transplant (HSCT) approaches for over a decade, there have been few comparisons of their outcomes (van Besien et al. Hematologica, 2016). No previous studies have evaluated differences following identical conditioning regimens. We report a retrospective analysis comparing patients treated with haplo-cord or dual-cord HSCTs at our institution following the same conditioning regimen. Methods: Between 10/2012-10/2022, 70 haplo-cord and 133 dual-cord transplants were performed following 50 mg/kg of IV cyclophosphamide, 150 mg/m 2 of IV fludarabine, 10 mg/kg of IV thiotepa, and 4 Gy total body irradiation conditioning. Cyclosporine and mycophenolate mofetil were used for graft versus host disease (GVHD) prophylaxis. Patient selection, infectious disease prophylaxis, and donor selection were per institutional standards. Patient characteristics between groups were compared using Fisher's exact test. Kaplan-Meier estimates were used to evaluate OS and RFS. Cumulative incidence estimates were used to compare relapse, aGVHD, cGVHD, and neutrophil and platelet engraftment. Two-tailed t-test was used to compare average in-hospital stays for transplant admissions. Results: There were no significant differences between median age at transplant (51.6 vs 50.3), female representation (41.4% vs 45.1%), or disease types (47.1% vs 51.1% acute myeloid leukemia (AML), 25.75% vs 17.3% acute lymphoblastic leukemia (ALL), 17.2% vs 15.1% myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN), 10% vs 16.5% other; p=0.373). With a median follow-up of over 2 years, there was no difference in or OS (p=0.96) or RFS (Figure 1, p=1) for all patients, or for the MDS/MPN and AML subset (OS p=0.47, RFS p=0.43). There was a significant increase in grade 3-4 acute GVHD (aGVHD) in haplo-cord recipients (Figure 2, p=0.007), but no difference in grade 2-4 aGVHD (p=0.11), all chronic GVHD (p=0.8), and moderate-severe cGVHD (p=0.3). Time to neutrophil recovery was faster in haplo-cord recipients (p=0.021), but there was no difference in platelet recovery to 20,000/uL (p=0.12). Average days admitted for haplo-cord HSCTs was 20.61 days compared to 27.56 days for dual-cord HSCTs (p<0.0001). Conclusion: In our experience, there were no differences in survival, relapse, or cGVHD between haplo-cord and dual cord HSCT. Haplo-cord HSCTs were associated with faster neutrophil engraftment and shorter hospital stays compared to dual-cord HSCTs; however, haplo-cord SCTs had significantly higher grade 3-4 aGVHD. When both are options, the choice of haplo-cord versus dual-cord HSCTs should consider these opposing factors. Reference: 1. Koen van Besien, Parameswaran Hari, Mei-Jie Zhang, Hong-Tao Liu, Wendy Stock, Lucy Godley, Olatoyosi Odenike, Richard Larson, Michael Bishop, Amittha Wickrema, Usama Gergis, Sebastian Mayer, Tsiporah Shore, Stephanie Tsai, Joanna Rhodes, Melissa M. Cushing, Sandra Korman, Andrew Artz. Reduced intensity haplo plus single cord transplant compared to double cord transplant: improved engraftment and graft-versus-host disease-free, relapse-free survival. Haematologica 2016;101(5):634-643; https://doi.org/10.3324/haematol.2015.138594.

Switch to generic formulation of temozolomide results in statistically significant increase in grade 3 and 4 bone marrow toxicity in glioma patients in the province of Alberta.

Temozolomide (TMZ) is an oral, systemic chemotherapy used chiefly for treating high-grade glioma. Due to the rising costs of systemic chemotherapy, many jurisdictions have replaced brand name with generic formulations. The aim of this study was to determine whether or not there was difference in the incidence of grade 3 or 4 bone marrow toxicity and median overall survival in patients treated with brand name versus generic TMZ in the province of Alberta, Canada. The province suspended the use of generic TMZ based on preliminary data pointing to excess toxicity. This multicenter, retrospective study included data from patients with newly diagnosed high-grade glioma that received treatment with TMZ in Alberta. Multivariate logistic regression analysis was performed to determine the association between grade 3 or 4 toxicity to generic versus brand name TMZ exposure, ECOG score, and age. Kaplan-Meier survival estimates and log-rank testing were used to determine differences in overall survival between the brand name and generic TMZ cohorts, as well as the cytopenic versus non-cytopenic patients. Furthermore, a screening analysis for grade 3 or 4 bone marrow toxicity was conducted on all de novo glioma patients treated with brand name TMZ after Alberta preemptively stopped generic TMZ. Grade 3 or 4 neutropenia and thrombocytopenia were observed in 15% and 19% of patients treated with generic TMZ (n = 156) as compared to 3% and 5% of patients (n = 100) treated with brand name TMZ-treated patients; P= .003 and .001. A trend toward increased median overall survival in glioblastoma patients treated with generic TMZ (13.7 months) versus brand name (15.8 months, P = .178.) was also observed through meeting statistical significance. Based on these results, the province stopped the use of generic TMZ and reverted to the Merck TMZ. An initial review of all new glioma patients (n = 89) treated with Merck TMZ since the province stopped the generic drug demonstrated 3.4% and 10.1% grade 3 or 4 neutropenia, respectively. The statistically significant difference in toxicity profile has prompted the province of Alberta to replace generic TMZ with brand name TMZ in high-grade glioma patients pending more detailed analysis. Our study provides evidence supporting the importance of conducting prospective studies on long-term safety for generic chemotherapies.

Breast cancer cell growth arrest and chemopreventive effects of Passiflora edulis Sims (Passifloraceae) ethanolic leaves extract on a rat model of mammary carcinoma.

Despite various prevention and treatment measures, the incidence and mortality due to breast cancer has been increasing globally. Passiflora edulis Sims is a plant used for the treatment of various diseases in traditional medicine, including cancers. To assess the anti-breast cancer activity of the ethanolic extract of P. edulis leaves in vitro and in vivo. In vitro, the cell growth and proliferation were determined based on the MTT and BrdU assays. The flow cytometry was used to analyze the cell death mechanism while, cell migration, cell adhesion and chemotaxis were assayed for anti-metastatic potential. In vivo, 56 female Wistar rats aged 45-50 days (∼75g) were exposed to 7,12-dimethylbenz(a)anthracene-DMBA except the normal group. Negative control group (DMBA) received solvent dilution throughout the study; standards groups (tamoxifen - 3.3mg/kg BW and letrozole - 1mg/kg BW) as well as P. edulis leaves ethanolic extract groups (50, 100 and 200mg/kg) treated for 20 weeks. Tumor incidence, tumor burden and volume, CA 15-3 serum' level, antioxidant, inflammatory status and histopathology were assessed. P. edulis extract showed a significant and concentration-dependent inhibition of MCF-7 and MDA-MB 231cells growth at 100μg/mL. It inhibited cell proliferation and clones' formation and induced apoptosis in MDA-MB 231cells. The migration of cell into the zone freed of cells and the number of invading cells after the 48 and 72h were significantly diminished while, it increased their adherence to collagen and fibronectin extracellular matrix as does Doxorubicin. In vivo, all rats in the DMBA group exhibited a significant (p < 0.001) increase in tumor volume, tumor burden and grade (adenocarcinoma of SBR III) and pro-inflammatory cytokine levels (TNF-α, INF-γ, IL-6 and IL-12). P. edulis extract at all tested doses significantly inhibited the DMBA-induced increase in tumor incidence, tumor burden and grade (SBR I) as well as pro-inflammatory cytokines. Moreover, it increased enzymatic and non-enzymatic antioxidants (SOD, catalase, and GSH) and decreased MDA levels although a greater effect was observed with Tamoxifen and Letrozole. P. edulis has medium content on polyphenols, flavonoids and tannins. P. edulis has chemo-preventive effects against DMBA-induced breast cancer in rats probably through its antioxidative, anti-inflammatory and apoptosis-inducing potentials.

IMPROVING READING-ALOUD ABILITY WITH A CONSTRUCTIVISM APPROACH FOR GRADE 2 ELEMENTARY STUDENTS

T his paper discusses the improvement of the reading - aloud ability of grade 2 elementary school students through a constructivism approach. The r esearch uses the classroom action method , which begins with the pre - cycle stages, cycle 1 and cycle 2 where each stage includes planning, implementation, observation, and reflection. After carrying out the research procedures and collecting data, the results indicate that the reading -aloud ability of grade 2 students using the constructivism approach provided a significant increase in grade 2 elementary school students ’ reading-aloud ability . The assessment indicators of reading- aloud ability were pronunciation, intonation, fluency, and students' courage , which describes an improvement in the students' reading -aloud ability test . The average pre-cycle score of students' reading - aloud ability was 67.85 increased to 73.53 in cycle 1. Subsequently, the average score increased to 80.23 in cycle 2 . Based on the research results above, the researcher concludes that students' reading - aloud ability could be improved by using a constructivism approach for grade 2 elementary school students .

Implementation of Project Based Learning (Pjbl) at Basic Physics Course Based on Aeromodelling Project

The objective of this study was to describe students' abilities through Project Based Learning in Basic Physics courses with aeromodelling aircraft manufacturing projects. This research was conducted using a One-Shot Case Study design with subjects consisting of a classroom with a total of 57 students in the teaching and education faculties. Research data obtained from pretest - posttest analysis. Data analysis with percentage technique was then processed descriptively. The results showed that students' comprehension abilities increased with a significant increase in grades. From this study it can be concluded that the Project Based Learning learning model can improve students' understanding abilities

Increasing retention in STEM by improving GPA through peer mentors and course enrichments in introductory biology

ABSTRACT This study investigated the role of experiential learning and peer mentors in undergraduate biology at a community college. While the impact on all students was studied, special attention was paid to the effect interventions had on underrepresented minority students. Thirty-three sections of an introductory biology class were randomly assigned to either treatment or control. Sections assigned to treatment received content enhancements geared at active learning strategies and metacognition. A portion of treatment sections also had the presence of peer mentors as part of their laboratory course. Results showed grade distributions were not significantly different when comparing control and treatment sections, but there was a significant increase in final course grade when mentors were present in the laboratory, and when enrichments alone were provided. These methods were just as impactful for minority students, indicating that active learning and peer support may help to decrease student attrition in introductory biology classes.

Influence of calcination temperatures on lithium deportment by screening hard rock lithium

Calcination of spodumene is a pre-treatment stage in preparation for sulfation roasting and leaching in lithium recovery. During calcination, α-spodumene (less reactive, monoclinic crystal structure) is converted to β-spodumene (more reactive, tetragonal crystal structure). A third, metastable γ-phase has been identified at lower temperatures than full conversion to the β-phase. It has been previously observed that calcination greatly alters the physical properties of the various minerals in pegmatite ores, impacting comminution energy and liberation. Thus, this work investigates the relationships between calcination temperatures and the physical behaviour of hard rock lithium ores. The results showed that the increase in calcination temperature resulted in a higher lithium deportment in the finest size fraction (−0.6 mm) and thus a higher lithium grade and recovery. The samples calcined at 813.15 K and 1223.15 K did not show a significant increase in lithium grades in the finest size fraction. This work shows the incremental change in the physical properties of various minerals in the ore with increasing calcination temperature.

Evaluation of alpelisib-induced hyperglycemia prophylaxis and associated risk factors in PIK3CA-mutated hormone-receptor positive, human epidermal growth factor-2 negative advanced breast cancer.

SOLAR-1 investigated alpelisib-fulvestrant (ALP + FLV) in patients with HR + /HER2-, PIK3CA-mutated advanced breast cancer and demonstrated a clinically significant increase in all-grade and grade (G) 3-4 hyperglycemia (HG) compared to placebo-fulvestrant. Given high rates of HG, a preventative protocol and identification of associated risk factors was implemented. This single-center, retrospective study included patients receiving ALP + FLV. One week before ALP initiation, patients started an insulin-sensitizer. Patients had fasting plasma glucose (FPG) levels drawn day 8, 15, 28, then monthly. Primary outcome was incidence of G2-4 HG by day 28. Risk factors assessed included age, BMI, FPG, and HbA1c. Number of risk factors were compared between patients with and without HG. Sixteen women were included with median age of 59years. The cohort was 69% White, 25% Black, 75% with BMI ≥ 25kg/m2, and 50% with history of diabetes. By day 28, 9 patients (56%) had G2-4 HG, with only 3 (19%) G3 and zero G4. Patients with G2-4 HG had a median of 2 risk factors compared to only 1 if no HG (p = 0.03). 5 patients (31%) required a temporary hold of ALP and 3 (19%) required dose reduction due to HG. 13 patients permanently discontinued ALP-9 due to disease progression and 4 from an adverse event (only 1 HG). Implementation of a HG prophylaxis protocol with ALP in a single-center study demonstrated fewer G3-4 HG events compared to that seen in SOLAR-1 (19% vs 36.6%). An increase in HG-associated risk factors correlated with a higher incidence of G2-4 HG.

Effects of hormonal treatment on dermatological outcome in transgender people: a multicentric prospective study (ENIGI)

PurposeThe aim of our study was to assess dermatological changes in transgender people after the start of gender-affirming hormonal treatment (GAHT) and to investigate whether various hormonal preparations differently affect dermatological changes in trans AFAB (assigned female at birth) people.MethodsIn a multicenter prospective study, 484 participants (193 assigned male at birth/AMAB and 291 AFAB) were evaluated at baseline (T0), 6 (T1) and 12 months (T2) after the start of GAHT. Hair growth was assessed by the Ferriman–Gallwey (FG) score, acne by the Global Acne Grading Scale (GAGS), and alopecia by the Norwood Hamilton (NH) score.ResultsIn AFAB people, a significant increase in FG score and NH grade was observed across time, as well as in GAGS score in a subsample of 71 individuals (p < 0.001). Testosterone (T) undecanoate and esters showed a higher increase in hair distribution at T2 vs. T1 as compared to T gel (p < 0.01). T esters showed a significantly higher impact in GAGS score modifications at T1 and at T2 vs. T0 compared to T gel (p = 0.021 and p = 0.003, respectively). In trans AMAB people, a significant decrease of FG score was observed across time (p < 0.001), although 51.3% of individuals still reported an FG score higher than eight after 12 months.ConclusionT treatment increased hair growth, acne and alopecia prevalence in AFAB people, with T undecanoate and esters influencing hair growth more than T gel. Opposite dermatological changes were observed in AMAB people.

Students, faculty perceptions and effectiveness of the early introduction of clinical skills teaching in the medical curriculum

ObjectiveWe hypothesized that the early introduction of clinical skills (CS) would help students to develop and apply clinical skills appropriately during the clinical years. Evaluating the perceptions of medical students and faculty regarding the early introduction of CS teaching and its effectiveness are important. MethodsThe CS curriculum was designed by integration with the system-oriented problem-based curriculum in years 1 and 2 at the College of Medicine, KSU, from January 2019 to December 2019. Students and faculty questionnaires were also designed. The impact of CS teaching effectiveness was assessed by comparing OSCE results for year-3 students who received early CS sessions with those who did not. The total number of student respondents was 461/598; and 259 (56.2%) were male and 202 (43.8%) were female. The first- and second-year respondents were 247 (53.6%) and 214 (46.4%), respectively. The number of faculty respondents was 35/43. ResultsThe majority of students and faculty were satisfied that the early introduction of CS increased student confidence when dealing with real patients, provided the opportunity to master skills, consolidated theoretical knowledge and clinical skills, motivated learning, and increased the enthusiasm of students to become doctors. The third-year students who received CS teaching in years 1 and 2 (during 2017–2018 and 2018–2019) showed a significant increase in mean grades (p value; 0.00) in OSCE tests during their courses in surgery (from 32.6 to 37.4 for females; 35.2 to 35.7 for males) and medicine (31.2–34.1 for females; 34.3 to 37.7 for males), respectively, when compared to students who did not receive CS teaching during the academic year 2016–2017 (in surgery, 22.2 and 23.2; in medicine 25.1 and 24.2) for females and males respectively. ConclusionEarly exposure of medical students to CS is a positive intervention that bridges the gap between basic sciences and clinical practice.

Rotation aiding technique for endobronchial ultrasound-guided transbronchial needle aspiration biopsy of intrathoracic lymph nodes: A complementary approach to the conventional jabbing method.

BackgroundThis study aimed to compare the lymph node core tissue lengths obtained via mediastinal or hilar lymphadenopathy using the complementary “rotation aiding” and conventional Jab technique.MethodsWe prospectively measured the lymph node core tissue length in patients who sequentially underwent the Jab and rotation aiding (RA) techniques between October 2012 and December 2014. Wilcoxon signed‐rank test was used to compare the core tissue length and grade of diagnostic cells obtained by each technique. McNemar's test was used to compare the proportion of adequate cellularity (≥grade 2) between the aspiration techniques.ResultsThe core tissue length of 61 lymph nodes from 43 patients (mean age: 63 years, range: 16–86 years) was analyzed. Pathological findings were consistent with malignant lesions in 25 (41%) patients and benign lesions in 36 (59%). The most common diagnosis in benign lymph nodes was reactive, followed by tuberculosis and sarcoidosis. We obtained longer core tissue with RA technique than with the Jab technique (83.2 ± 12.7 vs. 60.1 ± 10.1 mm; p = 0.02). There was a significant increase in cellularity grade and proportion of ≥grade 2 cells with the RA technique than with the Jab technique (2.39 ± 1.08 vs. 1.84 ± 1.14; p < 0.001, 78.7% vs. 52.5%; p = 0.002), regardless of the pathological diagnosis.ConclusionsRA technique facilitated more lymph node samples in terms of core tissue length and cellularity than the Jab technique.

A Specific High-Protein Weight Loss Program Does Not Impair Renal Function in Patients Who Are Overweight/Obese.

Although high-protein diets appear to be the most efficient way to lose weight, concerns may arise about their innocuity on renal function. The objective of this study is to assess the impact of a weight loss program on renal function. A multicentric cohort-based study was performed using the RNPC© French national weight loss program. Patients with at least two creatinine measurements at the beginning of the program and at the end of the weight loss phase between 1 January 2016 and 1 July 2021 were included. Renal function was assessed by Modification of Diet in Renal Disease (MDRD) equation-based estimated glomerular filtration rate (eGFR). From 4394 patients with two creatinine measurements included, 1579 (35.9%) had normal eGFR (MDRD 90–120 mL/min/1.73 m2), 210 (4.8%) had hyperfiltration (MDRD > 120 mL/min/1.73 m2), 2383 (54.2%) had chronic kidney disease (CKD) grade 2 (MDRD 60–90 mL/min/1.73 m2), and 221 (5.0%) had CKD grade 3 (MDRD 30–60 mL/min/1.73 m2). Multivariable analyses showed no eGFR change for patients in initial CKD grade 2, normal eGFR and hyperfiltration, and a significant increase in CKD grade 3. The RNPC© program avoids renal function impairment during the two first phases, regardless of the initial eGFR.

Genesis of langrial iron ore of hazara area, khyber pakhtunkhaw, parkistan

The Iron Ore of Hazara area has been studied at seven locations for detail mineralogical and genesis investigations. Thick bedded iron ore have been observed between Kawagarh Formation and Hangu Formation i.e Cretaceous-Paleocene boundary. At the base of Hangu Formation variable thickness of these lateritic beds spread throughout the Hazara and Kohat-Potwar plateau. This hematite ore exists in the form of unconformity. X-Ray Diffraction technique (XRD), X-ray Fluorescence Spectrometry (XRF), detailed petroghraphic study and Scanning Electron Microscope (SEM) techniques indicated that iron bearing minerals are hematite, chamosite and quartz, albite, clinochlore, illite-montmorillonite, kaolinite, calcite, dolomite and ankerite are the impurities present in these beds. The X-ray Fluorescence (XRF) results show that the total Fe2O3 ranges from 39 to 56% and it has high silica and alumina ratio is less than one. Beneficiation requires for significant increase in ore grade. The petroghraphic study revealed the presence of ooids fragments as nuclei of other ooids with limited clastic supply which indicate high energy shallow marine depositional setting under warm and humid climate. The overall results show that Langrial Iron ore is a low-grade iron ore and can be upgraded up to 62% by applying modern mining techniques to fulfill steel requirements of the country.

Genesis of Langrial Iron Ore of Hazara area, Khyber Pakhtunkhwa, Pakistan

In this paper, a detailed mineralogical and genesis investigation have been carried out in the seven locations of the Iron Ore in Hazara area. Thick bedded iron ore have been observed between Kawagarh Formation and Hangu Formation i.e, Cretaceous-Paleocene boundary. At the base of Hangu Formation, variable thickness of these lateritic beds spread throughout the Hazara and Kohat-Potwar plateau. This hematite ore exists in the form of unconformity. X-ray diffraction technique (XRD), X-ray fluorescence spectrometry (XRF), detailed petroghraphic study and scanning electron microscope (SEM) techniques indicated that those iron bears minerals including hematite, chamosite and quartz, albite, clinochlore, illite-montmorillonite, kaolinite, calcite, dolomite, whereas ankerite are the impurities present in these beds. The X-ray fluorescence (XRF) results show that the total Fe2O3 ranges from 39 to 56%, with high silica and alumina ratio of less than one. Beneficiation requires for significant increase in ore grade. The petroghraphic study revealed the presence of ooids fragments as nuclei of other ooids with limited clastic supply, which indicate high energy shallow marine depositional setting under warm and humid climate. The overall results show that Langrial Iron Ore is a low-grade iron ore which can be upgraded up to 62% by applying modern mining techniques so as to fulfill steel requirements of the country.

Pancreatic Stereotactic Body Radiation Therapy With or Without Hypofractionated Elective Nodal Irradiation

Pancreatic stereotactic body radiation therapy (SBRT) is limited to gross tumor without elective coverage for subclinical disease. Given a better understanding of recurrence patterns, we hypothesized that the addition of elective nodal irradiation (ENI) to pancreatic SBRT would be tolerable and would decrease locoregional progression. We conducted a retrospective 1:2 propensity-matched cohort study to compare toxicity and locoregional progression among patients treated with pancreatic SBRT with or without ENI. In the SBRT+ENI cohort, an elective target volume was delineated per Radiation Therapy Oncology Group guidelines and treated to 25 Gy in 5 fractions alongside 40 Gy in 5 fractions to gross disease. The primary outcome was the cumulative incidence of locoregional progression, with death as a competing risk. Among 135 candidate controls treated with SBRT alone, 100 were propensity-matched to 50 patients treated with SBRT+ENI. All patients completed SBRT. Median potential radiographic follow-up was 28 months. The incidence of late and serious acute toxicity was similar between matched cohorts. However, SBRT+ENI was associated with a statistically significant increase in acute grade 1 to 2 nausea (60% vs 20%, P < .001). The 24-month cumulative incidences of locoregional progression with and without ENI were 22.6% (95% confidence interval [CI], 10.0%-35.1%) versus 44.6% (95% CI, 34.8%-54.4%; multivariable-adjusted hazard ratio, 0.39; 95% CI, 0.18-0.87; P = .021). This was stable in sensitivity analyses of uniform prescription dose, multiagent chemotherapy, and resectability. There were fewer peripancreatic (0% vs 7%), porta hepatis (2% vs 7%), and peri-aortic/aortocaval (5% vs 12%) recurrences after SBRT+ENI, but no difference in survival. Pancreatic SBRT+ENI was tolerable and did not increase late or serious acute toxicity relative to a matched cohort undergoing SBRT alone, but did increase acute grade 1 to 2 nausea. The addition of ENI to SBRT was associated with decreased locoregional progression but not improved survival. Further studies are warranted to determine whether ENI offers meaningful benefit.

Pre-graduation grade inflation in medical training in Turkey: a longitudinal study from 2005 to 2020

BackgroundGrade inflation which is known as the awarding of higher grades than students deserve in higher education has been observed since the 1960s. There is comprehensive evidence that document the allegations, prevalence, and severity of grade inflation in higher education in universities around the world for the past 10 years.MethodsThis study analyzes the change in the ratio of graduates with a “very good (>2.99)” degree in medical education in Turkey within a 15-year-long period in terms of the grade inflation (when all other factors are constant), and factors that affect the overall achievement grades. The analyses were carried out using the grade point average (GPA) of 9,618 students who graduated from the medical schools of 25 Turkish universities, and grades of 288,540 students for 7,597 courses. In doing so, the “real” university random effects estimator modelling considering the differences in universities with correlation, ANOVA, t-test and ANCOVA analyses were carried out.ResultsThe results revealed that there was a marginal increase in grades in medical training before graduation. Twenty-nine percent grade inflation was detected in line with the relevant findings in literature and this figure is one of the highest that has been reported so far. It was also detected that the ratio of graduates with a “very good (>2.99)” degree was 17% in 2005 and it increased to 46% in 2020. Additionally, the class size, academic rank of the instructors, grades, course contents, types of the universities (public & non-profit private), accreditation of the program, and the age of the medical schools were considered as important determinants of the difference in course grades.ConclusionThese results show that both the uncontrolled expansion of medical schools in Turkey and the decrease in quality cause a significant increase in grades. Moreover, an important finding is that accreditation slows down the grade inflation. Both the course grades following the accreditation process and the inflation in the graduation grades (grade inflation) slowed down significantly in the accredited medical schools. This finding is an important example for the necessity of accreditation for universities, which is referred to as the “gold standard” to improve the quality of medical education.

The Difference in Accuracy Between Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score in Predicting In-Hospital Mortality of Acute ST-Elevation Myocardial Infarction Patients.

BackgroundIn-hospital mortality of ST-elevation myocardial infarction (STEMI) patients varies between 1% and 19% in Asia. Global Registry of Acute Coronary Events (GRACE) score and Thrombolysis in Myocardial Infarction (TIMI) score are the most frequently used risk scores for predicting in-hospital mortality. These two scores have different accuracy depending on the risk profiles of each region. This study aimed to identify the difference in accuracy between GRACE and TIMI scores.MethodsThis was an observational cohort retrospective study on consecutive patients with STEMI admitted to Dr. Hasan Sadikin General Hospital Bandung between July 2018 and June 2019.ResultsThe risk scores were evaluated in 255 patients with STEMI, whose data were collected from medical records. Patients in this study were 58 ± 11 years old, more often male (78.8%) and have smoking (65.5%), dyslipidemia (61%), hypertension (56.5%) and diabetes mellitus (21.6 %) as their risk factors. Forty-five patients died in hospitalization (17%). The TIMI and GRACE scores revealed a significant graded increase in mortality with a rising score. There was a statistically significant difference in accuracy between the scores of 0.082 (95% confidence interval (CI): 0.040 - 0.125; P < 0.001) with the GRACE score (C statistics of 0.91; P < 0.001) having better accuracy compared to TIMI score (C statistics of 0.83; P < 0.001). This might be due to the fact that the GRACE scoring system has more detail and complete variables than the TIMI score.ConclusionThere is a significant difference between the accuracy of GRACE and TIMI scores in predicting in-hospital mortality in STEMI patients. The accuracy of the GRACE score is better than the TIMI score for predicting in-hospital mortality in STEMI patients.

Inhomogeneous and anisotropic mechanical properties of the triceps surae muscles and aponeuroses in vivo during submaximal muscle contraction

This study aimed to identify characteristics of the triceps surae muscles and aponeuroses stiffness in vivo, during graded isometric submaximal plantarflexion efforts. A total of twelve healthy male subjects (age: 27 ± 4 years) participated and were required to stay at rest (0% MVC) and perform isometric submaximal plantar flexion contractions (20%, 40%, 60% of MVC) on a dynamometer. Young’s modulus of triceps surae muscles and the adjoining aponeuroses between gastrocnemii and soleus at the proximal and distal sites were obtained in the longitudinal direction (along muscle’s line of action) during at rest and submaximal plantar flexions. Additionally, Young’s modulus of adjoining aponeuroses in the transverse direction at the distal sites was also calculated. Young’s modulus of LG (lateral gastrocnemius), SOL-lat (lateral part of soleus) and LPS (superficial aponeurosis of LG) at the proximal site showed significant (p < 0.001) graded increase response to the submaximal contraction levels. Besides, in the lateral side, significant differences in the Young’s modulus of aponeuroses were observed between longitudinal and transverse directions at rest and during contractions (p < 0.002). Changes of aponeuroses length were significantly correlated with Young’s modulus changes of the proximal gastrocnemii muscle bellies (r = 0.43–0.45, p = 0.006–0.008) and superficial aponeuroses (r = 0.49–0.60, p < 0.002). The results further indicate that the triceps surae muscles and aponeuroses showed inhomogeneous and anisotropic mechanical properties during submaximal muscle contractions, and the stiffening effect of muscle belly possibly make influence on the mechanical properties of aponeuroses during muscle contractions, especially for the lateral gastrocnemius.