Stage Category Research Articles

Maternal diabetes independent of BMI is associated with altered accretion of adipose tissue in large for gestational age fetuses.

AimTo analyse the effects of maternal diabetes mellitus (DM) and body mass Index (BMI) on central and peripheral fat accretion of large for gestational age (LGA) offspring.MethodsThis retrospective study included LGA fetuses (n = 595) with ultrasound scans at early (19.23 ± 0.68 weeks), mid (28.98 ± 1.62 weeks) and late (36.20 ± 1.59 weeks) stages of adipogenesis and measured abdominal (AFT) and mid-thigh (TFT) fat as surrogates for central and peripheral adiposity. Women were categorised according to BMI and DM status [pre-gestational (P-DM; n = 59), insulin managed (I-GDM; n = 132) and diet managed gestational diabetes (D-GDM; n = 29)]. Analysis of variance and linear regressions were applied.ResultsAFT and TFT did not differ significantly between BMI categories (normal, overweight and obese). In contrast, AFT was significantly higher in pregnancies affected by D-GDM compared to non-DM pregnancies from mid stage (0.44 mm difference, p = 0.002) and for all DM categories in late stage of adipogenesis (≥ 0.49 mm difference, p < 0.008). Late stage TFT accretion was higher than controls for P-DM and I-GDM but not for D-GDM (0.67 mm difference, p < 0.001; 0.49 mm difference, p = 0.001, 0.56 mm difference, p = 0.22 respectively). In comparison to the early non-DM group with an AFT to TFT ratio of 1.07, the I-GDM group ratio was 1.25 (p < 0.001), which normalised by 28 weeks becoming similar to control ratios.ConclusionsDM, independent of BMI, was associated with higher abdominal and mid-thigh fat accretion in fetuses. Use of insulin improved central to peripheral fat ratios in fetuses of GDM mothers.

Key factors affecting the decision-making process for buildings projects in Egypt

The success of optimal system selection depends on many factors, such as the nature of the project itself, design team collaboration, team leader's personality, and client input. Unfortunately, despite numerous existing studies on key impacting factors in various fields of construction design, the majority of them failed to focus on the key factors affecting the structure design decision-making process. This study aims to identify, investigate, and rank factors perceived to affect decision-making for the optimal system in the construction industry, particularly that of buildings, during the early stages of the entire life cycle, in terms of their relative importance. Practitioners and experts from Egypt comprising a statistically representative sample, were invited to participate in a structured questionnaire survey to achieve this objective. The questionnaire was composed of 17 factors classified under three primary stage categories: feasibility study, planning, and design and engineering. The relative importance index and dispersion analysis were used to obtain statistics and calculate the collected data. The results show that “The impact of financial difficulties on the decision-making” is the first key factor, “The impact of errors and omissions due to the lack of communication and coordination on the decision-making” is the second key factor, and “The Impact of inaccurate evaluation of projects duration on the decision-making” and “The impact of design changes upon contractor request on the decision-making?” constitute the third key factors. Therefore, this work can guide decision-makers for effective construction management and help achieve a competitive quality and cost-effective project.

Radical prostatectomy findings and oncologic outcomes in patients with prostate cancer detected on systematic sextant biopsy only, MRI-targeted biopsy only, or both.

Magnetic resonance imaging-targeted biopsy (T-Bx) has been shown to more accurately detect clinically significant prostate cancer. However, the clinical significance of cancer detection on T-Bx, followed by definitive treatment, needs to be further investigated. We herein investigated unique cohorts of patients with prostate cancer detected on systematic sextant biopsy (S-Bx) and/or T-Bx. We assessed consecutive patients who had undergone T-Bx with concurrent S-Bx (6 sites, ≥12 cores), followed by radical prostatectomy from 2015 to 2019. Within our Surgical Pathology database, we identified a total of 222 men who met the inclusion criteria for prostatic adenocarcinoma on either S-Bx or T-Bx, or both (B-Bx). Radical prostatectomy findings and oncologic outcomes were then compared among groups. Prostate cancer was detected on S-Bx only (n = 32; 14%), T-Bx only (n = 40; 18%), or B-Bx (n = 150; 68%). Compared to cases with cancer detected on S-Bx only, those on T-Bx only or B-Bx showed significantly higher tumor grade (highest Grade Group in each patient) on biopsy and significantly larger estimated tumor volume on prostatectomy. There were no significant differences in tumor volume on biopsy, tumor grade on prostatectomy (except S-Bx vs. B-Bx), pT or pN stage category, surgical margin status, or preoperative prostate-specific antigen level between cases where cancer was detected on S-Bx only vs. T-Bx only or B-Bx. There were also no significant differences in any of these clinicopathologic features between cancers detected on T-Bx only vs. B-Bx. Kaplan-Meier analysis revealed a significantly higher risk of biochemical recurrence after prostatectomy in patients whose cancer was detected on T-Bx only (P = 0.020) or B-Bx (P = 0.032) than in those on S-Bx only. No significant difference in recurrence-free survival between T-Bx only vs. B-Bx cases (P = 0.601) was seen. In multivariate analysis, cancer detection on T-Bx only (vs. S-Bx only) showed significance for recurrence (hazard ratio = 8.482, P = 0.045). Detection of prostate cancer on T-Bx, in addition to or instead of S-Bx, was found to be associated with larger tumor volume as well as worse prognosis. However, no significant clinicopathologic impact of simultaneous tumor detection on S-Bx was indicated in patients with prostate cancer present on T-Bx.

Risk factors and prognostic implications of diagnosis of cancer within 30 days after an emergency hospital admission (emergency presentation): an International Cancer Benchmarking Partnership (ICBP) population-based study.

SummaryBackgroundGreater understanding of international cancer survival differences is needed. We aimed to identify predictors and consequences of cancer diagnosis through emergency presentation in different international jurisdictions in six high-income countries.MethodsUsing a federated analysis model, in this cross-sectional population-based study, we analysed cancer registration and linked hospital admissions data from 14 jurisdictions in six countries (Australia, Canada, Denmark, New Zealand, Norway, and the UK), including patients with primary diagnosis of invasive oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer during study periods from Jan 1, 2012, to Dec 31, 2017. Data were collected on cancer site, age group, sex, year of diagnosis, and stage at diagnosis. Emergency presentation was defined as diagnosis of cancer within 30 days after an emergency hospital admission. Using logistic regression, we examined variables associated with emergency presentation and associations between emergency presentation and short-term mortality. We meta-analysed estimates across jurisdictions and explored jurisdiction-level associations between cancer survival and the percentage of patients diagnosed as emergencies.FindingsIn 857 068 patients across 14 jurisdictions, considering all of the eight cancer sites together, the percentage of diagnoses through emergency presentation ranged from 24·0% (9165 of 38 212 patients) to 42·5% (12 238 of 28 794 patients). There was consistently large variation in the percentage of emergency presentations by cancer site across jurisdictions. Pancreatic cancer diagnoses had the highest percentage of emergency presentations on average overall (46·1% [30 972 of 67 173 patients]), with the jurisdictional range being 34·1% (1083 of 3172 patients) to 60·4% (1317 of 2182 patients). Rectal cancer had the lowest percentage of emergency presentations on average overall (12·1% [10 051 of 83 325 patients]), with a jurisdictional range of 9·1% (403 of 4438 patients) to 19·8% (643 of 3247 patients). Across the jurisdictions, older age (ie, 75–84 years and 85 years or older, compared with younger patients) and advanced stage at diagnosis compared with non-advanced stage were consistently associated with increased emergency presentation risk, with the percentage of emergency presentations being highest in the oldest age group (85 years or older) for 110 (98%) of 112 jurisdiction-cancer site strata, and in the most advanced (distant spread) stage category for 98 (97%) of 101 jurisdiction-cancer site strata with available information. Across the jurisdictions, and despite heterogeneity in association size (I2=93%), emergency presenters consistently had substantially greater risk of 12-month mortality than non-emergency presenters (odds ratio >1·9 for 112 [100%] of 112 jurisdiction-cancer site strata, with the minimum lower bound of the related 95% CIs being 1·26). There were negative associations between jurisdiction-level percentage of emergency presentations and jurisdiction-level 1-year survival for colon, stomach, lung, liver, pancreatic, and ovarian cancer, with a 10% increase in percentage of emergency presentations in a jurisdiction being associated with a decrease in 1-year net survival of between 2·5% (95% CI 0·28–4·7) and 7·0% (1·2–13·0).InterpretationInternationally, notable proportions of patients with cancer are diagnosed through emergency presentation. Specific types of cancer, older age, and advanced stage at diagnosis are consistently associated with an increased risk of emergency presentation, which strongly predicts worse prognosis and probably contributes to international differences in cancer survival. Monitoring emergency presentations, and identifying and acting on contributing behavioural and health-care factors, is a global priority for cancer control.FundingCanadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; the Scottish Government; Western Australia Department of Health; and Wales Cancer Network.

Pancreatic cancer survival by stage and age in seven high-income countries (ICBP SURVMARK-2): a population-based study.

The global burden of pancreatic cancer has steadily increased, while the prognosis after pancreatic cancer diagnosis remains poor. This study aims to compare the stage- and age-specific pancreatic cancer net survival (NS) for seven high-income countries: Australia, Canada, Denmark, Ireland, New Zealand, Norway, and United Kingdom. The study included over 35,000 pancreatic cancer cases diagnosed during 2012-2014, followed through 31 December 2015. The stage- and age-specific NS were calculated using the Pohar-Perme estimator. Pancreatic cancer survival estimates were low across all 7 countries, with 1-year NS ranging from 21.1% in New Zealand to 30.9% in Australia, and 3-year NS from 6.6% in the UK to 10.9% in Australia. Most pancreatic cancers were diagnosed with distant stage, ranging from 53.9% in Ireland to 83.3% in New Zealand. While survival differences were evident between countries across all stage categories at one year after diagnosis, this survival advantage diminished, particularly in cases with distant stage. This study demonstrated the importance of stage and age at diagnosis in pancreatic cancer survival. Although progress has been made in improving pancreatic cancer prognosis, the disease is highly fatal and will remain so without major breakthroughs in the early diagnosis and management.

Life cycle assessment and economic analysis of the electric motorcycle in the city of Barcelona and the impact on air pollution

In this work, the evaluation of the life cycle of the service provided by a medium-power motorcycle in a Spanish urban environment was carried out, comparing two motorcycles, a battery electric vehicle (BEV) is compared with an internal combustion engine vehicle (ICEV). The economic study of the total costs of ownership is also carried out considering the environmental costs associated with each type of vehicle. A comprehensive inventory is compiled for both vehicles (motorcycles) that describes the most relevant components and includes two types of batteries for the BEV. A sensitivity analysis of the most impactful parameters is also considered.The results indicate that the ICEV contributes approximately 5 times more in the global warming potential impact category mainly due to the consumption of fossil fuels. The BEV also impacts some categories in the manufacturing stage, a fact that is strongly related to the battery. Sensitivity analysis indicates that the total distance travelled plays an important role, but the electricity mix is probably the most relevant factor in terms of climate change impact category. The economic analysis reported lower environmental externality costs for the BEV, making it more affordable than the ICEV and highlighting the benefit in terms of air pollution. The BEV is presented as a suitable option vehicle from environmental and economic point of view and one of the actors to accelerate the transition towards a more sustainable urban mobility model.

Lymph node ratio is superior to AJCC N stage for predicting recurrence in papillary thyroid carcinoma.

ObjectiveRecently, lymph node ratio (LNR) has emerged as an alternative to American Joint Committee on Cancer (AJCC) N stage, with superior prognostic value. The utility of LNR in Middle Eastern papillary thyroid carcinoma (PTC) remains unknown. Therefore, we retrospectively analyzed a large cohort of 1407 PTC patients for clinicopathological associations of LNR.MethodsReceiver operating characteristics (ROC) curve was used to determine the cut-off for LNR. We also performed multivariate logistic regression analysis to determine whether LNR or AJCC N stage was superior in predicting recurrence in PTC.ResultsBased on ROC curve analysis, a cut-off of 0.15 was chosen for LNR. High LNR was significantly associated with adverse clinicopathological characteristics such as male sex, extrathyroidal extension, lymphovascular invasion, multifocality, bilateral tumors, T4 tumors, lateral lymph node (N1b) involvement, distant metastasis, advanced tumor stage, American Thyroid Association (ATA) high-risk category and tumor recurrence. On multivariate analysis, we found that LNR was a better predictor of tumor recurrence than AJCC N stage (odds ratio: 1.96 vs 1.30; P value: 0.0184 vs 0.3831). We also found that LNR combined with TNM stage and ATA risk category improved the prediction of recurrence-free survival, compared to TNM stage or ATA risk category alone.ConclusionsThe present study suggests LNR is an independent predictor of recurrence in Middle Eastern PTC. Integration of LNR with 8th edition AJCC TNM staging system and ATA risk stratification will improve the accuracy to predict recurrence in Middle Eastern PTC and help in tailoring treatment and surveillance strategies in these patients.

Conditional cancer-specific survival after radical hepatectomy in patients with nonmetastatic intrahepatic cholangiocarcinoma

Objectives To examine conditional survival (CS) in patients with non‐metastatic intrahepatic cholangiocarcinoma (nmICC) after surgical treatment according to pT and pN stages. Methods A total of 608 patients were included. Conditional three-year cancer-specific mortality estimates were obtained according to pT and pN stages. Multivariable Cox regression analysis was applied to predict factors affecting cancer-specific mortality (CSM). Results According to substages based on pT and pN status, 109 patients (17.9%) with pT1aN0, 96 (15.8%) with pT1bN0, 205 (33.7%) with pT2N0, 82(13.5%) with pT3-5N0, and 116 (19.1%) with pTanyN1 were identified. Conditional CSM-free estimates increased from 75% to 87%, 66% to 70%, 53% to 86%, and 36 to 54% after three years of event-free follow-up in pT1b, pT2, pT3-4N0, and pTanyN1 patients, respectively, whereas it decreased from 87% to 79% in pT1aN0 patients. Based on multivariable analysis, patients with pT2N0 (hazard ratio [HR] 2.0 p < .01), pT3-4N0 (HR 2,7 p < .01), and pTanyN1-3 (HR 4.8 p < .01) had higher CSM than patients with pT1aN0 at baseline. Conclusions CS varied across stage categories in nmICC patients after surgery, and it was important in individualized clinical counseling and decision‐making for nmICC.

Cognitive Skills in Basic Mathematics of College Freshmen in the Philippines

Many students consider mathematics as the most dreaded subject in their curriculum, so much so that the term “math phobia” or “math anxiety” is practically a part of clinical psychological literature. This symptom is widespread and students suffer mental disturbances when facing mathematical activity because understanding mathematics is a great task for them. This paper described the students’ cognitive skills performance in Basic Mathematics based on the following logical operations: Classification, Seriation, Logical Multiplication, Compensation, Ratio and Proportional Thinking, Probability Thinking and Correlation Thinking as it serves a critical element of teaching and learning, that is determining the current position of the learners’ mathematical capacity. Its implications for mathematics education were also revealed. A descriptive quantitative design was used in this study. The study included 1011 first-year college students from six state universities in the Philippines who were enrolled in the Bachelor of Science of Secondary Education Program during the first semester of the Academic Year 2019-2020. This study made use of the teacher-made test called the Test on Logical Operations. Findings revealed that the cognitive skills achievement of the first year BSE students from different state universities in the Philippines falls under the category of late concrete operational stage. As a result, students are unable to perform the logical operational skills expected of their age. At their age level, they are expected to be under the formal operational stage based on Piaget’s stages of cognitive development. These findings revealed a weak mathematical education foundation among students which requires immediate attention. This reality should be recognized by educational planners and implementers when making curricular and other instructional decisions.

Patient-Specific Genome-Scale Metabolic Models for Individualized Predictions of Liver Disease

The prevalence of liver disease is steadily increasing, coupled with the limited availability of therapeutic treatments. Recent literature points to metabolic reprogramming as a key feature of liver failure. Hence, we sought to uncover the metabolic pathways and mechanisms associated with liver disease and acute liver failure. We generated patient-specific genome scale metabolic models by integrating RNA-seq data from patient liver samples with a generalized human metabolic model. Flux balance analysis simulations showed a distinct separation of non-alcohol associated and alcohol-associated disease states. Our analysis suggests that the alcohol associated liver has an increased flux through nucleotide and glycerophospholipid metabolic pathways. By contrast, non-alcohol associated liver has an increased flux through fatty acid oxidation, the carnitine shuttle, and bile acid recycling pathways. Importantly, there was significant variation of metabolic fluxes between patients within the same clinical category of disease stage, pointing to the necessity and opportunity for personalized medicine in treating liver disease. We conclude that the metabolic reprogramming occurring in alcohol-associated liver disease is likely distinct from the adaptations in non-alcohol associated liver disease, potentially requiring alternative therapeutic approaches.

Blood pressure characteristics of collegiate female athletes: A call for more focused attention on young women's health

BackgroundThere is a paucity of data describing the association between blood pressure (BP) and cardiac remodeling in female collegiate athletes. MethodsThis retrospective cohort review describes the BP characteristics and echocardiographic features of female collegiate athletes during preparticipation evaluation. We evaluated data from 329 female athletes at two National Collegiate Athletic Association (NCAA) Division I universities who underwent preparticipation evaluation that included medical history, physical examination, 12-lead electrocardiography, and 2-dimensional transthoracic echocardiography. BP values were divided into categories of normal, elevated, stage 1 and stage 2 hypertension based on 2017 ACC/AHA Guidelines. Left ventricular mass index was calculated and indexed to body surface area and further classified into concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. ResultsNormal BP values were noted in 184 (56%) female athletes, 88 (26.7%) had elevated BP and 57 (17.3%) had BP values indicating stage 1 or 2 hypertension. The majority of participants were white (n = 136, 73.9%). There was significantly higher body surface area in female athletes with higher BP values: 1.85 ± 0.18 in the stage 1 and 2 hypertension range, 1.82 ± 0.18 in the elevated BP range versus 1.73 ± 0.16 in the normal BP range (p < 0.001). ConclusionsThere was a trend toward higher incidence of concentric and eccentric hypertrophy in athletes with higher than normal BP, however no statistical significance was noted. Elevated BP values were frequent among female collegiate athletes, and there is evidence of cardiac remodeling associated with higher BP values.

Incorporating rainy season and reproductive phenology into the survival and transition rates of the invasive speciesSambucus nigra: an approximation with multistate models

AbstractAlthough it has been demonstrated that environmental changes within a year can affect the reproduction, survival, and growth of invasive species, these factors have rarely been incorporated into demographic analyses. Therefore, we applied multistate demographic models (based on capture–recapture animal methods accounting for imperfect detectability of individuals in natural conditions) to evaluate the effects of reproductive phenology and rainy season on the survival and transition/retrogression rates among stage categories of black elderberry (Sambucus nigraL.)—an invasive tree species widely distributed in temperate forests of Europe and America. In theAbies religiosatemperate forest, Mexico City, a multistate demographic model ofS. nigrawas built using bimonthly censuses during a year. We selected the best-fitting model according to Akaike’s information criterion adjusted for small sample sizes (AICc). We determined the response of reproductive phenology ofS. nigrato the rainy season for 2 yr through repeatability and phenotypic plasticity indexes. Our results showed that the reproductive phenology ofS. nigrahas a low repeatability index and a high phenotypic plasticity index. We demonstrated that additive and interactive effects of reproductive phenology and rainy season promote changes in survival and transition/retrogression rates among stage categories. During the rainy season, the survival probability of seedlings and transition probability toward the adult category increased. Therefore, our study represents a significant contribution to the knowledge of the demographic dynamics of invasive species on an intra-annual scale.

Prediction of early recurrence and response to adjuvant Sorafenib for hepatocellular carcinoma after resection.

BackgroundEarly recurrence of hepatocellular carcinoma (HCC) is a major obstacle to improving the prognosis, and no widely accepted adjuvant therapy guideline for patients post-liver resection is available. Currently, all available methods and biomarkers are insufficient to accurately predict post-operation HCC patients’ risk of early recurrence and their response to adjuvant therapy.MethodsIn this study, we downloaded four gene expression datasets (GSE14520, GSE54236, GSE87630, and GSE109211) from the Gene Expression Omnibus database and identified 34 common differentially expressed genes associated with HCC dysregulation and response to adjuvant sorafenib. Then, we constructed a novel 11-messenger RNA predictive model by using ROC curves analysis, univariate Cox regression analysis, and LASSO Cox regression analysis. Furthermore, we validated the predictive values of the risk model in GSE14520 and TCGA-LIHC cohorts by using Kaplan–Meier survival analysis, multivariable Cox regression analysis, and decision curve analysis, respectively.ResultsThe risk score model could identify patients with a high risk of HCC recurrence at the early stage and could predict the response of patients to adjuvant sorafenib. Patients with a high risk score had a worse recurrence rate in training cohorts (2-year: p < 0.0001, hazard ratio (HR): 4.658, confidence interval 95% CI [2.895–7.495]; 5-year: p < 0.0001, HR: 3.251, 95% CI [2.155–4.904]) and external validation cohorts (2-year: p < 0.001, HR: 3.65, 95% CI [2.001–6.658]; 5-year: p < 0.001, HR: 3.156, 95% CI [1.78–5.596]). The AUC values of the risk score model for predicting tumor early recurrence were 0.746 and 0.618, and that of the risk score model for predicting the response to adjuvant sorafenib were 0.722 and 0.708 in the different cohort, respectively. Multivariable Cox regression analysis and decision curve analysis also showed that the risk score model was superior to and independent of other clinicopathologic characteristics. Moreover, the risk score model had excellent abilities to predict the overall survival and HCC recurrence of patients with the same tumor stage category.ConclusionsOur risk model is a reliable and superior predictive tool. With this model, we could optimize the risk stratification based on early tumor recurrence and could evaluate the response of patients to adjuvant sorafenib after liver resection.

Outcomes of Triple Class (Proteasome Inhibitor, IMiDs and Monoclonal Antibody) Refractory Patients with Multiple Myeloma

Outcomes of Triple Class (Proteasome Inhibitor, IMiDs and Monoclonal Antibody) Refractory Patients with Multiple Myeloma

Molecular Classification of Bladder Urothelial Carcinoma Using NanoString-Based Gene Expression Analysis.

Simple SummaryOur study aimed to apply a quantitative method based on mRNA counting as nCounter (NanoString Technologies, Inc). This method can obtain precise and accurate measures of RNA expression compared to RT-PCR, and which might represent an alternative to the NGS-genomic/transcriptomic profiling frequently used to generate molecular data in bladder cancer and provide clinically meaningful datasets for the molecular classification of bladder cancer. The current study generated a four-gene classifier, incorporating GATA3 and KRT20 (typically related to luminal molecular subtype) and KRT5 and KRT14 (typically related to basal molecular subtype). This methodology allowed us to explore differences in clinicopathologic parameters and potential sensitivities to ICI immunotherapy in a cohort series of 91 urothelial carcinomas of the bladder.Molecular classification of bladder carcinoma is a relevant topic in modern bladder cancer oncology due to its potential to improve oncological outcomes. The available molecular classifications are generally based on transcriptomic profiles, generating highly diverse categories with limited correlation. Implementation of molecular classification in practice is typically limited due to the high complexity of the required technology, the elevated costs, and the limited availability of this technology worldwide. We have conducted a gene expression analysis using a four-gene panel related to luminal and basal subtypes in a series of 91 bladder cancer cases. NanoString-based gene expression analysis using typically luminal (GATA3+/KRT20+) and basal markers (KRT14+/KRT5+/GATA3low/-/KRT20low/-) classified urothelial bladder carcinoma samples as luminal, basal, and a third category (KRT14-/KRT5-/GATA3-/KRT20-), null/double negative (non-luminal/non-basal). These three categories were meaningful in terms of overall cancer-specific survival (p < 0.0001) or when classified as conventional urothelial carcinoma and variant histology urothelial carcinoma (p < 0.0001), NMIBC vs. MIBC (p < 0.001), or by AJCC stage category Ta (p = 0.0012) and T1 (p < 0.0001) but did not reach significance in T2-T4 (p = 0.563). PD-L1 expression (low vs. high) was also different according to molecular subtype, with high PD-L1 expression mostly seen in basal and null subtypes and carcinomas with variant histology (p = 0.002). Additionally, the luminal subtype was enriched in NMIBC with favorable cancer-specific survival (p < 0.0001). In contrast, basal and null subtypes resulted in aggressive MIBC tumors with shorter cancer-specific survival (p < 0.0001), some of which presented variant histology. In conclusion, a comprehensive evaluation of a gene classifier related to molecular taxonomy using NanoString technology is feasible. Therefore, it might represent an accessible and affordable tool in this rapidly expanding area of precision genomics.

The Correlation Between Concept Mastery and Students Moral Reasoning Stage Through Socio Scientific Issue Approach on Human Reproduction System Material

The aim of this study was to obtain empirical data regarding the relationship between the mastery of concept, and the stage of students’ moral reasoning. The research method used was correlational research with cluster random sampling technique. The population in this study were all senior high schools in the city of Mataram and the sample consisted of 171 class XII students from three public senior high schools in the city of Mataram. Data collection was carried out using a concept mastery test instrument in the form of multiple choice questions and a moral reasoning stage test using a questionnaire on socio-scientific issues. The results of the research as a whole, it consisted of (1) Test of mastery of the material concept of the reproductive system of students in the less category with a percentage of 45%. (2) The moral reasoning test of students was categorized into the category of beginner reasoning stage with a percentage of 56% (3) The correlation test on concept mastery and moral reasoning stage used Spearman correlation and it showed that there was a significant relationship (r = 0835, = 0.000) with positive direction. This positive and significant relationship can be interpreted that the higher the mastery of the material concepts of the reproductive system of students, the better the stage of students’ moral reasoning.

Pan-Cancer Analysis of Prognostic Metastatic Phenotypes

<h3>Purpose/Objective(s)</h3> Staging for metastatic disease is unreliable; there is usually only one category of Stage IV in the American Joint Commission on Cancer (AJCC) 8^th edition, but survival can range from weeks to years. We hypothesize that prognostication can be improved for metastatic disease by using common clinical covariates in a pan-cancer phenotype staging system. <h3>Materials/Methods</h3> Latent class analysis was performed to explore the phenotypes using nationally representative patient data from the National Cancer Database (NCDB; n = 461,357, years 2010-2013, for the training cohort) and the Surveillance, Epidemiology, and End Results database (SEER; n = 106,595, years 2014-2015, for the validation cohort). The optimal number of clusters was determined based on Bayesian information criterion (BIC) and sample-size-adjusted BIC. Kappa coefficients were used to assess external validation. In addition, we used a Cox proportional hazards model with latent classification for survival prediction. Internal validation of the NCDB and the external validation of the training set of SEER were assessed using the concordance (C)-index. <h3>Results</h3> Of the 461,357 patients included from the NCDB (median age 65), latent class analysis identified five metastatic phenotypes: (Stage IVA) nearly-exclusive bone-only metastases, commonly seen in lung, breast, and prostate cancer (n = 59,049, 12.8%; median survival = 12.7 months); (IVB) predominant lung metastases, commonly seen in breast, stomach, kidney, ovary, uterus, thyroid, cervix, and soft tissue cancer (n = 62,491, 13.6%; median survival = 11.4 months); (IVC) predominant liver/lung metastases, commonly seen in colon, rectum, pancreas, lung, esophagus, and stomach cancer (n = 130,014, 28.2%; median survival = 7.0 months); (IVD) bone/liver/lung metastases predominant over brain, commonly seen in lung and breast cancer (n = 61,004, 13.2%; median survival = 5.9 months); (IVE) brain/lung metastases predominant over bone/liver, commonly seen in lung cancer and melanoma (n = 148,799, 32.3%; median survival = 5.7 months). These phenotypes had differences in overall survival, and long-term survivors were identified in Stages IVA-B (<i>P</i> < 0.0001). A pan-cancer nomogram model to predict survival (STARS; based on Site, Tumor, Age, Race, Sex) was created and validated. STARS has 13% better prognostication than AJCC: C-index at 1 month of 0.69 (95% CI 0.68-0.69) vs 0.61 (95% CI 0.60-0.61). <h3>Conclusion</h3> We created and validated a novel pan-cancer staging system for metastatic disease, termed STARS, which is significantly more prognostic than AJCC staging. STARS is innovative because: (1) it takes a global approach, not just focusing on primary tumor, (2) it can be used in all communities, since it relies on readily available, inexpensive predictors; (3) it is simple and allows for rapid validation.

PD63-04 ALL HIGH-GRADE NMIBC IS HIGH RISK: BCG RESPONSE IN HIGH-GRADE TA TUMORS

You have accessJournal of UrologyBladder Cancer: Non-invasive III (PD63)1 Sep 2021PD63-04 ALL HIGH-GRADE NMIBC IS HIGH RISK: BCG RESPONSE IN HIGH-GRADE TA TUMORS Kelly Bree, Nathan Brooks, Graciela Nogueras-Gonzalez, Supriya Nagaraju, H. Barton Grossman, Neema Navai, Colin Dinney, and Ashish Kamat Kelly BreeKelly Bree More articles by this author , Nathan BrooksNathan Brooks More articles by this author , Graciela Nogueras-GonzalezGraciela Nogueras-Gonzalez More articles by this author , Supriya NagarajuSupriya Nagaraju More articles by this author , H. Barton GrossmanH. Barton Grossman More articles by this author , Neema NavaiNeema Navai More articles by this author , Colin DinneyColin Dinney More articles by this author , and Ashish KamatAshish Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002107.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to the AUA/SUO Guideline on treatment of non-muscle invasive bladder cancer (NMIBC), not all patients with high-grade (HG) tumors are classified as high risk with solitary HG Ta lesions ≤3cm classified as intermediate risk (IR-Ta). The EAU guidelines, however, recommend all HG tumors be classified as high risk. We investigated the response to BCG in all Ta tumors and compared response based on classification as intermediate or high risk category. METHODS: An IRB approved review of patients with NMIBC who received adequate BCG, as defined by the US FDA and the International Bladder Cancer Group, at our institution from 2000-2018 was performed. Patients were then stratified by stage, grade, and AUA risk category. RESULTS: Of 522 patients who received adequate BCG, 234 (44.8%) had Ta tumors. 190 had HG Ta tumors- of these, 55 were AUA IR-Ta, while 135 had AUA high risk (HR-Ta). Oncologic behavior of IR-Ta tumors was more in alignment with their HR-Ta counterparts than low-grade Ta (LG Ta) intermediate risk tumors with respect to: BCG unresponsiveness (LG Ta 7.8% vs IR-Ta 13.0% vs HR-Ta 14.9%, p=0.475), progression to muscle invasive bladder cancer (MIBC) or distant metastasis (LG Ta 0.0% vs. IR-Ta 5.6% vs. HR-Ta 7.4%, p=0.118) and need for radial cystectomy (LG 3.9% vs IR-Ta 12.7% vs HR-Ta 11.9%, p=0.231). Recurrence rates were similar across groups (30.9-40.9%, p=0.550). CONCLUSIONS: In all HG Ta patients treated with adequate BCG, irrespective of size or multiplicity, rates of BCG unresponsiveness and progression (particularly to MIBC or metastasis) were similarly higher than LG Ta tumors. These data support the current EAU risk stratification model and suggest that all HG Ta lesions should be considered high risk. Source of Funding: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research and the Raymond and Maria Floyd Bladder Cancer Research Foundation grant to AMK © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1139-e1139 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kelly Bree More articles by this author Nathan Brooks More articles by this author Graciela Nogueras-Gonzalez More articles by this author Supriya Nagaraju More articles by this author H. Barton Grossman More articles by this author Neema Navai More articles by this author Colin Dinney More articles by this author Ashish Kamat More articles by this author Expand All Advertisement Loading ...

Qualitative Analysis of Corona Effects on the Environment

The purpose of this paper is to analyze the semantic system of ecotourism resort owners about the effects of Coronavirus on the environment and nature to show how they understand, interpret and evaluate this phenomenon and its consequences. 12 owners of ecotourism resorts in Mazandaran province participated in this study. After discovering the basic concepts and major categories in the axial coding stage, the process of connecting the categories was done based on their properties. The environmental effects of Coronavirus as a core category, major categories under the headings of consumption, environmental attitudes, barriers, and solutions/strategies were revealed as major categories. Food consumption (packaged and home-made), consumption of hygienic chemicals, consumption of natural sources (water, energy) under the category of consumption, attitudes towards littering, biodiversity conservation, environmental pollution under the category of attitudes towards the environment, legal, individual and structural barriers were placed under the category of barriers to pro-environmental behaviors and creating opportunities for support, increasing environmental awareness and attracting public participation under the category of solutions/strategies. According to the respondents, the emergence of Coronavirus has increased littering in nature and due to its social fear, the volume of new waste (masks and gloves) has increased; however, the positive effects such as biodiversity conservation and reduction of air pollutants due to reduced traffic would be transient and temporary.

Robust deep alignment network with remote sensing knowledge graph for zero-shot and generalized zero-shot remote sensing image scene classification

Although deep learning has revolutionized remote sensing (RS) image scene classification, current deep learning-based approaches highly depend on the massive supervision of predetermined scene categories and have disappointingly poor performance on new categories that go beyond predetermined scene categories. In reality, the classification task often has to be extended along with the emergence of new applications that inevitably involve new categories of RS image scenes, so how to make the deep learning model own the inference ability to recognize the RS image scenes from unseen categories, which do not overlap the predetermined scene categories in the training stage, becomes incredibly important. By fully exploiting the RS domain characteristics, this paper constructs a new remote sensing knowledge graph (RSKG) from scratch to support the inference recognition of unseen RS image scenes. To improve the semantic representation ability of RS-oriented scene categories, this paper proposes to generate a Semantic Representation of scene categories by representation learning of RSKG (SR-RSKG). To pursue robust cross-modal matching between visual features and semantic representations, this paper proposes a novel deep alignment network (DAN) with a series of well-designed optimization constraints, which can simultaneously address zero-shot and generalized zero-shot RS image scene classification. Extensive experiments on one merged RS image scene dataset, which is the integration of multiple publicly open datasets, show that the recommended SR-RSKG obviously outperforms the traditional knowledge types (e.g., natural language processing models and manually annotated attribute vectors), and our proposed DAN shows better performance compared with the state-of-the-art methods under both the zero-shot and generalized zero-shot RS image scene classification settings. The constructed RSKG will be made publicly available along with this paper (https://github.com/kdy2021/SR-RSKG).