Histopathological risk assessment in multisite epithelial dysplasia: A meta-analysis.

OBJECTIVE: Histopathological grading of oral epithelial dysplasia (OED) is the current standard for stratifying cancer progression risk but is associated with subjectivity and variability. This problem is not commonly seen regarding the grading of epithelial dysplasia in other sites. This systematic review aims to compare grading systems for oral, anal, penile, and cervical epithelial dysplasia to determine their predictive accuracy for recurrence and malignant transformation (MT) outcomes. METHODS: The review protocol was registered in PROSPERO (CRD42023403035) and was reported according to the PRISMA checklist. A comprehensive search was performed in the main databases and gray literature. The risk of bias in individual studies was analyzed using the Joanna Briggs Institute checklist for each study design. RESULTS: Forty-six studies were deemed eligible and included in this systematic review, of which 45 were included in the quantitative analysis. Meta-analysis revealed that the binary system demonstrated a higher predictive ability for MT/recurrence of OED compared to multilevel systems. Higher predictive accuracy of MT was also observed for binary grading systems in anal intraepithelial neoplasia. CONCLUSIONS: No significant difference was found between the current grading systems of epithelial dysplasia in different body parts. However, binary grading systems have shown better clinical outcomes.

Role of magnetic resonance imaging in the prediction of histological grade in soft tissue sarcomas.

BACKGROUND: Soft tissue sarcomas are rare malignant tumors with significant heterogeneity. The importance of classifying histological grades is fundamental to defining the treatment approach. OBJECTIVE: To evaluate magnetic resonance imaging (MRI) in predicting the histological grade of soft tissue sarcomas. METHODS: A retrospective observational study included patients over 18 years undergoing MRI and primary tumor surgery at AC Camargo Cancer Center from January 2015 to June 2022. Two radiologists evaluated MRI criteria (size, margin definition, heterogeneity of the T2 signal, high-intensity peritumoral signal on T2, and postperitumoral contrast), and a grading prediction score was calculated. χ2 and logistic regression analyses were conducted. RESULTS: Sixty-eight patients were included (38 men; median: 48 years). Moreover, 52 high-grade and 16 low-grade tumors were observed. The MRI criteria associated with histological grade were peritumoral high-intensity T2-weighted signals (p < 0.001) and peritumoral postcontrast enhancement (p = 0.006). Logistic regression confirmed their significance (odds ratio [OR]: 11.8 and 8.8, respectively). Each score point increment doubled the chance of high-grade tumors (OR: 2.0; p = 0.014). CONCLUSION: MRI effectively predicts histological grades of soft tissue sarcomas. Peritumoral high-intensity T2-weighted signals and peritumoral postcontrast enhancement are valuable indicators of high-grade tumors. This highlights MRI's importance in treatment decision-making for sarcoma patients.

Caracterización histológica del melanoma cutáneo en reportes de patología en la ciudad de Cali, 2016-2021 / Histological characterization of cutaneous melanoma in pathology reports in the city of Cali, 2016-2021

Introducción. El melanoma es la proliferación maligna de melanocitos asociado a un comportamiento agresivo. El objetivo de este estudio fue determinar las variables histológicas del melanoma cutáneo. Métodos. Estudio observacional retrospectivo, transversal descriptivo, realizado con reportes de patologías de pacientes con diagnóstico de melanoma cutáneo en un laboratorio de patología en Cali, Colombia, entre 2016-2021. Se incluyeron las variables edad, sexo, localización, subtipo, espesor de Breslow, ulceración, márgenes, mitosis, invasión linfovascular, neurotrofismo, regresión tumoral, nivel de Clark e infiltración tumoral por linfocitos. Resultados. Se obtuvieron 106 reportes y fueron excluidos 54 por duplicación. Se incluyeron 52 registros, la media de edad fue de 61 años, con una mayor frecuencia de mujeres (55,8 %). De los 33 casos donde se especificó el subtipo histológico, el más frecuente fue el de extensión superficial (66,6 %), seguido del acral lentiginoso (18,1 %) y nodular con (15,2 %). La localización más frecuente fue en extremidades (61,5 %). El espesor de Breslow más común fue IV (34,6 %) y el nivel de Clark más frecuente fue IV (34,6 %). La ulceración estuvo en el 40,4 %. El subtipo nodular fue el de presentación más agresiva, donde el 100 % presentaron espesor de Breslow IV. Conclusiones. El subtipo de melanoma más común en nuestra población fue el de extensión superficial; el segundo en frecuencia fue el subtipo acral lentiginoso, que se localizó siempre en extremidades. Más del 50 % de los melanomas tenían espesor de Breslow mayor o igual a III, lo que impacta en el pronóstico.

Background. Melanoma is the malignant proliferation of melanocytes associated with aggressive behavior. The objective of this study was to determine the histological variables of cutaneous melanoma. Methods. Observational, cross-sectional, descriptive, retrospective study carried out with reports of pathologies with a diagnosis of cutaneous melanoma in a pathology laboratory in Cali between 2016-2021. The variables were age, sex, location, subtype, Breslow thickness, ulceration, margins, mitosis, lymphovascular invasion, neurotropism, tumoral regression, Clark level and tumor infiltration by lymphocytes. Results. One hundred and six reports were obtained and 54 were excluded due to duplication. A descriptive analysis was made on the 52 records that were included, the mean age was 61 years, with a higher frequency in women with 55.8%. Of the 33 cases where the histological subtype was specified, the most frequent was superficial extension with 66.6%, followed by acral lentiginous with 18.1% and nodular with 15.2%. The most frequent location was in the extremities (61.5%); the most common Breslow was IV (34.6%), and the most frequent Clark was IV (34.6%). Ulceration was in 40.4%. The nodular subtype was the most aggressive presentation where 100% presented Breslow IV. Conclusions. The most common subtype of melanoma was that of superficial extension. In our population, the second most frequent was the acral lentiginous subtype, which was always located on the extremities. More than 50% of the melanomas had Breslow greater than or equal to III, which affects the prognosis.

Brain plasticity in neonatal brachial plexus palsies: quantification and comparison with adults' brachial plexus injuries.

PURPOSE: To compare two populations of brachial plexus palsies, one neonatal (NBPP) and the other traumatic (NNBPP) who underwent different nerve transfers, using the plasticity grading scale (PGS) for detecting differences in brain plasticity between both groups. METHODS: To be included, all patients had to have undergone a nerve transfer as the unique procedure to recover one lost function. The primary outcome was the PGS score. We also assessed patient compliance to rehabilitation using the rehabilitation quality scale (RQS). Statistical analysis of all variables was performed. A p ≤ 0.050 set as criterion for statistical significance. RESULTS: A total of 153 NNBPP patients and 35 NBPP babies (with 38 nerve transfers) met the inclusion criteria. The mean age at surgery of the NBPP group was 9 months (SD 5.42, range 4 to 23 months). The mean age of NNBPP patients was 22 years (SD 12 years, range 3 to 69). They were operated around sixth months after the trauma. All transfers performed in NBPP patients had a maximum PGS score of 4. This was not the case for the NNBPP population that reached a PGS score of 4 in approximately 20% of the cases. This difference was statistically significant (p < 0.001). The RQS was not significantly different between groups. CONCLUSION: We found that babies with NBPP have a significantly greater capacity for plastic rewiring than adults with NNBPP. The brain in the very young patient can process the changes induced by the peripheral nerve transfer better than in adults.

Bone metastatic cancer of unknown primary at initial presentation.

INTRODUCTION: Cancer of unknown primary (CUP) is a challenging malignancy. The purpose of this study was to investigate the clinical characteristics and prognosis of bone metastatic CUP using the population-based Surveillance, Epidemiology, and End Results (SEER) database. METHODS: From the SEER database, we identified 1908 patients with bone metastatic CUP at initial presentation between 2010 and 2018. Histology was subdivided following International Classification of Diseases for Oncology codes as Adenocarcinoma, Squamous cell, Neuroendocrine, or Carcinoma not otherwise specified (NOS). Cox proportional hazard modeling was applied using factors of age, sex, ethnicity, histological subtype, and therapeutic intervention. RESULTS: Among the 1908 patients, histology was Neuroendocrine in 240 patients, Squamous cell in 201 patients, Adenocarcinoma in 810 patients and NOS in 657 patients. In each subtype, patients tended to be predominantly male and white. Chemotherapy was introduced for 28% of patients and radiation for 34% in the entire cohort. Survival in patients with bone metastatic CUP was unfavorable, with a median survival of 2 months. Among the histological subtypes, Adenocarcinoma showed shorter survival than the other groups. In addition, treatment interventions such as chemotherapy and radiation therapy prolonged survival, particularly for Squamous cell, Adenocarcinoma and NOS, but not for Neuroendocrine. DISCUSSION: Bone metastatic CUP showed extremely poor prognosis, but treatment interventions such as chemotherapy and radiation generally offered survival benefits. Further randomized clinical research is needed to confirm the present results.

Prognostic Significance of Histopathological Parameters for Salivary Gland Adenoid Cystic Carcinoma.

Adenoid cystic carcinoma (ACC) is a rare salivary gland tumor that accounts for approximately 1% of all head and neck cancers. Despite its initial indolent behavior, long-term survival is poor due to locoregional recurrence in approximately 40% and distant metastasis in up to 60% of patients who undergo radical treatment. The histological parameters of ACC and the combination of these parameters in histopathological grading systems provide valuable prognostic information about the clinical course of the disease. Within this context, this review aims to analyze the impact of histopathological parameters, individual or combined in histopathological grading systems of malignancy, on ACC prognosis. Individual histopathological parameters such as solid pattern, presence of tumor necrosis, high-grade transformation, dominance of the epithelial component, presence of perineural and lymphovascular invasion, and positive surgical margins have negative impacts on the survival of patients with ACC. There are currently four histopathological grading systems for ACC; however, few studies have validated these systems and most of them explored small cohorts with short follow-up. Considering that the application of grading systems has been associated with ACC prognosis, a broader validation will allow not only their use for prognostic prediction but also assist in treatment planning.

The use of deep learning state-of-the-art architectures for oral epithelial dysplasia grading: A comparative appraisal.

BACKGROUND: Dysplasia grading systems for oral epithelial dysplasia are a source of disagreement among pathologists. Therefore, machine learning approaches are being developed to mitigate this issue. METHODS: This cross-sectional study included a cohort of 82 patients with oral potentially malignant disorders and correspondent 98 hematoxylin and eosin-stained whole slide images with biopsied-proven dysplasia. All whole-slide images were manually annotated based on the binary system for oral epithelial dysplasia. The annotated regions of interest were segmented and fragmented into small patches and non-randomly sampled into training/validation and test subsets. The training/validation data were color augmented, resulting in a total of 81,786 patches for training. The held-out independent test set enrolled a total of 4,486 patches. Seven state-of-the-art convolutional neural networks were trained, validated, and tested with the same dataset. RESULTS: The models presented a high learning rate, yet very low generalization potential. At the model development, VGG16 performed the best, but with massive overfitting. In the test set, VGG16 presented the best accuracy, sensitivity, specificity, and area under the curve (62%, 62%, 66%, and 65%, respectively), associated with the higher loss among all Convolutional Neural Networks (CNNs) tested. EfficientB0 has comparable metrics and the lowest loss among all convolutional neural networks, being a great candidate for further studies. CONCLUSION: The models were not able to generalize enough to be applied in real-life datasets due to an overlapping of features between the two classes (i.e., high risk and low risk of malignization).

Assessing the venous system: Correlation of mean systemic filling pressure with the venous excess ultrasound grading system in cardiac surgery.

BACKGROUND: Evaluation of the venous system has long been underestimated as an important component of the circulatory system. As systemic venous pressure increases, the perfusion pressure to the tissues is compromised. During initial resuscitation in cardiac surgery, excessive fluid administration is associated with increased morbidity and mortality. METHODS: We conducted a cross-sectional study of 60 consecutive adult patients who underwent cardiac surgery and in whom it was possible to obtain the venous excess ultrasound (VExUS) grading system and mean systemic filling pressure (Pmsf) in the postoperative period upon admission, at 24 and 48 h. We then determined the correlation between VExUS grading and Pmsf. RESULTS: On admission, patients with VExUS grading 0 predominated, with a progressive increase in venous congestion and an increase in Pmsf over the course of the first 48 h. There was a strong positive correlation between VExUS grading and the invasive measurement of Pmsf at 24 and 48 h after arrival. The presence of grade 2 or grade 3 venous congestion in the postoperative period poses an increased risk of developing acute kidney injury. CONCLUSION: The VExUS grading system indicates a high degree of systemic venous congestion in the first 48 h of the postoperative period after cardiac surgery and correlates with the Pmsf, which is the best surrogate of stressed circulatory volume.

Modified Puerto Rico Recurrence Scale for chronic subdural hematomas: augmenting the grading scale with postoperative pneumocephalus volume.

BACKGROUND: Chronic subdural hematomas (CSDHs) are common in the elderly, with a relatively high rate of recurrence after initial surgical intervention. Our research team previously created a predictive grading system, the Puerto Rico Recurrence Scale (PRRS), to identify patients at high risk of CSDH recurrence. In this study, we introduce a modification of the (mPRRS) that includes pneumocephalus volume, which has been independently associated with recurrence. METHODS: A single-center Puerto Rican population-based retrospective study was performed to analyze data for patients treated for CSDH at 1 institution between July 1, 2017, and December 31, 2019. Univariate and multivariate analyses were used to create a grading scale predictive of recurrence. Retrospective validation was conducted for the cohort. RESULTS: Of 108 patients included in the study, 42 had recurrence, and 66 had nonrecurrence. Postoperative subdural space, postoperative midline shift, and pneumocephalus volume were all higher with recurrence (P = 0.002, P = 0.009, and P < 0.001, respectively). Multivariate analysis was used to create a 6-point grading scale comprising 3 variables (pneumocephalus volume [< 10, 10-20, 21-30, and > 30 cm3], postoperative midline shift [< 0.4, 0.41-1.0, and > 1.0 cm], and laterality [unilateral and bilateral]). Recurrence rates progressively increased in low-risk to high-risk groups (2/18 [11%] vs 21/34 [62%]; P < 0.003). CONCLUSION: The mPRRS incorporating pneumocephalus measurement improves CSDH recurrence prediction. The mPRRS indicated that patients with higher scores have a greater risk of recurrence and emphasized the importance of measuring postoperative variables for prediction. The mPRRS grading scale for CSDHs may be applicable not only to the Puerto Rican population but also to the general population.

Retrospective validation of parkland grading scale in a Latin-American high-volume center.

BACKGROUND: Increased complication rates following laparoscopic cholecystectomies have been described, likely related to surgical difficulty, anatomical variations, and gallbladder inflammation severity. Parkland Grading Scale (PGS) stratifies the severity of intraoperative findings to predict operative difficulty and complications. This study aims to validate PGS as a postoperative-outcome predictive tool, comparing its performance with Tokyo Guidelines Grading System (TGGS). METHODS: This is a single-center retrospective cohort study where PGS and TGGS performances were evaluated regarding intraoperative and postoperative outcomes. Both univariate and bivariate analyses were performed on each severity grading scale using STATA-SE 16.0 software. Additionally, we proposed a Logistic Regression Model for each scale. Their association with outcomes was compared between both scales by their Receiver Operating Characteristic Curve. RESULTS: 400 Patients were included. Grade 1 predominance was observed for both PGS and TGGS (47.36% and 25.3%, respectively). A positive association was observed between higher PGS grades and inpatient postoperative care, length of stay, ICU care, and antibiotic requirement. Based on the area under the ROC curve, better performance was observed for PGS over TGGS in the evaluated outcomes. CONCLUSION: PGS performed better than TGGS as a predictive tool for inpatient postoperative care, length of stay, ICU, and antibiotic requirement, especially in severe cases.

Dry tobacco leaves: an in vivo and in silico approach to the consequences of occupational exposure.

Exposure of tobacco workers handling dried tobacco leaves has been linked to an increased risk of toxicity and respiratory illness due to the presence of nicotine and other chemicals. This study aimed to evaluate the DNA damage caused by the exposure of tobacco growers during the dry leaf classification process and the relation to cellular mechanisms. A total of 86 individuals participated in the study, divided into a group exposed to dry tobacco (n = 44) and a control group (n = 42). Genotoxicity was evaluated using the alkaline comet assay and lymphocyte micronucleus (MN) assay (CBMN-Cyt), and measurement of telomere length. The levels of oxidative and nitrosative stress were evaluated through the formation of thiobarbituric acid reactive species, and nitric oxide levels, respectively. The inorganic elements were measured in the samples using particle-induced X-ray emission method. The combination of variables was demonstrated through principal component analysis and the interactions were expanded through systems biology. Comet assay, MN, death cells, thiobarbituric acid reactive species, and nitrosative stress showed a significant increase for all exposed groups in relation to the control. Telomere length showed a significant decrease for exposed women and total exposed group in relation to men and control groups, respectively. Bromine (Br) and rubidium (Rb) in the exposed group presented higher levels than control groups. Correlations between nitrate and apoptosis; Br and MN and necrosis; and Rb and telomeres; besides age and DNA damage and death cells were observed. The systems biology analysis demonstrated that tobacco elements can increase the nuclear translocation of NFKB dimers inducing HDAC2 expression, which, associated with BRCA1 protein, can potentially repress transcription of genes that promote DNA repair. Dry tobacco workers exposed to dry leaves and their different agents showed DNA damage by different mechanisms, including redox imbalance.

Exploring the combination of tumor-stroma ratio, tumor-infiltrating lymphocytes, and tumor budding with WHO histopathological grading on early-stage oral squamous cell carcinoma prognosis.

BACKGROUND: While the relevance of the World Health Organization histopathological grading system as a prognostic tool for oral squamous cell carcinoma has received many critics, other histopathological features such as tumor-stroma ratio, tumor-infiltrating lymphocytes, and tumor budding are displaying promising results. Here, we evaluated the prognostic impact of the incorporation of tumor-stroma ratio, tumor-infiltrating lymphocytes, and tumor budding into World Health Organization histopathological grading for patients with oral squamous cell carcinoma. METHODS: A total of 95 patients with early-stage oral squamous cell carcinoma were enrolled in the study, and World Health Organization tumor grading, tumor-stroma ratio, tumor-infiltrating lymphocytes, and tumor budding were evaluated in surgical slides stained with hematoxylin and eosin. Survival analyses for cancer-specific survival and disease-free survival were performed using Cox regression models, and receiver operating characteristic curves were applied for assessment of the performance of the combinations. RESULTS: Tumor-stroma ratio (stroma-rich) was significantly and independently associated with both shortened cancer-specific survival and poor disease-free survival, individually and in combination with World Health Organization histopathological grading. The combination of tumor-stroma ratio with World Health Organization grading did not improve the discriminatory ability compared to tumor-stroma ratio alone. Although low tumor-infiltrating lymphocytes were associated with shortened cancer-specific survival, the association did not withstand multivariate analysis. However, in combination with World Health Organization grading, low tumor-infiltrating lymphocytes were independently associated with poor cancer-specific survival. The combination of tumor-infiltrating lymphocytes and World Health Organization histopathological grading displayed a better discrimination of poor cancer-specific survival than tumor-infiltrating lymphocytes alone, but not at a significant level. CONCLUSION: Our findings support tumor-stroma ratio as a potential prognostic marker for patients with oral squamous cell carcinoma, and the incorporation of tumor-infiltrating lymphocytes into the World Health Organization grading system improves the prognostic ability of the tumor grading alone.

[The intensity of PSMA intraprostatic uptake as a predictor of clinically significant prostate cancer]. / La intensidad de la captación intraprostática del PSMA como predictor de cáncer de próstata clínicamente significativo.

INTRODUCTION: Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) improves prostate cancer staging. Furthermore, the intensity of intraprostatic uptake of PSMA can predict clinically relevant oncologic outcomes. The objective of this study is to evaluate whether the intensity of PSMA uptake is associated with clinically significant prostate cancer and to determine which value of PSMA uptake best discriminates this relationship. METHODS: A cohort study of 40 patients with biopsy-proven prostate cancer prior to external radiotherapy was conducted. The correlation between intraprostatic PSMA uptake intensity and adverse pathological findings in prostate biopsy was evaluated. Which PSMA uptake value better discriminates clinically significant prostate cancer was assessed using ROC curves. RESULTS: Forty percent of the patients had a clinically significant prostate cancer and the maximum standardized uptake value (SUV max) had a mean of 11.5 (SD ± 7). The sample showed a Spearman correlation coefficient of 0.4 (p = 0.007). The area under the curve (AUC) was 0.73 and a SUV max = 9.5 showed a sensitivity of 0.81 and a specificity of 0.71 in the detection of clinically significant prostate cancer. CONCLUSION: Intraprostatic PSMA uptake intensity can be a new diagnostic tool in the detection of clinically significant prostate cancer. An uptake intensity equal or greater than 9.5 is correlated with clinically significant prostate cancer.

Introducción: La tomografía por emisión de positrones (PET) con antígeno de membrana específico de próstata (PSMA) mejora la estadificación del cáncer de próstata. Además, la intensidad de captación intraprostática del PSMA puede predecir resultados oncológicos clínicamente relevantes. Nuestro objetivo fue evaluar si la intensidad de captación de PSMA se asocia con el cáncer de próstata clínicamente significativo y poder conocer qué valor de captación de PSMA discrimina mejor esta relación. Métodos: Se realizó un estudio de cohorte de 40 pacientes con cáncer de próstata comprobado por biopsia previo a la realización de radioterapia externa. Se evaluó correlación entre intensidad de captación del PSMA intraprostático y los resultados patológicos adversos en la biopsia prostática. Se estudió qué valor de captación de PSMA discrimina mejor el cáncer de próstata clínicamente significativo utilizando curvas ROC. Resultados: El 40% de los pacientes tuvieron un cáncer de próstata clínicamente significativo, el maximum standardized uptake value (SUV max) tuvo una media de 11.5 (DE ± 7). La muestra arrojó un coeficiente de correlación Spearman de 0.4 (p = 0.007). El área bajo la curva (AUC) fue de 0.73, mostrando el punto de corte un SUV max = 9.5, sensibilidad 0.81 y especificidad 0.71 en la detección de cáncer de próstata clínicamente significativo. Conclusión: la intensidad de captación del PSMA intraprostático puede ser una nueva herramienta diagnóstica en la detección del cáncer de próstata clínicamente significativo. Una intensidad de captación = 9.5 tuvo una buena correlación con el cáncer de próstata clínicamente significativo.

La intensidad de la captación intraprostática del PSMA como predictor de cáncer de próstata clínicamente significativo / The intensity of PSMA intraprostatic uptake as a predictor of clinically significant prostate cancer

Resumen Introducción: La tomografía por emisión de positrones (PET) con antígeno de membrana específico de próstata (PSMA) mejora la estadificación del cáncer de próstata. Además, la intensidad de captación intraprostática del PSMA puede predecir resultados oncológicos clínicamente relevantes. Nuestro objetivo fue evaluar si la intensidad de captación de PSMA se asocia con el cáncer de próstata clínicamente significativo y poder conocer qué valor de captación de PSMA discrimina mejor esta relación. Métodos: Se realizó un estudio de cohorte de 40 pacientes con cáncer de próstata comprobado por biopsia previo a la realización de radioterapia externa. Se evaluó correlación entre intensidad de captación del PSMA intraprostático y los resulta dos patológicos adversos en la biopsia prostática. Se estudió qué valor de captación de PSMA discrimina mejor el cáncer de próstata clínicamente significativo utilizando curvas ROC. Resultados: El 40% de los pacientes tuvieron un cáncer de próstata clínicamente significativo, el maximum standardized uptake value (SUV max) tuvo una media de 11.5 (DE ± 7). La muestra arrojó un coeficiente de correlación Spearman de 0.4 (p = 0.007). El área bajo la curva (AUC) fue de 0.73, mostrando el punto de corte un SUV max ≥ 9.5, sensibilidad 0.81 y especificidad 0.71 en la detección de cáncer de próstata clínicamente significativo. Conclusión: la intensidad de captación del PSMA intraprostático puede ser una nueva herramienta diagnóstica en la detección del cáncer de próstata clínicamente significativo. Una intensidad de captación ≥ 9.5 tuvo una buena correlación con el cáncer de próstata clínicamente significativo.

Abstract Introduction: Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) improves prostate cancer staging. Furthermore, the intensity of intraprostatic uptake of PSMA can predict clinically relevant oncologic outcomes. The objective of this study is to evaluate whether the intensity of PSMA uptake is associated with clinically significant prostate cancer and to determine which value of PSMA uptake best dis criminates this relationship. Methods: A cohort study of 40 patients with biopsy-proven prostate cancer prior to external radiotherapy was conducted. The correlation between intraprostatic PSMA uptake intensity and adverse pathological findings in prostate biopsy was evaluated. Which PSMA uptake value better discriminates clinically significant prostate cancer was assessed using ROC curves. Results: Forty percent of the patients had a clinically significant prostate cancer and the maximum standardized uptake value (SUV max) had a mean of 11.5 (SD ± 7). The sample showed a Spearman correlation coefficient of 0.4 (p = 0.007). The area under the curve (AUC) was 0.73 and a SUV max ≥ 9.5 showed a sensitivity of 0.81 and a specificity of 0.71 in the detection of clinically significant prostate cancer. Conclusion: Intraprostatic PSMA uptake intensity can be a new diagnostic tool in the detection of clinically significant prostate cancer. An uptake intensity equal or greater than 9.5 is correlated with clinically significant prostate cancer.

Instrumento en Excel para la calificación de exámenes de la educación médica en Cuba / Instrument in Excel for the Qualification of Exams in the Cuban Medical Education

Introducción: La evaluación de un examen de varias preguntas genera un número elevado de combinaciones que, al sumar el descuento de errores ortográficos, dificulta el otorgamiento de la calificación correcta y requiere de mucho tiempo. La automatización de este proceso fue realizada por Santander Montes y colaboradores con el paquete profesional estadístico PSPP de libre distribución. Objetivo: Construir un instrumento en Excel para calificaciones de exámenes parciales y finales, de tres, cinco y siete preguntas, con descuento de errores ortográficos según los requisitos de la educación médica cubana. Métodos: Se utilizaron las herramientas de tabulación de información y fórmulas que ofrece el programa Excel de Microsoft Office 2013. Resultados: Se diseñó una interfaz simple, fácil de ejecutar. Se creó una secuencia para determinar en el instrumento: validez, confiabilidad, representatividad y factibilidad. Con la revisión reiterada de cinco profesores de manera independiente (1 Pediatría, 1 Medicina Interna y 3 Salud Pública) y la prueba piloto (examen final de Salud Pública de la carrera de medicina en el primer semestre del curso 2021-2022 en la Facultad Julio Trigo López"), se logró un instrumento de muy fácil uso, válido, confiable y accesible. Conclusiones: El instrumento en Excel propuesto proporciona una opción para automatizar el proceso de evaluación, evitando los errores que se cometen en la evaluación manual(AU)

Introduction: The evaluation of an exam of several questions generates a high number of combinations that, when adding the discount of spelling errors, makes it difficult to give the correct grade and requires a lot of time. The automation of this process was carried out by Santander Montes and collaborators with the professional statistical package PSPP of free distribution. Objective: To build an instrument in Excel for qualifications of partial and final exams, of three, five and seven questions, with spelling errors discounted according to the requirements of Cuban medical education. Methods: The information and formula tabulation tools offered by the Microsoft Office 2013 Excel program were used. Results: A simple interface was designed, easy to execute. A sequence was created to determine in the instrument: validity, reliability, representativeness and feasibility. With the repeated review of five professors independently (1 Pediatrics, 1 Internal Medicine and 3 Public Health) and the pilot test (final exam of Public Health of the medical career in the first semester of the 2021-2022 academic year in the Faculty Julio Trigo López), a very easy-to-use, valid, reliable and accessible instrument was achieved. Conclusions: The proposed instrument in Excel speeds up the evaluation process and avoids the errors that are made in manual evaluation(AU)

A hierarchical approach to combine histological grade and immunohistochemical factors to identify high-risk luminal breast cancers.

Background: The luminal subtype accounts for ~70% of newly diagnosed breast cancer patients. Although it has a better prognosis, approximately 30% of them develop a late relapse. Identifying those patients is of interest to improve treatment decisions. Methods: A retrospective observational, single-centre study based on data from medical records of 572 non-metastatic (I-III) invasive ductal breast carcinoma patients, 448 with luminal tumours and 124 with triple-negative tumours. Kaplan-Meier, Cox regression and time-dependent Cox regression were carried out to obtain the prognosis value of risk factors. Results: During a median observation of 5.5 years, 105 distant metastasis events and 105 all-cause deaths were observed. In addition to known clinicopathological factors (i.e., age, tumour size and lymph node metastasis), the high semi-quantitative expression of both hormone receptors was associated with distant metastasis-free survival (DMFS) (adjusted hazard ratio (HaR): 0.524 (0.316-0.867), p = 0.012) and overall survival (OS) (adjusted HaR: 0.486 (0.286-0.827), p = 0.008). The stratified analysis made it possible to identify risk modification factors. Subsequent stratification by histological grade, Ki-67 and semi-quantitative PR expression or, mainly, the composite semi-quantitative expression of hormone receptors (cHR) enabled the identification of luminal breast cancer patients of adjuvant schema at higher risk for metastasis and death. However, initial analyses including patients of neoadjuvant therapy pointed to a path of subsequent stratification by cHR and histological grade, also enabling grouping of luminal breast cancer patients with similar prognosis for DMFS (cHR ≤ 4+ G2 or G3 versus triple-negative, adjusted HaR: 0.703 (0.415-1.189), p = 0.189) and OS (cHR ≤4+ G2 or G3 versus triple-negative, adjusted HaR: 0.662 (0.403-1.088), p = 0.104). Conclusion: The semi-quantitative expression of both cHR, Ki-67 proliferation index and histological grade can identify luminal breast cancer patients at greater risk of developing metastasis and death when combined in a hierarchical fashion, and could be useful for a better prognosis stratification in services from low- and middle-income countries.

Automatic Facial Palsy Diagnosis as a Classification Problem Using Regional Information Extracted from a Photograph.

The incapability to move the facial muscles is known as facial palsy, and it affects various abilities of the patient, for example, performing facial expressions. Recently, automatic approaches aiming to diagnose facial palsy using images and machine learning algorithms have emerged, focusing on providing an objective evaluation of the paralysis severity. This research proposes an approach to analyze and assess the lesion severity as a classification problem with three levels: healthy, slight, and strong palsy. The method explores the use of regional information, meaning that only certain areas of the face are of interest. Experiments carrying on multi-class classification tasks are performed using four different classifiers to validate a set of proposed hand-crafted features. After a set of experiments using this methodology on available image databases, great results are revealed (up to 95.61% of correct detection of palsy patients and 95.58% of correct assessment of the severity level). This perspective leads us to believe that the analysis of facial paralysis is possible with partial occlusions if face detection is accomplished and facial features are obtained adequately. The results also show that our methodology is suited to operate with other databases while attaining high performance, even though the image conditions are different and the participants do not perform equivalent facial expressions.