Queen Medical

Squamous cell carcinoma in situ (SCCIS), also known as Bowen's disease, is a precancerous intradermal lesion that commonly arises in sun-exposed areas. Other risk factors include radiation, inflammation, carcinogen exposure, and human papilloma virus exposure. Its presentation on the nipple-areolar complex is extremely rare with 14 cases reported in literature. We report a case of a postmenopausal woman with remote history of breast cancer and DCIS treated with bilateral breast conserving surgery followed by adjuvant radiation. She developed SCCIS of the right nipple nearly 30 years later. Associated symptoms included bloody nipple discharge, nipple rash, and nipple pruritus for 1.5 years. A punch biopsy of the right nipple lesion identified epithelioid cells in the intradermal space staining CK7 (+) and p40 (+)/p63 (+), classifying the lesion as Paget's disease. The patient elected to proceed with bilateral mastectomies without reconstruction. Final surgical pathology revealed radiation induced atypia and atypical keratinocytes that focally extend throughout the full epidermal thickness. Immunohistochemical staining demonstrated CK7 (-), CK5/6 (+), p40 (+), HER2 (-) and GCDFP15 (-) consistent with the diagnosis of SCCIS. Paget's disease of the nipple and SCCIS may present with similar clinical and histopathologic features; however, they are managed differently. Nipple lesions in the setting of prior radiation should raise concern for SCCIS. Clinicians should be aware of this rare, but potential sequelae in patients with a history of breast cancer treated with breast conserving therapy and nipple complaints.

IntroductionThe utilization of zero-fluoroscopy and reduced fluoroscopy strategies in catheter ablation (CA) for atrial fibrillation (AF) is increasing. This aims to minimize radiation exposure and associated adverse effects for operators, patients, and laboratory staff.ObjectiveWe aimed to define the freedom from atrial arrhythmias in patients undergoing CA employing a zero-fluoroscopy approach compared to the conventional fluoroscopic approach.MethodsProspective, observational, multicenter registry. We enrolled patients with paroxysmal (PAF) and persistent (PsAF) and a minimum 12-month follow-up. Additional analysis classifying groups in conventional fluoroscopy (>1 minute), zero-fluoroscopy, or very low fluoroscopy (<1 minute) were performed. The primary efficacy outcome was freedom from atrial arrhythmias.ResultsWe included 7,196 patients. The mean age was 66.7 years, females represented 39.8% of the cohort. Ablation was performed to treat PAF in 61.9% and psAF in 38.1%. A zero-fluoroscopy approach was chosen in 4,874 patients (67.7%), 2,322 (32.3%) used fluoroscopy, and 922 (12.8%) patients were utilized with very low fluoroscopy. Freedom from atrial arrhythmias after one year of follow-up was 81%. Notably, zero-fluoroscopy and fluoroscopy-based ablation strategies exhibited comparable freedom from atrial arrhythmias (HR=1.15, 95% CI 0.92-1.43, p=0.2). Similarly, there was no significant difference in the primary outcome when comparing zero-fluoroscopy versus very low fluoroscopy. The complication rate was 1.6% without significant differences between groups (p>0.05).ConclusionReduced fluoroscopy techniques demonstrated a similar long-term success rate compared to conventional fluoroscopy approaches without increase un complications. These findings endorse recent regulatory agency approvals of tools for performing CA of AF using these strategies.Freedom from atrial arrhythmias Complications

Abstract Background: Pathological complete response (pCR) has been used as a primary endpoint in neoadjuvant clinical trials for non-metastatic breast cancer and as a surrogate endpoint for long-term survival outcomes. The U.S. Food and Drug Administration (FDA) accepted pCR as a surrogate endpoint for the approval of new drugs in the neoadjuvant setting in high-risk early-stage breast cancer. However, though the Collaborative Trials in Neoadjuvant Breast Cancer (CTNeoBC) pooled analysis in 2014 showed that at the patient level achieving pCR was associated with longer overall survival (OS) and event-free survival (EFS), at the trial-level the association between high pCR rate and better OS and EFS outcomes was weak (coefficient of difference [R2]; 0.03 and 0.24, respectively) among all subtypes of breast cancer. A recent study reported that this association at the trial-level was similarly weak among Human Epidermal Growth Factor Receptor-2 (HER-2) positive breast cancer (R2; 0.02 and 0.23, respectively). However, the potential surrogacy of pCR rate for OS and EFS in triple-negative breast cancer (TNBC) in the neoadjuvant setting has not been well studied in a comprehensive manner. Moreover, because of significant advances in systemic treatment strategies in TNBC over the past decade including a combination of immune checkpoint inhibitors (ICIs) with conventional cytotoxic agents, the trial-level surrogacy needs to be reassessed in recently published neoadjuvant clinical trials for TNBC. Our primary objective is to assess the association between pCR rate and survival outcomes in neoadjuvant clinical trials for TNBC by collecting data from articles published after the CTNeoBC article in 2014. Methods: We performed a systematic literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the PubMed, Cochrane Library, and Web of Science databases. Articles published between January 1, 2014, and March 31, 2023, were searched. We included only randomized control trials of neoadjuvant treatments for clinical stage I-III TNBC that compared two or more regimens followed by curative intent breast surgery. The selected trials had data for odds ratio (OR) for pCR and hazard ratios (HRs) either for OS or for EFS or disease-free survival (DFS). We excluded trials including estrogen receptor positive, progesterone receptor-positive, or HER-2 positive diseases, and those without data enough to obtain ORs for pCR, HRs for OS, EFS, or DFS. Unpublished data as a full article was also excluded. If EFS could not be obtained from the articles, DFS was used in place of EFS. Two independent investigators (TY and TF) searched and extracted data. Any disagreement was resolved by discussion with the third author (ZZ). A linear regression model on a logarithmic scale weighted by the sample size of each trial was performed and the R2 was used to assess the trial-level association between OR for pCR and HRs for OS or EFS. Results: We identified eight trials with a total of 2,926 patients. Three of the eight trials used ICIs in the intervention arm. One trial did not provide OS data and was not included in the OS analysis. In four trials, EFS was not available and DFS was used for EFS analysis. The R2 was 0.191 (95% confidence interval [CI], 0.165 to 0.218) for OS and 0.193 (95% CI, 0.167 to 0.219) for EFS. Conclusions: Similarly to the previous reports, our findings suggest that the surrogacy of the pCR rate for OS and EFS in recent neoadjuvant clinical trials for TNBC is weak. At this moment, there is no strong evidence to support using pCR as a surrogate for long-term survival outcomes in neoadjuvant clinical trials for TNBC. Citation Format: Toru Yoshino, Zao Zhang, Ryota Sato, Stanley Lipkowitz, Takeo Fujii. Revisiting the potential of pathological complete response as a surrogate for long-term survival outcomes in triple-negative breast cancer at the trial-level [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-03-07.

Introdução: A Atenção Primária à Saúde (APS) é o primeiro nível de atenção em saúde e se caracteriza por um conjunto de ações, no âmbito individual e coletivo. A equipe multiprofissional na atenção primária a saúde (eMulti) é um termo usado na área de saúde para descrever um grupo de profissionais de diferentes especialidades que trabalham juntos para abordar as necessidades complexas de um paciente oferendo um tratamento abrangente e holístico. A fisioterapia vai desempenhar um papel crucial na saúde do idoso, visando melhorar a qualidade de vida e a funcionalidade, através de educação e saúde, atendimentos individuais, atividades em grupos e atividades domiciliares. Objetivos: Verificar a importância da fisioterapia na promoção de saúde da pessoa idosa através da eMulti. Metodologia: Trata-se de uma revisão integrativa, na base de dados Lilacs, Scielo e MEDLINE, utilizando os seguintes descritores: "eMulti", "atenção básica", "fisioterapia", "idoso". Foram incluídos artigos publicados entre 2020 a 2021, escritos em inglês e português. Resultados: Foram selecionados 16 estudos, destes após os critérios de inclusão e exclusão foram analisados 5 que indicaram um atendimento mais qualificado, visando a manutenção da capacidade funcional dos idosos quando o fisioterapeuta está inseridona eMulti, teve uma participação positiva na saúde do idoso tanto na prevenção e promoção em âmbitos domiciliares trabalhando as suas atividades de vida diárias, coordenação, propriocepção e equilíbrio, mantendo e devolvendo as suas funcionalidades para evitar o surgimentos de quedas, pois torna-se evidente que a atenção à população idosa não é apenas uma questão de extensão da vida, mas sim de enriquecimento da vida. Conclusão: Com base nos estudos incluídos nesta revisão, conclui-se, que a fisioterapia desempenha um papel crucial na promoção da saúde e bem-estar dos idosos. Ao longo deste estudo, foi explorado como a integração da fisioterapia são essenciais para promover a independência, funcionalidade e o envelhecimento saudável e ativo dos idosos.

Abstract Background Our understanding of changes in hemodynamics in cirrhotic patients with sepsis and septic shock and its impact on outcomes remains limited. Our study aims to investigate differences in hemodynamic profiles using echocardiography between septic patients with and without cirrhosis. Methods This is a single-center, retrospective study of septic patients with echocardiogram within 3 days of a medical intensive care unit (MICU) admission. We compared baseline characteristics, echocardiographic parameters, and outcomes between patients with and without cirrhosis. A propensity score-matched case-control model was developed to describe the differences in hemodynamic parameters between the groups. Results 3,151 patients with sepsis and septic shock were included of which 421 (13%) had cirrhosis. In the propensity score model, cirrhotic patients had significantly higher left ventricular ejection fraction (63.4 vs. 56.2%, p &lt; 0.001) and stroke volume (73.3 vs. 52.0 ml, p &lt; 0.001) along with lower arterial elastance (Ea) (1.31 vs. 1.82, p &lt; 0.001) and systemic vascular resistance (SVR) (1,110 vs. 1,370 dynes/sec/m− 5, p = 0.001). There was no difference between left ventricular elastance (Ees) (0.99 vs. 1.09, p = 0.107) and ventricular-arterial coupling (Ea/Ees) (1.29 vs. 1.40, p = 0.061). Conclusion Septic patients with cirrhosis had higher LVEF with a significantly higher percentage of hyperdynamic state than those without cirrhosis. Lower Ea and SVR without significant differences in Ees and Ea/Ees suggest vasodilation as the principal driver of the hyperdynamic profile in cirrhosis. This finding may facilitate tailored hemodynamic management focused on restoring vascular tone in cirrhotic septic patients.

Background and Aim Individual air pollutants and green space are associated with inflammation in pregnancy, but their combined effects are not well understood. Our objective was to study the multipollutant effects of PM2.5, NO2, and O3 on C-reactive protein (CRP) levels in maternal blood (a marker of inflammation implicated in adverse pregnancy outcomes). Methods We analyzed data collected from 1,170 pregnant Canadian women enrolled in the MIREC Study. Maternal blood concentrations of CRP were measured in the third trimester. Residentially-based ambient concentrations of PM2.5, NO2, and O3 during the 14 days prior to blood draw were estimated using satellite-derived concentrations and land use regression models. Green space was measured using the Normalized Difference Vegetative Index (NDVI). We fit multipollutant linear regression models using 14-day average estimates of PM2.5, NO2, and O3. We also evaluated the effects of pollutant mixtures using Weighted Quantile Sum Regression (WQSR), and by calculating the Air Quality Health Index (AQHI), a Canadian risk communication tool that derives a weighted average of the pollutants. Results In multipollutant models that included NO2 and O3, each interquartile range (IQR) increase in 14-day average PM2.5 (IQR: 6.9 µg/m3) was associated with 27.1% (95% CI: 6.2, 50.7) higher CRP concentrations. In air pollution mixture models, each IQR increase in AQHI was associated with 37.7% (95% CI: 13.9, 66.5) higher CRP levels; and an IQR increase in the WQSR was associated with 78.6% (95% CI: 29.7, 146.0) higher CRP levels. Associations between air pollution and CRP were not confounded or modified by NDVI. Conclusions We provide evidence for stronger effects of the combined mixture of PM2.5, NO2, and O3 on inflammation levels during pregnancy compared with individual pollutants. This research emphasizes the importance of examining multipollutant analyses in future investigations. Keywords PM2.5, NO2, O3, green space, C-reactive protein, pregnancy

vi the "Hottentot Venus" in the classroom. In so doing, a literal and gurative re-membering of the past is activated within the context of the present that has bearing on the future.

ABSTRACTAcute scalp hair “felting” is a rare acquired condition that presents with sudden severe twisting, entangling, and matting of scalp hair into a stiff tightly packed mass, in otherwise healthy individuals. In such conditions, the mechanism of hair matting is almost like the process of “felting” in wool and textile industry, where adjacent fibers are compacted together in a warm liquid medium. Herein, a case of acute hair “felting” during styling practice is discussed with the possible predisposing factors, prophylaxis, and treatment.

Federated learning provides a solution for data privacy protection, while enabling training over the local data samples, without exchanging them. However, it is far from practical and secure because data privacy is still vulnerable due to the well-studied attacks, e.g., membership inference attacks and model inversion attacks. In this paper, to further prevent data leakage against these attacks, we propose FL-PATE, a differentially private federated learning framework with knowledge transfer. Specifically, participants with sensitive data are grouped to train teacher models under federated learning settings, and the knowledge of teacher models is transferred to a publicly accessible student model for prediction via aggregating teacher models&#x0027; outputs of public datasets. A modified client-level differential privacy mechanism is used to guarantee each participant&#x0027;s data privacy during the corresponding teacher model&#x0027;s training process. The proposed framework preserves participant&#x0027;s privacy against membership inference attacks and the differential privacy cost is fixed. The privacy analysis and experiments demonstrate that trained teacher and student models have an excellent performance in accuracy and robustness theoretically and empirically.

Abstract PurposeTumor infiltrating lymphocytes (TILs) have emerged as a predictor of cancer treatment response and patient outcomes, including for breast cancer. Current studies investigating racial/ethnic differences in TILs and immune profiles in breast cancer offer varying results. Our study hopes to address the paucity of data in breast cancer tumor microenvironment from different racial/ethnic groups not well represented in the literature.MethodsWe reviewed 183 cases of women diagnosed with early stage breast cancer who received neoadjuvant treatment at two large health systems in Hawaii between 2008 and 2020. We evaluated clinical and demographic information including: age at diagnosis, race/ethnicity, tumor stage, tumor subtype according to ER, PR, and HER2 receptor status and compared them with obtaining a pathologic complete response (pCR) and amount of stromal TILs (sTILs).ResultsWe found a significantly greater amount of sTILs in Asians (37.7%, p=0.01) and Native Hawaiian/Pacific Islander (NHPI) (37.2%, p=0.02) patients compared to White patients on multivariate analysis. We found no significant differences in pCR among the different racial/ethnic groups.ConclusionsRacial/ethnic differences in the amount of sTILs in breast cancer tumors suggest that higher sTIL percentages alone do not predict for pCR. Increases in sTILs in Asian and NHPI patients suggest differences in immune cell profiles in the breast tumor microenvironment. This may in part contribute to known outcome disparities in these populations.