Individualizing Pe for Intermediate Grades

The Gleason score (GS) to date remains one of the most reliable prognostic predictors in prostate cancer (PCa). However, the majority of studies supporting its prognostic relevance were performed prior to its modification by the International Society of Urological Pathology (ISUP) in 2005. Furthermore, the combination of Gleason grading and nuclear/nucleolar subgrading (Helpap score) has been shown to essentially improve grading concordance between biopsy and radical prostatectomy (RP) specimens. This prompted us to investigate the modified GS and combigrading (Gleason/Helpap score) in association with clinicopathological features, biochemical recurrence (BCR), and survival. Core needle biopsies and corresponding RP specimens from 580 patients diagnosed with PCa between 2005 and 2010 were evaluated. According to the modified GS, the comparison between biopsy and RP samples resulted in an upgrading from GS 6 to GS 7a and GS 7b in 65% and 19%, respectively. Combigrading further resulted in an upgrading from low grade (GS 6/2a) to intermediate grade PCa (GS 6/2b) in 11.1% and from intermediate grade (GS 6/2b) to high grade PCa (GS 7b/2b) in 22.6%. Overall, well-differentiated PCa (GS 6/2a) was detected in 2.8% of RP specimens, while intermediate grade (GS 6/2b and GS 7a/2b) and high grade cancers (≥ GS 7b) accounted for 39.5% and 57.4% of cases, respectively. At a mean follow-up of 3.9 years, BCR was observed in 17.6% of patients with intermediate (9.8%) or high grade PCa (30.2%), while PSA relapse did not occur in GS 6/2a PCa. In conclusion, adding nuclear/nucleolar subgrading to the modified GS allowed for a more accurate distinction between low and intermediate grade PCa, therefore offering a valuable tool for the identification of patients eligible for active surveillance (AS).

Long-term results of low dose total body irradiation for advanced non-hodgkin lymphoma

Background The variable natural history of ductal carcinoma in situ (DCIS) is poorly understood. The aim of this retrospective cohort study was to determine the outcomes of women who were diagnosed through the English National Health Service Breast Screening Programme (NHS BSP) and had no surgery for screen-detected DCIS. Method English NHS BSP databases were searched for women diagnosed with DCIS without invasive cancer on needle biopsy between 1 April 2001 and 31 March 2018 inclusive, who had no record of surgery within 6 months of diagnosis. These were cross-referenced with cancer registry data for further treatment, event information and mortality records. Details of potentially eligible women were sent to the relevant breast screening units for verification and for completion of data forms detailing clinical, radiological and pathological findings, non-surgical treatment, subsequent clinical course and outcomes. Results Data for 311 eligible women (median age 62 years) were included, with median follow-up (primary DCIS diagnosis to either surgery, development of invasive disease, death or last known to be alive) of 4.1 years (range 0.5 to 17.4 years). The median age at diagnosis was 64 years (range 47 to 90 years). Sixty (19%) women developed invasive breast cancer, 56 ipsilateral and 4 contralateral. Twenty-two women (7%) underwent surgery for DCIS (>6 months after diagnosis) and 86 (28%) died of other causes. Women with high or intermediate grade DCIS were significantly more likely to develop ipsilateral invasive breast cancer (iIBC) than those with low grade DCIS. 28/123 (23%) with high grade DCIS, 21/105 (20%) with intermediate grade DCIS, 5/76 (7%) with low grade DCIS and 2/7 (29%) with an unknown grade of DCIS developed iIBC. Ipsilateral invasion risk increased approximately linearly with time for at least 10 years. Women who developed iIBC were significantly younger than those who did not. This was driven primarily by a strong association among those with high grade DCIS. There was no significant difference in age between those with intermediate and low grade DCIS respectively who did or did not develop iIBC. The median baseline size of DCIS in women who developed iIBC was higher than in women who did not develop iIBC, both overall and in each of the three grade categories (median sizes - high grade 38 mm vs 29 mm, p=0.19; intermediate grade 35 mm vs 18 mm, p=0.31; low grade 18 mm vs 15 mm, p=0.38). This reached statistical significance for all grades combined: 37 mm (range 3-95) v 20 mm (range 3-200), p=0.02. Of the 262 women with a known microinvasion status, 8/25 (32%) with definite or possible microinvasion were subsequently diagnosed with ipsilateral invasive cancer compared to 38/237 (16%) without microinvasion (p=0.027). There was no significant association on univariable analysis between risk of iIBC and microcalcification as the predominant radiological feature (iIBC and microcalcification 47/258 vs iIBC and other radiological feature 7/46; p=0.83), the presence of histological necrosis (iIBC and necrosis, 14/89 vs iIBC and no necrosis, 31/157; p=0.49) or the use of ET (iIBC and ET 11/67 vs iIBC and no ET 45/244; p=0.86). Of the 51 invasive cancers that developed with a known grade, 46 (90%) were grade 2 or 3. Conclusion The findings suggest that women diagnosed with high or intermediate grade DCIS and those with microinvasion should continue to be offered surgery. For those with low grade DCIS there is a need for shared decision-making in the choice of surgery or active surveillance based on a discussion of the risks and benefits of the options as currently understood, and in the light of the low reproducibility of DCIS grading. Citation Format: Karen Clements, Anthony Maxwell, Bridget Hilton, Matthew Wallis, Cliona Kirwan, Hilary Stobart, Elena Provenzano, Nisha Sharma, Janet Litherland, Abeer Shaaban, David Dodwell, Joanne Dulson-Cox, Elinor Sawyer, Senthurun Mylvaganam, Olive Kearins, Samantha Brace-McDonnell, Sarah Pinder, Alastair Thompson. A longitudinal cohort study of outcomes in 311 women with unresected ductal carcinoma in situ detected through the English breast screening programme [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-22-06.

Holy Qur’an and Islamic education for the first intermediate grade, prepared by the researcher himself because there was no ready test in the subject of the Holy Qur’an and Islamic education. For the second intermediate grade, its validity and reliability were verified, and its stability value was (0,83). After the completion of the research tools, The current research aims to identify the effect of the Perkins and Blythe model on the acquisition of Islamic concepts by second-grade intermediate students in the subject of the Holy Qur’an and Islamic education in the academic year (2021-2022). The researcher used the experimental design of the control and the experimental groups with a post-test for both. The experimental group studied according to the Perkins and Blythe model, while the control group studied according to the usual method. The research sample consisted of (51) female students, chosen by the researcher intentionally with (25) female students in the experimental group and (26) female students in the control group. The researcher equalized both groups in some variables, including age calculated in months, the intelligence test, the parents’ academic achievement level, the grade of the Holy Qur’an and Islamic education for the first intermediate grade, and the general average for the first intermediate grade. Achieving the aim of the research required constructing a test for acquiring Islamic concepts in the subject of the he researcher applied the experiment for a whole semester. Then, the data was collected and analyzed statistically with the following results: * There is a statistically significant difference at the level of significance (0.05) between the average scores of the female students in the experimental group who study using the Perkins and Blythe model, and the female students in the control group who study in the usual way in the achievement and for the benefit of the experimental group. In light of the results, the researcher presented a set of recommendations: the necessity of using modern teaching models, including the Perkins and Blythe model, in teaching the Holy Qur’an and Islamic education at all academic levels, and conducting a study to find out the effect of the Barman model in acquiring Islamic concepts for students of the fourth literary class.

p53, cellular proliferation, and apoptosis-related factors in thymic neuroendocrine tumors


 AbstractThe aim of the research is to expound the impact of the distributed training method used by an experimental group and the method used in the school by a control group on motor building learning for the purpose of selecting from a number of team and individual games for students of the first intermediate grade. The researchers used the experimental method appropriate to the nature of the study, and the population of the study consisted of (232) students of the first intermediate grade in the Al-Shumookh Intermediate School for Boys in Nineveh Governorate. The study sample consisted of (30) students, representing (12.93%) of the population of the study and were randomly distributed into two (15) students experimental and control groups. The researcher adopted a questionnaire form, personal interviews, and scientific tests, measurements observation as means of collecting information. Parity between the four study groups was done for each of the variables (age, height, mass, some mental abilities, i.e. (attention and intelligence) and some physical and motor factors that affect motor building learning of a number of team and individual games in addition to some football skills and some athletics activities (under study). The school educational curriculum (Physical Education Teacher Guide for Intermediate Grades) was implemented by the control group while the distributed training method was implemented by the experimental group. The two training programs consisted of (36) educational units, (18) for each group, two educational units per week, and the time of each educational unit was (45) minutes. the researchers reached a number conclusions, the most important of which is that the educational program of distributed training method and the control group program (the school method) positively impacted the motor building learning of a number of team and individual games among first-grade intermediate students.In selecting between games, triple and complex motor building in team games was superior for those in individual games .In selecting between motor building types, complex motor building was superior to dual and triple motor building in team games, while dual motor building was superior to triple motor building in individual games among first-grade intermediate students,
 

The objective of this study was to examine the utility of postoperative radiation for low and intermediate grade cancers of the parotid and submandibular glands. The authors conducted a retrospective, Canadian-led, international, multi-institutional analysis of a patient cohort with low or intermediate grade salivary gland cancer of the parotid or submandibular gland who were treated from 2010 until 2020 with or without postoperative radiation therapy. A multivariable, marginal Cox proportional hazards regression analysis was performed to quantify the association between locoregional recurrence (LRR) and receipt of postoperative radiation therapy while accounting for patient-level factors and the clustering of patients by institution. In total, 621 patients across 14 tertiary care centers were included in the study; of these, 309 patients (49.8%) received postoperative radiation therapy. Tumor histologies included 182 (29.3%) acinic cell carcinomas, 312 (50.2%) mucoepidermoid carcinomas, and 137 (20.5%) other low or intermediate grade primary salivary gland carcinomas. Kaplan-Meier LRR-free survival at 10years was 89.0% (95% confidence interval [CI], 84.9%-93.3%). In multivariable Cox regression analysis, postoperative radiation therapy was independently associated with a lower hazard of LRR (adjusted hazard ratio, 0.53; 95% CI, 0.29-0.97). The multivariable model estimated that the marginal probability of LRR within 10years was 15.4% without radiation and 8.8% with radiation. The number needed to treat was 16 patients (95% CI, 14-18 patients). Radiation therapy had no benefit in patients who had early stage, low-grade salivary gland cancer without evidence of nodal disease and negative margins. Postoperative radiation therapy may reduce LLR in some low and intermediate grade salivary gland cancers with adverse features, but it had no benefit in patients who had early stage, low-grade salivary gland cancer with negative margins.

The total survival of 203 patients with non-Hodgkin's lymphoma (NHL) was analyzed according to the working formulation (WF) and "expanded" Kiel classifications. The original Kiel classification consisting of low grade (LG) and high grade (HG) forms corresponded well to the LG and HG forms of the WF. When an expanded Kiel containing an intermediate grade (IG) composed of the original LG diffuse group was devised, this gave a much better separation of survival of the three grades as compared with the WF where the survival of IG and HG forms were nonsignificantly different. The main reason for this difference was the inclusion of the so-called centroblastic diffuse form in the HG Kiel, but in the IG according to the WF. In a "modified" WF analysis where this histologic entity was placed in the HG subgroup, the three survival curves then gave excellent separation like the expanded Kiel classification. Since the centroblastic diffuse form (and its analogous forms according to other classifications) has a poor prognosis, it is important that it be so recognized and treated accordingly with aggressive therapy. We propose either our expanded Kiel or modified WF classification of the three grade forms as an excellent predictor of survival.

Dextranomer/Hyaluronic Acid Endoscopic Injection is Effective in the Treatment of Intermediate and High Grade Vesicoureteral Reflux in Patients with Complete Duplex Systems

Purpose:1. To find out the effect of Thriphaladi Rasayana along with Yoga Therapy on low grade Non Hodgkins Lymphoma and resistant intermediate and high grade NonHodgkins Lymphoma. 2. To apply a less costly, less morbid, well accepted method of treatment on NHL. 3.To find a simple method to increase the immunity. 4.To try a drug which is easy to prepare?Method:Purposive sampling technique was used for the study. Sample of 30 patients age range 25 75 years with histologicaly proven NonHodgkins lymphoma, attending the M.O.I.O.P of the regional cancer centre during a period of 18 months. Groups1) Low grade NonHodgkins Lymphoma 2) Resistant intermediate &High grade NonHodgkins lymphoma (failed chemotherapy) were taken. Procedure : 2 groups were given Triphaladhi Rasayana (15 grams of powder with ghee and honey) twice dailymorning& at bed time with milk as anupana for period of 1month along with selected yoga asanas and niyama?Result:Symptoms included were fever, night sweats, weight loss, lymph nodes enlargement, splenomegaly, and hepatomegaly. In low grade symptom relief was noted in almost all cases. Lymph node changes notedLow grade5 2% (complete remission), 38% (partial remission), 10% (no change), intermediate35% (CR), 52% (PR) & 13% (NC), High grade67% (CR), 33%(PR). Hepatomegaly changes :ve in low grade92.86%, intermediate 90.9% & high grade100%. Splenomegaly changes :ve in low grade92.86%, intermediate72.72% & high grade80% Over all remission status of 30 patientscomplete remission30%, partial remission 30% & no change30%?Conclusion:Thriphaladirasayana along with Yoga therapy is very effective in Low grade NonHodgkins lymphoma and resistant intermediate and high grade Non hodgkins Lymphoma?

EVALUATION OF HE4 AND SLPI EXPRESSION IN INTRAORAL MUCOEPIDERMOID CARCINOMAS

Leiomyosarcoma of the inferior vena cava

P2.15: Treatment Outcome of Metastatic Breast Angiosarcoma to the Lung, in a Reference Hospital in Latin America: A Case Report

The current research aims to find out the extent to which science books for the intermediate stage include scientific values for the academic year 2020/2021. For the purpose of achieving the goal of the research, a list of the main scientific values and their sub-indicators to be included in the science books for the intermediate level was prepared after the researcher reviewed a set of educational basics and previous studies related to the current research which helped in preparing a list that included (10) main scientific values and (39) behavioral indicators distributed on the main scientific values in their initial form. To be sure about this list, it evaluated by special experts. On their recommendations, two scientific values and their behavioral indicators were removed and some amendments were made to the list, so that the list consisted of (8) main scientific value and (31) behavioral indicators in its final form. After verifying the validity of the research tool, the reliability of the tool was extracted through an analysis of (20%) of the pages of the research sample to be analyzed, and the calculation of the percentage of agreement between the researcher and himself over time, as well as between the first analysis of the researcher and another analyst and between the second analysis of the researcher and the other analyst by using (Holsti) equation, and then presenting the analysis sample and the results obtained to two specialized experts, and after confirming the characteristics of the psychometric tool, the content of science books for the intermediate stage was analyzed in the light of the list of scientific values, and among the most important results that were reached: 1- Proposing eight scientific values. They are: curiosity, scientific honesty, acceptance of criticism, and patience in making judgments, ethics of science, scientific thinking, appreciation of science, and appreciation of scholars. 2- The behavioral appearance (attention to new attitudes) came to the scientific value of curiosity in: - A- The content of the science book for the first intermediate grade, with a total of (104) iterations and a percentage rate of (13.38%), ranked first

P-198 - Clinical outcomes of everolimus in patients with advanced pancreatic neuroendocrine tumor: A multicenter study in Korea