Sistem Pakar dalam Menganalisis Penyakit Kelenjar Getah Bening Menggunakan Metode Certainty Factor

In general, a person is difficult do dermine whether a lump or swelling of the lymph nodes in the body, is just a normal lump or whether it has become cancer. If the lumph does not go away whitin a few days, the patient is required to immediately consult a doctor to get detailed information about the disease and how to treat it. Lymph nodes scattered in the human body are round and are part of the lymphatic system that plays a role in fighting viruses that enter the body. The cause of these enlarged lymph nodes can be due to the type of food consumed, congenital disease in the patient’s body (comorbid), infection to lymph node cancer (lymphoma). For this reason, an Expert System is needed by applying the Certainty Factor method in order to assist the public in analyzing lymph node disease by answering several questions regarding the symptoms experienced. This system is implementad using the PHP programming language and MySQL database. The result of this study show that the Certainty Factor method can work well in the Expert System analysis process. From the result of system trials with several patient data, the disease accuracy rate in the patient named S is 63% and the disease accuracy rate in the patient named MR is 68%. Besides being useful for an expert, this Expert System can help patients to find out the type of disease they are suffering from, the accuracy of disease, the method of treatment and a guide for making decisions.

Understanding the Clinical Impact of MUC5AC Expression on Pancreatic Ductal Adenocarcinoma

Mucin-5AC (MUC5AC) is a heavily glycosylated gel-forming secreted mucin with a reliable prognostic value when detected in multiple malignancies. It is highly prevalent (70%) in PDA and is nonexistent in normal pancreatic tissues. Retrospective studies on PDA tumor tissue (detected by immunohistochemistry or IHC)) have investigated the prognostic value of MUC5AC expression but were equivocal. Some studies associated it with poor outcomes (survival or pathological features such as lymph node disease, vascular/neural invasion in resected tumors), while others have concluded that it is a good prognostic marker. The examination of expression level threshold (5%, 10%, or 25%) and the detected region (apical vs. cytoplasmic) were variable among the studies. The maturation stage and glycoform of MUC5AC detected also differed with the Monoclonal antibody (Mab) employed for IHC. CLH2 detects less mature/less glycosylated versions while 45M1 or 21-1 detect mature/more glycosylated forms. Interestingly, aberrantly glycosylated variants of MUC5AC were detected using lectin assays (Wheat Germ Agglutinin-MUC5AC), and Mabs such as NPC-1C and PAM4 have are more specific to malignant pancreatic tissues. NPC-1C and PAM4 antibody reactive epitopes on MUC5AC are immunogenic and could represent specific changes on the native MUC5AC glycoprotein linked to carcinogenesis. It was never studied to predict treatment response.

Immunoexpression of cyclin d1 in head and neck squamous cell carcinomas – Correlation with histopathological grade and clinical parameters

Squamous cell carcinomas constitute 95% of cancers of the head and neck region. The progression of disease in these patients depends on various molecular regulators. The present study is undertaken to identify the immunoexpression of Cyclin D1 in Head and Neck Squamous Cell Carcinomas (HNSCC) and to study their association with clinicopathological variables in routine diagnostics.1. To study the expression of Cyclin D1 in Head and Neck Squamous Cell Carcinomas by immunohistochemistry. 2. To correlate the expression of Cyclin D1 with histopathological grading and various demographic parameters.150 cases of HNSCCs were studied for a period of 18 months in ESIC MC & PGIMSR, Bangalore. The cases were subjected to immunohistochemical analysis of Cyclin D1 antigen. Immunoexpression of Cyclin D1 was correlated with histopathological differentiation and clinical parameters.Out of 150 cases; well, moderate and poorly differentiated grades constituted67, 63 and 20 cases respectively. Immunoexpression of Cyclin D1 wasfound in 100 % of the cases and they were significantly associated with worseninggrade of the tumour and positive lymph node disease while it was not found to be associated with other clinical parameters.Immunohistochemical analysis of cyclin D1 can be routinely done inHNSCC as it proves to be an effective, early prognostic indicator in predicting theadvanced stage of the disease and guiding appropriate management.

How good is operator opinion at predicting high ventricular pacing burden among patients receiving device therapy for bradycardia?

Funding Acknowledgements Type of funding sources: None. Introduction Current guidelines indicate that pacing methods that maintain physiologic ventricular activation (biventricular pacing or His-bundle pacing) should be chosen over right ventricular pacing (Vp) among patients with EF 36-50% who are expected to Vp >40% of the time. There are no guidelines to help predict which patients will receive a high burden of Vp and this is left to operator opinion. We sought to ascertain whether operator opinion is an accurate predictor of high burden of Vp. Methods This was a single-centre single-blinded observational study of patients who received pacemaker implant for treatment of bradycardia between April 2015 and 2019 and had at least 12 month follow-up data on record. Patients’ demographic, clinical, electrocardiographic and echocardiographic data were reviewed in a blinded fashion by a senior implanting physician, who estimated whether the Vp at 12 months would exceed 40%. The Vp at approximately 12 months was obtained from the pacing records and compared with the prediction. Results Some 982 patients underwent pacemaker implantation during the study period, 698 for conduction system disease (CSD), 267 for sinus node disease (SND) and 17 for other conditions. Overall, 856 had valid follow-up data. Of these, 543 (63.4%) were predicted to Vp >40% , and 527(61.6%) were documented as having Vp >40%. The sensitivity and specificity of operator prediction were 93.2% and 84.2%, with positive and negative predictive values of 90.4% and 88.5%. Table 1 illustrates analyses of different populations by clinical parameter. In sub-group analysis, complete heart block and PR > 300ms were significant factors for accurate prediction of Vp > 40%, however clinical features, such as syncope, were poor discriminators. Conclusion In this single-centre study, among patients receiving pacemaker implant for treatment of bradycardia, operator prediction of the burden of Vp >40% has an acceptable degree of accuracy. Sub-group analysis suggests that certain clinical parameters could make this prediction easier. Table 1. Comparison of operator opinion SND CSD CHB SND+PR < 160 PR > 300 Syncope Non-syncope n 698 267 216 84 60 409 344 Sensitivity 44.4% 97.7% 100% 6.3% 100% 86.4% 87.9% Specificity 98.3% 62.0% 45.2% 97.1% 0%* 89.9% 79.6% PPV 87.0% 90.6% 91.6% 33.3% 98.3% 94.2% 92.2% NPV 87.9% 87.9% 100% 81.5% - 77.6% 70.5% * only 1 patient did not RV pace >40% - this was not predicted. SND – sinus node disease; CSD – conduction system disease; CHB – complete heart block, PPV – positive predictive value; NPV – negative predictive value

Permanent pacemaker implantation in unexplained syncope patients with electrophysiology study-proven atrioventricular node disease

Funding Acknowledgements Type of funding sources: None. Background/Introduction: Syncope, whose cause is unknown after an initial assessment, has an uncertain prognosis. It is critical to identify patients at highest risk who may require a pacemaker and to identify the cause of recurrent syncope to prescribe proper therapy Purpose Aim of this study was to evaluate the effect of permanent pacing on the incidence of syncope in patients with unexplained syncope and electrophysiology study-proven atrioventricular node disease. Methods This was an observational study based on a prospective registry of 236 consecutive patients (60.20 ± 18.66 years, 63.1% male, 60.04 ± 9.50 bpm) presenting with recurrent unexplained syncope attacks admitted to our hospital for invasive electrophysiology study (EPS). Τhe implantation of a permanent antibradycardia pacemaker (ABP) was offered to all patients according to the results of the EPS. 135 patients received the ABP, while 101 denied. Results The mean of reported syncope episodes was 1.97 ± 1.10 (or presyncope 2.17 ± 1.50) before they were referred for a combined EP guided diagnostic and therapeutic approach. Over a mean follow-up of approximately 4 years (49.19 ± 29.58 months), the primary outcome event (syncope) occurred in 31 of 236 patients (13.1%), 6 of 135 (4.4%) in the ABP group as compared to 25 of 101 (24.8%) in the no pacemaker group (p < 0.001). Conclusion Among patients with a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined atrioventricular node disease, identifies a subset of patients who will benefit from permanent pacing.

Recent Evolution in the Management of Lymph Node Metastases in Melanoma

Introduction. Based upon two large randomized international clinical trials (German Dermatologic Cooperative Oncology Group (DeCOG-SLT) and Multicenter Selective Lymphadenectomy Trial II (MSLT-II)) which were published in 2016 and 2017, respectively, active surveillance has been demonstrated to have equivalent survival outcomes to completion lymphadenectomy (CLND) for a subset of patients who have microscopic lymph node disease. In this study, we examined the changes in national practice patterns regarding the utilization of CLND after positive sentinel lymph node biopsy (SLNB). Methods. Using the National Cancer Database, we examined CLND utilization in SLN-positive patients diagnosed with melanoma between 2012 and 2016. A hierarchal logistical regression model with hospital-level random intercepts was constructed to examine the factors associated with SLNB followed by observation vs. SLNB with CLND. Results. Of the 148,982 patients identified, 43% (n = 63,358) underwent SLNB, and 10.3% (n = 6,551) had a SLNB with microscopic disease. CLND was performed for 57% (n = 2,817) of these patients. Patients were more likely to undergo CLND if they were < 55 years of age (OR, 0.687; p = <0.0001), ages 56 - 65 (OR, 0.886; p = 0.0237), Charlson Deyo Score = 0 (OR, 0.859; p = 0.0437), or were diagnosed with melanoma in 2012 (OR, 0.794, p = <0.0001). Conclusions. We found the utilization of CLND among patients with microscopic nodal melanoma to be significantly lower in 2016 compared to 2012. Younger age, lack of comorbidities, and primary tumor location on the trunk or head/neck were associated with higher utilization of CLND.

Melanoma of Unknown Primary: Evaluation of the Characteristics, Treatment Strategies, Prognostic Factors in a Monocentric Retrospective Study

BackgroundMelanoma of unknown primary (MUP), accounts for up to 3% of all melanomas and consists of a histologically confirmed melanoma metastasis to either lymph nodes, (sub)cutaneous tissue, or visceral sites without any evidence of a primary cutaneous, ocular, or mucosal melanoma. This study aimed to investigate the characteristics, treatment strategies, and prognostic factors of MUP patients, in order to shed some light on the clinical behavior of this malignancy.MethodsAll the consecutive patients with a diagnosis of MUP referring to our institutions between 1985 and 2018 were considered in this retrospective cohort study. The records of 173 patients with a suspected diagnosis of MUP were retrospectively evaluated for inclusion in the study. Patient selection was performed according to the Das Gupta criteria, and a total of 127 MUP patients were finally included in the study, representing 2.7% of the patients diagnosed with melanoma skin cancer at our institutions during the same study period. A second cohort of all consecutive 417 MKP patients with AJCC stages IIIB–IV, referring tions in the period considered (1985–2018), was included in the study to compare survival between MUP and MKP patients. All the diagnoses were based on histopathologic, cytologic and immunohistochemical examination of the metastases. All tumors were re-staged according to the 2018 American Joint Committee on Cancer (AJCC) 8th Edition.ResultsMedian follow-up was 32 months (IQR: 15–84). 3-year progression-free survival (PFS) was 54%, while 3-year overall survival (OS) was 62%. Worse OS and PFS were associated with older age (P = 0.0001 for OS; P = 0.008 for PFS), stage IV (P &lt; 0.0001 for OS; P = 0.0001 for PFS) and higher Charlson Comorbidity Index (P &lt; 0.0001 for OS and P = 0.01 for PFS). Patients with lymph node disease showed longer PFS (P = 0.001) and OS (P = 0.0008) than those with (sub)cutis disease. Complete lymph node dissection (CLND) was the most common surgical treatment; a worse OS in these patients was associated with the number of positive lymph nodes (P = 0.01), without significant association with the number of retrieved lymph nodes (P = 0.79). Survival rates were lower in patients undergoing chemotherapy (CT) and target therapy (TT), and higher in those receiving immunotherapy (IT). 417 patients with AJCC stages IIIB–IV of Melanoma Known Primary (MKP) were included for the survival comparison with MUP. 3-year PFS rates were 54 and 58% in MUP and MKP, respectively (P = 0.30); 3-year OS rates were 62 and 70% in MUP and MKP, respectively (P = 0.40).ConclusionsThe most common clinical scenario of our series was a male patient around 59 years with lymph node disease. We report that CLND associated with IT was the best treatment in terms of survival outcome. In the current era of IT and TT for melanoma, new studies have to clarify the impact of novel drugs on MUP.