HER2, a human epidermal growth factor, being activated by amplification, is a negative prognostic factor in breast cancer. HER2 is the target of anti-HER2 antibodies (Trastuzumab, Pertuzumab…). For more than 10 years, breast cancers have been classified into HER2 positive and HER2 negative. However, the advent of new cytotoxic drugs combined with anti-HER2 antibodies, such as TDM1 or trastuzumab déruxtécan, have shown very promising therapeutic activity in patients with low HER2 expression breast cancer. These new therapeutic perspectives encourage a better identification of low HER2 tumours in order to identify patients who could benefit from them. Thus, the classification of breast tumours evolves to individualize HER2-negative tumours (score 0), HER2-positive tumours (score 3+ and 2+ amplified) and HER2-low tumours (scores 1+ and 2+ not-amplified). HER2-low tumours are common and represent more than half of all breast cancers. To identify these HER2-low tumours, pathology laboratories should not change their usual technique calibrated according to ASCO/CAP and GEFPICS recommendations. Until more clinical data about response to these new treatment strategies are available, GEFPICS does not require pathologists to identify this HER2-low category. Nevertheless, this designation will allow clinicians to identify patients whose tumours fall into this category in the very short term and offer them new treatment options.Drowsiness and distraction are major factors of road crashes and responsible of>35% of road fatalities. Automated driving could solve or minimize their impact, yet it is also in itself a way to promote them. Previous literature reviews and meta-analysis regarding take-overs during automated driving primarily focused on distraction rather than drowsiness. We thus present a systematic and meta-analysis literature review focused on the effect of distraction and drowsiness on take-over performance. From an initial selection of 1896 articles from databases, we obtained by applying systematic review methodology a total of 58 articles with 42 articles dedicated to distraction and 17 articles related to drowsiness. According to our analysis, we demonstrated that distraction and drowsiness increased the take-over request reaction time (TOR-RT), which could also lead to a reduction of the quality of take-overs. In addition, this longer reaction time was even more important in the case of handheld non-driving related taf the effect of distraction and drowsiness on take-over performance. Further studies should adopt more standardized measures of TOR-RT and additional take-over quality measures, try minimizing the number of take-over requests, and carefully consider the time budget available for the use case since it influences the TOR-RT. Regarding distraction, researchers should consider the impact of tasks requiring handholding items. Concerning drowsiness, further protocols should consider the non-linearity of drowsiness and presence of micro sleeps and favor take-over requests based on drowsiness level protocols rather than on fixed duration protocols.The mortality of women with ST-elevation myocardial infarction (STEMI) exceeds that of men, supposedly the result of older age and co-morbidities. Patients with STEMI can be transported directly to the catherization lab by the emergency medical service (EMS) or to the emergency department (ED) by the EMS, a regular ambulance, or independently. This raises the question whether gender disparity in the transport of patients with STEMI may affect time to therapy and consequently explain the disparate outcome in men and women with STEMI. We analyzed a large nationwide registry of prospectively-recorded patients with acute coronary syndromes in order to determine if there is a survival gap between men and women with STEMI, and to assess the gender-related effect of admission pathway on time intervals and 5-year mortality. Study population included 2,740 patients with STEMI who underwent primary percutaneous coronary interventions, comprising 464 women (17%, median-70 years) and 2,276 men (83%, median-58 years). The unadjusted 5-year mortality of women was higher compared with men (26.4% vs 15.6%, p = 0.001) but adjustment abrogated this survival difference. Regardless of adjustment, the 5-year mortality of patients with STEMI admitted directly to the catherization lab or to the ED by EMS was similar for men and women but significantly lower in the directly admitted patients (p less then 0.028). In contrast, admission to the ED by non-EMS was associated with markedly worse survival among women. These results indicate that women suspected of STEMI benefit from transportation by the EMS and should use this pathway exclusively to reach the hospital.

To evaluate the accuracy of multiple risk calculators for 30-day mortality on patients undergoing major lower extremity amputation.

The actual 30-day mortality at a single Veterans Affairs institution was compared to the predicted outcome from the following risk calculators ACS-NSQIP, VASQIP, amputation scoring tool (AST), and POTTER elective.

The overall calculated 30-day mortality was similar to the actual mortality with the VASQIP and POTTER elective risk calculators, while the NSQIP and AST over-estimated the 30-day mortality. The predictive accuracy of the POTTER and NSQIP risk calculators were moderate (AUC >0.7), and fair for the VASQIP and AST.

Risk assessment tools can provide adjunctive data on predicted 30-day mortality in patients undergoing major lower extremity amputation. In our study, there were differences in predictability of the risk calculators for lower extremity amputation that should be considered when utilizing a risk assessment tool to improve physician-patient shared decision-making.

Risk assessment tools can provide adjunctive data on predicted 30-day mortality in patients undergoing major lower extremity amputation. Aminocaproic nmr In our study, there were differences in predictability of the risk calculators for lower extremity amputation that should be considered when utilizing a risk assessment tool to improve physician-patient shared decision-making.

Anastomotic leaks (AL) contribute to postoperative mortality, prolonged hospitalization, and increased health care costs. While left-sided AL (LAL) are well described in the literature, there is a paucity of studies on outcomes and management of right-sided AL (RAL). This study aimed to compare the timing of RAL versus LAL, and the variable diagnosis, management and outcomes of RAL versus LAL. We hypothesized that the timing of RAL may be later compared to LAL and may result in worse overall outcomes.

Patients who underwent curative intent surgery for neoplastic disease from January 1995 to December 2015 were included. Patients that underwent an anastomosis below the peritoneal reflection, neoadjuvant treatment, fecal diversion, previous colectomy/anastomosis, multiple anastomoses, and patients with inflammatory bowel disease or hereditary colorectal cancer syndromes were excluded. Patient demographics, neoplastic data, operative data, time to AL, methods utilized for diagnosis of AL, and management of ALeen groups (p=0.70; p=1.0).

This study found overall very low AL rates with comparable timing of RAL and LAL, and no difference in management or outcome of RAL vs. LAL. These findings are informative for patient and surgeon expectations before and after surgery and when AL is suspected.

This study found overall very low AL rates with comparable timing of RAL and LAL, and no difference in management or outcome of RAL vs. LAL. These findings are informative for patient and surgeon expectations before and after surgery and when AL is suspected.

Surgical Mesh Infection (SMI) after Abdominal Wall Hernia Repair (AWHR) represents a catastrophic complication. We performed a systematic review and meta-analysis to analyze the risk factors for SMI in the context of AWHR.

PubMed, Embase, Scielo, and LILACS were searched without language or time restrictions from inception until June 2021. Articles evaluating the association between demographic, clinical, laboratory and surgical characteristics with SMI in AWHR were included.

23 studies were evaluated, comprising a total of 118,790 patients (98% males; mean age 56.5 years) with a mesh infection pooled prevalence of 4%. Significant risk factors for SMI were type 2 diabetes mellitus, obesity, smoking history, steroids use, ASA III/IV, laparotomy vs laparoscopy, emergency surgery, duration of surgery and onlay mesh position vs sublay. The quality of evidence was regarded as very low-moderate.

Several factors, highlighting sociodemographic characteristics, comorbidities, and the clinical scenario, may increase the risk of developing mesh infections in AWHR. The recognition and mitigation of these may significantly reduce mesh infection rates in this context.

Several factors, highlighting sociodemographic characteristics, comorbidities, and the clinical scenario, may increase the risk of developing mesh infections in AWHR. The recognition and mitigation of these may significantly reduce mesh infection rates in this context.

The aim of this study was to assess biomechanical performance of short and long Cephalomedullary nail constructs consisting of different number of distal screw for stabilizing different levels of subtrochanteric fracture.

The femur obtained from computed tomography scanner was used to create a transverse fracture at 15mm (level A), 35mm (level B), and 55mm (level C) below the lesser trochanter. Short and long Cephalomedullary nails were virtually inserted to the fractured femur. Four-node tetrahedral element was used to build up finite element (FE) models for biomechanical analysis. The analysis focused on post-operative stage of partial weight-bearing.

Stress on the implant localized at the surface between lag screw/nail and distal screw/nail. Short Cephalomedullary nail exhibited higher stress than long Cephalomedullary nail. The stress in short Cephalomedullary nail could be reduced by using two distal screws fixation and the fracture at level A produced less stress than that of level B and C. Eitherhalomedullary nail with two distal screws may be a candidate for a high subtrochanteric fracture. Single dynamic screw insertion is strongly not recommended with either short or long nail regarding implant failure.

This study sought to investigate the efficacy and safety of dapagliflozin in Black and White patients with heart failure (HF) with reduced ejection fraction (HFrEF) enrolled in DAPA-HF (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening HeartFailure or Cardiovascular Death in Patients With Chronic HeartFailure).

Black patients may respond differently to certain treatments for HFrEF than White patients.

Patients with New York Heart Association functional class II to IV with an ejection fraction of≤40% and elevated N-terminal pro-B-type natriuretic peptide were eligible for DAPA-HF. Because >99% of Black patients were randomized in the Americas, this post hoc analysis considered Black and White patients enrolled only in North and South America. The primary outcome was the composite of a worsening HF event (HF hospitalization or urgent HF visit requiring intravenous therapy) or cardiovascular death.

Of the 4,744 patients randomized in DAPA-HF, 1,494 (31.5%) were enrolled in the Americas.