Comparing the outcome between multifocal, multicentric, and bilateral breast cancer and the impact of guideline-adherent adjuvant treatment: A retrospective multicenter cohort study of 5,308 patients.

1078 Background: Beside unifocal-unilateral (UU) breast cancer (BC) there are several subtypes including multifocal, multicentric and bilateral BC. This study tries to answer the following questions:(1) Does localization (multifocal/multicentric/bilateral) influence outcome concerning BC mortality? (2) Is there an impact of guideline-adherent adjuvant treatment in these BC subtypes? Methods: This German multi-center retrospective cohort study called BRENDA included 5277 patients obtained from 1992 until 2005. The definition of guideline adherence was based on the German national S3 breast cancer guideline (2004). Results: 4085 (77.4%) were UU, 698 (13.2%) multifocal, 282 (5.3%) multicentric and 212 (4.0%) bilateral BC. RFS in multifocal [p=0.003; HR=1.35 (95% CI: 1.11-1.65)], multicentric [p&lt;0.001; HR=1.76 (95% CI: 1.31-2.34)] and bilateral [p&lt;0.001; HR=2.28 (95% CI: 1.76-2.97)] BC was significantly lower compared to unilateral-unifocal BC. Concerning OAS we found only a borderline difference between UU and unilateral-multifocal [p=0.057; HR=1.22 (95% CI: 0.99-1.48)], but a significant difference between multicentric [p= 0.018; HR=1.42 (95% CI: 1.06-1.90)] resp. bilateral [p&lt;0.001; HR=2.87 (95% CI: 2.21-3.74)] and UU-BC. There was a significant impact by guideline adherent adjuvant therapy [UU: p&lt;0.001, HR=2.76,95%C.I.:2.25-3.38], [unilateral-multifocal: p=0.001, HR=2.04,95%C.I.:1.33-3.14], [unilateral-multicentric: p=0.020, HR=2.13,95%C.I.:1.13-4.01] and [bilateral: p=0.042, HR=2.10,95%C.I.:1.03-4.31]. After stratifying for 100% guideline adherent treatment and adjusting for age, tumor size, nodal status and grading there was no significant difference in RFS/OAS in patients with multifocal [p=0.282/p=0.610], multicentric [p=0.829/p=0.609] or bilateral BC [p=0.457/p=0.773] compared to patients with UU-BC. Conclusions: Patients with multicentric and bilateral BC have primarily a worse prognosis in terms of RFS and OAS. However if guideline adherent adjuvant treatment was applied it was no more possible to demonstrate significant differences in survival. </jats:p

Sakai: A Mobile Learning Platform

These days, humans have been witnessing related technological and social development, by means of which mobile technologies and Internet yield global access to information with mobility of knowledge. Mobile learning platforms are designed based on electronic learning (e-learning) and mobility. It is regarded as a useful way to enhance the learning process. Sakai as a mobile learning platform, design intentions are to be adaptable to any educational purposes, within or outside the institution, dependent on the provision of effectiveness in classroom instruction based on the learning style of the students, extensible in the cultivation of thinking skills in the learner, and efficient in communicating and exchanging data among its enrolled classroom members and other online platforms. This study employed a systematic review of related literature to investigate the predominant research methodology adopted by various scholars to assess necessary factors concerning mobile learning platform. Fifteen articles are selected based on established criteria. The findings indicated that most of the researchers used quantitative research methodology in investigating the effectiveness and concern variable of mobile learning. Also find out is that most of the outcome of the studies include, achievement, perception, pedagogy, motivation and mobile learning platform as a form of educational technology.</jats:p

Sakai: A Mobile Learning Platform

These days, humans have been witnessing related technological and social development, by means of which mobile technologies and Internet yield global access to information with mobility of knowledge. Mobile learning platforms are designed based on electronic learning (e-learning) and mobility. It is regarded as a useful way to enhance the learning process. Sakai as a mobile learning platform, design intentions are to be adaptable to any educational purposes, within or outside the institution, dependent on the provision of effectiveness in classroom instruction based on the learning style of the students, extensible in the cultivation of thinking skills in the learner, and efficient in communicating and exchanging data among its enrolled classroom members and other online platforms. This study employed a systematic review of related literature to investigate the predominant research methodology adopted by various scholars to assess necessary factors concerning mobile learning platform. Fifteen articles are selected based on established criteria. The findings indicated that most of the researchers used quantitative research methodology in investigating the effectiveness and concern variable of mobile learning. Also find out is that most of the outcome of the studies include, achievement, perception, pedagogy, motivation and mobile learning platform as a form of educational technology

Clinical criteria replenish high-sensitive troponin and inflammatory markers in the stratification of patients with suspected acute coronary syndrome

OBJECTIVES: In patients with suspected acute coronary syndrome (ACS), rapid triage is essential. The aim of this study was to establish a tool for risk prediction of 30-day cardiac events (CE) on admission. 30-day cardiac events (CE) were defined as early coronary revascularization, subsequent myocardial infarction, or cardiovascular death within 30 days. METHODS AND RESULTS: This single-centre, prospective cohort study included 377 consecutive patients presenting to the emergency department with suspected ACS and for whom troponin T measurements were requested on clinical grounds. Fifteen biomarkers were analyzed in the admission sample, and clinical parameters were assessed by the TIMI risk score for unstable angina/Non-ST myocardial infarction and the GRACE risk score. Sixty-nine (18%) patients presented with and 308 (82%) without ST-elevations, respectively. Coronary angiography was performed in 165 (44%) patients with subsequent percutaneous coronary intervention - accounting for the majority of CE - in 123 (33%) patients, respectively. Eleven out of 15 biomarkers were elevated in patients with CE compared to those without. High-sensitive troponin T (hs-cTnT) was the best univariate biomarker to predict CE in Non-ST-elevation patients (AUC 0.80), but did not yield incremental information above clinical TIMI risk score (AUC 0.80 vs 0.82, p = 0.69). Equivalence testing of AUCs of risk models and non-inferiority testing demonstrated that the clinical TIMI risk score alone was non-inferior to its combination with hs-cTnT in predicting CE. CONCLUSIONS: In patients presenting without ST-elevations, identification of those prone to CE is best based on clinical assessment based on TIMI risk score criteria and hs-cTnT

Final diagnoses.

<p>Abbreviations: CAD, coronary artery disease; NSTEMI, non-ST-elevation myocardial infarction; UA, unstable angina.</p

Diagnostic performance of high-sensitive cardiac troponin T (hs-cTnT), myeloperoxidase (MPO), myeloid-related protein 8/14 (MRP 8/14), and conventional cardiac troponin T (c-cTnT) in relation to the clinical TIMI risk score of patients with suspected ACS and no obvious ST-segment elevations at presentation (Non-ST-elevation patients).

<p>AUC indicates area under the curve. The clinical TIMI risk score is the sum of 6 clinical factors without the biomarker variable of the 7 originally described risk predictors of the TIMI unstable angina/Non-ST myocardial infarction risk score.</p