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Background: There is an ongoing debate about expanding the resection criteria for hepatocellular carcinoma (HCC) beyond the Barcelona Clinic Liver Cancer (BCLC) guidelines. We sought to determine the factors that held the most prognostic weight in the pre- and postoperative setting for each BCLC stage by applying a machine learning method., Methods: Patients who underwent resection for BCLC-0, A and B HCC between 2000 and 2017 were identified from an international multi-institutional database. A Classification and Regression Tree (CART) model was used to generate homogeneous groups of patients relative to overall survival (OS) based on pre- and postoperative factors., Results: Among 976 patients, 63 (6.5%) had BCLC-0, 745 (76.3%) had BCLC-A, and 168 (17.2%) had BCLC-B HCC. Five-year OS among BCLC-0/A and BCLC-B patients was 64.2% versus 50.2%, respectively (p = 0.011). The preoperative CART model selected α-fetoprotein (AFP) and Charlson comorbidity score (CCS) as the first and second most important preoperative factors of OS among BCLC-0/A patients, whereas radiologic tumor burden score (TBS) was the best predictor of OS among BCLC-B patients. The postoperative CART model revealed lymphovascular invasion as the best postoperative predictor of OS among BCLC-0/A patients, whereas TBS remained the best predictor of long-term outcomes among BCLC-B patients in the postoperative setting. On multivariable analysis, pathologic TBS independently predicted worse OS among BCLC-0/A (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.02-1.07) and BCLC-B patients (HR 1.13, 95% CI 1.06-1.19) undergoing resection., Conclusion: Prognostic stratification of patients undergoing resection for HCC within and beyond the BCLC resection criteria should include assessment of AFP and comorbidities for BCLC-0/A patients, as well as tumor burden for BCLC-B patients.

Context.—: With widespread screening for colorectal cancer, the number of early-stage colorectal cancers is increasing. Local excision of pT1 tumors is associated with considerably less morbidity and mortality, but this must be weighed against risk of lymph node metastases., Objective.—: To understand histologic prognostic factors associated with adverse outcome in malignant polyps., Data Sources.—: Pertinent literature regarding histologic features of prognostic significance in malignant polyps and low-stage colorectal carcinomas is summarized and our institute's cases are used to highlight these histologic features., Conclusions.—: Poor prognostic factors for malignant polyps include high tumor grade, presence of lymphovascular invasion, tumor less than 1 mm from resection margin, submucosal invasion deeper than 1 mm, and high tumor budding. These features should be assessed by the pathologist and communicated to the clinical team in order to allow proper management.

To find an effective alternative to scarce, high-cost noble platinum (Pt) electrocatalyst for hydrogen evolution reaction (HER), researchers are pursuing inexpensive and highly efficient materials as an electrocatalyst for large scale practical application. Layered transition metal dichalcogenides (TMDCs) are promising candidates for durable HER catalysts due to their cost-effective, highly active edges and Earth-abundant elements to replace Pt electrocatalysts. Herein, we design an active, stable earth-abundant TMDCs based catalyst, WS (1- x ) Se x nanoparticles-decorated onto a 3D porous graphene/Ni foam. The WS (1- x ) Se x /graphene/NF catalyst exhibits fast hydrogen evolution kinetics with a moderate overpotential of ~-93 mV to drive a current density of 10 mA cm -2 , a small Tafel slope of ~51 mV dec -1 , and a long cycling lifespan more than 20 h in 0.5 M sulfuric acid, which is much better than WS₂/NF and WS₂/graphene/NF catalysts. Our outcomes enabled a way to utilize the TMDCs decorated graphene and precious-metal-free electrocatalyst as mechanically robust and electrically conductive catalyst materials.

Objective: To determine the effectiveness of intervention by education of doctors in improving the referral rate and quality in a public-sector healthcare setting., Methods: The quasi-experimental study was conducted from March to September 2012 at PNS Rahat Hospital in naval sailors' residential estate, Karsaz, Karachi. Two awareness sessions were held three months apart by a gynaecologist and a paediatrician. The sessions were aimed at communicating the consultant practice to female general practitioners employed at the two family welfare centres. Pre- and post-intervention data was collected manually from the record registers at the two centers as well as gynaecology and paediatrics outpatient clinics., Results: The study comprised 10 female GPs. In paediatric clinic, there was 47% (118 post intervention/ 187 pre intervention) reduction in referrals for acute gastroenteritis and fever of unknown origin (32 post intervention/75 pre intervention). In gynaecology, 30% (50 post intervention/61 pre intervention) reduction was seen in referrals for severe anaemia in 2nd and 3rd trimesters of pregnancy, and an increase in referrals (35 post intervention/19 pre intervention) for high-risk cases indicating better counselling and case identification. Improved standard of counselling was also reflected by 31% reduced referrals (40 post intervention/ 58 pre intervention) for hyper-emesis gravidarum during the first trimester. The difference in referrals was not statistically significant (p>0.05) for paediatrics, but it was highly significant (p<0.001) for gynaecology., Conclusions: Healthcare system can function optimally with focus on referral standards and by improving the communication between the primary care physicians and consultants.

Background: Integrated Modular Teaching program was introduced at Foundation University Medical College in 2009. The concept of integrated modular teaching was new to the faculty and students. A need was felt by Department of Medical Education for establishing a mentoring system in order to have a better understanding of students' problem, to provide them continuous support and to make them sail smoothly through this new system. This study was conducted for need assessment and to gain students' perspectives regarding establishing a mentoring system., Methods: It was a descriptive cross-sectional study. A 5-point Likert scale questionnaire was administered to third year medical students of academic year 2010-14, who underwent the new integrated curriculum. The questionnaire explored the students' view regarding the need of mentoring platform in the institution as part of formal education. The questionnaire focused on the students' knowledge of mentoring, their experience with informal mentoring, desire for mentoring and environment for mentoring. Data were analysed using SPSS-10)., Results: Eighty-six percent of the participants agreed to the statement that there is a need for a personal, confidential support system., Conclusion: Students are aware of benefits of mentoring and seek informal mentoring from faculty and senior colleagues. There is need of formal mentoring program at institutional level.

Background: The effect of multiple pregnancies, a very common pattern in reproductive lifestyle of Pakistani women, needs to be addressed to see if it affects the iron content and hence cause iron deficiency. Recognising this deficiency prior to development of anaemia can prevent disastrous consequences that can complicate the life of the mother and foetus especially in developing countries. The objective of this study was to assess the effect that the stress of multiple pregnancies has on the iron status of the body., Methods: This comparative study was conducted in a focus group of female population. Two hundred subjects were selected by convenient sampling and grouped depending on their parity status. Data regarding diet, and socioeconomic history was collected on pre-designed questionnaire. Serum Ferritin was used to assess iron deficiency using the Electrochemiluminescence Immunoassay (ECLIA). Data was statistically analysed using SPSS-17., Results: Mean value of serum Ferritin in the nulliparous group was 76.52 +/- 4.92 etag/mL with 16% of nulliparous subjects showing lower than normal values. Thirty-six percent of uniparous subjects showed low serum Ferritin values, mean value-being 45.74 +/- 4.51 etag/mL. Seventy-two percent of the multiparous subjects showed iron deficiency with Ferritin levels of < 20 etag/mL. Mean serum Ferritin in this group was 25.21 +/- 2.75 etag/mL. The differences between the Ferritin levels of the study groups were highly significant (p < 0.01)., Conclusions: Multiparous women had lower serum Ferritin levels than the control group suggesting that the stress of multiple pregnancies takes its toll on the iron content of the body.