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Anomalous origin of the circumflex artery from the pulmonary artery (ACxAPA) is a rare but clinically significant condition in which the circumflex artery arises from either the main pulmonary artery or one of its main branches. Untreated patients with ACxAPA may develop severe heart failure or sudden cardiac death. Diagnosis is established with either catheter or CT angiography. We present a case of an adult male with no prior known cardiac history who was found to have ACxAPA after presenting to our institution in acute decompensated heart failure.

Minali Prasad,1,&ast; Deniz Goodman,1,&ast; Jia Xu,2 Sanhit Gutta,2 Daniella Zubieta,2 Sreevardhan Alluri,2 Nicole H Siegel,1,2 Crandall E Peeler,1,2 Hyunjoo J Lee,1,2 Howard J Cabral,3 Manju L Subramanian1,2 1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; 2Department of Ophthalmology, Boston Medical Center, Boston, MA, USA; 3Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA&ast;These authors contributed equally to this workCorrespondence: Manju L Subramanian, Department of Ophthalmology, Boston Medical Center, 85 East Concord Street, &num;8813, Boston, MA, 02118, USA, Tel +1 (617) 638 – 4555, Fax +1 (617) 414 – 2929, Email Manju.Subramanian@bmc.orgPurpose: Long-term patient satisfaction may influence patients’ perspectives of the quality of care and their relationship with their providers. This is a follow up to a comparative effectiveness study investigating oral to intravenous sedation (OIV study). The OIV study found that oral sedation was noninferior in patient satisfaction to standard intravenous (IV) sedation for anterior segment and vitreoretinal surgeries. This study aims to determine if patient satisfaction with oral sedation remained noninferior long term.Patients and Methods: Patients were re-interviewed using the same satisfaction survey given during the OIV study. Statistical analysis involved t-tests for noninferiority of the long-term mean satisfaction score of oral and IV sedation. We also compared the original mean satisfaction score and the follow-up mean satisfaction score for each type of sedation and for both groups combined.Results: Participants were interviewed at a median of 1225.5 days (range 754– 1675 days) from their surgery. The original mean satisfaction score was 5.26 ± 0.79 for the oral treatment group (n = 52) and 5.27 ± 0.64 for the intravenous treatment group (n = 46), demonstrating noninferiority with a difference in mean satisfaction score of 0.015 (p < 0.0001). The follow-up mean satisfaction score was 5.23 ± 0.90 for oral sedation and 5.60 ± 0.61 for IV sedation, with a difference in the mean satisfaction score of 0.371 (p = 0.2071). Satisfaction scores did not differ between the original mean satisfaction score and the follow-up mean satisfaction score for the oral treatment group alone (p = 0.8367), but scores in the intravenous treatment group increased longitudinally (p = 0.0004).Conclusion: In this study, long-term patient satisfaction with oral sedation was not noninferior to satisfaction with IV sedation, unlike our findings with short-term patient satisfaction in our original study. Patient satisfaction also remained unchanged over time for the oral treatment group, but patients in the intravenous treatment group reported higher long-term satisfaction with their anesthesia experience compared to the immediate post-operative period.Keywords: longitudinal, ocular surgery, anesthesia, oral triazolam, intravenous midazolam, noninferiority

Deployment of marker-assisted selection (MAS) in the molecular breeding programmes has transformed the crop breeding over the last decade, bringing speed and precision to the breeding programmes. The experiment was conducted during rainy (kharif) seasons of 2019, 2020, and 2021 at ICAR-Indian Institute of Rice Research, Rajendranagar, Hyderabad, Telangana for validation of the Kompetitive Allele Specific PCR (KASP) SNP markers for routine marker- assisted selection through genotyping and phenotyping of a set of breeding lines segregating for grain number, yield and resistance to bacterial blight and blast diseases. Initially, 150 introgression lines of Swarna possessing bacterial leaf blight (Xa21), blast (Pi54) and yield enhancing gene (Gn1a) at ICF4 generation were genotyped using trait specific KASP markers, and a set of 22 plants was identified to be homozygous for all the three genes, 68 plants were found positive for two genes possessing either Xa21 + Gn1a and Pi54 + Gn1a, rest were having different single gene. Simultaneously, plants which were triple gene positives were also subjected for stringent phenotypic screening for the targeted stresses, viz. bacterial blight and blast disease resistance and further evaluated for grain number and other key agronomic traits. All the three-gene positive plants exhibited high level of resistance to bacterial blight and blast diseases in comparison with positive checks and displayed higher grain number and yield than the recurrent parent, Swarna. The efficiency of SNP marker system provided by Intertek is accurate, cost effective and accurate with phenotype.

Periosteal reaction may result from multiple causes including infection, trauma, medications, and neoplasms. One important etiology that must be considered in the differential diagnosis of symmetric periosteal reaction, especially in immunocompromised patients, is voriconazole use. We present a case of a 65-year-old man who underwent liver transplantation complicated by acute hypoxic respiratory failure and Aspergillus infection. Long term voriconazole therapy was initiated with resultant development of thoracic periosteal reaction which improved following discontinuation of the medication. Given the preferential upper body distribution of periosteal reaction induced by voriconazole, chest radiologists might be the first ones to recognize this adverse effect.

No abstract available. Manuscript truncated after 150 words. HPI: A 55-year-old man presents with a history of cough, poor appetite, low energy, and weight loss over the previous 6-10 months following COVID-19 infection 2 months earlier. PMH, SH, FH: The patient’s past medical history was positive for CVOID-19 infection 2 months earlier as well as pneumonia, not specified, in the previous year. The patient’s past medical history was also remarkable for a 7-unit gastrointestinal hemorrhage approximately one year earlier following polypectomy for benign lesions in the transverse colon. During that hospital admission a complete blood count showed 1% blasts which prompted hematology consultation. The consulting oncologist felt the peripheral blasts were the result of a leukemoid reaction secondary to increased bone marrow stimulation owing to the patient’s acute anemia caused by the gastrointestinal hemorrhage. Macrocytosis and reticulocytosis was also noted and attributed to the same. Repeat complete blood count showed no blasts although some myelocytes, metamyelocytes, and polychromasia …

The current computational investigation employs the stochastic extended finite element approach, which the authors have previously developed, to investigate the probabilistic fracture response of double edge cracked orthotropic laminated composite plates under varying stress conditions. The well-known extended finite element method is used to determine the mean and coefficient of variation of stress intensity factors KI and or KII by treating the input parameters as random variables. This is done under the assumption that all of the laminated plate's layers are perfectly bonded to one another and that there is no delamination effect between the layers, the matrix, or the fibres. And it's believed that the plate has through thickness crack. A combination of input random Gaussian variables is used to model the various input factors, such as the lamination angle, the applied loads, and the crack parameters (such the crack length and location). Typical numerical results are shown to investigate the effects of varying degrees of uncertainty in the lamination angle, crack length, crack length to plate width ratio, crack positions, and applied tensile, shear, and combined (tensile and shear) stresses. An excellent agreement arises when the findings generated with the stochastic extended finite element method methodology are assessed against the results found in the published literature through Monte Carlo simulations.

ABSTRACT: Impact of traditional halal meat production without stunning (NST) and commercial slaughter with electrical stunning (ST) of 100 slow-growing broiler chicken on blood plasma and different biochemical, enzymatic, hormonal, meat quality, and proteomic changes was evaluated. The results revealed lower (P < 0.05) postmortem pH values and higher redness (a*) scores for ST samples relative to NST group. Myofibrillar fragmentation index and bleeding efficiency (%) were lower (P < 0.05) in ST compared to NST samples. The ST group had higher (P < 0.05) creatinine, total protein, alanine aminotransferase (ALT), and triiodothyronine (T3) than NST group, however, no difference (P > 0.05) in blood glucose, lactate dehydrogenase (LDH), creatine kinase (CK), thyroxine (T4), cortisol, and aspartate aminotransferase (AST) was observed relative to NST samples. The 2-dimensional gel electrophoresis (2-DE) coupled to MALDI-TOF MS of meat samples has identified 14 differentially abundant proteins between 2 groups. Proteins demonstrating positive correlation with stress namely adenylate kinase isoenzyme-1, Rho guanine nucleotide exchange factor (NST), and apolipoprotein A-I (ST) were overabundant. From the current study, it is concluded that electrical stunning of broilers prior to slaughter or traditional halal slaughter without stunning does not adversely affect the meat quality.

Despite not being uniform, urban economic growth usually shows some inconsistency. Urban sustainable development may be harmed if the financial instability goes above a particular threshold. This article examines the current status of India's macro-economic real-time management of early warning alert systems and information warehouse-related innovations. In order to deal with the significant loss caused by the increased variation of an urban economy, it analyzes and explicates the position of Internet of Things (IoT) technology in the macro-economic alert system. This reviews the development path of financial monitoring and early alerting system whichsorts out and compares numerous popular economic monitoring techniques.Depending on IoT technology, the urban economic reports surveillance & advance warning system has conducted research on information transfer, tracking, forecasts, analysis, and presentation. After simulating the system, the proposed research's findings indicate that the overall accuracy of the model's macroeconomic fluctuation forecast approaches 80%, which may be used in real life.

No abstract available. Article truncated after the first 150 words. History of Present Illness: An 82-year-old man presented to his physician for general health maintenance as well as a complaint of persistently poor quality sleep and poor appetite with weight loss. The patient had undergone robotic-assisted radical left nephroureterectomy and cystectomy with pelvic lymph node dissection and urinary diversion for left clear cell renal cell carcinoma (staged T2a, grade 2) and transitional cell carcinoma of the bladder (carcinoma in situ at surgery), approximately 9 months earlier. The patient’s bladder malignancy was initially treated with transurethral resection, with histopathology at that procedure showing high-grade papillary urothelial malignancy with lamina propria invasion, but no muscular invasion; this procedure was followed by formal complete resection approximately 3 months later. The patient’s post-operative course was complicated by significant bleeding which required transfusion of 3 units of blood. He had undergone inferior vena caval filter placement prior to surgery when preoperative testing revealed lower extremity …

No abstract available. Article truncated after first page. Clinical History: A 43 -year-old woman with no past medical history presented to the Emergency Room with complaints of right chest wall pain extending into the right upper quadrant. The patient was a non-smoker, denied any allergies, and was not taking any prescription medications. Physical examination showed the patient to be afebrile with normal heart and respiratory rates and blood pressure = 110/75 mmHg. Her room air oxygen saturation was 99%. The patient’s complete blood count and serum chemistries showed normal values. Her liver function testing and renal function testing parameters were also within normal limits. Which of the following represents an appropriate next step for the patient’s management? 1. Perform abdominal ultrasound 2. Perform chest radiography 3. Perform unenhanced chest CT 4. More than one of the above 5. None of the above …

Disequilibrium syndrome is typically characterized by neurological manifestations that occur acutely posthemodialysis due to a significant drop in serum osmolality. We report a child with disequilibrium syndrome postrenal transplant and compare this presentation to previously reported cases.

Mellany A Stanislaus,1 Joseph L Reno,1 Robert H Small,1 Julie H Coffman,2 Mona Prasad,3 Avery M Meyer,4 Kristen M Carpenter,4 John C Coffman1 1Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; 2Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA; 3Department of OBGYN, Riverside Methodist Hospital, Columbus, OH, USA; 4Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, USACorrespondence: John C CoffmanDepartment of Anesthesiology, The Ohio State University Wexner Medical Center, Room N-411 North Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USATel +116142938487Fax +116142938153Email john.coffman@osumc.eduAbstract: The prevalence of opioid use disorder (OUD) in the United States has more than quadrupled over the past two decades. This patient population presents a number of challenges to clinicians, including difficult pain management after surgical procedures due to the development of opioid tolerance. Significantly greater opioid consumption and pain scores after cesarean delivery have been reported in patients with OUD compared to other obstetric patients. A multi-modal analgesic regimen is generally recommended, but there are few well-established pain management strategies after cesarean delivery specific to patients with OUD. We present the case of a patient with OUD maintained on daily methadone that received a continuous epidural hydromorphone infusion for post-cesarean analgesia, a technique not previously reported in obstetric patients and only rarely described for patients undergoing other surgical procedures. The patient received epidural anesthesia for cesarean delivery, and after surgery, the epidural catheter was left in place for the epidural hydromorphone infusion, initiated at 140 mcg/hr and continued for approximately 40 hrs. This strategy reduced her average daily oral opioid consumption by 97%, reduced self-reported pain scores, shortened the length of hospitalization and improved ability to ambulate compared to her previous cesarean delivery. The use of continuous epidural hydromorphone infusion was effective in this case, and this analgesic technique may also be applicable to other types of surgical procedures with the potential for significant post-operative pain, particularly in patients with OUD.Keywords: continuous epidural hydromorphone, opioid use disorder, cesarean delivery, medication-assisted treatment, methadone

Abstract In this paper, an attempt has been made to develop a statistical model based on Internet of Things (IoT) for water quality analysis of river Krishna using different water quality parameters such as pH, conductivity, dissolved oxygen, temperature, biochemical oxygen demand, total dissolved solids and conductivity. These parameters are very important to assess the water quality of the river. The water quality data were collected from six stations of river Krishna in the state of Karnataka. River Krishna is the fourth largest river in India with approximately 1400 km of length and flows from its origin toward Bay of Bengal. In our study, we have considered only stretch of river Krishna flowing in state of Karnataka, i.e., length of about 483 km. In recent years, the mineral-rich river basin is subjected to rapid industrialization, thus polluting the river basin. The river water is bound to get polluted from various pollutants such as the urban waste water, agricultural waste and industrial waste, thus making it unusable for anthropogenic activities. The traditional manual technique that is under use is a very slow process. It requires staff to collect the water samples from the site and take them to the laboratory and then perform the analysis on various water parameters which is costly and time-consuming process. The timely information about water quality is thus unavailable to the people in the river basin area. This creates a perfect opportunity for swift real-time water quality check through analysis of water samples collected from the river Krishna. IoT is one of the ways with which real-time monitoring of water quality of river Krishna can be done in quick time. In this paper, we have emphasized on IoT-based water quality monitoring by applying the statistical analysis for the data collected from the river Krishna. One-way analysis of variance (ANOVA) and two-way ANOVA were applied for the data collected, and found that one-way ANOVA was more effective in carrying out water quality analysis. The hypotheses that are drawn using ANOVA were used for water quality analysis. Further, these analyses can be used to train the IoT system so that it can take the decision whenever there is abnormal change in the reading of any of the water quality parameters.

Purpose Pancreaticoduodenenctomy is a complex surgery and the sequence of steps is affected by anatomical variations involving small intestine and major vascular structures. This article depicts our approach to two such cases and highlights the importance of identifying these variations preoperatively on imaging, so as to modify the surgery plan accordingly. Cases We report following two cases of pancreatic head adenocarcinoma (1) one with incomplete intestinal rotation with a replaced right hepatic artery and (2) one with intestinal nonrotation. In both cases, the small bowel was aggregated on the right side of the abdomen, making duodenal mobilization challenging. The surgical approach was modified to prevent injury to these vessels. A superior mesenteric artery (SMA)-first approach helped in early isolation of vascular structures especially when vascular anomaly was also present. Interbowel adhesiolysis, limited kocherisation, tracing all vessels to its origin before division, paracolic anastomotic limb after a longer jejunal limb resection in nonrotation cases, and modification in retropancreatic tunnel creation are few of the key surgical adaptations. Conclusion Asymptomatic Intestinal malrotation is rare in adults and must be identified on preoperative imaging. Resultant intestinal and vascular anatomical variations need meticulous surgical planning and modification of conventional surgical approach for safe performance of PD.

Some mineral nutrients may help to alleviate cadmium stress in plants. Therefore, influence of Fe, Ca, and Zn supplements on photosynthesis light reactions under Cd stress studied in two Indian rice cultivars namely, MO-16 and MTU-7029 respectively. Exogenous application of both Fe and Ca ions helped to uphold quantum efficiency and linear electron transport during Cd stress. Also, recovery of biomass noticed during Cd treatment with Fe and Ca supplements. It was found that accumulation of carotenoids as well as non photochemical quenching enhances with Fe, Ca, and Zn supplements. Chlorophyll a/b ratio increased with Cd accumulation as a strategy to increase light harvest. Lipid peroxidation level was ascertained the highest during Cd plus Zn treatments. Above results point that both Fe and Ca ions supplements help to alleviate Cd stress on photosynthesis light reactions of rice plants.

No abstract available. Article truncated after first 150 words. A 76-year-old woman with a past medical history significant for left-sided breast cancer status post lumpectomy recently underwent an extensive dental procedure about 1 month prior to presentation. The dental procedure was prolonged, and the patient reported falling asleep during the procedure several times. She presented with fatigue, right pleuritic chest pain, low-grade fevers, and drenching sweats. She underwent chest radiography at an outside institution which disclosed pneumonia, for which she was treated with cefdinir and doxycycline without improvement. Thoracostomy tube drainage of the pleural effusion was performed and showed empyema. Imaging showed an airway foreign body which was retrieved bronchoscopically. The patient made an uneventful recovery. Aspiration during dental procedures is rare but reported (1). Dental items have been reported as the second most commonly ingested/aspirated foreign objects in adults. If the airway is not compromised, assessment for any lost or missing instrument and its component should be done …

A 59-year-old gentleman with a history of aortic valve replacement presented with spontaneously ruptured hepatocellular carcinoma in right lobe of a hepatitis C virus (HCV)-related chronic liver disease with hemoperitoneum. This acute emergency was managed by transarterial embolization. Right trisectionectomy with preservation of segment IVB after augmentation of future liver remnant by transarterial chemoembolization followed by portal vein embolization was subsequently performed. Sustained virological response to HCV was attained after surgery using sofosbuvir-based regimen. He had a delayed operative bed recurrence 1.5 years later with pulmonary metastatic disease which was managed by operative bed metastasectomy with mesh reconstruction of diaphragm and sorafenib. He is on sorafenib since past 3 years and doing well at 4.5-years follow-up since the first presentation, with significant regression of pulmonary disease and no other disease elsewhere, which highlights that where there is hope, there is a way.

Abstract Prior solutions for securely handling SQL range predicates in outsourced Cloud-resident databases have primarily focused on passive attacks in the Honest-but-Curious adversarial model, where the server is only permitted to observe the encrypted query processing. We consider here a significantly more powerful adversary, wherein the server can launch an active attack by clandestinely issuing specific range queries via collusion with a few compromised clients. The security requirement in this environment is that data values from a plaintext domain of size N should not be leaked to within an interval of size $$H$$ H . Unfortunately, all prior encryption schemes for range predicate evaluation are easily breached with only $$O(\log _2\psi )$$ O(log2ψ) range queries, where $$\psi = N{/}H$$ ψ=N/H . To address this lacuna, we present SPLIT, a new encryption scheme where the adversary requires exponentially more—$${\mathbf{O}}(\psi )$$ O(ψ) —range queries to breach the interval constraint and can therefore be easily detected by standard auditing mechanisms. The novel aspect of SPLIT is that each value appearing in a range-sensitive column is first segmented into two parts. These segmented parts are then independently encrypted using a layered composition of a secure block cipher with the order-preserving encryption and prefix-preserving encryption schemes, and the resulting ciphertexts are stored in separate tables. At query processing time, range predicates are rewritten into an equivalent set of table-specific sub-range predicates, and the disjoint union of their results forms the query answer. A detailed evaluation of SPLIT on benchmark database queries indicates that its execution times are well within a factor of two of the corresponding plaintext times, testifying its efficiency in resisting active adversaries.

Pneumocytic adenomyoepithelioma is an extremely rare and poorly understood pulmonary neoplasm, so experience with this tumor is limited. Since the initial case series where the lesion was first proposed as a distinctive entity, only one additional report has been described. We present a case of pneumocytic adenomyoepithelioma with clinical and radiologic data that provide the first long-term evidence of the benignity of this extremely rare pulmonary neoplasm. We also review the available literature surrounding pneumocytic adenomyoepitheliomas. Our case provides important new data on the behavior of this lesion, as imaging studies showed essentially stable or very slowly progressive disease over the course of approximately 9 years. Collectively, this rare and poorly described lesion appears to behave in an indolent or benign fashion, a notion that our case further supports. Keywords: Pneumocytic adenomyoepithelioma, Pulmonary neoplasm, Benign pathology

No abstract available. Article truncated after 150 words. A 37-year-old woman complaining of chest pain and cough underwent resection of a mediastinal foregut duplication cyst complicated by a 10-day hospitalization with a prolonged air leak. Seven years later, she presented with worsening cough and shortness of breath, complaining of similar symptoms intermittently in the 7 years between her surgery and presentation. Chest CT showed a hyperattenuating lesion obstructing the medial basal segmental airways, with bronchoscopy revealing suture and a pledget obstructing the medial basal segmental right lower lobe bronchus. The pledget and suture were successfully removed. Repeat bronchoscopy several months later showed no residual airway foreign body, although medial basal subsegmental bronchial stenosis prevented advancement of the bronchoscope distally; this finding correlated with the CT impression of airway stenosis or occlusion in this region on the follow up CT. Bronchogenic cysts result from abnormal lung budding and development of the ventral foregut during the first trimester (1). Many …

In this review from literature appearing over about the past 5 years, we focus on selected selenide reports and related chemistry; we aimed for a digestible, relevant, review intended to be usefully interconnected within the realm of fluorescence and selenium chemistry. Tellurium is mentioned where relevant. Topics include selenium in physics and surfaces, nanoscience, sensing and fluorescence, quantum dots and nanoparticles, Au and oxide nanoparticles quantum dot based, coatings and catalyst poisons, thin film, and aspects of solar energy conversion. Chemosensing is covered, whether small molecule or nanoparticle based, relating to metal ion analytes, H2S, as well as analyte sulfane (biothiols—including glutathione). We cover recent reports of probing and fluorescence when they deal with redox biology aspects. Selenium in therapeutics, medicinal chemistry and skeleton cores is covered. Selenium serves as a constituent for some small molecule sensors and probes. Typically, the selenium is part of the reactive, or active site of the probe; in other cases, it is featured as the analyte, either as a reduced or oxidized form of selenium. Free radicals and ROS are also mentioned; aggregation strategies are treated in some places. Also, the relationship between reduced selenium and oxidized selenium is developed.

Ectodermal dysplasia is a hereditary disorder that occurs as a consequence of disturbances in the ectoderm of the developing embryo. It is usually accompanied by lack of sweat glands and a partial or complete absence of primary and/or permanent dentition. A case report illustrating the prosthetic rehabilitation of a young woman with anhidrotic ectodermal dysplasia associated with partial anodontia and mid facial defect are presented. Since the oral rehabilitation of these cases is often difficult; treatment should be administered by a multidisciplinary team involving orthodontics, prosthodontics and oral-maxillofacial surgery.

Megha Prasad, Martin Reriani, Sundeep Khosla, Mario Gössl, Ryan Lennon, Rajiv Gulati, Abhiram Prasad, Lilach O Lerman, Amir Lerman Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA Background: A growing body of evidence links coronary artery atherosclerosis and calcification to osteoporosis in women. The endothelium plays a critical role in maintaining vascular integrity and may play a role in bone metabolism. We aimed to determine whether early coronary atherosclerosis, as detected by coronary microvascular endothelial dysfunction (CMED), predicts the development of osteoporosis in postmenopausal women. Methods: Coronary vascular reactivity was evaluated in 194 postmenopausal women greater than 50 years of age and with non-obstructive coronary arteries by administration of intracoronary acetylcholine during diagnostic angiography. CMED was defined as ≤50% increase in coronary blood flow from baseline in response to maximal dose. After a median follow-up of 7.0±0.3 years, patients were assessed by a questionnaire for development of osteoporosis. Results: The average age of the cohort was 60.9±7.4 years. Women with CMED were twice as likely to develop osteoporosis compared with women without endothelial dysfunction after adjustment for potential confounders (relative risk, 2.4; 95% confidence interval [CI], 1.1, 5.6, P=0.02). Epicardial endothelial dysfunction was not associated with development of osteoporosis. Discussion: Early coronary atherosclerosis with endothelial dysfunction is an independent marker for increased risk of developing osteoporosis in postmenopausal women greater than 50 years of age without obstructive coronary artery disease. The current study supports a link between coronary atherosclerosis and osteoporosis. Keywords: coronary artery disease, endothelial dysfunction, endothelial progenitor cells, low bone mass, screening

Apart from germ-line BRCA1-mutated breast cancers, a significant proportion of women with sporadic triple negative breast cancer (TNBC) sub-type are known to harbour varying levels of BRCA1-dysfuction. There is currently no established diagnostic method to identify these patients.The analysis was performed on 183 primary breast cancer tumor specimens from our longitudinal case-series archived as formalin-fixed-paraffin-embedded (FFPE) blocks comprising 71 TNBCs and 112 Hormone receptor positive HER2 negative (HR+HER2-) tumors. Transcript levels of BRCA1 and two of its repressors ID4 and microRNA182 were determined by TaqMan quantitative PCR. BRCA1 protein was detected immunohistochemically with the MS110 antibody.The representation of BRCA1 and its repressor ID4 as a ratio led to improved separation of TNBCs from HR+HER2- compared to either measure by itself. We then dichotomised the continuous distribution of each of the three measurements (Protein, MIRNA and transcript:repressor ratio) into categories of deficient (0) and adequate (1). A composite BRCA1 Deficiency Score (BDS) was computed by the addition of the score for all three measures. Samples deficient on 2 or more measures were deemed to be BRCA1 deficient; and 40% of all TNBCs met this criterion.We propose here a simple multi-level assay of BRCA1 deficiency using the BRCA1:ID4 ratio as a critical parameter that can be performed on FFPE samples in clinical laboratories by the estimation of only 3 bio-markers. The ease of testing will hopefully encourage adoption and clinical validation.