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Background: It is need of an hour to establish an effective and efficient treatment modality for OLP and OSMF with lesser or no adverse effects. Platelet rich plasma can be used in mucosal lesions as it has a high concentration of various growth factors and anti-inflammatory properties. It could be a better novel substitute to the corticosteroid without any side effects. The present study is an effort to evaluate the therapeutic effects of intralesional injection of PRP in oral erosive lichen planus and OSMF compared to intralesional corticosteroids in the same patient. Methods: It was a randomized controlled clinical study consisting of 40 patients between the age groups of 18-60 years visiting dental OPD diagnosed clinically with either erosive lichen planus or OSMF. Triamcinolone 40 mg(1mg/ml) mixed with 2% (1:80,000) lignocaine hydrochloride was injected into the lesion on one side in case of erosive lichen planus and into the submucosal plane and fibrous bands in case of OSMF patients. Autologous PRP was prepared and injected on the other side in same patients. At every visit, all the patients were evaluated for pain and burning sensations, size, and severity of the lesion, and interincisal mouth opening (mm). The parameters were measured and recorded during the patient’s every visit. All the results were obtained and statically analyzed. Results: Intralesional injections of triamcinolone acetonide and PRP are effective in reducing pain and burning sensation in OSMF, but PRP is less effective in improving cheek flexibility as compared to triamcinolone acetonide. In OLP, both triamcinolone acetonide and PRP are almost equally effective in reducing the size of the lesion. However, PRP shows slightly better results in reducing the severity of the lesion and in pain and burning sensation in the patients of OLP as compared to intralesional triamcinolone acetonide. Conclusions: Thus, PRP is an effective modality in treating both OSMF and oral erosive lichen planus with no adverse effects.

Robotic manipulators are extremely nonlinear complex and, uncertain systems. They have multi-input multi-output (MIMO) dynamics, which makes controlling manipulators difficult. Robotic manipulators have wide applications in many industries like processes, medicine, and space. Effective control of these manipulators is extremely important to perform these industrial tasks. Researchers are working on the control of robotic manipulators using conventional and intelligent control methods. Conventional control methods are proportional integral and derivative (PID), Fractional order proportional integral and derivative (FOPID), sliding mode control (SMC), and optimal & robust control while intelligent control method includes Artificial Neural network (ANN), Fuzzy logic control (FLC) and metaheuristic optimization algorithms based control schemes. This paper presents the trajectory control of a robotic manipulator using a PID controller. Four different meta-heuristic algorithms namely Sooty tern optimization (STO), Spotted Hyena optimizer (SHO), Atom Search optimization (ASO), and Arithmetic Optimization algorithm (AOA) are used to optimize the gains of PID controller for trajectory control of a two-link robotic manipulator and a novel hybrid sooty tern and particle swarm optimization (STOPSO) has been designed. These optimization techniques are nature-inspired algorithms that give the optimal gain values while minimizing the performance indices. A performance index comprising Integral time absolute error (ITAE) having weights for both links has been considered to achieve the desired trajectory. These optimization techniques are stochastic in nature so statistical analysis and Freidman’s ranking test has been performed to evaluate the effectiveness of these algorithms. The proposed hybrid STOPSO provided a fitness value of 0.04541 and showed a standard deviation of 0.0002. A comparative study of these optimization techniques is presented and as a result, hybrid STOPSO provides the best results with minimum fitness value followed by STO, AOA, ASO, and SHO algorithms.

Internal combustion engines suffer from high cyclic variations that result in higher emissions, lower efficiency, higher fuel consumption and poor drivability. The purpose of this study is to investigate how Argemone mexicana biodiesel (AGB)/diesel blended fuels affect the cyclic variability of combustion parameters such as maximum cylinder pressure (Pmax) and indicated mean effective pressure (IMEP) in a four-cylinder turbocharged intercooled common-rail direct injection engine under various engine loading conditions. The chemical and physical properties of AGB produced from A. mexicana oil were measured and compared according to the ASTM D6751 standards. In various volumetric ratios, AGB and diesel fuel were blended as D100, AB10 (10% AGB + 90% D100), AB20 (20% AGB + 80% D100) and AB30 (30% AGB + 70% D100). The IMEP and Pmax time-series data were collected over 200 consecutive cycles at low, partial and high engine loads at a constant engine speed of 2000 rpm. The coefficients of variation (COV) of combustion parameters (Pmax and IMEP) were measured for different AGB/diesel blends and found to be within acceptable limits. The results show that COVPmax and COVIMEP decrease as the engine load increases. It was observed that at low load, AB10 has the lowest COV (Pmax, IMEP), and at partial and high load, AB20 has the lowest COV (Pmax, IMEP) among all the blends.

International audience; Aim: Glucagon-like peptide-1 receptor agonists (GLP1-RA) improve cardiovascular outcomes in patients with type 2 diabetes (T2D). However, some studies suggest that their effects in patients with heart failure (HF) may be attenuated. We aimed to explore the effects of the GLP1-RA albiglutide on HF outcomes in patients with and without HF history enrolled in the Harmony Outcomes trial.Methods and results: Harmony Outcomes enrolled patients with T2D and cardiovascular disease randomized to either albiglutide or placebo over a median follow-up of 1.6 years. A total of 9462 patients were included, of whom 1922 (20%) had HF history. Patients with HF had more cardiovascular comorbidities, poorer renal function, and had a three to four-fold higher risk of HF events compared to patients without HF. Compared to placebo, the effect of albiglutide on the composite of cardiovascular death or HF hospitalization was more pronounced among patients without HF (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.56-0.95) than in patients with HF (HR 1.06, 95% CI 0.79-1.43) (interaction p = 0.062). A similar pattern was observed for HF hospitalizations (interaction p = 0.025). The effect of albiglutide on cardiovascular death, sudden death or 'pump failure' death, and all-cause mortality was also attenuated among patients with HF history, but without significant interaction (p > 0.1). The benefit of albiglutide to reduce atherosclerotic events was consistent regardless of HF history.Conclusions: In patients with T2D and cardiovascular disease, albiglutide appeared to have no effect in reducing HF-related events among patients with HF history. These findings, placed in the context of other trials, suggest that GLP1-RA may not improve HF outcomes in patients with HF.

Frozen shoulder a condition very commonly encountered in Orthopaedics OPD with multiple variable treatment options. The study was done to infer out the efficacy of intraatricular steroid in shoulder joint in managing frozen shoulder.study encompassed 28 female patients, coming in Orthopaedics OPD of RBM Hospital and medical College, Bharatpur, Rajasthan.30 min post procedure 22 patients gained significant range of motion of shoulder with minimal pain. 24 patients completed their follow up of 6 weeks with significant overhead abduction and rotation.4 patients had limited rotationIntra atricular steroid injections in managing frozen shoulder is a cost effective, simple and safe method with clinical evaluation to exclude tendinopathy and radiography to exclude glenohumeral arthritis a mainstay before procedure.

The current care model of type 2 diabetes (T2D) and its complications appears to be "asynchronous" with patient care divided by specialty. This model is associated with low use of guideline-directed medical therapies.The use of integrated care models has been well described in the management of patients with T2D; this usually includes an endocrinologist coupled with a nutritionist and nurse. However, physician-based care models are largely "asynchronous," whereby the patient requires multiple different siloed specialties to manage their health care. To date, there has been limited exploration of synchronous care delivery, i.e., whereby multi-comorbid patients with T2D are seen simultaneously by health care providers from endocrinology, cardiology, and nephrology to optimize use of guideline-directed medical therapies (GDMT). Given the rising complexity of patients with T2D, further research is needed on the role of synchronous health care delivery in optimizing the use of GDMT and improving patient outcomes.

Odontogenic keratocyst (OKCs), first described by Philipsen in 1956, is characterized by an aggressive behavior with a relatively high recurrence rate. Its complicated behavior creates confusion for both clinicians and pathologists. Patients with OKC are often asymptomatic but may present with pain, swelling, or discharge. The lesion may occur sporadically or associated with nevoid basal cell carcinoma (NBCCS). Proper imaging modality and histopathological investigations are required for the diagnosis and management of OKCs. The purpose of this article is to provide an overview of many features of OKC, with a focus on etiopathogenesis, clinical symptoms, imaging and histological aspects, and various treatment methods, as well as recurrence rate and prognosis.

Honda is a multinational company mainly engaged in manufacturing and selling cars, motorcycles, and electric vehicles. It was created in 1948 by Japanese Soichiro Honda and Takeo Fujisawa. The company has grown to become the world's largest motorcycle manufacturer and one of the largest automakers, operating in more than 150 countries. Honda is known for its innovative and quality products, including the popular Civic and Accord cars and the Gold Wing motorcycle. The company is also a pioneer in the development of hybrid and fuel cell vehicles, and its Insight and Clarity models are leaders in environmentally friendly transportation. In addition to its automobile and motorcycle business, Honda manufactures a variety of electrical equipment, including lawn mowers, lawn mowers, and snow throwers. Working to reduce its environmental impact through initiatives such as energy efficiency and waste reduction programs, the company's commitment to sustainability continues from its products to its activities. Overall, Honda is a company that strives to provide its customers with reliable, innovative and environmentally friendly products. Its dedication to quality and safety has helped it become a trusted and respected brand worldwide.

Background Frailty is prevalent in older adults with heart failure and is associated with poor outcomes; however, there remains uncertainty on how to measure frailty in clinical practice. Methods and Results A multicentric prospective cohort study was assembled at 4 heart failure clinics to compare the prognostic value of 3 physical frailty scales in ambulatory patients with heart failure. Outcomes were all‐cause death or hospitalization and health‐related quality of life using the 36‐Item Short Form survey questionnaire (SF‐36) at 3 months. Multivariable regression was adjusted for age, sex, Meta‐Analysis Global Group in Chronic Heart Failure score, and baseline SF‐36 score. The cohort included 215 patients (mean age 77.6 years). All 3 frailty scales were independently associated with death or hospitalization at 3 months; the adjusted odds ratios standardized per 1 SD worsening of the Short Physical Performance Battery; Fried, and strength, assistance with walking, rising from a chair, climbing stairs, and falls scales were 1.67 (95% CI, 1.09–2.55), 1.60 (95% CI, 1.04–2.46), and 1.55 (95% CI, 1.03–2.35), respectively, with C statistics of 0.77 to 0.78. All 3 frailty scales were independently associated with worsening SF‐36 scores, especially the Short Physical Performance Battery, for which 1 SD worsening of frailty translated to a decrement of −5.86 (−8.55 to −3.17) and −5.51 (−7.82 to −3.21) points in the Physical Component Score and Mental Component Score. Conclusions All 3 physical frailty scales were associated with death, hospitalization, and reduced health‐related quality of life in ambulatory patients with heart failure. Questionnaire or performance‐based physical frailty scales can be used to offer prognostic value and a therapeutic target in this vulnerable population. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03887351.

Background: Dental implants have revolutionized dentistry for managing partially and fully edentulous patients. The present studywas conducted to evaluate effect of dental implant thread design on marginal bone loss using CBCT.Materials & Methods: 90 patients who received 125 dental implants of both genders were divided into 2 groups of 45 each. Group Ipatients received spiral implants and group II patients received dual fit implants. All patients were subjected to CBCT scan taken withPlanmica CBCT machine. Patients were recalled after 6 months and CBCT scans were repeated.Results: Group I had 25 males and 20 females and group II had 22 males and 23 females. The mean marginal bone loss in group I was2.01 mm and in group II was 2.23 mm. The difference was significant (P< 0.05). The mean survival rate in group I was 96.5% and ingroup II was 95.2%. The difference was significant (P< 0.05).Conclusion: Spiral implants had higher survival rate and minimum less bone loss as compared to dual fit implants. The use of CBCTcould aid in the accurate identification of bone loss around dental implants.

Lymphangioma is a benign tumor characterized by proliferation of thin-walled lymphatic spaces. Lymphangioma of the small-bowel mesentery is rare, with an incidence of 1 : 250,000, representing less than 1% of all lymphangiomas. The predilection of the tumor is in the head and neck (70%), axillary (20%), and internal organs (10%). They are usually asymptomatic but can cause acute abdominal symptoms due to complications such as volvulus, bleeding, or lymphangioma rupture that require emergent surgery. Here, we report a case of mesenteric lymphangioma (ML) of a small bowel in a paediatric patient who presented with pain abdomen on and off which increased in severity and later had features of subacute intestinal obstruction. He underwent explorative laparotomy, and the mass was excised completely along with the part of small intestine. Pathological analysis of the surgical specimen confirmed the diagnosis of ML of the small intestine. The postoperative recovery was uneventful, and the patient was discharged after ten days of hospital stay. Though benign in nature, ML may cause acute abdominal symptoms that require emergent surgery. Therefore, it has to be kept in differential diagnosis of the acute abdominal condition.

International audience; Background: Renin-angiotensin aldosterone system inhibitors (RAASi) are commonly used among patients hospitalized with a severe acute respiratory syndrome coronavirus 2 infection (COVID-19). We evaluated whether continuation versus discontinuation of RAASi were associated with short term clinical or biochemical outcomes. Methods: The RAAS-COVID-19 trial was a randomized, open label study in adult patients previously treated with RAASi who are hospitalized with COVID-19 (NCT04508985). Participants were randomized 1:1 to discontinue or continue RAASi. The primary outcome was a global rank score calculated from baseline to day 7 (or discharge) incorporating clinical events and biomarker changes. Global rank scores were compared between groups using the Wilcoxon test statistic and the negative binomial test (using incident rate ratio [IRR]) and the intention-totreat principle. Results: Overall, 46 participants were enrolled; 21 participants were randomized to discontinue RAASi and 25 to continue. Patients' mean age was 71.5 years and 43.5% were female. Discontinuation of RAASi, versus continuation, resulted in a non-statistically different mean global rank score (discontinuation 6 [standard deviation [SD] 6.3] vs continuation 3.8 (SD 2.5); p= 0.60). The negative binomial analysis identified that discontinuation increased the risk of adverse outcomes (IRR 1.67 [95% CI 1.06 to 2.62]; p=0.027); RAASi discontinuation increased brain natriuretic peptide (BNP) levels (% change from baseline: +16.7% vs.-27.5%; p= 0.024) and the incidence of acute heart failure (33% vs. 4.2%, p=0.016). Conclusion: RAASi continuation in participants hospitalized with COVID-19 appears safe; discontinuation increased BNP levels and may increase risk of acute heart failure; where possible, RAASi should be continued.

A network health monitoring system focuses on the quantification of the network's health by taking into account various security flaws, leaks, and vulnerabilities. A plethora of propriety tools and patents are available for network health quantification. However, there is a paucity of available research and literature in this field. Thus, in this study, we present an architectural design of a network health monitoring system. The design focuses on the quantification of the network health of each end-user as well as the entire network. The network health score for each end-user is quantified by identifying (1) illicit egress-ingress traffic, (2) anomalous fingerprints, and (3) system-network vulnerabilities based on the NVD-CVSS (National Vulnerability Database, Common Vulnerability Severity Score) standards. An overall network-health score is produced, along with a prevention and recovery mechanism that is triggered upon the detection of an anomaly. The proposed system is implemented in a local area network and has demonstrated to protect the network against various threats successfully. The study is concluded by comparing the proposed tool with the popular propriety tools available in the field. The results outline that the proposed system garners features of open-source tools and enriches them by introducing a state-of-the-art architecture coupled with multiple novel features like exhaustive identification of vulnerability and detection of network aberrations using timers.

OBJECTIVE Patients with type 2 diabetes (T2D) have a high risk for developing heart failure (HF), which is associated with poor prognosis. Fenofibrate may reduce HF events through multiple mechanisms. We sought to study the effect of fenofibrate (vs. placebo) in HF outcomes among patients with T2D receiving simvastatin enrolled in the Action to Control Cardiovascular Risk in Diabetes lipid trial (ACCORD Lipid). RESEARCH DESIGN AND METHODS We used Cox regression analysis with background glucose-lowering strategy as the stratification variable. The median follow-up was 4.7 years. RESULTS A total of 5,518 patients were included. Median age was 62 years, and 31% were women. Prior HF history was present in 5% of the patients. The composite outcome of HF hospitalization or cardiovascular death occurred in 190 (6.9%) patients in the fenofibrate group vs. 228 (8.3%) in the placebo group: HR 0.82, 95% CI 0.68–1.00 (P = 0.048). The beneficial effect of fenofibrate to reduce HF hospitalizations or cardiovascular death was present among patients receiving standard glucose-lowering strategy, HR 0.64, 95% CI 0.48–0.85, and not among patients receiving intensive glucose-lowering strategy, HR 1.02, 95% CI 0.79–1.33 (Pinteraction = 0.017). A similar pattern was observed for HF hospitalizations alone. The effect of fenofibrate on blood lipids was not influenced by background glucose-lowering therapy in a clinically important manner. Fenofibrate caused more transient worsening estimated glomerular filtration rate (eGFR) events but slowed long-term eGFR decline. CONCLUSIONS In patients with T2D treated with simvastatin, fenofibrate reduced the composite of HF hospitalizations or cardiovascular mortality, an effect that was seen predominantly in patients with standard background glucose-lowering therapy.

Worsening heart failure (WHF) is defined as persistent or worsening symptoms of heart failure that require an escalation in intravenous therapy or initiation of mechanical and ventilatory support during hospitalization. We assessed a simplified version of WHF called diuretic failure (DF), defined as an escalation of loop diuretic dosing after 48 h, and assessed its effects on mortality and rehospitalizations at 60-days.We conducted a multicenter retrospective study between December 1, 2017 and January 1, 2020. We identified 1389 patients of which 6.4% experienced DF.There was a significant relationship between DF and cumulative rates of 60-day mortality and 60-day rehospitalizations (p = 0.0002 and p = 0.0214). After multivariate adjustment, DF was associated with longer hospital stay (p 0.0001), increased rate of 60-day mortality (p = 0.026), 60-day rehospitalizations (p = 0.036), and a composite outcome of 60-day mortality and 60-day cardiac rehospitalizations (p = 0.018).DF has a strong relationship with adverse heart failure outcomes suggesting it is a simple yet robust prognostic indicator which can be used in real time to identify high-risk patients during hospitalization and beyond.

Background: We used data from people initially free of clinical cardiovascular disease to evaluate the association between metabolic syndrome (MS) and incident preclinical heart failure (pHF). Methods and Results: STANISLAS was a familial, single-center, longitudinal prospective cohort study composed of 1,006 families from Nancy, France (median follow-up, 17 years [1993–2016]). Age- and sex-adjusted logistic regression and inverse probability weighting models were used to evaluate the association between MS and pHF, which was defined by diastolic dysfunction, atrial enlargement, ventricular hypertrophy, or elevated natriuretic peptides. Among 944 people who were adults at the first and final visit, those with baseline MS were more likely to be older (63 vs. 61 vs. 59 years of age) and male (73% vs. 55% vs. 45%) compared to people who developed incident MS and people who had no baseline MS, respectively. Furthermore, compared to people without baseline MS, the risk of pHF was numerically larger among people with baseline MS (adjusted odds ratio [aOR] 2.27, 95% CI: 1.07–4.81) and people who developed incident MS (aOR 1.56, 95% CI: 1.00–2.43). Concerning the metabolic determinants of MS, the risk of pHF was most elevated in people with baseline hypertension (aOR 3.19, 95% CI: 1.80–5.63) and elevated waist circumference (aOR 2.59, 95% CI: 1.47–4.57). Conclusion: Overall, HF is an important public health concern given the high risk of mortality when patients with MS or elevated fasting glucose become established with the disease. Early aggressive lifestyle modification and medical intervention among patients free of cardiovascular disease with an obese-hypertensive phenotype may be warranted to prevent HF development.

Chemical energy is not effectively converted into mechanical energy by an internal combustion engine. Major portion of heat energy get dissipated with exhaust and coolant. Use of thermoelectric generator (TEG) technology is regarded as an environment friendly technique for recovering the waste heat, with which heat energy directly converts into electrical energy. In this study, an experiment is conducted in which TEG technology has been used to recover waste heat going out through exhaust gas from the diesel engine. Thermoelectric modules were fixed on the surface of stainless steel made pipe having square cross-section. It has been found that the power output of thermoelectric generator enhances with the increase in engine load. The maximum electrical power output of TEG has been obtained as 37 W at maximum load of 6 kg. Overall thermal efficiency of diesel engine has also been improved with the use of TEG type of waste heat recovery system.

Extensive applications are found in aluminum matrix composites, where high strength to weight ratio, low weight and high corrosion resistance are needed. One of the categories of such materials is the SiC reinforced aluminum matrix composite. This reinforcing material belongs to ceramic group of materials and can withstand high temperature and improve several properties when incorporating in the grain structure of the base matrix. The introduction of SiC enhances wear resistance, hardness value and tensile strength. However, the use of high percentage of SiC material reduces the machinability (ductility) and toughness resistance and the machining of such material becomes difficult. In this current study, an attempt is made to develop an aluminum (LM25 alloy) matrix composite, which is reinforced with 7%SiC and 3%Gr particulates through stir casting route. The fabrication of composite is followed by evaluating the machining behavior of hybrid composite through electric discharge machining. During machining, current, voltage, pulse on time and pulse off time are selected as input controllable variables while material removal rate (MRR), tool wear rate (TWR) and over cut are chosen as responses. The experiments are carried out as per Taguchi's L9 OA, with the aid of ANOVA and significant parameters effecting responses are identified. Main effects plots are drawn and optimum set of input machining conditions are determined.

Composite materials are progressively being employed in the aerospace, automotive, aeronautics, and marine sectors because of their high strength-to-weight ratio. Traditional machining methods have trouble machining composite materials. However, laser cutting provides an alternative quality machining method that can be accomplished by regulating various process variables. A commonly used thermally dependent non-contact advanced machining technique is laser cutting. The efficiency of the laser cutting method is the subject of extensive study. Analytical approaches based on Regression analysis, and Response surface methodology (RSM) are all standard techniques for solving optimization issues in laser cutting utilizing the Taguchi method. The main theories and practices used in the Taguchi method are explored in this article, as well as a summary of the Taguchi method. The paper discusses research study based on the implementation of the Taguchi method for laser cutting process optimization after examining the parameters as well as performance requirements of the laser cutting process and further concluded that most of the performance characteristics studied (kerf taper, and deviation) as well as surface quality was found to be related (surface roughness). In addition, the Taguchi method has only been utilized to increase metallurgical properties (HAZ, Burr inclusion) and production efficiency (MRR). Taguchi method, being a model-free optimization technique, restricts further level interpolation or extrapolation. It was also reported that to address this shortcoming of the Taguchi method, it was combined with response surface methodology to get optimal results. This paper offers a review of the literature's findings and addresses the problems that need to be discussed.

Internet of Things (IoT) gadgets are very attractive globally, and IoT facilities are universal. Their progress has not been ignored, and the number of invaders and outbreaks on IoT and facilities is growing. Because cyber-assaults are zero-trust to the IoT, and the IoT is deeply ingrained in our lives and culture, we must embrace a comprehensive Zero-Trust strategy for cyber defense. As a result, the new model is no longer vulnerable to fear and outbreak on the IoT structure. In this article, an effort is made to categorize threat types and analyze and explain invaders and assaults on IoT gadgets and facilities.

Abstract: Owing to the enhanced toxicity as well as consequences of allopathic medication, the research on herbal therapies is developing progressively. As a result, medicinal herbs are beginning to play a substantial role in the advancement of the dominant therapeutic medications. Since ancient times, the use of herbs has performed a vital part in human well-being as well in the invention of cutting-edge pharmaceuticals. Inflammation and related illnesses are a major health concern for the entire human population. Pain-inducing drugs including opiates, non-steroidal anti-inflammatory drugs, glucocorticoids, and corticosteroids have severe side effects and these therapies suffer from the recurrence of symptoms too after discontinuing the treatment. As a result, the diagnosis along with the advancement of medications with anti-inflammatory properties is the priority to conquer the drawbacks of the existing therapies. The present review article provides insight into the literature comprising promising phytochemicals from various medicinal plants tested through different model systems and employed for alleviating inflammation in several inflammatory disorders as well as clinical status of the herbal products.

Histological Grade is a well-known prognostic factor that is routinely assessed in breast tumours. However, manual assessment of Nottingham Histological Grade (NHG) has high inter-assessor and inter-lab variability, causing uncertainty in grade assignments. To address this challenge, we developed and validated a three-level NHG-like deep learning-based histological grade model. The primary performance evaluation focuses on prognostic performance.This observational study is based on two patient cohorts (SöS-BC-4, N=2421 (training and internal test); SCAN-B-Lund, N=1262 (test)) that include routine histological whole slide images together with patient outcomes. A Deep Convolutional Neural Network (CNN) model with an attention mechanism was optimised for the classification of the three-level histological grading (NHG) from hematoxylin and eosin-stained WSIs. The prognostic performance was evaluated by time-to-event analysis of Recurrence-free survival (RFS) and compared to clinical NHG grade assignments in the internal test set as well as in the fully independent external test cohort. We observed effect sizes (Hazard Ratio) for grade 3 vs 1, for the conventional NHG method (HR=2.60 (1.18-5.70 95%CI, p-value = 0.017)) and the deep learning model (HR = 2.27, 95%CI: 1.07-4.82, p-value = 0.033) on the internal test set after adjusting for established clinicopathological risk factors. In the external test set, the unadjusted HR for NHG 1 vs 2 was estimated to be 2.59 (p-value = 0.004) and NHG 1 vs 3 was estimated to be 3.58 (p-value < 0.001). For predGrade, the unadjusted HR for grade 1 vs 2 HR=2.52 (p-value = 0.030), and 4.07 (p-value = 0.001) for grade 1 vs 3. In multivariable analysis, HR estimates for neither NHG nor predGrade were found to be significant (p-value >0.05). We tested for differences in HR estimates between NHG and predGrade in the independent test set, and found no significant difference between the two classification models (p-value > 0.05), confirming similar prognostic performance between conventional NHG and predGrade.Routine histopathology assessment of NHG has a high degree of inter-assessor variability, motivating the development of model-based decision support to improve reproducibility in histological grading. We found that the proposed model provides similar prognostic performance as NHG. The results indicate that deep CNN-based models can be applied for breast cancer histological grading.