Home About us Contact
|
Home About us Contact | ||
|
|
||
Grade
Kinds of Grade Terms modified by Grade Selected AbstractsA method for assessing quality of control from glucose profilesDIABETIC MEDICINE, Issue 7 2007N. R. Hill Abstract Aim As the practice of multiple assessments of glucose concentration throughout the day increases for people with diabetes, there is a need for an assessment of glycaemic control weighted for the clinical risks of both hypoglycaemia and hyperglycaemia. Methods We have developed a methodology to report the degree of risk which a glycaemic profile represents. Fifty diabetes professionals assigned risk values to a range of 40 blood glucose concentrations. Their responses were summarised and a generic function of glycaemic risk was derived. This function was applied to patient glucose profiles to generate an integrated risk score termed the Glycaemic Risk Assessment Diabetes Equation (GRADE). The GRADE score was then reported by use of the mean value and the relative percent contribution to the weighted risk score from the hypoglycaemic, euglycaemic, hyperglycaemic range, respectively, e.g. GRADE (hypoglycaemia%, euglycaemia%, hyperglycaemia%). Results The GRADE scores of indicative glucose profiles were as follows: continuous glucose monitoring profile non-diabetic subjects GRADE = 1.1, Type 1 diabetes continuous glucose monitoring GRADE = 8.09 (20%, 8%, 72%), Type 2 diabetes home blood glucose monitoring GRADE = 9.97 (2%, 7%, 91%). Conclusions The GRADE score of a glucose profile summarises the degree of risk associated with a glucose profile. Values < 5 correspond to euglycaemia. The GRADE score is simple to generate from any blood glucose profile and can be used as an adjunct to HbA1c to report the degree of risk associated with glycaemic variability. [source] Evidence-based apheresis makes the GRADEJOURNAL OF CLINICAL APHERESIS, Issue 3 2010Robert Weinstein MD Editor-in-Chief No abstract is available for this article. [source] Canadian consensus guidelines on long-term nonsteroidal anti-inflammatory drug therapy and the need for gastroprotection: benefits versus risksALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009A. ROSTOM Summary Background, Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, but are not without risks. Aim, To provide evidence-based management recommendations to help clinicians determine optimal long-term NSAID therapy and the need for gastroprotective strategies based on an assessment of both gastrointestinal (GI) and cardiovascular (CV) risks. Methods, A multidisciplinary group of 21 voting participants revised and voted on the statements and the strength of evidence (assessed according to GRADE) at a consensus meeting. Results, An algorithmic approach was developed to help manage patients who require long-term NSAID therapy. The use of low-dose acetylsalicylic acid in patients with high CV risk was assumed. For patients at low GI and CV risk, a traditional NSAID alone may be acceptable. For patients with low GI risk and high CV risk, full-dose naproxen may have a lower potential for CV risk than other NSAIDs. In patients with high GI and low CV risk, a COX-2 inhibitor plus a proton pump inhibitor (PPI) may offer the best GI safety profile. When both GI and CV risks are high and NSAID therapy is absolutely necessary, risk should be prioritized. If the primary concern is GI risk, a COX-2 inhibitor plus a PPI is recommended; if CV risk, naproxen 500 mg b.d. plus a PPI would be preferred. NSAIDs should be used at the lowest effective dose for the shortest possible duration. Conclusion, More large, long-term trials that examine clinical outcomes of complicated and symptomatic upper and lower GI ulcers are needed. [source] Grading quality of evidence and strength of recommendations in clinical practice guidelinesALLERGY, Issue 5 2009Part 1 of 3. The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach provides guidance to grading the quality of underlying evidence and the strength of recommendations in health care. The GRADE system's conceptual underpinnings allow for a detailed stepwise process that defines what role the quality of the available evidence plays in the development of health care recommendations. The merit of GRADE is not that it eliminates judgments or disagreements about evidence and recommendations, but rather that it makes them transparent. This first article in a three-part series describes the GRADE framework in relation to grading the quality of evidence about interventions based on examples from the field of allergy and asthma. In the GRADE system, the quality of evidence reflects the extent to which a guideline panel's confidence in an estimate of the effect is adequate to support a particular recommendation. The system classifies quality of evidence as high, moderate, low, or very low according to factors that include the study methodology, consistency and precision of the results, and directness of the evidence. [source] Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2009Article first published online: 14 OCT 200 Abstract The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research. [source] USEFUL ENDOSCOPIC ULTRASONOGRAPHY TO ASSESS THE EFFICACY OF NEOADJUVANT THERAPY FOR ADVANCED ESOPHAGEAL CARCINOMA: BASED ON THE RESPONSE EVALUATION CRITERIA IN SOLID TUMORSDIGESTIVE ENDOSCOPY, Issue 1 2005Masaho Ota Objective:, The aim of the present study was to assess the usefulness of endoscopic ultrasonography (EUS) for evaluating the efficacy of neoadjuvant therapy for advanced esophageal carcinoma based on the Response Evaluation Criteria in Solid Tumors (RECIST). Patients and Methods:, Sixty-two patients with advanced esophageal carcinoma underwent surgical resection after neoadjuvant therapy. The maximal tumor thickness was measured by EUS before and after neoadjuvant therapy, and the percent reduction was compared with the pathological response. Based on the RECIST, PD-SD (progressive disease-stable disease) was defined as < 30% reduction of tumor thickness on EUS, PR (partial response) as , 30% reduction of tumor thickness, and CR (complete response) as no detectable tumor (100%). Results:, The percent reduction of the thickness of Grade 0,1, Grade 2 and Grade 3 tumor was 11.5 ± 21.0%, 48.2 ± 17.0% and 74.9 ± 21.1%, respectively. There were significant differences in the extent of reduction among the three groups. Based on the RECIST, 80% of Grade 0,1 cases, 91% of Grade 2 cases and 22% of Grade 3 cases were PD-SD, PR, and CR according to EUS, respectively. EUS correctly identified 80% of non-responders and 94% of responders. Conclusions:, The percentage reduction of tumor thickness on EUS closely reflected the pathological evaluation. EUS evaluation based on the RECIST seems to be useful for monitoring neoadjuvant therapy in patients with esophageal carcinoma. [source] Benzydamine for prophylaxis of radiation-induced oral mucositis in head and neck cancers: a double-blind placebo-controlled randomized clinical trialEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2009A. KAZEMIAN md, assistant professor We evaluated the efficacy of benzydamine oral rinse for prevention of radiation-induced mucositis. Patients with head and neck cancers, who were referred in 2004,2005, received an oral rinse of either benzydamine or placebo. One hundred patients were randomized in this trial. At the end of the study, 19 patients were excluded from the analysis because they did not use the medication for the assigned period. In the benzydamine group, the frequency of mucositis grade ,3 was 43.6% in contrast to 78.6% in other group (P = 0.001). Grade ,3 mucositis was 2.6 times more frequent in the placebo group. Intensity of mucositis increased up to fourth week of treatment in both groups to grade 2. In the treated group the grade of mucositis was approximately constant to the end of therapy; but in the control group it raised to grade 3 (P < 0.001). The highest grade of mucositis during the treatment time was significantly different between two groups (P = 0.049). The median interval to observation of grade ,2 mucositis was 24 days in the placebo group and 28 days in the benzydamine group (P = 0.12). Benzydamine oral rinse seems to be effective, safe, and well tolerated for prophylactic treatment of radiation-induced oral mucositis in head and neck tumours. [source] Absence of veno-occlussive disease in a cohort of multiple myeloma patients undergoing autologous stem cell transplantation with targeted busulfan dosageEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 1 2006A. Clopés Abstract:,Background:,Plasma concentrations of oral busulfan (BU) were measured in multiple myeloma (MM) patients undergoing autologous peripheral blood stem cell transplantation (ASCT) with a double alkylating conditioning protocol in order to individualise doses of BU based on individual pharmacokinetic parameters and to reduce toxicities related to BU exposure. Patients and methods:,Forty-four consecutive patients with MM participating in the co-operative Spanish protocol were prospectively evaluated. Conditioning regimen prior to autologous infusion consisted of BU followed by melphalan. BU pharmacokinetic parameters were estimated for each patient after the first dose based on measured concentrations and subsequent doses were modified as necessary to achieve target exposure. Results:,Mean BU exposure (AUCss) (±DS) before dosage modification range from 3192 to 12 180 ng h/mL. Twenty-six out of 44 (59%) patients required dose adjustment. None of the patients developed hepatic veno-occlusive disease (VOD). Grade , II oropharyngeal mucositis was observed in the majority of patients (95%) and the severity of mucositis increased with increasing average steady-state BU plasma concentration. There were four treatment-related deaths: two patients died from multiorgan failure and two of respiratory infections. Of the remaining 40 patients, 15 were in complete remission with negative immunofixation, 21 in partial remission and four in stable disease 3 months after ASCT. Conclusions:,The results of the present study show the variability in BU pharmacokinetic parameters and suggest the possible relationship between toxicities and BU exposure. Individualising BU dosage in MM patients undergoing ASCT we observed the absence of VOD. [source] Soil structure and pedotransfer functionsEUROPEAN JOURNAL OF SOIL SCIENCE, Issue 3 2003Y.A. Pachepsky Summary Accurate estimates of soil hydraulic properties from other soil characteristics using pedotransfer functions (PTFs) are in demand in many applications, and soil structural characteristics are natural candidates for improving PTFs. Soil survey provides mostly categorical data about soil structure. Many available characteristics such as bulk density, aggregate distribution, and penetration resistance reflect not only structural but also other soil properties. Our objective here is to provoke a discussion of the value of structural information in modelling water transport in soils. Two case studies are presented. Data from the US National Pedon Characterization database are used to estimate soil water retention from categorical field-determined structural and textural classes. Regression-tree estimates have the same accuracy as those from textural class as determined in the laboratory. Grade of structure appears to be a strong predictor of water retention at ,33 kPa and ,1500 kPa. Data from the UNSODA database are used to compare field and laboratory soil water retention. The field-measured retention is significantly less than that measured in the laboratory for soils with a sand content of less than 50%. This could be explained by Rieu and Sposito's theory of scaling in soil structure. Our results suggest a close relationship between structure observed at the soil horizon scale and structure at finer scales affecting water retention of soil clods. Finally we indicate research needs, including (i) quantitative characterization of the field soil structure, (ii) an across-scale modelling of soil structure to use fine-scale data for coarse-scale PTFs, (iii) the need to understand the effects of soil structure on the performance of various methods available to measure soil hydraulic properties, and (iv) further studies of ways to use soil,landscape relationships to estimate variations of soil hydraulic properties across large areas of land. [source] Pilot trial of concomitant chemotherapy with paclitaxel and split-course radiotherapy for very advanced squamous cell carcinoma of head and neck,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2002Olavo Feher MD Abstract Purpose The combination of chemotherapy and irradiation is considered the standard of care for the treatment of advanced squamous cell carcinoma of head and neck (SCCHN). Paclitaxel has shown a single-agent activity in SCCHN. Besides, this drug is a promising radiosensitizer for some human solid tumors. This is a phase II trial to evaluate the feasibility, efficacy, and toxicity of paclitaxel administered concurrently with split-course radiotherapy in advanced unresectable SCCHN. Methods and Materials Thirty-one patients with advanced SCCHN were enrolled in this trial. Radiotherapy consisted of 66 to 70 Gy delivered over 8 to 10 weeks to the primary tumor and lymphatic drainage, with a fractionation scheme of 1.8 to 2 Gy/field/d. After the initial five patients were treated, a 1-week treatment break was introduced. Paclitaxel was administered weekly in a 1-hour intravenous infusion at a projected dosage of 45 mg/m2/wk. Results The complete and partial response rates, based on a 4-week postradiation evaluation were 43.3% and 40%, respectively, with an overall response rate of 83.3%. Median survival was 49.4 weeks, and 1-year survival was 48%. Freedom from local progression was 65.6% at 1 year. Thirty-six percent and 20% of the patients are alive and disease free at 1 and 2 years, respectively. Grade 3/4 of acute toxicity consisted mostly of mucositis, cutaneous reaction, and weight loss. Conclusions Paclitaxel concurrent with radiotherapy seems to be active in squamous cell carcinoma of the head and neck. In the regimen selected for this trial, toxicity was significant and led to a prolongation of treatment time. © 2002 Wiley Periodicals, Inc. Head Neck 24: 228,235, 2002; DOI 10.1002/hed.10049 [source] Adenoid cystic carcinoma: A retrospective clinical reviewINTERNATIONAL JOURNAL OF CANCER, Issue 3 2001Atif J. Khan M.D. Abstract Adenoid cystic carcinoma (ACC) are uncommon tumors, representing about 10% to 15% of head and neck tumors. We compare the survival and control rates at our institution with those reported in the literature, and examine putative predictors of outcome. All patients registered with the tumor registry as having had ACC were identified. Demographic and survival variables were retrieved from the database. Additionally, a chart review of all patients was done to obtain specific information. Minor gland tumors were staged using the American Joint Committee on Cancer's criteria for squamous cell carcinomas in identical sites. Histopathologic variables retrieved included grade of the tumor, margins, and perineural invasion. Treatment modalities, field sizes, and radiation doses were recorded in applicable cases. An effort to retrieve archival tumor specimens for immunohistochemical analysis was undertaken. A total of 69 patients were treated for ACC from 1955 to 1999. One patient, who presented with fatal brain metastasis, was excluded from further analysis. Of the remaining 68 patients, 30 were men and 38 were women. The average age at diagnosis was 52 years, and mean follow-up was 13.2 years. Mean survival was 7.7 years. Overall survival (OS) rates at 5, 10, and 15 years were 72%, 44%, and 34%, and cause-specific survival was 83%, 71%, and 55%, respectively. Recurrence-free survival rates were 65%, 52%, and 30% at 5, 10, and 15 years, with a total of 29 of 68 (43%) eventually suffering a recurrence. Overall survival was adversely affected by advancing T and AJCC stage. Higher tumor grades were also associated with decreased OS, although the numbers compared were small. Primaries of the nasosinal region fared poorly when compared with other locations. Total recurrence-free survival, local and distant recurrence rates were distinctly better in primaries of the oral cavity/oropharynx when compared with those in other locations. Reduced distant recurrence-free survival was significantly associated with increasing stage. No other variables were predictive for recurrence. Additionally, we found that nasosinal tumors were more likely to display higher stage at presentation, and were more often associated with perineural invasion. Also of interest was the association of perineural invasion with margin status, with 15 of 20 patients with positive margins displaying perineural invasion, while only 5 of 17 with negative margins showed nerve invasion (P = 0.02). On immunohistochemistry, 2 cases of the 29 (7%) tumor specimens found displayed HER-2/neu positivity. No correlation between clinical behavior and positive staining could be demonstrated. Our data concur with previous reports on ACC in terms of survival and recurrence statistics. Stage and site of primary were important determinants of outcome. Grade may still serve a role in decision making. We could not demonstrate any differences attributable to primary modality of therapy, perhaps due to the nonrandomization of patients into the various treatment tracks and the inclusion of palliative cases. Similarly, perineural invasion, radiation dose and field size, and HER-2/neu positivity did not prove to be important factors in our experience. © 2001 Wiley-Liss, Inc. [source] Reflux esophagitis facilitates low Helicobacter pylori infection rate and gastric inflammationJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2002Tae Jung Jang Abstract Background:Helicobacter pylori is regarded as an important pathogen in upper gastrointestinal diseases. However, little is known about the relationship between H. pylori infection and reflux esophagitis. Therefore, an investigation was undertaken in Korean subjects regarding the incidence of H. pylori infection, and a histopathological study of reflux esophagitis was also carried out. Methods: Analysis of gastric biopsy specimens was conducted for 73 patients with reflux esophagitis and 132 control subjects without reflux esophagitis. The H. pylori infection was assessed by using rapid urease test and the immunohistochemical method, and gastric mucosal morphologic change was analyzed according to the updated Sydney system. Results: The prevalence of H. pylori infection was significantly lower in patients with reflux esophagitis than in the non-reflux group. Grade of inflammation and glandular atrophy in the antrum and body were higher in patients in the non-reflux group compared with those in the reflux esophagitis group. Conclusions: It is suggested that H. pylori infection decreases the risk of reflux esophagitis by inducing atrophic gastritis. © 2002 Blackwell Publishing Asia Pty Ltd [source] Scandinavian Clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrestACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009M. CASTRÉN Background and aim: Sudden cardiac arrest survivors suffer from ischaemic brain injury that may lead to poor neurological outcome and death. The reperfusion injury that occurs is associated with damaging biochemical reactions, which are suppressed by mild therapeutic hypothermia (MTH). In several studies MTH has been proven to be safe, with few complications and improved survival, and is recommended by the International Liaison of Committee on Resuscitation. The aim of this paper is to recommend clinical practice guidelines for MTH treatment after cardiac arrest from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI). Methods: Relevant studies were identified after two consensus meetings of the SSAI Task Force on Therapeutic Hypothermia (SSAITFTH) and via literature search of the Cochrane Central Register of Controlled Trials and Medline. Evidence was assessed and consensus opinion was used when high-grade evidence (Grade of Recommendation, GOR) was unavailable. A management strategy was developed as a consensus from the evidence and the protocols in the participating countries. Results and conclusion: Although proven beneficial only for patients with initial ventricular fibrillation (GOR A), the SSAITFTH also recommend MTH after restored spontaneous circulation, if active treatment is chosen, in patients with initial pulseless electrical activity and asystole (GOR D). Normal ethical considerations, premorbid status, total anoxia time and general condition should decide whether active treatment is required or not. MTH should be part of a standardized treatment protocol, and initiated as early as possible after indication and treatment have been decided (GOR E). There is insufficient evidence to make definitive recommendations among techniques to induce MTH, and we do not know the optimal target temperature, duration of cooling and rewarming time. New studies are needed to address the question as to how MTH affects, for example, prognostic factors. [source] Predicting the Histopathological Grade of Cerebral Gliomas Using High b value MR DW Imaging at 3-TeslaJOURNAL OF NEUROIMAGING, Issue 3 2008Juan Alvarez-Linera MD ABSTRACT BACKGROUND Our aim was to prospectively assess whether magnetic resonance (MR) diffusion-weighted (DW) imaging using high b values can predict better than b value of 1,000 s/mm2 the histopathological grade of cerebral gliomas. METHODS Fifty-four patients with histologically verified brain gliomas (35 high-grade and 19 low-grade gliomas) underwent MR DW imaging. Isotropic DW images and apparent diffusion coefficient (ADC) were obtained with b values of 1,000 and 3,000 s/mm2. Each tumor was evaluated as being hyperintense, iso-intense or hypointense to normal, contralateral-hemisphere white matter. RESULTS Most of the patients with high- and low-grade gliomas showed areas of increased signal intensity on their isotropic images, obtained with a b value of 1,000 s/mm2. However, with a b value of 3,000 s/mm2 the areas of increased signal intensity were seen in 97.1% of the high-grade gliomas, while 94.7% of the low-grade gliomas showed no area of increased signal intensity. The mean area under the ROC curve for ADC ratio, obtained with a b value of 3,000 s/mm2, was significantly higher than that obtained with 1,000 s/mm2 (.932 vs. .856, P= .04). CONCLUSION High b value DW MR might be useful as a complementary tool in preoperative assessment of the histopathological grading of cerebral gliomas. [source] Toothbrushing Competency Among High-risk Grade One Students: an Evaluation of Two Methods of Dental Health EducationJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 4 2001Robert J. Hawkins BSc Abstract Objective: To evaluate the effectiveness of two methods of dental health education (DHE) for improving toothbrushing competency among grade one students at high risk for dental diseases. Methods: Fifty elementary schools in the former city of North York, Ontario, Canada, were assigned to one of two groups. In one group, students received a classroom-based DHE lesson that was reinforced by two small group sessions (n=243). In the other group, students received only a single classroom-based DHE lesson (n=206). Trained examiners assessed 11 toothbrushing skills at pre- and postintervention. Results: At the preintervention test, few significant differences were found between the groups and many students did not display competency in fundamental oral health skills, such as placing a toothbrush at the gum line. Following DHE interventions, students in both groups demonstrated improvements in most skills. A significantly higher proportion of students who received both classroom and small group sessions displayed gains in competency in three skills, compared to students receiving only a classroom lesson. These skills were brushing anterior lingual surfaces, brushing posterior lingual surfaces, and brushing all areas in a routine fashion. Students receiving only a classroom session did not display greater improvements in any skill areas compared to "classroom plus small group" students. Some students in both groups still lacked fundamental skills at the end of the DHE program. Conclusions: While one must exercise caution in interpreting the results due to several methodologic limitations, findings suggest that for high-risk grade one students, a classroom-based lesson combined with small group sessions is a more effective method of improving toothbrushing skills compared to a single classroom-based lesson. [source] Toward dynamic assessment of reading: applying metacognitive awareness guidance to reading assessment tasksJOURNAL OF RESEARCH IN READING, Issue 3 2002Eva Guterman This paper focuses on research that aimed to provide a theoretical,practical framework to link literacy assessment practice with learning theory. An experimental study was designed with reference to three theoretical axes: ,metacognitive awareness' theory, ,schema' theory and the Vygotskian ,zone of proximal fevelopment'. The study tested the effect of using written metacognitive awareness guidance (MCAG) as a tool for activating and engaging learners'Habits of Mind while processing authentic reading assessment tasks taken from Israeli kits of assessment tasks (Guterman, 2000). The study on 300 Grade,4 pupils used three modalities: a control group, which received no treatment; a placebo group, which received content instructions (CI); and a treatment group, which was given written MCAG. The findings confirmed that applying metacognitive awareness guidance to reading assessment tasks makes a difference in the learners' level of performance and achievement on those tasks, and also increases learners' chances of internalising the guidance components. [source] In What Grade Should Backpack Safety Education Begin in Schools?JOURNAL OF SCHOOL HEALTH, Issue 5 2007Sriram Navuluri No abstract is available for this article. [source] Immune Response and Resistance to Stress and Edwardsiella ictaluri Challenge in Channel Catfish, Ictalurus punctatus, Fed Diets Containing Commercial Whole-Cell Yeast or Yeast SubcomponentsJOURNAL OF THE WORLD AQUACULTURE SOCIETY, Issue 1 2007Thomas L. Welker Dietary supplementation of yeast or yeast subcomponents (YYS) as commercial preparations of ,-glucan (MacroGard®; Biotec-Mackzymal, Tromsø, Norway; and Betagard A®; Aqua-In-Tech, Inc., Seattle, WA, USA), mannan oligosaccharide (Bio-MosÔ Aqua Grade; Alltech, Nicholasville, KY, USA), or whole-cell Saccharomyces cerevisiae (Levucell SB20®; Lallemand Animal Nutrition, Milwaukee, WI, USA) at the manufacturer's recommended levels was evaluated on the physiological performance of juvenile channel catfish, Ictalurus punctatus. Fish were fed YYS diets for 4 wk, followed by 2 wk of control diet. Fish were sampled at the end of each feeding period (4 and 6 wk) to measure hematological and immune parameters and growth and to determine the effects of dietary ,-glucan on resistance to Edwardsiella ictaluri infection and to low-water stress (6 wk). Supplementation of YYS in diets did not affect growth performance, hematology, or immune function. Survival from E. ictaluri infection was from 5 to 17.5% higher in fish fed YYS diets than in the control group, but the increases were not significant. Some improvement in stress resistance was observed in YYS-fed catfish after exposure to low-water stress. Stress reduction in fish fed diets supplemented with yeast subcomponents has been reported previously, but thus far, no explanation has been proposed for this effect. The present study and the previously published research suggest that dietary YYS supplementation does not appear to improve resistance of channel catfish to E. ictaluri. [source] Accommodating differences: variations in differentiated literacy instruction in Grade 2/3 classroomsLITERACY, Issue 1 2008Ruthanne Tobin Abstract Although teachers are acutely aware of variance in students' literacy needs, many are unsure exactly how to support these needs in the dynamic classroom. This study reports on compelling evidence from Grade 2/3 classrooms in which teachers differentiated instruction in a variety of ways to benefit all students. In particular, teachers provided additional scaffolding for struggling literacy learners by offering a menu of tiered work products, expert tutoring and additional supports. At the base of instruction were common essential understandings grounded in best literacy practices: shared reading and writing, guided reading, excellent texts and literacy centres. The article emphasises the critical importance of responding to the needs of diverse and at-risk learners in the regular classroom. Differentiated instruction is suggested as a powerful organising framework in the language arts classroom. [source] Pretreatment with sufentanil reduces myoclonus after etomidateACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2003L. Hueter Background: Myoclonic movements are a common problem during the induction of general anesthesia with etomidate. We investigated the influence of pretreatment with the opioid sufentanil on the incidence of etomidate-induced myoclonus. Methods: Forty female patients (ASA physical status I,III) were randomly assigned to receive double-blinded either 0.3 µg kg,1 of sufentanil or placebo 150 s before the induction of sleep with 0.3 mg kg,1 of etomidate. The patients were observed for any myoclonic movement. Grade of dizziness, breathing frequency, non-invasive blood pressure and heart rate were measured during the study period. Results: None of the 20 patients receiving sufentanil had myoclonic movements after the administration of etomidate, whereas 16 patients in the placebo group (80%) experienced such movements (P<0.01). No cases of apnoea before induction of sleep were seen in the sufentanil group. Conclusion: Sufentanil 0.3 µg kg,1 is an effective and safe drug to reduce myoclonus after etomidate without causing any harmful side-effect. [source] Long-term results of single-agent thalidomide as initial therapy for asymptomatic (smoldering or indolent) myeloma,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2010Kristen Detweiler-Short We report the long-term follow-up results of a phase II trial of thalidomide for early-stage multiple myeloma (MM). Patients were eligible if they had smoldering multiple myeloma (SMM) or indolent MM without the need for immediate therapy. Thalidomide was initiated at a dose of 200 mg/day and adjusted as tolerated. Disease progression was defined using modified American Society of Hematology/Food and Drug Administration consensus panel criteria for SMM. Thirty-one patients were enrolled; 29 (19 SMM and 10 indolent MM) were eligible. The median age was 61 years. Median follow-up of living patients was 10.2 years (range, 7.5-11.0 years). Ten patients (34%) had a partial response (PR) and nine had minimal response (MR) for an MR plus PR rate of 66%. The median time to progression (TTP) to symptomatic myeloma was 35 months. Median TTP was 61 months in those achieving PR, 39 months with MR, and 9 months among those failing to achieve either MR or PR, P = 0.005. Median overall survival from diagnosis was 86 months; median survival from onset of symptomatic myeloma was 49 months. Grade 3-4 nonhematologic adverse events were noted in 55% of patients. Randomized trials are needed to determine the role of early therapy in SMM. Am. J. Hematol., 2010. © 2010 Wiley-Liss, Inc. [source] Histologic survey of neuroblastomas after intensive induction chemotherapy,PEDIATRIC BLOOD & CANCER, Issue 5 2005Yoshiaki Tsuchida MD Abstract Background Histology after intensive induction chemotherapy is expected to become a beacon indicating when and how extensively radical surgery and lymph node dissection should be performed in advanced neuroblastoma. A thorough histologic review of surgical specimens was undertaken. Procedure All specimens from 34 patients who were pretreated intensively (,3 cycles) with recent chemotherapy were reviewed. Thirty patients were >12 months of age with stage 3/4 disease, and 4 were <12 months of age but with MYCN -amplified stage 4 diseases. After 3 to 7 cycles (mean, 4.3 cycles) of induction chemotherapy, patients underwent radical surgery of the primary tumor and lymph nodes in all retroperitoneal sections. A single pathologist reviewed all of the specimens, and histologic chemotherapeutic effects were graded as: (+++), <1% viable tumor; (++), 1%,10% viable tumor; (+), 11%,50% viable tumor; (±), 51%,90% viable tumor; and (,), >91% viable tumor. Results Grade (+++) effects were observed in 56% of patients treated with the new regimens, whereas grade (+++) was seen in only 20% treated with regimens before 1991. Operation time and blood loss were 7 hr and 6 min (P,=,0.087) and 646 ml (P,=,0.064), respectively, in patients with >5 cycles (mean, 5.3 cycles) of chemotherapy, while they were 7 hr and 50 min and 1,168 ml, respectively, in those with approximately 3 cycles (mean, 3.2 cycles). Histologically, metastases were found in the contralateral nodes beyond the aorta in 92% of those whose tumor originated on the left, and in 80% of those with tumors occurring on the right. Conclusions Five cycles of induction chemotherapy did not improve histologic chemotherapeutic effects, but helped to facilitate a shorter operation time and less blood loss than 3 cycles of chemotherapy. Surgery after 5 cycles of 98A3 also appears to be easier to perform than that after 3 cycles of A1/new A1. Only 14% of the children treated before 1985 with the St. Jude protocols experienced grade (+++) chemotherapeutic effects, and 22% of the patients treated before 1991 with regimen A1, or new A1 of the Study Group of Japan showed grade (+++) effects, whereas 56% of the patients treated after 1991 with either regimen A3 or 98A3 exhibited grade (+++) chemotherapeutic effects. Histologic chemotherapeutic effects were roughly parallel with a good prognosis. Pediatr Blood Cancer © 2005 Wiley-Liss, Inc. [source] Vertebral artery atherosclerosis: a risk factor in the use of manipulative therapy?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2002Jeanette Mitchell BSc (Physiotherapy), MSc Senior Lecturer Abstract Background and Purpose Vertebrobasilar insufficiency, a direct result of compromised blood flow in the vertebrobasilar circulation, may be caused by stretching and/or compression of the vertebral arteries, particularly if superimposed on underlying atherosclerosis of the vessels. This is an important consideration when using manipulative therapy techniques. The aim of the present study was to investigate the incidence of atherosclerosis and to calculate the relative associated decrease in blood flow in the third and fourth parts of the vertebral artery, in a sample of the adult population. Method A laboratory-based experimental investigation was used to study 362 vertebral arteries from embalmed adult cadavers that were routinely processed for light microscopic study. The incidence of each grade of atherosclerosis in the vessels was recorded. Atherosclerosis was classified as grades 0,5, where Grade 0 represented no atherosclerosis and Grade 5 a fully developed plaque occluding more than 75% of the vessel lumen. From mean measurements of 188 of these arteries, the estimated decrease in luminal cross-sectional area and the relative decrease in blood flow in the atherosclerotic vessels were calculated. Results The highest incidence of atherosclerosis found was Grade 3 (third part of the vertebral artery (VA3): 42.0%; fourth part of the vertebral artery (VA4): 35.2%). An estimated decrease in artery luminal cross-sectional area to 6.2% of normal in Grade 5 atherosclerosis was found. Because blood flow is proportional to the fourth power of the vessel radius, relative decreases in blood flow in grades 1,5 atherosclerosis from 100% to 0% (with critical closing pressure in vessels), respectively, are likely to occur. Conclusions These data suggest that, as significant numbers of the sample showed marked (Grade 3+) atherosclerosis, concomitant with decreased blood flow in the vertebral arteries, this population is at risk for developing vertebrobasilar insufficiency. Because other Western populations may be similarly at risk, particular care should be taken when considering the use of rotational manipulative therapy techniques in treatments of the cervical spine. Copyright © 2002 Whurr Publishers Ltd. [source] Differential protein expression in human gliomas and molecular insightsPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 4 2005Vaibhav C. Chumbalkar Abstract Gliomas are the most common of the primary intracranial tumors with astrocytomas constituting about 40%. Using clinically and histologically assessed astrocytomas, we have studied their protein profiles using a two-dimensional gel electrophoresis-mass spectrometry approach and identified differentially expressed proteins which may be useful molecular indicators to understand these tumors. Examination of the protein profiles of 27,astrocytoma samples of different grades revealed 72,distinct, differentially expressed proteins belonging to various functional groups such as cytoskeleton and intermediate filament proteins, heat shock proteins (HSPs), enzymes and regulatory proteins. Based on the consistency of their differential expression, 29,distinct proteins could be short-listed and may have a role in the pathology of astrocytomas. Some were found to be differentially expressed in both Grade,III and IV astrocytomas while others were associated with a particular grade. A notable observation was underexpression of Prohibitin, a potential tumor suppressor protein, Rho-GDP dissociation inhibitor, Rho-GDI, a regulator of Rho GTPases and HSPs as well as destabilization of glial fibrillary acidic protein, GFAP, major protein of the glial filaments, in Grade,III malignant tumors. We attempt to explain glioma malignancy and progression in terms of their combined role. [source] A Decision Tool for Predicting Sentinel Node Accuracy from Breast Tumor Size and GradeTHE BREAST JOURNAL, Issue 6 2007FRCS (Gen. Surg.), Nathan Coombs BSc Abstract:, The ability to predict axillary lymph node involvement in breast cancer patients in the preoperative setting is invaluable. This study provides a simple set of formulae to enable clinicians to make informed decisions in the management of screen-detected breast cancer. The tumor pathology reports were obtained of all 4,585 women identified between 1996 and 1999 in New South Wales (NSW) with T1 or T2 breast cancer by the statewide co-ordinated breast screening service (BreastScreen NSW). Equations predicting node positivity were calculated by linear regression analysis and, from published sentinel node false-negative rates, the probability of retrieval of a false-negative axillary lymph node by sentinel node biopsy was calculated for tumors of different size and grade. Node involvement was identified in 1,089 (23.8%) of women. A linear relationship for tumor size, grade, and nodal involvement was predicted by: frequency (%) = 1.5 × tumor size (mm) + 2 (or 6 or 10) for grade I (or II or III) tumors. Assuming a 7.5% false-negative rate, the probability of retrieving a false-negative sentinel node ranged from 0.8% for a patient with a 5 mm, grade I carcinoma to 6.0% for a 50 mm, grade III tumor. These simple formulae are easy to use in a clinical setting. The reference table enables breast surgeons to inform a patient about the absolute probability of false-negative sentinel biopsy rates for patients with screen-detected carcinomas when size can be estimated from preoperative imaging and when tumor grade is often available from preoperative core biopsy. Patients with large, T2 breast tumors may be best treated with axillary dissection rather than sentinel node biopsy alone due to the risk of under-staging the woman's disease and also the high probability of finding a positive sentinel node. [source] High Nuclear Grade, Frequent Mitotic Activity, Cyclin D1 and p53 Overexpression Are Associated with Stromal Invasion in Mammary Intracystic Papillary CarcinomaTHE BREAST JOURNAL, Issue 1 2005Cunxian Zhang MD Abstract: Stromal invasion is identified with difficulty in routine hematoxylin-eosin-stained sections of core needle biopsy specimens from mammary intracystic papillary carcinomas. The goal of this study was to determine if nuclear grade, mitotic activity, and immunohistochemical stains for p53 and cyclin D1 would assist in differentiating intracystic papillary carcinomas without stromal invasion (ICPC) from tumors with stromal invasion (ICPC-INVA). Eight cases of ICPC and 12 cases of ICPC-INVA were reviewed. Hematoxylin-eosin slides were examined to determine the histologic features. Immunohistochemistry was performed using monoclonal antibodies to human p53 and cyclin D1. Fisher's exact test was used to compare the nuclear grade, mitotic activity, and immunoreactivity between ICPC and ICPC-INVA. High nuclear grade was more often associated with ICPC-INVA than with ICPC, although the difference was not statistically significant (p = 0.069). Frequent mitotic activity was associated with ICPC-INVA more than with ICPC (p = 0.0198). All cases of ICPC were negative for either p53 or cyclin D1, whereas 7 of 12 cases (58.3%) of ICPC-INVA were positive for either cyclin D1 alone (3 cases), p53 alone (3 cases), or both cyclin D1 and p53 (1 case) (p = 0.0147). Identical nuclear grade, mitotic activity, and immunostaining patterns were seen in the intracystic and the invasive components, and in the core biopsy and the excision of the same tumor. When any one of the positive indicators (high nuclear grade, frequent mitotic activity, or positive immunostains for cyclin D1 and/or p53) was present, the positive predictive value for stromal invasion was 91.7%. When none of the positive indicators was present, the negative predictive value was 87.5%., [source] Effect of Radiation Techniques in Treatment of Oropharynx CancerTHE LARYNGOSCOPE, Issue 4 2008Kyle E. Rusthoven MD Abstract Objectives: To compare the toxicity and outcomes of three radiotherapy techniques,three-dimensional conformal (3D-RT), accelerated fractionation with concomitant boost (AFxCB), and intensity modulated radiotherapy (IMRT),in the combined modality treatment of stage III,IV squamous cell carcinoma (SCC) of the oropharynx. Study Design: Retrospective review. Methods: Between 1998 and 2007, a total of 87 patients were treated; 23 were treated with 3D-RT, 32 with AFxCB, and 32 with IMRT. Systemic therapy consisted of platinum-based chemotherapy in 81 and anti-epidermal growth factor receptor (anti-EGFR)-targeted therapy in 6 cases. Median radiotherapy doses were 70Gy with 3D-RT, 72Gy with AFxCB, and 69.3Gy with IMRT. Locoregional control, survival outcomes, and feeding tube (PEG) dependence were compared using log-rank method. The incidence of acute mucositis and skin reaction, and grade ,2 xerostomia at 6, 12, and 18 months after radiotherapy was compared using Fisher's exact test. Results: Median follow-up was 24 months (range 3 to 103 months) for living patients. Two-year overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were 77.3%, 69.5%, and 86.4%, respectively. There was a trend toward improvement in LRC in patients treated with IMRT. Acute grade ,3 skin and mucosal toxicity were significantly lower with IMRT compared to AFxCB (P < .001). Grade ,2 xerostomia was significantly reduced with IMRT compared to AFxCB and 3D-RT (P < .001). There was no difference in the actuarial rate of PEG dependence (P = .96). Conclusions: Compared to AFxCB and 3D-RT, IMRT confers an improvement in toxicity and appears to have similar efficacy in patients with SCC of the oropharynx. [source] Incidence, Risk Factors and Clinical Consequences of Neutropenia Following Kidney Transplantation: A Retrospective StudyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009L. Zafrani Neutropenic episodes in kidney transplant patients are poorly characterized. In this retrospective study, neutropenia was experienced by 112/395 patients (28%) during the first year posttransplant. The only factor found to be significantly associated with the occurrence of neutropenia was combined tacrolimus-mycophenolate therapy (p < 0.001). Neutropenic patients experienced more bacterial infections (43% vs. 32%, p = 0.04). Grade of neutropenia correlated with the global risk of infection. Discontinuation of mycophenolic acid (MPA) due to neutropenia was associated with an increased incidence of acute rejection (odds ratios per day 1.11, 95% confidence intervals 1.02,1.22) but not with reduced renal function at 1 year. The time from onset of neutropenia to MPA discontinuation correlated with the duration of neutropenia. Granulocyte colony-stimulating factor (G-CSF) administration was safe and effective in severely neutropenic kidney graft recipients, with absolute neutrophil count >1000/,L achieved in a mean of 1.5±0.5 days. Neutropenia is an important and frequent laboratory finding that may exert a significant influence on outcomes in kidney transplantation. As well as leading to an increased incidence of infection, it is associated with a higher rate of allograft rejection if MPA is discontinued for >6 days (p = 0.02). G-CSF accelerates recovery of neutropenia and may be a good therapeutic alternative for severely neutropenic patients. [source] Increased ,-Myosin Heavy Chain in Acute Cellular Rejection Following Human Heart TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2002Mohamad H. Yamani Background: Increased expression of smooth muscle and nonmuscle myosin heavy chains has been previously reported in animal models of cardiac allograft rejection. However, altered expression of ,-myosin heavy chain in human cardiac rejection has not been determined. Methods: Two-dimensional (2D)-gel electrophoresis of endomyocardial biopsies taken from patients with (Grade 3A, n = 6) and without (Grade 0, n = 6) acute rejection were analyzed. Increased expression of two protein spots (MW , 12 kDa) were identified in the presence of acute rejection and were further characterized by mass spectrometry analysis. In patients who had acute rejection, protein expression was subsequently analyzed by immunoblotting on biopsies preceding, during, and following treatment of rejection. Results: Mass spectrometric analysis of the protein spots detected 6 and 22 tryptic peptides, respectively. Protein sequence database search analysis identified the first protein as ,-myosin heavy chain and the second spot consisted of proteins of unidentified nature that may represent novel proteins. Immunoblotting analysis showed 1.4 × fold increase (p <,0.01) of protein expression of ,-myosin heavy chain expression in the presence of acute rejection. Conclusions: To our knowledge, this is the first 2D-gel study to describe increased expression of ,-myosin heavy chain and other proteins of unidentified nature in association with human cardiac allograft rejection. [source] Population Size Estimation Using Individual Level Mixture ModelsBIOMETRICAL JOURNAL, Issue 6 2008Daniel Manrique-Vallier Abstract We revisit the heterogeneous closed population multiple recapture problem, modeling individual-level heterogeneity using the Grade of Membership model (Woodbury et al., 1978). This strategy allows us to postulate the existence of homogeneous latent "ideal" or "pure" classes within the population, and construct a soft clustering of the individuals, where each one is allowed partial or mixed membership in all of these classes. We propose a full hierarchical Bayes specification and a MCMC algorithm to obtain samples from the posterior distribution. We apply the method to simulated data and to three real life examples. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||