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Grading Score (grading + score)
Selected AbstractsInvasive pattern grading score designed as an independent prognostic indicator in oral squamous cell carcinomaHISTOPATHOLOGY, Issue 2 2010Yun-Ching Chang Chang Y-C, Nieh S, Chen S-F, Jao S-W, Lin Y-L & Fu E (2010) Histopathology,57, 295,303 Invasive pattern grading score designed as an independent prognostic indicator in oral squamous cell carcinoma Aims:, To test the validity of an invasive pattern grading score (IPGS) developed for oral squamous cell carcinoma (OSCC) as a prognostic indicator and to elucidate the relationship between the IPGS and clinical parameters. Methods and results:, The IPGS was applied to a total of 153 cases of OSCC. There were significant correlations between IPGS and distant metastasis (P = 0.01) or recurrence (P = 0.001). However, there were no significant correlations between IPGS and gender, age, size or extent, location, status of lymph node metastasis, clinical staging, or histological grading. Cases of OSCC with higher IPGS were associated with poor patient survival (P < 0.001) and higher probability of tumour recurrence (P = 0.001). Intraobserver (, = 0.74) and interobserver agreement (, = 0.67) were very satisfactory. Conclusions:, Our study confirms the validity of the IPGS, an indicator that is simple and easy to use. IPGS not only provides histological assessment of biological behaviour, but also offers an independent prognostic factor that may influence the treatment of OSCC. [source] Tear-film lipid layer morphology and corneal sensation in the development of blinking in neonates and infantsJOURNAL OF ANATOMY, Issue 3 2005John G. Lawrenson Abstract The aim of the study was to evaluate the role of lipid layer thickness and corneal sensation in the development of blinking in neonates. The study group comprised sixty-four neonates and infants (mean age 27.5 ± 15 (sd) weeks, range 3.4,52) whose mothers were attending a general practice healthy baby clinic. Spontaneous eye-blink activity was determined from digital videographic recordings; tear film lipid layer morphology wasexamined using interference patterns produced by the Keeler TearscopeÔ Plus over a five-point grading scale (higher grades are associated with thick and stable lipid films); corneal sensation threshold was assessed with the Non-Contact Corneal Aesthesiometer (NCCA), using the eye-blink response as an objective indication that the cooling stimulus had been felt; palpebral aperture dimensions were measured using calibrated digital still images of the eye in the primary position. The overall mean spontaneous blink-rate was found to be 3.6 (± 0.3) blinks min,1, and the mean interblink time was 21.6 (± 2.8) s. The lowest blink-rates were observed in the 0,17-week age group (average 2 blinks min,1). The blink-rate showed a highly significant correlation with age (r = 0.46, P < 0.01). The overall mean lipid layer grading was 3.6 (± 0.2 SE) arbitrary units. Higher grades were found in the newborn and the mean grading score reduced with age (P < 0.01). The mean sensation threshold to blink (TTB) was 0.69 (0.04 SE) mbar, which did not differ from a control group of older subjects (P > 0.05). There was a rapid increase in palpebral aperture length and width from birth to 1 year old, with surface area increasing by 50% over the same period. We concluded that the low rate of spontaneous eye blink activity in neonates is associated with a thick stable lipid layer that may be a function of a small palpebral aperture. Furthermore, neonates appear to have the capacity to detect ocular surface cooling, which is a major trigger for spontaneous blinking. [source] Invasive front grading: reliability and usefulness in the management of oral squamous cell carcinomaJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 1 2003Faleh A. Sawair Abstract Background:, The value of histological grading was examined with emphasis on reliability of assessment in 102 cases of intraoral squamous cell carcinoma from Northern Ireland with known outcome. Methods:, Two pathologists independently graded the invasive tumour front blinded to the stage and outcome. Results:, Intraobserver agreement was acceptable but interobserver agreement was not satisfactory. The degree of keratinisation was assessed most consistently while nuclear polymorphism was the least reliable feature. Multivariate survival analysis showed that the total grading score was associated with overall survival while the pattern of tumour invasion was the most valuable feature in estimating regional lymph node involvement. The number of positive lymph nodes was strongly associated with regional relapse, while the treatment modality and status of the surgical margins correlated with local relapse. Conclusions:, Grading of selected features in OSCC is reliable and can facilitate treatment planning. [source] Efficacy and safety of a new clobetasol propionate 0.05% foam in alopecia areata: a randomized, double-blind placebo-controlled trialJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2006Antonella Tosti Abstract Background, Clinical efficacy of topical corticosteroids in alopecia areata (AA) is still controversial. Positive clinical results have been obtained using ointments with occlusive dressing but this approach has a low patient compliance. Recently, a new topical formulation (thermophobic foam: Versafoam®) of clobetasol propionate 0.05% has been introduced on the market (Olux®, Mipharm, Milan, Italy) (CF). This formulation is easy to apply. After application to the skin the foam quickly evaporates without residues and it has a good patient compliance. In vitro studies have also shown that this formulation enhances the delivery of the active compound through the skin. Aim, To evaluate the efficacy, safety and tolerability of CF in the treatment of moderate to severe AA. Subjects and methods, Thirty-four patients with moderate to severe AA (eight men, mean age 40 ± 13 years) were enrolled in a randomized, double-blind, right-to-left, placebo-controlled, 24-week trial. Alopecia grading score (AGS) was calculated at baseline and after 12 and 24 weeks of treatment using a 0,5 score (0 = no alopecia; 5 = alopecia totalis). Clobetasol foam and the corresponding placebo foam (PF) were applied twice a day for 5 days/week for 12 weeks (phase 1) using an intrapatient design (right vs. left). From weeks 13 to 24 each enrolled patient continued only with the treatment (both on the right and left site) that was judged to have a greater efficacy than that on the contralateral side (phase 2). The primary outcome of the trial, evaluated on an intention-to-treat basis, was the hair regrowth rate, which was evaluated using a semiquantitative score (RGS) (from 0: no regrowth, to 4: regrowth of 75%). Results, At baseline the AGS was 4.1 (range: 2,5). Nine (26%) patients prematurely concluded the trial. At the end of phase 1, a greater hair regrowth was observed in 89% of the head sites treated with CF vs. 11% in the sites treated with PF. The RGS was 1.2 ± 1.6 in the CF-treated sites and 0.4 ± 0.8 in the PF-treated sites (P = 0.001). A RGS of 2 (hair regrowth of more than 25%) was observed in 42% CF-treated sites and in 13% of PF-treated sites (P = 0.027). In seven subjects (20%) a RGS of 3 to 4 (hair regrowth of 50%) was observed in CF-treated sites. In three subjects (9%) a RGS of 4 (hair regrowth of 75%) was observed in CF-treated sites. In one patient only, in a PF-treated region, a RGS of 3 was observed. The AS was reduced to 3.8 by CF treatment at the end of phase 1 and to 3.3 at the end of phase 2 (P = 0.01). From weeks 12 to 24 the treatment with CF induced a further increase in the RGS (from 1.2 to 1.5 ± 1.4). Forty-seven per cent of CF-treated patients had a RGS of 2 at the end of the trial. A total of eight patients (25%) at the end of the treatment with CF showed a RGS of 3. Folliculitis occurred in two patients. No significant modifications in cortisol and ACTH blood levels were observed during the trial. Conclusion, This new formulation of clobetasol propionate foam is an effective, safe and well-tolerated topical treatment for AA. This formulation has a good cosmetic acceptance and patient compliance profile. [source] Impact of interferon-alpha therapy on liver fibrosis progression in patients with HBeAg-negative chronic hepatitis BJOURNAL OF VIRAL HEPATITIS, Issue 2 2005G. V. Papatheodoridis Summary., The possible effect of interferon-alpha (IFNa) on liver fibrosis progression has not been adequately studied in chronic hepatitis B. We evaluated 147 patients with HBeAg-negative chronic hepatitis B who had ,2 liver biopsies and had been treated with IFNa (n = 120) or had remained untreated (n = 27). The median interval between the two biopsies was 24 (12,160) months. All biopsies were scored blindly by a single liver histopathologist according to the classification of Ishak et al. (J Hepatol 1995; 22: 696,699). IFNa induced sustained biochemical response in 30, initial response and subsequent relapse in 57 and no response in 33 patients. Fibrosis improved in 17.5% of treated (sustained responders: 40%, relapsers: 9%, nonresponders: 12%) and 4% of untreated patients and worsened in 34% (sustained responders: 7%, relapsers: 40%, nonresponders: 48%) and 70% of cases, respectively (P = 0.002). The annual rate of fibrosis progression was worse in the untreated (0.427 ± 0.119) than in treated patients (0.067 ± 0.052, P = 0.001). However, the fibrosis progression rate in the untreated patients was not significantly different than the net fibrosis progression rate (after subtraction of IFNa duration) in nonresponders or relapsers. In multivariate analysis, worse fibrosis progression rate was associated with older age (P = 0.010), worse baseline grading score (P < 0.001), lower baseline fibrosis (P = 0.035) and the type of response to IFNa (P = 0.032). In conclusion, in HBeAg-negative chronic hepatitis B, IFNa significantly reduces the rate of fibrosis progression, but such an effect is mainly observed in patients with sustained biochemical responses. In relapsers and nonresponders, fibrosis benefit equals the treatment period. The strongest factor associated with fibrosis progression is the change in necroinflammatory activity. [source] Clinical characteristics of children with snakebite poisioning and management of complications in the pediatric intensive care unitPEDIATRICS INTERNATIONAL, Issue 6 2005Gonca Ozay AbstractBackground:,Venomous snakebite is an emergency condition with high morbidity and mortality in childhood. Nearly all venomous snakes in Turkey are members of the Viperidae family and show poisonous local and hematotoxic effects. Methods:,A total of 77 children (mean age 9.9 ± 2.9 years; age range 3,14 years) with venomous snakebites were investigated. General characteristics of the children, species of the snakes, localization of the bite, clinical and laboratory findings, treatment approaches, complications and prognosis were evaluated. Results:,The male to female ratio was 1.4. Ninety-one per cent of cases were from rural areas. Most of the bites were seen in May and June. Mean duration between snakebites and admissions to our department was 13 ± 6.5 h. According to a clinical grading score, 57.1% of patients presented to us as grade II. Mean leukocyte count, aspartate aminotransferase, lactate dehydrogenase, creatinine phosphokinase and protrombin time levels were above the normal ranges and mean activated partial tromboplastin time was below the normal range. Platelet counts inversely correlated with the grading score and duration of hospitalization. The most common complication that occurred during the treatment was tissue necrosis (13%). The mean hospital stay time was 6.3 ± 6 days. Three children with disseminated intravascular coagulation died. Fasciotomies were performed to seven (9.1%) children due to compartment syndrome. Of 10 children with tissue necrosis, three (3.9%) had finger amputation and seven (9.1%) had toe amputation. Higher grading score on admission, platelet count below 120 000/mm3, AST over 50 IU/L and existence of evident ecchymosis were found as significant risk factors for development of serious complications by logistic regression analysis. Conclusions:,Snakebite poisoning is an emergency medical condition that is particularly important in childhood. The envenomations are still considerable public health problems with a high morbidity and mortality in rural areas of Turkey. [source] Treatment of incontinence after prostatectomy using a new minimally invasive device: adjustable continence therapyBJU INTERNATIONAL, Issue 4 2005Wilhelm A. Hübner OBJECTIVE To evaluate the safety and efficacy of a new minimally invasive urological implant for incontinence after prostatectomy. PATIENTS AND METHODS The adjustable continence therapy device (ProACTTM, Uromedica, Plymouth, MN, USA) consists of two balloons placed via a perineal approach bilaterally at the bladder neck in patients after prostatectomy. Titanium ports, attached via discrete tubing to each balloon, are placed in the scrotum, allowing for separate volume adjustments of the balloons at any time during and after surgery. Changes in a quality-of-life questionnaire (I-QoL), pad usage and a subjective continence grading score were assessed in 117 consecutive men after implanting the Pro-ACT, at baseline and at 1, 3, 6, 12 and 24 months. RESULTS After a mean (range) follow-up of 13 (3,54) months and with a mean of 3 (0,15) adjustments, 67% of men were dry, using at most one ,security' pad daily; 92% were significantly improved, and 8% showed no improvement. The I-QoL score improved from a median of 34.7 to 66.3 after 2 years (42 men; P <,0.001), the daily pad count decreased from a mean of 6 (1,24)/day to 1 (0,6)/day at 2 years (P < 0.001). Continence achieved at ,,6 months after implantation through incremental adjustment remained durable at ,,2 years in most patients. There were complications during and after surgery in 54 patients, mostly minor and decreasing with increasing expertise, primarily reflecting the development and refinement of the new surgical technique and its instrumentation. Re-implantation for complications was required in 32 patients, with a 75% success rate. CONCLUSIONS The ProACT peri-urethral prosthesis produces durable outcomes equivalent or better than other minimally invasive treatments for incontinence after prostatectomy. Its unique design allows for easy adjustment after surgery to achieve the desired urethral resistance, with no further surgical intervention, thus allowing for an optimum balance between voiding pressures and continence. The promising results reported here suggest that this may be an appropriate, effective and durable first-line treatment to offer men with stress urinary incontinence after prostatectomy. [source] Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 7 2009W Manuskiatti Abstract Background, A wide variety of treatments for circumference reduction and cellulite are available, but most procedures offer suboptimal clinical effect and/or delayed therapeutic outcome. Objective, To determine the safety and efficacy of the TriPollar radiofrequency device for cellulite treatment and circumference reduction. Methods, Thirty-nine females with cellulite received eight weekly TriPollar treatments. Treatment areas included the abdomen, thighs, buttocks and arms. Subjects were evaluated using standardized photographs and measurements of body weight, circumference, subcutaneous thickness, and skin elasticity of the treatment sites at baseline, immediately after and 4 weeks after the final treatment. Physicians' evaluation of clinical improvement scores using a quartile grading scale was recorded. Results, Thirty-seven patients (95%) completed the treatment protocol. There was significant circumference reduction of 3.5 and 1.7 cm at the abdomen (P = 0.002) and thigh (P = 0.002) regions, respectively. At 4 weeks after the last treatment, the average circumferential reductions of the abdomen and thighs were sustained. No significant circumferential reductions of the buttocks and arms at the last treatment visit compared to baseline were demonstrated (P = 0.138 and 0.152, respectively). Quartile grading scores correlating to approximately 50% improvement in cellulite appearance were noted. Conclusions, Tripollar radiofrequency provided beneficial effects on the reduction of abdomen and thigh circumference and cellulite appearance. Conflict of Interest The authors have no financial interest in this article. [source] | ||||||||||