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Grading System (grading + system)
Selected AbstractsThe prevalence of age-related maculopathy (ARM) in an urban Norwegian population: the Oslo Macular StudyACTA OPHTHALMOLOGICA, Issue 5 2006Ólafur M. Björnsson Abstract. Purpose:, To examine the prevalence of early and late age-related maculopathy (ARM) in citizens aged 51 years and older in the city of Oslo and its surroundings. Methods: , We selected a random sample of 800 subjects, using a cross-sectional study design. A total of 459 of the 770 eligible subjects agreed to participate, giving an attendance rate of 59.6%. Stereoscopic colour digital photographs were obtained and graded at a certified reading centre using the International Classification Grading System for ARM. Results:, Early ARM in either eye was found in 43.1% (95% CI 38.5,47.7) of subjects aged 51 years and older. This was due to a much higher prevalence of pigmentary changes, predominantly hyperpigmentation in all age groups, than previously reported; 37.5% of people aged 51,60 years of age had pigmentary changes ,,63 µm, increasing to 66.0% in the oldest age group. In people aged 71 years and older, geographic atrophy (GA) was found in either eye in 3.6% (95% CI 0.4,6.8) and exudative macular degeneration (AMD) was found in either eye in 2.9% (95% CI 0.0,5.7) of subjects. Conclusion:, To our knowledge, this is the first published study to rely solely on digital photography for grading purposes in a population-based study. Early ARM was found to have a higher prevalence than previously reported in other populations. Exudative AMD and GA had similar prevalences to those described in the literature, although the prevalence of GA tended to be higher than previously reported in some surveys. [source] Angiotensin-converting enzyme inhibitors (ACEIs) and age-related maculopathy (ARM): cross-sectional findings from the Blue Mountains Eye StudyACTA OPHTHALMOLOGICA, Issue 3p1 2004Kathy H. C. Wu Abstract. Purpose:, To assess the relationship between the use of angiotensin-converting enzyme inhibitors (ACEIs) and prevalence of age-related maculopathy (ARM). Methods:, Eligible residents aged , 49 years were first examined in 1992,94 (Cross-section 1, n = 3654). Of these, 2335 were re-examined in 1997,99, together with an additional 1174 who became eligible after 1994 (Cross-section 2, n = 3509). Information regarding ACEI use was obtained and retinal photographs were graded using the Wisconsin ARM Grading System. Results:, In Cross-section 1, prevalence rates of late and early stage ARM were 1.3% and 4.3% among current ACEI users, and 2.0% and 4.8% among non-current users, respectively. In Cross-section 2, prevalence rates of late and early stage ARM were 2.3% and 11.3% among current ACEI users, and 1.3% and 9.3% among non-current users, respectively. After adjusting for age, sex and smoking, neither survey found any significant association between ACEI use and prevalence of either late or early ARM. Conclusions:, No significant cross-sectional associations were found between ACEI use and ARM prevalence in this population. [source] Methods for detecting age-related maculopathy: a comparison between photographic and clinical assessmentCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2000Gabriella Tikellis GradDip ABSTRACT Purpose: To examine the sensitivity, specificity and overall agreement between photographic and clinical assessment in detecting age-related maculopathy (ARM) features in the context of an epidemiological study, the Vitamin E, Cataract and Age-related Maculopathy Study (VECAT). Methods: A total of 1204 volunteers aged between 55 and 80 years of age, who were enrolled in the VECAT Study, had both slit-lamp biomicroscopy examination and fundus photos taken as part of the baseline ophthalmic examination. The Nidek 3-DX fundus camera (Nidek, Gamagori, Japan) was used to produce paired, one-framed, coloured, 15° stereoslides of the macular area at a fixed angle. An International Classification and Grading System for Age-related Maculopathy and Age-related Macular Degeneration was used to grade the stereoslides. Agreement in the detection of drusen, pigment abnormalities, and late stage ARM features was assessed using unweighted kappa statistic. Cases of disagreement were verified using clinical data records, grading documentation and the review of stereoslides. Results: Macula status was available for 2386 eyes. For drusen of size < 63 ,m, sensitivity was 47%, specificity was 68% with a kappa value of 0.20. For drusen , 125 ,m, sensitivity and specificity were , 81%. Kappa values ranged from 0.56 to 0.71. Levels of agreement for pigment abnormalities and late ARM were in the substantial range (i.e. kappa values from 0.70 to 1.00). Conclusions: Slit-lamp biomicroscopy was found to be comparable to photograding (using the Nidek 3-DX fundus camera) for detecting features pertaining to ARM. However, given the objectivity and permanency of stereoslides, photograding is still the more reliable and the preferred system of assessing ARM in the context of an epidemiological study. [source] Full Scope of Effect of Facial Lipoatrophy: A Framework of Disease UnderstandingDERMATOLOGIC SURGERY, Issue 8 2006BENJAMIN ASCHER MD BACKGROUND Facial lipoatrophy has been observed to occur in a variety of patient populations, with inherited or acquired disease, or even in aging patients as a natural progression of tissue change over time. There is currently no framework from which physicians of all medical specialties can communally discuss the manifestations, diagnoses, and management of facial lipoatrophy. OBJECTIVE The aim of this assembly was to derive a definition of facial lipoatrophy capable of being applied to all patient populations and develop an accompanying grading system. RESULTS The final consensus of the Facial Lipoatrophy Panel encompasses both aging and disease states: "Loss of facial fat due to aging, trauma or disease, manifested by flattening or indentation of normally convex contours." The proposed grading scale includes five gradations (Grades 1,5; 5 being the most severe), and the face is assessed according to three criteria: contour, bony prominence, and visibility of musculature. CONCLUSION Categorizing the presentation of facial lipoatrophy is subjective and qualitative, and will need to be validated with objective measures. Furthermore, during the assembly, several topics were exposed that warrant further research, including the physiology of volume loss, age and lipoatrophy, and human immunodeficiency virus and lipoatrophy. [source] ENDOSCOPIC DEFINITION OF ESOPHAGOGASTRIC JUNCTION FOR DIAGNOSIS OF BARRETT'S ESOPHAGUS: IMPORTANCE OF SYSTEMATIC EDUCATION AND TRAININGDIGESTIVE ENDOSCOPY, Issue 4 2009Norihisa Ishimura The diagnosis of Barrett's esophagus (BE) requires an accurate recognition of the columnar-lined esophagus at endoscopy. However, a universally accepted standardized endoscopic grading system of BE was lacking prior to the development of the Prague ,circumferential and maximal' criteria. In this system, the landmark for the esophagogastric junction (EGJ) is the proximal end of the gastric folds, not the distal end of the palisade vessels, which are used to endoscopically identify the EGJ in Japan. Although the circumferential and maximal criteria are clinically relevant, an important shortcoming of this system may be failure to identify short-segment BE, a lesion that is found frequently in the Japanese. To compare the diagnostic yield for BE when using the palisade vessels versus gastric folds as a landmark for the EGJ, we evaluated interobserver diagnostic concordance. The endoscopic identification of the EGJ using both landmarks resulted in unacceptably low kappa coefficients of reliability. However, there was a statistically significant improvement after the participants were thoroughly trained in identification of the EGJ during the endoscopic study. Although it remains controversial which landmark is better for the endoscopic diagnosis of BE, it is important to systematically educate and train endoscopists in order to improve diagnostic consistency in patients with BE. [source] The use of self-expandable metallic stents for palliative treatment of inoperable esophageal cancerDISEASES OF THE ESOPHAGUS, Issue 1 2010A. Eroglu SUMMARY Most patients with esophageal carcinoma present in the advanced stage die from tumor invasion and widespread metastases. Because radical regimens are not appropriate for the majority of patients, and their expected survivals are as short as to be measured by months, the main aim of therapy is palliation with minimum morbidity and mortality. Among the palliative modalities are surgery, external radiotherapy or brachytherapy, dilatation, laser, photodynamic therapy, bipolar electrocoagulation tumor probe, and chemical ablation. The placement of self-expandable metallic stents is another method that improves dysphagia for these patients. In this study, the aim was to evaluate retrospectively the effectiveness of metallic stents deployed because of inoperable malignant esophageal stenosis and esophagotracheal fistulas. The results of 170 patients with 202 stents administered because of inoperable malignant esophageal stenosis and esophagorespiratory fistula between January 2000 and October 2008 at the Ataturk University, Department of Thoracic Surgery, were investigated. Despite epidemiological and clinical data, information regarding relief of dysphagia and quality of life were also examined. One hundred seventy patients with stents were between 28 and 91 years old (mean age 63.7 years ± 11.4 years). Ninety-seven were male and 73 were female. Stent indications were advanced tumors with distant metastasis (82 cases, 48.2%), unresectable tumors (51 cases, 30%), patients who cannot tolerate surgery or chemoradiotherapy (18 cases, 10.5%), local recurrence after primary therapy (1 case, 0.5%), esophagorespiratory fistulas from tumor or therapy (14 cases, 8.2%), and refusal of surgery (4 cases, 2.3%). Dysphagia scores evaluated by a modified Takita's grading system improved from 3.4 before the procedure to 2.6 afterward. The overall complication rate without chest pain was 31.7% (occurring in 64 cases). Mean survival was 177.7 days ± 59.3 days (2,993 days). Quality-of-life scores (The European Organization of Research and Treatment of Cancer QLQ C30) improved from 73 ± 10.3 (57,85) to 112 ± 12.6 (90,125). In therapy of malignant esophageal obstructions, metallic stents provide a significant improvement in dysphagia and require less frequent re-intervention according to other methods of dysphagia palliation such as dilatation, laser, and photodynamic therapy, nearly completely relieve esophagotracheal fistulas and improve quality of life to an important degree. [source] Interstitial cells of Cajal (ICC) in equine colic: an immunohistochemical study of horses with obstructive disorders of the small and large intestinesEQUINE VETERINARY JOURNAL, Issue 6 2004C. FINTL Summary Reasons for performing study: The gastrointestinal pacemaker cells, the interstitial cells of Cajal (ICC), have been implicated in several human gastrointestinal dysmotility syndromes. Recently, the involvement of these cells in equine gastrointestinal diseases has been investigated in cases of equine grass sickness where a significant reduction in ICC density was observed. Objective: To investigate ICC density in equine obstructive gastrointestinal disorders using immunohistochemical labelling methods. Methods: Intestinal samples were analysed from 44 horses undergoing exploratory surgery for colic and from 11 control animals subjected to euthanasia for conditions not related to the gastrointestinal tract. Immunohistochemical labelling of ICC was carried out using an anti-c-Kit antibody. Two independent observers assessed ICC density using a semiquantitative grading system. Results: There was a significant reduction in ICC density in horses with large colon disorders compared to the controls (P<0.01). Horses with strangulating lesions of the small intestine showed no difference when compared to the controls. Conclusions: There was a reduction in ICC density in horses with large intestinal disorders. Potential relevance: The reduction in ICC density may be associated with the clinical findings as well as recurrent colic episodes observed in a number of these cases. This immunohistochemical study provides a basis for future functional electrophysiological investigations to determine the precise effect of ICC reduction on equine intestinal motility. [source] The application of a scintigraphic grading system to equine tibial stress fractures: 42 casesEQUINE VETERINARY JOURNAL, Issue 4 2003P. H. L. RAMZAN Summary Reasons for performing study: Tibial stress fractures are an important cause of lameness in the Thoroughbred racehorse. While it is recognised that these injuries can vary in clinical presentation and radiographic or scintigraphic appearance, little has been done to quantify lesion severity. By contrast the scintigraphic grading of tibial stress fractures in human athletes is widely reported and assists in the selection of appropriate management regimes. Objectives: To determine the relationship between scintigraphic grade, clinical severity and radiographic appearance of tibial stress fractures. Methods: The current study involved the retrospective analysis of records from 42 Thoroughbreds with abnormal tibial scintigraphic activity. Results: There was a significant association between lesion site and scintigraphic grade and good correlation of scintigraphic scoring between investigators. No significant association was found between scintigraphic grade and either radiographic grade or degree of lameness. Conclusions: The study confirmed that radiographic appearance is an unreliable measure of clinical severity or stage of progression of lesions. The scintigraphic grading system used in the study was not of use in defining stress fracture severity in the equine tibia. Potential relevance: Despite this finding, there is clearly a need for prospective investigations to explore the potential for targeted management regimes for tibial injuries based on lesion site or clinical criteria. [source] Effect of augmented visual feedback from a virtual reality simulation system on manual dexterity trainingEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 1 2005E. Wierinck Little research has been published about the impact of simulation technology on the learning process of novel motor skills. Especially the role of augmented feedback (FB) on the quality of performance and the transfer of the acquired behaviour to a no-augmented FB condition require further investigation. Therefore, novice dental students were randomly assigned to one of three groups and given the task of drilling a geometrical class 1 cavity. The FB group trained under augmented visual FB conditions, provided by the virtual reality (VR) system (DentSimTM). The no-FB group practised under normal vision conditions, in the absence of augmented FB. A control group performed the test sessions without participating in any training programme. All preparations were evaluated by the VR grading system according to four traditional (outline shape, floor depth, floor smoothness and wall inclination), and two critical, criteria (pulp exposure and damage to adjacent teeth). Performance analyses revealed an overall trend towards significant improvement with training for the experimental groups. The FB group obtained the highest scores. It scored better for floor depth (P < 0.001), whilst the no-FB group was best for floor smoothness (P < 0.005). However, at the retention tests, the FB group demonstrated inferior performance in comparison with the no-FB group. The transfer test on a traditional unit revealed no significant differences between the training groups. Consequently, drilling experience on a VR system under the condition of frequently provided FB and lack of any tutorial input was considered to be not beneficial to learning. The present data are discussed in view of the guidance hypothesis of FB, which refers to the apprentice's dependence on FB. [source] Exploring Daily Grading as a Form of Assessment in a College-Level Japanese Language ClassroomFOREIGN LANGUAGE ANNALS, Issue 1 2002Seonghee Choi ABSTRACT: Methods of evaluation affect learning in multiple and varied ways. The current distinction between testing and assessment invokes issues about which alternatives for evaluation are available and how they are applied in language classrooms. To explore a daily grading system as a form of assessment, this study surveyed 16 teachers and 90 students in college-level Japanese language classrooms where daily grading is practiced. The results showed that both teachers and students had positive beliefs about daily grading. It was also found that students had moderate anxiety levels when their performances were graded daily. In addition, the study revealed several areas of concern about daily grading. To use daily grading successfully as a language-learning assessment tool, appropriate and ongoing teacher training is recommended. [source] Geographic Pathology of Helicobacter pylori GastritisHELICOBACTER, Issue 2 2005Yi Liu ABSTRACT Background and aim.,Helicobacter pylori is etiologically associated with gastritis and gastric cancer. There are significant geographical differences between the clinical manifestation of H. pylori infections. The aim of this study was to compare gastric mucosal histology in relation to age among H. pylori -infected patients from different geographical areas using the same grading system. The prevalence of atrophy and intestinal metaplasia were also compared with the respective gastric cancer incidence in the different countries. Methods., A total of 1906 patients infected with H. pylori from seven countries were evaluated. Entry criteria included H. pylori positive cases with antral and corpus biopsies between the ages of 18 and 75 years. The minimum number of cases required from a country was 100. Hematoxylin-eosin stained biopsies from antrum and corpus were scored semiquantitatively using the parameters suggested by the Sydney Classification System. Statistical evaluation was performed using Krusakal-Wallis test and Spearman's rank correlation test. Results., The severity of gastric atrophy varied among the different groups with the highest scores being present in Japan. The lowest scores were found in four European countries and in Thailand. The scores for intestinal metaplasia were low in general except for Xi-an, Japan, and Shanghai. For all the countries, the presence of atrophy in the antrum correlated well (r = 0.891) with the incidence of gastric cancer. Conclusion., Using a standardized grading system in a large study of H. pylori -related geographic pathology, we found major differences in the overall prevalence and severity of H. pylori gastritis in relation to age. These differences mirrored the respective incidences of gastric cancer in those geographical areas. [source] Reversibility of hepatic fibrosis in treated genetic hemochromatosis: A study of 36 cases,HEPATOLOGY, Issue 2 2006Ludivine Falize The current study was undertaken to assess whether fibrosis could regress under venesection therapy in patients with C282Y homozygous genetic hemochromatosis. The 36 patients studied were recruited from a subfile of our database consisting of 125 C282Y homozygotes with either severe fibrosis or cirrhosis (F3 or F4 fibrosis stage, respectively, according to the METAVIR grading system). The second liver biopsy was performed for management of liver cancer, extrahepatic surgery, or assessment of liver fibrosis. All paired biopsies were reviewed by two pathologists without knowledge of clinical data. Among the 13 patients who had F3 fibrosis on their initial liver biopsy, 3 had F0, 6 had F1, and 2 had F2 on their second liver biopsy. Among the 23 patients with cirrhosis on their initial liver biopsy, 1 had F0, 4 had F1, 3 had F2, and 2 had F3 on their second liver biopsy. When defining regression of fibrosis as a decrease of at least 2 METAVIR units, fibrosis regressed in 9 of 13 (69%) F3 and in 8 of 23 (35%) F4. When the ratio of gammaglobulins (g/L) to (platelets [n/mm3] × prothrombin activity [%]) was greater than 7.5, fibrosis never regressed. In conclusion, these data extend the concept of regression of fibrosis to patients with treated genetic hemochromatosis and suggest that some simple biochemical tests would be predictive of further regression of fibrosis as a result of venesection therapy. If confirmed on larger series, this could modify the ultrasound screening policy of hepatocellular carcinoma in genetic hemochromatosis. (HEPATOLOGY 2006;44:472,477.) [source] Post pancreaticoduodenectomy haemorrhage: outcome prediction based on new ISGPS Clinical severity gradingHPB, Issue 5 2008G. Rajarathinam Abstract Objective & background data. Mortality following pancreatoduodenectomy (PD) has fallen below 5%, yet morbidity remains between 30 and 50%. Major haemorrhage following PD makes a significant contribution to this ongoing morbidity and mortality. The aim of the present study was to validate the new International Study Group of Pancreatic Surgery (ISGPS) Clinical grading system in predicting the outcome of post pancreaticoduodenectomy haemorrhage (PPH). Material and methods. Between January 1998 and December 2007 a total of 458 patients who underwent Whipple's pancreaticoduodenectomy in our department were analysed with regard to haemorrhagic complications. The onset, location and severity of haemorrhage were classified according to the new criteria developed by an ISGPS. Risk factors for haemorrhage, management and outcome were analysed. Results. Severe PPH occurred in 14 patients (3.1%). Early haemorrhage (<24 hours) was recorded in five (36%) patients, and late haemorrhage (>24 hours) in nine (64%) patients. As per Clinical grading of ISGPS 7 (50%) belongs to Grade C and 7 (50%) belongs to Grade B. Haemostasis was attempted by surgery in 10 (71%) patients; angioembolisation was successful in two (14%) and endotherapy in one (7%) patient. The overall mortality is 29%(n=4). Age >60 years (p=0.02), sentinel bleeding (p=0.04), pancreatic leak (p=0.04) and ISGPS Clinical grade C (p=0.02) were associated with increased mortality. Conclusion. Early haemorrhage was mostly managed surgically with better outcome when endoscopy is not feasible. Late haemorrhage is associated with high mortality due to pancreatic leak and sepsis. ISGPS Clinical grading of PPH is useful in predicting the outcome. [source] Oral contrast-enhanced sonography for the diagnosis and grading of postsurgical recurrence of Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 9 2008Fabiana Castiglione MD Abstract Background: Postsurgical recurrence (PSR) is very common in patients with Crohn's disease (CD) and previous surgery. Endoscopy is crucial for the diagnosis of PSR, also showing high prognostic value. Bowel sonography (BS) with or without oral contrast enhancement (OCBS) is accurate for CD diagnosis but its role in PSR detection and grading is poorly investigated. The aim was to evaluate the diagnostic accuracy of BS and OCBS for PSR compared to the endoscopical Rutgeerts's grading system. Methods: We prospectively performed endoscopy, BS, and OCBS in 40 CD patients with previous bowel resection to provide evidence of possible PSR. Endoscopy, BS, and OCBS were executed 1 year after surgery, with PSR diagnosis and grading made in accordance with Rutgeerts. BS and OCBS were considered suggestive for PSR in the presence of bowel wall thickness (BWT) >3 mm. OCBS was performed after ingestion of 750 mL of polyethylene glycol (PEG). Also, a receiver operating characteristic (ROC) curve was constructed in order to define the best cutoff of BWT to discriminate mild from severe PSR (grade 0,2 versus 3,4 of Rutgeerts) for both BS and OCBS. Results: In all, 22 out of the 40 CD showed an endoscopic evidence of PSR (55%). A severe PSR was present in 14 patients (64%). Sensitivity, specificity, and positive and negative predictive values were 77%, 94%, 93%, and 80% for BS, and 82%, 94%, 93%, and 84% for OCBS. On the ROC curve a BWT >5 mm showed sensitivity, specificity, and positive and negative predictive values of 93%, 96%, 88%, and 97% for the diagnosis of severe PSR at BS, while a BWT >4 mm was the best cutoff differentiating the mild from the severe CD recurrence for OCBS, with a sensitivity, specificity, and positive and negative predictive values of 86%, 96%, 97%, and 79%, respectively. Conclusions: Both BS and OCBS show good sensitivity and high specificity for the diagnosis of PSR in CD, with a BWT >5 mm for BS and BWT >4 mm for OCBS strongly indicative of severe endoscopic PSR. Accordingly, these techniques could replace endoscopy for the diagnosis and grading of PSR in many cases. (Inflamm Bowel Dis 2008) [source] Introduction to the updated Australian and New Zealand consensus guidelines for the use of antifungal agents in the haematology/oncology setting, 2008INTERNAL MEDICINE JOURNAL, Issue 6b 2008M. A. Slavin Abstract The process for development of these consensus Australasian antifungal guidelines for use in adult patients with haematological malignancy is described. New features included, how the guidelines should be applied, the risk assessment tool used and the grading system for evidence and strength of recommendation are discussed. [source] RM2 antigen (,1,4-GalNAc-disialyl-Lc4) as a new marker for prostate cancerINTERNATIONAL JOURNAL OF CANCER, Issue 1 2005Seiichi Saito Abstract Although prostate-specific antigen (PSA) has been widely used for early detection of prostate cancer, PSA has problems with specificity and prediction of pathological stage. Therefore, a new marker for prostate cancer is urgently required. We examined expression of a novel carbohydrate antigen, ,1,4-GalNAc-disialyl-Lc4, defined by the monoclonal antibody RM2, in prostate cancer using 75 cases of radical prostatectomy specimens. RM2 immunoreactivity was negative to weak in all benign glands, and weak to moderate in high-grade prostatic intraepithelial neoplasia. In prostatic adenocarcinoma, RM2 immunoreactivity was negative to weak (lower expression) in 20 cases, and moderate to strong (higher expression) in 55 cases. A clear difference of RM2 expression level was observed between Gleason patterns 3 and ,4. Higher expression of RM2 antigen was significantly associated with primary Gleason pattern ,4, high Gleason score (,8), larger tumor volume and advanced tumor stage. Furthermore, 5-year PSA failure-free survival was significantly lower in the higher expression group. However, no significant relationship was observed between RM2 expression level and preoperative serum PSA. Western blot analysis in prostate cancer cell lines PC3 and LNCap revealed that major 49-kDa and minor 39-kDa glycoproteins were common to both cells, but there was an increase of 59- and 125-kDa glycoproteins unique to LNCap and an increase of 88- and 98-kDa glycoproteins unique to PC3. RM2 antigen is a new histological marker for prostate cancer that may reflect the Gleason grading system. Identification of the glycoproteins carrying the RM2 antigen will provide new insights into the properties of prostate cancer. © 2005 Wiley-Liss, Inc. [source] Estimation of genetic parameters for canine hip dysplasia in the Swiss Newfoundland populationJOURNAL OF ANIMAL BREEDING AND GENETICS, Issue 3 2003E. Dietschi Summary Variance components and genetic parameters for hip dysplasia (HD) in a population of 1372 Newfoundlands were estimated using restricted maximum likelihood method applied to animal models comprising fixed effects of gender, screening expert and HD grading system. All models investigated included a random direct genetic effect, but differed for combinations of random maternal genetic effect, permanent maternal environmental effect and kennel effect. Although kennels had no effect on HD, the permanent maternal environmental effects, however were significant. The results for the maternal genetic effect were ambiguous. These results suggest a confounding of these three random effects. The model that included the fixed effects, the direct genetic effect and the permanent maternal environmental effect was the most parsimonious combined with an optimal fit. The heritability estimated with this model was 0.28 and the proportion of the permanent maternal environmental effect of the phenotypic variance was 0.10. The effects of gender and screening expert were significant but not the one of HD grading system. Zusammenfassung Schätzung genetischer Populationsparameter für die Hüftgelenksdysplasie bei den Neufundländern in der Schweiz In einer Hundepopulation von 1372 Neufundländern wurden für die Hüftgelenksdysplasie mit Hilfe der "restricted maximum likelihood method" Varianzkomponenten und genetische Parameter geschätzt, wobei ein Tiermodell zu Grunde gelegt wurde. Alle verwendeten Modelle enthielten einen zufälligen direkten genetischen Effekt und in unterschiedlichen Kombinationen einen zufälligen maternalen Effekt, einen zufälligen permanent maternalen Umwelteffekt und einen zufälligen Zwinger-Effekt. Als fixe Effekte wurden das Geschlecht, der Auswertungs-Experte und das HD-Einteilungssystem berücksichtigt. Der Zwinger hat keinen Einfluss auf die Hüftgelenksdysplasie, aber der permanent maternale Umwelteffekt ist signifikant. Der maternal genetische Effekt verhält sich je nach Modell unterschiedlich. Diese Resultate legen eine Vermengung dieser drei Effekte nahe. Die beste Anpassung an die Daten zeigt dasjenige Modell, das die fixen Effekte, den direkten genetischen Effekt und den permanent maternalen Umwelteffekt enthält. Die mit diesem Modell geschätzte Heritabilität beträgt 0,28 und der Anteil des permanent maternalen Umwelteffektes an der phänotypischen Varianz 0,10. Das Geschlecht und die Auswertungs-Experten sind signifikant, das HD-Einteilungssystem nicht. [source] Nutritional channels in breast cancerJOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 9b 2009Alejandro Godoy Abstract Breast cancers increase glucose uptake by increasing expression of the facilitative glucose transporters (GLUTs), mainly GLUT1. However, little is known about the relationship between GLUT1 expression and malignant potential in breast cancer. In this study, expression and subcellular localization of GLUT1 was analysed in vivo in breast cancer tissue specimens with differing malignant potential, based on the Scarff-Bloom-Richardson (SBRI, II, III) histological grading system, and in vitro in the breast cancer cell lines, MDA-MB-468 and MCF-7, and in MDA-MB-468 cells grown as xenografts in nude athymic BALB/c male mice. In situ hybridization analyses demonstrated similar levels of GLUT1 mRNA expression in tissue sections from breast cancers of all histological grades. However, GLUT1 protein was expressed at higher levels in grade SBRII cancer, compared with SBRI and SBRIII, and associated with the expression of the proliferation marker PCNA. Immunolocalization analyses in SBRII cancers demonstrated a preferential localization of GLUT1 to the portions of the cellular membrane that faced neighbouring cells and formed ,canaliculi-like structures', that we hypothesize could have a potential role as ,nutritional channels'. A similar pattern of GLUT1 localization was observed in confluent cultures of MDA-MB-468 and MCF-7, and in MDA-MB-468 cells grown as xenografts, but not in the normal breast epithelial cell line HMEC. However, no relationship between GLUT1 expression and malignant potential of human breast cancer was observed. Preferential subcellular localization of GLUT1 could represent a physiological adaptation of a subset of breast cancer cells that form infiltrative tumours with a nodular growth pattern and that therefore need a major diffusion of glucose from blood vessels. [source] Evaluation of chondromalacia of the patella with axial inversion recovery,fast spin-echo imagingJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 3 2001Sang Hoon Lee MD The purpose of our study was to assess the accuracy of inversion recovery,fast spin-echo (IR-FSE) imaging for the evaluation of chondromalacia of the patella. Eighty-six patients were included, they underwent magnetic resonance (MR) examination and subsequent knee arthroscopy. Medial and lateral facets of the patella were evaluated separately. Axial images were obtained by using IR-FSE (TR/TE/TI = 3000/25/150 msec; echo train length, 8; 4-mm thickness; 12-cm field of view; 512 × 256 matrix; two, number of excitations) with a 1.5-T MR machine. MR interpretation of chondromalacia was made on the basis of the arthroscopic grading system. Of a total of 172 facets graded, arthroscopy revealed chondromalacia in 14 facets with various grades (G0, 158; G1, 1; G2, 3; G3, 6; G4, 4). Sensitivity, specificity, and accuracy in the chondromalacia grades were 57.1%, 93.0%, and 90.1%, respectively. There was one false-negative case (G4) and 11 false-positive cases (G1, eight; G2, two; G3, one). Sensitivity and specificity corrected by one grade difference were improved to 85.7% and 98.1%, respectively. When cartilage changes were grouped into early (corresponding to grade 1 and 2) and advanced (grade 3 and 4) diseases, sensitivity and specificity of the early and advanced diseases were 75% and 94% and 80% and 99%, respectively. IR-FSE imaging of the knee revealed high specificity but low sensitivity for the evaluation of chondromalacia of the patella. J. Magn. Reson. Imaging 2001;13:412,416. © 2001 Wiley-Liss, Inc. [source] The role and scope of the clinical nurse consultant in Wentworth area health service, New South Wales, AustraliaJOURNAL OF NURSING MANAGEMENT, Issue 1 2007GradDipClinNsg, JENNY O'BAUGH RN, OncNsgCert Aims, This paper reports phase one of a two-part study in a New South Wales area health service, which aimed to evaluate the grading system for clinical nurse consultants. Background, Since its inception in 1986, the role and scope of practice of clinical nurse consultants in New South Wales has been viewed with differing expectations leading to role conflict from the nurse consultants themselves and others in health care including managers and other clinicians. Method, A quantitative approach was used for this study. A survey comprising of open and closed questions was mailed to all clinical nurse consultants (n = 42) employed in the area. Results, The data presented suggest that ambiguity continues about the role, the scope and the differences within the grading system of clinical nurse consultants. Conclusions, Clinical nurse consultants need leadership training and support from their managers to fulfil their role. More work is required to clarify the role of clinical nurse consultants. [source] Immunohistochemical evidence of PTEN in oral squamous cell carcinoma and its correlation with the histological malignancy grading systemJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 7 2002Cristiane Helena Squarize Abstract PTEN is a tumor suppressor gene that encodes a dual phosphatase protein capable of modulating membrane receptors and interaction of the cell and extracellular stimuli. PTEN regulates cell physiology such as division, differentiation/apoptosis and also migration and adhesion. The expression of PTEN was evaluated by immunohistochemistry in OSCC and compared to a well-established histological malignancy grading system. The well-differentiated OSCC were 59.1% and poorly differentiated were 40.9%. According to PTEN expression, the cases were 45.5% positive (the entire tumor showed stained), 22.7% mixed (both negative and positive cells were present) and 31.8% negative (no staining was seen in the tumor cells). PTEN expression in OSCC was related to the malignancy grade (P < 0.0005). Aggressive tumors with a high score of malignancy did not express PTEN, and clearly, the PTEN expression was present in the epithelium adjacent to the tumor. Negative cells were in the invasion border of the tumor. This result suggests that PTEN is related to histologic pattern and biological behavior of OSCC and may be a used as a prognostic marker in the future. The role of PTEN during carcinogenesis and as a biomarker should be further investigated. [source] Focal lymphocytic infiltration in aging human palatal salivary glands: a comparative study with labial salivary glandsJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 1 2001Marilena Vered Abstract: Investigation of age-related prevalence of various types of focal lymphocytic infiltration (FLI) and degrees of histomorphologic changes was conducted on 120 biopsies of palatal and labial salivary glands (PSG and LSG, respectively) obtained from autopsy subjects free of salivary gland tumors/diseases. Biopsies were divided into young (<30 years, n=30), adult (30,60 years, n=45) and old (>60 years, n=45) age groups. A modified Chisholm & Mason grading system was used to record grades of FLI and a modified Greenspan et al. system was used to evaluate the severity of histomorphologic changes. The prevalence of FLI in PSG increased significantly from 10% in the young group to 46.6% in the old group (P=0.0012). No significant changes were found with aging in LSG. FLI was significantly more prevalent in the adult and old age groups in PSG as compared with LSG (P=0.015 and P=0.003, respectively). Both glands demonstrated significant histomorphologic changes among age groups (p<0.0001); however, these changes were significantly less common in the old age group in PSG as compared to LSG (P=0.003). In cases showing severe histomorphologic changes, FLI was not present. Therefore, FLI should not be considered as part of the deteriorating histomorphologic changes that are usually encountered in salivary glands with aging. The immunologic profile of these infiltrates should be further clarified to understand their role, both in physiologic and pathologic conditions. [source] Prospective, open-label, comparative study of clindamycin 1%/benzoyl peroxide 5% gel with adapalene 0.1% gel in Asian acne patients: efficacy and tolerabilityJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 3 2009H-C Ko Abstract Background, Used as individual agents, topical antibiotics and benzoyl peroxide are known to be effective in treatment of acne. Clindamycin phosphate 1% with benzoyl peroxide 5% (CDP/BPO) is a new combination gel, made by rationale, in that combination drug is more effective than either ingredients used alone. Adapalene 0.1% (ADA) is the third-generation retinoid, shown to be as effective as other topical retinoid with well tolerability. Objectives, To compare the efficacy and tolerability in combination of CDP/BPO in comparison with ADA in Asian patients with mild to moderate acne vulgaris. Methods, Total of 69 patients, including 31 patients for CDP/BPO group and 38 for ADA group, with mild to moderate acne vulgaris were enrolled for a 12-week prospective, randomized, open-label comparative study of topical agents. Efficacy was assessed by lesion counts, acne grading system, and global improvement. Adverse events were also evaluated in scale of 0 (none) to 3 (severe). Results, Both CDP/BPO and ADA were effective in reducing lesion counts and acne severity scale and showed significant global improvement. However, CDP/BPO offered greater efficacy against inflammatory lesions than ADA. Both drugs were well tolerated with minimal adverse drug reactions. Conclusion, Combination formulation of CDP/BPO and ADA were shown to be both effective in decreasing total, inflammatory, and non-inflammatory lesion counts along with well tolerability in Asian patients with mild to moderate acne vulgaris. Conflicts of interest None declared [source] Clinical trial: prophylactic intravenous alanyl-glutamine reduces the severity of gastrointestinal toxicity induced by chemotherapy , a randomized crossover studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009Y. LI Summary Background, Glutamine has been shown in numerous studies to reduce intestinal permeability which can be increased by chemotherapy. However, there have been few reports that conduct on its clinical effect on gastrointestinal toxicity. Aim, To examine whether prophylactic intravenous alanyl-glutamine dipeptide can ameliorate clinical manifestations of gastrointestinal toxicity induced by chemotherapy. Methods, Forty-four patients with gastric or colorectal cancer developing WHO side-effect grading system of grade 2 or higher were randomized to either control group (n = 22) or Gln group (n = 22) during next cycle of chemotherapy. Patients were crossed over to the alternate treatment during chemotherapy cycle 2. In the control group, the patients received the same chemotherapy regimens as screening cycle and in the Gln group, the patients received chemotherapy and alanyl-glutamine. Prophylactic intravenous 20 g of alanyl-glutamine dipeptide was given for 5 days. Results, Compared with the control group, the plasma glutamine level in the Gln group was significantly higher and the plasma endotoxin level was significantly lower. The scores of nausea/vomiting and diarrhoea decreased significantly. Conclusion, Prophylactic intravenous alanyl-glutamine is effective in preventing intestinal permeability disruption induced by chemotherapy and clinical manifestations of gastrointestinal toxicity. [source] Consensus conference on chronic viral hepatitis and HIV infection: updated Spanish recommendationsJOURNAL OF VIRAL HEPATITIS, Issue 1 2004V. Soriano Summary., Chronic hepatitis B and C represent a leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients worldwide. New treatment options against both hepatitis B (HBV) and C (HCV) viruses have prompted us to update previous recommendations for the management of coinfected individuals. Fifteen topics (nine related to HCV, five to HBV and one to both viruses) were selected for this purpose. A panel of Spanish experts in the field was invited to review these areas and propose specific recommendations, which were scored according to the Infectious Disease Society of America (IDSA) grading system. These guidelines represent a comprehensive and updated overview on the management of hepatitis B and C in HIV-infected patients. [source] Vascular endothelial growth factor expression in oligodendrogliomas: a correlative study withSainte-Anne malignancy grade, growth fractionand patient survivalNEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 4 2000P. Varlet Microangiogenesis is a delayed but crucial event in the malignant progression of oligodendrogliomas. Accord-ingly, in the new Sainte-Anne grading system of oligodendrogliomas, endothelial hyperplasia and contrast enhancement, both being indicators of microangiogenesis, are key criteria for the distinction of grade A from grade B tumours. Vascular endothelial growth factor (VEGF) is a potent angiogenic factor: a strong correlation between VEGF expression, Sainte-Anne malignancy grade and patient outcome might thus be expected. In order to assess this hypothesis, VEGF immunostaining was performed in a series of 34 oligodendrogliomas that included 11 grade B and 23 grade A, of which nine became grade B during the study period (mean clinical and imaging follow-up: 41 months). VEGF expression correlated strongly with Sainte-Anne tumour grade (P < 0.001), and inversely with patient survival (P < 0.001) and recurrence-free survival (P = 0.002). One hundred per cent of grade B but only 17% of grade A were VEGF-positive. By contrast, the MIB-1 labelling index did not correlate with VEGF expression, total survival or recurrence-free survival. In accordance with the grading system, this study showed that, in oligodendrogliomas, VEGF expression and microangiogenesis are progression-related phenomena that confer on these tumours a growth advantage by presumably reducing hypoxia-induced apoptotic cell death. These findings might have important implications in the future for the indication and timing of anti-angiogenic therapies. [source] Validation of grading scales for contact lens complicationsOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2001Nathan Efron Summary The validity of use of two artist-rendered and two photographic sets of grading scales (grading ,systems') designed for gauging the severity of contact lens-related ocular pathology was assessed in terms of precision and reliability. Thirteen observers each graded 30 images , by interpolation or extrapolation to the nearest 0.1 increment , of each of the three contact lens complications (corneal staining, conjunctival redness and papillary conjunctivitis) that were common to all four grading systems. This entire procedure was repeated approximately two weeks later, yielding a total data base comprising of 9360 individual grading estimates. Analysis of variance revealed statistically significant differences in both precision and reliability between systems, observers and conditions (p<0.03 for system reliability; p=0.0001 for all other combinations). The artist-rendered systems generally afforded lower grading estimates and better grading reliability than the photographic systems. Corneal staining could be graded less reliably than conjunctival redness and papillary conjunctivitis. Grading reliability was generally unaffected by the severity of the condition being assessed. Notwithstanding the above differences, all four grading systems are validated for clinical use and practitioners can initially expect to use these systems with average 95% confidence limits of ±1.2 grading scale units (observer range ±0.7 to ±2.5 grading scale units). In view of the significant between-system differences revealed in this study, it is advisable to consistently use the same grading system. It may be possible to reduce between-observer differences by applying personalised correction factors to normalise grading estimates. [source] Results after surgical treatment of transtectal transverse acetabular fracturesORTHOPAEDIC SURGERY, Issue 1 2010Xi-gong Li MD Objective:, To retrospectively evaluate the results of operative treatment of transtectal transverse fractures of the acetabulum. Methods:, From May 1990 to July 2006, 40 patients with displaced transtectal transverse fracture of the acetabulum were treated surgically. A mean postoperative follow-up of 88.6 months' (range, 16,121 months) was achieved in 37 patients. Final clinical results were evaluated by a modified Merle d'Aubigné and Postel grading system. Postoperative radiographic results were evaluated by the Matta criteria. Fracture and radiographic variables were analyzed to identify possible associations with clinical outcome. Results:, Fracture reduction was graded as anatomic in 31 patients, imperfect in 4 and unsatisfactory in 2. Two hips were diagnosed to have subtle instability by postoperative radiography. The clinical outcome was graded as excellent in 16 patients, good in 14, fair in 4 and poor in 3. The radiographic result was graded as excellent in 14 patients, good in 15, fair in 4 and poor in 4. There was a strong association between the final clinical and radiographic outcomes. Variables identified as risk factors for unsatisfactory results included residual displacement greater than 2 mm, comminuted fracture of the weight bearing dome, postoperative subtle hip instability and damage to the cartilage of the femoral head. Conclusion:, The uncomplicated radiographic appearance of transtectal transverse fracture belies its complexity. Comminuted fracture of the weight bearing dome, unsatisfactory fracture reduction, subtle hip instability and damage to the cartilage of the femoral head are risk factors for the clinical outcome of transtectal transverse fracture of the acetabulum. [source] Incidence and Severity of Epidural Fibrosis after Back Surgery: An Endoscopic StudyPAIN PRACTICE, Issue 1 2010FIPP, Hemmo A. Bosscher MD Abstract Background: Epidural fibrosis has been implicated in the etiology of persistent pain after back surgery (Failed Back Surgery Syndrome [FBSS]). Using spinal endoscopy to view the lumbosacral epidural cavity, the incidence, severity, and appearance of epidural fibrosis was evaluated in patients with FBSS. Methods: A prospective cohort observational study using epidural endoscopy was done involving 78 patients with persistent pain after back surgery. Patients were evaluated prospectively for the presence of epidural fibrosis and fibrosis was rated using a 4-level grading system based on appearance and resistance to epiduroscope advancement. The incidence of fibrosis detected by epiduroscopy vs. the incidence as reported in magnetic resonance imaging (MRI) studies for the same patients were compared. Results: As diagnosed with epiduroscopy, 83.3% of all patients with persistent pain after back surgery had severe (grade 3 or 4) epidural fibrosis, while 91.0% had significant (grade 2, 3, or 4) fibrosis. In patients who had undergone more extensive surgery, severe fibrosis was present in 91.1% and significant fibrosis in 95.6%. Using MRI, epidural fibrosis was diagnosed only in 16.1% of these patients. All patients with severe epidural fibrosis had a filling defect on epidurography. Concordant pain was present in 84.3% of patients and depended on the severity of fibrosis. Results were statistically evaluated using analysis of frequencies and t -test. P < 0.05 was considered statistically significant. Conclusions: Epiduroscopy demonstrates that the prevalence of severe epidural fibrosis after FBSS is substantially higher than is generally reported in MRI evaluations. Severe epidural fibrosis is an underlying pathology in most patients with FBSS. [source] Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patientsTHE JOURNAL OF DERMATOLOGY, Issue 5 2009Bong Jin HAHM ABSTRACT Oral isotretinoin is a highly effective agent for the treatment of moderate to severe acne, but ever since oral isotretinoin was introduced as a modality for acne, the relationship between oral isotretinoin therapy and psychiatric problems, especially depression, has been controversial. The purposes of this study were to know the acute effects of oral isotretinoin therapy on psychiatric symptoms and to investigate the relationships among them, which have not been reported in the published work. This cohort study included 38 acne patients who started oral isotretinoin therapy. Individual patients were examined before administering oral isotretinoin and 2 and 8 weeks after commencement. Acne severity was graded using the Leeds revised acne grading system. Acute psychiatric effects of oral isotretinoin were assessed using a questionnaire authorized by two psychiatrists. This questionnaire included assessments of acne-related quality of life (Assessment of the Psychological and Social Effects of Acne [APSEA]), depression (Beck's depression inventory [BDI]), anxiety (Beck's anxiety inventory [BAI]) and psychopathology (Symptomchecklist-90-revised [SCL-90-R]). Acne grading and APSEA showed similar change patterns. Both improved after 8 weeks of oral isotretinoin treatment. On the other hand, the severity of depression decreased after 2 weeks of treatment. A significant correlation was found between BDI and APSEA, but no correlation was found between BDI and acne grade. These results indicate that oral isotretinoin therapy alleviates depressive symptoms. Improvements in depression are directly related to acne-related life quality improvements rather than to improvement in acne grade. [source] | |||||||||||||||||||||||||||||||||||||