Comparison of visual and CAS-200 quantitation of immunocytochemical staining in breast carcinoma samples.

Using the CAS-200 image analysis system, we compared the relationship between semiautomated computer measurements (QIC score) and visual scoring (H score) on 30 breast cancer fine needle aspirates (FNAs) and corresponding tissue specimens stained by the estrogen receptor immunocytochemical assay. These results were compared to the corresponding biochemistry assays for ER. We also investigated whether the computerized system could decrease false-negative staining for ER in 32 cryostat sections. QIC scores were generated using fixed nuclear and antibody thresholds after standardizing the illumination. Computer quantitation was essentially as precise as visual semiquantitation for FNAs: a small but significant correlation was found between tumor ER content and QIC score (r = .504, P less than .02) as compared with H score and ER content (rs = .55, P less than .005). The computerized system did not decrease the false-negative rate in cryostat sections. In all, computerized quantitation was no better than visual analysis of ER staining in these breast carcinomas.     

Characterisation of footpad lesions in organic and conventional broilers

Recent data suggest that organic broilers often score worse on footpad lesions than conventional broilers but also that the current scoring of organic broiler feet may be misleading. In order to characterise footpad lesions in organic broilers, this study assessed and compared footpad lesions in a sample of 2987 conventional and 3578 organic broiler feet obtained from a large Danish abattoir during summer and winter. The feet were scored according to two scoring systems: the modified Danish surveillance scoring system and a histopathology-based new scoring system specifically developed to target the ability to differentiate between broiler feet with hyperkeratosis and ulcers. For both systems, all broiler feet with visible lesions were cross-sectionally incised. Significant differences between the two production systems were found for both scoring systems (χ² = 710; P < 0.001 and χ² = 247; P < 0.001 for the new and the surveillance systems, respectively), showing that a larger proportion of the organic feet compared to conventional feet – summer and winter – exhibited signs of hyperkeratosis. In addition, a smaller fraction of the organic feet than of the conventional feet were given the outermost scores, that is, normal or ulcerated; 13.4% v. 25.3% broiler feet were given score 0 for organic v. conventional production systems, respectively (χ² = 152; P < 0.001), and 18.4% v. 23.8% feet were given score 4 for organic v. conventional production systems, respectively (χ² = 308; P < 0.001). Thus, the results suggest that surveillance scoring systems such as the one used in Denmark are useful for the examination of footpad lesions in broilers from both types of production systems. However, the results have also raised attention to a typical characteristic of the feet of organic broilers, that is, profound hyperkeratosis, which may underlie potential misclassifications in surveillance scoring systems like the one used in Denmark. Among the possible solutions to this challenge to the correctness and fairness of the scoring system are improved procedures (such as mandatory incision), training of technicians and calibration of results (especially for the organic footpads).     

Establishment and Validation of GV-SAPS II Scoring System for Non-Diabetic Critically Ill Patients

MethodsTraining and validation cohorts were exacted from the Multiparameter Intelligent Monitoring in Intensive Care database III version 1.3 (MIMIC-III v1.3). The GV-SAPS II score was constructed by Cox proportional hazard regression analysis and compared with the original SAPS II, Sepsis-related Organ Failure Assessment Score (SOFA) and Elixhauser scoring systems using area under the curve of the receiver operator characteristic (auROC) curve.Results4,895 and 5,048 eligible individuals were included in the training and validation cohorts, respectively. The GV-SAPS II score was established with four independent risk factors, including hyperglycemia, hypoglycemia, standard deviation of blood glucose levels (Glu_SD), and SAPS II score. In the validation cohort, the auROC values of the new scoring system were 0.824 (95% CI: 0.813–0.834, P< 0.001) and 0.738 (95% CI: 0.725–0.750, P< 0.001), respectively for 30 days and 9 months, which were significantly higher than other models used in our study (all P < 0.001). Moreover, Kaplan-Meier plots demonstrated significantly worse outcomes in higher GV-SAPS II score groups both for 30-day and 9-month mortality endpoints (all P< 0.001).ConclusionsWe established and validated a modified prognostic scoring system that integrated glucose variability for non-diabetic critically ill patients, named GV-SAPS II. It demonstrated a superior prognostic capability and may be an optimal scoring system for prognostic evaluation in this patient group.     

A correlation-based method for the enhancement of scoring functions on funnel-shaped energy landscapes

A correlation-based approach is introduced for enhancing the ability of structure-scoring methods to identify and distinguish native-like conformations. The proposed method relies on a funnel-shaped scoring function that decreases steadily toward the native state. It takes advantage of the idea that the structure from a given ensemble that is closest to the native basin leads to the highest correlation coefficient between a given score and distance to that structure as an approximation of the native state for the entire ensemble. The method is applied successfully to a number of different test cases that demonstrate substantial improvements in the correlation of the score with the distance from the true native state but also result in the selection of more native-like structures compared to the original score.     

Non-invasive femoropopliteal assessment: is that angiogram really necessary?

A method of non-invasive preoperative assessment of chronically ischaemic legs was developed that used clinical data and data derived from Doppler ultrasonography to produce a numerical score that could be compared with an angiographic score for stenosis of the popliteal artery trifurcation. The two scoring systems were applied retrospectively to 144 legs after femorodistal bypass. A close correlation was observed (r = 0.89, p less than 0.001), and both systems tended to predict the level of grafting undertaken. A prospective comparison was then made in 81 ischaemic legs that were examined by arteriography; the correlation between the two scoring systems remained close (r = 0.89, p less than 0.001), and the level of bypass was correctly predicted by the non-invasive assessment in 44 of 50 legs that were operated on. Use of the non-invasive assessment subsequently greatly reduced the indications for preoperative arteriography in patients requiring femorodistal vascular reconstruction.     

TLIF与PLIF对退行性腰椎滑脱合并腰椎管狭窄患者临床疗效及安全性比较

目的:比较经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)与经后路椎体间融合术(posterior lumbar interbody fusion,PLIF)对退行性腰椎滑脱合并腰椎管狭窄患者临床疗效及安全性。方法:选择2013年6月到2015年6月我院收治的90例退行性腰椎滑脱合并腰椎管狭窄患者,随机分为TLIF组和PLIF组,各45例。TLIF组患者给予TLIF治疗,PLIF组患者给予PLIF治疗。记录并比较两组患者手术时间、术中失血量、术后引流量及术后卧床时间。评价并比较两组患者治疗前后视觉疼痛评分(visual analogue scale,VAS)和Oswestry功能不良指数(oswestry disability index,ODI)。记录并比较两组患者治疗后神经根损伤、感染、硬膜囊破裂等并发症发生情况。结果:TLIF组患者的手术时间、术中失血量、术后引流量及术后卧床时间均明显小于PLIF组,均具有显著性差异(P0.05)。治疗前,两组患者VAS、ODI评分,相比均无显著性差异(P0.05);治疗后,两组患者VAS、ODI评分均明显小于治疗前,且TLIF组患者的VAS、ODI评分均明显小于PLIF组,均具有显著性差异(P0.05)。TLIF组患者的并发症发生率明显低于PLIF组,均具有显著性差异(X~2=3.873,P=0.049)。结论:相比于PLIF,TLIF治疗退行性腰椎滑脱合并腰椎管狭窄患者的临床疗效显著,有助于腰椎功能的恢复,并发症发生率较低,值得在临床上推广应用。     

Retrocrural Space Involvement on Computed Tomography as a Predictor of Mortality and Disease Severity in Acute Pancreatitis

Background

Because computed tomography (CT) has advantages for visualizing the manifestation of necrosis and local complications, a series of scoring systems based on CT manifestations have been developed for assessing the clinical outcomes of acute pancreatitis (AP), including the CT severity index (CTSI), modified CTSI, etc. Despite the internationally accepted CTSI having been successfully used to predict the overall mortality and disease severity of AP, recent literature has revealed the limitations of the CTSI. Using the Delphi method, we establish a new scoring system based on retrocrural space involvement (RCSI), and compared its effectiveness at evaluating the mortality and severity of AP with that of the CTSI.

Methods

We reviewed CT images of 257 patients with AP taken within 3–5 days of admission in 2012. The RCSI scoring system, which includes assessment of infectious conditions involving the retrocrural space and the adjacent pleural cavity, was established using the Delphi method. Two radiologists independently assessed the RCSI and CTSI scores. The predictive points of the RCSI and CTSI scoring systems in evaluating the mortality and severity of AP were estimated using receiver operating characteristic (ROC) curves.

Principal Findings

The RCSI score can accurately predict the mortality and disease severity. The area under the ROC curve for the RCSI versus CTSI score was 0.962±0.011 versus 0.900±0.021 for predicting the mortality, and 0.888±0.025 versus 0.904±0.020 for predicting the severity of AP. Applying ROC analysis to our data showed that a RCSI score of 4 was the best cutoff value, above which mortality could be identified.

Conclusion

The Delphi method was innovatively adopted to establish a scoring system to predict the clinical outcome of AP. The RCSI scoring system can predict the mortality of AP better than the CTSI system, and the severity of AP equally as well.     

腰椎间盘突出症康复治疗中腰部核心肌力训练的临床评估

为了系统评估腰椎间盘突出症患者康复治疗中腰部核心肌力训练治疗的临床疗效,本研究选取2012年1月至2014年1月研究者所在医院就诊的150例腰椎间盘突出症腰肌锻炼康复治疗患者,随机分成A、B两组。A组患者进行腰部核心肌力训练治疗,即核心肌力组;B组患者给予传统腰肌功能锻炼治疗,即传统腰肌锻炼组;康复治疗均在医生指导下进行,所有患者每天早晚各锻炼1次,每次持续15 min,共训练治疗12周。所有患者均定期随访,治疗后6周和12周分别通过VAS疼痛评分、JOA腰椎功能评分和ODI腰椎功能评分变化进行效果评价。治疗后6周,核心训练组VAS评分平均(5.0±1.5)分,JOA评分平均(21.4±2.6)分,ODI评分平均(29.5±8.0)分;但与传统腰肌训练组比较无明显差别(p>0.05);治疗后12周核心肌力锻炼组疼痛症状缓解明显,VAS平均(2.9±1.2)分;腰椎功能改善明显JOA评分平均(25.2±3.2)分,ODI评分平均(38.8±9.4)分;与传统腰肌训练组比较差异具有统计意义(p<0.05)。本研究说明腰肌核心肌力训练长期锻炼效果好于传统腰肌训练。     

Intra-laboratory Comet Assay Sample Scoring Exercise for Determination of Formamidopyrimidine DNA Glycosylase Sites in Human Mononuclear Blood Cell DNA

Oxidative DNA damage detected by the comet assay as formamidopyrimidine DNA glycosylase (FPG) senstitive sites, almost as a rule is reported as comet assay score rather than numerical sites in the genome, probably because the latter requires X-ray calibration. We compared the ability of five experienced and five inexperienced comet assay investigators to detect a dose-response relationship in irradiated A549 lung epithelial cell culture samples (0, 10 Gy and three samples of 5 Gy), based on an arbitrary five class scoring system. The samples were scored on three different occasions, thus allowing determination of the variation in sample scoring. All investigators qualitatively distinguished between samples in a dose-dependent manner, albeit with large variation in the slope and intercept of dose-response curves. There was a tendency that investigators with experience in scoring A549 cells had more consistent results than experienced investigators who had only scored lymphocytes or inexperienced investigators. The inexperienced investigators improved their scoring ability during the three sessions. Subsequently we showed that the variation in baseline level of FPG modifications in mononuclear blood cells of five healthy humans was lower when investigators used their individual X-ray calibration curve as compared to a common calibration curve. In conclusion, this study showed that comet assay investigators score differently when using a five class scoring system, which indicates that more consistent estimations of FPG sites in the genome are obtained by use of investigators' individual X-ray calibrations.     

Analysis of scores in diagnosis of acute appendicitis in women

Acute appendicitis is a common surgical condition that requires prompt diagnosis. Besides modern imaging techniques, scoring systems, based on clinical signs and symptoms and routine laboratory assessments, have been used as a diagnostic aid. However, differences in sensitivities and specificities were observed if the scores were applied to various populations and clinical settings. The purpose of this paper is to assess validity of three scores (modified Alvarado score, Ohmann score and Eskelinen score) for diagnosis of acute appendicitis in women. 126 female patients admitted for suspicion of acute appendicitis in a tertiary hospital emergency department were analyzed prospectively. Modified Alvarado score, Ohmann score and Eskelinen score were calculated at admission and compared to final diagnosis. All patients with modified Alvarado score 7 or more had acute appendicitis (100% specificity) and it can be used to determine the need for immediate appendectomy. Values of Ohmann score greater than 6 resulted in 0.9% rate of overlooked appendicitis. Besides obvious educational role, scores may help to determine the group of patients who require immediate appendectomy, therefore expediting treatment and avoid unnecessary observation or more lengthy diagnostic procedures that require highly educated and skilled senior staff: No single score may be used alone to dictate or decline surgery. Different cut-off points may also be considered for different subpopulations.     

Intra-laboratory comet assay sample scoring exercise for determination of formamidopyrimidine DNA glycosylase sites in human mononuclear blood cell DNA

Oxidative DNA damage detected by the comet assay as formamidopyrimidine DNA glycosylase (FPG) sensitive sites, almost as a rule is reported as comet assay score rather than numerical sites in the genome, probably because the latter requires X-ray calibration. We compared the ability of five experienced and five inexperienced comet assay investigators to detect a dose-response relationship in irradiated A549 lung epithelial cell culture samples (0, 10 Gy and three samples of 5 Gy), based on an arbitrary five class scoring system. The samples were scored on three different occasions, thus allowing determination of the variation in sample scoring. All investigators qualitatively distinguished between samples in a dose-dependent manner, albeit with large variation in the slope and intercept of dose-response curves. There was a tendency that investigators with experience in scoring A549 cells had more consistent results than experienced investigators who had only scored lymphocytes or inexperienced investigators. The inexperienced investigators improved their scoring ability during the three sessions. Subsequently we showed that the variation in baseline level of FPG modifications in mononuclear blood cells of five healthy humans was lower when investigators used their individual X-ray calibration curve as compared to a common calibration curve. In conclusion, this study showed that comet assay investigators score differently when using a five class scoring system, which indicates that more consistent estimations of FPG sites in the genome are obtained by use of investigators' individual X-ray calibrations.     

Hybrid alignment: high-performance with universal statistics

The score statistics of a recently introduced 'hybrid alignment' algorithm is studied in detail numerically. An extensive survey across the 2216 models of protein domains contained in the Pfam v5.4 database (Bateman et al., Nucleic Acids Res., 28, 263-266, 2000) verifies the theoretical predictions: For the position-specific scoring functions used in the Pfam models, the score statistics of hybrid alignment obey the Gumbel distribution, with the key Gumbel parameter lambda taking on the asymptotic value 1 universally for all models. Thus, the use of hybrid alignment eliminates the time-consuming computer simulations normally needed to assign p-values to alignment scores, freeing the users to experiment with different scoring parameters and functions. The performance of the hybrid algorithm in detecting sequence homology is also studied. For protein sequences from the SCOP database (Murzin et al., J. Mol. Biol., 247, 536-540, 1995) using uniform scoring functions, the performance is found to be comparable to the best of the existing methods. Preliminary results using the PfamA database suggest that the hybrid algorithm achieves similar performance as existing methods for position-specific scoring systems as well. Hybrid alignment is thereby established as a high performance alignment algorithm with well-characterized, universal statistics.     

Development and validation of on-farm behavioural scoring systems to assess birth assistance and lamb vigour

Lamb mortality remains a significant welfare and economic issue for sheep production. Lamb survival is to a degree dependent upon an easy delivery and the expression of appropriate behaviours from both mother and offspring, such as rapid standing, udder seeking and sucking by the lamb. Genetic solutions have the potential to improve birth assistance and lamb behaviour but large amounts of data are needed. Therefore, to achieve this objective, simple, proxy methods (scoring systems) were developed to quantify the level of birth difficulties and lamb vigour on farm. In the first study, detailed historical behavioural data from 1156 lambs (Scottish Blackface and Suffolk (S)) were analysed to develop criteria for 3 scores: birth assistance, lamb vigour and sucking assistance. The birth assistance score was developed by analysing the relationships between birth presentation and intervention levels, and intervention level and labour length. Lambs with abnormal birth positions required more assistance than normally presented lambs and lambs with long labours required more and greater assistance than those with short labours. Lamb vigour score was developed by analysing the latencies for the lamb to first perform specific behaviours; more vigorous lambs reach landmark behaviours faster than low vigour lambs. The sucking assistance score was developed from the relationship between the latency to suck successfully and assistance level, where lambs that were slow to suck required more assistance than lambs that were quick to suck. In the second study, the behaviour scoring systems (5-point categorical scales) were validated using a commercial flock of 80 twin-bearing crossbred ewes mated with either Texel (T) or S sires by simultaneously recording scores and the latency to perform specific landmark behaviours (i.e. to stand, seek the udder and suck). The vigour scores (recorded at 5 min of age) were compared with the latency from birth to standing and showed that lambs with lower (better) vigour scores were faster to stand after birth than those with higher scores. The sucking assistance scores were compared with the latency from birth to sucking, and showed that lambs with lower sucking assistance scores are quicker to suck than those with high scores. These results showed that the scoring systems could provide a practical and reliable assessment of birth assistance and lamb behaviour on farm and were sufficiently sensitive to discriminate vigour levels between lambs sired by either S or T rams.     

Estimation of Immunohistochemical Expression of VEGF in Ductal Carcinomas of the Breast

Vascular endothelial growth factor A (VEGF-A) is a very important growth factor in angiogenesis and holds potential as both a predictive marker for anti-angiogenic cancer treatment and a prognostic variable. Consequently, reliable estimation of VEGF expression is crucial. Investigators immunostained whole tumor sections for VEGF-A, VEGF-B, and VEGFR-1 of invasive ductal carcinomas of the breast and scored the tumors manually with staining intensity as the only parameter and by a combination of qualitative and quantitative information. The investigators also introduce an automated method for analyzing VEGF expression (so-called AI score) using the same tumor sections. Analysis of 100% of the tumor area was performed and the results were compared with the reduced analysis of 25% of the tumor area. These analyses were performed at ×5 and ×10 magnification, and each analysis was repeated in a second run with a new delineation of the tumor area. The AI scores were correlated to the manual scoring of VEGF intensity, but reproducibility of manual IHC scores was rather poor. The AI scores were reproducible, and the restricted analysis of 25% of the tumor area at ×5 magnifications was the most efficient considering time consumption and data load.     

Assessment of the effect of housing on feather damage in laying hens using IR thermography

Plumage damage represents one of the animal-based measures of laying hens welfare. Damage occurs predominantly due to age, environment and damaging pecking. IR thermography, due to its non-invasiveness, objectivity and repeatability is a promising alternative to feather damage scoring systems such as the system included in the Welfare Quality^R assessment protocol for poultry. The aim of this study was to apply IR thermography for the assessment of feather damage in laying hens kept in two housing systems and to compare the results with feather scoring. At the start of the experiment, 16-week-old laying hens (n=30) were divided into two treatments such as deep litter pen and enriched cage. During 4 months, feather damage was assessed regularly in 2-week intervals. One more single assessment was done nine and a half months after the start of the experiment. The feather damage on four body regions was assessed by scoring and IR thermography: head and neck, back and rump, belly, and underneck and breast. Two variables obtained by IR thermography were used: the difference between the body surface temperature and ambient temperature (ΔT_B) and the proportion of featherless areas, which were defined as areas with a temperature >33.5°C. Data were analyzed using a GLM model. The effects of housing, time, region and their interactions on feather damage, measured by the feather scoring and by both IR thermography measures, were all significant (P<0.001). The ΔT_B in all assessed regions correlated positively with the feather score. Feather scoring revealed higher damage in enriched cages compared with deep litter pens starting from week 6 of the experiment on the belly and back and rump regions, whereas ΔT_B from week 6 in the belly and from week 8 on the back and rump region. The proportion of featherless areas in the belly region differed significantly between the housings from week 8 of the experiment and on the back and rump region from week 12. The IR thermography assessment of the feather damage revealed differences between hens kept in different housing systems in agreement with the feather scoring. In conclusion, it was demonstrated that the IR thermography is a useful tool for the assessment of poultry feather cover quality that is not biased by the subjective component and provides higher precision than feather damage scoring.     

经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床疗效比较

目的:探讨和比较经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床效果和安全性。方法:回顾性分析2011年-2014年我院收治的明确诊断为腰椎间盘突出症并行经皮椎间孔镜或椎板开窗髓核摘除术患者192例,其中118例给予经皮椎间孔镜治疗(PELD组),74例给予椎板开窗髓核摘除术(对照)。结合随访资料,评价并比较两组患者在术前后的VAS疼痛评分、Mac Nab疗效、Lehmann腰椎功能评分及住院时间、费用、手术出血量以及并发症的发生情况。结果:两组患者的术后疼痛评分、Lehmann腰椎功能评分、Mac Nab疗效、总费用、手术时间比较均无统计学差异(P0.05),但PELD组术中出血量、切口长度、并发症的发生率均较对照组降低或减小,差异有统计学意义(P0.05)。结论:经皮椎间孔镜技术作为一种新型微创脊柱外科技术,能够在保证良好疗效的前提下,明显减少出血及并发症,在临床工作中可以进一步的开展。     

Testing equality of survival functions based on both paired and unpaired censored data

We introduce two test procedures for comparing two survival distributions on the basis of randomly right-censored data consisting of both paired and unpaired observations. Our procedures are based on generalizations of a pooled rank test statistic previously proposed for uncensored data. One generalization adapts the Prentice-Wilcoxon score, while the other adapts the Akritas score. The use of these particular scoring systems in pooled rank tests with randomly right-censored paired data has been advocated by several researchers. Our test procedures utilize the permutation distributions of the test statistics based on a novel manner of permuting the scores. Permutation versions of tests for right-censored paired data and for two independent right-censored samples that use the proposed scoring systems are obtained as special cases of our test procedures. Simulation results show that our test procedures have high power for detecting scale and location shifts in exponential and log-logistic distributions for the survival times. We also demonstrate the advantages of our test procedures in terms of utilizing randomly occurring unpaired observations that are discarded in test procedures for paired data. The tests are applied to skin graft data previously reported elsewhere.     

经皮椎板间内镜与椎板小开窗术治疗腰椎间盘突出症临床疗效比较

目的：分析和比较椎板间内镜与椎板小开窗术治疗腰椎间盘突出症的临床疗效和安全性指标。方法：使用回顾性分析的方法 对2012-2014 年共计126 例在我科行椎板间内镜手术或椎板小开窗手术的腰椎间盘突出患者进行分析和比较。通过纳入和排除 标准的筛选,经皮椎板间内镜组纳入48例,椎板小开窗组纳入78 例。结合详实的术后随访,对两组患者在花费,住院时间等一般 性指标,疼痛指标,功能指标,并发症等数据进行分析和比较。结果：两组患者在术后均取得明显的治疗疗效,在疼痛、功能等指标 中都有明显的改善。但两组之间并无明显统计学差异(P>0.05)。而椎板间内镜组在住院时间,出血量,切口长度及并发症等方面明 显的优于小开窗组,具有统计学意义(P<0.05)。结论：经皮椎板间内镜手术作为一种脊柱微创手术,治疗效果确切,安全性好,能体 现微创的优势,可作为椎间孔镜技术在治疗椎间盘突出症的有益补充,在临床中进一步的开展和推广。