BACKGROUND The optimal approach for managing hepatic hemangioma is controversial.AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience.MET...BACKGROUND The optimal approach for managing hepatic hemangioma is controversial.AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience.METHODS A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018.Patients were classified into four groups based on the clinical grading system and treatment:(1)Observation group with score<4(Obs score<4);(2)Surgical group with score<4(Sur score<4);(3)Observation group with score≥4(Obs score≥4);and(4)Surgical group with score≥4(Sur score≥4).The clinico-pathological index and outcomes were evaluated.RESULTS There were significantly fewer symptomatic patients in surgical groups(Sur score≥4 vs Obs score≥4,P<0.001;Sur score<4 vs Obs score<4,χ^(2)=8.60,P=0.004;Sur score≥4 vs Obs score<4,P<0.001).The patients in Sur score≥4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score≥4(P<0.001;P<0.001).Nevertheless,there was no significant difference in need for intervention and total patients with adverse event between the Sur score<4 and Obs score<4(P>0.05;χ^(2)=1.68,P>0.05).CONCLUSION This clinical grading system appeared as a practical tool for hepatic hemangioma.Surgery can be suggested for patients with a score≥4.For those with<4,follow-up should be proposed.展开更多
We compared the predictive ability of the 2014 and 2005 Gleason grading systems in 568 patients initially diagnosed with metastatic prostate cancer （PCa）. Outcomes included the duration of castration-resistant prost...We compared the predictive ability of the 2014 and 2005 Gleason grading systems in 568 patients initially diagnosed with metastatic prostate cancer （PCa）. Outcomes included the duration of castration-resistant prostate cancer-free survival （CFS） and overall survival （OS）. Univariate analyses and log-rank tests were used to identify prognosis indicators and assess univariable differences in CFS and OS in Gleason score （GS） groups. Cox proportional hazards and area under the curves of receiver operator characteristics methods were used to evaluate the predictive efficacy of the 2005 and 2014 ISUP grading systems. Univariate analyses showed that the 2005 and 2014 grading systems were prognosticators for CFS and OS; both systems could distinguish the clinical outcome of patients with GS 6, GS 7, and GS 8-10. Using the 2014 criteria, no statistical differences in patient survival were observed between GS 3 ＋ 4 and GS 4 ＋ 3 or GS 8 and GS 9-10. The predictive ability of the 2014 and 2005 grading systems was comparable for CFS and OS （P = 0.321）. However, the 2014 grading system did not exhibit superior predictive efficacy in patients initially diagnosed with PCa and bone metastasis; trials using larger cohorts are required to confirm its predictive value. To the best of our knowledge, ours is the first study to compare the 2005 and 2014 grading systems in initially diagnosed PCa with bone metastasis. At present, we recommend that both systems should be used to predict the prognosis of patients with metastatic PCa.展开更多
In the past half century, more than twenty facial grading systems have been developed to assess the facial nerve function after the onset of facial nerve paralysis and during rehabilitation.
BACKGROUND Claudin 7 is often abnormally expressed in cancers and promotes the progression of some malignancies. However, the role of claudin 7 in stage Ⅱ colorectal cancer(CRC) has not been studied.AIM To assess the...BACKGROUND Claudin 7 is often abnormally expressed in cancers and promotes the progression of some malignancies. However, the role of claudin 7 in stage Ⅱ colorectal cancer(CRC) has not been studied.AIM To assess the expression and prognostic value of claudin 7 in stage Ⅱ CRC.METHODS We retrospectively studied 231 stage Ⅱ CRC patients who underwent radical surgery at our hospital from 2013 to 2014. The protein expression level of claudin7 was assessed and its relationship with clinicopathological features and prognosis was statistically analyzed. The independent prognostic factors were identified by Cox proportional hazards models. A prognostic grading system was constructed to stratify the survival of CRC patients.RESULTS The expression of claudin 7 was significantly reduced in cancer tissues compared with normal tissues(P < 0.001), and its low expression was closely related to recurrence of the disease(P = 0.017). Multivariate analysis confirmed that claudin7 low expression(claudin 7-low)(P = 0.028) and perineural invasion positivity(PNI+)(P = 0.026) were independent predictors of poor disease-free survival(DFS). A prognostic grading system based on the status of claudin 7 and PNI classified the patients into three prognostic grades: grade A(claudin 7-high and PNI-), grade B(claudin 7-low and PNI-, claudin 7-high and PNI+), and grade C(claudin 7-low and PNI+). The DFS was significantly different among the three grades(grade B vs grade A, P = 0.032;grade C vs grade A, P < 0.001;grade C vs grade B, P = 0.040).CONCLUSION Claudin 7 can be used as a new prognostic marker to predict the DFS of patients with stage Ⅱ CRC. The prognostic grading system with the addition of claudin 7 can further improve prognosis stratification of patients.展开更多
The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the Intern...The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology （ISUP） in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/ UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new ＂Grade Group＂ system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.展开更多
Automated grading of colon biopsy images across all magnifications is challenging because of tailored segmentation and dependent features on each magnification.This work presents a novel approach of robust magnificati...Automated grading of colon biopsy images across all magnifications is challenging because of tailored segmentation and dependent features on each magnification.This work presents a novel approach of robust magnification-independent colon cancer grading framework to distinguish colon biopsy images into four classes:normal,well,moderate,and poor.The contribution of this research is to develop a magnification invariant hybrid feature set comprising cartoon feature,Gabor wavelet,wavelet moments,HSV histogram,color auto-correlogram,color moments,and morphological features that can be used to characterize different grades.Besides,the classifier is modeled as a multiclass structure with six binary class Bayesian optimized random forest(BO-RF)classifiers.This study uses four datasets(two collected from Indian hospitals—Ishita Pathology Center(IPC)of 4X,10X,and 40X and Aster Medcity(AMC)of 10X,20X,and 40X—two benchmark datasets—gland segmentation(GlaS)of 20X and IMEDIATREAT of 10X)comprising multiple microscope magnifications.Experimental results demonstrate that the proposed method outperforms the other methods used for colon cancer grading in terms of accuracy(97.25%-IPC,94.40%-AMC,97.58%-GlaS,99.16%-Imediatreat),sensitivity(0.9725-IPC,0.9440-AMC,0.9807-GlaS,0.9923-Imediatreat),specificity(0.9908-IPC,0.9813-AMC,0.9907-GlaS,0.9971-Imediatreat)and F-score(0.9725-IPC,0.9441-AMC,0.9780-GlaS,0.9923-Imediatreat).The generalizability of the model to any magnified input image is validated by training in one dataset and testing in another dataset,highlighting strong concordance in multiclass classification and evidencing its effective use in the first level of automatic biopsy grading and second opinion.展开更多
BACKGROUND Current tumor regression grade(TRG)evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results.The recent six-tier system(JGCA2017-TRG)recommen...BACKGROUND Current tumor regression grade(TRG)evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results.The recent six-tier system(JGCA2017-TRG)recommended by the Japanese Gastric Cancer Association(JGCA)is worth investigating,as four-tier TRG systems are favored in various parts of the world.AIM To compare the predictive accuracies of five published TRG systems.METHODS Data were retrospectively collected from patients with locally advanced gastric cancer(LAGC)who underwent neoadjuvant chemotherapy followed by D2 Lymphadenectomy between January 2005 and January 2014 at our institution.Outcomes were overall survival(OS)and disease-free survival(DFS),which were evaluated separately using the following TRG systems:JGCA2017,JGCA,Becker,AJCC/CAP,and Mandard.RESULTS All five published TRG systems were independent predictors for OS and DFS.Concordance indices of the JGCA2017,JGCA,Becker,AJCC/CAP-TRG,and Mandard systems were 0.651/0.6480.652/0.649,0.693/0.695,0.688/0.685,and 0.674/0.675 for OS and DFS,respectively.The four-tier Becker system showed the highest c-index,which was significantly greater than that of the six-tier JGCA2017 and five-tier JGCA systems(P<0.05 in OS and DFS).When residual tumor percentages were reset as:“no residual tumor”,<10%,<100%,and“no response”,the rearranged cutoff values achieved a maximum c-index with 0.728 for OS and 0.737 for DFS,which was superior to the other five systems.CONCLUSION The newly introduced six-tier JGCA-TRG system cannot increase prognostic stratification.The four-tier Becker system is more suitable for LAGC patients.A population-based study is warranted to define the optimal criterion for TRG in LAGC patients.展开更多
Objective The present study attempted to evaluate the value of neoadjuvant chemotherapy in limiteddisease small cell lung cancer(LD-SCLC),and to identify the predictive value of the tumor regression grading(TRG) syste...Objective The present study attempted to evaluate the value of neoadjuvant chemotherapy in limiteddisease small cell lung cancer(LD-SCLC),and to identify the predictive value of the tumor regression grading(TRG) system in LD-SCLC treatment-response and prognosis.Methods The records of patients with LD-SCLC(p-Stage I–IIIa) who underwent definitive radical resection at Shaanxi Provincial People's Hospital between March 1,2000 and March 31,2014 were retrospectively analyzed.We compared the disease-free survival(DFS) and overall survival(OS) rates between Group A patients(patients who underwent surgery combined with pre-and post-operative chemotherapy) and Group B patients(patients who underwent surgery combined with adjuvant chemotherapy only) using the Kaplan-Meier method and the Mantel-Cox test.The specimens of patients who received neoadjuvant chemotherapy were reassessed according to the TRG system.Results The median DFS for 27 patients was 16.267 months and the median OS was 81.167 months(1-year OS,74.07%;3-year OS,22.22%;5-year OS,14.81%).Thirteen patients received neoadjuvant chemotherapy,and their specimens were reassessed by TRG(pathological complete remission,3/13,23.08%).Patients in group A had a longer OS than those in group B(mean,93.782 months versus 42.322 months,P = 0.025),although there was no significant difference in DFS between the two groups(median 20.100 months versus 14.667 months,P = 0.551).Statistical analysis revealed that TRG Grade(G) 0(mean,61.222 months) was associated with better OS than G1-2(mean,31.213 months)(P = 0.311).Conclusion Our study indicated that neoadjuvant chemotherapy combined with surgical resection may represent a feasible treatment method for patients with LD-SCLC.The TRG system may be a valuable prediction tool to assess neoadjuvant chemotherapeutic efficacy,especially in patients with G0 disease as determined by TRG;these patients may attain an improved survival benefit with neoadjuvant chemotherapy.展开更多
Background: Ventral hernia is a complex and progressive condition that may lead to serious complications. However, no specified grading or classifying system is found to categorize the hernia, which leads to clinical ...Background: Ventral hernia is a complex and progressive condition that may lead to serious complications. However, no specified grading or classifying system is found to categorize the hernia, which leads to clinical complexities and may affect the patient outcome. Aim: The general aim of this paper is to build up an easy and comprehensive grading system to categorize ventral hernia. Methodology: By carrying out a secondary search over clinical presentation, physical examination, and imaging studies of ventral hernia, a valid grading system is developed. Results: Hanoon’s grading system is composed of seven grades, grades 1, 2A, 2B, 3A, 3B, 3C, and 4. Each grade entailed different clinical presentations, imaging characteristics, and progressivity of ventral hernia. Conclusion: Hanoon’s grading system for ventral hernia can be used to solve the clinical complexities of ventral hernia. Also, it can be a step forward in hernia research to build upon.展开更多
This study aims to explore the correlation between plasma homocysteine (Hcy) levels and the clinical grading of varicocele (VC) when analyzing the potential pathogenesis of endothelial cells injury by Hcy. A total of ...This study aims to explore the correlation between plasma homocysteine (Hcy) levels and the clinical grading of varicocele (VC) when analyzing the potential pathogenesis of endothelial cells injury by Hcy. A total of 184 VC patients, aged 18–46 years, were included in this study. These patients visited The Second Hospital of Dalian Medical University (Dalian, China), between January 2022 and September 2024. Patients were divided into three groups based on clinical grading: Group A (59 cases, Grade I), Group B (28 cases, Grade II), and Group C (97 cases, Grade III). Additionally, 120 individuals with normal fertility test results during the same period were selected as the control group. Routine blood and biochemical indices were collected from the patients. Differences in clinical indices between groups were compared, and univariate and multivariate linear regression analyses were performed to identify factors associated with clinical grading. The results showed that the median Hcy levels in the control group and in patients with Grade I, II, and III VC were 9.56 (interquartile range [IQR]: 8.66, 14.02) µmol l−1, 11.28 (IQR: 9.71, 14.55) µmol l−1, 11.84 (IQR: 10.14, 15.60) µmol l−1, and 12.27 (IQR: 9.52, 15.40) µmol l−1, respectively. The differences between the four groups were statistically significant (χ2 = 12.41, P = 0.006). Multivariate regression analysis indicated that Hcy is a factor associated with the clinical grading of VC (t = 2.53, P = 0.013). Hcy is associated with the clinical grading and may have clinical value in assessing severity of VC.展开更多
In order to clarify the preparation process parameters of manufactured sand,optimize its quality,and analyze the effect of its grading on the microstructure of concrete,the three-dimensional models of jaw crusher,vibr...In order to clarify the preparation process parameters of manufactured sand,optimize its quality,and analyze the effect of its grading on the microstructure of concrete,the three-dimensional models of jaw crusher,vibrating screen and conveyor belt were established by using SolidWorks 2016 software.Rocky DEM4.5 software was used to simulate the initial crushing,screening,and transportation stages of the manufactured sand preparation process,with Linear Spring Dashpot as the normal contact model and Coulomb as the tangential contact model;furthermore,the key process parameters were defined.The manufactured sand grading model was then proposed,thereby,the influence of the grading of manufactured sand on the distribution of pore structure in concrete and the interfacial transition zone(ITZ)was studied.The experimetal results show that the particle size of granite,after being crushed in the jaw crusher,is primarily concentrated between 80 and 130 mm,with a crushing energy consumption typically below 100000 J.However,certain instances of granite exhibit higher energy consumption due to undergoing multiple crushings within the chamber.At the same time,the granite causes significant wear on the jaw crusher plate.Furthermore,the tilt angle of the vibrating screen should be adjusted to between 10 and 15 degrees,while the layout angle of the conveyor belt needs to be set at 16 degrees.The proposed manufactured sand grading model is feasible,and the pore diameter distribution inside concrete increases with an increase in the fineness modulus of manufactured sand.展开更多
Innovation in learning algorithms has made retinal vessel segmentation and automatic grading tech-niques crucial for clinical diagnosis and prevention of diabetic retinopathy.The traditional methods struggle with accu...Innovation in learning algorithms has made retinal vessel segmentation and automatic grading tech-niques crucial for clinical diagnosis and prevention of diabetic retinopathy.The traditional methods struggle with accuracy and reliability due to multi-scale variations in retinal blood vessels and the complex pathological relationship in fundus images associated with diabetic retinopathy.While the single-modal diabetic retinopathy grading network addresses class imbalance challenges and lesion representation in fundus image data,dual-modal diabetic retinopathy grading methods offer superior performance.However,the scarcity of dual-modal data and the lack of effective feature fusion methods limit their potential due to multi-scale variations.This paper addresses these issues by focusing on multi-scale retinal vessel segmentation,dual feature fusion,data augmentation,and attention-based grading.The proposed model aims to improve comprehensive segmentation for retinal images with varying vessel thicknesses.It employs a dual-branch parallel architecture that integrates a transformer encoder with a convolutional neural network encoder to extract local and global information for synergistic saliency learning.Besides that,the model uses residual structures and attention modules to extract critical lesions,enhancing the accuracy and reliability of diabetic retinopathy grading.To evaluate the efficacy of the proposed approach,this study compared it with other pre-trained publicly open models,ResNet152V2,ConvNext,Efficient Net,DenseNet,and Swin Transform,with the same developmental parameters.All models achieved approximately 85%accuracy with the same image preparation method.However,the proposed approach outperforms and optimizes existing models by achieving an accuracy of 99.17%,99.04%,and 99.24%,on Kaggle APTOS19,IDRiD,and EyePACS datasets,respectively.These results support the model’s utility in helping ophthalmologists diagnose diabetic retinopathy more rapidly and accurately.展开更多
Addressing challenges in accurately detecting persimmon fruit quality in orchards—such as reliance on manual grading,low efficiency,severe foliage obstruction,and subtle differences between quality grades—this paper...Addressing challenges in accurately detecting persimmon fruit quality in orchards—such as reliance on manual grading,low efficiency,severe foliage obstruction,and subtle differences between quality grades—this paper proposes a lightweight persimmon detection model based on an improved YOLOv8s architecture.First,the Conv layer in the backbone network is replaced with an ADown module to reduce model complexity.Second,MSFAN is introduced in the Neck layer to fully extract texture features from persimmon images,highlighting differences between quality grades.Finally,the Wise-IoU loss function mitigates the impact of low-quality sample data on grading accuracy.The improved model accurately identifies and separates persimmons of varying quality,effectively addressing quality grading detection in complex backgrounds.This provides a viable technical approach for achieving persimmon quality grading detection.展开更多
As a paddy—upland rotation system, tobacco—rice rotation hastypical characteristics in the formation and evolution of soil fertility duringthe tobacco season with dry farming and rice season with water cultivation.T...As a paddy—upland rotation system, tobacco—rice rotation hastypical characteristics in the formation and evolution of soil fertility duringthe tobacco season with dry farming and rice season with water cultivation.To scientifically unveil the soil fertility formation process and grade thesoil fertility in tobacco—rice rotation areas, we collected 372 soil samplesfrom 11 tobacco stations (Haotang, Aoquan, Chengjiao, Renyi, Fangyuan,Anping, Huangsha, Taiping, Tushi, Dashiqiao, and Baimangying) in thetypical tobacco—rice rotation areas of Chenzhou and Yongzhou in SouthernHunan. The physical, chemical, and biological indicators of the soil sampleswere measured, and the tobacco and rice yields of each tobacco stationwere investigated. Machine learning was employed to screen the keyindicators influencing the tobacco yield, and a comprehensive numericalanalysis method combining principal component analysis and discriminantanalysis were adopted to cluster the sampling points, analyze their fertilityformation processes, and grade the soil fertility. The results showed thatclay content, available phosphorus, plow layer depth, slit-to-clay ratio, totalnitrogen, basal respiration, and organic carbon were identified as seven keyindicators influencing the tobacco yield. The results of the comprehensivenumerical analysis predicted two main processes involved in the formationof soil fertility in tobacco—rice rotation areas. One was the soil maturationprocess related to soil carbon and nitrogen cycling, and the other was theprocess of changes in soil physical properties such as clay content and slitto-clay ratio. According to the established soil fertility grading methodfor tobacco—rice rotation areas, the soil fertility of 11 tobacco stationswas graded. The results showed that the soil fertility was high in Haotang,Aoquan, Renyi, and Dashiqiao, medium in Huangsha and Tushi, and low inAnping, Baimangying, and Taiping. The tobacco and rice yields confirmedthat this grading standard can be effectively applied to the grading of soilfertility in the tobacco—rice rotation areas in Southern Hunan and canprovide a scientific basis for soil management in tobacco—rice rotation.展开更多
One in every eight men in the US is diagnosed with prostate cancer,making it the most common cancer in men.Gleason grading is one of the most essential diagnostic and prognostic factors for planning the treatment of p...One in every eight men in the US is diagnosed with prostate cancer,making it the most common cancer in men.Gleason grading is one of the most essential diagnostic and prognostic factors for planning the treatment of prostate cancer patients.Traditionally,urological pathologists perform the grading by scoring the morphological pattern,known as the Gleason pattern,in histopathology images.However,thismanual grading is highly subjective,suffers intra-and inter-pathologist variability and lacks reproducibility.An automated grading system could be more efficient,with no subjectivity and higher accuracy and reproducibility.Automated methods presented previously failed to achieve sufficient accuracy,lacked reproducibility and depended on high-resolution images such as 40×.This paper proposes an automated Gleason grading method,ProGENET,to accurately predict the grade using low-resolution images such as 10×.This method first divides the patient’s histopathology whole slide image(WSI)into patches.Then,it detects artifacts and tissue-less regions and predicts the patch-wise grade using an ensemble network of CNN and transformer models.The proposed method adapted the International Society of Urological Pathology(ISUP)grading system and achieved 90.8%accuracy in classifying the patches into healthy and Gleason grades 1 through 5 using 10×WSI,outperforming the state-of-the-art accuracy by 27%.Finally,the patient’s grade was determined by combining the patch-wise results.The method was also demonstrated for 4−class grading and binary classification of prostate cancer,achieving 93.0%and 99.6%accuracy,respectively.The reproducibility was over 90%.Since the proposedmethod determined the grades with higher accuracy and reproducibility using low-resolution images,it is more reliable and effective than existing methods and can potentially improve subsequent therapy decisions.展开更多
BACKGROUND Esophageal squamous cell carcinoma is a major histological subtype of esophageal cancer.Many molecular genetic changes are associated with its occurrence.Raman spectroscopy has become a new method for the e...BACKGROUND Esophageal squamous cell carcinoma is a major histological subtype of esophageal cancer.Many molecular genetic changes are associated with its occurrence.Raman spectroscopy has become a new method for the early diagnosis of tumors because it can reflect the structures of substances and their changes at the molecular level.AIM To detect alterations in Raman spectral information across different stages of esophageal neoplasia.METHODS Different grades of esophageal lesions were collected,and a total of 360 groups of Raman spectrum data were collected.A 1D-transformer network model was proposed to handle the task of classifying the spectral data of esophageal squamous cell carcinoma.In addition,a deep learning model was applied to visualize the Raman spectral data and interpret their molecular characteristics.RESULTS A comparison among Raman spectral data with different pathological grades and a visual analysis revealed that the Raman peaks with significant differences were concentrated mainly at 1095 cm^(-1)(DNA,symmetric PO,and stretching vibration),1132 cm^(-1)(cytochrome c),1171 cm^(-1)(acetoacetate),1216 cm^(-1)(amide III),and 1315 cm^(-1)(glycerol).A comparison among the training results of different models revealed that the 1Dtransformer network performed best.A 93.30%accuracy value,a 96.65%specificity value,a 93.30%sensitivity value,and a 93.17%F1 score were achieved.CONCLUSION Raman spectroscopy revealed significantly different waveforms for the different stages of esophageal neoplasia.The combination of Raman spectroscopy and deep learning methods could significantly improve the accuracy of classification.展开更多
With the continuous advancement of the internationalization of higher education in China,the Grade Point Average(GPA)has become a primary indicator for evaluating academic performance in universities,playing a positiv...With the continuous advancement of the internationalization of higher education in China,the Grade Point Average(GPA)has become a primary indicator for evaluating academic performance in universities,playing a positive role in educational management.However,as it is closely tied to students’immediate interests,such as awards,exemptions from entrance exams for postgraduate recommendations,and domestic or international further education,certain new issues have emerged in its practical application.These problems have hindered the effective functioning of the GPA system,attracting widespread attention.This paper examines the origin,connotation,and theoretical assumptions of the GPA system,discusses its positive functions and existing challenges,and proposes recommendations for further improving academic evaluation.展开更多
Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal(GI)injury in critically ill patients[the GI Dysfunction Score(GID...Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal(GI)injury in critically ill patients[the GI Dysfunction Score(GIDS)and the Acute Gastroin-testinal Injury(AGI)grade].The authors note that this study is the first proposal that suggests an equivalence between the ability of both scores to predict mor-tality at 28 days from intensive care unit(ICU)admission.Shen et al retrospec-tively analysed an ICU cohort of patients utilising two physicians administering both the AGI grade and GIDS score,using electronic healthcare records and ICU flowsheets.Where these physicians disagreed about the scores,the final decision as to the scores was made by an associate chief physician,or chief physician.We note that the primary reason for the development of GIDS was to create a clear score for GI dysfunction,with minimal subjectivity or inter-operator variability.The subjectivity inherent to the older AGI grading system is what ultimately led to the development of GIDS in 2021.By ensuring consensus between physicians administering the AGI,Shen et al have controlled for one of this grading systems biggest issues.We have concerns,however,that this does not represent the real-world challenges associated with applying the AGI compared to the newer GIDS,and wonder if this arbitration process had not been instituted,would the two scoring systems remain equivalent in terms of predicted mortality?展开更多
Background Different diagnostic and grading systems of conjunctivochalasis have resulted in apparent disparity between the prevalence rates of recent population-based studies.This study aimed to investigate the dispar...Background Different diagnostic and grading systems of conjunctivochalasis have resulted in apparent disparity between the prevalence rates of recent population-based studies.This study aimed to investigate the disparity between 4-level system cited from Meller and Tseng in 1998 （abbreviated here as Meller＇s system） and 5-level system modified from Meller＇s system cited from Zhang and associates （abbreviated here as Zhang＇s system） regarding the diagnosis and the patients＇ preferences for the treatment of conjunctivochalasis in the general population.Methods A total of 546 senile residents living in the Guiyangyuan community of Shanghai,China,participated in the study.The diagnostic criteria for conjunctivochalasis were based on two diagnostic grading systems：Meller＇s system and Zhang＇s system,which was modified from Meller＇s system.The participants＇ preference regarding medical treatment for conjunctivochalasis was determined according to the response to a question.One year later,a follow-up interview determines whether the patient had undergone surgery for conjunctivochalasis.Results With Meller＇s system,398 participants were confirmed as having conjunctivochalasis,and the prevalence rate was 72.89％.According to Zhang＇s system,only 213 participants were diagnosed as having conjunctivochalasis,and the prevalence rate was 39.01％.A total of 109 eyes underwent medical treatment or surgery for conjunctivochalasis in the following year,including eight eyes that were diagnosed as grade Ⅱ and 101 eyes that were diagnosed as grade Ⅲ according to Meller＇s system and five eyes that were diagnosed as grade Ⅰ,55 eyes that were diagnosed as grade Ⅱ,31 eyes that were diagnosed as grade Ⅲ,and 18 eyes that were diagnosed as grade Ⅳ according to Zhang＇s system.Conclusion Diagnoses of conjunctivochalasis using Zhang＇s system are more consistent with patient requests and the medical treatment strategies used than diagnoses made using Meller＇s system.展开更多
文摘BACKGROUND The optimal approach for managing hepatic hemangioma is controversial.AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience.METHODS A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018.Patients were classified into four groups based on the clinical grading system and treatment:(1)Observation group with score<4(Obs score<4);(2)Surgical group with score<4(Sur score<4);(3)Observation group with score≥4(Obs score≥4);and(4)Surgical group with score≥4(Sur score≥4).The clinico-pathological index and outcomes were evaluated.RESULTS There were significantly fewer symptomatic patients in surgical groups(Sur score≥4 vs Obs score≥4,P<0.001;Sur score<4 vs Obs score<4,χ^(2)=8.60,P=0.004;Sur score≥4 vs Obs score<4,P<0.001).The patients in Sur score≥4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score≥4(P<0.001;P<0.001).Nevertheless,there was no significant difference in need for intervention and total patients with adverse event between the Sur score<4 and Obs score<4(P>0.05;χ^(2)=1.68,P>0.05).CONCLUSION This clinical grading system appeared as a practical tool for hepatic hemangioma.Surgery can be suggested for patients with a score≥4.For those with<4,follow-up should be proposed.
基金This work was supported by the Natural Science Foundation of China （NSFC 81172439, 81272820, and 81402110）.
文摘We compared the predictive ability of the 2014 and 2005 Gleason grading systems in 568 patients initially diagnosed with metastatic prostate cancer （PCa）. Outcomes included the duration of castration-resistant prostate cancer-free survival （CFS） and overall survival （OS）. Univariate analyses and log-rank tests were used to identify prognosis indicators and assess univariable differences in CFS and OS in Gleason score （GS） groups. Cox proportional hazards and area under the curves of receiver operator characteristics methods were used to evaluate the predictive efficacy of the 2005 and 2014 ISUP grading systems. Univariate analyses showed that the 2005 and 2014 grading systems were prognosticators for CFS and OS; both systems could distinguish the clinical outcome of patients with GS 6, GS 7, and GS 8-10. Using the 2014 criteria, no statistical differences in patient survival were observed between GS 3 ＋ 4 and GS 4 ＋ 3 or GS 8 and GS 9-10. The predictive ability of the 2014 and 2005 grading systems was comparable for CFS and OS （P = 0.321）. However, the 2014 grading system did not exhibit superior predictive efficacy in patients initially diagnosed with PCa and bone metastasis; trials using larger cohorts are required to confirm its predictive value. To the best of our knowledge, ours is the first study to compare the 2005 and 2014 grading systems in initially diagnosed PCa with bone metastasis. At present, we recommend that both systems should be used to predict the prognosis of patients with metastatic PCa.
文摘In the past half century, more than twenty facial grading systems have been developed to assess the facial nerve function after the onset of facial nerve paralysis and during rehabilitation.
基金Supported by the Beijing Science and Technology Program,No.D171100002617004.
文摘BACKGROUND Claudin 7 is often abnormally expressed in cancers and promotes the progression of some malignancies. However, the role of claudin 7 in stage Ⅱ colorectal cancer(CRC) has not been studied.AIM To assess the expression and prognostic value of claudin 7 in stage Ⅱ CRC.METHODS We retrospectively studied 231 stage Ⅱ CRC patients who underwent radical surgery at our hospital from 2013 to 2014. The protein expression level of claudin7 was assessed and its relationship with clinicopathological features and prognosis was statistically analyzed. The independent prognostic factors were identified by Cox proportional hazards models. A prognostic grading system was constructed to stratify the survival of CRC patients.RESULTS The expression of claudin 7 was significantly reduced in cancer tissues compared with normal tissues(P < 0.001), and its low expression was closely related to recurrence of the disease(P = 0.017). Multivariate analysis confirmed that claudin7 low expression(claudin 7-low)(P = 0.028) and perineural invasion positivity(PNI+)(P = 0.026) were independent predictors of poor disease-free survival(DFS). A prognostic grading system based on the status of claudin 7 and PNI classified the patients into three prognostic grades: grade A(claudin 7-high and PNI-), grade B(claudin 7-low and PNI-, claudin 7-high and PNI+), and grade C(claudin 7-low and PNI+). The DFS was significantly different among the three grades(grade B vs grade A, P = 0.032;grade C vs grade A, P < 0.001;grade C vs grade B, P = 0.040).CONCLUSION Claudin 7 can be used as a new prognostic marker to predict the DFS of patients with stage Ⅱ CRC. The prognostic grading system with the addition of claudin 7 can further improve prognosis stratification of patients.
基金supported by grants from the Natural Science Foundation of China (NSFC 81272848, 81272820, 81302225, 81572540)
文摘The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology （ISUP） in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/ UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new ＂Grade Group＂ system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.
基金This work was partially supported by the Research Groups Program(Research Group Number RG-1439-033),under the Deanship of Scientific Research,King Saud University,Riyadh,Saudi Arabia.
文摘Automated grading of colon biopsy images across all magnifications is challenging because of tailored segmentation and dependent features on each magnification.This work presents a novel approach of robust magnification-independent colon cancer grading framework to distinguish colon biopsy images into four classes:normal,well,moderate,and poor.The contribution of this research is to develop a magnification invariant hybrid feature set comprising cartoon feature,Gabor wavelet,wavelet moments,HSV histogram,color auto-correlogram,color moments,and morphological features that can be used to characterize different grades.Besides,the classifier is modeled as a multiclass structure with six binary class Bayesian optimized random forest(BO-RF)classifiers.This study uses four datasets(two collected from Indian hospitals—Ishita Pathology Center(IPC)of 4X,10X,and 40X and Aster Medcity(AMC)of 10X,20X,and 40X—two benchmark datasets—gland segmentation(GlaS)of 20X and IMEDIATREAT of 10X)comprising multiple microscope magnifications.Experimental results demonstrate that the proposed method outperforms the other methods used for colon cancer grading in terms of accuracy(97.25%-IPC,94.40%-AMC,97.58%-GlaS,99.16%-Imediatreat),sensitivity(0.9725-IPC,0.9440-AMC,0.9807-GlaS,0.9923-Imediatreat),specificity(0.9908-IPC,0.9813-AMC,0.9907-GlaS,0.9971-Imediatreat)and F-score(0.9725-IPC,0.9441-AMC,0.9780-GlaS,0.9923-Imediatreat).The generalizability of the model to any magnified input image is validated by training in one dataset and testing in another dataset,highlighting strong concordance in multiclass classification and evidencing its effective use in the first level of automatic biopsy grading and second opinion.
基金the Beijing Municipal Health Commission,No.DFL20181103 and No.ZYLX201701.
文摘BACKGROUND Current tumor regression grade(TRG)evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results.The recent six-tier system(JGCA2017-TRG)recommended by the Japanese Gastric Cancer Association(JGCA)is worth investigating,as four-tier TRG systems are favored in various parts of the world.AIM To compare the predictive accuracies of five published TRG systems.METHODS Data were retrospectively collected from patients with locally advanced gastric cancer(LAGC)who underwent neoadjuvant chemotherapy followed by D2 Lymphadenectomy between January 2005 and January 2014 at our institution.Outcomes were overall survival(OS)and disease-free survival(DFS),which were evaluated separately using the following TRG systems:JGCA2017,JGCA,Becker,AJCC/CAP,and Mandard.RESULTS All five published TRG systems were independent predictors for OS and DFS.Concordance indices of the JGCA2017,JGCA,Becker,AJCC/CAP-TRG,and Mandard systems were 0.651/0.6480.652/0.649,0.693/0.695,0.688/0.685,and 0.674/0.675 for OS and DFS,respectively.The four-tier Becker system showed the highest c-index,which was significantly greater than that of the six-tier JGCA2017 and five-tier JGCA systems(P<0.05 in OS and DFS).When residual tumor percentages were reset as:“no residual tumor”,<10%,<100%,and“no response”,the rearranged cutoff values achieved a maximum c-index with 0.728 for OS and 0.737 for DFS,which was superior to the other five systems.CONCLUSION The newly introduced six-tier JGCA-TRG system cannot increase prognostic stratification.The four-tier Becker system is more suitable for LAGC patients.A population-based study is warranted to define the optimal criterion for TRG in LAGC patients.
文摘Objective The present study attempted to evaluate the value of neoadjuvant chemotherapy in limiteddisease small cell lung cancer(LD-SCLC),and to identify the predictive value of the tumor regression grading(TRG) system in LD-SCLC treatment-response and prognosis.Methods The records of patients with LD-SCLC(p-Stage I–IIIa) who underwent definitive radical resection at Shaanxi Provincial People's Hospital between March 1,2000 and March 31,2014 were retrospectively analyzed.We compared the disease-free survival(DFS) and overall survival(OS) rates between Group A patients(patients who underwent surgery combined with pre-and post-operative chemotherapy) and Group B patients(patients who underwent surgery combined with adjuvant chemotherapy only) using the Kaplan-Meier method and the Mantel-Cox test.The specimens of patients who received neoadjuvant chemotherapy were reassessed according to the TRG system.Results The median DFS for 27 patients was 16.267 months and the median OS was 81.167 months(1-year OS,74.07%;3-year OS,22.22%;5-year OS,14.81%).Thirteen patients received neoadjuvant chemotherapy,and their specimens were reassessed by TRG(pathological complete remission,3/13,23.08%).Patients in group A had a longer OS than those in group B(mean,93.782 months versus 42.322 months,P = 0.025),although there was no significant difference in DFS between the two groups(median 20.100 months versus 14.667 months,P = 0.551).Statistical analysis revealed that TRG Grade(G) 0(mean,61.222 months) was associated with better OS than G1-2(mean,31.213 months)(P = 0.311).Conclusion Our study indicated that neoadjuvant chemotherapy combined with surgical resection may represent a feasible treatment method for patients with LD-SCLC.The TRG system may be a valuable prediction tool to assess neoadjuvant chemotherapeutic efficacy,especially in patients with G0 disease as determined by TRG;these patients may attain an improved survival benefit with neoadjuvant chemotherapy.
文摘Background: Ventral hernia is a complex and progressive condition that may lead to serious complications. However, no specified grading or classifying system is found to categorize the hernia, which leads to clinical complexities and may affect the patient outcome. Aim: The general aim of this paper is to build up an easy and comprehensive grading system to categorize ventral hernia. Methodology: By carrying out a secondary search over clinical presentation, physical examination, and imaging studies of ventral hernia, a valid grading system is developed. Results: Hanoon’s grading system is composed of seven grades, grades 1, 2A, 2B, 3A, 3B, 3C, and 4. Each grade entailed different clinical presentations, imaging characteristics, and progressivity of ventral hernia. Conclusion: Hanoon’s grading system for ventral hernia can be used to solve the clinical complexities of ventral hernia. Also, it can be a step forward in hernia research to build upon.
文摘This study aims to explore the correlation between plasma homocysteine (Hcy) levels and the clinical grading of varicocele (VC) when analyzing the potential pathogenesis of endothelial cells injury by Hcy. A total of 184 VC patients, aged 18–46 years, were included in this study. These patients visited The Second Hospital of Dalian Medical University (Dalian, China), between January 2022 and September 2024. Patients were divided into three groups based on clinical grading: Group A (59 cases, Grade I), Group B (28 cases, Grade II), and Group C (97 cases, Grade III). Additionally, 120 individuals with normal fertility test results during the same period were selected as the control group. Routine blood and biochemical indices were collected from the patients. Differences in clinical indices between groups were compared, and univariate and multivariate linear regression analyses were performed to identify factors associated with clinical grading. The results showed that the median Hcy levels in the control group and in patients with Grade I, II, and III VC were 9.56 (interquartile range [IQR]: 8.66, 14.02) µmol l−1, 11.28 (IQR: 9.71, 14.55) µmol l−1, 11.84 (IQR: 10.14, 15.60) µmol l−1, and 12.27 (IQR: 9.52, 15.40) µmol l−1, respectively. The differences between the four groups were statistically significant (χ2 = 12.41, P = 0.006). Multivariate regression analysis indicated that Hcy is a factor associated with the clinical grading of VC (t = 2.53, P = 0.013). Hcy is associated with the clinical grading and may have clinical value in assessing severity of VC.
基金Funded by the National Natural Science Foundation of China(Nos.U21A20150,51978339,and 52178237)。
文摘In order to clarify the preparation process parameters of manufactured sand,optimize its quality,and analyze the effect of its grading on the microstructure of concrete,the three-dimensional models of jaw crusher,vibrating screen and conveyor belt were established by using SolidWorks 2016 software.Rocky DEM4.5 software was used to simulate the initial crushing,screening,and transportation stages of the manufactured sand preparation process,with Linear Spring Dashpot as the normal contact model and Coulomb as the tangential contact model;furthermore,the key process parameters were defined.The manufactured sand grading model was then proposed,thereby,the influence of the grading of manufactured sand on the distribution of pore structure in concrete and the interfacial transition zone(ITZ)was studied.The experimetal results show that the particle size of granite,after being crushed in the jaw crusher,is primarily concentrated between 80 and 130 mm,with a crushing energy consumption typically below 100000 J.However,certain instances of granite exhibit higher energy consumption due to undergoing multiple crushings within the chamber.At the same time,the granite causes significant wear on the jaw crusher plate.Furthermore,the tilt angle of the vibrating screen should be adjusted to between 10 and 15 degrees,while the layout angle of the conveyor belt needs to be set at 16 degrees.The proposed manufactured sand grading model is feasible,and the pore diameter distribution inside concrete increases with an increase in the fineness modulus of manufactured sand.
基金funded by Princess Nourah bint Abdulrahman University and Researchers Supporting Project number(PNURSP2025R346)Princess Nourah bint Abdulrahman University,Riyadh,Saudi Arabia.
文摘Innovation in learning algorithms has made retinal vessel segmentation and automatic grading tech-niques crucial for clinical diagnosis and prevention of diabetic retinopathy.The traditional methods struggle with accuracy and reliability due to multi-scale variations in retinal blood vessels and the complex pathological relationship in fundus images associated with diabetic retinopathy.While the single-modal diabetic retinopathy grading network addresses class imbalance challenges and lesion representation in fundus image data,dual-modal diabetic retinopathy grading methods offer superior performance.However,the scarcity of dual-modal data and the lack of effective feature fusion methods limit their potential due to multi-scale variations.This paper addresses these issues by focusing on multi-scale retinal vessel segmentation,dual feature fusion,data augmentation,and attention-based grading.The proposed model aims to improve comprehensive segmentation for retinal images with varying vessel thicknesses.It employs a dual-branch parallel architecture that integrates a transformer encoder with a convolutional neural network encoder to extract local and global information for synergistic saliency learning.Besides that,the model uses residual structures and attention modules to extract critical lesions,enhancing the accuracy and reliability of diabetic retinopathy grading.To evaluate the efficacy of the proposed approach,this study compared it with other pre-trained publicly open models,ResNet152V2,ConvNext,Efficient Net,DenseNet,and Swin Transform,with the same developmental parameters.All models achieved approximately 85%accuracy with the same image preparation method.However,the proposed approach outperforms and optimizes existing models by achieving an accuracy of 99.17%,99.04%,and 99.24%,on Kaggle APTOS19,IDRiD,and EyePACS datasets,respectively.These results support the model’s utility in helping ophthalmologists diagnose diabetic retinopathy more rapidly and accurately.
基金National Natural Science Foundation of China(61703363,62272284)Shanxi Provincial Basic Research Program(201801D121148)Yuncheng University Research and Innovation Team for Data Mining and Industrial Intelligence Applications(YCXYTD-202402)。
文摘Addressing challenges in accurately detecting persimmon fruit quality in orchards—such as reliance on manual grading,low efficiency,severe foliage obstruction,and subtle differences between quality grades—this paper proposes a lightweight persimmon detection model based on an improved YOLOv8s architecture.First,the Conv layer in the backbone network is replaced with an ADown module to reduce model complexity.Second,MSFAN is introduced in the Neck layer to fully extract texture features from persimmon images,highlighting differences between quality grades.Finally,the Wise-IoU loss function mitigates the impact of low-quality sample data on grading accuracy.The improved model accurately identifies and separates persimmons of varying quality,effectively addressing quality grading detection in complex backgrounds.This provides a viable technical approach for achieving persimmon quality grading detection.
文摘As a paddy—upland rotation system, tobacco—rice rotation hastypical characteristics in the formation and evolution of soil fertility duringthe tobacco season with dry farming and rice season with water cultivation.To scientifically unveil the soil fertility formation process and grade thesoil fertility in tobacco—rice rotation areas, we collected 372 soil samplesfrom 11 tobacco stations (Haotang, Aoquan, Chengjiao, Renyi, Fangyuan,Anping, Huangsha, Taiping, Tushi, Dashiqiao, and Baimangying) in thetypical tobacco—rice rotation areas of Chenzhou and Yongzhou in SouthernHunan. The physical, chemical, and biological indicators of the soil sampleswere measured, and the tobacco and rice yields of each tobacco stationwere investigated. Machine learning was employed to screen the keyindicators influencing the tobacco yield, and a comprehensive numericalanalysis method combining principal component analysis and discriminantanalysis were adopted to cluster the sampling points, analyze their fertilityformation processes, and grade the soil fertility. The results showed thatclay content, available phosphorus, plow layer depth, slit-to-clay ratio, totalnitrogen, basal respiration, and organic carbon were identified as seven keyindicators influencing the tobacco yield. The results of the comprehensivenumerical analysis predicted two main processes involved in the formationof soil fertility in tobacco—rice rotation areas. One was the soil maturationprocess related to soil carbon and nitrogen cycling, and the other was theprocess of changes in soil physical properties such as clay content and slitto-clay ratio. According to the established soil fertility grading methodfor tobacco—rice rotation areas, the soil fertility of 11 tobacco stationswas graded. The results showed that the soil fertility was high in Haotang,Aoquan, Renyi, and Dashiqiao, medium in Huangsha and Tushi, and low inAnping, Baimangying, and Taiping. The tobacco and rice yields confirmedthat this grading standard can be effectively applied to the grading of soilfertility in the tobacco—rice rotation areas in Southern Hunan and canprovide a scientific basis for soil management in tobacco—rice rotation.
基金supported by Princess Nourah bint Abdulrahman University Researchers Supporting Project number(PNURSP2025R104),Princess Nourah bint Abdulrahman University,Riyadh,Saudi Arabia.
文摘One in every eight men in the US is diagnosed with prostate cancer,making it the most common cancer in men.Gleason grading is one of the most essential diagnostic and prognostic factors for planning the treatment of prostate cancer patients.Traditionally,urological pathologists perform the grading by scoring the morphological pattern,known as the Gleason pattern,in histopathology images.However,thismanual grading is highly subjective,suffers intra-and inter-pathologist variability and lacks reproducibility.An automated grading system could be more efficient,with no subjectivity and higher accuracy and reproducibility.Automated methods presented previously failed to achieve sufficient accuracy,lacked reproducibility and depended on high-resolution images such as 40×.This paper proposes an automated Gleason grading method,ProGENET,to accurately predict the grade using low-resolution images such as 10×.This method first divides the patient’s histopathology whole slide image(WSI)into patches.Then,it detects artifacts and tissue-less regions and predicts the patch-wise grade using an ensemble network of CNN and transformer models.The proposed method adapted the International Society of Urological Pathology(ISUP)grading system and achieved 90.8%accuracy in classifying the patches into healthy and Gleason grades 1 through 5 using 10×WSI,outperforming the state-of-the-art accuracy by 27%.Finally,the patient’s grade was determined by combining the patch-wise results.The method was also demonstrated for 4−class grading and binary classification of prostate cancer,achieving 93.0%and 99.6%accuracy,respectively.The reproducibility was over 90%.Since the proposedmethod determined the grades with higher accuracy and reproducibility using low-resolution images,it is more reliable and effective than existing methods and can potentially improve subsequent therapy decisions.
基金Supported by Beijing Hospitals Authority Youth Programme,No.QML20200505.
文摘BACKGROUND Esophageal squamous cell carcinoma is a major histological subtype of esophageal cancer.Many molecular genetic changes are associated with its occurrence.Raman spectroscopy has become a new method for the early diagnosis of tumors because it can reflect the structures of substances and their changes at the molecular level.AIM To detect alterations in Raman spectral information across different stages of esophageal neoplasia.METHODS Different grades of esophageal lesions were collected,and a total of 360 groups of Raman spectrum data were collected.A 1D-transformer network model was proposed to handle the task of classifying the spectral data of esophageal squamous cell carcinoma.In addition,a deep learning model was applied to visualize the Raman spectral data and interpret their molecular characteristics.RESULTS A comparison among Raman spectral data with different pathological grades and a visual analysis revealed that the Raman peaks with significant differences were concentrated mainly at 1095 cm^(-1)(DNA,symmetric PO,and stretching vibration),1132 cm^(-1)(cytochrome c),1171 cm^(-1)(acetoacetate),1216 cm^(-1)(amide III),and 1315 cm^(-1)(glycerol).A comparison among the training results of different models revealed that the 1Dtransformer network performed best.A 93.30%accuracy value,a 96.65%specificity value,a 93.30%sensitivity value,and a 93.17%F1 score were achieved.CONCLUSION Raman spectroscopy revealed significantly different waveforms for the different stages of esophageal neoplasia.The combination of Raman spectroscopy and deep learning methods could significantly improve the accuracy of classification.
文摘With the continuous advancement of the internationalization of higher education in China,the Grade Point Average(GPA)has become a primary indicator for evaluating academic performance in universities,playing a positive role in educational management.However,as it is closely tied to students’immediate interests,such as awards,exemptions from entrance exams for postgraduate recommendations,and domestic or international further education,certain new issues have emerged in its practical application.These problems have hindered the effective functioning of the GPA system,attracting widespread attention.This paper examines the origin,connotation,and theoretical assumptions of the GPA system,discusses its positive functions and existing challenges,and proposes recommendations for further improving academic evaluation.
文摘Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal(GI)injury in critically ill patients[the GI Dysfunction Score(GIDS)and the Acute Gastroin-testinal Injury(AGI)grade].The authors note that this study is the first proposal that suggests an equivalence between the ability of both scores to predict mor-tality at 28 days from intensive care unit(ICU)admission.Shen et al retrospec-tively analysed an ICU cohort of patients utilising two physicians administering both the AGI grade and GIDS score,using electronic healthcare records and ICU flowsheets.Where these physicians disagreed about the scores,the final decision as to the scores was made by an associate chief physician,or chief physician.We note that the primary reason for the development of GIDS was to create a clear score for GI dysfunction,with minimal subjectivity or inter-operator variability.The subjectivity inherent to the older AGI grading system is what ultimately led to the development of GIDS in 2021.By ensuring consensus between physicians administering the AGI,Shen et al have controlled for one of this grading systems biggest issues.We have concerns,however,that this does not represent the real-world challenges associated with applying the AGI compared to the newer GIDS,and wonder if this arbitration process had not been instituted,would the two scoring systems remain equivalent in terms of predicted mortality?
文摘Background Different diagnostic and grading systems of conjunctivochalasis have resulted in apparent disparity between the prevalence rates of recent population-based studies.This study aimed to investigate the disparity between 4-level system cited from Meller and Tseng in 1998 （abbreviated here as Meller＇s system） and 5-level system modified from Meller＇s system cited from Zhang and associates （abbreviated here as Zhang＇s system） regarding the diagnosis and the patients＇ preferences for the treatment of conjunctivochalasis in the general population.Methods A total of 546 senile residents living in the Guiyangyuan community of Shanghai,China,participated in the study.The diagnostic criteria for conjunctivochalasis were based on two diagnostic grading systems：Meller＇s system and Zhang＇s system,which was modified from Meller＇s system.The participants＇ preference regarding medical treatment for conjunctivochalasis was determined according to the response to a question.One year later,a follow-up interview determines whether the patient had undergone surgery for conjunctivochalasis.Results With Meller＇s system,398 participants were confirmed as having conjunctivochalasis,and the prevalence rate was 72.89％.According to Zhang＇s system,only 213 participants were diagnosed as having conjunctivochalasis,and the prevalence rate was 39.01％.A total of 109 eyes underwent medical treatment or surgery for conjunctivochalasis in the following year,including eight eyes that were diagnosed as grade Ⅱ and 101 eyes that were diagnosed as grade Ⅲ according to Meller＇s system and five eyes that were diagnosed as grade Ⅰ,55 eyes that were diagnosed as grade Ⅱ,31 eyes that were diagnosed as grade Ⅲ,and 18 eyes that were diagnosed as grade Ⅳ according to Zhang＇s system.Conclusion Diagnoses of conjunctivochalasis using Zhang＇s system are more consistent with patient requests and the medical treatment strategies used than diagnoses made using Meller＇s system.
