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
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
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
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
Aimed at the remanufacturing system, the effect of the uncertainty of returns＇ quality on bottleneck shifting is investigated. A novel definition of bottleneck station is presented and the probability of a station be...Aimed at the remanufacturing system, the effect of the uncertainty of returns＇ quality on bottleneck shifting is investigated. A novel definition of bottleneck station is presented and the probability of a station becoming a bottleneck is also given. By calculating the effective output, the effective operation time （EOT） and the ratio of EOT of each station, the system＇s current bottleneck of effective output time is determined. By calculating the probability coefficient of variation and index of bottleneck shifting, the quantitative performance of bottleneck shifting is obtained. Discrete event simulation and the experiment design method are adopted to simulate the system, in which the proportion of quality grading, repair rates and process routes are considered. The case study shows that the uncertainty of returns＇ quality greatly increases the probability of bottleneck shifting, and with the increase of the discrete degree of the returns＇ repair rate, the bottleneck shifting phenomenon is more obvious. Furthermore, bottleneck shifting is closely related to the process route of the dominating returns＇ quality grade.展开更多
Background The reproducibility of the Nottingham modification of the Scarff-Bloom-Richardson （NSBR） histological grading system for invasive breast cancer （IBC） adopted by the World Health Organization （WHO） has...Background The reproducibility of the Nottingham modification of the Scarff-Bloom-Richardson （NSBR） histological grading system for invasive breast cancer （IBC） adopted by the World Health Organization （WHO） has previously not been studied in Chinese hospitals. The proliferation marker, Ki-67, has been widely applied in detecting IBC. The objective of this study was to assess the reproducibility of the NSBR system among Chinese pathologists and the complementary value that Ki-67 brings to this system.Methods Four general pathologists graded 100 IBC cases independently, which had previously been graded by specialists in breast pathology. The interobserver reproducibility among four general pathologists and pairwise reproducibility between each of them and the specialists were assessed. The Ki-67 labeling index （Ki-67LI） was determined by immunohistochemistry, and its correlations with histological grade and survival were determined.Results With respect to interobserver reproducibility, NSBR grading was fairly reproducible （kappa=0.34）; as for the components of NSBR grading, agreement was best for tubule formation （kappa=0.46）, intermediate for nuclear pleomorphism （kappa=0.42）, and poorest for mitotic count （kappa=0.28）. In terms of pairwise reproducibility, agreement was fair to substantial with NSBR grading （kappa=0.30-0.69） and nuclear pleomorphism （kappa=0.28-0.69）, moderate to substantial for tubule formation （kappa=0.51-0.78）, and slight to substantial for mitotic count （kappa=0.19-0.71）.There were characteristic Ki-67LI ranges for grades 1,2 and 3 tumors. Univariate analysis showed that Ki-67 was able to divide grade 2 patients into two different prognostic subgroups. Multivariate analysis of grade 2 patients with negative lymph node demonstrated that Ki-67 was an independent prognosticator for overall survival.Conclusions The reproducibility of grading by general pathologists could be enhanced. Specialization in breast pathology is essential for accurate grading and treatment for IBC. Ki-67, with proven prognostic significance, adds complementary value to the NSBR system.展开更多
Background The traditional approach to blunt aortic injury （BAI） has been emergent intervention. This study aimed to utilize a modified imaging grading system that may allow us to categorize these injuries as needin...Background The traditional approach to blunt aortic injury （BAI） has been emergent intervention. This study aimed to utilize a modified imaging grading system that may allow us to categorize these injuries as needing emergent, urgent, or non-operative management. Methods From January 2003 to December 2011, 28 patients with BAI were managed at our institution. Imaging and medical records were reviewed retrospectively. BAI was classified into 4 grades based on imaging studies. Grade la： intimal tear, Grade Ib： intramural hematoma; Grade Ⅱ： intimal injury with periaotic hematoma; Grade Ilia： aortic transection with pseudoaneurysm, Grade Illb： multiple aortic injuries; and Grade IV： free rupture. Progression and clinical outcomes of ABI were analyzed. Results Of the 28 patients, 22 were males and 6 were females with mean age of 38 （range, 7-69） years, Twenty-five （89.3%） had descending thoracic aortic injury, two （7.1%） had abdominal aortic injury and one （3.6%） presented with multiple aortic injuries. Three patients （10.7%） with Grade I, 1 （3.6%） Grade Ⅱ, 22 （78.6%） Grade Ⅲ, and 2 （7.1%） Grade IV injuries. Twenty-five patients underwent thoracic endovascular aortic repair and 3 were managed medically. Median time between injury and surgical intervention was （2±1） days. One （3.6%） patient developed paraplegia after thoracic endovascular aortic repair （TEVAR）. One Type 2 endoleak spontaneously sealed within 1 month, and another patient died from ruptured Type 1 endoleak 3 years later. Median follow-up time was 16 （range, 1-96） months. Perioperative 30-day mortality rate was 3.6%. Conclusions This study based on our modified BAI grading system indicated that Grade Ⅰ BAI can be managed conservatively. Grade Ⅱ injury requires close observation and repeated computerized tomography angiogram （CTA） within 48-72 hours. If injury appears worse on follow up imaging, surgery should be performed. Delayed repair of Grade Ⅲ BAI is acceptable if associated life threatenina traumatic iniuries need to be addressed first.展开更多
In order to objectively and reasonably evaluate the actual and potential value of cultivated land, both social and ecological values are introduced into the classification and grading index system of cultivated land b...In order to objectively and reasonably evaluate the actual and potential value of cultivated land, both social and ecological values are introduced into the classification and grading index system of cultivated land based on the viewpoint of sustainable development, after considering the natural and economic values of cultivated land. Index system construction of the sustainable utilization of cultivated land should follow the principles of economic viability, social acceptability, and ecological protection. Classification of cultivated land should take into account the soil fertility of cultivated land. Then, grading of cultivated land is carried out from the practical productivity (or potential productivity) of cultivated land. According to the existing classification index system of cultivated land, the soil, natural and environmental factors in plains, mountains and hills are mainly modified in the classification index system of cultivated land. And index systems for the cultivated land classification in plains, mountains and hills are set up. The grading index system of cultivated land is established based on the economic viability (economic value), social acceptability (social value) and protection of cultivated land (ecological value). Quantitative expression of cultivated land grading index is also carried out.展开更多
This paper discusses the urban land grading system based on the self_developed GIS software.The system establishes the system template,the relevant data structure and the empirical formulas of the affecting factor and...This paper discusses the urban land grading system based on the self_developed GIS software.The system establishes the system template,the relevant data structure and the empirical formulas of the affecting factor and economic data of land use.Besides,the system can calculate the service radius,sum and land grade automatically.Furthermore,it can do statistics and query on various land information and show the result of land grading with spatial and attribute data.This paper illustrates the result by giving an example of the commercial land grading of the urban area of Wuhan City by the urban land grading system.展开更多
At present, paid urban landuse system is one of the most important economic reform in China. In the other words, landuse right can be transferred and land users must pay the rent to the state according to the quality ...At present, paid urban landuse system is one of the most important economic reform in China. In the other words, landuse right can be transferred and land users must pay the rent to the state according to the quality of land. It is necessary toapply the theory of rent and location to the economic appraisal of urban land. China is vast in territory. Is's geographical condition and economic development vary from place to place, so does the urban land value. In order to reveal the difference of land value between different cities, the following method is used. (1) Analysing the factors and elements that affect the quality of urban land. Six factors including 17 elements were selected in this paper: macrolocation of a city, benefit of urban aggregation, infrastructure investment, output value of urban land, potential of urban land, and investment intensity. (2) Deciding the weight andvalue of each factor. (3) Appraising each element separately. (4) Accountingthe value of all factors and getting the total appraisal score of each city. (5) Grouping the 430 Chinese cities into sevencategories according to the appraisal values.The result shows that all the cities in the category with the highest land output values are in the coast belt, whereas most cities in the inland and outlying areas are belong to the category with low rank. For example, 87% of the cities in the outlying regions are belong to the lowest rank. Although there are some relationship between the size of cities and urban land rank, generally speaking, the larger the city, the higher the urban land rank. In fact, the locational condition is the most important factor which influences the rank of urban land.展开更多
Comprehensive surgical staging or optimal tumor cytoreductive surgery of malignant ovarian cancer directly affects disease prognosis.Therefore,a fluorescent selenium nanoparticle(Se@RGD/S2.2)decorated with cancer-targ...Comprehensive surgical staging or optimal tumor cytoreductive surgery of malignant ovarian cancer directly affects disease prognosis.Therefore,a fluorescent selenium nanoparticle(Se@RGD/S2.2)decorated with cancer-targeting Arg-Gly-Asp(RGD)peptides and GCAGTTGATCCTTTGGATACCCTGG aptamer(S2.2)was developed for use as a diagnostic agent to achieve rapid,noninvasive diagnosis and visualization of microinvasive lesions during surgery for malignant ovarian cancer.展开更多
Diabetic Retinopathy(DR)is an eye disease that mainly affects people with diabetes.People affected by DR start losing their vision from an early stage even though the symptoms are identified only at the later stage.On...Diabetic Retinopathy(DR)is an eye disease that mainly affects people with diabetes.People affected by DR start losing their vision from an early stage even though the symptoms are identified only at the later stage.Once the vision is lost,it cannot be regained but can be prevented from causing any further damage.Early diagnosis of DR is required for preventing vision loss,for which a trained ophthalmologist is required.The clinical practice is time-consuming and is not much successful in identifying DR at early stages.Hence,Computer-Aided Diagnosis(CAD)system is a suitable alternative for screening and grading of DR for a larger population.This paper addresses the different stages in CAD system and the challenges in identifying and grading of DR by analyzing various recently evolved techniques.The performance metrics used to evaluate the Computer-Aided Diagnosis system for clinical practice is also discussed.展开更多
To meet the requirements of college English teaching under the new situation and enhance the ability of college students to learn the English independently,modern information technology means is used to have a try and...To meet the requirements of college English teaching under the new situation and enhance the ability of college students to learn the English independently,modern information technology means is used to have a try and an experiment.English grading teaching is taken as the starting point,due to construct a mixed formative evaluation system,and provide a reference for improving the effects of college English teaching.展开更多
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.
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.
基金The Program for Special Talent in Six Fields of Jiangsu Province(No.2013ZBZZ-046)the Program of Lanzhou Technology Development(No.2014-1-175)
文摘Aimed at the remanufacturing system, the effect of the uncertainty of returns＇ quality on bottleneck shifting is investigated. A novel definition of bottleneck station is presented and the probability of a station becoming a bottleneck is also given. By calculating the effective output, the effective operation time （EOT） and the ratio of EOT of each station, the system＇s current bottleneck of effective output time is determined. By calculating the probability coefficient of variation and index of bottleneck shifting, the quantitative performance of bottleneck shifting is obtained. Discrete event simulation and the experiment design method are adopted to simulate the system, in which the proportion of quality grading, repair rates and process routes are considered. The case study shows that the uncertainty of returns＇ quality greatly increases the probability of bottleneck shifting, and with the increase of the discrete degree of the returns＇ repair rate, the bottleneck shifting phenomenon is more obvious. Furthermore, bottleneck shifting is closely related to the process route of the dominating returns＇ quality grade.
文摘Background The reproducibility of the Nottingham modification of the Scarff-Bloom-Richardson （NSBR） histological grading system for invasive breast cancer （IBC） adopted by the World Health Organization （WHO） has previously not been studied in Chinese hospitals. The proliferation marker, Ki-67, has been widely applied in detecting IBC. The objective of this study was to assess the reproducibility of the NSBR system among Chinese pathologists and the complementary value that Ki-67 brings to this system.Methods Four general pathologists graded 100 IBC cases independently, which had previously been graded by specialists in breast pathology. The interobserver reproducibility among four general pathologists and pairwise reproducibility between each of them and the specialists were assessed. The Ki-67 labeling index （Ki-67LI） was determined by immunohistochemistry, and its correlations with histological grade and survival were determined.Results With respect to interobserver reproducibility, NSBR grading was fairly reproducible （kappa=0.34）; as for the components of NSBR grading, agreement was best for tubule formation （kappa=0.46）, intermediate for nuclear pleomorphism （kappa=0.42）, and poorest for mitotic count （kappa=0.28）. In terms of pairwise reproducibility, agreement was fair to substantial with NSBR grading （kappa=0.30-0.69） and nuclear pleomorphism （kappa=0.28-0.69）, moderate to substantial for tubule formation （kappa=0.51-0.78）, and slight to substantial for mitotic count （kappa=0.19-0.71）.There were characteristic Ki-67LI ranges for grades 1,2 and 3 tumors. Univariate analysis showed that Ki-67 was able to divide grade 2 patients into two different prognostic subgroups. Multivariate analysis of grade 2 patients with negative lymph node demonstrated that Ki-67 was an independent prognosticator for overall survival.Conclusions The reproducibility of grading by general pathologists could be enhanced. Specialization in breast pathology is essential for accurate grading and treatment for IBC. Ki-67, with proven prognostic significance, adds complementary value to the NSBR system.
文摘Background The traditional approach to blunt aortic injury （BAI） has been emergent intervention. This study aimed to utilize a modified imaging grading system that may allow us to categorize these injuries as needing emergent, urgent, or non-operative management. Methods From January 2003 to December 2011, 28 patients with BAI were managed at our institution. Imaging and medical records were reviewed retrospectively. BAI was classified into 4 grades based on imaging studies. Grade la： intimal tear, Grade Ib： intramural hematoma; Grade Ⅱ： intimal injury with periaotic hematoma; Grade Ilia： aortic transection with pseudoaneurysm, Grade Illb： multiple aortic injuries; and Grade IV： free rupture. Progression and clinical outcomes of ABI were analyzed. Results Of the 28 patients, 22 were males and 6 were females with mean age of 38 （range, 7-69） years, Twenty-five （89.3%） had descending thoracic aortic injury, two （7.1%） had abdominal aortic injury and one （3.6%） presented with multiple aortic injuries. Three patients （10.7%） with Grade I, 1 （3.6%） Grade Ⅱ, 22 （78.6%） Grade Ⅲ, and 2 （7.1%） Grade IV injuries. Twenty-five patients underwent thoracic endovascular aortic repair and 3 were managed medically. Median time between injury and surgical intervention was （2±1） days. One （3.6%） patient developed paraplegia after thoracic endovascular aortic repair （TEVAR）. One Type 2 endoleak spontaneously sealed within 1 month, and another patient died from ruptured Type 1 endoleak 3 years later. Median follow-up time was 16 （range, 1-96） months. Perioperative 30-day mortality rate was 3.6%. Conclusions This study based on our modified BAI grading system indicated that Grade Ⅰ BAI can be managed conservatively. Grade Ⅱ injury requires close observation and repeated computerized tomography angiogram （CTA） within 48-72 hours. If injury appears worse on follow up imaging, surgery should be performed. Delayed repair of Grade Ⅲ BAI is acceptable if associated life threatenina traumatic iniuries need to be addressed first.
基金Supported by the Key Project of Chinese Ministry of Education ( 108098)the National Natural Science Foundation of China ( 40671078,40771088)the Dangui Plan of Huazhong Normal University
文摘In order to objectively and reasonably evaluate the actual and potential value of cultivated land, both social and ecological values are introduced into the classification and grading index system of cultivated land based on the viewpoint of sustainable development, after considering the natural and economic values of cultivated land. Index system construction of the sustainable utilization of cultivated land should follow the principles of economic viability, social acceptability, and ecological protection. Classification of cultivated land should take into account the soil fertility of cultivated land. Then, grading of cultivated land is carried out from the practical productivity (or potential productivity) of cultivated land. According to the existing classification index system of cultivated land, the soil, natural and environmental factors in plains, mountains and hills are mainly modified in the classification index system of cultivated land. And index systems for the cultivated land classification in plains, mountains and hills are set up. The grading index system of cultivated land is established based on the economic viability (economic value), social acceptability (social value) and protection of cultivated land (ecological value). Quantitative expression of cultivated land grading index is also carried out.
文摘This paper discusses the urban land grading system based on the self_developed GIS software.The system establishes the system template,the relevant data structure and the empirical formulas of the affecting factor and economic data of land use.Besides,the system can calculate the service radius,sum and land grade automatically.Furthermore,it can do statistics and query on various land information and show the result of land grading with spatial and attribute data.This paper illustrates the result by giving an example of the commercial land grading of the urban area of Wuhan City by the urban land grading system.
文摘At present, paid urban landuse system is one of the most important economic reform in China. In the other words, landuse right can be transferred and land users must pay the rent to the state according to the quality of land. It is necessary toapply the theory of rent and location to the economic appraisal of urban land. China is vast in territory. Is's geographical condition and economic development vary from place to place, so does the urban land value. In order to reveal the difference of land value between different cities, the following method is used. (1) Analysing the factors and elements that affect the quality of urban land. Six factors including 17 elements were selected in this paper: macrolocation of a city, benefit of urban aggregation, infrastructure investment, output value of urban land, potential of urban land, and investment intensity. (2) Deciding the weight andvalue of each factor. (3) Appraising each element separately. (4) Accountingthe value of all factors and getting the total appraisal score of each city. (5) Grouping the 430 Chinese cities into sevencategories according to the appraisal values.The result shows that all the cities in the category with the highest land output values are in the coast belt, whereas most cities in the inland and outlying areas are belong to the category with low rank. For example, 87% of the cities in the outlying regions are belong to the lowest rank. Although there are some relationship between the size of cities and urban land rank, generally speaking, the larger the city, the higher the urban land rank. In fact, the locational condition is the most important factor which influences the rank of urban land.
基金supported by the National Natural Science Foundation of China (Nos. 21877049, 32171296)Guangdong Natural Science Foundation (No. 2020B1515120043)+3 种基金Major Program for Tackling Key Problems of Industrial Technology in Guangzhou (No. 201902020013)Innovation Team Project in Guangdong Colleges and Universities (No. 2019KCXTD008)Guangdong Basic and Applied Basic Research Fund Project (No. 2021A1515111027)the Fundamental Research Funds for the Central Universities (No. 21620310)
文摘Comprehensive surgical staging or optimal tumor cytoreductive surgery of malignant ovarian cancer directly affects disease prognosis.Therefore,a fluorescent selenium nanoparticle(Se@RGD/S2.2)decorated with cancer-targeting Arg-Gly-Asp(RGD)peptides and GCAGTTGATCCTTTGGATACCCTGG aptamer(S2.2)was developed for use as a diagnostic agent to achieve rapid,noninvasive diagnosis and visualization of microinvasive lesions during surgery for malignant ovarian cancer.
文摘Diabetic Retinopathy(DR)is an eye disease that mainly affects people with diabetes.People affected by DR start losing their vision from an early stage even though the symptoms are identified only at the later stage.Once the vision is lost,it cannot be regained but can be prevented from causing any further damage.Early diagnosis of DR is required for preventing vision loss,for which a trained ophthalmologist is required.The clinical practice is time-consuming and is not much successful in identifying DR at early stages.Hence,Computer-Aided Diagnosis(CAD)system is a suitable alternative for screening and grading of DR for a larger population.This paper addresses the different stages in CAD system and the challenges in identifying and grading of DR by analyzing various recently evolved techniques.The performance metrics used to evaluate the Computer-Aided Diagnosis system for clinical practice is also discussed.
文摘To meet the requirements of college English teaching under the new situation and enhance the ability of college students to learn the English independently,modern information technology means is used to have a try and an experiment.English grading teaching is taken as the starting point,due to construct a mixed formative evaluation system,and provide a reference for improving the effects of college English teaching.
