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Sample records for improves prognostic stratification

  1. Improving Clinical Risk Stratification at Diagnosis in Primary Prostate Cancer: A Prognostic Modelling Study.

    Directory of Open Access Journals (Sweden)

    Vincent J Gnanapragasam

    2016-08-01

    new five-stratum risk stratification system was produced, and its prognostic power was compared against the current system, with PCSM as the outcome. The results were analysed using a Cox hazards model, the log-rank test, Kaplan-Meier curves, competing-risks regression, and concordance indices. In the training set, the new risk stratification system identified distinct subgroups with different risks of PCSM in pair-wise comparison (p < 0.0001. Specifically, the new classification identified a very low-risk group (Group 1, a subgroup of intermediate-risk cancers with a low PCSM risk (Group 2, hazard ratio [HR] 1.62 [95% CI 0.96-2.75], and a subgroup of intermediate-risk cancers with an increased PCSM risk (Group 3, HR 3.35 [95% CI 2.04-5.49] (p < 0.0001. High-risk cancers were also sub-classified by the new system into subgroups with lower and higher PCSM risk: Group 4 (HR 5.03 [95% CI 3.25-7.80] and Group 5 (HR 17.28 [95% CI 11.2-26.67] (p < 0.0001, respectively. These results were recapitulated in the testing set and remained robust after inclusion of competing risks. In comparison to the current risk stratification system, the new system demonstrated improved prognostic performance, with a concordance index of 0.75 (95% CI 0.72-0.77 versus 0.69 (95% CI 0.66-0.71 (p < 0.0001. In an external cohort, the new system achieved a concordance index of 0.79 (95% CI 0.75-0.84 for predicting PCSM versus 0.66 (95% CI 0.63-0.69 (p < 0.0001 for the current NICE risk stratification system. The main limitations of the study were that it was registry based and that follow-up was relatively short.A novel and simple five-stratum risk stratification system outperforms the standard three-stratum risk stratification system in predicting the risk of PCSM at diagnosis in men with primary non-metastatic prostate cancer, even when accounting for competing risks. This model also allows delineation of new clinically relevant subgroups of men who might potentially receive more appropriate

  2. Improving Clinical Risk Stratification at Diagnosis in Primary Prostate Cancer: A Prognostic Modelling Study

    Science.gov (United States)

    Wright, Karen A.; Muir, Kenneth R.; Gavin, Anna

    2016-01-01

    . Using this approach, a new five-stratum risk stratification system was produced, and its prognostic power was compared against the current system, with PCSM as the outcome. The results were analysed using a Cox hazards model, the log-rank test, Kaplan-Meier curves, competing-risks regression, and concordance indices. In the training set, the new risk stratification system identified distinct subgroups with different risks of PCSM in pair-wise comparison (p < 0.0001). Specifically, the new classification identified a very low-risk group (Group 1), a subgroup of intermediate-risk cancers with a low PCSM risk (Group 2, hazard ratio [HR] 1.62 [95% CI 0.96–2.75]), and a subgroup of intermediate-risk cancers with an increased PCSM risk (Group 3, HR 3.35 [95% CI 2.04–5.49]) (p < 0.0001). High-risk cancers were also sub-classified by the new system into subgroups with lower and higher PCSM risk: Group 4 (HR 5.03 [95% CI 3.25–7.80]) and Group 5 (HR 17.28 [95% CI 11.2–26.67]) (p < 0.0001), respectively. These results were recapitulated in the testing set and remained robust after inclusion of competing risks. In comparison to the current risk stratification system, the new system demonstrated improved prognostic performance, with a concordance index of 0.75 (95% CI 0.72–0.77) versus 0.69 (95% CI 0.66–0.71) (p < 0.0001). In an external cohort, the new system achieved a concordance index of 0.79 (95% CI 0.75–0.84) for predicting PCSM versus 0.66 (95% CI 0.63–0.69) (p < 0.0001) for the current NICE risk stratification system. The main limitations of the study were that it was registry based and that follow-up was relatively short. Conclusions A novel and simple five-stratum risk stratification system outperforms the standard three-stratum risk stratification system in predicting the risk of PCSM at diagnosis in men with primary non-metastatic prostate cancer, even when accounting for competing risks. This model also allows delineation of new clinically relevant

  3. Prognostic stratification of ulcerated melanoma

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    Bønnelykke-Behrndtz, Marie L; Schmidt, Henrik; Christensen, Ib J

    2014-01-01

    OBJECTIVES: For patients with melanoma, ulceration is an important prognostic marker and interestingly also a predictive marker for the response of adjuvant interferon. A consensual definition and accurate assessment of ulceration are therefore crucial for proper staging and clinical management. We...... stratification of ulcerated lesions. METHODS: From H&E-stained sections, the status (presence vs absence), extent (percentage of the total tumor length), and type (infiltrative vs attenuative) of ulceration and epidermal involvement were evaluated from 385 patients with cutaneous melanoma. RESULTS: The presence...... of ulceration (hazard ratio [HR], 1.83), an attenuative type of ulceration (HR, 3.02), and excessive ulceration (HR, 3.57) were independent predictors of poor melanoma-specific survival. Further subdivision of minimal/moderate ulceration showed independent prognostic value only for lesions with epidermal...

  4. An Ultra-Deep Targeted Sequencing Gene Panel Improves the Prognostic Stratification of Patients With Advanced Oral Cavity Squamous Cell Carcinoma.

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    Liao, Chun-Ta; Chen, Shu-Jen; Lee, Li-Yu; Hsueh, Chuen; Yang, Lan-Yan; Lin, Chien-Yu; Fan, Kang-Hsing; Wang, Hung-Ming; Ng, Shu-Hang; Lin, Chih-Hung; Tsao, Chung-Kan; Chen, I-How; Chang, Kai-Ping; Huang, Shiang-Fu; Kang, Chung-Jan; Chen, Hua-Chien; Yen, Tzu-Chen

    2016-02-01

    An improved prognostic stratification of patients with oral cavity squamous cell carcinoma (OSCC) and pathologically positive (pN+) nodes is urgently needed. Here, we sought to examine whether an ultra-deep targeted sequencing (UDT-Seq) gene panel may improve the prognostic stratification in this patient group.A mutation-based signature affecting 10 genes (including genetic mutations in 6 oncogenes and 4 tumor suppressor genes) was devised to predict disease-free survival (DFS) in 345 primary tumor specimens obtained from pN+ OSCC patients. Of the 345 patients, 144 were extracapsular spread (ECS)-negative and 201 were ECS-positive. The 5-year locoregional control, distant metastases, disease-free, disease-specific, and overall survival (OS) rates served as outcome measures.The UDT-Seq panel was an independent risk factor (RF) for 5-year locoregional control (P = 0.0067), distant metastases (P = 0.0001), DFS (P stratification for all the survival endpoints as compared with traditional AJCC staging (P stratification than traditional AJCC staging. It was also able to predict prognosis in OSCC patients regardless of ECS presence.

  5. A clinically based prognostic index for diffuse large B-cell lymphoma with a cut-off at 70 years of age significantly improves prognostic stratification

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    Gang, Anne O; Pedersen, Michael; d'Amore, Francesco

    2015-01-01

    lesion. The optimal age cut-off was 70 years. In a MVA of albumin, lymphocyte count, sex, immunoglobulin G, bulky disease, hemoglobin and B-symptoms, only albumin was prognostic. We propose: (1) a modified DLBCL prognostic index (DLBCL-PI) including: age (70 years), performance status (PS), lactate...

  6. A clinically based prognostic index for diffuse large B-cell lymphoma with a cut-off at 70 years of age significantly improves prognostic stratification: population-based analysis from the Danish Lymphoma Registry.

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    Gang, Anne O; Pedersen, Michael; d'Amore, Francesco; Pedersen, Lars M; Jensen, Bo A; Jensen, Paw; Møller, Michael B; Mourits-Andersen, Hans T; Pedersen, Robert S; Klausen, Tobias W; de N Brown, Peter

    2015-01-01

    The introduction of rituximab and generally improved health among elderly patients have increased the survival of patients with diffuse large B-cell lymphoma (DLBCL). The International Prognostic Index (IPI) from 1992 is based on pre-rituximab data from clinical trials including several lymphoma subtypes. We applied IPI factors to a population-based rituximab-treated cohort of 1990 patients diagnosed 2000-2010 and explored new factors and the optimal prognostic age cut-off for DLBCL. Multivariate-analyses (MVA) confirmed the prognostic value of all IPI factors except the presence of > 1 extranodal lesion. The optimal age cut-off was 70 years. In a MVA of albumin, lymphocyte count, sex, immunoglobulin G, bulky disease, hemoglobin and B-symptoms, only albumin was prognostic. We propose: (1) a modified DLBCL prognostic index (DLBCL-PI) including: age (70 years), performance status (PS), lactate dehydrogenase (LDH), stage and albumin level, and (2) a separate age-adjusted DLBCL-PI for patients ≤ 70 years including PS, LDH, albumin level and > 1 extranodal lesion, however excluding stage.

  7. Importance of the plasma soluble HLA-G levels for prognostic stratification with traditional prognosticators in colorectal cancer.

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    Li, Jing-Bo; Ruan, Yan-Yun; Hu, Bin; Dong, Shan-Shan; Bi, Tie-Nan; Lin, Aifen; Yan, Wei-Hua

    2017-07-25

    An increased peripheral soluble HLA-G (sHLA-G) expression has been observed in various malignancies while its prognostic significance was rather limited. In this study, the prognostic value of plasma sHLA-G in 178 colorectal cancer (CRC) patients was investigated. sHLA-G levels were analyzed by specific enzyme-linked immunosorbent assay. Data showed sHLA-G levels were significantly increased in CRC patients compared with normal controls (36.8 U/ml vs 25.4 U/ml, p = 0.009). sHLA-G in the died were obviously higher than that of alive CRC patients (46.8 U/ml vs 27.4 U/ml, p = 0.012). Patients with sHLA-G above median levels (≥ 36.8 U/ml, sHLA-Ghigh) had a significantly shorter survival time than those with sHLA-Glow (G could be an independent prognostic factor for CRC patients. With stratification of clinical parameters in survival by sHLA-Glow and sHLA-Ghigh, sHLA-G exhibited a significant predictive value for CRC patients of the female (p = 0.036), the elder (p = 0.009), advanced tumor burden (T3 + 4, p = 0.038), regional lymph node status (N0, p = 0.041), both metastasis status (M0, p = 0.014) and (M1, p=0.018), and clinical stage (I + II, p = 0.018), respectively. Summary, our data demonstrated for the first time that sHLA-G levels is an independent prognosis factor and improves the prognostic stratification offered by traditional prognosticators in CRC patients.

  8. Genomics-based Approach and Prognostic Stratification Significance of Gene Mutations in Intermediate-risk Acute Myeloid Leukemia

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    Bian-Hong Wang

    2015-01-01

    Conclusions: NGS represents a pioneering and helpful approach to prognostic risk stratification of IR-AML patients. Further large-scale studies for comprehensive molecular analysis are needed to provide guidance and a theoretical basis for IR-AML prognostic stratification and clinical management.

  9. Significant clinical impact and prognostic stratification provided by FDG-PET in the staging of oesophageal cancer

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    Duong, Cuong P.; Demitriou, Helen; Thompson, Anne; Williams, David; Thomas, Robert J.S. [Peter MacCallum Cancer Centre, Division of Surgical Oncology, Melbourne (Australia); Weih, LeAnn [Peter MacCallum Cancer Centre, Statistical Center, Melbourne (Australia); Hicks, Rodney J. [Peter MacCallum Cancer Centre, Centre for Molecular Imaging, Melbourne (Australia)

    2006-07-15

    To evaluate the clinical impact of FDG-PET in staging oesophageal cancer and whether this information improves prognostic stratification. Impact was based on comparison of a prospectively recorded pre-PET plan with post-PET treatment in 68 consecutive patients undergoing primary staging. Survival was analysed using the Kaplan-Meier product limit method and the Cox proportional hazards regression model. FDG-PET findings impacted on the management of 27/68 patients (40%): in 12 therapy was changed from curative to palliative and in three from palliative to curative, while in 12 other patients there was a change in the treatment modality or delivery but not in the treatment intent. The median survival was 21 months, with post-PET stage and treatment intent both strongly associated with survival (p<0.001). Conventional stage was not able to clearly stratify this population. The use of FDG-PET for primary staging of oesophageal cancer changed the clinical management of more than one-third of patients and provided superior prognostic stratification compared with conventional investigations. (orig.)

  10. Prognostic stratification of acute pulmonary embolism: Focus on clinical aspects, imaging, and biomarkers

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    Luca Masotti

    2009-07-01

    Full Text Available Luca Masotti1, Marc Righini2, Nicolas Vuilleumier3, Fabio Antonelli4, Giancarlo Landini5, Roberto Cappelli6, Patrick Ray71Internal Medicine, 4Clinical Chemistry, Cecina Hospital, Cecina, Italy; 2Division of Angiology and Haemostasis, Department of Internal Medicine, Geneva University Hospital, Switzerland; 3Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals and University of Geneva, Switzerland; 5Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy; 6Thrombosis Center, University of Siena, Siena, Italy; 7Department of Emergency Medicine, Centre Hospitalo-Universitaire Pitié-Salpêtrière, UPMC Paris 6, Paris, FranceAbstract: Pulmonary embolism (PE represents a common disease in emergency medicine and guidelines for diagnosis and treatment have had wide diffusion. However, PE morbidity and mortality remain high, especially when associated to hemodynamic instability or right ventricular dysfunction. Prognostic stratification to identify high risk patients needing to receive more aggressive pharmacological and closer monitoring is of utmost importance. Modern guidelines for management of acute PE are based on risk stratification using either clinical, radiological, or laboratory findings. This article reviews the modern treatment of acute PE, which is customized upon patient prognosis. Accordingly the current risk stratification tools described in the literature such as clinical scores, echocardiography, helical computer tomography, and biomarkers will be reviewed.Keywords: pulmonary embolism, prognosis, troponin, BNP, NT-proBNP, echocardiography, computer tomography

  11. Genomics-based Approach and Prognostic Stratification Significance of Gene Mutations in Intermediate-risk Acute Myeloid Leukemia

    Institute of Scientific and Technical Information of China (English)

    Bian-Hong Wang; Yong-Hui Li; Li Yu

    2015-01-01

    Objective:Intermediate-risk acute myeloid leukemia (IR-AML),which accounts for a substantial number of AML cases,is highly heterogeneous.We systematically summarize the latest research progress on the significance ofgene mutations for prognostic stratification of IR-AML.Data Sources:We conducted a systemic search from the PubMed database up to October,2014 using various search terms and their combinations including IR-AML,gene mutations,mutational analysis,prognosis,risk stratification,next generation sequencing (NGS).Study Selection:Clinical or basic research articles on NGS and the prognosis of gene mutations in IR-AML were included.Results:The advent of the era of whole-genome sequencing has led to the discovery of an increasing number of molecular genetics aberrations that involved in leukemogenesis,and some of them have been used for prognostic risk stratification.Several studies have consistently identified that some gene mutations have prognostic relevance,however,there are still many controversies for some genes because of lacking sufficient evidence.In addition,tumor cells harbor hundreds of mutated genes and multiple mutations often coexist,therefore,single mutational analysis is not sufficient to make accurate prognostic predictions.The comprehensive analysis of multiple mutations based on sophisticated genomic technologies has raised increasing interest in recent years.Conclusions:NGS represents a pioneering and helpful approach to prognostic risk stratification of IR-AML patients.Further large-scale studies for comprehensive molecular analysis are needed to provide guidance and a theoretical basis for IR-AML prognostic stratification and clinical management.

  12. Prognostic value of health-related quality of life for death risk stratification in patients with unresectable glioblastoma.

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    Paquette, Brice; Vernerey, Dewi; Chauffert, Bruno; Dabakuyo, Sandrine; Feuvret, Loic; Taillandier, Luc; Frappaz, Didier; Taillia, Hervé; Schott, Roland; Ducray, François; Fabbro, Michel; Tennevet, Isabelle; Ghiringhelli, François; Guillamo, Jean-Sébastien; Durando, Xavier; Castera, Daniel; Frenay, Marc; Campello, Chantal; Dalban, Cécile; Skrzypski, Jérome; Chinot, Olivier; Anota, Amélie; Bonnetain, Franck

    2016-08-01

    Glioblastoma is the most common malignant brain tumor in adults. Baseline health-related quality of life (HRQoL) is a major subject of concern for these patients. We aimed to assess the independent prognostic value of HRQoL in unresectable glioblastoma (UGB) patients for death risk stratification. One hundred and thirty-four patients with UGB were enrolled from the TEMAVIR trial. HRQoL was evaluated at baseline using the EORTC QLQ-C30 and BN20 brain cancer module. Clinical and HRQoL parameters were evaluated in univariable and multivariable Cox analysis as prognostic factors for overall survival (OS). Performance assessment and internal validation of the final model were evaluated with Harrel's C-index, calibration plot, and bootstrap sample procedure. Two OS independent predictors were identified: future uncertainty and sensitivity deficit. The final model exhibited good calibration and acceptable discrimination (C statistic = 0.63). The internal validity of the model was verified with robust uncertainties around the hazard ratio. The prognostic score identified three groups of patients with distinctly different risk profiles with median OS estimated at 16.2, 9.2, and 4.5 months. We demonstrated the additional prognostic value of HRQoL in UGB for death risk stratification and provided a score that may help to guide clinical management and stratification in future clinical trials.

  13. Prognostic Biomarkers in Acute Coronary Syndromes: Risk Stratification Beyond Cardiac Troponins.

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    Eggers, K M; Lindahl, B

    2017-04-01

    Cardiac troponin (cTn) plays an essential role for assessment of outcome in acute coronary syndrome (ACS). However, the prognostic value of cTn is not absolute. In this mini-review, we summarize the evidence on the utility of established biomarkers of left-ventricular dysfunction, hemodynamic stress, inflammation, and renal dysfunction for risk prediction beyond cTn in ACS. Only few biomarkers consistently demonstrate additive prognostic value to cTn levels. The B-type natriuretic peptides (NPs) and growth-differentiation factor-15 (GDF-15) are most promising in this regard. However, there are uncertainties regarding the role of these biomarkers for guidance of treatment decisions, and their prognostic increment to cTn levels measured with high-sensitivity assays is largely unknown. The NPs and GDF-15 provide the strongest prognostic increment to cTn levels in ACS. However, the role of these biomarkers for clinical decision-making in contemporary settings has still to be defined.

  14. Prognostic value of cardiac biomarkers in the risk stratification of syncope: a systematic review.

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    Thiruganasambandamoorthy, Venkatesh; Ramaekers, Rosa; Rahman, Mohammed Omair; Stiell, Ian Gilmour; Sikora, Lindsey; Kelly, Sarah-Louise; Christ, Michael; Claret, Pierre-Geraud; Reed, Matthew James

    2015-12-01

    The role of cardiac biomarkers in risk stratification of syncope is unclear. We undertook a systematic review to assess their predictive value for short-term major adverse cardiovascular events (MACE). We conducted a systematic review using MEDLINE, EMBASE, DARE and Cochrane databases from inception to July 2014. We included studies involving adult syncope patients that evaluated cardiac biomarker levels for risk stratification during acute management and excluded case reports, reviews and studies involving children. Primary outcome (MACE) included death, cardiopulmonary resuscitation, myocardial infarction (MI), structural heart disease, pulmonary embolism, significant hemorrhage or cardiac procedural interventions. Secondary outcome analysis assessed for prediction of MI, cardiac syncope and death. Two reviewers extracted patient-level data based on the cut-off reported. Pooled sensitivities and specificities were calculated using patient-level data. A total of 1862 articles were identified, and 11 studies with 4246 patients were included. Studies evaluated 3 biomarkers: contemporary troponin (2693 patients), natriuretic peptides (1353 patients) and high-sensitive troponin (819 patients). The pooled sensitivities and specificities for MACE were: contemporary troponin 0.29 (95 % CI 0.24, 0.34) and 0.88 (95 % CI 0.86, 0.89); natriuretic peptides 0.77 (95 % CI 0.69, 0.85) and 0.73 (95 % CI 0.70, 0.76); high-sensitive troponin 0.74 (95 % CI 0.65, 0.83) and 0.65 (95 % CI 0.62, 0.69), respectively. Natriuretic peptides and high-sensitive troponin showed good diagnostic characteristics for both primary and secondary outcomes. Natriuretic peptides and high-sensitive troponin might be useful in risk stratification.

  15. 18F-FDG Uptake in Less Affected Lung Field Provides Prognostic Stratification in Patients with Interstitial Lung Disease.

    Science.gov (United States)

    Nobashi, Tomomi; Kubo, Takeshi; Nakamoto, Yuji; Handa, Tomohiro; Koyasu, Sho; Ishimori, Takayoshi; Mishima, Michiaki; Togashi, Kaori

    2016-12-01

    were independently prognostic of lung transplantation-free survival. A higher SUVmean indicated a poorer prognosis, especially in patients with moderate risk based on ILD-GAP index. SUVmean was significantly but moderately correlated with clinical indicators, providing independent prognostic information in patients with ILD. (18)F-FDG PET/CT may be helpful for monitoring and risk stratification of ILD patients. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  16. Positron emission tomography changes management and prognostic stratification in patients with oesophageal cancer: results of a multicentre prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Chatterton, B.E. [Royal Adelaide Hospital, Department of Nuclear Medicine and PET, Adelaide, SA (Australia); Ho Shon, I. [Liverpool Hospital, Department of Nuclear Medicine and PET, Sydney (Australia); Baldey, A. [MIA at Monash Medical Centre, Melbourne (Australia); Lenzo, N.; Patrikeos, A. [Sir Charles Gairdner Hospital, WA PET/Cyclotron Service, Perth (Australia); Kelley, B.; Wong, D. [The Wesley Hospital, Southern X-Ray Clinics, Brisbane (Australia); Ramshaw, J.E. [Australian and New Zealand Association of Physicians in Nuclear Medicine, Melbourne (Australia); Scott, A.M. [Austin Hospital, Centre for PET, and Ludwig Institute for Cancer Research, Melbourne (Australia)

    2009-03-15

    The aims of this study were (1) to determine the incremental information provided by {sup 18}F-FDG positron emission tomography (PET) in staging patients with oesophageal cancer, and (2) to determine the impact of PET staging on post-PET clinical management of oesophageal cancer, and on prognosis. In a multicentre, single-arm open study, patients with proved oesophageal cancer without definite distant metastases and regarded as suitable for potentially curative treatment were examined by PET. Clinicians were requested to supply a management plan before and another plan after being supplied with the PET scan results. Patients were followed for at least 1 year for outcome analysis. A total of 129 patients (104 men, mean age 67 y) were recruited. PET detected additional sites of disease in 53 patients (41%). Significant changes in management (high or medium impact) were observed in 38% of patients, primarily as a result of identifying additional sites of disease and/or confirming previously equivocal regional and distant metastases. Progression-free survival was significantly shorter in patients found to have additional lesions on PET (p < 0.05), but was not related to SUV{sub max}. These findings demonstrate the significant impact of PET on the clinical management of patients with newly diagnosed oesophageal carcinoma, and on prognostic stratification of these patients. (orig.)

  17. High-sensitivity cardiac troponin assays: From improved analytical performance to enhanced risk stratification.

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    Kozinski, Marek; Krintus, Magdalena; Kubica, Jacek; Sypniewska, Grazyna

    2017-05-01

    Implementation of cardiac troponin (cTn) assays has revolutionized the diagnosis, risk stratification, triage and management of patients with suspected myocardial infarction (MI). The Universal Definition of MI brought about a shift in the diagnostics of MI, from an approach primarily based on electrocardiography (ECG) to one primarily based on biomarkers. Currently, detection of a rise and/or fall in concentration or activity of myocardial necrosis biomarkers, preferentially cTns, with at least one value above the 99th percentile upper reference limit (URL), is the essential component for the diagnosis of MI. High-sensitivity cardiac troponin (hs-cTn) assays with their superior analytical performance were designed to further facilitate clinical decision making. The ability of hs-cTn assays to detect measurable cTn concentrations in at least 50% of healthy individuals, along with their improved precision (expressed as coefficient of variation ≤10% at the 99th percentile URL) associated with increased recognition of changing values, leads to enhanced risk stratification of patients with suspected MI, and also enables them to be used as prognostic tools potentially useful in other patient subsets. In this comprehensive review, we aim to integrate updated laboratory and clinical knowledge regarding hs-cTn assays in order to promote their optimal use in daily practice. We primarily focus on the role of hs-cTn assays in patients with suspected MI, discussing recommended diagnostic algorithms and result interpretation. Emphasis is also placed on the release of cTns following myocardial injury, the characteristics of antibodies used in available cTn immunoassays, and analytical performance of hs-cTn assays. In this paper, we also review potential challenges related to the selection of a healthy reference population in determining 99th percentile values, biological variation of hs-cTns, inequality between hs-cTn assays, and outline the current status of c

  18. Prognostic value of immunohistochemical stratification of invasive duct carcinoma of the breast

    Institute of Scientific and Technical Information of China (English)

    Asmaa Salama; Habiba El-Fendy; Sahar Talaat; Badaweya Bayomi; Amr Amin

    2013-01-01

    Objective: Gene expression profiling of breast cancer has identified five molecularly distinct subtypes of breast cancer that have different biological behavior and clinical outcomes. These subtypes are termed luminal A, luminal B, luminal HER2, HER2-enriched and triple negative breast cancers (TNBC). We aimed at identification of breast cancer subtypes among Egyptian population and their clinicopathologic features using ER, PR and HER2, Ki-67 and CK5/6. Methods: Tumors from 100 patients with invasive duct carcinoma were subtyped by immunohistochemistry using ER, PR, HER2, Ki-67 and CK5/6. The prognostic value of the immunohistochemical assignment for breast cancer disease-specific survival was investigated by using Kaplan-Meier curves. Results: Immunohistochemical profiling classified 22 cases as luminal A, 33 cases as luminal B, 9 cases as luminal HER2, 26 cases as HER2-enriched and 10 cases as TNBC. Tumors that measured more than 3.5 cm, showed predominance of HER2-enriched subtype. HER2-enriched and luminal B subtypes dominated the node positive cases (35.4% and 33.8%; respectively). Large tumor size (> 3.5 cm), hormone receptor negative state and HER2 positive state were associated with poor prognosis. Disease free survivals (DFSs) were significantly different (P < 0.0001) among different breast subtypes with worst 2-year DFS for HER2-enriched subtype (40.77%) followed by luminal A (63.56%). DFS was almost similar in the remaining other subtypes, and luminal B, luminal HER2 and TNBC which were 86.85%, 87.5% and 88.89%; respectively. Conclusion: ER, PR, HER2 and Ki-67 constituted a strong surrogate for molecular breast cancer subtypes and can be easily applied. HER2-enriched subtype carries worse features being associated with large tumor size, nodal metastasis and is associated with poor outcome. Luminal A is a heterogeneous subtype with underlying several factors that can turn its prognosis adversely. TNBC subtype may behave unexpected in a favorable way.

  19. Potential demographic and baselines variables for risk stratification of high-risk post-myocardial infarction patients in the era of implantable cardioverter-defibrillator - a prognostic indicator

    DEFF Research Database (Denmark)

    Yap, Yee Guan; Duong, Trinh; Bland, Martin

    2008-01-01

    , sex, previous MI or angina, hypertension, diabetes, systolic blood pressure, heart rate, NYHA functional class and non-Q wave infarct on electrocardiogram. Distinct survival curves were obtained for 3 risk groups based on the median and inter-quartile range for the prognostic index. In the high-risk......BACKGROUND: Risk stratification after myocardial infarction (MI) remains expensive and disappointing. We designed a prognostic indicator using demographic information to select patients at risk of dying after MI. METHOD AND RESULTS: We combined individual patient data from the placebo arms of EMIAT......, CAMIAT, TRACE and DIAMOND-MI with LVEF 10 ventricular premature beats/hour or a run of ventricular tachycardia). Risk factors for mortality beginning at day 45 post-MI up to 2 years were examined using Cox regression analysis. Risk scores were derived from the equation of a Cox regression model...

  20. Does von Willebrand factor improve the predictive ability of current risk stratification scores in patients with atrial fibrillation?

    Science.gov (United States)

    García-Fernández, Amaya; Roldán, Vanessa; Rivera-Caravaca, José Miguel; Hernández-Romero, Diana; Valdés, Mariano; Vicente, Vicente; Lip, Gregory Y. H.; Marín, Francisco

    2017-01-01

    Von Willebrand factor (vWF) is a biomarker of endothelial dysfunction. We investigated its role on prognosis in anticoagulated atrial fibrillation (AF) patients and determined whether its addition to clinical risk stratification schemes improved event-risk prediction. Consecutive outpatients with non-valvular AF were recruited and rates of thrombotic/cardiovascular events, major bleeding and mortality were recorded. The effect of vWF on prognosis was calculated using a Cox regression model. Improvements in predictive accuracy over current scores were determined by calculating the integrated discrimination improvement (IDI), net reclassification improvement (NRI), comparison of receiver-operator characteristic (ROC) curves and Decision Curve Analysis (DCA). 1215 patients (49% males, age 76 (71–81) years) were included. Follow-up was almost 7 years. Significant associations were found between vWF and cardiovascular events, stroke, mortality and bleeding. Based on IDI and NRI, addition of vWF to CHA2DS2-VASc statistically improved its predictive value, but c-indexes were not significantly different. For major bleeding, the addition of vWF to HAS-BLED improved the c-index but not IDI or NRI. DCA showed minimal net benefit. vWF acts as a simple prognostic biomarker in AF and, whilst its addition to current scores statistically improves prediction for some endpoints, absolute changes and impact on clinical decision-making are marginal. PMID:28134282

  1. Boiling water scarification plus stratification improves germination of Iliamna rivularis (Malvaceae) seeds

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    Katri Himanen; Markku Nygren; R. Kasten Dumroese

    2012-01-01

    Scarification with boiling water plus stratification was most effective in improving germination of Iliamna rivularis (Douglas ex Hook.) Greene (Malvaceae) in an experiment that compared 3 treatments. Seeds from 15 sites representing 5 western US states were used in the experiment. Initial response of the seedlots to the treatments was similar, apart from one seedlot....

  2. 205_WS: Improving the Delivery of Primary Care Through Risk Stratification

    DEFF Research Database (Denmark)

    Kinder, Karen; Kristensen, Troels; Abrams, Chad

    Objectives The aim of this workshop is to provide an insight into how information gained through applications of risk stratification in the primary health care sector, from integrated care networks to primary care clinics and finally at the individual clinician level can improve the delivery of p...

  3. Procalcitonin Improves the Glasgow Prognostic Score for Outcome Prediction in Emergency Patients with Cancer: A Cohort Study

    Directory of Open Access Journals (Sweden)

    Anna Christina Rast

    2015-01-01

    Full Text Available The Glasgow Prognostic Score (GPS is useful for predicting long-term mortality in cancer patients. Our aim was to validate the GPS in ED patients with different cancer-related urgency and investigate whether biomarkers would improve its accuracy. We followed consecutive medical patients presenting with a cancer-related medical urgency to a tertiary care hospital in Switzerland. Upon admission, we measured procalcitonin (PCT, white blood cell count, urea, 25-hydroxyvitamin D, corrected calcium, C-reactive protein, and albumin and calculated the GPS. Of 341 included patients (median age 68 years, 61% males, 81 (23.8% died within 30 days after admission. The GPS showed moderate prognostic accuracy (AUC 0.67 for mortality. Among the different biomarkers, PCT provided the highest prognostic accuracy (odds ratio 1.6 (95% confidence interval 1.3 to 1.9, P<0.001, AUC 0.69 and significantly improved the GPS to a combined AUC of 0.74 (P=0.007. Considering all investigated biomarkers, the AUC increased to 0.76 (P<0.001. The GPS performance was significantly improved by the addition of PCT and other biomarkers for risk stratification in ED cancer patients. The benefit of early risk stratification by the GPS in combination with biomarkers from different pathways should be investigated in further interventional trials.

  4. Stratification devices

    DEFF Research Database (Denmark)

    Andersen, Elsa; Furbo, Simon

    2008-01-01

    heating system. High temperatures in the top of the storage tank established by the energy from the solar collector reduce the use of auxiliary energy. Low temperatures in the bottom of the storage tank improve the operation conditions for the solar collector. Using thermal stratified heat storages...... results in longer operation periods and improved utilization of the solar collector. Thermal stratification can be achieved, for example by using inlet stratification devices at all inlets to the storage tank. This paper presents how thermal stratification is established and utilized by means of inlet......Thermal stratification in the storage tank is extremely important in order to achieve high thermal performance of a solar heating system. High temperatures in the top of the storage tank and low temperatures in the bottom of the storage tank lead to the best operation conditions for any solar...

  5. Advances in the translational genomics of neuroblastoma: From improving risk stratification and revealing novel biology to identifying actionable genomic alterations.

    Science.gov (United States)

    Bosse, Kristopher R; Maris, John M

    2016-01-01

    Neuroblastoma is an embryonal malignancy that commonly affects young children and is remarkably heterogenous in its malignant potential. Recently, the genetic basis of neuroblastoma has come into focus and not only has catalyzed a more comprehensive understanding of neuroblastoma tumorigenesis but also has revealed novel oncogenic vulnerabilities that are being therapeutically leveraged. Neuroblastoma is a model pediatric solid tumor in its use of recurrent genomic alterations, such as high-level MYCN (v-myc avian myelocytomatosis viral oncogene neuroblastoma-derived homolog) amplification, for risk stratification. Given the relative paucity of recurrent, activating, somatic point mutations or gene fusions in primary neuroblastoma tumors studied at initial diagnosis, innovative treatment approaches beyond small molecules targeting mutated or dysregulated kinases will be required moving forward to achieve noticeable improvements in overall patient survival. However, the clonally acquired, oncogenic aberrations in relapsed neuroblastomas are currently being defined and may offer an opportunity to improve patient outcomes with molecularly targeted therapy directed toward aberrantly regulated pathways in relapsed disease. This review summarizes the current state of knowledge about neuroblastoma genetics and genomics, highlighting the improved prognostication and potential therapeutic opportunities that have arisen from recent advances in understanding germline predisposition, recurrent segmental chromosomal alterations, somatic point mutations and translocations, and clonal evolution in relapsed neuroblastoma.

  6. Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics has received considerable attention recently as an emerging sub-discipline within SHM. Prognosis is here strictly defined as “predicting the time at...

  7. Improving the Prognostic Ability through Better Use of Standard Clinical Data - The Nottingham Prognostic Index as an Example.

    Directory of Open Access Journals (Sweden)

    Klaus-Jürgen Winzer

    Full Text Available Prognostic factors and prognostic models play a key role in medical research and patient management. The Nottingham Prognostic Index (NPI is a well-established prognostic classification scheme for patients with breast cancer. In a very simple way, it combines the information from tumor size, lymph node stage and tumor grade. For the resulting index cutpoints are proposed to classify it into three to six groups with different prognosis. As not all prognostic information from the three and other standard factors is used, we will consider improvement of the prognostic ability using suitable analysis approaches.Reanalyzing overall survival data of 1560 patients from a clinical database by using multivariable fractional polynomials and further modern statistical methods we illustrate suitable multivariable modelling and methods to derive and assess the prognostic ability of an index. Using a REMARK type profile we summarize relevant steps of the analysis. Adding the information from hormonal receptor status and using the full information from the three NPI components, specifically concerning the number of positive lymph nodes, an extended NPI with improved prognostic ability is derived.The prognostic ability of even one of the best established prognostic index in medicine can be improved by using suitable statistical methodology to extract the full information from standard clinical data. This extended version of the NPI can serve as a benchmark to assess the added value of new information, ranging from a new single clinical marker to a derived index from omics data. An established benchmark would also help to harmonize the statistical analyses of such studies and protect against the propagation of many false promises concerning the prognostic value of new measurements. Statistical methods used are generally available and can be used for similar analyses in other diseases.

  8. The role of BRAF V600E mutation as a potential marker for prognostic stratification of papillary thyroid carcinoma: a long-term follow-up study.

    Science.gov (United States)

    Daliri, Mahdi; Abbaszadegan, Mohammad Reza; Bahar, Mostafa Mehrabi; Arabi, Azadeh; Yadollahi, Mona; Ghafari, Azar; Taghehchian, Negin; Zakavi, Seyed Rasoul

    2014-01-01

    Abstract Papillary carcinoma is the most prevalent malignancy of thyroid gland, and its incidence has been recently increased. The BRAF(V600E) mutation is the most frequent genetic alteration in papillary thyroid carcinoma (PTC). The role of BRAF(V600E) mutation as a potential prognostic factor has been controversially reported in different studies, with short-term follow-up. In this study, we evaluated the role of BRAF(V600E) mutation as a potential marker for prognostic stratification of patients with PTC in long-term follow-up. We studied 69 PTC patients with a mean follow-up period of 63.9 months (median: 60 m). The BRAF(V600E) mutation was analyzed by PCR-single-strand conformational polymorphism and sequencing. The correlation between the presence or absence of the BRAF(V600E) mutation, clinicopathological features and prognosis of PTC patients were studied. The BRAF(V600E) mutation was found in 28 of 69 (40.6%) PTC patients, and it was significantly more frequent in older patients (p papillary thyroid cancer in northeast of Iran. The BRAF(V600E) mutation was associated with older age and advanced tumor stage but was not correlated with incomplete response during follow-up.

  9. Ki-67 proliferation index but not mitotic thresholds integrates the molecular prognostic stratification of lower grade gliomas

    Science.gov (United States)

    Duregon, Eleonora; Bertero, Luca; Pittaro, Alessandra; Soffietti, Riccardo; Rudà, Roberta; Trevisan, Morena; Papotti, Mauro; Ventura, Laura; Senetta, Rebecca; Cassoni, Paola

    2016-01-01

    Despite several molecular signatures for “lower grade diffuse gliomas” (LGG) have been identified, WHO grade still remains a cornerstone of treatment guidelines. Mitotic count bears a crucial role in its definition, although limited by the poor reproducibility of standard Hematoxylin & Eosin (H&E) evaluation. Phospho-histone-H3 (PHH3) and Ki-67 have been proposed as alternative assays of cellular proliferation. Therefore in the present series of 141 LGG, the molecular characterization (namely IDH status, 1p/19q co-deletion and MGMT promoter methylation) was integrated with the tumor “proliferative trait” (conventional H&E or PHH3-guided mitotic count and Ki-67 index) in term of prognosis definition. Exclusively high PHH3 and Ki-67 values were predictor of poor prognosis (log rank test, P = 0.0281 for PHH3 and P = 0.032 for Ki-67), unlike standard mitotic count. Based on Cox proportional hazard regression analyses, among all clinical (age), pathological (PHH3 and Ki-67) and molecular variables (IDH, 1p/19q codeletion and MGMT methylation) with a prognostic relevance at univariate survival analysis, only IDH expression (P = 0.001) and Ki-67 proliferation index (P = 0.027) proved to be independent prognostic factors. In addition, stratifying by IDH expression status, high Ki-67 retained its prognostic relevance uniquely in the IDH negative patient (P = 0.029) doubling their risk of death (hazard ratio = 2.27). Overall, PHH3 immunostaining is the sole reliable method with a prognostic value to highlight mitotic figures in LGG. Ki-67 proliferation index exceeds PHH3 mitotic count as a predictor of patient's prognosis, and should be integrated with molecular markers in a comprehensive grading system for LGG. PMID:27049832

  10. HO-1, RET and PML as possible markers for risk stratification of acute myelocytic leukemia and prognostic evaluation.

    Science.gov (United States)

    Yu, Meisheng; Wang, Jishi; Ma, Dan; Chen, Shuya; Lin, Xiaojing; Fang, Qin; Zhe, Nana

    2015-11-01

    Heme oxygenase-1 (HO-1) is an inducible isoform of HO that is activated in response to oxidative stress and has anti-apoptotic and pro-proliferative effects on leukemia cells. RET, a tyrosine kinase receptor; its expression levels are associated with the differentiation degree of acute myelocytic leukemia (AML) cells. The promyelocytic leukemia (PML) gene inhibits cell proliferation and tumor growth, participates in the differentiation of hematopoietic progenitor cells and induces cell apoptosis. However, the association between the expression levels of HO-1, RET and PML genes and the risk stratification of AML and prognosis have not previously been reported. In the present study, HO-1 was expressed in the human AML Kasumi-1, HL-60 and THP-1 cell lines, and HO-1 expression was regulated by Hemin (20 µmol/l) and ZnPPIX (10 µmol/l). Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis demonstrated that expression of RET and PML were positively and negatively correlated with HO-1 expression, respectively. Bone marrow samples (18 favorable, 55 intermediate, 15 adverse and 2 unknown karyotype AML cases and 20 healthy donors) were collected from 90 randomly selected AML patients upon their first visit. The mRNA and protein expression of HO-1, RET and PML in samples was detected by RT-qPCR and western blot analysis. At the mRNA level, the adverse group expressed significantly higher levels of HO-1 and RET compared with the levels in the favorable and normal groups. The PML mRNA expression levels in adverse patient samples was lower compared with those of the intermediate group and favorable group. Western blot analysis demonstrated that the expression levels of HO-1, RET and PML proteins in all risk groups exhibited the same pattern of expression as was observed for the mRNA levels. The overall survival and relapse-free survival rates were shortest in AML patients with high HO-1 expression (Kaplan-Meier; log-rank, P<0.01). The results of the

  11. Stratification systems as prognostic tools for defining risk of lymph node metastasis in penile squamous cell carcinomas.

    Science.gov (United States)

    Chaux, Alcides; Cubilla, Antonio L

    2012-05-01

    Inguinal lymph node metastasis is the single most important factor for predicting survival in patients with penile squamous cell carcinomas. To estimate the likelihood of this event, investigators have combined pathologic features of the primary tumor in the form of stratification systems. In this article we review 3 such systems (Solsona et al, J Urol 2001;165:1506; Hungerhuber et al, Urology 68:621, 2006; and Chaux et al, Am J Surg Pathol 2009;33:1049) built upon histologic grade, extent and depth of tumor invasion, and perineural invasion. We evaluate their usefulness, limitations, and possible implications for the management of patients with penile cancer. We also provide clues for the proper identification and interpretation of these pathologic features. Inguinal metastases were observed in 64% to 83% of patients in high-risk groups, 20% to 33% of intermediate groups, and 0% to 8% of low-risk groups. The results of these studies suggest that patients in high-risk groups could benefit from prophylactic bilateral groin dissection. In addition, patients in low-risk groups might be managed by surveillance alone. Finally, the authors suggest that additional approaches, such as sentinel lymph node biopsy, should be used for the intermediate-risk group. The identification of other pathologic features, such as vascular and perineural invasion, could tip the scales in problematic or paradoxical cases. The fate of these risk groups would be better defined by the identification of molecular biomarkers and genetic profiling.

  12. Combining standardized uptake value of FDG-PET and apparent diffusion coefficient of DW-MRI improves risk stratification in head and neck squamous cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Preda, Lorenzo; Summers, Paul E. [European Institute of Oncology, Department of Radiology, Milan (Italy); Conte, Giorgio; Bonello, Luke; Giannitto, Caterina; Ruju, Francesca [University of Milan, Specialisation School of Radiology, Milan (Italy); Travaini, Laura L.; Grana, Chiara [European Institute of Oncology, Department of Nuclear Medicine, Milan (Italy); Raimondi, Sara [European Institute of Oncology, Department of Epidemiology and Biostatistics, Milan (Italy); Mohssen, Ansarin [European Institute of Oncology, Department of Head and Neck Surgery, Milan (Italy); Alterio, Daniela [European Institute of Oncology, Department of Radiotherapy, Milan (Italy); Cossu Rocca, Maria [European Institute of Oncology, Department of Urogenital Cancer Medical Treatment, Milan (Italy); Bellomi, Massimo [European Institute of Oncology, Department of Radiology, Milan (Italy); University of Milan, Department of Oncology and Haematology-Oncology, Milan (Italy)

    2016-12-15

    To assess the independent prognostic value of standardized uptake value (SUV) and apparent diffusion coefficient (ADC), separately and combined, in order to evaluate if the combination of these two variables allows further prognostic stratification of patients with head and neck squamous cell carcinomas (HNSCC). Pretreatment SUV and ADC were calculated in 57 patients with HNSCC. Mean follow-up was 21.3 months. Semiquantitative analysis of primary tumours was performed using SUV{sub maxT/B}, ADC{sub mean}, ADC{sub min} and ADC{sub max}. The prognostic value of SUV{sub maxT/B}, ADC{sub mean}, ADC{sub min} and ADC{sub max} in predicting disease-free survival (DFS) was evaluated with log-rank test and Cox regression models. Patients with SUV{sub maxT/B} ≥5.75 had an overall worse prognosis (p = 0.003). After adjusting for lymph node status and diameter, SUV{sub maxT/B} and ADC{sub min} were both significant predictors of DFS with hazard ratio (HR) = 10.37 (95 % CI 1.22-87.95) and 3.26 (95 % CI 1.20-8.85) for SUV{sub maxT/B} ≥5.75 and ADC{sub min} ≥0.58 x 10{sup -3} mm{sup 2}/s, respectively. When the analysis was restricted to subjects with SUV{sub maxT/B} ≥5.75, high ADC{sub min} significantly predicted a worse prognosis, with adjusted HR = 3.11 (95 % CI 1.13-8.55). The combination of SUV{sub maxT/B} and ADC{sub min} improves the prognostic role of the two separate parameters; patients with high SUV{sub maxT/B} and high ADC{sub min} are associated with a poor prognosis. (orig.)

  13. Peripheral Neutrophil to Lymphocyte Ratio Improves Prognostication in Colon Cancer.

    Science.gov (United States)

    Rashtak, Shahrooz; Ruan, Xiaoyang; Druliner, Brooke R; Liu, Hongfang; Therneau, Terry; Mouchli, Mohamad; Boardman, Lisa A

    2017-06-01

    We studied the role of peripheral neutrophil to lymphocyte ratio (NLR) on survival outcomes in colon and rectal cancer to determine if its inclusion improved prognostication within existing staging systems. Disease-free (DFS) and overall survival (OS) hazard ratios (HRs) of pretreatment NLR were calculated for 2536 patients with stage I to III colon or rectal cancer and adjusted for age, positive/total number of nodes, T stage, and grade. The association of NLR with clinicopathologic features and survival was evaluated and compared with the American Joint Committee on cancer (AJCC) TNM staging and Memorial Sloan Kettering Cancer Center (MSKCC) models. High NLR was significantly associated with worse DFS (HR, 1.36; 95% confidence interval [CI], 1.08-1.70; P = .009) and OS (HR, 1.65; 95% CI, 1.29-2.10; P colon, but not rectal, cancer. High NLR was significantly associated with site-specific worse prognosis, which was stronger in the left versus right colon; an inverse relationship with grade was found. The impact of high NLR on DFS and OS occurred early, with the majority of deaths within 2 years following surgery. Adjusted HRs for 5-year and 2-year outcomes in colon cancer per each additional 2-unit increase in NLR were 1.15 (95% CI, 1.08-1.23) and 1.20 (95% CI, 1.10-1.30), respectively. The addition of NLR enhanced the prognostic utility of TNM (TNM alone vs. TNM + NLR: concordance index, 0.60 vs. 0.68), and MSKCC (MSKCC alone vs. MSKCC + NLR: concordance index, 0.71 vs. 0.73) models for colon cancer patients. NLR is an independent prognostic variable for nonmetastatic colon cancer that enhances existing clinical staging systems. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. {sup 18}F-FDG PET/CT provides powerful prognostic stratification in the primary staging of large breast cancer when compared with conventional explorations

    Energy Technology Data Exchange (ETDEWEB)

    Cochet, Alexandre [Centre Georges-Francois Leclerc, Department of Nuclear Medicine, Dijon Cedex (France); Le2i UMR CNRS 6306, Dijon (France); Dygai-Cochet, Inna; Riedinger, Jean-Marc; Berriolo-Riedinger, Alina; Toubeau, Michel [Centre Georges-Francois Leclerc, Department of Nuclear Medicine, Dijon Cedex (France); Humbert, Olivier; Brunotte, Francois [Centre Georges-Francois Leclerc, Department of Nuclear Medicine, Dijon Cedex (France); Le2i UMR CNRS 6306, Dijon (France); CHU Dijon, MRI and Spectroscopy Unit, Dijon (France); Guiu, Severine; Coudert, Bruno [Centre Georges-Francois Leclerc, Department of Oncology, Dijon (France); Coutant, Charles; Fumoleau, Pierre [Centre Georges-Francois Leclerc, Department of Surgery, Dijon (France)

    2014-03-15

    The objective of this study was to assess the impact on management and the prognostic value of {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for initial staging of newly diagnosed large breast cancer (BC) when compared with conventional staging. We prospectively included 142 patients with newly diagnosed BC and at least grade T2 tumour. All patients were evaluated with complete conventional imaging (CI) procedures (mammogram and/or breast ultrasound, bone scan, abdominal ultrasound and/or CT, X-rays and/or CT of the chest), followed by FDG PET/CT exploration, prior to treatment. The treatment plan based on CI staging was compared with that based on PET/CT findings. CI and PET/CT findings were confirmed by imaging and clinical follow-up and/or pathology when assessable. Progression-free survival (PFS) was analysed using the Cox proportional hazards regression model. According to CI staging, 79 patients (56 %) were stage II, 46 (32 %) stage III and 17 (12 %) stage IV (distant metastases). Of the patients, 30 (21 %) were upstaged by PET/CT, including 12 (8 %) from stage II or III to stage IV. On the other hand, 23 patients (16 %) were downstaged by PET/CT, including 4 (3 %) from stage IV to stage II or III. PET/CT had a high or medium impact on management planning for 18 patients (13 %). Median follow-up was 30 months (range 9-59 months); 37 patients (26 %) experienced recurrence or progression of disease during follow-up and 17 patients (12 %) died. The Cox model indicated that CI staging was significantly associated with PFS (p = 0.01), but PET/CT staging provided stronger prognostic stratification (p < 0.0001). Moreover, Cox regression multivariate analysis showed that only PET/CT staging remained associated with PFS (p < 0.0001). FDG PET/CT provides staging information that more accurately stratifies prognostic risk in newly diagnosed large BC when compared with conventional explorations alone. (orig.)

  15. Pre-transplantation minimal residual disease with cytogenetic and molecular diagnostic features improves risk stratification in acute myeloid leukemia

    Science.gov (United States)

    Oran, Betül; Jorgensen, Jeff L.; Marin, David; Wang, Sa; Ahmed, Sairah; Alousi, Amin M.; Andersson, Borje S.; Bashir, Qaiser; Bassett, Roland; Lyons, Genevieve; Chen, Julianne; Rezvani, Katy; Popat, Uday; Kebriaei, Partow; Patel, Keyur; Rondon, Gabriela; Shpall, Elizabeth J.; Champlin, Richard E.

    2017-01-01

    Our aim was to improve outcome prediction after allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia by combining cytogenetic and molecular data at diagnosis with minimal residual disease assessment by multicolor flow-cytometry at transplantation. Patients with acute myeloid leukemia in first complete remission in whom minimal residual disease was assessed at transplantation were included and categorized according to the European LeukemiaNet classification. The primary outcome was 1-year relapse incidence after transplantation. Of 152 patients eligible, 48 had minimal residual disease at the time of their transplant. Minimal residual disease-positive patients were older, required more therapy to achieve first remission, were more likely to have incomplete recovery of blood counts and had more adverse risk features by cytogenetics. Relapse incidence at 1 year was higher in patients with minimal residual disease (32.6% versus 14.4%, P=0.002). Leukemia-free survival (43.6% versus 64%, P=0.007) and overall survival (48.8% versus 66.9%, P=0.008) rates were also inferior in patients with minimal residual disease. In multivariable analysis, minimal residual disease status at transplantation independently predicted 1-year relapse incidence, identifying a subgroup of intermediate-risk patients, according to the European LeukemiaNet classification, with a particularly poor outcome. Assessment of minimal residual disease at transplantation in combination with cytogenetic and molecular findings provides powerful independent prognostic information in acute myeloid leukemia, lending support to the incorporation of minimal residual disease detection to refine risk stratification and develop a more individualized approach during hematopoietic stem cell transplantation. PMID:27540139

  16. Comparison and combination of a hemodynamics/biomarkers-based model with simplified PESI score for prognostic stratification of acute pulmonary embolism: findings from a real world study

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2015-11-01

    Full Text Available Background: Prognostic stratification is of utmost importance for management of acute Pulmonary Embolism (PE in clinical practice. Many prognostic models have been proposed, but which is the best prognosticator in real life remains unclear. The aim of our study was to compare and combine the predictive values of the hemodynamics/biomarkers based prognostic model proposed by European Society of Cardiology (ESC in 2008 and simplified PESI score (sPESI. Methods: Data records of 452 patients discharged for acute PE from Internal Medicine wards of Tuscany (Italy were analysed. The ESC model and sPESI were retrospectively calculated and compared by using Areas under Receiver Operating Characteristics (ROC Curves (AUCs and finally the combination of the two models was tested in hemodinamically stable patients. All cause and PE-related in-hospital mortality and fatal or major bleedings were the analyzed endpoints Results: All cause in-hospital mortality was 25% (16.6% PE related in high risk, 8.7% (4.7% in intermediate risk and 3.8% (1.2% in low risk patients according to ESC model. All cause in-hospital mortality was 10.95% (5.75% PE related in patients with sPESI score and #8805;1 and 0% (0% in sPESI score 0. Predictive performance of sPESI was not significantly different compared with 2008 ESC model both for all cause (AUC sPESI 0.711, 95% CI: 0.661-0.758 versus ESC 0.619, 95% CI: 0.567-0.670, difference between AUCs 0.0916, p=0.084 and for PE-related mortality (AUC sPESI 0.764, 95% CI: 0.717-0.808 versus ESC 0.650, 95% CI: 0.598-0.700, difference between AUCs 0.114, p=0.11. Fatal or major bleedings occurred in 4.30% of high risk, 1.60% of intermediate risk and 2.50% of low risk patients according to 2008 ESC model, whereas these occurred in 1.80% of high risk and 1.45% of low risk patients according to sPESI, respectively. Predictive performance for fatal or major bleeding between two models was not significantly different (AUC sPESI 0.658, 95% CI

  17. Improved risk stratification in prevention by use of a panel of selected circulating microRNAs.

    Science.gov (United States)

    Keller, Till; Boeckel, Jes-Niels; Groß, Stefan; Klotsche, Jens; Palapies, Lars; Leistner, David; Pieper, Lars; Stalla, Günnter K; Lehnert, Hendrik; Silber, Sigmund; Pittrow, David; Maerz, Winfried; Dörr, Marcus; Wittchen, Hans-Ulrich; Baumeister, Sebastian E; Völker, Uwe; Felix, Stephan B; Dimmeler, Stefanie; Zeiher, Andreas M

    2017-07-03

    Risk stratification is crucial in prevention. Circulating microRNAs have been proposed as biomarkers in cardiovascular disease. Here a miR panel consisting of miRs related to different cardiovascular pathophysiologies, was evaluated to predict outcome in the context of prevention. MiR-34a, miR-223, miR-378, miR-499 and miR-133 were determined from peripheral blood by qPCR and combined to a risk panel. As derivation cohort, 178 individuals of the DETECT study, and as validation cohort, 129 individuals of the SHIP study were used in a case-control approach. Overall mortality and cardiovascular events were outcome measures. The Framingham Risk Score(FRS) and the SCORE system were applied as risk classification systems. The identified miR panel was significantly associated with mortality given by a hazard ratio(HR) of 3.0 (95% (CI): 1.09-8.43; p = 0.034) and of 2.9 (95% CI: 1.32-6.33; p = 0.008) after adjusting for the FRS in the derivation cohort. In a validation cohort the miR-panel had a HR of 1.31 (95% CI: 1.03-1.66; p = 0.03) and of 1.29 (95% CI: 1.02-1.64; p = 0.03) in a FRS/SCORE adjusted-model. A FRS/SCORE risk model was significantly improved to predict mortality by the miR panel with continuous net reclassification index of 0.42/0.49 (p = 0.014/0.005). The present miR panel of 5 circulating miRs is able to improve risk stratification in prevention with respect to mortality beyond the FRS or SCORE.

  18. Development of a hot water tank simulation program with improved prediction of thermal stratification in the tank

    DEFF Research Database (Denmark)

    Fan, Jianhua; Furbo, Simon; Yue, Hongqiang

    2015-01-01

    A simulation program SpiralSol was developed in previous investigations to calculate thermal performance of a solar domestic hot water (SDHW) system with a hot water tank with a built-in heat exchanger spiral [1]. The simulation program is improved in the paper in term of prediction of thermal...... stratification in the tank. The transient fluid flow and heat transfer in the hot water tank during cooling caused by standby heat loss are investigated by validated computational fluid dynamics (CFD) calculations. Detailed CFD investigations are carried out to determine the influence of thickness and material...... property of the tank wall on thermal stratification in the tank. It is elucidated how thermal stratification in the tank is influenced by the natural convection and how the heat loss from the tank sides will be distributed at different levels of the tank at different thermal conditions. The existing...

  19. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement.

    Directory of Open Access Journals (Sweden)

    Adam Csordas

    Full Text Available Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR. Elevated levels of midregional proadrenomedullin (MR-proADM levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population.We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population.We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality.During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%. Patients with MR-proADM levels above the 75th percentile (≥ 1.3 nmol/l had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0-26.0, P 6.8 only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8-5.6, P = 0.13. The Harrell's C-statistic was 0.58 (95% CI 0.45-0.82 for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71-0.92, P = 0.01. In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ≥1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1-31.3, P <0.01 and improved the model's net reclassification index (0.89, 95% CI (0.28-1.59. These results were confirmed in the independent validation cohort.Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis.

  20. Proposed modifications of supraclavicular lymph node metastasis in the esophageal squamous cell carcinoma staging system for improved survival stratification.

    Science.gov (United States)

    Zheng, Yuzhen; Wang, Zhen; Wang, Feng; Huang, Qingyuan; Liu, Shuoyan

    2017-06-20

    The present study aims to investigate the clinical implication of supraclavicular lymph nodes (SCLNs) in thoracic esophageal squamous cell carcinoma (ESCC). A total of 1156 ESCC patients who underwent three-field lymphadenectomy with node metastasis were analyzed retrospectively. SCLNs were defined as regional nodes in the current system or as distant nodes in the modified system. Survival was analyzed using the Kaplan-Meier method, and values were compared using the log-rank test. Multivariate analysis was performed using the Cox proportional hazard model. The Akaike information criterion (AIC) and the concordance index (c-index) were applied to compare the two prognostic systems. Among 1156 patients, 183 (15.8%) patients were diagnosed with SCLN metastasis. Higher rate of SCLN metastasis was associated with upper tumor location, metastasis involving seven or more nodes, and positive recurrent laryngeal nerve node status. The current staging system was unable to stratify overall survival well in patients with N2, N3, and M1 status using a univariate analysis. In both the current staging system and the modified version, age, gender, pathological T status, and nodal status were independent prognostic factors in a multivariate analysis. The AIC value for the modified version was smaller than that for the current staging system; the c-index value for the modified version was larger than that for the current staging system. Based on the data from our single center, SCLNs should be reclassified as regional lymph nodes in thoracic ESCC for better stratification of overall survival.

  1. Introduction of a prognostic biomarker to strengthen risk stratification of acutely admitted patients: rationale and design of the TRIAGE III cluster randomized interventional trial

    DEFF Research Database (Denmark)

    Sandø, Andreas; Schultz, Martin; Eugen-Olsen, Jesper

    2016-01-01

    patients at the ED. The main hypothesis is that the availability of suPAR can reduce all-cause mortality, assessed at least 10 months after admission, by drawing attention towards patients with an unrecognized high risk, leading to improved diagnostics and treatment. METHODS: The study is designed...... as a cross-over cluster randomized interventional trial. SuPAR is measured within 2 h after admission and immediately reported to the treating physicians in the ED. All ED physicians are educated in the prognostic capabilities of suPAR prior to the inclusion period. The inclusion period began January 11(th......) 2016 and ends June 6(th) 2016. The study aims to include 10.000 patients in both the interventional and control arm. The results will be presented in 2017. DISCUSSION: The present article aims to describe the design and rationale of the TRIAGE III study that will investigate whether the availability...

  2. PCM-module to improve hot water heat stores with stratification

    Energy Technology Data Exchange (ETDEWEB)

    Mehling, H.; Hippeli, S.; Hiebler, S. [ZAE Bayern, Garching (Germany); Cabeza, L.F. [Universitat de Lleida (Spain). Centre de Recerca en Energia Aplicada

    2003-04-01

    Hot water heat stores with stratification are a common technology used in solar energy systems and reuse of waste heat. Adding a PCM module at the top of the water tank would give the system higher storage density, and compensate heat loss in the top layer. The work presented here includes experimental results and numerical simulation of the system using an explicit finite-difference method. Experiments and simulations were carried out using different cylindrical PCM modules. With only 1/16 of the volume of the store being PCM, 3/16 of water at the top of the store was held warm for 50% to 200% longer and the average energy density was increased by 20% to 45%. Furthermore, these 3/16 of water were reheated by the heat from the module after being cooled down in only 20 min. (Author)

  3. Prognostic and predictive biomarkers in colorectal cancer. Towards precision medicine

    NARCIS (Netherlands)

    Reimers, Marlies Suzanne

    2015-01-01

    The aim of this thesis was to define prognostic and predictive biomarkers in colorectal cancer for improved risk stratification and treatment benefit in the individual patient, with the introduction of precision medicine in the near future as the ultimate goal. By definition, precision medicine is

  4. Targeted deep sequencing improves outcome stratification in chronic myelomonocytic leukemia with low risk cytogenetic features

    Science.gov (United States)

    Palomo, Laura; Garcia, Olga; Arnan, Montse; Xicoy, Blanca; Fuster, Francisco; Cabezón, Marta; Coll, Rosa; Ademà, Vera; Grau, Javier; Jiménez, Maria-José; Pomares, Helena; Marcé, Sílvia; Mallo, Mar; Millá, Fuensanta; Alonso, Esther; Sureda, Anna; Gallardo, David; Feliu, Evarist; Ribera, Josep-Maria; Solé, Francesc; Zamora, Lurdes

    2016-01-01

    Clonal cytogenetic abnormalities are found in 20-30% of patients with chronic myelomonocytic leukemia (CMML), while gene mutations are present in >90% of cases. Patients with low risk cytogenetic features account for 80% of CMML cases and often fall into the low risk categories of CMML prognostic scoring systems, but the outcome differs considerably among them. We performed targeted deep sequencing of 83 myeloid-related genes in 56 CMML patients with low risk cytogenetic features or uninformative conventional cytogenetics (CC) at diagnosis, with the aim to identify the genetic characteristics of patients with a more aggressive disease. Targeted sequencing was also performed in a subset of these patients at time of acute myeloid leukemia (AML) transformation. Overall, 98% of patients harbored at least one mutation. Mutations in cell signaling genes were acquired at time of AML progression. Mutations in ASXL1, EZH2 and NRAS correlated with higher risk features and shorter overall survival (OS) and progression free survival (PFS). Patients with SRSF2 mutations associated with poorer OS, while absence of TET2 mutations (TET2wt) was predictive of shorter PFS. A decrease in OS and PFS was observed as the number of adverse risk gene mutations (ASXL1, EZH2, NRAS and SRSF2) increased. On multivariate analyses, CMML-specific scoring system (CPSS) and presence of adverse risk gene mutations remained significant for OS, while CPSS and TET2wt were predictive of PFS. These results confirm that mutation analysis can add prognostic value to patients with CMML and low risk cytogenetic features or uninformative CC. PMID:27486981

  5. Clinical algorithm for improved prediction of ambulation and patient stratification after incomplete spinal cord injury.

    Science.gov (United States)

    Zörner, Björn; Blanckenhorn, Wolf U; Dietz, Volker; Curt, Armin

    2010-01-01

    The extent of ambulatory recovery after motor incomplete spinal cord injury (miSCI) differs considerably amongst affected persons. This makes individual outcome prediction difficult and leads to increased within-group variation in clinical trials. The aims of this study on subjects with miSCI were: (1) to rank the strongest single predictors and predictor combinations of later walking capacity; (2) to develop a reliable algorithm for clinical prediction; and (3) to identify subgroups with only limited recovery of walking function. Correlation and logistic regression analyses were performed on a dataset of 90 subjects with tetra- or paraparesis, recruited in a prospective European multicenter study. Eleven measures obtained in the subacute injury period, including clinical examination, tibial somatosensory evoked potentials (tSSEP), and demographic factors, were related to ambulatory outcome (WISCI II, 6minWT) 6 months after injury. The lower extremity motor score (LEMS) alone and in combination was identified as most predictive for later walking capacity in miSCI. Ambulatory outcome of subjects with tetraparesis was correctly predicted for 92% (WISCI II) or 100% (6minWT) of the cases when LEMS was combined with either tSSEP or the ASIA Impairment Scale, respectively. For individuals with paraparesis, prediction was less distinct, mainly due to low prediction rates for individuals with poor walking outcome. A clinical algorithm was generated that allowed for the identification of a subgroup composed of individuals with tetraparesis and poor ambulatory recovery. These data provide evidence that a combination of predictors enables a reliable prediction of walking function and early patient stratification for clinical trials in miSCI.

  6. Increased evidence for the prognostic value of primary tumor asphericity in pretherapeutic FDG PET for risk stratification in patients with head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hofheinz, Frank; Lougovski, Alexandr [Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Dresden (Germany); Zoephel, Klaus; Hentschel, Maria [University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Department of Nuclear Medicine, Dresden (Germany); Steffen, Ingo G.; Wedel, Florian; Buchert, Ralph; Brenner, Winfried [Charite - Universitaetsmedizin Berlin, Department of Nuclear Medicine, Berlin (Germany); Apostolova, Ivayla [Universitaetsklinikum Magdeburg A.oe.R., Klinik fuer Radiologie und Nuklearmedizin, Magdeburg (Germany); Baumann, Michael [University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Department of Radiation Oncology, Dresden (Germany); OncoRay - National Center for Radiation Research in Oncology, Dresden (Germany); Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Kotzerke, Joerg; Hoff, Joerg van den [Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Dresden (Germany); University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Department of Nuclear Medicine, Dresden (Germany)

    2014-11-22

    In a previous study, we demonstrated the first evidence that the asphericity (ASP) of pretherapeutic FDG uptake in the primary tumor provides independent prognostic information in patients with head and neck cancer. The aim of this work was to confirm these results in an independent patient group examined at a different site. FDG-PET/CT was performed in 37 patients. The primary tumor was delineated by an automatic algorithm based on adaptive thresholding. For the resulting ROIs, the metabolically active part of the tumor (MTV), SUV{sub max}, SUV{sub mean}, total lesion glycolysis (TLG) and ASP were computed. Univariate Cox regression with respect to progression free survival (PFS) and overall survival (OS) was performed. For survival analysis, patients were divided in groups of high and low risk according to the parameter cut-offs defined in our previous work. In a second step, the cut-offs were adjusted to the present data. Univariate and multivariate Cox regression was performed for the pooled data consisting of the current and the previously described patient group (N = 68). In multivariate Cox regression, clinically relevant parameters were included. Univariate Cox regression using the previously published cut-off values revealed TLG (hazard ratio (HR) = 3) and ASP (HR = 3) as significant predictors for PFS. For OS MTV (HR = 2.7) and ASP (HR = 5.9) were significant predictors. Using the adjusted cutoffs MTV (HR = 2.9/3.3), TLG (HR = 3.1/3.3) and ASP (HR = 3.1/5.9) were prognostic for PFS/OS. In the pooled data, multivariate Cox regression revealed a significant prognostic value with respect to PFS/OS for MTV (HR = 2.3/2.1), SUV{sub max} (HR = 2.1/2.5), TLG (HR = 3.5/3.6), and ASP (HR = 3.4/4.4). Our results confirm the independent prognostic value of ASP of the pretherapeutic FDG uptake in the primary tumor in patients with head and neck cancer. Moreover, these results demonstrate that ASP can be determined unambiguously across different sites. (orig.)

  7. Improved Risk Stratification in Pediatric Septic Shock Using Both Protein and mRNA Biomarkers. PERSEVERE-XP.

    Science.gov (United States)

    Wong, Hector R; Cvijanovich, Natalie Z; Anas, Nick; Allen, Geoffrey L; Thomas, Neal J; Bigham, Michael T; Weiss, Scott L; Fitzgerald, Julie C; Checchia, Paul A; Meyer, Keith; Quasney, Michael; Hall, Mark; Gedeit, Rainer; Freishtat, Robert J; Nowak, Jeffrey; Raj, Shekhar S; Gertz, Shira; Grunwell, Jocelyn R; Lindsell, Christopher J

    2017-08-15

    We previously derived and validated the Pediatric Sepsis Biomarker Risk Model (PERSEVERE) to estimate baseline mortality risk in children with septic shock. The PERSEVERE biomarkers are serum proteins selected from among the proteins directly related to 80 mortality risk assessment genes. The initial approach to selecting the PERSEVERE biomarkers left 68 genes unconsidered. To determine if the 68 previously unconsidered genes can improve upon the performance of PERSEVERE and to provide biological information regarding the pathophysiology of septic shock. We reduced the number of variables by determining the biological linkage of the 68 previously unconsidered genes. The genes identified through variable reduction were combined with the PERSEVERE-based mortality probability to derive a risk stratification model for 28-day mortality using classification and regression tree methodology (n = 307). The derived tree, PERSEVERE-XP, was then tested in a separate cohort (n = 77). Variable reduction revealed a network consisting of 18 mortality risk assessment genes related to tumor protein 53 (TP53). In the derivation cohort, PERSEVERE-XP had an area under the receiver operating characteristic curve (AUC) of 0.90 (95% confidence interval, 0.85-0.95) for differentiating between survivors and nonsurvivors. In the test cohort, the AUC was 0.96 (95% confidence interval, 0.91-1.0). The AUC of PERSEVERE-XP was superior to that of PERSEVERE. PERSEVERE-XP combines protein and mRNA biomarkers to provide mortality risk stratification with possible clinical utility. PERSEVERE-XP significantly improves on PERSEVERE and suggests a role for TP53-related cellular division, repair, and metabolism in the pathophysiology of septic shock.

  8. Comparison of two prognostic models for acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Abd-ElRahim Ibrahim Youssef

    2016-10-01

    Conclusion: (1 There is an agreement to great extent in risk stratification of APE patients by PESI and ESC prognostic models, where mortality rate is increased among high risk classes of both models, (2 ESC prognostic model is more accurate than PESI model in mortality prediction of APE patients especially in the high risk class, (3 echocardiographic evidence of RVD and elevated plasma BNP can help to identify APE patients at increased risk of adverse short-term outcome and (4 integration of RVD assessment by echocardiography and BNP to clinical findings improves the prognostic value of ESC model.

  9. Improving the prognostic value of disease specific Graded Prognostic Assessment (ds-GPA) model for renal cell carcinoma by incorporation of Cumulative Intracranial Tumor Volume (CITV).

    Science.gov (United States)

    Ali, Mir Amaan; Hirshman, Brian R; Wilson, Bayard; Schupper, Alexander J; Joshi, Rushikesh; Proudfoot, James A; Goetsch, Steven J; Alksne, John F; Ott, Kenneth; Aiyama, Hitoshi; Nagano, Osamu; Carter, Bob S; Chiang, Veronica; Serizawa, Toru; Yamamoto, Masaaki; Chen, Clark C

    2017-07-25

    We tested the prognostic value of cumulative intracranial tumor volume (CITV) in the context of ds-GPA model for renal cell carcinoma (RCC) patients with brain metastasis (BM) treated with stereotactic radiosurgery (SRS). Patient and tumor characteristics were collected from RCC cohorts with newly BM who underwent SRS. Univariable and multivariable logistic regression model was used to test the prognostic value of CITV, Karnofsky Performance Score (KPS), and the number of BM. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to assess whether CITV improved the prognostic utility of RCC ds-GPA. In univariable logistic regression models, CITV, KPS, and the number of BM independently associated with RCC patient survival. In a multivariable Cox proportional hazard model, the association between CITV and survival remained robust after controlling for KPS and the number of BM (P=.042). The incorporation of the cumulative intracranial tumor volume (CITV) into the RCC ds-GPA model (consisting of KPS and number of BM) improved prognostic accuracy with NRI>0 of 0.3156 (95% CI: 0.0883-0.5428, P=.0065) and integrated discrimination improvement (IDI) of 0.0151 (95% CI: 0.0036-0.0277, P=.0183). These findings were validated in an independent cohort of 107 SRS-treated RCC BM patients. CITV is an important prognostic variable in SRS-treated RCC patients with BM. The prognostic value of the ds-GPA scale for RCC brain metastasis was enhanced by the incorporation of CITV. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. pT but not pN stage of the 8th TNM classification significantly improves prognostication in pancreatic ductal adenocarcinoma.

    Science.gov (United States)

    Schlitter, Anna Melissa; Jesinghaus, Moritz; Jäger, Carsten; Konukiewitz, Björn; Muckenhuber, Alexander; Demir, Ihsan Ekin; Bahra, Marcus; Denkert, Carsten; Friess, Helmut; Kloeppel, Günter; Ceyhan, Güralp O; Weichert, Wilko

    2017-08-09

    The UICC TNM (tumour-node-metastasis) staging system for pancreatic ductal adenocarcinoma (PDAC) has been a matter of debate over decades because survival prediction based on T stages was weak and unreliable. To improve staging, the recently published 8th TNM edition (2016) introduced a conceptually completely changed strictly size-based T staging system and a refined N stage for PDAC. To investigate the clinical value of the novel TNM classification, we compared the prognostic impact of pT and pN stage between the 7th and 8th edition in two well-characterised independent German PDAC cohorts from different decades, including a total number of 523 patients. Former UICC T staging (7th edition 2009) resulted in a clustering of pT3 cases (72% and 85% of cases per cohort, respectively) and failed to show significant prognostic differences between the four stages in one of the investigated cohorts (p = 0.074). Application of the novel size-based T stage system resulted in a more equal distribution of cases between the four T categories with a predominance of pT2 tumours (65% and 60% of cases). The novel pT staging algorithm showed greatly improved discriminative power with highly significant overall differences between the four pT stages in both investigated cohorts in univariate and multivariate analyses (p < 0.001, each). In contrast, no prognostic differences were observed between the recently introduced pN1 and pN2 categories in both cohorts (p = 0.970 and p = 0.061). pT stage of resected PDAC patients according to the novel UICC staging protocol (8th edition) significantly improves patient stratification, whereas introduction of an extended N stage protocol does not demonstrate high clinical relevance in our cohorts. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Doppler Endoscopic Probe Monitoring of Blood Flow Improves Risk Stratification and Outcomes of Patients With Severe Nonvariceal Upper Gastrointestinal Hemorrhage.

    Science.gov (United States)

    Jensen, Dennis M; Kovacs, Thomas O G; Ohning, Gordon V; Ghassemi, Kevin; Machicado, Gustavo A; Dulai, Gareth S; Sedarat, Alireza; Jutabha, Rome; Gornbein, Jeffrey

    2017-05-01

    For 4 decades, stigmata of recent hemorrhage in patients with nonvariceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata rarely is monitored, but can be used to determine risk for rebleeding. We performed a randomized controlled trial to determine whether Doppler endoscopic probe monitoring of blood flow improves risk stratification and outcomes in patients with severe nonvariceal upper gastrointestinal hemorrhage. In a single-blind study performed at 2 referral centers we assigned 148 patients with severe nonvariceal upper gastrointestinal bleeding (125 with ulcers, 19 with Dieulafoy's lesions, and 4 with Mallory Weiss tears) to groups that underwent standard, visually guided endoscopic hemostasis (control, n = 76), or endoscopic hemostasis assisted by Doppler monitoring of blood flow under the stigmata (n = 72). The primary outcome was the rate of rebleeding after 30 days; secondary outcomes were complications, death, and need for transfusions, surgery, or angiography. There was a significant difference in the rates of lesion rebleeding within 30 days of endoscopic hemostasis in the control group (26.3%) vs the Doppler group (11.1%) (P = .0214). The odds ratio for rebleeding with Doppler monitoring was 0.35 (95% confidence interval, 0.143-0.8565) and the number needed to treat was 7. In a randomized controlled trial of patients with severe upper gastrointestinal hemorrhage from ulcers or other lesions, Doppler probe guided endoscopic hemostasis significantly reduced 30-day rates of rebleeding compared with standard, visually guided hemostasis. Guidelines for nonvariceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F). Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  12. Treatment with octreotide in patients with well-differentiated neuroendocrine tumors of the ileum: prognostic stratification with Ga-68-DOTA-TATE positron emission tomography.

    Science.gov (United States)

    Koch, Walter; Auernhammer, Christoph J; Geisler, Julia; Spitzweg, Christine; Cyran, Clemens C; Ilhan, Harun; Bartenstein, Peter; Haug, Alexander R

    2014-01-01

    We investigated the use of Ga-68-DOTA-Tyr3-octreotate (Ga-68-DOTA-TATE) positron emission tomography (PET) and standardized uptake values (SUVs) to predict the effectiveness of treatment with the somatostatin analogue octreotide acetate (Sandostatin LAR) in patients with neuroendocrine tumors (NETs). Thirty patients with well-differentiated NETs of the ileum (grades G1 and G2) were studied with Ga-68-DOTA-TATE. The average SUV of a 50% isocontour volume of interest covering the lesion with maximum uptake (SUV mean) and the maximum SUV (SUV max) were determined. Patients were followed up, and the time to progression was recorded. Twenty-one patients showed progressive disease at the end of the study; nine patients had stable disease. The median progression-free survival (PFS) was 51.0 weeks (95% confidence interval [CI] 26.4-75.6). A cutoff for the SUV max of 29.4 and for the SUV mean of 20.3 could separate between patients with a long PFS (69.0 weeks; 95% CI 9.8-128.2) and a short PFS (26.0 weeks; 95% CI 8.7-43.3) response to octreotide acetate therapy. Patients with high radiotracer uptake had significantly higher PFS with a 2.9-fold higher chance for stable disease after 45 weeks; however, the prognostic performance of SUV max on an individual basis was poor, with a sensitivity of 75% and a specificity of 64%. SUV max and SUV mean of NET tumor lesions in Ga-68-DOTA-TATE PET are important prognostic indices for predicting the response to therapy with octreotide acetate.

  13. A patient-centered methodology that improves the accuracy of prognostic predictions in cancer.

    Directory of Open Access Journals (Sweden)

    Mohammed Kashani-Sabet

    Full Text Available Individualized approaches to prognosis are crucial to effective management of cancer patients. We developed a methodology to assign individualized 5-year disease-specific death probabilities to 1,222 patients with melanoma and to 1,225 patients with breast cancer. For each cancer, three risk subgroups were identified by stratifying patients according to initial stage, and prediction probabilities were generated based on the factors most closely related to 5-year disease-specific death. Separate subgroup probabilities were merged to form a single composite index, and its predictive efficacy was assessed by several measures, including the area (AUC under its receiver operating characteristic (ROC curve. The patient-centered methodology achieved an AUC of 0.867 in the prediction of 5-year disease-specific death, compared with 0.787 using the AJCC staging classification alone. When applied to breast cancer patients, it achieved an AUC of 0.907, compared with 0.802 using the AJCC staging classification alone. A prognostic algorithm produced from a randomly selected training subsample of 800 melanoma patients preserved 92.5% of its prognostic efficacy (as measured by AUC when the same algorithm was applied to a validation subsample containing the remaining patients. Finally, the tailored prognostic approach enhanced the identification of high-risk candidates for adjuvant therapy in melanoma. These results describe a novel patient-centered prognostic methodology with improved predictive efficacy when compared with AJCC stage alone in two distinct malignancies drawn from two separate populations.

  14. Improving the precision of sample-based forest damage inventories through two-phase sampling and post-stratification using remotely sensed auxiliary information.

    Science.gov (United States)

    Roberge, Cornelia; Wulff, Sören; Reese, Heather; Ståhl, Göran

    2016-04-01

    Many countries have a national forest inventory (NFI) designed to produce statistically sound estimates of forest parameters. However, this type of inventory may not provide reliable results for forest damage which usually affects only small parts of the forest in a country. For this reason, specially designed forest damage inventories are performed in many countries, sometimes in coordination with the NFIs. In this study, we evaluated a new approach for damage inventory where existing NFI data form the basis for two-phase sampling for stratification and remotely sensed auxiliary data are applied for further improvement of precision through post-stratification. We applied Monte Carlo sampling simulation to evaluate different sampling strategies linked to different damage scenarios. The use of existing NFI data in a two-phase sampling for stratification design resulted in a relative efficiency of 50 % or lower, i.e., the variance was at least halved compared to a simple random sample of the same size. With post-stratification based on simulated remotely sensed auxiliary data, there was additional improvement, which depended on the accuracy of the auxiliary data and the properties of the forest damage. In many cases, the relative efficiency was further reduced by as much as one-half. In conclusion, the results show that substantial gains in precision can be obtained by utilizing auxiliary information in forest damage surveys, through two-phase sampling, through post-stratification, and through the combination of these two approaches, i.e., post-stratified two-phase sampling for stratification.

  15. Serum EBV EA-IgA and VCA-IgA antibodies can be used for risk group stratification and prognostic prediction in extranodal NK/T cell lymphoma: 24-year experience at a single institution.

    Science.gov (United States)

    Huang, Yuhua; Rao, Huilan; Yan, Shumei; Wang, Fang; Wu, Qinian; Feng, Yanfen; Zhang, Yujing

    2017-08-01

    Although extranodal NK/T cell lymphoma (ENKTCL) is consistently associated with Epstein-Barr virus (EBV) infection, the manifestation and prognostic value of serum EBV antibodies still remain unknown. One hundred and forty-one patients with ENKTCL were evaluated for serum EBV EA-IgA and VCA-IgA antibodies levels in the past 24 years in our institution. Their correlation with clinicopathological features, plasma EBV DNA load, and patients' outcomes was analyzed. EBV EA-IgA ≥1:10 and VCA-IgA ≥1:160 were found in 18.4 and 16.3% of patients, respectively. They correlated with adverse ENKTCL profile and inferior overall survival (OS) and progression-free survival (PFS). EA-IgA ≥1:10 was an independent prognostic factor on OS (RR = 2.276, p = 0.008) and associated with lower complete response (CR) rate (34.8 vs 70.6%, p = 0.001) and higher relapse rate in CR patients (62.5 vs 34.7%, p = 0.016). In subgroup analysis, both EA-IgA ≥1:10 and VCA-IgA ≥1:160 significantly correlated with inferior OS and PFS in patients with stage I/II, IPI score 0-1, plasma EBV DNA (+), and CR. Patients with plasma EBV DNA (+) and EA-IgA ≥1:10 (or VCA-IgA ≥1:160) had significantly shorter periods of OS and PFS in comparison with other corresponding groups. Elevated serum EBV EA-IgA and VCA-IgA levels were related to adverse ENKTCL profile and correlated with poor treatment response, early relapse, and poor prognosis in patients with ENKTCL. These findings provide convincing evidence for the use of serum EBV EA-IgA and VCA-IgA antibodies for risk group stratification and prognostic prediction in ENKTCL.

  16. Improved cancer risk stratification and diagnosis via quantitative phase microscopy (Conference Presentation)

    Science.gov (United States)

    Liu, Yang; Uttam, Shikhar; Pham, Hoa V.; Hartman, Douglas J.

    2017-02-01

    Pathology remains the gold standard for cancer diagnosis and in some cases prognosis, in which trained pathologists examine abnormality in tissue architecture and cell morphology characteristic of cancer cells with a bright-field microscope. The limited resolution of conventional microscope can result in intra-observer variation, missed early-stage cancers, and indeterminate cases that often result in unnecessary invasive procedures in the absence of cancer. Assessment of nanoscale structural characteristics via quantitative phase represents a promising strategy for identifying pre-cancerous or cancerous cells, due to its nanoscale sensitivity to optical path length, simple sample preparation (i.e., label-free) and low cost. I will present the development of quantitative phase microscopy system in transmission and reflection configuration to detect the structural changes in nuclear architecture, not be easily identifiable by conventional pathology. Specifically, we will present the use of transmission-mode quantitative phase imaging to improve diagnostic accuracy of urine cytology and the nuclear dry mass is progressively correlate with negative, atypical, suspicious and positive cytological diagnosis. In a second application, we will present the use of reflection-mode quantitative phase microscopy for depth-resolved nanoscale nuclear architecture mapping (nanoNAM) of clinically prepared formalin-fixed, paraffin-embedded tissue sections. We demonstrated that the quantitative phase microscopy system detects a gradual increase in the density alteration of nuclear architecture during malignant transformation in animal models of colon carcinogenesis and in human patients with ulcerative colitis, even in tissue that appears histologically normal according to pathologists. We evaluated the ability of nanoNAM to predict "future" cancer progression in patients with ulcerative colitis.

  17. Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)

    2014-07-01

    Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

  18. Numerical simulation of charge stratifications to improve combustion and NO formation of lean-burn SI engines

    Institute of Scientific and Technical Information of China (English)

    Zhijun PENG

    2009-01-01

    The influences of charge stratification on spark ignition (SI) engine combustion and NO emission were analyzed using a phenomenological model. The mixture in the cylinder was divided spherically into three parts: a central core with a stoichiometric air-fuel charge, a dilution region without any combustible charge, and a mixing region lying between the core and the dilution region.Three mixture stratification parameters such as the extent of dilution in the mixing region, the extent of combustible charge in the mixing region, and the gradient of stratification in the mixing region were investigated. The results indicate that the extent of combustible charge in the mixing region could reduce in-cylinder NO formation significantly, compared with the extent of dilution in the mixing region. As long as the degree of dilution in the mixing region is within the dilution limit of the combustible charge, the gradient of dilution has little effect on combustion and NO formation.

  19. EPS Biomarkers Improve Stratification of NCCN Active Surveillance Candidates: Performance of Secretion Capacity and TMPRSS2:ERG Models

    Science.gov (United States)

    Whelan, Christopher; Kawachi, Mark; Smith, David D.; Linehan, Jennifer; Babilonia, Gail; Mejia, Rosa; Wilson, Timothy; Smith, Steven

    2014-01-01

    Purpose Active surveillance (AS) is a viable patient option for prostate cancer where a clinical determination of low-risk and presumably organ-confined disease can be made. In an effort to standardize risk stratification schemes, the National Comprehensive Cancer Network (NCCN) has provided guidelines for the AS option. Our purpose was to determine the effectiveness of expressed prostatic secretion (EPS) biomarkers in detecting occult risk factors in NCCN AS candidates. Materials and Methods EPS specimens were obtained prior to Robot-Assisted Radical Prostatectomy (RARP). Secretion capacity biomarkers: total RNA and EPS specimen volume were measured by standard techniques. RNA expression biomarkers: TXNRD1-mRNA, PSA-mRNA, TMPRSS2:ERG fusion mRNA and PCA3-mRNAs were measured by quantitative reverse-transcription PCR. Results Of the 528 patients from whom EPS was collected, 216 were eligible for AS under NCCN guidelines. Variable Selection in logistic regression identified two models, one featuring Type III and Type VI TMPRSS2:ERG variants, and one featuring two secretion capacity biomarkers. Of the two high performing models, the secretion capacity model was the most effective in detecting patients within this group that were upstaged or both upstaged and upgraded. It reduced the risk of upstaging in patients with a negative test by nearly 8 fold, and reduced the risk of being both upstaged and upgraded by about 5 fold, while doubling the prevalence upstaging in the positive test group. Conclusions Non-invasive EPS testing may improve patient acceptance of AS by dramatically reducing the presence of occult risk factors among patients eligible for AS under NCCN guidelines. PMID:23669563

  20. Reassessment of Ambulatory Blood Pressure Improves Renal Risk Stratification in Nondialysis Chronic Kidney Disease: Long-Term Cohort Study.

    Science.gov (United States)

    Minutolo, Roberto; Gabbai, Francis B; Chiodini, Paolo; Garofalo, Carlo; Stanzione, Giovanna; Liberti, Maria Elena; Pacilio, Mario; Borrelli, Silvio; Provenzano, Michele; Conte, Giuseppe; De Nicola, Luca

    2015-09-01

    In nondialysis chronic kidney disease, ambulatory blood pressure (ABP) performs better than clinic BP in predicting outcome, but whether repeated assessment of ABP further refines prognosis remains ill-defined. We recruited 182 consecutive hypertensive patients with nondialysis chronic kidney disease who underwent 2 ABPs 12 months apart to evaluate the enhancement in risk stratification provided by a second ABP obtained 1 year after baseline on the risk (hazard ratio and 95% confidence interval) of composite renal end point (death, chronic dialysis, and estimated glomerular filtration rate decline ≥40%). The difference in daytime and nighttime systolic BP between the 2 ABPs (daytime and nighttime bias) was added to a survival model including baseline ABP. Net reclassification improvement was also calculated. Age was 65.6±13.4 years; 36% had diabetes mellitus and 36% had previous cardiovascular event; estimated glomerular filtration rate was 42.2±19.6 mL/min per 1.73 m(2), and clinic BP was 145±18/80±11 mm Hg. Baseline ABP (daytime, 131±16/75±10 and nighttime, 122±18/66±10 mm Hg) and daytime/nighttime BP goals (58.2% and 43.4%) did not change at month 12. Besides baseline ABP values, bias for daytime and nighttime systolic BP linearly associated with renal outcome (1.12, 1.04-1.21 and 1.18, 1.08-1.29 for every 5-mm Hg increase, respectively). Classification of patients at risk improved when considering nighttime systolic level at second ABP (net reclassification improvement, 0.224; 95% confidence interval, 0.005-0.435). Patients with first and second ABPs above target showed greater renal risk (2.15, 1.29-3.59 and 1.71, 1.07-2.72, for daytime and nighttime, respectively). In nondialysis chronic kidney disease, reassessment of ABP at 1 year further refines renal prognosis; such reassessment should specifically be considered in patients with uncontrolled BP at baseline.

  1. Improved Design of High Viscous Crude Oil Stratification Sampling Facility%超稠原油大罐分层取样装置改进型设计

    Institute of Scientific and Technical Information of China (English)

    宋传阳

    2014-01-01

    Stratification sampling facility is always adopted in high viscous liquid production at home and abroad. In this paper, based on practical application, aiming at problems of old stratification sampling facility, a new improved stratification sampling facility was designed. The improved facility is excellent in convenient use, easy operation and high sampling efficiency.%超稠原油大罐分层取样装置一直是国内外高粘液体生产中常用的大罐取样装置,本文结合现场实际应用,针对原有分层取样装置提手、取样尺宜断裂、取样瓶宜掉落等问题,设计出一种改进型大罐分层取样装置,该装置使用方便、易于操作、取样效果好,有效满足了油田及化工日常生产的需要。

  2. PROGNOSTIC SIGNIFICANCE OF CD56 EXPRESSION IN ACUTE LEUKEMIAS

    Directory of Open Access Journals (Sweden)

    B. M. Ahmed

    2014-12-01

    Conclusions. CD56 antigenic expression in AML cases represents an adverse prognostic factor. It should be regularly investigated in cases of AML for better prognostic stratification and assessment. KEY WORDS: CD56; leukemia, myeloid; prognosis

  3. Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry.

    Science.gov (United States)

    Sánchez-Gil, Justo; Manzano, Luis; Flather, Marcus; Formiga, Francesc; Martel, Alicia Conde; Molinero, Alberto Muela; López, Raul Quirós; Jiménez, Jose Luis Arias; Iborra, Pau Llácer; Perez-Calvo, Juan Ignacio; Montero-Pérez-Barquero, Manuel

    2017-03-01

    Heart rate (HR) and systolic blood pressure (SBP) are independent prognostic variables in patients with heart failure (HF). We evaluated if combining HR and SBP could improve prognostic assessment in older patients. Variables associated with all-cause mortality and readmission for HF during 9months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups. We evaluated 1551 patients, 82years and 56% women. Using HR strata of rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP≥140, 120-140 and rates were 8.2, 10.4 and 20.3%. respectively (hazard ratio 1.0, 1.34 and 2.76). Using combined strata of HRrates of 4.5%, 11.0% and 24.0%, respectively. Multivariate Cox regression for all-cause mortality shows for low-, middle- and high-risk groups was 1 (reference), 1.93 (95% CI: 0.93-3.99, p=0.077) and 4.32 (95% CI: 2.04-9.14, p<0.001). BMI, NYHA, MDRD, hypertension and sodium were also independent prognostic factors. The combination provides better risk discrimination than use of HR and SBP alone and may provide a simple and reliable tool for risk assessment for older HF patients in clinical practice. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Negative node count improvement prognostic prediction of the seventh edition of the TNM classification for gastric cancer.

    Science.gov (United States)

    Deng, Jingyu; Zhang, Rupeng; Zhang, Li; Liu, Yong; Hao, Xishan; Liang, Han

    2013-01-01

    To demonstrate that the seventh edition of the tumor-node-metastasis (TNM) classification for gastric cancer (GC) should be updated with the number of negative lymph nodes for the improvement of its prognostic prediction accuracy. Clinicopathological data of 769 GC patients who underwent curative gastrectomy with lymphadenectomy between 1997 and 2006 were retrospectively analyzed to demonstrate the superiority of prognostic efficiency of the seventh edition of the TNM classification, which can be improved by combining the number of negative lymph nodes. With the Cox regression multivariate analysis, the seventh edition of the TNM classification, the number of negative nodes, the type of gastrectomy, and the depth of tumor invasion (T stage) were identified as independent factors for predicting the overall survival of GC patients. Furthermore, we confirmed that the T stage-N stage-number of negative lymph nodes-metastasis (TNnM) classification is the most appropriate prognostic predictor of GC patients by using case-control matched fashion and multinominal logistic regression. Finally, we were able to clarify that TNnM classification may provide more precise survival differences among the different TNM sub-stages of GC by using the measure of agreement (Kappa coefficient), the McNemar value, the Akaike information criterion, and the Bayesian Information Criterion compared with the seventh edition of the TNM classification. The number of negative nodes, as an important prognostic predictor of GC, can improve the prognostic prediction efficiency of the seventh edition of the TNM classification for GC, which should be recommended for conventional clinical applications.

  5. Negative node count improvement prognostic prediction of the seventh edition of the TNM classification for gastric cancer.

    Directory of Open Access Journals (Sweden)

    Jingyu Deng

    Full Text Available OBJECTIVE: To demonstrate that the seventh edition of the tumor-node-metastasis (TNM classification for gastric cancer (GC should be updated with the number of negative lymph nodes for the improvement of its prognostic prediction accuracy. METHODS: Clinicopathological data of 769 GC patients who underwent curative gastrectomy with lymphadenectomy between 1997 and 2006 were retrospectively analyzed to demonstrate the superiority of prognostic efficiency of the seventh edition of the TNM classification, which can be improved by combining the number of negative lymph nodes. RESULTS: With the Cox regression multivariate analysis, the seventh edition of the TNM classification, the number of negative nodes, the type of gastrectomy, and the depth of tumor invasion (T stage were identified as independent factors for predicting the overall survival of GC patients. Furthermore, we confirmed that the T stage-N stage-number of negative lymph nodes-metastasis (TNnM classification is the most appropriate prognostic predictor of GC patients by using case-control matched fashion and multinominal logistic regression. Finally, we were able to clarify that TNnM classification may provide more precise survival differences among the different TNM sub-stages of GC by using the measure of agreement (Kappa coefficient, the McNemar value, the Akaike information criterion, and the Bayesian Information Criterion compared with the seventh edition of the TNM classification. CONCLUSION: The number of negative nodes, as an important prognostic predictor of GC, can improve the prognostic prediction efficiency of the seventh edition of the TNM classification for GC, which should be recommended for conventional clinical applications.

  6. Improving Computational Efficiency of Prediction in Model-based Prognostics Using the Unscented Transform

    Data.gov (United States)

    National Aeronautics and Space Administration — Model-based prognostics captures system knowledge in the form of physics-based models of components, and how they fail, in order to obtain accurate predictions of...

  7. Validation of risk stratification models in acute myeloid leukemia using sequencing-based molecular profiling.

    Science.gov (United States)

    Wang, M; Lindberg, J; Klevebring, D; Nilsson, C; Mer, A S; Rantalainen, M; Lehmann, S; Grönberg, H

    2017-10-01

    Risk stratification of acute myeloid leukemia (AML) patients needs improvement. Several AML risk classification models based on somatic mutations or gene-expression profiling have been proposed. However, systematic and independent validation of these models is required for future clinical implementation. We performed whole-transcriptome RNA-sequencing and panel-based deep DNA sequencing of 23 genes in 274 intensively treated AML patients (Clinseq-AML). We also utilized the The Cancer Genome Atlas (TCGA)-AML study (N=142) as a second validation cohort. We evaluated six previously proposed molecular-based models for AML risk stratification and two revised risk classification systems combining molecular- and clinical data. Risk groups stratified by five out of six models showed different overall survival in cytogenetic normal-AML patients in the Clinseq-AML cohort (P-value0.5). Risk classification systems integrating mutational or gene-expression data were found to add prognostic value to the current European Leukemia Net (ELN) risk classification. The prognostic value varied between models and across cohorts, highlighting the importance of independent validation to establish evidence of efficacy and general applicability. All but one model replicated in the Clinseq-AML cohort, indicating the potential for molecular-based AML risk models. Risk classification based on a combination of molecular and clinical data holds promise for improved AML patient stratification in the future.

  8. Transforming RNA-Seq data to improve the performance of prognostic gene signatures.

    Directory of Open Access Journals (Sweden)

    Isabella Zwiener

    Full Text Available Gene expression measurements have successfully been used for building prognostic signatures, i.e for identifying a short list of important genes that can predict patient outcome. Mostly microarray measurements have been considered, and there is little advice available for building multivariable risk prediction models from RNA-Seq data. We specifically consider penalized regression techniques, such as the lasso and componentwise boosting, which can simultaneously consider all measurements and provide both, multivariable regression models for prediction and automated variable selection. However, they might be affected by the typical skewness, mean-variance-dependency or extreme values of RNA-Seq covariates and therefore could benefit from transformations of the latter. In an analytical part, we highlight preferential selection of covariates with large variances, which is problematic due to the mean-variance dependency of RNA-Seq data. In a simulation study, we compare different transformations of RNA-Seq data for potentially improving detection of important genes. Specifically, we consider standardization, the log transformation, a variance-stabilizing transformation, the Box-Cox transformation, and rank-based transformations. In addition, the prediction performance for real data from patients with kidney cancer and acute myeloid leukemia is considered. We show that signature size, identification performance, and prediction performance critically depend on the choice of a suitable transformation. Rank-based transformations perform well in all scenarios and can even outperform complex variance-stabilizing approaches. Generally, the results illustrate that the distribution and potential transformations of RNA-Seq data need to be considered as a critical step when building risk prediction models by penalized regression techniques.

  9. Prognostic factors for short-term improvement in acute and persistent musculoskeletal pain consulters in primary care

    Directory of Open Access Journals (Sweden)

    Bolton Jennifer E

    2011-11-01

    Full Text Available Abstract Background Given the costs associated with the management of musculoskeletal pain in primary care, predicting the course of these conditions remains a research priority. Much of the research into prognostic indicators however considers musculoskeletal conditions in terms of single pain sites whereas in reality, many patients present with pain in more than one site. The aim of this study was to identify prognostic factors for early improvement in primary care consulters with acute and persistent musculoskeletal conditions across a range of pain sites. Methods Consecutive patients with a new episode of musculoskeletal pain completed self-report questionnaires at baseline, and then again at the 4/5th treatment visit, and if they were still consulting, at the 10th visit. The outcome was defined as patient self-report improvement sufficient to make a meaningful difference. Independent predictors of outcome were identified using multivariate regression analyses. Results Acute (th visit. Several variables at baseline were associated with improvement at the 4/5th visit, but the predictive models were weak and unable to discriminate between patients who were improved and those who were not. In contrast, it was possible to elicit a predictive model for improvement later on at the 10th visit, but only in patients with persistent pain. Being employed, reporting a decline in work fear-avoidance behaviour at the 4/5th visit, and being better by the 4/5th visit, were all independently associated with improvement. This model accounted for 34.3% (p Conclusions We were unable to identify baseline characteristics that predicted early outcome in musculoskeletal pain patients. However, early self-reported improvement and decline in work fear-avoidance behaviour as predictors of later improvement highlighted the importance of speedy recovery in persistent musculoskeletal pain consulters. Our findings reinforce the elusive nature of baseline predictors, and

  10. Measuring frailty in population-based healthcare databases: multi-dimensional prognostic indices for the improvement of geriatric care

    Directory of Open Access Journals (Sweden)

    Janet Sultana

    2016-04-01

    Full Text Available The prognostic evaluation of geriatric patients is critical in helping clinicians to weigh the risks versus the benefits of available therapeutic options. Frailty contributes significantly to the risk of mortality in older patients and is already known to have implications on the outcome of treatment in a clinical context. The multi-dimensional prognostic index (MPI is a prognostic tool based on a comprehensive geriatric assessment and includes detailed information on patient cognition, functionality, disease and drug burden. The value of the MPI in predicting mortality has already been shown in hospital and community settings but never in a population- based healthcare database setting. One of the aims of the ongoing EU-funded MPI_Age project is to improve our understanding of how geriatric frailty data can be identified in healthcare databases and whether this can be used to predict serious adverse events associated with pharmacotherapy. Our findings suggest that data on functionality in elderly patients is poorly registered in The Health Improvement Network (THIN, a UK nationwide general practice database, and only few of the functionality domains could be used in a population-based analysis. The most commonly registered functionality information was related to mobility, dressing, accommodation and cognition. Our results suggest that some of these functionality domains are predictive of short- and long-term mortality in community-dwelling patients. This may have implications in observational research where frailty is an unmeasured confounder.

  11. INLET STRATIFICATION DEVICE

    DEFF Research Database (Denmark)

    2006-01-01

    An inlet stratification device (5) for a circuit circulating a fluid through a tank (1 ) and for providing and maintaining stratification of the fluid in the tank (1 ). The stratification de- vice (5) is arranged vertically in the tank (1) and comprises an inlet pipe (6) being at least partially...... formed of a flexible porous material and having an inlet (19) and outlets formed of the pores of the porous material. The stratification device (5) further comprises at least one outer pipe (7) surrounding the inlet pipe (6) in spaced relationship thereto and being at least partially formed of a porous...

  12. Significance analysis of prognostic signatures.

    Directory of Open Access Journals (Sweden)

    Andrew H Beck

    Full Text Available A major goal in translational cancer research is to identify biological signatures driving cancer progression and metastasis. A common technique applied in genomics research is to cluster patients using gene expression data from a candidate prognostic gene set, and if the resulting clusters show statistically significant outcome stratification, to associate the gene set with prognosis, suggesting its biological and clinical importance. Recent work has questioned the validity of this approach by showing in several breast cancer data sets that "random" gene sets tend to cluster patients into prognostically variable subgroups. This work suggests that new rigorous statistical methods are needed to identify biologically informative prognostic gene sets. To address this problem, we developed Significance Analysis of Prognostic Signatures (SAPS which integrates standard prognostic tests with a new prognostic significance test based on stratifying patients into prognostic subtypes with random gene sets. SAPS ensures that a significant gene set is not only able to stratify patients into prognostically variable groups, but is also enriched for genes showing strong univariate associations with patient prognosis, and performs significantly better than random gene sets. We use SAPS to perform a large meta-analysis (the largest completed to date of prognostic pathways in breast and ovarian cancer and their molecular subtypes. Our analyses show that only a small subset of the gene sets found statistically significant using standard measures achieve significance by SAPS. We identify new prognostic signatures in breast and ovarian cancer and their corresponding molecular subtypes, and we show that prognostic signatures in ER negative breast cancer are more similar to prognostic signatures in ovarian cancer than to prognostic signatures in ER positive breast cancer. SAPS is a powerful new method for deriving robust prognostic biological signatures from clinically

  13. Baroclinic pressure gradient difference schemes of subtracting the local averaged density stratification in sigma coordinates models

    Institute of Scientific and Technical Information of China (English)

    ZHU Shouxian; ZHANG Wenjing

    2008-01-01

    Much has been written of the error in computing the baroclinic pressure gradient (BPG) with sigma coordinates in ocean or atmos- pheric numerical models. The usual way to reduce the error is to subtract area-averaged density stratification of the whole computa- tion region. But if there is great difference between the area-averaged and the local averaged density stratification, the error will be obvious. An example is given to show that the error from this method may be larger than that from no correction sometimes. The definition of local area is put forward. Then, four improved BPG difference schemes of subtracting the local averaged density strat- ification are designed to reduce the error. Two of them are for diagnostic calculation (density field is fixed), and the others are for prognostic calculation (density field is not fixed). The results show that the errors from these schemes all significantly decrease.

  14. Modeling Multimodal Stratification

    DEFF Research Database (Denmark)

    Boeriis, Morten

    2017-01-01

    This article discusses one of the core axioms of social semiotic theory, namely stratification, in the light of developments in multimodality in recent years. The discussion takes a point of departure in the approaches to stratification taken by Hjelmslev, Halliday, and Kress and van Leeuwen...

  15. Would Lipophilic Statin Therapy as a Prognostic Factor Improve Survival in Patients With Uterine Cervical Cancer?

    Science.gov (United States)

    Song, Moo-Kon; Shin, Byoung-Sub; Ha, Chung-Sik; Park, Won-Young

    2017-09-01

    In vitro studies showed that lipophilic statins inhibit cell growth, adhesion, and invasion and induce apoptosis in cancer cell lines. In uterine cervical cancer, several important factors including age, stage, anemia, lymphovascular invasion, lymph node metastases, and parametrial spread were known to significantly predict survival. We investigated whether statin therapy as a prognostic factor would significantly predict survival in cervical cancer. Patients with stages IB to IV cervical cancer who received radical hysterectomy and/or para-aortic lymph node dissection were included. The statin-use group was identified as patients who were continuously prescribed with lipophilic statins from prediagnostic period of the cancer. The baseline characteristics of both statin-use group and control group were comparable. During a median follow-up of 36.6 months, progression-free survival and overall survival of the statin-use group were significantly higher than the control group (P < 0.001 and P = 0.004, respectively). In multivariate analysis, the statin-use group had an independent prognostic significance compared with other prognostic factors (progression-free survival: hazards ratio = 0.062, 95% confidence interval = 0.008-0.517, P = 0.010; overall survival: hazards ratio = 0.098, 95% confidence interval = 0.041-0.459, P = 0.032). In the present study, continuous lipophilic statin therapy from the prediagnostic period of uterine cervical cancer could reflect favorable outcome, independently.

  16. Systematic Analysis of Challenge-Driven Improvements in Molecular Prognostic Models for Breast Cancer

    Science.gov (United States)

    Margolin, Adam A.; Bilal, Erhan; Huang, Erich; Norman, Thea C.; Ottestad, Lars; Mecham, Brigham H.; Sauerwine, Ben; Kellen, Michael R.; Mangravite, Lara M.; Furia, Matthew D.; Vollan, Hans Kristian Moen; Rueda, Oscar M.; Guinney, Justin; Deflaux, Nicole A.; Hoff, Bruce; Schildwachter, Xavier; Russnes, Hege G.; Park, Daehoon; Vang, Veronica O.; Pirtle, Tyler; Youseff, Lamia; Citro, Craig; Curtis, Christina; Kristensen, Vessela N.; Hellerstein, Joseph; Friend, Stephen H.; Stolovitzky, Gustavo; Aparicio, Samuel; Caldas, Carlos; Børresen-Dale, Anne-Lise

    2013-01-01

    Although molecular prognostics in breast cancer are among the most successful examples of translating genomic analysis to clinical applications, optimal approaches to breast cancer clinical risk prediction remain controversial. The Sage Bionetworks–DREAM Breast Cancer Prognosis Challenge (BCC) is a crowdsourced research study for breast cancer prognostic modeling using genome-scale data. The BCC provided a community of data analysts with a common platform for data access and blinded evaluation of model accuracy in predicting breast cancer survival on the basis of gene expression data, copy number data, and clinical covariates. This approach offered the opportunity to assess whether a crowdsourced community Challenge would generate models of breast cancer prognosis commensurate with or exceeding current best-in-class approaches. The BCC comprised multiple rounds of blinded evaluations on held-out portions of data on 1981 patients, resulting in more than 1400 models submitted as open source code. Participants then retrained their models on the full data set of 1981 samples and submitted up to five models for validation in a newly generated data set of 184 breast cancer patients. Analysis of the BCC results suggests that the best-performing modeling strategy outperformed previously reported methods in blinded evaluations; model performance was consistent across several independent evaluations; and aggregating community-developed models achieved performance on par with the best-performing individual models. PMID:23596205

  17. Nottingham prognostic index plus (NPI+) predicts risk of distant metastases in primary breast cancer.

    Science.gov (United States)

    Green, Andrew R; Soria, D; Powe, D G; Nolan, C C; Aleskandarany, M; Szász, M A; Tőkés, A M; Ball, G R; Garibaldi, J M; Rakha, E A; Kulka, J; Ellis, I O

    2016-05-01

    The Nottingham prognostic index plus (NPI+) is based on the assessment of biological class combined with established clinicopathologic prognostic variables providing improved patient outcome stratification for breast cancer superior to the traditional NPI. This study aimed to determine prognostic capability of the NPI+ in predicting risk of development of distant disease. A well-characterised series of 1073 primary early-stage BC cases treated in Nottingham and 251 cases from Budapest were immunohistochemically assessed for cytokeratin (Ck)5/6, Ck18, EGFR, oestrogen receptor (ER), progesterone receptor, HER2, HER3, HER4, Mucin 1 and p53 expression. NPI+ biological class and prognostic scores were assigned using individual algorithms for each biological class incorporating clinicopathologic parameters and investigated in terms of prediction of distant metastases-free survival (MFS). The NPI+ identified distinct prognostic groups (PG) within each molecular class which were predictive of MFS providing improved patient outcome stratification superior to the traditional NPI. NPI+ PGs, between series, were comparable in predicting patient outcome between series in luminal A, basal p53 altered and HER2+/ER+ (p > 0.01) tumours. The low-risk groups were similarly validated in luminal B, luminal N, basal p53 normal tumours (p > 0.01). Due to small patient numbers the remaining PGs could not be validated. NPI+ was additionally able to predict a higher risk of metastases at certain distant sites. This study may indicate the NPI+ as a useful tool in predicting the risk of metastases. The NPI+ provides accurate risk stratification allowing improved individualised clinical decision making for breast cancer.

  18. New prognostic biomarkers in multiple myeloma

    Directory of Open Access Journals (Sweden)

    Aneta Szudy-Szczyrek

    2016-01-01

    Full Text Available Multiple myeloma is a malignant neoplastic disease, characterized by uncontrolled proliferation and accumulation of plasma cells in the bone marrow, which is usually connected with production of a monoclonal protein. It is the second most common hematologic malignancy. It constitutes approximately 1% of all cancers and 10% of hematological malignancies. Despite the huge progress that has been made in the treatment of multiple myeloma in the past 30 years including the introduction of new immunomodulatory drugs and proteasome inhibitors, it is still an incurable disease. According to current data, the five-year survival rate is 45%. Multiple myeloma is a very heterogeneous disease with a very diverse clinical course, which is expressed by differences in effectiveness of therapeutic strategies and ability to develop chemoresistance. This diversity implies the need to define risk stratification factors that would help to create personalized and optimized therapy and thereby improve treatment outcomes. Prognostic markers that aim to objectively evaluate the risk of a poor outcome, relapse and the patient’s overall outcome are useful for this purpose. The existing, widely used prognostic classifications, such as the Salmon-Durie classification or ISS, do not allow for individualization of treatment. As a result of the development of diagnostic techniques, especially cytogenetics and molecular biology, we were able to discover a lot of new, more sensitive and specific prognostic factors. The paper presents recent reports on the role of molecular, cytogenetic and biochemical alterations in pathogenesis and prognosis of the disease.

  19. Overcoming intratumoural heterogeneity for reproducible molecular risk stratification: a case study in advanced kidney cancer.

    Science.gov (United States)

    Lubbock, Alexander L R; Stewart, Grant D; O'Mahony, Fiach C; Laird, Alexander; Mullen, Peter; O'Donnell, Marie; Powles, Thomas; Harrison, David J; Overton, Ian M

    2017-06-26

    Metastatic clear cell renal cell cancer (mccRCC) portends a poor prognosis and urgently requires better clinical tools for prognostication as well as for prediction of response to treatment. Considerable investment in molecular risk stratification has sought to overcome the performance ceiling encountered by methods restricted to traditional clinical parameters. However, replication of results has proven challenging, and intratumoural heterogeneity (ITH) may confound attempts at tissue-based stratification. We investigated the influence of confounding ITH on the performance of a novel molecular prognostic model, enabled by pathologist-guided multiregion sampling (n = 183) of geographically separated mccRCC cohorts from the SuMR trial (development, n = 22) and the SCOTRRCC study (validation, n = 22). Tumour protein levels quantified by reverse phase protein array (RPPA) were investigated alongside clinical variables. Regularised wrapper selection identified features for Cox multivariate analysis with overall survival as the primary endpoint. The optimal subset of variables in the final stratification model consisted of N-cadherin, EPCAM, Age, mTOR (NEAT). Risk groups from NEAT had a markedly different prognosis in the validation cohort (log-rank p = 7.62 × 10(-7); hazard ratio (HR) 37.9, 95% confidence interval 4.1-353.8) and 2-year survival rates (accuracy = 82%, Matthews correlation coefficient = 0.62). Comparisons with established clinico-pathological scores suggest favourable performance for NEAT (Net reclassification improvement 7.1% vs International Metastatic Database Consortium score, 25.4% vs Memorial Sloan Kettering Cancer Center score). Limitations include the relatively small cohorts and associated wide confidence intervals on predictive performance. Our multiregion sampling approach enabled investigation of NEAT validation when limiting the number of samples analysed per tumour, which significantly degraded performance

  20. Colon cancer and gene alterations: their immunological implications and suggestions for prognostic indices and improvements in biotherapy.

    Science.gov (United States)

    Contasta, Ida; Pellegrini, Patrizia; Berghella, Anna Maria; Del Beato, Tiziana; Adorno, Domenico

    2006-10-01

    Studies have shown that changes occur in c-Ki-ras, p53, and Bcl2 gene structure and function during the various stages of human colon carcinogenesis. Alterations of these genes are responsible for the establishment of a state of continuous stimulus for cell division and apoptotic inhibition at physiological and pharmacological levels. This paper focuses on the results of our research aimed at investigating how these gene alterations influence tumoral mechanisms on an immunological level and how immunological parameters can be used as prognostic markers for the passage of normal tissue to adenoma and adenoma to carcinoma. Overall, our data suggest that an alteration in the c-Ki-ras gene results in a switch to a suppressive type of immune response, determining an impairment of immune cell activation at both antigen- presenting-cell and T-cell levels. c-Ki-ras gene mutations, p53 deletions, and Bc12 expression, on the other hand, can be used as prognostic markers for the passage of normal tissue to adenoma and adenoma to carcinoma. The p53 oncogene does not appear to impair patients' immunological response further. In conclusion, an evaluation of c-Ki-ras, rather than p53 gene alterations, would seem to be more relevant in colon cancer prevention programs and biotherapy improvement.

  1. Improving risk stratification of patients with childhood acute lymphoblastic leukemia: Glutathione-S-Transferases polymorphisms are associated with increased risk of relapse

    Science.gov (United States)

    Riccheri, María C.; Nuñez, Myriam; Alfonso, Graciela; Gueron, Geraldine; De Siervi, Adriana; Vazquez, Elba; Cotignola, Javier

    2017-01-01

    The inclusion of genotype at Acute Lymphoblastic Leukemia (ALL) diagnosis as a genetic predictor of disease outcome is under constant study. However, results are inconclusive and seem to be population specific. We analyzed the predictive value of germline polymorphisms for childhood ALL relapse and survival. We retrospectively recruited 140 Argentine patients with de novo ALL. Genotypes were analyzed using PCR-RFLP (GSTP1 c.313A > G, MDR1 c.3435T > C, and MTHFR c.665C > T) and multiplex PCR (GSTT1 null, GSTM1 null). Patients with the GSTP1 c.313GG genotype had an increased risk for relapse in univariate (OR = 2.65, 95% CI = 1.03–6.82, p = 0.04) and multivariate (OR = 3.22, 95% CI = 1.17–8.83, p = 0.02) models. The combined genotype slightly increased risk for relapse in the univariate (OR = 2.82, 95% CI = 1.09–7.32, p = 0.03) and multivariate (OR = 2.98, 95% CI = 1.14–7.79, p = 0.03) models for patients with 2/3-risk-genotypes (GSTT1 null, GSTM1 null, GSTP1 c.313GG). The Recurrence-Free Survival (RFS) was shorter for GSTP1 c.313GG (p = 0.025) and 2/3-risk-genotypes (p = 0.021). GST polymorphisms increased the risk of relapse and RFS of patients with childhood ALL. The inclusion of these genetic markers in ALL treatment protocols might improve risk stratification and reduce the number of relapses and deaths. PMID:27058755

  2. The clinical implications of integrating additional prognostic factors into the TNM.

    Science.gov (United States)

    Henson, Donald Earl; Schwartz, Arnold M; Chen, Dechang; Wu, Dengyuan

    2014-04-01

    The management of solid tumors is governed by host and tumor factors that traditionally have incorporated TNM staging with additional pathologic, biologic, and clinical host factors. Beyond the anatomic-based TNM, increasingly new prognostic and predictive factors are being discovered that have important survival and treatment implications. However, because the TNM is based on a "bin" model, additional prognostic factors would rapidly overwhelm the current system. This communication demonstrates the clinical implications and improved patient prognosis derived from a new algorithmic model based on clustering analysis. A new algorithm is described that integrates additional factors into the TNM and calculates survival. The results indicate that additional factors can be integrated into the TNM staging system providing additional patient stratification without changing the TNM definitions. Adding prognostic factors to traditional TNM staging increases substratification of given stages and identifies and separates favorable and unfavorable clinical outcomes for specific TNM stages. Integration of additional prognostic factors into the TNM by a clustering algorithm can change the stratification of patient outcome. This may guide the clinician to select a more rational management program based on the additional factors and improve cohort selection for clinical trials. © 2013 Wiley Periodicals, Inc.

  3. Percentage of Positive Biopsy Cores: A Better Risk Stratification Model for Prostate Cancer?

    Energy Technology Data Exchange (ETDEWEB)

    Huang Jiayi; Vicini, Frank A. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Williams, Scott G. [Peter Maccallum Cancer Centre and University of Melbourne, Melbourne, Victoria (Australia); Ye Hong; McGrath, Samuel; Ghilezan, Mihai; Krauss, Daniel; Martinez, Alvaro A. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Kestin, Larry L., E-mail: lkestin@comcast.net [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

    2012-07-15

    Purpose: To assess the prognostic value of the percentage of positive biopsy cores (PPC) and perineural invasion in predicting the clinical outcomes after radiotherapy (RT) for prostate cancer and to explore the possibilities to improve on existing risk-stratification models. Methods and Materials: Between 1993 and 2004, 1,056 patients with clinical Stage T1c-T3N0M0 prostate cancer, who had four or more biopsy cores sampled and complete biopsy core data available, were treated with external beam RT, with or without a high-dose-rate brachytherapy boost at William Beaumont Hospital. The median follow-up was 7.6 years. Multivariate Cox regression analysis was performed with PPC, Gleason score, pretreatment prostate-specific antigen, T stage, PNI, radiation dose, androgen deprivation, age, prostate-specific antigen frequency, and follow-up duration. A new risk stratification (PPC classification) was empirically devised to incorporate PPC and replace the T stage. Results: On multivariate Cox regression analysis, the PPC was an independent predictor of distant metastasis, cause-specific survival, and overall survival (all p < .05). A PPC >50% was associated with significantly greater distant metastasis (hazard ratio, 4.01; 95% confidence interval, 1.86-8.61), and its independent predictive value remained significant with or without androgen deprivation therapy (all p < .05). In contrast, PNI and T stage were only predictive for locoregional recurrence. Combining the PPC ({<=}50% vs. >50%) with National Comprehensive Cancer Network risk stratification demonstrated added prognostic value of distant metastasis for the intermediate-risk (hazard ratio, 5.44; 95% confidence interval, 1.78-16.6) and high-risk (hazard ratio, 4.39; 95% confidence interval, 1.70-11.3) groups, regardless of the use of androgen deprivation and high-dose RT (all p < .05). The proposed PPC classification appears to provide improved stratification of the clinical outcomes relative to the National

  4. Non-hematologic predictors of mortality improve the prognostic value of the international prognostic scoring system for MDS in older adults†

    Science.gov (United States)

    Fega, K. Rebecca; Abel, Gregory A.; Motyckova, Gabriela; Sherman, Alexander E.; DeAngelo, Daniel J.; Steensma, David P.; Galinsky, Ilene; Wadleigh, Martha; Stone, Richard M.; Driver, Jane A.

    2016-01-01

    Objectives The International Prognostic Scoring System (IPSS) is commonly used to predict survival and assign treatment for the myelodysplastic syndromes (MDS). We explored whether self-reported and readily available non-hematologic predictors of survival add independent prognostic information to the IPSS. Materials and Methods Retrospective cohort study of consecutive MDS patients ≥age 65 who presented to Dana-Farber Cancer Institute between 2006 and 2011 and completed a baseline quality of life questionnaire. Questions corresponding to functional status and symptoms and extracted clinical-pathologic data from medical records. Kaplan–Meier and Cox proportional hazards models were used to estimate survival. Results One hundred fourteen patients consented and were available for analysis. Median age was 73 years, and the majority of patients were White, were male, and had a Charlson comorbidity score of <2. Few patients (24%) had an IPSS score consistent with lower-risk disease and the majority received chemotherapy. In addition to IPSS score and history of prior chemotherapy or radiation, significant univariate predictors of survival included low serum albumin, Charlson score, performance status, ability to take a long walk, and interference of physical symptoms in family life. The multivariate model that best predicted mortality included low serum albumin (HR = 2.3; 95% CI: 1.06–5.14), therapy-related MDS (HR = 2.1; 95% CI: 1.16–4.24), IPSS score (HR = 1.7; 95% CI: 1.14–2.49), and ease taking a long walk (HR = 0.44; 95% CI: 0.23–0.90). Conclusions In this study of older adults with MDS, we found that low serum albumin and physical function added important prognostic information to the IPSS score. Self-reported physical function was more predictive than physician-assigned performance status. PMID:26073533

  5. {sup 18}F-FDG PET/CT following chemoradiation of uterine cervix cancer provides powerful prognostic stratification independent of HPV status: a prospective cohort of 105 women with mature survival data

    Energy Technology Data Exchange (ETDEWEB)

    Siva, Shankar; Hicks, Rodney J.; Callahan, Jason [Peter MacCallum Cancer Centre, Division of Radiation Oncology and Cancer Imaging, East Melbourne, Victoria (Australia); University of Melbourne, Sir Peter MacCallum Department of Oncology, Parkville (Australia); Deb, Siddhartha [Peter MacCallum Cancer Centre, Department of Pathology, East Melbourne (Australia); Young, Richard J. [Peter MacCallum Cancer Centre, Molecular Therapeutics and Biomarkers Laboratory, East Melbourne (Australia); Bressel, Mathias [Peter MacCallum Cancer Centre, Department of Biostatistics and Clinical Trials, East Melbourne (Australia); Mileshkin, Linda [Peter MacCallum Cancer Centre, Department of Cancer Medicine, East Melbourne (Australia); Rischin, Danny [University of Melbourne, Sir Peter MacCallum Department of Oncology, Parkville (Australia); Peter MacCallum Cancer Centre, Department of Cancer Medicine, East Melbourne (Australia); Bernshaw, David; Narayan, Kailash [Peter MacCallum Cancer Centre, Division of Radiation Oncology and Cancer Imaging, East Melbourne, Victoria (Australia)

    2015-11-15

    To report 5-year outcomes of a prospective registry study investigating posttherapy FDG PET/CT in women with locally advanced cervical cancer. A secondary analysis assessing the prognostic significance of HPV infection was performed. Patients underwent definitive chemoradiation followed by a single FDG PET/CT scan for response assessment. A complete metabolic response (CMR) was defined as no evidence of FDG-avid disease. Patients were dichotomized according to HPV infection status into a 'higher-risk' group and a 'lower-risk' group, with the higher-risk group comprising those with alpha-7 strain HPV (subtypes 18, 39 and 45) and those who were HPV-negative and the lower-risk group comprising those with alpha-9 strain HPV (subtypes 16, 31, 33, 52 and 58) and those with mixed strains. Survival outcomes, patterns of failure and salvage therapy outcomes were investigated for their association with metabolic response and HPV status. In 105 patients the median prospective follow-up was 5.2 years. The 5-year cancer-specific, overall and progression-free survival rates in patients with a CMR were 97 %, 93 % and 86 %, respectively. In patients without a CMR, the corresponding 5-year survival rates were 36 %, 22 % and 0 % respectively (p < 0.01). PET response was associated with patterns of failure (p < 0.01), with the 5-year freedom from local, nodal and distant failure in patients with a CMR being 94 %, 90 % and 94 %, respectively. Of 16 patients who underwent salvage therapy, 12 had disease detected on the surveillance PET scan, and 8 achieved a post-salvage CMR of whom all were alive at a median of 4.9 years. DNA adequate for HPV analysis was extracted in 68 patients. The likelihood of a PET metabolic response was not influenced by HPV infection status, with 71 % and 75 % of higher-risk and lower-risk patients, respectively, achieving CMR (p = 0.83). Higher-risk patients had a poorer OS (HR 2.6, range 1.0 - 6.6, p = 0.05) in univariable analysis but

  6. ColoFinder: a prognostic 9-gene signature improves prognosis for 871 stage II and III colorectal cancer patients

    Directory of Open Access Journals (Sweden)

    Mingguang Shi

    2016-03-01

    Full Text Available Colorectal cancer (CRC is a heterogeneous disease with a high mortality rate and is still lacking an effective treatment. Our goal is to develop a robust prognosis model for predicting the prognosis in CRC patients. In this study, 871 stage II and III CRC samples were collected from six gene expression profilings. ColoFinder was developed using a 9-gene signature based Random Survival Forest (RSF prognosis model. The 9-gene signature recurrence score was derived with a 5-fold cross validation to test the association with relapse-free survival, and the value of AUC was gained with 0.87 in GSE39582(95% CI [0.83–0.91]. The low-risk group had a significantly better relapse-free survival (HR, 14.8; 95% CI [8.17–26.8]; P < 0.001 than the high-risk group. We also found that the 9-gene signature recurrence score contributed more information about recurrence than standard clinical and pathological variables in univariate and multivariate Cox analyses when applied to GSE17536(p = 0.03 and p = 0.01 respectively. Furthermore, ColoFinder improved the predictive ability and better stratified the risk subgroups when applied to CRC gene expression datasets GSE14333, GSE17537, GSE12945and GSE24551. In summary, ColoFinder significantly improves the risk assessment in stage II and III CRC patients. The 9-gene prognostic classifier informs patient prognosis and treatment response.

  7. Inlet stratification device

    DEFF Research Database (Denmark)

    2014-01-01

    ) with an inlet passage way (16). The upper end of the inlet pipe (6) is connected with a top cap (9). The top cap (9) and the bottom cap (10) are mutually connected by means of a wire (8) and the top cap (9) is configured as a floating device providing a buoyancy force larger than the downwardly directed force......An inlet stratification (5) is adapted to be arranged vertically in a tank (1) during operation. The stratification device (5) comprises an inlet pipe (6) formed of a flexible porous material and having a lower and upper end. The lower end of the inlet pipe (6) is connected to a bottom cap (10...

  8. The role of fluorescence in situ hybridization and gene expression profiling in myeloma risk stratification.

    Science.gov (United States)

    Hose, Dirk; Seckinger, Anja; Jauch, Anna; Rème, Thierry; Moreaux, Jérôme; Bertsch, Uta; Neben, Kai; Klein, Bernard; Goldschmidt, Hartmut

    2011-12-01

    Multiple myeloma patients' survival under treatment varies from a few months to more than 15 years. Clinical prognostic factors, especially beta2-microglobulin (B2M) and the international staging system (ISS), allow risk assessment to a certain extent, but do not identify patients at very high risk. As malignant plasma cells are characterized by a variety of chromosomal aberrations and changes in gene expression, a molecular characterization ofCD138-purified myeloma cells by interphase fluorescence in situ hybridization (iFISH) and gene expression profiling (GEP) can be used for improved risk assessment, iFISH allows a risk stratification with presence of a translocation t(4;14) and/or deletion of 17p13 being the best documented adverse prognostic factors. A deletion of 13q14 is no longer considered to define adverse risk. Patients harbouring a t(4;14) seems to benefit from a bortezomib- or lenalidomide containing regimen, whereas patients with deletion 17p13 seem only to benefit from a high dose therapy approach using long term bortezomib (in induction and maintenance) and autologous tandem-transplantation as used in the GMMG-HD4 trial, or the total therapy 3 concept. Gene expression profiling allows the assessment of high risk scores (IFM, UAMS), remaining prognostic despite treatment with novel agents, and prognostic surrogates of biological factors (e.g. proliferation) and (prognostic) target gene expression (e.g. Aurora-kinase A). Thus, assessment of B2M and ISS-stage, iFISH, and GEP is considered extended routine diagnostics in therapy requiring multiple myeloma patients for risk assessment and, even now, to a certain extent selection of treatment.

  9. Stratification and mixing in Lake Elsinore, California: an assessment of axial flow pumps for improving water quality in a shallow eutrophic lake.

    Science.gov (United States)

    Lawson, Rebecca; Anderson, Michael A

    2007-11-01

    A 3-year study was conducted to quantify the effectiveness of a destratification system on weakening thermal stratification and increasing dissolved oxygen (DO) levels in Lake Elsinore, California. Biweekly measurements of temperature, DO, and other parameters were made at 14 sites across the lake beginning in July 2003. A destratification system consisting of 20 axial flow pumps fitted with 3 HP electric motors and 1.8m diameter impellers mounted 2m below the water surface was installed in the spring of 2004 and made fully operational in July 2004. An unusually wet winter of 2005 raised the summer mean depth from 3.0m in 2004 to 6.7 m in 2005. This study thus allowed us to quantify the influence of axial flow pump operation on water column properties under shallow water conditions (i.e., before and after axial flow pump installation), and also to compare the effectiveness of the destratification system at two strongly different lake levels. Transparencies increased substantially after the winter storms in 2005 and thermal stability was shown to be strongly dependent upon lake level. Stratification and a large area of anoxic sediments persisted despite pump operation in the summers of 2004 and 2005. Acoustic Doppler current profiler (ADCP) measurements showed that mixing energy was not being efficiently transmitted laterally into the water column.

  10. miR-18b overexpression identifies mantle cell lymphoma patients with poor outcome and improves the MIPI-B prognosticator

    DEFF Research Database (Denmark)

    Husby, Simon; Ralfkiær, Ulrik Methner; Garde, Christian;

    2015-01-01

    of 74 diagnostic MCL samples from the Nordic MCL2 trial (screening cohort). Prognostic miRNAs were validated in diagnostic MCL samples from 94 patients of the independent Nordic MCL3 trial (validation cohort). Three miRNAs (miR-18b, miR-92a, and miR-378d) were significantly differentially expressed...... in patients who died of MCL in both cohorts. MiR-18b was superior to miR-92a and miR-378d in predicting high risk. Thus, we generated a new biological MCL International Prognostic Index (MIPI-B)-miR prognosticator, combining expression levels of miR-18b with MIPI-B data. Compared to the MIPI......-B, this prognosticator improved identification of high-risk patients with regard to cause-specific, overall, and progression-free survival. Transfection of 2 MCL cell lines with miR-18b decreased their proliferation rate without inducing apoptosis, suggesting that miR-18b may render MCL cells resistant to chemotherapy...

  11. Routine use of ancillary investigations in staging diffuse large B-cell lymphoma improves the International Prognostic Index (IPI

    Directory of Open Access Journals (Sweden)

    Shadbolt Bruce

    2009-11-01

    Full Text Available Abstract Background The International Prognostic Index (IPI is used to determine prognosis in diffuse large B-cell lymphoma (DLBCL. One of the determinants of IPI is the stage of disease with bone marrow involvement being classified as stage IV. For the IPI, involvement on bone marrow is traditionally defined on the basis of histology with ancillary investigations used only in difficult cases to aid histological diagnosis. This study aimed to determine the effect of the routine use of flow cytometry, immunohistochemistry and molecular studies in bone marrow staging upon the IPI. Results Bone marrow trephines of 156 histologically proven DLBCL cases at initial diagnosis were assessed on routine histology, and immunohistochemistry using two T-cell markers (CD45RO and CD3, two B-cell markers (CD20 and CD79a and kappa and lambda light chains. Raw flow cytometry data on all samples were reanalysed and reinterpreted blindly. DNA extracted from archived paraffin-embedded trephine biopsy samples was used for immunoglobulin heavy chain and light chain gene rearrangement analysis. Using immunophenotyping (flow cytometry and immunohistochemistry, 30 (19.2% cases were upstaged to stage IV. A further 8 (5.1% cases were upstaged using molecular studies. A change in IPI was noted in 18 cases (11.5% on immunophenotyping alone, and 22 (14.1% cases on immunophenotyping and molecular testing. Comparison of two revised IPI models, 1 using immunophenotyping alone, and 2 using immunophenotyping with molecular studies, was performed with baseline IPI using a Cox regression model. It showed that the revised IPI model using immunophenotyping provides the best differentiation between the IPI categories. Conclusion Improved bone marrow staging using flow cytometry and immunohistochemistry improves the predictive value of the IPI in patients with DLBCL and should be performed routinely in all cases.

  12. Cytogenetic risk stratification in chronic myelomonocytic leukemia

    Science.gov (United States)

    Such, Esperanza; Cervera, José; Costa, Dolors; Solé, Francesc; Vallespí, Teresa; Luño, Elisa; Collado, Rosa; Calasanz, María J.; Hernández-Rivas, Jesús M.; Cigudosa, Juan C.; Nomdedeu, Benet; Mallo, Mar; Carbonell, Felix; Bueno, Javier; Ardanaz, María T.; Ramos, Fernando; Tormo, Mar; Sancho-Tello, Reyes; del Cañizo, Consuelo; Gómez, Valle; Marco, Victor; Xicoy, Blanca; Bonanad, Santiago; Pedro, Carmen; Bernal, Teresa; Sanz, Guillermo F.

    2011-01-01

    Background The prognostic value of cytogenetic findings in chronic myelomonocytic leukemia is unclear. Our purpose was to evaluate the independent prognostic impact of cytogenetic abnormalities in a large series of patients with chronic myelomonocytic leukemia included in the database of the Spanish Registry of Myelodysplastic Syndromes. Design and Methods We studied 414 patients with chronic myelomonocytic leukemia according to WHO criteria and with a successful conventional cytogenetic analysis at diagnosis. Different patient and disease characteristics were examined by univariate and multivariate methods to establish their relationship with overall survival and evolution to acute myeloid leukemia. Results Patients with abnormal karyotype (110 patients, 27%) had poorer overall survival (P=0.001) and higher risk of acute myeloid leukemia evolution (P=0.010). Based on outcome analysis, three cytogenetic risk categories were identified: low risk (normal karyotype or loss of Y chromosome as a single anomaly), high risk (presence of trisomy 8 or abnormalities of chromosome 7, or complex karyotype), and intermediate risk (all other abnormalities). Overall survival at five years for patients in the low, intermediate, and high risk cytogenetic categories was 35%, 26%, and 4%, respectively (P<0.001). Multivariate analysis confirmed that this new CMML-specific cytogenetic risk stratification was an independent prognostic variable for overall survival (P=0.001). Additionally, patients belonging to the high-risk cytogenetic category also had a higher risk of acute myeloid leukemia evolution on univariate (P=0.001) but not multivariate analysis. Conclusions Cytogenetic findings have a strong prognostic impact in patients with chronic myelomonocytic leukemia. PMID:21109693

  13. Does the RIFLE Classification Improve Prognostic Value of the APACHE II Score in Critically Ill Patients?

    Directory of Open Access Journals (Sweden)

    Kátia M. Wahrhaftig

    2013-01-01

    Full Text Available Introduction. The RIFLE classification defines three severity criteria for acute kidney injury (AKI: risk, injury, and failure. It was associated with mortality according to the gradation of AKI severity. However, it is not known if the APACHE II score, associated with the RIFLE classification, results in greater discriminatory power in relation to mortality in critical patients. Objective. To analyze whether the RIFLE classification adds value to the performance of APACHE II in predicting mortality in critically ill patients. Methods. An observational prospective cohort of 200 patients admitted to the ICU from July 2010 to July 2011. Results. The age of the sample was 66 (±16.7 years, 53.3% female. ICU mortality was 23.5%. The severity of AKI presented higher risk of death: class risk (RR = 1.89 CI:0.97–3.38, , grade injury (RR = 3.7 CI:1.71–8.08, , and class failure (RR = 4.79 CI:2.10–10.6, . The APACHE II had C-statistics of 0.75, 95% (CI:0.68–0.80, and 0.80 (95% CI:0.74 to 0.86, after being incorporated into the RIFLE classification in relation to prediction of death. In the comparison between AUROCs, . Conclusion. The severity of AKI, defined by the RIFLE classification, was a risk marker for mortality in critically ill patients, and improved the performance of APACHE II in predicting the mortality in this population.

  14. Ventricular repolarization measures for arrhythmic risk stratification

    Institute of Scientific and Technical Information of China (English)

    Francesco Monitillo; Marta Leone; Caterina Rizzo; Andrea Passantino; Massimo Iacoviello

    2016-01-01

    Ventricular repolarization is a complex electrical phenomenon which represents a crucial stage in electrical cardiac activity. It is expressed on the surface electrocardiogram by the interval between the start of the QRS complex and the end of the T wave or U wave(QT). Several physiological, pathological and iatrogenic factors can influence ventricular repolarization. It has been demonstrated that small perturbations in this process can be a potential trigger of malignant arrhythmias, therefore the analysis of ventricular repolarization represents an interesting tool to implement risk stratification of arrhythmic events in different clinical settings. The aim of this review is to critically revise the traditional methods of static analysis of ventricular repolarization as well as those for dynamic evaluation, their prognostic significance and the possible application in daily clinical practice.

  15. Prognostic scores in brain metastases from breast cancer

    Directory of Open Access Journals (Sweden)

    Astner Sabrina T

    2009-04-01

    Full Text Available Abstract Background Prognostic scores might be useful tools both in clinical practice and clinical trials, where they can be used as stratification parameter. The available scores for patients with brain metastases have never been tested specifically in patients with primary breast cancer. It is therefore unknown which score is most appropriate for these patients. Methods Five previously published prognostic scores were evaluated in a group of 83 patients with brain metastases from breast cancer. All patients had been treated with whole-brain radiotherapy with or without radiosurgery or surgical resection. In addition, it was tested whether the parameters that form the basis of these scores actually have a prognostic impact in this biologically distinct group of brain metastases patients. Results The scores that performed best were the recursive partitioning analysis (RPA classes and the score index for radiosurgery (SIR. However, disagreement between the parameters that form the basis of these scores and those that determine survival in the present group of patients and many reported data from the literature on brain metastases from breast cancer was found. With the four statistically significant prognostic factors identified here, a 3-tiered score can be created that performs slightly better than RPA and SIR. In addition, a 4-tiered score is also possible, which performs better than the three previous 4-tiered scores, incl. graded prognostic assessment (GPA score and basic score for brain metastases (BSBM. Conclusion A variety of prognostic models describe the survival of patients with brain metastases from breast cancer to a more or less satisfactory degree. However, the standard brain metastases scores might not fully appreciate the unique biology and time course of this disease, e.g., compared to lung cancer. It appears possible that inclusion of emerging prognostic factors will improve the results and allow for development and validation

  16. Recent biologic and genetic advances in neuroblastoma: Implications for diagnostic, risk stratification, and treatment strategies.

    Science.gov (United States)

    Newman, Erika A; Nuchtern, Jed G

    2016-10-01

    Neuroblastoma is an embryonic cancer of neural crest cell lineage, accounting for up to 10% of all pediatric cancer. The clinical course is heterogeneous ranging from spontaneous regression in neonates to life-threatening metastatic disease in older children. Much of this clinical variance is thought to result from distinct pathologic characteristics that predict patient outcomes. Consequently, many research efforts have been focused on identifying the underlying biologic and genetic features of neuroblastoma tumors in order to more clearly define prognostic subgroups for treatment stratification. Recent technological advances have placed emphasis on the integration of genetic alterations and predictive biologic variables into targeted treatment approaches to improve patient survival outcomes. This review will focus on these recent advances and the implications they have on the diagnostic, staging, and treatment approaches in modern neuroblastoma clinical management. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Risk stratification for kidney sparing procedure in upper tract urothelial carcinoma

    Science.gov (United States)

    Khene, Zine-Eddine; Mathieu, Romain; Kammerer-Jacquet, Solène-Florence; Seisen, Thomas; Roupret, Morgan; Shariat, Shahrokh F.; Peyronnet, Benoit

    2016-01-01

    Risk stratification for kidney sparing procedures (KSP) to treat upper tract urothelial carcinoma (UTUC) is a major issue. A non-systematic Medline/PubMed literature search was performed using the terms “upper tract urothelial carcinoma” with different combinations of keywords to review the current knowledge on this topic. Original articles, reviews and editorials in English language were selected based on their clinical relevance. Available techniques for KSP include segmental ureterectomy and endoscopic resection through a percutaneous or flexible ureteroscopic access. These approaches were traditionally restricted to patients with imperative indications. Current recommendations suggest that selected patients with normal contralateral kidney should also be candidates for such treatments. Modern imaging and endoscopy have improved to accurately stage and grade the tumor while various prognostic clinical factors and biomarkers have been proposed to identify tumor with aggressive features and worse outcomes. Several predictive models using different combinations of such baseline characteristics may help clinicians in clinical decision making. However, risk-adapted based approach that has been proposed in recent guidelines to identify patients who are more likely to benefit from KSP only relies on few clinical and pathological factors. Despite growing understanding of the disease, treatment of UTUC remains challenging. Further efforts and collaborative multicenter studies are mandatory to improve risk stratification to decide and promote optimal KSP in UTUC. These efforts should focus on the integration of promising biomarkers and predictive tools in clinical decision making.

  18. Serial measurement of neuron specific enolase improves prognostication in cardiac arrest patients treated with hypothermia: A prospective study

    Directory of Open Access Journals (Sweden)

    Storm Christian

    2012-01-01

    Full Text Available Abstract Background Neuron specific enolase (NSE has repeatedly been evaluated for neurological prognostication in patients after cardiac arrest. However, it is unclear whether current guidelines for NSE cutoff levels also apply to cardiac arrest patients treated with hypothermia. Thus, we investigated the prognostic significance of absolute NSE levels and NSE kinetics in cardiac arrest patients treated with hypothermia. Methods In a prospective study of 35 patients resuscitated from cardiac arrest, NSE was measured daily for four days following admission. Outcome was assessed at ICU discharge using the CPC score. All patients received hypothermia treatment for 24 hours at 33°C with a surface cooling device according to current guidelines. Results The cutoff for absolute NSE levels in patients with unfavourable outcome (CPC 3-5 72 hours after cardiac arrest was 57 μg/l with an area under the curve (AUC of 0.82 (sensitivity 47%, specificity 100%. The cutoff level for NSE kinetics in patients with unfavourable outcome (CPC 3-5 was an absolute increase of 7.9 μg/l (AUC 0.78, sensitivity 63%, specificity 100% and a relative increase of 33.1% (AUC 0.803, sensitivity 67%, specificity 100% at 48 hours compared to admission. Conclusion In cardiac arrest patients treated with hypothermia, prognostication of unfavourable outcome by NSE kinetics between admission and 48 hours after resuscitation may be superior to prognostication by absolute NSE levels.

  19. THE INFLUENCE OF AN IMPROVED PRESERVATION SOLUTION ON PROGNOSTIC FACTORS FOR GRAFT-SURVIVAL IN PEDIATRIC LIVER-TRANSPLANTATION

    NARCIS (Netherlands)

    PEETERS, PMJG; TENVERGERT, EM; PISARSKI, S; BIJLEVELD, CMA; BLEICHRODT, RP; SLOOFF, MJH

    1992-01-01

    We investigated the influence of Eurocollins (EC) and University of Wisconson solution (UW) on prognostic factors for graft survival after pediatric liver transplantation. The 1-year graft survival was studied for 30 patients in which 38 transplantations were performed between 1982 and 1988. We pres

  20. Escore para avaliação do estado nutricional: seu valor na estratificação prognóstica de portadores de cardiomiopatia dilatada e insuficiência cardíaca avançada Score for nutritional status evaluation: the role played in the prognostic stratification of dilated cardiomyopathy and advanced heart failure patients

    Directory of Open Access Journals (Sweden)

    Luiz Guilherme Veloso

    2006-08-01

    Full Text Available OBJETIVO: Desenvolver método de avaliação do estado nutricional do paciente através de escore que expresse o estado nutricional de maneira universal e verificar se esse escore seria eficaz na estratificação prognóstica de pacientes com insuficiência cardíaca (IC avançada. MÉTODOS: Para compor o escore foram selecionados métodos de avaliação que procurassem quantificar forma de medida do estado nutricional: a porcentagem ideal do peso, a espessura da prega tricipital, os percentis da circunferência da massa muscular do braço, os níveis séricos de albumina, a contagem global de linfócitos. Para validá-lo, aplicou-se o escore num grupo de 95 pacientes com idade inferior a 65 anos, sem evidências de doenças consumptivas e analisou-se se esse escore manteria correlação com os dados clínicos da IC e permitiria estratificar o prognóstico. RESULTADOS: A situação nutricional esteve alterada nos pacientes e escore elevado sugerindo desnutrição moderada ou intensa foi observado em 31/95 (32,6% dos casos. Não houve correlação entre os valores do escore nutricional, duração dos sintomas e grau de disfunção ventricular. Os pacientes com escore nutricional elevado apresentaram tendência de maior mortalidade (p=0,0606. CONCLUSÕES: Os dados sugerem que a desnutrição atinge cerca de 1/3 dos pacientes com IC avançada. Um escore que englobou cinco parâmetros de avaliação nutricional teve boa correlação com a avaliação clínica e permitiu avaliar globalmente a desnutrição de portadores de IC. Escore superior a 8 identificou pacientes com maior probabilidade de morrer, confirmando que pacientes mais desnutridos têm pior evolução.OBJECTIVE: Develop a method for the evaluation of patient’s nutritional status through a score that expresses universal nutritional status, as well as investigate if that score would be efficient for the prognostic stratification of advanced heart failure (HF pts. METHODS: The score was

  1. DGKI methylation status modulates the prognostic value of MGMT in glioblastoma patients treated with combined radio-chemotherapy with temozolomide.

    Directory of Open Access Journals (Sweden)

    Amandine Etcheverry

    Full Text Available BACKGROUND: Consistently reported prognostic factors for glioblastoma (GBM are age, extent of surgery, performance status, IDH1 mutational status, and MGMT promoter methylation status. We aimed to integrate biological and clinical prognostic factors into a nomogram intended to predict the survival time of an individual GBM patient treated with a standard regimen. In a previous study we showed that the methylation status of the DGKI promoter identified patients with MGMT-methylated tumors that responded poorly to the standard regimen. We further evaluated the potential prognostic value of DGKI methylation status. METHODS: 399 patients with newly diagnosed GBM and treated with a standard regimen were retrospectively included in this study. Survival modelling was performed on two patient populations: intention-to-treat population of all included patients (population 1 and MGMT-methylated patients (population 2. Cox proportional hazard models were fitted to identify the main prognostic factors. A nomogram was developed for population 1. The prognostic value of DGKI promoter methylation status was evaluated on population 1 and population 2. RESULTS: The nomogram-based stratification of the cohort identified two risk groups (high/low with significantly different median survival. We validated the prognostic value of DGKI methylation status for MGMT-methylated patients. We also demonstrated that the DGKI methylation status identified 22% of poorly responding patients in the low-risk group defined by the nomogram. CONCLUSIONS: Our results improve the conventional MGMT stratification of GBM patients receiving standard treatment. These results could help the interpretation of published or ongoing clinical trial outcomes and refine patient recruitment in the future.

  2. Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study.

    Science.gov (United States)

    Andreini, Daniele; Pontone, Gianluca; Mushtaq, Saima; Gransar, Heidi; Conte, Edoardo; Bartorelli, Antonio L; Pepi, Mauro; Opolski, Maksymilian P; Ó Hartaigh, Bríain; Berman, Daniel S; Budoff, Matthew J; Achenbach, Stephan; Al-Mallah, Mouaz; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin J W; Cury, Ricardo; Delago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Feuchtner, Gudrun; Kim, Yong-Jin; Kaufmann, Philipp A; Leipsic, Jonathon; Lin, Fay Y; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J; Villines, Todd C; Dunning, Allison; Marques, Hugo; Rubinshtein, Ronen; Hindoyan, Niree; Gomez, Millie; Min, James K

    2017-03-15

    Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD). From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (CAD. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Stratification in Natural Water Bodies

    DEFF Research Database (Denmark)

    Møller, Jacob Steen

    2004-01-01

    Density stratification of natural water bodies plays an important role for a number of civil engineering problems. The origin of stratification in natural water is discussed and the Black Sea, the Gulf of Katchch, and Maarmorilik Fiord in Greenland are described and used as examples. Stratification...... has a number of civil engineering implications. The lock exchange problem is used as a canonical example, and implications for water exchange and sedimentation is discussed by means of examples: Sedimentation in locks and estuaries, salt transport into fresh water reservoirs, water exchange...

  4. Diabetes Mellitus and Prediabetes on Kidney Transplant Waiting List- Prevalence, Metabolic Phenotyping and Risk Stratification Approach.

    Directory of Open Access Journals (Sweden)

    Martina Guthoff

    Full Text Available Despite a significant prognostic impact, little is known about disturbances in glucose metabolism among kidney transplant candidates. We assess the prevalence of diabetes mellitus (DM and prediabetes on kidney transplant waiting list, its underlying pathophysiology and propose an approach for individual risk stratification.All patients on active kidney transplant waiting list of a large European university hospital transplant center were metabolically phenotyped.Of 138 patients, 76 (55% had disturbances in glucose metabolism. 22% of patients had known DM, 3% were newly diagnosed. 30% were detected to have prediabetes. Insulin sensitivity and-secretion indices allowed for identification of underlying pathophysiology and risk factors. Age independently affected insulin secretion, resulting in a relative risk for prediabetes of 2.95 (95%CI 1.38-4.83 with a cut-off at 48 years. Body mass index independently affected insulin sensitivity as a continuous variable.The prevalence of DM or prediabetes on kidney transplant waiting list is as high as 55%, with more than one third of patients previously undiagnosed. Oral glucose tolerance test is mandatory to detect all patients at risk. Metabolic phenotyping allows for differentiation of underlying pathophysiology and provides a basis for early individual risk stratification and specific intervention to improve patient and allograft outcome.

  5. Ki-67 is an independent indicator in non-muscle invasive bladder cancer (NMIBC); combination of EORTC risk scores and Ki-67 expression could improve the risk stratification of NMIBC.

    Science.gov (United States)

    Ding, Weihong; Gou, Yuancheng; Sun, Chuanyu; Xia, Guowei; Wang, Hong; Chen, Zhongqing; Tan, Jun; Xu, Ke; Qiang, Ding

    2014-01-01

    To prove the predicting role of Ki-67 expression and to demonstrate that the combination of European Organization for Research and Treatment of Cancer (EORTC) risk scores and Ki-67 staining status could improve the risk stratification in a large series of patients with non-muscle invasive bladder cancer (NMIBC). From October 2002 to July 2010, in our cohort, 332 patients who were treated with transurethral resection of the bladder tumor were diagnosed with NMIBC by histopathologic analysis. Two experienced uropathologists rereviewed the slides. The EORTC risk scores for recurrence and progression were determined. Ki-67 expression was evaluated using immunohistochemical studies and scored for intensity and area of staining. We correlated Ki-67 expression scores with clinical and pathologic variables. We evaluated the prognosis role of EORTC risk scores, Ki-67 staining, and their combination on tumor recurrence-free survival and progression-free survival (PFS) by univariate analysis, multivariate analysis, and Kaplan-Meier survival curves. With a median follow-up of 47 (range, 2-124) months, 119 patients (35.8%) had tumor recurrence and 40 patients (12%) had tumor progression. Ki-67 positivity (Ki-67>25%) was reported in 108 tumors (32.5%), and it was significantly associated with high EORTC risk scores for both tumor recurrence and progression. In univariate analysis, multifocality, tumor size, tumor stage, tumor grade, and Ki-67 staining correlated with recurrence-free survival, whereas tumor size, tumor stage, tumor grade, concomitant CIS, and Ki-67 staining correlated with PFS. In multivariable analysis, Ki-67 expression was an independent risk factor for predicting tumor recurrence (hazard ratio, 2.14; PEORTC risk scores and Ki-67 staining led to more accurate prediction for tumor recurrence and progression (log-rank test; PEORTC risk scores with Ki-67 expression could improve the risk stratification for both recurrence and progression in NMIBC. Copyright

  6. Sudden cardiac death risk stratification.

    Science.gov (United States)

    Deyell, Marc W; Krahn, Andrew D; Goldberger, Jeffrey J

    2015-06-01

    Arrhythmic sudden cardiac death (SCD) may be caused by ventricular tachycardia/fibrillation or pulseless electric activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our healthcare and research resources to tackle this important public health issue. Although our understanding of SCD because of pulseless electric activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-ventricular tachycardia/ventricular fibrillation. This review focuses on existing and novel risk stratification tools for SCD-ventricular tachycardia/ventricular fibrillation. For patients with left ventricular dysfunction or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining risk. Yet the majority of SCD-ventricular tachycardia/ventricular fibrillation occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further risk stratification in the general population beyond traditional risk stratification for coronary artery disease alone. Despite these advances, significant challenges in risk stratification remain that must be overcome before a meaningful impact on SCD can be realized.

  7. BAYESIAN BICLUSTERING FOR PATIENT STRATIFICATION.

    Science.gov (United States)

    Khakabimamaghani, Sahand; Ester, Martin

    2016-01-01

    The move from Empirical Medicine towards Personalized Medicine has attracted attention to Stratified Medicine (SM). Some methods are provided in the literature for patient stratification, which is the central task of SM, however, there are still significant open issues. First, it is still unclear if integrating different datatypes will help in detecting disease subtypes more accurately, and, if not, which datatype(s) are most useful for this task. Second, it is not clear how we can compare different methods of patient stratification. Third, as most of the proposed stratification methods are deterministic, there is a need for investigating the potential benefits of applying probabilistic methods. To address these issues, we introduce a novel integrative Bayesian biclustering method, called B2PS, for patient stratification and propose methods for evaluating the results. Our experimental results demonstrate the superiority of B2PS over a popular state-of-the-art method and the benefits of Bayesian approaches. Our results agree with the intuition that transcriptomic data forms a better basis for patient stratification than genomic data.

  8. High expression of FUNDC1 predicts poor prognostic outcomes and is a promising target to improve chemoradiotherapy effects in patients with cervical cancer.

    Science.gov (United States)

    Hou, Hailing; Er, Puchun; Cheng, Jingjing; Chen, Xiuli; Ding, Xiaofeng; Wang, Yuwen; Chen, Xi; Yuan, Zhiyong; Pang, Qingsong; Wang, Ping; Qian, Dong

    2017-08-01

    FUN14 domain containing 1 (FUNDC1) is an important molecule in receptor-dependent mitophagy. However, the roles of FUNDC1 in human cancer biology remain unknown. The aim of this study was to explore the expression and roles of FUNDC1 in cervical cancer. Immunohistochemistry and Western blotting were applied to detect the expression of FUNDC1, and small-hairpin RNA was applied to inhibit the expression of endogenous FUNDC1 in cervical cancer cells. MTT assays and Flow cytometric analysis were applied to examine cell proliferation and apoptosis. Immunofluorescence was used to detect the formation of γH2AX foci and evaluate the extent of DNA damage. Compared with corresponding adjacent noncancerous cervical tissues, the expression of FUNDC1 in cervical cancer cells was significantly increased. High expression of FUNDC1 and the prognosis of patients with cervical cancer were correlated negatively, which could be used as an independent prognostic factor for overall survival and disease-free survival. Depletion of FUNDC1 significantly inhibited the proliferation of tumor cells, induced apoptosis, and enhanced cell sensitivity to cisplatin and ionizing radiation (IR). Our data suggested that FUNDC1 can be used as a prognostic biomarker in patients with cervical cancer, and may be a new therapeutic target to improve the antitumor effects of chemoradiotherapy. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  9. Stratification requirements for seed dormancy alleviation in a wetland weed.

    Science.gov (United States)

    Boddy, Louis G; Bradford, Kent J; Fischer, Albert J

    2013-01-01

    Echinochloaoryzicola(syn.E. phyllopogon) is an exotic weed of California rice paddies that has evolved resistance to multiple herbicides. Elimination of seedlingsthroughcertain weed control methods can limit the spread of this weed, but is contingent on accurate predictions of germination and emergence timing, which are influenced by seed dormancy levels.In summer annuals, dormancy can often be relieved through stratification, a period of prolonged exposure to cold and moist conditions.We used population-based threshold models to quantify the effects of stratification on seed germination of four E. Oryzicola populations at a range of water potential (Ψ) and oxygen levels. We also determined how stratification temperatures, moisture levels and durations contributed to dormancy release. Stratification released dormancy by decreasing base Ψ and hydrotimerequired for germination and by eliminating any germination sensitivity to oxygen. Stratification also increased average germination rates (GR), which were used as a proxy for relative dormancy levels. Alternating temperatures nearly doubled GR in all populations, indicating that seeds could be partially dormant despite achieving high final germination percentages. Stratification at Ψ = 0 MPa increased GR compared to stratification at lower water potentials, demonstrating that Ψ contributed to regulating dormancy release. Maximum GR occurred after 2-4 weeks of stratification at 0 MPa; GR were often more rapid for herbicide-resistant than for herbicide-susceptible seeds, implying greater dormancy in the latter. Manipulation of field conditions to promote dormancy alleviation of E. oryzicola seeds might improve the rate and uniformity of germination for seed bank depletion through seedling weed control. Our results suggest field soil saturation in winter would contribute towards E. oryzicola dormancy release and decrease the time to seedling emergence.

  10. SOX11 and TP53 add prognostic information to MIPI in a homogenously treated cohort of mantle cell lymphoma--a Nordic Lymphoma Group study

    DEFF Research Database (Denmark)

    Nordström, Lena; Sernbo, Sandra; Eden, Patrik;

    2014-01-01

    Mantle cell lymphoma (MCL) is an aggressive B cell lymphoma, where survival has been remarkably improved by use of protocols including high dose cytarabine, rituximab and autologous stem cell transplantation, such as the Nordic MCL2/3 protocols. In 2008, a MCL international prognostic index (MIPI......) was created to enable stratification of the clinical diverse MCL patients into three risk groups. So far, use of the MIPI in clinical routine has been limited, as it has been shown that it inadequately separates low and intermediate risk group patients. To improve outcome and minimize treatment...

  11. Prostate Cancer Cell Telomere Length Variability and Stromal Cell Telomere Length as Prognostic Markers for Metastasis and Death

    Science.gov (United States)

    Heaphy, Christopher M.; Yoon, Ghil Suk; Peskoe, Sarah B.; Joshu, Corinne E.; Lee, Thomas K.; Giovannucci, Edward; Mucci, Lorelei A.; Kenfield, Stacey A.; Stampfer, Meir J.; Hicks, Jessica L.; De Marzo, Angelo M.; Platz, Elizabeth A.; Meeker, Alan K.

    2013-01-01

    Current prognostic indicators are imperfect predictors of outcome in men with clinicallylocalized prostate cancer. Thus, tissue-based markers are urgently needed to improve treatment and surveillance decision-making. Given that shortened telomeres enhance chromosomal instability and such instability is a hallmark of metastatic lesions, we hypothesized that alterations in telomere length in the primary cancer would predict risk of progression to metastasis and prostate cancer death. To test this hypothesis, we conducted a prospective cohort study of 596 surgically treated men who participated in the ongoing Health Professionals Follow-up Study. Men who had the combination of more variable telomere length among prostate cancer cells (cell-to-cell) and shorter telomere length in prostate cancer-associated stromal cells were substantially more likely to progress to metastasis or die of their prostate cancer. These findings point to the translational potential of this telomere biomarker for prognostication and risk stratification for individualized therapeutic and surveillance strategies. PMID:23779129

  12. Aircraft Anomaly Prognostics Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Ridgetop Group will leverage its proven Electromechanical Actuator (EMA) prognostics methodology to develop an advanced model-based actuator prognostic reasoner...

  13. Social Stratification in Higher Education

    Science.gov (United States)

    Grodsky, Eric; Jackson, Erika

    2009-01-01

    Background/Context: Over the past half century, scholars in a variety of fields have contributed to our understanding of the relationship between higher education and social stratification. We review this literature, highlighting complementarities and inconsistencies. Purpose/Objective/Research Question/Focus of Study: We situate our review of the…

  14. 2012 consensus document of the Italian Society of Hypertension (SIIA): strategies to improve blood pressure control in Italy: from global cardiovascular risk stratification to combination therapy.

    Science.gov (United States)

    Volpe, Massimo; Rosei, Enrico Agabiti; Ambrosioni, Ettore; Cottone, Santina; Cuspidi, Cesare; Borghi, Claudio; De Luca, Nicola; Fallo, Francesco; Ferri, Claudio; Morganti, Alberto; Muiesan, Maria Lorenza; Sarzani, Riccardo; Sechi, Leonardo; Virdis, Agostino; Tocci, Giuliano; Trimarco, Bruno; Filippi, Alessandro; Mancia, Giuseppe

    2013-03-01

    Observational clinical studies have demonstrated that only 30-40% of patients with arterial hypertension achieve the recommended blood pressure goals (below 140/90 mmHg). In contrast, interventional trials consistently showed that it is possible to achieve effective blood pressure targets in about 70% of treated hypertensive patients with different cardiovascular risk profiles, especially through the use of rational, effective and well tolerated combination therapies. In order to bridge the gap between current and desired blood pressure control and to achieve more effective prevention of cardiovascular diseases, the Italian Society of Hypertension (SIIA) has developed an interventional strategy aimed at reaching nearly 70% of treated controlled hypertensive patients by 2015. This ambitious goal can be realistically achieved by a more rational use of modern tools and supports, and also through the use of combination therapy in hypertension in daily clinical practice, especially if this approach can be simplified into a single pill (fixed combination therapy), which is a therapeutic option now also available in Italy. Since about 70-80% of treated hypertensive patients require a combination therapy based on at least two classes of drugs in order to achieve the recommended blood pressure goals, it is of key importance to implement this strategy in routine clinical practice. Amongst the various combination therapies currently available for hypertension treatment and control, the use of those strategies based on drugs that antagonize the renin-angiotensin system, such as angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) and ACE inhibitors, in combination with diuretics and/or calcium channel blockers, has been shown to significantly reduce the risk of major cardiovascular events and to improve patient compliance to treatment, resulting in a greater antihypertensive efficacy and better tolerability compared with monotherapy. The present document

  15. Evaluation of Breast Cancer Stem Cells and Intratumor Stemness Heterogeneity in Triple-negative Breast Cancer as Prognostic Factors

    Science.gov (United States)

    Yang, Fang; Cao, Lulu; Sun, Zijia; Jin, Juan; Fang, Hehui; Zhang, Wenwen; Guan, Xiaoxiang

    2016-01-01

    Triple-negative breast cancer (TNBC) is a tumor subtype with aggressive behavior and poor clinical outcome for lacking effective therapies. Breast cancer stem cells (BCSCs) have been suggested to have tumor-initiating properties, but it remains unclear whether their presence contributes to the increased aggressiveness and poor prognosis of TNBC. Also, the breast cancers display frequent inter- and intra-tumor heterogeneity, which adds the complexity in diagnosis and predicting prognosis. Here we investigated the clinical relevance and prognostic value of the BCSC markers, CD44+/CD24-, aldehyde dehydrogenase family 1 member A1 (ALDH1A1) and CD133 in 88 TNBC cases. We found that a few patients displayed spatial heterogeneity of the BCSC markers in expression, which was defined as intratumor stemness heterogeneity (ITSH) below. There was no significant correlation between any BCSC marker alone or ITSH and progression-free survival (PFS). Interestingly, the combined BCSC phenotype by CD44+/CD24- and ALDH1A1 was significantly associated with worse PFS (P = 0.009). Further stratification analysis revealed that this combined BCSC phenotype was an independent prognostic factor for PFS in some subgroups. In conclusion, we demonstrated the existence of ITSH in TNBC and found that the ITSH as well as a single BCSC marker was not significantly associated with survival, whereas combing the analysis of BCSC markers could improve prognostic value. Our findings may lead to an improvement of prognostic indicators in TNBC. PMID:27994520

  16. Multilayer fabric stratification pipes for solar tanks

    DEFF Research Database (Denmark)

    Andersen, Elsa; Furbo, Simon; Fan, Jianhua

    2007-01-01

    The thermal performance of solar heating systems is strongly influenced by the thermal stratification in the heat storage. The higher the degree of thermal stratification is, the higher the thermal performance of the solar heating systems. Thermal stratification in water storages can for instance...

  17. Dimensionless numbers used to characterize stratification in water tanks for discharging at low flow rates

    Energy Technology Data Exchange (ETDEWEB)

    Castell, A.; Medrano, M.; Sole, C.; Cabeza, L.F. [GREA Innovacio concurrent, Universitat de Lleida, Pere de Cabrera s/n, 25001 Lleida (Spain)

    2010-10-15

    The efficiency of thermal energy storage and solar collector systems is improved if the water tank is stratified. There are many parameters to characterize stratification but no work compares their suitability. This paper identifies the most used dimensionless numbers to characterize stratification in water tanks and studies their suitability. Experiments with different flow rates were done and the dimensionless numbers were determined. Richardson is the best number to define stratification in a water tank, while Mix number presents some problems and a bad behaviour. The other numbers do not clearly characterize stratification but can be useful combined with Richardson. (author)

  18. Two-protein signature of novel serological markers apolipoprotein-A2 and serum amyloid alpha predicts prognosis in patients with metastatic renal cell cancer and improves the currently used prognostic survival models

    NARCIS (Netherlands)

    J.S. Vermaat (Joost); I. van der Tweel (Ingeborg); N. Mehra (Niven); S. Sleijfer (Stefan); J.B. Haanen (John); J.M. Roodhart (Jeanine); J.Y. Engwegen (Judith); C.M. Korse (Catharina); M.H. Langenberg (Marlies); W.H.J. Kruit (Wim); G. Groenewegen (Gino); R.H. Giles

    2009-01-01

    textabstractBackground: In metastatic renal cell cancer (mRCC), the Memorial Sloan-Kettering Cancer Center (MSKCC) risk model is widely used for clinical trial design and patient management. To improve prognostication, we applied proteomics to identify novel serological proteins associated with over

  19. Microvascular structure as a prognostically relevant endpoint.

    Science.gov (United States)

    Agabiti-Rosei, Enrico; Rizzoni, Damiano

    2017-05-01

    Remodelling of subcutaneous small resistance arteries, as indicated by an increased media-to-lumen ratio, is frequently present in hypertensive, obese, or diabetic patients. The increased media-to-lumen ratio may impair organ flow reserve. This may be important in the maintenance and, probably, also in the progressive worsening of hypertensive disease. The presence of structural alterations represents a prognostically relevant factor, in terms of development of target organ damage or cardiovascular events, thus allowing us a prediction of complications in hypertension. In fact, media-to-lumen ratio of small arteries at baseline, and possibly their changes during treatment may have a strong prognostic significance. However, new, non-invasive techniques are needed before suggesting extensive application of the evaluation of remodelling of small arteries for the cardiovascular risk stratification in hypertensive patients. Some new techniques for the evaluation of microvascular morphology in the retina, currently under clinical investigation, seem to represent a promising and interesting future perspective. The evaluation of microvascular structure is progressively moving from bench to bedside, and it could represent, in the near future, an evaluation to be performed in all hypertensive patients, to obtain a better stratification of cardiovascular risk, and, possibly, it might be considered as an intermediate endpoint in the evaluation of the effects of antihypertensive therapy, provided that a demonstration of a prognostic value of non-invasive measures of microvascular structure is made available.

  20. 基于改进灰色模型的故障预测研究%Research on fault prognostic method based on improved grey model

    Institute of Scientific and Technical Information of China (English)

    李万领; 孟晨; 杨锁昌; 杨森

    2012-01-01

    随着系统发生故障所带来的财产损失、人员伤亡以及危害性越来越大,故障预测与健康管理(PHM)技术应用越来越广泛.该文重点介绍了改进灰色模型,并利用PSO算法实现了改进灰色模型的参数优化,然后以某制导雷达系统的波束控制中某电源组合为例采集电压信号数据,算法收敛性能很好,得到的结果用于改进灰色模型进行预测精度很高.%For more and more loss of belongings, personnel casualty and serious harm caused by fault occurring in systems, prognostic and health management/monitoring (PHM) technology is more and more widely applied. The paper mainly introduced the improved grey model, and used the PSO arithmetic to realize optimization of parameters for the improved grey model, and then a certain power supply combination in the beam control system of a certain control and guide radar was taken as an example to collect voltage signal. The arithmetic had very excellent astringency. The obtained results were used to forecast in the improved grey model, and the results showed the precision of the model was very good.

  1. Prognostic Significance of Preoperative and Postoperative Plasma Levels of Ghrelin in Gastric Cancer: 3-Year Survival Study

    Science.gov (United States)

    Soleyman-Jahi, Saeed; Abdirad, Afshin; Fallah, Amir Afraz; Ghasemi, Sevil; Sadeghi, Fatemeh; Heidari, Reza; Mahmoodzadeh, Habibollah; Zendehdel, Kazem

    2017-01-01

    OBJECTIVES: We aimed to investigate prognostic effects of plasma levels of ghrelin before and after gastrectomy in gastric cancer (GC). METHODS: We followed 81 GC patients up to 3 years in this study. They were candidates for curative gastrectomy with or without neoadjuvant chemotherapy. Plasma levels of total and active ghrelins before and after the operation were assessed. Association of plasma levels of ghrelin with survival were assessed and adjusted for other potential prognostic factors using Cox regression analyses. RESULTS: Both total and active ghrelins dropped after gastrectomy (Pcachexia (HR=2.99, 95% CI: 1.35–6.63), and receiving no neoadjuvant chemotherapy (HR=2.02, 95% CI: 1.04–3.92) were other poor prognostic factors. CONCLUSIONS: Preoperative and postoperative plasma levels of ghrelin could predict survival of GC patients with different patterns. This prognostic effect was independent of stage and cachexia. Measurement of plasma ghrelin in GC patients could complement conventional staging for more precise risk-stratification of the patients. Extrinsic admirations of ghrelin after total gastrectomy has potentials to improve survival of GC patients. PMID:28055030

  2. Sampling efficiency of national, EU and global stratifications : exploring by using CL2000

    NARCIS (Netherlands)

    Metzger, M.J.; Brus, D.J.; Ortega, M.

    2012-01-01

    Stratification, dividing the statistical population into less heterogeneous subgroups before sampling, can help improve sampling efficiency by improving representativeness and reducing sampling error. This report explores the added sampling efficiency that is achieved by using the European Environme

  3. Prognostic relevance of morphological classification models for myelodysplastic syndromes in an era of the revised International Prognostic Scoring System.

    Science.gov (United States)

    van Spronsen, Margot F; Ossenkoppele, Gert J; Westers, Theresia M; van de Loosdrecht, Arjan A

    2016-03-01

    Numerous morphological classification models have been developed to organise the heterogeneous spectrum of myelodysplastic syndromes (MDS). While the 2008 update of the World Health Organisation (WHO) is the current standard, the publication of the revised International Prognostic Scoring System (IPSS-R) has illustrated the need for supplemental prognostic information. The aim of this study was to investigate whether morphological classification models for MDS - of both the French-American-British (FAB) group and WHO - provide reliable criteria for their classification into homogeneous and clinically relevant categories with prognostic relevance beyond the IPSS-R. We reclassified 238 MDS patients using each of the FAB, WHO 2001 and WHO 2008 criteria and studied classification categories in terms of clinical, haematological and cytogenetic features. Subsequently, we calculated prognostic scores using the IPSS-R and investigated whether the morphological classification models had significantly prognostic value in patients stratified by the IPSS-R and vice versa. By adopting the FAB, WHO 2001 and WHO 2008 classifications, MDS patients were organised into homogeneous categories with intrinsic prognostic information. However, whereas the morphological classification models showed no prognostic value beyond the IPSS-R, the IPSS-R had significant prognostic value beyond the FAB, WHO 2001 and WHO 2008 classifications. Even though morphological classification models for MDS might be clinically relevant from a prognostic point of view, their relevance in terms of risk stratification is evidently limited in light of the IPSS-R. Therefore, we suggest to stop the use of morphological classification models for MDS for risk stratification in routine clinical practice.

  4. Judgement post-stratification for designed experiments.

    Science.gov (United States)

    Du, Juan; MacEachern, Steven N

    2008-06-01

    In many scientific studies, information that is not easily translated into covariates is ignored in the analysis. However, this type of information may significantly improve inference. In this research, we apply the idea of judgment post-stratification to utilize such information. Specifically, we consider experiments that are conducted under a completely randomized design. Sets of experimental units are formed, and the units in a set are ranked. Estimation is performed conditional on the sets and ranks. We propose a new estimator for a treatment contrast. We improve the new estimator by Rao-Blackwellization. Asymptotic distribution theory and corresponding inferential procedures for both estimators are developed. Simulation studies quantify the superiority of the new estimators and show their desirable properties for small and moderate sample sizes. The impact of the new techniques is illustrated with data from a clinical trial.

  5. Risk stratification for benign prostatic hyperplasia.

    Science.gov (United States)

    Zattoni, Fabio; Ficarra, Vincenzo; Novara, Giacomo

    2017-03-18

    Benign prostatic hyperplasia (BPH) represents an important public health problem in ageing men due to frequently associated lower urinary tract symptoms (LUTS), which may impair quality of life. BPH is also a progressive disease, mainly characterized by a worsening of LUTS over time, and in some patients by the occurrence of serious outcomes such as acute urinary retention and need for BPH-related surgery. The management of BPH and LUTS in men should move forward its focus on symptom control only. Indeed, the goals of therapy for BPH are not only to improve bothersome LUTS but also to identify those patients at risk of unfavourable outcomes in order to optimize their management and reduce complications. Risk stratification and tailored treatment should improve the reductions in both symptoms and the long-term consequences of BPH and BPH treatments. To do this, clinicians need to know possible factors that may support the develop of PBH and possible risks due to the BPH itself.

  6. Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.

    Directory of Open Access Journals (Sweden)

    Elisabet Zamora

    Full Text Available BACKGROUND: To compare the prognostic value of estimated glomerular filtration rate, cystatin-C, an alternative renal biomarker, and their combination, in an outpatient population with heart failure. Estimated glomerular filtration rate is routinely used to assess renal function in heart failure patients. We recently demonstrated that the Cockroft-Gault formula is the best among the most commonly used estimated glomerular filtration rate formulas for predicting heart failure prognosis. METHODOLOGY/PRINCIPAL FINDINGS: A total of 879 consecutive patients (72% men, age 70.4 years [P(25-75 60.5-77.2] were studied. The etiology of heart failure was mainly ischemic heart disease (52.7%. The left ventricular ejection fraction was 34% (P(25-75 26-43%. Most patients were New York Heart Association class II (65.8% or III (25.9%. During a median follow-up of 3.46 years (P(25-75 1.85-5.05, 312 deaths were recorded. In an adjusted model, estimated glomerular filtration rate and cystatin-C showed similar prognostic value according to the area under the curve (0.763 and 0.765, respectively. In Cox regression, the multivariable analysis hazard ratios were 0.99 (95% CI: 0.98-1, P = 0.006 and 1.14 (95% CI: 1.02-1.28, P = 0.02 for estimated glomerular filtration rate and cystatin-C, respectively. Reclassification, assessed by the integration discrimination improvement and the net reclassification improvement indices, was poorer with cystatin-C (-0.5 [-1.0;-0.1], P = 0.024 and -4.9 [-8.8;-1.0], P = 0.013, respectively. The value of cystatin-C over estimated glomerular filtration rate for risk-stratification only emerged in patients with moderate renal dysfunction (eGFR 30-60 ml/min/1.73 m(2, chi-square 12.9, P<0.001. CONCLUSIONS/SIGNIFICANCE: Taken together, the results indicate that estimated glomerular filtration rate and cystatin-C have similar long-term predictive values in a real-life ambulatory heart failure population. Cystatin-C seems to

  7. Prognostic indicators in acute burned patients–a review

    Directory of Open Access Journals (Sweden)

    Sherif Emara

    2015-06-01

    Full Text Available Burn trauma is in need for prognostic indicators or admission scores. This aims for realistic documentation of the burn injury, expectation of the prognosis, and to facilitate a patient stratification to evaluate therapeutic strategies. A computer search through different medical websites was performed looking for articles correlating prognosis with different burn indices. These were carefully summarized and analyzed for this review. Variable studies were found related to that issue; the reliable indicators found had been classified as general or specific. All of them had certain clinical importance, but limitations are a common feature. All the listed indices are useful to serve in the only special clinical situations. We couldn't claim that they are actual prognostic indicator in burn victims. We believe that we still lack the proper prognostic indicator in burn patients. Researchers are invited for more effort to organize a more reliable prognostic indicator and scoring system for burn patients.

  8. Prognostic indicators in acute burned patients-a review

    Institute of Scientific and Technical Information of China (English)

    Sherif Emara

    2015-01-01

    Burn trauma is in need for prognostic indicators or admission scores. This aims for realistic documentation of the burn injury, expectation of the prognosis, and to facilitate a patient stratification to evaluate therapeutic strategies. A computer search through different medical websites was performed looking for articles correlating prognosis with different burn indices. These were carefully summarized and analyzed for this review. Variable studies were found related to that issue; the reliable indicators found had been classified as general or specific. All of them had certain clinical importance, but limitations are a common feature. All the listed indices are useful to serve in the only special clinical situations. We couldn't claim that they are actual prognostic indicator in burn victims. We believe that we still lack the proper prognostic indicator in burn patients. Researchers are invited for more effort to organize a more reliable prognostic indicator and scoring system for burn patients.

  9. Emerging Prognostic Markers to Determine Crohn's Disease Natural History and Improve Management Strategies: A Review of Recent Literature

    OpenAIRE

    Lichtenstein, Gary R.

    2010-01-01

    Because Crohn's disease (CD) is a chronic, incurable condition, patients require life-long therapeutic approaches to initiate and maintain symptom control, improve quality of life, avoid hospitalizations and surgery, and minimize short- and long-term toxicity and complications such as stricturing, fistulae, osteoporosis and associated bony fractures, and linear growth failure in pediatric patients. Many physicians use symptom-based classifications, such as those published in the American Coll...

  10. Prognosis Research Strategy (PROGRESS 2: prognostic factor research.

    Directory of Open Access Journals (Sweden)

    Richard D Riley

    Full Text Available Prognostic factor research aims to identify factors associated with subsequent clinical outcome in people with a particular disease or health condition. In this article, the second in the PROGRESS series, the authors discuss the role of prognostic factors in current clinical practice, randomised trials, and developing new interventions, and explain why and how prognostic factor research should be improved.

  11. Sensor integritY Management and Prognostics Technology with On-line fault Mitigation (SYMPTOM) for Improved Flight Safety of Commercial Aircraft Project

    Data.gov (United States)

    National Aeronautics and Space Administration — SSCI proposes to develop and test the Sensor integritY Management and Prognostics Technology with On-line fault Mitigation (SYMPTOM) system. The SYMPTOM assures...

  12. An automated approach to improve efficacy in detecting residual malignant cancer cell for facilitating prognostic assessment of leukemia: an initial study

    Science.gov (United States)

    Qiu, Yuchen; Lu, Xianglan; Tan, Maxine; Li, Shibo; Liu, Hong; Zheng, Bin

    2015-03-01

    The purpose of this study is to investigate the feasibility of applying automatic interphase FISH cells analysis method for detecting the residual malignancy of post chemotherapy leukemia patients. In the experiment, two clinical specimens with translocation between chromosome No. 9 and 22 or No. 11 and 14 were selected from the patients underwent leukemia diagnosis and treatment. The entire slide of each specimen was first digitalized by a commercial fluorescent microscope using a 40× objective lens. Then, the scanned images were processed by a computer-aided detecting (CAD) scheme to identify the analyzable FISH cells, which is accomplished by applying a series of features including the region size, Brenner gradient and maximum intensity. For each identified cell, the scheme detected and counted the number of the FISH signal dots inside the nucleus, using the adaptive threshold of the region size and distance of the labeled FISH dots. The results showed that the new CAD scheme detected 8093 and 6675 suspicious regions of interest (ROI) in two specimens, among which 4546 and 3807 ROI contain analyzable interphase FISH cell. In these analyzable ROIs, CAD selected 334 and 405 residual malignant cancer cells, which is substantially more than those visually detected in a cytogenetic laboratory of our medical center (334 vs. 122, 405 vs. 160). This investigation indicates that an automatic interphase FISH cell scanning and CAD method has the potential to improve the accuracy and efficiency of the prognostic assessment for leukemia and other genetic related cancer patients in the future.

  13. Chromosome 1p/19q status combined with expression of protein improves the diagnostic and prognostic evaluation of oligodendrogliomas

    Institute of Scientific and Technical Information of China (English)

    XIONG Ji; LIU Ying; WANG Yin; KE Rong-hu; MAO Ying; YE Zhu-rong

    2010-01-01

    Background Our previous study confirmed that oligodendrogliomas had higher frequency of chromosome 1p/19q deletion. In order to improve the diagnostic criteria and to predict the prognosis of oligodendroglioma patients, the status of chromosome 1 p/19q deletion, the methylation of O6-methylguanine-DNA methyltransferase (MGMT), and the expression of p53 protein were evaluated and investigated in relation to patients' outcomes.Methods Methylation of MGMT in 73 cases was analyzed by nested methylation-specific PCR (MSP). The levels of MGMT and p53 protein were tested with immunohistochemistry. Pearson's chi-square test and Fisher's exact test were used. Multivariate and Kaplan-Meier analysis were performed to determine patients' outcomes.Results Both oligodendrogliomas and astrocytic gliomas exhibited frequent methylation of MGMT. However, the results of MSP did not completely correspond to that of the immunohistochemical staining for MGMT. The expression of p53 protein was more frequently observed in patients without a 1 p or 19q deletion in anaplastic oligodendrogliomas (=0.032,0.025). In low-grade oligodendrogliomas, methylation of MGMT was more frequent in patients with 1 p/19q deletion than in patients with 1p/19q intact (P=0.038). Patients with oligodendrogliomas with 1p/19q loss of heterozygosity and p53-negative showed a longer progression-free survival.Conclusion Detection of chromosome 1p/19q status combined with p53 protein immunohistochemistry might be beneficial to improve the pathological diagnosis and to determine the prognosis of patients with oligodendrogliomas.

  14. Interannual variability of upper ocean stratification in Bay of Bengal: observational and modeling aspects

    Science.gov (United States)

    Fousiya, T. S.; Parekh, Anant; Gnanaseelan, C.

    2016-10-01

    The annual cycle and interannual variability of stratification in Bay of Bengal (BoB) are studied using both observations and Global Ocean Data Assimilation System (GODAS) analysis during 2003-2012. Annual cycle of stratification and sea surface temperature (SST) evolve coherently, highlighting its role on modulating air-sea interaction over this climatologically important region. Spatial distribution of stratification shows strong seasonality in ARGO observations, whereas it is highly underestimated in GODAS with highest discrepancies during fall and spring. The annual cycle of sea surface salinity (SSS) in GODAS is out of phase with observations implying potential feedbacks. During La Niña years, SSS drop in fall and winter and are lesser than those reported during El Niño years. All these features are misrepresented in GODAS. As stratification modulates air-sea interaction over BoB especially during El Niño and La Niña years, such misrepresentation of ocean stratification may lead to unrealistic thermocline-SST coupling in the models. The mean stratification and its interannual variability in GODAS are weaker than observed even though interannual variability in freshwater flux (P-E) is higher in GODAS. Detailed analysis of GODAS with in situ observations reveals that upper ocean current shear (vertical) is overestimated in GODAS, leading to unrealistically strong mixing which is primarily responsible for the deeper penetration of surface warm and freshwater resulting weaker stratification. As GODAS is used to initialize the ocean component of the coupled forecasting system for seasonal prediction of Asian monsoon, proper representation of stratification is essential. This study advocates the need of accurate representation of upper ocean salinity in GODAS for improved stratification. We speculate that improved stratification and mixing in the BoB improve summer monsoon forecast.

  15. Assessment of Total Lesion Glycolysis by (18)F FDG PET/CT Significantly Improves Prognostic Value of GEP and ISS in Myeloma.

    Science.gov (United States)

    McDonald, James E; Kessler, Marcus M; Gardner, Michael W; Buros, Amy F; Ntambi, James A; Waheed, Sarah; van Rhee, Frits; Zangari, Maurizio; Heuck, Christoph J; Petty, Nathan; Schinke, Carolina; Thanendrarajan, Sharmilan; Mitchell, Alan; Hoering, Antje; Barlogie, Bart; Morgan, Gareth J; Davies, Faith E

    2017-04-15

    Purpose: Fluorine-18 fluorodeoxyglucose positron emission tomography with CT attenuation correction ((18)F-FDG PET/CT) is useful in the detection and enumeration of focal lesions and in semiquantitative characterization of metabolic activity (glycolytic phenotype) by calculation of glucose uptake. Total lesion glycolysis (TLG) and metabolic tumor volume (MTV) have the potential to improve the value of this approach and enhance the prognostic value of disease burden measures. This study aims to determine whether TLG and MTV are associated with progression-free survival (PFS) and overall survival (OS), and whether they improve risk assessments such as International Staging System (ISS) stage and GEP70 risk.Experimental Design: 192 patients underwent whole body PET/CT in the Total Therapy 3A (TT3A) trial and were evaluated using three-dimensional region-of-interest analysis with TLG, MTV, and standard measurement parameters derived for all focal lesions with peak SUV above the background red marrow signal.Results: In multivariate analysis, baseline TLG > 620 g and MTV > 210 cm(3) remained a significant factor of poor PFS and OS after adjusting for baseline myeloma variables. Combined with the GEP70 risk score, TLG > 205 g identifies a high-risk-behaving subgroup with poor expected survival. In addition, TLG > 205 g accurately divides ISS stage II patients into two subgroups with similar outcomes to ISS stage I and ISS stage III, respectively.Conclusions: TLG and MTV have significant survival implications at baseline and offer a more precise quantitation of the glycolytic phenotype of active disease. These measures can be assessed more readily than before using FDA-approved software and should be standardized and incorporated into clinical trials moving forward. Clin Cancer Res; 23(8); 1981-7. ©2016 AACR. ©2016 American Association for Cancer Research.

  16. Double positivity for HPV DNA/p16 in tonsillar and base of tongue cancer improves prognostication: Insights from a large population-based study.

    Science.gov (United States)

    Garnaes, Emilie; Frederiksen, Kirsten; Kiss, Katalin; Andersen, Luise; Therkildsen, Marianne H; Franzmann, Maria B; Specht, Lena; Andersen, Elo; Norrild, Bodil; Kjaer, Susanne K; von Buchwald, Christian

    2016-12-01

    The aim was to explore the overall survival (OS) for palatine tonsillar squamous cell carcinoma (TSCC), subdivided, according to certainty of tonsillar tumour origin, into specified tonsillar squamous cell carcinomas (STSCCs) and nonspecified tonsillar squamous cell carcinomas (NSTSCCs), and base of tongue squamous cell carcinoma (BSCC) when stratifying for HPV DNA status, p16 expression and combined HPV/p16 status. We included all patients (n = 797) diagnosed with TSCCs and BSCCs in Eastern Denmark as registered in the Danish Head and Neck Cancer Group (DAHANCA) database and the Danish Pathology Databank, 2000-2010. Patients were treated according to national guidelines (radiotherapy +/- concomitant cisplatin). All specimens were analysed using HPV DNA PCR and p16 immunohistochemistry. Clinical information was retrieved from the DAHANCA database and the Danish National Patient Registry. Information on vital status was obtained from the Danish Civil Registration System. We observed improved OS for HPV+/p16+ BSCCs compared to HPV-/p16- (hazard ratio for death [HR], 0.15; 95% CI, 0.09-0.24). Among STSCCs, HPV+/p16+ showed the lowest HR (0.19, 95% CI, 0.13-0.29); whereas, HPV-/p16+ showed an intermediate HR (0.39; 95% CI, 0.22-0.70). For NSTSCCs, HPV+/p16+ and HPV-/p16+ showed similar OS (HRs, 0.39; 95% CI, 0.26-0.59; and 0.48; 95% CI, 0.24-0.95, respectively). Combined HPV+/p16+ was a significantly better prognostic marker in BSCCs and STSCCs than HPV DNA and p16, alone (all p-values p16 (p = 0.53), alone. In conclusion, double positivity for HPV/p16 in conjunction with the certainty of tumour site improved prognosis.

  17. Double positivity for HPV DNA/p16 in tonsillar and base of tongue cancer improves prognostication

    DEFF Research Database (Denmark)

    Garnaes, Emilie; Frederiksen, Kirsten; Kiss, Katalin

    2016-01-01

    of tongue squamous cell carcinoma (BSCC) when stratifying for HPV DNA status, p16 expression and combined HPV/p16 status. We included all patients (n = 797) diagnosed with TSCCs and BSCCs in Eastern Denmark as registered in the Danish Head and Neck Cancer Group (DAHANCA) database and the Danish Pathology...... Databank, 2000–2010. Patients were treated according to national guidelines (radiotherapy +/− concomitant cisplatin). All specimens were analysed using HPV DNA PCR and p16 immunohistochemistry. Clinical information was retrieved from the DAHANCA database and the Danish National Patient Registry....... Information on vital status was obtained from the Danish Civil Registration System. We observed improved OS for HPV+/p16+ BSCCs compared to HPV−/p16− (hazard ratio for death [HR], 0.15; 95% CI, 0.09–0.24). Among STSCCs, HPV+/p16+ showed the lowest HR (0.19, 95% CI, 0.13–0.29); whereas, HPV−/p16+ showed...

  18. Role of risk stratification and genetics in sudden cardiac death.

    Science.gov (United States)

    Rai, Vikrant; Agrawal, Devendra K

    2017-03-01

    Sudden cardiac death (SCD) is a major public health issue due to its increasing incidence in the general population and the difficulty in identifying high-risk individuals. Nearly 300 000 - 350 000 patients in the United States and 4-5 million patients in the world die annually from SCD. Coronary artery disease and advanced heart failure are the main etiology for SCD. Ischemia of any cause precipitates lethal arrhythmias, and ventricular tachycardia and ventricular fibrillation are the most common lethal arrhythmias precipitating SCD. Pulseless electrical activity, bradyarrhythmia, and electromechanical dissociation also result in SCD. Most SCDs occur outside of the hospital setting, so it is difficult to estimate the public burden, which results in overestimating the incidence of SCD. The insufficiency and limited predictive value of various indicators and criteria for SCD result in the increasing incidence. As a result, there is a need to develop better risk stratification criteria and find modifiable variables to decrease the incidence. Primary and secondary prevention and treatment of SCD need further research. This critical review is focused on the etiology, risk factors, prognostic factors, and importance of risk stratification of SCD.

  19. CSF α-synuclein improves diagnostic and prognostic performance of CSF tau and Aβ in Alzheimer's disease.

    Science.gov (United States)

    Toledo, Jon B; Korff, Ane; Shaw, Leslie M; Trojanowski, John Q; Zhang, Jing

    2013-11-01

    Alzheimer's disease (AD) and Lewy body diseases (LBD), e.g., Parkinson's disease (PD) dementia and dementia with Lewy bodies (DLB), are common causes of geriatric cognitive impairments. In addition, AD and LBD are often found in the same patients at autopsy; therefore, biomarkers that can detect the presence of both pathologies in living subjects are needed. In this investigation, we report the assessment of α-synuclein (α-syn) in cerebrospinal fluid (CSF) and its association with CSF total tau (t-tau), phosphorylated tau181 (p-tau181), and amyloid beta1-42 (Aβ1-42) in subjects of the Alzheimer's Disease Neuroimaging Initiative (ADNI; n = 389), with longitudinal clinical assessments. A strong correlation was noted between α-syn and t-tau in controls, as well as in patients with AD and mild cognitive impairment (MCI). However, the correlation is not specific to subjects in the ADNI cohort, as it was also seen in PD patients and controls enrolled in the Parkinson's Progression Markers Initiative (PPMI; n = 102). A bimodal distribution of CSF α-syn levels was observed in the ADNI cohort, with high levels of α-syn in the subjects with abnormally increased t-tau values. Although a correlation was also noted between α-syn and p-tau181, there was a mismatch (α-syn-p-tau181-Mis), i.e., higher p-tau181 levels accompanied by lower α-syn levels in a subset of ADNI patients. We hypothesize that this α-syn-p-tau181-Mis is a CSF signature of concomitant LBD pathology in AD patients. Hence, we suggest that inclusion of measures of CSF α-syn and calculation of α-syn-p-tau181-Mis improves the diagnostic sensitivity/specificity of classic CSF AD biomarkers and better predicts longitudinal cognitive changes.

  20. European environmental stratifications and typologies

    DEFF Research Database (Denmark)

    Hazeu, G.W,; Metzger, M.J.; Mücher, C.A.

    2011-01-01

    A range of new spatial datasets classifying the European environment has been constructed over the last few years. These datasets share the common objective of dividing European environmental gradients into convenient units, within which objects and variables of interest have relatively homogeneous...... characteristics. The stratifications and typologies can be used as a basis for up-scaling, for stratified random sampling of ecological resources, for the representative selection of sites for studies across the continent and for the provision of frameworks for modeling exercises and reporting at the European...... their limitations and challenges. As such, they provide a sound basis for describing the factors affecting the robustness of such datasets. The latter is especially relevant, since there is likely to be further interest in European environmental assessment. In addition, advances in data availability and analysis...

  1. Pretreatment platelet count improves the prognostic performance of the TNM staging system and aids in planning therapeutic regimens for nasopharyngeal carcinoma: a single-institutional study of 2,626 patients.

    Science.gov (United States)

    Chen, Yu-Pei; Zhao, Bing-Cheng; Chen, Chen; Shen, Lu-Jun; Gao, Jin; Mai, Zhuo-Yao; Chen, Meng-Kun; Chen, Gang; Yan, Fang; Liu, Su; Xia, Yun-Fei

    2015-03-05

    Thrombocytosis has been identified as an unfavorable prognostic factor in several types of cancer. This study aimed to evaluate the prognostic value of pretreatment platelet count in association with the TNM staging system and therapeutic regimens in patients with nasopharyngeal carcinoma (NPC). A total of 2,626 patients with NPC were retrospectively analyzed. Platelet count >300 × 10(9)/L was defined as thrombocytosis. Matched-pair analysis was performed between patients receiving chemoradiotherapy and radiotherapy. Multivariate analysis showed that platelet count was an independent unfavorable prognostic factor for overall survival (OS) [hazard ratio (HR) = 1.810, 95% confidence interval (CI) = 1.531-2.140, P TNM classification (all P ≤ 0.001). Receiver operating characteristic (ROC) curves verified that the predictive value of TNM classification for OS was improved when combined with pretreatment platelet count (P = 0.030). Matched-pair analysis showed that chemoradiotherapy significantly improved OS only in advanced-stage NPC with thrombocytosis (HR = 0.416, 95% CI = 0.226-0.765, P = 0.005). Pretreatment platelet count, when combined with TNM classification, is a useful indicator for metastasis and survival in patients with NPC. It may improve the predictive value of the TNM classification and help to identify patients likely to benefit from more aggressive therapeutic regimens.

  2. Historical Studies of Social Mobility and Stratification

    NARCIS (Netherlands)

    Leeuwen, Marco H.D. van; Maas, Ineke

    2010-01-01

    This review discusses historical studies of social mobility and stratification. The focus is on changes in social inequality and mobility in past societies and their determinants. It discusses major historical sources, approaches, and results in the fields of social stratification (ranks and classes

  3. Historical Studies of Social Mobility and Stratification

    NARCIS (Netherlands)

    Leeuwen, Marco H.D. van; Maas, Ineke

    2010-01-01

    This review discusses historical studies of social mobility and stratification. The focus is on changes in social inequality and mobility in past societies and their determinants. It discusses major historical sources, approaches, and results in the fields of social stratification (ranks and classes

  4. Pretreatment platelet count improves the prognostic performance of the TNM staging system and aids in planning therapeutic regimens for nasopharyngeal carcinoma:a single-institutional study of 2,626 patients

    Institute of Scientific and Technical Information of China (English)

    Yu-Pei Chen; Su Liu; Yun-Fei Xia; Bing-Cheng Zhao; Chen Chen; Lu-Jun Shen; Jin Gao; Zhuo-Yao Mai; Meng-Kun Chen; Gang Chen; Fang Yan

    2015-01-01

    Introduction:Thrombocytosis has been identified as an unfavorable prognostic factor in several types of cancer. This study aimed to evaluate the prognostic value of pretreatment platelet count in association with the TNM staging system and therapeutic regimens in patients with nasopharyngeal carcinoma (NPC). Methods:A total of 2,626 patients with NPC were retrospectively analyzed. Platelet count>300 × 109/L was defined as thrombocytosis. Matched-pair analysis was performed between patients receiving chemoradiotherapy and radiotherapy. Results:Multivariate analysis showed that platelet count was an independent unfavorable prognostic factor for overal survival (OS) [hazard ratio (HR)=1.810, 95%confidence interval (CI)=1.531–2.140, P<0.001] and distant metastasis–free survival (DMFS) (HR=1.873, 95%CI=1.475–2.379, P<0.001) in the entire patient cohort. Further subgroup analysis revealed that increased platelet count was an independent unfavorable prognostic factor for OS and DMFS in patients with NPC stratified by early and advanced T category, N category, or TNM classification (al P≤0.001). Receiver operating characteristic (ROC) curves verified that the predictive value of TNM classification for OS was improved when combined with pretreatment platelet count (P=0.030). Matched-pair analysis showed that chemoradiotherapy significantly improved OS only in advanced-stage NPC with thrombocytosis (HR=0.416, 95%CI=0.226–0.765, P=0.005). Conclusions:Pretreatment platelet count, when combined with TNM classification, is a useful indicator for metastasis and survival in patients with NPC. It may improve the predictive value of the TNM classification and help to identify patients likely to benefit from more aggressive therapeutic regimens.

  5. Population-specific prognostic models are needed to stratify outcomes for African-Americans with diffuse large B-cell lymphoma.

    Science.gov (United States)

    Chen, Qiushi; Ayer, Turgay; Nastoupil, Loretta J; Koff, Jean L; Staton, Ashley D; Chhatwal, Jagpreet; Flowers, Christopher R

    2016-01-01

    Diffuse large B-cell lymphoma (DLBCL) demonstrates significant racial differences in age of onset, stage, and survival. To examine whether population-specific models improve prediction of outcomes for African-American (AA) patients with DLBCL, we utilized Surveillance, Epidemiology, and End Results data and compared stratification by the international prognostic index (IPI) in general and AA populations. We also constructed and compared prognostic models for general and AA populations using multivariable logistic regression (LR) and artificial neural network approaches. While the IPI adequately stratified outcomes for the general population, it failed to separate AA DLBCL patients into distinct risk groups. Our AA LR model identified age ≥ 55 (odds ratio 0.45, [95% CI: 0.36, 0.56], male sex (0.75, [0.60, 0.93]), and stage III/IV disease (0.43, [0.34, 0.54]) as adverse predictors of 5-year survival for AA patients. In addition, general-population prognostic models were poorly calibrated for AAs with DLBCL, indicating a need for validated AA-specific prognostic models.

  6. A probabilistic topic model for clinical risk stratification from electronic health records.

    Science.gov (United States)

    Huang, Zhengxing; Dong, Wei; Duan, Huilong

    2015-12-01

    Risk stratification aims to provide physicians with the accurate assessment of a patient's clinical risk such that an individualized prevention or management strategy can be developed and delivered. Existing risk stratification techniques mainly focus on predicting the overall risk of an individual patient in a supervised manner, and, at the cohort level, often offer little insight beyond a flat score-based segmentation from the labeled clinical dataset. To this end, in this paper, we propose a new approach for risk stratification by exploring a large volume of electronic health records (EHRs) in an unsupervised fashion. Along this line, this paper proposes a novel probabilistic topic modeling framework called probabilistic risk stratification model (PRSM) based on Latent Dirichlet Allocation (LDA). The proposed PRSM recognizes a patient clinical state as a probabilistic combination of latent sub-profiles, and generates sub-profile-specific risk tiers of patients from their EHRs in a fully unsupervised fashion. The achieved stratification results can be easily recognized as high-, medium- and low-risk, respectively. In addition, we present an extension of PRSM, called weakly supervised PRSM (WS-PRSM) by incorporating minimum prior information into the model, in order to improve the risk stratification accuracy, and to make our models highly portable to risk stratification tasks of various diseases. We verify the effectiveness of the proposed approach on a clinical dataset containing 3463 coronary heart disease (CHD) patient instances. Both PRSM and WS-PRSM were compared with two established supervised risk stratification algorithms, i.e., logistic regression and support vector machine, and showed the effectiveness of our models in risk stratification of CHD in terms of the Area Under the receiver operating characteristic Curve (AUC) analysis. As well, in comparison with PRSM, WS-PRSM has over 2% performance gain, on the experimental dataset, demonstrating that

  7. A five-factor biomarker profile obtained week 4-12 of treatment for improved prognostication in metastatic renal cell carcinoma

    DEFF Research Database (Denmark)

    Soerensen, Anne V; Geertsen, Poul F; Christensen, Ib J;

    2015-01-01

    BACKGROUND: Several biomarkers of treatment efficacy have been associated with a better prognosis in patients with metastatic renal cell carcinoma (mRCC). The prognostic significance of biomarkers in the early treatment phase is unclear. MATERIAL AND METHODS: In a complete national cohort of m...

  8. Design and Validation of the GI-NEC Score to Prognosticate Overall Survival in Patients With High-Grade Gastrointestinal Neuroendocrine Carcinomas

    OpenAIRE

    Valle, Juan; Lamarca, Angela; McNamara, Mairead; Hubner, Richard; Barriuso, Jorge

    2017-01-01

    BACKGROUND: Prognostic markers for risk stratification of patients with gastrointestinal high-grade neuroendocrine carcinomas (GI-NECs) are lacking; we designed and validated a prognostic score for overall survival (OS). METHODS: Consecutive patients diagnosed in five neuroendocrine specialist European centers were included. Patients were divided into three cohorts: a training cohort (TC), an external validation cohort (EVC), and a prospective validation cohort (PVC). Prognostic factors were ...

  9. Usefulness of staging systems and prognostic scores for hepatocellular carcinoma treatments

    Institute of Scientific and Technical Information of China (English)

    Xavier; Adhoute; Guillaume; Penaranda; Jean; Luc; Raoul; Patrice; Le; Treut; Emilie; Bollon; Jean; Hardwigsen; Paul; Castellani; Hervé; Perrier; Marc; Bourlière

    2016-01-01

    Therapeutic management of hepatocellular carcinoma(HCC) is quite complex owing to the underlying cirrhosis and portal vein hypertension. Different scores or classification systems based on liver function and tumoral stages have been published in the recent years. If none of them is currently "universally" recognized, the Barcelona Clinic Liver Cancer(BCLC) staging system has become the reference classification system in Western countries. Based on a robust treatment algorithm associated with stage stratification, it relies on a high level of evidence. However, BCLC stage B and C HCC include a broad spectrum of tumors but are only matched with a single therapeutic option. Some experts have thus suggested to extend the indications for surgery or for transarterial chemoembolization. In clinical practice, many patients are already treated beyond the scope of recommendations. Additional alternative prognostic scores that could be applied to any therapeutic modality have been recently proposed. They could represent complementary tools to the BCLC staging system and improve the stratification of HCC patients enrolled in clinical trials, as illustrated by the NIACE score. Prospective studies are needed to compare these scores and refine their role in the decision making process.

  10. Thermal Stratification in Vertical Mantle Tanks

    DEFF Research Database (Denmark)

    Knudsen, Søren; Furbo, Simon

    2001-01-01

    It is well known that it is important to have a high degree of thermal stratification in the hot water storage tank to achieve a high thermal performance of SDHW systems. This study is concentrated on thermal stratification in vertical mantle tanks. Experiments based on typical operation conditions...... are carried out to investigate how the thermal stratification is affected by different placements of the mantle inlet. The heat transfer between the solar collector fluid in the mantle and the domestic water in the inner tank is analysed by CFD-simulations. Furthermore, the flow pattern in the vertical mantle...... tank is investigated....

  11. Plasma levels of the MMP-9:TIMP-1 complex as prognostic biomarker in breast cancer

    DEFF Research Database (Denmark)

    Thorsen, Stine Buch; Christensen, Sarah Louise T; Würtz, Sidse Ørnbjerg

    2013-01-01

    Worldwide more than one million women are annually diagnosed with breast cancer. A considerable fraction of these women receive systemic adjuvant therapy; however, some are cured by primary surgery and radiotherapy alone. Prognostic biomarkers guide stratification of patients into different risk ...

  12. The prognostic importance of heart failure and age in patients treated with primary angioplasty

    NARCIS (Netherlands)

    Henriques, JPS; Zijlstra, F; de Boer, MJ; van't Hof, AWJ; Gosselink, ATM; Suryapranata, H; Hoorntje, JCA; Dambrink, Jan Hendrik Everwijn

    2003-01-01

    Background: Effective risk stratification is essential in the management of patients with acute myocardial infarction. Available models have not yet been studied and validated in patients treated with primary angioplasty for acute myocardial infarction. Methods: The prognostic value of heart failure

  13. Myelodysplastic syndrome: classification and prognostic systems

    Directory of Open Access Journals (Sweden)

    Rosangela Invernizzi

    2011-12-01

    Full Text Available Myelodysplastic syndromes (MDS are acquired clonal disorders of hematopoiesis, that are characterized most frequently by normocellular or hypercellular bone marrow specimens, and maturation that is morphologically and functionally dysplastic. MDS constitute a complex hematological problem: differences in disease presentation, progression and outcome have made it necessary to use classification systems to improve diagnosis, prognostication and treatment selection. On the basis of new scientific and clinical information, classification and prognostic systems have recently been updated and minimal diagnostic criteria forMDS have been proposed by expert panels. In addition, in the last few years our ability to define the prognosis of the individual patient with MDS has improved. In this paper World Health Organization (WHO classification refinements and recent prognostic scoring systems for the definition of individual risk are highlighted and current criteria are discussed. The recommendations should facilitate diagnostic and prognostic evaluations in MDS and selection of patients for new effective targeted therapies.

  14. Prognostic Performance Metrics

    Data.gov (United States)

    National Aeronautics and Space Administration — This chapter presents several performance metrics for offline evaluation of prognostics algorithms. A brief overview of different methods employed for performance...

  15. Prognostics for Microgrid Components

    Science.gov (United States)

    Saxena, Abhinav

    2012-01-01

    Prognostics is the science of predicting future performance and potential failures based on targeted condition monitoring. Moving away from the traditional reliability centric view, prognostics aims at detecting and quantifying the time to impending failures. This advance warning provides the opportunity to take actions that can preserve uptime, reduce cost of damage, or extend the life of the component. The talk will focus on the concepts and basics of prognostics from the viewpoint of condition-based systems health management. Differences with other techniques used in systems health management and philosophies of prognostics used in other domains will be shown. Examples relevant to micro grid systems and subsystems will be used to illustrate various types of prediction scenarios and the resources it take to set up a desired prognostic system. Specifically, the implementation results for power storage and power semiconductor components will demonstrate specific solution approaches of prognostics. The role of constituent elements of prognostics, such as model, prediction algorithms, failure threshold, run-to-failure data, requirements and specifications, and post-prognostic reasoning will be explained. A discussion on performance evaluation and performance metrics will conclude the technical discussion followed by general comments on open research problems and challenges in prognostics.

  16. Prognostic factors of improvement in health-related quality of life in atomoxetine-treated children and adolescents with attention-deficit/hyperactivity disorder, based on a pooled analysis.

    Science.gov (United States)

    Montoya, Alonso; Quail, Deborah; Anand, Ernie; Cardo, Esther; Alda, José A; Escobar, Rodrigo

    2014-03-01

    The objective of this study is to identify prognostic factors of treatment response to atomoxetine in improvement of health-related quality of life (HR-QoL), measured by the Child Health and Illness Profile-Child Edition Parent Report Form (CHIP-CE PRF) Achievement and Risk Avoidance domains, in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Pooled data from 3 placebo-controlled trials and separate data from 3 open-label trials of atomoxetine in children and adolescents with ADHD were analyzed using logistic regression methods. Based on baseline impairment in the Achievement and/or Risk Avoidance domains (CHIP-CE PRF Risk Avoidance domains. Data of 190 and 183 subjects from the pooled sample, and 422 and 355 subjects from the open-label trials were included in the analysis of Achievement and Risk Avoidance domains. Baseline CHIP-CE subdomain scores proved to be the most robust prognostic factors for treatment outcome in both domains, based on data from the pooled sample of double-blind studies and from the individual open-label studies (odds ratios [OR] 0.74-1.56, p ADHD Rating Scale scores in the first 4-6 weeks) was another robust prognostic factor, based on data from the open-label studies (OR 2.99-6.19, p factors of atomoxetine treatment outcome in HR-QoL in children and adolescents with ADHD.

  17. Simulation benchmark based on THAI-experiment on dissolution of a steam stratification by natural convection

    Energy Technology Data Exchange (ETDEWEB)

    Freitag, M., E-mail: freitag@becker-technologies.com; Schmidt, E.; Gupta, S.; Poss, G.

    2016-04-01

    Highlights: . • We studied the generation and dissolution of steam stratification in natural convection. • We performed a computer code benchmark including blind and open phases. • The dissolution of stratification predicted only qualitatively by LP and CFD models during the blind simulation phase. - Abstract: Locally enriched hydrogen as in stratification may contribute to early containment failure in the course of severe nuclear reactor accidents. During accident sequences steam might accumulate as well to stratifications which can directly influence the distribution and ignitability of hydrogen mixtures in containments. An international code benchmark including Computational Fluid Dynamics (CFD) and Lumped Parameter (LP) codes was conducted in the frame of the German THAI program. Basis for the benchmark was experiment TH24.3 which investigates the dissolution of a steam layer subject to natural convection in the steam-air atmosphere of the THAI vessel. The test provides validation data for the development of CFD and LP models to simulate the atmosphere in the containment of a nuclear reactor installation. In test TH24.3 saturated steam is injected into the upper third of the vessel forming a stratification layer which is then mixed by a superposed thermal convection. In this paper the simulation benchmark will be evaluated in addition to the general discussion about the experimental transient of test TH24.3. Concerning the steam stratification build-up and dilution of the stratification, the numerical programs showed very different results during the blind evaluation phase, but improved noticeable during open simulation phase.

  18. Temperature Stratification in a Cryogenic Fuel Tank

    Data.gov (United States)

    National Aeronautics and Space Administration — A reduced dynamical model describing temperature stratification effects driven by natural convection in a liquid hydrogen cryogenic fuel tank has been developed. It...

  19. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction.

    Science.gov (United States)

    Gatzoulis, Konstantinos A; Tsiachris, Dimitris; Arsenos, Petros; Tousoulis, Dimitris

    2016-01-26

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

  20. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    Konstantinos A Gatzoulis; Dimitris Tsiachris; Petros Arsenos; Dimitris Tousoulis

    2016-01-01

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

  1. Pure variation and organic stratification.

    Science.gov (United States)

    Rosanvallon, Jérôme

    2012-09-01

    The fundamental problem posed by Darwin distinguishes his theory from any transformism of the past as well as any evolutionism to come: since variation is inherent to the living, it is a question of explaining, not at all why the living varies, but instead why the living does not vary in all directions to the point of constituting a continuum of forms varying ad infinitum. What limits and stabilizes this intrinsically unlimited variation, allowing certain forms to subsist and multiply to the detriment of others, is natural selection. This double principle of intrinsic variation/extrinsic selection constitutes a vector for the unification of reality that underlies Jean-Jacques Kupiec's ontophylogenesis as well as Deleuze and Guattari's global philosophy of Nature. Therefore, everything would potentially tend to incessantly vary. The work of Kupiec and others identifies an intrinsic random variation within ontogenesis itself. For Deleuze and Guattari, it is nothing but the figure, already selected by the organic stratum, of a more fundamental or pure variation. But, in fact, nothing really varies incessantly: everything undergoes a selective pressure according to which nothing subsists as such except what manages to endure through invariance (physical stratum) or reproduction (organic stratum). Thus, organic stratification only retains from variation what ensures and augments this reproduction. In this sense, every organism stratifies, i.e. submits to its imperative of subsistence and reproduction, a body without organs that varies in itself and always tends to escape the organism, for better (intensifications of life) or worse (cancerous pathologies). Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Optimization of stratification scheme for a fishery-independent survey with multiple objectives

    Institute of Scientific and Technical Information of China (English)

    XU Binduo; REN Yiping; CHEN Yong; XUE Ying; ZHANG Chongliang; WAN Rong

    2015-01-01

    Fishery-independent surveys are often used for collecting high quality biological and ecological data to support fisheries management. A careful optimization of fishery-independent survey design is necessary to improve the precision of survey estimates with cost-effective sampling efforts. We developed a simulation approach to evaluate and optimize the stratification scheme for a fishery-independent survey with multiple goals including estimation of abundance indices of individual species and species diversity indices. We compared the performances of the sampling designs with different stratification schemes for different goals over different months. Gains in precision of survey estimates from the stratification schemes were acquired compared to simple random sampling design for most indices. The stratification scheme with five strata performed the best. This study showed that the loss of precision of survey estimates due to the reduction of sampling efforts could be compensated by improved stratification schemes, which would reduce the cost and negative impacts of survey trawling on those species with low abundance in the fishery-independent survey. This study also suggests that optimization of a survey design differed with different survey objectives. A post-survey analysis can improve the stratification scheme of fishery-independent survey designs.

  3. Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis.

    Science.gov (United States)

    Lamborn, Kathleen R; Chang, Susan M; Prados, Michael D

    2004-07-01

    Survival for patients with glioblastoma multiforme is short, and current treatments provide limited benefit. Therefore, there is interest in conducting phase 2 trials of experimental treatments in newly diagnosed patients. However, this requires historical data with which to compare the experimental therapies. Knowledge of prognostic markers would also allow stratification into risk groups for phase 3 randomized trials. In this retrospective study of 832 glioblastoma multiforme patients enrolled into prospective clinical trials at the time of initial diagnosis, we evaluated several potential prognostic markers for survival to establish risk groups. Analyses were done using both Cox proportional hazards modeling and recursive partitioning analyses. Initially, patients from 8 clinical trials, 6 of which included adjuvant chemotherapy, were included. Subsequent analyses excluded trials with interstitial brachytherapy, and finally included only nonbrachytherapy trials with planned adjuvant chemotherapy. The initial analysis defined 4 risk groups. The 2 lower risk groups included patients under the age of 40, the lowest risk group being young patients with tumor in the frontal lobe only. An intermediate-risk group included patients with Karnofsky performance status (KPS) >70, subtotal or total resection, and age between 40 and 65. The highest risk group included all patients over 65 and patients between 40 and 65 with either KPS<80 or biopsy only. Subgroup analyses indicated that inclusion of adjuvant chemotherapy provides an increase in survival, although that improvement tends to be minimal for patients over age 65, for patients over age 40 with KPS less than 80, and for those treated with brachytherapy.

  4. Risk stratification of intermediate-risk acute myeloid leukemia: integrative analysis of a multitude of gene mutation and gene expression markers.

    Science.gov (United States)

    Rockova, Veronika; Abbas, Saman; Wouters, Bas J; Erpelinck, Claudia A J; Beverloo, H Berna; Delwel, Ruud; van Putten, Wim L J; Löwenberg, Bob; Valk, Peter J M

    2011-07-28

    Numerous molecular markers have been recently discovered as potential prognostic factors in acute myeloid leukemia (AML). It has become of critical importance to thoroughly evaluate their interrelationships and relative prognostic importance. Gene expression profiling was conducted in a well-characterized cohort of 439 AML patients (age < 60 years) to determine expression levels of EVI1, WT1, BCL2, ABCB1, BAALC, FLT3, CD34, INDO, ERG and MN1. A variety of AML-specific mutations were evaluated, that is, FLT3, NPM1, N-RAS, K-RAS, IDH1, IDH2, and CEBPA(DM/SM) (double/single). Univariable survival analysis shows that (1) patients with FLT3(ITD) mutations have inferior overall survival (OS) and event-free survival (EFS), whereas CEBPA(DM) and NPM1 mutations indicate favorable OS and EFS in intermediate-risk AML, and (2) high transcript levels of BAALC, CD34, MN1, EVl1, and ERG predict inferior OS and EFS. In multivariable survival analysis, CD34, ERG, and CEBPA(DM) remain significant. Using survival tree and regression methodologies, we show that CEBPA(DM), CD34, and IDH2 mutations are capable of separating the intermediate group into 2 AML subgroups with highly distinctive survival characteristics (OS at 60 months: 51.9% vs 14.9%). The integrated statistical approach demonstrates that from the multitude of biomarkers a greatly condensed subset can be selected for improved stratification of intermediate-risk AML.

  5. Diagnostic and Prognostic Biomarkers in Melanoma

    Science.gov (United States)

    Leininger, Jennifer; Hamby, Carl; Safai, Bijan

    2014-01-01

    Melanoma is a lethal melanocytic neoplasm. Unfortunately, the histological diagnosis can be difficult at times. Distinguishing ambiguous melanocytic neoplasms that are benign nevi from those that represent true melanoma is important both for treatment and prognosis. Diagnostic biomarkers currently used to assist in the diagnosis of melanoma are usually specific only for melanocytic neoplasms and not necessarily for their ability to metastasize. Traditional prognostic biomarkers include depth of invasion and mitotic count. Newer diagnostic and prognostic biomarkers utilize immunohistochemical staining as well as ribonucleic acid, micro-ribonucleic acid, and deoxyribonucleic acid assays and fluorescence in situ hybridization. Improved diagnostic and prognostic biomarkers are of increasing importance in the treatment of melanoma with the development of newer and more targeted therapies. Herein, the authors review many of the common as well as newer diagnostic and prognostic biomarkers used in melanoma. PMID:25013535

  6. Escore TIMI no infarto agudo do miocárdio conforme níveis de estratificação de prognóstico Score TIMI en el infarto agudo de miocardio según niveles de estratificación de pronóstico TIMI risk score for acute myocardial infarction according to prognostic stratification

    Directory of Open Access Journals (Sweden)

    Jaqueline Locks Pereira

    2009-08-01

    hospitalaria postinfarto fue de un 17,5%. En el grupo de bajo riesgo no hubo óbito. La mortalidad fue del 8,1% en el grupo de medio riesgo y de un 55,6% en el de alto riesgo. El riesgo de muerte para casos de alto riesgo fue 14,1 veces mayor con relación a los casos de medio y bajo riesgo (IC95% = 4,4 a 44,1 y pBACKGROUND: The TIMI (Thrombolysis in Myocardial Infarction risk score is derived from clinical trial involving patients who are eligible for fibrinolysis. As the risk profiles of these cases differ from those found in non-selected populations, it is important to review the applicability of the score in usual clinical conditions. OBJECTIVES: To evaluate the management and clinical evolution of hospital inpatients with acute myocardial infarction, according to risk stratification by the TIMI score. METHODS: We evaluated, retrospectively, 103 cases of acute myocardial infarction with ST-segment elevation admitted to the Hospital Nossa Senhora da Conceição - Tubarão, in 2004 and 2005. The cases were analyzed in three risk groups according to the TIMI score. RESULTS: The hospital mortality after infarction was 17.5%. In the low-risk group there was no death. The mortality was 8.1% in the medium risk group and 55.6% in the high-risk group. The risk of death in cases of high risk was 14.1 times higher than in the cases of medium and low risk (95% CI = 4.4 to 44.1 and p <0.001. The chance of receiving fibrinolytic was 50% lower in the high-risk group in relation to the low risk group (95% CI = 0.27 to 0.85, p = 0.004. CONCLUSION: There was a progressive increase in mortality and incidence of in-hospital complications according to the stratification by the TIMI score. High risk patients received thrombolytic less frequently than the patients at low risk.

  7. Analytic prognostic for petrochemical pipelines

    CERN Document Server

    Jaoude, Abdo Abou; El-Tawil, Khaled; Noura, Hassan; Ouladsine, Mustapha

    2012-01-01

    Pipelines tubes are part of vital mechanical systems largely used in petrochemical industries. They serve to transport natural gases or liquids. They are cylindrical tubes and are submitted to the risks of corrosion due to high PH concentrations of the transported liquids in addition to fatigue cracks due to the alternation of pressure-depression of gas along the time, initiating therefore in the tubes body micro-cracks that can propagate abruptly to lead to failure. The development of the prognostic process for such systems increases largely their performance and their availability, as well decreases the global cost of their missions. Therefore, this paper deals with a new prognostic approach to improve the performance of these pipelines. Only the first mode of crack, that is, the opening mode, is considered.

  8. Could (Disseminated and Residual Minimal Disease be a useful prognostic marker in non-Hodgkin paediatric Lymphomas?

    Directory of Open Access Journals (Sweden)

    Lara Mussolin

    2014-06-01

    Full Text Available Minimal Disseminated Disease (MDD represents the small number of tumour cells in the patients' bone marrow at the time of diagnosis, whereas Minimal Residual Disease (MRD represents the small number of tumour cells remaining in the bone marrow during treatment. Generally, MDD and MRD are measured by polymerase chain reaction, a highly sensitive technique. For a long time, bone marrow involvement has been considered an uncommon event in solid tumours. However, in recent years, several studies demonstrated that MDD and MRD could be powerful tools in paediatric non-Hodgkin lymphoma for stratifying patients in different prognostic groups. Risk stratification in future clinical trials on non-Hodgkin lymphoma based on these newly identified risk categories should be useful to improve therapies in order to increase survival for high-risk patients and decrease toxicity for low-risk patients.http://dx.doi.org/10.7175/cmi.v8i2.902 

  9. Prognostic significance of peripheral monocyte count in patients with extranodal natural killer/T-cell lymphoma.

    Science.gov (United States)

    Huang, Jia-Jia; Li, Ya-Jun; Xia, Yi; Wang, Yu; Wei, Wen-Xiao; Zhu, Ying-Jie; Lin, Tong-Yu; Huang, Hui-Qiang; Jiang, Wen-Qi; Li, Zhi-Ming

    2013-05-03

    Extranodal natural killer/T-cell lymphoma (ENKL) has heterogeneous clinical manifestations and prognosis. This study aims to evaluate the prognostic impact of absolute monocyte count (AMC) in ENKL, and provide some immunologically relevant information for better risk stratification in patients with ENKL. Retrospective data from 163 patients newly diagnosed with ENKL were analyzed. The absolute monocyte count (AMC) at diagnosis was analyzed as continuous and dichotomized variables. Independent prognostic factors of survival were determined by Cox regression analysis. The AMC at diagnosis were related to overall survival (OS) and progression-free survival (PFS) in patients with ENKL. Multivariate analysis identified AMC as independent prognostic factors of survival, independent of International Prognostic Index (IPI) and Korean prognostic index (KPI). The prognostic index incorporating AMC and absolute lymphocyte count (ALC), another surrogate factor of immune status, could be used to stratify all 163 patients with ENKL into different prognostic groups. For patients who received chemotherapy followed by radiotherapy (102 cases), the three AMC/ALC index categories identified patients with significantly different survivals. When superimposed on IPI or KPI categories, the AMC/ALC index was better able to identify high-risk patients in the low-risk IPI or KPI category. The baseline peripheral monocyte count is shown to be an effective prognostic indicator of survival in ENKL patients. The prognostic index related to tumor microenvironment might be helpful to identify high-risk patients with ENKL.

  10. Diagnostic and prognostic gene expression signatures in 177 soft tissue sarcomas: hypoxia-induced transcription profile signifies metastatic potential

    Directory of Open Access Journals (Sweden)

    Bendahl Pär-Ola

    2007-03-01

    Full Text Available Abstract Background Soft tissue sarcoma (STS diagnosis is challenging because of a multitude of histopathological subtypes, different genetic characteristics, and frequent intratumoral pleomorphism. One-third of STS metastasize and current risk-stratification is suboptimal, therefore, novel diagnostic and prognostic markers would be clinically valuable. We assessed the diagnostic and prognostic value of array-based gene expression profiles using 27 k cDNA microarrays in 177, mainly high-grade, STS of 13 histopathological subtypes. Results Unsupervised analysis resulted in two major clusters – one mainly containing STS characterized by type-specific genetic alterations and the other with a predominance of genetically complex and pleomorphic STS. Synovial sarcomas, myxoid/round-cell liposarcomas, and gastrointestinal stromal tumors clustered tightly within the former cluster and discriminatory signatures for these were characterized by developmental genes from the EGFR, FGFR, Wnt, Notch, Hedgehog, RAR and KIT signaling pathways. The more pleomorphic STS subtypes, e.g. leiomyosarcoma, malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma and dedifferentiated/pleomorphic liposarcoma, were part of the latter cluster and were characterized by relatively heterogeneous profiles, although subclusters herein were identified. A prognostic signature partly characterized by hypoxia-related genes was identified among 89 genetically complex pleomorphic primary STS and could, in a multivariate analysis including established prognostic markers, independently predict the risk of metastasis with a hazard ratio of 2.2 (P = 0.04. Conclusion Diagnostic gene expression profiles linking signaling pathways to the different STS subtypes were demonstrated and a hypoxia-induced metastatic profile was identified in the pleomorphic, high-grade STS. These findings verify diagnostic utility and application of expression data for improved selection of high

  11. Differential intratumoral distributions of CD8 and CD163 immune cells as prognostic biomarkers in breast cancer.

    Science.gov (United States)

    Fortis, Sotirios P; Sofopoulos, Michael; Sotiriadou, Nectaria N; Haritos, Christoforos; Vaxevanis, Christoforos K; Anastasopoulou, Eleftheria A; Janssen, Nicole; Arnogiannaki, Niki; Ardavanis, Alexandros; Pawelec, Graham; Perez, Sonia A; Baxevanis, Constantin N

    2017-04-18

    Tumor immune cell infiltrates are essential in hindering cancer progression and may complement the TNM classification. CD8+ and CD163+ cells have prognostic impact in breast cancer but their spatial heterogeneity has not been extensively explored in this type of cancer. Here, their potential as prognostic biomarkers was evaluated, depending on their combined densities in the tumor center (TC) and the tumor invasive margin (IM). CD8+ and CD163+ cells were quantified by immunohistochemistry of formalin-fixed, paraffin-embedded (FFPE) tumor tissue samples from a cohort totaling 162 patients with histologically-confirmed primary invasive non-metastatic ductal breast cancer diagnosed between 2000 and 2015. Clinical follow-up (median 6.9 years) was available for 97 of these patients. Differential densities of CD8+ and CD163+ cells in the combined TC and IM compartments (i.e., high(H)/low(L), respectively for CD8+ cells and the reverse L/H combination for CD163+ cells) were found to have significant prognostic value for survival, and allowed better patient stratification than TNM stage, tumor size, lymph node invasion and histological grade. The combined evaluation of CD8+ and CD163+ cell densities jointly in TC and IM further improves prediction of clinical outcomes based on disease-free and overall survival. Patients having the favorable immune signatures had favorable clinical outcomes despite poor clinicopathological parameters. Given the important roles of CD8+ and CD163+ cells in regulating opposing immune circuits, adding an assessment of their differential densities to the prognostic biomarker armamentarium in breast cancer would be valuable. Larger validation studies are necessary to confirm these findings. Study code: IRB-ID 6079/448/10-6-13 Date of approval: 10/06/2013 Retrospective study (2000-2010) First patient prospectively enrolled 14/2/2014.

  12. A Distributed Approach to System-Level Prognostics

    Science.gov (United States)

    Daigle, Matthew J.; Bregon, Anibal; Roychoudhury, Indranil

    2012-01-01

    Prognostics, which deals with predicting remaining useful life of components, subsystems, and systems, is a key technology for systems health management that leads to improved safety and reliability with reduced costs. The prognostics problem is often approached from a component-centric view. However, in most cases, it is not specifically component lifetimes that are important, but, rather, the lifetimes of the systems in which these components reside. The system-level prognostics problem can be quite difficult due to the increased scale and scope of the prognostics problem and the relative Jack of scalability and efficiency of typical prognostics approaches. In order to address these is ues, we develop a distributed solution to the system-level prognostics problem, based on the concept of structural model decomposition. The system model is decomposed into independent submodels. Independent local prognostics subproblems are then formed based on these local submodels, resul ting in a scalable, efficient, and flexible distributed approach to the system-level prognostics problem. We provide a formulation of the system-level prognostics problem and demonstrate the approach on a four-wheeled rover simulation testbed. The results show that the system-level prognostics problem can be accurately and efficiently solved in a distributed fashion.

  13. The use of molecular-based risk stratification and pharmacogenomics for outcome prediction and personalized therapeutic management of multiple myeloma.

    Science.gov (United States)

    Johnson, Sarah K; Heuck, Christoph J; Albino, Anthony P; Qu, Pingping; Zhang, Qing; Barlogie, Bart; Shaughnessy, John D

    2011-10-01

    Despite improvement in therapeutic efficacy, multiple myeloma (MM) remains incurable with a median survival of approximately 10 years. Gene-expression profiling (GEP) can be used to elucidate the molecular basis for resistance to chemotherapy through global assessment of molecular alterations that exist at diagnosis, after therapeutic treatment and that evolve during tumor progression. Unique GEP signatures associated with recurrent chromosomal translocations and ploidy changes have defined molecular classes with differing clinical features and outcomes. When compared to other stratification systems the GEP70 test remained a significant predictor of outcome, reduced the number of patients classified with a poor prognosis, and identified patients at increased risk of relapse despite their standard clinico-pathologic and genetic findings. GEP studies of serial samples showed that risk increases over time, with relapsed disease showing GEP shifts toward a signature of poor outcomes. GEP signatures of myeloma cells after therapy were prognostic for event-free and overall survival and thus may be used to identify novel strategies for overcoming drug resistance. This brief review will focus on the use of GEP of MM to define high-risk myeloma, and elucidate underlying mechanisms that are beginning to change clinical decision-making and inform drug design.

  14. Prognostics of Power MOSFET

    Data.gov (United States)

    National Aeronautics and Space Administration — This paper demonstrates how to apply prognostics to power MOSFETs (metal oxide field effect transistor). The methodology uses thermal cycling to age devices and...

  15. DNA repair prognostic index modelling reveals an essential role for base excision repair in influencing clinical outcomes in ER negative and triple negative breast cancers

    Science.gov (United States)

    Abdel-Fatah, Tarek M.A.; Arora, Arvind; Moseley, Paul M.; Perry, Christina; Rakha, Emad A.; Green, Andrew R.; Chan, Stephen Y.T.; Ellis, Ian O.; Madhusudan, Srinivasan

    2015-01-01

    Stratification of oestrogen receptor (ER) negative and triple negative breast cancers (TNBCs) is urgently needed. In the current study, a cohort of 880 ER- (including 635 TNBCs) was immuno-profiled for a panel of DNA repair proteins including: Pol β, FEN1, APE1, XRCC1, SMUG1, PARP1, BRCA1, ATR, ATM, DNA-PKcs, Chk1, Chk2, p53, and TOPO2. Multivariate Cox proportional hazards models (with backward stepwise exclusion of these factors, using a criterion of p < 0.05 for retention of factors in the model) were used to identify factors that were independently associated with clinical outcomes. XRCC1 (p = 0.002), pol β (p = 0.032) FEN1 (p = 0.001) and BRCA1 (p = 0.040) levels were independently associated with poor BCSS. Subsequently, DNA repair index prognostic (DRPI) scores for breast cancer specific survival (BCSS) were calculated and two prognostic groups (DRPI-PGs) were identified. Patients in prognostic group 2 (DRPI-PG2) have higher risk of death (p < 0.001). Furthermore, in DRPI-PG2 patients, exposure to anthracycline reduced the risk of death [(HR (95% CI) = 0.79 (0.64–0.98), p = 0.032) by 21–26%. In addition, DRPI-PG2 patients have adverse clinicopathological features including higher grade, lympho-vascular invasion, Her-2 positive phenotype, compared to those in DRPI-PG1 (p < 0.01). Receiver operating characteristic (ROC) curves indicated that the DRPI outperformed the currently used prognostic factors and adding DRPI to lymph node stage significantly improved their performance as a predictor for BCSS [p < 0.00001, area under curve (AUC) = 0.70]. BER strongly influences pathogenesis of ER- and TNBCs. The DRPI accurately predicts BCSS and can also serve as a valuable prognostic and predictive tool for TNBCs. PMID:26267318

  16. Income, social stratification, class, and private health insurance: a study of the Baltimore metropolitan area.

    Science.gov (United States)

    Muntaner, C; Parsons, P E

    1996-01-01

    Most studies of inequalities and access to health care have used income as the sole indicator of social stratification. Despite the significance of social theory in health insurance research, there are no empirical studies comparing the ability of different models of social stratification to predict health insurance coverage. The aim of this study is to provide a comparative analysis using a variety of theory-driven indicators of social stratification and assess the relative strength of the association between these indicators and private health insurance. Data were collected in a 1993 telephone interview of a random digit dialing sample of the white population in the Baltimore Metropolitan Statistical Area. Indicators of social stratification included employment status, full-time work, education, occupation, industry, household income, firm size, and three types of assets: ownership, organizational, and skill/credential. The association between social stratification and private health insurance was strongest for those having higher household incomes, having attained at least a bachelor's degree, and working in a firm with more than 50 employees, followed by being an owner or manager, and by being employed. The addition of education and firm size improved the prediction of the household income model. The authors conclude that studies of inequalities in health insurance coverage can benefit from the inclusion of theory-driven indicators of social stratification such as human capital, labor market segmentation, and control over productive assets.

  17. Cardiopulmonary Exercise Testing in Patients with Chronic Heart Failure: Prognostic Comparison from Peak VO2 and VE/VCO2 Slope.

    Science.gov (United States)

    Sarullo, Filippo Maria; Fazio, Giovanni; Brusca, Ignazio; Fasullo, Sergio; Paterna, Salvatore; Licata, Pamela; Novo, Giuseppina; Novo, Salvatore; Di Pasquale, Pietro

    2010-05-26

    Cardiopulmonary exercise testing with ventilatory expired gas analysis (CPET) has proven to be a valuable tool for assessing patients with chronic heart failure (CHF). The maximal oxygen uptake (peak V02) is used in risk stratification of patients with CHF. The minute ventilation-carbon dioxide production relationship (VE/VCO2 slope) has recently demonstrated prognostic significance in patients with CHF. Between January 2006 and December 2007 we performed CPET in 184 pts (146 M, 38 F, mean age 59.8 +/- 12.9 years), with stable CHF (96 coronary artery disease, 88 dilated cardiomyopathy), in NYHA functional class II (n.107) - III (n.77), with left ventricular ejection fraction (LVEF) /= 35.6 and 25% in those with VE/VCO2 slope 12.2 ml/kg/min (log rank chi2: 50.98, p /= 32.5 and 23% in those with VE/VCO2 slope 12.3 ml/kg/min (log rank chi2: 72.86, p < 0.0001). The VE/VCO2 slope was demonstrated with receiver operating characteristic curve analysis to be equivalent to peak VO2 in predicting cardiac-related mortality (0.89 vs. 0.89). Although area under the receiver operating characteristic curve for the VE/VCO2 slope was greater than peak VO2 in predicting cardiac-related hospitalization (0.88 vs 0.82), the difference was no statistically significant (p = 0.13). These results add to the present body of knowledge supporting the use of CPET in CHF patients. The VE/VCO2 slope, as an index of ventilatory response to exercise, is an excellent prognostic parameter and improves the risk stratification of CHF patients. It is easier to obtain than parameters of maximal exercise capacity and is of equivalent prognostic importance than peak VO2.

  18. Long time durability tests of fabric inlet stratification pipes

    DEFF Research Database (Denmark)

    Andersen, Elsa; Furbo, Simon

    2008-01-01

    The long time durability of seven different two layer fabric inlet stratification pipes for enhancing thermal stratification in hot water stores is investigated experimentally. Accelerated durability tests are carried out with the inlet stratification pipes both in a domestic hot water tank...... and that this destroys the capability of building up thermal stratification for the fabric inlet stratification pipe. The results also show that although dirt, algae etc. are deposited in the fabric pipes in the space heating tank, the capability of the fabric inlet stratifiers to build up thermal stratification...

  19. R2(GFRCHADS2 and R2(GFRCHA2DS2VASc schemes improved the performance of CHADS2 and CHA2DS2VASc scores in death risk stratification of Chinese older patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Fu S

    2017-08-01

    Full Text Available Shihui Fu,1,2,* Shanjing Zhou,3,* Leiming Luo,1 Ping Ye1 1Department of Geriatric Cardiology, 2Department of Cardiology and Hainan Branch, 3Department of Traditional Chinese Medicine and Hainan Branch, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work Background: This analysis was carried out to refine the CHADS2 and CHA2DS2VASc scores by combining creatinine clearance (CrCl and glomerular filtration rate (GFR and evaluate the performance of CrCl-based and GFR-based schemes in death risk stratification of Chinese older patients with atrial fibrillation (AF.Methods: There were 219 older patients with AF, and all-cause mortality was assessed during the follow-up of 1.11 years. Renal function was evaluated using the CrCl formula and different GFR (Modification of Diet in Renal Disease [MDRD], Chinese MDRD [CMDRD], Mayo Clinic Quadratic [Mayo] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formulas, and five kinds of R2CHADS2 and R2CHA2DS2VASc schemes were generated by combining CrCl and GFR with CHADS2 and CHA2DS2VASc scores.Results: In Cox regression multivariate analysis, CrCl <60 mL/min was moderately associated with death risk (P=0.122 and P=0.144. When MDRD, CMDRD, CKD-EPI and Mayo formulas were used to ascertain the GFR, GFR <60 mL/min/1.73 m2 was significantly associated with death risk (P<0.001 for all. In the models with CHADS2 and CHA2DS2VASc scores as the linear covariates, CrCl and GFR as the continuous variables were significantly associated with death risk (P<0.05 for all. C-statistics of CrCl-based schemes – R2(CrClCHADS2 and R2(CrClCHA2DS2VASc – moderately exceeded that of CHADS2 and CHA2DS2VASc scores (P=0.081 and 0.082. C-statistics of GFR-based schemes – R2(GFRCHADS2 and R2(GFRCHA2DS2VASc – significantly exceeded that of CHADS2 and CHA2DS2VASc scores (P<0.05 for all.Conclusion: Chinese older patients with AF with

  20. Prognostic impact of nomogram based on whole tumour size, tumour disappearance ratio on CT and SUVmax on PET in lung adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Song, So Hee; Lee, Ho Yun; Kim, Eun Young; Lee, Kyung Soo [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Gangnam-Gu, Seoul (Korea, Republic of); Ahn, Joong Hyun [Samsung Biomedical Research Institute, Biostatistics Team, Seoul (Korea, Republic of); Lee, Geewon [Pusan National University Hospital, Pusan National University School of Medicine, Department of Radiology and Medical Research Institute, Busan (Korea, Republic of); Choi, Joon Young [Sungkyunkwan University School of Medicine, Departments of Nuclear Medicine, Samsung Medical Center, Seoul (Korea, Republic of); Kang, Jun [Catholic University of Korea, Department of Pathology, Inchun St. Mary' s Hospital, College of Medicine, Inchun (Korea, Republic of); Han, Joungho [Sungkyunkwan University School of Medicine, Department of Pathology, Samsung Medical Center, Seoul (Korea, Republic of); Kwon, O.J. [Sungkyunkwan University School of Medicine, Division of Respiratory and Critical Medicine of the Department of Internal Medicine, Samsung Medical Center, Seoul (Korea, Republic of); Kim, Hong Kwan; Choi, Yong Soo; Kim, Jhingook; Shim, Young Mog [Sungkyunkwan University School of Medicine, Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul (Korea, Republic of)

    2016-06-15

    Lung adenocarcinoma frequently manifests as subsolid nodules, and the solid portion and ground-glass-opacity (GGO) portion on CT have different prognostic significance. Therefore, current T descriptor, defined as the whole tumour diameter without discrimination between solid and GGO, is insufficient. We aimed to determine the prognostic significance of solid tumour size and attempt to include prognostic factors such as tumour disappearance rate (TDR) on CT and SUVmax on PET/CT. Five hundred and ninety-five patients with completely resected lung adenocarcinoma were analyzed. We developed a nomogram using whole tumour size, TDR, and SUVmax. External validation was performed in another 102 patients. In patients with tumours measuring ≤2 cm and >2 to 3 cm, disease free survival (DFS) was significantly associated with solid tumour size (P < 0.001), but not with whole tumour size (P = 0.052). Developed nomogram was significantly superior to the conventional T stage (area under the curve of survival ROC; P = 0.013 by net reclassification improvement) in stratification of patient survival. In the external validation group, significant difference was noted in DFS according to proposed T stage (P = 0.009). Nomogram-based T descriptors provide better prediction of survival and assessment of individual risks than conventional T descriptors. (orig.)

  1. Prognostic Factors and Outcome of Management of Ischemic ...

    African Journals Online (AJOL)

    2017-05-18

    May 18, 2017 ... management, prognostic factors, and outcome of ischemic priapism in patients ... before surgical intervention, SSA and previous episodes were the most important prognostic .... All patients had a triad of penile pain, sustained erection, and penile ... improvement in the time of presentations as compared.

  2. A new Child-Turcotte-Pugh class 0 for patients with hepatocellular carcinoma: determinants, prognostic impact and ability to improve the current staging systems.

    Directory of Open Access Journals (Sweden)

    Yun-Hsuan Lee

    Full Text Available Majority of patients with hepatocellular carcinoma (HCC belonged to Child-Turcotte-Pugh (CTP class A. We aimed to identify a new class of patients with very well-preserved liver function and analyze its impact on outcome prediction, tumor staging and treatment allocation.A total of 2654 HCC patients were retrospectively analyzed. The prognostic ability was compared by the Akaike information criterion (AIC.The CTP class 0 was defined by fulfilling all criteria of albumin ≧4 g/dL, bilirubin ≦0.8 mg/dL, prothrombin time prolongation <0 seconds, no ascites and encephalopathy. A total of 23% of patients of CTP class A were reclassified as CTP class 0. Patients with CTP class 0 had a higher serum sodium level, lower serum creatinine, alanine aminotransferase, α-fetoprotein levels, shorter prothrombin time, better general well-being, smaller tumor burden with more solitary nodules, lower rates of vascular invasion, ascites formation, hepatic encephalopathy, more frequently treated with curative interventions and better Barcelona Clinic Liver Cancer (BCLC stages (all p<0.001. In the Cox proportional hazards model, the adjusted hazard ratios for CTP class A, B and C were 1.739, 3.120 and 5.107, respectively, compared to class 0 (all p<0.001. Reassigning patients with CTP class 0, A, B, B and C to stage 0, A, B, C and D, respectively, provided the lowest AIC score among all BCLC-based models.The proposal of CTP class 0 independently predicted better survival in HCC patients. Modification of tumor staging systems according to the modified CTP classification further enhances their prognostic ability.

  3. Is surgery at progression a prognostic marker for improved 6-month progression-free survival or overall survival for patients with recurrent glioblastoma?

    Science.gov (United States)

    Clarke, Jennifer L; Ennis, Michele M; Yung, W K Alfred; Chang, Susan M; Wen, Patrick Y; Cloughesy, Timothy F; Deangelis, Lisa M; Robins, H Ian; Lieberman, Frank S; Fine, Howard A; Abrey, Lauren; Gilbert, Mark R; Mehta, Minesh; Kuhn, John G; Aldape, Kenneth D; Lamborn, Kathleen R; Prados, Michael D

    2011-10-01

    Historically, the North American Brain Tumor Consortium used 6-month progression-free survival (PFS6) as the primary outcome for recurrent glioma phase II clinical trials. In some trials, a subset of patients received the trial treatment before surgery to assess tumor uptake and biological activity. We compared PFS6 and overall survival (OS) for patients with glioblastoma undergoing surgery at progression to results for those without surgery to evaluate the impact of surgical intervention on these outcomes. Two data sets were analyzed. The first included 511 patients enrolled during the period 1998-2005, 105 of whom had surgery (excluding biopsies) during the study or ≤ 30 days prior to registration. Analysis was stratified on the basis of whether temozolomide was part of the protocol treatment regimen. The second data set included 247 patients enrolled during 2005-2008, 103 of whom underwent surgery during the clinical trial or immediately prior to study registration. A combined data set consisting of all patients who did not receive temozolomide was also compiled. No statistically significant difference in PFS6 or OS was found between the surgery and nonsurgery groups in either data set alone or in the combined data set (P > .45). We conclude that PFS6 and OS results for patients with and without surgical intervention at the time of progression are similar, allowing data from these patients to be combined in assessing the benefit of new treatments without the need for stratification or other statistical adjustment.

  4. Stratification in Ap star atmospheres: Simulations

    Science.gov (United States)

    Cowley, Charles R.; Castelli, Fiorella

    2017-01-01

    It is now well established that the atmospheres of Ap stars can be chemically stratified (cf. Babel, A\\&A 258, 645, 1992; Ryabchikova et al. A\\&A 384, 545, 2002). The most convincing cases have been made with the profiles of very strong lines, such as Ca II K. Weaker line profiles are less obvious indicators. The collective behavior of sets or groups of lines have also been used. For example, if higher abundances are derived for strong lines in an atmosphere with zero microturbulence, one may assume that the absorbing species has been pushed into the higher photospheres. An example are the medium-strong Mn II lines in HgMn stars. In this paper, we probe this assumption by calculating line strengths with various assumed stratification models, and then determining abundances from those lines using an {\\bf unstratified} model with the same Teff and log(g). We use the model from Castelli, Kurucz \\& and Hubrig (A\\&A, 508, 401, 2009) for HR 6000, whose spectrum shows numerous indications of stratification. A variety of stratification models are considered, for example, ones where the majority of an absorbing species is concentrated above (or below) $log(\\tau_{5000}$ = -2.0. Cloud models are also investigated, where a species is concentrated within a range of photospheric depths. Curves of growth are generated in unstratified atmospheres for lines by holding the abundance fixed, and increasing log(gf). Similar curves are made in stratified models, and the ratios of strong to weak linesare compared with and without stratification. The effects of stratification on ionization are also investigated, as well as on the profiles of strong lines. We find, in agreement with previous work, that severe abundance jumps are sometimes required to account for some of the observed peculiarities.

  5. Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment

    Directory of Open Access Journals (Sweden)

    David Corcoran

    2015-09-01

    Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom, in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment.

  6. A Dynamical model of the atmospheric turbulence from the unstable stratification to the stable stratification

    Institute of Scientific and Technical Information of China (English)

    ShidaLIU; ZuguangZheng; 等

    1996-01-01

    We analyse the behavior of the nonlinear dynamical systems which are the truncated-spectrum model of the atmospheric turbulence equation.It shows that the chaos can appear in the Lorenz equation obtained by simple equations for the unstable stratification(Ri0),And the chaos can also appear in Burgers-Chao equations for the stable stratification(Ri>0,Ra<0),The atmospheric turbulence is intermittent in the stable stratified atmosphere.

  7. A Comparative Review of Stratification Texts and Readers

    Science.gov (United States)

    Peoples, Clayton D.

    2012-01-01

    Social stratification is a core substantive area within sociology. There are a number of textbooks and readers available on the market that deal with this central topic. In this article, I conduct a comparative review of (a) four stratification textbooks and (b) four stratification readers. (Contains 2 tables.)

  8. Effect of sample stratification on dairy GWAS results

    Science.gov (United States)

    Background Artificial insemination and genetic selection are major factors contributing to population stratification in dairy cattle. In this study, we analyzed the effect of sample stratification and the effect of stratification correction on results of a dairy genome-wide association study (GWAS)....

  9. Incremental prognostic value of the SYNTAX score to late gadolinium-enhanced magnetic resonance images for patients with stable coronary artery disease.

    Science.gov (United States)

    Kato, Shingo; Saito, Naka; Kirigaya, Hidekuni; Gyotoku, Daiki; Iinuma, Naoki; Kusakawa, Yuka; Iguchi, Kohei; Nakachi, Tatsuya; Fukui, Kazuki; Futaki, Masaaki; Iwasawa, Tae; Taguri, Masataka; Kimura, Kazuo; Umemura, Satoshi

    2016-06-01

    The prognostic significance of the SYNTAX (Synergy between PCI with Taxus and cardiac surgery) score has recently been demonstrated in patients with stable multivessel or left main coronary artery disease (CAD). The present study determines whether adding the SYNTAX score to Framingham risk score (FRS), left ventricular ejection fraction (LVEF) and presence of myocardial infarction (MI) by late gadolinium enhancement (LGE) magnetic resonance imaging can improve the risk stratification in patients with stable CAD. We calculated the SYNTAX score in 161 patients with stable CAD (mean age: 66 ± 10 years old). During a mean follow-up of 2.3 years, 56 (35 %) of 161 patients developed cardiovascular events defined as cardiovascular death, non-fatal MI, cerebral infarction, unstable angina pectoris, hospitalization due to heart failure and revascularization. Multivariate Cox regression analysis selected triglycerides [hazard ratio (HR): 1.005 (95 % confidence interval (CI): 1.001-1.008), p SYNTAX score [HR: 1.085 (95 % CI: 1.044-1.127), p SYNTAX score to FRS, EF and LGE significantly improved the net reclassification index (NRI) [40.4 % (95 % CI: 18.1-54.8 %), p SYNTAX score to the FRS, LVEF and LGE incrementally improved risk stratification in patient with stable CAD.

  10. Prognostic Value of Beta-Tubulin-3 and c-Myc in Muscle Invasive Urothelial Carcinoma of the Bladder

    Science.gov (United States)

    Massari, Francesco; Bria, Emilio; Ciccarese, Chiara; Munari, Enrico; Modena, Alessandra; Zambonin, Valentina; Sperduti, Isabella; Artibani, Walter; Cheng, Liang; Martignoni, Guido; Tortora, Giampaolo; Brunelli, Matteo

    2015-01-01

    Background To date, putative prognostic biomarkers have shown limited utility from the clinical perspective for bladder urothelial carcinoma. Herein, the expression of beta-tubulin-3 and c-Myc was evaluated to determine their prognostic potential. Methods In formalin fixed-paraffin embedded blocks, immunohistochemical expression of c-Myc and beta-tubulin-3 was evaluated. H score ranging from 0 to 300 was obtained by multiplying the percentage of positive cells by intensity (0–3); c-Myc and beta-tubulin-3 expression was defined: 0: negative, 1: weakly positive, 2: strongly positive. Results beta-tubulin-3 and c-Myc immunoexpression was available for 46 cases. At the univariate analysis, node-involvement, beta-tubulin-3 and c-Myc overexpression discriminate shorter DFS (HR 2.19, p = 0.043; HR 3.10, p = 0.24 and HR 3.05, p = 0.011, respectively); 2-yrs DFS log-rank analysis according to low versus high level of immunoexpression were statistically significant; beta-tubulin-3, 53% low vs 12.7% high (p = value 0.02) and c-Myc 28 low vs 8 high (p-value 0.007). Patients displaying negative beta-tubulin-3/c-Myc had statistically significant better 2-yrs DFS than those with mixed expression or double positivity (54.5% versus 18.7% versus 0%, log-rank p = 0.006). Conclusions c-Myc and beta-tubulin-3 show improvement for prognostic risk stratification in patients with muscle invasive bladder urothelial carcinoma. These molecular pathways may also be candidate to improve predictiveness to targeted therapies. PMID:26046361

  11. Prognostic Value of Beta-Tubulin-3 and c-Myc in Muscle Invasive Urothelial Carcinoma of the Bladder.

    Directory of Open Access Journals (Sweden)

    Francesco Massari

    Full Text Available To date, putative prognostic biomarkers have shown limited utility from the clinical perspective for bladder urothelial carcinoma. Herein, the expression of beta-tubulin-3 and c-Myc was evaluated to determine their prognostic potential.In formalin fixed-paraffin embedded blocks, immunohistochemical expression of c-Myc and beta-tubulin-3 was evaluated. H score ranging from 0 to 300 was obtained by multiplying the percentage of positive cells by intensity (0-3; c-Myc and beta-tubulin-3 expression was defined: 0: negative, 1: weakly positive, 2: strongly positive.beta-tubulin-3 and c-Myc immunoexpression was available for 46 cases. At the univariate analysis, node-involvement, beta-tubulin-3 and c-Myc overexpression discriminate shorter DFS (HR 2.19, p = 0.043; HR 3.10, p = 0.24 and HR 3.05, p = 0.011, respectively; 2-yrs DFS log-rank analysis according to low versus high level of immunoexpression were statistically significant; beta-tubulin-3, 53% low vs 12.7% high (p = value 0.02 and c-Myc 28 low vs 8 high (p-value 0.007. Patients displaying negative beta-tubulin-3/c-Myc had statistically significant better 2-yrs DFS than those with mixed expression or double positivity (54.5% versus 18.7% versus 0%, log-rank p = 0.006.c-Myc and beta-tubulin-3 show improvement for prognostic risk stratification in patients with muscle invasive bladder urothelial carcinoma. These molecular pathways may also be candidate to improve predictiveness to targeted therapies.

  12. Effect of Tumor Subtype on Survival and the Graded Prognostic Assessment for Patients With Breast Cancer and Brain Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Sperduto, Paul W., E-mail: psperduto@mropa.com [University of Minnesota Gamma Knife, Minneapolis Radiation Oncology, Minneapolis, MN (United States); Kased, Norbert [Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA (United States); Roberge, David [Radiation Oncology, McGill University Health Center, Montreal, QC (Canada); Xu Zhiyuan [Department of Neurosurgery, Cleveland Clinic, Cleveland, OH (United States); Shanley, Ryan [Masonic Cancer Center, University of Minnesota, Minneapolis, MN (United States); Luo, Xianghua [Masonic Cancer Center, University of Minnesota, Minneapolis, MN (United States); Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN (United States); Sneed, Penny K. [Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA (United States); Chao, Samuel T. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States); Weil, Robert J. [Department of Neurosurgery, Cleveland Clinic, Cleveland, OH (United States); Suh, John [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States); Bhatt, Amit [Department of Human Oncology, University of Wisconsin, Madison, WI (United States); Jensen, Ashley W.; Brown, Paul D. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Shih, Helen A. [Massachusetts General Hospital, Department of Radiation Oncology, Harvard Medical School, Boston, MA (United States); Kirkpatrick, John [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Gaspar, Laurie E. [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO (United States); Fiveash, John B. [Radiation Oncology, University of Alabama Medical Center at Birmingham, Birmingham, AL (United States); and others

    2012-04-01

    Purpose: The diagnosis-specific Graded Prognostic Assessment (GPA) was published to clarify prognosis for patients with brain metastases. This study refines the existing Breast-GPA by analyzing a larger cohort and tumor subtype. Methods and Materials: A multi-institutional retrospective database of 400 breast cancer patients treated for newly diagnosed brain metastases was generated. Prognostic factors significant for survival were analyzed by multivariate Cox regression and recursive partitioning analysis (RPA). Factors were weighted by the magnitude of their regression coefficients to define the GPA index. Results: Significant prognostic factors by multivariate Cox regression and RPA were Karnofsky performance status (KPS), HER2, ER/PR status, and the interaction between ER/PR and HER2. RPA showed age was significant for patients with KPS 60 to 80. The median survival time (MST) overall was 13.8 months, and for GPA scores of 0 to 1.0, 1.5 to 2.0, 2.5 to 3.0, and 3.5 to 4.0 were 3.4 (n = 23), 7.7 (n = 104), 15.1 (n = 140), and 25.3 (n = 133) months, respectively (p < 0.0001). Among HER2-negative patients, being ER/PR positive improved MST from 6.4 to 9.7 months, whereas in HER2-positive patients, being ER/PR positive improved MST from 17.9 to 20.7 months. The log-rank statistic (predictive power) was 110 for the Breast-GPA vs. 55 for tumor subtype. Conclusions: The Breast-GPA documents wide variation in prognosis and shows clear separation between subgroups of patients with breast cancer and brain metastases. This tool will aid clinical decision making and stratification in clinical trials. These data confirm the effect of tumor subtype on survival and show the Breast-GPA offers significantly more predictive power than the tumor subtype alone.

  13. Prognostics of Power MOSFET

    Science.gov (United States)

    Celaya, Jose Ramon; Saxena, Abhinav; Vashchenko, Vladislay; Saha, Sankalita; Goebel, Kai Frank

    2011-01-01

    This paper demonstrates how to apply prognostics to power MOSFETs (metal oxide field effect transistor). The methodology uses thermal cycling to age devices and Gaussian process regression to perform prognostics. The approach is validated with experiments on 100V power MOSFETs. The failure mechanism for the stress conditions is determined to be die-attachment degradation. Change in ON-state resistance is used as a precursor of failure due to its dependence on junction temperature. The experimental data is augmented with a finite element analysis simulation that is based on a two-transistor model. The simulation assists in the interpretation of the degradation phenomena and SOA (safe operation area) change.

  14. Prognostic DNA Methylation Markers for Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Siri H. Strand

    2014-09-01

    Full Text Available Prostate cancer (PC is the most commonly diagnosed neoplasm and the third most common cause of cancer-related death amongst men in the Western world. PC is a clinically highly heterogeneous disease, and distinction between aggressive and indolent disease is a major challenge for the management of PC. Currently, no biomarkers or prognostic tools are able to accurately predict tumor progression at the time of diagnosis. Thus, improved biomarkers for PC prognosis are urgently needed. This review focuses on the prognostic potential of DNA methylation biomarkers for PC. Epigenetic changes are hallmarks of PC and associated with malignant initiation as well as tumor progression. Moreover, DNA methylation is the most frequently studied epigenetic alteration in PC, and the prognostic potential of DNA methylation markers for PC has been demonstrated in multiple studies. The most promising methylation marker candidates identified so far include PITX2, C1orf114 (CCDC181 and the GABRE~miR-452~miR-224 locus, in addition to the three-gene signature AOX1/C1orf114/HAPLN3. Several other biomarker candidates have also been investigated, but with less stringent clinical validation and/or conflicting evidence regarding their possible prognostic value available at this time. Here, we review the current evidence for the prognostic potential of DNA methylation markers in PC.

  15. Quantitative risk stratification of oral leukoplakia with exfoliative cytology.

    Directory of Open Access Journals (Sweden)

    Yao Liu

    Full Text Available Exfoliative cytology has been widely used for early diagnosis of oral squamous cell carcinoma (OSCC. Test outcome is reported as "negative", "atypical" (defined as abnormal epithelial changes of uncertain diagnostic significance, and "positive" (defined as definitive cellular evidence of epithelial dysplasia or carcinoma. The major challenge is how to properly manage the "atypical" patients in order to diagnose OSCC early and prevent OSCC. In this study, we collected exfoliative cytology data, histopathology data, and clinical data of normal subjects (n=102, oral leukoplakia (OLK patients (n=82, and OSCC patients (n=93, and developed a data analysis procedure for quantitative risk stratification of OLK patients. This procedure involving a step called expert-guided data transformation and reconstruction (EdTAR which allows automatic data processing and reconstruction and reveals informative signals for subsequent risk stratification. Modern machine learning techniques were utilized to build statistical prediction models on the reconstructed data. Among the several models tested using resampling methods for parameter pruning and performance evaluation, Support Vector Machine (SVM was found to be optimal with a high sensitivity (median>0.98 and specificity (median>0.99. With the SVM model, we constructed an oral cancer risk index (OCRI which may potentially guide clinical follow-up of OLK patients. One OLK patient with an initial OCRI of 0.88 developed OSCC after 40 months of follow-up. In conclusion, we have developed a statistical method for qualitative risk stratification of OLK patients. This method may potentially improve cost-effectiveness of clinical follow-up of OLK patients, and help design clinical chemoprevention trial for high-risk populations.

  16. Quantitative risk stratification of oral leukoplakia with exfoliative cytology.

    Science.gov (United States)

    Liu, Yao; Li, Jianying; Liu, Xiaoyong; Liu, Xudong; Khawar, Waqaar; Zhang, Xinyan; Wang, Fan; Chen, Xiaoxin; Sun, Zheng

    2015-01-01

    Exfoliative cytology has been widely used for early diagnosis of oral squamous cell carcinoma (OSCC). Test outcome is reported as "negative", "atypical" (defined as abnormal epithelial changes of uncertain diagnostic significance), and "positive" (defined as definitive cellular evidence of epithelial dysplasia or carcinoma). The major challenge is how to properly manage the "atypical" patients in order to diagnose OSCC early and prevent OSCC. In this study, we collected exfoliative cytology data, histopathology data, and clinical data of normal subjects (n=102), oral leukoplakia (OLK) patients (n=82), and OSCC patients (n=93), and developed a data analysis procedure for quantitative risk stratification of OLK patients. This procedure involving a step called expert-guided data transformation and reconstruction (EdTAR) which allows automatic data processing and reconstruction and reveals informative signals for subsequent risk stratification. Modern machine learning techniques were utilized to build statistical prediction models on the reconstructed data. Among the several models tested using resampling methods for parameter pruning and performance evaluation, Support Vector Machine (SVM) was found to be optimal with a high sensitivity (median>0.98) and specificity (median>0.99). With the SVM model, we constructed an oral cancer risk index (OCRI) which may potentially guide clinical follow-up of OLK patients. One OLK patient with an initial OCRI of 0.88 developed OSCC after 40 months of follow-up. In conclusion, we have developed a statistical method for qualitative risk stratification of OLK patients. This method may potentially improve cost-effectiveness of clinical follow-up of OLK patients, and help design clinical chemoprevention trial for high-risk populations.

  17. Towards Stratification Learning through Homology Inference

    CERN Document Server

    Bendich, Paul; Wang, Bei

    2010-01-01

    A topological approach to stratification learning is developed for point cloud data drawn from a stratified space. Given such data, our objective is to infer which points belong to the same strata. First we define a multi-scale notion of a stratified space, giving a stratification for each radius level. We then use methods derived from kernel and cokernel persistent homology to cluster the data points into different strata, and we prove a result which guarantees the correctness of our clustering, given certain topological conditions; some geometric intuition for these topological conditions is also provided. Our correctness result is then given a probabilistic flavor: we give bounds on the minimum number of sample points required to infer, with probability, which points belong to the same strata. Finally, we give an explicit algorithm for the clustering, prove its correctness, and apply it to some simulated data.

  18. Risk stratification in emergency patients by copeptin

    DEFF Research Database (Denmark)

    Iversen, Kasper; Gøtze, Jens P; Dalsgaard, Morten

    2014-01-01

    BACKGROUND: Rapid risk stratification is a core task in emergency medicine. Identifying patients at high and low risk shortly after admission could help clinical decision-making regarding treatment, level of observation, allocation of resources and post discharge follow-up. The purpose of the pre......BACKGROUND: Rapid risk stratification is a core task in emergency medicine. Identifying patients at high and low risk shortly after admission could help clinical decision-making regarding treatment, level of observation, allocation of resources and post discharge follow-up. The purpose...... to 0.1% (1/693) for patients with normal copeptin concentrations (that is, ≤11.3 pmol/L) (P figures for one-year mortality and for the entire...

  19. Risk Stratification for Second Primary Lung Cancer.

    Science.gov (United States)

    Han, Summer S; Rivera, Gabriel A; Tammemägi, Martin C; Plevritis, Sylvia K; Gomez, Scarlett L; Cheng, Iona; Wakelee, Heather A

    2017-09-01

    Purpose This study estimated the 10-year risk of developing second primary lung cancer (SPLC) among survivors of initial primary lung cancer (IPLC) and evaluated the clinical utility of the risk prediction model for selecting eligibility criteria for screening. Methods SEER data were used to identify a population-based cohort of 20,032 participants diagnosed with IPLC between 1988 and 2003 and who survived ≥ 5 years after the initial diagnosis. We used a proportional subdistribution hazards model to estimate the 10-year risk of developing SPLC among survivors of lung cancer LC in the presence of competing risks. Considered predictors included age, sex, race, treatment, histology, stage, and extent of disease. We examined the risk-stratification ability of the prediction model and performed decision curve analysis to evaluate the clinical utility of the model by calculating its net benefit in varied risk thresholds for screening. Results Although the median 10-year risk of SPLC among survivors of LC was 8.36%, the estimated risk varied substantially (range, 0.56% to 14.3%) when stratified by age, histology, and extent of IPLC in the final prediction model. The stratification by deciles of estimated risk showed that the observed incidence of SPLC was significantly higher in the tenth-decile group (12.5%) versus the first-decile group (2.9%; P risk thresholds (1% to 11.5%) at which the clinical net benefit of the risk model was larger than those in hypothetical all-screening or no-screening scenarios. Conclusion The risk stratification approach in SPLC can be potentially useful for identifying survivors of LC to be screened by computed tomography. More comprehensive environmental and genetic data may help enhance the predictability and stratification ability of the risk model for SPLC.

  20. Gene expression classification of colon cancer into molecular subtypes: characterization, validation, and prognostic value.

    Directory of Open Access Journals (Sweden)

    Laetitia Marisa

    -free survival, even after adjusting for age, sex, stage, and the emerging prognostic classifier Oncotype DX Colon Cancer Assay recurrence score (hazard ratio 1.5, 95% CI 1.1-2.1, p = 0.0097. However, a limitation of this study is that information on tumor grade and number of nodes examined was not available. CONCLUSIONS: We describe the first, to our knowledge, robust transcriptome-based classification of CC that improves the current disease stratification based on clinicopathological variables and common DNA markers. The biological relevance of these subtypes is illustrated by significant differences in prognosis. This analysis provides possibilities for improving prognostic models and therapeutic strategies. In conclusion, we report a new classification of CC into six molecular subtypes that arise through distinct biological pathways.

  1. Drainage and Stratification Kinetics of Foam Films

    Science.gov (United States)

    Zhang, Yiran; Sharma, Vivek

    2014-03-01

    Baking bread, brewing cappuccino, pouring beer, washing dishes, shaving, shampooing, whipping eggs and blowing bubbles all involve creation of aqueous foam films. Foam lifetime, drainage kinetics and stability are strongly influenced by surfactant type (ionic vs non-ionic), and added proteins, particles or polymers modify typical responses. The rate at which fluid drains out from a foam film, i.e. drainage kinetics, is determined in the last stages primarily by molecular interactions and capillarity. Interestingly, for certain low molecular weight surfactants, colloids and polyelectrolyte-surfactant mixtures, a layered ordering of molecules, micelles or particles inside the foam films leads to a stepwise thinning phenomena called stratification. Though stratification is observed in many confined systems including foam films containing particles or polyelectrolytes, films containing globular proteins seem not to show this behavior. Using a Scheludko-type cell, we experimentally study the drainage and stratification kinetics of horizontal foam films formed by protein-surfactant mixtures, and carefully determine how the presence of proteins influences the hydrodynamics and thermodynamics of foam films.

  2. Clinical outcomes and prognostic factors in patients with breast diffuse large B cell lymphoma; Consortium for Improving Survival of Lymphoma (CISL study

    Directory of Open Access Journals (Sweden)

    Lee Je-Jung

    2010-06-01

    Full Text Available Abstract Background The breast is a rare extranodal site of non-Hodgkin lymphoma, and primary breast lymphoma (PBL has been arbitrarily defined as disease localized to one or both breasts with or without regional lymph nodes involvement. The aim of this study was to evaluate the clinical outcomes in patients with diffuse large B cell lymphoma (DLBCL and breast involvement, and to find the criteria of PBL reflecting the outcome and prognosis. Methods We retrospectively analyzed data from 68 patients, newly diagnosed with DLBCL and breast involvement at 16 Korean institutions between January 1994 and June 2009. Results Median age at diagnosis was 48 years (range, 20-83 years. Forty-three (63.2% patients were PBL according to previous arbitrary criteria, sixteen (23.5% patients were high-intermediate to high risk of international prognostic index. The patients with one extranodal disease in the breast (OED with or without nodal disease were 49 (72.1%, and those with multiple extranodal disease (MED were 19 (27.9%. During median follow-up of 41.5 months (range, 2.4-186.0 months, estimated 5-year progression-free survival (PFS was 53.7 ± 7.6%, and overall survival (OS was 60.3 ± 7.2%. The 5-year PFS and OS was significantly higher for patients with the OED group than those with the MED group (5-year PFS, 64.9 ± 8.9% vs. 27.5 ± 11.4%, p = 0.001; 5-year OS, 74.3 ± 7.6% vs. 24.5 ± 13.0%, p Conclusions Our results show that the patients included in OED group, reflecting different treatment outcome, prognosis and pattern of progression, should be considered as PBL in the future trial. Further studies are warranted to validate our suggested criteria.

  3. Impact of gene expression profiling-based risk stratification in patients with myeloma receiving initial therapy with lenalidomide and dexamethasone.

    Science.gov (United States)

    Kumar, Shaji K; Uno, Hajime; Jacobus, Susanna J; Van Wier, Scott A; Ahmann, Greg J; Henderson, Kimberly J; Callander, Natalie S; Haug, Jessica L; Siegel, David S; Greipp, Philip R; Fonseca, Rafael; Rajkumar, S Vincent

    2011-10-20

    Detection of specific chromosomal abnormalities by FISH and metaphase cytogenetics allows risk stratification in multiple myeloma; however, gene expression profiling (GEP) based signatures may enable more specific risk categorization. We examined the utility of 2 GEP-based risk stratification systems among patients undergoing initial therapy with lenalidomide in the context of a phase 3 trial. Among 45 patients studied at baseline, 7 (16%) and 10 (22%), respectively, were high-risk using the GEP70 and GEP15 signatures. The median overall survival for the GEP70 high-risk group was 19 months versus not reached for the rest (hazard ratio = 14.1). Although the medians were not reached, the GEP15 also predicted a poor outcome among the high-risk patients. The C-statistic for the GEP70, GEP15, and FISH based risk stratification systems was 0.74, 0.7, and 0.7, respectively. Here we demonstrate the prognostic value for GEP risk stratification in a group of patients primarily treated with novel agents. This trial was registered at www.clinicaltrials.gov as #NCT00098475.

  4. PPOOLEX experiments on thermal stratification and mixing

    Energy Technology Data Exchange (ETDEWEB)

    Puustinen, M.; Laine, J.; Raesaenen, A. (Lappeenranta Univ. of Technology, Nuclear Safety Research Unit (Finland))

    2009-08-15

    The results of the thermal stratification experiments in 2008 with the PPOOLEX test facility are presented. PPOOLEX is a closed vessel divided into two compartments, dry well and wet well. Extra temperature measurements for capturing different aspects of the investigated phenomena were added before the experiments. The main purpose of the experiment series was to generate verification data for evaluating the capability of GOTHIC code to predict stratification and mixing phenomena. Altogether six experiments were carried out. Heat-up periods of several thousand seconds by steam injection into the dry well compartment and from there into the wet well water pool were recorded. The initial water bulk temperature was 20 deg. C. Cooling periods of several days were included in three experiments. A large difference between the pool bottom and top layer temperature was measured when small steam flow rates were used. With higher flow rates the mixing effect of steam discharge delayed the start of stratification until the pool bulk temperature exceeded 50 deg. C. The stratification process was also different in these two cases. With a small flow rate stratification was observed only above and just below the blowdown pipe outlet elevation. With a higher flow rate over a 30 deg. C temperature difference between the pool bottom and pipe outlet elevation was measured. Elevations above the pipe outlet indicated almost linear rise until the end of steam discharge. During the cooling periods the measurements of the bottom third of the pool first had an increasing trend although there was no heat input from outside. This was due to thermal diffusion downwards from the higher elevations. Heat-up in the gas space of the wet well was quite strong, first due to compression by pressure build-up and then by heat conduction from the hot dry well compartment via the intermediate floor and test vessel walls and by convection from the upper layers of the hot pool water. The gas space

  5. PROGNOSTIC FACTORS OF TUMORAL PROCESS IN PATIENTS WITH DISSEMINATED COLORECTAL CANCER

    Directory of Open Access Journals (Sweden)

    Ye. Yu. Zorina

    2014-01-01

    Full Text Available New prognostic factors for disseminated colorectal cancer (dCRC are being investigated in this article.Subjects and methods. In this study we have analyzed three clinical groups. First group – 60 patients with dCRC had not specifical therapy. Second group – 200 patients had specifical therapy, but without identification of prognostic and predictive markers. And third group – 93 patients had individual therapy which was based on prognostic and predictive markers of each patient.Results. Definition of prognostic factors (TS, TP, DPD, Ercc-1, СОХ-2, MSI, KRAS in patients with dCRC allowed to prescribe optimal specific therapy and improve results of treatment.Conclusion. Investigation of prognostic markers allowed to differentiate prognostic groups among dCRC patients. Investigation of prognostic factors in patients with intermediate prognosis allows to improve treatment outcome and improve number of liver surgery.

  6. Stratification of the elements in the atmospheres of blue horizontal-branch stars

    CERN Document Server

    LeBlanc, F; Khalack, V R

    2010-01-01

    Blue horizontal-branch (BHB) stars with $T_{\\rm eff}$ approximately larger than 11500 K show several observational anomalies. In globular clusters, they exhibit low rotational velocities, abundance anomalies (as compared to cluster abundances), photometric jumps and gaps and spectroscopic gravities lower than predicted by canonical models. It is commonly believed that the low rotational velocities of these stars permit atomic diffusion to be efficient in their atmosphere thereby causing the observed anomalies. Recent detections of vertical stratification of iron (and some other chemical elements) in several BHB stars concur with this framework. In this paper, improved model atmospheres that include the vertical stratification of the elements are applied to BHB stars to verify if they can explain their observational anomalies. The results from theoretical model atmospheres are consistent with the photometric jumps and gaps observed for BHB stars in globular clusters. It is found that iron stratification in the...

  7. Compression entropy contributes to risk stratification in patients with cardiomyopathy.

    Science.gov (United States)

    Truebner, Sandra; Cygankiewicz, Iwona; Schroeder, Rico; Baumert, Mathias; Vallverdú, Montserrat; Caminal, Pere; Vazquez, Rafael; Bayés de Luna, Antoni; Voss, Andreas

    2006-07-01

    Sudden cardiac death (SCD) is a leading cause of mortality with an incidence of 3 million cases per year worldwide. Therapies for patients who have survived an SCD episode or have a high risk of developing lethal ventricular arrhythmia are well established and depend mainly on risk stratification. In this study we investigated the suitability of the non-linear measure compression entropy (Hc) for improved risk prediction in cardiac patients. We recorded 24-h Holter ECG for 300 patients with congestive heart failure (CHF). During a mean follow-up period of 12 months, 32 patients died due to a cardiac event. Hc depends on the compression parameters window length w and buffer length b, which were optimised by analysing a subgroup of patients. Compression entropies based on the beat-to-beat interval (BBI) were subsequently calculated and compared with standard heartrate variability parameters. Statistical analysis revealed significant differences between high- and low-risk CHF patients in standard HRV measures, as well as compression entropy based on the BBI (cardiac death, p = 0.005; SCD, p = 0.02). In conclusion, the implementation of non-linear compression entropy analysis in multivariate analysis seems to be useful for enhanced risk stratification of cardiac death, especially SCD, in ischaemic cardiomyopathy patients.

  8. Prognostication and response assessment in liver and pancreatic tumors: The new imaging

    Science.gov (United States)

    De Robertis, Riccardo; Tinazzi Martini, Paolo; Demozzi, Emanuele; Puntel, Gino; Ortolani, Silvia; Cingarlini, Sara; Ruzzenente, Andrea; Guglielmi, Alfredo; Tortora, Giampaolo; Bassi, Claudio; Pederzoli, Paolo; D’Onofrio, Mirko

    2015-01-01

    Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term “functional imaging” is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive “one-step” morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring. PMID:26078555

  9. Modelling of stratification in cryogenic launch vehicle tanks in a fast engineering tool

    Science.gov (United States)

    van Foreest, Arnold

    Modelling of stratification in cryogenic launch vehicle tanks in a fast engineering tool Thermal stratification in cryogenic launch vehicle tanks can lead to several problems, such as sudden pressure drops in the tank due to sloshing of the stratified liquid or cavitation in rocket engine turbopumps. To obtain an optimal stage design, the stratification process muss be taken into account. Currently, stratification is often modelled by 3D CFD solvers, which is an extremely time consuming process. Analytical models do exists but are inaccurate. This paper will show how the currently existing analytical models are improved, by using experimental data and results obtained from numerical calculations using the 3D CFD tool FLOW 3D. The goal is to be able to model a stratification process of a few hundred seconds in just a few seconds of CPU time, so about a factor 100 faster than the physical process takes. A simulation using a 3D flow solver can take multiple days. Setting up the model for a 3D flow solver can even take longer. Therefore it would be a big advantage to have fast engineering tools describing the process so that stratification can be taken into account in the preliminary design phase. The stratification process has been investigated experimentally at ZARM (Centre of Applied Spaceflight and Microgravity), using a closed tank filled with liquid nitrogen. Due to unavoidable heat leaks from the surrounding, the liquid will start to heat up and thermal layers will form. The experiments are simulated using the commercial 3D flow solver "FLOW 3D". Once satisfying numerical results have been obtained, the stratification process can be investigated in more detail. The dimensioning parameters can be determined and their influence can be quantified. From these analyses it has been found that for example heat conduction through the tank wall in tangential direction has a big impact on the formation of thermal layers. The currently available analytical models for

  10. [Prognostic value of exercise testing in risk stratification of patients with heart failure].

    Science.gov (United States)

    Lara Vargas, Jorge; Ilarraza-Lomelí, Hermes; García Saldivia, Marianna; Bueno Ayala, Leopoldo

    2015-01-01

    To compare the predictive power of conventional exercise testing (CVET) vs cardiopulmonary exercise testing (CPET). A cohort study of 1,474 patients with heart failure was analyzed. We assessed variables of CVET and CPET. We used Schiller CS200 equipment with modified Balke protocol ramp. The comparison between groups was performed by correlation and contingency tables. It was considered stochastic significance when P<.05. 80% of the patients were male with an average age of 53±15 years. The most prevalent causes of heart failure were 65% for ischemic heart disease and 27% for dilated cardiomyopathy. Left ventricle ejection fraction (LVEF) was 34±10%, the workload were 6.3±2 (87%) METs and VO2 peak was 21±7mlO2/kg/min. CPET qualified 9% more patients at high risk compared to the 78% CVET, P<.001. The variables with more percentage at high risk were: 60% chronotropic incompetence and 49% VO2 recovery. The sensitivity, specificity and accuracy CVET for detecting high-risk subjects, compared to the CPET was 90%, 100% and 91% respectively. Weighted kappa between two tests was 0.7 (P<.001). The CVET has adequate sensitivity and specificity to detect patients with heart failure at high risk relative to the CPET. The degree of agreement is significant, but not enough to consider it as a surrogated test. Copyright © 2015 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  11. Diagnostic and prognostic risk stratification of venous thromboembolism in primary care

    NARCIS (Netherlands)

    Hendriksen, J.M.T.

    2016-01-01

    General practitioners (GPs) play an important role in the diagnosis and management of venous thromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). With an incidence of approximately 2-3 cases per 1000 persons annually, GPs are encountered with this potential

  12. Prognostic value of T peak-to-end interval for risk stratification after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Tarek Mohamed Abdelrahman

    2014-04-01

    Conclusion: TpTe was significantly and independently associated with increased odds of SCD and is linked to deterioration of Lv functions and myocardial aneurysms. It's highly correlated to presence of LAS and associate with severity of coronary lesions. Patients with prolonged TpTe intervals and dispersions were likely to develop fatal arrhythmias.

  13. Nottingham Prognostic Index Plus: Validation of a clinical decision making tool in breast cancer in an independent series.

    Science.gov (United States)

    Green, Andrew R; Soria, Daniele; Stephen, Jacqueline; Powe, Desmond G; Nolan, Christopher C; Kunkler, Ian; Thomas, Jeremy; Kerr, Gillian R; Jack, Wilma; Cameron, David; Piper, Tammy; Ball, Graham R; Garibaldi, Jonathan M; Rakha, Emad A; Bartlett, John Ms; Ellis, Ian O

    2016-01-01

    The Nottingham Prognostic Index Plus (NPI+) is a clinical decision making tool in breast cancer (BC) that aims to provide improved patient outcome stratification superior to the traditional NPI. This study aimed to validate the NPI+ in an independent series of BC. Eight hundred and eighty five primary early stage BC cases from Edinburgh were semi-quantitatively assessed for 10 biomarkers [Estrogen Receptor (ER), Progesterone Receptor (PgR), cytokeratin (CK) 5/6, CK7/8, epidermal growth factor receptor (EGFR), HER2, HER3, HER4, p53, and Mucin 1] using immunohistochemistry and classified into biological classes by fuzzy logic-derived algorithms previously developed in the Nottingham series. Subsequently, NPI+ Prognostic Groups (PGs) were assigned for each class using bespoke NPI-like formulae, previously developed in each NPI+ biological class of the Nottingham series, utilising clinicopathological parameters: number of positive nodes, pathological tumour size, stage, tubule formation, nuclear pleomorphism and mitotic counts. Biological classes and PGs were compared between the Edinburgh and Nottingham series using Cramer's V and their role in patient outcome prediction using Kaplan-Meier curves and tested using Log Rank. The NPI+ biomarker panel classified the Edinburgh series into seven biological classes similar to the Nottingham series (p > 0.01). The biological classes were significantly associated with patient outcome (p  0.01). The good PGs were similarly validated in Luminal B, Basal p53 normal, HER2+/ER- tumours and the poor PG in the Luminal N class (p > 0.01). Due to small patient numbers assigned to the remaining PGs, Luminal N, Luminal B, Basal p53 normal and HER2+/ER- classes could not be validated. This study demonstrates the reproducibility of NPI+ and confirmed its prognostic value in an independent cohort of primary BC. Further validation in large randomised controlled trial material is warranted.

  14. Is risk stratification ever the same as 'profiling'?

    Science.gov (United States)

    Braithwaite, R Scott; Stevens, Elizabeth R; Caplan, Arthur

    2016-05-01

    Physicians engage in risk stratification as a normative part of their professional duties. Risk stratification has the potential to be beneficial in many ways, and implicit recognition of this potential benefit underlies its acceptance as a cornerstone of the medical profession. However, risk stratification also has the potential to be harmful. We argue that 'profiling' is a term that corresponds to risk stratification strategies in which there is concern that ethical harms exceed likely or proven benefits. In the case of risk stratification for health goals, this would occur most frequently if benefits were obtained by threats to justice, autonomy or privacy. We discuss implications of the potential overlap between risk stratification and profiling for researchers and for clinicians, and we consider whether there are salient characteristics that make a particular risk stratification algorithm more or less likely to overlap with profiling, such as whether the risk stratification algorithm is based on voluntary versus non-voluntary characteristics, based on causal versus non-causal characteristics, or based on signifiers of historical disadvantage. We also discuss the ethical challenges created when a risk stratification scheme helps all subgroups but some more than others, or when risk stratification harms some subgroups but benefits the aggregate group.

  15. The Biochemical Prognostic Factors of Subclinical Hypothyroidism

    Directory of Open Access Journals (Sweden)

    Myung Won Lee

    2014-06-01

    Full Text Available BackgroundPatients with subclinical hypothyroidism (SHT are common in clinical practice. However, the clinical significance of SHT, including prognosis, has not been established. Further clarifying SHT will be critical in devising a management plan and treatment guidelines for SHT patients. Thus, the aim of this study was to investigate the prognostic factors of SHT.MethodsWe reviewed the medical records of Korean patients who visited the endocrinology outpatient clinic of Severance Hospital from January 2008 to September 2012. Newly-diagnosed patients with SHT were selected and reviewed retrospectively. We compared two groups: the SHT maintenance group and the spontaneous improvement group.ResultsThe SHT maintenance group and the spontaneous improvement group had initial thyroid-stimulating hormone (TSH levels that were significantly different (P=0.035. In subanalysis for subjects with TSH levels between 5 to 10 µIU/mL, the spontaneous improvement group showed significantly lower antithyroid peroxidase antibody (anti-TPO-Ab titer than the SHT maintenance group (P=0.039. Regarding lipid profiles, only triglyceride level, unlike total cholesterol and low density lipoprotein cholesterol, was related to TSH level, which is correlated with the severity of SHT. Diffuse thyroiditis on ultrasonography only contributed to the severity of SHT, not to the prognosis. High sensitivity C-reactive protein and urine iodine excretion, generally regarded as possible prognostic factors, did not show any significant relation with the prognosis and severity of SHT.ConclusionOnly initial TSH level was a definite prognostic factor of SHT. TPO-Ab titer was also a helpful prognostic factor for SHT in cases with mildly elevated TSH. Other than TSH and TPO-Ab, we were unable to validate biochemical prognostic factors in this retrospective study for Korean SHT patients.

  16. Plasma ion stratification by weak planar shocks

    Science.gov (United States)

    Simakov, Andrei N.; Keenan, Brett D.; Taitano, William T.; Chacón, Luis

    2017-09-01

    We derive fluid equations for describing steady-state planar shocks of a moderate strength ( 0 shock Mach number) propagating through an unmagnetized quasineutral collisional plasma comprising two separate ion species. In addition to the standard fluid shock quantities, such as the total mass density, mass-flow velocity, and electron and average ion temperatures, the equations describe shock stratification in terms of variations in the relative concentrations and temperatures of the two ion species along the shock propagation direction. We have solved these equations analytically for weak shocks ( 0 shocks, and they have been used to verify kinetic simulations of shocks in multi-ion plasmas.

  17. Risk stratification for indolent lymphomas Estratificação de risco dos linfomas indolentes

    Directory of Open Access Journals (Sweden)

    Abrahão Elias Hallack Neto

    2010-01-01

    Full Text Available Indolent B-cell lymphomas account for approximately 40% of all non-Hodgkin lymphomas (NHLs. Advances in technology have contributed to improvements in the diagnosis and classification of indolent non-Hodgkin lymphomas. Follicular Lymphomas are the most common although the frequency varies significantly throughout the world. The description of the Follicular Lymphoma International Prognostic Index (FLIPI was an important step in identifying patient subgroups, but its use in the clinical practice has not been established yet. The use of a larger number of paraffin active monoclonal antibodies for immunohistochemistry, molecular cytogenetic studies including standard cytogenetics, multi-color fluorescence in-situ hybridization (FISH, polymerase chain reaction and locus-specific fluorescence insitu hybridization as well as developments in high-resolution techniquesincluding microarray gene expression profiling allow more accurate diagnosis andprecise definition of biomarkers of value in risk stratification. The identification ofdiseasespecific gene lists resulting from expression profiling provides a number ofpotential protein targets that can be validated using immunohistochemistry. Analysesof gene expression profiles or constitutive gene variations may also provide additional insight for prognostication in the near future. A comprehensive understanding of the biology of these distinct lymphoid tumors will allow us to identify novel diseaserelated genes and should facilitate the development of improved diagnosis, outcome prediction, and personalized approaches to treatment.Os linfomas de células B indolentes representam aproximadamente 40% do total de linfomas não Hodgkin (LNHs. O avanço das tecnologias novas tem contribuído para a melhora no diagnóstico e classificação dos LNH indolentes. O linfoma folicular é o mais comum e sua frequência varia significantemente pelo mundo. Adescrição do Índice Internacional de Prognóstico dos

  18. Investigations on stratification devices for hot water stores

    DEFF Research Database (Denmark)

    Andersen, Elsa; Furbo, Simon; Hampel, Matthias;

    2008-01-01

    The significance of the thermal stratification for the energy efficiency of small solar-thermal hot water heat stores is pointed out. Exemplary the thermal stratification build-up with devices already marketed as well as with devices still in development has been investigated experimentally...... and theoretically, taking into account different realistic operation conditions. The methods (selective temperature measurement, non-invasive field measuring methods PIV and LIF, Computational Fluid Dynamics (CFD)) suitable for the experimental and theoretical analysis of thermal stratification devices...

  19. Stratification-Based Outlier Detection over the Deep Web

    Directory of Open Access Journals (Sweden)

    Xuefeng Xian

    2016-01-01

    Full Text Available For many applications, finding rare instances or outliers can be more interesting than finding common patterns. Existing work in outlier detection never considers the context of deep web. In this paper, we argue that, for many scenarios, it is more meaningful to detect outliers over deep web. In the context of deep web, users must submit queries through a query interface to retrieve corresponding data. Therefore, traditional data mining methods cannot be directly applied. The primary contribution of this paper is to develop a new data mining method for outlier detection over deep web. In our approach, the query space of a deep web data source is stratified based on a pilot sample. Neighborhood sampling and uncertainty sampling are developed in this paper with the goal of improving recall and precision based on stratification. Finally, a careful performance evaluation of our algorithm confirms that our approach can effectively detect outliers in deep web.

  20. Stratification-Based Outlier Detection over the Deep Web.

    Science.gov (United States)

    Xian, Xuefeng; Zhao, Pengpeng; Sheng, Victor S; Fang, Ligang; Gu, Caidong; Yang, Yuanfeng; Cui, Zhiming

    2016-01-01

    For many applications, finding rare instances or outliers can be more interesting than finding common patterns. Existing work in outlier detection never considers the context of deep web. In this paper, we argue that, for many scenarios, it is more meaningful to detect outliers over deep web. In the context of deep web, users must submit queries through a query interface to retrieve corresponding data. Therefore, traditional data mining methods cannot be directly applied. The primary contribution of this paper is to develop a new data mining method for outlier detection over deep web. In our approach, the query space of a deep web data source is stratified based on a pilot sample. Neighborhood sampling and uncertainty sampling are developed in this paper with the goal of improving recall and precision based on stratification. Finally, a careful performance evaluation of our algorithm confirms that our approach can effectively detect outliers in deep web.

  1. Thermal and compositional stratification of the inner core

    CERN Document Server

    Labrosse, Stéphane

    2014-01-01

    The improvements on the knowledge of the seismic structure of the inner core and the complexities thereby revealed ask for a dynamical origin. Sub-solidus convection was one of the early suggestions to explain the seismic anisotropy but requires an unstable density gradient either from thermal or compositional origin, or both. Temperature and composition profiles in the inner core are computed using a unidimensional model of core evolution including diffusion in the inner core and fractional crystallization at the the inner core boundary (ICB). The thermal conductivity of the core has been recently revised upwardly and, moreover, found increasing with depth. Values of the heat flow across the core mantle boundary (CMB) sufficient to maintain convection in the whole outer core are not sufficient to make the temperature in the inner core super-isentropic and therefore prone to thermal instability. An unreasonably high CMB heat flow is necessary to this end. The compositional stratification results from a compet...

  2. Cardiovascular risk stratification and management in pre-diabetes.

    Science.gov (United States)

    Færch, Kristine; Vistisen, Dorte; Johansen, Nanna Borup; Jørgensen, Marit Eika

    2014-06-01

    Prediabetes, covering individuals with impaired fasting glycemia, impaired glucose tolerance, or high-risk HbA1c levels, is associated with a ∼20 % increased risk of developing cardiovascular disease (CVD) compared with normoglycemic individuals. It is well-known that lifestyle or pharmacologic interventions can prevent diabetes in prediabetic people; however, the evidence is less clear regarding prevention of CVD. Most diabetes prevention trials have failed to show beneficial effects on CVD morbidity and mortality despite significant improvements of CVD risk factors in individuals with prediabetes. Another challenge is how to estimate CVD risk in prediabetic people. In general, prediction models for CVD do not take glucose levels or prediabetes status into account, thereby underestimating CVD risk in these high-risk individuals. More evidence within risk stratification and management of CVD risk in prediabetes is needed in order to recommend useful and effective strategies for early prevention of CVD.

  3. Cytoplasmic expression of C-MYC protein is associated with risk stratification of mantle cell lymphoma

    Directory of Open Access Journals (Sweden)

    Yi Gong

    2017-06-01

    Full Text Available Aim To investigate the association of C-MYC protein expression and risk stratification in mantle cell lymphoma (MCL, and to evaluate the utility of C-MYC protein as a prognostic biomarker in clinical practice. Methods We conducted immunohistochemical staining of C-MYC, Programmed cell death ligand 1 (PD-L1, CD8, Ki-67, p53 and SRY (sex determining region Y -11 (SOX11 to investigate their expression in 64 patients with MCL. The staining results and other clinical data were evaluated for their roles in risk stratification of MCL cases using ANOVA, Chi-square, and Spearman’s Rank correlation coefficient analysis. Results Immunohistochemical staining in our study indicated that SOX11, Ki-67 and p53 presented nuclear positivity of tumor cells, CD8 showed membrane positivity in infiltrating T lymphocytes while PD-L1 showed membrane and cytoplasmic positivity mainly in macrophage cells and little in tumor cells. We observed positive staining of C-MYC either in the nucleus or cytoplasm or in both subcellular locations. There were significant differences in cytoplasmic C-MYC expression, Ki-67 proliferative index of tumor cells, and CD8 positive tumor infiltrating lymphocytes (CD8+TIL among three risk groups (P = 0.000, P = 0.037 and P=0.020, respectively. However, no significant differences existed in the expression of nuclear C-MYC, SOX11, p53, and PD-L1 in MCL patients with low-, intermediate-, and high risks. In addition, patient age and serum LDH level were also significantly different among 3 groups of patients (P = 0.006 and P = 0.000, respectively. Spearman’s rank correlation coefficient analysis indicated that cytoplasmic C-MYC expression, Ki-67 index, age, WBC, as well as LDH level had significantly positive correlations with risk stratification (P = 0.000, 0.015, 0.000, 0.029 and 0.000, respectively, while CD8+TIL in tumor microenvironment negatively correlated with risk stratification of patients (P = 0.006. Patients with

  4. Social Capital and Stratification of Young People

    Directory of Open Access Journals (Sweden)

    Alireza Behtoui

    2013-08-01

    Full Text Available This paper addresses the impact of social capital on the status attainment process of young people at the start of their careers and examines how social class, gender and ethnicity affect the accumulation of social capital and thereby labour market stratification of young people. A sample of young Swedes graduating from vocational schools and universities between 2005 and 2006, was surveyed via the telephone about their experiences acquiring jobs. Two research questions are posed: (i Which characteristics (class, gender and ethnicity affect young people's access to more social capital? (ii How is social capital rewarded in the labour market? The results show that being female, coming from the lower social classes and being a member of a stigmatized immigrant groupare associated with a substantial social capital deficit. When socioeconomic and demographic backgrounds as well as the human capital of respondents are controlled, social capital is positively associated with salary level. The results indicate that social capital is a significant factor in the stratification process of young people.

  5. Life insurance: genomic stratification and risk classification.

    Science.gov (United States)

    Joly, Yann; Burton, Hilary; Knoppers, Bartha Maria; Feze, Ida Ngueng; Dent, Tom; Pashayan, Nora; Chowdhury, Susmita; Foulkes, William; Hall, Alison; Hamet, Pavel; Kirwan, Nick; Macdonald, Angus; Simard, Jacques; Van Hoyweghen, Ine

    2014-05-01

    With the development and increasing accessibility of new genomic tools such as next-generation sequencing, genome-wide association studies, and genomic stratification models, the debate on genetic discrimination in the context of life insurance became even more complex, requiring a review of current practices and the exploration of new scenarios. In this perspective, a multidisciplinary group of international experts representing different interests revisited the genetics and life insurance debate during a 2-day symposium 'Life insurance: breast cancer research and genetic risk prediction seminar' held in Quebec City, Canada on 24 and 25 September 2012. Having reviewed the current legal, social, and ethical issues on the use of genomic information in the context of life insurance, the Expert Group identified four main questions: (1) Have recent developments in genomics and related sciences changed the contours of the genetics and life insurance debate? (2) Are genomic results obtained in a research context relevant for life insurance underwriting? (3) Should predictive risk assessment and risk stratification models based on genomic data also be used for life insurance underwriting? (4) What positive actions could stakeholders in the debate take to alleviate concerns over the use of genomic information by life insurance underwriters? This paper presents a summary of the discussions and the specific action items recommended by the Expert Group.

  6. Inertial destabilization of highly viscous microfluidic stratifications

    Science.gov (United States)

    Hu, Xiaoyi; Cubaud, Thomas

    2016-08-01

    The hydrodynamic stability of stratifications made between miscible fluids having large differences in viscosity is experimentally investigated in square microchannels. Parallel fluid layers with a fast central stream and a slow sheath flow are produced by focusing a low-viscosity fluid into a high-viscosity fluid in a straight microchannel. Three regimes are identified and include diffusive, stable, and unstable flow patterns. In the unstable regime, coupled interfacial waves are seen to significantly disrupt strata when the Reynolds number associated with the low-viscosity stream is above 90. Several functional relationships are developed for the stratification width, propagating celerity, wavelength, amplitude, and frequency of interfacial waves over a range of viscosities and flow rates. We demonstrate, in particular, the wave phase locking for small central streams and show the production of high-viscosity fluid ligaments at the wave crests. In this case, a minute amount of high-viscosity fluid is entrained and blended into the low-viscosity fluid stream, thereby providing an original in-line mixing method for continuously adding a viscosifier to a thin fluid in microchannels.

  7. Preoperative serum CA 72.4 as prognostic factor of recurrence and death, especially at TNM stage II, for colorectal cancer.

    Science.gov (United States)

    Ayude, Daniel; Rodríguez-Berrocal, Francisco Javier; Ayude, José; Blanco-Prieto, Sonia; Vázquez-Iglesias, Lorena; Vázquez-Cedeira, Marta; Páez de la Cadena, María

    2013-11-12

    Nowadays, evaluation of colorectal cancer prognosis and decision-making for treatment continues to be based primarily on TNM tumour stage. Administration of adjuvant chemotherapy is especially challenging for stage II patients that can have very different disease-related outcomes. Therefore, more reliable prognostic markers need to be developed to improve the selection of stage II patients at high risk for recurrence. Our purpose is to assess the prognostic value of preoperative serum CA 72.4 to improve the risk stratification of CRC patients. Preoperative sera collected from 71 unselected patients between January 1994 and February 1997 was assayed for CA 72.4 and CEA levels. Patients were followed-up for at least 30 months or until relapse. Survival curves were estimated by the Kaplan-Meier method and the prognostic value was determined using Log-Rank test and Cox regression analysis. Preoperative CA 72.4 levels above 7 U/mL correlate with a worse prognosis, with associated recurrence and death percentages exceeding the displayed by CEA. In a multivariate analysis, its combination with CEA proved the most important independent factor predicting survival. Remarkably, at stage II CA 72.4 also discriminates better than CEA those patients that will relapse or die from those with a favourable prognosis; however, CEA has not a negligible effect on survival. The most outstanding finding of the present work is the correct classification of nearly every patient with bad prognosis (relapse or death) at TNM stage II when CEA and CA 72.4 are used altogether. This could improve the decision-making involved in the treatment of stage II colon cancer. Certainly further large-scale studies must be performed to determine whether CA 72.4 can be effectively used in the clinical setting.

  8. Confirmation of the mantle-cell lymphoma International Prognostic Index in randomized trials of the European Mantle-Cell Lymphoma Network

    DEFF Research Database (Denmark)

    Hoster, Eva; Klapper, Wolfram; Hermine, Olivier

    2014-01-01

    was independent of trial cohort and treatment strategy. CONCLUSION: MIPI was prospectively validated in a large MCL patient cohort homogenously treated according to recognized standards. As reflected in current guidelines, MIPI represents a generally applicable prognostic tool to be used in research as well......PURPOSE: Mantle-cell lymphoma (MCL) is a distinct B-cell lymphoma associated with poor outcome. In 2008, the MCL International Prognostic Index (MIPI) was developed as the first prognostic stratification tool specifically directed to patients with MCL. External validation was planned...

  9. Predicting outcome after traumatic brain injury: development of prognostic scores based on the IMPACT and the APACHE II.

    Science.gov (United States)

    Raj, Rahul; Siironen, Jari; Kivisaari, Riku; Hernesniemi, Juha; Skrifvars, Markus B

    2014-10-15

    Prediction models are important tools for heterogeneity adjustment in clinical trials and for the evaluation of quality of delivered care to patients with traumatic brain injury (TBI). We sought to improve the predictive performance of the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials) prognostic model by combining it with the APACHE II (Acute Physiology and Chronic Health Evaluation II) for 6-month outcome prediction in patients with TBI treated in the intensive care unit. A total of 890 patients with TBI admitted to a large urban level 1 trauma center in 2009-2012 comprised the study population. The IMPACT and the APACHE II scores were combined using binary logistic regression. A randomized, split-sample technique with secondary bootstrapping was used for model development and internal validation. Model performance was assessed by discrimination (by area under the curve [AUC]), calibration, precision, and net reclassification improvement (NRI). Overall 6-month mortality was 22% and unfavorable neurological outcome 47%. The predictive power of the new combined IMPACT-APACHE II models was significantly superior, compared to the original IMPACT models (AUC, 0.81-0.82 vs. 0.84-0.85; p0.05). However, NRI showed a significant improvement in risk stratification of patients with unfavorable outcome by the IMPACT-APACHE II models, compared to the original models (NRI, 5.4-23.2%; pAPACHE II with the IMPACT, improved 6-month outcome predictive performance is achieved. This may be applicable for heterogeneity adjustment in forthcoming TBI studies.

  10. Molecular prognostic markers for adult acute myeloid leukemia with normal cytogenetics

    Directory of Open Access Journals (Sweden)

    Gregory Tara K

    2009-06-01

    Full Text Available Abstract Acute myeloid leukemia (AML is a heterogenous disorder that results from a block in the differentiation of hematopoietic progenitor cells along with uncontrolled proliferation. In approximately 60% of cases, specific recurrent chromosomal aberrations can be identified by modern cytogenetic techniques. This cytogenetic information is the single most important tool to classify patients at their initial diagnosis into three prognostic categories: favorable, intermediate, and poor risk. Currently, favorable risk AML patients are usually treated with contemporary chemotherapy while poor risk AML patients receive allogeneic stem cell transplantation if suitable stem cell donors exist. The largest subgroup of AML patients (~40% have no identifiable cytogenetic abnormalities and are classified as intermediate risk. The optimal therapeutic strategies for these patients are still largely unclear. Recently, it is becoming increasingly evident that it is possible to identify a subgroup of poorer risk patients among those with normal cytogenic AML (NC-AML. Molecular risk stratification for NC-AML patients may be possible due to mutations of NPM1, FLT3, MLL, and CEBPα as well as alterations in expression levels of BAALC, MN1, ERG, and AF1q. Further prospective studies are needed to confirm if poorer risk NC-AML patients have improved clinical outcomes after more aggressive therapy.

  11. Contributions of nuclear cardiology to prognosis and risk stratification in coronary artery disease; Nuklearkardiologische Methoden zur Prognosebeurteilung und Risikostratifizierung bei koronarer Herzkrankheit

    Energy Technology Data Exchange (ETDEWEB)

    Nowak, B. [Klinik fuer Nuklearmedizin, Universitaetsklinikum der RWTH Aachen (Germany)

    2004-09-01

    Myocardial perfusion imaging in patients with suspected or known coronary artery disease and stable symptoms enables not only accurate diagnosis of disease but also entails prognostic value. Myocardial perfusion SPECT contributes to assessment of future cardiac events independently of other clinical parameters. A normal stress myocardial perfusion scan is associated with a favorable prognosis in all pre-test risk subsets similar to that of the general population independent of history, symptoms, and exercise electrocardiography test variables. Cardiac risk and benefit from invasive therapeutic strategies increase in relation to the severity of the abnormality of perfusion and function assessed by gated myocardial perfusion SPECT. Thus, stress myocardial perfusion imaging may serve as a gatekeeper for referral to coronary angiography enabling effective risk stratification in patients with suspected or documented coronary artery disease. In severe coronary artery disease accompanied by left ventricular dysfunction preoperative prediction of reversibility of functional impairment and improvement in survival after revascularization can be achieved by viability testing using nuclear cardiology. Absence of viability is associated with no significant difference in functional and survival outcomes, irrespective of treatment strategy. Therefore, unnecessary revascularization can be avoided in cases with absent evidence of viability. (orig.)

  12. Prognostic value of 18F-fludeoxyglucose uptake in 287 patients with head and neck squamous cell carcinoma

    DEFF Research Database (Denmark)

    Rasmussen, Jacob H; Vogelius, Ivan R; Fischer, Barbara M;

    2015-01-01

    proportional hazards model stratified by tumor subsite. The resulting multivariate prognostic model was used to generate a table of 2-year freedom from failure estimates with confidence intervals (CIs). RESULTS: Increasing values of standardized uptake value maximum (SUVmax) correlated with other known risk......BACKGROUND: The prognostic value of 18F-Fludeoxyglucose (FDG) uptake could be due to its association with already known clinical risk factors. METHODS: Correlation between FDG uptake metrics and other known risk factors from 287 patients were analyzed. Time to any failure was analyzed using Cox...... of the patients (23%). CONCLUSION: FDG uptake retains statistical significance in a multivariate analysis and has clinically relevant prognostic impact. We developed a prognostic model for risk stratification of patients in a clinical setting....

  13. Use of two gene panels for prostate cancer diagnosis and patient risk stratification.

    Science.gov (United States)

    Xiao, Kefeng; Guo, Jinan; Zhang, Xuhui; Feng, Xiaoyan; Zhang, Heqiu; Cheng, Zhiqiang; Johnson, Heather; Persson, Jenny L; Chen, Lingwu

    2016-08-01

    Currently, no ideal prostate cancer (PCa) diagnostic or prognostic test is available due to the lack of biomarkers with high sensitivity and specificity. There is an unmet medical need to develop combinations of multiple biomarkers which may have higher accuracy in detection of PCa and stratification of aggressive and indolent cancer patients. The aim of this study was to test two biomarker gene panels in distinguishing PCa from benign prostate and high-risk, aggressive PCa from low-risk, indolent PCa, respectively. We identified a five-gene panel that can be used to distinguish PCa from benign prostate. The messenger RNA (mRNA) expression signature of the five genes was determined in 144 PCa and benign prostate specimens from prostatectomy. We showed that the five-gene panel distinguished PCa from benign prostate with sensitivity of 96.59 %, specificity of 92.86 %, and area under the curve (AUC) of 0.992 (p 6) from indolent PCa (Gleason score ≤6) with sensitivity of 90.28 %, specificity of 80.00 %, and AUC of 0.967 (p diagnosis and patient risk stratification for biomarker-guided treatment.

  14. Nonlinear waves in waveguides with stratification

    CERN Document Server

    Leble, Sergei B

    1991-01-01

    S.B. Leble's book deals with nonlinear waves and their propagation in metallic and dielectric waveguides and media with stratification. The underlying nonlinear evolution equations (NEEs) are derived giving also their solutions for specific situations. The reader will find new elements to the traditional approach. Various dispersion and relaxation laws for different guides are considered as well as the explicit form of projection operators, NEEs, quasi-solitons and of Darboux transforms. Special points relate to: 1. the development of a universal asymptotic method of deriving NEEs for guide propagation; 2. applications to the cases of stratified liquids, gases, solids and plasmas with various nonlinearities and dispersion laws; 3. connections between the basic problem and soliton- like solutions of the corresponding NEEs; 4. discussion of details of simple solutions in higher- order nonsingular perturbation theory.

  15. Stratification of ALS patients' survival: a population-based study.

    Science.gov (United States)

    Marin, Benoît; Couratier, Philippe; Arcuti, Simona; Copetti, Massimiliano; Fontana, Andrea; Nicol, Marie; Raymondeau, Marie; Logroscino, Giancarlo; Preux, Pierre Marie

    2016-01-01

    The natural history of amyotrophic lateral sclerosis (ALS) and patient risk stratification are areas of considerable research interest. We aimed (1) to describe the survival of a representative cohort of French ALS patients, and (2) to identify covariates associated with various patterns of survival using a risk classification analysis. ALS patients recruited in the FRALim register (2000-2013) were included. Time-to-death analyses were performed using Kaplan-Meier method and Cox model. A recursive partitioning and amalgamation (RECPAM) algorithm analysis identified subgroups of patients with different patterns of survival. Among 322 patients, median survival times were 26.2 and 15.6 months from time of onset and of diagnosis, respectively. Four groups of patients were identified, depending on their baseline characteristics and survival (1) ALSFRS-R slope >0.46/month and definite or probable ALS (median survival time (MST) 10.6 months); (2) ALSFRS-R slope >0.46/month and possible or probable laboratory-supported ALS (MST: 18.1 months); (3) ALSFRS-R slope ≤0.46/month and definite or probable ALS (MST: 22.5 months), and (4) ALSFRS-R slope ≤0.46/month and possible or probable laboratory-supported ALS (MST: 37.6 months). Median survival time is among the shortest ever reported by a worldwide population-based study. This is probably related to the age structure of the patients (the oldest identified to date), driven by the underlying population (30 % of subjects older than 60 years). Further research in the field of risk stratification could help physicians better anticipate prognosis of ALS patients, and help improve the design of randomized controlled trials.

  16. Redox zones stratification and the microbial community characteristics in a periphyton bioreactor.

    Science.gov (United States)

    Liu, Junzhuo; Liu, Wei; Wang, Fengwu; Kerr, Philip; Wu, Yonghong

    2016-03-01

    Bioremediation techniques based on microorganisms have been widely applied to treat polluted surface water, but the efficiencies have been limited, especially in deep and static waters. Microbial aggregates, known as periphyton, were introduced into a tank bioreactor to improve pollutants removal and a periphyton bioreactor with an 84 cm column was built to investigate microbe-wastewater interactions. Periphyton greatly improved water quality and produced a distinct stratification in the water column into five redox zones with slight overlaps. From top to bottom these were: oxygen reduction, nitrate reduction, iron reduction, sulfate reduction and methanogenic zone. Periphyton communities had high species diversities (767-947 OTUs) with the facultative zone (middle layer) having higher species richness and functional diversity than the aerobic (top layer) and anaerobic zones (bottom layer). A good knowledge of interactions between periphyton and water column stratification could benefit from integration of periphyton to improve bioremediation of deep and static water.

  17. Racial Stratification and Education: The Case of Stockton, California.

    Science.gov (United States)

    Ogbu, John U.

    This paper examines the educational consequences of racial stratification or the system of racial castes in the United States. The central thesis of the paper is that the subordinate status occupied by blacks because of racial stratification requires and promotes lower school performance or school failure and that therefore this school failure…

  18. Using a Hypothetical Distribution of Grades to Introduce Social Stratification

    Science.gov (United States)

    Brislen, William; Peoples, Clayton D.

    2005-01-01

    Teaching undergraduates about social stratification can be a difficult endeavor. As a number of authors have noted, undergraduate students are sometimes resistant to learning about social stratification, a phenomenon that may be due, in part, to the fact that many undergraduates are from privileged backgrounds and "find it difficult to go beyond…

  19. Comments: Should Principal Stratification Be Used to Study Mediational Processes?

    Science.gov (United States)

    VanderWeele, Tyler J.

    2012-01-01

    Principal stratification provides an approach to study the effect of an exposure on an outcome within strata defined by the effect of the exposure on some third, posttreatment, variable (Frangakis & Rubin, 2002). There has been more recent interest in using principal stratification to study the extent to which the effect of an exposure on an…

  20. Temperature stratification in a hot water tank with circulation pipe

    DEFF Research Database (Denmark)

    Andersen, Elsa

    1998-01-01

    The aim of the project is to investigate the change in temperature stratification due to the operation of a circulation pipe. Further, putting forward rules for design of pipe inlet in order not to disturb the temperature stratification in the hot water tank. A validated computer model based...

  1. Dynamo tests for stratification below the core-mantle boundary

    Science.gov (United States)

    Olson, Peter; Landeau, Maylis; Reynolds, Evan

    2017-10-01

    Evidence from seismology, mineral physics, and core dynamics suggests a layer with an overall stable stratification in the Earth's outer core, possibly thermal in origin, extending below the core-mantle boundary (CMB) for several hundred kilometers. Yet vigorous deep mantle convection with locally elevated heat flux implies locally unstable thermal stratification below the CMB, consistent with interpretations of non-dipole geomagnetic field behavior that favor upwelling flows in places below the CMB. To resolve this apparent inconsistency, we investigate the structure of convection and magnetic fields in the core using numerical dynamos with laterally heterogeneous boundary heat flux. Strongly heterogeneous boundary heat flux generates localized convection beneath the CMB that coexists with an overall stable stratification there. Our partially stratified dynamos are distinguished by their time average magnetic field structures. Without stratification or with stratification confined to a thin layer, the octupole component is small and the CMB magnetic field structure includes polar intensity minima. With more extensive stratification, the octupole component is large and the magnetic field structure includes intense patches or high intensity lobes in the polar regions. Comparisons with the time-averaged geomagnetic field are generally favorable for partial stratification in a thin (<400 km) layer but unfavorable for stratification in a thick (∼1000 km) layer beneath the CMB.

  2. High temperature thermocline TES - effect of system pre-charging on thermal stratification

    Science.gov (United States)

    Zavattoni, Simone A.; Barbato, Maurizio C.; Zanganeh, Giw; Pedretti, Andrea

    2016-05-01

    The purpose of this study is to evaluate, by means of a computational fluid dynamics approach, the effect of performing an initial charging, or pre-charging, on thermal stratification of an industrial-scale thermocline TES unit, based on a packed bed of river pebbles. The 1 GWhth TES unit under investigation is exploited to fulfill the energy requirement of a reference 80 MWe concentrating solar power plant which uses air as heat transfer fluid. Three different scenarios, characterized by 4 h, 6 h and 8 h of pre-charging, were compared with the reference case of TES system operating without pre-charging. For each of these four scenarios, a total of 30 consecutive charge/discharge cycles, of 12 h each, were simulated and the effect of TES pre-charging on thermal stratification was qualitatively evaluated, by means of a stratification efficiency, based on the second-law of thermodynamics. On the basis of the simulations results obtained, the effect of pre-charging, more pronounced during the first cycles, is not only relevant in reducing the time required by the TES to achieve a stable thermal stratification into the packed bed but also to improve the performance at startup when the system is charged for the first time.

  3. Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Richard; A; Brogan; Christopher; J; Malkin; Philip; D; Batin; Alexander; D; Simms; James; M; McLenachan; Christopher; P; Gale

    2014-01-01

    Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

  4. Impact on Water Heater Performance of Heating Methods that Promote Tank Temperature Stratification

    Energy Technology Data Exchange (ETDEWEB)

    Gluesenkamp, Kyle R [ORNL; BushPE, John D [Electric Power Research Institute (EPRI)

    2016-01-01

    During heating of a water heater tank, the vertical temperature stratification of the water can be increased or decreased, depending on the method of heating. Methods that increase stratification during heating include (1) removing cold water from the tank bottom, heating it, and re-introducing it to the tank top at relatively low flow rate, (2) using a heat exchanger wrapped around the tank, through which heating fluid (with finite specific heat) flows from top to bottom, and (3) using an immersed heat element that is relatively high in the tank. Using such methods allows for improved heat pump water heater (HPWH) cycle efficiencies when the heat pump can take advantage of the lower temperatures that exist lower in the tank, and accommodate the resulting glide. Transcritical cycles are especially well-suited to capitalize on this opportunity, and other HPWH configurations (that have been proposed elsewhere) may benefit as well. This work provides several stratification categories of heat pump water heater tank configurations relevant to their stratification potential. To illustrate key differences among categories, it also compiles available experimental data for (a) single pass pumped flow, (b) multi-pass pumped flow, and (c) top-down wrapped tank with transcritical refrigerant.

  5. Analysis of local chronic inflammatory cell infiltrate combined with systemic inflammation improves prognostication in stage II colon cancer independent of standard clinicopathologic criteria.

    Science.gov (United States)

    Turner, Natalie; Wong, Hui-Li; Templeton, Arnoud; Tripathy, Sagarika; Whiti Rogers, Te; Croxford, Matthew; Jones, Ian; Sinnathamby, Mathuranthakan; Desai, Jayesh; Tie, Jeanne; Bae, Susie; Christie, Michael; Gibbs, Peter; Tran, Ben

    2016-02-01

    In Stage II colon cancer, multiple independent studies have shown that a dense intratumoural immune infiltrate (local inflammation) is associated with improved outcomes, while systemic inflammation, measured by various markers, has been associated with poorer outcomes. However, previous studies have not considered the interaction between local and systemic inflammation, nor have they assessed the type of inflammatory response compared with standard clinicopathologic criteria. In order to evaluate the potential clinical utility of inflammatory markers in Stage II colon cancer, we examined local and systemic inflammation in a consecutive series of patients with resected Stage II colon cancer between 2000 and 2010 who were identified from a prospective clinical database. Increased intratumoural chronic inflammatory cell (CIC) density, as assessed by pathologist review of hematoxylin and eosin stained slides, was used to represent local inflammation. Neutrophil-to-lymphocyte ratio (NLR) >5, as calculated from pre-operative full blood counts, was used to represent systemic inflammation. In 396 eligible patients identified, there was a non-significant inverse relationship between local and systemic inflammation. Increased CIC density was significantly associated with improved overall (HR 0.45, p = 0.001) and recurrence-free survival (HR 0.37, p = 0.003). High NLR was significantly associated with poorer overall survival (HR 2.56, p < 0.001). The combination of these markers further stratified prognosis independent of standard high-risk criteria, with a dominant systemic inflammatory response (low CIC/high NLR) associated with the worst outcome (5-year overall survival 55.8%). With further validation this simple, inexpensive combined inflammatory biomarker might assist in patient selection for adjuvant chemotherapy in Stage II colon cancer.

  6. Prognostic factors in lupus nephritis

    DEFF Research Database (Denmark)

    Faurschou, Mikkel; Starklint, Henrik; Halberg, Poul

    2006-01-01

    To evaluate the prognostic significance of clinical and renal biopsy findings in an unselected cohort of patients with systemic lupus erythematosus (SLE) and nephritis.......To evaluate the prognostic significance of clinical and renal biopsy findings in an unselected cohort of patients with systemic lupus erythematosus (SLE) and nephritis....

  7. Metrics for Offline Evaluation of Prognostic Performance

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostic performance evaluation has gained significant attention in the past few years.*Currently, prognostics concepts lack standard definitions and suffer from...

  8. Requirements Specifications for Prognostics: An Overview

    Data.gov (United States)

    National Aeronautics and Space Administration — With recent advancements in prognostics methodologies there has been a significant interest in maturing Prognostics and Health Management (PHM) to increase its...

  9. Cardiac Magnetic Resonance-Verified Myocardial Fibrosis in Chagas Disease: Clinical Correlates and Risk Stratification

    Science.gov (United States)

    Uellendahl, Marly; de Siqueira, Maria Eduarda Menezes; Calado, Eveline Barros; Kalil-Filho, Roberto; Sobral, Dário; Ribeiro, Clébia; Oliveira, Wilson; Martins, Silvia; Narula, Jagat; Rochitte, Carlos Eduardo

    2016-01-01

    Background Chagas disease (CD) is an important cause of heart failure and mortality, mainly in Latin America. This study evaluated the morphological and functional characteristics of the heart as well the extent of myocardial fibrosis (MF) in patients with CD by cardiac magnetic resonance (CMR). The prognostic value of MF evaluated by myocardial-delayed enhancement (MDE) was compared with that via Rassi score. Methods This study assessed 39 patients divided into 2 groups: 28 asymptomatic patients as indeterminate form group (IND); and symptomatic patients as Chagas Heart Disease (CHD) group. All patients underwent CMR using the techniques of cine-MRI and MDE, and the amount of MF was compared with the Rassi score. Results Regarding the morphological and functional analysis, significant differences were observed between both groups (p < 0.001). Furthermore, there was a strong correlation between the extent of MF and the Rassi score (r = 0.76). Conclusions CMR is an important technique for evaluating patients with CD, stressing morphological and functional differences in all clinical presentations. The strong correlation with the Rassi score and the extent of MF detected by CMR emphasizes its role in the prognostic stratification of patients with CD. PMID:27982271

  10. Risk stratification of non-contrast CT beyond the coronary calcium scan.

    Science.gov (United States)

    Madaj, Paul; Budoff, Matthew J

    2012-01-01

    Coronary artery calcification (CAC) is a well-known marker for coronary artery disease and has important prognostic implications. CAC is able to provide clinicians with a reliable source of information related to cardiovascular atherosclerosis, which carries incremental information beyond Framingham risk. However, non-contrast scans of the heart provide additional information beyond the Agatston score. These studies are also able to measure various sources of fat, including intrathoracic (eg, pericardial or epicardial) and hepatic, both of which are thought to be metabolically active and linked to increased incidence of subclinical atherosclerosis as well as increased prevalence of type 2  diabetes. Testing for CAC is also useful in identifying extracoronary sources of calcification. Specifically, aortic valve calcification, mitral annular calcification, and thoracic aortic calcium (TAC) provide additional risk stratification information for cardiovascular events. Finally, scanning for CAC is able to evaluate myocardial scaring due to myocardial infarcts, which may also add incremental prognostic information. To ensure the benefits outweigh the risks of a scanning for CAC for an appropriately selected asymptomatic patient, the full utility of the scan should be realized. This review describes the current state of the art interpretation of non-contrast cardiac CT, which clinically should go well beyond coronary artery Agatston scoring alone.

  11. Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study

    DEFF Research Database (Denmark)

    Bloch Thomsen, Poul Erik; Jons, Christian; Raatikainen, M J Pekka

    2010-01-01

    Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction (C...... (CARISMA) trial was designed to study the incidence and prognostic significance of arrhythmias documented by an implantable cardiac monitor among patients with acute myocardial infarction and reduced left ventricular ejection fraction.......Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction...

  12. Influence of upper-ocean stratification on tropical cyclone-induced surface cooling in the Bay of Bengal

    Science.gov (United States)

    Neetu, S.; Lengaigne, Matthieu; Vincent, Emmanuel M.; Vialard, JéRôMe; Madec, Gurvan; Samson, Guillaume; Ramesh Kumar, M. R.; Durand, Fabien

    2012-12-01

    Surface cooling induced by tropical cyclones (TCs) is about three times larger during premonsoon than during postmonsoon season in the Bay of Bengal. We investigate processes responsible for this seasonal contrast using an ocean general circulation model. The model is forced by TC winds prescribed from an analytic vortex using observed TC tracks and intensities during 1978-2007. The simulation accurately captures the seasonal cycle of salinity, temperature, and barrier layer in this region, with fresher waters, deeper upper-ocean stratification, and thicker barrier layers during postmonsoon season. It also reproduces the three times larger TC-induced cooling during premonsoon than during postmonsoon season. This difference is essentially related to seasonal changes in oceanic stratification rather than to differences in TC wind energy input. During the postmonsoon season, a deeper thermal stratification combined with a considerable upper-ocean freshening strongly inhibits surface cooling induced by vertical mixing underneath TCs. On average, thermal stratification accounts for ˜60% of this cooling reduction during postmonsoon season, while haline stratification accounts for the remaining 40%. Their respective contributions however strongly vary within the Bay: haline stratification explains a large part of the TC-induced cooling inhibition offshore of northern rim of the Bay (Bangladesh-Myanmar-east coast of India), where salinity seasonal changes are the strongest, while thermal stratification explains all the cooling inhibition in the southwestern Bay. This study hence advocates for an improved representation of upper-ocean salinity and temperature effects in statistical and dynamical TCs forecasts that could lead to significant improvements of TC intensity prediction skill.

  13. Endodontic surgery prognostic factors.

    Science.gov (United States)

    Azarpazhooh, Amir; Shah, Prakesh S

    2011-01-01

    Medline, (PubMed) and the Cochrane databases together with hand searching of the following journals: Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology (name changed to Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics in 1995), Endodontics and Dental Traumatology (name changed to Dental Traumatology in 2001), Journal of Oral and Maxillofacial Surgery, and International Journal of Oral and Maxillofacial Surgery. Clinical studies evaluating apical surgery with placement of a root-end filling were included. Studies on apical surgery with orthograde root canal filling or about apicectomy alone without root-end filling were excluded, as were experimental and animal studies. Only studies with ≥ ten patients with a minimum six month follow-up period and clearly defined radiographic and clinical healing criteria, with healing reported for at least two categories of a specific prognostic factor were accepted. Studies reporting in English, German, French, Spanish, Italian, Portuguese and Scandinavian languages were included. All studies were assessed separately by two of the three authors, with disagreements resolved by discussion. Prognostic factors were divided into patient related, tooth-related or treatment-related factors. The reported percentages of healed teeth were pooled per category. The statistical method of Mantel-Haenszel was applied to estimate the odds ratios and their 95% confidence intervals. Homogeneity was assessed using Woolf's test. With regard to tooth-related factors, the following were identified as predictors of healing: absence of preoperative pain or signs, good density of the root canal filling and a periapical lesion size of ≤ 5 mm. With regard to treatment-related factors, teeth treated with the use of an endoscope tended to have higher healed rates than teeth treated without the use of an endoscope. Although the clinician may be able to control treatment

  14. Prognostic Factors in Patients with Pancreatic Carcinoma

    Institute of Scientific and Technical Information of China (English)

    HANYue; SUICheng-guang1; RUANZhi-ping

    2004-01-01

    To evaluate the major prognostic factors in patients with pancreatic carcinoma.Methods : 113 cases of a particular disease were retrospectively analysed and 9 factors for prognosis were studied by muitivaritate analysis with Cox proportional hazards survival model. Survival rate was calculated by Kaplan-Meier estimation. Results:In this group,survival time was 0.1 to 82 months,and the median survival time was 3 months.Overall survival rates at month 6,12,18,36 were 35.6%, 20.3%, 15.9% and 6.2%, respectively.Multivariate analyses revealed significant prognostic factors as follows:jaundice, metastasis, therapy method and synthetic therapy. Conchusion: The prognosis of pancreatic carcinoma is determined by various factors. Jaundice and metastasis are independent predictors of poor survival.Radical operation and synthetic therapy will improve the prognosis.

  15. MICRONUCLEI: A PROGNOSTIC TOOL

    Directory of Open Access Journals (Sweden)

    Ankit

    2014-10-01

    Full Text Available Squamous cell carcinoma is one the most common oral mucosal malignant tumor, diagnosis of oral squamous cell carcinoma rarely presents difficulty, it is the cancer staging and histo pathological grading that are more important for prognosis, micronuclei are good prognostic indicator. Micronuclei screening can be done easily by exfoliative cytology, one of the most valuable diagnostic method other than routine histopathology (H and E-stained sections and immunohistochemistry. It has been used in the detection of oral squamous cell carcinoma and has been shown to have a sensitivity of 94%, specificity of 100%, and an accuracy of 95%. Micronuclei frequencies were also found to be raised with increasing histological grades of squamous cell carcinoma.

  16. Novel prognostic score for patients with gastric carcinoma%一个新的胃癌预后记分

    Institute of Scientific and Technical Information of China (English)

    Baihong Zhang; Hongyun Yue; Long Chen; Haizhong Wang; Jiawei Xu; Xianghui Wang

    2011-01-01

    Objective: The lack of a simple criterion for gastric carcinoma creates a persistent challenge for clinicians trying to provide patients with useful prognostic information. The aim of this study was to identify baseline prognostic factors, and use this information to establish a simple criterion to predict outcome in gastric carcinoma. Methods: Between 2005 and 2010,155 patients with gastric carcinoma, were enrolled. Clinicopathologic prognostic factors were evaluated by univariate and multivariate analysis. Results: Of the 155 patients, 48 (30.9%) died. Three independent poor prognostic factors were identified by multivariate analysis: gross type > or = 3 (hazard ratio [HR], 1.564; 95% CI, 1.067 to 2.294), peritoneal dissemination (HR, 3.750; 95% CI, 1.760 to 7.989) and lymphatic duct invasion (HR, 3.578; 95% CI, 1.422 to 9.004). One point was added for each category among three independent prognostic factors. Prognostic score (PS) was determined by an aggregate of these points for each category. There existed a significant difference between survival of patients with PS 0 or 1 and 2 (P <0.0001). Conclusion: Three poor prognostic factors were identified and a simple criteria was devised. Information from this analysis can be used to predict prognosis of gastric carcinoma with a strict stratification.

  17. Risk factors for mortality in patients with alcoholic hepatitis and assessment of prognostic models: A population-based study

    OpenAIRE

    Pang, Jack XQ; Ross, Erin; Borman, Meredith A; Zimmer, Scott; Gilaad G. Kaplan; Heitman, Steven J.; Swain, Mark G.; Burak, Kelly; Quan, Hude; Myers, Robert P

    2015-01-01

    The poor outcomes and high mortality risk associated with alcoholic hepatitis (AH) have prompted the search for predictive risk factors that could guide management and treatment, and facilitate risk stratification in clinical trials. Presently, several prognostic models for AH are available, all of which have helped physicians decide which therapies to initiate or to assess a given patient’s response to treatment. This retrospective study, conducted at a Canadian tertiary care centre, aimed t...

  18. Room air stratification in combined chilled ceiling and displacement ventilation systems.

    OpenAIRE

    Schiavon, Stefano; Bauman, Fred; Tully, Brad; Rimmer, Julian

    2012-01-01

    Radiant chilled ceilings (CC) with displacement ventilation (DV) represent a promising integrated system design that combines the energy efficiency of both sub-systems with the opportunity for improved ventilation performance resulting from the thermally stratified environment of DV systems. The purpose of this study was to conduct laboratory experiments for a typical U.S. interior zone office to investigate how room air stratification is affected by the ratio of cooling load removed by a chi...

  19. Effects of branched-chain amino acids and zinc-enriched nutrients on prognosticators in HCV-infected patients: a multicenter randomized controlled trial.

    Science.gov (United States)

    Kawaguchi, Takumi; Nagao, Yumiko; Abe, Kazumichi; Imazeki, Fumio; Honda, Koichi; Yamasaki, Kazumi; Miyanishi, Koji; Taniguchi, Eitaro; Kakuma, Tatsuyuki; Kato, Junji; Seike, Masataka; Yokosuka, Osamu; Ohira, Hiromasa; Sata, Michio

    2015-03-01

    Branched‑chain amino acids (BCAAs) and trace element deficiencies are associated with poor prognosis in hepatitis C virus (HCV)‑infected patients. The aim of this study was to investigate the effects of BCAA and zinc‑enriched supplementation on prognostic factors in HCV‑infected patients. Fifty‑three HCV‑infected patients were enrolled in this multicenter randomized controlled trial. The patients were assigned to either the placebo (n=27) or supplement group (n=26; 6,400 mg/day BCAAs and 10 mg/day zinc) and were followed up for 60 days. Primary outcomes were prognostic factors for chronic liver disease, including the serum BCAA‑to‑tyrosine ratio (BTR), zinc levels and α‑fetoprotein (AFP) levels. There were no significant differences in any of the prognostic factors between the placebo and supplement groups at baseline. In the supplement group, the BTR and zinc levels were significantly increased compared with the placebo group (BTR: 5.14 ± 1.59 vs. 4.23 ± 1.14, P=0.0290; zinc: 76 ± 11 vs. 68 ± 11 µg/dl, P=0.0497). No significant differences were observed in AFP levels between the groups in the whole analysis. However, a stratification analysis showed a significant reduction in ΔAFP levels in the supplement group, with elevated AFP levels compared with the other groups (‑2.72 ± 3.45 ng/ml, P=0.0079). It was demonstrated that BCAA and zinc‑enriched supplementation increased the BTR and zinc levels in the HCV‑infected patients. Furthermore, the supplementation reduced the serum AFP levels in patients who had elevated serum AFP levels at baseline. Thus, BCAA and zinc‑enriched supplementation may prolong the survival of HCV‑infected patients by improving amino acid imbalance and zinc deficiency, and by partly downregulating AFP.

  20. TET2 exon 2 skipping is an independent favorable prognostic factor for cytogenetically normal acute myelogenous leukemia (AML): TET2 exon 2 skipping in AML.

    Science.gov (United States)

    Mohamed, Aminetou Mint; Balsat, Marie; Koering, Catherine; Maucort-Boulch, Delphine; Boissel, Nicolas; Payen-Gay, Lea; Cheok, Meyling; Mortada, Hussein; Auboeuf, Didier; Pinatel, Christiane; El-Hamri, Mohamed; Tigaud, Isabelle; Hayette, Sandrine; Dumontet, Charles; Cros, Emeline; Flandrin-Gresta, Pascale; Nibourel, Olivier; Preudhomme, Claude; Thomas, Xavier; Nicolini, Franck-Emmanuel; Solly, Françoise; Guyotat, Denis; Campos, Lydia; Michallet, Mauricette; Ceraulo, Antony; Mortreux, Franck; Wattel, Eric

    2017-01-16

    In AML, approximately one-third of expressed genes are abnormally spliced, including aberrant TET2 exon 2 expression. In a discovery cohort (n=99), TET2 exon 2 skipping (TET2E2S) was found positively associated with a significant reduction in the cumulative incidence of relapse (CIR). Age, cytogenetics, and TET2E2S were independent prognostic factors for disease-free survival (DFS), and favorable effects on outcomes predominated in cytogenetic normal (CN)-AML and younger patients. Using the same cutoff in a validation cohort of 86 CN-AML patients, TET2E2S(high) patients were found to be younger than TET2(low) patients without a difference in the rate of complete remission. However, TET2E2S(high) patients exhibited a significantly lower CIR (p<10(-4)). TET2E2S and FLT3-ITD, but not age or NPM1 mutation status were independent prognostic factors for DFS and event-free survival (EFS), while TET2E2S was the sole prognostic factor that we identified for overall survival (OS). In both the intermediate-1 and favorable ELN genetic categories, TET2E2S remained significantly associated with prolonged survival. There was no correlation between TET2E2S status and outcomes in 34 additional AML patients who were unfit for IC. Therefore our results suggest that assessments of TET2 exon 2 splicing status might improve risk stratification in CN-AML patients treated with IC.

  1. Core merging and stratification following giant impact

    Science.gov (United States)

    Landeau, Maylis; Olson, Peter; Deguen, Renaud; Hirsh, Benjamin H.

    2016-10-01

    A stratified layer below the core-mantle boundary has long been suspected on the basis of geomagnetic and seismic observations. It has been suggested that the outermost core has a stratified layer about 100 km thick that could be due to the diffusion of light elements. Recent seismological evidence, however, supports a layer exceeding 300 km in thickness of enigmatic origin. Here we show from turbulent mixing experiments that merging between projectile and planetary core following a giant impact can lead to a stratified layer at the top of the core. Scaling relationships between post-impact core structure and projectile properties suggest that merging between Earth's protocore and a projectile core that is enriched in light elements and 20 times less massive can produce the thick stratification inferred from seismic data. Our experiments favour Moon-forming impact scenarios involving a projectile smaller than the proto-Earth and suggest that entrainment of mantle silicates into the protocore led to metal-silicate equilibration under extreme pressure-temperature conditions. We conclude that the thick stratified layer detected at the top of Earth's core can be explained as a vestige of the Moon-forming giant impact during the late stages of planetary accretion.

  2. The stratification of regolith on celestial objects

    CERN Document Server

    Schräpler, Rainer; von Borstel, Ingo; Güttler, Carsten

    2015-01-01

    All atmosphere-less planetary bodies are covered with a dust layer, the so-called regolith, which determines the optical, mechanical and thermal properties of their surface. These properties depend on the regolith material, the size distribution of the particles it consists of, and the porosity to which these particles are packed. We performed experiments in parabolic flights to determine the gravity dependency of the packing density of regolith for solid-particle sizes of 60 $\\mu$m and 1 mm as well as for 100-250 $\\mu$m-sized agglomerates of 1.5 $\\mu$m-sized solid grains. We utilized g-levels between 0.7 m s$^{-2}$ and 18 m s$^{-2}$ and completed our measurements with experiments under normal gravity conditions. Based on previous experimental and theoretical literature and supported by our new experiments, we developed an analytical model to calculate the regolith stratification of celestial rocky and icy bodies and estimated the mechanical yields of the regolith under the weight of an astronaut and a spacec...

  3. Stratification of women's sport in contemporary China.

    Science.gov (United States)

    Xiong, Huan

    2011-01-01

    Since economic reform in the 1980s, Chinese sport has undergone an extraordinary transformation. The most distinguishing phenomenon is the rapid growth of mass sport at the grassroots level with increasing demands for physical activities in women's daily lives. The rapid growth of women's sports participation at the grassroots is deeply embedded in the process of social stratification as a result of the urbanisation of Chinese society. The purpose of this paper is to use the socialist, feminist and theoretical framework to explore how Chinese women's different economic, educational, domestic and cultural situations shape their sports values and patterns of participation, marking social boundaries in Chinese urban communities. Semi-structured interviews and observations were conducted with 60 female physical exercisers in sports clubs, parks and neighbourhood playgrounds. Documentary research was also applied as a complement method to the interview. The findings indicate that within different classes (middle class, working class and a group who were unemployed), many different opportunities for and limitations on women to participate in sport are noticed. Chinese women have not fully and equally utilised sports opportunities created by urbanisation. Most Chinese women still live within patriarchal arrangements. Consequently, they do not completely fulfil their ambitions in sport.

  4. Long solitary internal waves in stable stratifications

    Directory of Open Access Journals (Sweden)

    W. B. Zimmerman

    2004-01-01

    Full Text Available Observations of internal solitary waves over an antarctic ice shelf (Rees and Rottman, 1994 demonstrate that even large amplitude disturbances have wavelengths that are bounded by simple heuristic arguments following from the Scorer parameter based on linear theory for wave trapping. Classical weak nonlinear theories that have been applied to stable stratifications all begin with perturbations of simple long waves, with corrections for weak nonlinearity and dispersion resulting in nonlinear wave equations (Korteweg-deVries (KdV or Benjamin-Davis-Ono that admit localized propagating solutions. It is shown that these theories are apparently inappropriate when the Scorer parameter, which gives the lowest wavenumber that does not radiate vertically, is positive. In this paper, a new nonlinear evolution equation is derived for an arbitrary wave packet thus including one bounded below by the Scorer parameter. The new theory shows that solitary internal waves excited in high Richardson number waveguides are predicted to have a halfwidth inversely proportional to the Scorer parameter, in agreement with atmospheric observations. A localized analytic solution for the new wave equation is demonstrated, and its soliton-like properties are demonstrated by numerical simulation.

  5. miRNA Expression Profiling Enables Risk Stratification in Archived and Fresh Neuroblastoma Tumor Samples

    NARCIS (Netherlands)

    K. de Preter; P. Mestdagh; J. Vermeulen; F. Zeka; A. Naranjo; I. Bray; V. Castel; C. Chen; E. Drozynska; A. Eggert; M.D. Hogarty; E. Izycka-Swieszewska; W.B. London; R. Noguera; M. Piqueras; K. Bryan; B. Schowe; P. van Sluis; J.J. Molenaar; A Schramm; J.H. Schulte; R.L. Stallings; R. Versteeg; G. Laureys; N. van Roy; F. Speleman; J. Vandesompele

    2011-01-01

    Purpose: More accurate assessment of prognosis is important to further improve the choice of risk-related therapy in neuroblastoma (NB) patients. In this study, we aimed to establish and validate a prognostic miRNA signature for children with NB and tested it in both fresh frozen and archived formal

  6. New prognostic model for extranodal natural killer/T cell lymphoma, nasal type.

    Science.gov (United States)

    Cai, Qingqing; Luo, Xiaolin; Zhang, Guanrong; Huang, Huiqiang; Huang, Hui; Lin, Tongyu; Jiang, Wenqi; Xia, Zhongjun; Young, Ken H

    2014-09-01

    Extranodal natural killer/T cell lymphoma, nasal type (ENKTL) is an aggressive disease with a poor prognosis, requiring risk stratification in affected patients. We designed a new prognostic model specifically for ENKTL to identify high-risk patients who need more aggressive therapy. We retrospectively reviewed 158 patients who were newly diagnosed with ENKTL. The estimated 5-year overall survival rate was 39.4 %. Independent prognostic factors included total protein (TP) 100 mg/dL, and Korean Prognostic Index (KPI) score ≥2. We constructed a new prognostic model by combining these prognostic factors: group 1 (64 cases (41.0 %)), no adverse factors; group 2 (58 cases (37.2 %)), one adverse factor; and group 3 (34 cases (21.8 %)), two or three adverse factors. The 5-year overall survival (OS) rates of these groups were 66.7, 23.0, and 5.9 %, respectively (p KPI model alone (p KPI model alone.

  7. A prognostic model for short term adverse events in normotensive patients with pulmonary embolism.

    Science.gov (United States)

    Agterof, Mariette J; Schutgens, Roger E G; Moumli, Noureddine; Eijkemans, M J C; van der Griend, René; Tromp, Ellen A M; Biesma, Douwe H

    2011-08-01

    Risk stratification of patients with PE has gained interest in terms of the identification of patients in whom treatment on an outpatient base can be considered. Previous studies are of limited value due to their focus on adverse clinical events within several months after diagnosis of PE. We developed a prognostic model, based on easily accessible, clinical, and laboratory parameters, to predict adverse events during the first 10 days after the diagnosis of acute PE. We have analyzed the data of 210 outpatients with confirmed PE. Collected data included medical history, pulse rate, blood pressure, NT-proBNP, and D-dimer concentrations. The primary outcome was the occurrence of adverse clinical events in a 10 day follow-up period. Our final prognostic model to predict short-term adverse events consists of NT-proBNP levels, D-dimer concentrations, pulse rate, and the occurrence of active malignancy; the total score ranges from 0 to 37 points. Patients with a low score (no active malignancy, pulse rate rate, D-dimer concentrations, and NT-proBNP levels. Our prognostic model, once prospectively validated in an independent sample of patients, can be used in the early risk stratification of PE to estimate the risk of adverse events and to differentiate between candidates for in- or out- hospital treatment. Copyright © 2011 Wiley-Liss, Inc.

  8. Thoracic tumors : prognostic and thearapeutic improvements

    NARCIS (Netherlands)

    Jong, Wouter Karst de

    2008-01-01

    Thoracic tumors are a major burden of disease in many countries. Non-small cell lung cancer and small-cell lung cancer are the most common thoracic malignancies, both tumors are one of the most well-known of the less common thoracic tumors. In this thesis, new ways in estimating the prognosis of pat

  9. Distinct microRNA expression profile in prostate cancer patients with early clinical failure and the impact of let-7 as prognostic marker in high-risk prostate cancer.

    Directory of Open Access Journals (Sweden)

    Maria Schubert

    Full Text Available BACKGROUND: The identification of additional prognostic markers to improve risk stratification and to avoid overtreatment is one of the most urgent clinical needs in prostate cancer (PCa. MicroRNAs, being important regulators of gene expression, are promising biomarkers in various cancer entities, though the impact as prognostic predictors in PCa is poorly understood. The aim of this study was to identify specific miRNAs as potential prognostic markers in high-risk PCa and to validate their clinical impact. METHODOLOGY AND PRINCIPAL FINDINGS: We performed miRNA-microarray analysis in a high-risk PCa study group selected by their clinical outcome (clinical progression free survival (CPFS vs. clinical failure (CF. We identified seven candidate miRNAs (let-7a/b/c, miR-515-3p/5p, -181b, -146b, and -361 that showed differential expression between both groups. Further qRT-PCR analysis revealed down-regulation of members of the let-7 family in the majority of a large, well-characterized high-risk PCa cohort (n = 98. Expression of let-7a/b/and -c was correlated to clinical outcome parameters of this group. While let-7a showed no association or correlation with clinical relevant data, let-7b and let-7c were associated with CF in PCa patients and functioned partially as independent prognostic marker. Validation of the data using an independent high-risk study cohort revealed that let-7b, but not let-7c, has impact as an independent prognostic marker for BCR and CF. Furthermore, we identified HMGA1, a non-histone protein, as a new target of let-7b and found correlation of let-7b down-regulation with HMGA1 over-expression in primary PCa samples. CONCLUSION: Our findings define a distinct miRNA expression profile in PCa cases with early CF and identified let-7b as prognostic biomarker in high-risk PCa. This study highlights the importance of let-7b as tumor suppressor miRNA in high-risk PCa and presents a basis to improve individual therapy for high

  10. Melanoma long non-coding RNA signature predicts prognostic survival and directs clinical risk-specific treatments.

    Science.gov (United States)

    Chen, Xijia; Guo, Wenna; Xu, Xin-Jian; Su, Fangchu; Wang, Yi; Zhang, Yingzheng; Wang, Qiang; Zhu, Liucun

    2017-03-01

    superior specificity and sensitivity of this signature. We identified a four-lncRNA prognostic signature with the ability of risk stratification for melanoma patients. Risk score acquired from this signature, combining with differential diagnosis and differential adjuvant therapy, could potentially improve the prognosis quality of life for patients, especially patients in the early course of disease or patients with a Breslow thickness no more than 2mm. Copyright © 2016 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.

  11. Standardizing Research Methods for Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics and health management (PHM) is a maturing system engineering discipline. As with most maturing disciplines, PHM does not yet have a universally accepted...

  12. Towards Prognostics for Electronics Components

    Data.gov (United States)

    National Aeronautics and Space Administration — Electronics components have an increasingly critical role in avionics systems and in the development of future aircraft systems. Prognostics of such components is...

  13. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  14. Educational stratification in cultural participation: Cognitive competence or status motivation?

    NARCIS (Netherlands)

    Notten, N.; Bol, Th.; Werfhorst, van de H.G.; Ganzeboom, H.B.G.

    2015-01-01

    This article examines educational stratification in highbrow cultural participation. Thereare two contrasting explanations of why cultural participation is stratified. The statushypothesis predicts that people come to appreciate particular forms of art because itexpresses their belonging to a certai

  15. Stratification of zooplankton in the northwestern Indian Ocean

    Digital Repository Service at National Institute of Oceanography (India)

    Paulinose, V.T.; Gopalakrishnan, T.C.; Nair, K.K.C.; Aravindakshan, P.N.

    Study on stratification of zooplankton in the north western Indian Ocean was carried out with special reference to its relative abundance and distribution. Samples were collected using multiple plankton net, during first cruise of ORV Sagar Kanya...

  16. Water Stratification Raster Images for the Gulf of Maine

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This geodatabase contains seasonal water stratification raster images for the Gulf of Maine. They were created by interpolating water density (sigma t) values at 0...

  17. Influence of upper ocean stratification interannual variability on tropical cyclones

    Digital Repository Service at National Institute of Oceanography (India)

    Vincent, E.M.; Emanuel, K.A.; Lengaigne, M.; Vialard, J.; Madec, G.

    downscaling approach that couples an axisymmetric TC model to a simple ocean model to quantify this interannual oceanic control on TC activity. We perform twin experiments with contrasted oceanic stratifications representative of interannual variability...

  18. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos;

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis.......The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  19. Accounting for population stratification in DNA methylation studies.

    Science.gov (United States)

    Barfield, Richard T; Almli, Lynn M; Kilaru, Varun; Smith, Alicia K; Mercer, Kristina B; Duncan, Richard; Klengel, Torsten; Mehta, Divya; Binder, Elisabeth B; Epstein, Michael P; Ressler, Kerry J; Conneely, Karen N

    2014-04-01

    DNA methylation is an important epigenetic mechanism that has been linked to complex diseases and is of great interest to researchers as a potential link between genome, environment, and disease. As the scale of DNA methylation association studies approaches that of genome-wide association studies, issues such as population stratification will need to be addressed. It is well-documented that failure to adjust for population stratification can lead to false positives in genetic association studies, but population stratification is often unaccounted for in DNA methylation studies. Here, we propose several approaches to correct for population stratification using principal components (PCs) from different subsets of genome-wide methylation data. We first illustrate the potential for confounding due to population stratification by demonstrating widespread associations between DNA methylation and race in 388 individuals (365 African American and 23 Caucasian). We subsequently evaluate the performance of our PC-based approaches and other methods in adjusting for confounding due to population stratification. Our simulations show that (1) all of the methods considered are effective at removing inflation due to population stratification, and (2) maximum power can be obtained with single-nucleotide polymorphism (SNP)-based PCs, followed by methylation-based PCs, which outperform both surrogate variable analysis and genomic control. Among our different approaches to computing methylation-based PCs, we find that PCs based on CpG sites chosen for their potential to proxy nearby SNPs can provide a powerful and computationally efficient approach to adjust for population stratification in DNA methylation studies when genome-wide SNP data are unavailable.

  20. Research in progress: Medical Research Council United Kingdom Refractory Asthma Stratification Programme (RASP-UK).

    Science.gov (United States)

    Heaney, Liam G; Djukanovic, Ratko; Woodcock, Ashley; Walker, Samantha; Matthews, John G; Pavord, Ian D; Bradding, Peter; Niven, Robert; Brightling, Chris E; Chaudhuri, Rekha; Arron, Joseph R; Choy, David F; Cowan, Douglas; Mansur, Adel; Menzies-Gow, Andrew; Adcock, Ian; Chung, Kian F; Corrigan, Chris; Coyle, Peter; Harrison, Timothy; Johnston, Sebastian; Howarth, Peter; Lordan, James; Sabroe, Ian; Bigler, Jeannette; Smith, Dirk; Catley, Matthew; May, Richard; Pierre, Lisa; Stevenson, Chris; Crater, Glenn; Keane, Frank; Costello, Richard W; Hudson, Val; Supple, David; Hardman, Tim

    2016-02-01

    The UK Refractory Asthma Stratification Programme (RASP-UK) will explore novel biomarker stratification strategies in severe asthma to improve clinical management and accelerate development of new therapies. Prior asthma mechanistic studies have not stratified on inflammatory phenotype and the understanding of pathophysiological mechanisms in asthma without Type 2 cytokine inflammation is limited. RASP-UK will objectively assess adherence to corticosteroids (CS) and examine a novel composite biomarker strategy to optimise CS dose; this will also address what proportion of patients with severe asthma have persistent symptoms without eosinophilic airways inflammation after progressive CS withdrawal. There will be interactive partnership with the pharmaceutical industry to facilitate access to stratified populations for novel therapeutic studies.

  1. Volunteer stratification is more relevant than technological treatment in orange juice flavanone bioavailability.

    Science.gov (United States)

    Tomás-Navarro, María; Vallejo, Fernando; Sentandreu, Enrique; Navarro, Jose L; Tomás-Barberán, Francisco A

    2014-01-01

    The effect of two technological treatments on orange juice flavanone bioavailability in humans was assessed. Processing affected flavanone solubility and particle size of the cloud. Volunteers were stratified in high, medium, and low urinary excretion capabilities. Flavanones from high-pressure homogenized juice showed better absorption than those of conventional pasteurized juice in high excretors. These differences were not observed in medium and low excretors. High flavanone excretors took advantage of the high-pressure homogenization juice attributes (smaller cloud particle size) and showed an improved absorption/excretion. Stratification of the individuals by their excretion capability is more relevant than technological treatments in terms of flavanone bioavailability. This stratification should be considered in clinical studies with citrus juices and extracts as it could explain the large interindividual variability that is often observed.

  2. Protein Changes during the Stratification of Malus domestica Borkh. Seed.

    Science.gov (United States)

    Eichholtz, D A; Robitaille, H A; Herrmann, K M

    1983-07-01

    Apple seeds (Malus domestica Borkh. cv Golden Delicious) were stratified at 5 and 15 degrees C for various lengths, weighed, and soluble protein of axis and cotyledon tissue was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Only seeds treated at 5 degrees C germinated; seeds treated at 15 degrees C did not germinate. Optimal germination required 63 days of stratification. Excised embryos required less stratification time for germination than intact seeds. When stratification was less than 35 days, the resulting seedlings from 5 degrees C stratified embryos were dwarfed and epinastic. After 63 days of stratification, axes from 5 and 15 degrees C treated intact seeds had increased in fresh weight by 72 and 28% (w/w), respectively. The dry weights of the axes did not change significantly and both fresh and dry weights of cotyledons remained unchanged during stratification. Total soluble protein in axes and cotyledons changed very little during stratification. However, axis polypeptide profiles changed. Most obvious was the occurrence of a new polypeptide and the increase of four other clearly identifiable polypeptides during 5 degrees C treatment. The levels of the five most predominant axis proteins decreased at the same time. We observed no changes in the profiles of soluble cotyledon proteins. Control seeds kept at -10 degrees C showed none of the reported changes.

  3. Survey on Prognostics Techniques for Updating Initiating Event Frequency in PSA

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyeonmin; Heo, Gyunyoung [Kyung Hee University, Yongin (Korea, Republic of)

    2015-05-15

    One of the applications using PSA is a risk monito. The risk monitoring is real-time analysis tool to decide real-time risk based on real state of components and systems. In order to utilize more effective, the methodologies that manipulate the data from Prognostics was suggested. Generally, Prognostic comprehensively includes not only prognostic but also monitoring and diagnostic. The prognostic method must need condition monitoring. In case of applying PHM to a PSA model, the latest condition of NPPs can be identified more clearly. For reducing the conservatism and uncertainties, we suggested the concept that updates the initiating event frequency in a PSA model by using Bayesian approach which is one of the prognostics techniques before. From previous research, the possibility that PSA is updated by using data more correctly was found. In reliability theory, the Bathtub curve divides three parts (infant failure, constant and random failure, wareout failure). In this paper, in order to investigate the applicability of prognostic methods in updating quantitative data in a PSA model, the OLM acceptance criteria from NUREG, the concept of how to using prognostic in PSA, and the enabling prognostic techniques are suggested. The prognostic has the motivation that improved the predictive capabilities using existing monitoring systems, data, and information will enable more accurate equipment risk assessment for improved decision-making.

  4. Enhancement of a Turbulence Sub-Model for More Accurate Predictions of Vertical Stratifications in 3D Coastal and Estuarine Modeling

    Directory of Open Access Journals (Sweden)

    Wenrui Huang

    2010-03-01

    Full Text Available This paper presents an improvement of the Mellor and Yamada's 2nd order turbulence model in the Princeton Ocean Model (POM for better predictions of vertical stratifications of salinity in estuaries. The model was evaluated in the strongly stratified estuary, Apalachicola River, Florida, USA. The three-dimensional hydrodynamic model was applied to study the stratified flow and salinity intrusion in the estuary in response to tide, wind, and buoyancy forces. Model tests indicate that model predictions over estimate the stratification when using the default turbulent parameters. Analytic studies of density-induced and wind-induced flows indicate that accurate estimation of vertical eddy viscosity plays an important role in describing vertical profiles. Initial model revision experiments show that the traditional approach of modifying empirical constants in the turbulence model leads to numerical instability. In order to improve the performance of the turbulence model while maintaining numerical stability, a stratification factor was introduced to allow adjustment of the vertical turbulent eddy viscosity and diffusivity. Sensitivity studies indicate that the stratification factor, ranging from 1.0 to 1.2, does not cause numerical instability in Apalachicola River. Model simulations show that increasing the turbulent eddy viscosity by a stratification factor of 1.12 results in an optimal agreement between model predictions and observations in the case study presented in this study. Using the proposed stratification factor provides a useful way for coastal modelers to improve the turbulence model performance in predicting vertical turbulent mixing in stratified estuaries and coastal waters.

  5. Biomarkers of renal injury and function: diagnostic, prognostic and therapeutic implications in heart failure.

    Science.gov (United States)

    van Veldhuisen, Dirk J; Ruilope, Luis M; Maisel, Alan S; Damman, Kevin

    2016-09-01

    Heart failure guidelines suggest evaluating renal function as a routine work-up in every patient with heart failure. Specifically, it is advised to calculate glomerular filtration rate and determine blood urea nitrogen. The reason for this is that renal impairment and worsening renal function (WRF) are common in heart failure, and strongly associate with poor outcome. Renal function, however, consists of more than glomerular filtration alone, and includes tubulointerstitial damage and albuminuria. For each of these renal entities, different biomarkers exist that have been investigated in heart failure. Hypothetically, and in parallel to data in nephrology, these markers may aid in the diagnosis of renal dysfunction, or for risk stratification, or could help in therapeutic decision-making. However, as reviewed in the present manuscript, while these markers may carry prognostic information (although not always additive to established markers of renal function), their role in predicting WRF is limited at best. More importantly, none of these markers have been evaluated as a therapeutic target nor have their serial values been used to guide therapy. The evidence is most compelling for the oldest-serum creatinine (in combination with glomerular filtration rate)-but even for this biomarker, evidence to guide therapy to improve outcome is circumstantial at best. Although many new renal biomarkers have emerged at the horizon, they have only limited usefulness in clinical practice until thoroughly and prospectively studied. For now, routine measurement of (novel) renal biomarkers can help to determine cardiovascular risk, but there is no role for these biomarkers to change therapy to improve clinical outcome in heart failure.

  6. Clinical Stratification of Pediatric Patients with Idiopathic Thoracic Aortic Aneurysm.

    Science.gov (United States)

    Landis, Benjamin J; Ware, Stephanie M; James, Jeanne; Shikany, Amy R; Martin, Lisa J; Hinton, Robert B

    2015-07-01

    To describe the global phenotypes of pediatric patients with thoracic aortic aneurysm (TAA) who do not have a clinical diagnosis of Marfan syndrome (MFS) or related connective tissue disorders. We hypothesized that the presence of noncardiovascular abnormalities correlate with TAA severity and that medical therapy reduces TAA progression. This is a retrospective case series of patients with TAA age ≤ 21 years evaluated in a cardiovascular genetics clinic. Patients meeting clinical criteria for MFS or related disorders were excluded. Repeated measures analyses of longitudinal echocardiographic measurements of the aorta were used to test associations between TAA severity and noncardiovascular phenotype and to assess the impact of medical therapy. Sixty-nine patients with TAA at mean age 12.5 ± 5.3 years were included. Noncardiovascular abnormalities, including skeletal (65%) or craniofacial (54%) findings, were frequently observed. Increased rate of aortic root enlargement was associated with ocular (P = .002) and cutaneous (P = .003) abnormalities, and increased rate of ascending aorta enlargement was associated with craniofacial (P < .001) abnormalities. Beta blocker or angiotensin receptor blocker therapy (n = 41) was associated with reduction in the rate of aortic root growth (P = .018). Children with TAA not satisfying diagnostic criteria for MFS or related disorders frequently have noncardiovascular findings, some of which are associated with TAA progression. Because therapy initiation may reduce risk of progression and long-term complications, comprehensive assessment of noncardiovascular findings may facilitate early risk stratification and improve outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Cumulative Intracranial Tumor Volume (CITV) Enhances the Prognostic Value of the Lung-Specific Graded Prognostic Assessment (GPA) Model.

    Science.gov (United States)

    Marcus, Logan P; Marshall, Deborah; Hirshman, Brian R; McCutcheon, Brandon A; Gonda, David D; Koiso, Takao; Hattangadi-Gluth, Jona A; Carter, Bob S; Yamamoto, Masaaki; Chen, Clark C

    2016-08-01

    Management of patients afflicted with brain metastasis requires tailoring of therapeutic strategies based on survival expectations. Therefore, the development of prognostic indices is of critical importance in this patient population. To determine whether the cumulative intracranial tumor volume (CITV) of brain metastasis augments the prognostic value of the lung-specific Graded Prognostic Assessment (GPA) index. Patient data were derived from 365 lung cancer patients with brain metastasis who were consecutively treated with stereotactic radiosurgery at the University of California, San Diego/San Diego Gamma Knife Center. CITV was analyzed to determine the volume cutoff that maximized sensitivity and specificity for 1-year survival. Multivariate Cox proportional hazard modeling was performed, and overall survival was estimated by the Kaplan-Meier method risk stratifying with or without this optimal CITV. The prognostic value of these models (lung-specific GPA ± CITV) was quantitatively compared with the use of net reclassification improvement (>0) and integrated discrimination improvement. For the University of California, San Diego/San Diego Gamma Knife Center cohort, the CITV cutoff that had the greatest survival discrimination at 1 year was 4 cm. The addition of CITV to the lung-specific GPA indexes significantly improved the prognostic value of lung-specific GPA, with net reclassification improvement >0 of 0.430 (95% confidence interval, 0.228-0.629) and integrated discrimination improvement of 0.029 (95% confidence interval, 0.004-0.073). These findings were validated in an independent cohort of 1638 lung cancer patients with brain metastasis who were treated with stereotactic radiosurgery at the Katsuta Hospital Mito Gamma House in Japan. In independent cohorts, the addition of CITV to the lung-specific GPA index significantly improved the prognostic value of this index. AUC, area under the receiver-operating characteristic curveBM, brain metastasis

  8. Independent prognostic value of eosinophil and mast cell infiltration in colorectal cancer tissue

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Hansen, Ulla; Christensen, Ib Jarle

    1999-01-01

    Overall peritumoural inflammatory cell infiltration is a prognostic variable in solid tumours, but the survival-related impact of the individual cell types within the infiltrate has still not been fully evaluated and compared with the conventional disease classification. In the present study......-assisted microscope, which allowed semi-automated quantification of cells within a fixed area. Total white cells and individual counts of eosinophils, neutrophils, mast cells, lymphocytes, and plasma cells were evaluated in every tumour specimen. Stratification into four groups with similar numbers of events was used...... should investigate the potential biological role of tumour tissue eosinophils and mast cells in the modulation of tumour growth....

  9. [Prognostic significance of cytogenetics in aged patients with acute myeloid leukemia].

    Science.gov (United States)

    Lin, Jie; Zhu, Hong-Li

    2015-04-01

    Aged patients with acute myeloid leukemia accounted for more than half of the adult AML patients, which has characteristics of low complete remission rate, short overall survival and poor prognosis. Recently, the importance of cytogenetics in AML was gradually realized. The diagnosis and typing, prognosis stratification and guide for treatment are performed on the basis of cytogenetics, but the research on influence of cytogenetics on adged patients with AML are relatively few. This review briefly summarizes the prognostic significance of cytogenetics in aged patients with AML.

  10. Prognostic value of immunophenotyping and gene mutations in elderly patients with acute myeloid leukemia with normal karyotype.

    Science.gov (United States)

    Dang, Harry; Jiang, Allan; Kamel-Reid, Suzanne; Brandwein, Joseph; Chang, Hong

    2013-01-01

    Elderly patients with acute myeloid leukemia generally have a poor prognosis and a highly heterogeneous clinical outcome. Prognostic indicators are required for and aid in patient stratification. However, the prognostic value of genetic mutations and immunophenotypic features in elderly normal karyotype acute myeloid leukemia, the largest cytogenetic risk group, remains unclear. We investigated the genetic mutations NPM1, FLT3-ITD, and FLT3-TKD and expression of the membrane antigens CD7, CD15, CD34, and CD56 in 144 elderly patients with de novo normal karyotype acute myeloid leukemia to retrospectively analyze the prognostic and clinical relevance of these parameters. CD7, CD15, CD34, and CD56 were expressed in 24%, 47%, 52%, and 15% of patients, respectively. NPM1 and FLT3-ITD mutations were detected in 51% and 17% of patients, respectively. Complete remission was obtained in 94 patients (65%), and the median overall survival was 16.5 months. Univariate analysis detected 5 markers with prognostic relevance: high leukocyte count, FLT3-ITD mutations, NPM1 mutations, CD34 expression, and CD56 expression in acute myeloid leukemia blasts. In multivariate analysis, patients with NPM1 predicted a higher complete remission (CR) rate (P = .016), longer event-free survival (P = .008), and longer overall survival (P = .049). FLT3-ITD mutations predicted a shorter event-free survival (P = .002) and shorter overall survival (P acute myeloid leukemia. By combining genetic and immunophenotypic markers, we can divide patients into distinct prognostic groups with important implications for prognostic stratification and risk-adapted therapy.

  11. Prognostic factorsin inoperable adenocarcinoma of the lung: A multivariate regression analysis of 259 patiens

    DEFF Research Database (Denmark)

    Sørensen, Jens Benn; Badsberg, Jens Henrik; Olsen, Jens

    1989-01-01

    and degree of differentiation, the new international staging system for lung cancer, and seven laboratory parameters. Staging of the patients included bone marrow examination but were otherwise nonextensive without routine bone, liver, and brain scans. Factors predicting poor survival were low performance...... status, stage IV disease, no prior nonradical resection, liver metastases, high values of white blood cell count, and lactate dehydrogenase, and low values of aspartate aminotransaminase. The nonradical resection may not be a prognostic factor because of the resection itself but may rather serve...... in the former Cox model to be of importance (performance status, stage, surgical resection, WBC, aspartate aminotransaminase, and lactate dehydrogenase). This simplified model appears to be a feasible clinical tool, allowing for prognostic stratification of patients when first the inoperability of the patient...

  12. Stratification criteria to fit taper functions on pine boles

    Directory of Open Access Journals (Sweden)

    Hassan Camil David

    2014-09-01

    Full Text Available This paper aimed to evaluate the accuracy of taper functions fitted with and without stratification on Pinus sp. trees. Three strata were allocated using diameter at 1.3 m above the ground, artificial form factor and Schiffel’s form quotient as stratification criteria. Schöepfer, Kozak et al. Hradetzky, Garcia et al., Ormerod and Demaerchalk taper functions were tested and the one which best fitted to the total population was selected by statistics standard error of estimate in percentage (syx%, adjusted coefficient of determination (R²aj. and residual scatterplots. After this, the selected function was fitted with data stratified and the gain of accuracy was evaluated by two statistical methods. As results, Hradetzky’s function adjusted better when compared to the others. Equations obtained for the total population and for strata are statistically different. Stratification by form factor and by form quotient provide considerable reduction of errors, reaching up to 50%, however it was not observed expressive reduction for stratification by diameter at 1.3 above the ground. So, the stratification by form factor is recommended for fitting taper functions to boles of Pinus sp.

  13. GOTHIC code simulation of thermal stratification in POOLEX facility

    Energy Technology Data Exchange (ETDEWEB)

    Li, H.; Kudinov, P. (Royal Institute of Technology (KTH) (Sweden))

    2009-07-15

    Pressure suppression pool is an important element of BWR containment. It serves as a heat sink and steam condenser to prevent containment pressure buildup during loss of coolant accident or safety relief valve opening during normal operations of a BWR. Insufficient mixing in the pool, in case of low mass flow rate of steam, can cause development of thermal stratification and reduction of pressure suppression pool capacity. For reliable prediction of mixing and stratification phenomena validation of simulation tools has to be performed. Data produced in POOLEX/PPOOLEX facility at Lappeenranta University of Technology about development of thermal stratification in a large scale model of a pressure suppression pool is used for GOTHIC lumped and distributed parameter validation. Sensitivity of GOTHIC solution to different boundary conditions and grid convergence study for 2D simulations of POOLEX STB-20 experiment are performed in the present study. CFD simulation was carried out with FLUENT code in order to get additional insights into physics of stratification phenomena. In order to support development of experimental procedures for new tests in the PPOOLEX facility lumped parameter pre-test GOTHIC simulations were performed. Simulations show that drywell and wetwell pressures can be kept within safety margins during a long transient necessary for development of thermal stratification. (au)

  14. The Evolution of Prognostic Factors in Multiple Myeloma

    Science.gov (United States)

    Hassanein, Mona; Rasheed, Walid; Aljurf, Mahmoud; Alsharif, Fahad

    2017-01-01

    Multiple myeloma (MM) is a heterogeneous hematologic malignancy involving the proliferation of plasma cells derived by different genetic events contributing to the development, progression, and prognosis of this disease. Despite improvement in treatment strategies of MM over the last decade, the disease remains incurable. All efforts are currently focused on understanding the prognostic markers of the disease hoping to incorporate the new therapeutic modalities to convert the disease into curable one. We present this comprehensive review to summarize the current standard prognostic markers used in MM along with novel techniques that are still in development and highlight their implications in current clinical practice.

  15. Distributed Prognostics Based on Structural Model Decomposition

    Data.gov (United States)

    National Aeronautics and Space Administration — Within systems health management, prognostics focuses on predicting the remaining useful life of a system. In the model-based prognostics paradigm, physics-based...

  16. Pediatric acute kidney injury: Appraisal of predictors and prognostic indicators

    Directory of Open Access Journals (Sweden)

    Samuel Nkachukwu Uwaezuoke

    2017-01-01

    Full Text Available Acute kidney injury (AKI is a major contributor to childhood morbidity and mortality worldwide. In spite of the advances in renal replacement therapy, there has been a minimal reduction in AKI-related morbidity and mortality. Identifying the prognostic indicators and the risk factors that predict disease onset and progression, and instituting appropriate measures will lead to better survival outcomes. This narrative review seeks to appraise the predictors and prognostic indicators of pediatric AKI. Several biomarkers clearly stand out as predictors and prognostic indicators of the acute disease. Some of them are urine angiotensinogen, fibroblast growth factor-23, cystacin C, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7. Combining few of these biomarkers with clinical prediction models has improved their predictive and prognostic utility for AKI. Hemodynamic parameters such as indexed systemic oxygen delivery and mean arterial blood pressure have been proved to be reliable in predicting the occurrence and progression of the disease and its outcomes. Miscellaneous predictors and prognostic indicators like AKI definition criteria, presence of co-morbidities, and health-related quality of life assessment have also been documented from evidence-based studies. An understanding and application of these indices will obviously help to reduce AKI mortality in children.

  17. [Cardiovascular risk stratification. Systolic, diastolic or pulse pressure?].

    Science.gov (United States)

    Pede, S; Lombardo, M

    2001-04-01

    and prognostic implications and account for the possible diversity of significance to attribute to systolic, diastolic, mean and pulse BP, factors which, in their entirety, can represent an element, albeit partial, of resolvability of problems in managing hypertension. In fact, possibilities of diversification in the stratification of risk of the hypertensive patients may be considered on a pathophysiological basis, with the prospect of better aimed therapeutic interventions. On the whole, it appears that the clinical significance to attribute to pulse BP should be considered not as an alternative to that of systolic and diastolic BP, but rather in complementary terms, with age kept in careful consideration. In practice, by simplifying to a maximum the state of present knowledge, the values of systolic, diastolic, mean and pulse BP are all important in subjects under 60 years old. This indicates that the clinical significance to attribute to diastolic hypertension in young or middle-aged patients, which have been so accurately described by well-known meta-analyses, is not presently under discussion. What seems to change, with respect to the past, is the importance that should be attributed to the systolic and pulse BP in subjects of all ages and in particular to pulse BP in subjects over 60 years old: in these persons, the increase in pulse BP summarizes and integrates the adverse prognostic value of an elevated systolic BP and a low diastolic BP. It should be clearly understood that, in subjects over 60 years old, a high systolic BP and a low diastolic BP mean rigidity of the wall of the aorta and of the main elastic arteries; in these subjects, the isolated increase in diastolic BP, usually easily controllable by antihypertensive treatment, should not cause excessive clinical concern; instead, an increase in systolic BP - even if isolated - and, above all, an increase in pulse BP, should cause greater preoccupation, inasmuch as they are signs of consistent serious

  18. Methylation of serum SST gene is an independent prognostic marker in colorectal cancer

    Science.gov (United States)

    Liu, Yanqun; Chew, Min Hoe; Tham, Chee Kian; Tang, Choong Leong; Ong, Simon YK; Zhao, Yi

    2016-01-01

    There is an increasing demand for accurate prognostication for colorectal cancer (CRC). This study sought to assess prognostic potentials of methylation targets in the serum of CRC patients. A total of 165 CRC patients were enrolled in this prospective study. Promoter methylation levels of seven genes in pre-operative sera and matched tumor tissues were evaluated by quantitative methylation-specific PCR. Kaplan-Meier test, and univariate and multivariate Cox proportional hazards regression models were used for survival analyses. After a median follow-up of 56 months, 43 patients (28.7%) experienced tumor recurrence. In univariate survival analyses, serum methylation levels of SST and MAL were significantly predictive of cancer-specific death (Pcancer death and recurrence, respectively). When focusing on stage II and III patients, prognostication with serum methylated SST remained significant. Methylated SST detected in all serum samples can be traced back to the matched primary tumor tissues. We believe that methylated SST detected in the pre-operative sera of CRC patients appear to be a novel promising prognostic marker and probably can be auxiliary to tumor staging system and serum carcinoembryonic antigen towards better risk stratification.

  19. Waldenström macroglobulinemia. Development of diagnostic criteria and identification of prognostic factors.

    Science.gov (United States)

    Owen, R G; Barrans, S L; Richards, S J; O'Connor, S J; Child, J A; Parapia, L A; Morgan, G J; Jack, A S

    2001-09-01

    To establish whether a combination of morphologic and immunophenotypic criteria could be developed to more precisely define Waldenström macroglobulinemia (WM) and prognostic factors, we retrospectively assessed the clinical and laboratory features of 111 cases of WM. Bone marrow infiltration by small lymphocytes was documented in each case; and diffuse, interstitial, nodular, and paratrabecular patterns of infiltration were documented in 58%, 32%, 6%, and 4% of cases, respectively. Ninety percent were characterized by a surface immunoglobulin-positive, CD19+CD20+CD5-CD10-CD23- immunophenotype. The median overall survival from diagnosis was 60 months; univariate analysis revealed the following adverse prognostic factors: older than 60 years, performance status more than 1, platelet count less than 100 x 10(3)/microL (< 100 x 10(9)/L), pancytopenia, and diffuse bone marrow infiltration. Associated median survival was 40, 38, 46, 28, and 59 months, respectively. Multivariate analysis revealed age, performance status, and platelet count as prognostically significant, but stratification of patients according to the International Prognostic Index had limited value. We suggest defining WM by the following criteria: IgM monoclonal gammopathy; bone marrow infiltration by small lymphocytes, plasmacytoid cells, and plasma cells in a diffuse, interstitial, or nodular pattern; and a surface immunoglobulin-positive, CD19+CD20+CD5-CD10-CD23- immunophenotype.

  20. Investigation of the Solvis stratification inlet pipe for solar tanks

    DEFF Research Database (Denmark)

    Andersen, Elsa; Jordan, Ulrike; Shah, Louise Jivan

    2004-01-01

    plates inside the pipes (Davidson, 1992) or openings in form of balls (e.g. Leibfried, 2000) or flaps (e.g. described in Krause, 2001) have entered the market during the recent years. In this paper an investigation of a stratification pipe with openings covered with flaps according to (Krause, 2001...... these openings from the bottom of the store mixed with the heated water that flew through the pipe and thereby induced mixing in the tank during charging. More detailed investigations of the flow structure close to the flaps of the stratification pipe are presented in the following for one set of operating......). The aim pursued was to transport the heated water into the tank level of corresponding temperature. Flexible stratification pipes (manifolds) have been further developed for example by (Gari et al., 1982). Furthermore, a wide variety of non flexible tubes with either open holes and perforated vertical...

  1. Dependence of offshore wind turbine fatigue loads on atmospheric stratification

    DEFF Research Database (Denmark)

    Hansen, Kurt Schaldemose; Larsen, Gunner Chr.; Ott, Søren

    2014-01-01

    The stratification of the atmospheric boundary layer (ABL) is classified in terms of the M-O length and subsequently used to determine the relationship between ABL stability and the fatigue loads of a wind turbine located inside an offshore wind farm. Recorded equivalent fatigue loads, representing...... measurements. The fatigue polar has been determined for an (almost) complete 360° inflow sector for both load sensors, representing mean wind speeds below and above rated wind speed, respectively, with the inflow conditions classified into three different stratification regimes: unstable, neutral and stable...... conditions. In general, impact of ABL stratification is clearly seen on wake affected inflow cases for both blade and tower fatigue loads. However, the character of this dependence varies significantly with the type of inflow conditions – e.g. single wake inflow or multiple wake inflow....

  2. The Implications of Migration for Traditional Forms of Gendered Stratification

    Institute of Scientific and Technical Information of China (English)

    许开文

    2013-01-01

    This article utilized de Haas and van Dooij’s research on Moroccan migrants families as an example and discussed the possible consequences to gender stratification in the traditional society of migrants sending country. I argue that migration is actu-ally like a pair of spectacles that makes the difference between the gender stratification in traditional societies and modern Western ones more obvious to females in traditional societies. Having male family members working in a western developed country does not necessarily empower the female ones left in the traditional societies but sometimes may contribute to more social insecurities and social gender stratification for the women even though the absence of the male family members could increase women ’s fam-ily leadership and the likelihood for them to receive education by using the remittances they regularly receive from overseas.

  3. Population stratification using a statistical model on hypergraphs

    CERN Document Server

    Vazquez, Alexei

    2007-01-01

    Population stratification is a problem encountered in several areas of biology and public health. We tackle this problem by mapping a population and its elements attributes into a hypergraph, a natural extension of the concept of graph or network to encode associations among any number of elements. On this hypergraph, we construct a statistical model reflecting our intuition about how the elements attributes can emerge from a postulated population structure. Finally, we introduce the concept of stratification representativeness as a mean to identify the simplest stratification already containing most of the information about the population structure. We demonstrate the power of this framework stratifying an animal and a human population based on phenotypic and genotypic properties, respectively.

  4. Horizontal Stratification in Access to Danish University Programmes

    DEFF Research Database (Denmark)

    Munk, Martin D.; Thomsen, Jens Peter

    2017-01-01

    In this paper, we use register data to examine horizontal stratification within university institutions and university fields of study in Denmark, a country that has experienced a reduction of the social class gap in access to higher education. First, we argue that it is important to use a relati...... in different fields of study and university institutions. Most importantly, we find distinct patterns of horizontal stratification by field of study and parental occupation that would have remained hidden had we used more aggregated classifications for field of study and social origin....

  5. Risk Stratification in Differentiated Thyroid Cancer: An Ongoing Process.

    Science.gov (United States)

    Omry-Orbach, Gal

    2016-01-28

    Thyroid cancer is an increasingly common malignancy, with a rapidly rising prevalence worldwide. The social and economic ramifications of the increase in thyroid cancer are multiple. Though mortality from thyroid cancer is low, and most patients will do well, the risk of recurrence is not insignificant, up to 30%. Therefore, it is important to accurately identify those patients who are more or less likely to be burdened by their disease over years and tailor their treatment plan accordingly. The goal of risk stratification is to do just that. The risk stratification process generally starts postoperatively with histopathologic staging, based on the AJCC/UICC staging system as well as others designed to predict mortality. These do not, however, accurately assess the risk of recurrence/persistence. Patients initially considered to be at high risk may ultimately do very well yet be burdened by frequent unnecessary monitoring. Conversely, patients initially thought to be low risk, may not respond to their initial treatment as expected and, if left unmonitored, may have higher morbidity. The concept of risk-adaptive management has been adopted, with an understanding that risk stratification for differentiated thyroid cancer is dynamic and ongoing. A multitude of variables not included in AJCC/UICC staging are used initially to classify patients as low, intermediate, or high risk for recurrence. Over the course of time, a response-to-therapy variable is incorporated, and patients essentially undergo continuous risk stratification. Additional tools such as biochemical markers, genetic mutations, and molecular markers have been added to this complex risk stratification process such that this is essentially a continuum of risk. In recent years, additional considerations have been discussed with a suggestion of pre-operative risk stratification based on certain clinical and/or biologic characteristics. With the increasing prevalence of thyroid cancer but stable mortality

  6. Rumen content stratification in the giraffe (Giraffa camelopardalis)

    DEFF Research Database (Denmark)

    Sauer, Cathrine; Clauss, Marcus; Bertelsen, Mads F;

    2016-01-01

    Ruminants differ in the degree of rumen content stratification, with 'cattle-types' (i.e., the grazing and intermediate feeding ruminants) having stratified content, whereas 'moose-types' (i.e., the browsing ruminants) have unstratified content. The feeding ecology, as well as the digestive...... of these parameters, indicating homogenous rumen content in the giraffes. In addition to the digesta samples, samples of dorsal rumen, ventral rumen and atrium ruminis mucosa were collected and the papillary surface enlargement factor was determined, as a proxy for content stratification. The even rumen papillation...

  7. Soil organic matter stratification as an indicator of soil quality

    OpenAIRE

    Franzluebbers, A.J.

    2002-01-01

    Metadata only record This paper explores the potential for using a ration of the stratification of soil organic C and N pools by depth as an indicator of soil quality. Stratification ratios offer a more universal indicator of soil quality, allowing comparison of soils across different soil types and climates. The ratios calculated for Georgia, Texas, and Alberta/British Colombia were, respectively, 1.1, 1.2, and 1.9 under conventional tillage, and 3.0, 2.0, and 2.1 under no tillage. High s...

  8. PROGNOSTIC FACTORS IN PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    N. A. Gorban

    2014-08-01

    Full Text Available Prostate cancer is most common and its heterogenicity is presently apparent. There is a continuous search for the factors allowing the prediction of the poor course and biological difference of tumors. The College of American Pathologists classifies the currently known prognostic factors into 3 categories: 1 the factors whose prognostic importance and successful use have been proven in practice; 2 those that have been widely studied biologically and clinically, but the significance of which needs to be proven in extensive statistical studies; 3 all other factors that have been inadequately studied to demonstrate their prognostic value. Category 1 prognostic factors, such as prostate-specific antigen levels, TNM stage, Gleason grading, and the status of surgical margins, enjoy wide application. Category 2 factors are not used IN clinical practice so extensively. The value of some Category 3 factors (the biomarkers p53, Ki-67, Bcl-2, receptors of androgens is indubitably and they claim to be widely applied in clinical practice with time. The clinical significance of molecular biological markers calls for further investigation.

  9. PROGNOSTIC FACTORS IN PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    N. A. Gorban

    2010-01-01

    Full Text Available Prostate cancer is most common and its heterogenicity is presently apparent. There is a continuous search for the factors allowing the prediction of the poor course and biological difference of tumors. The College of American Pathologists classifies the currently known prognostic factors into 3 categories: 1 the factors whose prognostic importance and successful use have been proven in practice; 2 those that have been widely studied biologically and clinically, but the significance of which needs to be proven in extensive statistical studies; 3 all other factors that have been inadequately studied to demonstrate their prognostic value. Category 1 prognostic factors, such as prostate-specific antigen levels, TNM stage, Gleason grading, and the status of surgical margins, enjoy wide application. Category 2 factors are not used IN clinical practice so extensively. The value of some Category 3 factors (the biomarkers p53, Ki-67, Bcl-2, receptors of androgens is indubitably and they claim to be widely applied in clinical practice with time. The clinical significance of molecular biological markers calls for further investigation.

  10. Non-muscle invasive bladder cancer risk stratification

    Directory of Open Access Journals (Sweden)

    Sumit Isharwal

    2015-01-01

    Conclusion: EORTC and CUETO risk tables are the two best-established models to predict recurrence and progression in patients with NMIBC though they tend to overestimate risk and have poor discrimination for prognostic outcomes in external validation. Future research should focus on enhancing the predictive accuracy of risk assessment tools by incorporating additional prognostic factors such as depth of lamina propria invasion and molecular biomarkers after rigorous validation in multi-institutional cohorts.

  11. Occurrence and prognostic significance of cytogenetic evolution in patients with multiple myeloma

    Science.gov (United States)

    Binder, M; Rajkumar, S V; Ketterling, R P; Dispenzieri, A; Lacy, M Q; Gertz, M A; Buadi, F K; Hayman, S R; Hwa, Y L; Zeldenrust, S R; Lust, J A; Russell, S J; Leung, N; Kapoor, P; Go, R S; Gonsalves, W I; Kyle, R A; Kumar, S K

    2016-01-01

    Cytogenetic evaluation at the time of diagnosis is essential for risk stratification in multiple myeloma, however little is known about the occurrence and prognostic significance of cytogenetic evolution during follow-up. We studied 989 patients with multiple myeloma, including 304 patients with at least two cytogenetic evaluations. Multivariable-adjusted regression models were used to assess the associations between the parameters of interest and cytogenetic evolution as well as overall survival. The prognostic significance of baseline cytogenetic abnormalities was most pronounced at the time of diagnosis and attenuated over time. In the patients with serial cytogenetic evaluations, the presence of t(11;14) at the time of diagnosis was associated with decreased odds of cytogenetic evolution during follow-up (odds ratio (OR)=0.22, 95% confidence interval (CI)=0.09–0.56, P=0.001), while the presence of at least one trisomy or tetrasomy was associated with increased odds (OR=2.96, 95% CI=1.37–6.42, P=0.006). The development of additional abnormalities during the 3 years following diagnosis was associated with increased subsequent mortality (hazard ratio=3.31, 95% CI=1.73–6.30, Pclonal disease process for risk assessment and suggest that selected patients may benefit from repeated risk stratification. PMID:26967818

  12. Electrical impedance tomography method for reconstruction of biological tissues with continuous plane-stratification.

    Science.gov (United States)

    Dolgin, M; Einziger, P D

    2006-01-01

    A novel electrical impedance tomography method is introduced for reconstruction of layered biological tissues with continuous plane-stratification. The algorithm implements the recently proposed reconstruction scheme for piecewise constant conductivity profiles, based on an improved Prony method in conjunction with Legendre polynomial expansion (LPE). It is shown that the proposed algorithm is capable of successfully reconstructing continuous conductivity profiles with moderate (WKB) slop. Features of the presented reconstruction scheme include, an inherent linearity, achieved by the linear LPE transform, a locality feature, assigning analytically to each spectral component a local electrical impedance associated with a unique location, and effective performance even in the presence of noisy measurements.

  13. Glacial ocean circulation and stratification explained by reduced atmospheric temperature

    Science.gov (United States)

    Jansen, Malte F.

    2017-01-01

    Earth’s climate has undergone dramatic shifts between glacial and interglacial time periods, with high-latitude temperature changes on the order of 5–10 °C. These climatic shifts have been associated with major rearrangements in the deep ocean circulation and stratification, which have likely played an important role in the observed atmospheric carbon dioxide swings by affecting the partitioning of carbon between the atmosphere and the ocean. The mechanisms by which the deep ocean circulation changed, however, are still unclear and represent a major challenge to our understanding of glacial climates. This study shows that various inferred changes in the deep ocean circulation and stratification between glacial and interglacial climates can be interpreted as a direct consequence of atmospheric temperature differences. Colder atmospheric temperatures lead to increased sea ice cover and formation rate around Antarctica. The associated enhanced brine rejection leads to a strongly increased deep ocean stratification, consistent with high abyssal salinities inferred for the last glacial maximum. The increased stratification goes together with a weakening and shoaling of the interhemispheric overturning circulation, again consistent with proxy evidence for the last glacial. The shallower interhemispheric overturning circulation makes room for slowly moving water of Antarctic origin, which explains the observed middepth radiocarbon age maximum and may play an important role in ocean carbon storage.

  14. Viral lysis of marine microbes in relation to vertical stratification

    NARCIS (Netherlands)

    Mojica, K.D.A.

    2015-01-01

    Marine microorganisms represent the largest reservoir of living organic carbon in the ocean and collectively manage the pools and fluxes of nutrients and energy. Climate-induced increases in sea surface temperature and associated modifications to vertical stratification are affecting the structure a

  15. Educational stratification in cultural participation: Cognitive competence or status motivation?

    NARCIS (Netherlands)

    Notten, N.; Bol, Th.; Werfhorst, van de H.G.; Ganzeboom, H.B.G.

    2015-01-01

    This article examines educational stratification in highbrow cultural participation. There are two contrasting explanations of why cultural participation is stratified. The status hypothesis predicts that people come to appreciate particular forms of art because it expresses their belonging to a cer

  16. Change in the Stratification of Educational Expectations and Their Realization

    Science.gov (United States)

    Reynolds, John R.; Johnson, Monica Kirkpatrick

    2011-01-01

    What do recent trends toward increasingly ambitious educational expectations and rising college completion rates mean for the stratification of higher education? This article shows that the odds of achieving expectations for a bachelor's degree increased across 15 cohorts of young adults, and to a lesser extent, for expectations to attend…

  17. The Social Stratification of the German VET System

    Science.gov (United States)

    Protsch, Paula; Solga, Heike

    2016-01-01

    Germany is widely known for its vocational education and training (VET) system and its dual apprenticeship system in particular. What is often overlooked, however, is the vertical stratification within the German VET system. This is the focus of this study. Our analysis shows that the VET system, like the German school system, is highly…

  18. Educational stratification in cultural participation: cognitive competence or status motivation?

    NARCIS (Netherlands)

    N. Notten; B. Lancee; H.G. van de Werfhorst; H.B.G. Ganzeboom

    2014-01-01

    This article examines educational stratification in highbrow cultural participation. There are two contrasting explanations of why cultural participation is stratified. The status hypothesis predicts that people come to appreciate particular forms of art because it expresses their belonging to a cer

  19. DYNAMICS OF SOCIAL STRATIFICATION FROM INDUSTRIALISM TO POST-INDUSTRIALISM

    Directory of Open Access Journals (Sweden)

    Anastasiya Valerevna Slobodskaya

    2014-12-01

    Full Text Available In a situation of transition from industrial to post-industrial stage social structure development of society undergoes significant changes. This article discusses the new forms of social stratification, analyzes the causes of the transformation of social processes. According to the author, the changes of social processes are the result of transition to the information economy and production system. The article presents the rationale of the new forms of social stratification. Access to information and the level of professional competence are the basis of social stratification and class division. The complexity of predicting changes of class structure caused rapid updating of transition from one stage of social development to another. The analysis revealed heterogeneity and contradictory scientific views on the class structure of the post-industrial society. The author identifies and organizes the three groups of research positions of class stratification. The basis of the study carried out by the classification serves economic and value, political, scientific and technical specificity of the post-industrial society. The paper contributes to the study of the social structure in post-industrial society advances grounds to predict further transformation of the class system.

  20. Glacial ocean circulation and stratification explained by reduced atmospheric temperature.

    Science.gov (United States)

    Jansen, Malte F

    2017-01-03

    Earth's climate has undergone dramatic shifts between glacial and interglacial time periods, with high-latitude temperature changes on the order of 5-10 °C. These climatic shifts have been associated with major rearrangements in the deep ocean circulation and stratification, which have likely played an important role in the observed atmospheric carbon dioxide swings by affecting the partitioning of carbon between the atmosphere and the ocean. The mechanisms by which the deep ocean circulation changed, however, are still unclear and represent a major challenge to our understanding of glacial climates. This study shows that various inferred changes in the deep ocean circulation and stratification between glacial and interglacial climates can be interpreted as a direct consequence of atmospheric temperature differences. Colder atmospheric temperatures lead to increased sea ice cover and formation rate around Antarctica. The associated enhanced brine rejection leads to a strongly increased deep ocean stratification, consistent with high abyssal salinities inferred for the last glacial maximum. The increased stratification goes together with a weakening and shoaling of the interhemispheric overturning circulation, again consistent with proxy evidence for the last glacial. The shallower interhemispheric overturning circulation makes room for slowly moving water of Antarctic origin, which explains the observed middepth radiocarbon age maximum and may play an important role in ocean carbon storage.

  1. Formulation parameters influencing self-stratification of coatings

    NARCIS (Netherlands)

    Vink, P.; Bots, T.L.

    1996-01-01

    Research was carried out aimed at the development of self-stratifying paints for steel which after application during film formation spontaneously form two well established layers of primer and top coat. The parameters affecting stratification were investigated for combinations of epoxy resins and

  2. Stratification of centrifuged amoeba nuclei investigated by electron microscopy

    Science.gov (United States)

    Breyer, E. P.; Daniels, E. W.

    1968-01-01

    Study establishes a relationship between radioresistance and the nucleolar stratification characteristics of various amoeba species. Two species of fresh water amoeba are studied with the electron microscope. The report discusses the nature of nucleolar layers and their possible relationship to the differences in radiosensitivity of the two amoeba species.

  3. USA Stratified Monopoly: A Simulation Game about Social Class Stratification

    Science.gov (United States)

    Fisher, Edith M.

    2008-01-01

    Effectively teaching college students about social class stratification is a difficult challenge. Explanations for this difficulty tend to focus on the students who often react with resistance, paralysis, or rage. Sociologists have been using games and simulations as alternative methods for several decades to teach about these sensitive subjects.…

  4. Pedagogic Stratification and the Shifting Landscape of Higher Education

    Science.gov (United States)

    Stevenson, Jacqueline; Burke, Penny-Jane; Whelan, Pauline

    2014-01-01

    This project examined the impact on learning and teaching of recent significant changes in UK higher education policy. The term "pedagogic stratification" is used to explore and analyse how institutional type may relate to different conceptions of "teaching excellence" and "the student experience" adopted across the…

  5. Tailoring the Surface Properties of Coatings Through Self-Stratification

    Science.gov (United States)

    2016-10-13

    assessments include thermal analysis using DSC, dynamic mechanical analysis using the parallel DMT A, and toughness measurements using our in- house ...stratification," ANZPAC Workshop, Melbourne , Australia, May 6-9, 2013. • Dean C. Webster, "Towards tough fouling-release coatings with tailorable surface

  6. Formulation parameters influencing self-stratification of coatings

    NARCIS (Netherlands)

    Vink, P.; Bots, T.L.

    1996-01-01

    Research was carried out aimed at the development of self-stratifying paints for steel which after application during film formation spontaneously form two well established layers of primer and top coat. The parameters affecting stratification were investigated for combinations of epoxy resins and p

  7. Effect of gravitational stratification on the propagation of a CME

    CERN Document Server

    Pagano, Paolo; Poedts, Stefaan

    2013-01-01

    Our aim is to study the role of gravitational stratification on the propagation of CMEs. In particular, we assess how it influences the speed and shape of CMEs and under what conditions the flux rope ejection becomes a CME or when it is quenched. We ran a set of MHD simulations that adopt an eruptive initial magnetic configuration that has already been shown to be suitable for a flux rope ejection. We varied the temperature of the backgroud corona and the intensity of the initial magnetic field to tune the gravitational stratification and the amount of ejected magnetic flux. We used an automatic technique to track the expansion and the propagation of the magnetic flux rope in the MHD simulations. From the analysis of the parameter space, we evaluate the role of gravitational stratification on the CME speed and expansion. Our study shows that gravitational stratification plays a significant role in determining whether the flux rope ejection will turn into a full CME or whether the magnetic flux rope will stop ...

  8. Formulation parameters influencing self-stratification of coatings

    NARCIS (Netherlands)

    Vink, P.; Bots, T.L.

    1996-01-01

    Research was carried out aimed at the development of self-stratifying paints for steel which after application during film formation spontaneously form two well established layers of primer and top coat. The parameters affecting stratification were investigated for combinations of epoxy resins and p

  9. Viral lysis of marine microbes in relation to vertical stratification

    NARCIS (Netherlands)

    Mojica, K.D.A.

    2015-01-01

    Marine microorganisms represent the largest reservoir of living organic carbon in the ocean and collectively manage the pools and fluxes of nutrients and energy. Climate-induced increases in sea surface temperature and associated modifications to vertical stratification are affecting the structure

  10. Testicular cancer: risk stratification in adolescents with nonseminoma.

    Science.gov (United States)

    Looijenga, Leendert H J

    2014-07-01

    Data are lacking on the role of histological risk factors (such as embryonal carcinoma and lymphovascular invasion) for occult metastasis in adolescents with testicular germ cell tumours. Investigators of a pilot study have now retrospectively reviewed a testis cancer database to identify risk stratification criteria in this population.

  11. Thermal Stratification in Lake Zige Tangco, Central Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    LI Wan-chun; YANG Xiang-dong; YIN Yu; JI Jiang; LI Shi-jie; PU Pei-min

    2005-01-01

    Lake Zige Tangco is an endorheic saline lake in central Tibetan Plateau. Investigations of 1998 and 1999 revealed that is was a typical stratified lake. The characteristics of thermal stratification of the lake have been extensively discussed from 4 aspects, i.e. thermocline, hydrochemistry and dissolved oxygen, stable isotope oxygen, and stability. The thermocline coupled with chemocline was further analyzed.

  12. Contemporary approach to neurologic prognostication of coma after cardiac arrest.

    Science.gov (United States)

    Ben-Hamouda, Nawfel; Taccone, Fabio S; Rossetti, Andrea O; Oddo, Mauro

    2014-11-01

    Coma after cardiac arrest (CA) is an important cause of admission to the ICU. Prognosis of post-CA coma has significantly improved over the past decade, particularly because of aggressive postresuscitation care and the use of therapeutic targeted temperature management (TTM). TTM and sedatives used to maintain controlled cooling might delay neurologic reflexes and reduce the accuracy of clinical examination. In the early ICU phase, patients' good recovery may often be indistinguishable (based on neurologic examination alone) from patients who eventually will have a poor prognosis. Prognostication of post-CA coma, therefore, has evolved toward a multimodal approach that combines neurologic examination with EEG and evoked potentials. Blood biomarkers (eg, neuron-specific enolase [NSE] and soluble 100-β protein) are useful complements for coma prognostication; however, results vary among commercial laboratory assays, and applying one single cutoff level (eg, > 33 μg/L for NSE) for poor prognostication is not recommended. Neuroimaging, mainly diffusion MRI, is emerging as a promising tool for prognostication, but its precise role needs further study before it can be widely used. This multimodal approach might reduce false-positive rates of poor prognosis, thereby providing optimal prognostication of comatose CA survivors. The aim of this review is to summarize studies and the principal tools presently available for outcome prediction and to describe a practical approach to the multimodal prognostication of coma after CA, with a particular focus on neuromonitoring tools. We also propose an algorithm for the optimal use of such multimodal tools during the early ICU phase of post-CA coma.

  13. Combustion Stratification for Naphtha from CI Combustion to PPC

    KAUST Repository

    Vallinayagam, R.

    2017-03-28

    This study demonstrates the combustion stratification from conventional compression ignition (CI) combustion to partially premixed combustion (PPC). Experiments are performed in an optical CI engine at a speed of 1200 rpm for diesel and naphtha (RON = 46). The motored pressure at TDC is maintained at 35 bar and fuelMEP is kept constant at 5.1 bar to account for the difference in fuel properties between naphtha and diesel. Single injection strategy is employed and the fuel is injected at a pressure of 800 bar. Photron FASTCAM SA4 that captures in-cylinder combustion at the rate of 10000 frames per second is employed. The captured high speed video is processed to study the combustion homogeneity based on an algorithm reported in previous studies. Starting from late fuel injection timings, combustion stratification is investigated by advancing the fuel injection timings. For late start of injection (SOI), a direct link between SOI and combustion phasing is noticed. At early SOI, combustion phasing depends on both intake air temperature and SOI. In order to match the combustion phasing (CA50) of diesel, the intake air temperature is increased to 90°C for naphtha. The combustion stratification from CI to PPC is also investigated for various level of dilution by displacing oxygen with nitrogen in the intake. The start of combustion (SOC) was delayed with the increase in dilution and to compensate for this, the intake air temperature is increased. The mixture homogeneity is enhanced for higher dilution due to longer ignition delay. The results show that high speed image is initially blue and then turned yellow, indicating soot formation and oxidation. The luminosity of combustion images decreases with early SOI and increased dilution. The images are processed to generate the level of stratification based on the image intensity. The level of stratification is same for diesel and naphtha at various SOI. When O concentration in the intake is decreased to 17.7% and 14

  14. Meningioma 1 (MN1) expression: refined risk stratification in acute myeloid leukemia with normal cytogenetics (CN-AML).

    Science.gov (United States)

    Aref, Salah; Ibrahim, Lamiaa; Morkes, Hana; Azmy, Emad; Ebrahim, Maha

    2013-09-01

    Prognostic stratification of cytogenetic normal acute myeloid leukemia (CN-AML) is an area of active research. The aim of this study was to determine the prognostic importance of the meningioma 1 (MN1) gene expression levels in CN-AML. One hundred patients with CN-AML were diagnosed; MN1 expressions were analyzed using quantitative real-time polymerase chain reaction. High expressions were detected in 48 (48%) patients (expression range: 2.35-31.99, mean: 13.9 ± 8.49) in comparison with 52 (52%) patients with low expression (expression range: 0.02-2.3, mean: 0.68 ± 0.77). The course of the disease in patients with high MN1 expression was unfavorable. Patients with high MN1 expression was associated with significant low complete remission rate (62.5 vs. 8.4%, high vs. low MN1, P = 0.001) and high mortality rate (75% vs. 46.1, P = 0.03). AML patients with high MN1 expression tended to be refractory (37.5 vs. 19.2%, P = 0.00) and relapse risk (54.1 vs. 23%, P = 0.02). Multivariable analysis confirmed high MN1 expression as an independent risk factor for disease-free survival and overall survival. In conclusion, MN1 overexpression independently predicts bad clinical outcome in CN-AML patients.

  15. Decreased Prognostic Value of International Prognostic Score in Chinese Advanced Hodgkin Lymphoma Patients Treated in the Contemporary Era

    Institute of Scientific and Technical Information of China (English)

    Qin Wang; Yan Qin; Su-Yi Kang; Xiao-Hui He; Peng Liu; Sheng Yang; Sheng-Yu Zhou

    2016-01-01

    Background:The International Prognostic Score (IPS) was developed based on the data of Western advanced Hodgkin lymphoma (HL) patients treated before 1992.Only a few studies ever evaluated the application value of IPS in Chinese population or in patients treated in the contemporary era whose outcomes has improved significantly than before.Methods:We conducted a retrospective study involving 208 previously untreated Chinese advanced HL patients,who were admitted to Cancer Hospital Chinese Academy of Medical Sciences from January 1,1999 to April 30,2015 and received uniform first-line treatment.The prognostic value of both IPS and the seven IPS factors for freedom-from progression (FFP) and overall survival (OS) was assessed in this population.The statistical methods included Kaplan-Meier methodology,log-rank testing,and Cox proportional hazard regression analysis.Results:With a median follow-up time of 79 months (range,15-210 months),the 5-year FFP and OS were 78.8% and 86.0% respectively,which improved obviously compared with the original IPS study.The IPS remained prognostic for both FFP (P =0.041) and OS (P =0.013),but the range narrowed obviously,with 5-year FFP ranging from 87.2% to 61.5%,5-year OS ranging from 94.1% to 69.2%,and the separation of survival curves was not as good as before.Only two of the seven IPS factors showed a significant independent prognostic value in the multivariate analysis:Stage Ⅳ (for FFP,hazard ratio [HR] =2.219,95% confidence interval [CI]:1.148-3.948,P =0.016;for OS,HR =2.491,95% CI:1.159-5.355,P =0.019) and hemoglobin <105 g/L (for FFP,HR =2.136,95% CI:1.123-4.060,P =0.021;for OS,HR =2.345,95% CI:1.099-5.042,P =0.028).A simple prognostic score calculated by adding one point each for any of the two factors was prognostic both for FFP (P < 0.001) and OS (P < 0.001) with the survival curves separating very well,but the range still narrowed.Conclusions:The IPS has decreased the prognostic value in Chinese

  16. Validation of dynamic risk stratification in pediatric differentiated thyroid cancer.

    Science.gov (United States)

    Sohn, Seo Young; Kim, Young Nam; Kim, Hye In; Kim, Tae Hyuk; Kim, Sun Wook; Chung, Jae Hoon

    2017-08-18

    There has been increasing interest in a risk-adopted management strategy known as dynamic risk stratification following the revised American Thyroid Association guidelines for differentiated thyroid cancer. We aimed to evaluate the usefulness of dynamic risk stratification for predicting structural disease in pediatric differentiated thyroid cancer patients. We retrospectively reviewed 130 pediatric differentiated thyroid cancer patients (≤19 years) who were treated between 1996 and 2015 at Samsung Medical Center. Patients were stratified according to three American Thyroid Association initial risk group (low, intermediate, or high risk) and four dynamic risk stratification group (excellent, indeterminate, biochemical incomplete, or structural incomplete). Based on dynamic risk stratification strategy, structural disease was identified 3.9% in the excellent group, 9.7% in the indeterminate group, 76.9% in the biochemical incomplete group, and 100% in the structural incomplete group. The hazard ratios of the structural disease were 18.10 (P < 0.001) in the biochemical incomplete group, and 19.583 (P < 0.001) in the structural incomplete group compared to the excellent group. The prevalence of structural disease also increased as American Thyroid Association initial risk classification increased (5.9% in the low-risk group, 13.6% in the intermediate-risk group, and 45% in the high-risk group). The hazard ratios of structural disease in the high-risk group was 10.296 (P < 0.001) in compared to the low-risk group. Dynamic risk stratification based on patient responses to initial therapy was able to effectively predict the risk of structural disease in a pediatric population, and as a follow-up strategy, may work as well in pediatric differentiated thyroid cancer patients as it does in adult differentiated thyroid cancer patients.

  17. Stratification for smoking in case-cohort studies of genetic polymorphisms and lung cancer

    DEFF Research Database (Denmark)

    Sørensen, Mette; López, Ana García; Andersen, Per Kragh;

    2009-01-01

    The risk estimates obtained in studies of genetic polymorphisms and lung cancer differ markedly between studies, which might be due to chance or differences in study design, in particular the stratification/match of comparison group. The effect of different strategies for stratification...... and adjustment for smoking on the estimated effect of polymorphisms on lung cancer risk was explored in the case-cohort design. We used an empirical and a statistical simulation approach. The stratification strategies were: no smoking stratification, stratification for smoking status and stratification...... with smoking. In the empirical approach the risk estimates of the investigated polymorphisms differed between the three different stratification strategies. Simulated data with neither stratification nor adjustment for smoking resulted in low biases and narrow confidence intervals (CI) in the absence...

  18. Towards Prognostics for Electronics Components

    Science.gov (United States)

    Saha, Bhaskar; Celaya, Jose R.; Wysocki, Philip F.; Goebel, Kai F.

    2013-01-01

    Electronics components have an increasingly critical role in avionics systems and in the development of future aircraft systems. Prognostics of such components is becoming a very important research field as a result of the need to provide aircraft systems with system level health management information. This paper focuses on a prognostics application for electronics components within avionics systems, and in particular its application to an Isolated Gate Bipolar Transistor (IGBT). This application utilizes the remaining useful life prediction, accomplished by employing the particle filter framework, leveraging data from accelerated aging tests on IGBTs. These tests induced thermal-electrical overstresses by applying thermal cycling to the IGBT devices. In-situ state monitoring, including measurements of steady-state voltages and currents, electrical transients, and thermal transients are recorded and used as potential precursors of failure.

  19. Combined Immunohistochemistry of PLK1, p21, and p53 for Predicting TP53 Status: An Independent Prognostic Factor of Breast Cancer.

    Science.gov (United States)

    Watanabe, Gou; Ishida, Takanori; Furuta, Akihiko; Takahashi, Shin; Watanabe, Mika; Nakata, Hideaki; Kato, Shunsuke; Ishioka, Chikashi; Ohuchi, Noriaki

    2015-08-01

    It is difficult to predict the TP53 status by p53 immunohistochemistry (IHC). We aimed to improve the accuracy of p53 IHC with p53-regulated proteins for predicting the TP53 mutation status. TP53 mutations were detected in 19 of 38 breast cancer patients (50%). Five of 7 cases of protein-truncating mutation of TP53 were completely negative for p53 IHC, whereas 11 of 12 cases of TP53 point mutation were strongly positive for p53 IHC. Therefore, to avoid false negatives, we extracted p53-dependent universally downregulated genes using microarray analysis from 38 breast cancer patients and 2 p53-inducible cell lines. From 9 commonly repressed genes, we evaluated 3 genes, baculoviral IAP repeat-containing 5 (BIRC5), polo-like kinase 1 (PLK1), and BUB1 mitotic checkpoint serine/threonine kinase (BUB1), which were previously identified as p53-dependent repressed genes. PLK1≥Allred total score (TS) 5 showed the highest correlation with TP53 mutation. To decrease false positivity, we evaluated p21 IHC. Although strong staining of p21 was observed in 4 cases (10.5%), all 4 were wild-type TP53. Thus, p53 mutation-like (p53mt-like) IHC was identified by p53 TS7,8 with PLK1≥TS 5 and p21 TS≤6. p53 mt-like IHC correlated with TP53 mutation (predictive value=0.94). In other 157 breast cancer cases, p53 mt-like was an independent prognostic marker in multivariate analysis and a strong prognostic factor. Stratification with p53 mt-like IHC identified patients with a poorer prognosis. In conclusion, we identified reliable IHC conditions to predict the TP53 status of breast cancer patients.

  20. Prognostic impact of clinic and ambulatory blood pressure components in high-risk type 2 diabetic patients: the Rio de Janeiro Type 2 Diabetes Cohort Study.

    Science.gov (United States)

    Salles, Gil F; Leite, Nathalie C; Pereira, Basílio B; Nascimento, Emilia M; Cardoso, Claudia R L

    2013-11-01

    The prognostic importance of tight clinic blood pressure (BP) control is controversial in diabetic patients. The objective was to investigate the prognostic impact of clinic and ambulatory BPs for cardiovascular morbidity and mortality in type 2 diabetes. In a prospective cohort study, 565 type 2 diabetic patients had clinical, laboratory and ambulatory BP monitoring (ABPM) data obtained at baseline and during follow-up. The primary endpoints were a composite of fatal and nonfatal cardiovascular events and all-cause mortality. Multivariable Cox survival and splines regression analyses assessed associations between each BP component [SBP, DBP and pulse pressure (PP)] and the endpoints. After a median follow-up of 5.75 years, 88 total cardiovascular events and 70 all-cause deaths occurred. After adjustments for cardiovascular risk factors, clinic SBP and DBPs were predictive of the composite endpoint but not of all-cause mortality, whereas all ambulatory BP components were predictors of both endpoints. Ambulatory systolic and PPs were the strongest predictors and achieved ambulatory BPs during follow-up improved risk prediction in relation to baseline values. When categorized at clinically relevant cut-off values, risk began only at clinic BPs at least 140/90 mmHg, whereas for ambulatory BPs it began at lower values (≥120/75 mmHg for the 24-h period). ABPM provides more valuable information regarding cardiovascular risk stratification than office BPs and should be performed, if possible, in every high-risk type 2 diabetic patient. Achieved 24-h ambulatory BPs less than 120/75 mmHg are associated with significant cardiovascular protection and, if confirmed by other studies, may be considered as BP treatment targets.

  1. Childhood Hodgkin International Prognostic Score (CHIPS) Predicts event-free survival in Hodgkin Lymphoma: A Report from the Children's Oncology Group.

    Science.gov (United States)

    Schwartz, Cindy L; Chen, Lu; McCarten, Kathleen; Wolden, Suzanne; Constine, Louis S; Hutchison, Robert E; de Alarcon, Pedro A; Keller, Frank G; Kelly, Kara M; Trippet, Tanya A; Voss, Stephan D; Friedman, Debra L

    2017-04-01

    Early response to initial chemotherapy in Hodgkin lymphoma (HL) measured by computed tomography (CT) and/or positron emission tomography (PET) after two to three cycles of chemotherapy may inform therapeutic decisions. Risk stratification at diagnosis could, however, allow earlier and potentially more efficacious treatment modifications. We developed a predictive model for event-free survival (EFS) in pediatric/adolescent HL using clinical data known at diagnosis from 1103 intermediate-risk HL patients treated on Children's Oncology Group protocol AHOD0031 with doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide (ABVE-PC) chemotherapy and radiation. Independent predictors of EFS were identified and used to develop and validate a prognostic score (Childhood Hodgkin International Prognostic Score [CHIPS]). A training cohort was randomly selected to include approximately half of the overall cohort, with the remainder forming the validation cohort. Stage 4 disease, large mediastinal mass, albumin (<3.5), and fever were independent predictors of EFS that were each assigned one point in the CHIPS.  Four-year EFS was 93.1% for patients with CHIPS = 0, 88.5% for patients with CHIPS = 1, 77.6% for patients with CHIPS = 2, and 69.2% for patients with CHIPS = 3. CHIPS was highly predictive of EFS, identifying a subset (with CHIPS 2 or 3) that comprises 27% of intermediate-risk patients who have a 4-year EFS of <80% and who may benefit from early therapeutic augmentation.  Furthermore, CHIPS identified higher risk patients who were not identified by early PET or CT response. CHIPS is a robust and inexpensive approach to predicting risk in patients with intermediate-risk HL that may improve ability to tailor therapy to risk factors known at diagnosis. © 2016 Wiley Periodicals, Inc.

  2. The prognostic value of arterial blood gas analysis in high-risk acute heart failure patients: an analysis of the Korean Heart Failure (KorHF) registry.

    Science.gov (United States)

    Park, Jin Joo; Choi, Dong-Ju; Yoon, Chang-Hwan; Oh, Il-Young; Lee, Ju Hyun; Ahn, Soyeon; Yoo, Byung-Su; Kang, Seok-Min; Kim, Jae-Joong; Baek, Sang-Hong; Cho, Myeong-Chan; Jeon, Eun-Seok; Chae, Shung Chull; Ryu, Kyu-Hyung; Oh, Byung-Hee

    2015-06-01

    In acute heart failure (AHF) patients, pulmonary oedema and low tissue perfusion may lead to changes in the acid-base balance, which may be associated with worse outcomes. In this prospective nationwide cohort study from 24 academic hospitals, arterial blood gas (ABG) was measured in 1982 AHF patients at hospital admission. Acidosis was defined as pH 7.44. Mortality was stratified according to ABG results. Overall, 19% had acidosis, 37% had normal pH, and 44% had alkalosis. The most common type of acidosis was the mixed type (42%) followed by metabolic acidosis (40%), and the most common type of alkalosis was respiratory alkalosis (58%). At 12 months' follow-up 304 patients (15%) died. Patients with acidosis had higher mortality (acidosis 19.5%, neutral pH 13.7%, alkalosis 14.9%; P = 0.007). In the Cox proportional-hazards regression model, acidosis was a significant predictor of mortality (hazard ratio 1.93; 95% confidence intervals 1.27-2.93) along with N-terminal pro-brain type natriuretic peptide (NT-proBNP), among others. In contrast, alkalosis was not associated with increased mortality. pH had an incremental prognostic value over NT-proBNP (net reclassification improvement 30%; P analysis identified extra patients at increased risk for mortality among patients with an NT-proBNP level less than the median (12-month mortality 17.5% vs. 9.9%; P = 0.009). In high-risk AHF patients, the most common acid-base imbalance is respiratory alkalosis. Acidosis is observed in every fifth patient and is a significant predictor of mortality. pH provides an additional prognostic value and may be used to optimize risk stratification in high-risk AHF patients. © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.

  3. Incremental Prognostic Use of Left Ventricular Global Longitudinal Strain in Asymptomatic/Minimally Symptomatic Patients With Severe Bioprosthetic Aortic Stenosis Undergoing Redo Aortic Valve Replacement.

    Science.gov (United States)

    Naji, Peyman; Shah, Shailee; Svensson, Lars G; Gillinov, A Marc; Johnston, Douglas R; Rodriguez, L Leonardo; Grimm, Richard A; Griffin, Brian P; Desai, Milind Y

    2017-06-01

    With improved survival of patients undergoing primary bioprosthetic aortic valve replacement (AVR), reoperation to relieve severe prosthetic aortic stenosis (PAS) is increasing. Timing of redo surgery in asymptomatic/minimally symptomatic patients remains controversial. Left ventricular (LV) global longitudinal strain (GLS) is a marker of subclinical LV dysfunction. In asymptomatic/minimally symptomatic patients with severe PAS undergoing redo AVR, we sought to determine whether LV-GLS provides incremental prognostic use. We studied 191 patients with severe bioprosthetic PAS (63±16 years, 58% men) who underwent redo AVR between 2000 and 2012 (excluding mechanical PAS, severe other valve disease transcatheter AVR, and LV ejection fraction 2+ aortic regurgitation. Median LV-GLS was -14.2% (-11.4, -17.1%). At 4.2±3 years, 41 (22%) patients met the composite end point (2.5% deaths and 1% strokes at 30 days postoperatively). On multivariable Cox survival analysis, LV-GLS was independently associated with longer-term composite events (hazard ratio, 1.21; 95% confidence interval, 1.10-1.33), P<0.01. The C statistic for the clinical model (Society of Thoracic Surgeons score, degree of aortic regurgitation, and right ventricular systolic pressure) was 0.64 (95% confidence interval 0.54-0.79), P<0.001. Addition of LV-GLS to the clinical model increased the C statistic significantly to 0.71 (95% confidence interval 0.58-0.81), P<0.001. In asymptomatic/minimally symptomatic patients with severe bioprosthetic PAS undergoing redo AVR, baseline LV-GLS provides incremental prognostic use over established predictors and could potentially aid in surgical timing and risk stratification. © 2017 American Heart Association, Inc.

  4. Gear Fatigue Diagnostics and Prognostics

    Science.gov (United States)

    2013-01-01

    The first objective was to collect meaningful gear fault progression data starting from healthy NASA-designed spur test gears and ending with failed...and D. P. Townsend, "Analysis of the effects of surface pitting and wear on the vibration of a gear transmission system," Tribology International...Reporting Period: April 15, 2012 to September 27, 2012 Attached is the Gear Fatigue Diagnostics and Prognostics project progress report for the

  5. Prognostic Significance of MiR-34a Expression in Patients with Gastric Cancer after Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Wen-Tao Hui; Xiao-Bin Ma; Ying Zan; Xi-Jing Wang; Lei Dong

    2015-01-01

    Background:MiR-34a dysregulation has been implicated in tumorigenesis and progression of gastric cancer,but its role in prognosis of patients with gastric cancer remains unknown.The aim of this study was to investigate the expression and prognostic significance of miR-34a in gastric cancer patients after radical gastrectomy.Methods:Quantitative real-time polymerase chain reaction was performed to detect the expression of miR-34a in human gastric cancer cell lines and tissues in 76 patients with gastric adenocarcinoma from China.Results are assessed for association with clinical features and overall survival (OS) using Kaplan-Meier analysis.Prognostic values of miR-34a expression and clinical outcomes were evaluated by Cox regression analysis.A molecular prognostic stratification scheme incorporating miR-34a expression was determined using receiver operating characteristic analysis.Results:The results show that the expression level of miR-34a was decreased in human gastric cancer cell lines and tissues,and down-regulated expression of miR-34a was associated with Lauren classification (P =0.034).Decreased miR-34a expression in gastric cancer tissues was positively correlated with poor OS of gastric cancer patients (P =0.013).Further multivariate Cox regression analysis suggested that miR-34a expression was an independent prognostic indicator for gastric cancer (P=0.027).Applying the prognostic value of miR-34a expression to tumor node metastasis (TNM) stage system showed a better prognostic value in patients with gastric cancer than miR-34a expression (P =0.0435) or TNM stage (P =0.0249) alone.Conclusion:The results reinforce the critical role for the down-regulated miR-34a expression in gastric cancer and suggest that miR-34a could be a prognostic indicator for this disease.

  6. BRAF V600E mutation in prognostication of papillary thyroid cancer (PTC) recurrence.

    Science.gov (United States)

    Czarniecka, Agnieszka; Oczko-Wojciechowska, Małgorzata; Barczyński, Marcin

    2016-10-01

    Papillary thyroid cancer (PTC) offers excellent prognosis, however relapse risk or persistent disease is related to ~30%. Currently, attention is paid to the possibility of patient group selection of different risk of unfavorable outcome to match a particular therapeutic approach. Therefore, interest in new prognostic and predictive markers known preoperatively is observed. BRAF V600E mutation is such a marker. Many studies analyzing the prevalence of the mutation and its relationship with other clinico-pathological risk factors were reported but with controversial conclusions. The prognostic significance of BRAF mutation was confirmed by some single centre studies, a few meta-analyses and a large multicenter retrospective international study. They confirmed a correlation between the mutation and the risk of recurrence. The strongest argument against using BRAF mutation as an independent prognostic and predictive factor in PTC is its high prevalence (30-80%). At present it seems that BRAF mutation is one of the factors influencing the prognosis and it should be analyzed in correlation with other prognostic factors. The most recent ATA recommendations do not indicate a routine application of BRAF status for initial risk stratification in differentiated thyroid cancer due to a lack of evident confirmation of a direct influence of mutation on the increase in relapse risk. However, ATA demonstrates the continuous risk scale for the relapse risk assessment, considering BRAF and/or TERT status. At present, researchers are working on determining the role of BRAF mutation in patients from a low-risk group and its correlations with others molecular events. Currently, BRAF mutation cannot be used as a single, independent predictive factor. However, its usefulness in the context of other molecular and clinico-pathological risk factors cannot be excluded. They may be used to make modern prognostic scales of relapse risk and be applied to individualized diagnostic and

  7. An operative dengue risk stratification system in Argentina based on geospatial technology

    Directory of Open Access Journals (Sweden)

    Ximena Porcasi

    2012-09-01

    Full Text Available Based on an agreement between the Ministry of Health and the National Space Activities Commission in Argentina, an integrated informatics platform for dengue risk using geospatial technology for the surveillance and prediction of risk areas for dengue fever has been designed. The task was focused on developing stratification based on environmental (historical and current, viral, social and entomological situation for >3,000 cities as part of a system. The platform, developed with open-source software with pattern design, following the European Space Agency standards for space informatics, delivers two products: a national risk map consisting of point vectors for each city/town/locality and an approximate 50 m resolution urban risk map modelling the risk inside selected high-risk cities. The operative system, architecture and tools used in the development are described, including a detailed list of end users’ requirements. Additionally, an algorithm based on bibliography and landscape epidemiology concepts is presented and discussed. The system, in operation since September 2011, is capable of continuously improving the algorithms producing improved risk stratifications without a complete set of inputs. The platform was specifically developed for surveillance of dengue fever as this disease has reemerged in Argentina but the aim is to widen the scope to include also other relevant vector-borne diseases such as chagas, malaria and leishmaniasis as well as other countries belonging to south region of Latin America.

  8. Prognostic risk stratification of myocardial ischaemia evaluated by gated myocardial perfusion SPECT in patients with chronic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Hatta, Tsuguru [Ohmihachiman Community Medical Center, Division of Nephrology, Department of Medicine, Shiga (Japan); Nishimura, Shigeyuki [Saitama Medical School Hospital, Division of Cardiology, Saitama (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, Kyoto (Japan)

    2009-11-15

    The aim of this study was to identify useful predictors of cardiac events in patients with chronic kidney disease (CKD). Among 4,031 patients identified from the Japanese Assessment of Cardiac Events and Survival Study (J-ACCESS) database with suspected or known ischaemic heart disease, we selected 820 with an estimated glomerular filtration rate (eGFR) of < 60 ml/min per 1.73 m{sup 2}. A total of 75 cardiac events developed among these 820 patients. The incidence of cardiac events was higher in the group with a lower eGFR. Multivariate Cox analysis indicated that age, diabetes mellitus, end-systolic volume, summed stress score (SSS) and eGFR were predictors of cardiac events. Event rates of patients with SSS {>=} 9 were significantly higher in groups with lower eGFR values (< 40 and 40-49 ml/min). The SSS value ({>=} 9) is a reliable predictor of cardiac events and myocardial single photon emission computed tomography has incremental value for predicting cardiac events and survival in CKD. (orig.)

  9. Independent validation of the prognostic capacity of the ISUP prostate cancer grade grouping system for radiation treated patients with long-term follow-up.

    Science.gov (United States)

    Spratt, D E; Jackson, W C; Abugharib, A; Tomlins, S A; Dess, R T; Soni, P D; Lee, J Y; Zhao, S G; Cole, A I; Zumsteg, Z S; Sandler, H; Hamstra, D; Hearn, J W; Palapattu, G; Mehra, R; Morgan, T M; Feng, F Y

    2016-09-01

    There has been a recent proposal to change the grading system of prostate cancer into a five-tier grade grouping system. The prognostic impact of this has been demonstrated in regards only to biochemical recurrence-free survival (bRFS) with short follow-up (3 years). Between 1990 and 2013, 847 consecutive men were treated with definitive external beam radiation therapy at a single academic center. To validate the new grade grouping system, bRFS, distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS) were calculated. Adjusted Kaplan-Meier and multivariable Cox regression analyses were performed to assess the independent impact of the new grade grouping system. Discriminatory analyses were performed to compare the commonly used three-tier Gleason score system (6, 7 and 8-10) to the new system. The median follow-up of our cohort was 88 months. The 5-grade groups independently validated differing risks of bRFS (group 1 as reference; adjusted hazard ratio (aHR) 1.35, 2.16, 1.79 and 3.84 for groups 2-5, respectively). Furthermore, a clear stratification was demonstrated for DMFS (aHR 2.03, 3.18, 3.62 and 13.77 for groups 2-5, respectively) and PCSS (aHR 3.00, 5.32, 6.02 and 39.02 for groups 2-5, respectively). The 5-grade group system had improved prognostic discrimination for all end points compared with the commonly used three-tiered system (that is, Gleason score 6, 7 and 8-10). In a large independent radiotherapy cohort with long-term follow-up, we have validated the bRFS benefit of the proposed five-tier grade grouping system. Furthermore, we have demonstrated that the system is highly prognostic for DMFS and PCSS. Grade group 5 had markedly worse outcomes for all end points, and future work is necessary to improve outcomes in these patients.

  10. Applications of cellular systems biology in breast cancer patient stratification and diagnostics.

    Science.gov (United States)

    Critchley-Thorne, Rebecca J; Miller, Steven M; Taylor, D Lansing; Lingle, Wilma L

    2009-11-01

    Tumors are complex structures of malignant cells and stromal cells that function as an integrated system that promotes tumor progression. Immune cells and other stromal components serve vital cooperative functions that often support tumor growth and metastasis; stromal content and function are strongly associated with disease progression and clinical outcome in cancer patients. Cellular systems biology considers tissues and tumors, and the cells within them, as integrated and interactive networks that function in concert as a system. Assessment of tumors as a "system" within the system of a patient using the cellular systems biology approach has the potential to improve on the current diagnostic tools for breast cancer by creating high content profiles of an individual patient's tumor. The application of cellular systems biology (CSB) profiling to early drug discovery using cellular models of disease [1] and to drug development using the CellCiphr Cytotoxicity Profiling panels [2] can optimize the efficacy and decrease the potential toxicity of compounds taken into pre-clinical trials. However, it has become clear that patient sub-populations can respond differently to drug candidates in clinical trials due to patient variability. Therefore, cellular systems biology can also be a powerful approach to patient stratification for clinical trials and could become an important diagnostic tool. This review describes how the cellular systems biology approach can be applied to patient stratification and diagnostics in breast cancer, focusing on the advantages of quantifying functional biomarkers representing key tumor system processes in intact tissues from patients in order to make highly specific and sensitive predictions towards development of individualized medicine for breast cancer. We discuss the state-of-the-art of multiplexing of functional biomarkers in tissues and the practical utilization of the cellular systems biology approach in creating classifiers for

  11. Recurrent abnormalities can be used for risk group stratification in pediatric AMKL: a retrospective intergroup study.

    Science.gov (United States)

    de Rooij, Jasmijn D E; Masetti, Riccardo; van den Heuvel-Eibrink, Marry M; Cayuela, Jean-Michel; Trka, Jan; Reinhardt, Dirk; Rasche, Mareike; Sonneveld, Edwin; Alonzo, Todd A; Fornerod, Maarten; Zimmermann, Martin; Pigazzi, Martina; Pieters, Rob; Meshinchi, Soheil; Zwaan, C Michel; Locatelli, Franco

    2016-06-30

    Genetic abnormalities and early treatment response are the main prognostic factors in acute myeloid leukemia (AML). Acute megakaryoblastic leukemia (AMKL) is a rare subtype of AML. Deep sequencing has identified CBFA2T3/GLIS2 and NUP98/KDM5A as recurrent aberrations, occurring in similar frequencies as RBM15/MKL1 and KMT2A-rearrangements. We studied whether these cytogenetic aberrations can be used for risk group stratification. To assess frequencies and outcome parameters of recurrent cytogenetic aberrations in AMKL, samples and clinical data of patients treated by the Associazione Italiana Ematologia Oncologia Pediatrica, Berlin-Frankfurt-Munster Study Group, Children's Oncology Group, Dutch Childhood Oncology Group, and the Saint Louis Hôpital were collected, enabling us to screen 153 newly diagnosed pediatric AMKL cases for the aforementioned aberrations and to study their clinical characteristics and outcome. CBFA2T3/GLIS2 was identified in 16% of the cases; RBM15/MKL1, in 12%; NUP98/KDM5A and KMT2A rearrangements, in 9% each; and monosomy 7, in 6%. These aberrations were mutually exclusive. RBM15/MKL1-rearranged patients were significantly younger. No significant differences in sex and white blood cell count were found. NUP98/KDM5A, CBFA2T3/GLIS2, KMT2A-rearranged lesions and monosomy 7 (NCK-7) independently predicted a poor outcome, compared with RBM15/MKL1-rearranged patients and those with AMKL not carrying these molecular lesions. NCK-7-patients (n = 61) showed a 4-year probability of overall survival of 35 ± 6% vs 70 ± 5% in the RBM15/MKL1-other groups (n = 92, P < .0001) and 4-year probability of event-free survival of 33 ± 6% vs 62 ± 5% (P = .0013), the 4-year cumulative incidence of relapse being 42 ± 7% and 19 ± 4% (P = .003), respectively. We conclude that these genetic aberrations may be used for risk group stratification of pediatric AMKL and for treatment tailoring.

  12. Stratification and therapeutic potential of PML in metastatic breast cancer

    Science.gov (United States)

    Martín-Martín, Natalia; Piva, Marco; Urosevic, Jelena; Aldaz, Paula; Sutherland, James D.; Fernández-Ruiz, Sonia; Arreal, Leire; Torrano, Verónica; Cortazar, Ana R.; Planet, Evarist; Guiu, Marc; Radosevic-Robin, Nina; Garcia, Stephane; Macías, Iratxe; Salvador, Fernando; Domenici, Giacomo; Rueda, Oscar M.; Zabala-Letona, Amaia; Arruabarrena-Aristorena, Amaia; Zúñiga-García, Patricia; Caro-Maldonado, Alfredo; Valcárcel-Jiménez, Lorea; Sánchez-Mosquera, Pilar; Varela-Rey, Marta; Martínez-Chantar, Maria Luz; Anguita, Juan; Ibrahim, Yasir H.; Scaltriti, Maurizio; Lawrie, Charles H.; Aransay, Ana M.; Iovanna, Juan L.; Baselga, Jose; Caldas, Carlos; Barrio, Rosa; Serra, Violeta; dM Vivanco, Maria; Matheu, Ander; Gomis, Roger R.; Carracedo, Arkaitz

    2016-01-01

    Patient stratification has been instrumental for the success of targeted therapies in breast cancer. However, the molecular basis of metastatic breast cancer and its therapeutic vulnerabilities remain poorly understood. Here we show that PML is a novel target in aggressive breast cancer. The acquisition of aggressiveness and metastatic features in breast tumours is accompanied by the elevated PML expression and enhanced sensitivity to its inhibition. Interestingly, we find that STAT3 is responsible, at least in part, for the transcriptional upregulation of PML in breast cancer. Moreover, PML targeting hampers breast cancer initiation and metastatic seeding. Mechanistically, this biological activity relies on the regulation of the stem cell gene SOX9 through interaction of PML with its promoter region. Altogether, we identify a novel pathway sustaining breast cancer aggressiveness that can be therapeutically exploited in combination with PML-based stratification. PMID:27553708

  13. Stratification and therapeutic potential of PML in metastatic breast cancer.

    Science.gov (United States)

    Martín-Martín, Natalia; Piva, Marco; Urosevic, Jelena; Aldaz, Paula; Sutherland, James D; Fernández-Ruiz, Sonia; Arreal, Leire; Torrano, Verónica; Cortazar, Ana R; Planet, Evarist; Guiu, Marc; Radosevic-Robin, Nina; Garcia, Stephane; Macías, Iratxe; Salvador, Fernando; Domenici, Giacomo; Rueda, Oscar M; Zabala-Letona, Amaia; Arruabarrena-Aristorena, Amaia; Zúñiga-García, Patricia; Caro-Maldonado, Alfredo; Valcárcel-Jiménez, Lorea; Sánchez-Mosquera, Pilar; Varela-Rey, Marta; Martínez-Chantar, Maria Luz; Anguita, Juan; Ibrahim, Yasir H; Scaltriti, Maurizio; Lawrie, Charles H; Aransay, Ana M; Iovanna, Juan L; Baselga, Jose; Caldas, Carlos; Barrio, Rosa; Serra, Violeta; Vivanco, Maria dM; Matheu, Ander; Gomis, Roger R; Carracedo, Arkaitz

    2016-08-24

    Patient stratification has been instrumental for the success of targeted therapies in breast cancer. However, the molecular basis of metastatic breast cancer and its therapeutic vulnerabilities remain poorly understood. Here we show that PML is a novel target in aggressive breast cancer. The acquisition of aggressiveness and metastatic features in breast tumours is accompanied by the elevated PML expression and enhanced sensitivity to its inhibition. Interestingly, we find that STAT3 is responsible, at least in part, for the transcriptional upregulation of PML in breast cancer. Moreover, PML targeting hampers breast cancer initiation and metastatic seeding. Mechanistically, this biological activity relies on the regulation of the stem cell gene SOX9 through interaction of PML with its promoter region. Altogether, we identify a novel pathway sustaining breast cancer aggressiveness that can be therapeutically exploited in combination with PML-based stratification.

  14. Fatigue of LMFBR piping due to flow stratification

    Energy Technology Data Exchange (ETDEWEB)

    Woodward, W.S.

    1983-01-01

    Flow stratification due to reverse flow was simulated in a 1/5-scale water model of a LMFBR primary pipe loop. The stratified flow was observed to have a dynamic interface region which oscillated in a wave pattern. The behavior of the interface was characterized in terms of location, local temperature fluctuation and duration for various reverse flow conditions. A structural assessment was performed to determine the effects of stratified flow on the fatigue life of the pipe. Both the static and dynamic aspects of flow stratification were examined. The dynamic interface produces thermal striping on the inside of the pipe wall which is shown to have the most deleterious effect on the pipe wall and produce significant fatigue damage relative to a static interface.

  15. Stratification and thermocirculation in a solar passive water wall

    Energy Technology Data Exchange (ETDEWEB)

    Russell, L.D.; Mustafa, H.; Johnson, R.

    1981-01-01

    The solar passive water wall is a passive system which collects, stores, and distributes thermal energy for the heating of buildings. An analytical model is presented in this paper for calculation of the thermocirculation through the water wall. Representative measured data are presented for the temperature stratification which occurs in a continuous water column of a water wall 2.4 meters high. 10 refs.

  16. Clinical risk stratification for gastrointestinal hemorrhage: still no consensus

    Science.gov (United States)

    Wira, Charles; Sather, John

    2008-01-01

    A lack of consensus exists in the pre-endoscopic risk stratification of patients with upper or lower gastrointestinal hemorrhage. The work by Das and colleagues in the previous issue of Critical Care serves to externally validate the BLEED criteria. Their results suggest that hemodynamically stable patients without evidence of ongoing bleeding or unstable comorbidities may be at lower risk for hospital complications. While their results reinforce previous studies, further investigation is needed before comprehensive practice guidelines can be established. PMID:18533048

  17. Potential Impacts of Offshore Wind Farms on North Sea Stratification.

    Science.gov (United States)

    Carpenter, Jeffrey R; Merckelbach, Lucas; Callies, Ulrich; Clark, Suzanna; Gaslikova, Lidia; Baschek, Burkard

    2016-01-01

    Advances in offshore wind farm (OWF) technology have recently led to their construction in coastal waters that are deep enough to be seasonally stratified. As tidal currents move past the OWF foundation structures they generate a turbulent wake that will contribute to a mixing of the stratified water column. In this study we show that the mixing generated in this way may have a significant impact on the large-scale stratification of the German Bight region of the North Sea. This region is chosen as the focus of this study since the planning of OWFs is particularly widespread. Using a combination of idealised modelling and in situ measurements, we provide order-of-magnitude estimates of two important time scales that are key to understanding the impacts of OWFs: (i) a mixing time scale, describing how long a complete mixing of the stratification takes, and (ii) an advective time scale, quantifying for how long a water parcel is expected to undergo enhanced wind farm mixing. The results are especially sensitive to both the drag coefficient and type of foundation structure, as well as the evolution of the pycnocline under enhanced mixing conditions-both of which are not well known. With these limitations in mind, the results show that OWFs could impact the large-scale stratification, but only when they occupy extensive shelf regions. They are expected to have very little impact on large-scale stratification at the current capacity in the North Sea, but the impact could be significant in future large-scale development scenarios.

  18. Translated Poisson Mixture Model for Stratification Learning (PREPRINT)

    Science.gov (United States)

    2007-09-01

    unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Translated Poisson Mixture Model for Stratification Learning Gloria Haro Dept. Teoria ...Pless. Figure 1 shows, for each algorithm, the point cloud with each point colored and marked differently according to its classification. In the dif...1: Clustering of a spiral and a plane. Results with different algorithms (this is a color figure). Due to the statistical nature of the R-TPMM

  19. Metrics for Evaluating Performance of Prognostic Techniques

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics is an emerging concept in condition basedmaintenance(CBM)ofcriticalsystems.Alongwith developing the fundamentals of being able to confidently predict...

  20. A DISTRIBUTED PROGNOSTIC HEALTH MANAGEMENT ARCHITECTURE

    Data.gov (United States)

    National Aeronautics and Space Administration — This paper introduces a generic distributed prognostic health management (PHM) architecture with specific application to the electrical power systems domain. Current...

  1. Health Monitoring and Prognostics for Computer Servers

    Data.gov (United States)

    National Aeronautics and Space Administration — Abstract Prognostics solutions for mission critical systems require a comprehensive methodology for proactively detecting and isolating failures, recommending and...

  2. A Survey of Artificial Intelligence for Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Integrated Systems Health Management includes as key elements fault detection, fault diagnostics, and failure prognostics. Whereas fault detection and diagnostics...

  3. Simulating Degradation Data for Prognostic Algorithm Development

    Data.gov (United States)

    National Aeronautics and Space Administration — PHM08 Challenge Dataset is now publicly available at the NASA Prognostics Respository + Download INTRODUCTION - WHY SIMULATE DEGRADATION DATA? Of various challenges...

  4. Prognostic Importance of Pretransplant Functional Capacity After Allogeneic Hematopoietic Cell Transplantation

    Science.gov (United States)

    Devlin, Sean M.; Maloy, Molly A.; Wood, William A.; Tuohy, Sharlynn; Espiritu, Noel; Aquino, Jennifer; Kendig, Tiffany; Michalski, Meghan G.; Gyurkocza, Boglarka; Schaffer, Wendy L.; Ali, Benzar; Giralt, Sergio; Jakubowski, Ann A.

    2015-01-01

    Background. The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies. Patients and Methods. Using a retrospective design, 407 patients completed a 6-minute walk distance (6MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6MWD category ( .05 for all). Patients presenting with a pre-HCT 6MWD of <400 m and experiencing a decline in 6MWD had the highest risk of NRM. Conclusion. The 6MWD is a significant univariate predictor of clinical outcomes but did not provide prognostic information beyond that of traditional prognostic markers in HCT. Implications for Practice: The pretransplant 6-minute walk test is a significant univariate predictor of clinical outcomes in hematological patients beyond age but not beyond that of performance status. On this basis, 6-minute walk distance testing should not be considered part of the standard battery of assessments for risk stratification before hematopoietic cell transplantation. PMID:26446235

  5. The prognostic value of serum LDH levels in patients with hepatocellualr carcinoma after hepatic resection.

    Science.gov (United States)

    Hu, Wen-Jie; Fu, Shun-Jun; Diao, Jing-Fang; Wan, Dai-Wei; Tan, Zhi-Jian; Zhi, Qiao-Ming; He, Jun-Ming

    2015-07-16

    Serum lactate dehydrogenase (LDH) is a prognostic marker in many tumor types. The present study is to determine the value of preoperative peripheral LDH in predicting the prognosis of patients with HCC after hepatectomy. Clinicopathological and follow-up data selected 323 HCC patients who underwent hepatectomy. These patients were categorized as high LDH(>240 U/I) and low LDH group (≤ 240 U/I). Significant differences in tumor size, capsulation, tumor number, vascular invasion and TNM stage were observed between these two groups (P 240 U/I group were poorer than those in the LDH ≤ 240 U/I group respectively. Multivariate analysis demonstrated that LDH > 240 U/I served as an independent prognostic indicator of worse disease-free survival [hazard ratio (HR) = 1.711; 95% confidence interval (CI), 1.275-2.297; P < 0.001] and overall survival (HR = 1.568; 95% CI, 1.144-2.149; P = 0.005). Stratification analysis showed that LDH exhibited a greater predictive value for DFS and OS in HCC patients with with AFP < 200 ng/ml. Our results suggested that serum LDH level might be a potential and reliable prognostic biomarker in HCC patients after liver resection.

  6. Effects of strong stratification on equatorward dynamo wave propagation

    CERN Document Server

    Käpylä, Petri J; Cole, Elizabeth; Warnecke, Jörn; Brandenburg, Axel

    2013-01-01

    We present results from simulations of rotating magnetized turbulent convection in spherical wedge geometry representing parts of the latitudinal and longitudinal extents of a star. Here we consider a set of runs for which the density stratification is varied, keeping the Reynolds and Coriolis numbers at similar values. In the case of weak stratification we find quasi-steady solutions for moderate rotation and oscillatory dynamos with poleward migration of activity belts for more rapid rotation. For stronger stratification a similar transition as a function of the Coriolis number is found, but with an equatorward migrating branch near the equator. We test the domain size dependence of our results for a rapidly rotating run with equatorward migration by varying the longitudinal extent of our wedge. The energy of the axisymmetric mean magnetic field decreases as the domain size increases and we find that an m=1 mode is excited for a full 2pi phi-extent, reminiscent of the field configurations deduced from obser...

  7. Microfluidic destabilization of viscous stratifications: Interfacial waves and droplets

    Science.gov (United States)

    Hu, Xiaoyi; Cubaud, Thomas

    2016-11-01

    Microfluidic two-fluid flows with large differences in viscosity are experimentally investigated to examine the role of fluid properties on hydrodynamic destabilization processes at the small scale. Two- and three-layer flow configurations are systematically studied in straight square microchannels using miscible and immiscible fluid pairs. We focus our attention on symmetric three-layer stratifications with a fast central stream made of low-viscosity fluid and a slow sheath flow composed of high-viscosity fluid. We quantify the influence of the capillary and the Reynolds numbers on the formation and evolution of droplets and wavy stratifications. Several functional relationships are developed for the morphology and dynamics of droplets and interfacial waves including size, celerity and frequency. In the wavy stratification regime, the formation and entrainment of thin viscous ligaments from wave crests display a rich variety of dynamics either in the presence or in the absence of interfacial tension between liquids. This work is supported by NSF (CBET-1150389).

  8. Glasgow Prognostic Score (GPS) can be a useful indicator to determine prognosis of patients with colorectal carcinoma.

    Science.gov (United States)

    Nozoe, Tadahiro; Matono, Rumi; Ijichi, Hideki; Ohga, Takefumi; Ezaki, Takahiro

    2014-01-01

    The Glasgow Prognostic Score (GPS), an inflammation-based score, has been used to predict the biologic behavior of malignant tumors. The aim of the current study was to elucidate a further significance of GPS in colorectal carcinoma. Correlation of GPS and modified GPS (mGPS), which are composed of combined score provided for serum elevation of C-reactive protein and hypoalbuminemia examined before surgical treatment, with clinicopathologic features was investigated in 272 patients with colorectal carcinoma. Survival of GPS 1 patients was significantly worse than that of GPS 0 patients (P= 0.009), and survival of GPS 2 patients was significantly worse than that of GPS 1 patients (P GPS (P GPS and mGPS could classify outcome of patients with a clear stratification, and could be applied as prognostic indicators in colorectal carcinoma.

  9. [Prognostic factors in hantavirus infections].

    Science.gov (United States)

    Kaya, Selçuk

    2014-01-01

    The hantaviruses classified in Hantavirus genus of Bunyaviridae family, may cause two different types of clinical conditions, namely hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Mortality may reach up to 40% in these infections. Hantavirus subtypes (Sin Nombre, Hantaan, Seoul, Puumala, Dobrava, etc) with different virulences represent one of the most significant factors affecting the mortality. Additionally, many other factors including age, gender, humoral immune response, genetic factors, patient's clinical and laboratory findings, transfusion, mechanical ventilation requirement, antiviral treatment and immunotherapy administered to the patient are prognostically important. Increasing age had an unfavorable effect on mortality. While the disease is commonly observed in the male gender, mortality rate is higher in the female gender. The higher the emergent neutralizing antibody response, the virus spread, the number of the infected cells and the cytotoxic T lymphocyte-mediated injury will be lower. The requirement for dialysis is reported to be higher with a poorer prognosis in individuals with HLA-B8, -DR3, -DQ2 alleles, and those with HLA-B27 allele usually experience a milder clinical course. Clinically, the risk of mortality increases in patients with multiple, central nervous system hemorrhage, sepsis, disseminated intravascular coagulation (DIC) and secondary infection. The presence of adult respiratory distress syndrome (ARDS), the requirement for mechanical ventilation, the presence of dyspnea and hemoconcentration in HPS are reported to be the most important prognostic factors associated with death. The correlation of severity and the transfusion requirement with mortality was demonstrated. High serum levels of white blood cells, blood urea nitrogen (BUN), creatinine phophokinase (CPK), C-reactive protein (CRP), prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer and INR (International

  10. Repeated diffusion MRI reveals earliest time point for stratification of radiotherapy response in brain metastases

    Science.gov (United States)

    Mahmood, Faisal; Johannesen, Helle H.; Geertsen, Poul; Hansen, Rasmus H.

    2017-04-01

    An imaging biomarker for early prediction of treatment response potentially provides a non-invasive tool for better prognostics and individualized management of the disease. Radiotherapy (RT) response is generally related to changes in gross tumor volume manifesting months later. In this prospective study we investigated the apparent diffusion coefficient (ADC), perfusion fraction and pseudo diffusion coefficient derived from diffusion weighted MRI as potential early biomarkers for radiotherapy response of brain metastases. It was a particular aim to assess the optimal time point for acquiring the DW-MRI scan during the course of treatment, since to our knowledge this important question has not been addressed directly in previous studies. Twenty-nine metastases (N  =  29) from twenty-one patients, treated with whole-brain fractionated external beam RT were analyzed. Patients were scanned with a 1 T MRI system to acquire DW-, T2*W-, T2W- and T1W scans, before start of RT, at each fraction and at follow up two to three months after RT. The DW-MRI parameters were derived using regions of interest based on high b-value images (b  =  800 s mm‑2). Both volumetric and RECIST criteria were applied for response evaluation. It was found that in non-responding metastases the mean ADC decreased and in responding metastases it increased. The volume based response proved to be far more consistently predictable by the ADC change found at fraction number 7 and later, compared to the linear response (RECIST). The perfusion fraction and pseudo diffusion coefficient did not show sufficient prognostic value with either response assessment criteria. In conclusion this study shows that the ADC derived using high b-values may be a reliable biomarker for early assessment of radiotherapy response for brain metastases patients. The earliest response stratification can be achieved using two DW-MRI scans, one pre-treatment and one at treatment day 7–9 (equivalent to 21

  11. Plasma copeptin for short term risk stratification in acute pulmonary embolism.

    Science.gov (United States)

    Wyzgał, Anna; Koć, Marcin; Pacho, Szymon; Bielecki, Maksymilian; Wawrzyniak, Radosław; Kostrubiec, Maciej; Ciurzyński, Michał; Kurnicka, Katarzyna; Goliszek, Sylwia; Paczyńska, Marzena; Palczewski, Piotr; Pruszczyk, Piotr

    2016-05-01

    Copeptin (COP) was reported to have prognostic value in various cardiovascular diseases. We hypothesized that COP levels reflect the severity of acute pulmonary embolism (PE) and may be useful in prognostic assessment. Plasma COP concentrations were measured on the Kryptor Compact Plus platform (BRAHMS, Hennigsdorf, Germany). The study included 107 consecutive patients with diagnosed acute PE (47 males, 60 females), with median age of 65 years (range 20-88). High risk PE was diagnosed in 3 patients (2.8 %), intermediate risk in 69 (64.5 %), and low risk PE in 35 (32.7 %) patients. Control group included 64 subjects (25 males, 39 females; median age 52.5 year, range 17-87). Four patients (3.7 %) died during 30-day observation. Complicated clinical course (CCC) was experienced by 10 (9.3 %) patients. COP level was higher in PE patients than in controls [11.55 pmol/L (5.16-87.97), and 19.00 pmol/L (5.51-351.90), respectively, p < 0.0001], and reflected PE severity. COP plasma concentration in low risk PE was 14.67 nmol/L (5.51-59.61) and in intermediate/high risk PE 19.84 mol/L (5.64-351.90) p < 0.05. Median COP levels in nonsurvivors was higher than in survivors, 84.6 (28.48-351.9) pmol/L and 18.68 (5.512-210.1) pmol/L, respectively, p = 0.009. Subjects with CCC presented higher COP levels than patients with benign clinical course 53.1 (17.95-351.9) pmol/L and 18.16 (5.51-210.1) pmol/L, respectively, p = 0.001. Log-transformed plasma COP was the significant predictor of CCC, OR 16.5 95 % CI 23.2-111.9, p < 0.001. AUC-for prediction of CCC using plasma COP was 0.811 (95 % CI 0.676-0.927). The COP cut off value of 17.95 nmol/l had sensitivity of 100 %, specificity 49.5 %, positive predictive value of 16.9 % and negative predictive value of 100 %. We conclude that plasma COP levels can be regarded for promising marker of severity of acute PE and show potential in risk stratification of these patients.

  12. Systematically enhanced subarctic Pacific stratification and nutrient utilization during glacials

    Science.gov (United States)

    Knudson, K. P.; Ravelo, A. C.

    2015-12-01

    The modern subarctic North Pacific is characterized as a high-nitrate, low-chlorophyll (HNLC) area, but evidence for increased nutrient utilization during the last glacial indicates that this region is highly dynamic. As such, this HNLC area is of particular interest in regard to understanding changes in the biological pump and carbon sequestration and predicting how biogeochemical processes will influence, or be influenced by, future climate change. While it has been suggested that changes in iron supply and/or ocean stratification could explain fluctuations in nutrient utilization and productivity in the subarctic Pacific, short records of nutrient utilization have previously hindered the evaluation of these potential mechanisms over long timescales. Here we present new, high-resolution records of bulk sediment δ15N from 0-1.2 Ma from Integrated Ocean Drilling Program Exp. 323 Site U1342, which are used to calculate Δδ15N (U1342 δ15Nbulk - ODP Site 1012 δ15Nbulk) as a nitrate utilization proxy. The unprecedented length and resolution of this new record allows us, for the first time, to determine orbital-scale systematic behavior in subarctic Pacific nutrient utilization over many glacial/interglacial cycles. Spectral analyses demonstrate that enhanced nutrient utilization was paced by climate on Milankovitch orbital cycles since the Mid-Pleistocene Transition (MPT; ~800 ka). Nitrate utilization maxima is statistically correlated with glacial maxima and enhanced dust/iron availability (represented by existing records of EPICA ice core dust, Southern Pacific Ocean sediment iron, and China loess) but shows low correlation to primary productivity, suggesting that stratification has systematically exerted an important control on subarctic Pacific nutrient utilization since the MPT. These findings imply that the presence of iron helped to change the region into a nitrate-limited, rather than iron-limited, region during glacials and that stratification, which

  13. Prognostic impact of lymphocytes in soft tissue sarcomas.

    Directory of Open Access Journals (Sweden)

    Sveinung W Sorbye

    Full Text Available PURPOSE: The purpose of this study was to clarify the prognostic significance of lymphocyte infiltration in soft tissue sarcomas (STS. Prognostic markers in potentially curable STS should guide therapy after surgical resection. The immune status at the time of resection may be important, but the prognostic significance of tumor infiltrating lymphocytes is controversial as the immune system has conflicting roles during cancer development. EXPERIMENTAL DESIGN: Tissue microarrays from 249 patients with STS were constructed from duplicate cores of viable and representative neoplastic tumor areas. Immunohistochemistry was used to evaluate the CD3+, CD4+, CD8+, CD20+ and CD45+ lymphocytes in tumors. RESULTS: In univariate analyses, increased numbers of CD4+ (P = 0.008 and CD20+ (P = 0.006 lymphocytes in tumor correlated significantly with an improved disease-specific survival (DSS in patients with wide resection margins (n = 108. In patients with non-wide resection margins (n = 141 increased numbers of CD3+ (P = 0.028 lymphocytes in tumor correlated significantly with shorter DSS. In multivariate analyses, a high number of CD20+ lymphocytes (HR = 5.5, CI 95%  = 1.6-18.6, P = 0.006 in the tumor was an independent positive prognostic factor for DSS in patients with wide resections margins. CONCLUSIONS: High density of CD20+ lymphocytes in STS with wide resection margins is an independent positive prognostic indicator for these patients. Further research is needed to define if CD20+ cells can modify tumors in a way that reduces disease progression and metastatic potential.

  14. Prognostic factors for gastrectomy in elderly patients with gastric cancer.

    Science.gov (United States)

    Ueno, Daisuke; Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Akiyama, Takashi; Shiotani, Akiko; Hirai, Toshihiro

    2017-03-11

    The aim of the present study was to investigate the age-specific prognostic factors in patients who underwent gastrectomy for gastric cancer. The medical records of 366 patients with gastric cancer who underwent surgical resection at our hospital between January 2007 and December 2014 were retrospectively reviewed. Of the 366 patients, 117 were aged 75 years or older and 249 were aged 74 years or younger. All factors that were identified as significant using univariate analysis were included in the multivariate analysis. The median follow-up duration was 52.9 months (range, 1.0-117.5 months). We found that in patients aged 75 years or older, postoperative complications and the extent of cancer were independent prognostic factors of overall survival and disease-free survival. In contrast, in patients aged 74 years or younger, only the lymph node status and postoperative chemotherapy were independent prognostic factors for overall survival and disease-free survival, respectively. Pathological outcomes and postoperative complications are important prognostic factors for survival in patients aged 75 years or older with gastric cancer, whereas pathological outcomes and postoperative chemotherapy are important prognostic factors for survival in patients aged 74 years or younger. Because the prevention of postoperative complications may contribute to improvements in the prognosis of elderly patients with gastric cancer, we suggest that it is necessary to consider limited surgery instead of radical surgery, depending on the patient's general condition and co-morbidities.

  15. Prognostic Value of Brain Diffusion Weighted Imaging After Cardiac Arrest

    Science.gov (United States)

    Wijman, Christine A.C.; Mlynash, Michael; Caulfield, Anna Finley; Hsia, Amie W.; Eyngorn, Irina; Bammer, Roland; Fischbein, Nancy; Albers, Gregory W.; Moseley, Michael

    2009-01-01

    Objective Outcome prediction is challenging in comatose post-cardiac arrest survivors. We assessed the feasibility and prognostic utility of brain diffusion-weighted MRI (DWI) during the first week. Methods Consecutive comatose post-cardiac arrest patients were prospectively enrolled. MRI data of patients who met predefined specific prognostic criteria were used to determine distinguishing ADC thresholds. Group 1: death at 6 months and absent motor response or absent pupillary reflexes or bilateral absent cortical responses at 72 hours, or vegetative at 1 month. Group 2A: Glasgow outcome scale (GOS) score of 4 or 5 at 6 months. Group 2B: GOS of 3 at 6 months. The percentage of voxels below different apparent diffusion coefficient (ADC) thresholds was calculated at 50 × 10−6 mm2/sec intervals. Results Overall, 86% of patients underwent MR imaging. Fifty-one patients with 62 brain MRIs were included in the analyses. Forty patients met the specific prognostic criteria. The percentage of brain volume with an ADC value below 650–700 × 10−6 mm2/sec best differentiated between group 1 and groups 2A and 2B combined (p<0.001), while the 400–450 × 10−6 mm2/sec threshold best differentiated between groups 2A and 2B (p=0.003). The ideal time window for prognostication using DWI was between 49 to 108 hours after the arrest. When comparing MRI in this time window with the 72 hour neurological examination MRI improved the sensitivity for predicting poor outcome by 38% while maintaining 100% specificity (p=0.021). Interpretation Quantitative DWI in comatose post-cardiac arrest survivors holds great promise as a prognostic adjunct. PMID:19399889

  16. Prognostic Indexes for Brain Metastases: Which Is the Most Powerful?

    Energy Technology Data Exchange (ETDEWEB)

    Arruda Viani, Gustavo, E-mail: gusviani@gmail.com [Department of Radiation Oncology, Marilia Medical School, Marilia, Sao Paulo, SP (Brazil); Bernardes da Silva, Lucas Godoi; Stefano, Eduardo Jose [Department of Radiation Oncology, Marilia Medical School, Marilia, Sao Paulo, SP (Brazil)

    2012-07-01

    survival of patients with BMs to a more or less satisfactory degree. Among the 5 PIs evaluated in the present study, GPA was the most powerful in predicting survival. Additional studies should include emerging biologic prognostic factors to improve the sensibility of these PIs.

  17. Fundamental Interactions in Gasoline Compression Ignition Engines with Fuel Stratification

    Science.gov (United States)

    Wolk, Benjamin Matthew

    Transportation accounted for 28% of the total U.S. energy demand in 2011, with 93% of U.S. transportation energy coming from petroleum. The large impact of the transportation sector on global climate change necessitates more-efficient, cleaner-burning internal combustion engine operating strategies. One such strategy that has received substantial research attention in the last decade is Homogeneous Charge Compression Ignition (HCCI). Although the efficiency and emissions benefits of HCCI are well established, practical limits on the operating range of HCCI engines have inhibited their application in consumer vehicles. One such limit is at high load, where the pressure rise rate in the combustion chamber becomes excessively large. Fuel stratification is a potential strategy for reducing the maximum pressure rise rate in HCCI engines. The aim is to introduce reactivity gradients through fuel stratification to promote sequential auto-ignition rather than a bulk-ignition, as in the homogeneous case. A gasoline-fueled compression ignition engine with fuel stratification is termed a Gasoline Compression Ignition (GCI) engine. Although a reasonable amount of experimental research has been performed for fuel stratification in GCI engines, a clear understanding of how the fundamental in-cylinder processes of fuel spray evaporation, mixing, and heat release contribute to the observed phenomena is lacking. Of particular interest is gasoline's pressure sensitive low-temperature chemistry and how it impacts the sequential auto-ignition of the stratified charge. In order to computationally study GCI with fuel stratification using three-dimensional computational fluid dynamics (CFD) and chemical kinetics, two reduced mechanisms have been developed. The reduced mechanisms were developed from a large, detailed mechanism with about 1400 species for a 4-component gasoline surrogate. The two versions of the reduced mechanism developed in this work are: (1) a 96-species version and (2

  18. Sudden cardiac arrest risk stratification based on 24-hour Holter ECG statistics.

    Science.gov (United States)

    Kasahara, Keisuke; Shiobara, Masahito; Nakamura, Saya; Yamashiro, Koichiro; Yana, Kazuo; Ono, Takuya

    2015-08-01

    This study examined the feasibility of using indices obtained from a long term Holter ECG record for sudden cardiac arrest (SCA) risk stratification. The ndices tested were the QT-RR interval co-variability and the alternans ratio percentile (ARP(θ)) which is defined as the θ(th) percentile of alternans ratios over a 24 hour period. The QT-RR interval co-variabilities are evaluated by the serial correlation coefficient between QT and RR trend sequences (QTRC). Previously reported Kalman filter technique and a simple smoothing spline method for the trend estimation are compared. Parameter θ in the alternans ratio percentile index was optimized to achieve the best classification accuracy. These indices were estimated from 26 cardiovascular outpatients for Holter ECG record. Patients were classified into high and low risk groups according to their clinical diagnosis, and the obtained indices were compared with those of 25 control subjects. A risk stratification using the two indices QTRC and ARP(θ) yielded an average sensitivity of 0.812 and a specificity of 0.925. The sensitivities and specificities of all three categories exceeded 0.8 except for the sensitivity to detect the high-risk patient group. Other short-term ECG parameters may need to be incorporated in order to improve the sensitivity.

  19. Cystatin C for enhancement of risk stratification in non-ST elevation acute coronary syndrome patients with an increased troponin T.

    NARCIS (Netherlands)

    Windhausen, F.; Hirsch, A.; Fischer, J.; Zee, P.M. van der; Sanders, G.T.; Straalen, J.P. van; Cornel, J.H.; Tijssen, J.G.P.; Verheugt, F.W.A.; Winter, R.J. de

    2009-01-01

    BACKGROUND: We assessed the value of cystatin C for improvement of risk stratification in patients with non-ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective

  20. Cystatin C for enhancement of risk stratification in non-ST elevation acute coronary syndrome patients with an increased troponin T.

    NARCIS (Netherlands)

    Windhausen, F.; Hirsch, A.; Fischer, J.; Zee, P.M. van der; Sanders, G.T.; Straalen, J.P. van; Cornel, J.H.; Tijssen, J.G.P.; Verheugt, F.W.A.; Winter, R.J. de

    2009-01-01

    BACKGROUND: We assessed the value of cystatin C for improvement of risk stratification in patients with non-ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective in

  1. Cystatin C for Enhancement of Risk Stratification in Non-ST Elevation Acute Coronary Syndrome Patients with an Increased Troponin T

    NARCIS (Netherlands)

    F. Windhausen; A. Hirsch; J. Fischer; P.M. van der Zee; G.T. Sanders; J.P. van Straalen; J.H. Cornel; J.G.P. Tijssen; F.W.A. Verheugt; R.J. de Winter

    2009-01-01

    BACKGROUND: We assessed the value of cystatin C for improvement of risk stratification in patients with non-ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective in

  2. Ventricular arrhythmias in competitive athletes: risk stratification with T-wave alternans

    Directory of Open Access Journals (Sweden)

    Rita Pizzi

    2009-08-01

    Full Text Available Introduction: Aim of our study is to evaluate the role of TWA to stratify the risk of sudden cardiac death in athletes (Ath with complex ventricular arrhythmias (VA, and to document a possible correlation between TWA and electrophysiological testing (EES results. Methods: We studied 43 Ath with VA (31 M, mean age 34 ± 12 years. In all cases a cardiological evaluation was performed, including TWA and EES. The patients were evaluated during a followup of 25 ± 22 months. The end-point was the occurrence of sudden death or malignant ventricular tachyarrhythmias (VT. Results: TWA was negative in 28 Ath (65%, positive in 8 (19% and indeterminate in 7 (16%. All subjects with negative TWA did not show induction of VT at EES, with significant correlation between negative TWA and negative EES (p<0.001. All Ath with positive TWA also had VT induced by a EES, but without significant correlation between positive TWA and positive EES. In 2 Ath with undetermined TWA (29% VT were induced at EES. Our data did not show significant correlation between indeterminate TWA and positive or negative EES. However, logistic regression analysis showed significant correlation between abnormal TWA test (positive or indeterminate and inducibility of VT at EES (p<0.001. During follow-up we observed a significant difference in end-point occurrence between Ath with negative or positive TWA and between Ath with negative or positive EES. Conclusion: TWA confirm its role as a simple and non-invasive test, and it seems useful for prognostic stratification of Ath with VA. (Heart International 2007; 3: 58-67

  3. Prognostic radiographic aspects of spondylolisthesis

    Energy Technology Data Exchange (ETDEWEB)

    Saraste, H.; Brostroem, L.A.; Aparisi, T.

    1984-01-01

    A series of 202 patients (133 men, 69 women) with lumbar spondylolysis were examined radiographically on two occasions, first at the time of diagnosis and later at a follow-up, after an observation period of 20 years or more. The films from patients in groups without and with moderate and severe olisthesis were evaluated with respect to variables describing lumbosacral lordosis, wedging of the spondylolytic vertebra, lengths of the transverse processes and iliolumbar ligaments, disk height, progression of slipping, and influence on measured olisthesis of lumbar spine flexion and extension at the radiographic examination. The evaluation was made with special attention to possible signs which could be predictive for the prognosis of vertebral slipping. Progression of slipping did not differ between patients diagnosed as adults or adolescents. Reduction of disk height was correlated to the degree of slipping present at the initial examination and to the progression of olisthesis. Flexion and extension of the lumbar spine did not modify the degree of olisthesis. Data concerning the lengths of the transverse processes and the iliolumbar ligaments, and lumbar lordosis, cannot be used for prognostic purposes. The lumbar index reflecting the degree of wedge deformity of the spondylolytic vertebra was shown to be the only variable of prognostic value for the development of vertebral slipping.

  4. Prognostic Analysis System and Methods of Operation

    Science.gov (United States)

    MacKey, Ryan M. E. (Inventor); Sneddon, Robert (Inventor)

    2014-01-01

    A prognostic analysis system and methods of operating the system are provided. In particular, a prognostic analysis system for the analysis of physical system health applicable to mechanical, electrical, chemical and optical systems and methods of operating the system are described herein.

  5. Distributed Prognostics based on Structural Model Decomposition

    Science.gov (United States)

    Daigle, Matthew J.; Bregon, Anibal; Roychoudhury, I.

    2014-01-01

    Within systems health management, prognostics focuses on predicting the remaining useful life of a system. In the model-based prognostics paradigm, physics-based models are constructed that describe the operation of a system and how it fails. Such approaches consist of an estimation phase, in which the health state of the system is first identified, and a prediction phase, in which the health state is projected forward in time to determine the end of life. Centralized solutions to these problems are often computationally expensive, do not scale well as the size of the system grows, and introduce a single point of failure. In this paper, we propose a novel distributed model-based prognostics scheme that formally describes how to decompose both the estimation and prediction problems into independent local subproblems whose solutions may be easily composed into a global solution. The decomposition of the prognostics problem is achieved through structural decomposition of the underlying models. The decomposition algorithm creates from the global system model a set of local submodels suitable for prognostics. Independent local estimation and prediction problems are formed based on these local submodels, resulting in a scalable distributed prognostics approach that allows the local subproblems to be solved in parallel, thus offering increases in computational efficiency. Using a centrifugal pump as a case study, we perform a number of simulation-based experiments to demonstrate the distributed approach, compare the performance with a centralized approach, and establish its scalability. Index Terms-model-based prognostics, distributed prognostics, structural model decomposition ABBREVIATIONS

  6. Concordance for prognostic models with competing risks

    NARCIS (Netherlands)

    M. Wolbers (Marcel); S. Blanche (Stephane); M. Koller (Michael); J.C.M. Witteman (Jacqueline); T.A. Gerds (Thomas)

    2014-01-01

    textabstractThe concordance probability is a widely used measure to assess discrimination of prognostic models with binary and survival endpoints. We formally define the concordance probability for a prognostic model of the absolute risk of an event of interest in the presence of competing risks and

  7. Development and Validation of a Lifecycle-based Prognostics Architecture with Test Bed Validation

    Energy Technology Data Exchange (ETDEWEB)

    Hines, J. Wesley [Univ. of Tennessee, Knoxville, TN (United States); Upadhyaya, Belle [Univ. of Tennessee, Knoxville, TN (United States); Sharp, Michael [Univ. of Tennessee, Knoxville, TN (United States); Ramuhalli, Pradeep [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Jeffries, Brien [Univ. of Tennessee, Knoxville, TN (United States); Nam, Alan [Univ. of Tennessee, Knoxville, TN (United States); Strong, Eric [Univ. of Tennessee, Knoxville, TN (United States); Tong, Matthew [Univ. of Tennessee, Knoxville, TN (United States); Welz, Zachary [Univ. of Tennessee, Knoxville, TN (United States); Barbieri, Federico [Univ. of Tennessee, Knoxville, TN (United States); Langford, Seth [Univ. of Tennessee, Knoxville, TN (United States); Meinweiser, Gregory [Univ. of Tennessee, Knoxville, TN (United States); Weeks, Matthew [Univ. of Tennessee, Knoxville, TN (United States)

    2014-11-06

    On-line monitoring and tracking of nuclear plant system and component degradation is being investigated as a method for improving the safety, reliability, and maintainability of aging nuclear power plants. Accurate prediction of the current degradation state of system components and structures is important for accurate estimates of their remaining useful life (RUL). The correct quantification and propagation of both the measurement uncertainty and model uncertainty is necessary for quantifying the uncertainty of the RUL prediction. This research project developed and validated methods to perform RUL estimation throughout the lifecycle of plant components. Prognostic methods should seamlessly operate from beginning of component life (BOL) to end of component life (EOL). We term this "Lifecycle Prognostics." When a component is put into use, the only information available may be past failure times of similar components used in similar conditions, and the predicted failure distribution can be estimated with reliability methods such as Weibull Analysis (Type I Prognostics). As the component operates, it begins to degrade and consume its available life. This life consumption may be a function of system stresses, and the failure distribution should be updated to account for the system operational stress levels (Type II Prognostics). When degradation becomes apparent, this information can be used to again improve the RUL estimate (Type III Prognostics). This research focused on developing prognostics algorithms for the three types of prognostics, developing uncertainty quantification methods for each of the algorithms, and, most importantly, developing a framework using Bayesian methods to transition between prognostic model types and update failure distribution estimates as new information becomes available. The developed methods were then validated on a range of accelerated degradation test beds. The ultimate goal of prognostics is to provide an accurate assessment for

  8. Effective Momentum and heat flux models for simulation of stratification and mixing in a large pool of water

    Energy Technology Data Exchange (ETDEWEB)

    Hua Li; Villanueva, W.; Kudinov, P. [Royal Institute of Technology (KTH). Div. of Nuclear Power Safety, Stockholm (Sweden)

    2012-06-15

    Performance of a boiling water reactor (BWR) containment is mostly determined by reliable operation of pressure suppression pool which serves as a heat sink to cool and condense steam released from the core vessel. Thermal stratification in the pool can significantly impede the pool's pressure suppression capacity. A source of momentum is required in order to break stratification and mix the pool. It is important to have reliable prediction of transient development of stratification and mixing in the pool in different regimes of steam injection. Previously, we have proposed to model the effect of steam injection on the mixing and stratification with the Effective Heat Source (EHS) and the Effective Momentum Source (EMS) models. The EHS model is used to provide thermal effect of steam injection on the pool, preserving heat and mass balance. The EMS model is used to simulate momentum induced by steam injection in different flow regimes. The EMS model is based on the combination of (1) synthetic jet theory, which predicts effective momentum if amplitude and frequency of flow oscillations in the pipe are given, and (2) model proposed by Aya and Nariai for prediction of the amplitude and frequency of oscillations at a given pool temperature and steam mass flux. The complete EHS/EMS models only require the steam mass flux, initial pool bulk temperature, and design-specific parameters, to predict thermal stratification and mixing in a pressure suppression pool. In this work we use EHS/EMS models implemented in containment thermal hydraulic code GOTHIC. The POOLEX/PPOOLEX experiments (Lappeenranta University of Technology, Finland) are utilized, to (a) quantify errors due to GOTHIC's physical models and numerical schemes, (b) propose necessary improvements in GOTHIC sub-grid scale modeling, and (c) validate our proposed models. Specifically the data from POOLEX STB-21 and PPOOLEX STR-03 and STR-04 tests are used for validation of the EHS and EMS models in this

  9. Cell Proliferation Activity and Prognostic Index in Squamous Cell Lung Carcinoma

    Directory of Open Access Journals (Sweden)

    José Antonio Alvarez-Riesgo

    1998-01-01

    Full Text Available Flow Cytometry (FC has been incorporated into cancer research in relation to its prognostic value together with histological parameters and TNM stages. We have studied by means of FC the cell cycle of 132 samples from male patients with Squamous Cell Lung Carcinoma (SQCLC. All of the patients received curative surgery and the clinical follow-up was 60 months. The clinical and cytometric parameters were evaluated in order to predict the patients’ outcome. The presence of tumoural recurrence and the tumoural stage showed statistical significance associated with survival. The multivariant analysis reveals radiotherapy (p = 0.004 as protective variable and the high S-phase fraction (SPF (p = 0.001 and stage IIIA (p = 0.012 as risk factors. The SPF appears as an independent prognostic factor for overall survival time. We can build a prognostic index representative of different prognostic groups, which allows us to improve the individual monitoring of these patients.

  10. Cell Proliferation Activity and Prognostic Index in Squamous Cell Lung Carcinoma

    Science.gov (United States)

    Alvarez-Riesgo, José Antonio; Sampedro, Andrés; Hernández, Radhamés; Folgueras, María Victoria; Salas-Bustamante, Ana; Cueto, Antonio

    1998-01-01

    Flow Cytometry (FC) has been incorporated into cancer research in relation to its prognostic value together with histological parameters and TNM stages. We have studied by means of FC the cell cycle of 132 samples from male patients with Squamous Cell Lung Carcinoma (SQCLC). All of the patients received curative surgery and the clinical follow-up was 60 months. The clinical and cytometric parameters were evaluated in order to predict the patients’ outcome. The presence of tumoural recurrence and the tumoural stage showed statistical significance associated with survival. The multivariant analysis reveals radiotherapy (p = 0.004) as protective variable and the high S-phase fraction (SPF) (p = 0.001) and stage IIIA (p = 0.012) as risk factors. The SPF appears as an independent prognostic factor for overall survival time. We can build a prognostic index representative of different prognostic groups, which allows us to improve the individual monitoring of these patients. PMID:9762370

  11. Predictive and prognostic value of preoperative serum tumor markers is EGFR mutation-specific in resectable non-small-cell lung cancer

    Science.gov (United States)

    Jiang, Richeng; Wang, Xinyue; Li, Kai

    2016-01-01

    Background The predictive and prognostic value of carcinoembryonic antigen (CEA), cytokeratin-19 fragments (Cyfra21-1), squamous cell carcinoma antigen (SCCA) and neuron-specific enolase (NSE) has been investigated in non-small-cell lung cancer (NSCLC) patients. However, few studies have directly focused on the association between these markers and epidermal growth factor receptor (EGFR) mutation status or mutation subtypes. Patients and methods We retrospectively analyzed 1016 patients with stage I-IIIA NSCLC who underwent complete resection between 2008 and 2012. Correlations between serum tumor marker levels and EGFR mutations and survival parameters were analyzed and prognostic factors were identified. Results Cyfra21-1 levels (P = 0.032 for disease-free survival [DFS]; P < 0.001 for overall survival [OS]) and clinical stage were identified as independent predictive and prognostic factors in EGFR-mutated adenocarcinoma patients. CEA levels (P < 0.001 for DFS; P = 0.002 for OS) and clinical stage were independently predictive and prognostic in EGFR wild-type adenocarcinoma patients. Further stratification analysis revealed that in EGFR exon 19 deletion adenocarcinomas, elevated Cyfra21-1 was an independent prognostic factor (P = 0.002). Within the Leu858Arg substitution subgroup, increased CEA (P = 0.005) and clinical stage were predictive factors of DFS, while elevated CEA (P = 0.005) and Cyfra21-1 (P = 0.027) were independent prognostic factors. Conclusion Cyfra21-1 and CEA exhibit different predictive and prognostic values between EGFR-mutated and wild-type adenocarcinomas, as well as between EGFR mutation subtypes. The prognostic impact of preoperative serum tumor markers should be evaluated together with EGFR mutation status. PMID:27072585

  12. Stratification at the Earth's largest hyperacidic lake and its consequences

    Science.gov (United States)

    Caudron, Corentin; Campion, Robin; Rouwet, Dmitri; Lecocq, Thomas; Capaccioni, Bruno; Syahbana, Devy; Suparjan; Purwanto, Bambang Heri; Bernard, Alain

    2017-02-01

    Volcanic lakes provide windows into the interior of volcanoes as they integrate the heat flux discharged by a magma body and condense volcanic gases. Volcanic lake temperatures and geochemical compositions therefore typically serve as warnings for resumed unrest or prior to eruptions. If acidic and hot, these lakes are usually considered to be too convective to allow any stratification within their waters. Kawah Ijen volcano, featuring the largest hyperacidic lake on Earth (volume of 27 million m3), is less homogeneous than previously thought. Hourly temperature measurements reveal the development of a stagnant layer of cold waters (<30 °C), overlying warmer and denser water (generally above 30 °C and density ∼1.083 kg/m3). Examination of 20 yrs of historical records and temporary measurements show a systematic thermal stratification during rainy seasons. The yearly rupture of stratification at the end of the rainy season causes a sudden release of dissolved gases below the cold water layer which appears to generate a lake overturn, i.e. limnic eruption, and a resonance of the lake, i.e. a seiche, highlighting a new hazard for these extreme reservoirs. A minor non-volcanic event, such as a heavy rainfall or an earthquake, may act as a trigger. The density driven overturn requires specific salinity-temperature conditions for the colder and less saline top water layer to sink into the hot saline water. Spectacular degassing occurs when the dissolved gases, progressively stored during the rainy season due to a weakened diffusion of carbon dioxide in the top layer, are suddenly released. These findings challenge the homogenization assumption at acidic lakes and stress the need to develop appropriate monitoring setups.

  13. Malaria stratification in a malarious area, a field exercise

    Institute of Scientific and Technical Information of China (English)

    Vatandoost Hassan; Esmailpour Mohammad; Hassen Abuelgasim; Oshaghi Mohamad Ali; Akbarzadeh Kamran; Hanafi-Bojd Ahmad Ali; Mashayekhi Minoo; Saffari Mohammad; Malik Elfatih M; Kenyi Luka; Abakar John Baptist; Busaq Alikhan

    2010-01-01

    Objective:To conducted a spatial analysis for stratification of priority malaria control areas in Kahnuj County, as part of field exercise.Methods:Information of Health Centers of Kahnuj County has been used for stratification retrospectively.A knowledge, attitudes and practices(KAP) study was arranged to provide preliminary information about the knowledge, attitude and practice related to malaria in the area.Results:Numbers of malaria cases has been decreased in year 2008. There were five important vectors of malaria in this region including:Anopheles stephensi (An. stephensi), Anopheles dthali (An. dthali), Anopheles superpictus (An. superpictus), Anophels culicifacies (An. culicifacies), andAnopheles fluviatilis (An. fluviatilis), but majority of malaria cases in this county was related toPlasmodium vivax (P. vivax). Educational levels of community were38%, 20%, 10% and 32% for illiterate, primary, secondary and university levels, respectively. KAPstudy revealed that about37% of people have got malaria at least once and only27% of people knew that mosquito is the vector of malaria.Conclusions: Malaria in Kahnuj represents a real threat. Transmission occurs in city center.An. stephensi can be suspected for the first peak of malaria cases in late spring in Kahnuj city.An. fluviatilishas a relatively high density in autumn while two malaria cases due toP. falciparum were reported in2008. Based onKAPstudy, the knowledge of respondents seems good but the attitude and practice is low. According to the data such asAPI, main malaria vector, transmission rate, and foreign migrants, the Kahnuj County has been spatially divided into three strata based on various characteristics. The authorities should implement all the interventions based on stratification.

  14. Time-dependent stratification in the Gauthami-Godavari Estuary

    Digital Repository Service at National Institute of Oceanography (India)

    Rao, T.V.N.

    dur- ing July to October, the flood months of the year. Results and Discussion SALINITY The tidally averaged salinity at Stations 1–3 in the winter and the dry seasons (Fig. 3) showed that the water in the upstream parts of the Gauthami- Godavari... quickly on the flood tide and minimum stratification of 0.3, 5.0, and 5.7 psu during the winter and 0.2, 5.9, and 8.2 psu during the dry season occur at Stations 1–3, respectively, and maximum surface salinity of 28.0, 24.5, and 19.9 psu during winter...

  15. The use of airborne laser scanning to develop a pixel-based stratification for a verified carbon offset project

    Science.gov (United States)

    2011-01-01

    Background The voluntary carbon market is a new and growing market that is increasingly important to consider in managing forestland. Monitoring, reporting, and verifying carbon stocks and fluxes at a project level is the single largest direct cost of a forest carbon offset project. There are now many methods for estimating forest stocks with high accuracy that use both Airborne Laser Scanning (ALS) and high-resolution optical remote sensing data. However, many of these methods are not appropriate for use under existing carbon offset standards and most have not been field tested. Results This paper presents a pixel-based forest stratification method that uses both ALS and optical remote sensing data to optimally partition the variability across an ~10,000 ha forest ownership in Mendocino County, CA, USA. This new stratification approach improved the accuracy of the forest inventory, reduced the cost of field-based inventory, and provides a powerful tool for future management planning. This approach also details a method of determining the optimum pixel size to best partition a forest. Conclusions The use of ALS and optical remote sensing data can help reduce the cost of field inventory and can help to locate areas that need the most intensive inventory effort. This pixel-based stratification method may provide a cost-effective approach to reducing inventory costs over larger areas when the remote sensing data acquisition costs can be kept low on a per acre basis. PMID:22004847

  16. Development of a Reduced-Order Three-Dimensional Flow Model for Thermal Mixing and Stratification Simulation during Reactor Transients

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Rui

    2017-09-03

    Mixing, thermal-stratification, and mass transport phenomena in large pools or enclosures play major roles for the safety of reactor systems. Depending on the fidelity requirement and computational resources, various modeling methods, from the 0-D perfect mixing model to 3-D Computational Fluid Dynamics (CFD) models, are available. Each is associated with its own advantages and shortcomings. It is very desirable to develop an advanced and efficient thermal mixing and stratification modeling capability embedded in a modern system analysis code to improve the accuracy of reactor safety analyses and to reduce modeling uncertainties. An advanced system analysis tool, SAM, is being developed at Argonne National Laboratory for advanced non-LWR reactor safety analysis. While SAM is being developed as a system-level modeling and simulation tool, a reduced-order three-dimensional module is under development to model the multi-dimensional flow and thermal mixing and stratification in large enclosures of reactor systems. This paper provides an overview of the three-dimensional finite element flow model in SAM, including the governing equations, stabilization scheme, and solution methods. Additionally, several verification and validation tests are presented, including lid-driven cavity flow, natural convection inside a cavity, laminar flow in a channel of parallel plates. Based on the comparisons with the analytical solutions and experimental results, it is demonstrated that the developed 3-D fluid model can perform very well for a wide range of flow problems.

  17. Risk stratification in Waldenström macroglobulinemia.

    Science.gov (United States)

    Morel, Pierre; Merlini, Giampaolo

    2012-04-01

    Waldenström macroglobulinemia is characterized by the production of serum monoclonal IgM and lymphoplasmacytic bone marrow infiltration. At least 25% of patients are asymptomatic at diagnosis and treatment is only mandatory in cases of symptomatic disease. Beside reports on treatment results, reviewing risk assessment is another way to describe the clinical course of the disease. This information may be particularly useful when numerous treatment options are available. While the introduction of new treatment approaches reinforces the need for careful risk assessment, the identification of useful prognostic information requires prolonged follow-up in patients who have not been treated with current therapeutic options. This limitation should be taken into account when using and interpreting available prognostic information, especially survival estimates.

  18. Stratification of Prognosis of Triple-Negative Breast Cancer Patients Using Combinatorial Biomarkers.

    Directory of Open Access Journals (Sweden)

    Yong Yue

    Full Text Available Triple-negative breast cancer (TNBC is highly diverse group of cancers, and generally considered an aggressive disease associated with poor survival. Stratification of TNBC is highly desired for both prognosis and treatment decisions to identify patients who may benefit from less aggressive therapy.This study retrieved 192 consecutive non-metastasis TNBC patients who had undergone a resection of a primary tumor from 2008 to 2012. All samples were negative for ER, PR, and HER2/neu. Disease-free-survival (DFS and overall-survival (OS were evaluated for expression of immunohistochemical biomarkers (P53, Ki-67, CK5/6 and EGFR, as well as clinicopathological variables including age, tumor size, grade, lymph node status, pathologic tumor and nodal stages. The cutoff values of the basal biomarkers, EGFR and CK5/6, were estimated by time-dependent ROC curves. The prognostic values of combinatorial variables were identified by univariate and multivariate Cox analysis. Patients were stratified into different risk groups based on expression status of identified prognostic variables.Median age was 57 years (range, 28-92 years. Patients' tumor stage and nodal stage were significantly associated with OS and DFS. EGFR and CK5/6 were significant prognostic variables at cutoff points of 15% (p = 0.001, AUC = 0.723, and 50% (p = 0.006, AUC = 0.675, respectively. Multivariate Cox analysis identified five significant variables: EGFR (p = 0.016, CK5/6 (p = 0.018, Ki-67 (p = 0.048, tumor stage (p = 0.010, and nodal stage (p = 0.003. Patients were stratified into low basal (EGFR≤15% and CK5/6≤50% and high basal (EGFR>15% and/or CK5/6>50% expression groups. In the low basal expression group, patients with low expressions of Ki-67, low tumor and nodal stage had significantly better survival than those with high expressions/stages of three variables, log-rank p = 0.015 (100% vs 68% at 50 months. In the high basal expression group, patient with high basal expression

  19. Numerical Study of Wake Vortex Behavior in Turbulent Domains with Ambient Stratification

    Science.gov (United States)

    Switzer, George F.; Proctor, Fred H.

    2000-01-01

    A three-dimensional large eddy simulation model is used to investigate the sensitivity of ambient stratification with turbulence on the behavior of aircraft wake vortices. Modeled ambient turbulence levels range from very weak to moderate, and stratification levels range from strongly stable to unstable. The results of profound significance from this study are: 1) very little sensitivity between vortex linking time and the level of stratification, 2) the mean vortex separation remained nearly constant regardless of stratification and turbulence (at least prior to linking), 3) the wake vortices did not rise regardless of the level of stratification, and 4) for very strong stratification, the vortex stopped descending and quickly dissipated even before vortex linking could occur. These results are supported by experimental data and are contrary to conclusions from other numerical studies that assume laminar flow and/or relatively-low Reynolds numbers.

  20. Validation of effective momentum and heat flux models for stratification and mixing in a water pool

    Energy Technology Data Exchange (ETDEWEB)

    Hua Li; Villanueva, W.; Kudinov, P. [Royal Institute of Technology (KTH), Div. of Nuclear Power Safety, Stockholm (Sweden)

    2013-06-15

    The pressure suppression pool is the most important feature of the pressure suppression system in a Boiling Water Reactor (BWR) that acts primarily as a passive heat sink during a loss of coolant accident (LOCA) or when the reactor is isolated from the main heat sink. The steam injection into the pool through the blowdown pipes can lead to short term dynamic phenomena and long term thermal transient in the pool. The development of thermal stratification or mixing in the pool is a transient phenomenon that can influence the pool's pressure suppression capacity. Different condensation regimes depending on the pool's bulk temperature and steam flow rates determine the onset of thermal stratification or erosion of stratified layers. Previously, we have proposed to model the effect of steam injection on the mixing and stratification with the Effective Heat Source (EHS) and the Effective Momentum Source (EMS) models. The EHS model is used to provide thermal effect of steam injection on the pool, preserving heat and mass balance. The EMS model is used to simulate momentum induced by steam injection in different flow regimes. The EMS model is based on the combination of (i) synthetic jet theory, which predicts effective momentum if amplitude and frequency of flow oscillations in the pipe are given, and (ii) model proposed by Aya and Nariai for prediction of the amplitude and frequency of oscillations at a given pool temperature and steam mass flux. The complete EHS/EMS models only require the steam mass flux, initial pool bulk temperature, and design-specific parameters, to predict thermal stratification and mixing in a pressure suppression pool. In this work we use EHS/EMS models implemented in containment thermal hydraulic code GOTHIC. The PPOOLEX experiments (Lappeenranta University of Technology, Finland) are utilized to (a) quantify errors due to GOTHIC's physical models and numerical schemes, (b) propose necessary improvements in GOTHIC sub-grid scale

  1. The Social-Institutional Bases of Gender Stratification: Japan as an Illustrative Case

    OpenAIRE

    1988-01-01

    Gender stratification theory can be informed by a cross-cultural perspective and greater attention to the embeddedness of stratification processes within the social context. This article focuses on how the development and evaluation of human capital varies across cultural settings and on the implications this has for the degree of gender stratification in the economy. An argument is made for the theoretical utility of the concept of a human capital development system, constituted by the way s...

  2. Coolant stratification and its thermohydrodynamic specificity under natural circulation in horizontal steam generator collectors

    Energy Technology Data Exchange (ETDEWEB)

    Blagovechtchenski, A.; Leontieva, V.; Mitriukhin, A. [Saint-Petersburg Technical Univ. (Russian Federation)

    1997-12-31

    The experiments and the test facilities for the study of the stratification phenomenon in the hot plenum of reactor and the upper parts of the steam generator collectors in a nuclear power plant are described. The aim of the experiments was to define the conditions of the stratification initiation, to study the temperature field in the upper part, the definition of the characteristics in the stratification layer, and also to study the factors which cause the intensity of the stagnant volume cooling.

  3. Stage II/III rectal cancer with intermediate response to preoperative radiochemotherapy: Do we have indications for individual risk stratification?

    Directory of Open Access Journals (Sweden)

    Becker Heinz

    2010-04-01

    Full Text Available Abstract Background Response to preoperative radiochemotherapy (RCT in patients with locally advanced rectal cancer is very heterogeneous. Pathologic complete response (pCR is accompanied by a favorable outcome. However, most patients show incomplete response. The aim of this investigation was to find indications for risk stratification in the group of intermediate responders to RCT. Methods From a prospective database of 496 patients with rectal adenocarcinoma, 107 patients with stage II/III cancers and intermediate response to preoperative 5-FU based RCT (ypT2/3 and TRG 2/3, treated within the German Rectal Cancer Trials were studied. Surgical treatment comprised curative (R0 total mesorectal excision (TME in all cases. In 95 patients available for statistical analyses, residual transmural infiltration of the mesorectal compartment, nodal involvement and histolologic tumor grading were investigated for their prognostic impact on disease-free (DFS and overall survival (OS. Results Residual tumor transgression into the mesorectal compartment (ypT3 did not influence DFS and OS rates (p = 0.619, p = 0.602, respectively. Nodal involvement after preoperative RCT (ypN1/2 turned out to be a valid prognostic factor with decreased DFS and OS (p = 0.0463, p = 0.0236, respectively. Persistent tumor infiltration of the mesorectum (ypT3 and histologic tumor grading of residual tumor cell clusters were strongly correlated with lymph node metastases after neoadjuvant treatment (p Conclusions Advanced transmural tumor invasion after RCT does not affect prognosis when curative (R0 resection is achievable. Residual nodal status is the most important predictor of individual outcome in intermediate responders to preoperative RCT. Furthermore, ypT stage and tumor grading turn out to be additional auxiliary factors. Future clinical trials for risk-adapted adjuvant therapy should be based on a synopsis of clinicopathologic parameters.

  4. Independent prognostic value of eosinophil and mast cell infiltration in colorectal cancer tissue

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Hansen, Ulla; Christensen, Ib Jarle;

    1999-01-01

    -assisted microscope, which allowed semi-automated quantification of cells within a fixed area. Total white cells and individual counts of eosinophils, neutrophils, mast cells, lymphocytes, and plasma cells were evaluated in every tumour specimen. Stratification into four groups with similar numbers of events was used...... age ( p=0.0003), and tumour location in the rectum predicted poor survival, while high counts of eosinophils ( p=0.006) and mast cells ( p=0.02) predicted good survival. Tumour-associated eosinophilia and mastocytosis appear to be independent prognostic variables in colorectal cancer. Future studies...... should investigate the potential biological role of tumour tissue eosinophils and mast cells in the modulation of tumour growth....

  5. MULTIGENERATIONAL ASPECTS OF SOCIAL STRATIFICATION: ISSUES FOR FURTHER RESEARCH.

    Science.gov (United States)

    Mare, Robert D

    2014-03-01

    The articles in this special issue show the vitality and progress of research on multigenerational aspects of social mobility, stratification, and inequality. The effects of the characteristics and behavior of grandparents and other kin on the statuses, resources, and positions of their descendants are best viewed in a demographic context. Intergenerational effects work through both the intergenerational associations of socioeconomic characteristics and also differential fertility and mortality. A combined socioeconomic and demographic framework informs a research agenda which addresses the following issues: how generational effects combine with variation in age, period, and cohort within each generation; distinguishing causal relationships across generations from statistical associations; how multigenerational effects vary across socioeconomic hierarchies, including the possibility of stronger effects at the extreme top and bottom; distinguishing between endowments and investments in intergenerational effects; multigenerational effects on associated demographic behaviors and outcomes (especially fertility and mortality); optimal tradeoffs among diverse types of data on multigenerational processes; and the variability across time and place in how kin, education, and other institutions affect stratification.

  6. Cardiovascular disease risk stratification and comparison in a California population.

    Science.gov (United States)

    Lin, Z; Meng, Y-Y; Leung, K-M; Jatulis, D E; Welsh, N J; Zaher, C A; Legorreta, A P

    2001-01-01

    This study was designed to identify the need for primary prevention of cardiovascular disease in an HMO population and to develop appropriate interventions for individuals in different risk groups, based on risk stratification and comparison. The analysis is based on a cross-sectional survey of the HMO members of a large employer group. Respondents (n=17,878) were stratified based on the Framingham model; 34% of respondents without cardiovascular disease were classified as moderate to high attributable risk for the disease, and 66% were classified as low attributable risk. Results of logistic regression analyses suggest that, compared with respondents with pre-existing cardiovascular disease, moderate- to high-risk respondents are more likely to smoke, have unhealthy diets, and be overweight, hypertensive, and hypercholesterolemic. More low-risk respondents had unhealthy diets than did those with pre-existing cardiovascular disease. There were no differences between these groups for physical activity and stress. Respondents had fewer modifiable risk factors and healthier lifestyles than did those who were at risk. These findings suggest that primary prevention should be enhanced, especially among those with significantly increased risk for the disease. Moreover, the approaches of this project-population-based risk assessment, stratification, and comparison-were instrumental in identifying the target population and designing appropriate interventions. (c) 2001 by CHF, Inc.

  7. Effects of stratification on an ocean surface Ekman layer

    Science.gov (United States)

    Pham, Hieu; Sarkar, Sutanu

    2014-11-01

    Large-eddy simulations are used to investigate the effects of stratification on structural and turbulent dynamics of an upper-ocean Ekman layer that is driven by a constant wind stress (friction velocity u*) at low latitude with Coriolis parameter f. The surface layer evolves in the presence of interior stratification whose buoyancy frequency varies among cases, taking three values: N / f = 19 , 60 and 192. At quasi-steady state, a stratified turbulent Ekman layer forms with a surface current veering to the right of the wind direction. The thickness of the Ekman layer decreases with increasing N and is found to scale with u*, f, and N, similar to the neutral atmospheric boundary layer of Zilitinkevich & Esau (2002) that is capped by a stratified layer with buoyancy frequency, N. As N increases, the speed of the Ekman current increases but the Ekman transport is invariant. The surface veering angle also increases with larger N. The shear rate and buoyancy frequency are elevated at the base of the Ekman layer. The peak of down-wind Reynolds stress occurs near the surface and scales with u*2 in all cases while the peak of cross-wind Reynolds stress occurs in the middle of the Ekman layer and decreases with increasing N.

  8. PROGNOSTIC FACTORS ANALYSIS FOR STAGEⅠ RECTAL CANCER

    Institute of Scientific and Technical Information of China (English)

    武爱文; 顾晋; 薛钟麒; 王怡; 徐光炜

    2001-01-01

    To explore the death-related factors of stageⅠrectal cancer patients. Methods: 89 cases of stage I rectal cancer patients between 1985 and 2000 were retrospectively studied for prognostic factors. Factors including age, gender, tumor size, circumferential occupation, gross type, pathological type, depth of tumor invasion, surgical procedure, adjuvant chemotherapy and postoperative complication were chosen for cox multivariate analysis (forward procedure) using Spss software (10.0 version). Results: multivariate analysis demonstrated that muscular invasion was an independent negative prognostic factor for stageⅠrectal cancer patients (P=0.003). Conclusion: Muscular invasion is a negative prognostic factor for stage I rectal cancer patients.

  9. Development and validation of effective models for simulation of stratification and mixing phenomena in a pool of water

    Energy Technology Data Exchange (ETDEWEB)

    Li, H.; Kudinov, P.; Villanueva, W. (Royal Institute of Technology (KTH). Div. of Nuclear Power Safety (Sweden))

    2011-06-15

    This work pertains to the research program on Containment Thermal-Hydraulics at KTH. The objective is to evaluate and improve performance of methods, which are used to analyze thermal-hydraulics of steam suppression pools in a BWR plant under different abnormal transient and accident conditions. The pressure suppression pool was designed to have the capability as a heat sink to cool and condense steam released from the core vessel and/or main steam line during loss of coolant accident (LOCA) or opening of safety relief valve in normal operation of BWRs. For the case of small flow rates of steam influx, thermal stratification could develop on the part above the blowdown pipe exit and significantly impede the pool's pressure suppression capacity. Once steam flow rate increases significantly, momentum introduced by the steam injection and/or periodic expansion and collapse of large steam bubbles due to direct contact condensation can destroy stratified layers and lead to mixing of the pool water. We use CFD-like model of the general purpose thermal-hydraulic code GOTHIC for addressing the issues of stratification and mixing in the pool. In the previous works we have demonstrated that accurate and computationally efficient prediction of the pool thermal-hydraulics in the scenarios with transition between thermal stratification and mixing, presents a computational challenge. The reason is that direct contact condensation phenomena, which drive oscillatory motion of the water in the blowdown pipes, are difficult to simulate with original GOTHIC models because of appearance of artificial oscillations due to numerical disturbances. To resolve this problem we propose to model the effect of steam injection on the mixing and stratification with the Effective Heat Source (EHS) model and the Effective Momentum Source (EMS) model. We use POOLEX/PPOOLEX experiment (Lappeenranta University of Technology in Finland), in order to (a) quantify errors due to GOTHIC

  10. Increasing the Knowledge of Stratification in Shallow Coastal Environments

    Science.gov (United States)

    Ojo, T.; Bonner, J.; Hodges, B.; Maidment, D.; Montagna, P.; Minsker, B.

    2006-12-01

    A testbed has been established using Corpus Christi Bay as an environmental field facility to study the phenomenon of hypoxia that has been observed to develop at certain periods during the year. Stratification affects vertical turbulent mixing of heat, momentum and mass (or constituents) within the water column, in turn influencing the transport of material. The mixing threshold is dependent on the value of the Richardson Number, Ri with inhibition due to stratification occurring at low values ( 0.25) of Ri. Corpus Christi Bay with average depth of ~3 m is the largest among a system of five bays has been known to stratify due to inflows of hypersaline water (up to 50 psu) from adjoining bays, the Laguna Madre and Oso Bay. Laguna Madre is separated from the Gulf of Mexico by a barrier island and becomes hypersaline because of the imbalance between inflow of freshwater and bay evaporation. Hypersalinity also occurs in Oso Bay due to anthropogenic forcing from a power plant that draws 400 MGD of cooling water from the upper Laguna Madre, discharging waste water into Oso Bay. Several wastewater treatment plants also discharge directly into Oso Bay or its tributary streams. The objective of this study is to develop a methodology for prescribing a set of parameters required for modeling and characterization of hypoxia in this shallow wind-driven bay. The extent to which Ri is dependent on external forcing at the surface boundary was measured using our fully instrumented sensor platforms. Each sensor platform includes sensors for synchronic near-surface meteorological (wind velocity, barometric pressure, air temperature) and water column oceanographic (current, water temperature, conductivity, particle size distribution, particulate concentration, dissolved oxygen, nutrient) variables. These were measured using fixed and mobile vertical profiling sensor platforms. A 2D hydrodynamic model was initially developed for the bay and results indicate that water mass is

  11. Prognostic value of MRD-dynamics in childhood acute lymphoblastic leukemia treated according to the MB-2002/2008 protocols.

    Science.gov (United States)

    Meleshko, Alexander N; Savva, Natalia N; Fedasenka, Uladzimir U; Romancova, Alexandra S; Krasko, Olga V; Eckert, Cornelia; von Stackelberg, Arend; Aleinikova, Olga V

    2011-10-01

    Detection of minimal residual disease (MRD) during the treatment of acute lymphoblastic leukemia (ALL) by RQ-PCR analysis of clonal Ig/TCR rearrangements is used for risk group stratification in European treatment protocols. In Belarus patients with childhood ALL are treated according to ALL-MB protocols, which do not use MRD-based risk stratification. To evaluate the prognostic significance of MRD for ALL-MB-2002/2008 protocols, MRD was quantified by RQ-PCR in 68 ALL patients at four time points: on day 15, on day 36, before and after maintenance therapy (MT). MRD positivity, as well as quantitative level of MRD were analyzed and compared between patients who stayed in remission and relapsed. Relapse-free survival revealed to be significantly associated with MRD levels at different time points. Unfavorable prognosis was shown for MRD≥10(-3) on day 36 (pPCR in children with ALL treated with ALL-MB protocols is feasible and independently associated with outcome. MRD may be a suitable parameter for treatment stratification in MB protocols in future.

  12. The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study.

    Science.gov (United States)

    de Groot, Bas; Stolwijk, Frank; Warmerdam, Mats; Lucke, Jacinta A; Singh, Gurpreet K; Abbas, Mo; Mooijaart, Simon P; Ansems, Annemieke; Esteve Cuevas, Laura; Rijpsma, Douwe

    2017-09-11

    Sepsis recognition in older emergency department (ED) patients is difficult due to atypical symptom presentation. We therefore investigated whether the prognostic and discriminative performance of the five most commonly used disease severity scores were appropriate for risk stratification of older ED sepsis patients (≥70 years) compared to a younger control group (<70 years). This was an observational multi-centre study using an existing database in which ED patients who were hospitalized with a suspected infection were prospectively included. Patients were stratified by age < 70 and ≥70 years. We assessed the association with in-hospital mortality (primary outcome) and the area under the curve (AUC) with receiver operator characteristics of the Predisposition, Infection, Response, Organ dysfunction (PIRO), quick Sequential Organ Failure Assessment (qSOFA), Mortality in ED Sepsis (MEDS), and the Modified and National Early Warning (MEWS and NEWS) scores. In-hospital mortality was 9.5% ((95%-CI); 7.4-11.5) in the 783 included older patients, and 4.6% (3.6-5.7) in the 1497 included younger patients. In contrast to younger patients, disease severity scores in older patients associated poorly with mortality. The AUCs of all disease severity scores were poor and ranged from 0.56 to 0.64 in older patients, significantly lower than the good AUC range from 0.72 to 0.86 in younger patients. The MEDS had the best AUC (0.64 (0.57-0.71)) in older patients. In older and younger patients, the newly proposed qSOFA score (Sepsis 3.0) had a lower AUC than the PIRO score (sepsis 2.0). The prognostic and discriminative performance of the five most commonly used disease severity scores was poor and less useful for risk stratification of older ED sepsis patients.

  13. Prognostic for hydraulic pump based upon DCT-composite spectrum and the modified echo state network.

    Science.gov (United States)

    Sun, Jian; Li, Hongru; Xu, Baohua

    2016-01-01

    Prognostic is a key step of the condition-based maintenance (CBM). In order to improve the predicting performance, a novel method for prognostic for the hydraulic pump is proposed in this paper. Based on the improvement of the traditional composite spectrum, the DCT-composite spectrum (DCS) fusion algorithm is initially presented to make fusion of multi-channel vibration signals. The DCS composite spectrum entropy is extracted as the feature. Furthermore, the modified echo state networks (ESN) model is established for prognostic using the extracted feature. The reservoir is updated and the elements of the neighboring matrix are redefined for improving predicting accuracy. Analysis of the application in the hydraulic pump degradation experiment demonstrates that the proposed algorithm is feasible and is meaningful for CBM.

  14. Low T3 syndrome is a strong prognostic predictor in diffuse large B cell lymphoma.

    Science.gov (United States)

    Gao, Rui; Liang, Jin-Hua; Wang, Li; Zhu, Hua-Yuan; Wu, Wei; Wu, Jia-Zhu; Xia, Yi; Cao, Lei; Fan, Lei; Yang, Tao; Li, Jian-Yong; Xu, Wei

    2017-02-01

    The aim of this study was to evaluate the prognostic effect of low triiodothyronine (T3) syndrome on patients with diffuse large B cell lymphoma (DLBCL). A hundred and eighty-eight patients with detailed thyroid hormone levels at diagnosis of DLBCL were enrolled. Low T3 syndrome was defined as a low serum free T3 (FT3) level with low or normal serum free tetraiodothyronine (FT4) and thyroid stimulating hormone levels. Multivariate Cox regression analysis was used to screen prognostic factors associated with progression-free survival (PFS) and overall survival (OS). Receiver-operator characteristic curves and the corresponding areas under the curve were calculated to assess the predictive accuracy of International Prognostic Index (IPI) and low T3 syndrome. Twenty-four patients were diagnosed with low T3 syndrome, which was associated with worse PFS and OS in the rituximab era. It was an independent prognostic factor for PFS and OS, especially for those with IPI 0-2, extranodal sites ≤1 and stage III-IV. Synchronously low FT3 and FT4 had poorer survival outcome compared to only low FT3 and adding criterion of low T3 syndrome improved the prognostic capacity of IPI for predicting PFS and OS in DLBCL. Low T3 syndrome was found to be a strong prognostic predictor in DLBCL.

  15. Diagnostic Reasoning using Prognostic Information for Unmanned Aerial Systems

    Science.gov (United States)

    Schumann, Johann; Roychoudhury, Indranil; Kulkarni, Chetan

    2015-01-01

    With increasing popularity of unmanned aircraft, continuous monitoring of their systems, software, and health status is becoming more and more important to ensure safe, correct, and efficient operation and fulfillment of missions. The paper presents integration of prognosis models and prognostic information with the R2U2 (REALIZABLE, RESPONSIVE, and UNOBTRUSIVE Unit) monitoring and diagnosis framework. This integration makes available statistically reliable health information predictions of the future at a much earlier time to enable autonomous decision making. The prognostic information can be used in the R2U2 model to improve diagnostic accuracy and enable decisions to be made at the present time to deal with events in the future. This will be an advancement over the current state of the art, where temporal logic observers can only do such valuation at the end of the time interval. Usefulness and effectiveness of this integrated diagnostics and prognostics framework was demonstrated using simulation experiments with the NASA Dragon Eye electric unmanned aircraft.

  16. B-type natriuretic peptide is a long-term predictor of all-cause mortality, whereas high-sensitive C-reactive protein predicts recurrent short-term troponin T positive cardiac events in chest pain patients: a prognostic study

    Directory of Open Access Journals (Sweden)

    Staines Harry

    2008-11-01

    Full Text Available Abstract Background Few studies have addressed whether the combined use of B-type natriuretic peptide (BNP and high-sensitive C-reactive protein (hsCRP improves risk stratification for mortality and cardiovascular events in a population with chest pain and suspected acute coronary syndromes (ACS. Therefore, we wanted to assess the incremental prognostic value of these biomarkers with respect to long-term all-cause mortality and recurrent troponin T (TnT positive cardiac events in 871 patients admitted to the emergency department. Methods Blood samples were obtained immediately following admission. Results After a follow-up period of 24 months, 129 patients had died. The BNP levels were significantly higher among patients dying than in long-term survivors (401 (145–736 versus 75 (29–235 pq/mL [median, 25 and 75% percentiles], p = 0.000. In a multivariable Cox regression model for death within 2 years, the hazard ratio (HR for BNP in the highest quartile (Q4 was 5.13 (95% confidence interval (CI, 1.97–13.38 compared to the lowest quartile (Q1 and was associated with all-cause mortality above and beyond age, congestive heart failure and the index diagnosis ST-segment elevation myocardial infarction. HsCRP rendered no prognostic information for all-cause mortality. However, within 30 days, the adjusted HR for patients with recurrent TnT cardiac positive events hsCRP in Q4 was 14.79 (95% CI, 1.89–115.63 compared with Q1 and was associated with recurrent ischemic events above and beyond age, hypercholesterolemia and TnT values at admission. Conclusion BNP may act as a clinically useful biomarker when obtained at admission in an unselected patient population following hospitalization with chest pain and potential ACS, and may provide complementary prognostic information to established risk determinants at long-term follow-up. Our data do not support the hypothesis that the additional assessment of hsCRP will lead to better risk stratification

  17. Building prognostic models for breast cancer patients using clinical variables and hundreds of gene expression signatures

    Directory of Open Access Journals (Sweden)

    Liu Yufeng

    2011-01-01

    Full Text Available Abstract Background Multiple breast cancer gene expression profiles have been developed that appear to provide similar abilities to predict outcome and may outperform clinical-pathologic criteria; however, the extent to which seemingly disparate profiles provide additive prognostic information is not known, nor do we know whether prognostic profiles perform equally across clinically defined breast cancer subtypes. We evaluated whether combining the prognostic powers of standard breast cancer clinical variables with a large set of gene expression signatures could improve on our ability to predict patient outcomes. Methods Using clinical-pathological variables and a collection of 323 gene expression "modules", including 115 previously published signatures, we build multivariate Cox proportional hazards models using a dataset of 550 node-negative systemically untreated breast cancer patients. Models predictive of pathological complete response (pCR to neoadjuvant chemotherapy were also built using this approach. Results We identified statistically significant prognostic models for relapse-free survival (RFS at 7 years for the entire population, and for the subgroups of patients with ER-positive, or Luminal tumors. Furthermore, we found that combined models that included both clinical and genomic parameters improved prognostication compared with models with either clinical or genomic variables alone. Finally, we were able to build statistically significant combined models for pathological complete response (pCR predictions for the entire population. Conclusions Integration of gene expression signatures and clinical-pathological factors is an improved method over either variable type alone. Highly prognostic models could be created when using all patients, and for the subset of patients with lymph node-negative and ER-positive breast cancers. Other variables beyond gene expression and clinical-pathological variables, like gene mutation status or DNA

  18. Metrics for Evaluating Performance of Prognostics Techniques

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics is an emerging concept in condition based maintenance (CBM) of critical systems. Along with developing the fundamentals of being able to confidently...

  19. Tackling V&V for Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — We believe our approach to gathering and organizing prognostics V the descriptive text recorded proved on occasion to be insufficient to serve as a standalone...

  20. Distilling the Verification Process for Prognostics Algorithms

    Data.gov (United States)

    National Aeronautics and Space Administration — The goal of prognostics and health management (PHM) systems is to ensure system safety, and reduce downtime and maintenance costs. It is important that a PHM system...

  1. Model-based Prognostics under Limited Sensing

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics is crucial to providing reliable condition-based maintenance decisions. To obtain accurate predictions of component life, a variety of sensors are often...

  2. Pediatric renal transplantation: Results and prognostic factors

    Directory of Open Access Journals (Sweden)

    Po-Cheng Huang

    2013-04-01

    Conclusion: For pediatric patients, we found that renal transplantation is now a safe and effective surgical procedure for children with end-stage renal disease. Acute rejection and male gender were identified as prognostic factors for poor graft survival.

  3. Evaluating Algorithm Performance Metrics Tailored for Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics has taken center stage in Condition Based Maintenance (CBM) where it is desired to estimate Remaining Useful Life (RUL) of a system so that remedial...

  4. Detection and Prognostics on Low Dimensional Systems

    Data.gov (United States)

    National Aeronautics and Space Administration — This paper describes the application of known and novel prognostic algorithms on systems that can be described by low dimensional, potentially nonlinear dynamics....

  5. Prognostic indicators influencing short term outcomes among ...

    African Journals Online (AJOL)

    Prognostic indicators influencing short term outcomes among operated head injury patients ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search ... indicators for short term outcomes in operated head injury patients at KCMC.

  6. Prognostic indices in childhood heart failure

    African Journals Online (AJOL)

    hood heart failure and highlight the factors that affect out- come among cases of heart failure ... month period were studied prospectively. Diagnosis of heart ... a case-fatality rate of 24% among the study population. Poor prognostic indices ...

  7. Precursor Parameter Identification for IGBT Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Precursor parameters have been identified to enable development of a prognostic approach for insulated gate bipolar transistors (IGBT). The IGBT were subjected to...

  8. Requirements Flowdown for Prognostics and Health Management

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics and Health Management (PHM) principles have considerable promise to change the game of lifecycle cost of engineering systems at high safety levels by...

  9. Prognostic Factors for Refractory Status Epilepticus

    Directory of Open Access Journals (Sweden)

    J. Gordon Millichap

    2013-03-01

    Full Text Available Researchers at the Mayo Clinic, Rochester, MN studied the outcome and identified prognostic factors for refractory status epilepticus (RSE in 54 adult patients, median age 52 years [range 18-93].

  10. RANS analyses on erosion behavior of density stratification consisted of helium–air mixture gas by a low momentum vertical buoyant jet in the PANDA test facility, the third international benchmark exercise (IBE-3)

    Energy Technology Data Exchange (ETDEWEB)

    Abe, Satoshi, E-mail: abe.satoshi@jaea.go.jp; Ishigaki, Masahiro; Sibamoto, Yasuteru; Yonomoto, Taisuke

    2015-08-15

    Highlights: . • The third international benchmark exercise (IBE-3) focused on density stratification erosion by a vertical buoyant jet in the reactor containment vessel. • Two types turbulence model modification were applied in order to accurately simulate the turbulence helium transportation in the density stratification. • The analysis result in case with turbulence model modification is good agreement with the experimental data. • There is a major difference of turbulence helium–mass transportation between in case with and without the turbulence model modification. - Abstract: Density stratification in the reactor containment vessel is an important phenomenon on an issue of hydrogen safety. The Japan Atomic Energy Agency (JAEA) has started the ROSA-SA project on containment thermal hydraulics. As a part of the activity, we participated in the third international CFD benchmark exercise (IBE-3) focused on density stratification erosion by a vertical buoyant jet in containment vessel. This paper shows our approach for the IBE-3, focusing on the turbulence transport phenomena in eroding the density stratification and introducing modified turbulence models for improvement of the CFD analyses. For this analysis, we modified the CFD code OpenFOAM by using two turbulence models; the Kato and Launder modification to estimate turbulent kinetic energy production around a stagnation point, and the Katsuki model to consider turbulence damping in density stratification. As a result, the modified code predicted well the experimental data. The importance of turbulence transport modeling is also discussed using the calculation results.

  11. Prognostic value of sarcopenia in liver surgery.

    Science.gov (United States)

    Cornet, M; Lim, C; Salloum, C; Lazzati, A; Compagnon, P; Pascal, G; Azoulay, D

    2015-11-01

    Current knowledge indicates that malnutrition increases the rate of post-operative complications, particularly respiratory and infectious, after major surgery. Almost all liver surgery is performed in patients with cancer, a factor that increases the risk of malnutrition. The primary risk factors for post-operative complications are pre-operative hypo-albuminemia and a body mass index less than 20 kg/m(2). To improve the prediction of complications in these patients, some teams have suggested measurement of muscle thickness by computed tomography. Muscular mass can thus be quantified by measuring the total surface of the psoas muscle or the total surface of all muscles (i.e. external and internal oblique, transverse, psoas and paravertebral muscles) seen on an axial CT slice at L3. As well, data exist suggesting that sarcopenia is an independent predictive factor of post-operative morbidity and poor long-term survival after resection for cancer. Nonetheless, the literature on the subject is limited, there are no standardized definitions for sarcopenia, and the need of special software to calculate the surfaces limits its usefulness. Lastly, there are little if any data concerning the nutritional or pharmacologic means to treat sarcopenia. This update, based on a literature review, deals with the value and the prognostic impact of sarcopenia in surgery for liver tumors. The current definition of sarcopenia, validated internationally, the methods of measurement, and the consequences of sarcopenia on the outcome of liver resections are detailed in this review.

  12. Heterogeneity of CD8(+) tumor-infiltrating lymphocytes in non-small-cell lung cancer: impact on patient prognostic assessments and comparison of quantification by different sampling strategies.

    Science.gov (United States)

    Obeid, Joseph M; Wages, Nolan A; Hu, Yinin; Deacon, Donna H; Slingluff, Craig L

    2017-01-01

    Infiltration of non-small-cell lung cancer (NSCLC) by CD8(+) T lymphocytes predicts improved patient survival; however, heterogeneity of intratumoral localization complicates this assessment. Strategies for tumor sampling may not accurately represent the whole tumor. We hypothesized that sampling strategies may alter the identification of tumors with high CD8 density and affect the prognostic significance. Twenty-three primary NSCLC tumors were immunohistochemically stained for CD8 and were assessed using automated software with eight different sampling strategies or the whole tumor. Results of all sampling strategies were compared to the whole tumor counts (paired t tests, Pearson's r). Associations between CD8 densities and overall survival were assessed (log-rank test). Counts from all eight sampling strategies significantly correlated with whole tumor counts (p ≤ 0.001). However, the magnitude of CD8(+) cell counts and categorization into high vs low infiltrate groups were affected by the sampling strategy. The most concordant values were derived from random sampling of 20 % of the tumor, a simulated core biopsy, or from sampling the tumor center. TIL infiltration was associated with survival when sampling the center (p = 0.038), but not the invasive margin (p > 0.2) or other strategies. Different tumor sampling strategies may yield discordant TIL density results and different stratification for risk assessment. Small biopsies may be particularly unrepresentative. Random sampling of larger tumor areas is recommended. Enumerating CD8(+) T cells in the tumor center may have prognostic value.

  13. Vehicle Integrated Prognostic Reasoner (VIPR) Metric Report

    Science.gov (United States)

    Cornhill, Dennis; Bharadwaj, Raj; Mylaraswamy, Dinkar

    2013-01-01

    This document outlines a set of metrics for evaluating the diagnostic and prognostic schemes developed for the Vehicle Integrated Prognostic Reasoner (VIPR), a system-level reasoner that encompasses the multiple levels of large, complex systems such as those for aircraft and spacecraft. VIPR health managers are organized hierarchically and operate together to derive diagnostic and prognostic inferences from symptoms and conditions reported by a set of diagnostic and prognostic monitors. For layered reasoners such as VIPR, the overall performance cannot be evaluated by metrics solely directed toward timely detection and accuracy of estimation of the faults in individual components. Among other factors, overall vehicle reasoner performance is governed by the effectiveness of the communication schemes between monitors and reasoners in the architecture, and the ability to propagate and fuse relevant information to make accurate, consistent, and timely predictions at different levels of the reasoner hierarchy. We outline an extended set of diagnostic and prognostics metrics that can be broadly categorized as evaluation measures for diagnostic coverage, prognostic coverage, accuracy of inferences, latency in making inferences, computational cost, and sensitivity to different fault and degradation conditions. We report metrics from Monte Carlo experiments using two variations of an aircraft reference model that supported both flat and hierarchical reasoning.

  14. Prognostic markers of canine pyometra

    Directory of Open Access Journals (Sweden)

    M.C. Sant'Anna

    2014-12-01

    Full Text Available The pyometra is a disease that affects middle age and elderly female dogs during diestrus. Hormonal, microbiological, biochemical and hematological aspects are well described. However, few studies have evaluated the role of each in the prognosis of canine pyometra. The aim of this study was to identify markers associated with clinical worsening of dogs with pyometra. We prospectively evaluated 80 dogs with pyometra treated surgically. Group 1 consisted of dogs that were discharged within 48 hours after surgery and Group 2 consisted of those who required prolonged hospitalization or died. The findings of hematological, biochemical and blood lactate levels were compared between groups and variables such as bacterial multidrug resistance, systemic inflammatory response syndrome (SIRS, hyperlactatemia and increased creatinine were analyzed through the dispersion of frequencies between groups. Among the variables studied, the presence of SIRS and elevated serum creatinine >2.5mg/mL were effective in predicting the worsening of the disease and can be used as prognostic markers of canine pyometra.

  15. Uveal Melanoma Treatment and Prognostication.

    Science.gov (United States)

    Dogrusöz, Mehmet; Jager, Martine J; Damato, Bertil

    2017-01-01

    Approximately 90% of uveal melanoma develop in the choroid, with the remainder arising in the ciliary body or the iris. The treatment of uveal melanoma is aimed at conserving the eye and useful vision, and, if possible, preventing metastatic disease. Enucleation is now reserved for tumors that are large and/or involve the optic disc, having largely been replaced by various forms of radiotherapy (plaque brachy-therapy, proton beam or stereotactic radiotherapy) and laser therapy. Whereas iridectomy and iridocyclectomy are widely performed, transscleral exoresection of choroidal tumors is performed only in a few centers because it requires special skills and hypotensive anesthesia. Transretinal endoresection using vitrectomy equipment is easier but controversial because of concerns about tumor seeding. Long-term postoperative surveillance is necessary to identify and treat local tumor recurrence and any other complications, such as radiation-induced morbidity, and to provide counseling to the patient. Factors predicting metastasis include older age, large tumor size, ciliary body involvement, extraocular spread, epithelioid cytomorphology, chromosome 3 loss and chromosome 8q gain, class 2 gene expression profile, loss of BRCA1-associated protein-1 (BAP1), and the presence of inflammation. Prognostication is enhanced by multi-variable analysis combining clinical, histologic, and genetic factors, also taking the patient's age and sex into account. As there is a lack of options for treating metastases, much research is focused on identifying potential therapeutic targets. Copyright 2017 Asia-Pacific Academy of Ophthalmology.

  16. Modeling of condensation, stratification, and mixing phenomena in a pool of water

    Energy Technology Data Exchange (ETDEWEB)

    Li, H.; Kudinov, P.; Villanueva, W. (Royal Institute of Technology (KTH). Div. of Nuclear Power Safety, Stockholm (Sweden))

    2010-12-15

    This work pertains to the research program on Containment Thermal-Hydraulics at KTH. The objective is to evaluate and improve performance of methods, which are used to analyze thermal-hydraulics of steam suppression pools in a BWR plant under different abnormal transient and accident conditions. As a passive safety system, the function of steam pressure suppression pools is paramount to the containment performance. In the present work, the focus is on apparently-benign but intricate and potentially risk-significant scenarios in which thermal stratification could significantly impede the pool's pressure suppression capacity. For the case of small flow rates of steam influx, the steam condenses rapidly in the pool and the hot condensate rises in a narrow plume above the steam injection plane and spreads into a thin layer at the pool's free surface. When the steam flow rate increases significantly, momentum introduced by the steam injection and/or periodic expansion and shrink of large steam bubbles due to direct contact condensation can cause breakdown of the stratified layers and lead to mixing of the pool water. Accurate prediction of the pool thermal-hydraulics in such scenarios presents a computational challenge. Lumped-parameter models have no capability to predict temperature distribution of water pool during thermal stratification development. While high-order-accurate CFD (RANS, LES) methods are not practical due to excessive computing power needed to calculate 3D high-Rayleighnumber natural circulation flow in long transients. In the present work, a middleground approach is used, namely CFD-like model of the general purpose thermalhydraulic code GOTHIC. Each cell of 3D GOTHIC grid uses lumped parameter volume type closures for modeling of various heat and mass transfer processes at subgrid scale. We use GOTHIC to simulate POOLEX/PPOOLEX experiment, in order to (a) quantify errors due to GOTHIC's physical models and numerical schemes, and (b

  17. The predictive and prognostic value of the Glasgow Prognostic Score in metastatic colorectal carcinoma patients receiving bevacizumab.

    Science.gov (United States)

    Maillet, Marianne; Dréanic, Johann; Dhooge, Marion; Mir, Olivier; Brezault, Catherine; Goldwasser, François; Chaussade, Stanislas; Coriat, Romain

    2014-11-01

    The Glasgow Prognostic Score (GPS), based on C-reactive protein and albumin levels, has shown its prognostic value in metastatic colorectal carcinoma (mCRC) patients receiving conventional cytotoxic therapy. Bevacizumab, a monoclonal antibody to vascular epidermal growth factor, improves the overall survival in mCRC. The aim of the present study was to assess the prognostic value of GPS in mCRC patients receiving antivascular epidermal growth factor therapy. From August 2005 to August 2012, consecutive patients with mCRC who received chemotherapy plus bevacizumab were eligible for the present analysis. The clinical stage, C-reactive protein, albumin and the Eastern Cooperative Oncology Group performance status were recorded at the time of initiation of bevacizumab. Patients received 5-fluorouracil-based chemotherapy plus bevacizumab in accordance with the digestive oncology multidisciplinary staff proposal and in line with the French recommendations for the treatment of mCRC. Eighty patients were eligible (colon n = 59, rectum n = 21), with a median follow-up of 14 months (range 1-58 months). Chemotherapy given with bevacizumab and 5-fluorouracil was oxaliplatin (n = 41, 51%) or irinotecan (n = 27, 34%). At baseline, 56, 31 and 13% of patients had a GPS of 0 (n = 45), 1 (n = 25) and 2 (n = 10), respectively. The median progression-free survival in these groups was 10.1, 6.5 and 5.6 months (P = 0.16), respectively. The median overall survival was 20.1, 11.4 and 6.5 months, respectively (P = 0.004). Our study confirmed the prognostic value of GPS in mCRC patients receiving chemotherapy plus bevacizumab. Given the poor survival observed in patients with an GPS of 2, studies dedicated to these patients could identify optimal treatment modalities.

  18. Japanese structure survey of radiation oncology in 2005 based on institutional stratification of patterns of care study.

    Science.gov (United States)

    Teshima, Teruki; Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi; Ikeda, Hiroshi; Ito, Hisao; Sekiguchi, Kenji; Kamikonya, Norihiko; Koizumi, Masahiko; Tago, Masao; Nagata, Yasushi; Masaki, Hidekazu; Nishimura, Tetsuo; Yamada, Shogo

    2008-09-01

    To evaluate the structure of radiation oncology in Japan in terms of equipment, personnel, patient load, and geographic distribution to identify and improve any deficiencies. A questionnaire-based national structure survey was conducted between March 2006 and February 2007 by the Japanese Society of Therapeutic Radiology and Oncology. These data were analyzed in terms of the institutional stratification of the Patterns of Care Study. The total numbers of new cancer patients and total cancer patients (new and repeat) treated with radiotherapy in 2005 were estimated at approximately 162,000 and 198,000, respectively. In actual use were 765 linear accelerators, 11 telecobalt machines, 48 GammaKnife machines, 64 60Co remote-controlled after-loading systems, and 119 192Ir remote-controlled after-loading systems. The linear accelerator systems used dual-energy function in 498 systems (65%), three-dimensional conformal radiotherapy in 462 (60%), and intensity-modulated radiotherapy in 170 (22%). There were 426 Japanese Society of Therapeutic Radiology and Oncology-certified radiation oncologists, 774 full-time equivalent radiation oncologists, 117 medical physicists, and 1,635 radiation therapists. Geographically, a significant variation was found in the use of radiotherapy, from 0.9 to 2.1 patients/1,000 population. The annual patient load/FTE radiation oncologist was 247, exceeding the Blue Book guidelines level. Patterns of Care Study stratification can clearly discriminate the maturity of structures according to their academic nature and caseload. The Japanese structure has clearly improved during the past 15 years in terms of equipment and its use, although the shortage of manpower and variations in maturity disclosed by this Patterns of Care Study stratification remain problematic. These constitute the targets for nationwide improvement in quality assurance and quality control.

  19. Treatment of Childhood Acute Lymphoblastic Leukemia: Prognostic Factors and Clinical Advances.

    Science.gov (United States)

    Vrooman, Lynda M; Silverman, Lewis B

    2016-10-01

    While the majority of children and adolescents with newly diagnosed childhood acute lymphoblastic leukemia (ALL) will be cured, as many as 20 % of patients will experience relapse. On current treatment regimens, the intensity of upfront treatment is stratified based upon prognostic factors with the aim of improving cure rates (for those at the highest risk of relapse) and minimizing treatment-related morbidity (for lower-risk patients). Here we review advances in the understanding of prognostic factors and their application. We also highlight novel treatment approaches aimed at improving outcomes in childhood ALL.

  20. Seven-CpG-based prognostic signature coupled with gene expression predicts survival of oral squamous cell carcinoma.

    Science.gov (United States)

    Shen, Sipeng; Wang, Guanrong; Shi, Qianwen; Zhang, Ruyang; Zhao, Yang; Wei, Yongyue; Chen, Feng; Christiani, David C

    2017-01-01

    DNA methylation has started a recent revolution in genomics biology by identifying key biomarkers for multiple cancers, including oral squamous cell carcinoma (OSCC), the most common head and neck squamous cell carcinoma. A multi-stage screening strategy was used to identify DNA-methylation-based signatures for OSCC prognosis. We used The Cancer Genome Atlas (TCGA) data as training set which were validated in two independent datasets from Gene Expression Omnibus (GEO). The correlation between DNA methylation and corresponding gene expression and the prognostic value of the gene expression were explored as well. The seven DNA methylation CpG sites were identified which were significantly associated with OSCC overall survival. Prognostic signature, a weighted linear combination of the seven CpG sites, successfully distinguished the overall survival of OSCC patients and had a moderate predictive ability for survival [training set: hazard ratio (HR) = 3.23, P = 5.52 × 10(-10), area under the curve (AUC) = 0.76; validation set 1: HR = 2.79, P = 0.010, AUC = 0.67; validation set 2: HR = 3.69, P = 0.011, AUC = 0.66]. Stratification analysis by human papillomavirus status, clinical stage, age, gender, smoking status, and grade retained statistical significance. Expression of genes corresponding to candidate CpG sites (AJAP1, SHANK2, FOXA2, MT1A, ZNF570, HOXC4, and HOXB4) was also significantly associated with patient's survival. Signature integrating of DNA methylation, gene expression, and clinical information showed a superior ability for prognostic prediction (AUC = 0.78). Prognostic signature integrated of DNA methylation, gene expression, and clinical information provides a better prognostic prediction value for OSCC patients than that with clinical information only.

  1. Redox stratification of an ancient lake in Gale crater, Mars

    Science.gov (United States)

    Hurowitz, J. A.; Grotzinger, J. P.; Fischer, W. W.; McLennan, S. M.; Milliken, R. E.; Stein, N.; Vasavada, A. R.; Blake, D. F.; Dehouck, E.; Eigenbrode, J. L.; Fairén, A. G.; Frydenvang, J.; Gellert, R.; Grant, J. A.; Gupta, S.; Herkenhoff, K. E.; Ming, D. W.; Rampe, E. B.; Schmidt, M. E.; Siebach, K. L.; Stack-Morgan, K.; Sumner, D. Y.; Wiens, R. C.

    2017-06-01

    In 2012, NASA's Curiosity rover landed on Mars to assess its potential as a habitat for past life and investigate the paleoclimate record preserved by sedimentary rocks inside the ~150-kilometer-diameter Gale impact crater. Geological reconstructions from Curiosity rover data have revealed an ancient, habitable lake environment fed by rivers draining into the crater. We synthesize geochemical and mineralogical data from lake-bed mudstones collected during the first 1300 martian solar days of rover operations in Gale. We present evidence for lake redox stratification, established by depth-dependent variations in atmospheric oxidant and dissolved-solute concentrations. Paleoclimate proxy data indicate that a transition from colder to warmer climate conditions is preserved in the stratigraphy. Finally, a late phase of geochemical modification by saline fluids is recognized.

  2. Disruption of SSP/VWI states by a stable stratification

    CERN Document Server

    Eaves, T S

    2015-01-01

    We identify `minimal seeds' for turbulence, i.e. initial conditions of the smallest possible total perturbation energy density $E_c$ that trigger turbulence from the laminar state, in stably stratified plane Couette flow using the `direct-adjoint-looping' (DAL) method for finding nonlinear optimal perturbations that optimise the time averaged total dissipation of energy in the flow. These minimal seeds are located adjacent to the edge manifold, the manifold in state space that separates trajectories which transition to turbulence from those which eventually decay to the laminar state. The edge manifold is also the stable manifold of the system's `edge state'. The trajectories from the minimal seed initial conditions spend a large amount of time in the vicinity of some states: the edge state; another state contained within the edge manifold; or even in dynamically slowly varying regions of the edge manifold, allowing us to investigate the effects of a stable stratification on any coherent structures associated...

  3. Stratification and enumeration of Boolean functions by canalizing depth

    Science.gov (United States)

    He, Qijun; Macauley, Matthew

    2016-01-01

    Boolean network models have gained popularity in computational systems biology over the last dozen years. Many of these networks use canalizing Boolean functions, which has led to increased interest in the study of these functions. The canalizing depth of a function describes how many canalizing variables can be recursively "picked off", until a non-canalizing function remains. In this paper, we show how every Boolean function has a unique algebraic form involving extended monomial layers and a well-defined core polynomial. This generalizes recent work on the algebraic structure of nested canalizing functions, and it yields a stratification of all Boolean functions by their canalizing depth. As a result, we obtain closed formulas for the number of n-variable Boolean functions with depth k, which simultaneously generalizes enumeration formulas for canalizing, and nested canalizing functions.

  4. Stratification and enumeration of Boolean functions by canalizing depth

    CERN Document Server

    He, Qijun

    2015-01-01

    Boolean network models have gained popularity in computational systems biology over the last dozen years. Many of these networks use canalizing Boolean functions, which has led to increased interest in the study of these functions. The canalizing depth of a function describes how many canalizing variables can be recursively picked off, until a non-canalizing function remains. In this paper, we show how every Boolean function has a unique algebraic form involving extended monomial layers and a well-defined core polynomial. This generalizes recent work on the algebraic structure of nested canalizing functions, and it yields a stratification of all Boolean functions by their canalizing depth. As a result, we obtain closed formulas for the number of n-variable Boolean functions with depth k, which simultaneously generalizes enumeration formulas for canalizing, and nested canalizing functions.

  5. The feature of stratification in the blowing sand cloud

    Institute of Scientific and Technical Information of China (English)

    ZHENG Xiaojing; HE Lihong; WU Jianjun

    2003-01-01

    The profiles of particle concentration in saltation layer versus height are calculated, by the motion equations for a saltating grain in conjunction with different probability distribution functions of the vertical liftoff velocities of grains and an empirical expression of wind velocity. The numerical results demonstrated that the stratification phenomenon exists in the particle concentration profiles and showed increasing, saturating and decreasing features, respectively, when the probability distribution functions of liftoff velocities adopted in the calculation are similar to a normal distribution or a two-parameter gamma distribution. When the distribution function of liftoff velocities is taken as an exponential form, the profile of particle concentration decreases monotonically. A numerical simulation of mass flux of grains, performed by the model suggested in this paper, is in reasonable accordance with the measured data.

  6. On the formation of couplet-style stratifications

    Institute of Scientific and Technical Information of China (English)

    Yu-Hai WANG; Yan-Hong WANG; Li-Qun TANG

    2008-01-01

    Couplet-style stratifications refer to the sedimentary sequences that consist of alternating coarse-grain-dominated bed and fine-grain-dominated bed.with or without a sandwiched middle-sized bed.The formation mechanism is complicated due to the interplays of varying driving force(s),sediment supply & transport and topographic configurations.This paper presents a comprehensive overview of such characteristic bedforms,which emerge during the transport and deposition of non-uniform sediments.The leading formative models include water-stage variation,gravel-overpassing process,superimposition of bedload sheets and avalanching process(inverse grading).Each process might produce similar or distinct sedimentological features with respect to grading,matrix content,grain attitude,bounding faces between beds and internal longitudinal/transverse geometry.The couplet-style stratified strata might play an active role in landscape evolution.

  7. Physiological stratification in electricity-producing biofilms of Geobacter sulfurreducens.

    Science.gov (United States)

    Schrott, Germán David; Ordoñez, María Victoria; Robuschi, Luciana; Busalmen, Juan Pablo

    2014-02-01

    The elucidation of mechanisms and limitations in electrode respiration by electroactive biofilms is significant for the development of rapidly emerging clean energy production and wastewater treatment technologies. In Geobacter sulfurreducens biofilms, the controlling steps in current production are thought to be the metabolic activity of cells, but still remain to be determined. By quantifying the DNA, RNA, and protein content during the long-term growth of biofilms on polarized graphite electrodes, we show in this work that current production becomes independent of DNA accumulation immediately after a maximal current is achieved. Indeed, the mean respiratory rate of biofilms rapidly decreases after this point, which indicates the progressive accumulation of cells that do not contribute to current production or contribute to a negligible extent. These results support the occurrence of physiological stratification within biofilms as a consequence of respiratory limitations imposed by limited biofilm conductivity.

  8. Career on the Move: Geography, Stratification, and Scientific Impact

    CERN Document Server

    Deville, Pierre; Sinatra, Roberta; Song, Chaoming; Blondel, Vincent D; Barabasi, Albert-Laszlo

    2014-01-01

    Changing institutions is an integral part of an academic life. Yet little is known about the mobility patterns of scientists at an institutional level and how these career choices affect scientific outcomes. Here, we examine over 420,000 papers, to track the affiliation information of individual scientists, allowing us to reconstruct their career trajectories over decades. We find that career movements are not only temporally and spatially localized, but also characterized by a high degree of stratification in institutional ranking. When cross-group movement occurs, we find that while going from elite to lower-rank institutions on average associates with modest decrease in scientific performance, transitioning into elite institutions does not result in subsequent performance gain. These results offer empirical evidence on institutional level career choices and movements and have potential implications for science policy.

  9. Influence of stable stratification on three-dimensional isotropic turbulence

    Science.gov (United States)

    Metais, O.

    The influence of a stable stratification on three-dimensional homogeneous turbulence is investigated by performing large eddy simulations with the subgrid scales procedure developed by Chollet and Lesieur for isotropic turbulence. Computational initial conditions close to those of the experiments performed by Itsweire, Helland and Van Atta allow the comparison of the experimental and numerical evolutions of density-stratified turbulent flows. Theoretical works by Riley, Metcalfe and Weisman and by Lilly suggest that low Froude number stably-stratified turbulence may be a nearly noninteracting superposition of wave and quasi-horizontal turbulent vortex motions. For our computations the stably-stratified turbulence seems to be a decaying three-dimensional turbulence pulsed by internal gravity waves. However some tendencies towards two-dimensional turbulence are observed.

  10. Mixed convection in turbulent channels with unstable stratification

    CERN Document Server

    Pirozzoli, Sergio; Verzicco, Roberto; Orlandi, Paolo

    2016-01-01

    We study turbulent flows in planar channels with unstable thermal stratification, using direct numerical simulations in a wide range of Reynolds and Rayleigh numbers and reaching flow conditions which are representative of asymptotic developed turbulence. The combined effect of forced and free convection produces a peculiar pattern of quasi--streamwise rollers occupying the full channel thickness with aspect--ratio considerably higher than unity; it has been observed that they have an important redistributing effect on temperature and momentum. The mean values and the variances of the flow variables do not appear to follow Prandtl's scaling in the flow regime near free convection, except for the temperature and vertical velocity fluctuations, which are more affected by turbulent plumes. Nevertheless, we find that the Monin--Obukhov theory still yields a useful representation of the main flow features. In particular, the widely used Businger--Dyer relationships provide a convenient way of accounting for the bu...

  11. Proposals for enhanced health risk assessment and stratification in an integrated care scenario.

    Science.gov (United States)

    Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastià; Schonenberg, Helen; Störk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep

    2016-04-15

    Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Responsible teams for regional data management in the five ACT regions. We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches. Applicability and impact of the proposals for enhanced clinical risk assessment require

  12. Risk stratification in motor area-related glioma surgery based on navigated transcranial magnetic stimulation data.

    Science.gov (United States)

    Rosenstock, Tizian; Grittner, Ulrike; Acker, Güliz; Schwarzer, Vera; Kulchytska, Nataliia; Vajkoczy, Peter; Picht, Thomas

    2016-06-03

    OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) is a noninvasive method for preoperatively localizing functional areas in patients with tumors in presumed motor eloquent areas. The aim of this study was to establish an nTMS-based risk stratification model by examining whether the results of nTMS mapping and its neurophysiological data predict postoperative motor outcome in glioma surgery. METHODS Included in this study were prospectively collected data for 113 patients undergoing bihemispheric nTMS examination prior to surgery for gliomas in presumed motor eloquent locations. Multiple ordinal logistic regression analysis was performed to test for any association between preoperative nTMS-related variables and postoperative motor outcome. RESULTS A new motor deficit or deterioration due to a preexisting deficit was observed in 20% of cases after 7 days and in 22% after 3 months. In terms of tumor location, no new permanent deficit was observed when the distance between tumor and corticospinal tract was greater than 8 mm and the precentral gyrus was not infiltrated (p = 0.014). New postoperative deficits on Day 7 were associated with a pathological excitability of the motor cortices (interhemispheric resting motor threshold [RMT] ratio 110%, p = 0.031). Interestingly, motor function never improved when the RMT was significantly higher in the tumorous hemisphere than in the healthy hemisphere (RMT ratio > 110%). CONCLUSIONS The proposed risk stratification model, based on objective functional-anatomical and neurophysiological measures, enables one to counsel patients about the risk of functional deterioration or the potential for recovery.

  13. Proposals for enhanced health risk assessment and stratification in an integrated care scenario

    Science.gov (United States)

    Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastià; Schonenberg, Helen; Störk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep

    2016-01-01

    Objectives Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. Settings The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Participants Responsible teams for regional data management in the five ACT regions. Primary and secondary outcome measures We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. Results There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. Conclusions The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches

  14. Economic Stratification Differentiates Home Gardens in the Maya Village of Pomuch, Mexico

    NARCIS (Netherlands)

    Poot-Pool, W.S.; Wal, van der J.C.; Flores-Guido, S.; Pat-Fernández, J.M.; Esparza-Olguín, L.

    2012-01-01

    Economic Stratification Differentiates Home Gardens in the Maya Village of Pomuch, Mexico. In this paper, we analyze if economic stratification of peasant families in a Maya village in the Yucatán Peninsula of Mexico influences species composition and structure of home gardens. Our general hypothesi

  15. Effects of stratification on dependence modeling for environmental studies in space and time

    NARCIS (Netherlands)

    Stein, A.; Sterk, G.

    1999-01-01

    This paper analyzes the use of stratification in the modeling of dependence for regionalized variables in space and time. Stratification enables optimal use of available information, and it is used when deterministic, small-scale information is combined with large-scale random variation: on the one

  16. Economic Stratification Differentiates Home Gardens in the Maya Village of Pomuch, Mexico

    NARCIS (Netherlands)

    Poot-Pool, W.S.; Wal, van der J.C.; Flores-Guido, S.; Pat-Fernández, J.M.; Esparza-Olguín, L.

    2012-01-01

    Economic Stratification Differentiates Home Gardens in the Maya Village of Pomuch, Mexico. In this paper, we analyze if economic stratification of peasant families in a Maya village in the Yucatán Peninsula of Mexico influences species composition and structure of home gardens. Our general hypothesi

  17. Economic Stratification Differentiates Home Gardens in the Maya Village of Pomuch, Mexico

    NARCIS (Netherlands)

    Poot-Pool, W.S.; Wal, van der J.C.; Flores-Guido, S.; Pat-Fernández, J.M.; Esparza-Olguín, L.

    2012-01-01

    Economic Stratification Differentiates Home Gardens in the Maya Village of Pomuch, Mexico. In this paper, we analyze if economic stratification of peasant families in a Maya village in the Yucatán Peninsula of Mexico influences species composition and structure of home gardens. Our general

  18. Creating Gender Equality: Cross-National Gender Stratification and Mathematical Performance.

    Science.gov (United States)

    Baker, David P.; Jones, Deborah Perkins

    1993-01-01

    Reports on a study of eighth-grade mathematical performance of 77,000 students in 19 countries, data from 1964 and 1982 studies in 9 countries, and data on gender stratification and its impact on mathematics performance. Finds that a cross-national variation exists and that it is related to gender stratification. (CFR)

  19. Methods to determine stratification efficiency of thermal energy storage processes–Review and theoretical comparison

    DEFF Research Database (Denmark)

    Haller, Michel; Cruickshank, Chynthia; Streicher, Wolfgang;

    2009-01-01

    This paper reviews different methods that have been proposed to characterize thermal stratification in energy storages from a theoretical point of view. Specifically, this paper focuses on the methods that can be used to determine the ability of a storage to promote and maintain stratification...

  20. Prognostic predictors of sudden sensorineural hearing loss in defibrinogenation therapy.

    Science.gov (United States)

    Oya, Ryohei; Horii, Arata; Akazawa, Hitoshi; Osaki, Yasuhiro; Inohara, Hidenori

    2016-01-01

    Defibrinogenation therapy rather than corticosteroids therapy should be chosen for patients specifically with profound hearing loss and with initial high fibrinogen. Corticosteroids therapy is the standard treatment for sudden sensorineural hearing loss (SSNHL) and prognostic factors by this therapy were reported. Defibrinogenation therapy is one of the treatment options for SSNHL. Aims of this study were to identify prognostic factors and correlative markers with hearing improvement in treating SSNHL by defibrinogenation therapy. During the early phase of the study, consecutive 61 patients were treated by defibrinogenation therapy with batroxobin (50 units), whereas corticosteroids (500 mg/day of hydrocortisone tapered by 9 days) were used for consecutive 64 patients during the late phase. Blood data that could predict a complete recovery were identified. Coagulation/fibrinolysis markers correlated with hearing improvement by defibrinogenation therapy were investigated. Although there were no overall differences in hearing improvement between the two therapies, recovery rate in profound hearing loss patients was better in defibrinogenation therapy. In patients who showed complete recovery, serum fibrinogen level before treatment was significantly higher in the defibrinogenation group than the corticosteroid group. Responses of several fibrinolysis markers to defibrinogenation therapy evaluated by post-/pre-values were negatively correlated with hearing improvement.

  1. Preliminary Exploration of Affective Stratification%情感分层的初步探讨

    Institute of Scientific and Technical Information of China (English)

    陈满琪

    2015-01-01

    As an important resource, affection is unequally distributed between different social ranks, and this phenomenon is called affective stratification. According to the affective valence, the research examined 1 ) whether the index of social stratification was sensitively reflected on affective stratification;2) the association between affective stratification and the other social stratification;3) the factors which influenced affective stratification;4 ) the relationship among affective stratification in different domains. The results are:1 ) there was a certain corresponding relationship between the distribution of the affective stratification and the existing social stratification index in the population; 2 ) the affective stratification was related to the subjective social stratification and the subjective socioeconomic status;3 ) the affective stratification was cross domain;4 ) the affective stratification was related to the source of pressure and the social support. Those results suggested that the concept of the affective stratification had its own value and characteristic.%作为一种重要资源,情感在不同社会阶层中的分布是不平等的,呈现出情感分层的状态。研究以效价作为分层依据,考察社会分层指标是否灵敏地反映情感分层,分析情感分层与其他社会分层间是否关联,解释情感分层的影响因素,讨论情感分层的跨领域性。研究发现:情感分层在人口中的分布与现有社会分层指标的分布具有一定的对应关系,它与主观社会分层、主观社会经济地位虽有关联,但并非对应关系。情感分层具有跨领域性,与压力源、社会支持密切相关。研究揭示了情感分层概念有其自身的价值和特点。

  2. Prognostic importance of expression of the Wilms' tumor 1 gene in newly diagnosed acute promyelocytic leukemia.

    Science.gov (United States)

    Hecht, Anna; Nolte, Florian; Nowak, Daniel; Nowak, Verena; Reinwald, Mark; Hanfstein, Benjamin; Faldum, Andreas; Büchner, Thomas; Spiekermann, Karsten; Sauerland, Cristina; Weiss, Christel; Hofmann, Wolf-Karsten; Lengfelder, Eva

    2015-01-01

    Wilms' tumor 1 gene (WT1) is known to be highly expressed in acute promyelocytic leukemia (APL) but information on its impact on prognosis is lacking. WT1 expression was analyzed in bone marrow samples of 79 patients with APL at initial diagnosis. Patients had a differing outcome according to their level of WT1 expression. In patients who achieved a complete remission (CR), low or high WT1 expression was significantly associated with inferior overall survival (OS) compared to intermediate WT1 expression (49% for WT1high vs. 63% for WT1low vs. 93% for WT1int; p=0.008). Moreover, there were significant differences in relapse-free survival (RFS) between the three expression groups (42% for WT1high vs. 63% for WT1low vs. 83% for WT1int; p=0.047). In multivariable analysis WT1 expression showed an independent prognostic impact on OS of responders to induction therapy. In conclusion, the level of WT1 expression can add prognostic information in APL risk stratification.

  3. Classification and Prognostic Evaluation of Left Ventricular Remodeling in Patients With Asymptomatic Heart Failure.

    Science.gov (United States)

    Pugliese, Nicola Riccardo; Fabiani, Iacopo; La Carrubba, Salvatore; Conte, Lorenzo; Antonini-Canterin, Francesco; Colonna, Paolo; Caso, Pio; Benedetto, Frank; Santini, Veronica; Carerj, Scipione; Romano, Maria Francesca; Citro, Rodolfo; Di Bello, Vitantonio

    2017-01-01

    Patients with asymptomatic heart failure (HF; stage A and B) are characterized by maladaptive left ventricular (LV) remodeling. Classic 4-group classification of remodeling considers only LV mass index and relative wall thickness as variables. Complex remodeling classification (CRC) includes also LV end-diastolic volume index. Main aim was to assess the prognostic impact of CRC in stage A and B HF. A total of 1,750 asymptomatic subjects underwent echocardiographic examination as a screening evaluation in the presence of cardiovascular risk factors. LV dysfunction, both systolic (ejection fraction) and diastolic (transmitral flow velocity pattern), was evaluated, together with LV remodeling. We considered a composite end point: all-cause death, myocardial infarction, coronary revascularizations, cerebrovascular events, and acute pulmonary edema. CRC was suitable for 1,729 patients (men 53.6%; age 58.3 ± 13 years). Two hundred thirty-eight patients presented systolic dysfunction (ejection fraction remodeling, 47 eccentric remodeling, 350 concentric hypertrophy, 29 mixed hypertrophy, 86 dilated hypertrophy, and 53 eccentric hypertrophy. Age and gender distribution was noticed (p remodeling classification, systolic, and diastolic dysfunction), CRC was independent predictor of primary end point (p = 0.044, hazard ratio 1.101, 95% CI 1.003 to 1.21), confirmed in a logistic regression (p <0.03). In conclusion, CRC could help physicians in prognostic stratification of patients in stage A and B HF.

  4. GATA3 Expression Is a Poor Prognostic Factor in Soft Tissue Sarcomas.

    Directory of Open Access Journals (Sweden)

    Toshiaki Haraguchi

    Full Text Available Recent studies have investigated the significance of GATA3 expression in patients with various malignant tumors. However, no previous studies have evaluated the clinicopathological importance of GATA3 expression in soft tissue sarcomas (STS patients.We evaluated GATA3 expression in 76 STS cases using immunohistochemical analysis, and statistically compared clinicopathological characteristics between GATA3-positive and GATA3-negative cases.GATA3-positive expression was significantly associated with a higher mitotic count (P < 0.0001. Disease-free survival (DFS of GATA3-positive cases was significantly shorter than that of cases without GATA3 expression (P = 0.0104. Overall survival (OS of GATA3-positive cases was significantly shorter than that of cases without GATA3 expression (P = 0.0006. GATA3-positive expression was significantly associated with shorter DFS in both univariate analysis (hazard ratio [HR], 2.719; P = 0.012 and multivariate analysis (HR, 2.711; P = 0.014. GATA3-positive expression was also significantly associated with worse OS in both univariate analysis (HR, 5.730; P = 0.0007 and multivariate analysis (HR, 5.789; P = 0.0008.These results indicate that GATA3 is an independent prognostic factor and suggest that evaluation of GATA3 expression might enable more effective clinical follow-up using prognostic stratification of STS patients.

  5. Development and Validation of a Lifecycle-based Prognostics Architecture with Test Bed Validation

    Energy Technology Data Exchange (ETDEWEB)

    Hines, J. Wesley [Univ. of Tennessee, Knoxville, TN (United States); Upadhyaya, Belle [Univ. of Tennessee, Knoxville, TN (United States); Sharp, Michael [Univ. of Tennessee, Knoxville, TN (United States); Ramuhalli, Pradeep [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Jeffries, Brien [Univ. of Tennessee, Knoxville, TN (United States); Nam, Alan [Univ. of Tennessee, Knoxville, TN (United States); Strong, Eric [Univ. of Tennessee, Knoxville, TN (United States); Tong, Matthew [Univ. of Tennessee, Knoxville, TN (United States); Welz, Zachary [Univ. of Tennessee, Knoxville, TN (United States); Barbieri, Federico [Univ. of Tennessee, Knoxville, TN (United States); Langford, Seth [Univ. of Tennessee, Knoxville, TN (United States); Meinweiser, Gregory [Univ. of Tennessee, Knoxville, TN (United States); Weeks, Matthew [Univ. of Tennessee, Knoxville, TN (United States)

    2014-11-06

    On-line monitoring and tracking of nuclear plant system and component degradation is being investigated as a method for improving the safety, reliability, and maintainability of aging nuclear power plants. Accurate prediction of the current degradation state of system components and structures is important for accurate estimates of their remaining useful life (RUL). The correct quantification and propagation of both the measurement uncertainty and model uncertainty is necessary for quantifying the uncertainty of the RUL prediction. This research project developed and validated methods to perform RUL estimation throughout the lifecycle of plant components. Prognostic methods should seamlessly operate from beginning of component life (BOL) to end of component life (EOL). We term this "Lifecycle Prognostics." When a component is put into use, the only information available may be past failure times of similar components used in similar conditions, and the predicted failure distribution can be estimated with reliability methods such as Weibull Analysis (Type I Prognostics). As the component operates, it begins to degrade and consume its available life. This life consumption may be a function of system stresses, and the failure distribution should be updated to account for the system operational stress levels (Type II Prognostics). When degradation becomes apparent, this information can be used to again improve the RUL estimate (Type III Prognostics). This research focused on developing prognostics algorithms for the three types of prognostics, developing uncertainty quantification methods for each of the algorithms, and, most importantly, developing a framework using Bayesian methods to transition between prognostic model types and update failure distribution estimates as new information becomes available. The developed methods were then validated on a range of accelerated degradation test beds. The ultimate goal of prognostics is to provide an accurate assessment for

  6. EBV-positive diffuse large B-cell lymphoma of the elderly: 2016 update on diagnosis, risk-stratification, and management.

    Science.gov (United States)

    Castillo, Jorge J; Beltran, Brady E; Miranda, Roberto N; Young, Ken H; Chavez, Julio C; Sotomayor, Eduardo M

    2016-05-01

    Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) of the elderly is a provisional entity included in the 2008 WHO classification of lymphoid neoplasms. It is a disease typically seen in the elderly and thought to be associated with chronic EBV infection and severe immunosuppression with a component of immunosenescence. Recent research, however, has suggested that EBV-positive DLBCL can be seen in younger, immunocompetent patients. The diagnosis of EBV-positive DLBCL of the elderly is made through a careful pathological evaluation. The differential diagnosis includes infectious mononucleosis (specifically in younger patients), lymphomatoid granulomatosis, Hodgkin lymphoma, and gray zone lymphoma, among others. Detection of EBV-encoded RNA (EBER) is considered standard for diagnosis; however, a clear cutoff for positivity has not been defined. The International Prognostic Index (IPI), and the Oyama score can be used for risk-stratification. The Oyama score includes age >70 years and presence of B symptoms. The expression of CD30 is emerging as a potential adverse, and targetable, prognostic factor. Patients with EBV-positive DLBCL should be staged and managed following similar guidelines than patients with EBV-negative DLBCL. It has been suggested, however, that EBV-positive patients have a worse prognosis than EBV-negative counterparts in the era of chemoimmunotherapy. There is an opportunity to study and develop targeted therapy in the management of patients with EBV-positive DLBCL.

  7. Vertical stratification of forest canopy for segmentation of understory trees within small-footprint airborne LiDAR point clouds

    Science.gov (United States)

    Hamraz, Hamid; Contreras, Marco A.; Zhang, Jun

    2017-08-01

    Airborne LiDAR point cloud representing a forest contains 3D data, from which vertical stand structure even of understory layers can be derived. This paper presents a tree segmentation approach for multi-story stands that stratifies the point cloud to canopy layers and segments individual tree crowns within each layer using a digital surface model based tree segmentation method. The novelty of the approach is the stratification procedure that separates the point cloud to an overstory and multiple understory tree canopy layers by analyzing vertical distributions of LiDAR points within overlapping locales. The procedure does not make a priori assumptions about the shape and size of the tree crowns and can, independent of the tree segmentation method, be utilized to vertically stratify tree crowns of forest canopies. We applied the proposed approach to the University of Kentucky Robinson Forest - a natural deciduous forest with complex and highly variable terrain and vegetation structure. The segmentation results showed that using the stratification procedure strongly improved detecting understory trees (from 46% to 68%) at the cost of introducing a fair number of over-segmented understory trees (increased from 1% to 16%), while barely affecting the overall segmentation quality of overstory trees. Results of vertical stratification of the canopy showed that the point density of understory canopy layers were suboptimal for performing a reasonable tree segmentation, suggesting that acquiring denser LiDAR point clouds would allow more improvements in segmenting understory trees. As shown by inspecting correlations of the results with forest structure, the segmentation approach is applicable to a variety of forest types.

  8. Prognostic value of cardiovascular MRI in diabetics; Prognostischer Wert der kardiovaskulaeren MRT bei Diabetikern

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, C.L.; Bertheau, R.C.; Kauczor, H.U.; Weckbach, S. [Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany)

    2015-04-01

    Despite an increased cardiovascular risk in patients with diabetes mellitus they are a heterogeneous population with very different individual manifestation of diseases; therefore, a profound stratification is recommended. Clinical examinations and blood biomarkers are typically used in diabetic patients to determine the risk for developing cardio-cerebrovascular events. Cardiac as well as whole-body magnetic resonance imaging (MRI) including cardiovascular sequences are established methods for clinical diagnostics. Their significance in predicting the outcome and the corresponding risk stratification for patients with diabetes is becoming increasingly more important based on recent study results. Late gadolinium enhancement (LGE) in cardiac MRI detects silent myocardial ischemia in up to 30 % of diabetic patients, which is associated with a hazard ratio of 3-6 for cardiovascular events. Regional left ventricular wall motion abnormalities and decreased ejection fraction also have a prognostic value in diabetics. Based on whole-body MRI, the vessel score as well as carotid artery stenosis have been evaluated as additional predictors for cardio-cerebrovascular events. The MRI-based predictors have independent and incremental prognostic value beyond traditional risk stratification for cardio-cerebrovascular events; however, only the comprehensive assessment of whole-body MRI including angiography allows the identification of patients who remain free of cardio-cerebrovascular events over a period of 6 years. Cardiac MRI, particularly the detection of LGE, can be recommended for risk stratification of patients with diabetes mellitus. The clinical relevance of the added prognostic value of whole-body MRI needs to be clarified in further studies. (orig.) [German] Trotz eines im Durchschnitt erhoehten kardiovaskulaeren Risikos sind Diabetiker eine heterogene Population mit hoechst unterschiedlichen individuellen Krankheitsverlaeufen, sodass eine fundierte

  9. Influence of upper-ocean stratification on tropical cyclone-induced surface cooling in the Bay of Bengal

    Digital Repository Service at National Institute of Oceanography (India)

    Neetu, S.; Lengaigne, M.; Vincent, E.M.; Vialard, J.; Madec, G.; Samson, G.; RameshKumar, M.R.; Durand, F.

    by vertical mixing underneath TCs. On average, thermal stratification accounts for ∼60% of this cooling reduction during postmonsoon season, while haline stratification accounts for the remaining 40 percent. Their respective contributions however strongly vary...

  10. Validation of cytogenetic risk groups according to International Prognostic Scoring Systems by peripheral blood CD34+FISH: results from a German diagnostic study in comparison with an international control group

    Science.gov (United States)

    Braulke, Friederike; Platzbecker, Uwe; Müller-Thomas, Catharina; Götze, Katharina; Germing, Ulrich; Brümmendorf, Tim H.; Nolte, Florian; Hofmann, Wolf-Karsten; Giagounidis, Aristoteles A. N.; Lübbert, Michael; Greenberg, Peter L.; Bennett, John M.; Solé, Francesc; Mallo, Mar; Slovak, Marilyn L.; Ohyashiki, Kazuma; Le Beau, Michelle M.; Tüchler, Heinz; Pfeilstöcker, Michael; Nösslinger, Thomas; Hildebrandt, Barbara; Shirneshan, Katayoon; Aul, Carlo; Stauder, Reinhard; Sperr, Wolfgang R.; Valent, Peter; Fonatsch, Christa; Trümper, Lorenz; Haase, Detlef; Schanz, Julie

    2015-01-01

    International Prognostic Scoring Systems are used to determine the individual risk profile of myelodysplastic syndrome patients. For the assessment of International Prognostic Scoring Systems, an adequate chromosome banding analysis of the bone marrow is essential. Cytogenetic information is not available for a substantial number of patients (5%–20%) with dry marrow or an insufficient number of metaphase cells. For these patients, a valid risk classification is impossible. In the study presented here, the International Prognostic Scoring Systems were validated based on fluorescence in situ hybridization analyses using extended probe panels applied to cluster of differentiation 34 positive (CD34+) peripheral blood cells of 328 MDS patients of our prospective multicenter German diagnostic study and compared to chromosome banding results of 2902 previously published patients with myelodysplastic syndromes. For cytogenetic risk classification by fluorescence in situ hybridization analyses of CD34+ peripheral blood cells, the groups differed significantly for overall and leukemia-free survival by uni- and multivariate analyses without discrepancies between treated and untreated patients. Including cytogenetic data of fluorescence in situ hybridization analyses of peripheral CD34+ blood cells (instead of bone marrow banding analysis) into the complete International Prognostic Scoring System assessment, the prognostic risk groups separated significantly for overall and leukemia-free survival. Our data show that a reliable stratification to the risk groups of the International Prognostic Scoring Systems is possible from peripheral blood in patients with missing chromosome banding analysis by using a comprehensive probe panel (clinicaltrials.gov identifier:01355913). PMID:25344522

  11. External validation of leukocytosis and neutrophilia as a prognostic marker in anal carcinoma treated with definitive chemoradiation.

    Science.gov (United States)

    Schernberg, Antoine; Huguet, Florence; Moureau-Zabotto, Laurence; Chargari, Cyrus; Rivin Del Campo, Eleonor; Schlienger, Michel; Escande, Alexandre; Touboul, Emmanuel; Deutsch, Eric

    2017-07-01

    To validate the prognostic value of leukocyte disorders in anal squamous cell carcinoma (SCC) patients receiving definitive concurrent chemoradiation. Bi-institutional clinical records from consecutive patients treated between 2001 and 2015 with definitive chemoradiation for anal SCC were retrospectively reviewed. Prognostic value of pretreatment leukocyte disorders was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as leukocyte or neutrophil count exceeding 10G/L and 7G/L, respectively. We identified 133 patients, treated in two institutions. Eight% and 7% displayed baseline leukocytosis and neutrophilia, respectively. Estimated 3-year overall survival (OS) and progression-free survival (PFS) were 88% and 77%, respectively. In univariate analysis, both leukocytosis and neutrophilia were associated with worse OS, PFS (p<0.01), locoregional control (LRC) and Distant Metastasis Control (DMC) (p<0.05), also after stratification by each institution. In multivariate analysis, leukocytosis and neutrophilia remained as independent risk factors associated with poorer OS, PFS, LRC and DMC (p<0.05). This study validates leukocytosis and neutrophilia as independent prognostic factors in anal SCC patients treated with definitive chemoradiation. Although prospective confirmation is warranted, it is suggested that the leukocyte and neutrophil count parameters are clinically relevant biomarkers to be considered for further clinical investigations. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Complex molecular genetic abnormalities involving three or more genetic mutations are important prognostic factors for acute myeloid leukemia.

    Science.gov (United States)

    Wakita, S; Yamaguchi, H; Ueki, T; Usuki, K; Kurosawa, S; Kobayashi, Y; Kawata, E; Tajika, K; Gomi, S; Koizumi, M; Fujiwara, Y; Yui, S; Fukunaga, K; Ryotokuji, T; Hirakawa, T; Arai, K; Kitano, T; Kosaka, F; Tamai, H; Nakayama, K; Fukuda, T; Inokuchi, K

    2016-03-01

    We conducted a comprehensive analysis of 28 recurrently mutated genes in acute myeloid leukemia (AML) in 271 patients with de novo AML. Co-mutations were frequently detected in the intermediate cytogenetic risk group, at an average of 2.76 co-mutations per patient. When assessing the prognostic impact of these co-mutations in the intermediate cytogenetic risk group, overall survival (OS) was found to be significantly shorter (P=0.0006) and cumulative incidence of relapse (CIR) significantly higher (P=0.0052) in patients with complex molecular genetic abnormalities (CMGAs) involving three or more mutations. This trend was marked even among patients aged ⩽65 years who were also FLT3-ITD (FMS-like tyrosine kinase 3 internal tandem duplications)-negative (OS: P=0.0010; CIR: P=0.1800). Moreover, the multivariate analysis revealed that CMGA positivity was an independent prognostic factor associated with OS (P=0.0007). In stratification based on FLT3-ITD and CEBPA status and 'simplified analysis of co-mutations' using seven genes that featured frequently in CMGAs, CMGA positivity retained its prognostic value in transplantation-aged patients of the intermediate cytogenetic risk group (OS: P=0.0002. CIR: Pmutation analysis to have clinical usefulness and applicability.

  13. BIOBEHAVIORAL PROGNOSTIC FACTORS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: Results from the INSPIRE-II Trial

    Science.gov (United States)

    Blumenthal, James A.; Smith, Patrick J.; Durheim, Michael; Mabe, Stephanie; Emery, Charles F.; Martinu, Tereza; Diaz, Philip T.; Babyak, Michael; Welty-Wolf, Karen; Palmer, Scott

    2015-01-01

    Objective To examine the prognostic value of select biobehavioral factors in patients with chronic obstructive pulmonary disease (COPD) in a secondary analysis of participants from the INSPIRE-II trial. Methods Three hundred twenty six outpatients with COPD underwent assessments of pulmonary function, physical activity, body mass index, inflammation, pulmonary symptoms, depression, and pulmonary quality of life, and were followed for up to 5.4 years for subsequent clinical events. The prognostic value of each biobehavioral factor, considered individually and combined, also was examined in the context of existing Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 risk stratification. Results Sixty-nine individuals experienced a hospitalization or died over a mean follow-up time period of 2.4 (interquartile range = 1.6) years. GOLD classification was associated with an increased risk of clinical events (HR = 2.72 [95% CI 1.63, 4.54], per stage); Six Minute Walk (HR = 0.50 [0.34, 0.73] per 500 feet), total steps (HR = 0.82 [0.71, 0.94] per 1,000 steps), hsC-reactive protein (HR = 1.44 [1.01, 2.06] per 4.5 mg/L), depression (HR = 1.12 [1.01, 1.25] per 4 points), and pulmonary quality of life (HR = 1.73 [1.14, 2.63] per 25 points) were each predictive over and above the GOLD assessment. However, only GOLD group and Six Minute Walk were predictive of all-cause mortality and COPD hospitalization when all biobehavioral variables were included together in a multivariable model. Conclusion Biobehavioral factors provide added prognostic information over and above measures of COPD severity in predicting adverse events in patients with COPD. PMID:26780299

  14. Development and External Validation of a Prognostic Nomogram for Metastatic Uveal Melanoma

    Science.gov (United States)

    Valpione, Sara; Moser, Justin C.; Parrozzani, Raffaele; Bazzi, Marco; Mansfield, Aaron S.; Mocellin, Simone; Pigozzo, Jacopo; Midena, Edoardo; Markovic, Svetomir N.; Aliberti, Camillo; Campana, Luca G.; Chiarion-Sileni, Vanna

    2015-01-01

    Background Approximately 50% of patients with uveal melanoma (UM) will develop metastatic disease, usually involving the liver. The outcome of metastatic UM (mUM) is generally poor and no standard therapy has been established. Additionally, clinicians lack a validated prognostic tool to evaluate these patients. The aim of this work was to develop a reliable prognostic nomogram for clinicians. Patients and Methods Two cohorts of mUM patients, from Veneto Oncology Institute (IOV) (N=152) and Mayo Clinic (MC) (N=102), were analyzed to develop and externally validate, a prognostic nomogram. Results The median survival of mUM was 17.2 months in the IOV cohort and 19.7 in the MC cohort. Percentage of liver involvement (HR 1.6), elevated levels of serum LDH (HR 1.6), and a WHO performance status=1 (HR 1.5) or 2–3 (HR 4.6) were associated with worse prognosis. Longer disease-free interval from diagnosis of UM to that of mUM conferred a survival advantage (HR 0.9). The nomogram had a concordance probability of 0.75 (SE .006) in the development dataset (IOV), and 0.80 (SE .009) in the external validation (MC). Nomogram predictions were well calibrated. Conclusions The nomogram, which includes percentage of liver involvement, LDH levels, WHO performance status and disease free-interval accurately predicts the prognosis of mUM and could be useful for decision-making and risk stratification for clinical trials. PMID:25780931

  15. Concordance for prognostic models with competing risks

    DEFF Research Database (Denmark)

    Wolbers, Marcel; Blanche, Paul; Koller, Michael T

    2014-01-01

    The concordance probability is a widely used measure to assess discrimination of prognostic models with binary and survival endpoints. We formally define the concordance probability for a prognostic model of the absolute risk of an event of interest in the presence of competing risks and relate i...... of the working model. We further illustrate the methods by computing the concordance probability for a prognostic model of coronary heart disease (CHD) events in the presence of the competing risk of non-CHD death.......The concordance probability is a widely used measure to assess discrimination of prognostic models with binary and survival endpoints. We formally define the concordance probability for a prognostic model of the absolute risk of an event of interest in the presence of competing risks and relate...... it to recently proposed time-dependent area under the receiver operating characteristic curve measures. For right-censored data, we investigate inverse probability of censoring weighted (IPCW) estimates of a truncated concordance index based on a working model for the censoring distribution. We demonstrate...

  16. Long-term survival in glioblastoma: methyl guanine methyl transferase (MGMT promoter methylation as independent favourable prognostic factor

    Directory of Open Access Journals (Sweden)

    Smrdel Uros

    2016-12-01

    Full Text Available In spite of significant improvement after multi-modality treatment, prognosis of most patients with glioblastoma remains poor. Standard clinical prognostic factors (age, gender, extent of surgery and performance status do not clearly predict long-term survival. The aim of this case-control study was to evaluate immuno-histochemical and genetic characteristics of the tumour as additional prognostic factors in glioblastoma.

  17. Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction

    DEFF Research Database (Denmark)

    Haugaa, Kristina H; Grenne, Bjørnar L; Eek, Christian H;

    2013-01-01

    The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI).......The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI)....

  18. Vertical stratification of the termite assemblage in a neotropical rainforest.

    Science.gov (United States)

    Roisin, Yves; Dejean, Alain; Corbara, Bruno; Orivel, Jerôme; Samaniego, Mirna; Leponce, Maurice

    2006-08-01

    The importance of termites as decomposers in tropical forests has long been recognized. Studies on the richness and diversity of termite species and their ecological function have flourished in more recent times, but these have been mostly conducted in a thin stratum within a standing man's reach. Our aims were to evaluate the specific richness and composition of the termite assemblage in the canopy of a tropical rainforest and to determine its originality with respect to the sympatric ground-level fauna. We conducted systematic searches for canopy termites, together with conventional sampling of the sympatric ground-level fauna, in the San Lorenzo forest, Panama. We hypothesized that (1) the canopy accommodates two categories of wood-feeding termites (long-distance foragers and small-colony "one-piece" species) and possibly soil-feeders in suspended soil-like habitats; (2) due to the abundance of soil-feeders, the overall diversity of the ground fauna is higher than that of the canopy; (3) differences in microclimate and resource accessibility favour vertical stratification among wood-feeders. Sixty-three canopy samples yielded ten species of termites, all wood-feeders. Five of these were not found at ground level, although a total of 243 ground samples were collected, representing 29 species. In addition to long-distance foragers (Microcerotermes and Nasutitermes spp.) and small-colony termites (mostly Kalotermitidae), the canopy fauna included Termes hispaniolae, a wood-feeding Termitidae from an allegedly soil-feeding genus, living in large dead branches. Soil-feeders were absent from the canopy, probably because large epiphytes were scarce. As predicted, the ground fauna was much richer than that of the canopy, but the species richness of both habitats was similar when only wood-feeders were considered. Vertical stratification was strongly marked among wood-feeders, as all common species, apart from the arboreal-nesting Microcerotermes arboreus, could

  19. Thermal stratification in a scaled-down suppression pool of the Fukushima Daiichi nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Jo, Byeongnam, E-mail: jo@vis.t.u-tokyo.ac.jp [Nuclear Professional School, The University of Tokyo, 2-22 Shirakata, Tokai-mura, Ibaraki 319-1188 (Japan); Erkan, Nejdet [Nuclear Professional School, The University of Tokyo, 2-22 Shirakata, Tokai-mura, Ibaraki 319-1188 (Japan); Takahashi, Shinji [Department of Nuclear Engineering and Management, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656 (Japan); Song, Daehun [Nuclear Professional School, The University of Tokyo, 2-22 Shirakata, Tokai-mura, Ibaraki 319-1188 (Japan); Hyundai and Kia Corporate R& D Division, Hyundai Motors, 772-1, Jangduk-dong, Hwaseong-Si, Gyeonggi-Do 445-706 (Korea, Republic of); Sagawa, Wataru; Okamoto, Koji [Nuclear Professional School, The University of Tokyo, 2-22 Shirakata, Tokai-mura, Ibaraki 319-1188 (Japan)

    2016-08-15

    Highlights: • Thermal stratification was reproduced in a scaled-down suppression pool of the Fukushima Daiichi nuclear power plants. • Horizontal temperature profiles were uniform in the toroidal suppression pool. • Subcooling-steam flow rate map of thermal stratification was obtained. • Steam bubble-induced flow model in suppression pool was suggested. • Bubble frequency strongly depends on the steam flow rate. - Abstract: Thermal stratification in the suppression pool of the Fukushima Daiichi nuclear power plants was experimentally investigated in sub-atmospheric pressure conditions using a 1/20 scale torus shaped setup. The thermal stratification was reproduced in the scaled-down suppression pool and the effect of the steam flow rate on different thermal stratification behaviors was examined for a wide range of steam flow rates. A sparger-type steam injection pipe that emulated Fukushima Daiichi Unit 3 (F1U3) was used. The steam was injected horizontally through 132 holes. The development (formation and disappearance) of thermal stratification was significantly affected by the steam flow rate. Interestingly, the thermal stratification in the suppression pool vanished when subcooling became lower than approximately 5 °C. This occurred because steam bubbles are not well condensed at low subcooling temperatures; therefore, those bubbles generate significant upward momentum, leading to mixing of the water in the suppression pool.

  20. Prognostic Relevance of Cytokine Receptor Expression in Acute Myeloid Leukemia: Interleukin-2 Receptor α-Chain (CD25) Expression Predicts a Poor Prognosis.

    Science.gov (United States)

    Nakase, Kazunori; Kita, Kenkichi; Kyo, Taiichi; Ueda, Takanori; Tanaka, Isao; Katayama, Naoyuki

    2015-01-01

    A variety of cytokine/cytokine receptor systems affect the biological behavior of acute leukemia cells. However, little is known about the clinical relevance of cytokine receptor expression in acute myeloid leukemia (AML). We quantitatively examined the expression of interleukin-2 receptor α-chain (IL-2Rα, also known as CD25), IL-2Rβ, IL-3Rα, IL-4Rα, IL-5Rα, IL-6Rα, IL-7Rα, the common β-chain (βc), γc, granulocyte-macrophage colony-stimulating factor (GM-CSF)Rα, G-CSFR, c-fms, c-mpl, c-kit, FLT3, and GP130 in leukemia cells from 767 adult patients with AML by flow cytometry and determined their prevalence and clinical significance. All cytokine receptors examined were expressed at varying levels, whereas the levels of IL-3Rα, GM-CSFRα, IL-2Rα, γc, c-kit, and G-CSFR exhibited a wide spectrum of ≥10,000 sites/cell. In terms of their French-American-British classification types, GM-CSFRα and c-fms were preferentially expressed in M4/M5 patients, G-CSF in M3 patients, and IL-2Rα in non-M3 patients. Elevated levels of IL-3Rα, GM-CSFRα, and IL-2Rα correlated with leukocytosis. In patients ≤60 years old, higher levels of these 3 receptors correlated with poor responses to conventional chemotherapy, but only IL-2Rα was associated with a shorter overall survival. By incorporating IL-2Rα status into cytogenetic risk stratification, we could sort out a significantly adverse-risk cohort from the cytogenetically intermediate-risk group. Analyses with various phenotypical risk markers revealed the expression of IL-2Rα as an independent prognostic indicator in patients with intermediate-risk cytogenetics. These findings were not observed in patients >60 years old. Our results indicate that several cytokine receptors were associated with certain cellular and clinical features, but IL-2Rα alone had prognostic value that provides an additional marker to improve current risk evaluation in AML patients ≤60 years old.

  1. Change in Quality of Life after Rehabilitation: Prognostic Factors for Visually Impaired Adults

    Science.gov (United States)

    Langelaan, Maaike; de Boer, Michiel R.; van Nispen, Ruth M. A.; Wouters, Bill; Moll, Annette C.; van Rens, Ger H. M. B.

    2009-01-01

    The overall aim of rehabilitation for visually impaired adults is to improve the quality of life and (societal) participation. The objectives of this study were to obtain the short-term and long-term outcome of a comprehensive rehabilitation programme on quality of life for visually impaired adults, and prognostic baseline factors responsible for…

  2. Exosomal proteins as prognostic biomarkers in non-small cell lung cancer

    DEFF Research Database (Denmark)

    Paulsen, Birgitte Sandfeld; Aggerholm-Pedersen, N; Bæk, R

    2016-01-01

    BACKGROUND: Use of exosomes as biomarkers in non-small cell lung cancer (NSCLC) is an intriguing approach in the liquid-biopsy era. Exosomes are nano-sized vesicles with membrane-bound proteins that reflect their originating cell. Prognostic biomarkers are needed to improve patient selection...

  3. Prognostic factors for the effect of a myofeedback-based teletreatment service

    NARCIS (Netherlands)

    Larsman, Pernilla; Hasenbring, Monika; Sandsjö, Leif; Huis in 't Veld, Rianne M.H.A.; Witvrouw, Erik; Kosterink, Stephanie M.; Kadefors, Roland; Vollenbroek-Hutten, Miriam M.R.

    2010-01-01

    We investigated the potential prognostic factors for clinically relevant improvements in pain intensity and pain-related disability after myofeedback-based teletreatment. Sixty-five female computer users, 56 female patients with whiplash-associated disorders and 18 female patients with non-specific

  4. Prognostic indicators in alcoholic cirrhotic men

    DEFF Research Database (Denmark)

    Gluud, C; Henriksen, Jens Henrik Sahl; Nielsen, G

    1988-01-01

    information regarding development of variceal hemorrhage, even when easily obtained variables with known prognostic information were included [modified Child-Turcotte's criteria and incapacitation index (a weighted sum of days without normal health)]. During follow-up, 17 patients (29%) died. Applying Cox......'s regression analysis, large varices at endoscopy (p = 0.012) and hepatic vein pressure gradient (p = 0.019) contained significant prognostic information regarding death, in addition to the information contained in the modified Child-Turcotte's criteria and incapacitation index. In conclusion, prediction...

  5. Free-hand stratification with composite resins for the closure of anterior diastema

    Directory of Open Access Journals (Sweden)

    Leonardo Fernandes da Cunha

    2012-09-01

    Full Text Available Introduction: Dental diastemas are common findings at dental clinics. This clinical situation produces discomfort in many patients and its solution is difficult to many professionals. Silicone guides, made from waxed casts, have been used to assist the stratification of resin composites in cases of dental diastemas. This technique, however, does not necessarily need to be used as protocol in all situations. Objective: To demonstrate the stratification technique without silicone guides. Case report: The present study reports a case of stratification technique for anterior diastemas closure without silicone guide. Conclusion: The closure of diastemas can be quickly and easily performed using composite resins without the need of previously manufacturing silicone guides.

  6. A method to determine stratification efficiency of thermal energy storage processes independently from storage heat losses

    DEFF Research Database (Denmark)

    Haller, M.Y.; Yazdanshenas, Eshagh; Andersen, Elsa

    2010-01-01

    A new method for the calculation of a stratification efficiency of thermal energy storages based on the second law of thermodynamics is presented. The biasing influence of heat losses is studied theoretically and experimentally. Theoretically, it does not make a difference if the stratification...... process is in agreement with the first law of thermodynamics. A comparison of the stratification efficiencies obtained from experimental results of charging, standby, and discharging processes gives meaningful insights into the different mixing behaviors of a storage tank that is charged and discharged...

  7. Isotopic Stratification and Its Implications in Groundwater of Northern China

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    The contents of D, 8O, 3H and 14C, distinctive in shallow and deep Quaternary aquifers beneath northern China, reflect differences in average paleoclimatic conditions between the Holocene and the last glacial period in Pleistocene. Groundwater in deep confined aquifer was recharged during the last glacial period. The depletions of δ(D) and δ(18O) of this water, 4× 10-3 -16× 10-3 and 1 × 10-3 -2 × 10-3 when compared with the shallow water recharged in Holocene, suggest that the annual mean temperature was lower in the last glacial period than that in the Holocene. The continental gradient of D and 18O fount in old groundwater is essentially similar to that in Holocene, suggesting that the atmospheric circulation did not undergo substantial changes over northern China for the past 30 000 years in spite of the changes in the temperature. Groundwater isotopic stratification indicates three different recharge mechanisms and the influence of modern hydrological circulation, which are very important for the understanding of the continental hydrological circulation and the sustainable development of groundwater resources.``

  8. Disadvantaged through discrimination? The role of employers in social stratification.

    Science.gov (United States)

    Jackson, Michelle

    2009-12-01

    Sociologists have consistently demonstrated that a rather strong association exists between an individual's social class origin and their social class destination, even after controlling for educational attainment. One explanation for this persisting association which is rarely addressed in research in social stratification and mobility is the extent to which class inequalities in access to advantaged class positions are due to discrimination by employers. I set up a field experiment to test whether employers discriminate on the basis of class origin characteristics. I sent letters of job application for professional and managerial occupations to 2560 large UK companies, so as to compare the prospects of equally matched potential employees differing on a range of characteristics, some related to class of origin. The six treatment conditions in the experiment were: the name of the candidate, the type of school attended, the candidate's interests outside work, their sex, the university that they attended and their achieved degree class. Results suggest that employers do pay attention to the class origin characteristics tested here, and that candidates with a name, school type and interests associated with the social elite are more likely to receive a reply to their application than candidates with the equivalent non-elite characteristics. However, the treatment conditions do not, on the whole, have significant effects on the employers' responses in and of themselves. Instead, employers appear to favour particular combinations of characteristics while penalising others.

  9. Modeling Residual Circulation and Stratification in Oujiang River Estuary

    Institute of Scientific and Technical Information of China (English)

    LIN Wei-bo; WANG Yi-gang; RUAN Xiao-hong; XU Qun

    2012-01-01

    A 3D,time-dependent,baroclinic,hydrodynamic and salinity model was implemented and applied to the Oujiang River estuarine system in the East China Sea.The model was driven by the forcing of tidal elevations along the open boundaries and freshwater inflows from the Oujiang River.The bottom friction coefficient and vertical eddy viscosity were adjusted to complete model calibration and verification in simulations.It is demonstrated that the model is capable of reproducing observed temporal variability in the water surface elevation and longitudinal velocity,presenting skill coefficient higher than 0.82.This model was then used to investigate the influence of freshwater discharge on residual current and salinity intrusion under different freshwater inflow conditions in the Oujiang River estuary.The model results reveal that the river channel presents a two-layer structure with flood currents near the bottom and ebb currents at the top layer in the region of seawater influenced on north shore under high river flow condition.The river discharge is a major factor affecting the salinity stratification in the estuarine system.The water exchange is mainly driven by the tidal forcing at the estuary mouth,except under high river flow conditions when the freshwater extends its influence from the river's head to its mouth.

  10. On summer stratification and tidal mixing in the Taiwan Strait

    Institute of Scientific and Technical Information of China (English)

    Jia ZHU; Jianyu HU; Zhiyu LIU

    2013-01-01

    On continental shelves,a front that separates the sea into well-mixed and stratified zones is usually formed in warm seasons due to spatial variations of tidal mixing.In this paper,using eight years of in situ hydrographic observations,satellite images of sea surface temperature (SST) and chlorophyll-a (Chl-a) concentration,and results of a tidal model,we investigate summer stratification in the Taiwan Strait and its dependence on tidal mixing,upwelling,and river diluted water plumes.In most regions of the strait the dominant role of tidal mixing in determining the thermohaline structure is confirmed by the correlation between the two; there are some regions,however,where thermohaline structttre varies in different ways owing to significant influences ofupwelling and river diluted water plumes.The well-mixed regions are mainly distributed on the Taiwan Bank and in the offshore regions offthe Dongshan Island,Nanao Island,and Pingtan Island,while the northern and central Taiwan Strait and the region south of the Taiwan Bank are stratified.The critical Simpson-Hunter parameter for the region is estimated to be 1.78.

  11. Spatial Stratification of Order As Used in Failure Analysis

    Science.gov (United States)

    Leonard, Robert H.; Bachlechner, Martina E.

    2007-03-01

    Silicon nitride deposited on silicon substrates has application in dielectric layers for microelectronics as well as in photovoltaics. During production and operation of components involving silicon/silicon nitride interfaces, stresses and strains can build up at various temperatures resulting in component failure. Using molecular dynamics simulations the influence of temperature and rate of externally applied strain on silicon/silicon nitride interfaces has been analyzed. The primary purpose of this research is to understand the mechanisms leading to the failure of these films. Analyses involving bond lengths and angles have been developed to gain insight into these mechanisms. Methods for stratifying bond lengths and bond angles into unique sub-populations on the basis of spatial orientation have been developed, and have given much insight to how the material behaves, particularly with regards to the Poisson effect. Possible extensions of this stratification method to primitive rings will also be examined. In combination with experimental observations, this analysis will deepen our understanding of the structural properties of silicon/silicon nitride interfaces.

  12. The density stratification and amplitude dispersion of internal waves

    Science.gov (United States)

    Makarenko, N.; Ulanova, E.

    2012-04-01

    We consider the theoretical model of large amplitude internal solitary waves propagating in a weakly stratified fluid under gravity. It is well known that steady 2D Euler equations of non-homogeneous fluid reduce in this case to the second-order quasi-linear equation for a stream function (the Dubreil-Jacotin-Long equation). Subsequently, the shape of traveling solitary wave can be determined in the long-wave scaling limit by solving the dispersive KdV-type model equation. The non-linear terms of this equation depend considerably on the instantaneous fine-scale density profile formed over background linear- or exponential stratification (Benney&Ko, 1978; Borisov&Derzho 1990; Derzho&Grimshaw 1997; Makarenko, 1999; Makarenko, Maltseva and Kazakov, 2009). Now we derive and analyze Fredholm-type integral equations coupling immediately the fluid density coefficient with the dispersion function for internal solitary waves. The inverse problem which means to find the fine-scale density by known curve of the amplitude dispersion is discussed in more details.

  13. Outer core stratification by crystallization of SiO2

    Science.gov (United States)

    Helffrich, G. R.; Hirose, K.; Morard, G.; Sinmyo, R.

    2016-12-01

    Wavespeeds lower than PREM's near-uniform self-compression profile in the outermost outer core constitute evidence for a radial compositional gradient there, and possibly for stable stratification. Based on melting experiments in the Fe-Si-O system in the diamond anvil at outer core pressures and temperatures that show crystallization of SiO2, we developed a thermodynamic model of SiO2 saturation in liquid Fe at high pressure and temperature conditions suitable for modeling magma ocean and outer core processes. Conditions in a magma ocean between 30-50 GPa allow for significant incorporation of Si + O in the metal, which, after the core evolves to its present temperature (3500-4500 K at the CMB), leads to exsolution of SiO2. The high efficiency of driving a dynamo by crystallization allows a dynamo of comparable strength to the present to be powered throughout Earth history. Using a transition-element hard-sphere model for seismic wavespeeds, we show that the continuous crystallization of SiO2 at the top of the core produces denser, iron-enriched liquid that mixes downward into the core. The net effects of the density and mean atomic weight change in the mixed region leads to reduced wavespeeds in the top of the outer core that require only a small change in concentration of the SiO2 component in the liquid, about 0.15 wt%.

  14. The biosocial female choice theory of social stratification.

    Science.gov (United States)

    Ellis, L

    2001-01-01

    For decades, the study of social stratification has been dominated by environmental theories. Herein a theory is proposed that contains both biological and sociocultural elements. The theory asserts that most human females, like females of many other mammalian species, have evolved mating preferences biased toward males who are competent in provisioning resources. This female bias is hypothesized to have been naturally selected because females with these biases nearly always have had a reproductive edge over females who lack such a bias. One result of this bias is that human females preferentially mate with males who strive to rise in social status. This, in turn, has favored males who attain or at least strive for high social status, and who advertise and even exaggerate whatever status they already have achieved. At the genetic level, the theory postulates that alleles have accumulated on the human genome that promote social status-striving and achievement to varying degrees. To account for why males are more prone toward status-striving than females, the theory contends that one or more genes on the Y-chromosome interact with genes on the remaining human chromosomes to incline males to gravitate toward social hierarchies and to strive for niches that are relatively high in those hierarchies. Both tested and untested hypotheses are derived from the theory and compared to the empirical evidence currently available.

  15. Rpt Analysis of Turbulent Flows With Stable Stratification

    Science.gov (United States)

    Sukoriansky, S.; Galperin, B.

    The Renormalized Perturbation Technique of successive small scales elimination is applied to turbulent flows with stable stratification. This procedure results in derivation of scale-dependent anisotropic viscosities and diffusivities that naturally incorporate the combined effect of turbulence and internal waves. In addition, this procedure ren- ders means to analyze the fundamentals of the turbulence-internal waves interaction, derive the criterion of the threshold of the internal waves generation that fully accounts for the spectral anisotropy, and derive the dispersion relation for internal waves with turbulence. A closure assumption is then introduced relating the renormalized param- eters to global flow characteristics such as the gradient Richardson number (Ri) or local Froude number. Anisotropic turbulent Prandtl numbers are compared with lab- oratory and numerical experiments. The agreement is good in the entire range of Ri, from very small to large indicating that our model captures the physics of strongly stratified turbulent flows. This result has immediate application value for modeling of atmospheric and oceanic boundary layers.

  16. Three-tiered risk stratification model to predict progression in Barrett's esophagus using epigenetic and clinical features.

    Directory of Open Access Journals (Sweden)

    Fumiaki Sato

    Full Text Available Barrett's esophagus predisposes to esophageal adenocarcinoma. However, the value of endoscopic surveillance in Barrett's esophagus has been debated because of the low incidence of esophageal adenocarcinoma in Barrett's esophagus. Moreover, high inter-observer and sampling-dependent variation in the histologic staging of dysplasia make clinical risk assessment problematic. In this study, we developed a 3-tiered risk stratification strategy, based on systematically selected epigenetic and clinical parameters, to improve Barrett's esophagus surveillance efficiency.We defined high-grade dysplasia as endpoint of progression, and Barrett's esophagus progressor patients as Barrett's esophagus patients with either no dysplasia or low-grade dysplasia who later developed high-grade dysplasia or esophageal adenocarcinoma. We analyzed 4 epigenetic and 3 clinical parameters in 118 Barrett's esophagus tissues obtained from 35 progressor and 27 non-progressor Barrett's esophagus patients from Baltimore Veterans Affairs Maryland Health Care Systems and Mayo Clinic. Based on 2-year and 4-year prediction models using linear discriminant analysis (area under the receiver-operator characteristic (ROC curve: 0.8386 and 0.7910, respectively, Barrett's esophagus specimens were stratified into high-risk (HR, intermediate-risk (IR, or low-risk (LR groups. This 3-tiered stratification method retained both the high specificity of the 2-year model and the high sensitivity of the 4-year model. Progression-free survivals differed significantly among the 3 risk groups, with p = 0.0022 (HR vs. IR and p<0.0001 (HR or IR vs. LR. Incremental value analyses demonstrated that the number of methylated genes contributed most influentially to prediction accuracy.This 3-tiered risk stratification strategy has the potential to exert a profound impact on Barrett's esophagus surveillance accuracy and efficiency.

  17. An overview of modeling methods for thermal mixing and stratification in large enclosures for reactor safety analysis

    Energy Technology Data Exchange (ETDEWEB)

    Haihua Zhao; Per F. Peterson

    2010-10-01

    Thermal mixing and stratification phenomena play major roles in the safety of reactor systems with large enclosures, such as containment safety in current fleet of LWRs, long-term passive containment cooling in Gen III+ plants including AP-1000 and ESBWR, the cold and hot pool mixing in pool type sodium cooled fast reactor systems (SFR), and reactor cavity cooling system behavior in high temperature gas cooled reactors (HTGR), etc. Depending on the fidelity requirement and computational resources, 0-D steady state models (heat transfer correlations), 0-D lumped parameter based transient models, 1-D physical-based coarse grain models, and 3-D CFD models are available. Current major system analysis codes either have no models or only 0-D models for thermal stratification and mixing, which can only give highly approximate results for simple cases. While 3-D CFD methods can be used to analyze simple configurations, these methods require very fine grid resolution to resolve thin substructures such as jets and wall boundaries. Due to prohibitive computational expenses for long transients in very large volumes, 3-D CFD simulations remain impractical for system analyses. For mixing in stably stratified large enclosures, UC Berkeley developed 1-D models basing on Zuber’s hierarchical two-tiered scaling analysis (HTTSA) method where the ambient fluid volume is represented by 1-D transient partial differential equations and substructures such as free or wall jets are modeled with 1-D integral models. This allows very large reductions in computational effort compared to 3-D CFD modeling. This paper will present an overview on important thermal mixing and stratification phenomena in large enclosures for different reactors, major modeling methods and their advantages and limits, potential paths to improve simulation capability and reduce analysis uncertainty in this area for advanced reactor system analysis tools.

  18. Combined p16 and p53 expression in cervical cancer of unknown primary and other prognostic parameters : A single-center analysis.

    Science.gov (United States)

    Yildirim, Müjdat; Müller von der Grün, Jens; Winkelmann, Ria; Fokas, Emmanouil; Rödel, Franz; Ackermann, Hanns; Rödel, Claus; Balermpas, Panagiotis

    2017-04-01

    Cervical cancer of unknown primary (CUP) represents an uncommon and heterogeneous subentity of head and neck cancer. However, both optimal diagnostics and therapy remain unclear. An improved understanding of the underlying pathology is essential to enable future tailored therapies and optimized outcomes. We retrospectively analyzed 53 patients with head and neck CUP a