Arbitrary Scoring System Research Articles

Multiple Scale of Complexity for Anorectal Fistulas

Background: Anorectal fistulas are frequently prevalent proctological entities, in which the complexity is frequently garbled. Objective: To create a scale of complexity for fistulas based on identification, medical history, physical examination, and ultrasonography findings. Design: A retrospective and descriptive study of a prospectively maintained database. Setting: A single medical group performed three-dimensional endoanal ultrasonography at two different tertiary care hospitals in Caracas, Venezuela. Patients and Methods: All patients who underwent anorectal three-dimensional endoanal ultrasonography at the two hospitals between 2010 and 2017 were included in the study. We created an arbitrary numerical scoring system ranging from 0 to 14 points, which classifies the structure of fistulas as simple, intermediate, and complex. The chi-squared test performed with Statistical Program of Social Sciences was used to establish the significance level of P < 0.005. Sample Size: a total of 1173 patients were evaluated, and perianal fistulas were identified in 989 patients. Results: Of the 232 intersphincteric fistulas, 75.86% were simple, 22.41% were intermediate, and 1.72% were complex. Of the 295 lower transsphincteric fistulas, 51.19% were simple, 42.71% were intermediate, and 6.10% were complex. Of the 327 high transsphincteric fistulas, 17.74% were simple, 59.94% were intermediate, and 22.32% were complex. Of the 48 extrasphincteric fistulas, 66.67% were intermediate and 33.33% were complex. Finally, of the 18 suprasphincteric fistulas, 50% were intermediate and 50% were complex. Conclusions: The complexity of fistulas may not be easy to determine, even in cases requiring further complementary studies. The application of our scale helped to prevent the factors that may be responsible for the deterioration of the complexity of fistulas, with a statistically significant difference compared to the classic Goodsall's classification, based exclusively on the anatomy of the fistula tract. Limitations: A single operative group study without surgical usefulness validation that warrants a further multicentric randomized study. Conflict of Interest: The authors have no conflict of interest to declare.

Knowledge, Attitude and Practice Regarding Kidney Diseases among Primary Care Physicians working in Nepal

Background: Medical officers and resident doctors as primary care physicians (PCPs) are the first contact health care providers to most of the kidney disease patients in Nepal. This study intends to assess knowledge, attitude and practice regarding kidney diseases among these nonnephrology doctors, working in different health institutes all over Nepal. Methods: This was a descriptive, cross sectional, questionnaire based study, conducted over the span of 12 weeks among the primary care physicians. The Ethical Review Board of Nepal Health Research Council had approved our protocol prior to starting the study. An arbitrary scoring system was used to classify knowledge, attitude and practice scores as: 0 to <50% - Poor score, 50% to <75% - Moderate score, ≥ 75% - Good score. Data was entered in Microsoft Excel and analyzed using IBM Statistical Package for the Social Sciences version 25. Results: Out of 239 PCPs enrolled in our study, 41 (17%) obtained good knowledge scores, 124 (51.8%) obtained good attitude scores and 198 (82.8%) obtained good practice scores. None of the study participants had negative attitude towards kidney diseases. The mean scores obtained in our study were 23.03±4.49 for knowledge, 17.64±2.30 for attitude and 6.27±1.24 for practice domains out of total score of 37, 24, and 8 respectively. Conclusions: Our study demonstrated that the majority of PCPs had obtained moderate to poor knowledge scores regarding kidney diseases. However, the majority had a positive attitude and good practice regarding kidney diseases in our study.

The Clinical Impact of Methotrexate-Induced Stroke-Like Neurotoxicity in Paediatric Departments: An Italian Multi-Centre Case-Series.

IntroductionStroke-like syndrome (SLS) is a rare subacute neurological complication of intrathecal or high-dose (≥500 mg) Methotrexate (MTX) administration. Its clinical features, evoking acute cerebral ischaemia with fluctuating course symptoms and a possible spontaneous resolution, have elicited interest among the scientific community. However, many issues are still open on the underlying pathogenesis, clinical, and therapeutic management and long-term outcome.Materials and MethodsWe retrospectively analyzed clinical, radiological and laboratory records of all patients diagnosed with SLS between 2011 and 2021 at 4 National referral centers for Pediatric Onco-Hematology. Patients with a latency period that was longer than 3 weeks between the last MTX administration of MTX and SLS onset were excluded from the analysis, as were those with unclear etiologies. We assessed symptom severity using a dedicated arbitrary scoring system. Eleven patients were included in the study.ResultsThe underlying disease was acute lymphoblastic leukemia type B in 10/11 patients, while fibroblastic osteosarcoma was present in a single subject. The median age at diagnosis was 11 years (range 4–34), and 64% of the patients were women. Symptoms occurred after a mean of 9.45 days (± 0.75) since the last MTX administration and lasted between 1 and 96 h. Clinical features included hemiplegia and/or cranial nerves palsy, paraesthesia, movement or speech disorders, and seizure. All patients underwent neuroimaging studies (CT and/or MRI) and EEG. The scoring system revealed an average of 4.9 points (± 2.3), with a median of 5 points (maximum 20 points). We detected a linear correlation between the severity of the disease and age in male patients.ConclusionsSLS is a rare, well-characterized complication of MTX administration. Despite the small sample, we have been able to confirm some of the previous findings in literature. We also identified a linear correlation between age and severity of the disease, which could improve the future clinical management.

What factors are associated with ambulance use for non-emergency problems in children? A systematic mapping review and qualitative synthesis

ObjectiveTo explore what factors are associated with ambulance use for non-emergency problems in children.MethodsThis study is a systematic mapping review and qualitative synthesis of published journal articles and grey literature....

Review of Health Insurance Policy Inclusivity of Gender Nonconforming and Nonbinary Individuals Seeking Gender-Affirming Health Care.

An increasing number of individuals who present to health care professionals identify as transgender, gender nonconforming (GNC), and gender nonbinary (NB). GNC/NB individuals experience higher rates of discrimination in health care settings compared with their binary (e.g., trans male and trans female) counterparts. Outdated language excludes the nuances of gender identity. The goal of this study was to evaluate whether current terminology found in health insurance policies may be a barrier to gender-affirming health care for GNC/NB individuals. Health insurance policies for a diverse subset of government (n=4) and private (n=6) payers were obtained in May 2020. Policies were reviewed independently by two members of the research team to determine whether each was supportive or unsupportive to GNC/NB individuals. An arbitrary scoring system was designed that allowed the reviewers to assign a specific number of points to each policy based on the aggregation of mention, coverage, and inclusivity. Most policies performed poorly as indicated by a support score less than zero. It was also noted that most policies used binary, gendered language, and terminology that excludes the unique gender identities of many GNC/NB individuals. Most policies currently failed to provide clear, inclusive coverage to GNC/NB individuals for relevant and important aspects of their care. In their current state, these policies are a source of confusion, uncertainty, and discouragement for these individuals, which can present as a barrier to accessing quality, inclusive, gender-affirming health care.

Analysis of the Educational Value of YouTube Laparoscopic Appendectomy Videos.

PurposeTo evaluate the educational value of laparoscopic appendectomy (LA) videos on YouTube for surgical trainees.MethodsThe search term “Laparoscopic appendectomy” was used on YouTube. The top 100 videos sorted by the number of views were evaluated. Each YouTube account was analyzed, and only videos uploaded by medical physicians were included in this study. Video quality was evaluated using an arbitrary appendectomy scoring system. Video characteristics and Global Operative Assessment of Laparoscopic Skills (GOALS) scores were analyzed regarding video quality and upload source.ResultsThe video quality of 14 (25.0%) videos was graded as good, 36 (64.3%) moderate, and 6 (10.7%) of poor quality. Video characteristic analysis showed no differences in video quality according to the upload source (p=0.573). Video quality and upload source were not related to video length, total views, days online, number of likes, number of dislikes, number of comments, or GOALS score. Among the factors analyzed, only appendicitis severity was found to be associated with video grade (p=0.049).ConclusionThe quality of LA YouTube videos varied. Categories considered as viewer feedback were not associated with video grade or upload source. Responsible video uploading by academic institutions, and appropriate censorship by YouTube seems necessary. Further research with objective data on actual application to surgical trainees is necessary.

Abstract 3947: Atypical chemokine receptor ACKR3 expression is associated with aggressive behavior and poor prognosis in gastric cancer

Abstract Chemokine and their receptors are key mediators of normal physiology and a large number of pathologic conditions such as cancer, and this family of receptors is the emerging therapeutic target in the field of cancer treatment. ACKR3 is an atypical chemokine receptor first cloned from a dog cDNA library as the orphan receptor and was initially named Receptor Dog cDNA 1 (RDC1). Shortly after demonstrating that RDC1 binds with its ligand, stromal cell-derived factor-1α (SDF-1α) and interferon-inducible T-cell α chemoattractant (I-TAC), RDC1 was officially deorphanized. Accumulating evidence of recent studies have suggested that expression of ACKR3 is augmented in most of tumor cells as compared to their normal counterparts and is involved in cell proliferation, survival, migration, invasion during the initiation and progression of cancer. However, there is little information regarding their expression and clinical relevance in gastric cancer. The expression status of ACKR3 was investigated in 221 specimens of primary gastric cancer using immunohistochemistry. The correlation of ACKR3 expression with the clinicopathological features and survival outcomes was analyzed as well. Immunohistochemical staining of gastric cancer tissue sections revealed diverse cytoplasmic and membrane staining patterns for ACKR3. One hundred-fourteen cases (51.6%) showed low ACKR3 expression according to an arbitrary scoring system (grade 0-1; grade 0, n = 26; grade 1, n = 88), and one hundred-seven cases (48.4%) showed high expression (grade 2-3; grade 2, n = 58; grade 3, n = 49). There were no significant differences in age, gender, histology, tumor location, lymphatic and venous invasion among the two groups. However, high CXCR7 expression in cancer cells tended to be associated with proportion of tumor size greater than 5 cm (P = 0.055) and was significantly correlated with depth of tumor invasion (P < 0.001), lymph node metastasis (P = 0.042), and higher stage (P = 0.002). Furthermore, patients with high ACKR3 expression showed worse overall survival rate of 47% compared to 56% in patients with low ACKR3 expression. In conclusion, ACKR3 is differentially expressed in gastric cancer cells, and high expression of ACKR3 is associated with aggressive tumor behavior and poor survival in patients with gastric cancer, suggesting that ACKR3 plays an important role during gastric cancer progression. Citation Format: Nayoung Kim, Seung-Woo Baek, Hyewon Ryu, Yoon Seok Choi, Ik Chan Song, Hwan Jung Yun, Deog Yeon Jo, Samyong Kim, Hyo Jin Lee. Atypical chemokine receptor ACKR3 expression is associated with aggressive behavior and poor prognosis in gastric cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3947.

Current skin symptoms of Yusho patients exposed to high levels of 2,3,4,7,8-pentachlorinated dibenzofuran and polychlorinated biphenyls in 1968

Yusho was a mass food poisoning event due to the ingestion of rice oil contaminated with polychlorinated biphenyls (PCBs) and various dioxins and dioxin-like compounds. At its outbreak in 1968, Yusho patients suffered severe skin symptoms. Although the blood concentrations of PCBs and dioxins, especially highly toxic 2,3,4,7,8-pentachlorinated dibenzofuran (2,3,4,7,8-PeCDF) remain high in these patients, extensive analysis has not been performed on their current skin symptoms. We categorized and evaluated the specific skin symptoms in Yusho in 2012 by grading their severity using an arbitrary scoring system, and analyzed their correlations with the blood concentrations of 2,3,4,7,8-PeCDF and PCBs. A total of 352 Yusho patients underwent annual dermatological check-ups, in which five skin symptoms: black comedones, acneiform eruptions, scar formation, pigmentation and nail deformity, were evaluated for their distribution and severity. Approximately one-third of Yusho patients still presented with black comedones, acneiform eruptions and scar formation; the distributions of these symptoms were similar to those at the time of the Yusho outbreak. The mean blood concentrations of 2,3,4,7,8-PeCDF and total PCBs in Yusho patients were still higher than those in controls. The prevalence and severity of black comedones were correlated with age. Severity scores of black comedones and scar formation were positively correlated with 2,3,4,7,8-PeCDF blood level, and those of black comedones, scar formation, and pigmentation were positively correlated with total PCBs blood level. This study suggests that 2,3,4,7,8-PeCDF and PCBs remaining in Yusho patients still play crucial roles in the development of skin symptoms in Yusho.

Forensic diagnosis and classification of snakebite (neurotoxic and haemotoxic) from renal changes at autopsy: morphological and histological determinants using a semi-quantitative method

Mortality due to poisonous snakebite is an emerging public health concern. Of late, snakebite has drawn global attention. Snakebite is a well-known cause of renal pathology especially in the haemotoxic group. Deaths due to renal failure are very common in envenomation due to poisonous snakebite. In this investigation our aim was to devise autopsy-proven diagnostic criteria of snakebite from the renal changes to confirm and classify the type of snakebite in forensic casework. That would be of practical help to the forensic pathologist with access to limited resources. An arbitrary scoring system from histology was adopted for the present semi-quantitative analysis. The scoring system (with scores from 0 to 5) developed by the present study was effective, valid and was able to distinguish between snakebite and control. The score obtained at histology in cases of snakebite was significantly different from the control group (Mann-Whitney U = 71.5; P = 0.011). Using stepwise linear discriminant function (DF) analysis, the score (Mukhopadhyay's score [MS]) was seen to be the only predictor of the type of snakebite. This model (DF = 1.05 x MS-1.78) could correctly classify 93.3% of the cases into neurotoxic and haemotoxic variety of offending snake. This is an effective, cheap and easy semi-quantitative method of distinguishing neurotoxic and haematoxic snakes from the renal changes at autopsy. It would be useful for practical application in centres where sophisticated biochemical or immunological analyses are not available due to limited resources.

The citation triad: An overview of a scientist's publication output based on Ferrers diagrams

In a recent work by Anderson, Hankin, and Killworth (2008), Ferrers diagrams and Durfee squares are used to represent the scientific output of a scientist and construct a new h-based bibliometric indicator, the tapered h-index ( h T). In the first part of this paper we examine h T, identifying its main drawbacks and weaknesses: an arbitrary scoring system and an illusory increase in discrimination power compared to h. Subsequently, we propose a new bibliometric tool, the citation triad ( CT), that better exploits the information contained in a Ferrers diagram, giving a synthetic overview of a scientist's publication output. The advantages of this new approach are discussed in detail. Argument is supported by several examples based on empirical data.

Blocking of Interleukin-17 during Reactivation of Experimental Arthritis Prevents Joint Inflammation and Bone Erosion by Decreasing RANKL and Interleukin-1

Rheumatoid arthritis is characterized by an intermittent course of disease with alternate periods of remission and relapse. T cells, and in particular the T-cell cytokine interleukin-17 (IL-17), are expected to be involved in arthritic flares. Here, we report that neutralizing endogenous IL-17 during reactivation of antigen-induced arthritis prevents joint inflammation and bone erosion. Synovial IL-17 mRNA expression was clearly up-regulated during primary arthritis and was further enhanced after antigen rechallenge. Neutralization of IL-17 significantly prevented joint swelling at day 1 of flare and significantly suppressed joint inflammation and cartilage proteoglycan depletion at day 4, as assessed by histology. Blocking IL-17 also clearly reduced bone erosions. Cathepsin K, a marker of osteoclast-like activity, and synovial RANKL mRNA expression were both suppressed. The degree of bone erosions strongly correlated with the severity of joint inflammation, suggesting that anti-IL-17 treatment reduced bone erosion by suppressing joint inflammation. Interestingly, blocking IL-17 suppressed synovial expression of both IL-1beta and tumor necrosis factor-alpha, whereas blocking IL-1 did not affect tumor necrosis factor-alpha levels. These data indicate that IL-17 is an important upstream mediator in joint pathology during flare-up of experimental arthritis.

Radiological and biochemical resolution of nutritional rickets with calcium

Aims: To determine the response to oral calcium in Nigerian children with rickets. Methods: In a teaching hospital in Western Nigeria, 26 children (13 boys, 13 girls, aged 2–5 years)...

Magnetic resonance findings in the brain of patients with multiple sclerosis without oligoclonal bands in the cerebrospinal fluid

Locally produced oligoclonal IgG bands (OCB) are present in the cerebrospinal fluid (CSF) of 95% patients with multiple sclerosis (MS) [2,3]. The most sensitive method for the detection of OCB is isoelectric focusing (IEF) [1]. Occasional patients with clinically definite MS lack evidence for intrathecal IgG synthesis [2,9]. This study was designed to compare brain magnetic resonance imaging (MRI) findings between CSF OCB positive and negative MS patients. The study comprised 22 OB negative patients with clinically definite MS and 22 OCB positive controls matched for age, disease duration, activity and course of MS. In the both groups clinical assessment was performed by using Expanded Disability Status Scale (EDSS) score. T2 weighted MRI of the brain was performed on a Siemens Magnetom (1.0T). Lesions were counted and sized for 15 anatomically defined locations: 7 periventricular (PV) and 8 non-periventricular (NPV) regions. An arbitrary scoring system weighted for lesions size was used to estimate total and regional lesions loads: a) 1 point was given for each lesion with a diameter 1-5 mm, b) 2 points for one lesion with a diameter 6-10 mm, c) 3 points for one over 10 mm, and confluent lesions scored one extra point [16]. Atrophy were scored as follows: 0-normal size, 1-mild atrophy, 2-moderate atrophy and 3-severe atrophy. Mean score of total brain MRI loads was lower in OCB negative than in OCB positive MS patients (44 vs. 50) but the difference was not statistically significant. Mean periventricular (32 vs. 23), non-periventricular (26 vs. 19) and infratentorial (11 vs. 9) scores were higher in OCB positive MS group in comparison with OCB negative patients, but non-significant (figure 1). There was no correlation between EDSS score and total MRI lesions load in OCB negative MS patients, while in OCB positive group we detected significant correlation between EDSS score and total MRI lesions load (p = 0.026) (figure 2). The results of this study demonstrate that by using conventional brain MRI the extent end severity of the pathological process seems to be similar in OCB negative and OCB positive MS patients. On the other hand, we found statistically significant correlation between brain MRI total lesion load and EDSS in the OCB positive MS patients, while this correlation was not detected in OCB negative MS patients. Differences in brain MRI findings between OCB positive nad OCB negative MS patients have been already analyzed [9,12]. In the first, Zeman et al. reported that OCB negative MS patients have lower total MRI brain lesion loads in comparison to OCB positive group, but the differences was not statistically significant [9]. In accordance with these findings, Fukazawa et al. also failed to show differences in the distribution, extent, shape and number of brain MRI lesions between OCB positive and negative MS patients. [12]. On the other hand, it has been demonstrated that the rate of intrathecal IgG synthesis apparently correlates with plaque volume in the brain, as demonstrated on MRI, in MS patients [17]. However, our results along with those from two above-mentioned previous studies do not support this notion. In conclusion, trend towards lesser MRI lesion load and lack of its correlation with EDSS in OCB negative MS patients, warrants further investigations with new MRI techniques (magnetic resonance spectroscopy and magnetisation transfer), including the thorough exploration of normal-appearing while matter, in OCB negative MS patients.

An assessment of tissue harmonic versus fundamental imaging modes for echocardiographic measurements

The study aimed to evaluate whether a significant difference exists between tissue harmonic imaging (THI) and fundamental imaging (FI) in routine quantitative echocardiographic assessment. We also examined the effects of THI on endocardial definition (ED). Fifty-eight unselected patients (29 men, 29 women; mean age 53 years) referred for transthoracic echocardiography were studied with use of both FI and THI modes. Two independent observers made M-mode measurements of the following: left atrium, aortic root, and left ventricular internal dimensions and wall thickness; they also measured left ventricular outflow tract diameter and left atrial area from 2-dimensional images. Endocardial definition was assessed with use of an arbitrary scoring system (0 = endocardium not visualized, 1 = endocardium visualized but suboptimally, 2 = endocardium well defined) and the American Society of Echocardiography 16-segment model. No significant difference existed between cardiac measurements derived from FI and THI. However, a highly significant improvement in ED occurred with THI (ED index 1.83 versus 1.70, P <.0001). This study suggests that no systematic differences exist in standard echocardiographic measurements between THI and FI, even in the setting of improved ED. (J Am Soc Echocardiogr 2001;14:1191-6.)

Amplification of the HER-2/neu oncogene is uncommon in pediatric osteosarcomas.

Recent reports have described overexpression of p185(c-erbB2), the product of the HER-2/neu oncogene, in more than 40% of archival osteosarcomas that were examined by immunohistochemistry (IHC). However, IHC can be influenced by the method of fixation, extent of antigen retrieval, specificity and sensitivity of the antibody clone, and the use of an arbitrary semiquantitative scoring system. In contrast, fluorescence in situ hybridization (FISH) assays that assess HER-2/neu gene copy numbers in individual cells are more consistent, more reproducible, and less subjective than IHC. The authors examined pretreatment nondecalcified archival tissue from 21 high-grade pediatric osteosarcomas for amplification of the HER-2/neu oncogene using an Food and Drug Administration (FDA)-approved FISH assay (PathVysion, Vysis Inc., Downers Grove, IL). Additionally, IHC for p185(c-erbB2) was performed in all cases using the Dako polyclonal antibody clone A0485 (Dako Co., Carpinteria, CA). None of the 21 osteosarcomas had evidence of HER-2/neu gene amplification by FISH, whereas p185(c-erbB2) IHC was negative in all cases. HER-2/neu gene amplification appeared to be an uncommon event in pediatric osteosarcomas. The reason(s) for discordance between previous IHC data and the current FISH and IHC results was unknown, but might reflect intrinsic variations in antibody clones, or might suggest that, in some cases, the occurrence of protein overexpression is independent of gene amplification.

Which extractant should be used for the screening and isolation of antimicrobial components from plants?

Freeze dried and finely ground leaves of two plants with known antimicrobial activity, Anthocleista grandiflora and Combretum erythrophyllum were extracted with acetone, ethanol, methanol, methylenedichloride, methanol/chloroform/water and water at a 1 to 10 ratio in each case. The quantity and diversity of compounds extracted, number of inhibitors extracted, rate of extraction, toxicity in a bioassay, ease of removal of solvent and biological hazard were evaluated for each extractant. An arbitrary scoring system was developed to evaluate the above parameters for the different extractants. Acetone gave the best results with these plants with an arbitrary value of 102 followed by methanol/chloroform/water (81), methylene dichloride (79), methanol (71), ethanol (58) and water (47). Four five minute sequential extractions of very finely ground A. grandiflora shaking at a high rate extracted 97% of the total antimicrobial activity.

The effect of anticipation in the scoring of mammographic accreditation phantom images

Purpose: Some of the subjectivity in the scoring of mammographic phantom images may be due to reader anticipation of the pattern of structures in the phantom. The extent of this bias was investigated by scoring images in which the positions of the structures were randomized. Methods: Images of the American College of Radiographers (ACR) mammography phantom were acquired under different X-ray techniques, digitized and scored by a group of five readers. The 16 structures comprising each image were then randomized in position to form new images, which were re-scored by the readers using the same criteria for visibility. Results: The scores after randomization were significantly lower than before randomization, indicating that a priori knowledge of the positions of the structures within the phantom resulted in false-positive scoring of individual structures and elevated net scores for the non-randomized images. Conclusions: Biased scoring due to reader anticipation of the phantom pattern contributes to the inherent subjectivity of the assessment mechanism. Computerized analysis of the phantom images would remove this bias and replace the arbitrary scoring system currently employed with an image quality index better correlated to clinical diagnostic quality.

The relationship between the expression of blood group-related antigens and the cell proliferation of pancreatic carcinomas induced by N-nitrosobis(2-oxopropyl)amine in hamsters.

The relationship between expression of blood group-related antigens (BGRAs) A, B, H, and cell proliferation was investigated during pancreatic carcinogenesis and in transplanted pancreatic carcinomas induced by N-nitrosobis(2-oxopropyl)amine in hamsters. Immunohistochemical staining was performed using monoclonal antibodies (MoAbs) against BGRAs A, B, H, and bromodeoxyuridine (BrdU). The labeling index (LI) was determined as the ratio of the number of BrdU-labeled cells to the total number of cells counted in each lesion. During carcinogenesis, the LI was observed to increase in line with the increase in the extent of atypism (P < 0.01). The mean LIs of the hyperplasia, atypical hyperplasia, and carcinoma were 0.32, 3.21, and 10.2, respectively. The mean LIs of transplanted carcinomas were higher than those of the original carcinomas (P < 0.01). The reactivity with each of the antibodies was determined using an arbitrary scoring system. Staining with MoAbs A and B (staining intensity; 1+ to 3+) appeared to be more intense than that with MoAb H (1+ to 2+) during carcinogenesis. Regarding the growth rate, which was very high, in the transplanted carcinomas, MoAb A reacted with all the cancer cells (4+), whereas, MoAbs B and H reacted with fewer cells (1+ to 3+). These results indicate that the A antigen in particular is associated with the cell proliferation of pancreas, especially with carcinoma induced in hamsters.

Detection of IgM Rheumatoid Factors by Enzyme-Linked Immunosorbent Assay in Children with Juvenile Rheumatoid Arthritis: Correlation With Articular Disease and Laboratory Abnormalities

This study was undertaken to determine the clinical relevance of IgM rheumatoid factors (RFs) detected by enzyme-linked immunosorbent assay (ELISA) in children with juvenile rheumatoid arthritis (JRA) by examining their association with severity of acute articular disease. ELISAs for IgM-RF were performed on serum specimens from 65 children with JRA. Activity of articular disease was estimated by an arbitrary scoring system. Significant differences were seen in articular disease activity between the group of children with polyarticular disease who were IgM-RF-positive by ELISA compared with those who were IgM-RF-negative (P = .0003). When a small group of individual children with polyarticular disease were followed longitudinally, similar correlations were found between severity of acute disease and the presence of IgM-RFs detected by ELISA. In children with pauciarticular JRA, expression of IgM-RFs appeared to be a transient phenomenon with no correlation with either articular disease or laboratory abnormalities.

Patterns of disease activity in multiple sclerosis: clinical and magnetic resonance imaging study.

To compare the abnormalities shown by magnetic resonance imaging of the brain in three clinically distinct groups of patients with multiple sclerosis, and to correlate the extent of abnormality with the degree of clinical disability in the three groups. All patients underwent magnetic resonance imaging and full neurological examination, and their disability was scored according to the expanded Kurtzke disability state scale. National Hospital for Nervous Diseases (Multiple Sclerosis NMR Research Group). Three groups of patients with confirmed multiple sclerosis were studied: 12 patients with minimal disability despite a long (greater than 10 years) duration of illness (benign multiple sclerosis), 16 who had developed progressive disability after a relapsing and remitting course (secondary progressive multiple sclerosis), and 13 who had had progressive disability from the onset of the disease (primary progressive multiple sclerosis). Number and size of lesions in 17 anatomically defined sites; total lesion load, estimated with an arbitrary scoring system weighted for the size of lesions; and disability score. Magnetic resonance imaging showed that all 41 patients had abnormalities. These were extensive in the groups with secondary progressive and benign disease compared with the group with primary progressive disease. The lesions in the patients with secondary progressive disease were larger and more confluent than those in the two other groups (p = 0.007). Most lesions (85%) in the patients with primary progressive disease were under 5 mm in diameter; this percentage was higher than that in the two other groups (p = 0.032). Consequently the patients with primary progressive disease had the lowest mean lesion load (36.7); that in the patients with benign disease was 52.7 and that in the patients with secondary progressive disease 64.6 (p = 0.05). No correlation existed between disability and total lesion load. The distribution of brain lesions and of detectable lesions of the spinal cord, and the frequency of cortical atrophy, were similar in all groups. No relation was found between the degree of clinical disability and the extent of abnormality shown by magnetic resonance imaging: patients with clinically benign disease often had extensive abnormalities and those with primary progressive disease had surprisingly few lesions. Though magnetic resonance imaging increases knowledge of the disease process in multiple sclerosis and is invaluable in diagnosis, it is not helpful in predicting disability in individual patients.