Classification Subgroups Research Articles

Early gastric cancer with a mixed-type Lauren classification is more aggressive and exhibits greater lymph node metastasis.

The clinicopathological features of mixed-type (MT) early gastric cancer (EGC) according to Lauren's classification remain uninvestigated. This study aimed to clarify the clinicopathological features of MT EGC, particularly in relation to lymph node metastasis (LNM) and long-term survival. This study included 5309 patients who underwent gastrectomy for EGC. The clinicopathological features, LNM, and long-term outcomes of patients with MT carcinomas were compared with those of patients with intestinal-type (IT) and diffuse-type (DT) cancers. Furthermore, we evaluated the predictors of LNM in each Lauren classification subgroup. Patients with MT carcinomas were likelier to have larger tumors, submucosal invasion, lymphovascular invasion, and LNM than those with IT or DT carcinomas. Multivariate logistic regression analysis revealed that the Lauren classification was a significant predictor of LNM (P<0.001). The significant predictors of LNM in MT carcinomas were female sex, greater tumor size, presence of submucosal invasion, and lymphovascular invasion. However, the overall survival of patients with MT carcinoma was not significantly different from that of patients with IT or DT carcinomas (P=0.104). The presence of MT EGC carries a higher risk of LNM compared with the presence of IT or DT carcinomas. Therefore, MT carcinomas should be managed with gastrectomy that includes lymph node dissection instead of endoscopic resection.

Correlation study between small vessel disease and early neurological deterioration in patients with mild/moderate acute ischemic stroke

Aims: Cerebral small vessel disease (SVD) refers to a group of pathological processes that affect small arteries, arterioles, venules, and capillaries of the brain. We hypothesized that imaging markers of SVD could be associated with neurological deterioration during acute phase of mild/moderate ischemic stroke. Methods: We performed a prospective cohort with 687 consecutive patients with acute ischemic stroke and also with admission NIHSS score below 12 points. Imaging markers of SVD include silent lacunar infarction, deep cerebral microbleeds (CMBs), brain atrophy, periventricular and semiovale white matter hyperintensities, basal ganglia and semiovale enlarged perivascular spaces as well as SVD burden rating scale, which were evaluated and calculated, respectively. Early neurology deterioration (END) was defined as an increment of NIHSS score ≥2 points in the first 72 h after admission. Results: None of these imaging markers and rating scale of SVD significantly correlated with END after adjusted for major confounders. Post hoc analysis indicated similar negative results in different age, TOAST classification and infarction location subgroups. Only silent infarction (OR 2.42, 95%CI 1.33–5.10) and deep CMBs (OR 2.10, 95%CI 1.08–3.72) seemed to be predictors for END in female patients. However, due to the increased type I error in multiple comparisons, these relationships should not be regarded as statistically significant. Conclusion: In patients with mild/moderate acute ischemic stroke, imaging markers of SVD did not correlate with END.

A comparison of outcomes after percutaneous nephrolithotomy in children and adults: A matched cohort study

Percutaneous nephrolithotomy (PCNL) has surpassed open stone surgery as the operation of choice for large and complex stone burdens (figure). Although the procedure was developed in adults, its principles have been extrapolated to children. There is a paucity of literature comparing outcomes of PCNL in adults and children for similar stone burdens. The purpose of this study was to evaluate outcomes following PCNL among children and adults with similar stone burdens. Data on patient characteristics and outcomes for 2196 consecutive patients undergoing PCNL at a single institution were collected prospectively from January 1992 to July 2013. Thirty-one pediatric patients undergoing 39 PCNLs were identified. Each pediatric PCNL was matched in a ratio of 1:4 to adult PCNLs by year of surgery and stone burden characteristics (staghorn, partial staghorn, number of stones). All PCNLs were performed by two fellowship-trained endourologists who operate on both adult and pediatric patients. Ultrasonic lithotripsy was used primarily. The primary outcome measure was stone-free rate (SFR) at hospital discharge. Secondary outcomes included the need for second-look nephroscopy, length of hospital stay, complication rate, and blood transfusion rate. The Student t test was used for continuous variables and the Fisher exact for categorical variables. The median age for the pediatric group was 13.9 ± 4.30 years and for the adult group was 55.4 ± 15.1 years. Pediatric patients tended to present with metabolic stones, with no difference in rates of infection stones. No difference was found in SFR at time of hospital discharge (86.1% vs. 86.4%, p = 0.2). More pediatric patients required a second access tract than adult patients (15.4% vs. 4.52%, p = 0.02). There was no significant difference in the need for second-look nephroscopy, length of stay, or complication rates (overall and by Clavien classification subgroup) between both groups. The rates of blood transfusion were low in both groups (0% vs. 0.6%, p = 0.80). There was no difference in primary and secondary outcomes among children compared with adults undergoing PCNL in our study. The outcomes reported in this study were similar to published literature. A limitation of this study is the low number of pediatric patients. However, it is unique to have a single-center study that compares PCNL outcomes in both adult and pediatric patient and accounts for stone burden characteristics. Although principles of PCNL were developed in adults, this study affirms the safety and efficacy of PCNL in both pediatric and adult patients.

Prognostic importance of ultrasound BI-RADS classification in breast cancer patients.

We investigated the prognostic importance of pre-operative Breast Imaging Reporting and Data System classification in ultrasound imaging. Histopathological differences and disease-free survival were analyzed in Breast Imaging Reporting and Data System classification subgroups. Univariate and multivariate analyses were used to identify the prognostic factors. We identified 531 invasive breast cancer patients eligible for this study. Most patients classified as Breast Imaging Reporting and Data System 5 had large tumors and a higher rate of lymph node metastasis. However, hormonal receptor or HER-2 status did not differ according to Breast Imaging Reporting and Data System classification. During a median post-operative follow-up of 42.0 months, 43 patients were diagnosed with a disease-specific event. Disease-free survival was significantly lower in patients with Breast Imaging Reporting and Data System 5 than in patients with Breast Imaging Reporting and Data System 3-4. Subgroup analysis of patients with invasive breast cancer of Stage I showed that Breast Imaging Reporting and Data System 5 was an independent negative prognostic indicator of disease-free survival (hazard ratio 9.195; 95% confidence interval, 1.175-71.955; P = 0.035). Breast Imaging Reporting and Data System classification might be considered as prognostic factors especially in Stage I breast cancer. Further confirmatory studies are needed.

FRI0460 Differences and similarities of spondyloarthritis classification subgroups defined by the assessment of spondyloarthritis international society (ASAS)

BackgroundSince the Assessment of SpondyloArthritis international Society (ASAS) developed new classification criteria, spondyloarthritis (SpA) is no longer divided into different phenotypic subtypes such as ankylosing spondylitis and psoriatic arthritis, but...

Neoadjuvant chemotherapy in locally advanced breast cancer.

e11034 Background: Neoadjuvant chemotherapy(NAC)is one of the treatment options for locally advanced breast cancer. In this study, we evaluated the efficacy and safety of 4 cycles of NAC doxorubicine,docetaxel and cyclophosphamide(TAC),correlation between the response to NAC and molecular classification sub-groups and between the pCR and the time to progression(TTP). Methods: This is a prospective study from January 2005 to December 2008.110 pts with locally advanced breast cancer stage III.All pts have received 4 cycles of NAC based on docetaxel 75 mg/m², doxorubicine 50 mg/m² and cyclophosphamide 500 mg/m² every 3 weeks, followed by surgery.101 pts were assessed, since 9 of them have progressed on treatment and came out of the study. Pts were stratified according to age, menopausal status, histopathological analysis (luminal tumors(ER-positive and HER2-negative), triple-negative tumors (TN)and HER2-positive tumors), response to the treatment and survival. The median follow up of patients was 39 months. The statistical study was done using SPSS 17. Results: The median age was 41(23–65).30% of pts were younger than 35 and 80% were premenopausal. 55% luminal tumors(56 pts), 33% HER2 positive(33 pts) and 12 % TN(12 pts).CRR was estimated at 89%(37% of CR and 63% of PR).There were 23, 7% of pCR according to Chevallier’s classification. In luminal, TN and HER2-positive pCR rates were 16%(9 of 56), 66,6%(8 of 12), and 21,2%(7 of 33) respectively. Multivariate analysis showed that the ER status was the only significant predictor of pCR(P = 0.025).HER2 status was not significantly associated with pCR(P= 0,423).TTP was 50 months. In luminal tumors, TN and HER2-positive tumors the TTP was respectively 59, 52 and 49 months. There was not a significant difference in TTP between the pCR(51 months) and the non-pCR group(44 months)(CI 95, p= 0.109).Grade III/IV toxicity included neutropenia(22%), febrile neutropenia(6,5%), mucositis(13%), and diarrhea(4%). Conclusions: Breast cancer occurs in young women in Algeria. In this study, neoadjuvant TAC was effective and well tolerated. The ER status was the only significant predictor of pCR. The molecular classification group with the highest percentage of pCR was the TN group. pCR was not associated with a better prognosis.

Systematic Review of Obesity Surgery Mortality Risk Score—Preoperative Risk Stratification in Bariatric Surgery

Bariatric surgery is the best long term treatment for morbid obesity. However, it carries risks of considerable morbidity and potential mortality. There is no published review on pre-operative identification of high-risk patients in bariatric surgery. This systematic review analyses obesity surgery mortality risk score (OS-MRS) as a tool for pre-operative prediction of mortality risk in bariatric surgery. Medline and Embase was systematically searched using the medical subjects headings (MeSH) terms 'bariatric surgery' and 'mortality' with further free text search and cross references. Studies that described OS-MRS to predict mortality risk after bariatric surgery were included in this review. Six studies evaluated 9,382 patients to assess the validity of OS-MRS to predict the mortality risk after bariatric surgery. Patient's age ranged from 19 to 67 years, and the body mass index ranged from 30 to 84. There were 83 deaths among the 9,382 patients (0.88 %) with individual studies reporting a mortality range from 0 % to 1.49 %. There were 13 deaths among 4,912 (0.26 %) class A patients, 55 deaths among 4,124 (1.33 %) class B patients and 15 deaths among 346 (4.34 %) class C patients. Mortality in classes A, B and C was significantly different from each of the other two classes (P < 0.05, χ(2)). This systematic review confirms that OS-MRS stratifies the mortality risk in the three-risk classification subgroups of patients. The OS-MRS can be used for pre-operative identification of high-risk patients undergoing primary Roux-en-Y gastric bypass surgery.

Abstract 5065: Gene expression profiling of colon adenocarcinomas reveals six prototypic molecular subtypes with distinct clinical and molecular characteristics

Abstract Purpose: The purpose of our study was to build up a molecular classification of colon cancers (CC) and to further identify a molecular signature that correlated with disease outcome through a genome-wide DNA and mRNA expression analysis. Material: Fresh frozen tumor tissues from 750 patients with stage I to IV CC were analyzed for anatomo-clinical characteristics and common DNA alterations including KRAS, BRAF, TP53 mutations, MMR (Mismatch Repair system) and CIMP (CpG island methylator phenotype) status. Among the 750 tumors, 443 were screened for pangenomic alteration and expression profiles using Affymetrix U133P2 chips and CGH arrays. Results: A robust approach based on unsupervised hierarchical clusterings of the 443 tumors revealed six main prototypic molecular subtypes with distinct clinical/molecular correlations and outcomes. The first (C1), fifth (C5) and sixth (C6) subtypes were more frequently CIN+ (chromosomal instability assessed by CGHa), TP53 mutant and left-sided tumors, without any molecular or clinical annotation able to clearly discriminate these three subgroups except the low relapse rate observed in the C5 subgroup (21.6% versus 30.9% and 39.3% in C1 and C6 subgroups, respectively). C2 was enriched for patients with deficient MMR (80.7%), CIMP+ (62.5%), BRAF mutant (37.3%) and right-sided (71%) CC with low relapsing rate (19.7%). C3 was enriched for KRAS mutant (76.2%) and right-sided tumors (57.8%). C4 included more CIMP+ (35.4%), BRAF mutant (25%), right-sided (64.2%) and relapsing (47.2%) CC. Of those 6 subtypes, C4 and C2 (dMMR) appeared to be the most segregated subtypes, others being less distant to each other. Although not significant, there was a trend in favor of a prognostic value of the six-subgroup classification, with C1, C4 and C6 subgroups having a relative poor outcome, and C2 and C5 a relative good outcome (65%, 64%, 63%, 77% and 83% 5-year disease-free survival, respectively; p=0.12). Using the limited number of molecular features available from 6 public datasets, we validated the molecular and clinical characteristics of C2, as well as the higher rate of relapse observed in C4. The prognostic value of the six-subtype classification was significant when applied to one independent dataset of 304 CC (p=0.012), with a worse prognosis confirmed for C1 and C4, and a better prognosis for C2 and C5. Conclusion: Our results suggest that CC develop as distinct molecular entities evolving through multiple pathways on the basis of several molecular features that may not result in a single but in several prognostic signatures according to each molecular subtype. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5065. doi:1538-7445.AM2012-5065

Subacute casemix classification for stroke rehabilitation in Australia. How well does AN-SNAP v2 explain variance in outcomes?

We sought the best predictors for length of stay, discharge destination and functional improvement for inpatients undergoing rehabilitation following a stroke and compared these predictors against AN-SNAP v2. The Oxfordshire classification subgroup, sociodemographic data and functional data were collected for patients admitted between 1997 and 2007, with a diagnosis of recent stroke. The data were factor analysed using Principal Components Analysis for categorical data (CATPCA). Categorical regression analyses was performed to determine the best predictors of length of stay, discharge destination, and functional improvement. A total of 1154 patients were included in the study. Principal components analysis indicated that the data were effectively unidimensional, with length of stay being the most important component. Regression analysis demonstrated that the best predictor was the admission motor FIM score, explaining 38.9% of variance for length of stay, 37.4%.of variance for functional improvement and 16% of variance for discharge destination. The best explanatory variable in our inpatient rehabilitation service is the admission motor FIM. AN- SNAP v2 classification is a less effective explanatory variable. This needs to be taken into account when using AN-SNAP v2 classification for clinical or funding purposes.

Poster 129: Describing What We Do: Clinician Perspectives on Documentation Challenges and Desired Features of a Future System for Classifying Rehabilitation Interventions

Objective: To describe challenges encountered during systematic documentation of rehabilitation interventions and to identify desired features of a future system for classifying rehabilitation interventions. Design: Focus groups and semi-structured interviews. Setting: 8 inpatient rehabilitation programs. Participants: 84 clinicians involved in data collection for practice-based evidence studies of spinal cord injury and traumatic brain injury rehabilitation. Interventions: Not applicable. Main Outcome Measures: Summary of themes reported by clinicians, determined by content analysis of focus group and interview transcripts. Results: The multi-faceted nature of rehabilitation treatment activities was identified as a major challenge to systematic documentation of interventions. Simultaneous delivery of more than one intervention, patient performance of complex tasks that challenge multiple systems, and conversation-based treatment interactions were reported to be difficult to categorize. Clinicians reported that categories that make reference to goals of treatment were clinically intuitive, but also reported difficulties when attempting to categorize activities that could address multiple goals. Clinicians considered the physical and temporal setting in which treatment occurs, adaptive or therapeutic equipment used, assistance or cueing provided, nature of participants in treatment, and specific tasks performed to be important descriptors of their interventions. Clinicians recommended creating a classification system that can be applied at greater or lesser levels of detail depending on the audience or purpose of documentation. Conclusions: Treatment descriptors identified by clinicians may be useful for differentiating classes of treatments or characterizing treatments within classification subgroups. Accommodation of multi-faceted treatment situations and sufficient flexibility to balance detail and documentation efficiency will be important in the successful clinical application of a future classification system.

Analysis of Maxillary Sinus Ventilation

and Its Impact on Asthma (ARIA) classification by correlating it to nasal eosinophilia as an objective tool. The secondary objective is to compare a Visual Analog Scale (VAS) assessment of severity to the ARIA classification. METHOD: Study design is cross-sectional correlational. We used specific serum IgE positivity along with other inclusion criteria. Nasal scrapping was done to evaluate nasal eosinophilia. We used VAS for subjective scoring of severity of the disease. Patients in the 4 ARIA classification subgroups were compared for all items. RESULTS: Our study included 33 patients. 63.6% had Persistent Allergic Rhinitis (PAR) and 26.4% Intermittent Allergic Rhinitis(IAR) with 15.1% mild and 85% moderate to severe form. Comparison for age, gender, allergen specific sensitization, asthma and severity according to ARIA criteria revealed no difference for all items. PER rated poorer (p0.002) than IAR on VAS while nasal eosinophilia was not significantly different between the 4 groups (p 0.792). CONCLUSION: Our study failed to show significant correlation between the nasal eosinophilia and the ARIA classification subgroups. The ARIA classification of AR reflects symptoms duration but does not seem to correlate with the severity of underlying inflammation. We found a correlation between the severity assessed by VAS and the IER and PER subgroups. The result of this study may open the discussion on the rationale behind the pharmacological options in ARIA recommendations.

Cause of death in patients with lower‐risk myelodysplastic syndrome

The authors have recently shown that a majority of patients with myelodysplastic syndrome (MDS) classified by the International Prognostic Scoring System as lower risk die without transformation to acute myelogenous leukemia (AML). The cause of death (COD) of these patients is not well understood. Identifying the COD could help to guide early therapy decisions. The authors retrospectively analyzed the COD in a cohort of 273 deceased patients with lower-risk MDS according to the International Prognostic Scoring System at presentation to The University of Texas M. D. Anderson Cancer Center from 1980 to 2004. MDS-related death was defined as infection, bleeding, transformation to AML, or disease progression. Remaining CODs were classified as non-MDS-related. Median age at presentation was 66 years (range, 19-88 years). Overall median survival was 59 weeks (range, 1-831 weeks). All French-American-British leukemia classification subgroups were represented. The percentage of International Prognostic Scoring System low and intermediate-1 groups were 21% and 79%, respectively. The most common cytogenetic abnormality (9%) was del(5q). Patients received supportive care only. The COD was identified as MDS-related in 230 of 273 (84%) patients. The most common disease-related CODs were infection (38%), transformation to AML (15%), and hemorrhage (13%). The most frequent non-disease-related COD was cardiovascular events (19 of 43 patients). The majority of patients with low- or intermediate-1 risk MDS will die because of causes related to their underlying disease. Although these results need to be validated in different populations, early therapeutic intervention could be considered in the management of these patients to improve survival.

A Distinct Expression of Various Gene Subsets in CD34+ Cells Obtained From Patients with Early and Advanced Myelodysplastic Syndrome.

Abstract 3795Poster Board III-731Gene expression profiles of CD34+ cells were compared between a cohort of 51 patients with MDS or AML from MDS and 7 healthy controls. The patients were classified according to the WHO criteria as follows: 5q- syndrome (n=7), RA (n=3), RARS (n=2), RCMD (n=10), RAEB-1 (n=7), RAEB-2 (n=15), and AML with MLD (multilineage dysplasia) (n=7). HumanRef-8 v2 Expression Bead Chips (Illumina) were used to generate expression profiles of the samples for >22,000 transcripts. The raw data were normalized data with the R software, lumi package. Normalized data were filtered by detection p-value <0.01, resulting in total number of 9811genes. To identify differentially expressed genes we performed two parallel statistical hypothesis testings: Analysis of Variance (ANOVA) together with Tukey test and empirical bayesian thresholding correction for multiple testing problem; and Significance Analysis of Microarrays (SAM). The results were confirmed by real-time quantitative PCR for six genes (TaqMan Gene Expression Assays). Hierarchical clustering of significantly differentially expressed genes clearly separated patients and controls, 5q-syndrome and RAEB-1 as a separate entities confirming usefulness of WHO classification subgroups. The most up-regulated genes in all patients included HBG2, HBG1, CYBRD1, HSPA1B, ANGPT1, and MYC. We assume that expression changes in globin genes, both fetal and adult globins (HBG2, HBG1 and HBA1, HBB) may play role not only in dysregulation of erythropoiesis but also in the disease progression or leukemic transformation of MDS. Among the most down-regulated genes, 13 genes related to B-lymphopoiesis (e.g. POU2AF1, VPREB1, VPREB3, CD79A, EBF1, LEF1, BCL3, IRF8 & IRF4) were detected, suggesting the abnormal development of B-cell progenitors in all MDS patients. Some of these genes (e.g. VPREB3, LEF1) showed decreasing trend in expression level from early to advanced MDS with the lowest expression in AML with MLD. Patients with advanced MDS had significantly decreased expression of genes involved in in the mitotic cell cycle, DNA replication, and chromosome segregation compared to early MDS where these gene subsets were up-regulated. The DAVID database also identified de-regulation in the cell cycle pathway through its 7 genes (CDC25C, CDC7, CDC20, ORC1L, CCNB2, BUB1, & CCNA2). On the other hand, advanced MDS patients showed significant up-regulation of proto-oncogenes (BMI1, MERTK) and genes related to angiogenesis (ANGPT1), anti-apoptosis (VNN1). The results confirm on molecular basis that increased cell proliferation and resistance to apoptosis together with a loss of cell cycle control, damaged DNA repair and altered immune response may play an important role in the expansion of malignant clone in MDS patients. The study was supported by Grant NR-9235 obtained from the Ministry of Health, Czech Republic. Disclosures:No relevant conflicts of interest to declare.

Skin prick test reactivity to common aeroallergens and ARIA classification of allergic rhinitis in patients of Central Greece

Allergic rhinitis (AR) is prevalent in Mediterranean countries, but there are no epidemiological studies in the Hellenic milieu in accordance with the recent ARIA guidelines. We investigated aetiological aeroallergens in AR patients of Central Greece using the ARIA classification. Between 2002 and 2006, 911 patients with rhinitis symptomatology were interviewed and underwent Skin prick testing and 623 completed the study. Seasonal rhinitis (SAR) represented 37.6%, Perennial rhinitis (PAR) 46.4% and SAR + PAR 16%. Intermittent mild and moderate/severe AR was evident in 9.3 and 24.5%, persistent mild and moderate/severe in 23.2 and 43.0%. Persistent AR appeared in overall 66.2% of patients and was prevalent in PAR and SAR + PAR (p < 0.0001). Severity of AR symptoms did not correlate more with ARIA than with the traditional subgroups. Marked statistical (p < 0.05) differences were evident for seven aeroallergens between the four geographic areas of the study. Pollen allergy was found in 77.8% but all pollens were significantly lower in coastal areas (p < 0.001), besides Parietaria (p < 0.003). Mite sensitivity manifested in 43.2%. Alternaria affected mostly the paediatric population (p < 0.0001). 12.4% (N = 77) was monosensitive, 58.7% (N = 366) oligosensitive, and 28.9% (N = 180) polysensitive. Rhinitis and asthma comorbidity was high (45.3%) and occurrence of asthma was related with PAR (p < 0.007) and SAR + PAR (p < 0.023) but not with the ARIA classification subgroups. This study provides compelling evidence of a typical Mediterranean allergic profile of patients of Central Greece with significant regional variability. Both classifications had approximately equal diagnostic value in our study besides the fact that ARIA subdivision is considered superior in determining treatment.

Clinical Outcomes for Patients Classified by Fear-Avoidance Beliefs and Centralization Phenomenon

Werneke MW, Hart DL, George SZ, Stratford PW, Matheson JW, Reyes A. Clinical outcomes for patients classified by fear-avoidance beliefs and centralization phenomenon. Objectives To (1) determine the prevalence of pain pattern classification subgroups (centralization, noncentralization, and not classified) observed during the initial evaluation of patients experiencing high versus low Fear-Avoidance Beliefs Questionnaire for physical activity (FABQ-PA) scores, (2) examine the association between discharge pain intensity and functional status (FS) outcomes based on FABQ-PA and pain pattern subgroups, and (3) compare minimal clinically important improvement for FS and pain intensity for FABQ-PA and pain pattern classification subgroups. Design Observational cohort design. Setting Suburban hospital-based outpatient rehabilitation clinic. Participants Consecutive patients with low back syndromes (N=238, mean ± SD, 59.1±17.0y; minimum=20, maximum=91). Interventions Interventions were designed to match patient classification by fear-avoidance level and pain pattern. Main Outcome Measures Two outcome measures were assessed: patient self-reported FS and pain intensity. FS was assessed by using computerized adaptive testing methods. Maximal pain intensity was assessed by using an 11-point numeric pain scale: 0 (no pain) to 10 (worst imaginable pain). Results There were no differences (χ 2 2=3.7, P=.16) in proportion of patients classified by pain pattern experiencing high or low fear-avoidance beliefs. After controlling for the effect of available risk-adjustment variables, only dual-level classification subgroups, symptom acuity, payer type, and intake FS or pain intensity were associated with discharge FS or pain outcomes. The highest proportion of patients achieving minimal clinically important improvement in pain and FS were reported by the following patient subgroup: centralization and low fear. Conclusions Pain pattern and FABQ-PA characteristics impacted rehabilitation outcomes. We recommend that both factors be considered when managing patients with low back pain in an effort to optimize rehabilitation outcomes.

Decrease in phenotypic regulatory T cells in subsets of patients with common variable immunodeficiency

Common variable immunodeficiencies (CVID) are a heterogeneous group of antibody deficiency disorders complicated by autoimmune, lymphoproliferative and/or granulomatous manifestations, suggesting variations in immunoregulation. We sought to quantify regulatory CD4 T cells (T(reg) cells) in the blood of CVID patients and to correlate the frequency with clinical manifestations and classification subgroups. Blood samples from 99 CVID patients in Freiburg, London and Sydney, who had been phenotyped clinically and stratified according to their memory B cell phenotype (Freiburg and Paris classification schemes), were analysed for the proportion of T(reg) cells, defined either as CD25(+)/forkhead box P3 (FoxP3)(+), CD25(+)/CD127(low)/FoxP3(+) or CD25(+)/CD127(low) CD4(+) T cells, and results compared with 49 healthy controls. Irrespective of the phenotype used to define them, there was a significant decrease in the T(reg) cell proportion in patients with granulomatous disease and immune cytopenias. This allowed the definition of a subgroup of CVID patients with abnormally low T(reg) cells, which had a higher rate of these two manifestations as well as autoimmune disease in general. There was also a significant reduction in the proportion of T(reg) cells in the Freiburg group Ia compared with other CVID patients and controls, but there were no differences between the Paris groups. The reduction in T(reg) cells in subsets of CVID patients may be relevant to their clinical manifestations, and may contribute to our understanding of the pathogenesis of CVID complications.

Plea for a uniform histological classification and patient subgroup analysis

Plea for a uniform histological classification and patient subgroup analysis

Quantitative trait locus-specific genotype × alcoholism interaction on linkage for evoked electroencephalogram oscillations

We explored the evidence for a quantitative trait locus (QTL)-specific genotype × alcoholism interaction for an evoked electroencephalogram theta band oscillation (ERP) phenotype on a region of chromosome 7 in participants of the US Collaborative Study on the Genetics of Alcoholism. Among 901 participants with both genotype and phenotype data available, we performed variance component linkage analysis (SOLAR version 2.1.2) in the full sample and stratified by DSM-III-R and Feighner-definite alcoholism categories. The heritability of the ERP phenotype after adjusting for age and sex effects in the combined sample and in the alcoholism classification sub-groups ranged from 40% to 66%. Linkage on chromosome 7 was identified at 158 cM (LOD = 3.8) in the full sample and at 108 in the non-alcoholic subgroup (LOD = 3.1). Further, we detected QTL-specific genotype × alcoholism interaction at these loci. This work demonstrates the importance of considering the complexity of common complex traits in our search for genes that predispose to alcoholism.

Classification and discrete cocompact subgroups of some 7-dimensional connected nilpotent groups

For real connected nilpotent groups, 7 is the lowest dimension where there are infinitely many non-isomorphic groups, and also where some groups (indeed, uncountably many) have no discrete cocompact subgroups. In [21] one infinite family ]]> ]]> ]]> ]]> ]]> ]]> ]]> \mathcal{G}$ of 7-dimensional groups was identified and classified. Discrete cocompact subgroups H were identified for some groups in $\mathcal{G}$ in [10], along with simple quotients of $C^{*}(\mathrm{H})$ and relevant flows $(\mathrm{H}_3,\mathbf{T}^3)$. In this paper, such H and attributes are determined for more groups in $\mathcal{G}$; in particular, the members of $\mathcal{G}$ that admit discrete cocompact subgroups are identified precisely. In achieving some of these results, we consider other known ways of classifying the groups in $\mathcal{G}$, and also the classification of the analogous family of complex groups.

Primary and transplanted ENU induced rat tumors in neurooncology

In neurooncology transplanting, tumors can be used for many purposes e.g. to solve questions concerning the etiology and pathogenesis of such tumors or their management. Experimentally induced and transplanted tumors of the nervous system become reproducible in their morphology and growth parameters after about 12 subsequent intracerebral passages. During the period from the first to the 12th intracerebral generations, a simplification of the histology and a reduction of the induction times take place. Nowadays the growth behavior of such tumors can be followed by imaging methods such as MRI if specially adapted to small animals. Our results are based on the investigation of over 2350 experimentally induced tumors of the central and peripheral nervous system that were diagnosed according to the rules of human and rodent brain tumor classification and various subgroups of this sample, analyzed by electron microscopy, postmortal angiography and MRI.