Clinical Grading System Research Articles

Evaluation of Primary Pterygia on Basis of the Loss of Vertical Length of Plica Semilunaris.

PurposeTo propose a new grading system for primary pterygia based on the morphological loss of vertical length of plica semilunaris (LPS).MethodsWe included 50 eyes from 41 patients with primary pterygium. LPS was defined and quantified as the ratio of the length of loss of the normal vertical morphology at plica semilunaris to the vertical corneal diameter using anterior-segment photographs. Grades of tear metalloproteinase 9 (MMP-9) expression by point-of-care immunoassay, which is a well-known biomarker for inflammation, was correlated with the extent of LPS (%) of pterygia. Then, LPS was paralleled with the pre-established grading systems on the basis of tissue translucency (i.e., T grade) and vascularity (i.e., V grade) of the pterygium body.ResultsMMP-9 grades was 2.39 ± 1.12 in the group with LPS ≥50% and was 1.56 ± 1.12 in the group with LPS <50% (P = 0.016). In a linear regression, the extent of LPS was positively correlated with MMP-9 grades (r = 0.315, P = 0.026). MMP-9 expression did not differ between T grades or V grades. The extents of LPS were well correlated positively with both T grades (r = 0.495 and P < 0.001) and V grades (r = 0.344 and P = 0.015).ConclusionsWe devised a new grading system using LPS on the basis of morphological loss of the normal vertical plica semilunaris in primary pterygia. The extent of LPS correlated well with T grades and V grades and also reflected the expression of MMP-9 in tears.Translational RelevanceThe new clinical LPS grading system reflects severity and MMP-9 expression in tears in primary pterygia.

Association of genetic variants rs641153 (CFB), rs2230199 (C3), and rs1410996 (CFH) with age-related macular degeneration in a Brazilian population

This study aimed to investigate the association among genetic variants of the complement pathway CFB R32Q (rs641153), C3 R102G (rs2230199), and CFH (rs1410996) with age-related macular degeneration (AMD) in a sample of the Brazilian population. In a case-control study, 484 AMD patients were classified according to the clinical age-related maculopathy grading system (CARMS) and compared to 479 unrelated controls. The genetic variants rs1410996 of complement H (CFH), rs641153 of complement factor B (CFB), and rs2230199 of complement 3 (C3) were evaluated through polymerase chain reaction (PCR) and direct sequencing. The associations between single nucleotide polymorphisms (SNPs) and AMD, adjusted by age, were assessed by using logistic regression models. A statistically significant association was observed between AMD risk and rs2230199 variant with an OR of 2.01 ( P = 0.0002) for CG individuals compared to CC individuals. Regarding the comparison of advanced AMD versus the control group, the OR was 2.12 ( P = 0.0036) for GG versus AA genotypes for rs1410996 variant. Similarly, the OR for rs2230199 polymorphism was 2.3034 ( P = 5.47e-05) when comparing CG individuals to CC carriers. In contrast, the rs641153 variant showed a significant protective effect against advanced AMD for GA versus GG genotype (OR = 0.4406; P = 0.0019). When comparing wet AMD versus controls, a significant association was detected for rs1410996 variant (OR = 2.16; P = 0.0039) comparing carriers of the homozygous GG versus AA genotype, as well as in the comparisons of GG (OR = 3.0713; P = 0.0046) and CG genotypes (OR = 2.2249; P = 0.0002) versus CC genotype for rs2230199 variant, respectively. The rs641153 variant granted a significant protective effect against wet AMD for GA versus GG genotypes (OR = 0.4601; P = 0.0044). Our study confirmed the risk association between rs2230199 and rs1410996 variants and AMD, and the protective role against AMD for rs641153 variant.

Hidradenitis suppurativa: pathogenesis, clinical presentation, epidemiology, and comorbid associations.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is clinically defined by lesions ranging from painful, deep seated nodules to abscesses, draining sinus tracts, and ultimately, irreversible fibrotic scars. While the etiology remains unclear, a number of mechanisms ranging from genetics to aberrations of the immune system have been proposed. In addition, HS has a number of associations and may occur in conjunction with several diseases that span a host of medical specialties. The estimated prevalence ranges are from 1% to 4%; however, a large degree of under-reporting and misdiagnosis of this condition likely underestimates its true clinical significance. The debilitating consequences of missed diagnoses or improper management leads to severe pain and irreversible cutaneous manifestations (i.e., fistulae, sinus tracts, disfiguring scarring). HS has been found to significantly impair patients' quality of life to a greater degree when compared with other skin conditions. Early recognition and treatment are critical for a favorable prognosis, and diagnostic delays may be related to variable presentations within numerous comorbidities. Here we provide an in-depth, clinical-based review of HS, highlighting the clinical presentation, pathophysiology, grading systems, epidemiology, and comorbidities, in hopes of shedding light on an often misunderstood disease and ultimately moving closer to a more conclusive understanding of its various presentations and association.

Prognostic Value of Various Hemostasis Parameters and Neurophysiological Examinations in Spontaneous Intracerebral Hemorrhage: The IRONHEART Study Protocol.

Rationale: Stroke is one of the leading causes of death in all developed countries. In Hungary, more than 10,000 patients die annually due to cerebrovascular diseases according to the WHO Mortality Database. Of these patients, 10–15 % suffer non-traumatic intracerebral hemorrhage (ICH). ICH results in a higher rate of mortality as compared to ischemic stroke and outcomes are difficult to predict. In the IRONHEART study, we aim to test various hemostasis parameters and clinical neurophysiological examinations in evaluating outcome in ICH.Methods: In this prospective, observational study, we plan to enroll consecutive patients with non-traumatic spontaneous ICH admitted to a single Stroke Center (Department of Neurology, University of Debrecen, Hungary). The protocol of the IRONHEART study includes the investigation of detailed clinical, laboratory investigations, and various neurophysiological examinations. Stroke severity is quantified based on the National Institutes of Health Stroke Scale (NIHSS) on admission and day 7, 14, and 90 after the onset of stroke. Cranial CT is performed on admission, day 14, and 90 to estimate the ICH volume. Modified Rankin Scale (mRS) is used for evaluating the long-term outcome (90 days post-event). Blood is drawn immediately on admission for specific hemostasis tests. Digital and quantitative EEG techniques and motor evoked potential (MEP) are performed to evaluate the prognosis of cerebral hemorrhage on admission (within 24–48 h), immediately before discharge (~10–14 days later), and 3 months after the event.Outcomes: The following outcomes are investigated: primary outcomes: mortality by day 14 and day 90, secondary long-term outcome at 90 days post-event where mRS 0–2 is defined as favorable long-term outcome.Discussion: If associations between outcomes and the investigated parameters (hemostasis and neurophysiological examinations) are confirmed, results might aid prognosis assessment in this subtype of stroke with particularly high mortality. Improving clinical grading systems on ICH severity and outcomes by including the investigated parameters could help to better guide the management of these patients in the future.

Differential and longitudinal immune gene patterns associated with reprogrammed microenvironment and viral mimicry in response to neoadjuvant radiotherapy in rectal cancer

BackgroundRectal cancers show a highly varied response to neoadjuvant radiotherapy/chemoradiation (RT/CRT) and the impact of the tumor immune microenvironment on this response is poorly understood. Current clinical tumor regression grading...

Skull base osteomyelitis: Comprehensive analysis and a new clinicoradiological classification system

ObjectiveSkull baseosteomyelitis (SBO) is a rare phenomenon that typically occurs in diabetic or immunocompromised patients, causing significant morbidity and mortality. This study aimed to analyze a single institution's treatment results in SBO patients and propose anew integrated clinicoradiological classification system. MethodsThe medical records of 32 SBO patients that were treated at a tertiary care center between 2006 and 2017 were retrospectively reviewed. A scoring system based on anatomical involvement according to MRI was created. Subsequently, the scoring system was integrated with cranial nerve dysfunction status and a clinical grading system (CGS) was proposed. ResultsAmong the 32 patients, 78.1% were diabetic and 63% had cranial nerve dysfunction at presentation. Bone erosion based on CT was greater in the patients without regression (P = 0.046). The regression rate decreased from clinical grade (CG)1 to CG3 (P = 0.029). Duration of hospitalization increased as CG increased (P = 0.047). Surgery had no effect on regression status at the time of discharge (P = 0.41). The 1-year, 2-year, and 5-year overall survival rates were 82.2%, 70.8%, and 45.8%, respectively. CG was significantly correlated with overall survival but not with disease-specific survival (log-rank; P = 0.017, P = 0.362, respectively). ConclusionSBO continues to pose a challenge to clinicians, and causes significant morbidity and mortality. The proposed new classification system can be an option for grouping SBO patients according to clinical and radiological findings, helping clinicians estimate prognosis.

Variations in the Course of the Carotid Arteries in Patients with Retropharyngeal Parathyroid Adenomas

The carotid arteries, classically described as taking a relatively straight course through the neck, deviate medially in a minority of patients. At the extreme, the internal carotid arteries may "kiss" in the midline, coming extremely close to the pharyngeal wall. In this clinical report, we describe 5 patients with primary hyperparathyroidism, all with ectopic retropharyngeal parathyroid adenomas but all with varying carotid artery anatomy. We describe these variations using a previously developed clinical grading system that highlights 1) the relationship between carotid artery location and risk of injury during pharyngeal procedures and 2) the importance of universal, objective criteria to classify carotid anatomy. Radiologists should be familiar with variations in carotid anatomy and communicate them to the operative team.

Bringing clerkship grading back to the bedside.

The hallmark of medical education is learning from patients through interactions at the bedside. However, many medical schools incorporate clinical clerkship grading systems that incentivize time away from patient care activities to focus on examinations of medical knowledge. The purpose of this innovation was to develop a grading system that encouraged development of competencies beyond medical knowledge, including patient care, communication, and professionalism skills. In 2016, the authors convened a diverse workgroup to reform the clerkship grading approach at their institution. The group reviewed relevant literature and discussed approaches used by other institutions. They developed a competency-based criterion system. For each of four competency domains (patient care, medical knowledge (examination score), professionalism, and communication/teamwork), students received a designation of inadequate, competent, or exemplary. The highest grade ("honors") was awarded to students who met the criteria for exemplary performance in at least two domains. It was a primarily compensatory model, although to achieve competency (pass) scoring was non-compensatory (acceptable performance in all categories). A total of 231 medical students received 1499 clerkship grades during the 2018-2019year. Compared to previous years, more students (40% vs. 15%) received honors. A substantial proportion (43%) received honors without achieving an exemplary designation in the medical knowledge domain (i.e., standardized examination). The revised grading system provided several avenues for students to excel and receive honors in their clerkships allowing for recognition of students who excelled in patient care-related areas other than standardized examinations.

Eritonitis outcome prediction

The review is devoted to the most common general clinical and specific grading systems for peritonitis outcome prediction. Particular attention is paid to methodological approaches, prediction reliability, simplicity of use in clinical practice and their importance in decision-making. It is shown that none of the modern grading systems is universal and absolutely reliable. Combining several systems is quite difficult and will take additional time that is impossible for intraoperative environment. Despite various systems for peritonitis outcome prediction, none of them can completely satisfy surgeons, primarily in choice of surgical access, intervention type and option for its completion.

Posterior Bite Collapse and Diagnostic Grading for Periodontitis.

The syndrome known as posterior bite collapse (PBC) has taken on multiple definitions over the years since its first introduction in 1964 by Morton Amsterdam and Leonard Abrams. In 2017, the World Workshop in the Classification of Periodontal and Peri-implant Diseases and Conditions proposed a staging system for periodontitis, defined by severity and extent of periodontal breakdown. Within this staging system, Stage IV periodontitis can include PBC. However, without a clear delineation regarding the clinical presentation or pathogenesis of PBC, this further obfuscates its definition. It is therefore the goal of this article to reexamine the original definition of PBC as defined by Amsterdam and Abrams, present an updated definition, and propose a clinical grading system of PBC to coincide with the 2017 staging of periodontitis.

Clinical profile of patients with acute pancreatitis in a tertiary care centre in Tripura: A retrospective study

Background: Acute Pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis is an inflammatory process leading to abdominal pain, progressive destruction of exocrine tissue and in some patients a loss of endocrine tissue as well, with multiple organ failure and high mortality. Severity of acute pancreatitis is linked to the presence of systemic organ dysfunction and/or necrotizing pancreatitis.&#x0D; Aims and Objective: The present study was aimed to study the clinical profile of acute pancreatitis, the etiology and complications of acute pancreatitis received treatment in the Department of Surgery, Tripura Medical College &amp; Dr. BRAM Teaching Hospital, Agartala, Tripura.&#x0D; Materials and Methods: This was a hospital based retrospective study which was conducted from January 2019 to December 2019. All patients with a diagnosis of acute pancreatitis were included in this study in order to find out the clinical presentations from the available clinical, laboratory and radiological data.&#x0D; Result: Of the 100 patients in this study, 96 were male and 4 were female. Minimum age in our study was 10 years and maximum were 70 years. Maximum numbers of patients were below 45 years of age. Alcohol was identified as the most important etiological factor associated with acute pancreatitis. Among the known etiological factors 90% of the cases were related to alcoholism and 4% were due to gall stone disease. Abdominal pain and vomiting were the most common symptoms in our study. Epigastric tenderness was present in 90% of the cases and guarding/rigidity in 50% of cases. 14% patients showed jaundice as a sign of acute pancreatitis. There was no major difference between the CT grading system and clinical grading system. Most of the patients recovered with conservative treatment. Adverse outcome was noted in one patient with acute necrotizing pancreatitis.&#x0D; Conclusion: Acute pancreatitis is one of the leading causes of increase in morbidity and mortality to society. Clinical assessment along with radiological findings correlated well with the morbidity and mortality. Our study identifies alcoholism as one of the most important etiological factors.&#x0D;

A new equine peripheral caries grading system: Are the caries likely active or inactive?

Equine peripheral caries can be a significant welfare issue in affected horses. Recent work has shown that complete reversal of the condition may be possible if the primary risk factor can be identified and corrected. Determining whether caries are active (deteriorating) or inactive (improving) is of vital importance when formulating a management and treatment plan. A new grading system is proposed that looks at whether caries are likely active or inactive to assist clinicians deciding whether intervention is required. To examine the reliability of an alternative grading method for equine peripheral caries. Online survey of veterinary surgeons. Reviewers (n=22) graded images of peripheral caries using three methods: the traditional grading system, a new research grading system and a new clinical grading system. Percentage agreement and Fleiss' kappa were used to examine the participant's agreement of the severity of caries. All percentage agreements and Fleiss' kappa values were significantly greater than zero (P<.001). The Fleiss' kappa for the new methods were higher (ranging from 0.48 to 0.58), but not significantly different from the traditional method (0.40). There was a high level of consistency in the assessment of caries as either active or inactive with both grading systems reporting over 80% agreement. Feedback on the grading systems was positive with over 90% of reviewers saying they were likely to use the system. The use of photographs provided some difficulties with image quality and judging whether the dentin was affected without an occlusal image. The new grading system produced a consistent estimate of caries severity and provided high levels of agreement on whether the caries were likely 'active' or 'inactive'. This is likely to be very useful clinically to assist practitioners to determine whether intervention is required.

Usefulness of electrophysiology in the prediction of outcome of Bell\u2019s palsy patients

BackgroundBell’s palsy (BP) is a common idiopathic cranial mononeuropathy. The electrophysiological tests are one of supportive tools for localizing the site of facial nerve lesion, and to determine the severity and prognosis of the injury. The aim of this study was to evaluate the role of electrophysiology in the prediction of outcome of patients with Bell’s palsy. This study was carried out on 30 adult patients with Bell’s palsy. All study subjects were assessed clinically by Sunnybrook facial nerve grading score (SBS) and electrophysiologically by electroneurography (ENoG), blink reflex (BR), and electromyography (EMG); first evaluation was within 7th to10th day from onset, the second evaluation was done at 20th day, and the follow-up visit was after 1 month to assess the clinical grading system (SBS).ResultsAt 1 month, 20 patients (66.7%) had good recovery, while 10 patients (33.3%) had poor recovery according to the Sunnybrook scale. Multiple logistic regression analysis showed that the most significant predictive indicator of BP recovery was ENoG value and R1 latency of BR test. The receiver operating characteristic (ROC) curves showed ENoG degeneration index of 74.6%, considered as a critical cutoff value of non-recovery, with the sensitivity 95% and specificity 90%, and the highest specificity was with blink reflex parameters (R1, R2 latency) 100%.ConclusionBR and ENoG were the best predictors of non-recovery of facial function, while EMG findings did not add any prognostic significance. The combination of both tests BR and ENoG, along with clinical findings can be considered a good indication in the acute phase of BP for the possibility to develop palsy residua.

A clinical classification system for grading platinum hypersensitivity reactions

ObjectivesCurrent grading systems for platinum hypersensitivities (pHSR) rely on subjective features rather than objective clinical signs leading to inconsistencies in grading. To standardize classification of pHSR, a clinical grading system was developed at our institution. We report the clinical outcomes our classification system and evaluate its correlation with the classification systems currently published and used in practice. MethodsThis was a retrospective review of patients with pHSR from 2011 to 2017. Demographics, chemotherapeutic histories (CT), and details of their initial HSR were collected. Mild reactions were defined as local skin manifestations only. Moderate-low reactions included widespread skin, respiratory or GI findings. Moderate-standard reactions were defined as transient cardiovascular compromise (CVC), hypoxia or neurologic changes whereas sustained changes (>10 min) were used to define severe reaction. Fischer Exact Tests (p < .05) and binary logistic regression analyses were performed. Spearman correlation were used to assess relationships between our grading system and the NCCN and CTCAEv4.0 criteria. Results87 patients were identified with most having ovarian cancer (n = 55, 63.2%), receiving carboplatin (n = 62, 71.3%), and on second-line CT (n = 34, 42.5%). Chest pain was associated with transient CVC (OR 10.0, 95% CI 1.148–87.133) while nausea/vomiting (OR 8.420, 95% CI 1.263–55.275) was associated with transient hypoxia albeit less closely than transient hypotension (OR 17.010, 95% CI 2.026–142.825). Only presyncope/syncope remained associated with sustained CVC (OR 38.0, 95% CI 2.815–512.912) on logistic regression. The classification system was most strongly correlated with the NCCN grading system (ρ 0.761, p < .001). ConclusionsThis classification system offers an objective means of grading pHSR severity and correlates with currently-used grading systems.

Posterior fossa decompression with duraplasty in Chiari malformation type 1: a systematic review and meta-analysis.

Surgery for symptomatic Chiari type I malformation (CM-I) patients include posterior fossa decompression (PFD) involving craniectomy with or without dural opening, and posterior fossa decompression with duraplasty (PFDD). This review aims to examine the evidence to aid surgical decision-making. A medical database search was expanded to include article references to identify all relevant published case series. Animal studies, editorials, letters, and review articles were excluded. A systemic review and meta-analysis were performed to assess clinical and radiological improvement, complications, and reoperation rates. Seventeen articles, containing data on 3618 paediatric and adult participants, met the inclusion criteria. In the group, 5 papers included patients that had the dura left open. PFDD is associated with better clinical outcomes (RR 1.24, 95% CI, 1.07 to 1.44; P = 0.004), but has a higher complication rate (RR 4.51, 95% CI, 2.01 to 10.11; P = 0.0003). In adults, clinical outcomes differences did not reach statistical significance (P = 0.07) but re-operation rates were higher with PFD (RR 0.17, 95% CI 0.03 to 0.86; P = 0.03), whilst in children re-operation rates were no different (RR 0.97, 95% CI 0.41 to 2.30; P = 0.94). Patients with a syrinx did better with PFDD (P = 0.02). No significant differences were observed concerning radiological improvement. In the absence of hydrocephalus and craniocervical region instability, PFDD provides better clinical outcomes but with higher risk. The use of PFD may be justified in some cases in children, and in the absence of a syrinx. To help with future outcome assessments in patients with a CM-I, standardization of clinical and radiological grading systems are required. not required.

Mapping the burden of onchocercal skin disease.

Onchocerciasis is a neglected tropical disease caused by a nematode parasite, Onchocerca volvulus, and transmitted by bites of Simulium blackflies which breed near fast-flowing rivers. In humans, thousands of microfilariae (immature worms) migrate to the skin and eyes where they cause pathology. Historically, much research was devoted to the serious effect of blindness, from which the disease earns its alternative name of 'river blindness'. Mapping the burden of onchocercal skin disease (OSD) was expedited by the development of a clinical classification and grading system that facilitated comparison of data from different countries. After successful field testing in Nigeria, the classification scheme was used in a multicountry study in seven endemic sites, to estimate the true burden of OSD across Africa. High levels of OSD were found, affecting 28% of the population. A new control programme, the African Programme for Onchocerciasis Control (APOC) was launched in 20 countries using annual doses of ivermectin, donated by Merck & Co., Inc. The multicountry study also found a close correlation between the levels of itching and OSD with the level of endemicity, as determined by the prevalence of onchocercal nodules. This enabled APOC to use Rapid Epidemiological Mapping of Onchocerciasis, which entailed identifying likely vector breeding sites near rivers, then sampling 50 adult males in nearby villages to determine the prevalence of nodules and delineate which villages required treatment. Onchocerciasis is now targeted for elimination in Africa, and the challenge is to complete Onchocerciasis Elimination Mapping of hypoendemic areas using serology.

P0748CLINICAL OUTCOMES OF JAPANESE ANTI-MYELOPEROXIDASE ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY-RELATED RAPIDLY PROGRESSIVE GLOMERULAR NEPHRITIS

Abstract Background and Aims Anti-myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-related nephritis constitutes 60% of rapidly progressive glomerular nephritis (RPGN). In 2014, Japanese Society of Nephrology (JSN) created RPGN clinical guidelines for Japanese MPO-ANCA-related RPGN patients, and proposed the clinical grading system for predicting their prognosis, which took into consideration factors such as age, renal function, lung involvement, and serum CRP (Yoshihiro Arimura et al. Clin Exp Nephrol. 2016). However, evidence regarding clinical outcomes is still limited. In the study reported here, we conducted a single-center retrospective study to evaluate the outcomes of MPO-ANCA-related RPGN patients and to establish an efficacy of RPGN guidelines of JSN. Method We retrospectively investigated 54 patients (female, n=32; average age ± 13.0 years) with MPO-ANCA-related nephritis. The patients were admitted to Fukuoka University Hospital between 2009 and 2018. Their clinical grade determined by JSN guideline and method of treatment were retrospectively evaluated for prediction of survival, as well as laboratory data and clinical features. Results 12 patients (22.2 %) has deceased during a median observation period of 17.1 months. 7 patients are died of infectious disease (Bacterial pneumonia 4, Sepsis 2, pulmonary aspergillosis 1), and 10 patients died within 1 year. Median estimated glomerular filtration rate (eGFR) was 15.5 mL/min/1.73m2 at admission. 14 patients (25.9%) presented with end-stage renal disease (ESRD) during the observation period, 8 of them were died. The distribution of clinical grade of JSN guideline was grade I for 10, II for 27, III for 10 and IV for 7. (grade IV is the most severe) Patients with high clinical grade showed significantly high mortality (Log Rank test, p&amp;lt;0.05; figure 1). Multivariate Cox proportional hazards model analysis revealed that high clinical grade was a significant risk factor for all-cause death (Hazard ratio (HR), 7.09; 95% confidence interval (CI), 2.01-15.69, p&amp;lt;0.05) and for infectious disease death (HR, 16.9; 95% CI, 2.56-121.5, p&amp;lt;0.05). On the other hands, the preventive administration of Trimethoprim-Sulfamethoxazole (TS) decreased the risk of infectious disease death (figure 2). Conclusion The MPO-ANCA-related RPGN clinical grading system created by JSN was a useful tool for prediction of prognosis. Furthermore, TS should be administrated for all immune-suppressive patients to prevent variable infections not only Pneumocystis.

Printed, Soft, Nanostructured Strain Sensors for Monitoring of Structural Health and Human Physiology.

Soft strain sensors that are mechanically flexible or stretchable are of significant interest in the fields of structural health monitoring, human physiology, and human-machine interfaces. However, existing deformable strain sensors still suffer from complex fabrication processes, poor reusability, limited adhesion strength, or structural rigidity. In this work, we introduce a versatile, high-throughput fabrication method of nanostructured, soft material-enabled, miniaturized strain sensors for both structural health monitoring and human physiology detection. Aerosol jet printing of polyimide and silver nanowires enables multifunctional strain sensors with tunable resistance and gauge factor. Experimental study of soft material compositions and multilayered structures of the strain sensor demonstrates the capabilities of strong adhesion and conformal lamination on different surfaces without the use of conventional fixtures and/or tapes. A two-axis, printed strain gauge enables the detection of force-induced strain changes on a curved stem valve for structural health management while offering reusability over 10 times without losing the sensing performance. Direct comparison with a commercial film sensor captures the advantages of the printed soft sensor in enhanced gauge factor and sensitivity. Another type of a stretchable strain sensor in skin-wearable applications demonstrates a highly sensitive monitoring of a subject's motion, pulse, and breathing, validated by comparing it with a clinical-grade system. Overall, the presented comprehensive study of materials, mechanics, printing-based fabrication, and interfacial adhesion shows a great potential of the printed soft strain sensor for applications in continuous structural health monitoring, human health detection, machine-interfacing systems, and environmental condition monitoring.

MP26-13 COLOR DOPPLER ULTRASOUND IMAGING IN VARICOCELES: IS THE DIFFERENCE IN VENOUS DIAMETER ENCOUNTERED DURING VALSALVA PREDICTIVE OF PALPABLE VARICOCELE GRADE?

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP26)1 Apr 2020MP26-13 COLOR DOPPLER ULTRASOUND IMAGING IN VARICOCELES: IS THE DIFFERENCE IN VENOUS DIAMETER ENCOUNTERED DURING VALSALVA PREDICTIVE OF PALPABLE VARICOCELE GRADE? Catherine Ingram*, Utsav Bansal, Adithya Balasubram, Nannan Thirumavalan, Matthew Pollard, Saneal Rajanahally, and Larry Lipshultz Catherine Ingram*Catherine Ingram* More articles by this author , Utsav BansalUtsav Bansal More articles by this author , Adithya BalasubramAdithya Balasubram More articles by this author , Nannan ThirumavalanNannan Thirumavalan More articles by this author , Matthew PollardMatthew Pollard More articles by this author , Saneal RajanahallySaneal Rajanahally More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000865.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The clinical grading system for varicoceles is subjective and dependent on clinician experience. Doppler ultrasound (US) has not been standardized in the diagnosis of varicoceles. We hypothesized that the difference between resting and Valsalva venous diameter would better correspond with palpable varicocele grade according to WHO criteria. METHODS: IRB approval was obtained for this study. Men who presented for either scrotal pain or fertility to our tertiary men’s health clinic underwent physical examination, and varicoceles were graded following WHO criteria (0 = subclinical, I, II, and III). Color Doppler US was used in the supine position to measure largest venous diameter in the pampiniform plexus bilaterally at rest and during Valsalva maneuver. Wilcoxon signed-rank test was used to compare right to left-sided venous diameters. Receiver operator characteristic (ROC) curve analysis was used to determine if resting diameter, diameter during Valsalva, or change in diameter between rest and Valsalva provided the highest sensitivity and specificity for determining clinical grade with US. Threshold values for diameter were determined from these ROC curves. RESULTS: A total of 104 men (51 with clinical varicocele and 53 with subclinical varicocele) were included in the analysis. Diameter at rest was the best ultrasonographic discriminator between subclinical and clinical varicoceles (AUC = 0.67) with a diameter threshold of 3 mm (sensitivity 79%, specificity 42%; Fig. 1). Diameter during Valsalva had the greatest AUC for determining clinical grades 1 versus 2 (AUC = 0.57) with diameter threshold of 5.7 mm (sensitivity 71%, specificity 33%). For differentiating between grades 2 and 3, diameter at rest had the greatest AUC of 0.65 with a threshold of 3.6 mm (sensitivity 71%, specificity 58%). CONCLUSIONS: Our results show a correlation between US and clinical grading. The use of Valsalva was less predictive than diameter at rest and was only clinically significant in differentiating between Grade I and II varicocele. A standardized method for determining clinically relevant varicoceles on US would allow for improved patient counseling and clinical decision-making. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e405-e405 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Ingram* More articles by this author Utsav Bansal More articles by this author Adithya Balasubram More articles by this author Nannan Thirumavalan More articles by this author Matthew Pollard More articles by this author Saneal Rajanahally More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement PDF downloadLoading ...

Principles of Subglottic and Tracheal Visualization with Transnasal Flexible Laryngoscopy

The subglottic area and trachea are important parts of the upper airway, and can be visualized easily using transnasal flexible laryngoscopy (TFL). The aim of this study was to develop a clinical grading system to assist in documentation of the subglottic area and trachea with TFL, and to demonstrate the basic principles of visualization of these anatomic areas as a laryngology practice. The TFL videos of 100 randomized patients were evaluated by three laryngologists. The simple head extension (SHE) position and flexion position (FP) were applied to the patients during the visualization of the subglottic area and trachea. A paired t test was used to compare the grades of the subglottic and tracheal view according to the SHE and FP scores. This study examined 50 male and 50 female patients ranging in age from 28 to 83 years (mean age: 50.09 ± 13.05 years). For the SHE and FP, the numbers of patients constituting grade 1 were 2 and 35, grade 2 were 2 and 37, grade 3 were 30 and 19, and grade 4 were 41 and 9, respectively. There was a statistically significant difference between SHE and FP (P < 0.05). The k score was 0.785 between the ratings of observer 1 and observer 2; 0.771 between observer 1 and observer 3; and 0.757 between observer 2 and observer 3 (P < 0.001). This new grading system for the visualization of the subglottis and trachea can help physicians assess and identify the upper airways, and FP provides a better subglottic and tracheal view than SHE.