Comprehensive Scoring System Research Articles

Comprehensive Clinical-Molecular Transplant Risk Model for Myelofibrosis Undergoing Allogeneic Stem Cell Transplantation

Background The Dynamic International Prognostic Scoring System (DIPSS) is commonly applied to predict survival among patients with primary myelofibrosis (PMF) but has been shown to perform less precisely in secondary myelofibrosis (SMF) and after transplantation. Furthermore, the prognostic relevance of mutation profile resulted in the mutation-enhanced IPSS (MIPSS70) in PMF, as well as in a model specific to SMF (MYSEC-PM). We aimed to develop a comprehensive clinical-molecular prognostic scoring system to determine outcome for myelofibrosis undergoing allogeneic stem cell transplantation. Patients and Methods We examined 361 myelofibrosis patients, of whom 260 had PMF and 101 SMF at time of transplantation. A training cohort of 205 patients was used to create a clinical-molecular transplant scoring system (MTSS) predicting survival from Cox models, internally validated by use of bootstrap and cross-validation. Model discrimination was measured by the concordance index (C). The final MTSS was externally validated in a cohort of 156 patients and was furthermore applied to posttransplant non-relapse mortality as a secondary objective. Results Multivariable analysis on 5-year survival identified age ≥57 years, Karnofsky performance status 25 × 109/L at time of transplantation, HLA-mismatched unrelated donor, ASXL1 mutated and CALR-/MPL-unmutated genotype being independent prognostic factors for outcome. The uncorrected concordance index for the final survival model was 0.723 (95% CI, 0.713-0.733), and bias-corrected indices were similar. A weighted score of 2 was assigned to transplantation from an HLA-mismatched unrelated donor and an CALR-/MPL-unmutated genotype, whereas a score of 1 was assigned to older age, leukocytosis, thrombocytopenia, ASXL1 mutation, and poor performance status. The MTSS consisted of four distinct risk groups showing 5-year survival in the validation cohort of 83% (95% CI, 71-95%) for low (score 0-2), 64% (95% CI, 53-75%) for intermediate (score 3-4), 37% (95% CI, 17-57%) for high (score 5), and 22% (95% CI, 4-39%) for very high risk (score >5), respectively (P Conclusion The MTSS integrates clinical, molecular as well as transplant-specific risk factors that independently affected survival. We show here that this internally and externally validated system accurately discriminated different risk for death and may improve counseling compared with currently existing systems, as well as facilitate design of clinical trials in the transplant setting.

The CFI score: Validation of a new comprehensive severity scoring system for facial injuries

At the time of writing there is no measuring scale for the severity of facial trauma that can effectively summarize its clinical relevance, and can therefore be proposed as a definitive tool in trauma center decision making.This paper introduces a new, simple, comprehensive, and reproducible score for facial trauma, in which its severity is expressed in relation to the surgical duration necessary for definitive treatment. This parameter is identified as the most significant in expressing the commitment of care required. Statistical validation of this comprehensive facial injury (CFI) score involved a sample of 1050 patients, treated by the same team in two highly specialized trauma centers. It demonstrated a linear regression between CFI score and surgical duration, and a high degree of accuracy in forecasting overall surgical time for each type of facial injury.The descriptive capacity of CFI score, and its extremely simple use, make it a perfect tool for widespread application and for facilitating communication inside trauma centers. It also allows the classification of homogeneous groups of patients — a prerequisite for benchmarking and effective analysis of results.The CFI model is definitively proposed for the classification of facial injuries, and therefore for the integration of maxillofacial skills, within the trauma team.

Sanbo Scoring System, Based on Age and Pre-treatment Hematological Markers, is a Non-invasive and Independent Prognostic Predictor for Patients with Primary Glioblastomas: A Retrospective Multicenter Study.

Various hematological markers are associated with survival in patients with glioblastomas (GBMs), as they reflect inflammation and nutrition status. However, single markers are insufficient for predicting prognosis in GBM, and a comprehensive scoring system is needed. In this study, we developed a simple, inexpensive, and non-invasive scoring system, referred to as the Sanbo Scoring System (SSS), to predict survival in patients with GBMs. Patients with GBM were retrospectively assigned to two independent cohorts at Sanbo Brain Hospital and National Cancer Center/Cancer Hospital. Clinical records, including age, routine blood tests, biochemistry and coagulation examinations, and IDH-1 status, were collected. In total, 274 and 87 patients with GBMs at Sanbo Brain Hospital and National Cancer Center/Cancer Hospital were included as derivation and validation cohorts, retrospectively. We developed the SSS based on data for the derivation cohort, i.e., age, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin-to-globulin ratio (AGR), and fibrinogen levels. These patients were divided into three groups that differed with respect to age, inflammation-nutrition status, and overall survival (p < 0.001), i.e., SSS 0, 1, and 2. NLR, PLR, and fibrinogen levels were lower and AGR was higher in the SSS 2 group than in the other groups, indicating better inflammation and nutrition statuses. Additionally, the longest overall survival was observed in this group. A multivariate analysis showed that SSS was an independent prognostic factor. The validation cohort supported all the results. SSS was a simple, non-invasive, and effective scoring system, and independently predicted survival in GBMs.

Clinical and epidemiological factors associated with suicide in colorectal cancer.

While increased suicidal tendencies among cancer patients have been well documented, this study aims to examine suicide rates and factors associated with suicide specifically in patients with colorectal cancer (CRC). Patients diagnosed with CRC between the years of 1988-2010 were selected from the Surveillance, Epidemiology, and End Result (SEER) database. Comparisons with the general population were done using the National Center for Disease Control registry. One thousand three hundred eighty-one suicides among 884,529 patients were identified, with a standardized mortality ratio (SMR) of 1.53 (95% CI, 1.13-1.33) compared to the general population. No statistically significant difference in suicide rate was found with respect to age, marital status, socio-economic status, surgical intervention, histologic subtype, or stage at diagnosis. Within the CRC population, Whites were significantly more likely to commit suicide than non-Whites (OR, 2.28; 95% CI, 1.89-2.75; P< 0.001), and males were significantly more likely than females (OR, 5.635; 95% CI, 4.85-6.54; P< 0.001). Most suicides occurred in patients with distal lesions in the sigmoid/rectosigmoid junction (P< 0.001). SMRs for CRC patients were 4.24 for females (95% CI, 3.69-4.86), 1.35 for males (95% CI, 1.28-1.43), 0.38 for African-Americans (95% CI, 0.28-0.52), 1.77 for Whites (95% CI, 1.68-1.87), and 0.90 for other races (95% CI, 0.72-1.12). Identification of risk factors associated with suicide among patients with CRC is an important step in developing screening strategies and management of psychosocial stressors. These results could be helpful in formulating a comprehensive suicide risk scoring system for screening all cancer patients.

Clock Drawing Test in acute stroke and its relationship with long-term functional and cognitive outcomes

Objective: The Clock Drawing Test (CDT) is commonly used as a screening tool for the assessment of dementia. The association between the CDT in acute stroke and long-term functional and cognitive outcomes in this population is unknown. The present prospective study is the first to examine if CDT scores in the acute stage after stroke are related to long-term outcomes and to compare the predictive ability of two scoring systems in a large sample of stroke patients. Method: A total of 340 patients admitted to an acute stroke unit were included in the present study. Separate stepwise multiple linear regression analyses were performed with eight independent variables (demographic/pre-stroke variables – age, sex, premorbid functioning; stroke-related variables – stroke severity, localization; cognitive variables – Orientation Test, CDT [2 scoring systems]), and four dependent variables administered one year post-stroke (Barthel Index, modified Rankin Scale, Reintegration to Normal Living index, Global Deterioration Scale). Results: Although both CDT scoring methods were related to all long-term outcome measures, the more comprehensive scoring system was the only baseline variable that significantly explained the variance in outcome measures in all four multiple regression models. Conclusion: Performance on the CDT in acute stroke is related to long-term outcomes including patients’ degree of independence in performing activities of daily living, the degree to which they achieved reintegration into daily occupations, and the degree of cognitive decline observed one-year post-stroke. Future studies are needed to clarify the nature of the relationship between different CDT scoring systems and post-stroke outcomes.

Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection.

Previous studies have demonstrated that patient, surgical, tumour and operative variables affect the complexity of laparoscopic liver resections. However, current difficulty scoring systems address only tumour factors. The aim of this study was to develop and validate a predictive model for the risk of intraoperative complications during laparoscopic liver resections. The prospectively maintained databases of seven European tertiary referral liver centres were compiled. Data from two-thirds of the patients were used for development and one-third for validation of the model. Intraoperative complications were based on a modified Satava classification. Using the methodology of the Framingham Heart Study, developed to identify risk factors that contribute to the development of cardiovascular disease, factors found to predict intraoperative complications independently were assigned points, and grouped into low-, moderate-, high- and extremely high-risk groups based on the likelihood of intraoperative complications. A total of 2856 patients were included. Neoadjuvant chemotherapy, lesion type and size, classification of resection and previous open liver resection were found to be independent predictors of intraoperative complications. Patients with intraoperative complications had a longer duration of hospital stay (5 versus 4 days; P < 0·001), higher complication rates (32·5 versus 15·5 per cent; P < 0·001), and higher 30-day (3·0 versus 0·3 per cent; P < 0·001) and 90-day (3·8 versus 0·8 per cent; P < 0·001) mortality rates than those who did not. The model was able to predict intraoperative complications (area under the receiver operating characteristic (ROC) curve (AUC) 0·677, 95 per cent c.i. 0·647 to 0·706) as well as postoperative 90-day mortality (AUC 0·769, 0·681 to 0·858). This comprehensive scoring system, based on patient, surgical and tumour factors, and developed and validated using a large multicentre European database, helped estimate the risk of intraoperative complications.

Available, Bed-sided, Comprehensive (ABC) score to a diagnosis of Methicillin-resistant Staphylococcus aureus infection: a derivation and validation study

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) infections continue to be a leading problem in health care facilities worldwide.MethodsThis single-center retrospective cohort study consisted of a derivation phase and a validation phase. The derivation phase included all patients admitted to Osaka University Hospital between May 2010 and April 2011. We proposed a provisional available, bed-sided, comprehensive (ABC) score, and evaluated its accuracy using the clinical diagnosis as a reference. We subsequently revised ABC scores based on k coefficient scores of each variable; this revision was validated by applying it to another patient population.ResultsA total of 172 patients and 154 cases were enrolled in the derivation and validation studies, respectively. The revised ABC score consisted of four simple variables: type of clinical specimen (1 to 3 points), Gram-staining result (1 point), presence of local inflammation (2 points), and a systemic inflammatory response (2 points). A revised score of ≥5 points was sensitive (93.8%) and specific (90.6%), and the area under the receiver-operating curve was 0.969 (95% CI; 0.957–1).ConclusionsWe developed a simple and comprehensive scoring system for diagnosis of nosocomial MRSA infections; this system is applicable in a wide variety of situations.

Development and validation of saving mothers score: A comprehensive scoring system for early identification of sick mothers

Context: Early identification of high-risk parturient and maternal physiological deterioration may reduce maternal morbidity and mortality. Aims: This study aimed to develop a comprehensive scoring system 'Saving Mothers Score' (SMS) to identify the sick mothers and validate SMS against the existing Modified Early Obstetric Warning System (MEOWS). Settings and Design: The SMS was developed through a formative research, item pool generation, content and construct validity. Methodology: Thirty-three (33) items were identified and pooled into three parameters pregnancy-related risk factors, physiological variables and biochemical tests. Each item was given a colour coding and a score. The trigger and score of SMS was prospectively analysed in 120 obstetric in-patients. Statistical Analysis Used: Tests of diagnostic effectiveness and 95% confidence intervals (95% CI) around point estimates. Results: Forty six women triggered (38.33%; 95% CI: 29.96, 47.26) and 41 (81.93%, 95% CI: 77.54, 95.91) of these 46 women developed morbidity. The overall accuracy of SMS chart was similar for trigger [sensitivity 60.9%; specificity 98.6%, area under receiver operator characteristic curve (AUROC) 0.80] and scoring (sensitivity 56.1%; specificity 92.4%, AUROC 0.74) with positive predictive value (PPV) and negative predictive value (NPV) of 96.6% and 80.2%, respectively. The accuracy of SMS was comparable to MEOWS (sensitivity 54.6%, specificity 97.8%, PPV 92.5% and NPV 79.9%). Conclusions: The diagnostic effectiveness of SMS was comparable to MEOWS. SMS may be used as a screening test to identify a sick mother. SMS can predict morbidity, help in triage and early intervention or timely referral to a higher centre.

Evaluation of the quality scoring system of hard red spring wheat using four different roller mills

ABSTRACTWheat quality laboratories need a scoring system for efficient segregation of wheat samples. A comprehensive and objective scoring system was developed to assist the evaluation of end-use quality of hard red spring (HRS) wheat. The overall quality score consisted of (1) wheat, (2) milling, (3) flour and dough, and (4) baking quality scores. Subscores attained from various quality tests were subdivided into individual categories. The objective of this experiment was to evaluate the quality scoring system. Since flour quality is highly influenced by experimental milling procedures, four different laboratory roller mills were compared for the scoring system using 12 HRS wheat samples. Although the mill type varied significantly (p < 0.001) for the overall quality scores, they appeared to be consistent for ranking of wheat samples, showing significant correlation coefficients (r ≥ 0.74, p < 0.01) between different mill types. Quad. Sr. mill was specifically identified to be more suitable for dough and bread-making quality evaluation of HRS wheat due to the higher consistency with a long-flow MIAG mill. The overall quality scores also showed a significant (p < 0.001) variation among wheat samples, indicating that the scoring system could be useful to segregate HRS wheat samples for end users and breeders.Abbreviation: HRS: Hard Red Spring; MN: Minnesota; MT: Montana; ND: North Dakota; SD: South Dakota; OVA: Overseas Varietal Analysis; Quad: Quadrumat; AACCI: American Association of Cereal Chemist International; SKB: Sandstedt Kneen and Blish; SAS: Statistical Analysis System; ANOVA: Analysis of Variance; LSD: Least Significant Difference; ERE: Extensograph Resistance to Extension; SDS: Sodium Dodecyl Sulfate

A proposal for a comprehensive risk scoring system for predicting postoperative complications in octogenarian patients with medically operable lung cancer: JACS1303.

Although some retrospective studies have reported clinicopathological scoring systems for predicting postoperative complications and survival outcomes for elderly lung cancer patients, optimized scoring systems remain controversial. The Japanese Association for Chest Surgery (JACS) conducted a nationwide multicentre prospective cohort and enrolled a total of 1019 octogenarians with medically operable lung cancer. Details of the clinical factors, comorbidities and comprehensive geriatric assessment were recorded for 895 patients to develop a comprehensive risk scoring (RS) system capable of predicting severe complications. Operative (30 days) and hospital mortality rates were 1.0% and 1.6%, respectively. Complications were observed in 308 (34%) patients, of whom 81 (8.4%) had Grade 3-4 severe complications. Pneumonia was the most common severe complication, observed in 27 (3.0%) patients. Five predictive factors, gender, comprehensive geriatric assessment75: memory and Simplified Comorbidity Score (SCS): diabetes mellitus, albumin and percentage vital capacity, were identified as independent predictive factors for severe postoperative complications (odds ratio = 2.73, 1.86, 1.54, 1.66 and 1.61, respectively) through univariate and multivariate analyses. A 5-fold cross-validation was performed as an internal validation to reconfirm these 5 predictive factors (average area under the curve 0.70). We developed a simplified RS system as follows: RS = 3 (gender: male) + 2 (comprehensive geriatric assessment 75: memory: yes) + 2 (albumin: <3.8 ng/ml) + 1 (percentage vital capacity: ≤90) + 1 (SCS: diabetes mellitus: yes). The current series shows that octogenarians can be successfully treated for lung cancer with surgical resection with an acceptable rate of severe complications and mortality. We propose a simplified RS system to predict severe complications in octogenarian patients with medically operative lung cancer. JACS1303 (UMIN000016756).

Diagnostic utility of Haematological scoring system (HSS) with clinicopathological and bacteriological evaluationin early diagnosis of neonatal sepsis

Background: Neonatal sepsis is a major cause of mortality with high incidence of 11 to 24.5 per 1000 live births in India. Delay in diagnosis further increases the mortality to 30-40% of total neonatal deaths. Though blood culture is gold standard for diagnosis of neonatal sepsis, it has limitations. The comprehensive Hematologic scoring system (HSS) formulated by Rodwell et al is used for early diagnosis of sepsis. This comprises of Immature/Total neutrophil ratio, Total PMN count, Immature/Mature ratio, Immature PMN count, degenerative changes in PMN, platelet count. Methods: This is a prospective study of haematologic profiles of 333 neonates admitted in neonatal care unit in our institute. Field stained blood smears were examined for HSS. Blood culture was done before administration of antibiotic treatment. Neonates with predisposing perinatal risk factors or if there was clinical suspicion of sepsis were included in this study from Nov 2014 to feb 2016. Result: Of the 303 neonates in the present study, 77 had positive blood cultures, The incidence of septicemia was higher in males (72.7%) than females (27.3%). Majority of the neonates presented with early onset type of sepsis (91%). Elevated I: T ratio and I:M ratio were seen in most cases of septicemia. Conclusion: HSS is the most sensitive indicator of sepsis. Use of HSS by peripheral smear study Blood culture can be used effectively as a sepsis screen for early diagnosis is useful to reduce neonatal morbidity and mortality. DOI: 10.21276/APALM.1504

A comprehensive scoring system in correlation with perioperative airway management for neonatal Pierre Robin Sequence.

PurposeTo evaluate a comprehensive scoring system which combines clinical manifestations of Pierre Robin Sequence (PRS) including severity of breathing difficulties, body weight and preoperative Cormack-Lehane grade, for its correlation with perioperative PRS airway management decision.DesignForty PRS children were retrospectively recruited after surgery. Specialists examined all subjects and scored for clinical manifestations (1´ - 4´), weight gain (1´- 4´), dyspnea scores (1´- 4´), and Cormack-Lehane grade (1´- 4´). The correlation of the integrated scores and the necessity of endotracheal intubation or laryngeal mask application were analyzed. In addition, the score correlation with postoperative dyspnea and/or low pulse oxygen saturation (SPO2) levels after extubation was determined.FindingsIn our study every individual patient had a score from 0´ to 16´, while the higher in the numbers represented higher risk of breathing difficulty. All patients with comprehensive scores <10 points underwent endotracheal intubation successfully. Patients scoring 10–12 points had an intubation success rate of 47%, whereas all patients scored >13 points required a laryngeal mask assisted airway management and were considered to have difficult airways. Dyspnea after extubation and postoperative low SPO2 occurred among patients who scored over 10 points.ConclusionIn PRS patients, preoperative weight gaining status and severity of dyspnea in combination with Cormack-Lehane classification provide a scoring system that could help to optimize airway management decisions such as endotracheal intubation or laryngeal mask airway placement and has the potential to predict postoperative dyspnea or low SPO2 levels.

Screen for sustainable cropping systems in the rain-fed area on the Loess Plateau of China

A challenge for dryland crop production in China is closing the yield gap while propelling the sustainable development of agriculture when the natural resources are limited. A 4-year fixed field experiment was conducted to analyse the effect of introducing leguminous green manure (LGM) to different cropping systems on soil water, residual nitrate, soil quality and economic benefits to compare their sustainability using a comprehensive scoring system. The main treatments of the experiment were different cropping systems, leguminous green manure-winter wheat (LGM-WW) and leguminous green manure-spring maize-winter wheat (LGM-SM-WW) with summer fallow-winter wheat (SF-WW) as control. LGM late incorporation, early mulch and early incorporation were sub-treatments for LGM-WW while stalk mulch, incorporation and move-away were the sub-treatments for LGM-SM-WW to study the effects of different LGM managements. Compared with SF-WW, LGM-WW decreased average soil water storage before wheat seeding by 11% and increased residual nitrate storage after wheat harvest by 77% while they were not significantly changed for LGM-SM-WW. The soil organic carbon (SOC) content of LGM-WW and LGM-SM-WW in the 0–20-cm layer significantly increased when using legume as mulch. The economic benefits of LGM-SM-WW were 2 times greater than those of the other 2 cropping systems. The scoring system indicates that the total score of LGM-WW ranged from 11.85 to 12.78, which was even lower than that of SF-WW (13.07). On the contrary, the total score of LGM-SM-WW ranged from 16.46 to 18.49. In conclusion, the scoring system determined that the optimum cropping system for sustainable dryland agriculture is leguminous green manure-spring maize-winter wheat with legume stalk mulch.

Parafibromin, APC, and MIB-1 Are Useful Markers for Distinguishing Parathyroid Carcinomas From Adenomas.

Differentiation of parathyroid carcinoma (PC) from parathyroid adenoma (PA) relies solely on the pathologic determination of invasion of surrounding structures and/or distant metastasis. Parathyroid lesions with atypical histologic features with no demonstration of invasion or metastasis present a diagnostic dilemma. Different authors report a parafibromin and adenomatous polyposis coli (APC) loss or reduction in PC cases. High proliferative activity of MIB-1 and increased galectin 3 expression are reported in PC. There is no clear cutoff for the sensitivity, specificity, or predictive value for all these markers. The immunohistochemical expression of parafibromin, APC, MIB-1, and galectin 3 was studied in 73 adenomas, 21 PCs, and 3 atypical adenomas. The presence or absence of each marker was identified through the use of a comprehensive scoring system based on multiplying the percentage of tumor cells stained (0 to 100) and the staining intensity (0 to 3) on each biopsy. The highest score that any slide could reach was 300. A cutoff of >100 was used to consider the specimen positive for parafibromin, APC, or galectin 3 staining. MIB-1 proliferation indices were calculated using image cytometry; proliferation indices >5% were considered positive. We identified parafibromin loss in 7/21 (33%) carcinomas and 1/73 (1%) adenomas. Loss of APC was seen in 20/21 (95%) carcinomas and 38/73 (52%) adenomas. MIB-1 indices were elevated in 18/21 (86%) carcinomas. MIB-1 indices were <5% in all (100%) adenomas. MIB-1 indices were elevated in 2/3 (67%) atypical adenomas. Our study presents a clear cutoff to determine the practicality of using parafibromin, APC, and MIB-1 as immunohistochemical markers to differentiate between PCs and PAs. Loss of parafibromin and a high MIB-1 index are both independently sensitive and specific markers for the diagnosis of PC. Loss of APC was only specific for PC. This panel of markers provides a novel, useful approach in the diagnosis and differentiation of PCs from PAs.

Development and proposal of a scoring system for giant cell tumour of the bone around the knee.

The purpose of this study was to provide the surgeons with effective and reliable guidelines for surgical decision-making by establishing a scoring system for giant cell tumour (GCTSS) based on evidence and expert opinion. The modified Delphi technique and analytic hierarchy process were used to establish the GCTSS. The GCTSS was defined and classified based on different surgical methods using data from 207 patients collected retrospectively between October 2003 and December 2014. Finally, prospective data of 40 patients between December 2014 and October 2015 were used to analyze concordance between score categorization and experts' consensus on surgical procedure. A novel GCTSS included pathological fracture, cortical bone destruction, tumour size, and articular surface involved. The total scores ranged from 1 to 12 points. The strategy for each patient was decided: a total score of 1-4 suggested intralesional curettage alone for excellent post-operative function; 5-9 points indicated intralesional curettage with internal fixation for less surgery-related complications; and 10-12 points indicated prosthesis replacement for long-term local control. The κ-statistic for the predictive validity of total score was 0.611. The κ coefficient of each group represented moderate or substantial agreement, which was acceptable. The intraclass correlation coefficient for inter- and intra-observer reliability of total score was 0.831 and 0.740, respectively. The novel GCTSS is a comprehensive scoring system with content validity that can aid surgeons in assessing the aggressiveness or severity of giant cell tumour and might become a prognostic tool for surgical decision-making.

Demographic and clinical factors associated with suicide in gastric cancer in the United States.

While increased suicidal tendencies among cancer patients have been well documented, there has been no specific examination of suicide and gastric cancer. The purpose of this study is to characterize suicide incidence among patients diagnosed with gastric cancer from 1973 to 2013 and identify variables associated with higher suicide rates. Patients with gastric cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The study included clinical and demographic data from 1973 to 2013. Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated. Comparisons with the general US population were based on mortality data collected by the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control using the Web-based Injury Statistics Query and Reporting System. Multivariable logistic regression models generated odds ratios (ORs) to assess factors associated with increased suicide in gastric malignancy. There were 210 suicides for patients with gastric cancer (SMR, 3.21; 95% CI: 2.80-3.67). Female gender (SMR 8.54), White race (SMR 4.08), age ≤39 years (SMR 3.06), and age 70-79 years (SMR 2.90), were found to be significant for an increased incidence of suicide compared with the general population. There was not a statistically significant relationship between suicide and marital status, income, mode of radiation therapy, and the role of surgical intervention. Approximately 77% of deaths by suicide occurred within the first year following diagnosis. Female gender, White race, age ≤39 years, and age 70-79 years are factors associated with increased risk of suicide in patients with gastric cancer. These results, coupled with further studies and analyses, will be used to formulate a comprehensive suicide risk factor scoring system for screening all cancer patients.

A comprehensive scoring system to evaluate patient-centred risk factors regarding lower extremity amputation

Care of the patient with a presumed life- or limb-threatening lower extremity wound poses many challenges. The mindset regarding potential outcomes of such conditions is mostly driven by the experiences and expertise of those providing the care. This mindset generally appears as two primary actions presented to the afflicted patient: attempted resolution of the problem via medical, surgical or combination treatment, with the hope of low recurrence risk, or exacerbation and amputation-amputations at a level sufficient to, at least in the mind of the surgeon, eliminate the problem. Achieving the former outcome is dependent on a number of factors associated with both patient and caregiver. If healing is achieved, the secondary goal of prevention of recurrence may be no less arduous, with failure most likely resulting in amputation. Clearly, these considerations appear to be based more on the health professionals perception, of the patient's physical and medical status rather than on patient-centred considerations. This article will review considerations and recommendations for lower extremity amputation, and the short- and long-term implications. Based on our research, there is clear need for a set of criteria against which to weigh not just the medical issues, but also definitive patient-centred issues when considering a lower extremity amputation. We offer a set of patient-centred, easily verified and recognised criteria that we believe addresses this need. The goal of the Miller-Newgent Amputation Scale (MENACE) is to provide a decision base from which to consider and evaluate all factors in determining the need for a lower extremity amputation. This involves identification of patient-centred issues, which are likely to produce satisfactory short- and long-term physical and quality-of-life outcomes if the amputation does proceed.

Population Characteristics and Progressive Disability in Neurofibromatosis Type 2

To characterize the clinical features of patients with neurofibromatosis type 2 (NF2) and determine prognostic risk factors for progressive disabilities. In this retrospective cohort study of the Japanese national NF2 registry between 2009 and 2013, clinical data (demographic, history, oncologic, and neurologic) of 807 patients with a diagnosis of NF2 were analyzed. The overall severity of neurologic disability was assessed using a comprehensive 25-point scoring system encompassing a wide variety of neurologic deficits. In 587 patients in whom longitudinal disability data were available, multivariate logistic regression was performed to identify risk factors for significant progression of disability. The clinical characteristics of the Japanese NF2 population were heterogeneous. The median age of onset was 24 years (range, 1-80 years), the male:female ratio was 1:1.29, and the initial severity score was 4 (range, 0-22) out of 25 points. A family history of NF2 was present in 33% of the patients. Most frequent clinical features were bilateral cranial nerve VIII nerve sheath tumor (NST) in 87%, spinal NST in 80%, hearing loss in 65%, spinal dysfunction in 50%, intracranial meningioma in 49%, and facial paresis in 36%. The disability score progressed by ≥5 points in 6.1% of patients over the study period. Based on multivariate logistic regression analyses, the significant independent risk factors of progression (P value) included age of onset <25 years (P= 0.015), positive family history (P= 0.007), positive treatment history (P= 0.026), hearing loss (P= 0.014), facial paresis (P= 0.015), blindness (P= 0.011), and hemiparesis (P= 0.025). The Japanese NF2 population has heterogeneous clinical features. Risk factors for progressive disability include younger age of onset, positive family history, positive treatment history, and specific neurologic deficits.

McGill Thyroid Nodule Score in Differentiating Benign and Malignant Pediatric Thyroid Nodules: A Pilot Study.

Objective The McGill Thyroid Nodule Score (MTNS) is a preoperative tool used to predict the risk for well-differentiated thyroid cancer given a specific nodule in adults. We evaluated the clinical utility of a modified pediatric MTNS with children and adolescents. Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods This is a retrospective chart review of 46 patients ≤18 years of age presenting with a solitary or dominant thyroid nodule treated with surgical resection between September 2008 and December 2015. The cumulative MTNS for each nodule was calculated and compared with the final pathology. Results Of 46 patients, 10 (21.7%) were diagnosed with well-differentiated thyroid cancer (80% papillary thyroid carcinoma, 10% follicular variant of papillary thyroid carcinoma, 10% follicular thyroid carcinoma). Malignant nodules were associated with a greater mean MTNS (benign, 5.72 ± 3.03; malignant, 16 ± 3.13; P < .05). The sensitivity, specificity, and positive predictive value of malignancy were 100%, 94.4%, and 83.3% for scores ≥10 and 80%, 100%, and 100% for scores ≥11, respectively. In nodules with indeterminate cytology (Bethesda III and IV), the pediatric MTNS showed good differentiation between benign and malignant disease, with mean scores of 7.95 and 12.5, respectively ( P = .006). Conclusion This pilot study suggests that a comprehensive scoring system may help assess the risk of malignancy in pediatric thyroid nodules and differentiate nodules with indeterminate cytology into higher- and lower-risk categories. Given these findings, larger, multi-institutional studies are warranted.

Diagnostic performance of thyroid multimodal-imaging comprehensive risk stratification scoring (TMC-RSS) system in characterising thyroid nodules.

e17588 Background: A univocal ultrasound (US) classification system for characterising thyroid nodules is still lacking. The aim was to create an algorithm (TMC-RSS) using US features in combination with Color Doppler (CD), TIRADS, elastography (ES) and test its diagnostic performance. Methods: Analysis of prospectively collected data over 10 months. All studies were performed on single equipment using standard US protocol with TIRADS scoring. Gold standard was pathology. 340 nodules in 260 patients of which 316 nodules included for final analysis. 148 (46.8%) benign and 168 (53.2%) Malignant. TMC-RSS Multiple Logistic Regression Model. Malignant characteristics:Plus (+) 3 points for: ES score 3/4, malignant nodes. (+) 1 point for: Taller than wider, microcalcification, hypoechogenicity, solid composition, ill-defined margins, central +/- peripheral vascularity. (+) 0.5 point for: irregular halo, size &gt; 1 cm. Benign characteristics:Minus (-) 3 points for: Purely cystic, ES score-1; (-) 1 point for: spongiform, comet tail artefact, complete halo. (-) 0.5 point for: peripheral vascularity. Final TMC-RSS Score calculated by addition of all the points. Results: Mean age was 47.3 yrs. Mean size was 2.3 +/- 1.5 cm. Diagnostic performance of combined US, ES, TIRADS and CD (sensitivity: 96%, specificity: 95%, PPV: 95%, NPV: 96%, kappa: 0.911) was significantly higher (p &lt; .001) than either combination of US, TIRADS, ES, CD. On multivariate analysis all US features except taller than wider were independent predictor of malignancy (p &lt; .01). TMC-RSS Model had 90% sensitivity, 89% specificity and 91% accuracy for characterising nodules. On the ROC curve the cut-off for best performance of TMC-RSS score was 5.75. The cumulative risk of malignancy based on TMC-RSS score was 2.4% for score &lt; 3, 18% for score ≥ 3 - &lt; 6 and 80% for score ≥ 6. Conclusions: The proposed TMC-RSS is easy-to-use, robust, reproducible and provides higher degree of confidence to a non-expert radiologist. It can be the first step in standardization of reporting lexicon to allow effective communication between the radiologists, pathologists, and clinicians; helping avoid unnecessary interventions.