Extent Score Research Articles

Adverse Cardiac Events in Cardiac Sarcoidosis Prediction by 123I-betamethyl-p-iodophenyl-pentadecanoic Acid Single-Photon Emission Computed Tomography and Cardiac Magnetic Resonance Late Gadolinium Enhancement

Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging can help detect myocardial damage. 123I-betamethyl-p-iodophenyl-pentadecanoic acid single-photon emission computed tomography (BMIPP-SPECT) was developed to evaluate fatty acid metabolism and has been reported to help detect myocardial damage in cardiac sarcoidosis (CS). We analyzed data from CMR-LGE and performed BMIPP-SPECT in patients with CS taking prednisolone and investigated the association of BMIPP-SPECT with LGE as a prognostic factor in CS. Patients with CS who underwent BMIPP-SPECT and CMR-LGE at the time of diagnosis within 2months were classified into those with and without a major adverse cardiac event (MACE). Total BMIPP-SPECT defect score (BDS) and LGE extent score (LES) were used to estimate myocardial damage. The relation between BDS and LES was explored using Pearson's correlation coefficient. Their ability to predict MACEs was analyzed using Kaplan-Meier analysis. Medical data of 45 patients were analyzed retrospectively (mean follow-up, 4.5years). BDS and LES were significantly correlated (p<0.0001). BDS was significantly greater for the group with MACE than that without MACE (p=0.0008). LES of patients with MACE was significantly greater than those without MACE (p=0.0045). Patients with BDS ≥16 had a significantly higher MACE rate than those with BDS <16 (p=0.0029). The group with LES ≥9 was significantly associated with MACE (p=0.0098). In conclusion, BDS reflected myocardial damage similar to that detected by CMR-LGE and was a predictive marker of MACE in patients with CS. BMIPP-SPECT may help predict the prognosis of patients with CS who cannot undergo CMR-LGE.

P-S6 as a Prognostic Biomarker in Canine Oral Squamous Cell Carcinoma.

Scarce information exists on the role of mTOR pathway proteins and their association to aggressiveness and prognosis of patients with canine oral cancers. We aimed to investigate the activated form of mTOR and its downstream S6 protein in canine oral squamous cell carcinoma (OSCC), and to evaluate potential associations between protein expression and clinic-pathologic variables and survival. For that we analysed p-mTOR and p-S6 protein expression by immunohistochemistry in 61 canine OSCCs. Multivariate analysis was conducted to examine their role in patients’ cancer-specific survival (CSS). p-mTOR and p-S6 expression were present in almost all cases. High-expression of p-mTOR was observed in 44 (72.1%) cases using extent score and 52 (85.2%) cases using intensity score. For p-S6, high expression was observed in 53 (86.9%) cases using extent score and in 54 (88.5%) cases using intensity score. An independent prognostic value for p-S6 extension (p = 0.027), tumour stage (p = 0.013) and treatment (p = 0.0009) was found in patients’ CSS analysis. Our data suggest that p-mTOR and p-S6 proteins are commonly expressed in canine OSCC and p-S6 expression is correlated with poor CSS in dogs with OSCC. More studies should be performed to identify possible therapeutic targets related with mTOR pathway for these patients.

Occludin and claudin-1 are potential prognostic biomarkers in patients with oral squamous cell carcinomas: An observational study

The objective of this study was to evaluate the expression of several cell membrane markers in oral squamous cell carcinomas (OSCC) and to examine their prognostic influence. We analyzed the immunohistochemical expression of claudin-1 (CLDN-1), claudin-4 (CLDN-4), claudin-5 (CLDN-5), claudin-7 (CLDN-7), occludin (OCLN), and E-cadherin (CDHE) in 60 patients with OSCC treated in a central hospital Center of Oporto. The prognostic significance of these biomarkers in cancer-specific survival and recurrence-free survival were evaluated using multivariate analysis. Claudin-1 was observed in the membrane of tumor cells in 51 cases (89.5%), CLDN-4 in 36 cases (63.2%), and CLDN-7 in 48 cases (80%). Claudin-5 was detected in the cytoplasm of tumor cells in 46 cases (78%) and OCLN in 40 cases (70.2%). In a multivariate analysis, the combined evaluation of OCLN and CLDN-1 revealed a significant and independent association with cancer-specific survival and recurrence-free survival. We found a low extent score for OCLN and a high intensity score for CLDN-1, presenting the hazard ratios of 15.48 (P=.014) and 9.446 (P=.012), respectively. The CLDN-1 and OCLN proteins could be involved in tumor progression of OSCC. Their combined deregulated expression showed an adverse effect on survival and therefore they could be regarded as important prognostic biomarkers in OSCC.

Validation of the Turkish version of the DOSE-Nonadherence measure among patients with cardiometabolic conditions.

There are no validated self-report measures to assess extent of and reasons for medication nonadherence in the Turkish language. The aim of this study is to evaluate validity and reliability of the Domains of Subjective Extent of Nonadherence Scale, which assesses extent of and reasons for nonadherence in Turkish patients with hypertension, diabetes mellitus and/or dyslipidaemia in community pharmacy settings. The Turkish version of the DOSE-Nonadherence scale was developed through translation and cultural adaption. Psychometric properties of the scale were evaluated in a cross-sectional study among 203 patients who visited six community pharmacies located in Istanbul, Turkey between November 2020 and March 2021. For the extent of nonadherence domain, reliability was estimated through Cronbach's alpha, and convergent validity was evaluated with Spearman's rank correlation with the validated Turkish version of the Medication Adherence Report Scale (MARS). Reasons for nonadherence were characterized among participants reporting nonadherence to the extent of nonadherence items. The measure was administered at baseline and 2 weeks later to 30 patients to estimate stability of extent scores using the Wilcoxon test and intraclass correlation coefficient. p< 0.05 was set as the level of statistical significance. Among the 203 participants (65 male), the median (25th-75th percentiles) age was 59.0 years [51.0-67.0]. Cronbach's alpha for the extent of nonadherence scale was 0.86. A moderate negative correlation (r= -0.58; p< 0.001) was found between the extent of nonadherence scores and MARS, supporting convergent validity. The most common reasons for medication nonadherence were forgetfulness (22.5%) and mismatch between the patients' daily routine and medication taking (17.5%). The intraclass correlation coefficient was 0.97 for extent of nonadherence scores at baseline and 2 weeks (p< 0.001). The DOSE-Nonadherence Scale could be used to identify nonadherent patients and their reasons for nonadherence in Turkish patients with chronic cardiometabolic conditions. This scale can be used to evaluate clinical pharmacist-led services to reduce medication nonadherence. Nonadherence could be recorded longitudinally in electronic health records to provide a more accurate picture of medication use. Pharmacists or other providers could administer interventions tailored to patients' reasons for nonadherence.

Different Lung Parenchyma Quantification Using Dissimilar Segmentation Software: A Multi-Center Study for COVID-19 Patients.

Background: Chest Computed Tomography (CT) imaging has played a central role in the diagnosis of interstitial pneumonia in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and can be used to obtain the extent of lung involvement in COVID-19 pneumonia patients either qualitatively, via visual inspection, or quantitatively, via AI-based software. This study aims to compare the qualitative/quantitative pathological lung extension data on COVID-19 patients. Secondly, the quantitative data obtained were compared to verify their concordance since they were derived from three different lung segmentation software. Methods: This double-center study includes a total of 120 COVID-19 patients (60 from each center) with positive reverse-transcription polymerase chain reaction (RT-PCR) who underwent a chest CT scan from November 2020 to February 2021. CT scans were analyzed retrospectively and independently in each center. Specifically, CT images were examined manually by two different and experienced radiologists for each center, providing the qualitative extent score of lung involvement, whereas the quantitative analysis was performed by one trained radiographer for each center using three different software: 3DSlicer, CT Lung Density Analysis, and CT Pulmo 3D. Results: The agreement between radiologists for visual estimation of pneumonia at CT can be defined as good (ICC 0.79, 95% CI 0.73–0.84). The statistical tests show that 3DSlicer overestimates the measures assessed; however, ICC index returns a value of 0.92 (CI 0.90–0.94), indicating excellent reliability within the three software employed. ICC was also performed between each single software and the median of the visual score provided by the radiologists. This statistical analysis underlines that the best agreement is between 3D Slicer “LungCTAnalyzer” and the median of the visual score (0.75 with a CI 0.67–82 and with a median value of 22% of disease extension for the software and 25% for the visual values). Conclusions: This study provides for the first time a direct comparison between the actual gold standard, which is represented by the qualitative information described by radiologists, and novel quantitative AI-based techniques, here represented by three different commonly used lung segmentation software, underlying the importance of these specific values that in the future could be implemented as consistent prognostic and clinical course parameters.

Clinical impact of p16 positivity in nasopharyngeal carcinoma.

PurposeThe clinical characteristics and prognosis of HPV‐related nasopharyngeal cancer (NPC) remain controversial. The relationship between p16 status and outcome was retrospectively investigated in the NPC patients.Materials and MethodsBetween May 2009 and May 2019, 81 NPC patients who received definitive radiation therapy, in a hospital in Japan, were identified and the prognosis was investigated. p16, p53, and Epstein–Barr virus (EBV) status were assessed. Also, circumferential tumor extent in the nasopharyngeal cavity was assessed on a 5‐point scale.ResultsNine and 72 patients were p16‐positive and p16‐negative, respectively. Fewer patients were EBV‐encoded RNA in situ hybridization (EBER‐ISH)‐positive in the p16‐positive group than in the p16‐negative group (p < .01). Seventy‐five patients were nonkeratinizing NPCs, and six patients were keratinizing NPCs. There were two p16‐positive patients among the keratinizing NPCs.The mean circumferential tumor extent scores of 16‐positive and p16‐negative NPCs were 4.2 and 3.2, respectively with a statistically significant difference (p = .02). Two‐year progression‐free survival (PFS) of p16‐positive and p16‐negative patients undergoing chemoradiation therapy were 100% and 69%, respectively (p = .13).ConclusionIn this study conducted in Japan, p16‐positive NPC patients are minor but not very low, and the proportion of keratinizing NPCs was small. p16‐positive NPCs were seen both in keratinizing and nonkeratinizing NPCs. P16‐positive NPC had a tendency of better PFS than p16‐negative NPC. This better prognosis might be due to the higher radiosensitivity of the p16‐positive cell. Additionally, p16‐positive NPCs seemed to spread more extensively in circumference along the nasopharyngeal mucosa than p16‐negative NPCs.

Efficacy and safety of combined fractional ablative CO2 laser and 5 fluorouracil in the treatment of acral vitiligo: An open, uncontrolled study.

Acral lesions of vitiligo are most likely recalcitrant to the known lines of treatment. Ablative fractional CO2 has shown efficacy in treatment of vitiligo in combination with other modalities. Thirty non-segmental vitiligo patients with acral lesion were included in the study. Each patient was subjected to fractional Carbon Dioxide Laser Treatment followed by application of 5 fluorouracil (5FU) cream for five consecutive days. Evaluation was done 3 weeks from the start of treatment and 12 weeks after the last treatment session using VESTA score, evaluation of patients' photos by blinded investigation in addition to patients' satisfaction scores. Patients showed significant improvement of Vitiligo extent score for a target area (VESTA) score and developed considerable degree of repigmentation as assessed by blinded investigators. The combination of fractional ablative CO2 and 5FU is an effective and safe procedure for the treatment of acral vitiligo with promising results offering patients a new therapeutic window.

POS0069 LONGITUDINAL CHANGES ON QUANTITATIVE CHEST HIGH-RESOLUTION COMPUTED TOMOGRAPHY IN EARLY DIFFUSE SYSTEMIC SCLEROSIS-RELATED INTERSTITIAL LUNG DISEASE AFTER AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION.

BackgroundSince Burt et al. first demonstrated in the ASSIST trial (1) that lung disease high-resolution computed tomography (HRCT) volumetric measurement decreased in autologous hematopoietic stem cell transplantation (aHSCT) recipients and increased in controls receiving cyclophosphamide iv one year after starting treatment, limited data have been reported concerning the evolution of Systemic Sclerosis-Interstitial Lund disease (SSc-ILD) since and its relationship with the evolution of esophageal volume is unknown.ObjectivesTo evaluate High-Resolution Computed Computed Tomography (HRCT) interstitial lung disease (ILD) and esophageal involvement in early diffuse systemic sclerosis (dSSc)-patients before and after autologous Hematopoietic Stem Cell Transplantation (aHSCT).MethodsOverall chest HRCT, lung function and skin score changes were evaluated in 33 consecutive dSSc-patients before and after aHSCT during yearly routine follow-up between January 2000 and september 2016.Two independent radiologists blindly assessed the ILD extent using semi-quantitative Goh and Wells method (2), the widest esophageal diameter (WED) and the esophageal volume (EV) on HRCT. Patients were retrospectively classified as radiological responders or non-responders at 24 months after aHSCT according to the stability or a 5% or more decrease of HRCT ILD extent. Two by two time points comparisons after versus before aHSCT were performed using linear regressions. Survival rates were assessed for all patients by Kaplan-Meier method.ResultsTwenty-four months after aHSCT, HRCT median [IQR] ILD (-2 [-10.3; 0] points, p=0.0002) and ground-grass opacities (-2.1 [-8.3; 0] points, p=0.02) extent scores had improved, with 18 patients radiological responders (probability of response 0.78, 95% CI (0.58;0.90), whereas median WED (from 24.5 [18; 29] to 28 [19; 33] mm; p= 0.005) and EV (from 19 [13; 33] to 30 [13; 58] mm3, p=0.01) increased significantly. Kaplan-Meier analyses showed a trend towards better 5 years survival rates (100% versus 60%; HR 0.23 95%CI 0.03 to 1.62, P = 0.11) among radiological responders versus non-responders at 24 months.ConclusionReal-world data analysis confirmed significant HRCT SSc-ILD improvement 24 months after aHSCT, although esophageal dilatation worsened requiring specific attention.

Extent of delivery and utilization of farm advisory services of public and private extension service organizations in Meghalaya

The study was conducted during 2020–21 in Ri-Bhoi district of Meghalaya with two organizations functioning therein, viz. Krishi Vigyan Kendra (KVK) as public extension organization and Rural Resource Training Centre (RRTC) as private extension organization. The present investigation was aimed to study the extent of delivery of services by these two farm advisory services i.e. KVK and RRTC, over a period of time and extent of utilisation of these by the farmers. The extension programs and activities of the two extension organisations in their adopted villages was documented using descriptive approach. The mean scores of extent of utilisation index of beneficiaries of RRTC were more than that of those of KVK. In KVK, Ri-Bhoi extent of utilization for exhibition is more withmean value of 69.6 and the least utilized farm advisory services was exposure visit with mean value of 1.82 whereas in RRTC, field day was the most utilized farm advisory services with mean value of 67 and New varieties/ inputs (in terms of improved crop seeds, fertilizers, pesticides, weedicides) were the least utilized farm advisory services with mean value of 7.9. The study revealed that both KVK and RRTC were found to be energetically working to cater the needs of farmers, youth and women for providing various kinds of farm advisory services. They appear to be at par as far as the extent of delivery of farm advisory services is concerned.

Comparative study of the effectiveness of combination therapy of vitiligo with methotrexate in combination with medium-wave narrow-band therapy UVB-311 nm and monotherapy UVB-311 nm

BACKGROUND: Vitiligo, a multifactorial chronic acquired disease with a genetic predisposition, occurs due to the destruction of melanocytes of the skin and is characterized by the appearance of foci of depigmentation. Despite the fact that new therapies are emerging, there are no actual treatment regimens that would guarantee a positive result, including stopping the progression of the process, repigmentation. In this regard, it is advisable to search for drugs that have an immunosuppressive effect.&#x0D; AIMS: Clinical evaluation of the effectiveness of methotrexate in combination with UVB-311 nm and UVB-311 nm monotherapy in vitiligo.&#x0D; MATERIALS AND METHODS: 77 patients suffering from progressive vitiligo were included in this study. All patients were divided into 2 groups. A course of methotrexate therapy in combination with UV therapy was prescribed to 39 patients, UVB-311 nm monotherapy was performed in 38 patients. The lesion area relative to the body surface area was estimated using the VES index (Vitiligo extent score) on the vitiligo calculator. The effect of the disease on the quality of life was assessed using the Dermatology Life Quality Index (DLQI). The duration of the study was 6 months.&#x0D; RESULTS: The patients included in the study were divided into two groups randomly. There were 39 patients in group I, 38 in group II. 76 out of 77 patients completed it: 1 patient was excluded due to increased hepatic transaminases during methotrexate therapy. Among patients receiving combination therapy with methotrexate in combination with medium-wave narrow-band therapy UVB-311 nm, there was a more pronounced decrease in the percentage of depigmentation relative to the body surface area. And also patients of this group demonstrated the most active positive dynamics of the Dermatology Life Quality Index than patients who received only phototherapy.&#x0D; CONCLUSIONS: The study demonstrated good clinical efficacy of the drug. Small doses of methotrexate have a positive effect on the tolerability of the drug and prevent the development of side effects, which makes it possible to influence pathogenetic mechanisms for a long time, stabilizing the skin process.

Validation of a Lymphedema Index Score Based on Noncontrast Magnetic Resonance Lymphangiography: Correlation with Clinical Staging and Indocyanine Green Lymphangiography.

Background: A standardized lymphedema grading system is a prerequisite for accurately and objectively evaluating its severity, both preoperatively and postoperatively. The purpose of this study was to establish a clinically feasible noncontrast magnetic resonance lymphangiography (NMRL) protocol and a standardized scoring system for the evaluation of lymphedema. Methods and Results: From January 2020 to February 2021, 39 patients who had been clinically diagnosed with lymphedema and had undergone NMRL were included. The severity and circumferential extent of lymphedema were assessed using magnetic resonance imaging, and a combined index was devised as the sum of the product of the severity and extent scores determined at four different levels. A magnetic resonance imaging (MRI) stage was allocated based on the combined index score, its correlation with clinical indices was analyzed. The MR and clinical staging showed a percentage agreement of 85.9% and a kappa coefficient of 0.641, indicating moderate agreement (p < 0.001). Both the interlimb volume and interlimb impedance ratios differed significantly between groups (p < 0.001 for both). The correlation analysis revealed a significant correlation between the combined index score and the inter-limb volume ratio (r = 0.70, p < 0.001) and inter-limb impedance ratio at both 1 kHz (r = 0.71, p < 0.001) and 5 kHz (r = 0.71, p < 0.001). The interobserver agreement was moderate for the severity score, extent score, and combined score. Conclusion: The proposed standardized scoring system for evaluating lymphedema based on NMRL can reproducibly determine the severity and extent of lymphedema in both the upper and lower extremities, and correlates strongly with established clinical measures.

Assessing the sustainability of land uses in Driefontein and Intunjambili wetlands, Zimbabwe

The study assesses the sustainability of the land uses in Driefontein and Intunjambili wetlands in Zimbabwe using the WET-Sustainable Use framework. The framework is based on indicator and impact scores of extent, intensity and magnitude of impact of different land use types on the wetland's ecological conditions. The study findings show that the two wetlands are vulnerable to crop cultivation and cattle grazing, although these two land uses have different impacts on each of the wetland's components such as hydrology, geomorphology, nutrient retention, soil organic matter (SOM) accumulation and vegetation. Of all the assessed components, vegetation has been modified by cultivation in the two wetlands, resulting in the introduction of alien invasive species and ruderal weeds. Cultivation has been contributing to increased bare land and drying in the Driefontein wetland where SOM accumulation is also altered by the removal of plant residues from the fields, although nutrient retention is enhanced by the application of inorganic fertilizers and livestock waste. Soil erosion, evidenced by gullies, and water abstraction using diesel powered pumps have been largely affecting water retention in the Intunjambili wetland, although SOM accumulation is high due to retention of crop residue in the fields. Overall, the study findings revealed that the current land uses are largely unsustainable as the wetlands’ hydrology and vegetation are declining though SOM is maintained in Intunjambili whose other parts are experiencing soil erosion. This calls for the identification of suitable crop farming and livestock grazing methods that maintain balanced wetland hydrology, vegetation, SOM, erosion and nutrient retention.

Utility of a Pulmonary Oedema Score for Predicting the Need for Mechanical Ventilation in COVID-19 Patients in a General Hospital

BackgroundThe Radiographic Assessment of Lung Edema (RALE) score has been used to estimate the extent of pulmonary damage in patients with acute respiratory distress syndrome and might be useful in patients with COVID-19.Aim of the studyTo examine factors associated with the need for mechanical ventilation in hospitalized patients with a clinical diagnosis of COVID-19, and to estimate the predictive value of the RALE score.MethodsIn a series of patients admitted between April 14 and August 28, 2020, with a clinical diagnosis of COVID-19, we assessed lung involvement on the chest radiograph using the RALE score. We examined factors associated with the need for mechanical ventilation in bivariate and multivariate analysis. The area under the receiver operating curve (AUC) indicated the predictive value of the RALE score for need for mechanical ventilation.ResultsAmong 189 patients, 90 (48%) were judged to need mechanical ventilation, although only 60 were placed on a ventilator. The factors associated with the need for mechanical ventilation were a RALE score >6 points, age >50 years, and presence of chronic kidney disease. The AUC for the RALE score was 60.9% (95% CI 52.9–68.9), indicating it was an acceptable predictor of needing mechanical ventilation.ConclusionsA score for extent of pulmonary oedema on the plain chest radiograph was a useful predictor of the need for mechanical ventilation of hospitalized patients with COVID-19.

Plasmacytoid urothelial carcinoma of the bladder: MRI features and their association with survival.

Plasmacytoid urothelial carcinomas (PUC) of the bladder are rare variants known for diffuse and infiltrative spread, however their magnetic resonance imaging (MRI) features are not well established. We aimed to evaluate MRI features of PUC of the bladder and their association with survival. This retrospective single-center study included 41 patients with pathologically-proven bladder PUC of the bladder that underwent pre-treatment MRI between January 2000 and March 2020. Two radiologists reviewed MRIs independently followed by consensus with a third radiologist. On MRI, tumor extent, size, Vesical Imaging-Reporting and Data System (VI-RADS) scores (≥4, muscle-invasive; 5, extravesical extension [EVE]), pelvic peritoneal spread (PPS), hydronephrosis, pelvic adenopathy and clinicopathological factors of age, gender, pathological stage, and treatment type were extracted. Kaplan-Meier curves and Cox proportional-hazards models were used to evaluate association with survival. Thirty-two men and 9 women (median age 70 years, IQR 64-76) were included. Most were muscle-invasive (n = 30 [73.2%]). On MRI, most tumors were diffuse (n = 28 [68.3%]), >5 cm (n = 30 [73.2%]), VI-RADS 4 to 5 (n = 36 [87.8%]) with features of EVE and (n = 31 [75.6%]) and PPS (n = 25 [61.0%]). Variables associated with survival were: Larger tumors (>5 cm; hazard ratio [HR] = 5.0; 95% confidence interval [CI] 1.6-15.5; P < 0.01), diffuse extent (HR = 4.0; 95% CI 1.4-11.2; P = 0.01), EVE (HR = 4.5; 95% CI 1.5-13.6; P < 0.01), PPS (HR = 3.0; 95% CI 1.2-7.4; P = 0.01), hydronephrosis (HR = 13.7; 95% CI 3.1-60.9; P < 0.01), pathologic stage (≥pT3 vs. pT1; HR = 5.6; 95% CI 1.3-22.0; P = 0.02), and margin positivity (HR = 4.4 [95% CI 1.2-16.4], P = 0.03). PUCs of the bladder are commonly large, diffuse VI-RADS score 4 to 5 tumors with MRI features of EVE and PPS. These features and pathological stage were associated with survival.

Canine memory T-cell subsets in health and disease

A more complete understanding of canine T-lymphocyte immunity is necessary for improving diagnostic and therapeutic approaches to canine diseases, developing cell-based canine immunotherapeutics, and evaluating dogs as large mammal models for comparative immunology research. The aim of this study was to utilize CD45RA (indicating antigen inexperience) and CD62L (indicating lymph node homing capability), to quantify canine memory T-cell subsets in healthy dogs and dogs with various diseases.Peripheral blood mononuclear cells (PBMCs) were prospectively collected from dogs belonging to one of four groups:dermatologic inflammation (n = 9), solid tumors (n = 9), lymphoma (n = 9), and age-/weight-matched healthy control dogs (n = 15). Dogs receiving prednisone or any other immunomodulating medication within two weeks were excluded. Flow cytometry was performed and T-cell subsets were defined as CD4+ or CD8+, and naïve (TN), central memory (CM), effector memory (EM), or terminal effector memory re-expressing CD45RA (TEMRA). T-cell subset proportions were compared between each disease group and their healthy age-/weight-matched controls using a Mann-Whitney test.Significantly increased %CD8+ TN (P = 0.036) and decreased %CD8+ TEMRA (P = 0.045) were detected in dogs with dermatologic inflammation compared to healthy controls. Furthermore, %CD4+ TN positively correlated with Canine Atopic Dermatitis Extent and Severity Index (CADESI) score within the inflammation group (ρ = 0.817, P = 0.011). No significant differences between either cancer group and their healthy controls were detected.Taken together, these data indicate that dermatologic inflammation can alter proportions of peripheral blood T-cell subsets, possibly due to the migration of antigen-specific T-cells into tissues. Furthermore, these findings support the utility of CD45RA and CD62L in characterizing clinical canine immune responses.

Validity and Reliability of the Hungarian Version of Aberdeen Varicose Vein Questionnaire.

Purpose: The aim of our study was to translate the Aberdeen Varicose Vein Questionnaire (AVVQ) into Hungarian, and to investigate the validity and reliability of the Hungarian AVVQ, as well as to assess the health-related quality of life in patients with varicose veins of the leg. Methods: 374 adults participated in this study who were divided into two groups (varicose vein, healthy). We analyzed internal consistency, convergent validity (using the 36-Item Short Form Survey, SF-36), repeatability, and intra-class correlation coefficient of the Hungarian AVVQ. Regarding discriminant validity, we determined the scores of the Hungarian AVVQ in both groups using the Mann-Whitney U-test. Results: The Cronbach-alpha value was 0.890, while the correlation coefficient was R = 1.000. According to the results of the convergent validation, the scores of pain and dysfunction moderately correlated with some scores of the SF-36. The score of cosmetic appearance had a relationship with many scores of the SF-36. We registered a significant relationship between the score of extent of varicosity and some scores of the SF-36. There was significant correlation between the score of complications and numerous scores of the SF-36 (physical functioning, role limitations due to physical health, pain and general health). The score of pain and dysfunction, cosmetic appearance, extent of varicosity, complications and total score of the Hungarian AVVQ showed a significant difference between both groups. Conclusions: The Hungarian AVVQ was a reliable and a valid tool to assess the health-related quality of life among patients with varicose veins and was a useful tool to justify the further treatment of the patients.

Development of severity and mortality prediction models for covid-19 patients at emergency department including the chest x-ray

ObjectivesTo develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters. MethodsAll symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay >3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for the optimal threshold selection of the classification model. ResultsA total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC = 0.94 and AUC-PRC = 0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC = 0.97 and AUC-PRC = 0.78. The addition of CXR CNN-based indices did not improve significantly the predictive metrics. ConclusionThe developed and internally validated severity and mortality prediction models could be useful as triage tools in ED for patients with COVID-19 or other virus infections with similar behaviour.

Usefulness of linked color imaging for the detection of obscure early gastric cancer: Multivariate analysis of 508 lesions.

Early gastric cancers (EGCs) of the elevated type or with submucosal invasion are easily found by routine endoscopy. However, most early cancers are challenging to detect because of subtle morphological or color differences from surrounding atrophic mucosa and intestinal metaplasia. Linked color imaging (LCI) enhances mucosal color difference, making it easier to detect EGCs. The aim of this study is to clarify the advantages and possible disadvantages of LCI for screening for obscure EGC. A total of 665 malignant gastric lesions resected using endoscopic submucosal dissection between January 2015 and April 2018 were retrospectively reviewed. Obviously detectable lesions were not included in the main analysis when determining the target lesion. White light imaging (WLI)/LCI images of 508 endoscopically obscure malignant lesions were included in the final analysis and evaluated by three non-expert and three expert endoscopists using visibility scores for detection and extent. The detection visibility scores using LCI were significantly higher than those using WLI regardless of lesion characteristics including location, size, histological type, depth of invasion, and Helicobacter pylori status. The detection score improved in 46.4% cases and deteriorated in 4.9% when the modality changed from WLI to LCI. A mixed-effects multivariate logistic regression analysis showed that use of LCI (odds ratio [OR] 2.57), elevated type (OR 1.92), invasion to submucosa (OR 2.18) were significantly associated with improved visibility of EGC. Linked color imaging significantly improves visibility of EGC regardless of differences in lesion morphology, histology, location, depth of invasion, and H. pylori status compared to conventional WLI.

Evolution of Systemic Sclerosis-Associated Interstitial Lung Disease One Year After Hematopoietic Stem Cell Transplantation or Cyclophosphamide.

ObjectiveHematopoietic stem cell transplantation (HSCT) and cyclophosphamide (CYC) are treatment options for progressive systemic sclerosis associated with interstitial lung disease (SSc‐ILD). The aims of our retrospective observational study were to evaluate: 1) the evolution of SSc‐ILD in SSc patients treated with HSCT (assessed by high‐resolution computed tomography [HRCT]; a group of patients treated with CYC was included as frame of reference); 2) how results of pulmonary function tests (PFTs) are associated with HRCT findings; and 3) which factors predict ILD reduction.MethodsWe semiquantitatively scored total ILD extent, reticulations, and ground‐glass opacities (GGO) scores at baseline and at the 1‐year HRCTs of SSc patients treated with HSCT or CYC. Linear association between changes in HRCT scores and PFT results and predictors of ILD improvement were studied.ResultsWe included 51 patients (those treated with HSCT [n = 20] and those treated with CYC [n = 31]). The mean change in total ILD score was –5.1% (95% confidence interval [95% CI] –10.2, 0.0) in the HSCT treatment group (P = 0.050), and –1.0% (95% CI –4.3, 2.3) in the CYC treatment group (P = 0.535). For all patients, the evolution of HRCT scores was weakly associated with relative changes in PFT results. In univariate logistic regression, higher ground‐glass opacities, higher total ILD, and lower single‐breath diffusing capacity for carbon monoxide scores at baseline predicted improvement of ILD extent after treatment, but a multivariable model could not be built to assess independency of predictors.ConclusionOne year after treatment with HSCT, a nonsignificant but clear reduction of SSc‐ILD extent was observed. Changes in PFT results were associated with changes in HRCT scores but the correlation was weak and cannot be considered conclusive.

Improving Diabetic Foot Ulcer Healing with Adjuvant Bitter Melon Leaf Extract (Momordica charantia L.)

BACKGROUND: Diabetes mellitus is a serious disease that affects more than 340 million people and causes approximately 20% of diabetic ulcer cases worldwide. Wound healing is a complex and dynamic process in restoring cellular structures and tissue layers. It consists of four continuous overlapping phases that are precisely programmed AIM: This study aims to examine the adjuvant administration of bitter melon leaf extract to increase the healing of diabetic foot ulcers (DFU). METHODS: This study used a randomized, double-blind, and placebo-controlled trial. A total of 30 DFU patients with a perfusion, extent, depth, infection, and sensation (PEDIS) score of 1–8 who met the criteria were divided into two groups, namely, the treatment group with adjuvant administration of bitter melon leaf extract at a dose of 6 g/day as many as 15 patients and the control group 15 patients with placebo. This intervention was carried out for 4 weeks. DFU cure was measured by PEDIS scores at baseline, weeks 2, 3, and the end of week 4. Data were analyzed using paired t-test and independent t-test. RESULTS: After 4 weeks of treatment, the PEDIS score in the treatment group decreased at week 2 (0.9 ± 1.8), but not significant (p = 0.19), decreased at week 3 (1.9 ± 1.9) and significant (p = 0.01), decreased in week IV (2.3 ± 2.1) and significantly (p = 0.001). The control group experienced a decrease in week 2 (0.3 ± 2.3), but not significant (p = 0.71), decreased in week 3 (1.2 ± 2.5), but not significant (p = 0.18), decreased in week 4 (1.9 ± 2.7) and significantly (p = 0.03), and there was an effect of adjuvant administration of bitter melon leaf extract on the cure of DFU (p = 0.004). CONCLUSION: Adjuvant administration of bitter melon leaf extract has been shown to increase the healing of DFU.