Multifactor Scoring Research Articles

Establishment and validation of early prediction model for hypertriglyceridemic severe acute pancreatitis

BackgroundThe prevalence of hypertriglyceridaemia-induced acute pancreatitis (HTG-AP) is increasing due to improvements in living standards and dietary changes. However, currently, there is no clinical multifactor scoring system specific to HTG-AP. This study aimed to screen the predictors of HTG-SAP and combine several indicators to establish and validate a visual model for the early prediction of HTG-SAP.MethodsThe clinical data of 266 patients with HTG-SAP were analysed. Patients were classified into severe (N = 42) and non-severe (N = 224) groups according to the Atlanta classification criteria. Several statistical analyses, including one-way analysis, least absolute shrinkage with selection operator (LASSO) regression model, and binary logistic regression analysis, were used to evaluate the data.ResultsThe univariate analysis showed that several factors showed no statistically significant differences, including the number of episodes of pancreatitis, abdominal pain score, and several blood diagnostic markers, such as lactate dehydrogenase (LDH), serum calcium (Ca2+), C-reactive protein (CRP), and the incidence of pleural effusion, between the two groups (P < 0.000). LASSO regression analysis identified six candidate predictors: CRP, LDH, Ca2+, procalcitonin (PCT), ascites, and Balthazar computed tomography grade. Binary logistic regression multivariate analysis showed that CRP, LDH, Ca2+, and ascites were independent predictors of HTG-SAP, and the area under the curve (AUC) values were 0.886, 0.893, 0.872, and 0.850, respectively. The AUC of the newly established HTG-SAP model was 0.960 (95% confidence interval: 0.936–0.983), which was higher than that of the bedside index for severity in acute pancreatitis (BISAP) score, modified CT severity index, Ranson score, and Japanese severity score (JSS) CT grade (AUC: 0.794, 0.796, 0.894 and 0.764, respectively). The differences were significant (P < 0.01), except for the JSS prognostic indicators (P = 0.130). The Hosmer–Lemeshow test showed that the predictive results of the model were highly consistent with the actual situation (P > 0.05). The decision curve analysis plot suggested that clinical intervention can benefit patients when the model predicts that they are at risk for developing HTG-SAP.ConclusionsCRP, LDH, Ca2+, and ascites are independent predictors of HTG-SAP. The prediction model constructed based on these indicators has a high accuracy, sensitivity, consistency, and practicability in predicting HTG-SAP.

Sector rotation multi-factor stock selection strategy based on six boards

This paper proposes an investment strategy based on a regression linear model to predict sector rotation and a multi-factor scoring model to select stocks to achieve excess returns. The strategy uses January 2006 December 2020 as the model construction period and January 2021 June 2021 as the model validation and backtesting period. Using Shenyin &amp; wanguo’s industry classification as a standard, the cyclicality of industries is classified by β value and the existence of sector rotation is verified using the difference in rate of return between cyclical and non-cyclical industry. The factors associated with the annualized rate of return are selected and the fitted formula for the annualized rate of return is obtained by regressing linear equation and neural network multidimensional correlation to select the dominant board. Valid factors for each board were selected for fitting, and the factors were assigned weights for scoring, resulting in 32 stocks. The backtest results significantly outperformed the CSI 300 Index, and the model performance is stable and can achieve better returns.

A New Multi-Factor Risk Score System Depending on Gene Mutation and Overexpression for Predicting the Outcome in AML1-ETO-Positive Acute Myeloid Leukemia

Acute myeloid leukemia with AML1-ETO-positive (AE-AML) is a heterogeneous myeloid tumor with a big scale of long-term survival. Lots of factors have been reported to have an effect on survival; however, there is not a multi-factor risk score system to balance the significance of different prognostic factors and guide the risk-stratification and precise treatment on patients. We enrolled 64 patients with newly diagnosed as AE-AML, detested their gene mutation with the next-generation sequencing (NGS), monitored the expression of amyloid precursor protein (APP) expression and minimal residual disease (MRD) using quantitative real-time polymerase chain reaction (qPCR). The results showed that 47/64 (73.4%) patients presented gene mutations at diagnosis and 6/11 underwent genetic alteration at relapse, in which c-KIT mutation showed up the most frequently. Univariate factors analysis showed that the clinical features of onset, including EML, bone marrow cellularity rate ≥90%, APP overexpression, additional gene mutations, especially mutations in MET, ASXL1, DNMT3A, MLH1 and c-KIT (exon 8, 17), badly affected on the RFS and OS, while MDAC-based regimens for consolidation after CR and obtaining major molecular remission (MMR) after two courses of consolidation were the protective factors for recurrence-free survival (RFS) and overall survival (OS). Multivariate analysis showed ASXL1 mutation (RFS: HR=4.16, 95%CI= 1.02-17.04, P=0.048), MET mutation (RFS: HR=6.01, 95%CI= 1.19-30.36, P=0.030; OS: HR=7.16, 95%CI= 1.36-37.70, P=0.020) and APP overexpression (RFS: HR=6.10, 95%CI= 1.05-35.42, P=0.044) were the adverse factors for survival; Obtaining MMR after two courses of consolidation was the protective factor for RFS (HR=0.03, 95%CI= 0.00-0.28, P=0.002) and OS (HR=0.05, 95%CI= 0.01-0.51, P=0.011). We defined each risk factor with score one, and divided all patients into score 0-1, 2 and 3-4 groups, and found that the RFS and OS rate significantly decreased with the risk factors increasing (the 3-year RFS: 82.0%±9.0% vs. 26.0%±6.0% vs. 0, P<0.001; the 3-year OS: 96.0%±4.0% vs. 31.0%±7.0% vs. 0, P<0.001). Both of the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) value of the new multi-factor risk score system were the smallest, compared with those of the four single factors and the NCCN risk system, suggesting that this new system might have great priority in risk stratification. In conclusions, most patients with AE-AML underwent gene mutations at diagnosis and experienced genetic alteration at relapse. The new multi-factor score risk system combined with ASXL1 and MET mutation, APP overexpression and MMR at the second-course consolidation might have great priority in risk stratification. DisclosuresNo relevant conflicts of interest to declare.

Ultra-early serum concentrations of neuronal and astroglial biomarkers predict poor neurological outcome after out-of-hospital cardiac arrest—a pilot neuroprognostic study

ObjectivesTo assess ultra-early neuroprognostic significance of GFAP, NF-L, UCH-L1, tau, and S100B concentrations, change trajectory, and combination profile after Out-of-Hospital Cardiac Arrest (OHCA). MethodsProspective enrollment of 22 OHCA and 10 control patients at an academic tertiary care center between May 1, 2017 and January 28, 2020. Blood was collected within one hour of return of spontaneous circulation (ROSC) (H0), at hours 6 (H6), 12, 18, 24, and daily or until discharge or death. Biomarker concentrations, multifactor score, and trajectory change were assessed and compared to final neurologic status (good vs poor Cerebral Performance Category; CPC 1–2 vs CPC 3–5, respectively). Results10 patients had good and 12 had poor neurologic outcomes. Poor outcome patients had higher biomarker concentrations and combined biomarker scores at early time points. The earliest significant difference between good and poor outcome patients’ serum biomarkers were at H12 for GFAP (good median: 425 pg/mL [IQR:370−630] vs poor: 5954[1712–65,055] pg/mL; p < 0.001), H12 for NF-L (64[41–69] vs 898[348–1990] pg/mL; p < 0.001), H0 for Tau (31[8–51] vs 124[53–238] pg/mL; p = 0.025), H0 for UCH-L1 (898[375–1600] vs 2475[1898–4098] pg/mL; p = 0.008), and H6 for S100B (123[70–290] vs 895[360–1199] pg/mL; p = 0.002). Four biomarker composite scores differed by H12 (78.03[52.03–111.25] vs 749 [198.46–4870.63] pg/mL; p = 0.003). Machine-learning approach also identified that four-marker score trajectory group memberships are in concordance with patient outcome. ConclusionsUltra-early serial serum concentrations of neuronal and astroglial biomarkers may be of neuroprognostic significance following OHCA.

A new model based on gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts prognostic outcome after curative resection of solitary hepatocellular carcinoma

BackgroundThis study intends to explore the potential clinical value of gamma-glutamyl transpeptidase to platelet ratio (GPR) and the new multi-factor scoring model for recurrence and prognosis prediction in solitary HCC patients who received radical resection. MethodsThis study retrospectively analyzed 295 HCC patients after curative resection. According to the Receiver Operating Characteristic (ROC) curve, the optimal cut-off value of GPR for predicting prognosis of HCC after resection was determined. The Kaplan Meier method and Cox regression analysis were performed to assess the important potential factors in the prognosis of HCC and determine the independent risk factors. Assign a value to each independent risk factor and establish a new scoring model. Then, using GPR and the new scoring model to evaluate overall survival (OS) and postoperative recurrence probability. ResultsWhen GPR’s cut-off value was selected as 0.30, its predictive efficiency for postoperative prognosis was more favorable than those of other cut-off values (0.76, 0.84 and 0.94). GPR, tumor size, microvascular invasion and neutrophil to lymphocyte ratio (NLR) were identified as independent prognostic predictors. Using these variables, a novel prognostic scoring model was devised and established to identify different levels of risk: high, intermediate and low risk groups. We found that patients with high GPR level and of high risk group would have a poorer OS and a higher recurrence rate after radical resection. ConclusionsGPR may serve as a promising predictor for postoperative prognosis and recurrence probability of HCC, and the new prognostic scoring model may be available for postoperative management among HCC patients.

Evaluation of Ranson’s Score, Glasgow, Apache II, Apache O, Balthazar CTSI in Acute Pancreatitis Patients

Background: Pancreatitis is an inflammation of the glandular parenchyma leading to injury or destruction of acinar components. This study was conducted to evaluate Ranson’s score, Glasgow, APACHE II, APACHE O, Balthazar CTSI in acute pancreatitis patients. Subjects and Methods: This study was conducted at Department of surgical Gastroenterology, Global hospital Hyderabad to evaluate Ranson’s score, Glasgow, APACHE II, APACHE O, Balthazar CTSI in acute pancreatitis patients. Results: 34% of the patients in the study were aged 31-40 years and only 6% of the patients were aged &gt;60 years. The etiologic factors for acute pancreatitis in the study group included alcoholism (n= 27, 50.94%), Idiopathic (n=15, 28.30%), biliary pancreatitis (n= 10, 18.87%) and hypertriglyceridemia (n=1, 1.89%). A significant difference in all scoring systems was found between cases of mild and severe pancreatitis (P&lt; 0.05). Among the multifactor scoring systems, Ranson’s was found to be a better predictor than APACHE-II. There was not much difference between APACHE-O and APACHE-II. Overall, CTSI found to be the best predictor, followed by APACHE-II. Conclusion: The authors found that there was no significant difference among the multifactor scoring systems, although Glasgow and APACHE-II fare better.

Advances in research on anti-thyroid drugs for recurrence risk factors and predictive models of Graves′ disease

Graves′ disease, also known as diffuse toxic goiter, is an autoimmune disease with increased secretion of thyroid hormone. There are three effective treatments for Graves′ disease, which including anti-thyroid drugs (ATD), radioactive iodine and thyroidectomy. In general, ATD is the first choice of Graves′ disease treatment for domestic physicians, but the high recurrence rate has always been the deficiency of ATD treatment. Recurrence is mainly related to gender, age, smoking, course of disease, goiter and other factors. Among them, the reliability and applicability of single risk factor in evaluating the recurrence rate of Graves′ disease after ATD treatment are poor. The prediction model of multi-factor comprehensive score is helpful for the naive patients to choose the best treatment plan, to achieve the goal of precise treatment and to improve the remission rate of Graves′ disease drug treatment. In this paper, the reliability of risk factors for Graves′ disease recurrence after ATD treatment is evaluated, and the development and application of prediction models such as Graves′ recurrent events after therapy (GREAT) score, GREAT + score, and clinical severity score (CSS) are reviewed. Key words: Anti-thyroid drugs; Recurrence of Graves′ disease; Risk factor; Predictive model

Methodical approaches to the evaluation of the trading enterprise competitiveness

The article is devoted to the issues of ensuring the competitiveness of a trading enterprise through its quantitative assessment. Analytic and graphical methods of evaluation are conventionally identified. The methodical approaches to the evaluation of the competitiveness of the trading enterprise, including the Rosenberg Model, the assessment of the quality level of production, matrix methods, the evaluation of comparative advantages, the multifactor score, the model of competitiveness are described, their strengths and weaknesses are identified.

Expert-guided optimization for 3D printing of soft and liquid materials.

Additive manufacturing (AM) has rapidly emerged as a disruptive technology to build mechanical parts, enabling increased design complexity, low-cost customization and an ever-increasing range of materials. Yet these capabilities have also created an immense challenge in optimizing the large number of process parameters in order achieve a high-performance part. This is especially true for AM of soft, deformable materials and for liquid-like resins that require experimental printing methods. Here, we developed an expert-guided optimization (EGO) strategy to provide structure in exploring and improving the 3D printing of liquid polydimethylsiloxane (PDMS) elastomer resin. EGO uses three steps, starting first with expert screening to select the parameter space, factors, and factor levels. Second is a hill-climbing algorithm to search the parameter space defined by the expert for the best set of parameters. Third is expert decision making to try new factors or a new parameter space to improve on the best current solution. We applied the algorithm to two calibration objects, a hollow cylinder and a five-sided hollow cube that were evaluated based on a multi-factor scoring system. The optimum print settings were then used to print complex PDMS and epoxy 3D objects, including a twisted vase, water drop, toe, and ear, at a level of detail and fidelity previously not obtained.

Current European guidelines for management of cardiovascular disease: Is medical treatment in nearly half a population realistic?

Background Health checks of the general population are widely used to prevent cardiovascular diseases, but are the current clinical guidelines from the European Society of Cardiology (ESC) suitable for screening the general population? Design A cross-sectional, population-based study of 978 men and women aged 40-65 years examined in 2010-2011 was used to estimate the proportion of the general Danish population fulfilling the criteria from the clinical guidelines from the ESC on medical treatment and lifestyle intervention to prevent cardiovascular disease. Methods The ESC criteria for medical treatment and lifestyle intervention were applied to a general population using information on previous cardiovascular diseases, known diabetes, urinalbumin, smoking, total cholesterol, systolic and diabolic blood pressure, low-density lipoprotein cholesterol and a multifactor risk score (SCORE). Results A total of 12.5% fulfilled the criteria for immediate medical treatment to prevent cardiovascular diseases. Furthermore, 30.4% are recommended for medical treatment if an initial lifestyle intervention fails summing to 42.9% eligible for medical treatment. The majority (79%) of persons aged 60-65 years are eligible for medical treatment, while close to half (44.9%) of all persons aged 50-59 years are recommended for medical treatment. Conclusion If ESC's guidelines were followed in Denmark, a conservative estimate shows that medical preventive treatment would involve nearly half the general population aged 40-65 years. The use of these guidelines in screening of the general population can be questioned as realistic and suitable.

Comparison of multifactor scoring systems and single serum markers for the early prediction of the severity of acute pancreatitis.

The purpose of this study was to clarify whether the current scoring systems and single serum markers used in pancreatitis remain applicable for the early prediction of infected pancreatic necrosis (IPN) and the severity and mortality of acute pancreatitis (AP) in accordance with the revised Atlanta and determinant-based classifications. Demographic, clinical, and laboratory data from 708 consecutive patients with AP were prospectively collected between January 2011 and December 2012. The severity was classified using the revised Atlanta and determinant-based classification systems. The predictive accuracies for moderately severe AP (MSAP), severe AP (SAP), critically severe AP (CAP), IPN, and mortality were measured using area under the receiver operating characteristic curves. The receiver operating characteristic analysis showed that the multifactor scoring systems and single serum markers had a low predictive accuracy regarding moderately severe AP. The Acute Physiology and Chronic Health Evaluation (APACHE) II score had the highest accuracy in predicting SAP with area under the curve (AUC) values of 0.75 (95% CI=0.71-0.79) and 0.77 (95% CI=0.73-0.81) at 24 and 48h after admission, respectively. Procalcitonin was the most accurate predictor for CAP and IPN, with respective AUCs of 0.86 (95% CI=0.82-0.89) and 0.83 (95% CI=0.78-0.87) at 48h after admission. In predicting mortality, both the APACHE II score and blood urea nitrogen had the highest accuracy. The APACHE II score had the highest predictive accuracy for SAP and mortality as defined by the revised Atlanta classification, whereas procalcitonin was the most accurate predictor for CAP and IPN.

Evaluation of Glasgow Multifactor Prognostic Scoring System in Acute Pancreatitis - A Study of 25 Cases

Evaluation of Glasgow Multifactor Prognostic Scoring System in Acute Pancreatitis - A Study of 25 Cases

Can only histological evaluation determine the allocation of ECD kidneys?

IntroductionThere is a recent debate on the "transplantability" of ECD (Expanded Criteria Donors) kidneys and the selection criteria used to allocate them to single or double transplantation. Remuzzi et al. have defined a protocol incorporating pre-transplant donor biopsy to guide the use of older donor organs. They allocated organs as single or double transplants on the basis of histological findings. We aim to show the pros and cons of the only histological evaluation in the allocation of ECD kidneys, to compare the different experiences in United States and Europe and thus to discuss whether this tool should be used alone or included in a comprehensive clinical and histopathological evaluation.DiscussionIn the United States many Authors stated that the biopsy actually increases the percentage of kidney discarded and they raised questions about the importance of the biopsy in evaluating ECD kidneys for transplantation. On the other hand, the experiences of the majority of european transplant centers showed that allocating kidneys as single or dual transplant based on biopsy findings may achieve good graft and patient outcomes.Moreover, the experience of some centers as ours showed that kidneys allocated as DKT (Dual Kidney Transplant) on the basis of Remuzzi’s score could have been suitable for single transplantation suggesting the need of an adjustment of the Remuzzi Score System. Many Authors, who are in favor of histological evaluation, actually believe that a comprehensive clinical and histopathological assessment before transplantation remains necessary.SummaryWe lack precise national- or international-based selection criteria to guide clinicians. An adjustment of the Remuzzi Score System could be taken into consideration such as narrowing the indication for DKT from those ECD kidneys with higher scores and including the histological evaluation in a multifactor score.

BISAP-eGFR could improve prediction of severity and mortality in acute pancreatitis. eGFR ? play the trump card.

Introduction: Early prediction of severity of acute pancreatitis (AP) by a simple system which includes clinical features would be very helpful as it may direct management and improve outcome. Certain components of different scores reflecting severe intravascular volume depletion can play an important role in accuracy of the method (but sensitivity and specificity of these scores are not at the desired level yet). Low eGFR (estimated glomerular filtration rate) is already known to be unfavorable prognostic parameter in AP, however it was never assessed as an element of multifactor score. Aim: The aim of this study is to determine whether replacing urea nitrogen (BUN) in bedside index of severity in acute pancreatitis (BISAP) score by eGFR (BISAP-eGFR score) improves prediction of severity and mortality in patients with AP. Methods: Cohort of 100 patients with AP were prospectively enrolled in the study. The BISAP and eGFR (abbreviated Modification of Diet in Renal Disease equation) were calculated using data from the first 24 h from admission. Severe AP was defined as the persistence of organ failure exceeding 48 hours. The predictive accuracy of the BISAP and BISAP-eGFR score was measured as the area under the receiver operating characteristic curve (AUC). Results: We evaluated a total of 100 consecutive patients with AP. Twenty of the 100 patients (20%) were considered severe AP. The best cutoff value of eGFR was 80 ml/min/1,73 m2. All 20 patients with severe pancreatitis had eGFR 25 mg/dL (BISAP score cut-off for BUN). Overall, 16% of the 100 evaluated patients had a BISAP score ≥3 while BISAP-eGFR score ≥ 3 was reported for 23% patients. A BISAP score ≥ 3 had a sensitivity, specificity, positive and negative predictive value of 65%, 96.1%, 81.2% and 91.3% respectively, with an accuracy of 87% comparing to 95.2%, 96.2%, 86.9% and 98.7% respectively for BISAP-eGFR score with an accuracy of 96%. The AUC for severity predicted by BISAP was 0.762 and by BISAP-eGFR score was 0.942. There were statistically significant trends for increasing severity (P<0.001) and mortality (P<0.001) with increasing BISAPeGFR score. Ten out of ten (100%) patients with fatal AP had BISAP-eGFR ≥3, 6 of them (60%) reported BISAP≥3. Conclusion: BISAP-eGFR score is a simple method to identify patients at risk of increased mortality and allows predicting the severity of the AP. eGFR replacing BUN in BISAP score provides higher sensitivity, specificity and diagnostic accuracy comparing to traditional BISAP score. In addition, eGFR component may be helpful in planning fluid therapy, particularly in the acute phase of the AP. This finding may have important clinical implications, however further studies are required to validate the BISAPeGFR score in predicting severity and mortality in AP.

Mo1327 Early Oral Feeding and Selection of Initial Diet in Mild Acute Pancreatitis

Introduction: Early prediction of severity of acute pancreatitis (AP) by a simple system which includes clinical features would be very helpful as it may direct management and improve outcome. Certain components of different scores reflecting severe intravascular volume depletion can play an important role in accuracy of the method (but sensitivity and specificity of these scores are not at the desired level yet). Low eGFR (estimated glomerular filtration rate) is already known to be unfavorable prognostic parameter in AP, however it was never assessed as an element of multifactor score. Aim: The aim of this study is to determine whether replacing urea nitrogen (BUN) in bedside index of severity in acute pancreatitis (BISAP) score by eGFR (BISAP-eGFR score) improves prediction of severity and mortality in patients with AP. Methods: Cohort of 100 patients with AP were prospectively enrolled in the study. The BISAP and eGFR (abbreviated Modification of Diet in Renal Disease equation) were calculated using data from the first 24 h from admission. Severe AP was defined as the persistence of organ failure exceeding 48 hours. The predictive accuracy of the BISAP and BISAP-eGFR score was measured as the area under the receiver operating characteristic curve (AUC). Results: We evaluated a total of 100 consecutive patients with AP. Twenty of the 100 patients (20%) were considered severe AP. The best cutoff value of eGFR was 80 ml/min/1,73 m2. All 20 patients with severe pancreatitis had eGFR 25 mg/dL (BISAP score cut-off for BUN). Overall, 16% of the 100 evaluated patients had a BISAP score ≥3 while BISAP-eGFR score ≥ 3 was reported for 23% patients. A BISAP score ≥ 3 had a sensitivity, specificity, positive and negative predictive value of 65%, 96.1%, 81.2% and 91.3% respectively, with an accuracy of 87% comparing to 95.2%, 96.2%, 86.9% and 98.7% respectively for BISAP-eGFR score with an accuracy of 96%. The AUC for severity predicted by BISAP was 0.762 and by BISAP-eGFR score was 0.942. There were statistically significant trends for increasing severity (P<0.001) and mortality (P<0.001) with increasing BISAPeGFR score. Ten out of ten (100%) patients with fatal AP had BISAP-eGFR ≥3, 6 of them (60%) reported BISAP≥3. Conclusion: BISAP-eGFR score is a simple method to identify patients at risk of increased mortality and allows predicting the severity of the AP. eGFR replacing BUN in BISAP score provides higher sensitivity, specificity and diagnostic accuracy comparing to traditional BISAP score. In addition, eGFR component may be helpful in planning fluid therapy, particularly in the acute phase of the AP. This finding may have important clinical implications, however further studies are required to validate the BISAPeGFR score in predicting severity and mortality in AP.

Style Investing: Benchmarks and Strategies

Capitalizing on the results in Shapovalova et al. (2011a} and Shapovalova et al. (2011b} on the properties of the stock returns premia, this paper focuses on the practical issues of equity style investment. Company fundamentals are often used to define the so-called style scores, from which the compositions of the style indices are defined. Style indices are used as benchmarks for dynamic style investment strategies. The value and growth indices, published by the leading providers, are based on the scores computed from multiple characteristics. Using a panel data model, we assess the quality of the multi-factor score definitions and find that aggregation of the company fundamentals often leads to significant losses of information, compared to the situation when style characteristics are analyzed separately. Generally, such aggregation is not justified by the empirical properties of the data, since characteristics' impacts on returns are highly heterogeneous in magnitude and direction. We propose a synthetic multi-factor style score, based on our model, and evaluate a corresponding long-short dynamic investment strategy. We then improve it by integrating the information about the size of the style premia contained in the past shocks to macroeconomic indicators.

Significance of Renal Rim Grade on Computed Tomography in Severity Evaluation of Acute Pancreatitis

Multifactor scoring systems, such as the Acute Physiology and Chronic Health Evaluation (APACHE) II, are useful for predicting the severity of acute pancreatitis (AP); however, they are rather complicated. The aim of this study was to introduce renal rim grade (RRG) as a severity assessment measure for AP. One hundred twenty-two eligible AP patients who underwent abdominal computed tomography (CT) on admission were evaluated for RRG (grades 1-3). The end points were the severity of illness and hospital mortality. Furthermore, RRG was compared with the Balthazar score, the CT severity index, the Ranson score, and the Acute Physiology and Chronic Health Evaluation (APACHE) II score, using a receiver operating characteristic analysis. The exacerbation rates into severe disease were 3% (grade 1), 48% (grade 2), and 89% (grade 3). The mortality rates were 3% (grade 1), 8% (grade 2), and 31% (grade 3). The area under the receiver operating characteristic curves to predict the severe disease and mortality using the RRG system were comparable with other scoring systems. Renal rim grade is useful for the evaluation of the severity of AP.

A preliminary design of a radon potential map for Canada: a multi-tier approach

Canada is a vast country with most of the population living on a small portion of the land. However, for a national radon potential map, it is mandatory to cover the entire country including sparsely populated areas. Because of these characteristics, the radon map development for Canada is challenging. After briefly reviewing of radon map development in the world, this study considers a multi-tier approach to best use available however limited resources and to generate a national radon map in a timely fashion. In summary, radon potential maps for highly populated areas should be determined by direct indoor radon measurements where enough indoor radon data are available. In areas where indoor radon measurements are limited or not yet available, the radon potential maps could be developed from various data sources with a multi-factor scoring system including geological information on soil permeability, soil gas radon concentration and ground uranium concentration. In sparsely populated areas, radon potential maps can only be generated with geological predictive tools, especially in those areas where no houses have yet been built. Because indoor radon measurement data and geological information relevant to radon are very limited in Canada, a multi-step strategy is also worth considering in addition to the multi-tier approach.

Consensus of primary care in acute pancreatitis in Japan

The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis. The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital. Monitoring of blood pressure, pulse and respiratory rate, body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as the diagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases.

Prospective study of 424 cases of Staphylococcus aureus bacteraemia: determination of factors affecting incidence and mortality

Staphylococcus aureus bacteraemia (SAB) is a common complication of S. aureus infection and is associated with a high mortality. To document prospectively the pattern of illness associated with SAB in New Zealand and, by recording patient demographic factors and clinical features, to identify risk factors associated with a poor outcome. From 1 July 1996 to 31 December 1997, adults with SAB were prospectively studied in six tertiary care hospitals. All information obtained from patients' records was recorded on worksheets and transferred to a computerized spreadsheet for analysis. There were 424 patients with SAB. Maori (relative risk (RR)= 1.8, 95% confidence interval (CI) = 1.3-2.6) and Pacific Island people (RR = 4.0, 95% CI = 3.1-5.3) were significantly more likely than people of European descent to acquire SAB, but not to die from the infection. Fifty per cent of cases were community acquired. A source was identified for 85%: intravenous catheter (31%), primarily hospital acquired, and skin/soft tissue (22%), primarily community acquired, were the most common foci. The 30-day mortality was 19%, 83% of whom died within 2 weeks. Risk factors for a poor outcome were: increasing age above 60, female sex (RR = 1.4, 95% CI = 1.0-2.1), diabetes mellitus (RR = 1.5, 95% CI = 1.0-2.4), immunosuppression (RR = 1.5, 95% CI = 1.0-2.4), pre-existing renal impairment (RR = 1.8, 95% CI = 1.2-2.7), malignancy (RR= 2.2, 95% CI = 1.4-3.5), lung as a source (RR = 2.8, 95% CI = 1.9-4.2) and unknown source (RR = 2.3, 95% CI = 1.5-3.3). Mortality was also accurately predicted by two multifactor scoring systems. There was a low rate of methicillin resistance (5%). Staphylococcus aureus bacteraemia is more likely to occur in certain ethnic groups, while mortality is associated with other identifiable risk factors and continues to be high. Intravenous catheters remain the most common and most preventable cause of SAB.