Prognostic Reliability Research Articles

Методика прогнозирования повторных общественно опасных действий у лиц с органическими психическими расстройствами

Study Objective: To describe a new method for predicting repeat socially dan-gerous acts (SDA) by persons with organic mental disorders. Study Design: This was a comparative study. Materials and Methods: The people studied were 118 male patients with organic mental disorders who had committed SDA and were subject to involuntary medical measures, administered in outpatient or inpatient settings. These patients were divided into a main group, which was made up of 45 men who had commit-ted repeat SDA, and a comparison group, which consisted of 73 men with no history of recidivist criminal behavior in the follow-up period. The main research methods included clinical psychopathological assessments, prospective clinical follow-up (mean duration of follow-up was 8.65 ± 2.17 years), statistical analysis of clinical data, and criminological analysis. Study Results: Mathematical analysis and identification of the main correlation relationships made it possible to develop a questionnaire and a computer program for predicting the possibility of committing a repeat SDA. There are 24 input parameters. This method predicts repeat SDA in 82.9% of cases. For a sample of at least 80 people, the average predictive reliability of this method exceeds 80%, with a minimum reliability no lower than 70% in the event of random fluctuations. The study also showed that even with only one input parameter the method provides a reliable prognosis in almost 70% of cases, and beginning at 23 input parameters its prognostic reliability exceeds 80% and increases with in-crease of the number of input characteristics. Conclusion: The authors have developed a tool for predicting a repeat SDA, and its characteristics, using the pattern proximity method. This tool can be used for patients with any type of disorder. Further multifactorial evaluation of the causes of both initial and repeat SDA in patients with mental disorders provides information for assessing the possibility of predicting such actions. This study gives us a practical data-assessment tool, which can be widely used at any stage of preventive measures against socially dangerous behavior by patients with mental disorders. Keywords: socially dangerous act, organic mental disorders, prognostic methodology.

Pre- and post-surgical evaluation of plasma lactate concentration in 45 dogs with gastric dilatation-volvulus: A preliminary study

This preliminary study was designed to contribute to the evaluation of reliability of plasma lactate concentration (PLC) and its clearance as predictive and prognostic factors of gastric necrosis and clinical outcome of dogs affected by gastric dilatation-volvulus (GDV). Main aims of the study were: 1) to evaluate the prognostic reliability of PLC at presentation (T0) in dogs with GDV, 2) to compare the obtained data and considerations with the veterinary literature, and 3) to introduce the possible validity of PLC values at 24 (T24) and 48 (T48) hours after surgery as a predictive factor.Dogs with GDV were retrospectively evaluated. PLC at T0, T24 and T48 were recorded and correlated to the presence or absence of macroscopic necrosis of the stomach and to outcome.Forty-five dogs met the inclusion criteria. Significant differences were not detected in the mean values between the initial PLC in dogs with and without necrosis of the gastric wall, as well as between surviving and non-surviving dogs; these values were not associated with higher risk of gastric necrosis or death.At T24 and T48 no significant differences were recorded between necrosis and non-necrosis, and surviving and non-surviving categories.A median plasma lactate concentration clearance from arrival to T24 ≥ 50% was identified in both groups (with and without necrosis), and this parameter failed in identifying dogs that survived to discharge.In conclusion, the results presented here failed to detect PLC at T0 and its clearance at T24 as prognostic factors in this population of dogs with GDV.

Development and psychometric verification of body existence diagnostics (BED)

Existential givenness is the main categories with which work takes place in existential analysis for the actualization of client being. Despite this, they have little operationalization and are poorly accessible to quantitative measurement methods. They are often investigated only through phenomenological means, which limits the possibilities of working with them. Especially it concerns the measurement of physicality, which has recently been discarded in favor of ontocentric spheres. Because of this, it is not always possible to understand the phenomenology of the inner world fairly accurately and in an accessible way, because the main existential, expressed in the possibility of being physically in this world, is not taken into account. It is also impossible to standardize the method of work and explore its effectiveness of psychotherapy without special tools. On the basis of this, the diagnosis of existential corporeality was developed. It investigated as a multidimensional phenomenon of the client's experience of its physical manifestation in the world. Specific methodological foundations were identified for creating diagnostics. The structure of the methodology and stimulus material was developed, which for the most part confirmed in factor analysis, only the Umwelt sphere - the objective world does not fully correspond to the expected characteristics. Convergent validity was established, which confirmed the subject of this tool, and also revealed the structure of bodily existential, which affects all other ontological characteristics. It confirms the hypothesis of necessary physicality basis for being. All major psychometric parameters were established, DET has high rates of convergent, prognostic and structural validity and reliability. This diagnosis can be used in practical work of a psychologist in the role of screening diagnosis, or the same as the reference stimulus material to be discussed at the session and allowing client to directly face the existential sphere of being.

Geographic information systems visualization of wind farm operational data to inform maintenance and planning discussions

As utility scale wind farms age, maintenance and contingency planning become increasingly important. Decisions about when and how to repair or replace major turbine components can critically influence profitability. Condition monitoring and prognostic reliability modelling are sometimes used to support these decision-making processes. These often resource intensive, sophisticated techniques are frequently administered by third parties and can be black boxes to wind farm stakeholders. Early experience from the YR21 Investment Decision Support Program has highlighted the importance of broad engagement across wind farm teams in maintenance and planning discussions. The utilization of geographic information systems to illustrate data trends across wind farms proved to be a valuable tool in fostering fundamental understanding of an operation’s signature performance characteristics. This graphical representation of the farm provides a useful visualization of the operation’s best and worst performers in terms of power produced, wind speeds experienced, total revolutions, or highest gear box temperature. These transparent representations of the data represent valuable starting points for discussion of performance or potential maintenance issues across farms. In some cases, it can reveal unexpected trends that may raise bigger questions about how the farm is operating in general. Finally, these simple figures can serve as complementary inputs to larger, more complex data-driven decision systems. Geographic information system plots are presented for three wind farms to demonstrate the potential utility in simple, transparent, and accessible data visualization.

Staging of liver fibrosis in biliary atresia : Comparison of Chevallier and Ishak score as well as automated evaluation

Biliary atresia (BA) is arare disease of the newborn, resulting in liver cirrhosis due to obliterative cholangiopathy. Liver biopsies are commonly performed in order to confirm the diagnosis and in order to stage fibrosis. The present study intended to analyze two established scores for evaluating liver fibrosis focusing on the interobserver variability as well as the prognostic reliability towards the time of liver transplantation. Liver biopsies of BA patients between 2012 and 2015 were evaluated retrospectively by two pathologists at the Hannover Medical School (MHH) and the RWTH Aachen University Hospital. Fibrosis was measured using Ishak and Chevallier scores. Furthermore, acomputerized automatically algorithm-based analyzation (ABAA) was performed. Results were evaluated towards the time point of liver transplantation and hepatoportoenterostomy (HPE). Overall, 34liver biopsies were analyzed. The Ishak score showed aremarkable interobserver variability (ΚW = 0.68) while the Chevallier score was proven to have apoor interobserver variability (Fleiss' Κappa = -0.01). However, both scores were correlated positively, as was the ABAA (p < 0.001). Regarding prognostic reliability, ROC analyses of the Ishak score revealed the best validity towards an early liver transplantation within 12months (AUC 0.813, p = 0.011). In addition, an increased Ishak score ≥4 reduced the survival time with the native liver (hazard ratio6.6 [95% CI1.9-23.3]). The Ishak score was revealed to have the best interobserver variability as well as prognostic validity towards an early liver transplantation in BA patients. Due to its easy applicability, the Ishak score was proven superior in comparison to the Chevallier score and ABAA. Therefore, use of the Ishak score is recommended in daily clinical routine for analyzing liver biopsies in BA patients.

Ampulla of Vater carcinoma: Molecular landscape and clinical implications.

Ampulla of Vater is a peculiar anatomical structure, characterized by the crossroad of three distinct epithelia: Intestinal, ductal pancreatic and biliary. Adenocarcinomas arising in this area represent an opportunity to understand the comparative biology of all periampullary malignancies. These neoplasms can exhibit intestinal, pancreaticobiliary or mixed features, whereas the subclassification based on morphology and immunohistochemical features failed in demonstrating a robust prognostic reliability. In the last few years, the molecular landscape of this tumor entity has been uncovered, identifying alterations that may serve as prognostic and predictive biomarkers. In this review, the histological and genetic characteristics of ampullary carcinomas are discussed, taking into account the main clinical and therapeutic implications related to this tumor type as well.

ASO Author Reflections: Incorporating Lymphovascular Invasion to Improve the Prognostic Reliability of the T-Staging System for Adrenocortical Carcinoma-A Multicenter Study.

ASO Author Reflections: Incorporating Lymphovascular Invasion to Improve the Prognostic Reliability of the T-Staging System for Adrenocortical Carcinoma-A Multicenter Study.

Assessment of a statistical AIF extraction method for dynamic PET studies with 15O water and 18F fluorodeoxyglucose in locally advanced breast cancer patients.

.Blood flow-metabolism mismatch from dynamic positron emission tomography (PET) studies with -labeled water () and -labeled fluorodeoxyglucose (FDG) has been shown to be a promising diagnostic for locally advanced breast cancer (LABCa) patients. The mismatch measurement involves kinetic analysis with the arterial blood time course (AIF) as an input function. We evaluate the use of a statistical method for AIF extraction (SAIF) in these studies. Fifty three LABCa patients had dynamic PET studies with and FDG. For each PET study, two AIFs were recovered, an SAIF extraction and also a manual extraction based on a region of interest placed over the left ventricle (LV-ROI). Blood flow-metabolism mismatch was obtained with each AIF, and kinetic and prognostic reliability comparisons were made. Strong correlations were found between kinetic assessments produced by both AIFs. SAIF AIFs retained the full prognostic value, for pathologic response and overall survival, of LV-ROI AIFs.

Neuron-specific enolase and S-100b in prolonged targeted temperature management after cardiac arrest: A randomised study

BackgroundWe aimed to investigate the impact of prolonged targeted temperature management (TTM) in cardiac arrest patients on release of serum levels of NSE and S-100b and their prognostic performances. MethodsThis is a substudy of the Targeted Temperature Management for 24 vs 48h trial. NSE and S-100b levels were analysed retrospectively in serum samples collected upon admission, at 24, 48, and 72h after reaching the target temperature of 33±1°C. The primary outcome was biomarker serum concentrations and secondary outcome was the cerebral performance category score after 6 months. Results115 patients from two centres were analysed. NSE and S-100b levels did not differ between TTM groups at any single time-point. Poor outcome patients had higher biomarker levels at 24, 48, and 72h: NSE: 9.73 (7.2; 10.9) versus 20.40 (12.7; 27.2), 8.86 (6.6; 9.6) versus 17.47 (11.1; 37.3) and 6.23 (5.3; 8.5) versus 31.05 (12.8; 52.5) respectively and S-100b: 0.09 (0.07; 0.11) versus 0.23 (0.19; 0.39), 0.08 (0.07; 0.09) versus 0.18 (0.15; 0.33) and 0.07 (0.06; 0.08) versus 0.13 (0.09; 0.23). The daily changes in NSE from admission to Day 2 after the cardiac arrest (CA) were also related to the outcome (p=0.003 and p=0.02). The best prediction of outcome was found at 72h for NSE and at 24h as well as 48h for S100b. ConclusionsNo clinically relevant differences were found in the levels of NSE or S-100b between standard and prolonged TTM. Prognostic reliability of NSE and S-100b was unaltered by prolonged TTM.

Bilateral loss of cortical SEPs predict severe MRI lesions in neonatal hypoxic ischemic encephalopathy treated with hypothermia

ObjectiveThe introduction of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy calls for reevaluation of the prognostic role of somatosensory evoked potentials (SEPs). MethodsAmong 80 consecutive neonates undergoing hypothermia for hypoxic-ischemic encephalopathy, 58 performed SEPs and MRI at 4–14 days of life and were recruited in this multicenter study. SEPs were scored as: 0 (bilaterally/unilaterally recorded N20) or 1 (bilaterally absent N20). The severity of brain injury was scored using MRI. ResultsBilaterally absent N20 was observed in 10/58 neonates (17%); all had moderate/severe MRI abnormalities; 36/48 neonates (75%) with score 0 at SEPs had normal MRI. The positive predictive value of SEPs on MRI outcome was of 1.00, while the negative predictive value 0.72, sensitivity 0.48, specificity 1.00, with an accuracy of 0.78 (p < .001). ConclusionsBilateral absence of cortical SEPs predicts moderate/severe MRI pattern of injury. SignificanceTherapeutic hypothermia does not seem to significantly affect prognostic reliability of SEPs.

Prognostic and discriminative power of the 7th TNM classification for patients with surgically treated papillary renal cell carcinoma: results of a multi-institutional validation study (CORONA subtype project)

Objective: Studies on the prognostic reliability of the Union for International Cancer Control tumor, node, metastasis (TNM) staging system for renal cell carcinoma (RCC) predominantly focus on clear-cell RCC. Therefore, the aim of this study was to investigate whether the oncological prognosis of surgically treated papillary RCC (papRCC) patients is reliably given by the current TNM system, by analyzing the largest database reported to date.Materials and methods: Data on 2325 papRCC patients who underwent surgical treatment in 1984– 2015 were collated from 17 international centers (median follow-up 47 months). Tumor stage was adapted to the 7th edition of the TNM system. Multivariable, bootstrap-corrected Cox regression models were applied to assess the independent impact of the TNM system on cancer-specific mortality (CSM) and all-cause mortality (ACM).Results: The median age at diagnosis was 63 years (interquartile range 54–70 years) and 77% of patients were male. Nephron-sparing surgery was performed in 42%, and 82% were with symptom free at diagnosis. In 6.7% (n = 156), organ metastasis (stage M1) was present at the time of surgery. On multivariable analysis, the TNM system and Fuhrman grade had an independent impact on both CSM and ACM, while patient age affected ACM only. The discriminative ability of the pT classification was significant for both endpoints: 5 year CSM rates were 5%, 17%, 36% and 56% for stages pT1, pT2, pT3 and pT4, respectively (each p < 0.001). The pT classification contributed significantly to the predictive accuracy of the CSM and ACM models by 6.3% and 2.5%, respectively (each p < 0.001).Conclusions: The 2010 TNM staging system can be reliably applied to papRCC patients and allows certain prognostic discrimination.

Comparison of different statistical approaches for urinary peptide biomarker detection in the context of coronary artery disease.

BackgroundWhen combined with a clinical outcome variable, the size, complexity and nature of mass-spectrometry proteomics data impose great statistical challenges in the discovery of potential disease-associated biomarkers. The purpose of this study was thus to evaluate the effectiveness of different statistical methods applied for urinary proteomic biomarker discovery and different methods of classifier modelling in respect of the diagnosis of coronary artery disease in 197 study subjects and the prognostication of acute coronary syndromes in 368 study subjects.ResultsComputing the discovery sub-cohorts comprising {scriptscriptstyle raisebox{1ex}{2}!left/ !raisebox{-1ex}{3}right.} of the study subjects based on the Wilcoxon rank sum test, t-score, cat-score, binary discriminant analysis and random forests provided largely different numbers (ranging from 2 to 398) of potential peptide biomarkers. Moreover, these biomarker patterns showed very little overlap limited to fragments of type I and III collagens as the common denominator. However, these differences in biomarker patterns did mostly not translate into significant differently performing diagnostic or prognostic classifiers modelled by support vector machine, diagonal discriminant analysis, linear discriminant analysis, binary discriminant analysis and random forest. This was even true when different biomarker patterns were combined into master-patterns.ConclusionIn conclusion, our study revealed a very considerable dependence of peptide biomarker discovery on statistical computing of urinary peptide profiles while the observed diagnostic and/or prognostic reliability of classifiers was widely independent of the modelling approach. This may however be due to the limited statistical power in classifier testing. Nonetheless, our study showed that urinary proteome analysis has the potential to provide valuable biomarkers for coronary artery disease mirroring especially alterations in the extracellular matrix. It further showed that for a comprehensive discovery of biomarkers and thus of pathological information, the results of different statistical methods may best be combined into a master pattern that then can be used for classifier modelling.Electronic supplementary materialThe online version of this article (doi:10.1186/s12859-016-1390-1) contains supplementary material, which is available to authorized users.

The prognostic reliability of intracranial pressure monitoring and MRI data in severe traumatic brain injury

ObjectiveThe predictive quality of intracranial pressure (ICP) monitoring has for many years been a matter of debate. We correlate ICP data comparing MRI data with the outcome after severe traumatic brain injury to evaluate their prognostic potency. MethodsThis study compares the results of ICP monitoring, MRI, coma duration and outcome according to Glasgow Outcome Scale obtained in 32 patients having suffered severe TBI. Level of significance was set to p≤0.05 in statistical tests. ResultsThe MRI results were closely correlated with coma duration and Glasgow Outcome Scale, but the ICP measurements were not. With the exception of severe, bipontine lesions, there is no other region of the brain in which increased evidence of traumatogenic lesions emerges as the intracranial pressure rises. Just bipontine lesions that proof to be infaust correlate with elevated ICP values. ConclusionICP monitoring does not allow individual prognostic conclusions to be made. Implantation of an intracranial pressure sensor alone for making a prognostic estimate is not advisable. The use of intracranial pressure measurements in the retrospective appraisal of disease progress is highly problematic. However, MRI diagnostic in patients with severe TBI improves prognostic potency of clinical parameters.

Initial Severity Scoring and Residual Deficit in Scuba Divers with Inner Ear Decompression Sickness.

Inner ear decompression sickness (IEDCS) in scuba diving results in residual vestibulocochlear deficits with a potential impact on health-related quality of life. The aim of this study was to determine the predictive factors for poor clinical recovery and to try to establish a prognostic score on initial physical examination. The medical records of injured divers with IEDCS treated in our facility between 2009 and 2014 were retrospectively analyzed. The clinical severity of the deficit was evaluated on admission using a numerical scoring system taking into account the intensity of vestibular symptoms and the presence of cochlear signs. The clinical outcome was assessed at 3 mo by telephone interview. After multivariate analysis of potential risk factors for sequelae, the discriminating value of the score and these prognostic reliability indices were calculated. Among the 99 patients included in the study, 24% still had residual symptoms. Statistical analysis revealed that only a high clinical score [OR = 1.39 (95% CI 1.13-1.71)] and a delay in hyperbaric recompression >6 h [OR = 1.001 (95% CI 1-1.003)] were independently associated with incomplete recovery. The advantage of the score lay in its highly specific nature (92%) rather than its sensitivity (48%) for a threshold of 10. Results suggest that the severity of IEDCS can be easily determined by a clinical score during the acute phase. Recompression treatment should not be delayed. Gempp E, Louge P, de Maistre S, Morvan J-B, Vallée N, Blatteau J-E. Initial severity scoring and residual deficit in scuba divers with inner ear decompression sickness. Aerosp Med Hum Perform. 2016; 87(8):735-739.

Prognostic Reliability Prediction for Repairable System Based on Non- Parametric Model

Prognostic Reliability Prediction for Repairable System Based on Non- Parametric Model

PD41-02 A NEW PROPOSAL FOR T1, HIGH GRADE (HG) BLADDER CANCER (BCA) MICRO-STAGING DEFINITION

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 2015PD41-02 A NEW PROPOSAL FOR T1, HIGH GRADE (HG) BLADDER CANCER (BCA) MICRO-STAGING DEFINITION Rodolfo Fausto Hurle, Carlo Patriarca, Luisa Pasini, Pier Giuseppe Colombo, Giario Natale Conti, Massimo Freschi, Fabio Capogrosso, Marco Moschini, Lucia Ferrari, Massimo Maffezzini, Maurizio Colecchia, Tiziana Magnani, Andrea Conti, and Renzo Colombo Rodolfo Fausto HurleRodolfo Fausto Hurle More articles by this author , Carlo PatriarcaCarlo Patriarca More articles by this author , Luisa PasiniLuisa Pasini More articles by this author , Pier Giuseppe ColomboPier Giuseppe Colombo More articles by this author , Giario Natale ContiGiario Natale Conti More articles by this author , Massimo FreschiMassimo Freschi More articles by this author , Fabio CapogrossoFabio Capogrosso More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Lucia FerrariLucia Ferrari More articles by this author , Massimo MaffezziniMassimo Maffezzini More articles by this author , Maurizio ColecchiaMaurizio Colecchia More articles by this author , Tiziana MagnaniTiziana Magnani More articles by this author , Andrea ContiAndrea Conti More articles by this author , and Renzo ColomboRenzo Colombo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2410AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Histological T1 sub-staging has been advocated as a potential prognostic factor. However, the absence of a standardized method, the inter-observers variability and the absence of a clear clinical validation prevent the spreading of T1 sub-staging in routine practice. This study was aimed to assess both feasibility and prognostic reliability of a new procedure (ROL) for the assessment of the T1 sub-staging in comparison to the other well known sub-staging methods METHODS The ROL sub-staging was defined as ROL 1: < 1 PF (20x) corresponding to 1mm of lamina propria thickness invasion and as ROL 2: > 1 PF (20x) or multifocality sizing more than 1mm of lamina propria invasion. Multiple slides of a series of consecutive patients with T1HG (2004-WHO classification) BCa at initial TUR were revised by uro-pathologists of four different centers. Both feasibility and prognostic reliability of ROL method were compared to those of T1a/T1b,c subdivision (above or under the muscolaris mucosae) and T1m/T1e subdivision (< 1 HPF 40x vs > 1 HPF 40x or multifocality), according to Angulo and to van Rhijn methods, respectively. Progression free survival (PFS) and recurrence-free survival (RFS) were analyzed by KM estimation. Univariable Cox regression analyses were used to test the risk factors associated with a detrimental effect on survival RESULTS Out of a total of 318 patients, 250 patients who received a second-TURB were confirmed as T1HG and entered the study. Mean age was 71 years and 40 patients were female. At a mean follow up of 45 months, 116 patients (36.5%) have a recurrence, 36 (11.3%) have a progression and 52 underwent radical cystectomy. The ROL methods was feasible in 99.7% of cases compared to 72.3% for Angulo and 99.7% for van Rhijn, respectively. RFS was 74% and 26% for T1a and T1b/c, 41% and 59 for T1m and T1e and 53.4% and 46.6% for ROL 1 and ROL 2 method, respectively (all p>0.2). PFS survival at 3 year follow-up was 94% and 76% for T1a and T1b,c (p=0.04), 91% and 92% for T1m and T1e (p=0.2), and 95% and 90% for ROL 1 and ROL 2 (p=0.04), respectively CONCLUSIONS According to the results of this retrospective study, the new threshold of sub-staging (ROL 1/2) of pT1HG was documented to be feasible in all cases, easy to report and reproducible due to its objective standardized definition. In addition, the ROL sub-staging resulted as a reliable predictor of oncologic outcomes also when compared to other sub-staging systems. These results may have a great impact in clinical practice and deserve to be confirmed in prospective multicentric investigations © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e840 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rodolfo Fausto Hurle More articles by this author Carlo Patriarca More articles by this author Luisa Pasini More articles by this author Pier Giuseppe Colombo More articles by this author Giario Natale Conti More articles by this author Massimo Freschi More articles by this author Fabio Capogrosso More articles by this author Marco Moschini More articles by this author Lucia Ferrari More articles by this author Massimo Maffezzini More articles by this author Maurizio Colecchia More articles by this author Tiziana Magnani More articles by this author Andrea Conti More articles by this author Renzo Colombo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Validation and Modification of the Japanese Classification System for Liver Metastases from Colorectal Cancer: A Multi-institutional Study.

A Japanese multicenter study disclosed four prognostic indicators of colorectal cancer liver metastases: ≥5 hepatic tumors (HT), HT size > 5 cm, nodal status (N2) of primary cancer, and the presence of extrahepatic metastases (EM). The Japanese classification was then defined as Stage A, HT1 (≤4 lesions and ≤5 cm) and N0/1; Stage B, HT2 (≥5 lesions or >5 cm) and N0/1, or HT1 and N2; and Stage C, HT2 and N2, HT3 (≥5 lesions and >5 cm) with any N, or EM1 (presence of EM) with any HT/N. This study aimed to validate the prognostic reliability in a recent population and to develop a modified staging system that divided Stage C patients. A total of 1185 patients diagnosed with liver metastases between 2007 and 2008 were enrolled in the study. According to the classification, 358, 257, and 570 patients were categorized as Stages A, B, and C, respectively. Stage C was further divided into two groups: Stage C-I, HT3 and N0/1, HT2 and N2, or HT1 and EM1; and Stage C-II, HT3 and N2, or HT2/3 and EM1. Cumulative overall survival curves for Stages A, B, and C were significantly different between each two stages (p < 0.0001, p < 0.0001). The modified system discriminated patients with a relatively better outcome (Stage C-I) from desperate patients (Stage C-II) (p < 0.0001). The Japanese classification system was adequately validated in a recent population, and the modified system is useful in risk stratification of Stage C cases.

Oncological predictive value of the 2004 World Health Organisation grading classification in primary T1 non‐muscle‐invasive bladder cancer. A step forward or back?

To compare the clinical reliability of the 1973 and 2004 World Health Organisation (WHO) classification systems in pT1 bladder cancer. We retrospectively evaluated 291 consecutive patients who had pT1 high grade bladder cancer between 2004 and 2011. All tumours were simultaneously evaluated by a single uro-pathologist as high grade and G2 or G3. All patients underwent a second transurethral resection (TUR) and those confirmed with non-muscle-invasive bladder cancer at second TUR received bacille Calmette-Guérin. Follow-up included urine cytology and cystoscopy 3 months after second TUR and then every 6 months for 5 years. Univariate and multivariate analysis to determine recurrence-free survival (RFS) and progression-free survival (PFS) rates were performed using the Kaplan–Meier method with the log-rank test. G2 tumours were found in 124 (46.6%) and G3 in 142 (53.4%) patients. The mean (median; range) follow-up period was 31.1 (19; 1–93) months. The 5-year RFS rate was 39.1% for the overall high grade population, and 49.1 and 31.8% for G2 and G3 subgroups, respectively. The 5-year PFS was 82% for the overall high grade population and 89 and 73% for G2 and G3 subgroups, respectively. RFS (P < 0.002) and PFS (P < 0.001) rates were significantly different between the G2 and G3 subgroups. In multivariate analysis, only the grade assessed according to the 1973 WHO significantly correlated with both RFS (P = 0.003) and PFS (P < 0.001). The results suggest that the 1973 WHO classification system has higher prognostic reliability for patients with T1 disease. If confirmed, these findings should be carefully taken into account when making treatment decisions for patients with T1 bladder cancer.

Using Decision Tree Analysis to Understand Foundation Science Student Performance. Insight Gained at One South African University

The Foundation Programme of the Centre for Science Access at the University of KwaZulu-Natal, South Africa provides access to tertiary science studies to educationally disadvantaged students who do not meet formal faculty entrance requirements. The low number of students proceeding from the programme into mainstream is of concern, particularly given the national imperative to increase participation and levels of performance in tertiary-level science. An attempt was made to understand foundation student performance in a campus of this university, with the view to identifying challenges and opportunities for remediation in the curriculum and processes of selection into the programme. A classification and regression tree analysis was used to identify which variables best described student performance. The explanatory variables included biographical and school-history data, performance in selection tests, and socio-economic data pertaining to their year in the programme. The results illustrate the prognostic reliability of the model used to select students, raise concerns about the inefficiency of school performance indicators as a measure of students' academic potential in the Foundation Programme, and highlight the importance of accommodation arrangements and financial support for student success in their access year.

Finding the Best Thresholds of FEV1 and Dyspnea to Predict 5-Year Survival in COPD Patients: The COCOMICS Study

BackgroundFEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence.ObjectivesWe aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients.Design and MethodsWe conducted a patient-based pooled analysis of eleven COPD Spanish cohorts (COCOMICS). Survival analysis, ROC curves, and C-statistics were used to identify and compare the best FEV1 (%) and mMRC scale thresholds that predict 5-yr survival.ResultsA total of 3,633 patients (93% men), totaling 15,878 person-yrs. were included, with a mean age 66.4±9.7, and predicted FEV1 of 53.8% (±19.4%). Overall 975 (28.1%) patients died at 5 years. The best thresholds that spirometrically split the COPD population were: mild ≥70%, moderate 56–69%, severe 36–55%, and very severe ≤35%. Survival at 5 years was 0.89 for patients with FEV1≥70 vs. 0.46 in patients with FEV1 ≤35% (H.R: 6; 95% C.I.: 4.69–7.74). The new classification predicts mortality significantly better than dyspnea (mMRC) or FEV1 GOLD and BODE cutoffs (all p<0.001). Prognostic reliability is maintained at 1, 3, 5, and 10 years. In younger patients, survival was similar for FEV1 (%) values between 70% and 100%, whereas in the elderly the relationship between FEV1 (%) and mortality was inversely linear.ConclusionsThe best thresholds for 5-yr survival were obtained stratifying FEV1 (%) by ≥70%, 56–69%, 36–55%, and ≤35%. These cutoffs significantly better predict mortality than mMRC or FEV1 (%) GOLD and BODE cutoffs.