Stratified Case Research Articles

M-Health for Early Detection of Oral Cancer in Low- and Middle-Income Countries.

Background: Up to 86% of oral cancer (OC) patients present at the late stage where survival is dismal. Limited access to specialist diagnosis is a significant factor for late presentation. The increasing use of smartphones presents an opportunity to use digital technology to facilitate early detection of OC. Aim: To evaluate the feasibility of using Mobile Mouth Screening Anywhere (MeMoSA®) to facilitate early detection of OC. Methods: A mobile phone app named MeMoSA was developed and the feasibility of integrating this for documentation of oral lesions, and communication between dentists and specialists for management decisions were evaluated. The experience of dentists and specialists in using MeMoSA was determined using qualitative questionnaires. Results: Communication between specialist and dentists using MeMoSA stratified cases and streamlined referral of patients. Twelve of 48 patients were found to have oral lesions or signs suspicious of cancer and 3 required referrals. The patient's compliance for referral was tracked with MeMoSA. All dentists agreed that MeMoSA could facilitate early detection of OC and believed that MeMoSA could assist in the identification of oral mucosal lesions through direct communication with specialists and continuous learning in the recognition of high-risk lesions. Conclusions: MeMoSA has the potential to be used to promote equitable health care and streamline patient management that could result in early detection of OC.

On Magnetic Inhibition Theory in Non-resistive Magnetohydrodynamic Fluids

We investigate why the non-slip boundary condition for the velocity, imposed in the direction of impressed magnetic fields, can contribute to the magnetic inhibition effect based on the nonhomogeneous magnetic Rayleigh--Taylor (abbr. NMRT) problem in non-resistive magnetohydrodynamic (abbr. MHD) fluids. Exploiting an infinitesimal method in Lagrangian coordinates, the idea of (equivalent) magnetic tension, and the differential version of magnetic flux conservation, we give an explanation of physical mechanism for the magnetic inhibition phenomenon in a non-resistive MHD fluid. Moreover, we find that the magnetic energy in the non-resistive MHD fluid depends on the displacement of fluid particles, and thus can be regarded as elastic potential energy. Motivated by this observation, we further use the well-known minimum potential energy principle to explain the physical meaning of the stability/instability criteria in the NMRT problem. As a result of the analysis, we further extend the results on the NMRT problem to the stratified MHD fluid case. We point out that our magnetic inhibition theory can be used to explain the inhibition phenomenon of other instabilities, such as thermal instability, magnetic buoyancy instability, and so on, by impressed magnetic fields in non-resistive MHD fluids.

Application and clinical significance of Silva pattern system in invasive endocervical adenocarcinoma

Objective: To investigate the significance of Silva pattern system about clinical application in invasive endocervical adenocarcinoma. Methods: Data obtained from the Maternity Affiliated Hospital of Dalian Medical University was analyzed, 78 endocervical adenocarcinoma cases were included from December, 2006 to August, 2017. The average age of patients was (45.1±9.1) years old (ranged 27-71 years old). Clinical stage: stageⅠa 26 cases and Ⅰb 49 cases and stage Ⅱa 3 cases. All pathological slides were reviewed, stratified cases into pattern A, B and C according to Silva system criteria. Clinicopathological parameters of three Silva subgroups were analyzed, χ(2) test was used to investigate the correlation of Silva system and clinicopathological parameters. Follow-up data were collected until Jan. 3rd, 2018. The median follow-up time was 41 months (ranged 5-90 months). Kruskal-Wallis H test and Fisher test were used to analyze prognoses among different Silva subgroups. Results: (1) Silva A cases accounted for 38% (30/78) of all patients, 24 cases were stageⅠa, 6 cases were stageⅠb. The median tumor thickness was 2.1 mm (ranged 1.0-10.0 mm). No lymph vascular space invasion (LVSI) and perineural invasion (PNI) was detected, and all lymph node (LN) were negative for metastatic carcinoma. All patients were alive and had no evidence of recurrence. About 21% (16/78) cases were classified as Silva B, including 2 stage Ⅰa and 14 stage Ⅰb. The median tumor thickness was 5.2 mm (ranged 2.0-11.0 mm). Several patients had LVSI (4/16), LN metastasis (1/10) or PNI (1/16), but there was no recurrence or death. Thirty two (41%, 32/78) cases were Silva C, including 29 stage Ⅰb and 3 stage Ⅱa. The median tumor thickness was 11.5 mm (ranged 4.0-21.0 mm). The incidence of LVSI (53%, 17/32), LN metastasis (31%, 8/26) or PNI (16%, 5/32) was significantly increased. There were two recurrent cases and one death cases. (2) Statistical data demonstrated that Silva pattern system was closely correlated with clinicopathological parameters, such as clinical stage (r=0.754, P=0.000), tumor depth (P=0.000) and LVSI (r=0.534, P=0.000). But there was no correlation between Silva system and LN metastasis or PNI (all P>0.05). (3) Silva subgroups demonstrated no significant difference in recurrence and death (P>0.05). Conclusions: The application of Silva pattern system could effectively predict the prognosis of patients. It may be helpful to select reasonable operation before surgery and to realize individualized treatment of cervical adenocarcinoma.

Why people engage in a weight loss intervention at their workplace - a stratified case study

BackgroundThe prevalence of obesity has increased significantly worldwide within the last decade. As obesity is recognised as a contributing factor when developing various health threatening chronic diseases, prevention initiatives focusing on weight loss are becoming more important. Because of the time spent at the workplace, workplaces can be optimal arenas for weight loss programs and these programs have been effective to decrease body weight. Thus, reasons for engaging in weight loss interventions needs exploring, in order to engage more workplaces in weight loss interventions. Such information provides important knowledge that may help to inform decisions of municipalities, employers and other public health decision makers, when and if implementing weight loss interventions. The aim of this study was therefore to explore reasons for employee engagement in weight loss projects at the workplace and the incentives a municipality, a manager at a home-care centre, and a project manager have to launch such project.MethodsA stratified case study was conducted. A representative from the municipality, the manager at a home-care centre, the project manager of the weight loss intervention and six health-care workers were interviewed at the end of a one-year weight loss intervention at the workplace. Data were analysed using Systematic Text Condensation.ResultsAnalysis identified different views and considerations for engaging in a weight loss intervention at the workplace. For the representative of the municipality the possible economical gain of the project was in focus. The project manager and the manager of the home-care centre both reflected mainly on improvement of the healthcare workers health. For the project manager, achieving good scientific results was highlighted as well. However, the employees were influenced by several factors, such as their own health and weight loss, the pressure from the environment and their struggle for recognition.ConclusionsThis study concluded that if targeting the increasing worldwide obesity problem through workplace initiated weight loss programs, the sales pitch to managements and employers have to be tailored in order to increase the participation and the motivation for the initiative.Trial registrationClinicalTrial.gov: NCT01015716, registration data 14.12.2010 (Prospectively registered).

In-cylinder flow and combustion modeling of a CNG-fuelled stratified charge engine

In-cylinder air-fuel stratification and combustion is evaluated in a CNG-fuelled IC engine using a transient, three-dimensional, computational fluid dynamic (CFD) model. Performance of the stratified mode of operation is compared with the premixed mode. The combustion process is modeled using the extended coherent flame model (ECFM-3Z). For simulating the ignition process, the arc and kernel tracking ignition model (AKTIM) is used. The combustion model is first validated with measured in-cylinder pressure data and other derived quantities such as heat release rate and mass burn fraction for the premixed case. A good agreement is observed between measured and simulated values. It is observed that there is a marginal improvement in terms of overall engine efficiency when the stoichiometric premixed case is compared with the lean stratified condition. However, a major improvement in performance is observed when the lean stratified case is compared with lean premixed condition. The stratified case shows a faster heat release rate which could potentially translate to lower cycle-to-cycle variations in actual engine operation. Also, the stratified cases show as much as 30% lower in-cylinder NOx emissions when compared with the premixed case at the same engine load and speed, underscoring the potential of in-cylinder stratification to achieve improved performance and lower NOx emissions.

Large eddy simulation/probability density function simulations of the Cambridge turbulent stratified flame series

The LES/PDF methodology is applied to the Cambridge/Sandia turbulent stratified flame series. The methane chemistry is represented by the 16-species reduced ARM1 mechanism, and the in situ adaptive tabulation method is adopted to accelerate the chemistry calculations. Differential diffusion effects are taken into account. The simulations are performed for premixed (SwB1), and moderately and highly stratified (SwB5 and SwB9, respectively) cases under non-swirling conditions. The results from LES/PDF simulations are compared with the experimental measurements and with previous calculations. The calculated length of the recirculation zone, the mean and r.m.s. profiles of velocity, temperature, equivalence ratio and mass fractions of species are in very good agreement with the measurements. In the stratified cases, the CO profiles are underestimated within the recirculation zone, close to the bluff body. Scatter plots of species mole fractions and temperature are presented and compared with the experimental data. Conditional means of species mass fractions demonstrate overall good consistency with the measurements. A parametric study is then performed to examine the effect of differential diffusion and the effect of the parameter controlling the scalar mixing rate. It is found that differential diffusion has a negligible effect on the mean and r.m.s. results, whereas, the mixing rate parameter has a considerable effect on the flow structure. Finally, the effect of stratification is investigated and characterized by scatter plots of OH mass fraction and heat release rate (HRR) in the equivalence ratio space.

An improved Multiphase Moving Particle Semi-implicit method in bubble rising simulations with large density ratios

Abstract In this study, an improved MMPS-CA method is developed against the inaccuracy of MMPS-CA (Continuous Acceleration) method in simulating bubble rising cases with large density ratios. A higher order Laplacian model is adopted to discretize pressure Poisson equation and a ECS source term with compressible form is adopted. A new multi-viscosity model is developed based on the Shepherd smoothing function, and the performances of different multi-viscosity models in bubble rising cases are investigated in detail. A higher order accuracy density smoothing scheme base on the Gaussian function is employed to avoid the unphysical invasions through the interface, and a dynamic displacement modification technique is developed to make the particle distribution more uniform in the calculation. Then several multiphase simulation cases including the stratified pool case, deformation of 2D square droplet case, single bubble rising case, two-phase Poiseuille flow case and the bubble rising benchmark case are employed to verify the robustness of the improved MMPS-CA method. Bubble pairs rising and coalescence cases are carried out to further verify the ability of the proposed method in simulating bubbles’ behaviors. Results of the improved MMPS method fit well enough to other numerical and experimental results. At the end of the paper, a 2D closed air-water separator case is carried out to investigate the robustness of the improved MMPS-CA method in general bubble rising simulations with large density ratios.

Reduction in tuberculosis incidence in the UK from 2011 to 2015: a population-based study

BackgroundFollowing nearly two decades of increasing tuberculosis in the UK, TB incidence decreased by 32% from 2011 to 2015. Explaining this reduction is crucial to informing ongoing TB control efforts.MethodsWe...

The 2D dynamics of radiative zones of low-mass stars

Context. Helioseismology and asteroseismology allow us to probe the differential rotation deep within low-mass stars. In the solar convective envelope, the rotation varies with latitude with an equator rotating faster than the pole, which results in a shear applied on the radiative zone below. However, a polar acceleration of the convective envelope can be obtained through 3D numerical simulations in other low-mass stars and the dynamical interaction of the surface convective envelope with the radiative core needs to be investigated in the general case. Aim. In the context of secular evolution, we aim to describe the dynamics of the radiative core of low-mass stars to get a deeper understanding of the internal transport of angular momentum in such stars, which results in a solid rotation in the Sun from 0.7R⊙ to 0.2R⊙ and a weak radial core-envelope differential rotation in solar-type stars. This study requires at least a 2D description to capture the latitudinal variations of the differential rotation. Methods. We build 2D numerical models of a radiative core on the top of which we impose a latitudinal shear so as to reproduce a conical or cylindrical differential rotation in a convective envelope. We perform a systematic study over the Rossby number Ro = ΔΩ/2Ω0 measuring the latitudinal differential rotation at the radiative–;convective interface. We provide a 2D description of the differential rotation and the associated meridional circulation in the incompressible and stably stratified cases using the Boussinesq approximation. Results. The imposed shear generates a geostrophic flow implying a cylindrical differential rotation in the case of an isotropic viscosity. When compared to the baroclinic flow that arises from the stable stratification, we find that the geostrophic flow is dominant when the Rossby number is high enough (Ro ≥ 1) with a cylindrical rotation profile. For low Rossby numbers (Ro < 1), the baroclinic solution dominates with a quasi-shellular rotation profile. Using scaling laws from 3D simulations, we show that slow rotators (Ω0 < 30Ω⊙) are expected to have a cylindrical rotation profile. Fast rotators (Ω0 > 30Ω⊙) may have a shellular profile at the beginning of the main sequence in stellar radiative zones. Conclusions. This study enables us to predict different types of differential rotation and emphasizes the need for a new generation of 2D rotating stellar models developed in synergy with 3D numerical simulations. The shear induced by a surface convective zone has a strong impact on the dynamics of the underlying radiative zone in low-mass stars. However, it cannot produce a flat internal rotation profile in a solar configuration calling for additional processes for the transport of angular momentum in both radial and latitudinal directions.

Flow Adjustment Inside and Around Large Finite-Size Wind Farms

In this study, large-eddy simulations are performed to investigate the flow inside and around large finite-size wind farms in conventionally-neutral atmospheric boundary layers. Special emphasis is placed on characterizing the different farm-induced flow regions, including the induction, entrance and development, fully-developed, exit and farm wake regions. The wind farms extend 20 km in the streamwise direction and comprise 36 wind turbine rows arranged in aligned and staggered configurations. Results show that, under weak free-atmosphere stratification ( Γ = 1 K/km), the flow inside and above both wind farms, and thus the turbine power, do not reach the fully-developed regime even though the farm length is two orders of magnitude larger than the boundary layer height. In that case, the wind farm induction region, affected by flow blockage, extends upwind about 0.8 km and leads to a power reduction of 1.3% and 3% at the first row of turbines for the aligned and staggered layouts, respectively. The wind farm wake leads to velocity deficits at hub height of around 3.5% at a downwind distance of 10 km for both farm layouts. Under stronger stratification ( Γ = 5 K/km), the vertical deflection of the subcritical flow induced by the wind farm at its entrance and exit regions triggers standing gravity waves whose effects propagate upwind. They, in turn, induce a large decelerating induction region upwind of the farm leading edge, and an accelerating exit region upwind of the trailing edge, both extending about 7 km. As a result, the turbine power output in the entrance region decreases more than 35% with respect to the weakly stratified case. It increases downwind as the flow adjusts, reaching the fully-developed regime only for the staggered layout at a distance of about 8.5 km from the farm edge. The flow acceleration in the exit region leads to an increase of the turbine power with downwind distance in that region, and a relatively fast (compared with the weakly stratified case) recovery of the farm wake, which attains its inflow hub height speed at a downwind distance of 5 km.

ANA Testing: What should we know about the methods, indication and interpretation?

AbstractThough ANA is a common test requested in several settings, one may not be aware of the potential traps for interpretation. Nowadays, there is a trend for autoantibodies diagnostics to move from traditional time honored manual methods to high throughput automated platforms. Nevertheless, the clinical significance and assay performance characteristics may be different from those “historical” methods. Though indirect immunofluorescence is the gold standard method for ANA tests, different laboratories vary in the slides (from different cell lines and commercial source, e.g., Hep 2, Hep 2000, etc.), screening dilutions, terminology, reporting format and expertise. Hence, discrepancy in results among different laboratories is not uncommon and could be confusing. Knowing the assay characteristic and limitations helps proper results interpretation and facilitate patient’s management. Indeed, the titer and pattern by indirect immunofluorescence do provide valuable information in screening patients. In particular, DFS pattern with the associated anti-DFS70 antibodies has been shown to have a role to risk stratify cases referred for suspected autoimmune rheumatic disease.

A study on some basic features of inertial oscillations and near-inertial internal waves

Abstract. Some basic features of inertial oscillations and near-inertial internal waves are investigated by simulating a two-dimensional (x − z) rectangular basin (300 km × 60 m) driven by a wind pulse. For the homogeneous case, near-inertial motions are pure inertial oscillations. The inertial oscillation shows typical opposite currents between the surface and lower layers, which is formed by the feedback between barotropic waves and inertial currents. For the stratified case, near-inertial internal waves are generated at land boundaries and propagate offshore with higher frequencies, which induce tilting of velocity contours in the thermocline. The inertial oscillation is uniform across the whole basin, except near the coastal boundaries ( ∼ 20 km), where it quickly declines to zero. This boundary effect is related to great enhancement of non-linear terms, especially the vertical non-linear term (w ∂ u∕ ∂ z). With the inclusion of near-inertial internal waves, the total near-inertial energy has a slight change, with the occurrence of a small peak at ∼ 50 km, which is similar to previous research. We conclude that, for this distribution of near-inertial energy, the boundary effect for inertial oscillations is primary, and the near-inertial internal wave plays a secondary role. Homogeneous cases with various water depths (50, 40, 30, and 20 m) are also simulated. It is found that near-inertial energy monotonously declines with decreasing water depth, because more energy of the initial wind-driven currents is transferred to seiches by barotropic waves. For the case of 20 m, the seiche energy even slightly exceeds the near-inertial energy. We suppose this is an important reason why near-inertial motions are weak and hardly observed in coastal regions.

PRESSURE GRADIENT PREDICTION FOR DIFFERENT FLOW PATTERNS OF HEAVY OIL AND NATURAL GAS IN A HORIZONTAL PIPE USING CFD TECHNIQUES AND EMPIRICAL CORRELATIONS

Two-phase flows are of fundamental importance in the petroleum industry, considering that most petroleum reservoirs produce oil and gas simultaneously. Because system pressure gradient is a result of the frictional effects between fluids and pipe wall, and the interfacial effects between the fluids themselves, the precise determination of this parameter is complex. Many authors have sought to predict pressure gradient by using computational fluid dynamic techniques and empirical correlations. The present work aims to compare heavy oil and natural gas mixture pressure gradients in a horizontal pipe for different flow patterns using the application ANSYS CFX 13.0, Lockhart and Martinelli, and Beggs and Brill correlations. The analysis investigated the results for bubbly, plug, and stratified flows. The results showed that Beggs and Brill over predicted pressure gradient values. It was also observed a good agreement between numerical and Lockhart and Martinelli correlation for bubbly and plug flows, with root-mean-square deviations (RMSD) of 5.78 and 19.55 percent, respectively. As for the stratified flow cases, the numerical results presented a poor agreement, with a RMSD greater than 90 percent. The high percent deviation for this flow regime is due to the increase in the gas input content. To compute the high gas velocity effects and, hence, improve the agreement, we suggest the use of turbulence and free surface models as well as different values of drag coefficient in the numerical setup.

A neural network approach for the blind deconvolution of turbulent flows

We present a single-layer feed-forward artificial neural network architecture trained through a supervised learning approach for the deconvolution of flow variables from their coarse-grained computations such as those encountered in large eddy simulations. We stress that the deconvolution procedure proposed in this investigation is blind, i.e. the deconvolved field is computed without any pre-existing information about the filtering procedure or kernel. This may be conceptually contrasted to the celebrated approximate deconvolution approaches where a filter shape is predefined for an iterative deconvolution process. We demonstrate that the proposed blind deconvolution network performs exceptionally well in the a priori testing of two-dimensional Kraichnan, three-dimensional Kolmogorov and compressible stratified turbulence test cases, and shows promise in forming the backbone of a physics-augmented data-driven closure for the Navier–Stokes equations.

Turbulence characteristics of a thermally stratified wind turbine array boundary layer via proper orthogonal decomposition

A large eddy simulation framework is used to explore the structure of the turbulent flow in a thermally stratified wind turbine array boundary layer. The flow field is driven by a constant geostrophic wind with time-varying surface boundary conditions obtained from a selected period of the CASES-99 field experiment. Proper orthogonal decomposition is used to extract coherent structures of the turbulent flow under the considered thermal stratification regimes. The flow structure is discussed in the context of three-dimensional representations of key modes, which demonstrate features ranging in size from the wind turbine wakes to the atmospheric boundary layer. Results demonstrate that structures related to the atmospheric boundary layer flow dominate over those introduced by the wind farm for the unstable and neutrally stratified regimes; large structures in atmospheric turbulence are beneficial for the wake recovery, and consequently the presence of the turbulent wind turbine wakes is diminished. Contrarily, the flow in the stably stratified case is fully dominated by the presence of the turbines and highly influenced by the Coriolis force. A comparative analysis of the test cases indicates that during the stable regime, higher-order modes contribute less to the overall character of the flow. Under neutral and unstable stratification, important turbulence dynamics are distributed over a larger range of basis functions. The influence of the wind turbines on the structure of the atmospheric boundary layer is mainly quantified via the turbulence kinetic energy of the first ten modes. Linking the new insights into structure of the wind turbine/atmospheric boundary layer and their interaction addressed here will benefit the formulation of new simplified models for commercial application.

Characteristics of Early Flame Development in a Direct-Injection Spark-Ignition CNG Engine Fitted with a Variable Swirl Control Valve

An experimental study was conducted to investigate the effect of the structure of the induction flow on the characteristics of early flames in a lean-stratified and lean-homogeneous charge combustion of compressed natural gas (CNG) fuel in a direct injection (DI) engine at different engine speeds. The engine speed was varied at 1500 rpm, 1800 rpm and 2100 rpm, and the ignition timing was set at a 38.5° crank angle (CA) after top dead center (TDC) for all conditions. The engine was operated in a partial-load mode and a homogeneous air/fuel charge was achieved by injecting the fuel early (before the intake valve closure), while late injection during the compression stroke was used to produce a stratified charge. Different induction flow structures were obtained by adjusting the swirl control valves (SCV). Using an endoscopic intensified CCD (ICCD) camera, flame images were captured and analyzed. Code was developed to analyze the level of distortion of the flame and its wrinkledness, displacement and position relative to the spark center, as well as the flame growth rate. The results showed a higher flame growth rate with the flame kernel in the homogeneous charge, compared to the stratified combustion case. In the stratified charge combustion scenario, the 10° SCV closure (medium-tumble) resulted in a higher early flame growth rate, whereas a homogeneous charge combustion (characterized by strong swirl) resulted in the highest rate of flame growth.

Numerical analysis and model development for laminar flame speed of stratified methane/air mixtures

Numerical simulations of stratified methane/air flames with various stratification configurations are conducted using an 1-D unsteady reacting flow solver. Among all the stratified flame cases investigated, rich-to-lean stratified flames show significant departures from homogeneous flames, i.e., up to 50% increase in fuel consumption speeds, primarily due to preferential diffusion of lighter species and radicals from rich burnt products. A sensitivity study of transport properties further reveals that preferential diffusion of molecular hydrogen H2 along with radicals H, OH is the dominant factor in increasing stratified flame speeds, compared to the influence of heat diffusion and diffusion of H2O. Larger departure of stratified flames from homogeneous flames is observed in those cases with higher degree of stratification. In order to model transient behaviors of stratified flames with arbitrary stratification configurations, a local stratification level (LSL) model is proposed. LSL incorporates the effect of preferential diffusion by introducing a transfer function from molecular hydrogen concentration gradients to equivalence ratio gradients, and the memory effect by solving the transient model equation of LSL. The model results match well with directly simulated results quantitatively with error less than ∼10% for both lean and rich conditions.

MAMA'S Neighborhood–Maternity Assessment Management Access & Service Synergy Through the Neighborhood for Health [16L

INTRODUCTION: MAMA's Neighborhood (MAMAs), funded by the Strong Start for Mothers and Newborns Initiative, aims to evaluate models of prenatal care to reduce preterm (PTB) and low birth weight (LBW). Using a medical home model in high prevalence areas of Los Angeles, MAMAs sought to better assess potential social determinants of PTB and LBW and organize care to address these risks via: 1. Collaborative care teams, 2. Risk stratified case management, 3. Population health management, and 4. Community engagement and care delivery with social-service agencies. METHODS: Data were collected December 2013–August 2016. MAMAs implemented a novel initial assessment with evidence-based screening tools for psychosocial risk factors, risk stratification, case management and population health tracking by collaborative care teams at 6 sites. Neighborhood services were linked for individualized care planning. RESULTS: A total of 3,214 women enrolled. This cohort exhibited disproportionately high rates of food insecurity (15%), depression (23%), anxiety (31%) and intimate partner violence (32%) when compared to the general obstetric population. All women received risk stratified case management, allocating services weekly to 4%, monthly to 23%, and trimesterly to 74% of the cohort. Neighborhood service referrals averaged 3.7 per participant for psychosocial needs. CONCLUSION: MAMAs Neighborhood successfully implemented evidence-based screening tools for psychosocial risk factors into prenatal care, risk stratify and manage population health. MAMAs also developed individualized care plans for pregnant women including services delivered by community-based agencies to meet social needs. This model, involving both health system and community partners, leverages a Neighborhood approach to optimize maternal-child health outcomes.

MP30-13 MTH SCORE – A NOVEL SCORING SYSTEM TO RISK STRATIFY RENAL TRANSPLANT CASES AND TO IMPROVE OUTCOMES POST RENAL TRANSPLANT

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2017MP30-13 MTH SCORE – A NOVEL SCORING SYSTEM TO RISK STRATIFY RENAL TRANSPLANT CASES AND TO IMPROVE OUTCOMES POST RENAL TRANSPLANT aditya yelikar and sachin joseph aditya yelikaraditya yelikar More articles by this author and sachin josephsachin joseph More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.946AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES ESRD is a highly prevalent cause of morbidity and mortality. Kidney transplantation is the optimal treatment of ESRD in terms of morbidity, mortality and quality of life. Maximum incidence of graft dysfunction in the first year post transplant. We wanted to study the pre and post transplant factors that can affect post transplant outcome and graft survival. We wanted to make a scoring system to predict outcomes post transplant. METHODS 450 cases of live donor renal transplant were studied in a period of 2 years. all recipients were followed for 1 year and their mean serum creatinine was considered to compare the outcomes post transplant. We studied the pre-transplant & post-transplant factors like donor age , donor sex , ratio of donor kidney weight to recipient body weight , recipient age , donor to recipient sex , cold ischemia time , time for diuresis , number of blood transfusions to recipient , amount of steroids taken by recipient in first 3 months after transplant , number of acute rejection episodes , number of renal arteries , hepatitis C virus infection of recipient. using these factors we made 3 score charts (pre transplant,post transplant & combined MTH score) by giving points in ascending order starting from 1 to each subgroup of the factors affecting transplant outcome. Maximum points were given to the category in the subgroup which has the best impact on the transplant outcome. We classified patients into low (score >30), intermediate risk (score 21-30) and high risk (score 11-20). Independent t test or Mann Witney U test (∗) was used as test of significance to identify the mean difference between two groups. ANOVA (Analysis of Variance) or Kruskal Wallis test (∗∗) was the test of significance to identify the mean difference between more than two groups. p value <0.05 was considered as statistically significant. RESULTS Overall 89.76% recipients had a serum creatinine of less than 2 at the end of one year 54.54 % recipients in MTH high risk group had serum creatinine < 2 at the end of 1 year. 96.72 % recipients in MTH low risk group had serum creatinine < 2 at the end of 1 year 27.27% recipients in MTH high risk group were restarted on HD in the first year post renal transplant CONCLUSIONS 1. MTH score can help risk stratify renal transplant cases 2. The MTH score can help predict the outcomes in renal transplant 3. MTH score can be a guide for future scoring systems in transplant 4. Modifying the risk factors can help high risk cases to fall into low risk category and may improve post transplant graft survival rates in the first year. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e394 Advertisement Copyright & Permissions© 2017MetricsAuthor Information aditya yelikar More articles by this author sachin joseph More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Atypical mucinous glandular proliferations in endometrial samplings: follow-up and other clinicopathological findings in 41 cases

The 2014 World Health Organization classification calls for endometrial mucinous proliferations that display "confluent or cribriform architecture with even minimal atypia" in sampling specimens to be classified as carcinoma, and others whose features are not diagnostic of carcinoma to be categorized as atypical mucinous glandular proliferations (AMGPs). Herein, we evaluate follow-up findings in 41 cases that were classified as AMGP from our files. The average patient age was 46years (range, 37-59 years). Postbiopsy follow-up duration ranged from 15 to 109weeks (mean, 40 weeks). There was no follow-up resection in 12 patients (9 with repeat biopsies, all 9 with no clinical evidence of disease, mean follow-up of 43weeks), and 29 patients underwent a hysterectomy an average of 2.4months after the index biopsy. The distribution of pathologic findings in the uteri was as follows: no residual AMGP or carcinoma (5/29; 17%), AMGP (11/29; 38%), and adenocarcinoma (13/29; 45%). All adenocarcinomas were grade I and stage I, and histotypes were endometrioid (n=8), mucinous (n=3), and endometrioid with mucinous differentiation (n=2). Only 3 (23%) carcinomas were myoinvasive, of which 1 case, a mucinous carcinoma with a 40% endometrioid component, showed greater than 50% myometrial invasion. None of a wide array of morphologic features was significantly associated with a hysterectomy diagnosis of carcinoma (versus AMGP) on univariate analyses. In conclusion, our cohort of AMGP represents a biologically variable spectrum of lesions that includes mucinous hyperplastic proliferations as well as endometrioid and mucinous adenocarcinomas that are occasionally myoinvasive. Morphologic features that optimally stratified AMGP cases into clinically relevant subgroups were not identified.