风险分析是一门具有重要实用价值的新兴学科,可对工程风险大小作出评估,从而找到为减少风险需要投入资金和改进管理的方向。危险是可产生潜在损失的特征或一组特征,风险是危险转变为现实的概率和损失程度的综合。某工程如果出现事故后...风险分析是一门具有重要实用价值的新兴学科,可对工程风险大小作出评估,从而找到为减少风险需要投入资金和改进管理的方向。危险是可产生潜在损失的特征或一组特征,风险是危险转变为现实的概率和损失程度的综合。某工程如果出现事故后果非常严重,尽管事故出现的概率很小,其风险仍是很大的,相反,事故后果轻微,虽然事故出现的概率高,其风险则不大,也就不值得花更多的资金去降低风险,通常把风险限定在一个可以接受的水平上。W Kent Muhlbauer提出了较完整的管道风险评分法,该方法评分时对影响风险的各因素假定为独立的并考虑到最坏状况,其得分值具有主观性和相对性。引起管道事故的原因有第三方破坏、腐蚀、设计和操作四大类,分别对这些因素进行分析评分,结合管输介质的危险性和影响面得出相对风险数,风险数越大表明风险越小。美国管道事故中第三方破坏占40％左右,第三方破坏因素可分为六个方面,分别介绍了其评分方法。展开更多
AIM:To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis(AP).METHODS:We retrospectively analyzed the prospectively collected clinical database f...AIM:To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis(AP).METHODS:We retrospectively analyzed the prospectively collected clinical database from consecutive patients with AP in our institution between January 2011 and December 2012.Ranson,Acute Physiology and Chronic Health Evaluation(APACHE)-Ⅱ,and bedside index for severity in acute pancreatitis(BISAP)scores,and computed tomography severity index(CTSI)of all patients were calculated.Serum C-reactive protein(CRP)levels were measured at admission(CRPi)and after 24h(CRP24).Severe AP was defined as persistent organ failure for more than 48 h.The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve(AUC).RESULTS:Of 161 patients,21(13%)were classified as severe AP,and 3(1.9%)died.Statistically significant cutoff values for prediction of severe AP were Ranson≥3,BISAP≥2,APACHE-Ⅱ≥8,CTSI≥3,and CRP24≥21.4.AUCs for Ranson,BISAP,APACHE-Ⅱ,CTSI,and CRP24 in predicting severe AP were 0.69(95%CI:0.62-0.76),0.74(95%CI:0.66-0.80),0.78(95%CI:0.70-0.84),0.69(95%CI:0.61-0.76),and0.68(95%CI:0.57-0.78),respectively.APACHE-Ⅱdemonstrated the highest accuracy for prediction of severe AP,however,no statistically significant pairwise differences were observed between APACHE-Ⅱand the other scoring systems,including CRP24.CONCLUSION:Various scoring systems showed similar predictive accuracy for severity of AP.Unique models are needed in order to achieve further improvement of prognostic accuracy.展开更多
BACKGROUND:The early identification of severe acute pancreatitis is important for the management and for improving outcomes.The bedside index for severity in acute pancreatitis(BISAP)has been considered as an accurate...BACKGROUND:The early identification of severe acute pancreatitis is important for the management and for improving outcomes.The bedside index for severity in acute pancreatitis(BISAP)has been considered as an accurate method for risk stratification in patients with acute pancreatitis.This study aimed to evaluate the comparative usefulness of the BISAP.METHODS:We retrospectively analyzed 303 patients with acute pancreatitis diagnosed at our hospital from March 2007to December 2010.BISAP,APACHE-II,Ranson criteria,and CT severity index(CTSI)of all patients were calculated.We stratified the number of patiants with severe pancreatitis,pancreatic necrosis,and organ failure as well as the number of deaths by BISAP score.We used the area under the receiveroperating curve(AUC)to compare BISAP with other scoring systems,C-reactive protein(CRP),hematocrit,and body mass index(BMI)with regard to prediction of severe acute pancreatitis,necrosis,organ failure,and death.RESULTS:Of the 303 patiants,31(10.2%)were classified as having severe acute pancreatitis.Organ failure occurred in 23(7.6%)patients,pancreatic necrosis in 40(13.2%),and death in6(2.0%).A BISAP score of 2 was a statistically significant cutoff value for the diagnosis of severe acute pancreatitis,organ failure,and mortality.AUCs for BISAP predicting severe pancreatitis and death were 0.80 and 0.86,respectively,which were similar to those for APACHE-II(0.80,0.87)and Ranson criteria(0.74,0.74)and greater than AUCs for CTSI(0.67,0.42).The AUC for organ failure predicted by BISAP,APACHE-II,Ranson criteria,and CTSI was 0.93,0.95,0.84 and 0.57,respectively.AUCs for BISAP predicting severity,organ failure,and death were greater than those for CRP(0.69,0.80,0.72),hematocrit(0.45,0.35,0.14),and BMI(0.41,0.47,0.17).CONCLUSION:The BISAP predicts severity,death,and especially organ failure in acute pancreatitis as well as APACHE-II does and better than Ranson criteria,CTSI,CRP,hematocrit,and BMI.展开更多
BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS...BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS2 score.METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows:age ≥75 years=1,atrial fi brillation=1,dysphagia=2,male sex=1; stroke severity:NIHSS score 0–4=0,5–15=3,≥16=5. The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1–9 group,and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1) fever ≥38 °C;(2) newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3) signs of pulmonary consolidation and/or wet rales;(4) peripheral white blood cell count ≥10×109/L or ≤4×109/L with or without nuclear shift to left,while excluding some diseases with clinical manifestations similar to pneumonia,such as tuberculosis,pulmonary tumors,non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data.RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1–9 and score 0 groups(71.7% vs. 22.7%,71.7% vs. 3.7%,respectively),whereas the mortality in the score≥10 group was significantly higher than th展开更多
BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the disease.It is dependent on the criteria of the Atlanta classification system.DATA SOURCES:PubMed search of...BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the disease.It is dependent on the criteria of the Atlanta classification system.DATA SOURCES:PubMed search of recent relevant articles was performed to identify information about the severity and prognosis of acute pancreatitis.RESULTS:The scoring systems included the Ranson’s or Glasgow’s criteria ≥3,the APACHE II classification system ≥8,and the Balthazar’s criteria ≥4 according to the computed tomography enhanced scanning findings.The single factors on admission included age >65 years,obesity,hemoconcentration(>44%),abnormal chest X-ray,creatinine >2 mg/dl,C-reactive protein>150 mg/dl,procalcitonin >1.8 ng/ml,albumin <2.5 mg/dl,calcium <8.5 mg/dl,early hyperglycemia,increased intra-abdominal pressure,macrophage migration inhibitory factor,or a combination of IL-10 >50 pg/ml with calcium <6.6 mg/dl.CONCLUSION:The prediction of the severity of acute pancreatitis is largely based on well defined multiple factor scoring systems as well as several single risk factors.展开更多
Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP)remarkably decreased the casemortality rate.To further decrease the mortality rate of SAP,it is important to precisely evaluate the severity...Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP)remarkably decreased the casemortality rate.To further decrease the mortality rate of SAP,it is important to precisely evaluate the severity at an early stage,and initiate appropriate treatment as early as possible.Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs.Severity can be evaluated by laboratory examinations or by clinical signs,reducing the defect values of the severity factors.Moreover,the severity criteria considered laboratory/clinical severity scores and contrastenhanced computed tomography(CE-CT)findings as independent risk factors.Thus,CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis.There was no fatal case in mild AP diagnosed by the CE-CT severity score,whereas case-mortality rate in those with SAP was 14.8%.Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%.It is recommended,therefore,to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria.Because the mortality rate of these patients with SAP is high,such patients should be transferred to advanced medical units.展开更多
Human epidermal growth factor receptor 2(HER2) overexpression is increasingly recognized as a frequent molecular abnormality in gastric and gastroesophageal cancer. With the recent introduction of HER2 molecular targe...Human epidermal growth factor receptor 2(HER2) overexpression is increasingly recognized as a frequent molecular abnormality in gastric and gastroesophageal cancer. With the recent introduction of HER2 molecular targeted therapy for patients with advanced gastric cancer, determination of HER2 status is crucial in order to select patients who may benefit from this treatment. This paper provides an update on our knowledge of HER2 in gastric and gastroesophageal cancer, including the prognostic relevance of HER2, the key differences between HER2 protein expression interpretation in breast and gastric cancer, the detection methods and the immunohistochemistry scoring system.展开更多
文摘风险分析是一门具有重要实用价值的新兴学科,可对工程风险大小作出评估,从而找到为减少风险需要投入资金和改进管理的方向。危险是可产生潜在损失的特征或一组特征,风险是危险转变为现实的概率和损失程度的综合。某工程如果出现事故后果非常严重,尽管事故出现的概率很小,其风险仍是很大的,相反,事故后果轻微,虽然事故出现的概率高,其风险则不大,也就不值得花更多的资金去降低风险,通常把风险限定在一个可以接受的水平上。W Kent Muhlbauer提出了较完整的管道风险评分法,该方法评分时对影响风险的各因素假定为独立的并考虑到最坏状况,其得分值具有主观性和相对性。引起管道事故的原因有第三方破坏、腐蚀、设计和操作四大类,分别对这些因素进行分析评分,结合管输介质的危险性和影响面得出相对风险数,风险数越大表明风险越小。美国管道事故中第三方破坏占40％左右,第三方破坏因素可分为六个方面,分别介绍了其评分方法。
文摘AIM:To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis(AP).METHODS:We retrospectively analyzed the prospectively collected clinical database from consecutive patients with AP in our institution between January 2011 and December 2012.Ranson,Acute Physiology and Chronic Health Evaluation(APACHE)-Ⅱ,and bedside index for severity in acute pancreatitis(BISAP)scores,and computed tomography severity index(CTSI)of all patients were calculated.Serum C-reactive protein(CRP)levels were measured at admission(CRPi)and after 24h(CRP24).Severe AP was defined as persistent organ failure for more than 48 h.The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve(AUC).RESULTS:Of 161 patients,21(13%)were classified as severe AP,and 3(1.9%)died.Statistically significant cutoff values for prediction of severe AP were Ranson≥3,BISAP≥2,APACHE-Ⅱ≥8,CTSI≥3,and CRP24≥21.4.AUCs for Ranson,BISAP,APACHE-Ⅱ,CTSI,and CRP24 in predicting severe AP were 0.69(95%CI:0.62-0.76),0.74(95%CI:0.66-0.80),0.78(95%CI:0.70-0.84),0.69(95%CI:0.61-0.76),and0.68(95%CI:0.57-0.78),respectively.APACHE-Ⅱdemonstrated the highest accuracy for prediction of severe AP,however,no statistically significant pairwise differences were observed between APACHE-Ⅱand the other scoring systems,including CRP24.CONCLUSION:Various scoring systems showed similar predictive accuracy for severity of AP.Unique models are needed in order to achieve further improvement of prognostic accuracy.
基金supported by a grant from the 2007 InjeUniversity(0001200743900)
文摘BACKGROUND:The early identification of severe acute pancreatitis is important for the management and for improving outcomes.The bedside index for severity in acute pancreatitis(BISAP)has been considered as an accurate method for risk stratification in patients with acute pancreatitis.This study aimed to evaluate the comparative usefulness of the BISAP.METHODS:We retrospectively analyzed 303 patients with acute pancreatitis diagnosed at our hospital from March 2007to December 2010.BISAP,APACHE-II,Ranson criteria,and CT severity index(CTSI)of all patients were calculated.We stratified the number of patiants with severe pancreatitis,pancreatic necrosis,and organ failure as well as the number of deaths by BISAP score.We used the area under the receiveroperating curve(AUC)to compare BISAP with other scoring systems,C-reactive protein(CRP),hematocrit,and body mass index(BMI)with regard to prediction of severe acute pancreatitis,necrosis,organ failure,and death.RESULTS:Of the 303 patiants,31(10.2%)were classified as having severe acute pancreatitis.Organ failure occurred in 23(7.6%)patients,pancreatic necrosis in 40(13.2%),and death in6(2.0%).A BISAP score of 2 was a statistically significant cutoff value for the diagnosis of severe acute pancreatitis,organ failure,and mortality.AUCs for BISAP predicting severe pancreatitis and death were 0.80 and 0.86,respectively,which were similar to those for APACHE-II(0.80,0.87)and Ranson criteria(0.74,0.74)and greater than AUCs for CTSI(0.67,0.42).The AUC for organ failure predicted by BISAP,APACHE-II,Ranson criteria,and CTSI was 0.93,0.95,0.84 and 0.57,respectively.AUCs for BISAP predicting severity,organ failure,and death were greater than those for CRP(0.69,0.80,0.72),hematocrit(0.45,0.35,0.14),and BMI(0.41,0.47,0.17).CONCLUSION:The BISAP predicts severity,death,and especially organ failure in acute pancreatitis as well as APACHE-II does and better than Ranson criteria,CTSI,CRP,hematocrit,and BMI.
文摘BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS2 score.METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows:age ≥75 years=1,atrial fi brillation=1,dysphagia=2,male sex=1; stroke severity:NIHSS score 0–4=0,5–15=3,≥16=5. The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1–9 group,and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1) fever ≥38 °C;(2) newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3) signs of pulmonary consolidation and/or wet rales;(4) peripheral white blood cell count ≥10×109/L or ≤4×109/L with or without nuclear shift to left,while excluding some diseases with clinical manifestations similar to pneumonia,such as tuberculosis,pulmonary tumors,non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data.RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1–9 and score 0 groups(71.7% vs. 22.7%,71.7% vs. 3.7%,respectively),whereas the mortality in the score≥10 group was significantly higher than th
文摘BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the disease.It is dependent on the criteria of the Atlanta classification system.DATA SOURCES:PubMed search of recent relevant articles was performed to identify information about the severity and prognosis of acute pancreatitis.RESULTS:The scoring systems included the Ranson’s or Glasgow’s criteria ≥3,the APACHE II classification system ≥8,and the Balthazar’s criteria ≥4 according to the computed tomography enhanced scanning findings.The single factors on admission included age >65 years,obesity,hemoconcentration(>44%),abnormal chest X-ray,creatinine >2 mg/dl,C-reactive protein>150 mg/dl,procalcitonin >1.8 ng/ml,albumin <2.5 mg/dl,calcium <8.5 mg/dl,early hyperglycemia,increased intra-abdominal pressure,macrophage migration inhibitory factor,or a combination of IL-10 >50 pg/ml with calcium <6.6 mg/dl.CONCLUSION:The prediction of the severity of acute pancreatitis is largely based on well defined multiple factor scoring systems as well as several single risk factors.
基金Supported by A Grant-in-Aid to the Research Committee on Intractable Pancreatic Diseases provided from the Ministry of HealthLabour and Welfare of Japan
文摘Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP)remarkably decreased the casemortality rate.To further decrease the mortality rate of SAP,it is important to precisely evaluate the severity at an early stage,and initiate appropriate treatment as early as possible.Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs.Severity can be evaluated by laboratory examinations or by clinical signs,reducing the defect values of the severity factors.Moreover,the severity criteria considered laboratory/clinical severity scores and contrastenhanced computed tomography(CE-CT)findings as independent risk factors.Thus,CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis.There was no fatal case in mild AP diagnosed by the CE-CT severity score,whereas case-mortality rate in those with SAP was 14.8%.Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%.It is recommended,therefore,to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria.Because the mortality rate of these patients with SAP is high,such patients should be transferred to advanced medical units.
文摘Human epidermal growth factor receptor 2(HER2) overexpression is increasingly recognized as a frequent molecular abnormality in gastric and gastroesophageal cancer. With the recent introduction of HER2 molecular targeted therapy for patients with advanced gastric cancer, determination of HER2 status is crucial in order to select patients who may benefit from this treatment. This paper provides an update on our knowledge of HER2 in gastric and gastroesophageal cancer, including the prognostic relevance of HER2, the key differences between HER2 protein expression interpretation in breast and gastric cancer, the detection methods and the immunohistochemistry scoring system.
