Graves′ ophthalmopathy: emphasis on assessment / 中华内分泌代谢杂志

Graves′ ophthalmopathy(GO) is an autoimmune disease closely related to thyroid diseases. Clinical manifestations of GO are various, making it hard to be diagnozed and treated. There are a number of treatments available clinically, however etiological treatment remains scarce. The choice of treatment, the evaluation of therapeutic effect and the prediction of patients′ outcomes should be rooted in the evaluation of patients′ condition. In this review, the clinical characteristics of GO were analyzed, and key points of assessment including risk factors, clinical activity, disease severity, quality of life and psychological status were also proposed. Clinicians are encouraged to shed more focus on the assessment of GO.

Development and validation of a standard area diagram set to assess powdery mildew severity on watermelon leaves / Desenvolvimento e validação de uma escala diagramática para avaliar a severidade oídio em folhas de melancia do

ABSTRACT: The development and validation of a standard area diagram set (SADs) was proposed in this study to assess the severity of powdery mildew (Podosphaera xanthii) in watermelon (Citrullus lanatus) leaves. The SADs proposed has twelve levels of severity, varying from 0.07 to 100%. The SADs were validated by 16 raters who had no previous experience in evaluating plant disease severity. Initially, the estimation of severity was performed without the use of the SADs in leaves with different levels of severity. In a second moment, the same raters estimated the disease severity using the SADs proposed. By Lin's concordance correlation analysis, there was an improvement in precision (coefficient of correlation, r = 0.878 and r = 0.959, without and with SADs, respectively) and accuracy (bias correction factor, Cb = 0.830 and 0.982, without and with SADs, respectively) using SADs when compared to the non-use of SADs. The agreement (Lin's concordance correlation coefficient, ρc = 0.734 and 0.952 without and with SADs, respectively) also improved using SADs. Severity estimates inter-rater were more reliable when using SADs (coefficient of determination, R2 = 0.681 without and R2 = 0.864 with SADs; Intra-class correlation coefficient, ρ = 0.759 and ρ = 0.928, without and with SADs, respectively). Therefore, SADs improved precision, accuracy and reliability of powdery mildew severity on watermelon leaves.

RESUMO: Neste estudo foi proposto o desenvolvimento e validação de uma escala diagramática (ED) para avaliar a severidade do oídio (Podosphaera xanthii) em folhas de melancia (Citrullus lanatus). A ED proposta possui 12 níveis de severidade, variando de 0,07 a 100%. A ED foi validada por 16 avaliadores inexperientes em avaliação de severidade de doenças de plantas. Inicialmente, as estimativas de severidade foram realizadas sem o uso da ED em folhas com diferentes níveis de severidade. No segundo momento, os mesmos avaliadores estimaram a severidade da doença usando a ED proposta. Pela análise da correlação concordante de Lin, houve melhoria na precisão (coeficiente de correlação, r = 0,787 e r = 0,959, sem e com o uso da ED, respectivamente) e acurácia (fator de correção do desvio, Cb = 0,830 e 0,982, sem e com o uso da ED, respectivamente) usando a ED quando comparado ao não uso da ED. O coeficiente de correlação concordante de Lin, ρc = 0,734 e 0,952 sem e com o uso da ED, respectivamente) também melhorou com o uso da ED. As estimativas de severidade tiveram melhoria na reprodutibilidade quando a ED foi usada (coeficiente de determinação, R2=0,681 e R2 = 0,864 sem e com o uso da ED, respectivamente; coeficiente de correlação intra-classe, ρ = 0,759 e ρ = 0,928, sem e com o uso da ED, respectivamente). Portanto, a ED melhorou a precisão, acurácia e reprodutibilidade das estimativas de severidade do oídio em folhas de melancia.

A standard area diagram set for assessing severity of eucalyptus bacterial blight caused by Erwinia psidii / Uma escala diagramática para a avaliação da severidade da seca-de-ponteiros do eucalipto causada por Erwinia psidii

This study aimed to develop and validate a standard area diagram (SAD) set to estimate the severity of bacterial blight of eucalyptus caused by Erwinia psidii. For this purpose, an eight-level SAD was developed and validated by ten inexperienced raters. Accuracy and precision of the estimates by each rater, with and without the SAD, were determined based on Lin's concordance correlation coefficient. The proposed SAD improved the accuracy and precision of the estimates. The SAD set studied here is a useful tool in assessments of bacterial blight of eucalyptus for epidemiological research and breeding programs.(AU)

Este trabalho objetivou o desenvolvimento de uma escala para estimar a severidade da seca-de-ponteiros do eucalipto causada por Erwinia psidii. Para isso, uma escala de oito níveis foi desenvolvida e validada por dez avaliadores inexperientes. A acurácia e precisão das estimativas de cada avaliador, com e sem a escala, foram determinadas baseadas no coeficiente de correlação concordante de Lin. A escala proposta melhorou a acurácia e a precisão das estimativas. A escala estudada se mostrou uma ferramenta útil na avaliação da seca-de-ponteiros do eucalipto para estudos epidemiológicos e em programas de melhoramento.(AU)

The role of Th17 cells and cytokines in the diagnosis and treatment of acute pancreatitis / 中华肝胆外科杂志

Objective To study the role of Th17 cells proportions and the cytokines levels in the diagnosis and treatment of acute pancreatitis (AP).Methods Patients with AP (n =82) treated in our hospital between August 2017 and August 2018 were divided into the mild AP group (MAP,n =36),the moderately severe AP group (MSAP,n =26) and the severe AP group (SAP,n =20).Twenty-five healthy subjects were chosen as the control group.The proportions of Th17 cells and the levels of cytokines including IL-17,IL-21,IL-22 and IL-23 in peripheral blood from the four groups were analyzed.The APACHE Ⅱ and Ranson scores were used to evaluate the illness severity.Spearman correlation analysis was conducted to detect the correlation between the Th17 cells,cytokines,and inflammatory factor,APACHE Ⅱ and Ranson scores.Results Compared with the control group,the proportion of Th17 cells and the levels of IL-17,IL-21,IL-22 and IL-23 in the peripheral blood of MAP,MSAP and SAP groups were significantly increased (SAP ＞ MSAP ＞ MAP,P ＜ 0.05).The levels of inflammatory cytokines IL-6,IL-8 and TNF-α,and the scores of APACHE Ⅱ and Ranson in the SAP group were significantly higher than those in the MSAP group and MAP group (P ＜ 0.05).The proportion of Th17 cells and their cytokine levels were positively correlated with IL-6,IL-8,TNF-o,APACHE Ⅱ and Ranson scores.The levels of Th17 cytokines returned to normal in AP patients after treatment.Conclusion Th17 cells and the cytokines have certain clinical significance in evaluating early inflammatory response,severity of illness,and therapeutic effect in AP patients.

Clinical Role of the Chronic Obstructive Pulmonary Disease Assessment Test in Prediction of the Response to Treatment for Exacerbations

Comparison of the positive rate of microbiological examination in different clinical specimens / 中国基层医药

Objective@#To compare the positive rate of microbiological examination in different clinical specimens, and to provide reliable basis for improving the quality of microbiological examination and management of nosocomial infection.@*Methods@#A total of 2 028 bacterial culture specimens were collected from the hospitalized patients in the Second People's Hospital of Jinanfrom March 2016 to February 2018.The samples were examined by Micro Scan autoSCAN4 automatic bacteriological identification analyzer.Strictly according to the specification of the standard operation, the positive rates of microbial testingof all kinds of clinical specimens were statistically analyzed.@*Results@#The positive rate of microbiological examination in 2 028 clinical specimens was 44.33%.The positive rate of microbiological examination in sputum was the highest(58.96%), followed by ophthalmic secretion(40.64%), eye contents(37.96%), urine(34.55%), blood(21.11%).@*Conclusion@#The positive rate of microbiological examination is different in different clinical specimens.The epidemiological situation of nosocomial infection can be understood by analyzing the microbiological examination of different clinical specimens in clinic.In order to provide a reliable basis for clinical prevention and treatment of nosocomial infection, and to further improve the positive rate of clinical microbiological examination, we should actively carry out improvement countermeasures against its influencing factors.

Recent developments in disease assessment for juvenile idiopathic arthritis / 中华实用儿科临床杂志

Juvenile idiopathic arthritis (JIA) is defined as arthritis of unknown etiology during childhood.The pathogenesis of this disease is still unclear and the main principle of treatment is to eliminate symptoms, control infla-mmation, and protect joint function.Clinical prognosis can be improved in most JIA patients, but still some patients will eventually become disabled.With the advent of new biologic treatment agents, the treatment management model of JIA is also facing great challenges.Currently, there is still no unified standard to measure and monitor the clinical situation in all patients.This review aims to describe the disease assessment indices important to routine clinical care and integral to the design of outcome studies and clinical trials in JIA.

Evidence-based research on the selection method system for China's essential medicine list / 中华医院管理杂志

Objective To find a selection method system appropriate for China's essential drug list.Methods Collection and analysis of technical paper literature on essential drug list developement,adjustment technical papers,and literature on evidence-based medicine,pharmacoeconomics evaluation,and medical insurance budget analysis from WHO and other countries.On such basis,a method system for selecting China's essential medicine list can be proposed,with its feasibility analyzed and demonstrated.Results The GRADE assessment proposed by WHO was used to evaluate the efficacy and safety of the drug;the pharmacy economics evaluation is added to assess the economic efficiency;these were aided by the pharmacoeconomics evaluation for a comprehensive evaluation of the pharmacoeconomics of the drug in question,supplementing analysis of the medical insurance,and ensuring its affordability of essential medicine so selected.The theory of this system is well developed,and supporting software ready for application.Examples in Zhejiang Province regarding essential medicine for diabetes have proved this method feasible.Data acquisition constitutes a major roadblock for scientific selection due to barriers against medical insurance data sharing.Conclusions Theoretic basis and method tools are fully available for essential medicine selection,and the selection method system as proposed in this study prove feasible to some extent.Decision makers are recommended to scientifically select the essential drugs,and to encourage data sharing,in order to make the list more scientific and pragmatic.

Evaluation of clinical value of chronic pulmomary disease assessment test score in patients with acute exacerbation of chronic obstructive pulmonary disease / 中国中西医结合急救杂志

Objective To explore the clinical value and significance of the chronic obstructive pulmonary disease (COPD) assessment test (CAT) in patients with acute exacerbation of COPD (AECOPD).Methods A prospective observational study was conducted,AECOPD patients were admitted to the Department of Respiration Medicine in Jiaxing Second Hospital from February 2011 to July 2016 were enrolled,and they all underwent CAT assessment test and lung function examination.The patients were assigned to Ⅱ,Ⅲ and Ⅳ grade groups according to the lung function level,and the difference of forced expiratory end volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) ratio were compared among the three groups;the patients were also assigned into 2,3 and 4 grade groups according to CAT scores,and the difference of length of stay in the hospital and hospitalization expenses were compared among the three groups.Spearman correlation analysis was used to analyze the correlations between the CAT score and lung function indexes.Results One hundred and thirty-five patients with AECOPD were accepted and all of their clinical data were analyzed in the study.Their mean FEV1 was (0.42±0.16) L,FEV1/FVC was 0.44 ±0.13 and CAT score was 26.64 ± 5.43.The correlation analyses showed:there were significant negative correlations between CAT score and FEV1,FEV1/FVC (r value was-0.691,-0.728,both P ＜ 0.001).With the elevation of lung function grade,FEV1 and FEV1/FVC were decreased gradually (1Ⅱ,Ⅲ,Ⅳ grade groups were 0.62±0.07,0.40±0.06,0.25±0.03 and 0.64±0.01,0.40±0.00,0.33±0.06 respectively),while CAT score raised gradually (20.03 ± 3.36,28.30 ± 3.31,30.18±3.86,all P ＜ 0.01);with the CAT score getting higher and higher,hospitalization expenses (yuan) and the length of stay in hospital (day) of patients with AECOPD were increased significantly (2,3,4 grade groups:expense were 6214.09±1396.16,8339.31±1866.46,9600.97±4339.87,and length of stay in hospital were 7.54± 1.62,9.52±2.21,14.85 ±5.62,respectively,all P ＜ 0.01).Conclusion CAT is a reliable tool to measure the life quality of AECOPD patients and has certain relevance to the severity and prognosis of the disease.

Usefulness of COPD Assessment Test as valuable predictor of depression in chronic obstructive pulmonary disease / 동물의과학연구지

Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, including depression, which carries a higher risk of exacerbation and hospitalization in patients with stable COPD. A newly developed questionnaire, the COPD Assessment Test (CAT), was developed as an alternative to other complex, time-consuming tools for quantifying the symptom burden of COPD in routine practice. It is possible that the correlation between the CAT and depression scales could be useful for early evaluation and management of depression in COPD patients. Thus, we investigated the relationship between the CAT and depression as measured by the Patient Health Questionnaires-9 (PHQ- 9). We performed a retrospective observational COPD cohort study. A total of 97 patients were enrolled. The Korean versions of the CAT and PHQ-9 were completed for stable patients. A correlation analysis was performed between the PHQ-9 and CAT scores. Significant depression among the groups based on the 2011 GOLD guidelines occurred only in class Gold B and D patients (40% and 60%, respectively). The frequency of depression was significantly higher in the group with higher CAT scores (20~29 versus > or =30; odds ratio: 5.67 versus 22.66). Significant association was observed between the PHQ-9 and CAT scores (r=0.545 and P<0.001). As a result, the PHQ-9 score was significantly higher in COPD patients with a higher CAT score. The CAT is a simple and valuable predictor of depression in COPD patients, and it should be frequently used to detect COPD patients with depression in clinical practice.

Elaboration and validation of a diagrammatic scale to assess downy mildew severity in grapevine / Elaboração e validação de uma escala diagramática para quantificação da severidade do míldio da videira

The downy mildew, caused by Plasmopora viticola, is one of the most important grapevine (Vitis vinifera) diseases in Southern Brazil, causing defoliation and economic losses. The evaluation of disease severity is an important decision for adoption of strategies and tactics for disease control. Therefore, the objective of this work was to elaborate and to validate a diagrammatic scale to assess downy mildew severity in grapevine, respecting the limitations of visual acuity. The diagrammatic scale with seven levels of disease severity of 1, 3, 6, 12, 25, 50 and 75% was developed in two versions of black-and-white and color scale. The scales were tested and validated by eight raters with and without previous experience with grapevine downy mildew. The raters estimated the severity of 30 grapevine leaves with different downy mildew severity, with and without the use of the scales. Minimum, intermediate and maximum severity levels were collected according to Weber-Fechner's stimulus-response law. The accuracy and precision were analyzed by linear regression between the actual and the estimated severity. Actual severity was assessed with ASSESS(r) Program. The scales provided good levels of accuracy (means of 88%) and excellent levels of precision (means of 95%). The raters showed great precision and accuracy when used the diagrammatic scale. The color scale provided more precise and accurate estimates than the black-and-white scale. The scale proposed in this work presented appropriate applicability for downy mildew evaluation in grapevine.

O míldio da videira causado pelo fungo Plasmopora viticola é uma das doenças mais importantes da videira (Vitis vinifera) no sul do Brasil, causando desfolha e perdas econômicas. A avaliação da severidade de doenças é uma decisão importante na adoção de estratégias e táticas de controle. Assim, o objetivo deste trabalho foi elaborar e validar uma escala diagramática para a avaliação da severidade do míldio da videira, respeitando as limitações da acuidade visual. A escala diagramática com sete níveis de severidade: 1, 3, 6, 12, 25, 50 e 75%, foi desenvolvida em duas versões preto-e-branco e em cores. As escalas foram avaliadas e validadas por oito avaliadores com e sem experiência prévia com o míldio da videira. Os avaliadores estimaram a severidade em 30 folhas de videira com diferentes níveis de severidade da doença, com e sem experiência no uso da escala diagramática. Severidades mínimas, médias e máximas foram obtidas pela Lei do estímulo visual de Weber-Fechner. A acurácia e a precisão foram analisadas por meio de regressão linear, confrontando os valores de severidade reais com os estimados. A severidade real foi estimada pelo programa ASSESS(r). As escalas proporcionaram bons níveis de acurácia (média 88%) e excelentes níveis de precisão (média de 95%). Os avaliadores apresentaram grande precisão e acurácia com o uso da escala diagramática. A escala colorida proporcionou estimativa melhor de precisão e acurácia do que a escala preto-e-branco. A escala diagramática proposta apresenta apropriada aplicabilidade para a avaliação do míldio da videira.

Value of procalcitonin and high sensitivity C-reactive protein in early diagnosis of neonatal septicemia / 国际检验医学杂志

Objective Too investigate the application value of procalcitonin(PCT)and high sensitivity C-reactive protein(hs-CRP)in early diagnosis of neonatal septicemia and disease condition assessment.Methods 48 patients with neonatal septicemia treated in the hospital from November 2011 to May 2013 were collected.The data of PCT,hs-CRP and blood culture were recorded and performed the comparative analysis with the serum PCT,hs-CRP detection results in contemporaneous 48 neonates without septicemia.Results The serum PCT and hs-CRP was 93.75% and 10.42% in the neonates with septicemia,which were signifi-cantly higher than 79.17% and 50% in the neonates without septicemia(P <0.05),the positive rate had statistical difference be-tween the two groups.Conclusion PCT and hs-CRP have remarkable change in the early stage of neonatal sepsis,the combination detection of serum PCT and hs-CRP can be used as the indicators for early diagnosis of neonatal sepsis,moreover the sensitivity and specificity of PCT for diagnosing neonatal septicemia are higher the those of hs-CRP,their combined detection can provide fast and accurate diagnostic basis for clinic.

Value of CAT and mMRC in clinical evaluation of chronic obstructive pulmonary disease / 重庆医学

Objective To evaluate the health status ,dyspnea and exercise endurance in the patients with chronic obstructive pul-monary disease(COPD) by the CAT scale ,modified medical research council(mMRC) dyspnea scale and 6-min walk test(6MWT) and to analyze the correlation between their evaluation results with the percentage (FEV1% pred) of the forced expiratory volume at 1 second(FEV1) in the predict value and whether complicating pulmonary hypertension (PH) .Methods 70 patients with COPD were performed the examinations of the lung function ,CAT scale ,mMRC score and 6MWT .The correlation among the various e-valuation systems and between each evaluation system with the severity of the pulmonary function airway limitation were compre -hensively evaluated .The CAT scores ,mMRC scores and 6 min walking distance(6MWD) were compared between the COPD com-plicating PH group and the simple COPD group .Results The CAT scale was negatively correlated with 6MWD(r= -0 .623 ,P0 .05) .The CAT scores had statistical difference between the COPD complicating PH group and the simple COPD group (P<0 .01) .6MWD had the highest accuracy for screening COPD whether complicating PH ,followed by CAT .The diagnostic cut-off point by adopting CAT for judging the risk of COPD complicating PH was 21 .Conclusion The CAT scale has good correlation with 6MWD and no correlation with FEV1% pred .The CAT scale is more suitable for the overall assessment of the total severity of COPD .Patients with the high CAT scores have higher risk of suffering from PH .

Relationship between chronic obstructive pulmonary disease (COPD) assessment test score and prognostic factors of COPD patients / 第二军医大学学报

Objective To observe the correlation between chronic obstructive pulmonary disease (COPD) assessment test (CAT) score and prognostic factors, so as to investigate the value of CAT score in predicting the prognosis of COPD. Methods A total of 81 patients with newly diagnosed COPD in our hospital during Jul. 2011 to Sep. 2012, without using inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) or long-acting antimuscarinic agent (LAMA), were divided into group A (low risk, less symptoms), B (low risk, more symptoms), C (high risk, less symptoms) and D (high risk, more symptoms) groups according to Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2011 edition), and the patients were given ICS/LABA or ICS/LABA+ LAMA treatment for 3 months. The CAT score, age, smoking quantity, pulmonary function indices, body mass index (BMI), 6-min walking distance (6MWD), modified medical British research council (mMRC) dyspnea scale, and the times of acute exacerbation of COPD (AECOPD) in previous one year were collected before and after treatment. The clinical characteristics analysis and correlation analysis were performed. Results The average age of the 81 COPD patients was (66.27±8.52) years, with 88.89% being males and 85.19% having smoking history. The proportions of group A, B, C and D were 8.64%, 30.86%, 4.94% and 55.56% before treatment, repectively. The values of the forced expiratory volumein one second (FEV1), predicted amount as a percentage of FEV1 (FEV1%Pred), forced vital capacity (FVC), predicted amount as a percentage of FVC (FVC% Pred), peak expiratory flow (PEF), predicted amount as a percentage of PEF (PEF%Pred), and 6MWD in CAT score ≥ 10 groups were significantly less than those in CAT score 10 group (P < 0. 05). The above parameterswere not significantly different between patients with CAT score being 10-20, 20-30 and ≥ 30 groups. mMRC scale and times of AECOPD in CAT score ≥20 groups were significantly higher than those in CAT score 10 group (P < 0. 05). No significant difference in FEV1/FVC was found in different CAT score groups. The CAT score was significantly correlated with mMRC scale (pre-treatment r2 = 0. 417, P lt; 0. 001; post-treatment r2 =0. 19, P < 0. 001), 6MWD (pretreatment r2 = 0. 320, P < 0. 001 post-treatment r2 = 0. 19, P < 0. 001), pre-treatment FEV1 (r2 = 0. 177, P = 0. 001 5), FEV1 %Pred(r2 = 0. 125, P = 0. 002), PEF(r2=0. 164, P = 0. 002 4), PEF%Pred (r2=0. 129, P = 0. 007 6), FVC (r2 = 0. 098, P=0. 021), FVC%Pred (r2 = 0. 094, P = 0. 024), FEV1/FVC(r2 = 0. 101, P = 0. 005 7), and AECOPD number (r2 = 0. 059, P = 0. 028); and not correlated with the quantity of smoking (r2 = 0. 041, P = 0. 083), BMI (r2 =0. 00, P = 0.89), and post-treatment FEV1 (r2 =0. 01, P = 0. 22) or FEV1 %Pred (r2 =0. 003, P = 0. 09). Conclusion COPD is prone to occur in the male smokers, with the highest proportion found in group D. CAT score has a good correlation with pre- and pos-- treatment mMRC scale and exercise capacity, suggesting it has a potential for predicting prognosis of COPD.

The Cognitive Subscale of Alzheimer's Disease Assessment Scale (ADAS-Cog) for Patients with Alzheimer's Disease in Korea

BACKGROUND: This study was designed to examine the utility of the ADAS-Cog, Korean version (ADAS-K-cog) for staging of dementia in Alzheimer disease (AD). We also studied the possible influence of age, sex, and education on a ADAS-K-cog. METHODS: A total of 70 patients with AD meeting the NINCDS-ADRDA criteria of probable AD were recruited. The ADAS-K-cog was administered to all AD subjects. Each patient was also rated on the Global Deterioration Scale (GDS). The probable AD patients were divided into three groups based on their GDS stage to evaluate the sensitivity of ADAS-K-cog to disease severity and their mean scores on ADAS-K-cog were compared. RESULTS: The subjects' age range was 65~93 years and their education range was 0~16 years. The total score of ADAS-K-cog and each item score differed significantly between each groups. The item score of orientation, expressive language, word finding difficulty, comprehension of spoken language and the ADAS-K-cog total score could classify severity of early AD patients efficiently. ADAS-K-cog had high correlations with scores on the GDS (Pearson's r=0.732) and the Mini-Mental State Examination (Pearson's r=-0.755). Multiple regression analysis revealed that performance on the Korean ADAS- Cog was uninfluenced by age or gender, and neither by education level. It's language items were best for monitoring the progression of dementia. CONCLUSION: Our results indicated that the ADAS-K-cog is useful for staging of AD and uninfluenced by education level, sex and age.