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At least 217 records · Page 12Linked to original sources
PubMed2006

Significant clinical impact and prognostic stratification provided by FDG-PET in the staging of oesophageal cancer.

PURPOSE: To evaluate the clinical impact of FDG-PET in staging oesophageal cancer and whether this information improves prognostic stratification. METHODS: Impact was based on comparison of a prospectively recorded pre-PET plan with post-PET treatment in 68 consecutive patients undergoing primary staging. Survival was analysed using the Kaplan-Meier product limit method and the Cox proportional hazards regression model. RESULTS: FDG-PET findings impacted on the management of 27/68 patients (40%): in 12 therapy was changed from curative to palliative and in three from palliative to curative, while in 12 other patients there was a change in the treatment modality or delivery but not in the treatment intent. The median survival was 21 months, with post-PET stage and treatment intent both strongly associated with survival (p<0.001). Conventional stage was not able to clearly stratify this population. CONCLUSION: The use of FDG-PET for primary staging of oesophageal cancer changed the clinical management of more than one-third of patients and provided superior prognostic stratification compared with conventional investigations.

Adult↗
PubMed2026

Osteoarthritis phenotypes: advancing precision medicine through clinical, structural, and molecular stratification.

PURPOSE: Osteoarthritis (OA) is now understood as a heterogeneous syndrome driven by diverse biological, biomechanical, metabolic, genetic, and molecular mechanisms. This variability explains differences in disease progression and treatment response, challenging the traditional "one-size-fits-all" approach. This review highlights OA phenotyping as a key step toward precision medicine, focusing on clinical, structural, and molecular classifications that inform individualized care. METHODS: A narrative review was conducted using a non-systematic search of major databases and Osteoarthritis Research Society International sources (2010-2026). Evidence was thematically synthesized across clinical, imaging, and molecular domains to characterize OA phenotypes and their potential relevance to precision medicine. RESULTS: Multiple OA phenotypes were identified: inflammatory, metabolic, biomechanical, cartilage-subchondral, pain-sensitization, and aging/senescence. These exhibit distinct clinical features, risk factors, and therapeutic responses. Imaging-based phenotypes (e.g., inflammatory, meniscus-cartilage, subchondral bone, atrophic, hypertrophic) and molecular endotypes (low turnover, structural damage, systemic inflammation) further refine stratification. Pain-structure discordance is notable in sensitization phenotypes and may predict poorer surgical outcomes. Joint-specific variations and emerging genomic and epigenetic insights underscore disease complexity. Advances in imaging, biomarkers, and machine learning may enable earlier detection and patient clustering, though clinical application remains limited. CONCLUSION: Phenotype- and endotype-based classification represents a critical advancement toward precision OA management. Tailored interventions based on stratification hold promise for improving outcomes; however, clinical translation remains limited by overlapping phenotypes, lack of validated biomarkers, and inconsistent results from phenotype-driven trials. Wider clinical adoption requires standardized definitions, validation across joints, and integration of multimodal diagnostic tools into routine practice.

Humans↗
PubMed2006

Sampling and mapping a soil erosion cover factor by integrating stratification, model updating and cokriging with images.

Cost-efficient sample designs for collection of ground data and accurate mapping of variables are required to monitor natural resources and environmental and ecological systems. In this study, a sample design and mapping method was developed by integrating stratification, model updating, and cokriging with Landsat Thematic Mapper (TM) imagery. This method is based on the spatial autocorrelation of variables and the spatial cross-correlation among them. It can lead to sample designs with variable grid spacing, where sampling distances between plots vary depending on spatial variability of the variables from location to location. This has potential cost-efficiencies in terms of sample design and mapping. This method is also applicable for mapping in the case in which no ground data can be collected in some parts of a study area because of the high cost. The method was validated in a case study in which a ground and vegetation cover factor was sampled and mapped for monitoring soil erosion. The results showed that when the sample obtained with three strata using the developed method was used for sampling and mapping the cover factor, the sampling cost was greatly decreased, although the error of the map was slightly increased compared to that without stratification; that is, the sample cost-efficiency quantified by the product of cost and error was greatly increased. The increase of cost-efficiency was more obvious when the cover factor values of the plots within the no-significant-change stratum were updated by a model developed using the previous observations instead of remeasuring them in the field.

Cost-Benefit Analysis↗
PubMed2004

[Cardiovascular risk stratification in general practice].

CONCLUSION: The ESC risk charts are helpful to identify high risk patients in general practice who are candidates for preventive treatment. The use of the ESC charts is one important step to initiate "evidence based medicine" in the daily practice of preventive cardiology.Cardiovascular diseases are the most important causes of premature disability and death in Germany. High risk patients however are frequently not recognized. A systematic risk stratification in general practice could identify high risk persons and allow a cost effective treatment approach. The goal of the CAD-scoring week was to identify high risk persons with the use of the ESC risk charts and to evaluate the treatment resulting from risk stratification. In addition the feasibility of the risk charts in daily office routine was to be evaluated. A total of 1122 of 20 000 (5.6%) contacted general physicians agreed to participate in the screening procedure. More than 27 000 patients (> 50 yrs) were evaluated using the ESC risk charts. 21.6% of women (n = 15 018) vs 22.2%* of men (n = 12 361) had markedly elevated blood pressure (> 150 mmHg), 29 vs. 24%* had a total cholesterol > 250 mg/dl (6.5 mmol/l), 25.5 vs 29.9%* smoked and 28.4 vs. 31.9%* had diabetes (*female vs male: p < 0.0003). Altogether 19.4% of women vs. 53% of men were newly identified as high risk patients (risk > 20% in 10 years). More than 40% of these high risk patients received drug treatment for prevention (ASA, lipid lowering drugs or ACE inhibitors). More than 70% of the participating physicians judged the risk charts to be helpful in patient management.

Adult↗
PubMed2000

[Risk stratification in heart surgery: do risk scores facilitate the determination of indications?].

Various risk scores have been developed for the assessment of operative risk in cardiac surgery. Although risk stratification has been acknowledged as a useful tool to analyze trends in therapy and changes in patient populations, its relevance in assessing the indication for surgery has been questioned. It was the goal of this prospective study to compare 6 common risk scores with regard to the predictive value for mortality in individual patients. Between September 1998 and February 1999 all adult patients undergoing heart surgery were prospectively scored according to the following scores: initial Parsonnet, Cleveland Clinic, French, Euro, Pons, and the Ontario Province Risk score. Early lethality was assessed within 30 days postoperatively. Follow-up was completed in 504 patients. With the exception of the Ontario Province Risk score, lethality in the high risk group was overestimated by all scores, whereas lethality in low to moderate risk groups was underestimated by several scores. Mean scores of surviving and deceased patients showed a broad overlap with high standard deviations. Preoperative risk scores are effective tools for stratification of patient populations and the analysis of surgical outcome. With the aid of risk scores, operative risk can be sufficiently predicted for patient populations or subpopulations. The Euro score best predicted the outcome of our patients. However, when the indication for surgery is to be determined in an individual patient, risk scores should be only considered as an orientation in the decision process.

Adult↗
PubMed2006

[Sports medical aspects in cardiac risk stratification--heart rate variability and exercise capacity].

The present study investigates the association of the predicted CHD-risk (PROCAM) with the individual endurance capacity and heart rate variability (HRV) in a population-based sample of sedentary elderly. After stratification, in 57 men (48.1+/-9.5 yrs.) with an overall PROCAM-risk <10% (28.7+/-10.9 points) and 22 men (54.5+/-7.7 yrs.) with a coronary 10-year risk > or =10% (50.8+/-5.6 points) cycle ergometries and short-term HRV analysis of time (RRMEAN, SDNN, RMSSD) and frequency domain parameters (LF, HF, TP, LF/HF) were conducted. Additionally the autonomic stress index (SI) was calculated. Nonparametric tests were used for statistical correlation analysis (Spearman rho) and group comparisons (Mann-Whitney). For endurance capacity [W/kg] (r=-0.469, p<0.001), SDNN (r=-0.302, p<0.05), RMSSD (r= -0.311, p<0.05), LF (r=-0.325, p<0.05), HF (r= -0.311, p<0.05) and TP (r= -0.307, p<0.05) negative monotone correlations with the coronary score-risk were determined. Significant positive correlations were calculated for SI (r=0.476, p<0.001). Except for RRMEAN and LF/HF significant group differences (p<0.05) were computed for SDNN (30.0+/-20.0 vs 20.0+/-10.0 ms), RMSSD (22.2+/-18.3 vs 18.0+/-8.7 ms), LF (90.9+/-241.5 vs 41.35+/-81.1 ms(2)), HF (43.0+/-105.1 vs 18.0+/-27.0 ms(2)) and TP (189.0+/-457.1 vs 100.0+/-157.6 ms(2)). Significant differences (p<0.01) were evaluated for exercise capacity (2.4+/-0.5 vs 1.8+/-0.3 W/kg) and SI (90+/-183 vs 322+/-291). The results underline the predictive value of HRV analysis in risk stratification and outline the interrelation of a decreased exercise capacity and autonomic function with a raised individual 10-year cardiac risk. As an independent parameter of the vegetative regulatory state the stress index may contribute to an increased practical relevance of short-time HRV analysis.

Adult↗
PubMed2004

Procalcitonin: improved biochemical severity stratification and postoperative monitoring in severe abdominal inflammation and sepsis.

BACKGROUND: Infections and sepsis are among the most devastating complications in abdominal surgery and significantly contribute to morbidity and mortality. Early and reliable diagnosis of septic complications is notoriously difficult, and the search for novel approaches to overcome this problem is still a compelling issue for clinicians. Among a large array of inflammatory parameters, procalcitonin (PCT), the 116-amino-acid pro-peptide of calcitonin, has gained considerable importance in identifying patients at risk of developing infection and sepsis in clinical practice. METHODS: Along with the latest insights into pathophysiological aspects of this pro-hormone, the literature as well as our own experience on the usefulness of PCT determinations in patients with severe inflammatory abdominal disorders was reviewed. RESULTS: Although the term "sepsis" does not embrace the integral properties of PCT, a remarkable number of clinical studies have demonstrated the pivotal role of this parameter in the host response to microbial and fungal infections. In acute pancreatitis PCT allows early severity stratification and closely correlates with the development of subsequent pancreatic infections. In patients with peritonitis PCT reflects overall disease severity and is an early and reliable indicator of overall prognosis. Postoperative monitoring of PCT is a helpful tool to identify patients with evolving or persisting septic complications after elective and emergency abdominal surgery. CONCLUSIONS: Compared with established biochemical routine variables, PCT significantly contributes to earlier and better stratification of patients at risk of developing septic complications and provides excellent prognostic assessment in severe abdominal inflammation. The currently available test systems render PCT an applicable and readily available parameter under clinical routine and emergency conditions.

Abdomen↗
PubMed2005

Comparison of three methods to estimate genetic ancestry and control for stratification in genetic association studies among admixed populations.

Population stratification may confound the results of genetic association studies among unrelated individuals from admixed populations. Several methods have been proposed to estimate the ancestral information in admixed populations and used to adjust the population stratification in genetic association tests. We evaluate the performances of three different methods: maximum likelihood estimation, ADMIXMAP and Structure through various simulated data sets and real data from Latino subjects participating in a genetic study of asthma. All three methods provide similar information on the accuracy of ancestral estimates and control type I error rate at an approximately similar rate. The most important factor in determining accuracy of the ancestry estimate and in minimizing type I error rate is the number of markers used to estimate ancestry. We demonstrate that approximately 100 ancestry informative markers (AIMs) are required to obtain estimates of ancestry that correlate with correlation coefficients more than 0.9 with the true individual ancestral proportions. In addition, after accounting for the ancestry information in association tests, the excess of type I error rate is controlled at the 5% level when 100 markers are used to estimate ancestry. However, since the effect of admixture on the type I error rate worsens with sample size, the accuracy of ancestry estimates also needs to increase to make the appropriate correction. Using data from the Latino subjects, we also apply these methods to an association study between body mass index and 44 AIMs. These simulations are meant to provide some practical guidelines for investigators conducting association studies in admixed populations.

Asthma↗
PubMed1999

A genome-wide search for genes predisposing to familial psoriasis by using a stratification approach.

We have performed a genome scan, using markers spaced by 10 cM, in the search for psoriasis-susceptibility loci. The family material of 134 affected sibling pairs was ascertained on the basis of a population genetic study in which 65% of the probands had two healthy parents. Genotyping results were analyzed for non-random excessive allele-sharing between sib pairs by using GENEHUNTER ver 1.1. A stratification approach was applied to increase the homogeneity of the material by means of an operational definition of joint complaints among affected individuals. Significant linkage to the human leukocyte antigen region on chromosome 6p in a cohort including 42 families without joint complaints (nonparametric linkage score of 2.83, P=0.002) strongly supported the validity of this operational definition as it replicated results from an earlier linkage report with similar stratification criteria. New candidate regions on chromosomes 3 and 15 were identified. The highest non-parametric linkage values in this study, 2.96 (P=0.0017) and 2.89 (P=0.0020), were reached on chromosome 15 in a subgroup with joint complaints and on chromosome 3 in a subgroup without joint complaints. In addition, confirmation of previously reported loci was established on chromosomes 4q, 6p, and 17q. This study indicates that distinct disease loci might be involved in psoriasis etiology for various phenotypes.

Arthritis, Psoriatic↗
PubMed2006

Vertical stratification of the termite assemblage in a neotropical rainforest.

The importance of termites as decomposers in tropical forests has long been recognized. Studies on the richness and diversity of termite species and their ecological function have flourished in more recent times, but these have been mostly conducted in a thin stratum within a standing man's reach. Our aims were to evaluate the specific richness and composition of the termite assemblage in the canopy of a tropical rainforest and to determine its originality with respect to the sympatric ground-level fauna. We conducted systematic searches for canopy termites, together with conventional sampling of the sympatric ground-level fauna, in the San Lorenzo forest, Panama. We hypothesized that (1) the canopy accommodates two categories of wood-feeding termites (long-distance foragers and small-colony "one-piece" species) and possibly soil-feeders in suspended soil-like habitats; (2) due to the abundance of soil-feeders, the overall diversity of the ground fauna is higher than that of the canopy; (3) differences in microclimate and resource accessibility favour vertical stratification among wood-feeders. Sixty-three canopy samples yielded ten species of termites, all wood-feeders. Five of these were not found at ground level, although a total of 243 ground samples were collected, representing 29 species. In addition to long-distance foragers (Microcerotermes and Nasutitermes spp.) and small-colony termites (mostly Kalotermitidae), the canopy fauna included Termes hispaniolae, a wood-feeding Termitidae from an allegedly soil-feeding genus, living in large dead branches. Soil-feeders were absent from the canopy, probably because large epiphytes were scarce. As predicted, the ground fauna was much richer than that of the canopy, but the species richness of both habitats was similar when only wood-feeders were considered. Vertical stratification was strongly marked among wood-feeders, as all common species, apart from the arboreal-nesting Microcerotermes arboreus, could unequivocally be assigned to either a ground or a canopy group. The canopy, therefore, contributes significantly to the total species richness of the termite assemblage, and the diversity, abundance and ecological importance of canopy termites in tropical rainforests may be higher than previously recognized.

Animals↗
PubMed1998

Stratification in clinical trials of febrile neutropenia.

Patients with febrile neutropenia are characterized by well described prognostic factors leading to heterogeneity of risk of serious clinical outcomes. These prognostic factors complicate the design and interpretation of clinical trials of antimicrobial therapy in this population. Stratification is a method by which comparability of groups is ensured. This method can be employed prior to randomization or during the analysis. Factors that should be considered for stratification prior to randomization include the underlying neoplasm (leukemia vs solid tumor vs BMT), use of granulocyte growth factors, comorbid conditions and study site (in multicenter trials). In stratified analyses, trend in neutrophil count, site of infection, organism and susceptibility should be considered.

Anti-Bacterial Agents↗
PubMed2005

The effects of organic carbon, ammoniacal-nitrogen, and oxygen partial pressure on the stratification of membrane-aerated biofilms.

The purpose of this study was to examine the effects of different nutrient (carbon, nitrogen, oxygen) concentrations on the microbial activity and community structure in membrane-aerated biofilms (MABs). MABs were grown under well-defined conditions of fluid flow, substrate concentration, and membrane oxygen partial pressure. Biofilms were then removed and thin-sliced using a cryostat/microtome parallel to the membrane. Individual slices were analyzed for changes with depth in biomass density, respiratory activity, and the population densities of ammonia-oxidizing and denitrifying bacteria populations. Oxygen-sensing microelectrodes were used to determine the depth of oxygen penetration into each biofilm. Our results demonstrated that ammonia-oxidizing bacteria grow near the membrane, while denitrifying bacteria grow a substantial distance from the membrane. However, nitrifying and denitrifying bacteria did not grow simultaneously when organic concentrations became too high or ammonia concentrations became too low. In conclusion, membrane-aerated biofilms exhibit substantial stratification with respect to community structure and activity. A fundamental understanding of the factors that control this stratification will help optimize the performance of full-scale membrane-aerated biofilm reactors for wastewater treatment.

Ammonia↗
PubMed2004

Individualizing therapy in acute coronary syndromes: using a multiple biomarker approach for diagnosis, risk stratification, and guidance of therapy.

Patients with non-ST-elevation acute coronary syndromes (ACS) are typically grouped together and treated with similar approaches to therapy despite tremendous variability in clinical presentation and prognosis. The cardiac troponins are biomarkers of myocardial necrosis that have recently been evaluated in conjunction with markers of neurohormonal activation such as brain natriuretic peptide, and markers of systemic inflammation such as C-reactive protein, to further characterize risk in the individual patient presenting with ACS. Measurement of biomarkers that reflect different components of the underlying pathophysiology appears to provide independent and complementary risk stratification information in patients with non-ST-elevation ACS. This review summarizes the rationale for a multimarker approach to risk stratification in ACS and also discusses other cardiac biomarkers under active investigation. One of these of particular interest is soluble CD40 ligand, a biomarker that may not only indicate active inflammation and platelet activation associated with ACS, but may also exhibit direct prothrombotic properties that mediate early atherogenesis, plaque rupture, and thrombosis.

Angina, Unstable↗
PubMed2004

Risk Stratification in Patients with Unstable Angina and Non-ST-elevation Myocardial Infarction.

Risk stratification in acute coronary syndromes is important both for prognosis and for treatment. Consistently, using any of a variety of clinical predictors of risk, patients at highest risk for poor outcomes derive the greatest benefit from aggressive therapy with early coronary angiography, glycoprotein IIb/IIIa antagonists, or low molecular weight heparins. By contrast, patients at low risk may be managed conservatively without long-term impact on their risk of death or myocardial infarction. Several clinical and laboratory parameters have been identified as independent, powerful predictors of poor outcome, helping to distinguish high-risk from low-risk patients. Although not a substitute for astute clinical judgment, risk prediction scores may help clinicians to synthesize the relevant clinical data at presentation into an overall assessment of risk, allowing for cost-effective utilization of therapies that add significant expense and morbidity. With the ever-expanding range of pharmacologic and interventional therapies that impact the treatment of patients with unstable angina and non-ST-elevation myocardial infarction (NSTEMI), risk stratification will become increasingly important in targeting therapies to those who are likely to achieve the most benefit. In this review, we first consider the identifiable components of risk in patients presenting with unstable angina or NSTEMI and then evaluate the emerging information regarding differential response to treatment based on the presence of these risk factors.

Journal Article↗
PubMed1981

Surgical wound infection occurrence in clean operations; risk stratification for interhospital comparisons.

A five year prospective study of surgical wound infection complicating eight clean elective operations was carried out in 9,108 community hospital patients by detailed stratification of risk. Remote infection, diabetes mellitus and/or operations lasting beyond 4 hours characterized high risk patients with disparate surgical wound infection rates of 1.7 percent to 7.9 percent for individual operations. Absence of these three factors defined a low risk population with statistically similar rates of 0.8 percent to 2.8 percent for the different operations, with an over-all rate of 1.5 percent. Low and high risk definitions derived from observations in eight hospitals in 1975-1977 were predictive in 12 hospitals in 1978-1979. Both classes of patients with surgical wound infection had prolonged postoperative hospitalization. Staphylococcus aureus was recovered from 50 percent of the surgical wound infections in low risk patients with hernia repair, hip fracture repair, hip prosthesis, laminectomy and mastectomy operations and from 5 percent with cesarean section, femoropopliteal bypass and hip replacement procedures (P less than 0.001). In nine high risk patients, bacteria recovered from remote infections were also present in surgical wound infections. Comparison of the occurrence of surgical wound infections in clean operations in different hospitals may be made more meaningful by stratification or risk factors and analysis of expected infecting bacteria.

Bacterial Infections↗
PubMed1978

Stratification of inspired air in the elongated lungs of the carpet python, Morelia spilotes variegata.

Using lung gas tensions via a triple lumen catheter to monitor ventilation distribution (VA) and radioactive techniques to study blood flow distribution (Q), the distribution of ventilation to perfusion ration (VA/Q) was studied in the elongated alveolar lung of the Carpet Python, Morelia spilotes variegata. In the resting, sleeping and agitated states both alveolar oxygen (PAO2) and carbon dioxide tensions (PACO2) were 'stratified' (unevenly distributed) within the alveolar lungs at end inspiration, during breath holding for up to 6 minutes and, when VA was low, at end expiration. The blood flow was also stratified. The degree of stratification of VA was influenced by the rate and depth of breathing and the length of the breath hold which preceeded the gas sampling. Similar results were obtained with a glass lung model. In both resting and sleeping states VA/Q ratios were similar over the proximal 75% of the alveolar lungs whereas VA nearly always exceeded Q over the distal 25%. The anatomic features of the lung are proposed as a possible mechanism for maintaining a uniform VA/Q distribution. Since the anatomical arrangement places the heart at the apical regions of the lungs, absence of cardiac mixing, combined with low respiratory rates, enables stratification to continue for very long periods within the aveolar lungs of the snake.

Animals↗
PubMed1989

Long-term survival and risk stratification in patients with angina at rest undergoing medical treatment.

In order to determine those factors which influence long-term prognosis in patients with angina at rest associated with transient ST-segment changes, 217 patients undergoing medical treatment were followed for a mean of 39 months. All patients underwent coronary arteriography. Univariate analysis identified 12 variables significantly related to prognosis. These were disease of the left main coronary artery; the number of diseased vessels; left ventricular end-diastolic pressure; ejection fraction; baseline electrocardiogram; presence of prior myocardial infarction; ST-segment depression and ventricular arrhythmias during pain; disease of the proximal anterior descending coronary artery; crescendo angina; hypertension; and age. Use of the Cox regression model for survival analysis revealed only 3 variables which were independent predictors of prognosis. They were disease of the left main coronary artery; the number of diseased vessels and left ventricular end-diastolic pressure. The model allowed stratification of patients into 3 groups. Survival at 3 years was 98% in the low risk group; 82% in the intermediate risk group; and 58% in the high risk group. These data indicate that disease of the left main coronary artery, the number of diseased vessels and left ventricular end-diastolic pressure are the independent predictors of prognosis in angina at rest. These variables may allow stratification of patients into groups having different long-term survivals.

Adult↗