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PubMed2005

Breast carcinoma malignancy grading by Bloom-Richardson system vs proliferation index: reproducibility of grade and advantages of proliferation index.

Questions of reproducibility and efficacy of histologic malignancy grading relative to alternative proliferation index measurements for outcome prediction remain unanswered. Microsections of specimens from the Cooperative Breast Cancer Tissue Resource (CBCTR) were evaluated by seven pathologists for reproducibility of grade and classification. Nuclear figure classification was assessed using photographs. Grade was assigned by the Bloom-Richardson method, Nottingham modification. Proliferation index was evaluated prospectively by deoxyribose nucleic acid precursor uptake with thymidine (autoradiographic) or bromodeoxyuridine (immunohistochemical) labeling index using fresh tissue from 631 node-negative breast cancer patients accessioned at St Luke's Hospital. A modified Nottingham-Bloom-Richardson grade was derived from histopathologic data. Median post-treatment observation was 6.4 years. Agreement on classification of nuclear figures (N=43) was less than good by kappa statistic (kappa=0.38). Grade was moderately reproducible in four trials (N=10,10,19, 10) with CBCTR specimens (kappa=0.50-0.59). Of components of Bloom-Richardson grade, agreement was least for nuclear pleomorphism (kappa=0.37-0.50), best for tubularity (kappa=0.57-0.83), and intermediate for mitotic count (kappa=0.45-0.64). Bloom-Richardson grade was a univariate predictor of prognosis in node-negative St Luke's patients, and was improved when mitotic count was replaced by labeling index (low, mid, or high). When labeling index was added to a multivariate model containing tumor size and vessel invasion, grade was no longer a significant predictor of tumor-specific relapse-free or overall survival. Mitotic index predicted best when intervals were lowered to 0-2, 3-10, and >10 mitotic figures per ten 0.18 mm(2) high-power fields. We conclude that Nottingham-Bloom-Richardson grades remain only modestly reproducible. Prognostically useful components of grade are mitotic index and tubularity. The Nottingham-Bloom-Richardson system can be improved by lowering cutoffs for mitotic index and by counting 20-30 rather than 10 high-power fields. Measurement of proliferation index by immunohistochemically detectable markers will probably give superior prognostic results in comparison to grade.

Breast Neoplasms↗
PubMed1993

American Urological Association symptom index for women with voiding symptoms: lack of index specificity for benign prostate hyperplasia.

An evaluation of the American Urological Association (AUA) symptom index was recently published as a valid symptom score for benign prostatic hyperplasia (BPH). To determine the specificity prospectively of the index for BPH and bladder outlet obstruction, we chose to administer the index to 38 consecutive women with voiding symptoms who were previously scheduled for video urodynamic evaluation. In each case the index was self-administered before the urodynamic study. Index determination was then repeated 1 to 4 months after the institution of therapy. Only 3 of the 38 women demonstrated true urethral obstruction. One patient exhibited urethral compression after a pubovaginal sling urethral suspension, 1 with multiple sclerosis demonstrated detrusor external sphincter dyssynergia and 1 suffered bladder neck obstruction caused by a leiomyoma. The AUA symptom index for the 35 nonobstructed women ranged from 4 to 33 (mean 17.6) Of the women 15 scored between 8 and 18, while 14 had a score of greater than 18. The mean score decreased to 9.4 after the institution of therapy, which included bladder suspension surgery, anticholinergics, timed voiding and pelvic floor exercises. Of the 3 women with bladder outlet obstruction the mean score was 22.7 before and 11.0 after therapy. A greater decrease in the AUA symptom index occurred among the obstructed group after urological therapy compared to the nonobstructed group. Our results indicate that the AUA symptom index is not specific for BPH. The index score for the women in our study rivaled the scores reported for men with BPH.

Adult↗
PubMed2001

Doppler echocardiography-derived index of myocardial performance (TEI index): comparison with brain natriuretic peptide levels in various heart disease.

Plasma brain natriuretic peptide (BNP) has diagnostic and prognostic value in heart failure. Cardiac dysfunction varies from systolic or diastolic dysfunction alone to the combination of both. In the present study, Doppler echocardiographic parameters, including the Doppler echocardiography-derived index (TEI index), were compared with plasma BNP levels in 74 patients with various heart diseases. Blood sampling was performed before an echocardiographic examination was conducted. The TEI index was defined as the summation of isovolumic contraction and relaxation time divided by ejection time. In patients with left ventricular (LV) systolic dysfunction (ejection fraction <50%), the TEI index and BNP were increased significantly compared with patients with normal LV systolic function (p<0.05). Patients with a TEI index > or =0.45 showed significantly increased BNP levels compared with patients with a TEI index <0.45, irrespective of LV systolic function (241.4+/-451.2 vs 65.9+/-81.8pg/ml; p<0.05). The TEI index was significantly higher in patients with a BNP > or =73pg/ml than in patients with BNP <73pg/ml (0.57+/-0.24 vs 0.46+/-0.17; p<0.05). Other echocardiographic parameters did not correlate significantly with levels of plasma BNP. Of the echocardiographic parameters, a simple Doppler index (TEI index) that combines systolic and diastolic function can detect LV dysfunction in patients with high levels of plasma BNP in various heart diseases.

Adolescent↗
PubMed1992

Indexing the sequence libraries: software providing a common indexing system for all the standard sequence libraries.

We describe a set of programs for creating and using indexes for the distributed forms of the major sequence libraries. The indexes conform to the specification of those distributed on cd-rom by the EMBL sequence library. The programs create entry name, accession number, author and freetext indexes and a brief directory index. If a suitable application program is given an entry name or accession number these indexes allow rapid retrieval of sequences or annotation. Similarly the author and freetext indexes provide the data for extremely fast searching on author names and "keywords". The indexing programs can create indexes for EMBL, Swiss-Prot, GenBANK, PIR and NRL3d libraries. We also describe the organisation and use of the different sequence libraries and their index files.

Abstracting and Indexing↗
PubMed2000

[Application of mitotic index and proliferating cell nuclear antigen index in monitoring the change of rat endometrium after administration of estrogen and progestin].

OBJECTIVE: To investigate the mitotic index (MI) and proliferating cell nuclear antigen (PCNA) index in monitoring the rat endometrium during estrogen and progestin administration. METHODS: One hundred and sixty Sprague-Dolly rats were randomly divided into seven groups. The 1st and 2nd group were normal estrous (E) and ovariectomized (OVX) control. The other groups received estradiol (E2V) only or combined with medroxyprogesterone(MPA) which imitated the clinical regimen in different dosage and different time before sacrificed. Uteri sections were stained with HE and immunohistochemical procedures to detect mitosis and PCNA. RESULTS: The MI and PCNA index were similar in the luminal and glandular cells. Both markers were low in the two control groups and increased with the E2V dosage in the treatment group. But if E2V was given for 1 to 21 days, the MI increased during the first 3 days and then dropped to low level and kept to the end. PCNA index increased in the first 3 days and decreased to a low level on the 4th day and then increased gradually to a high level until the last day. In the continuous regimen, both markers decreased as the MPA dosage increased. In the cyclic regimen, The MI reached to a significant low level nearly to zero in almost each ratio. Addition of MPA for 10 days, PCNA index at the ratio of 1:4.0 could be reduced to a low level and addition for 5 days, PCNA index in each subgroup was still as high as the positive control even though the dosage of MPA increased several times to 1:8.0. CONCLUSIONS: This study suggests that PCNA index can reflect both the effect of estrogen and progestogen. PCNA index is better than mitotic index in reflecting the change of endometrium.

Animals↗
PubMed1996

Body mass index (BMI) is a reliable index to estimate obesity as a risk factor for deteriorating health.

The objective of this study was to find out what index is appropriate to evaluate obesity, by measuring body fat using bioelectrical impedance analysis (BIA). Subjects in this study were 74 women, aged 44 to 73, living in Tokushima prefecture. The means +/- standard deviation (SD) of Broca index, Body mass index (BMI) and body fat were 103 +/- 14.3%, 23.0 +/- 2.8 kg/m2 and 28.1 +/- 5.5%, respectively. In addition, their clinical data such as blood pressure, glutamate-pyruvate transaminase activity (GPT), triglycerides (TG) and fasting blood sugar (FBS) were within normal ranges. When compared with correlation between obesity indices (Broca index or BMI) and height, there was a negative correlation between Broca index and height (= -0.447). Furthermore, the number of obese subjects estimated by Broca index was less than that of obese subjects estimated by BMI. Although both Broca index and BMI showed higher correlations with body fat estimated by BIA, BMI (r = 0.927) showed a higher correlation compared to that of Broca index (r = 0.875). These results suggest that BMI is a reliable index to evaluate the body fat.

Adipose Tissue↗
PubMed2005

Analysis of the WAIS-III Index score scatter using the significant deviation from the mean of the four Index scores.

Despite their validity and their potential clinical interest, the WAIS-III Index scores seem less used by clinicians than the traditional IQs. One of reason of this lack of interest in the Indices is the relative complexity of their interpretation. We advocate the use of the average index score as a baseline to analyze the Index score variability and to identify strengths and weaknesses in the profile of the Index scores. Davis's formula provides reference values to be used to highlight the Index scores significantly moving away from the baseline. The usefulness of this method is illustrated with the analysis the Index score scatter in the standardization sample of the French adaptation of the WAIS-III. A rather important dispersion of the Index scores around the average index score was observed, a large percentage of standardization sample showing one or two Index scores significantly different from the baseline.

Adolescent↗
PubMed2006

Left ventricular geometry in normal and post-anterior myocardial infarction patients: sphericity index and 'new' conicity index comparisons.

BACKGROUND: Anterior myocardial infarction leads a sequence of structural changes that alter the size and the shape of the left ventricle. Efforts to assess shape have been made by global left ventricular (LV) chamber analysis (sphericity index, SI) but this analysis does not detect regional shape abnormalities like those at the apical level, which precede global ventricular dilatation. OBJECTIVE: The present study will introduce a new analysis of regional apical changes in 52 normal subjects and in 92 patients with previous anterior myocardial infarction. METHODS: All patients had transthoracic echocardiogram and multiple views were obtained (long axis, 4CH, 2CH and short axis view). From the 4CH view the long and the short axes were measured and their ratio was calculated (sphericity index). In the same view, the apical axis length was also measured and the ratio between apical and short axis length was calculated (apical conicity index, ACI). RESULTS: Patients had all the measured parameters significantly worse than normal, except the sphericity index which remained unchanged. Ventricular length and width increased following anterior MI but the ratio between the two measurements did not change. Conversely, apical conicity index is significantly different following anterior MI, thereby indicating anterior infarction produces a less conical shape. SI and ACI differed when correlations were made in the relationship of mitral valve function; SI correlates with the degree of mitral regurgitation (MR) and with the distance of papillary muscles, conversely ACI shows an inverse correlation with the determinants of mitral regurgitation. These observations reflect differences between apical versus global dilatation in ischemic cardiomyopathy, so that mitral function is better (lower tenting area and lower coaptation height) when the apex is markedly dilated in respect to the short axis (high conicity index). In contrast, mitral function is impaired (bigger distance between papillary muscles and higher degree of mitral regurgitation), when sphericity index is high. CONCLUSIONS: Sphericity index fails to detect regional apical shape abnormalities. To address this focal change, we introduce a simple new measure termed apical conicity index, which is abnormal in patients with myocardial infarction, and can be useful to evaluate changes induced by the subsequent surgical approach of ventricular re-shaping.

Adult↗
PubMed2005

Evaluation of Tissue Doppler Tei index for global left ventricular function in mice after myocardial infarction: comparison with Pulsed Doppler Tei index.

AIM: The Pulsed Doppler Tei index is a parameter to evaluate combined systolic and diastolic function in humans. However, one major limitation is that the parameters of Pulsed Doppler Tei index cannot be measured within one cardiac cycle. Therefore, accuracy of the Pulsed Doppler Tei index may be affected by anesthesia induced heart rate variation in mice echocardiography. Tissue Doppler Imaging (TDI) enables us to measure both relaxation and contraction velocities simultaneously. Thus, the aim of our study was to validate TDI and Pulsed Doppler Tei index and their reproducibility in mice after experimental anterior myocardial infarction (MI). METHODS AND RESULTS: Pulsed Doppler Tei index and TDI Tei index were assessed before and 4 weeks after MI. Both parameters increased significantly after MI (Pulsed Doppler: 0.4+/-0.04 to 0.7+/-0.03; P<0.001; TDI: 0.2+/-0.03 to 0.5+/-0.04; P<0.0001). In addition, TDI Tei index showed a good correlation with ejection fraction and fractional shortening, and was indicated by better reproducibility than Pulsed Doppler Tei index. CONCLUSION: Tissue Doppler Tei index is appropriate to characterize global left ventricular function in mice after MI.

Animals↗
PubMed2002

The "Adequacy of Prenatal Care Utilization" (APNCU) index to study low birth weight: is the index biased?

A recent, nationwide study of 54 million births reported increasing trends toward more prenatal resource utilization from 1981 to 1995, when other indicators have shown worsening trends in birth outcomes. The Adequacy of Prenatal Care Utilization (APNCU) Index was used to measure resource utilization, but the Index appears to be biased because women grouped in the intensive category have the highest rates of low birth weight (LBW). The objective of this paper is to provide a systematic examination of the Index and to uncover biases that may preclude its use in analyzing the association between resource utilization and birth outcomes. This is a cross-sectional study including all singleton live births in 1993 through 1996 (n = 591,403) in Ohio. Birth certificate data are used to derive the Index, which categorizes women as follows: Adequate Plus (A+), Adequate, Intermediate, and Inadequate. The Index is based on the ratio of observed to expected (O/E) number of prenatal visits. The expected number of visits is based on the American College of Obstetricians and Gynecologists (ACOG) recommendations. The Index also considers the month of initiation of prenatal care. The outcome measures are low birth weight (LBW) and small-for-gestational age (SGA). The LBW rate is 11.8% in the (A+) category, compared to 9.4% in the Inadequate category, and 3.3% and 3.5% in each of the Intermediate and Adequate categories, respectively. Preterm births are disproportionately represented in the (A+) category: 61.2% of births prior to 37 weeks are (A+), whereas only 18.9% of term births are (A+). This apparent bias results from the fact that the ACOG schedule of prenatal visits allocates nearly one third of the total visits to the last 4-5 weeks of gestation. A shorter gestational age implies fewer number of expected visits, a smaller denominator in the O/E ratio, and O/E ratios exceeding 100% by large margins. In fact, the observed number of visits exceeds the expected number of visits by only one or two in 40.1% of all births grouped in the (A+) category. Consequently, the Index yields misleading results indicating that women grouped in the (A+) category (or O/E ratios > 110%) are most likely to deliver LBW infants. Contrary to the results obtained through the APNCU Index, our gestational age-specific analysis showed that increasing number of prenatal visits is associated with improved birth outcomes. We recommend that the use of the APNCU Index to study the association between prenatal resource utilization and LBW be discontinued.

Adult↗
PubMed2005

Ankle brachial index, C-reactive protein, and central augmentation index to identify individuals with severe atherosclerosis.

OBJECTIVES: We examined the ability of ankle brachial index, C-reactive protein and central augmentation index to identify individuals in the general population with severe atherosclerosis, diagnosed as those with ischaemic cardiovascular disease. METHODS AND RESULTS: We examined 4159 randomly sampled individuals from the Danish general population, of which 250 had severe atherosclerosis. After adjustment for gender and age, individuals with ankle brachial index of 0.71-0.90 and <0.70 vs. 0.91-1.10 had odds ratios for severe atherosclerosis of 1.6 (95%CI:1.1-2.3) and 2.9 (1.9-4.6), respectively. C-reactive protein of >3.0 or 1.0-3.0 mg/L vs. <1.0 mg/L as well as central augmentation index in quintiles did not identify individuals with severe atherosclerosis, and did not improve further the ability of ankle brachial index to identify such individuals. On a continuous scale using receiver operating characteristics curves, presence of severe atherosclerosis was predicted by ankle brachial index (P=0.00000003), C-reactive protein (P=0.000003), as well as central augmentation index (P=0.001); these three curves did not differ. CONCLUSION: Ankle brachial index <0.9 identify individuals with severe atherosclerosis in the general population, while C-reactive protein in three groups and central augmentation index in quintiles did not. On a continuous scale, all three variables predicted severe atherosclerosis.

Adult↗
PubMed2004

Application of Bispectral Index and Narcotrend index to the measurement of the electroencephalographic effects of isoflurane with and without burst suppression.

BACKGROUND: The Narcotrend monitor (MonitorTechnik, Bad Bramstedt, Germany) has recently been introduced as an intraoperative monitor of anesthetic state, based on a classification scheme originally developed for visual assessment of the electroencephalogram. The authors compared the performance of the Narcotrend index (software version 4.0) to the Bispectral Index (BIS, version XP; Aspect Medical Systems, Natick, MA) as electroencephalographic measures of isoflurane drug effect during general anesthesia. METHODS: The authors observed 15 adult patients scheduled to undergo radical prostatectomy with a combined epidural-isoflurane general anesthesia technique. At least 45 min after induction of general anesthesia, during a phase of constant surgical stimulation, end-tidal isoflurane concentrations were varied between 0.5 and 2.0 multiples of minimum alveolar concentration, and the BIS and the Narcotrend index were recorded. The prediction probability (PK) was calculated for the BIS and the Narcotrend index to predict isoflurane effect compartment concentration for each measure. The correlation analysis of the BIS and the Narcotrend index with the isoflurane effect compartment concentration was obtained by pharmacodynamic modeling based on two sigmoidal curves to account for the discontinuity in both indices with the onset of burst suppression. RESULTS: The prediction probabilities were indistinguishable (BIS PK = 0.72 +/- 0.07 (mean +/- SD); range, 0.61-0.84; Narcotrend index PK = 0.72 +/- 0.10; range, 0.51-0.87), as were the correlations between the electroencephalographic measures and isoflurane effect compartment concentrations (BIS R = 0.82 +/- 0.12; Narcotrend index R = 0.85 +/- 0.09). The pharmacodynamic models for the BIS and the Narcotrend index yielded nearly identical results. CONCLUSIONS: The BIS and the Narcotrend index detected the electroencephalographic effects of isoflurane equally. Combining two fractional sigmoid Emax models adequately described the data before and after the onset of burst suppression.

Aged↗
PubMed1997

[Risk indices in geriatric surgery: ASA index versus Reiss index].

The use of the Risk Index in surgery is aimed to plan surgical strategy in order to achieve a better postoperative prognosis. This is especially true in geriatric surgery where the ASA Index and, more recently, the Reiss Index are widely employed. Since the mentioned Risk Indices are calculated on the basis of different factors, in this study we compared the two Risk Indices with the aim of verifying which index offers better prognostic indications. 210 patients, aged over 70 years, undergoing surgical treatment, were investigated. The patients were grouped according to the ASA and Reiss Indices. The ASA Index showed good correlation only with postoperative mortality. The three classes of Reiss Index showed a significant correlation with the incidence of post-operative morbidity and mortality (p.o. morbidity: 7.1%, 21.5%, 30.3%; p.o. mortality; 1.7%, 9.2%, 24.2% -Chi 2 = 20.7; p < 0.001). Our results support the hypothesis that Reiss index offers better prognostic evaluation of postoperative outcome, suggesting its use in assessing postoperative prognosis in geriatric patients. In addition, our observation confirms the criticism reported of the ASA Index, merely considered as an indicator of health status regardless of surgical treatment. In conclusion, routine preoperative evaluation of the Reiss Index should be advised in geriatric patients with the aim to forecasting surgical risk in the first place, and them modifying operative strategy in order to improve postoperative results.

Age Factors↗
PubMed1996

Development of a symptom severity index and a symptom impact index for stress incontinence in women.

Stress incontinence is a common problem among women, yet there is no adequately validated instrument for measuring women's views of its severity (disease-specific health status). The only instrument for measuring the impact or bothersomeness of symptoms (disease-specific quality of life) has poor internal consistency. This paper describes the development and psychometric assessment of two new indexes, a Symptom Severity Index and a Symptom Impact Index. Following several qualitative enquiries, a questionnaire was developed and administered to 442 women undergoing stress incontinence surgery. The face and content validity of the items comprising the indexes was good. The Severity Index (0-20) showed good variability (median 14, interquartile range 6) and adequate internal consistency (alpha 0.76). The Impact Index (0-12) also had good variability (median 5, interquartile range 3.5) and internal consistency (alpha 0.80). Convergent and discriminant validity were demonstrated for both indexes. Test-retest reliability was high. While responsiveness is still to be tested, the two indexes are psychometrically strong and can be used to measure the severity and impact of stress incontinence in women.

Adult↗