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[Main principals of clinical diagnosis formation in peritonitis].

Based on great clinical experience (more 1000 patients) the author makes attempt to standardize classification of peritonitis. Bearing in mind the critical analysis of available peritonitis classifications, it is proposed to divide toxic phase of peritonitis (by K.S. Simonyan) into two variants--with poliorganic insufficiency or without it. This elaboration permits to make the treatment of the patients with general peritonitis more detailed. Besides, the changes were made in division of peritonitis by degree of generalization along peritoneum, it is proposed to distinguish only 4 types by abdominal exudate character that also determine the actions of surgeon. Individual surgical situations in various forms and types of peritonitis are analyzed. The own model of peritonitis classification permits to receive comparable immediate results of treatment.

Diagnosis, Differential↗

[Variants of chronic heart failure in ischemic heart disease patients and optimization of their treatment].

Computer-assisted classification of hemodynamic data was performed in 172 patients with coronary heart disease aggravated by chronic heart failure. Six groups of patients have been identified, and an individual treatment algorithm has been proposed for each of those. The use of optimum individual treatment schedules has produced good or satisfactory clinical effect in 87.3%.

Adult↗

[A preliminary study of angiographic classification and treatment of central arteriovenous malformations in jaws].

OBJECTIVE: To elaborate on the angiographic classification of central arteriovenous malformations (AVMs) in jaws, and to evaluate the correlation between this classification and treatment options. METHODS: X-ray films and angiograms of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of radiolucency, feeding arteries, nidus of the malformations and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation between this classification and treatment options. RESULTS: The angiographic pictures of 25 cases with central AVMs could be divided into five types: type I (n = 5) was with merely diffused micro-arteriovenous fistulas (AVFs); type II (n = 8) demonstrated a large venous pouch, all the feeding arteries drained into it; type III (n = 7) had a large venous pouch together with diffused micro-AVFs (I + II); type IV (n = 2) had multiple venous pouches; type V (n = 3) had multiple venous pouches and diffused micro-AVFs (I + IV). The angioarchitecture corresponded well to the radiographic appearance in all except one case. With respect to the treatment, type II, III, IV AVMs gained clinical cure in 100% of cases, whereas type I and type V AVMs obtained clinical cure only in 3 of 5 and 1 of 3 cases respectively. CONCLUSIONS: Central AVMs in jaws exhibited variant patterns of angioarchitecture, which could be divided into five types. Elaboration of this classification was helpful for decision-making on choosing appropriate therapy.

Adolescent↗

The nosology of rosacea.

The National Rosacea Society (NRS) convened a committee of dermatology thought leaders to develop a standard classification system for rosacea. Based on the primary and secondary characteristics of this disorder, the NRS Expert Committee identified 4 types of rosacea: erythematotelangiectatic, papulopustular, phymatous, and ocular; one variant, granulomatous, also was recognized. The NRS Expert Committee also developed a grading system for rosacea signs and symptoms that will complement this classification system. The classification system and forthcoming grading system will help practitioners refine their diagnosis and treatment of rosacea to ensure better outcomes for patients.

Humans↗

[Evaluation of the results of surgery of intracranial supratentorial tumors in 363 children over the past 50 years (1948-1997)].

At the Department of Neurosurgery, Hradec Králové, in the course of 50 years (1948-1997) 363 children, 199 boys and 164 girls (1.2:1) aged under 18 years were operated on for intracranial supratentorial tumours. The average age in children at the time of first operation was 9.3 years; most frequently they participated those of 8 and 11 to 14 years of age. Children aged 1, 2 and 3 years constituted 4.7%, 4.4% and 5% of operations. The tumours were located in: cerebral hemispheres 123 (33.8%), lateral ventricles 17 (4.7%), IIIrd ventricle 5 (1.4%), hypothalamus 26 (7.2%), thalamus 19 (5.2%), basal ganglia 24 (6.6%), sellar region 86 (23.7%), chiasmatic region 38 (10.5%) and pineal region 19 (5.2%). 223 of tumours (61.4%) were located in the midline and 140 of them (38.6%) laterally (in hemispheres and lateral ventricles of the brain). 268 of tumours were histologically verified (73.8%) and 95 of cases were evaluated according to the neurosurgeon's point of view and/or to the clinical and CT controls (26.2%), because of the biopsy (especially in the pre-CT era) was highly riskfull. Histological typing of tumours was retrospectively reevaluated according to the present WHO classification. Summarized 53 types of tumours were differentiated. The most frequent lesions were various variants of astrocytic gliomas (135 = 37.2%). Further on the craniopharyngiomas dominated (73 = 20.1%). The tumours were operated on through craniotomies 299 times, by primarily drainage operations 52 times, functions 6 times, stereotactically 8 times and or by combination of these operations 82 times. Reoperation was needed for postoperative complications in 1.7% (6 times) and for delayed recurrence in 11.3% (41 times). The postoperative mortality (up to 1 month after initial surgery) was in 156 children operated on in pre-CT era (between 1948 and 1977), as compared with 207 children operated on in the era of CT (between 1978 and 1997) in astrocytomas 3.8:0%, pilocytic astrocytomas 6.5:2.8%, craniopharyngiomas 15.4:0% and in all tumours 12.2:2.9%. 16 children with orbital tumours (the average age 5.8 years) operated on with orbitofrontal approach were also evaluated. 14 of them survive for 5-37 years (on the average 16.6 years). The chronological development of diagnostic and operative processes of supratentorial tumours in children's care is discussed. The prognostic elements of present histobiological classification of tumours are positively evaluated.

Adolescent↗

[Wounds and injuries to the colon].

On the basis of a retrospective analysis of results of treatment of 1097 patients with wounds and injuries of the colon of the peace and war time as well as of experiments in 160 dogs it has been established that the level of lethal outcomes and amount of complications are dependent on the size, number and localization of the colon wounds, severity of peritonitis by the moment of primary operation, degree of traumatic shock, blood loss volume, severity of the coexisting injuries and the chosen method of surgical treatment. A classification of the wounds according to the volume of injuries of the colon is proposed. Different variants of surgical treatment and outcomes are considered. Experiments in dogs have shown the indisputable effectiveness of precise one-row sero-musculo-submucous sutures with the present-day sutural material as compared with other methods of treatment of wounds of the colon. The peritoneal sorption with liquid colloid sorbents at the early postoperative period facilitate the prophylaxis and treatment of peritonitis, reduce lethality. A surgical classification of injuries of the colon is developed and types of operative interventions are recommended.

Adult↗

AI-enabled viral genomics: from virus discovery to host prediction and emerging variant forecasting.

The rapid expansion of metagenomic sequencing has generated vast repositories of viral sequence data that far outpace our capacity to interpret them using conventional approaches. Highly divergent sequences, sparse functional annotation, and taxonomically uneven sampling present fundamental challenges for reference-dependent methods, which lose sensitivity precisely for novel and understudied viruses with high public health relevance. Artificial intelligence (AI) provides a new avenue to address these challenges by enabling predictive inference from viral genomes and proteins while reducing dependence on sequence similarity. In this Review, we discuss representative advances in AI for virus discovery, taxonomic classification and functional annotation, prediction of host range and zoonotic potential, and efforts toward forecasting emerging variants. These advances are transforming viral genomics from a largely descriptive discipline into one with increasing predictive capability. We also critically assess the major challenges that constrain current approaches, including the availability of high-quality and representative datasets, rigorous model evaluation, biological interpretability and responsible governance for increasingly capable AI models.

Artificial Intelligence↗

Relative frequencies and sites of presentation of lymphoid neoplasms in a community hospital according to the revised European-American classification.

Relative frequencies for common subtypes in the revised European-American classification of lymphoid neoplasms (REAL classification) have been reported. We determined the relative frequencies and sites of presentation of REAL subtypes at a 700-bed community hospital in central Illinois. A database was used to identify and prospectively catalogue all newly diagnosed lymphoid neoplasms from July 1, 1995 to March 1, 1998. The approach to diagnosis and subtyping incorporated morphologic features, immunophenotype, and clinical findings according to criteria proposed in the REAL classification. Of 347 lymphoid neoplasms diagnosed, 319 were subtyped in the REAL classification. Of these, 261 were B-cell neoplasms, 21 were T-cell neoplasms, and 37 were Hodgkin disease variants. Chronic lymphocytic leukemia/small lymphocytic lymphoma/prolymphocytic leukemia, diffuse large cell, and follicle center neoplasms were the most common B-cell subtypes. Large granular lymphocyte leukemia was the most common T-cell neoplasm. Nodular sclerosis was the most common Hodgkin disease variant. The relative frequencies in a US community hospital setting are similar to those reported in other studies. Differences are attributable to patient selection criteria, study group geographic location and racial composition, and/or referral patterns. Diverse REAL classification subtypes may be expected in US community hospitals.

Adolescent↗

A revised classification of von Willebrand disease. For the Subcommittee on von Willebrand Factor of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis.

A simplified phenotypic classification of von Willebrand disease is proposed that is based on differences in pathophysiology. Quantitative defects are divided into partial deficiency (type 1) and severe deficiency (type 3). Qualitative defects (type 2) are divided into four subcategories. Type 2A refers to variants with decreased platelet-dependent function associated with the loss of high-molecular weight VWF multimers. Type 2B refers to variants with increased affinity for platelet glycoprotein Ib. Type 2M refers to qualitatively abnormal variants with decreased platelet-dependent function not associated with the loss of high-molecular weight multimers. Type 2N refers to variants with decreased affinity for factor VIII. When recognized, mixed phenotypes caused by compound heterozygosity are indicated by separate classification of each allele. Standard amino acid and nucleotide numbering schemes are recommended for the description of mutations.

Blood Coagulation Factors↗

Corticosteroid-responsive postmalaria encephalopathy characterized by motor aphasia, myoclonus, and postural tremor.

OBJECTIVES: To study the clinical spectrum of an acute severe encephalopathy occurring in 2 patients after recovery from falciparum malaria infection and to compare it with the reported clinical features of the postmalaria neurological syndrome. DESIGN: Case report. SETTING: Tertiary care hospital. PATIENTS: Two patients presented with acute onset of fluctuating motor aphasia, severe generalized myoclonus, and postural tremor. Additional signs were cerebellar ataxia, and in 1 patient, generalized epileptic seizures. Magnetic resonance imaging of the brain revealed patchy white matter lesions in 1 patient. Clinically, the patients' conditions continued to worsen until corticosteroids were introduced, the use of which induced a rapid, albeit incomplete, recovery. CONCLUSIONS: We describe a new, severe variant of the still poorly defined postmalaria neurological syndrome. We propose a preliminary classification of this syndrome, according to its clinical characteristics, as follows: a mild or localized form, characterized by isolated cerebellar ataxia or postural tremor; a diffuse, but relatively mild encephalopathic form, characterized by acute confusion or epileptic seizures; and a severe, corticosteroid-responsive encephalopathy that is characterized by motor aphasia, generalized myoclonus, postural tremor, and cerebellar ataxia.

Adrenal Cortex Hormones↗

Molecular pathology of well-differentiated thyroid carcinomas.

The newly discovered molecular features of well-differentiated thyroid carcinomas derived from follicular cells are reviewed, within the frame of the 2004 WHO classification of thyroid tumours, under the following headings: "Follicular carcinoma", "Papillary carcinoma", "Follicular variant of papillary carcinoma" and "Hürthle cell tumours". A particular emphasis is put on the meaning of PAX8-PPARgamma rearrangements, RAS and BRAF mutations, and deletions and mutations of mitochondrial genes and of nuclear genes encoding for mitochondrial enzymes, for thyroid tumorigenesis.

Adenoma, Oxyphilic↗

Migraine.

The most widely accepted classification of the migraine syndrome includes common, classic, complicated and cluster migraines. Migraine variants refer to episodic dysfunctions of an organ or system which either occur in the migraine sufferer, or replace the headache. While migraine appears to be a primary disorder of the cerebral vessels, there is current experimentation into the role of circulating serotin, prostaglandins, platelet abnormalities and estrogen levels. Both nonnarcotic and narcotic treatments are available, and prophylactic measures may be indicated.

Adult↗

Swan neck deformity in rheumatoid arthritis of the hand.

Swan neck deformity is not a single entity. Significantly different types of swan neck deformity are found, each demanding careful clinical evaluation and specialised treatment. This paper discusses the pathomechanics of swan neck deformity and presents a classification upon which rational treatment can be based. The surgical treatment of each variant is briefly outlined.

Arthritis, Rheumatoid↗

SpikeCell: a deterministic spiking neuron.

We present a model of spiking neuron that emulates the output of the usual static neurons with sigmoidal activation functions. It allows for hardware implementations of standard feedforward networks, trained off-line with any classical learning algorithm (i.e. back-propagation and its variants). The model is validated on hand-written digits recognition, and image classification tasks. A digital architecture is proposed and evaluated. The area needed for implementing the spiking neuron on a chip is 10 times smaller than that for the corresponding static neuron. The accuracy of the network's output increases with time, and reaches that of the emulated static neural network after an adequate integration period. Single errors in the spike trains, or interruption of the relaxation process, due for example to irradiation in harsh environments, are harmless.

Action Potentials↗

Prospects of cure in lymphocyte-predominant Hodgkin's disease.

This report concerns a particular benign histologic variant of Hodgkin's disease, the lymphocyte-predominant category of the Rye classification. The group of 24 cases, all involving localized disease, was first reported in 1960, and is now reappraised, incorporating subsequent data. The interpretations of the original findings are confirmed and elaborated. A characteristic feature had been the long relapse-free and symptom-free survival period, which gave a false impression of security but was followed in some instances by disseminated disease, usually after 5-15 years. The proportion of such cases is now shown to be greater, and the possible quiescent period extended. Cure was suspected in some instances, and can now be considered likely in about half of the cases. The present results include a substantial number of patients who have survived for very long periods and who must be regarded as cured, though careful confirmatory autopsies are still unavailable.

Adolescent↗

[Grounded theory as an approach to interpretive research].

Interpretative research comprehends studies on qualitative methodology and inductive research. According to Lowenberg's classification (1994), grounded theory is a type of interpretative research situated as a variant of symbolic interaction. The purpose of the present study was to discuss grounded theory as a methodological reference, presenting it and indicating its method. The following stages were presented: collection of empirical data, proceedings of data codification or analysis; open coding, axial coding or concept modification and integration and theory delimitation. The studies of CALIRI (1994) and CASSIANI (1994) exemplified the utilization of this methodological reference. Finally, authors visualized grounded theory as an useful reference of analysis, providing means and orienting, through its stages, the researcher aiming at using it.

Data Interpretation, Statistical↗

[Clinicopathological characteristics of Burkitt lymphoma].

In the new WHO classification, the category of Burkitt lymphoma includes classic Burkitt lymphoma and a variant-Burkitt-like-lymphoma. In addition, three subcategories--endemic, non-endemic, and immunodeficiency-associated--were proposed to reflect the major clinical and genetic subtypes of this disease. Endemic Burkitt lymphoma is well known to carry EB virus(EBV). However, not more than 20% of the sporadic Burkitt lymphoma carry EBV. One of the three alternative forms of the Ig/myc translocation are regularly present in all Burkitt lymphomas, whether EBV positive or negative. Thus, translocation, rather than EBV, must be considered as the main rate-limiting event in the development of Burkitt lymphoma. EBV may increase the probability of this event by expanding the target cell population at risk.

Burkitt Lymphoma↗

[Acquired dysimmune neuropathies. Clinical symptoms and classification].

INTRODUCTION: The neuropathies caused by dysimmunity have seen great changes in recent years. The different forms of clinical presentation, electrophysiological expression, associated anomalies seen on analytical tests, particularly the presence of antibodies to the various antigens of myelin are becoming better understood. This confirms their dysimmune nature and also offers unforeseen possibilities for the comprehension of etiopathogenic mechanisms and possible classifications of specific etiopathogenic factors. DEVELOPMENT: Based mainly on our own experience, in this paper we review current concepts of the three main dysimmune polyneuropathies, the Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuritis or CIDP and the motor multifocal neuropathies (MMN) with block-conduction or Lewis-Summer syndrome. Regarding the first condition, we particularly emphasize the convenience of establishing the broad classification needed by the variation in its clinical presentation, with regional and functional variants: among the latter we consider particularly the pure motor forms which in most cases are axonal forms with an etiopathogenic basis which is fairly well established and almost constantly associated with the presence of specific antibodies in the serum of patients with this condition. With reference to CIDP, we discuss the existence of atypical forms and the frequency of the relapsing form concerning the evolution. The MMN are the most recently discovered dysimmune neuropathies, according to both the literature and personal experience. We try to establish the difference between pure motor forms and those which also have sensory involvement (or MADSAM) and are called the Lewis-Sumner syndrome.

Adult↗