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An application of the Dempster-Shafer theory of evidence to the classification of knee function and detection of improvement due to total knee replacement surgery.

This paper utilises a novel method for the classification of subjects with osteoarthritic and normal knee function. The classification method comprises a number of different components. Firstly, the method exploits the Dempster-Shafer theory of evidence allowing for a degree of ignorance in the subject's classification, i.e., a level of uncertainty as to whether a gait variable indicates osteoarthritis or not. Secondly, the inclusion of simplex plots allows both the classification of a subject, and the contribution of each associated gait variable to that classification, to be represented visually. As a result, the method is further able to highlight periodic changes in a subject's knee function due to total knee replacement surgery and subsequent recovery. The visual representation enables a simple clinical interpretation of the results from the quantitative analysis.

Adult↗

Reliability of the pulp nail bone (PNB) classification for fingertip injuries.

Evans and Bernardis proposed the 'PNB classification', by which a fingertip injury is classified according to each structure: pulp P, nail N, bone B. The objective of this study was to assess the inter-observer reliability, repeatability and accuracy of PNB. One hundred patients presenting with a fingertip injury were included prospectively, photographed, then classified in randomly chosen orders by nine independent observers. A third were drawn randomly and classified a second time to measure repeatability. A reference classification was also provided by one of the authors of the PNB system. Classifications agreed with the reference in 59% of injuries for P, 55% for N and 54% for B. The Kappa values for inter-observer agreement were 0.520 for P, 0.512 for N, and 0.504 for B; for intra-observer agreement, they were 0.616 for P, 0.658 for N, and 0.577 for B. Although levels of agreement are comparable with results found for other classifications, they are insufficient for use of the PNB classification without improvement.

Adolescent↗

Topology representing network enables highly accurate classification of protein images taken by cryo electron-microscope without masking.

In single-particle analysis, a three-dimensional (3-D) structure of a protein is constructed using electron microscopy (EM). As these images are very noisy in general, the primary process of this 3-D reconstruction is the classification of images according to their Euler angles, the images in each classified group then being averaged to reduce the noise level. In our newly developed strategy of classification, we introduce a topology representing network (TRN) method. It is a modified method of a growing neural gas network (GNG). In this system, a network structure is automatically determined in response to the images input through a growing process. After learning without a masking procedure, the GNG creates clear averages of the inputs as unit coordinates in multi-dimensional space, which are then utilized for classification. In the process, connections are automatically created between highly related units and their positions are shifted where the inputs are distributed in multi-dimensional space. Consequently, several separated groups of connected units are formed. Although the interrelationship of units in this space are not easily understood, we succeeded in solving this problem by converting the unit positions into two-dimensional (2-D) space, and by further optimizing the unit positions with the simulated annealing (SA) method. In the optimized 2-D map, visualization of the connections of units provided rich information about clustering. As demonstrated here, this method is clearly superior to both the multi-variate statistical analysis (MSA) and the self-organizing map (SOM) as a classification method and provides a first reliable classification method which can be used without masking for very noisy images.

Algorithms↗

Factors influencing survival in myelodysplastic syndromes in a Brazilian population: comparison of FAB and WHO classifications.

The WHO classification for myelodysplastic syndromes (MDS) has introduced new categories with prognostic relevance. Our aim was to examine the predictive value of the WHO and the FAB classification compared to parameters of peripheral blood, bone marrow and IPSS. Clinical data, peripheral blood counts, bone marrow (BM) cytology and histology and survival were analyzed in consecutive newly diagnosed adult patients with MDS. All cases were diagnosed according to FAB criteria and reclassified by the WHO proposal. Among 150 patients entering the study median age was 58 years (12-90). According to FAB, 90 patients had refractory anemia (RA), 18 sideroblastic anemia, 34 refractory anemia with excess of blasts (RAEB), three RAEB-t and five chronic myelomonocytic leukemia. Using the WHO proposal, one half of the patients with RA changed category. One patient had the 5q-syndrome. There were 25 cases with refractory cytopenias with multilineage dysplasia (RCMD) and 23 WHO "unclassified". These last patients presented few cell atypias, favorable IPSS and a good survival as has been described for refractory cytopenias in pediatric MDS. Hypocellular BM was found in 24% of the patients. Karyotype was available in only 85 cases. In the univariate analysis, both classifications, hemoglobin values, hypercellular bone marrow and IPSS had an influence on survival. Using the bootstrap resampling as stability test for the model created by the multivariate analysis, the WHO classification entered the model in 73%, FAB in 38% and IPSS in only 7%. Therefore, in a setting with a high number of low-risk MDS, the WHO classification is the best predictor of survival of the patients.

Adolescent↗

Survival is better predicted with a new classification of stage III unresectable non-small cell lung carcinoma treated by chemotherapy and radiotherapy.

UNLABELLED: The 1997 International staging system (ISS) classification separated stage III non-small cell lung cancer (NSCLC) into stages IIIA and IIIB. In a previous study including unresectable NSCLC initially treated with chemotherapy, we analysed survival according to tumour (T) and node (N) stages and derived a classification into stages IIIbeta (T3-4N3) and IIIalpha (other TN stage III) that had a better discrimination on survival distribution. The aim of this study was to validate these results in a further set of patients. Patients with unresectable stage III NSCLC included in a phase III trial assessing the role of increased dose chemotherapy (SuperMIP: mitomycin 6 mg/m2, ifosfamide 4.5 g/m2, cisplatin 60 mg/m2, carboplatin 200 mg/m2) in comparison to standard chemotherapy MIP (mitomycin 6 mg/m2, ifosfamide 3 g/m2, cisplatin 50 mg/m2), before thoracic irradiation (60 Gy in 30 fractions over 6 weeks) were the subject of this study. Survival distributions were assessed by the method of Kaplan-Meier. Survival comparisons were made by the log-rank test. Multivariate analyses using Cox regression models, included all potential prognostic factors for survival with a P-value <0.2 in univariate analysis. According to the 1997 International staging system classification, 328 eligible patients were included in the study. There was no imbalance between the two arms. Five parameters were significantly associated (P < or = 0.05) with survival in univariate analysis: European lung cancer working party (ELCWP) staging (IIIalpha[n = 294 pts] versus IIIbeta [n = 46]), Karnofsky index, weight loss, platelet count and haemoglobin level. These variables as well as the 1997 ISS staging, white blood cell (WBC) count, LDH and sodium levels were included in a multivariate analysis. Two models were constructed, including either the ELCWP or the 1997 ISS. In model 1 (ISS included), Karnofsky index (HR 0.69; 95% confidence interval (CI) 0.47-1.00; P = 0.05) and haemoglobin (HR 1.49; 95% CI 1.11-1.99; P = 0.007) were found significant. In model 2, including ELCWP staging, two variables were associated with survival: ELCWP staging (HR 1.68; 95% CI 1.20-2.35; P = 0.002) and haemoglobin (HR 1.54; 95% CI 1.15-2.07; P = 0.01). CONCLUSION: In initially unresectable stage III NSCLC treated by chemotherapy and radiotherapy, we validated the results of our previous study. The classification into stages IIIbeta (T3-4N3M0) and IIIalpha (other TN stage III) better discriminates the patients in term of survival than the 1997 ISS classification.

Aged↗

Multispectral classification techniques for terahertz pulsed imaging: an example in histopathology.

Terahertz pulsed imaging is a spectroscopic imaging modality using pulses of electromagnetic radiation (100 GHz-10 THz), and there has been recent interest in studying biomedical specimens. It is usual to display parametric images derived from the measured pulses. In this work, classification was achieved by applying multispectral clustering techniques to sets of parametric images. It was hypothesised that adequate information for clustering was carried in a small number of parametric images, providing these were weighted by complementary physical properties. Materials prepared for histopathological examination were chosen because their condition remained stable during long imaging periods and because their dehydrated state led to greater penetration of the radiation. Two specimens were examined in this pilot study, one of basal cell carcinoma and one of melanoma. Unsupervised ISODATA classification using three selected parametric terahertz pulsed images was compared qualitatively with k-means classification using the shape of the whole time series, and with conventional stained microscope slides. There was good qualitative agreement between the classifications. Classifications were consistent with the morphological appearances expected, but further work is required to determine if tumour discrimination is possible. The results have implications for the future development of the technique as the need for only a small number of features could lead to considerably reduced acquisition times.

Algorithms↗

Morphological classification of brains via high-dimensional shape transformations and machine learning methods.

A high-dimensional shape transformation posed in a mass-preserving framework is used as a morphological signature of a brain image. Population differences with complex spatial patterns are then determined by applying a nonlinear support vector machine (SVM) pattern classification method to the morphological signatures. Significant reduction of the dimensionality of the morphological signatures is achieved via wavelet decomposition and feature reduction methods. Applying the method to MR images with simulated atrophy shows that the method can correctly detect subtle and spatially complex atrophy, even when the simulated atrophy represents only a 5% variation from the original image. Applying this method to actual MR images shows that brains can be correctly determined to be male or female with a successful classification rate of 97%, using the leave-one-out method. This proposed method also shows a high classification rate for old adults' age classification, even under difficult test scenarios. The main characteristic of the proposed methodology is that, by applying multivariate pattern classification methods, it can detect subtle and spatially complex patterns of morphological group differences which are often not detectable by voxel-based morphometric methods, because these methods analyze morphological measurements voxel-by-voxel and do not consider the entirety of the data simultaneously.

Aged↗

Pattern classification using principal components of cortical thickness and its discriminative pattern in schizophrenia.

We proposed pattern classification based on principal components of cortical thickness between schizophrenic patients and healthy controls, which was trained using a leave-one-out cross-validation. The cortical thickness was measured by calculating the Euclidean distance between linked vertices on the inner and outer cortical surfaces. Principal component analysis was applied to each lobe for practical computational issues and stability of principal components. And, discriminative patterns derived at every vertex in the original feature space with respect to support vector machine were analyzed with definitive findings of brain abnormalities in schizophrenia for establishing practical confidence. It was simulated with 50 randomly selected validation set for the generalization and the average accuracy of classification was reported. This study showed that some principal components might be more useful than others for classification, but not necessarily matching the ordering of the variance amounts they explained. In particular, 40-70 principal components rearranged by a simple two-sample t-test which ranked the effectiveness of features were used for the best mean accuracy of simulated classification (frontal: (left(%)|right(%))=91.07|88.80, parietal: 91.40|91.53, temporal: 93.60|91.47, occipital: 88.80|91.60). And, discriminative power appeared more spatially diffused bilaterally in the several regions, especially precentral, postcentral, superior frontal and temporal, cingulate and parahippocampal gyri. Since our results of discriminative patterns derived from classifier were consistent with a previous morphological analysis of schizophrenia, it can be said that the cortical thickness is a reliable feature for pattern classification and the potential benefits of such diagnostic tools are enhanced by our finding.

Adult↗

A preliminary study of angiographic classification and its correlation to treatment of central arteriovenous malformation in the jaw.

OBJECTIVE: To elaborate on the classification of central arteriovenous malformations (AVMs) in the jaw based on angioarchitecture and to evaluate the correlation of this classification with treatment options. STUDY DESIGN: X-ray films and digital subtraction angiograms (DSA) of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of bone resorption, 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 of this classification system with treatment options. RESULTS: The angiographic pictures of 25 cases with central AVMs could be divided into 5 types: Type I (n = 5) had diffused microarteriovenous fistulas (AVFs); type II (n = 8) had 1 large venous pouch with all the feeding arteries draining into it; type III (n = 7) had a large venous pouch as well as diffused microAVFs (I+II); type IV (n = 2) had multiple venous pouches; and type V (n = 3) had multiple venous pouches and diffused microAVFs (I + IV). The angioarchitecture corresponded well to the x-ray appearance in all cases except 1 (96%). With respect to the treatment outcomes, type II, III, and IV AVMs gained clinical cure in 100% of the cases, whereas type I and type V AVMs obtained clinical cure only in 60% and 33.3% of the cases, respectively. CONCLUSIONS: Central AVMs in the jaw contained variant patterns of angioarchitecture and could be divided into 5 types. This angiographic classification was helpful for decision making about appropriate therapy.

Adolescent↗

Use of American Society of Anesthesiologists physical status classification to assess perioperative risk in patients undergoing radical nephrectomy for renal cell carcinoma.

OBJECTIVES: To perform a retrospective analysis to determine the operative morbidity in patients with substantial comorbidities requiring renal surgery. Increasing numbers of patients requiring renal surgery are presenting with substantial comorbidities, such as diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease. METHODS: The American Society of Anesthesiologists (ASA) physical status classification was used to define perioperative risk. Of 1087 patients who underwent nephrectomy between 1989 and 2001, 237 patients were classified as ASA classification 1 or 2 (low risk), 297 were ASA classification 3 (intermediate risk), and 17 were ASA classification 4 (high risk). RESULTS: No statistically significant differences were found among the low-risk, intermediate-risk, or high-risk patients with regard to 1997 T stage distribution, mean tumor size, vascular and/or inferior vena cava involvement, percentage of partial nephrectomy, adjacent organ resection, or preoperative hemoglobin. Intermediate-risk patients did have a greater estimated blood loss (946 versus 739 mL, P = 0.05), leading to greater transfusion rates (42% versus 28%, P = 0.001). However, no increase occurred in intraoperative or postoperative morbidity. High-risk patients also had greater transfusion rates, as well as a greater rate of complications occurring more than 24 hours after surgery. CONCLUSIONS: Partial or radical nephrectomy can be offered to patients with comorbid conditions. ASA classification 3 patients are more likely to require transfusion. This may have been a result of a lower threshold to transfuse patients with preoperative morbidities. However, the perioperative and postoperative complication rates were similar to those of low-risk patients. Not surprisingly, high-risk patients had greater rates of transfusions and complications.

Aged↗

Analysis of reproductive toxicity and classification of glufosinate-ammonium.

CONCLUSION REGARDING CLASSIFICATION OF GLUFOSINATE-AMMONIUM: Science Partners' Evaluation Group (Evaluation Group) has conducted an independent analysis of the herbicide glufosinate-ammonium (GA) relative to its potential to cause reproductive toxicity in humans. Further, the Evaluation Group has evaluated the implementation of Annex 6 of Commission Directive 2001/59/EC (28th ATP of Council Directive 67/548/EEC) and Council Directive 91/414/EEC, with respect to classification of chemicals posing potential reproductive hazards. After consideration of all information available to us relevant to the potential of glufosinate-ammonium (GA) to cause reproductive toxicity, the Science Partners Evaluation Group concludes that no classification of GA is justified. The following form the basis of this conclusion. There are no human data to suggest that GA causes reproductive toxicity in women or in their conceptus. The issue concerning possible reproductive hazard to humans is raised solely on the basis of positive animal test results that show GA to cause preimplantation or implantation losses in rats. SPECIFICALLY: a. Daily treatment with GA had no detectable effect on the earliest stages of the reproductive sequence including gametogenesis, ovulation, mating and conception; b. Treatment with GA interfered with rat gestation before and at the stage when the conceptus implants into the uterus. This effect occurred at doses of 360 ppm in the feed (corresponding to daily doses of 27.8 mg/kg bw) and above; and c. After implantation, no further effect of GA on prenatal and post-natal development was recognized. Previous concerns that GA might be toxic to embryonic stages after implantation were not supported by the data. Abortions and stillbirth seen were associated with, and regarded as secondary to, maternal toxicity. There was no evidence suggesting the induction of malformations in the offspring. The mechanism underlying this adverse effect in experimental laboratory animals is identified-inhibition of glutamine synthetase. Glutamine is essential to the viability of the embryo. The embryo is dependent on a maternal source of the amino acid. For embryo lethality to occur, a significant reduction of maternal glutamine is required. Such reduction in maternal glutamine depends on a significant inhibition of glutamine synthetase by GA. This can only occur when the mother is exposed to very high levels of GA. SPECIFICALLY: a. The reproductive toxicity of GA is confined to very short, early stages of reproduction, during which the conceptus is dependent on maternal glutamine; and b. In order for the effect to occur, significant reduction in maternal blood glutamine level is required, which in turn depends on a significant inhibition of glutamine synthetase, induced by high levels of GA in the maternal system. There is no evidence for accumulation of GA in the mammalian organism beyond a factor of two and no evidence for its metabolic toxification. To raise a concern in humans, women would have to be exposed to GA during the very limited time frame of preimplantation or implantation and the exposure would have to be to the exceedingly high levels necessary to alter the maternal metabolism and, correspondingly, result in glutamine levels in maternal tissue and blood plasma being drastically reduced. There is no basis to suggest that such exposures would occur under conditions of normal handling and use. SPECIFICALLY: a. Under conditions of normal handling and use, operators would never be exposed to GA levels that could potentially inhibit glutamine synthetase to the extent that this inhibition could impair preimplantation or implantation. b. All acceptable exposure measurements and predictive calculations confirm this conclusion, and in fact demonstrate that reasonably foreseeable exposure of workers would be to levels significantly below the AOEL. c. The evidence is also clear that there is no reproductive toxicity hazard to workers upon reentry tosprayed fields, bystanders, consumers or toddlers. The safety margin compared to the NOAEL in animal studies is sufficiently large to assure protection of the health of workers using GA as well as bystanders, consumers, and toddlers. Pursuant to Annex 6 of Commission Directive 2001/59/EC (28th ATP of Council Directive 67/548/EEC), to justify a classification of category 2 there must be sufficient evidence to produce a strong presumption that human exposure to the substance may result in impaired fertility in humans. It is the conclusion of the Science Partners Evaluation Group that there is no reasonable evidence to suggest a strong presumption of impairment. To the contrary, there is clear evidence demonstrating a strong presumption that exposure to GA would not cause the adverse effect demonstrated in rats. Pursuant to Annex 6 of Commission Directive 2001/59/EC (28th ATP of Council Directive 67/548/EEC), to justify a classification of category 3, there must be sufficient evidence to provide a strong suspicion of impaired fertility in humans. There is no basis to conclude that the animal data demonstrating impaired preimplantation or implantation has any relevance to humans in that the effect found in rats only occurs at levels which would never be experienced by workers under conditions of normal handling and use or by bystanders, consumers, or toddlers.

Aminobutyrates↗

Comparison of the classification ability of the electrocardiogram and vectorcardiogram.

Controversy exists over the classification ability of the standard 12-lead electrocardiogram (EGG) and the vectorcardiogram (VCG). In this study the diagnostic information content and classification performance of the ECG and VCG were examined using multivariate statistical techniques and a large validated data base of 3,266 cases. Logistic classification models were developed to differentiate between 7 diagnostic entities: normal (n = 538), left (n = 557), right (n = 323) and biventricular (n = 437) hypertrophy, and anterior (n = 390), inferior (n = 657) and combined (n = 364) myocardial infarction. The models were obtained from a learning sample (n = 2,446) using an optimal set of computer derived ECG and VCG measurements. They were subsequently applied to a test sample (n = 820). In the learning sample, the discrimination models resulted in a total correct classification rate of 69.6% for the ECG and 69.4% for the VCG. The total accuracy rate was slightly lower in the test set: 66.3% for the ECG and 67.1% for the VCG. The combined use of the best ECG and VCG variables did not increase total diagnostic accuracy. When cases with biventricular hypertrophy and combined infarction were deleted, accuracy rates of more than 80% were achieved for both lead systems. Differences in the classification rates for the subgroups were not statistically significant. Thus, the conventional 12-lead ECG is as good as the VCG for the differential diagnosis of 7 main entities, provided identical procedures are used in the design of the classifiers.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomegaly↗

Classifying incomplete spinal cord injury syndromes: algorithms based on the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients.

OBJECTIVE: To develop an objective and uniform means for classifying patients with incomplete spinal cord injury (SCI) according to SCI syndromes. DESIGN: Criteria for assigning the syndromes (defined by the International Standards for Neurological and Functional Classification of SCI Patients) were operationalized by means of sensory and motor scores and were incorporated into a set of six independent algorithms and two composite algorithms. SETTING: A regional SCI rehabilitation center in Canada. PATIENTS: SCI patients (n = 56) with incomplete injuries (American Spinal Injury Association classes B, C, D) and stable neurologic deficits. RESULTS: Individual algorithms allowed the highest classification rate but with some patients meeting the criteria for more than one syndrome. A composite, differential allocation algorithm, with selected thresholds at decision nodes, yielded a classification rate approximating that of the individual algorithms but without double classifications. CONCLUSIONS: The composite algorithm provided an objective and standardized means of assigning patients to syndromes based on clinically measurable sensory and motor scores. The thresholds used to implement criteria and the order of decision nodes greatly influenced the outcomes and may be adjusted to suit the needs of the classification, that is, embracing liberal or stringent criteria. Controversy remains about the interpretation of some syndromes, and many patients remain unclassifiable because of mixed clinical presentation.

Adult↗

A fuzzy logic diagnosis system for classification of pharyngeal dysphagia.

Identification and classification of the dysphagic patient at risk of aspiration is important from a clinical point of view. Recently, we have developed techniques to quantify various biomechanical parameters that characterize the dysphagic patient, and have developed an expert system to classify patients based on these measurements. The purpose of the present investigation was to develop a fuzzy logic diagnosis system for classification of the patient with pharyngeal dysphagia into four categories of risk for aspiration. Non-invasive acceleration and swallow pressure measurements were obtained and five parameters were extracted from these measurements. A set of membership functions were defined for each parameter. The measured parameter values were fuzzified and fed to a rule base which provided a set of output membership values corresponding to each of the categories. The set of output values were defuzzified to obtain a continuous measure of classification. The fuzzy system was evaluated using the data obtained from 22 subjects. There was a complete agreement between the fuzzy system classification and the clinician's classification in 18 of the 22 patients. The fuzzy system overestimated the risk by half a category in two patients and underestimated by half a category in two patients. The fuzzy logic diagnosis system, together with the biomechanical measures, provides a tool for continued patient assessment on a daily basis to identify the patient who needs further videofluorography examination.

Biomechanical Phenomena↗

Comparison of multigroup logistic and linear discriminant ECG and VCG classification.

The performance of logistic (LOG) and linear discriminant analysis (LDA) has been studied, both for the conventional 12-lead electrocardiogram (ECG) and the orthogonal Frank 3-lead electrocardiogram (VCG), using a large validated data base. Classification rules were derived form a learning set (N = 2446) and applied to a test set (N = 820) to differentiate between normal, left, right and biventricular hypertrophy, anterior, inferior and combined myocardial infarction (MI). Total accuracy of LOG, assuming no normal distribution and using population proportions as prior probabilities, was up to 3% higher than that of LDA, depending on the number of variables used. The 12- and 3-lead LOG and LDA formulas resulted in very similar accuracy rates, i.e., between 67 and 70% for the seven-group and between 77 and 84% for the five-group analysis. LDA posterior probabilities were systematically more extreme than LOG ones. Correct classification of normals' specificity by LDA was 5 to 9% higher, but sensitivity for different groups was 1.5 to 10% lower than by LOG, with sample size proportions as priors. Specificity could be improved by changing the priors at the cost of lower sensitivity and vice versa, both for the LDA and LOG models. Classification results at 95% specificity were only slightly different, except for anterior MI where LOG scored 6% better. Other measures of performance demonstrated that the LDA model was overconfident and that the LOG model fitted better the real class membership of the patients. In conclusion, logistic ECG and VCG models improve the total accuracy of classification by about 1 to 3% when compared to LDA. More importantly, reliability of classification represents the improvement we want to emphasize. These methods may enhance the diagnostic utility of the ECG and VCG in routine practice.

Analysis of Variance↗

The application of the International Statistical Classification of Diseases to neurology: ICD-10 NA.

Rapid advances in the clinical neurosciences in the last decade have led to considerable amplification of our ability to classify neurological diseases. For these classifications to be widely used, they must be compatible with the 'International Statistical Classification of Diseases and related health problems' (ICD) of the World Health Organization (WHO), which system is used throughout the world for classification of diseases and reasons of death. The 'Ninth' revision of the ICD (ICD-9), published in 1976, is currently in use in a number of Member States of the World Health Organization, including the United States. However, it is expected that by the end of this decade virtually all Member States will have introduced the 10th Revision of the ICD (ICD-10), published in 1992. An 'Application of ICD-10 to neurology' (ICD-10 NA) has been developed, with a specific coding system for virtually every neurological disease currently recognized. This article describes the structure and background of this work, that is offered as a definitive international classification of neurological disease to be used by clinical and research organizations, governmental and nongovernmental bodies, and for epidemiological and research purposes. It is concordant with the new and proposed classifications of subspecialty neurological organizations.

Cause of Death↗

Thymoma: a clinicopathologic study based on the new World Health Organization classification.

OBJECTIVE: This study explored the relationship between the histologic subtype of thymoma according to the new World Health Organization histologic classification and the clinical findings, as well as the prognostic significance of the classification. METHODS: A total of 130 patients with thymoma, who underwent resection at the National Cancer Center Hospital, Tokyo, from 1962 to 2000, were studied retrospectively. The histologic subtype of thymoma was determined according to the new World Health Organization histologic classification. The stage was also determined according to a modified Masaoka's classification as stage I, II, III, IVa, or IVb. To determine the factors that may affect the prognosis of thymoma, a multivariate analysis with Cox's proportional hazards regression model was performed. RESULTS: The distribution of histologic subtype was type A (n = 18), type AB (n = 56), type B1 (n = 15), type B2 (n = 29), and type B3 (n = 12). A close correlation was seen between the histologic subtype and stage (P =.000). The overall survivals at 5 and 10 years were 92% and 91%, respectively. The 5- and 10-year survivals according to stage were 100% and 100% (stage I, n = 40; stage II, n = 54), 81% and 76% (stage III, n = 25), and 47% and 47% (stage IV, n = 11), respectively. The difference in survival between stage III and stage IV was significant (P =.000). Patients with type A or AB thymoma demonstrated a 100% survival at both 5 and 10 years. Recurrences were seen in 12 patients with complete resection. According to a multivariate analysis, tumor size (P =.001), completeness of resection (P =.002), histologic subtype (P =.011), and stage (P =.00) were significant prognostic factors. CONCLUSION: The World Health Organization histologic classification significantly correlated with the clinical stage. Tumor size, completeness of resection, histologic subtype, and stage predicted the prognosis of thymoma.

Adult↗

Morbidity of schistosomiasis mansoni in the highlands of Madagascar and comparison of current sonographical classification systems.

To study the morbidity of schistosomiasis mansoni in the highlands of Madagascar, a cross-sectional study examined the extent to which liver fibrosis occurred in a rural community. The Managil and the Cairo classification systems were used. A second purpose was to investigate the effect of the measurements of 2 different branches of the portal vein (either segmental or sub-segmental branches) on the resulting staging of morbidity using the Cairo classification system. In a rice farmer village, 656 inhabitants (95% of the total population) were parasitologically examined; 561 patients underwent sonographic work-up based on the Managil scoring system, and in 307 randomized patients the outer to outer diameters of both the segmental and the sub-segmental branches of the portal vein were measured and scored by the Cairo classification system. Overall prevalence of schistosomiasis mansoni in the study area in 1994 was 68.3%. Upon sonographic examination and scoring by the Managil system 23.4% of the population showed liver changes (Managil degree I/II/III, 20%/2.5%/0.9%). Measuring the sub-segmental branches only and scoring by the Cairo classification, 19% of the study population were found to have liver changes, none with severe fibrosis. By contrast, 82% were found to have liver changes (Cairo degree 1/2/3, 70%/11%/2%) when the segmental branches were measured. The diameters of the sub-segmental branches were about two-thirds of those of the segmental branches. Both the Cairo- and the Managil-examination protocols have pitfalls. Using the Cairo classification, a considerable systematic error in classifying morbidity is created by measuring different branches of the portal vein.

Adolescent↗