Cambridge-Miami score for intestinal transplantation preoperative risk assessment: initial development and validation.

INTRODUCTION: Preoperative quantification of survival after transplantation would assist in assessing patients. We have developed a preliminary preoperative scoring system, called the Cambridge-Miami (CaMi) score, for transplantation of the small intestine either alone or as a composite graft. METHODS: The score combines putative risk factors for early-, medium-, and long-term survival. Factors included were loss of venous access and impairment of organs or systems not corrected by transplantation. Each factor was scored 0-3. A score of 3 indicated comorbidity approaching a contraindication for transplantation, that which might lead to but was not currently an adverse risk factor scored 1, and that presenting a definite but moderate increase in risk scored 2. The preoperative scores of 20 patients who had received intestinal transplants either isolated or as part of a cluster graft, who had either been followed up postoperatively for at least 10 years, or died within 10 years were compared with their survivals. RESULTS: Postoperative survival and CaMi score inversely correlated when analysed using Spearman test (r(s) = -0.82; P = .0001). A score of <3 associated with survival > or =3 years (12/12 patients) and >3 with survival of <6 months (4/4). Patient Kaplan-Meier (KM) survival curves for patients grouped according to CaMi score became significantly different from group 0 to group 3. Using this as a threshold score patients grouped as either >2 or <3 had significantly different survival rates (log-rank; P = .0001), KM median survival hazard ratio (HR) = 6, and rate of death KM HR = 5. Receiver-operator characteristics indicate a high degree of accuracy for prediction of death with an area under the curve (C statistic) at 3 years of 0.98, at 5 years of 0.82, and at 10 years of 0.65. CONCLUSION: This initial validation suggested that the preoperative CaMi score predicted postoperative survival.

Modelling number of services per conception of Japanese Black cattle by random regression.

Repeated records of number of services per conception (NSC) were collected on 607 Japanese Black cows. Data were analysed by random regression (RRM) and multiple trait (MTM) models, considering NSC in each parity as a separate trait. The chosen RRM included additive genetic and permanent environmental effects fitted with a third-order Legendre polynomials of parity. Heritabilities (h2) estimated by RRM decreased along the NSC trajectory from 0.15 in the first parity to 0.04 in the sixth parity and then increased up to 0.22 in the 10th parity. The corresponding estimates obtained by MTM ranged between 0.04 in parity 9 and 0.13 in parity 1. Permanent environmental proportions (p2) of the total phenotypic variance estimated by RRM showed similar pattern and magnitude to those of h2 estimated by the same method. On the contrary, the p2 estimated by MTM ranged between 0.04 in the first parity and 0.11 in the 10th parity. Additive genetic (r(G)), permanent environmental (r(P)) and phenotypic (r(PH)) correlations were also estimated. The values estimated by RRM between adjacent parities were higher than those of parities far apart. The corresponding values estimated by MTM were lower than those estimated by RRM with no certain trend. The results indicated that NSC in heifers is more heritable than NSC in cows with different parities. Reproductive traits are economically important traits and hence, they should be considered in breeding goals.

Markov process amplitude EEG model for spontaneous background activity.

The Markov process amplitude (MPA) EEG model effectively representing spontaneous brain activity of the EEG was introduced. The relationship between the electrical mechanism for EEG generation and the proposed model was also investigated. The MPA EEG model was described by the sinusoidal waves with the randomly fluctuating amplitude of the first-order Markov process. The parameters of the MPA EEG model were determined optimally based on the real EEG records. The results of model outputs in the frequency domain demonstrated an excellent fit with the power spectrum of the corresponding EEG. The simulated model signal in the time domain also showed good agreement with the EEG time series. The satisfactory results from the MPA EEG model suggest its possible applicability in clinical practice. Furthermore, from the high goodness of fit, the authors think that the neurons oscillate at fixed frequencies and are modulated by synaptic interactions in accordance with the first-order Markov process.

Clinical application of three-dimensional ultrasound in fetal brain assessment.

AIM: To clarify the usefulness of three-dimensional (3D) ultrasound in the assessment of the fetal head and brain, according to 3D ultrasound surface reconstruction, multiplanar image analysis, three-dimensional angiography, and volume calculation. METHODS: We examined 326 normal fetuses between 10 and 40 weeks of gestation using 3D ultrasound (Voluson, 530D, Medison, Seoul, Korea), mainly with transvaginal 3D transducer. Fetal head structures, such as the skull, brain structure, and brain circulation, were presented by surface mode, multiplanar imaging mode, and three-dimensional Doppler mode. After automatic volume acquisition of the fetal head, image analyses were performed off-line, and 3D View software was used for volume imaging of the lateral ventricle and choroid plexus in randomly selected 30 normal fetuses. Seven fetuses with intracranial abnormalities were evaluated by 3D ultrasound functions. RESULTS: Surface mode of 3D ultrasound objectively depicted in vivo development of the cranial bones and formation of the cranial sutures and fontanelles in normal fetuses. Multiplanar image analysis of the brain structure presented a fetal brain in more cutting sections than conventional 2D ultrasound. Transvaginal 3D angiography was successful in 13% of normal fetuses and rotation of 3D circulatory image allowed the analysis of the intracranial vessels. Volume imaging showed the intracranial structures, such as the lateral ventricle and choroid plexus. Intracranial abnormalities were longitudinally evaluated by 3D ultrasound and objective images helped in reaching prenatal diagnoses. CONCLUSION: Advanced 3D ultrasonography and software for volume analysis can provide additional objective information about the fetal skull formation, brain structure, and brain circulation.

Assessment of lupus nephritis activity using urinary retinol-binding protein.

We evaluated the presence of proximal renal tubular dysfunction as measured by urinary retinol-binding protein (RBP) in 70 patients with systemic lupus erythematosus. Renal disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index. This is a clinical-laboratory score based on the principle of the physician's intention to treat. Increased urinary RBP (> 400 micrograms/l) was detected in 17 of 22 (77%) patients with active nephritis, six of 18 (33%) patients with probably active nephritis, one of nine (12%) cases with stable renal disease, and one of 21 (5%) cases without apparent renal disease (P < 0.01). Compared to initial values, mean urinary RBP decreased significantly in six patients evaluated after improvement of the exacerbation of renal disease. There was a positive correlation between urinary RBP and 24-h proteinuria (r = 0.40, P < 0.01), and an inverse correlation between urinary RBP and creatinine clearance (r = -0.60, P < 0.01). In a multivariate analysis adjusting for duration of disease, blood pressure, 24-h proteinuria, and creatinine clearance, mean urinary RBP continued to be significantly and progressively greater for patients with no renal disease, stable renal disease, probably active and active nephritis. Proximal tubular dysfunction is frequent in patients with active lupus nephritis. This association cannot be completely explained by the effects of increased total proteinuria, reduced glomerular filtration rate, and systemic hypertension. Urinary RBP seems to be a marker of renal disease activity. This test may be clinically useful to differentiate patients with active lupus nephritis from those with stable or absent renal disease.

Method for predicting an EEG waveform as an aid to the accurate recording of evoked potentials.

Evoked potentials are the brain's responses to incoming stimuli and are usually recorded under noisy circumstances. To improve the signal-to-noise ratio, signal averaging has been widely applied to the recorded data, but an improved method is required. A method of EEG waveform prediction for the accurate recording of evoked potentials is proposed, and an electroencephalographic waveform predicted by using an EEG model and a nonlinear exponentially weighted least squares method, subtracting the predicted EEG waveform from the raw data and extracting the evoked waveform. By the use of this method, we have successfully predicted the EEG waveform and detected the evoked potential with only a small number of averages.