Bladder cancer grading using the four-tier combination of the World Health Organization (WHO) 1973 and WHO 2004 classifications.

OBJECTIVE: To investigate the impact of grading in urothelial bladder cancer (UBC) stages Ta and T1, comparing the World Health Organization (WHO) grading classifications of 1973 (WHO73) and 2004 (WHO04) and a combination of these (WHO73/04). PATIENTS AND METHODS: All patients with primary Ta and T1 UBC in the Östergötland region, Sweden, between 1992 and 2007 were included. From 1992, we introduced a new programme for management and follow-up of UBC, including prospectively performed registration of all patients, a systematic description of the location and size of all tumours, primary resection and intravesical treatment in the case of recurrence. All tumour specimens were retrospectively reviewed in 2008 and graded according to the WHO73 and WHO04. A combination of WHO73/04, Grade 1 (G1), Grade 2 low grade (G2LG), Grade 2 high grade (G2HG) and Grade 3 (G3) was analysed in relation to clinical variables and outcomes. RESULTS: There were 769 patients with a median age of 72 years and a median follow-up duration of 74 months. Recurrence was noted in 484 patients (63%) and progression in 80 patients (10%). Recurrence was more common in multiple tumours, larger tumours and in tumours of higher grade (G2LG, G2HG and G3). Progression was more common in tumours classified as larger, T1 and G2HG and G3. Notably, in tumours classified as G2HG, recurrence and progression were more common than in the G2LG group. Harrell's concordance index for the WHO73/04 was higher for recurrence and progression than in the WHO73 or WHO04. CONCLUSION: In the four-tier combined WHO73/04 for urothelial cancer, we observed two G2 sub-groups, G2HG and G2LG. There was a better outcome in the latter group, and the importance of G1 and G3 tumours could be fully evaluated. The WHO73/04 had greater accuracy for recurrence and progression than either the WHO73 or WHO04.

Serum C-reactive protein level in COPD patients stratified according to GOLD 2011 grading classification.

BACKGROUND AND OBJECTIVE: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 grading classification has been used to evaluate the severity of patients with chronic obstructive pulmonary disease (COPD). However, little is known about the relationship between the systemic inflammation and this classification. We aimed to study the relationship between serum CRP and the components of the GOLD 2011 grading classification. METHODS: C-reactive protein (CRP) levels were measured in 391 clinically stable COPD patients and in 50 controls from June 2, 2015 to October 31, 2015 in the First Affiliated Hospital of Xiamen University. The association between CRP levels and the components of the GOLD 2011 grading classification were assessed. RESULTS: Correlation was found with the following variables: GOLD 2011 group (0.240), age (0.227), pack year (0.136), forced expiratory volume in one second % predicted (FEV1%; -0.267), forced vital capacity % predicted (-0.210), number of acute exacerbations in the past year (0.265), number of hospitalized exacerbations in the past year (0.165), British medical Research Council dyspnoea scale (0.121), COPD assessment test score (CAT, 0.233). Using multivariate analysis, FEV1% and CAT score manifested the strongest negative association with CRP levels. CONCLUSIONS: CRP levels differ in COPD patients among groups A-D based on GOLD 2011 grading classification. CRP levels are associated with several important clinical variables, of which FEV1% and CAT score manifested the strongest negative correlation.

Classification of peanut pod rot based on improved YOLOv5s.

Peanut pod rot is one of the major plant diseases affecting peanut production and quality over China, which causes large productivity losses and is challenging to control. To improve the disease resistance of peanuts, breeding is one significant strategy. Crucial preventative and management measures include grading peanut pod rot and screening high-contributed genes that are highly resistant to pod rot should be carried out. A machine vision-based grading approach for individual cases of peanut pod rot was proposed in this study, which avoids time-consuming, labor-intensive, and inaccurate manual categorization and provides dependable technical assistance for breeding studies and peanut pod rot resistance. The Shuffle Attention module has been added to the YOLOv5s (You Only Look Once version 5 small) feature extraction backbone network to overcome occlusion, overlap, and adhesions in complex backgrounds. Additionally, to reduce missing and false identification of peanut pods, the loss function CIoU (Complete Intersection over Union) was replaced with EIoU (Enhanced Intersection over Union). The recognition results can be further improved by introducing grade classification module, which can read the information from the identified RGB images and output data like numbers of non-rotted and rotten peanut pods, the rotten pod rate, and the pod rot grade. The Precision value of the improved YOLOv5s reached 93.8%, which was 7.8%, 8.4%, and 7.3% higher than YOLOv5s, YOLOv8n, and YOLOv8s, respectively; the mAP (mean Average Precision) value was 92.4%, which increased by 6.7%, 7.7%, and 6.5%, respectively. Improved YOLOv5s has an average improvement of 6.26% over YOLOv5s in terms of recognition accuracy: that was 95.7% for non-rotted peanut pods and 90.8% for rotten peanut pods. This article presented a machine vision- based grade classification method for peanut pod rot, which offered technological guidance for selecting high-quality cultivars with high resistance to pod rot in peanut.

Interest of the preventive and curative use of defibrotide on the occurrence and severity of sinusoidal obstruction syndrome after hematopoietic stem cell transplant in children.

Defibrotide (DF) is indicated for the treatment of severe sinusoidal obstruction syndrome (SOS) following hematopoietic stem cell transplantation (HSCT), but its prophylactic use against SOS is not recommended yet. This study describes the impact of the preventive and curative use of DF on reducing the incidence and severity of SOS in children. Patients aged 0-19 years, who received allogenic HSCT after myeloablative conditioning regimen with busulfan or total body irradiation in our comprehensive cancer center, between 2013 and 2017, were included. The Baltimore or modified Seattle criteria were used for SOS diagnosis. SOS was graded using the 2017 European Society for Blood and Marrow Transplantation classification defining severity criteria of SOS in children. SOS occurrence tended to decrease with prophylactic DF, but no significant difference was observed in terms of severity. When not treated with preventive DF, 50% (19/38) of the patients with SOS were graded severe to very severe, but only 37% (7/19) had organ dysfunction. Curative DF was administered at a median of 2 days post-HSCT, for a median of 6.5 days. The absence of fatal SOS supports the use of early curative DF with acceptable toxicities and questions the optimal duration of DF treatment.

The utility of renal sonographic measurements in differentiating children with high grade congenital hydronephrosis.

INTRODUCTION: Current grading systems for hydronephrosis include a subjective determination of parenchymal 'thickness' and suffer from poor reliability. Use of more objective ultrasonographic measurements including medullary pyramidal thickness (PT) may be useful in augmenting current grading systems by decreasing subjectivity and enhancing prognostic ability. OBJECTIVE: To evaluate the utility of PT measurements in patients with SFU grades 3 and 4 hydronephrosis, we assessed the: 1) the inter-rater reliability of PT measurements, 2) the correlation between relative renal function on nuclear renal scan and PT, and 3) the pyeloplasty predictive ability of PT alone and in combination with SFU grade and/or other sonographic measurements in multivariate statistical models. STUDY DESIGN: We retrospectively reviewed 110 children with SFU grade III and IV hydronephrosis. Most patients presented with a history of prenatally detected hydronephrosis at a median age (IQR) of 1.7 months (0.6-5.2). Sixty-two kidneys were followed without operative intervention while 63 underwent pyeloplasty. Indications for surgery included an obstructive drainage pattern with a T1/2 > 20 min on diuretic renal scan in addition to decreased relative renal function less than 40%, increasing hydronephrosis on serial ultrasounds, and/or a decline in relative renal function >10% on serial renal scans. The median age at the time of pyeloplasty was 5.7 months (2.8-13.7). The median time from initial presentation to final follow-up for all patients was 28 months (18.3-44.6). The PT, APD, and renal length were measured on sonographic images. The inter-rater reliability for SFU grading was only fair whereas it was excellent for PT measurements. Receiver operating characteristic (ROC) curves were generated for inclusive multivariate models for prediction of pyeloplasty with and without SFU grade. DISCUSSION AND CONCLUSIONS: PT is a reliable and useful measurement to characterize the hydronephrotic kidney parenchyma and a PT > 3 mm occurs significantly more frequently in patients with a DRF ≥ 45% (p = 0.0056). PT alone was predictive of subsequent pyeloplasty (AUC = 0.781). A novel pyeloplasty predictive score (PPS) using only objective measurements including PT, APD, and renal length was more accurate than a PPS that incorporated SFU grade (AUC of 0.885 and 0.866, respectively). Utilization of PT ≤ 3 mm as a criterion for 'thinned parenchyma' in the SFU, UTD, and other hydronephrosis grading systems should be considered if confirmed by additional studies.

Analysis of risk factors for recurrence after curative resection of well-differentiated pancreatic neuroendocrine tumors based on the new grading classification.

BACKGROUND: It is difficult to predict the malignant potential of pancreatic neuroendocrine tumors (PNETs) precisely. This study investigated the validity of a new grading system adopted by the World Health Organization 2010 classification to determine risk factors for recurrence of PNETs. METHODS: Data of 70 patients with PNETs who underwent curative resection were retrospectively examined by uni- and multivariate analyses. Histopathological findings were re-reviewed by experienced pathologists. NET G1 was defined as mitotic count <2 per 10 high power fields (HPF) and/or ≤2% Ki67 index, and NET G2 as 2-20 mitosis per 10 HPF and/or 3-20% Ki67 index. RESULTS: There were 58 patients with NET G1 and 12 with NET G2. Incidence of recurrence was 11.4%. Univariate analysis demonstrated significant risk factors for recurrence including NET G2 of histological grade (P = 0.0089), male gender (P = 0.0333), tumor size ≥ 20 mm (P = 0.0117), lymph node metastasis (P = 0.0004), liver metastasis (P < 0.0001), lymphatic invasion (P = 0.046), and neural invasion (P = 0.0002). By multivariate analysis, histological grade (hazard ratio; 59.76, P = 0.0022) and neural invasion (hazard ratio; 147.49, P = 0.0016) were significantly associated with recurrence of PNETs. CONCLUSIONS: This study confirmed the prognostic relevance of the new grading classification and that evaluation of perineural invasion and histological grade should be considered as prognostic predictors in well-differentiated PNETs (NET G1 and G2).