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Assessment of Recanalization after Intra-Arterial Thrombolysis in Patients with Acute Ischemic Stroke : Proposed Modification of the Qureshi Grading System

  • Kim, Jae-Hoon;Kang, Hee-In;Moon, Byung-Gwan;Lee, Seung-Jin;Kim, Joo-Seung
    • Journal of Korean Neurosurgical Society
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    • v.51 no.5
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    • pp.262-267
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    • 2012
  • Objective : We aimed to investigate the correlation between the success of recanalization and a modified version of the Qureshi grading system in acute ischemic stroke patients. Methods : We retrospectively analyzed the intra-arterial thrombolysis (IAT) records of 37 patients who were evaluated by Thrombolysis in Myocardial Infarction (TIMI) and a modified version of the Qureshi grading systems as follows : 1) post-IAT Qureshi grade, 2) modified ${\Delta}$ Qureshi grade : pre-IAT group grade - post-IAT group grade (grade 1 : Qureshi grades 0-2 and grade 2 : Qureshi grade 3-5) and 3) ${\Delta}$ Qureshi grade (post-IAT Qureshi grade - pre-IAT Qureshi grade). Successful recanalization was defined as follows : 1) post-IAT TIMI grades 2 and 3, 2) post-IAT Qureshi grade 0-2, 3) modified ${\Delta}$ Qureshi grade=1, and 4) ${\Delta}$ Qureshi grade of ${\geq}2$ and/or post-IAT Qureshi grade=0. We investigated the correlation between the post-IAT TIMI grade and the modified Qureshi grade and also compared the various grading systems with modified Rankin Scale scores for evaluating the clinical outcome at 3 months. Results : The post-IAT Qureshi grade and ${\Delta}$ Qureshi grade and/or post-IAT Qureshi grade were significantly correlated with the TIMI grade (${\gamma}$=0.976 and, 0.942, respectively). Further, post-IAT Qureshi grade and ${\Delta}$ Qureshi grade and/or post-IAT Qureshi grade showed a significantly stronger association with clinical outcome than did the post-IAT TIMI grade (p=0.001 and, 0.000 vs. 0.083, respectively). Conclusion : Our preliminary results suggest that the modified Qureshi grading system is a useful tool for assessing the success of recanalization after IAT.

Grade I and II Chondrosarcoma of the Humerus (상완골에서 발생한 Grade I 및 Grade II 연골육종 - 증례 보고 -)

  • Cho, Wan-Hyeong;Jeon, Dae-Geun;Park, Jong-Hoon;Song, Won-Seok;An, Joon-Hwan;Lee, Soo-Yong
    • The Journal of the Korean bone and joint tumor society
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    • v.12 no.2
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    • pp.131-135
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    • 2006
  • Chondrosarcoma can be divided into grade I, II and III by histological finding and a relationship between the prognosis and the histological grading has been identified. Although the surgical treatment of grade II and III chondrosarcoma necessitates wide resection margin, there has been controversy about curettage versus wide resection in case of grade I chondrosarcoma. The authors report a case of grade I chondrosarcoma of proximal humerus and grade II chondrosarcoma of distal humerus with good oncological and functional result through curettage and wide resection respectively.

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A Study on the Waveform Analysis of Left KWAN Pulse Dignosis by the Pressure (단계별(段階別) 가압(加壓)에 따른 좌관부위(左關部位) 맥파(脈波) 변화(變化))

  • Kim, Gyeong-Cheol;Lee, Jeong-Won;Ryu, Kyeong-Ho;Kim, Jong-Hwan;Park, Ju-Yeon
    • The Journal of the Society of Korean Medicine Diagnostics
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    • v.13 no.1
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    • pp.19-35
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    • 2009
  • Objectives : In the study on the waveform analysis of radial artery pulse diagnosis, we need to establish fundamentals of contemporary pulse diagnosis research. To achieve certain experimental basis on traditional pulse diagnosis, we have to research the differences of pulse waveform according to pressure (in 5 level) and position (Chon, Gwan, Cheok in radial artery). As a first step, in present thesis, we tried to find the differences of pulse waveform according to pressure. Methods and Results : In this research, we analyzed seven parameters of the waveform at five levels of pressure. The parameters are E(so called 'energy', a representative of pulse strength), h1(height of percussion wave) and h2(height of subincisura). The results were as follows. 1. When we analyzed the change of the waveform according to pressure in the left Gwan, E, hl, h2 and A differed between 1st and 2nd grade, between 1st and 3rd grade, between 1st and 4th grade, between 1st and 5th grade, between 2nd and 3rd grade, between 2nd and 5th grade, between 3rd and 5th grade and between 4th and 5th grade in 95% confidence interval. 2. And t2, t4 differed between 1st and 2nd grade, between 1st and 5th grade, between 2nd and 4th grade, between 2nd and 4th grade, between 2nd and 5th grade, between 3rd and 4th grade, between 3rd and 5th grade and between 4th and 5th grade in 95% confidence interval. 3. W differed between 1st and 3rd grade, between 1st and 4th grade, between 2nd and 3rd grade, between 2nd and 4th grade, between 2nd and 5th grade, between 3rd and 4th grade, between 3rd and 5th grade, and between 4th and 5th grade in 95% confidence interval. 4. And h2/h1 differed between 1st and 4th grade, between 1st and 5th grade, between 2nd and 4th grade, between 2nd and 5th grade, between 3rd and 4th grade & between 3rd and 5th grade in 95% confidence interval. 5. There were differences between 1st and 2nd grade & between 2nd and 5th grade in the case of t4/t2 in 95% confidence interval. And there were differences between 1st and 5th grade, between 3rd and 4th grade, between 3rd and 5th grade & between 4th and 5th grade in the case of W/A in 95% confidence interval. And were differences between 1st and 2nd grade, between 2nd and 3rd grade, between 2nd and 4th grade, between 3rd and 4th grade, between 3rd and 5th grade & between 4th and 5th grade in the case of A/E in 95% confidence interval. Conclusions : As mentioned above, we conclude that the waveform analysis according to five grade pressure in the left Gwan shows the difference of waveform in each grade pressure.

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Necessity of 99mTc-dimercaptosuccinic acid scan in infants with low grade vesicoureteral feflux (경도의 방광요관역류가 있는 소아에서 99mTc-dimercaptosuccinic acid 신 스캔의 필요성)

  • Koh, Ji Yeon;Koo, Ja Wook
    • Clinical and Experimental Pediatrics
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    • v.49 no.6
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    • pp.648-652
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    • 2006
  • Objective : $^{99m}Tc$-dimercaptosuccinic acid(DMSA) scan is considered to be the most sensitive examination for detection of renal scars. However, because of its high radiation exposure to the kidney and its limited usefulness for patients with low grade vesicoureteral reflux(VUR), some authors have suggested that DMSA scans should be reserved primarily for children with VUR grade 3 and above. The aim of this study was to reevaluate the necessity of DMSA scans as a screening test in infants without reflux or with low grade reflux. Methods : In this retrospective study, 189 infants(mean age : 6.2 months) diagnosed as UTI were enrolled. Voiding cystourethrogram(VCUG), DMSA scan and renal ultrasonography were performed within 1 month of UTI. VUR grade was classified into three subgroups; low grade(grade 1-2), moderate grade(grade 3), and high grade(grade 4-5), respectively. Results : Renal defects were present in 67 of 189 infants, and 82 of the 378 renal units. The incidence of renal defects was significantly correlated with VUR grade(P<0.01); 28 percent without reflux, 38 percent with low grade, 53 percent with moderate grade, 100 percent with high grade, respectively. However, there was no significant differences in incidence of renal defects between the low grade and moderate grade group. Conclusion : In this study, renal defects were found in quite high percentages; 28 percent patients without reflux and 38 percent patients with low grade VUR, respectively. Moreover, there was no significant difference in the incidence of renal defects between the low grade and moderate grade groups. Therefore, DMSA scan should be performed for infants with UTI as a screening test regardless of the presence of VUR.

Helicobacter pylori Infection in Children with Recurrent Abdominal Pain (소아에서 만성 반복성 복통(Recurrent Abdominal Pain)과 Helicobacter pylori 감염과의 연관성에 대한 연구)

  • Na, So Young;Seo, Jeong Kee
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.8 no.1
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    • pp.1-11
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    • 2005
  • Purpose: The aim of this study was to evaluate the relationship between H. pylori infection and recurrent abdominal pain (RAP) in children and to evaluate the effects of eradication therapy on RAP. Methods: From January 1998 to January 2005, 166 children with RAP (61 male, 105 female) aged $10.0{\pm}3.3$ years were included. Upper gastrointestinal endoscopies were performed for all the patients. All H. pylori infected children (n=70) received the eradication therapy and were divided into two groups: Group Ia (n=52); eradicated, Group Ib (n=18); non-eradicated. H. pylori-negative children (n=96) were divided into three groups according to the medication: Group IIa (n=67); no medication, Group IIb (n=13); acid-suppressant, Group IIc (n=16); both acid-suppressant and antibiotics. Questionnaire for symptoms were asked at the first, 6th, 12th, 24th, and 36th months following the treatment (grade 0; completely resolved, grade 1; definitely improved, but there are occasional episodes of mild abdominal pain, grade 2; no change in the frequency and intensity of abdominal pain). Results: In about 90% of H. pylori positive children, RAP improved in the both H. pylori-eradicated and non-eradicated children in a follow-up survey. In about 75% of H. pylori-negative children, RAP also improved among in the three groups of patients regardless of medication. Conclusion: These results suggest that there was no correlations between improvement of RAP and eradication of H. pylori, and between improvement of RAP and medication. Consequently the reassurance that the children with RAP have no serious organic cause was important to improvement of RAP.

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Experimental Studies of the Pericardial Substitutes in Rabbits (가토에서 심낭대치물에 관한 실험적 연구)

  • Baeck, Seung-Hwan;Yang, Suk-Rhin;Kim, Sun-Han;Nam, Choong-Hee;Lee, Khil-Rho
    • Journal of Chest Surgery
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    • v.22 no.5
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    • pp.724-730
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    • 1989
  • The development of severe pericardial adhesion after cardiovascular surgical procedures often increases the risk of injuring the heart, great vessels, or extracardiac grafts during resternotomy. Several pericardial substitutes have been tested in an attempt to facilitate reoperation with inconclusive results. This study was designed to evaluate the applicability of two different materials as pericardial substitutes to minimize the pericardial adhesion and epicardial reaction. A procedure for induction of pericardial adhesion was carried out in 30 rabbits. Rabbits were divided into three groups of ten rabbits each: Group 1[control, simple pericardial closure]: Group 2[bovine pericardium as pericardial substitute]: Group 3[e-polytetrafluoroethylene surgical membrane, e-PTFE as a pericardial substitute]. Bovine pericardium or e-PTFE surgical membrane was interposed between the sternum and the heart. Rabbits were sacrificed at 4 weeks after operation. The development of adhesions and epicardial reactions were graded as: none [I]; minimal[II]; moderate[Ill]; and severe[1V]. Histologic studies of the substitute, the pericardium, and the epicardium were performed. The results were as follows; l. In group 1[control group], the degree of pericardial adhesions were grade I in none, grade II in 1, grade III in 3, and grade 1V in 6 animals. Epicardial reactions were grade I in none, grade II in 3, grade K in 4, grade 1V in 3 animals respectively. 2. In group 2[bovine pericardium], the degree of pericardial adhesions were grade I in 1, grade II in 5, grade III in 3, and grade 1V in 1 animal. Epicardial reactions were grade I in 1, grade II in 2, grade III in 4, and grade 1V in 3 animals respectively. 3. In group 3[e-PTFE], the degree of pericardial adhesions were grade I in 7 animals, grade II in 2, grade III in 1, and grade g in none. Epicardial reactions were grade I in 4, grade II in 3, grade III in 2, and grade IV in 1 animal respectively. Pericardial adhesions more than grade II were 90.9% in group 1, 40 % in group 2, and 10% in group 3. Pericardial adhesions were significantly reduced in group 3 compared to group 1 or 2. Epicardial reactions more than grade II were 70 % in group 1, 70 % in group 2 and 30 % in group 3. We concluded that this 0.1mm thick polytetrafluoroethylene surgical membrane is a suitable pericardial substitute to minimize the development of pericardial adhesion or epicardial reaction following cardiovascular surgery.

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Association of tumor differentiation grade and survival of women with squamous cell carcinoma of the uterine cervix

  • Matsuo, Koji;Mandelbaum, Rachel S.;Machida, Hiroko;Purushotham, Sanjay;Grubbs, Brendan H.;Roman, Lynda D.;Wright, Jason D.
    • Journal of Gynecologic Oncology
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    • v.29 no.6
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    • pp.91.1-91.12
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    • 2018
  • Objective: To examine the association between tumor grade and survival for women with squamous cervical cancer. Methods: This retrospective observational study utilized the Surveillance, Epidemiology, and End Result program data between 1983 and 2013 to examine women with squamous cervical cancer with known tumor differentiation grade. Multivariable analyses were performed to assess independent associations between tumor differentiation grade and survival. Results: A total of 31,536 women were identified including 15,175 (48.1%) with grade 3 tumors, 14,084 (44.7%) with grade 2 neoplasms and 2,277 (7.2%) with grade 1 tumors. Higher tumor grade was significantly associated with older age, higher stage disease, larger tumor size, and lymph node metastasis (all, p<0.001). In a multivariable analysis, grade 2 tumors (adjusted-hazard ratio [HR]=1.21; p<0.001) and grade 3 tumors (adjusted-HR=1.45; p<0.001) were independently associated with decreased cause-specific survival (CSS) compared to grade 1 tumors. Among the 7,429 women with stage II-III disease who received radiotherapy without surgical treatment, grade 3 tumors were independently associated with decreased CSS compared to grade 2 tumors (adjusted-HR=1.16; p<0.001). Among 4,045 women with node-negative stage I disease and tumor size ${\leq}4cm$ who underwent surgical treatment without radiotherapy, grade 2 tumors (adjusted-HR=2.54; p=0.028) and grade 3 tumors (adjusted-HR=4.48; p<0.001) were independently associated with decreased CSS compared to grade 1 tumors. Conclusion: Our study suggests that tumor differentiation grade may be a prognostic factor in women with squamous cervical cancer, particularly in early-stage disease. Higher tumor grade was associated with poorer survival.

The Influence of Parenting Attitude to Using Life Time of Adolescent Children (청소년 자녀의 생활시간 사용에 부모의 양육태도가 미치는 영향)

  • Park, Jeongyun;Jeon, yujin
    • Journal of Family Resource Management and Policy Review
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    • v.20 no.4
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    • pp.35-47
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    • 2016
  • This research aimed to observe adolescent children's use of time and to discover the parent-related factors that affect adolescent children's use of time. The subjects included 2,092 fourth-grade elementary school students and 2,108 first-grade middle school students. We used data from the Korean Children and Youth Panel Survey. We tested sociodemographic factors, parents characteristics, and time usage, and we studied these factors using SPSS version 23.0; the results are as follows. Firstly, in the subordinate scope of the child-rearing attitude of parents, affection fourth-grade elementary school students(M = 1.83) and first-grade middle school students(M = 2.02). Inconsistency had an effect on fourth-grade elementary school students(M = 1.99), and first-grade middle school students(M = 2.12). Excessive expectations had an effect on fourth-grade elementary school students(M = 2.40) and first-grade middle school students(M = 2.55). Over-involvement had an effect on fourth-grade elementary school students(M = 2.68)and first-grade middle school students(M = 2.80). Finally, giving reasonable explanations had an effect on fourth-grade elementary school students(M = 1.51)and first-grade middle school students(M = 1.68). Secondly, in fourth-grade elementary school students(M = 463.35) and first-grade middle school students(M = 378.75). Further, studying hours during weekdays had an effect on fourth-grade elementary school students(M = 456.15) and first-grade middle school students(M = 460.86). Free activity hours during had an effect on fourth-grade elementary school students(M = 390.54) and first-grade middle school students(M = 387.11). Sleeping hours during holidays had an effect on fourth-grade elementary school students(M = 544.85) and first-grade middle school students (M = 511.74). Studying hours during holidays had an effect on fourth-grade elementary school students (M = 484.86) and first-grade middle school students (M = 511.74). Free activity hours during holidays had an effect on fourth-grade elementary school students(M = 518.68) and first-grade middle school students(M = 509.73). Thirdly, by observing the relative influence of related factors on adolescent children's use of time, grade(${\beta}$ = -.284), gender(${\beta}$ = -.208), over-involvement(${\beta}$ = -.380), supervising(${\beta}$ = -.217), and (${\beta}$ = .243) in terms of the child-rearing attitudes of parents was found to affect study hours($F=2.595^{**}$). The education level of fathers(${\beta}$ = -.144) results in(${\beta}$ = 1.991) and longer free activity hours for children($F= 4.116^{***}$). This research can be used to study the influence of parents'child-rearing attitudes on adolescent children's use of time and to suggest the role of parents in adolescents' ability to manage time effectively using practical.

Quality Comparison of Loin Muscles from Carcass of Grade B2 and D (상등급과 등외등급 우육의 품질특성 비교)

  • 강세주;김미숙;양종범;정인철;문윤희
    • Food Science of Animal Resources
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    • v.21 no.4
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    • pp.329-336
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    • 2001
  • The experiments were carried out to investigate the aging effect between loin muscles from Hanwoo and Helstein. Two kinds of loin samples were prepared from the carcasses of grade B2 from Hanwoo and D from Holstein. The carcasses were chilled for 24 hours after slaughter. The carcasses was obtained by chilling the loin fort 1 day after wrapping it. On the other hand. was obtained divided by 500g and stored at 2$^{\circ}C$ for 11 days after air packing. In the case of fresh beef pH and lactic acid of grade B2 were lower than that of grade D. Hardness and chewiness of grade B2 were lower than that of grade D, but myofibrillar fragmentation index(MFI) of glade B2 were higher than that of grade D. Total concentrations of free amino acid of grade B2 were higher than those of D. The contents of monounsaturated fatty acid of grade B2 was lower than grade D, and monosaturated fatty acid/saturated fatty acid(MUFA/SFA) of grade B2 were higher than grade D. The contents of nonprotein nitrogen of the aged beef was higher than the fresh beef, and beef of grade B2 was higher than that of grade D. In case of aging beef. cooking loss of grade B2 was lower than grade D.

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Experimental Studies of the Pericardial Releasing Technique in Rabbits (가토에서 심낭이완술에 관한 실험적 연구)

  • 박만실
    • Journal of Chest Surgery
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    • v.20 no.3
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    • pp.451-457
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    • 1987
  • Reoperations following cardiac surgery have an increased risk of the danger of damaging the heart, great vessels or extracardiac grafts because of adhesions to the sternum. We experimentally evaluated 3 different methods for pericardial closure. A standardized procedure for induction of pericardial adhesions was carried out in 30 rabbits. For closure of pericardium, animals were divided into 3 groups, 10 animals respectively: Croup 1 [simple pericardial closure]The pericardium was primarily resuture; Group 2 [Core-Tex surgical membrane as a pericardial substitute]- A Gore-Tex surgical membrane was interposed between the sternum and the heart; and Group 3 [pericardial tension releasing technique]-Three longitudinal overlapping incisions were made on the right side of the pericardium while the midline incison was sutured. Animals were put to death 4 weeks postoperatively and the pericardial space was examined for pericardial adhesions and epicardial reactions. The extent of adhesions and reactions were graded as: I-none; II-minimal; III-moderate; and IV-severe. Histologic studies of the pericardium, the pericardial substitute and the epicardium were also performed. The results were as follows: 1. In group 1 [simple pericardial closure], the degree of pericardial adhesions were grade I in 1 animal, grade II in 2, grade III in 4 and grade IV in 3. Epicardial reactions were grade I in 1 animal, grade II in 3, grade III in 5 and grade IV in 1. Histologic examination revealed thick fibrous tissue that obliterated the pericardial space in 7 animals. 2. In group 2 [Gore-Tex surgical membrane as a pericardial substitute], the degree of pericardial adhesions were grade I in 3 animals, grade II in 3, grade III in 2 and grade IV in 2. The degree of epicardial reactions were grade II in 1 animal, grade III in 5 and grade IV in 4. Histologic studies revealed a thin layer of dense fibrous tissue which covered the Gore-Tex surgical membrane and thick loose fibrous tissue on the epicardium just beneath the substitute. 3. In group 3 [pericardial tension releasing technique], the degree of pericardial adhesions were grade I in 3 animals, grade II in 4, grade III in 2 and grade IV in 1. The degree of epicardial reactions were grade 1 in 4 animals, grade II in 4 and grade III in 2. Severe epicardial reactions were not observed in this group. Histologic examination showed normal epicardium in 4 animals and the epicardium of the other 6 animals only revealed very thin fibrous layer compared to group I and group II. Pericardial adhesions more than grade III were 70% in group 1, 40% in group 2 and 30% in group 3. Pericardial adhesions were reduced in group 2 and group 3 compared to group 1, but statistically not significant. Epicardial reactions more than grade III were 60% in group 1, 90% in group 2 and 20% in group 3. Epicardial reactions were significantly reduced in group 3 compared to group 2. Author`s modified pericardial releasing technique provides marked augment of pericardial surface area and facilitates tension-free pericardial closure. Furthermore, pericardial adhesion and epicardial reaction will be reduced with the pericardial tension releasing technique.

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