Retrospective analysis based on a clinical grading system for patients with hepatic hemangioma:A single center experience

BACKGROUND The optimal approach for managing hepatic hemangioma is controversial.AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience.METHODS A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018.Patients were classified into four groups based on the clinical grading system and treatment:(1)Observation group with score<4(Obs score<4);(2)Surgical group with score<4(Sur score<4);(3)Observation group with score≥4(Obs score≥4);and(4)Surgical group with score≥4(Sur score≥4).The clinico-pathological index and outcomes were evaluated.RESULTS There were significantly fewer symptomatic patients in surgical groups(Sur score≥4 vs Obs score≥4,P<0.001;Sur score<4 vs Obs score<4,χ^(2)=8.60,P=0.004;Sur score≥4 vs Obs score<4,P<0.001).The patients in Sur score≥4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score≥4(P<0.001;P<0.001).Nevertheless,there was no significant difference in need for intervention and total patients with adverse event between the Sur score<4 and Obs score<4(P>0.05;χ^(2)=1.68,P>0.05).CONCLUSION This clinical grading system appeared as a practical tool for hepatic hemangioma.Surgery can be suggested for patients with a score≥4.For those with<4,follow-up should be proposed.

Facial Grading System:Physical and Psychological Impairments to Be Considered

In the past half century, more than twenty facial grading systems have been developed to assess the facial nerve function after the onset of facial nerve paralysis and during rehabilitation.

Evaluation of clinical significance of claudin 7 and construction of prognostic grading system for stage Ⅱ colorectal cancer

BACKGROUND Claudin 7 is often abnormally expressed in cancers and promotes the progression of some malignancies. However, the role of claudin 7 in stage Ⅱ colorectal cancer(CRC) has not been studied.AIM To assess the expression and prognostic value of claudin 7 in stage Ⅱ CRC.METHODS We retrospectively studied 231 stage Ⅱ CRC patients who underwent radical surgery at our hospital from 2013 to 2014. The protein expression level of claudin7 was assessed and its relationship with clinicopathological features and prognosis was statistically analyzed. The independent prognostic factors were identified by Cox proportional hazards models. A prognostic grading system was constructed to stratify the survival of CRC patients.RESULTS The expression of claudin 7 was significantly reduced in cancer tissues compared with normal tissues(P < 0.001), and its low expression was closely related to recurrence of the disease(P = 0.017). Multivariate analysis confirmed that claudin7 low expression(claudin 7-low)(P = 0.028) and perineural invasion positivity(PNI+)(P = 0.026) were independent predictors of poor disease-free survival(DFS). A prognostic grading system based on the status of claudin 7 and PNI classified the patients into three prognostic grades: grade A(claudin 7-high and PNI-), grade B(claudin 7-low and PNI-, claudin 7-high and PNI+), and grade C(claudin 7-low and PNI+). The DFS was significantly different among the three grades(grade B vs grade A, P = 0.032;grade C vs grade A, P < 0.001;grade C vs grade B, P = 0.040).CONCLUSION Claudin 7 can be used as a new prognostic marker to predict the DFS of patients with stage Ⅱ CRC. The prognostic grading system with the addition of claudin 7 can further improve prognosis stratification of patients.

The evolving Gleason grading system

The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology （ISUP） in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/ UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new ＂Grade Group＂ system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.

Robust Magnification Independent Colon Biopsy Grading System over Multiple Data Sources

Automated grading of colon biopsy images across all magnifications is challenging because of tailored segmentation and dependent features on each magnification.This work presents a novel approach of robust magnification-independent colon cancer grading framework to distinguish colon biopsy images into four classes:normal,well,moderate,and poor.The contribution of this research is to develop a magnification invariant hybrid feature set comprising cartoon feature,Gabor wavelet,wavelet moments,HSV histogram,color auto-correlogram,color moments,and morphological features that can be used to characterize different grades.Besides,the classifier is modeled as a multiclass structure with six binary class Bayesian optimized random forest(BO-RF)classifiers.This study uses four datasets(two collected from Indian hospitals—Ishita Pathology Center(IPC)of 4X,10X,and 40X and Aster Medcity(AMC)of 10X,20X,and 40X—two benchmark datasets—gland segmentation(GlaS)of 20X and IMEDIATREAT of 10X)comprising multiple microscope magnifications.Experimental results demonstrate that the proposed method outperforms the other methods used for colon cancer grading in terms of accuracy(97.25%-IPC,94.40%-AMC,97.58%-GlaS,99.16%-Imediatreat),sensitivity(0.9725-IPC,0.9440-AMC,0.9807-GlaS,0.9923-Imediatreat),specificity(0.9908-IPC,0.9813-AMC,0.9907-GlaS,0.9971-Imediatreat)and F-score(0.9725-IPC,0.9441-AMC,0.9780-GlaS,0.9923-Imediatreat).The generalizability of the model to any magnified input image is validated by training in one dataset and testing in another dataset,highlighting strong concordance in multiclass classification and evidencing its effective use in the first level of automatic biopsy grading and second opinion.

Comparison of tumor regression grading systems for locally advanced gastric adenocarcinoma after neoadjuvant chemotherapy

BACKGROUND Current tumor regression grade(TRG)evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results.The recent six-tier system(JGCA2017-TRG)recommended by the Japanese Gastric Cancer Association(JGCA)is worth investigating,as four-tier TRG systems are favored in various parts of the world.AIM To compare the predictive accuracies of five published TRG systems.METHODS Data were retrospectively collected from patients with locally advanced gastric cancer(LAGC)who underwent neoadjuvant chemotherapy followed by D2 Lymphadenectomy between January 2005 and January 2014 at our institution.Outcomes were overall survival(OS)and disease-free survival(DFS),which were evaluated separately using the following TRG systems:JGCA2017,JGCA,Becker,AJCC/CAP,and Mandard.RESULTS All five published TRG systems were independent predictors for OS and DFS.Concordance indices of the JGCA2017,JGCA,Becker,AJCC/CAP-TRG,and Mandard systems were 0.651/0.6480.652/0.649,0.693/0.695,0.688/0.685,and 0.674/0.675 for OS and DFS,respectively.The four-tier Becker system showed the highest c-index,which was significantly greater than that of the six-tier JGCA2017 and five-tier JGCA systems(P<0.05 in OS and DFS).When residual tumor percentages were reset as:“no residual tumor”,<10%,<100%,and“no response”,the rearranged cutoff values achieved a maximum c-index with 0.728 for OS and 0.737 for DFS,which was superior to the other five systems.CONCLUSION The newly introduced six-tier JGCA-TRG system cannot increase prognostic stratification.The four-tier Becker system is more suitable for LAGC patients.A population-based study is warranted to define the optimal criterion for TRG in LAGC patients.

Analysis of long-term outcomes and application of the tumor regression grading system in the therapeutic assessment of resectable limited-disease small cell lung cancer

Objective The present study attempted to evaluate the value of neoadjuvant chemotherapy in limiteddisease small cell lung cancer(LD-SCLC),and to identify the predictive value of the tumor regression grading(TRG) system in LD-SCLC treatment-response and prognosis.Methods The records of patients with LD-SCLC(p-Stage I–IIIa) who underwent definitive radical resection at Shaanxi Provincial People's Hospital between March 1,2000 and March 31,2014 were retrospectively analyzed.We compared the disease-free survival(DFS) and overall survival(OS) rates between Group A patients(patients who underwent surgery combined with pre-and post-operative chemotherapy) and Group B patients(patients who underwent surgery combined with adjuvant chemotherapy only) using the Kaplan-Meier method and the Mantel-Cox test.The specimens of patients who received neoadjuvant chemotherapy were reassessed according to the TRG system.Results The median DFS for 27 patients was 16.267 months and the median OS was 81.167 months(1-year OS,74.07%;3-year OS,22.22%;5-year OS,14.81%).Thirteen patients received neoadjuvant chemotherapy,and their specimens were reassessed by TRG(pathological complete remission,3/13,23.08%).Patients in group A had a longer OS than those in group B(mean,93.782 months versus 42.322 months,P = 0.025),although there was no significant difference in DFS between the two groups(median 20.100 months versus 14.667 months,P = 0.551).Statistical analysis revealed that TRG Grade(G) 0(mean,61.222 months) was associated with better OS than G1-2(mean,31.213 months)(P = 0.311).Conclusion Our study indicated that neoadjuvant chemotherapy combined with surgical resection may represent a feasible treatment method for patients with LD-SCLC.The TRG system may be a valuable prediction tool to assess neoadjuvant chemotherapeutic efficacy,especially in patients with G0 disease as determined by TRG;these patients may attain an improved survival benefit with neoadjuvant chemotherapy.

Ventral Hernia: An Innovative Grading System

Background: Ventral hernia is a complex and progressive condition that may lead to serious complications. However, no specified grading or classifying system is found to categorize the hernia, which leads to clinical complexities and may affect the patient outcome. Aim: The general aim of this paper is to build up an easy and comprehensive grading system to categorize ventral hernia. Methodology: By carrying out a secondary search over clinical presentation, physical examination, and imaging studies of ventral hernia, a valid grading system is developed. Results: Hanoon’s grading system is composed of seven grades, grades 1, 2A, 2B, 3A, 3B, 3C, and 4. Each grade entailed different clinical presentations, imaging characteristics, and progressivity of ventral hernia. Conclusion: Hanoon’s grading system for ventral hernia can be used to solve the clinical complexities of ventral hernia. Also, it can be a step forward in hernia research to build upon.

Hypoxia-inducible factor 1alpha and vascular endothelial growth factor in Glioblastoma Multiforme:a systematic review going beyond pathologic implications

Glioblastoma multiforme(GBM)is an aggressive primary brain tumor characterized by extensive heterogeneity and vascular proliferation.Hypoxic conditions in the tissue microenvironment are considered a pivotal player leading tumor progression.Specifically,hypoxia is known to activate inducible factors,such as hypoxia-inducible factor 1alpha(HIF-1α),which in turn can stimulate tumor neo-angiogenesis through activation of various downward mediators,such as the vascular endothelial growth factor(VEGF).Here,we aimed to explore the role of HIF-1α/VEGF immunophenotypes alone and in combination with other prognostic markers or clinical and image analysis data,as potential biomarkers of GBM prognosis and treatment efficacy.We performed a systematic review(Medline/Embase,and Pubmed database search was completed by 16th of April 2024 by two independent teams;PRISMA 2020).We evaluated methods of immunoassays,cell viability,or animal or patient survival methods of the retrieved studies to assess unbiased data.We used inclusion criteria,such as the evaluation of GBM prognosis based on HIF-1α/VEGF expression,other biomarkers or clinical and imaging manifestations in GBM related to HIF-1α/VEGF expression,application of immunoassays for protein expression,and evaluation of the effectiveness of GBM therapeutic strategies based on HIF-1α/VEGF expression.We used exclusion criteria,such as data not reporting both HIF-1αand VEGF or prognosis.We included 50 studies investigating in total 1319 GBM human specimens,18 different cell lines or GBM-derived stem cells,and 6 different animal models,to identify the association of HIF-1α/VEGF immunophenotypes,and with other prognostic factors,clinical and macroscopic data in GBM prognosis and therapeutic approaches.We found that increased HIF-1α/VEGF expression in GBM correlates with oncogenic factors,such as miR-210-3p,Oct4,AKT,COX-2,PDGF-C,PLDO3,M2 polarization,or ALK,leading to unfavorable survival.Reduced HIF-1α/VEGF expression correlates with FIH-1,ADNP,or STAT1 upregulation,as well as with clinical manifestations,like epileptogenicity,and a favorable prognosis of GBM.Based on our data,HIF-1αor VEGF immunophenotypes may be a useful tool to clarify MRI-PET imaging data distinguishing between GBM tumor progression and pseudoprogression.Finally,HIF-1α/VEGF immunophenotypes can reflect GBM treatment efficacy,including combined first-line treatment with histone deacetylase inhibitors,thimerosal,or an active metabolite of irinotecan,as well as STAT3 inhibitors alone,and resulting in a favorable tumor prognosis and patient survival.These data were supported by a combination of variable methods used to evaluate HIF-1α/VEGF immunophenotypes.Data limitations may include the use of less sensitive detection methods in some cases.Overall,our data support HIF-1α/VEGF’s role as biomarkers of GBM prognosis and treatment efficacy.

Combined Optimal Dispatch of Thermal Power Generators and Energy Storage Considering Thermal Power Deep Peak Clipping and Wind Energy Emission Grading Punishment

Peak load and wind energy emission pressure rise more as wind energy penetration keeps growing,which affects the stabilization of the PS(power system).This paper suggests integrated optimal dispatching of thermal power generators and BESS(battery energy storage system)taking wind energy emission grading punishment and deep peak clipping into consideration.Firstly,in order to minimize wind abandonment,a hierarchical wind abandonment penalty strategy based on fuzzy control is designed and introduced,and the optimal grid-connected power of wind energy is determined as a result of minimizing the peak cutting cost of the system.Secondly,considering BESS and thermal power,the management approach of BESS-assisted virtual peak clipping of thermal power generators is aimed at reducing the degree of deep peak clipping of thermal power generators and optimizing the output of thermal power generators and the charging and discharging power of BESS.Finally,Give an example of how this strategy has been effective in reducing abandonment rates by 0.66% and 7.46% individually for different wind penetration programs,and the daily average can reduce the peak clipping power output of thermal power generators by 42.97 and 72.31 MWh and enhances the effect and economy of system peak clipping.

Relationship between neonatal respiratory distress syndrome pulmonary ultrasonography and respiratory distress score,oxygenation index,and chest radiography grading

BACKGROUND Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome(RDS),but current assessment methods for RDS pose a cumulative risk of harm to neonates.Thus,a less harmful method for assessing the health of neonates with RDS is needed.AIM To analyze the relationships between pulmonary ultrasonography and respiratory distress scores,oxygenation index,and chest X-ray grade of neonatal RDS to identify predictors of neonatal RDS severity.METHODS This retrospective study analyzed the medical information of 73 neonates with RDS admitted to the neonatal intensive care unit of Liupanshui Maternal and Child Care Service Center between April and December 2022.The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest Xray grade of each newborn before and after treatment were collected.Spearman correlation analysis was performed to determine the relationships among these values and neonatal RDS severity.RESULTS The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest X-ray RDS grade of the neonates were significantly lower after treatment than before treatment(P<0.05).Spearman correlation analysis showed that before and after treatment,the pulmonary ultrasonography score of neonates with RDS was positively correlated with the respiratory distress score,oxygenation index,and chest X-ray grade(ρ=0.429–0.859,P<0.05).Receiver operating characteristic curve analysis indicated that pulmonary ultrasonography screening effectively predicted the severity of neonatal RDS(area under the curve=0.805–1.000,P<0.05).CONCLUSION The pulmonary ultrasonography score was significantly associated with the neonatal RDS score,oxygenation index,and chest X-ray grade.The pulmonary ultrasonography score was an effective predictor of neonatal RDS severity.

Sound Transmission Loss Analysis of a Double Plate-Acoustic Cavity Coupling System with In-Plane Functionally Graded Materials

In this paper, the isogeometric analysis (IGA) is employed to develop an acoustic radiation model for a double plate-acoustic cavity coupling system, with a focus on analyzing the sound transmission loss (STL). The functionally graded (FG) plate exhibits a different material properties in-plane, and the power-law rule is adopted as the governing principle for material mixing. To validate the harmonic response and demonstrate the accuracy and convergence of the isogeometric modeling, ANASYS is utilized to compare with numerical examples. A plane wave serves as the acoustic excitation, and the Rayleigh integral is applied to discretize the radiated plate. The STL results are compared with the literature, confirming the reliability of the coupling system. Finally, the investigation is conducted to study impact of cavity depth and power-law parameter on the STL.

Comparison study of two diagnostic and grading systems for conjunctivochalasis

Background Different diagnostic and grading systems of conjunctivochalasis have resulted in apparent disparity between the prevalence rates of recent population-based studies.This study aimed to investigate the disparity between 4-level system cited from Meller and Tseng in 1998 （abbreviated here as Meller＇s system） and 5-level system modified from Meller＇s system cited from Zhang and associates （abbreviated here as Zhang＇s system） regarding the diagnosis and the patients＇ preferences for the treatment of conjunctivochalasis in the general population.Methods A total of 546 senile residents living in the Guiyangyuan community of Shanghai,China,participated in the study.The diagnostic criteria for conjunctivochalasis were based on two diagnostic grading systems：Meller＇s system and Zhang＇s system,which was modified from Meller＇s system.The participants＇ preference regarding medical treatment for conjunctivochalasis was determined according to the response to a question.One year later,a follow-up interview determines whether the patient had undergone surgery for conjunctivochalasis.Results With Meller＇s system,398 participants were confirmed as having conjunctivochalasis,and the prevalence rate was 72.89％.According to Zhang＇s system,only 213 participants were diagnosed as having conjunctivochalasis,and the prevalence rate was 39.01％.A total of 109 eyes underwent medical treatment or surgery for conjunctivochalasis in the following year,including eight eyes that were diagnosed as grade Ⅱ and 101 eyes that were diagnosed as grade Ⅲ according to Meller＇s system and five eyes that were diagnosed as grade Ⅰ,55 eyes that were diagnosed as grade Ⅱ,31 eyes that were diagnosed as grade Ⅲ,and 18 eyes that were diagnosed as grade Ⅳ according to Zhang＇s system.Conclusion Diagnoses of conjunctivochalasis using Zhang＇s system are more consistent with patient requests and the medical treatment strategies used than diagnoses made using Meller＇s system.

Performance of bottleneck shifting for remanufacturing system considering returns' quality grading

Aimed at the remanufacturing system, the effect of the uncertainty of returns＇ quality on bottleneck shifting is investigated. A novel definition of bottleneck station is presented and the probability of a station becoming a bottleneck is also given. By calculating the effective output, the effective operation time （EOT） and the ratio of EOT of each station, the system＇s current bottleneck of effective output time is determined. By calculating the probability coefficient of variation and index of bottleneck shifting, the quantitative performance of bottleneck shifting is obtained. Discrete event simulation and the experiment design method are adopted to simulate the system, in which the proportion of quality grading, repair rates and process routes are considered. The case study shows that the uncertainty of returns＇ quality greatly increases the probability of bottleneck shifting, and with the increase of the discrete degree of the returns＇ repair rate, the bottleneck shifting phenomenon is more obvious. Furthermore, bottleneck shifting is closely related to the process route of the dominating returns＇ quality grade.

Reproducibility of the Nottingham modification of the Scarff- Bloom-Richardson histological grading system and the complementary value of Ki-67 to this system

Background The reproducibility of the Nottingham modification of the Scarff-Bloom-Richardson （NSBR） histological grading system for invasive breast cancer （IBC） adopted by the World Health Organization （WHO） has previously not been studied in Chinese hospitals. The proliferation marker, Ki-67, has been widely applied in detecting IBC. The objective of this study was to assess the reproducibility of the NSBR system among Chinese pathologists and the complementary value that Ki-67 brings to this system.Methods Four general pathologists graded 100 IBC cases independently, which had previously been graded by specialists in breast pathology. The interobserver reproducibility among four general pathologists and pairwise reproducibility between each of them and the specialists were assessed. The Ki-67 labeling index （Ki-67LI） was determined by immunohistochemistry, and its correlations with histological grade and survival were determined.Results With respect to interobserver reproducibility, NSBR grading was fairly reproducible （kappa=0.34）; as for the components of NSBR grading, agreement was best for tubule formation （kappa=0.46）, intermediate for nuclear pleomorphism （kappa=0.42）, and poorest for mitotic count （kappa=0.28）. In terms of pairwise reproducibility, agreement was fair to substantial with NSBR grading （kappa=0.30-0.69） and nuclear pleomorphism （kappa=0.28-0.69）, moderate to substantial for tubule formation （kappa=0.51-0.78）, and slight to substantial for mitotic count （kappa=0.19-0.71）.There were characteristic Ki-67LI ranges for grades 1,2 and 3 tumors. Univariate analysis showed that Ki-67 was able to divide grade 2 patients into two different prognostic subgroups. Multivariate analysis of grade 2 patients with negative lymph node demonstrated that Ki-67 was an independent prognosticator for overall survival.Conclusions The reproducibility of grading by general pathologists could be enhanced. Specialization in breast pathology is essential for accurate grading and treatment for IBC. Ki-67, with proven prognostic significance, adds complementary value to the NSBR system.

Predictive efficacy of the 2014 International Society of Urological Pathology Gleason grading system in initially diagnosed metastatic prostate cancer

We compared the predictive ability of the 2014 and 2005 Gleason grading systems in 568 patients initially diagnosed with metastatic prostate cancer （PCa）. Outcomes included the duration of castration-resistant prostate cancer-free survival （CFS） and overall survival （OS）. Univariate analyses and log-rank tests were used to identify prognosis indicators and assess univariable differences in CFS and OS in Gleason score （GS） groups. Cox proportional hazards and area under the curves of receiver operator characteristics methods were used to evaluate the predictive efficacy of the 2005 and 2014 ISUP grading systems. Univariate analyses showed that the 2005 and 2014 grading systems were prognosticators for CFS and OS; both systems could distinguish the clinical outcome of patients with GS 6, GS 7, and GS 8-10. Using the 2014 criteria, no statistical differences in patient survival were observed between GS 3 ＋ 4 and GS 4 ＋ 3 or GS 8 and GS 9-10. The predictive ability of the 2014 and 2005 grading systems was comparable for CFS and OS （P = 0.321）. However, the 2014 grading system did not exhibit superior predictive efficacy in patients initially diagnosed with PCa and bone metastasis; trials using larger cohorts are required to confirm its predictive value. To the best of our knowledge, ours is the first study to compare the 2005 and 2014 grading systems in initially diagnosed PCa with bone metastasis. At present, we recommend that both systems should be used to predict the prognosis of patients with metastatic PCa.

Grading system modification and management of blunt aortic injury

Background The traditional approach to blunt aortic injury （BAI） has been emergent intervention. This study aimed to utilize a modified imaging grading system that may allow us to categorize these injuries as needing emergent, urgent, or non-operative management. Methods From January 2003 to December 2011, 28 patients with BAI were managed at our institution. Imaging and medical records were reviewed retrospectively. BAI was classified into 4 grades based on imaging studies. Grade la： intimal tear, Grade Ib： intramural hematoma; Grade Ⅱ： intimal injury with periaotic hematoma; Grade Ilia： aortic transection with pseudoaneurysm, Grade Illb： multiple aortic injuries; and Grade IV： free rupture. Progression and clinical outcomes of ABI were analyzed. Results Of the 28 patients, 22 were males and 6 were females with mean age of 38 （range, 7-69） years, Twenty-five （89.3%） had descending thoracic aortic injury, two （7.1%） had abdominal aortic injury and one （3.6%） presented with multiple aortic injuries. Three patients （10.7%） with Grade I, 1 （3.6%） Grade Ⅱ, 22 （78.6%） Grade Ⅲ, and 2 （7.1%） Grade IV injuries. Twenty-five patients underwent thoracic endovascular aortic repair and 3 were managed medically. Median time between injury and surgical intervention was （2±1） days. One （3.6%） patient developed paraplegia after thoracic endovascular aortic repair （TEVAR）. One Type 2 endoleak spontaneously sealed within 1 month, and another patient died from ruptured Type 1 endoleak 3 years later. Median follow-up time was 16 （range, 1-96） months. Perioperative 30-day mortality rate was 3.6%. Conclusions This study based on our modified BAI grading system indicated that Grade Ⅰ BAI can be managed conservatively. Grade Ⅱ injury requires close observation and repeated computerized tomography angiogram （CTA） within 48-72 hours. If injury appears worse on follow up imaging, surgery should be performed. Delayed repair of Grade Ⅲ BAI is acceptable if associated life threatenina traumatic iniuries need to be addressed first.

System describing surgical field extension associated with flap reconstruction after resection of a superficial malignant soft tissue tumor

BACKGROUND Flap reconstruction after resection of a superficial malignant soft tissue tumor extends the surgical field and is an indicator for potential recurrence sites.AIM To describe a grading system for surgical field extension of soft tissue sarcomas.METHODS Grading system:CD-grading is a description system consisting of C and D values in the surgical field extension,which are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle,respectively.C1/D1 are positive values and C0/D0 are negative.With a known location,1/0 values can be"p"(proximal),"d"(distal),and"b"(in the tumor bed),and the description method is as follows:flap type,CxDx[x=0,1,p,d or b].RESULTS Four representative patients with subcutaneous sarcomas who underwent reconstruction using fasciocutaneous flaps are presented.The cases involved a distal upper arm(elbow)synovial sarcoma reconstructed using a pedicled latissimus dorsi(pedicled flap:CpDp);a distal upper arm(elbow)pleomorphic rhabdomyosarcoma reconstructed using a transpositional flap from the forearm(transpositional flap:CdD0);an undifferentiated pleomorphic sarcoma in the buttocks reconstructed using a transpositional flap(transpositional flap:C0D0);and a myxofibrosarcoma in the buttocks reconstructed using a propeller flap from the thigh(pedicled flap:CdDd).CONCLUSION The reconstruction method is chosen by the surgeon based on size,location,and other tumor characteristics;however,the final surgical field cannot be determined based on preoperative images alone.CD-grading is a description system consisting of C and D values in the surgical field extension that are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle,respectively.The CD-grading system gives a new perspective to the flap reconstruction classification.The CD-grading system also provides important information for follow-up imaging of a possible recurrence.

Construction of the Classification and Grading Index System of Cultivated Land Based on the Viewpoint of Sustainable Development

In order to objectively and reasonably evaluate the actual and potential value of cultivated land, both social and ecological values are introduced into the classification and grading index system of cultivated land based on the viewpoint of sustainable development, after considering the natural and economic values of cultivated land. Index system construction of the sustainable utilization of cultivated land should follow the principles of economic viability, social acceptability, and ecological protection. Classification of cultivated land should take into account the soil fertility of cultivated land. Then, grading of cultivated land is carried out from the practical productivity (or potential productivity) of cultivated land. According to the existing classification index system of cultivated land, the soil, natural and environmental factors in plains, mountains and hills are mainly modified in the classification index system of cultivated land. And index systems for the cultivated land classification in plains, mountains and hills are set up. The grading index system of cultivated land is established based on the economic viability (economic value), social acceptability (social value) and protection of cultivated land (ecological value). Quantitative expression of cultivated land grading index is also carried out.

Catalyst grading technology for promoting the diesel hydrocracking to naphtha

This paper reports the application of multi-component hydrocracking catalyst grading technology in diesel hydrocracking system to increase naphtha,and studies the influence of catalyst systems with different number of graded beds on the reaction process of diesel hydrocracking.Three hydrocracking catalysts with different physicochemical properties as gradation components,the diesel hydrocracking reaction on catalyst systems of one-component,two-component and three-component graded beds with different loading sequences are carried out and evaluated,respectively.The catalytic mechanism of the multi-component grading system is analyzed.The results show that,with the increase of the number of grading beds,the space velocity of reaction on each catalyst increases,which can effectively control the overreaction process;along the flow direction of feedstock,the loading sequences of catalysts with acidity decreasing and pore properties increasing can satisfy the demand of different catalytic activity for the conversion of reactant with changing composition to naphtha,which has a guiding role in the conversion of feedstock to target products.Therefore,the conversion of diesel,the selectivity and yield of naphtha all increase significantly on the multi-component catalyst system.The research on the grading technology of multi-component catalysts is of great significance to the promotion and application of catalyst systems in various catalytic fields.