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New objective scoring system to clinically assess fecal incontinence

World Journal of Gastroenterology 2023年第29期29卷 4593-4603页

作者： Pankaj Garg Iwona Sudol-Szopinska Małgorzata Kolodziejczak Kaushik Bhattacharya Gurleen Kaur Colorectal Surgery Garg Fistula Research Institute(GFRI)Panchkula 134113HaryanaIndia Colorectal Surgery Indus International HospitalMohali 140507PunjabIndia Department ofRadiology National Institute of GeriatricsRheumatology and RehabilitationWarsaw 02-637Poland Department of Proctology Proctologic CenterSt.Elizabeth HospitalWarsaw 02-616Poland Department of Surgery MGM Medical College and LSK HospitalKishanganj 855107BiharIndia Department of Pharmacology Adesh Medical College and HospitalShahbad 136143HaryanaIndia

BACKGROUND Several scoring systems are used to assess fecal incontinence(FI),among which,the most commonly used are Wexner and Vaizey’s scoring systems.However,there are significant lacunae in these scoring systems,due to which they are neither accurate nor comprehensive.AIM To develop a new scoring system for FI that is accurate,comprehensive,and easy to use.METHODS A pro forma was made in which six types of FI were included:solid,liquid,flatus,mucous,stress,and urge.The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100(0-least,100-maximum disability).The disability was assessed on a modified EQ-5D+(EuroQol)description system,4D3L(4 dimensions and 3 levels)for each FI.The average score of each FI was calculated,divided by 10,and rounded off to determine the weight of each FI type.The scores for the three levels of frequency of each FI were assigned as never=0(No episode of FI ever),occasional=1(≤1 episode of FI/wk),and common=2(>1 episode of FI/wk),and was termed as frequency score.The score for each FI would be derived by multiplying the frequency score and the weight for that FI type.In the second phase of the study,a group of colorectal surgeons was asked to rank the six FI types in order of severity,and their ranking was compared with the patient and laypersons’rankings.RESULTS Fifty patients and 50 laypersons participated in the study.The weight was assigned to each FI(solid-8,liquid-8,urge-7,flatus-6,mucus-6,and stress-5),and an new scoring system was formulated.The maximum possible score was 80(total incontinence),and the least 0(no incontinence).The surgeons’ranking of FI severity did not correlate well with patients’and laypersons’rankings of FI,highlighting that surgeons and patients may perceive the severity of FI differently.CONCLUSION A new scoring system for FI was formulated,which was simple,logical,comprehensive,and easy to use,and eliminated previous shortcomings.Patients’and surgeons’perceptions of FI sever

关键词： Feal incontinence scoring system Urge Stress Flatus

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Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis

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Military Medical Research 2021年第1期8卷 48-61页

作者： Meng-Meng Yang Lu Wang Yu Zhang Rui Yuan Yan Zhao Jie Hu Fei-Hu Zhou Hong-Jun Kang Department of Critical Care Medicine The First Medical CentreChinese PLA General HospitalNo.28Fuxing RoadHaidian DistrictBeijing 100853China Medical School of Chinese PLA BeijingChina

Background: Heat stroke(HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke(EHS).Methods: Data were collected from a total of 170 exertional heat stroke(EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic(ROC) curve(AUC) were used to screen exertional heat stroke score(EHSS) parameters, including but not limited body temperature(T), Glasgow Coma Scale(GCS) and others. By comparing the sizes of the AUCs of the APACHE II, SOFA and EHSS assessments, the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified.Results: Through screening with a series of methods, as described above, the present study determined 12 parameters – body temperature(T), GCS, p H, lactate(Lac), platelet count(PLT), prothrombin time(PT), fibrinogen(Fib), troponin I(Tn I), aspartate aminotransferase(AST), total bilirubin(TBIL), creatinine(Cr) and acute gastrointestinal injury(AGI) classification – as EHSS parameters. It is a 0–47 point system designed to reflect increasing severity of heat stroke. Low(EHSS35) showed 100% survival and 100% mortality, respectively. We found that AUCEHSS>AUCSOFA>AUCAPACHE II.Conclusions: A total of 12 parameters – T, GCS, p H, Lac, PLT, PT, Fib, Tn I, AST, TBIL, Cr and gastrointestinal AGI classification – are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases, the mortality rate of EHS patients gradually increases.

关键词： Exertional heat stroke scoring system Prognosis Effectiveness of evaluation

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Prognostic scoring system for synchronous brain metastasis at diagnosis of colorectal cancer: A population-based study

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World Journal of Gastrointestinal Oncology 2020年第2期12卷 195-204页

作者： Ji-Chuan Quan Xu Guan Chen-Xi Ma Zheng Liu Ming Yang Zhi-Xun Zhao Peng Sun Meng Zhuang Song Wang Zheng Jiang Xi-Shan Wang Department of Colorectal Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Colorectal Surgery The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150000Heilongjiang ProvinceChina

BACKGROUND Brain metastasis(BM)from colorectal cancer(CRC)is rarely encountered clinically,and its prognosis has not been fully evaluated.AIM To construct a scoring system and accurately predict the survival of patients with synchronous BM at diagnosis of CRC.METHODS A retrospective study of 371 patients with synchronous BM from CRC was performed,using the data from 2010 to 2014 from the Surveillance,Epidemiology,and End Results database.Survival time and prognostic factors were statistically analyzed by the Kaplan-Meier method and Cox proportional hazards models,respectively.A scoring system was developed using the independent prognostic factors,and was used to measure the survival difference among different patients.RESULTS For the 371 patients,the median overall survival was 5 mo,survival rates were 27%at 1 year and 11.2%at 2 years.Prognostic analysis showed that age,carcinoembryonic antigen level and extracranial metastasis to the liver,lung or bone were independent prognostic factors.A scoring system based on these three prognostic factors classified the patients into three prognostic subgroups(scores of 0-1,2-3,and 4).The median survival of patients with scores of 0-1,2-3 and 4 was 14,5 and 2 mo,respectively(Pscoring system effectively distinguishes long-term and short-term survivors with synchronous BM from CRC.These results are helpful in providing a reference for guiding therapy.

关键词： Colorectal cancer Brain metastasis Survival Prognosis factors scoring system Synchronous

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A new scoring system for predicting extent of resection in medial sphenoid wing meningiomas based on three-dimensional multimodality fusion imaging

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中华神经外科杂志(英文) 2021年第1期07卷 43-52页

作者： Wang Zilan Liang Xiaolong Yang Yanbo Gao Bixi Wang Ling You Wanchun Chen Zhouqing Wang Zhong Department of Neurosurgery The First Affiliated Hospital of Soochow University 188 Shizi Street Suzhou 215006 Jiangsu Province ChinaDepartment of Orthopedics ChinaDepartment of Neurosurgery ChinaDepartment of Radiology Suzhou Hospital of Traditional Chinese Medicine

Background: Three-dimensional (3D) fusion imaging has been proved to be a promising neurosurgical tool for presurgical evaluation of tumor removal. We aim to develop a scoring system based on this new tool to predict the resection grade of medial sphenoid wing meningiomas (mSWM) intuitively.Methods: We included 46 patients treated for mSWM from 2014 to 2019 to evaluate their tumors’’ location, volume, cavernous sinus involvement, vascular encasement, and bone invasion by 3D multimodality fusion imaging. A scoring system based on the significant parameters detected by statistical analysis was created and evaluated.Results: The tumor volumes ranged from 0.8 cm3 to 171.9 cm3. A total of 39 (84.8%) patients had arterial involvement. Cavernous sinus (CS) involvement was observed in 23 patients (50.0%) and bone invasion was noted in 10 patients (21.7%). Simpson I resection was achieved in 10 patients (21.7%) and Simpson II resection was achieved in 17 patients (37.0%). Fifteen patients (32.6%) underwent Simpson III resection and 4 patients (8.7%) underwent Simpson IV resections. A scoring system was created. The score ranged from 1 to 10 and the mean score of our patients was 5.3 ± 2.8. Strong positive monotonic correlation existed between the score and resection grade (Rs = 0.772,P scoring system had good predictive capacity with an accuracy of 69.60%.Conclusions: We described a scoring system that enabled neurosurgeons to predict extent of resection and outcomes for mSWM preoperatively with 3D multimodality fusion imaging.Trial registration: Retrospectively registered

关键词： Brain tumor Sphenoid wing meningioma scoring system Fusion imaging 3D reconstruction

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Acute pancreatitis:A review of diagnosis,severity prediction and prognosis assessment from imaging technology,scoring system and artificial intelligence

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世界胃肠病学杂志:英文版 2023年第37期29卷 5268-5291页

作者： Jian-Xiong Hu Cheng-Fei Zhao Shu-Ling Wang Xiao-Yan Tu Wei-Bin Huang Jun-Nian Chen Ying Xie Cun-Rong Chen Intensive Care Unit The Affiliated Hospital of Putian UniversityPutian 351100Fujian ProvinceChina School of Pharmacy and Medical Technology Putian UniversityPutian 351100Fujian ProvinceChina Key Laboratory of Pharmaceutical Analysis and Laboratory Medicine Putian UniversityPutian 351100Fujian ProvinceChina Department of Critical Care Medicine Fujian Medical University Union HospitalFuzhou 350001Fujian ProvinceChina School of Mechanical Electrical and Information EngineeringPutian UniversityPutian 351100Fujian ProvinceChina

Acute pancreatitis(AP)is a potentially life-threatening inflammatory disease of the pancreas,with clinical management determined by the severity of the disease.Diagnosis,severity prediction,and prognosis assessment of AP typically involve the use of imaging technologies,such as computed tomography,magnetic resonance imaging,and ultrasound,and scoring systems,including Ranson,Acute Physiology and Chronic Health Evaluation II,and Bedside Index for Severity in AP scores.Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity,while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications.scoring systems utilize clinical and laboratory parameters to classify AP patients into mild,moderate,or severe categories,guiding treatment decisions,such as intensive care unit admission,early enteral feeding,and antibiotic use.Despite the central role of imaging technologies and scoring systems in AP management,these methods have limitations in terms of accuracy,reproducibility,practicality and economics.Recent advancements of artificial intelligence(AI)provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data.AI algorithms can analyze large amounts of clinical and imaging data,identify scoring system patterns,and predict the clinical course of disease.AI-based models have shown promising results in predicting the severity and mortality of AP,but further validation and standardization are required before widespread clinical application.In addition,understanding the correlation between these three technologies will aid in developing new methods that can accurately,sensitively,and specifically be used in the diagnosis,severity prediction,and prognosis assessment of AP through complementary advantages.

关键词： Acute pancreatitis Imaging technology scoring system Artificial intelligence Severity prediction Prognosis assessment

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Garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?

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World Journal of Gastroenterology 2024年第3期30卷 204-210页

作者： Petr Tsarkov Inna Tulina Parvez Sheikh Darya D Shlyk Pankaj Garg Department of Colorectal Surgery Sechenov First Moscow State Medical UniversityMoscow 119991Russia Department of Oncologic Colorectal Surgery Sechenov First Moscow State Medical UniversityMoscow 119991Russia Department of Colorectal Surgery Saifee HospitalMumbai 400004MaharashtraIndia Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia

The main aim of this opinion review is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593–4603.The authors in the published article developed a new scoring system,Garg incon-tinence scores(GIS),for fecal incontinence(FI).FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the patients.Rome IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a month.The associated social stigmatization often leads to significant under-reporting of the condition,which further impairs management.An important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their physicians.Due to this,the management becomes even more difficult.This issue is resolved up to a considerable extent by a scoring ques-tionnaire.There were several scoring systems in use for the last three decades.The prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system,St.Marks Hospital or Vaizey’s scores,and the FI severity index.However,there were several shortcomings in these scoring systems.In the opinion review,we tried to analyze the strength of GIS and compare it to the existing scoring systems.The main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI(solid,liquid,flatus,etc.),were not comprehensive,and took only the surgeon’s perception of FI into view.In GIS,almost all shortcomings of previous scoring systems had been addressed:different weights were assigned to different types of FI by a robust statistical methodology;the scoring system was made comprehensive by including all types of FI that were previously omitted(urge,stress and mucus FI)and gave priority to patients’rather than the physicians’perceptions while developing the scoring system.Due to this,GIS indeed looked like a paradigm shift in the evaluat

关键词： Fecal incontinence scoring system Urge Stress Flatus

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Predictive value of a serum tumor biomarkers scoring system for clinical stage Ⅱ/Ⅲ rectal cancer with neoadjuvant chemoradiotherapy

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World Journal of Gastrointestinal Oncology 2022年第10期14卷 2014-2024页

作者： Jie-Yi Zhao Qing-Qing Tang Yu-Ting Luo Shu-Min Wang Xiao-Rui Zhu Xiao-Yu Wang Department of Neurosurgery West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Ophthalmology West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina West China Medical School Sichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND Multiple classes of molecular biomarkers have been studied as potential predictors for rectal cancer(RC)response.Carcinoembryonic antigen(CEA)is the most widely used blood-based marker of RC and has proven to be an effective predictive marker.Cancer antigen 19-9(CA19-9)is another tumor biomarker used for RC diagnosis and postoperative monitoring,as well as monitoring of the therapeutic effect.Using a panel of tumor markers for RC outcome prediction is a practical approach.AIM To assess the predictive effect of pre-neoadjuvant chemoradiotherapy(NCRT)CEA and CA19-9 levels on the prognosis of stage II/III RC patients.METHODS CEA and CA19-9 levels were evaluated 1 wk before NCRT.According to the receiver operating characteristic curve analysis,the optimal cut-off point of CEA and CA19-9 levels for the prognosis were 3.55 and 19.01,respectively.The novel serum tumor biomarker(NSTB)scores were as follows:score 0:Pre-NCRT CEA3.55 and CA19-9>19.01;score 1:Other situations.Pathological information was recorded according to histopathological reports after the operation.RESULTS In the univariate analysis,pre-NCRT CEA<3.55[P=0.025 for overall survival(OS),P=0.019 for disease-free survival(DFS)],pre-NCRT CA19-9<19.01(P=0.014 for OS,P=0.009 for DFS),a lower NSTB score(0-1 vs 2,P=0.009 for OS,P=0.005 for DFS)could predict a better prognosis.However,in the multivariate analysis,only a lower NSTB score(0-1 vs 2;for OS,HR=0.485,95%CI:0.251-0.940,P=0.032;for DFS,HR=0.453,95%CI:0.234-0.877,P=0.019)and higher pathological grade,node and metastasis stage(0-I vs II-III;for OS,HR=0.363,95%CI:0.158-0.837,P=0.017;for DFS,HR=0.342,95%CI:0.149-0.786,P=0.012)were independent predictive factors.CONCLUSION The combination of post-NCRT CEA and CA19-9 was a predictive factor for clinical stage II/III RC patients receiving NCRT,and the combined index had a stronger predictive effect.

关键词： Rectal cancer Neoadjuvant chemoradiotherapy scoring system Carcinoembryonic antigen Carbohydrate antigen 19-9 Predictive

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Precise prediction model and simplified scoring system for sustained combined response to interferon-α

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World Journal of Gastroenterology 2010年第27期16卷 3465-3471页

作者： Qian-Guo Mao Ru-Mian Zhang Jin-Shui Pan Kuang-Nan Fang Jian-Ping Zhu Qing-Yang Hong Hepatology Unit and Department of Infectious Diseases Xiamen Hospital of Traditional Chinese Medicine Xiamen 361000 Fujian Province China Division of Gastroenterology Zhongshan Hospital Xiamen University Gastroenterology Institute of Xiamen University Gastroenterology Center of Xiamen Xiamen 361004 China Department of Planning and Statistics Xiamen University Xiamen 361005 China College of Information Science and Technology Xiamen UniversityXiamen 361005Fujian ProvinceChina

AIM:To establish a predictive algorithm which may serve for selecting optimal candidates for interferon-α(IFN-α) treatment.METHODS:A total of 474 IFN-α treated hepatitis B virus e antigen(HBeAg)-positive patients were enrolled in the present study.The patients' baseline characteristics,such as age,gender,blood tests,activity grading(G) of intrahepatic inflammation,score(S) of liver fibrosis,hepatitis B virus(HBV) DNA and genotype were evaluated;therapy duration and response of each patient at the 24th wk after cessation of IFN-α treatment were also recorded.A predictive algorithm and scoring system for a sustained combined response(CR) to IFN-α therapy were established.About 10% of the patients were randomly drawn as the test set.Responses to IFN-α therapy were divided into CR,partial response(PR) and non-response(NR).The mixed set of PR and NR was recorded as PR+NR.RESULTS:Stratified by therapy duration,the most significant baseline predictive factors were alanine aminotransferase(ALT),HBV DNA level,aspartate aminotransferase(AST),HBV genotype,S,G,age and gender.According to the established model,the accuracies for sustained CR and PR+NR,respectively,were 86.4% and 93.0% for the training set,81.5% and 91.0% for the test set.For the scoring system,the sensitivity and specificity were 78.8% and 80.6%,respectively.There were positive correlations between ALT and AST,and G and S,respectively.CONCLUSION:With these models,practitioners may be able to propose individualized decisions that have an integrated foundation on both evidence-based medicine and personal characteristics.

关键词： Chronic hepatitis B Interferon-α Patient selection Predictive model scoring system Treatment outcome

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Role of orthoptics and scoring system for orbital floor blowout fracture:surgical or conservative treatment

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International Journal of Ophthalmology(English edition) 2021年第12期14卷 1928-1934页

作者： Juraj Timkovic Jiri Stransky Katerina Janurova Petr Handlos Jan Stembirek Clinic of Ophthalmology University Hospital Ostrava17.Listopadu 1790/5Ostrava 70852Czech Republic Department of Craniofacial Surgery Faculty of MedicineOstrava UniversitySyllabova 19Ostrava 70300Czech Republic Clinic of Oral and Maxillofacial Surgery University Hospital Ostrava17.Listopadu 1790/5Ostrava 70852Czech Republic IT4Innovations VSB-Technical University of OstravaStudentská6231Ostrava 70833Czech Republic Department of Forensic Medicine University Hospital Ostrava17.Listopadu 1790/5Ostrava 70852Czech Republic Laboratory of Molecular Morphogenesis Institute of Animal Physiology and Genetics CASVeveří97Brno 60200Czech Republic

AIM:To assess the role of orthoptics in referring patients with orbital floor blowout fracture(OFBF)for conservative or surgical treatment and based on the results,to propose a scoring system for such decision making.METHODS:A retrospective analysis of 69 patients with OFBF was performed(35 treated conservatively,34 surgically).The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated,the factors with the highest significance for decision making were identified,and a scoring system proposed using Logistic regression.RESULTS:According to defined criteria,the treatment was unsuccessful in 2(6%)surgically treated and only in one(3%)conservatively treated patient.The proposed scoring system includes the defect size and several values resulting from the orthoptic examination,the elevation of the eyebulb measured on Lancaster screen being the most significant.CONCLUSION:The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder(with or without binocular diplopia)in OFBF patients.The proposed scoring system could,following verification in a prospective study,become a valuable adjunctive tool.

关键词： orbital floor blowout fracture scoring system orthoptics ocular motility diplopia conservative treatment surgical treatment

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Prediction of presence and severity of coronary artery disease using prediction for atherosclerotic cardiovascular disease risk in China scoring system

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World Journal of Clinical Cases 2021年第20期9卷 5453-5461页

作者： Xu-Lin Hong Hao Chen Ya Li Hema Darinee Teeroovengadum Guo-Sheng Fu Wen-Bin Zhang Department of Cardiology Sir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhou 310016Zhejiang ProvinceChina Department of Cardiology Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang ProvinceHangzhou 310016Zhejiang ProvinceChina Department of Cardiology Shengzhou People’s Hospital(The First Affiliated Hospital of Zhejiang University Shengzhou Branch)Shaoxing 312400Zhejiang ProvinceChina

BACKGROUND Coronary artery disease(CAD)is one of the leading causes of death and disease burden in China and worldwide.A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention.AIM To examine whether the prediction for atherosclerotic cardiovascular disease risk in China(China-PAR)scoring system could be used for this purpose.METHODS A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled.The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score(GS).RESULTS Correlation analysis demonstrated a significant relationship between China-PAR and GS(r=0.266,Pscoring system may be useful in predicting the presence and severity of CAD.

关键词： Coronary artery disease Prediction for atherosclerotic cardiovascular disease risk in China scoring system Coronary angiography Gensini score Retrospective study

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