Under high magnification, it is possible to observe the nuclear and nucleolar morphometry using a computer-assisted image analyser (9). These nucleolar events can also be demonstrated with silver staining of the nuclear organiser region (AgNOR). Nuclear organiser regions (NOR) are loops of ribosomal DNA located in the short arm of chromosomes 13, 14, 15, 21, and 22, and transcribe to ribosomal RNA. NOR vary in size and shape according to the nucleolar transcription. Interestingly, they are related to the cell cycle and may also be related to cell proliferation. Binding of silver and protein occur in carboxyl and sulfhydryl groups by colloidal precipitating ionic silver. The carboxyl group on the protein reduces the silver solution that forms the micronuclei of silver. The large aggregate of silver is deposited on the disulfide and sulfhydryl group sites; they are easily observed using light microscopy. An increase in the AgNORscore suggests an increase in ribosomal activity. Studies of the predictive index based on AgNORscore are effective as early as after the first fraction of radiotherapy; the AgNORscore is correlated with local control of the disease by a full radiotherapy protocol. Knowledge of the probability of radiation response before the completion of radiotherapy would allow re-evaluation of therapeutic options (10). The nuclear roundness factor (NRF), detectable by an image analyzer, is another parameter that has been demonstrated to predict radiation response in Wilms’ tumour and prostate cancer (11,12). In this study, we examined the AgNORscore as well as nuclear and nucleolar morphometry before and during radiotherapy as a predictor of radio- sensitivity.
A study was conducted in the Gynaecology out patient department of GRH between the period May 2005 to May 2006. 50 Women with abnormal symptoms of white discharge and bleeding were screened for the presence of cervical pathology. A detailed history was elicited and a thorough clinical examination was done. Cervical biopsy was taken in all the 50 patients and the sections were stained with conventional H&E stain to study the HPE and with silver stain to study the AgNOR scores. AgNORscore was correlated with HPE report.
Ruschoff J, Plate K, Contractor H, Neumann K, Thomas C 76 found a considerable overlap of mean AgNORscore between malignant and benign lesions. They found the mAgNOR values for benign lesions in the range of 1.2 to 3.8 and the mAgNOR values for malignant lesions in the range of 1.5 to 16.2. Giri DD, Dundas SA, Lawry J, Nottingham JF, Underwood JC 77 also noted overlapping of AgNOR counts in 25 to 30% of carcinomas with epithelial hyperplastic lesions in the range of 2 to 3 AgNOR dots per nuclear profile. In our present study 3 of the cases, 2 from epithelial hyperplasia and 1 from atypical ductal hyperplasia showed a mild overlap in the mAgNOR count with that of malignant lesions of breast.
The AgNORscore for malignant tumours was 7.9 ± 3.1. Ductal in situ stage of the breast cancer showed AgNORscore of 61 ± 1.3. The infiltrating ductal and Lobular carcinoma showed AgNORscore of 9 ± 2.1. The AgNOR index was 6 for DCIS and 9 for invasive carcinomas. It has been observed that AgNOR scores are directly proportional to grading i.e., with increased grades the AgNOR scores also increased and can be used for assessing the clinical outcome and prognosis of the cases. However the AgNOR scores in our study shows a significant high value for malignant than benign.
A study was conducted in our gynnaec OPD and inpatient between the period from may 2013 to may 2014.women with symptoms of bleeding and profuse white discharge were screened. History in detail and thorough gynaecological examination was done. Cervical biopsy was taken from 100 patients and the sections were stained with conventional H & E stain to study the HPE and with silver stain to study AgNOR scores. AgNORscore was correlated with HPE report.
Introduction: Oral Squamous Cell Carcinoma (OSCC) accounts for approximately 90% of all the oral malignancies and a major cause of morbidity and mortality worldwide. The study utilises the Anneroth’s multifactorial grading system with Argyrophilic Nucleolar Organiser Region (AgNOR) score and the p53 expression as adjuncts; emphasising on the enhanced efficiency rendered by nuclear proliferative indices is the gold standard method of histomorphological grading of OSCC.
There are no reliable histological criteria for predicting recurrences of PA. Accordingly, hope is groped by trying some indicators such as proliferative markers. In a study of the proliferative activity of the structural components of normal salivary glands and characteristic histological areas in salivary PA, by visualization of AgNORs, the mean number of AgNORs in this portion was 1.80 within the intercalated ducts, which was significantly higher than in the other epithelial parts. This indicated a relative proliferative activity of the intercalated ducts. Solid nests in PA revealed a higher AgNORscore than scattered stromal neoplastic cells . Another study considered the higher cellular activity than the chondroid cells indicative of malignant transformation . On the other hand, AgNOR count and area, in a third study, did not show any significant differences between recurring and nonrecurring PA.
(1.85%)}. HGPIN had high degree of association with prostatic carcinoma (25%). Among the malignant lesions of the prostate, primary prostatic adenocarcinoma was the commonest (80%). According to Gleason Grading system higher grades were more commonly observed as the predominant pattern. Mean AgNOR counts (proliferative activity) were higher in malignant lesions (4.81) when compared with the benign lesions (1.44). With Immunohistochemical staining invasiveness increasesd from benign (continuous staining) to malignant (absence of staining) end in the spectrum of prostatic lesions. Two rare cases, Leiomyosarcoma of prostate and contiguous spread of rectal adenocarcinoma to prostate were observed in the present study which were confirmed with immunohistochemical study with desmin and PSA respectively.
Interphase AgNOR quantification appears to be very interesting and promising method for the routine evaluation of cell kinetics for prognostic purposes. It is the only method which permits information to be obtained on the rapidity of cell proliferation in routinely processed samples. Only flow cytometry, by simultaneous analysis of DNA content and incorporation of injected bromo deoxyuridine in vivo, permits measurement of cell doubling time.
To our knowledge, this is the first ACB score developed especially for prescribers in Germany. There have been similar international publications [18, 27]. The drugs most commonly used in Germany differ from other countries especially England, USA, and Australia, where many published studies on anticholinergic drugs were conducted. Our ACB score did not only summarize existing scores but re-evaluated the drugs, especially those with discrepancies, and reduced the list to those authorized in Germany. This saves valuable time and ef- fort for clinicians trying to evaluate anticholinergic bur- den in patients.
One study on prostate cytology suggested that AgNOR analysis improves the differentiation between malignant and benign prostatic cells,2 but a few papers have shown that there is considerable overlap in AgNOR counting and therefore AgNOR counts are not useful for diagnosis of hyperplastic and neoplastic prostatic lesions.I,s,9,14,18
Lung cancer is in industrial countries the most frequent cause of death for men and women. The overall 5-year survival rate is only about 15%. One part of lung tumours are neuroendocrine tumours divided in subtypes with different malignant potential (benign or low-grade malignant tumours, called typical carcinoids (TC) and on the other side the high-grade malignant tumours, poorly differentiated of small (SCLC) or large cell type (LCLC). Between these tumour types, the well- differentiated carcinoma with a lower grade of malignancy (WDNEC) take place (WHO, 1998). In clinical routine it is important to distinguish patients with better and worse prognosis. The aim of this study was to test the markers MIB-1, AgNOR and DNA distribution parameters, which are applied as different biological indicators of proliferation, ploidy and kinetics, with regard to the survival of patients and to the improvement of their therapy.
The quantitative assessment of PCNA expression plays a vital role in the prediction of survival rate, choice of treatment modalities and planning of prophylactic adjuvant therapy. PCNA aid in histopathological grading of OSCC (Zain et al., 1995). In our study the mean count of PCNA was 66.8 for hundred cells. High expression of PCNA would signify high proliferative activity in tumours which is more precise for proliferating cells. PCNA also can be used as a biomarker for differentiating between normal epithelium from dysplastic epithelium (Zain et al., 1995). The mean AgNOR count was 3.84 per cells with a standard deviation of 11.4. This was in correlation with the study done by Smith F G et al. (1993) in Non Hodgkin Lymphomas. According to their study AgNOR counts were relatively high in PCNA negative cells. This may indicate that PCNA and AgNORs are presented at different stages of cell cycle or may linger for different durations after mitosis. In the present study poorly differentiated OSCC showed 89% of positive cells compared with moderately differentiated and well differentiated (72.4% and 61.6% respectively, P<0.001 vhs (very highly significant), F=34.16). It indicates proliferation activity is more in poorly differentiated OSCC followed by moderately differentiated and well differentiated OSCC. This is in accordance with study by Hall et al. (1994). Wherein they reported, a correlation of
Materials and methods: This is an interobservational study including a total of 40 samples of which 10 cases each of mild, moderate, and severe grades of oral epithelial dysplasia con- stituted the study group, whereas 10 cases of normal mucosa formed the control group. The AgNORs were analyzed in formalin-fixed paraffin-embedded blocks of histopathologically confirmed cases using silver staining technique. Counting of AgNORs was done and the mean AgNOR count was obtained and statistically analyzed using analysis of variance (ANOVA) post hoc test.
Various techniques are available like DNA content analysis, ‘S’ phase fraction calculation by means of DNA cytometry, proliferating antigens like C3, F10, DNA polymerase-2, Ki67 and PCNA. But these techniques are expensive and can be carried out in some sophisticated diagnostic research centers. A simple and inexpensive method is the staining and counting of the Nucleolar Organizer Regions. This is based on RNA transcription activity. Silver colloidal solutions of high concentration have been used for this purpose and this is called AgNOR stain. The number of AgNORS in a cell nucleus reflects the proliferative activity of the cell with progressive increase in number from normal cells to dysplastic and carcinomatous cells. AgNOR in cervical cytology has also been studied. AgNOR though expensive, the single step technique and ease, which it can be done, is very impressive. Pap though less expensive than AgNOR is a cumbersome procedure with lot of chemicals involved.
plied, is a tool for standardized assessment. It also pro- vides a mechanism to record fetal-to-neonatal transition. An Apgar score of 0 to 3 at 5 minutes may correlate with neonatal mortality but alone does not predict later neurologic dysfunction. The Apgar score is affected by gestational age, maternal medications, resuscitation, and cardiorespiratory and neurologic conditions. Low 1- and 5-minute Apgar scores alone are not conclusive markers of an acute intrapartum hypoxic event. Resus- citative interventions modify the components of the Ap- gar score. There is a need for perinatal health care pro- fessionals to be consistent in assigning an Apgar score during a resuscitation. The American Academy of Pedi- atrics and the American College of Obstetricians and Gynecologists propose use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.
There is no accepted standard for reporting an Apgar score in infants undergoing resuscitation after birth because many of the elements contributing to the score are altered by resuscitation. The concept of an assisted score that accounts for resuscitative interventions has been suggested, but the predictive reliability has not been studied. To correctly describe such infants and provide accurate documentation and data collection, an expanded Apgar score reporting form is encouraged (Fig 1). This expanded Apgar score may also prove useful in the setting of delayed cord clamping, in which the time of birth (ie, complete delivery of the infant), the time of cord clamping, and the time of initiation of
characteristically different outcomes. It measures how much the conditional probabilities given the different forecasts differ from the climatic average. Even if the forecasts are wrong, the forecast system has resolution if it can successfully separate one type of outcome from another. To assess these properties, and evaluate probabilistic forecasts, several statistical evaluation measures have been proposed in the literature such as the Brier score, the ranked probability score, the continuous rank probability score, the reliability diagram and the rank histogram (Cloke & Pappenberger, 2009). The ranked probability score and the continuous ranked probability score would enable to assess the overall quality of the ensemble, or the quality on a certain range of the forecast. The BS on the other hand permits to focus on specific warnings and thresholds meaningful for studies to flood forecasts. The BS is chosen for this study as it permits to look at specific thresholds and also two out of the three properties defined above that describe an accurate forecast can be calculated, namely reliability and resolution. The other property, sharpness, can be shown by a reliability diagram with a corresponding sharpness diagram and will therefore also be used in this study. Next to these two evaluation methods the continuous ranked probability score and the root mean square error will be used for the combination of the different TIGGE ensemble forecast models and for the evaluation of the overall performance of the forecasts.
criteria for more efficient and fair organ placement  . Again, attention skipped from TIPS to transplantation. In a subsequent study  , a slightly modified score, termed MELD, was tested in different populations of cirrhotic patients. For ease of use, the score was multiplied by 10 and rounded, giving the following formula: MELD score = 9.6 loge (creatinine mg/dl) +3.8 loge (bilirubin mg/dl) + 11.2 loge (INR) + 6.4 (cause of cirrhosis [0 if cholestatic or alcoholic, 1 otherwise]). This study showed that MELD score adequately predicts mortality in hospitalized as well as ambulatory cirrhotic patients, that the model is generalizable to patients with various causes and severity of cirrhosis, that MELD score is a useful scale for assessing On the grounds of these results, MELD score was finally adopted in the United States in 2002 as the reference scoring system to rank patients for liver transplantation. Practically, two additional modifications have been performed so far. Firstly, the variable referring to the cause of cirrhosis (cholestatic or alcoholic versus other causes) has been abandoned and replaced by a constant value. As a result the current score is as follows: 9.6 loge (creatinine mg/dl) + 3.8 loge (bilirubin mg/dl) + 11.2 loge (INR)+ 6.4.