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Clinical Purposes (clinical + purpose)
Selected AbstractsClinical significance of tumor markers and an emerging perspective on colorectal cancerCANCER SCIENCE, Issue 2 2009Keishi Yamashita Serum carcinoembryonic antigen (CEA) and CA19-9, a carbohydrate antigen recognized by the monoclonal antibody NS19-9, are commonly used as classical tumor markers in colorectal cancer (CRC) clinics. The roles of tumor markers include: (1) diagnostic screening (diagnostic markers); (2) prediction of prognosis after treatment (prognostic markers); and (3) judgment tools for treatment effect (surveillance markers). Tumor markers can be evaluated in serum, stools, or even in tissues depending on the clinical purpose. The American Society for Clinical Oncology recommends that CEA is the only marker of choice for monitoring the response of metastatic disease to systemic therapy at present. In the present paper, we are the first to review the clinical significance of the classical tumor markers CEA and CA19-9 in serum, allowing for our original data, and present our view on the newly emerging biomarkers in CRC. Novel promising biomarkers for diagnostic, prognostic, and surveillance purposes are reviewed and considered, some of which are anticipated for further validation. For diagnostic markers, urine or serum might replace fecal samples in the near future. On the other hand, prognostic or predictive markers for treatment sensitivity may be identified from the molecular profiles of primary cancer tissues. Selection of patients who are sensitive to chemotherapy will reduce the number of patients who undergo harmful chemotherapy with no effectiveness. The optimal tumor markers would be generalized, easy to assess, and accurate, and such markers are eagerly anticipated to enable personalized tailored therapy for CRC patients. (Cancer Sci 2009; 100: 195,199) [source] Simultaneous determination of nine endogenous steroids in human urine by polymeric-mixed micelle capillary electrophoresisELECTROPHORESIS, Issue 19 2010Sabrina Flor Abstract A new CE system based on the use of polymeric-mixed micelles (cholic acid, SDS and the poloxamine Tetronic® 1107) was developed for the simultaneous determination of nine steroids in human urine. This method allows the baseline separation and quantitation of cortisol, androstenedione, estriol, dehydroepiandrosterone sulfate, testosterone, dehydroepiandrosterone, estrone, progesterone and estradiol in less than 25,min showing to be sensitive enough to detect low concentrations of these steroids in urine samples (5,45,ng/mL). The optimized electrophoretic conditions were performed using a 50,cm×75,,m capillary, 18,kV, 25°C, with 44,mM cholic acid, 10,mM SDS, 0.05%,w/v tetronic® 1107, 2.5%,v/v methanol, 2.5%,v/v tetrahydrofuran in 5,mM borate , 5,mM phosphate buffer (pH=8.0) as a background electrolyte and a dual 210/254 UV-detection. The method can simultaneously determine 0.1,120,,g/mL, which corresponds to 5,6000,ng/mL of steroids in 2,mL urine. The recoveries ranged between 82.4 and 101.5%. Due to its simplicity, speed, accuracy and reliability, the proposed method could be a potential alternative to the traditional methodologies used with clinical purposes. [source] The bootstrap and cross-validation in neuroimaging applications: Estimation of the distribution of extrema of random fields for single volume tests, with an application to ADC mapsHUMAN BRAIN MAPPING, Issue 10 2007Roberto Viviani Abstract We discuss the assessment of signal change in single magnetic resonance images (MRI) based on quantifying significant departure from a reference distribution estimated from a large sample of normal subjects. The parametric approach is to build a test based on the expected distribution of extrema in random fields. However, in conditions where the variance is not uniform across the volume and the smoothness of the images is moderate to low, this test may be rather conservative. Furthermore, parametric tests are limited to datasets for which distributional assumptions hold. This paper investigates resampling methods that improve statistical tests for signal changes in single images in such adverse conditions, and that can be used for the assessment of images taken for clinical purposes. Two methods, the bootstrap and cross-validation, are compared. It is shown that the bootstrap may fail to provide a good estimate of the distribution of extrema of parametric maps. In contrast, calibration of the significance threshold by means of cross-validation (or related sampling without replacement techniques) address three issues at once: improved power, better voxel-by-voxel estimate of variance by local pooling, and adaptation to departures from ideal distributional assumptions on the signal. We apply the cross-validated tests to apparent diffusion coefficient maps, a type of MRI capable of detecting changes in the microstructural organization of brain parenchyma. We show that deviations from parametric assumptions are strong enough to cast doubt on the correctness of parametric tests for these images. As case studies, we present parametric maps of lesions in patients suffering from stroke and glioblastoma at different stages of evolution. Hum Brain Mapp 2007. © 2007 Wiley-Liss, Inc. [source] Transcription-mediated amplification linked to line probe assay as a routine tool for HCV typing in clinical laboratories,JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 5 2007R.S. Ross Abstract Typing of hepatitis C virus (HCV) isolates is currently a prerequisite for adequate tailoring of antiviral combination therapy. In many diagnostic laboratories, there seems to be a tendency toward convenient and time-saving procedures utilizing amplification products, which are already available from preceding qualitative or quantitative HCV ribonucleic acid (RNA) assays. In this context, we evaluated the performance characteristics of a combination of techniques, i.e., transcription-mediated amplification-line probe assay (TMA-LiPA), which links highly sensitive TMA of HCV RNA to the VERSANT HCV Genotype Assay (version 1). A total of 100 clinical samples were genotyped by TMA-LiPA. The obtained results were compared to those recorded by the original, nested reverse transcription (RT)-polymerase chain reaction (PCR)-based VERSANT assay, the core-related GEN-ETI-K DEIA, and phylogenetic analyses of partial sequences from the HCV core and NS5B regions. TMA-LiPA assigned the correct genotype to all 100 HCV isolates. For subtyping of genotype 1 and 2 isolates, TMA-LiPA only showed discriminatory powers of 82% and 53%, respectively. Thus, TMA-LiPA in our hands turned out as a convenient and time-saving routine procedure for HCV typing which currently provides sufficient information for clinical purposes. Like all 5,untranslated region (UTR)-based assays, the technique is limited, however, in its potentials to resolve the complexity of existing HCV subtypes. J. Clin. Lab. Anal. 21:340,347, 2007. © 2007 Wiley-Liss, Inc. [source] Population pharmacokinetics of cefepime in neonates with severe nosocomial infectionsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 3 2008V. Lima-Rogel MD Summary Objective:, To define the pharmacokinetic behaviour of cefepime in neonates with severe nosocomial infections using a mixed effects model. Patients and methods:, Thirty-one newborn infants were included in the study; 10 additional infants participated in the validation of the pharmacokinetic model. Cefepime CL and V were determined using an open monocompartmental model with first-order elimination. The influence of demographic and clinical characteristics on the model was evaluated. The non-linear mixed effect model (nonmem) program was used to determine the pharmacokinetic population model. Results:, The mean corrected gestational age for infants participating in the construction and validation of the model were 35 and 33 weeks, respectively. Factors included in the final pharmacokinetic model were body surface area (BSA) and calculated CLCR. The final population model was CL (L/h) = 0·457 BSA (m2) + 0·243 CLCR (L/h) and V(L) = 4·12 BSA (m2). This model explains 33·3% of the interindividual variability for CL and 12·8% for V. This model was validated in ten neonates with nosocomial infections by assessing the predictive capacity of plasma cefepime concentrations using a priori and Bayesian strategies. Conclusions:, The predictive performance of this population model for cefepime plasma concentrations was adequate for clinical purposes and can be used for individualizing cefepime therapy in newborn infants with severe infections. Cefepime plasma concentrations can be predicted based on BSA and calculated CLCR. Cefepime therapy using a 250 mg/m2 dose administered every 12 h is adequate to achieve plasma concentrations greater than 8 ,g/mL during more than 60% of the dosing interval and is expected to be effective in the treatment of bloodstream infections caused by most gram negative organisms in newborn infants. A dose of 550 mg/m2 would be required for the treatment of infections caused by Pseudomonas sp. [source] Development and validation of a liquid chromatographic/tandem mass spectrometric assay for the quantitation of nucleoside HIV reverse transcriptase inhibitors in biological matricesJOURNAL OF MASS SPECTROMETRY (INCORP BIOLOGICAL MASS SPECTROMETRY), Issue 1 2005Séverine Compain Abstract Besides liquid chromatographic (LC)/UV methods adapted to therapeutic drug monitoring, there is still a need for more powerful techniques that can be used for pharmacological research and clinical purposes. We developed an LC method coupled with tandem mass spectrometry (MS/MS) to separate, detect and quantify with high sensitivity the nucleoside analogues used in multitherapies (zidovudine, stavudine, zalcitabine, didanosine, lamivudine and abacavir) in plasma and in the intracellular medium. We worked on two essential issues: (i) the need to use two ionization modes in order to achieve the best sensitivity, which leads to the optimization of the chromatographic separation of drugs detected in the positive ionization mode and drugs detected in the negative ionization mode, and (ii) the need to optimize the extraction step in order to enhance sample recovery. The peripheral blood mononuclear cells were lysed in Tris buffer,MeOH. A clean-up procedure was performed by solid-phase extraction only for plasma samples. The LC separation was carried out on a Zorbax Stable Bond C18 column followed by MS/MS analysis after electrospray ionization in either the negative or positive mode. The positive ionization mode was applied at the beginning of the run to detect zalcitabine and lamivudine, then the ionization mode was changed to negative for the detection of didanosine, stavudine, internal standard and zidovudine. The calibration range for all the analytes was 0.5,200 ng ml,1. The recoveries were between 64 and 90%, with coefficients of variation (CVs) lower than 15%. The inaccuracy (bias) was ±15% with CVs always lower than 12%. The analytes were stable at room temperature and in the extraction solvent for at least 24 h, after storage at ,80 °C for 3 months, after three freeze,thaw cycles and in the injection solvent after 48 h at 4 °C. Together with the measurement of intracellular triphosphorylated metabolites thanks to the powerful plasma and intracellular assay method for intact drugs, it is possible to describe the behaviour of nucleoside analogues against HIV through plasma pharmacokinetics, cell membrane diffusion including drug transport involvement, and also the intracellular metabolism. Copyright © 2005 John Wiley & Sons, Ltd. [source] The perceived expressed emotion in staff scaleJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2003J. FORSTER Recent research has highlighted the role of expressed emotion by ward staff in determining the well-being of psychiatric inpatients. Existing methods of assessing staff expressed emotion involve standardized interviews and are expensive and time-consuming. We report the development of a questionnaire measure of expressed emotion in staff as perceived by patients. In study 1, factor analysis of items administered to patients in a variety of settings led to the development of a questionnaire with three subscales: supportiveness, criticism and intrusiveness. In study 2, the test,retest reliability of the questionnaire was found to be adequate, and some evidence of concurrent validity for the scale was obtained against expressed emotion rated from staff speech samples. In study 3, the scale was shown to have good concurrent validity against the ward atmosphere scale, and scores were found to be independent of insight or experience of admission to hospital. The perceived expressed emotion in staff scale is a convenient measure, which may have utility for both research and clinical purposes. [source] Assessing experiences and responses of crime victims,JOURNAL OF TRAUMATIC STRESS, Issue 2 2003Eve B. Carlson Abstract This paper reviews strategies and methods for assessing crime victims with an emphasis on assessments for clinical purposes. In terms of outcomes, this paper primarily focuses on assessing posttraumatic symptoms of PTSD, dissociation, and traumatic grief as these are all quite disabling and may be mediators of other responses. Additional topics reviewed include reasons to assess experiences and responses of crime victims, issues to bear in mind when conducting assessments for different purposes, considerations for use of various sources of information about a client, characteristics of measures and of clinents to take into account when selecting measures, recommended domains of experiences and symptoms to assess, and suggestions about the process of administering measures and conducting therapeutic assessments. [source] Characterization of autonomic dysfunction in patients with irritable bowel syndrome using fingertip blood flowNEUROGASTROENTEROLOGY & MOTILITY, Issue 5 2008T. Tanaka Abstract, Fingertip blood flow (FTBF) as measured by laser Doppler flowmetry (LDF) measurement is considered an indicator of sympathetic nerve function. We evaluated autonomic function in patients with irritable bowel syndrome (IBS) by assessing FTBF with both LDF and continuous-wave (cw) Doppler sonography. Firstly, the two methods were compared in 40 healthy volunteers. Next, 59 patients with IBS as well as 118 healthy volunteer controls were studied. In the supine position, FTBF in the right index finger was measured with cw Doppler sonography, whereas FTBF in the left index finger was assessed with LDF. After baseline measurement for at least 5 min, the volunteers received sympathetic stimulation from cold stress applied without notification in the form of an icebag (0 °C) upon the left forearm for 1 min. The new cw Doppler sonography method can be used in place of the old LDF method for clinical purposes. FTBF velocity before stimulation (Vpre) was significantly lower in the IBS group than that in the healthy volunteers (P < 0.01). In addition, the time required for FTBF to return to Vpre after stimulation was significantly longer in the IBS group than that in the control group. (P = 0.02). Thus, measurement of FTBF with cw Doppler sonography can be useful in the assessment of sympathetic nerve function. The IBS patients showed an abnormal FTBF response suggesting the presence of excess sympathetic activity. [source] Morphology of the Lingual Dorsal Surface and Oral Taste Buds in Italian Lizard (Podarcis sicula)ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 2 2010F. Abbate Summary With 4 figures The Italian lizard (Podarcis sicula) is the most diffused reptile in Italy, but it is also present in other European countries. This lizard belongs to the Lacertidae family, lives near walls, slants and along the borders of the paths; its diet includes bugs and aracnids. No data are so far available in literature about the three-dimensional morphology of the tongue of Podarcis sicula, therefore the aim of the present paper was to study by scanning electron and light microscopy the three-dimensional characteristics of the dorsal lingual surface and moreover the presence of chemosensory receptors like the taste buds in the oral cavity. Our results demonstrate that the Podarcis sicula tongue is a triangular muscular membranous organ, dorsoventrally flattened and that three different areas can be observed: a bifid apex, a body and a root. No papillae were observed in the apex, characterized by a flattened mucosa and by two deep median pouches. In the body cylindrical papillae with a flat surface are present, aborally gradually substituted by imbricated papillae. Foliate-like papillae were observed in the lateral parts of the tongue body. No sensory structures were showed on the lingual dorsal surface, while they were numerous in the oral cavity, particularly on the gingival epithelium. The light microscopy shows, on the dorsal surface, a stratified pavimentous not keratinized epithelium, conversely keratinized along the ventral surface. Many caliciform cells on the lateral parts of the papillae, deputed to the secretion of mucus, were also observed. Therefore, the results obtained in this paper could give a contribution to the knowledge of the tongue anatomy in a species widely diffused in different European countries and could be of help for clinical purposes in reptiles. [source] Population pharmacokinetics of valproate in Mexican children with epilepsyBIOPHARMACEUTICS AND DRUG DISPOSITION, Issue 9 2008Tania Correa Abstract Background. The aim of this study was to determine the factors that influence valproate clearance (CL) in Mexican epileptic pediatric patients using a mixed-effect model and sparse data of serum concentrations of valproic acid (VPA) collected during routine clinical care of patients. Methods. The number of patients included in the study was 110. The population CL was calculated by using the NONMEM program. The following covariates were tested by their influence on CL: total body weight (TBW), height, age, body surface area, daily dose (DD), sex of the patient and comedication with phenobarbital (PB) or carbamazepine. Results. The final regression model for valproic CL found best to describe the data was: CL/F=(0.0466+0.00363 TBW+0.000282 DD) * (1+0.236 PB). This model allows a reduction of 50% of the interindividual variability and of 31% of the residual variability described by the basic model that does not include covariables. Conclusions. Total body weight, daily dose of valproate and concomitant therapy with PB are factors that significantly influence VPA kinetic disposition and they should be considered in programming dosage regimens for this antiepileptic drug in the pediatric population. The validation of the model supports its acceptability for clinical purposes. Copyright © 2008 John Wiley & Sons, Ltd. [source] RTVue Fourier-domain OCT: reproducibility of RNFLT and macular thickness measurementsACTA OPHTHALMOLOGICA, Issue 2009A GARAS Purpose To evaluate the reproducibility of peripapillary retinal nerve fiber layer thickness (RNFLT) and macular thickness (MT) measurements with the RTVue-100 Fourier-domain optical coherence tomography, and to determine the influence of pupil dilation, patients' experience in examinations and severity of glaucoma. Methods One eye of 14 normal subjects, 11 patients with moderate, 12 patients with severe glaucoma and 40 screening trial participants were imaged 5 times on the same day. For the hospital-based patients, the measurement series was repeated after pupil dilation and 3 months later. Results For the RNFLT and the MT parameters, intrasession intraclass correlation coefficient (ICC) varied between 93.9 and 99.0%, intrasession coefficient of variation (CV) between 1.95 and 5.69 %, and intratest variability between 3.11 and 9.13 µm. Most thickness values, all intrasession CV and intratest variability values and the signal strength index remained unchanged after pupil dilation. Most intrasession CV values increased significantly with increasing disease severity. Patients' experience in imaging examinations had no influence on intrasession CV. Intratest variability and intrasession CV represented 79.1 to 98.6 % and 77.1 to 95.0 % of test-retest variability and intervisit CV, respectively. Conclusion Reproducibility of RNFLT and MT measurement with the RTVue-100 OCT are satisfactory for clinical purposes both in normals and glaucoma patients. Pupil dilation and patients' experience in imaging examinations do not influence the reproducibility of the measurements clinically significantly. Commercial interest [source] Pneumonia in the elderlyCLINICAL MICROBIOLOGY AND INFECTION, Issue 11 2001B. A. Cunha Pneumonia is one of the commonest infections in elderly patients. The pathogens responsible for pneumonias in the elderly are the same as in younger adults. Because of associated cardiopulmonary disease and/or impaired host defenses, pneumonia in elderly patients is associated with increased mortality and morbidity compared to younger patients. The clinical importance of pneumonias in the elderly relates to age-dependent and pathologic changes in the immune system as well as the lungs. Pneumonias in the elderly may be classified, for clinical purposes, according to their location of acquisition, i.e. community-acquired pneumonias, nursing home-acquired pneumonias, or hospital-acquired pneumonias. The clinical presentation of pneumonias in the elderly may be difficult, due to pre-existing cardiopulmonary disease that mimics pneumonia. This review discusses the diagnostic and therapeutic approaches to elderly patients with pneumonia. [source] Diagnostic value of self-reported symptoms in Danish outpatients referred with symptoms consistent with colorectal cancerCOLORECTAL DISEASE, Issue 5 2007N. C. Bjerregaard Abstract Objective, To assess the association between self-reported symptoms and a diagnosis of colorectal cancer (CRC) in symptomatic outpatients without CRC risk factors, defined by a Danish expert group. Method, A cross-sectional study of patients aged 40 years and older referred by general practitioners to two Danish surgical outpatient clinics for symptoms consistent with CRC during a 16-month period. CRC was diagnosed at endoscopy and through follow up. Before their first appointment, participants completed a questionnaire about symptoms. Results, The study included 2172 patients. Of these, 122 were diagnosed with CRC (5.6%). Median age was 61 years (range: 40,97) and 44.0% were men. All symptoms had high (93.4,96.8%) negative predictive values for CRC. The highest positive predictive values (PPV) were found for dark rectal bleeding (PPV: 20.6%) and CRC was diagnosed in a first-degree relative over the age of 50 years (PPV: 11.2%). At multiple logistic regression analysis dark rectal blood was the most important predictor of CRC (OR: 7.4). Other predictors were age 60 years or older (OR: 3.0), change in frequency of bowel movements (OR: 2.5), CRC diagnosed in a first-degree relative over the age of 50 years (OR: 2.6), male gender (OR: 2.2) and mono-symptomatic fresh rectal blood (OR: 1.7). Conclusion, No self-reported symptoms presented by outpatients without CRC risk factors can be used accurately to identify patients with CRC with certainty. For clinical purposes self-reported symptoms seems thus not to be a useful accurate tool to distinguish between symptomatic outpatients with and without CRC. [source] | |||||||||||||