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Clinical Value (clinical + value)
Kinds of Clinical Value Selected AbstractsClinical Value of the Tissue Doppler S Wave to Characterize Left Ventricular Hypertrophy as Defined by EchocardiographyECHOCARDIOGRAPHY, Issue 4 2010Demian Chejtman M.D. Left ventricular hypertrophy (LVH) may be a physiological finding and may also be associated with different disease entities and hence, with different outcomes. Regional myocardial function can be assessed with color Doppler tissue imaging, specifically by the waveform of the isovolumic contraction (IC) period and the regional systolic wave ("s"). Methods and Results: We studied five groups (G): healthy, sedentary young volunteers (G1, n:10); healthy sedentary adult volunteers (G2, n:8); and subjects with LVH (left ventricular mass index >125 g/m2) including: high performance athletes (G3, n:21), subjects with hypertension (G4, n:21), subjects with hypertrophic cardiomyopathy (HCM) (G5, n:18). We measured peak "s" wave velocity (cm/sec) at the basal and mid septum, the IC/s ratio, and basal to mid-septal velocity difference (BMVD) of the "s" wave. Regional "s" wave values (cm/sec) were G1 = 5.6 ± 1; G2 = 5.4 ± 0.8; G3 = 5.7 ± 0.6; G4 = 5.3 ± 1.1; G5 = 4.2 ± 1.1 (P < 0.0001). The IC/s ratio was G1 = 0.28 ± 0.18; G2 = 0.39 ± 0.21; G3 = 0.23 ± 0.10; G4 = 0.42 ± 0.15; G5 = 0.64 ± 0.15 (P < 0.0001). The BMVD (cm/sec) was G1 = 2 ± 0.51; G2 = 1.71 ± 0.29; G3 = 1.78 ± 0.44; G4 = 1.26 ± 0.96; G5 = 0.45 ± 0.4 (P < 0.0001). IC/s < 0.38 discriminated physiological from pathological forms of hypertrophy (sensitivity 90%; specificity 88%). Peak "s" wave velocity discriminated HCM from other causes of hypertrophy, with a cutoff value of 4.46 cm/sec (sensitivity 72%; specificity 90%). BMVD <0.98 cm/sec detected HCM with 89% sensitivity and 86% specificity. Conclusions: Peak "s" wave velocity and two indices: IC/s and BMDV are novel parameters that may allow to discriminate physiological from pathological forms of hypertrophy as well as different subtypes of hypertrophy. (ECHOCARDIOGRAPHY 2010;27:370-377) [source] Clinical Value of Monitoring BMD in Patients Treated With Bisphosphonates for Osteoporosis,,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2009Nelson B Watts MD First page of article [source] Nonlinear Indices of Heart Rate Variability in Chronic Heart Failure Patients: Redundancy and Comparative Clinical ValueJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2007ROBERTO MAESTRI M.S. Aims: We aimed to assess the mutual interrelationships and to compare the prognostic value of a comprehensive set of nonlinear indices of heart rate variability (HRV) in a population of chronic heart failure (CHF) patients. Methods and Results: Twenty nonlinear HRV indices, representative of symbolic dynamics, entropy, fractality-multifractality, predictability, empirical mode decomposition, and Poincaré plot families, were computed from 24-hour Holter recordings in 200 stable CHF patients in sinus rhythm (median age [interquartile range]: 54 [47,58] years, LVEF: 23 [19,28]%, NYHA class II,III: 88%). End point for survival analysis (Cox model) was cardiac death or urgent transplantation. Homogeneous variables were grouped by cluster analysis, and in each cluster redundant variables were discarded. A prognostic model including only known clinical and functional risk factors was built and the ability of each selected HRV variable to add prognostic information to this model assessed. Bootstrap resampling was used to test the models stability. Four nonlinear variables showed a correlation >0.90 with classical linear ones and were discarded. Correlations >0.80 were found between several nonlinear variables. Twelve clusters were obtained and from each cluster a candidate predictor was selected. Only two variables (from empirical mode decomposition and symbolic dynamics families) added prognostic information to the clinical model. Conclusion: This exploratory study provides evidence that, despite some redundancies in the informative content of nonlinear indices and strong differences in their prognostic power, quantification of nonlinear properties of HRV provides independent information in risk stratification of CHF patients. [source] Clinical Value of Electrocardiographic Parameters in Genotyped Individuals with Familial Long QT SyndromePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2001GEROLD MOENNIG MOENNIG, G., et al.: Clinical Value of Electrocardiographic Parameters in Genotyped Individuals with Familial Long QT Syndrome. Rate corrected QT interval (QTc) and QT dispersion (QTd) have been suggested as markers of an increased propensity to arrhythmic events and efficacy of therapy in patients with long QT syndrome (LQTS). To evaluate whether QTc and QTd correlate to genetic status and clinical symptoms in LQTS patients and their relatives, ECGs of 116 genotyped individuals were analyzed. JTc and QTc were longest in symptomatic patients (n = 28). Both QTd and JTd were significantly higher in symptomatic patients than in asymptomatic (n = 29) or unaffected family members (n = 59). The product of QTd/JTd and QTc/JTc was significantly different among all three groups. Both dispersion and product put additional and independent power on identification of mutation carriers when adjusted for sex and age in a logistic regression analysis. Thus, symptomatic patients with LQTS show marked inhomogenity of repolarization in the surface ECG. QT dispersion and QT product might be helpful in finding LQTS mutation carriers and might serve as additional ECG tools to identify asymptomatic LQTS patients. [source] Clinical value of optical coherence tomography in laryngologyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2008Marcel Kraft MD Abstract Background. Optical coherence tomography (OCT) is a new, noninvasive imaging technology for the evaluation of superficial lesions. The objective of this study is to evaluate microlaryngoscopy in combination with OCT compared with microlaryngoscopy alone (ie, without OCT) in supplying a specific diagnosis, predicting invasive tumor growth and epithelial dysplasia in the larynx. Methods. This was a prospective study including 217 laryngeal lesions in a total of 193 patients undergoing surgery. Intraoperative suspicion diagnosis gained by microlaryngoscopy with and without OCT was compared with conventional histopathology after excisional biopsy. Results. Microlaryngoscopy with OCT supplied a specific diagnosis in 89% of cases, but in only 80% of cases with microlaryngoscopy alone. In particular, our results in malignant and benign pathologies were correct in 93% each, and the exact grade of dysplasia could be predicted in 71% of precancerous lesions. Microlaryngoscopy with OCT presented a higher sensitivity than microlaryngoscopy alone in predicting invasive tumor growth (93% vs 87%) and epithelial dysplasia (78% vs 66%), but the specificity and accuracy were comparable in both methods. Conclusions. OCT is a simple, rapid, and reliable aid in the diagnostic investigation and intraoperative monitoring of laryngeal disease. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Clinical value of p53, c-erbB-2, CEA and CA125 regarding relapse, metastasis and death in resectable non-small cell lung cancerINTERNATIONAL JOURNAL OF CANCER, Issue 5 2003Marina Pollán Abstract The prognostic value of p53 and c-erbB-2 immunostaining and preoperative serum levels of CEA and CA125 was investigated in a prospective multicentric study including 465 consecutive non-small cell lung cancer (NSCLC) patients with resectable tumors. Four end-points were used: lung cancer death, first relapse (either locoregional or metastasis), loco-regional recurrence and metastasis development. Standard statistical survival methods (Kaplan-Meier and Cox regression) were used. The specificity of the prognostic effect across different types of tumors was also explored, as had been planned in advance. Our results showed, once again, that pathological T and N classifications continue to be the strongest predictors regarding either relapse or mortality. Three of the studied markers seemed to add further useful information, however, but in a more specific context. For example, increased CEA concentration defined a higher risk population among adenocarcinomas but not among people with squamous tumors; and p53 overexpression implied a worse prognosis mainly in patients with well differentiated tumors. The analysis of type of relapse proved to be very informative. Thus, CA125 level was associated with a worse prognosis mainly related with metastasis development. Another interesting result was the influence of smoking, which showed a clear dose-response relationship with the probability of metastasis. For future studies, we recommend the inclusion of different endpoints, namely considering the relationship of markers with the type of relapse involved in lung-cancer recurrence. They can add useful information regarding the complex nature of prognosis. © 2003 Wiley-Liss, Inc. [source] Clinical value of urinary kidney biomarkers for estimation of renal impairment in elderly Chinese with essential hypertensionJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 1 2008XunHui Xu Abstract The purpose of this work was to observe the excretion of specific types of urinary proteins and urinary enzymes in elderly essential hypertension patients, for early detection and targeted treatment of hypertensive nephropathy in the elderly. A total of 120 elderly essential hypertensive patients and 38 healthy elderly volunteers were involved. The urinary excretion rate of retinal-binding protein (RBP), transferrin (Tf), albumin (Alb), and urinary enzyme N-acetyl-beta-D-glucosaminidase (NAG) activity were determined. Patients were divided into two groups according to their creatinine clearance (Cockroft-Gault formula). There were 88 patients in group A, whose glomerular filtration rate (GFR) was ,80,mL/min, and 32 patients in group B with a GFR <80,mL/min. Among the essential hypertensive patients, urinary excretion rates of RBP, Alb, Tf, and NAG were increased in both groups compared with the healthy controls. But the amount of urinary protein differed between group A and group B. The excretion rate of specific urinary protein and urinary enzyme had a positive relationship with the duration of course of hypertension. We believe that specific types of urinary proteins and urinary enzymes may be useful markers for early diagnosis of hypertensive nephropathy; they can also be regarded as a clinical indicator of the progression of hypertensive nephropathy, serving in the assessment of therapeutic effects. J. Clin. Lab. Anal. 22:86,90, 2008. © 2008 Wiley-Liss, Inc. [source] Clinical value of 12 occlusal features for the prediction of disc displacement with reduction (RDC/TMD Axis I group IIa)JOURNAL OF ORAL REHABILITATION, Issue 5 2009G. CHIAPPE Summary, The purpose of this study is to quantify the clinical value of 12 occlusal variables for the prediction of disc displacement with reduction diagnosed according to research diagnostic criteria (RDC)/temporomandibular disorder (TMD). Twelve occlusal features were clinically assessed by the same three operators. The sample consisted of 165 TMD patients (65 males, 100 females; mean age: 32·55 ± 11·685years) with only disc displacement with reduction (RDC/TMD Axis I group IIa) and a control sample of 145 healthy subjects (65 males, 80 females; mean age: 31·24 ± 12·436 years) diagnosed with RDC/TMD Axis I group 0. A stepwise multiple logistic regression model was used to identify the significant correlation between occlusal features and disease. The odds ratio for disc displacement was 2·84 for absence of canine guidance, 2·14 for mediotrusive interference and 1·75 for retruded contact position (RCP)/maximum intercuspation (MI) slide ,2 mm. Other occlusal variables did not reveal to be statistically significant. The percentage of the total log likelihood for disc displacement explained by the significant occlusal factors was acceptable with a Nagelkerke's R2 = 0·124. The final model including the significant occlusal features revealed an optimal discriminant capacity to predict patients with disc displacement with a sensitivity of 63·6% or with a specificity of 64·8% for healthy subjects and an accuracy of 64·2%. Occlusal features showed a low predictive value for detecting disc displacement. Multifactorial complex pathologies such as TMD should be investigated using a multivariate statistical analysis; moreover, the future of aetiopathogenic research in this matter requires a multifactorial approach. [source] Clinical value of minor responses after 4 doses of rituximab in Waldenström macroglobulinaemia: a follow-up of the Eastern Cooperative Oncology Group E3A98 trialBRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2009Morie A. Gertz Summary Waldenström macroglobulinaemia is a low-grade, lymphoplasmacytic lymphoma that is responsive to rituximab. We report the role of a minor response in predicting overall outcomes. We extended follow-up of a previously described cohort (n = 69) treated with 4 weekly doses of rituximab and observed durable responses (median time to progression, 30 months; 5-year survival rate, 66%). Patients achieving a minor response [25,50% immunoglobulin M (IgM) reduction] appeared to do as well as those achieving an objective response (>50% IgM reduction), which suggests that more aggressive or intensive therapy for minor responders is not required. Future studies of Waldenström macroglobulinaemia should report minor responses because they are associated with clinically meaningful benefits. This trial was registered at http://www.clinicaltrials.gov as #NCT00005609. [source] Facets on the psychopathy checklist screening version and instrumental violence in forensic psychiatric patientsCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2010Jenny Laurell Background,There is a recognised relationship between psychopathy and instrumental violence, but not all violence by people who meet the criteria for psychopathy is instrumental. Aims,Our aims were to compare offence types among forensic psychiatric patients with and without the Psychopathy Checklist: Screening Version (PCL: SV) criteria for psychopathy. Our specific questions were whether factor 1 , the interpersonal affective dimension , was related to instrumentality and on severity of the violent crime. Our hypothesis was that the relationship between psychopathy and instrumental violence would be dependent on the severity of the violent crime. Methods,Sixty-five male patients at the forensic psychiatric hospital in Sundsvall, all with a violent criminal history, were assessed for psychopathy through interview and records using the PCL: SV. Severity and the instrumentality of their previous violence were coded using the Cornell coding guide for violent incidents. Results,The interpersonal features of psychopathy (the interpersonal facet), and only the interpersonal features were significantly associated with instrumentality and severity of violence. Instrumentality was also significantly related to the severity of the violence, independent of psychopathy score. Conclusions,The results indicated that, at least among forensic psychiatric patients, planning is more likely than not with respect to serious crimes. The specific link between interpersonal features of psychopathy and instrumental and severe violence suggests potential clinical value in recognising subtypes of psychopathy. Copyright © 2010 John Wiley & Sons, Ltd. [source] Utility of flow cytometry immunophenotyping in multiple myeloma and other clonal plasma cell-related disorders,CYTOMETRY, Issue 4 2010Bruno Paiva Abstract In recent years, multiparameter flow cytometry (MFC) immunophenotyping has become mandatory in the clinical management of hematological malignancies, both for diagnostic and monitoring purposes. Multiple myeloma (MM) and other clonal plasma cell-related (PC) disorders should be no exception to this paradigm, but incorporation of immunophenotypic studies in the management of patients with PC disorders is still far from being routinely established in many diagnostic flow cytometry laboratories. For clonal PC disorders, MFC is of clear and established clinical relevance in: (1) the differential diagnosis between MM and other PC-related disorders; (2) the identification of high-risk MGUS and smoldering MM; (3) minimal residual disease investigation after therapy; additionally it may also be useful for (4) the definition of prognosis-associated antigenic profiles; and (5) the identification of new therapeutic targets. In this article, we review the clinical value of MFC in the study of PC disorders, with specific emphasis in those areas where consensus exists on the need to incorporate MFC into routine evaluation of MM and other clonal PC-related disorders. © 2010 Clinical Cytometry Society [source] Amisulpride , dose, plasma concentration, occupancy and response: implications for therapeutic drug monitoringACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009A. Sparshatt Objective:, To evaluate the relationships between dose, plasma concentration, pharmacological activity and clinical outcome to evaluate the appropriateness of therapeutic drug monitoring (TDM) in patients receiving amisulpride. Method:, Literature search of Embase, Medline and PubMed databases. Results:, Amisulpride plasma concentration is closely correlated with dose (r2 = 0.96, P < 0.0001), dopamine occupancy, response and with extra-pyramidal symptoms (EPS). Dose is correlated with response, dopamine occupancy and EPS. Optimal clinical response was found at doses of 400,800 mg/day, corresponding to plasma levels of approximately 200,500 ng/ml. EPS appears to be more reliably predicted by a plasma level above 320 ng/ml than by a particular dose. Conclusion:, The effects and safety of amisulpride in the treatment of schizophrenia and schizoaffective disorder are predicted by daily dose. The plasma concentration threshold for response appears to be approximately 200 ng/ml. EPS are more reliably predicted by plasma level than by dose. TDM for patients prescribed amisulpride is thus of some clinical value. [source] Assessment of cerebral visual impairment with the L94 visual perceptual battery: clinical value and correlation with MRI findingsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2009E ORTIBUS MD In this article we describe visual perceptual abilities of a clinical population, referred for visual problems to our multidisciplinary team and assessed with the five computer tasks from the L94 visual perceptual battery. Clinical and neuroimaging findings were correlated with the findings on this task battery. Seventy children (35 males, 35 females) constituted our cohort. Age ranged from 4 to 20 years (mean 7y [SD 3y]). Forty children were born before 37 weeks gestational age. Thirty-six children had cerebral palsy (CP), of whom 24 had spastic diplegia, five had spastic hemiplegia, and four had spastic quadriplegia. Three children had ataxic CP. Perceptual visual impairment (PVI) was established in comparison to the performance age obtained on non-verbal intelligence subtests, instead of chronological age. Our results suggest that children with a history of preterm birth and a clinical CP picture are most at risk for a specific PVI. Correlations among other clinical variables did not define a clinical subgroup more at risk. Children with periventricular leucomalacia were almost equally represented in both PVI and non-PVI groups. Normal magnetic resonance imaging did not exclude the presence of PVI. In these children, however, we found another impairment profile, more in favour of dorsal stream impairment. [source] The Myocardial Performance Index in Patients with Aortic StenosisECHOCARDIOGRAPHY, Issue 4 2002Jude A. Mugerwa M.D. Objectives: This study was designed to determine the effect of chronic afterload on a Doppler-derived myocardial performance index (MPI) combining both systolic and diastolic left ventricular dysfunction. Methods: The study included 36 patients with a diagnosis of aortic stenosis and 36 normal subjects. Doppler-derived myocardial performance index (MPI), defined as the sum of the isovolumic contraction time and isovolumic relaxation time divided by ejection time, was measured from the mitral valve inflow and left ventricular outflow velocity patterns and was then related to the aortic valve area, valve gradient, and other echocardiographic variables. Results: The values of the Doppler-derived MPI in the patients with aortic stenosis were significantly higher than those in the controls (0.54 ± 0.20 vs 0.38 ± 0.04, respectively; P < 0.001). Transmitral deceleration time and the E/A ratio (r = 0.47 and r = 0.35, respectively; P < 0.05) were significant univariate correlates, and mitral deceleration time was the only significant correlate of MPI. However the index did not correlate with aortic valve area, peak and mean valve gradients, left ventricular mass, or age. Conclusions: Doppler-derived MPI reflects severity of global left ventricular dysfunction in patients with aortic stenosis and may be of clinical value in this patient population. [source] Analysis of ,-globulin mobility on routine clinical CE equipment: Exploring its molecular basis and potential clinical utilityELECTROPHORESIS, Issue 15 2009Dieter Vanderschaeghe Abstract A study was conducted on the variability of ,-globulin mobility in serum protein electrophoresis and its molecular basis. We found that the migration time of ,-globulins can be reproducibly determined (CV=1.1%) on clinical CE equipment. Moreover, we found a significant difference (p<0.001) in the migration of ,-globulins between chronic liver disease patients (n=98) and a healthy reference group (n=47). Serum immunoglobulins were purified from these patients' sera using protein L -agarose and their glycosylation was studied using CE on a DNA sequencer. This glycomics approach revealed that several non-sialylated N-glycans show a moderate Pearson correlation coefficient (r=0.2,0.4) with the migration time of ,-globulins. Their sialylated structures correlate negatively (r=,0.2 to ,0.3). Immunoglobulins are significantly more sialylated in the healthy reference group compared with the patients (p<0.001). We estimated that sialylation heterogeneity contributes about 36% to the molecular variance (carbohydrates and amino acid composition) that affects the electrophoretic mobility of immunoglobulins. This is the first report on the migration time of ,-globulins on a clinical CE instrument and its potential clinical value to the routinely analyzed serum protein CE profiles. [source] Ictal Brain Hyperperfusion Contralateral to Seizure Onset: The SPECT Mirror ImageEPILEPSIA, Issue 1 2006Gilles Huberfeld Summary:,Purpose: Ictal single-photon emission computed tomography (SPECT) may help localize the seizure-onset zone (SOZ) by detecting changes in regional cerebral blood flow induced by epileptic discharges. This imaging method also reveals hyperperfusions in areas of seizure propagation, including the hemisphere contralateral to the SOZ. We have studied the occurrence, the topography, and the clinical value of such contralateral ictal hyperperfusion areas (HPAs). Methods: We examined data from presurgical evaluations of 36 consecutive patients with pharmacoresistant partial epilepsy of various localizations. Ictal and interictal SPECT examinations were made with 99mTc-ECD, and the scans were processed for coregistration, normalization, subtraction, and merging with MRI images. Results: Contralateral HPAs were observed in 72% of the patients: 50% of mesiotemporal epilepsy cases with hippocampal sclerosis, 85.7% of the other mesiotemporal epilepsies, 85.7% of neocortical lateral temporal epilepsies, and 87.5% of extratemporal epilepsies. Contralateral HPAs were usually symmetrical to the SOZ, forming a mirror image, observed in 57.1% of the patients. They could be slightly asymmetrical in mesiotemporal epilepsies, perhaps because of the particular anatomic pathways linking temporal lobes. In neocortical epilepsies, they were located in the cortex homotopic to the SOZ. Conclusions: We show that the symmetrical nature of the mirror image usually does not disturb SPECT interpretation. It can confirm the location of the SOZ (11 patients) and even occasionally improve the precision of its definition (nine patients) by restraining several potential SOZ-related HPAs to a single one or by permitting a restricted localization of the SOZ in a large HPA. [source] Interictal and Ictal Magnetoencephalographic Study in Patients with Medial Frontal Lobe EpilepsyEPILEPSIA, Issue 7 2001Hideaki Shiraishi Summary: ,Purpose: To determine whether magnetoencephalography (MEG) has any clinical value for the analysis of seizure discharges in patients with medial frontal lobe epilepsy (FLE). Methods: Four patients were studied with 74-channel MEG. Interictal and ictal electroencephalographic (EEG) and MEG recordings were obtained. The equivalent current dipoles (ECDs) of the MEG spikes were calculated. Results: In two patients with postural seizures, interictal EEG spikes occurred at Cz or Fz. The ECDs of interictal MEG spikes were localized around the supplementary motor area. In the other two patients with focal motor or oculomotor seizures, interictal EEG spikes occurred at Fz or Cz. The ECDs of interictal MEG spikes were localized at the top of the medial frontal region. The ECDs detected at MEG ictal onset were also localized in the same area as those of the interictal discharges. Conclusions: In medial FLE patients, interictal and ictal MEG indicated consistent ECD localization that corresponded to the semiology of clinical seizures. Our findings demonstrate that MEG is a useful tool for detecting epileptogenic focus. [source] The prognostic significance of cytogenetic aberrations in childhood acute myeloid leukaemia.EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2007A study of the Swiss Paediatric Oncology Group (SPOG) Abstract In childhood-onset acute myeloid leukaemia (AML) the clinical value of karyotypic aberrations is now acknowledged, although there is still debate concerning the prognostic significance of some events. To add to this knowledge, cytogenetic analysis was performed on a consecutive series of 84 childhood AML patients diagnosed in Switzerland. A result was obtained for all patients, with 69 (82%) showing a clonal karyotypic aberration. In the remaining 15 (18%), no karyotypic aberration was seen by either conventional or fluorescence in situ hybridisation analyses. The most frequent aberrations observed were t(11q23) (19% of all patients), t(8;21) (12%) and +8 (11%). Except for cytogenetics, no clinical parameter was shown to be significantly associated with outcome. The analysis of individual cytogenetic subgroups demonstrated that aberrations involving chromosome 16q were the strongest predictor of a good prognosis, while +8 and complex karyotypes represented the strongest predictors of a poor prognosis. It was also noteworthy that patients with the rare aberrations of del(11q) (n = 4) and t(16;21)(p11;q22) (n = 3) had a poor outcome. The results support the importance of cytogenetic analysis in childhood AML, but show that further work is required in the classification of the poor prognosis aberrations. [source] The response to IV rt-PA in very old stroke patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2008M. Gómez-Choco The use of rtPA in stroke patients aged >80 years remains controversial and it is debated whether there are sex-based differences in the response to rtPA. We assessed the clinical value of thrombolytic therapy in patients aged >80 years (elderly group) in comparison with a non-elderly group, and evaluated the existence of sex differences in the response to rtPA. All consecutive patients (n = 157) treated with rtPA were prospectively assessed since July 2001, including 49 elderly patients who fulfilled the National Institute of Neurological Disorders and Stroke (NINDS) criteria. Changes of the National Institute of Health Stroke Scale (NIHSS) score at 1 h, 24 h, and 7 days after rtPA administration, favourable outcome at day 90 [(modified Rankin Scale) mRS 0,1, or 2 if mRS = 2 before the stroke], symptomatic bleedings, and death rates were compared between elderly and non-elderly patients. Using logistic regression, baseline NIHSS score [odds ratio (OR) 0.59, 95% confidence interval (CI) 0.41,0.84] was an independent predictor of favourable outcome, but not sex (OR 0.72, 95% CI 0.33,1.56), or age >80 years (OR 0.74, 95% CI 0.32,1.70). The rates of clinical improvement, mortality, or symptomatic CNS bleeding were also unrelated to age and sex. In conclusion, the response to IV rtPA is not impaired in elderly stroke patients and male and female are equally responsive. [source] Tumor microenvironment in head and neck squamous cell carcinomas: Predictive value and clinical relevance of hypoxic markers.HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2007A review Abstract Background. Hypoxia and tumor cell proliferation are important factors determining the treatment response of squamous cell carcinomas of the head and neck. Successful approaches have been developed to counteract these resistance mechanisms although usually at the cost of increased short- and long-term side effects. To provide the best attainable quality of life for individual patients and the head and neck cancer patient population as a whole, it is of increasing importance that tools be developed that allow a better selection of patients for these intensified treatments. Methods. A literature review was performed with special focus on the predictive value and clinical relevance of endogenous hypoxia-related markers. Results. New methods for qualitative and quantitative assessment of functional microenvironmental parameters such as hypoxia, proliferation, and vasculature have identified several candidate markers for future use in predictive assays. Hypoxia-related markers include hypoxia inducible factor (HIF)-1,, carbonic anhydrase IX, glucose transporters, erythropoietin receptor, osteopontin, and others. Although several of these markers and combinations of markers are associated with treatment outcome, their clinical value as predictive factors remains to be established. Conclusions: A number of markers and marker profiles have emerged that may have potential as a predictive assay. Validation of these candidate assays requires testing in prospective trials comparing standard treatment against experimental treatments targeting the related microregional constituent. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source] Lymphoscintigraphy for sentinel node mapping using a hybrid single photon emission CT (SPECT)/CT system in oral cavity squamous cell carcinomaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2006Avi Khafif MD Abstract Background. We assessed the added clinical value of fused single photon emission computed tomography (SPECT) and low-dose CT images compared with planar images for sentinel node (SN) mapping in patients with oral cavity squamous cell carcinoma (SCC). Methods. Twenty consecutive patients with newly diagnosed biopsy-proven SCC of the oral cavity were enrolled. Scintigraphy was performed using a hybrid gamma-camera/low-dose CT system. Planar images and fused SPECT/CT images were interpreted separately. All patients underwent a sentinel node biopsy (SNB) followed by a neck dissection. All SNs underwent meticulous pathologic examination and immunohistochemistry staining (cytokeratin complex) in addition to routine pathologic examinations of the neck dissection specimen. Results. The sensitivity for the detection of nodal metastases was 87.5%. SPECT/CT improved SN identification and/or localization compared with planar images in 6 patients (30%). Conclusions. SPECT/CT SN mapping provides additional preoperative data of clinical relevance to SNB in patients with oral cavity SCC. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Determining the impact of health library services on patient care: a review of the literatureHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 1 2002Patrick O'Connor The impact of health library information has been studied in a number of settings and populations. This review examines both the methods employed and the outcomes reported in a series of impact studies conducted in four countries since the late 1980's. It demonstrates that health library information can affect patient care outcomes in various ways and has high cognitive and clinical value in diagnosing and treating patients. But there remains no agreed technique or methodology for determining the level of this impact. In many cases evaluation of the health library's impact will be located within a central process of evaluation of the greater organization to which the library belongs. Consequently, local ad hoc evaluation is rarely reported outside an organization. The author considers the question of whether it is worthwhile doing an impact study and what form it might take. The author concludes by identifying seminal papers on the topic. [source] Prognostic relevance of circulating matrix metalloproteinase-2 in acute myeloid leukaemia patientsHEMATOLOGICAL ONCOLOGY, Issue 3 2007Salah Aref Abstract Matrix metalloproteinases (MMPs) were postulated to have important implication in progression and invasiveness of many malignant disorders. On the other hand the biological role of MMP-2 in acute myeloid leukaemia (AML) is not fully clear. Serum samples from 37 adult patients with AML had been taken before chemotherapy was administered. In addition 20 out of the 37 patients were analysed again after achieving complete remission (CR). Ten samples from healthy volunteers were evaluated as the control. Total MMP-2 levels were measured using ELISA Kit obtained from R&D system. MMP-2 serum levels were significantly lower in pretreatment AML patients than that in the normal controls (p,=,0.000) and in CR (p,=,0.007). No significant correlations were detected between pretreatment sMMP-2 levels and FAB subtypes, peripheral blood blast cell counts, peripheral blood WBCs, bone marrow blast cell counts or blast cell distribution ratio. The prognostic value of MMP-2 was evaluated by dividing AML patients into high and low MMP-2 groups using the pretreatment median MMP-2 level of the AML group as the cut-off. The authors found that patients in the high group survived for a significantly shorter time than those patients in the lower MMP-2 group. High pretreatment levels of sMMP-2 among AML patients were associated with poor survival. Prospective studies are recommended to establish the clinical value of longitudinal sMMP-2 measurement. Copyright © 2007 John Wiley & Sons, Ltd. [source] Ischaemic preconditioning of the graft in adult living related right lobe liver transplantation: impact on ischaemia,reperfusion injury and clinical relevanceHPB, Issue 7 2010Paola Andreani Abstract Background:, Ischaemic preconditioning (IPC) of the right liver graft in the donor has not been studied in adult-to-adult living related liver transplantation (LRLT). Objective:, To assess the IPC effect of the graft on ischaemia reperfusion injury in the recipient and compare recipient and donor outcomes with and without preconditioned grafts. Patients and methods:, Alternate patients were transplanted with right lobe grafts that were (n= 22; Group Precond) or were not (n= 22; Group Control) subjected to IPC in the living donor. Liver ischaemia,reperfusion injury, liver/kidney function, morbidity/mortality rates and outcomes were compared. Univariate and multivariate analyses were performed to identify factors predictive of the aspartate aminotransferase (AST) peak and minimum prothrombin time. Results:, Both groups had similar length of hospital stay, morbidity/mortality, primary non-function and acute rejection rates. Post-operative AST (P= 0.8) and alanine aminotransferase (ALT) peaks (P= 0.6) were similar in both groups (307 ± 189 and 437 ± 302 vs. 290 ± 146 and 496 ± 343, respectively). In univariate analysis, only pre-operative AST and warm ischemia time (WIT) were significantly associated with post-operative AST peak (in recipients). In multivariate analysis, the graft/recipient weight ratio (P= 0.003) and pre-operative bilirubin concentration (P= 0.004) were significantly predictive of minimum prothrombin time post-transplantation. Conclusions:, Graft IPC in the living related donor is not associated with any benefit for the recipient or the donor and its clinical value remains uncertain. [source] Prediction of extraprostatic extension by prostate specific antigen velocity, endorectal MRI, and biopsy Gleason score in clinically localized prostate cancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2008Koshiro Nishimoto Objectives: To investigate the clinical value of prostate specific antigen velocity (PSAV) in predicting the extraprostatic extension of clinically localized prostate cancer. Methods: One hundred and three patients who underwent radical prostatectomy for clinically localized prostate cancer were included in the analysis. The correlation between preoperative parameters, including PSA-based parameters, clinical stage, and histological biopsy findings, and the pathological findings were analyzed. Logistic regression analysis was performed to identify a significant set of independent predictors for the local extent of the disease. Results: Sixty-four (60.2%) patients had organ confined prostate cancer and 39 (39.8%) patients had extraprostatic cancer. The biopsy Gleason score, PSA, PSA density, PSA density of the transition zone, and PSAV were significantly higher in the patients with extraprostatic cancer than in those with organ confined cancer. Multivariate logistic regression analysis indicated that the biopsy Gleason score, endorectal magnetic resonance imaging findings, and PSAV were significant predictors of extraprostatic cancer (P < 0.01). Probability curves for extraprostatic cancer were generated using these three preoperative parameters. Conclusions: The combination of PSAV, endorectal magnetic resonance imaging findings, and biopsy Gleason score can provide additional information for selecting appropriate candidates for radical prostatectomy. [source] Predicting Recurrence of Vasovagal Syncope: A Simple Risk Score for the Clinical RoutineJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009MUHAMMET A. AYDIN M.D. Background: Predictors for recurrence of syncope are lacking in patients with vasovagal syncope. The aim of this study was to identify risk factors for recurrence of syncope and develop a simple prognostic risk score of clinical value. Methods: Two hundred seventy-six patients with a history of vasovagal syncope were prospectively followed for 2 years. Diagnosis of vasovagal syncope was based on clinical history and negative standard work-up. Inclusion in the study was independent from the result of the head-up tilt test, which was performed in all cases. Risk factors for syncope recurrence were evaluated by the Cox proportional hazards regression model and implemented in a risk score, which was validated with the log-rank test and an internal cross-validation. Results: The Cox-regression analysis identified the number of previous syncopal events, history of bronchial asthma, and female gender as predictors for syncope recurrence (all P < 0.05). In contrast, head-up tilt test response had no predictive value (P = 0.881). Developing a risk score, study patients were identified as having high (recurrence rate during 2 years of follow-up: 37.2%), intermediate (24.8%), and low (6.5%) risk for syncope recurrence (receiver operating characteristic [ROC] of score 0.83, P < 0.01; Log-rank test for event-free survival, P < 0.005). Conclusions: In patients with vasovagal syncope, risk of recurrence can be stratified and is predictable based on a simple risk score. [source] Application of a virtual reality prototype for pain relief of pediatric burn in TaiwanJOURNAL OF CLINICAL NURSING, Issue 4 2007Engle Angela Chan PhD Aim., This study examines the usability and effectiveness of virtual reality in reducing pain in wound-care procedures for pediatric burn patients in Taiwan. Background., Virtual reality has continuously gained prominence in the medical arena, for instance, the telepresence for surgery, the management of mental health disorders and pain control of the paediatric burn. Notwithstanding an increased application of virtual reality in the medical arena in North America, there have been no studies investigating its use for paediatric burn patients in Asia. Methods., This descriptive study has two phases: Phase I: the development of a virtual reality prototype. Phase II: the implementation of the prototype to discern its usability and efficacy with paediatric burn patients at a local hospital. Results., The findings suggest that a significant difference is found in the children's reported pain, with or without the virtual reality intervention, over the three phases: before, during and after the dressing change. However, less pain was noted in the intervention group during and after the dressing change. Conclusion., Adding to the existing clinical value of virtual reality identifies the nature of and different children's responses to pain with the use of virtual reality. Relevance to clinical practice., This study is significant since it demonstrates a difference in the child's response to pain based on the nature of presence and distraction. Moreover, given the evidence that a decrease in anxiety was experienced after the dressing change with virtual reality intervention, timing of using the virtual reality intervention before the child develops conditioning anxiety and anticipated pain for the procedure would be of importance. [source] Value of sonography for follow-up of mediastinal lymphadenopathy in children with tuberculosisJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2007Joaquim Bosch-Marcet Abstract Purpose. To assess the clinical value of sonography for the follow-up of mediastinal lymphadenopathy in children diagnosed with pulmonary tuberculosis (TB). Methods. We conducted a retrospective review of the medical records of 21 children (9 boys, 12 girls) with a mean age of 6 years (range, 7.4 months to 18 years) who had a positive intradermal tuberculin skin test. All patients underwent thorough history-taking, physical examination, frontal and lateral chest radiographs, and sonographic study of the mediastinum. The mediastinum was accessed through the suprasternal and left parasternal approaches. The presence of 1 or more masses with an ovoid or round shape and hypoechoic appearance in the anterior or middle mediastinum was recorded. A comparison was made between the results of the sonographic examination of the mediastinum before administration of anti-TB agents and after 3 months of treatment. Results. Pulmonary radiographic findings were suggestive of TB in 17 patients and were uncertain in 4 patients. Sonographic examination, however, detected mediastinal lymphadenopathy in all patients. A comparison of pretreatment mediastinal sonograms with those obtained after 3 months of anti-TB treatment showed a marked reduction of lymph node involvement in 17 patients (80.9%). In the remaining 4 patients, mediastinal lymphadenopathy was still present. Conclusion. Mediastinal sonography appears to be a valuable tool for the diagnosis of TB and in the monitoring of response to treatment in children. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007 [source] Preliminary assessment of miniprobe sonography in the diagnosis of gastric varices and evaluation of treatment with HistoacrylJOURNAL OF DIGESTIVE DISEASES, Issue 1 2001Zhu Qi OBJECTIVE: In comparison with conventional endoscopy, the clinical value of miniprobe sonography (MPS) was assessed both in the diagnosis of gastric varices (GV) and in the evaluation of its treatment with the tissue adhesive agent Histoacryl. METHODS: Twelve patients with liver cirrhosis and portal hypertension caused by hepatitis B in nine cases and hepatitis C in three cases were examined by MPS to verify the presence of gastric fundic varices before and after endoscopic treatment with Histoacryl. Curative efficacy of Histoacryl treatment was defined by the finding of variceal lumen obliteration characteristics in the ultrasonic image. RESULTS: Gastric fundic varices were detected in 10 patients by using MPS, however, only seven cases were detected by using conventional macroscopic examination. For gastric fundic varices, the diagnostic accuracies of standard endoscopy and MPS were 75% (9/12) and 100% (12/12), respectively. Furthermore, MPS was able to produce a practical ultrasonic image of complete or incomplete variceal vessel lumen obliteration for use in the assessment of the efficacy of endoscopic treatment with Histoacryl. CONCLUSIONS: Miniprobe sonography was found to be significantly superior to conventional macroscopic diagnosis in both the detection of fundic varices and the evaluation of the efficacy of endoscopic therapy. Moreover, MPS could play an important role in follow up and in evaluation of the need for further treatment. Therefore, MPS appears to be a safe and very useful clinical technique in evaluating patients with portal hypertension with respect to the detection of fundic varices and may help in selecting patients for appropriate therapy. [source] Determination of intrathyroidal iodine by X-ray fluorescence analysis in 60- to 65-year olds living in an iodine-sufficient areaJOURNAL OF INTERNAL MEDICINE, Issue 1 2006M. MILAKOVIC Abstract. Objectives., X-ray fluorescence (XRF) is a non-invasive method for determining the iodine content of the thyroid gland in vivo. In spite of the obvious clinical value of such a method in situations of iodine deficiency or iodine overload, the method has not so far been widely used. The objective was to investigate the applicability of the XRF method in a larger number of subjects. Design and subjects., The study comprised 37 individuals, aged 60,65 years, who had spent their entire life with iodine supplementation through iodinated table salt. Individuals with (previous) thyroid disease were excluded. The individual thyroid function had previously been evaluated by measurements of thyroid-related hormones, thyroid volume and 131-Iodine (131I) uptake which indicated a sufficient iodine intake of the population in the area. Iodine in the right thyroid lobe in each subject was examined using XRF. Results., The mean thyroid iodine concentration was 0.4 mg mL,1, corresponding to a mean total iodine content of 5.2 mg (range 0.9,20.2). There was a pronounced difference between individuals. No correlation was found between iodine concentration and 131I uptake or thyroid volume. Neither was iodine content and 131I uptake correlated. Conclusions., In a population living under iodine-sufficient conditions, a large variation of iodine stored in the thyroid is compatible with euthyroidism. Determination of the iodine pool by XRF investigation is feasible in a clinical setting and the method offers a unique possibility to study the intrathyroidal iodine pool in subjects with thyroid disease. The low radiation dose enables the use of the method in pregnant women and also in young individuals. [source] | |||||||||||||||||||||||||||||||||||||||||||