Application of the Cozart DDS system to postmortem screening of drugs of abuse in vitreous humor

The analysis of drugs of abuse in human specimens is essential in forensic medicine. This study evaluated the use of Cozart DDS for postmortem screening of some drugs of abuse in vitreous humor (VH) prior to forensic autopsies. The Cozart DDS is an on-site drug detection system that has been validated for oral fluid. Seventy-one VH specimens were obtained from cadavers. Causes of death included injury, drug poisoning, natural disorders, and traffic accidents. The samples were tested for cannabis, cocaine, opiate, amphetamine, and methamphetamine. Thirty-three of 71 samples were positive for drugs of abuse (42% for cocaine, 28% for cannabis, 26% for opiates, and 3% for methamphetamine). The positive specimens for opiates and methamphetamine were reexamined by gas chromatography-mass spectrometry (GC-MS); benzoylecgonine (cocaine product) was detected by liquid chromatography-tandem mass spectrometry (LC-MS-MS). All positive results for cocaine or its products and opiates by the Cozart test were confirmed by MS analysis, whereas one positive result for methamphetamine was negative by MS. The Cozart DDS system is generally a useful screening test for VH specimens prior to autopsies, because of its simplicity and rapidness.     

Applicability of an on-site test for its use in post-mortem blood

The number of deaths related to drugs of abuse makes necessary the use of an on-site test for those cases in which a rapid detection of the consumed drug is required. Cozart® DDS test provides a simple, fast and reliable tool for the qualitative on-site analysis in post-mortem blood. Owing that this test is prepared for oral fluid samples, a validation becomes essential in order to use it for a different matrix than the established one. According to that, results obtained by Cozart® DDS test used in post-mortem blood samples have been compared with a qualitative gas chromatography–mass spectrometry (GC/MS/MS). Positive results for cocaine family compounds (COC-F) were 43.75%, for opiates family compounds (OPI-F) 25.78%, and for cannabis family compounds (THC-F) 2.34%. Negative results were 28.13%. No amphetamines (AMP) or methamphetamines (MA) were found. Sensitivity and specificity was available for cocaine and opiates but not for cannabis because only five cases were detected. Sensitivity, specificity, predictive positive value and predictive negative value for cocaine were 98%, 91%, 88% and 99%, respectively. Sensivilty, specificity, predictive positive value (PPV) and predictive negative value (NPV) for opiates were 93%, 92%, 76% and 98%, respectively. Likelihood positive ratios for cocaine and opiates have been 10.92 and 11.69, respectively, while likelihood negative ratios have been 0.02 and 0.08, respectively. Results show the suitability of Cozart® DDS test for the qualitative detection of cocaine and opiates in post-mortem blood.     

急诊晕厥患者危险分层评估方法的临床应用与比较

 目的 对比理解急诊晕厥患者的危险分层评估方法。方法 应用英国ROSE规则、美国SFSR规则分别对2016-06至2018-11在北京天坛医院就诊的108例晕厥患者快速评估,对所有患者随访1个月,统计分析其灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比,并对比分析两种危险分层的规则。结果 108例在1个月内有43例发生不良事件,ROSE规则评判的特异度86.2%,阴性预测值90.3%,阴性似然比0.16;而SFSR规则评判的特异度84.6%,阴性预测值85.9%,阴性似然比0.25。二种规则一致性分析的Kappa值是0.732。结论 两种危险分层规则对筛查判定非高危患者均具有重要的临床意义,可以结合患者临床实际灵活运用。     

The FADIR test accuracy for screening cam and pincer morphology in youth ice hockey players

Objectives

Aim of this study was to evaluate the flexion-adduction-internal rotation (FADIR) test accuracy for screening cam and pincer morphology in youth male ice hockey players without diagnosed hip disorders.

Performance evaluation of the DrugWipe<Superscript>®</Superscript> 5/5<Superscript>+</Superscript> on-site oral fluid screening device

This study presents a retrospective performance evaluation of an on-site oral fluid drug screening device DrugWipe® 5/5⁺ (Securetec). The results obtained by the device were compared with gas chromatography–mass spectrometry confirmation analysis results in whole blood. Data used in the comparison were based on 1,807 real cases in which the Finnish police had conducted an on-site drug test on persons suspected of driving under the influence of drugs. The present data cover only cases wherein the DrugWipe device has shown a positive result for at least one substance. The data were compiled from the databases of Alcohol and Drug Analytics Unit at the National Institute for Health and Welfare. The performance of the DrugWipe was evaluated for its relevant drug groups: amphetamines, cannabis, opiates, and cocaine. The evaluation was carried out by calculating the sensitivity, specificity, and accuracy as well as the positive and negative predictive values. These calculations were based on the classification of the results as true positives, false positives, true negatives, and false negatives. Additionally, the demographics of the cases and analytical findings in whole blood are discussed. According to this study, the DrugWipe device performed quite well in detecting amphetamines, the most frequently encountered group of illicit drugs in Finnish traffic. The performance of the cannabis, opiate, and cocaine tests was not at the same level.     

急性阑尾炎超声检查方法的再探讨

目的为提高急性阑尾炎超声诊断的准确性,对其超声检查方法予以进一步探讨。方法对278例疑似急性阑尾炎患者术前随机分成两组,分别行方法一、二两种检查,结果与手术病理对照。结果方法一的敏感度65.3%,特异度44.4%,阳性预测值88.7%,阴性预测值16.0%,准确度69.7%,阳性似然比1.5。方法二的敏感度90.4%,特异度84.0%,阳性预测值96.3%、阴性预测值65.6%、准确度89.2%,阳性似然比5.7。结论检查方法二明显提高了急性阑尾炎术前诊断的准确性。     

乳腺病高频钼靶X线与病理诊断对比研究

目的　评价高频钼靶X线摄像对乳腺病定性诊断价值 ,提高乳腺病的术前诊断水平。方法　对 13 9例乳腺病人实施高频钼靶X线摄像 ,并与术后病理结果对照。结果　X线诊断的敏感性、特异性、准确性分别为 91.43 %、95.65%和 93 .53 % ,阳性似然比为 2 1.0 3 ,阴性似然比为 0 .0 9。阳性预测值为 95.52 % ,阴性预测值为 91.67%。假阳性率和假阴性率分别为 4.3 %和 8.6%。结论　高频钼靶乳腺照相可以显示绝大多数乳腺恶性病变特征 ,有很高的定性诊断价值 ,值得临床推广应用。     

On-site oral fluid Δ<Superscript>9</Superscript>-tetrahydrocannabinol (THC) screening after controlled smoked,vaporized, and oral cannabis administration

Increasing driving under the influence of cannabis cases is an important short-term consequence of cannabis legalization. On-site oral fluid (OF) testing devices provide advantages for roadside drug screening, because OF Δ⁹-tetrahydrocannabinol (THC) indicates more recent cannabis intake than urine, and it can be collected non-invasively by law enforcement personnel. THC presence in OF primarily results from oromucosal contamination during cannabis inhalation. To date, on-site OF devices were not investigated following edible cannabis. We evaluated sensitivity, specificity, and efficiency of the Dräger DrugTest^® 5000 [DT5000] and Alere? DDS^®2 [DDS2] at various OF THC confirmatory cutoffs following controlled smoked, vaporized, and edible cannabis in frequent and occasional smokers. Times of last positive (t _last) were evaluated for each device, cutoff, and smoking group. At a 5 µg/L OF THC confirmation cutoff, overall performance criteria exceeded the recommended 80% for both devices. At lower THC confirmation cutoffs (1–2 µg/L), true positive results were maximized but sensitivity was <80%. When confirmation cutoffs were below manufacturers’ screening cutoffs (5 µg/L DT5000, 25 µg/L DDS2), false negative results increased. No differences in t _last were observed for DT5000 between the three administration routes, but later t _last times were observed after smoking compared to vaporization with DDS2. Frequent smokers had significantly later median t _last (5 h) compared to occasional smokers (1.5–3.5 h) for all conditions. There were no true positive results at 44 and 50 h with the DT5000 and DDS2, respectively. OF screening followed by confirmatory OF analysis is an important strategy for investigations of driving under the influence of drugs, with these data improving interpretation of cannabinoid OF results.     

On-site testing of saliva and sweat with Drugwipe and determination of concentrations of drugs of abuse in saliva, plasma and urine of suspected users

Potential drug users participated voluntarily in a Belgian study on the usefulness of the non-instrumental immunoassay Drugwipe (Securetec, Germany) for the screening of cocaine, opiates, amphetamine and cannabinoids in saliva and sweat. If one of the screening assays (urine, oral fluid, sweat) showed a positive result, blood and saliva were collected. The on-site Drugwipe results were correlated with the Drugwipe results for saliva in the laboratory and with the GC/MS results of the corresponding saliva, plasma and urine samples and pharmacological effects at the time of sampling. The Drugwipe assay proved to be sufficiently sensitive for the detection of recent cocaine (n = 6) and amphetamine (n = 15) abuse, whether the device was wiped on the tongue or on the surface of the body, or when a saliva sample was applied to the wiping part. In five of the six potential cocaine users, the saliva concentrations of cocaine exceeded 1000 ng/ml. In the amphetamine group, the saliva concentrations of amphetamine, MDMA or both were high (> 1000 ng/ml) in 13 subjects. For cocaine and amphetamine, the positive scores for Drugwipe matched the GC/MS results for the three body fluids. Recent heroin abuse (n = 5) could be demonstrated to some extent with Drugwipe on samples from the tongue but only the two subjects with the highest saliva concentrations of MAM (> 500 ng/ml) and morphine (> 500 ng/ml) were positive. If the legal cut-off value for driving under the influence of opiates in Belgium (20 ng/ml of free morphine in plasma) was taken into account, only three subjects would have been legally positive. For cannabinoids (n = 15), false negatives and even some false positives were observed. Saliva can be considered as a useful analytical matrix for the detection of drugs of abuse after recent abuse when analysed with GC/MS. Received: 26 January 1999 / Received in revised form: 19 May 1999 / Accepted: 17 June 1999     

Hyperacute extensive middle cerebral artery territory infarcts. Role of computed tomography in predicting outcome

OBJECTIVE: To assess the prognostic value of computed tomography (CT) in hyperacute middle cerebral artery (MCA) infarcts. METHODS: The CT features, total CT score, and National Institutes of Health Stroke Scale (NIHSS) score were correlated with the 30-day mortality in 16 patients with a hyperacute MCA infarct. RESULTS: Admission NIHSS scores were significantly lower in the survival group (P = 0.016). The extent of infarct, attenuation of corticomedullary differentiation, and total CT score were associated with 30-day mortality (P < 0.05). In prediction of mortality, extent of an infarct > 67% gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 100%, 100%, and 90%, respectively. Attenuation of corticomedullary differentiation gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 89%, 86%, and 89%, respectively. An NIHSS score > 28 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 67%, 67%, and 86%, respectively. A CT score > 4 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 78%, 75%, and 88%, respectively. CONCLUSIONS: Computed tomography features and the admission NIHSS score are important predictors of survival in hyperacute extensive MCA infarcts.     

SPECT/CT骨显像在肿瘤患者可疑脊柱转移灶中的诊断价值

目的 评价99Tcm-亚甲基二膦酸盐(MDP)SPECT/CT骨显像对肿瘤患者可疑脊柱转移灶的诊断价值.方法 选取76例99Tcm-MDP骨显像可疑脊柱转移灶患者,进行SPECT/CT同机融合显像.76例患者中,与病理(含术中病理)检查结果对照19例,与随访1年余(2006年6月至2006年12月患者,随访至2008年3月)结果对照14例,显像结果与CT及MRI的共同结果对照43例.结果 SPECT/CT显像诊断肿瘤脊柱转移灶的灵敏度为95.83%(23/24),特异性为90.38%(47/52),准确性为92.11%(70/76),阳性预测值为82.14%(23/28),阴性预测值为97.92%(47/48),阳性似然比为9.97,阴性似然比为0.05.结论 SPECT/CT提高了肿瘤可疑脊柱转移灶鉴别诊断的准确性和特异性.     

The validity of the motion palpation test for determining patellofemoral joint articular cartilage damage

ObjectivesThis study investigated the validity of the motion palpation test (MPT) for pre-operatively grading patellofemoral joint articular cartilage damage.DesignRetrospective review of cases.ParticipantsConsecutive patients (N=188) with suspected patellofemoral joint articular cartilage damage.ProcedureThe medical records of patients who underwent clinical examination using the MPT and proceeded to undergo knee arthroscopy were reviewed.ResultsBased on arthroscopic findings the MPT revealed excellent overall sensitivity (87%), positive test predictive value (97%), and accuracy (85%), but specificity (33%) and negative test predictive values (10%) were poor. However, overall likelihood ratios for a positive (1.3) or negative (0.39) test indicated only a minimal increase in the likelihood of having articular cartilage damage with a positive test, and only a small decrease in ruling-out the condition with a negative test. With a severe MPT crepitation grade subclassification, sensitivity was 65%, specificity was 96%, positive test predictive value was 99%, negative test predictive value was 38%, and accuracy was 99%. For a moderate MPT crepitation grade sensitivity was 77%, specificity was 44%, positive predictive value was 81%, negative predictive value was 38%, and accuracy was 81%. For a mild MPT crepitation grade sensitivity was 66%, specificity was 51%, positive test predictive value was 77%, negative test predictive value was 38%, and accuracy was 62%. Positive likelihood ratios for MPT crepitation grade subclassifications revealed a large and likely conclusive increase in the likelihood of having articular cartilage damage for the severe condition (16.25, 95% CI 9.9, 22.6), but only a minimal likelihood for ruling-in the disease for mild (1.35, 95% CI −5, 7.7) or moderate (1.38, 95% CI −5, 7.7) conditions. Having a negative test was suggestive of only a small or minimal decrease in ruling-out the disease for all conditions (0.67–0.36).ConclusionsMPT is only useful as a physical examination tool for identifying patellofemoral joint articular cartilage damage when the crepitation grade subclassification is severe.     

物理检查和MRI检查在前交叉韧带完全断裂中的诊断价值

目的 比较并评价物理检查、MRI检查对前交叉韧带(ACL)完全断裂的诊断价值.方法 回顾性分析2005年8月-2006年4月因单侧膝关节外伤、初诊怀疑为单纯膝关节韧带断裂或伴有半月板损伤而需入院手术的患者115例,于入院时分别行MRI检查及物理检查,后者包括前抽屉试验、Lachman试验、轴移试验.并于3日内对所有患者行关节镜检查.以膝关节镜检查为金标准,运用临床流行病学方法对各诊断试验的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、准确度进行评价和比较. 结果 经关节镜检查证实,115例患者中确诊为ACL完全断裂的有41例,物理检查和MRI检查比较,灵敏度为95.1%、92.7%,特异度为87.8%、97.3%,阳性预测值为81.3%、95.0%,阴性预测值为97.0%、96.0%,准确度为90.4%、95.7%,阳性似然比为7.80,34.33,阴性似然比为0.06,0.08. 结论 在诊断ACL完全断裂方面,MRI与物理检查相比具有更高的诊断价值,但是,专业规范的物理检查也可以获得较高的诊断价值,因此在l临床实践中不应被忽视.     

Individualized periapical radiography determined by clinical and panoramic examination.

The efficiency of panoramic radiography compared with full-mouth periapical examination is an unresolved problem. The diagnostic yield of periapical lesions when the clinical signs and symptoms and the findings from a panoramic radiograph served as the basis for an individualized periapical radiographic examination was studied. Two hundred patients were examined clinically and radiographically. The periapical status was assessed step by step with access to increasing numbers of radiographs. For the clinical examination, the sensitivity was 0.24, the positive predictive value 0.62, the specificity 0.98, the negative predictive value 0.90 and the likelihood ratio for the positive test result 12. For radiographs indicated by the clinical examination plus the panoramic radiograph and selected periapical radiographs, both the sensitivity and the positive predictive value were 0.91, the specificity and the negative predictive value 0.99 each and the likelihood ratio was 91. False findings were twice as frequent in the upper as in the lower arch and particularly found in the incisor and premolar regions. In 30% of the patients no periapical radiograph was needed to supplement the panoramic radiograph. In the other patients, two supplementary periapical radiographs were needed on average. We conclude that the information obtained from the clinical and panoramic examinations supplemented with no more than two periapical radiographs will result in a high diagnostic yield on the periapical status.     

Predictive value of gadolinium enhancement in differentiating ALT/WD liposarcomas from benign fatty tumors

Objective To determine the predictive value of gadolinium enhancement on MRI in differentiating atypical lipomatous tumor (ALT)/well-differentiated (WD) liposarcoma from benign fatty tumors.Design All histologically proven fatty tumors with preoperative gadolinium-enhanced MRI were reviewed. Only those tumors with predominantly fatty signal were included. Sensitivity, specificity, and positive and negative predictive values for both gadolinium enhancement and biopsy as predictors for the final diagnosis of ALT/WD liposarcoma were calculated.Patients From 129 patients evaluated for fatty tumors between 1994 and 2002, the patient population was narrowed to 32 excised fatty tumors with preoperative gadolinium-enhanced MRI.Results As a predictor of ALT/WD liposarcoma, the presence of gadolinium enhancement showed 100% sensitivity, 71% specificity, 53% positive predictive value and 100% negative predictive value. Needle or incisional biopsy yielded 57% sensitivity, 100% specificity, 100% positive predictive value and 63% negative predictive value for a diagnosis of ALT/WD liposarcoma.Conclusions Gadolinium enhancement of a homogeneous fatty soft tissue tumor is a sensitive screening tool to determine possible diagnosis of ALT/WD liposarcoma. Biopsy, on the other hand, is specific but insensitive.     

淋巴滤泡增生在幽门螺杆菌性胃炎中的病理诊断价值

目的 评价胃窦黏膜淋巴滤泡增生在幽门螺杆菌性胃炎病理诊断中的价值.方法 以淋巴滤泡增生为诊断幽门螺杆菌性胃炎的标准,与诊断幽门螺杆菌阳性的＂金标准＂进行临床流行病学分析.结果 在1385例慢性胃炎中,以淋巴滤泡增生为诊断幽门螺杆菌性胃炎标准,其诊断的准确度为79.35%,灵敏度为79.43%,特异度为79.18%,阳性预告值89.22%,阳性似然比3.93,漏诊率为20.57%,误诊率为20.82%,阴性预告值79.18%,阴性似然比0.26.结论 淋巴滤泡增生是幽门螺杆菌性胃炎的组织病理形态学特征之一,是诊断幽门螺杆菌性胃炎的重要组织学依据,但不是唯一标准.     

彩色多普勒超声联合D-二聚体对周围型下肢深静脉血栓筛查的价值

目的探讨彩色多普勒超声(CDUL)联合D-二聚体检测对周围型下肢深静脉血栓的筛查价值。方法对1821例下肢深静脉血栓的高危患者行下肢深静脉CDUL检查及D-二聚体的检测。分别计算CDUL、血浆D-二聚体浓度水平检测以及二者联合对高危人群中周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值以及Kappa值。结果CDUL诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为95.8%、94.5%、88.2%、98.1%、0.881。血浆D-二聚体浓度检测诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为85.2%、95.6%、89.3%、93.8%、0.818。二者联合诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为98.0%、100.0%、100.0%、99.1%、0.986。CDUL联合D-二聚体检测与单独行D-二聚体检测及CDUL检查的差异均有统计学意义(均P<0.05)。结论CDUL检查联合血清D-二聚体检测对筛查周围型下肢深静脉血栓有较高的诊断准确率,具有较高的临床价值。     

Sixty-four-slice computed tomography coronary angiography compared with myocardial perfusion scintigraphy for the diagnosis of functionally significant coronary stenoses in patients with a low to intermediate likelihood of coronary artery disease

Background. Multislice computed tomography coronary angiography (CTA) was proposed as a method for investigating possible coronary artery disease (CAD) in patients who present with chest pain but with a low to intermediate likelihood of CAD. Sixty-four-channel CTA was compared prospectively with ^99mTc-tetrofosmin myocardial perfusion scintigraphy (MPS) (as the gold standard in the detection of flow-limiting stenoses) for the detection of functionally significant CAD. Methods and Results. Fifty-two consecutive symptomatic patients with a low to intermediate likelihood of coronary artery disease, and who were referred for MPS, also underwent CTA. The CTA datasets were analyzed by two experienced observers who were blinded to the MPS data, and coronary artery segments were reported as <50%, 50% to 69%, 70% to 99% stenoses, or occluded. The MPS images were similarly analyzed for inducible perfusion abnormalities, and coronary territories were identified. At the patient level, agreement between CTA and MPS for CTA lesions at ≥50% was 87% (sensitivity, 100%; specificity, 84%; positive predictive value, 50%; negative predictive value, 100%). For CTA lesions, agreement at ≥70% was 96% (sensitivity, 86%; specificity, 98%; positive predictive value, 86%; negative predictive value, 98%). Conclusions. In patients with a low to intermediate likelihood of CAD, there is good correlation between MPS and CTA for the detection of functionally significant coronary artery stenoses when CTA detects a narrowing of ≥70% severity. Computed tomography coronary angiography stenoses of 70% should be used to determine functional significance, and not 50%, as is the usual practice at present. This work was funded by an unrestricted research grant from the United Kingdom Defence Postgraduate Medical Deanery. We also thank the Royal Air Force Medical Branch for financial support.     

Comparison of thallium-201 SPET and CT/MRI in the detection of residual/recurrent squamous cell carcinoma of the oral cavity

This study was designed to compare the effectiveness of thallium-201 single-photon emission tomography (SPET) and conventional imaging, comprising computed tomography (CT) and magnetic resonance imaging (MRI), in the detection of residual/recurrent squamous cell carcinoma (SCC) of the oral cavity. Thirty-two patients with clinically suspected recurrent SCC of the oral cavity were recruited. All patients underwent ²⁰¹Tl SPET and CT or MRI within 2 weeks. The final diagnoses were based on the histology of the biopsy specimen. ²⁰¹Tl SPET and CT/MRI both accurately detected 17 of 18 residual/recurrent tumours. CT/MRI yielded eight false-positive studies, whereas ²⁰¹Tl SPET successfully excluded all tumours. The sensitivity, specificity, positive and negative predictive values and accuracy of ²⁰¹Tl SPET for the detection of recurrent oral SCC were 94%, 100%, 100%, 93% and 97%, respectively. The sensitivity, specificity, positive and negative predictive values and accuracy of CT/MRI for the detection of recurrent oral SCC were 94%, 43%, 68%, 86% and 72%, respectively. Thallium-201 SPET is more accurate than conventional imaging (CT or MRI) in differentiating residual/recurrent oral SCC from post-therapy changes.     

液基薄层细胞学和DNA定量分析方法在宫颈癌筛查中的对比分析

目的 比较采用液基薄层细胞学和DNA定量分析方法进行宫颈癌筛查的有效性.方法 对参与宫颈癌普查的2 199名妇女用宫颈刷取材,进行液基薄层制片,分别行液基薄层细胞学诊断和DNA定量分析.其中136例进一步行宫颈组织病理检查.结果 分别以≥3个DNA异倍体细胞和低级别鳞状上皮内病变及以上级别作为评估CINII及以上病理改变,其敏感度、特异度、阳性预测值、阴性预测值分别为95.83%和87.50%、72.32%和58.04%、42.59%和30.88%、98.78%和95.59%.DNA定量分析方法的敏感度、特异度、阳性预测值、阴性预测值均高于液基薄层细胞学方法.结论 DNA定量分析方法可提高宫颈癌筛查的敏感度和特异度.