Comparison of the clinical usefulness of two quantitative D-Dimer tests in patients with a low clinical probability of pulmonary embolism

Background

Quantitative D-Dimer tests are established methods in the non-invasive diagnostic management to rule out venous thromboembolism (VTE). The diagnostic performance and the clinical efficiency different D-Dimer assays in the exclusion of pulmonary embolism (PE) have not yet been compared in a clinical outcome study.

Objective

Evaluation of the efficiency and safety of excluding the diagnosis of PE with two different quantitative D-Dimer assays in consecutive patients with clinically suspected PE.

Patients and Methods

We studied the VTE-failure rate of 2206 consecutive patients with an unlikely clinical probability in whom VIDAS or Tinaquant D-Dimer tests were performed.

Results

The prevalence of PE in 1238 patients whose D-Dimer level was analyzed with Tinaquant assay was 11%. The VIDAS assay group consisted of 968 patients with a PE prevalence of 13%. The VIDAS assay had a sensitivity of 99.2% (95%CI; 96- > 99.9%), the Tinaquant assay of 97.3% (95%CI; 93 -99%). The negative predictive value (NPV) in the Tinaquant assay group was 99.4% (95%CI 98-99.8%) in comparison to 99.7% (95%CI 99-> 99.9%) in the VIDAS assay group. During 3 month of follow-up, there were no fatal cases of PE among patients with normal D-Dimer and unlikely clinical probability in both D-Dimer assay groups. In addition, the test efficiency of Tinaquant assay was significantly higher in comparison to VIDAS assay (52% vs 42%, p < 0.001).

Conclusion

Both Tinaquant and VIDAS D-Dimer tests perform equally well in combination with an unlikely clinical probability in excluding PE. The Tinaquant test was shown to be more efficient.     

One-stage tract dilation for percutaneous nephrolithotomy: is it justified?

PURPOSE: To assess the feasibility of one-stage acute dilation of the nephrostomy tract with a 30F Amplatz dilator in patients who are candidate for percutaneous nephrolithotomy (PCNL) regardless of whether there is a previous renal scar to make the procedure less time consuming and more cost effective. PATIENTS AND METHODS: The outcomes of one-stage tract dilation for PCNL in 100 consecutive patients with and without a history of ipsilateral open stone surgery (OSS), treated by one surgeon, were examined prospectively. Forty-six patients (group 1) had a history of ipsilateral OSS, and 54 patients (group 2) did not have this history. Demographic data as well as intraoperative information, such as access time and radiation exposure time during access, were recorded. The success of the access technique and its bleeding complications were analyzed between the two groups. RESULTS: By applying a "one-stage" technique, the targeted calix could be entered with a success rate of 93%. There was no difference in the procedural success rate between groups 1 and 2 (93.5% v 92.6%, respectively). All seven failed attempts (7%; three with previous OSS) were managed successfully using an Alken dilator to gain access to the proposed calix in the same session. Previous OSS did not impact access time, radiation exposure time during access, postoperative hemoglobin drop, and bleeding complications. There were no visceral and vascular injuries. CONCLUSIONS: One-stage tract dilation for PCNL is a safe and effective method in almost every adult patient.     

A logistic regression model for predicting health-related quality of life in kidney transplant recipients

BACKGROUND: To develop a logistic regression model capable of predicting health-related quality of life (HRQOL) among kidney transplant recipients and determine its accuracy. METHODS: Three groups of patients were selected: 70 healthy controls, 136 kidney transplant patients as a derivation set, and another 110 kidney transplant patients as a validation set. SF-36 score was used for HRQOL measurement. A cutoff point to define poor versus good HRQOL was calculated using the SF-36 scores of healthy controls. A logistic regression model was used to derive predictive parameters from the derivation set. The derived model was then tested among the validation set. HRQOL predictions made by the model for the patients in the validation set and the SF-36 scores were compared. We calculated sensitivity, specificity, positive and negative predictive values, and model accuracy. RESULTS: SF-36 scores below 58.8 were defined as an indication of poor HRQOL. The regression model suggested that poor HRQOL was positively associated with lower education (below high school diploma), being single or widowed, and diabetes/hypertension as etiology. It was negatively associated with younger age (<45 years) at the time of transplantation. Optimal sensitivity and specificity were achieved at a cutoff value of 0.74 for the estimated probability of poor HRQOL. Sensitivity, specificity, positive and negative predictive values, and accuracy of the model were 73%, 70%, 80%, 60%, and 72%, respectively. CONCLUSION: The suggested model can be used to predict poor posttransplant HRQOL among renal graft recipients using simple variables with acceptable accuracy. This modal can be of use in decision making in the recipients for whom achieving good HRQOL is the main aim of transplantation, to select high-risk patients and to start interventional programs to prevent a poor HRQOL.     

Earlier age at diagnosis: Another dimension in cancer disparity?

BACKGROUND: The age at diagnosis is of vital consideration for maximizing the benefits of screening recommendations, prevention initiatives, and treatment strategies. The current study compared the age at diagnosis in African Americans (AA) and whites for the 12 most frequently occurring cancers from 1996 to 2002. Using three criteria, this study determined whether cancers in most anatomic sites were more likely to occur at an earlier age in AA than in whites in the United States. METHODS: The Surveillance, Epidemiology, and End Results (SEER) Program was used to collect publicly accessible cancer data from 1996 through 2002 for AA and whites. Frequency, population size, and median age at diagnosis were collected for each of the 12 most commonly occurring cancers. These included: prostate, breast, lung, colon, urinary bladder, corpus uteri, non-Hodgkin's lymphoma, ovary, kidney, leukemia, oral cavity and pancreas. Poisson and logistic regression were used to investigate the possible association between race/ethnicity and an earlier age at cancer diagnosis. RESULTS: In general, AA had an earlier age at diagnosis for invasive cancer compared with whites. According to the median age at diagnosis, all 12 frequently occurring cancers from 1996 to 2002 were diagnosed significantly earlier in AA than in whites. Eight of the 12 cancers reached an arbitrary rate of >or=3 cases per 100,000 persons at a significantly younger age in AA than in whites. However, the relative risk of a cancer diagnosis for persons 5-45 years of age was significantly greater for only 3 of the 12 cancers in AA. CONCLUSION: Cancers in general have an earlier age at diagnosis in AA than in whites. Earlier age at diagnosis may be another indicator of disparity since cancers that arise at a younger age tend to be more aggressive and frequently result in a less favorable outcome.     

A case-control study of occupation/industry and renal cell carcinoma risk

ABSTRACT: BACKGROUND: The role of occupation in the etiology of renal cell carcinoma (RCC) is unclear. Here, we investigated associations between employment in specific occupations and industries and RCC, and its most common histologic subtype, clear cell RCC (ccRCC). METHODS: Between 2002 and 2007, a population-based case-control study of Caucasians and African Americans (1,217 cases; 1,235 controls) was conducted within the Detroit and Chicago metropolitan areas to investigate risk factors for RCC. As part of this study, occupational histories were ascertained through in-person interviews. We computed odds ratios (ORs) and 95% confidence intervals (CIs) relating occupation and industry to RCC risk using adjusted unconditional logistic regression models. RESULTS: Employment in the agricultural crop production industry for five years or more was associated with RCC (OR = 3.3 [95% CI = 1.0-11.5]) and ccRCC in particular (OR = 6.3 [95% CI = 1.7-23.3], P for trend with duration of employment = 0.0050). Similarly, RCC risk was elevated for employment of five years or longer in non-managerial agricultural and related occupations (ORRCC = 2.1 [95% CI = 1.0-4.5]; ORccRCC = 3.1 [95% CI = 1.4-6.8]). Employment in the dry-cleaning industry was also associated with elevated risk (ORRCC = 2.0 [95% CI = 0.9-4.4], P for trend = 0.093; ORccRCC = 3.0 [95% CI = 1.2-7.4], P for trend = 0.031). Suggestive elevated associations were observed for police/public safety workers, health care workers and technicians, and employment in the electronics, auto repair, and cleaning/janitorial services industries; protective associations were suggested for many white-collar jobs including computer science and administrative occupations as well employment in the business, legislative, and education industries. CONCLUSIONS: Our findings provide support for an elevated risk of RCC in the agricultural and dry-cleaning industries and suggest that these associations may be stronger for the ccRCC subtype. Additional studies are needed to confirm these findings.     

The results of Chiari pelvic osteotomy in adolescents with a brief literature review

Purpose Chiari medial displacement osteotomy is a procedure that uses the cancellous bone of the ilium to contain the femoral head and bear weight. It is the most contraversial osteotomy of the hip joint. This study was therefore conducted to determine the results of this osteotomy with mid-term follow-up in children. Methods From 1995 to 2004, 20 Chiari pelvic osteotomies (in 18 patients) were performed. There were 15 male and 3 female patients. The average age at operation was 12.6 years and the mean follow-up was 54 months. The operative technique was as described by Chiari. An iliofemoral approach was used without utilizing a traction table. If there was anterior or anterolateral uncoverage of the femoral head, bone graft augmentation was performed. Results The angle of the osteotomy averaged 12°, with the distance from the acetabulum averaging 3.2 mm. The average displacement was 42%. Of the 20 Chiari osteotomies, 11 were categorized as excellent, 8 as good and one as fair in terms of clinical and radiological results. Student’s t test statistics showed improvements in all radiologic parameters of the hip joint (Sharp angle, center-edge angle and coverage of the femoral head). Graft resorption was observed in 25% of the patients. Conclusion There are very rare indications of Chiari osteotomy in patients younger than 10 years. Because of the high rate of graft resorption, Chiari osteotomy should be the last treatment option when there is anterior or anterolateral uncoverage of the hip joint.     

High D-dimer level is associated with increased 15-d and 3 months mortality through a more central localization of pulmonary emboli and serious comorbidity

High D-dimer levels are predictors of death in patients with pulmonary embolism (PE), as are more proximally located, larger emboli. The direct link between these three has not yet been described. A cohort of 674 consecutive patients with confirmed PE was studied. Patients were followed up for 3 months. D-dimer levels were measured only in patients with an unlikely clinical probability ( n  = 262). The odds ratio (OR) for death of all variables was calculated. Multivariate analysis was performed to identify independent risk factors for mortality. The best predictive D-dimer cut-off point for mortality was a concentration >3000 ng/ml FEU (OR 7·29). High D-dimer levels were correlated with active malignancy and age over 65 years, both being indicators of 3-month mortality. High D-dimer levels were also correlated with centrally located pulmonary emboli and 15-d mortality. The combination of high D-dimer levels and central emboli increased early mortality risk by 2·2. High D-dimer levels in patients with an unlikely clinical probability were associated with fatal outcome after PE. Centrally located pulmonary emboli were associated with higher D-dimer levels and worse 15-d mortality. Active malignancy, being an inpatient at time of diagnosis and age over 65 years were associated with higher D-dimer levels and worse 3-month survival.     

A 12-month clinical evaluation of pit-and-fissure sealants placed with and without etch-and-rinse and self-etch adhesive systems in newly-erupted teeth

Objectives

The objective of this one-year clinical study was to investigate the effect of two adhesive systems (Adper Single Bond, a two-step etch-and-rinse and Clearfil SE Bond, a two-step self-etch system) on pit-and-fissure sealant retention in newly-erupted teeth. This study compared the success of the sealants in mesial and distopalatal grooves with and without these two adhesive systems.

Material and Methods

In a clinical trial, 35 children aged 6-8 years undergoing sealant placement were recruited. This one-year clinical study scored 70 mesial and 70 distopalatal sealants of newly-erupted permanent maxillary first molar, with a split-mouth design. All children received sealant alone in one permanent maxillary molar tooth. Children were randomized into two groups. One group received Self-Etch (SE) bond plus sealant and the other group received Single Bond plus sealant in another permanent maxillary molar tooth. Clinical evaluation at 3, 6 and 12 months was performed and the retention was studied in terms of the success and failure.

Results

The success rate of sealant in the distopalatal groove, using SEB at 3, 6 and 12 months was 93.3% (95% CI: 68.0, 99.8), 73.3% (95% CI: 44.9, 92.2) and 66.7% (95% CI: 38.4, 88.2), respectively. It was greater than that of the distopalatal groove in SB group with a success rate of 62.5% (95% CI: 35.4, 84.8), 31.3% (95% CI: 11.8, 58.7) and 31.3% (95% CI: 11.8, 58.7), at the three evaluation periods. The success rate of sealant in the mesial groove using SEB was 86.6% (95% CI: 59.5, 98.3), 53.3% (95% CI: 26.6, 78.7) and 53.3% (95% CI: 26.6, 78.7), while this was 100% (95% CI: 79.4, 100.0), 81.3% (95% CI: 54.4, 96.0) and 81.3% (95% CI: 54.4, 96.0) using SB, at 3, 6 and 12-month evaluation periods.

Conclusions

These results support the use of these two bonding agents in pit-and-fissure sealants under both isolated and contaminated conditions. Further, SE bond seemed to be less sensitive to moisture contamination.