Exclusion of venous thromboembolism: evaluation of D-Dimer PLUS for the quantitative determination of D-dimer

The objective of this study was to evaluate if D-Dimer PLUS (Dade Behring, USA), a rapid fully automated assay, could be used as an initial screening test in the diagnosis of venous thromboembolism (VTE). Samples from 274 consecutive symptomatic patients with suspected pulmonary embolism (n=229; 79% outpatients, 21% inpatients), deep venous thrombosis (n=37; 84% outpatients, 16% inpatients) or suspected for both complications (n=8) were tested with this D-dimer assay with a Sysmex CA-1500 Coagulation Analyzer. Clinical probability for pulmonary embolism (PE) or deep venous thrombosis (DVT) was staged according to a pretest risk score proposed by Wells. Final diagnosis of PE and/or DVT was established by spiral-computed tomography of the pulmonary arteries or compression ultrasonography, respectively. PE was diagnosed in 13.5% of the patients, whereas DVT was confirmed in 17.7% of the patients. The optimal cut-off value for exclusion of venous thromboembolism was 130 mug/l, and sensitivity, specificity and negative predictive value (NPV) were 95.0% (95% CI: 92.4-97.6), 30.4% (95% CI: 25.0-35.8) and 97.2% (95% CI: 95.2-99.2), respectively. In fact, two patient with PE were missed using D-Dimer PLUS; both cases were outpatients. In conclusion, this assay appears to be safe when implemented in an algorithm based on clinical assessment, D-dimer concentration, and radiological diagnostic techniques to stratify the risk for PE or DVT. However, higher sensitivities and negative predictive values were claimed in the scarce published reports for the D-Dimer PLUS assay than found in this study.     

Short Poster Abstracts

Abstract

Evaluation of vascular responses to metallic stent implantation is essential in the setting of vascular disease. Study of the vascular response to stent implantation has been hampered by difficulties in sectioning metal and tissue without distortion of the tissue stent interface. Physical removal of the metal prior to processing frequently results in loss of arterial architecture, and current methods of embedding in resin have multiple drawbacks including expense, toxic or hazardous solution components, stent displacement and slow turnaround time.     

外翻弹性垫夹板治疗儿童肱骨髁上尺偏型骨折63例临床观察

根据肱骨髁上尺偏型骨折的损伤机制和治疗原理,研制出外翻弹性垫夹板。外侧板下段向外弯150°,其弧背可压骨折近端向内;内侧板加弹簧垫可推骨折远端向外。故能保持骨折端良好对位,减少因错位而发生的肘内翻。治疗63例,经6个月～3年随访的61例,优良率达873％,肘内翻发生率为13％,低于国内外文献报导。     

Triaging HPV-positive women with p16/Ki-67 dual-stained cytology: Results from a sub-study nested into the ATHENA trial

Objectives

In addition to genotyping for HPV16/18, dual-immunostaining for p16/Ki-67 has shown promise as a triage of HPV-positive women. We assessed the performance of p16/Ki-67 dual-stained cytology for triaging HPV-positive women undergoing primary HPV screening.

Evaluation of p16INK4a/Ki‐67 dual stain in comparison with an mRNA human papillomavirus test on liquid‐based cytology samples with low‐grade squamous intraepithelial lesion

BACKGROUND:

The objective of the current study was to investigate the clinical performance of detecting high‐grade lesions with the CINtec PLUS p16^INK4a/Ki‐67 dual stain and the APTIMA human papillomavirus (HPV) Assay in a cohort of women with low‐grade squamous intraepithelial lesion (LSIL) cytology. The authors also assessed the reproducibility of the evaluation of immunocytochemical staining.

METHODS:

The 2 tests were performed on liquid‐based residual material from 469 women with LSILs. The samples had at least 5 years of follow‐up and the gold standard used was high‐grade cervical intraepithelial neoplasia (CIN2+/CIN3+) proven on histology.

RESULTS:

Approximately 69% of all the women included in the study had a positive test for HPV mRNA and 56% was positive for the dual stain. The 2 tests demonstrated high sensitivities. When examining the specificities, the APTIMA HPV Assay performed with significantly lower values than the CINtec PLUS test. For patients with CIN2+, the APTIMA HPV Assay had a specificity of 36.1% versus 51.3% for the CINtec PLUS test, and for women with CIN3+, the specificity was 33.8% versus 48.2%, respectively. The difference was even more pronounced when analyzing women aged < 30 years separately. The kappa values between the 3 observers in scoring the dual stain ranged from 0.43 to 0.49 and improved in a second evaluation round to values ranging from 0.50 to 0.66.

CONCLUSIONS:

The CINtec PLUS p16^INK4a/Ki‐67 dual‐staining test in LSIL cytology samples demonstrated high sensitivity that was similar to that of the APTIMA HPV Assay in the detection of underlying high‐grade disease but with enhanced specificity, especially among women aged < 30 years. The kappa value for the evaluation of the CINtec PLUS dual‐staining test was moderate but could be improved through training. Cancer (Cancer Cytopathol) 2013. © 2012 American Cancer Society.     

小地域分析的集合数据模型在鼻咽癌发病因素研究中的应用

目的 :探讨用于小地域鼻咽癌发病因素分析的较优模型。方法 :收集 1989～ 1998年 10年、前后 5年、1997年和 1998年的有关数据 ,分别在SAS、Splus软件中拟合 3种模型 :集合数据分析、logistic回归、Poissin回归。结果 :鼻咽癌发病因素小地域分析的 3种模型比传统分析方法具有明显的优势 ,集合数据模型共发现 4个有统计学意义的因素 ,其中饮水来源与四会市的发病率分布一致 ;与泊松回归和logistic回归相比 ,集合数据模型的残差较小 ,结果较稳健。结论 :集合数据模型可用于小地域的各种群体水平数据分析及其他肿瘤等少见病的危险因素研究     

两种需氧血培养系统对模拟菌血症检测能力的比较

目的比较BACTEC PLUS树脂需氧瓶与BacT／Alert FA活性炭需氧瓶对模拟菌血症的检测能力。方法选择烧伤科常用的抗生素与细菌病原体,将菌液、抗生素、新鲜无菌血注入各培养瓶内,记录5d内阳性瓶的检出时间及二者对万古霉素的吸附能力,对2种具有不同吸附剂的血培养瓶的阳性检出率及平均检出时间进行比较。结果除替考拉宁组外,BACTEC PLUS树脂需氧瓶的细菌阳性检出率和平均检出时间均优于BacT／Alert FA活性炭需氧瓶,差异有统计学意义（P〈0．001）;替考拉宁组BacT／Alert FA活性炭需氧瓶的细菌阳性检出率和平均检出时间优于BACTEC PLUS树脂需氧瓶。结论在进行血培养时,应该尽可能在抗生素使用以前或F次使用抗生素以前采血。对已经应用抗生素的患者,应选择具有中和、吸附抗生素能力的培养系统。     

Testing the 2017 PHC reform through pilots: Strengthening prevention and chronic care coordination

Numerous official reports have highlighted insufficient provision of preventive services within primary health care (PHC) in Poland. Other identified weaknesses include inappropriate referrals to ambulatory care that contribute to long waiting times for specialist consultations. Since mid-2018, a new model of PHC organization has been piloted and can be seen as an attempt to address some of these weaknesses. It draws on the Primary Health Care Act of 2017 and puts much more emphasis on disease prevention and health promotion within PHC as well as shifts management of common chronic conditions to multidisciplinary PHC teams. The implementation of this model has been supported by a range of financial and non-financial measures, including a special grant that helps PHC practices to adapt their IT systems to the requirements of the pilot. Yet, the overall requirements were prohibitive to most PHC practices and only 42 were eventually included in the pilot. In this paper, we describe the content of this model, the difficulties in its implementation and how they were addressed and discuss its possible effects on PHC and the health system more broadly.     

Comparison of whole-body MR imaging and conventional X-ray examination in patients with multiple myeloma and implications for therapy

Skeletal X-ray survey is the established method of diagnosis in patients with multiple myeloma; however, whole-body magnetic resonance imaging (wb-MRI) has become an important additional tool. The aim of this study was to compare the different patterns of infiltration on conventional X-ray examinations (X-ray survey) with findings from wb-MRI to subsequently determine the influence of wb-MRI on therapy changes. In 60 patients with a mean age of 65.1 ± 11.7 years, wb-MRI examinations were correlated with a recent X-ray survey. The results were independently assessed by two radiologists and the patterns of infiltration were described in both modalities. Subsequently, the disease was staged according to Salmon and Durie and Salmon and Durie PLUS. Additionally, the influence of MRI on potential changes in therapy was assessed using a three-range Likert-type scale. In all, 480 skeletal regions were compared. In 183 skeletal regions, an increased degree of infiltration was identified on wb-MRI. Significant differences (p < 0.05) between the modalities could be found in the thorax, spine, pelvis, and both lower extremities. Based on wb-MRI, tumor stage was upgraded in 19 of the 60 patients using the Durie and Salmon PLUS classification. In ten out of these 19 patients (42%), the wb-MRI result was essential for making the decision to initiate further therapy due to the degree of infiltration, extramedullary tumor extension, and/or further risk of fracture. Whole-body MRI provides a more detailed assessment of the pattern of bone marrow infiltration and strongly influences therapeutic strategies.