Test predicts cirrhosis likelihood.
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Fibrosis↗
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[The mixed lympho-epidermal culture: a predictive test of the graft-versus-host reaction in receivers of bone marrow grafts].
Mixed lymphocyte reactions (MLR) and mixed epidermal cell-lymphocyte reactions (MECLR) were performed concurrently before grafting in patients scheduled to receive a bone marrow graft from an HLA-identical sibling for an hematological malignancy. For each donor-recipient pair, the ratio of the counts per minute (cpm) for MECLR to the cpm for MLR was calculated. This ratio was significantly higher in the group of patients who subsequently developed grade II to IV graft-vs-host (GVH) disease as compared to the group who had grade O-I GVH. Statistical analysis showed that this parameter was the most significant risk factor for acute GVH, as it was the leading factor selected by stepwise discriminant analysis. The other significant risk factors for acute GVH were previous pregnancies in female donors and chronic myeloid leukemia in recipients. Thus, these parameters allow more accurate evaluation of the risk for GVH in individual recipients before grafting and therefore of the indications for T-cell depletion.
Bone Marrow Transplantation↗
Clomiphene citrate challenge test predicts outcome of intrauterine insemination in women aged under 37 years.
The clomiphene citrate challenge test is a tool to predict ovarian reserve and fertility. It has mainly been used as a predictor of success of IVF/intracytoplasmic sperm injection (ICSI) cycles. Infertile young women with diminished ovarian reserve have a worse prognosis than women with adequate ovarian reserve attempting IVF/ICSI cycles. Nothing is known regarding the outcome of young women with diminished ovarian reserve undergoing low-complexity assisted reproductive treatment such as ovulation induction plus intrauterine insemination (IUI). This study included all women under 37 years who consulted in the authors' centre between May 2004 and August 2005 who underwent ovulation induction and IUI. Ninety-six women younger than 37 years with adequate ovarian reserve, and 50 women with diminished ovarian reserve were found. The pregnancy rate and pregnancy rate per cycle in the adequate ovarian reserve group were significantly higher than those of the diminished ovarian reserve group (46.7% versus 25%, P < 0.02 ; 15.9% versus 7.6%, P < 0.02 respectively). It is concluded that the clomiphene citrate challenge test is a good predictor of low-complexity infertility intervention outcome, and represents an effective tool to establish a prognosis. Therefore, it is very useful in planning therapy, and advising the infertile couple.
Adult↗
Do preoperative laboratory tests predict blood transfusion needs in cardiac operations?
We retrospectively compared preoperative prothrombin (PT), partial thromboplastin (PTT), dilute whole blood clot lysis and bleeding times, fibrinogen level, and platelet count with subsequent blood component administration in 92 patients who had undergone cardiac operations with cardiopulmonary bypass (CPB). Abnormal results for one or more tests were found in 34% of 71 adults and 81% of 21 children and teenagers. The patients with abnormal test(s) received no more whole blood and packed red cell units, platelets, or plasma than those with normal tests in either age group. No individual or multiple test abnormalities predicted excess blood component transfusion, even when low-grade abnormalities were excluded. The high rate of abnormal tests in patients less than 20 years of age was not due to polycythemia and may indicate a need for age-specific reference ranges. Baseline PT, PTT, and platelet count may aid in the evaluation of the potential for subsequent development of coagulopathy, but we conclude that further preoperative testing may be reserved for infants, polycythemic individuals, or others in whom history or drug use suggests potential bleeding problems.
Adolescent↗
Pre-test prediction models of BRCA1 or BRCA2 mutation in breast/ovarian families attending familial cancer clinics.
OBJECTIVE: To test whether statistical models developed to calculate pre-test probability of being a BRCA1/2 carrier can differentiate better between the breast/ovarian families to be referred to the DNA test laboratory. STUDY DESIGN: A retrospective analysis was performed in 109 Spanish breast/ovarian families previously screened for germline mutations in both the BRCA1 and BRCA2 genes. Four easy to use logistic regression models originally developed in Spanish (HCSC model), Dutch (LUMC model), Finnish (HUCH model), and North American (U Penn model) families and one model based on empirical data of Frank 2002 were tested. A risk counsellor was asked to assign a subjective pre-test probability for each family. Sensitivity, specificity, negative and positive predictive values, and areas under receiver operator characteristics (ROC) curves were calculated in each case. Correlation between predicted probability and mutation prevalence was tested. All statistical tests were two sided. RESULTS: Overall, the models performed well, improving the performances of a genetic counsellor. The median ROC curve area was 0.80 (range 0.77-0.82). At 100% sensitivity, the median specificity was 30% (range 25-33%). At 92% sensitivity, the median specificity was 42% (range 33.3-54.2%) and the median negative predictive value was 93% (range 89.7-98%). BRCA1 families tended to score higher risk than BRCA2 families in all models tested. CONCLUSIONS: All models increased the discrimination power of an experienced risk counsellor, suggesting that their use is valuable in the context of clinical counselling and genetic testing to optimise selection of patients for screening and allowing for more focused management. Models developed in different ethnic populations performed similarly well in a Spanish series of families, suggesting that models targeted to specific populations may not be necessary in all cases. Carrier probability as predicted by the models is consistent with actual prevalence, although in general models tend to underestimate it. Our study suggests that these models may perform differently in populations with a high prevalence of BRCA2 mutations.
BRCA1 Protein↗
Canadian experience with predictive testing for Huntington disease: lessons for genetic testing centers and policy makers.
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Canada↗
Early recovery of oxygen kinetics after submaximal exercise test predicts functional capacity in patients with chronic heart failure.
BACKGROUND: Oxygen (O2) uptake at peak exercise (VO2 peak) is an objective measurement of functional capacity in patients with chronic heart failure (CHF). The significance of recovery O2 kinetics parameters in predicting exercise capacity, and the parameters of submaximal exercise testing have not been thoroughly examined. METHODS AND RESULTS: Thirty-six patients (mean age = 48+/-14 years) with CHF and New York Heart Association functional class I, II, or III, and eight healthy volunteers (mean age = 39+/-13 years) were studied with maximal and submaximal cardiopulmonary exercise testing (CPET). The first degree slope of O2 uptake decay during early recovery from maximal (VO2/t-slope), and submaximal exercise (VO2/t-slope)(sub), were calculated, along with VO2 half-time (T(1/2)VO2). Patients with CHF had a longer recovery of O2 uptake after exercise than healthy volunteers, expressed by a lower VO2/t-slope (0.616+/-0.317 vs. 0.956+/-0.347 l min(-1) min(-1), P=0.029) and greater T(1/2)VO2 (1.28+/-0.30 vs. 1.05+/-0.15 min, P = 0.005). VO2/t-slope correlated with the VO2 peak (r = 0.84, P<0.001), anaerobic threshold (r = 0.79, P<0.001), and T(1/2)VO2, a previously established estimate of recovery O2 kinetics (r = -0.59, P<0.001). (VO2/t-slope)(sub) was highly correlated with VO2/t-slope after maximal exercise (r=0.87, P<0.001), with the VO2 peak (r=0.87, P<0.001) and with T(1/2)VO2 after maximal exercise (r=-0.62, P<0.001). VO2/t-slope after maximal and submaximal exercise was reduced in patients with severe exercise intolerance (F=9.3, P<0.001 and F=12.8, P<0.001, respectively). CONCLUSIONS: Early recovery O2 kinetics parameters after maximal and submaximal exercise correlate closely with established indices of exercise capacity in patients with CHF and in healthy volunteers. These findings support the use of early recovery O2 kinetics after submaximal exercise testing as an index of functional capacity in patients with CHF.
Adult↗
Pulmonary function tests predict outcome after cardiac surgery.
The aim of this study was to examine the value of systematic preoperative pulmonary function tests (PFTs) in order to reliably predict prolonged stay in I.C.U., prolonged mechanical ventilation and mortality in elective cardiac surgical patients. 149 consecutive adult patients (valvular replacement or coronary bypass graft) were studied retrospectively. We examined the preoperative respiratory data: vital capacity (VC), first second forced expired volume (FEV1), PaCO2 and PO2. Length of stay in I.C.U. (LICU), duration of mechanical ventilation (DMV), incidence of reintubation and survival rate were used as indices of respiratory morbidity. The results of the present study clearly indicate that patients with impaired airway flow rates had a prolonged postoperative recovery following cardiac surgery. Mortality, ICV and DMV increased when FEV1 was less than 1.5 L, VC was less than 2.5 L, or PaO2 was less than 8.5 kPa. Reintubation was associated with impaired flow rates. Pulmonary function tests appeared effective in predicting postoperative complications and the need for prolonged ventilatory support.
Cardiac Surgical Procedures↗
Prospective clinical study comparing DNA flow cytometry and HPV typing as predictive tests for persistence and progression of CIN I/II.
A cohort of 70 consecutive women at a university hospital colposcopy clinic with untreated CIN I and CIN II (CIN I/II) confirmed by cytology and histology was followed for 1 year in the setting of a prospective trial. In the lesions, the presence of DNA from HPV types was examined by restriction fragment length polymorphism (RFLP) analysis. Aneuploid cell lines were demonstrated by aneuploid histograms generated by high-resolution DNA flow cytometry. HPV type 16 infection and the existence of aneuploid cell lines proved to be significant risk factors for CIN I/II lesions to persist or progress to CIN III in the 1-year follow-up period in the same cohort of patients. The relative risks and 95% confidence intervals (CI) were 1.81 (1.44-2.76) for aneuploid cell lines and 1.74 (1.10-2.76) for HPV type 16 infection in CIN I/II lesions. As a predictive diagnostic test for CIN I/II lesions to persist or progress, the specificity and positive predictive value (PPV) for aneuploid histograms were 100% (CI, 73.5-100%) and 100% (CI, 86.8-100%), respectively. The low sensitivity of 27.3% (CI, 14.9-42.8%) restricted the clinical application of the test, leaving 32 of 44 women with persisting or progressing CINI/II with diploid histograms. HPV type 16 positivity by FRLP had a PPV of 68.4% (CI, 43.5-87.4%) as a prognostic test. Six of 19 HPV 16 infected women showed complete remission of their CIN lesion. A combination of the two tests did not provide any additional information.
Adolescent↗
The 6-minute walk test predicts clinical outcome in Asian patients with chronic congestive heart failure on contemporary medical therapy: a study of the multiracial population in Singapore.
BACKGROUND: We sought the value of the 6-min walk test (6MWT) in predicting morbidity and mortality in Asian patients with congestive heart failure (CHF). METHODS: 668 patients (Age 66+/-12 years, Ejection fraction 29+/-13%, NYHA I to IV) were prospectively followed up for 36+/-12 months. 386 patients (58%) took the 6MWT. Cardiac events, defined as the composite end-point of death or CHF readmission were documented. RESULTS: 188 patients (28%) reached the composite end-point (63 deaths, 125 readmissions). 6MWT distance was an independent predictor of cardiac events (quartile 1 vs quartile 4)(p=0.041), as were beta-blocker or spironolactone use (p=0.008 for both), diabetes (p=0.042), monthly income less than SGD$1000 (p=0.030), and NYHA class (class III vs class I)(p=0.003). A 6MWT distance <340 m predicted occurrence of cardiac events with a sensitivity of 69% and specificity of 48%. CONCLUSIONS: The 6MWT is a safe and simple clinical tool, which could predict both morbidity and mortality in a large population of Asian patients with CHF of differing etiology and severity (169 words).
Age Factors↗
Does the medical college admission test predict clinical reasoning skills? A longitudinal study employing the Medical Council of Canada clinical reasoning examination.
BACKGROUND: To investigate the predictive validity of the Medical College Admission Test (MCAT) for clinical reasoning skills upon completion of medical school. METHOD: A total of 597 students (295 males, 49.4%; 302 females, 50.6%) participated from 1991 to 1999. Stepwise multiple regressions of the MCAT and premedical school GPA (independent variables) on the Part 1(declarative knowledge) and Part 2 (clinical reasoning) of the Medical Council of Canada Examinations (dependent variables) were employed. RESULTS: For Part 1, the multiple regression revealed that three predictors (verbal reasoning, biological sciences, GPA) accounted for 23.3% of the variance, and for Part 2, two predictors (verbal reasoning, GPA) accounted for 11.2%. CONCLUSION: There is both convergent and divergent evidence for the predictive validity of the MCAT for clinical reasoning.
Canada↗
Predictive testing and oncogenes.
Case vignette: sharing unanticipated genetic information. The Questor family has experienced an unusual number of malignancies in the past two generations and has been advised by an oncologist that the p53 oncogene known as Li-Fraumeni Syndrome may be present in the family genome. The option of predictive genetic testing has been raised and several branches of the family have chosen to undergo screening to determine whether they are at risk for cancer because of the gene. Roger and Liz Questor have arranged for screening of themselves and their three children, ages 12, 10, and 7. The couple has, by all appearances, been happily married for 14 years. None of the family members are found to carry the oncogene; however, the geneticist conducting the analyses has made an interesting incidental discovery. The 10-year-old child is not the biological progeny of Roger Questor. Although the 12- and 7-year-olds are clearly the biological children of the couple, it is evident that the 10-year-old born to Liz Questor was fathered by a person other than Roger. What are the ethical obligations of the geneticist with respect to any sharing or disclosure of the information that has been discovered incidentally? What course of action, if any, do you recommend?
Adult↗
Comparing patients' predicted test scores from a regression equation with their obtained scores: a significance test and point estimate of abnormality with accompanying confidence limits.
In contrast to the standard use of regression, in which an individual's score on the dependent variable is unknown, neuropsychologists are often interested in comparing a predicted score with a known obtained score. Existing inferential methods use the standard error for a new case (s-subN+1) to provide confidence limits on a predicted score and hence are tailored to the standard usage. However, s-subN+1 can be used to test whether the discrepancy between a patient's predicted and obtained scores was drawn from the distribution of discrepancies in a control population. This method simultaneously provides a point estimate of the percentage of the control population that would exhibit a larger discrepancy. A method for obtaining confidence limits on this percentage is also developed. These methods can be used with existing regression equations and are particularly useful when the sample used to generate a regression equation is modest in size. Monte Carlo simulations confirm the validity of the methods, and computer programs that implement them are described and made available.
Confidence Intervals↗
The aminopyrine breath test predicts the outcome of hepatic transplantation in pigs.
The aminopyrine breath test has been performed on Day 1 and Day 7 in pigs following experimental liver allografting. The results show that at 24 hr after surgery there was a significant reduction in liver function in all animals as measured by the elimination rate constant of 14CO2 in the breath. This was very profound in the group that died within 5 days (0.09 +/- 0.01 hr-1) and was significantly different from the group that survived (0.16 +/- 0.01 hr-1). There appears to be a critical value of the elimination rate constant (= 0.12 hr-1) which predicts death within 5 days. These results would justify a trial of the aminopyrine breath test in patients after liver transplantation.
Aminopyrine↗
Zotepine: preclinical tests predict antipsychotic efficacy and an atypical profile.
Zotepine, an atypical antipsychotic structurally similar to clozapine, is in Phase III clinical trials in the United States and Europe for the treatment and management of acute and chronic schizophrenia. Zotepine's pharmacological profile has been compared with those of the atypical antipsychotic clozapine, and the typical neuroleptics haloperidol and chlorpromazine in preclinical tests that predict antipsychotic efficacy and extrapyramidal symptoms (EPS). Because zotepine causes potent, long-lasting inhibition of dopaminergic behavioral responses in animals, it may have an efficacious prolonged antipsychotic action in humans. In contrast, it induces little catalepsy, indicating that it should cause minimal motor side effects, such as EPS. Like clozapine but unlike the typical neuroleptics, zotepine's affinities for cloned human D1 and D2 receptors are very similar. Since a stimulation imbalance favoring D1 over D2 receptors has been suggested to induce dyskinesias, zotepine's reduced EPS profile in humans may derive, in part, from balanced inhibition of these receptors.
Animals↗
Can glucose tolerance test predict fetal hyperinsulinism?
OBJECTIVE: To establish cut off levels for oral glucose tolerance test in pregnancy using fetal hyperinsulinism as a clinical endpoint. DESIGN: Capillary blood glucose levels at 0, 1, and 2 hours after the ingestion of either 1 g/kg or 75 g glucose, at 28 (SD 5) weeks of gestation were analysed in 220 women with elevated amniotic fluid insulin levels [> or =42 pmol/L (> or =7 microU/mL)] after a mean (SD) of 31 weeks (3) and in 220 nondiabetic controls. RESULTS: In women with elevated amniotic fluid insulin levels the mean (SD) capillary blood glucose values at 0, 1, and 2 hours were 5.2 mmol/L (1.0) [94 mg/dL (18)], 10.5 mmol/L (1.4) [189 mg/dL (25)] and 8.2 mmol/L (2.0) [147 mg/dL (36)], respectively. The one-hour value had the highest sensitivity to predict elevated amniotic fluid insulin levels. The 5th centile of the one-hour blood glucose levels representing a detection rate of 95% was 8.9 mmol/L (160 mg/dL). CONCLUSION: Glucose cut off levels in most established oral glucose tolerance test criteria are too high, to accurately predict amniotic fluid hyperinsulinism. A one-hour test may be sufficient for detecting amniotic fluid hyperinsulinism. Since different loads (1 g/kg, 75 g or 100 g) and blood fractions (venous plasma or capillary blood) have minimal impact on oral glucose tolerance test results, a single one-hour cut off of 8.9 mmol/L (160 mg/dL), independent of the sampling method, may be appropriate for the diagnosis of gestational diabetes mellitus severe enough to cause amniotic fluid hyperinsulinism.
Adult↗
Sexual performance of rams in serving capacity tests predicts success in pen breeding.
The purpose of this study was to determine the extent to which sexual performance (serving capacity) tests can be used to predict the sexual behavior and reproductive success of rams in the context of pen mating. Standard serving capacity tests were used to select four low (LP) and four high-performing (HP) rams from a population of 94 yearling males. Each selected ram was then exposed to approximately 30 estrus-synchronized ewes for a 9-d period. Ejaculations observed and mounting marks left on ewes confirmed the greater (P less than .001) sexual activity of the HP rams in the field. In addition, ewes exposed to HP rams had a higher lambing percentage, more lambs born, and more live lambs born per ewe. Ram classification was not related (P greater than .60) to the number of lambs born per ewe lambing (prolificacy). It was concluded that serving capacity tests, properly conducted, can be used to predict ram mating performance and thus aid in establishing more efficient ram-to-ewe stocking rates.
Animals↗
A study of homicide: the validity of predictive test factors.
This study is a retrospective comparison of the psychological test findings within four groups, including 61 murderers, 42 assaulters, 71 perpetrators of theft, and 24 unemployed non-criminal controls. Psychological test findings did not discriminate very well among these groups. Some purported hostility scales, such as the Elizur Hostility Scale, the DeVos Hostility Scale, and Megargee's Overcontrolled-Hostility Scale, did not discriminate at all. The 16 Personality-Factor Questionnaire was particularly unhelpful, rating all four groups as having above-average emotional stability, One must conclude that individual psychological test factors are of little value in predicting violent behaviour. Further research is being undertaken to separate the murder group into motivational sub-categories.
Adult↗