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PubMed1994

Demand for predictive genetic testing for Huntington's disease in Australia, 1987 to 1993.

OBJECTIVE: To assess the demand for genetic testing for Huntington's disease among at-risk individuals and for prenatal testing among parents at risk of transmitting the disease, from January 1987 to March 1993. METHODS: Questionnaires were sent to all State coordinators of genetic testing services. RESULTS: One hundred and ninety adults (5.5% of those at risk) and 56 fetuses were tested. Nine per cent more women than men used the service. Most people tested were married and had offspring. Men generally presented for testing at an older age than women. CONCLUSION: The low uptake for testing is not surprising given the severity and untreatability of the illness. Careful monitoring is required, particularly of the effects on individuals told of their genetic status and of possible abuse of the information by third parties.

Adolescent↗
PubMed1989

[Dobutamine infusion test for predicting the postoperative recovery of left ventricular function in patients with chronic aortic regurgitation].

In order to predict the postoperative recovery of left ventricular (LV) function after valve replacement, dobutamine (DOB) infusion tests were performed on 21 patients with chronic aortic regurgitation (AR). As a predictor of the LV functional reserve. delta mVcf, calculated from the difference between the mVcf in echocardiographs before and after DOB infusion, was used. According to the values of delta mVcf, patients were classified into two groups. The good-response group consisted of 15 patients with delta mVcf greater than or equal to 0.45 cir/sec, and the poor-response group consisted of 6 patients with delta mVcf less than 0.45 cir/sec. Comparison of the early postoperative values in these two groups disclosed that the LV end-systolic dimensions (LVDs) and the %fractional shortening (%FS) improved in the good-response group, whereas in the poor-response group, the LVDs remained above 40 mm and the %FS, below 28% in the early postoperative period. A significant correlation was found between the preoperative delta mVcf and early postoperative %FS in both groups. The value of delta mVcf improved postoperatively, both in the good-response group and in the poor-response group; the %FS increased in the poor-response group late postoperatively. In patients whose delta mVcf did not improve in the postoperative DOB infusion test, the %FS remained depressed throughout the follow-up periods. Thus, the postoperative delta mVcf showed a significant correlation with the late postoperative %FS. In conclusion, DOB infusion tests were found to be an excellent indicator for estimating the amount and time course of improvement of LV function after surgery.

Aortic Valve↗
PubMed1996

Prognostic value of the galactose test in predicting survival of patients with cirrhosis evaluated for liver transplantation. A prospective multicenter Italian study. AISF Group for the Study of Liver Transplantation. Associazione Italiana per lo Studio del Fegato.

AIMS/METHODS: The present study aimed to examine whether the galactose elimination capacity can be used to predict the survival of patients with advanced liver disease. We studied 194 patients with cirrhosis, belonging to Child class B and C, for 2 years each. RESULTS: The overall probability of survival was 79% at 6 months, 72% at 1 year and 62% at 2 years. Variables significantly associated with the duration of survival, as assessed by univariate analysis, were the Child-Pugh score, presence of ascites, size of esophageal varices, prothrombin time, albumin, bilirubin, urea, creatinine, glucose and galactose elimination capacity. By a multivariable analysis, only Pugh score (p = 0.005), creatinine (p < 0.001), varices (p = 0.001) and galactose elimination capacity (p < 0.001) were independent predictors of mortality. The galactose elimination capacity was even more sensitive when the end-point was limited to deaths due to liver failure and hepatorenal syndrome. A new score obtained by summing the Pugh score with a score derived from galactose elimination capacity was quite simple and accurate for predicting survival. CONCLUSIONS: The quantitative measurement of liver function as the galactose elimination capacity could be of use to identify patients with cirrhosis and probable short survival who might benefit most from urgent transplantation.

Adolescent↗
PubMedDate not supplied

Clinical value of SDI test for predicting effect of postoperative chemotherapy for patients with gastric cancer.

We retrospectively evaluated the clinical usefulness of the succinate dehydrogenase inhibition (SDI) test as a chemosensitivity test, using 168 resected specimens of gastric cancer, with special reference to the correlation between the results of the SDI test and clinical effects of the corresponding chemotherapy. The rate of sensitivity of these tissues to DDP, CQ, ACR, MMC, ADM, and 5-FU were 63.5%, 54.2%, 47.4%, 42.9%, 31.4%, and 10.8%, respectively. Survival rates for patients with a positive chemosensitivity to MMC and postoperatively prescribed more than 20 mg of MMC were significantly better than those without sensitivity to MMC, even when treated with MMC, although no statistical differences existed in clinicopathologic factors between the two groups. We conclude that the SDI test for human gastric cancer is a rapid, reliable, and useful assay to determine the compatibility between the results of assay and the clinical effects of corresponding chemotherapy. We propose that the regimen of postoperative adjuvant chemotherapy be tailored according to results of the SDI test, using tissues resected from individual patients.

Aclarubicin↗
PubMed1999

Comparison of the Vitek GPS-TB card with disk diffusion testing for predicting the susceptibility of enterococci to vancomycin.

OBJECTIVE: To compare the ability of the Vitek GPS-TB card with disk diffusion testing for determining the susceptibility of enterococci to vancomycin. DESIGN: Vitek susceptibility testing was performed using the GPS-TB card and software version R05.03. Disk diffusion susceptibility testing was performed according to National Committee for Clinical Laboratory Standards guidelines. When discrepancies occurred between the interpretation of Vitek and disk diffusion, both tests were repeated and the epsilometer test (E test) and agar screen containing 6 microgram/mL vancomycin were performed. RESULTS: Of 415 isolates tested, 313 were susceptible to vancomycin and 97 were resistant to vancomycin by both test methods. Two isolates were intermediate by Vitek and resistant by disk diffusion, 2 were intermediate by Vitek and susceptible by disk diffusion, and 1 was susceptible by Vitek and intermediate by disk diffusion. All but 1 of these latter 5 isolates (intermediate by Vitek and susceptible by disk diffusion) were available for retesting. On repeat testing, the 2 isolates that were intermediate by Vitek and resistant by disk diffusion were resistant by both methods, the 1 isolate that was intermediate by Vitek and susceptible by disk diffusion was susceptible by both methods, and the isolate that was susceptible by Vitek and intermediate by disk diffusion was also susceptible by both methods. These results were confirmed by E test and agar screen. CONCLUSION: We found the results of the GPS-TB card compared well with disk diffusion. However, isolates with intermediate results by Vitek should be retested using another method, such as the E test.

Anti-Bacterial Agents↗
PubMed2005

Hereditary melanoma and predictive genetic testing: why not?

BACKGROUND: Since p16-Leiden presymptomatic testing for hereditary melanoma has become available in the Netherlands, the benefits and risks of offering such testing are evaluated. The current paper investigated why the non-participants were reluctant to participate in genetic testing. METHODS: Sixty six eligible individuals, who were knowledgeable about the test but had not participated in genetic testing by January 2003, completed a self-report questionnaire assessing motivation, anxiety, family dynamics, risk knowledge and causal attributions. RESULTS: Non-participants reported anxiety levels below clinical significance. A principal components analysis on reasons for non-participation distinguished two underlying motives: emotional and rational motivation. Rational motivation for non-participation was associated with more accurate risk knowledge, the inclination to preselect mutation carriers within the family and lower scores on anxiety. Emotional motivation for non-participation was associated with disease misperceptions, hesitation to communicate unfavourable test results within the family and higher scores on anxiety. CONCLUSION: Rational and emotional motivation for non-participation in the genetic test for hereditary melanoma was found. Emotionally motivated individuals may be reluctant to disseminate genetic risk information. Rationally motivated individuals were better informed than emotionally motivated individuals. It is suggested that a leaflet is added to the invitation letter to enhance informed decision-making about genetic testing.

Adult↗
PubMed2003

Three-dimensional quantitative structure-activity relationship analysis of propafenone-type multidrug resistance modulators: influence of variable selection on test set predictivity.

An extended set of multidrug-resistance modulators of the propafenone type were investigated using CoMFA and CoMSIA. A number of 3D-QSAR models were derived from steric, electrostatic, and hydrophobic fields and their combinations. The hydrophobic fields alone and in combination with the steric and both (steric and electrostatic) fields yielded the models with the highest cross-validated predictivity, in agreement with a previous analysis of a smaller data set of propafenone-type multidrug-resistance (MDR) modulators. Inclusion of lipophilicity did not lead to an improvement of the models. The results point to the importance of hydrophobicity as a space-directed molecular property for MDR-modulating activity. The influence of variable selection applying the GOLPE procedure was investigated with an external test set. Variable-selection procedure was repetitively applied, keeping at each stage variables with uncertain contribution to the models. For the CoMFA-based 3D-QSAR models, an increase in external prediction quality was found. In contrast, the CoMSIA-based 3D-QSAR models were not improved by the GOLPE variable-selection procedure.

Drug Resistance, Multiple↗
PubMed2006

Clinically isolated syndromes: a new oligoclonal band test accurately predicts conversion to MS.

BACKGROUND: Patients with a clinically isolated demyelinating syndrome (CIS) are at risk of developing a second attack, thus converting into clinically definite multiple sclerosis (CDMS). Therefore, an accurate prognostic marker for that conversion might allow early treatment. Brain MRI and oligoclonal IgG band (OCGB) detection are the most frequent paraclinical tests used in MS diagnosis. A new OCGB test has shown high sensitivity and specificity in differential diagnosis of MS. OBJECTIVE: To evaluate the accuracy of the new OCGB method and of current MRI criteria (MRI-C) to predict conversion of CIS to CDMS. METHODS: Fifty-two patients with CIS were studied with OCGB detection and brain MRI, and followed up for 6 years. The sensitivity and specificity of both methods to predict conversion to CDMS were analyzed. RESULTS: OCGB detection showed a sensitivity of 91.4% and specificity of 94.1%. MRI-C had a sensitivity of 74.23% and specificity of 88.2%. The presence of either OCGB or MRI-C studied simultaneously showed a sensitivity of 97.1% and specificity of 88.2%. CONCLUSIONS: The presence of oligoclonal IgG bands is highly specific and sensitive for early prediction of conversion to multiple sclerosis. MRI criteria have a high specificity but less sensitivity. The simultaneous use of both tests shows high sensitivity and specificity in predicting clinically isolated demyelinating syndrome conversion to clinically definite multiple sclerosis.

Adolescent↗
PubMed1983

Imaging ultrasound in the intraoperative diagnosis of vascular defects.

High-resolution real-time ultrasonography was employed during 267 vascular operations in order to diagnose vascular defects such as intimal flaps, strictures, and thrombi. These defects occur at operative areas (e.g., anastomoses, endarterectomized segments, and sites of placement of occlusive clamps) and can lead to serious thrombotic complications in the early post-operative period. Ultrasound detected vascular defects in 83 patients (31.1 per cent). The defects in 59 patients were considered clinically insignificant because of their sizes and locations, and were not re-explored. Early post-operative results of these patients were comparable to those of the patients without demonstrated defects. In 24 patients (9.0 per cent of all patients examined), ultrasonography revealed clinically significant defects which prompted re-exploration. In 20 of these 24 patients, these vascular defects were confirmed and corrected. No defect was found at re-exploration in four patients, but two of them developed early postoperative thrombosis. Ultrasonography and arteriography were compared at 100 operative sites. The two imaging methods were equal in terms of sensitivity, specificity, efficiency, and predictability of a negative test. Predictability of a positive test was 77.8 per cent for ultrasonography and 59.1 per cent for arteriography. This indicates that fewer needless re-explorations would occur following a decision based on ultrasonography. Operative ultrasonography is a simple, safe and accurate technique that should be applied to reconstructive vascular surgery for diagnosis of vascular defects.

Diagnostic Techniques, Surgical↗
PubMed1981

Pharmacogenetic interactions in G6PD deficiency and development of an in vitro test to predict a drug's hemolytic potential.

To summarize our results and their implications, by adding induced mouse liver microsomes to an in vitro test for the hemolytic potential of a drug in G6PD deficiency, we found that: 1) Hydroxylation appears to play an important role in activating the hemolytic potential of many drugs. 2) Use of an in vitro test system combining drug, hydroxylation system and red cell, appears to be very reliable in ruling out hemolytic potential, when it is in fact absent, and about 80% effective in identifying hemolytic potential when it is present. 3) Acetylation seems to markedly reduce the hemolytic potential of two drugs studied: promizole and DDS. The genetic polymorphism in acetylation may explain the bimodal response to promizole. 4) These studies suggest that interaction among three pharmacogenetic systems produces a given hemolytic result. Variability of hydroxylation and acetylation rates can be expected to contribute to variability in individual responses to certain hemolytic drugs.

Animals↗
PubMed2006

Value of routine admission laboratory tests to predict thirty-day mortality in patients with acute myocardial infarction.

Most risk-stratification instruments that have been developed to predict outcome after myocardial infarction do not make use of laboratory parameters, although several laboratory parameters have been shown to be predictors of adverse outcome. To assess the prognostic value of routine admission laboratory tests, we studied a sample of 264 of 3,746 patients with myocardial infarction from a coronary care unit database of 12,043 patients for differences between survivors and nonsurvivors at 30 days. In multivariate analyses, higher white blood cell count, higher levels of serum creatinine, glucose, and lactate dehydrogenase, and lower platelet count were identified as independent risk factors for 30-day mortality. The model that incorporated these risk factors (added laboratory parameters model) had a 17% higher predictive power than did the model that contained only conventional risk factors (conventional risk factor model). The added laboratory parameters model showed better discriminative ability than the conventional risk factor model according to the area under the curve (0.87 vs 0.80). In conclusion, routine admission laboratory tests hold significant prognostic information, with value in addition to conventional risk factors. Incorporating these tests in risk-stratification instruments will further improve risk assessment of patients with myocardial infarction.

Aged↗
PubMed2001

A comparison of the shuttle and 6 minute walking tests with measured peak oxygen consumption in patients with heart failure.

This study investigated the use of an incremental, externally-paced 10 m shuttle walk test (SWT) as an objective, reliable and predictive test of functional capacity in patients with heart failure (CHF). The SWT was compared to a 6 minute walk test (6WT) and a maximal symptom-limited treadmill peak oxygen consumption (VO2peak) test. Experiment 1 examined the reproducibility of the SWT. Two SWF trials were performed and distance ambulated (DA), heart rate (HR) and rate of perceived exertion (RPE) results compared. In experiment 2, SWT, 6WT, and VO2 peak tests were performed and HR. RPE and ambulatory VO2 compared. The SWT demonstrated strong test/retest reliability for DA (r = 0.98). HR (r = 0.96) and RPE (r = 0.89). Treadmill VO2 peak was significantly correlated with DA during the SWT (r = 0.83, P < 0.05), but not the 6WT. SWT peak VO2 (18.5 +/- 1.8 ml.kg(-1) x min(-1)) and treadmill VO2 peak (18.3 +/-2.0 ml.kg(-1) x min(-1)) were also highly correlated (r = 0.78, P < 0.05). Conversely, 6WT peak VO2 and treadmill VO2 peak were not significantly correlated. This study suggests the SWT is a reliable, objective test, highly predictive of VO2 peak which may be a more optimal field exercise test than the self paced 6WT.

Exercise Test↗
PubMed2003

Do growth hormone (GH) serial sampling, insulin-like growth factor-I (IGF-I) or auxological measurements have an advantage over GH stimulation testing in predicting the linear growth response to GH therapy?

OBJECTIVE: To compare the relative utility of GH secretion via pharmacological stimulation, overnight serial sampling, IGF-I levels and auxological variables as predictors of change in height standard deviation score (deltaHt SDS) during GH treatment. DESIGN: A multicentre observational study. PATIENTS: Prepubertal children (n = 825) with idiopathic growth failure who were subsequently treated with GH were divided into two groups, based on their maximum GH response to pharmacological stimulation testing: (1) idiopathic GH deficiency (IGHD), defined by a maximum GH response < 10 microg/l (n = 300); and (2) idiopathic short stature (ISS), with a maximum GH response > or = 10 microg/l (n = 525) (GH conversion factor: 3 IU = 1 mg). MEASUREMENTS: Overnight spontaneous GH secretion was measured in all patients. The following characteristics of spontaneous GH secretion were studied: maximum or peak GH, mean peak GH, number of GH peaks, pooled GH, mean GH, and approximate entropy of GH secretion. RESULTS: Although children with IGHD had lower indices of spontaneous GH secretion, there were no differences between IGHD and ISS groups in baseline Ht SDS, growth rate or IGF-I level. The dose and duration of GH therapy were similar. There was no statistically significant difference in the mean (+/- SD) change in Ht SDS (deltaHt SDS) in the two groups (IGHD 1.3 +/- 0.9 and ISS 1.2 +/- 0.8). Measures of spontaneous secretion, such as peak GH, mean of GH peaks, mean area under GH peaks, and mean GH, as well as IGF-I concentrations, were all statistically significantly correlated with deltaHt SDS in IGHD children (P < 0.0001). A significant correlation was also observed for pooled GH (P = 0.002) and approximate entropy (P = 0.01). Children with the most severe ISS (Ht SDS < -3.33) demonstrated a more disorganized pattern of GH secretion compared to children who were not as short (Ht SDS -2.33 to -1.64), as indicated by a higher approximate entropy (0.673 +/- 0.193 vs. 0.607 +/- 0.161, P < 0.004). This increased disorder in GH secretion was accompanied by lower IGF-I levels (104 +/- 99 microg/l vs. 137 +/- 74 microg/l, P < 0.001), even though pooled GH concentrations were indistinguishable between the two groups (2.2 +/- 1.3 microg/l vs. 2.0 +/- 1.0 microg/l). Children with IGHD demonstrated lower approximate entropy than did those with ISS (0.551 +/- 0.235 vs. 0.631 +/- 0.182, P < 0.0001). Duration of GH treatment, height deficit and genetic potential (midparental Ht SDS) were the most important variables influencing deltaHt SDS in children receiving GH therapy. Maximum stimulated GH, IGF-I and indices of spontaneous GH secretion also correlated with deltaHt SDS, but their relative importance varied among diagnostic groups. CONCLUSIONS: Patients with GH deficiency demonstrate a reduced capacity for GH secretion, while those with idiopathic short stature exhibit a more disorderly and less functional secretory pattern. Although effective in predicting a response to GH treatment in patients with severe GH deficiency, overnight serial sampling is less practical than other methods currently available. In addition, serial sampling was less useful as a predictor of growth response to exogenous GH in patients with idiopathic short stature.

Blood Specimen Collection↗
PubMed2001

Testing the predictability of the relative urinary supersaturation from the Bonn-Risk-Index for calcium oxalate stone formation.

When introducing a new parameter, it is necessary to compare the power of the new measure with already established ones. For a new method it is quite difficult to compete with established methods which have already ascertained sets of data over many years. A formal comparison of the new parameter with the actual "gold-standard" method can be a useful approach to reduce that problem. It cannot be expected that a new measure would reflect the "gold-standard" method in a simple proportionality. Therefore, it is important to find out the accuracy of the prediction of one parameter from the other, based on simple, e.g. linear, functions. A number of methods exist to determine the crystallization risk of calcium oxalate salts from urine. The most established method is the calculation of the relative urinary supersaturations with respect to these salts using the EQUIL-program, a program computing the equilibrium concentrations of complexes of primary cations and anions commonly found in urine. The Bonn-Risk-Index (BRI) is a new strategy for the evaluation of the risk of calcium oxalate formation, by performing crystallization experiments on native unprepared urine samples. Although the analytical and computational efforts of both approaches are quite different (relative supersaturation = high, BRI = low), the measurements revealed a considerable and significant linear relationship between the relative urinary calcium oxalate supersaturation, and BRI. We were, therefore, interested in predicting the relative supersaturation from the BRI and in the accuracy of this prediction.

Calcium Oxalate↗