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PubMed1999

99mTc-tetrofosmin SPECT for prediction of functional recovery defined by MRI in patients with severe left ventricular dysfunction: additional value of gated SPECT.

UNLABELLED: This study was designed to evaluate gated 99mTc-tetrofosmin SPECT for prediction of functional recovery proven by sequential MRI. 99mTc-labeled tetrofosmin is a recently introduced tracer for myocardial perfusion. However, its role for viability assessment is still under investigation. METHODS: 99mTc-tetrofosmin uptake in 19 patients with coronary artery disease and severe left ventricular dysfunction was correlated to regional wall thickening before and 4.5 +/- 0.8 mo after successful coronary artery bypass grafting, as derived from corresponding gated short-axis MRI. Preoperative wall thickening determined by gated SPECT was used as an additional parameter for prediction of functional outcome. Optimal threshold cutoffs to separate reversible from irreversible dysfunction were determined by receiver operator characteristic (ROC) analysis. RESULTS: The sensitivity and specificity of regional 99mTc-tetrofosmin for prediction of functional recovery was 87% and 42%, respectively (cutoff: 50% of maximum tracer retention). The area under ROC curves for prediction of functional recovery measured 0.66 +/- 0.01. Segments with > or =50% uptake and impaired but detectable wall thickening determined by gated SPECT had a significantly higher likelihood for functional improvement compared with segments with absent wall thickening (P < 0.05). There was no difference in segments with <50% tracer retention. There was good agreement for ejection fraction measurements by MRI and gated SPECT (mean ejection fraction 32 +/- 12 versus 34 +/- 11; r = 0.71, P < 0.001). CONCLUSION: Regional 99mTc-tetrofosmin uptake provided high sensitivity but limited specificity for prediction of functional recovery after revascularization, leading to fair overall accuracy. Wall thickening assessment derived from gated SPECT may improve the specificity of 99mTc-tetrofosmin uptake for prediction of functional recovery but not the sensitivity in low-flow areas. In addition to the assessment of global function, gated data acquisition can be helpful to improve the overall accuracy of 99mTc-tetrofosmin SPECT for prediction of functional recovery after bypass surgery.

Coronary Artery Bypass↗
PubMed2000

The predictive value of intraoperative ST-segment monitoring as a marker of myocardial injury.

AIM: To evaluate the usefulness of dynamic intraoperative ST-monitoring in high-risk patients comparing it to preoperative clinical assessment and concurrent biochemical markers of cardiac injury. MATERIALS AND METHODS: Twenty-three patients clinically assessed as being at high risk for perioperative cardiac complications were recruited into this prospective, observational study in a public hospital. All had serial ECGs, cardiac enzymes and troponin-T measurements. The sensitivity, specificity, positive and negative predictive value of ST-segment changes in terms of predicting cardiac complications were calculated. We investigated the relationship between ST changes and biochemical markers of ischaemia and the predictive value of nonspecific (ASA) and specific (Goldman) clinical scores for cardiac complications. RESULTS: When correlated with cardiac complications, ST-segment monitoring had sensitivity 45.4%, specificity 100%, positive predictive value 100% and negative predictive value 66.7%. The correlation with CK-MB and troponin T was sensitivity 16.7% and 25%, specificity 73.3% and 75%, positive predictive value 20% and 20%, and negative predictive value 68.8% and 80%, respectively. The percentage of patients with cardiac complications increased with poor Goldman and ASA clinical scores; 25%, 40%, 62.5% and 100% in Goldman risk index groups of 0-5, 6-12, 13-25 and > 25, respectively; and 33.3% and 52.6% in ASA II and ASA III, respectively. CONCLUSIONS: This study demonstrates the importance of the anaesthesiologist preoperative assessment of cardiac risk. The probability that a patient with significant ST-depression will develop subsequent cardiac complications is 100%, which reflects its usefulness in this high-risk pre-selected sample. However, the test has a low sensitivity (45.4%).

Aged↗
PubMed2001

A validated strategy for side specific prediction of organ confined prostate cancer: a tool to select for nerve sparing radical prostatectomy.

PURPOSE: Nerve sparing radical prostatectomy for prostate cancer should be restricted to patients who harbor tumors without capsular penetration. To our knowledge the selection criteria for nerve sparing radical prostatectomy are not clearly defined. We investigated a panel of preoperative tumor characteristics with respect to their ability to predict organ confined tumor growth for each lobe of the prostate to indicate unilateral or bilateral nerve sparing radical prostatectomy. MATERIALS AND METHODS: Nine preoperative tumor characteristics in 278 patients with clinically localized prostate cancer were included in retrospective univariate and multivariate tree structured regression analysis. The association of clinical stage, serum prostate specific antigen (PSA), PSA density, and results of transrectal ultrasound and systematic sextant biopsy, including a quantitative assessment of cancer in the biopsies with organ confined tumor growth, was statistically evaluated. Except for serum PSA and PSA density preoperative characteristics were considered separately for each prostate lobe. Multivariate analysis results were validated prospectively in 353 patients. RESULTS: On univariate analysis the number of positive biopsies was the most useful single parameter with a positive predictive value of 83% in 274 lobes and a negative predictive value of 55%, followed by mm. of tumor in the biopsy. Of all characteristics included in multivariate analysis only the number of biopsies with high grade cancer, the number of positive biopsies and serum PSA were independent for predicting organ confined cancer. When PSA was less than 10 ng./ml. and not more than 1 biopsy with high grade cancer was identified in a lobe, organ confined tumor growth was present in 86.1% of cases. On prospective validation the same criteria led to an 88.5% incidence of organ confined prostate cancer. Pooling the 2 most favorable groups led to 391 prostate lobes (70.8% of those investigated) with a positive predictive value of 82.1% (95% confidence interval 77.9% to 85.8%). Using the multivariate approach more prostate lobes were assigned to a favorable risk group than on univariate analysis. Clinical stage and simple Gleason grade did not contribute independent information for predicting organ confined disease. CONCLUSIONS: Quantifying cancer and high grade cancer by systematic biopsy and serum PSA concentration are useful preoperative characteristics for predicting organ confined prostate cancer. Side specific analysis of these parameters is a flexible and reliable tool for selecting patients for nerve sparing radical prostatectomy.

Humans↗
PubMed2001

[A method for modeling skin explants--an in vitro predictive test for graft vs host disease in allogenic hematopoietic cell transplantation].

BACKGROUND: Acute graft versus host disease (GvHD) remains a severe complication of allogeneic haematopoietic stem cell transplantation (HSCT). Our study summaries results of skin explant assay (SEA) as a pretransplant GvHD predictive test in a cohort of paediatric (n = 33) and adult (a = 8) patients receiving grafts from their HLA identical siblings (n = 28), haploidentical relatives (n = 3) and unrelated donors (n = 10). Results GvHD prediction are correlated with the occurrence and severity of acute GvHD posttransplant and effect of GvHD prophylaxis on GvHD clinical outcome is evaluated. METHODS AND RESULTS: SEA utilises responding lymphocytes of the donor, which are sensitized firstly in vitro by mononuclears cells of patient in allogeneic mixed lymphocyte culture (MLC) and subsequently co-cultured with recipient's skin. Histopathological changes found in patients' skin explants are evaluated according to standard Lerner classification for acute GvHD. In general, GvHD predictive results in SEA correlated with GvHd clinical outcome in 28 out of 41 tested patients (68%, p = 0.015). In a cohort of HLA identical sibling transplants GvHD predictive results correlated with clinical manifestation of acute GvHD only in 15 out of 28 patients on individual GvHD prophylaxis. GvHD prophylaxis in the form of cyclosporine A (CsA) combined with short-term methotrexate (MTX) reduced the risk of acute GvHD in 10 out of 14 transplanted patients (71%) meanwhile CsA alone prophylaxis only in 1 out of 5 patients (20%). In a cohort of unrelated pairs on CsA/MTX prophylaxis combined with horse anti-lymphocyte globuline (ALG) correlated the GvHD prediction with GvHD clinical outcome (100%, p = 0.003). In all patients transplanted with the grafts from their haploidentical relatives the occurrence of severe GvHD was predicted. CONCLUSION: Skin explant assay helps identify pretransplant patients at higher risk of severe acute GvHD. GvHD predictive results enable the transplantation team to individualise GvHD prophylaxis and to optimise selection of the donor.

Acute Disease↗
PubMed2001

[The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon].

BACKGROUND: Although many studies have been implemented in order to determine the pre-treatment factors that can predict patients' response to interferon (IFN) therapy, it is not yet clear whether characteristic histologic abnormalities in chronic hepatitis C can predict such response. AIMS: The aim of this study were to evaluate, in patients with chronic hepatitis C, (i) the predictive value of histologic lesions for the sustained response to IFN therapy (ii) other pre-treatment (epidemiological and analytical) factors known to be predictive of response. PATIENTS AND METHODS: Sustained response was retrospectively evaluated in two hundred one patients who had been treated with IFN for at least 3 months in four different hospitals from Castilla y León. The following histological parameters were studied as predictors of response: histological diagnosis, Knodell index, grading and stage, characteristic histologic lesions of HCV infection. Epidemiological and analytical parameters were also evaluated. RESULTS: The rate of patient's sustained response to IFN treatment was 16%. None of the histological parameters was useful to predict this response. By univariate analysis, age, disease evolution time, mode of viral transmission, GGT, ferritin and viral genotype were associated with a sustained response. The most powerful, and only independent predictive factor, however, was the genotype (the response odds ratio was 8.6). CONCLUSIONS: Histological parameters do not predict the response to IFN treatment. Other factors (mainly the viral genotype) are associated with a higher response percentage, although no one is useful to decide which patients are going to respond.

Adult↗
PubMed2000

Early prediction in acute pancreatitis: the contribution of amylase and lipase levels in peritoneal fluid.

CONTEXT: Predicting the severity of acute pancreatitis early in the course of the disease is still difficult. OBJECTIVE: The value of amylase and lipase levels in serum and peritoneal fluid might be of value in predicting the course of acute pancreatitis. DESIGN: Prospective study. PATIENTS: One-hundred and sixty-seven patients with acute pancreatitis as confirmed by computed tomography scan within 24 hours of admission were studied. MAIN OUTCOME MEASURES: Each patient was given an enzymatic score which reflected the predominance of serum or peritoneal levels of amylase and/or lipase. Enzymatic score was 0 if neither enzyme was predominant in the peritoneal fluid, 1 if amylase or lipase alone were predominant and 2 if both enzymes were predominant. The predictive value of the enzymatic score or computed tomography scan for a severe attack was determined. RESULTS: One-hundred and thirty-three attacks were graded as mild (79.6%) and 34 were considered as severe (20.4%). The frequency of severe acute pancreatitis significantly increased as the enzymatic score increased (5.4%, 12.5%, and 31.7% in 0, 1, and 2 enzymatic score patients, respectively; P<0.001). An enzymatic score greater than 0 predicted a severe outcome in 32 of 34 patients (sensitivity 94.1%, specificity 26.3%), whereas an enzymatic score of 2 predicted a severe attack in 26 of 34 patients (sensitivity 76.5%, specificity 57.9%). Edema on computed tomography scan was found in 97 of 129 mild attacks (specificity 75.2%) and necrosis in 25 of 33 severe attacks (sensitivity 75.8%), whereas all patients with severe attacks exhibited extrapancreatic acute fluid collection (sensitivity 100%, specificity 34.9%). CONCLUSIONS: Peritoneal dialysis is less predictive and more cumbersome than a computed tomography scan in the early prediction of acute pancreatitis.

Acute Disease↗
PubMedDate not supplied

Prediction of mandibular growth in Japanese children age 4 to 9 years.

PURPOSE: The purpose of this study was to propose mathematical models for predicting mandibular growth direction and amount in children with normal skeletal relationship from 4 to 9 years of age using the craniofacial characteristics found on the head films. METHODS: Lateral cephalograms of 27 Japanese children with normal occlusion at 4 (T1) and 9 (T2) years of age were traced and measured. Fifteen linear and angular measurements were performed. The angle NSGn and the distance S-Gn were used to represent the growth direction of the mandible and its growth amount, respectively. The data were analyzed by multiple linear regression analysis. RESULTS: The multiple regression analysis revealed 2 models for the mandibular growth prediction. The equation (model) for the mandibular growth direction is YD=-39.844+1.206 X1 +0.333 X2, where YD is the predicted value of the angle NSGn at T2. X1 is the value of the angle NSGn at T1 and X2 is the value of the angle SNB at T1 (R2=0.719, P<0.05). The equation for the mandibular growth amount is YA=99.052+0.782 X3-0.517 X4, where YA is the predicted value of the distance S-Gn at T2. X3 is the distance S-Gn at T1 andX4is the angle NSAr at T1 (R2=0.610, P< 0.05). CONCLUSIONS: The direction of the mandibular growth at 9 years of age can be predicted by 72% with the regression equation using the angles NSGn and SNB at 4 years of age. The amount of growth of the mandible can be predicted by 62% by using the distance S-Gn and the angle NSAr at 4 years old. The model for the growth amount provides a relatively lower predictive value than that of the growth direction.

Cephalometry↗
PubMed2002

[The prediction of pulmonary artery systolic pressure and vascular resistance by using tricuspid annular tissue Doppler imaging].

OBJECTIVE: This study was planned to determine pulmonary artery pressure and pulmonary vascular resistance by using tricuspid annular tissue Doppler imaging in patients with valvular and congenital heart disease. METHODS: The study group consisted of patients with valvular and congenital heart disease (n=28). Healthy volunteers (n=10) were included into the control group. Systolic (Sm), early (Em) and late diastolic velocity (Am), isovolumetric relaxation time (IVRTm) were measured from tricuspid annulus by tissue Doppler imaging. Patients of the study group underwent cardiac catheterization and right atrial mean pressure, right ventricle and pulmonary artery systolic- diastolic pressures (PASP and PADP), and pulmonary capillary wedge pressure (PVR, dyn/s/cm-5) were obtained. RESULTS: There were no significant differences between the groups according to age, gender, left and right ventricle ejection fraction, tricuspid annular Sm, Em and Am velocities and velocity- time integrales (p>0.05). IVRTm was increased in the study group (73.75+/-3.1 ms, p<0.05). For Sm velocities of 11 cm/sec, prediction of PASP >/=30 mmHg was calculated with specificity of 57%, sensitivity of 93%, positive predictive value of 88%, negative predictive value of 68% and accuracy of 75%. For Sm velocities - time integral value of 2.7 cm/sec, prediction of the PVR >/=65 dyn/s/cm-5 was estimated with sensitivity of 88%, specificity of 36%, positive predictive value of 68%, negative predictive value of 66% and accuracy of 68 %. CONCLUSION: Pulmonary artery pressure and pulmonary vascular resistance in patients with valvular and congenital heart disease can be predicted by using the Sm wave parameters detected with tricuspid annular tissue Doppler imaging.

Echocardiography, Doppler, Pulsed↗
PubMed2001

[Population pharmacokinetic model for gentamycin and its predictive value].

AIM: To construct a population pharmacokinetic model to describe gentamycin concentrations in serum in newborn infants and to validate the predictive ability of this model. METHODS: Data used in this study were obtained from 30 neonates with 80 serum samples. A one-compartment open model was used to describe the kinetics of gentamycin after intravenous infusion. Following Sheiner's idea of population pharmacokinetics, a programs to estimate population parameter and individual parameter of gentamycin was made. The target function minimality was obtained from Monte Carlo algorithm. The predictive ability of the developed model was evaluated by computing precision and accuracy of serum concentration predicted using the parameter estimates. RESULTS: Fitted population pharmacokinetic parameters (mean +/- standard deviation) were as follows: Ke: 0.220 +/- 0.022 h-1, Vd: 0.51 +/- 0.06 L.kg-1, Cl: 112 +/- 10 mL.h-1.kg-1. For the population analysis sample and the predictive sample, predicted and observed concentrations were all close with correlation coefficient 0.920 and 0.946, respectively. Mean prediction error (ME) and root mean squared error (RMSE) were 0.001 mg.L-1 and 0.84 mg.L-1 for the predictive sample, respectively. CONCLUSION: Observed gentamycin serum concentrations were explained very well by this model. We propose the use of this population pharmacokinetic model to optimize gentamycin clinical therapies in our institution and others with similar patient population characteristics.

Anti-Bacterial Agents↗
PubMed2003

Ultrasonic prediction of term birth weight in Hispanic women. Accuracy in an outpatient clinic.

OBJECTIVE: To investigate the accuracy of ultrasonic fetal biometric algorithms for estimating term fetal weight. STUDY DESIGN: Ultrasonographic fetal biometric assessments were made in 74 Hispanic women who delivered at 37-42 weeks of gestation. Measurements were taken of the fetal biparietal diameter, head circumference, abdominal circumference and femur length. Twenty-seven standard fetal biometric algorithms were assessed for their accuracy in predicting fetal weight. Results were compared to those obtained by merely guessing the mean term birth weight in each case. RESULTS: The correlation between ultrasonically predicted and actual birth weights ranged from 0.52 to 0.79. The different ultrasonic algorithms estimated fetal weight to within +/- 8.6-15.0% (+/- 295-520 g) of actual birth weight as compared with +/- 13.6% (+/- 449 g) for guessing the mean birth weight in each case (mean +/- SD). The mean absolute prediction errors for 17 of the ultrasonic equations (63%) were superior to those obtained by guessing the mean birth weight by 3.2-5.0% (96-154 g) (P < .05). Fourteen algorithms (52%) were more accurate for predicting fetal weight to within +/- 15%, and 20 algorithms (74%) were more accurate for predicting fetal weight to within +/- 10% of actual birth weight than simply guessing the mean birth weight (P < .05). Ten ultrasonic equations (37%) showed significant utility for predicting fetal weight > 4,000 g (likelihood ratio > 5.0). CONCLUSION: Term fetal weight predictions using the majority of sonographic fetal biometric equations are more accurate, by up to 154 g and 5%, than simply guessing the population-specific mean birth weight.

Adult↗
PubMed2002

The application of a new predictive technique for lossless compression of medical images.

A new predictive technique for lossless compression is applied to CT and MR images in order to achieve high compression in the lossless mode. To accomplish this, a prediction value was obtained by assuming the horizontal and vertical components of each pixel. Wide and narrow predictive coding modes were adaptively selected to achieve an accurate prediction. The performance of the predictive technique was compared with the performance of four representative compression techniques in the lossless mode, using different types of CT and MR image sets with different bit rates. Overall, the proposed predictive technique yielded the best compression, particularly with the lower bit-rate images tested. While the compression results are largely dependent on the images used, the results confirm the strong potential of the proposed predictive technique as a strategy for obtaining high lossless-compression in medical images.

Humans↗
PubMedDate not supplied

Comparison of heated-probe laser Doppler and transcutaneous oxygen measurements for predicting outcome of ischemic wounds.

Transcutaneous oxygen (TcPO2) measurement has proven to be an accurate means of predicting healing of ischemic wounds. This study compares the ability of TcPO2 and laser Doppler, modified by the addition of a heated probe (LDHP), to assess wound outcome. TcPO2 and LDHP measurements were made at the same site for 80 wounds, which consisted of 51 amputations (25 above knee, 6 below knee, 20 forefoot) and 29 ulcerations. Healing was defined as complete wound closure. Failure to heal was defined by the necessity for proximal amputation in 22 wounds (6 amputations, 16 ulcers). Outcome criteria were chosen to maximize accuracy and either positive or negative predictive values. Criteria with the greatest accuracy and positive predictive value for wound healing were > or = 11 mmHg for TcPO2 and > or = 50 mv for LDHP range. Criteria with the most appropriate accuracy and negative predictive value for wound failure were < 5 mmHg for TcPO2 and < 35 mv LDHP range. All wounds whose LDHP range was < 35 mv failed to heal, whereas some wounds with a TcPO2 of 0-1 mmHg healed successfully. An absolute prediction of wound healing (100% specificity and negative predictive value) was offered when either LDHP range was > or = 125 mv or TcPO2 was > or = 33 mmHg, although accuracy of either measurement at this criteria was unacceptable for more general application. We conclude that TcPO2 or LDHP will assess wound outcome with similar overall accuracy, although each test may be better for predicting a specific outcome.

Aged↗
PubMed1992

The reliability of computerized cephalometric soft tissue prediction following bimaxillary anterior subapical osteotomy.

The accuracy of predicting the results of orthodontic-surgical treatment following bimaxillary anterior subapical setback osteotomy was analyzed retrospectively. Comparisons of pretreatment prediction tracings of the lateral cephalograms with the 6-month postsurgical cephalograms of 38 patients showed that there was no statistically significant difference between the actual and predicted dentoalveolar setback in both arches. The computer-generated soft tissue predictions were generally accurate, with the exception of the horizontal position of the lower lip, which was underestimated, and, to a lesser extent, the vertical position of the upper lip, which was also underestimated. Computerized cephalometric prediction following bimaxillary anterior subapical osteotomy is sufficiently accurate to be of value to be used routinely in treatment planning for the horizontal upper lip prediction, but some modifications are advisable to obtain a more accurate horizontal lower lip prediction.

Adult↗
PubMed2002

Early prediction of severe acute pancreatitis by urinary trypsinogen activation peptide.

OBJECTIVE: To investigate the value of urinary trypsinogen activation peptide (TAP) in the early prediction of severe acute pancreatitis and to compare it with acute physiology and chronic health evaluation II (APACHE II). METHODS: We assessed the predictive value of urinary TAP concentrations measured by a competitive enzyme-linked immunosorbent assay. Urine samples were collected for detecting TAP concentrations at admission, and 24, 48, and 72 h from 41 patients with acute pancreatitis (12 with severe disease, 29 with mild disease) who presented within 48 h the onset of symptoms and from 11 control patients, while APACHE II scores were recorded at 48 h after admission. RESULTS: The peak median urinary TAP concentration was seen at admission. The median urinary TAP concentration at admission for severe pancreatitis (95 nmol/L) was significantly higher than the median for patients with mild pancreatitis (20 nmol/L, P<0.005) and controls (15 nmol/L, P<0.005). TAP concentrations were significantly higher in patients with severe acute pancreatitis than the median in patients with mild pancreatitis (P<0.05) and controls (P<0.05) on days 2 to 3. The median APACHE II scores of severe patients were significantly different from those of mild patients (10.5 vs 6.0, P<0.01). The sensitivity, specificity, positive predictive, and negative predictive values of an admission urinary TAP>/=35 nmol/L for severe pancreatitis were 91.7%, 89.7%, 78.6% and 96.3%, whereas 48 h after admission the values for APACHE II scores (>/=9) were 75.0%, 72.7%, 52.9% and 87.5%. In prediction of disease severity, the urine TAP concentration was much better than APACHE II at 48 h. CONCLUSIONS: Urinary TAP obtained at the first 48 h of the onset of symptoms can predict severe acute pancreatitis. In prediction of disease severity, the urinary TAP is much better than APACHE II score.

APACHE↗
PubMed2004

Predicting recurrence and metastasis of stage III/Dukes' C colorectal cancer with lymph node metastasis.

This study was designed to compare the prediction of recurrence based on detection of occult neoplastic cells (ONCs) in lymph nodes or using specific criteria to identify patients at high risk of recurrence/metastasis among 105 patients with Dukes' C colorectal cancer. Prediction of recurrence based on the detection of ONCs had a sensitivity of 50.0% (22/44), specificity of 80.3% (49/61), and an accuracy of 65.2%. Prediction of recurrence based on positivity for at least 2 of the 3 high-risk criteria had a sensitivity of 54.5% (24/44), specificity of 83.6% (51/61), and an accuracy of 69.1%. Among the 34 patients with ONCs, prediction of recurrence based on positivity for all 3 high-risk criteria had a sensitivity of 27.3% (6/22), specificity of 91.7% (11/12), an accuracy of 59.5%, and a positive predictive value (PPV) of 85.7% (6/7). These results suggest that the predictive value of ONCs and the high-risk criteria was similar, and that recurrence is likely to occur in patients who fulfill < or =2 of the high-risk criteria. Accordingly, combined use of these parameters may be more effective for the early prediction of recurrence/metastasis to assist in the choice of postoperative systemic chemotherapy.

Colorectal Neoplasms↗
PubMedDate not supplied

Prediction of the hepatitis C viremia using immunoassay data and clinical expertise.

Detection of anti-hepatitis C virus (anti-HCV) antibodies may yield a high frequency of false-positive results in people at low risk. To date, no clinical rule had been developed to predict viremia in HCV-seropositive patients. Therefore, we aimed to generate a prediction rule on the basis of clinical and serologic data, which can be used in outpatient care. We selected 114 seropositive patients without antiviral treatment or hepatitis B coinfection. Subsequently we identified independent predictors of the hepatitis C viremia by logistic regression and selected the quantitative value of the screening test for anti-HCV antibodies with the best performance in detecting viremia. Then, we combined clinical and serologic data to generate different prediction rules. Ratio of immunoassay signal strength of the sample to cut-off (S/CO) >15 had accuracy, positive predictive value (PPV) and positive likelihood ratio (LR+) of 84%, 83%, and 3.7; respectively. The rule compounded of the antecedent of blood transfusion before 1993 and S/CO >15 performed the best in prediction of viremia in all patients, with accuracy, PPV and LR+ of 71%, 88%, and 5.6; respectively. In the group of asymptomatic patients this rule improved in efficacy of prediction, with accuracy, PPV and LR+ of 79%, 91% and 12.8; respectively. In conclusion, a clinical rule is better than S/CO alone in prediction of the hepatitis C viremia. In a patient that meet the rule the probability of having viremia is high, therefore, it can be indicated directly an assay for viral load instead of other supplemental tests, thus, saving time and economic resources.

Adolescent↗
PubMed2005

Predicting the development of jaws in patients with complete unilateral cleft of the lip and palate.

The main objective of this study was to find a predictive multivariate model of jaw development in patients with the most frequent cleft malformation, i.e. complete unilateral cleft lip and palate (UCLP). The prediction is urgently needed from the clinical aspect. It will be possible to detect early adversely developing patients upon whom intensive care and adequate orthodontic treatment could be devoted in good time. The study is based on a long-term cephalometric follow-up of lateral X-rays of 48 boys with UCLP during puberty. Using multivariate methods we investigated the relationship of 75 craniofacial characteristics of size, shape and position during the time interval from 10 to 15 years of age. As the prediction of the development of the jaws in patients with clefts is very complicated, we have attempted to find a reliable predictive system. Sagittal intermaxillary relations can be predicted most accurately in the investigated group by means of the angular dimension Ss-N-Sm (A-N-B angle). We suggest using in clinical practice trinomial equations, the coefficient of determination of which varies round 0.80, and thus the position of the variables can be explained with sufficient accuracy (the coefficient of determination 0.64 is considered in orthodontics a value of predictive significance). The proposed predictive technique was successfully tested in a group of 12 patients with the same diagnosis and therapy.

Adolescent↗
PubMed2006

Study of cyclosporine level at 2 hours after administration in preoperative kidney transplant recipients for prediction of postoperative optimal cyclosporine dose.

OBJECTIVE: Absorption profiling of cyclosporine is a current concept of drug monitoring. A single blood concentration measurement 2 hours after cyclosporine administration (C2) has been shown to be a good predictor of drug exposure and clinical outcome. The recommendation states that achieving the recommended target level of 1700 +/- 340 ng/ml within 3-5 days after renal transplantation is associated with a lower rate of acute rejection and nephrotoxicity. The high variation of pharmacokinetic profile and short limited time during early post-transplantation period make it hard to adjust the cyclosporine dose that can reach that target level on time. The present study was designed to be a method to predict the optimal pre-transplant CsA dose. MATERIAL AND METHOD: Eleven living-related kidney transplant recipients were recruited to receive cyclosporine and were monitored for C2 concentration during the 2 weeks before operation by the designed method. The pre-transplant empirical dose of 3.5 mg/kg/dose every 12 hours were assigned to all patients. The first predicted dose was estimated by using C2 concentration of 1,700 ng/mL. The first predicted dose was prescribed to the patients. The second predicted dose was estimated by using C2 concentration of the first predicted dose. All patients received the average of the first and the second predicted doses of cyclosporine within 12-24 hrs before transplantation and until the 3rd day after transplantation. RESULTS: Nine out of 11 patients (81.81%) reached the target C2 level on the 3rd day after transplantation without any serious side effect and complications. The most common side effect was nausea and a flushing sensation that usually abated with a later dose after transplantation. CONCLUSION: The early postoperative optimal cyclosporine dose can be effectively predicted by pre-transplant C2 measurement as conducted in the present study.

Absorption↗