血浆内皮素配合描记动态脑电图在儿童晕厥诊断中应用的临床意义

摘要 目的：探究血浆内皮素配合描记动态脑电图在儿童晕厥诊断中的应用意义。方法：选择2017年1月至2020年1月于我院接受治疗的83例存在晕厥风险儿童,采集其静脉血样进行血浆内皮素水平测定,并实施动态脑电图检测,而后以倾斜试验结果为金标准,分别分析单纯血浆内皮素、单纯动态脑电图以及血浆内皮素+动态脑电图对晕厥的诊断应用意义。结果：（1）83例入组儿童中阳性为68例,阴性为15例,血浆内皮素检测阳性51例,阴性32例,一致性为77.11 %,灵敏度为73.53 %,特异度为93.33 %,阳性预测值为98.04 %, 阴性预测值为43.75 %;（2）动态脑电图诊断一致性为78.31 %,灵敏度为80.88 %,特异度为66.67 %,阳性预测值为91.67 %,阴性预测值为43.48 %;（3）联合检测诊断一致性为93.98 %,灵敏度为94.12 %,特异度为93.33 %,阳性预测值为98.46 %,阴性预测值为77.78 %;（4）检测方式差异性比较发现,联合检测在一致性、灵敏度、阴性预测值方面明显优于血浆内皮素和动态脑电图检测,在特异度方面优于动态脑电图检测（P<0.05）。结论：血浆内皮素联合描记动态脑电图对儿童晕厥具有较好的诊断辅助价值,能够显著提高诊断的一致性、灵敏度和特异度。     

Flash双源CT冠脉成像联合心肌灌注显像对猪急性心肌梗死模型的诊断价值

目的:探讨Flash双源CT(DSCT)冠脉成像联合心肌灌注显像对猪急性心肌梗死模型的诊断价值。方法:使用明胶海绵栓塞法建立5只猪急性心肌梗死模型,使用DSCT冠脉成像联合心肌灌注显像进行"一站式"扫描得到冠脉图像和心肌灌注图像,并与冠脉造影和病理染色相比较。结果:DSCT得到的心肌灌注图像结果与病理染色相比较,敏感性为93%,特异性为91%,阴性预测值为96%,阳性预测值为84%,Kappa值为0.82;DSCT得到的冠脉图像与冠脉造影相比较,敏感性为93%,特异性为81%,阴性预测值为95%,阳性预测值为75%,Kappa值为0.71。结论:DSCT冠脉成像联合心肌灌注显像与组织病理学及冠脉造影一致性较好,可以用于对猪急性心肌梗死模型的诊断。     

冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠状动脉硬化性心脏病的价值研究

摘要 目的：探讨冠状动脉CTA结合动态心电图夜间ST段趋势图对冠状动脉硬化性心脏病（冠心病）的诊断价值。方法：回顾性分析2022年1月-2023年2月在我院疑似冠心病的患者104例,所有患者均行冠状动脉造影、冠状动脉CTA、动态心电图及临床相关实验室检查。以冠状动脉造影结果作为诊断冠心病的金标准,分析比较冠状动脉CTA、动态心电图夜间ST段趋势图及两者联合诊断冠心病的诊断效能和一致性。结果：104例疑似冠心病的患者确诊93例（89.42%）。冠状动脉CTA诊断冠心病的敏感性为90.32%,特异性为72.73%,阳性预测值为96.55%,阴性预测值为47.06%,准确率为88.46%,与冠状动脉造影的Kappa值为0.813,一致性好。动态心电图夜间ST段趋势图诊断冠心病的敏感性为84.95%,特异性为63.64%,阳性预测值为95.18%,阴性预测值为33.33%,准确率为82.69%,与冠状动脉造影的Kappa值为0.724,一致性较好。有夜间ST段动态改变的冠心病检出率（84.95%,79/93）明显高于无夜间ST段动态改变的冠心病检出率（15.05%,14/93）,差异有统计学意义（P＜0.001）。冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠心病的敏感性为96.77%,特异性为90.91%,阳性预测值为98.90%,阴性预测值为76.92%,准确率为96.15%,与冠状动脉造影的Kappa值为0.923,一致性好。结论：冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠心病的临床价值优于冠状动脉CTA或动态心电图夜间ST段趋势图单独检查。     

宫颈特殊染色法、液基薄层细胞学及人乳头瘤病毒检测对宫颈癌前病变的应用价值分析

目的:探讨宫颈特殊染色法(FRD)、液基薄层细胞学(TCT)及人乳头瘤病毒(HPV)检测对宫颈癌前病变筛查的应用价值。方法:选取2015年1月～2018年1月于我院行宫颈癌筛查的1794例妇女作为研究对象,所有研究对象均接受FRD、TCT、HPV检测,以经阴道镜取样活检结果为阳性标准,对比分析三种不同检测方法以及联合检测的诊断效能。结果:病理科活检检出阳性111例,检出率为6.19%;FDR检测检出阳性114例,检出率为6.35%,漏诊率为16.22%;TCT检测检出阳性115例,检出率为6.41%,漏诊率为19.82%;HPV检测检出阳性108例,检出率为6.02%,漏诊率为19.82%;FRD检测与TCT、HPV检测的检出率比较差异无统计学意义(P0.05)。FRD检测敏感度为83.78%,特异度为98.75%,阳性预测值为81.58%,阴性预测值为98.93%;TCT检测敏感度为80.18%,特异度为98.46%,阳性预测值为77.39%,阴性预测值为98.69%;HPV检测敏感度为80.18%,特异度为98.87%,阳性预测值为82.41%,阴性预测值为98.70%;FRD、TCT、HPV联合检测敏感度为93.69%,特异度为99.52%,阳性预测值为92.86%,阴性预测值为99.58%;FRD、TCT、HPV联合检测与FRD、TCT、HPV单独检测的敏感度、阳性预测值比较差异具有统计学意义(P0.05)。结论:FRD、TCT、HPV检测对宫颈癌前病变的诊断效能相当,而FRD、TCT、HPV联合检测的诊断效能优于各方法单独检测。     

血浆(1,3)-β-D-葡聚糖对深部真菌感染诊断的临床意义

目的研究血浆中(1,3)-β-D-葡聚糖检测和真菌培养对诊断深部真菌感染的临床应用价值。方法对我院2009年8月~2010年7月长期使用广谱抗菌药物、免疫抑制剂以及皮质类固醇激素等,且临床出现感染症状的1 868例住院患者,在其抽静脉血做(1,3)-β-D-葡聚糖检测的同时留取血液或痰、中段尿、脓等分泌物标本做真菌培养。通过回顾性调查,了解使用抗真菌药后患者临床症状是否缓解作为临床诊断标准,并以此为标准比较两种检测方法的差异。结果 1 868例患者中使用抗真菌药物后症状缓解757例,使用抗真菌药物后症状未缓解和临床未使用抗真菌药物症状缓解1 082例,无临床资料29例(剔除);实际有效病例1 839例。其中以20 pg/mL为临界值时(1,3)-β-D-葡聚糖含量检测阳性778例,阴性1 061例,以50 pg/mL为临界值时(1,3)-β-D-葡聚糖含量检测阳性623例,阴性1 216例;真菌培养阳性457例,阴性1 382例。血浆(1,3)-β-D-葡聚糖检测试验分别以20 pg/mL和50 pg/mL为临界值时,均得到较好的敏感度(分别为89.3%,74.9%)和特异度(分别为90.6%,94.8%),阳性预测值(86.9%和91.0%)和阴性预测值(92.4%和84.4%)均较高,无显著性差别(P>0.05);真菌培养的敏感度(49.0%)较低但特异度较高(92.1%)阳性预测值和阴性预测值分别为81.2%和72.1%;两种方法联合检测后敏感度提高至93.0%,特异度为88.9%。结论 G试验的方法检测血浆(1,3)-β-D-葡聚糖较传统的真菌分离、培养与鉴定方法简便,快速,阳性率高,但有时发生假阳性。传统的真菌培养方法虽敏感性低,但特异性高,建议临床在诊断深部真菌感染时,同时行血浆(1,3)-β-D-葡聚糖检测及真菌镜检和培养等检查以提高侵袭性真菌感染诊断的敏感性和特异性。     

Transrectal sonography in prostate cancer detection--our 25 years experience of implementation

Prostate cancer is a leading public health problem of male population in developed countries. Gold standard for prostate cancer diagnosis is true cut biopsy guided by transrectal ultrasound. Aim of this study was to determine sensitivity, specificity, accuracy, positive and negative predictive value of transrectal sonography (TRUS) in prostate cancer detection. The analysis was made for two time periods, before and after routine implementation of prostate specific antigen (PSA) in prostate cancer diagnostics. From 1984 to 1993 TRUS guided prostate biopsy was performed in 564, and from 1994 to 2008 in 5678 patients. In the second period PSA was routinely used in prostate cancer diagnostics. In the first period by TRUS we have made an exact diagnosis of prostate cancer in 18.97% of patients what was confirmed by biopsy. 4.61% ware false positive and 11.34% ware false negative. In the second period prostate cancer was recognized in 30.34% of patients, confirmed by biopsy. False positive cases ware 6.11% and false negative 29.31%. Sensitivity of transrectal sonography in the first period was 62.57%, specificity 94.2%, accuracy 86.2%, positive predictive value 80.45% and negative predictive value 87.72%. In the second period sensitivity was 50.87%, specificity 91.93%, accuracy 73.84%, positive predictive value 83.24% and negative predictive value 70.39%. Based on our experience we can conclude that prostate cancer is mostly found in the peripheral zone. Smaller tumors are hypoechoic and bigger tumors are hyperechoic. Prostate cancer lesions are impossible to differentiate from chronic prostatitis only by TRUS. Implementation of PSA has significantly decrease sensitivity, accuracy and negative predictive value of TRUS in prostate cancer detection. TRUS guided true cut biopsy is a gold standard in prostate cancer diagnostics.     

弹性成像定量分析联合硬环征在甲状腺良恶性结节鉴别诊断中的应用价值分析

目的:探究弹性定量分析联合硬环征在甲状腺良恶性结节鉴别诊断中的应用价值。方法:回顾性分析2018年1月至2018年9月于我院行手术或穿刺活检病理证实的121例甲状腺结节患者临床资料,所有患者均行弹性成像定量分析以及剪切波弹性成像(SWE)分析,计算弹性成像定量分析、SWE分析以及联合检测,以病理检查结果为金标准(良性78个,恶性43个),对甲状腺良恶性结节诊断的敏感性、特异度、准确性、阳性预测值以及阴性预测值,分别绘制弹性成像定量分析、SWE以及联合检测的受试者工作特征(ROC)曲线,并比较ROC曲线下面积。结果:(1)弹性定量分析诊断良性结节87个,恶性34个,敏感性73.08%,特异度30.23%,阳性预测值65.51%,阴性预测值38.24%;(2)SWE分析良性结节76个,恶性结节45个,敏感性64.10%,特异度39.53%,阳性预测值65.79%,阴性预测值37.78%;(3)联合检测良性结节73个,恶性结节48个,敏感性89.74%,特异度93.02%,阳性预测值95.89%,阴性预测值83.33%;(4)联合检测敏感性、特异度、阳性预测值及阴性预测值均高于单独检测(P 0.05);(5)弹性成像定量分析、SWE及联合检测ROC曲线下面积分别为0.843、0.819、0.940,联合检测准确率高于单一检测(P0.05);SWE分析甲状腺良恶性结节的弹性模量值Emean、Emin、Emax、Esd、Emean-p及Emean-m均显著大于恶性结节(P 0.05)。结论:弹性成像定量分析联合硬环征检测能够显著提高对甲状腺结节良恶性病变的诊断敏感性及特异度,具有较高的临床应用价值。     

侵袭性真菌深部感染的早期实验室诊断

目的探讨假丝酵母菌甘露聚糖抗原和假丝酵母菌IgG/IgM抗体、曲霉半乳甘露聚糖抗原和烟曲霉IgG抗体在侵袭性真菌病早期临床诊断中的应用价值。方法收集已确诊侵袭性假丝酵母菌病患者18例,侵袭性烟曲霉病患者6例,单纯细菌感染患者20例,浅部真菌感染患者20例,健康体检者(正常对照组)20例,通过酶联免疫吸附法(ELISA)检测患者血清甘露聚糖和假丝酵母菌IgG/IgM抗体以及曲霉半乳甘露聚糖抗原和烟曲霉IgG抗体浓度,计算各指标的灵敏度、特异度、阳性预测值、阴性预测值和受试者工作特征(ROC)曲线下面积。结果甘露聚糖抗原和假丝酵母菌IgG/IgM抗体联合测定的敏感度为66.7%,特异度为83.3%,阴性预测值为100.0%,阳性预测值为85.7%,ROC曲线下面积为0.992(95%CI:0.974~1.000);半乳甘露聚糖抗原和烟曲霉IgG抗体联合测定的敏感度为66.7%,特异度为95.0%,阴性预测值为98.2%,阳性预测值为100.0%,ROC曲线下面积为0.978(95%CI:0.934~1.000)。结论甘露聚糖抗原和假丝酵母菌IgG/IgM抗体、半乳甘露聚糖抗原和烟曲霉IgG抗体联合检测对深部真菌感染的早期诊断具有重要意义。     

多种无创检查组合在冠心病诊断中的价值

目的：评价多种无创辅助检查组合对冠状动脉粥样硬化性心脏病（冠心病）辅助诊断价值,筛选有效的冠心病确诊和排除指标,初步确定优化的冠心病早期诊断策略。方法：回顾性分析6419例冠心病患者多项无创辅助检查结果（包括静息心电图、24小时动态心电图、负荷心电图、负荷核素心肌显像、16或64排CT冠状动脉成像）,以冠状动脉造影阳性（至少一支主要冠状动脉或其主要分支的内径有≥50％的狭窄）为金标准,观察各种无创辅助检查组合对冠心病诊断的特异性、敏感性、误诊率、漏诊率、阳性预测值和阴性预测值。结果：多项无创辅助检查组合在冠心病的诊断中敏感性56．02-87．43％,特异36．13-87．61％,阳性预测值58．83．97．16％,阴性预测值30．21．73．36％,非介入手段中,敏感性和阴性预测值以动态心电图联合核素心肌灌注显像组最高,特异性和阳性预测值以动态心电图联合冠脉CT成像组最高。结论：辅助检查组合可作为无创性诊断、评价冠心病的重要方法,动态心电图可作为各级别医院冠心病筛查的基本及重要手段。     

全身运动质量评估联合颅脑超声对脑损伤高危儿运动发育结局的预测价值

摘要 目的：研究全身运动（GMs）质量评估和颅脑超声（CUS）在脑损伤高危儿运动发育结局中的预测价值。方法：选取2019年10月至2021年6月入住徐州医科大学附属医院新生儿重症监护室（NICU）具有脑损伤高危因素的早产儿605例,建立随访档案。入院24h、3d、7d内各做一次CUS检查,异常者每周复查1次直至出院,记录最异常结果。矫正胎龄36～40周行扭动运动GMs质量评估,矫正3～6月龄行不安运动GMs质量评估。矫正12月龄通过Gesell发育量表和小儿脑瘫诊断分型标准明确运动发育结局,分析GMs质量评估、CUS对不良运动发育结局和脑瘫的预测效度。结果：最终获得完整随访资料的脑损伤高危儿为536例,随访至12月龄的运动发育结局为运动发育正常424例,运动发育迟缓105例,脑瘫7例。扭动运动GMs质量评估对运动发育结局预测的敏感性为56.25%、特异性为82.78%;不安运动GMs质量评估对运动发育结局预测的敏感性为73.21%、特异性为98.82%;CUS对运动发育结局预测的敏感性为54.46%、特异性为94.34%。扭动运动GMs质量评估联合CUS对运动发育结局预测的敏感性为81.25%、特异性为81.13%;不安运动GMs质量评估联合CUS对运动发育结局预测的敏感性为84.82%、特异性为96.46%。GMs质量评估和CUS对脑瘫预测的敏感性和阴性预测值均为100.00%;联合应用GMs质量评估和CUS可明显提高对不良运动结局的敏感性及阳性预测值。结论：CUS对脑损伤高危儿的不良运动发育结局尤其是脑瘫具有良好的预测价值,GMs质量评估联合CUS可明显提升对脑损伤高危儿不良运动发育结局的早期预测价值。     

HPV16感染检测和TCT筛查联用的临床应用

目的评估人乳头瘤病毒(Human papillomavirus,HPV)16感染和液基薄层细胞学(thinprep cytologic test,TCT)筛查在预测宫颈病变中的临床价值。方法以门诊537例高危型HPV感染疑似宫颈病变女性为对象,进行HPV16感染分析、液基薄层细胞学和阴道镜病理检查,以病理活检为金标准,比较HPV16感染筛查方法、TCT筛查方法以及二者联用在筛查中的敏感度、特异度等指标,判断其临床应用价值。结果 HPV16感染筛查方法的敏感度为62.9%,特异度为83.5%,阳性预测值为53.4%,阴性预测值为88.2%;TCT筛查方法的敏感度为41.2%,特异度为92.7%,阳性预测值为62.9%,阴性预测值为84.0%;二者联合筛查,以HPV16感染或TCT异常为阳性,敏感度为84.7%,特异度为75.8%,阳性预测值为51.2%,阴性预测值为94.3%。结论 HPV16感染联合TCT异常筛查可以提高筛查的灵敏度,特异度也在可接受范围内,可以作为宫颈防癌初筛方法。     

Detection of methicillin-resistant <Emphasis Type="BoldItalic">Staphylococcus aureus</Emphasis> (MRSA) from nasal samples by multiplex real-time PCR based on dual priming AT-rich primers

In this study, we reported on the design of a multiplex real-time PCR assay based on SYBR Green I, incorporating dual priming adenine-thymine (AT)-rich primers for direct detection of MRSA from nasal samples. The multiplex real-time polymerase chain reaction (RT-PCR) assay reported in this study is based on SYBR Green I with incorporation of six dual priming AT-rich primers designed from the SCCmec/orf junction. A string (4–6 bp) of low-melting bases, such as adenine and thymine, was incorporated into the primers, which virtually divided a single primer in two functional regions, thus decreasing non-specific PCR products. The analytical sensitivity and specificity of the RT-PCR assay was determined with genomic DNA of reference strains (MRSA, MSSA, and MRCoNS). RT-PCR assay was performed for analysis of 72 nasal swab specimens, and the results were confirmed by use of a culture method. Furthermore, the results of RT-PCR were compared with LightCycler MRSA advance test. The multiplex RT-PCR assay reproducibly detected a minimum of 1 pg genomic DNA (31.5 copy of genome) of MRSA reference strains and clinical isolates, with a specific melting peak at 83.5 ± 1.5°C, and neither fluorescence nor a melting peak was detected in non-target isolates. The concordance rate between RT-PCR assay and culture method was 87.5% with Cohen's kappa value (κ) 0.75, which showed good agreement between the two assays. The sensitivity, specificity, positive predictive value, and negative predictive value of the assay were 93.5%, 82.9%, 80.5%, and 94.4%, respectively. In a comparative study for the detection of 72 nasal samples, the sensitivity, specificity, positive predictive value, and negative predictive value of the multiplex RT-PCR assay with respect to LightCycler MRSA advance test was 84.2%, 88.2%, 89%, and, 83.3%, respectively. The results of RT-PCR assay demonstrated high specificity (88.2%) and positive predictive value (89%) for the direct detection of MRSA from nasal samples.     

冠状动脉CT造影对冠心病的临床诊断价值研究

目的：探讨研究冠状动脉CT造影检查对冠心病的临床诊断价值。方法：收集我院2012年1月至2013年10月共计70例临床怀疑为冠心病的患者,对这些患者分别进行冠状动脉CT造影检查和数字减影冠状动脉造影（DSA）检查,记录这两项检查所得结果及数据,以检查数据为基础对冠状动脉CT造影和数字减影冠状动脉造影检查的临床实验效果进行对比研究。结果：70例病人均可顺利完成以上两种检查,按照数字减影冠状动脉造影检查的标准,冠状动脉CT造影的敏感度为92.2%,特异度为97.4%、阳性预测率为90.5%、阴性预测率98%。结论：相对于数字减影冠状动脉造影检查,冠状动脉CT造影检查是一种更加安全、可靠、无创且更具临床指导意义的检测技术,因此可以推荐作为冠心病诊断的首选方法。     

冠状动脉CT造影对冠心病的临床诊断价值研究

目的:探讨研究冠状动脉CT造影检查对冠心病的临床诊断价值。方法:收集我院2012年1月至2013年10月共计70例临床怀疑为冠心病的患者,对这些患者分别进行冠状动脉CT造影检查和数字减影冠状动脉造影(DSA)检查,记录这两项检查所得结果及数据,以检查数据为基础对冠状动脉CT造影和数字减影冠状动脉造影检查的临床实验效果进行对比研究。结果:70例病人均可顺利完成以上两种检查,按照数字减影冠状动脉造影检查的标准,冠状动脉CT造影的敏感度为92.2%,特异度为97.4%、阳性预测率为90.5%、阴性预测率98%。结论:相对于数字减影冠状动脉造影检查,冠状动脉CT造影检查是一种更加安全、可靠、无创且更具临床指导意义的检测技术,因此可以推荐作为冠心病诊断的首选方法。     

64层螺旋CT脑血管造影在颅内动脉瘤诊断中的应用

目的:探讨64层螺旋CT血管造影(CTA)对颅内动脉瘤的诊断价值。方法:回顾性分析54例临床怀疑为颅内动脉瘤,并同时行64层CTA和DSA检查的病例,其中47例疑诊动脉瘤患者行动脉瘤夹闭手术,将MSCTA,DSA与手术结果对照。结果:54患者中经MSCTA检出57个动脉瘤,DSA检出55个动脉瘤,另7例MSCTA和DSA均未检出动脉瘤,余47例接受手术并检出58个动脉瘤。64层CTA发现动脉瘤的敏感性为96.6%,特异性为87.5%,准确性为96.5%,阳性预测值为98.2,阴性预测值为77.7。MIP和VR技术对动脉瘤的形态、分支血管、血栓和钙化方面的显示优于DSA。结论:64层CTA诊断颅内动脉瘤具有较好的异性、敏感性及三维显示能力,具有较高的临床应用价值。。     

CTCA for detection of significant coronary artery disease in routine TAVI work-up

Transcatheter aortic valve implantation (TAVI) has evolved to standard treatment of severe aortic stenosis in patients with an intermediate to high surgical risk. Computed tomography coronary angiography (CTCA) could partially replace invasive coronary angiography to diagnose significant coronary artery disease in the work-up for TAVI. A literature search was performed in MEDLINE and EMBASE for papers comparing CTCA and coronary angiography in TAVI candidates. The primary endpoint was the diagnostic accuracy of CTCA, compared to coronary angiography, for detection of significant (>50% diameter stenosis) coronary artery disease, measured as sensitivity, specificity, positive—(PPV) and negative predictive value (NPV). Seven studies were included, with a cumulative sample size of 1,275 patients. The patient-based pooled sensitivity, specificity, PPV and NPV were 95, 65, 71 and 94% respectively. Quality assessment revealed excellent and good quality in terms of applicability and risk of bias respectively, with the main concern being patient selection. In conclusion, on the basis of a significance cut-off value of 50% diameter stenosis, CTCA provides acceptable diagnostic accuracy for the exclusion of coronary artery disease in patients referred for TAVI. Using the routinely performed preoperative computed tomography scans as a gatekeeper for coronary angiography could decrease additional coronary angiographies by 37% in this high-risk and fragile population.     

The pressure/volume relationship during dobutamine stress echocardiography in transplanted heart: comparison with quality of life and coronary anatomy

Background

Cardiac allograft vasculopathy (CAV) is a major late complication in cardiac transplant recipients and has a relevant impact on outcome of these patients. Aims of this study: to compare, in cardiac transplant recipients patients, the diagnostic value of pressure/volume relationship (ESPVR) during dobutamine stress echocardiography (DSE) for coronary artery disease, assessed by Multislice Computed Tomography (MSCT), and by coronary angiography (CA). We also analyzed any possible relationship between ESPVR and the Health Related Quality of Life of the patients (HRQoL), evaluated by SF–36 questionnaire.

Methods

25 consecutive patients underwent DSE within 24 hours after MSCT coronary angiogram and then they underwent CA. The HRQoL questionnaire was administered to the patients in the settings of DSE. They were followed-up for 6 months.

Results

DSE has a sensitivity in detecting CAV of 67%, specificity of 95%, positive predictive value of 67% and negative predictive value of 95%; DSE with ESPVR has a sensitivity of 100%, specificity of 95%, positive predictive value of 75%, negative predictive value of 100%; MSCT has a sensitivity of 100%; specificity of 82%; positive predictive value of 43%; negative predictive value of 100%. Htx recipients with a flat-biphasic ESPVR, although asymptomatic, perceived a worst HRQoL compared with the up-sloping ESPVR population, and this is statistically significant for the general health (p 0.0004), the vitality (p 0.0013) and the mental health (p 0.021) SF-36 subscale.

Conclusions

Evaluation with DSE and ESPVR is accurate in the clinical control of heart transplant recipients reserving invasive evaluation only for patients with abnormal contractility indexes.     

Immunodiagnosis of Dengue Virus Infection Using Saliva

Keeping in view the complications and the case fatality associated with dengue virus, several serologic tests have been developed. However, the major drawback of these serologic tests is the need for a venous blood sample obtained by invasive venipuncture. As a noninvasive alternative, saliva provides a body fluid that contains antibodies of diagnostic importance. Hence, the detection of DEN-specific IgM and IgG antibodies in serum and saliva from 80 patients was compared. Salivary IgM antibodies were detected in 100% of the serum IgM-positive samples and in 30% of the serum samples that were negative for IgM antibodies. Salivary IgG antibodies were detected in 93.3% of the serum samples that were positive for anti-dengue IgG antibodies and in none of the serum IgG-negative cases. None of the specimens from the healthy controls showed the presence of IgM or IgG antibodies. The detection of both IgG and IgM antibodies in saliva correlated well with the serum IgG and IgM detection by the ELISA test (r = 0.6322 and r = 0.4227). Detection of salivary IgM antibodies by ELISA showed 100% sensitivity, 70% specificity, 90.9% positive predictive value, and 100% negative predictive value. The detection of IgG in saliva proved to be a promising tool as the sensitivity, specificity, positive predictive value, and negative predictive value were found out to be 93.3%, 100%, 100%, and 83.3%, respectively. Thus, from this study we conclude that the detection of DEN-specific salivary IgG and IgM antibodies are useful markers for dengue infection.     

Simultaneous single-tube PCR-based assay for the direct identification of the five most common meningococcal serogroups from clinical samples

This study presents a stepdown multiplex PCR assay for the simultaneous detection of the five most common Neisseria meningitidis serogroups (A, B, C, W-135 and Y) in 530 clinical samples obtained from 428 patients (271 blood and 259 cerebrospinal fluid). The sensitivity and the specificity was calculated to 100% [positive predictive value 100% (95%, CI 99.0-100%) and negative predictive value 100% (95% CI 99.0-100%)]. The overall effectiveness permits the rapid, accurate and inexpensive detection of the five most prevalent meningococcal serogroups in clinical samples. It is potentially a valuable tool for diagnosis and epidemiological monitoring of disease due to N. meningitidis.