Relative Positive Predictive Values Research Articles

Accuracy of molecular diagnostics in pemphigus and bullous pemphigoid: comparison of commercial and modified mosaic indirect immunofluorescence tests as well as enzyme-linked immunosorbent assays.

IntroductionPemphigus and bullous pemphigoid (BP) are identified by autoantibodies (abs) against desmoglein 1, 3 (DSG1/3) and BP180/BP230, respectively. A novel mosaic to indirect immunofluorescence (IIF) using purified BP180 recombinant proteins spotted on slide and transfected cells expressing BP230, DSG1, DSG3 is available. The commercial (IgG detection) and modified (IgG4 detection) mosaic for indirect immunofluorescence (IIFc – IIF commercial, IIFm – IIF modified) and IgG ELISAs were evaluated in pemphigus and bullous pemphigoid (BP) molecular diagnostics.AimTo compare diagnostic accuracy of commercial (IgG detection) and modified (IgG4 detection) mosaic IIF assay and to examine the diagnostic value of ELISAs in relation to mosaic IIF in routine laboratory diagnostics of pemphigus and BP.Material and methodsSera from 37 BP and 19 pemphigus patients were studied. Associations between tests were assessed using Fisher’s exact test.ResultsThere are associations between the positive/negative samples detected by IIFc with desmoglein1 (DSG1)/desmoglein3 (DSG3)/BP230 transfected cells and ELISAs and no association between anti-BP180 IgG detection by IIFc and ELISA. IIFm with DSG1 and DSG3 showed both 100% sensitivity and 100% and 78% specificity, respectively, and 100% and 83% positive predictive value in relation to IIFc. IIFm with BP230 had 87% specificity, 55% sensitivity, whereas IIFm with BP180 had a 100% sensitivity and 13% specificity in relation to IIFc.ConclusionsThe IIFc with DSG1/DSG3/BP230 transfected cells, excluding BP180 spots, is an alternative method to ELISA in pemphigus/BP diagnostics. IgG4 antibodies, both pathogenically and diagnostically important, are inconsistently detectable with IIFm.

Validity and Interrater Reliability of a Regional Mock Oral Board Examination

There have been decreasing pass rates recently on the American Board of Surgery Certifying Examination (ABSCE). General surgery residents from the University of Pittsburgh Medical Center, the West Penn Allegheny Health System, the Conemaugh Health System, and Mercy Hospital participate in a mock oral board examination, which is similar to the ABSCE. The aims of the study are to compare examinee performance on the mock oral boards with the ABSCE and to evaluate the interrater reliability of examiner pairs. In this retrospective study from 2003 to 2010, outcomes on the mock oral boards and the first attempt of the ABSCE for chief residents were compared for the 4 regional residency programs. Interrater reliability for examiner pairs was evaluated with agreement and kappa statistics. Nonparametric statistics were performed, with α = 0.05. A total of 32 of 38 (84.2%) chief residents passed the mock oral boards. The median score for each of the 3 rooms was 6 (clear pass). A total of 37 of 38 (97.4%) residents passed the ABSCE. The sensitivity of the mock oral boards was 83.8%, with a positive predictive value of 96.9%, and an accuracy of 81.6%. A total of 25 of 47 (53.2%) examiner pairs were from the same residency institution, whereas 22 of 47 (46.8%) were from different institutions. The median agreement was 100% (interquartile range (IQR) [100% - 100%]). The median kappa statistic was 1.00 (IQR [0.38-1.00]). The Mann-Whitney U tests showed no difference in agreement or kappa for examiner pairs from the same or from different institutions (p> 0.05). The mock oral boards have substantial sensitivity and positive predictive value in relation to the ABSCE. There are also very high levels of interrater agreement and interrater reliability. This regional mock oral board examination is valuable for ABSCE preparation.

The Prognostic and Predictive Value of Combined HE4 and CA-125 in Ovarian Cancer Patients

A risk-of-ovarian-malignancy algorithm (ROMA) based on human epididymis protein 4 (HE4) and CA-125 has been reported to categorize women with a pelvic mass into high or low risk of ovarian malignancy. Originally, the ROMA score was developed for diagnostic purposes and the clinical application of HE4 for other purposes such as a predictor of survival or platinum resistance has not been extensively investigated. The objective of the present study was to evaluate the prognostic importance of prechemotherapy combined levels of HE4 and CA-125 and prediction of platinum resistance. Furthermore, we wanted to investigate the dynamics of the markers during treatment. Serum from 137 patients with newly diagnosed serous ovarian cancer was analyzed for CA-125 and HE4 using ELISAs in a training data set. Patients with high levels (upper third percentiles) of both HE4 and CA-125 were classified as high-risk patients. Data were validated in an independent data set of an additional 94 patients. HE4 and CA-125 were also analyzed at all cycles of subsequent chemotherapy. The combined score of HE4 and CA-125 was highly predictive of both progression-free and overall survival in univariate as well as multivariate survival analysis. Values in the upper third percentiles (66th) were significantly associated with decreased progression-free and overall survival in both the training and in the validation set (P < 0.05 in all analyses).The positive predictive value in relation to platinum resistance was higher for the combination of markers than for the markers individually. The positive predictive values were 64.3% and 60.7% for combined CA-125/HE4 in the training and validation sets, respectively. The combination of HE4 and CA-125 levels at baseline just before initiation of chemotherapy was significantly associated with decreased progression-free and overall survival and to some extent with platinum resistance.

Meiotic spindle and zona pellucida characteristics as predictors of embryonic development using polscope imaging

OBJECTIVE: To evaluate and analyze the characteristics of meiotic spindle (MS) and zona pellucida (ZP) of oocytes using the PolScope, and to assess their influence on embryonic development. DESIGN: A retrospective study. MATERIALS AND METHODS: The study group consisted of 270 metaphase II oocytes obtained from 79 patients. The average age was 38.4±4.8. The study was approved by our clinical board allowing informed consent. Oocyte retrieval was scheduled 36 h after hCG 5,000IU. The oocytes were placed in an incubator for 3h, before spindle imaging, and confirmed by the presence of the first polar body. For spindle imaging, each oocyte was placed in an equilibrated 7μl media droplet overlaid with mineral oil in a glass bottomed culture dish. Oocytes were imaged using a Leica DMI 6000 (Leica microsystems) equipped with Oocyte™ imaging system (CRi,USA) controller and CCD camera. The images were acquired at ×400 magnification and the location, length, mean retardance(R) of the MS, and the mean R of inner layer of ZP and its thickness were analyzed using an Oocyte™ imaging system. In order to optimize the spindle and polar body visualization, oocytes were rotated using the holding pipette. After ICSI, oocytes with and without spindles were washed twice and cultured separated and sequentially in fertilization media droplets for further analysis. RESULTS: A total of 270 oocytes from 79 patients were examined, and visualized spindle was confirmed in 81.1%(219/270) oocytes; group A, but was not found in the remaining 18.9%(51/270) oocytes; group B. Fertilization rate was 74.0% (162/219) in group A versus 68.6% (35/51) in group B. There was no significant difference. Blastulation rate(BR) on day 5 was 50.0% (43/86) in group A versus 36.8%(7/19) in group B. There was no significant difference. The R of the inner layer of the ZPwas measured prior to ICSI. Among 86 oocytes which progressed to blastocysts, BR was 78.9% (15/19) in zona retardance (ZR); >3nm, 40.4% (19/47) in ZR; between 2-3 nm, and 44.4% (8/20) in ZR; <2nm. BR on day 5 was significantly higher in ZR; > 3nm than ZR; between 2-3 nm and ZR <2 nm, respectively (P<0.05). Other relationships among spindle R, spindle length, and inner zona thickness were no significant. CONCLUSIONS: The present study shows that ZR > 3 nm has positive predictive value in relation to progression to blastocysts. However, further prospective studies with large patient populations are needed.

Meiotic spindle and zona pellucida characteristics as predictors of embryonic development: a preliminary study using PolScope imaging

This study assesses meiotic spindle and zona pellucida characteristics using the PolScope, and analyses their relationship to embryonic development potential. A total of 205 matured oocytes retrieved from 25 patients undergoing ovarian stimulation were imaged for meiotic spindle and zona pellucida characteristics using the PolScope. After intracytoplasmic sperm injection, the oocytes were cultured and assessed for progression to blastocysts. Meiotic spindles were visualized in 78.0% of oocytes. Significantly more oocytes with visible spindles fertilized and progressed to blastocysts compared with oocytes without visible spindles. Oocytes with spindle retardance of >3 nm showed a greater progression to blastocysts compared with those with a retardance of 2–3 nm or <2 nm. More blastocysts were obtained from oocytes with spindle lengths of >12 nm than from oocytes with spindle lengths 10–12 nm or <10 nm. A difference in progression to blastocyst was observed in oocytes with a zona inner layer retardance of >3 nm compared with oocytes with retardance of 2–3 nm or <2 nm. Oocytes with an inner layer zona of 10–12 nm thickness showed better progression compared with those with a thickness of 8–10 nm or <8 nm. Quantitative measurement of length and retardance of the meiotic spindle and zona pellucida has a positive predictive value in relation to embryonic development.

Equal overall rejection rate in pre-transplant flow-cytometric cross-match negative and positive adult recipients in liver transplantation

T cell IgG flow-cytometric cross-matches (FCXM) using 48 stored pre-transplant patient serum samples and 40 stored serum samples collected 3 wk after liver transplantation and frozen spleen cells of cadaveric donors in 48 consecutive liver transplantations were performed retrospectively. T cell IgG FCXM using pre-transplant serum samples was compared with 46 complement-dependent lymphocytotoxic cross-matches (CDCXM) performed at the time of transplantation. Clinical relevance of these tests was evaluated in relation to acute rejection, 1-, 3- and 5-yr graft and patient survival. The incidence of positive FCXM was 33% (16 of 48) and 13% (six of 46) by CDCXM. The median time of acute rejection was 29 d after transplantation in FCXM positive group (range 13-101 d) and 22 d in FCXM negative group (range 7-157 d, NS). Rejection rate was similar in 16 pre-transplant FCXM positive patients (eight of 16, 50%) compared with six pre-transplant CDCXM positive patients (three of six, 50%; NS). Recipients having graft rejection tended to be more often pre-transplant FCXM positive (eight of 21, 38%) than CDCXM positive (three of 21, 14%), but the difference was not significant (p > 0.1). No difference was found in the positive predictive value in relation to acute rejection between positive FCXM and CDCXM (69% vs. 50%; NS). Furthermore there was no correlation between post-transplant positive FCXM and acute rejection. No difference was found between pre-transplant T cell IgG FCXM positive and negative recipients in relation to graft or patient survival. Our findings are supportive for little risk associated with preformed donor-specific antibodies in liver transplantation.

Is the CRIB Score (Clinical Risk Index for Babies) a Valid Tool in Predicting Neurodevelopmental Outcome inExtremely Low Birth Wei ght Infants?

The study aimed to assess how well the severity of clinical conditions in extremely low birth weight infants in the first 12 h of life, as measured by the CRIB (clinical risk index for babies), relates to hospital outcome and subsequent disability at 18 months of age. The CRIB was confirmed as a valid index of initial neonatal risk, even in extremely low birth weight infants, predicting hospital outcome (death or major brain lesions) more accurately than birth weight or gestational age. However, an adjustment of the CRIB score for gestational age might enhance its positive predictive value in relation to short-term developmental outcome in this particular population.

Einsatz der Sonographie in der Diagnostik der frischen fibulo-talaren Bandläsion

Sonography of the ankle joint is a simple method of exploring articular soft tissue. 100 patients with acute injury of the lateral ligaments were examined with a 7.5 MHz linear array transducer. Diagnostic criteria were haematoma and capsular deformation. Sonographic findings were assessed by stress films (n = 94), arthrography (n = 29) and operative evaluation (n = 28). In 94 of 100 joints, acute injury could be demonstrated with sonography. In most cases sonography was able to differentiate the site of the lesion: anterior talofibular or fibulocalcaneal ligament. The positive predictive value in relation to the operative findings is 100% for talofibular ligament and 96% for fibulocalcaneal ligament.