The utility and cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis

BACKGROUND AND OBJECTIVE: The potential utility of D-dimer measurements for the diagnosis of deep vein thrombosis became evident soon after the development of reliable commercial assays. The purpose of this review is to outline some critical aspects affecting cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis (DVT). METHODS: The authors have been working in this field contributing original papers whose data have been used for this study. In addition, the material analyzed in this article includes papers published in the journals covered by the Science Citation Index and Medline. RESULTS: D-dimer levels are very sensitive to the process of fibrin formation/dissolution occurring with ongoing thrombosis. However, they may not be highly specific for venous thromboembolism as they are influenced by the presence of comorbid conditions potentially elevating plasma D-dimer (cancer, surgery, infectious diseases). In addition, commercially available ELISA assays, although quantitative and reproducible, cannot be used under emergency conditions because they are time-consuming and suited for batch-processing of plasma samples. Recently, new assays have been introduced which permit fast and quantitative D-dimer estimations in individual patients. We have evaluated the utility of two new rapid assays (LPIA D-dimer. Mitsubishi, and VIDAS D-DIMER, bio-Merieux) in combination with compression real-time-B-mode ultrasonography for the detection of deep vein thrombosis in asymptomatic patients following elective hip replacement and in patients with clinically suspected deep vein thrombosis. In both settings, we identified cut-off values with optimal sensitivity which allow exclusion of deep vein thrombosis in a considerable percentage of patients, with substantial sparing of economic resources. In fact, based on a cost-effectiveness analysis, a diagnostic algorithm combining D-dimers measurement and compression ultrasonography would result in cost-savings ranging from 5% to 55% in patients with high or low clinical pretest probability respectively. However, the specificity of D-dimer measurements for deep vein thrombosis was much higher in symptomatic than in asymptomatic patients. Choice of the cut-off value proved to be dependent on the method as well as on the patient populations studied. CONCLUSIONS: The cost-effectiveness of D-dimers measurement in the diagnosis of asymptomatic DVT remains questionable. Conversely, our data strongly support the utility of D-dimers determinations in the diagnosis of symptomatic DVT. In terms of sparing economic resources, the introduction in the clinical laboratory of the rapid quantitative assays would be highly convenient, because they avoid a source of bias in the interpretation of D-dimers results, are easy to perform and do not require dedicated personnel or instrumentation. Prospective management studies validating the utility of D-dimer measurement in the diagnosis of deep vein thrombosis are urgently needed.     

Thermal and mechanical properties of a polypropylene nanocomposite

An experimental polypropylene (PP) nanocomposite, containing approximately 4 wt % of an organophilic montmorillonite clay, was prepared and characterized, and its properties were compared with those of talc‐filled (20–40 wt %) compositions. Weight reduction, with maintained or even improved flexural and tensile moduli, especially at temperatures up to 70°C, was a major driving force behind this work. By a comparison with the analytical data from a nylon 6 (PA‐6) nanocomposite, it was found that the PP nanocomposite contained well‐dispersed, intercalated clay particles; however, X‐ray diffraction, transmission electron microscopy, dynamic mechanical analysis, and permeability measurements confirmed that exfoliation of the clay in PP was largely absent. The increased glass‐transition temperature (T_g) of a PA‐6 nanocomposite, which possessed fully exfoliated particles, indicated the molecular character of the matrix–particle interaction, whereas the PP nanocomposite exhibited simple matrix–filler interactions with no increase in T_g. The PP nanocomposite exhibited a weight reduction of approximately 12% in comparison with the 20% talc‐filled PP, while maintaining comparable stiffness. Undoubtedly, considerable advantages may be available if a fully exfoliated PP nanocomposite is fabricated; however, with the materials available, a combination of talc, or alternative reinforcements, and nanocomposite filler particles may provide optimum performance. © 2003 Wiley Periodicals, Inc. J Appl Polym Sci 90: 1639–1647, 2003     

Aurally aided visual search in three-dimensional space

We conducted an experiment to evaluate the effectiveness of spatial audio displays on target acquisition performance. Participants performed a visual search task with and without the aid of a spatial audio display. Potential target locations ranged between plus and minus 180 degrees in azimuth and from -70 degrees to +90 degrees in elevation. Independent variables included the number of visual distractors present (1, 5, 10, 25, 50) and the spatial audio condition (no spatial audio, free-field spatial audio, virtual spatial audio). Results indicated that both free-field and virtual audio cues engendered a significant decrease in search times. Potential applications of this research include the design of spatial audio displays for aircraft cockpits and ground combat vehicles.     

Radiation therapy in the management of symptomatic bone metastases: the effect of total dose and histology on pain relief and response duration

PURPOSE: In order to better define variables and factors that may influence the pain response to radiation, and to look for a radiation regimen that can assure the highest percentage and the longest duration of pain relief, we performed a prospective, although not randomized, study on patients with bone metastases from various primary sites. METHODS AND MATERIALS: From December 1988 to March 1994, 205 patients with a total of 255 solitary or multiple bone metastases from several primary tumors were treated in our radiotherapy center with palliative intent. Irradiation fields were treated with three main fractionation schedules: (1) Conventional fractionation: 40-46 Gy/20-23 fractions in 5-5.5 weeks; (2) Short course: 30-36 Gy/10-12 fractions in 2-2.3 weeks; (3) Fast course: 8-28 Gy/1-4 consecutive fractions. Pain intensity was self-assessed by patients using a visual analogic scale graduated from 0 (no pain) to 10 (the strongest pain one can experience). Analgesic requirement was assessed by using a five-point scale, scoring both analgesic strength and frequency (0 = no drug or occasional nonopioids; 1 = Nonopioids once daily; 2 = Nonopioids more than once daily; 3 = Mild opioids (oral codeine, pentazocine, etc.), once daily; 4 = Mild opioids more than once daily; 5 = Strong opioids (morphine, meperidine, etc.). Complete pain relief meant the achievement of a score < or = 2 in the pain scale or 0 in the analgesic requirement scale. Partial pain relief indicated a score of 3 to 4 or of 1 to 2 on the former and latter scale, respectively. RESULTS: Total pain relief (complete + partial) was observed in 195 (76%) sites, in 158 of which (62%) a complete response was obtained. Metastases from NSC lung tumors appeared to be the least responsive among all primary tumors, with 46% complete pain relief in comparison to 65% and 83% complete relief in breast (p = 0.04) and in prostate metastases (p = 0.002), respectively. A significant difference in pain relief was detected among the several ranges of total dose delivered to the painful metastases, with 81%, 65%, and 46% complete relief rates in the 40-46 Gy, 30-36 Gy (p = 0.03), and 8-28 Gy (p = 0.0001) dose ranges respectively. A straight correlation between total dose and complete pain relief was confirmed by the curve calculated by the logistic model which shows that doses of 30 Gy or more are necessary to achieve complete pain relief in 70% or more of bone metastases. This correlation holds also for the duration of pain control, as shown by the actuarial analysis of time to pain progression. Multivariate analyses, with complete pain relief and time to pain progression as endpoints show a highly significant effect of radiation dose (p = 0.0007) and performance status (p = 0.003), with lower rates of complete pain relief and shorter time to pain progression observed after smaller radiation total doses or higher Eastern Cooperative Oncology Group (ECOG) scores. CONCLUSION: Although single-dose or short course irradiation is an attractive treatment in reducing the number of multiple visits to radiotherapy departments for patients with painful bone metastases, it is nevertheless clear that aggressive protracted treatments seem to offer significant advantages especially for patients in whom the expected life span is not short.     

Removal of azinphos methyl by alfalfa plants (Medicago sativa L.) in a soil-free system

The objective of this study was to investigate the removal of azinphos methyl assisted by alfalfa plants, with special emphasis on the effects of this compound on some plant's physiological parameters. Hydroponic cultures of alfalfa (Medicago sativa L., var Romagnola) were employed as a model system. These cultures were exposed to a nutrient medium containing 10 mg/l of azinphos methyl. A first-order kinetic approach was used to describe the removal of azinphos methyl from the solution. After 20 days of culture, the initial amount of azinphos methyl was reduced to non-detectable levels in the presence of plants. In the absence of plants, 20% of azinphos methyl remained in the solution after 30 days of treatment. The half-life of the pesticide was reduced from 10.8 to 3.4 days in the presence of plants. The growth index of alfalfa plants exposed to azinphos methyl was negatively affected. Chlorophyll contents were reduced after 24 h of treatment and thereafter the levels were comparable to that of control plants. The peroxidase activity of alfalfa roots was not affected by the presence of azinphos methyl. In conclusion, alfalfa plants were able to survive when exposed to an effective concentration of 10 mg/l of azinphos methyl in the root zone, with some alterations on their physiological parameters.     

Modifying the Electronic Character of Single‐Walled Carbon Nanotubes Through Anisotropic Polymer Interaction: A Raman Study

Using Raman spectroscopy, we demonstrate that the anisotropic interaction between single‐walled carbon nanotubes (SWNTs) and poly(methyl methacrylate) (PMMA) causes significant changes in the electronic properties of their composites. Two different procedures were used to prepare the composites: melt blending and in‐situ UV polymerization. Resonant Raman studies relate the electronic density of states (DOS) of the SWNTs to the corresponding vibration symmetry changes of both the PMMA and the SWNTs. Our results show that, in the melt‐blended sample, the SWNTs—originally semiconducting—became predominantly metallic. The changes in the electronic properties were also confirmed by dielectric constant measurements. We propose that the anisotropic interaction between PMMA and SWNTs in the melt‐blended composite is the dominant reason for the observed electronic character change.     

LPC总线和固件集线器

引言 　　ST最新推出的M50FW040固件集线器，采用了被称作‘低引脚数接口规范’或LPC的新主板互连协议。LPC总线是主板芯片组和单板外设功能之间的高速接口。……     

High-performance liquid chromatographic method for measuring total plasma homocysteine levels

We have modified a high-performance liquid chromatographic (HPLC) procedure based on SBD-F (ammonium-7-fluorobenzo-2-oxa-1,3-diazole-4-sulphonate) pre-column derivatization to obtain an assay that is useful for routine clinical total plasma homocysteine (tHcy) analysis. The introduction of easily handled sodium borohydride instead of the traditional tri-n-butylphosphine in dimethylformamide as a reductant and a 14-min run-time using basic isocratic HPLC equipment are the more notable advantages. The addition of mercaptopropionylglycine as an internal standard contributed to improvements in the reproducibility of the assay, yielding within- and between-run precisions of 1.9 and 4% (C.V.), respectively. Reference values for fasting tHcy were 7.65+/-2.3 and 8.9+/-2.4 micromol/l, while post-methionine load gave tHcy levels of 19.9+/-5.5 and 26.8+/-5.5 micromol/l, for women and men, respectively (n=40).     

Comparison of mean normal prothrombin time (PT) with PT of fresh normal pooled plasma or of a lyophilized control plasma (R82A) as denominator to express PT results: collaborative study of the International Federation of Clinical Chemistry. IFCC Working Group Standardization of Coagulation Tests

The mean normal prothrombin time (MNPT) is currently recommended as the denominator term in the expression of PT ratio or International Normalized Ratio (INR) values. The PT of lyophilized normal control plasmas might also be used in calculating PT ratios, but the overall accuracy of this approach and its dependence on reagents and endpoint detectors have not been evaluated in detail. In an IFCC collaborative study involving 15 expert laboratories and 58 PT systems, the PT ratios of 30 apparently healthy subjects were expressed with the use of the MNPT, the PT of fresh normal pooled plasma (FNPP) obtained from the same apparently healthy subjects, or the PT of plasma R82A--a lyophilized normal pooled plasma prepared by the Verband der Deutschen Ger?te-Hersteller for in-house calibration of a large amount of control plasma--as the denominator term. The total imprecision of the PT of plasma R82A averaged 2.16%. Mean PT ratios did not differ from 1.00 (mean 1.00, range 1.00-1.01) with the use of the MNPT as the denominator term. Mean PT ratios were > 1.00 with the FNPP-PT as the denominator term (1.02, 0.96-1.05), and differed according to endpoint detectors (P = 0.024). Mean PT ratios with plasma R82A-PT as the denominator term averaged 0.98 (range 0.91-1.06) with plain thromboplastins (n = 11), 1.02 (0.98-1.06) with combined thromboplastins (n = 3), and 0.93 (0.87-0.97) with recombinant thromboplastins (n = 2), but they differed according to the brand of plain or recombinant reagents (P = 0.00001), the endpoint detector (P < 0.0025), and the plasma citrate concentration (P < 0.0025). These findings underline the differences in the PT of lyophilized plasma R82A and the MNPT and PT of FNPP obtained from the same individuals and support the recommendation that the system-specific MNPT should be used as the ideal index of the normal PT in the calculation of INR values.