BACKGROUND & AIMS: PURPOSE:Currently, studies on serologic diagnosis of Helicobacter pylori-associated gastric cancer (GC) in Latin America are scarce. The aim of the present study was to evaluate the association between H. pylori serology tests in patients with early precancerous lesions or GC, when compared with non-atrophic gastritis in Colombia, Paraguay, and Mexico, three countries in Latin America with a high prevalence of H. pylori infection but contrasting rates of GC mortality. METHODS:Gastric biopsies and blood samples were obtained from patients attending the gastroenterology or oncology services of hospitals in the three participating countries. IgG antibodies against H. pylori whole-cell antigens and CagA were tested in 1,117 sera using an enzyme-linked immunoabsorbent assay. RESULTS:Positive and significant associations were shown for H. pylori seropositivity and preneoplastic lesions in Mexico (OR 2.0; 95 % CI 1.1-3.4) but not in Colombia (OR 1.2; 95 % CI 0.6-2.1) or Paraguay (OR 1.5; 95 % CI 0.6-3.2); no significant associations were shown for GC in any country. CagA seropositivity was associated with preneoplasic lesions in all three countries (ORs = 2.1, 3.0, and 3.1 for Mexico, Colombia, and Paraguay, respectively), and with GC only in Colombia (OR 4.3; 95 % CI 2.1-9.2). CONCLUSIONS:In countries of Latin America, the IgG CagA test might be a useful biomarker for patients with gastric preneoplastic lesions and for those at risk of developing gastric cancer.

背景与目标： 目的：目前，拉丁美洲缺乏关于幽门螺杆菌相关性胃癌（GC）的血清学诊断的研究。本研究的目的是，与哥伦比亚，巴拉圭和墨西哥这三个高流行率国家中的非萎缩性胃炎相比，评估具有早期癌前病变或GC的幽门螺杆菌血清学检测之间的相关性幽门螺杆菌感染的发生率，但GC死亡率却相反。
方法：从三个参与国医院的胃肠病学或肿瘤学服务的患者那里获取胃活检和血液样本。使用酶联免疫吸附试验在1117份血清中测试了针对幽门螺杆菌全细胞抗原和CagA的IgG抗体。
结果：在墨西哥（OR 2.0； 95％CI 1.1-3.4）或哥伦比亚（OR 1.2； 95％CI 0.6-2.1）或巴拉圭（OR 1.5；墨西哥； OR）；幽门螺杆菌血清阳性和肿瘤前病变的阳性和显着相关性。 95％CI 0.6-3.2）；在任何国家/地区，GC均未显示任何重要关联。在所有三个国家中，CagA血清阳性与肿瘤前病变有关（墨西哥，哥伦比亚和巴拉圭的OR分别为2.1、3.0和3.1），仅在哥伦比亚与GC相关（OR 4.3； 95％CI 2.1-9.2）。
结论：在拉丁美洲国家，IgG CagA检测对于胃癌前病变和有患胃癌风险的患者可能是有用的生物标志物。

BACKGROUND & AIMS: OBJECTIVES:Iopentol (Nycomed Imaging AS, Oslo, Norway) and iopromide (Schering AG, Berlin, Germany) are low-osmolar, non-ionic, iodinated contrast media (CM) used in abdominal CT examinations. The intravenous safety profile and radiological efficacy of iopentol and iopromide were studied in 518 patients. Specifically, frequency of adverse events (AEs), subjective change in quality of diagnostic information, and quantitative enhancement characteristics were compared. MATERIALS AND METHODS:A prospective, double-blind, randomized, multicentre, parallel-group study was conducted at 8 hospitals. Patients received 100 ml of either iopentol 300 mg I/ml or iopromide 300 mg I/ml. RESULTS:The incidence of patients with AEs was statistically significantly lower in the iopentol group compared to the iopromide group (2.3% vs. 8.9%, p < 0.001). Discomfort was frequent in both groups (44.8% vs. 49.4%, p = 0.33), sensation of heat and warmth being most common. Overall, diagnostic information was similar in both groups. Both CM gave high percentages of examinations rated as optimal (87.1% vs. 90.5%, p = 0.34) and in which diagnostic confidence was increased (87.5% vs. 91.1%, p = 0.22). No significant differences between the two CM were found concerning quantitative enhancement characteristics. CONCLUSIONS:In this study iopentol was significantly safer than iopromide for contrast enhanced CT examination of the abdomen. Radiological efficacy was similar with both CM.

背景与目标： 目的：Iopentol（Nycomed Imaging AS，挪威奥斯陆）和iopromide（Schering AG，柏林，德国）是用于腹部CT检查的低渗，非离子碘化造影剂（CM）。研究了518例患者中的碘戊醇和碘普罗胺的静脉内安全性和放射线有效性。具体来说，比较了不良事件（AE）的发生频率，诊断信息质量的主观变化以及定量增强特征。
材料与方法：在8家医院进行了一项前瞻性，双盲，随机，多中心，平行分组的研究。患者接受100 ml的iopentol 300 mg I / ml或iopromide 300 mg I / ml。
结果：与戊普罗米特组相比，碘戊醇组的AE患者发生率在统计学上显着较低（2.3％对8.9％，p <0.001）。两组的不适感都很常见（44.8％vs. 49.4％，p = 0.33），最常见的是热感和温暖感。总体而言，两组的诊断信息相似。两种CM均给出了较高的检查率，被认为是最佳检查（87.1％对90.5％，p = 0.34），并且诊断可信度有所提高（87.5％对91.1％，p = 0.22）。在定量增强特性方面，未发现两个CM之间存在显着差异。
结论：在这项研究中，碘伏特醇比碘普罗胺显着增强腹部CT检查的安全性。两种CM的放射线疗效均相似。

BACKGROUND & AIMS: :Tarso-metatarsal injuries are rare but frequently missed. Due to the large variation in pathomorphic forms of these injuries, great precision is required when carrying out clinical and X-ray diagnostic procedures. The aim of the study was to describe the different forms of Lisfranc joint injuries and analyse the causes of delayed treatment. The treatment results of acute and chronic injuries were compared in 41 patients, with an average follow-up period of 16 years. Statistically significant poorer results were obtained in the group of chronic cases, based on two functional scores - the AOFAS evaluation questionnaire and the Lublin functional questionnaire. The main factor delaying the start of the proper treatment was diagnostic error during initial admission. The best results were achieved after closed reduction and percutaneous Kirschner wire fixation in acute cases.

背景与目标： ：躯干部颅骨损伤很少见，但经常被遗漏。由于这些伤害的病态形式差异很大，因此在执行临床和X射线诊断程序时需要很高的精确度。该研究的目的是描述Lisfranc关节损伤的不同形式，并分析延迟治疗的原因。比较了41例急性和慢性损伤的治疗结果，平均随访时间为16年。基于两个功能评分-AOFAS评估问卷和Lublin功能问卷，在慢性病例组中获得了统计学上较差的较差结果。延迟开始适当治疗的主要因素是初次入院时的诊断错误。在急性病例中，经闭合复位和经皮克氏针固定后，可获得最佳结果。

BACKGROUND & AIMS: Importance:Individuals with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for academic problems. Pharmacologic treatment is effective in reducing the core symptoms of ADHD, but it is unclear whether it helps to improve academic outcomes. Objective:To investigate the association between the use of ADHD medication and performance on higher education entrance tests in individuals with ADHD. Design, Setting, and Participants:This cohort study observed 61 640 individuals with a diagnosis of ADHD from January 1, 2006, to December 31, 2013. Records of their pharmacologic treatment were extracted from Swedish national registers along with data from the Swedish Scholastic Aptitude Test. Using a within-patient design, test scores when patients were taking medication for ADHD were compared with scores when they were not taking such medication. Data analysis was performed from November 24, 2015, to November 4, 2016. Exposures:Periods with and without ADHD medication use. Main Outcomes and Measures:Scores from the higher education entrance examination (score range, 1-200 points). Results:Among 930 individuals (493 males and 437 females; mean [SD] age, 22.2 [3.2] years) who had taken multiple entrance tests (n = 2524) and used ADHD medications intermittently, the test scores were a mean of 4.80 points higher (95% CI, 2.26-7.34; P < .001) during periods they were taking medication vs nonmedicated periods, after adjusting for age and practice effects. Similar associations between ADHD medication use and test scores were detected in sensitivity analyses. Conclusions and Relevance:Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs nonmedicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.

背景与目标： 重要性：患有注意力缺陷/多动症（ADHD）的人更容易出现学术问题。药物治疗可有效减轻多动症的核心症状，但尚不清楚它是否有助于改善学业成果。
目的：探讨多动症患者使用多动症药物与高等教育入学考试成绩之间的关系。
设计，背景和参与者：该队列研究从2006年1月1日到2013年12月31日观察了61640名患有ADHD的患者。他们的药物治疗记录与瑞典的学历能力数据一起被提取。测试。使用患者内设计，将患者服用ADHD药物时的测试得分与未服用ADHD药物时的得分进行比较。数据分析时间为2015年11月24日至2016年11月4日。
暴露：有或没有使用ADHD药物的时期。
主要成果和措施：高等教育入学考试分数（分数范围：1-200分）。
结果：在930名个体（平均年龄[SD]，22.2 [3.2]岁）中，参加多次入院测试（n = 2524）并间歇性使用ADHD药物，测试得分平均为4.80分在调整年龄和实践影响后，他们在服药期间与非服药期间相比更高（95％CI，2.26-7.34； P <.001）。在敏感性分析中，ADHD药物使用与测试评分之间存在相似的关联。
结论与相关性：ADHD患者在接受ADHD药物治疗期间与非药物治疗期间在高等教育入学考试中得分较高。这些发现表明，多动症药物可能有助于改善多动症患者的教育相关成果。

BACKGROUND & AIMS: PURPOSE:To assess how different diagnostic decision aids perform in terms of sensitivity, specificity, and harm. METHODS:Four diagnostic decision aids were compared, as applied to a simulated patient population: a findings-based algorithm following a linear or branched pathway, a serial threshold-based strategy, and a parallel threshold-based strategy. Headache in immune-compromised HIV patients in a developing country was used as an example. Diagnoses included cryptococcal meningitis, cerebral toxoplasmosis, tuberculous meningitis, bacterial meningitis, and malaria. Data were derived from literature and expert opinion. Diagnostic strategies' validity was assessed in terms of sensitivity, specificity, and harm related to mortality and morbidity. Sensitivity analyses and Monte Carlo simulation were performed. RESULTS:The parallel threshold-based approach led to a sensitivity of 92% and a specificity of 65%. Sensitivities of the serial threshold-based approach and the branched and linear algorithms were 47%, 47%, and 74%, respectively, and the specificities were 85%, 95%, and 96%. The parallel threshold-based approach resulted in the least harm, with the serial threshold-based approach, the branched algorithm, and the linear algorithm being associated with 1.56-, 1.44-, and 1.17-times higher harm, respectively. Findings were corroborated by sensitivity and Monte Carlo analyses. CONCLUSION:A threshold-based diagnostic approach is designed to find the optimal trade-off that minimizes expected harm, enhancing sensitivity and lowering specificity when appropriate, as in the given example of a symptom pointing to several life-threatening diseases. Findings-based algorithms, in contrast, solely consider clinical observations. A parallel workup, as opposed to a serial workup, additionally allows for all potential diseases to be reviewed, further reducing false negatives. The parallel threshold-based approach might, however, not be as good in other disease settings.

背景与目标： 目的：评估在敏感性，特异性和危害性方面不同的诊断决策辅助措施的表现。
方法：比较了四种诊断决策辅助方法，将其应用于模拟患者人群：遵循线性或分支途径的基于发现的算法，基于串行阈值的策略和基于并行阈值的策略。以发展中国家免疫受损的艾滋病毒患者的头痛为例。诊断包括隐球菌性脑膜炎，脑弓形体病，结核性脑膜炎，细菌性脑膜炎和疟疾。数据来自文献和专家意见。根据敏感性，特异性以及与死亡率和发病率相关的危害，评估了诊断策略的有效性。进行了敏感性分析和蒙特卡洛模拟。
结果：基于平行阈值的方法导致敏感性为92％，特异性为65％。基于串行阈值的方法，分支算法和线性算法的灵敏度分别为47％，47％和74％，特异性为85％，95％和96％。基于并行阈值的方法造成的危害最小，而基于串行阈值的方法，分支算法和线性算法分别造成的伤害分别高1.56倍，1.44倍和1.17倍。敏感性和蒙特卡洛分析证实了这一发现。
结论：基于阈值的诊断方法旨在找到最佳折衷方案，以便在适当的情况下最大程度地减少预期的伤害，增强敏感性并降低特异性，如在给定的症状示例中指出的，这些症状可能会危及生命。相比之下，基于结果的算法仅考虑临床观察结果。与串行检查相反，并行检查另外还允许检查所有潜在疾病，从而进一步减少假阴性。但是，基于并行阈值的方法在其他疾病环境中可能不那么理想。

BACKGROUND & AIMS: OBJECTIVE:The aims of this study were to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the characterization of atypical cystic and cysticlike focal liver lesions in comparison with conventional US and to determine whether the use of CEUS can reduce the need for further diagnostic workup. SUBJECTS AND METHODS:In a 3-year period 48 patients with 50 atypical cystic and cysticlike lesions found at conventional US underwent CEUS. Diagnostic confirmation was obtained in cytohistopathologic examinations, with other imaging modalities, and in follow-up. Overall, there were 24 cystic lesions and 26 cysticlike solid lesions, specifically 32 benign and 18 malignant lesions. The conventional US and CEUS images and cine loops were reviewed by two blinded readers independently. Sensitivity, specificity, area under the ROC curve (Az), and interobserver agreement were calculated. RESULTS:Diagnostic performance improved after review of CEUS examinations by both readers (conventional US Az = 0.781 vs 0.972; CEUS Az = 0.734 vs 0.957). Interreader agreement increased, although slightly (conventional US weighted κ = 0.894; CEUS weighted κ = 0.953). In terms of differential diagnosis, the occurrence of correctly characterized lesions increased after CEUS for both readers (reader 1, 62% to 98%; reader 2, 56% to 96%). CONCLUSION:The development of low-acoustic-power CEUS has made it possible to identify several imaging features of cystic and cysticlike focal liver lesions that, in association with history and clinical findings, may help to correctly characterize them. Our data indicate the usefulness of CEUS in the evaluation of patients with these lesions.

背景与目标： 目的：本研究的目的是评估与常规超声检查相比，超声造影（CEUS）在表征非典型性囊性和囊性样局灶性肝病中的诊断性能，并确定使用CEUS是否可以减少对超声造影的需求。进一步的诊断工作。
研究对象和方法：在3年的时间里，对48例常规美国超声检查中发现的50例非典型囊性和囊样病变患者进行了CEUS。在细胞组织病理学检查，其他影像学检查和随访中获得了诊断确认。总体上，有24个囊性病变和26个囊样实性病变，特别是32个良性病变和18个恶性病变。两个盲人分别对常规的US和CEUS图像以及电影放映机进行了审查。计算灵敏度，特异性，ROC曲线下面积（Az）和观察者之间的一致性。
结果：两位读者对CEUS进行检查后，诊断性能均得到改善（常规US Az = 0.781 vs 0.972； CEUS Az = 0.734 vs 0.957）。阅读器之间的一致性有所提高，尽管有所提高（常规美国加权κ= 0.894； CEUS加权κ= 0.953）。在鉴别诊断方面，两种阅读器在CEUS后正确表征病变的发生率均增加（阅读器1、62％至98％；阅读器2、56％至96％）。
结论：低声功率CEUS的发展使得鉴别囊性和囊样性局灶性肝病的几种影像学特征与历史和临床发现相关联，可能有助于正确地表征它们。我们的数据表明CEUS在评估这些病变患者中的有用性。

BACKGROUND & AIMS: :Seven healthy men volunteers received 6.6 +/- 1.3 (SD) percent-hours of halothane oxygen anesthesia without surgery. Serum bilirubin, alanine aminotransferase, and aspartate aminotransferase significantly increased after anesthesia, which may indicate subclinical liver-cell damage. Creatine kinase of skeletal muscle origin increased above 90 U/liter in six subjects, indicating subclinical muscle-cell damage. Cortisol, triiodothyronine uptake, thyroxine, and free thyroxine index increased significantly immediately after anesthesia. Serum bromide concentrations had increased by fivefold on the second day after anesthesia, and on the ninth day was still elevated fourfold. Oral temperatures increased 0.7 degrees C 6 h post-anesthesia, possibly because of increased thyroxine activity. Lactate dehydrogenase, hydroxybutyrate dehydrogenase and gamma-glutamyltransferase activities did not change significantly. No drugs administered during the course of this study chemically interfered with any of the test methods used.

背景与目标： ：七名健康男性志愿者在未经手术的情况下接受了6.6 /-1.3（SD）％的氟烷氧麻醉。麻醉后血清胆红素，丙氨酸氨基转移酶和天冬氨酸氨基转移酶显着增加，这可能表明亚临床肝细胞受损。骨骼肌源性肌酸激酶在六名受试者中增加至90 U / L以上，表明亚临床性肌细胞损伤。麻醉后，皮质醇，三碘甲状腺素摄取，甲状腺素和游离甲状腺素指数显着增加。麻醉后第二天，血清溴化物浓度增加了五倍，而在第九天，血清溴化物浓度仍增加了四倍。麻醉后6小时，口腔温度升高了0.7摄氏度，这可能是由于甲状腺素活性增加所致。乳酸脱氢酶，羟丁酸脱氢酶和γ-谷氨酰转移酶活性没有明显变化。在此研究过程中使用的任何药物均不会化学干扰所使用的任何测试方法。

BACKGROUND & AIMS: UNLABELLED:Heart failure (HF) is, after cirrhosis, the second-most common cause of ascites. Serum B-type natriuretic peptide (BNP) plays an important role in the diagnosis of HF. Therefore, we hypothesized that BNP would be useful in the differential diagnosis of ascites. Consecutive patients with new onset ascites were prospectively enrolled in this cross-sectional study. All patients had measurements of serum-ascites albumin gradient (SAAG), total protein concentration in ascitic fluid, serum, and ascites BNP. We enrolled 218 consecutive patients with ascites resulting from HF (n = 44), cirrhosis (n = 162), peritoneal disease (n = 10), and constrictive pericarditis (n = 2). Compared to SAAG and/or total protein concentration in ascites, the test that best discriminated HF-related ascites from other causes of ascites was serum BNP. A cutoff of >364 pg/mL (sensitivity 98%, specificity 99%, and diagnostic accuracy 99%) had the highest positive likelihood ratio (168.1); that is, it was the best to rule in HF-related ascites. Conversely, a cutoff ≤ 182 pg/mL had the lowest negative likelihood ratio (0.0) and was the best to rule out HF-related ascites. These findings were confirmed in a 60-patient validation cohort. CONCLUSIONS:Serum BNP is more accurate than ascites analyses in the diagnosis of HF-related ascites. The workup of patients with new onset ascites could be streamlined by obtaining serum BNP as an initial test and could forego the need for diagnostic paracentesis, particularly in cases where the cause of ascites is uncertain and/or could be the result of HF.

背景与目标： 肝硬化后，心力衰竭（HF）是引起腹水的第二大常见原因。血清B型利钠肽（BNP）在HF的诊断中起重要作用。因此，我们假设BNP在腹水的鉴别诊断中将是有用的。连续有新发腹水的患者前瞻性地参与了这项横断面研究。所有患者均测量血清腹水白蛋白梯度（SAAG），腹水，血清和腹水BNP中的总蛋白浓度。我们招募了218位连续的因HF（n = 44），肝硬化（n = 162），腹膜疾病（n = 10）和缩窄性心包炎（n = 2）引起的腹水患者。与SAAG和/或腹水中的总蛋白浓度相比，最能区分HF相关性腹水与其他腹水原因的测试是血清BNP。 > 364 pg / mL的临界值（灵敏度98％，特异性99％和诊断准确度99％）具有最高的阳性似然比（168.1）；也就是说，这是最好的HF相关腹水。相反，临界值≤182 pg / mL具有最低的负似然比（0.0），是排除HF相关腹水的最佳方法。这些发现在60名患者的验证队列中得到了证实。
结论：血清BNP在腹水相关性腹水的诊断中比腹水分析更准确。可以通过获取血清BNP作为初始检测来简化新发腹水患者的检查工作，并且可以放弃诊断性穿刺的需要，尤其是在腹水原因不确定和/或可能是HF的情况下。

BACKGROUND & AIMS: :Adults with intellectual disabilities need thoughtful, well-coordinated primary care from family physicians. However, evidence-based screening recommendations are lacking. We examined screening recommendations for common preventable conditions using the US Preventative Service Task Force guidelines. We also reviewed the literature about the prevalence of these conditions in adults with intellectual disabilities. Obesity, osteoporosis, and smoking are more prevalent in adults with intellectual disabilities, and enhanced screening for these conditions is recommended. Abnormal Papanicolaou smears and cervical cancer are less common in adults with intellectual disabilities and screening recommendations should be individualized. We also discussed strategies to make screening procedures less stressful for these patients.

背景与目标： ：智力障碍的成人需要家庭医生提供周到且协调良好的初级保健。但是，缺乏基于证据的筛查建议。我们使用美国预防服务工作队指南检查了针对常见可预防疾病的筛查建议。我们还回顾了有关智力障碍成年人中这些疾病患病率的文献。肥胖，骨质疏松和吸烟在智力残疾的成年人中更为普遍，因此建议对这些疾病进行更严格的筛查。在智力障碍的成年人中，巴氏涂片和子宫颈癌的涂片异常少见，因此筛查建议应个体化。我们还讨论了降低这些患者筛查压力的策略。

BACKGROUND & AIMS: PURPOSE:To determine the applicability of the international revised diagnostic criteria for Vogt-Koyanagi-Harada disease. METHODS:Retrospective study. Medical charts of 140 patients with the diagnosis of Vogt-Koyanagi-Harada disease, from the Uveitis Sector of the Federal University of Sao Paulo (UNIFESP), were revised and classified following the revised diagnostic criteria. RESULTS:Of the 140 patients, 12.85% fulfilled the criteria for complete disease, 29.28% incomplete disease, 28.57% "probable" Vogt-Koyanagi-Harada disease and 28.27% were considered not Vogt-Koyanagi-Harada disease. CONCLUSION:The authors consider that the international revised diagnostic criteria have good applicability and are very useful to help in the diagnosis of Vogt-Koyanagi-Harada disease.

背景与目标： 目的：确定国际修订的沃格特-小柳-原田病诊断标准的适用性。
方法：回顾性研究。根据修订后的诊断标准，对来自圣保罗联邦大学葡萄膜炎科的140名诊断为Vogt-Koyanagi-Harada病的患者的病历表进行了修订和分类。
结果：140例患者中，完全性疾病的标准为12.85％，不完全性疾病的标准为29.28％，“可能”沃格特-小柳原田病的患病率为28.57％，被认为不是沃格特-小柳原田原病的28.27％。
结论：作者认为，国际修订的诊断标准具有良好的适用性，对于帮助诊断Vogt-Koyanagi-Harada病非常有用。

BACKGROUND & AIMS: :Emergency physicians use diagnostic tests extensively, and the ability to order and interpret test results appropriately is a critical skill. An understanding of sensitivity, specificity, predictive values and likelihood ratios, as well as an awareness of the importance of pre-test probability, is essential. The purpose of this article is to explain, in a straightforward and clinically applicable manner, the core concepts related to diagnostic testing.

背景与目标： ：急诊医师广泛使用诊断测试，正确地定购和解释测试结果的能力是一项关键技能。对敏感性，特异性，预测值和似然比的理解以及对测试前概率重要性的认识是必不可少的。本文的目的是以一种直接且可临床应用的方式来解释与诊断测试有关的核心概念。

BACKGROUND & AIMS: :Dengue virus (DENV) is the most prevalent arbovirus in the world, found mainly in tropical regions. As clinical manifestations present frequently as nonspecific febrile illness, laboratory diagnosis is essential to confirm DENV infections and for epidemiological studies. Recombinant envelope (E) antigens of four serotypes of DENV were used to develop an immunoglobulin G enzyme-linked immunosorbent assay (IgG-ELISA). To evaluate the IgG-ELISA, a panel of serum samples that had been tested previously by a plaque reduction neutralization test (PRNT) was investigated for the presence of anti-E antibodies against the four DENV serotypes. IgG-ELISA was found to have a sensitivity (91%) and specificity (98%) at a receiver-operating characteristic (ROC) optimized cutoff and demonstrated high performance as well as good indexes. A concordance of 97% was achieved between both assays, and only 21/704 (3%) samples were not concordant. The results of the present study demonstrate a moderate correlation between neutralizing antibody titers and IgG-ELISA values. These findings indicate that the recombinant protein-based IgG-ELISA is a suitable method for routine serodiagnosis, monitoring and seroepidemiological studies of DENV infections.

背景与目标： 登革热病毒（DENV）是世界上最流行的虫媒病毒，主要发现于热带地区。由于临床表现经常以非特异性高热疾病的形式出现，因此实验室诊断对于确定DENV感染和进行流行病学研究至关重要。四种血清型DENV的重组包膜（E）抗原用于开发免疫球蛋白G酶联免疫吸附测定（IgG-ELISA）。为了评估IgG-ELISA，研究了先前通过噬斑减少中和测试（PRNT）测试过的一组血清样品中是否存在针对四种DENV血清型的抗E抗体。发现IgG-ELISA在接受者操作特征（ROC）优化的临界值上具有灵敏度（91％）和特异性（98％），并表现出较高的性能和良好的指标。两种测定之间的一致性达到97％，只有21/704（3％）个样品不一致。本研究的结果表明中和抗体滴度与IgG-ELISA值之间存在适度的相关性。这些发现表明，基于重组蛋白的IgG-ELISA是用于DENV感染的常规血清诊断，监测和血清流行病学研究的合适方法。

BACKGROUND & AIMS: :Abstract An accumulating number of studies are revealing that platelet reactivity above specific cut-off scores leads to exponentially increased rates of post-percutaneous coronary intervention (PCI) ischemic events. To evaluate the optimal predictive values for three different platelet function measurement assays of platelet reactivity on early clinical outcomes in Korean patients undergoing PCI, we enrolled 228 patients receiving clopidogrel prior to PCI. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow P2Y12 assay, and multiple electrode platelet aggregometry (MEA). The primary endpoint was the 30-day occurrence of ischemic events after PCI. MACE occurred in 36 patients (15.8%), including 35 patients (15.4%) with periprocedural MI and the death of one patient (0.4%). ADP-induced LTA and VerifyNow values (pre- and post-PCI) were significantly higher in patients with the subsequent occurrence of periprocedural MI, but the MEA assay data (PCI and post-PCI) displayed no significant differences (pre-PCI p=0.25 and post-PCI p=0.33). ROC curve analysis demonstrated HPR values for LTA (pre-PCI, >66% and post-PCI, >53 %, all p<0.001), VerifyNow (pre-PCI, >347 PRU and post-PCI >272 PRU, all p<0.001) and MEA (pre-PCI, >50 U and post-PCI >39 U, all p>0.05). The platelet reactivity measurements by LTA and the VerifyNow assay can discriminate the risk of 30-day ischemic events after PCI. The predictive cut-off values for adverse events are dependent on sampling time.

背景与目标： 摘要：越来越多的研究表明，超过特定临界值的血小板反应性会导致经皮冠状动脉介入治疗（PCI）缺血事件的发生率呈指数增加。为了评估在接受PCI手术的韩国患者中进行血小板反应性对早期临床结局的三种不同血小板功能测量测定的最佳预测值，我们招募了228名在接受PCI术前接受氯吡格雷治疗的患者。血小板反应性通过透光率聚集法（LTA），VerifyNow P2Y12测定和多电极血小板聚集法（MEA）进行测量。主要终点是PCI后30天发生的缺血性事件。 MACE发生在36例（15.8％）患者中，其中35例（15.4％）患有围手术期心肌梗死且1例患者死亡（0.4％）。在随后发生围手术期MI的患者中，ADP诱导的LTA和VerifyNow值（PCI之前和之后）明显更高，但是MEA分析数据（PCI和PCI之后）没有显着差异（PCI之前p = 0.25，PCI后p = 0.33）。 ROC曲线分析显示了LTA的HPR值（PCI前> 66％，PCI后> 53％，所有p <0.001），VerifyNow（PCI前> 347 PRU和PCI后> 272 PRU，所有p <0.001）和MEA（PCI前> 50 U，PCI后> 39 U，所有p> 0.05）。通过LTA和VerifyNow测定进行的血小板反应性测量可以区分PCI后30天缺血事件的风险。不良事件的预测临界值取决于采样时间。

BACKGROUND & AIMS: BACKGROUND:Systematic reviews have gradually replaced single studies as the highest level of documented effectiveness of health care interventions. Systematic reviewing is a new scientific method, concerned with the development and application of methods for identifying relevant literature, analysing the material while increasing validity and precision, and presenting and discussing the results in a way that does justice to the research question and to the available evidence. The objective of this study was to review the systematic reviews in laboratory medicine, to evaluate the methods applied in these reviews and the applicability of guidelines of the Cochrane Methods Working Group on Screening and Diagnostic Tests, and identify areas for future research. METHODS:All the systematic reviews in the field of clinical chemistry and laboratory haematology that could be identified in Medline, EMBASE and other literature databases up to December 1998, were evaluated. RESULTS:We studied 23 reviews of diagnostic trials. Although all reviews share the same basic methodology, there was a wide variation in the methods applied. There was no consensus on the quality criteria for inclusion of primary studies. The results of the primary studies were heterogeneous in most cases. This was partly due to design flaws in the primary studies, but was also inherent in the diverse study designs in diagnostic trials. We observed differences in the analysis of the factors that cause heterogeneity of the results, and in the summary statistics used to pool the data from the primary studies. The additional diagnostic value of a test, after other test results are taken into consideration, was only addressed in one study. CONCLUSION:This overview of 23 reviews of diagnostic trials identifies areas in the methods of systematic reviewing where consensus is lacking, such as quality rating of primary studies, analysis of heterogeneity between primary studies and pooling of data. Guidelines need to be improved on these points.

背景与目标： 背景：系统评价已逐渐取代单一研究，成为卫生保健干预措施有据可查的最高水平。系统评价是一种新的科学方法，涉及识别相关文献，在提高有效性和准确性的同时对材料进行分析，并提出和讨论结果的方法，这种方法对研究问题和可用方法都具有公义性。证据。这项研究的目的是回顾实验室医学的系统评价，评价这些评价中应用的方法以及Cochrane方法筛查和诊断测试工作组指南的适用性，并确定未来的研究领域。
方法：对临床化学和实验室血液学领域的所有系统评价进行了评估，这些评价可在1998年12月之前在Medline，EMBASE和其他文献数据库中确定。
结果：我们研究了23条诊断性试验的评价。尽管所有评论都使用相同的基本方法，但是所采用的方法却存在很大差异。纳入小学研究的质量标准尚未达成共识。在大多数情况下，基础研究的结果是不同的。部分原因是由于基础研究存在设计缺陷，但也存在于诊断试验的各种研究设计中。我们在导致结果异质性的因素分析以及汇总主要研究数据的汇总统计中观察到了差异。在考虑了其他测试结果之后，该测试的附加诊断价值仅在一项研究中得到了解决。
结论：这份对23项诊断性试验评论的概述确定了系统评价方法中缺乏共识的领域，例如基础研究的质量评级，基础研究之间的异质性分析和数据汇总。这些方面的指导方针有待改进。

BACKGROUND & AIMS: BACKGROUND:The symptoms and signs of small intestinal bacterial overgrowth (SIBO) are often identical to a variety of diseases and can lead to diagnostic confusion. AIMS:To review the diagnostic options for SIBO and present new investigative options for the condition. METHODS:A literature search was performed on MEDLINE, EMBASE and Web of Science for English articles and abstracts. Search terms included free text words and combinations of the following terms 'small intestinal bacterial overgrowth', 'small bowel bacterial overgrowth', 'diagnostic tests', 'treatment', 'antibiotics', 'probiotics', 'metabonomics', 'proton nuclear magnetic resonance spectroscopy', 'electronic nose' and 'field asymmetric ion mobility spectrometry'. RESULTS:All of the available methods to test for SIBO have inherent limitations and no 'gold-standard' diagnostic test for the condition exists. Accurate diagnosis of SIBO requires identification of bacterial species growing inappropriately within the small intestine and symptom response to antibiotics. Proton nuclear magnetic resonance spectroscopy, electronic nose technology and/or field asymmetric ion mobility spectrometry may represent better investigative options for the condition. CONCLUSIONS:Novel diagnostic options are needed to supplement or replace available tests.

背景与目标： 背景：小肠细菌过度生长（SIBO）的症状和体征通常与多种疾病相同，并可能导致诊断混乱。
目的：审查SIBO的诊断方案并提出针对该病的新研究方案。
方法：在MEDLINE，EMBASE和Web of Science上对英文文章和摘要进行文献检索。搜索词包括自由文本单词和以下术语的组合：“小肠细菌过度生长”，“小肠细菌过度生长”，“诊断测试”，“治疗”，“抗生素”，“益生菌”，“代谢组学”，“质子核”磁共振波谱”，“电子鼻”和“场非对称离子迁移谱”。
结果：所有可用于SIBO检验的方法都有其固有的局限性，并且不存在针对这种情况的“金标准”诊断测试。 SIBO的准确诊断需要鉴定在小肠内不适当生长的细菌种类以及对抗生素的症状反应。质子核磁共振波谱，电子鼻技术和/或场不对称离子迁移谱法可能代表对该病的更好的研究选择。
结论：需要新颖的诊断选项来补充或替换可用的测试。