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A comparison of fixed and variable kVp technique protocols for film-screen mammography.

Mammographic image quality, contrast and dose for a variable tube potential (kVp) technique protocol for film-screen mammography have been investigated. In this protocol, the tube potential is increased for larger breast thicknesses. Comparisons were made with fixed kVp protocols, in which the tube potential is kept constant and the breast thickness compensated for by prolonging the exposure ("fixed kVp" protocol). All measurements were performed on a mammography unit with a molybdenum target and filter. Image quality was quantified by image contrast, image detail detection and the minimum detectable dimension of low contrast objects. It was demonstrated that for a compressed breast thickness of less than about 40 mm, varying the tube potential had a negligible effect upon dose but a significant effect upon image quality. For a compressed breast thickness greater than about 60 mm, the effect of the tube potential upon image quality was much reduced; however, the effect upon dose was significantly greater. The variable kVp protocol takes advantage of this feature to yield a significantly lower dose for thicker breasts with a small reduction in image quality, often only within experimental uncertainty. For an exposure under automatic exposure control, increasing the tube potential from 26 kVp to 30 kVp for a breast of a reference tissue composition (50% adipose and 50% glandular) with a compressed thickness of 60 mm reduced the mean glandular dose from 6 mGy to 3.9 mGy (-35%), but increased the minimum detectable dimension of a low contrast mass from 0.8 (+/- 0.1) mm to 1.1 (+/- 0.1) mm. Adopting a variable kVp protocol led to a median patient mean glandular dose per film of 2.7 mGy, nearly independent of compressed breast thickness. In our survey, the mean age of women presenting for mammography is younger and the mean compressed breast thickness is less than reported from screening centres. This suggests that there will be a higher proportion of denser, glandular tissue in the breasts incorporated within this survey than for surveys from screening centres. The clinical use of the variable kVp protocol allows the extraction from patient data of separate changes in breast composition which are due to patient age and breast thickness. It is concluded that the reference breast tissue composition is not an accurate representation of the women presenting at this centre.

Adolescent↗

Relations between plasma IGF-I concentrations during treatment with CIDR-based or Ovsynch protocol for timed AI and conception in early postpartum Japanese black beef cows.

We examined the relations between plasma insulin-like growth factor (IGF) -I concentrations during treatment with CIDR-based or Ovsynch protocol for timed AI and conception and plasma steroid concentrations in early postpartum Japanese Black beef cows. Cows in the control group (Ovsynch; n = 21) underwent Ovsynch protocol (GnRH analogue on Day 0, PGF(2alpha) analogue on Day 7, and GnRH analogue on Day 9), with AI on Day 10, approximately 20 h after the second GnRH treatment. Cows in the Ovsynch+CIDR group (n = 22) received Ovsynch protocol plus a CIDR for 7 days (starting on Day 0). Cows in the further treatment group (EB+CIDR+GnRH; n = 22) received 2 mg of estradiol benzoate (EB) on Day 0 in lieu of the first GnRH treatment, followed by the same treatment as in the Ovsynch+CIDR protocol. Plasma IGF-I concentrations were determined on Days -7, 0, 7, 9 and 17. Conception rates were improved in the CIDR-combined groups (both CIDR-treated groups were combined) relative to Ovsynch group (P < 0.05) for cows with low IGF-I concentrations (<1,000 ng/ml) on Days -7, 0, and 7, but improved conception rate produced by the CIDR-based protocols did not occur in cows with a high IGF-I concentration (> or =1,000 ng/ml). Plasma estradiol-17beta concentrations increased from Day 0 to 7 (P < 0.05) and were unchanged from Day 7 to 9 in the Ovsynch group with low IGF-I concentrations on Day 0, while they were unchanged from Day 0 to 7 and increased from Day 7 to 9 (P < 0.05) in the Ovsynch group with high IGF-I concentrations on Day 0 and in the CIDR-combined group. Plasma progesterone concentrations in the Ovsynch group with low IGF-I concentrations on Day 0 were higher on Day 14 than in the Ovsynch group with high IGF-I concentrations on Day 0 and in the CIDR-combined group (P < 0.05). In conclusion, CIDR-based protocols may improve conception relative to Ovsynch in early postpartum beef cows with lower plasma IGF-I concentrations at the start of the protocols. This improvement is probably due to prevention of premature increases of estradiol-17beta and progesterone concentrations, which occurred in cows with low IGF-I concentrations treated with Ovsynch, by the CIDR treatment.

Animals↗

The development and use of a triage protocol for patients with dental problems contacting an out-of-hours general medical practitioner cooperative.

PURPOSE OF THE STUDY: The number of patients contacting general medical practitioner (GMP) out-of-hours services with dental problems is perceived to be a significant problem by the medical profession. This study was undertaken to design and pilot a triage protocol that could be used by non-dental staff to refer callers with dental complaints for appropriate treatment. BASIC PROCEDURES: A triage protocol was designed to address the patient conditions considered to be relevant to emergency dental care. The triage protocol was piloted for three months at a GMP cooperative in North Wales, which provided an out-of-hours service for 61 GMPs. Baseline data were collected for three months prior to the introduction of the triage protocol. MAIN FINDINGS: The study showed that the number of dental callers contacting the out-of-hours service was not as great as GMPs imagined, and was similar to other studies. The introduction of the triage protocol resulted in a rise in the number of callers asked to call the general dental practitioner (GDP) support line. The number of unregistered patients given the name of a dentist also increased. The need to make a second telephone call seemed not to affect patient satisfaction since when patients were later questioned on their experience, those who had used the service since the introduction of the triage protocol were more likely to be satisfied with the service. PRINCIPAL CONCLUSIONS: This study provides some evidence that a triage protocol can be used successfully by non-dental staff to sift requests for out-of-hours emergency dental care.

Dental Care↗

Evaluation of a new treadmill exercise protocol.

STUDY OBJECTIVES: To confirm that a newly drafted treadmill exercise protocol designed on a theoretical basis to span a range of 0 to 200 W with approximately 25-W increments by alteration of either speed or grade from one stage to the next should correspond to a standard bicycle protocol consisting of 25-W steps. DESIGN: Randomized, crossover study to compare both exercise test modes. STUDY PARTICIPANTS: Twenty-one consecutive healthy volunteers. INTERVENTIONS: Subjects underwent both exercise tests until either exhaustion or completion of the respective protocol, and cardiopulmonary exercise parameters were assessed during either of them. For comparison, correlation coefficients (r) were calculated. RESULTS: Exercise tolerance time was 9% higher on the treadmill (p<0.05). Ten subjects completed the bicycle program, whereas 18 subjects did so on the treadmill. With both protocols, there were comparably linear increases in heart rate (r=0.885), oxygen uptake (r=0.925), oxygen uptake per body weight (r=0.944), carbon dioxide output (r=0.937), and minute ventilation (r=0.914). For the 2-min stage duration, a plateau in oxygen uptake was achieved with neither protocol. The ventilatory equivalent for oxygen, which is not linear, showed its minimum at comparable workloads, at the point of surpassing the anaerobic threshold. Correlation of oxygen pulse was fair (r=0.896). CONCLUSIONS: There was an excellent correlation of the parameters with respect to both measured values at identical workloads and slopes of both protocols, thus enabling comparability of treadmill and bicycle ergometry. Due to its practical handling, the new protocol may facilitate acceptance, especially when used for elderly or disabled patients.

Adult↗

Effects of differential stretching protocols during warm-ups on high-speed motor capacities in professional soccer players.

The purpose of this study was to examine the effects of different modes of stretching within a pre-exercise warm-up on high-speed motor capacities important to soccer performance. Eighteen professional soccer players were tested for countermovement vertical jump, stationary 10-m sprint, flying 20-m sprint, and agility performance after different warm-ups consisting of static stretching, dynamic stretching, or no stretching. There was no significant difference among warm-ups for the vertical jump: mean +/- SD data were 40.4 +/- 4.9 cm (no stretch), 39.4 +/- 4.5 cm (static), and 40.2 +/- 4.5 cm (dynamic). The dynamic-stretch protocol produced significantly faster 10-m sprint times than did the no-stretch protocol: 1.83 +/- 0.08 seconds (no stretch), 1.85 +/- 0.08 seconds (static), and 1.87 +/- 0.09 seconds (dynamic). The dynamic- and static-stretch protocols produced significantly faster flying 20-m sprint times than did the no-stretch protocol: 2.41 +/- 0.13 seconds (no stretch), 2.37 +/- 0.12 seconds (static), and 2.37 +/- 0.13 seconds (dynamic). The dynamic-stretch protocol produced significantly faster agility performance than did both the no-stretch protocol and the static-stretch protocol: 5.20 +/- 0.16 seconds (no stretch), 5.22 +/- 0.18 seconds (static), and 5.14 +/- 0.17 seconds (dynamic). Static stretching does not appear to be detrimental to high-speed performance when included in a warm-up for professional soccer players. However, dynamic stretching during the warm-up was most effective as preparation for subsequent high-speed performance.

Acceleration↗

Training parents to implement pediatric feeding protocols.

Four different multicomponent training packages were evaluated to increase the treatment integrity of parents implementing pediatric feeding protocols. In Study 1 we exposed 3 parents to a training package that consisted of written protocols (baseline), verbal instructions, therapist modeling, and rehearsal training. Results suggested that the package was successful in increasing treatment integrity of the feeding protocols to high levels. Study 2 investigated three different parent-training packages comprised of components used in Study 1. Two parents were exposed to written protocols, verbal instructions, and modeling; 2 parents were exposed to written protocols, verbal instructions, and rehearsal; and 2 parents were exposed to written protocols and verbal instructions. Results of Study 2 showed that each parent-training package produced very high treatment integrity. Follow-up data in the clinic and home for 5 participants suggested that the results were durable for up to 3 months. These results demonstrate a first step in the transfer and application of research findings into routine clinical practice because we evaluated several methods for training parents to implement behavioral feeding protocols, and we demonstrated that these methods resulted in high levels of treatment integrity in a controlled clinical setting.

Behavior Therapy↗

The effectiveness of an abuse assessment protocol in public health prenatal clinics.

OBJECTIVES: This study evaluated whether incorporation of an abuse assessment protocol into the routine procedures of the prenatal clinics of a large urban public health department led to increased referral for and assessment, identification, and documentation of abuse. METHODS: Evaluation was conducted at 3 matched prenatal clinics serving a total of 12,000 maternity patients per year. Two clinics used the abuse protocol and 1 did not. An audit was performed at the clinics on a randomly selected sample of 540 maternity patient charts for the 15 months before the protocol was initiated and of 540 records for the 15 months after the protocol was introduced. Ninety-six percent of the patients represented in the sample were Latina. RESULTS: At the clinics using the protocol, abuse assessment increased from 0 to 88%. Detection of abuse increased from 0.8% to 7%. There were no changes at the comparison clinic. CONCLUSIONS: Incorporation of an abuse assessment protocol into the routine procedures of public health department prenatal clinics increases the assessment, identification, and documentation of and referral for abuse among pregnant women. An abuse protocol should be a routine part of maternity care.

Adult↗

Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. Improvement with a standard protocol.

BACKGROUND: An ipsilateral fracture of the femoral neck is seen in association with 1% to 9% of femoral shaft fractures, and 20% to 50% of these injuries are missed initially. Recognition of an associated femoral neck fracture prior to stabilization of the femoral shaft fracture is imperative to avoid or minimize complications of displacement and osteonecrosis. METHODS: A protocol to look for a femoral neck fracture in all patients with a femoral shaft fracture was instituted at a single level-I trauma center. This protocol consisted of a dedicated anteroposterior internal rotation plain radiograph, a fine (2-mm) cut computed tomographic scan through the femoral neck, and an intraoperative fluoroscopic lateral radiograph prior to fixation as well as postoperative anteroposterior and lateral radiographs of the hip in the operating room prior to awakening the patient. A chi-square analysis comparing pre-protocol and post-protocol fracture prevalences was used to assess the relative risk of missing an associated femoral neck fracture. RESULTS: Two hundred and sixty-eight consecutive patients with a femoral shaft fracture formed the basis of the study group. Of 254 who were followed for at least two months, sixteen were identified as having an associated ipsilateral femoral neck fracture with use of the protocol. Thirteen associated femoral neck fractures were identified before the patient entered the operating room for definitive fixation, and twelve of them were identified with the fine-cut computed tomographic scan. One fracture was identified intraoperatively. There was one iatrogenic fracture and one delayed diagnosis of a femoral neck fracture. With this protocol, we reduced the delay in diagnosis by 91% as compared with our experience in the year prior to the initiation of the protocol. CONCLUSIONS: In the presence of a femoral shaft fracture, evaluation of the femoral neck with fine-cut computed tomography and dedicated internal rotation hip radiographs significantly improves the ability to diagnose an associated femoral neck fracture.

Adult↗

Hepatic enhancement during helical CT: a comparison of moderate rate uniphasic and biphasic contrast injection protocols.

OBJECTIVE: The purpose of this study was to compare the degree and timing of peak hepatic enhancement, optimal scanning intervals, and optimal delay times of moderate-rate uniphasic and biphasic contrast material injection protocols for hepatic helical CT. MATERIALS AND METHODS: One hundred fifty patients were randomized into three injection protocols, receiving 42.3 g iodine (150 ml iothalamate meglumine) delivered using 3 ml/sec uniphasic, 2 ml/sec uniphasic, or biphasic (3 ml/sec [50 ml], 1 ml/sec [100 ml]) technique. Statistically fitted aortic and hepatic enhancement curves were generated from dynamic incremental CT data for each patient. Protocols were compared by maximum hepatic enhancement, and contrast enhancement indices were modeled for a 38-sec helical acquisition. RESULTS: The 3 ml/sec and 2 ml/sec uniphasic protocols produced higher peak hepatic enhancement (64 +/- 15 H and 62 +/- 15 H [mean +/- 1 SD]) than the 3 ml/sec biphasic protocol (52 +/- 10 H; p < .001). Contrast enhancement indices for the 3 ml/sec uniphasic and 2 ml/sec uniphasic protocols (385 +/- 398 H/sec and 397 +/- 412 H/sec) were significantly greater than the index for the 3 ml/sec biphasic protocol (123 +/- 194 H/sec; p < .0001) at a 50-H threshold. Optimal scan delay times were 50 +/- 8, 75 +/- 7, and 119 +/- 8 sec, respectively, for the 3 ml/sec uniphasic, 2 ml/sec uniphasic, and 3 ml/sec biphasic techniques. CONCLUSION: The moderate-rate uniphasic injections studied provided greater hepatic enhancement throughout the helical acquisition without requiring the prohibitively long delay time necessitated by the moderate-rate biphasic injection. These findings differ from prior results that showed that a uniphasic injection may provide comparable levels of hepatic enhancement when compared with a high-flow-rate biphasic injection.

Adult↗

Effect of four sedative and anesthetic protocols on quantitative thyroid scintigraphy in euthyroid cats.

OBJECTIVES: To determine the effect of sedation and anesthesia on thyroid and salivary gland uptake of technetium Tc 99m pertechnetate ((99m)TcO(4)) in euthyroid cats. ANIMALS: 6 euthyroid cats. PROCEDURES: Thyroid scintigraphy was performed by use of a high-resolution low-energy parallel-hole collimator after IV injection of 117 to 133 MBq (3.16 to 3.59 mCi) of (99m)TcO(4)(-). The procedure was performed 4 times on each cat during different sedative and anesthetic protocols in a rotating schedule as follows: propofol, ketamine-midazolam-atropine, ketaminemidazolam, and medetomidine. Regions of interest were drawn around thyroid and salivary glands and counts corrected for background and decay. Percentage of (99m)TcO(4)(-) uptake in salivary and thyroid glands and thyroid-to-salivary gland (99m)TcO(4)(-) uptake ratio were calculated at 20 and 40 minutes. Relative effects of anesthesia and sedation on salivary and thyroid gland (99m)TcO(4)(-) uptake were compared. RESULTS: Significant differences among sedativeanesthetic protocols were found for thyroid gland (99m)TcO(4)(-) uptake, salivary gland (99m)TcO(4)(-) uptake, and thyroid-to-salivary gland (99m)TcO(4)(-) uptake ratio. Thyroid gland (99m)TcO(4)(-) uptake for the ketamine-midazolam protocol at 20 and 40 minutes after (99m)TcO(4)(-) administration was significantly higher than for the propofol protocol. A significant difference in salivary gland(99m) TcO(4)(-) uptake was found between ketamine-midazolam and ketamine-midazolam-atropine protocols at 40 minutes. The thyroid-to-salivary gland (99m)TcO(4)(-) uptake ratio for the ketamine-midazolam protocol was significantly higher at 40 minutes than for propofol or ketamine-midazolam-atropine protocols. CONCLUSIONS AND CLINICAL RELEVANCE: Sedation and anesthesia have a significant effect on thyroid and salivary gland (99m)TcO(4) uptake in euthyroid cats that may interfere with thyroid scintigraphic image interpretation.

Anesthetics↗

Methods to reduce or eliminate detection of estrus in a melengestrol acetate-PGF2alpha protocol for synchronization of estrus in beef heifers.

Three experiments were conducted to evaluate methods to decrease or eliminate the detection of estrus inherent to a melengestrol acetate (MGA)-PGF2alpha (PGF) protocol for synchronization of estrus in heifers. In each experiment, all heifers received 0.5 mg of MGA x animal(-1) x d(-1) for 14 d (d -32 to -19) and PGF (25 mg, i.m.; d 0, 0 h) 19 d after the last feeding of MGA (MGA-PGF protocol). In Exp. 1, heifers (n = 709) were assigned to each of the following protocols: 1) the MGA-PGF protocol with AI 6 to 12 h after detection of estrus (estrus AI; MGA-PGF); 2) MGA-PGF plus 100 microg, i.m. of GnRH on d -7 (1x GnRH) and estrus AI; or 3) MGA-PGF, GnRH on d -7, and GnRH (100 microg, i.m.) at 48 h after PGF, coincident with insemination (2x GnRH-TB48). In Exp. 2, heifers (n = 559) received the MGA-PGF protocol and were inseminated by either estrus AI or fixed-time AI (TAI) at 60 h, coincident with an injection of GnRH (GnRH-TB60). In Exp. 3, all heifers (n = 460) received the MGA-PGF protocol and were inseminated by estrus AI when detected up to 73 h. Heifers not observed in estrus by 73 h received TAI between 76 and 80 h. Half the heifers inseminated by TAI received no further treatment (TB80), and the remaining half was injected with GnRH at insemination (GnRH-TB80). Variance associated with the interval to estrus and the proportion in estrus from d 0 to 5 was similar for 1x GnRH and MGA-PGF treatments in Exp. 1. Pregnancy rate (d 0 to 5) did not differ for the MGA-PGF and 1x GnRH treatments (62.5 and 60.4%, respectively), and both were greater (P < 0.05) than TAI pregnancy rate in the 2x GnRH-TB48 treatment (42.3%). In Exp. 2, the peak estrous response occurred 60 h after PGF. Pregnancy rate during the synchrony period was greater (P < 0.05) for the MGA-PGF (255/401; 63.6%) than the GnRH-TB60 (74/158; 46.6%) treatment. In Exp. 3, 75.7% of heifers (348/460) were detected in estrus by 73 h and were inseminated, with a conception rate of 74.4%. Pregnancy rates after TAI did not differ between TB80 and GnRH-TB80 (14/56 = 25% and 19/ 56 = 33.9%, respectively). Total pregnancy rate was 63.5% for heifers inseminated after detected estrus and by TAI. Collectively, these data indicate that the exclusive use of TAI for heifers treated with the MGA-PGF protocol resulted in lower pregnancy rates than when AI was performed after detection of estrus. However, estrus AI for 3 d and TAI at the end of d 3 could result in pregnancy rates similar to those achieved after a 5-d period of detecting estrus.

Animals↗

Comparison of a blocking vs. a flare-up protocol in poor responders with a normal and abnormal clomiphene citrate challenge test.

This study aimed to standardize the clomiphene citrate test (CC-t) in our laboratory while comparing two different protocols of controlled ovarian stimulation in poor responders. One hundred and forty-four patients scheduled for assisted reproductive techniques were submitted to the CC-t within 3 months before starting stimulation; 133 underwent controlled ovarian stimulation with a blocking protocol. Poor responders in the first cycle (n = 30) were subsequently treated with a flare-up protocol. Although it was not statistically significant, more patients reached oocyte retrieval with the flare-up protocol. In the completed cycles, more gonadotropin ampules (55 +/- 15 vs. 34 +/- 13; p < 0.001) and more stimulation days (12.6 +/- 1 vs. 11.6 +/- 1.2; p < 0.005) were needed in the blocking than in the flare-up protocol. No difference was observed in peak 17 beta-estradiol levels, preovulatory follicles, oocytes retrieved or pregnancy rate between the two protocols. According to the threshold values, established on CC-t of patients who obtained a clinical pregnancy (n = 44), the incidence of abnormal results was 10%. All but one patient with abnormal CC-t were poor responders during the first stimulation cycle. The flare-up protocol did not improve the ovarian response in these patients.

Adult↗

A comparison of concurrent and retrospective verbal protocol analysis.

In verbal protocol analysis, verbalization can occur either during decision making (concurrent data) or after (retrospective data). Although both methods have advantages and disadvantages, no empirical research has focused on a direct comparison. This study compared the effectiveness of concurrent and retrospective data for revealing the human decision making process. In general, the concurrent protocol analysis method outperformed the retrospective method. Not only was the number of concurrent protocol segments elicited higher than that of retrospective protocol segments, but concurrent data provided more insights into the decision-making steps occurring between stimulus introduction and the final choice outcome. However, retrospective protocols offer an interesting advantage: More statements about the final choice are provided in retrospective protocols than in concurrent protocols.

Data Collection↗

Effect of prophylactic polishing protocols on the surface roughness of esthetic restorative materials.

Many polishing protocols have been evaluated in vitro for their effect on the surface roughness of restorative materials. These results have been useful in establishing protocols for in vivo application. However, limited research has focused on the subsequent care and maintenance of esthetic restorations following their placement. This investigation evaluated the effect of five polishing protocols that could be implemented at recall on the surface roughness of five direct esthetic restorative materials. Specimens (n=25) measuring 8 mm diameter x 3 mm thick were fabricated in an acrylic mold using five light-cured resin-based materials (hybrid composite, microfilled composite, packable composite, compomer and resin-modified glass ionomer). After photopolymerization, all specimens were polished with Sof-Lex Disks to produce an initial (baseline) surface finish. All specimens were then polished with one of five prophylactic protocols (Butler medium paste, Butler coarse paste, OneGloss, SuperBuff or OneGloss & SuperBuff). The average surface roughness of each treated specimen was determined from three measurements with a profilometer (Surface 1). Next, all specimens were brushed 60,000 times at 1.5 Hz using a brush-head force of 2 N on a Manly V-8 cross-brushing machine in a 50:50 (w/w) slurry of toothpaste and water. The surface roughness of each specimen was measured after brushing (Surface 2) followed by re-polishing with one of five protocols, then final surface roughness values were determined (Surface 3). The data were analyzed using repeated measures ANOVA. Significant differences (p=0.05) in surface roughness were observed among restorative materials and polishing protocols. The microfilled and hybrid resin composite yielded significantly rougher surfaces than the other three materials following tooth brushing. Prophylactic polishing protocols can be used to restore a smooth surface on resin-based esthetic restorative materials following simulated tooth brushing.

Analysis of Variance↗

A simple and sensitive pulsed field gel electrophoresis protocol to study 50 kb apoptotic DNA fragmentation in human lymphocytes.

DNA fragmentation of 50 kb is observed in apoptotic human lymphocytes as measured with pulsed field gel electrophoresis (PFGE). Standard PFGE assay involves embedding of cells into agarose blocks followed by lysis in the presence of proteinase K. In this study, we modified the PFGE protocol by omitting the proteinase K. In this study, we modified the PFGE assay by omitting the proteinase K and changing lysis solution according to the method of anomalous viscosity time dependence (AVTD). The conditions of PFGE were adjusted aiming to compress apoptotic fragments, increasing sensitivity and the number of samples that could be loaded on the same gel. Lymphocytes were irradiated with gamma-rays and apoptotic fragmentation of DNA was determined by PFGE using standard lysis with proteinase K and lysis protocol from AVTD method. Both protocols of lysis resulted in the same pattern of DNA fragments. The yield of radiation-induced apoptotic fragmentation was higher with the AVTD protocol of lysis. The novel PFGE protocol is simple and relatively non-expensive, requires only 7 h running time and gives a possibility to analyse simultaneously up to 69 samples in the same gel. The sensitivity of our protocol provides reproducible detection of 50 kb fragmentation after irradiation of human lymphocytes with 5 cGy of gamma-rays. In 2 of 6 donors tested, this DNA fragmentation was detected at dose on 2 cGy. The novel protocol can be used for quantification of 50 kb apoptotic fragments induced by different agents including low dose ionising radiations, chemicals and electromagnetic fields.

DNA Fragmentation↗

[Quantitative analysis of Sokal's risk index in relation to 2 therapy protocols: their respective impact on clinical remission of chronic myeloid leukemia].

OBJECTIVE: To quantitatively evaluate the impact of Sokal's risk index and that of 2 therapy protocols on the clinical outcome of patients with chronic myeloid leukemia (CML). METHODS: With the assistance of Access 2000 database of CML, 94 patients with CML were grouped on the basis of either different therapy protocols utilizing harringtonine plus Ara-C (HA) vs hydroxyurea (Hu) or Sokal scores, and the impact of therapy protocol and risk profile were quantitatively evaluated respectively. RESULT: Treatment protocol utilizing HA was incapable of lengthening the duration of chronic phase (DCP) of CML, regardless of its better short-term effect than that of Hu. The impact of risk profile of the patients on clinical remission rate and DCP was more significant than that of the therapy protocols. CONCLUSION: HA should not be used as the first-line protocol in the treatment of CML patients in chronic phase who have not received any previous medical intervention. Patients should be categorized according to the risk profile for choosing appropriate treatment protocol and making better clinical judgement.

Adolescent↗

[Impact of the protocol of ABO group and irregular antibodies on the transfusional index].

OBJECTIVES: The ABO group/irregular red cell antibodies (G/A) protocol is a scheme for reducing the number of unnecessary crossmatch tests in selected patients scheduled for surgery. Reduction would lower expenses and risks related to the overuse of such tests. Studying transfusion rates allows us to predict which patients are candidates for application of the protocol. The present study evaluated the impact of the G/A protocol on transfusion rate. PATIENTS AND METHODS: A retrospective analysis of pre-transfusion testing of patients in our hospital in 1996, before application of the G/A protocol, and in 2001, after four years of experience with the scheme. RESULTS: The G/A protocol was followed with 194 patients in 2001. The surgical transfusion rate decreased by 27.8% over the rate for 1996 (1.84 vs. 2.55). The outdating of blood units in 2001 decreased by 42.4% (65 units outdated vs. 113). Only one patient subject to the protocol had to be transfused. CONCLUSION: The transfusion rate can be significantly reduced by applying the G/A protocol with selected patients, with no loss of transfusion safety.

ABO Blood-Group System↗

Protocol optimization of multidetector computed tomography colonography using pig colonic phantoms.

OBJECTIVE: The introduction of multidetector computed tomography (CT) increases the possibility of enhanced polyp detection using CT colonography. The effects of collimation and tube currents on polyp detection were investigated in pig colonic phantoms to determine the optimal scanning parameters. MATERIALS AND METHODS: Twenty pig colons were prepared, and polyps with diameters ranging from 3 mm to 15 mm were created and randomly distributed. There was a total of 60 polyps; 20 polyps were 3 to 5 mm in size, 21 polyps 6 to 9 mm, and 19 polyps 10 to 15 mm. The pig colons were sealed, distended with air, submerged in water, and were arranged to mimic the in vivo arrangement. CT was performed using a 4-row multidetector CT scanner with collimations of 1, 2.5, and 5 mm, a pitch of 1.75, and mA of 100. A low-dose protocol (mA of 50) was added with a collimation of 1 mm. Two blinded observers independently analyzed the datasets. RESULTS: : The overall sensitivities of CT colonography were 94.2% with 1-mm collimation, 80% with 2.5-mm collimation, and 75% with 5-mm collimation. Considering the sensitivity of each protocol for the size of the polyps, the 1-mm collimation protocol had a sensitivity of 87.5% for 3- to 5-mm polyps, 95.2% sensitivity for 6- to 9-mm polyps, and 100% sensitivity for 10- to 15-mm polyps; the 2.5-mm protocol had 50%, 92.9%, and 97.4% sensitivities, respectively; and the 5-mm protocol had 47.5%, 88.1%, and 89.5% sensitivities, respectively, for the respective polyp size group. A significant difference in sensitivity among the protocols was present in the 3- to 5-mm polyps. No significant difference was seen between the standard- and the low-dose protocols. CONCLUSIONS: The sensitivity of multidetector CT colonography for detecting polyps larger than 5 mm is robust over a range of collimation in pig colonic phantoms. However, reliable detection of polyps 5 mm or smaller requires a 1-mm collimation. Sensitivity is not influenced by lowering the mA from 100 to 50.

Animals↗