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PubMed2002

Depot versus daily administration of gonadotrophin releasing hormone agonist protocols for pituitary desensitization in assisted reproduction cycles.

BACKGROUND: Gonadotrophin-releasing hormone agonist (GnRHa) has been widely used in cycles of in vitro fertilization (IVF). Among the various types of GnRHa ovarian stimulation protocols, the long protocol presents the best clinical pregnancy rates per cycle initiated (GnRHa administration until the suppression of ovarian activity is evident, within approximately 14 days). There are two types of GnRHa administration that can be used to lead to hypophysis desensitization in the IVF cycle in the long protocol: one consisting of daily GnRHa low doses, and another with the administration of analogues in higher long-acting doses (depot). There are controversies in the data as far as the number of ampoules to be used in the cycles with the depot GnRHa treatment, as well as regarding the number of follicles made available, the number of oocytes, fertilization, implantation and pregnancy rates. OBJECTIVES: The objective of this study is to compare the use of a single long-acting depot dose to that of daily GnRHa doses in in vitro fertilization cycles. SEARCH STRATEGY: Relevant RCTs were identified by electronic search of the following databases: MEDLINE, EMBASE, LILACS (Latin American and Caribbean Center on Health Sciences Information) and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Types of studies: The study analyses RCTs comparing depot and daily administration of GnRHa for long protocols in IVF treatment cycles. TYPES OF PARTICIPANTS: Couples with any cause of infertility. Types of interventions: Ovarian stimulation with human follicle stimulating hormone (hFSH) and/or human menopausal gonadotropin (hMG) and/or recombinant follicle stimulating hormone (rFSH) in IVF treatment cycles. Types of outcome measures: Clinical pregnancy rates per woman, per oocyte retrieval procedure, per embryo transfer, number of oocytes retrieved, oocyte fertilization rates, ongoing/delivered pregnancy rates per cycle started, abortion rates, multiple pregnancy rates, number of ampoules of gonadotropin employed, ovarian hyperstimulation syndrome (OHSS) incidence rates, cost analysis and patient convenience. DATA COLLECTION AND ANALYSIS: The reviewers evaluated allocation concealment, classified as adequate, uncertain or inadequate. Two reviewers extracted the data independently. All analyses were performed according to the intention-to-treat method. MAIN RESULTS: Six studies, with a total of 552 women, were included and analysed. The studies do not indicate that there is statistically significant difference between the use of depot GnRHa or daily GnRHa in the primary outcome, clinical pregnancy rates per woman (OR 0.94, 95% CI 0.65 to 1.37). However, there was sufficient evidence that the use of depot GnRHa for pituitary desensitization in IVF cycles increased the number of gonadotrophins ampoules (WMD 3.30, 95% CI 1.27 to 5.34) and the duration of the ovarian stimulation (WMD 0.56, 95% CI 0.31 to 0.81), as compared with daily GnRHa. REVIEWER'S CONCLUSIONS: Although we recognise that the clinical pregnancy rates per woman are not the ideal primary outcome, we found no evidence of differences between the long protocol using depot or daily GnRHa for IVF cycles. However, the use of depot GnRHa is associated with increased requirements for gonadotrophins and a longer time required for ovarian stimulation. If these differences could be shown to translate into economic benefit, depot GnRHa should increase the overall costs of IVF treatment.

Delayed-Action Preparations↗

PubMed2005

Depot versus daily administration of gonadotrophin releasing hormone agonist protocols for pituitary desensitization in assisted reproduction cycles.

BACKGROUND: Gonadotrophin-releasing hormone agonist (GnRHa) has been widely used in cycles of in vitro fertilization (IVF). Among the various types of GnRHa ovarian stimulation protocols, the long protocol presents the best clinical pregnancy rates per cycle initiated (GnRHa administration until the suppression of ovarian activity is evident, within approximately 14 days). There are two types of GnRHa administration that can be used to lead to hypophysis desensitization in the IVF cycle in the long protocol: one consisting of daily GnRHa low doses, and another with the administration of analogues in higher long-acting doses (depot). There are controversies in the data as far as the number of ampoules to be used in the cycles with the depot GnRHa treatment, as well as regarding the number of follicles made available, the number of oocytes, fertilization, implantation and pregnancy rates. OBJECTIVES: The objective of this study is to compare the use of a single long-acting depot dose to that of daily GnRHa doses in in vitro fertilization cycles. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of trials (searched 15 April 2004), Cochrane Central Register of Controlled Trials (Issue 2, 2004), MEDLINE (1984 to April 2004), EMBASE (1984 to June 2003), LILACS (1984 to April 2004) and reference lists of articles. SELECTION CRITERIA: Types of studies: RCTs comparing depot and daily administration of GnRHa for long protocols in IVF treatment cycles. TYPES OF PARTICIPANTS: Couples with any cause of infertility. Types of interventions: Ovarian stimulation with human follicle stimulating hormone (hFSH) and/or human menopausal gonadotropin (hMG) and/or recombinant follicle stimulating hormone (rFSH) in IVF treatment cycles. Types of outcome measures: Clinical pregnancy rates per woman, per oocyte retrieval procedure, per embryo transfer, number of oocytes retrieved, oocyte fertilization rates, ongoing/delivered pregnancy rates per cycle started, abortion rates, multiple pregnancy rates, number of ampoules of gonadotropin employed, ovarian hyperstimulation syndrome (OHSS) incidence rates, cost analysis and patient convenience. DATA COLLECTION AND ANALYSIS: The reviewers evaluated allocation concealment, classified as adequate, uncertain or inadequate. Two reviewers extracted the data independently. All analyses were performed according to the intention-to-treat method. MAIN RESULTS: Six studies, with a total of 552 women, were included and analysed. The studies do not indicate that there is statistically significant difference between the use of depot GnRHa or daily GnRHa in the primary outcome, clinical pregnancy rates per woman (OR 0.94, 95% CI 0.65 to 1.37). However, there was sufficient evidence that the use of depot GnRHa for pituitary desensitization in IVF cycles increased the number of gonadotrophins ampoules (WMD 3.30, 95% CI 1.27 to 5.34) and the duration of the ovarian stimulation (WMD 0.56, 95% CI 0.31 to 0.81), as compared with daily GnRHa. AUTHORS' CONCLUSIONS: Although we recognise that the clinical pregnancy rates per woman are not the ideal primary outcome, we found no evidence of differences between the long protocol using depot or daily GnRHa for IVF cycles. However, the use of depot GnRHa is associated with increased requirements for gonadotrophins and a longer time required for ovarian stimulation. If these differences could be shown to translate into economic benefit, depot GnRHa should increase the overall costs of IVF treatment.

Delayed-Action Preparations↗

PubMed2001

Comparison of protocols for pulsed-field gel electrophoresis of Clostridia.

Genotyping of bacterial strains via pulsed-field gel electrophoresis has to be considered an important tool for epidemiological investigations in food hygiene as well as in other areas. Yet, a major disadvantage of this method is its long duration. Therefore, rapid procedures for DNA isolation and restriction are being sought. One such protocol was modified and further shortened to two days. This short protocol was used for macrorestriction analysis of 34 strains of 25 different Clostridium species. Parallel analyses were performed using a conventional 5-day protocol in order to compare the long and the short method by running the DNA samples obtained via both protocols on the same gel. In the case of nine strains, none of the two methods yielded satisfactory results, whereas for three strains the long protocol proved to be preferable to the short one. Comparable results were obtained using both methods in the case of 22 strains belonging to 17 different Clostridium species.

Clostridium↗

PubMed2026

The Case for Master Protocols for Rare Neurological Diseases.

Master protocol trials allow for simultaneous multiple hypothesis testing within a common framework and might be applicable for rare diseases. In May 2025, the Network for Excellence in Neuroscience Clinical Trials convened a multistakeholder conference to discuss master protocol trials in rare neurological disorders. In this paper, we explore how master protocol trial designs may apply to rare neurological disorders, using the neuronal ceroid lipofuscinoses as an example. Through shared protocol elements and trial infrastructure, master protocols may decrease cost and improve efficiency in testing potential therapeutics in rare disease, accelerating the delivery of urgently needed therapies to patients. ANN NEUROL 2026;100:477-486.

Humans↗

PubMed2026

DNA Extraction Optimisation for Minute Land Snails of Vertigo Müller, 1773 (Gastropoda: Vertiginidae): A Comparative Evaluation of Six Methods, Including a Non-Destructive Shell-Preserving Protocol.

No systematic comparison of DNA extraction strategies exists for minute Vertiginidae (shell height < 3 mm), a group posing a dual analytical challenge: extremely low tissue input and co-purified PCR-inhibitory mucus. For legally protected species, an additional requirement to preserve the shell voucher further constrains available protocols. Using Vertigo antivertigo as the model species, we compared six approaches applied to specimens preserved in 96% ethanol (n = 10 per method): two HotSHOT alkaline-lysis protocols (destructive and non-destructive shell-preserving variants), a modified CTAB protocol supplemented with PVP-40 and DTT, and three commercial silica-column kits (GeneJET Genomic, DNeasy Blood & Tissue, QIAamp DNA Micro). DNA yields were quantified by QuantiFluor fluorometry, and PCR performance was subsequently assessed across four loci (COI barcode, COI mini-barcode, ITS1, ITS2). DNeasy Blood & Tissue produced the highest fluorometric concentrations; QIAamp DNA Micro and CTAB + PVP-40 gave intermediate values. The shell-preserving HotSHOT variant yielded lower concentrations but improved A260/230 ratios. BSA and trehalose supplementation increased PCR success in inhibition-prone HotSHOT extracts from 70% to 100%. ITS1 Sanger sequencing of three Vertigo species listed in Annex II of the EU Habitats Directive, all extracted with the shell-preserving protocol, confirmed species-level identification (99.8%-100% BLASTn identity; mean Phred Q > 51). The shell-preserving non-destructive HotSHOT protocol yields sequenceable DNA from protected Vertiginidae while retaining the morphological voucher, making it the preferred option for conservation-genetic monitoring. The practical decision framework documented here-integrating voucher preservation, amplification robustness and per-sample cost-has broad applicability to other minute terrestrial gastropods processed in large-scale biodiversity surveys.

Habitats Directive↗

PubMed1985

Screening program theory: decision functions and protocols.

A screening program is defined to include a set of tests, a decision function, and a protocol. The major characteristics of a screening program are the error rates of the individual tests, the overall error rates of the program, the costs of the individual tests, and the overall program costs. It is shown how to calculate the program error rates for any given decision function. The concept of a screening protocol is developed and a method for enumerating all protocols of a given decision function is given. A given protocol has two calculable costs: the average cost of testing a mutagen and the average cost of calculating a nonmutagen. A method for calculating these costs for any protocol is given. All decision functions utilizing up to five tests are enumerated.

Costs and Cost Analysis↗

PubMed1981

A single-dose protocol for azaserine initiation of pancreatic carcinogenesis in the rat.

Previously, the induction of pancreatic carcinogenesis in the rat using azaserine has involved a multiple-dose treatment protocol. The objective of the present study was to determine the effect of multiple azaserine treatments on pancreatic DNA synthesis and to develop a protocol for a single-dose initiation of pancreatic carcinogenesis by azaserine in the rat. Pancreatic DNA synthesis in young rats, which was determined by measuring the amount of [3H]-thymidine incorporation into DNA, was found to be elevated at 4.3 weeks of age and to decrease to a baseline level by 6.3 weeks. Treatment of 4-week-old rats with azaserine resulted in a dose-dependent inhibition of [3H]-thymidine incorporation into both pancreatic and liver DNA. Maximum inhibition was seen at 10 mg/kg body weight. This inhibition was followed by a gradual return of incorporation to normal values over a 48 h period. One week following pretreatment with four weekly injections of azaserine at 30 mg/kg, [3H]-thymidine incorporation into pancreatic and liver DNA was significantly elevated, suggesting that multiple injection protocols caused enhanced DNA synthesis which could have a co-carcinogenic and/or promotional effect. Single-doses of azaserine (10, 30 and 60 mg/kg) given at 7 weeks of age caused the appearance of more atypical acinar cell nodules (AACN) than when given at 5 weeks of age. The most effective dose was 30 mg/kg. Using alkaline elution, we determined that this response was due to the occurrence of more DNA damage in the 7-week-old animals. Thus, these results demonstrate a rationale for the use of single-dose initiation protocols in the pancreas. An effective single-dose protocol for induction of AACN in azaserine-treated rats fed semi-synthetic diet is presented.

Animals↗

PubMed1997

Pathological changes in yearly protocol liver biopsy specimens from healthy pediatric liver recipients.

Many centers perform biopsies on transplanted livers annually to assess allograft function because serum biochemical tests do not always correlate with histological findings. Although criteria exist for diagnosing acute cellular rejection, no similar criteria exist to describe the histopathological changes observed in the "normal" liver of an immunosuppressed but healthy child. The purpose of this study was to define the histopathological changes in the allografted livers of healthy children who have undergone transplantation and to evaluate them during long-term follow-up. One hundred fifty-eight yearly protocol liver biopsy specimens of 54 children who received transplants between January 1988 and March 1996 and at least 1 year of follow-up were reviewed, and the biopsy findings were correlated with those of serum tests of liver function performed concomitantly. Thirty-three biopsy specimens were excluded because serum transaminase levels were abnormal, the biopsy specimen was abnormal and diagnostic for a specific lesion, or follow-up showed progression of a specific disease process. In addition, time zero biopsy specimens from 21 of the 54 children were available for comparison. In the protocol biopsy specimens, portal and/or parenchymal mononuclear inflammatory infiltrates were frequent findings (48% and 25%, respectively). Other less common features were mild fibrosis (8%) and focal pericholangitis (6%). Findings in both protocol and time zero biopsy specimens included minimal to mild bile ductular proliferation (15% and 9.5%, respectively) and rare hepatocyte necrosis (1.6% and 5%). No yearly protocol biopsy specimens resulted in any patient benefit. Transplanted livers in immunosuppressed children who are clinically healthy and have normal transaminase levels commonly show histological changes consisting of scattered, mild to moderate, portal and/or parenchymal mononuclear infiltrates that are clinically insignificant. Yearly protocol biopsies in healthy pediatric recipients have been abandoned by the investigators after 3 years of follow-up.

Biopsy↗

PubMed2005

A simplified 2-D electrophoresis protocol with the aid of an organic disulfide.

2-DE is still a relatively cumbersome and labor intensive method. Given the successful cysteinyl protection concept with hydroxyethyl disulfide (specific oxidation) during the first dimension separation, the possibility for a simplified equilibration procedure was investigated. This was achieved by maintaining the S-mercaptoethanol modified cysteinyls throughout the 2-D workflow including second dimension separation, spot handling, protein digestion, and protein identification. The traditional equilibration protocol encompassing thiol reduction and alkylation was compared with a one-step protocol employing continuous exposure to hydroxyethyl disulfide. Both equilibration protocols gave equally well-resolved spot maps with analytical protein loads regardless of IPG strip pH range. Using preparative protein loads, narrow range IPG strips gave comparable results for the two protocols while preparative load on wide range IPG strips was the only condition where classical reduction/alkylation outperformed hydroxyethyl disulfide equilibration. Moreover, with analytical protein loads, the hydroxyethyl disulfide equilibration time could be significantly reduced without apparent loss of spot map quality or quantitative protein transfer from the first- to the second dimension gel. MALDI-TOF mass spectrometric protein identification was successfully performed with either iodoacetamide or hydroxyethyl disulfide as the cysteine modifier, yielding comparable identification results with high confidence in protein assignment, sequence coverage, and detection of cysteine-containing peptides. The results provide a novel and simplified protocol for 2-DE where the concept of hydroxyethyl disulfide as the cysteinyl protecting agent is extended to cover the entire 2-D work flow.

Animals↗

PubMed2005

Comparison of cell-based and cell-free protocols for producing target proteins from the Arabidopsis thaliana genome for structural studies.

We describe a comparative study of protein production from 96 Arabidopsis thaliana open reading frames (ORFs) by cell-based and cell-free protocols. Each target was carried through four pipeline protocols used by the Center for Eukaryotic Structural Genomics (CESG), one for the production of unlabeled protein to be used in crystallization trials and three for the production of 15N-labeled proteins to be analyzed by 1H-15N NMR correlation spectroscopy. Two of the protocols involved Escherichia coli cell-based and two involved wheat germ cell-free technology. The progress of each target through each of the protocols was followed with all failures and successes noted. Failures were of the following types: ORF not cloned, protein not expressed, low protein yield, no cleavage of fusion protein, insoluble protein, protein not purified, NMR sample too dilute. Those targets that reached the goal of analysis by 1H-15N NMR correlation spectroscopy were scored as HSQC+ (protein folded and suitable for NMR structural analysis), HSQC+/- (protein partially disordered or not in a single stable conformational state), HSQC- (protein unfolded, misfolded, or aggregated and thus unsuitable for NMR structural analysis). Targets were also scored as X- for failing to crystallize and X+ for successful crystallization. The results constitute a rich database for understanding differences between targets and protocols. In general, the wheat germ cell-free platform offers the advantage of greater genome coverage for NMR-based structural proteomics whereas the E. coli platform when successful yields more protein, as currently needed for crystallization trials for X-ray structure determination.

Arabidopsis↗

PubMed1992

The effect of shuttle test protocol and the resulting lactacidaemia on maximal velocity and maximal oxygen uptake during the shuttle exercise test.

The purpose of this study was to investigate the influence of the shuttle test protocol (20-MST) and the resulting lactacidaemia on maximal velocity (Vmax) and maximal oxygen uptake (VO2max). Firstly, three randomly assigned tests to exhaustion were performed by 12 subjects: the treadmill test, the 20-MST, and a continuous running track test using the same prerecorded 1-min protocol as in the 20-MST (T1). One week later, subjects performed another track test, which was conducted up to the same level of effort as attained during the 20-MST (T2). For each test, Vmax, VO2max, lactate concentration at rest and during recovery, maximal heart rate, and distance covered were determined. The results indicated that the 20-MST underestimated Vmax; only T1 satisfactorily assessed Vmax (F = 15.49, P < 0.001). At the same level of effort, the peak blood lactate concentration (t = 2.7, P < 0.02) and VO2max (t = 11.35, P < 0.001) values were higher for the shuttle than for the continuous protocol. It was concluded that Vmax was limited by the running backwards and forwards in the protocol of the shuttle test. The higher values of peak blood lactate concentration and its earlier appearance obtained for the shuttle may have been one of the limiting factors of Vmax. However, the higher values of VO2max obtained for the 20-MST were most likely due to a combination of the relative hyperlactacidaemia and the biomechanical complexities required for this type of protocol.

Adolescent↗

PubMed1989

Biological assays for irritant, tumor-initiating and tumor-promoting activities. II. Standardized initiation/promotion protocol and semiquantitative estimation of promoting (or initiating) potencies in skin of NMRI mice.

A versatile standardized protocol of initiation/promotion of skin is described using 7,12-dimethylbenz[a]anthracene as initiator and diterpene esters as promoters in 28 female NMRI mice per promoter (or initiator) dose group including appropriate positive and negative controls ("standardized initiation/promotion protocol 28" or "protocol 28"). To monitor the weekly tumor responses, the tumor rate Tr and the tumor yield Ty were recorded per dose group collectively as a measure of the tumor-promoting (or initiating) activity of individual compounds; similarly the general health status of the group was controlled twice weekly by collective weighing of the dose group and recorded daily by the survival rate Sr. Synoptic consideration of Tr, Ty and the promoter dose (or initiator dose) at a set time period of exposure was used for the semiquantitative estimation of the relative tumor-promoting (or initiating) potency, referring to a high-potency promoter (or initiator) as standard. The full scope of utilization of "protocol 28" to determine comparable individual promoting activities and -at 24 weeks of exposure--relative tumor-promoting potencies (rtpp24) is demonstrated in typical examples with 12-O-tetradecanoylphorbol 13-acetate (TPA) as well as various other phorbol esters as promoters. For estimation of promoting potencies TPA is rated a rtpp24 of + + + +. The other phorbol derivatives exhibit rtpp24 between 0 and + + + +. In this manner, "protocol 28" was verified in 1000 promoter dose groups (i.e. 28,000 mice) to determine tumor-promoting activities of individual diterpene esters and partly also their rtpp24. Grading of tumor-promoting potencies of diterpene esters in skin by rtpp24 proved useful for evaluating the relative environmental risk involved in exposure to various diterpene esters as well as in comparative mechanistic investigations including structure/activity relationships. As an example, the correlation of irritancy and tumor-promoting potency of certain diterpene esters in epithelial tissue, postulated previously from essentially qualitative data, is verified in semiquantitative terms by comparison--as a typical example--of the irritancy of phorbol esters on the ear and of the corresponding rtpp24 on the back skin of NMRI mice.

9,10-Dimethyl-1,2-benzanthracene↗

PubMed1987

Three protocols for measuring subcutaneous fat thickness on the upper extremities.

Three protocols for measuring subcutaneous fat thickness were compared and their level of association determined in young adults. Subjects included 21 men and 21 women, 18-24 years of age. Skinfold calipers, A- and B-mode ultrasound were used to measure the thickness of the subcutaneous fat layer overlying the anterior and posterior aspects of the upper arm. Each protocol was independently administered within a 30-min block of time in a randomly rotated sequence. Significant differences (p less than 0.05) between protocols were observed depending upon site of measurement and gender of the subject. At both the anterior and posterior sites for men, B-mode and halved skinfold were similar but significantly less than A-mode measurements. At the anterior site for women, A-mode and skinfold were similar but significantly greater than B-mode measurements. At the posterior site for women, all three measurements were similar. Correlations between the protocols were positive with men's levels ranging from 0.59 to 0.74, while women's levels were from 0.39 to 0.89. It was concluded that although skinfold calipers, A-mode ultrasound, and B-mode ultrasound may be used to obtain moderately associated measurements of upper-arm subcutaneous fat thickness in young adults, the three protocols yield inconsistently similar data.

Adolescent↗

PubMed1987

Combination clomiphene citrate/human menopausal gonadotropin stimulation protocols for in vitro fertilization-embryo transfer.

Various protocols have been utilized for stimulation of multiple ovarian follicles in patients undergoing in vitro fertilization-embryo transfer (IVF-ET). Previous studies have suggested that the combination of clomiphene citrate (CC) and human menopausal gonadotropins (hMG) is superior to either CC or hMG alone in terms of follicular development, oocyte recovery, and embryo transfer. However, no significant increase in viable pregnancy rates has been reported with any of the protocols. This report examines five different CC/hMG protocols. While differences were seen in terms of serum estradiol response and fertilization rates of mature oocytes among the various protocols, no significant differences were found in terms of follicular development, oocyte recovery, embryo transfer, or pregnancy. The pregnancy rate in IVF-ET appears unaffected by variations in the dose and timing of CC and hMG in a combination protocol.

Adult↗

PubMed1996

Identifying the sex of human preimplantation embryos in X-linked disease: amplification efficiency of a Y-specific alphoid repeat from single blastomeres with two lysis protocols.

INTRODUCTION: Preimplantation diagnosis involves detecting genetic defects in one or two blastomeres biopsied from cleavage stage embryos following a vitro fertilization (IVF). For X-linked recessive disease, identification of the sex of embryos allows transfer of only unaffected females. To examine how critical the preparation of the single blastomere is for amplification of a Y chromosome specific repeat sequence using the polymerase chain reaction (PCR), the incidence of amplification failure has been examined following two lysis protocols. MATERIALS AND METHODS: Amplification of a Y alphoid repeat sequence from single blastomeres disaggregated from cleavage stage embryos was examined after either (1) lysis in distilled water and freeze-thawing twice or (2) a two-step lysis protocol involving an initial treatment in potassium hydroxide and dithiothreitol. Some of the embryos had been previously sexed by cleavage-stage biopsy and fluorescent in situ hybridization with X- and Y-specific probes. RESULTS: Amplification failure occurred in 6 of 50 (12%) and 4 of 60 (7%) single blastomeres from male embryos following lysis in distilled water or using the two-step protocol, respectively. Conversely, amplification from contaminating DNA occurred in 5 of 63 (8%) single blastomeres from female embryos and 6 of 94 (6%) of control medium-blanks. CONCLUSIONS: The incidence of amplification failure was improved but not eliminated using the two-step lysis protocol. At least two cells, therefore, would be necessary for accurate identification of males by amplification of Y-specific repeat sequences alone. Nevertheless, this protocol for preparing cleavage-stage blastomeres is likely to give more consistent amplification of any unique or repeat sequences.

Blastomeres↗

PubMed1984

A sequential protocol for the optimization of diagnostic procedures in hepatology.

The aim of this paper is to present a sequential protocol to be used in clinical practice for the detection of liver diseases, based on clinical history, physical examination, and laboratory investigation. The evaluation of the protocol efficacy was carried out on a sample of 288 subjects (92 normal, and 196 affected by various liver alterations) by comparing the obtained results with reference classifications independently performed on the basis of all available subject records (including many more laboratory tests than the ones used in the protocol). A cost-benefit analysis was also carried out, based on the resident population of Regione Piemonte, comparing the protocol with two other simpler ones. Results show that the proposed protocol allows a considerable reduction of costs, showing a high estimated efficacy for clinical use.

Adolescent↗

PubMedDate not supplied

Thallium 201 for detection of viable myocardium: comparison of different reinjection protocols.

BACKGROUND: The finding fo false fixed 201Tl defects by the conventional stress-redistribution protocol is a well-known phenomenon. The aim of this study was to compare two different 201Tl reinjection protocols to identify viable myocardium in the same group of patients. METHODS AND RESULTS: Twenty-seven patients with ischemic heart disease and at least one persistent defect on 201Tl uptake redistribution images 3 hours after stress were investigated. In the same-day protocol (R1) patients were reinjected with 1 mCi 201Tl immediately after redistribution images, with imaging starting 15 minutes later; in the different-day protocol the patients were reinjected with 2 mCi 48 to 96 hours later. Two sets of images were obtained, 30 (R2) and 180 (R3) minutes after reinjection. The comparison of redistribution and reinjection versus stress images showed a significant (p < 0.01) frequency distribution. The uptake of 201Tl of the 111 irreversible segments at redistribution was enhanced in 35.1% with R1, 43.2% with R2, and 49.5% with R3. The agreement among the three procedures in classifying the segmental defects was high between R2 and R3 (r = 0.81) and lower between the same- and different-day protocols. Of the 19 patients with a dominant scar pattern demonstrated by the conventional stress-redistribution study, 37%, 47%, and 53% were judged mainly ischemic after R1, R2, and R3, respectively. All but three of the 55 segments-showing an increased 201Tl uptake by R3 had an echocardiographic score of 2 or greater. CONCLUSION: The best technique to differentiate scarred from viable myocardium seems to be the reinjection of a second dose of 201Tl on a different day followed by imaging 3 hours later.

Adult↗

PubMed1998

Rapid data acquisition protocol in ECG-gated myocardial perfusion SPECT with Tc-99m-tetrofosmin.

Into 25 patients with heart disorders, 99mTc-tetrofosmin 555-740 MBq was injected intravenously at rest. After 40 minutes, ECG-gated myocardial perfusion SPECT was performed with a two detector gamma camera VERTEX (ADAC), setting up two detectors to form a 90-degree angle. Sixteen frames per R-R interval were acquired during a 180 degree rotation from the RAO 45 degrees to the LPO 45 degrees. A pair of data sets with standard (SDA) and rapid data acquisition (RDA) protocols was collected. In an SDA protocol, SPECT imaging was performed for 50 sec per step in 5 degree angular steps (total acquisition time; 15 minutes). An RDA protocol was conducted with 12 sec per step, 6 degree angular steps (acquisition time, 3 minutes). LVEF (%) and LVEDV (ml) quantitated automatically with a QGS program showed excellent correlations between two protocols with correlation coefficients of 0.980 (p < 0.01) and 0.983 (p < 0.01), respectively. Subsequently visual assessment of regional wall motion based on a four-point grading system was carried out with a 3-D cine LV display. High complete agreement was gained with 158 (90.3%) out of total 175 segments, so that assessment of the global and regional LV function with the RDA protocol demonstrated high reliability and feasibility.

Electrocardiography↗