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Objective: To evaluate the predicting value of Wells, Kahn, St. André and Constans scores for the diagnosis of deep venous thrombosis in Chinese patients., Methods: A total of 274 patients suspected with deep venous thrombosis was prospectively blinded evaluated with the four clinical-score systems. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operation curves were calculated for four clinical scores according sonography results., Results: Sonography evidenced deep venous thrombosis in 88 out of 274 patients. The sensitivity, specificity, positive predictive value and negative predictive value was 77.3%, 65.6%, 51.5% and 85.9%, respectively, for Wells score; 58%, 55.9%, 38.3% and 73.8%, respectively, for Kahn score; 64.8%, 55.4%, 40.7% and 76.9%, respectively, for St. André score and 86.4%, 37.6%, 39.6% and 85.4%, respectively, for Constans score. ROC was 0.761 for Wells score, which was similar as that of Constans score (0.759), then followed by St. André score (0.627) and Kahn score (0.591)., Conclusion: Our results showed that Wells score and Constans score are superior to Kahn score or St. André score for diagnosing patients with suspected deep venous thrombosis in terms of sensitivity, negative prediction value and ROC values.

Objective: This meta-analysis evaluated the accuracy of diagnosing coronary artery disease using 64-section spiral computed tomography, and compared the difference between Chinese studies and abroad studies., Methods: Relevant English and Chinese articles published from 1998 to 2009 were searched in Cochrane library, Medline, Embase database, OVID database and CNKI. Heterogeneity was tested, pooled weighted sensitivity and specificity and the corresponding 95%CI were calculated. Summary receiver operating characteristic (SROC) curve was drawn and the area under the curve was calculated, differences between studies from China and abroad were compared., Results: A total of 433 articles were searched and 108 articles were included (46 English articles and 62 Chinese articles) after excluding articles of research purposes or design does not match. Because of no gold standard, no blind, can not be calculated literature data, 7 and 20 (P > 0.05), 44 and 6 (P < 0.05), 3 and 1 (P < 0.05) Chinese studies and English articles respectively were excluded. Twenty-seven articles fulfilled all inclusion criteria (8 Chinese and 19 foreign studies) In 8 Chinese studies the pooled weighted sensitivity and specificity and area under SROC curve was 0.892 (95%CI: 0.868 - 0.913), 0.972 (95%CI: 0.966 - 0.977) and 0.983 (95%CI: 0.966 - 1.000) at segment-based analysis. In 19 foreign studies, the pooled weighted sensitivity and specificity and area under SROC curve was 0.971(95%CI: 0.957 - 0.982), 0.878 (95%CI: 0.852 - 0.902) and 0.973 (95%CI: 0.958 - 0.989) at patient-based analysis, 0.917 (95%CI: 0.895 - 0.936), 0.919 (95%CI: 0.909 - 0.928) and 0.974 (95%CI: 0.964 - 0.984) at vessel-based analysis, 0.882 (95%CI: 0.868 - 0.895), 0.959 (95%CI: 0.956 - 0.962) and 0.985 (95%CI: 0.978 - 0.992) at segment-based analysis. Pooled weighted pecificity of 64-section spiral CT angiography at segment-based analysis has significant different between home and abroad (P < 0.05)., Conclusions: Meta-analysis showed that noninvasive 64-section spiral computed tomography could correctly diagnose coronary artery disease with high sensitivity and specificity. Quality of related studies performed in abroad is significantly higher than those performed in China.

Objective: to evaluate whether there are difference among different thickness of CTPA imagings for detection of emboli in peripheral pulmonary arteries., Methods: CTPA Images of 97 patients with acute pulmonary embolism were divided into four series for each patient: 0.625 mm thick original transaxial soure images and 3 series of reconstructed images using the MIP technique with slab thicknesses of 1.25 mm, 2.5 mm, and 5.0 mm. The difference was compared among 4 series of CTPA images for detection of emboli in peripheral pulmonary arteries, and the agreement of 2 observers for detection of emboli in peripheral pulmonary arteries in different thickness images was tested. Chi-Square test was taken for comparison of 4 series of CTPA images for detection of emboli in peripheral pulmonary arteries. Kappa test was taken for the agreement of 2 observers for detection of emboli in peripheral pulmonary arteries., Results: the average images number of 0.625 mm, 1.25 mm, 2.5 mm, 5.0 mm thickness imaging was 403, 201, 101, and 53, respectively. For detecting clots in segmental pulmonary arteries, there was statistically significant difference between 5.0 mm thick imaging and other 3 series imagings (chi(2) = 60.099, P < 0.01), but agreement of 2 observers in each series imaging was excellent (value of κ from 0.751 to 0.973).For clots in sub-segment pulmonary arteries, no statistical significant difference was observed between 0.625 mm and 1.25 mm thick imagings (chi(2) = 1.051, P > 0.05), and superior to 2.5 mm and 5.0 mm thick images (chi(2) = 151.892, 204.553, respectively, P < 0.01), but agreement of two observers in each series imaging was good (value of kappa from 0.611 to 0.935)., Conclusion: compared with 0.625 mm thick transaxial imaging, 1.25 mm thick MIP imaging is equally sensitive for detecting emboli in peripheral pulmonary arteries, but needs fewer images and less time for image reading.

Objective: To evaluate the value of Wells score or/and D-dimer test on diagnosing or excluding deep venous thrombosis (DVT)., Methods: Patients with suspected DVT were retrospectively analyzed. All patients underwent clinical assessment, D-dimer assay and bilateral lower extremity compression sonography within 48 hours of admission. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing DVT by Wells score, D-dimer test, and combined Wells score and D-dimer were compared., Results: A total of 274 patients were analyzed. If low probability was defined as negative and moderate and high probabilities were defined as positive, the sensitivity, specificity, PPV and NPV of the Wells score were 78.4%, 66.1%, 52.3% and 86.6%, respectively. At a cut-off of 500 microg/L, the sensitivity, specificity, PPV and NPV of D-dimer test were 73.9%, 66.1%, 50.8% and 84.2%, respectively. If low probability and D-dimer < 500 microg/L were defined as negative, moderate and high probabilities and D-dimer > or = 500 microg/L were defined as positive, the sensitivity, specificity, PPV and NPV of the combined Wells score and D-dimer test were 88.3%, 76.8%, 67.1% and 92.5%, respectively., Conclusion: For clinical suspected DVT patients, DVT diagnosis could be reliably obtained by combined Wells score and D-dimer test.

Objective: To explore whether acute pulmonary embolism (APE) can be quantitatively predicated early with 3 clinical scoring systems, with multidetector CT angiography (MDCTA) as the gold standard, and therefore to select a scoring system more suitable for the Chinese., Methods: Five hundred and seventy consecutive inpatients with highly suspected APE underwent prospective MDCTA at the time of initial diagnosis. Three clinical predication scoring systems (Wells', Geneva' and revised Geneva') were used to estimate APE in low, moderate and high probability groups. Two radiologists independently reviewed the MDCTA without any clinical information. When consensus could not be reached, a third radiologist with 20-years' experience was asked to make the final decision. The threshold value for the prediction of APE by the 3 scoring systems was measured by receiver-operating-characteristics (ROC) analysis., Results: APE was identified in 169 of the 570 cases. Kappa analysis for the 3 scoring systems revealed a low level of agreement: 0.269-0.374, P<0.05. The result of the Geneva score was consistent with that of the revised Geneva score, between them there was an excellent correlation. The positive predictive values of Wells, Geneva, revised Geneva scores for APE were 83.8%, 53.3%, and 61.3% respectively, while the negative predictive values were 85.0%, 80.6%, and 80.0%, respectively. ROC analysis showed that the area under curve (AUC) of Wells, Geneva and revised Geneva score for APE was 0.823 (95% CI: 0.710-0.976), 0.677 (95% CI: 0.646-0.990), and 0.661 (95% CI: 0.631-0.983), respectively. The Wells score showed the best discriminatory ability as compared to the other 2 scores., Conclusion: The 3 scoring systems can be used for both inpatients and emergency cases, while the Wells Score may be more accurate for Chinese people for predicting APE.

To explore the role of immune regulating cytokines in pathogenesis of the idiopathic thrombocytopenic purpura (ITP) and its clinical significance, the levels of IL-18, TNF-alpha and Sc5b-9 in plasma of 32 ITP patients and 18 normal individuals were detected using ELISA methods. The results showed that IL-18, TNF-alpha and sC5b-9 levels in plasma of ITP patients were higher than that in normal individuals. The level of IL-18 was positively correlated with the levels of TNF-alpha and sC5b-9. In conclusion, The rising levels of the IL-18, TNF-alpha and sC5b-9 were correlated with disorder of Th1/Th2 subsets, and may contribute to the immune dysfunction in ITP patients. The dynamic observation of these cytokines may be useful in directing the clinical treatment for ITP patients.

To explore the alteration of plasma level of IL-18 in patients with leukemia before and after chemotherapy and its clinical significance, the plasma level of IL-18 was determined with ELISA method before and 2 weeks after chemotherapy in 37 leukemia patients, and 18 normal individuals. The results showed that the plasma IL-18 level (153.34 +/- 50.74 pg/ml) in leukemia patients was similar to the level (135.82 +/- 47.00 pg/ml) in normal control, and the IL-18 level in ALL patients was significantly increased (173.3 +/- 34.4 pg/ml), while the IL-18 level in CML patients (111.8 +/- 50.5 pg/ml) was lower than normal level. After chemotherapy, the IL-18 level (100.89 +/- 50.07 pg/ml) was significantly lower than normal level and oneself before treatment. It is concluded that plasma IL-18 levels in leukemia patients are un-homogeneous and IL-18 production decreased after chemotherapy, and immunologic hypofunction in patients with chemotherapy might be related with the decrease of IL-18 and related cytokines.