Background: Our aim was to investigate the efficacy of the Pap test in combination with the ThinPrep cytological test (TCT) in screening for cervical cancer in China. Design: From March 2006 to October 2008, 988 women with the mean age $46.4{\pm}10.5$ years (range, 23-80 years) were recruited to receive cervical cancer screening. Pap test results ${\geq}$ grade III and TCT findings ${\geq}$ ASCUS/AGUS were considered abnormal. Subjects with a Pap test result ${\geq}$ grade IIb received TCT. Colposcopy and biopsies were performed in all participants, and final diagnosis was based on pathological findings. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index for predicting CIN I or above were determined. Results: The sensitivity, specificity, PPV, NPV and Youden index of the Pap test were 43.1%, 97.2%, 70.0%, 91.9%, and 40.3%, respectively. The same values for TCT in predicting CIN were 80.0%, 63.2%, 16.0%, 97.3%, and 43.2%, respectively. The two tests in combination gave values for predicting CIN of 64.8%, 87.6%, 43.6%, 94.4%, and 53.5%, respectively. Combined testing exhibited the highest Youden index (53.4%). Conclusion: The Pap test with a reduced threshold in combination with the TCT has high sensitivity and high specificity in screening for cervical cancer.
Substitution of graphic representation for extensive lists of numerical statistical data is highly desirable by both editors and readers of medical journals, faced with an exploding abundance of contemporary medical literature. A novel graphic tool. the 'double-ring diagram', is described herein which permits visual representation of information regarding certain statistical variables used to describe the performance of a test or physical sign in the diagnosis of a disease. The diagram is relatively easy to construct on the basis of a number of primary data such as the prevalence and the true positive, true negative. false positive and false negative test results. These values are reflected in the diagram along with the values of other statistical variables derived from them. such as the sensitivity. specificity, predictive values for positive and negative test result. and accuracy. This diagram may be useful in visualizing a test's performance and facilitating visual comparison of performance of two or more tests.
Candidiasis is a fungal infection of the most common causes; generally, opportunistic infections occur often in patients with weakened immune systems. Because of high rates in fungal infection patients and increasing frequency of being isolated from clinical materials, quickly identifying of Candida albicans is critical. By identifying 404 yeast cell strains of referred samples via API 20C kits, NGL and PRO tests and Germ tube (GT) test were conducted and compared. In the 3.0 McFarland yeast cells, 0.1% ${\rho}-nitrophenyl-N-acetyl-{\beta}-D-galactosaminide$ (NGL) and 0.04% ${\small{L}}$-proline ${\beta}$-naphtylamide (PRO) were each put in test tubes and incubated at $35^{\circ}C$ for 15, 30, 60 and 90 minutes. Afterwards, 1 drop of 2% NaOH was applied, and if the color turned yellow; it was positive for NGL test. Afterwards, 1% ${\rho}$-dimethylaminocinnamaldehyde was applied, and if the upper layer turned pink or red, it was positive for PRO test. NGL and PRO tests were conducted for all C. albicans and identified accurately within 30 minutes. In NGL, PRO test, false-positive, negative were not seen, whereas, GT test showed false-positive in 1 strain and false-negative in 3 strains. Therefore, sensitivity and specificity of NGL, PRO tests were 100% and 99.5%, respectively, and positive and negative predictive rate were 99.5% and 100%, respectively. However, GT test sensitivity and specificity were 98.5% and 99.5%, respectively, and positive and negative predictive rates were 99.5% and 98.5%, respectively. In conclusion, NGL, PRO tests are better than GT tests for sensitivity and specificity, therefore, these reliable tests will be useful in clinical laboratories.
In order to measure in vitro cell mediated immunity in the guinea pigs sensitized with the killed bacilli of Mycobacterium bovis ($AN_5$), M avium (serotype 2), M tuberculosis and M intracellulare (serotype 8), leukocyte adherence inhibition (LAI) test was established using the antigens of purified protein derivatives (PPD) tuberculin. By using LAI test, specificity of cell-mediated immune responses of the guinea pigs inoculated with various Mycobacterium spp was investigated, and comparison between values of LAI and skin test was also made to evaluate the specificity of the newly designed test. The results obtained throughout the experiments were summarized as follows; 1. The optimal concentration of PPD antigens for LAI test was 1 to 2mg per ml of medium. 2. When the leukocytes of guinea pigs sensitized with both M bovis($AN_5$) and M avium (serotype 2) for 2 to 8 weeks were incubated with homologous or heterologous PPD antigens, mean values of LAI test were $61.2{\pm}11.2$ and $65.6{\pm}5.1%$ in homologous PPD antigens respectively, while $30.0{\pm}3.7$ and $32.8{\pm}5.7%$ in heteNlogous PPD antigens, showing the prominently high value of LAI in the homologous syst,em (p<0.01). 3. When the leukocytes of guinea pigs sensitized with both M tuberculosis and M intracellulare (serotype 8) for 2 to 8 weeks were incubated with homologous and heterologous PPD antigens, mean values of LAI test were $67.9{\pm}2.9$ and $66.9{\pm}5.0%$ in homologous PPD antigens, while $27.4{\pm}7.4$ and $24.4{\pm}7.1%$ in heterologous PPD antigens, showing the prominently high value of LAI in the homologous system (p<0.01). 4. Comparing with the specificity of LAI and skin tests on the basis of the value obtained from the homologous system, deviation of reaction was revealed to be 49.5 to 100.2 in LAI test, and -15.9 to 52.0 in skin test.
The objective of this study was to determine appropriate sample size that simulated different assumptions for diagnostic test characteristics and true prevalences when designing serological surveillance plan for pullorum disease and fowl typhoid in domestic poultry production. The number of flocks and total number of chickens to be sampled was obtained to provide 95% confidence of detecting at least one infected flock, taking imperfect diagnostic tests into account. Due to lack of reliable data, within infected flock prevalence (WFP) was assumed to follow minimum 1%, most likely 5% and maximum 9% and true flock prevalence of 0.1%, 0.5% and 1% in order. Sensitivity were modeled using the Pert distribution: minimum 75%, most likely 80% and maximum 90% for plate agglutination test and 80%, 85%, and 90% for ELISA test. Similarly, the specificity was modeled 85%, 90%, 95% for plate agglutination test and 90%, 95%, 99% for ELISA test. In accordance with the current regulation, flock-level test characteristics calculated assuming that 30 samples are taken from per flock. The model showed that the current 112,000 annual number of testing plan which is based on random selection of flocks is far beyond the sample size estimated in this study. The sample size was further reduced with increased sensitivity and specificity of the test and decreased WFP. The effect of increasing samples per flock on total sample size to be sampled and optimal combination of sensitivity and specificity of the test for the purpose of the surveillance is discussed regarding cost.
OLUT Ali I.;ERGUVEN Sibel;EMRI Salih;OZUNLU Haluk;AKAY Hadi
Parasites, Hosts and Diseases
/
제43권1호
/
pp.15-18
/
2005
The diagnosis of human hydatidosis is primarily made using radiological and serological methods. Radiological methods are generally of low specificity and serological methods lack sensitivity, especially for pulmonary disease. In this study the capabilities of a new rapid test, the hydatid antigen dot immunobinding assay (HA-DIA), which was developed for the diagnosis of pulmonary hydatidosis, were studied and compared with another immunodiagnostic method, indirect hemagglutination (IHA). The study subjects included 18 patients, 9 women, 9 men; range 7 to 63 years; mean 30 years, with surgically proven pulmonary hydatidosis, a control group comprised of 14 patients; viral respiratory infections (1), cirrhosis (2), connective tissue disease (2), taeniasis (3), and 6 healthy donors. We found that the HA-DIA test had a sensitivity of $67\%$ and specificity of $100\%$, and that the IHA test had a sensitivity of $50\%$ and specificity of $100\%$. We conclude that HA-DIA is a simple, rapid, low cost assay that does not require instrumentation and has a higher sensitivity than IHA for the diagnosis of pulmonary hydatidosis.
A study on the morbidity of syphilis among 729 workers in Po Hang and Ul San Industiral Complexes at the routine periodical examination was performed. In addition to the morbidity, factors related to the disease infection such as educational level, religion, preventive measures taken by the workers, history of urethritis, and so on were studied and analysed to check significant relation. The results were as follows: 1. VDRL and RPR tests were undertaken to determine the sensitivity and specificity of RPR test which was utilized for all the workers studied. It revealed 86.4% of sensitivity and 87.7% of specificity from RPR test, and 81.8% of sensitivity and 90.1% of specificity from the VDRL test compared with RPCF test. There were 87.4% of agreement rate between RPR and VDRL. Actually, RPR was more sensitive but less specific than VDRL, and found to be a satisfactory screening test for syphilis especially in the fields. 2. Among the workers in Po Hang Area 24.0% of them revealed reactive result, and in Ul San Area 5.2% revealed reactive result showing 4.6 times of risk among workers in Po Hang Area. 3. There were no statistically significant differences between RPR reactive rates and personal characteristics such as educational level, religion, history of urethritis experience, history of coitus with prostitute, and preventive measures of V.D. taken by workers if evaluated by area of Po Hang and Ul Srn separately. 4. V.D. could be encountered as an occupational disease in certain conditions of working places and the psychosocial problems of workers. And so, it is necessary that all the workers working in special estates such as in Po Hang Industrial Complex should be checked to be screened out by RPR test at periodical examinations and part of pre-employment examination also should include RPR test to be compared with. Regardless of the workmen's compensation, establishment of V.D. treatment clinic or system for such industrial workers is urgently needed. Health education regarding V.D. is another subject to be performed.
Aim: Liquid-based cytology is the most often used method for cervical cancer screening, but it is relatively insensitive and frequently gives equivocal results. Used as a complementary procedure, the high-risk human papillomavirus (HPV) DNA test is highly sensitive but not very specific. The human telomerase RNA gene (TERC) is the most often amplified oncogene that is observed in cervical precancerous lesions. We assessed genomic amplification of TERC in liquid-based cytological specimens to explore the optimal strategy of using this for cervical cancer screening. Methods: Six hundred and seventy-one residual cytological specimens were obtained from outpatients aged 25 to 64 years. The specimens were evaluated by the Digene Hybrid Capture 2 (HC2) HPV DNA test and fluorescence in situ hybridization (FISH) with a chromosome probe to TERC (3q26). Colposcopic examination and histological evaluation were performed where indicated. Results: The TERC positive rate was higher in the CIN2+ (CIN2, CIN3 and SCC) group than in the normal and CIN 1 groups (90.0% vs. 10.4%, p < 0.01). In comparison with the HC2 HPV DNA test, the TERC amplification test had lower sensitivity but higher specificity (90.0% vs. 100.0%, 89.6% vs. 44.0%, respectively). TERC amplification test used in conjunction with the HC2 HPV DNA test showed a combination of 90.0% sensitivity and 92.2% specificity. Conclusion: The TERC amplification test can be used to diagnose cervical precancerous lesions. TERC and HPV DNA co-testing shows an optimal combination of sensitivity and specificity for cervical cancer screening.
To attempt to measure the effect of domestic product P.H.A. kit 'Hepa-S' after completion of 'Hepa-Vax' vaccination schedule, P.H.A. test and R.I.A. test on the 330 healthy adults were carried out. The results obtained were as follow ; 1. The positive anti HBs rate after completion of 'Hepa-Vax' vaccination were; in P.H.A. test with domestic product P.H.A. kit 81.2%, in P.H.A. test with foreign product P.H.A. kit 82.7%, and in R.I.A. test 95.8% 2. Using the result of R.I.A. test as the standard, sensitivity of P.H.A. test with domestic product P.H.A. kit was 84.8% and specificity was 100.0% 3. Using the result of R.I.A. test as standard, sensitivity of P.H.A. test with foreign P.H.A. kit was 86.4% and specificity was 100.0%. 4. The concordance rate of P.H.A. test with domestic product and foreign product kit was 98.5%. On the result of this study, there was no significant difference in the validity between the domestic product P.H.A. kit 'Hepa-S' and the foreign P.H.A. kit $'Hebsgencell^{TM}'$. So that it is recommendable to use domestic product P.H.A. kit instead of foreign product P.H.A. kit.
To evaluate the diagnostic accuracy of two commercial ELISA tests (Allied- and CSL-ELISA) for the diagnosis of Mycobacterium paratuberculosis in cattle, Meta-analysis using English language papers published during 1990-2001 was performed. Diagnostic odds ratios (DOR) were analyzed using regression analysis together with summary receiver operating characteristic (ROC) curves. The difference in diagnostic performance between the two ELISA systems was evaluated by using linear regression. Publication bias was assessed by funnel plot and linear regression. The pooled sensitivity and specificity were 44% (95% CI, 38 to 51) and 98% (95% CI, 96 to 99) for the random-effect model. The DOR between studies was heterogeneous. The area under the fitted ROC curve (AUC) was 0.72 for the unweighted and 0.77 for the weighted model. Maximum joint sensitivity and specificity for the unweighted and weighted model from their summary ROC curve were 70% and 75%, respectively. Based on the fitted model, at a specificity of 95%, sensitivity was estimated to be 52% for the unweighted and 57% for the weighted model. From the final multivariable model study characteristic, the country was the only significant variable with an explained component variance of 13.3%. There were no significant differences in discriminatory power, sensitivity, and specificity between the two ELISA tests. The overall diagnostic accuracy of two commercial ELISA tests was moderate, as judged by the AUC, maximum joint sensitivity and specificity, and estimates from the fitted model and clinical usefulness of the tests for screening program is limited because of low sensitivity and heterogeneous of DOR. It is, therefore, recommended to use ELISA tests as a parallel testing with other diagnostic tests together to increase test sensitivity in the screening program.
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