New diagnostic criteria for infective endocarditis: A study of sensitivity and specificity

OBJECTIVE: The purpose of this study was to determine the sensitivity andspecificity of new criteria proposed by Duke University forcase definition of infective endocarditis as compared to thepreviously accepted Von Reyn criteria. PATIENTS: A total of 143 consecutive suspected cases of infective endocarditisin 137 febrile patients were included. Of these, 69 had infectiveendocarditis, pathologically proven in 28, but with only a clinicaldiagnosis in 41. In the remaining 74 cases, the diagnosis of-infectiveendocarditis was rejected after a follow-up of at least 3 months. RESULTS: The sensitivity of Duke's criteria was significantly higher,both when patients with possible infective endocarditis wereconsidered as true-positive (definition 1; 100% vs 69%,P<0·001)and when possible cases were considered as rejected (definition2; 76% vs 51%, P<0·01). Specificity was very highwith both criteria: 92% Von Reyn vs 88% Duke (ns) with definition1 and 99% Von Reyn vs 97% Duke (ns) with definition 2. The overallaccuracy of the Duke criteria in the entire population was significantlyhigher with both definitions (0·94 vs 0·81 definition1, P<0·001; 0·87 vs 0·75, P=0·015definition 2). CONCLUSION: Duke's criteria for defining infective endocarditis has beenshown to be more sensitive than previously adopted criteria,while maintaining a high degree of specificity. Therefore, theymust be accepted as a substitute for previous criteria.     

Fibroblast Heterogeneity and Immunosuppressive Environment in Human Breast Cancer

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Treatment of hirsutism: comparisons between different antiandrogens with central and peripheral effects

OBJECTIVE: To compare the clinical and endocrinologic effects of cyproterone acetate (CPA), an antiandrogen with progestational activity; flutamide, a nonsteroidal antiandrogen, and finasteride, an inhibitor of 5alpha-reductase. DESIGN: Randomized, open, controlled clinical study. SETTING: Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy. PATIENT(S): Forty-five hirsute women were enrolled in the study: 29 were hyperandrogenic and 16 had idiopathic hirsutism. Three women dropped out of the study. INTERVENTION(S): Women were randomly treated with finasteride (5 mg/d; n = 14), CPA (25 mg plus ethinyl E2 (EE); n = 13), or flutamide (500 mg/d; n = 15) for 1 year. MAIN OUTCOME MEASURE(S): Hirsutism was assessed using the Ferriman-Gallwey method. Levels of total and free T, androstenedione (A), DHEAS, sex hormone-binding globulin, dihydrotestosterone, and 3alpha-androstanediol glucuronide were evaluated at the beginning of the study and every 3 months. RESULT(S): Treatment with finasteride, flutamide, and CPA significantly decreased the Ferriman-Gallwey score. The percent decreases in the hirsutism score induced by the different treatments were similar. Treatment with CPA plus EE significantly decreased levels of total and free T, A, dihydrotestosterone, and 3alpha-androstanediol glucuronide. These parameters were unchanged with flutamide therapy. Finasteride significantly increased total T levels but reduced dihydrotestosterone and 3alpha-androstanediol glucuronide concentrations. CONCLUSION(S): Finasteride, CPA, and flutamide are equally effective in decreasing hirsutism, despite different mechanisms of action.     

Efficacy of clear aligners in controlling orthodontic tooth movement: A systematic review

Objective:To assess the scientific evidence related to the efficacy of clear aligner treatment (CAT) in controlling orthodontic tooth movement.Materials and Methods:PubMed, PMC, NLM, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Knowledge, Scopus, Google Scholar, and LILACs were searched from January 2000 to June 2014 to identify all peer-reviewed articles potentially relevant to the review. Methodological shortcomings were highlighted and the quality of the studies was ranked using the Cochrane Tool for Risk of Bias Assessment.Results:Eleven relevant articles were selected (two Randomized Clinical Trials (RCT), five prospective non-randomized, four retrospective non-randomized), and the risk of bias was moderate for six studies and unclear for the others. The amount of mean intrusion reported was 0.72 mm. Extrusion was the most difficult movement to control (30% of accuracy), followed by rotation. Upper molar distalization revealed the highest predictability (88%) when a bodily movement of at least 1.5 mm was prescribed. A decrease of the Little''s Index (mandibular arch: 5 mm; maxillary arch: 4 mm) was observed in aligning arches.Conclusions:CAT aligns and levels the arches; it is effective in controlling anterior intrusion but not anterior extrusion; it is effective in controlling posterior buccolingual inclination but not anterior buccolingual inclination; it is effective in controlling upper molar bodily movements of about 1.5 mm; and it is not effective in controlling rotation of rounded teeth in particular. However, the results of this review should be interpreted with caution because of the number, quality, and heterogeneity of the studies.