BACKGROUND:Statistical methodology has become an increasingly important topic in dermatological research. Adequacy of the statistical procedure depends among others on distributional assumptions. In dermatological articles, the choice between parametric and nonparametric methods is often based on preliminary goodness-of-fit tests.AIM:For the special case of the assumption of normally distributed data, the Kolmogorov-Smirnov test is the most popular choice. We investigated the performance of this test on four types of non-normal data, representing the majority of real data in dermatological research.METHODS:Simulations were run to assess the performance of the Kolmogorov-Smirnov test, depending on sample size and severity of violations of normality.RESULTS:The Kolmogorov-Smirnov test performs badly on data with single outliers, 10% outliers and skewed data at sample sizes < 100, whereas normality is rejected to an acceptable degree for Likert-type data.CONCLUSION:Preliminary testing for normality is not recommended for small-to-moderate sample sizes.

PURPOSE:Bone marrow neoangiogenesis plays an important pathogenetic and possible prognostic role in acute myeloid leukemia (AML). Members of the vascular endothelial growth factor (VEGF) and angiopoietin family represent the most specific inducers of angiogenesis secreted by AML blasts. We therefore correlated expression of angiogenic factors with clinical variables.PATIENTS AND METHODS:We investigated the expression of VEGF-A, VEGF-C, angiopoietin-1 (Ang1), angiopoietin-2 (Ang2), and the receptor Tie2 by quantitative polymerase chain reaction in a cohort of 90 patients younger than 61 years with de novo AML entered into the German AML Süddeutsche Hämoblastose Gruppe Hannover 95 trial. Uni- and multivariate analyses were performed using clinical and gene expression variables.RESULTS:Univariate analysis of overall survival indicated the following variables as prognostic factors: good response on a day-15 bone marrow examination after initiation of induction chemotherapy, karyotype, and high Ang2 expression. In multivariate analysis, only bad response and log Ang2 expression remained of statistical significance, with a hazard ratio of 3.51 (95% CI, 1.91 to 6.47) and 0.75 (95% CI, 0.61 to 0.91), respectively. Subgroup analysis suggested that the prognostic impact of Ang2 expression was especially evident in cohorts with low VEGF-C and Ang1 mRNA levels.CONCLUSION:These results show that expression of Ang2 represents an independent prognostic factor in AML. Additional research into interactions of angiogenic cytokines in the pathogenesis of bone marrow angiogenesis in AML is warranted.

Im Verlauf einer Studie in der ägäischen Stadt Izmir (Türkei, Stadbezitk Evka 2) wurden im Sommer 2002 im Rahmen einer zahnärztlichen Untersuchung an 2 Schulen und einem Kindergarten insgesamt 2101 Probanden (1046 Jungen; 1055 Mädchen) untersucht. Das Altersintervall lag zwischen 3,98 und 24,91 Jahren. Die hierbei bestimmten Zahneruptionszeiten beim weiblichen Geschlecht liegen deutlich vor denen des männlichen Geschlechts. Der Gesamtablauf der zweiten Dentition liegt bei Mädchen zeitlich vor dem der Jungen. Der Zahndurchbruch im Ober- und Unterkiefer männlicher und weiblicher Probanden ist seitengleich. Im Vergleich zwischen Ober- und Unterkiefer ist bei beiden Geschlechtern eine Tendenz zum früheren Zahndurchbruch im Unterkiefer erkennbar. Es bestehen keine bemerkenswerten Abweichungen in der Eruptionssequenz und in den Durchbruchszeiten im Vergleich zu den Untersuchungsergebnissen an anderen Bevölkerungsstichproben. Es besteht keine relevante Beschleunigung der gesamten Dentition.

In a study in the Aegean city of Izmir, Turkey, during the summer of 2002, 2101 patients (1046 boys and 1055 girls) were examined. The examination occurred within the framework of a dental check-up performed at two schools and one pre-school unit. The age span ranged from 3.98 to 24.91 years. Sex, age and present permanent teeth were recorded. Wisdom teeth were excluded.

This study evaluated the sensitivity and specificity of the cerebrospinal fluid (CSF) levels of tau-protein, amyloid-ß-peptide 1-42 (Aß1-42), ApoE-genotype and the degree of cognitive decline as diagnostic markers for Alzheimer’s disease (AD). Data was obtained from 105 AD patients and 68 controls.

Objective To assess the diagnostic power of the umbilical venous-arterial index (VAI) for the prediction of poor fetal outcome.Subjects and methods This was a retrospective, cross-sectional clinical study in which normalized umbilical vein blood volume flow rate (nUV) (mL/min/kg estimated body weight), umbilical artery pulsatility index (UAPI), the newly developed VAI (nUV/UAPI), and the uterine artery resistance index (UTRI) were determined in 85 fetuses once (17-41 gestational weeks) during pregnancy using standard ultrasound Doppler equipment. A risk score based on umbilical blood pH, 1-min Apgar score, birth weight, duration of gestation, type of respiratory support, and referral to the pediatric department was constructed, and fetuses were assigned to a control or a pathological group accordingly. Logistic regression and analysis of fitted receiver-operating characteristics curves were performed to evaluate the diagnostic power of nUV, UAPI, UTRI, and VAI.Results The incidence of compromised neonates was 17.6%. The area under the receiver-operating characteristics curve was larger for VAI than for UTRI or for UAPI (P < 0.002). At a cut-off value of 100 mL/min/kg, the sensitivity of VAI to predict poor neonatal outcome was 85% with a 15% false-positive rate.Conclusion Determination of the VAI has a greater diagnostic power to predict poor fetal outcome than the pulsatility index in the umbilical artery or the resistance index in the uterine artery.

The role of platelet hyperaggregability as a possible risk factor for venous thromboembolism is not well defined. Some authors described enhanced maximal platelet aggregation in platelet aggregometry as a contributing factor for arterial and venous thrombosis. This syndrome has been termed "sticky-platelet syndrome" (SPS). The diagnosis of SPS is based on the demonstration of platelet hyperaggregability in aggregometry after stimulation with epinephrine (EPI) and/or adenosine diphosphate (ADP). We investigated platelet hyperaggregability in platelet-rich plasma (PRP) of patients (n = 34) with unexplained venous thromboembolism in comparison to healthy individuals (n = 53). For analysis, platelet aggregometry was performed and the influence of epinephrine, adenosine diphosphate, collagen (Coll) and thrombin receptor-activated peptide (TRAP-6) as agonist were determined. Compared to the control group, patients with venous thromboembolism showed an enhanced maximal platelet aggregation with low concentrations of TRAP-6 (2 microM) and collagen (0.05 microM). In contrast, we could not detect an increased platelet aggregation with EPI or ADP. Our results indicate that platelet hyperaggregability may represent an independent risk factor in patients with otherwise unexplained venous thromboembolism. In our study, low concentrations of TRAP-6 and collagen are superior to EPI and ADP to define platelet hyperreactivity in platelet aggregometry.

BACKGROUND:The technique of liver splitting is an effective way of increasing the donor pool and reducing pediatric waiting list mortality. But the procedure is still not fully accepted because of concerns that it may cause complications in adult recipients. STUDY DESIGN:Fifty-nine adult recipients of primary extended right split liver transplantations (SLTs) were matched to recipients of whole liver transplantations (WLTs) according to the following criteria: 1) United Network for Organ Sharing (UNOS) status, 2) donor age, 3) recipient age, 4) total cold ischemic time, 5) indication for liver transplantation, 6) Child-Pugh class, and 7) year of transplantation. A WLT-recipient match was identified in 40 adult recipients of primary SLT. RESULTS:Fifteen percent of the recipients in our study were highly urgent cases (UNOS 1), and 85% were UNOS status 3-4. The 3- and 12-month patient survival rates after SLT and WLT were 82.5% and 77.1%, and 92.5% and 87.5%, respectively (log rank p = 0.358). The 3- and 12-month graft survival rates showed no significant difference in either group (80% and 74% in SLT and 87.5% and 77.4% in WLT [log rank p = 0.887]). The rates of primary nonfunction, primary poor function, biliary and vascular complications, intra- and postoperative blood transfusion, and intensive care stay were comparable for SLT and WLT. CONCLUSIONS:SLT, using the extended right hepatic lobe, does not notably differ from WLT with regard to initial graft function, postoperative complications, or patient and graft survival. Based on this, the liver can be considered a paired organ, and mandatory splitting of good-quality livers can be recommended.

Hypothermia following pre-hospital treatment of burn patients is a common risk with increasing lethality. Soon after admission to our burn unit, the body temperature of 212 adult patients with more than 5% total body surface area burned was documented. We found no influence of the time of pre-hospital care and cold-water treatment alone on the body temperature. If the patients were not anesthetized, the initial temperature was normal. Only the anesthetized and artificial ventilated patients were hypothermic. We conclude that hypothermia is not a problem of the nonanesthetized and cold-water-treated patient. However, all anesthetized patients must be carefully treated to avoid hypothermia as an important complication in the pre-hospital management.

We investigated subtype-dependent development of lamivudine resistance In hepatitis B virus (HBV) longitudinally In 26 consecutive patients (13 adw and 13 ayw carriers) during antiviral treatment of chronic hepatitis B, Lamivudine resistance developed in seven adw carriers and one ayw carrier. Risk of lamivudine resistance was significantly higher for adw carriers than for ayw carriers (p=0.03). We believe that the adw subtype of HBV Is associated with a high risk of lamivudine resistance, which might be linked to simultaneous changes of the HBsAg that occurs with the emergence of resistance.