6%–100%, a positive predictive value of 92.8%–100%, and a negative predictive value of 98%–100% when compared against the gold standard
of conventional angiography.5,6 Both retro-and prospective analyses have suggested MDCTA is effective at reducing the number of invasive tests required in patients with penetrating neck injury.7,8 SUMMARY Evaluation of the patient with penetrating neck trauma has traditionally relied primarily on physical exam this website findings and assessment of patient hemodynamics, in association with selective multi-modal, invasive investigation to rule out vascular or aerodigestive injury in clinically stable patients. Although an effective strategy, and much superior to previous policies of routine Inhibitors,research,lifescience,medical exploration for penetrating injury, this approach still Inhibitors,research,lifescience,medical relies heavily on resource-intensive and invasive exams. A protocol-driven approach, integrating MDCTA with physical exam findings, and the clinical distinction of “hard” signs, “soft” signs, and “no” signs of vascular or aerodigestive injury, minimizes both the rate of negative explorations and the need for further invasive testing, decreasing overall resource burden and preventing unnecessary patient morbidity.
Patients with hard signs proceed directly to Inhibitors,research,lifescience,medical the operating room. Completely asymptomatic patients may be observed. In those with soft signs, initial screening with MDCTA Inhibitors,research,lifescience,medical has high sensitivity for vascular injury and allows risk stratification of patients with possible aerodigestive trauma for further diagnostic investigation or intervention. MDCTA should be the first-line test in the evaluation of these patients. Patients with negative MDCTAs can be safely observed and discharged. Clinically stable patients with equivocal or concerning MDCTA findings should undergo appropriate further evaluation with traditional angiography, contrast studies, or endoscopy. Abbreviations: ATLS advanced trauma life support MDCTA multidetector computed tomographic angiography Footnotes Conflict of interest:
No potential conflict of interest relevant to this article was reported.
Phase 1 first-in-human Inhibitors,research,lifescience,medical studies with anti-cancer products differ from other phase 1 studies in that they are evaluated in patients rather than healthy volunteers. The rationale design of targeted drugs triggers changes in the design of these studies. Patient populations much are more precisely defined and pose a challenge to the efficient inclusion of study patients. Objectives shift from the definition of a maximum tolerated dose to the evaluation of a recommended phase 2 dose. Other challenges related to the efficacy and safety profile of novel targeted anti-cancer drugs call for changes in designing first-in-human studies, such as definitions of biological doses, collection of fresh tumor tissue for surrogate marker analyses, and the management of infusion-related reactions with monoclonal antibodies.