Ca/P mol ratio of cries-affected dentin structures.

BACKGROUND: A new approach called "minimum intervention" has been introduced for restoration of carious lesions to preserve tooth structure. This approach suggests that perhaps caries need not always be removed completely from deeper portions of the cavity. It is, therefore, important to characterize caries-affected dentin structures, because of the potential changes in bonding quality when using different dentinal substrates. MATERIALS AND METHOD: Ninety teeth (30 teeth each group) were studied. The first group (CF) consisted of 30 caries-free teeth. The second group (CC) consisted of 30 teeth, for which caries-free dentin teeth was chemically demineralized. The third group (ND) consisted of 30 extracted human molars with coronal carious lesions. After all tooth samples were water-polished with grit #600 SiC paper, they were tested by surface contact angle measurements and the electron-probe microanalyzer to measure Ca/P mol ratio. RESULTS: Contact angles were CF = 60.07 degrees ; CC = 30.8 degrees; ND = 26.11 degrees , p<0.05. Ca/P mol ratios were as follows; CF = 1.549 (+/-0.0435); CC = 1.324 (+/-0.2305); ND = 1.568 (+/-0.0523), p<0.05. Weibull analyses for Ca/P mol ratio indicated shape parameter (m) of CF was 13.3; it was 12.8 for ND and 11.8 for CC. Above the delta point (=1.65 in Ca/P ratio), for both groups m = 3.4. CONCLUSION: Caries-affected dentin surfaces (naturally-developed and chemically created) were statistically more chemically active than caries-free dentin surface. Ca/P mol ratio of chemically created caries was less than other two groups.

Development of a general method of limited sampling for the determination of AUC for a drug that displays two-compartment pharmacokinetics.

OBJECTIVES: To develop a method of limited sampling that would enable accurate estimation of the area under the concentration time curve (AUC) when using the log trapezoidal method. METHODS: A series of datasets were simulated. Each dataset comprised 1000 subjects. Each subject was "administered" an intravenous bolus dose of a drug that displays two compartment pharmacokinetics. In the first series of simulations, a variety of combinations of the number of sampling times (K) and number of replicate measurements (R) at each of these times were tested, where K x R = 12 (i.e. N = 12). The times that each of the K samples were taken were chosen to be those that divided the AUC into K - 1 trapezoids of equal area. The concentration-time curves were estimated based on a priori estimates of the population parameters. The best combination of K and R was tested under various conditions of parameter variability and assay variability. The combinations were compared with a conventional sampling strategy, where N = 12, K = 12 (R = 1). RESULTS: The combination K = 4 and R = 3 proved to be the "best". It had similar accuracy to the conventional method. The best limited sampling combination was superior to the conventional method when assay variability was high (CV= 30%), was similar when assay variability was 15%, but the conventional method became statistically superior when assay variability was 7.5% or less. The accuracy of the best limited sampling combination was inversely related to the parameter variability. If K was set to 4 and R allowed to increase to 6 (i.e. N is not equal to 12), there was no further gain in accuracy. CONCLUSION: The proposed method of limited sampling is at least as accurate as the conventional intensive sampling technique, but more efficient in terms of sampling.

Generalized likelihood ratios for quantitative diagnostic test scores.

The reduction of quantitative diagnostic test scores to the dichotomous case is a wasteful and unnecessary simplification in the era of high-speed computing. Physicians could make better use of the information embedded in quantitative test results if modern generalized curve estimation techniques were applied to the likelihood functions of Bayes' theorem. Hand calculations could be completely avoided and computed graphical summaries provided instead. Graphs showing posttest probability of disease as a function of pretest probability with confidence intervals (POD plots) would enhance acceptance of these techniques if they were immediately available at the computer terminal when test results were retrieved. Such constructs would also provide immediate feedback to physicians when a valueless test had been ordered.

A sequential Bayesian algorithm for dose individualisation of carboplatin.

Carboplatin is associated with significantly less nephrotoxicity and neurotoxicity than is cisplatin. The dose-limiting toxicity of carboplatin is myelotoxicity. A number of dosing methods have been described that allow a value for the area under the concentration-time curve to be targeted on the basis of the patient's renal function. Recently a formalised analysis of the pharmacodynamic response to carboplatin revealed a therapeutic window in which the response rate was maximal and toxicity, tolerable. Optimal therapy would result from targeting this window in the individual patient. The aim of this study was to develop a Bayesian dose-individualisation method for carboplatin. The method involved (1) development of a high-performance liquid chromatography (HPLC) method to measure serum concentrations of carboplatin; (2) a pharmacokinetic study in 12 women receiving carboplatin for ovarian cancer to estimate the population pharmacokinetic values for this group of patients; (3) development of population models to describe the concentration-time course of carboplatin in serum along with associated errors; and (4) development of an algorithm that uses a sequential Bayesian design, which enables estimation of future doses of carboplatin on the basis of feedback from serum concentrations. The results of each of the stages were (1) the coefficient of variation of the assay was 6.3% within day and 8.4% between days (r2 = 0.9993), and the limit of detection was 0.25 mg/l; (2) Patients' ages ranged from 49 to 68 years, their weights varied from 46 to 85 kg, and their glomerular filtration rate ranged from 3.2 to 7.4 l/h. A geometric mean clearance (Cl) of 6.8 L/h and a steady-state volume of distribution (Vss) of 221 were estimated, which are similar to previously published data; (3) and a two-compartment model best described the data. Two error models were developed, the first describing the error associated with the assay and the second, the error of the two-compartment model, i.e. error due to individual variation in pharmacokinetics and error due to model mis-specification. Finally, (4) the development of a sequential Bayesian dose-individualisation method for carboplatin is described. To our knowledge, this is the first sequential design that has been used for dose individualisation of chemotherapy. The program is specific for carboplatin and operates independently of commercially available Bayesian software. Doses predicted by this program are being tested prospectively against conventional dosing methods.