ABSTRACT
OBJECTIVE: To assess the correlation between Z-scores of positive noninvasive prenatal testing (NIPT) results and the positive predictive value (PPV) of NIPT. METHODS: Pregnancies with positive NIPT results at Guangzhou Women and Children's Medical Centre between July 2017 and May 2020 were included in this study. Fetal karyotyping or microarray analysis was provided to patients with abnormal NIPT results for confirmatory testing. Logistic regression analyses was applied to study the relationship between the Z scores and the PPV performance. The optimal cutoff values for indicating fetal common trisomies were obtained based on receiver operating characteristic (ROC) curve analysis, and then the PPV were calculated in pregnancies with positive NIPT results at Z-score greater than or equal to cutoff value and in patients with a Z-score between 3 and cutoff value respectively. RESULTS: A total of 214 pregnancies with positive NIPT results for fetal common trisomies were validated by invasive prenatal diagnosis and follow up in this study. Of these, NIPT indicated trisomy 13 in 25 cases, trisomy 18 in 54 cases and trisomy 21 in 135 patients. Logistic regression analyses showed a significant association (p < 0.05) between the Z-scores and true positive results for T21 and T18. For T13, the significant association was not observed (p > 0.05). The ROC curve analysis showed that the optimal cutoff Z-score for indicating fetal trisomies 13, 18, and 21 were 6.889, 7.574 and 6.612 respectively, and the corresponding area under curve were 0.706, 0.916, and 0.954. In this cohort with abnormal NIPT results, the cutoff values revealed a sensitivity of 96.8% and a specificity of 90% for indicating trisomies 21, and a sensitivity of 88.9% and a specificity of 92.6% for trisomies 18. However, probably due to the sample size, the sensitivity and specificity for indicating trisomy 13 were lower (85.7% and 61.1%) than that for trisomies 21 and 18. The PPVs in pregnancies with positive NIPT results at Z-score greater than or equal to cutoff value were 99.18% (121/122) for trisomy 21, 92.31% (24/26) for trisomy 18 and 46.15% (6/13) for trisomy 13. In patients with a Z-score between 3 and cutoff Z-score, the PPV of NIPT for trisomies 21, 18, and 13 were 30.77% (4/13), 10.71% (3/28), and 8.33% (1/12) respectively. Moreover, by classifying Z scores as 3 ≤ Z < 5, 5 ≤ Z < 10, and Z ≥ 10, the majority of Z scores were above 10 with a PPV of 99% for T21 and just 5.2% were between 3 and 5 with a PPV of 14.3%. In contrast for T18, over a third of tests had Z scores between 3 and 5. The PPV in this group is just over 5%. CONCLUSIONS: The present results show that the PPV performance of NIPT for fetal trisomies 13, 18, and 21 are closely associated with Z-score. The higher the Z-score, the greater the likelihood that the aneuploidy result is correct. Our experience in evaluating the Z-score accuracy of NIPT in this study could be of use in similar work.
Subject(s)
Down Syndrome/diagnosis , Noninvasive Prenatal Testing/standards , Trisomy 13 Syndrome/diagnosis , Trisomy 18 Syndrome/diagnosis , Adult , Area Under Curve , China/epidemiology , Down Syndrome/classification , Down Syndrome/epidemiology , Female , Humans , Logistic Models , Noninvasive Prenatal Testing/methods , Noninvasive Prenatal Testing/statistics & numerical data , Pregnancy , ROC Curve , Retrospective Studies , Statistics, Nonparametric , Trisomy 13 Syndrome/classification , Trisomy 13 Syndrome/epidemiology , Trisomy 18 Syndrome/classification , Trisomy 18 Syndrome/epidemiologyABSTRACT
Objective:To explore the level of oncology nurses’ organizational silence and its influencing factors.Methods:Totally, 278 oncology nurses were recruited to fill out the General Information Questionnaire, Nurses’ Organizational Questionnaire, Perceived Social Support Scale and Connor-Davidson Resilience Scale short version.Results:The score of Nurses’ Organizational Questionnaire was (51.27±17.28), the score of acquiescent silence was (15.91±5.42), the score of defensive silence was (15.83±6.29), the score of prosocial silence was (11.03±4.16) and the score of indifferent silence was (8.50±3.46). The perceived social support and psychological reliance were negatively associated with nurses’ organizational silence ( r values were -0.364, -0.497, all P<0.01). The results of multiple linear regression analysis showed that age, degree of education, perceived social support and psychological reliance were the influencing factors of oncology nurses’ organizational silence (all P<0.05), which could explain 45.00% of the variation. Conclusions:The level of oncology nurses’ organizational silence is at a medium level, which should be improved. Nursing managers should pay attention to the phenomenon of oncology nurses’ organizational silence, and take appropriate interventions to break the phenomenon, so as to improve the job satisfaction and work efficiency of nurses’.
ABSTRACT
Objective To study the expression of muhidrug resistance( MDR1 ) ,and clinical significance of MDR1 gone expression in EOC. Methods Reverse transcription polymerase chain reaction was used to determine the expression of MDR1 in 27 cases of epithelial ovarian cancer,38 cases of benign tumor and 20 cases of normal ovarian tissue. The expression rate of MDR1 and the clinical significance was explored. Results The expression rate of MDR1 gone in malignant,benign tumor and normal tissue of ovary was74.1%, 15.7 % and 0 % respectively. The levd of MDR1 gone expression in EOC was obviously higher than that in benign tumor(P<0.01 ). The non-respond-era to combination chemotherapy exhibited higher ratio of MDR1 expression than the respondera( P<0.05 ). Conclu-sion The expression of MDR1 is higher in EOC than that in normal ovary tissue and benign tumor. The expression of MDR1 is closely related to the tumor response to chemotherapy.
