Background-Serial ultrasonography is reliable for the diagnosis of deep venous thrombosis in symptomatic patients, but the low prevalence of thrombosis in this group renders the approach costly and inconvenient to patients. We studied the clinical validity of the combination of a pretest clinical probability score and a D-dimer test in the initial evaluation of patients suspected of deep venous thrombosis. Methods and Results-Patients with a normal D-dimer concentration (Ͻ500 fibrin equivalent units [FEU] g/L) and a non-high probability score (Ͻ3) had no further testing. Patients with a normal D-dimer concentration and a high probability score (Ն3) underwent one ultrasonogram. Serial ultrasonography was performed in patients with an abnormal D-dimer concentration. Patients were followed for 3 months. A total of 812 patients were evaluable for efficacy. Only 1 of 176 patients (0.6%; 95% CI, 0.02% to 3.1%) with a normal D-dimer concentration and a non-high probability score developed thrombosis during follow-up. A normal D-dimer concentration and a high probability score were found in 39 patients; 3 of them (7.7%; 95% CI, 1.6% to 20.9%) had thrombosis at presentation, and one (2.8%; 95% CI, 0.07% to 14. 5%) developed pulmonary embolism during follow-up. In 306 of 597 patients (51.3%) with an abnormal D-dimer concentration, thrombosis was detected by serial ultrasonography. Six patients (2.1%; 95% CI, 0.8% to 4. 4%) developed thrombosis during follow-up. No deaths due to thromboembolism occurred during follow-up. The total need for ultrasonography was reduced by 29%. Conclusion-The combination of a non-high pretest clinical probability score and a normal D-dimer concentration is a safe strategy to rule out deep venous thrombosis and to withhold anticoagulation. (Circulation. 2003;107:593-597.)

COPD is characterised by damage to small airways due to an inflammatory process as well as an imbalance between oxidants and antioxidants. Several cytokines and cell adhesion molecules enhancing a mainly neutrophilic inflammation have been associated with COPD. The aim of the study was to investigate whether inflammation or oxidative markers gave an indication of the course of COPD during an exacerbation. Fourteen patients with moderate to severe COPD admitted to the St. Antonius Hospital because of an exacerbation have been monitored during treatment with prednisolone 50 mg intravenously during 24 h at admission, reduced to 25 mg at day 3 and tapered off with oral prednisolone at day 7. On three separate occasions, day 1, 3 and 7, H2O2 in exhaled air, IL-8 and the soluble cell adhesion molecule sICAM and sE-selectin in serum were measured. We compared the patients at day 1 with healthy controls (in both non-smokers and smokers). Furthermore, we examined the changes from the study group in time during therapy. At admission all the markers were raised in comparison with the control groups. During treatment H2O2 concentrations in breath condensate declined significantly (P<0.001) as well as IL-8 and sICAM in serum (P=0.002, respectively, P<0.001). There was no significant change in sE-selectin (P=0.132). No significant improvement has been found in spirometry. These data suggest that the markers H2O2 in exhaled air, IL-8 and sICAM in serum are suitable markers in monitoring exacerbated COPD.

Only mild signs of oxidative stress and no renal dysfunction were found during and after off-pump CABG compared with on-pump CABG.

students, and leaders in the technology and communication industries were invited to participate. The broad range of topics discussed included means to improve access to data, approaches for better information filtering and for electronic annotation, the merits and limitations of the peer-review process, and pathways to transition from today's static publication format to an interactive one. A unique aspect of this meeting was the participation of HighWire Press, the leading e-publishing platform, which facilitates the digital dissemination of 1696 journals, such as Science, the Journal of Biological Chemistry, the Proceedings of the National Academy of Sciences, the British Medical Journal, and Clinical Chemistry. HighWire Press and similar publishing entities have the ability to transform some of these ideas into reality and the potential to change the way that readers access and communicate scientific information. To access the executive summary of this exercise, go to: https://lib.stanford.edu/files/ Colloquium.Summary.Final_.pdf.

d-dimer decreased with age: 12% in the highest quartile (>73AE8 years) versus 25% in younger patients (P ¼ 0AE00005). We therefore conclude that the combined strategy of a low/moderate PCP score with a normal d-dimer test is safe for excluding DVT in all age groups, but is less useful in the elderly.