Alternative Diagnostic Method Research Articles

Advancing prostate cancer detection: High-accuracy urine test distinguishes between high and low-risk cancers

Prostate cancer remains one of the leading causes of cancer-related deaths among men. The standard method for early detection involves measuring Prostate-specific antigen (PSA) levels in the blood, with elevated PSA levels prompting further diagnostic procedures, such as a prostate biopsy. While effective, biopsies can be painful and carry risks of complications such as fever and urinary tract infections. To reduce unnecessary biopsies, researchers have sought alternative diagnostic methods. In recent years, a urine test was developed for early-stage prostate cancer detection. However, this test struggled to differentiate between aggressive and slow-growing cancers, the latter of which often require minimal treatment and are managed through active surveillance. To address this limitation, scientists at Wunderkind University have significantly enhanced the urine test. By analysing the genomes of thousands of prostate cancer patients, they identified a panel of 16 genes detectable in urine that can effectively distinguish between high-risk and low-risk cancers. When applied to individuals with elevated PSA levels, this improved test demonstrated an impressive 97% accuracy in identifying advanced prostate cancer. This advancement holds great promise for reducing unnecessary biopsies and improving patient outcomes by accurately identifying those needing aggressive treatment versus those suitable for observation. This review paper will explore the development, validation, and clinical implications of this novel urine test, highlighting its potential to transform prostate cancer diagnostics and patient management.

The diagnostic accuracy of aortic valve calcium score in patients with low gradient and high gradient aortic stenosis

Abstract Introduction The standard imaging modality for diagnosing aortic stenosis (AS) is echocardiography (echo), by which the definition of severe AS is based on the transvalvular mean gradient (AMG) (>40 mmHg) and aortic valve area (AVA) (<1 cm2). However, in around one quarter of the cases, echo provides discordant findings (AVA<1 cm2, despite of an AMG <40 mmHg), complicating clinical decision making. Computed tomography aortic valve calcium scoring (CT- AVCS) offers an alternative diagnostic method. In cases with discordant echo measurements current guidelines recommend the use CT-AVCS to decide on severity. Purpose Our aim was to validate the sensitivity of the recommended AVCS thresholds within our patient population, as well as to identify any factors associated with below cut-off AVCS values despite confirmed severe AS (low AVCS). Methods Our retrospective study included 332 consecutive patients with severe AS (AVA ≤1 cm2), who underwent CT angiography (CTA) for transcatheter aortic valve implantation (TAVI) planning. Based on the AMG the patients were classified into high gradient (HG: AMG ≥ 40 mmHg) and low gradient (LG: AMG <40 mmHg) groups. In the LG group AS severity was assessed by a multiparametric algorithm. To specify the predictors of low AVCS among patients with HG-AS, logistic regression analysis was used. The patients were followed for 50 months. Cox proportional hazard model was used to assess the risk of death from any cause. Results The HG-AS group consisted of 244 and the LG-AS cohort of 88 patients. In the HG-AS population the sensitivity of AVCS to diagnose severe AS was 89%. Within the HG severe AS group, logistic regression analysis revealed an association between low AVCS and the AMG (OR 0.89, CI 0.83 – 0.95, p <0,001), whereas none of the other tested factors (age, sex, hypertension, diabetes, left ventricle function, renal function) showed any association. In the LG-AS group, contrary to the HG- AS patients, the sensitivity of AVCS to define severe LG AS was limited (53% in males and 67% in females). Over a median follow-up of 50 months, the prognosis of HG AS patients with low AVCS was more favourable than that of the high AVCS patient population (HR 0.41; CI 017 – 097; p=0.04), however, in the LG AS group, the prognosis was not different when stratifying the patients according to high or low AVCS (p=0.21). Conclusions Our results confirmed that among patients with HG AS, the recommended AVCS thresholds provide a good diagnostic sensitivity for severe AS. Nonetheless, the number of severe AS patients with low AVCS is not negligible, especially within the LG-AS population, where the diagnosis is the most challenging. Our findings underline that in patients with discordant echocardiographic findings, a personalized, multiparametric diagnostic approach is needed, instead basing the final diagnosis exclusively on AVCS.

Evaluation of a novel biplex rapid diagnostic test for antibody responses to Loa loa and Onchocerca volvulus infections.

Endemic to Central Africa, loiasis, caused by the vector-borne worm Loa loa, affects approximately 10 million individuals. Clinical manifestations include transient angioedema (Calabar swellings), migration of the adult worm under the eye conjunctiva (eye worm) and less specific general symptoms. Loiasis presents a significant public health challenge because L. loa-infected individuals can develop serious adverse events after taking ivermectin, the drug used to combat onchocerciasis. In this context, alternative interventions and rigorous diagnostic approaches are needed. Diagnosing loiasis is challenging because its main clinical manifestations are sporadic and non-specific. The definitive diagnosis relies on identifying adult worms migrating beneath the conjunctiva, or microfilariae (pre-larvae) in blood smears. However, "occult loiasis" (infection without blood microfilariae) is frequent. Serological rapid antibody diagnostic tests (ARTs) can provide an alternative diagnostic method. We compared a novel ART simultaneously targeting onchocerciasis (IgG4 to Ov-16 and OvOC3261, test line 1) and loiasis (IgG4 to L1-SXP-1, test line 2), called IgG4-SXP-1 biplex test) to the already established Loa-ART (all IgG isotypes to Ll-SXP-1, called pan-IgG-SXP-1 test). Blood samples underwent both ARTs, read qualitatively and semi-quantitatively. Additionally, blood smears, skin snips, Kato-Katz method for soil-transmitted helminthiases identification and eosinophilia measurements were performed. Questionnaires gathered demographic details and loiasis-related signs. ARTs performance was compared using specific loiasis-related signs and microfilaremia as references. Discordances between the two ARTs were investigated using logistic regression models. Out of 971 participants, 35.4% had L. loa microfilaremia, 71.9% had already experienced loiasis-related signs, 85.1% were positive in the pan-IgG-SXP-1 test and 79.4% were positive in the IgG4-SXP-1 biplex test. In the microfilariae-positive population, the sensitivity of the rapid tests was 87.4% for the pan-IgG-SXP-1 test and 88.6% for the prototype IgG4-SXP-1 biplex test. Sensitivity was similar for both ARTs when using eye worm or Calabar swelling as references, but diagnostic performance varied based on microfilaremia levels and occult loiasis. Overall, IgG4-SXP-1 biplex test demonstrated a sensitivity of 84.1% and specificity of 47.6% for loiasis compared to the pan-IgG-SXP-1 test, leading to a Kappa coefficient estimated at 0.27 ± 0.03 for the qualitative results of the 2 ARTs. In the group that tested positive with the Pan-IgG test but negative with the IgG4-specific test, there was a lower prevalence of STH infection (p = 0.008) and elevated eosinophilia (p<0.001) compared to the general tested population. The sensitivity of each test was good (84-85%) but the diagnostic agreement between the two ARTs was poor, suggesting that IgG and IgG4 antibody responses should be interpreted differently. The assessment of the innovative rapid diagnostic IgG4-SXP-1 biplex test, designed for onchocerciasis and loiasis, shows encouraging sensitivity but underlines the necessity for further in vitro assessment.

Evaluation of testing face-mask filter samples with LAMP shows high rates of detection in pulmonary TB.

<sec><title>BACKGROUND</title>Detection of Mycobacterium tuberculosis (MTB) in bioaerosols derived from patients with active pulmonary TB is a potential alternative diagnostic method for patients with presumed TB who cannot expectorate sputum.</sec><sec><title>OBJECTIVE</title>To assess the efficacy of a bioaerosol particle collection method to capture MTB and diagnose TB.</sec><sec><title>METHODS</title>A mask-like filter holder (3D mask) with a water-soluble gelatine filter (GF) and one containing a water-insoluble polypropylene filter (PPF) were prepared. Eligible patients wore the 3D mask with GF or PPF within 3 days of starting anti-TB drugs. The GF and PPF filters were collected after 2 and 8 h. DNA was extracted from the filter samples and tested using loop-mediated isothermal amplification (LAMP).</sec><sec><title>RESULTS</title>Filter samples were collected from 57 and 20 patients with and without active pulmonary TB, respectively. The GF and PPF sensitivity was 76.2% and 83.3%, respectively. The specificity of both methods was 100%. Of the 57 patients diagnosed with non-expectorated sputum samples, including suction phlegm, gastric lavage, and bronchial lavage fluid, 55.6% and 50.0% were positive by GF and PPF, respectively.</sec><sec><title>CONCLUSION</title>We present a 3D mask filter sampling method for exhaled bioaerosol particles that can be used in clinical practice to diagnose patients with presumed TB.</sec>.

Comparison of Measurements for Recording Postural Control in Standing and Seated Position in Healthy Individuals.

Background: A standard method of assessing postural control is to measure while standing. However, its implementation is usually limited. Recording postural control directly on the trunk in a seated position could provide an alternative diagnostic method for quantifying neuromuscular control. Methods: A comparison of center of pressure (CoP) measurements in the standing and sitting positions was performed on 66 healthy adult subjects. The reliability of the measurements in the sitting position was tested in 23 subjects. In addition, the extension force of all test subjects was recorded. Results: The assessments of CoP fluctuations in standing and seated positions showed adequate agreement (deviation 9.1%). Furthermore, good internal consistencies with a sufficient test-retest reliability could be demonstrated for the measurements in seated position. Both CoP measurement methods showed a comparable Spearman correlation to obtained extension force measurements (standing: 0.24, seated: 0.23). Conclusions: Our results show that recording CoP fluctuations in the sitting position is a reliable and valid adjunct to single-leg stance measurements. It could serve as an additional alternative to quantify neuromuscular control in impaired patients who cannot adequately perform the single-leg stance. In addition, measurement in the seated position allows direct recording of neuromuscular control at the trunk.

Intracranial Solitary Fibrous Tumor in a 25-Year-Old Woman

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Intracranial solitary fibrous tumors (ISFTs) are extremely rare spindle cell tumors originating from dendritic mesenchymal cells expressing CD34 antigens that are usually benign, although malignant transformation had been reported. The knowledge of natural course and prognostic factors of ISFTs is still limited and the tumor is easily misdiagnosed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Presentation:&lt;/strong&gt; An intra-cranial extra-axial tumor tissue resection from a 25-year-old woman was evaluated in the Surgical Pathology Laboratory. Histologic findings (cellular spindle cell tumor with ‘patternless’ pattern, staghorn blood vessels and &amp;lt;5 mitoses per 10 hpf) and immunophenotype (positive for CD34, weakly and focally positive for STAT6) suggested a diagnosis of intracranial solitary fibrous tumor WHO Grade II.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion:&lt;/strong&gt; ISFTs have very low incidence in the CNS and are difficult to distinguish radiologically from meningiomas, thus post operative pathological examination and immunohistochemistry markers evaluations are the mainstay for diagnosis. ISFT is associated with NAB2-STAT6 gene fusion and may exhibits a wide spectrum of histological features. STAT6 immunohistochemistry is considered as one of the most sensitive diagnostic methods, while the evaluation of CD34 expression can be used as alternative diagnostic method despite having lower sensitivity.&lt;/p&gt;

A simple color absorption analysis of colorimetric loop-mediated isothermal amplification for detection of Raillietina spp. in clinical samples using a 3D-printed tube holder coupled with a smartphone camera and notebook screen.

Asimple method has been developedfor semi-quantitative analysis of the colorimetric output of loop-mediated isothermal amplification (LAMP) using a 3D-printed tube holder with a smartphone and notebook for the detection of Raillietina, which is the cause of Raillietiniasis affecting free-range chicken farming. In this method, a light is directedfrom a notebook screen to the LAMP products in the tube holder and the color absorption of the LAMP products is measured by using the appropriate smartphone application. It was found that the malachite green dye-coupled LAMP (MaG-LAMP) assay showed the highest sensitivity and specificity for detecting Raillietina without any cross-reaction with other related parasites and hosts. The limit of detection was 10fg/μL of DNA. A total of 60 fecal samples were infectively confirmed by microscopic examination and the results of microscopy compared with those of MaG-LAMP and triplex PCR assays. Microscopy and MaG-LAMP based on the color absorption demonstrated high agreement in Raillietina detection with kappa = 1. Rapid, simple, cost-effective, and easy interpretation of colorimetric LAMP assays and their high sensitivity make them superior to PCR and morphological investigation, demonstrating the feasibility of this assay in point-of-care screening to support farm management and solve chicken health problems. Our study presentsis an alternative diagnostic method using semi-quantitative analysis of colorimetric LAMP based on the differing solution color absorptions between positive and negative reactions for infectious disease diagnosis.

Performance evaluation of portable respiratory polygraphy for assessing sleep bruxism in adults.

Polysomnography (PSG) is the gold standard for sleep bruxism (SB) assessment, it is expensive, not widely accessible, and time-consuming. Given the increasing prevalence of SB, there is a growing need for an alternative, readily available, reliable and cost-effective diagnostic method. This study aimed to evaluate the diagnostic validity of portable respiratory polygraphy (PRPG) compared with PSG for SB diagnosis. One hundred and three subjects underwent simultaneous examinations using PRPG (NOX T3, NOX Medical) and PSG (NOX A1, NOX Medical) in a sleep laboratory. The mean Bruxism Episodes Index (BEI) measured by PRPG was 4.70 ± 3.98, whereas PSG yielded a mean BEI of 3.79 ± 3.08. The sensitivity for detecting sleep bruxism (BEI >2) by PRPG was 48.3%, with a specificity of 81.2%. The positive predictive value was estimated at 51.9%, and the negative predictive value at 78.9%. However, when distinguishing between mild bruxism (BEI >2 < 4) and severe bruxism (BEI >4), PRPG demonstrated a sensitivity of 77.8% and 68.3% and a specificity of 48.6% and 71.4%, respectively. Polysomnography continues to be the SB diagnostic gold standard tool, as the sensitivity and specificity of PRPG are significantly lower when compared with PSG. Nevertheless, PRPG could serve as an alternative tool for SB screening or diagnosis, despite its limitations. Furthermore, our data indicate that comorbidities such as sleep apnea and sleep quality do not influence the diagnostic accuracy of PSG, suggesting its potential as a screening instrument in individuals with other sleep disorders.

The most dangerous factors for pancreatitis after ERCP – systematic review with a prevention approach

Summary Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most prevalent and harmful side effect of diagnostic and therapeutic ERCP. Identifying high risk patients and subsequent selection of alternative diagnostic methods needs a multifactorial study of PEP (post-ERCP pancreatitis) risk variables. To determine the most hazardous PEP-related variables, a systematic study was conducted. In order to find relevant studies published between 1/1/2017 and 1/10/2022, two independent researchers conducted searches (MT, SH R). A literature search of English language publications was conducted using MEDLINE through PubMed, EMBASETM through Ovid, the Cochrane Library, and Trip. In addition to Magiran and SID, we searched KoreaMed and LILACS for literature published in other languages. Endoscopic retrograde cholangiopancreatography OR Pancreatitis OR Risk factors OR ERCP OR Systematic review were used in the search strategy. A total of 174 studies were selected. After analyzing their compliance with the required criteria, a final review of five studies was conducted. This article presents the current findings on the most critical risk factors for post-ERCP pancreatitis. The most frequent ERCP operation side effect is PEP, which concerns individuals with high-risk factors. There is significant debate over PEP‘s pathophysiology. Due to its complex pathophysiology, PEP prevention should include a variety of criteria, including patient-related risk factors, pharmacological prophylaxis, and procedural methods. The patient‘s age, gender, and previous history of the disease are the most critical risk factors for pancreatitis after ERCP. Keywords pancreatitis, endoscopic retrograde cholangiography, risk factors, ERCP, PEP,

The Interplay between Mitochondrial Metabolism and Nasal Mucociliary Function as a Surrogate Method to Diagnose Thyroid Dysfunction: Insights from a Population-Based Study.

Aim and Background. This study aims to explore alternative diagnostic methods to assess thyroid function in patients unable to undergo blood tests for thyroid-stimulating hormones (TSH) and thyroxine (T4), such as individuals with trypanophobia, severe medical conditions, or coagulopathy. Considering the impact of thyroid dysfunction on mitochondrial metabolism and the essential role of proper mitochondrial function in ciliary motility, we postulate that assessing nasal ciliary function could serve as a surrogate diagnostic approach for thyroid dysfunction. Methods. This cross-sectional study was performed on individuals with no history of thyroid diseases. The primary endpoint was the diagnostic value of the nasal mucociliary (NMC) test using Iranica Picris (Asteraceae) aqueous extract in differentiating hypo- or hyperthyroidism cases from euthyroid cases. Results. 232 individuals were recruited (71% females, 86% euthyroid). Receiver operating characteristic (ROC) analysis showed a good diagnostic value for the NMC test in differentiating overt hypothyroidism (area under the ROC curve [AUROC] = 0.82, p = 0.004) and its fair value in diagnosing subclinical hyperthyroidism (AUROC = 0.78, p = 0.01) from the euthyroid condition. The NMC test had a significant positive correlation with TSH (r = 0.47, p < 0.001) and a significant negative correlation with T4 (r = -0.32, p < 0.001). The NMC rate was significantly different in distinct thyroid function groups (p < 0.001). Compared with euthyroid cases, the post-hoc analysis showed that the NMC test is significantly higher in overt hypothyroidism (15.06 vs. 21.07 min, p = 0.003) and significantly lower in subclinical hyperthyroidism (15.05 vs. 10.9 min, p = 0.02). Conclusions. The Iranica Picris-based NMC test might serve as a diagnostic method to distinguish overt hypothyroidism and subclinical hyperthyroidism.

Nanoparticle Uptake in the Aging and Oncogenic Drosophila Midgut Measured with Surface-Enhanced Raman Spectroscopy.

Colorectal cancer remains a major global health concern. Colonoscopy, the gold-standard colorectal cancer diagnostic, relies on the visual detection of lesions and necessitates invasive biopsies for confirmation. Alternative diagnostic methods, based on nanomedicine, can facilitate early detection of malignancies. Here, we examine the uptake of surface-enhanced Raman scattering nanoparticles (SERS NPs) as a marker for intestinal tumor detection and imaging using an established Drosophila melanogaster model for gut disease. Young and old Oregon-R and w1118 flies were orally administered SERS NPs and scanned without and upon gut lumen clearance to assess nanoparticle retention as a function of aging. Neither young nor old flies showed significant NP retention in their body after gut lumen clearance. Moreover, tumorigenic flies of the esg-Gal4/UAS-RasV12 genotype were tested for SERS NP retention 2, 4 and 6 days after RasV12 oncogene induction in their midgut progenitor cells. Tumorigenic flies showed a statistically significant NP retention signal at 2 days, well before midgut epithelium impairment. The signal was then visualized in scans of dissected guts revealing areas of NP uptake in the posterior midgut region of high stem cell activity.

Performance of the IMMY® sona Aspergillus lateral flow assay for the detection of galactomannan in tracheal aspirate samples from Brazilian patients with COVID-19-associated pulmonary aspergillosis: Cross-sectional and systematic review of literature.

During the COVID-19 pandemic, many patients in intensive care units (ICUs) were affected by invasive fungal infections, including aspergillosis, contributing to a high mortality rate. Diagnosing proven COVID-19-associated pulmonary aspergillosis (CAPA) requires clinical and radiological evaluations, along with laboratory testing of bronchoalveolar lavage samples or lung biopsies. However, these procedures and equipment are often inaccessible in developing countries or regions with limited resources, including Brazil. Consequently, alternative diagnostic methods, such as measuring Aspergillus galactomannan (GM) in tracheal aspirate (TA), have been explored for CAPA diagnosis. Nonetheless, research on the efficacy of TA-based diagnostic tests is limited. This study aimed to assess the performance of the IMMY® Sona Aspergillus lateral flow assay (LFA) for GM detection in TA samples from 60 ICU patients with suspected CAPA at two tertiary hospitals in Campo Grande, Brazil. The ELISA method (Platelia Aspergillus AG, Bio-Rad®) was used to detect Aspergillus GM in TA samples, serving as the microbiological criterion and reference test. Fifteen patients (12.4%) were identified as having possible CAPA. The overall accuracy of LFA was 94%, and the tests demonstrated an agreement of 93.1% (Cohen's kappa of 0.83). Based on our findings, the LFA for Aspergillus GM detection in TA samples exhibited excellent performance, proving to be a valuable diagnostic tool for potential CAPA. In a systematic review, two studies were included, and the meta-analysis revealed pooled estimates provided a sensitivity of 86% (95% CI, 80%-91%) and specificity of 93% (95% CI, 86%-97%). The diagnostic odds ratio (DOR) for identification of Aspergillus using LFA was 103.38 (95% CI, 38.03-281.03). Despite its lower sensitivity compared to our study, the LFA appears to be a promising diagnostic option for CAPA, particularly in suspected cases that have not received antifungal therapy. This enables timely antifungal treatment and could reduce mortality rates in regions where bronchoscopy is unavailable or limited.

A single-center pilot study on the efficacy and safety of acetic acid–enhanced magnifying endoscopy with narrow-band imaging for diagnosis of colorectal epithelial neoplasms

Background and aimsWe investigated the ideal acetic acid (AA) concentration for AA-enhanced, narrow-band imaging (NBI) magnifying endoscopy (ANBI-ME) in the diagnosis of superficial colorectal neoplasms and evaluated its clinical efficacy. MethodsDuring the exploratory phase, we investigated four concentrations (1.5%, 2.25%, 3.0%, and 4.5%) in rotation by performing ANBI-ME on 50 superficial colorectal neoplasms at each concentration. A favorable AA concentration was determined by evaluating the diagnostic accuracy, AA whitening duration (AD), peristalsis, and bleeding following endoscopic resection. In the validation phase, we assessed inter-observer agreements for ANBI-ME with the determined AA concentration and inter-methodological agreements between that and subsequently conducted crystal violet-stained magnifying endoscopy (CV-ME) with the exploratory set and 98 additional patients. ResultsThe diagnostic accuracies were 89.3% (42/47) for 1.5% AA, 92.0% (46/50) for 2.25%, 96.8% (61/63) for 3.0%, and 97.8% (46/47) for 4.5% with no significant difference (p = 0.26). A significant positive correlation was observed between the AA concentrations and ADs (p < 0.001). No significant differences in hyperperistalsis or post-resection bleeding were observed. The optimal AA concentration was determined to be 4.5%. In the validation analysis, the accuracy rates were 72.4% (105/145) using AMBI-ME and 68.3% (99/145) using CV-ME (p = 0.43). Strong agreements were noted between two observers (κ, 0.87 for ANBI-ME; 0.83 for CV-ME) and between the methods (κ, 0.87 and 0.81 for each observer). ConclusionFor diagnosing colorectal lesions, an AA concentration of 4.5% in ANBI-ME was safe and effective. Its diagnostic performance was comparable to CV-ME, and future large-sample studies may confirm its potential as a reliable alternative endoscopic diagnostic method.

Biomarcadores proteómicos para la predicción no invasiva de trombos en la orejuela izquierda de pacientes con fibrilación auricular

Introduction and objectivesThe CHA2DS2-VASc score, used to assess the risk of left atrial appendage thrombus (LAAT) formation in patients with atrial fibrillation (AF), has limited predictive value. Moreover, transesophageal echocardiography imaging, the gold standard diagnostic method to identify thrombi, is semi-invasive. Consequently, there is a need for alternative and noninvasive diagnostic methods for LAAT risk assessment. MethodsDeep proteomic analysis was conducted in plasma samples from 8 patients with nonvalvular AF, divided into thrombus and control groups (4 patients in each group) based on the presence or absence of LAAT. Biomarkers associated with LAAT were validated using an enzyme-linked immunosorbent assay in a cohort of 179 patients with available clinical, transthoracic, and transesophageal echocardiography data. Predictive models were developed to assess the improvement in LAAT identification. ResultsThe LAAT group had higher CHA2DS2-VASc scores, larger LA diameter, and lower LAA flow velocities. Deep proteomic analysis identified 30 differentially expressed proteins, including myosin light chain 4, prenylcysteine oxidase 1 (PCYOX1), and decorin as potential diagnostic biomarkers of LAAT. The model showed that PCYOX1 and decorin provided an area under the curve (AUC) of 0.970 for LAAT prediction compared with 0.672 in a model including the CHA2DS2-VASc score and LAA cauliflower morphology. The incremental value of proteomic biomarkers for LAAT in patients with nonvalvular AF was further confirmed with the net reclassification improvement and integrated discrimination improvement indices. ConclusionsProtein levels of PCYOX1 and decorin improve the predictive performance for LAAT in patients with nonvalvular AF.

Fusion of transformer attention and CNN features for skin cancer detection

Melanoma is a skin cancer that spreads quickly and has serious risks. Early diagnosis is essential, but since the symptoms of skin lesions in the early stages are vague and similar, they can be difficult for specialists to detect. Therefore, machine learning-based alternative diagnostic methods can be developed in addition to existing ones. This study proposes a new deep learning model, a modified lightweight vision transformer (ViT) architecture, and a hybrid framework developed with an integrated deep learning model and an Ensemble Learning (EL) model for the early-stage diagnosis of skin lesions. The proposed deep learning model was developed based on convolution layers and transformers. The model is called multi-head attention block depthwise separable convolution network (MABSCNET). The proposed hybrid framework was developed by combining modern deep learning and EL models pre-trained with the ImageNet dataset along with the MABSCNET model. In the experimental process, the effectiveness of the proposed methods was evaluated on the ISIC 2020 dataset. Additionally, additional experiments were conducted on ISIC 2018 and a Kaggle dataset to analyze the proposed hybrid framework's classification performance. Image enhancement techniques were used in the datasets. In the ISIC 2020 dataset, the MABSCNET model reached 78.63 % accuracy, the ViT model obtained 76.50 %, and the hybrid framework reached 92.74 % accuracy. Moreover, the proposed hybrid framework achieved 100 % on the ISIC 2018 dataset and 94.24 % on the Kaggle dataset.

The diagnostic accuracy of conventional breast ultrasound in Diagnosing Malignant Breast Lesions Taking Histopathology as Gold Standard

Breast cancer is a prominent worldwide health issue, with difficulties in detection worsened by the presence of dense breast tissue. Ultrasound and other alternative diagnostic methods have demonstrated potential to enhance detection rates, especially in situations involving thick breast tissue. Objective: To evaluate how well conventional breast ultrasonography can accurately differentiate between benign and malignant tumors, using histopathology as the most reliable method of comparison. Methods: A cross-sectional study was conducted at a tertiary care hospital to evaluate 185 female patients with breast lesions using sonographic examination. Demographic information, ultrasonography results and histopathological data were gathered and examined using SPSS version 26.0. Calculations were performed to determine the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. Results: The study demonstrated that conventional breast ultrasound has a high diagnostic accuracy rate, with ratings of 91.07%, 83.57%, 89.47%, 85.92%, and 88.11% for sensitivity, specificity, positive predictive value and negative predictive value, respectively. Statistically significant differences in diagnostic accuracy were observed when stratification was performed based on age, duration of disease, parity, and history of breastfeeding. Conclusions: The findings indicated that ultrasound is highly effective in differentiating between benign and malignant breast lesions, with substantial diagnostic precision. However, false positives remain a concern, necessitating ongoing research for optimizing ultrasound efficacy, especially in high-risk cohorts.

Ready-to-use diagnostic kit based on electrochemical nanobiosensor for antibiotic resistance gene determination

Nowadays, antibiotic resistance, which occurs as a result of mutations in bacterial genes due to the frequent use of antibiotics, causes serious health problems and deaths. One of the resistance mechanisms that develop with the use of antibiotics is that bacteria begin to produce carbapenemase enzymes that cause multiple drug resistance in bacteria by hydrolyzing antibiotics. In this study, an alternative diagnostic kit method to traditional tests was developed for the determination of bacteria carrying relevant antibiotic resistance genes because these analyzes have multi-step sample preparation, long/complex determination schemes and are high cost.With the diagnostic kit containing a stable electrochemical nanobiosensor developed in this study, the presence of two different antibiotic resistance gene regions of the carbapenemase enzyme named OXA-48 and VIM, which are responsible for more than 50 % of deaths due to antibiotic resistance, was investigated. Carbon nanotubes (CNTs) has been modified to the pencil graphite electrode (PGE), then the synthetic capture probe DNAs are immobilized covalently to the surface containing nanomaterial. Later, the sensor surface, whose stability was ensured by surface blockage, thus gained “diagnostic kit feature” and was stored in the refrigerator (+4 °C) until analysis. Thus, the preparation of a ready-to-analyze diagnostic kit, which will provide detection without any preparation, has been completed. With the developed kit, it was possible to determine the resistance gene with 2.5 pmole/50 μL of detection limit. In addition, analyzes with real samples could be performed even after 150 days (5 months) of kit preparation.This represents the first diagnostic kit system containing PGE and CNT for the detection of antibiotic resistance based on electrochemical alpha naphthol signal measurement in real samples with symmetrical and asymmetric structures (PCR). In the developed alternative test platform, the sample volume required for determination is 50 μL and the analysis time with this portable open-use and throw-away diagnostic kit is 30 min.

Pancreatic juice cytology for diagnosing invasive pancreatic carcinoma/high-grade pancreatic intraepithelial neoplasia without visible tumors on endoscopic ultrasound

ObjectivesPancreatic ductal adenocarcinoma (PDAC) with a diameter ≤10 mm and high-grade pancreatic intraepithelial neoplasia (HG-PanIN) require pre-operative diagnosis. Most cases present only indirect imaging findings without visible tumors on endoscopic ultrasound (EUS). Therefore, EUS-guided fine-needle aspiration/biopsy is not applicable. An alternative diagnostic method is pancreatic juice cytology (PJC) via endoscopic naso-pancreatic drainage (ENPD-PJC), which is not the standard practice. This study aimed to investigate ENPD-PJC for diagnosing suspected PDAC/HG-PanIN cases without visible tumors on EUS. MethodsData of patients with suspected PDAC/HG-PanIN without visible tumors who underwent PJC were retrospectively evaluated. One PJC sample was collected during endoscopic retrograde pancreatography (ERP-PJC), and 12 samples were collected during ENPD-PJC, 3-hourly for cytological analysis. ERP-PJC, ERP/ENPD-PJC, and ENPD-PJC positivity indicated cytologically positive samples. Patients with positive/negative PJC with follow-up for <4-years were excluded as undiagnosed cases. A non-malignant diagnosis was based on histopathological absence/stable imaging findings for ≥4-years. The primary endpoint was to demonstrate that ERP/ENPD-PJC has a higher diagnostic ability than ERP-PJC. ResultsTwenty-two patients with histopathologically diagnosed PDAC/HG-PanIN and 31 with a non-malignant diagnosis were enrolled. ERP-PJC, ERP/ENPD-PJC, and ENPD-PJC showed sensitivities of 36.4 %, 86.4 %, and 77.3 %, specificities of 93.5 %, 87.1 %, and 93.5 %, and accuracies of 69.8 %, 86.7 %, and 86.7 %, respectively. ERP/ENPD-PJC and ENPD-PJC demonstrated superior sensitivity and accuracy compared to ERP-PJC. A greater occurrence of positive outcomes markedly distinguished true positives from false positives. ConclusionsERP/ENPD-PJC and ENPD-PJC had higher diagnostic accuracies for PDAC/HG-PanIN without visible tumors on EUS. ENPD-PJC is recommended for the diagnosis of these lesions.

Advancing serologic diagnosis: assessing the efficacy of rErpY-like protein in human leptospirosis detection.

Leptospirosis is a globally distributed infectious disease caused by pathogenic spirochetes of the Leptospira genus, often overlooked. It is estimated that the disease affects approximately one million people annually, resulting in more than 58,900 deaths. The gold standard for serodiagnosis of leptospirosis is the Microscopic Agglutination Test (MAT). However, the limitations of this technique necessitate the exploration of alternative diagnostic methods. In this study, we evaluated the ErpY-like recombinant protein (rErpY-like) in the development of a serologic diagnostic assay for human leptospirosis. Eighty-six human sera samples, characterized by MAT, underwent evaluation through indirect IgM-ELISA and IgG-ELISA. The sensitivity and specificity values obtained from IgM-ELISA were 60% and 76%, respectively, while those from IgG-ELISA were 96.4% and 100%, respectively. The use of the rErpY-like protein in both IgM-ELISA and IgG-ELISA proves to be a sensitive and specific method for antibody detection. This could potentially serve as a valuable alternative tool in the diagnosis of human leptospirosis.

Pedal Acceleration Time An Alternative Tool To Ankle-Brachial Index In Peripheral Arterial Disease.

Ankle-Brachial Index (ABI) is a well-established diagnostic tool for evaluating peripheral arterial disease (PAD). Limitations in its application led to the development of alternative diagnostic methods, including Toe-Brachial Index (TBI) and Transcutaneous Pressure of Oxygen (TcPO2), yet these are not as widely available as ABI. Recently, Pedal Acceleration Time (PAT), has gained popularity as a new tool to assess PAD, requiring only an ultrasound. This study seeks to further establish the correlation between ABI and PAT, determining whether PAT can be a reliable alternative for diagnosing and assessing the severity of PAD. ABI and PAT were measured in patients attending our consult with no history of vascular or endovascular surgery. Limbs with unmeasurable ABI were excluded. Patients were categorized into groups based on their PAD stage according to the Fontaine classification. Patient demographics, comorbidities and respective ABI and PAT were analysed. Sixty-nine patients (114 limbs) were included in the study. Mean age 68 ± 11.7 years, 78.3% male and 33.3% diabetic patients. Fifty-three claudicant limbs (46.5%) and 26 limbs (22.8%) with chronic limb threatening ischemia. Pearson correlation coefficient between ABI and PAT, showed a strong negative correlation (r= -0.78; p<0.01). Mean ABI and PAT for limbs in Fontaine stage I were 0.94 ± 0.17 and 82.0 ± 27.4 ms; Fontaine stage IIa 0.69 ± 0.21 and 141.3 ± 57.8 ms; Fontaine stage IIb 0.54 ± 0.14 and 173.4 ± 65.1 ms; Fontaine stage III 0.43 ± 0.15 and 216 ± 33.2 ms; Fontaine stage IV 0.49 ± 0.17 and 206.7 ± 78.1 ms, respectively. Our study suggests an inverse correlation between ABI and PAT, in accordance with the findings published in the literature, thus supporting the use of PAT as an easily reproducible and efficient alternative to ABI for evaluating the severity of PAD.