Aspiration Test Research Articles

THE ROLE OF BRONCHOSCOPY IN INTENSIVE CARE MEDICINE, CASE REPORT

Purpose. Airway maintenance, adequate ventilation, and pulmonary gas exchange are crucial for critically ill patients. The challenges of performing in intensive care patients often differ significantly from routine surgical procedures in the operating room. The aim of our study was to assess the effectiveness of bronchoscopic aspiration in improving respiratory function in a patient on prolonged artificial ventilation. Material/Methods. A 69-year-old male was admitted to the ICU six days after an open cystoprostatectomy, presenting with respiratory failure. Initial treatment included blind airway suctioning, nebulization, chest physiotherapy, and empirical antibiotics. Due to persistent atelectasis and respiratory failure, bronchoscopic aspiration was performed. A total of nine bronchoscopies with bronchoalveolar lavage (BAL) were conducted for aspiration and microbiological testing, guiding adjustments in antibiotic therapy. After 61 days in the ICU, the patient was transferred to the Department of Urology and later discharged. Results. Bronchoscopic aspiration significantly improved the patient's condition, with noticeable improvements after the first bronchoalveolar lavage (BAL). Pulmonary imaging on X-ray and blood oxygenation showed clear progress, with better lung function and enhanced ventilation parameters. These changes allowed for a reduction in oxygen concentration and improved gas exchange. After 61 days in the ICU, the patient was successfully transferred to the Department of Urology and later discharged in stable condition. Conclusions. Bronchoscopic aspiration is a highly effective method for improving ventilation and oxygenation in patients on prolonged mechanical ventilation. It plays a crucial role in managing airway obstructions atelectasis, and enhancing microbiological diagnostics.

Epstein–Barr virus-positive mucocutaneous ulcer resulting in severe methotrexate intoxication: a case report

BackgroundEpstein–Barr virus-positive mucocutaneous ulcer is one of the mature B-cell lymphoproliferative diseases occurring in patients with immune dysfunction including those with immunosuppressive treatment such as methotrexate.Case presentationA Japanese elderly man in his 80s with rheumatoid arthritis on methotrexate was admitted to our hospital complaining persistent pharyngeal pain. Laboratory tests revealed severe pancytopenia, elevated C-reactive protein, and increased creatinine levels. An otolaryngological examination showed ulceration of the right tonsil, from which diagnostic biopsy was performed. The diagnosis of Epstein–Barr virus-positive mucocutaneous ulcer was made and bone marrow aspiration revealed hypocellularity and megaloblastic changes. Pancytopenia was improved after discontinuing methotrexate, and repeated bone marrow aspiration test revealed recovery of normal cellularity and disappearance of dysplasia, confirming the diagnosis of methotrexate intoxication. Tonsil ulcer was improved only with discontinuation of methotrexate, which strongly supported the diagnosis of EBV-MCU.ConclusionOur case suggested that even this best prognosis form of lymphoproliferative disease could lead to fatal complications if not appropriately managed.

The Combined Use of Fine-Needle Aspiration (FNA) and BRAF V600E Gene Testing: Can it Increase the Definitive Diagnosis Rate of Nodules Categorized as Bethesda III for Papillary Thyroid Carcinoma?

This study aimed to analyze the malignant probability of thyroid nodules diagnosed as indeterminate cytology, including atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), and investigate the diagnostic value of combining BRAF V600E gene testing within this classification. We conducted a retrospective analysis of 126 patients who underwent fine-needle aspiration (FNA) examination of thyroid nodules and subsequent surgical treatment at Beijing Haidian Hospital between October 2021 and November 2022. Among them, there were 22 male and 104 female patients, aged between 18 and 75years old. Surgical pathology results were considered the gold standard for diagnosing the nature of thyroid nodules, evaluating the malignant incidence of cytological results categorized as AUS/FLUS. Fisher's exact test and diagnostic test evaluation methods were used to analyze the discriminatory diagnostic efficacy of preoperative FNA combined with BRAF V600E gene testing for papillary thyroid carcinoma (PTC). Statistical analysis was performed using SPSS 22.0 software. In PTC patients, the BRAF V600E gene mutation rate was 87.93% (102/116). Within the category of FNA results as AUS/FLUS, the proportion of PTC was 60.00% (15/25). The specificity, sensitivity, positive predictive value, and negative predictive value of the BRAF V600E gene mutation in diagnosing PTC within the AUS/FLUS category were 10/10, 6/15, 6/6, and 10/19, respectively. The BRAF V600E gene mutation significantly increased the detection rate of PTC in patients classified under this cytology (P = 0.028, <0.05). Preoperative FNA combined with BRAF V600E gene mutation testing significantly enhances the malignant detection rate of thyroid nodules diagnosed cytologically as AUS/FLUS. This combined approach provides a potent tool to improve diagnostic accuracy in this indeterminate classification.

Adverse Effects Associated with Dermal Filler Treatments: Part II Vascular Complication.

Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected fillers compress adjacent blood vessels, leading to ischemia and potential necrosis, while intravascular emboli result from fillers entering blood vessels, causing blockages. The study emphasizes the importance of anatomical knowledge, careful injection techniques, and early intervention. Management strategies include the use of hyaluronidase to dissolve HA fillers, vasodilators to improve blood circulation, and hyperbaric oxygen therapy. The regions most susceptible to complications align with major arterial pathways, particularly the nasolabial folds and nasal region. The study also highlights the need for meticulous injection techniques, the use of cannulas over needles in high-risk areas, and the aspiration test to detect vessel penetration. Early detection and immediate intervention are crucial to mitigate adverse outcomes. Continuous education and training for practitioners, along with advancements in filler materials and injection methods, are essential for improving the safety of cosmetic procedures. This comprehensive understanding aids in preventing and managing vascular complications, ensuring better patient outcomes. The field of dermal filler treatments is advancing with new techniques and technologies, such as High-Resolution Ultrasound, Infrared Imaging, self-crossing hyaluronic acid filler, biodegradable microspheres, and microinjection.

Venetoclax combined with hypomethylating agents for favorable risk acute myeloid leukemia: A single center experience.

e18514 Background: Favorable risk acute myeloid leukemia (FR-AML) is typically treated with intensive induction chemotherapy followed by high dose consolidative cytarabine. However, a subgroup of FR-AML are not candidates for high intensity induction because of advanced age, comorbidities, or poor performance status. For these patients, hypomethylating agents (HMA) combined with venetoclax (HMA-Ven) is inferred as the standard of care based upon results of the VIALE-A trial; however, that trial enrolled only intermediate or poor risk AML. The efficacy of HMA-Ven in FR-AML is unclear. Here we present a single center experience of this regimen in FR-AML. Methods: In this retrospective single center case series, we collected data from all patients &gt;18 years old with newly diagnosed FR-AML between January 2018 to December 2022 at AdventHealth Orlando who were treated with HMA-Ven. Patient with relapsed/refractory disease or a diagnosis of acute promyelocytic leukemia were excluded. FR-AML was defined using ELN 2022 guidelines based on the results of genomic testing of the initial bone marrow aspirate. The primary endpoints were the complete remission (CR) rate and 1-year overall survival (OS). Statistical analyses were performed using the R survminer package. Results: Newly diagnosed FR-AML who received HMA-Ven were identified (n=12). The median age was 67.5 years. 3 (25%) cases had inversion of chromosome 16 and 9 (75%) had NPM1 mutations without FLT3-ITD mutations. 11 (92%) patients received decitabine and venetoclax. Patients received a median of 2.5 cycles of HMA-Ven, and all 12 patients achieved CR after one cycle of treatment. 6 (50%) patients were consolidated with intermediate-dose cytarabine (IDAC), 3 (25%) continued HMA-Ven, 2 (17%) underwent allogeneic stem cell transplant, and 1 (8%) received enasidenib. The 1-year OS was 80% (CI 0.59-1), and the median OS was not reached. 1 patient died due to chemotherapy toxicity with IDAC, and 1 patient died due to heart complications. 2 patients relapsed, 1 after IDAC and 1 after intolerance to further treatment after 6 cycles of HMA-Ven. Conclusions: Our findings suggest that HMA-Ven is an effective treatment for newly diagnosed favorable risk AML. All patients achieved CR with one cycle of treatment with most surviving more than one year. Large multicenter studies are needed to further validate these promising results.

CLINICAL AND RADIOGRAPHIC FEATURES OF ODONTOGENIC CYSTS OF JAW PRESENTED TO THE DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY, KHYBER COLLEGE OF DENTISTRY PESHAWAR

Objectives: To determine frequency, clinical and radiographic features of diff erent types of odontogenic cysts in patients reported to the department of Oral and Maxillofacial surgery, Khyber College of Dentistry Peshawar.Materials and Methods: This descriptive, cross sectional study was conducted at department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar from November 2019 to October 2021.This study was conducted on 89 patients with histopathologically confi rmed reports of odontogenic cysts. Data with respect to age, gender, type of odontogenic cyst, clinical and radiographic features of these cysts were analyzed from the data obtained through a customized structured proforma.Results: Out of the total 89 patient, there was male predilection (2.17:1). The most frequent age group was 2nd and 3rd decades. Among diff erent types of odontogenic cysts, radicular cyst (37.1%) was the most common cyst followed by dentigerous cyst (33.7%) and odontogenic keratocyst (27%). The most common aff ected site was posterior mandible (46.1%). Paresthesia was present in 22.5% cases. Unicortical expansion was present in 59.6 % and bicortical expansion in 38.2% cases. Tenderness was present in 50.6% cases and teeth mobility in 28.1% cases. Needle aspiration test was positive in 78.7% cases. Mean size was 32.23mm + 14.53 standard deviation. Unilocular radiolucency was present in 74.2% and multilocular radiolucency in 25.8%. Root resorption was present in 64% cases and impacted tooth was associated with 52.2% odontogenic cysts.Conclusion: It is concluded from this study that odontogenic cysts frequently encountered during 2nd and 3rd decades of life and more common in males with a predilection for the posterior mandible. Radicular cysts are most frequent among the other types of odontogenic cysts. Majority of patients has cortical expansion and positive needle aspiration test. Impacted tooth is associated with all the dentigerous cysts and most of OKC‘s and none of radicular cyst. Odontogenic cysts can reach to a considerable size to involve even half of the mandible.

Tuberculosis contact tracing, Angola.

To assess the outcomes of a contact-tracing programme to increase the diagnosis of tuberculosis in Cubal, Angola and offer preventive treatment to high-risk groups. A health centre-based contact-tracing programme was launched in Hospital Nossa Senhora da Paz in March 2015 and we followed the programme until 2022. In that time, staffing and testing varied which we categorized as four periods: medical staff reinforcement, 2015-2017, with a doctor seconded from Vall d'Hebron University Hospital, Spain; routine staff, 2017-2021, with no external medical support; community directly observed treatment (DOT), 2018-2019 with community worker support; and enhanced contact tracing, 2021-2022, with funding that allowed free chest radiographs, molecular and gastric aspirate testing. We assessed differences in contacts seen each month, and testing and treatment offered across the four periods. Overall, the programme evaluated 1978 contacts from 969 index cases. Participation in the programme was low, although it increased significantly during the community DOT period. Only 16.6% (329/1978) of contacts had a chest radiograph. Microbiological confirmation increased to 72.2% (26/36) after including molecular testing, and 10.1% (200/1978) of contacts received treatment for tuberculosis. Of 457 contacts younger than 5years, 36 (7.9%) received preventive tuberculosis treatment. Half of the contacts were lost to follow-up before a final decision was taken on treatment. Contact tracing increased the diagnosis of tuberculosis although engagement with the programme was low and loss to follow-up was high. Participation increased during community DOT. Community-based screening should be explored to improve participation and diagnosis.

Pathology of Ketoacidosis in Emergency of Diabetic Ketoacidosis and Alcoholic Ketoacidosis: A Retrospective Study.

This study is aimed at examining which factors are useful for the diagnosis and distinction of ketoacidosis. We recruited 21 diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) patients hospitalized in Kawasaki Medical School General Medical Center from April 2015 to March 2021. Almost all patients in this study were brought to the emergency room in a coma and hospitalized. All patients underwent blood gas aspiration and laboratory tests. We evaluated the difference in diagnosis markers in emergencies between DKA and alcoholic ketoacidosis AKA. Compared to AKA patients, DKA patients had statistically higher values of serum acetoacetic acid and lower values of serum lactate, arterial blood pH, and base excess. In contrast, total ketone bodies, β-hydroxybutyric acid, and β-hydroxybutyric acid/acetoacetic acid ratio in serum did not differ between the two patient groups. It was shown that evaluation of each pathology such as low body weight, diabetes, liver dysfunction, and dehydration was important. It is important to perform differential diagnosis for taking medical histories such as insulin deficiency, alcohol abuse, or starvation as the etiology in Japanese subjects with DKA or AKA. Moreover, it is important to precisely comprehend the pathology of dehydration and alcoholic metabolism which would lead to appropriate treatment for DKA and AKA.

Approach to the Diagnosis and Management of Essential Thrombocytosis in a Resource-Limited Setting

Essential thrombocytosis (ET) is a myeloproliferative neoplasm (together with polycythemia vera, chronic myelogenous leukemia, and primary myelofibrosis) characterized by clonal proliferation of megakaryocytes, usually due to the presence of JAK2, CALR, or MPL mutations. Whereas a bone marrow aspirate and genetic testing for these mutations are necessary for an accurate diagnosis of ET, in resource-limited settings, these are often either inaccessible or limited by prohibitive costs. A nuanced clinical approach is necessary to diagnose and manage ET in these settings. In this study, we present a case of ET diagnosed and managed in a resource-limited rural setting in Kenya with hydroxyurea and aspirin. We highlight the importance of individualized therapeutic targets, the challenges with dose adjustments in the setting of hydroxyurea-induced neutropenia, and how extrapolated data from the use of hydroxyurea elsewhere may help guide such dose adjustments. Finally, we propose a rationalized approach to treating ET in a resource-limited clinical setting.

Intraglandular dissemination: a special pathological feature.

Intraglandular dissemination is an important pathological feature of thyroid cancer, yet the biological characteristics of this phenomenon remain relatively underexplored. This paper aims to provide a comprehensive overview of its biological behaviors, protein expressions, and identification methods. Several retrospective studies have found that thyroid cancers with intraglandular dissemination have higher rates of lymph node metastasis, capsule invasion, and vascular invasion, exhibiting more aggressive biological behavior. Immunohistochemistry results show abnormal expression of proteins such as FKBP5, CENPF, CX26, KIF11, PTK7, which are associated with poor prognosis in thyroid cancers with intraglandular dissemination, offering potential guidance for specific targeted therapy in the future. Moreover, adjunctive techniques including ultrasound, fine-needle aspiration, and genetic testing offer valuable support in accurately identifying these cases, facilitating moreproactive treatment and closer follow-up.

Optimization of Deep CNN Techniques to Classify Breast Cancer and Predict Relapse

Breast cancer is a fatal disease that has a high rate of morbidity and mortality. Finding the right diagnosis is one of the most crucial steps in breast cancer treatment. Doctors can use machine learning (ML) and deep learning techniques to aid with diagnosis. This work makes an effort to devise a methodology for the classification of Breast cancer into its molecular subtypes and prediction of relapse. The objective is to compare the performance of Deep CNN, Tuned CNN and Hypercomplex-Valued CNN, and infer the results, thus automating the classification process. The traditional method used by doctors to detect is tedious and time consuming. It employs multiple methods, including MRI, CT scanning, aspiration, and blood tests as well as image testing. The proposed approach uses image processing techniques to detect irregular breast tissues in the MRI. The survivors of Breast Cancer are still at risk for relapse after remission, and once the disease relapses, the survival rate is much lower. A thorough analysis of data can potentially identify risk factors and reduce the risk of relapse in the first place. A SVM (Support Vector Machine) module with GridSearchCV for hyperparameter tuning is used to identify patterns in those patients who experience a relapse, so that these patterns can be used to predict the relapse before it occurs. The traditional deep learning CNN model achieved an accuracy of 27%, the tuned CNN model achieved an accuracy of 92% and the hypercomplex-valued CNN achieved an accuracy of 98%. The SVM model achieved an accuracy of 89% and on tuning the hyperparameters by using GridSearchCV it achieved and accuracy of 98%.

Minimal Residual Disease (MRD) Testing By Next Generation Sequencing (NGS) after Two Cycles (CY) of Non-Intensive Chemoimmunotherapy Is Predictive of Remission Duration and Need for Maintenance Therapy (MT) in Previously Untreated Mantle Cell Lymphoma (MCL): A Wisconsin Oncology Network Study

Introduction: Despite the variable course of MCL, limited prospective markers exist to identify more indolent disease. MCL is often diagnosed in older patients (pts) less able to tolerate intensive approaches. Bendamustine/rituximab (BR) is a standard non-intensive regimen for MCL, and use of MT remains controversial. Emerging data in MCL suggest a correlation between achieving MRD negativity (MRD-) and progression-free survival (PFS). The GALLIUM study (Marcus R, et al, N Engl J Med 2017) previously showed improved PFS with a bendamustine/obinutuzumab (BO) induction compared with BR in follicular lymphoma, and we postulated this benefit may be observed in MCL. Using MRD testing, we predicted that MT may be omitted in pts achieving MRD- status after induction BO chemoimmunotherapy for MCL. Methods: Adult pts ≥18 years (yrs) with previously untreated MCL who were ineligible for more intensive therapies (including transplant) were enrolled. Pts received 4-6 CY of BO induction intravenously (IV) every 28 days (D) with B 90 mg/m2 IV D1 &amp; 2 every 28D for 6 CY concurrent with O IV (cycle 1 = 100 mg D1, 900 mg D2, and 1000 mg D8 &amp; 15; then 1000 mg D1, CY 2-6). Peripheral blood (PB) MRD was obtained using NGS (ClonoSEQ®) after cycle 2 BO as an exploratory endpoint. Consolidation O (CO) 1000 mg IV weekly for 4 doses was initiated ≤12 weeks after the final dose of BO. Restaging and MRD testing of PB and bone marrow aspirate (BMA) was done ≤30 days after CO completion. For pts with complete response (CR) radiographically and MRD- in PB/BMA, maintenance O (MO) was omitted. For pts without CR or persistent MRD positivity (MRD+) in the PB or BMA, MO was given with 1000 mg IV D1 of a 56-day cycle for 8 CY. Pts were followed for ≥2 years from therapy completion. The primary endpoint is PFS from D1 of BO induction. Secondary endpoints are MRD status, concordance rate of PB/BMA in predicting MRD status, response rates and overall survival (OS). Results: Twenty-one pts (of planned 32) enrolled beginning 2/2018, with follow-up through 6/1/2023. The study closed prematurely due to slow enrollment. Median age is 70 yrs with 3 pts &amp;gt;80 yrs; majority were men (76%). Median MIPI score is 6.11 and median ECOG performance status 0. Twenty pts (95%) have stage IV disease. Twenty pts completed 4 (n=1) or 6 CY BO. Ten pts received MO; 10 did not receive MO per protocol due to radiographic CR and MRD- PB/BMA post-CO. Six pts did not complete MO for reasons of progressive disease (n=4), infection (n=1) and new carcinoma (n=1). After cycle 2 BO, PB analysis was MRD+ in 7 pts and MRD- in 13. Concordance rates between post-CO MRD testing in PB and BMA was 70% (14/20). Of non-concordant values, all had PB MRD- but BMA MRD+. Best responses in 20 assessable pts are: CR 75% (15/20), partial response 20% (4/20), and stable disease 5% (1/20). Most common grade 3/4 toxicities were: neutropenia (10/21), leukopenia (6/21), infections (5/21) and infusion reactions (2/21). One pt had grade 5 cardiac arrest with sepsis during BO. Most common grade 3 infections were abdominal/colitis (n=3) and pneumonia (n=2). Most common grade 1/2 toxicities were nausea (14/21), diarrhea (10/21), constipation (8/21), dysgeusia (6/21), fatigue (8/21) and dry skin/rash (12/21). After a median duration of follow-up of 43.9 months (mos) (95% confidence interval [CI] 28.3-60.1), PFS at 2-yrs and 3-yrs is 66.0% (95% CI 41.6-82.2) and 58.7% (95% CI 33.2-77.3), respectively; and median PFS is 46.5 mos (95% CI 16.4-∞). MRD- status after the exploratory endpoint post-C2 BO was predictive of 2-year PFS (Figure 1a), 83.3% (95% CI 48.2-95.6) for MRD- vs. 42.9% (95% CI 9.78-73.4) for MRD+, with hazard ratio [HR] 0.34 (95% CI 0.09-1.39), p value 0.133. Evaluation of PFS by MRD status post-CO showed similar outcomes regardless of receiving MO (Figure 1b): 2-year PFS is 77.8% (95% CI 36.5-93.9) in MRD- pts post-CO vs 60.0% (95% CI 25.3-82.7) in MRD+ pts; HR 0.45 (95% CI 0.10-1.91, p value 0.278. Median OS is 46.5 mos (95% CI 35.1-∞). Conclusion: Omission of MO in pts achieving MRD- status after induction/CO did not result in worsening PFS. Observed PFS and toxicities with BO induction and CO appears comparable with other data sets utilizing a BR-based induction +/- MT in older, less fit MCL pts. Correlation between PFS and PB MRD testing after C2 induction therapy represents a potential new prognostic marker of MCL behavior, and may be an important early disease indicator in development of risk-adapted therapies.

전염성 생식기 종양 개에서 빈크리스틴 투여 후 ECPKA 수치의 변화

A spayed male, Pomeranian, 10-year-old, presented to the veterinary hospital with swelling of the bulbus gland and exudate from the genitals. After general examinations such as complete blood counts, serum chemistry, X-rays and abdominal ultrasounds, fine needle aspiration tests for genital masses were performed. It was diagnosed with infectious genital tumor [Transmissible Venereal Tumor (TVT)] from the test results, vincristine was administered intravenously at a dose of 0.7 mg/m2 at intervals of 1 week and 3 times as a chemotherapy.&#x0D; During chemotherapy, genital masses decreased to normal, and the level of ECPKA(Extracellular cyclic AMP-dependent protein kinase A) before chemotherapy was 1015.08 UI, but one week after the third administration of vincristine, the level decreased significantly to 260.94 UI.&#x0D; ECPKA is very low in normal conditions, but its usefulness in the early detection of tumors in dogs has been suggested in the fact that it can be elevated in tumor tissue. Evaluation of the termination of chemotherapy while proceeding with treatment by checking blood levels such as ECPKA makes it possible to judge tumor remission, and it can be used before and after chemotherapy in various tumors other than TVT.

Arthroscopic tissue biopsy as a preoperative diagnostic test for periprosthetic shoulder arthroplasty infections: a systematic review and meta-analysis.

The diagnosis of periprosthetic infection in shoulder arthroplasty remains a challenge. Conventional methods for evaluating periprosthetic joint infections are poor because of lower-virulence organisms affecting the shoulder. The aim of our systematic review was to evaluate the diagnostic accuracy of preoperative arthroscopic tissue cultures compared with tissue biopsy samples obtained at the time of revision surgery. We conducted a systematic search of the MEDLINE, Embase, and Cochrane Central databases. The inclusion criteria consisted of studies that used arthroscopy to obtain preoperative tissue cultures for the diagnosis of shoulder arthroplasty infections. Studies were excluded if they obtained non-arthroscopic tissue samples. We reported the sensitivity, specificity, positive predictive value, and negative predictive value. Culture findings from the arthroscopic biopsy samples were also compared with conventional tests of fluoroscopy-guided joint aspiration and serum inflammatory marker testing (positive erythrocyte sedimentation rate or C-reactive protein) within the included studies. A meta-analysis was performed to assess the overall diagnostic accuracy of the studies. Our search strategy yielded 795 potentially relevant publications; 572 underwent title and abstract screening, and 14 studies underwent full-text review, of which 7 were included in our systematic review. The studies represented a balance of shoulder arthroplasty types, including anatomic total shoulder arthroplasty (n=75, 38%), reverse total shoulder arthroplasty (n=60, 30%), and hemiarthroplasty (n=64, 32%). There were 56 of 120 arthroscopic procedures that returned positive tissue culture findings compared with 64 of 157 positive open biopsy culture findings obtained from revision surgery. The meta-analysis total for sensitivity and specificity for all studies combined indicated that arthroscopic tissue cultures (0.76 [95% confidence interval (CI), 0.57-0.88] and 0.91 [95% CI, 0.79-0.97], respectively) were superior to both aspiration (0.15 [95% CI, 0.03-0.48] and 0.93 [95% CI, 0.65-0.99], respectively) and a positive erythrocyte sedimentation rate or C-reactive protein level (0.14 [95% CI, 0.02-0.62] and 0.83 [95% CI, 0.56-0.95], respectively) in diagnosing periprosthetic shoulder infections. Our systematic review demonstrated that preoperative arthroscopic tissue biopsy used for microbiology cultures accurately predicts intraoperative culture findings obtained during revision surgery with high sensitivity and specificity. Additionally, arthroscopy appears to be superior to conventional techniques of joint aspiration and inflammatory marker testing. Therefore, arthroscopic tissue cultures may be an emerging useful tool to help guide the management of periprosthetic infections in shoulder arthroplasty.

Clinical significance of multigene assay in papillary thyroid carcinoma

Objective:To analyze the clinical significance of multigene assay in papillary thyroid carcinoma（PTC）. Methods:Patients who underwent thyroidectomy in a tertiary hospital from August 2021 to May 2022 were enrolled. The eight-gene panel was used to detect the tumor tissue of patients, and the correlation between gene mutations and clinical features was analyzed. Results:Among 161 patients, mutation rate of BRAF V600E, RET/PTC1 and TERT promotor were 82.0%, 6.8% and 4.3%, respectively. BRAF V600E mutation was more common in male patients（P=0.023）. TERT promotor-mutated tumors had a large diameter（P=0.019）, a high proportion of multifocal lesions（P=0.050）, and a large number of lymph node metastases（P=0.031）. Among 89 patients who completed preoperative BRAF detection, there was a strong consistency between the preoperative aspiration test and postoperative panel（Cohen κ=0.694, 95%CI: 0.482-0.906, P<0.01）. In the hematoxylin-eosin sections obtained from 80 patients, BRAF V600E was still the main type of gene mutation, and the classical/follicular type was more distributed. TERT promotor and RET/PTC1 mutation were the main genetic events for tall-cell/columnar/hobnail type and diffuse sclerosing type, respectively. One-way ANOVA showed that there were differences in diagnosis age（P=0.029） and tumor size（P<0.01） among different pathological types. Conclusion:As a simple and feasible clinical detection method for PTC, the multigene assay can supplement the identification of important genetic events other than BRAF V600E, and provide more prognostic information and follow-up hints for postoperative patients.

Performance of fine-needle aspirate testing compared with superficial swab testing for quantification of BPV-1/−2 viral load in equine sarcoids

Bovine papillomavirus (BPV) types 1 and 2 are causally associated with equine sarcoid, the most common mesenchymal neoplasm of horses, but the viral load (VL) differs between lesions. Sensitive and accurate BPV detection and quantification is essential for clinicians to confirm clinical suspicion, as well as in research settings for stratifying these skin lesions. Due to the limitations of histopathology in sarcoid diagnosis, PCR screening of superficial swabs constitutes the principal sampling method for BPV detection. This study aimed to investigate the ability of superficial swabs and fine-needle aspirates (FNA) to accurately detect the VL in equine sarcoids, considering the main clinical types: occult, nodular, verrucous and fibroblastic. Superficial swabs and FNAs from a series of sarcoid-affected horses were tested in parallel for BPV DNA quantification. Quantitative real-time PCR screening of postoperative tissue biopsies served as reference standard for the accuracy assessment of the viral titters. Our results indicate that VL is not a predictor of the clinical type. Student's t-test results gave evidence of a significant difference between both sample methods (P < 0.001) with FNA giving the best approximation of the actual VL (P < 0.01). In contrast to superficial swabs, the reference standard correlated moderately with FNA in general (P < 0.05; r = 0.39) and strongly with FNA results within the occult sarcoid group (P < 0.05; r = 0.59). In conclusion, the correlation of FNA with the reference standard was strong enough to suggest this is the preferred method for quantifying VL in sarcoids.

Performance of galactomannan testing from endotracheal aspirate to guide bronchoalveolar lavage in the diagnosis of invasive aspergillosis

PurposeInvasive aspergillosis is a major threat to immunocompromised individuals. Galactomannan (GM) is used as a biomarker for invasive aspergillosis. Investigations recommended in current guidelines include GM testing of bronchoalveolar lavage (BAL) fluids. GM testing of endotracheal aspirate, the sampling of which is less invasive, less resource-intensive and less aerosol-generating, is not validated. We compared the performance of endotracheal aspirate GM as a screening tool to predict BAL fluid GM-positivity in patients with suspected invasive aspergillosis.MethodsOf each patient, a pair of corresponding endotracheal aspirate and BAL fluid samples was tested and compared for GM results. Two sample sets were included. The first consisted of 140 consecutive BAL fluid/endotracheal aspirate pairs obtained from 133 patients. The pairs of the second sample set (n = 38) were selected based on the criterion that the BAL tested positive for GM. All specimens were obtained in a German 2,000 bed tertiary care center.ResultsAmong BAL fluid GM-positive samples, endotracheal aspirate GM demonstrated poor specificity (72%) but high sensitivity (92% in predicting BAL fluid GM of ≥ 0.50 and 91% for BAL fluid GM of ≥ 1.00) and an excellent negative predictive value (98%). The use of a marginally elevated cutoff of 0.63 resulted in an improved specificity (72–81%), without loss of sensitivity.ConclusionsFor screening purposes, one might consider testing endotracheal aspirate for GM, which could help avoid unnecessary BAL.

892 ELECTRICAL STORM IN ISCHAEMIC HEART DISEASE: A CASE OF LEFT STELLATE GANGLION BLOCK AS BRIDGE TO URGENT PCI RESCUE

Abstract A 73 year-old man was admitted for syncope and sustained ventricular arrhythmia complicated by cardiogenic shock treated with electrical cardioversion and restoration of sinus rhythm. Former smoker, he suffered by arterial hypertension, hypercholesterolemia and known heart failure with reduced ejection fraction. In the 1995 the patient underwent aortic valve replacement surgery with a mechanical prosthetic valve. The patient underwent coronary angiography that showed multivessel coronary artery disease with functional occlusion of posterior interventricular artery (rehabilitated by hetero-coronary circles) and critical stenosis of the middle left anterior descending artery. In this angiographic framework, the indication was collegial revaluation considering other patient's comorbidities (chronic renal dysfunction, mitral moderate-severe regurgitation). The patient underwent ICD implantation for secondary prevention. Despite maximal medical therapy, the patient experienced new episodes of sustained VT complicated by hemodynamic instability. Hypokalemia, hypomagnesemia and hyperthyroidism were excluded as triggering factors for arrhythmias on laboratory investigations. In the following days due to persistent and symptomatic arrhythmias, configuring electrical storm, we decided to proceed with anatomical stellate ganglion block, guarantying a free interval from ventricular arrhythmia about six hours. The anesthetic has been injected at the C6 or C7 vertebral level with the Chassignac's tubercle, the cricoid cartilage, and the carotid artery serving as the anatomic landmarks to the procedure. An aspiration test must be done to avoid the suction of blood or cerebrospinal fluid, then a local anesthetic is injected, and the diffusion of the injectate is seen in real-time. Local anesthetic (lidocaine mixed with bupivacaine) is injected until the fluid spread along the paravertebral fascia to the stellate ganglion. The period free from VA allowed us to transfer the patient in another center in order to receive myocardial revascularization supported by ECMO. Left ganglion stellate block has a central role in the treatment of the refractory ventricular arrhythmias and may offer effective arrhythmia control giving time to rescue and/or other bridge therapy. In our case, it had a key role to perform an inter-hospital transfer and subsequent “rescue PCI therapy”. Thanks to Stellate ganglion block, the sinus rhythm was retained immediately, there were no ventricular tachycardia episodes for at least six hours allowing to perform myocardial revascularization supported by ECMO. No further ventricular arrhythmias occurred after revascularization, corroborating the ischemic trigger of electrical storm.

Fibre-optic, electronic pH test device compared with current NHS guidance to confirm nasogastric tube placement

The clinical objectives of this prospective, random, convenience series were:1. Compare a novel fibre-optic pH test device (NGPOD) to gastric aspirate and pH testing for nasogastric tube (NGT) confirmation.2. Determine...

Which screening tool should be used for identifying aspiration risk associated with dysphagia in acute stroke? A Cochrane Review summary with commentary.

Dysphagia is a common impairment in patients with acute stroke and is associated with an increased risk of complications such as aspiration pneumonia, malnutrition and dehydration, as well as with poor outcome and higher mortality. Therefore, immediate screening for aspiration risk is recommended, using a bedside swallow screening tool. To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke. A summary of the Cochrane Review by Boaden et al. 2021, with comments from a rehabilitation perspective. The review included 25 studies with 3953 participants and 37 screening tests. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing swallow screening tools were the Bedside Aspiration test (combined water swallow and instrumental tool), the Gugging Swallowing Screen (GUSS, water plus other consistencies) and the Toronto Bedside Swallowing Screening Test (TOR-BSST, water only). However, these tests were based on single studies with small sample sizes. It was not possible to explore the influence of sources of heterogeneity. No single swallow screening tool with high accuracy as well as good quality evidence could be identified, but recommendations for further high-quality research are offered.