Clinical Request Research Articles

Liquid-Biopsy Glycan Score Biomarker Accurately Indicates and Stratifies Primary and Metastatic Prostate Cancers.

Prostate cancer (PCa) is the most commonly diagnosed cancer in males. Early PCa usually shows no clinical symptoms and its primary diagnosis is currently guided by liquid-biopsy testing of serum prostate-specific antigen (PSA). This testing suffers from high false-positive and false-negative rates. Identifying new biomarkers for precise liquid-biopsy detection of PCa is, thus, an acute clinical request. Here, by using an advanced dual-functional aptamer assay, we quantified the extent of glycosylation of PSA circulating in cancer patients' serum, linked it to cancer-related breakage of PSA complexes with serum-circulating proteins, and proved its facility for stratification of primary and metastatic PCa. PSA's "Glycan Score" 100% accurately informed about PCa status in a 30-patient cohort, while serum PSA's concentration correctly classified only 53% of PCa patients and did not inform about their PCa status. The Glycan Score liquid-biopsy test thus has a huge potential for accurate diagnosis and staging of PCa, enabling mass-screening program progress and advanced PCa treatment monitoring.

Assessment of Reason for Exam Imaging Reporting and Data System (RI-RADS) in inpatient diagnostic imaging referrals

ObjectivesTo test the Reason for Exam Imaging Reporting and Data System (RI-RADS) in assessing the quality of radiology requests in an Italian cohort of inpatients; to evaluate the interobserver reliability of RI-RADS.MethodsA single-center quality care study was designed to retrospectively identify consecutive radiology request forms for computed tomography, magnetic resonance imaging, and conventional radiography examinations. One radiologist scored the requests using the RI-RADS. The association between RI-RADS and clinical request variables (urgent request, on-call requests, indication for imaging, requesting specialty, imaging modality, and body region) was evaluated. We calculated interobserver agreement between four readers in a subset of 450 requests.ResultsWe included 762 imaging requests. RI-RADS grades A (adequate request), B (barely adequate request), C (considerably limited request), D (deficient request), and X were assigned to 8 (1%), 49 (7%), 237 (31%), 404 (53%), and 64 (8%) of cases, respectively. In the multivariate analysis, the indication for imaging, body region, and requesting specialty significantly influenced the RI-RADS. Indications for imaging with a high risk of poor RI-RADS grade were routine preoperative imaging and device check requests. The upper extremity was the body region with the highest risk of poor RI-RADS grade. Requesting specialties with a high risk of poor RI-RADS grade were cardiovascular surgery, intensive care medicine, and orthopedics. The analysis of the interobserver agreement revealed substantial agreement for the RI-RADS grade.ConclusionThe majority of radiology exam requests were inadequate according to RI-RADS, especially those for routine imaging. RI-RADS demonstrated substantial reliability, suggesting that it can be satisfactorily employed in clinical settings.Critical relevant statementThe implementation of RI-RADS can provide a framework for standardizing radiology requests, thereby enabling quality assurance and promoting a culture of quality improvement.Key PointsRI-RADS aims to grade the completeness of radiology requests.Over half of the imaging requests were RI-RADS D grade; RI-RADS demonstrated substantial reliability.Most radiology requests were inadequate and RI-RADS could classify them in clinical practice.Graphical

Real-world data on the prevalence of BRCA1/2 and HRR gene mutations in patients with primary and metastatic castration resistant prostate cancer

PurposeThis study seeks to contribute real-world data on the prevalence of BRCA1/2 and HRR gene mutations in prostate cancer.MethodsWe compiled sequencing data of 197 cases of primary and metastatic prostate cancer, in which HRR mutation analysis was performed upon clinical request within the last 5 years. All cases were analyzed using a targeted NGS BRCAness multigene panel, including 8 HRR genes (ATM, BRCA1, BRCA2, CDK12, CHEK2, FANCA, HDAC2, PALB2).ResultsOur findings reveal a prevalence of potentially targetable mutations based on FDA criteria of 20.8%, which is comparable to the literature. However, the frequency of targetable BRCA2 mutations within our cohort was lower than reported for mCRPC and ATM and CHEK2 mutations were more prevalent instead. Thus, while 20.8% (n = 38) of the cases meet the criteria for olaparib treatment per FDA approval, only 4.9% (n = 9) align with the eligibility criteria according to the EMA approval.ConclusionThis study offers valuable real-world insights into the landscape of BRCA1/2 and HRR gene mutations and the practical clinical management of HRR gene testing in prostate cancer, contributing to a better understanding of patient eligibility for PARPi treatment.

Utilization of international normalized ratio-derived formula to predict plasma rivaroxaban level-Validation study and real-world experience.

Specific assays of plasma rivaroxaban level are not always readily available with short turnaround time, which hamper the management of urgent clinical situations. In this study, we aimed to build a predictive formula of plasma rivaroxaban levels from international normalized ratio (INR) value and validated in real world clinical situations. Ninety-four patients who were taking rivaroxaban participated in the study. Patients were randomized into testing cohort and validation cohorts. The prediction formula was built from the testing cohort and then validated in validation cohort. The predictive performance was further validated on real-world clinical requests. The root mean square error (RMSE) of the predictive formula for the testing and validation cohorts were 61.81 and 69.32 ng/mL, respectively. The sensitivity and specificity for the formula to predict the threshold plasma rivaroxaban level of 75 ng/mL were 95% (95% CI: 85.4%-100%) and 87.5% (95% CI: 71.3%-100%), respectively, in real-world clinical situations. Plasma rivaroxaban level of threshold level of 75 ng/mL can be calculated from prediction formula by INR value with satisfactory accuracy and it can be used to guide the decision for reversal.

Examining Diagnostic Efficacy: GeneXpert Versus Traditional Staining Techniques With Culture in the Diagnosis of Tuberculosis.

Introduction The tuberculosis (TB) diagnosis involves various methods, such as microscopic examination, culture-based methods, molecular techniques, chest X-rays, serological tests, and interferon-gamma release assays. These methods help identify and confirm TB and its resistance to rifampicin, balancing speed and accuracy for prompt treatment initiation and effective disease management. Aims and objectives To assess the diagnostic accuracy of GeneXpert, Ziehl-Neelsen staining, and fluorescence staining compared to culture media in TB-suspected patients. Materials and methods We analysed 416 patient samples for TB over one year using GeneXpert, Ziehl-Neelsen staining, fluorescence staining, andLöwenstein-Jensen (LJ) medium. Only samples with a suspicion of TB were included in the study. The samples received without clinical history and requests for all four tests were excluded. Results A total of 416 patient samples were categorised into pulmonary and extrapulmonary samples. GeneXpert detected 62 positive cases for TB, out of which 53 were rifampicin-sensitive, seven were rifampicin-indeterminate, and two were rifampicin-resistant. The indeterminate samples were further evaluated using the line probe assay (LPA), of which six were rifampicin-sensitive, and one was rifampicin-resistant. Fluorescent staining detected 44 cases, Ziehl-Neelsen staining detected 40 cases, and LJ culture medium detected 65 cases. Conclusion GeneXpert is superior to staining methods for detecting TB. GeneXpert, combined with microscopyand culture, can enhance TB and multi-drug resistant tuberculosis (MDR-TB) detection and aid in early treatment initiation.

Referral Patterns to an Ophthalmic Outpatient Clinic in a Tertiary Eye Care Center in Iraq

Purpose: We aim to conduct a comprehensive review of outpatients at a tertiary ophthalmology clinic to evaluate various aspects including the spectrum of eye disorders, referral patterns, reasons for referral, and patient self-assessment, with a particular focus on self-referrals. Study Design: A cross-sectional study. Place and Duration of Study: Ibn Al-Haitham Teaching Eye Hospital from April to May, 2023. Methods: Referral letters were grouped into the primary health center (PHC), secondary hospital, internal referral and private clinic. Referral letter quality was assessed based on clinical information and particular request. Results: A total of 1367 individuals aged 40.8 ± 22.17 years were eligible for study. There were 19.2% referrals form PHC, 18.4% from secondary hospitals, 10.7% from private clinics, 3.3% were internal referrals, 37.2% were self-referred and 11.3% had medical or surgical follow-up. Blurred vision was the predominant complaint of 677 (51.6%) patients. Out of 659 referral letters, 25% scored two essential information items, 5.2% scored three, and only 0.8% scored four items. The majority (97.2%) of letters provided specific requests. Among all, 26.3% of PHC, 38.2% of hospitals, 34.9% of private clinics, 21.7% self-referred and 51.1% of internally referred patients considered their situations difficult. Conclusion: Majority of cases seen in ophthalmology tertiary centers consist of common conditions that could be effectively managed by PHCs and general hospitals. Improved referral standards for specialized medical institutions may reduce tertiary hospital over population.

Too much ado about data: continuous remote monitoring of water temperatures, circulation and throughput can assist in the reduction of hospital-associated waterborne infections

National and international guidance provides advice on maintenance and management of water systems in healthcare buildings; however, healthcare-associated waterborne infections (HAWIs) are increasing. To identify parameters critical to water quality in healthcare buildings and to assess whether remote sensor monitoring can deliver safe water systems, thus reducing HAWIs. A narrative review was performed using the following search terms: (1) consistent water temperature AND waterborne pathogen control OR nosocomial infection; (2) water throughput AND waterborne pathogen control OR nosocomial infection; (3) remote monitoring of in-premises water systems AND continuous surveillance for temperature OR throughput OR flow OR use. Databases employed were PubMed, CDSR (Clinical Study Data Request) and DARE (Database of Abstracts of Reviews of Effects) from January 2013 to March 2024. Single ensuite-patient rooms, expansion of handwash basins, widespread glove use, alcohol gel and wipes have increased water system stagnancy resulting in amplification of waterborne pathogens and transmission risk of legionella, pseudomonas, and non-tuberculous mycobacteria. Manual monitoring does not represent temperatures across large complex water systems. This review deems that multiple-point continuous remote sensor monitoring is effective at identifying redundant and low use outlets, hydraulic imbalance and inconsistent temperature delivery across in-premises water systems. As remote monitoring becomes more common there will be greater recognition of failures in temperature control, hydraulics, and balancing in water systems, and there remains much to learn as we adopt this developing technology within our hospitals.

Comparative performance of the Platelia Aspergillus Antigen and Aspergillus Galactomannan antigen Virclia Monotest immunoassays in serum and lower respiratory tract specimens: a "real-life" experience.

The Platelia Aspergillus Antigen immunoassay is the "gold standard" for Aspergillus galactomannan (GLM) measurement in sera and bronchoalveolar lavage (BAL) for the diagnosis of invasive pulmonary aspergillosis (IPA). We evaluated the performance of the Aspergillus GLM antigen Virclia Monotest compared to the Platelia assay. A total of 535 specimens [320 sera, 86 bronchial aspirates (BAs), 70 BAL, and 59 tracheal aspirates (TAs)] from 177 adult patients (72 hematological, 32 Intensive Care Unit, and 73 hospitalized in other wards) were processed for GLM testing upon clinical request. One patient had proven IPA, and 11 had probable disease. After excluding indeterminate Virclia results (n = 38), 396 specimens yielded concordant results (56 positive and 340 negative) and 101 discordant results (Virclia positive/Platelia negative, n = 95). The overall agreement between immunoassays was higher for sera (κ 0.56) than for BAL (κ ≤ 0.24) or BAS and TA (κ ≤ 0.22). When considering all specimen types in combination, the overall sensitivity and specificity of the Virclia assay for the diagnosis of proven/probable IPA were 100% and 65%, respectively, and for the Platelia immunoassay, sensitivity and specificity were 91.7% and 89.4%, respectively. The correlation between index values by both immunoassays was strong for serum/BAL (ρ = 0.73; P < 0.001) and moderate for BAS/TA (Rho = 0.52; P = 0.001). The conversion of Virclia index values into the Platelia index could be derived by the formula y = (11.97 * X)/3.62 + X). Data from GLM-positive serum/BAL clinical specimens fitted the regression model optimally (R2 = 0.94), whereas that of BAS and TA data did not (R2 = 0.11). Further studies are needed to determine whether the Virclia assay may be an alternative to the Platelia assay for GLM measurement in sera and lower respiratory tract specimens.IMPORTANCEGalactomannan detection in serum or bronchoalveolar fluid specimens is pivotal for the diagnosis of invasive pulmonary aspergillosis (IPA). The Platelia Aspergillus Antigen immunoassay has become the "gold standard" for Aspergillus GLM measurement. Here, we provide data suggesting that the Virclia Monotest assay, which displays several operational advantages compared with the Platelia assay, may become an alternative to the Platelia assay, although further studies are needed to validate this assumption. We also provide a formula allowing the conversion of Virclia index values into Platelia values. The study may contribute toward positioning the Virclia assay within the diagnostic algorithm of IPA.

Is PAS Stain Necessary to Exclude Whipple Disease in Duodenal Biopsies?

Objective. Whipple disease, caused by Tropheryma whipplei, is a rare infectious condition primarily presenting with malabsorptive diarrhea. Small bowel biopsies typically reveal foamy macrophages containing periodic acid-Schiff-positive/diastase (PAS/D) resistant T. whipplei bacilli, and PAS(D) staining is occasionally requested by clinicians in duodenal biopsies, which are often histologically unremarkable. The yield of PAS(D) staining in such biopsies has never been reported to our knowledge. Methods. The anatomic pathology database was searched for all specimens of duodenal biopsies stained with PAS(D) from 1993 to 2021. Specimens were categorized by the following histomorphologic features: unremarkable, nonspecific changes, or expansion of the lamina propria by aggregates of foamy histiocytes. Follow-up information was collected, including microbiologic confirmatory testing. Results. There was a total of 193 specimens of duodenal biopsies stained with PAS(D). Biopsies lacking foamy histiocytes on H&E (n = 158) were never PAS-positive. Thirteen biopsies contained PAS-positive histiocytes; 9 out of the 13 PAS-positive specimens were subsequently confirmed to be T. whipplei. Of the 193 specimens, 124 specimens had a clinical request for PAS(D) staining. Only 3 of the 124 (2.4%) specimens showed foamy histiocytes containing PAS-positive granules, all of which were confirmed positive for T. whipplei. Conclusion. PAS(D) staining is unnecessary to exclude Whipple disease in duodenal biopsies without foamy macrophage aggregates, regardless of clinical suspicion. Clinical suspicion-driven biopsies often yield negative results for Whipple disease.

Evaluating data accuracy in clinical laboratory requests: A therapeutic drug monitoring study

Evaluating data accuracy in clinical laboratory requests: A therapeutic drug monitoring study

Magnetic resonance imaging of the knee joint : What does the orthopedic surgeon expect from the radiologist?

Magnet resonance imaging (MRI) offers aprecise visualization of structural changes with high sensitivity and specificity. However, not all these soft tissue damages or bony lesions are clinically relevant or require treatment. Therefore, it is important to provide the radiologist with aspecific clinical request when asking for an MRI examination of the knee. In this article, all important anatomical structures of the knee joint will be addressed with emphasis on the relevant questions for the radiologist. Based on the clinical examination, the MRI provides information about the damage of anatomical structures. This information is of utmost importance for therapeutic decision-making in order to allow an adequate and personalized treatment of patients.

Engineering a mussel-inspired hemostatic sealant with a strong tissue anchor as a first-aid tissue adhesive

During injury, achieving quick hemostasis, while maintaining adhesive performances on wet tissue and providing appropriate dynamical mechanical properties remain crucial clinical requests for the current tissue adhesives. Here, we design a double-crosslinking tissue adhesive with tunable degradation rate, adhesion strength, mechanical properties, and cell responses, using thiolated gelatin (Gel-SH) or gelatin and tannic acid (TA). We also investigate the role of different concentrations of gelatin (70 and 150 mg/ml), TA (7, 20, and 70 mg/ml), and crosslinkers (sodium periodate (11.3 and 16.8 mg/ml) and Fe3+ ions (1.7 and 4.8 mg/ml)) to provide a balance of covalent and noncovalent interactions leading to establish muscular tissue adhesive strength and superior hemostasis. Our findings reveal that the Gel-SH(gelatin)/TA adhesives have a range of swelling ability (300–700 %), compressive modulus (0.2–1.2 kPa), strength (0.1–0.8 kPa), and toughness (10–15 kJ/m3). In addition, Gel-SH/TA sample shows rapid self-healing ability and offers robust adhesiveness to wet cow skin and cardiac tissue (50–70 kPa) compared to others mainly owing to the improved cohesive strength originating from the range of chemical interaction within the adhesive network and abundant phenolic hydroxyl groups, surface water removal, and dynamic phenol-quinone balance at the tissue interfaces. Meanwhile, Gel-SH/TA adhesive also exhibits high hemocompatibility and hemostatic properties and appropriate in vitro biocompatibility. Notably, Gel-SH/TA adhesive could support attachment, viability and proliferation, of H9c2 cells. Overall, the multifunctional Gel-SH/TA adhesive hydrogel, owing to the range of molecular interactions opens a new opportunity for quick sealing hemostasis and wound healing and could potentially be harnessed for the development of clinically relevant tissue adhesives.

Deviation in White Blood Cell Count Measurement between WNR and WDF Channels on an Automated Hematology Analyzer XN-3000: A Case Report

BACKGROUND: At present, complete blood count (CBC) testing is one of the most common clinical tests. The XN-3000 used in our hospital utilizes the principles of impedance and semiconductor laser flow cytometry, which contains two types of leukocyte fractionation methods: White cell nucleated (WNR) and white cell differential (WDF) channels. CASE PRESENTATION: Herein, we present the case of a 63-year-old male patient who was admitted to our hospital for the treatment of non-small cell lung cancer (T4N3M1 [LYM, HEP, and OSS]). Biochemical data showed abnormal liver function and anemia. WNR results showed poor leukocyte and debris fractions compared with WDF results, and leukocyte counts were different between the two channels. However, the poor fractionation of the leukocyte and debris fractions in the WNR was resolved at the twofold dilution stage. To investigate the cause of the problem, precipitates affecting the WNR measurement were visually checked. Consequently, insoluble precipitates were observed in the WNR mixture of the specimen of the patient. In our hospital, we measure 1200 CBCs/day and very rarely encounter abnormal specimens such as in the presented case. Normally, leukocyte counts are reported in priority to those measured by the WNR channel; however, in this case, the switching function was effective in giving priority to WDF count results because of the appearance of abnormal WNR plots. However, a system that can promptly confirm events when results are reported is necessary. CONCLUSION: We very rarely encounter abnormal specimens such as in the presented case. Normally, leukocyte counts are reported in priority to those measured by the WNR channel; however, in this case, the switching function was effective in giving priority to WDF count results because of the appearance of abnormal WNR plots. However, a system that can promptly confirm events when results are reported is necessary. When no clinical request for WDF measurement was made, the WNR scattergram must be confirmed, dilution measurement, if necessary, must be performed, or the WDF must be measured and reported to the clinician as useful criteria for diagnosis.

Utilization of International Normalized Ratio-Derived Formula to Predict Plasma Rivaroxaban Level - Validation Study and Real-World Experience

Introduction: Specific assay of plasma rivaroxaban level are not always readily available with short turn-around-time which hampered the management of urgent clinical situations. The response of routine coagulation screening tests show huge lot-to-lot differences with the plasma rivaroxaban level. International normalized ratio (INR) is a standardized measurement taking into account of lot-to-lot variations of PT reagents. In this study, we aimed to build a predictive formula of plasma rivaroxaban levels from INR value and validated in real world clinical situations. Method: The study period was 1 st January 2018 to 31 st December 2021. Ninety-four patients who taking rivaroxaban participated in the study. Patients were randomized into testing cohort and validation cohorts. The prediction formula was built from the testing cohort and then validated in validation cohort. The predictive performance was further validated on real-world clinical requests. Results: The baseline characteristics of both cohorts were well-balance. There was significant correlation between the plasma rivaroxaban level and PT in both the testing and validation cohorts (Testing cohort: R square 0.838, p &amp;lt; 0.01; Validation cohort: R square 0.836, p &amp;lt; 0.01). The plasma rivaroxaban level showed significant correlation with APTT in both the testing and validation cohorts (Testing cohort: R square 0.744, p &amp;lt; 0.01; Validation cohort: R square 0.654, p &amp;lt; 0.01). There was also significant correlation between INR and plasma rivaroxaban levels in both the testing and validation cohorts (Testing cohort: R square 0.819, p &amp;lt;0.01; Validation cohort: R square 0.816, p &amp;lt; 0.01). Both INR and plasma rivaroxaban levels were undergone natural logarithmic transformation. We choose the quadratic model to determine the relationship between the natural log of plasma rivaroxaban level and the natural log of INR as it had highest R square value (R square 0.850, p&amp;lt;0.01). The formula is: ln (plasma rivaroxaban level) = 2.96+7.87 X ln (INR) - 5.04X (ln (INR))^2. The root mean square error (RMSE) of the predictive formula for the testing and validation cohorts were 61.81 ng/ml and 69.32 ng/ml, respectively. We received a total of 43 requests for plasma rivaroxaban assay involved 29 patients during the study period (Table 1). Three patients had multiple requests for plasma DOAC level assays during this period. The cut-off INR value was 1.3 for administration of antidote for rivaroxaban, which corresponded to a rivaroxaban level of 75 ng/ml. The sensitivity and specificity for using this INR cut-off value to determine the threshold plasma rivaroxaban level (75 ng/ml) for administration of reversal agents were 95% (95%CI: 85.4 -100%) and 87.5% (95%CI:71.3-100%) respectively in real world clinical situations (Table 2). Conclusion: Plasma rivaroxaban level can be calculated from prediction formula by INR value with satisfactory accuracy and the INR cut-off value derived from it can be used to guide the decision for administration of reversal agents with excellent sensitivity and specificity.

CD34+ Megakaryocytes Associate with Myelodysplastic Syndromes and Related Cytogenetic Abnormalities, but Not Other Hematological Disorders

Background: CD34 is a transmembrane phosphoglycoprotein that is a marker of hematopoietic stem cells and is used clinically to aid in enumeration of blast cells for identification of advanced myeloid neoplasms. Megakaryocytes are differentiated cells from the myeloid lineage that reside in the bone marrow and generally stain negative for CD34 (CD34-). However, CD34 positive (CD34+) megakaryocytes have been observed in hematological disorders such as myelodysplastic syndrome, myeloproliferative neoplasms, and acute leukemias. CD34+ megakaryocytes are proposed to be relatively specific for malignant hematologic conditions and have been reported to associate with a worse prognosis. However, the general clinical, biochemical, and cytogenic characteristics for bone marrow cases of CD34+ megakaryocytes versus CD34- megakaryocytes remains unclear. Objective: We sought to determine the clinical, biochemical, and cytogenetic characteristics associated with finding CD34+ megakaryocytes on bone marrow biopsies. Methods: We identified 281 independent, index bone marrow biopsy cases between 2011-01-01 and 2017-12-31 from Vancouver General Hospital, Canada that underwent CD34 immunohistochemistry at clinical request. The clinical, biochemical, and cytogenetic characteristics of patients were compared based on megakaryocytes being CD34+ vs CD34- on immunohistochemistry. Cases of CD34+ megakaryocytes were defined as having &amp;gt;5% of megakaryocytes staining CD34+, but sensitivity analyses were performed using different percentage cut-offs of 10, 30, and 50%. Results: Out of 281 cases, 134 had CD34+ megakaryocytes (58.2% male sex; mean age = 64.1 years [SD = 15.2 years]) and 147 had CD34- megakaryocytes (57.1% male sex; mean age = 60.0 years [SD = 16.6 years]). There was a significant difference in the distribution of diagnostic categories observed between cases of CD34+ versus CD34- megakaryocytes: myelodysplastic syndromes 35.1% (n=47) versus 21.8% (n=32), acute myeloid leukemias 20.9% (n=28) versus 21.1% (n=31), non-diagnostic etiology 17.9% (n=24) versus 14.3% (n=21), and myeloproliferative neoplasms 10.4% (n=14) versus 19.7% (n=29) (Figure A; Chi-square p-value=0.0004). Sensitivity analyses using different percentage cut-offs to define cases of CD34+ from CD34- megakaryocytes yielded similar results. The differences in biochemical characteristics between cases of CD34+ versus CD34- megakaryocytes were generally unremarkable. The median (IQR) for biochemical parameters between cases of CD34+ and CD34- megakaryocytes were hemoglobin 99 (28) versus 100 (34) g/L, mean corpuscular volume 94 (14) versus 93 (10) fL, neutrophil count 2.20 (3.68) versus 2.46 (3.63) x10 9/L, platelet count 98 (158) versus 112 (194) x10 9/L, and bone marrow blasts 7 (4) versus 3 (14)%. Lastly, there were notable trends in cytogenetic results associated with 90 cases with CD34+ versus 84 cases with CD34- megakaryocytes including: complex karyotypes for 15.6% (n=14) versus 6.0% (n=5), isolated deletion 5q for 7.8% (n=7) versus 1.2% (n=1), and/or isolated trisomy 8 for 5.6% (n=5) versus 2.4% (n=2). Similar cytogenetic results were observed when cases were restricted to only cases of CD34+ versus CD34- megakaryocytes with a diagnosis of myelodysplastic syndrome (Figure B). Conclusion: The presence of CD34+ megakaryocytes is more common in cases of myelodysplastic syndrome relative to other neoplastic hematologic disorders, but does not appear to help with discriminating between neoplastic and non-neoplastic hematological disorders ( e.g. non-diagnostic etiology). Cases with CD34+ megakaryocytes tend to associate with complex karyotype and deletion 5q abnormalities relative to cases with CD34- megakaryocytes.

Abstracts from the Hispanic Neuropsychological Society Annual Conference.

POSTER SESSIONS SCHEDULE Poster Session B: Thursday, October 26, 6:00pm - 7:00pm The abstracts published in this special edition are provided as a service to the membership of the Hispanic Neuropsychological Society, the conference attendees, and the field of clinical neuropsychology. Abstracts in this issue have been reviewed by the Poster Committee for the Annual Conference of the Hispanic Neuropsychological Society. They have not undergone the standard peer-reviewed process for papers published in Archives of Clinical Neuropsychology. The Conference Poster Chair and the Editor-in-Chief of Archives of Clinical Neuropsychology request that the following method be used in citing published abstracts based upon a poster presentation at the Hispanic Neuropsychological Society. Author 1 & Author 2 (2023) [Abstract published in Archives of Clinical Neuropsychology, vol, page number]. Abstract Title. Based upon poster presented at the Annual Conference of the Hispanic Neuropsychological Society, Philadelphia, PA. Hispanic Neuropsychological Society (HNS) Abstracts from the HNS Annual Conference October 28, 2023. Conference Abstracts Accepted under the Guest Editorship of Mirella Díaz-Santos, Ph.D., Poster Chair. Members of the 2023 HNS Poster Program Review Committee: Martina Azar Franchesca Arias Kristin Krueger Gloria Morel Laura Renteria Octavio Santos Karen Torres Stephanie Torres.

Abstracts from the 43nd Annual National Academy of Neuropsychology Conference.

GRAND ROUNDS SCHEDULE Pediatric Grand Rounds: Friday, October 27 Adult Grand Rounds: Friday, October 27 PAPER SESSIONS SCHEDULE Paper Session: Assessment: Friday, October 27, 11:00am - 12:00pm Paper Session: Neurological/Neuropsychiatric: Friday, October 27, 11:00am - 12:00pm POSTER SESSIONS SCHEDULE Poster Session A: Wednesday, October 25, 6:00pm - 7:00pm Poster Session B: Thursday, October 26, 6:00pm - 7:00pm AWARDS SCHEDULE Student & Diversity Poster Awards: Wednesday, October 25, 1:15pm The abstracts published in this special edition are provided as a service to the membership of the National Academy of Neuropsychology, the conference attendees, and the field of clinical neuropsychology. Abstracts in this issue have been reviewed by the Poster Committee for the 43rd Annual Conference of the National Academy of Neuropsychology. They have not undergone the standard peer-reviewed process for papers published in Archives of Clinical Neuropsychology. The Conference Poster Chair and the Editor-in-Chief of Archives of Clinical Neuropsychology request that the following method be used in citing published abstracts based upon a poster presentation at the Annual Conference of the National Academy of Neuropsychology. Author 1 & Author 2 (2023) [Abstract published in Archives of Clinical Neuropsychology, vol, page number]. Abstract Title. Based upon poster presented at the 43rd Annual Conference of the National Academy of Neuropsychology, Philadelphia, PA. National Academy of Neuropsychology Abstracts from the 43rd Annual Conference October 25-28, 2023 Conference Abstracts Accepted under the Guest Editorship of Seth A. Margolis, Ph.D., Poster Chair. Members of the 2023 NAN Poster Program Review Committee: Ashlee Loughan Brett Parmenter Brian Ivins Christian LoBue Cynthia Funes Dede O'Shea Douglas Cooper Geoffrey Tremont Jennifer Davis Jeremy Davis Justin Karr Karen Sullivan Katherine Kane Keenan Walker Kevin O'Brien Kristin Wilmoth Kyle Noll Mathew Thornton Noelle Carlozzi Rael Lange Sara Lippa Seth Margolis Stephen Woods Surabi Patwardhan Vanessa Williams Victor Del Bene Victoria Merritt.

A Comprehensive Study of the CA-72.4 Tumor Marker Utilization and Cancer Detection: Analysis Based on Ministry of Health Data

Background: This study aims to explore the relevance and utilization of the CA 72.4 tumor marker in cancer diagnosis, with a particular focus on gastrointestinal tumors and ovarian cancer, based on data from the Minis-try of Health. Materials and Methods: We conducted a retrospective analysis of health records from the Ministry of Health spanning over five years. The data, consisting of various demographics, including gender, age, and clinical service requests, was statistically analyzed. The rates of reference range exceedance for the CA 72.4 tumor marker, diagnosis times, the ratio of cancer diagnosis, and the cost distribution were among the key aspects evaluated. Results: The analysis revealed a significant increase in the request for CA 72.4 tests over the years. It was also observed that cancer detection rates slightly increased over time, with a higher percentage in patients testing positive for CA 72.4, primarily requested before diagnosis. The highest requests for the test were made by the Medical Oncology clinic. Furthermore, it was observed that gender and age groups played significant roles in the prevalence of cancer diagnoses. Conclusions: Our study indicates that the use of CA 72.4 as a tumor marker could be valuable, especially in the detection of certain types of cancer. However, the correlation between a positive CA 72.4 test and a definitive cancer diagnosis requires further investigation, as the sensitivity and specificity of this marker are still subjects of debate. Despite certain limitations, this study offers substantial insights into the utility of CA 72.4 in the current healthcare setting.

1069 Radiological Diagnosis of Groin Hernia - The New Norm?

Abstract Aim Ultrasound is an effective means for diagnosis of groin hernia however, RCS England and The British Hernia Society recommend that herniae should be diagnosed clinically and ultrasound should not be arranged at a primary care level. Following an increase in radiologically-diagnosed herniae referred to the general surgery department, we sought to determine whether ultrasound was used as a primary diagnostic tool. Method Ultrasound requests received from primary care between January and December 2021 were identified using radiology department records. Exclusion of incomplete, follow up and paediatric scans (&amp;lt;16 years old) was ensured. Electronic records were reviewed for clinical history, examination, radiology request and imaging report. Results 342 patients were included. 193 patients had the right groin scanned and 149, the left. The predominant symptoms for which scans were requested were “lump/swelling” (46%) and “pain” (36%). 13% were for suspected recurrence. 27% had a hernia on examination and 45% had no documented examination findings. The most common clinical question on imaging requests was “?hernia” (63%). 143 (42%) of ultrasound scans positively identified a hernia. Of these, 52% had a documented hernia on examination. Conclusions Ultrasound imaging is commonly used to diagnose or confirm diagnosis of groin hernia in the primary care setting. This study was conducted during the COVID-19 pandemic; reduced access to face-to-face consultations may have resulted in increased use of imaging and absence of clinical examination in the assessment of these patients. Patients with suspected hernia should be reviewed by a secondary care specialist prior to diagnostic imaging.

259 Avoiding Face-to-Face Appointments Following Benign Breast Biopsies: Improving The Patient Experience Without Compromising Safety

Abstract Aim Minimising face to face (F2F) contact can reduce the costs of outpatient clinics and increase patient satisfaction. Patients undergoing biopsy for suspected benign disease need discussing at an MDT meeting as per national guidelines, however, the majority of these do not need further treatment. We aimed to assess the utility and safety of managing patients without a further F2F appointment following benign MDT discussion. Method A retrospective case-note review was performed on 100 patients discussed at the benign biopsy MDT between June and August 2020. Clinicopathological data was collected on presenting symptoms, histopathology, management, and subsequent requirement for F2F appointment. Results Median age was 43 years (range 25-88). Eighty-one patients (81%) presented with a lump or nipple discharge. The final diagnosis was normal in 22(22%) patients, a diagnosis of fibroadenoma in 35(35%), a B3 lesion in 8 (8%) patients and another benign diagnosis in the remaining 35(35%) patients. Sixteen (16%) patients required surgery or vacuum-assisted-Biopsy, 18(18%) required further clinical or radiology follow up and 66(66%) were reassured and discharged. Forty-three (43%) patients were informed of the MDT plan by letter and 42(42%) by telephone. There were no malignancies identified in any patients. Fourteen (14%) patients required a F2F appointment most commonly because of further clinical review, patient request or interpreter requirements. Conclusions The vast majority of patients undergoing benign biopsy can avoid a further F2F appointment, even if further biopsies or intervention is needed. This can reduce the burden on outpatient clinics whilst improving patient convenience.