Clinical Screening Tool Research Articles

Using Breast Tissue Information and Subject-Specific Finite-Element Models to Optimize Breast Compression Parameters for Digital Mammography

Digital mammography has become a first-line diagnostic tool for clinical breast cancer screening due to its high sensitivity and specificity. Mammographic compression force is closely associated with image quality and patient comfort. Therefore, optimizing breast compression parameters is essential. Subjects were recruited for digital mammography and breast magnetic resonance imaging (MRI) within a month. Breast MRI images were used to calculate breast volume and volumetric breast density (VBD) and construct finite element models. Finite element analysis was performed to simulate breast compression. Simulated compressed breast thickness (CBT) was compared with clinical CBT and the relationships between compression force, CBT, breast volume, and VBD were established. Simulated CBT had a good linear correlation with the clinical CBT (R2 = 0.9433) at the clinical compression force. At 10, 12, 14, and 16 daN, the mean simulated CBT of the breast models was 5.67, 5.13, 4.66, and 4.26 cm, respectively. Simulated CBT was positively correlated with breast volume (r > 0.868) and negatively correlated with VBD (r < –0.338). The results of this study provides a subject-specific and evidence-based suggestion of mammographic compression force for radiographers considering image quality and patient comfort.

High sensitivity and rapid detection of KRAS and BRAF gene mutations in colorectal cancer using YbTixOy electrolyte-insulator-semiconductor biosensors

The KRAS and BRAF genes are attractive for a predictive biomarker to determine whether the colorectal cancer (CRC) patient predicts response to anti-epidermal growth factor receptor treatment. The detection of KRAS and BRAF mutation statuses has to be considered as a diagnostic and prognostic factor for the treatment of metastatic CRC patients because the targeted therapy may be expensive as well as toxic. In this work, we develop an YbTixOy electrolyte-insulator-semiconductor (EIS) biosensor to detect the KRAS and BRAF gene mutations in CRC. X-ray diffraction, atomic force microscopy, X-ray photoelectron spectroscopy, and secondary ion mass spectrometry were used to explore the structural features of YbTixOy films prepared under three Ti plasma power conditions. We found that the YbTixOy-based EIS sensor fabricated at the 80 W condition exhibited a higher sensitivity of 69.54 mV/pH (in pH range 2–12), a lower hysteresis voltage of 1 mV (in pH loop of 7→4→7→10→7), and a smaller drift rate of 0.15 mV/h (in pH 7) than those of the other Ti plasma power conditions. Furthermore, we successfully demonstrated that the single strain DNA probe-immobilized YbTixOy EIS biosensors functionalized with 3-aminopropyl triethoxysilane followed by glutaraldehyde were screened for the KRAS and BRAF gene mutations in CRC. High sensitivity and rapid detection of the YbTixOy-based EIS biosensor are expected to serve as the diagnostic tool for clinical examination and screening with CRC.

Timing and Persistence of Material Hardship Among Children in the United States.

ObjectiveScreening for social determinants of health (SDH) has been widely adopted to identify child health risks associated with exposure to material hardship. Whereas SDH screening typically addresses a 12-month span, we sought to compare the prevalence of exposure to present (within the past year) as compared to recent (2–4 years ago) hardship among children in the United States.MethodsWe analyzed the 2014 Survey of Income and Program Participation, a nationally representative survey that interviewed participating households annually between 2014 and 2017. We included data from households with children in all waves. As of 2017, households were categorized as (1) experiencing present hardship (within the last year); (2) experiencing recent but not present hardship (any year between 2014 and 2016); and (3) experiencing no hardship over the 4-year period.ResultsOf 2422 households, 27% experienced present hardship and 29% experienced recent but not present hardship. Households presently experiencing hardship were more likely to have Medicaid insurance, less likely to be married, and had more children than families who had experienced recent hardship. However, these groups were similar on caregivers’ educational attainment, race/ethnicity, language spoken in the home, and age of the youngest child.ConclusionsOur results suggest that clinical screening tools for SDH that use a 12-month time frame risk missing many children who have recently (within the past 4 years) experienced material hardship and may benefit from interventions to improve social support; a longer time frame could provide clinicians with valuable information for understanding social factors that impact child health and development.

Figure-Ground Testing as an Accurate and Efficient Tool For Clinical Screening of Posterior Cortical Atrophy (P14-3.003)

Figure-Ground Testing as an Accurate and Efficient Tool For Clinical Screening of Posterior Cortical Atrophy (P14-3.003)

The Reliability of Two Dimensional Kinematic Assessment of a 45-Degree Side Step Cut

Background:Up to 70% of all anterior cruciate ligament (ACL) injuries occur via a non-contact mechanism involving deceleration and direction change on a planted foot. Clinical screening tools analyzing movement patterns during a cutting task are reliable and valid. The Expanded Cutting Alignment Scoring Tool (E-CAST) is a reliable tool to qualitatively assess trunk and lower extremity (LE) alignment during a 45-degree side step cut (SSC). Previous works found two-dimensional (2D) kinematic analysis more reliable than qualitative assessments when evaluating jumping and squatting movements. However, there is limited evidence on the reliability of 2D assessments to evaluate SSC tasks.Hypothesis/Purpose:To determine if using 2D kinematic analysis with the E-CAST improves the tool’s reliability for evaluating trunk and LE alignment during a 45-degree SSC.Methods:25 healthy females (age 13.8 ± 1.4 years, mass 52.4 ± 9.3 kg, height 161.7 ± 6.0 cm) who regularly participated in cutting or pivoting sports were included. A repeated measures study design was used. Each subject performed three SSC trials with one trial randomly selected for analysis. Trials were recorded in the frontal and sagittal planes. Two physical therapist raters independently viewed and scored each video on two separate occasions. Videos orders were randomized and a two-week wash out period occurred between rounds. The E-CAST evaluates six movement variables (Figure 1). The assessment criteria for each variable was adapted to utilize the Dartfish motion analysis application on a smart phone (Figure 2). If a movement variable falls outside of the motion analysis definition, the subject scores a point, therefore a higher score represents poorer technique. Intraclass correlation coefficients (ICC) and 95% confident intervals (95% CI) were calculated for the E-CAST total score, and a kappa coefficient was calculated for each variable. Correlations were converted to z scores and compared for significance.Results:The cumulative intra-rater reliability was good (ICC= 0.821, 95% CI 0.687 – 0.898) and the cumulative inter-rater reliability was moderate (ICC= 0.752, 95% CI 0.565-0.859). Intra-rater kappa coefficients ranged from moderate to almost perfect for all variables (k= 0.505-0.875) and inter-rater kappa coefficients ranged from slight to good for all variables (k=0.336-0.733).Conclusion:The use of 2D kinematic analysis resulted in higher intra-and inter-rater reliability compared to the traditional qualitative E-CAST (ICC: 0.77, 95% CI 0.59-0.96 and ICC: 0.71, 95% CI 0.50-0.91), however, the difference was not significant (Zobs = -0.46 and Zobs = -0.30).

The development of a clinical screening tool to evaluate unilateral landing performance in a healthy population

ObjectivesTo develop a clinical tool to evaluate unilateral landing quality in a healthy population. The reliability of the novel tool was evaluated, and the influence of gender and leg-dominance was investigated. DesignAn experimental study for developing a test protocol, scoring criteria, and scoring method, based on observable landing errors, for the novel Unilateral Landing Error Scoring System (ULESS). SettingControlled lab environment. ParticipantsHealthy participants (25♂ and 25♀) performed the ULESS. Main outcome measuresThe ULESS was scored with video analysis. Unilateral landing performance, measured with the ULESS, was compared to bilateral landing performance. ResultsSixteen items to assess trunk, pelvic, and lower limb movement patterns during a unilateral landing task resulted in a composite score on an interval scale. Moderate to excellent intra- and inter-tester reliability (ICC(2,1) = 0.77–0.90) was determined. The ULESS was able to identify moderate to poor unilateral landing quality in subjects with good to excellent bilateral landing quality. No main effect of gender (p = 0.19) or leg-dominance (p = 0.65) on ULESS scores was found. ConclusionModerate to excellent reliability can be expected when using the newly developed protocol and scoring method. The ULESS is feasible to perform with limited materials.

P101 Estimating the quality of life and economic impact of arthritis in Tanzania

Abstract Background/Aims Musculoskeletal (MSK) disorders are one of the major causes of non-traumatic disability within the global burden of disease. A 2010 Global Burden of Disease study reported that MSK diseases account for 20% of all Years Lived with Disability (YLDs) in low/middle income countries. Significantly contributing to this MSK burden is arthritis. In Tanzania, a lack of data exists on the prevalence, quality of life, economic and societal impact of arthritis. We aim to estimate the health, economic and societal burden of arthritis in Tanzania. Methods A community-based cross-sectional survey was undertaken between January 2021 to Sept 2021 in the Kilimanjaro region of Tanzania working in partnership with the Kilimanjaro Christian Research Institute and Kilimanjaro Christian Medical Centre. Clinical screening tools, including the Gait Arms Legs Spine (GALS) and Regional Examination of the Musculoskeletal system (REMS) were used to screen people with MSK diseases and possible arthritis through a tiered system approach. Economic and quality of life questionnaires were used for a representative sample of all residents (aged over 5 years old) in selected households. Ethiopia and Zimbabwe tariffs were used for the EuroQol EQ-5D. Resource use captured out-of-pocket costs, healthcare costs, absenteeism, presenteeism & work productivity loss. Regression based analysis were undertaken to estimate differences in utility scores and resources use / costs between those presenting as REMS+/- and GALS+/-. Other explanatory variables in the model included age, occupation, marital status, gender, religion, tribe, education. Results Preliminary results on data collected to-date show that for all QoL dimensions those with a positive diagnosis had lower utility scores. Whilst the population norms are in line with utility values for that age group from other countries (30-40 years, ∼0.9 utility), those presenting with a positive diagnosis had a significant reduction in utility of ∼0.12 to 0.15 depending on what country tariff was used. A higher proportion of participants in GALS/REMS +ve groups experienced work loss (6 x more likely) and had visited healthcare facilities/hospitalisation (2.5 x more likely) compared to GALS/REMS -ve. Health-related costs reported by household financial respondents did not show a significant statistical difference albeit a likely economically significant difference (Tanzanian Shillings 13,535 vs 6,683, p = 0.05), when adjusted for age and gender. Conclusion This is the first study to estimate burden and prevalence estimates of MSK in Tanzania using valid screening tools along with estimates of preference-based quality of life, disability impacts and quantification of the economic impacts of MSK. This study quantifies the significant burden of rheumatological conditions both in terms of health and poverty. The results will be used to guide clinical health practices, intervention design, service provision, and health promotion and awareness activities both at KCMC institutional level, Kilimanjaro region and national level. Disclosure E. Grieve: None. P. Hsieh: None. E. McIntosh: None. M. Deidda: None.

Reliability of the Expanded Cutting Alignment Scoring Tool (E-CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut.

BackgroundCurrent clinical screening tools assessing risky movements during cutting maneuvers do not adequately address sagittal plane foot and ankle evaluations. The Cutting Alignment Scoring Tool (CAST) is reliable in evaluating frontal plane trunk and lower extremity alignment during a 45-degree side-step cut. The Expanded Cutting Alignment Scoring Tool (E-CAST) includes two new sagittal plane variables, knee flexion and ankle plantarflexion angle.Hypothesis/PurposeTo assess the inter-and intra-rater reliability of the E-CAST to evaluate trunk and lower extremity alignment during a 45-degree side-step cut.Study DesignRepeated MeasuresMethodsParticipants included 25 healthy females (13.8 ± 1.4 years) regularly participating in cutting or pivoting sports. Participants were recorded performing a side-step cut in frontal and sagittal planes. One trial was randomly selected for analysis. Two physical therapists independently scored each video using the E-CAST on two separate occasions, with randomization and a two-week wash-out between rounds. Observed movement variables were awarded a score of “1”, with higher scores representing poorer technique. Intraclass correlation coefficients (ICC) and 95% confident intervals (95% CI) were calculated for the total score, and a kappa coefficient (k) was calculated for each variable.ResultsThe cumulative intra-rater reliability was good (ICC=0.78, 95% CI 0.59-0.96) and the cumulative inter-rater reliability was moderate (ICC=0.71, 95% CI 0.50-0.91). Intra-rater kappa coefficients ranged from moderate to excellent for all variables (k= 0.50-0.84) and inter-rater kappa coefficients ranged from slight to excellent for all variables (k=0.20-0.90).ConclusionThe addition of two sagittal plane variables resulted in lower inter-rater ICC compared to the CAST (ICC= 0.81, 95% CI 0.64-0.91). The E-CAST is a reliable tool to evaluate trunk and LE alignment during a 45-degree side-step cut, with good intra-rater and moderate inter-rater reliability.Level of EvidenceLevel 2, Diagnosis

Clinical correlation and assessment of olfactory dysfunction with n-butanol in COVID-19 patients: our experience

Background: Studies showed olfactory disturbances in COVID patients. This has attracted focus of clinicians as an easy clinical screening tool in suspected population. Material and methods: 70 mild and moderate category COVID-19 RT-PCR positive patients, more than 10 years of age were tested on day of admission for olfaction with serial dilution of n-butanol and asked to grade severity of their olfactory dysfunction according to visual analogue score from 1-10. Results: Fatigue 42 (93.33%), sore throat 37 (82.22%), fever 36 (80%) and dyspnea 23 (51.11%) were the most common symptoms in moderate patients. Diabetes, hypertension and allergy were the three prominent risk factors. At time of admission, n-butanol diagnosed 20 patients having olfactory dysfunction compared to 11 by VAS. Patients tend to grade their dysfunction higher on VAS whereas the n-butanol test classified their olfactory dysfunction lower. Viral load and high CRP were not found to be significantly related with olfactory dysfunction. d-Dimer and LDH levels were found statistically associated with higher grading of olfactory dysfunction detected by n-butanol. Conclusion: The majority of cases developed hyposmia before they were admitted to hospital even before they realized that they were having hyposmia as revealed by n-butanol testing. We should go for objective tests of olfaction.

Examining the association between blood-based biomarkers and human post mortem neuropathology in the University of Kentucky Alzheimer's Disease Research Center autopsy cohort.

Clinically, detection of disease-causing pathology associated with Alzheimer's disease (AD) and vascular contributions to cognitive impairment and dementia (VCID) is limited to magnetic resonance imaging and positron emission tomography scans, which are expensive and not widely accessible. Here, we assess angiogenic, inflammatory, and AD-related plasma biomarkers to determine their relationships with human post mortem neuropathology. Plasma samples were analyzed using a digital immunoassay and pathological evaluation was performed by University of Kentucky Alzheimer's Disease Research Center neuropathologists. The association of plasma markers with neuropathology was estimated via proportional odds and logistic regressions adjusted for age. Included cases (N=90) showed increased tau/amyloid beta (Aβ)42 ratio, glial fibrillary acidic protein (GFAP), vascular endothelial growth factor A (VEGF-A), and placental growth factor (PlGF) were positively associated with higher level of AD neuropathological change, while higher Aβ42/Aβ40 ratio was inversely associated. Higher PlGF, VEGF-A, and interleukin 6 were inversely associated with chronic cerebrovascular disease, while Aβ42/Aβ40 ratio was positively associated. Our results provide support for the continued study of plasma biomarkers as a clinical screening tool for AD and VCID pathology.

Investigation of Red Blood Cells by Atomic Force Microscopy.

Currently, much research is devoted to the study of biological objects using atomic force microscopy (AFM). This method’s resolution is superior to the other non-scanning techniques. Our study aims to further emphasize some of the advantages of using AFM as a clinical screening tool. The study focused on red blood cells exposed to various physical and chemical factors, namely hemin, zinc ions, and long-term storage. AFM was used to investigate the morphological, nanostructural, cytoskeletal, and mechanical properties of red blood cells (RBCs). Based on experimental data, a set of important biomarkers determining the status of blood cells have been identified.

Rapid detection of hysteromyoma and cervical cancer based on serum surface-enhanced Raman spectroscopy and a support vector machine.

In this study, we investigated the feasibility of using surface-enhanced Raman spectroscopy (SERS) combined with a support vector machine (SVM) algorithm to discriminate hysteromyoma and cervical cancer from healthy volunteers rapidly. SERS spectra of serum samples were recorded from 30 hysteromyoma patients, 36 cervical cancer patients as well as 30 healthy subjects. SVM was used to establish the classification models, and three types of kernel functions, namely linear, polynomial, and Gaussian radial basis function (RBF), were utilized for comparison. When the polynomial kernel function was employed, the overall diagnostic accuracy for classifying the three groups could achieve 86.5%. In addition, when the optimal kernel function was selected, the diagnostic accuracy for identifying healthy versus hysteromyoma, healthy versus cervical cancer, and hysteromyoma versus cervical cancer reached 98.3%, 93.9%, and 90.9%, respectively. The current results indicate that serum SERS technology, together with the SVM algorithm, is expected to become a clinical tool for rapid screening of hysteromyoma and cervical cancer.

Clinical parameters of hypervirulent Klebsiella pneumoniae disease and ivermectin treatment in New Zealand sea lion (Phocarctos hookeri) pups.

Hypervirulent Klebsiella pneumoniae infection causes significant mortality of endangered New Zealand sea lion pups at Enderby Island, Auckland Islands. Gross necropsy and histopathology findings are well reported, but little is known about the clinical course of disease in affected pups. To determine factors feasible as clinical screening tools for hypervirulent K. pneumoniae in live pups, 150 pups over two field seasons (2016–18) were recruited shortly after birth for a prospective cohort study. A randomised controlled clinical treatment trial with the anthelmintic ivermectin was conducted concurrently and risk factor data and biological samples were collected approximately fortnightly. Treatment with ivermectin has been demonstrated to reduce the risk of hypervirulent K. pneumoniae mortality in pups, so effects on clinical parameters between the treated and control cohorts were also investigated. A broader sample of pups were monitored for clinical signs to investigate the course of disease in affected pups. Clinical signs, haematology and oral and rectal swabs to detect gastrointestinal carriage of hypervirulent K. pneumoniae were not useful for detection of disease prior to death. Of those pups that died due to hypervirulent K. pneumoniae, only 26.1% (18/69) had any clinical signs prior, likely a reflection of the peracute course of disease. On comparison of haematological parameters between ivermectin-treated and control pups, significantly lower total plasma protein and higher eosinophil counts were seen in control versus treated pups, however standard length as a surrogate for age was a more important influence on parameters overall than ivermectin treatment. This study also highlighted a cohort of pups with severe clinical signs suggestive of hypervirulent K. pneumoniae infection were lost to follow up at the end of the monitored season, which could be contributing to cryptic juvenile mortality.

Exploring the ability of self-report measures to identify risk of high treatment burden in chronic disease patients: a cross-sectional study

BackgroundEffective self-management of chronic health conditions is key to avoiding disease escalation and poor health outcomes, but self-management abilities vary. Adequate patient capacity, in terms of abilities and resources, is needed to effectively manage the treatment burden associated with chronic health conditions. The ability to measure different elements of capacity, as well as treatment burden, may assist to identify those at risk of poor self-management. Our aims were to: 1. Investigate correlations between established self-report tools measuring aspects of patient capacity, and treatment burden; and 2. Explore whether individual questions from the self-report tools will correlate to perceived treatment burden without loss of explanation. This may assist in the development of a clinical screening tool to identify people at risk of high treatment burden.MethodsA cross-sectional survey in both a postal and online format. Patients reporting one or more chronic diseases completed validated self-report scales assessing social, financial, physical and emotional capacity; quality of life; and perceived treatment burden. Logistic regression analysis was used to explore relationships between different capacity variables, and perceived high treatment burden.ResultsRespondents (n = 183) were mostly female (78%) with a mean age of 60 years. Most participants were multimorbid (94%), with 45% reporting more than five conditions. 51% reported a high treatment burden. Following logistic regression analyses, high perceived treatment burden was correlated with younger age, material deprivation, low self-efficacy and usual activity limitation. These factors accounted for 50.7% of the variance in high perceived treatment burden. Neither disease burden nor specific diagnosis was correlated with treatment burden.ConclusionsThis study supports previous observations that psychosocial factors may be more influential than specific diagnoses for multimorbid patients in managing their treatment workload. A simple capacity measure may be useful to identify those who are likely to struggle with healthcare demands.

Quantitative and qualitative impact of One Key Question on primary care providers’ contraceptive counseling at routine preventive health visits

ObjectivesOne Key Question (OKQ) is a clinical screening tool to assess pregnancy desire in the next year. We aimed to 1) describe the effect of OKQ implementation on contraceptive counseling rates at preventive health visits and 2) evaluate primary care providers’ perception of OKQ implementation on their contraceptive counseling practices. Study designWe performed a quantitative retrospective chart review of preventive health visits at eight federally qualified health centers in Utah between 2014 and 2017. Implementation of OKQ included a brief training and inclusion of OKQ in the electronic medical record. Providers received OKQ training in August 2015 and re-training in March 2017. We assessed OKQ and contraceptive counseling documentation rates using interrupted-time-series analysis. We then conducted semi-structured interviews with providers and queried them about the impact of OKQ. We identified dominant themes using modified grounded theory to create an explanatory framework. ResultsAbstracting 6634 charts yielded 9840 visits with 56 unique providers (51% physician assistant, 34% physician, 14% nurse practitioner). Interrupted-time-series analysis showed a documentation increase of OKQ in late 2015 (2.6%) and again in spring 2017 (9%), however rates remained low. Contraceptive counseling rates (39.7%) did not change after OKQ implementation. Charts with evidence of a current contraceptive method were less likely to have a OKQ response documented. Interviewees reported OKQ's algorithm did not alter their contraceptive counseling. ConclusionsOKQ did not change documented rates of contraceptive counseling and uptake was low in quantitative and qualitative analyses. Our study suggests limited usefulness of OKQ in the primary care setting. ImplicationsImplementation of the One Key Question tool through training and optional EHR field did not increase documented rates of contraceptive counseling in a large federally qualified health center or affect provider contraceptive counseling. Our study suggests limited usefulness of OKQ as a robust screening tool in this primary care setting.

Cognitive Ability as a Non-modifiable Risk Factor for Post-prostatectomy Urinary Incontinence: A Double-Blinded, Prospective, Single-Center Trial.

Introduction: Urinary incontinence (UI) is a wide-spread and feared side-effect of conventional or even robot-assisted laparoscopic prostatectomy (RALP) due to its high impact on patients' quality of life (QoL). Non-modifiable risk factors for UI have already been identified – on surgical and patient side. Yet, to our knowledge, focus thus far has not been placed on functional aspects regarding general cognitive ability.Materials and Methods: This is an observational single-center, prospective, double-blinded evaluation of 109 RALPs performed between 07/2020 and 03/2021. All patients underwent a Mini Mental State Examination (MMSE) prior to surgery to evaluate their cognitive ability. Early post-prostatectomy incontinence (PPI) was evaluated using a standardized 1 h pad test performed 24 h after removal of the urinary catheter. The association between MMSE results and PPI were evaluated using univariate and multivariate logistic regression models.Results: Multivariate logistic regression analyses identified MMSE results and nerve sparing (NS) as independent predictors for PPI in patients with an intermediate MMSE result (25–27 points) having a 3.17 times higher risk of PPI when compared to patients with a good MMSE result (≥28) (95% Confidence Interval (CI): 1.22–9.06, p = 0.023), while patients without NS had a 3.53 times higher risk of PPI when compared to patients with NS (95% CI: 1.54–11.09, p = 0.006).Conclusion: A lower cognitive ability should be treated as a non-modifiable risk-factor for early PPI. In the future it could find its place as a clinical screening tool to identify patients who require more attention especially in the pre-, but also in the postoperative phase.

A primer extension activating 3D DNAzyme walker for in situ imaging and sensitive detection of telomerase activity.

Acquiring information on telomerase activity at multiple levels contributes to a better understanding of its role in various physiological and pathological processes. Herein, a primer extension activating 3D DNAzyme walker is developed for in situ imaging and sensitive detection of telomerase activity. This walker is constructed via co-modifying specially designed hairpin structured walking strands and track strands on a gold nanoparticle (AuNP). The walking strand contains a pre-blocked DNAzyme sequence and a telomerase primer hybridized to its root. The track strand embeds at an RNA cleavage site and is labeled with the FAM group. After this walker is taken up by cells, the telomerase primer is extended under the action of endogenous telomerase to liberate DNAzyme. The liberated DNAzyme cuts track strands in the presence of the cofactor Mn2+ to drive the walker's processive operation, resulting in an enhanced fluorescence recovery of the AuNP-quenched FAM fluorophore. In situ imaging of telomerase activity in three different cell lines (MCF-7 cells, HeLa cells and HL-7702 cells) was well implemented. The discrimination of cancer cells from normal cells and the screening of telomerase inhibitors have been achieved. The sensitive detection of telomerase activity in HeLa cell lysate has also been realized with a detection limit of 10 cells. This walker performed a new approach for monitoring telomerase activity from different levels, providing a potential tool for clinical diagnosis, prognostic evaluation and drug screening.

Identification of Malnutrition Risk Using Malnutrition Screening Tool in an Ambulatory Pancreas Clinic.

The aim of this project was to assess malnutrition risk in a well-defined cohort of pancreatic diseases. We performed a retrospective, cross-sectional study of 401 subjects with available malnutrition screening tool scores who received care at a single outpatient pancreas clinic during a 6-month study period. Univariate analyses were performed to compare demographic, anthropometric, symptoms/diseases, and risk for malnutrition characteristics across 3 strata of diseases: acute pancreatitis (n = 141), chronic pancreatitis (n = 193), and other pancreatic diagnoses (n = 67). A total of 18% of subjects were identified as at risk for malnutrition, including 25% who reported involuntary weight loss and/or decreased appetite. Subjects categorized as at risk for malnutrition were more likely to have gastrointestinal symptoms. Although the nutrition consultation rates were higher in subjects at risk for malnutrition (P = 0.03), 66% did not receive a clearly indicated dietary evaluation or management recommendations. One fifth of all patients in an ambulatory pancreas clinic are identified as at risk for malnutrition using a simple, validated tool. The majority of patients at increased risk for nutritional complications did not receive nutritional recommendations.

Developing the breast cancer risk prediction system using hybrid machine learning algorithms.

Breast cancer (BC) is the most common cause of cancer-related deaths in women globally. Currently, many machine learning (ML)-based predictive models have been established to assist clinicians in decision making for the prediction of BC. However, preventing risk factor formation even with having healthy lifestyle behaviors or preventing disease at early stages can significantly lead to optimal population-wide BC health. Thus, we aimed to develop a prediction model by using a genetic algorithm (GA) incorporating several ML algorithms for the prediction and early warning of BC. The data of 3168 healthy individuals and 1742 patient case records in the BC Registry Database in Ayatollah Taleghani hospital, Abadan, Iran were analyzed. First, a modified hybrid GA was used to perform feature selection and optimization of selected features. Then, with the use of selected features, several ML algorithms were trained to predict BC. Afterward, the performance of each model was measured in terms of accuracy, precision, sensitivity, specificity, and receiver operating characteristic (ROC) curve metrics. Finally, a clinical decision support system based on the best model was developed. After performing feature selection, age, consumption of dairy products, BC family history, breast biopsy, chest X-ray, hormone therapy, alcohol consumption, being overweight, having children, and education statuses were selected as the most important features for prediction of BC. The experimental results showed that the decision tree yielded a superior performance than other ML models, with values of 99.3%, 99.5%, 98.26% for accuracy, specificity, and sensitivity, respectively. The developed predictive system can accurately identify persons who are at elevated risk for BC and can be used as an essential clinical screening tool for the early prevention of BC and serve as an important tool for developing preventive health strategies.

Symptom Scores and pH-Impedance: Secondary Analysis of a Randomized Controlled Trial in Infants Treated for Gastroesophageal Reflux.

BACKGROUND AND AIMS:To evaluate and compare gastro-esophageal reflux (GER) symptom scores with pH-impedance and test the effects of acid-suppressive medications with or without feeding modifications on pH-impedance in high-risk infants.METHODS:Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) and 24-hour pH-impedance data were analyzed from 94 infants evaluated in a tertiary care setting for GER disease. Longitudinal data from 40 infants that received randomized GER therapy (proton pump inhibitor [PPI] with or without feeding modifications) for 4 weeks followed by 1-week washout were analyzed. Relationships between I-GERQ-R and pH-impedance metrics (acid reflux index, acid and bolus GER events, distal baseline impedance, and symptoms) were examined and effects of treatments compared.RESULTS:(A) Correlations between I-GERQ-R and pH-impedance metrics were weak. (B) I-GERQ-R sensitivity, specificity, and positive predictive values were suboptimal when correlated with pH-impedance metrics. I-GERQ-R negative predictive value (NPV) was high for acid symptom–association probability (NPV = 84%) and distal baseline impedence (NPV = 86%) thresholds. (C) PPI with feeding modifications (vs PPI alone) did not alter pH-impedance metrics or symptom scores (P > .05); however, bolus clearance metrics worsened for both treatment groups (P < .05).CONCLUSIONS:In high-risk infants (1) I-GERQ-R may be a helpful clinical screening tool to exclude acid-GER disease diagnosis and minimize unnecessary acid-suppressive treatment, but further testing is needed for diagnosis. (2) Acid-suppressive therapy with feeding modifications has no effect on symptom scores or pH-impedance metrics. Clearance of refluxate worsened despite PPI therapy, which may signal development of pharyngoesophageal dysmotility and persistence of symptoms. (3) Placebo-controlled trials are needed in high-risk infants with objective pH-impedance criteria to determine efficacy, safety, and underlying mechanisms. Clinicaltrials.gov ID: NCT02486263.