Clinical Testing Methods Research Articles

Sources of discordance among germ-line variant classifications in ClinVar

PurposeClinVar is increasingly used as a resource for both genetic variant interpretation and clinical practice. However, controversies exist regarding the consistency of classifications in ClinVar, and questions remain about how best to use these data. Our study systematically examined ClinVar to identify common sources of discordance and thus inform ongoing practices.MethodsWe analyzed variants that had multiple classifications in ClinVar, excluding benign polymorphisms. Classifications were categorized by potential actionability and pathogenicity. Consensus interpretations were calculated for each variant, and the properties of the discordant outlier classifications were summarized.ResultsOur study included 74,065 classifications of 27,224 unique variants in 1,713 genes. We found that (i) concordance rates differed among clinical areas and variant types; (ii) clinical testing methods had much higher concordance than basic literature curation and research efforts; (iii) older classifications had greater discordance than newer ones; and (iv) low-penetrance variants had particularly high discordance.ConclusionRecent variant classifications from clinical testing laboratories have high overall concordance in many (but not all) clinical areas. ClinVar can be a reliable resource supporting variant interpretation, quality assessment, and clinical practice when factors uncovered in this study are taken into account. Ongoing improvements to ClinVar may make it easier to use, particularly for nonexpert users.

Composite Configuration Interventional Therapy Robot for the Microwave Ablation of Liver Tumors

The existing interventional therapy robots for the microwave ablation of liver tumors have a poor clinical applicability with a large volume, low positioning speed and complex automatic navigation control. To solve above problems, a composite configuration interventional therapy robot with passive and active joints is developed. The design of composite configuration reduces the size of the robot under the premise of a wide range of movement, and the robot with composite configuration can realizes rapid positioning with operation safety. The cumulative error of positioning is eliminated and the control complexity is reduced by decoupling active parts. The navigation algorithms for the robot are proposed based on solution of the inverse kinematics and geometric analysis. A simulation clinical test method is designed for the robot, and the functions of the robot and the navigation algorithms are verified by the test method. The mean error of navigation is 1.488 mm and the maximum error is 2.056 mm, and the positioning time for the ablation needle is in 10 s. The experimental results show that the designed robot can meet the clinical requirements for the microwave ablation of liver tumors. The composite configuration is proposed in development of the interventional therapy robot for the microwave ablation of liver tumors, which provides a new idea for the structural design of medical robots.

Big data in sleep medicine: prospects and pitfalls in phenotyping.

Clinical polysomnography (PSG) databases are a rich resource in the era of “big data” analytics. We explore the uses and potential pitfalls of clinical data mining of PSG using statistical principles and analysis of clinical data from our sleep center. We performed retrospective analysis of self-reported and objective PSG data from adults who underwent overnight PSG (diagnostic tests, n=1835). Self-reported symptoms overlapped markedly between the two most common categories, insomnia and sleep apnea, with the majority reporting symptoms of both disorders. Standard clinical metrics routinely reported on objective data were analyzed for basic properties (missing values, distributions), pairwise correlations, and descriptive phenotyping. Of 41 continuous variables, including clinical and PSG derived, none passed testing for normality. Objective findings of sleep apnea and periodic limb movements were common, with 51% having an apnea–hypopnea index (AHI) >5 per hour and 25% having a leg movement index >15 per hour. Different visualization methods are shown for common variables to explore population distributions. Phenotyping methods based on clinical databases are discussed for sleep architecture, sleep apnea, and insomnia. Inferential pitfalls are discussed using the current dataset and case examples from the literature. The increasing availability of clinical databases for large-scale analytics holds important promise in sleep medicine, especially as it becomes increasingly important to demonstrate the utility of clinical testing methods in management of sleep disorders. Awareness of the strengths, as well as caution regarding the limitations, will maximize the productive use of big data analytics in sleep medicine.

Mental health of elderly and old people when using a complete dry dental prosthesis: myth or reality?

The study studied the ratio of 17 adults with complete loss of teeth and using complete removable acrylic dentures, to the disease, taking into account the degree of stability of dentures during chewing. To determine the type of patient's attitude toward the disease, a clinical test method was used to determine the type of attitude towards the disease, in which the clinical-psychological typology of patients' attitude to 'illness' was realized, which provides the possibility of determining one of the twelve types of response. It was found that when using complete removable dentures, regardless of age and sex, the types of attitude towards the disease were more often noted, with a marked disadaptive behavior with a predominantly intrapsychic orientation of the response to the disease, which was manifested by characteristic reactions such as irritable weakness, anxious, depressed, oppressed state. The use of the cream to fix the removable dental prostheses Corega allowed to improve the stability of complete removable dentures, to eliminate the pronounced phenomena of mental disadaptation, and to create realistic treatment settings for patients, to help restore social ties.

An Accurate Diagnosis of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome requires strict Clinical Case definitions and Objective Test Methods

Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are subject to controversy. Although ME and CFS are often considered to be to be synonymous, the case criteria for ME and CFS define two distinct diseases with partial overlap. ME, recognized as a new clinical entity in the 1950’s, is characterized by distinctive muscular, neurological and autonomic symptoms. In contrast the core feature of CFS, introduced in 1988 and redefined in 1994, is chronic fatigue. Some researchers consider CFS to be equivalent to (incapacitating) chronic fatigue (CF). After the introduction of CFS, other criteria for ME, ME/CFS, CFS and CF were introduced and used in research studies, creating obfuscation and controversy. The use of various diagnostic criteria has hampered effective research into ME and CFS. Next to the various diagnostic criteria, the assessment of symptoms is almost always based on questionnaires and subjective measures, e.g. physical functioning. Due to their nature subjective measures are incomparable over time and between patients. Moreover subjective measures introduce a significant risk of bias, for example due to researcher allegiance, the Hawthorne effect, and buy-in effects. Despite the fact that ME and CFS (subclasses) lack a clear etiological explanation (yet), the symptoms can and should be assessed by objective test measures, since subjective measures are ambiguous, incomparable and minimize the risk of bias. Objective test measures can also confirm the seriousness of both ME and CFS. To resolve the diagnostic issues in research studies and clinical practice, a clear distinction between ME and CFS (not ME), based on the original criteria, is crucial. Although the use of objective test methods is more expensive and time-consuming and severe cases cannot be subjected to these tests, considering the (scientific) confusion originating from the use of subjective measures it is essential to assess the symptoms of patients objectively both in clinical practice and research settings.

CORRELATION BETWEEN BONE DENSITY OBTAINED BY CBCT AND PRIMARY STABILITY OF SINGLE MIDLINE IMPLANT USED TO RETAIN MANDIBULAR OVER DENTURE IN ELDERLY EDENTULOUS PATIENTS

Introduction: Implant retained over-dentures are widely used for the rehabilitation of edentulous mandible to increase over-denture retention and stability. Implant stability can be measured by various non-invasive clinical test methods as resonance frequency analysis using Osstell. CBCT is widely used in dentistry specially in implant planning but without accurate information about bone density. However, with this increased usage of CBCT in dental field especially in implantology, the predictability of primary implant stability from CBCT image is of great value for oral implantologists.Methodology: Twenty two completely edentulous patients were included in our study. After performing the conventional steps of complete denture construction, the patients were imaged by CBCT using Planmeca ProMax® 3D Mid (Planmeca, Helsinki, Finland). A virtual implant was placed in the potential implant site in a position simulating the planned position of implant in the midline of mandible and the bone density in the potential implant site (inside) and 1mm around the implant (outside) was assessed. After implant installation, the primary stability was assessed using radiofrequency by the osstell device. Results: There was non-statistically significant direct correlation between bone density (for both inside and 1mm surrounding the potential implant site) and primary implant stability. Conclusion: Within the limitation of our study, no correlation was found between bone density measured from cone beam CT and primary stability measured by Osstell in elderly edentulous patients receiving single midline implant

SUBCLINICAL LESION OF CAROTID ARTERIES IN CHRONIC GLOMERULONEPHRITIS

Purpose of the study. Examine gender characteristics of lesion of precerebral arteries and their relationship with renal dysfunction in patients with chronic glomerulonephritis at predialysis stage of the disease.Material and methods.The study included 306 patients with chronic glomerulonephritis aged 17 to 71 years. Group 1 — male (n = 210), group 2 — women (n = 96). All patients, in addition to general clinical testing methods, had noninvasive assessment of structural changes in precerebral arteries. Results and conclusion. In patients with chronic glomerulonephritis, structural changes in precerebral arteries are detected at predialysis stage and do not showsignificant difference depending on gender. Male individuals had hypoproteinemia, subnephrotic proteinuria, clinically relevant hypertriglyceridemia and higher rates of precerebral arteries’ thickness, compared to female patients. At the same time, female individuals showed significantly worse parameters of peripheral blood and renal function, compared to male patients. Negative correlation between glomerular filtration rate and thickness of common and internal carotid artery was found both in general group and in individual male group. The results of the study suggest that in order to prevent vascular complications in the future, patients with chronic glomerulonephritis on the pre-dialysis stage of CKD need to study carotid arteries, as well as in a comprehensive analysis of renal function

PERSONAL RESPONSE TO DISEASE IN PARAFUNCTIONS OF MASTICATORY MUSCLES

Introduction. Particularities of personality of a sick person play an important role in providing effective treatment and prevention of relapse in various pathologies. Therefore, the position of the patient in relation to his/her health and ongoing treatment, as well as to doctors and auxiliary medical personnel are important factors in the success of rehabilitation.Parafunctions of masticatory muscles, which are understood as an impractical inappropriate activity, are known to be often found. They are poorly amenable to treatment and very painful for patients. The use of psychopharmaceutical and psychotherapeutic methods aimed at changing the patient’s attitude to the disease can help to cure such dental patient. This can change the patient’s response to the disease and create realistic settings for treatment. At the same time, the study of the attitude of dental patients to the disease is practically not covered in the accessible domestic and foreign literature. The purpose of study is researchthe attitude to the disease of adults suffering from various forms of parafunctions of the masticatory muscles. Material and methods. The work was carried out to study the attitude of 29 adults suffering from various forms of parafunctions of the masticatory muscles to the disease. To determine the type of attitude to the patient’s disease,we used the TOBOL clinical test method (type of attitude to the disease), which implements the clinical and psychological typology of patient attitude and provides for the possibility of defining one of the twelve types of responses. Results. It was found that before treatment, regardless of age in individuals suffering from parafunction of the masticatory muscles,there were more common types of attitude to the disease, in which the observed maladaptive behavior with predominantly intrapsychic oriented response to the disease manifested the characteristic reactions of the type of irritable weakness, anxiety, depressed and oppressed condition. The performed complex treatment with the use of complex dental treatment and preventive measures, physical therapy exercises and antispasmodic of skeletal muscles allowed to achieve treatment efficiency of 95.8 %. Thus, it changed patients’ inadequate response to the disease, eliminated significant signs of mental maladjustment, as well as createdrealistic attitude to treatmentin patients, helped to restore broad social relations and active participation in treatment. Conclusions. The obtained data about the type of attitude of patients with such chronic, severe and painful pathology as parafunct ions of masticatory muscles are of practical value, as the achievement of a positive therapeutic result and successful rehabilitation are possible only if the patient’s attitude toward the disease changes, especially in the second and third types in the framework of the test «Type of attitude towards the disease» (TOBOL), therefore the involvement of a clinical pharmacologist or psychiatrist is necessary for rehabilitation of such patients.

34 Hour QT analysis in the prediction of genotype positivity in suspected LQTS: a study in both proband and family screening populations

Introduction LQTS is an inheritable condition with a suspected prevalence on 1/2000 and has a risk of sudden cardiac death due to ventricular arrhythmia if untreated. 24 hour QT analysis is a method of averaging QT measurements obtained via holter monitoring over a 24 hour period. The utility of 24 hour QT analysis to predict genotype positivity has not been widely studied. Methods 28 probands with genetic testing results and 107 first degree relatives of genotyped LQTS patients were included in the analysis. Retrospective review of the medical charts of all patients was performed. Parameters analysed included corrected QT (QTc) interval on 12 lead ECG, 24 hour ambulatory ECG, the QTc after 4 minutes of recovery post exercise stress testing (EST), and the Schwartz score based on clinical and ECG criteria. All these parameters were then compared to the results of subsequent genetic testing. Results 28 probands were analysed with 7 returning a positive gene test and 21 returning a negative gene test. Gene positive individuals had significantly greater QTc by resting ECG (p = 0.047), 24 hour ECG (p = 0.005) and after 4 minutes recovery post EST (p = 0.001) (independent t-test). Using standard cut offs (450 ms for males and 460 ms for females) the association between clinically positive resting ECG and positive genotype was not statistically significant (p = 0.17). Schwartz score >3.5 showed no significant difference between gene positive and gene negative groups (p = 0.33). 24 hour QTc (p = 0.029) was significantly associated with positive genotype and QTc at 4 minutes recovery post EST showed a trend toward significance (p = 0.069). Of 107 first degree relatives of LQTS cases there were 50% gene positive cases. There were statistically significant differences between gene positive and gene negative family members in QTc (p 3.5 was 98% specific for genotype positive LQTS but this test had a very low sensitivity of 29%. The most sensitive test was 24 hour QTc with a cut off of 450 ms for males and 460 ms for females with a sensitivity of 69% and specificity of 83%. Conclusions Family screening and prevention of sudden cardiac death is central to the management of LQTS. Current individual clinical testing methods are not sufficiently sensitive to diagnose LQTS alone and must be used in combination to assess the risk of LQTS. 24 hour QT analysis is the most sensitive method of predicting positive genotype in both probands and family members of affected individuals.

An ensemble model of QSAR tools for regulatory risk assessment.

Quantitative structure activity relationships (QSARs) are theoretical models that relate a quantitative measure of chemical structure to a physical property or a biological effect. QSAR predictions can be used for chemical risk assessment for protection of human and environmental health, which makes them interesting to regulators, especially in the absence of experimental data. For compatibility with regulatory use, QSAR models should be transparent, reproducible and optimized to minimize the number of false negatives. In silico QSAR tools are gaining wide acceptance as a faster alternative to otherwise time-consuming clinical and animal testing methods. However, different QSAR tools often make conflicting predictions for a given chemical and may also vary in their predictive performance across different chemical datasets. In a regulatory context, conflicting predictions raise interpretation, validation and adequacy concerns. To address these concerns, ensemble learning techniques in the machine learning paradigm can be used to integrate predictions from multiple tools. By leveraging various underlying QSAR algorithms and training datasets, the resulting consensus prediction should yield better overall predictive ability. We present a novel ensemble QSAR model using Bayesian classification. The model allows for varying a cut-off parameter that allows for a selection in the desirable trade-off between model sensitivity and specificity. The predictive performance of the ensemble model is compared with four in silico tools (Toxtree, Lazar, OECD Toolbox, and Danish QSAR) to predict carcinogenicity for a dataset of air toxins (332 chemicals) and a subset of the gold carcinogenic potency database (480 chemicals). Leave-one-out cross validation results show that the ensemble model achieves the best trade-off between sensitivity and specificity (accuracy: 83.8 % and 80.4 %, and balanced accuracy: 80.6 % and 80.8 %) and highest inter-rater agreement [kappa (κ): 0.63 and 0.62] for both the datasets. The ROC curves demonstrate the utility of the cut-off feature in the predictive ability of the ensemble model. This feature provides an additional control to the regulators in grading a chemical based on the severity of the toxic endpoint under study.Electronic supplementary materialThe online version of this article (doi:10.1186/s13321-016-0164-0) contains supplementary material, which is available to authorized users.

Detection of antidrug antibodies against human therapeutic antibodies lacking Fc-effector functions by usage of soluble Fcγ receptor I.

Bridging immunoassays for the detection of antidrug antibodies (ADAs) are limited to detection of bivalent molecules and are prone to interference by drug and soluble targets. Hence, alternative approaches for ADA detection are desired. Materials& methods: A novel ADA assay with secondary Fc detection using human soluble Fcγ receptor I (hsFcγRI) was established and compared with standard bridging assay. Both assays showed consistent results in human and cynomolgus monkey samples. In contrast to the bridging assay, the hsFcγRI-based assay was insensitive to the presence of oligomeric targets and appeared to have better drug tolerance. The hsFcγRI-based ADA assay can serve as alternative screening assay or as orthogonal confirmation method for preclinical and clinical immunogenicity testing of IgG therapeutics lacking Fc effector functions.

Identifying early signs of peripheral neuropathy among patients with diabetes mellitus

This article aims to help nurse practitioners develop a best practice algorithm to identify the early signs of peripheral neuropathy (PNP) among individuals living with diabetes mellitus. This literature review also seeks to determine if there are better clinical testing methods than the Semmes-Weinstein monofilament examination to detect diabetes-related PNP.

Skriningovaya diagnostika skolioza metodom komp'yuternoy stabilometrii

The study involved 47 young people aged 18 to 20 years. Among them, 11 people with previously diagnosed idiopathic scoliosis of the 1 st and 2 nd levels were the group "scoliosis", 36 persons without orthopedic and neurological disorders were the group "norm." A method of computed stabilometry was used. We obtained functional dependences that characterized the distribution of movement rate of foot pressure center on support surfaces in the frontal plane, which differed parametrically in both groups. Diagnostic feature, namely the number of movement intervals with the constant velocity of 0.02 seconds was identified, which allowed to include the subject in the scoliosis risk group. Clinical testing method was carried out in two groups of children aged 7-8 years. The first group, "scoliosis control", had 12 children with clinically confirmed diagnosis of the 1 st and 2 nd degrees idiopathic scoliosis. In the second group of "normal control" 12 children were without orthopedic and neurological disorders. The sensitivity of this method was 92%.

Getting CHO host cell protein analysis up to speed

Aim: Host cell proteins represent a major process-related impurity in recombinant biotherapeutics. Present work reports about a fully automated platform based on a cobas instrument (Roche Diagnostic GmbH, Mannheim, Germany) allowing high-throughput determination of host cell proteins. Materials & methods: The instrument combines automated sample preparation with electrochemiluminescence-based detection technology, facilitating highly sensitive and accurate detection. Results: Our data shows that the assay performs readily comparable to conventional ELISAs, but outperforms in speed, sample throughput and by its superior linear range. Comparison of ELISA and electrochemiluminescence immunoassay validation results from more than ten independent validations of clinical product testing methods supports our comparability claim. Conclusion: The electrochemiluminescence immunoassay represents a milestone for bioprocess impurity testing and abolishes the sample throughput limitations posed by conventional ELISA.

Normative Results of Healthy Older Adults on Standard Clinical Vestibular Tests

To describe the performance of healthy older adults on common clinical vestibular tests. Fifty community-dwelling older adults aged 70 and older, with mean age of 77.2 ± 6.1 years and range of 70 to 95 years. Clinical vestibular tests, including spontaneous and head-shaking nystagmus, head impulse test (HIT), bucket test of subjective visual vertical, modified Romberg test (MRT), and Dizziness Handicap Inventory (DHI). Prevalence of abnormal vestibular tests and DHI score. We observed a 36% and 44% prevalence of abnormal right and left horizontal HIT, respectively. The bucket test was abnormal in 18% of participants; head-shaking nystagmus was present in 2%, and no participant had spontaneous nystagmus. Approximately 68% of participants had abnormal MRT. Abnormal horizontal HIT and MRT were significantly more prevalent among individuals age 80 years and older compared with those age 70 to 79 years (p < 0.05). Mean DHI score was 5.6 ± 11.2, consistent with no self-reported dizziness handicap. This study documents the expected performance of normative older adults on vestibular tests commonly administered in the neurotology clinic. We observed a high prevalence of abnormalities on clinical vestibular testing in healthy older adults, although self-perceived dizziness handicap was low. Further studies using newly available clinical testing methods (e.g., video HIT) may identify finer gradations of vestibular function in older individuals and the levels of vestibular loss associated with functional impairment.

QEEG and 19-Channel Neurofeedback as a Clinical Evaluation Tool for Children with Attention, Learning and Emotional Problems

Attention, learning and emotional problems can have different causes that cannot be easily and clearly distinguished by clinical testing methods. But, QEEG and, even more so, live 19-channel Z-score training under different task conditions can both give very detailed insights about the specific functioning and dysregulations of an individual’s brain. The clinical intake evaluation of the child is optimized by including a quantitative, neurometric analysis of an eyes open (EO) and eyes closed (EC) EEG acquisition combined with a real-time analysis of the child’s (in vivo) brain functioning during a specific set of conditions, as described below. This method was developed and refined with more than 300 children who were tested between June 2012 and April 2014. The goal is to get as much information as possible in only one session lasting 45 to 60 minutes. The different parts of the evaluation consist of: eyes open (EO) and eyes closed (EC) collection of data, display of the actual brain waves, listing of the Z-score values (also presented as plots or instant brain maps with different task conditions), followed by games to play with a challenge condition. In addition, current source density (CSD) sLORETA of the different wave frequencies (usually delta, theta, alpha, beta, and gamma bands), distribution and velocity are shown as they change, as well as when the brain evaluates emotions. The session ends with a brief, individual 19-channel training with video feedback. Because of the usefulness of the information obtained from using this QEEG method, the author recommends that QEEG and an interactive neurofeedback session be included as a standard component in the diagnosis of and treatment planning for children with attention, learning and emotional problems.

Noninvasive Prenatal Methylomic Analysis by Genomewide Bisulfite Sequencing of Maternal Plasma DNA

Epigenetic mechanisms play an important role in prenatal development, but fetal tissues are not readily accessible. Fetal DNA molecules are present in maternal plasma and can be analyzed noninvasively. We applied genomewide bisulfite sequencing via 2 approaches to analyze the methylation profile of maternal plasma DNA at single-nucleotide resolution. The first approach used maternal blood samples and polymorphic differences between the mother and fetus to analyze the fetal methylome across the genome. The second approach used the methylation profile of maternal blood cells and the fractional fetal DNA concentration in maternal plasma to deduce the placental methylomic profile from maternal plasma DNA-sequencing data. Because of the noninvasive nature of these approaches, we were able to serially assess the methylation profiles of fetal, placental, and maternal plasma with maternal blood samples collected in the first and third trimesters and after delivery. Gestation-related changes were observed. The fetal methylation profile deduced from maternal plasma data resembled that of the placental methylome, both on a genomewide level and per CpG site. Imprinted genes and differentially methylated regions were identified from the maternal plasma data. We demonstrated one potential clinical application of maternal plasma bisulfite sequencing with the successful detection of fetal trisomy 21. We successfully analyzed fetal and placental methylomes on a genomewide scale, noninvasively and serially. This development offers a powerful method for research, biomarker discovery, and clinical testing for pregnancy-related disorders.

Effectiveness testing of non-lethal weapons

Non-lethal weapons (NLWs) provide the warfighter with tools to effectively wage full spectrum operations, particularly in counterinsurgency, stability and support, and peace operations. However, it is widely recognized that evaluation of a NLW’s performance and effectiveness is problematic. The principal difficulty is that a NLW must be evaluated as both a non-lethal device (based on clinical testing methods of life science) and as a weapon (based on US Department of Defense (DoD) evaluation and testing methods of engineering and physics). This paper argues that live-virtual-constructive (LVC) methods constitute a critical component of a comprehensive research program on NLW effectiveness. In support of this contention, the article has three parts. Section 2 reviews briefly NLW effectiveness testing. This section will then present general LVC methods and the advantages they have over typical methods of evaluating NLW effects. Following this introduction, and in line with the intent of the special issue, an overview will be given on LVC methods as employed in NLW testing by the US Army’s Target Behavioral Response Laboratory (TBRL). Since its inception in 2004, the TBRL at Picatinny Arsenal has conducted comprehensive LVC studies on NLW effectiveness. These experiments examine NLW effectiveness against intended targets under controlled laboratory experimentation. A third component presents empirical quantitative results from LVC experimentation with NLW effectiveness in a crowd scenario. The article concludes with a brief summary of the use and particular benefits of LVC methods on NLW effectiveness testing.

Necessity of Magnetic Resonance Imaging (MRI) using an appropriate sequence for diagnosis of trigeminal neuralgia associated with intracranial tumor

Aims: Trigeminal neuralgia is generally caused by neurovascular compression. In rare cases intracranial tumors may also lead to this condition. The present study was conducted to identify clinical symptoms and testing methods that are useful for early detection of trigeminal neuralgia associated with intracranial tumor. Methods: Five patients with trigeminal neuralgia suspected to be due to intracranial tumor, who visited our department for the first time during the period between February 2007 and March 2009, were examined. We analyzed the medical records and MRI findings of these patients. The clinical symptoms of subjects were compared to those presented at the International Classification of Headache Disorders. Results: There were no feature symptoms to trigeminal neuralgia caused by intracranial tumors compared with trigeminal neuralgia in general. None of the patients complained of spontaneous headache and nausea, which are clinical symptoms characteristic of brain tumor. Head MRI at our hospital was the most accurate method to detect intracranial tumors. Finally four of five patients received brain surgery to remove tumors. Conclusion: Small tumors and roots of the trigeminal nerve may not create accurate images by regular head MRI. Therefore, MRI using the imaging sequence which enables accurate visualization of roots of the trigeminal nerve is essential to confirm the presence of tumors in patients with suspected trigeminal neuralgia.

Discrimination of type 2 diabetes mellitus corresponding to different traditional Chinese medicine syndromes based on plasma fatty acid profiles and chemometric methods

Aims of the studyTraditional Chinese medicine (TCM) has a long history and particular advantages in the diagnosis and treatment of type 2 diabetes mellitus (T2DM). Syndrome differentiation is the foundation and essence of TCM theories. The aims of the study are to discriminate T2DM corresponding to different syndromes (Qi-deficiency, Qi and Yin-deficiency and Damp heat) and discover syndrome-related biomarkers using metabolomics technology. Materials and methodsPlasma fatty acid profiles of 85 clinical samples were established by high performance liquid chromatography (HPLC). Moreover, some of the lipid parameters, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL), were obtained through clinical testing methods. Orthogonal signal correction-partial least squares (OSC-PLS) and uncorrelated linear discriminant analysis (ULDA) were employed to establish two-class models for three different syndromes. ResultsCompared with the plasma fatty acid profiles of healthy controls, the characteristic fatty acids of three TCM syndromes were discovered (p<0.01). Totally, the plasma fatty acids of T2DM were up-regulated, while significant differences existed in different syndromes. Results of ULDA indicate that the three TCM syndromes could be effectively separated by the plasma fatty acid profiles and the syndrome-related biomarkers were also screened. ConclusionsThe fact that three TCM syndromes can be separated indicates certain metabolic differences in different TCM syndromes of T2DM really exist and such differences can be manifested by fatty acids and lipid parameters. The results benefit modern biological interpretation of the three TCM syndromes and in a sense the diagnosis and treatment of diabetes.