Comprehensive Clinical Diagnosis Research Articles

INTEGRIN BETA2 GENE VARIANT CAUSING LEUKOCYTE ADHESION DEFICIENCY TYPE 1 IN A PAKISTANI FAMILY

Background: Leukocyte adhesion deficiency type 1 (LAD1), an autosomal recessive condition, arises from partial or complete deficiency of CD18 expression. LAD1 patients commonly manifest recurrent skin and respiratory tract infections, delayed umbilical cord separation, and impaired wound healing due to hindered leukocyte migration. This study aims to clinically and molecularly diagnose LAD in a highly consanguineous Pakistani family, investigating a recurrent mutation within the integrin ?2 (ITGB2) gene. Methods: A comprehensive clinical and molecular diagnosis of LAD1 was made in on a patient from a consanguineous Pakistani family. Lymphocyte subset analysis was performed using a flow cytometer, followed by whole exome sequencing and DNA Sanger sequencing to identify the pathogenic mutation within the ITGB2 gene. Further to provide genetic counselling all the healthy siblings were also Sanger sequenced. Results: Flow cytometry indicated CD18 deficiency, while sequencing of the ITGB2 gene unveiled a nonsense mutation, c.186C>A, p. (Cys62*), located in exon four. This mutation segregates in an autosomal recessive pattern within the family. Conclusion: A mutation c.186C>A (Cys62*) in a patient of LAD1 was identified which is potentially pathogenic in nature. Pak J Physiol 2024;20(1):15-8

Understanding the scope of Homoeopathy along with a multidisciplinary integrated approach for holistic management of epilepsy with co-morbidity in children: Case studies

Epilepsy is a complex neurological disorder that affects the patient’s mental and physical development as well as their functioning, especially in children. It also presents with mental and/or physical co-morbidities/disabilities. This manuscript describes the importance of an individualised multidisciplinary integrated approach, including homoeopathy, for the holistic management of epileptic children through two illustrative cases. The team included homoeopaths, paediatricians, paediatric neurologists, physiotherapists, and psychologists in both cases. We aimed to demonstrate the scope of the homoeopathic individualised approach for managing epilepsy and its role in improving the quality of life of patients and caretakers. Both cases involved detailed case-taking, including homoeopathic and clinical perspectives. A multidisciplinary integrated approach enabled a comprehensive clinical diagnosis. An individualised approach was used to form a totality and perform repertorisation to select the most appropriate remedy and potency. Follow-up criteria enabled us to measure the progress. The homoeopathic individualised approach resulted in considerable relief in seizures and a reduction in allopathic medication available only in 1st case. and relief in seizures in both the cases. The functioning of the patient and their quality of life improved considerably in both cases as well. Homoeopathic individualised approach, along with the integrated system, helps in the relief/cure of epileptic episodes, enables a reduction in the use of antiepileptic drugs, and improves associated co-morbidities. Through this approach, holistic care is possible and improves the quality of life of the child and the parents.

Automated classification of multiple ophthalmic diseases using ultrasound images by deep learning

BackgroundUltrasound imaging is suitable for detecting and diagnosing ophthalmic abnormalities. However, a shortage of experienced sonographers and ophthalmologists remains a problem. This study aims to develop a multibranch transformer network...

Transparent Electronics for Wearable Electronics Application.

Recent advancements in wearable electronics offer seamless integration with the human body for extracting various biophysical and biochemical information for real-time health monitoring, clinical diagnostics, and augmented reality. Enormous efforts have been dedicated to imparting stretchability/flexibility and softness to electronic devices through materials science and structural modifications that enable stable and comfortable integration of these devices with the curvilinear and soft human body. However, the optical properties of these devices are still in the early stages of consideration. By incorporating transparency, visual information from interfacing biological systems can be preserved and utilized for comprehensive clinical diagnosis with image analysis techniques. Additionally, transparency provides optical imperceptibility, alleviating reluctance to wear the device on exposed skin. This review discusses the recent advancement of transparent wearable electronics in a comprehensive way that includes materials, processing, devices, and applications. Materials for transparent wearable electronics are discussed regarding their characteristics, synthesis, and engineering strategies for property enhancements. We also examine bridging techniques for stable integration with the soft human body. Building blocks for wearable electronic systems, including sensors, energy devices, actuators, and displays, are discussed with their mechanisms and performances. Lastly, we summarize the potential applications and conclude with the remaining challenges and prospects.

Potential predictors of severe course and outcome of community-acquired pneumonia

Severe pneumonia is a condition with a high risk of death and mandatory hospitalization in the intensive care unit. The incidence of severe pneumonia has increased dramatically during the pandemic of new coronavirus infection. Timely diagnosis and early initiation of adequate treatment of severe pneumonia are crucial for improving survival of critically ill patients.The aim of this review was to analyze published scientific research on molecular markers that allow to objectively assess the severity of pneumonia and to determine treatment tactics based on the predicted outcome upon admission to the hospital. A systematic search was conducted in the electronic databases PubMed, Medline, Web of Science for the period 2019 - 2022.Conclusion. The review focuses on the prognostic role of a number of markers of immune response, vascular transformation, as well as angiotensin II and angiotensin converting enzyme-2. Further prospective studies of potential predictors of severe pneumonia will enable using marker molecules in a comprehensive clinical and laboratory diagnosis for early prediction of the hospitalized patient’s condition and expected outcome.

Clinical Efficacy and Diagnostic Value of Metagenomic Next-Generation Sequencing for Pathogen Detection in Patients with Suspected Infectious Diseases: A Retrospective Study from a Large Tertiary Hospital.

Metagenomic next-generation sequencing (mNGS) is a powerful yet unbiased method to identify pathogens in suspected infections. However, little is known about its clinical effectiveness. The present study aimed to assess the efficacy of mNGS in routine clinical practice. In this single-center retrospective cohort study, 518 patients with suspected infectious diseases were assessed for inclusion. Among them, each patient had undergone mNGS testing; 407 patients had undergone both microbial culture and mNGS testing. The result of mNGS testing was compared to microbial culture performed concurrently. The diagnostic performance of mNGS was evaluated using the comprehensive clinical diagnosis as the reference standard. There was a significant difference in the positive detection rates of pathogens between mNGS and culture (331/407, 81.3% vs 79/407, 19.4%, P < 0.001). The sensitivity of mNGS was much higher than the culture method (79.5% vs 21.3%, P < 0.001), especially in sample types of sputum and bronchoalveolar lavage fluid (BALF). Notably, the sensitivity of blood mNGS was relatively lower than other sample types (67.4% vs 88.9-93.8%). Pathogen cfDNA load based on standardized stringently mapped read number at the species level of microorganisms (SDSMRN) was significantly lower in blood than in other sample types from the same patient (P = 0.0003). Importantly, mNGS directly led to a change of treatment regimen in 142 (27.4%) cases, including antibiotic escalation (15.3%), antibiotic de-escalation (9.1%), and early definitive diagnosis to initiate appropriate treatment (3.1%). Our in-house mNGS platform significantly improved the sensitivity for the diagnosis of infectious diseases. mNGS has the potential to improve clinical outcomes by optimizing antimicrobial therapy.

Risk Prediction Model for Crohn's Disease Based on Hematological Indicators.

The similarity between Crohn's disease (CD) and non-CD, especially with ulcerative colitis (UC) or intestinal tuberculosis (ITB), makes the diagnostic error rate not low. Therefore, there is an urgent need for an efficient, fast, and simple predictive model that can be applied in clinical practice. The purpose of this study is to establish the risk prediction model for CD based on five routine laboratory tests by logistic-regression algorithm, to construct the early warning model for CD and the corresponding visual nomograph, and to provide an accurate and convenient reference for the risk determination and differential diagnosis of CD, in order to assist clinicians to better manage CD and reduce patient suffering. Using a retrospective analysis, a total of 310 cases were collected from 2020 to 2022 at The Sixth Affiliated Hospital, Sun Yat-sen University, who were diagnosed by comprehensive clinical diagnosis, including 100 patients with CD, 50 patients with ulcerative colitis (UC), 110 patients with non-inflammatory bowel disease (non-IBD) diseases (65 cases of intestinal tuberculosis, radioactive enterocolitis 39, and colonic diverticulitis 6), and 50 healthy individuals (NC) in the non-CD group. Risk prediction models were established by measuring ESR, Hb, WBC, ALb, and CH levels in hematology. The models were evaluated and visualized using logistic-regression algorithm. 1) ESR, WBC, and WBC/CH ratios in the CD group were higher than those in the non-CD group, while ALb, Hb, CH, WBC/ESR ratio, and Hb/WBC ratio were lower than those in the non-CD group, and the differences were statistically significant (all p < 0.05). 2) CD occurrence had a strong correlation with the WBC/CH ratio, with the correlation coefficient exceeding 0.4; CD occurrence was correlated with other indicators. 3) A risk prediction model containing age, gender, ESR, ALb, Hb, CH, WBC, WBC/CH, WBC/ESR, and Hb/WBC characteristics was constructed using a logistic-regression algorithm. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of the model were 83.0%, 76.2%, 59.0%, 90.5%, and 0.86, respectively. The model based on the corresponding index also had high diagnostic accuracy (AUC = 0.88) for differentiating CD from ITB. Visual nomograph based on the logistic-regression algorithm was also constructed for clinical application reference. In this study, a CD risk prediction model was established and visualized by five conventional hema-tological indices: ESR, Hb, WBC, ALb, and CH, in addition to a high diagnostic accuracy for the differential diagnosis of CD and ITB.

DNA image cytometry ploidy analysis technique improves the detection rate of pleural effusion cytology.

To explore the clinical diagnostic value of DNA image cytometry (DNA-ICM) ploidy analysis in malignant pleural effusion cancer screening, this study analyzed the effect of exfoliated cell smears (ECSs), cell blocks (CBs), and immunochemistry. A total of 830 cases of pleural effusion were considered for the DNA-ICM ploidy analysis. The ECSs were centrifuged, the CBs were formed, and the DNA-ICM ploidy analysis was carried out in the diagnosis of malignant pleural effusion. Immunochemistry and biopsy was applied to differentiate between benign and malignant pleural effusion and to determine the source of the latter. The sensitivity and specificity differences between the three methods alone and in combination were compared. The sensitivity of the DNA-ICM, ECS, and CB methods was 96.28%, 94.93%, and 95.95%, respectively, and the specificity of each method was 86.52%, 87.08%, and 86.14%, respectively. The sensitivity and specificity of the combined diagnosis method were 99.32% and 75.09%, respectively. Among the 22 cases diagnosed as positive in the DNA-ICM ploidy analysis but negative in the ECS and CB analyses, four cases were diagnosed as positive by comprehensive clinical diagnosis. The sensitivity and specificity of DNA-ICM ploidy analysis are high; the positive detection rate of pleural fluid cytology is effectively increased, and the missed detection rate of cell pathologies is effectively reduced. The combination of the three methods significantly improves the specificity and sensitivity of the diagnosis of malignant pleural effusion, and immunochemistry with CBs can be used to accurately analyze the primary tumor site.

Deep learning-assisted co-registration of full-spectral autofluorescence lifetime microscopic images with H&E-stained histology images

Autofluorescence lifetime images reveal unique characteristics of endogenous fluorescence in biological samples. Comprehensive understanding and clinical diagnosis rely on co-registration with the gold standard, histology images, which is extremely challenging due to the difference of both images. Here, we show an unsupervised image-to-image translation network that significantly improves the success of the co-registration using a conventional optimisation-based regression network, applicable to autofluorescence lifetime images at different emission wavelengths. A preliminary blind comparison by experienced researchers shows the superiority of our method on co-registration. The results also indicate that the approach is applicable to various image formats, like fluorescence in-tensity images. With the registration, stitching outcomes illustrate the distinct differences of the spectral lifetime across an unstained tissue, enabling macro-level rapid visual identification of lung cancer and cellular-level characterisation of cell variants and common types. The approach could be effortlessly extended to lifetime images beyond this range and other staining technologies.

Metagenomic Next-Generation Sequencing in the Diagnosis of Infectious Fever During Myelosuppression Among Pediatric Patients with Hematological and Neoplastic Diseases.

PurposeTo analyze the contribution of metagenomic next-generation sequencing (mNGS) in the guidance of clinical treatment and outcomes of infection during myelosuppression among children with hematological and neoplastic diseases.Patients and MethodsThe clinical data and results of mNGS assay of febrile patients suspected of infection were retrospectively collected. The characteristics of pathogenic microorganisms and clinical course of myelosuppressed children with hematological diseases were summarized.ResultsOur study included 70 patients (45 males) with a median age of 5 years (range: 0.5 to 13 y). During the study period, there were 96 events of suspected infection. According to comprehensive clinical diagnosis, 73 blood infections, 43 pneumonia and 2 urinary tract infections occurred. The positive rate of mNGS was significantly higher than that of traditional microbial detection (83.3% vs 17.7%). The main pathogens detected by mNGS were Pseudomonas aeruginosa, Acinetobacter, human herpesvirus, Candida and Aspergillus. The average duration of fever was 4.9 days and 11.6 days (P < 0.05), and the average cost of anti-infection treatment was RMB ¥28,077 and 39,898 (P < 0.05) among children received mNGS within 48 hours and more than 48 hours after the onset of infection symptoms.ConclusionmNGS contributes to clinical management of children with infection during myelosuppression, especially among patients with negative traditional microbial detection. Early implementation of mNGS in children with symptoms has a tendency to reduce the time of infection, fever and the cost of treatment.

Sequence of actions for visualization of soft tissue hemorrhages/hematomas in elderly patients infected with SARS-CoV-2

Aim. To determine ultrasound, computed tomography and angiographic image characteristics for soft tissue hemorrhages/hematomas, the sequence of using imaging methods in patients infected with SARS-CoV-2, to study the morphology of changes in soft tissues, to determine the essence of the concept and to develop treatment tactics for this complication of COVID-19.Material and methods. During 4 months of treatment of elderly patients (+60) infected with SARS-CoV-2, 40 patients were identified with soft tissue hemorrhages/hematomas, of which 26 (65%) patients with large hematomas (&gt;10 cm in size and &gt; 1000 ml in volume). The analysis of clinical and laboratory parameters, methods of instrumental diagnostics (ultrasound – 26 patients, CT – 10 patients, angiography – 9 patients, punctures – 6 patients) was carried out; autopsy material was studied in 11 cases.Results. Image characteristics of hemorrhages/hematomas of soft tissue density were obtained using modern instrumental methods, and the sequence of application of visualization methods was determined. A tactic for managing a patient with stopped and ongoing bleeding has been developed. The morphological substrate of hemorrhagic complications in a new viral infection was studied. All patients were treated with conservative and minimally invasive procedures (embolization, puncture with pressure bandage). 15 patients (57.7%) recovered, 11 patients (42.3%) died from the progression of COVID-19 complications.Conclusion. Comprehensive clinical and laboratory sequential instrumental diagnosis of soft tissue hemorrhages in COVID-19. Treatment should be conservative and significantly invasive. The use of the term “soft tissue hematoma” in SARS-CoV-2 infected patients is not a natural quality of the normal pathological process and should not be observed from our point of view.

Ossifying fibrous epulis as an IgG4-related disease of the oral cavity: a case report and literature review

BackgroundFibrous sclerosing tumours and hypertrophic lesions in IgG4-related disease (IgG4-RD) are formed in various organs throughout the body, but disease in the oral region is not included among individual organ manifestations. We report a case of ossifying fibrous epulis that developed from the gingiva, as an instance of IgG4-RD.Case presentationA 60-year-old Japanese man visited the Department of Oral and Maxillofacial Surgery, Gunma University Hospital, with a chief complaint of swelling of the left mandibular gingiva. A 65 mm × 45 mm pedunculated tumour was observed. The bilateral submandibular lymph nodes were enlarged. The intraoperative pathological diagnosis of the enlarged cervical lymph nodes was inflammation. Based on this diagnosis, surgical excision was limited to the intraoral tumour, which was subsequently pathologically diagnosed as ossifying fibrous epulis. Histopathologically, the ossifying fibrous epulis exhibited increased levels of fibroblasts and collagen fibres, as well as infiltration by numerous plasma cells. The IgG4/IgG cell ratio was > 40%. Serologic analysis revealed hyper-IgG4-emia (> 135 mg/dL). The patient met the comprehensive clinical diagnosis criteria and the American College of Rheumatology and European League Against Rheumatism classification criteria for IgG4-RD. Based on these criteria, we diagnosed the ossifying fibrous epulis in our patient as an IgG4-related disease. A pathological diagnosis of IgG4-related lymphadenopathy was established for the cervical lymph nodes. Concomitant clinical findings were consistent with type II IgG4-related lymphadenopathy.ConclusionsA routine serological test may be needed in cases with marked fibrous changes (such as epulis) in the oral cavity and plasma cells, accompanied by tumour formation, to determine the possibility of individual-organ manifestations of IgG4-related disease.

Characteristics of magnetic resonance imaging and clinical etiology of ovarian infertility

Objective: To analyze the characteristics of magnetic resonance imaging (MRI) and clinical etiology of ovarian infertility. Methods: The data of infertile women who underwent 3.0T MRI and magnetic resonance hysterosalpingography (MR-HSG) examination in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2017 to March 2020 were collected. The ovarian factors of infertility, as well as the abnormalities of bilateral fallopian tubes and uterus, were evaluated. Etiologies assessed by MRI were finally confirmed by hysteroscopy, laparoscopy, surgery, or a comprehensive clinical diagnosis. Results: Among 1 351 patients, 1 296 cases were eligible and included for further analysis. Evaluated by MRI and MR-HSG, 494(38.12%) cases had ovarian abnormalities, including 239(48.38%) cases of ovarian endometriosiss, 116(23.48%) cases of polycystic ovary syndrome (PCOS), 37(7.49%) cases of diminished ovarian reserve (DOR), 33(6.68%) cases of ovarian mass, 28(5.67%) cases of ovarian injury, and 41(8.30%) cases who had at least two kinds of ovarian diseases. Unilateral and bilateral ovarian abnormalities accounted for 52.02% (257/494) and 47.98%(237/494), respectively.In total, 453 of 494(91.7%) patients had only one kind of ovarian disease. Among the 494 patients, 103(20.85%) cases had abnormal ovary with normal uterus and fallopian tubes, and the other 391(79.15%) cases had abnormalities not only in ovary, but in fallopian tube and/or uterus. Conclusion: Infertility-related ovarian diseases have certain characteristics of MRI findings. 3.0T MRI is useful for comprehensive analysis of etiology in ovarian infertility. Combined with MR-HSG, it provides one-stop assessments of the pelvic factors in female infertility.

Frequencies and Neuropsychological Characteristics of Errors in the Clock Drawing Test.

Few studies have investigated associations between types of clock drawing test (CDT) errors and cognitive impairment. To explore associations of qualitative errors in the CDT with comprehensive neurocognitive assessment scores and clinical diagnosis. Outpatients at a memory clinic were enrolled. Frequencies of errors determined by Cahn's method were explored according to cognitive status (cognitively normal [CN] (n = 279), mild cognitive impairment [MCI] (n = 321), and Alzheimer's disease [AD]) (n = 575). Neuropsychological assessment scores were compared between participants with and without errors. Stimulus-bound response (SB) was relatively rare (6.8%) in the CN group but was markedly more common in the MCI (23.4%) and AD (33.2%) groups. Conceptual deficit (CD) was found in more than 20%of CN individuals, as well as about 50%of AD patients. Planning deficit (PD) frequencies were relatively similar among the groups. SB in both of CN and MCI individuals, and CD in both of CN and MCI individuals were associated with lower scores in several neuropsychological assessments. Meanwhile, PD was not associated with lower assessment scores in any of CN, MCI, or AD individuals. The frequencies of SB and CD increased from CN, MCI, to AD but showed somewhat different patterns. Both SB and CD were associated with lower cognition in all three cognitive stages.

Massive Open Online Courses Combined with Flipped Classroom: An Approach to Promote Training of Resident Physicians in Rheumatology.

BackgroundThis study aims to evaluate the feasibility, acceptability, and effectiveness of massive open online courses (MOOCs) in combination with flipped classroom teaching in the standard training of resident physicians (resident physician trainees).MethodsA total of 110 resident physician trainees enrolled in 2018, with a major in Internal Medicine, were selected and divided into a control group (n = 55) who experienced traditional teaching methods and an experimental group (n = 55) who experienced MOOCs plus flipped classroom teaching. Their post-class test scores and satisfaction questionnaires were compared.ResultsThe test scores (80.60 ± 7.65) of resident physician trainees in the experimental group were higher than those of the control group (77.05 ± 8.08), and the difference was statistically significant (P < 0.05). The experimental group trainees were highly satisfied with the MOOC + flipped classroom program.ConclusionMOOCs in combination with flipped classroom teaching can increase the effectiveness of teaching in the standard training for resident physicians and trainees’ comprehensive clinical diagnosis and treatment ability.

Guidelines and standards for comprehensive clinical diagnosis and interventional treatment for diabetic foot in China (Issue 7.0)

Diabetic foot (DF) is one of the most common complications of diabetes and is associated with high morbidity, disability, lethality and low cure-rate. The clinical diagnosis and treatment of DF need to be standardized. The Chinese Diabetic Foot Cell and Interventional Therapy Technology Alliance has released six editions of guidelines and standards for clinical diagnosis and interventional treatment of DF, which filled the gap in the domestic DF treatment standard and played an important role in improving the level of diagnosis and treatment in China. In line with the latest developments in diagnosis and treatment, the Alliance, along with other 89 institutions, developed and issued the new edition based on the sixth edition to help standardize the clinical diagnosis and treatment of DF in China.

Comprehensive clinical and biochemical diagnosis of hypomicroelementosis in the saaneni white german improved goats acclimatized in biogeochemical conditions of the Astrakhan Region

The study of trace elements in recent years has reached a new comprehensive clinical and biochemical level of diagnosis of the latent form of hypomicroelementoses. About this in the literature, there are serious studies performed on various productive animals, including farm birds. Of particular importance are these data when transporting animals from one biogeochemical region to another, and their acclimatization. The work shows the data from a study of a large complex of physiological and biochemical blood parameters in Zaanen white German improved goats imported to the Astrakhan region from the “reference” chernozem region (Krasnodar Territory), where, due to the optimal level of trace elements in the main components of terrestrial ecosystems (soil, water, various types of plants and plant foods) endemic pathologies are not observed, including hypomicroelementoses. The studied clinical parameters (body temperature, pulse rate, the number of respiratory movements per minute) in Saanen white German improved goats acclimatizing in the Astrakhan region were determined by generally accepted methods and they were within the range of normative and published data. The content of trace elements in biological samples was determined by the atomic absorption method. The main changes were revealed during the biochemical analysis of the blood of the studied goats, which indicate the presence in the Saanen white German improved goats of a latent (asymptomatic) form of the combined (Se, I, Co) hypomicroelementosis, which was accompanied by a decrease in the integrative functions of milk productivity and reproduction of the studied ruminants.

A multidisciplinary approach to urinary system iatrogenic injuries.

IntroductionUrinary system iatrogenic injuries appear because of urological, obstetric-gynecological, and surgical manipulations in the retroperitoneal space, pelvis, or perineum. The purpose of this research was to analyze and obtain knowledge about the issue of iatrogenic injuries, to apply injury prevention algorithms, and to assess multidisciplinary perspectives in modern surgery.Material and methodsThe research was interdisciplinary and consisted of several modules: a prospective, single-centre study of urinary system iatrogenic injuries (476 patients) along with four interregional and international procedural types of research.ResultsThe analysis results indicate an extremely high significance of urinary system injuries evoking numerous negative consequences that are hard to eliminate. A comparative assessment of interdisciplinary interaction demonstrates the more effective interpretation of examination results, more comprehensive and credible clinical diagnosis, more qualitative evaluation of a patient’s condition, more effective choice of initial treatment policy, and more satisfactory treatment in patients’ opinion. The research allowed for the identification of a typical procedural mistake in the urethral catheter setting causing a high risk of urethra injuries followed by urethra strictures or consecutive infections of the urinary tract.ConclusionsMore complicated treatment procedures cause a higher probability of urinary system iatrogenic injuries. The absence of unified algorithms and typical procedural mistakes cause such incidents. A partial solution to this issue could be found in a more profound interdisciplinary interaction in all treatment phases as well as in identifying and eliminating procedural mistakes.

3D vertical-flow paper-based device for simultaneous detection of multiple cancer biomarkers by fluorescent immunoassay

A novel three-dimensional (3D) vertical-flow paper-based device (3VPD), integrated with a sandwich-type fluorescent immunoassay, was developed for multiplexed detection of cancer biomarkers simultaneously based on the principle of origami. The developed 3VPD, composed of a sample layer, a splitting layer, and a test layer, could be fabricated simply by wax-printing on paper at a large scale. Herein, a vertical-flow immunoassay was introduced into the device, in which fluorescein isothiocyanate labeled antibodies were coated on the splitting layer and mouse monoclonal capture antibodies were functionalized on the test layer. The proposed 3VPD showed high sensitivity and selectivity for detecting three cancer biomarkers, carcinoembryonic antigen (CEA), a-fetoprotein (AFP), and cancer antigen 199 (CA199) with detection limits of 0.03 ng/mL, 0.05 ng/mL, and 0.09 U/mL in human serum, respectively. The results obtained in human serum were compatible with the reference values which were acquired from parallel single-analyte. The developed 3VPD provides a new strategy to develop an inexpensive and sensitive approach for simultaneous detection of multiple analytes and comprehensive clinical diagnosis by a single test.

Research Progress of Different Acupuncture and Moxibustion Methods in the Treatment of GERD (Gastro Esophageal Reflux Disease)

Over the past decade, there have been many clinical reports on acupuncture and moxibustion in the treatment of gastro esophageal reflux disease, which has been an increasing trend year by year. The authors use "acupuncture", "acupuncture and moxibustion" or "electric acupuncture" and "GERD" or "gastro esophageal reflux disease" as key words for retrieval. Through the clinical articles on acupuncture and moxibustion methods in the treatment of GERD indexed by China CNKI academic literature database, VPCS database and Wanfang database from 2006 to 2016, we find that: acupuncture and moxibustion methods in the treatment of GERD has definite curative effect and outstanding advantages. It can better improve the symptoms of patients and can effectively improve their quality of life. At present, in clinical applications, there are treatment ideas such as the method of acupuncture on governor vessel back segment, the old ten needles, and compatibility of five meridians in the aspect of acupoint selection; there are treatment ideas such as fire acupuncture, thread-embedding, and electric acupuncture in the aspect of method of needling and moxibustion; there are treatment ideas such as acupuncture and moxibustion combined with pinellia ternate Xiexin Decoction, Chinese herb bath, deanxit (flupentixol and melitracen tablets) in the aspect of acupuncture and medicinal treatment. This paper comb integration of the current variety of therapies, in order to allow readers to obtain a more comprehensive clinical diagnosis and treatment ideas of gastro esophageal reflux disease.