Diagnostic Basis Research Articles

Assessment of magnetic resonance imaging and histopathological changes in chordoid glioma: A retrospective analysis of 13 cases

AbstractChordoid glioma (CG) is a rare tumor, and its predominantly anterior location is in the third ventricle. However, the clinical characteristics of CG were not obvious, and there was less knowledge of CG‐related imaging. This study aimed at exploring the MRI imaging features of CG. We retrospectively analyzed the MRI data of 13 patients diagnosed with CG from January 2015 to May 2021. The pathological change of tumor tissue was observed using H&E staining and immunohistochemical. The MRI manifestations of CG often include phyllode masses in the anterior part of the third ventricle. T2WI is dominated by iso‐ and hypointensity, with internal patchy hyperintensity, marked enhancement, and peritumoral edema. The “eight‐character edema sign” runs along the optic beam and may be useful for distinguishing CG from other tumors. CG has unique MRI manifestations that can serve as a diagnostic basis. Our study may help to enhance the understanding of imaging about CG and improve the diagnosis of patients with CG.

Immunoproteomics enable broad identification of new Aspergillus fumigatus antigens in severe equine asthma.

Severe equine asthma (SEA) is a common chronic disease of adult horses with characteristic recurrent airway obstruction and similarities to neutrophilic asthma in humans. As an extrinsic stimulus, hay dust exposure is a major risk factor and induces acute exacerbation in susceptible horses. However, single inducing agents of SEA have hardly been identified on a molecular basis. Aspergillus fumigatus (A. fumigatus) is a common mold species in hay and has been described as a major provoking agent of SEA. Aiming to identify disease-relevant antigens, we analyzed A. fumigatus using an immunoproteomics approach on two-dimensional immunoblots of A.fumigatus protein probed with serum from environmentally matched asthmatic and healthy horses (n=5 pairs). A. fumigatus binding serum immunoglobulins (Pan-Ig), and the isotypes IgG4/7 and IgG3/5 were quantified for each protein spot and then compared between asthmatic and healthy horses. For 21 out of 289 spots serum immunoglobulin (Ig) binding was different between the two groups for Pan-Ig or the isotypes. If differences were detected, Pan-Ig and IgG4/7 binding to the proteins were lower, while IgG3/5 binding was higher in asthmatic than healthy horse sera. Proteins were extracted from the 21 spots of interest and analyzed by liquid chromatography mass spectrometry. Eight prioritized proteins (candidate antigens) were expressed as recombinant proteins. Some of these have been previously described as major or minor A. fumigatus allergens, alongside other proteins, most with hydrolase activity. Recombinant candidate antigens were tested on 1D immunoblots to confirm their relevance as antigens by serum antibody binding. Four proteins (beta-hexosaminidase, class II aldolase/adducin domain protein, glucoamylase, peptide hydrolase B0XX53) showed different antibody binding characteristics between asthmatic and healthy horses and are likely relevant antigens in SEA. Their identification can provide the basis for innovative diagnostics, prevention, or therapeutic approaches. Additionally, a more profound understanding of SEA and its potential underlying mechanisms can be established. Elevated serum IgG3/5 antibodies correlate with T helper cell 2 responses in other equine pathologies, and the recombinant SEA antigens developed here can become instrumental in analyzing the involvement of SEA-specific T cell responses and Ig responses in future studies.

Balanced transformer: efficient classification of glioblastoma and primary central nervous system lymphoma

Objective. Primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) are malignant primary brain tumors with different biological characteristics. Great differences exist between the treatment strategies of PCNSL and GBM. Thus, accurately distinguishing between PCNSL and GBM before surgery is very important for guiding neurosurgery. At present, the spinal fluid of patients is commonly extracted to find tumor markers for diagnosis. However, this method not only causes secondary injury to patients, but also easily delays treatment. Although diagnosis using radiology images is non-invasive, the morphological features and texture features of the two in magnetic resonance imaging (MRI) are quite similar, making distinction with human eyes and image diagnosis very difficult. In order to solve the problem of insufficient number of samples and sample imbalance, we used data augmentation and balanced sample sampling methods. Conventional Transformer networks use patch segmentation operations to divide images into small patches, but the lack of communication between patches leads to unbalanced data layers. Approach. To address this problem, we propose a balanced patch embedding approach that extracts high-level semantic information by reducing the feature dimensionality and maintaining the geometric variation invariance of the features. This approach balances the interactions between the information and improves the representativeness of the data. To further address the imbalance problem, the balanced patch partition method is proposed to increase the receptive field by sampling the four corners of the sliding window and introducing a linear encoding component without increasing the computational effort, and designed a new balanced loss function. Main results. Benefiting from the overall balance design, we conducted an experiment using Balanced Transformer and obtained an accuracy of 99.89%, sensitivity of 99.74%, specificity of 99.73% and AUC of 99.19%, which is far higher than the previous results (accuracy of 89.6% ∼ 96.8%, sensitivity of 74.3% ∼ 91.3%, specificity of 88.9% ∼ 96.02% and AUC of 87.8% ∼ 94.9%). Significance. This study can accurately distinguish PCNSL and GBM before surgery. Because GBM is a common type of malignant tumor, the 1% improvement in accuracy has saved many patients and reduced treatment times considerably. Thus, it can provide doctors with a good basis for auxiliary diagnosis.

Imaging in pediatric traumatology and orthopedics

Conventional or digital radiography is still the basis of imaging diagnostics of the skeletal system in pediatric patients. It is considered the gold standard for diagnosis, treatment selection, and follow-up. In addition, procedures such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and also nuclear medicine techniques can and should be used. It is advantageous to use trained radiology technicians who are familiar with the handling of children in X‑ray diagnostics. If there is no dedicated pediatric radiology department, it is recommended to follow the guidelines from radiology societies (as low as reasonably achievable [ALARA]) and radiation protection commissions. The present article describes how state-of-the-art tools such as dose monitoring systems and software-controlled image processing and also postprocessing can be used. The article provides information on how the various modalities can be optimally used in order to achieve the best result, i.e., diagnosis, with the least possible effort and burden for the child.

Right ventricular-pulmonary arterial coupling ratio derived from 3-dimensional echocardiography predicts outcomes in systemic lupus erythematosus-associated pulmonary arterial hypertension patients.

Systemic lupus erythematosus (SLE) is a complex autoimmune connective tissue disease (CTD) that is an important cause of devastating pulmonary arterial hypertension (PAH), and persistent progression of PAH can lead to right heart failure, predicting a poor prognosis for SLE patients. Right ventricular-pulmonary arterial (RV-PA) coupling with echocardiography has been demonstrated to be a noninvasive alternative method for evaluating PAH patients' predictive outcomes. Whether the ratio of right ventricular stroke volume (RVSV) to right ventricular end-systolic volume (RVESV) measured by three-dimensional echocardiography (3DE) is a new index of RV-PA coupling has not been discussed as a new predictor for the clinical outcome of systemic lupus erythematosus-associated pulmonary arterial hypertension (SLE-PAH). From June 2019 to February 2023, 46 consecutive patients with SLE-PAH were enrolled prospectively, and their clinical data and echocardiographs were studied and analyzed. The control group consisted of 30 healthy subjects matched for age, sex, and body surface area (BSA). The main endpoints of this study were a composite of all-cause mortality and adverse clinical events. Baseline clinical characteristics and echocardiographic assessments were analyzed. During a median of 24months (IQR 18-31), 16 of 46 SLE-PAH patients (34.7%) experienced endpoint-related events. At baseline, patients who experienced mortality or adverse events had a worse WHO functional class (WHO FC) and lower anti-double-stranded DNA (dsDNA) antibody levels. The right ventricular (RV) systolic dysfunction in SLE-PAH subjects was significantly worse than that in the healthy control group, especially in SLE-PAH patients in the endpoint event group. Compared to controls, patients with SLE-PAH had a lower RVSV/RVESV ratio. In the group comparison, patients who had experienced an endpoint event had a sequentially worse ratio (1.86 (1.65-2.3) versus 1.30 (1.09-1.46) versus 0.64 (0.59-0.67), p < .001). There were statistically significant associations between the RVSV/RVESV ratio to routine RV systolic function and clinical parameters. The RVSV/RVESV ratio was negatively correlated with the WHO FC (r = -0.621, p < .001) and positively correlated with the anti-dsDNA level. The ROC curve showed that the optimal cutoff for RVSV/RVESV < 0.712 determined a higher risk of poor prognosis. Kaplan‒Meier survival curves showed that an RVSV/RVESV ratio >0.712 was associated with more favorable long-term outcomes. The 3DE-derived SV/ESV ratio as a noninvasive alternative surrogate of RV-PA coupling was an eximious indicator for identifying endpoint events in SLE-PAH patients and can provide a diagnostic basis for clinical intervention.

Molecular basis for non-invasive diagnostics of cardiac amyloids using bone tracers.

Amyloid diseases including Alzheimer's, Parkinson's and over 30 others are incurable life-threatening disorders caused by abnormal protein deposition as fibrils in various organs. Cardiac amyloidosis is particularly challenging to diagnose and treat. Identification of the fibril-forming protein, which in the heart is usually amyloid transthyretin (ATTR) or amyloid immunoglobulin light chain (AL), is paramount to treatment. A transformative non-invasive diagnostic modality is imaging using technetium-labeled pyrophosphate or diphosphonate bone tracers, 99mTc-PYP/DPD/HMDP. For unknown reasons, these tracers show preferential uptake by ATTR deposits. The tracer-binding moiety is unknown and potentially involves amyloid fibrils and/or amyloid-associated calcific deposits. We propose that, like in the bone, the tracers chelate to surface-bound Ca2+ in amyloid. In high-affinity protein sites, Ca2+ is coordinated by pairs of acidic residues. To identify such residues on amyloids, we harnessed atomic structures of patient-derived cardiac amyloids determined using cryogenic electron microscopy since 2019. These structures help explain why most but not all ATTR deposits uptake 99mTc-PYP/DPD/HMDP radiotracers, while in AL the opposite is true. Moreover, fibril structures help explain greater microcalcification observed in ATTR vs. AL deposits. These findings may aid the diagnostics and therapeutic targeting of cardiac amyloidosis and are relevant to other amyloids.

Pathogenetic Significance of Long Non-Coding RNAs in the Development of Thoracic and Abdominal Aortic Aneurysms.

Aortic aneurysm (AA) is a life-threatening condition with a high prevalence and risk of severe complications. The aim of this review was to summarize the data on the role of long non-coding RNAs (lncRNAs) in the development of AAs of various location. Within less than a decade of studies on the role of lncRNAs in AA, using experimental and bioinformatic approaches, scientists have obtained the data confirming the involvement of these molecules in metabolic pathways and pathogenetic mechanisms critical for the aneurysm development. Regardless of the location of pathological process (thoracic or abdominal aorta), AA was found to be associated with changes in the expression of various lncRNAs in the tissue of the affected vessels. The consistency of changes in the expression level of lncRNA, mRNA and microRNA in aortic tissues during AA development has been recordedand regulatory networks implicated in the AA pathogenesis in which lncRNAs act as competing endogenous RNAs (ceRNA networks) have been identified. It was found that the same lncRNA can be involved in different ceRNA networks and regulate different biochemical and cellular events; on the other hand, the same pathological process can be controlled by different lncRNAs. Despite some similarities in pathogenesis and overlapping of involved lncRNAs, the ceRNA networks described for abdominal and thoracic AA are different. Interactions between lncRNAs and other molecules, including those participating in epigenetic processes, have also been identified as potentially relevant to the AA pathogenesis. The expression levels of some lncRNAs were found to correlate with clinically significant aortic features and biochemical parameters. Identification of regulatory RNAs functionally significant in the aneurysm development is important for clarification of disease pathogenesis and will provide a basis for early diagnostics and development of new preventive and therapeutic drugs.

Wpływ metody inokulacji roślin kukurydzy patogenami bakteryjnymi na powstawanie i rozwój objawów chorobowych

The basis of phytopathological diagnostics are Koch’s postulates, the fulfillment of which allows determining whether the examined microorganism is the cause of a given disease. The third of these postulates specifies that inoculation of a healthy host plant with a pure culture of the putative pathogen must result in the induction of disease symptoms similar or the same to those occurring in natural con¬ditions. To meet Koch’s third postulate, a pathogenicity test result is required, and incorrect interpretation may lead to rejection of cor¬rect results. Many years of research on bacteriosis of crop plants, including corn, have shown that the symptoms of the disease resulting from inoculation with the tested strain of bacteria may vary, depending on the inoculation method used and the incubation conditions of the inoculated plants. The conducted research determined the impact of various methods of inoculating corn plants with selected strains of pathogenic bacteria isolated from diseased corn plants on the occurrence and development of disease symptoms. These strains belonged to the species Pectobacterium carotovorum subsp. carotovorum, Dickeya zeae, Pantoea ananatis, Pantoea agglomerans and Enterobacter cloaceae subsp. dissolvens. It was observed that the symptoms of the disease caused by the inoculation methods used dif¬fer from the symptoms observed in natural conditions. Moreover, regardless of the species affiliation of the tested bacterial strains, the observed symptoms were similar within a given inoculation method. Also, regardless of the species affiliation of the tested strain, incuba¬tion of inoculated plants in a culture chamber with optimal conditions for the development of the disease resulted in the acceleration of symptoms and disease development.

Генеза розвитку форензік-діагностики й аудиту діяльності суб’єкта господарювання

The aim of the article is to study the determinant of forensic and the genesis of the development of forensic diagnostics and audit of the activities of an economic entity. The article characterizes the scientific international and domestic achievements of scientists, the experience of practical activities of audit firms, as well as analyzes the key aspects of defining the determinant of forensic as a tool for counteracting internal corporate fraud of business entities. An analysis of different opinions and discussions of domestic and foreign scientists on the concept of forensic and its role in the field of accounting and auditing is presented. The statistics of intra-corporate fraud presented in the article requires a careful set of skills and tools to detect fraudulent activities by diagnosing the financial and economic activities of a business entity, as well as losses associated with this fraud, providing evidence in court and assisting the management of the business entity in regulating and preventing fraud. Forensic diagnostics is such a tool, which works effectively in synergy with audit. For the effective application of the determinant of «forensic diagnostics», it is necessary to have a clear understanding of the term in all its specifications, since this research topic is gaining significant relevance in the current realities of the development of the national economy. The importance of the study is determined by the fact that the evolution and development of the determinant of forensic diagnostics should take into account the trends and processes that occur in changes in approaches to the formation of the basis of forensic diagnostics, since it is a key point that forms the basis for ensuring the quality of the final result of the provision of forensic diagnostics services. The genesis and evolution of forensic diagnostics help to define the direction of development of its theory. The control system that is in place in the company is not always effective in the fight against fraud. At the present stage, as practice shows, the existing control systems are weak in detecting, countering and preventing fraudulent activities. Certain types of fraud only continue to develop owing to technological progress, and employees of various companies can both accidentally and quite purposefully become a catalyst for an attack against business. And although it is impossible to completely overcome fraud, it is vital to investigate, detect and prevent fraud. To build a stable and reliable system that would detect and prevent fraud, it is important to thoroughly study the genesis of forensic development. As a result of the study, an innovative direction of the dual combination of forensic diagnostics and audit of economic entities is allocated, which is aimed at identifying risks and consequences of actions with signs of deception, fraud and corruption.

Spectrophotometric method for determining the quantity and quality of DNA in animal breeding

In animal breeding, genetic methods have become the basis of breeding work and veterinary diagnostics. Therefore, their development and improvement is an actual direction of modern science. The aim of the presented work was to study the concentration and quality of nucleic acids obtained from venous blood of cattle for further genetic studies. For this purpose, a modified method of phenolchloroform extraction, adapted for DNA extraction from blood, with subsequent spectrometric determination of DNA concentration and assessment of its quality were applied. As a result of this research, it was found that the average concentration of genetic material isolated from animal blood was 146.5±14.98 ng/µl. The main part of samples – more than 93% contained concentration of nucleic acids in the range from 50 to 200 ng/µl. At the same time, the time interval between DNA extraction and its spectrometric determination of concentration and quality of genetic material by the ratio of optical density at A260/A280 wavelengths during a year did not have significant changes on its parameters. The used method of nucleic acid extraction in 94% allowed obtaining samples of good quality suitable for further genetic studies. A correlation of 43% (P&lt;0.001) was obtained between the concentration of genetic material and its quality. The coefficients of repetition of intra-laboratory studies of the results of extraction and spectrometric analysis were at the level of 97% (P&lt;0.001), which indicates that this method of obtaining nucleic acids is adapted for its use in animal husbandry. The use of this method of DNA extraction allows obtaining quality material from animals with minimal economic costs for its further use in genetic research

Initial Validation of a Behavioral Phenotyping Model for Substance Use Disorder.

Standard nosological systems, such as DSM-5 or ICD-10, are relied upon as the diagnostic basis when developing treatments for individuals with substance use disorder (SUD). Unfortunately, the vast heterogeneity of individuals within a given SUD diagnosis results in a variable treatment response and/or difficulties ascertaining the efficacy signal in clinical trials of drug development. Emerging precision medicine methods focusing on targeted treatments based on phenotypic subtypes rather than diagnosis are being explored as alternatives. The goal of the present study was to provide initial validation of emergent subtypes identified by an addiction-focused phenotyping battery. Secondary data collected as part of a feasibility study of the NIDA phenotyping battery were utilized. Participants completed self-report measures and behavioral tasks across six neurofunctional domains. Exploratory and confirmatory factor analysis (EFA/CFA) were conducted. A three-factor model consisting of negative emotionality, attention/concentration, and interoception and mindfulness, as well as a four-factor model adding a second negative emotion domain, emerged from the EFA as candidate models. The CFA of these models did not result in a good fit, possibly resulting from small sample sizes that hindered statistical power.

Clinicopathologic and trichoscopic features of keratosis follicularis spinulosa decalvans: A case series study.

Keratosis follicularis spinulosa decalvans (KFSD) is a rare X-linked hereditary disorder characterized by the triad of follicular hyperkeratosis-photophobia-alopecia. The clinical heterogeneity makes the diagnosis difficult. To investigate the clinicopathologic and trichoscopic features of KFSD and to further clarify the essential requisites for the diagnosis, we conducted a retrospective study of patients with KFSD. The clinical information, histologic features, and trichoscopic findings were evaluated. Eight patients were from seven separate families. Two females were mother and daughter from the same family and the other six patients were male and represented sporadic cases. The average age of onset of alopecia was 21.25 years. Involvement of the scalp hairs leading to progressive scarring alopecia on the midline of the scalp with variable degrees of inflammation was the pathognomonic feature. It typically began after puberty. Vellus hair-associated follicular hyperkeratosis affected all of the patients. However, photophobia was not a constant feature. Histopathologic examination revealed disorders of the hair follicle with an acute-chronic inflammatory response. Follicular changes including fused infundibulum, the protrusion of the outer root sheath into the follicular canal, and a dilatation of the follicles at the isthmus level caused by the occlusion of keratin were observed. The trichoscopic features included perifollicular scaling, tufted hairs, and loss of follicular openings. In conclusion, terminal hair involvement, either scalp hairs, eyebrows, or eyelashes, and the hyperkeratosis of the follicle of vellus hairs is the diagnostic basis of KFSD. We hypothesize that follicular changes in histopathology are the primary event that trigger variable inflammation and further follicular destruction.

Myocardial Edema: A Rare but Specific Manifestation of Neonatal Capillary Leak Syndrome

Capillary leak syndrome (CLS) is a rare, potentially life-threatening systemic disease with a mortality rate of more than 30%. Its major clinical manifestation and diagnostic basis are systemic hyperedema. However, we lack knowledge about the presence of severe myocardial edema in patients with CLS. If myocardial edema cannot be detected, it will become a dangerous hidden condition that threatens the safety of patient lives. With the routine application of point-of-care critical ultrasound (POC-CUS) in clinical practice, we found that 2 of 37 (5.41%) CLS patients had severe myocardial edema as the main manifestation. It is also necessary to distinguish it from myocardial noncompaction in newborn infants with severe myocardial edema. This paper will help us to have a deeper understanding and correct management of CLS and, thus, help us to improve the prognosis of patients. This article also suggests the necessity of routine implementation of POC-CUS in the neonatal intensive care unit.

Not a wordsmith, but a teacher with great rhetorical and diagnostic talent - Johann Lukas Schönlein (1793-1864)

AbstractBy the second half of the 19th century at the latest, the scientific methods of physiology, clinical chemistry and physics formed a new basis for clinical diagnostics. The transformation of the hospital in Germany is essentially linked to the name of Johann Lukas Schönlein. Schönlein initiated and accomplished the transition from a natural-philosophical to a scientific approach to medicine. He was the first in Germany to use and teach auscultation and percussion. Schönlein not only introduced physical diagnostics, but also promoted microscopic, chemical and physiological research at the bedside. After years of successful work in Würzburg and Zurich, Schönlein was appointed to Berlin in 1890 on the recommendation of Johannes Müller. With Schönlein and Müller as well as their numerous students, a new generation of scientifically oriented physicians was established.

New progress in diagnosis and treatment of congenital laryngomalacia in infants

Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.

Detection and quantification of JAK2V617F copy number by droplet digital PCR versus real-time PCR.

Myeloproliferative neoplasm (MPN) usually has an adverse prognosis, progressing to acute leukemia or splanchnic vein thromboses (SVTs). Therefore, early diagnosis and intervention are significantly important. Clinically, the burden of JAK2V617F is a vital diagnostic basis, which can be detected during the early stage of MPN. Thus, an accurate and rapid detective technique is urgently required. In recent years, real-time quantitative PCR (qPCR) has primarily been applied to detect the copies of JAK2V617F, whereas droplet digital PCR (ddPCR), a novel and promising detective tool, can conduct precise and repeatable quantification of nucleic acid copies without relying on the standard curve. In our study, both qPCR and ddPCR are used to evaluate the mutation burden of JAK2V617F in a series of gradient diluted standards and clinical JAK2V617F-positive MPN patients' bone marrow samples collected, while using next-generation sequencing technology (NGS) as a contrast. With the help of statistical methods, our study concluded that ddPCR had a better performance in accuracy, sensitivity, and stability, especially in a low burden. Regarding the accuracy, ddPCR showed a better linearity (Pearson R2 = 0.9926; P < 0.0001) than qPCR (Pearson R2 = 0.9772; P < 0.0001). What is more, ddPCR showed lower intra-assay and inter-assay CVs and the limit of detection (LOD) for the series of diluted standards than qPCR, demonstrating better stability and lower LOD. In a nutshell, ddPCR is a more promising technique for the detection and quantification of JAK2V617F.

Evaluating Chatgpt As an Adjunct for Analyzing Challenging Case

Introduction Despite the rapid development of medicine, clinicians still faced with many challenging cases in practice. For challenging cases, most inexperienced doctors are unable to make a clear diagnosis in the first place, resulting in misdiagnosis and delayed disease. Recently, OpenAI released a new Chatbot model, called ChatGPT (Generation Pre training Converter), which is an artificial intelligence (AI) system that uses reinforcement learning model based on human feedback for training. There have been many research reports on the application of ChatGPT in the medical field, and it has been proven to have a wide range of clinical applications. In our study, we aimed to assess the accuracy and reliability of ChatGPT in diagnosing and treating challenging case. Methods We provided 2 challenging cases. Case 1 provided a medical history and auxiliary test results for ChatGPT, and then ChatGPT answered the possible diagnosis, diagnostic basis, further auxiliary examination and treatment. Case 2 provides negative symptoms and auxiliary test results for ChatGPT, which answers all possible diagnoses. Conduct a comprehensive evaluation and scoring of the results of ChatGPT responses by 5 senior physicians. A score of 10 is the perfect score. Results The analysis results of 2 challenging cases by ChatGPT were comprehensively evaluated by senior experienced professional doctors and scored 9 points. We found that ChatGPT's analysis of challenging case is comprehensive. Especially for the diagnosis and treatment of diseases, ChatGPT analyzes all possible diagnoses and provides accurate treatment plans through the provided medical history, auxiliary examination results, and treatment processes. ChatGPT can directly interpret the auxiliary examination results, such as high level of procalcitonin (PCT), abnormal kidney function, and with negative results can rule out certain diseases, such as ANA, ENA, and ANCA negative, ruling out the possibility of autoimmune diseases. ChatGPT can summarize all the diagnoses including rare diseases, based on the results of an auxiliary test, and explain the cause of the disease and the pathogenesis in detail. Conclusions Our study shows that ChatGPT can provide important reference value as an adjunct to clinicians in challenging case analysis. In particular, it can assist inexperienced doctors in remote areas and underdeveloped medical conditions to make clear diagnosis and treatment as soon as possible, avoid unnecessary referral to higher-level hospitals, reduce medical burden, and reduce waste of medical resources. In the medical field, ChatGPT needs more research to evaluate in clinical applications and become a better adjunct tool in clinical work.

Bilateral Pleural Chylothorax from A Blunt Chest Trauma

Introduction: Bilateral traumatic chylothorax is a very rare condition. Approximately80% of chylothorax are unilateral and usually 2/3 of cases on the right side [1]. The chyle leakage shows a milky white appearance, inexhaustible, in a consideration amount. Purpose: To report the management of bilateral traumatic chylothorax as a very rare condition. Material and methods: We present a patient with bilateral pleural chylothorax from a blunt chest trauma which is combined with a vertebral thoracal fracture of Th8, Th10.We present the diagnostic basis, treatment and evolution of chilies leakage. Results: A 36 years old man involved in a car crash. He was hospitalized with a diagnose such as right pleural effusion and thoracal vertebral fractures of the Th8, Th10.2 days after trauma the scan examination showed a large amount of effusion in the right hemithorax and minimal effusion in the left hemithorax. From the drainage tube in the right pleural cavity there was a flow of about 1000ml with a milky appearance. The biochemical analyses of the pleural effusion showed the presence of triglycerides with more than 1.24mmol /l and the cholesterol level with less than 5.18mmol/l which support the diagnosis of chylothorax. Initial treatment was conservative. A zero nutritional regimen was implemented for the first 10 days, being replaced by total parenteral nutrition such as plasma, albumin, electrolytes, vitamins. After that we passed to a fat-free nutritional diet. In the scan examination 6 days after the trauma, there was an increase in the amount of pleural effusion on the left side. A chest tube was performed from which there was 700 ml leakage, which had the appearance of chyle. The biochemical tests confirmed the diagnose of chylothorax. The chest tube of the left pleural cavity was removed after 5 days. The chyle leakage from the right pleural cavity has continued for about 3 weeks in a quantity ranging from 150-300 ml in 24 hours. After this period, approximately for 1 week the chyle leakage was in an amount of less than 1000ml in 24 hours. In the 5th week, the chest tube was removed, since the leaks were reduced to about 20-30 ml in 24 hours. The patient left the hospital after 30 days. The patient was completely recovered. Conclusions: The case was managed conservatively, based on a bilateral pleural drainage and a diet without fats, which proved to be successful.

Revised Proposed Classifications for Typical Anthropogenic Soils in China

As global industrialization and its associated anthropogenic activities rapidly increase, so too does the areal extent of human-altered soils. The soil classification framework must incorporate the classification schemes of these disturbed soils in order to remediate land. Soil Taxonomy (ST) and the World Reference Base for Soil Resources (WRB) are the most widely used soil classification systems in the world. In this study, 15 typical anthropogenic soil profiles with engineering and technical characteristics from China were selected for a classification study. The aim of this study was to clarify the classifications of these soil profiles in the ST, WRB, Chinese Soil Taxonomy (CST), and Geogenetic Soil Classification of China (GSCC), and make references accordingly. The results showed that the WRB can classify these soils as Technosols in the first level. ST can classify most of these soils as subgroups within the different great groups under Entisols, as well as the Human-Altered and Human-Transported Material classes within the soil family differentiae. For Chinese soil classification schemes, there is a large loophole in the CST regarding the classification of anthropogenic soils. Many anthropogenic soils cannot reflect these soils’ artificial and technical naming characteristics. For the CST, revised proposals based on the WRB and ST were proposed. Based on the artificial disturbance of soil layers, a manufactured layer was added to the diagnostic basis. The Artificalic Anthrosols suborder was added, and it can be divided into the Transporti-Artificalic Anthrosols and Alteri-Artificalic Anthrosols groups. The subgroups were defined by their levels of contamination, imperviousness, and artifact content. The “T” layer symbol was added to soil profile descriptions to reflect a specific layer about technology, such as A, E, B, and C, to reflect the main genetic horizons. This revised classification system is proposed for inclusion in the revised CST to account for the very large and expanding extent of disturbed soils in China and to remain current with other global soil taxonomy systems.

Critical review of diagnosis in rhinology and its therapeutical implications

Diagnosis in rhinology is currently based on the concept of inflammation (chronic rhinosinusitis [CRS]) or the clinical concept of chronic nasal dysfunction (CND). The complementarity between these two approaches can be discussed by a critical review of the literature structured by the analysis of the fundamental and diagnostic bases and the therapeutic implications linked to each. The concept of CRS is based on the anatomical continuity of the nasal and sinus respiratory mucosa and molecular biology data, seeking to analyze the mechanisms of chronic inflammation and to identify proteins and biomarkers involved in the different supposed endotypes of chronic inflammation of this mucosa. The concept of CND seeks to analyze medical, instrumental or surgical diagnostic and therapeutic strategies, taking account of both inflammatory and non-inflammatory causes impacting the anatomy or physiology of each of the three noses (olfactory, respiratory and sinus) that make up the mid-face sinonasal organ of evolution-development (Evo-Devo) theory. Thus, the concept of CRS offers an endotypic approach, based on biological characterization of mucosal inflammation, while the concept of CND offers a compartmentalized phenotypic and pathophysiological approach to sinonasal diseases. The joint contribution of these two concepts in characterizing nasal functional pathology could in future improve the medical service provided to patients.