Diagnostic Benefit Research Articles

Determination of Ideal Factors for Early Adoption and Standardization of Metagenomic Next-generation Sequencing for Respiratory System Infections.

Metagenomic next-generation sequencing (mNGS) demonstrates great promise as a diagnostic tool for determining the cause of pathogenic infections. The standard diagnostic procedures (SDP) include smears and cultures and are typically viewed as less sensitive and more time-consuming when compared to mNGS. There are concerns about the logistics and ease of transition from SDP to mNGS. mNGS lacks standardization of collection processes, databases, and sequencing. Additionally, there is the burden of training clinicians on interpreting mNGS results. Until now, few studies have explored factors that could be used as early adoption candidates to ease the transition between SDP and mNGS. This study evaluated 123 patients who had received both SDP and mNGS and compared several variables across a diagnostic test evaluation. The diagnostic test evaluation observed metrics such as sensitivity, specificity, positive and negative likelihood ratios (PLR, NLR), positive and negative predictive values (PPV, NPV), and accuracy. Factors included various sample sources such as bronchoalveolar lavage fluid (BALF), lung tissue, and cerebral spinal fluid (CSF). An additional factor observed was the patient's immune status. Pathogen detection was found to be significantly greater for mNGS for total patients, BALF sample source, CSF sample source, and non-immunocompromised patients (p<0.05). Pathogen detection was found to be insignificant for lung tissue sample sources and immunocompromised patients. Sensitivity, PLR, NLR, PPV, NPV, and accuracy appeared to be higher with mNGS for the total patients, BALF sample source, and non-immunocompromised patients when compared with SDP (p<0.05). With higher metrics in sensitivity, specificity, PLR, NLR, PPV, NPV, and accuracy for overall patients, mNGS may prove a better diagnostic tool than SDP. When addressing sample sources, mNGS for BALF-collected samples appeared to have higher scores than SDP for the same metrics. When patients were in a non-immunocompromised state, mNGS also demonstrated greater diagnostic benefits to BALF and overall patients compared to SDP. This study demonstrates that using BALF as a sample source and selecting non-immunocompromised patients may prove beneficial as early adoption factors for mNGS standard protocol. Such a study may pave the road for mNGS as a routine clinical method for determining the exact pathogenic etiology of lung infections.

Meta-Analysis of the Impact of Low-Dose Ionizing Radiation on Mortality and Progression of Heart Disease in the General Patient Population: Insights from Hormesis Theory in Cardiology.

Background/Objectives: Low-dose ionizing radiation (LDIR) is commonly used in medical diagnoses and certain professions, but its long-term effects on noncancer diseases, particularly cardiovascular disease (CVD), remain uncertain. While LDIR has recognized diagnostic benefits, its influence on CVD mortality and disease progression is still debated, with some suggesting that low doses may even have beneficial effects, as per the hormesis theory. Methods: This meta-analysis aimed to evaluate the impact of LDIR on cardiovascular health outcomes. The study followed a systematic approach, using the PRISMA guidelines to select and analyze relevant studies from databases such as PubMed, Scopus, Web of Science, and Embase. Out of 167 identified studies, 8 were chosen for analysis, including 6 cohort studies and 2 experimental studies. Results: The findings indicated a significant link between LDIR exposure and increased CVD mortality and progression, though some studies also noted potential benefits of LDIR in certain conditions, aligning with the hormesis theory. Conclusions: These mixed results raise questions about the specific conditions under which LDIR might be beneficial or harmful. Overall, the study emphasizes the need for strict radiation control measures and health monitoring for individuals regularly exposed to LDIR, both in clinical and occupational settings.

Use and De-implementation of Fecal Occult Blood Tests in the Acute Care Setting: A Systematic Review and Meta-Analysis.

To determine methods of FOBT de-implementation in acute care practice while summarizing the reasons and contraindications for inappropriate FOBT in acute care settings. Fecal occult blood testing is valuable for colorectal cancer screening in ambulatory settings but is not valuable for diagnostics in acute care with consistent indications for discontinuation as a tradition-based practice. We included all English language prospective and retrospective evaluation studies of FOBT use in acute care settings with or without de-implementation interventions and published as original research articles in peer-reviewed journals. A meta-analysis of FOBT positivity was conducted using a random effects model. Quality was assessed using Critical Appraisals Skills Programme criteria. Of 2,471 abstract/titles screened, 157 full-text articles were reviewed, and 22 articles met inclusion criteria of measuring prevalence or de-implementation of FOBT use in acute care settings. All 22 studies evaluated either FOBT use or de-implementation. Twenty articles reported FOBT positivity, with some illustrating that FOBT results were inconsequential to subsequent endoscopy decisions (n=7, 32%). The included studies represent a publication date range spanning 32 years, with limited documentation of de-implementation strategies. Four published studies described system-level disinvestment to administratively eliminate access to inpatient FOBT orders. Overall, all studies endorsed that the use of FOBTs in acute care settings results in increased workload and/or cost without diagnostic benefit. Critical appraisal of low-value tradition-based practices such as FOBT use in acute care settings are essential for deploying deliberate and effective de-implementation strategies.

Scoping review of enablers and challenges of implementing pharmacogenomics testing in the primary care settings

IntroductionPharmacogenomic testing (PGx) plays a crucial role in improving patient medication safety, yet ethical concerns and limitations impede its clinical implementation in the primary care settings.AimsTo systematically review the current...

Beyond Glasgow Coma Scale: Prehospital prediction of traumatic brain injury

IntroductionEarly identification of traumatic brain injury followed by timely, targeted treatment is essential. We aimed to establish the ability of prehospital Glasgow Coma Scale score alone and combined with vital signs to predict hospital-diagnosed traumatic brain injury. MethodsThis study included adults from the 2017–2020 Trauma Quality Improvement Program data set with blunt mechanism. We calculated test characteristics of prehospital Glasgow Coma Scale score ≤12 alone and Glasgow Coma Scale score combined with heart rate and systolic blood pressure for predicting (1) any traumatic brain injury and (2) moderate to severe traumatic brain injury. Diagnostic performances were calculated in all patients and older adults (≥55 years). We used decision curve analysis to determine the net diagnostic benefit of prehospital Glasgow Coma Scale score combined with heart rate + systolic blood pressure over Glasgow Coma Scale score alone. ResultsOf 1,687,336 patients, 39.1% had any traumatic brain injury, 3.7% had moderate to severe traumatic brain injury, and 9.1% had a prehospital Glasgow Coma Scale score ≤12. Prehospital Glasgow Coma Scale score ≤12 alone had a sensitivity 83.1%, specificity 93.7%, negative predictive value 99.3%, and positive predictive value 33.7% for predicting moderate to severe traumatic brain injury. Adding prehospital heart rate <65/min and systolic blood pressure >150 mm Hg to Glasgow Coma Scale score ≤12 improved the positive predictive value for moderate to severe traumatic brain injury (55.3%), with a preserved negative predictive value of 96.4%. Decision curve analysis showed the traumatic brain injury prediction model including prehospital heart rate and systolic blood pressure had the greatest net benefit across most threshold probabilities. ConclusionLess than a third of adult blunt trauma patients with a prehospital Glasgow Coma Scale score ≤12 have moderate to severe traumatic brain injury. Supplementing Glasgow Coma Scale score with prehospital vital signs improves diagnostic accuracy, potentially by filtering out patients with altered consciousness due to shock. Future work should better identify patients for traumatic brain injury–specific treatments in prehospital settings, including triage destination.

Urological Examination Compared to Ultrasonography in Testicular Lump Assessment: A Retrospective Cohort Study.

Background General practitioners (GPs) often expedite indeterminate scrotal lumpsfor urological evaluation. While a scrotal examination by a urologist is crucial, ultrasound (US) has become a routine component of clinical assessment regardless of the clinical examination findingsand the nature of the symptoms. This study aimed to evaluate the efficacy of clinical examination compared to scrotal ultrasound, even when the suspicion of cancer was low. Methodology A retrospective review of all fast-track testicular referrals seen in the clinic between January 2018 and January 2021 was conducted. Data on clinical examination findings, ultrasound results, and final diagnoses were analyzed. Patients for whom ultrasound scans were available before clinical examination were excluded from the study to avoid confounding the results. Results A total of 398 male subjects were referred for urological assessment, and 123 cases were excluded based on specified exclusion criteria. Two hundred seventy-five patients were identified who underwent clinical examination by urologists and subsequent ultrasound scans. Among 30 (11%) potentially malignant cases, 18 (60%) were confirmed malignancies. Sixty-eight (24.7%) cases were deemed unlikely to be malignant, and an ultrasound scan confirmed 40 (58.8%) cases as normal and four (5.9%) cases of unexpected malignancy. Ultrasonography confirmed 19 of 27 hydroceles (70.4%), 64 of 89 epididymal cysts (71.9%), and 5 of 9 varicoceles (55.6%). Of 51 epididymo-orchitis cases, 14 (27.5%) were confirmed. Conclusions Urological examinations demonstrated high reliability in most cases, with clinical diagnoses frequently corroborated by ultrasonographic findings. The results indicate that when there is no clinical indication for an ultrasound scan, it is more efficient to avoid unnecessary ultrasonography, as it can be time-consuming without providing additional diagnostic benefits. This underscores the value of thorough clinical assessment in guiding the need for further imaging.

Safety Analysis of Fiberoptic Bronchoscopy in Children

Fiberoptic bronchoscopy (FOB) is a crucial procedure in pediatric pulmonology, providing significant diagnostic and therapeutic benefits. This study evaluates the safety of FOB in children at The People's Hospital of Keyouqianqi, Inner Mongolia. A retrospective analysis was conducted on the medical records of 10 pediatric patients who underwent FOB between 2018 and 2023. The study assessed the incidence, types, and severity of complications, as well as factors contributing to these complications. The findings indicated a complication rate of 20%, with transient hypoxia and mild bleeding as the most common minor complications. No severe complications, such as severe bleeding, bronchospasm, or pneumothorax, were observed. Statistical analysis revealed that procedural factors significantly influenced the occurrence of complications. The study concludes that FOB is generally safe for pediatric patients, with a low incidence of severe complications. Recommendations include enhancing training and protocols, continuous monitoring, preventive measures, further research, and policy development to ensure the highest standards of patient care.

Preoperative Delta Neutrophil Index, Platelet Lymphocyte Ratio and Immature Granulocyte Count for Differentiating Metastatic Colon Cancer from Non-Metastatic Colon Cancer: A Retrospective Study.

Immature granulocytes show bone marrow activation before neutrophil response and there are studies in the literature showing that the number of immature granulocytes is an auxiliary marker in the diagnosis and treatment of different diseases. The Delta Neutrophil Index (DNI), Immature Granulocyte Count (IGC) have previously been studied as markers in thyroid and breast cancers. The aim of this study was to determine whether immature granulocyte IGC and DNI values measured in preoperative blood parameters have a diagnostic benefit for the detection of advanced colon cancer. A study was conducted on patients who had undergone selective operation for colon cancer in our clinic from February 2015 to February 2020. The patients were divided into two groups: early stage (stage I-III) and advanced stage (stage IV) colon cancer. The IGC and DNI values as well as other hematological parameters, demographic parameters (sex, age) in these two groups were compared. A total of 43 patients with mean age 67.47 (35-96) years were included in the study. Eighteen of the patients were male and 25 were female. When the early stage and advanced stage colon cancer groups were compared, no statistically significant difference was found between age, sex, white blood cell count, lymphocyte-to-monocyte ratio, eosinophil count, basophil count, mean platelet volume and: systemic immune-inflammation index score. It was observed that platelet-to-lymphocyte ratio, IGC and DNI or Immature Granulocyte Percentage (IGP) values were statistically significantly higher in the metastatic colon cancer group compared to the non-metastatic group. When the specificity and sensitivity of laboratory markers in metastatic colon cancer were examined, it was observed that the specificity and sensitivity of DNI or IGP and IGC were statistically higher than other values. DNI, IGC and PLR values, which are the parameters measured in the preoperative period are easily measurable laboratory parameters and do not involve additional costs in differentiating metastatic from non-metastatic colon cancer in the preoperative period.

Construction and validation of a histone-related gene signature for the diagnosis of endometriosis.

Endometriosis is a common chronic disease in childbearing women and a major cause of infertility. Our study aimed to identify and validate a novel gene signature for diagnosing endometriosis based on histone-related genes (HRGs), and to investigate their biological functions in endometriosis. RNA sequence data were downloaded from the Gene Expression Omnibus database, and HRGs were retrieved from the GeneCards database. We identified differentially expressed genes using the limma package, and constructed a diagnostic model using the rms package. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analyses were performed for visualization, annotation, and integrated discovery. Subsequently, we validated the model using the recall and decision curve analysis (DCA). Additionally, we analyzed the immune microenvironment features using CIBERSORT. A total of 18 differentially expressed HRGs were identified in patients with endometriosis compared with controls. GO and KEGG enrichment was mainly in spindle organization, positive regulation of the cell cycle process, progesterone-mediated oocyte maturation, and cellular senescence and cell cycle. We obtained a signature of four HRGs (JUNB, FRY, LMNB1, and SPAG1). DCA revealed that the diagnostic model benefits patients with endometriosis, regardless of the incidence. CIBERSORT analysis showed that the number of plasma cells increased significantly in endometriosis samples from all four datasets. Our findings provide novel insights into the function of HRGs in the development of endometriosis and identify a new signature of four HRGs that may serve as valuable diagnostic markers and therapeutic targets for this disease.

What factors affect a patient’s subjective perception of MRI examination

MRI is becoming increasingly available and more common. However, it is a long examination, within a limited space, and making strong demands on the patient for proper co-operation. Using survey data collected by prospective questionnaire, this work examines the influence of patient preparation and type of MRI device on patients’ subjective perception of the examination. The work analysed 800 patient questionnaires from 7 radiology centres, 12 MRI machines from 3 manufacturers. It was shown that 20% of patients were not informed at all or only insufficiently about the MRI examination by the referring physician, and this had a statistically significant effect on subjective perception as to the length of the examination. In claustrophobic patients, there was no significant difference in the perception of MRI examination between machine types (open vs. closed) or between bore size. This work demonstrated the influence of technical parameters of MRI devices on some other evaluated aspects in terms of patients’ perception of MRI examinations (such as noise perception or peripheral nerves irritation) and that the preparation prior to the examination itself plays also an important role. Sufficient explanation from the referring physician, good workplace time management, and sufficient communication with the patient influence the subjective perception of the examination and thus indirectly its diagnostic benefit.

Comprehensive risk management and safety strategies in radiation use in medical imaging

Radiation use in medical imaging, while essential for accurate diagnosis and treatment planning, poses inherent risks that require comprehensive risk management and safety strategies. This review discusses the critical aspects of managing these risks in clinical settings, focusing on patient safety, staff protection, and environmental considerations. A major challenge in medical imaging is balancing the diagnostic benefits of radiation against potential harms, particularly in sensitive populations such as children and pregnant women. Comprehensive risk management involves implementing dose optimization techniques, such as using low-dose imaging protocols and advanced technologies like iterative reconstruction and artificial intelligence (AI) algorithms, which enhance image quality while minimizing exposure. Additionally, ensuring the safety of healthcare staff is paramount. This requires adherence to strict safety protocols, including the use of personal protective equipment (PPE), regular monitoring of radiation levels, and continuous education on safe radiation practices. Institutional policies must also address the proper maintenance and calibration of imaging equipment to prevent unnecessary exposure due to equipment malfunction or improper use. Environmental safety is another critical component, necessitating the safe disposal of radioactive materials and the adoption of energy-efficient technologies to reduce the environmental footprint of medical imaging. Regulatory compliance with international safety standards, such as those set by the International Commission on Radiological Protection (ICRP) and national bodies, is essential for ensuring consistent safety practices across healthcare institutions. Future directions in radiation safety include the integration of digital health technologies to monitor and manage radiation exposure more effectively, and ongoing research into novel imaging techniques that could further reduce radiation risks. Collaboration between healthcare providers, researchers, and policymakers is crucial to advancing safety standards and improving risk management strategies in medical imaging. This review highlights the importance of a comprehensive approach to managing radiation risks in medical imaging, emphasizing the need for continuous innovation, education, and policy support to protect patients, healthcare workers, and the environment.

The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study

BackgroundWhite blood cell count (WBC) is a widely used marker for the prediction of serious bacterial infection (SBI); however, previous research has shown poor performance. This study aims to assess...

Development of Quantitative Norms for Normal Lung Uptake Based on Three-Dimensional Gallium-67 Single Photon Emission Computed Tomography/Computed Tomography

Abstract Purpose Gallium-67 (Ga-67) lung scans assess alveolitis and interstitial lung disease, with Ga-67 accumulation correlating with inflammation intensity as seen in lung biopsy sections. Both semi-quantitative and quantitative methods have been used, with the latter providing an inflammatory activity index linked to lung lavage and histopathological scores. However, differing reference points result in varying outcomes. This study aimed to establish standard Ga-67 index parameters using semi-quantitative analysis and a linear regression model based on planar and SPECT/CT images. Methods Twenty subjects without lung disease received a 5–6 mCi Ga-67 injection via the ankle. Both planar and SPECT/CT images were analyzed, with semi-quantitative values assessed using GraphPad Prism 9.5.1. Results Compared to planar images, SPECT/CT acquisitions for the lung-to-arm uptake ratio proved the most reliable indicator for assessing lung inflammation. Increased lung Ga-67 uptake was defined as greater than 2 standard deviations from the average Ga-67 uptake for healthy subjects. The normal range was 0.065 ± 0.049 for the right side and 0.076 ± 0.070 for the left side. Conclusion Lung-to-arm ratios in SPECT/CT images are more accurate than those in planar images. This method should be adopted as a standard clinical practice, providing more reliable diagnostic information and improving patient management. Future studies should compare patients without lung disease to those with lung disease to determine the diagnostic benefit of these norms.

Diagnostic Benefit of Molecular Imaging in Patients Undergoing Heart Valve Surgery for Infective Endocarditis.

(1) Background: The successful treatment of infective endocarditis (IE) relies on detecting causative pathogens to administer targeted antibiotic therapy. In addition to standard microbiological cultivation of pathogens from tissue obtained during heart valve surgery, the potential of molecular biological methods was evaluated. (2) Methods: A retrospective study was performed on heart valve tissue from 207 patients who underwent heart valve surgery for IE. FISHseq (fluorescence in situ hybridization combined with 16S rRNA gene PCR and sequencing) was performed in addition to conventional culture-based microbiological diagnostics. The diagnostic performance of FISHseq was compared with the conventional methods and evaluated in the clinical context. (3) Results: Overall, FISHseq provided a significantly higher rate of specific pathogen detection than conventional valve culture (68.1% vs. 33.3%, p < 0.001). By complementing the findings from blood culture and valve culture, FISHseq was able to provide a new microbiological diagnosis in 10% of cases, confirm the cultural findings in 24.2% of cases and provide greater diagnostic accuracy in 27.5% of cases. FISHseq could identify a pathogen in blood-culture-negative IE in 46.2% of cases, while valve culture provided only 13.5% positive results (p < 0.001). (4) Conclusions: This study demonstrates that using FISHseq as an additional molecular biological technique for diagnostics in IE adds substantial diagnostic value, with potential implications for the treatment of IE. It provides pathogen detection, especially in cases where conventional microbiological cultivation is negative or inconclusive.

Predicting clinically significant prostate cancer in elderly patients: A nomogram approach with shear wave elastography.

This study was to construct a nomogram utilizing shear wave elastography and assess its efficacy in detecting clinically significant prostate cancer (csPCa). 290 elderly people with suspected PCa who received prostate biopsy and shear wave elastography (SWE) imaging were respectively registered from April 2022 to December 2023. The elderly participants were stratified into two groups: those with csPCa and those without csPCa, which encompassed cases of clinically insignificant prostate cancer (cisPCa) and non-prostate cancer tissue, as determined by pathology findings. The LASSO algorithm, known as the least absolute shrinkage and selection operator, was utilized to identify features. Logistic regression analysis was utilized to establish models. Receiver operating characteristic (ROC) and calibration curves were utilized to evaluate the discriminatory ability of the nomogram. Bootstrap (1000 bootstrap iterations) was employed for internal validation and comparison with two models. A decision curve and a clinical impact curve were employed to assess the clinical usefulness. Our nomogram, which contained Emean, ΔEmean, prostate volume, prostate-specific antigen density (PSAD), and transrectal ultrasound (TRUS), showed better discrimination (AUC = 0.89; 95% CI: 0.83-0.94), compared to the clinical model without SWE parameters (p = 0.0007). Its accuracy, sensitivity and specificity were 0.83, 0.89 and 0.78, respectively. Based on the analysis of decision curve, the thresholds ranged from 5% to 90%. According to our nomogram, biopsying patients at a 20% probability threshold resulted in a 25% reduction in biopsies without missing any csPCa. The clinical impact curve demonstrated that the nomogram's predicted outcome is closer to the observed outcome when the probability threshold reaches 20% or greater. Our nomogram demonstrates efficacy in identifying elderly individuals with clinically significant prostate cancer, thereby facilitating informed clinical decision-making based on diagnostic outcomes and potential clinical benefits.

Combined PCL instabilities cannot be identified using posterior stress radiographs in external or internal rotation: A cadaveric study.

Posterior stress radiography is recommended to identify isolated or combined posterior cruciate ligament (PCL) deficiencies. The posterior drawer in internal (IR) or external rotation (ER) helps to differentiate between these combined instabilities. The purpose of this study was to evaluate posterior stress radiography (PSR) in isolated and combined PCL deficiency with IR and ER compared to PSR in neutral rotation (NR) for diagnosing combined PCL instabilities. Six paired fresh-frozen human cadaveric legs (n = 12) were mounted in a Telos device for PSR. The tibia was rotated using an attached foot apparatus capable of rotating the foot 30° internally and externally. A posterior tibial load of 15 kp (147.1 N) was applied to the tibial tubercle at 90° knee flexion, and a lateral radiograph was obtained. This was repeated with the foot in 30° IR and ER. The PCL, posterolateral complex (PLC), and posteromedial complex (PMC) were sectioned in six knees, while the PMC was sectioned before the PLC in the other six knees. Posterior tibial displacement (PTD) was measured radiographically. Statistical analysis was performed using a two-way ANOVA and a mixed model with Bonferroni correction, and the significance was set at p < 0.05. Furthermore, intra- and interobserver reliability was determined. Cutting the PCL significantly increased the radiographic PTD by 9.8 ± 1.8 mm (side-to-side difference compared to the intact state of the knee, n = 12; p < 0.001). This further increased to 12.2 ± 2.3 mm (n = 6; p < 0.01) with an additional PLC deficiency and to 15.4 ± 3.4 mm (n = 6; p < 0.05) with an additional PMC deficiency. A combined PLC and PMC deficiency resulted in an increase of the PTD to 15.9 ± 4.5 mm (n = 12; p < 0.01). In the PCL/PLC deficient state, ER did not demonstrate a higher PTD, compared to the NR and IR posterior drawer. In the PCL/PMC deficient state in IR, PTD was 1.6 ± 0.7 mm (p < 0.01) higher compared to NR and 3.2 ± 1.9 mm (p < 0.05) higher compared to ER. We showed excellent intra- and interobserver reliability (0.987-0.997). Combined PCL instabilities resulted in a significant increase in posterior tibial displacement in posterior stress radiographs. However, PSR in IR or ER was unable to differentiate between these combined instabilities. Based on our data, additional stress radiographs in rotation are unlikely to provide any diagnostic benefit in the clinical setting. There is no level of evidence as this study was an experimental laboratory study.

Radiofrequency stimulation of the dorsal root ganglion as a diagnostic tool for radicular pain syndromes: six representative cases

BackgroundWe discuss the diagnostic benefit of pulsed radiofrequency (PRF) of the dorsal root ganglion (DRG) in a case series of patients with different pathologies. We expand the diagnostic potential of DRG stimulation beyond paresthesia mapping by using DRG stimulation to help determine the role of the DRG in the patient’s pain and narrow down the etiology. In some cases, DRG stimulation was also part of the treatment plan.MethodsSix patients underwent DRG radiofrequency as a diagnostic/therapeutic step before considering implantation of a DRG neurostimulator. First, patients underwent a basic bedside neurological evaluation. Next, an electrode was placed in the epidural space through the sacral hiatus or between vertebral laminae. Then, sensory stimulation was applied at 50 Hz and gradually increased from 0.1 V until the patient reported paresthesia or until a maximum intensity of 2 V was reached. Patients were asked to describe where the stimulation was felt and outline the anatomical area the paresthesia covered. Then a motor stimulation was applied at 2 Hz until muscle twitching was reported by the patient or observed by the physician.ResultsThe information obtained helped diagnose the type of lesion as principally preganglionic, ganglionic, or postganglionic. This information guided patient management.ConclusionPRF of the DRG can provide valuable diagnostic information and is a useful step before ganglionic electrode implantation. In all cases, PRF of the DRG provided valuable diagnostic information and guided management options.

Additional benefit of endoscopic ultrasound with bronchoscope-guided fine needle aspiration to endobronchial ultrasound-guided transbronchial needle aspiration in the evaluation of lung cancer: a systematic review and meta-analysis.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) are minimally invasive procedures for the diagnosis and staging of lung cancer. This study aimed to investigate the additional diagnostic value of EUS-B-FNA following EBUS-TBNA. We performed a systematic literature review of PubMed, Embase, and the Cochrane Central Register databases and extracted the studies reporting the implementation of the combined EBUS-TBNA/EUS-B-FNA. A proportional meta-analysis was conducted to determine the pooled diagnostic yield of this procedure. We identified nine studies involving 2,375 patients. The overall pooled diagnostic yield of EBUS-TBNA alone and combined EBUS-TBNA/EUS-B-FNA was 0.87 [95% confidence interval (CI): 0.79-0.95, I2=96.55%] and 0.92 (95% CI: 0.85-0.99, I2=97.89%), respectively. Adding EUS-B-FNA to EBUS-TBNA increased the diagnostic yield by approximately 0.05. There was statistical heterogeneity among the studies (I2=54.49%). Among the 832 patients in seven studies, additional diagnostic benefits of EUS-B-FNA were observed in 37 lesions. The most common diagnosed lesion was in station 4L (n=10), followed by station 5 (n=8) and station 7 (n=8). In pooled estimates, the addition of EUS-B-FNA to EBUS-TBNA increased the diagnostic yield for the diagnosis and staging of lung cancer. Nodal station 4L, station 5, and station 8 were lesions frequently diagnosed by the addition of EUS-B-FNA. Because of statistical between-study heterogeneity, our findings should be interpreted with caution.

Genetic investigations in cerebral palsy.

The original description of cerebral palsy (CP) contained case histories suggesting that perinatal environmental stressors resulted in brain injury and neurodevelopmental disability. While there are clear associations between environmental impact on brain development and CP, recent studies indicate an 11% to 40% incidence of monogenic conditions in patients given a diagnosis of CP. A genetic diagnosis supports the delivery of personalized medicine. In this review, we describe how the Wnt pathway exemplifies our understanding of pathophysiology related to a gene variant (CTNNB1) found in some children diagnosed with CP. We cover studies undertaken to establish the baseline prevalence of monogenic conditions in populations attending CP clinics. We list factors indicating increased likelihood of a genomic diagnosis; and we highlight the need for a comprehensive, accurate, genotype-phenotype reference data set to aid variant interpretation in CP cohorts. We also consider the wider societal implications of genomic management of CP including significance of the diagnostic label, benefits and pitfalls of a genetic diagnosis, logistics, and cost.

Construction of a decision model for donor testing in cases of suspected antibody-mediated transfusion-related-acute-lung-injury.

To propose a rational basis for donor testing in cases of suspected antibody-mediated transfusion-related lung injury (AMT). Anti-leukocyte antibodies in donated blood are established causes of transfusion-related lung injury (TRALI). However, the question of whether to test donors for antibodies is not identical to whether the case meets definition criteria for TRALI. There is a balance between the potential benefits of testing and the costs of donor deferral and investigation. We propose that a decision-making process based on optimising the balance between risk and benefit requires a subjective choice of the relative value of different outcomes of testing. We have developed a formal decision model to illustrate how these choices affect testing decisions. Using a Bayesian probability model, we show that the diagnostic benefit and TRALI prevention benefit of testing donors have a complex interrelationship with the number of implicated donors and clinical suspicion of antibody-mediated TRALI (AMT) and that rational testing choices vary according to value assigned to outcomes. The challenges to the use of a formal decision model for clinical testing are discussed and conclude that a formal model is a useful consensus-building tool for improving consistency and openness in decision making.