Diagnostic Mode Research Articles

Ocular manifestation in patients with HIV/AIDS: a hospital-based retrospective study

BackgroundOcular manifestation, which occurs in 82·6% patients with HIV/AIDS, affects quality of life and has become a serious global public health problem. However, little attention has been paid to this issue because of its uncertain relationship with survival outcome. We aimed to demonstrate the potential relationship between ocular manifestation and the activity of general diseases in patients with HIV/AIDS, discover the trends and related factors of HIV/AIDS ocular manifestation, and make suggestions to ophthalmic patients with HIV/AIDS. MethodsWe retrospectively enrolled patients with HIV/AIDS admitted to Guangzhou Hospital for Infectious Diseases between Jan 1, 2005, and Dec 31, 2016. We collected their HIV/AIDS-related clinical data, hospitalisation information, and demographics. We classified patients into three groups according to the different ophthalmic diagnostic mode they received: non-professional inspection group (2005–11, patients were treated by infectious disease physicians alone without eye examination or the necessary equipment); on-demand inspection group (2012–13, infectious disease physicians decided whether to order an ophthalmology consultation according to the patient's condition); and routine examination group (2014–16, every hospitalised patient with HIV/AIDS had to undergo an ophthalmic examination). Findings8743 hospitalised patients with HIV/AIDS (15 116 cases) were enrolled, including 667 (8%) patients diagnosed with ocular diseases. Ocular disease was detected in 65 (2%) of 2902 patients in the non-professional inspection group, 46 (2%) of 1621 in the on-demand inspection group, and 556 (13%) of 3553 in the routine examination group. Infectious disease (354 [53%] of 667 patients) was the main type of ocular manifestation in HIV/AIDS. Most infections occurred in the cornea and conjunctiva (152 [43%] of 354 patients) and retina (145 [41%] of 354 patients). Retinopathy (β=2·392, p=0·007) and retinitis (β=3·562, p<0·001) were positively correlated with CD4-positive counts of less than 200 cells per μL. Among all the hospitalisation and demographic parameters, the ophthalmic examination mode (β=9·427, p<0·001) was the strongest factor for detecting ocular disease, followed by paying by medical insurance, hospitalisation times, average hospitalisation duration, and increasing age. InterpretationOcular manifestation in patients with HIV/AIDS is closely related to immune function and nutritional status. Routine ophthalmic examination is the most important factor associated with the detection rate of ocular diseases. Thus, ophthalmic examination should be done on every patient with HIV/AIDS. For patients diagnosed with retinopathy or retinitis, immune system function examination (such as CD4-positive T cell count) is necessary. FundingNational Key Research and Development Program of China (2018YFC011650), Major Research Plan of the National Natural Science Foundation of China, (91846109) and the National Natural Science Foundation of China (81770967).

Sucker rod string dynamics in deviated wells

Beam pumping is the most common artificial lift system. The down-hole dynamometer card, calculated using surface measurements, is an important tool to determine the pump operating condition and optimize the well production strategy. The description of the dynamics of a vertical sucker rod string has been well understood since S. G. Gibbs paper in the sixties [1]. The vertical well problem can be easily solved because the rod string is accurately approximated by a 1D linear elastic model, where the fluid drag is also linear with velocity. This can be solved in closed form and the parameters inferred from it, such as the down-hole card or pump fillage factor, have been widely used as the basis of most automatic well controllers.The number of deviated wells in the world has been steadily increasing since new technologies such as directional drilling became available and unlocked the potential of unconventional resources, where the possibility of drilling horizontal wells or multipad directional wells is critical for field development. These directional wells many times are produced using beam pumps after the primary depletion stage. Thus the description of the dynamics of a sucker rod string in non-vertical cases has become an important problem in recent years. These wells need to be analyzed including the effects of the non-vertical well trajectory and its consequent rod-tubing Coulomb friction losses. Coulomb friction is a highly non-linear phenomena that introduces very important dynamical effects. The increase in the complexity of this system is probably the cause of a lack of a consensus on how to deal with the problem. This fact has a clear impact on the industry, most well controllers do not include the possibility of calculating the down-hole card for a deviated well and many patents with different numerical schemes trying to solve the system have been disclosed recently.In this article a new model for the system that includes all the relevant physical mechanism that need to be incorporated in the description is proposed. The model is fully self contained and can be solved by numerical means, giving an accurate representation of the sucker rod string dynamics for directional wells. In contrast to other approaches to the problem, this model solves a closed system of equations without any external estimation of the variables in the system. Using this framework both the forward, or predictive, scheme, useful in the design of the rod string, and the down-hole card problem, needed to monitor down-hole conditions (diagnostic mode) are solved. This theory is used to move one step ahead and predict new effects not previously discussed in the literature, such as multiple micro sticking events of the rod string that are generated by static Coulomb friction.Field cases are analyzed and agree with the predictions of the model. These examples demonstrate that it is critical to take into account Coulomb friction to properly describe qualitative and quantitative features, that cannot be approximated by any means using a one dimensional vertical well approximation.

Diagnostic knowing in general practice: interpretative action and reflexivity

Background: Getting the right diagnosis is supposed to provide an explanation of a patient’s health problem and inform health care decisions. As a core element of clinical reasoning, diagnosis deserves systematic and transparent analysis. Conceptual tools can make doctors become aware of and explore diagnostic knowing.Methods: We demonstrate diagnostic knowing analysed as interpretative and contextualised activity. Our analysis is based on Lonergan’s theory of knowing, constituting the cognitive structures as experiencing, understanding, and judging, in a general practice case.Findings: Analysis makes the complexity of diagnostic knowing in this context more transparent, in this case concluding with four diagnostic labels: a corn, constipation, headache and atrial fibrillation. We demonstrate how a medically significant diagnosis does not necessarily evolve deductively from complaints. The opening lines from the patient give ideas of where to look for possible explanations – questions for understanding – rather than diagnostic hypotheses. Such questions emerge from the GP’s experiences from meeting the patient, including imaginations and interpretations. When ideas and questions regarding diagnoses have been developed, they may be judged and subjected to reflection. Questioning may also emerge as transitory concerns, not extensively ruled out. Lonergan’s theory demonstrated a strong fit with these aspects of diagnostic knowing in general practice.Implications: Analysis demonstrated systematic, transparent approaches to diagnostic knowing, relevant for clinical teaching. We argue that an interpretative understanding of diagnosis can change clinical practice, complementing hypothetico-deductive strategies by recognising additional substantial diagnostic modes and giving access to scholarly reflection.Key PointsDiagnosis is a core element of clinical reasoning, deserving systematic and transparent analysis beyond hypothetico-deductive reasoning or pattern recognitionDiagnostic knowing in general practice is a special instance of all human knowing with subjectivity, interpretation and reflexivity as essential elementsLonergan’s theory for knowing based on experiencing, understanding, and judging allowed us to map, decode and recognise advanced acts of clinical reasoning We share our experiences of how these concepts gave us a tool for systematic analysis of the complexities taking place in the GP’s office on an ordinary day

Pulmonary Capillary Hemorrhage Induced by Super Sonic Shear Wave Elastography in Rats

The occurrence of the pulmonary capillary hemorrhage (PCH) bioeffect of diagnostic ultrasound in rats was investigated for a SuperSonic Imagine shear wave elastography system (Aixplorer, Supersonic Imagine, Aix-en-Provence, France). The elastography imaging repeated at 1 Hz and consisted of widely spaced B-mode image pulses, supersonic push (SSP) pulses and shear wave imaging (SWI) pulses. Groups of rats anesthetized with ketamine and xylazine, or with ketamine only, were imaged on their right side in a warm water bath for one frame, 30 s and 300 s. The image focus and region of interest were adjusted to give exposure only with the background B-mode imaging, or primarily with the SSP and SWI pulses. A sham group had only low power aiming scans. The lungs were removed 5 min after exposure and evaluated for PCH area and volume. The B mode was notably ineffective and produced significant PCH only at the maximum 0 dB output. The SSP pulses together with the SWI pulses produced significant PCH for 300 s, 30 s and even single image exposures. Peak rarefactional pressure amplitude PCH thresholds for 300 s exposure were the same with or without the B-mode pulses at 1.5 MPa (in situ mechanical index, MIIS = 0.67). A 30 s duration resulted in a slightly increased threshold of 1.7 MPa (MIIS = 0.76). The omission of xylazine from the anesthetic, which reduces the sensitivity of rat lung to PCH occurrence, resulted in an increased threshold of 2.1 MPa (MIIS = 0.94). The unique SSP pulses were much more effective than the B mode, but thresholds were comparable to previous results with other diagnostic ultrasound modes on other systems.

GENERAL CONCEPT OF CREATING UNIVERSAL DIAGNOSTIC LASER SCANNERS FOR CONSTRUCTION AND OPERATION OF MAIN GAS PIPELINES

Background The article is devoted to common concept development for the creation of diagnostic geodesic laser scanners for the construction and operation of main gas pipelines. Aims and Objectives The aim of work is to develop a general model for diagnosing gas pipelines to detect a gas cloud using a laser scanner and to search for the possibility of determining the optimal modes of such diagnostics. Results In order to be used in the construction and operation of gas pipelines, the general task of creating laser scanners operating in the infrared range was formulated. The optimization of operation mode of the laser scanner for detecting gas leaks in gas pipelines is fulfield. The synthesis of a specialized laser scanner, capable of realizing the geodetic laser scanner functions during gas pipeline construction, as well as diagnosing gas pipeline functions in order to detect gas leaks during its operation, was performed.

Ultrasonography guided fine needle aspiration cytology of benign and malignant ovarian masses with histopathological correlation

Background: In recent past image guided fine needle aspiration cytology of ovarian masses is being used for the pre-operative diagnosis of neoplastic ovarian lesions, The imaging may be in the form of routinely performed ultrasonography and fine needle aspiration cytology is done from the solid component of lesion. Material and Methods: A prospective study was conducted at our tertiary care center over the period of two years. The 32 patients with ovarian masses encountered. The sensitivity, specificity and diagnostic accuracy of FNAC was calculated. Pitfalls and limitations of cytological evaluation and histopathological diagnosis has been highlighted.Results: The sensitivity of fine needle aspiration cytology in this study is 81.81%, Specificity is 95.23% and diagnostic accuracy is 90.60%.Conclusion: The Ultrasonography guided FNAC is less invasive, economic, rapid diagnostic mode of early evaluation of benign and malignant ovarian tumors and helps in early management.

Acoustic Fountains and Atomization at Liquid Surfaces Excited by Diagnostic Ultrasound

Pulmonary capillary hemorrhage (PCH) has been found in mammalian lungs exposed to diagnostic ultrasound (DUS), although the mechanism is poorly understood. This work investigates acoustic atomization and fountains at liquid-air interfaces subjected to DUS, which has been suggested as a possible PCH damage mechanism. Primarily using a SuperSonic Imagine Aixplorer DUS machine (SuperSonic Imagine, Aix-en-Provence, France), blood and water surfaces were excited in vitro by DUS and recorded with a high-speed camera. The surface was driven by B-mode, color Doppler, pulsed Doppler, and shear wave elastography imaging modes with center frequencies from 5.0–7.2 MHz and mechanical indexes (MI) up to 1.7. Fountains and atomization were only observed for SWE, for MI as low as 1.0. A comparison of the SWE waveforms with the surface dynamics suggests that fountains and atomization were driven by push-pulses and depended on pulse duration and intensity. However, we conclude that atomization and fountaining are unlikely primary mechanisms behind all DUS-induced PCH because neither phenomenon occurred for traditional diagnostic imaging modes.

Biological Effect of Modern Fetal Ultrasound Techniques on Human Dermal Fibroblast Cells.

Background:Diagnostic ultrasound has been used to detect human disease especially fetus abnormalities in recent decades. Although the harmful effects of diagnostic ultrasound on human have not been established so far, several researchers showed it has had bioeffects in cell lines and in experimental animals. Three-dimensional (3D), four-dimensional (4D), and color Doppler sonography are new techniques which are widely used in diagnostic fetal ultrasonography. Objective:The study aims to evaluate some bioeffects of 3D, 4D, and color Doppler sonography in different exposure times according to the acoustic output which is set as ultrasound scanner’s default for fetal sonography in the second trimester on human dermal fibroblast (HDF) cells. Material and Methods: Exposure times selected consist of 10, 40, 70, and 100 seconds for 3D sonography, 10, 20, and 30 minutes for 4D sonography, and 10, 30, and 50 seconds for color Doppler. Cell viability, cell proliferation, and apoptosis induction on HDF cells were assessed using MTT assay, immunocytochemistry of Ki-67, and Terminal Transferase-mediated dUTP End-labeling (TUNEL) assay, respectively. Results:Exposure of cells to 3D, 4D, and color Doppler modes led to decreased cell viability and increased proliferation rate of HDF. None of the diagnostic ultrasound modes induced cell apoptosis. . Conclusion: The results indicated that 3D, 4D, and color Doppler techniques may affect the cell viability and proliferation of HDF cells, however, have no effects on the induction of apoptosis probability. Further long-term studies with other molecular endpoints are required.

The value of preoperative ultrasound in predicting microvascular invasion of hepatocellular carcinoma

Objective To analyze the ultrasound imaging features and clinical characteristics in patients with hepatocellular carcinoma (HCC), and assess the value of ultrasound in preoperatively predicting microvascular invasion(MVI) of HCC. Methods One hundred and seventy-one patients with HCC were retrospectively collected from January 2016 to July 2018. The ultrasound imaging features and clinical data that may be associated with MVI were analyzed by univariate and multivariate analyses, and the diagnostic efficacy of independent risk factors was further evaluated. ROC curves were plotted to compare the diagnostic efficacy of combined diagnostic mode 1, mode 2, peritumoral enhancement, and tumor margin. Results Univariate analysis showed that the serum AFP level, tumor size, peritumoral hypoechoic halo, peritumoral enhancement, and tumor margin were significantly correlated with MVI (P<0.05). Multivariate logistic regression analysis further indicated that peritumoral enhancement and non-smooth tumor margin were the independent risk factors for predicting MVI. The sensitivity, specificity, positive predictive value and negative predictive value of peritumoral enhancement and non-smooth tumor margin were 51.4% vs 83.8%, 81.4% vs 48.5%, 67.9% vs 55.4%, and 68.7% vs 79.7%, respectively. The AUC of mode 1, mode 2, peritumoral enhancement and tumor margin were 0.741, 0.716, 0.664, and 0.661, respectively. Conclusions Preoperative ultrasound is valuable in predicting MVI of HCC. Peritumoral enhancement and non-smooth tumor margins are independent risk factors for predicting MVI of HCC. Tumor size, hypoechoic halo around the tumor, and serum AFP levels must be taken into account when predicting MVI of HCC by using preoperative ultrasound. Key words: Ultrasonography; Carcinoma, hepatocellular; Contrast-enhanced ultrasound; Microvascular invasion; Risk factors

Evaluation of the feasibility and preference of Nox-A1 type 2 ambulatory device for unattended home sleep test: a randomized crossover study

There is an increasing need for portable sleep monitoring in clinical practice, but there is no comparative study that used the same device for home and in-laboratory sleep monitoring and device close to full polysomnography (PSG) to evaluate the feasibility and preference of home unattended sleep monitoring. Twenty male participants with high risk for moderate to severe OSA based on the STOP-BANG questionnaire were included. The participants were randomly assigned to group A (home unattended monitoring after in-laboratory monitoring) or group B (in-laboratory monitoring after home unattended monitoring). A 2-week washout period was implemented between the sleep tests. All hook-up procedures were performed in laboratory. Participants were asked to complete a questionnaire after finishing each sleep test. There was no difference in sleep efficiency, arousal index, or time spent in each sleep stage between the two monitoring modes using Nox-A1. Additionally, other respiratory parameters such as apnea–hypopnea index (AHI), supine AHI, and snoring time did not differ. A high and similar sensor quality for airflow, oxygen, and respiratory effort was observed in both monitoring groups. Patient’s feelings and satisfaction with the test were similar between in-laboratory and home monitoring, but preference rate for the in-laboratory test was higher than that for home monitoring (70% vs. 30%, respectively). These data suggest that home unattended monitoring with Nox-A1 type 2 ambulatory device is a feasible alternative diagnostic mode for high risk of moderate to severe OSA, yielding reliable quality recordings and high patient satisfaction.

Classification of EEG Signal into Different Epileptic Stages based on Feature Extraction

Epilepsy affects almost 50 million populations worldwide and it is one of the most common disorders of the neurological system. Epilepsy is characterised by chronic seizures with a broad range of seizure types based on the condition that differs from one person to another. There various diagnostic modes such as EEG, Magnetic Resonance Imaging (MRI) and f MRI. In this paper, we have made an approach to classify epileptic seizures of EEG signals with ease, instead of using complex and ancient methods of decision making and to describe and find out which wave has significant disturbance in the Epileptic condition. In the work carried out, firstly, the EEG signals were split into separate frequency band wave and time-frequency features were extracted. Then, the extracted features were fed to classifier system, the Linear SVM and ANN classifier and the performances between the classifier were compared in terms of Accuracy, Sensitivity and Specificity.

THE INFLUENCE OF VARIOUS METHODS OF ANESTHESIA ON TIME OF POSTOPERATIVE RECOVERY OF PATIENTS’ CONCIOUSNESS AFTER CURETTAGE OF UTERINE CAVITY

Introduction: Scientific information sources point to the significant effectiveness of curettage of uterine cavity (CUC) as a diagnostic and treatment mode of gynecologic oncology. Today the anesthesia service is able to satisfy virtually all the requirements of a surgeon and a female patient, however, some institutional factors, as for example postoperative recovery of consciousness, and factors influencing it, remain unaddressed. The aim: to explore the possibilities of influence of different combinations and dosages of medical preparations used to provide monitored anesthesia care of CUC, to change the time of postoperative recovery of patient's consciousness. Materials and methods: an interview of 96 patients by VAS, studies of cortisol, insulin and glucose levels in blood serum, measurements of time from the end of surgery to the awakening and complete recovery of consciousness and statistical processing of the results have been conducted. Results: A combination of 50 mg of dexketoprofen and half-dose drugs for narcosis can hasten the postoperative wake-up time by 38%, while maintaining dosages can prolong by 37% on the contrary. There is a dose-dependent effect of drugs for narcosis on the time of full post-operative recovery of consciousness. The reduction of their dosages by half can reduce this time by almost 40%. Conclusions: the dosage modification of anesthetic drugs and their combinations may have a significant effect on the time of postoperative awaking and complete recovery of consciousness in female patients after CUC. As a result, it has a positive physiological, psychological and social effect.

Treatment of the focal nodular hyperplasia of the liver. Is there any place for surgical indication?

Background: Focal nodular hyperplasia (FNH) is a very common benign liver tumor, which occurs in the vast majority of the cases in young women. FNH is characterized by local vascular abnormalities and is a truly benign lesion Methods: A retrospective single institution analysis of 227 FNH patients, treated from 1990 to 2016 and a review of studies reporting surgical therapy of overall 293 patients with FNH was performed. Indications for resection with a focus on diagnostic workup, patient selection, surgical mode and surgical morbidity and mortality have been analysed. Results: Ninety three patients underwent elective hepatectomy and 134 patients observation alone, where median follow-up was 107 months. Postoperative complications were recorded in 14 patients, 92% of patients reported an improvement with respect to their symptoms. Overall among 293 patients underwent surgery in the series, included to this review, there was a morbidity of 13%, where median follow-up was 53 months Conclusion: Systematic follow-up remains the gold standard in asymptomatic patients with FNH. However elective surgery should be considered in symptomatic patients, in those with marked enlargement and in case of uncertainty of diagnosis. Surgical treatment for FNH is a safe procedure with low morbidity and very good long term results as far as quality of life after surgery is concerned and surely an integral part of the modern management of FNH.

Treatment of the focal nodular hyperplasia of the liver. Is there any place for surgical indication?

Background: Focal nodular hyperplasia (FNH) is a very common benign liver tumor, which occurs in the vast majority of the cases in young women. FNH is characterized by local vascular abnormalities and is a truly benign lesion. Methods: A retrospective single institution analysis of 227 FNH patients, treated from 1990 to 2016 and a review of studies reporting surgical therapy of overall 293 patients with FNH was performed. Indications for resection with a focus on diagnostic workup, patient selection, surgical mode and surgical morbidity and mortality have been analysed. Results: Ninety three patients underwent elective hepatectomy and 134 patients observation alone, where median follow-up was 107 months. Postoperative complications were recorded in 14 patients, 92% of patients reported an improvement with respect to their symptoms. Overall among 293 patients underwent surgery in the series, included to this review, there was a morbidity of 13%, where median follow-up was 53 months. Conclusion: Systematic follow-up remains the gold standard in asymptomatic patients with FNH. However elective surgery should be considered in symptomatic patients, in those with marked enlargement and in case of uncertainty of diagnosis. Surgical treatment for FNH is a safe procedure with low morbidity and very good long term results as far as quality of life after surgery is concerned and surely an integral part of the modern management of FNH.

Accuracy of High- and Low-Resolution Cone-Beam Computed Tomographic Scans in the Detection of Impacted Tooth-Induced External Root Resorption: An Ex-Vivo Study.

Objectives:Cone-beam computed tomography (CBCT) is used in diagnostic situations, as well as tooth impaction and its complications. A possible sequela of tooth impaction is resorption of adjacent teeth, complicating the treatment plans. This study aimed to determine the diagnostic accuracy of high- and low-resolution CBCT scans in the detection of external root resorptions (ERRs), caused by an adjacent impacted tooth in the cementoenamel junction (CEJ), mid-root, and apical areas.Materials and Methods:Forty-five intact single-rooted teeth were divided into three groups of 15. Each group was dedicated to each zone of the root. Slight, moderate, and severe ERRs were formed, and CBCT scans were taken before and after the formation of ERRs. The diagnostic accuracy was assessed, and the Proportion test was used to compare the results.Results:The statistical analyses of high- and low-resolution images showed a significant difference (P<0.05), which implies the higher accuracy of high-resolution images. The highest diagnostic accuracy among different zones was related to the mid-root, and the lowest was related to the apical zone. In terms of the size of ERRs, the diagnostic accuracy was the lowest for slight ERRs.Conclusion:The most reliable and accurate diagnostic mode was found in high-resolution images, in the mid-root zone, and with severe ERRs. The lowest diagnostic accuracy was found in low-resolution images, in the apical zone, and with slight ERRs.

Mineralogy and spectroscopy (VIS near infrared and micro-Raman) of chromite from Nidar ophiolite complex, SE Ladakh, India: Implications for future planetary exploration

To determine the chemical composition of minerals on planetary surfaces from spectroscopic data, it is required to establish the link between mineralogy, spectroscopy and chemical composition of rock forming minerals on Earth. To meet this requirement, we performed integrated mineralogical and spectroscopic (Visible-Near Infrared and micro Raman) characterisation of chromite from the chromitite layer in the mantle section of the Nidar ophiolite complex, SE Ladakh, J&K, India. Chromite commonly occurs as monominerallic chromitite layers (up to 1 meter wide) and disseminated grains within the dunites and harzburgites. The Cr2O3 content is generally high (>60 wt%) and chemically homogeneous across the grains. The X-ray Diffraction (XRD) analyses show highest peak intensity at ∼36° 2θ, followed by other diagnostic peaks for chromite. Micro-Raman of chromite yields very strong diagnostic Raman active vibrational modes at 685 cm−1 (A1g), followed by 520 cm−1 (F2g(2)). The other peaks, viz. 446 cm−1 and 610 cm−1 are rather weak and correspond to Eg and F2g, respectively. VNIR (0.4μ to 2.4μ) reflectance spectroscopy of chromite suggested strong absorption near 2 μm and could be useful to quantify the chemical composition (especially Cr2O3, Al2O3 and Cr#). We found a good correlation of VNIR absorption and chemical composition of chromite (e.g. band positions versus Al2O3 and Cr# are well within 95% correlation interval). The intense Raman peak at 685 cm−1 corresponds to higher Cr content. This study, therefore, implies a significant understanding in determination of mineral chemistry (especially Chromites) by VNIR and micro Raman spectroscopy, which could be a useful tool for the future planetary exploration.

Diagnostic Mode Detecting Solid Mineral Inclusions in Medical Ultrasound Imaging

The proposed ultrasound imaging mode allows detection of objects, which essentially differ in their scattering properties from the surrounding tissues and liquids. The objects in question are primarily microcalcifications, renal and urinary stones. Our previous study has shown that the Doppler signals from these objects have two components common for echoes from solid mineral inclusions. They can be in superposition with the blood and noise signals. One of these two mineral-related components is characterized by cavitation, the other – by elastic vibrations of the object presumably caused by acoustic radiation force. According to statistical and energy parameters, these components differ from each other, as well as from noise and blood echoes. The article proposes a practical method for identifying signals with mineral-related components. This method is the base for the novel diagnostic visualization mode specifically designed for the mineral inclusions detection with ultrasound.

Comparison of diagnostic values between ultrasound elastography and ultrasound-guided thyroid nodular puncture in thyroid nodules.

Diagnostic value between ultrasound elastography and ultrasound-guided fine needle puncture biopsy in thyroid nodules was compared to provide reference for the selection of thyroid nodule (TN) diagnostic mode. A total of 194 patients with TN, admitted from June 2014 to June 2015, were selected to be treated with ultrasound elastography and ultrasound-guided fine needle puncture biopsy. The ultrasonic elasticity score and results of ultrasound-guided TN puncture were compared with diagnostic results of surgical or ultrasound follow-up for 12 months, and the sensitivity, specificity and accuracy of differentiating and diagnosing TN of the two methods were calculated to compare the clinical diagnostic values. A total of 194 patients were diagnosed with TN 217, including 129 benign and 88 malignant lesions. All the nodules were obtained by effective ultrasound elastography and ultrasound-guided fine needle puncture cytological pathological specimens, and it was diagnosed by ultrasound elastography that there were 75 benign nodules and 142 malignant nodules. It was diagnosed by ultrasound-guided fine needle puncture that there were 112 benign, 78 malignant and 27 uncertain nodules. The specificity and accuracy of ultrasound-guided fine needle puncture in the diagnosis of TN were higher than that of ultrasound elastography and the differences were statistically significant (P<0.05), while there was no statistically significant difference between the sensitivity of ultrasound elastography and ultrasound-guided fine needle puncture biopsy in the diagnosis of TN (P>0.05). Ultrasound elastography in the diagnosis of TN has a low specificity and the diagnosis of ultrasound-guided fine needle puncture biopsy may have uncertain results. There are some defects in the two diagnostic schemes and their combined application can complement each other's advantages and improve the early diagnostic efficiency of TN.

Direct Real-Time Monitoring of Prodrug Activation by Chemiluminescence.

The majority of theranostic prodrugs reported so far relay information through a fluorogenic response generated upon release of the active chemotherapeutic agent. A chemiluminescence detection mode offers significant advantages over fluorescence, mainly due to the superior signal-to-noise ratio of chemiluminescence. Here we report the design and synthesis of the first theranostic prodrug monitored by a chemiluminescence diagnostic mode. As a representative model, we prepared a prodrug from the chemotherapeutic monomethyl auristatin E, which was modified for activation by β-galactosidase. The activation of the prodrug in the presence of β-galactosidase is accompanied by emission of a green photon. Light emission intensities, which increase with increasing concentration of the prodrug, were linearly correlated with a decrease in the viability of a human cell line that stably expresses β-galactosidase. We obtained sharp intravital chemiluminescent images of endogenous enzymatic activity in β-galactosidase-overexpressing tumor-bearing mice. The exceptional sensitivity achieved with the chemiluminescence diagnostic mode should allow the exploitation of theranostic prodrugs for personalized cancer treatment.

Low serum trypsin levels predict deep pancreatic cannulation failure during ERCP in patients with symptomatic obstructive chronic pancreatitis

Advances in cell and molecular biology studies have revolutionized the diagnosis and treatment of many different diseases. Cell and molecular diagnostics (CMD) have become an essential part of investigations required in providing optimal care and has become an important tool for the health care providers for better treatment. CMD gives insights into the pathogenesis and prognosis of various diseases. Rapid technological advances have helped to increase the speed and performance of various molecular assays thereby reducing turnaround time, in turn translating to providing better clinical services. With the increase in CMD applications to clinical services, entire world has seen a sudden spurt of cellular and molecular labs. However, this has highlighted an acute shortage of trained laboratory personnel who can carry out cellular or molecular assays in a diagnostic mode. Understanding the mechanisms of disease at the molecular and genetic levels can now be translated into diagnostic, prognostic, and therapeutic applications in modern medicine. Molecules at abnormal levels (quantitative or qualitative) provide not only a signature for the presence of a disease, but also the indication for a drug targeting the specific abnormal function. Concurrently, the role of CMD has expanded from mere study observations to constantly translating new discoveries and novel technologies into useful clinical tests that provide a molecular fingerprint of diseases and that are predictive of the response. In the introductory chapter we will cover the importance of biological sample collection from different methods; cell-based diagnostic methods, cellular pathway diagnostic targets, and molecular-based methods.