Diagnostic Options Research Articles

Addressing controversial areas in the management of advanced prostate cancer in Canada Areas of consensus and controversy from the third Canadian consensus forum.

The management of prostate cancer (PCa) is rapidly evolving. Treatment and diagnostic options grow annually, however, high-level evidence for the use of new therapeutics and diagnostics is lacking. In November 2022, the Genitourinary Research Consortium held its 3rd Canadian Consensus Forum (CCF3) to provide guidance on key controversial areas for management of PCa. A steering committee of eight multidisciplinary physicians identified topics for discussion and adapted questions from the Advanced Prostate Cancer Consensus Conference 2022 for CCF3. Questions focused on management of metastatic castration-sensitive prostate cancer (mCSPC); use of novel imaging, germline testing, and genomic profiling; and areas of non-consensus from CCF2. Fifty-eight questions were voted on during a live forum, with threshold for "consensus agreement" set at 75%. The voting panel consisted of 26 physicians: 13 urologists/uro-oncologists, nine medical oncologists, and four radiation oncologists. Consensus was reached for 32 of 58 questions (one ad-hoc). Consensus was seen in the use of local treatment, to not use metastasis-directed therapy for low-volume mCSPC, and to use triplet therapy for synchronous high-volume mCSPC (low prostate-specific antigen). Consensus was also reached on sufficiency of conventional imaging to manage disease, use of germline testing and genomic profiling for metastatic disease, and poly (ADP-ribose) polymerase (PARP) inhibitors for BRCA-positive prostate cancer. CCF3 identified consensus agreement and provides guidance on >30 practice scenarios related to management of PCa and nine areas of controversy, which represent opportunities for research and education to improve patient care. Consensus initiatives provide valuable guidance on areas of controversy as clinicians await high-level evidence.

Unraveling the Complexity of triple-negative breast cancer: A comprehensive research analysis

TNBC, also known as triple-negative breast cancer, is a predominantly female-targeting and stands out due to its defining attribute. TNBC accounts for a considerable percentage of BC cases, and unfortunately, it is associated with poor prognoses and limited treatment options. In-depth information about TNBC, including its epidemiology, clinical expression, molecular features, and current diagnostic and treatment options, is provided in this research paper. In addition to examining ongoing research projects to better TNBC patient outcomes and treatment options, the report also suggests potential future routes for improved management tactics. The development of effective targeted treatments and individualized treatment plans for such a challenging disease necessitates an understanding of the distinctive characteristics of TNBC. This article contributes to continuing efforts to meet the unmet clinical requirements of patients affected by this aggressive BC subtype by offering insight into the complexity of TNBC.

Features of trigeminal nerve exit on the base of the brain: neurovascular conflict

The trigeminal nerve is a complex anatomical formation that performs very important tasks in terms of functionality. This article focuses on the study of the exit of the trigeminal nerve and its syntopy with arteries. It is the study of the location of nearby vessels relative to the nerve and their neurovascular conflict that determines the relevance of this work. The prevalence of trigeminal neuralgia (TN) is quite high and amounts to 40–60 patients per 100,000 population, and the incidence according to the World Health Organization is within 2–4 people per 10,000 population. The maximum risk of neurovascular conflict is observed in the age group of people from 45 to 60 years. It is also known that women suffer from neuralgia significantly more often than men. Not only the exact diagnosis, but also the selection of the most appropriate treatment tactics will depend on the result of studies of the individual anatomical features of the pons area. The authors of the article studied 17 preparations of the base of the brain of middle-aged individuals, fixed in a 7 % formalin solution. Of the 17 preparations studied, neurovascular relationships were noted in 14, which is 82.4 % of the total. As a result of morphometric measurements, the data on the length and width of the pons, the thickness of the trigeminal nerve roots, and the middle cerebellar peduncles were obtained. Statistical data processing and photographic documentation were carried out. The clinical manifestations of the disease, diagnostic options, and various methods of treatment were considered. The most effective method of treating neurovascular conflict is surgery, the first mention of which dates back to 1934.

Closing the Gaps in Care of Dyslipidemia: Revolutionizing Management with Digital Health and Innovative Care Models.

Although great progress has been made in the diagnostic and treatment options for dyslipidemias, unawareness, underdiagnosis and undertreatment of these disorders remain a significant global health concern. Growth in digital applications and newer models of care provide novel tools to improve the management of chronic conditions such as dyslipidemia. In this review, we discuss the evolving landscape of lipid management in the 21st century, current treatment gaps and possible solutions through digital health and new models of care. Our discussion begins with the history and development of value-based care and the national establishment of quality metrics for various chronic conditions. These concepts on the level of healthcare policy not only inform reimbursements but also define the standard of care. Next, we consider the advances in atherosclerotic cardiovascular disease risk score calculators as well as evolving imaging modalities. The impact and growth of digital health, ranging from telehealth visits to online platforms and mobile applications, will also be explored. We then evaluate the ways in which machine learning and artificial intelligence-driven algorithms are being utilized to address gaps in lipid management. From an organizational perspective, we trace the redesign of medical practices to incorporate a multidisciplinary team model of care, recognizing that atherosclerotic cardiovascular disease risk is multifaceted and requires a comprehensive approach. Finally, we anticipate the future of dyslipidemia management, assessing the many ways in which atherosclerotic cardiovascular disease burden can be reduced on a population-wide scale.

Update in imaging tests used for the localization of parathyroid pathology

Preoperative localization of parathyroid pathology, generally a parathyroid adenoma, can be difficult in some cases due to the anatomical variants that these glands present. The objective of this review is to analyse the different imaging techniques used for preoperative localization of parathyroid pathology (scintigraphy, ultrasound, CT, MRI and PET).There is great variability between the different tests for the preoperative localization of parathyroid pathology. The importance of knowing the different diagnostic options lies in the need to choose the most suitable test at each moment and for each patient for an adequate management of primary hyperparathyroidism (PHP) with surgical criteria.

Распространенность гельминтозов среди сельского населения Хабаровского края

The large medical and socio-economic burden of helminth infections provides the basis for studying the frequency and type of helminth infections among the population of residents of the Russian Far East and is relevant. The purpose of this study was to study the prevalence and type of parasitosis among different age groups of the rural population of the Lazo District. The study was carried out in the design of a retrospective cohort non-randomized continuous study. On the basis of the District Hospital of the Lazo District, 26,483 medical records were processed and analyzed among the adult and child population for the period 2013–2023, with the study of data on the incidence of parasitosis in the rural population based on the results of a microscopic examination of feces for helminth eggs and protozoan cysts ( by Kato method). Statistical analysis was carried out in the STATISTICA 16.0 program, as well as the use of statistical functions of the EXCEL program, using nonparametric data processing methods. After a parasitological survey carried out in 2013–2023, it was revealed that the largest proportion among the infested were children, predominantly in the age group of 4–7 years. There were no significant differences by gender. Based on the set of indicators that determine the structure and dynamics of epidemiological processes in the Lazo District, clonorchiasis (0.07 %, 19 people), ascariasis (0.90 %, 238 people), enterobiasis (1.90 %, 503 people) were diagnostically significant. people), as well as giardiasis (2.00 %, 530 people). There is a need for improved diagnostic tools and effective control options to scale up public health interventions and improve clinical detection and treatment of helminth infections in the Russian Far East.

Fluorescent pH‐sensing bandage for point‐of‐care wound diagnostics

AbstractDiabetic foot ulcers (DFUs) are a serious and prevalent complication of diabetes. Current diagnostic options are limited to macroscopic wound analysis such as wound size, depth, and infection. Molecular diagnostics promise to improve DFU diagnosis, staging, and assessment of treatment response. Here, we developed a rapid and easy‐to‐use fluorescent pH‐sensing bandage for wound diagnostics. In a fluorescent dye screen, we identified pyranine as the lead compound due to its suitable pH‐sensing properties in the clinically relevant pH range of 6–9. To minimize the release of this dye into the wound bed, we screened a library of ionic microparticles and found a strong adhesion of the anionic dye to a cationic polymeric microparticle. These dye‐loaded microparticles showed a strong fluorescence response in the clinically relevant pH range of 6–9 and a dye release below 1% after 1 day in biological media. The dye‐loaded microparticles were subsequently encapsulated in a calcium alginate hydrogel to minimize the interaction of the microparticles with the wound tissue. This pH‐sensing diagnostic wound dressing was tested on full thickness dorsal wounds of mice, and a linear fluorescence response (R2 = 0.9909) to clinically relevant pH values was observed. These findings encourage further development of this pH‐sensing system for molecular diagnostics in DFUs.

Bilingual Primary Progressive Aphasia: A Scoping Review of Assessment and Treatment Practices.

Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by speech and/or language impairment with relatively spared cognition. Research investigating behavioral speech-language intervention and methods for cognitive-linguistic assessment in PPA has predominantly centered around monolingual speakers. This gap hinders the widespread adoption of evidence-based approaches and exacerbates the inequities faced by culturally and linguistically diverse populations living with PPA. This scoping review synthesizes the current evidence for assessment and treatment practices in bilingual PPA as well as the operationalization of bilingualism in PPA. Arksey & O'Malley's scoping review methodology was utilized. Information was extracted from each study and entered into a data-charting template designed to capture information regarding operationalization of bilingualism in PPA and assessment and treatment practices. Of the 16 identified studies, 14 reported the results of assessments conducted in both languages. Three studies reported positive naming treatment outcomes. Thirteen studies included English-speaking participants, revealing linguistic bias. Most studies reported age of acquisition, proficiency, and patterns of language use rather than providing an operational definition for bilingualism. Neither formal assessment measures nor clear guidelines for assessment of bilingual PPA currently exist; however, language-specific measures are emerging. Speech-language intervention in bilingual PPA has been relatively unexplored, representing a significant gap in the literature. In order to improve diagnostic and treatment options for bilingual PPA, targeted efforts to increase representation of bilinguals from various sociocultural contexts, as well as those who speak a variety of language pairs, is necessary.

Historical and current aspects of angiovisualization methods in CАD (a literature review)

The aim of the work. To summarize and expand knowledge about current methods used for visualization of coronary arteries, their evolution, capabilities, effectiveness, indications for use, safety for patients, guided by the principles of evidence-based medicine. Coronary artery disease (CАD) is an extremely common clinical cardiovascular disease, which is caused by atherosclerosis of the subepicardial coronary arteries (CAs) and can have both acute and chronic course. The incidence of CАD is increasing every year and getting younger. CАD has not only a high morbidity rate, but also a high mortality rate. In Ukraine, mortality from CАD is the main cause of population mortality. Without timely diagnosis and effective treatment, myocardial infarction or sudden cardiac death may develop. It is possible to ascertain the etiological cause of myocardial ischemia only after visualization of the СAs. A practicing physician is able to visualize the СAs using X-ray contrast coronary angiography or contrast-enhanced computed tomography of the chest. СA visualization methods have been used in clinical practice for more than half a century. The hardware and software are constantly upgraded, the diagnostic options of these methods are improved and expanded, and recommendations regarding their use in general clinical practice are updated. The main task for clinicians is to confirm or rule out the presence of a СA atherosclerotic lesion, as well as to determine its localization, extent, degree of stenosis and its significance for coronary blood flow, the presence of СA calcification, collateral pathways, plaque composition and its internal structure. Only after identifying the anatomical and physiological aspects of the atherosclerotic process in СA, it is possible to choose the right strategy for the treatment of patients by a multidisciplinary heart team including pharmacological therapy, a method of cardiac revascularization, and measures for primary or secondary prevention. Conclusions. CАD is a common disease worldwide. Today, two methods of the CА visualization are available – invasive coronary angiography and non-invasive coronary CT angiography. Further research is needed on the efficacy and safety of different СA imaging methods in CAD. Better results of the diagnostic search depend on both the capabilities of the clinic hardware component and on the optimal sequence for diagnostic processes rationally constructed by physicians.

Ureterosciatic Hernia in Focus: A Narrative Review of the Literature.

Pelvic herniation of the ureter through anatomical musculoskeletal foramina stands out as one of the rarest causes of ureteric obstruction. Historically, most cases have been documented as incidental intraoperative findings. The herniation of the ureter through the sciatic foramen presents as a particularly uncommon variant of this condition, distinguished by its potential to cause life-threatening sepsis or renal failure if not promptly recognized and treated. The diagnostic process remains challenging, attributed partly to the vague initial symptomatology and subtle radiological findings, and second, to the rarity of this condition. This challenge may be further compounded by the lack of a clear description of clinical features and pathways to raise clinician suspicion. In light of these considerations, we conducted this literature review to illuminate this unique cause of obstructive uropathy, aiming to delineate its clinical features and explore common diagnostic and treatment options.

Histamine intoxication in scombroid poisoning

Objective: based on the data of modern domestic and foreign scientific literature, to study the state of the issue of histamine intoxication in scombroid poisoning. Materials and methods: the materials of the works of modern literary sources on this topic are studied. Results: the article presents current information on the development of histamine intoxication in scombroid poisoning. The pathogenetic mechanisms of the disease and its clinical features, possible diagnostic options, principles of therapy are considered. Conclusions: currently, scombroidosis remains an urgent problem, since the absence of specific clinical manifestations and laboratory diagnostics, the similarity of the clinical picture with the symptoms of an IgE allergic reaction to fish are the cause of incorrect diagnosis, underestimation of the clinical symptoms of the disease.

Cavernous haemangioma and mid trimester pregnancy loss leading to severe haemorrhage and hysterectomy: a case report and review of literature.

Cavernous haemangiomas are benign vascular tumours that are known to occasionally involve the female genital tract, including the uterus. They are often underdiagnosed during pregnancy, although they can also lead to severe postpartum or antepartum haemorrhage. Describe our case of an uncommon second-trimester pregnancy loss in a woman with a diffuse cavernous haemangioma of the uterus and cervix and review the wider literature. The review was conducted using MEDLINE, Scopus and PubMed electronic databases from beginning of the database to May 2023, using the following keywords: arteriovenous malformation; cavernous haemangioma/hemangioma; uterine neoplasms; pregnancy complications; abnormal vaginal bleeding. Description of the characteristics of cavernous haemangioma during pregnancy as well as diagnostic criteria and treatment options. Twenty publications were included in the review, which included English-language case reports over a period from 1959 to 2022. No pathognomonic symptoms for cavernous haemangioma of the uterus in a pregnant woman were noted. Complications including massive secondary postpartum haemorrhage, haemoperitoneum, and severe thrombocytopenia with anaemia after delivery were reported. Diagnosis and management during pregnancy can be challenging and requires considerable attention, with a multidisciplinary approach including gynaecologists, radiologists, and pathologists to avoid major complications. An additional case of diffuse cavernous haemangioma of the uterus and cervix is described, that adds to the little existing literature.

Acute spinal cord injury in Africa: exploring the long-term outcomes and future directions of acute spinal cord injury – short communication

Acute spinal cord injury (ASCI), a key factor behind serious sensory, motor, and autonomic dysfunctions, holds on as a fundamental cause of morbidity, psychological disturbances, and high socioeconomic burden. This study sheds light, particularly on the African countries where it is found that traumatic ASCI, mainly due to road traffic accidents, remains the leading cause, with 130 cases per million in this part of the world. Moreover, limited resources, with the lack of funds and equipment, as well as widespread poverty, restrict the availability of suitable diagnostic, management, and treatment options. The weight of the evidence suggests that there is an ultimate need for well-developed infrastructure embracing a multidisciplinary approach to rehabilitation in Africa. Furthermore, international collaborations, posing a significantly wide background for evidence-based information and resources, are indispensable for ASCI prospects and future studies among the African population. The purpose of this study is to fill a part of the persistent gap in the research era regarding the ASCI in Africa and direct future research toward investigating its different aspects as well as exploring its interventional needs.

Abstract C092: PRMT1 promotes pancreatic cancer development and resistance to chemotherapy

Abstract Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal types of cancer due to the lack of early diagnostic markers and effective therapeutic options. While epigenetic gene regulation is critically involved in the development of various types of cancer, its role in development of PDAC and the potential of therapeutically targeting epigenetic regulators remains underexplored. To identify a targetable epigenetic regulator, we utilized public datasets of pancreatic cancer and show that protein arginine methyl transferase 1 (PRMT1) is highly expressed in pancreatic cancer cells and that high expression of PRMT1 is a poor prognosis factor. Using loss of function studies in vitro and in vivo, we show that PRMT1 is essential for promoting cancer cell proliferation and tumorigenesis. We also demonstrate that the loss of PRMT1 relates to global changes in chromatin accessibility and gene expression pattern. Notably, we revealed that high PRMT1 negatively correlates with gemcitabine sensitivity and exhibit that pharmacological inhibition of PRMT1 in combination with gemcitabine had a greater anticancer effect on pancreatic cancer cells. Collectively, we suggest PRMT1 as a key factor of pancreatic cancer development and a potential candidate of chemotherapy. Citation Format: Bomin Ku, David Eisenbarth, Dae-Sik Lim. PRMT1 promotes pancreatic cancer development and resistance to chemotherapy [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr C092.

Iliac endofibrosis in high-performance sports: an interdisciplinary diagnostic challenge

Iliac endofibrosis (IE) is a rare arterial disease in endurance athletes, especially cyclists and triathletes. The diagnosis is considered challenging and the latency from the onset of initial symptoms to diagnosis is often several years. Diagnostic options include determination of the ankle brachial index (ABI) after maximal exercise as a non-invasive procedure, as well as duplex sonography, CT or MRI angiography, and invasive angiography. The aim of this paper is to analyse in more detail this time lag to correct diagnosis from the first description in 1985 to the year 2021, as well as to identify the most important diagnostic tools for practice. Literature research according to PRISMA criteria in PubMed, Web of Science, Cochrane databases, supplemented by a search in Google Scholar up to 10/18/2021. We identified a total of 133 publications that dealt thematically with IE in endurance athletes. In 42 publications (40 case reports and 2 clinical trials), the diagnosis was confirmed intraoperatively, and in 32 (32/42; 74.4%), statements were made about the duration from the onset of the first symptoms to the final diagnosis (mean 45, median 36 months). This latency was constant over the entire observation period from 1985 to 2021, with no trend toward shortening. Twenty-four papers (24/42; 56%) reported detailed results of ABI determination as well as further diagnostic testing. In all cases, the ABI value decreased to less than 0.66 (in 5 case reports, this decrease was measured at rest; in 19 case reports, it occurred after stress), whereas further diagnostic testing by duplex sonography, DSA, MRA, or CTA revealed no abnormal findings in 3 cases (3/24; 12.5%) and showed no more than minor stenosis in 14 cases (14/24; 58.3%). A drop in ABI after exercise is the most reliable method to diagnose iliac endofibrosis. This non-invasive and easy-to-perform examination should be integrated into the performance diagnostics of highly ambitious endurance athletes at risk. This may ideally prevent irreversible vessel wall damage by early diagnosis as well as a reduction of the presumed high number of undetected cases.

An international RAND/UCLA expert panel to determine the optimal diagnosis and management of burn inhalation injury

BackgroundBurn inhalation injury (BII) is a major cause of burn-related mortality and morbidity. Despite published practice guidelines, no consensus exists for the best strategies regarding diagnosis and management of BII. A modified DELPHI study using the RAND/UCLA (University of California, Los Angeles) Appropriateness Method (RAM) systematically analysed the opinions of an expert panel. Expert opinion was combined with available evidence to determine what constitutes appropriate and inappropriate judgement in the diagnosis and management of BII.MethodsA 15-person multidisciplinary panel comprised anaesthetists, intensivists and plastic surgeons involved in the clinical management of major burn patients adopted a modified Delphi approach using the RAM method. They rated the appropriateness of statements describing diagnostic and management options for BII on a Likert scale. A modified final survey comprising 140 statements was completed, subdivided into history and physical examination (20), investigations (39), airway management (5), systemic toxicity (23), invasive mechanical ventilation (29) and pharmacotherapy (24). Median appropriateness ratings and the disagreement index (DI) were calculated to classify statements as appropriate, uncertain, or inappropriate.ResultsOf 140 statements, 74 were rated as appropriate, 40 as uncertain and 26 as inappropriate. Initial intubation with ≥ 8.0 mm endotracheal tubes, lung protective ventilatory strategies, initial bronchoscopic lavage, serial bronchoscopic lavage for severe BII, nebulised heparin and salbutamol administration for moderate-severe BII and N-acetylcysteine for moderate BII were rated appropriate. Non-protective ventilatory strategies, high-frequency oscillatory ventilation, high-frequency percussive ventilation, prophylactic systemic antibiotics and corticosteroids were rated inappropriate. Experts disagreed (DI ≥ 1) on six statements, classified uncertain: the use of flexible fiberoptic bronchoscopy to guide fluid requirements (DI = 1.52), intubation with endotracheal tubes of internal diameter < 8.0 mm (DI = 1.19), use of airway pressure release ventilation modality (DI = 1.19) and nebulised 5000IU heparin, N-acetylcysteine and salbutamol for mild BII (DI = 1.52, 1.70, 1.36, respectively).ConclusionsBurns experts mostly agreed on appropriate and inappropriate diagnostic and management criteria of BII as in published guidance. Uncertainty exists as to the optimal diagnosis and management of differing grades of severity of BII. Future research should investigate the accuracy of bronchoscopic grading of BII, the value of bronchial lavage in differing severity groups and the effectiveness of nebulised therapies in different severities of BII.Graphical

Non-ST-elevation infarction, the stepchild of interventional myocardial salvage: experience of a single institute

The diagnosis of acute myocardial infarction is based on ECG abnormalities besides to chest pain and dyspnea. It is caused by myocardial hypoperfusion, in most patients due to severe coronary artery narrowing or occlusion, but it can also occur without visible coronary artery changes. The non-ST-elevation form (NSTEMI) is usually associated with less complaints compared to the ST-elevation form (STEMI), the ECG changes are not so typical, so its recognition is more difficult in the early stage. Possibility of myocardial cell damage reduction is the restoration of perfusion with coronary intervention. To investigate how much time elapses in acute NSTEMI from the onset of the complaint to the opening of the coronary vasodilator balloon. From 3733 acute coronary interventions performed in NSTEMI between 01. 01. 2016 and 12. 31. 2020, in 1376 patients who underwent percutaneous intervention for the first time, the onset of the complaints, the date of the first medical contact and opening of the balloon, as well as the 30-day or 1-year mortality were known. The median values of the time differences and the mortality data were compared with the similar data of 1718 STEMI patients of this period. The median times were given in hours:minutes, incidence in percent, a two-sample t-test was calculated for the comparison of mortality data. In NSTEMI, the median time between the first medical contact (5:35 vs. 2:05 h:min) and PTCA balloon opening (18:12 vs. 4:05 h:min) was longer compared to the onset of the complaint as in STEMI. Within 2 hours, 21.3% of NSTEMI patients reached the first medical contact and 1.2% had the PTCA balloon opened, in STEMI this ratios were 48.7% and 11.7%. Within 4 hours, these were in NSTEMI 36.3% and 6.1%, in STEMI 64.1% and 46.8%. The 30-day mortality rate in NSTEMI was lower than in STEMI (5.9% vs. 7.9%, p = 0.03), the 1-year rate was higher (16.1% vs. 12.5%, p = 0.004). In 554 primarily admitted patients who met the study criteria, the median P-B time intervals were shorter (10:55 h:min), the mortality data showed a mild but statistically insignificant difference (5.6% at 30 days, 13.9% at 1 year). Based on the 1-year mortality data, NSTEMI cannot be considered less harmful compared to STEMI. After the onset of hypoperfusion, myocardium necrosis proportional to the elapsed time increases the likelihood of subsequent heart failure. For this reason, it seems advisable for patients to reach the intervention center earlier than at present due to the invasive diagnostic and therapeutic options. Orv Hetil. 2023; 164(47): 1865-1870.

Review of the role of biofilms in equine wounds: Clinical indications and treatment strategies

SummaryRecognition of the role that biofilms play in the persistence of wounds and lack of response to therapy in horses is increasing. Prevention of biofilm development in the early stages of wound care involves three primary strategies: wound debridement and cleansing to reduce bacterial counts in the wound bed, appropriate use of advanced wound dressings and implementation of topical antimicrobial agents. Once formed, eradication of biofilms requires elimination to improve the wound environment for contraction and epithelialisation while not further harming the native cells integral to the healing process, which is achieved predominantly through repeated lavage and debridement combined with topical antimicrobial therapy. Pseudomonas, Enterococcus and Staphylococcus bacterial species have been most commonly identified in equine wounds with delayed healing. This review will establish why and how biofilms form, how to recognise clinical indications that biofilms have formed in equine wounds and review current diagnostic options and biofilm‐based wound care strategies to eradicate biofilms. Clinical scenarios for cases in which biofilms developed and were successfully treated will be presented. This review will advance practitioners' understanding of the presence and role of biofilms in equine wounds and provide an updated summary of recommended treatment strategies.

Análisis de coste de pruebas de nueva generación en estadificación de pacientes con cáncer de próstata de alto riesgo

Introduction and objectiveNext-generation imaging tests, such as choline PET/CT and PSMA PET, have shown to increase sensitivity in the detection of nodal and metastatic disease in prostate cancer. However, their use implies an increase in diagnostic costs compared to conventional imaging (CI) tests such as CT and bone scan. The aim of our study was to determine which diagnostic pathway is more cost-effective in high-risk prostate cancer. Material and methodCost-effectiveness analysis of the available imaging tests (CI, Choline/PSMA PET) for the staging of high-risk prostate cancer. Sensitivity and specificity were estimated based on published evidence, and costs were collected from the Management Department. In order to carry out a cost-effectiveness analysis, five diagnostic pathways were proposed estimating the accurate diagnoses. ResultsPSMA PET was the most accurate diagnostic option. The CI diagnostic workup was the most economical and CI+PSMA the most expensive. Analyzing the diagnostic cost-effectiveness ratio, CI+PSMA proved to be the most expensive (€5627.30 per correct diagnosis) followed by PET PSMA (€4987.11), choline (€4599.84) and CI (€4444.22). ConclusionsPSMA PET is the most accurate strategy in staging distant disease in patients with high-risk prostate cancer. Radiotracer uptake tests such as CI have been shown to be the most cost-effective option, followed by choline and PSMA.

Patiëntgerapporteerde zorgverlening voor het grote-trochanterpijnsyndroom

Patient-reported care for the greater trochanteric pain syndrome The greater trochanteric pain syndrome (GTPS) is a condition that mostly affects middle-aged women. At the University Hospitals Leuven (Belgium), many patients consult a physician for this problem. This retrospective cohort study evaluated the technical investigations and treatment options women with GTPS went through before presenting to a university hospital. Despite the fact that GTPS is described as a clinical diagnosis, most patients already underwent technical investigations. In literature, an MRI of the pelvis is often considered the gold standard for the differential diagnosis, but only a minority already got one. The most performed technical investigation was a hip radiography, followed by an ultrasound of the hip. Less than half of the patient population reported they already had physiotherapy with an active exercise program. About 25% received a corticosteroid injection. Both the proposed diagnostic examinations and treatment options for GTPS seem to differentiate among caregivers. This type of descriptive study makes them reflect critically about the care provided.