Diagnostic Possibilities Research Articles

The possibilities of ultrasound imaging in the diagnosis of follicular neoplasia of the thyroid gland

Thyroid cancer is the most common cancer of the endocrine system. The diagnosis of thyroid cancer has taken a step forward due to the introduction of fine-needle biopsy of the thyroid gland with subsequent evaluation of cytological material using the Bethesda system. One category of this classification traditionally remains a gray area of diagnosis. The detection of a follicular tumor in the cytological material (category IV according to Bethesda) does not allow one to reliably classify the neoplasia as benign or malignant and requires surgical intervention. The traditional informative and widely used method for diagnosing thyroid tumors is ultrasound. However, the sensitivity and specificity of the method varies over a wide range. This review analyzes the literature on the possibilities of ultrasound diagnostics in assessing the malignant potential of follicular tumors of the thyroid gland.

MRI-guided thoraco-abdominal percutaneous needle biopsy: our initial experience.

The aim of this study is to describe the technique and to report early results of thoraco-abdominal biopsies in the Interventional Magnetic Resonance Imaging Suite (IMRIS). We prospectively evaluated patients with indications for MRI-guided biopsy between January 2021 and May 2022. Exclusion criteria were indication for US-/CT-guided biopsy, contraindication to percutaneous biopsy, inability to lie flat for at least 30min, claustrophobic, severe obesity, or non-MRI compatible devices. Biopsies were performed by 3 interventional radiologists, with at least 8years of experience in oncological interventional radiology. Epidemiological, clinical, procedural, and histopathological data were retrospectively collected. From an initial population of 117 patients, 57 patients (32 male, mean age 64 ± 8 y) were finally enrolled. All 57 patients suspected thoraco-abdominal malignant lesions finally underwent MRI-guided percutaneous biopsy. The mean duration of the entire procedure was 37min (range 28-65min); the mean duration of the total needle-in-patient time was 10min (range 6-19min). Technical and clinical success were obtained for all the biopsies performed. Malignancy was demonstrated in 47/57 (82%) cases and benignancy in the remaining 10/57 (18%) cases. No major complications were detected after the biopsies; two minor compliances (severe pain) occurred and were managed conservatively. Our initial experience demonstrated the technical feasibility and the accuracy of MRI-guided biopsies of thoraco-abdominal masses. The reported data associated with the best comfort for the patient and for the operator make the use of MRI a valid alternative to other methods, especially in lesions that are difficult to approach via US or CT. Interventional MRI is one of the most important innovations available for interventional radiologists. This method will broaden the diagnostic and therapeutic possibilities, allowing treatment of lesions up to now not approachable percutaneously. For this, it is necessary to start publishing the data of the few groups that are developing the method. • To evaluate the use of MRI as a guide for percutaneous biopsies of various districts. • Our preliminary experience confirms experience demonstrated the technical feasibility and the accuracy of MRI-guided biopsies of thoraco-abdominal masses. • Interventional MRI can become the reference method for percutaneous biopsies in particular for lesions with difficult percutaneous approach.

Dual-Source Photon-Counting Computed Tomography-Part III: Clinical Overview of Vascular Applications beyond Cardiac and Neuro Imaging.

Photon-counting computed tomography (PCCT) is an emerging technology that is expected to radically change clinical CT imaging. PCCT offers several advantages over conventional CT, which can be combined to improve and expand the diagnostic possibilities of CT angiography. After a brief description of the PCCT technology and its main advantages we will discuss the new opportunities brought about by PCCT in the field of vascular imaging, while addressing promising future clinical scenarios.

The GermanS3 guidelines on dementia

Due to the demographic development, the number of dementia patients in Germany is continuously increasing. The complex care situation of those affected calls for meaningful guidelines. In 2008, the first S3guideline on dementia was published, coordinated by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and the German Association for Neurology (DGN) and accompanied by the Association of the Scientific Medical Societies in Germany (AWMF). An update was published in 2016. In recent years, the diagnostic possibilities for Alzheimer's disease, in particular, have greatly developed and anew disease concept has emerged that includes mild cognitive impairment (MCI) as part of the clinical manifestation of the disease and also enables the diagnosis of Alzheimer's disease in this phase. In the area of treatment, the first causal disease-modifying therapies will likely soon be available. Furthermore, epidemiological studies have also shown that up to 40% of the risks for dementia are dependent on modifiable risk factors, making prevention increasingly more important. In order to do justice to these developments acompletely updated S3guideline on dementia is currently being developed, which will be available digitally for the first time in the form of an app and which, in the sense of living guidelines, will enable rapid adjustments to progress in the future.

New guideline and treatment options for hand eczema

Due to its high prevalence and associated socioeconomic consequences, hand eczema is aburden for those affected and for society. The various hand eczema subtypes must be differentiated from each other through structured anamnesis and diagnostics in order to initiate cause-related preventive measures in addition to symptomatic therapy. There are new developments in the diagnosis, prevention, and treatment of hand eczema. The diagnostic possibilities are being expanded through molecular methods. Modern topical and systemic therapies offer promising treatment options for patients with atopic but also chronic hand eczema regardless of the underlying etiology.

Behavioural biases in the interaction with food objects in virtual reality and its clinical implication for binge eating disorder

Cognitive processes play a central role in the development, maintenance and remission in mental disorders, like in Binge Eating Disorder (BED). Insights into cognitive mechanisms reflected by embodied interaction with food and its connections to clinically relevant psychopathology offer new possibilities for translational diagnostics and interventions. We longitudinally investigated the manual interaction with food in a virtual reality (VR) in 31 patients with BED. Patients were assessed at baseline before participating in a randomized-controlled trial (RCT) investigating a computer-based inhibitory control training programme enhanced by transcranial direct current stimulation (tDCS) and at a 6-week follow-up. At both assessments, an experimental VR paradigm was conducted and patients were characterized concerning eating disorder psychopathology, eating behaviour, general impulsivity and food craving. In the experimental task, one of two simultaneously presented objects (food vs. office tools) had to be collected. Food was recognized faster than office tools and subsequent approach behaviour was initiated faster, whereas thereafter, food was collected slower than office tools. Exploratory, we could not find a modulatory effect of applied tDCS on the interaction with food. No relationship between behavioural biases and sample characterizations could be detected. Two different stages in the manual interaction with food were found: a faster first stage that comprises recognition and movement initiation and a slower second stage that comprises controlled handling and may reflect aversive motivational processes. As the behavioural patterns do not change with an ameliorated BED-psychopathology at the second assessment, the task seems insensitive in detecting translational interconnections between behavioural biases and BED-characteristics.Level of evidence: Level I, experimental study.

Дебют системной красной волчанки во время беременности

For a long time, systemic lupus erythematosus remains an insufficiently studied problem of rheumatology, the factors influencing the development and progression of the disease are not clear. The hormonal factor remains one of the possible triggers in the development of the disease in predisposed individuals. The course of pregnancy in patients with systemic lupus erythematosus is always associated with multiple risks. The onset of the disease during pregnancy often leads to the death of the fetus and the threat to the life of the mother. At the present stage, thanks to the possibilities of modern diagnostics and treatment, the prognosis for the life and health of both mother and fetus has improved. A case of the development of systemic lupus erythematosus during pregnancy and successful therapy with corticosteroids and belimumab is presented.

Polish recommendations for diagnosis and therapy of paediatric stroke.

Stroke remains one of the greatest health challenges worldwide, due to a high mortality rate and, despite great progress in its treatment, the significant disability that it causes. Studies conducted around the world show that the diagnosis of stroke in children is often significantly delayed. Paediatric ischaemic arterial stroke (PAIS) is not only a problem that varies greatly in frequency compared to the adult population, it is also completely different in terms of its risk factors, clinical course and outcome. The main reason for the lack of a rapid diagnosis of PAIS is a lack of access to neuroimaging under general anaesthesia. The insufficient knowledge regarding PAIS in society as a whole is also of great importance. Parents and carers of children should always bear in mind that paediatric age is not a factor that excludes a diagnosis of stroke. The aim of this article was to develop recommendations for the management of children with acute neurological symptoms suspected of ischaemic stroke and further treatment after confirmation of the ischaemic aetiology of the problem. These recommendations are based on current global recommendations for the management of children with stroke, but our goal was also to match them as closely as possible to the needs and technical diagnostic and therapeutic possibilities encountered in Poland. Due to the multifactorial problem of stroke in children, not only paediatric neurologists but also a neurologist, a paediatric cardiologist, a paediatric haematologist and a radiologist took part in the preparation of these recommendations.

Dural arteriovenous fistula presenting with stroke-like symptoms and regional cerebral hyperperfusion: a case report

BackgroundNon-hemorrhagic focal neurological deficit is one of the clinical manifestations of intracranial dural arteriovenous fistulas (DAVF). When symptoms appear suddenly, it is difficult to distinguish it from ischemic stroke in certain circumstances, which might easily lead to misdiagnosis. Here, we report a rare case of DAVF with sudden onset sensory aphasia mimicking hyperacute stroke but presented with unexpected regional hyperperfusion on the site corresponding to its symptoms.Case presentationA 76-year-old male with histories of atrial fibrillation and hypertension was admitted to the emergency department due to sudden sensory aphasia. The diagnosis of ischemic stroke was made based on clinical experience after non-contrast CT excluding hemorrhage. As in the absence of clear contraindication, the patient received intravenous thrombolysis. On the cerebral CT perfusion, the left temporal lobe, where the sensory speech center is located, was manifested as regional hyperperfusion. Thrombolysis was subsequently halted, but scheduled cranial imaging indicated hemorrhagic transformation. According to the radiological hint from cranial MRI, the patient was suspected of having DAVF, which was finally confirmed by cerebral digital subtraction angiography.ConclusionWhen DAVF is presented as sudden onset focal neurological deficit, cranial CT perfusion at an early stage might reveal an abnormal hyperperfusion pattern. Clinicians should be aware of the diagnostic possibility of DAVF in this situation and double-review the CT angiography image to reduce missed diagnoses.

Abnormal Dihydrorhodamine Result in a Patient with Diabetes Mellitus, Recurrent Candida Liver Abscesses: Diagnostic Possibilities

A 17-year-old female with type I diabetes mellitus (DM) and a history of recurrent candidal vaginal infections and liver abscesses was assessed fora potential neutrophil oxidative burst defect by DHR flow cytometry. The DHR result was abnormal with significantly decreased MFI (MFI = 9; ref. cutoff: >/ = 60) after stimulation with PMA though all of her neutrophils (99%; ref. cutoff >/ = 95%) showed respiratory burst. This DHR pattern has been previously observed in patients with complete myeloperoxidase deficiency (cMPO), p40phox deficiency and hypomorphic X-linked chronic granulomatous disease (CGD). Genetic evaluation of the genes commonly associated with CGD (CYBB, CYBA, NCF1, NCF2 and NCF4) was negative. It must be noted that many genetic laboratories either do not sequence the NCF1 gene or have limited sequencing to the most commonly observed pathogenic variant in exon 2. Most targeted genetic panels currently do not include MPO (myeloperoxidase) or CYBC1 (Eros). The clinical phenotype of Candida infection in the context of diabetes has been previously reported in 5% of cMPO deficiency. The patient underwent a partial hepatectomy and was initiated on an 8-month course of fluconazole. Three months later, there was a recurrence of hepatic abscesses (Figure 1), requiring treatment with a 12-week course of IV micafungin. Complete MPO deficiency can cause a false-positive result on the DHR assay but the pattern is different from that observed in typical XL- and autosomal recessive CGD. There are two ways of confirming cMPO deficiency, besides genetic testing: 1) staining for MPO in neutrophils in a peripheral smear, or 2) repeating the DHR assay and gating on eosinophils as eosinophil peroxidase can overcome the lack of MPO deficiency and demonstrate a normal oxidative burst. These studies are currently under investigation. In summary, cMPO deficiency should be included in the differential diagnosis of patients with diabetes and invasive Candida infections. Communication with the clinical laboratory is essential to identify the DHR pattern and obtain additional confirmatory testing. From a clinical perspective, cMPO-deficient patients do not require prophylactic antibiotics but they have a high rate of recurrence of fungal infections and require aggressive management with antifungal therapies. [Display omitted]

Исследование связи тепловых и энергетических характеристик монокристаллических солнечных элементов

The paper shows the possibility and results of measuring the thermal resistance junction-to-board of monocrystalline solar cells using the modulation method. Shown the dependance between the solar cell efficiency on temperature and its “junction-to-board” thermal resistance value. Approved the possibility of express solar cells diagnostics based on the thermal resistance measuring results at the input control in the production of solar batteries.

Refinement of three-layer model of a damaged human body for the case of changing the moisture of the banding material

The object of study is a three-layer model of a damaged human body. In the course of the study, it was found that the generally accepted three-layer model of a damaged human body is built, in particular, on the assumption that the characteristics of dressings remain unchanged over time. Therefore, the vast majority of modern research in the field of passive radiometry requires the removal of such materials from the human body during the measurement or considers their characteristics to be unchanged and insignificant. Questions of a possible change in the results of measuring the radiation of the human body due to the use of plaster casts of varying degrees of humidity remain almost unexplored. As a result of the study, the mathematical three-layer model of the damaged human body was refined. An element was introduced into the model that describes the dependence of the attenuation of radio wave energy on the relative humidity of the plaster cast. The refined model makes it possible to increase the accuracy of measuring the temperature of the human body, taking into account the time of applying a plaster cast to it. Unlike the existing ones, the proposed model is based on an experimental study that simulates the measurement of the radiation of a human body with a plaster cast of different degrees of humidity. To refine the model, the obtained experimental data were processed by regression analysis methods. The results of processing the experimental data made it possible to establish the specific type and value of the coefficients of the desired dependence. The use of the obtained results of the study proves the possibility of remote non-invasive express diagnostics of the state of the human body in the presence of plaster-gauze bandages. Providing such an opportunity allows disaster medicine workers to increase the ability to fulfill the so-called “golden hour rule”, as well as to clarify the requirements for a medical radiothermal mapping system

The Urogynecology Section of the Polish Society of Gynecologists and Obstetricians Guideline for the diagnostic assessment of stress urinary incontinence in women.

The aim of the Urogynecology Section of the Polish Society of Gynecologists and Obstetricians (PSGO) was to develop an updated Guideline for the diagnostic assessment of stress urinary incontinence (SUI) in women. Earlier PSGO guidelines and the literature about the diagnostic assessment of SUI, including current international guidelines, were reviewed. As in the earlier guidelines, the diagnostic process was subdivided into the initial and the specialized diagnostics. Patients who required specialized diagnostic testing were identified. Functional diagnostic tests, performed by physiotherapists, were included. Attention was paid to new diagnostic possibilities. Initial diagnostic assessment is sufficient to devise the optimal treatment plan in a number of patients. It also allows to identify which patients will require specialized diagnostics, whose scope is individually tailored to the patient needs and depends on symptom complexity, surgical history, treatment plan, experience of the physician, availability of the equipment, and cost-effectiveness ratio.

SFRP5 as a new cardiovascular biological marker: a literature review

Research into new biological markers may help early diagnosis and effective therapy for cardiology patients. The use of biomarkers to evaluate patients has made a major impact in oncology, but is still in its infancy in the cardiology field. Studies on secreted frizzled-related protein 5 (SFRP5) have revealed its potential use as a marker of cardiovascular pathology. Preclinical studies have highlighted the important role this protein plays in many biological processes. It reduces the proliferation and migration of cardiac fibroblasts and suppresses the Wnt5A/JNK signaling pathway thus reducing the severity of oxidative stress and inflammation. It normalizes nitric oxide production and has several other effects. However, recent clinical studies of SFRP5 have produced conflicting data. Nevertheless, this protein shows promise as a marker for several metabolic and cardiovascular diseases. Preliminary data also suggest SFRP5 may be a therapeutic target. Further study of SFRP5 and its role in cardiovascular pathology is necessary, and will create new diagnostic and prognostic possibilities for this biological marker.

Clinical and neuroimaging laboratory possibilities of diagnostics of vestibulo-atactic syndrome in patients with postmastectomic syndrome

Background. In recent years, the prognosis of survival after treatment for breast cancer (BC) has improved significantly, leading to an increase in the life expectancy of patients and the incidence of long-term side effects of therapy. reducing the risks of complications and developing a unified algorithm for diagnosing cerebral complications are necessary to improve the quality of life of patients.Objective. To correlate the CNS and endothelium damage biomarkers concentration and the functional connectivity of the brain in patients with newly diagnosed vestibulo-atactic syndrome (VAS) and without it in the late period of radical treatment of breast cancer.Design and methods. The study involved 21 patients with VAS in the late postoperative period after radical treatment of breast cancer, as well as a group of healthy volunteers — 17 people. Biomarkers were determined by ELISA. Functional MRI was performed.Results. An increase in markers of CNS damage and endothelial damage (ICAM, PECAM) was noted in patients with post-mastectomy syndrome (PMES) and VAS, compare with control group and PMES without VAS group. The processes of disorganization and the formation and strengthening of interand intrahemispheric connections were noted using fMRI.Conclusion. The development of novel diagnostics methods, including the use of fMRI and the determination of different biomarkers are promising for improvement of the VAS treatment effectiveness in patients with PMES.

Texture Analysis for the Bone Age Assessment from MRI Images of Adolescent Wrists in Boys.

The use of magnetic resonance images (MRI) to assess the age of the patient would extend diagnostic possibilities. The bone age test could then become a routine screening test. Changing the method of determining the bone age would also prevent the patient from taking a dose of ionizing radiation, making the test less invasive. The regions of interest containing the wrist area and the epiphyses of the radius are marked on the magnetic resonance imaging of the non-dominant hand of boys aged 9 to 17 years. Textural features are computed for these regions, as it is assumed that the texture of the wrist image contains information about bone age. The regression analysis revealed that there is a high correlation between the bone age of a patient and the MRI-derived textural features derived from MRI. For DICOM T1-weighted data, the best scores reached 0.94 R2, 0.46 RMSE, 0.21 MSE, and 0.33 MAE. The experiments performed have shown that using the MRI images gives reliable results in the assessment of bone age while not exposing the patient to ionizing radiation.

Abstract 5783: Integration of AI-powered digital pathology and imaging mass cytometry to identify relevant features of the tumor microenvironment

Abstract Digital pathology coupled to artificial intelligence (AI)-powered approaches are receiving great attention in the oncoimmunology field, as their adoption holds promise to improve current diagnostic workflows and potentiate the analytic outputs. In this work, we aimed at combining different histopathological approaches and AI-aided analytic tools to analyze the ecosystem of tumor tissues. By deploying AI-powered standard H&E and high-dimensional imaging-mass cytometry (IMC) to FFPE tissue samples, we could extract quantitative and standardized features that couldn’t have been easily identified and integrated by eye. One tissue microarray (TMA) slide containing 108 spots of NSCLC specimens (both adenocarcinoma and squamous carcinoma) was stained with H&E and scanned through the Axio Scan.Z1 (ZEISS) to generate high-quality virtual images. A deep learning algorithm was trained and applied to H&E images to identify tumor cells. The consecutive tissue section was stained with metal-labeled antibodies and processed through the Hyperion workflow (StandardBiotools), allowing quantitative detection of a panel of 23 markers related to tumor cells (Pan-cytokeratin), tissue architecture (aSMA, Vimentin, CD31, Collagen I, nuclei), CD45+ immune cells, comprehensive of myeloid cells (CD68, CD14, CD16, CD163, CD63, CCR4), lymphoid cells (CD3, CD4, CD8, FOXP3, CD20) and immune activation (S100A8, HLA-DR, Granzyme-B, KI67, Arginase-1). Data were exported as MCD files, visualized using the MCD viewer and further analyzed with the Qupath software. Cell segmentation was performed by the CellProfiler and Ilastik softwares and main cell populations were identified by a supervised approach through Cytomap. On H&E images, we generated a classifier of tumor heterogeneity, by exploring the spatial localization of tumor cells with the K-function summary statistic, which analyzes the distribution of tumor cells as a function of their distance. The resulting K-score value was then used to classify each tumor spot as diffuse, poorly clustered or highly clustered. Multiparametric computational analysis of the IMC images allowed to grasp immune and stromal classifiers, including frequency of immune cell populations in the tumor nests versus fibrotic stroma and immune cell interactions. In conclusion, AI-powered analysis of H&E slides is a robust approach that can improve manual scoring and unlock tissue relevant features opening to new diagnostic possibilities. Meanwhile, the analysis of the immune ecosystem by multiparametric imaging mass cytometry allows investigating spatial patterns and cell interactions at single-cell level. Integration of these approaches is feasible and allows the identification of tumor patient profiles with clinical relevance. Citation Format: Alessandra Rigamonti, Marika Viatore, Rebecca Polidori, Marco Erreni, Maria Fumagalli, Daoud Rahal, Massimo Locati, Alberto Mantovani, Federica Marchesi. Integration of AI-powered digital pathology and imaging mass cytometry to identify relevant features of the tumor microenvironment. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5783.

Slipped Capital Femoral Epiphysis (SCFE) - diagnosis and treatment

Background
 Slipped Capital Femoral Epiphysis is the most common pathology of the hip joint in preschool children and adolescents consisting of migration of the proximal femoral epiphysis, posteriorly and inferiorly, to the metaphysis (neck of the femur), which occurs through the epiphyseal (growth) cartilage. SCFE occurs with a frequency of 0.33 per 100,000 to 24.58 per 100,000 children aged 8–15 years.
 Purpouse
 The aim of the article is to characterize the disease which is SCFE, draw attention to its etiology, diagnostic and therapeutic possibilities. 
 Materials and methods
 The article was based on scientific publications in the Pubmed database. The database was searched on 12 February 2023 using the phrases 'SCFE', 'Slipped Capital Femoral Epiphysis'. After reading the titles of found articles, 23 publications were selected. After the pre-analysis of the abstracts, 15 full-text works were selected to prepare the article.
 Results 
 Most SCFE is idiopathic. The relationship between the development of SCFE and endocrine disorders, renal dysfunction and Down syndrome has been noted. The displacement is presumed to be caused by the application of a large axial load to the relatively fragile growth plate. Symptoms of the disease may include atraumatic pain in the hip, thigh or knee, especially if accompanied by a limp or inability to support weight. The first imaging test performed is a radiograph. If radiographs do not show changes consistent with SCFE but clinical suspicion is high, the physician may consider magnetic resonance imaging (MRI) for further evaluation. The goal of treating the lesions is to prevent further scaling of the head and to correct the deformity and to avoid osteonecrosis and chondrolysis, so various surgical procedures are used.
 Conclusions 
 SCFE is an insidious disease that should always be ruled out in the diagnosis of hip pain in children. Its early treatment prevents later complications.

Impression Cytology as a Method of Cytological Diagnostics in Ophthalmology. Literature Review

Impression cytology (from the Latin impressio — impact, indentation) is a minimally invasive method of cytological examination of the surface epithelium of the cornea, limbus and conjunctiva using various sorbing applicators for the collection of cellular material. The spectrum of diseases, in the diagnosis of which impression cytology is traditionally used, is mainly associated with pathological processes occurring in the conjunctiva. Such diseases as: Sjogren’s syndrome, dry eye syndrome, mucopolysaccharidosis, vitamin A deficiency, trachoma, squamous cell neoplasia of the ocular surface, etc. With the advent of the concept of limbal epithelial stem cell, new diagnostic possibilities of impression cytology in ophthalmology occurred.

Ultrasound diagnostics: Differentiated vision - upgrading - better reimbursement

Ultrasonography is an imaging modality of great importance in everyday clinical practice. Technical innovations continuously expand the diagnostic and therapeutic possibilities of ultrasonography requiring continuous upskilling of sonographers. Only a small number of practitioners, in hospital and practice settings in Germany, currently have the required level of skills. Therefore, these techniques are not as readily available as would be desirable. A modern high-end ultrasound scanner in the hands of a qualified sonographer is a diagnostic high-tech precision instrument, which can compete with any other imaging modality.In conclusion, basic sonography, as it is currently practised should be separated from high-end sonography, requiring extensive training and better remuneration. In this context the introduction of a new medical board speciality for ultrasonography, "Advanced Ultrasonography", with corresponding upgrading should be recommended for high-end sonography.