Diagnostic Strategies Research Articles

PSMA PET/CT quick procedure guide

The application of PET/CT with radiopharmaceuticals targeting PSMA is significantly transforming the diagnostic and therapeutic strategies of patients with prostate cancer. In Spain, the availability and access to positron-emitting radiopharmaceuticals targeting Prostate-Specific Membrane Antigen (PSMA) have significantly changed in recent months. These changes are affecting their use in diagnostic procedures. As a result, its use within diagnostic protocols for patients with prostate cancer is undergoing significant modifications. In this collective and cooperative document, the authors have selected the most robust evidence accumulated to date to generate a clinical guide to achieve appropriate use of this technology. A format that presents the most frequent clinical situations and the patient profiles in which PSMA PET/CT plays a significant role or will do so in the immediate future has been chosen. It should be taken into account that regulatory restrictions mediate the current indications for its use in Spain, as well as its current cost and the production capacity of radiopharmaceuticals. The guideline presents a review of the established methodology for optimized imaging with each of the radiopharmaceutical variants targeting PSMA and recommendations for structured and accurate reporting of metabolic findings in combination with CT.

Declining translational capacity as a potential driver for oocyte meiotic instability.

Errors during female meiosis lead to embryonic aneuploidy and miscarriage and occur with increasing frequency during aging. The underlying molecular changes that drive female meiotic instability remain a subject of debate. Developing oocytes undergo a tremendous increase in cytoplasmic volume during follicle development and rely on long-lived mRNAs and ribosomes accumulated during this growth phase for subsequent meiotic maturation. In this perspective article, we discuss how the unique reliance on stores of long-lived mRNAs and ribosomes may represent an Achilles' heel for oocyte function, and that alterations that reduce the translational capacity of oocytes could be a factor significantly contributing to meiotic instability. Understanding these mechanisms could lead to new diagnostic and therapeutic strategies to improve fertility outcomes.

Bone and joint infections due to melioidosis; diagnostic and management strategies to optimise outcomes.

Melioidosis, a life-threatening infection caused by the gram negative bacterium Burkholderia pseudomallei, can involve almost any organ. Bone and joint infections (BJI) are a recognised, but incompletely defined, manifestation of melioidosis that are associated with significant morbidity and mortality in resource-limited settings. We identified all individuals with BJI due to B. pseudomallei managed at Cairns Hospital in tropical Australia between January 1998 and June 2023. The patients' demographics, their clinical findings and their treatment were correlated with their subsequent course. Of 477 culture-confirmed cases of melioidosis managed at the hospital during the study period, 39 (8%) had confirmed BJI; predisposing risk factors for melioidosis were present in 37/39 (95%). However, in multivariable analysis only diabetes mellitus was independently associated with the presence of BJI (odds ratio (95% confidence interval): 4.04 (1.81-9.00), p = 0.001). BJI was frequently only one component of multi-organ involvement: 29/39 (74%) had infection involving other organs and bacteraemia was present in 31/39 (79%). Of the 39 individuals with BJI, 14 (36%) had osteomyelitis, 8 (20%) had septic arthritis and 17 (44%) had both osteomyelitis and septic arthritis; in 32/39 (83%) the lower limb was involved. Surgery was performed in 30/39 (77%). Readmission after the initial hospitalisation was necessary in 11/39 (28%), 5/39 (13%) had disease recrudescence and 3/39 (8%) had relapse; 4/39 (10%) developed pathological fractures. ICU admission was necessary in 11/39 (28%) but all 11 of these patients survived. Only 1/39 (3%) died, 138 days after admission, due to his significant underlying comorbidity. The case-fatality rate from melioidosis BJI in Australia's well-resourced health system is very low. However, recrudescence, relapse and orthopaedic complications are relatively common and emphasise the importance of collaborative multidisciplinary care that includes early surgical review, aggressive source control, prolonged antibiotic therapy, and thorough, extended follow-up.

Neurological manifestations of Flaviviridae, Togaviridae, and Peribunyaviridae as vector-borne viruses.

Vector-borne viruses pose a significant health problem worldwide, as they are transmitted to humans through the bite of infected arthropods such as mosquitoes and ticks. In recent years, emerging and re-emerging vector-borne diseases have gained attention as they can cause a wide spectrum of neurological manifestations. The neurological manifestations of vector-borne viruses encompass a board spectrum of clinical manifestations, ranging from mild and self-limiting symptoms to severe and life-threatening conditions. Common neurological complications include viral encephalitis, acute flaccid paralysis, aseptic meningitis, and various neuromuscular disorders. The specific viruses responsible for these neurological sequelae vary by geographic region and include Orthoflavivirus nilense, Zika virus, dengue virus, chikungunya virus, Japanese encephalitis virus, and tick-borne encephalitis virus. This review focuses on the pathogenesis of these neurologic complications and highlights the mechanisms by which vector-borne viruses invade the central nervous system and trigger neuroinflammatory responses. Diagnostic challenges and strategies for early detection of neurological manifestations are discussed, emphasising the importance of clinical suspicion and advanced laboratory testing.

Advancing personalized medicine: Integrating statistical algorithms with omics and nano-omics for enhanced diagnostic accuracy and treatment efficacy

Medical laboratory services enable precise measurement of thousands of biomolecules and have become an inseparable part of high-quality healthcare services, exerting a profound influence on global health outcomes. The integration of omics technologies into laboratory medicine has transformed healthcare, enabling personalized treatments and interventions based on individuals' distinct genetic and metabolic profiles. Interpreting laboratory data relies on reliable reference values. Presently, population-derived references are used for individuals, risking misinterpretation due to population heterogeneity, and leading to medical errors. Thus, personalized references are crucial for precise interpretation of individual laboratory results, and the interpretation of omics data should be based on individualized reference values. We reviewed recent advancements in personalized laboratory medicine, focusing on personalized omics, and discussed strategies for implementing personalized statistical approaches in omics technologies to improve global health and concluded that personalized statistical algorithms for interpretation of omics data have great potential to enhance global health. Finally, we demonstrated that the convergence of nanotechnology and omics sciences is transforming personalized laboratory medicine by providing unparalleled diagnostic precision and innovative therapeutic strategies.

Antibody-mediated rejection in post-liver transplant clinical care: Are we there yet for timely diagnosis and treatment?

With improvements in medical management and surgical technique in the field of solid organ transplantation, many historically prominent causes of liver allograft injury have been ameliorated or, in the case of Hepatitis C virus, eliminated altogether. In this transformed clinical landscape, antibody-mediated rejection (AMR) has emerged as a defining barrier to maintenance of long-term liver allograft function. The liver's unique anatomy, high regenerative capacity, and tolerogenic immunological environment tend to mitigate the severest AMR manifestations. Consequently, the clinical importance of AMR in the liver has been recognized more slowly than for other solid organ allografts. Significant strides have been made in elucidating clinical and histopathologic features of acute and chronic liver AMR, with the Banff 2016 criteria among the most notable. However, current histopathologic definitions of AMR are lacking in sensitivity and specificity. C4d staining is an imperfect biological surrogate for antibody-mediated injury, and suffers from significant technical limitations. The frequent co-occurrence of T cell mediated rejection and non-immunologic allograft damage (including recurrence of primary disease) also hinders definitive identification of AMR and results in misattribution of its effects. The goal of this review is to summarize the current understanding of AMR in the context of liver transplantation, including risk factors, pathogenesis, and current diagnostic and treatment strategies. Potential directions of future research are also addressed.

Rapid identification of chemical components and screening of acetylcholinesterase inhibitors from Dalbergia odorifera based on mass defect and diagnostic ion filtering strategy, affinity ultrafiltration, and liquid chromatography-tandem mass spectrometry.

Dalbergia odorifera is a natural product rich in pharmacological ingredients, but the comprehensive characterization and rapid profiling of active components remain a challenge. Thus, an integrated data mining and identification strategy was exploited to efficiently identify the chemical constituents and screen acetylcholinesterase inhibitors (AChEIs) through affinity ultrafiltration and ultra-high-performance liquid chromatography-mass spectrometry (AUF-UHPLC-MS). As a result, polygonal mass defect filtering, diagnostic product ions, and neutral loss rules were created for rapid structural classification and component identification. A total of 140 flavonoids were tentatively characterized, including 41 isoflavonoids, 23 flavanones, 21 isoflavans, 19 flavones and flavonols, 13 neoflavonoids, 11 isoflavanones, seven flavone glycosides, and five chalcones. Subsequently, six natural AChEIs including tectorigenin, fisetin, dalbergin, pterostilbene, isoliquiritigenin, and biochanin A were screened out using AUF-UHPLC-MS and molecular docking. Meanwhile, the AChE inhibitory activities of the six compounds were assessed in vitro, tectorigenin, fisetinand, and dalbergin have moderate inhibitory activity. In conclusion, a novel strategy for systematic characterization and further screening of active compounds in natural products was established, which provides a material basis for quality control of Dalbergia odorifera.

Advancing personalized medicine: Integrating statistical algorithms with omics and nano-omics for enhanced diagnostic accuracy and treatment efficacy

Medical laboratory services enable precise measurement of thousands of biomolecules and have become an inseparable part of high-quality healthcare services, exerting a profound influence on global health outcomes. The integration of omics technologies into laboratory medicine has transformed healthcare, enabling personalized treatments and interventions based on individuals' distinct genetic and metabolic profiles. Interpreting laboratory data relies on reliable reference values. Presently, population-derived references are used for individuals, risking misinterpretation due to population heterogeneity, and leading to medical errors. Thus, personalized references are crucial for precise interpretation of individual laboratory results, and the interpretation of omics data should be based on individualized reference values. We reviewed recent advancements in personalized laboratory medicine, focusing on personalized omics, and discussed strategies for implementing personalized statistical approaches in omics technologies to improve global health and concluded that personalized statistical algorithms for interpretation of omics data have great potential to enhance global health. Finally, we demonstrated that the convergence of nanotechnology and omics sciences is transforming personalized laboratory medicine by providing unparalleled diagnostic precision and innovative therapeutic strategies.

Metagenomic analysis of the gut virome in patients with irritable bowel syndrome.

Irritable bowel syndrome (IBS), a chronic functional gastrointestinal disorder, is recognized for its association with alterations in the gut microbiome and metabolome. This study delves into the largely unexplored domain of the gut virome in IBS patients. We conducted a comprehensive analysis of the fecal metagenomic data set from 277 IBS patients and 84 healthy controls to characterize the gut viral community. Our findings revealed a distinct gut virome in IBS patients compared to healthy individuals, marked by significant variances in between-sample diversity and altered abundances of 127 viral operational taxonomic units (vOTUs). Specifically, 111 vOTUs, predominantly belonging to crAss-like, Siphoviridae, Myoviridae, and Quimbyviridae families, were more abundant in IBS patients, whereas the healthy control group exhibited enrichment of 16 vOTUs from multiple families. We also investigated the interplay between the gut virome and bacteriome, identifying a correlation between IBS-enriched bacteria like Klebsiella pneumoniae, Fusobacterium varium, and Ruminococcus gnavus, and the IBS-associated vOTUs. Furthermore, we assessed the potential of gut viral signatures in predicting IBS, achieving a notable area under the receiver operator characteristic curve (AUC) of 0.834. These findings highlight significant shifts in the viral diversity, taxonomic distribution, and functional composition of the gut virome in IBS patients, suggesting the potential role of the gut virome in IBS pathogenesis and opening new avenues for diagnostic and therapeutic strategies targeting the gut virome in IBS management.

Emerging Biohybrids of Aptamer-Based Nano-Biosensing Technologies for Effective Early Cancer Detection.

Cancer is a leading global cause of mortality, which underscores the imperative of early detection for improved patient outcomes. Biorecognition molecules, especially aptamers, have emerged as highly effective tools for early and accurate cancer cell identification. Aptamers, with superior versatility in synthesis and modification, offer enhanced binding specificity and stability compared with conventional antibodies. Hence, this article reviews diagnostic strategies employing aptamer-based biohybrid nano-biosensing technologies, focusing on their utility in detecting cancer biomarkers and abnormal cells. Recent developments include the synthesis of nano-aptamers using diverse nanomaterials, such as metallic nanoparticles, metal oxide nanoparticles, carbon-derived substances, and biohybrid nanostructures. The integration of these nanomaterials with aptamers significantly enhances sensitivity and specificity, promising innovative and efficient approaches for cancer diagnosis. This convergence of nanotechnology with aptamer research holds the potential to revolutionize cancer treatment through rapid, accurate, and non-invasive diagnostic methods.

Fault diagnosis of landing gear retraction system with bond graph under uncertain conditions.

Given the lack of sufficient historical data for aircraft landing gear retractor systems, a model-based fault diagnosis approach is needed to overcome this data deficiency. Meanwhile, inherent uncertainties are inevitable in engineering practice, and it is a great challenge to construct a model that accurately reflects the complexity of the actual system under uncertain conditions. Due to the urgent need for reliable model-based diagnostic methods and the need to cope with inherent uncertainties, this paper proposes an improved fault diagnostic method aimed at increasing the diagnostic efficiency of the landing gear retractor system, a critical component in aircraft take-off and landing operations. Due to a lack of historical data, the model-based fault diagnosis method can solve the problem of lack of data. The proposed uncertainty method addresses the challenge of multiple sources of uncertainty by using subsystems to reduce complexity. Fault diagnosis is achieved by comparing residuals with thresholds derived from a diagnostic bond graph (DBG) model. To address the problem of limited fault data, we modeled and simulated the landing gear retractor system using AMESim®. In addition, the linear fractional transform (LFT) approach has been used to resolve parametric uncertainties, but is unable to resolve system structural uncertainties. Therefore, we also analyzed the comparative fault diagnosis results derived from the linear fractional transformation-DBG (LFT-DBG) and the subsystem-DBG approaches. The experimental results support the effectiveness of the subsystem approach in improving fault diagnosis accuracy and reliability, highlighting its potential as a viable diagnostic strategy in aerospace engineering applications.

Exploring urinary proteomics and peptidomics biomarkers for the diagnosis of mekong schistosomiasis

Schistosomiasis caused by Schistosoma mekongi is one of the causative agents of human blood fluke infection in the lower Mekong River. Traditionally, the detection of egg morphology in stool samples has served as the prevailing method for diagnosing Schistosoma infection. Nonetheless, this approach exhibits low sensitivity, particularly in early infection detection. Urine has been extensively studied as a noninvasive clinical sample for diagnosing infectious diseases. Despite this, urine proteomic analysis of S. mekongi infection has been less investigated. This study aimed to characterize proteins and peptides present in mouse urine infected with S. mekongi both before infection and at intervals of 1, 2, 4, and 8 weeks post-infection using mass spectrometry-based proteomics. Proteomics analysis revealed 13 up- and only one down-regulated mouse protein consistently found across all time points. Additionally, two S. mekongi uncharacterized proteins were detected throughout the infection period. Using a peptidomics approach, we consistently identified two peptide sequences corresponding to S. mekongi collagen alpha-1(V) in mouse urine across all time points. These findings highlight the potential of these unique proteins, particularly the S. mekongi uncharacterized proteins and collagen alpha-1(V), as potential biomarkers for early detection of S. mekongi infection. Such insights could significantly advance diagnostic strategies for human Mekong schistosomiasis.

The Epileptic Heart Syndrome: Epidemiology, pathophysiology and clinical detection

Population studies report elevated prevalence of cardiovascular disease in patients with chronic epilepsy. Multiple pathophysiologic processes have been implicated, including accelerated atherosclerosis, myocardial infarction, altered autonomic tone, heart failure, atrial and ventricular arrhythmias, and hyperlipidemia. These deleterious influences on the cardiovascular system have been attributed to seizure-induced surges in catecholamines and hypoxemic damage to the heart and coronary vasculature. Certain antiseizure medications can accelerate heart disease through enzyme-inducing increases in plasma lipids and/or increasing risk for life-threatening ventricular arrhythmias as a result of sodium channel blockade. In this review, we propose that this suite of pathophysiologic processes constitutes “The Epileptic Heart Syndrome.” We further propose that this condition can be diagnosed using standard electrocardiography, echocardiography, and lipid panels. The ultimate goal of this syndromic approach is to evaluate cardiac risk in patients with chronic epilepsy and to promote improved diagnostic strategies to reduce premature cardiac death.

Large-Scale Outbreak of Mycoplasma pneumoniae Infection, Marseille, France, 2023-2024.

We report a large-scale outbreak of Mycoplasma pneumoniae respiratory infections encompassing 218 cases (0.8% of 26,449 patients tested) during 2023-2024 in Marseille, France. The bacterium is currently circulating and primarily affects children <15 years of age. High prevalence of co-infections warrants the use of a syndromic diagnostic strategy.

CLINICAL PROFILE OF PATIENTS WITH HEMOPTYSIS AT A TERTIARY CARE CENTRE IN CENTRAL INDIA: A RETROSPECTIVE STUDY OF 47 CASES

Background: Hemoptysis, the expectoration of blood from the respiratory tract, is a symptom with a wide spectrum of underlying causes, ranging from benign to life-threatening conditions. Understanding the clinical characteristics of these patients is vital for prompt diagnosis and effective management, particularly in tertiary care centers where complex cases are prevalent. Objective: To analyze the clinical presentations, diagnostic findings, and outcomes of patients presenting with hemoptysis at a tertiary care center. Materials and Methods: This retrospective observational study was conducted from January 2022 to December 2023 in the respiratory medicine department of a tertiary care center. A total of 47 patients aged over 18 years with confirmed hemoptysis were included. Data were collected from medical records, covering demographic details, clinical presentation, laboratory and radiological findings, bronchoscopy results, treatment methods, and outcomes. Descriptive statistics were employed to summarize the data. Results: The study cohort consisted of 47 patients with a mean age of 52 ± 14 years 60% were male. Acute hemoptysis was observed in 64% of cases. Hemoptysis severity was categorized as mild in 43%, moderate in 32%, and massive in 25% of patients. Common associated symptoms included cough (85%), fever (60%), weight loss (32%), chest pain (26%), and dyspnea (53%). Smoking history was present in 60% of patients. The predominant underlying conditions were COPD (30%), bronchiectasis (21%), tuberculosis (15%), lung cancer (11%), cardiovascular diseases (11%), and other conditions (13%). Abnormalities were detected in 74% of chest X-rays and 89% of CT scans, which included findings such as consolidation, cavitation, masses, and bronchiectasis. Bronchoscopy was performed in 51% of patients, with a diagnostic yield of 64%, revealing endobronchial lesions, bleeding sites, and inflammation. Management and Outcomes: Medical management included antibiotics (43%), bronchodilators (32%), steroids (19%), antitubercular therapy (15%), and anticoagulant reversal (6%). Interventional procedures, such as bronchial artery embolization, were performed in 11% of patients, and surgical resection was referred for 4% of patients. Hemoptysis resolution was achieved in 81% of cases, with a recurrence rate of 11% and a mortality rate of 6%. Discussion: COPD and bronchiectasis were the leading causes of hemoptysis, highlighting the prevalence of chronic respiratory diseases in the studied population. The significant diagnostic yield of CT chest and bronchoscopy underscores their importance in evaluating hemoptysis. Effective medical management was achieved in most cases, while interventional procedures were critical for controlling massive hemoptysis. The study identifies challenges in managing massive and recurrent hemoptysis and suggests the need for standardized management protocols. Conclusion: Hemoptysis in a tertiary care setting is frequently associated with chronic respiratory diseases such as COPD and bronchiectasis. Comprehensive diagnostic approaches, particularly CT chest and bronchoscopy, are crucial for effective management. Early identification and treatment of the underlying causes are essential for improving patient outcomes. The findings underscore the need for developing clinical guidelines and conducting further research on innovative diagnostic and therapeutic strategies.

CLINICAL PROFILE OF PATIENTS WITH HEMOPTYSIS AT A TERTIARY CARE CENTRE IN CENTRAL INDIA: A RETROSPECTIVE STUDY OF 47 CASES

Background: Hemoptysis, the expectoration of blood from the respiratory tract, is a symptom with a wide spectrum of underlying causes, ranging from benign to life-threatening conditions. Understanding the clinical characteristics of these patients is vital for prompt diagnosis and effective management, particularly in tertiary care centers where complex cases are prevalent. Objective: To analyze the clinical presentations, diagnostic findings, and outcomes of patients presenting with hemoptysis at a tertiary care center. Materials and Methods: This retrospective observational study was conducted from January 2022 to December 2023 in the respiratory medicine department of a tertiary care center. A total of 47 patients aged over 18 years with confirmed hemoptysis were included. Data were collected from medical records, covering demographic details, clinical presentation, laboratory and radiological findings, bronchoscopy results, treatment methods, and outcomes. Descriptive statistics were employed to summarize the data. Results: The study cohort consisted of 47 patients with a mean age of 52 ± 14 years 60% were male. Acute hemoptysis was observed in 64% of cases. Hemoptysis severity was categorized as mild in 43%, moderate in 32%, and massive in 25% of patients. Common associated symptoms included cough (85%), fever (60%), weight loss (32%), chest pain (26%), and dyspnea (53%). Smoking history was present in 60% of patients. The predominant underlying conditions were COPD (30%), bronchiectasis (21%), tuberculosis (15%), lung cancer (11%), cardiovascular diseases (11%), and other conditions (13%). Abnormalities were detected in 74% of chest X-rays and 89% of CT scans, which included findings such as consolidation, cavitation, masses, and bronchiectasis. Bronchoscopy was performed in 51% of patients, with a diagnostic yield of 64%, revealing endobronchial lesions, bleeding sites, and inflammation. Management and Outcomes: Medical management included antibiotics (43%), bronchodilators (32%), steroids (19%), antitubercular therapy (15%), and anticoagulant reversal (6%). Interventional procedures, such as bronchial artery embolization, were performed in 11% of patients, and surgical resection was referred for 4% of patients. Hemoptysis resolution was achieved in 81% of cases, with a recurrence rate of 11% and a mortality rate of 6%. Discussion: COPD and bronchiectasis were the leading causes of hemoptysis, highlighting the prevalence of chronic respiratory diseases in the studied population. The significant diagnostic yield of CT chest and bronchoscopy underscores their importance in evaluating hemoptysis. Effective medical management was achieved in most cases, while interventional procedures were critical for controlling massive hemoptysis. The study identifies challenges in managing massive and recurrent hemoptysis and suggests the need for standardized management protocols. Conclusion: Hemoptysis in a tertiary care setting is frequently associated with chronic respiratory diseases such as COPD and bronchiectasis. Comprehensive diagnostic approaches, particularly CT chest and bronchoscopy, are crucial for effective management. Early identification and treatment of the underlying causes are essential for improving patient outcomes. The findings underscore the need for developing clinical guidelines and conducting further research on innovative diagnostic and therapeutic strategies.

Thyroid cancer and pregnancy: a systematic ten-year-review.

Thyroid cancer is the second most common malignancy during pregnancy, especially the well-differentiated thyroid cancer (well-DTC). Therefore, complex medical and social dilemmas arise, dealing with which requires deep knowledge of the nature and characteristics of the disease and pregnancy as a whole. The purpose of this review is to present the diagnostic and therapeutic strategies of thyroid cancer during pregnancy and the postpartum period. Extended review of the literature [2011-2023] was performed. Two hundred ninety-six articles were found, from which 225 were excluded due to irrelevant subjects. Seventy-one articles were assessed for eligibility, from which 33 articles were cohort studies and case reports and were included in the review. From the 33 included studies, 18 were retrospective cohort studies, 1 was cohort study, 2 were case control studies, 1 was meta-analysis and 11 were case reports. The primary endpoints of these studies refer to the progression and recurrence of DTC during pregnancy, the prevalence of thyroid cancer in pregnancy and the most appropriate time for surgical intervention. The majority of the studies agree that well-differentiated tumors with mild clinical and imaging characteristics do not require immediate surgical treatment, but mere monitoring. Surgery can be delayed after childbirth. In contrast, tumors with aggressive behavior as well as non-differentiated ones, require immediate surgery because delay under these circumstances can dramatically reduce survival rates. Finally, a history of thyroid cancer does not seem to affect future deliveries, on condition that no residual disease exists at the onset of pregnancy.

Pathological and imaging features of pulmonary invasive mucinous adenocarcinoma-a retrospective cohort study.

Pulmonary invasive mucinous adenocarcinoma (IMA) is a rare subtype of lung cancer which is easily misdiagnosed as inflammatory nodules, tuberculosis, pulmonary diffuse lesions, or hamartomas due to the lack of clinical specificity. This study aims to identify the pathological and imaging characteristics of IMA, which will favor to improve the diagnostic and therapeutic efficacy. A retrospective study was conducted by enrolling patients histopathologically diagnosed with pulmonary IMA in the current study between January 2014 and December 2021. The clinical pathological and radiological data were collected for analysis to evaluate the radiological patterns and pathological and molecular characteristics of IMA. A total of 136 patients were included in the study, of whom 58 were male and 78 were female. The patients had an average age of 63.0±9.7 years. The tumors were classified into the following three pathological types: pure mucinous (76 cases) featured by only mucinous cells observed under the microscope; mixed mucinous (23 cases) featured as an attached-wall, papillary, acinar, and solid tumor cells with more than 10% mucinous cells.; and mucinous-absent (29 cases) featured with the absence of mucous cells, but still can detect more than 10% of mucin expresses. In terms of the morphological classification based on the CT scans, 88 (64.7%) cases were identified as the nodular type, 31 (22.8%) as the inflammatory type, 15 (11.1%) as the mass-like type, and two (1.5%) as the diffuse type. For the molecular features, patients afflicted with IMA showed much lower levels of thyroid transcription factor-1 (15%) than those with usual adenocarcinoma (over 80%). However, cytokeratin 20 was more common in IMA (50%) than the usual adenocarcinoma (about 5%). The K-RAS mutation was prevalent in 75% of IMA, which contrasted sharply to its occurrence in a mere 15% of the usual adenocarcinoma. Epidermal growth factor receptor mutations were rarer in IMA (less than 5%) than the usual adenocarcinoma (about 50%). The pathological and imaging features enrich our understanding of the disease's heterogeneity, which will contribute to more personalized diagnostic and therapeutic strategies.

An analysis of HRCT imaging characteristics and sputum culture results in hospitalized patients with community-acquired pneumonia - an institutional observational study

Background and Objectives. Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality worldwide. High-resolution computed tomography (HRCT) and sputum cultures are critical in diagnosing and managing CAP. This study aims to analyze HRCT imaging characteristics and sputum culture results in hospitalized patients with CAP, correlating imaging findings with specific pathogens to enhance diagnostic accuracy and treatment strategies. Materials and Methods. A retrospective analysis was conducted on 133 patients admitted with CAP at a tertiary care center in Chennai in last 12 months. HRCT scans were reviewed for specific imaging patterns, including ground-glass opacities, consolidation, interstitial patterns, and pleural effusion. Sputum samples were collected and cultured for bacterial pathogens. Data on patient demographics, HRCT findings, and sputum culture results were analyzed to identify correlations between imaging patterns and pathogens. Results. The study included 133 patients, with a mean age of 58 years, comprising 78 males (59%) and 55 females (41%). HRCT findings revealed ground-glass opacities in 68% of patients, consolidation in 54%, interstitial patterns in 32%, and pleural effusion in 21%. The most common organisms identified in sputum cultures were Klebsiella pneumoniae (20%), Pseudomonas aeruginosa (22%), Acinetobacter baumannii complex (9%), and E. coli (8%), with 25% of cultures yielding no growth. Ground-glass opacities were predominantly observed in cases with no bacterial growth, suggesting a viral etiology. Consolidation was the most common pattern associated with bacterial infections, particularly Klebsiella pneumoniae and Pseudomonas aeruginosa. Conclusions. This study highlights the importance of HRCT in diagnosing CAP and distinguishing between bacterial and viral infections. The correlation between specific HRCT patterns and pathogens can enhance diagnostic accuracy and guide treatment strategies. Future research should focus on integrating advanced diagnostic modalities and understanding the evolving patterns of CAP etiology to improve patient outcomes.

An overview of the current diagnostic approach to Periprosthetic Joint Infections.

The diagnosis of periprosthetic joint infections (PJI) presents a formidable challenge to orthopaedic surgeons due to its complex and diverse manifestations. Accurate diagnosis is of utmost importance, as even mild pain following joint replacement surgery may indicate PJI in the absence of a definitive gold standard diagnostic test. Numerous diagnostic modalities have been suggested in the literature, and international societies have continually updated diagnostic criteria for this debilitating complication. This review article aims to comprehensively examine the latest evidence-based approaches for diagnosing PJI. Through a thorough analysis of current literature, we explore promising diagnostic strategies that have demonstrated effectiveness in identifying PJI. These strategies encompass the utilization of laboratory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), alongside imaging techniques such as magnetic resonance imaging (MRI) and leukocyte scintigraphy. Additionally, we highlight the importance of synovial fluid analysis, including the potential role of alpha-defensin as a biomarker, and examine evolving international diagnostic criteria to standardize and improve diagnostic accuracy.