Diagnostic Success Research Articles

Effectiveness of ADC histogram analysis in the diagnosis of focal liver lesions; is a contrast agent necessary?

Objective: The diagnostic success of apparent diffusion coefficient (ADC) histogram analysis in focal liver lesions, and the effects of quantitative data added to contrast-enhanced abdominal magnetic resonance imaging (MRI) on the diagnostic accuracy were investigated. Materials and Methods: The conventional MRI findings of 524 lesions in total were retrospectively examined. Contrast enhancement kinetics and ADC values for each lesion were found through an image analysis software. Results: Three hundred and fifty (67%) of the lesions were diagnosed as benign and 174 (33%) as malignant. Statistically significant difference was found between the benign and malignant lesion groups in terms of the minimum, maximum and mean ADC values (p<0.001). When optimal thresholds for minimum, maximum and mean ADC were taken as 1.47x10-3mm2/s; 1.85x10-3mm2/s; 1.72x10-3mm2/s respectively, sensitivity was found to be 97%; 83%; 95%, specificity was 100%; 98%; 99%, NPV was 100%; 99%; 99%, and PPV was 93%; 74%; 90%. ADC values added to MRI increased the diagnostic success for metastases (92%→96%), HCC (63%→73%), hemangioma (90%→99%) and FNH (56%→75%). Conclusion: ADC measurement could not show reasonable success in the diagnosis of specific lesions while being successful in the differentiation of benign and malignant lesions. Minimum ADC is more successful than mean and maximum ADC. A non-contrastenhanced MRI protocol based on the ADC measurement applicable to the selected patient group may be helpful.

Diagnostic yield of a portable electrocardiographic device versus 24-hours conventional holter monitoring in the diagnosis of arrhythmic events

Abstract Funding Acknowledgements Type of funding sources: None. Background The study of palpitations, presyncope or dizziness constitutes an important part of the cardiology consultations. These symptoms are nonspecific most of times, and with the usual diagnostic tools (24-hour Holter mainly) it is difficult to reach an accurate diagnosis, since episodes occur erratically once or a few times a month. The Kardia® electrocardiographic monitoring device is a diagnostic tool that allows the patient to self-perform ECG based on symptoms and send it for later review and interpretation by a cardiologist. Purpose We compared the diagnostic yield of the conventional 24-hour Holter monitor versus the Kardia® device in patients undergoing a cardiology study. Methods We conducted a prospective cohort study in 36 patients referred to the cardiology consultation due to palpitations or presyncope. In all of them, a 24-hour Holter was carried out, according to the usual protocol, and then a KardiaMobile® 6L device was given for a month. They received training to perform an ECG (six limb leads) and use the mobile application. The quantitative variables are expressed as means and standard deviation and the qualitative values as percentages. Results The study included 36 patients, of which 66.7% were women and 33.3% men, mean age of 44.2±14.3 years. The most frequent clinical symptom was palpitations (88.9%). Regarding the 24-hour Holter, only 22.2% of patients felt the symptoms for which they consulted during the day they wore it. Only in 19.4% the etiological diagnosis was reached through this method. Regarding the KardiaMobile® device, 72.2% of patients presented symptoms during the month of follow-up. Through the records obtained with this device, the diagnosis was reached in 52.8% of the cases, taking into account that if the patient reported having symptoms at the time the ECG was performed, if the ECG was normal, it was considered a diagnostic success, since the non-cardiological cause of the symptom was demonstrated. The diagnosis implied a therapeutic approach in 30.6% of cases: antiarrhythmic drugs were started in 8 patients, and 4 electrophysiological studies were indicated: in 3 patients for AVRNT ablation and in 1 patient for sustained ventricular tachycardias. Table1 shows a summary of the results. Conclusion Despite the limited number of patients, in our study, the 30-day recording with portable KardiaMobile® monitoring system showed statistically significant superiority (p <0.05) compared to the conventional 24-hour Holter monitor in the etiological diagnosis of palpitations and dizziness in a selected group of patients. It must be borne in mind that this is a relatively young population and the study needs to be extended to a larger number of patients to generalize these conclusions. The main limitation of the KardiaMobile® device is that it requires minimal skills in terms of using a smartphone, so this tool is not extensible to any patient profile.

Application of a custom NGS gene panel revealed a high diagnostic utility for molecular testing of hereditary ataxias.

Hereditary ataxias (HA) are a rare group of heterogeneous disorders. Here, we present the results of molecular testing of a group of ataxia patients using a custom-designed next-generation sequencing (NGS) panel. Due to the genetic and clinical overlapping of hereditary ataxias and spastic paraplegias (HSP), the panel encompasses together HA and HSP genes. The NGS libraries, comprising coding sequences for 152 genes, were performed using KAPA HyperPlus and HyperCap Target Enrichment Kit, sequenced on the MiSeq instrument. The results were analyzed using the BaseSpace Variant Interpreter and Integrative Genomics Viewer. All pathogenic and likely pathogenic variants were confirmed using Sanger sequencing. A total of 29 patients with hereditary ataxias were enrolled in the NGS testing, and 16 patients had a confirmed molecular diagnosis with diagnostic accuracy rate of 55.2%. Pathogenic or likely pathogenic mutations were identified in 10 different genes: POLG (PEOA1, n = 3; SCAE, n = 2), CACNA1A (EA2, n = 2), SACS (ARSACS, n = 2), SLC33A1 (SPG42, n = 2), STUB1 (SCA48, n = 1), SPTBN2 (SCA5, n = 1), TGM6 (SCA35, n = 1), SETX (AOA2, n = 1), ANO10 (SCAR10, n = 1), and SPAST (SPG4, n = 1). We demonstrated that an approach based on the targeted use of the NGS panel can be highly effective and a useful tool in the molecular diagnosis of ataxia patients. Furthermore, we highlight the fact that a sequencing panel targeting both ataxias and HSP genes increases the diagnostic success level.

Results from Genetic Studies in Patients Affected with Craniosynostosis: Clinical and Molecular Aspects.

Background: Craniosynostosis (CS) represents a highly heterogeneous genetic condition whose genetic background has not been yet revealed. The abnormality occurs either in isolated form or syndromic, as an element of hundreds of different inborn syndromes. Consequently, CS may often represent a challenging diagnostic issue. Methods: We investigated a three-tiered approach (karyotyping, Sanger sequencing, followed by custom gene panel/chromosomal microarray analysis, and exome sequencing), coupled with prioritization of variants based on dysmorphological assessment and description in terms of human phenotype ontology. In addition, we have also performed a statistical analysis of the obtained clinical data using the nonparametric test χ2. Results: We achieved a 43% diagnostic success rate and have demonstrated the complexity of mutations’ type harbored by the patients, which were either chromosomal aberrations, copy number variations, or point mutations. The majority of pathogenic variants were found in the well-known CS genes, however, variants found in genes associated with chromatinopathies or RASopathies are of particular interest. Conclusion: We have critically summarized and then optimised a cost-effective diagnostic algorithm, which may be helpful in a daily diagnostic routine and future clinical research of various CS types. Moreover, we have pinpointed the possible underestimated co-occurrence of CS and intellectual disability, suggesting it may be overlooked when intellectual disability constitutes a primary clinical complaint. On the other hand, in any case of already detected syndromic CS and intellectual disability, the possible occurrence of clinical features suggestive for chromatinopathies or RASopathies should also be considered.

A Multidisciplinary Team Approach Is Highly Effective in the Management of Nondiagnostic Bone Tumour Biopsies: A 10-Year Retrospective Review at a Specialist Sarcoma Unit.

Nondiagnostic (ND) biopsies are frequently encountered during the investigation of bone tumours and can lead to treatment delay. We performed a retrospective review of all ND bone tumour biopsies discussed at our regional MDT meeting between 2004 and 2014 with the aim of establishing the incidence of ND biopsies, identifying any factors that could predict the requirement for repeat biopsies, and evaluating the effectiveness of multidisciplinary team (MDT) decisions. We identified 98 ND out of 4949 biopsies. Diagnostic yield (DY) was 98%, 76%, and 40% for the first, second, and third successive biopsy, respectively. With an MDT approach utilising radiological and clinical information, the diagnostic success rate achieved was 99%, 85%, and 80% for the first, second, and third biopsies, respectively. Although a repeat biopsy was only performed in 34% of cases, there were no patients originally diagnosed with a benign lesion that re-presented with the same lesion subsequently being malignant throughout the study period. Malignant primary bone tumours (p < 0.01) and malignant secondary tumours (p=0.02) were more likely to undergo repeat biopsy compared to benign and infective lesions. Upper limb (p=0.04) and lower limb (p=0.03) were more likely than pelvic and spinal tumours to undergo a repeat biopsy. Tumours of haematological origin frequently required multiple biopsies. Our study demonstrated that a specialist MDT approach leads to high diagnostic rates and is a safe and effective method of preventing unnecessary, repeat biopsies where the initial biopsy is ND.

AI and Clinical Decision Making: The Limitations and Risks of Computational Reductionism in Bowel Cancer Screening

Advances in artificial intelligence in healthcare are frequently promoted as ‘solutions’ to improve the accuracy, safety, and quality of clinical decisions, treatments, and care. Despite some diagnostic success, however, AI systems rely on forms of reductive reasoning and computational determinism that embed problematic assumptions about clinical decision-making and clinical practice. Clinician autonomy, experience, and judgement are reduced to inputs and outputs framed as binary or multi-class classification problems benchmarked against a clinician’s capacity to identify or predict disease states. This paper examines this reductive reasoning in AI systems for colorectal cancer (CRC) to highlight their limitations and risks: (1) in AI systems themselves due to inherent biases in (a) retrospective training datasets and (b) embedded assumptions in underlying AI architectures and algorithms; (2) in the problematic and limited evaluations being conducted on AI systems prior to system integration in clinical practice; and (3) in marginalising socio-technical factors in the context-dependent interactions between clinicians, their patients, and the broader health system. The paper argues that to optimise benefits from AI systems and to avoid negative unintended consequences for clinical decision-making and patient care, there is a need for more nuanced and balanced approaches to AI system deployment and evaluation in CRC.

Comparison of arthroscopy versus percutaneous radiofrequency thermal ablation for the management of intra- and juxta-articular elbow osteoid osteoma: case series and a literature review

BackgroundToday, intra-articular and juxta-articular osteoid osteomas are treated with arthroscopy and radiofrequency thermal ablation. However, for the case of an elbow joint, arguments are made for the use of a minimally invasive technique to be the optimal choice. This study aims to analyse our experiences of arthroscopically treated elbow osteoid osteomas and to compare it with the published results of both techniques.MethodsThe retrospective study analyses the patients who underwent elbow arthroscopy ablation of an elbow osteoid osteoma at a single institution from January 2014 until March 2020. Clinical and diagnostic features, success and treatment failure rates, complications and tumour recurrence rates were all compared to 13 studies of intra-articular elbow osteoid osteoma arthroscopic ablation and 15 studies involving radiofrequency thermal ablation of intra-articular osteoid osteoma within different joints.ResultsFour males and two females, with a mean age of 19.3 years, were encompassed. All the patients had immediate postoperative pain relief and improved range of motion. No tumour recurrences were observed during a median of 21.7 months. The literature review yielded 86.4% success rate, 68.2% successful biopsies, one minor complication and no recurrences following the arthroscopic ablation of an elbow osteoid osteoma; while radiofrequency thermal ablation of an intra-articular elbow osteoid osteoma yielded 96.3% success rate, 33.3% successful biopsies, no complications and 3.7% recurrence rate.ConclusionsOur results are consistent with the published literature proving that arthroscopic ablation is an efficient method with low treatment failure rates and no recurrences in treating intra- and juxta-articular elbow osteoid osteomas. Advantages of arthroscopic ablation stem from the ability to visualise and safely deal with the lesion and the joint’s reactive changes resulting in high biopsy rates, no recurrences and better postoperative elbow’s range of motion. Still, the technique selection should be personalised considering the medical expertise of every institution.

Failure of pregnancy in horses and camelids

Determining pregnancy failures in horses and camelids is approached as a diagnostic investigation of an individual animal. Itbegins with the preliminary discussion around expectations of the investigation and apparently, diagnostic success rate is highin horses. However, diagnostic success in camelids is low. General approach from a pathology point of view is to identify severalof noninfectious fetal and fetal membranes’ lesions and then determine the potential infectious causes; agents include viruses,eubacteria, protozoa, and fungi. Bacterial and fungal infections are mostly ascending infections whereas viral and protozoal aresystemic infections. When an infectious cause is excluded, the focus is directed on potential noninfectious causes and particularlythose with detectible lesions. Maternal evaluation, specifically, via endometrial biopsy and examination of fetus and fetal membranes(including umbilical cord) in horses, normally provide an explanation for noninfectious failure of pregnancy in severalcircumstances. Special attention should be given to fetal thyroid gland, tracheal contents, and musculoskeletal system, particularly,the medulla of long bones. In horses, noninfectious failure of pregnancy with no lesions (idiopathic abortion) is observed in asmall percentage of cases. In camelids, it is a common ‘diagnosis.’

Minimally Invasive Excision of Breast Masses under Ultrasound Guidance: A Single Center's Five-Year Experience on the Breast Lesion Excision System.

Background The purpose of this study was to investigate the feasibility of the percutaneous radiofrequency (RF) excision system (BLES) as a primary method of diagnosis and removal of small breast masses. Methods Ninety-six lesions in 95 patients with 50.5 ± 8.4 years of age were treated in a five-year period by a single operator. Inclusion criteria were as follows: size (<20 mm), depth (>10 mm), and indeterminate or suspicious radiological features (74 BI-RADS 3 and 22 BI-RADS 4). The procedure was performed under ultrasound (US) guidance using 6 G retriever probes with 12-, 15-, and 20-mm baskets. Results Lesions were between 5 and 20 (12.3 ± 3.8) mm in length. They were removed at the first attempt in all but one case. The technical success rate was 98.95%, and the diagnostic success rate was 100%. Ninety-one lesions were histologically benign and five were neoplastic. Two lesions that were previously classified as BI-RADS 3 were diagnosed as neoplasia (atypical lobular hyperplasia), and nineteen lesions that were previously classified as BI-RADS 4a were diagnosed as benign. The complete excision rate (presence of tumor-free negative surgical margin) was 40% in neoplastic lesions. There were no major complications. The minor complication rate was 1.58%. No recurrence was observed during 18 months of follow-up. Conclusion BLES delivers surgical quality specimens for confident histopathological examination and is a safe alternative to surgical resection in lesions with suitable size.

Can laboratory parameters be an alternative to CT and RT‐PCR in the diagnosis of COVID‐19? A machine learning approach

In this study, a machine learning‐based decision support system that uses routine laboratory parameters has been proposed in order to increase the diagnostic success in COVID‐19. The main goal of the proposed method was to reduce the number of misdiagnoses in the RT‐PCR and CT scans and to reduce the cost of testing. In this study, we retrospectively reviewed the files of patients who presented to the coronavirus outpatient. The demographic, thoracic CT, and laboratory data of the individuals without any symptoms of the disease, who had negative RT‐PCR test and who had positive RT‐PCR test were analyzed. CT images were classified using hybrid CNN methods to show the superiority of the decision support system using laboratory parameters. Detection of COVID‐19 from CT images achieved an accuracy of 97.56% with the AlexNet‐SVM hybrid method, while COVID‐19 was classified with an accuracy of 97.86% with the proposed method using laboratory parameters.

Sagacious epitope selection for vaccines, and both antibody-based therapeutics and diagnostics: tips from virology and oncology.

The target of an antibody plays a significant role in the success of antibody-based therapeutics and diagnostics, and vaccine development. This importance is focused on the target binding site—epitope, where epitope selection as a part of design thinking beyond traditional antigen selection using whole cell or whole protein immunization can positively impact success. With purified recombinant protein production and peptide synthesis to display limited/selected epitopes, intrinsic factors that can affect the functioning of resulting antibodies can be more easily selected for. Many of these factors stem from the location of the epitope that can impact accessibility of the antibody to the epitope at a cellular or molecular level, direct inhibition of target antigen activity, conservation of function despite escape mutations, and even noncompetitive inhibition sites. By incorporating novel computational methods for predicting antigen changes to model-informed drug discovery and development, superior vaccines and antibody-based therapeutics or diagnostics can be easily designed to mitigate failures. With detailed examples, this review highlights the new opportunities, factors, and methods of predicting antigenic changes for consideration in sagacious epitope selection.

The distribution in joint recesses and adjacent synovial compartments of loose bodies determined on MR and CT arthrographies of ankle joint.

Loose bodies (LBs) are intraarticular free bodies and may cause synovial inflammation.Accurate and complete determination of the number and location of LBs before surgery are very important for effective treatment.The location, number and distribution of LBs in the ankle joint may be determined successfully by high-resolution magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA).For this purpose, MRA and CTA may increase the diagnostic and therapeutic success of the arthroscopy.

Prenatal diagnosis from fetal urine in bladder outlet obstruction: Success rates for traditional cytogenetic evaluation and interphase fluorescence in situ hybridization

Purpose: To determine the optimal approach to the prenatal chromosome analysis of fetal urine from fetuses with bladder outlet obstruction.Methods: Retrospective evaluation of traditional cytogenetic and interphase fluorescence in situ hybridization (FISH) analysis on fetal urine specimens from fetuses with bladder outlet obstruction.Results: Traditional cytogenetic analysis was successful on 71 (95%) of 75 samples, and FISH was informative on 20 (65%) of 31 specimens. The combination of traditional cytogenetic analysis and FISH yielded a 96% diagnostic success rate. The mean turnaround time was 8 days (range 5–14) for traditional cytogenetic analysis and 1.6 days (range 1.0–4.0) for FISH. Chromosome abnormalities were detected in 6 (7.9%) of 76 pregnancies.Conclusion: Traditional cytogenetic analysis achieves a high success rate (95%) and is superior to FISH for chromosome evaluation of fetal urine. However, FISH, when informative, can complement traditional cytogenetics as it will expeditiously rule out common trisomies in fetuses with bladder outlet obstruction.

Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center.MethodsWe included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events.ResultsA total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI 2.693–466.104; p = 0.007) were independently associated with ERCP-related adverse events.ConclusionsERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

Accurate Prediction of Protein Thermodynamic Stability Changes upon Residue Mutation using Free Energy Perturbation

This work describes the application of a physics-based computational approach to predict the relative thermodynamic stability of protein variants, and evaluates the quantitative accuracy of those predictions compared to experimental data obtained from a diverse set of protein systems assayed at variable pH conditions. Physical stability is a key determinant of the clinical and commercial success of biological therapeutics, vaccines, diagnostics, enzymes and other protein-based products. Although experimental techniques for measuring the impact of amino acid residue mutation on the stability of proteins exist, they tend to be time consuming and costly, hence the need for accurate prediction methods. In contrast to many of the commonly available computational methods for stability prediction, the Free Energy Perturbation approach applied in this paper explicitly accounts for solvent effects and samples conformational dynamics using a rigorous molecular dynamics simulation process. On the entire validation dataset, consisting of 328 single point mutations spread across 14 distinct protein structures, our results show good overall correlation with experiment with an R2 of 0.65 and a low mean unsigned error of 0.95 kcal/mol. Application of the FEP approach in conjunction with experimental assessment techniques offers opportunities to lower the time and expense of product development and reduce the risk of costly late-stage failures.

Abstract 9778: Insertable Cardiac Monitoring in Unexplained Syncope Patients is Cost-Saving Compared to External ECG Monitoring Followed by Insertable Cardiac Monitor

Background: Insertable cardiac monitors (ICMs) are recommended early in the evaluation of unexplained syncope patients after a non-diagnostic initial evaluation, and have been demonstrated as cost-effective for arrhythmia detection in this population. However, pathways frequently include short-term external cardiac monitors (ECM) prior to ICM. Objective: We aimed to evaluate the cost-effectiveness of immediate ICM versus a delayed ICM approach (30-day ECM followed by ICM in patients remaining undiagnosed), in unexplained syncope patients in the U.S. Methods: A discrete state Markov model assessed the cost-effectiveness of immediate vs. delayed ICM, from a U.S. payer perspective. Cohort characteristics were informed using the 2008-2016 Optum ® Clinformatics ® U.S. claims database. Syncope recurrence was modeled based on the EasyAs trial, with risks of mortality, injury, and quality of life consequences identified from the literature. ICM data capture was based on data for Reveal LINQ™ ICM. Diagnostic success with ECM was simulated based on the likelihood of monitoring occurring simultaneously to syncopal recurrence and patient adherence. Cost inputs were derived from claims and national average payment data. All diagnostic and arrhythmia-related treatment costs and benefits were modeled over a lifetime horizon, and future costs/effects were discounted at 3% per annum. Results: Immediate ICM was associated with lower lifetime per-patient costs compared to delayed ICM ($36,348 vs.$36,826), and a gain of 0.013 quality-adjusted life-years. This was largely driven by the cost of ECMs in the delayed ICM strategy, totaling $616,600 per 1,000 patients but with a small diagnostic yield such that 92.8%of patients required an ICM. The immediate ICM approach remained the dominant strategy when the assumed patient adherence to prescribed ECM was increased to 100%, and regardless of the choice of initial ECM (1, 2, 14, or 30-day monitor). Cost savings with immediate ICM increased further in scenarios assuming some delayed ICM patients are loss to follow-up after the initial ECM. Conclusions: A strategy of immediate ICM was cost-saving compared to delayed ICM, due to the cost and low diagnostic yield of ECM and the delay in arrhythmia detection and treatment.

Seasonal dynamics and optimal diagnostics of Grapevine red blotch virus in a British Columbian vineyard

Tracking the occurrence and spread of Grapevine red blotch virus (GRBV) depends on robust and reliable diagnostics. Tissue sampling strategy and optimal choice of molecular test are critical for diagnostic success. This study investigated GRBV titres from several grapevine tissues, including roots, buds, cortical scrapings, and leaves, at varying distances from the cordons, and at different times during the growing season and winter dormancy. Two common nucleic acid extraction techniques were compared, a low-cost high-throughput nucleic acid extraction method (GES) and a DNA column purification method. Optimal combinations of sampling parameters were determined for summer and winter diagnostics. In dormant samples, cortical scrapings yielded the highest GRBV titres and produced no false-negatives. In summer samples, basal leaves yielded high GRBV titres throughout the summer months, with only one false negative on the earliest sample date. These two tissues provide the best samples for reliable and reproducible GRBV diagnostics. The crude GES and DNA column purification methods performed comparably well for binary diagnostics, however, the GES method performed poorly in quantitative analysis.

Retrospective evaluation of laboratory findings of suspected paediatric COVID-19 patients with positive and negative RT-PCR

INTRODUCTION: It was observed that the new coronavirus disease had a different clinical course in children compared to adults. Fewer cases and deaths have been reported in children. MATERIAL AND METHODS: All children with suspected COVID-19 who applied to a secondary health care centre were included in this study and blood parameters were compared according to Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) results. This study is a retrospective, cross-sectional study and was conducted by accessing the hospital records of 40 paediatric patients aged 0–16 years. RT-PCR test was performed by isolating Viral RNA with RNA Isolation System after oropharyngeal and nasopharyngeal sam­ples were taken from patients with appropriate sterile swabs and transferred to tubes containing SNP Viral Inactivation Solution. All statistical calculations were done with SPSS 23.0 (SPSS for Windows, Chicago, IL, SA). Mean values of continuous variables were compared between groups using the Mann-Whitney U test. RESULTS: The results were evaluated as 95% confidence interval and p-value &lt; 0.05 and were considered statistically significant. In the light of the blood results of a small number of paediatric cases who applied, the authors tried to determine the parameters that could increase the success in diagnosis in asymptomatic paediatric cases. C-Reactive Protein, ID-dimer (quantitative), leukocytes, monocytes, sodium, mean platelet volume levels were found to be significantly different between the patients with positive and negative COVID test results. CONCLUSIONS: The results of this study reveal that the use of leukocytopenia, monocytopenia and mean platelet volume elevation as diagnostic markers may increase diagnostic success, especially in asymptomatic paediatric COVID-19 patients.

Endoscopic retrograde cholangiopancreatography using short‐type double‐balloon enteroscope: Experience in Hong Kong

To illustrate the efficacy and safety profile of double-balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) using a short enteroscope in patients with surgically altered anatomy. A retrospective study was performed to review the endoscopic outcomes of patients undergoing DBE-assisted ERCP for biliary diseases in Tuen Mun and Pok Oi hospitals in Hong Kong SAR, China from December 2015 to December 2020. Altogether 46 DBE-assisted ERCP procedures were performed in 37 patients. The enteroscopic success rate, defined as reaching the papilla or bilioenteric anastomosis, was 95.7% (95% confidence interval [CI] 85.2%-99.5%), which was significantly lower in patients with intact stomach than in those who had a previous gastrectomy (67% vs 100%, P=0.014). The diagnostic ERCP success rate, defined as performance in an informative cholangiogram, was 84.1% (95% CI 69.9%-93.4%) in cases where it was attempted. Intended biliary therapeutic interventions were successfully performed in 76.1% (95% CI 61.2%-87.4%) of all procedures. Adverse events were reported in six (13.0%) procedures (95% CI 4.9%-26.3%), including the micro-perforation of the intestine in two (4.3%) patients with prior Roux-en-Y gastrectomy, three (6.5%) of acute cholangitis and one (2.2%) of acute pancreatitis. All adverse events were managed successfully using conservative methods except in one case of micro-perforation, which required a laparotomy. DBE-assisted ERCP using a short enteroscope is a promising technique for managing biliary diseases in patients with surgically altered anatomy. It must be performed to avoid perforation, particularly in patients with a Roux-en-Y reconstruction.

Computed Tomography-Navigation™ Electromagnetic System Compared to Conventional Computed Tomography Guidance for Percutaneous Lung Biopsy: A Single-Center Experience.

The aim of our study was to assess the efficacy of a computed tomography (CT)-Navigation™ electromagnetic system compared to conventional CT methods for percutaneous lung biopsies (PLB). In this single-center retrospective study, data of a CT-Navigation™ system guided PLB (NAV-group) and conventional CT PLB (CT-group) performed between January 2017 and February 2020 were reviewed. The primary endpoint was the diagnostic success. Secondary endpoints were technical success, total procedure duration, number of CT acquisitions and the dose length product (DLP) during step ∆1 (from planning to initial needle placement), step ∆2 (progression to target), and the entire intervention (from planning to final control) and complications. Additional parameters were recorded, such as the lesion’s size and trajectory angles. Sixty patients were included in each group. The lesions median size and median values of the two trajectory angles were significantly lower (20 vs. 29.5 mm, p = 0.006) and higher in the NAV-group (15.5° and 10° vs. 6° and 1°; p < 0.01), respectively. Technical and diagnostic success rates were similar in both groups, respectively 95% and 93.3% in the NAV-group, and 93.3% and 91.6% in the CT-group. There was no significant difference in total procedure duration (p = 0.487) and total number of CT acquisitions (p = 0.066), but the DLP was significantly lower in the NAV-group (p < 0.01). There was no significant difference in complication rate. For PLB, CT-Navigation™ system is efficient and safe as compared to the conventional CT method.