Fluid For Diagnosis Research Articles

Clinical utility of metagenomic next-generation sequencing on bronchoalveolar lavage fluid in diagnosis of lower respiratory tract infections

BackgroundIn this study, we aimed to evaluate the clinical utility of Metagenomic Next-Generation sequencing (mNGS) on bronchoalveolar lavage fluid (BALF) in diagnosis of Lower Respiratory Tract Infections (LRTIs).MethodsIn this study, we retrospectively analyzed 186 hospitalized patients who were suspected with LRTIs and performed mNGS (DNA) test of BALF simultaneously at The Fifth Affiliated Hospital of Sun Yat-Sen University from March 2023 to August 2023. Suspected LRTI was based on LRTI related clinical manifestations or imaging examination. Among them, 155 patients had undergone conventional culture and mNGS (DNA) testing simultaneously. Finally, 138 cases (89.03%,138/155) were diagnosed as LRTI and 17 cases (10.97%,17/155) were diagnosed as non-LRTI. Both detecting rate and diagnostic efficacy of mNGS and conventional culture were compared.ResultsThe positive detection rates of pathogens between mNGS and conventional culture were significant different (81.29% VS 39.35%, P < 0.05). Compared with paired conventional culture result, the sensitivity of mNGS in diagnosis of LRTIs was more superior (88.41% VS 43.48%; P < 0.05), the specificity was opposite (76.47% VS 94.12%; P > 0.05). Furthermore, 77.54% and 35.51% of LRTI cases were being etiologically diagnosed by mNGS and culture respectively. Importantly, mNGS directly led to a change of treatment regimen in 58 (37.42%) cases, including antibiotic adjustment (29.68%) and ruling out active infection (7.74%). Moreover, treatment regimen remained unchanged in 97 (62.58%) cases, considering the current antibiotic therapy already covered the detected pathogens (36.13%) or empirical treatment was effective (11.61%).ConclusionsmNGS can identify a wide range of pathogens in LRTIs, with improved sensitivity and being more superior at diagnosing LRTIs etiologically. mNGS has the potential to enhance clinical outcomes by optimizing the treatment regimens.

Application of metagenomic next-generation sequencing of bronchoalveolar lavage fluid in the diagnosis and treatment of refractory pneumonia in children

To investigate the clinical application of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) in the etiological diagnosis and treatment of refractory pneumonia (RTP) in children. A retrospective analysis was performed on 160 children with RTP who were admitted to the Department of Pediatric Internal Medicine, Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, from January 2020 to March 2023. According to whether mNGS was performed, they were divided into two groups: mNGS (n=80) and traditional testing (n=80). All children received the tests of inflammatory markers and pathogen tests after admission. Traditional pathogenicity tests included microbial culture (sputum specimen collected by suction tube), nucleic acid detection of respiratory pathogens, and serological test (mycoplasma, tuberculosis, and fungi). For the mNGS group, BALF specimens were collected after bronchoscopy and were sent to the laboratory for mNGS and microbial culture. The two groups were analyzed and compared in terms of the detection of pathogens and treatment. Compared with the traditional testing group, the mNGS group had a significantly higher detection rate of pathogens (92% vs 58%, P<0.05), with more types of pathogens and a higher diagnostic rate of mixed infections. Compared with the traditional testing group, the mNGS group had a significantly higher treatment response rate and a significantly lower incidence rate of complications during hospitalization (P<0.05). Treatment was adjusted for 68 children in the mNGS group according to the results of mNGS, with a treatment response rate of 96% (65/68) after adjustment. Compared with traditional pathogen tests, BALF mNGS can significantly improve the detection rate of pathogens and find some rare pathogens. In clinical practice, when encountering bottlenecks during the diagnosis and treatment of children with RTP, it is advisable to promptly perform the mNGS to identify the pathogens.

Role of Cell Count of Synovial Fluid in Diagnosis of Joint Disease Compared to Gross Analysis

Joint effusion is a common clinical problem throughout the world. Synovial fluid analysis is one of the most important diagnostic tests to differentiate various inflammatory and non-inflammatory joint diseases. Gross examination and cell count of synovial fluid are two important test modalities. A comparison of performances of the tests would enable us to emphasize on the diagnostic procedures for better outcomes. A total of 105 cases were included in this study, performances of the tests such as accuracy, sensitivity, specificity, positive and negative predictive values of each test modality were calculated for comparison. Joint effusions were diagnosed as 19 rheumatoid arthritis, 12 non- inflammatory, 15 inflammatory, 14 infective, 7 tubercular, 4 traumatic, 6 osteoarthritis, 5 crystal induced arthritis, 6 non- specific arthritis and 8 normal cases. Accuracy, sensitivity, specificity, PPV and NPV of cell count were 76.19%, 72.72%, 94.11%, 98.46% and 40% respectively and accuracy, sensitivity, specificity, PPV and NPV of gross examination were 71.42%, 68.18%, 88.23%, 96.77% and 34.88% respectively. The individual parameters of synovial fluid study overlaps among each other test modalities and a combination of test procedures would yield better performances for diagnosis.

Utility of cell-free DNA from bronchial washing fluid in diagnosis and genomic determination for radiology-suspected pulmonary nodules.

Bronchial washing fluid (BWF) is a less-invasive specimen. Due to the limited sensitivity of BWF cellular component diagnosis, the aim of this study was to explore the potential role of BWF supernatant as a source of liquid biopsy of lung cancer. This prospective study enrolled 76 suspected and 5 progressed lung cancer patients. Transbronchial biopsy tissues, BWF supernatant (BWF_Sup) and BWF precipitant (BWF_Pre) were tested by a targeted panel of 1021 genes. BWF_Sup cell-free DNA (cfDNA) was superior to tissue biopsy and BWF_Pre in determining mutational allele frequency, tumour mutational burden, and chromosomal instability. Moreover, BWF_Sup and BWF_Pre achieved comparable efficacy to tissue samples in differentiating malignant and benign patients, but only BWF_Sup persisted differentiated performance after excluding 55 malignancies pathologically diagnosed by bronchoscopic biopsy. Among 67 malignant patients, 82.1% and 71.6% of tumour-derived mutations (TDMs) were detected in BWF_Sup and BWF_Pre, respectively, and the detectability of TDMs in BWF_Sup was independent of the cytological examination of BWF. BWF_Sup outperformed BWF_Pre in providing more subclonal information and thus might yield advantage in tracking drug-resistant markers. BWF_Sup cfDNA is a reliable medium for lung cancer diagnosis and genomic profiles and may provide important information for subsequent therapeutic regimens.

EFFICACY OF ASCITIC ACID DIPSTICK LEUKOCYTE ESTERASE ACTIVITY IN EARLY DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS

Background: Spontaneous bacterial peritonitis is serious medical complication associated with advanced stage of hepatic cirrhosis and requires quick diagnosis for initiating appropriate antibiotics. Leukocyte esterase reagent dipstick works upon esterase activity of activated granulocytes. This enzyme functions by undergoing reaction with an ester‑releasing hydroxyphenylpyrrole which causes color changes in azo dye coated reagent strip. Aim:The aim of present study was to assess the diagnostic importance of leukocyte esterase reagent dipstick in ascitic fluid for diagnosis of SBP. Materials and Methods: Ascitic fluid sample were obtained from 100 hospitalized patients with liver cirrhosis. PMNL cell count was performed and results were compared with Leukocyte Esterase Dipstick strip test. The strips were observed in 90 seconds by comparing with colorimetric grade scale (from 0 to 4). Results: 99.1% specificity, 100% sensitivity, 93% PPV and 100% NPV were obtained for diagnosing SBP. Conclusion: Leukocytic esterase reagent (dipstick test) is a specific, quick, less expensive as well as simple bed-side method for arriving at diagnosis of spontaneous bacterial peritonitis. Negative strip test can be used for excluding a SBP diagnosis.

Classification tree for the inference of the nursing diagnosis Fluid Volume Excess (00026).

To generate a Classification Tree for the correct inference of the Nursing Diagnosis Fluid Volume Excess (00026) in chronic renal patients on hemodialysis. Methodological, cross-sectional study with patients undergoing renal treatment. The data were collected through interviews and physical evaluation, using an instrument with socio-demographic variables, related factors, associated conditions and defining characteristics of the studied diagnosis. The classification trees were generated by the Chi-Square Automation Interaction Detection method, which was based on the Chi-square test. A total of 127 patients participated, of which 79.5% (101) presented the diagnosis studied. The trees included the elements "Excessive sodium intake" and "Input exceeds output", which were significant for the occurrence of the event, as the probability of occurrence of the diagnosis in the presence of these was 0.87 and 0.94, respectively. The prediction accuracy of the trees was 63% and 74%, respectively. The construction of the trees allowed to quantify the probability of the occurrence of Fluid Volume Excess (00026) in the studied population and the elements "Excessive sodium intake" and "Input exceeds output" were considered predictors of this diagnosis in the sample.

A COMPARATIVE STUDY OF SERUM AND SALIVARY BIOCHEMICAL MARKERS IN DIABETES MELLITUS TYPE II WITH HEALTHY INDIVIDUALS

Introduction: Blood is the gold standard body fluid for diagnosis of Diabetes Mellitus (DM) but saliva can offers an alternative to serum as a biological fluid for diagnostic purposes because it contains serum constituents. People wants that medical science should promote non invasive method for diagnosis of disease.&#x0D; Aim: The study was conducted to estimate and compare serum and salivary glucose, total protein, calcium and phosphorus levels in DM type ll and healthy subjects and to evaluate whether saliva can be used as a diagnostic fluid in DM type ll patients. The target population of this study was individuals who have Type-2 DM for different period of time and resident INDORE.&#x0D; Materials &amp; Methods: Study consisted of 50 subjects from OPD/IPD Index Medical College &amp; Research Center, INDORE, MADHYA PRADESH, India. The study groups were divided into Group I-25 DM patients (TypeII) and Group II-25 healthy subjects. The saliva and serum samples were collected from each subject and levels of different biochemical parameters were estimated.&#x0D; Result: were noted. On comparing values in saliva and serum, among two groups, a significant difference (p&lt;0.005) was found between few of them.&#x0D; Conclusion: Values regarding blood and salivary biochemical parameters were distinctly different between two groups suggesting salivary parameters can be used as a diagnostic alternative to blood parameters for diabetes mellitus.&#x0D;

Special Staining of the Liquid-Based Cytopathology Test in Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis with Nonneutropenic Patients.

In recent years, various biomarkers have been gradually applied on bronchoalveolar lavage (BAL) fluid for the diagnosis of invasive pulmonary aspergillosis (IPA). The objective of this study is to assess the value of the liquid-based cytopathology test (LCT) for improving the identification of IPA in BAL fluid from possible IPA patients, following special staining with periodic acid-Schiff staining (PAS) or Grocott's methenamine silver (GMS). A total of 47 consecutive possible IPA patients who underwent bronchoscopy with BAL fluid from January 2017 to December 2018 were included. 45 people had a pair of BAL fluid specimens and 2 patients had two BAL fluid specimens. The 49 pairs of BAL fluid specimens were processed for culture, tuberculosis acid fast staining smear, direct microbial smear, and LCT with special staining (PAS and GMS), respectively. Then, we compared the sensitivity and specificity of PAS and GMS in BAL fluid in high-risk patients. Among 47 possible IPA patients, 25 patients had proven/probable IPA, and 11 patients had other invasive fungal diseases. The sensitivity of GMS was higher than that of PAS (92.11% versus 81.58%; P = 0.175). The specificity of GMS was 81.82%, which was higher than that of PAS (81.82% versus 72.73%; P = 0.611). The negative predictive value (NPV) for PAS and GMS were 53.33% and 75.00%, respectively. The positive predictive value (PPV) for PAS and GMS were 91.18% and 94.59%, respectively. This study showed that special staining of LCT in BAL fluid may be a novel method for the diagnosis of IPA, and the GMS of LCT had higher sensitivity and specificity, which was superior to PAS.

Adenosine deaminase activity in cerebrospinal fluid for diagnosis of tuberculous meningitis

Adenosine deaminase activity in cerebrospinal fluid for diagnosis of tuberculous meningitis

Evaluation of adenosine deaminase in serum and exudative pleural fluid for diagnosis of HIV seronegative tuberculous pleural effusions

Introduction: Tuberculosis, both pulmonary and extra pulmonary pose great threat to individual health and community economy. The diagnosis of tuberculosis is currently made by a detailed medical history, clinical examination, radiological, microbiological, immunological, biochemical, molecular-biological and histological investigations. The current diagnostic methods either are relatively expensive, feasible, and insufficient or give erroneous results especially while diagnosing extra pulmonary tuberculosis. However recent trials have shown that enzymatic, evaluations in serum and pleural fluid have given excellent diagnostic results in diagnosis of extra pulmonary tuberculosis. Aim: The current study was aimed to evaluate whether analysis of adenosine deaminase enzyme in serum and pleural fluid helps in diagnosis of HIV sero negative tuberculous pleural effusion. Material and Methods: The study encompassed a total of 100 subjects of which 50 patients were known cases of tuberculous pleural effusion and remaining 50 patients served as control subjects Adenosine deaminase was estimated in serum and pleural fluids using kits and auto analyzer. Results: The results were tabled and analyzed using MEDCALC statistical software and are in favor of the study, supporting adenosine deaminase as a reliable marker in diagnosis of sero negative pleural effusions. Conclusion: The current study has indicated that promising positive results can be obtained by estimating levels of Adenosine deaminase enzyme in diagnosis of HIV sero negative pleural effusions. Further the study concludes that testing the adenosine deaminase levels in a cheaper, cost effective diagnostic tool and can be used in large community of individuals with minimal costs. Keywords: Adenosine deaminase, Extrapulmonary tuberculosis, Exudative pleural fluid HIV, seronegative.

Application of MGMT Promoter Methylation of Cerebrospinal Fluid in Diagnosis of Glioma

目的比较胶质瘤患者脑脊液与外周血中MGMT（O6-甲基鸟嘌呤-DNA-甲基转移酶）启动子甲基化在胶质瘤初期诊断中的敏感度和特异性。 方法收集283例胶质瘤患者肿瘤组织及其对应的术前外周血和脑脊液，10例颅脑外伤患者挫伤的脑组织及其对应的术前外周血、脑脊液。MGMT启动子甲基化状态通过甲基化特异性PCR（methylation-specific PCR, MSP）确定，比较脑肿瘤组织，外周血和脑脊液中MGMT启动子甲基化率。 结果不同级别胶质瘤组织MGMT启动子甲基化阳性率分别为68.13%（WHO Ⅱ）、65.69%（WHO Ⅲ）以及67.78%（WHO Ⅳ），三者之间差异无统计学意义（P > 0.05）。胶质瘤瘤体组织、对应的外周血和脑脊液启动子甲基化率为分别为67.14%、44.87%和66.08%，阴性对照组中检测结果均为0。MGMT启动子甲基化阳性瘤体组织，对应的脑脊液中MGMT启动子甲基化敏感度为79.66%（141/177），较对应的外周血58.82%（110/187）高（P 结论术前患者肿瘤组织、脑脊液和外周血中MGMT启动子甲基化率与肿瘤级别无关。与外周血相比，脑脊液中的MGMT启动子甲基化特异性和敏感度更高。

Local retrospective analysis of galactomannan cut-off values in bronchoalveolar lavage fluids for diagnosis of invasive aspergillosis.

Galactomannan antigen (GM) testing has been used for decades to screen immunocompromised patients for invasive aspergillosis (IA). Recent publications suggested that using a higher cut-off value than 0.5 in bronchoalveolar lavage fluid (BALF) could be more discriminant for hematology patients. We retrospectively analyzed the values of GM in BALF over 7years (from 2010 to 2016). Performance indicators of the GM in BALF, according to three different cut-off values (0.5, 0.8, 1.5), were calculated using Stata 14.1. IA classification for hematology patients was based on European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria, as defined in 2008. A number of 716 GM were performed on BALF from 2010 to 2016 (597 patients) and 66 were positive (> 0.5). Among these 597 patients, 27 IA were diagnosed, 13 with a positive GM in BALF, 9 with a negative GM in BALF, and 5 unclassified IA (ICU patients). The analysis of performance indicators, based on our local data, did not demonstrate any significant difference using a higher cut-off value of GM in BALF. This result may be explained by the local recruitment of patients and by pre-analytic variations during BALF realization.

Performance evaluation of detecting circulating tumor cells and tumor cells in bronchoalveolar lavage fluid in diagnosis of peripheral lung cancer.

To evaluate the diagnostic performances of detecting circulating tumor cells (CTCs) and tumor cells in bronchoalveolar lavage fluid (BALF) for peripheral lung cancer. A total of 247 patients with lung cancer and 70 cases with benign lung disease were recruited in this study. Peripheral blood and BALF samples were collected, in which the tumor cells were enriched by negative immunomagnetic selection and detected by fluorescence in situ hybridization (FISH) of chromosome enumeration probe 8 (CEP8). The levels of tumor-associated markers (e.g., CEA, CA125, and NSE) in peripheral blood plasma were measured by using electrochemiluminescence. The numbers of CTCs detected in peripheral blood were significantly higher in patients with lung cancer than those with benign lung disease (5.78±0.57 vs. 1.13±0.39, Z=-8.64, P<0.01). Similarly, tumor cells count in BALF of malignancy were higher than that of benign lesions (6.76±0.89 vs. 0.89±0.23, Z=-6.254, P<0.01). However, as for patients with lung cancer and benign lung disease, the numbers of tumor cells in peripheral blood were comparable with those in BALF (both P>0.05). Detecting CTCs and tumor cells in BALF had similar areas under curves (AUC =0.871 and 0.963, respectively; P>0.05) in discriminating benign lesions from lung cancer (sensitivity 83.8% and 92.6%, specificity 86.5% and 99.9%, respectively), both of which were larger than those of NSE, CEA, and CA125 (AUC =0.564, 0.512 and 0.554, respectively; all P<0.05). The diagnostic performances of discriminating benign lesions and lung cancer in BALF and peripheral blood were both in concordance with that of histopathology (kappa values 0.662 and 0.569, respectively; both P<0.001). Detecting tumor cells in peripheral blood and BALF may sensitive to identify benign and malignant peripheral lung lesions and be of value for early diagnosis of lung cancer.

Use of beta subunit of human chorionic gonadotropin assay as a diagnostic tool for prelabor rupture of membranes

Purpose: The study aimed at assessment of the accuracy of the β-hCG test in vaginal washing fluid for diagnosis of prelabor rupture of membranes (PROM).Patients and methods: Two groups of pregnant women from 17 to 38 weeks of gestation were recruited. The first group (PROM group) included 50 pregnant women with unequivocal PROM. The other group included 50 pregnant women with intact membranes. A sterile speculum examination was performed. If less than 5 cc was collected or no fluid found, 10 cc sterile saline was sprinkled on the vaginal wall and 5 cc were recollected in a sterile syringe. Two drops of collected fluid were used for qualitative testing of β-hCG. The remaining fluid was used for quantitative assessment of β-hCG.Results: The quantitative β-hCG test results were significantly higher in PROM group (median and range: 138.5 (23–475) versus 13 (1–55); the difference in medians and 95% CI: 105 (91–166); p value: <.001). The qualitative β-hCG test was positive in 42/50 (84%) of the PROM group, while it was negative in 50/50 (100%) of the intact membranes group. Areas under receiver operating characteristics (AUC) for both the quantitative and qualitative β-hCG tests were high (0.97, 95% CI: 0.91–0.99, p value: <.001 and .92, 95% CI: 0.84–0.96, p value: <.001, respectively). The suggested cut-off of β-hCG for the quantitative test was 32 mIU/ml. The sensitivity of quantitative and qualitative tests are: 94, 95% CI: 83.5–98.7% and 84, 95% CI: 70.9–92.8%, respectively. The specificity of quantitative and qualitative tests are: 94, 95% CI: 83.5–98.7% and 100, 95% CI: 92.9–100%, respectively.Conclusion: β-hCG test (either quantitative or qualitative) in vaginal washing fluid can be used in the diagnosis of PROM in both preterm and term cases.

Diagnostic accuracy of Bronchoalveolar lavage fluid in diagnosis of lung cancers in a tertiary care hospital in coastal region of Karnataka

Diagnostic accuracy of Bronchoalveolar lavage fluid in diagnosis of lung cancers in a tertiary care hospital in coastal region of Karnataka

A concise assessment of salivary modifications in patients with chronic hepatitis

Background. Saliva is a complex biological fluid that has great potential as a diagnosis fluid for both oral and systemic diseases. At the same time, chronic hepatitis affects millions of people worldwide and can lead to liver cirrhosis and hepatocellular carcinoma. In this context, our research group aimed to evaluate the modifications produced in the saliva of patients with chronic hepatitis compared to healthy subjects. Material and method. The present work included 88 subjects that were divided into 4 groups, each consisting of 22 people. Saliva samples were collected for each participant to the study. Salivary levels of total protein (TP), IgA, IgG and aminotransferases AST (aspartate aminotransferase) and ALT (alanine aminotransferase) were determined. Results. Our results showed significantly increased salivary levels of TP, IgA, AST and ALT for patients with chronic viral hepatitis (CHV) and chronic alcoholic hepatitis (CAH) compared to controls. IgG salivary levels were also higher in patients with hepatitis versus controls, however while statistical significance could be found for patients with chronic hepatitis C (CHC) and CAH, this was not the case for the patients with chronic hepatitis B (CHB). Conclusions. The results of our study showed significantly increased salivary levels of the determined parameters in hepatitis patients compared to the healthy subjects, hence promoting the use of saliva as a diagnosis and monitoring fluid for chronic hepatitis.

Salivary Diagnosis - Clinical Uses in Assessing Oral Inflammation

The past decades demonstrated that saliva and its components represent a remarkable diagnosis fluid with valuable clinical uses for both oral and systemic diseases. At the same time it is well established that oxidative stress is involved in a wide number of pathologies, including periodontitis. The specific aim of the present study which included 50 subjects is to determine if saliva can be used in clinical settings to correlate oxidative stress and tissue destruction markers with the severity of periodontal disease. An important oxidative stress marker - 8-hydroxydesoxyguanosine (8-OHdG) and a collagen degradation marker - beta-crosslaps (b-CTX) were quantified in both saliva and gingival crevicular fluid (GCF) using ELISA kits and were found to be significantly increased in the chronic periodontitis group when compared to respective controls (p[0.05). At the same time positive correlations were observed between whole saliva and gingival crevicular fluid (p[0.05). Significant correlations were also determined between GCF and salivary markers and clinical parameters of periodontal disease. Present results demonstrate that saliva and its components can successfully be used in clinical settings and represents a reliable tool for assessing periodontal disease severity.

Galactomannan in Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis with Nonneutropenic Patients.

Background We evaluated the utility of galactomannan (GM) in bronchoalveolar lavage fluid (BALF) for the diagnosis of invasive pulmonary aspergillosis (IPA) in nonneutropenic patients. Methods A total of 183 patients were included in the final analysis. Bronchoscopies and the detection of GM in BALF were all performed on them. Results Ten cases of IPA were diagnosed. ROC data demonstrated that, for diagnosing IPA, an optimal cutoff value for GM in BALF of 0.76 yielded a sensitivity of 100.0% and a specificity of 76.2%. Symptoms and radiological findings had no significant difference between proven or probable IPA group and non-IPA group. In our case-control analysis, although nine patients with false-positive results received treatment with Piperacillin/tazobactam, there was no significant difference between case and control group. Conclusions BALF GM detection is a valuable adjunctive diagnostic tool. Our retrospective study suggests that the optimal value of GM detection in BALF is 0.76 in nonneutropenic patients.

Detection value of tumor cells in cerebrospinal fluid in the diagnosis of meningeal metastasis from lung cancer by immuno-FISH technology.

To investigate the detection value of tumor cells in cerebrospinal fluid (CSF) in the adjuvant diagnosis of meningeal metastasis from lung cancer by immunofluorescence in situ hybridization (immuno-FISH) technology. The circulating tumor cells (CTCs) in the CSF of 16 patients with meningeal metastasis from lung cancer and 8 with non-tumor diseases in the brain were detected using immuno-FISH technology. The diagnosis of meningeal metastasis from lung cancer was based on neurological symptoms, enhanced magnetic resonance imaging (MRI) scans and CSF cytological examination. The number of CTCs in the patients with meningeal metastasis from lung cancer was significantly higher than those with non-tumor diseases in the brain (P<0.01). The critical point of the maximum correct diagnostic index (Youden index) was regarded as the judging criterion for positive tumor cells in CSF according to the receiver operating characteristic curve. When there was one tumor cell in 7.5 ml CSF, the area under curve was 0.875 (95% confidence interval, 0.705~1.000). The diagnostic sensitivity, specificity, effectiveness, positive and negative predictive values were 75.0, 100.0, 83.3, 100.0 and 66.7%, respectively. There may be great clinical value in the detection of CTCs in CSF for the diagnosis of meningeal metastasis from lung cancer by immuno-FISH technology.

16S rRNA Real-Time reverse transcription PCR in synovial fluid for diagnosis of periprosthetic joint infection

Objective To investigate the efficiency of 16S rRNA Real-time reverse transcription PCR technique in the diagnosis of periprosthetic joint infection, and compare its sensitivity and specificity with conventional culture. Methods There were 43 revision cases from July 2013 to December 2015. Synovial fluid collected by puncture preoperatively, tissues from five different parts around the prosthesis collected intra-operatively were cultured by blood plate and BacT/Alert FN respectively. The 16S rRNA in interface membrane was detected by real-time reverse transcription PCR as a marker to diagnose PJI. At the same time, the synovial fluid was routinely bacterial cultured. We compared the sensitivity and specificity of two methods. Results There are 22 THAs and 21 TKAs respectively in 43 cases, 23 cases diagnosed prosthetic joint infection and 20 cases diagnosed non prosthetic joint infection. The sensitivity of 16S rRNA Real-time reverse transcription PCR is higher than the conventional bacterial culture (78.2% vs. 47.8%). There was no difference in the specificity and PPV and NPV. For PCR in prosthetic joint infection group, Staphylococcus epidermidis in 5 cases, Staphylococcus aureus in 3 cases, streptococcus in 4 cases, E.coli in 2 cases, Staphylococcus lugdunensis, Pseudomonas aeruginosa, Staphylococcus haemolyticus and Mycoplasma in 1 case respectively. For culture in prosthetic joint infection group, Staphylococcus epidermidis in 5 cases, Staphylococcus aureus in 2 cases, Staphylococcus lugdunensis, Pseudomonas aeruginosa, Staphylococcus haemolyticus and E.coli in 1 case respectively. For non prosthetic joint infection group, PCR and culture are all negative. Conclusion The sensitivity of 16S rRNA Real-time reverse transcription PCR is higher than the conventional bacterial culture. Key words: Arthroplasty, replacement, hip; Arthroplasty, replacement, knee; Infection; Reverse transcriptase polymerase chainreaction