Gold Standard Research Articles

Discriminative diagnosis of ovarian endometriosis cysts and benign mucinous cystadenomas based on the ConvNeXt algorithm

PurposeThe objective of this study was to develop a deep learning model, using the ConvNeXt algorithm, that can effectively differentiate between ovarian endometriosis cysts (OEC) and benign mucinous cystadenomas (MC) by analyzing ultrasound images. The performance of the model in the diagnostic differentiation of these two conditions was also evaluated. MethodsA retrospective analysis was conducted on OEC and MC patients who had sought medical attention at the Fourth Affiliated Hospital of Harbin Medical University between August 2018 and May 2023. The diagnosis was established based on postoperative pathology or the characteristics of aspirated fluid guided by ultrasound, serving as the gold standard. Ultrasound images were collected and subjected to screening and preprocessing procedures. The data set was randomly divided into training, validation, and testing sets in a ratio of 5:3:2. Transfer learning was utilized to determine the initial weights of the ConvNeXt deep learning algorithm, which were further adjusted by retraining the algorithm using the training and validation ultrasound images to establish a new deep learning model. The weights that yielded the highest accuracy were selected to evaluate the diagnostic performance of the model using the validation set. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was calculated. Additionally, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and odds ratio were calculated. Decision curve analysis (DCA) curves were plotted. Results: The study included 786 ultrasound images from 184 patients diagnosed with either OEC or MC. The deep learning model achieved an AUC of 0.90 (95 % CI: 0.85–0.95) in accurately distinguishing between the two conditions, with a sensitivity of 90 % (95 % CI: 84 %-95 %), specificity of 90 % (95 % CI: 77 %-97 %), a positive predictive value of 96 % (95 % CI: 91 %-99 %), a negative predictive value of 77 % (95 % CI: 63 %-88 %), a positive likelihood ratio of 9.27 (95 % CI: 3.65–23.56), and a negative likelihood ratio of 0.11 (95 % CI: 0.06–0.19). The DCA curve demonstrated the practical clinical utility of the model. ConclusionsThe deep learning model developed using the ConvNeXt algorithm exhibits high accuracy (90 %) in distinguishing between OEC and MC. This model demonstrates excellent diagnostic performance and clinical utility, providing a novel approach for the clinical differentiation of these two conditions.

Recommendation of minimal distal tibial length for long axis coordinate system definitions

Accurate anatomical coordinate systems for the foot and ankle are critical for interpreting their complex biomechanics. The tibial superior-inferior axis is crucial for analyzing joint kinematics, influencing bone motion analysis during gait using CT imaging and biplane fluoroscopy. However, the lack of consensus on how to define the tibial axis has led to variability in research, hindering generalizability. Even as advanced imaging techniques evolve, including biplane fluoroscopy and weightbearing CT, there exist limitations to imaging the entire foot together with the full length of the tibia. These limitations highlight the need to refine axis definitions. This study investigated various superior-inferior axes using multiple distal tibia lengths to determine the minimal field of view for representing the full tibia long-axis. Twenty human cadaver tibias were imaged and segmented to generate 3D bone models. Axes were calculated based on coordinate definitions that required user manual input, and a gold standard mean superior-inferior axis was calculated based on the population’s principal component analysis axis. Four manually calculated superior-inferior tibial axes groups were established based on landmarks and geometric fittings. Statistical analysis revealed that geometrically fitting a cylinder 1.5 times the mediolateral tibial width, starting 5 cm above the tibial plafond, yielded the smallest angular deviation from the gold standard. From these findings, we recommend a minimum field of view that includes 1.5 times the mediolateral tibial width, starting 5 cm above the tibial plafond for tibial long-axis definitions. Implementing these findings will help improve foot and ankle research generalizability and impact clinical decisions.

Skene’s gland abscess: a rare case report

Background: The Para urethral gland of Skene is a pair of glands in the vestibule on the distal two-thirds of the female urethra, they are homologous to the male prostate gland and are believed to secrete fluid that lubricates the urethral opening. They contain about 6 to 30 small glands. The grand’s duct can get infected and hence inflamed obstruct. The secretion may accumulate leading an abscess formation. The patients may develop fever, dysuria, or dyspareunia. On examination, there may be a visible palpable Para urethral mass which may be unilateral or bilateral, it may also be tender. The incidence of Skene’s gland abscess is unknown, it is common in premenopausal women usually in the third and fourth decades of life. Trans trans-perineal ultrasound scan is very useful in the diagnosis but MRI is the gold standard. An important differential diagnosis is urethral diverticulitis which can be distinguished using these imaging modalities. Case report: We present a 30 years old nulliparous single lady who had a 2-year history of vaginal swelling and superficial dyspareunia we made a final diagnosis of palpable skene’s gland abscess, which was treated by marsupialization.

Types of ultraviolet filters and their combination used in sunscreen determine the appropriate sun protection factor values in vivo

Background The application of sunscreen has been shown to prevent the detrimental effects of ultraviolet. The effectiveness of a sunscreen formulation protection against ultraviolet B is measured by sun protection factor (SPF) and its value determined by in vivo testing is still the gold standard. The consistency between the in vivo and in vitro SPF values is still interesting to investigate, including the influencing factors. Objective To analyze the correlation between the products’ manufacturer estimation in vitro SPF value with the in vivo SPF value and assessing determinant factors that may influence the in vivo SPF value. Patients and methods Ten sunscreen products from various manufacturers were tested in vivo using The European Cosmetic Toiletry and Perfumery Association (COLIPA) method. All the tested products in this study have the manufacturer’s estimated SPF value determined based on in vitro test conducted by the manufacturer. The Spearman correlation test was used for data analysis. Results All sunscreen products had the estimated SPF values of 30 and 50, for five products each. Nine products were in cream formulations and one in lotion formulation, as ‘day cream’ and ‘BB cream,’ respectively. Six sunscreen products had lower in vivo SPF values compared with the manufacturer’s SPF value estimation, whereas four products had shown higher values. Although statistical analysis showed P value of 0.63 that indicates no significant correlation between both of the SPF values. Several products with the appropriate and higher in vivo SPF values contain octocrylene as a photostabilizer and additional coating materials such as stearic acid, aluminum hydroxide, and alumina. Conclusion This study demonstrated that the appropriateness of the in vivo SPF value to in vitro-estimated SPF value may be influenced by the photostabilizer substance and combination with additional coating materials also can increase stability and efficacy of the products.

Consistency Analysis of the UF-1500 and UF-5000 Automated Urine Particle Analyzers.

The aim was to evaluate the consistency of the results between the UF-1500 and UF-5000, fully automated urine particle analyzers. A total of 554 randomly selected inpatient and outpatient urine samples were collected for analysis using the UF-1500, the UF-5000, and by manual microscopic examination. The coincidence rate, intraday repeatability, and interday reproducibility were evaluated on the UF-1500 and UF-5000. To analyze the review flags from the UF-1500, the UF-1500 results were compared to manual microscopy as the gold standard. The repeatability of red blood cells (RBCs), white blood cells (WBCs), epithelial cells (ECs), casts, and bacteria using the UF-1500 and UF-5000 is expressed as the relative standard deviations of the intraday and inter-day measurements. For the UF-1500, the relative standard deviation values ranged from 5.9% to 12.6% and 4.9% to 17.2% for the low and 1.6% to 9.3% and 2.3% to 16.9% for the high samples, respectively. The correlation co-efficient for RBCs, WBCs, ECs, SECs, casts, crystals, and bacteria for the UF-1500 were 0.981, 0.993, 0.968, 0.963, 0.821, 0.783, and 0.992, respectively. Review samples from the UF-1500 were confirmed by microscopic examination. Review flags for all 554 samples included 3 samples with "DEBRIS High" and 23 samples with "RBCs/YLC Abnormal classification". The identification of various urine components by both instruments meets laboratory requirements. These two instruments with different performances have specific characteristics and should be used based upon the needs of each laboratory.

Breast imaging reporting and data system for sonography: Positive and negative predictive values of sonographic features in Kumasi, Ghana

BackgroundBreast cancer is the most common female cancer globally. The method of choice for screening and diagnosing breast cancer is mammography, which is not widely available in Ghana as compared to ultrasonography. This study aimed to evaluate the sonographic features of solid breast lesions using the new sonographic Breast Imaging- Reporting and Data System (BI-RADS-US) lexicon for malignancy with histopathology as the gold standard. MethodsThis was a prospective quantitative study that sonographically scanned female patients with breast masses and consecutively selected cases recommended for core biopsy from May 2018 to May 2021. Sixty (60) solid breast masses were described using the sonographic BI-RADS lexicon features. Lesion description and biopsy results from histopathology were compared and analyzed using Pearson's Chi-square test. Odds ratios, sensitivity, specificity, and predictive values were also calculated. Statistical significance level was set at p ≤ 0.05. ResultsIrregular shape (p < 0.0001), spiculated mass margins (p < 0.0001), and not parallel mass orientation (p= 0.0007) were more commonly associated with malignant masses. The sensitivity of breast ultrasound for malignancy was 93.9 % and the specificity was 55.6 % with an overall accuracy rate of 76.6 %. The negative predictive value was 88.7 % and the positive predictive value was 72.1 %. Descriptors like irregular shape, non-parallel orientation, angular and spiculated margins, echogenic halo, and markedly hypoechoic internal content, demonstrated higher odds ratios for malignancy. ConclusionsThis study adds valuable insights to the diagnosis of breast cancer using the sonographic BI-RADS lexicon features. The results demonstrate that specific sonographic descriptors can effectively differentiate between benign and malignant breast masses.

A multi-institutional comparison of retrospective deformable dose accumulation for online adaptive magnetic resonance-guided radiotherapy

Background and PurposeApplication of different deformable dose accumulation (DDA) solutions makes institutional comparisons after online-adaptive magnetic resonance-guided radiotherapy (OA-MRgRT) challenging. The aim of this multi-institutional study was to analyze accuracy and agreement of DDA-implementations in OA-MRgRT. Material and MethodsOne gold standard (GS) case deformed with a biomechanical-model and five clinical cases consisting of prostate (2x), cervix, liver, and lymph node cancer, treated with OA-MRgRT, were analyzed. Six centers conducted DDA using institutional implementations. Deformable image registration (DIR) and DDA results were compared using the contour metrics Dice Similarity Coefficient (DSC), surface-DSC, Hausdorff-distance (HD95%), and accumulated dose-volume histograms (DVHs) analyzed via intraclass correlation coefficient (ICC) and clinical dosimetric criteria (CDC). ResultsFor the GS, median DDA errors ranged from 0.0 to 2.8 Gy across contours and implementations. DIR of clinical cases resulted in DSC>0.8 for up to 81.3% of contours and a variability of surface-DSC values depending on the implementation. Maximum HD95%=73.3 mm was found for duodenum in the liver case. Although DVH ICC>0.90 was found after DDA for all but two contours, relevant absolute CDC differences were observed in clinical cases: Prostate I/II showed maximum differences in bladder V28Gy (10.2/7.6%), for cervix, liver, and lymph node highest differences were found for rectum D2cm3 (2.8 Gy), duodenum Dmax (7.1 Gy), and rectum D0.5cm3 (4.6 Gy), respectively. ConclusionOverall, high agreement was found between the different DIR and DDA implementations. Case- and algorithm-dependent differences were observed, leading to potentially clinically relevant results. Larger studies are needed to define future DDA-guidelines.

Interdisciplinary plastic and reconstructive surgery of head and neck squamous cell carcinomas.

Squamous cell carcinomas are the most common malignancies in the oral cavity, pharynx, and larynx. Even in the age of the most modern drug treatment methods, radical resection of these tumors is and currently remains the therapeutic gold standard. The loss of anatomical structures associated with surgery inevitably increases the functional deficits caused by the tumor itself. In this context, the extent of functional deficits is largely determined by the extent of resection. Complete organ resections, such as glossectomy, complete palate resection, laryngectomy, or transverse pharyngo-laryngectomy, lead to severe functional deficits, such as swallowing disturbances with life-threatening aspiration and articulation disorders up to the inability to speak. With the help of plastic reconstructive surgery, the lost tissue can be replaced and the specific functions of the upper aerodigestive tract can be preserved or restored.In recent decades, reconstructive surgical procedures have developed enormously in the treatment of malignant tumors of the head and neck. In order to make optimal use of them, a comprehensive, interdisciplinary therapy concept is a prerequisite for positive oncological and functional outcome. In addition to general medical and social parameters, surgical parameters play a crucial role in the choice of the reconstruction method. The extent to which the surgical measures must be interdisciplinary depends on the localization of the defects in the head and neck region and on the type of replacement tissue required. Here, the expertise of plastic surgery, oral and maxillofacial surgery, and abdominal surgery comes into play in particular. The use of different tissues, the combination of different grafts and flaps, or the preforming of donor regions allow reconstructions far beyond the level of simply restoring surface integrity. The functional results and thus the quality of life of patients after surgical therapy of extensive tumors of the mentioned localizations depend decisively on the type of reconstruction. Therefore, in the following review, special emphasis 1 be placed on the choice of reconstruction method and reconstruction technique for tissue loss after resections of HNSCC.

Cyto R-CNN and CytoNuke Dataset: Towards reliable whole-cell segmentation in bright-field histological images

Background and objective:Cell segmentation in bright-field histological slides is a crucial topic in medical image analysis. Having access to accurate segmentation allows researchers to examine the relationship between cellular morphology and clinical observations. Unfortunately, most segmentation methods known today are limited to nuclei and cannot segment the cytoplasm. Methods:We present a new network architecture Cyto R-CNN that is able to accurately segment whole cells (with both the nucleus and the cytoplasm) in bright-field images. We also present a new dataset CytoNuke, consisting of multiple thousand manual annotations of head and neck squamous cell carcinoma cells. Utilizing this dataset, we compared the performance of Cyto R-CNN to other popular cell segmentation algorithms, including QuPath’s built-in algorithm, StarDist, Cellpose and a multi-scale Attention Deeplabv3+. To evaluate segmentation performance, we calculated AP50, AP75 and measured 17 morphological and staining-related features for all detected cells. We compared these measurements to the gold standard of manual segmentation using the Kolmogorov–Smirnov test. Results:Cyto R-CNN achieved an AP50 of 58.65% and an AP75 of 11.56% in whole-cell segmentation, outperforming all other methods (QuPath 19.46/0.91%; StarDist 45.33/2.32%; Cellpose 31.85/5.61%, Deeplabv3+ 3.97/1.01%). Cell features derived from Cyto R-CNN showed the best agreement to the gold standard (D¯=0.15) outperforming QuPath (D¯=0.22), StarDist (D¯=0.25), Cellpose (D¯=0.23) and Deeplabv3+ (D¯=0.33). Conclusion:Our newly proposed Cyto R-CNN architecture outperforms current algorithms in whole-cell segmentation while providing more reliable cell measurements than any other model. This could improve digital pathology workflows, potentially leading to improved diagnosis. Moreover, our published dataset can be used to develop further models in the future.

Efficacy of sintered Zinc-doped fluorapatite scaffold as an antimicrobial regenerative bone filler for dental applications

ObjectivesThe objective of this study was to assess whether zinc-doped fluorapatite (ZnFA) could serve as an effective antimicrobial dental bone filler for bone regeneration compared to autografts. MethodsFA and 2% zinc-doped FA (2ZnFA) were synthesized and characterized in-house. Compressed and sintered FA and 2ZnFA disks were incubated with bacteria to assess antimicrobial properties. Adipose-derived stem cells were cultured on these discs to evaluate the surfaces’ ability to support cell growth and promote osteogenic differentiation. Surfaces exhibiting the highest expressions of the bone markers osteopontin and osteocalcin were selected for an in vivo study in a rat mandibular defect model. Twenty rats were divided into 5 groups, equally, and a 5mm surgical defect of the jaw was left untreated or filled with 2ZnFA, FA, autograft, or demineralized bone matrix (DBM). At 12 weeks, the defects and surrounding tissues were harvested and subjected to microCT and histological evaluations. ResultsStandard techniques such as FTIR, ICP-MS, fluoride probe, and XRD revealed the sintered FA and ZnFA's chemical compositions and structures. Bacterial studies revealed no significant differences in surface bacterial adhesion properties between FA and 2ZnFA, but significantly fewer bacterial loads than control titanium discs (p<0.05). Cell culture data confirmed that both surfaces could support cell growth and promote the osteogenic differentiation of stem cells. MicroCT analysis confirmed statistical similarities in bone regeneration within FA, 2ZnFA, and autograft groups. ConclusionThe data suggests that both FA and 2ZnFA could serve as alternatives to autograft materials, which are the current gold standard. Moreover, these bone fillers outperformed DBM, an allograft material commonly used as a dental bone void filler. Clinical SignificanceThe use of FA or 2ZnFA for treating mandibular defects led to bone regeneration statistically similar to autograft repair and significantly outperformed the widely used dental bone filler, DBM. Additional translational research may confirm FA-based materials as superior substitutes for existing synthetic bone fillers, ultimately enhancing patient outcomes.

Fidelity to the acupuncture intervention protocol in the ACUpuncture In The EmergencY Department for Pain Management (ACUITY) trial: expanding the gold standard of STRICTA and CONSORT guidelines.

Fidelity to the acupuncture intervention protocol in the ACUpuncture In The EmergencY Department for Pain Management (ACUITY) trial: expanding the gold standard of STRICTA and CONSORT guidelines.

HOW IS CARDIOPULMONARY EXERCISE TESTING CONDUCTED IN NSW AND ACT?

INTRODUCTION/AIM Cardiopulmonary exercise testing (CPET) is considered the gold standard of assessing functional capacity under stress. Given the growing utility of CPET, understanding the current standards of practice is crucial. However, little is known about CPET accessibility, protocols used, or barriers to testing in NSW and ACT. This study aimed to understand clinical CPET practices and identify possible areas of protocol variability. METHOD 40 hospitals were contacted: 28 in metropolitan Sydney, 9 in regional/remote NSW, and 3 in metropolitan Canberra. Hospitals confirming that they had a CPET service were asked to complete a 28-question survey of CPET practices via Qualtrics. The survey explored testing personnel, medical supervision, protocol design, data reporting, and barriers to CPET. RESULTS Most hospitals (n = 28) did not have a CPET service. Of the 11 sites that performed CPET, respondents were split evenly between adult (n = 6) and paediatric (n = 5) testing capacity. Cycle ergometry (n = 10) was the dominant exercise modality. Most sites reported using ramp (n = 8) rather than stepwise (n = 3) protocols. 73% of sites adapted the test work-rate to facilitate a test duration of 8-12 minutes. 27% used a standard work-rate, regardless of patient presentation or test indication. All sites reported anaerobic threshold-related variables, ECG-related measurements, and Borg scores. CPET endpoints were typically in line with American College of Sports Medicine guidelines (73%). Barriers to CPET included lack of suitable staffing (n = 10), lack of medical availability (n = 4), and space (n = 3). CONCLUSION Despite its value, CPET appears to be underused in NSW/ACT. While consistency in CPET reporting and endpoints was identified, there was variability in protocols across testing sites. This variation has potential to impact consistency and comparability of test results, affecting clinical decision-making.

Accuracy of methods for tracking anxiety and depression symptoms in childrens and adolescentes: integrative review

Objective: This integrative review article’s purpose is to compare the accuracy tracking methods for anxiety and depression symptoms in children and adolescentes. Methods: Studies that investigate the accuracy of diagnosis methods for anxiety and depression in children and adolescents were reviewed, including a variety of questionnaires and psychometric properties (specificity, sensibility and under the curve area) compared to the golden standard. Results: The results highlights that some questionnaires, such as SCARED and RCADS, presents sensibility and specificity appropriate for diagnosis (AUC= 0,9; 0,98 and 0,72; 0,82, respectively). However, other scales presented mixed results, indicating the necessity of further research to have a better rating of their accuracy. Conclusion: Comprehending the challenges of an accurate diagnosis for anxiety and depression in children and adolescents is essential to improve the treatment and intervention approaches. This integrative review emphasizes the significance of research about psychometric data for more diagnosis with accuracy and reliability.

Implications of Artificial intelligence in the form of 3D-printing in Endodontics: A Review

Three-dimensional (3D) printing has become an emerging technology in dentistry, and specifically in endodontics. This technology enables the creation of highly accurate and patient-specific 3D models, surgical guides, and custom-made instruments that have revolutionized endodontic treatment. This abstract provides an overview of the applications of 3D printing in endodontics, including preoperative planning, fabrication of surgical guides, production of custom-made instruments, and postoperative evaluation. The accuracy and precision of 3D-printed models have shown to improve the quality of endodontic treatment and reduce the risk of complications. The creation of new dental models is made possible by three-dimensional printing. 3D-printed teeth have been used in a lot of studies, however standards for standardised research are still being created. Although they have significant disadvantages, using real teeth is still the norm in ex vivo investigations and pre-clinical training. All the restrictions of natural teeth may be overcome by printed teeth. Printing technology uses 3D data and post-processing tools to create a 3D model, which is then used by 3D printers to create a prototype. The hardness of the resin and the correctness of the canal anatomy printing are the main issues with 3D-printed teeth. Future research is given direction in order to address the issues with 3D-printed teeth and create defined protocols in order to attain method standardisation. In the future, ex vivo investigations and endodontic training could use 3D-printed teeth as the gold standard. Furthermore, 3D printing has also facilitated communication between the dental team and the patient, leading to a better understanding of the treatment plan and enhancing the patient experience. This review intends to gather information regarding 3D-printed teeth on the following themes: (1) their benefits; (2) their manufacturing processes; (3) their issues; and (4) potential future research topics. In conclusion, 3D printing has the potential to enhance the accuracy and efficiency of endodontic treatment and improve clinical outcomes.

EMS injury cause codes more accurate than emergency department visit ICD-10-CM codes for firearm injury intent in North Carolina.

The timeliness, accuracy, and completeness of data for firearm injury surveillance is crucial for public health surveillance efforts and informing injury prevention measures. While emergency department (ED) visit data can provide near real-time information on firearms injuries, there are concerns surrounding the accuracy of intent coding in these data. We examined whether emergency medical service (EMS) data provide more accurate firearm injury intent coding in comparison to ED data. We applied a firearm injury definition to EMS encounter data in NC's statewide syndromic surveillance system (NC DETECT), from January 1, 2021, through December 31, 2022. We manually reviewed each record to determine intent, and the corresponding manual classifications were compared to the injury cause codes entered in the EMS data and to ED visit records where EMS-ED record linkage was possible. We then calculated the sensitivity, specificity, positive and negative predictive values for each intent classification in SAS 9.4 using the manually reviewed intent classifications as the gold standard. We identified 9557 EMS encounters from January 1, 2021, through December 31, 2022 meeting our firearm injury definition. After removing false positives and duplicates, 8584 records were available for manual injury classification. Overall, our analysis demonstrated that manual and EMS injury cause code classifications were comparable. However, for the 3401 EMS encounters that could be linked to an ED visit record, sensitivity of the ED ICD-10-CM codes was low for assault and intentional self-harm encounters at 18.2% (CI 16.5-19.9%) and 22.2% (CI 16-28.5%), respectively. This demonstrates a marked difference in the reliability of the intent coding in the two data sources. This study illustrates both the value of examining EMS encounters for firearm injury intent, and the challenges of accurate intent coding in the ED setting. EMS coding has the potential for more accurate intent coding than ED coding within the context of existing hospital-based coding guidance. This may have implications for future firearm injury research, especially for nonfatal firearm injuries.

Utility of Blood Biomarkers to Predict Marrow Iron Stores in Children.

Iron deficiency is common in children with kidney failure, but current guidelines are based on biomarkers of iron stores that may be influenced by inflammation. This is the first study that examined which serum iron indices were associated with stainable marrow iron stores (the gold standard) in this population with kidney failure who underwent bone biopsies. This cross-sectional study enrolled 71 clinically stable children and young adults receiving dialysis who underwent bone biopsy for chronic kidney disease-mineral bone disorder between 2007 through 2011. Bone biopsies were stained with Perls' Prussian blue and independently interpreted by a pathologist blinded to participants' iron parameters and clinical status. Marrow staining was scored absent vs. present to facilitate receiver operator curve (ROC) analysis. In ROC analysis, the ability of serum ferritin to detect stainable marrow iron stores was compared with that of transferrin saturation (TSAT), serum hepcidin, and clinical guideline-based iron deficiency cut-offs for serum iron, TSAT, and their combinations. Mean age was 17.2 ± 4.4 years (range 2-28), and 30% of patients were female. Median dialysis vintage was 1.2 (IQR 0.7, 2.0) years, and 56% were supported by peritoneal dialysis. Mean hemoglobin was 12.4 ± 1.7 g/dl, and 35% were receiving iron supplementation at the time of biopsy. Based on the gold standard of depleted marrow iron stores, 46.5% of patients were iron-deficient. As an indicator of marrow iron staining, serum ferritin provided a higher area under the ROC curve than serum hepcidin, TSAT, or clinical guidelines-based evaluation of TSAT + ferritin. In this cohort of children and young adults with kidney failure, serum ferritin provided the best indication of stainable marrow iron stores, followed by transferrin saturation.

Identification of novel resistance-associated mutations and discrimination within whole-genome sequences of fluoroquinolone-resistant Mycobacterium tuberculosis isolates.

This study aims to elucidate additional mutation loci associated with fluoroquinolone (FQ) resistance and evaluate the discriminatory capacity of mutation loci and allele mutation frequencies in identifying FQ-resistant Mycobacterium tuberculosis (MTB) isolates. A random selection of isolates was extracted from an ongoing collection. Drug resistance was determined using the resazurin microtiter assay (REMA) as the gold standard. Mutation loci and the burden of mutations in the quinolone resistance-determining region (QRDR) were elucidated through whole-genome sequencing (WGS). Novel amino acid mutations, namely, G520D and G520T, were identified in the gyrB and associated with FQ resistance. In the context of distinguishing FQ-resistant isolates, the AUC for the QRDR mutation frequency burden (0.969) surpassed that of the mutation locus (0.929), and this difference was statistically significant (P = 0.03). Furthermore, using the resistance mutation locus as a reference, setting the QRDR mutation frequency burden threshold at 1.31% resulted in a 3.60% increase in the accuracy of classifying FQ-resistant isolates (NRI = 3.60%, P < 0.001). The QRDR mutation frequency burden appears to offer superior diagnostic efficacy in discriminating FQ-resistant isolates compared to qualitative detection of mutant loci.IMPORTANCEFluoroquinolone (FQ) drugs are recommended as second-line drugs for the treatment of multidrug-resistant tuberculosis. With the massive use of FQ drugs in the clinical treatment of tuberculosis (TB), there is an increasing rate of drug resistance to FQ drugs. In this study, we identified and demonstrated novel amino acid mutations associated with FQ resistance in Mycobacterium tuberculosis (MTB), and we quantified the mutation sites and identified the quinolone resistance-determining region (QRDR) mutation frequency burden as a novel diagnostic method for FQ resistance. We hope that the results of this study will provide data support and a theoretical basis for the rapid diagnosis of FQ-resistant MTB.

Neutron Macromolecular Crystallography for Biological Samples—Current State and Future Perspectives

Knowledge of hydrogen locations and protonation states is critical for a fundamental understanding of biological macromolecular function/interactions, and neutron macromolecular crystallography (NMX) is uniquely suited among the experimental structural-determination methods to provide this information. However, despite its potential, NMX remains a relatively niche technique, due to substantial limitations. This review explores NMX’s role amongst the evolving landscape of structural biology, comparing and contrasting it to the historical gold standard of X-ray macromolecular crystallography (X-ray MX) and the increasingly prevalent electron-based methods—i.e., electron microscopy (EM) and electron diffraction (ED). Forthcoming developments (e.g., the European Spallation Source in Lund, Sweden, coming online) are expected to substantially address current limitations and ensure NMX will remain relevant in the coming decades.

MRI Accuracy in Diagnosing Sonographically Indeterminate Masses Taking Histopathology as Standard

Introduction: Approximately 25% of ultrasound-detected adnexal masses pose clinical challenges, being indeterminately categorized as benign or malignant. Characterizing them is pivotal for deciding surgery or pelvic MRI. Aims and Objectives: To validate the accuracy of MRI for diagnosing sonographically indeterminate masses using biopsy as the gold standard. Place and Duration of study: A validation cross-sectional study was performed at the Department of Radiology, Mayo Hospital, Lahore, for a period of six months i.e. from December 2019 to June 2020. Material and Methods: Non-probability consecutive sampling was employed to select 289 patients (12-60 years) with sonographically indeterminate adnexal masses. All those patients who were unwilling to participate or had MRI contraindications like metallic inserts, pacemakers, and claustrophobia were excluded from the study. Data was collected using the proforma as approved by IRB. All patients underwent MR imaging on a 1.5-T GE unit, and MRI accuracy was calculated. The analysis of data was performed using SPSS 25.0 version software, p-value ? 0.05 was taken as significant. Results: MRI sensitivity, specificity, PPV, NPV, FP, FN, and diagnostic accuracy in sonographically inconclusive adnexal lesions were 94.25%, 85.22%, 90.61%, 90.74%, 3.46%, 5.88% and 90.66%, respectively, referencing histopathology. Conclusion: The study concludes MRI as a noninvasive, accurate modality for distinguishing benign and malignant adnexal masses. While IOTA Simple Rules can't categorize all masses, around 20% with inconclusive results may need alternative evaluation, like skilled ultrasound examination&amp; MRI. It significantly enhances preoperative differentiation, aiding surgeons in making informed decisions regarding treatment approaches.

Hirschsprung’s disease in adulthood: a case report

Hirschsprung’s disease (HD) is caused by a gut development anomaly that leads to functional constipation. In most cases, HD is diagnosed and treated during childhood. Abdominal pain, distension and chronic constipation are typical symptoms of adult presentation. An adult HD case is presented, using analysis of electronic medical records and literature review for diagnostic and management insights. A man in his early 40s, with a history of chronic constipation since infancy, presented to the emergency department with an intestinal obstruction. Imaging tests revealed pronounced colonic dilation along with faecal loading. Following favourable progress, the patient was referred for outpatient investigation. Endoscopy revealed rectal scars with biopsy consistent with HD. A laparoscopic Duhamel-Martin procedure was performed in two stages. The postoperative period was uneventful. Adult HD is overlooked and misdiagnosed. Therefore, a high level of suspicion is needed to diagnose and avoid urgent surgeries, often with the need of colostomy and its particularities. When feasible, appropriate management by elective surgery should be the gold standard.