Low Sensitivity For Diagnosis Research Articles

Biomimetic semiconducting polymer dots for highly specific NIR-II fluorescence imaging of glioma

Glioma with very short medium survival time consists of 80% of primary malignant types of brain tumors. The unique microenvironment such as the existence of the blood-brain barrier (BBB) makes the glioma theranostics exhibit low sensitivity in diagnosis, a poor prognosis and low treatment efficacy. Therefore, the development of multifunctional nanoplatform that can cross BBB and target the glioma is essential for the high-sensitivity detection and ablation of cancer cells. In this study, C6 cell membrane-coated conjugated polymer dots (Pdots-C6) were constructed for targeted glioma tumor detection. As a new kind of biomimetic and biocompatible nanoprobes, Pdots-C6 preserve the complex biological functions of natural cell membranes while possessing physicochemical properties for NIR-II fluorescence imaging of glioma. After encapsulating C6 cell membrane on the surface of conjugated Pdots, Pdots-C6 exhibited the most favorable specific targeting capabilities in vitro and in vivo. In particular, this pilot study demonstrates that biomimetic nanoparticles offer a potential tool to enhance specific targeting to the brain, hence improving glioma tumor detection accuracy.

Methylated Septin9 has moderate diagnostic value in colorectal cancer detection in Chinese population: a multicenter study

BackgroundThe detection rate of methylated Septin9 (mSEPT9) in colorectal cancer (CRC) is varied greatly across the studies. This study aimed to evaluate the diagnostic ability of mSEPT9 in CRC, and compare the diagnostic efficacy with fecal immunochemical test (FIT).Methods326 subjects from four centers were prospectively recruited, including 179 CRC and 147 non-CRC subjects. The plasma was collected for mSEPT9 and CEA, AFP, CA125, CA153 and CA199 test, and fecal samples for FIT tests. Sensitivity, specificity and area under the curve (AUC) of receiver operating characteristic curve were calculated to evaluate the diagnostic value of each biomarker.ResultsThe positive rate in mSEPT9 and FIT, and the level of CEA, CA125 and CA199 were significantly higher in CRC compared with non-CRC subjects. The mSEPT9 positive rate was not associated with TNM stage and tumor stage. The sensitivity, specificity and AUC of mSEPT9 in diagnostic CRC were 0.77, 0.88 and 0.82, respectively, while the value in FIT was 0.88, 0.80 and 0.83, respectively. mSEPT9 and FIT have higher AUC value than that of CEA, CA125 and CA199. Combination of both mSEPT9 and FIT positive increased sensitivity and AUC to 0.98 and 0.83, respectively, but the specificity was declined. mSEPT9 has a slightly low sensitivity in diagnosis of colon cancer (0.87) compared with rectal cancer (0.93).ConclusionmSEPT9 demonstrated moderate diagnostic value in CRC detection, which was similar to the FIT but superior to the CEA, CA125 and CA199. Combination of mSEPT9 and FIT further improved diagnostic sensitivity in CRC.Trial registration: ChiCTR2000038319.

Sensitivity of Romberg Test in Diagnosis of Peripheral Vestibular Disorders in Comparison with Caloric Test: Psychometric Study

Introduction: Romberg test is one of the balance screening tests. Since this test does not require special equipment, it is widely used in the evaluation of people suffering from balance disorders. This study aimed to determine the sensitivity of the Romberg test for the diagnosis of peripheral vestibular dysfunction compared with the caloric test that is the gold standard for the diagnosis of horizontal semicircular canal/superior vestibular nerve disorders. Materials and Methods: This study was a cross-sectional-comparative study and the sample was selected from those who referred to the audiology clinic of the School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran. Romberg test with closed eyes was performed in 47 people suffering from unilateral or bilateral peripheral vestibular disorders (25 women and 22 men, mean age: 43.80 ± 4.46 years) whose lesion was confirmed by caloric test. The results were recorded in the participants’ history files and the files were reviewed. Chi-square test was used to compare the results. The sensitivity of Romberg test was determined in comparison with their caloric test results. Results: Only 5 participants had abnormal Romberg results, while 35 patients showed unilateral caloric weakness and 12 had bilateral deficits. Therefore, Romberg's sensitivity was 10.64%. There was no significant correlation between Romberg results and duration of disease. Conclusion: Romberg test seems to have low sensitivity in diagnosis of peripheral vestibular disorders. Therefore, vestibular tests with higher sensitivity are recommended for the diagnostic purposes and caloric test may not be replaced by Romberg test.

VP01.13: Predicting aneuploidy with first trimester ultrasound: a systematic review and meta‐analysis

As part of investigations for recurrent miscarriage, pregnancy tissue is sent for cytogenetic tests. A common cause of miscarriage is abnormal fetal karyotype. Diagnosis depends on the collection of uncontaminated pregnancy tissue which is not achieved in 25% of cases (Carp et al, 2001). This study sought to assess the potential role of ultrasound in diagnosis of abnormal karyotype in the first trimester. A prospectively registered (PROSPERO) systematic review of observational studies was performed. All studies reporting karyotype and ultrasound features in the first trimester were included. A pooled estimate of predictive capacity was generated using a random-effects model. Sensitivity and specificity of sonographic features was assessed. We included 66 papers with a total of 104468 cases. The presence of a fetal pole (OR 0.12, 0.09-0.15, p= 0.00001), yolk sac abnormalities (OR of 2.81, 1.25-6.30, p= 0.01) and small/restricted CRL (OR 1.64, 1.25-2.51, p= 0.0003) were related to abnormal karyotype. The sensitivity and specificity of ultrasound features are seen in the graph below. This review has demonstrated the role of ultrasound in diagnosing first trimester aneuploidy. It suggests that although ultrasound has a low sensitivity for diagnosis; several features are highly specific. Patients can be given information regarding the likelihood that their miscarriage was an abnormal pregnancy on the basis of ultrasound features. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Abstract 90: Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening among HIV-Positive Women in Western Kenya

Abstract Purpose: Adjunct cervical cancer screening methods, including cervicography, are under evaluation to improve the accuracy of HPV-based screening in low- and middle-income countries (LMICs). We evaluated the feasibility and acceptability of smartphone-based cervicography among HPV-positive women living with HIV (WLWH) in Western Kenya. Methods: HPV-positive WLWH age 25-49 years enrolled in a clinical trial (NCT04191967) had digital images of the cervix taken using a smartphone by a nonphysician provider following visual inspection with acetic acid (VIA). All participants had colposcopy-directed biopsy prior to treatment. A questionnaire was administered to assess acceptability of cervicography. Cervical images were evaluated by three off-site colposcopists for quality, diagnostic utility, and assigned a presumed diagnosis. We determined the proportion of images rated as low, medium, or high quality, the interobserver agreement using Cohen's Kappa statistic, and the colposcopist's sensitivity and specificity for diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with histopathology. Results: One hundred and sixty-four HPV-positive WLWH underwent cervicography during the study period. Mean age was 37.3 years. The vast majority of women, 99.4%, were comfortable having an image of their cervix taken as part of screening. Images from the first 94 participants were evaluated by off-site colposcopists, with a majority (70.9%) rated as high quality, and 86.9% of sufficient quality for diagnosis. Off-site colposcopists had a sensitivity ranging from 21.4% (95% CI 0.06-0.43) to 35.7% (95% CI 0.26-0.46), and specificity between 85.5% (95% CI 0.81-0.90) to 94.9% (95% CI 0.92-0.98) for diagnosis of CIN2+ compared to histopathology. Conclusion: Cervicography by a nonphysician provider as an adjunct to HPV-based screening among WLWH in an LMIC setting is feasible and acceptable. However, low sensitivity for diagnosis of CIN2+ from cervical images by off-site expert colposcopists highlights the limitations of cervicography and need for a better triage test in this population. Citation Format: Chemtai Mungo, Cyrillus Ogollah, Jennifer Ambaka, Magdalene Randa, Anagha Guliam, Craig Cohen. Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening among HIV-Positive Women in Western Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 90.

Clinical Assay for the Early Detection of Colorectal Cancer Using Mass Spectrometric Wheat Germ Agglutinin Multiple Reaction Monitoring.

Simple SummaryColorectal cancer (CRC) is currently the third leading cause of cancer death worldwide. Early diagnosis of CRC is important for increasing the opportunity for treatment and receiving a good prognosis. The aim of our study was to develop a detection method that combined wheat germ agglutinin (WGA) chromatography with mass spectrometry (MS) for early detection of CRC. Further, machine learning algorithms and logistic regression were applied to combine multiple biomarkers we discovered. We validated in a population of 286 plasma samples the diagnostic performance of peptides corresponding to WGA-captured protein and its combination, which received a sensitivity of 84.5% and a specificity of 97.5% in the diagnoses of CRC. Proteomic biomarkers combined with algorithms can provide a powerful tool for discriminating patients with CRC and health controls (HCs). Measurements of WGA-captured PF4, ITIH4, and APOE with MS are then useful for early detection of CRC. Additionally, our study revealed the potential of applying lectin chromatography with MS for disease diagnosis.Colorectal cancer (CRC) is currently the third leading cause of cancer-related mortality in the world. U.S. Food and Drug Administration-approved circulating tumor markers, including carcinoembryonic antigen, carbohydrate antigen (CA) 19-9 and CA125 were used as prognostic biomarkers of CRC that attributed to low sensitivity in diagnosis of CRC. Therefore, our purpose is to develop a novel strategy for novel clinical biomarkers for early CRC diagnosis. We used mass spectrometry (MS) methods such as nanoLC-MS/MS, targeted LC-MS/MS, and stable isotope-labeled multiple reaction monitoring (MRM) MS coupled to test machine learning algorithms and logistic regression to analyze plasma samples from patients with early-stage CRC, late-stage CRC, and healthy controls (HCs). On the basis of our methods, 356 peptides were identified, 6 differential expressed peptides were verified, and finally three peptides corresponding wheat germ agglutinin (WGA)-captured proteins were semi-quantitated in 286 plasma samples (80 HCs and 206 CRCs). The novel peptide biomarkers combination of PF454–62, ITIH4429–438, and APOE198–207 achieved sensitivity 84.5%, specificity 97.5% and an AUC of 0.96 in CRC diagnosis. In conclusion, our study demonstrated that WGA-captured plasma PF454–62, ITIH4429–438, and APOE198–207 levels in combination may serve as highly effective early diagnostic biomarkers for patients with CRC.

Role of ultrasound in diagnosis of pleural and parenchymal lung diseases in OPD patients

Thoracic CT is the most common imaging modality used after screening with chest x-ray in treatment of lung pathologies. But high cost, radiation, immobility & availability restrict its widespread use. For many years transthoracic ultrasound is being used in examination of pleural effusions in ICU patients. To study the role of chest ultrasonography in diagnosing pleural & parenchymal pathologies in OPD patients this study was carried out. 32 adult patientswithdyspnoea, cough & other chest symptoms coming to OPD ofpulmonary department of Santosh hospitals from January 2017 to July 2018 were enrolled in the study. In diagnosing pleural lung diseases- pleural effusion, pneumothorax, hydropneumothorax and pleural thickening, US showed a sensitivity, specificity, PPV & NPV all of 100% and accuracy of 1.00. But for parenchymal lesions taken all together (Consolidation, collapse, atelectasis, lung abscess, fibrocavitary lesion with necrosis, idiopathic pulmonary fibrosis, bleb/ bulla) it showed low accuracy of 0.62 with 42.86% sensitivity, 86.36% specificity, 80% positive and 54.29% negative predictive values respectively.Thoracic US offers fast, cheap, safe, radiation free, widely available, easily reproducible and non-invasive diagnostic modality for evaluating pleural lung diseases in OPD patients. But low sensitivity in diagnosis of parenchymal diseases is not encouraging.

Performance of morphologic criteria for the diagnosis of cirrhosis in patients with non-alcoholic steatohepatitis compared to other etiologies of chronic liver disease: effect of level of training and experience.

To compare the diagnostic performance of morphologic criteria for detection of cirrhosis in patients with alcoholic liver disease (ALD), hepatitis C (HCV), and non-alcoholic steatohepatitis (NASH). One hundred patients (53 male) with different etiologies of chronic liver disease (NASH, n=41; HCV, n=39; and ALD, n=20) and with different degrees of fibrosis on histopathologic examination (74 with cirrhosis) were retrospectively evaluated. Four readers (R1: fellowship-trained abdominal radiologist, R2: community attending radiologist, R3: senior radiology resident/research fellow, R4: junior radiology resident) analyzed the contrast-enhanced CTs for presence of commonly accepted morphologic changes of cirrhosis and portal hypertension. Each reader assigned an overall score (using a 5-point scale) for possibility of cirrhosis based on liver morphology and features of portal hypertension. Diagnostic performance, sensitivity, and specificity for the diagnosis of cirrhosis were calculated and compared between different etiologies of chronic liver disease. Performance of readers was affected by their level of training. Less experienced readers had overall lower sensitivity for diagnosis of cirrhosis in NASH group (R3: 81.5%, R4: 63.0% compared to 96.3% for both R1 and R2). Sensitivities for detection of NASH cirrhosis significantly decreased for less experienced readers in the absence of ascites (R3: 75.0%, R4: 62.0%) or other features of portal hypertension (R3: 50.0%; R4: 0%). The specificity was consistently high among different etiologies and for all readers (85.7-100%). Inter-reader agreement for morphologic features ranged widely from fair to almost perfect (k: 0.23-0.85). Cirrhotic changes in NASH are subtler and can be underestimated by less experienced readers.

Auxiliary Diagnostic Value of Tumor Markers in the Cerebrospinal Fluid and Blood for Leptomeningeal Metastasis from Non-small Cell Lung Cancer

背景与目的软脑膜转移（leptomeningeal metastasis, LM）是指恶性肿瘤细胞浸润软脑膜，并在脑脊液（cerebrospinal fluid, CSF）中播散，预后极差，是晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）患者致死的重要原因之一，因此早期的诊断和及时的治疗具有重要意义，CSF细胞学是LM诊断的金标准，但常常伴随着检测敏感性低、无法评估疗效等问题。本文旨在探讨血清及CSF中肿瘤标志物（tumor markers, TM）在NSCLC伴LM患者诊治的临床价值。方法选取NSCLC伴LM患者19例，另选同期27例神经系统良性肿瘤（nonmalignant neurological diseases, NMNDs）患者作为对照组。观察比较两组患者血清和CSF中癌胚抗原（carbohydrate antigen, CEA）、糖类抗原125（carbohydrate antigen-125, CA125）、细胞角蛋白19片断抗原（cytokeratin 19 fragments, CYFRA21-1）和神经元烯醇化酶（neurone specific enolase, NSE）检测水平和检出阳性率，比较不同组TM的敏感性和特异性，并分析血清与CSF中TM检出情况相关性，最后动态监测2例LM患者血清和CSF中TM水平，分别评估颅外和颅内治疗疗效。结果LM组CSF和血清中TM水平和检出阳性率均高于对照组（P < 0.05），同时LM组CSF中CEA、CYFRA21-1、NSE水平高于血清，差异有统计学意义（P < 0.05）。CSF中TM检出阳性率与血清差异不具有统计学意义（P > 0.05）。CSF中CYFRA21-1敏感性最高（88.2%），CEA特异性最好（92.3%），联合指标中CEA或NSE任一项超过临界值则敏感性和阴性预测值为100%，特异性为74.1%。CYFRA21-1和NSE同时超过临界值时特异性和阳性预测值为100%，敏感性为78.9%。亚组分析显示，CSF细胞学阳性人群TM检出阳性率超过有磁共振成像（magnetic resonance imaging, MRI）异常的人群，但不具有统计学差异（P > 0.05）。LM组血清与CSF中TM检出阳性率不一致。另外，脑室中CSF与腰穿中CSF具有相同的生化性质，动态监测血清和CSF中TM浓度，可分别评估颅外和颅内病灶的疗效。结论血清和CSF中TM为NSCLC伴LM患者增加了一个早期辅助诊断指标，动态监测可评估治疗疗效，值得临床推广应用。

New Methods in the Diagnosis of Prosthetic Joint Infection

A timely and accurate diagnosis of periprosthetic joint infection (PJI) is crucial to plan adequate treatment. Purpose of the study. To evaluate the performance of new diagnostic tests for the diagnosis of PJI. Material and Methods. The performance of novel biomarkers in synovial fluid (i.e. D-lactate and alfa-defensin), molecular test (i.e. PCR of synovial fluid and sonication fluid), new methods to dislodge biofilm from implant surface (i.e. MicroDTTect) and sonication of explanted prosthesis were investigated in patients with PJI and aseptic loosening of the prosthesis. Results. D-lactate showed better sensitivity for the diagnosis of PJI compared to leukocyte count (86% and 80%, respectively). The optimal D-lactate cut-off value was calculated at 1.26 mmol/l. The ADLF test showed sensitivity of 84%, 67% and to 54% depending on classification criteria used for the diagnosis of PJI (Musculoskeletal Infection Society (MSIS), The Infectious Diseases Society of America (IDSA) and proposed European Bone and Joint Infection Society (EBJIS) criteria, respectively). Using the proposed EBJIS definition criteria, the sensitivity of the leukocyte count was significantly higher than that of the ADLF test (86% compared with 54%; p0,001), particularly in chronic PJI (81% compared with 44%, respectively; p0,001). The sensitivity of synovial fluid PCR was 60% and herewith comparable with synovial fluid culture (52%, p = 0,239). The sensitivity and specificity of sonication fluid culture were 58% and 100%, which was comparable to sonication fluid PCR 51% and 94%, respectively. DTT-based method showed low sensitivity for diagnosis of PJI (40%) compared to sonication (80%, p0,01). Conclusion. Synovial fluid D-lactate demonstrated good analytical performance and diagnostic value for the diagnosis of PJI. In particular, the high sensitivity for diagnosing infection and rapid availability of the test result make synovial fluid D-lactate suitable as screening test, whereas ADLF had limited sensitivity (54%) but high specificity (95%) and it should therefore not be used for screening, but rather as a confirmatory test for PJI. Multiplex PCR of synovial fluid and sonication fluid has similar sensitivity and specificity compared to synovial fluid culture, having the advantage of rapid availability of results (within 5 hours) and fully automated process. With further improvement of its performance and inclusion of additional primers, multiplex PCR may complement conventional cultures, especially for rapid and accurate diagnosis of low-grade PJI. Culture of samples obtained by sonication of prostheses showed better sensitivity for the microbiologic diagnosis of prosthetic hip and knee infection compared to chemical based dislodgement such as MicroDTTect.

Role of serum procalcitonin as a marker for diagnosing neonatal sepsis

Background: Neonatal sepsis is a continuing problem causing significant burden on health care, especially in developing world. As blood culture has low sensitivity in diagnosis of neonatal sepsis, strong clinical suspicion along with combination of different laboratory tests is required. The data available for extensively studied acute phase reactant, procalcitonin (PCT) remains controversial. This study was done to assess role of PCT alone and in combination with different tests for diagnosing neonatal sepsis.Methods: Blood samples of 275 neonates (&gt;35 weeks of gestation) admitted to NICU, with suspicion of neonatal sepsis were collected for bacterial culture, serum procalcitonin level and sepsis screen (CRP, mESR, I/T ratio, Total Leucocyte Count, Absolute Neutrophil Count).Results: Blood culture was positive in 30.5% of enrolled neonates. At a cut-off value of 0.5 ng/ml the sensitivity, specificity, PPV, NPV of serum PCT in neonatal sepsis cases was 73.8%, 47.1%, 48%, 80.4% respectively. Serum PCT was found raised in 60 (48.8%) clinically suspected cases of neonatal sepsis where sepsis screen and blood culture both were negative, also it was not raised in 17 (32.7%) of clinically suspected cases of septicemia where both blood culture and sepsis screen were positive. Amongst other individual tests, CRP was found to have best sensitivity (79.7%) and NPV (85%) followed by PCT (73.8% and 80.4%) while best specificity was found for I/T ratio (93.7%) followed by mESR (89%) for diagnosis of neonatal sepsis with positive blood culture. Best NPV was seen for combination of PCT+CRP+I/T ratio (95.6%) for the suspected cases of neonatal sepsis.Conclusions: Thus, we conclude that serum PCT can play a useful role when combined with other test markers but may not find its way as a sole diagnostic marker for diagnosing neonatal sepsis in term/near term babies.

Anatomical variations related to pathological conditions of the peroneal tendon: evaluation of ankle MRI with a 3D SPACE sequence in symptomatic patients.

To evaluate anatomical variations in the lateral ankle and their relationships with pathological conditions of the peroneal tendon on magnetic resonance imaging (MRI) in symptomatic patients. Sixty-nine ankles MRIs of 60 adult patients with symptomatic ankles were included. The presence and sizes of peroneal tubercle and retrotrochlear eminence (RTE), the prevalence of peroneus quartus (PQ), os peroneum, and boomerang-shaped peroneus brevis (PB) tendon, the shape of the retromalleolar fibular groove (RMFG), and the location of the PB muscle-tendon junction were evaluated. The relationships of these variations with peroneal tendinopathies were assessed. The correlations between pathological peroneal conditions on MRI and clinical findings were evaluated. Peroneal tubercle (mean size, 3.2mm) and RTE (mean size, 4.5mm) were identified in 58 (84%) and 69 (100%) ankles respectively. PQ muscle, os peroneum, and boomerang-shaped PB tendon were found in 9 (13%), 7 (10%), and 24 (34.8%) ankles respectively. The RMFG was concave, flat, convex, and irregular in 14 (20.3%), 40 (58%), 13 (18.8%), and 2 (2.9%) ankles respectively. Sixteen (23.2%) patients had low-lying PB muscle belly. Only boomerang-shaped PB tendons showed a significant relationship with peroneal tendinopathies. MRI and clinical findings had a poor correlation in pathological peroneal conditions and both had low sensitivity in diagnosis. Lateral ankle anatomical variations are common and cannot be attributed to pathological conditions of the peroneal tendon, except for boomerang-shaped PB tendons. Both clinical and MRI findings have low sensitivity in the diagnosis of peroneal tendinopathies, which are often incidental findings on MRI.

The diagnostic value of GerdQ in subjects with atypical symptoms of gastro-esophageal reflux disease

Background: Symptoms are essential in the clinical diagnosis of gastro-esophageal reflux disease (GERD). Questionnaires such as GerdQ have been developed as diagnostic aids. GerdQ has been thoroughly validated in well-characterized GERD patients, but has not yet been fully evaluated in a population that includes subjects with atypical symptoms.Aim: To evaluate GerdQ in a population with typical and/or atypical symptoms of GERD, defined by 24-h pH monitoring. The secondary aim was to investigate the outcome of GerdQ depending on the response to proton pump inhibitor (PPI) treatment.Methods: The study included 646 subjects referred for 24-h pH monitoring due to a clinical suspicion of GERD. All subjects completed GerdQ before performing a 24-h pH monitoring.Results: In total, 377 (58%) subjects were diagnosed with GERD based on symptoms and 24-h pH monitoring (GERDpH). Of these, 46% had atypical main symptoms. Overall, GerdQ (at cut-off 8) predicted GERDpH with a sensitivity and specificity of 62% and 74%, respectively. A high specificity but poor sensitivity for diagnosis of GERDpH was found for atypical main symptoms such as cough, dysphagia and globus. GerdQ had a relatively high sensitivity and specificity in predicting PPI response and a PPV of 99% at cut-off 8.Conclusions: GerdQ has a diagnostic value in an unselected population presenting with typical and/or atypical symptoms of GERD, but a low sensitivity for diagnosis of GERDpH was found in subjects with predominant symptoms such as cough, dysphagia and globus.

A Supervised Learning Tool for Prostate Cancer Foci Detection and Aggressiveness Identification using Multiparametric magnetic resonance imaging/magnetic resonance spectroscopy imaging

Prostate cancer is the most frequently diagnosed cancer in men in the United States. The current main methods for diagnosing prostate cancer include prostate-specific antigen test and transrectal biopsy. Prostate-specific antigen screening has been criticized for overdiagnosis and unnecessary treatment, and transrectal biopsy is an invasive procedure with low sensitivity for diagnosis. We provided a quantitative tool using supervised learning with multiparametric imaging to be able to accurately detect cancer foci and its aggressiveness. A total of 223 specimens from patients who received magnetic resonance imaging (MRI) and magnetic resonance spectroscopy imaging prior to the surgery were studied. Multiparametric imaging included extracting T2-map, apparent diffusion coefficient (ADC) using diffusion-weighted MRI, using dynamic contrast-enhanced MRI, and 3-dimensional-MR spectroscopy. A pathologist reviewed all 223 specimens and marked cancerous regions on each and graded them with Gleason scores, which served as the ground truth to validate our prediction model. In cancer aggressiveness prediction, the average area under the receiver operating characteristic curve (AUC) value was 0.73 with 95% confidence interval (0.72-0.74) and the average sensitivity and specificity were 0.72 (0.71-0.73) and 0.73 (0.71-0.75), respectively. For the cancer detection model, the average AUC value was 0.68 (0.66-0.70) and the average sensitivity and specificity were 0.73 (0.70-0.77) and 0.62 (0.60-0.68), respectively. Our method included capability to handle class imbalance using adaptive boosting with random undersampling. In addition, our method was noninvasive and allowed for nonsubjective disease characterization, which provided physician information to make personalized treatment decision.

Effect of Culture Technique on the Work Up in cirrhotic Patients with Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with advance liver cirrhosis and is associated with significant mortality. Multidrug resistance is an evolving problem in management of SBP. Therefore, early diagnosis and proper selection of antimicrobial therapy are warranted. Objective: Assessment of the accuracy of conventional culture compared to blood culture in diagnosis of SBP and evaluation the role of blood culture in selection of antimicrobial therapy for treatment of SBP. Methods: One hundred unselected consecutive cirrhotic patients with moderate or severe ascitis who were admitted to Internal Medicine Department during the period from October 2016 to April 2017 were included. Diagnostic aspiration of the ascetic fluid was made for each patient. The aspirated samples underwent chemical and cytological analysis as well as inoculation on conventional culture and on blood culture. Positive growths were tested for antibiotic sensitivity. Results: 47 patients (47%) among the 100 cirrhotic patients had spontaneous bacterial peritonitis. Positive growths were detected in 11 patients (23.4%) and in 32(68.1%) patients by using conventional culture and blood culture respectively. By using blood culture as gold stander, the sensitivity, specificity, positive predictive value and negative predictive value of conventional culture were 34.38%, 100%, 100% and 41.67% respectively. All isolated growths were sensitive to meropenem. Resistance to cefotaxime was detected in 20 cases (62.5%). Other tested drugs showed variable degrees of sensitivity. Conclusion: Conventional culture is of low sensitivity in diagnosis of SBP among cirrhotic patients and blood culture should be considered the gold standard for diagnosis of SBP. Multidrug resistance in SBP is common and antibiotic selection should be based on culture and sensitivity tests.

NEW MODIFICATION OF ISOMETRIC HANDGRIP STRESS ECHOCARDIOGRAPHY FOR DETECTION OF CORONARY ARTERY DISEASE: COMBINATION OF EXERCISE AND EMOTIONAL STRESS ECHOCARDIOGRAPHY

Background: Conventional isometric stress echocardiography is not routinely used in the assessment of coronary artery disease (CAD) because of low sensitivity in diagnosis of coronary lesions. The purpose of this study was to determine diagnostic value of new modification of isometric handgrip

Meta-analysis of anti-GP210 antibody and anti-SP100 antibody detection for diagnosis of primary biliary cirrhosis

To conduct a systematic review of studies assessing the association of anti-GP210 antibody and anti-SP100 antibody with diagnosis of primary biliary cirrhosis (PBC) using meta-analysis. Five research literature databases, including the Cochrane Library, MEDLINE, VIP, CNKI and WanFang, were searched for studies of anti-GP210 antibody and anti-SP100 antibody in diagnosis of PBC. Meta-disc statistical software was used for analysis. The meta-analysis included a total of 25 studies on anti-GP210 antibody and 21 studies on anti-SP100 antibody. The diagnostic odds ratio, sensitivity, and specificity of anti-GP210 antibody for diagnosis of PBC were 24.854 (11.957-51.660), 0.272 (0.257-0.288), and 0.985 (0.982-0.988), respectively, and for anti-SP100 antibody they were 9.133 (4.739-17.600), 0.231 (0.213-0.249), and 0.977 (0.973-0.981), respectively. Both anti-GP210 antibody and anti-SP100 antibody show high specificity but low sensitivity in diagnosis of PBC.

Meta-analysis assessment of GP210 and SP100 for the diagnosis of primary biliary cirrhosis.

PurposeTo conduct a systematic review of included studies assessing the association of GP210 and SP100 with the risk of primary biliary cirrhosis (PBC) using meta-analysis.MethodsFive databases, the Cochrane Library, MEDLINE, VIP, CNKI, WANFANG were used to detect the role of GP210 and SP100 in diagnosis of PBC. Approximately 13,000 participants from several countries were included in this analysis. Meta-DiSc statistical software was used for analysis.Results25 studies on GP210 and 21 studies on SP100 were included in the meta-analysis. The DOR, sensitivity, specificity of GP210 in diagnosis of PBC were 24.854 (11.957–51.660), 0.272 (0.257–0.288), 0.985 (0.982–0.988), respectively, and they were 9.133 (4.739–17.600), 0.231 (0.213–0.249), 0.977 (0.973–0.981) for SP100.ConclusionOur meta-analysis indicated both GP210 and SP100 had high specificity but low sensitivity in diagnosis of PBC.

Progression of Tokyo Guidelines and Japanese Guidelines for Management of Acute Cholangitis and Cholecystitis

The Japanese Guidelines for management of acute cholangitis and cholecystitis were published in 2005 as the first practical guidelines presenting diagnostic and severity assessment criteria for these diseases. After the Japanese version, the Tokyo Guidelines (TG07) were reported in 2007 as the first international practical guidelines. There were some differences between the two guidelines, and some weak points in TG07 were pointed out, such as low sensitivity for diagnosis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. Therefore, revisions were started to not only make them up to date but also concurrent with the same diagnostic and severity assessment criteria. The Revision Committee for the revision of TG07 (TGRC) performed validation studies of TG07 and new diagnostic and severity assessment criteria of acute cholangitis and cholecystitis. These were retrospective multi-institutional studies that collected cases of acute cholangitis, cholecystitis, and non-inflammatory biliary disease. TGRC held 35 meetings as well as international email exchanges with co-authors abroad and held three International Meetings. Through these efforts, TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The world's first management bundles of acute cholangitis and cholecystitis were also presented. The revised Japanese version was published with the same content as TG13. An electronic application of TG13 that can help to diagnose and assess the severity of these diseases using the criteria of TG13 was made for free download.

Role of magnetic resonance imaging in the diagnosis and single-stage surgical resection of invasive lobular carcinoma of the breast.

Conventional imaging with mammography and ultrasonography has a low sensitivity for diagnosis and a tendency to underestimate the extent of invasive lobular carcinoma (ILC) of the breast. The aim was to determine whether magnetic resonance imaging (MRI) had any advantages for the characterization of ILC. Twenty patients with histologically proven ILC underwent preoperative imaging with MRI. MRI was performed to aid detection of malignancy in six patients with a clinically suspicious presentation but normal or indeterminate imaging on mammography and ultrasonography. In 14 patients MRI was performed to determine tumour extent. MRI accurately identified malignancy in five of six patients with normal or indeterminate conventional imaging. In seven of 14 patients in whom MRI was performed to determine tumour extent, it provided significant additional information. These included four patients in whom conventional imaging grossly underestimated tumour size, two patients in whom MRI identified an unsuspected contralateral breast tumour and one patient in whom MRI predicted tumour invasion of the pectoral muscle. The correlation between tumour size on histological examination was better with MRI (r = 0.967) than with mammography (r = 0.663) and ultrasonography (r = 0.673). MRI can provide considerable additional information in the detection and characterization of ILC.