Positive Diagnosis Rate Research Articles

Abstract 160: Impact of ECG to Decision Time and Sex Differences on False Positive STEMI Diagnosis Rate in a Large Rural Healthcare Center

Objectives: A false positive diagnosis of STEMI may lead to unnecessary treatments and increased costs. Little data are published on the unique care performance metric of electrocardiogram-to-decision time (E2Decide) for the diagnosis of STEMI. The objective of this quality improvement analysis was to determine the association between E2Decide time and sex differences on false positive diagnosis rates for STEMI Methods: A retrospective analysis was conducted of consecutive STEMI diagnoses treated at a rural tertiary care hospital, located in Duluth, Minnesota, USA, between May 2013 to December 2017, originating from 4 different settings: (1) non-PCI facilities, (2) in the field by emergency medical services, (3) tertiary hospital emergency department, or (4) tertiary hospital in-patient. A false positive STEMI diagnosis was defined as no culprit lesion or multi-vessel disease found during angiography, or if the cardiologist rejected the initial diagnosis of STEMI and cancelled angiography. Multivariate logistic regression modeling was used for parameter estimates. Results: There were 1278 consecutive STEMI diagnoses in our analysis, of which there were 429 (33.6%) females. A total of 215 (16.8%) were false positives. Females had a 45.2% increased odds of a false positive diagnosis compared to males [estimated odds ratio (OR) 1.452 (95% CI: 1.062- 1.984)]. E2Decide time was positively associated with an increase in odds of a false positive (OR 1.007; 95% CI: 1.001-1.012). For every 5 minutes of increase in E2Decide time, there was a 3.6% increase in the odds of a false positive STEMI diagnosis. Conclusions: We observed a higher false positive STEMI diagnosis rate with females compared to males. Longer E2Decide times were significantly associated with higher false positive STEMI diagnosis rates. In addition to demonstrating the impact of sex differences on false positive STEMI diagnosis rate, this analysis demonstrates the potential value of the metric E2Decide time.

Clinical Value of Serum p53 Antibody in the Diagnosis and Prognosis of Esophageal Squamous Cell Carcinoma.

Identifying useful biomarkers is central to selecting optimal therapeutic strategies for esophageal squamous cell carcinoma (ESCC). Serum p53 antibody (S-p53Ab), squamous cell carcinoma antigen (SCC-Ag), and carcinoembryonic antigen (CEA) were investigated to evaluate the significance of single and combined tumor markers in determining the diagnosis and prognosis of ESCC. Serum samples were obtained preoperatively from 133 patients with histologically-confirmed ESCC, including 32 patients with stage I (24.1%). Levels of S-p53Ab were assessed by enzyme-linked immunosorbent assay, using a new version of a highly specific, quantitative kit. The cut-off value for S-p53Ab was 1.3 U/ml. S-p53Ab was detected in 39.1% (52 out of 133) of patients with ESCC, including 40.0% (20 out of 50) of patients with early-stage ESCC. Positive rates for S-p53Ab, CEA, and SCC-Ag among patients with stage I ESCC (n=32) were 40.6%, 12.5%, and 31.3%, respectively. Positivity for S-p53Ab was not associated with positivity for CEA or SCC-Ag (p=0.249 and 0.747, respectively). The positive rate for diagnosis of ESCC increased from 39.1% to 65.4% when S-p53Ab was combined with SCC-Ag in this study. We found no significant correlation between the presence of S-p53Ab in ESCC and overall survival. Conversely, Cox regression analysis revealed that the International Union Against Cancer/TNM classification and systemic inflammation score were independent prognostic factors for ESCC in this series (hazard ratio(HR)=3.811, 95% confidence interval(CI)=1.548-9.378, p=0.004; and HR=2.218; 95% CI=1.087-4.523, p=0.029, respectively). Kaplan-Meier analysis revealed significant differences between patients with elevated S-p53Ab and SCC-Ag and patients with elevated levels of only one or neither of these factors (p=0.009). The diagnostic rate with S-p53Ab was better than that with SCC-Ag and CEA in patients with early-stage ESCC. Combined detection of S-p53Ab and SCC-Ag can markedly improve diagnostic sensitivity and may permit more accurate stratification of patients with ESCC.

Management of Occult Breast Cancer with Axillary Involvement

Occult breast cancer (OBC), which is defined as clinically recognizable axillary metastatic carcinoma from an undetectable primary breast tumor, accounts for less than 1% of all patients who present with breast cancer (BC). Although criticized for high false positive rate (FPR) in routine BC diagnosis, the role of magnetic resonance imaging (MRI) is crucial in the diagnosis of OBC. The standard treatment for OBC, initially, was blind modified radical mastectomy, but one third of patients who undergo blind mastectomy, will have no histopathological findings of carcinoma. Current evidence supports the use of whole breast radiotherapy (WBRT) and axillary nodes clearance (ANC) as the locoregional treatment for patients with OBC. Management of the axilla does not differ from that of patients with BC with clinically palpable axillary lymph nodes (LNs) and ANC, which remains the gold standard, should be used for staging and loco-regional control. Neo-adjuvant chemotherapy (NACT) could reduce ANC by 43%, and for patients who undergo NACT with complete radiological response, a more conservative surgical approach, with a minimum of 3 sentinel lymph node biopsies (SLNBs), together with targeted dissection of the involved LNs could be considered as an option. This offers adequate staging and loco-regional control, combined with significantly less comorbidities than ANC. Overall, the prognosis of OBC is equal to or better than that of other BCs with metastasis to the axillary LNs. Progesterone receptor (PR) expression should be taken into account when evaluating the prognosis of OBC because PR-positive patients achieve better overall survival and have a lower risk of local recurrence. Surveillance should include breast MRI and mammography.

A retrospective analysis of 171 neonates with congenital duodenal obstruction

Objective To investigate the incidence, clinical characteristics, diagnosis and treatment of various congenital duodenal obstruction in neonates. Methods Cases diagnosed with congenital duodenal obstruction admitted to Shengjing Hospital from 2006 to 2015 were collected.Clinical characteristics and prognosis were then analyzed. Results One hundred and seventy-one patients were included(106 males and 65 females), among which 26 were premature and 145 mature .In these patients, 55 were diagnosed with duodenal atresia or stenosis, 39 annular pancrea, 89 midgut malrotation(70 associated with midgut volvulus), and 15 with at least two conditions above.Bile vomiting was the most common clinical manifestation.For 41.52% of the patients, symptoms occurred within the first 24 hours after birth, and children with duodenal stenosis, duodenal atresia, or annular pancreas were significantly linked with earlier symptoms than patients with intestinal malrotation.Positive diagnosis rate of abdominal plain film, abdominal doppler ultrasonography, and upper gastrointestinal contrast were 73.10%, 37.14%, and 100%, respectively, with significant difference(P<0.01). Compared with those whose first diagnosis were executed postnally, patients whose anomalies were found prenatally were diagnosed and operated significantly earlier(P<0.01). Postoperative fasting time and hospitalization time of patients with various malformations were significantly longer than groups with single anomaly.Among the 171 cases, 162 were performed operation(9 cases abandoned treatment because of extensive intestinal necrosis), 145 cases recovered well 25 quitted, and 1 died, with a cure rate of 94.77%.Postoperative short-term complications included incision infection, unwound, intestinal perforation and anastomotic fistula. Conclusion The causes of congenital duodenal obstruction include duodenal atresia or stenosis, annular pancreas and congenital intestinal malrotation, among which congenital intestinal malrotation is most common.A higher incidence was seen in male infants.The onset of symptoms is seen later in intestinal malrotation.The positive diagnosis rate of upper gastric contrast study is highest.The recovery process for patients diagnosed prenatally is not better than patients diagnosed after birth.Patients with multiple malformations need more time to cure.The prognosis is excellent in most cases. Key words: Congenital duodenal obstruction; Newborn; Clinical characteristics

Clinical value of spiral CT in the diagnosis of abdominal trauma

Objective To analyze the value of spiral CT in the diagnosis of abdominal trauma, thus to provide reference for clinical diagnosis and treatment. Methods 98 patients with abdominal trauma were selected.Abdominal ultrasonography and spiral CT were given before operation and the results were compared, including sensitivity, specificity and accuracy according to intraoperative situations. Results According to CT, there were 81 positive cases and 17 negative cases, and the positive diagnosis rate was 82.65%.The intraoperative exploration showed that there was 1 false positive case and 3 false negative cases.The sensitivity of spiral CT was 96.39%, specificity was 93.33%, and accuracy was 95.92%.According to abdominal ultrasonography, there were 77 positive cases and 21 negative cases, and the positive diagnosis rate was 78.57%.The intraoperative exploration showed that there was 4 false positive cases and 10 false negative cases.The sensitivity of spiral CT was 87.95%, specificity was 73.33%, and accuracy was 85.71%.The sensitivity of CT was higher than ultrasonography(χ2=5.081, P<0.05), the specificity of CT was higher than ultrasonography(χ2=6.491, P<0.05), the accuracy of CT was higher than ultrasonography(χ2=6.667, P<0.05). Conclusion The diagnosis accuracy of spiral CT is higher for abdominal trauma, and it is more helpful for doctors to definite the damaged organ and degree to adopt corresponding treatment methods, and the risk of death can be decreased. Key words: Abdominal injuries; Tomography, spiral computed; Ultrasonography, doppler, color

Analysis on the value of cytological and histological noninvasive methods in endometrial cancer screening

Objective To explore the value of cytological and histological noninvasive methods in the screening of endometrial cancer (EC). Methods Seventy-six cases of suspected EC high risk patients diagnosed in the gynecological outpatient department of the People Hospital of Longhua from January 2015 to May 2017 were selected as the research object, the endometrial cells and tissues were collected for cytological and histological examination, the diagnosis of curettage or hysteroscopy performed as agold standardto determine the effect of cytology, histology and combined examination on the ensitivity, specificity, positive coincidence rate of EC diagnosis. Results 76 patients with suspected EC high risk factors were diagnosed as EC 48 cases (63.16%) viagold standard. The sensitivity, specificity and positive coincidence rate of cytology were (75.00%, 89.29%, 80.26%, χ2=1.0105, P=0.6033), histology were(79.17%, 92.86%, 84.21%, χ2=0.3117, P=0.8557) and combined examination in EC were(83.33%, 92.86%, 86.84%, χ2=1.2260, P=0.5417). Conclusion Cytological and histological noninvasive screening has high sensitivity, specificity and positive coincidence rate in EC and has a high diagnostic value for individual or combined exams and can be used as a routine screening for EC in clinical practice. Key words: Endometrial Cancer; Cytology; Histology

EP07.07: The value of prenatally quantitative evaluation the severity of clubfoot by sonography

To investigate the value of the severity of fetal clubfoot evaluated by sonography prenatal. By routine sonography totally 32 feet with clubfoot were chosen as case group, and 414 normal feet between 16 and 38 weeks gestation were enrolled in control group stochastically. The length and width of the foot in both group were measured, and then the length-to- width ratio was calculated. The angle that the long-axis of the foot made with the long-axis of the lower leg was measured and classified into mild, moderate, severe. The foot length, foot width and the length-to-width in both groups were compared. After birth, the fetuses of case group were followed up and Dimeglio score was recorded. The correlation analysis between the ratio and the angle and the Dimeglio score were also made respectively. The length-to-width ratio in case group were smaller than the control group (ZFL=-2.10, p<0.05; ZFL/FW=-8.46, p<0.001), and the foot width was wider (ZFW=-2.06, p<0.05). Significant negative correlation was identified between the ratio and the Dimeglio score (r=-0.600,p<0.01)and significant positive correlation was identified between the angle and the Dimeglio score (r=0.764,P<0.01). By combining the ratio with the angle, the false positive rate dropped from 6/32 (18.8%) to 1/27 (3.7%). The angle and ratio can provide information for prenatal quantitative evaluation the severity of clubfoot and reduce the false positive rate in diagnosis of fetal clubfoot.

Alvarado score: can it reduce unnecessary interventions for acute appendicitis in children?

Abstract The purpose of the study is to compare the outcomes of surgical interventions for acute appendicitis with the values of the Alvarado score. We conducted the study on 572 patients that underwent surgical interventions for acute appendicitis. Retrospectively, based on the medical records, we calculated the MANTRELS score and compared the outcomes of the intervention with the values of the applied score. Almost one third of the patients with a MANTRELS score lower than 6 had negative appendectomies. These patients represent 60% of the total cases of negative appendectomies, while in the case of patients with a high score around 2% had negative appendectomies. We concluded that using this scoring system to assess the need of immediate surgical intervention is important and can increase the rate of positive diagnosis mainly by limiting the number of unnecessary interventions.

An efficacy analysis of whole-body magnetic resonance imaging in the diagnosis and follow-up of polymyositis and dermatomyositis.

ObjectivesTo evaluate the value of whole-body magnetic resonance imaging (WBMRI) in diagnosing muscular and extra muscular lesions in patients with polymyositis (PM) and dermatomyositis (DM).MethodsA retrospective analysis of WBMRI data from PM/DM patients who met the Bohan and Peter diagnostic criteria was performed. X2 test was used to compare the rate of positive diagnosis of newly diagnosed patients using WBMRI, serum creatine kinase test, and EMG. McNemar test was used to compare the performance of WBMRI and chest CT in detecting interstitial lung disease (ILD).ResultsThe study included 129 patients (30 PM cases and 99 DM cases). Of them, 81.4% (105/129) showed a visible inflammatory muscular edema on their WBMRI; 29.5% (38/129) had varying degrees of fatty infiltration (9 cases with clear muscular atrophy). Of the 66 newly diagnosed patients, the positive rates of WBMRI, muscle biopsy, serum creatine kinase test and EMG were 86.4% (57/66), 92.4% (61/66), 71.2% (47/66) and 71.1% (32/45), respectively. There was no significant difference in the positive rates between WBMRI and muscle biopsy (X2 = 1.28, P = 0.258). The WBMRI had a higher positive rate than both serum creatine kinase test (X2 = 4.53, P = 0.033) and EMG (X2 = 3.92, P = 0.047). In addition to muscular changes, WBMRI also detected interstitial lung disease (ILD) in 38 cases (29.5%), osteonecrosis in 15 cases (11.6%), and neoplastic lesions (5 malignant; 7 benign) in 12 cases (9.3%). Of the 61 patients who underwent routine chest CT examinations, the WBMRI and CT revealed ILD in 29 cases and 35 cases respectively. There was no significant difference in the sensitivity between WBMRI and CT (p = 0.146).ConclusionsWBMRI is a sensitive, non-invasive and efficient imaging method. It comprehensively displays the extent of muscular involvement in PM/DM patients, and it has the ability to diagnose other associated extra muscular diseases, such as ILD and systemic malignancy. WBMRI can also help screen steroid-induced osteonecrosis.

Stroke chameleons: Uncommon presentations of a common disease

Stroke is one of the major causes of death and morbidity worldwide and carries an important economic impact. The diagnosis is still a clinical one, supported by brain imaging. However, up to 30% of suspected stroke presentations have a different diagnosis. In these cases, two scenarios must be considered: a false positive diagnosis, or “stroke mimic”, and a false negative or “stroke chameleon”. The diagnosis of acute ischemic stroke is often straightforward. The sudden onset of a focal neurologic deficit in a recognizable vascular distribution with a common presentation - such as hemiparesis, facial weakness and aphasia - identifies a common syndrome of acute stroke. But differential diagnostic problems remain because there are several subtypes of stroke and also because some non-vascular disorders may have clinical pictures that appear identical to strokes. Acute ischemic stroke (AIS) with neurological deficit is a very debilitating condition, especially in younger patients and the rate of false positive diagnosis of ischemic stroke labeled ''stroke mimics'' ranges from 1.3% to 25%.

Poster Number: NR 11 - Determining the Impact of Psychosis on Rates of False Positive and False Negative Diagnosis in Alzheimer's Disease

Poster Number: NR 11 - Determining the Impact of Psychosis on Rates of False Positive and False Negative Diagnosis in Alzheimer's Disease

Automated Detection of Malarial Retinopathy in Digital Fundus Images for Improved Diagnosis in Malawian Children with Clinically Defined Cerebral Malaria

Cerebral malaria (CM), a complication of malaria infection, is the cause of the majority of malaria-associated deaths in African children. The standard clinical case definition for CM misclassifies ~25% of patients, but when malarial retinopathy (MR) is added to the clinical case definition, the specificity improves from 61% to 95%. Ocular fundoscopy requires expensive equipment and technical expertise not often available in malaria endemic settings, so we developed an automated software system to analyze retinal color images for MR lesions: retinal whitening, vessel discoloration, and white-centered hemorrhages. The individual lesion detection algorithms were combined using a partial least square classifier to determine the presence or absence of MR. We used a retrospective retinal image dataset of 86 pediatric patients with clinically defined CM (70 with MR and 16 without) to evaluate the algorithm performance. Our goal was to reduce the false positive rate of CM diagnosis, and so the algorithms were tuned at high specificity. This yielded sensitivity/specificity of 95%/100% for the detection of MR overall, and 65%/94% for retinal whitening, 62%/100% for vessel discoloration, and 73%/96% for hemorrhages. This automated system for detecting MR using retinal color images has the potential to improve the accuracy of CM diagnosis.

Rate of positive diagnosis of skin cancer and its stage in two-week wait referrals in England according to age.

The incidence of skin cancer is increasing. The two-week wait conversion rate (TWWCR) is the percentage of urgent suspected skin cancer referrals that are confirmed as cancer. To examine the relationships between different epidemiological factors and TWWCR for malignant melanoma (MM) and cutaneous squamous cell carcinoma (SCC). We extracted data from the National Cancer Data Repository (NCDR) and National Cancer Waiting Times Monitoring Dataset between 2009 and 2010 for MM and SCC in England. We conducted partial correlation and stepwise multiple regression analysis on TWWCR, age, incidence, detection rate, tumour thickness (MM only), percentage MM/SCC and social deprivation. We also looked at the two-week wait referral rate (TWWRR) and incidence rate with respect to age. TWWCR was significantly correlated with age when partial correlation was used to control for the factors described above for MM (P < 0.05) and SCC (P < 0.001). Stepwise regression of these factors returned only age as significant in the final model for MM (P < 0.001) and SCC (P < 0.01). Incidence of MM and SCC increased with age. TWWRR also increase with age, but with higher rate in younger people relative to their incidence. Age is a predictor of TWWCR independent of the other factors measured, including thickness and incidence. This may be explained by the higher number of referrals for younger patients despite the lower incidence of skin cancer in this group. This may reflect a more appropriate rate of referral in order to achieve earlier diagnosis and better outcomes.

The Modern Diagnostic Approach to Community-Acquired Pneumonia in Adults.

Respiratory tract infections, the majority of which are community acquired, are among the leading causes of death worldwide and a leading indication for hospital admission. The burden of disease demonstrates a "U"-shaped distribution, primarily affecting young children as the immune system matures, and older adults as the process of immunosenescence and accumulation of comorbidities leads to increased susceptibility to infection. Diagnosis of community-acquired pneumonia (CAP) is traditionally based on demonstration of a new infiltrate on a chest radiograph in a patient presenting with an acute respiratory illness or sepsis. Advances in diagnosis have been slow, and although there are increasing data on the value of computed tomography or lung ultrasound as more sensitive diagnostic methodologies, they are not widely used as initial diagnostic tests. There are a wide range of differential diagnoses and pneumonia "mimics" which should be considered in patients presenting with CAP. Once the diagnosis of CAP has been made, identifying the causative microorganism is the next stage in the diagnostic process. Traditional culture-based approaches are relatively insensitive and achieve a positive diagnosis in only 30 to 70% of cases, even when rigorously applied. Urinary antigen tests, polymerase chain reaction assays, and even next-generation sequencing technologies have become available and are increasing the rates of positive diagnosis. In an era of increasing antimicrobial resistance, the accurate diagnosis of CAP and determining the causative pathogen are ever more important. Getting these both right is key in reducing both morbidity and mortality from CAP, and appropriate antimicrobial stewardship which is now an international healthcare priority.

Molecular diagnosis of infectious diseases in São Miguel Island (Azores, Portugal): A hospital-based descriptive study.

We performed a descriptive analysis of molecular diagnosis of infectious agents in the São Miguel Island population, in order to address questions like what is the frequency of clinical requests, is it observable seasonality of pathogens, and what is the positive rate for the clinical diagnosis. This was a retrospective and descriptive study based on 878 individuals suspected of harboring infectious diseases during two consecutive years, 2012-2013. More than 25 different pathogens were investigated by polymerase chain reaction (PCR)-based methods. The individuals were stratified into gender, occupation, and age groups. The pathogen with more clinical requests was hepatitis C virus, investigated in 225 individuals (30.0%), followed by Leptospira spp., in 187 (24.9%). Overall, data demonstrated a gender distribution bias, where 72.9% of cases were males. The age group of 25 to 44 years was the class with more clinical requests. Regarding occupation, a predominance of construction workers (12.0%) was observed, followed by retired workers (11.0%). Patient distribution per year showed a higher number of patients in the fall months. Diagnoses of leptospirosis and respiratory virus infections presented seasonality. The present study provides a valid contribution to the knowledge of the epidemiology of infectious diseases in the São Miguel Island (Azores, Portugal) population.

Utility of Whole Exome Sequencing for Genetic Diagnosis of Previously Undiagnosed Pediatric Neurology Patients.

Whole exome sequencing enables scanning a large number of genes for relatively low costs. The authors investigate its use for previously undiagnosed pediatric neurological patients. This retrospective cohort study performed whole exome sequencing on 57 patients of "Magen" neurogenetic clinics, with unknown diagnoses despite previous workup. The authors report on clinical features, causative genes, and treatment modifications and provide an analysis of whole exome sequencing utility per primary clinical feature. A causative gene was identified in 49.1% of patients, of which 17 had an autosomal dominant mutation, 9 autosomal recessive, and 2 X-linked. The highest rate of positive diagnosis was found for patients with developmental delay, ataxia, or suspected neuromuscular disease. Whole exome sequencing warranted a definitive change of treatment for 5 patients. Genetic databases were updated accordingly. In conclusion, whole exome sequencing is useful in obtaining a high detection rate for previously undiagnosed disorders. Use of this technique could affect diagnosis, treatment, and prognostics for both patients and relatives.

Expanding the Spectrum of Genes Involved in Huntington Disease Using a Combined Clinical and Genetic Approach.

Huntington disease (HD), a prototypic monogenic disease, is caused by an expanded CAG repeat in the HTT gene exceeding 35 units. However, not all patients with an HD phenotype carry the pathological expansion in HTT, and the positive diagnosis rate is poor. To examine patients with HD phenotypes to determine the frequency of HD phenocopies with typical features of HD but without pathological CAG repeat expansions in HTT in an attempt to improve the positive diagnosis rate. Between January 1, 2004, and April 18, 2011, a total of 226 consecutive index patients with an HD phenotype were referred to specialized clinics of the French National Huntington Disease Reference Centre for Rare Diseases. They underwent detailed clinical examination and follow-up, as well as neuropsychological, biological, imaging, and genetic examinations. Nucleotide expansions in JPH3, ATN1, TBP, and C9ORF72 and mutations in PRNP, as well as acquired conditions commonly causing HD phenocopies, were first screened. The diagnostic rate of HD phenocopies and frequency of other etiologies using deep clinical phenotyping and next generation sequencing. Our goal was to improve the genetic diagnosis of HD phenocopies and to identify new HD related genes. One hundred ninety-eight patients carried a pathological CAG repeat expansion in HTT, whereas 28 patients (12 women and 16 men) did not. Huntington disease phenocopies accounted for 12.4%, and their mean (SD) age at onset was similar to those of the HD-HTT group (47.3 [12.7] years vs 50.3 [16.4] years, P = .29). We first identified 3 patients with abnormal CTG expansions in JPH3, a fourth patient with an antiphospholipid syndrome, and a fifth patient with B12 avitaminosis. A custom-made 63-gene panel was generated based on clinical evolution and exome sequencing. It contained genes responsible for HD phenocopies and other neurodegenerative conditions, as well as candidate genes from exome sequencing in 3 index cases with imaging features of brain iron accumulation. We identified mutations in genes associated with neurodegeneration, including CACNA1A (n = 2), VPS13A (n = 1), UBQLN2 (n = 1), and VCP (n = 1). Huntington disease phenocopies without CAG repeat expansions in HTT are not rare, occurring in 12.4% (28 of 226) herein, and should be considered in genetic counseling. We used next-generation sequencing combined with clinical data and disease evolution to explore multiple etiologies simultaneously. Our combined clinical and genetic exploration of 28 HD phenocopies identified the underlying cause in 35.7% (10 of 28). In conclusion, the etiologies of HD phenocopies are heterogeneous, and clinical evolution should be taken into account when searching for a genetic cause. The panel of candidate genes to be examined is larger than expected but can be guided by specific imaging and clinical features. Other neurodegenerative diseases with late onset in which variant segregation cannot be verified could be productively explored with the combined approach illustrated herein.

Metabolite Profiles in Sepsis: Developing Prognostic Tools Based on the Type of Infection.

Currently used biomarkers insufficiently discriminate between patients with systemic inflammatory response syndrome of non-infectious origin and sepsis. The aim of this study was to identify surrogate markers that distinguish between systemic inflammatory response syndrome and sepsis as well as the underlying type of infection by targeted metabolomics. Retrospective analysis. Six sites of the Hellenic Sepsis Study Group and at Jena University Hospital. A total of 406 patients were analyzed: 66 fulfilling criteria for diagnosis of systemic inflammatory response syndrome, 100 for community-acquired pneumonia, 112 for urinary tract infection, 83 for intra-abdominal infection and 45 for bloodstream infection. Patients were divided into test cohort (n = 268) and confirmation cohort (n = 138). A total of 186 metabolites were determined by liquid chromatography tandem mass spectrometry. Serum concentrations of most acylcarnitines, glycerophospholipids and sphingolipids were altered in sepsis compared to systemic inflammatory response syndrome. A regression model combining the sphingolipid SM C22:3 and the glycerophospholipid lysoPCaC24:0 was discovered for sepsis diagnosis with a sensitivity of 84.1% and specificity of 85.7%. Furthermore, specific metabolites could be used for the discrimination of different types of infection. The glycerophospholipid lysoPCaC26:1 identified patients with community-acquired pneumonia in sepsis or severe sepsis/septic shock. Within severe sepsis/septic shock, patients with bloodstream infection could be discriminated by a decrease of acetylornithine. Changes of metabolites between sepsis and severe sepsis/septic shock also varied according to the underlying type of infection, showing that putrescine, lysoPCaC18:0 and SM C16:1 are associated with unfavorable outcome in community-acquired pneumonia, intra-abdominal infections and bloodstream infections, respectively. Using a metabolomics approach, single metabolites are identified that allow a good, albeit at about 14% false positive rate of sepsis diagnosis. Additionally, metabolites might be also useful for differentiation and prognosis according to the type of underlying infection. However, confirmation of the findings in ongoing studies is mandatory before they can be applied in the development of novel diagnostic tools for the management of sepsis.

Value of percutaneous transhepatic cholangiobiopsy for pathologic diagnosis of obstructive jaundice: analysis of 826 cases.

Obstructive jaundice (OJ) is insensitive to radiation and chemotherapy, and a pathologic diagnosis is difficult to make clinically. Percutaneous transhepatic cholangiobiopsy (PTCB) is simple to perform and minimally invasive, and clinical practice has shown it to be an accurate and reliable new method for bile duct histopathologic diagnosis. To investigate the value of PTCB for pathologic diagnosis of causes of OJ. From April 2001 to December 2011, PTCB was performed in 826 consecutive patients. Data on pathologic diagnosis, true positive rate, and complications were analyzed retrospectively. Patients with negative pathologic findings were diagnosed using clinical, imaging, laboratory, and prognostic data. The feasibility and safety of PTCB for OJ were evaluated and true positive rates for biliary carcinoma and non-biliary carcinoma compared. PTCB was successful in all cases. Of 740 patients clinically diagnosed with malignant biliary stricture and 86 with benign biliary stricture, 727 received a positive pathologic diagnosis; in 99, the pathologic findings were considered false negative. The true positive rate for PTCB was 88.01% overall, differing significantly for biliary and non-biliary carcinoma (χ2 = 12.87, P < 0.05). Malignancy accounted for 89.59% of OJ cases; well, moderately, and poorly differentiated carcinoma represented 57.88%, 19.97%, and 22.15%. Biliary adenocarcinoma was the predominant malignant pathologic type (96.41%). Transient bilemia, bile leakage, and temporary hemobilia occurred in 47, 11, and 28 cases, respectively, with no serious complications. PTCB is safe, feasible, and simple, with a high true positive rate for definitive diagnosis of OJ causes. Well differentiated adenocarcinoma was the predominant pathologic type.

Understanding the diagnostic yield of current endoscopic biopsy for gastric neoplasm: A prospective single-center analysis based on tumor characteristics stratified by biopsy number and site.

Although there are general guidelines on endoscopic biopsy for diagnosing gastric neoplasms, they are predominantly based on outdated literature obtained with fiberscopes without analyses specific to tumor characteristics.This study aims to comprehensively characterize the contemporary endoscopic biopsy by determining the diagnostic yield across different lesion morphologies and histological stages, especially exploring how the number and site of biopsy may influence the overall yield.Biopsy samples from suspected gastric neoplasms were collected prospectively from May 2011 to August 2014 in a tertiary care medical center. A standardized methodology was used to obtain a total of 6 specimens from 2 defined sites per lesion. Rate of positive diagnosis based on the biopsy number and site was assessed for specific gastric lesion morphologies and histological stages.A total of 1080 biopsies from 180 pathologically diagnosed neoplastic lesions in 176 patients were obtained during the study. For depressed/ulcerative and polypoid lesions, the yield was already >99% by the fourth biopsy without further gain from additional biopsies. Lower overall yield was observed for infiltrative lesions (57.1% from 4 biopsies). The site of biopsy did not influence the diagnostic yield except for with infiltrative lesions in which biopsies from thickened mucosal folds were of higher yield than erosive regions.Obtaining 4 specimens may be sufficient for accurate diagnosis of a depressed/ulcerative or polypoid gastric lesion regardless of its histological stage. For infiltrative lesions, at least 5 to 6 biopsies per lesion with more representative sampling from thickened mucosal folds may be preferable.