Routine Diagnostic Work-up Research Articles

CTPA imaging findings, beyond pulmonary embolism, in patients with Severe Acute Respiratory Syndrome Corona Virus-2 infection and their relation to clinical outcome - a single center experience.

The aim of our study was to investigate a potential association between the severity of COVID-19 disease and related 28-day mortality, with the presence of mediastinal lymphadenopathy, the extension of lung parenchymal infiltrates, the presence of pulmonary embolism, the density and distribution of mediastinal and subcutaneous fat, the inflammatory markers and the direct and indirect radiological signs of right heart overload and strain. We retrospectively included patients diagnosed with SARS-CoV-2 infection, who were admitted to the Departments of Internal and Respiratory Medicine of Patras University Hospital during the second pandemic wave (February 2021 up to July 2021) and underwent CTPA for routine diagnostic workup. Demographic characteristics, routine laboratory, radiological parameters and 28-day mortality were also recorded. Fifty-three consecutive patients were included. The mean age was 64.47±17.1 years and 64,1% (n=34) were males. Pulmonary embolism (PE) (p=0.019), Right Ventricle-to-Left Ventricle Diameter (RV/LV) Ratio>1 (p<0.01), Reverse Flow in Hepatic Veins (RFHV) (p=0.019), higher density in subcutaneous fat (-99 HU vs. -104HU, p=0.016), increased Lactic Dehydrogenase (LDH), Polymorphonuclear cells (PMN), ferritin, and d-dimer levels (534 vs. 367 U/L, p=0.001, 9220 vs. 5660 Κ/μL, p=001, 956 vs. 360 ng/ml, p=0.005 and 2300 vs. 1040 μg/ml, p=0.003, respectively) were statistically significant related with worse 28-day mortality. Binomial multivariate regression analysis revealed that only RV/LV diameter>1, higher subcutaneous fat density and higher LDH values were independently associated with increased 28-day mortality (OR: 82.9, 95%CI: 1.334-5158, p=0.036, OR: 1.2, 95%CI: 1.016-1.426, p=0.032 and OR:1.016, 95% CI:1.004-1.029, p=0.011, respectively). Subgroup analysis revealed that mediastinal lymph node enlargement (EML) and PE were associated to increased Pulmonary Disease Severity Index (PDSI) score (p=0.042 and p=0.007, respectively), but not to mortality. Our study showed that right heart strain as depicted by a RV/LV diameter>1, higher subcutaneous fat density and higher LDH values are independently associated with an increased 28-day mortality in our SARS-COV2 patient group.

Validation of a new NGS-based myeloid panel in acute myeloid leukemia: A single-center experience

Acute myeloid leukemia (AML) identifies a heterogeneous group of clonal disorders, both clinically and genetically. A large number of mutations have been described in AML, although only a few are currently employed in clinical practice. Next generation sequencing (NGS) allows for better understanding of the complex genetic background in AML and may direct individualized therapies. In this study, we aim to identify molecular aberrations that are not routinely investigated in AML using an NGS-based panel encompassing 101 genes and to evaluate how their oncogenic potential correlates with survival. Forty consecutive patients with newly diagnosed AML were enrolled between January 2018 and April 2020. We performed targeted NGS and detected 96 mutations in 36 patients (90%), while 14 fusion genes were detected in 13 patients (32%). Each mutation was weighed using OncoScore, a text-mining tool ranking genes according to their oncogenic potential. An OncoScore ≥ 100 was associated with shorter PFS among our patients (p = 0.05). In 11 patients with no available MRD markers at diagnosis, we were able to perform NGS-based MRD monitoring using targeted deep sequencing. Overall, our study shows that NGS is a powerful tool in AML and should be employed both in routine diagnostic workup and follow up.

FC030: Diagnostic Yield of Exome Sequencing in Hypertensive Nephropathy

Abstract BACKGROUND AND AIMS Hypertensive nephrosclerosis ranks as one of the most frequent causes of chronic kidney disease (CKD) worldwide and is deemed to be especially prevalent among patients of African ancestry [1]. The very existence of hypertensive nephropathy has been called into question, especially in young adults. Its diagnostic framework is based on non-specific clinical criteria, and its histopathological features are in fact unspecific. Genetic testing with exome sequencing (ES) has emerged as a comprehensive tool to detect Mendelian diseases in nephrology with a significant number of post-hoc re-established diagnoses [2]. Nevertheless, ES has yet to be incorporated into the diagnostic workup of patients with hypertensive nephropathy consistently. This study aimed to investigate the diagnostic yield of ES in patients with a clinical diagnosis of hypertensive nephropathy. METHOD Since September 2018, ES is readily available as part of the routine diagnostic workup in our institution. The indication of ES includes hypertensive nephropathy of early onset (i.e. &amp;lt;45 years old). We retrospectively collected the ES performed in the context of hypertensive nephropathy [3] in our institution between September 2018 and February 2021. RESULTS A total of 128 patients were sequenced in the context of hypertensive nephropathy with early-onset. Women were 29 (22.7%), the mean age was 43 (35; 51) years and 60% of them were patients of African ancestry. The main indications of ES was an early onset of CKD (47%), a family history of kidney disease (8%) or both (18%). We detected diagnostic variants (ACM class 4/5) in 22 of the 128 patients (17.2%) encompassing a total of 16 different monogenic disorders. Two diseases accounted for more than half of the genetic diagnoses: nephronophthisis (n = 7, 32%) and Alport syndrome (n = 5, 23%). Complement variation did not account for a significant part of the diagnosis. The diagnostic yield of ES was lower in patients of African ancestry (diagnostic yield of 10.4% versus 27.4% in the non-African ancestry patients; P = 0.01). Co-segregation data was lacking in patients of African ancestry, with significantly more ES performed in singleton (96% compared with 76% in non-African ancestry patients; P &amp;lt; 0.001). In addition to disease reclassification, genetic diagnosis enabled guidance for family counseling (n = 11, 50% of positive patients) and thus helped for potential related donor selection for transplantation. In the whole cohort, ES results modified the therapeutic in 6 patients (5%) and ruled out potential recurrence in the graft in 10 patients (8%). CONCLUSION Physicians should be wary of tentative diagnosis of nephrosclerosis, especially in patients of non-African ethnic background. Instead, it should prompt genetic investigations, which overturned the initial diagnosis in 17% of the cases. The lower diagnostic yield of ES in patients of African ancestry in our cohort might partly be due to the lack of available co-segregation data, as well as the underrepresentation of subjects of African ancestry in the reference genome.

Current status of the management of isolated syndesmotic injuries in Germany

IntroductionAlthough non-fracture-related syndesmotic injuries of the ankle are relatively rare, they may lead to poor clinical outcome if initially undiagnosed or managed improperly. Despite a variety of literature regarding possibilities for treatment of isolated syndesmotic injuries, little is known about effective applications of different therapeutic methods in day-to-day work. The aim of this study was to assess the current status of the treatment of isolated syndesmotic injuries in Germany.Materials and methodsAn online-questionnaire, capturing the routine diagnostic workup including clinical examination, radiologic assessment and treatment strategies, was sent to all members of the German Society of Orthopedic Surgery and Traumatology (DGOU) and Association of Arthroscopic and Joint Surgery (AGA). Statistical analysis was performed using Microsoft excel and SPSS.ResultsEach question of the questionnaire was on average answered by 431 ± 113 respondents. External rotation stress test (66%), squeeze test (61%) and forced dorsiflexion test (40%) were most commonly used for the clinical examination. In the diagnostic workup, most clinicians relied on MRI (83%) and conventional X-ray analysis (anterior–posterior 58%, lateral 41%, mortise view 38%). Only 15% of the respondents stated that there is a role for arthroscopic evaluation for the assessment of isolated syndesmotic injuries. Most frequently used fixation techniques included syndesmotic screw fixation (80%, 42% one syndesmotic screw, 38% two syndesmotic screws), followed by suture-button devices in 13%. Syndesmotic screw fixation was mainly performed tricortically (78%). While 50% of the respondents stated that syndesmotic screw fixation and suture-button devices are equivalent in the treatment of isolated syndesmotic injuries with respect to clinical outcome, 36% answered that syndesmotic screw fixation is superior compared to suture-button devices.ConclusionsWhile arthroscopy and suture-button devices do not appear to be widely used, syndesmotic screw fixation after diagnostic work-up by MRI seems to be the common treatment algorithm for non-fracture-related syndesmotic injuries in Germany.

Correlation of cytomorphology with flowcytometric immunophenotyping in patients of acute leukemia in tertiary care hospital

Background: Morphological diagnosis of leukemias may sometimes not correlate with flow cytometry diagnosis. Classification of hematological neoplasm by the World Health Organization gives priority to cytogenetic, molecular biology, and even patient history, in an attempt to classify patients primarily regarding prognosis. Cytomorphology and immunophenotyping complement each other. Morphology is burdened by a high degree of subjectivity. That is why correlation of information provided by the two techniques is still absolutely necessary. The aim of our study was to correlate between cytomorphological findings and immunophenotyping results on a group of patients investigated for acute leukemia. Materials and Methods: Study was conducted in department of pathology in Chirayu Medical College and Hospital, Bhopal from December 2018 to September 2019. Cases were diagnosed as acute leukemia based on complete blood count and bone marrow aspirate/peripheral smear.These cases were sent to flowcytometry for immunophenotyping for further confirmation. Results: Total 74 cases of acute leukemias were diagnosed, out of which 30 were Acute myeloid leukemia and 44 were Acute lymphoblastic leukemia. There was 95.95% correlation between diagnosis on cytomorphology and flowcytometry. Two cases remain unclassified on cytomorphology which turn out to be Acute myeloid leukemia on flowcytometry. One case of Acute myeloid leukemia on cytomorphology was diagnosed as Acute lymphoblastic leukemia on flowcytometry. Conclusions: Inclusion of flowcytometry in routine diagnostic workup of acute leukemia ensures proper characterization as well as management. Major challenges for the near future are the standardization of technical procedures, data interpretation, and reporting.

Derangements of vaginal and cervical canal microbiota determined with real-time PCR in women with recurrent miscarriages

Balanced vaginal microbiota and, as a continuum, cervical canal microbiota help prevent reproductive disorders, including recurrent miscarriage (RM). In a significant proportion of couples with RM, routine diagnostic workup cannot find any manageable cause, leading to a requirement for new diagnostic tools. In the present study, we determined the quantitative composition of the microbiota of the vagina and cervical canal, assessed by real-time polymerase chain reaction, in women with RM. It also evaluated their derangements related to the pathogenesis of RM, and thus the suitability of this test as a diagnostic tool for managing RM. Vaginal and cervical canal specimens of 25 women with RM and 25 healthy volunteers were collected. The test results revealed information about the total vaginal bacterial biomass by measuring the abundance of Lactobacillus spp.; other bacteria; and pathogens, including Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma (urealyticum + parvum), and Candida spp. Overall, the findings of this study implied the abundance of Lactobacillus spp. decreased in women with RM with an increase in the abundance of other microorganisms in accordance with the reduction in the abundance of Lactobacillus spp. due to aerobic vaginitis and bacterial vaginosis. Vaginal and cervical canal microbiota need to be considered during the diagnostic workup of women with RM. IMPACT STATEMENT What is already known on this subject? Recurrent miscarriage (RM) is a well-known reproductive disorder. Its diagnostic workup is not successful in determining the underlying problem in many cases. Hence, novel diagnostic tools based on real-time polymerase chain reaction (PCR) are needed for evaluating reproductive microbiota, which are considerably reliable, to satisfy the expectations of women with RM. What do the results of this study add? Overall, the decrease in the abundance of Lactobacillus spp. was found to be related to RM, and the patterns of the presence of other microorganisms were in accordance with the reduction in the abundance of Lactobacillus spp. These findings suggested an important role of vaginal and cervical canal microbiota in the pathogenesis of RM. What are the implications of these findings for clinical practice and/or further research? Additional research is warranted to elucidate the functional impact of altered components of the microbiota of vaginal and cervical canals on the physiology of the local cervical canal and its participation in the microbiota of the endometrial cavity, especially regarding unsuccessful pregnancies as a result of the disturbed physiology of the local endometrial microenvironment. However, possible applications of real-time PCR-based tests for the screening of subclinical infections in clinical practice require the performance of further investigations in patients with RM.

A study of incidental appendectomy during diagnostic laparoscopy performed to evaluate the causes of lower abdominal pain

Background: Diagnostic laparoscopy is a minimally invasive method for the diagnosis of intra-abdominal diseases by direct inspection of intra-abdominal organs whenever there is a diagnostic dilemma even after routine diagnostic workup. Incidental appendectomy is defined as the removal of a clinically normal appendix during non-appendiceal surgery. The study is performed to evaluate the causes of lower abdominal pain during diagnostic laparoscopy and to determine the benefits of incidental appendectomy.Methods: This study, performed at the department of surgery, B. J. medical college, Ahmedabad from May 2012 to October 2014 is a prospective study. Incidental appendectomy was performed during diagnostic laparoscopy in 30 patients with abdominal pain. Criteria such as symptomatology, aetiology of pain as found on laparoscopy, post-operative pain relief and complications were analysed.Results: Nearly two third of the patients who presented with intractable lower abdominal pain were females. Mesenteric lymphadenopathy was the commonest per-operative finding affecting half of the patients, followed by adhesions present in about one quarter of the patients. Gynaecological conditions represented about one third of the cases. All, except one patient, had satisfactory pain relief and no complications of incidental appendectomy over a one year follow up.Conclusions: We conclude that diagnostic laparoscopy is a very good and accurate tool to diagnose the causes of abdominal pain and should be routinely used where radiological investigations are inconclusive. Incidental appendectomy indeed has many advantages when performed in an appropriate age group and proper setting.

Positioning of myositis-specific and associated autoantibody (MSA/MAA) testing in disease criteria and routine diagnostic work-up

Nowadays, the importance of detection of myositis-specific antibodies (MSA) and myositis-associated antibodies (MAA) in diagnosis and in delineating disease subsets of idiopathic inflammatory myopathy (IIM) is highly acknowledged by IIM experts. Consequently, MSA/MAA are increasingly integrated in expert-based myositis (sub)classification criteria as well as in routine diagnostics. In contrast, MSA/MAA are under-represented in data-based (sub)classification criteria, mostly related to the lack of sufficient data on the wide spectrum of MSA/MAA in large multicenter cohorts. Unfortunately, the current commercially available assays to detect MSA/MAA show variable analytical and clinical performance characteristics. This challenges the design of prospective multicenter studies on MSA/MAA as well as the optimization of their routine clinical use. Additional validation studies and continuous harmonization initiatives on MSA/MAA detection from the pre-analytical to the post-analytical phase (e.g. from defining request criteria to guidelines for reporting), will be needed to overcome these hurdles. To speed up this process, we encourage close collaborations between IIM clinical experts, laboratory professionals and diagnostic companies.

Is in vitro cytokine release a suitable marker to improve the diagnosis of suspected mold-related respiratory symptoms? A proof-of-concept study.

Indoor mold infestation can lead to a variety of adverse health effects, including allergic and non-allergic respiratory complaints. Especially if no evidence of an allergic reaction can be found for the complaints, diagnostic tools that might explain mold-associated health problems are missing. As a proof-of-concept, in the present study whole blood assay (WBA) was used to determine cellular response by measuring cytokine release (IL-1β and IL-8) after in vitro stimulation. Blood was available from a total of 48 subjects. By questionnaire, complaints and possible mold exposure were documented. Specific in vitro blood stimulation was tested with Escherichia coli endotoxin and extracts of different molds (Aspergillus fumigatus, Penicillium chrysogenum, Aspergillus versicolor, and Cladosporium herbarum). To characterize the relevance of WBA in describing the mold-induced immune response, we compared the following groups: asthmatics vs. non-asthmatics, mx1-sensitized vs. non-mx1-sensitized, mold-exposed vs. non-mold-exposed. In response to endotoxin stimulation, a significantly higher IL-1β release was found in mx1-sensitized than in non-mx1-sensitized subjects. Furthermore, the blood of asthmatics showed significantly higher IL-8 and IL-1β release after stimulation with Penicillium chrysogenum and endotoxin, respectively, compared to non-asthmatics. However, no significant difference in the level of cytokine release was observed between the mold-exposed and non-exposed group, neither after endotoxin nor mold stimulation. In conclusion, the WBA used in this study is not a suitable tool for clinical routine diagnostic workup. Our data suggests that WBA reflects cellular differences that are disease-related but not directly attributable to mold exposure. However, in combination with further data, WBA will be a helpful und interesting tool in research, e.g., in description of the complex immune response to molds.

Multiparametric differentiation of intracranial central nervous system lymphoma and high-grade glioma using diffusion-, perfusion-, susceptibility-weighted magnetic resonance imaging, and spectroscopy

Aims and Objectives: To observe the characteristics of primary central nervous system lymphoma (PCNSL) and high-grade glioma (HGG) in diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), susceptibility-weighted imaging (SWI) and spectroscopy, and differentiate them based on these parameters. Materials and Methods: A total of 45 patients diagnosed with the central nervous system (CNS) neoplasm on magnetic resonance imaging (MRI) using 1.5 Tesla MRI Siemens Magnetom Avanto (Siemens, Germany) and with subsequent histopathological evidence as glioblastoma or CNS lymphoma were included. The study was completed over a period of 2 years. Results: It was found that DWI is effective in the differentiation of HGGs and PCNSLs. A total of 20 (57.1%) HGGs showed diffusion restriction, whereas 9 (90%) of the PCNSLs showed diffusion restriction. The mean apparent diffusion coefficient (ADC) (×10–6 mm2/s) in PCNSLs was 646 whereas, in HGGs, it was found to be 824.3. Thirty-one (88.6%) of the HGGs showed increased perfusion. The mean value of rCBVmean in HGG was found to be 4.06 and the mean value of rCBVmax was 3.63. None of the PCNSLs showed increased perfusion. The mean value of rCBVmean in PCNSLs was 0.097 and rCBVmax was 0.133. 30 (85.7%) of HGGs showed significant areas of blooming on SWI (in the form of intratumoral susceptibility signals [ITSS]). None of the PCNSLs showed blooming. All HGGs and PCNSLs showed increased choline and decreased N acetyl aspartate (NAA) on spectroscopy. Mean Choline/Creatine (Cho/Cr) in HGGs was found to be 3.06, whereas in PCNSLs, it was 1.84. Conclusion: It is important to make a distinction between HGG and PCNSL as the treatment modalities are different for both. Multiparametric evaluation of ADC, ITSS, and rCBVmean allows the differentiation of PCNSLs and solid glioblastoma which supports the integration of advanced MR imaging techniques including DSC-PWI, DWI, and SWI for the routine diagnostic workup of these tumors.

Drug-resistance and its impact on cutaneous tuberculosis.

Drug resistance in tuberculosis is a universal health problem, with India and China having the highest number of multidrug resistant tuberculosis (MDR-TB) cases globally. As cutaneous tuberculosis (CTB) accounts for 1.5% of all extrapulmonary tuberculosis, drug resistance in CTB remains less discussed and understood. The sensitivity and specificity of the routine diagnostic workup for CTB are low compared to pulmonary tuberculosis. Therefore, identifying drug resistance becomes challenging and needs a high index of suspicion. Molecular techniques such as polymerase chain reaction (PCR), line probe assays, DNA microarray, and sequencing help us to identify tubercular bacilli and drug resistance early. Prompt initiation of effective therapy reduces disease-related morbidity and mortality and makes the patient non-contagious. Lately, World Health Organization (WHO) has recommended using “all oral longer MDR TB regimen” for pulmonary and extrapulmonary drug-resistant TB instead of a painful older regimen requiring long term therapy with injectables. This review focuses on the drug resistance in CTB, various methods and newer techniques to diagnose them and recent updates on treatment guidelines.

A systematic review of the neglect of non-COVID patients amidst COVID pandemic

The rapidly evolving health concern for COVID-19 has considerably overshadowed the non-COVID ailments. Ranging from delays in diagnosis and treatment, neglect of mild-moderate diseases resulting into their progression, adverse pregnancy outcomes and many others, an array of the collateral damage of this pandemic is still evolving. We have performed this systematic review about the impact of COVID pandemic on patients suffering from other ailments. Our search was conducted through PubMed, Cochrane and Google scholar databases. We included systematic reviews and meta- analysis, and randomized controlled trials, observational studies, case series and case reports to ensure comprehensiveness of our search. We excluded abstract only articles, news articles, the non-scientific commentaries and reports from the review. Primary outcome was assessment of the impact of COVID pandemic on non-COVID diseases and management strategies for tackling the same. This review showed that this crisis has resulted into a significant delay in routine diagnostic procedures and workup with p value &lt; 0.00001 (OR of 0.36; 95% CI, 0.24 to 0.55). The highest impacts will be seen with preexisting major health priorities like HIV, tuberculosis, malignancy, various non-communicable diseases, reproductive and child health. The chief culprits for this include inadequate supplies of medicines, healthcare staff, diagnostics and other technologies. Expansion of the health care workforce, enhanced health financing and supply chain resilience can help us override this pandemic. Hence, the intersection of COVID-19 with other non- COVID ailments can have drastic effects. To minimize this surplus morbidity and mortality, we need to adopt comprehensive strategies and maintain the momentum even after this pandemic is surpassed. Keywords: COVID-19; neglect; non-COVID; non-communicable diseases; communicable diseases; management.

Somatostatin receptor imaging with [68Ga]Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) in patients with nasopharyngeal carcinoma.

To explore the feasibility of [68Ga]Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) in patients with non-keratinizing nasopharyngeal carcinoma (NPC) and to evaluate whether [68Ga]Ga-DOTATATE PET/CT could be used for non-invasive determination of somatostatin receptor 2 (SSTR2) expression in NPC. This prospective study included patients with NPC who underwent [68Ga]Ga-DOTATATE PET/CT between February and May 2021. The [68Ga]Ga-DOTATATE and [18F]FDG uptakes in primary and metastatic NPC lesions were calculated and compared, and the [68Ga]Ga-DOTATATE uptake between SSTR2 score groups was analysed. A total of 36 participants (25 patients, initial staging; 11 patients, recurrence detection) were included; 33 patients also underwent [18F]FDG PET/CT for staging/restaging as a part of their routine diagnostic workup. [68Ga]Ga-DOTATATE PET/CT showed an intense tracer uptake in primary and metastatic NPC lesions. The radiotracer uptake was higher with [68Ga]Ga-DOTATATE than with [18F]FDG PET in primary NPC lesions (SUVmax: 12.03 vs. 10.07, P = 0.048; tumour-to-brain ratio: 36.16 vs. 0.86, P < 0.001) and regional lymph node metastases (median SUVmax: 9.11 vs. 6.12, P < 0.001) and comparable in bone and visceral metastases. Importantly, most NPC lesions showed intense SSTR2 expression (85.7%), which was strongly correlated with the [68Ga]Ga-DOTATATE uptake. The SUVmax of SSTR2-negative lesions was significantly lower than that of SSTR2-positive lesions (SUVmax: 4.95 vs. 12.61, P = 0.013). [68Ga]Ga-DOTATATE PET/CT is a promising imaging modality for detecting primary and metastatic NPC, with favourable image contrast and comparable diagnostic efficacy when compared to [18F]FDG PET/CT. An intense SSTR2 expression was observed in most NPCs, and this expression was significantly correlated with the [68Ga]Ga-DOTATATE uptake.

Clinical Implementation and Initial Experience of Neutrophil Gelatinase-Associated Lipocalin Testing for the Diagnostic and Prognostic Assessment of Acute Kidney Injury Events in Hospitalized Patients

Introduction: The use of novel kidney injury biomarkers has been shown to improve diagnostic assessment and prognostic prediction in various populations with acute kidney injury (AKI), but their use in a standard clinical practice have been rarely reported. Methods: We reported the clinical implementation of neutrophil gelatinase-associated lipocalin (NGAL) measurement for routine AKI diagnostic workup of patients receiving nephrology consultation in a tertiary academic centre. Specific focus was made on the diagnostic performance to discriminate functional (“pre-renal”) from intra-renal AKI and to predict AKI progression. Results: Forty-five urine NGAL (uNGAL) and 25 plasma NGAL (pNGAL) samples in the first 50 consecutive patients were analysed. KDIGO Stage 1, 2, 3 AKI, and renal replacement therapy occurred in 10%, 40%, 50%, and 24% of cases, respectively. The uNGAL was lower in patients with transient AKI (<48 h) and no sign of urinary tract infections (37 [25–167] ng/mL) than sustained or progressive AKI (298 [74–1,308] ng/mL) (p = 0.016), while pNGAL did not discriminate transient (264 [100–373] ng/mL) from persistent AKI (415 [220–816] ng/mL) (p = 0.137). The median uNGAL level was 63 (35–1,123) ng/mL for functional/pre-renal AKI and 451 (177–1,315) ng/mL for intra-renal AKI (p = 0.043), while the pNGAL was 264 (114–468) and 415 (230–816) ng/mL (p = 0.235), respectively. Conclusion: NGAL, as part of the routine workup, is useful for diagnostic and prognostic assessment of new-onset AKI in clinical practice. Interpretation of an increased NGAL level should be clinically evaluated in its clinical context, particularly considering concomitant infection (urinary or systemic). Clinical adoption of emerging AKI biomarkers as diagnostic tests in clinical practice should be further encouraged.

Decision Threshold for Kryptor sFlt-1/PlGF Ratio in Women With Suspected Preeclampsia: Retrospective Study in a Routine Clinical Setting.

BackgroundThe objective was to evaluate predictive performance and optimal decision threshold of the Kryptor soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio when implemented for routine management of women presenting with symptoms of preeclampsia.Methods and ResultsObservational retrospective study of a cohort of 501 women with suspected preeclampsia after 20 weeks of gestation. Women referred to maternity ward for observation of preeclampsia had an sFlt‐1/PlGF ratio test included in routine diagnostic workup. Maternal and offspring characteristic data included maternal risk factors, outcomes, delivery mode, and indication for suspected preeclampsia. Biochemical measurements to determine sFlt‐1/PlGF ratio were performed using the BRAHMS/Kryptor sFlt‐1/PlGF ratio immunoassays. Results were analyzed by area under receiver‐operating characteristic curve. Preeclampsia occurred in 150 of 501 (30%) of symptomatic women with an sFlt‐1/PlGF ratio determined before the time of diagnosis. Area under receiver‐operating characteristic curve for diagnosis of early‐onset preeclampsia within 1 and 4 weeks was 0.98 (95% CI, 0.96–1.00) and 0.95 (95% CI, 0.92–0.98), respectively. For late‐onset preeclampsia, predictive performance within 1 and 4 weeks was lower: 0.90 (95% CI, 0.85–0.94) and 0.85 (95% CI, 0.80–0.90), respectively. The optimal single sFlt‐1/PlGF ratio threshold for all preeclampsia and late‐onset preeclampsia within 1 and 4 weeks was 66. The negative and positive predictive values for ruling out and ruling in developing preeclampsia within 1 week were 96% and 70%, respectively.ConclusionsThe Kryptor sFlt‐1/PlGF ratio is a useful clinical tool ruling out and in preeclampsia within 1 week. Prediction within 4 weeks is superior for early‐onset preeclampsia. A single decision threshold of 66 is indicated for use in clinical routine.

Consistency of 3D femoral torsion measurement from MRI compared to CT gold standard

BackgroundSeveral hip and knee pathologies are associated with aberrant femoral torsion. Diagnostic workup includes computed tomography (CT) and magnetic resonance imaging (MRI). For three-dimensional (3D) analysis of complex deformities it would be desirable to measure femoral torsion from MRI data to avoid ionizing radiation of CT in a young patient population. 3D measurement of femoral torsion from MRI has not yet been compared to measurements from CT images. We hypothesize that agreement will exist between MRI and CT 3D measurements of femoral torsion.MethodsCT and MRI data from 29 hips of 15 patients with routine diagnostic workup for suspected femoroacetabular impingement (FAI) were used to generate 3D bone models. 3D measurement of femoral torsion was performed by two independent readers using the method of Kim et al. which is validated for CT. Inter-modalitiy and inter-reader intraclass correlation coefficients (ICC) were calculated.ResultsBetween MRI and CT 3D measurements an ICC of 0.950 (0.898; 0.976) (reader 1) respectively 0.950 (0.897; 0.976) (Reader 2) was found. The ICC (95% CI) expressing the inter-reader reliability for both modalities was 0.945 (0.886; 0.973) for MRI and 0.957 (0.910; 0.979) for CT, respectively. Mean difference between CT and MRI measurement was 0.42° (MRI – CT, SD: 2.77°, p = 0.253).ConclusionsThere was consistency between 3D measurements of femoral torsion between computer rendered MRI images compared to measurements with the “gold standard” of CT images. ICC for inter-modality and inter-reader consistency indicate excellent reliability. Accurate, reliable and reproducible 3D measurement of femoral torsion is possible from MRI images.

Impact of periodontitis on systemic anxiety and oral health quality of life

Aim : The aim of the present study was to measure dental anxiety levels and oral health-related qualities of life (OHRQoL) in patients with periodontitis compared to healthy controls and to analyze their association with various demographic, clinical and periodontal parameters. Methods : Fifty-five patients with periodontitis and 56 healthy controls were enrolled. Collected data included demographics, smoking habits, numerical rating scale (NRS), Corah’s Dental Anxiety Scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), DMFT index (Decayed, Missing and Filled Teeth), Plaque Index (PI), probing depth (PD), bleeding on probing (BOP), and radiographic bone loss. Results : Periodontitis patients exhibited statistically significant higher scores in the total DAS and in almost of single DAS domains. Compared to the control group, periodontitis patients exhibited worse OHIP-14 global as well as in all individual OHIP-14 domains scores. Among both periodontitis and control patients, the physical pain domain was where the highest impact was recorded, while the lowest impact was recorded in the functional limitation domain. Conclusion : Periodontitis patients were positively associated with higher levels of dental anxiety and worse OHRQoL. Self-perception of dental anxiety and OHRQoL should be regarded as an integral element in routine diagnostic work-up process of periodontal diseases. This study showed that for a nationally representative sample of the southern Italian population population, periodontal disease was significantly associated with the domains of OHRQoL.

WS7.4. NMUS of the brachial plexus

The brachial plexus can be involved in a variety of neuromuscular disorders, such as inflammatory and hereditary demyelinating neuropathies, neurofibromatosis, traumatic injuries, neoplasms, nerve sheath tumors. Traditionally, the evaluation of brachial plexus involvement has relied on combination of clinical features, electrodiagnostic testing and MRI imaging. Nerve imaging is an important and powerful add-on strategy, that can help to localize site of lesion and uncover nature and extend of nerve involvement. The apparent lack of clear association between nerve morphology and function further supports complementary role of imaging modalities in routine diagnostic work-up of peripheral nerve disorders. Although MRI has dedicated sequences that allow refined tissue discrimination, lack of objective cut-off values hamper it’s used in the routine clinical setting. Nerve ultrasound is an emerging practical bedside alternative to MRI, which the advantage of flexible field of view, superior image resolution for superficial structures, broad availability and relatively low cost. This neuromuscular ultrasound workshop will focus on main anatomical targets for sonographic evaluation of brachial plexus, including important landmarks and notes for discrimination. The workshop will also address standardized assessment and reference values for abnormality, including sonographic examples of neuromuscular disorders.

Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias.

Background: A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients. Methods: A single-centre prospective study was undertaken of 72 patients (mean age 46 ± 16 years; 53% females) with frequent premature ventricular contractions (PVCs ≥ 500/24 h) and/or non-sustained ventricular tachycardia (NSVT), an otherwise normal electrocardiogram, normal echocardiography and no coronary artery disease. Results: CMR provided an additional diagnostic yield in 54.2% of patients. The most prevalent diagnosis was previous myocarditis (23.6%) followed by possible PVC-related cardiomyopathy (20.8%), non-ischaemic cardiomyopathy (8.3%) and ischaemic heart disease (1.4%). The predictors of abnormal CMR findings were male gender, age and PVCs/NSVT non-outflow tract-related or with multiple morphologies. Patients with VAs had an impaired peak left ventricular (LV) global radial strain (GRS) compared with the controls (28.88% (IQR: 25.87% to 33.97%) vs. 36.65% (IQR: 33.19% to 40.2%), p < 0.001) and a global circumferential strain (GCS) (−17.66% (IQR: −19.62% to −16.23%) vs. −20.66% (IQR: −21.72% to −19.6%), p < 0.001). Conclusion: CMR reveals abnormalities in a significant proportion of patients with frequent idiopathic VAs. Male gender, age and non-outflow tract PVC origin can be clinical indicators for CMR referral.

Genotyping diagnosis of gestational trophoblastic disease: frontiers in precision medicine.

Investigations in recent decades have exploited tissue DNA genotyping as a powerful ancillary tool for the precision diagnosis and subclassification of gestational trophoblastic disease. As lesions of gestational origin, the inherited paternal genome, with or without copy number alterations, is the fundamental molecular basis for the diagnostic applications of DNA genotyping. Genotyping is now considered the gold standard in the confirmation and subtyping of sporadic hydatidiform moles. Although a precise diagnosis of partial mole requires DNA genotyping, prognostic stratification according to distinct genetic zygosity in complete moles has recently gained significant clinical relevance for patient care. Beyond hydatidiform moles, DNA genotyping has fundamental applications in the diagnosis or prognostic assessment of gestational trophoblastic tumors, in particular gestational choriocarcinoma. DNA genotyping provides a decisive tool in the separation of gestational trophoblastic neoplasia from non-gestational counterparts/mimics of either germ cell or somatic origin. The FIGO/WHO prognostic scoring scheme requires ascertaining the precise index gestational event and the time interval between the tumor and index gestation, where DNA genotyping can provide highly relevant information. With rapid acquisition of molecular diagnostic capabilities in the clinical practice, DNA genotyping has become closely integrated into the routine diagnostic workup of various forms of gestational trophoblastic disease.