Routine Testing Research Articles

Role of serum procalcitonin in differentiating disease flare and systemic bacterial infection among febrile children with known chronic rheumatic diseases: a cross-sectional study

Objectives. To evaluate the role of serum procalcitonin (PCT) as a diagnostic tool to differentiate bacterial sepsis from flare-ups during febrile episodes in children with known rheumatic disorders compared to other inflammatory markers like C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Methods. Previously diagnosed patients with known rheumatic disorders presenting in emergency or outpatient departments with febrile episodes were included in the study. Blood samples were collected upon admission to test for signs of infection, including serum PCT levels with routine laboratory and radiological tests. Patients with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) were stratified using the Juvenile Arthritis Disease Activity Score (JADAS-27) and SLE Disease Activity Index (SLEDAI) respectively. Patients without bacterial focus with high disease activity were included in the flare-up group and the rest in the sepsis cohort. The diagnostic value of PCT was calculated using receiver operating characteristic (ROC) curve analysis. Results. In the study (N=73), 41 (56.2%) patients were previously diagnosed with JIA and 28 (38.3%) had SLE. 38 patients had definite evidence of sepsis and 35 had disease flare-ups as per respective disease activity scores. There was a significant difference in PCT and CRP among the flare-up and sepsis groups. For detecting sepsis, the area under curve (0.959), sensitivity (94.7%), and specificity (74.3%) of PCT at a cut-off of 0.275 ng/mL were significantly better than those of CRP. Conclusion. PCT is a better diagnostic test than CRP or ESR during febrile episodes in differentiating flare-ups from infection and PCT >0.275 ng/mL indicates bacterial infection with good specificity and sensitivity in children with low disease activity.

An additive opinion to the committee opinion of ASRM and SART on the use of preimplantation genetic testing for aneuploidy (PGT-A).

After over 20years of progressively increasing clinical utilization of PGT-A (and its precursors), the American Society for Reproductive Medicine (ASRM) and its daughter society, the Society for Assisted Reproduction (SART), for the first time published a committee opinion clearly acknowledging that "the value of PGT-A as a routine screening test for patients undergoing in vitro fertilization (IVF) has not been demonstrated." This statement is timely and welcome but requires some additions and raises some new questions, among those why, if PGT-A in a general population does not improve IVF cycle outcomes, the routine clinical utilization of PGT-A should continue.

The clinical indexes and immunological status of HIV/AIDS patients undergoing different highly active antiretroviral treatments

ObjectiveThis study aims to investigate the differences of clinical indices in HIV patients between three different first-line antiretroviral treatment strategies in Yunnan Province, China. Furthermore, the hematologic system, liver function, kidney function, blood lipid levels of HIV patients and its association with CD4+ count, CD8+ count, CD4/CD8 ratio and antiretroviral treatment were also assessed.MethodsThis retrospective cohort study included 81 participants who underwent highly active antiretroviral treatment from September 2009 to September 2019. Baseline sociodemographic and clinical characteristics were collected from each study participant. Routine blood tests, liver and renal function, lipid levels as well as lymphocyte subset counts were measured and recorded for evaluation before and 3, 6, 9, and 12 months after the treatment. Paired t-test was used to compare clinical indices changes after antiretroviral treatment. Univariate linear regression was performed to determine the association between clinical indices and CD4+ count, CD8+ count, CD4/CD8 ratio and antiretroviral treatment.ResultThere were no statistical differences in baseline demographic and clinical characteristics in either treatment group. Compared with the initiation of HARRT treatment, the CD4+ count(p < 0.001), CD4/CD8 ratio(p < 0.001) and PLT(p < 0.001) were increased in the three treatment groups. The TC(p < 0.01) and TG(p < 0.05) were increased in 3TC+AZT+EFV group after treatment. The ALT(p < 0.05), AST(p < 0.01) were decreased in 3TC+EFV+TDF group after treatment. The study indicated statistical differences in CD4+ count (p < 0.001), CD8+ count (p < 0.001), and CD4/CD8 ratio (p < 0.001) in the three treatment cohorts. Furthermore, a strong positive correlation was observed between WBC (p < 0.001), platelet (p < 0.001), Hb (p < 0.001), and CD4+ count in the three treatment cohorts. Moreover, ALT and AST were negatively associated with CD4+ count in the 3TC + AZT + EFV group. Whereas WBC were positively correlated with CD8+ count in the three treatment methods. In addition, platelet and TG were positively correlated with CD8+ count in the 3TC + EFV + TDF. The study also indicated that TC was positively associated with CD8+ count in the 3TC + AZT + NVP group. Furthermore, WBC was negatively related to CD4/CD8 ratio in the 3TC + EFV + TDF group. The platelet level analysis revealed a positive, while TG indicated a negative association with CD4/CD8 ratio in the 3TC + AZT + NVP group. Moreover, ALT and AST were negatively correlated with the CD4/CD8 ratio in the 3TC + AZT + EFV and 3TC + AZT + NVP groups.ConclusionThe results showed that HIV/AIDS patients treated with different first-line antiretroviral treatment strategies had different hematopoietic, liver, renal and immune system functions. Furthermore, some clinical indicators such as WBC, PLT, TC, TG, and ALT could predict the CD4+ count, CD8+ count, CD4/CD8 ratio levels and recuperation of HIV/AIDS patients, therefore, should be monitored by clinicians.

Electrolyte imbalance and liver function test abnormalities among pregnant women with hyperemesis gravidarum at Wag-himra zone public hospitals, Northeast Ethiopia, 2023: a comparative cross-sectional study

BackgroundHyperemesis gravidarum affects about 4.8% of pregnant women. It can lead to electrolyte imbalances and liver function disturbances, which may result in pregnancy complications. Despite its prevalence, data on these abnormalities in the study area is scarce. Therefore, the current study investigated these health concerns among HG-affected pregnant women in this region from June to October 2023.MethodA comparative cross-sectional study was conducted on 123 study participants. Socio-demographic, clinical, and anthropometric data were collected using structured questionnaires. Blood samples were taken to determine liver function tests and electrolyte levels. Statistical analysis was performed using a one-way ANOVA with a Tuckey post hoc test, Kruskal-Wallis with a Mann–Whitney U test, and binary logistic regression analysis. A p-value of <0.05 with 95% confidence intervals was considered statistically significant.ResultsThe results showed that pregnant women with hyperemesis gravidarum had significantly higher levels of AST and ALT and lower levels of Na+ and K+ compared to normal pregnant women and non-pregnant women. The abnormalities observed were elevated AST (48.8%), ALT (46.3%), and decreased Na+ (51.2%) and K+ (41.5%). Hyperemesis gravidarum was associated with both electrolyte imbalances and liver function test abnormalities.ConclusionPregnant women with hyperemesis gravidarum experience electrolyte imbalances and liver function test abnormalities. Given the marked increase in liver enzymes and decrease in electrolyte levels, the authors recommend routine laboratory testing of liver function and electrolyte parameters for pregnant women with hyperemesis gravidarum is recommended.

Diagnostic and Prognostic/Therapeutic Significance of Comprehensive Analysis of Bone and Soft Tissue Tumors Using Optical Genome Mapping and Next-generation Sequencing.

Detecting somatic structural variants (SVs), copy number variants (CNVs), and mutations in bone and soft tissue tumors is essential for accurately diagnosing, treating, and prognosticating outcomes. Optical genome mapping (OGM) holds promise to yield useful data on SVs and CNVs but requires fresh or snap-frozen tissue. This study aimed to evaluate the clinical utility of data from OGM compared to current standard-of-care cytogenetic testing. We evaluated 60 consecutive specimens from bone and soft tissue tumors using OGM and karyotyping, FISH, gene fusion assays, and deep next-generation sequencing (NGS). OGM accurately identified diagnostic SVs/CNVs previously detected by karyotyping and FISH (specificity=100%). OGM identified diagnostic and pathogenic SVs/CNVs (∼23% of cases) undetected by karyotyping (cryptic/submicroscopic). OGM allowed detection and further characterization of complex structural rearrangements including chromoanagenesis (27% of cases) and complex 3-6-way translocations (15% of cases). In addition to identifying 321 SVs and CNVs among cases with chromoanagenesis events, OGM identified approximately 9 SVs and 12 CNVs per sample. A combination of OGM and deep NGS data identified diagnostic and pathogenic SVs, CNVs, and mutations in ∼98% of cases. Our cohort contained the most extensive collection of bone and soft tissue tumors profiled by OGM. OGM had excellent concordance with standard-of-care cytogenetic testing, detecting and assigning high-resolution genome-wide genomic abnormalities with higher sensitivity than routine testing. This is the first and largest study to provide insights into the clinical utility of combined OGM and deep sequencing for the pathologic diagnosis and potential prognostication of bone and soft tissue tumors in routine clinical practice.

Evaluation of endocrine changes and insulin release in patients with hereditary spherocytosis.

To evaluate endocrinological changes and insulin secretion in patients with hereditary spherocytosis (HS). The study included 30 patients with HS and 30 healthy control groups who were of similar age and gender. Routine tests, including hemogram, biochemical and hormonal tests were conducted on both patients with HS and the control group. HOMA-IR (Homeostasis Model Assessment for Insulin Resistance) and HOMA-ß% (Homeostasis Model Assessment for ß-cell function) values of all cases were also calculated using fasting insulin and fasting glucose values. Among the patient group, 7 patients (23.3%) had short stature, 16 patients (53.3%) had vitamin D deficiency, 1 patient (3.3%) had impaired glucose tolerance, 1 patient (3.3%) had subclinical hypothyroidism, 23 patients (76.6%) had dyslipidemia and 2 patients (6.6%) had growth hormone deficiency. The insulin value in the patient group was 4.0 ± 2.7 mlU/mL and significantly lower than the control group with an insulin value of 9.1 ± 3.9 mlU/mL (P < 0.001). Moreover, glucose (P = 0.036), HOMA-IR (P < 0.001), HOMA-beta (P < 0.001) and C-peptide (P = 0.001) values of the patient group were significantly lower than the control group. The cholesterol (P < 0.001), HDL (P < 0.001) and LDL (P < 0.001) values of the patient group were found to be significantly lower than the control group. We found that insulin secretion decreased in patients with HS and hypocholesterolemia occurred due to chronic hemolysis. More research is needed to elucidate the pathophysiology of decreased insulin secretion seen in HS patients.

Quality of life, fatigue and markers in sarcoidosis: A section from Turkey.

Sarcoidosis can affect every organ with varying frequency based on ethnicity, gender and age. We aimed to evaluate the health-related quality of life (HRQoL) and fatigue levels of our sarcoidosis patients. However, our second aim is to determine whether patient or disease markers correlate with quality of life assessment questionnaires. Pulmonary sarcoidosis patients who were followed up in the chest diseases outpatient clinic of our hospital were included in this prospective study. In the follow-up of 2023, routine blood tests, angiotensin-converting enzyme (ACE), posteroanterior lung (thorax computed tomography in patients with parenchymal involvement) were requested from the patients. Participants were asked to fill out the short-form 36-item questionnaire (SF-36), fatigue assessment scale (FAS) and fatigue severity scale (FSS) under the control of the outpatient clinic. A total of 189 patients, 139 (73.5%) female and 50 (26.5%) male, diagnosed with Sarcoidosis were included. The mean age of our patients was 53.1±13.6. ACE (IU/L) 68.5±44.5. Of the patients we followed up for pulmonary sarcoidosis, 111 (58.7%) had single organ involvement and 78 (41.3%) had additional organ involvement. FAS; It was high in 103 (64.3%) patients and 29 (15.3%) were very tired. FSS value was 4.45±0.7 (3-5.88). All SF-36 parameters were lower than expected; MH and SF was minimally lower, PF, RP, BP, GH, RE and VT were significantly lower. SF-36 scores were found to be lower in the women and additional organ involvement participating. We found a significant decrease in HRQoL and an increase in fatigue scores of our patients. These changes were more pronounced in women participating in the study than in men. In addition, the involvement of additional organs with the lung negatively affected the quality of life.

Imaging Assessment of the Pituitary Gland and Long-Term Endocrinological Abnormalities in Pediatric Brain Cancer Survivors.

Pediatric brain cancer survivors often experience hypothalamic-pituitary dysfunction due to cranial irradiation and chemotherapy. While hormone deficiencies have been studied, the changes in pituitary size and shape on long-term MRI and their relationship to endocrine dysfunction remain under-explored. To evaluate pituitary gland height, volume, and shape in relation to long-term endocrine abnormalities in pediatric brain tumor survivors. Retrospective cohort study. A total of 56 pediatric brain tumor survivors (50% male) with an average follow-up of 10.8 ± 1.6 years; 44.6% underwent radiotherapy, and 48% were treated with chemotherapy. One-third of the cohort experienced at least one pituitary hormone deficiency. 3 T, including volumetric 1 mm sagittal post-contrast T1 images. Pituitary height, volume, and shape (concave, horizontal, convex) were measured. Endocrine abnormalities were diagnosed through routine serum hormone testing. The t test, chi-square test, and Pearson test with significance at P < 0.05 were used. Receiver-operating characteristic (ROC) analysis assessed the association of imaging parameters and pituitary dysfunction. Radiation and chemotherapy treatment were significantly associated with pituitary hormone deficiencies. There were significant differences in pituitary height and volume in patients with pituitary hormone deficiencies compared with normal pituitary function (4.0 ± 1.3 vs. 5.5 ± 1.5 mm, and 354.2 ± 198.0 vs. 568.3 ± 184.4 mm3, respectively). There was a significant association between radiation therapy and pituitary gland shape, with 60.0% of patients who received radiation therapy exhibiting a pituitary shape categorized as concave, 32.0% as horizontal, and 8.0% as convex, compared to 9.7%, 74.2%, and 16.1%, respectively. ROC analysis for association with pituitary hormone deficiency was 0.81, 0.8, and 0.74 for pituitary height, volume, and shape, respectively. Cranial irradiation and chemotherapy in pediatric brain tumors are associated with endocrine dysfunction, with decreased pituitary height, volume, and concave shape in long-term MRI surveillance are associated with such late endocrine dysfunction. 4 TECHNICAL EFFICACY: Stage 2.

Integration of single-cell and bulk analysis reveals TBXAS1 as a key platelet-related gene causing poor prognosis in osteosarcoma

BackgroundPlatelets are associated with poor prognosis in most tumors, but their specific pathogenic mechanism in osteosarcoma is not yet clear. The objective of this study is to conduct an in-depth analysis of how genes closely related to platelet function impact the prognosis of osteosarcoma patients. We hope that through this research, we can uncover the potential mechanisms of these genes in the development and progression of osteosarcoma, thereby providing new therapeutic strategies and theoretical foundations for improving the prognosis of osteosarcoma patients.MethodWe collected the blood routine test data of patients who were initially diagnosed with osteosarcoma at the Department of Bone Tumors, West China Hospital, from January 2012 to January 2022. By applying the LASSO-COX regression analysis, a statistical method, we found that the platelet count is associated with the prognosis of osteosarcoma patients. To further explore this relationship, we obtained single-cell data and bulk RNA data of osteosarcoma patients from the TARGET database and GEO database, respectively. By analyzing these data, we revealed at the transcriptomic level how platelets contribute to the poor prognosis in osteosarcoma patients.ResultPlatelets are associated with the prognosis of osteosarcoma patients (HR = 3.9, 95% CI = 1.9–8.1, P &amp;lt; 0.001). Through the analysis of transcriptomic data from the TARGET database and GEO database, we found significant heterogeneity in tumor-specific pathways and immune infiltration under different platelet-related gene expression patterns. Among these, TBXAS1 was identified as a key gene that affects the prognosis of osteosarcoma patients. In addition, single-cell data analysis showed that the platelet-related gene TBXAS1 is mainly enriched in macrophages, and markers of macrophages are significantly associated with poor prognosis in osteosarcoma patients.ConclusionTBXAS1 is a key platelet-related gene that leads to poor prognosis in osteosarcoma, and this gene may affect the prognosis of osteosarcoma patients by interacting with macrophages.

A Comparative Study for Iohexol and Ioversol Effects on Renal Function in Patients with Coronary Artery Intervention Treatment

&amp;lt;i&amp;gt;Objective: &amp;lt;/i&amp;gt;To compare the effects of iohexol and ioversol on the incidence of contrast induced nephropathy (CIN) and renal function in patients who received percutaneous coronary intervention (PCI); to investigate the related risk factors of CIN in patients after PCI; to evaluate the preventative effect of different dose of atorvastatin on the incidence of CIN in the patients after PCI. &amp;lt;i&amp;gt;Methods: &amp;lt;/i&amp;gt;140 patients who received PCI were chosen as research subjects in the Third People&amp;apos;s Hospital of Mianyang from June 2013 to March 2015, which were randomly divided into iohexol group and ioversol group (74 cases for iohexol group, 66 cases for ioversol group). It was recorded that the patients’ general condition, blood routine test, urine examination, renal function, etc before and after PCI. And it was observed after PCI that the dosage of contrast material, the numbers of damaged coronary artery and implanting stent, the exposure time of contrast material, etc. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;The incidences of CIN for iohexol and ioversol were not significantly different (&amp;lt;I&amp;gt;P &amp;lt;/I&amp;gt;&amp;gt; 0.05). The differences between the two groups in the Serum creatinine (Scr), blood urea nitrogen (BUN), glomerular filtration rate (GFR), urine β2- microglobulin (β2-MG), and cystatin C (Cys C) before and after PCI were not obvious (&amp;lt;I&amp;gt;P &amp;lt;/I&amp;gt;&amp;gt; 0.05) ; the changes of Scr, β&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt;-MG, CysC, GFR of the patients before and after PCI in the two groups were significant (&amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;&amp;lt;0.05), but the change of BUN was not significant (&amp;lt;I&amp;gt;P &amp;lt;/I&amp;gt;&amp;gt; 0.05).Through multiple regression analysis, it was found that type 2 diabetes (&amp;lt;I&amp;gt;OR&amp;lt;/I&amp;gt; = 9.560, &amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;=0.001), two coronary artery implanting stents (&amp;lt;I&amp;gt;OR&amp;lt;/I&amp;gt; = 6.252, &amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;=0.044), three and above coronary artery implanting stents (&amp;lt;I&amp;gt;OR&amp;lt;/I&amp;gt;=12.499, &amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;=0.009) were independent risk factors of CIN. It was not significantly different that the effects of 20mg atorvastatin and 40mg atorvastatin on the incidence of CIN, Scr and GFR (&amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;&amp;gt;0.05). &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; There are no significant differences in the incidence of CIN and renal function for PCI patients with ioversol or iohexol. Moreover, diabetes and two or more coronary artery implanting stents are independent risk factors for CIN in PCI patients. It doesn’t show any benefits for PCI patients to take the large dose of atorvastatin to prevent CIN before operation.

Adalimumab Autoantibodies in Uveitis Patients: Do We Need Routine Drug Monitoring?

Background: Adalimumab, an anti-TNF-α biologic agent, has emerged as a principal treatment option for patients with non-infectious uveitis. The influence of adalimumab anti-drug antibodies (AAA) on the efficacy of adalimumab therapy is not yet fully understood. We aim to understand their clinical implications in the context of therapeutic drug monitoring and the factors contributing to the formation of these antibodies. Methods: We conducted a retrospective analysis of 114 patients with non-infectious uveitis who developed AAA while undergoing adalimumab therapy. Results: Among the 114 AAA-positive uveitis patients, a significant correlation was observed between AAA levels and reduced adalimumab serum levels (r = −0.58, p &lt; 0.001). The mean time to AAA detection was 2.1 years (range 0.1–11.9 years), with 45.6% of cases identified through routine testing. If AAA levels were initially low, subsequent measurements for AAA were more likely to become negative during treatment (r = 0.63, p &lt; 0.001). Higher AAA concentrations were associated with a shorter time to detection (r = −0.27, p = 0.01) and younger age (r = −0.21, p = 0.03). There was a trend, though no significant influence, of concomitant immunosuppression with prednisolone ≤ 7.5 mg or methotrexate on antibody formation (p = 0.18). No significant difference was observed in AAA levels between uveitis subtypes. Conclusions: Higher AAA concentrations are associated with lower adalimumab serum levels in uveitis patients. Routine clinical testing is essential for optimal therapeutic drug monitoring to prevent early loss of effectiveness.

Thymidine Analogue Mutations with M184V Significantly Decrease Phenotypic Susceptibility of HIV-1 Subtype C Reverse Transcriptase to Islatravir

Islatravir (ISL) is the first-in-class nucleoside reverse transcriptase translocation inhibitor (NRTtI) with novel modes of action. Data on ISL resistance are currently limited, particularly to HIV-1 non-B subtypes. This study aimed to assess prevalent nucleos(t)ide reverse transcriptase inhibitor (NRTI)-resistant mutations in HIV-1 subtype C for their phenotypic resistance to ISL. Prevalent single and combinations of NRTI-resistant mutations were selected from a routine HIV-1 genotypic drug resistance testing database and introduced into HIV-1 subtype C-like pseudoviruses, which were then tested for ISL susceptibility. Single NRTI-resistant mutations were susceptible or showed only a low level of resistance to ISL. This included thymidine analogue mutations (TAMs, i.e., M41L, D67N, K70R, T215FY, and K219EQ) and non-TAMs (i.e., A62V, K65R, K70ET, L74IV, A114S, Y115F, and M184V). Combinations of M184V with one or more additional NRTI-resistant mutations generally displayed reduced ISL susceptibilities. This was more prominent for combinations that included M184V+TAMs, and particularly M184V+TAM-2 mutations. Combinations that included M184V+K65R did not impact significantly on ISL susceptibility. Our study suggests that ISL would be effective in treating people living with HIV (PLWH) failing tenofovir disoproxil fumarate (TDF)/lamivudine (3TC) or TDF/emtricitabine (FTC)-containing regimens, but would be less effective in PLH failing zidovudine (AZT) with 3TC or FTC-containing regimens.

Diagnosis of Vibrio cholerae isolated from patients with Vibriosis in Thi-Qar province

The gram-negative bacteria Vibrio cholerae is the source of cholera a severe case of diarrhea. Cholera occurs either sporadically, epidemically, or endemic. Overpopulation, untreated water supplies, and unsanitary circumstances have historically been closely linked to cholera outbreaks and pandemics. This study aimed to determine the accuracy of routine and advanced biochemical methods in diagnosing Vibrio cholerae, the extent of the prevalence of bacteria and which age groups and gender are most susceptible to infection. Stool specimens were obtained from patients suspected with cholera disease from both gender in different hospitals in Thi-Qar province through the period from September to December 2023. Cary Blair medium was used to transfer the suspicious stool specimens to the Thi-Qar province's Central Health Laboratory. Routine and advanced biochemical methods were used to diagnose Vibrio cholerae. A total of 400 specimens of stool from patients suspected cholera have been collected, only (45) isolates were given growth V. cholerae with 11.25 % in biochemical routine test while in API20 E test 41 isolates were given growth V. cholerae with 10.25%. The age group with the highest infection rate was 55–65, whereas the age group with the lowest infection rate was under 5 years. With no statistically significant difference, the illness most commonly impacted females. The results have showed different morphology characteristics of all V. cholerae isolates which grow on different media. Routine and advanced biochemical tests may not give the same results, which have prompted to search for a more accurate and faster method of diagnosis.

Temporary recommendations of the russian association of functional diagnostics specialists on the registration of a conclusion based on the results of spirometry

The article presents concise guidelines for quality control and protocol development for spirometry, a routine test of lung function. Based on Russian methodological recommendations for spirometry, standards of the American Thoracic Society, and the European Respiratory Society, these guidelines cover all stages of spirometry, from patient preparation to result interpretation, aiming to ensure high quality and reliability of the tests performed. The importance of adhering to standards and quality control is emphasized to guarantee the accuracy and reliability of spirometry results. The guidelines provide criteria for the quality of individual attempts and the entire test, criteria for selecting the best attempt, and recommendations for assessing the severity of abnormalities. Examples of formulating spirometry protocols are also given. These recommendations are intended for physicians in functional diagnostics, pulmonologists, therapists, anesthesiologists, medical staff, and aim to standardize the formation of spirometry protocols.

Deep learning-assisted colonoscopy images for prediction of mismatch repair deficiency in colorectal cancer.

Deficient mismatch repair or microsatellite instability is a major predictive biomarker for the efficacy of immune checkpoint inhibitors of colorectal cancer. However, routine testing has not been uniformly implemented due to cost and resource constraints. We developed and validated a deep learning-based classifiers to detect mismatch repair-deficient status from routine colonoscopy images. We obtained the colonoscopy images from the imaging database at Endoscopic Center of the Sixth Affiliated Hospital, Sun Yat-sen University. Colonoscopy images from a prospective trial (Neoadjuvant PD-1 blockade by toripalimab with or without celecoxib in mismatch repair-deficient or microsatellite instability-high locally advanced colorectal cancer) were used to test the model. A total of 5226 eligible images from 892 tumors from the consecutive patients were utilized to develop and validate the deep learning model. 2105 colorectal cancer images from 306 tumors were randomly selected to form model development dataset with a class-balanced approach. 3121 images of 488 proficient mismatch repair tumors and 98 deficient mismatch repair tumors were used to form the independent dataset. The model achieved an AUROC of 0.948 (95% CI 0.919-0.977) on the test dataset. On the independent validation dataset, the AUROC was 0.807 (0.760-0.854), and the NPV in was 94.2% (95% CI 0.918-0.967). On the prospective trial dataset, the model identified 29 tumors among the 33 deficient mismatch repair tumors (87.88%). The model achieved a high NPV in detecting deficient mismatch repair colorectal cancers. This model might serve as an automatic screening tool.

Artificial Intelligence–Assisted Colonoscopy for Detecting Polyps, Adenomas, Precancerous Lesions, and Colorectal Cancer

What Is the Issue? Colorectal cancer is 1 of the most common cancers globally. In Canada, it is estimated that more than 25,000 people will be diagnosed with colorectal cancer in 2024 and that more than 9,000 people will die of it. To reduce the incidence and mortality of colorectal cancer, screening programs across various jurisdictions in Canada have implemented screening strategies involving routine fecal testing and colonoscopy. While colonoscopy is often considered the gold standard for colorectal cancer screening, missed polyps remain a challenge with this modality. In recent years, many artificial intelligence (AI)–enabled polyp detection systems have been developed for use during colonoscopy. A review of the clinical and cost-effectiveness of these systems could help clarify their potential role in clinical practice. What Did We Do? To inform decisions regarding the use of AI-assisted colonoscopy, we conducted a rapid review to identify and summarize evidence that compared the clinical and cost-effectiveness of AI-assisted colonoscopy to conventional colonoscopy and among different AI-assisted colonoscopy systems. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2019. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? We found 1 health technology assessment (HTA), 3 systematic reviews (SRs), and 1 randomized controlled trial (RCT) that evaluated the clinical and cost-effectiveness of AI-assisted colonoscopy for detecting polyps, adenomas, precancerous lesions, and colorectal cancer. AI-assisted colonoscopy may improve clinical outcomes compared to conventional colonoscopy, including adenoma detection rates, the number of adenomas detected per procedure, and adenoma miss rates, although it may also lead to longer withdrawal times. However, not all studies included in this report demonstrated statistically significant differences between the groups for each of these outcomes. The included RCT allocated participants to receive AI-assisted colonoscopy with either Deep-GI or CAD EYE, but the authors did not perform statistical testing to compare the outcomes between these 2 treatment groups. Findings from 6 economic evaluations summarized in the HTA suggest that AI-assisted colonoscopy is likely to be cost-effective or dominant — meaning it is less costly and more effective — compared to conventional colonoscopy. We did not find any studies on the relative cost-effectiveness of different AI-assisted colonoscopy systems that met our selection criteria for this review. None of the included studies reported long-term outcomes, such as colorectal cancer incidence and mortality; therefore, the impact of AI-assisted colonoscopy on these outcomes is unknown. What Does This Mean? AI-assisted colonoscopy may improve clinical outcomes and be more cost-effective than conventional colonoscopy for detecting polyps, adenomas, precancerous lesions, and colorectal cancer. The clinical and cost-effectiveness of different types of AI-assisted colonoscopy systems compared to each other is unknown. Clinicians and decision-makers can use the evidence summarized in this review to inform decisions regarding the implementation of AI-assisted colonoscopy.

Comprehensive pathogen identification and antimicrobial resistance prediction from positive blood cultures using nanopore sequencing technology

BackgroundBlood cultures are essential for diagnosing bloodstream infections, but current phenotypic tests for antimicrobial resistance (AMR) provide limited information. Oxford Nanopore Technologies introduces nanopore sequencing with adaptive sampling, capable of real-time host genome depletion, yet its application directly from blood cultures remains unexplored. This study aimed to identify pathogens and predict AMR using nanopore sequencing.MethodsIn this cross-sectional genomic study, 458 positive blood cultures from bloodstream infection patients in central Taiwan were analyzed. Parallel experiments involved routine microbiologic tests and nanopore sequencing with a 15-h run. A bioinformatic pipeline was proposed to analyze the real-time sequencing reads. Subsequently, a comparative analysis was performed to evaluate the performance of species identification and AMR prediction.ResultsThe pipeline identified 76 species, with 88 Escherichia coli, 74 Klebsiella pneumoniae, 43 Staphylococcus aureus, and 9 Candida samples. Novel species were also discovered. Notably, precise species identification was achieved not only for monomicrobial infections but also for polymicrobial infections, which was detected in 23 samples and further confirmed by full-length 16S rRNA amplicon sequencing. Using a modified ResFinder database, AMR predictions showed a categorical agreement rate exceeding 90% (3799/4195) for monomicrobial infections, with minimal very major errors observed for K. pneumoniae (2/186, 1.1%) and S. aureus (1/90, 1.1%).ConclusionsNanopore sequencing with adaptive sampling can directly analyze positive blood cultures, facilitating pathogen detection, AMR prediction, and outbreak investigation. Integrating nanopore sequencing into clinical practices signifies a revolutionary advancement in managing bloodstream infections, offering an effective antimicrobial stewardship strategy, and improving patient outcomes.

Laboratory Evaluation of Mechanical Properties and Noise Absorption in Magnetite-Enhanced Concrete for Pavement Applications

This paper aims to evaluate the effects of incorporating magnetite as an aggregate in concrete mixtures and as a partial replacement for Portland cement in standard mortar mixtures, focusing on performance and mechanical properties. Noise pollution from cement concrete pavements has become a significant concern for residents, making it a priority to implement effective measures to reduce traffic noise pollution. The primary goal of this research is to explore the relationship between mixture design variables with magnetite aggregates as a partial replacement for Portland cement in concrete pavement and the mixture's acoustic performance. Samples with 0, 10, 20, 30, 40, and 50% replacement of aggregates with magnetite sand were prepared initially. Subsequently, Portland cement was replaced with 0, 1, 2, 3.5, 5, 7.5, 10, 15, and 20% magnetite concentrate powder in standard mortar. Routine tests, such as slump, density, and flow table, were conducted on fresh concrete and mortar. Additionally, compressive strength, flexural strength, water absorption, electrical resistance, and impedance tube tests were performed on the concrete and mortar mixes. The impedance tube measurements demonstrated an increase in the sound absorption coefficient for concrete incorporating magnetite compared to the reference concrete. Among the tested concrete samples, the one containing 50% magnetite as aggregate exhibited the highest sound absorption coefficient, reaching a maximum value of 0.1 within the frequency range of 315 to 400Hz. This value was 2.5 times higher than the maximum sound absorption coefficient of the reference concrete.

Routine stress testing in diabetic patients after coronary intervention: a systematic review and meta-analysis

Routine stress testing in diabetic patients after coronary intervention: a systematic review and meta-analysis

Antibiotic over-administration in hospitalized infants with Adenovirus infection.

Infection with Adenovirus in children may clinically resemble a bacterial infection in several aspects, including high and prolonged fever, and increased inflammation markers. We aimed to estimate the rate of antibiotics administration among hospitalized infants with Adenovirus infection and to evaluate its justification. Included were hospitalized patients aged 2 months - 2 years who found positive for Adenovirus in PCR tests (Ct <36). Basic epidemiological and clinical features were retrieved retrospectively. A panel of three certified pediatricians examined each case to decide whether the antibiotic treatment was justified. Subsequently, the cases were divided into two groups - the group treated with antibiotics and the untreated group. The groups were compared in terms of the various parameters. Out of 183 children with Adenovirus, 92 (50.3%) were treated with antibiotics. Only 42.4% of the antibiotics prescribed were medically justified. Children treated with antibiotics had a higher level of fever (39.4±0.90 vs. 38.6±0.98 °C; P<0.001), their blood oxygen saturation was higher (96.7±4.4% vs. 92.9±7.7%; P=0.0003), they were less dyspneic, and their inflammatory markers were higher as compared to those who had not been treated with antibiotics. Approximately half of hospitalized pediatric patients <2 years old who were found positive for Adenovirus infection were treated with antibiotics during hospitalization. Most of these treatments were found retrospectively to be unjustified. Rapid and routine Adenovirus PCR testing can potentially reduce the rate of antibiotic treatment amongst hospitalized children.