Significant Difference In Detection Rate Research Articles

A meta-analysis of narrow-band imaging for the diagnosis of primary nasopharyngeal carcinoma

Background: Narrow band imaging (NBI), an endoscopic technique featuring an augmented definition of microvasculature and mucosal patterns. NBI is increasingly advocated as a tool to characterize neoplasia and intestinal metaplasia in endoscopic standards, such as for colorectal polyps and tumors. Recently NBI has also been studied in the detection of Nasopharyngeal Carcinoma (NPC). Here we aimed to assess the diagnostic utility of NBI for the diagnosis of NPC. Methods: A meta-analysis of studies comparing narrow-band imaging and white light endoscopy in the diagnosis of primary nasopharyngeal carcinoma was performed. The review process involved two independent investigators. The databases used were MEDLINE, PubMed, the Cochrane library, Embase, and the Web of Science. Statistical analysis was performed with OpenMetaAnalyst, MetaDiSc version 1.4, and Medcalc version 17.9.7. Results: Five studies including 2480 patients were included. The sensitivity and specificity for narrow-band imaging were 0.90 (0.73-0.97) and 0.95 (0.81-0.99) respectively. The positive likelihood ratio and negative likelihood ratio were 18.82 (0.31-82.1) and 0.08 (0.02-0.31). For white light endoscopy, the sensitivity and specificity were 0.77 (0.58-0.89) and 0.91 (0.79-0.96). The positive likelihood ratio was 7.61 (3.61-16.04), and the negative likelihood ratio was 0.21 (0.11-0.39). The odds ratio for detection rates between narrow-band imaging and white light endoscopy was 4.29 (0.56-33.03, p = 0.16). Area under the curve for narrow-band imaging was 0.98 (SE: 0.02), and for white light it was 0.93 (SE: 0.03). There was no significant difference in the receiver operating characteristic curves between the two modalities (p = 0.14). Conclusion: Narrow-band imaging showed a higher sensitivity and positive likelihood ratio for the diagnosis of nasopharyngeal carcinoma. However, there was no significant difference in detection rates compared to white light endoscopy. Further investigation with a uniform diagnostic criteria and terminology is needed for narrow-band imaging in the diagnosis of nasopharyngeal carcinoma.

A meta-analysis of narrow-band imaging for the diagnosis of primary nasopharyngeal carcinoma.

Background: Narrow band imaging (NBI), an endoscopic technique featuring an augmented definition of microvasculature and mucosal patterns. NBI is increasingly advocated as a tool to characterize neoplasia and intestinal metaplasia in endoscopic standards, such as for colorectal polyps and tumors. Recently NBI has also been studied in the detection of Nasopharyngeal Carcinoma (NPC). Here we aimed to assess the diagnostic utility of NBI for the diagnosis of NPC. Methods: A meta-analysis of studies comparing narrow-band imaging and white light endoscopy in the diagnosis of primary nasopharyngeal carcinoma was performed. The review process involved two independent investigators. The databases used were MEDLINE, PubMed, the Cochrane library, Embase, and the Web of Science. Statistical analysis was performed with OpenMetaAnalyst, MetaDiSc version 1.4, and Medcalc version 17.9.7. Results: Five studies including 2480 patients were included. The sensitivity and specificity for narrow-band imaging were 0.90 (0.73-0.97) and 0.95 (0.81-0.99) respectively. The positive likelihood ratio and negative likelihood ratio were 18.82 (0.31-82.1) and 0.08 (0.02-0.31). For white light endoscopy, the sensitivity and specificity were 0.77 (0.58-0.89) and 0.91 (0.79-0.96). The positive likelihood ratio was 7.61 (3.61-16.04), and the negative likelihood ratio was 0.21 (0.11-0.39). The odds ratio for detection rates between narrow-band imaging and white light endoscopy was 4.29 (0.56-33.03, p = 0.16). Area under the curve for narrow-band imaging was 0.98 (SE: 0.02), and for white light it was 0.93 (SE: 0.03). There was no significant difference in the receiver operating characteristic curves between the two modalities (p = 0.14). Conclusion: Narrow-band imaging showed a higher sensitivity and positive likelihood ratio for the diagnosis of nasopharyngeal carcinoma. However, there was no significant difference in detection rates compared to white light endoscopy. Further investigation with a uniform diagnostic criteria and terminology is needed for narrow-band imaging in the diagnosis of nasopharyngeal carcinoma.

Sa1036 FOLLOW-UP COLONOSCOPY IN COLORECTAL CANCER SCREENING REMAINS EFFECTIVE AMONG ELDERLY INDIVIDUALS WHO SHOW POSITIVE FIT RESULTS

Both American College of Physicians and U.S. Preventive Services Task Force recommend for people aged 75 and over to consider stopping the screening for colorectal cancer (CRC). But in Japan, there is no guideline about the ages of CRC screening, a lot of people over 75 years are receiving fecal immunochemical test (FIT) for mass screening for CRC, and consequently, a good number of elderly people undergo a follow-up exam, colonoscopy (CS). Because CS has possible severe complications, the follow-up CS among elderly people should contribute to CRC screening no less than among younger people. We investigated the efficacy of the follow-up CS among individuals over 75 years old, by comparing the results of the follow-up CS with those among younger individuals. This retrospective study was carried out in a single center. A total of 1336 subjects (657 men; 679 women) who underwent CS based on the positive result of FIT were enrolled. After dividing them into two groups, over 75 years (group A, 589 subjects) and 75 years or less (group B, 747), the detection rate of CRC, the rate of invasive CRC, treatment methods, CRC sites, and the detection rate of any neoplasm (CRC or adenoma) were determined. χ2 test was used for statistical analysis. The detection rate of CRC showed no significant difference between group A and B (8.8%, 52 out of 589 subjects; 7.5%, 56 out of 747, respectively). However, the rate of invasive CRC was significantly higher in group A than B (69%, 36 out of 52 CRC subjects; 41%, 23 out of 56, respectively, P < 0.005). As a result, 58% in group A needed surgery, on the other hand, 34% in group B underwent surgery (P < 0.015), and the others were endoscopically treated. CRCs were more frequently detected in the right side colon in group A than B (59%, 32 out of total 54 CRC lesions; 28%, 17 out of 61, respectively, P < 0.005). There was no significant difference in the total neoplasm detection rate between group A and B (53%, 312 out of 589 subjects; 55%, 411 out of 747, respectively). Individuals over 75 years who underwent the follow-up colonoscopy showed no significant difference in the detection rates of CRC or neoplasm compared with the younger individuals. However, CRCs detected in the individuals over 75 years were more deeply invasive and were more frequently seen and predominant especially in the right side colon than the younger individuals, where CRC is thought to be more difficult in early detection without any symptoms than in the left side. Taken together, we believe that CRC screening after the age of 75, using FIT and the follow-up CS, may have some efficacy.

Drug abuse screening with exhaled breath and oral fluid in adults with substance use disorder.

In the treatment of substance use disorder, regular laboratory-based testing has the dual purpose of monitoring compliance with the prescribed medication and abstention from medically non-motivated substances (ie, drug abuse screening). The principal specimen for testing is urine, but collection of urine has some disadvantages, for example being more time-consuming and more intrusive compared to other matrices. There is also the risk of adulteration. This project compared exhaled breath and oral fluid as alternative matrices for drug abuse screening in patients with substance use disorder. All 51 subjects included in the study were enrolled at the Drug Addiction Emergency Unit in Stockholm. Exhaled breath, oral fluid, and urine samples were collected together with a self-report. Of all 117 self-reported drug intakes during the previous week, 72% were confirmed in urine, 73% in oral fluid and 39% in exhaled breath. In 31% of the subjects, additional substances other than those self-reported were detected analytically. For substance abuse screening, urine had the highest detection rate for buprenorphine, cannabis, and benzodiazepines, while oral fluid had the highest detection rate for amphetamines and methadone. Exhaled breath showed the highest detection rate of all matrices for cocaine. To identify significant differences in detection rates between the matrices future studies with larger sampling sizes are needed. Both oral fluid and exhaled breath are viable alternative specimens to urine, depending on the circumstances and purpose of the testing.

Evaluation of a real-time PCR assay for detection and quantification of bacterial DNA directly in blood of preterm neonates with suspected late-onset sepsis

BackgroundRapid and accurate diagnosis of neonatal sepsis is highly warranted because of high associated morbidity and mortality. The aim of this study was to evaluate the performance of a novel multiplex PCR assay for diagnosis of late-onset sepsis and to investigate the value of bacterial DNA load (BDL) determination as a measure of infection severity.MethodsThis cross-sectional study was conducted in a neonatal intensive care unit. Preterm and/or very low birth weight infants suspected for late-onset sepsis were included. Upon suspicion of sepsis, a whole blood sample was drawn for multiplex PCR to detect the eight most common bacteria causing neonatal sepsis, as well as for blood culture. BDL was determined in episodes with a positive multiplex PCR.ResultsIn total, 91 episodes of suspected sepsis were investigated, and PCR was positive in 53 (58%) and blood culture in 60 (66%) episodes, yielding no significant difference in detection rate (p = 0.17). Multiplex PCR showed a sensitivity of 77%, specificity of 81%, positive predictive value of 87%, and negative predictive value of 68% compared with blood culture. Episodes with discordant results of PCR and blood culture included mainly detection of coagulase-negative staphylococci (CoNS). C-reactive protein (CRP) level and immature to total neutrophil (I/T) ratio were lower in these episodes, indicating less severe disease or even contamination. Median BDL was high (4.1 log10 cfu Eq/ml) with a wide range, and was it higher in episodes with a positive blood culture than in those with a negative blood culture (4.5 versus 2.5 log10 cfu Eq/ml; p < 0.0001). For CoNS infection episodes BDL and CRP were positively associated (p = 0.004), and for Staphylococcus aureus infection episodes there was a positive association between BDL and I/T ratio (p = 0.049).ConclusionsMultiplex PCR provides a powerful assay to enhance rapid identification of the causative pathogen in late-onset sepsis. BDL measurement may be a useful indicator of severity of infection.

Detection of Intravascular Injection During Cervical Transforaminal Epidural Injection: A Comparison of Digital Subtraction Angiography and Real Time Fluoroscopy

Background: Transforaminal epidural injection (TFEI) with local anesthetics and steroids are effective in treating spinal radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. To reduce complications of intravascular injection, use of imaging modality, such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA), has been recommended. DSA is an imaging technique that can clearly visualize the blood vessels from surrounding bones or dense soft tissues by subtracting the pre-contrast image from the image after injecting contrast medium. Objective: In this study, we investigated whether there is a difference between RTF and DSA in the detection of intravascular injection during cervical TFEI. Study Design: Clinical study. Setting: Pain clinic in South Korea. Methods: We prospectively examined 137 cervical TFEIs on 128 patients who have a radiating pain from spinal stenosis and herniated nucleus pulposus. The needle position was confirmed using biplanar fluoroscopy and 2 mL of nonionic contrast medium was injected at the rate of 0.5 mL/sec under RTF. Thirty seconds later, 2 mL of nonionic contrast medium was injected at the rate of 0.5 mL/sec under DSA. Intravascular injection was defined as contrast medium spreading throughout the vascular channel during injection of contrast medium under RTF and DSA. This study is registered in the ClinicalTrials.gov (NCT03040648). Results: The detection rate of intravascular injection in RTF was not statistically different compared to that in DSA (30.7 % vs. 34.3%, P &gt; 0.05). Limitations: We injected 2 mL of contrast medium at the rate of 0.5 mL/sec. Further studies about the ideal injection speed and volume of contrast medium for improvement of detection of intravascular injection during TFEI are needed. This study was a single center study. Therefore, multi-center studies are needed to obtain the high level of evidence. Additionally, the procedural pain physician was not blinded to the type of imaging modality, such as RTF and DSA, to detect intravascular injection. To minimize this confirmation bias and provide homogenous procedural conditions for TFEI, the same procedural physician performed all 137 injections. Conclusions: In this study, there is no significant difference in detection rate of intravascular injection between RTF and DSA during cervical TFEI. Key words: Analgesia, bleeding, clinical trials, complications, diagnostic equipment, epidural, radiculopathy, spine

Identification of occult prostate malignancy in a large patient cohort using a stereotactic transperineal prostate biopsy technique.

9 Background: Continued rising PSA, despite prior transrectal prostate biopsy (TRPB), can cause significant anxiety for patients and physicians. This study investigates the detection rate of non-palpable, isoechoic occult malignancy using a stereotactic transperineal prostate biopsy (STPB) technique in patients with previous negative TRPB. Methods: 2,565 men with continued rising prostate specific antigen (PSA) with a minimum of 1 prior benign TRPB, underwent STPB at a single out-patient institution between 04/04 - 02/17 (See table). Specimens were obtained according to x, y, and z coordinates from 8 equal octants with pathology reported accordingly. A greater number of specimens were obtained from the apical half than the basilar half of the prostate; this was attributed to smaller glands in which the apical specimens sufficiently sampled the anterior curvature of the gland. Results: STPB yielded adenocarcinoma in 965/2,565 (37.6%) patients. The number of biopsy cores obtained per patient approximated the prostate gland volume in cm3. Statistical analysis demonstrated there was a significant difference in detection rates with the apex having a higher incidence of malignancy than the base of the prostate gland (p=.000). Furthermore, the anterior apex harbored significantly more adenocarcinoma when compared to the posterior apex (p=.026). Conclusions: STPB is efficacious for diagnosis of non-palpable, isoechoic occult prostate malignancy. Repeated sequential analysis of malignancy identification has consistently resulted in approximately 40% positive yield. Furthermore, a possible explanation for the significant finding in this study that occult malignancies occupy a higher percentage of apical biopsies using STPB may be related to difficulty and limitations of apical sampling using a standard transrectal biopsy approach. [Table: see text]

Electroflotation of Escherichia coli Improves Detection Rates by Loop-Mediated Isothermal Amplification

Abstract. The power of portable molecular diagnostic systems for detection of pathogenic microorganisms in food and environmental samples is largely limited by small assay volumes (typically 1 to 5 µL), making direct detection of trace contamination (i.e., &amp;lt;104 CFU mL-1) unreliable. To improve detection limits for pathogens dispersed on an ecological scale, we developed a portable point-of-care (POC) sample preparation system using electroflotation (EF) to recover small quantities of these organisms from samples of hundreds of milliliters. Electrolysis reactions, supported on platinum-coated titanium electrodes, generate hydrogen and oxygen microbubbles that impel and displace suspended cells into a recovered concentrate. Samples were prepared by inoculating 380 mL of sterilized phosphate buffer (0.1 M, pH 6.6) with stock culture of ATCC 25922 to final concentrations ranging from 102 to 104 CFU mL-1. Samples were subjected to 10, 15, and 20 min durations of EF treatment under high and low turbulence conditions. We used a loop-mediated amplification (LAMP) assay with primers targeting a single-copy gene (glycerate kinase) in generic to evaluate the effects of EF treatment on concentration and recovery of detectable cell material. LAMP failed to detect in all untreated (control) samples at concentrations below 104 CFU mL-1 but was able to detect in 102 CFU mL-1 samples subjected to various conditions of EF treatment. Two-way ANOVA showed significant differences in detection rates between EF treatment durations for both high (p = 0.0019) and low turbulence (p = 0.002). Dunnett’s multiple comparison tests identified five process conditions resulting in significant (p &amp;lt; 0.05) differences in detection between treatments and the control. Keywords: Biotechnology, Electrolysis, Food pathogens, Microbubbles, Molecular diagnostics, Pathogen detection, POC sample preparation.

Are we still adjusting to multigene panel testing? An NCI-designated cancer center's 2-year experience.

1585 Background: Genetic testing for hereditary cancer predisposition has rapidly changed over the past few years with the introduction of multigene panel testing. Multigene testing has evolved from disease-agnostic comprehensive (C) panels alone to include disease-specific but expanded (DSE) panels as well as guideline-based (GB) panels. We analyzed trends in utilization of genetic testing over a two-year period in one NCI-designated Cancer Center, hypothesizing that over time genetic testing usage would trend toward more disease-specific panels. Methods: We conducted a retrospective analysis of our program’s database for all germline genetic tests ordered from 9/1/2013 to 8/31/2015 (n = 619; 246 in year 1, and 373 in year 2). Tests were categorized into three groups based on specificity: GB (range: 2-12 genes tested), DSE (12-35 genes tested), and C (28-80 genes tested). The Chi-square test was used to analyze test types ordered in year 1 (9/1/2013-8/31/2014) and year 2 (9/1/2014 – 8/31/2015) and the proportions of resulting mutation types. Results: A total of 604 germline genetic tests met the inclusion criteria: 39 GB (20 year 1, 19 year 2), 171 DSE (43 year 1, 128 year 2), and 394 C (180 year 1, 214 year 2). Compared to year 1, a larger proportion of DSE tests (35% v. 18%, p &lt; 0.001), and a smaller proportion of C tests (59% v. 74%, p &lt; 0.001) and GB tests (5% vs. 8%, p = 0.146) were ordered. DSE panels revealed a pathogenic variant (PV) at a rate of 16% and a variant of unknown significance (VUS) at a rate of 24%. C tests revealed a PV and VUS at rates of 14% and 29%, respectively. GB tests revealed a PV and VUS at rates of 21% and 18%, respectively. No statistically significant differences in detection rates of mutation types (PV or VUS) were found between GB, DSE, or C tests. Conclusions: The rates of PV detection were not significantly different between test types, but the profile of tests ordered changed over time to favor DSE panels. Exploration of factors contributing to changing trends in genetic testing are warranted as counselors and clinicians adapt to the quickly expanding number of genes associated with hereditary cancer risks, many of them moderate-risk, and the evolving landscape of multigene panel testing.

Dedicated Barrett's surveillance sessions managed by trained endoscopists improve dysplasia detection rate.

Background and study aim Barrett's esophagus (BE)-associated dysplasia is an important marker for risk of progression to esophageal adenocarcinoma (EAC) and an indication for endoscopic therapy. However, BE surveillance technique is variable. The aim of this study was to assess the effect of dedicated BE surveillance lists on dysplasia detection rate (DDR). Patients and methods This was a prospective study of patients undergoing BE surveillance at two hospitals - community (UHL) and upper gastrointestinal center (GSTT). Four endoscopists (Group A) were trained in Prague classification, Seattle protocol biopsy technique, and lesion detection prior to performing BE surveillance endoscopies at both sites, with dedicated time slots or lists. The DDR was then compared with historical data from 47 different endoscopists at GSTT and 24 at UHL (Group B) who had undertaken Barrett's surveillance over the preceding 5-year period. Results A total of 729 patients with BE underwent surveillance endoscopy between 2007 and 2012. There was no significant difference in patient age, sex, or length of BE between the two groups. There was a significant difference in detection rate of confirmed indefinite or low grade dysplasia and high grade dysplasia (HGD)/EAC between the two groups: 18 % (26 /142) Group A vs. 8 % (45/587) in Group B (P < 0.001). Documentation of Prague criteria and adherence to the Seattle protocol was significantly higher in Group A. Conclusion This study demonstrated that a group of trained endoscopists undertaking Barrett's surveillance on dedicated lists had significantly higher DDR than a nonspecialist cohort. These findings support the introduction of dedicated Barrett's surveillance lists.

Identification of a novel cosavirus species in faeces of children and its relationship with acute gastroenteritis in China

ObjectivesTo assess the prevalence of human cosavirus (HCosV) in China and to determine the association of a novel HCosV (Cosa-CHN) with acute gastroenteritis (AGE). MethodsA case–control study with 461 paired stool samples from diarrhoea and healthy children was conducted. Real-time PCR and nested PCR were used to detect the HCosVs. Rapid amplification of cDNA ends was used to obtain the ends of the Cosa-CHN. ResultsKnown HCosVs were detected in two control samples, while Cosa-CHN was detected in eight (1.7%) and six (1.3%) of the case and control samples respectively. The complete genome of Cosa-CHN comprises 7213 bp. The P1 and P2 regions of the Cosa-CHN were closely related to those of HCosV B, while the P3 region was most similar to that of HCosV D, albeit with low amino acid identities (66 and 67% respectively). Phylogenetic analyses of the polyprotein and partial VP3/VP1 regions indicated that Cosa-CHN could be classified as a novel species (tentatively named HCosV G) in cosavirus. There was no significant difference in detection rate (p 0.59) or mean virus load (p 0.43) of Cosa-CHN between the cases and controls. Statistical analysis revealed no association between Cosa-CHN and AGE (p 0.76), and the virus did not exacerbate clinical symptoms. ConclusionsA low prevalence of HCosV was detected, but a novel Cosavirus species was found in children with and without gastroenteritis in this study. The evidence did not support a causative role for the novel virus in paediatric AGE.

Capturing the cryptic: a comparison of detection methods for stoats (Mustela erminea) in alpine habitats

Context The ability to monitor the spatial distribution and abundance of species is essential for detecting population changes, and assessing the progress of conservation management programs. Stoats (Mustela erminea) are a serious conservation pest in New Zealand, but current monitoring methods are not sensitive enough to detect stoats in all situations. Aims We compare the effectiveness of the most commonly employed method for monitoring mustelids in New Zealand, footprint-tracking tunnels, with two alternative detection methods, camera traps and artificial nests. We were interested in determining whether alternative detection methods were more sensitive in detecting stoats than tracking tunnels. Methods We established a network of tracking tunnels, artificial nests and camera traps within alpine habitat. Devices were checked for stoat detections weekly across two seasons, in spring–early summer and autumn. Differences in detection rates and cost effectiveness among methods were analysed among seasons. Key results In spring–early summer, the time to first stoat detection using footprint-tracking tunnels was 61 days, compared with 7 days for camera traps and 8 days for artificial nests. The rate of stoat detection using artificial nests was significantly higher than it was using tracking tunnels (coef = 3.05 ± 1.29, P = 0.02), and moderately higher using camera traps (coef = 1.34 ± 1.09, P = 0.22). In autumn, when overall detectability of stoats was higher, there was no significant difference in detection rates among the three methods, although camera traps again recorded the earliest detection. Artificial nests were the most cost effective detection method in both seasons. Conclusions Artificial nests and camera traps were more efficient at detecting stoats during their spring breeding season (when they are known to be difficult to detect), compared with the more established footprint-tracking tunnel method. Artificial nests have potential to be developed into a monitoring index for small mammals, although further research is required. Both methods provide an important alternative to footprint tracking indices for monitoring stoats. Implications Our study demonstrated the importance of calibration among different monitoring methods, particularly when the target species is difficult to detect. We hypothesise that detection methods that do not rely on conspicuous, artificially constructed devices, may be more effective for monitoring small, cryptic mammals.

Development of a quantitative real-time PCR assay for sapovirus in children under 5-years-old in Regina Margherita Hospital of Turin, Italy.

Gastroenteritis is a common disease in children. It is characterized by diarrhea, vomiting, abdominal pain, and fever. Sapovirus (SaV) is a causative agent of acute gastroenteritis, but it causes milder illness than do rotavirus and norovirus. There is high variability in the analytical performance of quantitative PCR-based assays among clinical laboratories. This study developed a reverse transcription real-time PCR method to detect SaV in fecal specimens collected from children under 5-years-old with acute gastroenteritis. Of 137 episodes of acute gastroenteritis, 15 (10.9%) were associated with SaV genomic detection, with a median viral load of 6.6(log10) ± 7.1(log10) genomes/mg fecal specimens. There was a significant difference in detection rate between males and females (9.48% (13/15) vs. 1.46% (2/15), p = 0.0232). Among the 15 SaV-positive cases, 6 were also positive for rotavirus. Viral RNA recovery rate ranged from 46% to 77% in the manual RNAzol protocol and from 31% to 90% in the automated Maxwell protocol. We also studied whether human genomic DNA influences the sensitivity of the assay: its presence caused a decrease in PCR sensitivity. The development of a laboratory-designed real-time PCR TaqMan assay for quantitative detection of SaV and the optimization and standardization of this assay, using stools of children with acute gastroenteritis, are described.

Seasonal variation of peptic ulcer disease in eastern China—a 10-year single center retrospective study

Objective To detect the changing discipline of detection rate of gastric and duodenal ulcers varied by season based on the database of Digestive Endoscopy Center of Changhai Hospital of 10 years and the trend of the number of upper endoscopies in Changhai Hospital, and to figure out the detection rate of peptic ulcer in different genders, age groups and patient status. Methods All endoscopy data were listed by season. The number of endoscopic procedures and diagnosis were obtained. The analysis of detection rate of peptic ulcer disease in different seasons in different gender, age group and patient status was conducted using the chi square test. One-Way-ANOVA test was used to validate the time trends of the number of endoscopic procedures and diagnosis, while binary logistic regression was used for detection rate of peptic ulcer disease. Results A total of 215 692 endoscopic reports were derived from the database, among which 33 559 were diagnosed as peptic ulcer, with 18 270 as gastric ulcer and 15 289 as duodenal ulcer. There were significant differences in detection rates of peptic ulcer disease in different seasons in different gender, age group and patient status. The detection rates of gastric ulcer(P<0.01, OR=0.983, 95%CI: 0.976-0.987) and duodenal ulcer (P<0.05, OR=0.992, 95%CI: 0.986-0.997)decreased along the time trend. The detection rates of gastric ulcer (P<0.01, OR=1.04, 95%CI: 1.03-1.06) and duodenal ulcer(P<0.01, OR=1.05, 95%CI: 1.03-1.06) showed a significant seasonal variation. The detection rate of gastric ulcer was higher in winter (9.26%) and lower in spring (8.16%). As for duodenal ulcer, the detection rate is also higher in winter (8.38%), but lower in autumn (5.88%). Conclusion From 2004 January to 2014 February, the number of endoscopic procedures increased and showed a significant seasonal variation. Although the number of endoscopic diagnosis increased in the past 10 years, the overall detection rate of the two kinds of peptic ulcer declined. The time trends of detection rate of both ulcer showed a significant seasonal variation, higher in winter. Key words: Peptic ulcer; Esophagogastroduodenoscopy; Seasons

MP55-01 CONTEMPORARY PRACTICE PATTERNS IN VOIDING CYSTOURETHROGRAM (VCUG) USE: THE IMPACT OF EVIDENCE-BASED GUIDELINES

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2016MP55-01 CONTEMPORARY PRACTICE PATTERNS IN VOIDING CYSTOURETHROGRAM (VCUG) USE: THE IMPACT OF EVIDENCE-BASED GUIDELINES Linda Lee, Armando Lorenzo, Rakan Odeh, Paul Bowlin, Jeffrey Traubici, and Martin Koyle Linda LeeLinda Lee More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , Rakan OdehRakan Odeh More articles by this author , Paul BowlinPaul Bowlin More articles by this author , Jeffrey TraubiciJeffrey Traubici More articles by this author , and Martin KoyleMartin Koyle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.592AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While VCUG is a widely accepted test, it is invasive and associated with radiation exposure. Most cases of VUR are low-grade and unlikely to be associated with acquired renal scarring. In an effort to select patients at greatest risk, the American Academy of Pediatrics (AAP) published revised guidelines on urinary tract infections in children ages 2 to 24 months in 2011. In this project, we examine contemporary practice patterns and indications for VCUG, in the context of newer evidence-based guidelines. We hypothesize that the rate of VCUGs has declined over time, which may be geared towards detection of more clinically significant VUR. METHODS All VCUGs performed at our institution from 2008 to present were identified. Follow-up VCUGs were excluded. Further data collection was performed for patients whom had a VCUG in the first six months of 2009 and 2014, in order to obtain representative data before and after publication of the 2011 AAP guidelines. Medical records for these patients were retrospectively reviewed for baseline patient characteristics, indication for VCUG, type of ordering physician, prior history of febrile UTIs, renal and bladder ultrasound and renal scan findings. RESULTS From January 2008 to August 2014, a total of 8214 VCUGs were performed at our institution. The annual number of VCUGs has declined steadily over time. We then compared the 6-month periods from January to June (inclusive) in 2009 and 2014, which identified 634 and 292 VCUGs, respectively. There were no statistically significant differences in mean age or gender between both groups. Although there was a decline in VCUGs in 2014, the rate of VCUGs performed for UTIs remained the same (65% in 2009 and 64% in 2014, p=0.88). In both groups, pediatric urologists comprised the minority of ordering physicians (14% in 2009 and 16% in 2014, p=0.48). While there is no statistically significant difference in detection rate of VUR from 2009 to 2014 (31% vs. 37%, p=0.07), there has been a three-fold increase in diagnosis of high grade (IV-V) VUR in 2014, compared to 2009 (10.2% vs 3.2%, p=0.0001). CONCLUSIONS There has been an overall trend towards fewer VCUGS being performed at our institution, even prior to the 2011 AAP guidelines. While the majority of VUR cases detected remain low-grade, there has been a higher detection rate of high-grade (IV-V) VUR in 2014, compared to 2009. This may be a reflection of changing practice patterns of ordering physicians. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e735 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Linda Lee More articles by this author Armando Lorenzo More articles by this author Rakan Odeh More articles by this author Paul Bowlin More articles by this author Jeffrey Traubici More articles by this author Martin Koyle More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of Including or Removing Nuchal Translucency Measurement on the Detection and False-Positive Rates of First-Trimester Down Syndrome Screening

Introduction: First-trimester Down syndrome (DS) screening combining maternal age, serum markers (pregnancy-associated plasma protein-A and beta-human chorionic gonadotropin) and nuchal translucency (NT) gives an 85% detection rate for a 5% false-positive rate. These results largely depend on quality assessment of biochemical markers and of NT. In routine practice, despite an ultrasound quality control organization, NT images can be considered inadequate. The aim of the study was to evaluate the consequences for risk calculation when NT measurement is not taken into account. Material and Method: Comparison of detection and false-positive rates of first-trimester DS screening (PerkinElmer, Turku, Finland), with and without NT, based on a retrospective study of 117,126 patients including 274 trisomy 21-affected fetuses. NT was measured by more than 3,000 certified sonographers. Results: There was no significant difference in detection rates between the two strategies including or excluding NT measurement (86.7 vs. 81.8%). However, there was a significant difference in the false-positive rates (2.23 vs. 9.97%, p < 0.001). Discussion: Sonographers should be aware that removing NT from combined first-trimester screening would result in a 5-fold increase in false-positive rate to maintain the expected detection rates. This should be an incentive for maintaining quality in NT measurement.

The epidemic characteristics of short stature in school students.

BackgroundThere was no large-scale population survey on the prevalence of short stature in Anhui province yet. To further acquainting the epidemiological character of teenage children short stature in Anhui province, and to provide basis for exploring reasonable intervention measure about children’s height, we took this survey on short stature in primary and middle school students of Anhui province.MethodsTwelve thousand nine primary and secondary school students in urban and rural aged from 7 to 18 years were recruited. The comparison of short stature in different genders, regions and age groups was done according to genetic metabolic endocrine group of pediatrics branch in Chinese Medical Association (CMA).ResultsThe average detection rate of short stature in primary and middle school students was 3.16% in Anhui province. The detection rate was higher in rural area than in urban area, higher in economic backward area than in economic developed areas.ConclusionThere was no significant difference in detection rate in gender and age.

Evaluation of lid speculum with a drape (LiDrape(®)) for preventing surgical-field contamination.

PurposeTo compare the degree of surgical-field contamination in cataract surgeries between a new draping method using a lid speculum with a drape (LiDrape®) and a conventional draping method.MethodsCataract surgery was performed on 21 eyes using LiDrape® (LiDrape® group) and on 22 eyes using a conventional draping method (conventional group). Contamination was evaluated by bacterial culture of conjunctival sac scrapings and ocular surface irrigation fluid. Conjunctival sac scrapings were collected before and after application of preoperative antibiotics. Ocular surface irrigation fluid was collected before incision placement and during surgery. Bacterial detection rate and types of organisms isolated at these four time points were examined.ResultsBacterial detection rates were significantly decreased in the LiDrape® group at all time points after the application of antibiotics compared with preapplication. Regarding between-group comparisons, the bacterial detection rate in the LiDrape® group was only significantly lower than that in the conventional group in the intraoperative sample. Propionibacterium acnes was the most common organism isolated from ocular surface irrigation fluid. The number of P. acnes in the intraoperative sample was significantly lower in the LiDrape® group compared with the conventional group. There were no significant differences in detection rates for other bacteria between the groups.ConclusionLiDrape® was as effective as conventional draping for preventing surgical-field contamination. The number of P. acnes during surgery was significantly lower in the LiDrape® group compared with the conventional group, suggesting that LiDrape® may contribute to the prevention of postoperative infection.

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials).

Computed tomographic colonography (CTC) is a relatively new diagnostic test that may be superior to existing alternatives to investigate the large bowel. To compare the diagnostic efficacy, acceptability, safety and cost-effectiveness of CTC with barium enema (BE) or colonoscopy. Parallel randomised trials: BE compared with CTC and colonoscopy compared with CTC (randomisation 2 : 1, respectively). A total of 21 NHS hospitals. Patients aged ≥ 55 years with symptoms suggestive of colorectal cancer (CRC). CTC, BE and colonoscopy. For the trial of CTC compared with BE, the primary outcome was the detection rate of CRC and large polyps (≥ 10 mm), with the proportion of patients referred for additional colonic investigation as a secondary outcome. For the trial of CTC compared with colonoscopy, the primary outcome was the proportion of patients referred for additional colonic investigation, with the detection rate of CRC and large polyps as a secondary outcome. Secondary outcomes for both trials were miss rates for cancer (via registry data), all-cause mortality, serious adverse events, patient acceptability, extracolonic pathology and cost-effectiveness. A total of 8484 patients were registered and 5384 were randomised and analysed (BE trial: 2527 BE, 1277 CTC; colonoscopy trial: 1047 colonoscopy, 533 CTC). Detection rates in the BE trial were 7.3% (93/1277) for CTC, compared with 5.6% (141/2527) for BE (p = 0.0390). The difference was due to better detection of large polyps by CTC (3.6% vs. 2.2%; p = 0.0098), with no significant difference for cancer (3.7% vs. 3.4%; p = 0.66). Significantly more patients having CTC underwent additional investigation (23.5% vs. 18.3%; p = 0.0003). At the 3-year follow-up, the miss rate for CRC was 6.7% for CTC (three missed cancers) and 14.1% for BE (12 missed cancers). Significantly more patients randomised to CTC than to colonoscopy underwent additional investigation (30% vs. 8.2%; p < 0.0001). There was no significant difference in detection rates for cancer or large polyps (10.7% for CTC vs. 11.4% for colonoscopy; p = 0.69), with no difference when cancers (p = 0.94) and large polyps (p = 0.53) were analysed separately. At the 3-year follow-up, the miss rate for cancer was nil for colonoscopy and 3.4% for CTC (one missed cancer). Adverse events were uncommon for all procedures. In 1042 of 1748 (59.6%) CTC examinations, at least one extracolonic finding was reported, and this proportion increased with age (p < 0.0001). A total of 149 patients (8.5%) were subsequently investigated, and extracolonic neoplasia was diagnosed in 79 patients (4.5%) and malignancy in 29 (1.7%). In the short term, CTC was significantly more acceptable to patients than BE or colonoscopy. Total costs for CTC and colonoscopy were finely balanced, but CTC was associated with higher health-care costs than BE. The cost per large polyp or cancer detected was £4235 (95% confidence interval £395 to £9656). CTC is superior to BE for detection of cancers and large polyps in symptomatic patients. CTC and colonoscopy detect a similar proportion of large polyps and cancers and their costs are also similar. CTC precipitates significantly more additional investigations than either BE or colonoscopy, and evidence-based referral criteria are needed. Further work is recommended to clarify the extent to which patients initially referred for colonoscopy or BE undergo subsequent abdominopelvic imaging, for example by computed tomography, which will have a significant impact on health economic estimates. Current Controlled Trials ISRCTN95152621.

121 Detection of Dysplasia Arising in Barrett's Esophagus Is Improved by Trained Endoscopists With a Specialist Interest on Dedicated Lists

Introduction Barrett’s oesophagus (BE) is the pre-malignant lesion to oesophageal adenocarcinoma (OAC). The presence of dysplasia, when diagnosed in surveillance programmes, is an important marker of risk of progression and an indication for endoscopic therapy. We have previously demonstrated that BE surveillance technique is variable and suggest centralised lists with few highly trained endoscopists. The aim of this study was to assess the introduction of dedicated BE surveillance lists on dysplasia detection rate (DDR). Method Prospective study of patients undergoing BE surveillance at two hospitals – district general hospital (DGH), and tertiary referral upper GI centre. A group of 4 endoscopists (group A) were trained in Prague classification, Seattle protocol biopsy technique and lesion detection. They were nominated to undertake BE surveillance, with dedicated time slots or lists. The DDR was then compared with historical data from 47 different endoscopists at GSTT (group B) and 24 at UHL (Group C) who had undertaken Barrett’s surveillance over the 5 year period. Analysis was by independent t-tests for continuous variables and chi-squared tests for categorical variables. Results A total of 729 patients with BE underwent endoscopy, between 2007 and 2012. Results are shown in Table 1. There was no significant difference in patient’s age, sex or length of BE between the three groups. Of these, 21% (30/144) were diagnosed with dysplasia/EAC by group A endoscopists vs. 9% (55/587) in Group B/C (p = 0.0004). There was a significant difference in detection rate of Indefinite or Low grade dysplasia (IND/LGD) and High grade dysplasia (HGD)/EAC between the 2 groups. There was a significant difference in diagnosis of IND in community (25/271) vs. teaching hospital (5/458) (p = 0.0001). Documentation of length of BE by Prague criteria was significantly higher in group A than group B&C. The use of High Resolution Endoscopy was similar between both groups. Conclusion This study demonstrates that a group of endoscopists trained in BE surveillance, have significantly higher dysplasia detection rate (DDR) than a non specialist cohort. These findings support the argument that BE surveillance, either at DGH or tertiary centre, should only be carried out on dedicated lists by trained endoscopists with a specialist interest. Disclosure of interest None Declared.