Specific Clinical Tests Research Articles

A Lack of Joint Line Tenderness Is Consistent With a Healed Meniscus, But Positive Clinical Examination Findings and MRI Scans Are Inconsistent in Identifying Failure After Meniscal Repair: A Systematic Review and Subgroup Meta-analysis.

The number of meniscal repairs being completed each year is increasing; however, the optimal, cost-effective postoperative assessment to determine the success or failure of a meniscal repair is not well known. The purpose of this systematic review was to identify the clinical examination testing that correlates with objective magnetic resonance imaging (MRI) or second-look arthroscopy (SLA) findings to determine an optimal clinical workup for assessing postoperative meniscal repair healing. It was hypothesized that specific clinical tests would correlate with meniscal repairs that did not heal. Systematic review and meta-analysis; Level of evidence, 4. This systematic review included all clinical studies investigating meniscal repairs, meniscal repair outcomes, and meniscal healing with clinical findings, MRI, and/or SLA, published in a peer-reviewed journal and with full English text available. All included studies were evaluated for bias using the Methodological Index for Non-Randomized Studies (MINORS). The clinical tests included those using "Barrett's criteria," with the assessment of effusion, joint line tenderness, locking, McMurray testing, and radiographs. This parameter has also been abbreviated to "modified Barrett's criteria" to include only joint line tenderness, effusion, and McMurray testing. No significant correlations were found between clinical tests and MRI or SLA. A subgroup meta-analysis between Barrett's and non-Barrett's studies reported no significant subgroup differences (χ12 = 0.24; P = .62). A meta-analysis of diagnostic accuracy using a group of 7 studies that reported on true-positive, true-negative, false-positive, and false-negative data for SLA demonstrated that only a lack of joint line tenderness had a high specificity for a healed meniscal repair, with a log diagnostic odds ratio of 2.62 (95% CI, 0.47-4.76). This study found no significant correlation with any specific clinical test for meniscal repair healing status using postoperative MRI and/or SLA findings. However, it was found that no healing (when compared with complete or incomplete healing) on MRI and joint line tenderness should be considered when assessing the status of postoperative meniscal repair healing. In addition, a subgroup meta-analysis found that a lack of joint line tenderness was highly correlated with a healed meniscal repair.

May a Single Presurgical High-Field MRI Sequence Replace Standard Radiographs for TPLO Surgical Planning in Dogs?

Cranial cruciate ligament (CCL) disease causes variable stifle instability assessed by specific clinical tests. Radiographs are performed to measure the tibial plateau angle (TPA) for planning tibial plateau leveling osteotomy (TPLO) surgery. Concomitant damage to other intra-articular structures, for which clinical detection is unreliable, may occur and potentially affect the surgical outcome. Joint assessment during TPLO through instrumented inspection is therefore advised, though it increases the risk of complications. Magnetic resonance imagingoffers a noninvasive alternative, adds information about intra- and periarticular structures, and could potentially be used for TPA measurements. This prospective study aimed to (1) assess the correlation between the TPA measured with the standard presurgical radiographs and with a single sagittal intermediate-weighted fat-saturated MRI sequence and (2) compare the surgical findings with the information obtained by the MRI sequence. Twenty-one stifles were included; TPA correlation using radiographs-MRI was available for 17 stifles, and surgery-MRI comparison was available for 18 stifles. A strong significant correlation was identified between the TPA measurements on radiographs-MRI (Pearson correlation coefficient 0.923; p-value <.0001). The sensitivity and specificity of MRI to detect surgically confirmed complete versus partial CCL rupture were 85.7% and 75%, respectively; MRI identified 7 of 8 surgically confirmed injured menisci and detected abnormal signal intensity in 8 of 10 medial menisci and nine caudal cruciate ligaments reported as normal intra-operatively. The MRI additionally identified abnormal subchondral bone signals in nine stifles and muscular hyperintensity in six cases. This presurgical MRI sequence might replace standard radiographs for TPA measurements and can provide information about concomitant joint injuries with potential prognostic impact.

Assessing diagnostic challenges in acute soft-tissue knee injuries.

This Delphi study assessed the challenges of diagnosing soft-tissue knee injuries (STKIs) in acute settings among orthopaedic healthcare stakeholders. This modified e-Delphi study consisted of three rounds and involved 32 orthopaedic healthcare stakeholders, including physiotherapists, emergency nurse practitioners, sports medicine physicians, radiologists, orthopaedic registrars, and orthopaedic consultants. The perceived importance of diagnostic components relevant to STKIs included patient and external risk factors, clinical signs and symptoms, special clinical tests, and diagnostic imaging methods. Each round required scoring and ranking various items on a ten-point Likert scale. The items were refined as each round progressed. The study produced rankings of perceived importance across the various diagnostic components. In Round 1, the study revealed widespread variability in stakeholder opinions on diagnostic components of STKIs. Round 2 identified patterns in the perceived importance of specific items within each diagnostic component. Round 3 produced rankings of perceived item importance within each diagnostic component. Noteworthy findings include the challenges associated with accurate and readily available diagnostic methods in acute care settings, the consistent acknowledgment of the importance of adopting a patient-centred approach to diagnosis, and the transition from divergent to convergent opinions between Rounds 2 and 3. This study highlights the potential for a paradigm shift in acute STKI diagnosis, where variability in the understanding of STKI diagnostic components may be addressed by establishing a uniform, evidence-based framework for evaluating these injuries.

Clinical and Structural Results Following Arthroscopic and Open Repair of Isolated Subscapularis Tears.

Objective: With advances in techniques, arthroscopic repair of isolated subscapularis tendon tears has become increasingly popular in recent years. The aim of this study was to analyze the clinical and structural results of arthroscopic repair versus the gold standard of open repair. It is a prospective cohort study with a control group; evidence level III. Methods: In a prospective study performed at two centers, 18 patients with an isolated subscapularis tear were treated with arthroscopic repair (ARG) and 16 patients with open repair (ORG) using a uniform single-row suture anchor repair technique in both groups. The subscapularis function was assessed using specific clinical tests (belly-press and lift-off tests), strength testing and shoulder function with the use of the Constant-Murley score (CMS). Standardized magnetic resonance imaging (MRI) was used to evaluate the postoperative subscapularis muscle-tendon status. Results: At a minimum follow-up of 48 months, the CMS increased from a mean of 54 points preoperatively to a mean of 86 points postoperatively in the ARG (p < 0.01) and from 50 points to 85 points postoperatively in the ORG (p < 0.01). Specific subscapularis tests (belly-press test and lift-off test) were significantly improved from the preoperative to the postoperative status in both repair groups (p < 0.05). Despite a subscapularis tendon healing rate of over 90% on MRI scans in both repair groups, the incomplete correction of specific muscle tests was a frequent postoperative finding. Conclusions: Arthroscopic repair of isolated subscapularis tears achieved equivalent clinical and structural results compared to the gold standard of open repair.

Minimum visual acuity: a new cone specific clinical test

Minimum visual acuity: a new cone specific clinical test

Eagle’s syndrome: Modern systematic review and presentation of radiographic cases

Introduction: The styloid process is a bony structure of the base of the skull, which can undergo pathological structural changes. So, its elongation may possibly provoke Eagle’s syndrome, also known as stylohyoid syndrome, which is a head and neck pathological condition that rarely manifests with severely painful symptomatology. Objective: The present literature review aims to deal with the understanding of the pathophysiology, as well as the investigation of the diagnostic and therapeutic facts regarding Eagle’s syndrome. Materials – Methods: An extended research of modern literature through papers published in scientific journals has been conducted, deploying the databases PubMed and Google Scholar. Results: Eagle’s syndrome is a rare pathological condition, whose prevalence is approximately 4% of general population. In the literature, several pathogenetic patterns have been reported and they are divided into acquired and idiopathic biochemical mechanisms. In order to diagnose the disease, one should take the painful symptoms referred by the patient into consideration, in conjunction with specific clinical tests. However, the final diagnosis is set after the radiological evaluation. Eagle’s syndrome manifests with non-specific symptomatology, thus it should be differentiated from other diseases and conditions of the head and neck anatomical area. Regarding the therapy of the syndrome, a vast range of conservative choices is available nowadays, mainly basedon drugs, while at the same time there are surgical techniques with comparatively better long-term outcome. Conclusions: There is an expressively increased interest, regarding the diagnosis and the therapeutics of Eagle’s syndrome. Modern medical sciences attempt to gradually advance the diagnostic methodology and constantly improve the therapeutic choices of this disease. The ultimate purpose is the more effective management of the patients and the enhancement of their life quality.

Label free quantitative proteomic profiling of serum samples of intellectually disabled young patients revealed dysregulation of complement coagulation and cholesterol cascade systems.

Intellectual disability is a heterogeneous disorder, diagnosed using intelligence quotient (IQ) score criteria. Currently, no specific clinical test is available to diagnose the disease and its subgroups due to inadequate understanding of the pathophysiology. Therefore, current study was designed to explore the molecular mechanisms involved in disease perturbation, and to identify potential biomarkers for disease diagnosis and prognosis. A total of 250 participants were enrolled in this study, including 200 intellectually disabled (ID) subjects from the subgroups (mild, moderate, and severe) with age and gender matched healthy controls (n = 50). Initially, IQ testing score and biochemical profile of each subject was generated, followed by label-free quantitative proteomics of subgroups of IQ and healthy control group through nano-LC/MS- mass spectrometry. A total of 310 proteins were identified, among them198 proteins were common among all groups. Statistical analysis (ANOVA) of the subgroups of ID showed 142 differentially expressed proteins, in comparison to healthy control group. From these, 120 proteins were found to be common among all subgroups. The remaining 22 proteins were categorized as exclusive proteins found only in disease subgroups. Furthermore, the hierarchical cluster analysis (HCL) of common significant proteins was also performed, followed by PANTHER protein classification and GO functional enrichment analysis. Results provides that the datasets of differentially expressed proteins, belong to the categories of immune / defense proteins, transfer carrier proteins, apolipoproteins, complement proteins, protease inhibitors, hemoglobin proteins etc., they are known to involvein immune system, and complement and coagulation pathway cascade and cholesterol metabolism pathway. Exclusively expressed 22 proteins were found to be disease stage specific and strong PPI network specifically those that have significant role in platelets activation and degranulation, such as Filamin A (FLNA). Furthermore, to validate the mass spectrometric findings, four highly significant proteins (APOA4, SAP, FLNA, and SERPING) were quantified by ELISA in all the study subjects. AUROC analysis showed a significant association of APOA4 (0.830), FLNA (0.958), SAP (0.754) and SERPING (0.600) with the disease. Apolipoprotein A4 (APOA4) has a significant role in cholesterol transport, and in modulation of glucose and lipid metabolism in the CNS. Similarly, FLNA has a crucial role in the nervous system, especially in the functioning of synaptic network. Therefore, both APOA4, and FLNA proteins represent good potential for candidate biomarkers for the diagnosis and prognosis of the intellectual disability. Overall, serum proteome of ID patients provides valuable information of proteins/pathways that are altered during ID progression.

Skin Biopsy Detection of Phosphorylated α-Synuclein in Patients With Synucleinopathies

Finding a reliable diagnostic biomarker for the disorders collectively known as synucleinopathies (Parkinson disease [PD], dementia with Lewy bodies [DLB], multiple system atrophy [MSA], and pure autonomic failure [PAF]) is an urgent unmet need. Immunohistochemical detection of cutaneous phosphorylated α-synuclein may be a sensitive and specific clinical test for the diagnosis of synucleinopathies. To evaluate the positivity rate of cutaneous α-synuclein deposition in patients with PD, DLB, MSA, and PAF. This blinded, 30-site, cross-sectional study of academic and community-based neurology practices conducted from February 2021 through March 2023 included patients aged 40 to 99 years with a clinical diagnosis of PD, DLB, MSA, or PAF based on clinical consensus criteria and confirmed by an expert review panel and control participants aged 40 to 99 years with no history of examination findings or symptoms suggestive of a synucleinopathy or neurodegenerative disease. All participants completed detailed neurologic examinations and disease-specific questionnaires and underwent skin biopsy for detection of phosphorylated α-synuclein. An expert review panel blinded to pathologic data determined the final participant diagnosis. Skin biopsy for detection of phosphorylated α-synuclein. Rates of detection of cutaneous α-synuclein in patients with PD, MSA, DLB, and PAF and controls without synucleinopathy. Of 428 enrolled participants, 343 were included in the primary analysis (mean [SD] age, 69.5 [9.1] years; 175 [51.0%] male); 223 met the consensus criteria for a synucleinopathy and 120 met criteria as controls after expert panel review. The proportions of individuals with cutaneous phosphorylated α-synuclein detected by skin biopsy were 92.7% (89 of 96) with PD, 98.2% (54 of 55) with MSA, 96.0% (48 of 50) with DLB, and 100% (22 of 22) with PAF; 3.3% (4 of 120) of controls had cutaneous phosphorylated α-synuclein detected. In this cross-sectional study, a high proportion of individuals meeting clinical consensus criteria for PD, DLB, MSA, and PAF had phosphorylated α-synuclein detected by skin biopsy. Further research is needed in unselected clinical populations to externally validate the findings and fully characterize the potential role of skin biopsy detection of phosphorylated α-synuclein in clinical care.

Polysensitization in the Spanish Contact Dermatitis Registry (REIDAC): A 2019-2022 prospective study with cluster and network analysis.

There is still limited clinical-practice data on specific clinical and patch test features, as well as on allergen clusters in polysensitization (PS). To determine the frequency, relevance, symptoms duration and risk factors in polysensitized patients and to assess possible allergen aggregation. Prospective multicentric study (January 2019-December 2022) conducted in setting of the Spanish Contact Dermatitis Register (REIDAC). Clinical and patch test data of polysensitized and oligosensitized patients were compared, and risk factors of PS were investigated with logistic multivariate regression. Unsupervised hierarchical clustering and network analysis were used to study allergen aggregation in PS. A total of 10,176 patients were analysed. PS was found in 844 (8.3%). Current relevance was significantly higher in polysensitized patients (p < 0.01). Risk factors for PS were atopic dermatitis (OR: 1.58, 95% CI: 1.24-2.02), age (≥60 years vs. ≤24 years, OR: 1.75, 95% CI: 1.25-2.44) and some special locations (legs vs. face OR: 1.54, 95% CI: 1.05-2.25, hands vs. face OR: 1.46, 95% CI:1.15-1.85, arms vs. face OR: 1.49, 95% CI:1.01-2.20, trunk vs. face OR: 1.40, 95% CI:1.06-1.85). Cluster and network analyses revealed specific-allergen clusters and significant associations, including allergens belonging to metals group, fragrances and botanicals group, topical drugs group, rubber allergens and biocides. This study confirms that PS is structured by discernible patterns of specific-allergen clusters and reinforces significant allergen associations in PS. Cross-reactivity and/or concomitant sensitization could explain the formation of allergen clusters in PS.

Evaluation of Clinical Subacromial Impingement Test Positive Patients with Ultrasonographic Subacromial Impingement Test

Objective: Knowing which of the special clinical tests used in subacromial impingement syndrome is more successful in making the diagnosis is important for patient evaluation, determining if further examination is necessary, and arranging treatment. Utilizing sonographic impingement as a reference diagnostic technique, the study sought to evaluate how well clinical test results performed in diagnosing patients with subacromial impingement syndrome. Material and method: The study involved 42 patients with shoulder pain and at least one positive subacromial impingement test, including Neer, Hawkins, or Yocum tests. Dynamic sonographic compression of the tendon in the coracoacromial area was examined by abducting the shoulder. Dynamic sonographic compression findings were compared with clinical examination tests. Results: In 40.5% of the patients, the ultrasonographic impingement test was positive. Hawkins test was positive in 81% of patients, Neer test was positive in 69% of patients, and Yocum test was positive in 78.6% of patients. A significant relationship was found between the ultrasonographically evaluated subacromial impingement test and the Neer test, but no significant relationship was found with other special tests (Hawkins and Yocum test) (p = 0.02, p = 0.4, p = 0.12, respectively). Conclusion: We have demonstrated a significant relationship between the ultrasonographic finding of dynamic subacromial impingement and the Neer test, which is a non-invasive and device-independent physical examination test.

Clinical presentation and diagnosis of pediatric urinary tract infections: A comprehensive study

Background: Urinary tract infections (UTIs) pose a significant health concern for children worldwide, with a prevalence ranging from 2% to 20%. If not promptly diagnosed and treated, these infections can lead to severe complications such as renal scarring, hypertension, and chronic renal failure. Aims and Objectives: This study aims to evaluate the clinical presentation, diagnostic methods, and common bacterial pathogens associated with pediatric UTIs. The focus is on identifying age-specific symptoms and improving diagnostic accuracy to mitigate long-term complications. Materials and Methods: Over 1 year, we conducted a cross-sectional study at MES Medical College in Perinthalmanna, Kerala. Fifty-four children with culture-positive UTIs were included. Clinical data were collected using a semi-structured pro forma, and laboratory tests were performed to identify the causative organisms and their antibiotic susceptibility patterns. Results: Among neonates, fever (100%), jaundice (100%), and vomiting (83.3%) were the most common symptoms. Older children predominantly presented with fever (93.3%), pain or burning during urination (79.63%), and lethargy (53.7%). Escherichia coli was the most frequently identified pathogen, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. High sensitivity was noted for piperacillin-tazobactam (100%) and amikacin (88.89%). Conclusion: Early and precise diagnosis of pediatric UTIs, based on specific clinical presentations and laboratory tests, is crucial for preventing severe complications. Recognizing common pathogens and their antibiotic sensitivities helps in developing effective treatment guidelines.

Distal biceps tendon rupture: a comprehensive overview

Distal biceps tendon (DBT) is a relatively rare injury mainly occurring in middle-aged men while in eccentric biceps muscle contraction. Clinical appearance with proximal avulsion of the muscle and specific clinical tests are most of the time sufficient for diagnosing DBT, but if needed ultrasonography and MRI, most often in FABS view, can be used to ensure diagnosis of DBT and partial DBT. Surgical anatomical reinsertion has shown to be a successful method of treatment, although conservative treatment can be initiated in older patients. Two different approaches are described in literature: single- and double-incision techniques with different fixation methods proving to have similarly good results. Major complications of surgical intervention are posterior interosseous nerve palsy and symptomatic heterotropic ossification. Overall outcome of surgical intervention has shown high subjective satisfaction with slight weakness in flexion and supination but mostly without loss in range of motion.

Successful treatment of habit cough using suggestion therapy

Background: Habit cough is one of the causes of chronic cough in children. Many cases do not reach the psychiatrists due to lack of specific clinical features and diagnostic tests. We present a case of 13 year old boy with habit cough who was successfully treated by suggestion therapy and lignocaine based mouth gargle as a distracter. This case highlights that suggestion therapy can be an important treatment option to this fairly common condition.

Popliteal tendon impingement as a cause of pain following total knee arthroplasty: a systematic review

IntroductionPopliteal tendon impingement (PTI) is an under-recognized cause of persistent pain following total knee arthroplasty (TKA). The purpose of the systematic review was to summarize and outline successful strategies in the diagnosis and management of PTI.MethodsA systematic review following the PRISMA guidelines was performed for four databases: MEDLINE (Pubmed), Ovid EMBASE, Web of Science, and Cochrane Database. It was registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42023398723. The risk of bias assessment was performed using the criteria of the methodological index for non-randomized studies (MINORS).ResultsA total of 8 studies were included. There were 2 retrospective case series and 6 case reports. The follow-up ranged from 6 to 30 months. Two studies described PTI as an intraoperative phenomenon during TKA with “snapping”; whilst 6 studies described indications and outcomes for arthroscopic tenotomy for PTI following TKA. In making the diagnosis, there was concurrence that the posterolateral pain should be focal and that dynamic ultrasonography and diagnostic injection play an important role. Two specific clinical tests have been described. There was no consistency regarding the need for imaging. There were no reports of instability following popliteal tendon tenotomy or other complications.ConclusionPTI should be suspected as a cause for persistent focal pain at the posterolateral knee following TKA. The diagnosis can be suspected on imaging and should be confirmed with dynamic ultrasonography and an ultrasound-guided diagnostic injection. An arthroscopic complete tenotomy of the tendon can reliably alleviate pain and relies on correct diagnosis. There is no evidence for clinically relevant negative biomechanical consequences following tenotomy.Level of evidenceSystematic Review of Level IV and V studies.

The diagnostic value of physical examination tests in adhesive capsulitis: a systematic review.

Adhesive capsulitis, a condition marked by pain and stiffness of the shoulder, can have a frustrating clinical course for patients and health care professionals. Despite huge research interest, a universally accepted and used definition of clinical criteria for the diagnosis of adhesive capsulitis is currently still lacking. This systematic review aimed to identify diagnostic values for clinical examinations tests used in the diagnosis of adhesive capsulitis. A total of 5 electronic databases (PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials [CENTRAL] and PEDro) were searched for relevant studies from 2002 until October 2022 using the terms: "adhesive capsulitis AND diagnosis" and "frozen shoulder AND diagnosis." The Downs and Black Checklist (modified) was used to assess the risk of bias. The study protocol was prospectively registered at the International prospective register of systematic reviews (PROSPERO, CRD42022365993). The initial database search identified 1799 studies, of which 9 (0.50%) were eventually included in the systematic review. Non-intrusive shoulder range of motion measurements in patients with adhesive capsulitis using the Kinect for Windows (Microsoft, Redmond, WA, USA) showed high correlation with clinical range of motion measurement. Two specific clinical tests, the affected-unaffected shoulder approach of the Coracoid Pain Test and the Distension Test in Passive External Rotation, were identified and presented excellent sensibility and specificity in the diagnosis of adhesive capsulitis, in their original study. Comparison between clinical tests was not possible due to the heterogeneity in clinical tools. This systematic review identified several physical examination tests developed for the diagnosis of adhesive capsulitis but could not compare them nor advance a set of clinical diagnostic tests that are scientifically validated. Further research is warranted to obtain validation of clinical diagnosis tools for adhesive capsulitis.

Assessment of the acutely injured shoulder

Trauma of the shoulder encompasses a wide range of potential injuries. The shoulder forms the articulation between the upper limb and trunk, with a close anatomical relationship to the neck and brachial plexus. Acute injuries can have large overlaps of presenting symptoms and many of the special tests we use are imperfect, and must be applied and interpreted in the context of the injury. It is important that a holistic approach is taken to the assessment of acutely injured shoulders in order to ensure injuries are adequately recognized and to guide appropriate further investigations and management. The purpose of this article is to provide a systematic approach to assessment of acute shoulder injuries and summarize the evidence base for special clinical tests that aid in diagnosis.

Identification of age-dependent features of human bronchi using explainable artificial intelligence.

Ageing induces functional and structural alterations in organs, and age-dependent parameters have been identified in various medical data sources. However, there is currently no specific clinical test to quantitatively evaluate age-related changes in bronchi. This study aimed to identify age-dependent bronchial features using explainable artificial intelligence for bronchoscopy images. The present study included 11 374 bronchoscopy images, divided into training and test datasets based on the time axis. We constructed convolutional neural network (CNN) models and evaluated these models using the correlation coefficient between the chronological age and the "bronchial age" calculated from bronchoscopy images. We employed gradient-weighted class activation mapping (Grad-CAM) to identify age-dependent bronchial features that the model focuses on. We assessed the universality of our model by comparing the distribution of bronchial age for each respiratory disease or smoking history. We constructed deep-learning models using four representative CNN architectures to calculate bronchial age. Although the bronchial age showed a significant correlation with chronological age in each CNN architecture, EfficientNetB3 achieved the highest Pearson's correlation coefficient (0.9617). The application of Grad-CAM to the EfficientNetB3-based model revealed that the model predominantly attended to bronchial bifurcation sites, regardless of whether the model accurately predicted chronological age or exhibited discrepancies. There were no significant differences in the discrepancy between the bronchial age and chronological age among different respiratory diseases or according to smoking history. Bronchial bifurcation sites are universally important age-dependent features in bronchi, regardless of the type of respiratory disease or smoking history.

Graph data science and machine learning for the detection of COVID-19 infection from symptoms.

COVID-19 is an infectious disease caused by SARS-CoV-2. The symptoms of COVID-19 vary from mild-to-moderate respiratory illnesses, and it sometimes requires urgent medication. Therefore, it is crucial to detect COVID-19 at an early stage through specific clinical tests, testing kits, and medical devices. However, these tests are not always available during the time of the pandemic. Therefore, this study developed an automatic, intelligent, rapid, and real-time diagnostic model for the early detection of COVID-19 based on its symptoms. The COVID-19 knowledge graph (KG) constructed based on literature from heterogeneous data is imported to understand the COVID-19 different relations. We added human disease ontology to the COVID-19 KG and applied a node-embedding graph algorithm called fast random projection to extract an extra feature from the COVID-19 dataset. Subsequently, experiments were conducted using two machine learning (ML) pipelines to predict COVID-19 infection from its symptoms. Additionally, automatic tuning of the model hyperparameters was adopted. We compared two graph-based ML models, logistic regression (LR) and random forest (RF) models. The proposed graph-based RF model achieved a small error rate = 0.0064 and the best scores on all performance metrics, including specificity = 98.71%, accuracy = 99.36%, precision = 99.65%, recall = 99.53%, and F1-score = 99.59%. Furthermore, the Matthews correlation coefficient achieved by the RF model was higher than that of the LR model. Comparative analysis with other ML algorithms and with studies from the literature showed that the proposed RF model exhibited the best detection accuracy. The graph-based RF model registered high performance in classifying the symptoms of COVID-19 infection, thereby indicating that the graph data science, in conjunction with ML techniques, helps improve performance and accelerate innovations.

Diagnostic value of imaging modalities in primary squamous cell carcinoma of the liver

Primary squamous cell carcinoma of the liver (PSCCL) is rare. PSCCL's lack of specific clinical manifestations and laboratory tests necessitate preoperative diagnosis via imaging examination. Conventional ultrasound (US) demonstrates a mass with mixed echogenicity, and contrast-enhanced US shows a circular pattern of "fast forward, fast backward or slow backward, high enhancement." Enhanced computed tomography (CT) showed enhancement in the center or edge of the lesion, and the density of the enhanced lesion was lower than that of the liver tissue in the same layer. Positron emission tomography-CT demonstrates an inhomogeneous low-density mass with increased 18F-FDG metabolism. Magnetic resonance imaging shows low signal intensity on T1-weighed images (T1WI) and high signal on T2-weighed images (T2WI). By summarizing the imaging characteristics of PSCCL, this review aims to improve clinicians' understanding of PSCCL and its diagnosis.

Role of cerebrospinal fluid lactate in diagnosing meningitis in critically ill patients.

Meningitis is a life-threatening clinical condition associated with high mortality and morbidity. Early diagnosis and specific treatment may improve outcomes. Lack of specific clinical signs or tests make the diagnosis challenging. To assess the efficacy of cerebrospinal fluid (CSF) lactate in diagnosing meningitis in critically ill patients. A prospective, observational cohort study was carried out in a neuro-medical intensive care unit (ICU) over a 22 mo period. Adult patients, with suspected meningitis admitted in ICU, were serially recruited. Patients who refused consent, those with peripheral sensorineural deficit, or with any contraindication to lumber puncture were excluded. CSF cytology, bio-chemistry, lactates, culture and polymerase chain reaction based meningo-encephalitis panel were evaluated. Patients were divided in two groups based on clinical diagnosis of meningitis. The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests. Seventy-one patients were included and 23 were diagnosed with meningitis. The mean values of CSF total leucocyte count (TLC), proteins and lactates were significantly higher in meningitis group. There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel. CSF lactate (> 2.72 mmol/L) showed good accuracy in diagnosing meningitis with an area under the curve of 0.81 (95% confidence interval: 0.69-0.93), sensitivity of 82.6%, and specificity 72.9%. These values were comparable to those of CSF TLC and protein. Twelve patients with bacterial meningitis had significantly higher CSF lactate (8.9 ± 4.7 mmol/L) than those with non-bacterial meningitis (4.2 ± 3.8 mmol/L), P = 0.006. CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients. CSF lactate (> 2.72 mmol/L) showed good accuracy, sensitivity, and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.