Specific Diagnostic Strategies Research Articles

Associations between bullous pemphigoid and hematological diseases: Literature review on mechanistic connections and possible treatments.

Bullous pemphigoid is an autoimmune blistering disorder that primarily occurs in elderly patients. Reports indicate that BP coexists with various hematological diseases, including acquired hemophilia A, hypereosinophilic syndrome, aplastic anemia, autoimmune thrombocytopenia, and hematological malignancies. Early identification of these comorbidities contributes to a better control and reduced mortality. This article details the atypical clinical manifestations of BP when associated with hematological diseases, specific diagnostic strategies, underlying mechanistic connections, and possible treatments. Cross-reactivity between autoantibodies and exposed abnormal epitopes, shared cytokines and immune cells, together with genetic susceptibility are the most common connections between BP and hematological diseases. Patients were most often successfully treated with oral steroids combined with medications specifically targeting the hematological disorders. However, the individual comorbidities require specific considerations.

A Common Diagnosis Delayed by Three "Wrong Footing" Anchoring Errors - it is Difficult to Remember What You Have Forgotten.

If a patient has unexplained lower left abdominal pain, it is advisable to deploy a "searchlight" strategy.When a hydroureter was found to have no apparent source obstruction, a vertical tracing strategy should have been undertaken to detect its root cause.To avoid the wrong diagnosis through anchoring bias, pivot and cluster strategy - deploying differential diagnosis specific to the initial diagnosis (constipation in this case) - should be adopted at the start, considering the important differential diagnosis and thus preventing a missed diagnosis.

Reactive Species-Activatable AIEgens for Biomedical Applications.

Precision medicine requires highly sensitive and specific diagnostic strategies with high spatiotemporal resolution. Accurate detection and monitoring of endogenously generated biomarkers at the very early disease stage is of extensive importance for precise diagnosis and treatment. Aggregation-induced emission luminogens (AIEgens) have emerged as a new type of excellent optical agents, which show great promise for numerous biomedical applications. In this review, we highlight the recent advances of AIE-based probes for detecting reactive species (including reactive oxygen species (ROS), reactive nitrogen species (RNS), reactive sulfur species (RSS), and reactive carbonyl species (RCS)) and related biomedical applications. The molecular design strategies for increasing the sensitivity, tuning the response wavelength, and realizing afterglow imaging are summarized, and theranostic applications in reactive species-related major diseases such as cancer, inflammation, and vascular diseases are reviewed. The challenges and outlooks for the reactive species-activatable AIE systems for disease diagnostics and therapeutics are also discussed. This review aims to offer guidance for designing AIE-based specifically activatable optical agents for biomedical applications, as well as providing a comprehensive understanding about the structure–property application relationships. We hope it will inspire more interesting researches about reactive species-activatable probes and advance clinical translations.

A Label-Based Polymer Nanoparticles Biosensor Combined with Loop-Mediated Isothermal Amplification for Rapid, Sensitive, and Highly Specific Identification of Brucella abortus.

Brucella abortus (B. abortus), an important zoonotic pathogen in Brucella spp., is the major causative agent of abortion in cattle (namely, bovine brucellosis). Currently, although the isolation and identification of the Brucella abortus were commonly accepted as the gold standard method, it cannot meet the requirements for early diagnostic strategies. Conventional PCR techniques and immunological tests can realize rapid detection of B. abortus, but the demands for PCR thermal cyclers and/or specific antibodies hinder their application in basic laboratories. Thus, rapid, sensitive, and specific diagnostic strategies are essential to prevent and control the spread of the bovine brucellosis. In this work, a novel detection method for the rapid identification of B. abortus, which uses loop-mediated isothermal amplification (LAMP) combined with a label-based polymer nanoparticles lateral flow immunoassay biosensor (LFIA), was established. One set of specific B. abortus-LAMP primers targeting the BruAb2_0168 gene was designed by the online LAMP primer design tool. The B. abortus-LAMP-LFIA assay was optimized and evaluated using various pathogens and whole blood samples. The optimal amplification temperature and time for B. abortus-LAMP-LFIA were determined to be 65°C and 50 min, respectively. The B. abortus-LAMP-LFIA method limit of detection (LoD) was 100 fg per reaction for pure genomic DNA of B. abortus. Meanwhile, the detection specificity was 100%, and there was no cross-reactivity for other Brucella members and non-Brucella strains. Furthermore, the entire procedure, including the DNA preparation for whole blood samples (30 min), isothermal incubation (50 min), and LFIA detection (2–5 min), can be completed in approximately 85 min. Thus, the B. abortus-LAMP-LFIA assay developed was a simple, rapid, sensitive, and reliable detection technique, which can be used as a screening and/or diagnostic tool for B. abortus in the field and basic laboratories.

The role of echocardiography in the embolic stroke of undetermined source.

: Echocardiography plays an important role both in the diagnosis and the treatment/prevention of embolic stroke of undetermined source and should be performed as soon as possible for preventing ischemic stroke recurrencies, which occur more frequently during the first week after the first ischemic event. Early identification of the cause of a transient ischemic attack or stroke is indeed a primary goal for the neurologist in the Stroke Unit and requires specific diagnostic strategies. Echocardiography, together with other diagnostic tools such as carotid and transcranial ultrasounds, provides this information promptly. In particular, echocardiography might be able to detect the main sources of the embolic stroke, such as atrial fibrillation, ventricular akinesia, aortic atheroma plaques and/or cardiac shunts. The present review discusses the importance and the practical role of echocardiography as a crucial diagnostic tool for detecting the main source of emboli in the setting of the acute stroke.

Predictive and Prognostic Value of Heart Rate Variability Analysis in Early Bedside Diagnosis and Management of COVID-19 Patients

Viral infection, sepsis and multiple organ dysfunction are the most common causes of death in critically ill patients. Early diagnosis and early management are the key factor in improving outcome in sepsis due to viral infection, so, there is need to develop more rapid, sensitive, and specific diagnostic strategies that allow early intervention to improve patient outcome. Heart rate variability (HRV) has been documented to be both altered in the presence of systemic infection, and correlated with its severity. This aim of this article is to review the HRV analysis and its value in detection early diagnosis of viral infection including COVID-19 patients.

Prevalence of Pulmonary Embolism in Patients Presenting With Syncope.

Prevalence of Pulmonary Embolism in Patients Presenting With Syncope.

Exploring the potential of needle trap microextraction combined with chromatographic and statistical data to discriminate different types of cancer based on urinary volatomic biosignature

The worldwide high cancer incidence and mortality demands for more effective and specific diagnostic strategies. In this study, we evaluated the efficiency of an innovative methodology, Needle Trap Microextraction (NTME), combined with gas chromatography-mass spectrometry (GC-MS), for the establishment of the urinary volatomic biosignature from breast (BC), and colon (CC) cancer patients as well as healthy individuals (CTL). To achieve this, 40 mL of the headspace of acidified urine (4 mL, 20% NaCl, pH = 2), equilibrated at 50 °C during 40 min, were loaded through the DVB/Car1000/CarX sorbent inside the NTD, and subjected to a GC-MS analysis. This allowed the identification of 130 VOMs from different chemical families that were further processed using discriminant analysis through the partial least squares method (PLS-DA). Several pathways are over activated in cancer patients, being phenylalanine pathway in BC and limonene and pinene degradation pathway in CC the most relevant. Butanoate metabolism is also highly activated in both cancers, as well as tyrosine metabolism in a lesser extension. In BC the xenobiotics metabolism by cytochrome P450 and fatty acid biosynthesis are also differentially activated. Different clusters corresponding to the groups recruited allowed to define sets of volatile organic metabolites (VOMs fingerprints) that exhibit high classification rates, sensitivity and specificity in the discrimination of the selected cancers. As far as we are aware, this is the first time that NTME is used for isolation urinary volatile metabolites, being the obtained results very promising.

Atheroma Burden and Morphology in Women.

Ischemic heart disease is the major cause of death in women. Men and women have many similarities in relation to cardiovascular risk factors, but they differ in the pathophysiology, clinical presentation and outcomes in the setting of coronary artery disease and myocardial ischemia. Over the last years, due to innovative imaging technologies and more specific diagnostic strategies, increasing number of clinical studies report on specific-gender characteristics on plaque composition and burden, associated to acute coronary syndromes, and also on coronary vascular dysfunction as a major cause of clinical symptoms in women with apparently normal arteries. Here we performed a review of the literature focused on atheroma burden in women that includes information provided in original articles (basic and clinical oriented), cohort studies, trial and registry data, metaanalysis and other systematic reviews. The Studies published over the last 30 years provide a new view about the pathophysiology and presentation of ischemic heart disease in women. However, many questions remain to be addressed by future research. The mechanisms behind the delay on disease presentation in women over the fertile period and the paradoxical fact that young women have more adverse outcomes after an ischemic event need to be identified. A better understanding of these issues is expected to derive in better strategies for prevention and management of ischemic heart disease in women.

Management options for minimal hepatic encephalopathy

Minimal hepatic encephalopathy (MHE) is a neurocognitive dysfunction that is present in the majority of patients with cirrhosis. MHE has a characteristic cognitive profile that cannot be diagnosed clinically. This cognitive dysfunction is independent of sleep dysfunction or problems with overall intelligence. MHE has a significant impact on quality of life, the ability to function in daily life and progression to overt hepatic encephalopathy. Driving ability can be impaired in MHE and this may be a significant factor behind motor vehicle accidents. A crucial aspect of the clinical care of MHE patients is their driving history, which is often ignored during routine care and can add a vital dimension to the overall disease assessment. Driving history should be an integral part of the care of patients with MHE. The preserved communication skills and lack of specific signs and insight make MHE difficult to diagnose. The predominant strategies for MHE diagnosis are psychometric or neurophysiological testing. These are usually limited by financial, normative or time constraints. Studies into inhibitory control, cognitive drug research and critical flicker frequency tests are encouraging. These tests do not require a psychologist for administration and interpretation. Lactulose and probiotics have been studied for their potential use as therapies for MHE, but these are not standard-of-care practices at this time. Therapy can improve the quality of life in MHE patients but the natural history, specific diagnostic strategies and treatment options are still being investigated.

Influence of age on the cost-effectiveness of diagnostic strategies for suspected pulmonary embolism.

Age has a marked effect on the diagnostic yield of D-dimer measurement and lower limb compression ultrasonography (CUS) in patients with suspected pulmonary embolism (PE), suggesting that specific diagnostic strategies may be needed in elderly patients. To evaluate the cost-effectiveness of including D-dimer and CUS in the workup of PE, with particular attention to patient age. We analyzed data from two recent outcome studies that enrolled 1721 consecutive outpatients with suspected PE. Both studies used a sequential diagnostic strategy that included assessment of clinical probability, D-dimer measurement, CUS, and helical computed tomography (hCT). A decision analysis model was created for analyzing cost-effectiveness according to six classes of age. The main outcome measures were 3-month quality-adjusted expected survival and costs per patient managed. All strategies were equally safe, with variations in the 3-month survival never exceeding 0.5% as compared to the most effective strategy. D-dimer measurement was highly cost-saving under the age of 80 years. Above 80 years, the cost-sparing effect of D-dimer was diminished, but not completely abolished. Inclusion of CUS increased the costs of diagnostic strategies irrespective of age. Results were unchanged over a wide range of the variables of interest (costs, sensitivity, and specificity of the tests). Diagnostic strategies using D-dimer are less expensive. The cost-sparing effect of D-dimer is reduced but not abolished above 80 years, suggesting that adapting specific diagnostic strategies in elderly outpatients is not mandatory. CUS is costly, and only marginally improves the safety of diagnostic strategies for PE.