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Sample records for postsurgical diagnostic evaluation

  1. Implantable microelectromechanical sensors for diagnostic monitoring and post-surgical prediction of bone fracture healing.

    PubMed

    McGilvray, Kirk C; Unal, Emre; Troyer, Kevin L; Santoni, Brandon G; Palmer, Ross H; Easley, Jeremiah T; Demir, Hilmi Volkan; Puttlitz, Christian M

    2015-10-01

    The relationship between modern clinical diagnostic data, such as from radiographs or computed tomography, and the temporal biomechanical integrity of bone fracture healing has not been well-established. A diagnostic tool that could quantitatively describe the biomechanical stability of the fracture site in order to predict the course of healing would represent a paradigm shift in the way fracture healing is evaluated. This paper describes the development and evaluation of a wireless, biocompatible, implantable, microelectromechanical system (bioMEMS) sensor, and its implementation in a large animal (ovine) model, that utilized both normal and delayed healing variants. The in vivo data indicated that the bioMEMS sensor was capable of detecting statistically significant differences (p-value <0.04) between the two fracture healing groups as early as 21 days post-fracture. In addition, post-sacrifice micro-computed tomography, and histology data demonstrated that the two model variants represented significantly different fracture healing outcomes, providing explicit supporting evidence that the sensor has the ability to predict differential healing cascades. These data verify that the bioMEMS sensor can be used as a diagnostic tool for detecting the in vivo course of fracture healing in the acute post-treatment period.

  2. Implantable microelectromechanical sensors for diagnostic monitoring and post-surgical prediction of bone fracture healing.

    PubMed

    McGilvray, Kirk C; Unal, Emre; Troyer, Kevin L; Santoni, Brandon G; Palmer, Ross H; Easley, Jeremiah T; Demir, Hilmi Volkan; Puttlitz, Christian M

    2015-10-01

    The relationship between modern clinical diagnostic data, such as from radiographs or computed tomography, and the temporal biomechanical integrity of bone fracture healing has not been well-established. A diagnostic tool that could quantitatively describe the biomechanical stability of the fracture site in order to predict the course of healing would represent a paradigm shift in the way fracture healing is evaluated. This paper describes the development and evaluation of a wireless, biocompatible, implantable, microelectromechanical system (bioMEMS) sensor, and its implementation in a large animal (ovine) model, that utilized both normal and delayed healing variants. The in vivo data indicated that the bioMEMS sensor was capable of detecting statistically significant differences (p-value <0.04) between the two fracture healing groups as early as 21 days post-fracture. In addition, post-sacrifice micro-computed tomography, and histology data demonstrated that the two model variants represented significantly different fracture healing outcomes, providing explicit supporting evidence that the sensor has the ability to predict differential healing cascades. These data verify that the bioMEMS sensor can be used as a diagnostic tool for detecting the in vivo course of fracture healing in the acute post-treatment period. PMID:26174472

  3. Diagnostic evaluation of rhabdomyolysis.

    PubMed

    Nance, Jessica R; Mammen, Andrew L

    2015-06-01

    Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. Serum creatine kinase and urine myoglobin levels are markedly elevated. Clinical examination, history, laboratory studies, muscle biopsy, and genetic testing are useful tools for diagnosis of rhabdomyolysis, and they can help differentiate acquired from inherited causes of rhabdomyolysis. Acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbances, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid β-oxidation, and mitochondrial oxidative phosphorylation. Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle-cell disease. This review focuses on the differentiation of acquired and inherited causes of rhabdomyolysis and proposes a practical diagnostic algorithm. Muscle Nerve 51: 793-810, 2015. PMID:25678154

  4. Diagnostic Evaluation of Rhabdomyolysis

    PubMed Central

    Nance, Jessica R.; Mammen, Andrew L.

    2015-01-01

    Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days following an inciting factor and may be associated with dark pigmentation of the urine. Serum creatine kinase and urine myoglobin levels are markedly elevated. The clinical examination, history, laboratory studies, muscle biopsy, and genetic testing are useful tools for diagnosis of rhabdomyolysis, and they can help differentiate acquired from inherited causes of rhabdomyolysis. Acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbance, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid beta-oxidation, and mitochondrial oxidative phosphorylation. Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle cell disease. This review focuses on the differentiation of acquired and inherited causes of rhabdomyolysis and proposes a practical diagnostic algorithm. PMID:25678154

  5. How the radiologist can add value in the evaluation of the pre- and post-surgical pancreas.

    PubMed

    Patel, Bhavik N; Gupta, Rajan T; Zani, Sabino; Jeffrey, R Brooke; Paulson, Erik K; Nelson, Rendon C

    2015-10-01

    Disease involving the pancreas can be a significant diagnostic challenge to the interpreting radiologist. Moreover, the majority of disease processes involving the pancreas carry high significant morbidity and mortality either due to their natural process or related to their treatment options. As such, it is critical for radiologists to not only provide accurate information from imaging to guide patient management, but also deliver that information in a clear manner so as to aid the referring physician. This is no better exemplified than in the case of pre-operative staging for pancreatic adenocarcinoma. Furthermore, with the changing healthcare landscape, it is now more important than ever to ensure that the value of radiology service to other providers is high. In this review, we will discuss how the radiologist can add value to the referring physician by employing novel imaging techniques in the pre-operative evaluation as well as how the information can be conveyed in the most meaningful manner through the use of structured reporting. We will also familiarize the radiologist with the imaging appearance of common complications that occur after pancreatic surgery.

  6. Evaluation of clinical effectiveness and subjective satisfaction of a new toothbrush for postsurgical hygiene care: a randomized split-mouth double-blind clinical trial.

    PubMed

    Montevecchi, Marco; Moreschi, Annalisa; Gatto, Maria Rosaria; Checchi, Luigi; Checchi, Vittorio

    2015-01-01

    The aim of this RCT was to evaluate plaque control and gingival health promotion effectiveness of a new toothbrush with extra-soft filaments in postsurgical sets. Ten consecutive patients with at least two scheduled symmetrical periodontal surgeries were selected. Following the first periodontal surgery, a test (TB1) or control (TB2) toothbrush was randomly assigned. After the second surgery, the remaining toothbrush was given. Patients were asked to gently wipe the surgical area from days 3 to 7 postoperatively and to gently brush using a roll technique from day 7 till the end of the study. Baseline evaluation took place on the day of surgery and follow-ups were performed at days 7, 14, and 30 postoperatively. A more evident PI reduction was recorded for test toothbrush where a regular decrease was observed till day 14; then, this parameter tended to stabilize, remaining however lower than that recorded for the control toothbrush. There were no statistical differences in the GI between test and control toothbrushes. All patients introduced the test toothbrush at surgical site at third day; the control toothbrush was introduced within a mean of 9 days. The introduction of the test toothbrush 3 days after periodontal surgery may be recommended.

  7. Practical Diagnostics for Evaluating Residential Commissioning Metrics

    SciTech Connect

    Wray, Craig; Walker, Iain; Siegel, Jeff; Sherman, Max

    2002-06-11

    In this report, we identify and describe 24 practical diagnostics that are ready now to evaluate residential commissioning metrics, and that we expect to include in the commissioning guide. Our discussion in the main body of this report is limited to existing diagnostics in areas of particular concern with significant interactions: envelope and HVAC systems. These areas include insulation quality, windows, airtightness, envelope moisture, fan and duct system airflows, duct leakage, cooling equipment charge, and combustion appliance backdrafting with spillage. Appendix C describes the 83 other diagnostics that we have examined in the course of this project, but that are not ready or are inappropriate for residential commissioning. Combined with Appendix B, Table 1 in the main body of the report summarizes the advantages and disadvantages of all 107 diagnostics. We first describe what residential commissioning is, its characteristic elements, and how one might structure its process. Our intent in this discussion is to formulate and clarify these issues, but is largely preliminary because such a practice does not yet exist. Subsequent sections of the report describe metrics one can use in residential commissioning, along with the consolidated set of 24 practical diagnostics that the building industry can use now to evaluate them. Where possible, we also discuss the accuracy and usability of diagnostics, based on recent laboratory work and field studies by LBNL staff and others in more than 100 houses. These studies concentrate on evaluating diagnostics in the following four areas: the DeltaQ duct leakage test, air-handler airflow tests, supply and return grille airflow tests, and refrigerant charge tests. Appendix A describes those efforts in detail. In addition, where possible, we identify the costs to purchase diagnostic equipment and the amount of time required to conduct the diagnostics. Table 1 summarizes these data. Individual equipment costs for the 24

  8. Uveitis: the collaborative diagnostic evaluation.

    PubMed

    Harman, Lynn E; Margo, Curtis E; Roetzheim, Richard G

    2014-11-15

    Uveitis, or inflammation of the uveal tract (i.e., iris, ciliary body, and choroid), results from a heterogeneous collection of disorders of varying etiologies and pathogenic mechanisms. Uveitis is caused by a systemic disease in 30% to 45% of patients. Primary care physicians may be asked to evaluate patients with uveitis when an underlying systemic diagnosis is suspected but not apparent from eye examination or history. If the history, physical examination, and basic laboratory studies do not suggest an underlying cause, serologic tests for syphilis and chest radiography for sarcoidosis and tuberculosis are recommended. Typing for human leukocyte antigen-B27 is appropriate for patients with recurrent anterior uveitis. Because the prevalence of many rheumatologic and infectious diseases is low among persons with uveitis, Lyme serology, antinuclear antibody tests, serum angiotensin-converting enzyme tests, serum lysozyme tests, and tuberculin skin tests can result in false-positive results and are not routinely recommended. Drug-induced uveitis is rare and can occur from days to months after the time of initial exposure. Primary ocular lymphoma should be considered in persons older than 50 years with persistent intermediate or posterior uveitis that does not respond to anti-inflammatory therapy.

  9. Cryptosporidiosis: multiattribute evaluation of six diagnostic methods.

    PubMed

    MacPherson, D W; McQueen, R

    1993-02-01

    Six diagnostic methods (Giemsa staining, Ziehl-Neelsen staining, auramine-rhodamine staining, Sheather's sugar flotation, an indirect immunofluorescence procedure, and a modified concentration-sugar flotation method) for the detection of Cryptosporidium spp. in stool specimens were compared on the following attributes: diagnostic yield, cost to perform each test, ease of handling, and ability to process large numbers of specimens for screening purposes by batching. A rank ordering from least desirable to most desirable was then established for each method by using the study attributes. The process of decision analysis with respect to the laboratory diagnosis of cryptosporidiosis is discussed through the application of multiattribute utility theory to the rank ordering of the study criteria. Within a specific health care setting, a diagnostic facility will be able to calculate its own utility scores for our study attributes. Multiattribute evaluation and analysis are potentially powerful tools in the allocation of resources in the laboratory.

  10. The postsurgical spine.

    PubMed

    Santos Armentia, E; Prada González, R; Silva Priegue, N

    2016-04-01

    Failed back surgery syndrome is the persistence or reappearance of pain after surgery on the spine. This term encompasses both mechanical and nonmechanical causes. Imaging techniques are essential in postoperative follow-up and in the evaluation of potential complications responsible for failed back surgery syndrome. This review aims to familiarize radiologists with normal postoperative changes and to help them identify the pathological imaging findings that reflect failed back surgery syndrome. To interpret the imaging findings, it is necessary to know the type of surgery performed in each case and the time elapsed since the intervention. In techniques used to fuse the vertebrae, it is essential to evaluate the degree of bone fusion, the material used (both its position and its integrity), the bone over which it lies, the interface between the implant and bone, and the vertebral segments that are adjacent to metal implants. In decompressive techniques it is important to know what changes can be expected after the intervention and to be able to distinguish them from peridural fibrosis and the recurrence of a hernia. It is also crucial to know the imaging findings for postoperative infections. Other complications are also reviewed, including arachnoiditis, postoperative fluid collections, and changes in the soft tissues adjacent to the surgical site. PMID:26767541

  11. The postsurgical spine.

    PubMed

    Santos Armentia, E; Prada González, R; Silva Priegue, N

    2016-04-01

    Failed back surgery syndrome is the persistence or reappearance of pain after surgery on the spine. This term encompasses both mechanical and nonmechanical causes. Imaging techniques are essential in postoperative follow-up and in the evaluation of potential complications responsible for failed back surgery syndrome. This review aims to familiarize radiologists with normal postoperative changes and to help them identify the pathological imaging findings that reflect failed back surgery syndrome. To interpret the imaging findings, it is necessary to know the type of surgery performed in each case and the time elapsed since the intervention. In techniques used to fuse the vertebrae, it is essential to evaluate the degree of bone fusion, the material used (both its position and its integrity), the bone over which it lies, the interface between the implant and bone, and the vertebral segments that are adjacent to metal implants. In decompressive techniques it is important to know what changes can be expected after the intervention and to be able to distinguish them from peridural fibrosis and the recurrence of a hernia. It is also crucial to know the imaging findings for postoperative infections. Other complications are also reviewed, including arachnoiditis, postoperative fluid collections, and changes in the soft tissues adjacent to the surgical site.

  12. Radiofrequency ablation for postsurgical thyroid removal of differentiated thyroid carcinoma

    PubMed Central

    Xu, Dong; Wang, Lipin; Long, Bin; Ye, Xuemei; Ge, Minghua; Wang, Kejing; Guo, Liang; Li, Linfa

    2016-01-01

    Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy. Surgical removal with radioactive iodine therapy is recommended for recurrent thyroid carcinoma, and the postsurgical thyroid removal is critical. This study evaluated the clinical values of radiofrequency ablation (RFA) in the postsurgical thyroid removal for DTC. 35 DTC patients who had been treated by subtotal thyroidectomy received RFA for postsurgical thyroid removal. Before and two weeks after RFA, the thyroid was examined by ultrasonography and 99mTcO4 - thyroid imaging, and the serum levels of free triiodothyronine (FT3), free thyroxin (FT4), thyroid stimulating hormone (TSH) and thyroglobulin (Tg) were detected. The efficacy and complications of RFA were evaluated. Results showed that, the postsurgical thyroid removal by RFA was successfully performed in 35 patients, with no significant complication. After RFA, the average largest diameter and volume were significantly decreased in 35 patients (P > 0.05), and no obvious contrast media was observed in ablation area in the majority of patients. After RFA, the serum FT3, FT4 and Tg levels were markedly decreased (P < 0.05), and TSH level was significantly increased (P < 0.05). After RFA, radioiodine concentration in the ablation area was significantly reduced in the majority of patients. The reduction rate of thyroid update was 0.69±0.20%. DTC staging and interval between surgery and RFA had negative correlation (Pearson coefficient = -0.543; P = 0.001), with no obvious correlation among others influential factors. RFA is an effective and safe method for postsurgical thyroid removal of DTC. PMID:27186311

  13. Chronic postsurgical pain: still a neglected topic?

    PubMed Central

    Kissin, Igor; Gelman, Simon

    2012-01-01

    Background Surgical injury can frequently lead to chronic pain. Despite the obvious importance of this problem, the first publications on chronic pain after surgery as a general topic appeared only a decade ago. This study tests the hypothesis that chronic postsurgical pain was, and still is, represented insufficiently. Methods We analyzed the presentation of this topic in journal articles covered by PubMed and in surgical textbooks. The following signs of insufficient representation in journal articles were used: (1) the lack of journal editorials on chronic pain after surgery, (2) the lack of journal articles with titles clearly indicating that they are devoted to chronic postsurgical pain, and (3) the insufficient representation of chronic postsurgical pain in the top surgical journals. Results It was demonstrated that insufficient representation of this topic existed in 1981–2000, especially in surgical journals and textbooks. Interest in this topic began to increase, however, mostly regarding one specific surgery: herniorrhaphy. It is important that the change in the attitude toward chronic postsurgical pain spreads to other groups of surgeries. Conclusion Chronic postsurgical pain is still a neglected topic, except for pain after herniorrhaphy. The change in the attitude toward chronic postsurgical pain is the important first step in the approach to this problem. PMID:23152698

  14. Diagnostic evaluation of low back pain.

    PubMed

    Carragee, Eugene J; Hannibal, Matthew

    2004-01-01

    The diagnostic evaluation of chronic LBP is at best a complex and involved undertaking. The most important part of the process lies in the knowledge of the patient and a solid history and physical examination. From there, most of the serious and life-threatening causes of LBP can be elucidated and studies may be used for confirmation. Imaging studies are used most practically as confirmation studies once a working diagnosis is determined. MRI, although excellent at defining tumor, infection, and nerve compression, can be too sensitive with regard to degenerative disease findings and commonly displays pathology that is not responsible for the patient's symptoms. As an example, the high-intensity zones (HIZ) seen on MRI are reliable in determining annular defects in the disc but are not reliable in establishing internal disc disruption as the cause of LBP. Discography is the primary tool used by many physicians to determine the true pain generator when discogenic LBP is suspected. Because the reliability of the patient response is fundamental to discography, interpreting the test in different settings must be considered. In individuals with disc degeneration and annular defects, discography may elicit LBP with injection whether the patient is symptomatic with serious LBP or not. The pain response may be amplified in those subjects with issues of chronic pain, social stressors, such as secondary gain or litigation claims, or psychologic distress disorder. These factors have been shown experimentally to be associated with an increased risk for a false positive injection. The ability of an individual to differentiate the true site of LBP by the quality of sensation with disc injection (concordancy) of pain produced by the injected disc also may not be reliable. In fact, individuals may not have the neural discrimination to differentiate sclerotomal pain originating from different sites in the low back and pelvis. One may realize that chronic LBP illness may not stem

  15. Improving early cycle economic evaluation of diagnostic technologies.

    PubMed

    Steuten, Lotte M G; Ramsey, Scott D

    2014-08-01

    The rapidly increasing range and expense of new diagnostics, compels consideration of a different, more proactive approach to health economic evaluation of diagnostic technologies. Early cycle economic evaluation is a decision analytic approach to evaluate technologies in development so as to increase the return on investment as well as patient and societal impact. This paper describes examples of 'early cycle economic evaluations' as applied to diagnostic technologies and highlights challenges in its real-time application. It shows that especially in the field of diagnostics, with rapid technological developments and a changing regulatory climate, early cycle economic evaluation can have a guiding role to improve the efficiency of the diagnostics innovation process. In the next five years the attention will move beyond the methodological and analytic challenges of early cycle economic evaluation towards the challenge of effectively applying it to improve diagnostic research and development and patient value. Future work in this area should therefore be 'strong on principles and soft on metrics', that is, the metrics that resonate most clearly with the various decision makers in this field. PMID:24766321

  16. Diagnostic Evaluation of Pelvic Inflammatory Disease

    PubMed Central

    Soper, David E.

    1994-01-01

    Pelvic inflammatory disease (PID) is a serious public health and reproductive health problem in the United States. An early and accurate diagnosis of PID is extremely important for the effective management of the acute illness and for the prevention of long-term sequelae. The diagnosis of PID is difficult, with considerable numbers of false-positive and false-negative diagnoses. An abnormal vaginal discharge or evidence of lower genital tract infection is an important and predictive finding that is often underemphasized and overlooked. This paper reviews the clinical diagnosis and supportive laboratory tests for the diagnosis of PID and outlines an appropriate diagnostic plan for the clinician and the researcher. PMID:18475365

  17. Diagnostic Evaluation of Chronic Thromboembolic Pulmonary Hypertension.

    PubMed

    Gopalan, Deepa; Blanchard, Daniel; Auger, William R

    2016-07-01

    Pulmonary hypertension is defined by a mean pulmonary artery pressure greater than 25 mm Hg. Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as pulmonary hypertension in the presence of an organized thrombus within the pulmonary vascular bed that persists at least 3 months after the onset of anticoagulant therapy. Because CTEPH is potentially curable by surgical endarterectomy, correct identification of patients with this form of pulmonary hypertension and an accurate assessment of surgical candidacy are essential to provide optimal care. Patients most commonly present with symptoms of exertional dyspnea and otherwise unexplained decline in exercise capacity. Atypical chest pain, a nonproductive cough, and episodic hemoptysis are observed less frequently. With more advanced disease, patients often develop symptoms suggestive of right ventricular compromise. Physical examination findings are minimal early in the course of this disease, but as pulmonary hypertension progresses, may include nonspecific finding of right ventricular failure, such as a tricuspid regurgitation murmur, pedal edema, and jugular venous distention. Chest radiographs may suggest pulmonary hypertension, but are neither sensitive nor specific for the diagnosis. Radioisotopic ventilation-perfusion scanning is sensitive for detecting CTEPH, making it a valuable screening study. Conventional catheter-based pulmonary angiography retains an important role in establishing the presence and extent of chronic thromboembolic disease. However, computed tomographic and magnetic resonance imaging are playing a growing diagnostic role. Innovative technologies such as dual-energy computed tomography, dynamic contrast-enhanced magnetic resonance imaging, and optical coherence tomography show promise for contributing diagnostic information and assisting in the preoperative characterization of patients with CTEPH. PMID:27571004

  18. From Colorado to Guam: Infant Diagnostic Audiological Evaluations by Telepractice

    ERIC Educational Resources Information Center

    Hayes, Deborah; Eclavea, Elaine; Dreith, Susan; Habte, Bereket

    2012-01-01

    This manuscript describes a pilot project in which infants in Guam who refer on newborn hearing screening receive diagnostic audiological evaluation conducted by audiologists in Colorado over the Internet (telepractice). The evaluation is completed in real time using commercially-available software and personal computers to control the diagnostic…

  19. Use of the SADS Diagnostic Interview in Evaluating Legal Insanity.

    ERIC Educational Resources Information Center

    Rogers, Richard; And Others

    1984-01-01

    Examined clinical usefulness of the Schedule of Affective Disorders and Schizophrenia (SADS) diagnostic interview in evaluations of criminal responsibility. Findings, based on 78 evaluations from a forensic clinic, indicated that SADS successfully differentiated between sane and insane evaluatees. Differences were primarily in severity of symptoms…

  20. Evaluation of a Diagnostic Encyclopedia Workstation for ovarian pathology.

    PubMed

    van Ginneken, A M; Baak, J P; Jansen, W; Smeulders, A W

    1990-10-01

    The Diagnostic Encyclopedia Workstation (DEW) is a computer system that provides completely integrated pictorial and textual information as reference knowledge in the field of ovarian pathology. The textual component comprises information per diagnosis such as descriptions of macroscopic and microscopic images, clinical signs, and prognosis. In addition, the system offers lists of differential diagnoses and criteria to differentiate among lists of differential diagnoses and criteria to differentiate among them. The present study evaluates to what extent the system influences the diagnostic process in efficiency and outcome. Therefore, two groups of six pathologists each, covering a wide spectrum of experience in ovarian pathology, participated in the evaluation of the DEW. The quality of the resulting diagnoses was statistically analyzed with the Wilcoxon rank sum test with respect to five different viewpoints: classification, morphology, clinical consequences, duration of diagnostic process, and consensus among the participants. The results are discussed and it is concluded that classification and morphology showed better results when books were used. The evaluation experiment was, however, very rigid and negatively biased with respect to the DEW system. Positive aspects of the encyclopedia are the easy access to diagnostic and differential diagnostic information and the large set of illustrations. Insight is acquired with respect to existing bottlenecks and how they may be overcome.

  1. Validity Arguments for Diagnostic Assessment Using Automated Writing Evaluation

    ERIC Educational Resources Information Center

    Chapelle, Carol A.; Cotos, Elena; Lee, Jooyoung

    2015-01-01

    Two examples demonstrate an argument-based approach to validation of diagnostic assessment using automated writing evaluation (AWE). "Criterion"®, was developed by Educational Testing Service to analyze students' papers grammatically, providing sentence-level error feedback. An interpretive argument was developed for its use as part of…

  2. Diagnostic Evaluation and Educational Programing for Hearing Impaired Children.

    ERIC Educational Resources Information Center

    McCoy, George F.

    Various aspects of diagnostic evaluation and educational programing for hearing impaired children are described. Discussion of hearing disorders from a medical perspective covers anatomy of the ear, types and causes of hearing disorders, and medical and surgical treatment. A review of audiological assessment of hearing disorders focuses upon…

  3. Counseling and diagnostic evaluation for the infertile couple.

    PubMed

    Marshburn, Paul B

    2015-03-01

    Educating couples about natural means to improve fertility should include a discussion about appropriate timing to initiate a diagnostic evaluation for infertility. Complete infertility testing for both male and female factors allows directed care for all abnormalities to optimize chances for conception.

  4. [Ecological and hygienic evaluation of production waste of diagnostic preparations].

    PubMed

    2012-01-01

    For the first time eco-hygienic evaluation of waste materials of production of diagnostic products has been performed. The methodology of risk assessment included consideration of the technology for their delivery, assessment of potential hazards (biological, chemical, and toxicological) based on the study of physico-chemical properties and performance of toxicological, hygienic and ecological research.

  5. Use of the SADS diagnostic interview in evaluating legal insanity.

    PubMed

    Rogers, R; Thatcher, A; Cavanaugh, J L

    1984-11-01

    Examined clinical usefulness of the SADS diagnostic interview in evaluations of criminal responsibility. Findings, based on 78 SADS evaluations from a specialized forensic clinic, indicated that SADS successfully differentiated between sane and insane evaluatees. These differences were found primilarily in the severity of psychotic symptoms and overall level of psychological impairment. In addition, preliminary data on institutionalized and outpatient Ss suggested the potential applicability of the SADS for assessing the general psychological functioning of insane patients in treatment.

  6. An evaluation of the diagnostic accuracy of Pathfinder.

    PubMed

    Heckerman, D E; Nathwani, B N

    1992-02-01

    We present an evaluation of the diagnostic accuracy of Pathfinder, an expert system that assists pathologists with the diagnosis of lymph node diseases. We evaluate two versions of the system using both informal and decision-theoretic metrics of performance. In one version of Pathfinder, we assume incorrectly that all observations are conditionally independent. In the other version, we use a belief network to represent accurately the probabilistic dependencies among the observations. In both versions, we make the assumption--reasonable for this domain--that diseases are mutually exclusive and exhaustive. The results of the study show that (1) it is cost effective to represent probabilistic dependencies among observations in the lymph node domain, and (2) the diagnostic accuracy of the more complex version of Pathfinder is at least as good as that of the Pathfinder expert. In addition, the study illustrates how informal and decision-theoretic metrics for performance complement one another.

  7. Clinical, histological, and biochemical predictors of postsurgical neuropathic pain.

    PubMed

    Martinez, Valéria; Üçeyler, Nurcan; Ben Ammar, Skander; Alvarez, Jean-Claude; Gaudot, Fabrice; Sommer, Claudia; Bouhassira, Didier; Fletcher, Dominique

    2015-11-01

    Surgical nerve injury sometimes leads to chronic postsurgical neuropathic pain (CPSNP). The risk factors for this condition are not well understood. We prospectively assessed 46 patients scheduled for iliac crest bone harvest, 2 days (D2) and 3 months (M3) after surgery, to determine the time course of nerve fiber degeneration and expression of the TNF-α and NGF genes in skin punch biopsies. Mechanical and thermal detection and pain thresholds were evaluated at D2 and M3, by quantitative sensory testing. Skin punch biopsies were also obtained from the thighs ipsilateral and contralateral to iliac crest bone harvest. Intraepidermal nerve fiber density (IENFD) and cutaneous TNF-α and NGF gene expression were analyzed. Forty-five volunteers matched for age, sex, skin color were examined as controls. Chronic postsurgical neuropathic pain was defined as pain in an area of hypesthesia with a positive Douleur Neuropathique 4 questionnaire score. Overall, 73% (N = 32) of patients developed hypesthesia and 40% (N = 13) of these patients had developed CPSNP at M3. Quantitative sensory testing results, IENFD, and skin TNF-α and NGF gene expression at D2 and M3 did not differ between patients with and without CPSNP. However, in patients with CPSNP, burning, compression, and pain provoked by brushing were correlated with IENFD at M3, suggesting a possible association between partial nerve lesions and more intense CPSNP, than with total nerve lesion. Furthermore, preoperative pain and opioid use were higher in patients who developed CPSNP than in those without CPSNP. These findings suggest that the predictors of CPSNP development are clinical rather than histological or biochemical.

  8. Uncertainty evaluation of dead zone of diagnostic ultrasound equipment

    NASA Astrophysics Data System (ADS)

    Souza, R. M.; Alvarenga, A. V.; Braz, D. S.; Petrella, L. I.; Costa-Felix, R. P. B.

    2016-07-01

    This paper presents a model for evaluating measurement uncertainty of a feature used in the assessment of ultrasound images: dead zone. The dead zone was measured by two technicians of the INMETRO's Laboratory of Ultrasound using a phantom and following the standard IEC/TS 61390. The uncertainty model was proposed based on the Guide to the Expression of Uncertainty in Measurement. For the tested equipment, results indicate a dead zone of 1.01 mm, and based on the proposed model, the expanded uncertainty was 0.17 mm. The proposed uncertainty model contributes as a novel way for metrological evaluation of diagnostic imaging by ultrasound.

  9. Signal evaluations using singular value decomposition for Thomson scattering diagnostics

    SciTech Connect

    Tojo, H. Yatsuka, E.; Hatae, T.; Itami, K.; Yamada, I.; Yasuhara, R.; Funaba, H.; Hayashi, H.

    2014-11-15

    This paper provides a novel method for evaluating signal intensities in incoherent Thomson scattering diagnostics. A double-pass Thomson scattering system, where a laser passes through the plasma twice, generates two scattering pulses from the plasma. Evaluations of the signal intensities in the spectrometer are sometimes difficult due to noise and stray light. We apply the singular value decomposition method to Thomson scattering data with strong noise components. Results show that the average accuracy of the measured electron temperature (T{sub e}) is superior to that of temperature obtained using a low-pass filter (<20 MHz) or without any filters.

  10. Toward diagnostic model calibration and evaluation: Approximate Bayesian computation

    NASA Astrophysics Data System (ADS)

    Vrugt, Jasper A.; Sadegh, Mojtaba

    2013-07-01

    The ever increasing pace of computational power, along with continued advances in measurement technologies and improvements in process understanding has stimulated the development of increasingly complex hydrologic models that simulate soil moisture flow, groundwater recharge, surface runoff, root water uptake, and river discharge at different spatial and temporal scales. Reconciling these high-order system models with perpetually larger volumes of field data is becoming more and more difficult, particularly because classical likelihood-based fitting methods lack the power to detect and pinpoint deficiencies in the model structure. Gupta et al. (2008) has recently proposed steps (amongst others) toward the development of a more robust and powerful method of model evaluation. Their diagnostic approach uses signature behaviors and patterns observed in the input-output data to illuminate to what degree a representation of the real world has been adequately achieved and how the model should be improved for the purpose of learning and scientific discovery. In this paper, we introduce approximate Bayesian computation (ABC) as a vehicle for diagnostic model evaluation. This statistical methodology relaxes the need for an explicit likelihood function in favor of one or multiple different summary statistics rooted in hydrologic theory that together have a clearer and more compelling diagnostic power than some average measure of the size of the error residuals. Two illustrative case studies are used to demonstrate that ABC is relatively easy to implement, and readily employs signature based indices to analyze and pinpoint which part of the model is malfunctioning and in need of further improvement.

  11. Diagnostic peritoneal lavage in evaluating acute abdominal pain.

    PubMed

    Barbee, C L; Gilsdorf, R B

    1975-06-01

    A study was performed to determine the value of peritoneal lavage in the acute abdomen not related to trauma. Lavage was performed in 33 patients in the evaluation of abdominal pain of sufficient degree to warrant consideration for surgical intervention. Peritoneal lavage was truly positive or truly negative in 64% of the cases. It showed false negative results in 28% and false positive results in 8%. The lavage was most accurate in the evaluation of appendicitis, colonic disease, and intra abdominal bleeding. It was highly inaccurate in the evaluation of cholecystitis and peptic ulcer disease. It was concluded that the peritoneal lavage can be a useful adjunct in the evaluation of patients with abdominal pain and should be considered in difficult diagnostic problems but not routinely employed.

  12. Studies and analyses of the Space Shuttle Main Engine: SSME failure data review, diagnostic survey and SSME diagnostic evaluation

    NASA Technical Reports Server (NTRS)

    Glover, R. C.; Kelley, B. A.; Tischer, A. E.

    1986-01-01

    The results of a review of the Space Shuttle Main Engine (SSME) failure data for the period 1980 through 1983 are presented. The data was collected, evaluated, and ranked according to procedures established during this study. A number of conclusions and recommendations are made based upon this failure data review. The results of a state-of-the-art diagnostic survey are also presented. This survey covered a broad range of diagnostic sensors and techniques and the findings were evaluated for application to the SSME. Finally, a discussion of the initial activities for the on-going SSME diagnostic evaluation is included.

  13. Evaluation of two-beam spectroscopy as a plasma diagnostic

    SciTech Connect

    Billard, B.D.

    1980-04-01

    A two-beam spectroscopy (TBS) system is evaluated theoretically and experimentally. This new spectroscopic technique uses correlations between components of emitted light separated by a small difference in angle of propagation. It is thus a non-perturbing plasma diagnostic which is shown to provide local (as opposed to line-of-sight averaged) information about fluctuations in the density of light sources within a plasma - information not obtainable by the usual spectroscopic methods. The present design is an improvement on earlier systems proposed in a thesis by Rostler.

  14. Diagnostic evaluation of hereditary hemochromatosis (HFE and non-HFE).

    PubMed

    Bardou-Jacquet, Edouard; Brissot, Pierre

    2014-08-01

    The management and understanding of hereditary hemochromatosis have evolved with recent advances in iron biology and the associated discovery of numerous genes involved in iron metabolism. HFE-related (type 1) hemochromatosis remains the most frequent form, characterized by C282Y mutation homozygosity. Rare forms of hereditary hemochromatosis include type 2 (A and B, juvenile hemochromatosis caused by HJV and HAMP mutation), type 3 (related to TFR2 mutation), and type 4 (A and B, ferroportin disease). The diagnostic evaluation relies on comprehension of the involved pathophysiologic defect, and careful characterization of the phenotype, which gives clues to guide appropriate genetic testing.

  15. The Use of Information Based Evaluation in Evaluating the Diagnostic Teaching Center.

    ERIC Educational Resources Information Center

    Poteet, James A.

    Information Based Evaluation (IBE) is identified as a design procedure for assessing a variety of projects, programs, and educational changes. IBE was used to evaluate a Comprehensive Diagnostic Teaching Center (DTC) which, in addition to providing teacher training and services to handicapped pupils, would bring together and focus all of the…

  16. Evaluation of two-beam spectroscopy as a plasma diagnostic

    NASA Astrophysics Data System (ADS)

    Billard, B. D.

    1980-12-01

    A two beam spectroscopy system is evaluated theoretically and experimentally. This spectroscopic technique uses correlations between components of emitted light separated by a small difference in angle of propagation. It is a nonperturbing plasma diagnostic which is shown to provide local (as opposed to line of sight averaged) information about fluctuations in the density of light sources within a plasma information not obtainable by the usual spectroscopic methods. The improved design, which abandons some of the components previously deemed essential, does not sacrifice any of the capabilities of the earlier systems in exchange for greater simplicity and increased light efficiency. The hot cathode discharge and prototype TBS system built for evaluation of the technique are described.

  17. Evaluation of the NDP (neutron diagnostic probe) system

    SciTech Connect

    Pentaleri, E.A.; Eisen, Y.Y.

    1990-12-01

    The neutron diagnostic probe (NDP), an explosive detection system developed by Consolidated Controls Corporation and based on the associated-alpha-particle technique, was evaluated. Although many problems were found with the prototype system that make it useless for most practical applications, the NDP system may be considered a successful proof-of-principle for the basic explosive detection system design. In addition to evaluating the design and performance of the present system, models were developed to estimate the performance that might reasonably be expected from full scale systems of different conceptual design. Specific examples involved various types of bulk and sheet explosives contained in a suitcase and a large crate. Also considered were the effects of innocuous materials surrounding explosives in different scenarios, including the deliberate use of shielding materials as a countermeasure to detection. 11 refs., 46 figs., 24 tabs.

  18. Evaluating Students' Learning and Communication Processes: Handbook 3--Diagnostic Teaching Units: Social Studies.

    ERIC Educational Resources Information Center

    Alberta Dept. of Education, Edmonton. Student Evaluation Branch.

    Presenting the diagnostic teaching units for grades 7, 8, and 9 social studies, this handbook is intended to be used along with the companion handbook 1, "Evaluating Students' Learning and Communication Processes: Integrating Diagnostic Evaluation and Instruction." The student activities of the diagnostic teaching units in the handbook have been…

  19. Do postsurgical interventions optimize ultimate scar cosmesis.

    PubMed

    Viera, M H; Amini, S; Konda, S; Berman, B

    2009-06-01

    Keloids and other scars are different manifestations of the normal wound healing process. If located in visible areas, scars may have a psychological impact that could affect the quality of life of the scar-bearing population. Good preoperatory planning including hiding incisions in natural anatomical landmarks or placing them parallel to relaxed skin tension lines are among the techniques used to improve the cosmesis of scars. Once a prominent or noticeable scar has developed, multiple therapeutic modalities can be applied including surgical excision, although high recurrence rates precludes its use as monotherapy. Several advanced surgical correction techniques including Z-plasty and W-plasty may be useful in repositioning scars. Other modalities that have been reported to improve scar cosmesis include cryosurgery, radiotherapy, lasers, and skin substitute grafts. Adjuvant postsurgical treatment modalities have reduced dramatically the recurrence rates associated with the removal of the scar. In this review of the literature the authors discuss evidence based data related to the abovementioned modalities and other topical and intralesional therapies including occlusion, compression, silicone, corticosteroids, interferons, imiquimod, resiquimod, tacrolimus, 5-fluorouracil, retinoids, as well as the role of several over-the-counter agents such as onion extract, vitamin E and the combination of hydrocortisone, vitamin E and silicone. Finally, they address newer modalities including vascular endothelial growth factor inhibitor, transforming growth factor-3, interleukin-10, mannose-6-phosphate, UVA-1, narrowband UVB, intense pulsed light and photodynamic therapy. Ultimately, the decision of choosing the most appropriate postexcisional management treatment should be taken by physicians on a case-by-case basis in order to obtain the best cosmetically acceptable results. PMID:19528906

  20. The relation of gingival thickness to dynamics of gingival margin position pre- and post-surgically

    PubMed Central

    Vandana, Kharidhi Laxman; Gupta, Ira

    2016-01-01

    Background: To evaluate the gingival margin position (GMP) before and after open flap debridement in different gingival thickness (GT). Materials and Methods: Twenty-seven healthy patients with moderate to advanced adult periodontitis were included in a randomized control clinical trial. A calibrated UNC-15 periodontal probe, an occlusal onlay stent was used for clinical measurements recorded at baseline, 3 month, 6 month, and 16 month. The changes in the GMP were studied at midbuccal (Mi-B), mesiobuccal (MB), and distobuccal sites. GT was measured presurgically, transgingivally at Mi-B and interdental sites, divided into 2 groups: Group 1 (thin) and Group 2 (thick). Results: In GT of ≤1 mm group, the statistically significant apical shift of GMP led to gingival recession at all study sites in the early postsurgical period of 1 and 3 months. During 6 and 16 months, the apical shift of GMP coincided with the Chernihiv Airport at Mi-B site (6 months), MB site (16 months). The gingival recession was obvious at Mi-B sites (16 months). In the GT of >1 mm, the statistically significant apical shift of GMP did not cause gingival recession at any sites throughout postsurgical (1, 3, 6, and 16 months) period. Conclusion: Thin gingiva showed apical shift of GMP leading to gingival recession as compared to thick gingiva postsurgically. PMID:27143829

  1. Intraperitoneal administration of activated protein C prevents postsurgical adhesion band formation.

    PubMed

    Dinarvand, Peyman; Hassanian, Seyed Mahdi; Weiler, Hartmut; Rezaie, Alireza R

    2015-02-19

    Postsurgical peritoneal adhesion bands are the most important causes of intestinal obstruction, pelvic pain, and female infertility. In this study, we used a mouse model of adhesion and compared the protective effect of activated protein C (APC) to that of the Food and Drug Administration-approved antiadhesion agent, sodium hyaluronate/carboxymethylcellulose (Seprafilm) by intraperitoneal administration of either APC or Seprafilm to experimental animals. Pathological adhesion bands were graded on day 7, and peritoneal fluid concentrations of tissue plasminogen activator (tPA), d-dimer, thrombin-antithrombin complex, and cytokines (IL-1β, IL-6, interferon-γ, tumor necrosis factor-α, transforming growth factor-β1) were evaluated. Inflammation scores were also measured based on histologic data obtained from peritoneal tissues. Relative to Seprafilm, intraperitoneal administration of human APC led to significantly higher reduction of postsurgical adhesion bands. Moreover, a markedly lower inflammation score was obtained in the adhesive tissues of the APC-treated group, which correlated with significantly reduced peritoneal concentrations of proinflammatory cytokines and an elevated tPA level. Further studies using variants of human APC with or without protease-activated receptor 1 (PAR1) signaling function and mutant mice deficient for either endothelial protein C receptor (EPCR) or PAR1 revealed that the EPCR-dependent signaling activity of APC is primarily responsible for its protective activity in this model. These results suggest APC has therapeutic potential for preventing postsurgical adhesion bands. PMID:25575539

  2. [Imputation methods for missing data in educational diagnostic evaluation].

    PubMed

    Fernández-Alonso, Rubén; Suárez-Álvarez, Javier; Muñiz, José

    2012-02-01

    In the diagnostic evaluation of educational systems, self-reports are commonly used to collect data, both cognitive and orectic. For various reasons, in these self-reports, some of the students' data are frequently missing. The main goal of this research is to compare the performance of different imputation methods for missing data in the context of the evaluation of educational systems. On an empirical database of 5,000 subjects, 72 conditions were simulated: three levels of missing data, three types of loss mechanisms, and eight methods of imputation. The levels of missing data were 5%, 10%, and 20%. The loss mechanisms were set at: Missing completely at random, moderately conditioned, and strongly conditioned. The eight imputation methods used were: listwise deletion, replacement by the mean of the scale, by the item mean, the subject mean, the corrected subject mean, multiple regression, and Expectation-Maximization (EM) algorithm, with and without auxiliary variables. The results indicate that the recovery of the data is more accurate when using an appropriate combination of different methods of recovering lost data. When a case is incomplete, the mean of the subject works very well, whereas for completely lost data, multiple imputation with the EM algorithm is recommended. The use of this combination is especially recommended when data loss is greater and its loss mechanism is more conditioned. Lastly, the results are discussed, and some future lines of research are analyzed.

  3. Mission Evaluation Room Intelligent Diagnostic and Analysis System (MIDAS)

    NASA Technical Reports Server (NTRS)

    Pack, Ginger L.; Falgout, Jane; Barcio, Joseph; Shnurer, Steve; Wadsworth, David; Flores, Louis

    1994-01-01

    The role of Mission Evaluation Room (MER) engineers is to provide engineering support during Space Shuttle missions, for Space Shuttle systems. These engineers are concerned with ensuring that the systems for which they are responsible function reliably, and as intended. The MER is a central facility from which engineers may work, in fulfilling this obligation. Engineers participate in real-time monitoring of shuttle telemetry data and provide a variety of analyses associated with the operation of the shuttle. The Johnson Space Center's Automation and Robotics Division is working to transfer advances in intelligent systems technology to NASA's operational environment. Specifically, the MER Intelligent Diagnostic and Analysis System (MIDAS) project provides MER engineers with software to assist them with monitoring, filtering and analyzing Shuttle telemetry data, during and after Shuttle missions. MIDAS off-loads to computers and software, the tasks of data gathering, filtering, and analysis, and provides the engineers with information which is in a more concise and usable form needed to support decision making and engineering evaluation. Engineers are then able to concentrate on more difficult problems as they arise. This paper describes some, but not all of the applications that have been developed for MER engineers, under the MIDAS Project. The sampling described herewith was selected to show the range of tasks that engineers must perform for mission support, and to show the various levels of automation that have been applied to assist their efforts.

  4. Evaluation of coproexamination as a diagnostic test for avian botulism

    USGS Publications Warehouse

    Jensen, W.I.

    1981-01-01

    Fecal extracts and blood sera from 113 ducks showing clinical signs of botulism were examined for Clostridium botulinum type C toxin by means of the mouse toxicity test to evaluate coproexamination as a diagnostic procedure, as compared with demonstration of toxin in serum. When death of test mice unprotected with type specific antitoxin (while protected controls survived) was the criterion, 78.8% of the sera and 5.3% of the fecal extracts were positive. When characteristic signs of intoxication in the unprotected mice was included as evidence of toxin in the specimens, these percentages increased to 86.7 and 6.2, respectively. Fecal specimens were collected hourly for the first 6 h after peroral dosing of eight mallards (Anas platyrhynchos) with 1.0 LD50 of type C toxin and at 24, 48, and 72 h from birds surviving that long. From 2 to 4 toxin-positive specimens were passed by all eight ducks during the first 6 h, five specimens were positive at 24 h, and three were positive at 48 h. Only three specimens were collected at 72 h, all of which were negative. These findings suggest that attempts to detect toxin in the feces of wild ducks might have been more successful had the birds been captured earlier in the course of the disease.

  5. An Evaluation of a Diagnostic Wind Model (CALMET)

    SciTech Connect

    Wang, Weiguo; Shaw, William J.; Seiple, Timothy E.; Rishel, Jeremy P.; Xie, YuLong

    2008-06-01

    An EPA-recommended diagnostic wind model (CALMET) was evaluated during a typical lake-breeze event in the Chicago region. We focused on the performance of CALMET in terms of simulating winds that were highly variable in space and time. The reference winds were generated by the PSU/NCAR MM5 assimilating system, with which CALMET results were compared. Statistical evaluations were conducted to quantify overall errors in wind speed and direction over the domain. Within the atmospheric boundary layer (ABL), relative errors in (layer-averaged) wind speed were about 25% to 40% during the simulation period; wind direction errors generally ranged from 6 to 20 deg. Above the ABL, the errors became larger due to lack of upper air stations in the studied domain. Analyses implied that model errors were dependent on time due to time-dependent spatial variability in winds. Trajectory analyses were made to examine the likely spatial dependence of model errors within the domain, suggesting that the quality of CALMET winds in local areas depended on their locations with respect to the lake-breeze front position. Large errors usually occurred near the front area, where observations cannot resolve the spatial variability of wind, or in the fringe of the domain, where observations are lacking. We also compared results simulated using different datasets and model options. Model errors tended to be reduced with data sampled from more stations or from more uniformly-distributed stations. Suggestions are offered for further improving or interpreting CALMET results under complex wind conditions in the Chicago region, which may also apply to other regions.

  6. [STARD 2015 for the evaluation of diagnostic tests].

    PubMed

    Korevaar, Daniël A; Bossuyt, Patrick M M

    2016-01-01

    Each year, many new diagnostic tests appear on the market that claim to be better, faster, cheaper, less invasive and more reliable than those already available. Diagnostic accuracy studies can assist in the objective assessment of such claims but, unfortunately, important information is often missing from the corresponding study reports. Authors are responsible for the completeness of their study reports, but they may not always be aware of the type of information that needs to be provided for an adequate appraisal of the study. To assist authors in writing informative reports, the STAndards for Reporting Diagnostic accuracy studies (STARD) were recently updated. The aim of STARD 2015 is to improve the ease of use of STARD, while also including several new crucial elements. Future initiatives to improve the uptake of STARD 2015 include the development of extensions for specific fields of testing and tools for specific user groups. PMID:27165460

  7. Meloxicam prevents COX-2 mediated post-surgical inflammation but not pain following laparotomy in mice

    PubMed Central

    Roughan, John V.; Bertrand, Henri G.M.J.; Isles, Hannah M.

    2015-01-01

    Background Inflammation is thought to be a major contributor to post-surgical pain so nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesics. However, compared to rats, considerably less is known as to how successfully these prevent pain in mice. Methods A fluorescent COX-2 selective probe was used for the first time to evaluate the post-surgical anti-inflammatory effects of meloxicam, and automated behaviour analyses (HomeCageScan; HCS), the Mouse Grimace Scale (MGS) and body weight changes to assess its pain preventative properties. Groups of 8-9 BALB/c mice were subcutaneously injected with saline (0.3mls) or meloxicam at (1, 5 or 20mg/kg) 1 hour before a 1.5cm midline laparotomy. The probe or a control dye (2mg/kg) was injected intravenously 3 hours later. Imaging was used to quantify inflammation at 7, 24 and 48 hours following surgery. HCS data and MGS scores were obtained from video recordings and photographs before and at 24 hours. Results Post-surgical inflammation was dose dependently reduced by meloxicam; with 5 or 20mg/kg being most effective compared to saline. However, all mice lost weight, MGS scores increased and behavioural activity was reduced by surgery for at least 24 hours with no perceivable beneficial effect of meloxicam on any of these potentially pain-associated changes. Conclusions Although meloxicam prevented inflammation, even large doses did not prevent post-laparotomy pain possibly arising due a range of factors, including, but not limited to inflammation. MGS scoring can be applied by very naïve assessors and so should be effective for cage-side use. PMID:25908253

  8. Acquiring, Representing, and Evaluating a Competence Model of Diagnostic Strategy.

    ERIC Educational Resources Information Center

    Clancey, William J.

    This paper describes NEOMYCIN, a computer program that models one physician's diagnostic reasoning within a limited area of medicine. NEOMYCIN's knowledge base and reasoning procedure constitute a model of how human knowledge is organized and how it is used in diagnosis. The hypothesis is tested that such a procedure can be used to simulate both…

  9. Evaluation of tuberculosis diagnostics in children: 2. Methodological issues for conducting and reporting research evaluations of tuberculosis diagnostics for intrathoracic tuberculosis in children. Consensus from an expert panel.

    PubMed

    Cuevas, Luis E; Browning, Renee; Bossuyt, Patrick; Casenghi, Martina; Cotton, Mark F; Cruz, Andrea T; Dodd, Lori E; Drobniewski, Francis; Gale, Marianne; Graham, Stephen M; Grzemska, Malgosia; Heinrich, Norbert; Hesseling, Anneke C; Huebner, Robin; Jean-Philippe, Patrick; Kabra, Sushil Kumar; Kampmann, Beate; Lewinsohn, Deborah; Li, Meijuan; Lienhardt, Christian; Mandalakas, Anna M; Marais, Ben J; Menzies, Heather J; Montepiedra, Grace; Mwansambo, Charles; Oberhelman, Richard; Palumbo, Paul; Russek-Cohen, Estelle; Shapiro, David E; Smith, Betsy; Soto-Castellares, Giselle; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire; Worrell, Carol

    2012-05-15

    Confirming the diagnosis of childhood tuberculosis is a major challenge. However, research on childhood tuberculosis as it relates to better diagnostics is often neglected because of technical difficulties, such as the slow growth in culture, the difficulty of obtaining specimens, and the diverse and relatively nonspecific clinical presentation of tuberculosis in this age group. Researchers often use individually designed criteria for enrollment, diagnostic classifications, and reference standards, thereby hindering the interpretation and comparability of their findings. The development of standardized research approaches and definitions is therefore needed to strengthen the evaluation of new diagnostics for detection and confirmation of tuberculosis in children. In this article we present consensus statements on methodological issues for conducting research of Tuberculosis diagnostics among children, with a focus on intrathoracic tuberculosis. The statements are complementary to a clinical research case definition presented in an accompanying publication and suggest a phased approach to diagnostics evaluation; entry criteria for enrollment; methods for classification of disease certainty, including the rational use of culture within the case definition; age categories and comorbidities for reporting results; and the need to use standard operating procedures. Special consideration is given to the performance of microbiological culture in children and we also recommend for alternative methodological approaches to report findings in a standardized manner to overcome these limitations are made. This consensus statement is an important step toward ensuring greater rigor and comparability of pediatric tuberculosis diagnostic research, with the aim of realizing the full potential of better tests for children. PMID:22476719

  10. Using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule with Young Children with Developmental Delay: Evaluating Diagnostic Validity

    ERIC Educational Resources Information Center

    Gray, Kylie M.; Tonge, Bruce J.; Sweeney, Deborah J.

    2008-01-01

    Few studies have focused on the validity of the ADI-R and ADOS in the assessment of preschool children with developmental delay. This study aimed to evaluate the diagnostic validity of the ADI-R and the ADOS in young children. Two-hundred and nine children aged 20-55 months participated in the study, 120 of whom received a diagnosis of autism.…

  11. PEMFs: new post-surgical management in dentristry

    NASA Astrophysics Data System (ADS)

    Tonetti, Luca

    2014-01-01

    Aim of study: the possible effects on dental postsurgical management using small and not invasive devices: RecoveryRx or ActiPatch producted by Bioelectronics company (USA) Materials and methods: review of literature using searching engines Keywords: PEMFs, postsurgical treatment, pain, wound healing, RecoveryRx, ActiPatch Results: Pulsed Electro Magnetic Fields have been used extensively for decades for many conditions and medical disciplines. Imperceptible cell dysfunction that is not corrected early can lead to disease. Fine-tuning can be done daily in only minutes, using pulsed electromagnetic fields (PEMFs). In addition, when there is a known imbalance (when symptoms are present) or there is a known disease or condition, PEMF treatments, used either alone or along with other therapies, can often help cells rebalance dysfunction faster. It is seen in literature that RecoveryRX and ActiPatch improve the cell metabolism, rebalance the membrane potential difference, improve the circulation and the oxigenation of the tissues, acceleration of osteogenesis, acceleration repair of soft tissues, reduce pain. Conclusion: the RecoveryRX and ActiPatch devices could improve the postsurgical healing reducing the patient discomfort.

  12. Diagnostic evaluations of microwave generated helium and nitrogen plasma mixtures

    NASA Technical Reports Server (NTRS)

    Haraburda, Scott S.; Hawley, Martin C.; Dinkel, Duane W.

    1990-01-01

    The goal of this work is to continue the development to fundamentally understand the plasma processes as applied to spacecraft propulsion. The diagnostic experiments used are calorimetric, dimensional, and spectroscopic measurements using the TM 011 and TM 012 modes in the resonance cavity. These experimental techniques are highly important in furthering the understanding of plasma phenomena and of designing rocket thrusters. Several experimental results are included using nitrogen and helium gas mixtures.

  13. Diagnostic Air Quality Model Evaluation of Source-Specific Primary and Secondary Fine Particulate Carbon

    EPA Science Inventory

    Ambient measurements of 78 source-specific tracers of primary and secondary carbonaceous fine particulate matter collected at four midwestern United States locations over a full year (March 2004–February 2005) provided an unprecedented opportunity to diagnostically evaluate...

  14. Heterogeneous postsurgical data analytics for predictive modeling of mortality risks in intensive care units.

    PubMed

    Yun Chen; Hui Yang

    2014-01-01

    The rapid advancements of biomedical instrumentation and healthcare technology have resulted in data-rich environments in hospitals. However, the meaningful information extracted from rich datasets is limited. There is a dire need to go beyond current medical practices, and develop data-driven methods and tools that will enable and help (i) the handling of big data, (ii) the extraction of data-driven knowledge, (iii) the exploitation of acquired knowledge for optimizing clinical decisions. This present study focuses on the prediction of mortality rates in Intensive Care Units (ICU) using patient-specific healthcare recordings. It is worth mentioning that postsurgical monitoring in ICU leads to massive datasets with unique properties, e.g., variable heterogeneity, patient heterogeneity, and time asyncronization. To cope with the challenges in ICU datasets, we developed the postsurgical decision support system with a series of analytical tools, including data categorization, data pre-processing, feature extraction, feature selection, and predictive modeling. Experimental results show that the proposed data-driven methodology outperforms traditional approaches and yields better results based on the evaluation of real-world ICU data from 4000 subjects in the database. This research shows great potentials for the use of data-driven analytics to improve the quality of healthcare services.

  15. Diagnostic evaluation of a case of lingual thyroid ectopia.

    PubMed

    Fiaschetti, Valeria; Claroni, Giulia; Scarano, Angela Lia; Schillaci, Orazio; Floris, Roberto

    2016-09-01

    Thyroid ectopia can occur when the process of thyroid embryogenesis fails. Here, we present the case of a 30-year-old woman with thyroid ectopia that was discovered during magnetic resonance imaging of cervical spine for referred neck pain. Imaging revealed the presence of an encapsulated mass at the base of her tongue. The patient was not symptomatic for any compression of the airways. Diagnosis of ectopic lingual thyroid was confirmed by (99m)TC scintigraphy. Incidental diagnosis of thyroid ectopia in asymptomatic adult patients is rare, and it should be considered on diagnostic imaging in case of an anterior midline cervical mass. PMID:27594942

  16. Prevalence of Autism Spectrum Disorder in Children Referred for Diagnostic Autism Evaluation.

    PubMed

    Monteiro, Sonia A; Spinks-Franklin, Adiaha; Treadwell-Deering, Diane; Berry, Leandra; Sellers-Vinson, Sherry; Smith, Eboni; Proud, Monica; Voigt, Robert G

    2015-12-01

    Increased public awareness of autism spectrum disorders (ASD) and routine screening in primary care have contributed to increased requests for diagnostic ASD evaluations. However, given the scarcity of subspecialty autism diagnostic resources, overreferral of children suspected of having ASD may be contributing to long waiting lists at tertiary care autism centers and delaying diagnosis for those children who truly have ASD. To determine whether children are being excessively referred to ASD-specific diagnostic clinics, our objective was to determine the prevalence of true ASD diagnoses in children referred for diagnostic ASD evaluation. Charts of all patients referred to a regional autism center between April 2011 and August 2012 for suspicion of a possible ASD were retrospectively reviewed and demographic and clinical diagnoses abstracted. Only 214 of 348 patients evaluated (61%) received an ASD diagnosis. Thus, concerns about autism are not confirmed by an ASD diagnosis in a significant number of children. PMID:26130396

  17. Prevalence of Autism Spectrum Disorder in Children Referred for Diagnostic Autism Evaluation.

    PubMed

    Monteiro, Sonia A; Spinks-Franklin, Adiaha; Treadwell-Deering, Diane; Berry, Leandra; Sellers-Vinson, Sherry; Smith, Eboni; Proud, Monica; Voigt, Robert G

    2015-12-01

    Increased public awareness of autism spectrum disorders (ASD) and routine screening in primary care have contributed to increased requests for diagnostic ASD evaluations. However, given the scarcity of subspecialty autism diagnostic resources, overreferral of children suspected of having ASD may be contributing to long waiting lists at tertiary care autism centers and delaying diagnosis for those children who truly have ASD. To determine whether children are being excessively referred to ASD-specific diagnostic clinics, our objective was to determine the prevalence of true ASD diagnoses in children referred for diagnostic ASD evaluation. Charts of all patients referred to a regional autism center between April 2011 and August 2012 for suspicion of a possible ASD were retrospectively reviewed and demographic and clinical diagnoses abstracted. Only 214 of 348 patients evaluated (61%) received an ASD diagnosis. Thus, concerns about autism are not confirmed by an ASD diagnosis in a significant number of children.

  18. Propulsion Diagnostic Method Evaluation Strategy (ProDiMES) User's Guide

    NASA Technical Reports Server (NTRS)

    Simon, Donald L.

    2010-01-01

    This report is a User's Guide for the Propulsion Diagnostic Method Evaluation Strategy (ProDiMES). ProDiMES is a standard benchmarking problem and a set of evaluation metrics to enable the comparison of candidate aircraft engine gas path diagnostic methods. This Matlab (The Mathworks, Inc.) based software tool enables users to independently develop and evaluate diagnostic methods. Additionally, a set of blind test case data is also distributed as part of the software. This will enable the side-by-side comparison of diagnostic approaches developed by multiple users. The Users Guide describes the various components of ProDiMES, and provides instructions for the installation and operation of the tool.

  19. Monitoring of Serial Presurgical and Postsurgical Changes in the Serum Proteome in a Series of Patients with Calcific Aortic Stenosis

    PubMed Central

    Satoh, Kazumi; Yamada, Kazuo; Maniwa, Tomoko; Oda, Teiji; Matsumoto, Ken-ichi

    2015-01-01

    Background. Comprehensive analysis of proteome differentially expressed in response to surgery or drug treatment is useful to understand biological responses to dispensed interventions. Here we investigated expression changes in sera of patients who suffered from calcific aortic stenosis (CAS), before and after surgery for aortic valve replacement. Materials and Methods. Sera obtained before and after surgery with depletion of highly abundant proteins were analyzed with iTRAQ labeling followed by nanoLC-MALDI-TOF/TOF-MS/MS. Results. Fifty-one proteins shared in five patients were identified with differential levels in postsurgical and presurgical sera. Finally, 16 proteins that show statistically significant levels in patients' sera compared with those in control sera (P < 0.05) were identified. Most of the identified proteins were positive acute-phase proteins. Among three proteins other than acute-phase proteins, we confirmed increased levels of antithrombin-III and zinc-α-2-glycoprotein in postsurgical sera by Western blot analysis using other CAS patients' sera. Furthermore, antithrombin-III and zinc-α-2-glycoprotein were not found among proteins with differential levels in postsurgical and presurgical sera of patients with aortic aneurysms that we identified in a previous study. Conclusions. The results indicated that antithrombin-III and zinc-α-2-glycoprotein would become unique monitoring proteins for evaluating pathophysiological and biochemical processes occurring before and after surgery for CAS. PMID:26078484

  20. Evaluating Diagnostic Point-of-Care Tests in Resource-Limited Settings

    PubMed Central

    Drain, Paul K; Hyle, Emily P; Noubary, Farzad; Freedberg, Kenneth A; Wilson, Douglas; Bishai, William; Rodriguez, William; Bassett, Ingrid V

    2014-01-01

    Diagnostic point-of-care (POC) testing is intended to minimize the time to obtain a test result, thereby allowing clinicians and patients to make an expeditious clinical decision. As POC tests expand into resource-limited settings (RLS), the benefits must outweigh the costs. To optimize POC testing in RLS, diagnostic POC tests need rigorous evaluations focused on relevant clinical outcomes and operational costs, which differ from evaluations of conventional diagnostic tests. Here, we reviewed published studies on POC testing in RLS, and found no clearly defined metric for the clinical utility of POC testing. Therefore, we propose a framework for evaluating POC tests, and suggest and define the term “test efficacy” to describe a diagnostic test’s capacity to support a clinical decision within its operational context. We also proposed revised criteria for an ideal diagnostic POC test in resource-limited settings. Through systematic evaluations, comparisons between centralized diagnostic testing and novel POC technologies can be more formalized, and health officials can better determine which POC technologies represent valuable additions to their clinical programs. PMID:24332389

  1. CLINICAL APPROACH TO THE DIAGNOSTIC EVALUATION OF HERDITARY AND ACQUIRED NEUROMUSCULAR DISEASES

    PubMed Central

    McDonald, Craig M.

    2012-01-01

    SYNOPSIS In the context of a neuromuscular disease diagnostic evaluation, the clinician still must be able to obtain a relevant patient and family history and perform focused general, musculoskeletal, neurologic and functional physical examinations to direct further diagnostic evaluations. Laboratory studies for hereditary neuromuscular diseases include relevant molecular genetic studies. The EMG and nerve conduction studies remain an extension of the physical examination and help to guide further diagnostic studies such as molecular genetic studies, and muscle and nerve biopsies. All diagnostic information needs to be interpreted not in isolation, but within the context of relevant historical information, family history, physical examination findings, and laboratory data, electrophysiologic findings, pathologic findings, and molecular genetic findings if obtained. PMID:22938875

  2. Postsurgical care for rehabilitation with implant-retained extraoral prostheses.

    PubMed

    Goiato, Marcelo Coelho; Takamiya, Aline Satie; Alves, Luciana Mara Negrão; dos Santos, Daniela Micheline

    2010-03-01

    The health of a peri-implant tissue is a critical factor for the long-term success of treatment with extraoral implants. However, infection and inflammation may occur and lead to implant loss and prostheses failure. Therefore, some postsurgical care as hygiene with soap and water, soft toothbrush, and Superfloss type dental floss and medication with anti-inflammatory and antibiotic are suggested to avoid complications. In addition, a thin and smooth layer of subcutaneous tissue in the peri-implant area should be preserved during implant insertion to favor the assistance recommended in this phase. PMID:20216436

  3. NC-16PREDICTORS OF POST-SURGICAL QUALITY OF LIFE IN PATIENTS WITH NON-FUNCTIONAL PITUITARY ADENOMA: THE INFLUENCE OF NEUROBEHAVIORAL FUNCTIONS

    PubMed Central

    Yang, Chih-Yu; Yang, Shih-Hung; Yang, Chi-Cheng

    2014-01-01

    INTRODUCTION: Non-functional pituitary adenoma (NFPA) is one of the commonest subtypes of the pituitary adenomas. Although NFPA was benign, the mass effect of the adenoma would cause hypopituitarism or other complications which may affect the cognitive functions, emotional status or quality of life (QoL). Unfortunately, most of the previous studies were cross-sectional and could not reveal the changes of cognitive functions after surgery. This study thus aims to prospectively evaluate the neurobehavioral functions and related factors in patients with NFPA. METHOD: In this prospective study, 36 subjects with NFPA were recruited. Neurobehavioral functions, which included memory, executive function and speed of information processing, were evaluated. Depression, anxiety and QoL, were also examined by self-reported questionnaires. All participants were evaluated at the time of pre-operation, three and six months after surgery. RESULT: The substantial improvements in the memory, executive function and information processing were found. In respect to the emotional status and the QoL, depression and anxiety decreased significantly, while the physical QoL has a significant improvement. Importantly, the results showed that the pre-surgical psychological QoL was significantly associated with the post-surgical physical and global QoLs. In addition, the post-surgical social QoL was significantly negatively associated with the post-surgical disinhibited symptoms. CONCLUSION: This study not only revealed the post-surgical progression of neurobehavioral functions in patients with NFPA, but showed the principal predictors of post-surgical outcomes in those patients. It thus merits a comprehensive evaluation of neurobehavioral functions when patients with NFPA ready for the surgical treatments.

  4. Pedophilia: an evaluation of diagnostic and risk prediction methods.

    PubMed

    Wilson, Robin J; Abracen, Jeffrey; Looman, Jan; Picheca, Janice E; Ferguson, Meaghan

    2011-06-01

    One hundred thirty child sexual abusers were diagnosed using each of following four methods: (a) phallometric testing, (b) strict application of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM-IV-TR]) criteria, (c) Rapid Risk Assessment of Sex Offender Recidivism (RRASOR) scores, and (d) "expert" diagnoses rendered by a seasoned clinician. Comparative utility and intermethod consistency of these methods are reported, along with recidivism data indicating predictive validity for risk management. Results suggest that inconsistency exists in diagnosing pedophilia, leading to diminished accuracy in risk assessment. Although the RRASOR and DSM-IV-TR methods were significantly correlated with expert ratings, RRASOR and DSM-IV-TR were unrelated to each other. Deviant arousal was not associated with any of the other methods. Only the expert ratings and RRASOR scores were predictive of sexual recidivism. Logistic regression analyses showed that expert diagnosis did not add to prediction of sexual offence recidivism over and above RRASOR alone. Findings are discussed within a context of encouragement of clinical consistency and evidence-based practice regarding treatment and risk management of those who sexually abuse children.

  5. Evaluating diagnostic accuracy in the face of multiple reference standards.

    PubMed

    Naaktgeboren, Christiana A; de Groot, Joris A H; van Smeden, Maarten; Moons, Karel G M; Reitsma, Johannes B

    2013-08-01

    A universal challenge in studies that quantify the accuracy of diagnostic tests is establishing whether each participant has the disease of interest. Ideally, the same preferred reference standard would be used for all participants; however, for practical or ethical reasons, alternative reference standards that are often less accurate are frequently used instead. The use of different reference standards across participants in a single study is known as differential verification.Differential verification can cause severely biased accuracy estimates of the test or model being studied. Many variations of differential verification exist, but not all introduce the same risk of bias. A risk-of-bias assessment requires detailed information about which participants receive which reference standards and an estimate of the accuracy of the alternative reference standard. This article classifies types of differential verification and explores how they can lead to bias. It also provides guidance on how to report results and assess the risk of bias when differential verification occurs and highlights potential ways to correct for the bias.

  6. Development of optical diagnostics for performance evaluation of arcjet thrusters

    NASA Technical Reports Server (NTRS)

    Cappelli, Mark A.

    1995-01-01

    Laser and optical emission-based measurements have been developed and implemented for use on low-power hydrogen arcjet thrusters and xenon-propelled electric thrusters. In the case of low power hydrogen arcjets, these laser induce fluorescence measurements constitute the first complete set of data that characterize the velocity and temperature field of such a device. The research performed under the auspices of this NASA grant includes laser-based measurements of atomic hydrogen velocity and translational temperature, ultraviolet absorption measurements of ground state atomic hydrogen, Raman scattering measurements of the electronic ground state of molecular hydrogen, and optical emission based measurements of electronically excited atomic hydrogen, electron number density, and electron temperature. In addition, we have developed a collisional-radiative model of atomic hydrogen for use in conjunction with magnetohydrodynamic models to predict the plasma radiative spectrum, and near-electrode plasma models to better understand current transfer from the electrodes to the plasma. In the final year of the grant, a new program aimed at developing diagnostics for xenon plasma thrusters was initiated, and results on the use of diode lasers for interrogating Hall accelerator plasmas has been presented at recent conferences.

  7. Evaluation of the Revised Algorithm of Autism Diagnostic Observation Schedule (ADOS) in the Diagnostic Investigation of High-Functioning Children and Adolescents with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Kamp-Becker, Inge; Ghahreman, Mardjan; Heinzel-Gutenbrunner, Monika; Peters, Mira; Remschmidt, Helmut; Becker, Katja

    2013-01-01

    The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured, standardized assessment designed for use in diagnostic evaluation of individuals with suspected autism spectrum disorder (ASD). The ADOS has been effective in categorizing children who definitely have autism or not, but has lower specificity and sometimes sensitivity for…

  8. An Application of M[subscript 2] Statistic to Evaluate the Fit of Cognitive Diagnostic Models

    ERIC Educational Resources Information Center

    Liu, Yanlou; Tian, Wei; Xin, Tao

    2016-01-01

    The fit of cognitive diagnostic models (CDMs) to response data needs to be evaluated, since CDMs might yield misleading results when they do not fit the data well. Limited-information statistic M[subscript 2] and the associated root mean square error of approximation (RMSEA[subscript 2]) in item factor analysis were extended to evaluate the fit of…

  9. Echocardiographic agreement in the diagnostic evaluation for infective endocarditis.

    PubMed

    Lauridsen, Trine Kiilerich; Selton-Suty, Christine; Tong, Steven; Afonso, Luis; Cecchi, Enrico; Park, Lawrence; Yow, Eric; Barnhart, Huiman X; Paré, Carlos; Samad, Zainab; Levine, Donald; Peterson, Gail; Stancoven, Amy Butler; Johansson, Magnus Carl; Dickerman, Stuart; Tamin, Syahidah; Habib, Gilbert; Douglas, Pamela S; Bruun, Niels Eske; Crowley, Anna Lisa

    2016-07-01

    Echocardiography is essential for the diagnosis and management of infective endocarditis (IE). However, the reproducibility for the echocardiographic assessment of variables relevant to IE is unknown. Objectives of this study were: (1) To define the reproducibility for IE echocardiographic variables and (2) to describe a methodology for assessing quality in an observational cohort containing site-interpreted data. IE reproducibility was assessed on a subset of echocardiograms from subjects enrolled in the International Collaboration on Endocarditis registry. Specific echocardiographic case report forms were used. Intra-observer agreement was assessed from six site readers on ten randomly selected echocardiograms. Inter-observer agreement between sites and an echocardiography core laboratory was assessed on a separate random sample of 110 echocardiograms. Agreement was determined using intraclass correlation (ICC), coverage probability (CP), and limits of agreement for continuous variables and kappa statistics (κweighted) and CP for categorical variables. Intra-observer agreement for LVEF was excellent [ICC = 0.93 ± 0.1 and all pairwise differences for LVEF (CP) were within 10 %]. For IE categorical echocardiographic variables, intra-observer agreement was best for aortic abscess (κweighted = 1.0, CP = 1.0 for all readers). Highest inter-observer agreement for IE categorical echocardiographic variables was obtained for vegetation location (κweighted = 0.95; 95 % CI 0.92-0.99) and lowest agreement was found for vegetation mobility (κweighted = 0.69; 95 % CI 0.62-0.86). Moderate to excellent intra- and inter-observer agreement is observed for echocardiographic variables in the diagnostic assessment of IE. A pragmatic approach for determining echocardiographic data reproducibility in a large, multicentre, site interpreted observational cohort is feasible.

  10. [Economic evaluation studies in diagnostic imaging: justification and critical reading].

    PubMed

    Rueda Martínez de Santos, J R

    2015-11-01

    First, this article describes the concepts and tools most widely used for economic evaluation in healthcare. Second, it discusses some elements that must be taken into account in the social decision about how much we are willing to spend to prolong a person's life by one year. Third, it describes the criteria recommended for the critical analysis of publications that evaluate the economic aspects of health interventions. Finally, several studies about ultrasound screening for aneurysms of the abdominal aorta are used as illustrative examples to show how these elements and criteria can be applied. PMID:26563613

  11. Multivariate Decoding of Cerebral Blood Flow Measures in a Clinical Model of On-Going Postsurgical Pain

    PubMed Central

    O'Muircheartaigh, Jonathan; Marquand, Andre; Hodkinson, Duncan J; Krause, Kristina; Khawaja, Nadine; Renton, Tara F; Huggins, John P; Vennart, William; Williams, Steven CR; Howard, Matthew A

    2015-01-01

    Recent reports of multivariate machine learning (ML) techniques have highlighted their potential use to detect prognostic and diagnostic markers of pain. However, applications to date have focussed on acute experimental nociceptive stimuli rather than clinically relevant pain states. These reports have coincided with others describing the application of arterial spin labeling (ASL) to detect changes in regional cerebral blood flow (rCBF) in patients with on-going clinical pain. We combined these acquisition and analysis methodologies in a well-characterized postsurgical pain model. The principal aims were (1) to assess the classification accuracy of rCBF indices acquired prior to and following surgical intervention and (2) to optimise the amount of data required to maintain accurate classification. Twenty male volunteers, requiring bilateral, lower jaw third molar extraction (TME), underwent ASL examination prior to and following individual left and right TME, representing presurgical and postsurgical states, respectively. Six ASL time points were acquired at each exam. Each ASL image was preceded by visual analogue scale assessments of alertness and subjective pain experiences. Using all data from all sessions, an independent Gaussian Process binary classifier successfully discriminated postsurgical from presurgical states with 94.73% accuracy; over 80% accuracy could be achieved using half of the data (equivalent to 15 min scan time). This work demonstrates the concept and feasibility of time-efficient, probabilistic prediction of clinically relevant pain at the individual level. We discuss the potential of ML techniques to impact on the search for novel approaches to diagnosis, management, and treatment to complement conventional patient self-reporting. Hum Brain Mapp 36:633–642, 2015. © 2014 The Authors. Human Brain Mapping Published by Wiley Periodicals, Inc. PMID:25307488

  12. Evaluation Of Vibration-Monitoring Gear-Diagnostic System

    NASA Technical Reports Server (NTRS)

    Townsend, Dennis P.; Zakrajsek, James J.

    1995-01-01

    Report describes experimental evaluation of commercial electronic system designed to monitor vibration signal from accelerometer on gear-box to detect vibrations indicative of damage to gears. System includes signal-conditioning subsystem and personal computer in which analog-to-digital converter installed. Results show system fairly effective in detecting surface fatigue pits on spur-gear teeth.

  13. Postsurgical Parsonage-Turner syndrome: a challenging diagnosis.

    PubMed

    Verhasselt, Skrallan; Schelfaut, Sebastiaan; Bataillie, Filiep; Moke, Lieven

    2013-02-01

    Parsonage-Turner syndrome (PTS) is a distinct clinical syndrome, characterized by acute and severe (mostly) unilateral shoulder pain, followed by paresis and atrophy of the shoulder girdle, while the pain decreases. Most authors consider it as an immune-mediated disorder. PTS is notoriously unrecognised and is usually diagnosed with delay. A PTS may also occur following a surgical procedure. Postsurgical PTS is an under-recognised and challenging clinical entity, as illustrated in the case reported here of a 59-year-old man, 4 weeks after anterior discectomy and fusion C5C7. In such cases, the differential diagnosis must be made with a complication of surgery, such as postoperative C5 palsy due for instance to a migrated bone graft. Arguments for PTS are: a certain delay between surgery and symptoms, intolerable pain followed by weakness and improvement of pain complaints, divergent distribution of weakness, sensory deficit and pain, which may be confirmed by electrodiagnosis. Early recognition of postsurgical PTS may avoid unnecessary investigations or surgical exploration. It allows to treat the patient properly, leading to greater satisfaction of both surgeon and patient; pain management, physical therapy and reassurance are the cornerstones.

  14. Development and clinical evaluation of a rapid diagnostic kit for feline leukemia virus infection

    PubMed Central

    Kim, Won-Shik; Chong, Chom-Kyu; Kim, Hak-Yong; Lee, Gyu-Cheol; Jeong, Wooseog; An, Dong-Jun; Jeoung, Hye-Young; Lee, Jae-In

    2014-01-01

    Feline leukemia virus (FeLV) causes a range of neoplastic and degenerative diseases in cats. To obtain a more sensitive and convenient diagnosis of the disease, we prepared monoclonal antibodies specific for the FeLV p27 to develop a rapid diagnostic test with enhanced sensitivity and specificity. Among these antibodies, we identified two clones (hybridomas 8F8B5 and 8G7D1) that specifically bound to FeLV and were very suitable for a diagnostic kit. The affinity constants for 8F8B5 and 8G7D1 were 0.35 × 109 and 0.86 × 109, respectively. To investigate the diagnostic abilities of the rapid kit using these antibodies, we performed several clinical studies. Assessment of analytical sensitivity revealed that the detection threshold of the rapid diagnostic test was 2 ng/mL for recombinant p27 and 12.5 × 104 IU/mL for FeLV. When evaluating 252 cat sera samples, the kit was found to have a kappa value of 0.88 compared to polymerase chain reaction (PCR), indicating a significant correlation between data from the rapid diagnostic test and PCR. Sensitivity and specificity of the kit were 95.2% (20/21) and 98.5% (257/261), respectively. Our results demonstrated that the rapid diagnostic test would be a suitable diagnostic tool for the rapid detection of FeLV infection in cats. PMID:24136209

  15. Modeling the Frequency and Costs Associated with Postsurgical Gastrointestinal Adverse Events for Tapentadol IR versus Oxycodone IR

    PubMed Central

    Paris, Andrew; Kozma, Chris M.; Chow, Wing; Patel, Anisha M.; Mody, Samir H.; Kim, Myoung S.

    2013-01-01

    subsequent cost-savings in the postsurgical hospital setting. In the absence of sufficient real-world data, this literature-based cost calculator may assist hospital Pharmacy & Therapeutics committees in their evaluation of the costs of opioid-related GI events. PMID:24991383

  16. He Did What?: The role of diagnosticity in revising implicit evaluations

    PubMed Central

    Cone, Jeremy; Ferguson, Melissa J.

    2015-01-01

    Research suggests that implicit evaluations are relatively insensitive to single instances of new, countervailing information that contradicts prior learning. In six experiments, however, we identify the critical role of the perceived diagnosticity of that new information: counter-attitudinal information that is deemed highly diagnostic of the target's true nature leads to a complete reversal of the previous implicit evaluation. Experiments 1a and 1b establish this effect by showing that newly-formed implicit evaluations are reversed minutes later with exposure to a single piece of highly diagnostic information. Experiment 2 demonstrates a valence asymmetry in participants’ likelihood of exhibiting rapid reversals of newly formed positive versus negative implicit evaluations. Experiment 3 provides evidence that a target must be personally responsible for the counter-attitudinal behavior and not merely incidentally associated with a negative act. Experiment 4 shows that participants exhibit revision only when they judge the target's counter-attitudinal behavior as offensive and thus diagnostic of his character. Experiment 5 demonstrates the behavioral implications of newly-revised implicit evaluations. These studies show that newly-formed implicit evaluations can be completely overturned through deliberative considerations about a single piece of counter-attitudinal information. PMID:25365037

  17. Diagnostic validity of ultrasonography in evaluation of pulmonary thromboembolism

    PubMed Central

    Abootalebi, Alireza; Golshani, Keihan; Karami, Mehdi; Masoumi, Babak; Aliasgharlou, Maryam

    2016-01-01

    Background: Diagnosis of pulmonary embolism (PE) remains difficult due to its nonspecific symptoms and signs. Therefore, many patients die undiagnosed or untreated. We decided to study the sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of pulmonary thromboembolism. Materials and Methods: In this prospective study, 77 patients with clinically suspected PE in the emergency department of Isfahan Al-Zahra Hospital were enrolled from September 2011 to September 2012. At first, they were evaluated by thoracic ultrasonography (TUS) and then divided into four groups based on their TUS findings. Multi-slice computed tomography (MSCT) was the reference method in this study performed within 24 h from admission. MSCT scans were interpreted by a radiologist who was unaware of the TUS results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPVs) of thoracic ultrasonography were determined. Results: PE diagnosis was confirmed by MSCT in 25 patients and 54 hypoechoic lesions were detected by TUS with the average size of 16.4 mm × 11.1 mm. In our study, sensitivity, specificity, PPV, NPV, and accuracy of TUS for PE diagnosis were 84%, 94.2%, 87.5%, and 92.5%, respectively. Conclusion: TUS is an inexpensive, safe and easily available method for timely diagnosis and treatment of PE in emergency department and its NPV is high for cases with low scores for Wells criteria who had a normal or possible TUS findings. It is also specific in the diagnosis of PE in cases with high scores Wells criteria who have confirmed or probable TUS findings. PMID:26955625

  18. Fully covered self-expandable metal stent in the treatment of postsurgical colorectal diseases: outcome in 29 patients

    PubMed Central

    Cereatti, Fabrizio; Fiocca, Fausto; Dumont, Jean-Loup; Ceci, Vincenzo; Vergeau, Bertrand-Marie; Tuszynski, Thierry; Meduri, Bruno; Donatelli, Gianfranco

    2016-01-01

    Background: Self-expandable metal stent (SEMS) placement is a minimally invasive treatment for palliation of malignant colorectal strictures and as a bridge to surgery. However, the use of SEMS for benign colorectal diseases is controversial. The purpose of this retrospective study is to evaluate the efficacy and safety of fully covered SEMS (FCSEMS) placement in postsurgical colorectal diseases. Methods: From 2008 to 2014, 29 patients with 32 FCSEMS deployment procedures were evaluated. The indications for stent placement were: 17 anastomotic strictures (3/17 presented complete closure of the anastomosis); four anastomotic leaks; seven strictures associated with anastomotic leak; and one rectum-vagina fistula. Results: Clinical success was achieved in 18 out of 29 patients (62.1%) being symptom-free at an average of 19 months. In the remaining 11 patients (37.9%), a different treatment was needed: four patients required multiple endoscopic dilations, 4 patients colostomy confection, one patient definitive ileostomy and three patients revisional surgery. The FCSEMS were kept in place for a mean period of 34 (range: 6–65) days. Major complications occurred in 12 out of 29 patients (41.4%) and consisted of stent migration. Minor complications included two cases of transient fever, eight cases of abdominal or rectal pain, and one case of tenesmus. Conclusion: FCSEMS are considered a possible therapeutic option for treatment of postsurgical strictures and leaks. However, their efficacy in guaranteeing long-term anastomotic patency and leak closure is moderate. A major complication is migration. The use of FCSEMS for colonic postsurgical pathologies should be carefully evaluated for each patient. PMID:26929780

  19. Interleukin-8 reduces post-surgical lymphedema formation by promoting lymphatic vessel regeneration.

    PubMed

    Choi, Inho; Lee, Yong Suk; Chung, Hee Kyoung; Choi, Dongwon; Ecoiffier, Tatiana; Lee, Ha Neul; Kim, Kyu Eui; Lee, Sunju; Park, Eun Kyung; Maeng, Yong Sun; Kim, Nam Yun; Ladner, Robert D; Petasis, Nicos A; Koh, Chester J; Chen, Lu; Lenz, Heinz-Josef; Hong, Young-Kwon

    2013-01-01

    Lymphedema is mainly caused by lymphatic obstruction and manifested as tissue swelling, often in the arms and legs. Lymphedema is one of the most common post-surgical complications in breast cancer patients and presents a painful and disfiguring chronic illness that has few treatment options. Here, we evaluated the therapeutic potential of interleukin (IL)-8 in lymphatic regeneration independent of its pro-inflammatory activity. We found that IL-8 promoted proliferation, tube formation, and migration of lymphatic endothelial cells (LECs) without activating the VEGF signaling. Additionally, IL-8 suppressed the major cell cycle inhibitor CDKN1C/p57(KIP2) by downregulating its positive regulator PROX1, which is known as the master regulator of LEC-differentiation. Animal-based studies such as matrigel plug and cornea micropocket assays demonstrated potent efficacy of IL-8 in activating lymphangiogenesis in vivo. Moreover, we have generated a novel transgenic mouse model (K14-hIL8) that expresses human IL-8 in the skin and then crossed with lymphatic-specific fluorescent (Prox1-GFP) mouse. The resulting double transgenic mice showed that a stable expression of IL-8 could promote embryonic lymphangiogenesis. Moreover, an immunodeficient IL-8-expressing mouse line that was established by crossing K14-hIL8 mice with athymic nude mice displayed an enhanced tumor-associated lymphangiogenesis. Finally, when experimental lymphedema was introduced, K14-hIL8 mice showed an improved amelioration of lymphedema with an increased lymphatic regeneration. Together, we report that IL-8 can activate lymphangiogenesis in vitro and in vivo with a therapeutic efficacy in post-surgical lymphedema.

  20. Liposomal extended-release bupivacaine for postsurgical analgesia

    PubMed Central

    Lambrechts, Mark; O’Brien, Michael J; Savoie, Felix H; You, Zongbing

    2013-01-01

    When physicians consider which analgesia to use postsurgery, the primary goal is to relieve pain with minimal adverse side effects. Bupivacaine, a commonly used analgesic, has been formulated into an aqueous suspension of multivesicular liposomes that provide long-lasting analgesia for up to 72 hours, while avoiding the adverse side effects of opioids. The increased efficacy of liposomal extended-release bupivacaine, compared to bupivacaine hydrochloride, has promoted its usage in a variety of surgeries including hemorrhoidectomy, bunionectomy, inguinal hernia repair, total knee arthroplasty, and augmentation mammoplasty. However, like other bupivacaine formulations, the liposomal extended-release bupivacaine does have some side effects. In this brief review, we provide an update of the current knowledge in the use of bupivacaine for postsurgical analgesia. PMID:24043932

  1. Liposomal extended-release bupivacaine for postsurgical analgesia.

    PubMed

    Lambrechts, Mark; O'Brien, Michael J; Savoie, Felix H; You, Zongbing

    2013-09-06

    When physicians consider which analgesia to use postsurgery, the primary goal is to relieve pain with minimal adverse side effects. Bupivacaine, a commonly used analgesic, has been formulated into an aqueous suspension of multivesicular liposomes that provide long-lasting analgesia for up to 72 hours, while avoiding the adverse side effects of opioids. The increased efficacy of liposomal extended-release bupivacaine, compared to bupivacaine hydrochloride, has promoted its usage in a variety of surgeries including hemorrhoidectomy, bunionectomy, inguinal hernia repair, total knee arthroplasty, and augmentation mammoplasty. However, like other bupivacaine formulations, the liposomal extended-release bupivacaine does have some side effects. In this brief review, we provide an update of the current knowledge in the use of bupivacaine for postsurgical analgesia.

  2. Postsurgical mortality secondary to zinc toxicity in dogs.

    PubMed

    Meurs, K M; Breitschwerdt, E B; Baty, C J; Young, M A

    1991-12-01

    Zinc may be extremely toxic when absorbed from a metallic foreign body retained in the stomach. The most common cause of zinc toxicosis in dogs appears associated with accidental ingestion of copper-coated zinc pennies minted after 1982. In a retrospective literature search, zinc toxicosis due to penny ingestion was reported in 5 dogs, 2 of which died postoperatively, and 1 was euthanatized due to severe multiorgan system failure. In this report, we describe 3 additional cases of zinc toxicosis due to penny ingestion that resulted in a fatal outcome. Two dogs died during the early postoperative period, and another dog was euthanatized 5 d postoperatively due to continued deterioration. These cases emphasize the potential of perioperative complications associated with zinc toxicosis due to penny ingestion and suggest the need for better treatment options to decrease postsurgical mortality associated with this disease entity.

  3. [Post-surgical septic arthritis of the pubic symphysis].

    PubMed

    Salomon, S; Lasselin-Boyard, P; Lasselin, J; Goëb, V

    2015-03-01

    The post-surgical septic arthritis of the pubic symphysis is a rare infection, often unrecognized because sometimes it is difficult to diagnose. It should be suspected in the presence of pelvic pain with fever and sometimes lameness or painful radiation to the lower limbs but the symptoms can be misleading. We report 3 cases of post surgical septic arthritis of the pubic symphysis to illustrate it. Differential diagnoses are numerous and additional tests not always specific. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations are essential to substantiate the diagnosis or to guide sampling. The appropriate antibiotic treatment against the identified germ, which is extended at least six weeks, will most often, when started early, allow the healing though pain can persist for several months.

  4. Evaluation of diagnostic criteria for night eating syndrome using item response theory analysis.

    PubMed

    Allison, Kelly C; Engel, Scott G; Crosby, Ross D; de Zwaan, Martina; O'Reardon, John P; Wonderlich, Stephen A; Mitchell, James E; West, Delia Smith; Wadden, Thomas A; Stunkard, Albert J

    2008-12-01

    Uniform diagnostic criteria for the night eating syndrome (NES), a disorder characterized by a delay in the circadian pattern of eating, have not been established. Proposed criteria for NES were evaluated using item response theory (IRT) analysis. Six studies yielded 1,481 Night Eating Questionnaires which were coded to reflect the presence/absence of five night eating symptoms. Symptoms were evaluated based on the clinical usefulness of their diagnostic information and on the assumptions of IRT analysis (unidimensionality, monotonicity, local item independence, correct model specification), using a two parameter logistic (2PL) IRT model. Reports of (1) nocturnal eating and/or evening hyperphagia, (2) initial insomnia, and (3) night awakenings showed high precision in discriminating those with night eating problems, while morning anorexia and delayed morning meal provided little additional information. IRT is a useful tool for evaluating the diagnostic criteria of psychiatric disorders and can be used to evaluate potential diagnostic criteria of NES empirically. Behavioral factors were identified as useful discriminators of NES. Future work should also examine psychological factors in conjunction with those identified here.

  5. Evaluation of diagnostic criteria for night eating syndrome using item response theory analysis.

    PubMed

    Allison, Kelly C; Engel, Scott G; Crosby, Ross D; de Zwaan, Martina; O'Reardon, John P; Wonderlich, Stephen A; Mitchell, James E; West, Delia Smith; Wadden, Thomas A; Stunkard, Albert J

    2008-12-01

    Uniform diagnostic criteria for the night eating syndrome (NES), a disorder characterized by a delay in the circadian pattern of eating, have not been established. Proposed criteria for NES were evaluated using item response theory (IRT) analysis. Six studies yielded 1,481 Night Eating Questionnaires which were coded to reflect the presence/absence of five night eating symptoms. Symptoms were evaluated based on the clinical usefulness of their diagnostic information and on the assumptions of IRT analysis (unidimensionality, monotonicity, local item independence, correct model specification), using a two parameter logistic (2PL) IRT model. Reports of (1) nocturnal eating and/or evening hyperphagia, (2) initial insomnia, and (3) night awakenings showed high precision in discriminating those with night eating problems, while morning anorexia and delayed morning meal provided little additional information. IRT is a useful tool for evaluating the diagnostic criteria of psychiatric disorders and can be used to evaluate potential diagnostic criteria of NES empirically. Behavioral factors were identified as useful discriminators of NES. Future work should also examine psychological factors in conjunction with those identified here. PMID:18928902

  6. Does Sex Influence the Diagnostic Evaluation of Autism Spectrum Disorder in Adults?

    ERIC Educational Resources Information Center

    Wilson, C. Ellie; Murphy, Clodagh M.; McAlonan, Grainne; Robertson, Dene M.; Spain, Debbie; Hayward, Hannah; Woodhouse, Emma; Deeley, P. Quinton; Gillan, Nicola; Ohlsen, J. Chris; Zinkstok, Janneke; Stoencheva, Vladimira; Faulkner, Jessica; Yildiran, Hatice; Bell, Vaughan; Hammond, Neil; Craig, Michael C.; Murphy, Declan G. M.

    2016-01-01

    It is unknown whether sex influences the diagnostic evaluation of autism spectrum disorder, or whether male and female adults within the spectrum have different symptom profiles. This study reports sex differences in clinical outcomes for 1,244 adults (935 males and 309 females) referred for autism spectrum disorder assessment. Significantly, more…

  7. Diagnostic Evaluation of Ozone Production and Horizontal Transport in a Regional Photochemical Air Quality Modeling System

    EPA Science Inventory

    A diagnostic model evaluation effort has been performed to focus on photochemical ozone formation and the horizontal transport process since they strongly impact the temporal evolution and spatial distribution of ozone (O3) within the lower troposphere. Results from th...

  8. A Statistical Evaluation of the Diagnostic Performance of MEDAS-The Medical Emergency Decision Assistance System

    PubMed Central

    Georgakis, D. Christine; Trace, David A.; Naeymi-Rad, Frank; Evens, Martha

    1990-01-01

    Medical expert systems require comprehensive evaluation of their diagnostic accuracy. The usefulness of these systems is limited without established evaluation methods. We propose a new methodology for evaluating the diagnostic accuracy and the predictive capacity of a medical expert system. We have adapted to the medical domain measures that have been used in the social sciences to examine the performance of human experts in the decision making process. Thus, in addition to the standard summary measures, we use measures of agreement and disagreement, and Goodman and Kruskal's λ and τ measures of predictive association. This methodology is illustrated by a detailed retrospective evaluation of the diagnostic accuracy of the MEDAS system. In a study using 270 patients admitted to the North Chicago Veterans Administration Hospital, diagnoses produced by MEDAS are compared with the discharge diagnoses of the attending physicians. The results of the analysis confirm the high diagnostic accuracy and predictive capacity of the MEDAS system. Overall, the agreement of the MEDAS system with the “gold standard” diagnosis of the attending physician has reached a 90% level.

  9. Development and Evaluation of the Diagnostic Power for a Computer-Based Two-Tier Assessment

    ERIC Educational Resources Information Center

    Lin, Jing-Wen

    2016-01-01

    This study adopted a quasi-experimental design with follow-up interview to develop a computer-based two-tier assessment (CBA) regarding the science topic of electric circuits and to evaluate the diagnostic power of the assessment. Three assessment formats (i.e., paper-and-pencil, static computer-based, and dynamic computer-based tests) using…

  10. An Evaluation of Physician Assistants in Diagnostic Radiology. Research Digest Series.

    ERIC Educational Resources Information Center

    Kiernan, Brian; Rosenbaum, H. D.

    Based on a followup study of graduates from a two-year training program for Physician Assistants in Diagnostic Radiology (PA-DR) at the University of Kentucky Medical Center, results are presented of an evaluation of the first year of postgraduate work activities of the initial two classes (twelve students) in nine different radiological work…

  11. Evaluating Secondary Students' Scientific Reasoning in Genetics Using a Two-Tier Diagnostic Instrument

    NASA Astrophysics Data System (ADS)

    Tsui, Chi-Yan; Treagust, David

    2010-05-01

    While genetics has remained as one key topic in school science, it continues to be conceptually and linguistically difficult for students with the concomitant debates as to what should be taught in the age of biotechnology. This article documents the development and implementation of a two-tier multiple-choice instrument for diagnosing grades 10 and 12 students' understanding of genetics in terms of reasoning. The pretest and posttest forms of the diagnostic instrument were used alongside other methods in evaluating students' understanding of genetics in a case-based qualitative study on teaching and learning with multiple representations in three Western Australian secondary schools. Previous studies have shown that a two-tier diagnostic instrument is useful in probing students' understanding or misunderstanding of scientific concepts and ideas. The diagnostic instrument in this study was designed and then progressively refined, improved, and implemented to evaluate student understanding of genetics in three case schools. The final version of the instrument had Cronbach's alpha reliability of 0.75 and 0.64, respectively, for its pretest and the posttest forms when it was administered to a group of grade 12 students (n = 17). This two-tier diagnostic instrument complemented other qualitative data collection methods in this research in generating a more holistic picture of student conceptual learning of genetics in terms of scientific reasoning. Implications of the findings of this study using the diagnostic instrument are discussed.

  12. Dynamic evaluation and control of blood clotting using a microfluidic platform for high-throughput diagnostics

    NASA Astrophysics Data System (ADS)

    Combariza, Miguel E.; Yu, Xinghuo; Nesbitt, Warwick; Tovar-Lopez, Francisco; Rabus, Dominik G.; Mitchell, Arnan

    2015-12-01

    Microfluidic technology has the potential to revolutionise blood-clotting diagnostics by incorporating key physiological blood flow conditions like shear rate. In this paper we present a customised dynamic microfluidic system, which evaluates the blood clotting response to multiple conditions of shear rate on a single microchannel. The system can achieve high-throughput testing through use of an advanced fluid control system, which provides with rapid and precise regulation of the blood flow conditions in the platform. We present experimental results that demonstrate the potential of this platform to develop into a high-throughput, low-cost, blood-clotting diagnostics device.

  13. Evaluating radiographers' diagnostic accuracy in screen-reading mammograms: what constitutes a quality study?

    SciTech Connect

    Debono, Josephine C; Poulos, Ann E

    2015-03-15

    The aim of this study was to first evaluate the quality of studies investigating the diagnostic accuracy of radiographers as mammogram screen-readers and then to develop an adapted tool for determining the quality of screen-reading studies. A literature search was used to identify relevant studies and a quality evaluation tool constructed by combining the criteria for quality of Whiting, Rutjes, Dinnes et al. and Brealey and Westwood. This constructed tool was then applied to the studies and subsequently adapted specifically for use in evaluating quality in studies investigating diagnostic accuracy of screen-readers. Eleven studies were identified and the constructed tool applied to evaluate quality. This evaluation resulted in the identification of quality issues with the studies such as potential for bias, applicability of results, study conduct, reporting of the study and observer characteristics. An assessment of the applicability and relevance of the tool for this area of research resulted in adaptations to the criteria and the development of a tool specifically for evaluating diagnostic accuracy in screen-reading. This tool, with further refinement and rigorous validation can make a significant contribution to promoting well-designed studies in this important area of research and practice.

  14. Commercial Dengue Rapid Diagnostic Tests for Point-of-Care Application: Recent Evaluations and Future Needs?

    PubMed Central

    Blacksell, Stuart D.

    2012-01-01

    Dengue fever, dengue haemorrhagic fever, and dengue shock syndrome (DF/DHF/DSS) are tropical diseases that cause significant humanitarian and economic hardship. It is estimated that more than 2.5 billion people are at risk of infection and more than 100 countries have endemic dengue virus transmission. Laboratory tests are essential to provide an accurate diagnosis of dengue virus infection so that appropriate treatment and patient management may be administered. In many dengue endemic settings, laboratory diagnostic resources are limited and simple rapid diagnostic tests (RDTs) provide opportunities for point-of-care diagnosis. This paper addresses current issues relating to the application of commercial dengue RDTs for the diagnosis of acute dengue virus infection, recent diagnostic evaluations, and identifies future needs. PMID:22654479

  15. Commercial dengue rapid diagnostic tests for point-of-care application: recent evaluations and future needs?

    PubMed

    Blacksell, Stuart D

    2012-01-01

    Dengue fever, dengue haemorrhagic fever, and dengue shock syndrome (DF/DHF/DSS) are tropical diseases that cause significant humanitarian and economic hardship. It is estimated that more than 2.5 billion people are at risk of infection and more than 100 countries have endemic dengue virus transmission. Laboratory tests are essential to provide an accurate diagnosis of dengue virus infection so that appropriate treatment and patient management may be administered. In many dengue endemic settings, laboratory diagnostic resources are limited and simple rapid diagnostic tests (RDTs) provide opportunities for point-of-care diagnosis. This paper addresses current issues relating to the application of commercial dengue RDTs for the diagnosis of acute dengue virus infection, recent diagnostic evaluations, and identifies future needs.

  16. Diagnostic agreement when comparing still and video imaging for the medical evaluation of child sexual abuse.

    PubMed

    Killough, Emily; Spector, Lisa; Moffatt, Mary; Wiebe, Jan; Nielsen-Parker, Monica; Anderst, Jim

    2016-02-01

    Still photo imaging is often used in medical evaluations of child sexual abuse (CSA) but video imaging may be superior. We aimed to compare still images to videos with respect to diagnostic agreement regarding hymenal deep notches and transections in post-pubertal females. Additionally, we evaluated the role of experience and expertise on agreement. We hypothesized that videos would result in improved diagnostic agreement of multiple evaluators as compared to still photos. This was a prospective quasi-experimental study using imaging modality as the quasi-independent variable. The dependent variable was diagnostic agreement of participants regarding presence/absence of findings indicating penetrative trauma on non-acute post-pubertal genital exams. Participants were medical personnel who regularly perform CSA exams. Diagnostic agreement was evaluated utilizing a retrospective selection of videos and still photos obtained directly from the videos. Videos and still photos were embedded into an on-line survey as sixteen cases. One-hundred sixteen participants completed the study. Participant diagnosis was more likely to agree with study center diagnosis when using video (p<0.01). Use of video resulted in statistically significant changes in diagnosis in four of eight cases. In two cases, the diagnosis of the majority of participants changed from no hymenal transection to transection present. No difference in agreement was found based on experience or expertise. Use of video vs. still images resulted in increased agreement with original examiner and changes in diagnostic impressions in review of CSA exams. Further study is warranted, as video imaging may have significant impacts on diagnosis. PMID:26746111

  17. Diagnostic agreement when comparing still and video imaging for the medical evaluation of child sexual abuse.

    PubMed

    Killough, Emily; Spector, Lisa; Moffatt, Mary; Wiebe, Jan; Nielsen-Parker, Monica; Anderst, Jim

    2016-02-01

    Still photo imaging is often used in medical evaluations of child sexual abuse (CSA) but video imaging may be superior. We aimed to compare still images to videos with respect to diagnostic agreement regarding hymenal deep notches and transections in post-pubertal females. Additionally, we evaluated the role of experience and expertise on agreement. We hypothesized that videos would result in improved diagnostic agreement of multiple evaluators as compared to still photos. This was a prospective quasi-experimental study using imaging modality as the quasi-independent variable. The dependent variable was diagnostic agreement of participants regarding presence/absence of findings indicating penetrative trauma on non-acute post-pubertal genital exams. Participants were medical personnel who regularly perform CSA exams. Diagnostic agreement was evaluated utilizing a retrospective selection of videos and still photos obtained directly from the videos. Videos and still photos were embedded into an on-line survey as sixteen cases. One-hundred sixteen participants completed the study. Participant diagnosis was more likely to agree with study center diagnosis when using video (p<0.01). Use of video resulted in statistically significant changes in diagnosis in four of eight cases. In two cases, the diagnosis of the majority of participants changed from no hymenal transection to transection present. No difference in agreement was found based on experience or expertise. Use of video vs. still images resulted in increased agreement with original examiner and changes in diagnostic impressions in review of CSA exams. Further study is warranted, as video imaging may have significant impacts on diagnosis.

  18. Does sex influence the diagnostic evaluation of autism spectrum disorder in adults?

    PubMed

    Wilson, C Ellie; Murphy, Clodagh M; McAlonan, Grainne; Robertson, Dene M; Spain, Debbie; Hayward, Hannah; Woodhouse, Emma; Deeley, P Quinton; Gillan, Nicola; Ohlsen, J Chris; Zinkstok, Janneke; Stoencheva, Vladimira; Faulkner, Jessica; Yildiran, Hatice; Bell, Vaughan; Hammond, Neil; Craig, Michael C; Murphy, Declan Gm

    2016-10-01

    It is unknown whether sex influences the diagnostic evaluation of autism spectrum disorder, or whether male and female adults within the spectrum have different symptom profiles. This study reports sex differences in clinical outcomes for 1244 adults (935 males and 309 females) referred for autism spectrum disorder assessment. Significantly, more males (72%) than females (66%) were diagnosed with an autism spectrum disorder of any subtype (x(2) = 4.09; p = 0.04). In high-functioning autism spectrum disorder adults (IQ > 70; N = 827), there were no significant sex differences in severity of socio-communicative domain symptoms. Males had significantly more repetitive behaviours/restricted interests than females (p = 0.001, d = 0.3). A multivariate analysis of variance indicated a significant interaction between autism spectrum disorder subtype (full-autism spectrum disorder/partial-autism spectrum disorder) and sex: in full-autism spectrum disorder, males had more severe socio-communicative symptoms than females; for partial-autism spectrum disorder, the reverse was true. There were no sex differences in prevalence of co-morbid psychopathologies. Sex influenced diagnostic evaluation in a clinical sample of adults with suspected autism spectrum disorder. The sexes may present with different manifestations of the autism spectrum disorder phenotype and differences vary by diagnostic subtype. Understanding and awareness of adult female repetitive behaviours/restricted interests warrant attention and sex-specific diagnostic assessment tools may need to be considered.

  19. Chronic postsurgical pain and neuropathic symptoms after abdominal hysterectomy: A silent epidemic.

    PubMed

    Beyaz, Serbülent Gökhan; Özocak, Hande; Ergönenç, Tolga; Palabyk, Onur; Tuna, Ayça Taş; Kaya, Burak; Erkorkmaz, Ünal; Akdemir, Nermin

    2016-08-01

    Chronic postsurgical pain (CPSP) is an important clinic problem. It is assessed that prevalence of chronic pain extends to 30% but it is contended that there are various risk factors. We aimed to evaluate the prevalence of chronic pain after hysterectomy, risk factors of chronicity, neuropathic features of pain, and sensorial alterations at surgery area.Between years 2012 and 2015, 16 to 65 ages old patients that electively undergone total abdominal hysterectomy bilateral salpingo-oophorectomy and passed minimum 3 months after surgery were included to study. Visual analog scale (VAS) and Douleur Neuropathique 4-questionnaire (DN-4) surveys were used to evaluate pain symptoms, algometry device was used for evaluating abdominal pressure threshold and Von Frey Filament was used for sensorial alterations.Ninety-three of 165 eligible patients were included to study. As the groups were compared by demographic data, no difference was obtained (P > 0.05). There was no difference between groups regarding patient and surgery attributes (P > 0.05). Most frequently performed incision type was Pfannenstiel. Neuropathic symptoms were observed in 90 patients (96.8%). Sensorial alterations as hypoesthesia and hyperesthesia were detected around abdominal scar in 18 patients (19.4%) with pinprick test.Neuropathic symptoms should not be ignored in studies evaluating CPSP and a standard methodology should be designed for studies in this topic. PMID:27537570

  20. Veterinary practitioners’ selection of diagnostic tests for the primary evaluation of colic in the horse

    PubMed Central

    Curtis, L.; Trewin, I.; England, G. C. W.; Burford, J. H.; Freeman, S. L.

    2015-01-01

    The aim of this study was to survey veterinary practitioners’ selection of diagnostic tests for horses with clinical signs of abdominal pain. A questionnaire was distributed to veterinary surgeons involved in the primary evaluation of horses with abdominal pain, including the respondent's demographics, selection of diagnostic tests and factors affecting decision-making. Data analysis included descriptive analysis, categorisation of free text and simple univariable correlations to explore the relationships between independent variables and the relative self-estimated frequency that diagnostic tests were performed. A total of 228 responses were analysed. Participants worked in mixed practice (55.7 per cent), first opinion equine (22.8 per cent), first and second opinion equine (17.9 per cent) and referral practice (3.1 per cent). The majority (48.2 per cent, 105/218) were very confident managing a colic case (confidence level 4/5). The most frequently used diagnostic tests were ‘response to analgesia’ (87.2±24.0 per cent cases), rectal examination (75.9±21.2 per cent) and nasogastric intubation (43.8±27.6 per cent). Approach varied between practitioners, and for all diagnostic tests with frequency of use ranging from 0 to 100 per cent of cases. ‘Risk to personal safety’ was the most common reason for not using rectal examination. Practitioner's opinion of their confidence level in managing a colic case was associated with how frequently they used different diagnostic tests. There was marked variation in practitioners’ approaches, highlighting the need for further evidence to support decision-making. PMID:26457192

  1. Methods and recommendations for evaluating and reporting a new diagnostic test.

    PubMed

    Hess, A S; Shardell, M; Johnson, J K; Thom, K A; Strassle, P; Netzer, G; Harris, A D

    2012-09-01

    No standardized guidelines exist for the biostatistical methods appropriate for studies evaluating diagnostic tests. Publication recommendations such as the STARD statement provide guidance for the analysis of data, but biostatistical advice is minimal and application is inconsistent. This article aims to provide a self-contained, accessible resource on the biostatistical aspects of study design and reporting for investigators. For all dichotomous diagnostic tests, estimates of sensitivity and specificity should be reported with confidence intervals. Power calculations are strongly recommended to ensure that investigators achieve desired levels of precision. In the absence of a gold standard reference test, the composite reference standard method is recommended for improving estimates of the sensitivity and specificity of the test under evaluation.

  2. [Evaluating extensive consciousness disturbance. Roulette or well-founded forensic diagnostics?].

    PubMed

    Schiffer, B

    2007-03-01

    The difficulties of experts to judge and evaluate so-called affect crimes are due to theoretical and conceptual shortcomings on the one hand and problems of reproducibility on the other. This study describes an attempt to set up diagnostic guidelines for such cases. A vulnerability/stress model was developed which integrates features from different areas: predisposition (including social perception, thinking, and problem solving), triggering conditions (mainly derived from stress theories and concepts), and the established Sass criteria (1983). The characteristics of these respective diagnostic features were collected from a sample of 31 criminal responsibility examinations. Finally, implementing multivariate analysis, 13 criteria were established that could be useful in evaluating criminal responsibility with regard to consciousness disturbances in that they enable testimony based on the prognostic and discriminant validity of the individual criteria.

  3. Thrombocytosis: Diagnostic Evaluation, Thrombotic Risk Stratification, and Risk-Based Management Strategies

    PubMed Central

    Bleeker, Jonathan S.; Hogan, William J.

    2011-01-01

    Thrombocytosis is a commonly encountered clinical scenario, with a large proportion of cases discovered incidentally. The differential diagnosis for thrombocytosis is broad and the diagnostic process can be challenging. Thrombocytosis can be spurious, attributed to a reactive process or due to clonal disorder. This distinction is important as it carries implications for evaluation, prognosis, and treatment. Clonal thrombocytosis associated with the myeloproliferative neoplasms, especially essential thrombocythemia and polycythemia vera, carries a unique prognostic profile, with a markedly increased risk of thrombosis. This risk is the driving factor behind treatment strategies in these disorders. Clinical trials utilizing targeted therapies in thrombocytosis are ongoing with new therapeutic targets waiting to be explored. This paper will outline the mechanisms underlying thrombocytosis, the diagnostic evaluation of thrombocytosis, complications of thrombocytosis with a special focus on thrombotic risk as well as treatment options for clonal processes leading to thrombocytosis, including essential thrombocythemia and polycythemia vera. PMID:22084665

  4. Methods and recommendations for evaluating and reporting a new diagnostic test

    PubMed Central

    Shardell, M.; Johnson, J. K.; Thom, K. A.; Strassle, P.; Netzer, G.; Harris, A. D.

    2013-01-01

    No standardized guidelines exist for the biostatistical methods appropriate for studies evaluating diagnostic tests. Publication recommendations such as the STARD statement provide guidance for the analysis of data, but biostatistical advice is minimal and application is inconsistent. This article aims to provide a self-contained, accessible resource on the biostatistical aspects of study design and reporting for investigators. For all dichotomous diagnostic tests, estimates of sensitivity and specificity should be reported with confidence intervals. Power calculations are strongly recommended to ensure that investigators achieve desired levels of precision. In the absence of a gold standard reference test, the composite reference standard method is recommended for improving estimates of the sensitivity and specificity of the test under evaluation. PMID:22476385

  5. Comparison of Endoscopic Vacuum Therapy and Endoscopic Stent Implantation With Self-Expandable Metal Stent in Treating Postsurgical Gastroesophageal Leakage.

    PubMed

    Hwang, Jae J; Jeong, Yeon S; Park, Young S; Yoon, Hyuk; Shin, Cheol M; Kim, Nayoung; Lee, Dong H

    2016-04-01

    The aim of the present study was to evaluate the more effective therapy for the postsurgical gastroesophageal leakage by a head-to-head comparison of endoscopic vacuum therapy (EVT) and endoscopic stent implantation with self-expandable metal stent (E-SEMS). In this hospital-based, retrospective, observative study, the patients were classified into 2 groups. Those treated with EVT were assigned to the EVT group (n = 7), and those treated with E-SMS were assigned to the E-SEMS group (n = 11). We evaluated the clinical characteristics and treatment outcomes between the 2 groups. All 7 patients (100%) were treated with EVT, but only 7 of 11 patients (63.6%) in the stenting group were treated successfully. The median time to clinical success was 19.5 (5-21) days in the EVT group and 27.0 (3-84) days in the E-SEMS group. The median hospital stay was 37.1 (13-128) days in the EVT group and 87.3 (17-366) days in the E-SEMS group. The complicaion rate was lower in the EVT group (0/7, 0.0%) than that in the E-SEMS group (6/11, 54.5%) with statistically significant difference (P = 0.042). EVT is more effective and has fewer adverse effects than E-SMS therapy as a treatment for postsurgical gastroesophageal leakage.

  6. Comparison of Endoscopic Vacuum Therapy and Endoscopic Stent Implantation With Self-Expandable Metal Stent in Treating Postsurgical Gastroesophageal Leakage

    PubMed Central

    Hwang, Jae J.; Jeong, Yeon S.; Park, Young S.; Yoon, Hyuk; Shin, Cheol M.; Kim, Nayoung; Lee, Dong H.

    2016-01-01

    Abstract The aim of the present study was to evaluate the more effective therapy for the postsurgical gastroesophageal leakage by a head-to-head comparison of endoscopic vacuum therapy (EVT) and endoscopic stent implantation with self-expandable metal stent (E-SEMS). In this hospital-based, retrospective, observative study, the patients were classified into 2 groups. Those treated with EVT were assigned to the EVT group (n = 7), and those treated with E-SMS were assigned to the E-SEMS group (n = 11). We evaluated the clinical characteristics and treatment outcomes between the 2 groups. All 7 patients (100%) were treated with EVT, but only 7 of 11 patients (63.6%) in the stenting group were treated successfully. The median time to clinical success was 19.5 (5–21) days in the EVT group and 27.0 (3–84) days in the E-SEMS group. The median hospital stay was 37.1 (13–128) days in the EVT group and 87.3 (17–366) days in the E-SEMS group. The complicaion rate was lower in the EVT group (0/7, 0.0%) than that in the E-SEMS group (6/11, 54.5%) with statistically significant difference (P = 0.042). EVT is more effective and has fewer adverse effects than E-SMS therapy as a treatment for postsurgical gastroesophageal leakage. PMID:27100431

  7. Comparison of Endoscopic Vacuum Therapy and Endoscopic Stent Implantation With Self-Expandable Metal Stent in Treating Postsurgical Gastroesophageal Leakage.

    PubMed

    Hwang, Jae J; Jeong, Yeon S; Park, Young S; Yoon, Hyuk; Shin, Cheol M; Kim, Nayoung; Lee, Dong H

    2016-04-01

    The aim of the present study was to evaluate the more effective therapy for the postsurgical gastroesophageal leakage by a head-to-head comparison of endoscopic vacuum therapy (EVT) and endoscopic stent implantation with self-expandable metal stent (E-SEMS). In this hospital-based, retrospective, observative study, the patients were classified into 2 groups. Those treated with EVT were assigned to the EVT group (n = 7), and those treated with E-SMS were assigned to the E-SEMS group (n = 11). We evaluated the clinical characteristics and treatment outcomes between the 2 groups. All 7 patients (100%) were treated with EVT, but only 7 of 11 patients (63.6%) in the stenting group were treated successfully. The median time to clinical success was 19.5 (5-21) days in the EVT group and 27.0 (3-84) days in the E-SEMS group. The median hospital stay was 37.1 (13-128) days in the EVT group and 87.3 (17-366) days in the E-SEMS group. The complicaion rate was lower in the EVT group (0/7, 0.0%) than that in the E-SEMS group (6/11, 54.5%) with statistically significant difference (P = 0.042). EVT is more effective and has fewer adverse effects than E-SMS therapy as a treatment for postsurgical gastroesophageal leakage. PMID:27100431

  8. Data mining approach to the evaluation of diagnostic tests in Wilson disease

    NASA Astrophysics Data System (ADS)

    Plutecki, Michal M.; Dądalski, Maciej; Socha, Piotr; Mulawka, Jan J.

    2009-06-01

    The purpose of this paper is to figure out a new, better than so-far-known, evaluation method of diagnostic tests in Wilson disease. In order to find the most interesting classification models various data mining techniques were applied to real, suffering from Wilson disease, set of patients. It occurred that a combination of two classification algorithms with its implementations in Weka environment may significantly increase classification ability.

  9. [Evaluating radiation dose load in medical personnel of radiologic diagnostic departments].

    PubMed

    Trunov, B V; Koroleva, E P

    2014-01-01

    The article deals with materials on radiation hygienic evaluation of radiologic diagnostic departments in various medical institutions of Moscow. The studies covered work of medical staffers in X-ray examination and in contact with short-lived isotope generators. The authors outlined the examination types and stages with maximal radiation danger. Disimetric information obtained during the study helped to calculate values of equivalent, effective doses of radiation for medical personnel and maximal potential doses.

  10. Diagnostic evaluation for interventional bronchoscopists and radiologists in lung cancer practice.

    PubMed

    Lau, W F Eddie; Ware, Rob; Herth, Felix J F

    2015-07-01

    The global epidemic of lung cancer shows no signs of abating. It is generally accepted that accurate and cost-efficient diagnostic evaluation is the first important step to achieve the best outcomes of treatment. This is true in the context of disease confirmation, treatment planning, treatment monitoring, detection of and management of treatment failure or prognostication. Fortunately, major advances in the diagnostic evaluation of lung cancer have been made in the past three decades allowing more patients to get the appropriate treatment at the right time. This paper outlines how computed tomography, positron emission tomography/computed tomography and endobronchial ultrasound contribute to lung cancer management and discuss their strengths and weaknesses and their complimentary roles at different stages of lung cancer management. Due to financial constraint and reimbursement restrictions, not all clinically important advances in the diagnostic evaluation of lung cancer have been readily accepted into routine clinical care. This enforces the need to maintain ongoing dialogue between cancer clinicians, imaging specialists and health-care economists.

  11. Postsurgical pain: zomepirac sodium, propoxyphene/-acetaminophen combination, and placebo.

    PubMed

    Honig, S; Murray, K A

    1981-10-01

    Zomepirac sodium, a new, nonnarcotic analgesic agent, was compared with the combination of propoxyphene/acetaminophen in a placebo-controlled, double-blind, single-dose study in 196 hospitalized postsurgical patients with pain severe enough to require a prescription analgesic. Patients received 100 mg zomepirac sodium, 50 mg zomepirac sodium, 100 mg propoxyphene napsylate with 650 mg acetaminophen, or placebo. Total pain relief during the 6-hour observation period showed that 100 mg zomepirac sodium was significantly more effective than the propoxyphene combination. All active drugs were superior to placebo. Percentages of patients requiring remedication before the end of the study were: 77 per cent for placebo, 48 per cent for propoxyphene/acetaminophen, 43 per cent for 50 mg zomepirac sodium, and 29 per cent for 100 mg zomepirac sodium. The numbers of patients reporting side effects were not significantly different among the treatment groups. These results confirm those of other single-dose pain studies which showed 100 mg zomepirac sodium significantly more efficacious than the propoxyphene/acetaminophen combination.

  12. Low-power laser effects in equine traumatology and postsurgically

    NASA Astrophysics Data System (ADS)

    Antikas, Theo G.

    1991-05-01

    The present field study on 800 cases of LPL treatments in situ using a preset `blind code' was designed to verify previously published field results; and to check whether a practicing equine vet, trainer, horse owner or rider may obtain beneficial therapeutic effects in traumatology and/or post-surgery, two of the most prevailing modalities in equine sportsmedicine. With the exception of chronic infected traumas, the positive/beneficial response to LPL treatment was verified in a range of 33.3% (infected) to 100% (non-infected, surgical) of the traumas under investigation. The administration of antibiotics, a modality compatible with LPL treatment in infected injuries, increased the beneficial effects of LPL irradiation to 66.7%. This fact indicates that laser irradiation should not be considered a replacement of common therapeutic routine but simply an efficient follow up or parallel treatment that may act synergistically to the benefit of an injured equine athlete. In the case of non-infected surgical trauma, LPL-treatment was additionally found to shorten the post-surgical `inactive' time period or `comeback time' (CBT), thus bringing the horse back into its sportive capacity considerably faster than without LPL irradiation, and at a statistically significant level (p < 0.001).

  13. Post-surgical management of non-functioning pituitary adenoma.

    PubMed

    Cortet-Rudelli, Christine; Bonneville, Jean-François; Borson-Chazot, Françoise; Clavier, Lorraine; Coche Dequéant, Bernard; Desailloud, Rachel; Maiter, Dominique; Rohmer, Vincent; Sadoul, Jean Louis; Sonnet, Emmanuel; Toussaint, Patrick; Chanson, Philippe

    2015-07-01

    Post-surgical surveillance of non-functioning pituitary adenoma (NFPA) is based on magnetic resonance imaging (MRI) at 3 or 6 months then 1 year. When there is no adenomatous residue, annual surveillance is recommended for 5 years and then at 7, 10 and 15 years. In case of residue or doubtful MRI, prolonged annual surveillance monitors any progression. Reintervention is indicated if complete residue resection is feasible, or for symptomatic optic pathway compression, to create a safety margin between the tumor and the optic pathways ahead of complementary radiation therapy (RT), or in case of post-RT progression. In case of residue, unless the tumor displays elevated growth potential, it is usually recommended to postpone RT until progression is manifest, as efficacy is comparable whether treatment is immediate or postponed. The efficacy of the various RT techniques in terms of tumor volume control is likewise comparable. RT-induced hypopituitarism is frequent, whatever the technique. The choice thus depends basically on residue characteristics: size, delineation, and proximity to neighboring radiation-sensitive structures. Reduced rates of vascular complications and secondary brain tumor can be hoped for with one-dose or hypofractionated stereotactic RT, but there has been insufficient follow-up to provide evidence. Somatostatin analogs and dopaminergic agonists have yet to demonstrate sufficient efficacy. Temozolomide is an option in aggressive NFPA resistant to surgery and RT. PMID:26116412

  14. Successful management of chronic postsurgical pain following total knee replacement.

    PubMed

    Vas, Lakshmi; Khandagale, Nishigandha; Pai, Renuka

    2014-10-01

    We report reversal of chronic postsurgical pain (CPSP) along with functional restoration after total knee replacement (TKR) in two patients, using a combination therapy that included ultrasonography-guided pulsed radiofrequency (PRF) of nerves supplying the knee to provide pain relief, along with dry needling (DN) to relax myofascial triggers/bands that caused painful stiffness and restricted movement of muscles acting across the knee. Both patients showed demonstrable pain relief, as evidenced by changes in pain as assessed on the Numeric Rating Scale (patient 1: 4-9/10 [pre-treatment] to 0-3/10 [6 months post-treatment]; patient 2: 5-9/10 to 0-4/10), Oxford Knee Score (patient 1: 17 to 40; patient 2: 12 to 39), Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs score (patient 1: 16 to 0; patient 2: 18 to 0), and Patient Health Questionnaire-9 score (patient 1: 17 to 2; patient 2: 20 to 2). The selection of the PRF-and-DN combination for treating post-TKR CPSP was based on a new idea that CPSP is a neuromyopathic phenomenon involving both sensory and motor neuropathy. It has evolved from our experience of 8 years. Physiotherapy worked synergistically with DN, optimizing muscle performance and pain relief.

  15. Diagnostic accuracy of the clinical feeding evaluation in detecting aspiration in children: a systematic review.

    PubMed

    Calvo, Irene; Conway, Aifric; Henriques, Filipa; Walshe, Margaret

    2016-06-01

    The aim of this systematic review is to determine the diagnostic accuracy of clinical feeding evaluation (CFE) compared to instrumental assessments in detecting oropharyngeal aspiration (OPA) in children. This is important to support clinical decision-making and to provide safe, cost-effective, higher quality care. All published and unpublished studies in all languages assessing the diagnostic accuracy of CFE compared to videofluoroscopic swallowing study (VFSS) and/or fibre-optic endoscopic examination of swallowing (FEES) in detecting OPA in paediatric populations were sought. Databases were searched from inception to April 2015. Grey literature, citations, and references were also searched. Two independent reviewers extracted and analysed data. Accuracy estimates were calculated. Research reports were translated into English as required. Six studies examining the diagnostic accuracy of CFE using VFSS and/or FEES were eligible for inclusion. Sample sizes, populations studied, and CFE characteristics varied widely. The overall methodological quality of the studies, assessed with QUADAS-2, was considered 'low'. Results suggested that CFEs trialling liquid consistencies might provide better accuracy estimates than CFEs trialling solids exclusively. This systematic review highlights the critical lack of evidence on the accuracy of CFE in detecting OPA in children. Larger well-designed primary diagnostic test accuracy studies in this area are needed to inform dysphagia assessment in paediatrics. PMID:26862075

  16. Evaluation of the diagnostic accuracy of a kit for the rapid detection of group A streptococci.

    PubMed

    Savoia, D; Francesetti, C; Millesimo, M; Dotti, G; Gatti, G; Rurali, C

    1994-01-01

    A rapid immunoassay method using an Event Test Strip Strep A experimental kit (Boehringer Mannheim) was evaluated. Results obtained were compared with culture results to evaluate the accuracy of detection of group A streptococci directly from throat swabs or from artificial swabs containing various bacterial concentrations. A good diagnostic accuracy was obtained with a sensitivity of 96.9% in the assay of throat swabs which provided more than ten group A Streptococcus colonies per plate. Since a low level of micro-organisms may indicate infection, it is recommended that a culture be performed when the rapid test based on antigen detection is negative. PMID:8208140

  17. [Evaluation of the clinical diagnostic reasoning. Use of dynamic attractors as an alternative].

    PubMed

    Prado-Vega, Rodolfo; Zacatelco-Ramírez, Oliva R; Ortiz-Montalvo, Armando; Ponce de León-Castañeda, Ma Eugenia

    2002-01-01

    The purpose of this study was to apply diagnostic clinical reasoning, based upon cognitive teaching, to help the student develop their own mental structure of an ailment or disease. Such a structure is built as mathematical chaotic deterministic type that can be evaluated through identification of dynamic attractors. To achieve our purpose, clinical diagnostic reasoning skills of two groups of students was compared against those of an expert through revision of 17 clinical cases. Such revision, selection of relevant data, allows for construction of conceptual maps in which several dynamic attractors can be identified, based on the largest number of connections that stem from some concepts. In the majority of cases, statistical analysis showed similarity among types of connections established by the expert; several similar dynamic attractors could be identified, leading us to conclude that cognitive-based teaching of diagnostic clinical reasoning is useful in developing this type of skill, and that it can be evaluated through identification of dynamic attractors. PMID:12404724

  18. Evaluating Operational Specifications of Point-of-Care Diagnostic Tests: A Standardized Scorecard

    PubMed Central

    Lehe, Jonathan D.; Sitoe, Nádia E.; Tobaiwa, Ocean; Loquiha, Osvaldo; Quevedo, Jorge I.; Peter, Trevor F.; Jani, Ilesh V.

    2012-01-01

    The expansion of HIV antiretroviral therapy into decentralized rural settings will increasingly require simple point-of-care (POC) diagnostic tests that can be used without laboratory infrastructure and technical skills. New POC test devices are becoming available but decisions around which technologies to deploy may be biased without systematic assessment of their suitability for decentralized healthcare settings. To address this, we developed a standardized, quantitative scorecard tool to objectively evaluate the operational characteristics of POC diagnostic devices. The tool scores devices on a scale of 1–5 across 30 weighted characteristics such as ease of use, quality control, electrical requirements, shelf life, portability, cost and service, and provides a cumulative score that ranks products against a set of ideal POC characteristics. The scorecard was tested on 19 devices for POC CD4 T-lymphocyte cell counting, clinical chemistry or hematology testing. Single and multi-parameter devices were assessed in each of test categories. The scores across all devices ranged from 2.78 to 4.40 out of 5. The tool effectively ranked devices within each category (p<0.01) except the CD4 and multi-parameter hematology products. The tool also enabled comparison of different characteristics between products. Agreement across the four scorers for each product was high (intra-class correlation >0.80; p<0.001). Use of this tool enables the systematic evaluation of diagnostic tests to facilitate product selection and investment in appropriate technology. It is particularly relevant for countries and testing programs considering the adoption of new POC diagnostic tests. PMID:23118871

  19. Evaluation of a lens-free imager to facilitate tuberculosis diagnostics in MODS.

    PubMed

    Solis, Leonardo; Coronel, Jorge; Rueda, Daniel; Gilman, Robert H; Sheen, Patricia; Zimic, Mirko

    2016-03-01

    Tuberculosis (TB) control efforts are hampered by a mismatch in diagnostic technology. Lack of adequate early diagnostics and Multi-drug resistant (MDR) detection is a critical problem in control efforts. Alternate and novel diagnostic approaches are required, especially in low-resources settings where they are needed most. The Microscopic Observation Drug Susceptibility (MODS) assay is a cost-effective, highly sensitive, and specific method based on the detection of characteristic cording growth patterns of Mycobacterium tuberculosis (MTB), in microscopic examination of a liquid culture under an inverted microscope. By adding antimicrobials to the wells, MODS also determines antimicrobial susceptibility in both MDR and Extreme Drug Resistant (XDR) tuberculosis. The interpretation of a MODS culture performed in a 24 well plate, requires an extensive inspection over the entire surface to detect TB cords. This process requires significant time and effort from a trained microscopist. We evaluated a lens-free imager system, able to render microscopic images of live specimens, for the proof of principle to be used for MODS culture interpretation. The lens-free imager system is able to digitalize a 24-mm(2) surface with approximately 40X magnification in a single capture. The evaluation of the lens-free imager found that it produced microscopic images that were adequate for MODS interpretation by a human expert. Compared to the average time that takes a microscopist to completely examine a MODS culture sample, the lens free imager notably reduced the time of inspection. Therefore, lens-free imager variants may constitute promising systems to aid in the diagnostics of tuberculosis, by simplifying and reducing the time of inspection and permitting automatization of MODS interpretation. PMID:26980492

  20. Epidemic of Postsurgical Infections Caused by Mycobacterium massiliense▿

    PubMed Central

    Duarte, Rafael Silva; Lourenço, Maria Cristina Silva; Fonseca, Leila de Souza; Leão, Sylvia Cardoso; Amorim, Efigenia de Lourdes T.; Rocha, Ingrid L. L.; Coelho, Fabrice Santana; Viana-Niero, Cristina; Gomes, Karen Machado; da Silva, Marlei Gomes; de Oliveira Lorena, Nádia Suely; Pitombo, Marcos Bettini; Ferreira, Rosa M. C.; de Oliveira Garcia, Márcio Henrique; de Oliveira, Gisele Pinto; Lupi, Otilia; Vilaça, Bruno Rios; Serradas, Lúcia Rodrigues; Chebabo, Alberto; Marques, Elizabeth Andrade; Teixeira, Lúcia Martins; Dalcolmo, Margareth; Senna, Simone Gonçalves; Sampaio, Jorge Luiz Mello

    2009-01-01

    An epidemic of infections after video-assisted surgery (1,051 possible cases) caused by rapidly growing mycobacteria (RGM) and involving 63 hospitals in the state of Rio de Janeiro, Brazil, occurred between August 2006 and July 2007. One hundred ninety-seven cases were confirmed by positive acid-fast staining and/or culture techniques. Thirty-eight hospitals had cases confirmed by mycobacterial culture, with a total of 148 available isolates recovered from 146 patients. Most (n = 144; 97.2%) isolates presented a PRA-hsp65 restriction pattern suggestive of Mycobacterium bolletii or Mycobacterium massiliense. Seventy-four of these isolates were further identified by hsp65 or rpoB partial sequencing, confirming the species identification as M. massiliense. Epidemic isolates showed susceptibility to amikacin (MIC at which 90% of the tested isolates are inhibited [MIC90], 8 μg/ml) and clarithromycin (MIC90, 0.25 μg/ml) but resistance to ciprofloxacin (MIC90, ≥32 μg/ml), cefoxitin (MIC90, 128 μg/ml), and doxycycline (MIC90, ≥64 μg/ml). Representative epidemic M. massiliense isolates that were randomly selected, including at least one isolate from each hospital where confirmed cases were detected, belonged to a single clone, as indicated by the analysis of pulsed-field gel electrophoresis (PFGE) patterns. They also had the same PFGE pattern as that previously observed in two outbreaks that occurred in other Brazilian cities; we designated this clone BRA100. All five BRA100 M. massiliense isolates tested presented consistent tolerance to 2% glutaraldehyde. This is the largest epidemic of postsurgical infections caused by RGM reported in the literature to date in Brazil. PMID:19403765

  1. Distinction of infected and non-infected post-surgical incisions with In-111-WBC scintigraphy

    SciTech Connect

    Abdel-Nabi, H.; Hinkle, G.H.; Olsen, J.O.

    1985-05-01

    To determine if In-111-WBCs scintigraphy can distinguish between healing and infection in post-surgical wounds, a prospective study was performed in patients with 3-14 day old surgical incisions. Eighteen patients (11 males and 7 females) were scanned 24 hrs after injection of 0.5 mCi of In-111 labeled autologous leukocytes. The scan findings were correlated with blood and/wound cultures results and diagnosis at time of discharge. Incisional uptake of In-111-WBCs was noted in 9 patients with infected surgical wounds and was absent in those 9 patients with non-infected surgical wounds. The results of the authors' study show that In-111-WBCs do not accumulate in non-infected surgical incisions. This confirms their previous findings in rats. The high specificity of In-111 leukocytes imaging makes it a valuable study in the evaluation of post-operative patients with suspected surgical wound infections. In-111 WBCs scintigraphy can distinguish between normal healing and infection at the site of recent (3-14 days) surgical incisions.

  2. Update of Diagnostic Evaluation of Craniosynostosis with a Focus on Pediatric Systematic Evaluation and Genetic Studies

    PubMed Central

    Hwang, Su-Kyeong; Park, Ki-Su; Park, Seong-Hyun

    2016-01-01

    Most craniosynostoses are sporadic, but may have an underlying genetic basis. Secondary and syndromic craniosynostosis accompanies various systemic diseases or associated anomalies. Early detection of an associated disease may facilitate the interdisciplinary management of patients and improve outcomes. For that reason, systematic evaluation of craniosynostosis is mandatory. The authors reviewed systematic evaluation of craniosynostosis with an emphasis on genetic analysis. PMID:27226851

  3. Evaluation of diagnostic accuracy and dimensional measurements by using CBCT in mandibular first molars

    PubMed Central

    Asgary, Saeed; Nikneshan, Sima; Akbarzadeh-Bagheban, Alireza

    2016-01-01

    Background This study aimed to assess the diagnostic accuracy of cone beam computed tomography (CBCT) and quantitatively evaluate the morphology of mandibular first molars using CBCT. Material and Methods Twenty-four double-rooted mandibular first molars were evaluated by NewTom VGi CBCT. The distance from the furcation and apex to the cementoenamel junction (CEJ), diameter and thickness of canal walls, the buccolingual (BL) to mesiodistal (MD) ratio (ΔD), prevalence of oval canals at different sections and taper of the canals were all determined. In order to assess the diagnostic accuracy of CBCT, distance from the furcation and apex to the CEJ and thickness of canal walls at the CEJ and apex were compared with the gold standard values (caliper and stereomicroscope). Statistical analyses were carried out using intraclass correlation coefficient (ICC), paired t-test and repeated measures ANOVA. Results A high correlation existed between the CBCT and gold standard measurements (P<0.001). In dimensional measurements, length of mesial root was higher than the distal root and lingual furcation was farther from the CEJ than the buccal furcation (P<0.001). An important finding of this study was the mesiodistal taper of the mesiobuccal (MB) and mesiolingual (ML) canals; which was equal to 0.02. Conclusions CBCT has acceptable diagnostic accuracy for measurement of canal wall thickness. Cleaning and shaping of the canals should be performed based on the unique anatomy of the respective canal; which necessitates the use of advanced imaging techniques for thorough assessment of root canal anatomy in a clinical setting. Key words:Permanent mandibular first molar, accuracy, cone-beam computed tomography, dimensional measurement. PMID:26855697

  4. The Diagnostic Accuracy of Linear Endoscopic Ultrasound for Evaluating Symptoms Suggestive of Common Bile Duct Stones

    PubMed Central

    He, Xu; Li, Jian; Min, Feng; Li, Hong-yan

    2016-01-01

    Background. In order to assess the diagnostic accuracy of linear EUS for evaluating clinically suggestive CBD stones in high-risk groups. Methods. 202 patients with clinically suggestive CBD stones in high-risk groups who underwent linear EUS examination between January 2012 and January 2015 were retrospectively reviewed. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction or surgical choledochoscopy was only performed when a CBD stone was detected by linear EUS. Cases that were negative for CBD stones were followed up for at least 6 months. Results. Of 202 enrolled patients, 126 were positive for CBD stones according to linear EUS findings. 124 patients successfully underwent ERCP, and ERCP failed in 2 who were later successfully treated by surgical intervention. There were 2 false-positive cases with positive findings for CBD stones on ERCP. Among 76 patients without CBD stones, no false-negative cases were identified during the mean 6-month follow-up. Linear EUS had sensitivity, specificity, and positive and negative predictive values for the detection of CBD stones of 100%, 92.88%, 98.21%, and 100%, respectively. Conclusions. Linear EUS is a safe and efficacious diagnostic tool for evaluating clinically suggestive CBD stones with high risk of choledocholithiasis. Performing linear EUS prior to ERCP in patients with symptoms suggestive of CBD stones can reduce unnecessary ERCP procedures.

  5. Clinical evaluation of a wireless ECG sensor system for arrhythmia diagnostic purposes.

    PubMed

    Fensli, Rune; Gundersen, Torstein; Snaprud, Tormod; Hejlesen, Ole

    2013-06-01

    In a clinical study, a novel wireless electrocardiogram (ECG) recorder has been evaluated with regard to its ability to perform arrhythmia diagnostics. As the ECG recorder will detect a "non-standard" ECG signal, it has been necessary to compare those signals to "standard" ECG recording signals in order to evaluate the arrhythmia detection ability of the new system. Simultaneous recording of ECG signals from both the new wireless ECG recorder and a conventional Holter recorder was compared by two independent cardiology specialists with regard to signal quality for performing arrhythmia diagnosis. In addition, calculated R-R intervals from the two systems were correlated. A total number of 16 patients participated in the study. It can be considered that recorded ECG signals obtained from the wireless ECG system had an acceptable quality for arrhythmia diagnosis. Some of the patients used the wireless sensor while doing physical sport activities, and the quality of the recorded ECG signals made it possible to perform arrhythmia diagnostics even under such conditions. Consequently, this makes possible improvements in correlating arrhythmias to physical activities.

  6. The Diagnostic Accuracy of Linear Endoscopic Ultrasound for Evaluating Symptoms Suggestive of Common Bile Duct Stones

    PubMed Central

    He, Xu; Li, Jian; Min, Feng; Li, Hong-yan

    2016-01-01

    Background. In order to assess the diagnostic accuracy of linear EUS for evaluating clinically suggestive CBD stones in high-risk groups. Methods. 202 patients with clinically suggestive CBD stones in high-risk groups who underwent linear EUS examination between January 2012 and January 2015 were retrospectively reviewed. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction or surgical choledochoscopy was only performed when a CBD stone was detected by linear EUS. Cases that were negative for CBD stones were followed up for at least 6 months. Results. Of 202 enrolled patients, 126 were positive for CBD stones according to linear EUS findings. 124 patients successfully underwent ERCP, and ERCP failed in 2 who were later successfully treated by surgical intervention. There were 2 false-positive cases with positive findings for CBD stones on ERCP. Among 76 patients without CBD stones, no false-negative cases were identified during the mean 6-month follow-up. Linear EUS had sensitivity, specificity, and positive and negative predictive values for the detection of CBD stones of 100%, 92.88%, 98.21%, and 100%, respectively. Conclusions. Linear EUS is a safe and efficacious diagnostic tool for evaluating clinically suggestive CBD stones with high risk of choledocholithiasis. Performing linear EUS prior to ERCP in patients with symptoms suggestive of CBD stones can reduce unnecessary ERCP procedures. PMID:27610131

  7. The Diagnostic Accuracy of Linear Endoscopic Ultrasound for Evaluating Symptoms Suggestive of Common Bile Duct Stones.

    PubMed

    Wang, Min; He, Xu; Tian, Chuan; Li, Jian; Min, Feng; Li, Hong-Yan

    2016-01-01

    Background. In order to assess the diagnostic accuracy of linear EUS for evaluating clinically suggestive CBD stones in high-risk groups. Methods. 202 patients with clinically suggestive CBD stones in high-risk groups who underwent linear EUS examination between January 2012 and January 2015 were retrospectively reviewed. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction or surgical choledochoscopy was only performed when a CBD stone was detected by linear EUS. Cases that were negative for CBD stones were followed up for at least 6 months. Results. Of 202 enrolled patients, 126 were positive for CBD stones according to linear EUS findings. 124 patients successfully underwent ERCP, and ERCP failed in 2 who were later successfully treated by surgical intervention. There were 2 false-positive cases with positive findings for CBD stones on ERCP. Among 76 patients without CBD stones, no false-negative cases were identified during the mean 6-month follow-up. Linear EUS had sensitivity, specificity, and positive and negative predictive values for the detection of CBD stones of 100%, 92.88%, 98.21%, and 100%, respectively. Conclusions. Linear EUS is a safe and efficacious diagnostic tool for evaluating clinically suggestive CBD stones with high risk of choledocholithiasis. Performing linear EUS prior to ERCP in patients with symptoms suggestive of CBD stones can reduce unnecessary ERCP procedures. PMID:27610131

  8. Evaluation of Possible Nuclear Magnetic Resonance Diagnostic Techniques for Tokamak Experiments

    SciTech Connect

    S.J. Zweben; T.W. Kornack; D. Majeski; G. Schilling; C.H. Skinner; R. Wilson

    2002-08-05

    Potential applications of nuclear magnetic resonance (NMR) diagnostic techniques to tokamak experiments are evaluated. NMR frequencies for hydrogen isotopes and low-Z nuclei in such experiments are in the frequency range approximately equal to 20-200 MHz, so existing RF [radio-frequency] antennas could be used to rotate the spin polarization and to make the NMR measurements. Our tentative conclusion is that such measurements are possible if highly spin polarized H or (superscript)3He gas sources (which exist) are used to fuel these plasmas. In addition, NMR measurements of the surface layers of the first wall (without plasma) may also be possible, e.g., to evaluate the inventory of tritium inside the vessel.

  9. Climate Model Diagnostic and Evaluation: With a Focus on Satellite Observations

    NASA Technical Reports Server (NTRS)

    Waliser, Duane

    2011-01-01

    Each year, we host a summer school that brings together the next generation of climate scientists - about 30 graduate students and postdocs from around the world - to engage with premier climate scientists from the Jet Propulsion Laboratory and elsewhere. Our yearly summer school focuses on topics on the leading edge of climate science research. Our inaugural summer school, held in 2011, was on the topic of "Using Satellite Observations to Advance Climate Models," and enabled students to explore how satellite observations can be used to evaluate and improve climate models. Speakers included climate experts from both NASA and the National Oceanic and Atmospheric Administration (NOAA), who provided updates on climate model diagnostics and evaluation and remote sensing of the planet. Details of the next summer school will be posted here in due course.

  10. Theoretical evaluation of measurement uncertainties of two-color pyrometry applied to optical diagnostics

    SciTech Connect

    Fu Tairan; Cheng Xiaofang; Yang Zangjian

    2008-11-10

    We present a theoretical analysis of two-color pyrometry applied to optical diagnostics. A two-color pyrometer built with a single CCD is advantageous due to the simple system design. We evaluate the possibility and degree of ill-conditionness on the basis of measurement uncertainties for different measurement approaches of this two-color system. We classify measurement approaches. The corresponding ill-conditionness criterion is established. The greater the criterion value is, the worse the ill-conditioned degree of solution is. So, the optimum choice of measurement approach for the two-color system is achieved through intercomparison of the criterion values. Numerical examples are also given to illustrate this point. The theoretical analysis not only provides an effective way of evaluating different measurement approaches, but also may help us to better understand the influences that determine the choices between wavelength/waveband measurements and calibration/noncalibration modes for temperature and soot distribution.

  11. Theoretical evaluation of measurement uncertainties of two-color pyrometry applied to optical diagnostics.

    PubMed

    Fu, Tairan; Cheng, Xiaofang; Yang, Zangjian

    2008-11-10

    We present a theoretical analysis of two-color pyrometry applied to optical diagnostics. A two-color pyrometer built with a single CCD is advantageous due to the simple system design. We evaluate the possibility and degree of ill-conditionness on the basis of measurement uncertainties for different measurement approaches of this two-color system. We classify measurement approaches. The corresponding ill-conditionness criterion is established. The greater the criterion value is, the worse the ill-conditioned degree of solution is. So, the optimum choice of measurement approach for the two-color system is achieved through intercomparison of the criterion values. Numerical examples are also given to illustrate this point. The theoretical analysis not only provides an effective way of evaluating different measurement approaches, but also may help us to better understand the influences that determine the choices between wavelength/waveband measurements and calibration/noncalibration modes for temperature and soot distribution. PMID:19002237

  12. Summative Evaluation of Diagnostic and Prescriptive Reading Instruction K-6 Course, Spring, 1975. (Evaluation: DPRI 2).

    ERIC Educational Resources Information Center

    Bramble, William J.; And Others

    An inservice educational television course, which offered individualized experience in diagnosing specific reading problems and in locating remedial materials, was beamed by communication satellite to 286 elementary school teachers in the Appalachian region. Course evaluation concluded that: (1) participants demonstrated a significant gain in the…

  13. Drainoscopy: a doorway to the abdomen in the post-surgical patient.

    PubMed

    Atallah, S; deBeche-Adams, T; Imam, Z; Amir, K

    2015-08-01

    The ability to optically visualize the abdominal cavity in the post-surgical patient can prove to be invaluable, particularly when imaging studies and exam findings can be difficult to interpret. Post-surgical drains are often used and provide a window into the abdominal cavity. In this proof-of-concept study, it is demonstrated that an ordinary drain can be used as a point of access and hence a doorway into the abdominal cavity. This technique has been termed drainoscopy, and the approach is demonstrated with video supplement.

  14. Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance

    PubMed Central

    2016-01-01

    Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus. PMID:27478327

  15. Comparative Evaluation of the Diagnostic Performance of the Prototype Cepheid GeneXpert Ebola Assay.

    PubMed

    Jansen van Vuren, Petrus; Grobbelaar, Antoinette; Storm, Nadia; Conteh, Ousman; Konneh, Kelfala; Kamara, Abdul; Sanne, Ian; Paweska, Janusz T

    2016-02-01

    The Ebola virus disease (EVD) outbreak in West Africa has highlighted an urgent need for point-of-care (POC) assays for the diagnosis of this devastating disease in resource-limited African countries. The diagnostic performance characteristics of a prototype Cepheid GeneXpert Ebola POC used to detect Ebola virus (EBOV) in stored serum and plasma samples collected from suspected EVD cases in Sierra Leone in 2014 and 2015 was evaluated. The GeneXpert Ebola POC is a self-contained single-cartridge automated system that targets the glycoprotein (GP) and nucleoprotein (NP) genes of EBOV and yields results within 90 min. Results from 281 patient samples were compared to the results of a TaqMan real-time reverse transcription-PCR (RT-PCR) targeting the polymerase gene and performed on two real-time PCR machines. Agreement between the three platforms was 100% at cycle threshold (CT) values of ≤34.99, but discordant results were noted between CT values of 35 and 45.The diagnostic sensitivity of the three platforms was 100% in 91 patient samples that were confirmed to be infectious by virus isolation. All three molecular platforms detected viral EBOV RNA in additional samples that did not contain viable EBOV. The analytical sensitivity of the GeneXpert Ebola POC for the detection of NP was higher, and comparable to that of polymerase gene detection, than that for the detection of GP when using a titrated laboratory stock of EBOV. There was no detectable cross-reactivity with other hemorrhagic fever viruses or arboviruses. The GeneXpert Ebola POC offers an easy to operate and sensitive diagnostic tool that can be used for the rapid screening of suspected EVD cases in treatment or in holding centers during EVD outbreaks.

  16. Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance.

    PubMed

    Kim, Young-Jin; Park, Sungman; Premaratna, Ranjan; Selvaraj, Stephen; Park, Sang-Jin; Kim, Sora; Kim, Donghwan; Kim, Min Soo; Shin, Dong Hoon; Choi, Kyung-Chan; Kwon, Soon-Hwan; Seo, Wonjun; Lee, Nam Taek; Kim, Seung-Han; Kang, Heui Keun; Kim, Yoon-Won

    2016-08-01

    Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus. PMID:27478327

  17. Variation in inpatient therapy and diagnostic evaluation of children with Henoch Schönlein purpura

    PubMed Central

    Weiss, Pamela F.; Klink, Andrew J.; Hexem, Kari; Burnham, Jon M.; Leonard, Mary B.; Keren, Ron; Localio, Russell; Feudtner, Chris

    2009-01-01

    Objective To describe variation regarding inpatient therapy and evaluation of children with Henoch Schönlein purpura (HSP) admitted to children’s hospitals across the United States. Study design We conducted a retrospective cohort study of children discharged with a diagnosis of HSP between 2000 and 2007 using inpatient administrative data from 36 children’s hospitals. We examined variation among hospitals in the use of medications, diagnostic tests, and intensive care services using multivariate mixed effects logistic regression models. Results During the initial HSP hospitalization (N=1,988), corticosteroids were the most common medication (56% of cases), followed by opioids (36%), NSAIDs (35%), and anti-hypertensives (11%). After adjustment for patient characteristics, hospitals varied significantly in their use of corticosteroids, opioids, and NSAIDs; the use of diagnostic abdominal imaging, endoscopy, laboratory testing, and renal biopsy; and the utilization of intensive care services. By contrast, hospitals did not differ significantly regarding administration of anti-hypertensives or performance of skin biopsy. Conclusions The significant variation identified may contribute to varying HSP clinical outcomes between hospitals, warrants further investigation, and represents a potentially important opportunity to improve quality of care. PMID:19643437

  18. The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation

    PubMed Central

    Henderson, Emily J; Rubin, Greg P

    2013-01-01

    Objectives To evaluate the utility of Isabel, an online diagnostic decision support system developed by Isabel Healthcare primarily for secondary medical care, in the general practice setting. Design Focus groups were conducted with clinicians to understand why and how they used the system. A modified online post-use survey asked practitioners about its impact on their decision-making. Normalization process theory (NPT) was used as a theoretical framework to determine whether the system could be incorporated into routine clinical practice. Setting The system was introduced by NHS County Durham and Darlington in the UK in selected general practices as a three-month pilot. Participants General practitioners and nurse practitioners who had access to Isabel as part of the Primary Care Trust's pilot. Main outcome measures General practitioners’ views, experiences and usage of the system. Results Seven general practices agreed to pilot Isabel. Two practices did not subsequently use it. The remaining five practices conducted searches on 16 patients. Post-use surveys (n = 10) indicated that Isabel had little impact on diagnostic decision-making. Focus group participants stated that, although the diagnoses produced by Isabel in general did not have an impact on their decision-making, they would find the tool useful if it were better tailored to the primary care setting. Our analysis concluded that normalization was not likely to occur in its current form. Conclusions Isabel was of limited utility in this short pilot study and may need further modification for use in general practice. PMID:23772310

  19. Development and Evaluation of the Diagnostic Power for a Computer-Based Two-Tier Assessment

    NASA Astrophysics Data System (ADS)

    Lin, Jing-Wen

    2016-06-01

    This study adopted a quasi-experimental design with follow-up interview to develop a computer-based two-tier assessment (CBA) regarding the science topic of electric circuits and to evaluate the diagnostic power of the assessment. Three assessment formats (i.e., paper-and-pencil, static computer-based, and dynamic computer-based tests) using two-tier items were conducted on Grade 4 ( n = 90) and Grade 5 ( n = 86) students, respectively. One-way ANCOVA was conducted to investigate whether the different assessment formats affected these students' posttest scores on both the phenomenon and reason tiers, and confidence rating for an answer was assessed to diagnose the nature of students' responses (i.e., scientific answer, guessing, alternative conceptions, or knowledge deficiency). Follow-up interview was adopted to explore whether and how the various CBA representations influenced both graders' responses. Results showed that the CBA, in particular the dynamic representation format, allowed students who lacked prior knowledge (Grade 4) to easily understand the question stems. The various CBA representations also potentially encouraged students who already had learning experience (Grade 5) to enhance the metacognitive judgment of their responses. Therefore, CBA could reduce students' use of test-taking strategies and provide better diagnostic power for a two-tier instrument than the traditional paper-based version.

  20. [THE DIFFERENTIAL DIAGNOSTIC POSSIBILITIES IN EVALUATION OF IRON-DEFICIENT CONDITION UNDER ANEMIAS].

    PubMed

    Zubrikhina, G N; Blindar, V N; Matveeva, I I

    2016-03-01

    The article presents data concerning differential diagnostic possibilities of evaluation of genuine iron-deficient anemia and anemia of chronic diseases. The variety of mechanisms of development of anemia of chronic diseases is demonstrated, including effect of humoral inhibitors of erythropoiesis, disorder of iron metabolism at the expense of its redistribution into cells of macrophage system, suppression of erythropoiesis resulted in redistributed or functional iron deficiency. The data is presented concerning significance in diagnostic of anemia of chronic diseases of such factors as content of ferritin, dissolving receptors of transferrin and role of hepcidin protein in pathogenesis of anemia of chronic diseases. The analysis of scientific publications demonstrated that hepcidin is a negative regulator of iron metabolism. Under iron-deficient anemia its level in blood decreases that contribute to extensive absorption of iron in gastrointestinal tract. On the contrary, under anemia of chronic diseases its content drastically increases and results in blocking of iron transport everywhere, including internal epithelium, macrophages, placenta and other types of cells. The hyper-production of hepcidin during infection and inflammation is responsible for anemia of chronic diseases. The perspectives of development of pharmaceuticals decreasing level of hepcidin for treatment of anemia of chronic diseases is demonstrated.

  1. Evaluation of Contrast Extravasation as a Diagnostic Criterion in the Evaluation of Arthroscopically Proven HAGL/pHAGL Lesions

    PubMed Central

    Maldjian, Catherine; Khanna, Vineet; Bradley, James; Adam, Richard

    2014-01-01

    Purpose. The validity of preoperative MRI in diagnosing HAGL lesions is debated. Various investigations have produced mixed results with regard to the utility of MRI. The purpose of this investigation is to apply a novel method of diagnosing HAGL/pHAGL lesions by looking at contrast extravasation and to evaluate the reliability of such extravasation of contrast into an extra-articular space as a sign of HAGL/pHAGL lesion. Methods. We utilized specific criteria to define contrast extravasation. We evaluated these criteria in 12 patients with arthroscopically proven HAGL/pHAGL lesion. We also evaluated these criteria in a control group. Results. Contrast extravasation occurred in over 83% of arthroscopically positive cases. Contrast extravasation as a diagnostic criterion in the evaluation of HAGL/pHAGL lesions demonstrated a high interobserver degree of agreement. Conclusions. In conclusion, extra-articular contrast extravasation may serve as a valid and reliable sign of HAGL and pHAGL lesions, provided stringent criteria are maintained to assure that the contrast lies in an extra-articular location. In cases where extravasation is not present, the “J” sign, though nonspecific, may be the only evidence of subtle HAGL and pHAGL lesions. Level of Evidence. Level IV, Retrospective Case-Control series. PMID:25530880

  2. Evaluating cost-effectiveness of diagnostic equipment: the brain scanner case.

    PubMed Central

    Bartlett, J R; Neil-Dwyer, G; Banham, J M; Cruickshank, D G

    1978-01-01

    An approach to evaluating the cost-effectiveness of high-technology diagnostic equipment has been devised, using the introduction of computerised axial tomography (CAT) as a model. With the advent of CAT scanning, angiography and air encephalography have a reduced, though important, role in investigating intracranial disease, and the efficient use of conventional equipment requires the centralisation of neuroradiological services, which would result in major cash savings. In contrast, the pattern of demand for CAT scanning, in addition to the acknowledged clinical efficiency of the scanner and its unique role in the head-injured patient, ephasies the need for improved access to scanners. In the interest of the patients the pattern of service must change. PMID:100168

  3. An economic evaluation of public programs for internationalization: the case of the Diagnostic Program in Spain.

    PubMed

    Cansino, José M; Lopez-Melendo, Jaime; Pablo-Romero, María del P; Sánchez-Braza, Antonio

    2013-12-01

    This paper evaluates the Diagnostic Program in Spain which is a publicly funded program to promote internationalization of companies located in Andalusia (south of Spain). The methodology used is the propensity score-matching. The treatment group consists of companies which participated in the Program until 2008. The control group has companies which planned to participate in the Program but had not done so up to that date. The response variable measures the ratio of export to total sales for each company. Four covariates have been taken into account: activity, location, sales and number of employees. The analysis leads to the conclusion that the companies that participated in the Program improved their ratio of exports to total sales by about 10 percentage points.

  4. Evaluation of the diagnostic power of thermography in breast cancer using Bayesian network classifiers.

    PubMed

    Nicandro, Cruz-Ramírez; Efrén, Mezura-Montes; María Yaneli, Ameca-Alducin; Enrique, Martín-Del-Campo-Mena; Héctor Gabriel, Acosta-Mesa; Nancy, Pérez-Castro; Alejandro, Guerra-Hernández; Guillermo de Jesús, Hoyos-Rivera; Rocío Erandi, Barrientos-Martínez

    2013-01-01

    Breast cancer is one of the leading causes of death among women worldwide. There are a number of techniques used for diagnosing this disease: mammography, ultrasound, and biopsy, among others. Each of these has well-known advantages and disadvantages. A relatively new method, based on the temperature a tumor may produce, has recently been explored: thermography. In this paper, we will evaluate the diagnostic power of thermography in breast cancer using Bayesian network classifiers. We will show how the information provided by the thermal image can be used in order to characterize patients suspected of having cancer. Our main contribution is the proposal of a score, based on the aforementioned information, that could help distinguish sick patients from healthy ones. Our main results suggest the potential of this technique in such a goal but also show its main limitations that have to be overcome to consider it as an effective diagnosis complementary tool.

  5. Evaluation of the diagnostic power of thermography in breast cancer using Bayesian network classifiers.

    PubMed

    Nicandro, Cruz-Ramírez; Efrén, Mezura-Montes; María Yaneli, Ameca-Alducin; Enrique, Martín-Del-Campo-Mena; Héctor Gabriel, Acosta-Mesa; Nancy, Pérez-Castro; Alejandro, Guerra-Hernández; Guillermo de Jesús, Hoyos-Rivera; Rocío Erandi, Barrientos-Martínez

    2013-01-01

    Breast cancer is one of the leading causes of death among women worldwide. There are a number of techniques used for diagnosing this disease: mammography, ultrasound, and biopsy, among others. Each of these has well-known advantages and disadvantages. A relatively new method, based on the temperature a tumor may produce, has recently been explored: thermography. In this paper, we will evaluate the diagnostic power of thermography in breast cancer using Bayesian network classifiers. We will show how the information provided by the thermal image can be used in order to characterize patients suspected of having cancer. Our main contribution is the proposal of a score, based on the aforementioned information, that could help distinguish sick patients from healthy ones. Our main results suggest the potential of this technique in such a goal but also show its main limitations that have to be overcome to consider it as an effective diagnosis complementary tool. PMID:23762182

  6. Evaluation of the Diagnostic Power of Thermography in Breast Cancer Using Bayesian Network Classifiers

    PubMed Central

    Nicandro, Cruz-Ramírez; Efrén, Mezura-Montes; María Yaneli, Ameca-Alducin; Enrique, Martín-Del-Campo-Mena; Héctor Gabriel, Acosta-Mesa; Nancy, Pérez-Castro; Alejandro, Guerra-Hernández; Guillermo de Jesús, Hoyos-Rivera; Rocío Erandi, Barrientos-Martínez

    2013-01-01

    Breast cancer is one of the leading causes of death among women worldwide. There are a number of techniques used for diagnosing this disease: mammography, ultrasound, and biopsy, among others. Each of these has well-known advantages and disadvantages. A relatively new method, based on the temperature a tumor may produce, has recently been explored: thermography. In this paper, we will evaluate the diagnostic power of thermography in breast cancer using Bayesian network classifiers. We will show how the information provided by the thermal image can be used in order to characterize patients suspected of having cancer. Our main contribution is the proposal of a score, based on the aforementioned information, that could help distinguish sick patients from healthy ones. Our main results suggest the potential of this technique in such a goal but also show its main limitations that have to be overcome to consider it as an effective diagnosis complementary tool. PMID:23762182

  7. An economic evaluation of public programs for internationalization: the case of the Diagnostic Program in Spain.

    PubMed

    Cansino, José M; Lopez-Melendo, Jaime; Pablo-Romero, María del P; Sánchez-Braza, Antonio

    2013-12-01

    This paper evaluates the Diagnostic Program in Spain which is a publicly funded program to promote internationalization of companies located in Andalusia (south of Spain). The methodology used is the propensity score-matching. The treatment group consists of companies which participated in the Program until 2008. The control group has companies which planned to participate in the Program but had not done so up to that date. The response variable measures the ratio of export to total sales for each company. Four covariates have been taken into account: activity, location, sales and number of employees. The analysis leads to the conclusion that the companies that participated in the Program improved their ratio of exports to total sales by about 10 percentage points. PMID:23920021

  8. 3D-DIR for early differential diagnostic and prognostic evaluation of NMO

    PubMed Central

    Wang, Yanbing; Yan, Hong; Ding, Qixing; Mao, Cunhua; Shen, Yelong; Wang, Guangbin

    2016-01-01

    Neuromyelitis optica (NMO) is an acute or subacute lesion of demyelinating disease involving the optic nerve and spinal cord, and imaging techniques and their effects have been the focus of investigations. The aim of the present study was to examine the value of three-dimensional double inversion recovery (3D-DIR) in the early differential diagnostic and prognostic evaluation of NMO. Forty-eight patients with suspicious NMO were included into the study and underwent a combination of serum NMO-IgG quantitative detection and 3D-DIR examination. Forty cases (83.3%) of the suspicious cases were confirmed with NMO. The average time from onset to definite diagnosis was 3.5±0.6 days. The brain showed high T2W and fluid-attenuated inversion recovery (FLAIR) signals, involving 5.8±1.2 sites on average, distributed in the peripheral lateral ventricle, medulla, cerebral white matter, the third ventricle, peripheral aqueduct of sylvius, pons and diencephalon. The average T2W signal strength was 2.73±0.12. The signal intensity of DIR was significantly higher than that of T2W and FLAIR, and the difference was statistically significant. The optic nerve and chiasma showed a high FLAIR signal, with an average signal intensity of 2.13±0.14. The spinal cord showed swelling, necrosis and cavity lesion, involving the gray and white matter of the central site, transversely, with an average lesion length of 4.7±0.6 centrum. The relative signal intensity of DIR was significantly higher than that of T2W and FLAIR. Following treatment, the signal intensity of the brain, optic nerve, optic chiasma and spinal cord decreased significantly (P<0.05). In conclusion, 3D-DIR has great application value in the early differential diagnostic and prognostic evaluation of NMO. PMID:27588068

  9. Evaluation of three rapid diagnostic methods for direct identification of microorganisms in positive blood cultures.

    PubMed

    Martinez, Raquel M; Bauerle, Elizabeth R; Fang, Ferric C; Butler-Wu, Susan M

    2014-07-01

    The identification of organisms from positive blood cultures generally takes several days. However, recently developed rapid diagnostic methods offer the potential for organism identification within only a few hours of blood culture positivity. In this study, we evaluated the performance of three commercial methods to rapidly identify organisms directly from positive blood cultures: QuickFISH (AdvanDx, Wolburn, MA), Verigene Gram-Positive Blood Culture (BC-GP; Nanosphere, Northbrook, IL), and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) with Sepsityper processing (Bruker Daltonics, Billerica, MA). A total of 159 blood cultures (VersaTREK Trek Diagnostic Systems, Cleveland, OH) positive for Gram-positive and Gram-negative bacteria as well as yeast were analyzed with QuickFISH and MALDI-TOF MS. In all, 102 blood cultures were analyzed using the BC-GP assay. For monomicrobial cultures, we observed 98.0% concordance with routine methods for both QuickFISH (143/146) and the BC-GP assay (93/95). MALDI-TOF MS demonstrated 80.1% (117/146) and 87.7% (128/146) concordance with routine methods to the genus and species levels, respectively. None of the methods tested were capable of consistently identifying polymicrobial cultures in their entirety or reliably differentiating Streptococcus pneumoniae from viridans streptococci. Nevertheless, the methods evaluated in this study are convenient and accurate for the most commonly encountered pathogens and have the potential to dramatically reduce turnaround time for the provision of results to the treating physician.

  10. Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas

    PubMed Central

    Shahrami, Ali; Shojaee, Majid; Tabatabaee, Seyed Mohammadreza; Mianehsaz, Elaheh

    2016-01-01

    Introduction: Necessity of imaging for symptom-free conscious patients presented to emergency department (ED) following traumatic thoracolumbar spine injuries has been a matter of debate. The present study was aimed to evaluate the diagnostic value of clinical findings in prediction of traumatic thoracolumbar injuries compared tocomputed tomography (CT) scan. Methods: The present diagnostic value study was carried out using non-random convenience sampling during the time between October 2013 and March 2014. All trauma patients > 15 years old underwent thoracolumbar CT scan were included. Correlation between clinical and CT findings was measured using SPSS 21.0 and screening performance characteristics of clinical findings in prediction of thoracolumbar fracture were calculated. Results: 169 patients with mean age of 37.8 ± 17.3 years (rage: 15-86) were evaluated (69.8% male). All fracture patients had at least 1 positive finding in history and physical examination. The fracture was confirmed in only 24.6% of the patients with positive findings in history or physical examination. In 37.5% of patients the location of fracture, matched the area of positive physical examinations. Sensitivity, specificity, PPV, NPV, PLR, and NLR of clinical findings in comparison to thoracolumbar CT scan were 100 (95% CI: 89 - 100), 1.5 (95% CI: 0.2-6), 24.5 (95% CI: 18.3-31.9), 100 (95% CI: 19.7-100), 32.5 (95% CI: 24.6-43.03), and infinite, respectively. Conclusion: The results of the present study, show the excellent screening performance characteristics of clinical findings in prediction of traumatic thoracolumbar fracture (100% sensitivity). It could be concluded that in conscious patients with stable hemodynamic, who have no distracting pain and are not intoxicated, probability of thoracolumbar fracture is very low and near to zero in case of no positive clinical finding. PMID:27299140

  11. A Global Comparative Evaluation of Commercial Immunochromatographic Rapid Diagnostic Tests for Visceral Leishmaniasis

    PubMed Central

    Cunningham, Jane; Hasker, Epco; Das, Pradeep; El Safi, Sayda; Goto, Hiro; Mondal, Dinesh; Mbuchi, Margaret; Mukhtar, Maowia; Rabello, Ana; Rijal, Suman; Sundar, Shyam; Wasunna, Monique; Adams, Emily; Menten, Joris; Peeling, Rosanna; Boelaert, Marleen

    2012-01-01

    Background. Poor access to diagnosis stymies control of visceral leishmaniasis (VL). Antibody-detecting rapid diagnostic tests (RDTs) can be performed in peripheral health settings. However, there are many brands available and published reports of variable accuracy. Methods. Commercial VL RDTs containing bound rK39 or rKE16 antigen were evaluated using archived human sera from confirmed VL cases (n = 750) and endemic non-VL controls (n = 754) in the Indian subcontinent (ISC), Brazil, and East Africa to assess sensitivity and specificity with 95% confidence intervals. A subset of RDTs were also evaluated after 60 days’ heat incubation (37°C, 45°C). Interlot and interobserver variability was assessed. Results. All test brands performed well against ISC panels (sensitivity range, 92.8%–100%; specificity range, 96%–100%); however, sensitivity was lower against Brazil and East African panels (61.5%–91% and 36.8%–87.2%, respectively). Specificity was consistently > 95% in Brazil and ranged between 90.8% and 98% in East Africa. Performance of some products was adversely affected by high temperatures. Agreement between lots and readers was good to excellent (κ > 0.73–0.99). Conclusions. Diagnostic accuracy of VL RDTs varies between the major endemic regions. Many tests performed well and showed good heat stability in the ISC; however, reduced sensitivity against Brazilian and East African panels suggests that in these regions, used alone, several RDTs are inadequate for excluding a VL diagnosis. More research is needed to assess ease of use and to compare performance using whole blood instead of serum and in patients coinfected with human immunodeficiency virus. PMID:22942208

  12. Evaluation of Three Rapid Diagnostic Methods for Direct Identification of Microorganisms in Positive Blood Cultures

    PubMed Central

    Martinez, Raquel M.; Bauerle, Elizabeth R.; Fang, Ferric C.

    2014-01-01

    The identification of organisms from positive blood cultures generally takes several days. However, recently developed rapid diagnostic methods offer the potential for organism identification within only a few hours of blood culture positivity. In this study, we evaluated the performance of three commercial methods to rapidly identify organisms directly from positive blood cultures: QuickFISH (AdvanDx, Wolburn, MA), Verigene Gram-Positive Blood Culture (BC-GP; Nanosphere, Northbrook, IL), and matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) with Sepsityper processing (Bruker Daltonics, Billerica, MA). A total of 159 blood cultures (VersaTREK Trek Diagnostic Systems, Cleveland, OH) positive for Gram-positive and Gram-negative bacteria as well as yeast were analyzed with QuickFISH and MALDI-TOF MS. In all, 102 blood cultures were analyzed using the BC-GP assay. For monomicrobial cultures, we observed 98.0% concordance with routine methods for both QuickFISH (143/146) and the BC-GP assay (93/95). MALDI-TOF MS demonstrated 80.1% (117/146) and 87.7% (128/146) concordance with routine methods to the genus and species levels, respectively. None of the methods tested were capable of consistently identifying polymicrobial cultures in their entirety or reliably differentiating Streptococcus pneumoniae from viridans streptococci. Nevertheless, the methods evaluated in this study are convenient and accurate for the most commonly encountered pathogens and have the potential to dramatically reduce turnaround time for the provision of results to the treating physician. PMID:24808235

  13. Can Acute Pain Treatment Reduce Postsurgical Comorbidity after Breast Cancer Surgery? A Literature Review

    PubMed Central

    Amaya, Fumimasa; Hosokawa, Toyoshi; Okamoto, Akiko; Matsuda, Megumi; Yamaguchi, Yosuke; Yamakita, Shunsuke; Taguchi, Tetsuya; Sawa, Teiji

    2015-01-01

    Regional analgesia, opioids, and several oral analgesics are commonly used for the treatment of acute pain after breast cancer surgery. While all of these treatments can suppress the acute postsurgical pain, there is growing evidence that suggests that the postsurgical comorbidity will differ in accordance with the type of analgesic used during the surgery. Our current study reviewed the effect of analgesics used for acute pain treatments on the major comorbidities that occur after breast cancer surgery. A considerable number of clinical studies have been performed to investigate the relationship between the acute analgesic regimen and common comorbidities, including inadequate quality of recovery after the surgery, persistent postsurgical pain, and cancer recurrence. Previous studies have shown that the choice of the analgesic modality does affect the postsurgical comorbidity. In general, the use of regional analgesics has a beneficial effect on the occurrence of comorbidity. In order to determine the best analgesic choice after breast cancer surgery, prospective studies that are based on a clear definition of the comorbidity state will need to be undertaken in the future. PMID:26495309

  14. Effects of Stress Inoculation Training on Athletes' Postsurgical Pain and Rehabilitation after Orthopedic Injury.

    ERIC Educational Resources Information Center

    Ross, Michael J.; Berger, R. Scott

    1996-01-01

    Tested the efficacy of a cognitive-behavioral intervention (stress inoculation training; SIT) for postsurgical anxiety, pain and physical rehabilitation in injured athletes. Sixty male athletes who underwent arthroscopic surgery for miniscus injury in one knee were randomly assigned to either treatment (SIT and physical therapy) or control…

  15. Model-independent evaluation of tumor markers and a logistic-tree approach to diagnostic decision support.

    PubMed

    Ni, Weizeng; Huang, Samuel H; Su, Qiang; Shi, Jinghua

    2014-01-01

    Sensitivity and specificity of using individual tumor markers hardly meet the clinical requirement. This challenge gave rise to many efforts, e.g., combing multiple tumor markers and employing machine learning algorithms. However, results from different studies are often inconsistent, which are partially attributed to the use of different evaluation criteria. Also, the wide use of model-dependent validation leads to high possibility of data overfitting when complex models are used for diagnosis. We propose two model-independent criteria, namely, area under the curve (AUC) and Relief to evaluate the diagnostic values of individual and multiple tumor markers, respectively. For diagnostic decision support, we propose the use of logistic-tree which combines decision tree and logistic regression. Application on a colorectal cancer dataset shows that the proposed evaluation criteria produce results that are consistent with current knowledge. Furthermore, the simple and highly interpretable logistic-tree has diagnostic performance that is competitive with other complex models. PMID:25516124

  16. [Evaluation of the toxoplasmosis seroprevalence in pregnant women and creating a diagnostic algorithm].

    PubMed

    Mumcuoglu, Ipek; Toyran, Alparslan; Cetin, Feyza; Coskun, Feride Alaca; Baran, Irmak; Aksu, Neriman; Aksoy, Altan

    2014-04-01

    Toxoplasma gondii, an obligatory intracellular protozoon is widely distributed around the world and can infect all mammals and birds. While acquired toxoplasmosis is usually asymptomatic in healthy subjects, acute infection during pregnancy may lead to abortion, stillbirth, fetal neurological and ocular damages. For the prevention of congenital toxoplasmosis it is recommended that a screening programme and a diagnostic algorithm in pregnant women should be implemented while considering the cost effectiveness. Thus, it is necessary to determine the seroprevalence of toxoplasmosis in pregnant women and the actual risk of T.gondii transmission during pregnancy in a certain area. The aims of this study were to detect the T.gondii seropositivity in the pregnant women admitted to our hospital and to create a diagnostic algorithm in order to solve the problems arising from interpretation of the serological test results. A total of 6140 women aged 15-49 years who were admitted to our hospital between April 1st, 2010 to July 31st, 2013, were evaluated retrospectively. In the serum samples, T.gondii IgM, IgG and IgG avidity tests were performed by VIDAS automated analyzer using TOXO IgM, TOXO IgG II and TOXO IgG avidity kits (bioMerieux, France). It was noted that, both T.gondii IgM and IgG tests were requested from 4758 (77.5%) of the pregnant women, while only IgM test from 1382 (22.5%) cases. Sole IgM positivity was found as 0.2% (11/6140), IgG as 26.4% (1278/4758) and both IgM + IgG as 0.9% (44/4758). T.gondii IgG avidity tests were requested from 12 of 44 women who were found both IgM and IgG positive and eight of them revealed high avidity and four low avidity. Avidity test was ordered for the 91 (7.1%) of 1278 sole IgG positive cases and four of them were found to have low avidity. IgG avidity test was ordered for 554 (16.2%) of IgM and/or IgG negative subjects, however, the test was not performed according to rejection criteria of the laboratory. It was noticed that

  17. [Evaluation of the toxoplasmosis seroprevalence in pregnant women and creating a diagnostic algorithm].

    PubMed

    Mumcuoglu, Ipek; Toyran, Alparslan; Cetin, Feyza; Coskun, Feride Alaca; Baran, Irmak; Aksu, Neriman; Aksoy, Altan

    2014-04-01

    Toxoplasma gondii, an obligatory intracellular protozoon is widely distributed around the world and can infect all mammals and birds. While acquired toxoplasmosis is usually asymptomatic in healthy subjects, acute infection during pregnancy may lead to abortion, stillbirth, fetal neurological and ocular damages. For the prevention of congenital toxoplasmosis it is recommended that a screening programme and a diagnostic algorithm in pregnant women should be implemented while considering the cost effectiveness. Thus, it is necessary to determine the seroprevalence of toxoplasmosis in pregnant women and the actual risk of T.gondii transmission during pregnancy in a certain area. The aims of this study were to detect the T.gondii seropositivity in the pregnant women admitted to our hospital and to create a diagnostic algorithm in order to solve the problems arising from interpretation of the serological test results. A total of 6140 women aged 15-49 years who were admitted to our hospital between April 1st, 2010 to July 31st, 2013, were evaluated retrospectively. In the serum samples, T.gondii IgM, IgG and IgG avidity tests were performed by VIDAS automated analyzer using TOXO IgM, TOXO IgG II and TOXO IgG avidity kits (bioMerieux, France). It was noted that, both T.gondii IgM and IgG tests were requested from 4758 (77.5%) of the pregnant women, while only IgM test from 1382 (22.5%) cases. Sole IgM positivity was found as 0.2% (11/6140), IgG as 26.4% (1278/4758) and both IgM + IgG as 0.9% (44/4758). T.gondii IgG avidity tests were requested from 12 of 44 women who were found both IgM and IgG positive and eight of them revealed high avidity and four low avidity. Avidity test was ordered for the 91 (7.1%) of 1278 sole IgG positive cases and four of them were found to have low avidity. IgG avidity test was ordered for 554 (16.2%) of IgM and/or IgG negative subjects, however, the test was not performed according to rejection criteria of the laboratory. It was noticed that

  18. Improvement in the Diagnostic Evaluation of a Positive Fecal Occult Blood Test in an Integrated Health Care Organization

    PubMed Central

    Miglioretti, Diana L.; Rutter, Carolyn M.; Bradford, Susan Carol; Zauber, Ann G.; Kessler, Larry G.; Feuer, Eric J.; Grossman, David C.

    2014-01-01

    Background Screening for fecal occult blood can be effective in reducing colorectal cancer mortality only if positive tests are appropriately followed up with complete diagnostic evaluation (i.e., colonoscopy or flexible sigmoidoscopy with double contrast barium enema) and treatment. Objectives To examine whether rates of complete diagnostic evaluation following a positive fecal occult blood test (FOBT) have improved over time after the implementation of tracking systems and physician guidelines within a large integrated health care organization. Research Design From 1993 to 2005, 8513 positive FOBTs were identified on 8291 enrollees aged 50–79 of a large health care system. Automated records were used to identify repeat FOBTs, colonoscopy, flexible sigmoidoscopy, and double-contrast barium enema within one year after the positive FOBT. National rates of complete diagnostic evaluation were estimated from the 2005 National Health Interview Survey. Results In this integrated health care organization, the percentage of positive FOBTs followed by complete diagnostic evaluation within one year increased from 57%–64% in 1993–1996 to 82%–86% from 2000–2005. Use of repeat FOBT following a positive FOBT decreased from 28–31% in 1993–1996 to 6–11% in 2000–2005. Based on the National Health Interview Survey, only 52% of positive FOBTs from 2000–2005 were followed by complete diagnostic evaluation nationally. Conclusions Adherence to recommendations for complete diagnostic evaluation following a positive FOBT has greatly improved over time in an integrated group medical practice. Through the use of tracking systems and screening guidelines, it may be possible to reach levels of follow-up that are comparable to those observed in randomized trials. PMID:18725839

  19. Automated registration of diagnostic to prediagnostic x-ray mammograms: Evaluation and comparison to radiologists' accuracy

    SciTech Connect

    Pinto Pereira, Snehal M.; Hipwell, John H.; McCormack, Valerie A.; Tanner, Christine; Moss, Sue M.; Wilkinson, Louise S.; Khoo, Lisanne A. L.; Pagliari, Catriona; Skippage, Pippa L.; Kliger, Carole J.; Hawkes, David J.; Santos Silva, Isabel M. dos

    2010-09-15

    Purpose: To compare and evaluate intensity-based registration methods for computation of serial x-ray mammogram correspondence. Methods: X-ray mammograms were simulated from MRIs of 20 women using finite element methods for modeling breast compressions and employing a MRI/x-ray appearance change model. The parameter configurations of three registration methods, affine, fluid, and free-form deformation (FFD), were optimized for registering x-ray mammograms on these simulated images. Five mammography film readers independently identified landmarks (tumor, nipple, and usually two other normal features) on pairs of diagnostic and corresponding prediagnostic digitized images from 52 breast cancer cases. Landmarks were independently reidentified by each reader. Target registration errors were calculated to compare the three registration methods using the reader landmarks as a gold standard. Data were analyzed using multilevel methods. Results: Between-reader variability varied with landmark (p<0.01) and screen (p=0.03), with between-reader mean distance (mm) in point location on the diagnostic/prediagnostic images of 2.50 (95% CI 1.95, 3.15)/2.84 (2.24, 3.55) for nipples and 4.26 (3.43, 5.24)/4.76 (3.85, 5.84) for tumors. Registration accuracy was sensitive to the type of landmark and the amount of breast density. For dense breasts ({>=}40%), the affine and fluid methods outperformed FFD. For breasts with lower density, the affine registration surpassed both fluid and FFD. Mean accuracy (mm) of the affine registration varied between 3.16 (95% CI 2.56, 3.90) for nipple points in breasts with density 20%-39% and 5.73 (4.80, 6.84) for tumor points in breasts with density <20%. Conclusions: Affine registration accuracy was comparable to that between independent film readers. More advanced two-dimensional nonrigid registration algorithms were incapable of increasing the accuracy of image alignment when compared to affine registration.

  20. Multicenter Evaluation of Clinical Diagnostic Methods for Detection and Isolation of Campylobacter spp. from Stool.

    PubMed

    Fitzgerald, Collette; Patrick, Mary; Gonzalez, Anthony; Akin, Joshua; Polage, Christopher R; Wymore, Kate; Gillim-Ross, Laura; Xavier, Karen; Sadlowski, Jennifer; Monahan, Jan; Hurd, Sharon; Dahlberg, Suzanne; Jerris, Robert; Watson, Renee; Santovenia, Monica; Mitchell, David; Harrison, Cassandra; Tobin-D'Angelo, Melissa; DeMartino, Mary; Pentella, Michael; Razeq, Jafar; Leonard, Celere; Jung, Carrianne; Achong-Bowe, Ria; Evans, Yaaqobah; Jain, Damini; Juni, Billie; Leano, Fe; Robinson, Trisha; Smith, Kirk; Gittelman, Rachel M; Garrigan, Charles; Nachamkin, Irving

    2016-05-01

    The use of culture-independent diagnostic tests (CIDTs), such as stool antigen tests, as standalone tests for the detection of Campylobacter in stool is increasing. We conducted a prospective, multicenter study to evaluate the performance of stool antigen CIDTs compared to culture and PCR for Campylobacter detection. Between July and October 2010, we tested 2,767 stool specimens from patients with gastrointestinal illness with the following methods: four types of Campylobacter selective media, four commercial stool antigen assays, and a commercial PCR assay. Illnesses from which specimens were positive by one or more culture media or at least one CIDT and PCR were designated "cases." A total of 95 specimens (3.4%) met the case definition. The stool antigen CIDTs ranged from 79.6% to 87.6% in sensitivity, 95.9 to 99.5% in specificity, and 41.3 to 84.3% in positive predictive value. Culture alone detected 80/89 (89.9% sensitivity) Campylobacter jejuni/Campylobacter coli-positive cases. Of the 209 noncases that were positive by at least one CIDT, only one (0.48%) was positive by all four stool antigen tests, and 73% were positive by just one stool antigen test. The questionable relevance of unconfirmed positive stool antigen CIDT results was supported by the finding that noncases were less likely than cases to have gastrointestinal symptoms. Thus, while the tests were convenient to use, the sensitivity, specificity, and positive predictive value of Campylobacter stool antigen tests were highly variable. Given the relatively low incidence of Campylobacter disease and the generally poor diagnostic test characteristics, this study calls into question the use of commercially available stool antigen CIDTs as standalone tests for direct detection of Campylobacter in stool.

  1. Prospective evaluation of serum glial fibrillary acidic protein (GFAP) as a diagnostic marker for glioblastoma.

    PubMed

    Tichy, Julia; Spechtmeyer, Sabrina; Mittelbronn, Michel; Hattingen, Elke; Rieger, Johannes; Senft, Christian; Foerch, Christian

    2016-01-01

    Glioblastoma (GBM) is the most common malignant primary brain tumor. Although clinical presentation and brain imaging might be suggestive, histopathological evaluation by means of a brain biopsy is routinely performed to establish the diagnosis. A serum marker indicative of GBM may simplify the diagnostic work-up of patients suspected to having a brain tumor. We prospectively examined 113 patients with newly diagnosed single supratentorial or infratentorial space-occupying brain lesions. Glial fibrillary acidic protein (GFAP) levels were determined from venous blood samples via a prototype ELISA assay prior to any invasive procedures. Serum levels of GFAP were correlated with histopathological findings and MRI parameters. GFAP values were significantly higher in GBM patients (n = 33) compared to all other tumors (p < 0.001). A GFAP serum concentration of ≥0.01 µg/L revealed a sensitivity of 85 % and a specificity of 70 % for differentiating GBM from other entities. By applying a GFAP cut-off point of 0.20 µg/L, specificity was maximized (99 %), but sensitivity dropped to 27 %. In GBM patients, serum GFAP values were significantly correlated with tumor volume. GBM patients with high GFAP levels showed more in vivo GFAP expression as well as more necrosis and perilesional edema compared to GBM patients having low or non-detectable GFAP levels. GFAP serum concentrations differentiated between patients with GBM and patients with cerebral mass lesions of other entities with a moderate diagnostic accuracy. Serum GFAP levels in GBM patients were positively correlated with tumor volume and histopathological tumor characteristics.

  2. Research Diagnostic Criteria for Temporomandibular Disorders: Evaluation of Psychometric Properties of the Axis II Measures

    PubMed Central

    Ohrbach, Richard; Turner, Judith A.; Sherman, Jeffrey J.; Mancl, Lloyd A.; Truelove, Edmond L.; Schiffman, Eric L.; Dworkin, Samuel F.

    2011-01-01

    AIMS To evaluate the psychometric properties of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) biobehavioral (Axis II) screening instruments. METHODS Participants with Axis I TMD diagnoses (n=626) completed the Axis II instruments (Depression, Nonspecific Physical Symptoms, Graded Chronic Pain) and other instruments assessing psychological distress, pain, and disability at three study sites. Internal consistency, temporal stability, and convergent/discriminant validity of the Axis II measures were assessed. To assess criterion validity of Depression and Nonspecific Physical Symptoms instruments as screeners, 170 participants completed a structured psychiatric diagnostic interview. RESULTS The Axis II instruments showed very good-excellent internal consistency (Cronbach’s alpha = 0.80 – 0.95). Their convergent (correlation range 0.3–0.9) and discriminant (range 0.0–0.6) validity were generally supported, although Nonspecific Physical Symptoms was more strongly associated with depressive than with somatic symptoms. Temporal stability was high for characteristic pain intensity (Lin’s correlation concordance coefficient [CCC] = 0.91), interference (CCC = 0.89), and chronic pain grade (weighted kappa = 0.87), and fair-good for Depression and Nonspecific Physical Symptoms (CCC = 0.63 – 0.78). The Depression instrument normal vs moderate-severe cut-point was good at identifying current-year DSM-IV depression and dysthymia diagnoses (sensitivity 87%, specificity 53%). Nonspecific Physical Symptoms did not have high utility for detecting psychiatric disorders (sensitivity 86%, specificity 31%). CONCLUSION The Axis-II Depression and Graded Chronic Pain instruments have clinically relevant and acceptable psychometric properties for reliability and validity and utility as instruments for identifying TMD patients with high levels of distress, pain, and disability that can interfere with treatment response and course of Axis I disorders

  3. Autofluorescence guided diagnostic evaluation of suspicious oral mucosal lesions: opportunities, limitations, and pitfalls

    NASA Astrophysics Data System (ADS)

    Vigneswaran, Nadarajah

    2011-03-01

    Wide-filed autofluorescence examination is currently considered as a standard of care for screening and diagnostic evaluation of early neoplastic changes of the skin, cervix, lung, bladder, gastrointestinal tract and oral cavity. Naturally occurring fluorophores within the tissue absorb UV and visible light and can re-emit some of this light at longer wavelengths in the form of fluorescence. This non-invasive tissue autofluorescence imaging is used in optical diagnostics, especially in the early detection of cancer. Usually, malignant transformation is associated with thickening of the epithelium, enhanced cellular density due to increased nuclear cytoplasmic ratio which may attenuate the excitation leading to a decrease in collagen autofluorescence. Hence, dysplastic and cancerous tissues often exhibit decreased blue-green autofluorescence and appear darker compared to uninvolved mucosa. Currently, there are three commercially available devices to examine tissue autofluorescence in the oral cavity. In this study we used the oral cancer screening device IdentafiTM 3000 to examine the tissue reflectance and autofluorescence of PML and confounding lesions of the oral cavity. Wide-field autofluorescence imaging enables rapid inspection of large mucosal surfaces, to aid in recognition of suspicious lesions and may also help in discriminate the PML (class 1) from some of the confounding lesions (class II). However, the presence of inflammation or pigments is also associated with loss of stromal autofluorescence, and may give rise to false-positive results with widefield fluorescence imaging. Clinicians who use these autofluorescence based oral cancer screening devices should be aware about the benign oral mucosal lesions that may give false positivity so that unnecessary patient's anxiety and the need for scalpel biopsy can be eliminated.

  4. Malaria rapid diagnostic test evaluation at private retail pharmacies in Kumasi, Ghana

    PubMed Central

    Audu, Rauf; Anto, Berko Panyin; Koffuor, George Asumeng; Abruquah, Akua Afriyie; Buabeng, Kwame Ohene

    2016-01-01

    Objective: Malaria rapid diagnostic test (MRDT) provides a good alternative to malaria microscopy diagnosis, particularly in resource-constrained settings. This study therefore evaluated MRDT in private retail pharmacies (PRPs) as a critical step in community case malaria management. Methods: In a prospective, cross-over, validation survey at six PRPs in the Ashanti Region of Ghana, 1200 patients presenting with fever in the preceding 48 h were sampled. Fingerstick blood samples were collected for preparation of thick and thin blood films for malaria microscopy. Categorized patients (600 each) went through the processes of MRDT or presumptive diagnosis (PD) of malaria. The malaria disease prevalence of the study area was established. Selectivity (Se), specificity (Sp), positive predictive value (PPV) along with false discovery rate (FDR), and negative predictive value (NPV) along with the false omission rate (FOR), and diagnostic odds ratio (DOR) of MRDT were then calculated. Findings: While 43.0% tested positive using the MRDT, 57.0% tested negative. However, 62.0% MRDT-negative patients in addition to all the MRDT positives were given artemether-lumefantrine. Of those diagnosed by PD, 98.2% were prescribed with an antimalarial (microscopy however confirmed only 70.3% as positive). Se and Sp of the MRDT were 90.68 ± 11.18% and 98.68 ± 1.19%, respectively. Malaria prevalence was estimated to be 43.3%. PPV was 98.0%, FDR was 2.0%, NPV was 98.0%, FOR was 2.0%, and DOR was 2366.43. Conclusion: Results highlighted good performance of MRDTs at PRPs which could inform decision toward its implementation. PMID:27512708

  5. Multicenter Evaluation of Clinical Diagnostic Methods for Detection and Isolation of Campylobacter spp. from Stool.

    PubMed

    Fitzgerald, Collette; Patrick, Mary; Gonzalez, Anthony; Akin, Joshua; Polage, Christopher R; Wymore, Kate; Gillim-Ross, Laura; Xavier, Karen; Sadlowski, Jennifer; Monahan, Jan; Hurd, Sharon; Dahlberg, Suzanne; Jerris, Robert; Watson, Renee; Santovenia, Monica; Mitchell, David; Harrison, Cassandra; Tobin-D'Angelo, Melissa; DeMartino, Mary; Pentella, Michael; Razeq, Jafar; Leonard, Celere; Jung, Carrianne; Achong-Bowe, Ria; Evans, Yaaqobah; Jain, Damini; Juni, Billie; Leano, Fe; Robinson, Trisha; Smith, Kirk; Gittelman, Rachel M; Garrigan, Charles; Nachamkin, Irving

    2016-05-01

    The use of culture-independent diagnostic tests (CIDTs), such as stool antigen tests, as standalone tests for the detection of Campylobacter in stool is increasing. We conducted a prospective, multicenter study to evaluate the performance of stool antigen CIDTs compared to culture and PCR for Campylobacter detection. Between July and October 2010, we tested 2,767 stool specimens from patients with gastrointestinal illness with the following methods: four types of Campylobacter selective media, four commercial stool antigen assays, and a commercial PCR assay. Illnesses from which specimens were positive by one or more culture media or at least one CIDT and PCR were designated "cases." A total of 95 specimens (3.4%) met the case definition. The stool antigen CIDTs ranged from 79.6% to 87.6% in sensitivity, 95.9 to 99.5% in specificity, and 41.3 to 84.3% in positive predictive value. Culture alone detected 80/89 (89.9% sensitivity) Campylobacter jejuni/Campylobacter coli-positive cases. Of the 209 noncases that were positive by at least one CIDT, only one (0.48%) was positive by all four stool antigen tests, and 73% were positive by just one stool antigen test. The questionable relevance of unconfirmed positive stool antigen CIDT results was supported by the finding that noncases were less likely than cases to have gastrointestinal symptoms. Thus, while the tests were convenient to use, the sensitivity, specificity, and positive predictive value of Campylobacter stool antigen tests were highly variable. Given the relatively low incidence of Campylobacter disease and the generally poor diagnostic test characteristics, this study calls into question the use of commercially available stool antigen CIDTs as standalone tests for direct detection of Campylobacter in stool. PMID:26962088

  6. Immune-Signatures for Lung Cancer Diagnostics: Evaluation of Protein Microarray Data Normalization Strategies

    PubMed Central

    Brezina, Stefanie; Soldo, Regina; Kreuzhuber, Roman; Hofer, Philipp; Gsur, Andrea; Weinhaeusel, Andreas

    2015-01-01

    New minimal invasive diagnostic methods for early detection of lung cancer are urgently needed. It is known that the immune system responds to tumors with production of tumor-autoantibodies. Protein microarrays are a suitable highly multiplexed platform for identification of autoantibody signatures against tumor-associated antigens (TAA). These microarrays can be probed using 0.1 mg immunoglobulin G (IgG), purified from 10 µL of plasma. We used a microarray comprising recombinant proteins derived from 15,417 cDNA clones for the screening of 100 lung cancer samples, including 25 samples of each main histological entity of lung cancer, and 100 controls. Since this number of samples cannot be processed at once, the resulting data showed non-biological variances due to “batch effects”. Our aim was to evaluate quantile normalization, “distance-weighted discrimination” (DWD), and “ComBat” for their effectiveness in data pre-processing for elucidating diagnostic immune-signatures. “ComBat” data adjustment outperformed the other methods and allowed us to identify classifiers for all lung cancer cases versus controls and small-cell, squamous cell, large-cell, and adenocarcinoma of the lung with an accuracy of 85%, 94%, 96%, 92%, and 83% (sensitivity of 0.85, 0.92, 0.96, 0.88, 0.83; specificity of 0.85, 0.96, 0.96, 0.96, 0.83), respectively. These promising data would be the basis for further validation using targeted autoantibody tests.

  7. Evaluating the accuracy of molecular diagnostic testing for canine visceral leishmaniasis using latent class analysis.

    PubMed

    Solcà, Manuela da Silva; Bastos, Leila Andrade; Guedes, Carlos Eduardo Sampaio; Bordoni, Marcelo; Borja, Lairton Souza; Larangeira, Daniela Farias; da Silva Estrela Tuy, Pétala Gardênia; Amorim, Leila Denise Alves Ferreira; Nascimento, Eliane Gomes; de Sá Oliveira, Geraldo Gileno; dos-Santos, Washington Luis Conrado; Fraga, Deborah Bittencourt Mothé; Veras, Patrícia Sampaio Tavares

    2014-01-01

    Host tissues affected by Leishmania infantum have differing degrees of parasitism. Previously, the use of different biological tissues to detect L. infantum DNA in dogs has provided variable results. The present study was conducted to evaluate the accuracy of molecular diagnostic testing (qPCR) in dogs from an endemic area for canine visceral leishmaniasis (CVL) by determining which tissue type provided the highest rate of parasite DNA detection. Fifty-one symptomatic dogs were tested for CVL using serological, parasitological and molecular methods. Latent class analysis (LCA) was performed for accuracy evaluation of these methods. qPCR detected parasite DNA in 100% of these animals from at least one of the following tissues: splenic and bone marrow aspirates, lymph node and skin fragments, blood and conjunctival swabs. Using latent variable as gold standard, the qPCR achieved a sensitivity of 95.8% (CI 90.4-100) in splenic aspirate; 79.2% (CI 68-90.3) in lymph nodes; 77.3% (CI 64.5-90.1) in skin; 75% (CI 63.1-86.9) in blood; 50% (CI 30-70) in bone marrow; 37.5% (CI 24.2-50.8) in left-eye; and 29.2% (CI 16.7-41.6) in right-eye conjunctival swabs. The accuracy of qPCR using splenic aspirates was further evaluated in a random larger sample (n = 800), collected from dogs during a prevalence study. The specificity achieved by qPCR was 76.7% (CI 73.7-79.6) for splenic aspirates obtained from the greater sample. The sensitivity accomplished by this technique was 95% (CI 93.5-96.5) that was higher than those obtained for the other diagnostic tests and was similar to that observed in the smaller sampling study. This confirms that the splenic aspirate is the most effective type of tissue for detecting L. infantum infection. Additionally, we demonstrated that LCA could be used to generate a suitable gold standard for comparative CVL testing.

  8. Evaluating the Accuracy of Molecular Diagnostic Testing for Canine Visceral Leishmaniasis Using Latent Class Analysis

    PubMed Central

    Solcà, Manuela da Silva; Bastos, Leila Andrade; Guedes, Carlos Eduardo Sampaio; Bordoni, Marcelo; Borja, Lairton Souza; Larangeira, Daniela Farias; da Silva Estrela Tuy, Pétala Gardênia; Amorim, Leila Denise Alves Ferreira; Nascimento, Eliane Gomes; de Sá Oliveira, Geraldo Gileno; dos-Santos, Washington Luis Conrado; Fraga, Deborah Bittencourt Mothé; Veras, Patrícia Sampaio Tavares

    2014-01-01

    Host tissues affected by Leishmania infantum have differing degrees of parasitism. Previously, the use of different biological tissues to detect L. infantum DNA in dogs has provided variable results. The present study was conducted to evaluate the accuracy of molecular diagnostic testing (qPCR) in dogs from an endemic area for canine visceral leishmaniasis (CVL) by determining which tissue type provided the highest rate of parasite DNA detection. Fifty-one symptomatic dogs were tested for CVL using serological, parasitological and molecular methods. Latent class analysis (LCA) was performed for accuracy evaluation of these methods. qPCR detected parasite DNA in 100% of these animals from at least one of the following tissues: splenic and bone marrow aspirates, lymph node and skin fragments, blood and conjunctival swabs. Using latent variable as gold standard, the qPCR achieved a sensitivity of 95.8% (CI 90.4–100) in splenic aspirate; 79.2% (CI 68–90.3) in lymph nodes; 77.3% (CI 64.5–90.1) in skin; 75% (CI 63.1–86.9) in blood; 50% (CI 30–70) in bone marrow; 37.5% (CI 24.2–50.8) in left-eye; and 29.2% (CI 16.7–41.6) in right-eye conjunctival swabs. The accuracy of qPCR using splenic aspirates was further evaluated in a random larger sample (n = 800), collected from dogs during a prevalence study. The specificity achieved by qPCR was 76.7% (CI 73.7–79.6) for splenic aspirates obtained from the greater sample. The sensitivity accomplished by this technique was 95% (CI 93.5–96.5) that was higher than those obtained for the other diagnostic tests and was similar to that observed in the smaller sampling study. This confirms that the splenic aspirate is the most effective type of tissue for detecting L. infantum infection. Additionally, we demonstrated that LCA could be used to generate a suitable gold standard for comparative CVL testing. PMID:25076494

  9. Immunotherapy trial as diagnostic test in evaluating patients with presumed autoimmune gastrointestinal dysmotility

    PubMed Central

    Flanagan, Eoin P.; Saito, Yuri A.; Lennon, Vanda A.; McKeon, Andrew; Fealey, Robert D.; Szarka, Lawrence A.; Murray, Joseph A.; Foxx-Orenstein, Amy E.; Fox, Jean C.; Pittock, Sean J.

    2014-01-01

    Background Chronic gastrointestinal dysmotility greatly impacts the quality of life. Treatment options are limited and generally symptomatic. Neural autoimmunity is an under-recognized etiology. We evaluated immunotherapy as an aid to diagnosing autoimmune gastrointestinal dysmotility (AGID). Methods 23 subjects evaluated at the Mayo Clinic for suspected AGID (August 2006-February 2014) fulfilled the following criteria: 1) prominent symptoms of gastrointestinal dysmotility with abnormalities on scintigraphy-manometry; 2) serological evidence or personal/family history of autoimmune disease; 3) treated by immunotherapy on a trial basis, 6-12 weeks (intravenous immune globulin, 16; or methylprednisolone, 5; or both, 2). Response was defined subjectively (symptomatic improvement) and objectively (gastrointestinal scintigraphy/manometry studies). Key Results Symptoms at presentation: constipation, 18/23; nausea or vomiting, 18/23; weight loss, 17/23; bloating, 13/23; and early satiety, 4/23. Thirteen patients had personal/family history of autoimmunity. Sixteen had neural autoantibodies and 19 had extra-intestinal autonomic testing abnormalities. Cancer was detected in 3 patients. Pre-immunotherapy scintigraphy revealed slowed transit (19/21 evaluated; gastric, 11; small-bowel, 12; colonic, 11); manometry studies were abnormal in 7/8. Post-immunotherapy, 17 (74%) had improvement (both symptomatic and scintigraphic, 5; symptomatic alone, 8; scintigraphic alone, 4). Nine responders reevaluated had scintigraphic evidence of improvement. The majority of responders who were re-evaluated had improvement in autonomic testing (6 of 7) or manometry (2 of 2). Conclusions & Inferences This proof of principle study illustrates the importance of considering an autoimmune basis for idiopathic gastrointestinal dysmotility and supports the utility of a diagnostic trial of immunotherapy. PMID:25039328

  10. Functional C1-inhibitor diagnostics in hereditary angioedema: assay evaluation and recommendations.

    PubMed

    Wagenaar-Bos, Ineke G A; Drouet, Christian; Aygören-Pursun, Emel; Bork, Konrad; Bucher, Christoph; Bygum, Anette; Farkas, Henriette; Fust, George; Gregorek, Hanna; Hack, C Erik; Hickey, Alaco; Joller-Jemelka, Helen I; Kapusta, Maria; Kreuz, Wolfhart; Longhurst, Hilary; Lopez-Trascasa, Margarita; Madalinski, Kazimierz; Naskalski, Jerzy; Nieuwenhuys, Ed; Ponard, Denise; Truedsson, Lennart; Varga, Lilian; Nielsen, Erik Waage; Wagner, Eric; Zingale, Lorenza; Cicardi, Marco; van Ham, S Marieke

    2008-09-30

    Hereditary angioedema (HAE) is an autosomal dominant disease characterized by recurrent episodes of potentially life-threatening angioedema. The most widespread underlying genetic deficiency is a heterozygous deficiency of the serine protease inhibitor C1 esterase inhibitor (C1-Inh). In addition to low C4 levels, the most important laboratory parameter for correct diagnosis of HAE or angioedema due to acquired C1-Inh deficiency is reduced C1-Inh function (fC1-Inh). No direct recommendations about the assays for fC1-Inh or sample handling conditions are available, although this would prove especially useful when a laboratory first starts to offer assays on fC1-Inh for HAE diagnosis. In the present study we evaluated the performance of fC1-Inh assays in the 15 different laboratories that are specialised in HAE diagnostics and assessed inter-laboratory variation with each laboratory using their own assays and standards. A double-blind survey was conducted using plasma/serum samples from healthy donors and HAE patients and the uniformity of HAE diagnosis was evaluated. It can be concluded that the diagnosis of fC1-Inh deficiency was made correctly in most cases in this survey. We can recommend the chromogenic assay for the determination of fC1-Inh, while the complex ELISA needs further investigation.

  11. Evaluation of immuno diagnostic assay for the exposure of stage specific filarial infection.

    PubMed

    Ravishankaran, Rajendran; Shridharan, Radhika Nagamangalam; Vishal, Lawrence Ansel; Meenakshisundaram, Sankaranarayanan; Karande, Anjali Anoop; Kaliraj, Perumal

    2016-03-01

    Lymphatic filariasis is a debilitating diseases caused by filarial parasitic nematodes. The infection may be acquired in childhood but the symptoms become apparent only in later life. To evaluate the success of any intervention, sensitive diagnostics were used to identify infection among endemic normals that are likely to develop microfilaremia in due course of time. Capture assay was standardized using the recombinant protein Brugia malayi Abundant Larval Transcript-2 (ALT-2) specific monoclonal and poly-clonal antibodies and evaluated with serum samples of clinical groups from high and low filarial infection area individuals (HIA/LIA), Endemic Normal (EN, n = 478), microfilaeremics (MF, n = 77), chronic pathology (CP, n = 57) and non endemic normal (NEN, n = 20). In order to assess stage-specific infection, ALT-2 capture assay was compared with the early reported Venom allergen homologue (VAH) and microfilariae specific SXP-1 capture assays. Of the 632 serum samples tested, ALT-2 and VAH capture assays detected circulating filarial antigen (CFA) in 57% and 52% of HIA-EN individuals, respectively. As expected, the VAH and SXP-1 capture assays were positive for 100 % of MF individuals. The described capture assays can be useful for the detection of early and stage-specific filarial infections in endemic regions of developing countries. PMID:27078646

  12. Evaluation of the Diagnostic Utility of the Traditional and Revised WHO Dengue Case Definitions

    PubMed Central

    Gutiérrez, Gamaliel; Gresh, Lionel; Pérez, María Ángeles; Elizondo, Douglas; Avilés, William; Kuan, Guillermina; Balmaseda, Ángel; Harris, Eva

    2013-01-01

    Dengue, a mosquito-borne viral illness, is a major public health problem worldwide, and its incidence continues to increase. In 2009, the World Health Organization published guidelines that included a revision of the dengue case definition. Compared to the traditional definition, the revised case definition relies more on signs than on symptoms, making it more applicable to young children. We evaluated the diagnostic utility of both case definitions in two studies of pediatric dengue in Managua, Nicaragua. In a community-based cohort study, we included data from 3,407 suspected dengue cases, of which 476 were laboratory-confirmed. In the second study, we collected information from 1,160 participants recruited at the national pediatric reference hospital (723 laboratory-confirmed). In the cohort study, the traditional definition had 89.3% sensitivity and 43.1% specificity, while the revised definition yielded similar sensitivity (86.6%) and higher specificity (55.2%, p<0.001). In the hospital study, the traditional case definition yielded 96.7% sensitivity and 22.0% specificity, whereas the revised case definition had higher sensitivity (99.3%, p<0.001) but lower specificity (8.5%, p<0.001). We then evaluated the performance of two diagnostic models based on the signs/symptoms included in each definition by analyzing the effect of increasing numbers of signs/symptoms on the sensitivity and specificity of case capture. Receiver operating characteristic analysis showed a slightly better performance for the revised model in both studies. Interestingly, despite containing less symptoms that cannot be readily expressed by children aged less than 4 years, the revised definition did not perform better in this age group. Overall, our results indicate that both case definitions have similar capacity to diagnose dengue. Owing to their high sensitivity and low specificity, they should be primarily used for screening purposes. However, in a primary care setting, neither of the

  13. Development of practical diagnostic methods for monitoring rice bacterial panicle blight disease and evaluation of rice germplasm for resistance

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A study was initiated to understand Burkholderia glumae, the major causal agent for bacterial panicle blight disease of rice; to develop practical diagnostic methods for monitoring the disease; and to evaluate rice germplasm for resistance. Burkholderia glumae was frequently isolated from infected p...

  14. Development of practical diagnostic methods for monitoring rice bacterial panicle blight disease and evaluation of rice germplasm for resistance

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A study was initiated to understand Burkholderia glumae (major causal agent for bacterial panicle blight disease of rice) to develop practical diagnostic methods for monitoring the disease; and to evaluate rice germplasm for resistance. B. glumae was frequently isolated from symptomatic panicles on...

  15. Evaluation of thermal helium beam and line-ratio fast diagnostic on the National Spherical Torus Experiment-Upgrade

    NASA Astrophysics Data System (ADS)

    Muñoz Burgos, J. M.; Agostini, M.; Scarin, P.; Stotler, D. P.; Unterberg, E. A.; Loch, S. D.; Schmitz, O.; Tritz, K.; Stutman, D.

    2016-05-01

    A 1-D kinetic collisional radiative model with state-of-the-art atomic data is developed and employed to simulate line emission to evaluate the Thermal Helium Beam (THB) diagnostic on NSTX-U. This diagnostic is currently in operation on RFX-mod, and it is proposed to be installed on NSTX-U. The THB system uses the intensity ratios of neutral helium lines 667.8, 706.5, and 728.1 nm to derive electron temperature (eV) and density (cm-3) profiles. The purpose of the present analysis is to evaluate the applications of this diagnostic for determining fast ( ∽ 4 μs ) electron temperature and density radial profiles on the scrape-off layer and edge regions of NSTX-U that are needed in turbulence studies. The diagnostic is limited by the level of detection of the 728.1 nm line, which is the weakest of the three. This study will also aid in future design of a similar 2-D diagnostic system on the divertor.

  16. Evaluation of thermal helium beam and line-ratio fast diagnostic on the National Spherical Torus Experiment-Upgrade

    DOE PAGES

    Munoz Burgos, Jorge M.; Agostini, Matteo; Scarin, Paolo; Stotler, Daren P.; Unterberg, Ezekial A.; Loch, Stuart D.; Schmitz, Oliver; Tritz, Kevin; Stutman, Dan

    2015-05-06

    A 1-D kinetic collisional radiative model (CRM) with state-of-the-art atomic data is developed and employed to simulate line emission to evaluate the Thermal Helium Beam (THB) diagnostic on NSTX-U. This diagnostic is currently in operation on RFX-mod, and it is proposed to be installed on NSTX-U. The THB system uses the intensity ratios of neutral helium lines 667.8, 706.5, and 728.1 nm to derive electron temperature (eV ) and density (cm–3) profiles. The purpose of the present analysis is to evaluate the applications of this diagnostic for determining fast (~4 μs) electron temperature and density radial profiles on the scrape-offmore » layer (SOL) and edge regions of NSTX-U that are needed in turbulence studies. The diagnostic is limited by the level of detection of the 728.1 nm line, which is the weakest of the three. In conclusion, this study will also aid in future design of a similar 2-D diagnostic systems on the divertor.« less

  17. Evaluation of thermal helium beam and line-ratio fast diagnostic on the National Spherical Torus Experiment-Upgrade

    SciTech Connect

    Munoz Burgos, Jorge M.; Agostini, Matteo; Scarin, Paolo; Stotler, Daren P.; Unterberg, Ezekial A.; Loch, Stuart D.; Schmitz, Oliver; Tritz, Kevin; Stutman, Dan

    2015-05-06

    A 1-D kinetic collisional radiative model (CRM) with state-of-the-art atomic data is developed and employed to simulate line emission to evaluate the Thermal Helium Beam (THB) diagnostic on NSTX-U. This diagnostic is currently in operation on RFX-mod, and it is proposed to be installed on NSTX-U. The THB system uses the intensity ratios of neutral helium lines 667.8, 706.5, and 728.1 nm to derive electron temperature (eV ) and density (cm–3) profiles. The purpose of the present analysis is to evaluate the applications of this diagnostic for determining fast (~4 μs) electron temperature and density radial profiles on the scrape-off layer (SOL) and edge regions of NSTX-U that are needed in turbulence studies. The diagnostic is limited by the level of detection of the 728.1 nm line, which is the weakest of the three. In conclusion, this study will also aid in future design of a similar 2-D diagnostic systems on the divertor.

  18. Is referral of postsurgical colorectal cancer survivors to cardiac rehabilitation feasible and acceptable? A pragmatic pilot randomised controlled trial with embedded qualitative study

    PubMed Central

    Hubbard, Gill; Adams, Richard; Campbell, Anna; Kidd, Lisa; Leslie, Stephen J; Munro, Julie; Watson, Angus

    2016-01-01

    Objectives (1) Assess whether cardiac rehabilitation (CR) is a feasible and acceptable model of rehabilitation for postsurgical colorectal cancer (CRC) survivors, (2) evaluate trial procedures. This article reports the results of the first objective. Design and setting A pragmatic pilot randomised controlled trial with embedded qualitative study was conducted in 3 UK hospitals with CR facilities. Descriptive statistics were used to summarise trial parameters indicative of intervention feasibility and acceptability. Interviews and focus groups were conducted and data analysed thematically. Participants People with CRC were considered for inclusion in the trial if they were ≥18 years old, diagnosed with primary CRC and in the recovery period postsurgery (they could still be receiving adjuvant therapy). 31% (n=41) of all eligible CRC survivors consented to participate in the trial. 22 of these CRC survivors, and 8 people with cardiovascular disease (CVD), 5 CRC nurses and 6 CR clinicians participated in the qualitative study. Intervention Referral of postsurgical CRC survivors to weekly CR exercise classes and information sessions. Classes included CRC survivors and people with CVD. CR nurses and physiotherapists were given training about cancer and exercise. Results Barriers to CR were protracted recoveries from surgery, ongoing treatments and poor mobility. No adverse events were reported during the trial, suggesting that CR is safe. 62% of participants completed the intervention as per protocol and had high levels of attendance. 20 health professionals attended the cancer and exercise training course, rating it as excellent. Participants perceived that CR increased CRC survivors’ confidence and motivation to exercise, and offered peer support. CR professionals were concerned about CR capacity to accommodate cancer survivors and their ability to provide psychosocial support to this group of patients. Conclusions CR is feasible and acceptable for postsurgical

  19. Evaluation of Diagnostic Systems: The Selection of Students at Risk of Academic Difficulties

    ERIC Educational Resources Information Center

    Smolkowski, Keith; Cummings, Kelli D.

    2015-01-01

    Diagnostic tools can help schools more consistently and fairly match instructional resources to the needs of their students. To ensure the best educational outcome for each child, diagnostic decision-making systems seek to balance time, clarity, and accuracy. However, recent research notes that many educational decisions tend to be made using…

  20. Diagnostic air quality model evaluation of source-specific primary and secondary fine particulate carbon.

    PubMed

    Napelenok, Sergey L; Simon, Heather; Bhave, Prakash V; Pye, Havala O T; Pouliot, George A; Sheesley, Rebecca J; Schauer, James J

    2014-01-01

    Ambient measurements of 78 source-specific tracers of primary and secondary carbonaceous fine particulate matter collected at four midwestern United States locations over a full year (March 2004-February 2005) provided an unprecedented opportunity to diagnostically evaluate the results of a numerical air quality model. Previous analyses of these measurements demonstrated excellent mass closure for the variety of contributing sources. In this study, a carbon-apportionment version of the Community Multiscale Air Quality (CMAQ) model was used to track primary organic and elemental carbon emissions from 15 independent sources such as mobile sources and biomass burning in addition to four precursor-specific classes of secondary organic aerosol (SOA) originating from isoprene, terpenes, aromatics, and sesquiterpenes. Conversion of the source-resolved model output into organic tracer concentrations yielded a total of 2416 data pairs for comparison with observations. While emission source contributions to the total model bias varied by season and measurement location, the largest absolute bias of -0.55 μgC/m(3) was attributed to insufficient isoprene SOA in the summertime CMAQ simulation. Biomass combustion was responsible for the second largest summertime model bias (-0.46 μgC/m(3) on average). Several instances of compensating errors were also evident; model underpredictions in some sectors were masked by overpredictions in others.

  1. Basic FGF and Ki-67 proteins useful for immunohistological diagnostic evaluations in malignant solitary fibrous tumor.

    PubMed

    Sun, Yuliang; Naito, Zenya; Ishiwata, Toshiyuki; Maeda, Shotaro; Sugisaki, Yuichi; Asano, Goro

    2003-05-01

    Solitary fibrous tumor (SFT) is an uncommon soft tissue tumor initially reported in the pleura but recently described in other sites in the body. Morphological distinction between benign and malignant SFT is often difficult. An immunohistochemical study was performed in pleural and extrapleural sites. The aim of this study was to determine if an immunohistochemical method is helpful in distinguishing benign SFT from malignant SFT, and providing valid information to predict the prognosis associated with malignant SFT. Twenty-four cases of benign (14 patients) and malignant (10 patients) SFT in the pleura, pelvic space, prostate and other sites of soft tissue were analyzed. Tumors from 10 patients were diagnosed as malignant on the basis of markedly increased cellularity, mitotic activity (>4/10 high-power fields), nuclear pleomorphism and areas of necrosis. Immunohistochemically, we found a mean basic fibroblast growth factor (bFGF) labeling index of 48.67% (48.67 +/- 8.52%) for benign SFT and 74.5% (74.5 +/- 6.92%) for malignant SFT (P < 0.05). We also found a mean Ki-67 labeling index of 1.9% (1.9 +/- 0.43%) for benign SFT and 6.11% (6.11 +/- 1.05%) for malignant SFT (P < 0.05). Our results suggest that bFGF and Ki-67 are diagnostically relevant to the evaluation of malignant SFT and these proteins are thought to be potentially useful markers for prognosis of SFT.

  2. Evaluating the diagnostic and prognostic value of circulating cathepsin S in gastric cancer

    PubMed Central

    Cheng, Kai; Liu, Yi-Jun; Xing, Shan; Chi, Pei-dong; Liu, Xiao-Hua; Xue, Ning; Lai, Yan-zhen; Guo, Ling; Zhang, Ge

    2016-01-01

    To evaluate whether serum Cathepsin S (Cat S) could serve as a biomarker for the diagnosis and prognosis of gastric cancer (GC), Enzyme-linked immuno sorbent assay (ELISA) was used to detect serum Cat S in 496 participants including healthy controls and patients with benign gastric diseases, gastric cancer, esophageal cancer, liver cancer, colorectal cancer, nasopharyngeal cancer and lung cancer. The levels of serum Cat S were significantly increased in cancer patients, especially in GC patients. The qRT-PCR, Western blotting, and immunohistochemical staining revealed the overexpression of Cat S in GC cell lines and tissues. The diagnostic value of serum Cat S for GC patients from controls resulted in an AUC of 0.803 with a sensitivity of 60.7% and a specificity of 90.0%. Moreover, the levels of serum Cat S were associated with GC tumor volume, lymphoid nodal status, metastasis status, and stages. Moreover, the patients with high levels of serum Cat S had a poorer overall survival. Univariate analysis revealed Cat S expression was a prognostic factor. The knockdown of Cat S significantly suppressed the migration and invasion of GC cells. This study suggested serum Cat S may be a potential biomarker for the diagnosis and prognosis of GC. PMID:27058412

  3. Diagnostic air quality model evaluation of source-specific primary and secondary fine particulate carbon.

    PubMed

    Napelenok, Sergey L; Simon, Heather; Bhave, Prakash V; Pye, Havala O T; Pouliot, George A; Sheesley, Rebecca J; Schauer, James J

    2014-01-01

    Ambient measurements of 78 source-specific tracers of primary and secondary carbonaceous fine particulate matter collected at four midwestern United States locations over a full year (March 2004-February 2005) provided an unprecedented opportunity to diagnostically evaluate the results of a numerical air quality model. Previous analyses of these measurements demonstrated excellent mass closure for the variety of contributing sources. In this study, a carbon-apportionment version of the Community Multiscale Air Quality (CMAQ) model was used to track primary organic and elemental carbon emissions from 15 independent sources such as mobile sources and biomass burning in addition to four precursor-specific classes of secondary organic aerosol (SOA) originating from isoprene, terpenes, aromatics, and sesquiterpenes. Conversion of the source-resolved model output into organic tracer concentrations yielded a total of 2416 data pairs for comparison with observations. While emission source contributions to the total model bias varied by season and measurement location, the largest absolute bias of -0.55 μgC/m(3) was attributed to insufficient isoprene SOA in the summertime CMAQ simulation. Biomass combustion was responsible for the second largest summertime model bias (-0.46 μgC/m(3) on average). Several instances of compensating errors were also evident; model underpredictions in some sectors were masked by overpredictions in others. PMID:24245475

  4. Evaluation of diagnostic procedures for subclinical mastitis in meat-producing sheep.

    PubMed

    Clements, Archie C A; Taylor, David J; Fitzpatrick, Julie L

    2003-05-01

    Samples of foremilk were collected from 261 clinically normal glands of 150 ewes, and tested using the California mastitis test (CMT). Further samples were collected from 195 of these glands for determination of automated somatic cell counts (SCC), and from 60 of these glands for bacteriological assessment. The sensitivity and specificity of CMT for detecting samples with SCC above different threshold levels and for CMT and SCC in determining bacteriological status were evaluated using two-graph receiver operating characteristics (TG-ROC). Milk samples were obtained subsequently from ten CMT positive, and five CMT negative first- and second-lactation ewes. Samples were cultured using a variety of media, incubation temperatures and atmospheric conditions, immediately after collection, and 1 week after storage at 4 degrees C and -21 degrees C. Results suggested that CMT is best used as a diagnostic test for ovine subclinical mastitis (SCM) with a cut-off of 3 (distinct gel formation), and that automated SCC thresholds of > 1200 x 10(3) cells/ml are appropriate, especially where low prevalences are expected (e.g. < 5%). Additionally, this study showed that routine bacteriological methods were appropriate for isolation of most species of pathogen responsible for ovine SCM, but storage of samples prior to culture, either at 4 degrees C or -21 degrees C, was detrimental to the isolation of several of these organisms.

  5. Diagnostic electrocardiography in epidemiological studies of Chagas' disease: multicenter evaluation of a standardized method.

    PubMed

    Lázzari, J O; Pereira, M; Antunes, C M; Guimarães, A; Moncayo, A; Chávez Domínguez, R; Hernández Pieretti, O; Macedo, V; Rassi, A; Maguire, J; Romero, A

    1998-11-01

    An electrocardiographic recording method with an associated reading guide, designed for epidemiological studies on Chagas' disease, was tested to assess its diagnostic reproducibility. Six cardiologists from five countries each read 100 electrocardiographic (ECG) tracings, including 30 from chronic chagasic patients, then reread them after an interval of 6 months. The readings were blind, with the tracings numbered randomly for the first reading and renumbered randomly for the second reading. The physicians, all experienced in interpreting ECGs from chagasic patients, followed printed instructions for reading the tracings. Reproducibility of the readings was evaluated using the kappa (kappa) index for concordance. The results showed a high degree of interobserver concordance with respect to the diagnosis of normal vs. abnormal tracings (kappa = 0.66; SE 0.02). While the interpretations of some categories of ECG abnormalities were highly reproducible, others, especially those having a low prevalence, showed lower levels of concordance. Intraobserver concordance was uniformly higher than interobserver concordance. The findings of this study justify the use by specialists of the recording of readings method proposed for epidemiological studies on Chagas' disease, but warrant caution in the interpretation of some categories of electrocardiographic alterations.

  6. Use of time-resolved fluorescence spectroscopy to evaluate diagnostic value of collagen degradation products.

    PubMed

    Sikora, Joanna; Cyrankiewicz, Michał; Wybranowski, Tomasz; Ziomkowska, Blanka; Ośmiałowski, Borys; Obońska, Ewa; Augustyńska, Beata; Kruszewski, Stefan; Kubica, Jacek

    2015-05-01

    The concentration of collagen degradation products (CDPs) may reflect the process of left ventricular remodeling (LVR). The aim of this study was to evaluate the potential diagnostic usefulness of time-resolved fluorescence spectroscopy (TRFS) in assessment of CDPs. The preliminary experiment was designed to establish if CDPs’ characteristics might be visible by mean fluorescence lifetime (FLT) in determined conditions. The in vitro model of CDPs was prepared by conducting the hydrolysis of type III collagen. The FLT of samples was measured by the time-resolved spectrometer Life Spec II with the subnanosecond pulsed 360-nm EPLED diode. The FLTs were obtained by deconvolution analysis of the data using a multiexponential model of fluorescence decay. In order to determine the limit of traceability of CDPs, a comparison of different collagen/plasma ratio in samples was performed. The results of our study showed that the increase of added plasma to hydrolyzed collagen extended the mean FLT. Thus, the diagnosis of LVR based on measurements using TRFS is possible. However, it is important to point out the experiment was preliminary and further investigation in this field of research is crucial. PMID:25764396

  7. Use of time-resolved fluorescence spectroscopy to evaluate diagnostic value of collagen degradation products

    NASA Astrophysics Data System (ADS)

    Sikora, Joanna; Cyrankiewicz, Michał; Wybranowski, Tomasz; Ziomkowska, Blanka; Ośmiałowski, Borys; Obońska, Ewa; Augustyńska, Beata; Kruszewski, Stefan; Kubica, Jacek

    2015-05-01

    The concentration of collagen degradation products (CDPs) may reflect the process of left ventricular remodeling (LVR). The aim of this study was to evaluate the potential diagnostic usefulness of time-resolved fluorescence spectroscopy (TRFS) in assessment of CDPs. The preliminary experiment was designed to establish if CDPs' characteristics might be visible by mean fluorescence lifetime (FLT) in determined conditions. The in vitro model of CDPs was prepared by conducting the hydrolysis of type III collagen. The FLT of samples was measured by the time-resolved spectrometer Life Spec II with the subnanosecond pulsed 360-nm EPLED diode. The FLTs were obtained by deconvolution analysis of the data using a multiexponential model of fluorescence decay. In order to determine the limit of traceability of CDPs, a comparison of different collagen/plasma ratio in samples was performed. The results of our study showed that the increase of added plasma to hydrolyzed collagen extended the mean FLT. Thus, the diagnosis of LVR based on measurements using TRFS is possible. However, it is important to point out the experiment was preliminary and further investigation in this field of research is crucial.

  8. Diagnostic use of angiotensin converting enzyme inhibitors in radioisotope evaluation of unilateral renal artery stenosis

    SciTech Connect

    Kremer Hovinga, T.K.; de Jong, P.E.; Piers, D.A.; Beekhuis, H.; van der Hem, G.K.; de Zeeuw, D.

    1989-05-01

    Iodine-123 hippurate renography, (/sup 99m/Tc)diethylenetriaminepentaacetic acid (DTPA) renography, and (/sup 99m/Tc)dimercapto succinic acid (DMSA) renal scintigraphy were performed before and during angiotensin converting enzyme (ACE) inhibition in a group of 15 hypertensive patients with angiographically ''significant'' unilateral renal artery stenosis. Visual and quantitative evaluation of the three radioisotope methods before ACE inhibition already disclosed abnormalities suggestive of renal artery stenosis in a high percentage (87%, 60%, and 60%, respectively) in this group of patients, but ACE inhibition further improved the diagnostic yield in all three methods (93%, 86%, and 80%). Iodine-123 hippurate renography was at least as useful as (/sup 99m/Tc)DTPA renography in this respect, while (/sup 99m/Tc)DMSA scintigraphy can be used particularly in segmental stenosis. Despite a large drop in blood pressure after ACE inhibition little adverse reactions were seen and overall renal function was fairly well maintained, the exceptions noted in patients with initially a more impaired renal function.

  9. Use of Diagnostic Imaging in the Evaluation of Gastrointestinal Tract Duplications

    PubMed Central

    Laskowska, Katarzyna; Gałązka, Przemysław; Daniluk-Matraś, Irena; Leszczyński, Waldemar; Serafin, Zbigniew

    2014-01-01

    Summary Background Gastrointestinal tract duplication is a rare malformation associated with the presence of additional segment of the fetal gut. The aim of this study was to retrospectively review clinical features and imaging findings in intraoperatively confirmed cases of gastrointestinal tract duplication in children. Material/Methods The analysis included own material from the years 2002–2012. The analyzed group included 14 children, among them 8 boys and 6 girls. The youngest patient was diagnosed at the age of three weeks, and the oldest at 12 years of age. Results The duplication cysts were identified in the esophagus (n=2), stomach (n=5), duodenum (n=1), terminal ileum (n=5), and rectum (n=1). In four cases, the duplication coexisted with other anomalies, such as patent urachus, Meckel’s diverticulum, mesenteric cyst, and accessory pancreas. Clinical manifestation of gastrointestinal duplication cysts was variable, and some of them were detected accidently. Thin- or thick-walled cystic structures adjacent to the wall of neighboring gastrointestinal segment were documented on diagnostic imaging. Conclusions Ultrasound and computed tomography are the methods of choice in the evaluation of gastrointestinal duplication cysts. Apart from the diagnosis of the duplication cyst, an important issue is the detection of concomitant developmental pathologies, including pancreatic heterotopy. PMID:25114725

  10. Evaluating the diagnostic and prognostic value of circulating cathepsin S in gastric cancer.

    PubMed

    Liu, Wan-Li; Liu, Dan; Cheng, Kai; Liu, Yi-Jun; Xing, Shan; Chi, Pei-Dong; Liu, Xiao-Hua; Xue, Ning; Lai, Yan-Zhen; Guo, Ling; Zhang, Ge

    2016-05-10

    To evaluate whether serum Cathepsin S (Cat S) could serve as a biomarker for the diagnosis and prognosis of gastric cancer (GC), Enzyme-linked immuno sorbent assay (ELISA) was used to detect serum Cat S in 496 participants including healthy controls and patients with benign gastric diseases, gastric cancer, esophageal cancer, liver cancer, colorectal cancer, nasopharyngeal cancer and lung cancer. The levels of serum Cat S were significantly increased in cancer patients, especially in GC patients. The qRT-PCR, Western blotting, and immunohistochemical staining revealed the overexpression of Cat S in GC cell lines and tissues. The diagnostic value of serum Cat S for GC patients from controls resulted in an AUC of 0.803 with a sensitivity of 60.7% and a specificity of 90.0%. Moreover, the levels of serum Cat S were associated with GC tumor volume, lymphoid nodal status, metastasis status, and stages. Moreover, the patients with high levels of serum Cat S had a poorer overall survival. Univariate analysis revealed Cat S expression was a prognostic factor. The knockdown of Cat S significantly suppressed the migration and invasion of GC cells. This study suggested serum Cat S may be a potential biomarker for the diagnosis and prognosis of GC.

  11. Diagnostic evaluation for autism spectrum disorder: a survey of health professionals in Australia

    PubMed Central

    Taylor, Lauren J; Eapen, Valsamma; Maybery, Murray T; Midford, Sue; Paynter, Jessica; Quarmby, Lyndsay; Smith, Timothy; Williams, Katrina; Whitehouse, Andrew J O

    2016-01-01

    Objectives There is currently no agreed Australian standard for the diagnosis of autism spectrum disorder (ASD) even though there are specific diagnostic services available. We suspected inconsistency in the diagnostic practices of health professionals in Australia and aimed to assess these practices across the nation by surveying all relevant professional groups. Design In this study, we completed a survey of 173 health professionals whose clinical practice includes participating in the diagnostic process for ASD in Australia. Participants completed an online questionnaire which included questions about their diagnostic setting, diagnostic practice and diagnostic outcomes in 2014–2015. Participants Participants covered a range of disciplines including paediatrics, psychiatry, psychology, speech pathology and occupational therapy. All states and territories of Australia were represented. Setting Participants came from a range of service settings which included hospitals, non-governmental organisations, publicly funded diagnostic services and private practice. Results There was variability in diagnostic practices for ASD in Australia. While some clinicians work within a multidisciplinary assessment team, others practice independently and rarely collaborate with other clinicians to make a diagnostic decision. Only half of the respondents reported that they include a standardised objective assessment tool such as the Autism Diagnostic Observation Schedule in ASD assessments, and one-third indicated that they do not include measures of development, cognition and language in assessments where ASD is suspected. Conclusions Reported practice of some professionals in Australia may not be consistent with international best practice guidelines for ASD diagnosis. These findings highlight the need for a minimum national standard for ASD diagnosis throughout Australia that ensures best practice regardless of the type of setting in which the service is provided. PMID:27601502

  12. Erectile dysfunction in uremic dialysis patients: diagnostic evaluation in the sildenafil era.

    PubMed

    Bellinghieri, G; Santoro, D; Lo Forti, B; Mallamace, A; De Santo, R M; Savica, V

    2001-10-01

    The two words that mean sexual dysfunction, impotence and erectile dysfunction (ED), express two different concepts. Impotence is a general male sexual dysfunction that includes libidinal, orgasmic, and ejaculatory dysfunction. ED is the inability to achieve or maintain an erection sufficient to allow satisfactory sexual intercourse and is part of the general male sexual dysfunction termed impotence that includes libidinal, orgasmic, and ejaculatory dysfunction. Uremic men of different ages report a variety of sexual problems, including sexual hormonal pattern alterations, reduction in or loss of libido, infertility, and impotence, conditioning their well-being status. In evaluating and treating sexual dysfunction, a nephrologist must consider factors involved in its pathogenesis, such as hypothalamic-pituitary-gonadal axis alterations, psychological problems related to chronic disease, secondary hyperparathyroidism, anemia, autonomic neuropathy, derangements in arterial supply or venous outflow, and the normal structure of cavernous body smooth muscle cells. The introduction of sildenafil to treat impotent patients has completely changed the approach to evaluating these subjects because this drug is considered an effective well-tolerated treatment for men with ED. In the past, we proposed an algorithm that gave the opportunity to explore the previously mentioned factors using such instrumental interventions as the nocturnal penile tumescence test, penile echo color Doppler, nervous conduction velocity, and cavernous body biopsy, addressed to prescribe needed surgical or medical interventions. The complexity of the proposed algorithm requires many diagnostic procedures and much time and economic resources to localize the pathological lesions responsible for ED. Because of the new oral drug sildenafil, we propose a new algorithm to test the possibility of obtaining an erection and classify patients as responders or nonresponders to the sildenafil test.

  13. Development of UK recommendations on treatment for post-surgical erectile dysfunction

    PubMed Central

    Kirby, M G; White, I D; Butcher, J; Challacombe, B; Coe, J; Grover, L; Hegarty, P; Jackson, G; Lowndes, A; Payne, H; Rees, J; Sangar, V; Thompson, A

    2014-01-01

    Aim To develop a management strategy (rehabilitation programme) for postsurgical erectile dysfunction (ED) among men experiencing ED associated with treatment of prostate, bladder or rectal cancer that is suitable for use in a UK NHS healthcare context. Methods PubMed literature searches of ED management together with a survey of 13 experts in the management of ED from across the UK were conducted. Results Data from 37 articles and completed questionnaires were collated. The results discussed in this study demonstrate improved objective and subjective clinical outcomes for physical parameters, sexual satisfaction, and rates of both spontaneous erections and those associated with ED treatment strategies. Conclusion Based on the literature and survey analysis, recommendations are proposed for the standardisation of management strategies employed for postsurgical ED. PMID:24188207

  14. Evaluation of the International Society on Thrombosis and Haemostasis and institutional diagnostic criteria of disseminated intravascular coagulation in pediatric patients.

    PubMed

    Soundar, Esther P; Jariwala, Purviben; Nguyen, Trung C; Eldin, Karen W; Teruya, Jun

    2013-06-01

    Globally, adult intensive care units routinely use the International Society on Thrombosis and Haemostasis (ISTH) scoring system for identifying overt disseminated intravascular coagulation (DIC). However, in our pediatric intensive care unit, a modified diagnostic criterion (Texas Children's Hospital [TCH] criteria) that requires serial monitoring of the coagulation variables is employed. A retrospective analysis of 2,136 DIC panels from 130 patients who had at least 4 DIC panels during 1 admission to a pediatric intensive care unit was done to compare the diagnostic utility of the TCH criteria with the ISTH scoring method in children. Both scoring systems were evaluated against the gold standard diagnostic method of autopsy confirmation of DIC in the subset of children who died. Receiver operating characteristic analysis indicates that TCH diagnostic criteria are comparable to the ISTH scoring method (area under the curve of 0.878 for TCH and 0.950 for ISTH). On the contrary, TCH diagnostic criteria perform better, with a sensitivity significantly higher than the ISTH scoring method when tested against the gold standard (P < .05). Fibrinogen is not a significant predictor of overt DIC in both models. Sequential testing of coagulation parameters is recommended for improved sensitivity when applying ISTH criteria to pediatric populations.

  15. Evaluation of the Accuracy of the EasyTest™ Malaria Pf/Pan Ag, a Rapid Diagnostic Test, in Uganda

    PubMed Central

    Chong, Chom-Kyu; Cho, Pyo Yun; Na, Byoung-Kuk; Ahn, Seong Kyu; Kim, Jin Su; Lee, Jin-Soo; Lee, Sung-Keun; Han, Eun-Taek; Kim, Hak-Yong; Park, Yun-Kyu; Cha, Seok Ho

    2014-01-01

    In recent years, rapid diagnostic tests (RDTs) have been widely used for malaria detection, primarily because of their simple operation, fast results, and straightforward interpretation. The Asan EasyTest™ Malaria Pf/Pan Ag is one of the most commonly used malaria RDTs in several countries, including Korea and India. In this study, we tested the diagnostic performance of this RDT in Uganda to evaluate its usefulness for field diagnosis of malaria in this country. Microscopic and PCR analyses, and the Asan EasyTest™ Malaria Pf/Pan Ag rapid diagnostic test, were performed on blood samples from 185 individuals with suspected malaria in several villages in Uganda. Compared to the microscopic analysis, the sensitivity of the RDT to detect malaria infection was 95.8% and 83.3% for Plasmodium falciparum and non-P. falciparum, respectively. Although the diagnostic sensitivity of the RDT decreased when parasitemia was ≤500 parasites/µl, it showed 96.8% sensitivity (98.4% for P. falciparum and 93.8% for non-P. falciparum) in blood samples with parasitemia ≥100 parasites/µl. The specificity of the RDT was 97.3% for P. falciparum and 97.3% for non-P. falciparum. These results collectively suggest that the accuracy of the Asan EasyTest™ Malaria Pf/Pan Ag makes it an effective point-of-care diagnostic tool for malaria in Uganda. PMID:25352698

  16. Translating diagnostic assays from the laboratory to the clinic: analytical and clinical metrics for device development and evaluation.

    PubMed

    Borysiak, Mark D; Thompson, Matthew J; Posner, Jonathan D

    2016-04-21

    As lab-on-a-chip health diagnostic technologies mature, there is a push to translate them from the laboratory to the clinic. For these diagnostics to achieve maximum impact on patient care, scientists and engineers developing the tests should understand the analytical and clinical statistical metrics that determine the efficacy of the test. Appreciating and using these metrics will benefit test developers by providing consistent measures to evaluate analytical and clinical test performance, as well as guide the design of tests that will most benefit clinicians and patients. This paper is broken into four sections that discuss metrics related to general stages of development including: (1) laboratory assay development (analytical sensitivity, limit of detection, analytical selectivity, and trueness/precision), (2) pre-clinical development (diagnostic sensitivity, diagnostic specificity, clinical cutoffs, and receiver-operator curves), (3) clinical use (prevalence, predictive values, and likelihood ratios), and (4) case studies from existing clinical data for tests relevant to the lab-on-a-chip community (HIV, group A strep, and chlamydia). Each section contains definitions of recommended statistical measures, as well as examples demonstrating the importance of these metrics at various stages of the development process. Increasing the use of these metrics in lab-on-a-chip research will improve the rigor of diagnostic performance reporting and provide a better understanding of how to design tests that will ultimately meet clinical needs. PMID:27043204

  17. A new predilection site of Mycoplasma bovis: Postsurgical seromas in beef cattle.

    PubMed

    Gille, L; Pilo, P; Valgaeren, B R; Van Driessche, L; Van Loo, H; Bodmer, M; Bürki, S; Boyen, F; Haesebrouck, F; Deprez, P; Pardon, B

    2016-04-15

    Mycoplasma bovis is a highly contagious bacterium, which predominantly causes chronic pneumonia, otitis and arthritis in calves and mastitis in adult cattle. In humans, Mycoplasma species have been associated with post-surgical infections. The present study aimed to identify the bacteria associated with three outbreaks of infected seromas after caesarian section in Belgian Blue beef cattle. A total of 10 cases occurred in three herds which were in close proximity of each other and shared the same veterinary practice. M. bovis could be cultured from seroma fluid in five of the six referred animals, mostly in pure culture and was isolated from multiple chronic sites of infection (arthritis and mastitis) as well. DNA fingerprinting of the isolates targeting two insertion sequence elements suggested spread of M. bovis from chronic sites of infection (udder and joints) to the postsurgical seromas. Identical genetic profiles were demonstrated in two animals from two separate farms, suggesting spread between farms. Mortality rate in the referred animals positive for M. bovis in a seroma was 80% (4/5), despite intensive treatment. A massive increase in antimicrobial use was observed in every affected farm. These observations demonstrate involvement of mycoplasmas in outbreaks of postsurgical seromas in cattle. PMID:27016759

  18. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus.

    PubMed Central

    Kalff, J C; Schraut, W H; Simmons, R L; Bauer, A J

    1998-01-01

    OBJECTIVE: To investigate the pathophysiologic mechanisms that lead to ileus after abdominal surgery. SUMMARY BACKGROUND DATA: The common supposition is that more invasive operations are associated with a more extensive ileus. The cellular mechanisms of postsurgical ileus remain elusive, and few studies have addressed the mechanisms. METHODS: Rats were subjected to incremental degrees of surgical manipulation: laparotomy, eventration, "running," and compression of the bowel. On postsurgical days 1 and 7, muscularis infiltrates were characterized immunohistochemically. Circular muscle activity was assessed using mechanical and intracellular recording techniques in vitro. RESULTS: Surgical manipulation caused an increase in resident phagocytes that stained for the activation marker lymphocyte function-associated antigen (LFA-1). Incremental degrees of manipulation also caused a progressive increase in neutrophil infiltration and a decrease in bethanechol-stimulated contractions. Compression also caused an increase in other leukocytes: macrophages, monocytes, dendritic cells, T cells, natural killer cells, and mast cells. CONCLUSION: The data support the hypothesis that the degree of gut paralysis to cholinergic stimulation is directly proportional to the degree of trauma, the activation of resident gut muscularis phagocytes, and the extent of cellular infiltration. Therefore, postsurgical ileus may be a result of an inflammatory response to minimal trauma in which the resident macrophages, activated by physical forces, set an inflammatory response into motion, leading to muscle dysfunction. Images Figure 4. Figure 5. Figure 7. PMID:9833803

  19. Evaluation of three rapid diagnostic tests for the detection of human infections with Plasmodium knowlesi

    PubMed Central

    2014-01-01

    Background Plasmodium knowlesi, a malaria parasite of Southeast Asian macaques, infects humans and can cause fatal malaria. It is difficult to diagnose by microscopy because of morphological similarity to Plasmodium malariae. Nested PCR assay is the most accurate method to distinguish P. knowlesi from other Plasmodium species but is not cost effective in resource-poor settings. Rapid diagnostic tests (RDTs) are recommended for settings where malaria is prevalent. In this study, the effectiveness of three RDTs in detecting P. knowlesi from fresh and frozen patient blood samples was evaluated. Methods Forty malaria patients (28 P. knowlesi, ten P. vivax and two P. falciparum) diagnosed by microscopy were recruited in Sarawak, Malaysian Borneo during a 16-month period. Patient blood samples were used to determine parasitaemia by microscopy, confirm the Plasmodium species present by PCR and evaluate three RDTs: OptiMAL-IT, BinaxNOW® Malaria and Paramax-3. The RDTs were also evaluated using frozen blood samples from 41 knowlesi malaria patients. Results OptiMAL-IT was the most sensitive RDT, with a sensitivity of 71% (20/28; 95% CI = 54-88%) for fresh and 73% (30/41; 95% CI = 59-87%) for frozen knowlesi samples. However, it yielded predominantly falciparum-positive results due to cross-reactivity of the P. falciparum test reagent with P. knowlesi. BinaxNOW® Malaria correctly detected non-P. falciparum malaria in P. knowlesi samples but was the least sensitive, detecting only 29% (8/28; 95% CI = 12-46%) of fresh and 24% (10/41; 95% CI = 11-37%) of frozen samples. The Paramax-3 RDT tested positive for P. vivax with PCR-confirmed P. knowlesi samples with sensitivities of 40% (10/25; 95% CI = 21-59%) with fresh and 32% (13/41; 95% CI = 17-46%) with frozen samples. All RDTs correctly identified P. falciparum- and P. vivax-positive controls with parasitaemias above 2,000 parasites/μl blood. Conclusions The RDTs detected Plasmodium in P. knowlesi-infected blood samples with

  20. Comparison between computed tomography multislice and high-field magnetic resonance in the diagnostic evaluation of patients with renal masses

    PubMed Central

    Baldari, Diana; Capece, Sergio; Mainenti, Pier Paolo; Tucci, Anna Giacoma; Klain, Michele; Cozzolino, Immacolata; Salvatore, Marco

    2015-01-01

    Background Renal masses are a common finding in diagnostic imaging; these lesions usually are solid or cystic, benign or malignant, and the correct diagnosis may be difficult. The aim of our study was the comparison of multi-slice computed tomography (MSCT) and high-field magnetic resonance (MR) in the diagnostic evaluation of renal masses. Methods We studied 29 patients, 16 men and 13 women aged 8-85 years (mean 61±17 years) with histo-cytological diagnosis of renal masses (n=31), of which the majority (74%; n=23) was represented by malignant lesions [renal cell carcinoma (Ca) =16, chromophobe renal cell Ca =2, squamous cell Ca =1, urothelial Ca =2, lymphoma =1, Wilms tumor =1]; the remaining 8 masses (26%) were benign (pyelonephritis =2, simple cyst =1, hematic cyst =1, lipoma =1 and oncocytoma =3). All patients underwent MSCT and MR (3.0 Tesla) before and after contrast injection; the images were evaluated in double-blind by two expert radiologists. The results of the images were then compared with the histo-cytological data to calculate the values of diagnostic accuracy for both methods in the identification and characterization of renal masses. The benign or malignant nature of the lesions was established according to the regularity of the margins, presence or absence of significant contrast enhancement, infiltration of perirenal fat and vascular invasion. The concordance of the results of the two imaging techniques was then calculated using the coefficient Kappa Cohen. Results For both identification and characterization of renal masses, MSCT and MR showed comparable values of diagnostic accuracy with a significant concordance (k=1); in particular, the diagnostic accuracy of MSCT/MR was 100%/100% for lesion identification, 90%/90% for lesion characterization in terms of benign or malignant nature, 97%/97% for the evaluation of lesion edges, 90%/90% for the assessment of lesion contrast enhancement, 93%/93% for the evaluation of peri-renal fat infiltration

  1. Field evaluation of a rapid diagnostic test to detect antibodies in human toxocariasis.

    PubMed

    Lim, P K C; Yamasaki, H; Mak, J W; Wong, S F; Chong, C W; Yap, I K S; Ambu, S; Kumarasamy, V

    2015-08-01

    Human toxocariasis which is caused mainly by the larvae of Toxocara canis and Toxocara cati, is a worldwide zoonotic disease that can be a potentially serious human infection. The enzyme-linked immunosorbent assay (ELISA) using T. canis excretory-secretory (TES) antigens harvested from T. canis larvae is currently the serological test for confirming toxocariasis. An alternative to producing large amounts of Toxocara TES and improved diagnosis for toxocariasis is through the development of highly specific recombinant antigens such as the T. canis second stage larva excretory-secretory 30 kDa protein (recTES-30). The aim of this study was to evaluate the sensitivity and specificity of a rapid diagnostic kit (RDT, named as iToxocara kit) in comparison to recTES-30 ELISA in Serendah Orang Asli village in Selangor, Malaysia. A total of 133 subjects were included in the study. The overall prevalence rates by ELISA and RDT were 29.3% and 33.1%, respectively, with more positive cases detected in males than females. However, no association was found between toxocariasis and gender or age. The percentage sensitivity, specificity, positive predictive value and negative predictive value of RDT were 85.7%, 90.1%, 80% and 93.2%, respectively. The prevalence for toxocariasis in this population using both ELISA and RDT was 27.1% (36/133) and the K-concordance test suggested good agreement of the two tests with a Cohen's kappa of 0.722, P<0.01. In addition, the followed-up Spearman rank correlation showed a moderately high correlation at R=0.704 and P<0.01. In conclusion, the RDT kit was faster and easier to use than an ELISA and is useful for the laboratory diagnosis of hospitalized cases of toxocariasis. PMID:25910623

  2. Cytogenomic Evaluation of Children with Congenital Anomalies: Critical Implications for Diagnostic Testing and Genetic Counseling.

    PubMed

    Szczałuba, Krzysztof; Jakubiuk-Tomaszuk, Anna; Kędzior, Marta; Bernaciak, Joanna; Zdrodowska, Jolanta; Kurzątkowski, Wiesław; Radkowski, Marek; Demkow, Urszula

    2016-01-01

    Identification of submicroscopic chromosomal aberrations, as a cause of structural malformations, is currently performed by MLPA (multiplex ligation-dependent probe amplification) or array CGH (array comparative genomic hybridization) techniques. The aim of this study was the evaluation of diagnostic usefulness of MLPA and array CGH in patients with congenital malformations or abnormalities (at least one major or minor birth defect, including dysmorphism) with or without intellectual disability or developmental delay and the optimization of genetic counseling in the context of the results obtained. The MLPA and array CGH were performed in 91 patients diagnosed with developmental disorders and major or minor congenital anomalies. A total of 49 MLPA tests toward common microdeletion syndromes, 42 MLPA tests for subtelomeric regions of chromosomes, two tests for common aberrations in autism, and five array CGH tests were performed. Eight (9 %) patients were diagnosed with microdeletion MLPA, four (4 %) patients with subtelomeric MLPA, one (1 %) patient with autism MLPA. Further three (3 %) individuals had rearrangements diagnosed by array CGH. Altogether, chromosomal microaberrations were found in 16 patients (17 %). All the MLPA-detected rearrangements were found to be pathogenic, but none detected with array CGH could unequivocally be interpreted as pathogenic. In patients with congenital anomalies, the application of MLPA and array CGH techniques is efficient in detecting syndromic and unique microrearrangements. Consistent pre-MLPA test phenotyping leads to better post-test genetic counseling. Incomplete penetrance and unknown inheritance of detected variants are major issues in clinical interpretation of array CGH data. PMID:26987321

  3. Achieving successful evidence-based practice implementation in juvenile justice: The importance of diagnostic and evaluative capacity.

    PubMed

    Walker, Sarah Cusworth; Bumbarger, Brian K; Phillippi, Stephen W

    2015-10-01

    Evidence-based programs (EBPs) are an increasingly visible aspect of the treatment landscape in juvenile justice. Research demonstrates that such programs yield positive returns on investment and are replacing more expensive, less effective options. However, programs are unlikely to produce expected benefits when they are not well-matched to community needs, not sustained and do not reach sufficient reach and scale. We argue that achieving these benchmarks for successful implementation will require states and county governments to invest in data-driven decision infrastructure in order to respond in a rigorous and flexible way to shifting political and funding climates. We conceptualize this infrastructure as diagnostic capacity and evaluative capacity: Diagnostic capacity is defined as the process of selecting appropriate programing and evaluative capacity is defined as the ability to monitor and evaluate progress. Policy analyses of Washington State, Pennsylvania and Louisiana's program implementation successes are used to illustrate the benefits of diagnostic and evaluate capacity as a critical element of EBP implementation. PMID:26141970

  4. A Multicenter Evaluation of Diagnostic Tools to Define Endpoints for Programs to Eliminate Bancroftian Filariasis

    PubMed Central

    Gass, Katherine; Beau de Rochars, Madsen V. E.; Boakye, Daniel; Bradley, Mark; Fischer, Peter U.; Gyapong, John; Itoh, Makoto; Ituaso-Conway, Nese; Joseph, Hayley; Kyelem, Dominique; Laney, Sandra J.; Legrand, Anne-Marie; Liyanage, Tilaka S.; Melrose, Wayne; Mohammed, Khalfan; Pilotte, Nils; Ottesen, Eric A.; Plichart, Catherine; Ramaiah, Kapa; Rao, Ramakrishna U.; Talbot, Jeffrey; Weil, Gary J.; Williams, Steven A.; Won, Kimberly Y.; Lammie, Patrick

    2012-01-01

    Successful mass drug administration (MDA) campaigns have brought several countries near the point of Lymphatic Filariasis (LF) elimination. A diagnostic tool is needed to determine when the prevalence levels have decreased to a point that MDA campaigns can be discontinued without the threat of recrudescence. A six-country study was conducted assessing the performance of seven diagnostic tests, including tests for microfilariae (blood smear, PCR), parasite antigen (ICT, Og4C3) and antifilarial antibody (Bm14, PanLF, Urine SXP). One community survey and one school survey were performed in each country. A total of 8,513 people from the six countries participated in the study, 6,443 through community surveys and 2,070 through school surveys. Specimens from these participants were used to conduct 49,585 diagnostic tests. Each test was seen to have both positive and negative attributes, but overall, the ICT test was found to be 76% sensitive at detecting microfilaremia and 93% specific at identifying individuals negative for both microfilariae and antifilarial antibody; the Og4C3 test was 87% sensitive and 95% specific. We conclude, however, that the ICT should be the primary tool recommended for decision-making about stopping MDAs. As a point-of-care diagnostic, the ICT is relatively inexpensive, requires no laboratory equipment, has satisfactory sensitivity and specificity and can be processed in 10 minutes—qualities consistent with programmatic use. Og4C3 provides a satisfactory laboratory-based diagnostic alternative. PMID:22272369

  5. [Critical evaluation of current diagnostic classification systems in psychiatry: the case of DSM-5].

    PubMed

    Luciano, Mario; Sampogna, Gaia; Del Vecchio, Valeria; De Rosa, Corrado; Albert, Umberto; Carrà, Giuseppe; Dell'Osso, Bernardo; Lorenzo, Giorgio Di; Ferrari, Silvia; Martinotti, Giovanni; Nanni, Maria Giulia; Pinna, Federica; Pompili, Maurizio; Volpe, Umberto; Catapano, Francesco; Fiorillo, Andrea

    2016-01-01

    Since its first edition, the Diagnostic and Statistical manual of Mental disorders (DSM) has had a great impact on the scientific community and the public opinion as well. In 2013, the American Psychiatric Association released the fifth edition of the manual and - as for the previous versions - several criticisms raised. In particular, the persistence of the categorical approach to mental disorders represents one of the main debated topics, as well as the introduction of new diagnostic syndromes, which are not based on an adequate evidences. Moreover, the threshold of diagnostic criteria for many mental disorders has been lowered, with the consequence that the boundaries between "normality" and "pathology" is not so clear. In this paper, we will: 1) report the historical development of the DSM from the publication of its first edition; 2) describe the main changes introduced in the DSM-5; 3) discuss critical elements in the DSM-5. The current debate regarding the validity of diagnostic manuals and its criteria is threatening the psychiatric discipline, but a possible solution should be represented by the integration of diagnostic criteria with the in-depth description of patient's psychopathological experiences. PMID:27362823

  6. Evaluation of a vibration diagnostic system for the detection of spur gear pitting failures

    NASA Technical Reports Server (NTRS)

    Townsend, Dennis P.; Zakrajsek, James J.

    1993-01-01

    A vibration diagnostic system was used to detect spur gear surface pitting fatigue in a closed-loop spur gear fatigue test rig. The diagnostic system, comprising a personal computer with an analog-to-digital conversion board, a diagnostic system unit, and software, uses time-synchronous averaging of the vibration signal to produce a vibration image of each tooth on any gear in a transmission. Several parameters were analyzed including gear pair stress wave and raw baseband vibration, kurtosis, peak ratios, and others. The system provides limits for the various parameters and gives a warning when the limits are exceeded. Several spur gear tests were conducted with this system and vibration data analyzed at 5-min. intervals. The results presented herein show that the system is fairly effective at detecting spur gear tooth surface fatigue pitting failures.

  7. Evaluation of a vibration diagnostic system for the detection of spur gear pitting failures

    SciTech Connect

    Townsend, D.P.; Zakrajsek, J.J.

    1993-06-01

    A vibration diagnostic system was used to detect spur gear surface pitting fatigue in a closed-loop spur gear fatigue test rig. The diagnostic system, comprising a personal computer with an analog-to-digital conversion board, a diagnostic system unit, and software, uses time-synchronous averaging of the vibration signal to produce a vibration image of each tooth on any gear in a transmission. Several parameters were analyzed including gear pair stress wave and raw baseband vibration, kurtosis, peak ratios, and others. The system provides limits for the various parameters and gives a warning when the limits are exceeded. Several spur gear tests were conducted with this system and vibration data analyzed at 5-min. intervals. The results presented herein show that the system is fairly effective at detecting spur gear tooth surface fatigue pitting failures. 4 refs.

  8. Evaluation of observed blast loading effects on NIF x-ray diagnostic collimatorsa)

    NASA Astrophysics Data System (ADS)

    Masters, N. D.; Fisher, A.; Kalantar, D.; Prasad, R.; Stölken, J. S.; Wlodarczyk, C.

    2014-11-01

    We present the "debris wind" models used to estimate the impulsive load to which x-ray diagnostics and other structures are subject during National Ignition Facility experiments. These models are used as part of the engineering design process. Isotropic models, based on simulations or simplified "expanding shell" models, are augmented by debris wind multipliers to account for directional anisotropy. We present improvements to these multipliers based on measurements of the permanent deflections of diagnostic components: 4× for the polar direction and 2× within the equatorial plane—the latter relaxing the previous heuristic debris wind multiplier.

  9. Evaluation of observed blast loading effects on NIF x-ray diagnostic collimators.

    PubMed

    Masters, N D; Fisher, A; Kalantar, D; Prasad, R; Stölken, J S; Wlodarczyk, C

    2014-11-01

    We present the "debris wind" models used to estimate the impulsive load to which x-ray diagnostics and other structures are subject during National Ignition Facility experiments. These models are used as part of the engineering design process. Isotropic models, based on simulations or simplified "expanding shell" models, are augmented by debris wind multipliers to account for directional anisotropy. We present improvements to these multipliers based on measurements of the permanent deflections of diagnostic components: 4× for the polar direction and 2× within the equatorial plane-the latter relaxing the previous heuristic debris wind multiplier.

  10. Tantalum implants as markers for evaluating postoperative orthognathic surgical changes.

    PubMed

    Rubenstein, L K; Strauss, R A; Lindauer, S J; Davidovitch, M; Isaacson, R J

    1993-01-01

    The stability of sagittal split osteotomy advancements is not always 100% predictable. Assessment of postsurgical changes has historically relied on clinical evaluation of dental changes and superimposition of serial cephalograms, both of which have been shown to have serious drawbacks. A technique that improves the analysis of postsurgical changes is described in this paper; tantalum pin implants are placed in the osteotomized segments of patients undergoing surgical advancements. Implants eliminate many of the problems (orthodontic, growth, and remodeling changes) related to superimposition of presurgical and postsurgical cephalograms. Using this technique, surgical changes can be precisely analyzed, and the contribution of each factor of postsurgical relapse can be determined. This information, concerning the magnitude and direction of postsurgical changes, aids in following an individual's progress and increases the accuracy of large group studies by eliminating sources of variability in radiographic and clinical interpretation.

  11. Evaluating the Diagnostic Validity of a Facet-Based Formative Assessment System

    ERIC Educational Resources Information Center

    DeBarger, Angela Haydel; DiBello, Louis; Minstrell, Jim; Feng, Mingyu; Stout, William; Pellegrino, James; Haertel, Geneva; Harris, Christopher; Ructinger, Liliana

    2011-01-01

    This paper describes methods for an alignment study and psychometric analyses of a formative assessment system, Diagnoser Tools for physics. Diagnoser Tools begin with facet clusters as the interpretive framework for designing questions and instructional activities. Thus each question in the diagnostic assessments includes distractors that…

  12. Using a Nonparametric Multilevel Latent Markov Model to Evaluate Diagnostics for Trachoma

    PubMed Central

    Koukounari, Artemis; Moustaki, Irini; Grassly, Nicholas C.; Blake, Isobel M.; Basáñez, María-Gloria; Gambhir, Manoj; Mabey, David C. W.; Bailey, Robin L.; Burton, Matthew J.; Solomon, Anthony W.; Donnelly, Christl A.

    2013-01-01

    In disease control or elimination programs, diagnostics are essential for assessing the impact of interventions, refining treatment strategies, and minimizing the waste of scarce resources. Although high-performance tests are desirable, increased accuracy is frequently accompanied by a requirement for more elaborate infrastructure, which is often not feasible in the developing world. These challenges are pertinent to mapping, impact monitoring, and surveillance in trachoma elimination programs. To help inform rational design of diagnostics for trachoma elimination, we outline a nonparametric multilevel latent Markov modeling approach and apply it to 2 longitudinal cohort studies of trachoma-endemic communities in Tanzania (2000–2002) and The Gambia (2001–2002) to provide simultaneous inferences about the true population prevalence of Chlamydia trachomatis infection and disease and the sensitivity, specificity, and predictive values of 3 diagnostic tests for C. trachomatis infection. Estimates were obtained by using data collected before and after mass azithromycin administration. Such estimates are particularly important for trachoma because of the absence of a true “gold standard” diagnostic test for C. trachomatis. Estimated transition probabilities provide useful insights into key epidemiologic questions about the persistence of disease and the clearance of infection as well as the required frequency of surveillance in the postelimination setting. PMID:23548755

  13. Special Education Diagnostic and Resource Center Project, 1967-68. ESEA Title III Evaluation Report.

    ERIC Educational Resources Information Center

    Wichita Unified School District 259, KS.

    The project provided for the 2nd year of operation of a special education diagnostic and resource center, special classes, and supportive services for handicapped children and youth between the ages of 3 and 21. Cooperation was obtained from existing community agencies, participating school districts, and local private practitioners. Center staff…

  14. Development and Use of Diagnostic Tests to Evaluate Students' Misconceptions in Science.

    ERIC Educational Resources Information Center

    Treagust, David F.

    1988-01-01

    Describes 10 steps for developing a diagnostic test of students' misconceptions and the use of two tests in chemistry (covalent bonding and structure) and in biology (photosynthesis and respiration in plants). Discusses the results and some implications for teaching science. (YP)

  15. Development and Evaluation of a Diagnostic Documentation Support System using Knowledge Processing

    NASA Astrophysics Data System (ADS)

    Makino, Kyoko; Hayakawa, Rumi; Terai, Koichi; Fukatsu, Hiroshi

    In this paper, we will introduce a system which supports creating diagnostic reports. Diagnostic reports are documents by doctors of radiology describing the existence and nonexistence of abnormalities from the inspection images, such as CT and MRI, and summarize a patient's state and disease. Our system indicates insufficiencies in these reports created by younger doctors, by using knowledge processing based on a medical knowledge dictionary. These indications are not only clerical errors, but the system also analyzes the purpose of the inspection and determines whether a comparison with a former inspection is required, or whether there is any shortage in description. We verified our system by using actual data of 2,233 report pairs, a pair comprised of a report written by a younger doctor and a check result of the report by an experienced doctor. The results of the verification showed that the rules of string analysis for detecting clerical errors and sentence wordiness obtained a recall of over 90% and a precision of over 75%. Moreover, the rules based on a medical knowledge dictionary for detecting the lack of required comparison with a former inspection and the shortage in description for the inspection purpose obtained a recall of over 70%. From these results, we confirmed that our system contributes to the quality improvement of diagnostic reports. We expect that our system can comprehensively support diagnostic documentations by cooperating with the interface which refers to inspection images or past reports.

  16. Interrelation of Evaluation and Self-Evaluation in the Diagnostic Procedures to Assess Teachers' Readiness for Innovation

    ERIC Educational Resources Information Center

    Tyunnikov, Yurii S.

    2016-01-01

    The paper solves the problem of the relationship of external diagnosis and self-diagnosis of readiness of teachers to innovative activity. It highlights major disadvantages of measurement tools that are used to this process. The author demonstrates an alternative approach to harmonizing the diagnosis, based on a modular diagnostic model, general…

  17. A systematic review of model-based economic evaluations of diagnostic and therapeutic strategies for lower extremity artery disease.

    PubMed

    Vaidya, Anil; Joore, Manuela A; ten Cate-Hoek, Arina J; Kleinegris, Marie-Claire; ten Cate, Hugo; Severens, Johan L

    2014-01-01

    Lower extremity artery disease (LEAD) is a sign of wide spread atherosclerosis also affecting coronary, cerebral and renal arteries and is associated with increased risk of cardiovascular events. Many economic evaluations have been published for LEAD due to its clinical, social and economic importance. The aim of this systematic review was to assess modelling methods used in published economic evaluations in the field of LEAD. Our review appraised and compared the general characteristics, model structure and methodological quality of published models. Electronic databases MEDLINE and EMBASE were searched until February 2013 via OVID interface. Cochrane database of systematic reviews, Health Technology Assessment database hosted by National Institute for Health research and National Health Services Economic Evaluation Database (NHSEED) were also searched. The methodological quality of the included studies was assessed by using the Philips' checklist. Sixteen model-based economic evaluations were identified and included. Eleven models compared therapeutic health technologies; three models compared diagnostic tests and two models compared a combination of diagnostic and therapeutic options for LEAD. Results of this systematic review revealed an acceptable to low methodological quality of the included studies. Methodological diversity and insufficient information posed a challenge for valid comparison of the included studies. In conclusion, there is a need for transparent, methodologically comparable and scientifically credible model-based economic evaluations in the field of LEAD. Future modelling studies should include clinically and economically important cardiovascular outcomes to reflect the wider impact of LEAD on individual patients and on the society.

  18. Assessment of postsurgical distress and pain in laboratory mice by nest complexity scoring.

    PubMed

    Jirkof, Paulin; Fleischmann, Thea; Cesarovic, Nikola; Rettich, Andreas; Vogel, Johannes; Arras, Margarete

    2013-07-01

    Preliminary studies have suggested a correlation between postsurgical pain and nest building behaviour in laboratory mice. However, there is no standardized measure for estimating pain by means of nest building performance. Here, we investigated nest building under various conditions, and scored nest complexity to assess postsurgical pain. Mice of both sexes, different strains [C57BL/6J, DBA/2J, and B6D2-Tg(Pr-mSMalphaActin)V5rCLR-25], and kept under different housing conditions, showed no differences in their latency to use the offered nest material. Healthy female C57BL/6J mice were engaged 4.3% of the day with nest building and showed three peaks of this behaviour: in the beginning and middle of the light phase, and in the second half of the dark phase. For assessment of postsurgical pain, female C57BL/6J mice underwent a sham embryo transfer +/− different doses of the analgesic carprofen or control treatment. Nest complexity scoring at 9 h after the experimental treatments (i.e. at the end of the light phase) resulted in less than 10% of animals with noticeably manipulated nest material (nestlet) after surgery and more than 75% of healthy mice having built identifiable-to-complex nests or had noticeably manipulated nestlets, while animals after anaesthesia-only showed intermediate nest complexity. Carprofen analgesia resulted in no (5 mg/kg) or only slight (50 mg/kg) improvement of nest complexity after surgery. Thus, nest complexity scoring can be incorporated into daily laboratory routine and can be used in mice as a sensitive tool for detecting reduced wellbeing and general condition, but probably not for determining the efficacy of pain treatment. PMID:23563122

  19. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Ratings The Cardiovascular System § 4.100 Application of the evaluation criteria for diagnostic codes 7000... medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability....

  20. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Ratings The Cardiovascular System § 4.100 Application of the evaluation criteria for diagnostic codes 7000... medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability....

  1. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Ratings The Cardiovascular System § 4.100 Application of the evaluation criteria for diagnostic codes 7000... medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability....

  2. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Ratings The Cardiovascular System § 4.100 Application of the evaluation criteria for diagnostic codes 7000... medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability....

  3. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Ratings The Cardiovascular System § 4.100 Application of the evaluation criteria for diagnostic codes 7000... medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability....

  4. Application of the Diagnostic Evaluation for Alopecia in Traditional Veterinary Species to Laboratory Rhesus Macaques (Macaca mulatta)

    PubMed Central

    Luchins, Kerith R; Baker, Kate C; Gilbert, Margaret H; Blanchard, James L; Liu, David Xianhong; Myers, Leann; Bohm, Rudolf P

    2011-01-01

    Alopecia in nonhuman primates in the biomedical research setting is often attributed to compromised psychologic wellbeing. Behavioral causes, mainly hair plucking, have become the unconfirmed and exclusive default diagnosis, and the possibility that alopecia may be secondary to a primary medical or dermatologic disease is often overlooked. Although nonbehavioral causes of alopecia in nonhuman primates are described in the literature, few prospective hypothesis-based studies have investigated medical and behavioral etiologies concurrently. We therefore undertook such a study with the aim of designing a clinical diagnostic guide for approaching cases of nonhuman primate alopecia. Because most cases of alopecia in nonhuman primates in the literature and at our facility are not associated with a definitive diagnosis, the hypothesis we tested was that the well-established diagnostic evaluation for alopecia used for traditional veterinary species is not applicable to nonhuman primates. Discounting differences in histopathology and behavioral assessment, the current study revealed few clinically relevant significant differences between nonhuman primates with and without alopecia. As a result, our hypothesis was confirmed, and we conclude that the standard dermatologic diagnostic plan typically described for alopecia diagnosis in traditional veterinary species and used as the basis for assessment of alopecia in nonhuman primates should be reassessed. PMID:22330789

  5. Production of a fragment of glycoprotein G of herpes simplex virus type 2 and evaluation of its diagnostic potential

    PubMed Central

    Liu, Tao; Liu, Ji Feng; Yu, Hua; Si, Guo Jing; Hu, Jun; Li, Jun

    2015-01-01

    INTRODUCTION Herpes simplex virus type 2 (HSV-2) is the most common cause of genital herpes. Glycoprotein G (gG) is a prototype antigen for type-specific serodiagnosis distinguishing between HSV type 1 (HSV-1) and HSV-2 infections. As immunological diagnosis kits for accurate differentiation between HSV-1 and HSV-2 antibodies can be expensive, there is a need to develop a convenient, sensitive, specific and cost-effective serodiagnostic kit. METHODS We successfully expressed a fragment of gG comprising residues 321–580 of HSV-2 with histidine tag (gG321–580His) in a Bac-to-Bac baculovirus expression system, which had an antigenicity similar to its native counterpart. An indirect enzyme-linked immunosorbent assay (ELISA) was developed using gG321–580His as the diagnostic antigen and evaluated by comparison with a commercial HerpeSelect 2 ELISA immunoglobulin G kit as reference. RESULTS In testing 318 field serum samples, the diagnostic relative sensitivity and specificity of the developed gG321–580His-ELISA test in qualitative comparison with the commercial kit were 93.81% and 96.74%, respectively, and the accuracy was 94.65%. CONCLUSION The study indicates that gG321–580His has a high diagnostic potential for HSV-2 virus serodiagnosis in humans. PMID:25532518

  6. Evaluation of serological diagnostic tests for typhoid fever in Papua New Guinea using a composite reference standard.

    PubMed

    Siba, Valentine; Horwood, Paul F; Vanuga, Kilagi; Wapling, Johanna; Sehuko, Rebecca; Siba, Peter M; Greenhill, Andrew R

    2012-11-01

    Typhoid fever remains a major global health problem. A major impediment to improving outcomes is the lack of appropriate diagnostic tools, which have not significantly improved in low-income settings for 100 years. We evaluated two commercially available rapid diagnostic tests (Tubex and TyphiDot), a prototype (TyphiRapid TR-02), and the commonly used single-serum Widal test in a previously reported high-burden area of Papua New Guinea. Samples were collected from 530 outpatients with axillary temperatures of ≥37.5°C, and analysis was conducted on all malaria-negative samples (n = 500). A composite reference standard of blood culture and PCR was used, by which 47 participants (9.4%) were considered typhoid fever positive. The sensitivity and specificity of the Tubex (51.1% and 88.3%, respectively) and TyphiDot (70.0% and 80.1%, respectively) tests were not high enough to warrant their ongoing use in this setting; however, the sensitivity and specificity for the TR-02 prototype were promising (89.4% and 85.0%, respectively). An axillary temperature of ≥38.5°C correlated with typhoid fever (P = 0.014). With an appropriate diagnostic test, conducting typhoid fever diagnosis only on patients with high-grade fever could dramatically decrease the costs associated with diagnosis while having no detrimental impact on the ability to accurately diagnose the illness.

  7. Diagnostic accuracy of late iodine enhancement on cardiac computed tomography with a denoise filter for the evaluation of myocardial infarction.

    PubMed

    Matsuda, Takuya; Kido, Teruhito; Itoh, Toshihide; Saeki, Hideyuki; Shigemi, Susumu; Watanabe, Kouki; Kido, Tomoyuki; Aono, Shoji; Yamamoto, Masaya; Matsuda, Takeshi; Mochizuki, Teruhito

    2015-12-01

    We evaluated the image quality and diagnostic performance of late iodine enhancement (LIE) in dual-source computed tomography (DSCT) with low kilo-voltage peak (kVp) images and a denoise filter for the detection of acute myocardial infarction (AMI) in comparison with late gadolinium enhancement (LGE) magnetic resonance imaging (MRI). The Hospital Ethics Committee approved the study protocol. Before discharge, 19 patients who received percutaneous coronary intervention after AMI underwent DSCT and 1.5 T MRI. Immediately after coronary computed tomography (CT) angiography, contrast medium was administered at a slow injection rate. LIE-CT scans were acquired via dual-energy CT and reconstructed as 100-, 140-kVp, and mixed images. An iterative three-dimensional edge-preserved smoothing filter was applied to the 100-kVp images to obtain denoised 100-kVp images. The mixed, 140-kVp, 100-kVp, and denoised 100-kVp images were assessed using contrast-to-noise ratio (CNR), and their diagnostic performance in comparison with MRI and infarcted volumes were evaluated. Three hundred four segments of 19 patients were evaluated. Fifty-three segments showed LGE in MRI. The median CNR of the mixed, 140-, 100-kVp and denoised 100-kVp images was 3.49, 1.21, 3.57, and 6.08, respectively. The median CNR was significantly higher in the denoised 100-kVp images than in the other three images (P < 0.05). The denoised 100-kVp images showed the highest diagnostic accuracy and sensitivity. The percentage of myocardium in the four CT image types was significantly correlated with the respective MRI findings. The use of a denoise filter with a low-kVp image can improve CNR, sensitivity, and accuracy in LIE-CT.

  8. Diagnostic accuracy of late iodine enhancement on cardiac computed tomography with a denoise filter for the evaluation of myocardial infarction.

    PubMed

    Matsuda, Takuya; Kido, Teruhito; Itoh, Toshihide; Saeki, Hideyuki; Shigemi, Susumu; Watanabe, Kouki; Kido, Tomoyuki; Aono, Shoji; Yamamoto, Masaya; Matsuda, Takeshi; Mochizuki, Teruhito

    2015-12-01

    We evaluated the image quality and diagnostic performance of late iodine enhancement (LIE) in dual-source computed tomography (DSCT) with low kilo-voltage peak (kVp) images and a denoise filter for the detection of acute myocardial infarction (AMI) in comparison with late gadolinium enhancement (LGE) magnetic resonance imaging (MRI). The Hospital Ethics Committee approved the study protocol. Before discharge, 19 patients who received percutaneous coronary intervention after AMI underwent DSCT and 1.5 T MRI. Immediately after coronary computed tomography (CT) angiography, contrast medium was administered at a slow injection rate. LIE-CT scans were acquired via dual-energy CT and reconstructed as 100-, 140-kVp, and mixed images. An iterative three-dimensional edge-preserved smoothing filter was applied to the 100-kVp images to obtain denoised 100-kVp images. The mixed, 140-kVp, 100-kVp, and denoised 100-kVp images were assessed using contrast-to-noise ratio (CNR), and their diagnostic performance in comparison with MRI and infarcted volumes were evaluated. Three hundred four segments of 19 patients were evaluated. Fifty-three segments showed LGE in MRI. The median CNR of the mixed, 140-, 100-kVp and denoised 100-kVp images was 3.49, 1.21, 3.57, and 6.08, respectively. The median CNR was significantly higher in the denoised 100-kVp images than in the other three images (P < 0.05). The denoised 100-kVp images showed the highest diagnostic accuracy and sensitivity. The percentage of myocardium in the four CT image types was significantly correlated with the respective MRI findings. The use of a denoise filter with a low-kVp image can improve CNR, sensitivity, and accuracy in LIE-CT. PMID:26202159

  9. Highly time-resolved evaluation technique of instantaneous amplitude and phase difference using analytic signals for multi-channel diagnostics.

    PubMed

    Ohshima, S; Kobayashi, S; Yamamoto, S; Nagasaki, K; Mizuuchi, T; Kado, S; Okada, H; Minami, T; Lee, H Y; Zang, L; Kenmochi, N; Kasajima, K; Ohtani, Y; Shi, N; Nagae, Y; Konoshima, S; Sano, F

    2014-11-01

    A fluctuation analysis technique using analytic signals is proposed. Analytic signals are suitable to characterize a single mode with time-dependent amplitude and frequency, such as an MHD mode observed in fusion plasmas since the technique can evaluate amplitude and frequency at a specific moment without limitations of temporal and frequency resolutions, which is problematic in Fourier-based analyses. Moreover, a concept of instantaneous phase difference is newly introduced, and error of the evaluated phase difference and its error reduction techniques using conditional/ensemble averaging are discussed. These techniques are applied to experimental data of the beam emission spectroscopic measurement in the Heliotron J device, which demonstrates that the technique can describe nonlinear evolution of MHD instabilities. This technique is widely applicable to other diagnostics having necessity to evaluate phase difference.

  10. Characterization of post-surgical alterations in the bile duct-cannulated rat.

    PubMed

    Bachir-Cherif, Dalila; Blum, Denise; Braendli-Baiocco, Annamaria; Chaput, Evelyne; Pacheco, Gonzalo Christiano Duran; Flint, Nicholas; Haiker, Monika; Hoflack, Jean-Christophe; Justies, Nicole; Neff, Rachel; Starke, Volkmar; Steiner, Guido; Tournillac, Charles Alexandre; Singer, Thomas; Ubeaud-Séquier, Geneviève; Schuler, Franz

    2011-08-01

    The bile duct-cannulated (BDC) rat is a standard animal model used in ADME experiments. The aim of this study was to investigate post-surgical alterations that are relevant to ADME investigations in BDC rats compared with sham- and non-operated animals. Water and food intake was reduced in the animals' post-surgery. This led to a lower body weight in operated animals. In BDC animals, aspartate aminotransferase (AST) levels in plasma were transiently elevated and total bile acid levels were reduced. Alpha(1)-acid glycoprotein (AGP) in plasma and the concentration of bile components in bile were elevated. Histopathology showed inflammation in the area of the cannulation between the liver and the small intestine. A microarray-based gene expression and RTq-PCR analysis identified altered expression for several genes involved in drug disposition including the down-regulation of cytochrome P450 enzymes. This led to reduced cytochrome P450 content in the liver and lower metabolic activity in microsomes from BDC and sham-operated rats compared with naïve animals. The results of the study suggest that the post-surgical inflammation leads to physiological changes relevant for drug absorption and disposition. These alterations should be accounted for in the interpretation of ADME studies in BDC animals. PMID:21521079

  11. Virtual simulation of the postsurgical cosmetic outcome in patients with Pectus Excavatum

    NASA Astrophysics Data System (ADS)

    Vilaça, João L.; Moreira, António H. J.; L-Rodrigues, Pedro; Rodrigues, Nuno; Fonseca, Jaime C.; Pinho, A. C. M.; Correia-Pinto, Jorge

    2011-03-01

    Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which several ribs and the sternum grow abnormally. Nowadays, the surgical correction is carried out in children and adults through Nuss technic. This technic has been shown to be safe with major drivers as cosmesis and the prevention of psychological problems and social stress. Nowadays, no application is known to predict the cosmetic outcome of the pectus excavatum surgical correction. Such tool could be used to help the surgeon and the patient in the moment of deciding the need for surgery correction. This work is a first step to predict postsurgical outcome in pectus excavatum surgery correction. Facing this goal, it was firstly determined a point cloud of the skin surface along the thoracic wall using Computed Tomography (before surgical correction) and the Polhemus FastSCAN (after the surgical correction). Then, a surface mesh was reconstructed from the two point clouds using a Radial Basis Function algorithm for further affine registration between the meshes. After registration, one studied the surgical correction influence area (SCIA) of the thoracic wall. This SCIA was used to train, test and validate artificial neural networks in order to predict the surgical outcome of pectus excavatum correction and to determine the degree of convergence of SCIA in different patients. Often, ANN did not converge to a satisfactory solution (each patient had its own deformity characteristics), thus invalidating the creation of a mathematical model capable of estimating, with satisfactory results, the postsurgical outcome.

  12. Macrophage depletion reduces postsurgical tumor recurrence and metastatic growth in a spontaneous murine model of melanoma

    PubMed Central

    Tham, Muly; Khoo, Karen; Yeo, Kim Pin; Kato, Masashi; Prevost-Blondel, Amelle; Angeli, Veronique; Abastado, Jean-Pierre

    2015-01-01

    Surgical resection of tumors is often followed by regrowth at the primary site and metastases may emerge rapidly following removal of the primary tumor. Macrophages are important drivers of tumor growth, and here we investigated their involvement in postoperative relapse as well as explore macrophage depletion as an adjuvant to surgical resection. RETAAD mice develop spontaneous metastatic melanoma that begins in the eye. Removal of the eyes as early as 1 week of age did not prevent the development of metastases; rather, surgery led to increased proliferation of tumor cells locally and in distant metastases. Surgery-induced increase in tumor cell proliferation correlated with increased macrophage density within the tumor. Moreover, macrophages stimulate tumor sphere formation from tumor cells of post-surgical but not control mice. Macrophage depletion with a diet containing the CSF-1R specific kinase inhibitor Ki20227 following surgery significantly reduced postoperative tumor recurrence and abrogated enhanced metastatic outgrowth. Our results confirm that tumor cells disseminate early, and show that macrophages contribute both to post-surgical tumor relapse and growth of metastases, likely through stimulating a population of tumor-initiating cells. Thus macrophage depletion warrants exploration as an adjuvant to surgical resection. PMID:25762633

  13. [Newborn Hearing Screening and Subsequent Diagnostic Evaluation: Analysis and Outcomes of 6,063 Infants Born in a Community Hospital].

    PubMed

    Tanaka, Yasuko; Enomoto, Hiroyuki; Takada, Kentaro; Inoue, Maki; Ogawara, Noboru; Takahashi, Masahiro; Oridate, Nobuhiko

    2016-03-01

    A retrospective study was conducted to examine the implementation status of newborn hearing screening (NHS) of 6,063 infants born in a single community hospital in Japan between 2005 and 2013. An automated auditory brainstem response device was used for NHS and an auditory brainstem response was mainly used for further diagnostic evaluation. Although the participation rate in the NHS was 88.8% in 2013, increasing year by year, it failed to reach 100% probably because NHS is a charged option under the current Japanese healthcare system. Among 40 (0.66%) infants who finally failed their NHS, 34 were referred for subsequent diagnostic evaluation and the remaining 6 were lost to follow-up. Thirty-one of these 34 were diagnosed as having hearing impairment and 3 (0.05%) were identified as having normal hearing, which is considered as a false positive. Both the final referral rate and the hearing impairment rate were significantly higher in the high-risk than in the low-risk group. Compared to the previous national report, the rate of bilateral hearing impairment (0.33%) was significantly higher in this study. Ten (38.5%) out of 26 in the high-risk group were most often diagnosed with otitis media with effusion (OME), while 4 (50%) out of 8 in the low-risk group were diagnosed as having sensorineural hearing loss. Seven (35%) out of 20 with bilateral hearing impairment attained a normal hearing level at a median age of 18 months. Although the primary aim of NHS is early detection of congenital permanent hearing loss, OME is observed commonly in NHS-failed infants. It is therefore important to examine the middle ear status carefully as part of the diagnostic evaluation. Thirty-four infants underwent further diagnostic evaluation at a median age of 46 days, and hearing aids were given in 10 of them at a median age of 5.6 months without delay. Because high-risk patients often tend to be lost to follow-up, otolaryngologists have to give a detailed explanation to caregivers

  14. Evaluation of unexplained peripheral lymphadenopathy and suspected malignancy using a distinct quick diagnostic delivery model: prospective study of 372 patients.

    PubMed

    Bosch, Xavier; Coloma, Emmanuel; Donate, Carolina; Colomo, Lluís; Doti, Pamela; Jordán, Anna; López-Soto, Alfonso

    2014-10-01

    Although rapid diagnostic testing is essential in suspicious peripheral lymphadenopathy, delays in accessing them can be considerable. We investigated the usefulness of an internist-led outpatient quick diagnosis unit (QDU) in assessing patients with unexplained peripheral lymphadenopathy, focusing on the characteristics, diagnostic, and treatment waiting times of those with malignancy. Patients aged ≥ 18 years, consecutively referred from 12 primary health care centers (PHCs) or the emergency department (ED) for unexplained peripheral lymphadenopathy, were prospectively evaluated during 7 years. Diagnostic investigations were done using a predefined study protocol. Three experienced cytopathologists performed a fine-needle aspiration cytology (FNAC) systematic approach of clinically suspicious lymphadenopathy with cytomorphology and immunophenotyping analyses. We evaluated 372 patients with a mean age (SD) of 45.3 (13.8) years; 56% were women. Malignancy was diagnosed in 120 (32%) patients, including 81 lymphomas and 39 metastatic tumors. Metastatic lymphadenopathy was diagnosed by FNAC in all 39 patients and the primary tumor site was identified in 82% of them when cytomorphology and immunocytochemistry were combined. A correct diagnosis of lymphoma was reached by FNAC in 73% of patients. When accepting "suspicious of" as correct diagnosis, the FNAC diagnosis rate of lymphoma increased to 94%. Among patients with malignancy, FNAC yielded 1.3% of false negatives and no false positives. All patients with an FNAC report of correct or suspicious lymphoma underwent a surgical biopsy, as it is a mandatory requirement of the hematology department. Mean times from first QDU visit to FNAC diagnosis of malignancy were 5.4 days in metastatic lymphadenopathy and 7.5 days in lymphoma. Mean times from receiving the initial referral report to first treatment were 29.2 days in metastatic lymphadenopathy and 40 days in lymphoma. In conclusion, a distinct internal medicine QDU

  15. Internal Amplification Control for a Cryptosporidium Diagnostic PCR: Construction and Clinical Evaluation.

    PubMed

    Hawash, Yousry; Ghonaim, M M; Al-Hazmi, Ayman S

    2015-04-01

    Various constituents in clinical specimens, particularly feces, can inhibit the PCR assay and lead to false-negative results. To ensure that negative results of a diagnostic PCR assay are true, it should be properly monitored by an inhibition control. In this study, a cloning vector harboring a modified target DNA sequence (≈375 bp) was constructed to be used as a competitive internal amplification control (IAC) for a conventional PCR assay that detects ≈550 bp of the Cryptosporidium oocyst wall protein (COWP) gene sequence in human feces. Modification of the native PCR target was carried out using a new approach comprising inverse PCR and restriction digestion techniques. IAC was included in the assay, with the estimated optimum concentration of 1 fg per reaction, as duplex PCR. When applied on fecal samples spiked with variable oocysts counts, ≈2 oocysts were theoretically enough for detection. When applied on 25 Cryptosporidium-positive fecal samples of various infection intensities, both targets were clearly detected with minimal competition noticed in 2-3 samples. Importantly, both the analytical and the diagnostic sensitivities of the PCR assay were not altered with integration of IAC into the reactions. When tried on 180 randomly collected fecal samples, 159 were Cryptosporidium-negatives. Although the native target DNA was absent, the IAC amplicon was obviously detected on gel of all the Cryptosporidium-negative samples. These results imply that running of the diagnostic PCR, inspired with the previously developed DNA extraction protocol and the constructed IAC, represents a useful tool for Cryptosporidium detection in human feces.

  16. [Practical evaluation of rapid diagnostic tests for mycobacteriosis and virus infection].

    PubMed

    Nakamura, Hisako

    2002-01-01

    Because cultures of mycobacteria and viruses take a great number of days, the results are delayed in these clinical laboratory tests. For this reason, rapid diagnostic tests without these cultures are required. Among the laboratory tests of mycobacteria, acid-fast stain as a rapid diagnostic test is the first to give significant information to laboratory staffs and physicians. There are mainly two procedures, directly smearing clinical specimens and smearing concentrated specimens treated with NALC-NaOH on slide glass. The former is performed for specimens from emergency patients. When a patient is suspected of tuberculosis, a DNA-amplification test such as COBAS AMPLICOR TEST (PCR test) is performed for directly detecting Mycobacterium tuberculosis in clinical specimens, regardless of whether the specimens show positive or negative by acid-fast stain. Sixty-one of 1,023 specimens tested in Showa University Fujigaoka Hospital in February 2000-May 2002 were found positive by both PCR and culture tests. Fourteen were found negative by PCR test and positive by culture test. Five were found positive by PCR test and negative by culture test. Alternatively, MTB-64 (Capilia TB) is a kit for rapidly identifying M. tuberculosis using colonies. The time necessary for completion of the test was approximately 15 minutes per sample. In our study, the identification test showed weak-positive for 2 strains of M. marinum (ATCC927 and one clinical isolate), compared with positive for 28 clinical isolates and strain H37Ra of M. tuberculosis. Recently, rapid diagnostic kits for detecting various pathogenic viruses have been developed. The kits for detecting influenza virus are in especially great demand with the spread of newly-developed antiviral agents. There was an epidemic of the type A virus in the winters 2001-2002. 101 (32%) of 316 clinical specimens tested in the hospital were found positive with InfluA. B-Quick [SEIKEN] (Denka) or Directigen Flu A (Becton Dickinson). These

  17. Paranoia.Ada: A diagnostic program to evaluate Ada floating-point arithmetic

    NASA Technical Reports Server (NTRS)

    Hjermstad, Chris

    1986-01-01

    Many essential software functions in the mission critical computer resource application domain depend on floating point arithmetic. Numerically intensive functions associated with the Space Station project, such as emphemeris generation or the implementation of Kalman filters, are likely to employ the floating point facilities of Ada. Paranoia.Ada appears to be a valuabe program to insure that Ada environments and their underlying hardware exhibit the precision and correctness required to satisfy mission computational requirements. As a diagnostic tool, Paranoia.Ada reveals many essential characteristics of an Ada floating point implementation. Equipped with such knowledge, programmers need not tremble before the complex task of floating point computation.

  18. Primary myoepithelial carcinoma of rib bone: Morphology, immunohistochemical evaluation and diagnostic dilemma in an unusual case.

    PubMed

    Biradar, Pramod; Menon, Santosh; Patil, Asawari; Karimundakal, George; Jambhekar, Nirmala

    2015-01-01

    Myoepithelial tumors are most commonly seen as salivary gland tumors. Tumors of similar morphology and nomenclature are also seen rarely in soft tissue, skin, lungs and breast. Bone is an uncommon anatomical site for occurrence of myoepithelial tumors. Histologically, they have variable admixture of epithelial elements in a gamut of patterns with myxoid matricial background. Most of these are benign with very anecdotal reports of malignant counterpart, myoepithelial carcinoma. Herein we describe an extremely rare case of a malignant myoepithelial tumor arising from the rib which owing to unusual location and immunohistochemical profile was diagnostically challenging.

  19. Cases from the aerospace medicine residents' teaching file. Case #42. An aviator with concentration deficit, Lyme disease organic diagnostic evaluation, and a somatoform disorder.

    PubMed

    Stephens, P J; Carpenter, F E

    1991-04-01

    An aviator with concentration deficit, Lyme disease organic diagnostic evaluation, and a somatoform disorder. The clinical presentation, evaluation and diagnosis of an aviator being evaluated for vague cognitive deficits of episodic and long duration with a history of rigid ideation concerning Lyme disease. The patient was diagnosed as having an atypical somatoform disorder. The aeromedical disposition of this patient is also presented.

  20. Evaluation of virus inactivation by formaldehyde to enhance biosafety of diagnostic electron microscopy.

    PubMed

    Möller, Lars; Schünadel, Livia; Nitsche, Andreas; Schwebke, Ingeborg; Hanisch, Manuela; Laue, Michael

    2015-02-10

    Formaldehyde (FA) fixation of infectious samples is a well-established protocol in diagnostic electron microscopy of viruses. However, published experimental data that demonstrate virus inactivation by these fixation procedures are lacking. Usually, fixation is performed immediately before the sample preparation for microscopy. The fixation procedure should transform viruses in a non-infectious but nonetheless structurally intact form in order to allow a proper diagnosis based on morphology. FA provides an essential advantage in comparison to other disinfectants, because it preserves the ultrastructure of biological material without interfering significantly with the preparation (i.e., the negative staining) and the detection of viruses. To examine the efficiency of FA inactivation, we used Vaccinia virus, Human adenovirus and Murine norovirus as models and treated them with FA under various conditions. Critical parameters for the inactivation efficiency were the temperature, the duration of the FA treatment, and the resistance of the virus in question. Our results show that FA inactivation at low temperature (4 °C) bears a high risk of incomplete inactivation. Higher temperatures (25 °C) are more efficient, although they still require rather long incubation times to fully inactivate a complex and highly robust virus like Vaccinia. A protocol, which applied 2% buffered FA for 60 min and a temperature-shift from 25 to 37 °C after 30 min was efficient for the complete inactivation of all test viruses, and therefore has the potential to improve both biosafety and speed of diagnostic electron microscopy.

  1. Evaluation of Virus Inactivation by Formaldehyde to Enhance Biosafety of Diagnostic Electron Microscopy

    PubMed Central

    Möller, Lars; Schünadel, Livia; Nitsche, Andreas; Schwebke, Ingeborg; Hanisch, Manuela; Laue, Michael

    2015-01-01

    Formaldehyde (FA) fixation of infectious samples is a well-established protocol in diagnostic electron microscopy of viruses. However, published experimental data that demonstrate virus inactivation by these fixation procedures are lacking. Usually, fixation is performed immediately before the sample preparation for microscopy. The fixation procedure should transform viruses in a non–infectious but nonetheless structurally intact form in order to allow a proper diagnosis based on morphology. FA provides an essential advantage in comparison to other disinfectants, because it preserves the ultrastructure of biological material without interfering significantly with the preparation (i.e., the negative staining) and the detection of viruses. To examine the efficiency of FA inactivation, we used Vaccinia virus, Human adenovirus and Murine norovirus as models and treated them with FA under various conditions. Critical parameters for the inactivation efficiency were the temperature, the duration of the FA treatment, and the resistance of the virus in question. Our results show that FA inactivation at low temperature (4 °C) bears a high risk of incomplete inactivation. Higher temperatures (25 °C) are more efficient, although they still require rather long incubation times to fully inactivate a complex and highly robust virus like Vaccinia. A protocol, which applied 2% buffered FA for 60 min and a temperature–shift from 25 to 37 °C after 30 min was efficient for the complete inactivation of all test viruses, and therefore has the potential to improve both biosafety and speed of diagnostic electron microscopy. PMID:25674771

  2. Initial Evaluation of Engine Combustion Network Injectors with X-Ray Diagnostics

    SciTech Connect

    Kastengren, A.; Powell, C.F.; Tilocco, F.Z.; Fezzaa, K.

    2012-09-10

    A significant hurdle in the understanding of diesel sprays is the sensitivity of such sprays to the detailed geometry of the spray nozzle. This sensitivity hampers the comparison of results from spray measurements by different research groups, even if the groups measure nozzles with the same nominal geometry. Moreover, these differences make the comparison and validation of different diagnostic techniques problematic. To remove this source of uncertainty from diesel spray measurements, a collaboration of several research groups has formed to measure a common set of injectors under identical conditions under the auspices of Sandia National Laboratorys Engine Combustion Network. The current work describes the initial measurement of these injectors and the sprays created by these injectors using the x-ray diagnostics available at the Advanced Photon Source. X-ray phase-enhanced imaging is used to perform time-resolved, in situ measurements of injector pintle motion. In addition to these measurements, x-ray radiography measurements of the sprays from these injectors will be performed to better understand the near-nozzle fuel mass distribution in these sprays.

  3. A Guide for Clinicians in the Evaluation of Emerging Molecular Diagnostics for Newly Diagnosed Prostate Cancer

    PubMed Central

    Canfield, Steven E; Kibel, Adam S; Kemeter, Michael J; Febbo, Phillip G; Lawrence, H. Jeffrey; Moul, Judd W

    2014-01-01

    Prostate-specific antigen (PSA) screening is associated with a decline in prostate cancer-related mortality. However, screening has also led to overdiagnosis and overtreatment of clinically insignificant tumors. Recently, certain national guidelines (eg, US Preventive Services Task Force) have recommended against PSA screening, which may lead to a reverse-stage migration. Although many prostate tumors are indolent at presentation, others are aggressive and are appropriate targets for treatment interventions. Utilization of molecular markers may improve our ability to measure tumor biology and allow better discrimination of indolent and aggressive tumors at diagnosis. Many emerging commercial molecular diagnostic assays have been designed to provide more accurate risk stratification for newly diagnosed prostate cancer. Unfamiliarity with molecular diagnostics may make it challenging for some clinicians to navigate and interpret the medical literature to ascertain whether particular assays are appropriately developed and validated for clinical use. Herein, the authors provide a framework for practitioners to use when assessing new tissue-based molecular assays. This review outlines aspects of assay development, clinical and analytic validation and clinical utility studies, and regulatory issues, which collectively determine whether tests (1) are actionable for specific clinical indications, (2) measurably influence treatment decisions, and (3) are sufficiently validated to warrant incorporation into clinical practice. PMID:25548544

  4. Safety and effectiveness of therapeutic magnetic resonance in the management of postsurgical lesion of the diabetic foot.

    PubMed

    Abbruzzese, Lorenza; Iacopi, Elisabetta; Coppelli, Alberto; Bonino, Giovanni; Goretti, Chiara; Piaggesi, Alberto

    2015-03-01

    To evaluate the safety and effectiveness of therapeutic magnetic resonance (TMR) in the management of the diabetic foot (DF), we treated a group of consecutive type 2 diabetic inpatients with wide postsurgical lesions (Group A: N = 10; age 67.7 ± 18.9 years, duration of diabetes 22.3 ± 6.6 years, 8.1 ± 1.1%, body mass index 29.4 ± 2.1 kg/m(2)), for 2 consecutive weeks, while admitted, with a low-intensity magnetic resonance equipment, in addition to standard treatment. Patients, compared with a matched control group with the same clinical characteristics (Group B), were then followed monthly for 6 months to evaluate healing rate (HR), healing time (HT), rate of granulation tissue (GT) at 3 months, and adverse events. HR was of 90% in Group A and 30% in Group B (P < .05); GT was 73.7 ± 13.2% in Group A versus 51.84 ± 18.77% in Group B (P < .05). HT in Group A was 84.46 ± 54.38 days versus 148.54 ± 78.96 days in Group B (P < .01). No difference in adverse events (5 in Group A and 6 in Group B) was observed throughout the study period. In this pilot study, the use of TMR at this dose and duration was safe. The results also permit the observation that TMR plus standard care offered a faster healing rate compared with standard care alone.

  5. Digital Breast Tomosynthesis versus Supplemental Diagnostic Mammographic Views for Evaluation of Noncalcified Breast Lesions

    PubMed Central

    Bandos, Andriy I.; Ganott, Marie A.; Sumkin, Jules H.; Kelly, Amy E.; Catullo, Victor J.; Rathfon, Grace Y.; Lu, Amy H.; Gur, David

    2013-01-01

    Purpose: To compare the diagnostic performance of breast tomosynthesis versus supplemental mammography views in classification of masses, distortions, and asymmetries. Materials and Methods: Eight radiologists who specialized in breast imaging retrospectively reviewed 217 consecutively accrued lesions by using protocols that were HIPAA compliant and institutional review board approved in 182 patients aged 31–60 years (mean, 50 years) who underwent diagnostic mammography and tomosynthesis. The lesions in the cohort included 33% (72 of 217) cancers and 67% (145 of 217) benign lesions. Eighty-four percent (182 of 217) of the lesions were masses, 11% (25 of 217) were asymmetries, and 5% (10 of 217) were distortions that were initially detected at clinical examination in 8% (17 of 217), at mammography in 80% (173 of 217), at ultrasonography (US) in 11% (25 of 217), or at magnetic resonance imaging in 1% (2 of 217). Histopathologic examination established truth in 191 lesions, US revealed a cyst in 12 lesions, and 14 lesions had a normal follow-up. Each lesion was interpreted once with tomosynthesis and once with supplemental mammographic views; both modes included the mediolateral oblique and craniocaudal views in a fully crossed and balanced design by using a five-category Breast Imaging Reporting and Data System (BI-RADS) assessment and a probability-of-malignancy score. Differences between modes were analyzed with a generalized linear mixed model for BI-RADS–based sensitivity and specificity and with modified Obuchowski-Rockette approach for probability-of-malignancy–based area under the receiver operating characteristic (ROC) curve. Results: Average probability-of-malignancy–based area under the ROC curve was 0.87 for tomosynthesis versus 0.83 for supplemental views (P < .001). With tomosynthesis, the false-positive rate decreased from 85% (989 of 1160) to 74% (864 of 1160) (P < .01) for cases that were rated BI-RADS category 3 or higher and from 57% (663 of

  6. Synthetic Diagnostic for the Evaluation of New Microwave Imaging Reflectometry System for Large Tokomaks - DIII-D and KSTAR

    NASA Astrophysics Data System (ADS)

    Lei, Li Juan

    Microwave Imaging Reflectometry (MIR) systems have been used as diagnostic tools for characterization of fluctuating plasma density in large tokamaks. Such a technique has been implemented on the TEXTOR device [H. Park, et al., Review of Scientific Instruments, 2004] and is being continued on DIII-D and KSTAR. To develop a new MIR system for density fluctuation measurements for DIII-D and KSTAR, one requires an understanding of how to preserve phase information. The current design for an MIR optical system makes use of design tools in free space, which is great for evaluation of port access but not provide significant information when it comes to the plasma region. This thesis describes a numerical study of MIR in the presence of turbulent fluctuations by evaluating the effectiveness in coupling the reflection layer in the full wave region and the detector array in free space with respect to fluctuation levels. A synthetic diagnostic tool making use of 2D full-wave diffractive simulation in full plasma geometry is applied to couple an optical imaging system with different optical arrangements.

  7. Evaluation of a Density-Based Rapid Diagnostic Test for Sickle Cell Disease in a Clinical Setting in Zambia

    PubMed Central

    Hennek, Jonathan W.; Mantina, Hamakwa; Lee, S. Y. Ryan; Patton, Matthew R.; Sambo, Pauline; Sinyangwe, Silvester; Kankasa, Chipepo; Chintu, Chifumbe; Brugnara, Carlo; Stossel, Thomas P.; Whitesides, George M.

    2014-01-01

    Although simple and low-cost interventions for sickle cell disease (SCD) exist in many developing countries, child mortality associated with SCD remains high, in part, because of the lack of access to diagnostic tests for SCD. A density-based test using aqueous multiphase systems (SCD-AMPS) is a candidate for a low-cost, point-of-care diagnostic for SCD. In this paper, the field evaluation of SCD-AMPS in a large (n = 505) case-control study in Zambia is described. Of the two variations of the SCD-AMPS used, the best system (SCD-AMPS-2) demonstrated a sensitivity of 86% (82–90%) and a specificity of 60% (53–67%). Subsequent analysis identified potential sources of false positives that include clotting, variation between batches of SCD-AMPS, and shipping conditions. Importantly, SCD-AMPS-2 was 84% (62–94%) sensitive in detecting SCD in children between 6 months and 1 year old. In addition to an evaluation of performance, an assessment of end-user operability was done with health workers in rural clinics in Zambia. These health workers rated the SCD-AMPS tests to be as simple to use as lateral flow tests for malaria and HIV. PMID:25490722

  8. Evaluation of the efficiency of biofield diagnostic system in breast cancer detection using clinical study results and classifiers.

    PubMed

    Subbhuraam, Vinitha Sree; Ng, E Y K; Kaw, G; Acharya U, Rajendra; Chong, B K

    2012-02-01

    The division of breast cancer cells results in regions of electrical depolarisation within the breast. These regions extend to the skin surface from where diagnostic information can be obtained through measurements of the skin surface electropotentials using sensors. This technique is used by the Biofield Diagnostic System (BDS) to detect the presence of malignancy. This paper evaluates the efficiency of BDS in breast cancer detection and also evaluates the use of classifiers for improving the accuracy of BDS. 182 women scheduled for either mammography or ultrasound or both tests participated in the BDS clinical study conducted at Tan Tock Seng hospital, Singapore. Using the BDS index obtained from the BDS examination and the level of suspicion score obtained from mammography/ultrasound results, the final BDS result was deciphered. BDS demonstrated high values for sensitivity (96.23%), specificity (93.80%), and accuracy (94.51%). Also, we have studied the performance of five supervised learning based classifiers (back propagation network, probabilistic neural network, linear discriminant analysis, support vector machines, and a fuzzy classifier), by feeding selected features from the collected dataset. The clinical study results show that BDS can help physicians to differentiate benign and malignant breast lesions, and thereby, aid in making better biopsy recommendations. PMID:20703753

  9. Evaluation of the efficiency of biofield diagnostic system in breast cancer detection using clinical study results and classifiers.

    PubMed

    Subbhuraam, Vinitha Sree; Ng, E Y K; Kaw, G; Acharya U, Rajendra; Chong, B K

    2012-02-01

    The division of breast cancer cells results in regions of electrical depolarisation within the breast. These regions extend to the skin surface from where diagnostic information can be obtained through measurements of the skin surface electropotentials using sensors. This technique is used by the Biofield Diagnostic System (BDS) to detect the presence of malignancy. This paper evaluates the efficiency of BDS in breast cancer detection and also evaluates the use of classifiers for improving the accuracy of BDS. 182 women scheduled for either mammography or ultrasound or both tests participated in the BDS clinical study conducted at Tan Tock Seng hospital, Singapore. Using the BDS index obtained from the BDS examination and the level of suspicion score obtained from mammography/ultrasound results, the final BDS result was deciphered. BDS demonstrated high values for sensitivity (96.23%), specificity (93.80%), and accuracy (94.51%). Also, we have studied the performance of five supervised learning based classifiers (back propagation network, probabilistic neural network, linear discriminant analysis, support vector machines, and a fuzzy classifier), by feeding selected features from the collected dataset. The clinical study results show that BDS can help physicians to differentiate benign and malignant breast lesions, and thereby, aid in making better biopsy recommendations.

  10. Evaluation of FTIR spectroscopy as diagnostic tool for colorectal cancer using spectral analysis

    NASA Astrophysics Data System (ADS)

    Dong, Liu; Sun, Xuejun; Chao, Zhang; Zhang, Shiyun; Zheng, Jianbao; Gurung, Rajendra; Du, Junkai; Shi, Jingsen; Xu, Yizhuang; Zhang, Yuanfu; Wu, Jinguang

    2014-03-01

    The aim of this study is to confirm FTIR spectroscopy as a diagnostic tool for colorectal cancer. 180 freshly removed colorectal samples were collected from 90 patients for spectrum analysis. The ratios of spectral intensity and relative intensity (/I1460) were calculated. Principal component analysis (PCA) and Fisher's discriminant analysis (FDA) were applied to distinguish the malignant from normal. The FTIR parameters of colorectal cancer and normal tissues were distinguished due to the contents or configurations of nucleic acids, proteins, lipids and carbohydrates. Related to nitrogen containing, water, protein and nucleic acid were increased significantly in the malignant group. Six parameters were selected as independent factors to perform discriminant functions. The sensitivity for FTIR in diagnosing colorectal cancer was 96.6% by discriminant analysis. Our study demonstrates that FTIR can be a useful technique for detection of colorectal cancer and may be applied in clinical colorectal cancer diagnosis.

  11. [Evaluation of the use of diagnostic/treatment algorithms in the health centers of North Cameroon].

    PubMed

    Haegeman, F; Ledecq, J L; Wyffels, A; Dama, K

    1994-09-01

    In February 1993, four years after their introduction, an assessment was made of the use of clinical flow charts (algorithms) by 16 nurses in charge of primary medical health centers in Northern Cameroon (Diamare Division, Far North Province). A study of the knowledge, attitude and behaviour of the nurses shows the flow charts to be appreciated as a tool for diagnostic aid and for professional training. 11 nurses report an initial systematic use of the flow charts. This associates with the observation of good skills in using the charts, observed among 10 of the nurses, and also with treatment standardisation. Problems in reading the flow charts correctly hinder their systematic use in diagnostic decision making. A retrospective analysis of 800 treatment prescriptions noted in the consultation registers, shows an average rate of treatment standardisation of 75%, varying from 52 to 98% among the different health centers. Three quarters of non standardised treatment is ineffective or inefficient. Specific training is using the flow charts, given in the form of a 4 day seminar to 7 of the nurses concerned, showed no better results, after 4 years, than those obtained during a practical training session of a global nature, taking place in a functional health centre. Basic professional training, as well as previous professional experience influences the performances of the nurses. This study confirms the need to introduce rationalisation in the prescription of treatment, and shows the importance of verifying practical user skills at the end of specific training sessions. It would be advisable to include the principles of clinical algorithms in the teaching programs of medical schools. PMID:7840690

  12. Specialized data analysis for the Space Shuttle Main Engine and diagnostic evaluation of advanced propulsion system components

    NASA Technical Reports Server (NTRS)

    1993-01-01

    The Marshall Space Flight Center is responsible for the development and management of advanced launch vehicle propulsion systems, including the Space Shuttle Main Engine (SSME), which is presently operational, and the Space Transportation Main Engine (STME) under development. The SSME's provide high performance within stringent constraints on size, weight, and reliability. Based on operational experience, continuous design improvement is in progress to enhance system durability and reliability. Specialized data analysis and interpretation is required in support of SSME and advanced propulsion system diagnostic evaluations. Comprehensive evaluation of the dynamic measurements obtained from test and flight operations is necessary to provide timely assessment of the vibrational characteristics indicating the operational status of turbomachinery and other critical engine components. Efficient performance of this effort is critical due to the significant impact of dynamic evaluation results on ground test and launch schedules, and requires direct familiarity with SSME and derivative systems, test data acquisition, and diagnostic software. Detailed analysis and evaluation of dynamic measurements obtained during SSME and advanced system ground test and flight operations was performed including analytical/statistical assessment of component dynamic behavior, and the development and implementation of analytical/statistical models to efficiently define nominal component dynamic characteristics, detect anomalous behavior, and assess machinery operational condition. In addition, the SSME and J-2 data will be applied to develop vibroacoustic environments for advanced propulsion system components, as required. This study will provide timely assessment of engine component operational status, identify probable causes of malfunction, and indicate feasible engineering solutions. This contract will be performed through accomplishment of negotiated task orders.

  13. Fool's Gold: Why Imperfect Reference Tests Are Undermining the Evaluation of Novel Diagnostics: A Reevaluation of 5 Diagnostic Tests for Leptospirosis

    PubMed Central

    Limmathurotsakul, Direk; Turner, Elizabeth L.; Wuthiekanun, Vanaporn; Thaipadungpanit, Janjira; Suputtamongkol, Yupin; Chierakul, Wirongrong; Smythe, Lee D.; Day, Nicholas P. J.; Cooper, Ben; Peacock, Sharon J.

    2012-01-01

    Background. We observed that some patients with clinical leptospirosis supported by positive results of rapid tests were negative for leptospirosis on the basis of our diagnostic gold standard, which involves isolation of Leptospira species from blood culture and/or a positive result of a microscopic agglutination test (MAT). We hypothesized that our reference standard was imperfect and used statistical modeling to investigate this hypothesis. Methods. Data for 1652 patients with suspected leptospirosis recruited during three observational studies and one randomized control trial that described the application of culture, MAT, immunofluorescence assay (IFA), lateral flow (LF) and/or PCR targeting the 16S rRNA gene were reevaluated using Bayesian latent class models and random-effects meta-analysis. Results. The estimated sensitivities of culture alone, MAT alone, and culture plus MAT (for which the result was considered positive if one or both tests had a positive result) were 10.5% (95% credible interval [CrI], 2.7%–27.5%), 49.8% (95% CrI, 37.6%–60.8%), and 55.5% (95% CrI, 42.9%–67.7%), respectively. These low sensitivities were present across all 4 studies. The estimated specificity of MAT alone (and of culture plus MAT) was 98.8% (95% CrI, 92.8%–100.0%). The estimated sensitivities and specificities of PCR (52.7% [95% CrI, 45.2%–60.6%] and 97.2% [95% CrI, 92.0%–99.8%], respectively), lateral flow test (85.6% [95% CrI, 77.5%–93.2%] and 96.2% [95% CrI, 87.7%–99.8%], respectively), and immunofluorescence assay (45.5% [95% CrI, 33.3%–60.9%] and 96.8% [95% CrI, 92.8%–99.8%], respectively) were considerably different from estimates in which culture plus MAT was considered a perfect gold standard test. Conclusions. Our findings show that culture plus MAT is an imperfect gold standard against which to compare alterative tests for the diagnosis of leptospirosis. Rapid point-of-care tests for this infection would bring an important improvement

  14. Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve

    PubMed Central

    Man, Wanrong; Hu, Jianqiang; Zhao, Zhijing; Zhang, Mingming; Wang, Tingting; Lin, Jie; Duan, Yu; Wang, Ling; Wang, Haichang; Sun, Dongdong; Li, Yan

    2016-01-01

    Abstract Background: The instantaneous wave-free ratio (iFR) is a new vasodilator-free index of coronary stenosis severity. The aim of this meta-analysis is to assess the diagnostic performance of iFR for the evaluation of coronary stenosis severity with fractional flow reserve as standard reference. Methods: We searched PubMed, EMBASE, CENTRAL, ProQuest, Web of Science, and International Clinical Trials Registry Platform (ICTRP) for publications concerning the diagnostic value of iFR. We used a random-effects covariate to synthesize the available data of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR). Overall test performance was summarized by the summary receiver operating characteristic curve (sROC) and the area under the curve (AUC). Results: Eight studies with 1611 subjects were included in the meta-analysis. The pooled sensitivity, specificity, LR+, LR−, and DOR for iFR were respectively 73.3% (70.1–76.2%), 86.4% (84.3–88.3%), 5.71 (4.43–7.37), 0.29 (0.22–0.38), and 20.54 (16.11–26.20). The area under the summary receiver operating characteristic curves for iFR was 0.8786. No publication bias was identified. Conclusion: The available evidence suggests that iFR may be a new, simple, and promising technology for coronary stenosis physiological assessment. PMID:27603377

  15. Evaluation of interpolation procedures to input turbulence fields from a prognostic model to a diagnostic mass consistent model

    NASA Astrophysics Data System (ADS)

    Trini Castelli, S.; Anfossi, D.

    2009-09-01

    An appropriate description of the meteorology in highly complex terrain encompasses atmospheric processes characterized by all scales of motion, from synoptic scale fronts and waves, through mesoscale mountain-valley circulations and gravity waves, till very small scale turbulence. To study the regional and local circulation at high resolutions (around 100 m) in complex terrain, we often couple a prognostic model (RAMS) to a mass-consistent diagnostic model (MINERVE). This downscaling approach allows representing both the mesoscale forcing and the peculiarities of the local flow in complex topography, since it combines the 3D gridded prognostic fields with local available measurements and it gives the possibility to include a high-resolution detailed topography, thus providing more spatially detailed meteorological fields. Diagnostic atmospheric mass-consistent models generally are used together with turbulence parameterisations defined for flat terrain, thus in principle not able to catch the variability of the turbulence field induced by the presence of complex terrain and inhomogeneous conditions. The possibility of using prognostic turbulence fields produced accounting for the topography is then an appealing approach in inhomogeneous conditions. In this work we investigate whether a proper interpolation from the coarser-resolution prognostic 3D-gridded turbulence fields, like diffusion coefficients, turbulent kinetic energy and its dissipation, might be used in mountainous and inhomogeneous terrain. The final goal is to evaluate if the shortcoming of using parameterised turbulent fields might be overcome when coupling the mass consistent model with a module calculating the turbulence fields at the high-resolution diagnostic grid points, by interpolating from the coarser prognostic grid.

  16. Convergence between DSM-IV-TR and DSM-5 diagnostic models for personality disorder: evaluation of strategies for establishing diagnostic thresholds.

    PubMed

    Morey, Leslie C; Skodol, Andrew E

    2013-05-01

    The Personality and Personality Disorders Work Group for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recommended substantial revisions to the personality disorders (PDs) section of DSM-IV-TR, proposing a hybrid categorical-dimensional model that represented PDs as combinations of core personality dysfunctions and various configurations of maladaptive personality traits. Although the DSM-5 Task Force endorsed the proposal, the Board of Trustees of the American Psychiatric Association (APA) did not, placing the Work Group's model in DSM-5 Section III ("Emerging Measures and Models") with other concepts thought to be in need of additional research. This paper documents the impact of using this alternative model in a national sample of 337 patients as described by clinicians familiar with their cases. In particular, the analyses focus on alternative strategies considered by the Work Group for deriving decision rules, or diagnostic thresholds, with which to assign categorical diagnoses. Results demonstrate that diagnostic rules could be derived that yielded appreciable correspondence between DSM-IV-TR and proposed DSM-5 PD diagnoses-correspondence greater than that observed in the transition between DSM-III and DSM-III-R PDs. The approach also represents the most comprehensive attempt to date to provide conceptual and empirical justification for diagnostic thresholds utilized within the DSM PDs.

  17. PLGA nanofiber membranes loaded with epigallocatechin-3-O-gallate are beneficial to prevention of postsurgical adhesions

    PubMed Central

    Shin, Yong Cheol; Yang, Won Jun; Lee, Jong Ho; Oh, Jin-Woo; Kim, Tai Wan; Park, Jong-Chul; Hyon, Suong-Hyu; Han, Dong-Wook

    2014-01-01

    This study concentrates on the development of biodegradable nanofiber membranes with controlled drug release to ensure reduced tissue adhesion and accelerated healing. Nanofibers of poly(lactic-co-glycolic acid) (PLGA) loaded with epigallocatechin-3-O-gallate (EGCG), the most bioactive polyphenolic compound in green tea, were electrospun. The physicochemical and biomechanical properties of EGCG-releasing PLGA (E-PLGA) nanofiber membranes were characterized by atomic force microscopy, EGCG release and degradation profiles, and tensile testing. In vitro antioxidant activity and hemocompatibility were evaluated by measuring scavenged reactive oxygen species levels and activated partial thromboplastin time, respectively. In vivo antiadhesion efficacy was examined on the rat peritonea with a surgical incision. The average fiber diameter of E-PLGA membranes was approximately 300–500 nm, which was almost similar to that of pure PLGA equivalents. E-PLGA membranes showed sustained EGCG release mediated by controlled diffusion and PLGA degradation over 28 days. EGCG did not adversely affect the tensile strength of PLGA membranes, whereas it significantly decreased the elastic modulus and increased the strain at break. E-PLGA membranes were significantly effective in both scavenging reactive oxygen species and extending activated partial thromboplastin time. Macroscopic observation after 1 week of surgical treatment revealed that the antiadhesion efficacy of E-PLGA nanofiber membranes was significantly superior to those of untreated controls and pure PLGA equivalents, which was comparable to that of a commercial tissue-adhesion barrier. In conclusion, the E-PLGA hybrid nanofiber can be exploited to craft strategies for the prevention of postsurgical adhesions. PMID:25187710

  18. Contrast agents for diagnostic ultrasound: development and evaluation of polymer-coated microbubbles.

    PubMed

    Wheatley, M A; Schrope, B; Shen, P

    1990-11-01

    Although the concept of an ultrasound contrast agent dates from Gramiak's work in 1968 in which indocyanine green was injected into the ascending aorta and heart, no universally accepted contrast agent for ultrasound now exists. This is primarily due to problems with stability, size and/or toxicity of the agents which have been investigated. Development of an effective ultrasound contrast agent would be highly significant for the health care industry, since it would greatly expand the scope of ultrasound (a noninvasive and safe procedure) as a diagnostic technique. While encapsulated gas bubbles offer particular advantages in stability over hand-agitated systems, they frequently present problems with size. Capsules larger than 10 microns in diameter become entrapped in the capillary bed of the lung. This paper describes the use of ionotropic gelation of the naturally occurring polysaccharide, alginate, for microencapsulation of air. Two procedures have been investigated. A novel jet head has been developed which allows co-extrusion of a solution of sodium alginate and air to produce nascent microencapsulated air bubbles which fall into a hardening solution of calcium ions. A second method employs ultrasound to introduce cavitation-induced bubbles into the alginate before capsule formation by spraying. Power spectra of these preparations demonstrate echogenicity (that is strong scatter of the incident ultrasound wave back to the emitting transducer, which also acts as a receiver), with resonant peaks that are a function of capsule size and wall characteristics. PMID:2090309

  19. Performance Evaluation and Implementation of FPGA Based SGSF in Smart Diagnostic Applications.

    PubMed

    Agarwal, Shivangi; Rani, Asha; Singh, Vijander; Mittal, A P

    2016-03-01

    The main objective of the paper is to implement Savitzky Golay Smoothing Filter (SGSF) so as to apply in pre-processing of real time smart medical diagnostic systems. As very important information of EEG and ECG waveforms lies in the peak of the signal, hence it becomes absolutely necessary to filter noise and artifacts from the signal. The implemented filter should be able to reject the noise efficiently along with the least distortion from the original signal. The shape preserving characteristics of the filter are determined by introducing different noise levels in the signal. The designed filter is tested on synthetic signals of EEG and ECG by adding different types of noise and the performance is analysed on various parameters, i.e., SNR, SSNR, SNRI, MSE, COR and signal distortion of the final output. The smoothing performance comparison of SGSF with the most commonly used Moving Average Filter (MAF) proves that SGSF is more efficient. Hence it is suggested that MAF can be replaced by SGSF. For real time issues, it is further implemented on reconfigurable architectures so as to achieve high speed, low cost, low power consumption and less area. Therefore SGSF is realized on FPGA platform to combine the advantages of both. Real time EEG and ECG signals are also considered for experimentation. The experimental results show that the proposed methodology (FPGA-SGSF) significantly reduces the processing time and preserves the actual features of the signal.

  20. Evaluation of rucaparib and companion diagnostics in the PARP inhibitor landscape for recurrent ovarian cancer therapy.

    PubMed

    Jenner, Zachary B; Sood, Anil K; Coleman, Robert L

    2016-06-01

    Rucaparib camsylate (CO-338; 8-fluoro-2-{4-[(methylamino)methyl]phenyl}-1,3,4,5-tetrahydro-6H-azepino[5,4,3-cd]indol-6-one ((1S,4R)-7,7-dimethyl-2-oxobicyclo[2.2.1]hept-1-yl)methanesulfonic acid salt) is a PARP1, 2 and 3 inhibitor. Phase I studies identified a recommended Phase II dose of 600 mg orally twice daily. ARIEL2 Part 1 established a tumor genomic profiling test for homologous recombination loss of heterozygosity quantification using a next-generation sequencing companion diagnostic (CDx). Rucaparib received US FDA Breakthrough Therapy designation for treatment of platinum-sensitive BRCA-mutated advanced ovarian cancer patients who received greater than two lines of platinum-based therapy. Comparable to rucaparib development, other PARP inhibitors, such as olaparib, niraparib, veliparib and talazoparib, are developing CDx tests for targeted therapy. PARP inhibitor clinical trials and CDx assays are discussed in this review, as are potential PARP inhibitor combination therapies and likely resistance mechanisms. PMID:27087632

  1. Prospective evaluation of costs of disposable accessories in diagnostic and therapeutic ERCP.

    PubMed

    Kim-Deobald, J; Kozarek, R A; Ball, T J; Patterson, D J; Brandabur, J J; Raltz, S

    1993-01-01

    Procedural (room fee) reimbursement from insurance payers is usually fixed for individual endoscopic procedures and may not include the costs of disposable equipment. This study estimated costs of disposable items used in ERCP procedures and calculated the percentage of total reimbursement spent on such equipment. A total of 248 ERCPs were performed in a 5-month study period, 192 (77%) of which were therapeutic. Total reimbursement was estimated to be $112,262 ($452 per procedure) and total disposable equipment costs were $47,195 ($190 per procedure), or 42% of total reimbursement. Disposable instrument costs in diagnostic ERCP approximated 13% of those associated with therapeutic ERCP, and the latter costs in turn utilized more than 60% of Medicare/Medicaid room fee reimbursement. This reimbursement may be inadequate to cover both disposable instrument costs and other procedural expenses, such as admit-recovery costs, nursing assistance, expenses related to endoscope purchase and capitalization, and equipment cleaning or sterilization. Our data suggest the need for either re-usable endoscopic accessories or adequate compensation to cover disposable instrument costs.

  2. A comprehensive review of diagnostic imaging technologies to evaluate the retina and the optic disk.

    PubMed

    Bajwa, Asima; Aman, Rabia; Reddy, Ashvini K

    2015-10-01

    Ophthalmic imaging has undergone a revolution over the past 20 years with increasingly efficient and high-definition modalities now available. The use of wide-field retinal angiography, fundus autofluorescence, state-of-the-art spectral domain, and enhanced depth imaging optical coherence tomography has proven to be effective in this field. This comprehensive review is devoted to retinal and optic disk imaging modalities and their clinical implications. It is based on the published literature in the field of ophthalmic imaging with a focus on recent advances. Ophthalmic imaging plays a crucial role in the management of patients with both isolated retinal disease and systemic diseases with ocular manifestations. Evolving technology enables imaging of ocular disease in vivo, facilitating objective assessment of disease progression and response to treatment. These latest technical improvements in ophthalmic imaging are now a part of standard ophthalmic assessment in academic centers and most private practices. In the coming years, further advances may improve diagnostic sensitivity and enable cost-effective screening of large populations. PMID:26043677

  3. Performance Evaluation and Implementation of FPGA Based SGSF in Smart Diagnostic Applications.

    PubMed

    Agarwal, Shivangi; Rani, Asha; Singh, Vijander; Mittal, A P

    2016-03-01

    The main objective of the paper is to implement Savitzky Golay Smoothing Filter (SGSF) so as to apply in pre-processing of real time smart medical diagnostic systems. As very important information of EEG and ECG waveforms lies in the peak of the signal, hence it becomes absolutely necessary to filter noise and artifacts from the signal. The implemented filter should be able to reject the noise efficiently along with the least distortion from the original signal. The shape preserving characteristics of the filter are determined by introducing different noise levels in the signal. The designed filter is tested on synthetic signals of EEG and ECG by adding different types of noise and the performance is analysed on various parameters, i.e., SNR, SSNR, SNRI, MSE, COR and signal distortion of the final output. The smoothing performance comparison of SGSF with the most commonly used Moving Average Filter (MAF) proves that SGSF is more efficient. Hence it is suggested that MAF can be replaced by SGSF. For real time issues, it is further implemented on reconfigurable architectures so as to achieve high speed, low cost, low power consumption and less area. Therefore SGSF is realized on FPGA platform to combine the advantages of both. Real time EEG and ECG signals are also considered for experimentation. The experimental results show that the proposed methodology (FPGA-SGSF) significantly reduces the processing time and preserves the actual features of the signal. PMID:26671061

  4. Prediction of stroke-related diagnostic and prognostic measures using robot-based evaluation.

    PubMed

    Mostafavi, Sayyed Mostafa; Glasgow, Janice I; Dukelow, Sean P; Scott, Stephen H; Mousavi, Parvin

    2013-06-01

    Traditional clinical scores for assessment of impairments resulting from stroke are inherently subjective and limited by inter-rater and intra-rater reliability. In contrast, robotic technologies provide objective, highly repeatable tools for quantification of motor performance of stroke subjects. Although use of robotic technologies has been widely suggested in the literature, they are not an established tool and their relationship to traditional clinical scales for stroke diagnosis and prognosis is mostly unknown. In this study we propose the application of two non-linear system identification methods, Parallel Cascade Identification and Fast Orthogonal Search, for prediction of stroke-related clinical scores using robot-based metrics. We show the suitability of these two methods for prediction of both diagnostic and prognostic scores. We compare our results with a previously applied approach based on linear regression and show the superiority of our modeling approach. Our results also underscore the importance of quantifying proprioceptive deficits in the prediction of motor-related prognosis scores.

  5. Spectro-temporal diagnostics to evaluate physical structure around the AGN

    NASA Astrophysics Data System (ADS)

    Mizumoto, M.; Ebisawa, K.

    2016-06-01

    X-ray energy spectra from the AGN exhibit a lot of emission/absorption lines, which have been studied in detail by grating devices such as RGS on XMM-Newton. Variability of these spectral lines is considered to reflect physical conditions of the line emitting/absorbing matter. Thus, we study root-mean-square (RMS) spectra of several AGN observed with RGS to diagnose physical structures around these AGN. As a result, we have found clear peaks/dips in the RMS spectrum of NGC 4051, which can be modeled with variable absorption lines and non-variable emission lines. Several absorbers with different ionization states are required, where a lower-ionized (logξ=1.5) absorber shows larger variability and a higher-ionized (logξ=2.5) absorber shows little variability. These results directly give hints on physical structure around the AGN. We also show simulated RMS spectra of several AGN with Hitomi SXS, which is a more powerful diagnostic tool than RGS.

  6. Myositis ossificans: radiologic evaluation of two cases with diagnostic computed tomograms

    SciTech Connect

    Zeanah, W.R.; Hudson, T.M.

    1982-08-01

    Although most physicians associated myositis ossificans with recent, acute trauma, only 40%-60% of patients give such a history. The appearance of a soft tissue mass without a clear history of trauma may suggest a diagnosis of sarcoma, especially because results of a biopsy of the central portion of an area of myositis ossificans may yield immature, undifferentiated tissue resembling a sarcoma. Pain and rapid growth of a mass are more usual in myositis ossificans than in sarcomas, and careful inquiry may reveal stretching injury or chronic trauma associated with normal, vigorous, physical activities. Recognizing the characteristic histologic zoning phenomenon (immature tissue centrally surrounded by more mature tissue and a peripheral shell of benign bone) during the biopsy procedure permits the correct diagnosis of myositis ossificans. Plain radiographs or conventional tomograms may reflect this histologic zoning by demonstrating the typical, mature, outer shell of bone. Although additional radiographic studies are not usually necessary, they may be obtained when the mass is suspected to be a sarcoma. In two patients computed tomographic scans clearly demonstrated well-defined, peripheral shells of mature bone, diagnostic of myositis ossificans.

  7. Evaluation of the diagnostic value of 64 simultaneously measured autoantibodies for early detection of gastric cancer

    PubMed Central

    Werner, Simone; Chen, Hongda; Butt, Julia; Michel, Angelika; Knebel, Phillip; Holleczek, Bernd; Zörnig, Inka; Eichmüller, Stefan B.; Jäger, Dirk; Pawlita, Michael; Waterboer, Tim; Brenner, Hermann

    2016-01-01

    Autoantibodies against tumor-associated antigens (TAAs) have been suggested as biomarkers for early detection of gastric cancer. However, studies that systematically assess the diagnostic performance of a large number of autoantibodies are rare. Here, we used bead-based multiplex serology to simultaneously measure autoantibody responses against 64 candidate TAAs in serum samples from 329 gastric cancer patients, 321 healthy controls and 124 participants with other diseases of the upper digestive tract. At 98% specificity, sensitivities for the 64 tested autoantibodies ranged from 0–12% in the training set and a combination of autoantibodies against five TAAs (MAGEA4 + CTAG1 + TP53 + ERBB2_C + SDCCAG8) was able to detect 32% of the gastric cancer patients at a specificity of 87% in the validation set. Sensitivities for early and late stage gastric cancers were similar, while chronic atrophic gastritis, a precursor lesion of gastric cancer, was not detectable. However, the 5-marker combination also detected 26% of the esophageal cancer patients. In conclusion, the tested autoantibodies and combinations alone did not reach sufficient sensitivity for gastric cancer screening. Nevertheless, some autoantibodies, such as anti-MAGEA4, anti-CTAG1 or anti-TP53 and their combinations could possibly contribute to the development of cancer early detection tests (not necessarily restricted to gastric cancer) when being combined with other markers. PMID:27140836

  8. Diagnostic efficacy of color Doppler ultrasound in evaluation of cervical lymphadenopathy

    PubMed Central

    Misra, Deepankar; Panjwani, Sapna; Rai, Shalu; Misra, Akansha; Prabhat, Mukul; Gupta, Prashant; Talukder, Subrata K.

    2016-01-01

    Background: To evaluate the efficacy of color Doppler ultrasound (CDUS) in differentiating benign and malignant cervical lymph nodes by detecting differences in blood flow patterns. Materials and Methods: In this cross-sectional prospective study, 25 untreated patients with clinical evidence of cervical lymphadenopathy were evaluated. CDUS was performed for 80 cervical lymph nodes. The gray scale parameters of the lymph node and intranodal perfusion sites were the key CDUS features used to differentiate between reactive and metastatic lymph nodes. Histopathological confirmations were obtained and compared with the results of CDUS. Results: Initially, 53 cervical lymph nodes were evaluated by clinical examination. Twenty-seven additional lymph nodes (53 + 27 = 80) were discovered by CDUS evaluation. Gray scale parameters for lymph nodes such as size of lymph node, shape of lymph node, and presence or absence of hilum revealed highly significant results (P < 0.0001). Color Doppler flow signals revealed that central/hilar flow was characteristic for benign nodes whereas peripheral/mixed flow was characteristic for malignant nodes, the findings were highly significant (P < 0.0001). Gray scale and color Doppler features are used to differentiate benign and malignant nodes. Conclusion: Within the limitations of this study, CDUS evaluation was found to be highly significant with a high sensitivity and specificity over clinical evaluation CDUS examination provides a prospect to reduce the need for biopsy/fine needle aspiration cytology in reactive nodes. PMID:27274341

  9. Howling at the moon? The effect of lunar phases on post-surgical pain outcome

    PubMed Central

    Weinmann, Claudia; Meissner, Winfried

    2014-01-01

    Objective: Many people are convinced that lunar phases influence their lives – despite the fact that a lot of studies have shown that this belief is wrong. In this article, we investigate the effect of lunar phases on acute post-surgical pain and on treatment-related side effects. We hypothesize that there is no influence. Methods: The data for the study were collected in 2010 and 2011 in 10 international hospitals participating in the research project PAIN OUT. Hospitalized patients were asked for their pain after surgery and pain treatment side effects using numerical ratings scales from 0 to 10. We applied Kurskal–Wallis H-tests to find out if the four moon phases show significant differences in 14 outcome variables. Afterwards, we adjusted for age, gender and three tracer surgeries. Results: A total of 12,224 patient data sets were assessed. For most variables and sub-groups, there is no lunar effect on the observed outcome variables. The only items that show statistically significant differences are pain interference with sleep (p = 0.01) and drowsiness (p = 0.01). The only sub-groups that show statistically significant connections to lunar phases in some variables are men (7 out of 14 variables significant) and elderly people (4 out of 14 variables significant). Discussion: Even in the statistically significant sub-groups, the differences are small and only show up in some variables. We conclude that lunar phases have no effect on post-surgical pain or its side effects. The hypothesis holds. Thus, there is no reason for patients to postpone surgeries or to fear surgeries on any given date. PMID:26516538

  10. Postsurgical Cystoid Macular Edema following Posterior Chamber Toric Phakic Intraocular Lens Implantation Surgery: A Case Report

    PubMed Central

    Canan, Julide; Akkan, Umurhan; Tuncer, Kemal; Elbay, Ahmet

    2015-01-01

    Purpose To describe a case of cystoid macular edema (CME) developing after posterior chamber toric phakic intraocular lens (PIOL) implantation. Methods Case report. Results A 33-year-old male underwent implantation of toric implantable collamer lenses (ICL), a new generation of PIOLs, for both eyes. Preoperative best spectacle-corrected distance visual acuity (BCVA) was 20/25 in the right eye and 20/32 in the left eye, with a manifest refraction of −9.25 −4.0 × 4° and −9.75 −4.25 × 171°, respectively. On day 1 postoperatively, the left eye had an uncorrected distance visual acuity (UDVA) of 20/60 with a refraction of +2.0 −3.5 × 11°. Despite the rotation of the PIOL, the cylindrical refractive component persisted in the left eye with a refraction of +2.0 −3.5 × 11°. Two weeks after the initial surgery, he presented with a decrease in his visual acuity in the left eye. The UDVA and BCVA were both 20/100 in the left eye with a refraction of +2.0 −4.25 × 3°. Dilated fundus examination and macular optical coherence tomography revealed a CME in the left eye. Following topical nepafenac therapy and explantation of the ICL, we observed a complete resolution of the CME at 3 months with an improvement in BCVA to 20/32 in the left eye. Conclusions To our knowledge, this is the first reported case of postsurgical CME following toric ICL implantation. In cases of phakic eyes with an intact posterior capsule, postsurgical CME can develop, thus highlighting the purpose of this report. PMID:26265909

  11. Perioperative Statin Treatment: Can It Decrease Postsurgical Cardiac Event Risk in Noncardiac Surgery?

    PubMed

    Spivey, Matthew G; Atwood, Jon; Fogel, Sandy L

    2016-08-01

    Cardiac events are an important cause of postsurgical morbidity and mortality. Statin drugs have been studied as potentially risk-modifying agents in perioperative medicine. They have been shown to confer a protective benefit in cardiac surgery, but the evidence available in noncardiac surgery patient populations remains less conclusive. We hypothesized that perioperative statin treatment would be associated with lower incidence of postsurgical cardiac events (PSCEs) after major noncardiac surgery. A retrospective cohort study included 21,637 major noncardiac surgeries. Statin treatment was the exposure of interest and PSCE was the primary outcome measure. Data collection included patient age, body mass index, smoking status, diabetic status, cardiac event history, statin treatment history, and PSCE diagnoses. Perioperative statin treatment occurred in 4176 cases (19.3%). PSCEs occurred in 50 cases (0.23%), 29 in the untreated control group (0.17%) and 21 in the statin treatment group (0.50%). Relative risk in the untreated group was 0.3303 (95% confidence interval = 0.1886, 0.5786). This implied that statin-treated patients had higher risk than the untreated group. However, a logistic regression model that accounted for observed cardiac disease risk factors showed statin treatment not to be a significant predictor of PSCE in this sample. Analysis repeated in high-risk subsets of the cohort yielded similar results. A propensity score matching method that minimized differences between study groups also failed to demonstrate a significant association between statin treatment and PSCE risk. Our study did not demonstrate a significant association between perioperative statin treatment and PSCEs after major noncardiac surgery.

  12. Perioperative Statin Treatment: Can It Decrease Postsurgical Cardiac Event Risk in Noncardiac Surgery?

    PubMed

    Spivey, Matthew G; Atwood, Jon; Fogel, Sandy L

    2016-08-01

    Cardiac events are an important cause of postsurgical morbidity and mortality. Statin drugs have been studied as potentially risk-modifying agents in perioperative medicine. They have been shown to confer a protective benefit in cardiac surgery, but the evidence available in noncardiac surgery patient populations remains less conclusive. We hypothesized that perioperative statin treatment would be associated with lower incidence of postsurgical cardiac events (PSCEs) after major noncardiac surgery. A retrospective cohort study included 21,637 major noncardiac surgeries. Statin treatment was the exposure of interest and PSCE was the primary outcome measure. Data collection included patient age, body mass index, smoking status, diabetic status, cardiac event history, statin treatment history, and PSCE diagnoses. Perioperative statin treatment occurred in 4176 cases (19.3%). PSCEs occurred in 50 cases (0.23%), 29 in the untreated control group (0.17%) and 21 in the statin treatment group (0.50%). Relative risk in the untreated group was 0.3303 (95% confidence interval = 0.1886, 0.5786). This implied that statin-treated patients had higher risk than the untreated group. However, a logistic regression model that accounted for observed cardiac disease risk factors showed statin treatment not to be a significant predictor of PSCE in this sample. Analysis repeated in high-risk subsets of the cohort yielded similar results. A propensity score matching method that minimized differences between study groups also failed to demonstrate a significant association between statin treatment and PSCE risk. Our study did not demonstrate a significant association between perioperative statin treatment and PSCEs after major noncardiac surgery. PMID:27657588

  13. Postsurgical hypoparathyroidism--risk of fractures, psychiatric diseases, cancer, cataract, and infections.

    PubMed

    Underbjerg, Line; Sikjaer, Tanja; Mosekilde, Leif; Rejnmark, Lars

    2014-11-01

    Data on co-morbidity in patients with postsurgical hypoparathyroidism (HypoPT) are sparse. We aimed to assess risk of fractures, spinal stenosis, cataract, neuropsychiatric diseases, cancer, and infections within the historic cohort of patients with postsurgical HypoPT due to non-malignant causes that we previously have characterized. Patients were identified through the Danish National Patient Registry and regional prescription databases, with subsequent validation of their individual hospital records. Identified cases were matched with three age- (± 2 yr) and gender-matched controls from the general background population. Compared with controls, patients did not have an increased risk of cataract (p = 0.52), spinal stenosis (p = 0.59), or any fracture (p = 0.98). However, the risk of fractures at the upper extremities was significantly decreased in patients (HR 0.69, 95% CI 0.49-0.97). Compared with controls, patients had a significantly increased risk of hospitalization due to infections (HR 1.42, 95% CI 1.20-1.67) and depression/bipolar affective disorders (HR 1.99, 95% CI 1.14-3.46). The risk of malignant diseases did not differ between groups although the risk of gastrointestinal cancers was significantly lower in patients compared with controls (HR 0.63, 95% CI 0.44-0.93). In conclusion, HypoPT is associated with an increased risk of depression and other types of neuropsychiatric diseases as well as infections, whereas patients seem to be protected against fractures at the upper extremities and gastrointestinal malignancies.

  14. Post-surgical wound management of pilonidal cysts with a haemoglobin spray: a case series.

    PubMed

    Mustafi, N; Engels, P

    2016-04-01

    Painful acute cysts in the natal cleft or lower back, known as pilonidal sinus disease, are a severe burden to many younger patients. Although surgical intervention is the preferred first line treatment, postsurgical wound healing disturbances are frequently reported due to infection or other complications. Different treatment options of pilonidal cysts have been discussed in the literature, however, no standardised guideline for the postsurgical wound treatment is available. After surgery, a common recommended treatment to patients is rinsing the wound with clean water and dressing with a sterile compress. We present a case series of seven patients with wounds healing by secondary intention after surgical intervention of a pilonidal cyst. The average age of the patients was 40 years old. Of the seven patients, three had developed a wound healing disturbance, one wound had started to develop a fibrin coating and three were in a good condition. The applied wound care regimens comprised appropriate mechanical or autolytic debridement, rinsing with an antimicrobial solution, haemoglobin application, and primary and secondary dressings. In all seven cases a complete wound closure was achieved within an average of 76 days with six out of seven wounds achieving wound closure within 23-98 days. Aesthetic appearance was deemed excellent in five out of seven cases excellent and acceptable in one. Treatment of one case with a sustained healing disturbance did result in wound closure but with a poor aesthetic outcome and an extensive cicatrisation of the new tissue. Based on these results we recommend that to avoid healing disturbances of wounds healing by secondary intention after surgical pilonidal cyst intervention, an adequate wound care regime comprising appropriate wound debridement, rinsing, topically applied haemoglobin and adequate wound dressing is recommendable as early as possible after surgery. PMID:27064368

  15. Post-surgical wound management of pilonidal cysts with a haemoglobin spray: a case series.

    PubMed

    Mustafi, N; Engels, P

    2016-04-01

    Painful acute cysts in the natal cleft or lower back, known as pilonidal sinus disease, are a severe burden to many younger patients. Although surgical intervention is the preferred first line treatment, postsurgical wound healing disturbances are frequently reported due to infection or other complications. Different treatment options of pilonidal cysts have been discussed in the literature, however, no standardised guideline for the postsurgical wound treatment is available. After surgery, a common recommended treatment to patients is rinsing the wound with clean water and dressing with a sterile compress. We present a case series of seven patients with wounds healing by secondary intention after surgical intervention of a pilonidal cyst. The average age of the patients was 40 years old. Of the seven patients, three had developed a wound healing disturbance, one wound had started to develop a fibrin coating and three were in a good condition. The applied wound care regimens comprised appropriate mechanical or autolytic debridement, rinsing with an antimicrobial solution, haemoglobin application, and primary and secondary dressings. In all seven cases a complete wound closure was achieved within an average of 76 days with six out of seven wounds achieving wound closure within 23-98 days. Aesthetic appearance was deemed excellent in five out of seven cases excellent and acceptable in one. Treatment of one case with a sustained healing disturbance did result in wound closure but with a poor aesthetic outcome and an extensive cicatrisation of the new tissue. Based on these results we recommend that to avoid healing disturbances of wounds healing by secondary intention after surgical pilonidal cyst intervention, an adequate wound care regime comprising appropriate wound debridement, rinsing, topically applied haemoglobin and adequate wound dressing is recommendable as early as possible after surgery.

  16. Evaluation of real-time PCR for Strongyloides stercoralis and hookworm as diagnostic tool in asymptomatic schoolchildren in Cambodia.

    PubMed

    Schär, Fabian; Odermatt, Peter; Khieu, Virak; Panning, Marcus; Duong, Socheat; Muth, Sinuon; Marti, Hanspeter; Kramme, Stefanie

    2013-05-01

    Diagnosis of soil-transmitted helminths such as Strongyloides stercoralis and hookworms (Ancylostoma duodenale and Necator americanus) is challenging due to irregular larval and egg output in infected individuals and insensitive conventional diagnostic procedures. Sensitive novel real-time PCR assays have been developed. Our study aimed to evaluate the real-time PCR assays as a diagnostic tool for detection of Strongyloides spp. and hookworms in a random stool sample of 218 asymptomatic schoolchildren in Cambodia. Overall prevalence of 17.4% (38/218) and 34.9% (76/218) were determined by real-time PCR for S. stercoralis and hookworms, respectively. Sensitivity and specificity of S. stercoralis specific real-time PCR as compared to the combination of Baermann/Koga Agar as gold standard were 88.9% and 92.7%, respectively. For hookworm specific real-time PCR a sensitivity of 78.9% and specificity of 78.9% were calculated. Co-infections were detectable by PCR in 12.8% (28/218) of individuals. S. stercoralis real-time PCR applied in asymptomatic cases showed a lower sensitivity compared to studies undertaken with symptomatic patients with the same molecular tool, yet it proved to be a valid supplement in the diagnosis of STH infection in Cambodia.

  17. Improving Diagnostic Accuracy of Dermoscopically Equivocal Pink Cutaneous Lesions with Reflectance Confocal Microscopy in Telemedicine Settings: Double Reader Concordance Evaluation of 316 Cases

    PubMed Central

    Roterman-Konieczna, I.; Bassoli, S.

    2016-01-01

    Background Solitary pink lesions in differential diagnosis with hypopigmented/amelanotic melanoma present a diagnostic challenge in daily practice and are regularly referred for second expert opinion. Reflectance confocal microscopy (RCM) has been shown to improve diagnostic accuracy of dermoscopically equivocal pink lesions. No studies have been performed to evaluate the effect of adding a second expert reader and automatic removal of lesions with discordant management recommendations and its potential effect on diagnostic sensitivity and final management of these lesions in retrospective or telemedicine settings. Objective To improve diagnostic accuracy and reduce potential mismanagement of dermoscopically equivocal pink cutaneous lesions by implementing double reader concordance evaluation of RCM images. Methods 316 dermoscopically equivocal pink lesions with dermoscopy-RCM image sets were evaluated retrospectively. Accuracy of three readers was evaluated by single reader evaluation of dermoscopy only and dermoscopy-RCM image sets and finally by double reader evaluation of dermoscopy-RCM image sets. Lesions with discordant diagnosis between two readers were automatically recommended for excision. Results Dermoscopy only evaluation resulted in an overall sensitivity of 95.9% and specificity of 33.6%, with 1 of 12 amelanotic melanomas mismanaged. Dermoscopy-RCM image set single reader evaluation resulted in an overall sensitivity of 93.9% and overall specificity of 54.2%, with 1 of 12 melanomas mismanaged. Dermoscopy-RCM image set double reader concordance evaluation resulted in an overall sensitivity of 98.3% and specificity of 42.7%, with no amelanotic melanoma mismanagement. Conclusion Evaluation of dermoscopy-RCM image sets of equivocal pink lesions by a single reader in telemedicine settings is limited by the potential for misdiagnosis of dangerous malignant lesions. Double reader concordance evaluation with automatic referral of lesions for removal in the

  18. Evaluation of a new paleosecular variation activity index as a diagnostic tool for geomagnetic field variations

    NASA Astrophysics Data System (ADS)

    Panovska, Sanja; Constable, Catherine

    2015-04-01

    Geomagnetic indices like Dst, K and A, have been used since the early twentieth century to characterize activity in the external part of the modern geomagnetic field and as a diagnostic for space weather. These indices reflect regional and global activity and serve as a proxy for associated physical processes. However, no such tools are yet available for the internal geomagnetic field driven by the geodynamo in Earth's liquid outer core. To some extent this reflects limited spatial and temporal sampling for longer timescales associated with paleomagnetic secular variation, but recent efforts in both paleomagnetic data gathering and modeling activity suggest that longer term characterization of the internal geomagnetic weather/climate and its variability would be useful. Specifically, we propose an index for activity in paleosecular variation, useful as both a local and global measure of field stability during so-called normal secular variation and as a means of identifying more extreme behavior associated with geomagnetic excursions and reversals. To date, geomagnetic excursions have been identified by virtual geomagnetic poles (VGPs) deviating more than some conventional limit from the geographic pole (often 45 degrees), and/or by periods of significant intensity drops below some critical value, for example 50% of the present-day field. We seek to establish a quantitative definition of excursions in paleomagnetic records by searching for synchronous directional deviations and lows in relative paleointensity. We combine paleointensity variations with deviations from the expected geocentric axial dipole (GAD) inclination in a single parameter, which we call the paleosecular variation (PSV) activity index. This new diagnostic can be used on any geomagnetic time series (individual data records, model predictions, spherical harmonic coefficients, etc.) to characterize the level of paleosecular variation activity, find excursions, or even study incipient reversals

  19. Evaluating the accessibility and utility of HIV-related point-of-care diagnostics for maternal health in rural South Africa: a study protocol

    PubMed Central

    Mashamba-Thompson, T P; Drain, P K; Sartorius, B

    2016-01-01

    Introduction Poor healthcare access is a major barrier to receiving antenatal care and a cause of high maternal mortality in South Africa (SA). ‘Point-of-care’ (POC) diagnostics is a powerful emerging healthcare approach to improve healthcare access. This study focuses on evaluating the accessibility and utility of POC diagnostics for maternal health in rural SA primary healthcare (PHC) clinics in order to generate a model framework of implementation of POC diagnostics in rural South African clinics. Method and analyses We will use several research methods, including a systematic review, quasi-experiments, survey, key informant interviews and audits. We will conduct a systematic review and experimental study to determine the impact of POC diagnostics on maternal health. We will perform a cross-sectional case study of 100 randomly selected rural primary healthcare clinics in KwaZulu-Natal to measure the context and patterns of POC diagnostics access and usage by maternal health providers and patients. We will conduct interviews with relevant key stakeholders to determine the reasons for POC deficiencies regarding accessibility and utility of HIV-related POC diagnostics for maternal health. We will also conduct a vertical audit to investigate all the quality aspects of POC diagnostic services including diagnostic accuracy in a select number of clinics. On the basis of information gathered, we will propose a model framework for improved implementation of POC diagnostics in rural South African public healthcare clinics. Statistical (Stata-13) and thematic (NVIVO) data analysis will be used in this study. Ethics and dissemination The study protocol was approved by the Ethics Committee of the University of KwaZulu-Natal (BE 484/14) and the KwaZulu-Natal Department of Health based on the Helsinki Declaration (HRKM 40/15). Findings of this study will be disseminated electronically and in print. They will be presented to conferences related to HIV/AIDS, diagnostics

  20. The iliac crest in forensic age diagnostics: evaluation of the apophyseal ossification in conventional radiography.

    PubMed

    Wittschieber, Daniel; Vieth, Volker; Domnick, Christoph; Pfeiffer, Heidi; Schmeling, Andreas

    2013-03-01

    Due to the increasing significance of forensic age estimations in the age of globalisation, novel radiographic criteria besides clavicles and hand bones may provide additional certainty for forensic age expertises. The present study analyses the suitability of the iliac crest apophysis by means of 643 pelvic radiographs of patients between 10 and 30 years of age. Retrospective assessments were carried out according to the forensically established classification and sub-classification systems modified after Kreitner et al. (Rofo 166(6):481-486, 1997) and Kellinghaus et al. (Int J Legal Med 124(4):321-325, 2010). The basic ossification stages range from 1 to 4, and the sub-stages of stage 2 and 3 range from a to c. While stage 3c was first achieved at the age of 15 by both sexes, stage 4 was first observed in females at the age of 16 and in males at the age of 17. This indicates the possibility of a valid diagnosis of both the age of 14 and the age of 16 years which represent legally relevant age thresholds in numerous countries. Applied as targeted radiography on the iliac crest, the exposure to radiation would range between other radiographic techniques recently applied. Therefore, the iliac crest apophysis appears principally suitable as novel possible criterion for forensic age estimation in the living. However, for the establishment of the iliac crest apophysis in routine diagnostics, further studies are needed focussing on the comparison of different grading systems and different radiological techniques.

  1. Radiological health; evaluation of radiation exposure in diagnostic radiology examinations; availability of draft recommendations--FDA. Notice.

    PubMed

    1983-07-29

    The Food and Drug Administration (FDA) announces the availability for public review and comment of draft recommendations on evaluation of radiation exposure in diagnostic radiology examinations, prepared by FDA's National Center for Devices and Radiological Health (NCDRH). In addition to the draft recommendations, FDA is making available background information, rationale, and NCDRH's response to comments that were received on a notice of inquiry regarding the need for and content of such recommendations. FDA is also encouraging private groups and individuals to join in the research efforts needed to develop further technique/exposure guidance and suggests a number of principles to be followed in these efforts so all interested parties may achieve consistent and useful results. Final recommendations, when developed, will be published as a technical report in NCDRH's radiation recommendation series. PMID:10261489

  2. Evaluation of the Diagnostic Ability of Optical Enhancement System in Early Gastric Cancer Demarcation

    PubMed Central

    Nagao, Misato; Ogawa, Ryo; Sasaki, Sho; Nakamura, Munetaka; Nishimura, Junichi; Goto, Atsushi; Hashimoto, Shinichi; Okamoto, Takeshi; Suenaga, Masato

    2016-01-01

    This study aimed to evaluate the utility of optical enhancement (OE) in early gastric cancer demarcation. Twenty lesions of early gastric cancer were examined by PENTAX endoscopy system with OE-1 and OE-2 functions. The areas of tumor demarcation identified by 12 evaluators (6 novice and 6 experienced) were compared to the corresponding correct areas determined by postoperative histopathology findings. The misdiagnosed scores that were the sums of false-positive and false-negative areas were compared. Color of one hundred pixels from the inside of the cancerous area and the outside of the cancerous area was expressed as three-dimensional RGB component vectors. The mean vectors and covariance matrixes were calculated and the Mahalanobis distance, indicative of color differences between two areas, was tested. Comparisons of the misdiagnosed score revealed that OE-1 was preferred over WL-1 for gastric cancer demarcation for all 12 evaluators (p = 0.008) and in novice evaluators (p = 0.026). OE-2 was not significantly different from WL-2 in all cases. OE-1 images gave significantly larger Mahalanobis distances, indicative of color differences, than WL-1 images (p = 0.002). It was demonstrated that the OE Mode 1 has a significant advantage over the white light mode in demarcation of early gastric cancer. PMID:27774101

  3. In vivo bio-safety evaluations and diagnostic/therapeutic applications of chemically designed mesoporous silica nanoparticles.

    PubMed

    Chen, Yu; Chen, Hangrong; Shi, Jianlin

    2013-06-18

    The remarkable progress of nanotechnology and its application in biomedicine have greatly expanded the ranges and types of biomaterials from traditional organic material-based nanoparticles (NPs) to inorganic biomaterials or organic/inorganic hybrid nanocomposites due to the unprecedented advantages of the engineered inorganic material-based NPs. Colloidal mesoporous silica NPs (MSNs), one of the most representative and well-established inorganic materials, have been promoted into biology and medicine, and shifted from extensive in vitro research towards preliminary in vivo assays in small-animal disease models. In this comprehensive review, the recent progresses in chemical design and engineering of MSNs-based biomaterials for in vivo biomedical applications has been detailed and overviewed. Due to the intrinsic structural characteristics of elaborately designed MSNs such as large surface area, high pore volume and easy chemical functionalization, they have been extensively investigated for therapeutic, diagnostic and theranostic (concurrent diagnosis and therapy) purposes, especially in oncology. Systematic in vivo bio-safety evaluations of MSNs have revealed the evidences that the in vivo bio-behaviors of MSNs are strongly related to their preparation prodecures, particle sizes, geometries, surface chemistries, dosing parameters and even administration routes. In vivo pharmacokinetics and pharmacodynamics further demonstrated the effectiveness of MSNs as the passively and/or actively targeted drug delivery systems (DDSs) for cancer chemotherapy. Especially, the advance of nano-synthetic chemistry enables the production of composite MSNs for advanced in vivo therapeutic purposes such as gene delivery, stimuli-responsive drug release, photothermal therapy, photodynamic therapy, ultrasound therapy, or anti-bacteria in tissue engineering, or as the contrast agents for biological and diagnostic imaging. Additionally, the critical issues and potential challenges

  4. Survivors of early childhood trauma: evaluating a two-dimensional diagnostic model of the impact of trauma and neglect

    PubMed Central

    Wildschut, Marleen; Langeland, Willemien; Smit, Jan H.; Draijer, Nel

    2014-01-01

    Background A two-dimensional diagnostic model for (complex) trauma-related and personality disorders has been proposed to assess the severity and prognosis of the impact of early childhood trauma and emotional neglect. An important question that awaits empirical examination is whether a distinction between trauma-related disorders and personality disorders reflects reality when focusing on survivors of early childhood trauma. And, is a continuum of trauma diagnoses a correct assumption and, if yes, what does it look like? Objective We describe the design of a cross-sectional cohort study evaluating this two-dimensional model of the impact of trauma and neglect. To provide the rationale of our study objectives, we review the existing literature on the impact of early childhood trauma and neglect on trauma-related disorders and personality disorders. Aims of the study are to: (1) quantify the two-dimensional model and test the relation with trauma and neglect; and (2) compare the two study groups. Method A total of 200 consecutive patients referred to two specific treatment programs (100 from a personality disorder program and 100 from a trauma-related disorder program) in the north of Holland will be included. Data are collected at the start of treatment. The assessments include all DSM-5 trauma-related and personality disorders, and general psychiatric symptoms, trauma history, and perceived emotional neglect. Discussion The results will provide an evaluation of the model and an improvement of the understanding of the relationship between trauma-related disorders and personality disorders and early childhood trauma and emotional neglect. This may improve both diagnostic as well as indication procedures. We will discuss possible strengths and limitations of the design. PMID:24711888

  5. Evaluation of different diagnostic methods of American Cutaneous Leishmaniasis in the Brazilian Amazon.

    PubMed

    Espir, Thais Tibery; Guerreiro, Thayanne Sá; Naiff, Maricleide de Farias; Figueira, Luanda de Paula; Soares, Fabiane Veloso; da Silva, Susi Simas; Franco, Antonia Maria Ramos

    2016-08-01

    Epidemiological studies have been conducted to better understand the dynamics of American Cutaneous Leishmaniasis (ACL) in the Amazon region where distinct species of Leishmania circulate. In endemic areas, the optimal diagnosis must be made in the earlier clinical presentation to avoid the complications of chronic disease. The scarcity of financial support, laboratory infrastructure and trained persons are the major obstacles in this reality. This paper describes the result of performing different diagnostic methods for ACL in Amazonas State between the years 2010 and 2011. The tests used were the intradermal skin test (Montenegro's skin test), ELISA (Enzyme-Linked Immunosorbent Assay), direct examination, culture isolation and identification of Leishmania species. A total of 38 suspected human cases of ACL were diagnosed by different methods, of which 71.0% (n = 27) were positive by direct examination, 75.6% (n = 28) had positivity in the culture isolates and, of these, 54.0% (n = 19) had infection with Leishmania (Viannia) guyanensis. The positivity of the intradermal skin test with the leishmanin solution was observed in 77.0% of cases analyzed and the serology with detection of IgG and IgM showed the presence of antibodies in 100% of exams realized results, showing variation in the titles of antibodies. The success of Leishmaniasis treatment depends on an effective and early diagnosis. Parasitological diagnosis is highly specific, but sensitivity is subject to variation because the tissue distribution of parasites generally is not homogeneous and depends on the specie of parasite. Moreover, parasitological tests require invasive procedures and depend on restrictive conditions for the collection of biological sample, which limit their use in large-scale for epidemiological studies. ELISA has been the most widely used serological method for the diagnosis of Visceral Leishmaniasis (VL) as it is easy to perform and has a low cost. However, flaws in

  6. Histopathological Osteomyelitis Evaluation Score (HOES) – an innovative approach to histopathological diagnostics and scoring of osteomyelitis

    PubMed Central

    Tiemann, A.; Hofmann, G. O.; Krukemeyer, M. G.; Krenn, V.; Langwald, S.

    2014-01-01

    Background: Treatment and diagnosis of osteomyelitis are still a challenging problem for surgeons, microbiologists and histopathologists. A direct microbiological detection of bacteria in tissues is still gold standard, but it is not always successful for example in chronic osteomyelitis and/or when an antibiotic treatment has already been started or in cases of low virulent bacteria. The goal of this study was to define diagnostic criteria of osteomyelitis, the inflammatory regression of osteomyelitis (“osteomyelitis score”) under specific therapy by the correlation of histopathological and microbiological and clinical standard tests. Methods: In this retrospective analysis patients with medical history and clinically clear signs of bacterial infection and osteomyelitis underwent surgery between 01.01.2013 and 31.12.2012. Their formal consent was given. Tissue samples were taken during surgery according to defined criteria including surgical interventions. Histopathological diagnosis was carried out by conventional techniques based on defined criteria of bacterial infection in connective tissue, peri-implant membrane and bone. These results were carried out in tables by numbers representing the histopathological criteria of acute osteomyelitis (A1 to A3) as well as the chronic criteria (C1 and C2) in a semiquantitative way (scale 0 to 3). On the other hand a notational, graduated histopathological report was performed. Preoperative clinical diagnosis, perioperative macroscopic diagnosis, histopathological and microbiological findings were correlated. Results: Histopathological samples of 52 surgical interventions based on the preoperative diagnosis “osteomyelitis” (AOM, ECOM or COM) were included. 37 times preoperatively signs of a chronic osteomyelitis (COM), 10 times preoperatively acute osteomyelitis (AOM) was diagnosed. Another 5 patients were preoperatively diagnosed as acute exacerbated osteomyelitis (ECOM). The correlation of the histopathological

  7. Evaluation of Diagnostic CO2 Flux and Transport Modeling in NU-WRF and GEOS-5

    NASA Astrophysics Data System (ADS)

    Kawa, S. R.; Collatz, G. J.; Tao, Z.; Wang, J. S.; Ott, L. E.; Liu, Y.; Andrews, A. E.; Sweeney, C.

    2015-12-01

    We report on recent diagnostic (constrained by observations) model simulations of atmospheric CO2 flux and transport using a newly developed facility in the NASA Unified-Weather Research and Forecast (NU-WRF) model. The results are compared to CO2 data (ground-based, airborne, and GOSAT) and to corresponding simulations from a global model that uses meteorology from the NASA GEOS-5 Modern Era Retrospective analysis for Research and Applications (MERRA). The objective of these intercomparisons is to assess the relative strengths and weaknesses of the respective models in pursuit of an overall carbon process improvement at both regional and global scales. Our guiding hypothesis is that the finer resolution and improved land surface representation in NU-WRF will lead to better comparisons with CO2 data than those using global MERRA, which will, in turn, inform process model development in global prognostic models. Initial intercomparison results, however, have generally been mixed: NU-WRF is better at some sites and times but not uniformly. We are examining the model transport processes in detail to diagnose differences in the CO2 behavior. These comparisons are done in the context of a long history of simulations from the Parameterized Chemistry and Transport Model, based on GEOS-5 meteorology and Carnegie Ames-Stanford Approach-Global Fire Emissions Database (CASA-GFED) fluxes, that capture much of the CO2 variation from synoptic to seasonal to global scales. We have run the NU-WRF model using unconstrained, internally generated meteorology within the North American domain, and with meteorological 'nudging' from Global Forecast System and North American Regional Reanalysis (NARR) in an effort to optimize the CO2 simulations. Output results constrained by NARR show the best comparisons to data. Discrepancies, of course, may arise either from flux or transport errors and compensating errors are possible. Resolving their interplay is also important to using the data in

  8. Evaluation of Signature Erosion in Ebola Virus Due to Genomic Drift and Its Impact on the Performance of Diagnostic Assays

    PubMed Central

    Sozhamannan, Shanmuga; Holland, Mitchell Y.; Hall, Adrienne T.; Negrón, Daniel A.; Ivancich, Mychal; Koehler, Jeffrey W.; Minogue, Timothy D.; Campbell, Catherine E.; Berger, Walter J.; Christopher, George W.; Goodwin, Bruce G.; Smith, Michael A.

    2015-01-01

    Genome sequence analyses of the 2014 Ebola Virus (EBOV) isolates revealed a potential problem with the diagnostic assays currently in use; i.e., drifting genomic profiles of the virus may affect the sensitivity or even produce false-negative results. We evaluated signature erosion in ebolavirus molecular assays using an in silico approach and found frequent potential false-negative and false-positive results. We further empirically evaluated many EBOV assays, under real time PCR conditions using EBOV Kikwit (1995) and Makona (2014) RNA templates. These results revealed differences in performance between assays but were comparable between the old and new EBOV templates. Using a whole genome approach and a novel algorithm, termed BioVelocity, we identified new signatures that are unique to each of EBOV, Sudan virus (SUDV), and Reston virus (RESTV). Interestingly, many of the current assay signatures do not fall within these regions, indicating a potential drawback in the past assay design strategies. The new signatures identified in this study may be evaluated with real-time reverse transcription PCR (rRT-PCR) assay development and validation. In addition, we discuss regulatory implications and timely availability to impact a rapidly evolving outbreak using existing but perhaps less than optimal assays versus redesign these assays for addressing genomic changes. PMID:26090727

  9. Diagnostic methods of a bladed disc mode shape evaluation used for shrouded blades in steam turbines

    NASA Astrophysics Data System (ADS)

    Strnad, Jaromir; Liska, Jindrich

    2015-11-01

    This paper deals with advanced methods for the evaluation of a bladed disc behavior in terms of the wheel vibration and blade service time consumption. These methods are developed as parts of the noncontact vibration monitoring system of the steam turbine shrouded blades. The proposed methods utilize the time-frequency processing (cross spectra) and the method using least squares to analyse the data from the optical and magnetoresistive sensors, which are mounted in the stator radially above the rotor blades. Fundamentally, the blade vibrations are detected during the blade passages under the sensors and the following signal processing, which covers also the proposed methods, leads to the estimation of the blade residual service life. The prototype system implementing above mentioned techniques was installed into the last stage of the new steam turbine (LP part). The methods for bladed disc mode shape evaluation were successfully verified on the signals, which were obtained during the commission operation of the turbine.

  10. Development of an economic evaluation of diagnostic strategies: the case of monogenic diabetes

    PubMed Central

    Peters, Jaime L; Anderson, Rob; Hyde, Chris

    2013-01-01

    Objectives To describe the development process for defining an appropriate model structure for the economic evaluation of test–treatment strategies for patients with monogenic diabetes (caused by mutations in the GCK, HNF1A or HNF4A genes). Design Experts were consulted to identify and define realistic test–treatment strategies and care pathways. A systematic assessment of published diabetes models was undertaken to inform the model structure. Setting National Health Service in England and Wales. Participants Experts in monogenic diabetes whose collective expertise spans the length of the patient care pathway. Primary and secondary outcomes A defined model structure, including the test–treatment strategies, and the selection of a published diabetes model appropriate for the economic evaluation of strategies to identify patients with monogenic diabetes. Results Five monogenic diabetes test–treatment strategies were defined: no testing of any kind, referral for genetic testing based on clinical features as noted by clinicians, referral for genetic testing based on the results of a clinical prediction model, referral for genetic testing based on the results of biochemical and immunological tests, referral for genetic testing for all patients with a diagnosis of diabetes under the age of 30 years. The systematic assessment of diabetes models identified the IMS CORE Diabetes Model (IMS CDM) as a good candidate for modelling the long-term outcomes and costs of the test–treatment strategies for monogenic diabetes. The short-term test–treatment events will be modelled using a decision tree which will feed into the IMS CDM. Conclusions Defining a model structure for any economic evaluation requires decisions to be made. Expert consultation and the explicit use of critical appraisal can inform these decisions. Although arbitrary choices have still been made, decision modelling allows investigation into such choices and the impact of assumptions that have to be

  11. Diagnostic evaluations of a beam-shielded 8-cm mercury ion thruster

    NASA Technical Reports Server (NTRS)

    Nakanishi, S.

    1978-01-01

    An engineering model thruster fitted with a remotely actuated graphite fiber polyimide composite beam shield was tested in a 3- by 6.5-meter vacuum facility for in-situ assessment of beam shield effects on thruster performance. Accelerator drain current neutralizer floating potential and ion beam floating potential increased slightly when the shield was moved into position. A target exposed to the low density regions of the ion beam was used to map the boundaries of energetic fringe ions capable of sputtering. The particle efflux was evaluated by measurement of film deposits on cold, heated, bare, and enclosed glass slides.

  12. High-sensitivity MALDI-TOF MS quantification of anthrax lethal toxin for diagnostics and evaluation of medical countermeasures.

    PubMed

    Boyer, Anne E; Gallegos-Candela, Maribel; Quinn, Conrad P; Woolfitt, Adrian R; Brumlow, Judith O; Isbell, Katherine; Hoffmaster, Alex R; Lins, Renato C; Barr, John R

    2015-04-01

    Inhalation anthrax has a rapid progression and high fatality rate. Pathology and death from inhalation of Bacillus anthracis spores are attributed to the actions of secreted protein toxins. Protective antigen (PA) binds and imports the catalytic component lethal factor (LF), a zinc endoprotease, and edema factor (EF), an adenylyl cyclase, into susceptible cells. PA-LF is termed lethal toxin (LTx) and PA-EF, edema toxin. As the universal transporter for both toxins, PA is an important target for vaccination and immunotherapeutic intervention. However, its quantification has been limited to methods of relatively low analytic sensitivity. Quantification of LTx may be more clinically relevant than LF or PA alone because LTx is the toxic form that acts on cells. A method was developed for LTx-specific quantification in plasma using anti-PA IgG magnetic immunoprecipitation of PA and quantification of LF activity that co-purified with PA. The method was fast (<4 h total time to detection), sensitive at 0.033 ng/mL LTx in plasma for the fast analysis (0.0075 ng/mL LTx in plasma for an 18 h reaction), precise (6.3-9.9% coefficient of variation), and accurate (0.1-12.7%error; n ≥ 25). Diagnostic sensitivity was 100% (n = 27 animal/clinical cases). Diagnostic specificity was 100% (n = 141). LTx was detected post-antibiotic treatment in 6/6 treated rhesus macaques and 3/3 clinical cases of inhalation anthrax and as long as 8 days post-treatment. Over the course of infection in two rhesus macaques, LTx was first detected at 0.101 and 0.237 ng/mL at 36 h post-exposure and increased to 1147 and 12,107 ng/mL in late-stage anthrax. This demonstrated the importance of LTx as a diagnostic and therapeutic target. This method provides a sensitive, accurate tool for anthrax toxin detection and evaluation of PA-directed therapeutics.

  13. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel.

    PubMed

    Graham, Stephen M; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E; Gale, Marianne; Gie, Robert P; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J; McNeeley, David F; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire

    2012-05-15

    There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.

  14. Adaptation and Psychometric Evaluation of the Young Diagnostic Questionnaire (YDQ) for Parental Assessment of Adolescent Problematic Internet Use.

    PubMed

    Wartberg, Lutz; Kriston, Levente; Kegel, Katharina; Thomasius, Rainer

    2016-06-01

    Background and aims The surge of problematic Internet use in adolescents is a continuously growing problem across the globe. To our knowledge, to date valid questionnaire-based measurement of problematic Internet use is possible only by self-assessment. The objective for the present study was to adapt an established instrument for a parental assessment of adolescent problematic Internet use and to evaluate the psychometric properties of this questionnaire. Methods Data were collected from a representative German sample of 1,000 parents of adolescents aged between 12 and 17 years using a standardized questionnaire. To assess problematic Internet use, we adapted the established Young Diagnostic Questionnaire by rewording the items to survey a parental rating instead of a self-report ("Parental version of the Young Diagnostic Questionnaire," PYDQ). Additionally, we assessed the Internet usage time, parental monitoring, family functioning, school performance of the adolescent, and parent-adolescent conflicts. We conducted a confirmatory factor analysis based on the 8 items of the PYDQ modeled as categorical indicators and one latent factor using a robust weighted least squares estimator. We also calculated a reliability coefficient, the acceptance of the instrument, and performed correlation analyses. Results The unidimensional model showed excellent global goodness-of-fit (χ(2)/df = 1.65, RMSEA = 0.03, CFI = 0.99, TLI = 0.99) and satisfactory factor loadings (standardized values ranged from 0.60 to 0.77). We observed a reliability coefficient of 0.70, a good acceptance of the instrument, and the correlation analyses indicated the construct validity of the PYDQ. Discussion and conclusion The proposed PYDQ is a suitable instrument for parental assessment of adolescent problematic Internet use. PMID:27363465

  15. Evaluation of the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration for metastatic mediastinal tumors

    PubMed Central

    Dziedzic, Dariusz; Peryt, Adam; Szolkowska, Malgorzata; Langfort, Renata; Orlowski, Tadeusz

    2016-01-01

    Background and Objectives: The mediastinum is a relatively uncommon site of distant metastases, which typically appear as peripheral lung nodules. We chose to assess the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of distant metastases to the mediastinum. Materials and Methods: Over the period 2008–2013, a total of 446 patients with concurrent or previously diagnosed and treated extrathoracic malignancies were evaluated. Results: Surgical treatment was carried out in 414 patients (156 women and 237 men aged 26–68 years, mean age of 56.5 years) presenting with distant metastases to the lungs: Thoracoscopic wedge resection was completed in 393 patients and lobectomy and segmentectomy were performed in 7 and 14 patients, respectively. The median time from primary tumor resection was 6.5 years (range: 4.5 months to 17 years). Thirty-two of these patients underwent EBUS-TBNA for mediastinal manifestation of the underlying disease. EBUS-TBNA specimens were aspirated from the subcarinal or right paratracheal lymph node stations in 26 (81%) patients and from the hilar lymph nodes in 6 (18.8%) patients only. Metastases to lymph nodes were confirmed in 14 of these patients (43.8%). Primary lung cancer was diagnosed in seven patients. Mediastinoscopy was performed in two patients to reveal either lymph node metastasis or sarcoidosis. Thoracotomy for pulmonary metastases resection and mediastinal lymph node biopsy was performed in nine patients. Lymph node metastasis was confirmed in five patients (15.6%). The diagnostic efficacy, sensitivity, specificity, and negative predictive value (NPV) of EBUS-TBNA were 78.8%, 93.3%, 100%, and 87.5%, respectively. Conclusion: EBUS-TBNA is a valuable diagnostic tool in a selected group of patients with secondary tumors in the mediastinum and lungs. PMID:27386474

  16. Evaluation of three different methods of distance learning for postgraduate diagnostic imaging education: A pilot study.

    PubMed

    Poirier, Jean-Nicolas; Cooley, Jeffrey R; Wessely, Michelle; Guebert, Gary M; Petrocco-Napuli, Kristina

    2014-10-01

    Objective : The purpose of this study was to evaluate the perceived effectiveness and learning potential of 3 Web-based educational methods in a postgraduate radiology setting. Methods : Three chiropractic radiology faculty from diverse geographic locations led mini-courses using asynchronous discussion boards, synchronous Web conferencing, and asynchronous voice-over case presentations formatted for Web viewing. At the conclusion of each course, participants filled out a 14-question survey (using a 5-point Likert scale) designed to evaluate the effectiveness of each method in achieving specified course objectives and goals and their satisfaction when considering the learning potential of each method. The mean, standard deviation, and percentage agreements were tabulated. Results : Twenty, 15, and 10 participants completed the discussion board, Web conferencing, and case presentation surveys, respectively. All educational methods demonstrated a high level of agreement regarding the course objective (total mean rating >4.1). The case presentations had the highest overall rating for achieving the course goals; however, all but one method still had total mean ratings >4.0 and overall agreement levels of 70%-100%. The strongest potential for interactive learning was found with Web conferencing and discussion boards, while case presentations rated very low in this regard. Conclusions : The perceived effectiveness in achieving the course objective and goals was high for each method. Residency-based distance education may be a beneficial adjunct to current methods of training, allowing for international collaboration. When considering all aspects tested, there does not appear to be a clear advantage to any one method. Utilizing various methods may be most appropriate.

  17. Evaluation of three different methods of distance learning for postgraduate diagnostic imaging education: A pilot study

    PubMed Central

    Poirier, Jean-Nicolas; Cooley, Jeffrey R.; Wessely, Michelle; Guebert, Gary M.; Petrocco-Napuli, Kristina

    2014-01-01

    Objective The purpose of this study was to evaluate the perceived effectiveness and learning potential of 3 Web-based educational methods in a postgraduate radiology setting. Methods Three chiropractic radiology faculty from diverse geographic locations led mini-courses using asynchronous discussion boards, synchronous Web conferencing, and asynchronous voice-over case presentations formatted for Web viewing. At the conclusion of each course, participants filled out a 14-question survey (using a 5-point Likert scale) designed to evaluate the effectiveness of each method in achieving specified course objectives and goals and their satisfaction when considering the learning potential of each method. The mean, standard deviation, and percentage agreements were tabulated. Results Twenty, 15, and 10 participants completed the discussion board, Web conferencing, and case presentation surveys, respectively. All educational methods demonstrated a high level of agreement regarding the course objective (total mean rating >4.1). The case presentations had the highest overall rating for achieving the course goals; however, all but one method still had total mean ratings >4.0 and overall agreement levels of 70%–100%. The strongest potential for interactive learning was found with Web conferencing and discussion boards, while case presentations rated very low in this regard. Conclusions The perceived effectiveness in achieving the course objective and goals was high for each method. Residency-based distance education may be a beneficial adjunct to current methods of training, allowing for international collaboration. When considering all aspects tested, there does not appear to be a clear advantage to any one method. Utilizing various methods may be most appropriate. PMID:24779546

  18. Diagnostic imaging to detect and evaluate response to therapy in bone metastases from prostate cancer: current modalities and new horizons.

    PubMed

    Evangelista, Laura; Bertoldo, Francesco; Boccardo, Francesco; Conti, Giario; Menchi, Ilario; Mungai, Francesco; Ricardi, Umberto; Bombardieri, Emilio

    2016-07-01

    Different therapeutic options for the management of prostate cancer (PC) have been developed, and some are successful in providing crucial improvement in both survival and quality of life, especially in patients with metastatic castration-resistant PC. In this scenario, diverse combinations of radiopharmaceuticals (for targeting bone, cancer cells and receptors) and nuclear medicine modalities (e.g. bone scan, SPECT, SPECT/CT, PET and PET/CT) are now available for imaging bone metastases. Some radiopharmaceuticals are approved, currently available and used in the routine clinical setting, while others are not registered and are still under evaluation, and should therefore be considered experimental. On the other hand, radiologists have other tools, in addition to CT, that can better visualize bone localization and medullary involvement, such as multimodal MRI. In this review, the authors provide an overview of current management of advanced PC and discuss the choice of diagnostic modality for the detection of metastatic skeletal lesions in different phases of the disease. In addition to detection of bone metastases, the evaluation of response to therapy is another critical issue, since it remains one of the most important open questions that a multidisciplinary team faces when optimizing the management of PC. The authors emphasize the role of nuclear modalities that can presently be used in clinical practice, and also look at future perspectives based on relevant clinical data with novel radiopharmaceuticals. PMID:26956538

  19. Evaluation of the role of corpus cavernosum electromyography as a noninvasive diagnostic tool in male erectile dysfunction.

    PubMed

    Aggour, A; Mostafa, H; el-Shawaf, H

    1998-01-01

    Corpus cavernosum electromyography (EMG) and its evolution: single potential analysis of cavernous electrical activity (SPACE) seem to be promising diagnostic methods in the evaluation of erectile dysfunction and smooth muscle integrity. Our study concentrates on the role of EMG in the evaluation of corpus cavernosum smooth muscles, using it as a noninvasive technique for demonstrating autonomic erectile dysfunction through their influence on recording SPACE and consequent proper selection of patients for different therapeutic modalities. A total of 80 male patients were examined for the feasibility of transcutaneous registration of cavernous electrical activity with a 2-channel electrophysiological unit (Evamatic 2000, Dantec) with two surface electrodes bilaterally placed on the penile shaft. Ten patients had normal erectile function, but complained of other urological symptoms. They served as the controls for normal electrical activity. Fifty patients with organic impotence of nonvascular (neurogenic) or vascular (venogenic, arteriogenic) aetiologies were subjected to EMG in both the flaccid and the erect state. On the basis of the EMG patterns the patients were divided into the following groups: 34 patients having normal tracing in both the flaccid and the erect state, and 21 patients showing abnormal patterns of waves with evidence of autonomic neurogenic dysfunction and incomplete smooth muscle relaxation. Of the latter 4 had long-standing diabetes mellitus and 4 had spinal injuries. PMID:9569116

  20. Diagnostic Potential of Evaluation of SDF-1α and sRAGE Levels in Threatened Premature Labor

    PubMed Central

    Rajewska, Aleksandra; Budkowska, Marta; Kwiatkowski, Sebastian; Torbé, Andrzej

    2016-01-01

    Preterm birth remains the most prevalent cause of neonatal morbidity. This study aimed to evaluate the diagnostic value of SDF-1α, resistin, secretory RAGE (sRAGE), and endogenous secretory RAGE (esRAGE) in preterm labor. A total of 211 pregnant women participated in the study. Group A contained 72 women between 22 and 36 weeks of gestation, with premature labor, who finally had preterm birth. Group B contained 66 women in labor between 37 and 41 weeks of gestation. Women in group A had lower SDF-1α and sRAGE levels than those in group B. Moreover, in group A, SDF-1α and sRAGE levels were correlated with the latency period from the occurrence of premature labor symptoms until delivery. Sensitivity and specificity of studied parameters for prediction of preterm birth were 95% and 40% for SDF-1α and 51.3% and 93.5% for sRAGE, respectively. The prognostic value of plasma SDF-1α and sRAGE levels was comparable with that of cervical length ultrasound measurement and serum C-reactive protein levels. We conclude that SDF-1α and sRAGE appear to play a major role in the diagnosis of preterm birth and its evaluation could be convenient and useful for predicting preterm birth. PMID:27556030

  1. Prediction of post-surgical seizure outcome in left mesial temporal lobe epilepsy.

    PubMed

    Feis, Delia-Lisa; Schoene-Bake, Jan-Christoph; Elger, Christian; Wagner, Jan; Tittgemeyer, Marc; Weber, Bernd

    2013-01-01

    Mesial temporal lobe epilepsy is the most common type of focal epilepsy and in its course often becomes refractory to anticonvulsant pharmacotherapy. A resection of the mesial temporal lobe structures is a promising option in these cases. However, approximately 30% of all patients remain with persistent seizures after surgery. In other words, reliable criteria for patients' outcome prediction are absent. To address this limitation, we investigated pre-surgical brain morphology of patients with unilateral left mesial temporal lobe epilepsy who underwent a selective amygdalohippocampectomy. Using support vector classification, we aimed to predict the post-surgical seizure outcome of each patient based on the pre-surgical T1-weighted structural brain images. Due to morphological gender differences and the evidence that men and women differ in onset, prevalence and symptomology in most neurological diseases, we investigated male and female patients separately. Thus, we benefitted from the capability to validate the reliability of our method in two independent samples. Notably, we were able to accurately predict the individual patients' outcome in the male (94% balanced accuracy) as well as in the female (96% balanced accuracy) group. In the male cohort relatively larger white matter volumes in the favorable as compared to the non-favorable outcome group were identified bilaterally in the cingulum bundle, fronto-occipital fasciculus and both caudate nuclei, whereas the left inferior longitudinal fasciculus showed relatively larger white matter volume in the non-favorable group. While relatively larger white matter volumes in the female cohort in the left inferior and right middle longitudinal fasciculus were associated with the favorable outcome, relatively larger white matter volumes in the non-favorable outcome group were identified bilaterally in the superior longitudinal fasciculi I and II. Here, we observed a clear lateralization and distinction of structures

  2. Evaluation of a diagnostic ELISA for insect bite hypersensitivity in horses using recombinant Obsoletus complex allergens.

    PubMed

    van der Meide, Nathalie M A; Savelkoul, Huub F J; Meulenbroeks, Chantal; Ducro, Bart J; Tijhaar, Edwin

    2014-04-01

    Culicoides spp. of the Obsoletus complex belong to the most important species of midge, involved in causing insect bite hypersensitivity (IBH) in horses in The Netherlands. The aim of the current study was to evaluate seven different Obsoletus complex-derived recombinant allergens (Cul o 1-Cul o 7) and to compare these with Obsoletus complex whole body extract (WBE) in an IgE ELISA, using sera of 194 clinically-confirmed cases of IBH and 175 unaffected horses. The highest test accuracy was obtained with WBE, followed by Cul o 2, 3 and 5. Two ELISAs with a combination of recombinant allergens, Combi-1 (Cul o 3, 5 and 7) and Combi-2 (Cul o 1, 2, 5 and 7) were additionally performed and both resulted in high test accuracies close to that obtained with WBE. Combi-1 resulted in the best sensitivity and specificity, both 89%. Both Combi-1 and Combi-2 performed less well with samples collected in winter, but over 70% of the IBH-affected horses could still be identified. In conclusion, a combination of three Obsoletus complex recombinant allergens (Cul o 3, 5 and 7) could potentially replace Obsoletus complex WBE in an IgE ELISA for diagnosis of IBH in horses.

  3. Immunohistochemical evaluation of chemically induced rhabdomyosarcomas in rats: diagnostic utility of MyoD1.

    PubMed

    Newsholme, S J; Zimmerman, D M

    1997-01-01

    Monoclonal antibodies (mAbs) to selected muscle proteins were assessed as potential immunohistochemical markers to assist in the definitive diagnosis of poorly differentiated soft tissue sarcomas in rats. A series of 7 rat rhabdomyosarcomas (RMS) induced with nickel subsulfide were studied by light microscopy and were evaluated for immunoreactivity to desmin, vimentin, fast (type II isoform) skeletal myosin, alpha-actin (smooth muscle isoform), or MyoD1 (myogenic regulatory protein) mAbs using an avidin-biotin-chromogen technique. Consecutive RMS slices were fixed in 10% neutral buffered formalin (the fixative routinely used in carcinogenicity bioassays) for periods of 3 days or 2 mo prior to paraffin embedding to determine the effect of fixation time on immunoreactivity. Desmin and vimentin mAbs bound to many cells of all tumors, but fixation for 2 mo resulted in irretrievable loss of desmin and vimentin binding. Fast myosin and alpha-actin mAbs bound to many cells in 1 RMS but to < 1% of the cells in the remainder. MyoD1 mAb bound to tumor cell nuclei in 5/7 RMS with no loss of staining in tissue fixed for 2 mo. Results indicate that MyoD1 immunostaining, in contrast to desmin, maintains its sensitivity following prolonged formalin fixation and may be of value to distinguish RMS from other soft tissue sarcomas in the rat.

  4. Evaluation of an automated rapid diagnostic test for detection of Clostridium difficile.

    PubMed

    Tojo, Masayoshi; Nagamatsu, Maki; Hayakawa, Kayoko; Mezaki, Kazuhisa; Kirikae, Teruo; Ohmagari, Norio

    2014-01-01

    The Verigene Clostridium difficile Nucleic Acid Test (Verigene CDF Test) (Nanosphere, Northbrook, IL, USA) is a new multiplex qualitative polymerase chain reaction (PCR) test used to detect C. difficile toxin genes in fecal specimens. To evaluate the performance of the new method, we tested 69 fecal samples from patients with suspected C. difficile infection using the Verigene CDF test, an enzyme immunoassay (EIA) and PCR following anaerobic fecal culture. The sensitivity, specificity, and accuracy of the Verigene CDF test were 96.7% (29/30), 97.4% (38/39), and 97.1% (67/69) respectively, using PCR following fecal culture as a reference method. We also analyzed the potential clinical impact of the Verigene CDF test using chart reviews of the 69 patients with suspected C. difficile infection and found that 11 of the 69 patients were incorrectly diagnosed, and the Verigene CDF test would have led to them receiving more appropriate management including practice of treatment and contact precaution, although, of the 69 patients, there are two whose samples were incorrectly identified with the Verigene CDF test. The Verigene CDF test will have a positive impact on patient care.

  5. Open flap debridement in combination with acellular dermal matrix allograft for the prevention of postsurgical gingival recession: a case series.

    PubMed

    Chavan, Ramesh Sundersing; Bhongade, Manohar Laxman; Tiwari, Ishan Ramakant; Jaiswal, Priyanka

    2013-01-01

    Open flap debridement with flap repositioning may result in significant gingival recession. Patients with chronic periodontitis were treated with open flap debridement followed by placement of an acellular dermal matrix allograft (ADMA) underneath the flap to minimize the occurrence of postsurgical gingival recession. Ten patients (total, 60 teeth) with periodontal pockets in the anterior dentition underwent open flap debridement combined with ADMA. Probing pocket depth, relative attachment level, and relative gingival margin level were recorded at baseline and 6 months postsurgery. The mean probing pocket depth at baseline and 6 months was 4.4 and 1.7 mm, respectively (P < .05); the mean relative attachment level at baseline and 6 months was 12.9 and 10.7 mm, respectively (P < .05); and the mean relative gingival margin level at baseline and 6 months was 8.4 and 9.0 mm, respectively. ADMA underneath the flap when combined with open flap debridement effectively minimizes postsurgical gingival recession.

  6. Tools for Evaluating Fault Detection and Diagnostic Methods for HVAC Secondary Systems

    NASA Astrophysics Data System (ADS)

    Pourarian, Shokouh

    Although modern buildings are using increasingly sophisticated energy management and control systems that have tremendous control and monitoring capabilities, building systems routinely fail to perform as designed. More advanced building control, operation, and automated fault detection and diagnosis (AFDD) technologies are needed to achieve the goal of net-zero energy commercial buildings. Much effort has been devoted to develop such technologies for primary heating ventilating and air conditioning (HVAC) systems, and some secondary systems. However, secondary systems, such as fan coil units and dual duct systems, although widely used in commercial, industrial, and multifamily residential buildings, have received very little attention. This research study aims at developing tools that could provide simulation capabilities to develop and evaluate advanced control, operation, and AFDD technologies for these less studied secondary systems. In this study, HVACSIM+ is selected as the simulation environment. Besides developing dynamic models for the above-mentioned secondary systems, two other issues related to the HVACSIM+ environment are also investigated. One issue is the nonlinear equation solver used in HVACSIM+ (Powell's Hybrid method in subroutine SNSQ). It has been found from several previous research projects (ASRHAE RP 825 and 1312) that SNSQ is especially unstable at the beginning of a simulation and sometimes unable to converge to a solution. Another issue is related to the zone model in the HVACSIM+ library of components. Dynamic simulation of secondary HVAC systems unavoidably requires an interacting zone model which is systematically and dynamically interacting with building surrounding. Therefore, the accuracy and reliability of the building zone model affects operational data generated by the developed dynamic tool to predict HVAC secondary systems function. The available model does not simulate the impact of direct solar radiation that enters a zone

  7. Tools for Evaluating Fault Detection and Diagnostic Methods for HVAC Secondary Systems

    NASA Astrophysics Data System (ADS)

    Pourarian, Shokouh

    Although modern buildings are using increasingly sophisticated energy management and control systems that have tremendous control and monitoring capabilities, building systems routinely fail to perform as designed. More advanced building control, operation, and automated fault detection and diagnosis (AFDD) technologies are needed to achieve the goal of net-zero energy commercial buildings. Much effort has been devoted to develop such technologies for primary heating ventilating and air conditioning (HVAC) systems, and some secondary systems. However, secondary systems, such as fan coil units and dual duct systems, although widely used in commercial, industrial, and multifamily residential buildings, have received very little attention. This research study aims at developing tools that could provide simulation capabilities to develop and evaluate advanced control, operation, and AFDD technologies for these less studied secondary systems. In this study, HVACSIM+ is selected as the simulation environment. Besides developing dynamic models for the above-mentioned secondary systems, two other issues related to the HVACSIM+ environment are also investigated. One issue is the nonlinear equation solver used in HVACSIM+ (Powell's Hybrid method in subroutine SNSQ). It has been found from several previous research projects (ASRHAE RP 825 and 1312) that SNSQ is especially unstable at the beginning of a simulation and sometimes unable to converge to a solution. Another issue is related to the zone model in the HVACSIM+ library of components. Dynamic simulation of secondary HVAC systems unavoidably requires an interacting zone model which is systematically and dynamically interacting with building surrounding. Therefore, the accuracy and reliability of the building zone model affects operational data generated by the developed dynamic tool to predict HVAC secondary systems function. The available model does not simulate the impact of direct solar radiation that enters a zone

  8. Evaluation of complementary diagnostic tools for bovine tuberculosis detection in dairy herds from India

    PubMed Central

    Thakur, Mukesh Kumar; Sinha, Dharmender Kumar; Singh, Bhoj Raj

    2016-01-01

    Aim: A cross-sectional study was undertaken to know the herd prevalence and evaluate the single intradermal tuberculin testing (SITT), culture isolation, and polymerase chain reaction (PCR) analysis for the diagnosis of bovine tuberculosis (TB). Materials and Methods: A total of 541 cows of three dairy farms of Bareilly and Mukteshwar were screened by SITT followed by collection of pre-scapular lymph node (PSLN) aspirates (71), milk (54), and blood (71) samples from reactor animals. These clinical samples were processed for culture isolation and direct PCR-based identification and species differentiation. Results: Out of 541 cows screened by SITT, 71 (13.12%) animals were found positive. Mycobacteria were isolated from 3 (4.22%) PSLN aspirate but not from any cultured milk and blood samples. 28 (39.43%) PSLN aspirate and 5 (9.25%) milk samples were positive for Mycobacterium TB (MTB) complex (MTC) by PCR amplification for the IS6110 insertion sequence; however, blood samples were found negative. For species differentiation, multiplex-PCR using 12.7 kb primers was conducted. Out of 28 PSLN aspirate, Mycobacterium bovis was detected in 18 (64.28%) and MTB in 8 (28.57%), whereas 2 aspirate samples (7.14%) were positive for both the species. All the five milk positive samples were positive for M. bovis. Conclusion: Direct detection of bovine TB by a molecular-based method in dairy animals after preliminary screening was appeared to be more sensitive and specific compared to the conventional method (i.e., culture isolation). Its application in form of serial testing methodology for the routine diagnosis and thereafter, culling of infected stock may be suggested for the control programs in dairy herds. The PSLN aspirate was found to be the most suitable specimen for culture isolation and PCR-based detection of Mycobacterium spp. among live infected animals. PMID:27651675

  9. Evaluation of complementary diagnostic tools for bovine tuberculosis detection in dairy herds from India

    PubMed Central

    Thakur, Mukesh Kumar; Sinha, Dharmender Kumar; Singh, Bhoj Raj

    2016-01-01

    Aim: A cross-sectional study was undertaken to know the herd prevalence and evaluate the single intradermal tuberculin testing (SITT), culture isolation, and polymerase chain reaction (PCR) analysis for the diagnosis of bovine tuberculosis (TB). Materials and Methods: A total of 541 cows of three dairy farms of Bareilly and Mukteshwar were screened by SITT followed by collection of pre-scapular lymph node (PSLN) aspirates (71), milk (54), and blood (71) samples from reactor animals. These clinical samples were processed for culture isolation and direct PCR-based identification and species differentiation. Results: Out of 541 cows screened by SITT, 71 (13.12%) animals were found positive. Mycobacteria were isolated from 3 (4.22%) PSLN aspirate but not from any cultured milk and blood samples. 28 (39.43%) PSLN aspirate and 5 (9.25%) milk samples were positive for Mycobacterium TB (MTB) complex (MTC) by PCR amplification for the IS6110 insertion sequence; however, blood samples were found negative. For species differentiation, multiplex-PCR using 12.7 kb primers was conducted. Out of 28 PSLN aspirate, Mycobacterium bovis was detected in 18 (64.28%) and MTB in 8 (28.57%), whereas 2 aspirate samples (7.14%) were positive for both the species. All the five milk positive samples were positive for M. bovis. Conclusion: Direct detection of bovine TB by a molecular-based method in dairy animals after preliminary screening was appeared to be more sensitive and specific compared to the conventional method (i.e., culture isolation). Its application in form of serial testing methodology for the routine diagnosis and thereafter, culling of infected stock may be suggested for the control programs in dairy herds. The PSLN aspirate was found to be the most suitable specimen for culture isolation and PCR-based detection of Mycobacterium spp. among live infected animals.

  10. Evaluation of Diagnostic Efficiency of Ultrasound Features on Malignant Thyroid Nodules in Chinese Patients

    PubMed Central

    Li, Ru-Qiang; Yuan, Ge-Heng; Chen, Ming; Shao, Yi-Min; Zhu, Sai-Nan; Zhang, Jun-Qing; Guo, Xiao-Hui

    2016-01-01

    Background: The aim of this study was to evaluate the efficacy of ultrasonic features in predicting the malignancy of thyroid nodules in a group of Chinese patients. Methods: In all, 762 patients with thyroid nodules (424 malignant and 338 benign) underwent ultrasound (US) check and surgery between March 2011 and July 2014 at Peking University First Hospital were identified. Univariate and receiver operating characteristic (ROC) analyses were performed to calculate the sensitivity, specificity, negative and positive predictive values of each US feature, and the accuracy of their combinations for prediction of malignancy. Results: Patients with malignant nodules were younger and without obvious risk history than those in the benign group (P < 0.001, P = 0.93). No individual US sign was fully predictive of a malignant lesion. The Youden indexes of irregular margins and hypoechogenicity were the first and second highest in all US features, which were 51.9% and 45.2%, respectively. The sensitivity of solid components (89.7%) and hypoechogenicity (89.2%) and the specificity of taller-than-wide shape (98.5%) and microcalcifications (90.6%) were the first and second highest in all US features. Intranodular flow on a color Doppler examination was a weak predictor of malignancy. Under ROC analysis excepting intranodular flow, the 95% confidence interval (CI) of areas under the curves of hypoechogenicity and irregular margins with any one of the US features were overlapped that of five-feature combinations (95% CI: 0.850–0.901). Conclusions: We should be alert with taller-than-wide shape and microcalcifications. Intranodular flow was a weak predictor of malignancy. According to Youden indexes and ROC analysis, irregular margins and hypoechogenicity combined with solid component or taller-than-wide shapes or microcalcifications have a high predicative value for malignant thyroid nodules in Chinese patients. PMID:27453225

  11. Evaluation of two herd-level diagnostic tests for Streptococcus agalactiae using a latent class approach.

    PubMed

    Mweu, Marshal M; Toft, Nils; Katholm, Jørgen; Nielsen, Søren S

    2012-09-14

    Streptococcus agalactiae mastitis persists as a significant economic problem for the dairy industry in many countries. In Denmark, the annual surveillance programme for this mastitis pathogen initially based only on bacteriological culture of bulk tank milk (BTM) samples, has recently incorporated the use of the real-time PathoProof Mastitis PCR assay with the goal of improving detection of infected herds. The objective of our study was to estimate the herd sensitivity (Se) and specificity (Sp) of both tests of BTM samples using latent class models in a Bayesian analysis while evaluating the effect of herd-level covariates on the Se and Sp of the tests. BTM samples were collected from all 4258 Danish dairy herds in 2009 and screened for the presence of S. agalactiae using both tests. The highest Se of PCR was realized at a cycle threshold (Ct) cut-off value of 40. At this cut-off, the Se of the PCR was significantly higher (95.2; 95% posterior credibility interval [PCI] [88.2; 99.8]) than that of bacteriological culture (68.0; 95% PCI [55.1; 90.0]). However, culture had higher Sp (99.7; 95% PCI [99.3; 100.0]) compared to PCR (98.8; 95% PCI [97.2; 99.9]). The accuracy of the tests was unaffected by the herd-level covariates. We propose that screenings of BTM samples for S. agalactiae be based on the PCR assay with Ct readings of <40 considered as positive. However, for higher Ct values, confirmation of PCR test positive herds by bacteriological culture is advisable especially when the between-herd prevalence of S. agalactiae is low. PMID:22542270

  12. Analysis of Postsurgical Health-Related Quality of Life and Quality of Voice of Patients With Laryngeal Carcinoma.

    PubMed

    Luo, Jie; Wu, Jieli; Lv, Kexing; Li, Kaichun; Wu, Jianhui; Wen, Yihui; Li, Xiaoling; Tang, Haocheng; Jiang, Aiyun; Wang, Zhangfeng; Wen, Weiping; Lei, Wenbin

    2016-01-01

    This study aims to analyze the postsurgical health-related quality of life (HRQOL) and quality of voice (QOV) of patients with laryngeal carcinoma with an expectation of improving the treatment and HRQOL of these patients. Based on the collection of information of patients with laryngeal carcinoma regarding clinical characteristics (age, TNM stage, with or without laryngeal preservation and/or neck dissection, with or without postoperative irradiation and/or chemotherapy, etc.), QOV using Voice Handicap Index (VIH) scale and HRQOL using EORTC QLQ-C30 and EORTCQLQ-H&N35 scales, the differences of postsurgical HRQOL related to their clinical characteristics were analyzed using univariate nonparametric tests, the main factors impacting the postsurgical HRQOL were analyzed using regression analyses (generalized linear models) and the correlation between QOV and HRQOL analyzed using spearman correlation analysis. A total of 92 patients were enrolled in this study, on whom the use of EORTC QLQ-C30, EORTC QLQ-H&N35 and VHI scales revealed that: the differences of HRQOL were significant among patients with different ages, TNM stages, and treatment modalities; the main factors impacting the postsurgical HRQOL were pain, speech disorder, and dry mouth; and QOV was significantly correlated with HRQOL. For the patients with laryngeal carcinoma included in our study, the quality of life after open surgeries were impacted by many factors predominated by pain, speech disorder, and dry mouth. It is suggested that doctors in China do more efforts on the patients' postoperative pain and xerostomia management and speech rehabilitation with the hope of improving the patients' quality of life. PMID:26735538

  13. New concepts in acute pain management: strategies to prevent chronic postsurgical pain, opioid-induced hyperalgesia, and outcome measures.

    PubMed

    Grosu, Irina; de Kock, Marc

    2011-06-01

    Chronic postsurgical pain (CPSP) is a pain syndrome that has attracted attention for more than 10 years. CPSP is a pain syndrome that develops postoperatively and lasts for at least 2 months in the absence of other causes for pain (eg, recurrence of malignancy, chronic infection, and so forth). Pain continuing from a preexisting disease is not considered as CPSP. In this article, the authors discuss the etiopathogenesis of CPSP and interventions that can help prevent and treat this condition.

  14. Analysis of Postsurgical Health-Related Quality of Life and Quality of Voice of Patients With Laryngeal Carcinoma

    PubMed Central

    Luo, Jie; Wu, Jieli; Lv, Kexing; Li, Kaichun; Wu, Jianhui; Wen, Yihui; Li, Xiaoling; Tang, Haocheng; Jiang, Aiyun; Wang, Zhangfeng; Wen, Weiping; Lei, Wenbin

    2016-01-01

    Abstract This study aims to analyze the postsurgical health-related quality of life (HRQOL) and quality of voice (QOV) of patients with laryngeal carcinoma with an expectation of improving the treatment and HRQOL of these patients. Based on the collection of information of patients with laryngeal carcinoma regarding clinical characteristics (age, TNM stage, with or without laryngeal preservation and/or neck dissection, with or without postoperative irradiation and/or chemotherapy, etc.), QOV using Voice Handicap Index (VIH) scale and HRQOL using EORTC QLQ-C30 and EORTCQLQ-H&N35 scales, the differences of postsurgical HRQOL related to their clinical characteristics were analyzed using univariate nonparametric tests, the main factors impacting the postsurgical HRQOL were analyzed using regression analyses (generalized linear models) and the correlation between QOV and HRQOL analyzed using spearman correlation analysis. A total of 92 patients were enrolled in this study, on whom the use of EORTC QLQ-C30, EORTC QLQ-H&N35 and VHI scales revealed that: the differences of HRQOL were significant among patients with different ages, TNM stages, and treatment modalities; the main factors impacting the postsurgical HRQOL were pain, speech disorder, and dry mouth; and QOV was significantly correlated with HRQOL. For the patients with laryngeal carcinoma included in our study, the quality of life after open surgeries were impacted by many factors predominated by pain, speech disorder, and dry mouth. It is suggested that doctors in China do more efforts on the patients’ postoperative pain and xerostomia management and speech rehabilitation with the hope of improving the patients’ quality of life. PMID:26735538

  15. Fibrin matrices enhance the transplant and efficacy of cytotoxic stem cell therapy for post-surgical cancer.

    PubMed

    Bagó, Juli R; Pegna, Guillaume J; Okolie, Onyi; Hingtgen, Shawn D

    2016-04-01

    Tumor-homing cytotoxic stem cell (SC) therapy is a promising new approach for treating the incurable brain cancer glioblastoma (GBM). However, problems of retaining cytotoxic SCs within the post-surgical GBM resection cavity are likely to significantly limit the clinical utility of this strategy. Here, we describe a new fibrin-based transplant approach capable of increasing cytotoxic SC retention and persistence within the resection cavity, yet remaining permissive to tumoritropic migration. This fibrin-based transplant can effectively treat both solid and post-surgical human GBM in mice. Using our murine model of image-guided model of GBM resection, we discovered that suspending human mesenchymal stem cells (hMSCS) in a fibrin matrix increased initial retention in the surgical resection cavity 2-fold and prolonged persistence in the cavity 3-fold compared to conventional delivery strategies. Time-lapse motion analysis revealed that cytotoxic hMSCs in the fibrin matrix remain tumoritropic, rapidly migrating from the fibrin matrix to co-localize with cultured human GBM cells. We encapsulated hMSCs releasing the cytotoxic agent TRAIL (hMSC-sTR) in fibrin, and found hMSC-sTR/fibrin therapy reduced the viability of multiple 3-D human GBM spheroids and regressed established human GBM xenografts 3-fold in 11 days. Mimicking clinical therapy of surgically resected GBM, intra-cavity seeding of therapeutic hMSC-sTR encapsulated in fibrin reduced post-surgical GBM volumes 6-fold, increased time to recurrence 4-fold, and prolonged median survival from 15 to 36 days compared to control-treated animals. Fibrin-based SC therapy could represent a clinically compatible, viable treatment to suppress recurrence of post-surgical GBM and other lethal cancer types.

  16. The use of Emeraid Exotic Carnivore Diet improves postsurgical recovery and survival of long-tailed ducks

    USGS Publications Warehouse

    Olsen, Glenn H.; Ford, Scott; Perry, Matthew C.; Wells-Berlin, Alicia M.

    2010-01-01

    Gavage feeding is a commonly used technique in wildlife rehabilitation. While implanting satellite transmitters in long-tailed ducks (Clangula hyemalis), a need for extra postsurgical nutritional support was identified. A new product, Emeraid Exotic Carnivore Diet, has proven effective in maintaining and even increasing the birds' body weights while in captivity. This has resulted in a 54-g increase in weight at release and better survival postrelease. Tips for mixing and using the new diet are included.

  17. An evaluation of the diagnostic efficacy of fine needle aspiration biopsy in patients operated for a thyroid nodular goiter

    PubMed Central

    Janczak, Dariusz; Pawlowski, Wiktor; Dorobisz, Tadeusz; Janczak, Dawid; Dorobisz, Karolina; Leśniak, Michal; Ziomek, Agnieszka; Chabowski, Mariusz

    2016-01-01

    Background Thyroid cancer (TC) comprises 1% of all carcinomas and is the most common malignancy of the endocrine system. The disease is more common in women, with its peak morbidity observed in 40–50-year-old patients. The main risk factors include radiation, iodine deficiency, hereditary background, and genetic mutations. Among all diagnosed thyroid nodules, 5%–30% will evolve into cancer. The gold-standard procedure in the preoperative evaluation of a nodular goiter, apart from ultrasonography, is fine needle aspiration (FNA) biopsy. The FNA biopsy is favored for its simplicity, safety, and high specificity and sensitivity rates. Aim The aim of our study was to evaluate the clinical efficacy of FNA based on the patients’ register. Materials and methods In the Department of Surgery at the 4th Military Teaching Hospital in Wroclaw, 2,133 patients underwent thyroid surgery for thyroid goiter between 1996 and 2015. One hundred and eight cases of TC were diagnosed and of these, 66 patients had a preoperative FNA. Results Fourteen FNA biopsies (21%) revealed cancer, all of which were confirmed in the postoperative histopathology, although six cases of FNA-diagnosed cancer revealed a different histological type postoperatively. Eighteen FNA biopsies (27%) were suspected of being malignant. A disturbingly high rate of “benign” FNA biopsies (32 cases; 48%) revealed TC after surgery. Conclusion It is of great importance that the quality and quantity of FNA biopsies that are performed have been improved, especially due to the wide adoption of the Bethesda cytological evaluation system. FNA biopsy remains an obligatory and valuable diagnostic tool in thyroid nodules, but it is still insufficient as a standard procedure. A preoperative biopsy should always be related to all the available clinical data in order to provide the best treatment option for each patient individually. PMID:27703381

  18. Evaluation of the e-Learning material developed by EMERALD and EMIT for diagnostic imaging and radiotherapy.

    PubMed

    Aitken, Victoria; Tabakov, Slavik

    2005-09-01

    Two Leonardo projects, EMERALD and EMIT, have developed in a partnershipof university and hospital departments (the consortia) e-Learning materials in X-ray diagnostic radiology, nuclear medicine, radiotherapy, ultrasound and magnetic resonance imaging for medical physics graduates and other healthcare professionals. These e-Learning materials are described in a separate paper in this issue. To assess the effectiveness and relevance of the e-Learning material, a series of evaluations by student users groups plus experts in medical physics education and training were undertaken. The students, with backgrounds in physics and clinical ultrasound, reviewed the e-Learning material using an evaluation form developed by the consortia. The student feedback was favourable with students commenting that their level of knowledge had increased having completed the tasks. Areas identified for development were a reduction in text volume and an increase in the time allowed for completion of some tasks. The feedback from the experts was positive with an overall appreciation of the value of the learning material as a resource for students in medical physics field across Europe and identified other disciplines in which the access to the learning material could be useful contribution to their learning. Suggestions made for improvements ranged from grading the tasks into basic and advanced topics to increasing the interactive nature of the material. These early evaluation of the e-Learning material look promising and provide a framework for further developments in the field. Insight into users and providers views is important if developers are to provide relevant and worthwhile educational learning opportunities.

  19. Evaluation of the e-Learning material developed by EMERALD and EMIT for diagnostic imaging and radiotherapy.

    PubMed

    Aitken, Victoria; Tabakov, Slavik

    2005-09-01

    Two Leonardo projects, EMERALD and EMIT, have developed in a partnershipof university and hospital departments (the consortia) e-Learning materials in X-ray diagnostic radiology, nuclear medicine, radiotherapy, ultrasound and magnetic resonance imaging for medical physics graduates and other healthcare professionals. These e-Learning materials are described in a separate paper in this issue. To assess the effectiveness and relevance of the e-Learning material, a series of evaluations by student users groups plus experts in medical physics education and training were undertaken. The students, with backgrounds in physics and clinical ultrasound, reviewed the e-Learning material using an evaluation form developed by the consortia. The student feedback was favourable with students commenting that their level of knowledge had increased having completed the tasks. Areas identified for development were a reduction in text volume and an increase in the time allowed for completion of some tasks. The feedback from the experts was positive with an overall appreciation of the value of the learning material as a resource for students in medical physics field across Europe and identified other disciplines in which the access to the learning material could be useful contribution to their learning. Suggestions made for improvements ranged from grading the tasks into basic and advanced topics to increasing the interactive nature of the material. These early evaluation of the e-Learning material look promising and provide a framework for further developments in the field. Insight into users and providers views is important if developers are to provide relevant and worthwhile educational learning opportunities. PMID:16087384

  20. Evaluation of the DIBELS (Sixth Edition) Diagnostic System for the Selection of Native and Proficient English Speakers at Risk of Reading Difficulties

    ERIC Educational Resources Information Center

    Smolkowski, Keith; Cummings, Kelli D.

    2016-01-01

    This comprehensive evaluation of the Dynamic Indicators of Basic Early Literacy Skills Sixth Edition (DIBELS6) set of measures gives a practical illustration of signal detection methods, the methods used to determine the value of screening and diagnostic systems, and offers an updated set of cut scores (decision thresholds). Data were drawn from a…

  1. Evaluation of the Criterion and Convergent Validity of the Diagnostic Interview for Social and Communication Disorders in Young and Low-Functioning Children

    ERIC Educational Resources Information Center

    Maljaars, Jarymke; Noens, Ilse; Scholte, Evert; van Berckelaer-Onnes, Ina

    2012-01-01

    The Diagnostic Interview for Social and Communication Disorders (DISCO; Wing, 2006) is a standardized, semi-structured and interviewer-based schedule for diagnosis of autism spectrum disorder (ASD). The objective of this study was to evaluate the criterion and convergent validity of the DISCO-11 ICD-10 algorithm in young and low-functioning…

  2. Onset of Analgesia and Efficacy of Ibuprofen Sodium in Postsurgical Dental Pain

    PubMed Central

    Brain, Patrick; Leyva, Rina; Doyle, Geraldine

    2015-01-01

    Objectives: A novel, immediate-release tablet formulation of ibuprofen (IBU) sodium dihydrate, Advil Film Coated Tablets (IBUNa), has been developed that is absorbed faster than standard IBU tablets. The objective of the current study was to compare the efficacy and onset of analgesia of this new formulation with standard IBU tablets after a single dose. Materials and Methods: Patients (N=316) with at least moderate baseline postsurgical dental pain were randomized to 400 mg IBUNa, Advil (IBUAdv), Motrin (IBUMot), or placebo. Primary endpoints were time-weighted sum of pain relief (PR) and pain intensity differences over 8 hours (SPRID 0-8) and time to onset of meaningful pain relief (TMPR) measured by the double-stopwatch method. Results: SPRID 0-8 was significantly greater for IBUNa and the other active treatments versus placebo (P<0.001). IBUNa had a significantly earlier TMPR versus placebo, pooled IBUAdv/IBUMot, and IBUMot (P<0.001 for all), and a marginally faster TMPR (P=0.075) versus IBUAdv. Results for secondary endpoints were similar. Adverse events were comparable across treatment groups, with gastrointestinal disorders being most frequently reported. Most adverse events were mild or moderate. Discussion: This novel formulation of IBUNa provided superior overall PR compared with placebo and more rapid onset of analgesic effect compared with standard IBU tablets. Rapid PR is important in the treatment of acute pain, including dental pain, and this IBUNa formulation represents a new treatment option for rapid PR. PMID:25119511

  3. Inhibition of postsurgical adhesions by methylene blue-loaded nanofibers versus cast film matrices.

    PubMed

    El-Sayed, Nesma; Galal, Sally; El-Gowelli, Hanan; El-Khordagui, Labiba

    2016-07-01

    In the quest for barrier membranes for the prevention of post-surgical tissue adhesions, polymer matrices may provide a platform of biomaterials with versatile properties. However, the relationship between the anti-adhesion effects of different polymer matrices and their physicochemical and structural properties is not yet adequately understood. In a preclinical study using a rat cecum model, we directly compared the anti-adhesion potential of polyhydroxybutyrate (PHB) electrospun nanofibrous versus cast film matrices loaded with methylene blue (MB) as antioxidant adhesion inhibitor. PHB retained MB presumably forming MB-bioactivated matrices. In the preclinical study, quantitative morphologic assessment in addition to histopathologic and SEM examinations 14 days post-surgery indicated that plain PHB NFs and MB-PHB NFs, moderately enhanced cecal wall healing and inhibited adhesion formation. In contrast, reshaping PHB as cast films, significantly enhanced healing, reduced adhesion bands and prevented inter-visceral adhesions. Cast films also inhibited tissue attachment to the matrix recovered 14 days post-surgery. Both PHB matrix types reduced tissue inflammation. Despite tissue anti-adhesion potential of individual matrix components, modulation of the micro-architectural properties generated polymer barriers with varying tissue anti-adhesion and healing potentials, the MB-loaded cast film achieving the best outcome.

  4. Benefits of a Multimodal Regimen for Postsurgical Pain Management in Colorectal Surgery

    PubMed Central

    Beck, David E.; Margolin, David A.; Babin, Sheena Farragut; Russo, Christine Theriot

    2015-01-01

    Background Postoperative pain management is a major concern and a significant component of postoperative care pathways for surgery patients. Methods We performed a retrospective medical record review of 233 consecutive patients undergoing major colorectal surgery from October 2011 to January 2013 at an academic medical center. All patients were managed with similar enhanced recovery pathways; 66 patients received multimodal postsurgical pain management that included liposomal bupivacaine intraoperatively, and 167 patients received conventional pain management with intravenous opioids. Comparisons were made using t test and chi-square analysis with StatView (SAS Institute Inc.). Results Patients receiving multimodal pain management with liposomal bupivacaine injected in the surgical site at the end of major colorectal procedures had lower postoperative pain scores and used significantly less opioids at 12, 24, 36, 48, 60, and 72 hours (P=0.03). Patients in the multimodal group also had a significantly decreased risk of opioid-related adverse events, with decreased use of antipruritic medications and antiemetic medications postoperatively. A significant decrease in length of postoperative hospital stay was seen in the multimodal group (7.2 vs 9.0 days, P=0.04). Conclusion The use of multimodal pain management including liposomal bupivacaine during major colorectal surgeries improved postoperative outcomes, decreased lengths of stay, and increased bed availability. PMID:26730224

  5. Inhibition of postsurgical adhesions by methylene blue-loaded nanofibers versus cast film matrices.

    PubMed

    El-Sayed, Nesma; Galal, Sally; El-Gowelli, Hanan; El-Khordagui, Labiba

    2016-07-01

    In the quest for barrier membranes for the prevention of post-surgical tissue adhesions, polymer matrices may provide a platform of biomaterials with versatile properties. However, the relationship between the anti-adhesion effects of different polymer matrices and their physicochemical and structural properties is not yet adequately understood. In a preclinical study using a rat cecum model, we directly compared the anti-adhesion potential of polyhydroxybutyrate (PHB) electrospun nanofibrous versus cast film matrices loaded with methylene blue (MB) as antioxidant adhesion inhibitor. PHB retained MB presumably forming MB-bioactivated matrices. In the preclinical study, quantitative morphologic assessment in addition to histopathologic and SEM examinations 14 days post-surgery indicated that plain PHB NFs and MB-PHB NFs, moderately enhanced cecal wall healing and inhibited adhesion formation. In contrast, reshaping PHB as cast films, significantly enhanced healing, reduced adhesion bands and prevented inter-visceral adhesions. Cast films also inhibited tissue attachment to the matrix recovered 14 days post-surgery. Both PHB matrix types reduced tissue inflammation. Despite tissue anti-adhesion potential of individual matrix components, modulation of the micro-architectural properties generated polymer barriers with varying tissue anti-adhesion and healing potentials, the MB-loaded cast film achieving the best outcome. PMID:27093975

  6. Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries

    PubMed Central

    Gadsden, Jeffrey; Ayad, Sabry; Gonzales, Jeffrey J; Mehta, Jaideep; Boublik, Jan; Hutchins, Jacob

    2015-01-01

    Transversus abdominis plane (TAP) infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by administration of a local anesthetic in close proximity, TAP infiltration involves administration and spread of local anesthetic within an anatomical plane of the surgical site. PMID:26677342

  7. Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas.

    PubMed

    Pérez Roldán, F; González Carro, P; Villafáñez García, M C; Aoufi Rabih, S; Legaz Huidobro, M L; Sánchez-Manjavacas Múñoz, N; Roncero García-Escribano, O; Ynfante Ferrús, M; Bernardos Martín, E; Ruiz Carrillo, F

    2012-03-01

    Benign colonic strictures and fistulas are a growing problem presenting most commonly after bowel resection. Standard treatment is with endoscopic bougies or, more usually, balloon dilation. When these approaches are not successful, other solutions are available and different endoscopic and surgical approaches have been used to treat fistulas. We present an additional option--biodegradable stents--for the treatment of colonic strictures and fistulas that have proven refractory to other endoscopic interventions. We analyzed the results from 10 patients with either a postsurgical colorectal stricture (n =7) or rectocutaneous fistula (n =3) treated with the biodegradable SX-ELLA esophageal stent (covered or uncovered). Stents were successfully placed in nine patients, although early migration subsequently occurred in one. Placement was impossible in one patient due to deformity of the area and the fact that the stricture was approximately 30cm from the anus. The fistulas were successfully closed in all patients, although symptoms reappeared in one patient. In the six patients who received stents for strictures, symptoms resolved in five; in the remaining patient, the stent migrated shortly after the endoscopy. Treatment of colonic strictures and rectocutaneous fistulas with biodegradable stents is an effective alternative in the short-to-medium term. The stent does not have to be removed and is subject to very few complications. The drawbacks of this approach are the need to repeat the procedure in some patients and the lack of published series on efficacy.

  8. Mesothelial-to-mesenchymal transition in the pathogenesis of post-surgical peritoneal adhesions.

    PubMed

    Sandoval, Pilar; Jiménez-Heffernan, José A; Guerra-Azcona, Gonzalo; Pérez-Lozano, María L; Rynne-Vidal, Ángela; Albar-Vizcaíno, Patricia; Gil-Vera, Fernando; Martín, Paloma; Coronado, María José; Barcena, Carmen; Dotor, Javier; Majano, Pedro Lorenzo; Peralta, Abelardo Aguilera; López-Cabrera, Manuel

    2016-05-01

    Peritoneal adhesions (PAs) are fibrotic bands formed between bowel loops, solid organs, and the parietal peritoneum, which may appear following surgery, infection or endometriosis. They represent an important health problem with no effective treatment. Mesothelial cells (MCs) line the peritoneal cavity and undergo a mesothelial-to-mesenchymal transition (MMT) under pathological conditions, transforming into myofibroblasts, which are abundant in peritoneal fibrotic tissue. The aim of this study was to investigate if peritoneal MCs undergo a MMT contributing to the formation of post-surgical adhesions. Biopsies from patients with PAs were analysed by immunohistochemistry, immunofluorescence, and quantitative RT-PCR. A mouse model of PAs based on ischaemic buttons was used to modulate MMT by blocking the transforming growth factor-beta (TGF-β) pathway. The severity of adhesions and MMT-related marker expression were studied. We observed myofibroblasts derived from the conversion of MCs in submesothelial areas of patients with PAs. In addition, MMT-related markers were dysregulated in adhesion zones when compared to distant normal peritoneal tissue of the same patient. In animal experiments, blockage of TGF-β resulted in molecular reprogramming of markers related to the mesenchymal conversion of MCs and in a significant decrease in the severity of the adhesions. These data indicate for the first time that MMT is involved in PA pathogenesis. This finding opens new therapeutic strategies to interfere with adhesion formation by modulating MMT with a wide range of pharmacological agents. PMID:27071481

  9. Mesothelial-to-mesenchymal transition in the pathogenesis of post-surgical peritoneal adhesions.

    PubMed

    Sandoval, Pilar; Jiménez-Heffernan, José A; Guerra-Azcona, Gonzalo; Pérez-Lozano, María L; Rynne-Vidal, Ángela; Albar-Vizcaíno, Patricia; Gil-Vera, Fernando; Martín, Paloma; Coronado, María José; Barcena, Carmen; Dotor, Javier; Majano, Pedro Lorenzo; Peralta, Abelardo Aguilera; López-Cabrera, Manuel

    2016-05-01

    Peritoneal adhesions (PAs) are fibrotic bands formed between bowel loops, solid organs, and the parietal peritoneum, which may appear following surgery, infection or endometriosis. They represent an important health problem with no effective treatment. Mesothelial cells (MCs) line the peritoneal cavity and undergo a mesothelial-to-mesenchymal transition (MMT) under pathological conditions, transforming into myofibroblasts, which are abundant in peritoneal fibrotic tissue. The aim of this study was to investigate if peritoneal MCs undergo a MMT contributing to the formation of post-surgical adhesions. Biopsies from patients with PAs were analysed by immunohistochemistry, immunofluorescence, and quantitative RT-PCR. A mouse model of PAs based on ischaemic buttons was used to modulate MMT by blocking the transforming growth factor-beta (TGF-β) pathway. The severity of adhesions and MMT-related marker expression were studied. We observed myofibroblasts derived from the conversion of MCs in submesothelial areas of patients with PAs. In addition, MMT-related markers were dysregulated in adhesion zones when compared to distant normal peritoneal tissue of the same patient. In animal experiments, blockage of TGF-β resulted in molecular reprogramming of markers related to the mesenchymal conversion of MCs and in a significant decrease in the severity of the adhesions. These data indicate for the first time that MMT is involved in PA pathogenesis. This finding opens new therapeutic strategies to interfere with adhesion formation by modulating MMT with a wide range of pharmacological agents.

  10. [Post-surgical management of split-thickness skin grafts in oculoplastic surgery].

    PubMed

    Tost, F; Kempin, R

    2015-01-01

    Malignant skin tumours in periocular regions often demand ophthalmo-surgical measures. Split-thickness skin grafts still represent an important treatment alternative when plastic-reconstructive covering through local tissue of the facial area is impossible. Essential technical steps to gain viable split-thickness skin grafts are introduced. Current standards in the after-treatment of split-thickness skin grafts at the receiving location as well as in the after-care of the donor area are presented from interdisciplinary points of view referring to the latest publications. Hydrocolloidal dressings are recommended for the after-treatment of removal areas such as the inside of the forearm since they improve post-surgical management for the ophthalmologist significantly and help in abbreviating healing duration. Pain sensation of the patient as well as the rate of infection are minimal. Throughout the early stages, split-thickness skin grafts at reception areas often demand an intensified local massage treatment with hydrocortisone 2.5 % ophthalmic cream. During the later stages follow-up measures should be stopped neither too soon nor abruptly. Ointments with polysiloxane and silicon dioxide preserve skin suppleness and prevent the occurrence of shrinkage as well as hypertrophic scars. PMID:25611496

  11. Scratching Where They Itch: Evaluation of Feedback on a Diagnostic English Grammar Test for Taiwanese University Students

    ERIC Educational Resources Information Center

    Yin, Muchun; Sims, James; Cothran, Daniel

    2012-01-01

    Feedback to the test taker is a defining characteristic of diagnostic language testing (Alderson, 2005). This article reports on a study that investigated how much and in what ways students at a Taiwan university perceived the feedback to be useful on an online multiple-choice diagnostic English grammar test, both in general and by students of…

  12. Evaluation of the immunogenicity and diagnostic interference caused by M. tuberculosis SO2 vaccination against tuberculosis in goats.

    PubMed

    Bezos, Javier; Casal, Carmen; Puentes, Eugenia; Díez-Guerrier, Alberto; Romero, Beatriz; Aguiló, Nacho; de Juan, Lucía; Martín, Carlos; Domínguez, Lucas

    2015-12-01

    The immunogenicity and diagnostic interference caused by M. tuberculosis SO2, a prototype vaccine first time tested in goats was evaluated. Tuberculosis-free goats were distributed in four groups: [1], non-vaccinated; [2], subcutaneously (SC) BCG vaccinated; [3], intranasally (IN) SO2 vaccinated and [4], SC SO2 vaccinated. Intradermal tuberculin and IFN-γ tests using PPDs and alternative antigenic cocktails containing mainly ESAT-6 and CFP-10 (E/C) were applied at different times post-vaccination. Results showed a significant (p<0.05) increase in the number of reactors detected using both PPD-based intradermal and IFN-γ tests at different times in all the vaccinated groups. No intradermal reactivity was detected in the vaccinated goats using a cocktail containing E/C, Rv3615c and Rv3020c. A higher overall reactivity was observed in the group [4] in comparison with the other vaccinated groups. Results showed that antigens used to differentiate BCG vaccinated animals could be potentially used to differentiate SO2 vaccinated ones.

  13. Evaluation of serum PIVKA-II and MIF as diagnostic markers for HCV/HBV induced hepatocellular carcinoma.

    PubMed

    Kamel, Mahmoud M; Saad, Mohamed F; Mahmoud, Amal A; Edries, Awatief A; Abdel-Moneim, Ahmed S

    2014-12-01

    Viral hepatitis is the most significant predisposing factor for hepatocellular carcinoma (HCC). Liver cancer grows silently with mild or no symptoms until the disease is advanced and with little hope of cure. Early recognition of the onset of HCC would help to select more effective therapies for patients leading to a better prognosis and life span. The current study aims to evaluate two diagnostic and prognostic markers - Prothrombin induced by vitamin K absence-II (PIVKA-II) and macrophage migration inhibitory factor (MIF) in the serum of patients with HCC and those with a high risk of developing hepatic cancers. Serum samples from hepatocellular carcinoma, hepatitis C and normal subjects were subjected to quantitative determinations of different parameters including alpha-fetoprotein (AFP), PIVKA-II and MIF. Significant differences between the various groups were recorded. PIVKA-II and AFP showed a higher specificity and sensitivity compared to MIF, and there was considerable correlation between AFP and both PIVKA and MIF. It is concluded that analysis of PIVKA-II and AFP can serve as useful non-invasive markers for the early detection of HCC with good sensitivity and specificity.

  14. The diagnostic evaluation of patients with potential adult-onset autoinflammatory disorders: our experience and review of the literature.

    PubMed

    Muscari, Isabella; Iacoponi, Francesca; Cantarini, Luca; Lucherini, Orso Maria; Simonini, Gabriele; Brizi, Maria Giuseppina; Vitale, Antonio; Frediani, Bruno; Cimaz, Rolando; Galeazzi, Mauro

    2012-11-01

    Hereditary periodic fever syndromes (HPFSs) are a group of inherited disorders of the innate immune system caused by mutations of genes involved in the regulation or activation of the inflammatory response, which belong to the category of autoinflammatory disorders. Most HPFs typically have an onset in pediatric age, while a limited number of patients experience disease onset during adulthood. The relative rarity and lack of information on adult-onset autoinflammatory diseases make it likely that genetic testing is often inconclusive. Recently, we have identified a set of variables related to the probability of detecting gene mutations in MEFV, responsible for familial Mediterranean fever, and TNFRSF1A, responsible for tumor necrosis factor receptor-associated periodic syndrome. In addition, we have proposed a diagnostic score for identifying those patients at high risk of carrying mutations in these genes. However, before the score can be recommended for application, further evaluation by means of longitudinal studies on different ethnicities and different populations deriving from other geographical areas is needed in order to definitively verify both its sensitivity and its specificity. The present manuscript offers our suggestions on how to establish a differential diagnosis for adult-onset HPFs, as well as a review of the literature, and we also provide a score revision available online.

  15. Diagnostic Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Biliary Obstruction

    PubMed Central

    Bilgin, Mehmet; Toprak, Hüseyin; Burgazli, Mehmet; Bilgin, S. Sennur; Chasan, Ritvan; Erdogan, Ali; Balcı, Cem

    2012-01-01

    Purpose. In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction. Materials and Methods. 108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18–86 years) were included in this study. All the patients underwent conventional upper abdomen MRI using intravenous contrast material (Gd-DTPA) and MRCP in 1.5 Tesla MRI scanner. MRCP images were evaluated together with the T1 and T2w images, and both biliary ducts and surrounding tissues were examined for possible pathologies that may cause obstruction. Results. MRI/MRCP findings compared with final diagnoses, MRI/MRCP in the demonstration of bile duct obstruction sensitivity 96%, the specificity 100%, and accuracy 96.3%, in the detection of presence and level of obstruction, the sensitivity 96.7%, specificity 100%, and accuracy 97.2%, in the diagnosis of choledocholithiasis, the sensitivity 82.3%, specificity 96%, and accuracy 91.7%, and in the determination of the character of the stenosis, sensitivity 95.6%, specificity 91.3%, and accuracy 94.5% were found. Conclusion. The combination of dynamic contrast-enhanced MRI and MRCP techniques in patients with suspected biliary obstruction gives the detailed information about the presence of obstruction, location, and causes and is a highly specific and sensitive method. PMID:22489200

  16. Evaluation of Diagnostic Value and Epidemiological Implications of PCR for Pneumocystis carinii in Different Immunosuppressed and Immunocompetent Patient Groups

    PubMed Central

    Sing, Andreas; Trebesius, Karlheinz; Roggenkamp, Andreas; Rüssmann, Holger; Tybus, Karin; Pfaff, Friederike; Bogner, Johannes R.; Emminger, Christoph; Heesemann, Jürgen

    2000-01-01

    To evaluate the value of single and nested PCRs for diagnosis of Pneumocystis carinii pneumonia (PCP) in a variety of respiratorily distressed patient groups, 574 respiratory samples from 334 patients (89 human immunodeficiency virus [HIV]-positive patients, 61 transplant recipients, 66 malignancy patients, 34 otherwise immunosuppressed patients, and 84 immunocompetent patients) were prospectively examined by microscopy and single and nested PCRs. The resulting data were correlated with clinical evidence of PCP. Microscopy and single PCR of bronchoalveolar lavage (BAL) specimens from HIV patients were 100% sensitive and specific in detecting PCP, whereas nested PCR, although being 100% sensitive, reached a specificity of only 97.5%. In the three non-HIV immunosuppressed patient groups, both single and nested PCR invariably produced lower positive predictive values than microscopy. Among immunocompetent patients, the positive predictive values of both PCRs were 0%. Therefore, the diagnostic values of the PCR methods tested do not seem to offer any additional advantage compared to that of conventional microscopy for these patient groups. However, nested PCR identified a significant percentage of clinically silent P. carinii colonizations in about 17 to 20% of immunocompetent and immunosuppressed non-HIV patients. PMID:10747126

  17. Positron emission tomography-computed tomography in the diagnostic evaluation of smoldering multiple myeloma: identification of patients needing therapy

    PubMed Central

    Siontis, B; Kumar, S; Dispenzieri, A; Drake, M T; Lacy, M Q; Buadi, F; Dingli, D; Kapoor, P; Gonsalves, W; Gertz, M A; Rajkumar, S V

    2015-01-01

    We studied 188 patients with a suspected smoldering multiple myeloma (MM) who had undergone a positron emission tomography-computed tomography (PET-CT) scan as part of their clinical evaluation. PET-CT was positive (clinical radiologist interpretation of increased bone uptake and/or evidence of lytic bone destruction) in 74 patients and negative in 114 patients. Of these, 25 patients with a positive PET-CT and 97 patients with a negative PET-CT were observed without therapy and formed the study cohort (n=122). The probability of progression to MM within 2 years was 75% in patients with a positive PET-CT observed without therapy compared with 30% in patients with a negative PET-CT; median time to progression was 21 months versus 60 months, respectively, P=0.0008. Of 25 patients with a positive PET-CT, the probability of progression was 87% at 2 years in those with evidence of underlying osteolysis (n=16) and 61% in patients with abnormal PET-CT uptake but no evidence of osteolysis (n=9). Patients with positive PET-CT and evidence of underlying osteolysis have a high risk of progression to MM within 2 years when observed without therapy. These observations support recent changes to imaging requirements in the International Myeloma Working Group updated diagnostic criteria for MM. PMID:26495861

  18. Evaluation of the immunogenicity and diagnostic interference caused by M. tuberculosis SO2 vaccination against tuberculosis in goats.

    PubMed

    Bezos, Javier; Casal, Carmen; Puentes, Eugenia; Díez-Guerrier, Alberto; Romero, Beatriz; Aguiló, Nacho; de Juan, Lucía; Martín, Carlos; Domínguez, Lucas

    2015-12-01

    The immunogenicity and diagnostic interference caused by M. tuberculosis SO2, a prototype vaccine first time tested in goats was evaluated. Tuberculosis-free goats were distributed in four groups: [1], non-vaccinated; [2], subcutaneously (SC) BCG vaccinated; [3], intranasally (IN) SO2 vaccinated and [4], SC SO2 vaccinated. Intradermal tuberculin and IFN-γ tests using PPDs and alternative antigenic cocktails containing mainly ESAT-6 and CFP-10 (E/C) were applied at different times post-vaccination. Results showed a significant (p<0.05) increase in the number of reactors detected using both PPD-based intradermal and IFN-γ tests at different times in all the vaccinated groups. No intradermal reactivity was detected in the vaccinated goats using a cocktail containing E/C, Rv3615c and Rv3020c. A higher overall reactivity was observed in the group [4] in comparison with the other vaccinated groups. Results showed that antigens used to differentiate BCG vaccinated animals could be potentially used to differentiate SO2 vaccinated ones. PMID:26679799

  19. Hemoglobin levels and circulating blasts are two easily evaluable diagnostic parameters highly predictive of leukemic transformation in primary myelofibrosis.

    PubMed

    Rago, Angela; Latagliata, Roberto; Montanaro, Marco; Montefusco, Enrico; Andriani, Alessandro; Crescenzi, Sabrina Leonetti; Mecarocci, Sergio; Spirito, Francesca; Spadea, Antonio; Recine, Umberto; Cicconi, Laura; Avvisati, Giuseppe; Cedrone, Michele; Breccia, Massimo; Porrini, Raffaele; Villivà, Nicoletta; De Gregoris, Cinzia; Alimena, Giuliana; D'Arcangelo, Enzo; Guglielmelli, Paola; Lo-Coco, Francesco; Vannucchi, Alessandro; Cimino, Giuseppe

    2015-03-01

    To predict leukemic transformation (LT), we evaluated easily detectable diagnostic parameters in 338 patients with primary myelofibrosis (PMF) followed in the Latium region (Italy) between 1981 and 2010. Forty patients (11.8%) progressed to leukemia, with a resulting 10-year leukemia-free survival (LFS) rates of 72%. Hb (<10g/dL), and circulating blasts (≥1%) were the only two independent prognostic for LT at the multivariate analysis. Two hundred-fifty patients with both the two parameters available were grouped as follows: low risk (none or one factor)=216 patients; high risk (both factors)=31 patients. The median LFS times were 269 and 45 months for the low and high-risk groups, respectively (P<.0001). The LT predictive power of these two parameters was confirmed in an external series of 270 PMF patients from Tuscany, in whom the median LFS was not reached and 61 months for the low and high risk groups, respectively (P<.0001). These results establish anemia and circulating blasts, two easily and universally available parameters, as strong predictors of LT in PMF and may help to improve prognostic stratification of these patients particularly in countries with low resources where more sophisticated molecular testing is unavailable. PMID:25636356

  20. Evaluation of serum PIVKA-II and MIF as diagnostic markers for HCV/HBV induced hepatocellular carcinoma.

    PubMed

    Kamel, Mahmoud M; Saad, Mohamed F; Mahmoud, Amal A; Edries, Awatief A; Abdel-Moneim, Ahmed S

    2014-12-01

    Viral hepatitis is the most significant predisposing factor for hepatocellular carcinoma (HCC). Liver cancer grows silently with mild or no symptoms until the disease is advanced and with little hope of cure. Early recognition of the onset of HCC would help to select more effective therapies for patients leading to a better prognosis and life span. The current study aims to evaluate two diagnostic and prognostic markers - Prothrombin induced by vitamin K absence-II (PIVKA-II) and macrophage migration inhibitory factor (MIF) in the serum of patients with HCC and those with a high risk of developing hepatic cancers. Serum samples from hepatocellular carcinoma, hepatitis C and normal subjects were subjected to quantitative determinations of different parameters including alpha-fetoprotein (AFP), PIVKA-II and MIF. Significant differences between the various groups were recorded. PIVKA-II and AFP showed a higher specificity and sensitivity compared to MIF, and there was considerable correlation between AFP and both PIVKA and MIF. It is concluded that analysis of PIVKA-II and AFP can serve as useful non-invasive markers for the early detection of HCC with good sensitivity and specificity. PMID:25448465

  1. [Evaluation of a rapid diagnostic test in the diagnosis of toxoplasmosis in pregnant women in Cotonou (Bénin)].

    PubMed

    Ogouyèmi-Hounto, A; Agbayahoun-Chokki, F; Sissinto Savi de Tove, Y; Biokou Bankole, B; Adinsi de Souza, V; Assogba, M; Kinde-Gazard, D; Massougbodji, A

    2014-05-01

    The aim of the study was to evaluate the performance of the ImmunoComb® Toxo IgG and ImmunoComb® Toxo IgMassays (rapid diagnostic test) in the laboratory diagnosis of toxoplasmosis in pregnant women in Cotonou. We interviewed 266 pregnant women, who first answered an epidemiological questionnaire, and collected blood samples for measurement of IgG and IgM anti T. gondii antibodies with the ImmunoComb toxo assays and with the ARCHITECT CIMA method. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated to determine the performance of the rapid test. The seroprevalences of IgG against T. gondii by CIMA technique and rapid test were respectively 48.9% and 48.5%. The prevalence increased with age. Performances for IgG were: sensitivity 97%, specificity 100%, PPV 100%, NPV = 97.10%. For IgM, Sensitivity: 33.3% Specificity: 100%, PPV 100%, NPV = 99.2%. Seroprevalence obtained shows that about half of the study population is not immune against T. gondii and requires regular serological monitoring until delivery. According to these results, and given the needs of toxoplasmosis diagnosis on the field characterized by an important decrease of immunized women, this test may be recommended in the laboratory diagnosis of toxoplasmosis in peripheral levels of the health pyramid.

  2. Chronic persistent post-surgical pain following staging laparotomy for carcinoma of ovary and its relationship to signal transduction genes

    PubMed Central

    Saxena, Ashok Kumar; Chopra, Anand K; Banerjee, Basu Dev; Sharma, Tusha

    2016-01-01

    Background The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. Methods The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20−70 years, scheduled for elective staging laparotomy for carcinoma ovary were included. Patients were excluded if had other causes of pain, cognitive dysfunction or chronic neurological disorders. Statistical analysis of pool data was done using SPSS version-17. For various scales like GPE, PDQ, NPSI, the visual analogue scale (VAS), global perceived effect (GPE), the pain DETECT questionnaire (PDQ), and neuropathic pain symptoms inventory (NPSI), one factor repaeted measure ANOVA applied with simple contrast with baseline as on post-operative day 1 (considered as reference and compared with subsequent time-interval), and the P values were adjusted according to "Bonferroni adjustments". In patients with CPPP, the Δct values of mRNA expressions of genes at the end of postoperative day 90 were compared with the baseline control values by one factor repeated ANOVA. P value < 0.005 significant. Results The present study demonstrates 38.1% (8 out of 21 patients) incidence of CPPP. The functional status and quality of life as were observed to be significantly diminished in all patients with chronic pain. An up-regulation in the mRNA expression of signal transduction and a positive correlation was noted between the mRNA expression of signal transduction genes and VAS score in all patients with CPPP at the end of postoperative day 90. Conclusions The reported incidence of CPPP in patients with carcinoma ovary was 38.1%. An up-regulation and positive correlation between mRNA expression of signal transduction genes and VAS score depicts its potential

  3. Resected Brain Tissue, Seizure Onset Zone and Quantitative EEG Measures: Towards Prediction of Post-Surgical Seizure Control

    PubMed Central

    Andrzejak, Ralph G.; Hauf, Martinus; Pollo, Claudio; Müller, Markus; Weisstanner, Christian; Wiest, Roland; Schindler, Kaspar

    2015-01-01

    Background Epilepsy surgery is a potentially curative treatment option for pharmacoresistent patients. If non-invasive methods alone do not allow to delineate the epileptogenic brain areas the surgical candidates undergo long-term monitoring with intracranial EEG. Visual EEG analysis is then used to identify the seizure onset zone for targeted resection as a standard procedure. Methods Despite of its great potential to assess the epileptogenicty of brain tissue, quantitative EEG analysis has not yet found its way into routine clinical practice. To demonstrate that quantitative EEG may yield clinically highly relevant information we retrospectively investigated how post-operative seizure control is associated with four selected EEG measures evaluated in the resected brain tissue and the seizure onset zone. Importantly, the exact spatial location of the intracranial electrodes was determined by coregistration of pre-operative MRI and post-implantation CT and coregistration with post-resection MRI was used to delineate the extent of tissue resection. Using data-driven thresholding, quantitative EEG results were separated into normally contributing and salient channels. Results In patients with favorable post-surgical seizure control a significantly larger fraction of salient channels in three of the four quantitative EEG measures was resected than in patients with unfavorable outcome in terms of seizure control (median over the whole peri-ictal recordings). The same statistics revealed no association with post-operative seizure control when EEG channels contributing to the seizure onset zone were studied. Conclusions We conclude that quantitative EEG measures provide clinically relevant and objective markers of target tissue, which may be used to optimize epilepsy surgery. The finding that differentiation between favorable and unfavorable outcome was better for the fraction of salient values in the resected brain tissue than in the seizure onset zone is consistent

  4. ESMValTool (v1.0) - a community diagnostic and performance metrics tool for routine evaluation of Earth system models in CMIP

    NASA Astrophysics Data System (ADS)

    Eyring, Veronika; Righi, Mattia; Lauer, Axel; Evaldsson, Martin; Wenzel, Sabrina; Jones, Colin; Anav, Alessandro; Andrews, Oliver; Cionni, Irene; Davin, Edouard L.; Deser, Clara; Ehbrecht, Carsten; Friedlingstein, Pierre; Gleckler, Peter; Gottschaldt, Klaus-Dirk; Hagemann, Stefan; Juckes, Martin; Kindermann, Stephan; Krasting, John; Kunert, Dominik; Levine, Richard; Loew, Alexander; Mäkelä, Jarmo; Martin, Gill; Mason, Erik; Phillips, Adam S.; Read, Simon; Rio, Catherine; Roehrig, Romain; Senftleben, Daniel; Sterl, Andreas; van Ulft, Lambertus H.; Walton, Jeremy; Wang, Shiyu; Williams, Keith D.

    2016-05-01

    A community diagnostics and performance metrics tool for the evaluation of Earth system models (ESMs) has been developed that allows for routine comparison of single or multiple models, either against predecessor versions or against observations. The priority of the effort so far has been to target specific scientific themes focusing on selected essential climate variables (ECVs), a range of known systematic biases common to ESMs, such as coupled tropical climate variability, monsoons, Southern Ocean processes, continental dry biases, and soil hydrology-climate interactions, as well as atmospheric CO2 budgets, tropospheric and stratospheric ozone, and tropospheric aerosols. The tool is being developed in such a way that additional analyses can easily be added. A set of standard namelists for each scientific topic reproduces specific sets of diagnostics or performance metrics that have demonstrated their importance in ESM evaluation in the peer-reviewed literature. The Earth System Model Evaluation Tool (ESMValTool) is a community effort open to both users and developers encouraging open exchange of diagnostic source code and evaluation results from the Coupled Model Intercomparison Project (CMIP) ensemble. This will facilitate and improve ESM evaluation beyond the state-of-the-art and aims at supporting such activities within CMIP and at individual modelling centres. Ultimately, we envisage running the ESMValTool alongside the Earth System Grid Federation (ESGF) as part of a more routine evaluation of CMIP model simulations while utilizing observations available in standard formats (obs4MIPs) or provided by the user.

  5. ESMValTool (v1.0) - a community diagnostic and performance metrics tool for routine evaluation of Earth System Models in CMIP

    NASA Astrophysics Data System (ADS)

    Eyring, V.; Righi, M.; Evaldsson, M.; Lauer, A.; Wenzel, S.; Jones, C.; Anav, A.; Andrews, O.; Cionni, I.; Davin, E. L.; Deser, C.; Ehbrecht, C.; Friedlingstein, P.; Gleckler, P.; Gottschaldt, K.-D.; Hagemann, S.; Juckes, M.; Kindermann, S.; Krasting, J.; Kunert, D.; Levine, R.; Loew, A.; Mäkelä, J.; Martin, G.; Mason, E.; Phillips, A.; Read, S.; Rio, C.; Roehrig, R.; Senftleben, D.; Sterl, A.; van Ulft, L. H.; Walton, J.; Wang, S.; Williams, K. D.

    2015-09-01

    A community diagnostics and performance metrics tool for the evaluation of Earth System Models (ESMs) has been developed that allows for routine comparison of single or multiple models, either against predecessor versions or against observations. The priority of the effort so far has been to target specific scientific themes focusing on selected Essential Climate Variables (ECVs), a range of known systematic biases common to ESMs, such as coupled tropical climate variability, monsoons, Southern Ocean processes, continental dry biases and soil hydrology-climate interactions, as well as atmospheric CO2 budgets, tropospheric and stratospheric ozone, and tropospheric aerosols. The tool is being developed in such a way that additional analyses can easily be added. A set of standard namelists for each scientific topic reproduces specific sets of diagnostics or performance metrics that have demonstrated their importance in ESM evaluation in the peer-reviewed literature. The Earth System Model Evaluation Tool (ESMValTool) is a community effort open to both users and developers encouraging open exchange of diagnostic source code and evaluation results from the CMIP ensemble. This will facilitate and improve ESM evaluation beyond the state-of-the-art and aims at supporting such activities within the Coupled Model Intercomparison Project (CMIP) and at individual modelling centres. Ultimately, we envisage running the ESMValTool alongside the Earth System Grid Federation (ESGF) as part of a more routine evaluation of CMIP model simulations while utilizing observations available in standard formats (obs4MIPs) or provided by the user.

  6. Liposome bupivacaine for postsurgical pain in an obese woman with chronic pain undergoing laparoscopic gastrectomy: a case report

    PubMed Central

    2014-01-01

    Introduction To reduce incidence and severity of postsurgical pain and minimize the effect of its clinical and economic correlates, multimodal therapy for surgical patients is recommended. In this report, we discuss the use of liposome bupivacaine, a novel multivesicular formulation of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia, as part of a multimodal analgesic regimen in a patient with a history of chronic pain scheduled to undergo laparoscopic sleeve gastrectomy. To the best of our knowledge, this is the first published report of liposome bupivacaine in the setting of laparoscopic sleeve gastrectomy. Case presentation A 35-year-old white woman with morbid obesity was admitted for laparoscopic sleeve gastrectomy to lose weight prior to hip replacement surgery. Because of a complicated medical history that included rheumatoid arthritis, fibromyalgia, diabetes mellitus, hypertension, and chronic pain, for which she was receiving high doses of opioid analgesics, postsurgical pain management was a concern and she was considered a candidate for multimodal analgesia. At initiation of surgery, 50mL of lidocaine and epinephrine was infiltrated around the port sites. At the conclusion, 25mL of normal sterile saline was added to a 20mL vial of liposome bupivacaine (266mg) and injected around the port sites and at the site of liver retraction. Laparoscopic sleeve gastrectomy was successfully completed. Our patient was discharged to the postanesthesia care unit for approximately four hours before discharge to the surgical floor with a pain score of 5 (11-point scale; 0 = no pain, 10 = worst possible pain). Her postoperative course was uneventful; no adverse events were recorded during surgery or during the remainder of her hospital stay. Our patient was discharged on the same opioid regimen used previously for control of her preexisting chronic pain. Conclusions Liposome bupivacaine use in this morbidly obese

  7. Comparative evaluation of molecular diagnostic tests for Nucleospora salmonis and prevalence in migrating juvenile salmonids from the Snake River, USA.

    PubMed

    Badil, Samantha; Elliott, Diane G; Kurobe, Tomofumi; Hedrick, Ronald P; Clemens, Kathy; Blair, Marilyn; Purcell, Maureen K

    2011-03-01

    Nucleospora salmonis is an intranuclear microsporidian that primarily infects lymphoblast cells and contributes to chronic lymphoblastosis and a leukemia-like condition in a range of salmonid species. The primary goal of this study was to evaluate the prevalence of N. salmonis in out-migrating juvenile hatchery and wild Chinook salmon Oncorhynchus tshawytscha and steelhead O. mykiss from the Snake River in the U.S. Pacific Northwest. To achieve this goal, we first addressed the following concerns about current molecular diagnostic tests for N. salmonis: (1) nonspecific amplification patterns by the published nested polymerase chain reaction (nPCR) test, (2) incomplete validation of the published quantitative PCR (qPCR) test, and (3) whether N. salmonis can be detected reliably from nonlethal samples. Here, we present an optimized nPCR protocol that eliminates nonspecific amplification. During validation of the published qPCR test, our laboratory developed a second qPCR test that targeted a different gene sequence and used different probe chemistry for comparison purposes. We simultaneously evaluated the two different qPCR tests for N. salmonis and foundthat both assays were highly specific, sensitive, and repeatable. The nPCR and qPCR tests had good overall concordance when DNA samples derived from both apparently healthy and clinically diseased hatchery rainbow trout were tested. Finally, we demonstrated that gill snips were a suitable tissue for nonlethal detection of N. salmonis DNA in juvenile salmonids. Monitoring of juvenile salmonid fish in the Snake River over a 3-year period revealed low prevalence of N. salmonis in hatchery and wild Chinook salmon and wild steelhead but significantly higher prevalence in hatchery-derived steelhead. Routine monitoring of N. salmonis is not performed for all hatchery steelhead populations. At present, the possible contribution of this pathogen to delayed mortality of steelhead has not been determined.

  8. Comparative evaluation of molecular diagnostic tests for Nucleospora salmonis and prevalence in migrating juvenile salmonids from the Snake River, USA

    USGS Publications Warehouse

    Badil, Samantha; Elliott, Diane G.; Kurobe, Tomofumi; Hedrick, Ronald P.; Clemens, Kathy; Blair, Marilyn; Purcell, Maureen K.

    2011-01-01

    Nucleospora salmonis is an intranuclear microsporidian that primarily infects lymphoblast cells and contributes to chronic lymphoblastosis and a leukemia-like condition in a range of salmonid species. The primary goal of this study was to evaluate the prevalence of N. salmonis in out-migrating juvenile hatchery and wild Chinook salmon Oncorhynchus tshawytscha and steelhead O. mykiss from the Snake River in the U.S. Pacific Northwest. To achieve this goal, we first addressed the following concerns about current molecular diagnostic tests for N. salmonis: (1) nonspecific amplification patterns by the published nested polymerase chain reaction (nPCR) test, (2) incomplete validation of the published quantitative PCR (qPCR) test, and (3) whether N. salmonis can be detected reliably from nonlethal samples. Here, we present an optimized nPCR protocol that eliminates nonspecific amplification. During validation of the published qPCR test, our laboratory developed a second qPCR test that targeted a different gene sequence and used different probe chemistry for comparison purposes. We simultaneously evaluated the two different qPCR tests for N. salmonis and found that both assays were highly specific, sensitive, and repeatable. The nPCR and qPCR tests had good overall concordance when DNA samples derived from both apparently healthy and clinically diseased hatchery rainbow trout were tested. Finally, we demonstrated that gill snips were a suitable tissue for nonlethal detection of N. salmonis DNA in juvenile salmonids. Monitoring of juvenile salmonid fish in the Snake River over a 3-year period revealed low prevalence of N. salmonis in hatchery and wild Chinook salmon and wild steelhead but significantly higher prevalence in hatchery-derived steelhead. Routine monitoring of N. salmonis is not performed for all hatchery steelhead populations. At present, the possible contribution of this pathogen to delayed mortality of steelhead has not been determined.

  9. Concept of computer-assisted clinical diagnostic documentation systems for the practice with the option of later scientific evaluations.

    PubMed

    Ahlers, M O; Jaeger, D; Jakstat, H A

    2010-01-01

    Treatment data from practices and specialization centers, especially in the increasingly specialized areas which university clinics do not cover, are very important for evaluating the effectiveness and efficiency of dental examination and treatment methods. In the case of paper-based documentation, the evaluation of these data usually fails because of the cost it entails. With the use of electronic medical records, this expense can be markedly lower, provided the data acquisition and storage is structured accordingly. Since access to sensitive person-related data is simplified considerably by this method, such health data are protected, especially on the European level. Other than generally assumed, this protection is not restricted solely to the confidentiality principle, but also comprises the power of disposition over the data (data protection). The result is that from a legal point of view, the treatment data cannot be readily used for scientific studies, not even by dentists and physicians who have collected the data legally during the course of their therapeutic work. The technical separation of treatment data from the personal data offers a legally acceptable solution to this problem. It must ensure that a later assignment to individual persons will not be feasible at a realistic expense ("effective anonymization"). This article describes the legal and information technology principles and their practical implementation, as illustrated by the concept of a respective compliant IT architecture for the dentaConcept CMD fact diagnostic software. Here, a special export function automatically separates the anonymized treatment data and thus facilitates multicentric studies within an institution and among dental practices. PMID:20879462

  10. SU-E-I-49: The Evaluation of Usability of Multileaf Collimator for Diagnostic Radiation in Cephalometric Exposure

    SciTech Connect

    Han, S; Kim, K; Jung, H; Kim, M; Ji, Y; Park, S; Choi, S

    2014-06-01

    Purpose: This study evaluated usability of Multileaf collimator (MLC) for diagnostic radiation in cephalometric exposure using optical stimulated luminance dosimeters (OSLDs) Methods: The MLC material was made alloy tool steel (SKD-11) and the density of it is 7.89g/m3 that is similar to it of steel (Fe, 7.85 g/m3) and the MLC was attached to general radiography unit (Rex-650R, Listem Inc, Korea) for cephalometric exposure. The OSLDs that used were nanoDotTM Dosimeter (Landauer Inc, Glenwood, USA) and we read out OSLDs with micro star system (Landauer Inc, Glenwood, USA). The Optical annealing system contained fluorescent lamps (Osram lumilux, 24 W, 280 ∼780 nm). To measure absorbed dose using OSLDs, was carried out dosimetric characteristics of OSLDs. Based on these, we evaluated dose reduction of critical organ (Eyes, Thyroids) with MLC in cephalometric exposure Results: The dosimetric characteristics were following that batch homogeneity was 1.21% and reproducibility was 0.96% of the coefficient of variation The linearity was that the correlation of between dose and count was fitted by linear function (dose,mGy = 0.00029 × Count, R2 =0.997). The range of angular dependence was from −3.6% to 3.7% variation when each degree was normalized by zero degree. The organ dose of Rt. eye, Lt eye, thyroids were 77.8 μGy, 337.0 μGy, 323.1μGy, respectively in open field and the dose reduction of organ dose was 10.6%(8.3μGy), 12.4 %(42 μGy), 87.1%(281.4μGy) with MLC Conclusion: We certified dose reduction of organ dose in cephalometric exposure. The dose reduction of Eye was 11% because of reduction of field size and it of thyroids was 87% by primary beam shielding.

  11. Multicountry Prospective Clinical Evaluation of Two Enzyme-Linked Immunosorbent Assays and Two Rapid Diagnostic Tests for Diagnosing Dengue Fever

    PubMed Central

    Dauner, Allison L.; Valks, Andrea; Forshey, Brett M.; Long, Kanya C.; Thaisomboonsuk, Butsaya; Sierra, Gloria; Picos, Victor; Talmage, Sara; Morrison, Amy C.; Halsey, Eric S.; Comach, Guillermo; Yasuda, Chadwick; Loeffelholz, Michael; Jarman, Richard G.; Fernandez, Stefan; An, Ung Sam; Kochel, Tadeusz J.; Jasper, Louis E.; Wu, Shuenn-Jue L.

    2015-01-01

    We evaluated four dengue diagnostic devices from Alere, including the SD Bioline Dengue Duo (nonstructural [NS] 1 Ag and IgG/IgM), the Panbio Dengue Duo Cassette (IgM/IgG) rapid diagnostic tests (RDTs), and the Panbio dengue IgM and IgG capture enzyme-linked immunosorbent assays (ELISAs) in a prospective, controlled, multicenter study in Peru, Venezuela, Cambodia, and the United States, using samples from 1,021 febrile individuals. Archived, well-characterized samples from an additional 135 febrile individuals from Thailand were also used. Reference testing was performed on all samples using an algorithm involving virus isolation, in-house IgM and IgG capture ELISAs, and plaque reduction neutralization tests (PRNT) to determine the infection status of the individual. The primary endpoints were the clinical sensitivities and specificities of these devices. The SD Bioline Dengue Duo had an overall sensitivity of 87.3% (95% confidence interval [CI], 84.1 to 90.2%) and specificity of 86.8% (95% CI, 83.9 to 89.3%) during the first 14 days post-symptom onset (p.s.o.). The Panbio Dengue Duo Cassette demonstrated a sensitivity of 92.1% (87.8 to 95.2%) and specificity of 62.2% (54.5 to 69.5%) during days 4 to 14 p.s.o. The Panbio IgM capture ELISA had a sensitivity of 87.6% (82.7 to 91.4%) and specificity of 88.1% (82.2 to 92.6%) during days 4 to 14 p.s.o. Finally, the Panbio IgG capture ELISA had a sensitivity of 69.6% (62.1 to 76.4%) and a specificity of 88.4% (82.6 to 92.8%) during days 4 to 14 p.s.o. for identification of secondary dengue infections. This multicountry prospective study resulted in reliable real-world performance data that will facilitate data-driven laboratory test choices for managing patient care during dengue outbreaks. PMID:25588659

  12. Multicountry prospective clinical evaluation of two enzyme-linked immunosorbent assays and two rapid diagnostic tests for diagnosing dengue fever.

    PubMed

    Pal, Subhamoy; Dauner, Allison L; Valks, Andrea; Forshey, Brett M; Long, Kanya C; Thaisomboonsuk, Butsaya; Sierra, Gloria; Picos, Victor; Talmage, Sara; Morrison, Amy C; Halsey, Eric S; Comach, Guillermo; Yasuda, Chadwick; Loeffelholz, Michael; Jarman, Richard G; Fernandez, Stefan; An, Ung Sam; Kochel, Tadeusz J; Jasper, Louis E; Wu, Shuenn-Jue L

    2015-04-01

    We evaluated four dengue diagnostic devices from Alere, including the SD Bioline Dengue Duo (nonstructural [NS] 1 Ag and IgG/IgM), the Panbio Dengue Duo Cassette (IgM/IgG) rapid diagnostic tests (RDTs), and the Panbio dengue IgM and IgG capture enzyme-linked immunosorbent assays (ELISAs) in a prospective, controlled, multicenter study in Peru, Venezuela, Cambodia, and the United States, using samples from 1,021 febrile individuals. Archived, well-characterized samples from an additional 135 febrile individuals from Thailand were also used. Reference testing was performed on all samples using an algorithm involving virus isolation, in-house IgM and IgG capture ELISAs, and plaque reduction neutralization tests (PRNT) to determine the infection status of the individual. The primary endpoints were the clinical sensitivities and specificities of these devices. The SD Bioline Dengue Duo had an overall sensitivity of 87.3% (95% confidence interval [CI], 84.1 to 90.2%) and specificity of 86.8% (95% CI, 83.9 to 89.3%) during the first 14 days post-symptom onset (p.s.o.). The Panbio Dengue Duo Cassette demonstrated a sensitivity of 92.1% (87.8 to 95.2%) and specificity of 62.2% (54.5 to 69.5%) during days 4 to 14 p.s.o. The Panbio IgM capture ELISA had a sensitivity of 87.6% (82.7 to 91.4%) and specificity of 88.1% (82.2 to 92.6%) during days 4 to 14 p.s.o. Finally, the Panbio IgG capture ELISA had a sensitivity of 69.6% (62.1 to 76.4%) and a specificity of 88.4% (82.6 to 92.8%) during days 4 to 14 p.s.o. for identification of secondary dengue infections. This multicountry prospective study resulted in reliable real-world performance data that will facilitate data-driven laboratory test choices for managing patient care during dengue outbreaks. PMID:25588659

  13. Multicountry prospective clinical evaluation of two enzyme-linked immunosorbent assays and two rapid diagnostic tests for diagnosing dengue fever.

    PubMed

    Pal, Subhamoy; Dauner, Allison L; Valks, Andrea; Forshey, Brett M; Long, Kanya C; Thaisomboonsuk, Butsaya; Sierra, Gloria; Picos, Victor; Talmage, Sara; Morrison, Amy C; Halsey, Eric S; Comach, Guillermo; Yasuda, Chadwick; Loeffelholz, Michael; Jarman, Richard G; Fernandez, Stefan; An, Ung Sam; Kochel, Tadeusz J; Jasper, Louis E; Wu, Shuenn-Jue L

    2015-04-01

    We evaluated four dengue diagnostic devices from Alere, including the SD Bioline Dengue Duo (nonstructural [NS] 1 Ag and IgG/IgM), the Panbio Dengue Duo Cassette (IgM/IgG) rapid diagnostic tests (RDTs), and the Panbio dengue IgM and IgG capture enzyme-linked immunosorbent assays (ELISAs) in a prospective, controlled, multicenter study in Peru, Venezuela, Cambodia, and the United States, using samples from 1,021 febrile individuals. Archived, well-characterized samples from an additional 135 febrile individuals from Thailand were also used. Reference testing was performed on all samples using an algorithm involving virus isolation, in-house IgM and IgG capture ELISAs, and plaque reduction neutralization tests (PRNT) to determine the infection status of the individual. The primary endpoints were the clinical sensitivities and specificities of these devices. The SD Bioline Dengue Duo had an overall sensitivity of 87.3% (95% confidence interval [CI], 84.1 to 90.2%) and specificity of 86.8% (95% CI, 83.9 to 89.3%) during the first 14 days post-symptom onset (p.s.o.). The Panbio Dengue Duo Cassette demonstrated a sensitivity of 92.1% (87.8 to 95.2%) and specificity of 62.2% (54.5 to 69.5%) during days 4 to 14 p.s.o. The Panbio IgM capture ELISA had a sensitivity of 87.6% (82.7 to 91.4%) and specificity of 88.1% (82.2 to 92.6%) during days 4 to 14 p.s.o. Finally, the Panbio IgG capture ELISA had a sensitivity of 69.6% (62.1 to 76.4%) and a specificity of 88.4% (82.6 to 92.8%) during days 4 to 14 p.s.o. for identification of secondary dengue infections. This multicountry prospective study resulted in reliable real-world performance data that will facilitate data-driven laboratory test choices for managing patient care during dengue outbreaks.

  14. Evaluation of the LLNL Spectrometer for Possible use with the NSTec Optical Streak Camera as a Light Gas Gun Diagnostic

    SciTech Connect

    O'Connor, J., Cradick, J.

    2012-09-27

    In fiscal year 2012, it was desired to combine a visible spectrometer with a streak camera to form a diagnostic system for recording time-resolved spectra generated in light gas gun experiments. Acquiring a new spectrometer was an option, but it was possible to borrow an existing unit for a period of months, which would be sufficient to evaluate both “off-line” and in-gas gun shots. If it proved adequate for this application, it could be duplicated (with possible modifications); if not, such testing would help determine needed specifications for another model. This report describes the evaluation of the spectrometer (separately and combined with the NSTec LO streak camera) for this purpose. Spectral and temporal resolutions were of primary interest. The first was measured with a monochromatic laser input. The second was ascertained by the combination of the spectrometer’s spatial resolution in the time-dispersive direction and the streak camera’s intrinsic temporal resolution. System responsivity was also important, and this was investigated by measuring the response of the spectrometer/camera system to black body input—the gas gun experiments are expected to be similar to a 3000K black body—as well as measuring the throughput of the spectrometer separately over a range of visible light provided by a monochromator. The flat field (in wavelength) was also measured and the final part of the evaluation was actual fielding on two gas gun shots. No firm specifications for spectral or temporal resolution were defined precisely, but these were desired to be in the 1–2 nm and 1–2 ns ranges, respectively, if possible. As seen below, these values were met or nearly met, depending on wavelength. Other performance parameters were also not given (threshold requirements) but the evaluations performed with laser, black body, and successful gas gun shots taken in aggregate indicate that the spectrometer is adequate for this purpose. Even still, some (relatively

  15. “A New Tool Improves Diagnostic Test Performance for Transmission EM Evaluation of Axonemal Dynein Arms”

    PubMed Central

    Funkhouser, W. Keith; Niethammer, Marc; Carson, Johnny L.; Burns, Kimberlie A.; Knowles, Michael R.; Leigh, Margaret W.; Zariwala, Maimoona A.; Funkhouser, William K.

    2014-01-01

    Diagnosis of primary ciliary dyskinesia (PCD) by identification of dynein arm loss in transmission electron microscopy (TEM) images can be confounded by high background noise due to random electron-dense material within the ciliary matrix, leading to diagnostic uncertainty even for experienced morphologists. We developed a novel image analysis tool to average the axonemal peripheral microtubular doublets, thereby increasing microtubular signal and reducing random background noise. In a randomized, double-blinded study that compared two experienced morphologists and three different diagnostic approaches, we found that use of this tool led to improvement in diagnostic TEM test performance. PMID:23957500

  16. The complement component C5a receptor mediates pain and inflammation in a postsurgical pain model.

    PubMed

    Liang, De-Yong; Li, XiangQi; Shi, Xiaoyu; Sun, Yuan; Sahbaie, Peyman; Li, Wen-Wu; Clark, J David

    2012-02-01

    The complement system is an important part of innate immunity. Complement activation generates a set of effector molecules with diverse biological functions. C5a is a crucial terminal component of the complement cascade. Several reports suggest that C5a can support nociceptive sensitization and inflammation in various models, including models of incisional pain. However, information concerning the differential effects of C5a on specific modalities of nociception, the role of C5a in supporting neutrophil infiltration, secondary nociceptive mediator generation, and the location of the relevant populations of C5a receptors supporting incisional sensitization are needed. In these studies we utilized C5a receptor-null mice (C5aR(-/-)) and matched controls to study nociceptive changes after hind paw incision. Heat hyperalgesia and mechanical allodynia were measured for 4 days after incision. We also followed hind paw edema, wound area neutrophil infiltration using the myeloperoxidase assay, and interleukin-1β and nerve growth factor levels using both enzyme-linked immunosorbent assay and immunohistochemical techniques. The main findings were: (1) Heat vs mechanical nociceptive sensitization after incision were differentially reduced in C5aR(-/-) mice, with thermal sensitization affected throughout the postincisional period but mechanical sensitization affected only at later time points; (2) Edema developed after incision in wild-type mice but only slightly and transiently in C5aR(-/-) mice, and (3) Deletion of C5aR blocked interleukin-1β and nerve growth factor production near the wound site. These findings demonstrate that the complement system component C5a is a novel biomarker and mediator associated with postsurgical nociceptive processing. C5aR may provide a novel target for the control of pain and inflammation after surgery.

  17. Post-surgical mediastinitis due to carbapenem-resistant Enterobacteriaceae: Clinical, epidemiological and survival characteristics.

    PubMed

    Abboud, C S; Monteiro, J; Stryjewski, M E; Zandonadi, E C; Barbosa, V; Dantas, D; Sousa, E E; Fonseca, M J; Jacobs, D M; Pignatari, A C; Kiffer, C; Rao, G G

    2016-05-01

    Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE), including polymyxin-resistant (PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life-threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE, including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE (PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carried blaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received at least one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higher in patients infected with PR-CRE (17% vs. 53%; P=0.06). In conclusion, mediastinitis due to CRE, including PR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a high mortality, particularly those infected with PR-CRE.

  18. Pectus excavatum postsurgical outcome based on preoperative soft body dynamics simulation

    NASA Astrophysics Data System (ADS)

    Moreira, Antonio H. J.; Rodrigues, Pedro L.; Fonseca, Jaime; Pinho, A. C. M.; Rodrigues, Nuno F.; Correia-Pinto, Jorge; Vilaça, João L.

    2012-02-01

    Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which an abnormal formation of the rib cage gives the chest a caved-in or sunken appearance. Today, the surgical correction of this deformity is carried out in children and adults through Nuss technic, which consists in the placement of a prosthetic bar under the sternum and over the ribs. Although this technique has been shown to be safe and reliable, not all patients have achieved adequate cosmetic outcome. This often leads to psychological problems and social stress, before and after the surgical correction. This paper targets this particular problem by presenting a method to predict the patient surgical outcome based on pre-surgical imagiologic information and chest skin dynamic modulation. The proposed approach uses the patient pre-surgical thoracic CT scan and anatomical-surgical references to perform a 3D segmentation of the left ribs, right ribs, sternum and skin. The technique encompasses three steps: a) approximation of the cartilages, between the ribs and the sternum, trough b-spline interpolation; b) a volumetric mass spring model that connects two layers - inner skin layer based on the outer pleura contour and the outer surface skin; and c) displacement of the sternum according to the prosthetic bar position. A dynamic model of the skin around the chest wall region was generated, capable of simulating the effect of the movement of the prosthetic bar along the sternum. The results were compared and validated with patient postsurgical skin surface acquired with Polhemus FastSCAN system.

  19. Post-surgical mediastinitis due to carbapenem-resistant Enterobacteriaceae: Clinical, epidemiological and survival characteristics.

    PubMed

    Abboud, C S; Monteiro, J; Stryjewski, M E; Zandonadi, E C; Barbosa, V; Dantas, D; Sousa, E E; Fonseca, M J; Jacobs, D M; Pignatari, A C; Kiffer, C; Rao, G G

    2016-05-01

    Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE), including polymyxin-resistant (PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life-threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE, including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE (PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carried blaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received at least one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higher in patients infected with PR-CRE (17% vs. 53%; P=0.06). In conclusion, mediastinitis due to CRE, including PR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a high mortality, particularly those infected with PR-CRE. PMID:27155944

  20. A case of acute reversible Charles Bonnet syndrome following postsurgical unilateral eye patch placement.

    PubMed

    Khadavi, Nicole Miriam; Lew, Helen; Goldberg, Robert Alan; Mancini, Ronald

    2010-01-01

    A fully alert 70-year-old male with no significant medical or psychiatric history presented for surgical follow-up after uncomplicated right lower eyelid cicatricial ectropion surgery with postoperative unilateral, eye patch placement complaining of visual hallucinations. Preoperative unaided visual acuity was 20/20 in each eye. The patient described simple, nonformed and complex, formed images that were both static and animated. The images included crystal-like formations that appeared to bubble, green leaves against a vivid magenta backdrop, and an isolated hallucination of a lifelike plant with trembling leaves. These hallucinations began 2 days postoperatively and persisted 2 days following eye patch removal. The patient perceived the hallucinations multiple times a day over the 7-day period, without a stereotyped pattern. The images occurred when the eyes were open and ceased when they were closed. They were prompted by looking at a blank wall or white surface. The patient consistently recognized these images as unreal. They typically persisted for 1 to 2 minutes and could be extinguished by looking away. There were no associated auditory hallucinations, psychosis, or delirium and no history of visual, cognitive, or neurological deficit. The patient denied the use of hallucinogenic medications, including analgesics, or the initiation of any new medications. To the authors' knowledge, this is the first reported case of acute reversible CBS following unilateral eye patch placement. CBS may be a frightening postsurgical consequence of eye patch placement. It is important that the ophthalmic surgeon be aware of the potential for development of CBS and offer appropriate referral and reassurance should it occur. PMID:20551853

  1. Copper as ancillary diagnostic tool in preoperative evaluation of possible papillary thyroid carcinoma in patients with benign thyroid disease.

    PubMed

    Dragutinović, Vesna V; Tatić, Svetislav B; Nikolić-Mandić, Snežana D; Tripković, Tatjana M; Dunđerović, Duško M; Paunović, Ivan R

    2014-09-01

    Preoperative diagnosis of papillary thyroid carcinoma (PTC) comprises numerous diagnostic procedures which are mostly applicable in tertiary institutions. Normal thyroid function depends on the presence of many trace elements and copper (Cu) and zinc (Zn) are some of those. The study is based on retrospective review of 118 patients with preoperatively diagnosed benign thyroid disease (BTD) and 12 with PTC, who underwent thyroid surgery at the Center for Endocrine Surgery Clinical Center of Serbia, Belgrade, between 2010 and 2012. The objective was to evaluate concentrations of Cu and Zn in serum as possible prediction markers for PTC in patients who underwent surgery for preoperatively diagnosed BTD. Concentrations of Cu and Zn ions in serum were measured using atomic absorption spectrophotometer. Data were analyzed using methods of descriptive statistics, Anova and t-test (p < 0.05 was considered statistically significant). Definitive pathohistological findings revealed PTC in 23 (19.5%) and papillary microcarcinoma-mPTC in 13 (11.0%) of BTD patients. The concentrations of Cu ions in serum of PTC patients as well as in serum of patients with mPTC were significantly higher than in serum of BTD patients (p < 0.05). The concentrations of Zn ions and Cu/Zn ratio in serum of PTC and mPTC patients were not significantly higher than in serum of BTD patients. The concentration of Cu ions in serum of patients before thyroid surgery can be useful, easy available, and a low-cost tool in prediction of preoperatively undiagnosed PTC in patients with BTD.

  2. Evaluation of ultrasonography as a diagnostic tool in the management of head and neck facial space infections: A clinical study

    PubMed Central

    Shah, Ajaz; Ahmed, Irshad; Hassan, Shahid; Samoon, Amina; Ali, Babar

    2015-01-01

    Introduction: Superficial facial space infections represent a significant amount of the dental problems that present to hospital. Determining whether an odontogenic swelling is a cellulitis or abscess is difficult, but important as both may require different treatments. The use of an ultrasound may aid in differentiating cellulitis and abscess. This study was done to compare the accuracy of clinical examination alone versus ultrasonography (USG) in the diagnosis of cellulitis and abscess in symptomatic patients with a diagnosis of superficial facial space infection. Materials and Methods: Twenty patients (1870 years) diagnosed as superficial facial space infections by clinical and radiographic examinations were included in the study and patients with significant medical conditions were excluded. The provisional clinical diagnosis was made after a thorough history was taken and clinical examination was performed to determine if the swelling was a cellulitis or abscess. Swelling was then evaluated using the ultrasonic transducer which was placed over the swelling to aid the diagnosis which was again recorded. An incision and drainage procedure was performed after the administration of local anesthesia. The success of the ultrasound intervention versus clinical examination was based on whether frank exudation was detected during incision and drainage of such swellings. Results: The statistical analysis found that USG is a valuable diagnostic aid for detection of abscess or cellulitis in head and neck facial space infections. Interpretation and Conclusion: The findings of this prospective analysis indicate that there was statistical difference between clinical examination alone and USG in making the correct diagnosis. The sensitivity, specificity, positive predictive, negative predictive, and accuracy were not similar for all methods tested. From the results of this study, ultrasound is recommended as an adjunct to clinical examination in differentiating between

  3. Toward noninvasive microspectrofluorometry of skin lesions for diagnostic and prognostic evaluation of cell metabolism and organelle interactions

    NASA Astrophysics Data System (ADS)

    Hirschberg, Joseph G.; Schachtschabel, Astrid; Kohen, Elli; Kohen, Cahide; Schachtschabel, Dietrich O.

    1995-02-01

    studies with the new highly sensitive cyanine nucleic acid dyes and their dimers, but caution should be exerted in the use of such compounds because of cytotoxicity (e.g., limiting it to cellular studies used in the interpretation of dermatological findings). Parallel cellular and non-invasive dermatological studies will help to define the most specific set of parameters to be used in diagnostic and prognostic evaluations of skin lesions.

  4. [Reduction in requirements of oral calcium and 1-25 dihydroxy vitamin D in patients with post-surgical hypoparathyroidism treated with teriparatide (PTH1-34)].

    PubMed

    Gutiérrez-Cerecedo, Leticia Eugenia; Vergara-López, Alma; Rosas-Barrientos, José Vicente; Guillén-González, Miguel Ángel

    2016-01-01

    The objective of the study is to evaluate the effect of daily administration of recombinant parathyroid hormone (PTH1-34), 20 μg, on serum calcium concentrations (Cas), and the requirements of oral calcium and calcitriol in patients with hypoparathyroidism. It is a prospective, longitudinal study, analytical, with intervention, in patients treated with high doses of calcium (> 7 g/day), with symptoms of hypocalcemia and/or intolerant to treatment. Serum levels of phosphorus (Ps) and Cas, urinary calcium excretion, oral doses of calcitriol and calcium were compared before and after administration of teriparatide, for three months on average, in patients with post-surgical hypoparathyroidism. We studied 16 patients with oral elemental calcium requirements of 22.5 ± 16 g/day of calcitriol 0.79 ± 0.4 µg/day. Cas at baseline was 7.6 ± 1.2 and Ps 5.4 ± 0.76 mg/dl. After administration of teriparatide, Cas was 9.0 ± 0.69 mg/dl (p = 0.007) and Ps of 4.5 ± 0.87 mg/dl (p = 0.003). Doses of calcium and calcitriol showed a statistically significant reduction (p = 0.0001 and 0.001, respectively). We conclude that use of recombinant parathyroid hormone can normalize Cas and Ps, with reduction in oral calcium and calcitriol requirements.

  5. Suicide plus immune gene therapy prevents post-surgical local relapse and increases overall survival in an aggressive mouse melanoma setting.

    PubMed

    Villaverde, Marcela S; Combe, Kristell; Duchene, Adriana G; Wei, Ming X; Glikin, Gerardo C; Finocchiaro, Liliana M E

    2014-09-01

    In an aggressive B16-F10 murine melanoma model, we evaluated the effectiveness and antitumor mechanisms triggered by a surgery adjuvant treatment that combined a local suicide gene therapy (SG) with a subcutaneous genetic vaccine (Vx) composed of B16-F10 cell extracts and lipoplexes carrying the genes of human interleukin-2 and murine granulocyte and macrophage colony stimulating factor. Pre-surgical SG treatment, neither alone nor combined with Vx was able to slow down the fast evolution of this tumor. After surgery, both SG and SG + Vx treatments, significantly prevented (in 50% of mice) or delayed (in the remaining 50%) post-surgical recurrence, as well as significantly prolonged recurrence-free (SG and SG + Vx) and overall median survival (SG + Vx). The treatment induced the generation of a pseudocapsule wrapping and separating the tumor from surrounding host tissue. Both, SG and the subcutaneous Vx, induced this envelope that was absent in the control group. On the other hand, PET scan imaging of the SG + Vx group suggested the development of an effective systemic immunostimulation that enhanced (18)FDG accrual in the thymus, spleen and vertebral column. When combined with surgery, direct intralesional injection of suicide gene plus distal subcutaneous genetic vaccine displayed efficacy and systemic antitumor immune response without host toxicity. This suggests the potential value of the assayed approach for clinical purposes.

  6. Nitric oxide is involved in ibuprofen preemptive analgesic effect in the plantar incisional model of postsurgical pain in mice.

    PubMed

    Saad, Sherin S T; Hamza, May; Bahr, Mohamed H; Masoud, Somaia I

    2016-02-12

    Control of postoperative pain is far from satisfactory. Yet, non-steroidal anti-inflammatory drugs (NSAIDs) remain an important choice. The production of nitric oxide (NO), which plays an important role in the development and maintenance of inflammatory hyperalgesia, is inhibited by NSAIDs. Monoamines also play a key role in the modulation of nociception. The aim of the present work is to study the involvement of NO and monoamines in the antinociceptive mechanism of ibuprofen in postsurgical pain in mice. Surgical incision resulted in mechanical allodynia and increased spinal NO levels. The nitric oxide synthase inhibitor l-NAME (50mg/kg), administered intraperitoneally (i.p.), 30min before the incision decreased the development of postsurgical mechanical allodynia and reduced spinal NO levels. Ibuprofen (100 and 300mg/kg, i.p.), administered 30min before the incision, dose-dependently decreased both spinal NO levels and the development of mechanical allodynia. Administration of ibuprofen (100mg/kg i.p.), 20min following surgery, did not significantly reduce spinal NO level and resulted in a smaller antiallodynic effect. l-Arginine (600mg/kg i.p.), administered 20min before ibuprofen administration, restored both spinal NO level and mechanical allodynia in ibuprofen-treated mice. The selective alpha-2 adrenoceptor blocker yohimbine (4mg/kg i.p.), administered 30min before ibuprofen, also blocked ibuprofen effect on both mechanical allodynia and spinal NO level. These results suggest that inhibition of NO synthesis is involved in the analgesic activity of ibuprofen in post-surgical pain. Alpha-2 adrenoceptors are also involved in the analgesic activity of ibuprofen and NO may be involved in this mechanism.

  7. [The use of multivariate mathematical methods in medical diagnostic systems--a model for the evaluation of cytological smears].

    PubMed

    Molnár, B; Szentirmay, Z; Bodó, M; Sugár, J; Fehér, J

    1992-10-18

    The methods of the multivariate mathematics have been applied in several studies to increase the diagnostic reliability of medical decision support system. In the recent years some new algorithms for decision support (fuzzy logic) and for pattern recognition (neural nets), both specified by nonlinearity, were developed. This paper provides results for the application of this methods in the area of quantitative cytology and the comparison with the traditional classifiers. 21 normal, 15 dysplastic, 23 malignant, Feulgen stained gastric imprint smears were analysed on a Leitz Miamed DNA equipment. The determination of mean DNA content, the 2c deviation index (2cDI), 5c Exceeding rate (RcER), G1,S,G2 phase fraction ratios, cell nucleus area, form factor was performed. The discriminant analysis classified correctly the 95.6% of malignant cases, 86.7% of dysplasias, and 80.7% normal cases. Our diagnostic system using fuzzy logic made the diagnostic borders fine tuneable, and reliable. The back propagation neural net could classify all three diagnostic groups above 95% correctly. The application of nonlinear computational methods made the diagnostic system more reliable. The application of these algorithms are encouraged.

  8. Differentiating between analytical and diagnostic performance evaluation with a focus on the method comparison study and identification of bias.

    PubMed

    Flatland, Bente; Friedrichs, Kristen R; Klenner, Stefanie

    2014-12-01

    Prior to introduction of a new method to the diagnostic laboratory, analytical performance must be validated to ensure operation within the manufacturer's specifications and/or within predetermined quality requirements. In addition, the new method may require diagnostic performance assessment to ensure it differentiates between diseased and nondiseased individuals as intended. These 2 phases of assessment, while complementary, are not equivalent and require a different set of experiments, statistical analyses, and interpretation. Studies of analytical performance typically include a method comparison experiment, the purpose of which is to identify bias (inaccuracy) of the "test" (or "index") method (new method) relative to a "comparative method" (established method). Analysis of method comparison data is facilitated by commercial software programs that present the statistical significance of identified bias; however, the clinical relevance of any bias also should be considered. Studies of diagnostic performance should not be pursued until analytical performance is fully characterized and may not be required for well-established tests or for those for which results are nonspecific (ie, not referable to a specific disease or condition). Diagnostic performance assessment may include assessment of sensitivity, specificity, predictive values, odds ratios, and/or likelihood ratios. The purpose of this review is to clarify differences between the assessment of analytical and diagnostic performance, and to explore the method comparison study and bias assessment from a perspective not addressed in prior veterinary articles.

  9. Spectrally selective UV bactericidal effect for curative treatment of post-surgical intra-abdominal abscesses and other infections

    NASA Astrophysics Data System (ADS)

    Dudelzak, Alexander E.; Miller, Mark A.; Babichenko, Sergey M.

    2004-07-01

    Results of in-vitro studies of bactericidal effects of ultraviolet (UV) irradiation on strains causing drug-resistant endo-cavital infections (Enterococcus, Staphylococcus aureus, Pseudomonas aeruginosa, and others) are presented. An original technique to measure effects of UV-irradiation on bacterial growth at different wavelengths has been developed. Spectral dependences of the bactericidal effect have been observed, and spectral maxima of bactericidal efficiency have been found. Applications to curative treatments of wounds, post-surgical intra-abdominal abscesses and other diseases are discussed.

  10. Medial and Lateral Pectoral Nerve Block with Liposomal Bupivacaine for the Management of Postsurgical Pain after Submuscular Breast Augmentation

    PubMed Central

    Barlow, Mark; Carpin, Kimberly; Piña, Edward M.; Casso, Daniel

    2014-01-01

    Summary: This report describes an ultrasound-guided medial and lateral pectoralis nerve block using liposome bupivacaine, performed before the surgical incision, in a patient undergoing submuscular breast augmentation. The anatomic basis and technique are described. This procedure may be offered to patients undergoing submuscular insertion of a breast implant or tissue expander. Advancements in ultrasound guidance allow for more precise anatomic placement of local anesthetic agents. The injection technique used for this procedure resulted in complete relaxation of the pectoralis major, facilitating the surgical dissection and markedly diminishing postsurgical pain and muscle spasms. PMID:25587516

  11. Clinical diagnostic tools for screening of perioperative stroke in general surgery: a systematic review.

    PubMed

    Sun, Z; Yue, Y; Leung, C C H; Chan, M T V; Gelb, A W

    2016-03-01

    Perioperative stroke is a devastating complication that carries high mortality and functional disability. Unfortunately, residual anaesthesia and analgesia may obscure important warning signs and may lead to a delay in the assessment and treatment of major stroke after surgery. The purpose of this review is to examine the utility of existing stroke scales, for the recognition of perioperative stroke in the general surgical population. A total of 21 stroke scales have been described in the literature. Diagnostic performance was reported in 17 scales. The majority of the stroke scales were designed to evaluate current neurological deficits after an established stroke event. Recent abbreviated stroke test, such as the Face, Arm, Speech Test (FAST), were developed to facilitate stroke identification in the emergency department. Only two stroke scales have been applied in the perioperative setting after cardiac, carotid and neurological surgeries. The modified National Institutes of Health Stroke Scale appears to be useful in detecting new subtle neurological deficits in critical care, or high dependency units after surgery. However, in the general postsurgical wards, given the concern about the workload required, abbreviated stroke tests may be more appropriate for routine regular stroke surveillance. It is hoped that these tests will provide rapid assessment of global neurological function to facilitate timely diagnosis and treatment of perioperative stroke.

  12. More Than Just Accuracy: A Novel Method to Incorporate Multiple Test Attributes in Evaluating Diagnostic Tests Including Point of Care Tests

    PubMed Central

    Weigl, Bernhard; Fitzpatrick, Annette; Ide, Nicole

    2016-01-01

    Current frameworks for evaluating diagnostic tests are constrained by a focus on diagnostic accuracy, and assume that all aspects of the testing process and test attributes are discrete and equally important. Determining the balance between the benefits and harms associated with new or existing tests has been overlooked. Yet, this is critically important information for stakeholders involved in developing, testing, and implementing tests. This is particularly important for point of care tests (POCTs) where tradeoffs exist between numerous aspects of the testing process and test attributes. We developed a new model that multiple stakeholders (e.g., clinicians, patients, researchers, test developers, industry, regulators, and health care funders) can use to visualize the multiple attributes of tests, the interactions that occur between these attributes, and their impacts on health outcomes. We use multiple examples to illustrate interactions between test attributes (test availability, test experience, and test results) and outcomes, including several POCTs. The model could be used to prioritize research and development efforts, and inform regulatory submissions for new diagnostics. It could potentially provide a way to incorporate the relative weights that various subgroups or clinical settings might place on different test attributes. Our model provides a novel way that multiple stakeholders can use to visualize test attributes, their interactions, and impacts on individual and population outcomes. We anticipate that this will facilitate more informed decision making around diagnostic tests. PMID:27574576

  13. More Than Just Accuracy: A Novel Method to Incorporate Multiple Test Attributes in Evaluating Diagnostic Tests Including Point of Care Tests.

    PubMed

    Thompson, Matthew; Weigl, Bernhard; Fitzpatrick, Annette; Ide, Nicole

    2016-01-01

    Current frameworks for evaluating diagnostic tests are constrained by a focus on diagnostic accuracy, and assume that all aspects of the testing process and test attributes are discrete and equally important. Determining the balance between the benefits and harms associated with new or existing tests has been overlooked. Yet, this is critically important information for stakeholders involved in developing, testing, and implementing tests. This is particularly important for point of care tests (POCTs) where tradeoffs exist between numerous aspects of the testing process and test attributes. We developed a new model that multiple stakeholders (e.g., clinicians, patients, researchers, test developers, industry, regulators, and health care funders) can use to visualize the multiple attributes of tests, the interactions that occur between these attributes, and their impacts on health outcomes. We use multiple examples to illustrate interactions between test attributes (test availability, test experience, and test results) and outcomes, including several POCTs. The model could be used to prioritize research and development efforts, and inform regulatory submissions for new diagnostics. It could potentially provide a way to incorporate the relative weights that various subgroups or clinical settings might place on different test attributes. Our model provides a novel way that multiple stakeholders can use to visualize test attributes, their interactions, and impacts on individual and population outcomes. We anticipate that this will facilitate more informed decision making around diagnostic tests. PMID:27574576

  14. More Than Just Accuracy: A Novel Method to Incorporate Multiple Test Attributes in Evaluating Diagnostic Tests Including Point of Care Tests.

    PubMed

    Thompson, Matthew; Weigl, Bernhard; Fitzpatrick, Annette; Ide, Nicole

    2016-01-01

    Current frameworks for evaluating diagnostic tests are constrained by a focus on diagnostic accuracy, and assume that all aspects of the testing process and test attributes are discrete and equally important. Determining the balance between the benefits and harms associated with new or existing tests has been overlooked. Yet, this is critically important information for stakeholders involved in developing, testing, and implementing tests. This is particularly important for point of care tests (POCTs) where tradeoffs exist between numerous aspects of the testing process and test attributes. We developed a new model that multiple stakeholders (e.g., clinicians, patients, researchers, test developers, industry, regulators, and health care funders) can use to visualize the multiple attributes of tests, the interactions that occur between these attributes, and their impacts on health outcomes. We use multiple examples to illustrate interactions between test attributes (test availability, test experience, and test results) and outcomes, including several POCTs. The model could be used to prioritize research and development efforts, and inform regulatory submissions for new diagnostics. It could potentially provide a way to incorporate the relative weights that various subgroups or clinical settings might place on different test attributes. Our model provides a novel way that multiple stakeholders can use to visualize test attributes, their interactions, and impacts on individual and population outcomes. We anticipate that this will facilitate more informed decision making around diagnostic tests.

  15. Comparison of the diagnostic value of pump and gravity cavernosometry in the evaluation of the cavernous veno-occlusive mechanism.

    PubMed

    Meuleman, E J; Wijkstra, H; Doesburg, W H; Debruyne, F M

    1991-11-01

    We performed cavernosometry in 96 patients with erectile dysfunction. Two different techniques were compared: pump cavernosometry using a roller pump as the inflow source and gravity cavernosometry using an infusion set as the inflow source. We conclude that the diagnostic value of both techniques is comparable. In pump cavernosometry maintenance flow is the most accurate parameter of veno-occlusive function. Gravity cavernosometry has the advantages of simplicity, cost-effectiveness and a lower complication rate. Incomplete cavernous smooth muscle relaxation appeared to be limiting the diagnostic value of both techniques.

  16. Evaluating Diagnostic and Prognostic Value of Plasma miRNA133a in Acute Chest Pain Patients Undergoing Coronary Angiography

    PubMed Central

    Ke-Gang, Jia; Zhi-Wei, Li; Xin, Zhang; Jing, Wang; Ping, Shi; Xue-Jing, Han; Hong-Xia, Tang; Xin, Tang; Xiao-Cheng, Liu

    2016-01-01

    Abstract Circulating microRNA has recently emerged as a promising biomarker for cardiovascular disease. This study sought to evaluate the diagnostic and prognostic value of circulating miR-133a as a marker of acute myocardial infarction in acute chest pain patients undergoing coronary angiography. Plasma was collected from 312 patients with chest pain on admission in the emergency department and 67 healthy controls. MiR-133a was detected using real-time quantitative PCR and enhanced accu-TnI, creatinine kinase-MB mass, and myoglobin were measured by immunoassay. End-point events (serious adverse cardiovascular events which require hospitalization or cardiovascular death) were examined in the AMI (acute myocardical infarction) group within 1, 6, 12, and 24 months. The miR-133a level was higher in AMI patients than in non-AMI patients (P < 0.001). In the ROC analysis, the sensitivity of miR-133a in diagnosis of AMI is 0.61 and the specificity is 0.68. In the prognostic analysis, only 1 endpoint event was observed in the non-AMI group; the amount of cases with end-point events in the AMI group at 1,6,12, and 24 months were 8, 19, 28, and 35, respectively. The cutoff value of miR-133a was determined using the median value of the AMI group and separated the patients into a positive group and a negative group. The Kaplan–Meier survival curve showed no significant difference in survival was detected in AMI patients between the miR-133a positive group and negative group after follow-up (12-month: x2 = 1.353, P = 0.245; 24-month: x2 = 3.722, P = 0.054). After adjusting for age, gender, Killip classes, prior myocardiac infarction history, myoglobin, LVEF (left ventricular ejection fraction), diabetes, hypertension, smoking and systolic blood pressure, miR133a had a significant association with the risk of events at 12 months (HR = 2.869, P = 0.024) and 24 months (HR = 3.936, P = 0.001). In patients undergoing coronary angiography

  17. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI.

    PubMed

    Cavallari, Michele; Dai, Weiying; Guttmann, Charles R G; Meier, Dominik S; Ngo, Long H; Hshieh, Tammy T; Callahan, Amy E; Fong, Tamara G; Schmitt, Eva; Dickerson, Bradford C; Press, Daniel Z; Marcantonio, Edward R; Jones, Richard N; Inouye, Sharon K; Alsop, David C

    2016-04-01

    incidence and severity. This study raises the intriguing possibility that structural dysconnectivity involving interhemispheric and fronto-thalamo-cerebellar networks, as well as microstructural changes of structures involved in limbic and memory functions predispose to delirium under the stress of surgery. While the diffusion tensor imaging abnormalities observed in the corpus callosum, cingulum, and temporal lobe likely constitute the neural substrate for the association between premorbid cognition, as measured by general cognitive performance, and postoperative delirium, the microstructural changes observed in the cerebellum, hippocampus, thalamus and basal forebrain seem to constitute a separate phenomenon that predisposes to postsurgical delirium independent of presurgical cognitive status. PMID:26920674

  18. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI.

    PubMed

    Cavallari, Michele; Dai, Weiying; Guttmann, Charles R G; Meier, Dominik S; Ngo, Long H; Hshieh, Tammy T; Callahan, Amy E; Fong, Tamara G; Schmitt, Eva; Dickerson, Bradford C; Press, Daniel Z; Marcantonio, Edward R; Jones, Richard N; Inouye, Sharon K; Alsop, David C

    2016-04-01

    incidence and severity. This study raises the intriguing possibility that structural dysconnectivity involving interhemispheric and fronto-thalamo-cerebellar networks, as well as microstructural changes of structures involved in limbic and memory functions predispose to delirium under the stress of surgery. While the diffusion tensor imaging abnormalities observed in the corpus callosum, cingulum, and temporal lobe likely constitute the neural substrate for the association between premorbid cognition, as measured by general cognitive performance, and postoperative delirium, the microstructural changes observed in the cerebellum, hippocampus, thalamus and basal forebrain seem to constitute a separate phenomenon that predisposes to postsurgical delirium independent of presurgical cognitive status.

  19. Feasibility and Safety of Evaluating Patients with Prior Coronary Artery Disease Using an Accelerated Diagnostic Algorithm in a Chest Pain Unit

    PubMed Central

    Goldkorn, Ronen; Goitein, Orly; Ben-Zekery, Sagit; Shlomo, Nir; Narodetsky, Michael; Livne, Moran; Sabbag, Avi; Asher, Elad; Matetzky, Shlomi

    2016-01-01

    An accelerated diagnostic protocol for evaluating low-risk patients with acute chest pain in a cardiologist-based chest pain unit (CPU) is widely employed today. However, limited data exist regarding the feasibility of such an algorithm for patients with a history of prior coronary artery disease (CAD). The aim of the current study was to assess the feasibility and safety of evaluating patients with a history of prior CAD using an accelerated diagnostic protocol. We evaluated 1,220 consecutive patients presenting with acute chest pain and hospitalized in our CPU. Patients were stratified according to whether they had a history of prior CAD or not. The primary composite outcome was defined as a composite of readmission due to chest pain, acute coronary syndrome, coronary revascularization, or death during a 60-day follow-up period. Overall, 268 (22%) patients had a history of prior CAD. Non-invasive evaluation was performed in 1,112 (91%) patients. While patients with a history of prior CAD had more comorbidities, the two study groups were similar regarding hospitalization rates (9% vs. 13%, p = 0.08), coronary angiography (13% vs. 11%, p = 0.41), and revascularization (6.5% vs. 5.7%, p = 0.8) performed during CPU evaluation. At 60-days the primary endpoint was observed in 12 (1.6%) and 6 (3.2%) patients without and with a history of prior CAD, respectively (p = 0.836). No mortalities were recorded. To conclude, Patients with a history of prior CAD can be expeditiously and safely evaluated using an accelerated diagnostic protocol in a CPU with outcomes not differing from patients without such a history. PMID:27669521

  20. The Application and Evaluation of a Two-Concept Diagnostic Instrument with Students Entering College General Chemistry

    ERIC Educational Resources Information Center

    Heredia, Keily; Xu, Xiaoying; Lewis, Jennifer E.

    2012-01-01

    The Particulate Nature of Matter and Chemical Bonding Diagnostic Instrument (Othman J., Treagust D. F. and Chandrasegaran A. L., (2008), "Int. J. Sci. Educ.," 30(11), 1531-1550) is used to investigate college students' understanding of two chemistry concepts: particulate nature of matter and chemical bonding. The instrument, originally developed…

  1. Evaluating Secondary Students' Misconceptions of Photosynthesis and Respiration in Plants Using a Two-Tier Diagnostic Instrument.

    ERIC Educational Resources Information Center

    Treagust, David F.; Haslam, Filocha

    Based on the premise that multiple choice tests can be used as diagnostic tools for teachers in identifying and remedying student misconceptions, this study focused on the development of an instrument for diagnosing secondary students' understanding of photosynthesis and respiration. Information is presented on: (1) procedures of development of…

  2. The Job Diagnostic Survey: An Instrument for the Diagnosis of Jobs and the Evaluation of Job Redesign Projects.

    ERIC Educational Resources Information Center

    Hackman, J. Richard; Oldham, Greg R.

    The report describes the Job Diagnostic Survey (JDS), an instrument designed to measure the following classes of variables: (1) objective job characteristics, particularly the degree to which jobs are designed so that they enhance work motivation and job satisfaction; (2) personnel affective reactions of individuals to their jobs and work setting;…

  3. Prospective versus retrospective ECG-gated 64-detector coronary CT angiography for evaluation of coronary artery bypass graft patency: comparison of image quality, radiation dose and diagnostic accuracy.

    PubMed

    Lee, Jae Hwan; Chun, Eun Ju; Choi, Sang Il; Vembar, Mani; Lim, Cheong; Park, Kay-Hyun; Choi, Dong-Ju

    2011-06-01

    We aimed to evaluate image quality, radiation dose and diagnostic accuracy of coronary CT angiography (CCTA) with a prospectively gated transverse-axial scan (PGT) compared with a retrospectively gated helical scan (RGH), using a 64-slice scanner in patients who underwent coronary artery bypass graft (CABG). Of the 131 consecutive patients that underwent CABG using 64-slice multidetector row computed tomography during 2008, patients with heart rate (HR) of <75 beats/minute (bpm), and HR variation <10 bpm were included in the study. PGT was performed on 39 patients with 93 grafts, with RGH performed on 43 patients with 102 grafts. Image quality (1: excellent-4: poor) and estimated radiation dose were compared between the two groups. Of these, a total of 64 segments in 26 patients were subjected to invasive coronary angiography (ICA) for clinical reasons. Diagnostic accuracy of CCTA for evaluation of graft was performed between the two groups with ICA as a reference standard in terms of significant stenosis (≥ 50% of luminal stenosis). The image quality was not statistically different in the two groups. Mean effective radiation dose was 6.5 mSv in PGT-group, which was significantly lower than that in the RGH-group (21.2 mSv; P < 0.001). There was no statistically significant difference in diagnostic accuracy between the two groups (PGT-group versus RGH-group; 93.1% versus 91.4%). PGT can achieve dose reductions of up to 70% compared to RGH while maintaining image quality and high diagnostic accuracy in patients undergoing CABG. PMID:21678128

  4. Prospectively ECG-Triggered Sequential Dual-Source Coronary CT Angiography in Patients with Atrial Fibrillation: Influence of Heart Rate on Image Quality and Evaluation of Diagnostic Accuracy

    PubMed Central

    Yang, Lin; Xu, Lei; Schoepf, U. Joseph; Wichmann, Julian L.; Fox, Mary A.; Yan, Jing; Fan, Zhanming; Zhang, Zhaoqi

    2015-01-01

    Objectives To evaluate the effects of mean heart rate (HR) and heart rate variation (HRV) on image quality and diagnostic accuracy of prospectively ECG-triggered sequential dual-source coronary CT angiography (CCTA) in patients with atrial fibrillation (AF). Methods Eighty-five patients (49 women, 36 men; mean age 62.1±9.5 years) with persistent AF underwent prospectively ECG-triggered sequential second-generation dual-source CCTA. Tube current and voltage were adjusted according to body mass index (BMI) and iterative reconstruction was used. Image quality of coronary segments (four-point scale) and presence of significant stenosis (>50%) were evaluated. Diagnostic accuracy was analyzed in 30 of the 85 patients who underwent additional invasive coronary angiography (ICA). Results Only 8 of 1102 (0.7%) segments demonstrated poor image quality. No significant impact on image quality was found for mean HR (94.9±21.8 bpm; r=0.034, p=0.758; F=0.413, p=0.663) or HRV (67.5±22.8 bpm; r=0.097, p=0.377; F=0.111, p=0.895). On per-segment analysis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 89.7% (26/29), 99.4% (355/357), 92.9% (26/28), and 99.2% (355/358), respectively, with excellent correlation (kappa=0.91) with ICA. Mean effective dose was 3.3±1.0 mSv. Conclusions Prospectively ECG-triggered sequential dual-source CCTA provides diagnostic image quality and good diagnostic accuracy for detection of coronary stenosis in AF patients without significant influence by HR or HRV. PMID:26221952

  5. Evaluation of commercially available diagnostic tests for the detection of dengue virus NS1 antigen and anti-dengue virus IgM antibody.

    PubMed

    Hunsperger, Elizabeth A; Yoksan, Sutee; Buchy, Philippe; Nguyen, Vinh Chau; Sekaran, Shamala Devi; Enria, Delia A; Vazquez, Susana; Cartozian, Elizabeth; Pelegrino, Jose L; Artsob, Harvey; Guzman, Maria G; Olliaro, Piero; Zwang, Julien; Guillerm, Martine; Kliks, Susie; Halstead, Scott; Peeling, Rosanna W; Margolis, Harold S

    2014-10-01

    Commercially available diagnostic test kits for detection of dengue virus (DENV) non-structural protein 1 (NS1) and anti-DENV IgM were evaluated for their sensitivity and specificity and other performance characteristics by a diagnostic laboratory network developed by World Health Organization (WHO), the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and the Pediatric Dengue Vaccine Initiative (PDVI). Each network laboratory contributed characterized serum specimens for the panels used in the evaluation. Microplate enzyme-linked immunosorbent assay (ELISA) and rapid diagnostic test (RDT formats) were represented by the kits. Each ELISA was evaluated by 2 laboratories and RDTs were evaluated by at least 3 laboratories. The reference tests for IgM anti-DENV were laboratory developed assays produced by the Armed Forces Research Institute for Medical Science (AFRIMS) and the Centers for Disease Control and Prevention (CDC), and the NS1 reference test was reverse transcriptase polymerase chain reaction (RT-PCR). Results were analyzed to determine sensitivity, specificity, inter-laboratory and inter-reader agreement, lot-to-lot variation and ease-of-use. NS1 ELISA sensitivity was 60-75% and specificity 71-80%; NS1 RDT sensitivity was 38-71% and specificity 76-80%; the IgM anti-DENV RDTs sensitivity was 30-96%, with a specificity of 86-92%, and IgM anti-DENV ELISA sensitivity was 96-98% and specificity 78-91%. NS1 tests were generally more sensitive in specimens from the acute phase of dengue and in primary DENV infection, whereas IgM anti-DENV tests were less sensitive in secondary DENV infections. The reproducibility of the NS1 RDTs ranged from 92-99% and the IgM anti-DENV RDTs from 88-94%. PMID:25330157

  6. Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Evaluation of Newly Diagnosed Heart Failure With Reduced Left Ventricular Ejection Fraction.

    PubMed

    Won, Eugene; Donnino, Robert; Srichai, Monvadi B; Sedlis, Steven P; Feit, Frederick; Rolnitzky, Linda; Miller, Louis H; Iqbal, Sohah N; Axel, Leon; Nguyen, Brian; Slater, James; Shah, Binita

    2015-10-01

    The aim of this study was to determine the diagnostic value of cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE), cine imaging, and resting first-pass perfusion (FPP) in the evaluation for ischemic (IC) versus nonischemic (NIC) cardiomyopathy in new-onset heart failure with reduced (≤40%) left ventricular ejection fraction (HFrEF). A retrospective chart review analysis identified 83 patients from January 2009 to June 2012 referred for CMR imaging evaluation for new-onset HFrEF with coronary angiography performed within 6 months of CMR. The diagnosis of IC was established using Felker criteria on coronary angiography. CMR sequences were evaluated for the presence of patterns suggestive of severe underlying coronary artery disease as the cause of HFrEF (subendocardial and/or transmural LGE, regional wall motion abnormality on cine, regional hypoperfusion defect on resting FPP). Discriminative power was assessed using receiver operator characteristics curve analysis. Coronary angiography identified 36 patients (43%) with IC. Presence of subendocardial and/or transmural LGE alone demonstrated good discriminative power (C-statistic 0.85, 95% confidence interval 0.76 to 0.94) for the diagnosis of IC. The presence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 87% for the diagnosis of IC, whereas the absence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 94% for the diagnosis of NIC. Addition of resting FPP on a subset of patients did not improve diagnostic values. In conclusion, CMR has potential value in the diagnostic evaluation of IC versus NIC.

  7. Bone marrow histopathology in the diagnostic evaluation of splenic marginal-zone and splenic diffuse red pulp small B-cell lymphoma: a reliable substitute for spleen histopathology?

    PubMed

    Ponzoni, Maurilio; Kanellis, George; Pouliou, Evi; Baliakas, Panagiotis; Scarfò, Lydia; Ferreri, Andrés J M; Doglioni, Claudio; Bikos, Vasilis; Dagklis, Antonis; Anagnostopoulos, Achilles; Ghia, Paolo; Stamatopoulos, Kostas; Papadaki, Theodora

    2012-11-01

    Primary splenic small B-cell lymphomas mostly comprise the distinct entity of splenic marginal-zone lymphoma (SMZL) and the provisional category of splenic lymphoma/leukemia unclassifiable, mainly represented by the hairy cell leukemia variant and splenic diffuse red pulp small B-cell lymphoma (SDRL). Until recently, histopathologic examination of splenectomy specimens was considered mandatory for the diagnosis of SMZL. However, nowadays, mainly because of advances in chemoimmunotherapy, splenectomy is performed much less frequently. We evaluated the diagnostic efficacy of bone marrow biopsy (BMB) histopathology in the diagnostic approach toward SMZL and SDRL and tested whether it may serve as a substitute for spleen histopathology in the differential diagnosis between these 2 entities. To this end, we conducted a paired assessment of BMB and spleen diagnostic samples from 46 cases with a diagnosis of SMZL (n=32) or SDRL (n=14) based on spleen histopathology. We demonstrate that detailed immunohistopathologic BMB evaluation offers adequate evidence for the confirmation of these entities and their differential diagnosis from other small B-cell lymphoma histotypes. Notably, the immunophenotypical profile of SMZL and SDRL was identical in both BMB and spleen specimens for 21 evaluated markers. Paired assessment of BMB and spleen specimens did not identify discriminating patterns of BMB infiltration, cytology, and/or immunohistology between SMZL and SDRL. Accordingly, bone marrow histopathology contributes significantly in confirming the diagnosis of SMZL and SDRL. However, presently it is not possible to distinguish SMZL from SDRL on the basis of BMB evaluation alone; hence, histopathologic examination of the spleen remains the "gold standard" approach.

  8. Effect of methylphenidate on neurocognitive test battery: an evaluation according to the diagnostic and statistical manual of mental disorders, fourth edition, subtypes.

    PubMed

    Durak, Sibel; Ercan, Eyup Sabri; Ardic, Ulku Akyol; Yuce, Deniz; Ercan, Elif; Ipci, Melis

    2014-08-01

    The aims of this study were to evaluate the neuropsychological characteristics of the restrictive (R) subtype according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the attention-deficit/hyperactivity disorder (ADHD) combined (CB) type and predominantly inattentive (PI) type subtypes and to evaluate whether methylphenidate (MPH) affects neurocognitive test battery scores according to these subtypes. This study included 360 children and adolescents (277 boys, 83 girls) between 7 and 15 years of age who had been diagnosed with ADHD and compared the neuropsychological characteristics and MPH treatment responses of patients with the R subtype-which has been suggested for inclusion among the ADHD subtypes in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-with those of patients with the PI and CB subtypes. They did not differ from the control subjects in the complex attention domain, which includes Continuous Performance Test, Stroop test, and Shifting Attention Test, which suggests that the R subtype displayed a lower level of deterioration in these domains compared with the PI and CB subtypes. The patients with the CB and PI subtypes did not differ from the control subjects in the Continuous Performance Test correct response domain, whereas those with the R subtype presented a poorer performance than the control subjects. The R subtype requires a more detailed evaluation because it presented similar results in the remaining neuropsychological evaluations and MPH responses.

  9. Characterization of alpha-toxin hla gene variants, alpha-toxin expression levels, and levels of antibody to alpha-toxin in hemodialysis and postsurgical patients with Staphylococcus aureus bacteremia.

    PubMed

    Sharma-Kuinkel, Batu K; Wu, Yuling; Tabor, David E; Mok, Hoyin; Sellman, Bret R; Jenkins, Amy; Yu, Li; Jafri, Hasan S; Rude, Thomas H; Ruffin, Felicia; Schell, Wiley A; Park, Lawrence P; Yan, Qin; Thaden, Joshua T; Messina, Julia A; Fowler, Vance G; Esser, Mark T

    2015-01-01

    Alpha-toxin is a major Staphylococcus aureus virulence factor. This study evaluated potential relationships between in vitro alpha-toxin expression of S. aureus bloodstream isolates, anti-alpha-toxin antibody in serum of patients with S. aureus bacteremia (SAB), and clinical outcomes in 100 hemodialysis and 100 postsurgical SAB patients. Isolates underwent spa typing and hla sequencing. Serum anti-alpha-toxin IgG and neutralizing antibody levels were measured by using an enzyme-linked immunosorbent assay and a red blood cell (RBC)-based hemolysis neutralization assay. Neutralization of alpha-toxin by an anti-alpha-toxin monoclonal antibody (MAb MEDI4893) was tested in an RBC-based lysis assay. Most isolates encoded hla (197/200; 98.5%) and expressed alpha-toxin (173/200; 86.5%). In vitro alpha-toxin levels were inversely associated with survival (cure, 2.19 μg/ml, versus failure, 1.09 μg/ml; P < 0.01). Both neutralizing (hemodialysis, 1.26 IU/ml, versus postsurgical, 0.95; P < 0.05) and IgG (hemodialysis, 1.94 IU/ml, versus postsurgical, 1.27; P < 0.05) antibody levels were higher in the hemodialysis population. Antibody levels were also significantly higher in patients infected with alpha-toxin-expressing S. aureus isolates (P < 0.05). Levels of both neutralizing antibodies and IgG were similar among patients who were cured and those not cured (failures). Sequence analysis of hla revealed 12 distinct hla genotypes, and all genotypic variants were susceptible to a neutralizing monoclonal antibody in clinical development (MEDI4893). These data demonstrate that alpha-toxin is highly conserved in clinical S. aureus isolates. Higher in vitro alpha-toxin levels were associated with a positive clinical outcome. Although patients infected with alpha-toxin-producing S. aureus exhibited higher anti-alpha-toxin antibody levels, these levels were not associated with a better clinical outcome in this study.

  10. Characterization of Alpha-Toxin hla Gene Variants, Alpha-Toxin Expression Levels, and Levels of Antibody to Alpha-Toxin in Hemodialysis and Postsurgical Patients with Staphylococcus aureus Bacteremia

    PubMed Central

    Wu, Yuling; Tabor, David E.; Mok, Hoyin; Sellman, Bret R.; Jenkins, Amy; Yu, Li; Jafri, Hasan S.; Rude, Thomas H.; Ruffin, Felicia; Schell, Wiley A.; Park, Lawrence P.; Yan, Qin; Thaden, Joshua T.; Messina, Julia A.; Esser, Mark T.

    2014-01-01

    Alpha-toxin is a major Staphylococcus aureus virulence factor. This study evaluated potential relationships between in vitro alpha-toxin expression of S. aureus bloodstream isolates, anti-alpha-toxin antibody in serum of patients with S. aureus bacteremia (SAB), and clinical outcomes in 100 hemodialysis and 100 postsurgical SAB patients. Isolates underwent spa typing and hla sequencing. Serum anti-alpha-toxin IgG and neutralizing antibody levels were measured by using an enzyme-linked immunosorbent assay and a red blood cell (RBC)-based hemolysis neutralization assay. Neutralization of alpha-toxin by an anti-alpha-toxin monoclonal antibody (MAb MEDI4893) was tested in an RBC-based lysis assay. Most isolates encoded hla (197/200; 98.5%) and expressed alpha-toxin (173/200; 86.5%). In vitro alpha-toxin levels were inversely associated with survival (cure, 2.19 μg/ml, versus failure, 1.09 μg/ml; P < 0.01). Both neutralizing (hemodialysis, 1.26 IU/ml, versus postsurgical, 0.95; P < 0.05) and IgG (hemodialysis, 1.94 IU/ml, versus postsurgical, 1.27; P < 0.05) antibody levels were higher in the hemodialysis population. Antibody levels were also significantly higher in patients infected with alpha-toxin-expressing S. aureus isolates (P < 0.05). Levels of both neutralizing antibodies and IgG were similar among patients who were cured and those not cured (failures). Sequence analysis of hla revealed 12 distinct hla genotypes, and all genotypic variants were susceptible to a neutralizing monoclonal antibody in clinical development (MEDI4893). These data demonstrate that alpha-toxin is highly conserved in clinical S. aureus isolates. Higher in vitro alpha-toxin levels were associated with a positive clinical outcome. Although patients infected with alpha-toxin-producing S. aureus exhibited higher anti-alpha-toxin antibody levels, these levels were not associated with a better clinical outcome in this study. PMID:25392350

  11. Diffusion tensor imaging study of pediatric patients with congenital hydrocephalus: 1-year postsurgical outcomes.

    PubMed

    Mangano, Francesco T; Altaye, Mekibib; McKinstry, Robert C; Shimony, Joshua S; Powell, Stephanie K; Phillips, Jannel M; Barnard, Holly; Limbrick, David D; Holland, Scott K; Jones, Blaise V; Dodd, Jonathan; Simpson, Sarah; Mercer, Deanna; Rajagopal, Akila; Bidwell, Sarah; Yuan, Weihong

    2016-09-01

    significant in FA and AD at 3 months after surgery but did not persist when tested at 12 months after surgery. Significant longitudinal DTI changes in the patients with hydrocephalus were found in the gCC when findings at 3 and 12 months after surgery were compared. In the PLIC, trend-level longitudinal changes were observed between preoperative findings and 3-month postoperative findings, as well as between 3- and 12-month postoperative findings. Significant correlation between DTI and developmental outcome was found at all 3 time points. Notably, a significant correlation was found between DTI in the PLIC at 3 months after surgery and developmental outcome at 12 months after surgery. CONCLUSIONS The data showed significant WM abnormality based on DTI in both the gCC and the PLIC in patients with congenital hydrocephalus before surgery, and the abnormalities persisted in both the gCC and the PLIC at 3 months after surgery. The DTI values remained significantly abnormal in the gCC at 12 months after surgery. Longitudinal analysis showed signs of recovery in both WM structures between different time points. Combined with the significant correlation found between DTI and neuropsychological measures, the findings of this study suggest that DTI can serve as a sensitive imaging biomarker for underlying neuroanatomical changes and postsurgical developmental outcome and even as a predictor for future outcomes.

  12. DTI study of Children with Congenital Hydrocephalus: 1 Year Post-Surgical Outcomes

    PubMed Central

    Mangano, Francesco T.; Altaye, Mekibib; McKinstry, Robert C.; Shimony, Joshua S.; Powell, Stephanie K.; Phillips, Jannel M.; Barnard, Holly; Limbrick, David D.; Holland, Scott K.; Jones, Blaise V.; Dodd, Jonathon; Simpson, Sarah; Deanna, Mercer; Rajagopal, Akila; Bidwell, Sarah; Yuan, Weihong

    2016-01-01

    patients were found in the gCC between 3-month and 12-month post-surgery. In the PLIC, trend level longitudinal changes were found between pre-surgery and 3-month post-surgery as well as between 3-month and 12-month post-surgery. Significant correlation between DTI and developmental outcome were found at all three time points. Notably, significant correlation was found between DTI in the PLIC at 3-month post-surgery and developmental outcome at 12-month pots-surgery. Conclusion Our data showed significant WM abnormality based on DTI in both the gCC and the PLIC in children with congenital hydrocephalus before surgery and the abnormalities persisted in both the gCC and the PLIC at 3-month post-surgery. The DTI values remained significantly abnormal in the gCC at 12-month post-surgery. Longitudinal analysis showed signs of recovery in both WM structures between different time points. Combined with the significant correlation found between DTI and neuropsychological outcome, our study suggests that DTI can serve as a sensitive imaging biomarker for underlying neuroanatomical changes and post-surgical developmental outcome and even as a predictor for future outcomes. PMID:27203134

  13. Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy: A Practical Review for Clinical Researchers-Part I. General Guidance and Tips

    PubMed Central

    Kim, Kyung Won; Lee, Juneyoung; Choi, Sang Hyun; Huh, Jimi

    2015-01-01

    In the field of diagnostic test accuracy (DTA), the use of systematic review and meta-analyses is steadily increasing. By means of objective evaluation of all available primary studies, these two processes generate an evidence-based systematic summary regarding a specific research topic. The methodology for systematic review and meta-analysis in DTA studies differs from that in therapeutic/interventional studies, and its content is still evolving. Here we review the overall process from a practical standpoint, which may serve as a reference for those who implement these methods. PMID:26576106

  14. Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy: A Practical Review for Clinical Researchers-Part I. General Guidance and Tips.

    PubMed

    Kim, Kyung Won; Lee, Juneyoung; Choi, Sang Hyun; Huh, Jimi; Park, Seong Ho

    2015-01-01

    In the field of diagnostic test accuracy (DTA), the use of systematic review and meta-analyses is steadily increasing. By means of objective evaluation of all available primary studies, these two processes generate an evidence-based systematic summary regarding a specific research topic. The methodology for systematic review and meta-analysis in DTA studies differs from that in therapeutic/interventional studies, and its content is still evolving. Here we review the overall process from a practical standpoint, which may serve as a reference for those who implement these methods. PMID:26576106

  15. Evaluation of Optical Coherence Tomography as a Means of Identifying Earlier Stage Basal Cell Carcinomas while Reducing the Use of Diagnostic Biopsy

    PubMed Central

    Schwartz, Michelle; Feldman, Eleanor; Bienenfeld, Amanda; Bieber, Amy K.; Ellis, Jeffery; Alapati, Usha; Lebwohl, Mark; Siegel, Daniel M.

    2015-01-01

    Objective: To determine the diagnostic accuracy of optical coherence tomography for basal cell carcinoma and the proportion of biopsies that could be avoided if optical coherence tomography is used to rule-in surgery. Design: Multicenter, prospective, observational study. Setting: Dermatology clinics. Participants: Consecutive patients with clinically challenging pink lesions suspicious for basal cell carcinoma. Measurements: Clinical, dermoscopic, and optical coherence tomography images were obtained for all subjects. At each stage, the clinician made a diagnosis (pathology + subtype if applicable), and assessed his/her own confidence in the diagnosis. Results: Optical coherence tomography significantly (p<0.01) improved sensitivity and specificity over clinical or dermoscopic evaluation. The percentage of correct diagnoses was 57.4 percent (clinical), 69.6 percent (dermoscopy), and 87.8 percent (optical coherence tomography). Optical coherence tomography significantly increased the certainty of diagnosis; clinicians indicated they were certain (>95% confident) in 17 percent of lesions examined clinically, in 38.6 percent examined with dermoscopy, and in 70 percent examined with optical coherence tomography. With the use of optical coherence tomography in the diagnosis of basal cell carcinoma, more than 1 in 3 patients could avoid a diagnostic biopsy. Conclusion: In a population of clinically challenging lesions, optical coherence tomography improved diagnostic certainty by a factor of four over clinical examination alone and improved diagnostic accuracy by 50 percent (57-88%). The addition of optical coherence tomography to other standard assessments can improve the false-positive rate and give a high degree of certainty for ruling in a positive diagnosis for basal cell carcinoma. A reduction of 36 percent in overall biopsies could be achieved by sending high certainty basal cell carcinoma positive optical coherence tomography diagnoses straight to surgery. PMID

  16. Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy

    PubMed Central

    Quinlivan, L; Cooper, J; Davies, L; Hawton, K; Gunnell, D; Kapur, N

    2016-01-01

    Objectives The aims of this review were to calculate the diagnostic accuracy statistics of risk scales following self-harm and consider which might be the most useful scales in clinical practice. Design Systematic review. Methods We based our search terms on those used in the systematic reviews carried out for the National Institute for Health and Care Excellence self-harm guidelines (2012) and evidence update (2013), and updated the searches through to February 2015 (CINAHL, EMBASE, MEDLINE, and PsychINFO). Methodological quality was assessed and three reviewers extracted data independently. We limited our analysis to cohort studies in adults using the outcome of repeat self-harm or attempted suicide. We calculated diagnostic accuracy statistics including measures of global accuracy. Statistical pooling was not possible due to heterogeneity. Results The eight papers included in the final analysis varied widely according to methodological quality and the content of scales employed. Overall, sensitivity of scales ranged from 6% (95% CI 5% to 6%) to 97% (CI 95% 94% to 98%). The positive predictive value (PPV) ranged from 5% (95% CI 3% to 9%) to 84% (95% CI 80% to 87%). The diagnostic OR ranged from 1.01 (95% CI 0.434 to 2.5) to 16.3 (95%CI 12.5 to 21.4). Scales with high sensitivity tended to have low PPVs. Conclusions It is difficult to be certain which, if any, are the most useful scales for self-harm risk assessment. No scales perform sufficiently well so as to be recommended for routine clinical use. Further robust prospective studies are warranted to evaluate risk scales following an episode of self-harm. Diagnostic accuracy statistics should be considered in relation to the specific service needs, and scales should only be used as an adjunct to assessment. PMID:26873046

  17. Diagnostic Criteria for Problematic Internet Use among U.S. University Students: A Mixed-Methods Evaluation.

    PubMed

    Li, Wen; O'Brien, Jennifer E; Snyder, Susan M; Howard, Matthew O

    2016-01-01

    Empirical studies have identified increasing rates of problematic Internet use worldwide and a host of related negative consequences. However, researchers disagree as to whether problematic Internet use is a subtype of behavioral addiction. Thus, there are not yet widely accepted and validated diagnostic criteria for problematic Internet use. To address this gap, we used mixed-methods to examine the extent to which signs and symptoms of problematic Internet use mirror DSM-5 diagnostic criteria for substance use disorder, gambling disorder, and Internet gaming disorder. A total of 27 university students, who self-identified as intensive Internet users and who reported Internet-use-associated health and/or psychosocial problems were recruited. Students completed two measures that assess problematic Internet use (Young's Diagnostic Questionnaire and the Compulsive Internet Use Scale) and participated in focus groups exploring their experiences with problematic Internet use. Results of standardized measures and focus group discussions indicated substantial overlap between students' experiences of problematic Internet use and the signs and symptoms reflected in the DSM-5 criteria for substance use disorder, gambling disorder, and Internet gaming disorder. These signs and symptoms included: a) use Internet longer than intended, b) preoccupation with the Internet, c) withdrawal symptoms when unable to access the Internet, d) unsuccessful attempts to stop or reduce Internet use, e) craving, f) loss of interest in hobbies or activities other than the Internet, g) excessive Internet use despite the knowledge of related problems, g) use of the Internet to escape or relieve a negative mood, and h) lying about Internet use. Tolerance, withdrawal symptoms, and recurrent Internet use in hazardous situations were uniquely manifested in the context of problematic Internet use. Implications for research and practice are discussed.

  18. Diagnostic Criteria for Problematic Internet Use among U.S. University Students: A Mixed-Methods Evaluation

    PubMed Central

    Li, Wen; O’Brien, Jennifer E.; Snyder, Susan M.; Howard, Matthew O.

    2016-01-01

    Empirical studies have identified increasing rates of problematic Internet use worldwide and a host of related negative consequences. However, researchers disagree as to whether problematic Internet use is a subtype of behavioral addiction. Thus, there are not yet widely accepted and validated diagnostic criteria for problematic Internet use. To address this gap, we used mixed-methods to examine the extent to which signs and symptoms of problematic Internet use mirror DSM-5 diagnostic criteria for substance use disorder, gambling disorder, and Internet gaming disorder. A total of 27 university students, who self-identified as intensive Internet users and who reported Internet-use-associated health and/or psychosocial problems were recruited. Students completed two measures that assess problematic Internet use (Young’s Diagnostic Questionnaire and the Compulsive Internet Use Scale) and participated in focus groups exploring their experiences with problematic Internet use. Results of standardized measures and focus group discussions indicated substantial overlap between students’ experiences of problematic Internet use and the signs and symptoms reflected in the DSM-5 criteria for substance use disorder, gambling disorder, and Internet gaming disorder. These signs and symptoms included: a) use Internet longer than intended, b) preoccupation with the Internet, c) withdrawal symptoms when unable to access the Internet, d) unsuccessful attempts to stop or reduce Internet use, e) craving, f) loss of interest in hobbies or activities other than the Internet, g) excessive Internet use despite the knowledge of related problems, g) use of the Internet to escape or relieve a negative mood, and h) lying about Internet use. Tolerance, withdrawal symptoms, and recurrent Internet use in hazardous situations were uniquely manifested in the context of problematic Internet use. Implications for research and practice are discussed. PMID:26751569

  19. Evaluation of an Advanced-Practice Physical Therapist in a Specialty Shoulder Clinic: Diagnostic Agreement and Effect on Wait Times

    PubMed Central

    Robarts, Susan; Kennedy, Deborah; McKnight, Cheryl; MacLeod, Anne Marie; Holtby, Richard

    2013-01-01

    ABSTRACT Purpose: To examine the role of an advanced-practice physiotherapist (APP) with respect to (1) agreement with an orthopaedic surgeon on diagnosis and management of patients with shoulder problems; (2) wait times; and (3) satisfaction with care. Methods: This prospective study involved patients with shoulder complaints who were referred to a shoulder specialist in a tertiary care centre. Agreement was examined on seven major diagnostic categories, need for further examination and surgery, and type of surgical procedure. Wait times were compared between the APP- and surgeon-led clinics from referral date to date of initial consultation, date of final diagnostic test, and date of confirmed diagnosis and planned treatment. A modified and validated version of the Visit-Specific Satisfaction Instrument assessed satisfaction in seven domains. Kappa (κ) coefficients and bias- and prevalence-adjusted kappa (PABAK) values were calculated, and strength of agreement was categorized. Wait time and satisfaction data were examined using non-parametric statistics. Results: Agreement on major diagnostic categories varied from 0.68 (good) to 0.96 (excellent). Agreement with respect to indication for surgery was κ=0.75, p<0.001; 95% CI, 0.62–0.88 (good). Wait time for APP assessment was significantly shorter than wait time for surgeon consultation at all time points (p<0.001); the surgeon's wait time was significantly reduced over 3 years. High satisfaction was reported in all components of care received from both health care providers. Conclusions: Using experienced physiotherapists in an extended role reduces wait times without compromising patient clinical management and overall satisfaction. PMID:24381382

  20. Expression, purification and evaluation of diagnostic potential and immunogenicity of dengue virus type 3 domain III protein.

    PubMed

    Reddy, Pradeep B J; Pattnaik, Priyabrata; Tripathi, Nagesh K; Srivastava, Ambuj; Rao, P V Lakshmana

    2012-05-01

    Dengue hemorrhagic fever and dengue shock syndrome are the severe manifestations of dengue infection. The quest for reliable dengue diagnostics and a dengue vaccine remained elusive for decades. Domain III of dengue virus envelope contains multiple conformation dependant neutralizing epitopes, thus making it an attractive diagnostic and vaccine candidate. In this report we show the expression of dengue virus type 3 envelope domain III protein (D3EDIII) and demonstrate its potential as a diagnostic and vaccine candidate. Accordingly, D3EDIII was expressed to high levels in Escherichia coli and purified by Ni-NTA affinity chromatography. The purified protein was used to develop an in-house plate ELISA and was further tested with a panel of 40 dengue infected serum samples previously characterized by commercially available serological tests. The in-house results were in excellent agreement with the commercial kits. D3EDIII was refolded by rapid dilution method and the refolded monomer protein was purified by Ion exchange chromatography. Further, the recombinant protein was biologically functional and found to inhibit dengue virus type 3 plaque formation on LLC-MK2 cells demonstrating its function of receptor interaction. Furthermore, D3EDIII in combination with Freund's complete adjuvant induced high antibody titers in BALB/c mice and these antibodies efficiently neutralized dengue 3 virus. Additionally, D3EDIII induced expression of Th1 cytokines that can inhibit the intracellular viral infections. Thus, our results demonstrate that D3EDIII protein has tremendous potential both in diagnosis of dengue infections and in vaccine development.

  1. The effect of a program to promote play to reduce children's post-surgical pain: with plush toys, it hurts less.

    PubMed

    Ullán, Ana M; Belver, Manuel H; Fernández, Esperanza; Lorente, Felix; Badía, Marta; Fernández, Beatriz

    2014-03-01

    Various nonpharmacological strategies to relieve hospitalized children's pain propose play as a central element. Play is considered an essential resource to improve the negative psychosocial effects of the disease and the hospitalization itself. However, the empirical research of play in health settings has not received much attention. The goal of this study was to determine the effect of a program to promote play in the hospital on postsurgical pain in pediatric patients. The research hypothesis was that children will manifest less pain if they are distracted through play during the postsurgical period. We carried out a randomized parallel trial with two groups, an experimental group and a control group. The control group did not receive any specific treatment, only the standard attention contemplated in the hospital. The parents of the children from the experimental group received instructions to play with their children in the postsurgical period and specific play material with which to play. The results obtained support the research hypothesis. On average, the children from the experimental group scored lower on a pain scale than the children from the control group. This occurred in the three postsurgical measurements of pain. It is concluded that the program to promote play can decrease children's perception of pain.

  2. Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes☆

    PubMed Central

    Candiotti, Keith A.; Sands, Laurence R.; Lee, Edward; Bergese, Sergio D.; Harzman, Alan E.; Marcet, Jorge; Kumar, Anjali S.; Haas, Eric

    2013-01-01

    Background Opioid-based postsurgical analgesia exposes patients undergoing laparoscopic colectomy to elevated risk for gastrointestinal motility problems and other opioid-related adverse events (ORAEs). The purpose of our research was to investigate postsurgical outcomes, including opioid consumption, hospital length of stay, and ORAE risk associated with a multimodal analgesia regimen, employing a single administration of liposome bupivacaine as well as other analgesics that act by different mechanisms. Methods We analyzed combined results from 6 Phase IV, prospective, single-center studies in which patients undergoing laparoscopic colectomy received opioid-based intravenous patient-controlled analgesia (PCA) or multimodal analgesia incorporating intraoperative administration of liposome bupivacaine. As-needed rescue therapy was available to all patients. Primary outcome measures were postsurgical opioid consumption, hospital length of stay, and hospitalization costs. Secondary measures included time to first rescue opioid use, patient satisfaction with analgesia (assessed using a 5-point Likert scale), and ORAEs. Results Eighty-two patients underwent laparoscopic colectomy and did not meet intraoperative exclusion criteria (PCA n = 56; multimodal analgesia n = 26). Compared with the PCA group, the multimodal analgesia group had significantly lower mean total postsurgical opioid consumption (96 vs 32 mg, respectively; P < 0.0001) and shorter median postsurgical hospital length of stay (3.0 vs 4.0 days; P = 0.0019). Geometric mean costs were $11,234 and $13,018 in the multimodal analgesia and PCA groups, respectively (P = 0.2612). Median time to first rescue opioid use was longer in the multimodal analgesia group versus PCA group (1.1 hours vs 0.6 hours, respectively; P=0.0003). ORAEs were experienced by 41% of patients receiving intravenous opioid PCA and 8% of patients receiving multimodal analgesia (P = 0.0019). Study limitations included use of an open

  3. [Development of DICOM image viewing software for efficient image reading and evaluation of distributed server system for diagnostic environment].

    PubMed

    Ishikawa, K

    2000-12-01

    To construct an efficient diagnostic environment using computer displays, the author investigated the time of network transmission using clinical images. In our hospital, we introduced optical-fiber 100Base-Fx Ethernet connections between 22 HIS-segments and one RIS-segment. Although Ethernet architecture is inexpensive, the speed of image transmission becomes 2371 KB/sec. (4.6 CT-slice/sec.) in the RIS-segment and 996 KB/sec. (1.9 CT-slice/sec.) from the RIS-segment to HIS-segments. Because one examination is transmitted in one minute, it does not disturb image reading. Otherwise, a distributed server system using inexpensive personal computers helps in constructing an efficient system. This investigation showed that commercially based Digital Imaging and Communications in Medicine(DICOM) servers and RSNA Central Test Node servers are not so different in transmission speed. The author programmed and developed DICOM transmission and viewing software for Macintosh computers. This viewer includes two inventions, dynamic tiling window system (DTWS) and window binding mode(WBM). On DTWS, windows, tiles, and images are independent objects, which are movable and resizable. The tile-matrix is changeable by mouse dragging, which realizes suitable tile rectangles for wide-low or narrow-high images. The arranging window tool prevents windows from scattering. Using WBM, any operation affects each window similarly. This means that the relationship of compared images is always equivalent. DTWS and WBM contribute greatly to a filmless diagnostic environment.

  4. Evaluation of tissue-equivalent materials to be used as human brain tissue substitute in dosimetry for diagnostic radiology

    NASA Astrophysics Data System (ADS)

    Ferreira, C. C.; Ximenes Filho, R. E. M.; Vieira, J. W.; Tomal, A.; Poletti, M. E.; Garcia, C. A. B.; Maia, A. F.

    2010-08-01

    Tissue-equivalent materials to be used as substitutes for human brain tissue in dosimetry for diagnostic radiology have been investigated in terms of calculated total mass attenuation coefficient ( μ/ ρ), calculated mass energy-absorption coefficient ( μen/ ρ) and absorbed dose. Measured linear attenuation coefficients ( μ) have been used for benchmarking the calculated total mass attenuation coefficient ( μ/ ρ). The materials examined were bolus, nylon®, orange articulation wax, red articulation wax, PMMA (polymethylmethacrylate), bees wax, paraffin I, paraffin II, pitch and water. The results show that water is the best substitute for brain among the materials investigated. The average percentage differences between the calculated μ/ ρ and μen/ ρ coefficients for water and those for brain were 1.0% and 2.5%, respectively. Absorbed doses determined by Monte Carlo methods confirm water as being the best brain substitute to be used in dosimetry for diagnostic radiology, showing maximum difference of 0.01%. Additionally this study showed that PMMA, a material often used for the manufacturing of head phantoms for computed tomography, cannot be considered to be a suitable substitute for human brain tissue in dosimetry.

  5. Evaluating a counselling strategy for diagnostic WES in paediatric neurology: an exploration of parents' information and communication needs.

    PubMed

    Krabbenborg, L; Schieving, J; Kleefstra, T; Vissers, L E L M; Willemsen, M A; Veltman, J A; van der Burg, S

    2016-02-01

    As whole exome sequencing (WES) is just starting to be used as a diagnostic tool in paediatric neurology for children with a neurological disorder, and patient experiences and preferences with regard to counselling are relatively underexplored. This article explores experiences and preferences of parents with pre-test and post-test counselling in a trial that uses WES for diagnostics. Second, it maps information and communication needs which exceed the counselling protocol, in order to acquire insight into how it can be improved. Data were gathered through in-depth interviews with parents of 15 children who were included in the trial. Information and communication needs of parents differed from the protocol with respect to (i) the type and amount of information provided about WES research, (ii) incidental findings, (iii) communication about progress of the study, and (iv) the communication of the results. Furthermore, parents preferred to have more of a communicative exchange with health care providers about their daily struggles and concerns related to their life with a diseased child and wanted to know how a diagnosis could offer help. There are different ways to meet parental needs, but we suggest that assigning a case manager might be a helpful option that deserves further exploration.

  6. Development and evaluation of a saliva-based chair-side diagnostic for the detection of Porphyromonas gingivalis.

    PubMed

    O'Brien-Simpson, Neil M; Burgess, Kate; Brammar, Gail C; Darby, Ivan B; Reynolds, Eric C

    2015-01-01

    Porphyromonas gingivalis is a key pathogen in the polymicrobial biofilm that is associated with the oral disease chronic periodontitis. A number of studies have shown that in humans the level of P. gingivalis in the polymicrobial biofilm is positively correlated with disease progression. The aim of this study was to develop a P. gingivalis diagnostic that has high specificity and sensitivity for P. gingivalis using a range of laboratory and clinical isolates and then compare the efficacy of the diagnostic with RTPCR using samples from chronic periodontitis patients and age- and sex-matched healthy controls. Key parameters for the kit were to use saliva as the biological fluid as this is a most convenient medium for chair-side sampling and to give a positive reading for the reported threshold for detection of 5×10(5) P. gingivalis cells/mL that indicates disease progression. We initially screened a range of monoclonal antibodies for recognition of the P. gingivalis conserved virulence factor RgpA-Kgp complex and identified two mAbs that could be used in a capture and detection ELISA system. These mAbs were used to formulate and manufacture the GC P. gingivalis saliva diagnostic kit used in the study. To validate the saliva kit, saliva (P. gingivalis free) was spiked with known concentrations of viable P. gingivalis whole cells of W50, 381, A7A1-28, and ATCC 33277; P. gingivalis clinical isolates; P. gingivalis vesicles; and the secreted form of the RgpA-Kgp complex. Laboratory findings indicated that the kit was able to detect all laboratory and clinical isolate strains of P. gingivalis at 5×10(4)/mL to 5×10(5)/mL. It was also able to detect the RgpA-Kgp complex and vesicles at 5×10(4) and 5×10(5) cell equivalent doses, respectively. Saliva and plaque were then collected from 50 subjects with moderate-severe chronic periodontitis and 50 age- and sex-matched subjects with healthy periodontium. Real-time PCR was utilised to analyse levels of P. gingivalis in both

  7. Postsurgical Pathologies Associated with Intradural Electrical Stimulation in the Central Nervous System: Design Implications for a New Clinical Device

    PubMed Central

    Gibson-Corley, Katherine N.; Flouty, Oliver; Oya, Hiroyuki; Gillies, George T.; Howard, Matthew A.

    2014-01-01

    Spinal cord stimulation has been utilized for decades in the treatment of numerous conditions such as failed back surgery and phantom limb syndromes, arachnoiditis, cancer pain, and others. The placement of the stimulating electrode array was originally subdural but, to minimize surgical complexity and reduce the risk of certain postsurgical complications, it became exclusively epidural eventually. Here we review the relevant clinical and experimental pathologic findings, including spinal cord compression, infection, hematoma formation, cerebrospinal fluid leakage, chronic fibrosis, and stimulation-induced neurotoxicity, associated with the early approaches to subdural electrical stimulation of the central nervous system, and the spinal cord in particular. These findings may help optimize the safety and efficacy of a new approach to subdural spinal cord stimulation now under development. PMID:24800260

  8. Molecular Diagnostics

    PubMed Central

    Choe, Hyonmin; Deirmengian, Carl A.; Hickok, Noreen J.; Morrison, Tiffany N.; Tuan, Rocky S.

    2015-01-01

    Orthopaedic infections are complex conditions that require immediate diagnosis and accurate identification of the causative organisms to facilitate appropriate management. Conventional methodologies for diagnosis of these infections sometimes lack accuracy or sufficient rapidity. Current molecular diagnostics are an emerging area of bench-to-bedside research in orthopaedic infections. Examples of promising molecular diagnostics include measurement of a specific biomarker in the synovial fluid, polymerase chain reaction–based detection of bacterial genes, and metabolomic determination of responses to orthopaedic infection. PMID:25808967

  9. Comparative evaluation of 11 commercialized rapid diagnostic tests for detecting Trypanosoma cruzi antibodies in serum banks in areas of endemicity and nonendemicity.

    PubMed

    Sánchez-Camargo, Claudia L; Albajar-Viñas, Pedro; Wilkins, Patricia P; Nieto, Javier; Leiby, David A; Paris, Luc; Scollo, Karenina; Flórez, Carolina; Guzmán-Bracho, Carmen; Luquetti, Alejandro O; Calvo, Nidia; Tadokoro, Kenji; Saez-Alquezar, Amadeo; Palma, Pedro Pablo; Martin, Miguel; Flevaud, Laurence

    2014-07-01

    Chagas disease is one of the main public health issues in Latin America. Increasingly during the past few decades, Trypanosoma cruzi infection has been detected in North America, Europe, and the Western Pacific, mainly as a result of population movement. The limited availability of rapid serological diagnostic tests hinders rapid diagnosis and early treatment in areas of endemicity and nonendemicity. In collaboration with 11 national reference laboratories (NRLs) from different geographical areas, we evaluated the performances of commercialized serological rapid diagnostic tests (RDT) for T. cruzi infection. Eleven commercialized T. cruzi infection RDTs were evaluated on a total of 474 samples extensively tested with at least three different techniques for Chagas disease, maintained at controlled low temperatures, and stored in the serum banks of the 11 NRLs. We measured the sensitivity, specificity, and concordance of each RDT and provided an additional questionnaire to evaluate its ease of use. The selected RDTs in this study were performed under controlled laboratory conditions. Out of the 11 RDTs, we found 8 of them to be useful, with the cassette format favored over the strip. We did not observe significant differences in RDT performances in the different regions. Overall, the performance results were lower than those disclosed by the manufacturers. The results of this evaluation validate the possibility of using RDTs to diagnose Chagas disease, thereby decreasing the time to treatment at a primary health care facility for patients who are willing to be treated. Further studies should be conducted in the laboratory and in the field to confirm these data, expressly to evaluate reproducibility in resource-limited settings, or using whole blood in clinical settings in areas of endemicity and nonendemicity.

  10. Comparative Evaluation of 11 Commercialized Rapid Diagnostic Tests for Detecting Trypanosoma cruzi Antibodies in Serum Banks in Areas of Endemicity and Nonendemicity

    PubMed Central

    Albajar-Viñas, Pedro; Wilkins, Patricia P.; Nieto, Javier; Leiby, David A.; Paris, Luc; Scollo, Karenina; Flórez, Carolina; Guzmán-Bracho, Carmen; Luquetti, Alejandro O.; Calvo, Nidia; Tadokoro, Kenji; Saez-Alquezar, Amadeo; Palma, Pedro Pablo; Martin, Miguel

    2014-01-01

    Chagas disease is one of the main public health issues in Latin America. Increasingly during the past few decades, Trypanosoma cruzi infection has been detected in North America, Europe, and the Western Pacific, mainly as a result of population movement. The limited availability of rapid serological diagnostic tests hinders rapid diagnosis and early treatment in areas of endemicity and nonendemicity. In collaboration with 11 national reference laboratories (NRLs) from different geographical areas, we evaluated the performances of commercialized serological rapid diagnostic tests (RDT) for T. cruzi infection. Eleven commercialized T. cruzi infection RDTs were evaluated on a total of 474 samples extensively tested with at least three different techniques for Chagas disease, maintained at controlled low temperatures, and stored in the serum banks of the 11 NRLs. We measured the sensitivity, specificity, and concordance of each RDT and provided an additional questionnaire to evaluate its ease of use. The selected RDTs in this study were performed under controlled laboratory conditions. Out of the 11 RDTs, we found 8 of them to be useful, with the cassette format favored over the strip. We did not observe significant differences in RDT performances in the different regions. Overall, the performance results were lower than those disclosed by the manufacturers. The results of this evaluation validate the possibility of using RDTs to diagnose Chagas disease, thereby decreasing the time to treatment at a primary health care facility for patients who are willing to be treated. Further studies should be conducted in the laboratory and in the field to confirm these data, expressly to evaluate reproducibility in resource-limited settings, or using whole blood in clinical settings in areas of endemicity and nonendemicity. PMID:24808239

  11. Rapid on-site evaluation has high diagnostic yield differentiating adenocarcinoma vs squamous cell carcinoma of non-small cell lung carcinoma, not otherwise specified subgroup.

    PubMed

    Celik, Betul; Khoor, Andras; Bulut, Tangul; Nassar, Aziza

    2015-01-01

    Our objective was to evaluate the diagnostic yield of rapid on-site evaluation (ROSE) on the differential diagnosis of non-small cell lung carcinoma, not otherwise specified (NSCLC-NOS). Biopsied cases diagnosed as NSCLC-NOS with ROSE during 2004 through 2008 were retrieved. Diagnostic confirmation was done with immunohistochemistry (IHC) involving thyroid transcription factor-1 and p63 immunostains. For the study, 106 cases were available. The final diagnoses rendered were squamous cell carcinoma (SqCC) (n = 39) and adenocarcinoma (AC) (n = 67). Cytologic, histologic, and IHC concordance for these diagnoses occurred in 75 cases (70.8 %), of which 56 (52.8%) were AC and 19 (17.9%) were SqCC. Cytologic, histologic, and IHC discordance was found in 31 cases (29.2%). Of these 31 cases, 11 NSCLC-NOS diagnoses histologically corresponded to 1 SqCC plus 4 ACs, and 4 favor SqCC plus 2 ACs; the former 5 NSCLC-NOS cases classified correctly through cytology, as well as IHC. However, IHC was not available for the latter 6 NSCLC-NOS cases that were also classified correctly through cytology. In addition, only 3 NSCLC-NOS diagnoses cytologically corresponded to 3 favor SqCC histologically, in which IHC was not available, and for 2 cases that both corresponded to favor SqCC and favor AC histologically and cytologically. In the other 15 cases, histology labeled 4 cases NSCLC-NOS and misclassified 2 cases; cytology labeled 1 case NSCLC-NOS and misclassified 13 cases. ROSE has high diagnostic yield over subclassification of NSCLC-NOS. We recommend allocating a cytotechnologist for specimen adequacy and a cytopathologist for cytologic diagnosis.

  12. [The combined application of thermography and local thermometry for diagnostics, prognostication, modeling, and evaluation of the effectiveness of the treatment of acute sinusitis].

    PubMed

    Sergeev, S V; Grigor'kina, E S; Smogunov, V V; Kuz'min, A V; Volkova, N A

    2014-01-01

    The objective of the present work was to study the possibilities of the combined application of thermography and local thermometry for diagnostics of acute sinusitis, characteristic of dynamics of the clinical course of this pathology, and evaluation of the effectiveness of its treatment. The study included 23 patients presenting with acute rhinosinusitis and 21 ones free from pathology of paranasal sinuses. Contact thermometry was performed with the use of the electronic thermometer applied to the anterior surface of the inferior turbinated bone. An infrared thermovision camera was employed to carry out thermographic measurements. The study demonstrated variations in endonasal and surface temperature under effect of the treatment. Positive dynamics of the patients' conditions was manifested as a drop of endonasal temperature and relatively constant surface temperature. A rise in the surface temperature was associated with the pathological process. In the patients showing slightly positive dynamics of the disease, the surface temperature on the side of the pathological process was lower than on the unaffected side. This difference was interpreted as an indication of the reduced microcirculatory activity in this region. It was hypothesized that dynamics of the inflammatory process is to a large extent determined by the character of blood circulation in the affected region. The authors conclude that the combined application of thermometry and thermography not only improves the quality of diagnostics of acute rhinosinusitis but also facilitates the evaluation of its dynamics and the effectiveness of the treatment.

  13. System Diagnostic Builder - A rule generation tool for expert systems that do intelligent data evaluation. [applied to Shuttle Mission Simulator

    NASA Technical Reports Server (NTRS)

    Nieten, Joseph; Burke, Roger

    1993-01-01

    Consideration is given to the System Diagnostic Builder (SDB), an automated knowledge acquisition tool using state-of-the-art AI technologies. The SDB employs an inductive machine learning technique to generate rules from data sets that are classified by a subject matter expert. Thus, data are captured from the subject system, classified, and used to drive the rule generation process. These rule bases are used to represent the observable behavior of the subject system, and to represent knowledge about this system. The knowledge bases captured from the Shuttle Mission Simulator can be used as black box simulations by the Intelligent Computer Aided Training devices. The SDB can also be used to construct knowledge bases for the process control industry, such as chemical production or oil and gas production.

  14. Rapid molecular diagnostic tests in patients with bacteremia: evaluation of their impact on decision making and clinical outcomes.

    PubMed

    Vardakas, K Z; Anifantaki, F I; Trigkidis, K K; Falagas, M E

    2015-11-01

    We performed a systematic review of the data regarding rapid diagnostic tests and their advantages or limitations on patients' clinical outcomes. The PubMed and Scopus databases were searched independently by two reviewers. Mortality was the primary outcome. Most studies compared rapid tests with blood cultures. Although not observed in all studies, only studies comparing rapid tests in conjunction with antimicrobial stewardship programs (ASPs) showed a mortality benefit. A reduction in hospital or intensive care unit (ICU) length of stay was also observed in almost all studies when the rapid tests, with or without ASPs, were used. Finally, treatment decisions were taken earlier in the rapid test groups. Despite a faster treatment decision, a clear mortality benefit was not seen when rapid tests were used. It is crucial to differentiate the influence of rapid tests from that of ASPs and clarify the actual effect of each factor separately.

  15. Evaluation of the RADCHEM Diagnostic as an Assessment of Fuel-Ablator Mix and Fuel Rho R

    SciTech Connect

    Shaughnessy, D A; Cerjan, C; Moody, K J; Bernstein, L; Hoffman, R; Stoyer, M A; Fortner, R; Schneider, D

    2011-03-07

    The RADCHEM diagnostic consists of the collection of both gaseous and solid debris samples following a NIF shot. Small amounts of detector elements are doped into the inner-most layer of the ablator shell, which then undergo nuclear activations with neutrons and/or charged particles that are produced during the fusion process. Reaction products are collected and their radioactive decays are counted in order to determine the number and type of activations that occurred. Simulations have shown that these data can then be correlated to several capsule parameters, including fuel rhoR ({rho}R), implosion asymmetry, and fuel-ablator mix. In this document we present a brief summary of the simulations that have been performed, and evalute the ability of RADCHEM to assess capsule performance. A longer, follow-on document, which will include more details on the specific simulations and experimental techniques that have been considered for RADCHEM, is currently being written.

  16. Collection and Characterization of Samples for Establishment of a Serum Repository for Lyme Disease Diagnostic Test Development and Evaluation

    PubMed Central

    Molins, Claudia R.; Sexton, Christopher; Young, John W.; Ashton, Laura V.; Pappert, Ryan; Beard, Charles B.

    2014-01-01

    Serological assays and a two-tiered test algorithm are recommended for laboratory confirmation of Lyme disease. In the United States, the sensitivity of two-tiered testing using commercially available serology-based assays is dependent on the stage of infection and ranges from 30% in the early localized disease stage to near 100% in late-stage disease. Other variables, including subjectivity in reading Western blots, compliance with two-tiered recommendations, use of different first- and second-tier test combinations, and use of different test samples, all contribute to variation in two-tiered test performance. The availability and use of sample sets from well-characterized Lyme disease patients and controls are needed to better assess the performance of existing tests and for development of improved assays. To address this need, the Centers for Disease Control and Prevention and the National Institutes of Health prospectively collected sera from patients at all stages of Lyme disease, as well as healthy donors and patients with look-alike diseases. Patients and healthy controls were recruited using strict inclusion and exclusion criteria. Samples from all included patients were retrospectively characterized by two-tiered testing. The results from two-tiered testing corroborated the need for novel and improved diagnostics, particularly for laboratory diagnosis of earlier stages of infection. Furthermore, the two-tiered results provide a baseline with samples from well-characterized patients that can be used in comparing the sensitivity and specificity of novel diagnostics. Panels of sera and accompanying clinical and laboratory testing results are now available to Lyme disease serological test users and researchers developing novel tests. PMID:25122862

  17. PIK3CA-Related Overgrowth Spectrum (PROS): Diagnostic and Testing Eligibility Criteria, Differential Diagnosis, and Evaluation

    PubMed Central

    Keppler-Noreuil, Kim M.; Rios, Jonathan J.; Parker, Victoria E.R.; Semple, Robert K.; Lindhurst, Marjorie J.; Sapp, Julie C.; Alomari, Ahmad; Ezaki, Marybeth; Dobyns, William; Biesecker, Leslie G.

    2015-01-01

    Somatic activating mutations in the phosphatidylinositol-3-kinase/AKT/mTOR pathway underlie heterogeneous segmental overgrowth phenotypes. Because of the extreme differences among patients, we sought to characterize the phenotypic spectrum associated with different genotypes and mutation burdens, including a better understanding of associated complications and natural history. Historically, the clinical diagnoses in patients with PIK3CA activating mutations have included Fibroadipose hyperplasia or Overgrowth (FAO), Hemihyperplasia Multiple Lipomatosis (HHML), Congenital Lipomatous Overgrowth, Vascular Malformations, Epidermal Nevi, Scoliosis/Skeletal and Spinal (CLOVES) syndrome, macrodactyly, Fibroadipose Infiltrating Lipomatosis, and the related megalencephaly syndromes, Megalencephaly-Capillary Malformation (MCAP or M-CM) and Dysplastic Megalencephaly (DMEG). A workshop was convened at the National Institutes of Health (NIH) to discuss and develop a consensus document regarding diagnosis and treatment of patients with PIK3CA-associated somatic overgrowth disorders. Participants in the workshop included a group of researchers from several institutions who have been studying these disorders and have published their findings, as well as representatives from patient-advocacy and support groups. The umbrella term of “PIK3CA-Related Overgrowth Spectrum (PROS)” was agreed upon to encompass both the known and emerging clinical entities associated with somatic PIK3CA mutations including, macrodactyly, FAO, HHML, CLOVES, and related megalencephaly conditions. Key clinical diagnostic features and criteria for testing were proposed, and testing approaches summarized. Preliminary recommendations for a uniform approach to assessment of overgrowth and molecular diagnostic testing were determined. Future areas to address include the surgical management of overgrowth tissue and vascular anomalies, the optimal approach to thrombosis risk, and the testing of potential

  18. Hemoptysis with diagnostic dilemma.

    PubMed

    Pramanik, Bimalendu

    2013-02-01

    Hemoptysis is a common symptom. Although initial diagnostic workup, including a chest radiograph, often gives a clue to the cause, it provides no diagnostic hints in 3.0-42.2% of episodes of hemoptysis. To describe those cases with no diagnostic hints at initial investigations, experts have used different terms, including unexplained hemoptysis, idiopathic hemoptysis, cryptogenic hemoptysis and hemoptysis with normal chest radiographs. As hemoptysis is a common symptom of bronchogenic carcinoma, there is a concern of having underlying malignancy. Physicians value high-resolution computed tomography and fiberoptic bronchoscopy as the next investigations to establish diagnosis. These investigations however are expensive and nonspecific results are common in those cases of hemoptysis where initial diagnostic workup gives no clues to the cause. As a result, controversies exist with regard to their use. In this article, the author has proposed diagnostic approaches to evaluate those cases of hemoptysis with no diagnostic hints at initial investigation, after extensive review of published articles related to the case scenario. PMID:23362818

  19. [Diagnostics in osteology].

    PubMed

    Jakob, F; Genest, F; Seefried, L; Tsourdi, E; Lapa, C; Hofbauer, L C

    2016-07-01

    Clinical diagnostics in metabolic bone diseases cover a broad spectrum of conventional and state of the art methods ranging from the medical history and clinical examination to molecular imaging. Patient treatment is carried out in an interdisciplinary team due to the multiple interactions of bone with other organ systems. Diagnosis of osteoporosis is supported by high level national guidelines. A paradigm shift concerning the clinical relevance of bone mineral density measurement renders this now to be a strong risk factor rather than a diagnostic parameter, while strengthening the value of other clinical factors for risk assessment. The impact of parameters for muscle mass, structure and function is steadily increasing in all age groups. In order to identify underlying diseases that influence bone metabolism a panel of general laboratory diagnostic parameters is recommended. Markers for bone formation and resorption and specific parameters for the regulation of calcium and phosphate metabolism should be evaluated by specialists because they require diligence in preanalytics and experience in interpretation. Genetic diagnosis is well established for rare bone diseases while diagnostic panels are not yet available for routine diagnostics in polygenetic diseases such as osteoporosis. Conventional radiology is still very important to identify, e. g. fractures, osteolytic and osteoblastic lesions and extraosseous calcifications; however tomography-based methods which combine, e. g. scintigraphy or positron emission technologies with anatomical imaging are of increasing significance. Clinical diagnostics in osteology require profound knowledge and are subject to a dynamic evolution. PMID:27307159

  20. Fungal Diagnostics

    PubMed Central

    Kozel, Thomas R.; Wickes, Brian

    2014-01-01

    Early diagnosis of fungal infection is critical to effective treatment. There are many impediments to diagnosis such as a diminishing number of clinical mycologists, cost, time to result, and requirements for sensitivity and specificity. In addition, fungal diagnostics must meet the contrasting needs presented by the increasing diversity of fungi found in association with the use of immunosuppressive agents in countries with high levels of medical care and the need for diagnostics in resource-limited countries where large numbers of opportunistic infections occur in patients with AIDS. Traditional approaches to diagnosis include direct microscopic examination of clinical samples, histopathology, culture, and serology. Emerging technologies include molecular diagnostics and antigen detection in clinical samples. Innovative new technologies that use molecular and immunoassay platforms have the potential to meet the needs of both resource-rich and resource-limited clinical environments. PMID:24692193

  1. Field Evaluation of Diagnostic Accuracy of an Oral Fluid Rapid Test for HIV, Tested at Point-of-Service Sites in Rural Zimbabwe

    PubMed Central

    Langhaug, Lisa F.; Mudzori, James; Burke, Eileen; Hayes, Richard; Cowan, Frances M.

    2009-01-01

    Abstract The objective of this study was to validate the use of OraQuick® ADVANCE Rapid HIV-1/2 Antibody test (OraSure Technologies Inc., Bethlehem, PA) on oral fluid for a population-based HIV prevalence survey of rural youth in southeast Zimbabwe. The evaluation was conducted in patients presenting for voluntary counseling and testing at rural clinics. Each participant provided an oral fluid sample tested using OraQuick® ADVANCE. In addition, dried blood specimens were collected and tested blind at the National Microbiology Reference Laboratory in Harare using two enzyme-linked immunosorbent assays (ELISA; Vironostika®, Biomérieux BV, Boxtel, The Netherlands and Ani Labsystems, Ltd., Vantaa, Finland) with confirmatory Western blot (MP Diagnostics [formerly Genelabs Diagnostics], Medical Technology Promedt Consulting GMBH, St. Ingbert, Germany) for samples with discrepant results. Diagnostic accuracy of the oral fluid assay was determined against the ELISA/Western blot algorithm as gold standard. Five hundred and ninety-one participants took part in the study between February and July 2006. Sensitivity of the test on oral fluid was 100% (95% confidence interval [CI]: 97.9–100), and specificity was 100% (95% CI: 99.1–100). HIV prevalence based on the reference standard was 29.8% (95% CI: 26.1–33.5). This is one of the first validations of this rapid assay on oral fluid conducted in a general population to be reported in Africa. While there are some limitations with the assay (e.g., unlikely to detect those in early stages of HIV infection or with reduced viral load; altered accuracy in pregnancy) these limitations also apply to other rapid assays. The results showed the assay to be 100% accurate in determining HIV status, performed well in field settings, and can be considered suitable for use in epidemiologic surveys aiming to estimate HIV prevalence in general populations. PMID:19530953

  2. Field evaluation of diagnostic accuracy of an oral fluid rapid test for HIV, tested at point-of-service sites in rural Zimbabwe.

    PubMed

    Pascoe, Sophie J S; Langhaug, Lisa F; Mudzori, James; Burke, Eileen; Hayes, Richard; Cowan, Frances M

    2009-07-01

    The objective of this study was to validate the use of OraQuick ADVANCE Rapid HIV-1/2 Antibody test (OraSure Technologies Inc., Bethlehem, PA) on oral fluid for a population-based HIV prevalence survey of rural youth in southeast Zimbabwe. The evaluation was conducted in patients presenting for voluntary counseling and testing at rural clinics. Each participant provided an oral fluid sample tested using OraQuick ADVANCE. In addition, dried blood specimens were collected and tested blind at the National Microbiology Reference Laboratory in Harare using two enzyme-linked immunosorbent assays (ELISA; Vironostika, Biomérieux BV, Boxtel, The Netherlands and Ani Labsystems, Ltd., Vantaa, Finland) with confirmatory Western blot (MP Diagnostics [formerly Genelabs Diagnostics], Medical Technology Promedt Consulting GMBH, St. Ingbert, Germany) for samples with discrepant results. Diagnostic accuracy of the oral fluid assay was determined against the ELISA/Western blot algorithm as gold standard. Five hundred and ninety-one participants took part in the study between February and July 2006. Sensitivity of the test on oral fluid was 100% (95% confidence interval [CI]: 97.9-100), and specificity was 100% (95% CI: 99.1-100). HIV prevalence based on the reference standard was 29.8% (95% CI: 26.1-33.5). This is one of the first validations of this rapid assay on oral fluid conducted in a general population to be reported in Africa. While there are some limitations with the assay (e.g., unlikely to detect those in early stages of HIV infection or with reduced viral load; altered accuracy in pregnancy) these limitations also apply to other rapid assays. The results showed the assay to be 100% accurate in determining HIV status, performed well in field settings, and can be considered suitable for use in epidemiologic surveys aiming to estimate HIV prevalence in general populations.

  3. Field evaluation of two diagnostic antigen tests for Wuchereria bancrofti infection among Indian expatriates in Saudi Arabia.

    PubMed

    Omar, M S; Sheikha, A K; Al-Amari, O M; Abdalla, S E; Musa, R A

    2000-06-01

    Two commercially available diagnostic tools (Tro-Bio ELISA and ICT card test) were used to detect circulating filarial antigen of Wuchereria bancrofti infections among Indian expatriate workers in Saudi Arabia. Daytime serum samples collected from 302 individuals (210 men and 92 women) were tested. Night blood surveys for microfilaraemia were restricted to those individuals who became positive for the trop-Bio assay test. The overall prevalence of filarial antigeaemia was 10.6% (32 individuals). Of these 32 antigen positive cases, microfilariae were found in 10 men (31.3%), with a mean microfilarial count of 105 mff/ml. No positive antigen results were found in control sera from 200 native healthy Saudis or from patients with helminthic infections (schistosomiasis, echinicoccosis, hookworm, ascariasis and trichuriasis). All 32 positive sera with the Trop-Bio ELISA showed a positive ICT card reaction (specificity and sensitivity 100%). It is concluded that, in Saudi Arabia and other Gulf states, where a continuous flow of south- and southeastern workers coming from areas endemic for bancroftian filariasis, the ICT card test may be useful in monitoring the potential risk of introducing bacncroftian filariasis to the host countries.

  4. Evaluation of the sensitivity and fading characteristics of an image plate system for x-ray diagnostics

    NASA Astrophysics Data System (ADS)

    Meadowcroft, A. L.; Bentley, C. D.; Stott, E. N.

    2008-11-01

    Image plates (IPs) are a reusable recording media capable of detecting ionizing radiation, used to diagnose x-ray emission from laser-plasma experiments. Due to their superior performance characteristics in x-ray applications [C. C. Bradford, W. W. Peppler, and J. T. Dobbins III, Med. Phys. 26, 27 (1999) and J. Digit. Imaging. 12, 54 (1999)], the Fuji Biological Analysis System (BAS) IPs are fielded on x-ray diagnostics for the HELEN laser by the Plasma Physics Department at AWE. The sensitivities of the Fuji BAS IPs have been absolutely calibrated for absolute measurements of x-ray intensity in the energy range of 0-100 keV. In addition, the Fuji BAS IP fading as a function of time was investigated. We report on the characterization of three Fuji BAS IP responses to x-rays using a radioactive source, and discrete x-ray line energies generated by the Excalibur soft x-ray facility and the Defense Radiological Standards Centre filter-fluorescer hard x-ray system at AWE.

  5. Diagnostic evaluation of power fade phenomena and calendar lifereduction in high-power lithium-ion batteries

    SciTech Connect

    Kostecki, Robert; McLarnon, Frank

    2004-05-01

    High-power Li-ion cells with graphite anodes and LiNi{sub 0.8}Co{sub 0.15}Al{sub 0.05}O{sub 2} cathodes that were cycled and stored at elevated temperatures showed a significant impedance rise and capacity fade, which were associated primarily with the LiNi{sub 0.8}Co{sub 0.15}Al{sub 0.05}O{sub 2} cathode. A combination of electrochemical, physical, and chemical diagnostic techniques, including Raman, SEM, and current-sensing AFM, was used to characterize the cathodes from these cells in order to produce a clear picture of the mechanism for cell degradation. Systematic Raman mapping of 50 x 80 {mu}m areas at 0.9 {mu}m spatial resolution produced semi-quantitative composition maps of cathode surfaces. Raman microscopy surface composition maps and SEM images of cathodes from tested cells revealed that cell cycling or storage at elevated temperatures led to significant changes in the LiNi{sub 0.8}Co{sub 0.15}Al{sub 0.05}O{sub 2}/elemental-carbon surface concentration ratio. The loss of conductive carbon correlated with the power and capacity fade of the tested cathodes and the loss of surface electronic conductivity.

  6. Spontaneous Tumor Lysis Syndrome: A Case Report and Critical Evaluation of Current Diagnostic Criteria and Optimal Treatment Regimens.

    PubMed

    Weeks, Alicia C; Kimple, Michelle E

    2015-01-01

    Tumor lysis syndrome (TLS) is a known complication of malignancy and its treatment. The incidence varies on malignancy type, but is most common with hematologic neoplasms during cytotoxic treatment. Spontaneous TLS is thought to be rare. This case study is of a 62-year-old female admitted with multisystem organ failure, with subsequent diagnosis of aggressive B cell lymphoma. On admission, laboratory abnormalities included renal failure, elevated uric acid (20.7 mg/dL), and 3+ amorphous urates on urinalysis. Oliguric renal failure persisted despite aggressive hydration and diuretic use, requiring initiation of hemodialysis prior to chemotherapy. Antihyperuricemic therapy and hemodialysis were used to resolve hyperuricemia. However, due to multisystem organ dysfunction syndrome with extremely poor prognosis, the patient ultimately expired in the setting of a terminal ventilator wean. Although our patient did not meet current TLS criteria, she required hemodialysis due to uric acid nephropathy, a complication of TLS. This poses the clinical question of whether adequate diagnostic criteria exist for spontaneous TLS and if the lack of currently accepted guidelines has resulted in the underestimation of its incidence. Allopurinol and rasburicase are commonly used for prevention and treatment of TLS. Although both drugs decrease uric acid levels, allopurinol mechanistically prevents formation of the substrate rasburicase acts to solubilize. These drugs were administered together in our patient, although no established guidelines recommend combined use. This raises the clinical question of whether combined therapy is truly beneficial or, conversely, detrimental to patient outcomes. PMID:26904699

  7. Evaluation of EGFR as a prognostic and diagnostic marker for head and neck squamous cell carcinoma patients

    PubMed Central

    Polanska, Hana; Raudenska, Martina; Hudcová, Kristyna; Gumulec, Jaromir; Svobodova, Marketa; Heger, Zbynek; Fojtu, Michaela; Binkova, Hana; Horakova, Zuzana; Kostrica, Rom; Adam, Vojtech; Kizek, Rene; Masarik, Michal

    2016-01-01

    Approximately 90% of all head and neck tumors are squamous cell carcinomas. The overall survival of patients with head and neck squamous cell carcinoma (HNSCC) is low (≤50%). A non-invasive marker of disease progression is sorely required. The present study focused on the plasmatic levels of epidermal growth factor receptor (EGFR) in HNSCC patients (N=92) compared with healthy (N=29) and diabetic [type 2 diabetes mellitus (T2DM); N=26] controls. Enzyme-linked immunosorbent assay using antibodies against the extracellular region of EGFR (L25-S645) was performed. No significant changes were observed between diabetic and healthy controls. However, there were significantly higher EGFR plasma levels in HNSCC patients compared with both control groups (P=0.001 and 0.005, respectively). Receiver operating characteristic curve analysis identified a sensitivity of 76.09%, a specificity of 67.27% and an area under curve of 0.727 for this comparison. No significant association was observed between EGFR plasma levels and tumor stage, tumor grade, lymph node or distant metastasis occurrence, smoking habit or hypertension. However, the presence of human papillomavirus infection and T2DM in HNSCC patients had borderline effect on the plasma EGFR levels. Survival analysis revealed no significant influence of plasmatic EGFR levels on the overall and disease-specific survival of HNSCC patients. In conclusion, EGFR plasma levels appear to be a relatively promising diagnostic, but poor prognostic, HNSCC marker.

  8. Evaluation of EGFR as a prognostic and diagnostic marker for head and neck squamous cell carcinoma patients

    PubMed Central

    Polanska, Hana; Raudenska, Martina; Hudcová, Kristyna; Gumulec, Jaromir; Svobodova, Marketa; Heger, Zbynek; Fojtu, Michaela; Binkova, Hana; Horakova, Zuzana; Kostrica, Rom; Adam, Vojtech; Kizek, Rene; Masarik, Michal

    2016-01-01

    Approximately 90% of all head and neck tumors are squamous cell carcinomas. The overall survival of patients with head and neck squamous cell carcinoma (HNSCC) is low (≤50%). A non-invasive marker of disease progression is sorely required. The present study focused on the plasmatic levels of epidermal growth factor receptor (EGFR) in HNSCC patients (N=92) compared with healthy (N=29) and diabetic [type 2 diabetes mellitus (T2DM); N=26] controls. Enzyme-linked immunosorbent assay using antibodies against the extracellular region of EGFR (L25-S645) was performed. No significant changes were observed between diabetic and healthy controls. However, there were significantly higher EGFR plasma levels in HNSCC patients compared with both control groups (P=0.001 and 0.005, respectively). Receiver operating characteristic curve analysis identified a sensitivity of 76.09%, a specificity of 67.27% and an area under curve of 0.727 for this comparison. No significant association was observed between EGFR plasma levels and tumor stage, tumor grade, lymph node or distant metastasis occurrence, smoking habit or hypertension. However, the presence of human papillomavirus infection and T2DM in HNSCC patients had borderline effect on the plasma EGFR levels. Survival analysis revealed no significant influence of plasmatic EGFR levels on the overall and disease-specific survival of HNSCC patients. In conclusion, EGFR plasma levels appear to be a relatively promising diagnostic, but poor prognostic, HNSCC marker. PMID:27602151

  9. Relationship between Overall Survival of Patients with Non–Small Cell Lung Cancer and Whole-Body Metabolic Tumor Burden Seen on Postsurgical Fluorodeoxyglucose PET Images

    PubMed Central

    Zhang, Chenpeng; Liao, Chuanhong; Penney, Bill C.; Appelbaum, Daniel E.; Simon, Cassie A.; Pu, Yonglin

    2015-01-01

    Purpose To test the hypothesis that whole-body metabolic tumor burden (MTBWB) on postsurgical fluorodeoxyglucose (FDG) positron emission tomographic (PET)/computed tomographic (CT) images in patients with non–small cell lung cancer (NSCLC) is associated with their overall survival (OS). Materials and Methods The institutional review board approved this study and waived the requirement for obtaining informed consent. One hundred forty-two patients with NSCLC (69 men, 73 women; median age, 67.7 years) who underwent postsurgical FDG PET/CT were retrospectively reviewed. The whole-body metabolic tumor volume (MTVWB), whole-body total lesion glycolysis (TLGWB), and whole-body maximum standardized uptake value (SUVWBmax) were measured. OS served as the primary end point of the study. Kaplan-Meier curves and Cox regression were used to assess the association between PET/CT markers and OS. Results The interobserver variability was low, as demonstrated with intraclass correlation coefficients higher than 0.94 for SUVWBmax, MTVWB, and TLGWB. When compared with those with negative postsurgical FDG PET/CT findings, a significant decrease of OS was found in patients with the presence of FDG-avid tumor on the basis of both a log-rank test (P = .001) and a univariate Cox model (hazard ratio = 2.805, P = .001). In patients with FDG-avid tumor, there was a significant association between OS and ln MTVWB (P < .001), ln TLGWB (P < .001), and ln SUVWBmax (P < .010) in either univariate or multivariate analysis, after adjusting for patient age, sex, TNM restage, and therapy after postsurgical PET/CT studies. The OS differences between the groups dichotomized by the median value of MTVWB (11.54 mL, P = .004), TLGWB (32.38 mL, P < .001), or SUVWBmax (4.93, P = .023) were significant. Conclusion MTBWB and tumor maximum standardized uptake at postsurgical FDG PET/CT are related to the patient's OS in NSCLC, independent of age, sex, TNM restaging, and therapy after postsurgical PET

  10. Diagnostic accuracy of ELISA methods as an alternative screening test to indirect immunofluorescence for the detection of antinuclear antibodies. Evaluation of five commercial kits.

    PubMed

    Tonuttia, Elio; Bassetti, Danila; Piazza, Anna; Visentini, Daniela; Poletto, Monica; Bassetto, Franca; Caciagli, Patrizio; Villalta, Danilo; Tozzoli, Renato; Bizzaro, Nicola

    2004-03-01

    Detection of antinuclear antibodies (ANA) is a fundamental laboratory test for diagnosing systemic autoimmune diseases. Currently, the method of choice is indirect immunofluorescence (IIF) on a HEp-2 cell substrate. The goal of this study was to evaluate the diagnostic accuracy of five commercially available enzyme immunoassay (EIA) kits for ANA detection and to verify the possibility of using them as an alternative to the IIF method. The study involved 1513 patients, 315 of whom were diagnosed with a systemic autoimmune disease and 1198 in whom an autoimmune disorder was excluded. For all sera, ANA detection was performed via IIF and with five different EIA kits. The results were evaluated in relation to clinical diagnosis and the presence of possible specific autoantibodies (anti-ENA or anti-dsDNA); lastly, they were compared with the results obtained using ANA-IIF as the method of reference. The positive rate of the ANA-IIF test in subjects with systemic autoimmune diseases was 92%, whereas in the five ANA-EIA kits there was broad diversity in terms of response, with positive rates ranging from 74 to 94%. All the EIA kits correctly detected the presence of antibodies (anti-dsDNA, anti-RNP, anti-Ro/SSA) responsible for homogeneous and speckled fluorescence pattern, but at the same time they showed substantial inaccuracy with the nucleolar pattern, with a mean sensitivity of approximately 50% in this case. Instead, there was a large kit-to-kit difference in terms of identification of anti-Scl70 and centromere patterns, for which sensitivities ranged between 45 and 91%, and between 49 and 100%, respectively. The results of the study demonstrate that the commercially available ANA-EIA kits show different levels of sensitivity and specificity. Some of them have a diagnostic accuracy that is comparable and, in some cases, even higher than the IIF method. Consequently, these could be used as an alternative screening test to IIE. However, others do not ensure acceptable

  11. Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women: a multivariate comparison of cardiac fluoroscopy, exercise electrocardiography and exercise thallium myocardial perfusion scintigraphy

    SciTech Connect

    Hung, J.; Chaitman, B.R.; Lam, J.; Lesperance, J.; Dupras, G.; Fines, P.; Bourassa, M.G.

    1984-07-01

    Several diagnostic noninvasive tests to detect coronary and multivessel coronary disease are available for women. However, all are imperfect and it is not yet clear whether one particular test provides substantially more information than others. The aim of this study was to evaluate clinical findings, exercise electrocardiography, exercise thallium myocardial scintigraphy and cardiac fluoroscopy in 92 symptomatic women without previous infarction and determine which tests were most useful in determining the presence of coronary disease and its severity. Univariate analysis revealed two clinical, eight exercise electrocardiographic, seven myocardial scintigraphic and seven fluoroscopic variables predictive of coronary or multivessel disease with 70% or greater stenosis. The multivariate discriminant function analysis selected a reversible thallium defect, coronary calcification and character of chest pain syndrome as the variables most predictive of presence or absence of coronary disease. The ranked order of variables most predictive of multivessel disease were cardiac fluoroscopy score, thallium score and extent of ST segment depression in 14 electrocardiographic leads. Each provided statistically significant information to the model. The estimate of predictive accuracy was 89% for coronary disease and 97% for multivessel coronary disease. The results suggest that cardiac fluoroscopy or thallium scintigraphy provide significantly more diagnostic information than exercise electrocardiography in women over a wide range of clinical patient subsets.

  12. Determination of the Diagnostic Values of Asymmetric Dimethylarginine as an Indicator for Evaluation of the Endothelial Dysfunction in Patients with Rheumatoid Arthritis

    PubMed Central

    Spasovski, Dejan; Latifi, Arif; Krstevska-Balkanov, Svetlana; Kafedizska, Irena; Slaninka-Micevska, Maja; Dejanova, Beti; Alabakovska, Sonja; Balkanov, Trajan

    2013-01-01

    Introduction. To compare the diagnostic values of laboratory variables, to present evaluations of the diagnostic test for asymmetric dimethyl arginine (ADMA), rheumatoid factor (RF), C-reactive protein (CRP), and DAS28 index, and to define the effect of untreated rheumatoid arthritis on endothelial function. In order to determine whether ADMA changes depending on the disease evolution, ADMA was used as an indicator for endothelial dysfunction. Methods. Using an ELISA technology of DLD-Diagnostika-GMBH for the detection of ADMA, the samples of serum and urine have been examined in 70 participants (35 RA who were not treated, 35 healthy controls). RF was defined with the test for agglutination (Latex RF test) in the same participants. Results. Out of 35 examined patients with RA, RF appeared in 17 patients (sensitivity of the test, 51.42%). In 20 of the 35 examined patients with RA, we found the presence of ADMA (sensitivity of the test, 57.14%). Anti-CCP antibody was present in 24 examined patients with RA (sensitivity of the test, 68.57%). Conclusion. ADMA has equal or very similar sensitivity and specificity to RF in untreated RA (sensitivity of 57.14% versus 48.57%, specificity of 88.57% versus 91.42%) in the detection of asymptomatic endothelial dysfunction in untreated RA. PMID:23762554

  13. Development and Diagnostic Evaluation of Loop-Mediated Isothermal Amplification Using a New Gene Target for Rapid Detection of Helicobacter pylori

    PubMed Central

    Bakhtiari, Somaye; Alvandi, Amirhooshang; Pajavand, Hamid; Navabi, Jafar; Najafi, Farid; Abiri, Ramin

    2016-01-01

    Background Helicobacter pylori cause chronic gastritis and subsequent diseases like gastric and duodenal ulcers and gastric adenocarcinoma. Current methods for detecting H. pylori have several disadvantages and it is of utmost importance to develop a simple, quick, accurate, and cost-effective diagnostic test. Objectives The aim of this study was to set up and evaluate a diagnostic value of loop- mediated isothermal amplification (LAMP) for detecting H. pylori. Patients and Methods The analytical sensitivity values (limit of detection) of LAMP and polymerase chain reaction (PCR) were determined using serial dilutions of H. pylori DNA. Analytical specificity of the methods using new designed primers targeted ureC gene was also determined. Results The detection limits of the LAMP and PCR assay were similar and were 10 fg of pure DNA of H. pylori, which is equal to 6 copy numbers of H. pylori genome. Analytical specificity of the tests was 100% because the tests were positive only with H. pylori DNA. Conclusions The analytical sensitivity of LAMP and PCR methods, using the designed primers, was 8 times more than any other reported methods. The designed methods are specific and sensitive for detection of H. pylori in different clinical and environmental samples. PMID:27540449

  14. DIAGNOSTIC PERFORMANCE EVALUATION OF THE SD BIOLINE MALARIA ANTIGEN AG PF/PAN TEST (05FK60) IN A MALARIA ENDEMIC AREA OF SOUTHERN ETHIOPIA

    PubMed Central

    TADESSE, Endale; WORKALEMAHU, Bereket; SHIMELIS, Techalew

    2016-01-01

    SUMMARY Rapid diagnostic tests (RDTs) capable of detecting and differentiating Plasmodium species are needed in areas in which microscopy is unsuitable. This study was conducted to assess the diagnostic performance of the rapid test kit - SD BIOLINE Malaria Ag Pf/Pan(r) (05FK60) in an endemic area. Microscopy of Giemsa-stained blood films were performed to detect and estimate the Plasmodium density in malaria suspected patients. The performance of the SD BIOLINE Malaria Ag Pf/Pan test was evaluated using 272 Plasmodium-positive and 102 negative blood samples. The overall sensitivity of the SD BIOLINE Malaria Ag Pf/Pan test was 99.5% for P. falciparum and 92.6% for non-P. falciparum malaria infections. The respective specificity, PPV, and NPV of the test were 98.0, 98.4, and 99.0% for the diagnosis of P. falciparum, and 100.0 %, 100.0%, and 94.4% for non-P. falciparum species. The SD BIOLINE Malaria Ag Pf/Pan test showed an excellent performance in diagnosing Plasmodium infections in an endemic setting. Therefore, this point-of-care test could be used as an alternative to microscopy in places where P. falciparum is endemic and microscopy is unsuitable. PMID:27680164

  15. Immediate diagnostic criteria for bacterial infection of ascitic fluid. Evaluation of ascitic fluid polymorphonuclear leukocyte count, pH, and lactate concentration, alone and in combination.

    PubMed

    Stassen, W N; McCullough, A J; Bacon, B R; Gutnik, S H; Wadiwala, I M; McLaren, C; Kalhan, S C; Tavill, A S

    1986-05-01

    We prospectively evaluated the ascitic fluid (AF) polymorphonuclear cell (PMN) count, pH, and lactate concentration in single ascitic fluids from 60 patients to determine their relative predictive values for the immediate diagnosis of ascitic fluid infection. Nine of the 60 ascitic fluids were malignant. Of the remaining 51 samples, nine from cirrhotic patients were infected. The mean AF pH, lactate concentration, and PMN count in the infected group were 7.20 +/- 0.19, 80 +/- 51 mg/dl, and 18,199 +/- 19,650 cells/mm3, respectively, and all were significantly different from the corresponding values in noninfected ascites. Mean arterial blood-ascitic fluid (B-AF) pH and lactate gradients in the infected group were 0.23 +/- 0.17 and -46 +/- 31 mg/dl, respectively, and were significantly different from the corresponding values in noninfected ascites (p less than 0.05). Significant differences were not found between infected and malignant ascites, except for the AF PMN count (p less than 0.001). In cirrhosis with ascites, an AF pH less than or equal to 7.34 was the most specific single test (100%) and had the highest diagnostic accuracy (98%). In the larger group of patients with ascites of diverse etiology, a B-AF pH gradient greater than or equal to 0.10 or an AF PMN count greater than or equal to 500 cells/mm3 were the single tests with the highest diagnostic accuracy (92%). Combining an AF PMN count greater than 500 cells/mm3 with any of the other diagnostic criteria increased the specificity and diagnostic accuracy (up to 98%) compared to the best single criterion. Although our data support the use of a number of different combinations of AF measurements for the immediate diagnosis of infection, the simplest and most readily obtainable measurements are the pH and PMN count. Therefore, in the clinical setting we recommend the use of either an AF pH less than or equal to 7.34 or a B-AF pH gradient greater than or equal to 0.10 in combination with an AF PMN count

  16. Diagnostic imaging.

    PubMed

    Morris, Peter; Perkins, Alan

    2012-04-21

    Physical techniques have always had a key role in medicine, and the second half of the 20th century in particular saw a revolution in medical diagnostic techniques with the development of key imaging instruments: x-ray imaging and emission tomography (nuclear imaging and PET), MRI, and ultrasound. These techniques use the full width of the electromagnetic spectrum, from gamma rays to radio waves, and sound. In most cases, the development of a medical imaging device was opportunistic; many scientists in physics laboratories were experimenting with simple x-ray images within the first year of the discovery of such rays, the development of the cyclotron and later nuclear reactors created the opportunity for nuclear medicine, and one of the co-inventors of MRI was initially attempting to develop an alternative to x-ray diffraction for the analysis of crystal structures. What all these techniques have in common is the brilliant insight of a few pioneering physical scientists and engineers who had the tenacity to develop their inventions, followed by a series of technical innovations that enabled the full diagnostic potential of these instruments to be realised. In this report, we focus on the key part played by these scientists and engineers and the new imaging instruments and diagnostic procedures that they developed. By bringing the key developments and applications together we hope to show the true legacy of physics and engineering in diagnostic medicine. PMID:22516558

  17. Diagnostic Imaging

    MedlinePlus

    Diagnostic imaging lets doctors look inside your body for clues about a medical condition. A variety of machines and techniques can create pictures of the structures and activities inside your body. The type of imaging your doctor uses depends on your symptoms and ...

  18. Rapid diagnostic imaging and pathologic evaluation of surgical tissue using video rate structured illumination microscopy (VR-SIM) (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Wang, Mei; Tulman, David; Elfer, Kate; Sholl, Andrew; Brown, J. Quincy

    2016-03-01

    Currently available pathology techniques for obtaining a rapid tissue diagnosis, or for determining the adequacy of specimens intended for downstream analysis, are too slow, labor-intensive, and destructive for point-of-care (POC) applications. We previously demonstrated video-rate structured illumination microscopy (VR-SIM) for accurate, high-throughput, non-destructive diagnostic imaging of fluorescently-stained prostate biopsies in seconds per biopsy, with an area under the ROC curve of 0.82-0.88 after pathologist review. In addition, we have demonstrated that it is feasible to use VR-SIM to routinely image very large gross pathology specimens, such as entire prostate resection surfaces, in relatively short timeframes at subcellular resolution. However, our prior work has focused on applications in prostate cancer; the utility in other organ sites has not been explored. Here we extended our technology to varying size kidney, liver, and lung biopsies. We conducted a validation study of VR-SIM against histopathology on a variety of human tissues, including both small biopsies and large slices of tissue. We conducted a blinded study in which the study pathologist accurately identified the organs based on VR-SIM images alone. The results were then used to create a clinical atlas between VR-SIM and H and E images for the different tissues of interest. This clinical atlas will be used to aid in pathologist interpretation in future POC clinical applications of VR-SIM in kidney, liver, and lung. Such applications could include on-site identification of the presence of kidney glomeruli for to ensure successful downstream IHC analysis, or determination of the adequacy of lung cancer biopsies for genomic analysis.

  19. An Evidence-Based Approach to the Evaluation, Diagnostic Assessment and Treatment of Fecal Incontinence in Women

    PubMed Central

    Richter, Holly E.

    2014-01-01

    Fecal incontinence (FI) is a debilitating disorder which negatively impacts quality of life. The etiology is often multifactorial and although most women with FI are able to be treated, many remain untreated because a significant proportion of women do not report their symptoms and seek care. The evaluation and treatment of FI can be also hindered by a lack of understanding of the mechanisms and current options. This article provides a review on the evidence-based evaluation and management for FI. PMID:25505643

  20. A diagnostic evaluation model for complex research partnerships with community engagement: the partnership for Native American Cancer Prevention (NACP) model.

    PubMed

    Trotter, Robert T; Laurila, Kelly; Alberts, David; Huenneke, Laura F

    2015-02-01

    Complex community oriented health care prevention and intervention partnerships fail or only partially succeed at alarming rates. In light of the current rapid expansion of critically needed programs targeted at health disparities in minority populations, we have designed and are testing an "logic model plus" evaluation model that combines classic logic model and query based evaluation designs (CDC, NIH, Kellogg Foundation) with advances in community engaged designs derived from industry-university partnership models. These approaches support the application of a "near real time" feedback system (diagnosis and intervention) based on organizational theory, social network theory, and logic model metrics directed at partnership dynamics, combined with logic model metrics.

  1. Diagnostic hematology of reptiles.

    PubMed

    Stacy, Nicole I; Alleman, A Rick; Sayler, Katherine A

    2011-03-01

    The hematologic evaluation of reptiles is an indispensable diagnostic tool in exotic veterinary practice. The diversity of reptile species, their characteristic physiologic features, and effects of intrinsic and extrinsic factors present unique challenges for accurate interpretation of the hemogram. Combining the clinical presentation with hematologic findings provides valuable information in the diagnosis and monitoring of disease and helps guide the clinician toward therapy and further diagnostic testing. This article outlines the normal and pathologic morphology of blood cells of reptile species. The specific comparative aspects of reptiles are emphasized, and structural and functional abnormalities in the reptilian hemogram are described.

  2. An evaluation of the Performance Diagnostic Checklist-Human Services to assess an employee performance problem in a center-based autism treatment facility.

    PubMed

    Ditzian, Kyle; Wilder, David A; King, Allison; Tanz, Jeanine

    2015-01-01

    The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool designed to assess the environmental variables that contribute to poor employee performance in human services settings. We administered the PDC-HS to 3 supervisors to assess the variables that contributed to poor performance by 4 staff members when securing clients in therapy rooms at a treatment center for children with autism. The PDC-HS identified a lack of appropriate consequences as contributing to poor staff performance. We then evaluated a PDC-HS-indicated intervention as well as an intervention not suggested by PDC-HS results. The PDC-HS-indicated intervention (graphed feedback) was effective to increase performance; the non-PDC-HS-based intervention was ineffective.

  3. Evaluation of the Performance of Five Diagnostic Tests for Fasciola hepatica Infection in Naturally Infected Cattle Using a Bayesian No Gold Standard Approach.

    PubMed

    Mazeri, Stella; Sargison, Neil; Kelly, Robert F; Bronsvoort, Barend M deC; Handel, Ian

    2016-01-01

    The clinical and economic importance of fasciolosis has been recognised for centuries, yet diagnostic tests available for cattle are far from perfect. Test evaluation has mainly been carried out using gold standard approaches or under experimental settings, the limitations of which are well known. In this study, a Bayesian no gold standard approach was used to estimate the diagnostic sensitivity and specificity of five tests for fasciolosis in cattle. These included detailed liver necropsy including gall bladder egg count, faecal egg counting, a commercially available copro-antigen ELISA, an in-house serum excretory/secretory antibody ELISA and routine abattoir liver inspection. In total 619 cattle slaughtered at one of Scotland's biggest abattoirs were sampled, during three sampling periods spanning summer 2013, winter 2014 and autumn 2014. Test sensitivities and specificities were estimated using an extension of the Hui Walter no gold standard model, where estimates were allowed to vary between seasons if tests were a priori believed to perform differently for any reason. The results of this analysis provide novel information on the performance of these tests in a naturally infected cattle population and at different times of the year where different levels of acute or chronic infection are expected. Accurate estimates of sensitivity and specificity will allow for routine abattoir liver inspection to be used as a tool for monitoring the epidemiology of F. hepatica as well as evaluating herd health planning. Furthermore, the results provide evidence to suggest that the copro-antigen ELISA does not cross-react with Calicophoron daubneyi rumen fluke parasites, while the serum antibody ELISA does. PMID:27564546

  4. Evaluation of the Performance of Five Diagnostic Tests for Fasciola hepatica Infection in Naturally Infected Cattle Using a Bayesian No Gold Standard Approach

    PubMed Central

    Sargison, Neil; Kelly, Robert F.; Bronsvoort, Barend M. deC.; Handel, Ian

    2016-01-01

    The clinical and economic importance of fasciolosis has been recognised for centuries, yet diagnostic tests available for cattle are far from perfect. Test evaluation has mainly been carried out using gold standard approaches or under experimental settings, the limitations of which are well known. In this study, a Bayesian no gold standard approach was used to estimate the diagnostic sensitivity and specificity of five tests for fasciolosis in cattle. These included detailed liver necropsy including gall bladder egg count, faecal egg counting, a commercially available copro-antigen ELISA, an in-house serum excretory/secretory antibody ELISA and routine abattoir liver inspection. In total 619 cattle slaughtered at one of Scotland’s biggest abattoirs were sampled, during three sampling periods spanning summer 2013, winter 2014 and autumn 2014. Test sensitivities and specificities were estimated using an extension of the Hui Walter no gold standard model, where estimates were allowed to vary between seasons if tests were a priori believed to perform differently for any reason. The results of this analysis provide novel information on the performance of these tests in a naturally infected cattle population and at different times of the year where different levels of acute or chronic infection are expected. Accurate estimates of sensitivity and specificity will allow for routine abattoir liver inspection to be used as a tool for monitoring the epidemiology of F. hepatica as well as evaluating herd health planning. Furthermore, the results provide evidence to suggest that the copro-antigen ELISA does not cross-react with Calicophoron daubneyi rumen fluke parasites, while the serum antibody ELISA does. PMID:27564546

  5. Experimental assessment of pro-lymphangiogenic growth factors in the treatment of post-surgical lymphedema following lymphadenectomy

    PubMed Central

    2010-01-01

    Introduction Lymphedema is a frequent consequence of lymph node excision during breast cancer surgery. Current treatment options are limited mainly to external compression therapies to limit edema development. We investigated previously, postsurgical lymphedema in a sheep model following the removal of a single lymph node and determined that autologous lymph node transplantation has the potential to reduce or prevent edema development. In this report, we examine the potential of lymphangiogenic therapy to restore lymphatic function and reduce postsurgical lymphedema. Methods Lymphangiogenic growth factors (vascular endothelial growth factor C (VEGF-C)) and angiopoietin-2 (ANG-2) were loaded into a gel-based drug delivery system (HAMC; a blend of hyaluronan and methylcellulose). Drug release rates and lymphangiogenic signaling in target endothelial cells were assessed in vitro and vascular permeability biocompatibility tests were examined in vivo. Following, the removal of a single popliteal lymph node, HAMC with the growth factors was injected into the excision site. Six weeks later, lymphatic functionality was assessed by injecting 125Iodine radiolabeled bovine serum albumin (125I-BSA) into prenodal vessels and measuring its recovery in plasma. Circumferential leg measurements were plotted over time and areas under the curves used to quantify edema formation. Results The growth factors were released over a two-week period in vitro by diffusion from HAMC, with 50% being released in the first 24 hr. The system induced lymphangiogenic signaling in target endothelial cells, while inducing only a minimal inflammatory response in sheep. Removal of the node significantly reduced lymphatic functionality (nodectomy 1.9 ± 0.9, HAMC alone 1.7 ± 0.8) compared with intact groups (3.2 ± 0.7). In contrast, there was no significant difference between the growth factor treatment group (2.3 ± 0.73) and the intact group indicating improved function with the molecular factors. An

  6. Infiltration of liposome bupivacaine into the transversus abdominis plane for postsurgical analgesia in robotic laparoscopic prostatectomy: a pilot study

    PubMed Central

    Sternlicht, Andrew; Shapiro, Max; Robelen, Gary; Vellayappan, Usha; Tuerk, Ingolf A

    2014-01-01

    Background Transversus abdominis plane (TAP) infiltration has been increasingly used for postsurgical analgesia in abdominal/pelvic procedures; however, duration/extent of analgesia with standard local anesthetics is limited. This pilot study assessed the preliminary efficacy and safety of two volumes of liposome bupivacaine administered via TAP infiltration in patients undergoing robotic laparoscopic prostatectomy. Methods In this single-center, open-label, prospective study, patients older than 18 years received TAP infiltration with liposome bupivacaine immediately after surgery. The first 12 patients received a total volume of 20 mL liposome bupivacaine (266 mg); the next 12 received 40 mL liposome bupivacaine (266 mg). The liposome bupivacaine was diluted with 0.9% normal saline. The primary efficacy measure was duration of analgesia, measured by time to first opioid administration. Secondary outcome measures included patient-assessed pain scores, opioid use, and opioid-related adverse events (AEs). Results Twenty-four patients received liposome bupivacaine (20 mL, n=12; 40 mL, n=12) and were included in the primary analysis. Three refused participation in a 10-day follow-up visit and did not complete the study. Median time to first opioid administration after surgery was 23 and 26 minutes for the 20 and 40 mL groups, respectively. Mean total amount of postsurgical opioids ranged from 25.4 to 27.3 mg; after hospital discharge to day 10, both groups required a mean of 0.7 oxycodone/acetaminophen tablets/day. Mean pain scores of 4.4 and 5.3 were reported at 1 hour and 3.1 and 3.9 at 2 hours postsurgery, with 20 and 40 mL doses, respectively. Neither group had mean scores higher than 3.0 at any further assessments. No opioid-related or treatment-related serious AEs were reported. Conclusion Median time to first opioid administration did not differ between the two groups. No differences in secondary outcomes were observed on the basis of volume administered. These

  7. SU-E-P-09: Radiation Transmission Measurements and Evaluation of Diagnostic Lead-Based and Lead-Free Aprons

    SciTech Connect

    Syh, J

    2014-06-01

    Purpose: This study was conducted to ensure that various lead shield apron manufacturers provided accurate attenuation factors regardless of whether the apron was made of lead-based or lead-free equivalent material. Methods: A calibrated ionization survey meter was placed at chest height and 36 cm horizontally away from a solid water phantom on a simulator couch. Measurements were done with or without apron. Radiation field was set to 24cmx24cm with the phantom at 100cm source-to-surface distance. Irradiation time was set for 1 minute at voltages of 60, 80, 100 and 120 kVp. Current was set at 6mA. Results: Between 60 kVp and 120 kVp, the transmission through 0.50 mm of lead-based apron was between 1.0% and 6.5% with a mean value of 3.2% and a standard deviation (s.d.) of 1.4%. The transmissions through the 0.50 mm lead-free aprons were 1.0 % to 12.0% with a mean value of 6.1% and s.d. of 2.6%. At 120 kVp, the transmission value was 6.5% for 0.50 mm lead-based apron and 11.1% to 12.0% for 0.50 mm lead-free aprons. The radiation transmissions at 80 kVp, measured in two different 0.5 mm lead-free aprons, were 4.3% each. However, only 1.4% transmission was found through the lead-based apron. Overall, the radiation transmitted through the lead-based apron was 1/3 transmission of lead-free at 80kVp, and half value of lead-free aprons at 100 and 120 kVp. Conclusion: Even though lead-based and lead-free aprons all claimed to have the same lead equivalent thickness, the transmission might not be the same. The precaution was needed to exercise diligence in quality assurance program to assure adequate protection to staff who wear it during diagnostic procedures. The requirement for aprons not only should be in certain thickness to meet state regulation but also to keep reasonably achievable low exposure with the accurate labeling from manufacturers.

  8. Comparative evaluation and economic assessment of coprological diagnostic methods and PCR for detection of Cryptosporidium spp. in bovines.

    PubMed

    Paul, S; Chandra, D; Tewari, A K; Banerjee, P S; Ray, D D; Boral, R; Rao, J R

    2009-10-14

    The role of Cryptosporidium spp. as a major cause of diarrhoea and gastrointestinal illness of protozoan origin in neonatal calves has been established. Many coprological and serological techniques have been described for detection of the parasites with the limitations of sensitivity and specificity. Polymerase chain reaction (PCR) technique offers a useful alternative to conventional diagnosis of Cryptosporidium spp. in bovines from both clinical and environmental samples. We compared four conventional coprological techniques, viz., direct faecal smear staining (DFSS), normal saline sedimentation staining (NSSS), Sheather's flotation (SF) and Sheather's flotation sedimentation staining (SFSS) with PCR directed against the 18S SSU rRNA gene as standard reference test for the diagnosis of cryptosporidiosis in bovines. Out of 457 faecal samples collected from neonatal bovine calves, specific PCR amplification was achieved in 138 samples, whereas, 65 samples turned positive by DFSS. Normal saline sedimentation staining, SF and SFSS could detect 92, 82 and 109 samples as positive, respectively. Sheather's flotation sedimentation staining was found to be the most sensitive (82.6%) and specific (98.76%) among the coprological techniques. On per sample processing based cost analysis, DFSS was found to be the most economical method (15 cents) followed by NSSS (19.6 cents), SF (23.6 cents) and SFSS (33.9 cents). The time taken for complete processing and diagnosis varied between 70 and 100 min. PCR based diagnosis of a sample took about 7.5-8h for completion and cost of diagnosis was estimated as approximately 7.604 US$ per sample. Among the conventional coprological methods, SFSS provided the required sensitivity and specificity along with nominal cost for diagnosis on per sample basis, and may be considered as a viable diagnostic alternative when PCR is not an option for a particular laboratory setting, especially in developing countries. This is the first comparative

  9. Evaluation of the diagnostic and prognostic utility of ultrasonography at first diagnosis of presumptive bovine respiratory disease

    PubMed Central

    Abutarbush, Sameeh M.; Pollock, Colleen M.; Wildman, Brian K.; Perrett, Tye; Schunicht, Oliver C.; Fenton, R. Kent; Hannon, Sherry J.; Vogstad, Amanda R.; Jim, G. Kee; Booker, Calvin W.

    2012-01-01

    This project investigated the use of ultrasonography at first diagnosis of presumptive early bovine respiratory disease (BRD) in feedlot cattle from western Canada. One hundred seventy-four cattle (116 cases and 58 controls) at high risk of developing BRD were enrolled in a prospective longitudinal study over 2 y (2006–2007). Cattle with clinical signs relating to the respiratory system and assessed as sick at the time of feedlot arrival (arrival fever cases) or assessed as sick in the pen 3 to 30 d post-arrival (post-arrival fever cases, post-arrival no fevers cases) were eligible for enrollment. Control animals were identified at the time of case enrollments. Ultrasonography was done using a 3.5 sector transducer at enrollment and at 2, 4, and 6 wk post-enrollment. Lung lesions were identified at least 1 time over the course of the trial in 32/116 (28%) cases and 9/58 (16%) controls. At enrollment, lung lesions were identified in 20/115 (17%) cases and 2/55 (4%) controls (data unreadable n = 4). Post-arrival fever cases (14/48) were the most likely to have a lesion identified using ultrasound. In arrival fever cases, average daily gain (enrollment to last ultrasound, average 34 d) was improved (P = 0.007) in cattle identified with a lesion at enrollment using ultrasound compared with those not identified with a lesion at that time, potentially demonstrating the effects of gut fill at arrival weighing, as these sicker animals may have eaten less prior to arrival and, therefore, had more room for improvement in weight over time due to restoration of normal gut fill. None of the ultrasound time points explored (enrollment, 2, 4, or 6 wk post-enrollment) were associated with the animal health outcomes of interest (subsequent treatment, chronicity, wastage, or mortality) for cattle enrolled at arrival or post-arrival. Ultrasonography using a 3.5 sector transducer was not particularly effective as a prognostic/diagnostic tool for early detection of BRD, but may be

  10. A diagnostic evaluation model for complex research partnerships with community engagement: The partnership for Native American Cancer Prevention (NACP) model

    PubMed Central

    Trotter, Robert T.; Laurila, Kelly; Alberts, David; Huenneke, Laura F.

    2014-01-01

    Complex community oriented health care prevention and intervention partnerships fail or only partially succeed at alarming rates. In light of the current rapid expansion of critically needed programs targeted at health disparities in minority populations, we have designed and are testing an “logic model plus” evaluation model that combines classic logic model and query based evaluation designs (CDC, NIH, Kellogg Foundation) with advances in community engaged designs derived from industry-university partnership models. These approaches support the application of a “near real time” feedback system (diagnosis and intervention) based on organizational theory, social network theory, and logic model metrics directed at partnership dynamics, combined with logic model metrics. PMID:25265164

  11. [Menière's disease: diagnostic criteria, criteria to establish stages, and standards for treatment evaluation. Bibliographic review and update].

    PubMed

    Pérez Fernández, N; Pérez Garrigues, H; Antolí Candela, F; García Ibáñez, E

    2002-11-01

    If all doctors would use the same concepts to define Meniere's Disease (MD) and the same scale to either establish the different steps of the disease or to evaluate a specific treatment, it would be easy to compare our results. This would be beneficial for patients because of the possibility of giving them a more accurate information about the follow-up of their disease and the advantages of the different possibilities of treatment. Since the introduction of informatic systems a new goal appeared: large databases could be achieved, as a result of being able to gather the different database that are independently used in each hospital, provided that rules to establish data would be previously standardized. The purpose of this paper is to evaluate the proposal of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology and those proposed by other authors according to the stated courses of action.

  12. Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients

    PubMed Central

    Feierman, Dennis E; Kronenfeld, Mark; Gupta, Piyush M; Younger, Natalie; Logvinskiy, Eduard

    2014-01-01

    Background Achieving adequate control of postsurgical pain remains a challenge in patients undergoing abdominal surgery. Transversus abdominis plane (TAP) infiltration has been shown to provide postsurgical analgesia following lower abdominal surgery. We assessed the safety and efficacy of a prolonged-release liposomal formulation of the local anesthetic bupivacaine administered via infiltration into the TAP in a cohort of patients undergoing open abdominal umbilical hernia repair. Methods Patients included in the study were 18–75 years of age, had American Society of Anesthesiologists physical classification status 1–3, and underwent open abdominal umbilical hernia repair with ultrasound-guided TAP infiltration immediately after surgery using an equal-volume bilateral infusion of liposomal bupivacaine 266 mg (diluted to 30 mL in normal saline). Outcome measures included patient-reported pain intensity (11-point numeric rating scale), satisfaction with postsurgical analgesia (5-point Likert scale), incidence of opioid-related adverse events, and time to first use of supplemental rescue analgesia. Results Thirteen patients underwent surgery and received bilateral TAP infiltration with liposomal bupivacaine; TAP infiltration failed in the first patient. Mean numeric rating scale pain scores were 0.6 immediately before TAP infiltration and remained ≤2.3 through 120 hours after infiltration; mean scores at 120 hours and 10 days were 0.9 and 0.4, respectively. Ten patients (77%) required supplemental analgesia; median time to first use was 11 hours. At discharge and day 10, 54% and 62% of patients, respectively, were “extremely satisfied” with postsurgical analgesia (Likert score 5). There were no opioid-related or other adverse events. Conclusion Although the current study was limited by both its lack of a control group and its small size, to our knowledge, it is the first published report on use of liposomal bupivacaine for TAP infiltration. In this cohort

  13. MJO Simulation Diagnostics

    SciTech Connect

    Waliser, D; Sperber, K; Hendon, H; Kim, D; Maloney, E; Wheeler, M; Weickmann, K; Zhang, C; Donner, L; Gottschalck, J; Higgins, W; Kang, I; Legler, D; Moncrieff, M; Schubert, S; Stern, W; Vitart, F; Wang, B; Wang, W; Woolnough, S

    2008-06-02

    The Madden-Julian Oscillation (MJO) interacts with, and influences, a wide range of weather and climate phenomena (e.g., monsoons, ENSO, tropical storms, mid-latitude weather), and represents an important, and as yet unexploited, source of predictability at the subseasonal time scale. Despite the important role of the MJO in our climate and weather systems, current global circulation models (GCMs) exhibit considerable shortcomings in representing this phenomenon. These shortcomings have been documented in a number of multi-model comparison studies over the last decade. However, diagnosis of model performance has been challenging, and model progress has been difficult to track, due to the lack of a coherent and standardized set of MJO diagnostics. One of the chief objectives of the US CLIVAR MJO Working Group is the development of observation-based diagnostics for objectively evaluating global model simulations of the MJO in a consistent framework. Motivation for this activity is reviewed, and the intent and justification for a set of diagnostics is provided, along with specification for their calculation, and illustrations of their application. The diagnostics range from relatively simple analyses of variance and correlation, to more sophisticated space-time spectral and empirical orthogonal function analyses. These diagnostic techniques are used to detect MJO signals, to construct composite life-cycles, to identify associations of MJO activity with the mean state, and to describe interannual variability of the MJO.

  14. Evaluation of inhibitor-resistant real-time PCR methods for diagnostics in clinical and environmental samples.

    PubMed

    Trombley Hall, Adrienne; McKay Zovanyi, Ashley; Christensen, Deanna Rose; Koehler, Jeffrey William; Devins Minogue, Timothy

    2013-01-01

    Polymerase chain reaction (PCR) is commonly used for pathogen detection in clinical and environmental samples. These sample matrices often contain inhibitors of PCR, which is a primary reason for sample processing; however, the purification process is highly inefficient, becoming unacceptable at lower signature concentrations. One potential solution is direct PCR assessment without sample processing. Here, we evaluated nine inhibitor-resistant PCR reagents for direct detection of Francisella tularensis in seven different clinical and environmental samples using an established real-time PCR assay to assess ability to overcome PCR inhibition. While several of these reagents were designed for standard PCR, the described inhibitor resistant properties (ex. Omni Klentaq can amplify target DNA samples of up to 20% whole blood or soil) led to our evaluation with real-time PCR. A preliminary limit of detection (LOD) was determined for each chemistry in whole blood and buffer, and LODs (20 replicates) were determined for the top five chemistries in each matrix (buffer, whole blood, sputum, stool, swab, soil, and sand). Not surprisingly, no single chemistry performed the best across all of the different matrices evaluated. For instance, Phusion Blood Direct PCR Kit, Phire Hot Start DNA polymerase, and Phire Hot Start DNA polymerase with STR Boost performed best for direct detection in whole blood while Phire Hot Start DNA polymerase with STR Boost were the only reagents to yield an LOD in the femtogram range for soil. Although not the best performer across all matrices, KAPA Blood PCR kit produced the most consistent results among the various conditions assessed. Overall, while these inhibitor resistant reagents show promise for direct amplification of complex samples by real-time PCR, the amount of template required for detection would not be in a clinically relevant range for most matrices. PMID:24040090

  15. Diagnostic testing and evaluation of the community WRF-Hydro Modeling System for national streamflow prediction application

    NASA Astrophysics Data System (ADS)

    Rafieei Nasab, A.; Gochis, D.; Dugger, A. L.; Pan, L.; McCreight, J. L.; Yu, W.; Zhang, Y.; Yates, D. N.; Somos-Valenzuela, M. A.; Salas, F. R.; Maidment, D. R.

    2015-12-01

    A fully-distributed WRF-Hydro modeling system developed at National Center of Atmospheric Research (NCAR) will serve the initial operational nationwide streamflow forecasting needs of the National Water Center (NWC). This paper presents a multi-faceted evaluation of the WRF-hydro modeling system in preparation for operational national streamflow prediction. The testing period encompasses the 2015 warm season which included the National Flood Interoperability Experiment (NFIE) where WRF-Hydro and the RAPID channel routing model were driven by the Multi-Radar Multi-Sensor (MRMS) estimates as the real-time precipitation estimate product and the High Resolution Rapid Refresh (HRRR) for the short term forecast. Here, we validate the MRMS estimates and HRRR precipitation forecasts at national scale using daily precipitation observations from the Global Historical Climatology Network (GHCN). Because WRF-Hydro has several physics options such as surface overland flow, saturated subsurface flow, channel routing as well as conceptual deep groundwater base flow also conducted additional simulations to evaluate WRF-Hydro performance under different processes configurations. Streamflow verification data for model simulations and predictions was completed for a subset of GAGES-II reference basins. Multi-temporal and spatial scale verification is performed in order to test the robustness and skill improvement in WRF-Hydro streamflow simulations under different configuration over a wide range of basins sizes and from short-term (hourly) to longer-term (monthly) flow simulations. Evaluation will be also carried out based on various geographic regions to relate the skill improvement to dominant controls on flow based on the actual physical and climatic properties of the basins. The goal is to inform WRF-Hydro model configuration for the initial operating capabilities (IOC) project and target processes and parameter estimates for improvement.

  16. Proton HR-MAS spectroscopy and quantitative pathologic analysis of MRI/3D-MRSI-targeted postsurgical prostate tissues.

    PubMed

    Swanson, Mark G; Vigneron, Daniel B; Tabatabai, Z Laura; Males, Ryan G; Schmitt, Lars; Carroll, Peter R; James, Joyce K; Hurd, Ralph E; Kurhanewicz, John

    2003-11-01

    Proton high-resolution magic angle spinning ((1)H HR-MAS) NMR spectroscopy and quantitative histopathology were performed on the same 54 MRI/3D-MRSI-targeted postsurgical prostate tissue samples. Presurgical MRI/3D-MRSI targeted healthy and malignant prostate tissues with an accuracy of 81%. Even in the presence of substantial tissue heterogeneity, distinct (1)H HR-MAS spectral patterns were observed for different benign tissue types and prostate cancer. Specifically, healthy glandular tissue was discriminated from prostate cancer based on significantly higher levels of citrate (P = 0.04) and polyamines (P = 0.01), and lower (P = 0.02) levels of the choline-containing compounds choline, phosphocholine (PC), and glycerophosphocholine (GPC). Predominantly stromal tissue lacked both citrate and polyamines, but demonstrated significantly (P = 0.01) lower levels of choline compounds than cancer. In addition, taurine, myo-inositol, and scyllo-inositol were all higher in prostate cancer vs. healthy glandular and stromal tissues. Among cancer samples, larger increases in choline, and decreases in citrate and polyamines (P = 0.05) were observed with more aggressive cancers, and a MIB-1 labeling index correlated (r = 0.62, P = 0.01) with elevated choline. The elucidation of spectral patterns associated with mixtures of different prostate tissue types and cancer grades, and the inclusion of new metabolic markers for prostate cancer may significantly improve the clinical interpretation of in vivo prostate MRSI data.

  17. Utilization of silver hydrogel sheet dressing on postsurgical incisions: a pilot study in foot and ankle surgery.

    PubMed

    Galli, Melissa M; Protzman, Nicole M; Brigido, Stephen A

    2013-12-01

    Silver hydrogel dressings are antimicrobial, nonadherent, and have an absorptive capacity many times their weight. Fifty-nine (49.44 ± 16.85 years) foot and ankle patients with incisions >1 cm were prospectively enrolled to compare infection, scarring, and complication rates between the postoperative use of a silver hydrogel sheet (SHS) dressing and a standard petroleum-based (P) dressing. Overall, there were 5 (8.47%) infections; 4 (6.78%) superficial and 1 (1.69%) deep. The SHS group had 1 (3.45%) superficial infection, whereas the P group had 3 (10.00%) superficial infections and 1 (3.33%) deep infection. Infection incidence was similar for both groups (P = .37). However, in the P group, 3 (10.00%) patients developed wound dehiscence and 1 (1.69%) patient developed a fibrinous scab. Compared with SHS patients, the P patients had a greater incidence of incisional complications (1 [3.45%] vs 8 [26.67%], respectively; P = .03). The percent change in scar length was greater in the SHS group (18.04 ± 41.10%) when compared with the P group (2.00 ± 9.93%; P < .001) while the percent change in scar width was similar in the 2 groups (P = .19). The lower incidence of incisional complications and the greater reduction in scar length suggest that the inherent properties of the silver hydrogel dressing aid in postsurgical healing.

  18. Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair

    PubMed Central

    Lavand'homme, Patricia; Ambrosoli, Andrea Luigi; Cappelleri, Gianluca; Saccani Jotti, Gloria MR; Fanelli, Guido; Allegri, Massimo

    2016-01-01

    Poor acute pain control and inflammation are important risk factors for Persistent Postsurgical Pain (PPSP). The aim of the study is to investigate, in the context of a prospective cohort of patients undergoing hernia repair, potential risk factors for PPSP. Data about BMI, anxious-depressive disorders, neutrophil-tolymphocyte ratio (NLR), proinflammatory medical comorbidities were collected. An analysis for correlation between comorbidities and PPSP was performed in those patients experiencing chronic pain at 3 months after surgery. Tramadol resulted less effective in pain at movement in patients with a proinflammatory status. Preoperative hypertension and NLR > 4 were correlated with PPSP intensity. Regional anesthesia was significantly protective on PPSP when associated with ketorolac. Patients with pain at 1 month were significantly more prone to develop PPSP at 3 months. NSAIDs or weak opioids are equally effective on acute pain and on PPSP development after IHR, but Ketorolac has better profile in patients with inflammatory background or undergoing regional anesthesia. Drug choice should be based on their potential side effects, patient's profile (comorbidities, preoperative inflammation, and hypertension), and type of anesthesia. Close monitoring is necessary to early detect pain conditions more prone to progress to a chronic syndrome. PMID:27051077

  19. Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair.

    PubMed

    Bugada, Dario; Lavand'homme, Patricia; Ambrosoli, Andrea Luigi; Cappelleri, Gianluca; Saccani Jotti, Gloria Mr; Meschi, Tiziana; Fanelli, Guido; Allegri, Massimo

    2016-01-01

    Poor acute pain control and inflammation are important risk factors for Persistent Postsurgical Pain (PPSP). The aim of the study is to investigate, in the context of a prospective cohort of patients undergoing hernia repair, potential risk factors for PPSP. Data about BMI, anxious-depressive disorders, neutrophil-tolymphocyte ratio (NLR), proinflammatory medical comorbidities were collected. An analysis for correlation between comorbidities and PPSP was performed in those patients experiencing chronic pain at 3 months after surgery. Tramadol resulted less effective in pain at movement in patients with a proinflammatory status. Preoperative hypertension and NLR > 4 were correlated with PPSP intensity. Regional anesthesia was significantly protective on PPSP when associated with ketorolac. Patients with pain at 1 month were significantly more prone to develop PPSP at 3 months. NSAIDs or weak opioids are equally effective on acute pain and on PPSP development after IHR, but Ketorolac has better profile in patients with inflammatory background or undergoing regional anesthesia. Drug choice should be based on their potential side effects, patient's profile (comorbidities, preoperative inflammation, and hypertension), and type of anesthesia. Close monitoring is necessary to early detect pain conditions more prone to progress to a chronic syndrome. PMID:27051077

  20. Development and prospective multicenter evaluation of the long noncoding RNA MALAT-1 as a diagnostic urinary biomarker for prostate cancer.

    PubMed

    Wang, Fubo; Ren, Shancheng; Chen, Rui; Lu, Ji; Shi, Xiaolei; Zhu, Yasheng; Zhang, Wei; Jing, Taile; Zhang, Chao; Shen, Jian; Xu, Chuanliang; Wang, Huiqing; Wang, Haifeng; Wang, Yang; Liu, Bin; Li, Yaoming; Fang, Ziyu; Guo, Fei; Qiao, Meng; Wu, Chengyao; Wei, Qiang; Xu, Danfeng; Shen, Dan; Lu, Xin; Gao, Xu; Hou, Jianguo; Sun, Yinghao

    2014-11-30

    The current strategy for diagnosing prostate cancer (PCa) is mainly based on the serum prostate-specific antigen (PSA) test. However, PSA has low specificity and has led to numerous unnecessary biopsies. We evaluated the effectiveness of urinary metastasis-associated lung adenocarcinoma transcript 1 (MALAT-1), a long noncoding RNA, for predicting the risk of PCa before biopsy. The MALAT-1 score was tested in a discovery phase and a multi-center validation phase. The predictive power of the MALAT-1 score was evaluated by the area under receiver operating characteristic (ROC) curve (AUC) and by decision curve analysis. As an independent predictor of PCa, the MALAT-1 score was significantly higher in men with a positive biopsy than in those with a negative biopsy. The ROC analysis showed a higher AUC for the MALAT-1 score (0.670 and 0.742) vs. the total PSA (0.545 and 0.601) and percent free PSA (0.622 and 0.627) in patients with PSA values of 4.0-10 ng/ml. According to the decision curve analysis, using a probability threshold of 25%, the MALAT-1 model would prevent 30.2%-46.5% of unnecessary biopsies in PSA 4-10 ng/ml cohorts, without missing any high-grade cancers. Our results demonstrate that urine MALAT-1 is a promising biomarker for predicting prostate cancer risk.

  1. [Evaluation of the diagnostic value of color Doppler ultrasound examination of salivary gland neoplasms and metastatic tumors from the facial bones].

    PubMed

    Falkowski, A

    1998-01-01

    The aim of the study was to evaluate usefulness of colour Doppler ultrasound examination in diagnosing the salivary gland tumours and the metastatic tumours of the neck originating from the facial part of the skull. Epidemiology and histopathology of the neoplasms involving the salivary glands and the facial skeleton were discussed including the route of their spreading to the neck. The author presents update techniques of bony face radiologic imaging and basic principles of modern colour Doppler ultrasound. The examinations with the use of a colour Doppler equipment-Acuson 128-XP 10 were performed in 150 patients with the neck tumours. The exact location, size, morphology and blood supply were assessed using B and B colour mode. Then some big neck vessels like the common, internal and external carotid artery, vertebral artery, internal jugular vein were visualized. All the patients were divided into three groups according to what they were suffering from: sialoadenitis, benign and malignant tumours. The obtained results were compared and confronted with clinical features. The pattern of vascularization failed to allow for establishing preliminary diagnosis in patients in each group. Within the first group, with inflamed glands did not compress the neck vessels. Of all the patients with benign tumours, extrinsic compression on the internal jugular vein and the carotid arteries was found in 16 and 14 patients respectively. In the third group of patients with malignant disease, compression on the veins was detected in 10 cases while 5 tumours compressed the arteries. The invasion involved the internal jugular vein in 7 patients while the common and internal carotid arteries were invaded in 6. The vertebral artery was never found to be affected. It was demonstrated that compression on veins resulted in disturbing the flow which was not observed as far as the arteries were concerned. Disturbing in the flow of veins and arteries was disclosed in cases of invasion

  2. Detection of Echinococcus multilocularis by MC-PCR: evaluation of diagnostic sensitivity and specificity without gold standard

    PubMed Central

    Wahlström, Helene; Comin, Arianna; Isaksson, Mats; Deplazes, Peter

    2016-01-01

    Introduction A semi-automated magnetic capture probe-based DNA extraction and real-time PCR method (MC-PCR), allowing for a more efficient large-scale surveillance of Echinococcus multilocularis occurrence, has been developed. The test sensitivity has previously been evaluated using the sedimentation and counting technique (SCT) as a gold standard. However, as the sensitivity of the SCT is not 1, test characteristics of the MC-PCR was also evaluated using latent class analysis, a methodology not requiring a gold standard. Materials and methods Test results, MC-PCR and SCT, from a previous evaluation of the MC-PCR using 177 foxes shot in the spring (n=108) and autumn 2012 (n=69) in high prevalence areas in Switzerland were used. Latent class analysis was used to estimate the test characteristics of the MC-PCR. Although it is not the primary aim of this study, estimates of the test characteristics of the SCT were also obtained. Results and discussion This study showed that the sensitivity of the MC-PCR was 0.88 [95% posterior credible interval (PCI) 0.80–0.93], which was not significantly different than the SCT, 0.83 (95% PCI 0.76–0.88), which is currently considered as the gold standard. The specificity of both tests was high, 0.98 (95% PCI 0.94–0.99) for the MC-PCR and 0.99 (95% PCI 0.99–1) for the SCT. In a previous study, using fox scats from a low prevalence area, the specificity of the MC-PCR was higher, 0.999% (95% PCI 0.997–1). One reason for the lower estimate of the specificity in this study could be that the MC-PCR detects DNA from infected but non-infectious rodents eaten by foxes. When using MC-PCR in low prevalence areas or areas free from the parasite, a positive result in the MC-PCR should be regarded as a true positive. Conclusion The sensitivity of the MC-PCR (0.88) was comparable to the sensitivity of SCT (0.83). PMID:26968153

  3. Evaluation of diagnostic efficacy of ultrasound scoring system to select thyroid nodules requiring fine needle aspiration biopsy

    PubMed Central

    Mohammadi, Afshin; Hajizadeh, Tohid

    2013-01-01

    Introduction: The large number of patients that require fine needle aspiration biopsy (FNAB) to discriminate malignant from benign thyroid nodules is a practical problem especially in iodine deficient area. To obtain an ultrasound (US) score and for predicting malignant nodules and reduce the number of unnecessary and expensive FNAB. Materials and Methods: A total of 280 thyroid nodules observed from August 2009 to August 2011 that had underwent FNAB were evaluated by US for echogenicity, peripheral halo, microcalcifications and intranodular vascularity. Results: showed that nodules with two ultrasonographic features (US score = 4) were characterized by a 67.9% sensitivity and a 87% specificity for prediction of malignant thyroid nodules. Conclusion: According to our data, we suggest FNAB for nodules with US score ≥ 4. The practical use of this US score may help reduce unnecessary and expensive FNAB especially in iodine-deficient areas. PMID:24040471

  4. Diagnostic evaluation of a multiplexed RT-PCR microsphere array assay for the detection of foot-and-mouth and look-alike disease viruses

    SciTech Connect

    Hindson, B J; Baker, B R; Bentley Tammero, L F; Lenhoff, R J; Naraghi-Arani, P; Vitalis, E A; Slezak, T R; Hullinger, P J; Reid, S M; Ebert, K; Ferris, N P; King, D P

    2007-09-18

    A high-throughput multiplexed assay (Multiplex Version 1.0) was developed for the differential laboratory diagnosis of foot-and-mouth disease virus (FMDV) from viruses which cause clinically similar diseases of livestock. This assay simultaneously screens for five RNA and two DNA viruses using multiplexed reverse transcription PCR (mRT-PCR) amplification coupled with a microsphere hybridization array and flow-cytometric detection. Two of the seventeen primer-probe sets included in this multiplex assay were adopted from previously characterized real-time RT-PCR (rRT-PCR) assays for FMDV. The diagnostic accuracy of the mRT-PCR was evaluated using 287 field samples, including 248 (true positive n= 213, true negative n=34) from suspect cases of foot-and-mouth disease collected from 65 countries between 1965 and 2006 and 39 true negative samples collected from healthy animals. The mRT-PCR assay results were compared with two singleplex rRT-PCR assays, using virus isolation with antigen-ELISA as the reference method. The diagnostic sensitivity of the mRT-PCR assay for FMDV was 93.9% [95% C.I. 89.8-96.4%], compared to 98.1% [95% C.I. 95.3-99.3%] for the two singleplex rRTPCR assays used in combination. In addition, the assay could reliably differentiate between FMDV and other vesicular viruses such as swine vesicular disease virus and vesicular exanthema of swine virus. Interestingly, the mRT-PCR detected parapoxvirus (n=2) and bovine viral diarrhea virus (n=2) in clinical samples, demonstrating the screening potential of this mRT-PCR assay to identify viruses in FMDV-negative material not previously recognized using focused single-target rRT-PCR assays.

  5. Diagnostic evaluation of a multiplexed RT-PCR microsphere array assay for the detection of foot-and-mouth disease virus and look-alike disease viruses

    SciTech Connect

    Hindson, B J; Reid, S M; Baker, B R; Ebert, K; Ferris, N P; Bentley Tammero, L F; Lenhoff, R J; Naraghi-Arani, P; Vitalis, E A; Slezak, T R; Hullinger, P J; King, D P

    2007-07-26

    A high-throughput multiplexed assay was developed for the differential laboratory diagnosis of foot-and-mouth disease virus (FMDV) from viruses which cause clinically similar diseases of livestock. This assay simultaneously screens for five RNA and two DNA viruses using multiplexed reverse transcription PCR (mRT-PCR) amplification coupled with a microsphere hybridization array and flow-cytometric detection. Two of the seventeen primer-probe sets included in this multiplex assay were adopted from previously characterized real-time RT-PCR (rRT-PCR) assays for FMDV. The diagnostic accuracy of the mRT-PCR was evaluated using 287 field samples, including 248 (true positive n= 213, true negative n=34) from suspect cases of foot-and-mouth disease collected from 65 countries between 1965 and 2006 and 39 true negative samples collected from healthy animals. The mRT-PCR assay results were compared with two singleplex rRT-PCR assays, using virus isolation with antigen-ELISA as the reference method. The diagnostic sensitivity of the mRT-PCR assay for FMDV was 93.9% [95% C.I. 89.8-96.4%], compared to 98.1% [95% C.I. 95.3-99.3%] for the two singleplex rRT-PCR assays used in combination. In addition, the assay could reliably differentiate between FMDV and other vesicular viruses such as swine vesicular disease virus and vesicular exanthema of swine virus. Interestingly, the mRT-PCR detected parapoxvirus (n=2) and bovine viral diarrhea virus (n=2) in clinical samples, demonstrating the screening potential of this mRT-PCR assay to identify viruses in FMDV-negative material not previously recognized using focused single-target rRT-PCR assays.

  6. Back to basics: an evaluation of NaOH and alternative rapid DNA extraction protocols for DNA barcoding, genotyping, and disease diagnostics from fungal and oomycete samples.

    PubMed

    Osmundson, Todd W; Eyre, Catherine A; Hayden, Katherine M; Dhillon, Jaskirn; Garbelotto, Matteo M

    2013-01-01

    The ubiquity, high diversity and often-cryptic manifestations of fungi and oomycetes frequently necessitate molecular tools for detecting and identifying them in the environment. In applications including DNA barcoding, pathogen detection from plant samples, and genotyping for population genetics and epidemiology, rapid and dependable DNA extraction methods scalable from one to hundreds of samples are desirable. We evaluated several rapid extraction methods (NaOH, Rapid one-step extraction (ROSE), Chelex 100, proteinase K) for their ability to obtain DNA of quantity and quality suitable for the following applications: PCR amplification of the multicopy barcoding locus ITS1/5.8S/ITS2 from various fungal cultures and sporocarps; single-copy microsatellite amplification from cultures of the phytopathogenic oomycete Phytophthora ramorum; probe-based P. ramorum detection from leaves. Several methods were effective for most of the applications, with NaOH extraction favored in terms of success rate, cost, speed and simplicity. Frozen dilutions of ROSE and NaOH extracts maintained PCR viability for over 32 months. DNA from rapid extractions performed poorly compared to CTAB/phenol-chloroform extracts for TaqMan diagnostics from tanoak leaves, suggesting that incomplete removal of PCR inhibitors is an issue for sensitive diagnostic procedures, especially from plants with recalcitrant leaf chemistry. NaOH extracts exhibited lower yield and size than CTAB/phenol-chloroform extracts; however, NaOH extraction facilitated obtaining clean sequence data from sporocarps contaminated by other fungi, perhaps due to dilution resulting from low DNA yield. We conclude that conventional extractions are often unnecessary for routine DNA sequencing or genotyping of fungi and oomycetes, and recommend simpler strategies where source materials and intended applications warrant such use.

  7. Instructive even after a decade: Complete results of initial virological diagnostics and re-evaluation of molecular data in the German rabies virus "outbreak" caused by transplantations.

    PubMed

    Ross, R Stefan; Wolters, Bernd; Hoffmann, Bernd; Geue, Lutz; Viazov, Sergei; Grüner, Nico; Roggendorf, Michael; Müller, Thomas

    2015-10-01

    In 2005, six patients in Germany received solid organs and both corneas from a donor with an unrecognized rabies infection. Initial virological diagnostics with the machinery available at the two national reference laboratories could quickly clarify the situation. Rabies virus antigen was detected in the organ donor's brain. In two of the three recipients with neurological alterations, intra vitam diagnosis was achieved by conventional RT-PCRs. Comparison of the phylogenetic relatedness of the different viral isolates proved transmission from the donor and, consequently, also established the diagnosis for the third patient. As indicated by the titre of neutralizing antibodies, the liver transplant recipient was protected from the lethal infection due to a vaccination against rabies virus, which he had received more than 15 years ago. All samples from the recipients of the corneas were invariably negative. Re-evaluation of the molecular data by real-time PCR did not lead to an improvement of intra vitam diagnosis but provided intriguing insights regarding the relative amounts of rabies virus RNA in different body fluids and peripheral organs. In saliva and skin, they were 250-200,000 times lower than in the infected patient's brains. Furthermore, in saliva samples taken serially from the same patient fluctuations by a factor of 160-500 were recorded. These findings highlight the problems of intra vitam diagnosis of rabies virus infections and make understandable why the virus can escape from all diagnostic attempts. Finally, in this context one should recall an almost trivial fact: Simple and appropriate postexposure prophylaxis could not only have saved the young organ donor's life but would also have prevented the whole transplantation-associated rabies "outbreak" in Germany.

  8. A diagnostic evaluation of modeled mercury wet depositions in Europe using atmospheric speciated high-resolution observations.

    PubMed

    Bieser, J; De Simone, F; Gencarelli, C; Geyer, B; Hedgecock, I; Matthias, V; Travnikov, O; Weigelt, A

    2014-01-01

    This study is part of the Global Mercury Observation System (GMOS), a European FP7 project dedicated to the improvement and validation of mercury models to assist in establishing a global monitoring network and to support political decisions. One key question about the global mercury cycle is the efficiency of its removal out of the atmosphere into other environmental compartments. So far, the evaluation of modeled wet deposition of mercury was difficult because of a lack of long-term measurements of oxidized and elemental mercury. The oxidized mercury species gaseous oxidized mercury (GOM) and particle-bound mercury (PBM) which are found in the atmosphere in typical concentrations of a few to a few tens pg/m(3) are the relevant components for the wet deposition of mercury. In this study, the first European long-term dataset of speciated mercury taken at Waldhof/Germany was used to evaluate deposition fields modeled with the chemistry transport model (CTM) Community Multiscale Air Quality (CMAQ) and to analyze the influence of the governing parameters. The influence of the parameters precipitation and atmospheric concentration was evaluated using different input datasets for a variety of CMAQ simulations for the year 2009. It was found that on the basis of daily and weekly measurement data, the bias of modeled depositions could be explained by the bias of precipitation fields and atmospheric concentrations of GOM and PBM. A correction of the modeled wet deposition using observed daily precipitation increased the correlation, on average, from 0.17 to 0.78. An additional correction based on the daily average GOM and PBM concentration lead to a 50% decrease of the model error for all CMAQ scenarios. Monthly deposition measurements were found to have a too low temporal resolution to adequately analyze model deficiencies in wet deposition processes due to the nonlinear nature of the scavenging process. Moreover, the general overestimation of atmospheric GOM by the CTM

  9. Clinical Evaluation of the ZstatFlu-II Test: a Chemiluminescent Rapid Diagnostic Test for Influenza Virus

    PubMed Central

    Hamilton, Marilyn S.; Abel, David M.; Ballam, Yolanda J.; Otto, Mary K.; Nickell, Angela F.; Pence, Lisa M.; Appleman, James R.; Shimasaki, Craig D.; Achyuthan, Komandoor E.

    2002-01-01

    Exploiting the high sensitivity of the chemiluminescence phenomenon, an accurate and sensitive point-of-care test, called the ZstatFlu-II test (ZymeTx, Inc., Oklahoma City, Okla.), was developed to detect influenza virus infections. The ZstatFlu-II test takes 20 min and requires approximately 2 min of “hands-on” time for operational steps. The ZstatFlu-II test does not distinguish between infections with influenza virus types A and B. ZstatFlu-II test results are printed on Polaroid High-Speed Detector Film, allowing test results to be archived. A prototype version of the ZstatFlu-II test was evaluated during the 2000-to-2001 flu season with 300 nasal aspirate specimens from children at a pediatric hospital. Compared to culture, the ZstatFlu-II test had 88% sensitivity and 92% specificity. The Directigen test had a sensitivity of 75% and a specificity of 93%. The sensitivity of the ZstatFlu-II test was significantly higher than that of the Directigen test (P < 0.0574). PMID:12089243

  10. A novel case report of sickle cell disease-associated immunoglobulin A nephropathy: the diagnostic value of erythrocyte dysmorphism evaluation

    PubMed Central

    Silva, Gyl EB; Teixeira, André C; Vergna, José GG; Salgado-Filho, Natalino; Crivellentti, Leandro Z; Costa, Roberto S; Dantas, Márcio

    2014-01-01

    Sickle cell disease is a severe disease with a genetic pattern; it may cause anemia, vaso-occlusive phenomena, and multiorgan injury. It may damage any renal compartment, thereby causing tubular abnormalities, papillary necrosis, or glomerulopathies such as focal and segmental glomerulosclerosis and membranoproliferative pattern. The clinical consequences are hematuria and proteinuria. Hematuria associated with SCD is characteristically isomorphic (non-glomerular). This case report describes a novel case of a patient with sickle cell disease who presented with proteinuria and microscopic dysmorphic (glomerular) hematuria. A renal biopsy revealed immunoglobulin A nephropathy. Despite the fact that immunoglobulin A nephropathy is the most commonly diagnosed glomerulonephritis worldwide, an association between this entity and sickle cell disease has not yet been reported, probably because all cases of hematuria in patients with sickle cell disease have been regarded as secondary to sickle cell disease. Thus, new approaches are necessary to differentiate these conditions, such as evaluation of urinary erythrocyte dysmorphism, even more so because these two entities have different therapeutic options, morbidity, and mortality rates. PMID:25035790

  11. Evaluation of the TMJ by means of Clinical TMD Examination and MRI Diagnostics in Patients with Rheumatoid Arthritis

    PubMed Central

    Vogl, Thomas J.; Rehart, Stefan

    2014-01-01

    This study included 30 patients with diagnosed rheumatoid arthritis (RA) and 30 test subjects without RA (control group). The objective of the study was to examine both groups for the presence of temporomandibular disorders (TMD) and morphological changes of the temporomandibular joint (TMJ). All individuals were examined using a systematic detailed clinical TMD examination as well as magnetic resonance imaging (MRI). The clinical TMD examination yielded significant differences between the RA patients and the control group concerning crepitus of the TMJ, and palpation tenderness of the masticatory muscles as well as the unassisted mandibular opening. The evaluation of the MRI images for the RA group showed significantly more frequent deformations of the condyle, osteophyte formations and erosions in the condylar compacta, and degenerative changes in the spongiosa. Increased intra-articular accumulation of synovial liquid and signs of inflammatory changes of the spongiosa were only found in the RA group. Statistical analysis showed a significant correlation between crepitus and specific osteoarthrotic changes (MRI), respectively, and between crepitus and a complete anterior disk displacement without reduction (MRI). The duration of the RA disease correlated neither with the anamnestic and clinical dysfunction index by Helkimo nor with RA-specific MRI findings. PMID:25243130

  12. Evaluation of the TMJ by means of clinical TMD examination and MRI diagnostics in patients with rheumatoid arthritis.

    PubMed

    Witulski, Silke; Vogl, Thomas J; Rehart, Stefan; Ottl, Peter

    2014-01-01

    This study included 30 patients with diagnosed rheumatoid arthritis (RA) and 30 test subjects without RA (control group). The objective of the study was to examine both groups for the presence of temporomandibular disorders (TMD) and morphological changes of the temporomandibular joint (TMJ). All individuals were examined using a systematic detailed clinical TMD examination as well as magnetic resonance imaging (MRI). The clinical TMD examination yielded significant differences between the RA patients and the control group concerning crepitus of the TMJ, and palpation tenderness of the masticatory muscles as well as the unassisted mandibular opening. The evaluation of the MRI images for the RA group showed significantly more frequent deformations of the condyle, osteophyte formations and erosions in the condylar compacta, and degenerative changes in the spongiosa. Increased intra-articular accumulation of synovial liquid and signs of inflammatory changes of the spongiosa were only found in the RA group. Statistical analysis showed a significant correlation between crepitus and specific osteoarthrotic changes (MRI), respectively, and between crepitus and a complete anterior disk displacement without reduction (MRI). The duration of the RA disease correlated neither with the anamnestic and clinical dysfunction index by Helkimo nor with RA-specific MRI findings.

  13. Evaluation of an Enhanced Bank of Kalman Filters for In-Flight Aircraft Engine Sensor Fault Diagnostics

    NASA Technical Reports Server (NTRS)

    Kobayashi, Takahisa; Simon, Donald L.

    2004-01-01

    In this paper, an approach for in-flight fault detection and isolation (FDI) of aircraft engine sensors based on a bank of Kalman filters is developed. This approach utilizes multiple Kalman filters, each of which is designed based on a specific fault hypothesis. When the propulsion system experiences a fault, only one Kalman filter with the correct hypothesis is able to maintain the nominal estimation performance. Based on this knowledge, the isolation of faults is achieved. Since the propulsion system may experience component and actuator faults as well, a sensor FDI system must be robust in terms of avoiding misclassifications of any anomalies. The proposed approach utilizes a bank of (m+1) Kalman filters where m is the number of sensors being monitored. One Kalman filter is used for the detection of component and actuator faults while each of the other m filters detects a fault in a specific sensor. With this setup, the overall robustness of the sensor FDI system to anomalies is enhanced. Moreover, numerous component fault events can be accounted for by the FDI system. The sensor FDI system is applied to a commercial aircraft engine simulation, and its performance is evaluated at multiple power settings at a cruise operating point using various fault scenarios.

  14. Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases.

    PubMed

    Souza, Wayner Vieira de; Araújo, Thalia Velho Barreto de; Albuquerque, Maria de Fátima P Militão; Braga, Maria Cynthia; Ximenes, Ricardo Arraes de Alencar; Miranda-Filho, Demócrito de Barros; Bezerra, Luciana Caroline Albuquerque; Dimech, George Santiago; Carvalho, Patrícia Ismael de; Assunção, Romildo Siqueira de; Santos, Roselene Hans; Oliveira, Wanderson Kleber de; Rodrigues, Laura Cunha; Martelli, Celina Maria Turchi

    2016-01-01

    The increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition.

  15. Noninvasive Tests for the Diagnostic Evaluation of Dyspnea Among Outpatients: the Multi-Ethnic Study of Atherosclerosis Lung Study

    PubMed Central

    Oelsner, Elizabeth C; Lima, Joao AC; Kawut, Steven M; Burkart, Kristin M; Enright