BBC Russian

11 pages, 1142 KiB

Open AccessArticle

Endoscopic Retrograde Cholangiopancreatography-Related Procedures for the Differential Diagnosis of Isolated Immunoglobin G4-Related Sclerosing Cholangitis and Perihilar Cholangiocarcinoma

by Masaru Furukawa, Yasutaka Ishii, Yumiko Tatsukawa, Shinya Nakamura, Juri Ikemoto, Sayaka Miyamoto, Kazuki Nakamura, Yumiko Yamashita, Noriaki Iijima, Yasuhiro Okuda, Risa Nomura, Koji Arihiro, Keiji Hanada and Shiro Oka

Diagnostics 2024, 14(15), 1621; https://doi.org/10.3390/diagnostics14151621 (registering DOI) - 26 Jul 2024

Abstract

Background/Purpose: Differential diagnosis of isolated immunoglobin (Ig)G4-related sclerosing cholangitis (IgG4-SC) and cholangiocarcinoma is challenging. We aimed to clarify the role of endoscopic retrograde cholangiography (ERCP)-related procedures in the differential diagnosis of isolated IgG4-SC and perihilar cholangiocarcinoma (PHCC). Methods: Seven patients with hilar-type isolated [...] Read more.

Background/Purpose: Differential diagnosis of isolated immunoglobin (Ig)G4-related sclerosing cholangitis (IgG4-SC) and cholangiocarcinoma is challenging. We aimed to clarify the role of endoscopic retrograde cholangiography (ERCP)-related procedures in the differential diagnosis of isolated IgG4-SC and perihilar cholangiocarcinoma (PHCC). Methods: Seven patients with hilar-type isolated IgG4-SC diagnosed at Hiroshima University Hospital and sixty-five patients with surgically resected invasive PHCC were enrolled, and the diagnostic yields of intraductal ultrasonography (IDUS), peroral cholangioscopy (POCS), and pathological examinations were determined. Results: In six of seven (86%) patients with isolated IgG4-SC, the stricture was in the perihilar bile duct. IDUS showed that symmetrical wall thickening (40% vs. 5%, p = 0.04), homogeneous internal echo (80% vs. 5%, p < 0.001), and smooth outer margins (80% vs. 6%, p < 0.001) were more frequent in isolated IgG4-SC than in PHCC. POCS showed a smooth mucosal surface more frequent in isolated IgG4-SC (75% vs. 7%, p = 0.006). Only one patient had two pathological findings characteristic of IgG4-SC. The sensitivity for diagnosing PHCC was 81% using two or more combined sampling methods. Conclusions: Pathological examinations have limitations in the differential diagnosis of isolated-IgG4-SC and PHCC, and a diagnostic strategy that combines multiple ERCP-related procedures, including IDUS and POCS, is recommended. Full article

(This article belongs to the Special Issue Endoscopy and Diagnostic Tools in Hepatobiliary and Pancreatic Diseases)

12 pages, 301 KiB

Open AccessArticle

Is It Safe to Treat Stable Patients with Bacteremic Urinary Tract Infections with High-Resistant-Rate Antibiotics?

by Zvi Shimoni, Hanna Salama, Talya Finn and Paul Froom

Diagnostics 2024, 14(15), 1620; https://doi.org/10.3390/diagnostics14151620 (registering DOI) - 26 Jul 2024

Abstract

Background and Objectives: In most areas of the world, urine bacteria have high resistance rates to third-generation cephalosporins, and it is unclear if it is safe to treat stable patients with bacteremic urinary tract infections (UTI) with those antibiotics. There are recommendations that [...] Read more.

Background and Objectives: In most areas of the world, urine bacteria have high resistance rates to third-generation cephalosporins, and it is unclear if it is safe to treat stable patients with bacteremic urinary tract infections (UTI) with those antibiotics. There are recommendations that empiric therapy for a suspected UTI should include only antibiotics with resistance rates less than 10%. Materials and Methods: In this historical observational single center study, we selected 180 stable internal medicine patients hospitalized between January 2019 and December 2021, with identical bacteria isolated from blood and urine cultures. Charts were reviewed to determine if deaths and readmissions up to 30 days after discharge were due to bacterial resistance to initial antibiotic therapy (BRIAT). Results: The patient’s median age was 82 years (1st–3rd quartiles, 73–87 years). A total of 54.4% were female. There were 125 patients treated with ceftriaxone. A total of 38 (30.3%) had BRIAT. Four patients died, but none were because of a delay in appropriate treatment. The median days of hospitalization for all patients was 7 days, and 9 days versus 6 days in those with and without BRIAT. There were no re-hospitalizations for a UTI in patients with BRIAT. Conclusions: We conclude that, despite high resistance rates, empiric ceftriaxone in stable hospitalized patients with a bacteremic UTI is safe. There was no urosepsis-related mortality during the hospitalization or on follow-up. The treatment of all patients with wider-spectrum antibiotics might have decreased the median hospital stay by only one day. The potential effect would be even lower if all patients with a suspected systemic UTI were treated with wide-spectrum antibiotics, because some patients do not have an infection of the urinary tract. A reassessment of the recommendation that empiric therapy for a suspected systemic urinary tract infection should include only wider-spectrum antibiotics is warranted. Full article

(This article belongs to the Special Issue Urinary Tract Infections: Diagnosis and Management)

26 pages, 4472 KiB

Open AccessArticle

EEG-Based Detection of Mild Cognitive Impairment Using DWT-Based Features and Optimization Methods

by Majid Aljalal, Saeed A. Aldosari, Khalil AlSharabi and Fahd A. Alturki

Diagnostics 2024, 14(15), 1619; https://doi.org/10.3390/diagnostics14151619 (registering DOI) - 26 Jul 2024

Abstract

In recent years, electroencephalography (EEG) has been investigated for identifying brain disorders. This technique involves placing multiple electrodes (channels) on the scalp to measure the brain’s activities. This study focuses on accurately detecting mild cognitive impairment (MCI) from the recorded EEG signals. To [...] Read more.

In recent years, electroencephalography (EEG) has been investigated for identifying brain disorders. This technique involves placing multiple electrodes (channels) on the scalp to measure the brain’s activities. This study focuses on accurately detecting mild cognitive impairment (MCI) from the recorded EEG signals. To achieve this, this study first introduced discrete wavelet transform (DWT)-based approaches to generate reliable biomarkers for MCI. These approaches decompose each channel’s signal using DWT into a set of distinct frequency band signals, then extract features using a non-linear measure such as band power, energy, or entropy. Various machine learning approaches then classify the generated features. We investigated these methods on EEGs recorded using 19 channels from 29 MCI patients and 32 healthy subjects. In the second step, the study explored the possibility of decreasing the number of EEG channels while preserving, or even enhancing, classification accuracy. We employed multi-objective optimization techniques, such as the non-dominated sorting genetic algorithm (NSGA) and particle swarm optimization (PSO), to achieve this. The results show that the generated DWT-based features resulted in high full-channel classification accuracy scores. Furthermore, selecting fewer channels carefully leads to better accuracy scores. For instance, with a DWT-based approach, the full-channel accuracy achieved was 99.84%. With only four channels selected by NSGA-II, NSGA-III, or PSO, the accuracy increased to 99.97%. Furthermore, NSGA-II selects five channels, achieving an accuracy of 100%. The results show that the suggested DWT-based approaches are promising to detect MCI, and picking the most useful EEG channels makes the accuracy even higher. The use of a small number of electrodes paves the way for EEG-based diagnosis in clinical practice. Full article

(This article belongs to the Special Issue Artificial Intelligence in Brain Diseases)

► Show Figures

Figure 1

10 pages, 1122 KiB

Open AccessArticle

Prognostic Indicators of Morbidity and Mortality in Children with Congestive Hepatopathy Presenting with Ascites

by Harisa Spahic, Paul Wasuwanich, Bahareh Modanloo, Songyos Rajborirug, Shelby Kutty, Ari Cedars and Wikrom Karnsakul

Diagnostics 2024, 14(15), 1618; https://doi.org/10.3390/diagnostics14151618 (registering DOI) - 26 Jul 2024

Abstract

Objectives: Congestive hepatopathy is a significant complication for children suffering from right-sided heart disease (RHD). We hypothesize that hospitalized pediatric patients with ascites will have congestive hepatopathy leading to advanced liver disease if their cardiac condition is RHD versus non-right-sided heart disease (NRHD). [...] Read more.

Objectives: Congestive hepatopathy is a significant complication for children suffering from right-sided heart disease (RHD). We hypothesize that hospitalized pediatric patients with ascites will have congestive hepatopathy leading to advanced liver disease if their cardiac condition is RHD versus non-right-sided heart disease (NRHD). Methods: This is a retrospective cohort study of pediatric patients who presented with an ascites diagnosis (ICD-10 R18) and at least one cardiac diagnosis. Patient demographics, past medical history, laboratory values, imaging results, calculated clinical scores (e.g., APRI, FIB-4), treatment, length of stay (LOS), and death at hospital discharge were analyzed. Results: Of the 136 patients with ascites, 21 patients presented with a primary cardiac disease (12 in RHD and 9 in NRHD). Of these patients, eight (38%) were female, and nine (43%) were White, seven (33%) were Black, and five (24%) were unknown. The RHD group had a mean age of 5.1 Y (vs. 9.5 Y in NRHD). The mean APRI score in RHD patients was 2.87, and it was 0.85 in NRDH. Treatments were similar, with most patients requiring diuretics (11 RHD (92%) vs. 8 NRDH (89%)); 5 RHD (42%) vs. 4 NRDH (44%) required inotropic support. RHD patients had a longer LOS, with an average of 92 days vs. 52 days for NRDH patients. Overall, each group had one death at discharge (8% RHD vs. 11% NRDH). Conclusions: In the realm of children with ascites, the subset grappling with congestive heart disease paints a unique picture. In this context, ascites stands as an elusive predictor of liver decompensation, defying conventional diagnostic pathways. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

► Show Figures

Figure 1

10 pages, 3922 KiB

Open AccessArticle

The Auditory Steady-State Response and the Relationship between Electrophysiological and Behavioural Thresholds

by Cyntia Barbosa Laureano Luiz, Daniela Gil, Piotr Henryk Skarzynski, Magdalena Beata Skarżyńska, Milaine Dominici Sanfins and Marisa Frasson de Azevedo

Diagnostics 2024, 14(15), 1617; https://doi.org/10.3390/diagnostics14151617 (registering DOI) - 26 Jul 2024

Abstract

Background: This study examined the relationship between behavioural thresholds as measured by pure tone audiometry and electrophysiological thresholds measured by the Auditory Steady-State Response (ASSR) in children with normal hearing and sensorineural hearing loss. Materials and Methods: After being assessed, 45 children of [...] Read more.

Background: This study examined the relationship between behavioural thresholds as measured by pure tone audiometry and electrophysiological thresholds measured by the Auditory Steady-State Response (ASSR) in children with normal hearing and sensorineural hearing loss. Materials and Methods: After being assessed, 45 children of both sexes, ranging in age from 5 to 15, were split into four groups: 10 with moderate to moderately severe sensorineural hearing loss (G2M); 10 with steeply sloping sensorineural hearing loss (G2D); 10 with profound and severe sensorineural hearing loss (G2S); and 15 with normal hearing (G1). ASSR, tympanometry, acoustic reflex testing, pure tone audiometry, and speech audiometry (SRT and SDT) were performed. Results: The electrophysiological maximum in the group with normal hearing thresholds varied from 19 to 27 dB NA. The correlation in the group with moderate to moderately severe hearing loss was 0.42–0.74. The correlation in the steeply sloping hearing loss group was 0.68–0.94. The correlation in the group of people with profound and severe hearing loss was 0.59–0.86. The normal hearing group’s mean differences in ASSR threshold and audiometric threshold ranged from −0.3 to 12 dB, in the moderate and moderately severe hearing loss group from −9 to 2 dB, in the steeply sloping hearing loss group from 1.4 to 7.5 dB, and in the severe and profound hearing loss group from −0.40 to 8.5 dB. Conclusion: As expected, there was no strong relationship between behavioural and electrophysiological thresholds in the group with normal hearing. But in children with hearing loss, there was a strong correlation between electrophysiological and behavioural thresholds; this relationship was especially evident in children with severe and profound hearing loss and those with steeply sloping hearing loss. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

► Show Figures

Figure 1

15 pages, 6723 KiB

Open AccessArticle

Localised Objective Characterisation Assessment of Lymphoedema (LOCAL): Using High-Frequency Ultrasound, Bioelectrical Impedance Spectroscopy and Volume to Evaluate Superficial Tissue Composition

by Jennifer Sanderson, Neil Tuttle, Robyn Box, Hildegard Reul-Hirche and E-Liisa Laakso

Diagnostics 2024, 14(15), 1616; https://doi.org/10.3390/diagnostics14151616 (registering DOI) - 26 Jul 2024

Abstract

Lymphoedema tissue is characterised by excess free fluid and structural changes to the extracellular matrix (ECM) in the form of fibrotic and fatty deposition. These tissue characteristics are integral to the assessment of lymphoedema progression; however, clinicians and researchers often focus on changes [...] Read more.

Lymphoedema tissue is characterised by excess free fluid and structural changes to the extracellular matrix (ECM) in the form of fibrotic and fatty deposition. These tissue characteristics are integral to the assessment of lymphoedema progression; however, clinicians and researchers often focus on changes in the free fluid, volume and function of lymphatic vasculature to inform practice. Subsequently, little is known about the effect of clinical interventions on lymphoedema tissue composition. This article presents a novel approach to classify lymphoedema tissue. The Localised Objective Characterisation Assessment of Lymphoedema (LOCAL) classification combines diagnostic and clinically meaningful objective assessment thresholds to infer lymphoedema pathophysiological changes in tissue layers. The LOCAL classification method was verified using data from fifteen women with unilateral breast cancer-related lymphoedema who were evaluated at three sites on each arm using high-frequency ultrasound (HFUS), bio-electrical impedance spectroscopy (BIS) and volume measurements. Participants exhibited an uneven distribution of volume between the proximal and distal segments of the arm (p = 0.023), with multiple tissue compositional categories observed across sites on the same limb (p < 0.001). The LOCAL method demonstrated utility in categorising a diverse range of lymphoedema tissue layer changes beyond what can be ascertained from whole-limb measures. Full article

(This article belongs to the Special Issue Ultrasound in the Diagnosis and Management of Skin Diseases)

► Show Figures

Figure 1

12 pages, 4694 KiB

Open AccessArticle

Compact Linear Flow Phantom Model for Retinal Blood-Flow Evaluation

by Achyut J. Raghavendra, Abdelrahman M. Elhusseiny, Anant Agrawal, Zhuolin Liu, Daniel X. Hammer and Osamah J. Saeedi

Diagnostics 2024, 14(15), 1615; https://doi.org/10.3390/diagnostics14151615 (registering DOI) - 26 Jul 2024

Abstract

Impaired retinal blood flow is associated with ocular diseases such as glaucoma, macular degeneration, and diabetic retinopathy. Among several ocular imaging techniques developed to measure retinal blood flow both invasively and non-invasively, adaptive optics (AO)-enabled scanning laser ophthalmoscopy (AO-SLO) resolves individual red blood [...] Read more.

Impaired retinal blood flow is associated with ocular diseases such as glaucoma, macular degeneration, and diabetic retinopathy. Among several ocular imaging techniques developed to measure retinal blood flow both invasively and non-invasively, adaptive optics (AO)-enabled scanning laser ophthalmoscopy (AO-SLO) resolves individual red blood cells and provides a high resolution with which to measure flow across retinal microvasculature. However, cross-validation of flow measures remains a challenge owing to instrument and patient-specific variability in each imaging technique. Hence, there is a critical need for a well-controlled clinical flow phantom for standardization and to establish blood-flow measures as clinical biomarkers for early diagnosis. Here, we present the design and validation of a simple, compact, portable, linear flow phantom based on a direct current motor and a conveyor-belt system that provides linear velocity tuning within the retinal microvasculature range (0.5–7 mm/s). The model was evaluated using a sensitive AO-SLO line-scan technique, which showed a <6% standard deviation from the true velocity. Further, a clinical SLO instrument showed a linear correlation with the phantom’s true velocity (r² > 0.997). This model has great potential to calibrate, evaluate, and improve the accuracy of existing clinical imaging systems for retinal blood flow and aid in the diagnosis of ocular diseases with abnormal blood flow. Full article

(This article belongs to the Special Issue High-Resolution Retinal Imaging: Hot Topics and Recent Developments)

► Show Figures

Figure 1

9 pages, 1130 KiB

Open AccessBrief Report

Peripherical Blood hsa-miR-335-5p Quantification as a Prognostic, but Not Diagnostic, Marker of Gastric Cancer

by Lizbeth Ramírez-Vidal, Jared Becerril-Rico, Alberto Monroy-Mora, Jose Manuel Tinajero-Rodríguez, Federico Centeno-Cruz, Luis F. Oñate-Ocaña and Elizabeth Ortiz-Sánchez

Diagnostics 2024, 14(15), 1614; https://doi.org/10.3390/diagnostics14151614 (registering DOI) - 26 Jul 2024

Abstract

Gastric cancer (GC) is a leading cause of death, and this pathology often receives a diagnosis in an advanced stage. The development of a less invasive and cost-effective test for detection is essential for decreasing the mortality rate and increasing the life expectancy [...] Read more.

Gastric cancer (GC) is a leading cause of death, and this pathology often receives a diagnosis in an advanced stage. The development of a less invasive and cost-effective test for detection is essential for decreasing the mortality rate and increasing the life expectancy of GC patients. We evaluated the potential targeting of CD54/ICAM1, a marker of gastric cancer stem cells, with miRNAs to detect GC in blood samples. The analyses included 79 blood samples, 38 from GC patients and 41 from healthy donors, who attended INCan, México City. The total RNA was obtained from the blood plasma, and RT-PCR and qPCR were performed to obtain the relative expression of each miRNA. Hsa-miR-335-5p was detected in the plasma of GC patients and healthy donors at the same levels. The ROC curve analyses indicated that this miRNA was not a candidate for the molecular diagnosis of GC. We did not observe a correlation between the expression of hsa-miR-335-5p and clinical variables; however, the Kaplan–Meier analyses indicated that, in patients who survived more than 12 months, a lower expression of hsa-miR-335-5p was correlated with a better prognosis. It would be convenient to evaluate a larger panel of miRNAs, including miRNAs expressed in a limited number of cell types or with a low number targets, to obtain more specific candidates for developing a robust test for the diagnosis/prognosis of GC. Full article

(This article belongs to the Section Pathology and Molecular Diagnostics)

► Show Figures

Figure 1

13 pages, 2397 KiB

Open AccessReview

Confocal Microscopy of the Cornea in Aqueous-Deficient Dry Eye Disease—A Literature Review

by Radu Bucsan, Ruxandra Coroleucă, Gerhard Garhöfer, Alina Popa-Cherecheanu, Leopold Schmetterer and Raluca Iancu

Diagnostics 2024, 14(15), 1613; https://doi.org/10.3390/diagnostics14151613 - 26 Jul 2024

Abstract

Background: In vivo confocal microscopy (IVCM) is a vital tool in studying dry eye disease (DED), providing insights into morphological changes at ocular surface unit levels. This review presents the main differences in corneal structure between aqueous-deficient dry eye disease (AD-DED) and normal [...] Read more.

Background: In vivo confocal microscopy (IVCM) is a vital tool in studying dry eye disease (DED), providing insights into morphological changes at ocular surface unit levels. This review presents the main differences in corneal structure between aqueous-deficient dry eye disease (AD-DED) and normal eyes. Methods: A comprehensive search of PubMed, Web of Science, Embase, and MEDLINE databases from January 2000 to December 2023 was conducted. The study selection process, as well as data selection and examination, were independently performed by two members of the review team. Results: The review reveals a consistent decrease in corneal surface epithelial cell density in AD-DED cases compared to a control group, but conflicting data on basal epithelial cell density. Notably, the abnormal hyperreflectivity of keratocytes in patients with Sjogren’s syndrome was recorded, and there was a significant keratocyte density in AD-DED subjects compared to evaporative DED and control groups. Studies also found a decrease in sub-basal nerve density, increased tortuosity, and the fragmentation of nerve fibers. Dendritic cell density and dendritic cell dendrites increase in AD-DED patients compared to healthy subjects. Conclusions: IVCM is a powerful tool for enhancing our understanding of the pathophysiological mechanisms underlying DED. However, the review underscores the urgent need to standardize the terminology, analysis, and units used for accurate interpretation, a crucial step in advancing our knowledge of DED. Full article

(This article belongs to the Section Medical Imaging and Theranostics)

► Show Figures

Figure 1

12 pages, 859 KiB

Open AccessArticle

The INVISION Talar Component in Revision Total Ankle Arthroplasty: Analysis of Early Outcomes

by Bruno Valan, Albert T. Anastasio, Billy Kim, Alexandra Krez, Kevin A. Wu, Grayson M. Talaski, James Nunley, James K. DeOrio, Mark E. Easley and Samuel B. Adams

Diagnostics 2024, 14(15), 1612; https://doi.org/10.3390/diagnostics14151612 - 26 Jul 2024

Abstract

Introduction: Launched in 2018 for revision total ankle arthroplasty (rTAA), the INVISION talar component addresses subsidence when poor talar bone stock is present. Due to the recency of the market-availability of the INVISION, studies evaluating its efficacy are lacking. This study presents the [...] Read more.

Introduction: Launched in 2018 for revision total ankle arthroplasty (rTAA), the INVISION talar component addresses subsidence when poor talar bone stock is present. Due to the recency of the market-availability of the INVISION, studies evaluating its efficacy are lacking. This study presents the first analysis of early-term outcomes of patients undergoing rTAA with the INVISION talar component. Methods: This was a single-center, retrospective review of 28 patients undergoing rTAA with the INVISION talar component and INBONE II tibial component performed between 2018 and 2022. Data on preoperative characteristics, postoperative complications, secondary procedures, and survivorship were collected. The primary outcome measures were rates of major complications, re-operation, and implant failure. Secondary outcomes included post-operative changes in varus and valgus alignment of the tibia and talus. Results: The most common secondary procedures performed with rTAA were medial malleolus fixation (n = 22, 78.6%) and gastrocnemius recession (n = 14, 50%). Overall, 10.7% (n = 3) of patients underwent reoperation and 14.3% (n = 4) suffered major complications. Incidence of implant failure was 10.7% (n = 3). All reoperations were caused by infection. Mean varus alignment of the tibia and talus improved from 4.07 degrees and 4.83 degrees to 1.67 degrees and 1.23 degrees, respectively. Mean valgus alignment of the tibia and talus improved from 3.67 degrees and 4.22 degrees to 2.00 degrees and 2.32 degrees, respectively. Conclusions: In a series of 28 patients undergoing rTAA with the INVISION talar component, we discovered comparatively low rates of reoperation, major complication, and implant failure (10.7%, 14.3%, and 10.7%). The INVISION system appears to have a reasonable safety profile, but further studies evaluating long-term outcomes are required to assess the efficacy of the INVISION system. Full article

(This article belongs to the Special Issue Imaging Diagnosis of Foot and Ankle Injuries)

► Show Figures

Figure 1

13 pages, 1451 KiB

Open AccessArticle

Comparison of the Direct Identification and Short-Term Incubation Methods for Positive Blood Cultures via MALDI-TOF Mass Spectrometry

by Shu-Fang Kuo, Tsung-Yu Huang, Chih-Yi Lee and Chen-Hsiang Lee

Diagnostics 2024, 14(15), 1611; https://doi.org/10.3390/diagnostics14151611 - 26 Jul 2024

Viewed by 13

Abstract

Timely pathogen identification in bloodstream infections is crucial for patient care. A comparison is made between positive blood culture (BC) pellets from serum separator tubes using a direct identification (DI) method and colonies on agar plates from a short-term incubation (STI) method with [...] Read more.

Timely pathogen identification in bloodstream infections is crucial for patient care. A comparison is made between positive blood culture (BC) pellets from serum separator tubes using a direct identification (DI) method and colonies on agar plates from a short-term incubation (STI) method with a matrix-assisted laser desorption/ionization Biotyper for the evaluation of 354 monomicrobial BCs. Both the DI and STI methods exhibited similar identification rates for different types of bacteria, except for Gram-positive and anaerobic bacteria. The DI method’s results aligned closely with the STI method’s results for Enterobacterales, glucose-non-fermenting Gram-negative bacilli (GNB), and carbapenem-resistant Enterobacterales. The DI method exhibited high concordance with the conventional method for GNB identification, achieving 88.2 and 87.5% accuracy at the genus and species levels, respectively. Compared with the STI method, the DI method showed a less successful performance for Gram-positive bacterial identification (50.5 vs. 71.3%; p < 0.01). The DI method was useful for anaerobic bacterial identification of slow-growing microorganisms without any need for colony growth, unlike in the STI method (46.7 vs. 13.3%; p = 0.04). However, both methods could not identify yeast in positive BCs. Overall, the DI method provided reliable results for GNB identification, offering many advantages over the STI method by significantly reducing the turnaround time and enabling quicker pathogen identification in positive BCs. Full article

(This article belongs to the Special Issue Microbiology Laboratory: Sample Collection and Diagnosis Advances)

► Show Figures

Figure 1

12 pages, 10917 KiB

Open AccessCase Report

Early Diagnosis and Treatment of Mandibular Second Premolar Impaction: A Case Report

by Anna-Maria Janosy, Abel Emanuel Moca and Raluca Iulia Juncar

Diagnostics 2024, 14(15), 1610; https://doi.org/10.3390/diagnostics14151610 - 26 Jul 2024

Viewed by 147

Abstract

Odontogenesis, the process of tooth formation, is complex and susceptible to disruptions that can result in dental anomalies such as tooth impaction. The mandibular second premolar, though less commonly impacted than wisdom teeth, presents a unique challenge in pediatric dentistry due to its [...] Read more.

Odontogenesis, the process of tooth formation, is complex and susceptible to disruptions that can result in dental anomalies such as tooth impaction. The mandibular second premolar, though less commonly impacted than wisdom teeth, presents a unique challenge in pediatric dentistry due to its intricate etiology and the need for timely intervention. This case report aims to highlight the significance of early diagnosis and conservative management strategies in treating mandibular second premolar impaction. The case involves a pediatric patient with impacted mandibular second premolars. Initial treatment included the use of a lower removable appliance with an expansion screw to alleviate crowding, followed by a fixed space maintainer and a Haas rapid palatal expander. These interventions created the necessary space for the premolars to erupt. Self-ligating brackets were later applied, reducing friction and improving periodontal health. The patient underwent two CBCT examinations to monitor progress, which confirmed the successful eruption and alignment of the impacted premolars without the need for surgical exposure. This case underscores the effectiveness of early diagnosis and minimally invasive treatment in managing mandibular second premolar impaction. The tailored approach facilitated the natural eruption of the teeth, highlighting the importance of individualized treatment plans. Future research should focus on optimizing these conservative strategies to enhance patient outcomes in similar cases. Full article

(This article belongs to the Special Issue Advanced Diagnosis and Treatment Plan for Orthodontic and Oro-Facial Rehabilitations)

► Show Figures

Figure 1

12 pages, 1801 KiB

Open AccessArticle

The Impact of the Dietary Intake of Vitamin B12, Folic Acid, and Vitamin D3 on Homocysteine Levels and the Health-Related Quality of Life of Levodopa-Treated Patients with Parkinson’s Disease—A Pilot Study in Romania

by Adina Turcu-Stiolica, Mihaela-Simona Naidin, Steliana Halmagean, Ana Maria Ionescu and Ionica Pirici

Diagnostics 2024, 14(15), 1609; https://doi.org/10.3390/diagnostics14151609 (registering DOI) - 26 Jul 2024

Viewed by 183

Abstract

Background and Objectives: Previous studies have shown that the levodopa treatment of Parkinson’s disease (PD) elevates circulating homocysteine levels, which are associated with an increased risk of cardiovascular and neurological disorders, or thrombosis. The present trial aimed to examine whether the intake of [...] Read more.

Background and Objectives: Previous studies have shown that the levodopa treatment of Parkinson’s disease (PD) elevates circulating homocysteine levels, which are associated with an increased risk of cardiovascular and neurological disorders, or thrombosis. The present trial aimed to examine whether the intake of vitamin B12, folic acid, and vitamin D3 supplements improved homocysteine level and quality of life (QoL). Materials and Methods: An interventional prospective trial was conducted in multiple centers across Romania. Participants with clinically established PD taking at least 300 mg/day of levodopa for more than 1 year received a daily tablet of a supplement containing 800 UI of vitamin D3, 1000 µg of folic acid, and 15 µg of vitamin B12. They were followed for 6 months and their serum homocysteine, vitamin B12, vitamin D, and QoL scores were measured at baseline and at 6 months of treatment. QoL was measured using a 15D questionnaire, which assesses mobility, vision, hearing, breathing, sleeping, eating, speech, excretion, usual activities, mental function, discomfort and symptoms, depression, distress, vitality, and sexual activity. Results: Twenty-four PD patients with a mean age of 71 ± 5.04 years (54.2% male and 45.8% female) finished the study. After the intervention, the mean score of speech, mental function, discomfort and symptoms, depression, and QoL significantly increased (p < 0.05 for all). Also, the serum homocysteine and vitamin D were significantly enhanced (p < 0.0001 and p = 0.025, respectively). Changes in vitamin B12 were not statistically significant at 6 months of treatment (p = 0.996). No gender differences were found among the changes that we have demonstrated for homocysteine, vitamin B12, vitamin D, and QoL levels (p < 0.05 for all). Conclusions: The findings of this study showed that the dietary intake of vitamin B12, folic acid, and vitamin D3 remarkably decreased the dimensions of homocysteine and finally increased the total score of QoL in PD patients. We have successfully captured the potential benefits of the supplementation regimen over time and provided insights into the broader implications for managing PD with a focus on nutritional support. Full article

(This article belongs to the Special Issue Neurodegenerative Disease and Cognitive Impairment in Neurological Pathologies – Diagnosis and Management)

► Show Figures

Figure 1

12 pages, 1529 KiB

Open AccessArticle

Biparametric vs. Multiparametric MRI in the Detection of Cancer in Transperineal Targeted-Biopsy-Proven Peripheral Prostate Cancer Lesions Classified as PI-RADS Score 3 or 3+1: The Added Value of ADC Quantification

by Elena Bertelli, Michele Vizzi, Chiara Marzi, Sandro Pastacaldi, Alberto Cinelli, Martina Legato, Ron Ruzga, Federico Bardazzi, Vittoria Valoriani, Francesco Loverre, Francesco Impagliazzo, Diletta Cozzi, Samuele Nardoni, Davide Facchiano, Sergio Serni, Lorenzo Masieri, Andrea Minervini, Simone Agostini and Vittorio Miele

Diagnostics 2024, 14(15), 1608; https://doi.org/10.3390/diagnostics14151608 - 25 Jul 2024

Viewed by 117

Abstract

Background: Biparametric MRI (bpMRI) has an important role in the diagnosis of prostate cancer (PCa), by reducing the cost and duration of the procedure and adverse reactions. We assess the additional benefit of the ADC map in detecting prostate cancer (PCa). Additionally, we [...] Read more.

Background: Biparametric MRI (bpMRI) has an important role in the diagnosis of prostate cancer (PCa), by reducing the cost and duration of the procedure and adverse reactions. We assess the additional benefit of the ADC map in detecting prostate cancer (PCa). Additionally, we examine whether the ADC value correlates with the presence of clinically significant tumors (csPCa). Methods: 104 peripheral lesions classified as PI-RADS v2.1 score 3 or 3+1 at the mpMRI underwent transperineal MRI/US fusion-guided targeted biopsy. Results: The lesions were classified as PI-RADS 3 or 3+1; at histopathology, 30 were adenocarcinomas, 21 of which were classified as csPCa. The ADC threshold that maximized the Youden index in order to predict the presence of a tumor was 1103 (95% CI (990, 1243)), with a sensitivity of 0.8 and a specificity of 0.59; both values were greater than those found using the contrast medium, which were 0.5 and 0.54, respectively. Similar results were also found with csPCa, where the optimal ADC threshold was 1096 (95% CI (988, 1096)), with a sensitivity of 0.86 and specificity of 0.59, compared to 0.49 and 0.59 observed in the mpMRI. Conclusions: Our study confirms the possible use of a quantitative parameter (ADC value) in the risk stratification of csPCa, by reducing the number of biopsies and, therefore, the number of unwarranted diagnoses of PCa and the risk of overtreatment. Full article

(This article belongs to the Special Issue Imaging-Based Diagnosis of Prostate Cancer: State of the Art)

► Show Figures

Figure 1

14 pages, 1247 KiB

Open AccessArticle

The Burden of Inpatient Hospitalizations with Cardiac and Cerebrovascular Diseases in Patients with Type 1 Diabetes: Insights from the National Inpatient Sample in the US

by Chun Shing Kwok, Adnan I. Qureshi, Anne Phillips, Gregory Y. H. Lip, Wasim Hanif and Josip Andelo Borovac

Diagnostics 2024, 14(15), 1607; https://doi.org/10.3390/diagnostics14151607 - 25 Jul 2024

Viewed by 139

Abstract

Background: This study aimed to evaluate the burden and impact of cardiac and cerebrovascular disease (CCD) on hospital inpatients with type 1 diabetes mellitus (T1DM). Methods: This is a retrospective nationwide cohort study of people with T1DM with or without CCD in the [...] Read more.

Background: This study aimed to evaluate the burden and impact of cardiac and cerebrovascular disease (CCD) on hospital inpatients with type 1 diabetes mellitus (T1DM). Methods: This is a retrospective nationwide cohort study of people with T1DM with or without CCD in the US National Inpatient Sample between 2016 and 2019. The in-hospital mortality rates, length of stay (LoS), and healthcare costs were determined. Results: A total of 59,860 T1DM patients had a primary diagnosis of CCD and 1,382,934 did not. The median LoS was longer for patients with CCD compared to no CCD (4.6 vs. 3 days). Patients with T1DM and CCD had greater in-hospital mortality compared to those without CCD (4.1% vs. 1.1%, p < 0.001). The estimated total care cost for all patients with T1DM with CCD was approximately USD 326 million. The adjusted odds of mortality compared to patients with non-CCD admission was greatest for intracranial hemorrhage (OR 17.37, 95%CI 12.68–23.79), pulmonary embolism (OR 4.39, 95%CI 2.70–7.13), endocarditis (OR 3.46, 95%CI 1.22–9.84), acute myocardial infarction (OR 2.31, 95%CI 1.92–2.77), and stroke (OR 1.47, 95%CI 1.04–2.09). Conclusions: The burden of CCD in patients with T1DM is substantial and significantly associated with increased hospital mortality and high healthcare expenditures. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis and Management)

► Show Figures

Figure 1

9 pages, 599 KiB

Open AccessProject Report

Alterations in Intestinal Mucosal Barrier Visualized by Confocal Laser Endomicroscopy in Liver Cirrhosis: A Pilot Trial (AMBIC)

by Monica Alexandrina Rusticeanu and Vincent Zimmer

Diagnostics 2024, 14(15), 1606; https://doi.org/10.3390/diagnostics14151606 - 25 Jul 2024

Viewed by 140

Abstract

Background: Chronic liver disease occurs throughout the world irrespective of region, age, sex, or race, and it is caused by a variety of liver conditions. One of the most frequent infectious complications in liver cirrhosis that severely reduces the median survival is spontaneous [...] Read more.

Background: Chronic liver disease occurs throughout the world irrespective of region, age, sex, or race, and it is caused by a variety of liver conditions. One of the most frequent infectious complications in liver cirrhosis that severely reduces the median survival is spontaneous bacterial peritonitis. Current guidelines recommend a paracentesis before starting an antibiotic prophylaxis for this complication. Methods: Selective intestinal decontamination significantly lowers the rate of first or recurrent SBP in cirrhotic patients, so in this study we aimed to investigate and quantify the intestinal integrity of patients with liver cirrhosis and correlate a pathologically increased permeability with the incidence of SPB. We included 14 patients who met the inclusion criteria. No patient was excluded. For the CLE investigation, we use probe based confocal laser endomicroscopy techniques from Mauna Kea (Cellvizio), enabling in vivo surface imaging. The images (optical biopsies) were analyzed for functional and structural barrier defects after the procedure using Mauna Kea software (version 1.0.09). Results: Because of the small number of included patients and healthy controls, most results are lacking statistical relevance. We found that the CLE investigation showed an increased intestinal permeability in patients with liver cirrhosis, in concordance with previous published data, based on other assessment methods. Conclusions: This study confirms that previously published permeability scores can be applied for patients with liver cirrhosis and is, to our knowledge, the first to investigate the intestinal permeability in vivo in patients with liver cirrhosis. Further data are needed to identify patients at risk and help develop new and less invasive diagnostic criteria for cirrhotic patients who may profit from a prophylactic antibiotic treatment. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound (EUS) in Gastrointestinal Diseases)

► Show Figures

Figure 1

11 pages, 500 KiB

Open AccessReview

Artificial Intelligence Models for the Detection of Microsatellite Instability from Whole-Slide Imaging of Colorectal Cancer

by Gavino Faa, Ferdinando Coghe, Andrea Pretta, Massimo Castagnola, Peter Van Eyken, Luca Saba, Mario Scartozzi and Matteo Fraschini

Diagnostics 2024, 14(15), 1605; https://doi.org/10.3390/diagnostics14151605 (registering DOI) - 25 Jul 2024

Viewed by 145

Abstract

With the advent of whole-slide imaging (WSI), a technology that can digitally scan whole slides in high resolution, pathology is undergoing a digital revolution. Detecting microsatellite instability (MSI) in colorectal cancer is crucial for proper treatment, as it identifies patients responsible for immunotherapy. [...] Read more.

With the advent of whole-slide imaging (WSI), a technology that can digitally scan whole slides in high resolution, pathology is undergoing a digital revolution. Detecting microsatellite instability (MSI) in colorectal cancer is crucial for proper treatment, as it identifies patients responsible for immunotherapy. Even though universal testing for MSI is recommended, particularly in patients affected by colorectal cancer (CRC), many patients remain untested, and they reside mainly in low-income countries. A critical need exists for accessible, low-cost tools to perform MSI pre-screening. Here, the potential predictive role of the most relevant artificial intelligence-driven models in predicting microsatellite instability directly from histology alone is discussed, focusing on CRC. The role of deep learning (DL) models in identifying the MSI status is here analyzed in the most relevant studies reporting the development of algorithms trained to this end. The most important performance and the most relevant deficiencies are discussed for every AI method. The models proposed for algorithm sharing among multiple research and clinical centers, including federal learning (FL) and swarm learning (SL), are reported. According to all the studies reported here, AI models are valuable tools for predicting MSI status on WSI alone in CRC. The use of digitized H&E-stained sections and a trained algorithm allow the extraction of relevant molecular information, such as MSI status, in a short time and at a low cost. The possible advantages related to introducing DL methods in routine surgical pathology are underlined here, and the acceleration of the digital transformation of pathology departments and services is recommended. Full article

(This article belongs to the Special Issue AI Transparency in Digital Pathology)

► Show Figures

Figure 1

13 pages, 19652 KiB

Open AccessReview

Advancements in Interventional Pulmonology: Harnessing Ultrasound Techniques for Precision Diagnosis and Treatment

by Alireza Nathani, Sevak Keshishyan and Roy Joseph Cho

Diagnostics 2024, 14(15), 1604; https://doi.org/10.3390/diagnostics14151604 - 25 Jul 2024

Viewed by 140

Abstract

Medical ultrasound has emerged as an indispensable tool within interventional pulmonology, revolutionizing diagnostic and procedural practices through its non-invasive nature and real-time visualization capabilities. By harnessing the principles of sound waves and employing a variety of transducer types, ultrasound facilitates enhanced accuracy and [...] Read more.

Medical ultrasound has emerged as an indispensable tool within interventional pulmonology, revolutionizing diagnostic and procedural practices through its non-invasive nature and real-time visualization capabilities. By harnessing the principles of sound waves and employing a variety of transducer types, ultrasound facilitates enhanced accuracy and safety in procedures such as transthoracic needle aspiration and pleural effusion drainage, consequently leading to improved patient outcomes. Understanding the fundamentals of ultrasound physics is paramount for clinicians, as it forms the basis for interpreting imaging results and optimizing interventions. Thoracic ultrasound plays a pivotal role in diagnosing conditions like pleural effusions and pneumothorax, while also optimizing procedures such as thoracentesis and biopsy by providing precise guidance. Advanced ultrasound techniques, including endobronchial ultrasound, has transformed the evaluation and biopsy of lymph nodes, bolstered by innovative features like elastography, which contribute to increased procedural efficacy and patient safety. Peripheral ultrasound techniques, notably radial endobronchial ultrasound (rEBUS), have become essential for assessing pulmonary nodules and evaluating airway structures, offering clinicians valuable insights into disease localization and severity. Neck ultrasound serves as a crucial tool in guiding supraclavicular lymph node biopsy and percutaneous dilatational tracheostomy procedures, ensuring safe placement and minimizing associated complications. Ultrasound technology is suited for further advancement through the integration of artificial intelligence, miniaturization, and the development of portable devices. These advancements hold the promise of not only improving diagnostic accuracy but also enhancing the accessibility of ultrasound imaging in diverse healthcare settings, ultimately expanding its utility and impact on patient care. Additionally, the integration of enhanced techniques such as contrast-enhanced ultrasound and 3D imaging is anticipated to revolutionize personalized medicine by providing clinicians with a more comprehensive understanding of anatomical structures and pathological processes. The transformative potential of medical ultrasound in interventional pulmonology extends beyond mere technological advancements; it represents a paradigm shift in healthcare delivery, empowering clinicians with unprecedented capabilities to diagnose and treat pulmonary conditions with precision and efficacy. By leveraging the latest innovations in ultrasound technology, clinicians can navigate complex anatomical structures with confidence, leading to more informed decision-making and ultimately improving patient outcomes. Moreover, the portability and versatility of modern ultrasound devices enable their deployment in various clinical settings, from traditional hospital environments to remote or resource-limited areas, thereby bridging gaps in healthcare access and equity. Full article

(This article belongs to the Special Issue Future Challenges for Lung and Liver Ultrasound)

► Show Figures

Figure 1

14 pages, 1842 KiB

Open AccessSystematic Review

Performance of [¹⁸F]FDG PET/CT in Diagnosing Cyst Infections in Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and a Bivariate Meta-Analysis

by Giorgio Treglia, Domenico Albano, Alessio Rizzo, Antonio Bellasi, Andor W. J. M. Glaudemans and Olivier Gheysens

Diagnostics 2024, 14(15), 1603; https://doi.org/10.3390/diagnostics14151603 - 25 Jul 2024

Viewed by 219

Abstract

Background: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([¹⁸F]FDG PET/CT) has been suggested as a useful imaging method for diagnosing cyst infections in patients with autosomal dominant polycystic kidney disease (ADPKD). The aim of this article is to provide evidence-based data in [...] Read more.

Background: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([¹⁸F]FDG PET/CT) has been suggested as a useful imaging method for diagnosing cyst infections in patients with autosomal dominant polycystic kidney disease (ADPKD). The aim of this article is to provide evidence-based data in this setting. Methods: A systematic literature review (exploring several bibliographic databases) and a bivariate meta-analysis were carried out to calculate the pooled diagnostic performance of [¹⁸F]FDG PET/CT in diagnosing probable cyst infection in ADPKD. Results: Ten studies (282 PET/CT scans and 249 patients) were included in the analysis. The pooled sensitivity and specificity of [¹⁸F]FDG PET/CT in this setting were 84.6% (95% confidence interval: 75.4–90.7) and 94.9% (95% confidence interval: 72.6–99.2), respectively, without statistical heterogeneity or significant publication bias. [¹⁸F]FDG PET/CT significantly changed patient management in more than half of ADPKD patients with suspected cyst infection. Conclusions: [¹⁸F]FDG PET/CT has high performance in diagnosing probable cyst infections in ADPKD patients with an impact on management in the majority of patients. Although more studies are warranted, the provided evidence-based data are an important step towards the integration of [¹⁸F]FDG PET/CT in clinical and diagnostic guidelines on probable cyst infection in ADPKD patients. Full article

(This article belongs to the Special Issue Advances in Inflammation and Infection Imaging)

► Show Figures

Figure 1

17 pages, 3245 KiB

Open AccessArticle

Improving Lesion Location Reproducibility in Handheld Breast Ultrasound

by James Chiu, Davide Bova, Georgia Spear, Jacob Ecanow, Alyssa Choate, Pierre Besson and Calin Caluser

Diagnostics 2024, 14(15), 1602; https://doi.org/10.3390/diagnostics14151602 - 25 Jul 2024

Viewed by 165

Abstract

Interoperator variability in the reproducibility of breast lesions found by handheld ultrasound (HHUS) can significantly interfere with clinical care. This study analyzed the features associated with breast mass position differences during HHUS. The ability of operators to reproduce the position of small masses [...] Read more.

Interoperator variability in the reproducibility of breast lesions found by handheld ultrasound (HHUS) can significantly interfere with clinical care. This study analyzed the features associated with breast mass position differences during HHUS. The ability of operators to reproduce the position of small masses and the time required to generate annotations with and without a computer-assisted scanning device (DEVICE) were also evaluated. This prospective study included 28 patients with 34 benign or probably benign small breast masses. Two operators generated manual and automated position annotations for each mass. The probe and body positions were systematically varied during scanning with the DEVICE, and the features describing mass movement were used in three logistic regression models trained to discriminate small from large breast mass displacements (cutoff: 10 mm). All models successfully discriminated small from large breast mass displacements (areas under the curve: 0.78 to 0.82). The interoperator localization precision was 6.6 ± 2.8 mm with DEVICE guidance and 19.9 ± 16.1 mm with manual annotations. Computer-assisted scanning reduced the time to annotate and reidentify a mass by 33 and 46 s on average, respectively. The results demonstrated that breast mass location reproducibility and exam efficiency improved by controlling operator actionable features with computer-assisted HHUS. Full article

(This article belongs to the Special Issue Recent Advances in Breast Imaging)

► Show Figures

Figure 1

11 pages, 468 KiB

Open AccessArticle

Cutaneous Adverse Reactions and Survival Outcomes of Advanced Melanoma Treated with Immune Checkpoint Inhibitors in an Academic Medical Centre in Singapore

by Agnes Yeok-Loo Lim, Jason Yongsheng Chan and Choon Chiat Oh

Diagnostics 2024, 14(15), 1601; https://doi.org/10.3390/diagnostics14151601 - 25 Jul 2024

Viewed by 163

Abstract

Programmed cell death-1 (PD1) inhibitors, a form of immune checkpoint inhibitor, are efficacious for metastatic melanoma but are associated with cutaneous adverse reactions (CARs). Studies in Europe and North America showed that CARs are associated with an increased overall survival. However, studies from [...] Read more.

Programmed cell death-1 (PD1) inhibitors, a form of immune checkpoint inhibitor, are efficacious for metastatic melanoma but are associated with cutaneous adverse reactions (CARs). Studies in Europe and North America showed that CARs are associated with an increased overall survival. However, studies from Asia showed mixed results. There is a paucity of data regarding the efficacy of PD1 inhibitors and the effect of CARs on overall survival from Southeast Asia. A retrospective study of patients in the National Cancer Centre Singapore who were diagnosed with melanoma between 2015 and 2020 was conducted. Patients were included in the study if they had stage IV melanoma (advanced melanoma). Sixty-two patients were included in the study. The median age was 62.5 years and acral melanoma was the commonest subtype. Forty-three patients received PD1 inhibitors. Comparing patients who did not receive PD1 inhibitors to patients who received PD1 inhibitors, the former had a median overall survival of 6 months (95% CI: 5.07, 6.93), whereas the latter had a median overall survival of 21 months (95% CI: 13.33, 28.67; p < 0.001) (Hazard ratio 0.32; 95% CI: 0.16, 0.63; p = 0.001). Amongst patients who received PD1 inhibitors, patients who developed CARs had a greater median overall survival of 33 months (95% CI: 17.27, 48.73) compared to 15 months (95% CI: 9.20, 20.80; p = 0.013) for patients who did not (HR 0.29; 95% CI: 0.098, 0.834; p = 0.022). This study provides insight into the outcomes of metastatic melanoma in Singapore, and adds to the body of evidence supporting the use of PD1 inhibitors in Asians. Full article

(This article belongs to the Special Issue Latest Advances in Diagnosis and Management of Skin Cancer)

► Show Figures

Figure 1

10 pages, 17960 KiB

Open AccessCase Report

Diagnostic Challenges in Difficult-to-Localize Insulinomas: A Case Report and Review of Literature

by Nikica M. Grubor, Nikola N. Grubor and Marjan Micev

Diagnostics 2024, 14(15), 1600; https://doi.org/10.3390/diagnostics14151600 - 25 Jul 2024

Viewed by 153

Abstract

Non-somatostatin receptor expressing hypovascular insulinomas can be challenging to prove through imaging. This case highlights the utility of a structured approach to molecular imaging in patients with confirmed endogenous hyperinsulinemia. A 54-year-old woman was admitted because of a sudden loss of consciousness. Her [...] Read more.

Non-somatostatin receptor expressing hypovascular insulinomas can be challenging to prove through imaging. This case highlights the utility of a structured approach to molecular imaging in patients with confirmed endogenous hyperinsulinemia. A 54-year-old woman was admitted because of a sudden loss of consciousness. Her relative reported that she complained of dizziness, intense sweating, blurry vision, and upper extremity tingling before becoming unresponsive for 20 min, after which the patient had little recollection of the event. She experienced similar episodes of shorter duration, trouble recalling everyday events, and unintentional weight gain of over 10 kg during the previous two years. Abdominal magnetic resonance imaging (MRI) and multidetector computerized tomography (MDCT) were unremarkable. Selective arterial calcium stimulation significantly increased hepatic venous insulin concentrations when the superior mesenteric and gastroduodenal arteries were stimulated. Technetium-99m (99mTc) octreotide single-photon emission computed tomography (SPECT) did not localize the lesion. Gallium-68 DOTA-Exendin-4 PET/CT acquisition was performed. A single intense 2 cm hyperperfused pancreatic lesion was located anteriorly in the head of the pancreas. Earlier targeted PET/CT imaging and recognition of significant neuropsychiatric symptoms attributable to the patient’s hypoglycemic state might have accelerated the resolution of her condition and obviated the need for unnecessary testing. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

► Show Figures

Figure 1

11 pages, 834 KiB

Open AccessArticle

Combined Use of Phenotypic Screening and of a Novel Commercial Assay (REALQUALITY Carba-Screen) for the Rapid Molecular Detection of Carbapenemases: A Single-Center Experience

by Federica Novazzi, Gabriele Arcari, Francesca Drago Ferrante, Sara Boutahar, Angelo Paolo Genoni, Davide Carcione, Gianluca Cassani, Paolo Gigante, Mattia Carbotti, Riccardo Capuano, Renée Pasciuta and Nicasio Mancini

Diagnostics 2024, 14(15), 1599; https://doi.org/10.3390/diagnostics14151599 - 25 Jul 2024

Viewed by 169

Abstract

Carbapenem resistance is a serious public health threat, causing numerous deaths annually primarily due to healthcare-associated infections. To face this menace, surveillance programs in high-risk patients are becoming a widespread practice. Here we report the performance of the combined use of a recently [...] Read more.

Carbapenem resistance is a serious public health threat, causing numerous deaths annually primarily due to healthcare-associated infections. To face this menace, surveillance programs in high-risk patients are becoming a widespread practice. Here we report the performance of the combined use of a recently approved commercial multiplex real-time PCR assay (REALQUALITY Carba-Screen kit) with conventional phenotypic screening. In this three-month study, 479 rectal swabs from 309 patients across high-risk units were evaluated by combining the two approaches. Although the molecular assay showed a higher positivity rate than phenotypic screening (7.1% vs. 5%), it should be noted that the molecular method alone would have missed eight carbapenem-resistant isolates, while using only phenotypic screening would not have detected sixteen isolates. This demonstrates the complementary strengths of each method. Our study confirms the need for a combined approach to maximize the possible clinical impact of this kind of screening, ensuring a more comprehensive detection of resistant strains. Full article

(This article belongs to the Special Issue Editorial Board Members' Collection Series: Molecular Diagnostics of Infectious Diseases)

► Show Figures

Figure 1

18 pages, 679 KiB

Open AccessReview

Advancing Pathogen Identification: The Role of Digital PCR in Enhancing Diagnostic Power in Different Settings

by Alessia Mirabile, Giuseppe Sangiorgio, Paolo Giuseppe Bonacci, Dalida Bivona, Emanuele Nicitra, Carmelo Bonomo, Dafne Bongiorno, Stefania Stefani and Nicolò Musso

Diagnostics 2024, 14(15), 1598; https://doi.org/10.3390/diagnostics14151598 - 25 Jul 2024

Viewed by 319

Abstract

Digital polymerase chain reaction (dPCR) has emerged as a groundbreaking technology in molecular biology and diagnostics, offering exceptional precision and sensitivity in nucleic acid detection and quantification. This review highlights the core principles and transformative potential of dPCR, particularly in infectious disease diagnostics [...] Read more.

Digital polymerase chain reaction (dPCR) has emerged as a groundbreaking technology in molecular biology and diagnostics, offering exceptional precision and sensitivity in nucleic acid detection and quantification. This review highlights the core principles and transformative potential of dPCR, particularly in infectious disease diagnostics and environmental surveillance. Emphasizing its evolution from traditional PCR, dPCR provides accurate absolute quantification of target nucleic acids through advanced partitioning techniques. The review addresses the significant impact of dPCR in sepsis diagnosis and management, showcasing its superior sensitivity and specificity in early pathogen detection and identification of drug-resistant genes. Despite its advantages, challenges such as optimization of experimental conditions, standardization of data analysis workflows, and high costs are discussed. Furthermore, we compare various commercially available dPCR platforms, detailing their features and applications in clinical and research settings. Additionally, the review explores dPCR’s role in water microbiology, particularly in wastewater surveillance and monitoring of waterborne pathogens, underscoring its importance in public health protection. In conclusion, future prospects of dPCR, including methodological optimization, integration with innovative technologies, and expansion into new sectors like metagenomics, are explored. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Sepsis)

► Show Figures

Figure 1

12 pages, 2149 KiB

Open AccessArticle

Performance of Intraoperative Contrast-Enhanced Ultrasound (Io-CEUS) in the Diagnosis of Primary Lung Cancer

by Martin Ignaz Schauer, Ernst Michael Jung, Hans-Stefan Hofmann, Natascha Platz Batista da Silva, Michael Akers and Michael Ried

Diagnostics 2024, 14(15), 1597; https://doi.org/10.3390/diagnostics14151597 - 24 Jul 2024

Viewed by 157

Abstract

Background: Suspicious tumors of the lung require specific staging, intraoperative detection, and histological confirmation. We performed an intrathoracic, intraoperative contrast-enhanced ultrasound (Io-CEUS) for characterization of lung cancer. Methods: Retrospective analysis of prospectively collected data on the application of Io-CEUS in thoracic surgery for [...] Read more.

Background: Suspicious tumors of the lung require specific staging, intraoperative detection, and histological confirmation. We performed an intrathoracic, intraoperative contrast-enhanced ultrasound (Io-CEUS) for characterization of lung cancer. Methods: Retrospective analysis of prospectively collected data on the application of Io-CEUS in thoracic surgery for patients with operable lung cancer. Analysis of the preoperative chest CT scan and FDG-PET/CT findings regarding criteria of malignancy. Immediately before lung resection, the intrathoracic Io-CEUS was performed with a contrast-enabled T-probe (6–9 MHz—L3-9i-D) on a high-performance ultrasound machine (Loqic E9, GE). In addition to intraoperative B-mode, color-coded Doppler sonography (CCDS), or power Doppler (macrovascularization) of the lung tumor, contrast enhancement (Io-CEUS) was used after venous application of 2.4–5 mL sulfur hexafluoride (SonoVue, Bracco, Italy) for dynamic recording of microvascularization. The primary endpoint was the characterization of operable lung cancer with Io-CEUS. Secondly, the results of Io-CEUS were compared with the preoperative staging. Results: The study included 18 patients with operable lung cancer, who received Io-CEUS during minimally invasive thoracic surgery immediately prior to lung resection. In the chest CT scan, the mean size of the lung tumors was 2.54 cm (extension of 0.7–4.5 cm). The mean SUV in the FDG-PET/CT was 7.6 (1.2–16.9). All lung cancers were detected using B-mode and power Doppler confirmed macrovascularization (100%) of the tumors. In addition, Io-CEUS showed an early wash-in with marginal and mostly simultaneous central contrast enhancement. Conclusions: The intrathoracic application of Io-CEUS demonstrated a peripheral and simultaneous central contrast enhancement in the early phase, which seems to be characteristic of lung cancer. In comparison to preoperative imaging, Io-CEUS was on par with the detection of malignancy and offers an additional tool for the intraoperative assessment of lung cancer before resection. Full article

(This article belongs to the Special Issue Current Challenges and Perspectives of Ultrasound)

► Show Figures

Figure 1

21 pages, 16757 KiB

Open AccessArticle

Flow-Field Inference for Turbulent Exhale Flow Measurement

by Shane Transue, Do-kyeong Lee, Jae-Sung Choi, Seongjun Choi, Min Hong and Min-Hyung Choi

Diagnostics 2024, 14(15), 1596; https://doi.org/10.3390/diagnostics14151596 - 24 Jul 2024

Viewed by 219

Abstract

Background: Vision-based pulmonary diagnostics present a unique approach for tracking and measuring natural breathing behaviors through remote imaging. While many existing methods correlate chest and diaphragm movements to respiratory behavior, we look at how the direct visualization of thermal CO₂ exhale flow [...] Read more.

Background: Vision-based pulmonary diagnostics present a unique approach for tracking and measuring natural breathing behaviors through remote imaging. While many existing methods correlate chest and diaphragm movements to respiratory behavior, we look at how the direct visualization of thermal CO₂ exhale flow patterns can be tracked to directly measure expiratory flow. Methods: In this work, we present a novel method for isolating and extracting turbulent exhale flow signals from thermal image sequences through flow-field prediction and optical flow measurement. The objective of this work is to introduce a respiratory diagnostic tool that can be used to capture and quantify natural breathing, to identify and measure respiratory metrics such as breathing rate, flow, and volume. One of the primary contributions of this work is a method for capturing and measuring natural exhale behaviors that describe individualized pulmonary traits. By monitoring subtle individualized respiratory traits, we can perform secondary analysis to identify unique personalized signatures and abnormalities to gain insight into pulmonary function. In our study, we perform data acquisition within a clinical setting to train an inference model (FieldNet) that predicts flow-fields to quantify observed exhale behaviors over time. Results: Expiratory flow measurements capturing individualized flow signatures from our initial cohort demonstrate how the proposed flow field model can be used to isolate and analyze turbulent exhale behaviors and measure anomalous behavior. Conclusions: Our results illustrate that detailed spatial flow analysis can contribute to unique signatures for identifying patient specific natural breathing behaviors and abnormality detection. This provides the first-step towards a non-contact respiratory technology that directly captures effort-independent behaviors based on the direct measurement of imaged CO₂ exhaled airflow patterns. Full article

(This article belongs to the Special Issue Diagnosis, Classification, and Monitoring of Pulmonary Diseases)

► Show Figures

Figure 1

9 pages, 239 KiB

Open AccessArticle

Impact of Net Atrioventricular Compliance on Mitral Valve Area Assessment—A Perspective Considering Three-Dimensional Mitral Valve Area by Transesophageal Echocardiography

by Tony Li, Ryan Leow, Meei Wah Chan, William K. F. Kong, Ivandito Kuntjoro, Kian Keong Poh, Ching Hui Sia and Tiong Cheng Yeo

Diagnostics 2024, 14(15), 1595; https://doi.org/10.3390/diagnostics14151595 - 24 Jul 2024

Viewed by 192

Abstract

Background: Net atrioventricular compliance (C_n) can affect the accuracy of mitral valve area (MVA) assessment. We assessed how different methods of MVA assessment are affected by C_n, and if patients with abnormal C_n may be identified by clinical [...] Read more.

Background: Net atrioventricular compliance (C_n) can affect the accuracy of mitral valve area (MVA) assessment. We assessed how different methods of MVA assessment are affected by C_n, and if patients with abnormal C_n may be identified by clinical and/or echocardiographic parameters. Methods: We studied 244 patients with rheumatic MS. The concordance between mitral valve area (MVA) by 2D planimetry, pressure half-time (PHT), continuity equation (CE), Yeo’s index, and 3-dimensional mitral valve area assessed by transesophageal echocardiography (TEE 3DMVA) in patients with normal and abnormal C_n (C_n ≤ 4 mL/mmHg) were evaluated in the 110 patients with both transesophageal echocardiogram (TEE) and transthoracic echocardiogram (TTE). Variables that were associated with abnormal C_n were validated in the remaining 134 patients with only TTE. Results: Except for MVA by CE, concordance with TEE 3DMVA was poorer for all other methods of MVA assessment in patients with abnormal C_n. But, the difference in concordance was only statistically significant for MVA by PHT. Patients with MVA ≤ 1.5 cm² by 2D planimetry and PHT ≤ 130 ms were likely to have an abnormal C_n. (specificity 98.5%). This finding was validated in the remaining 134 patients (specificity 93%). Conclusions: MVA assessment by PHT is significantly affected by C_n. Abnormal C_n should be suspected when 2D planimetry MVA is ≤1.5 cm² together with an inappropriately short PHT that is ≤130 ms. In this scenario, MVA by PHT is inaccurate. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

13 pages, 639 KiB

Open AccessSystematic Review

Machine Learning Models for Predicting Mortality in Critically Ill Patients with Sepsis-Associated Acute Kidney Injury: A Systematic Review

by Chieh-Chen Wu, Tahmina Nasrin Poly, Yung-Ching Weng, Ming-Chin Lin and Md. Mohaimenul Islam

Diagnostics 2024, 14(15), 1594; https://doi.org/10.3390/diagnostics14151594 - 24 Jul 2024

Viewed by 232

Abstract

While machine learning (ML) models hold promise for enhancing the management of acute kidney injury (AKI) in sepsis patients, creating models that are equitable and unbiased is crucial for accurate patient stratification and timely interventions. This study aimed to systematically summarize existing evidence [...] Read more.

While machine learning (ML) models hold promise for enhancing the management of acute kidney injury (AKI) in sepsis patients, creating models that are equitable and unbiased is crucial for accurate patient stratification and timely interventions. This study aimed to systematically summarize existing evidence to determine the effectiveness of ML algorithms for predicting mortality in patients with sepsis-associated AKI. An exhaustive literature search was conducted across several electronic databases, including PubMed, Scopus, and Web of Science, employing specific search terms. This review included studies published from 1 January 2000 to 1 February 2024. Studies were included if they reported on the use of ML for predicting mortality in patients with sepsis-associated AKI. Studies not written in English or with insufficient data were excluded. Data extraction and quality assessment were performed independently by two reviewers. Five studies were included in the final analysis, reporting a male predominance (>50%) among patients with sepsis-associated AKI. Limited data on race and ethnicity were available across the studies, with White patients comprising the majority of the study cohorts. The predictive models demonstrated varying levels of performance, with area under the receiver operating characteristic curve (AUROC) values ranging from 0.60 to 0.87. Algorithms such as extreme gradient boosting (XGBoost), random forest (RF), and logistic regression (LR) showed the best performance in terms of accuracy. The findings of this study show that ML models hold immense ability to identify high-risk patients, predict the progression of AKI early, and improve survival rates. However, the lack of fairness in ML models for predicting mortality in critically ill patients with sepsis-associated AKI could perpetuate existing healthcare disparities. Therefore, it is crucial to develop trustworthy ML models to ensure their widespread adoption and reliance by both healthcare professionals and patients. Full article

(This article belongs to the Special Issue Artificial Intelligence for Clinical Diagnostic Decision Making)

► Show Figures

Figure 1

13 pages, 5039 KiB

Open AccessGuidelines

An Interdisciplinary Approach: Presentation of the Pediatric Obstructive Sleep Apnea Diagnostic Examination Form (POSADEF)

by Janine Sambale, Richard Birk, Ulrich Koehler, Wulf Hildebrandt and Heike Maria Korbmacher-Steiner

Diagnostics 2024, 14(15), 1593; https://doi.org/10.3390/diagnostics14151593 - 24 Jul 2024

Viewed by 206

Abstract

This report emphasizes the need for interdisciplinary collaboration in diagnosing and treating pediatric obstructive sleep apnea (OSA). OSA, affecting 1% to 4% of children, often results from adenotonsillar hypertrophy, craniofacial disorders, or obesity. While adenotonsillectomy is the primary treatment, about 75% of children, [...] Read more.

This report emphasizes the need for interdisciplinary collaboration in diagnosing and treating pediatric obstructive sleep apnea (OSA). OSA, affecting 1% to 4% of children, often results from adenotonsillar hypertrophy, craniofacial disorders, or obesity. While adenotonsillectomy is the primary treatment, about 75% of children, especially those with craniofacial disorders or obesity, continue to experience OSA symptoms post-surgery. To address these cases, several medical fields emphasize the necessity and demand for interdisciplinary collaboration in managing pediatric OSA. Therefore, the authors aimed to develop the Pediatric Obstructive Sleep Apnea Diagnostic Examination Form (POSADEF). This form, based on clinical experience and the literature, captures craniofacial and functional characteristics linked to pediatric OSA. A case study of an eight-year-old girl with OSA, who was unsuccessfully treated with adenotonsillectomy, underlines the importance of the diagnostic examination form. The orthodontic assessment revealed craniofacial disorders and subsequent treatment with maxillary expansion and functional appliance therapy resolved her OSA symptoms. This case demonstrates the value of POSADEF in enabling comprehensive evaluation and treatment across medical disciplines. POSADEF is designed to assist health care professionals in diagnosing craniofacial and orofacial anomalies contributing to pediatric OSA. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Obstructive Sleep Apnea)

► Show Figures

Figure 1

11 pages, 11056 KiB

Open AccessCase Report

Early Presentation of Boerhaave Syndrome in the Emergency Department: A Case Report and Review of the Literature

by Irina-Anca Eremia, Cătălin-Alexandru Anghel, Florina-Alexandra Cofaru and Silvia Nica

Diagnostics 2024, 14(15), 1592; https://doi.org/10.3390/diagnostics14151592 - 24 Jul 2024

Viewed by 199

Abstract

We present the case of a 46-year-old patient who arrived at the emergency department with chest pain following an episode of vomiting. The diagnosis was Boerhaave syndrome and acute mediastinitis. Due to the prompt presentation and the location of the rupture in the [...] Read more.

We present the case of a 46-year-old patient who arrived at the emergency department with chest pain following an episode of vomiting. The diagnosis was Boerhaave syndrome and acute mediastinitis. Due to the prompt presentation and the location of the rupture in the lower esophagus, emergency surgical intervention was performed, including esophageal suturing, mediastinal drainage, and jejunostomy for feeding. Postoperatively, the patient was transferred to the intensive care unit for advanced monitoring and support. The patient’s condition improved favorably in the intensive care unit, allowing for extubation. Progress continued positively, and the patient was discharged 12 days postoperatively with a functional jejunostomy. At regular follow-ups, the patient’s recovery remained favorable, and the jejunostomy was removed 30 days after the surgery. This case highlights the importance of rapid diagnosis and early surgical intervention in Boerhaave syndrome, demonstrating the successful management of a severe condition through a multidisciplinary effort. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Diagnostics, Volume 14, Issue 15 (August-1 2024) – 43 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI