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Rapid analysis of porphyrins at low ng/l and microg/l levels in human urine by a gradient liquid chromatography method using octadecylsilica monolithic columns.

Rapid gradient RP-HPLC method with fluorimetric detection for trace analysis of diagnostically significant porphyrins in human urine was developed for clinical and diagnostic purposes. Results show that optimized high-pressure gradient elution and monolithic column Chromolith SpeedRod RP18e enabled separation of seven urine porphyrins including baseline separation of I and III positional isomers of uro- and coproporphyrins within 3.2 min. Problems associated with high metal cation complexing ability of the analytes and common stainless steel based instrumentation were substantially reduced by use of 0.1 mol/l ammonium citrate buffer (pH 5.47) and methanol as a mobile phase components. Good reproducibilities of retention times (within +/- 0.36% RSD) and peak areas (from +/- 0.6 to +/- 2.5% RSD) at 5-20 microg/l level of the analytes were achieved. Determined LOQ (10 x S/N) values of diagnostically important porphyrins using fluorimetric detection (ex.405 nm/em.620 nm) were 82 pmol/l (65 ng/l, 1.30 pg/injection) for uroporphyrin I, 44 pmol/l (33 ng/l, 0.66 pg/injection) for uroporphyrin III, 50 pmol/l (40 ng/l, 0.80 pg/injection) for coproporphyrin I and 47 pmol/l (39 ng/l, 0.78 pg/injection) for coproporphyrin III. Attained LOQ concentration level is approximately 20-120 times lower than concentration of porphyrins in a urine of healthy person. Calculated LOD's (3 x S/N) were at a low ng/l levels, what enabled quantification of carry-over effect to be from 2.0% to 0.2% in each of three consecutive blank runs and from 2.5% to 7% in total after injection of mixed standard of porphyrins with 5-20 microg/l concentrations. Recovery of porphyrins at low microg/l concentration levels was from 93% to 97.5%. Devised method increases productivity of clinical laboratory from 2 to 10 times in dependence of duration of currently used method.

Chromatography, High Pressure Liquid↗

A computer program for selection of variables in diagnostic and prognostic problems.

The computer program INDEP-SELECT has been developed for selection of an optimal subset from a set of possibly informative diagnostic or prognostic variables. But the program is equally useful for other discriminant analysis or pattern recognition problems involving variable selection. The approach is probabilistic; i.e., diagnostic probabilities are assigned to a patient on the basis of the values observed on the diagnostic variables. The statistical model used is largely based on the assumption of independency between the variables, but one model-parameter, the so-called 'global association factor', is added in order to take dependency into account. The stepwise forward selection strategy of adding in each selection step a new variable to the set of already selected variables, is used. The user may choose between a number of selection criteria. Such a criterion is used in order to decide in each selection step which variable should be added. All criteria are based on measures of diagnostic or prognostic performance. INDEP-SELECT is able to handle a large number of variables, also with missing data, and a large number of patients. The program is written in ANS Standard FORTRAN, and takes relatively little computation time.

Bayes Theorem↗

Optimizing interdisciplinary cooperation for patients with orofacial dysfunctions. Presentation of an interdisciplinary diagnostic referral sheet.

BACKGROUND: The quality of interdisciplinary cooperation is one of the most important factors in the success and long-term stability of treatment of patients suffering from orofacial dysfunctions. However, speech pathologists have criticized the poor communication and diagnostics at the time of referral and have requested a standardized diagnostic referral sheet with the aim of improving interdisciplinary cooperation. DIAGNOSTIC REFERRAL SHEET: The diagnostic referral sheet presented here is based on the demands of speech pathologists focusing on myofunctional therapy and helps in initial assessment of the individual situation and necessary treatment. It is subject to continuous updating and coordinates the many medical disciplines involved on account of the complex pathology. CONCLUSION: The multidisciplinary diagnostic referral sheet, which is independent of treatment methods and compressed into one page, is aimed at contributing to quality assurance and to the improved documentation of orofacial dysfunctions.

Child↗

A toxicologist's guide to studying diagnostic tests.

Diagnostic testing plays an important role in medicine, including in clinical toxicology. In comparison with therapeutics however, until recently, much less focus has been input in this vital area of research and practice. In the absence of stringent and constructive criteria, the quality and interpretability of studies evaluating diagnostic accuracy has been less than optimal. Recently, a group of researchers and clinicians have attempted to outline a checklist intended to provide guidelines for undertaking and reporting studies examining diagnostic accuracy. Also, a tool to assess the quality of diagnostic accuracy studies was developed. The purpose of this review is to inform practitioners and researchers in the field of clinical toxicology on the basic concepts underlying measurements of the accuracy of diagnostic tests, methodological concerns related to design and analysis of studies, the strengths and weaknesses of different measures of accuracy and an overview of the Standards for Reporting Diagnostic Accuracy (STARD statement) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Understanding key concepts in the field of diagnostic testing can not only help improve future studies but also explain why diagnostic tests currently used by clinical toxicologists are not performing well in particular circumstances.

Diagnostic Tests, Routine↗

Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis--report of the Radiology Diagnostic Oncology Group.

PURPOSE: To determine the optimal imaging modality for diagnosis and staging of ovarian cancer. MATERIALS AND METHODS: Two hundred eighty women suspected to have ovarian cancer were enrolled in a prospective study before surgery. Doppler ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging were used to evaluate the mass; conventional US, CT, and MR imaging were used to stage spread. RESULTS: All three modalities had high accuracy (0.91) for the overall diagnosis of malignancy. In the ovaries, the accuracy of MR imaging (0.91) was higher than that of CT and significantly higher than that of Doppler US (0.78). In the extraovarian pelvis and in the abdomen, conventional US, CT, and MR imaging had similar accuracies (0.87-0.95). In differentiation of disease confined to the pelvis from abdominal spread, the specificity of conventional US (96%) was higher than that of CT and significantly higher than that of MR imaging (88%), whereas the sensitivities of MR imaging (98%) and CT (92%) were significantly higher than that of conventional US (75%). CONCLUSION: MR imaging is superior to Doppler US and CT in diagnosis of malignant ovarian masses. There is little variation among conventional US, CT, and MR imaging as regards staging.

Adult↗

Rapid MR imaging of the pediatric brain using the fast spin-echo technique.

PURPOSE: To evaluate diagnostic reliability and to establish optimal scanning techniques of a recently developed Fast Spin-echo MR pulse sequence that allows rapid proton density-weighted and T2-weighted imaging. METHODS: We compared lesion conspicuity and signal intensity measurements on Fast Spin-echo and conventional spin-echo sequences in 81 patients ranging from 1 week to 25 years in age on a 1.5-T MR unit. A total of 28 Fast Spin-echo dual-echo images (14 slice locations) were obtained in 2:08 minutes with a 256 x 128 matrix or in 3:12 minutes with a 256 x 192 matrix at a TR of 2000 msec and two excitations. RESULTS: Lesion conspicuity and characterization on Fast Spin-echo images compared favorably with conventional spin-echo images in our series when pseudo-TEs of 15 and 90 msec were employed for proton density-weighted and T2-weighted images, respectively. Fast Spin-echo images yielded diagnostic information in four nonsedated patients whose conventional spin-echo images were either degraded by motion or unobtainable. Fat signal remained bright on T2-weighted Fast Spin-echo images. Magnetic-susceptibility effects were slightly reduced with Fast Spin-echo but did not pose any diagnostic problem in our series. CONCLUSION: Diagnostically reliable rapid dual-echo brain images can be obtained with Fast Spin-echo sequences.

Adolescent↗

Precision medicine in combating antimicrobial resistance: A comprehensive review.

Antimicrobial resistance (AMR) represents one of the most pressing threats to global public health, undermining the effectiveness of modern antimicrobial therapy and challenging decades of medical progress. This comprehensive review examines the transition from broad-spectrum empirical therapy toward precision medicine as an integrated framework for improving antimicrobial use and combating AMR. Precision medicine seeks to tailor treatment decisions by combining pathogen-specific genomic and resistance data with relevant host characteristics to optimize therapy while limiting unnecessary antimicrobial exposure and the selective pressures that drive resistance. The review synthesizes advances reported from 2020, highlighting established and emerging approaches including rapid molecular diagnostics, next-generation sequencing, CRISPR-based detection, machine learning (ML)-assisted decision support, precision dosing, and targeted therapeutics such as bacteriophage therapy, antimicrobial peptides, and bacterial proteolysis-targeting chimeras. Rather than functioning as isolated technologies, these approaches achieve their greatest clinical value when integrated within antimicrobial stewardship programs and a One Health framework that recognizes the interconnected human, animal, and environmental drivers of resistance. Despite considerable progress, important challenges remain, including equitable access to advanced technologies, interpretation of increasingly complex datasets, workforce and infrastructure limitations, and evolving regulatory pathways for novel diagnostics and therapeutics. This review concludes that while precision medicine is not a standalone solution, its successful implementation will depend on coordinated integration of diagnostics, host factors, computational tools, pharmacological optimization, and stewardship strategies to improve patient outcomes while preserving the long-term effectiveness of existing antimicrobials.

Antimicrobial resistance↗

[Recent progress in computer-assisted laboratory diagnosis].

To assist the physician in the clinical decision making process, the CALD (computer-assisted laboratory diagnosis) system was constructed. This was serially connected with a multi-center laboratory information system for practical use. From among the examples of CALD used, a diagnostic system for the blood spectrum and peripheral hemogram was selected for the evaluation of the principle and usefulness, and for a discussion of further problems. The method of selection of suitable tests for hepatobiliary disease screening (from a normal group and 10 groups of other diseases) and its diagnostic logic and usefulness of quantitative diagnosis using a discriminant curve were then discussed. The optimal combinations were most often found to involve 1-5 tests. Near maximal diagnostic efficiency was achieved by 50-100 combinations. The diagnostic efficiency of the optimal test was higher than expected, with a range of 80-100% (92.7% on average).

Acute Disease↗

Remission versus response as the goal of therapy in ADHD: a new standard for the field?

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) has a substantial negative impact; however, within long-term follow-up studies, a proportion of patients do very well, both symptomatically and functionally, suggesting that the lower the symptom burden, the greater the functional improvements. Studies in major depressive disorder have identified a relationship between symptomatic remission and restoration of normal functioning. OBJECTIVE: The purpose of this article was to propose a definition of remission in ADHD, review remission rates in clinical trials for commonly used medications, and explore the relationship between symptomatic remission and optimal functioning. METHODS: Remission and response rates for medications were obtained through MEDLINE searches of English-language citations (1999-2005) and meeting abstracts (2003-2005) using the terms amphetamine, atomoxetine, methylphenidate, ADHD, efficacy, effectiveness, and controlled trial, as well as hand searches of efficacy studies. Evidence from randomized controlled trials, as well as effectiveness studies, where the proportions of patients achieving predefined cutoff points for remission or response are reported, was reviewed. Because higher remission rates were identified with the oral, osmotic, controlled-release system (OROS) of methylphenidate, a relationship between symptomatic response/remission and optimal functioning was explored further. RESULTS: Remission in ADHD should be defined as a loss of diagnostic status, minimal or no symptoms, and optimal functioning when individuals are being treated with or without medication. Symptomatic remission can be operationalized as a mean total score of S1 on most standardized questionnaires. For the medications examined (OROS methylphenidate, immediate-release methylphenidate, atomoxetine, and mixed amphetamine salts), response rates were comparable at approximately 70% to 75%; however, remission rates were higher with OROS methylphenidate compared with either immediate-release methylphenidate or atomoxetine (remission rates with amphetamines were not found). Benefits, including decreased illness burden as well as improved psychosocial and academic functioning, were associated with treatment versus no treatment and were greater with medication that offered higher remission rates. CONCLUSIONS: The literature provided evidence that greater symptom improvements are associated with greater functional improvements, emphasizing that remission of ADHD as defined should be the goal of therapy. Treatment ought to include the early use of strategies with the greatest chance of achieving remission. Future clinical research should use remission as the primary outcome.

Attention Deficit Disorder with Hyperactivity↗

Optimal mouth position for magnetic resonance imaging of the temporomandibular joint disk.

Optimal mouth positioning for magnetic resonance imaging of the TMJ is controversial. This study evaluates the closed mouth position and partial-open mouth position for diagnostic accuracy of anterior displacement of the disk. Sixty-two joints were considered abnormal in at least one position. In the positive joints, the closed mouth position sequences were all abnormal and diagnostic, while 34% of partial-open mouth position sequences were falsely normal. It was found that the closed mouth position provides higher diagnostic accuracy for disk displacement, although optimal examinations include imaging in both positions.

Adolescent↗

[Use of computer-aided x-ray diagnosis in oncology (author's transl)].

The introduction of computer-aided diagnostic reveals new perspectives for diagnostic decisions. The results of the hitherto used mathematical diagnostic models are represented. The Bayes's theorem as the most used model exhibited very different, in parts unsatisfactory results. More convenient seems to be multivariate models, like discriminant analysis. Hitherto the computer-sided diagnostic was used in a relative small number of differential diagnostic problems. There are yet many replying questions. It is necessary to compare the efficiency of the different mathematical-statistical methods and to search for optimal solution ways for all differential diagnostic problems.

Abdominal Neoplasms↗

[Preparation and study of the efficacy of a toxoplasmic erythrocytic diagnostic agent].

Comparison of various antigenic preparations of Toxoplasma and of the methods for red cell sensitization with these antigens has shown that sensitization with Toxoplasma summary fraction, containing the cytoplasmic and envelope antigens, and rivanol, is the optimal method for preparing an erythrocytic diagnostic agent. A test with such a diagnosticum has proved to be much more effective than the complement fixation test. Though the results of the two tests correlate, this correlation is curvilinear, and therefore it is desirable to use both the tests for the diagnostic investigations.

Animals↗

[Preoperative MR mammography in breast carcinoma. Effect on operative treatment from the surgical viewpoint].

INTRODUCTION: In a prospective study the diagnostic validity of magnetic resonance mammography (MRM) as well as its impact on the choice of the operative procedure in the treatment of breast cancer was examined. In 125 patients who were suspected of having breast cancer by clinical examination, ultrasound, and X-ray mammography, additional bilateral MRM was performed. Of special interest was the diagnostic potential of MRM with regard to multifocal, multicentric and contralateral lesions. METHODS: After a complete resection all lesions diagnosed by the various conventional methods were examined patho-histologically. In 112 patients, complete data were available to calculate the sensitivity and the specificity of each method as well as to correlate its results with the pathohistological findings. RESULTS: In 91 cases, a breast carcinoma was diagnosed by conventional methods, with a sensitivity/specificity of 73%/67% for clinical examination, of 58%/86% for ultrasound, and of 89%/20% for X-ray mammography. In this preselected series of patients with a prevalence of 81.25% the diagnosis established by the various methods was confirmed by MRM with sensitivity of 96.7% and specificity of 19%. Forty-six additional suspicious lesions were found only by MRM, of which 28 were malignant (25 multifocal or multicentric and 3 contralateral carcinomas), and 18 benign. The rate of false-positive MRM results was 18%. Due to the MRM findings, the therapeutic procedure was changed from breast preservation to mastectomy in 14.3%. CONCLUSION: Not only for the differential diagnosis of discrepant findings between X-ray mammography and ultrasound, but especially for the diagnosis of multifocal or multicentric lesions, MRM seems to be the method of choice. Consequently, MRM plays an important role in planning the operative procedure in breast cancer patients, especially in the context of breast preservation. To ensure optimal use of this new diagnostic tool high technical standards, proper expertise on the part of the examining radiologist, and effective cooperation among the involved disciplines (radiology, pathology, surgery) must be guaranteed.

Adult↗

Single serum progesterone as a screen for ectopic pregnancy: exchanging specificity and sensitivity to obtain optimal test performance.

OBJECTIVE: To investigate the diagnostic accuracy of screening serum P in diagnosis of ectopic pregnancy (EP) and to identify a cutoff value that provides the best compromise between test sensitivity and specificity. DESIGN: Retrospective analysis. SETTING: University hospital. INTERVENTIONS: Observation only. PATIENTS: First trimester pregnant women at risk for EP. MAIN OUTCOME MEASURE: Single P measurements were obtained from 3,674 pregnancies with outcomes defined as EP, viable intrauterine pregnancy (IUP), and spontaneous abortion (SAB). Diagnostic accuracy of the test was analyzed by generating receiver operating characteristic (ROC) curves, which quantify the ability of the test to distinguish EP and SAB from IUP. RESULTS: Diagnostic accuracy for EP versus IUP was 88.7% +/- 0.1% (mean +/- SEM); for SAB versus IUP, 93.8% +/- 0.4%; and for SAB + EP versus IUP, 92.8% +/- 0.4%. Diagnostic accuracy for SAB versus EP was only 39.4% +/- 0.2%. In the interval of 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L), P missed 5.3% of the EPs and incorrectly included 84.3% of the viable IUPs; in the interval of 20.0 to 24.9 ng/mL (63.6 to 79.2 nmol/L), sensitivity improved in that only 3.5% of the EPs were missed but 88.8% of viable IUPs were included incorrectly. A cutoff value of > or = 17.5 ng/mL (55.7 nmol/L), the median point of the 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L) interval, missed only 35 of 423 (8.3%) total EPs in the study. CONCLUSION: Analysis of ROC curves demonstrates that single serum P has high diagnostic accuracy for differentiating accidents of pregnancy (SAB and EP) from viable IUP, both individually (SAB versus IUP and EP versus IUP) and collectively (SAB + EP versus IUP); it cannot efficiently discriminate SAB versus EP. We conclude that for P > or = 17.5 ng/mL (55.7 nmol/L), patients thought to be at risk for EP may be followed reasonably without ultrasound or further invasive diagnostic studies.

Abortion, Spontaneous↗

Diagnostic approach to adults with hypoglycemic disorders.

Optimal conditions for confirming the presence and accurately diagnosing the type of hypoglycemic disorder occur at the time of a spontaneous spell. Otherwise, dynamic testing to generate conducive conditions should be conducted in any patient with a history of neuroglycopenic symptoms, regardless of relation to meal ingestion. Specific criteria regarding beta-cell polypeptide concentrations are required to establish hyperinsulinemia. Sulfonylureas in plasma should be measured with sensitive assays. In complex cases, the selective arterial calcium test may be a useful dynamic test.

Antibodies↗

Gene expression profile of papillary thyroid cancer: sources of variability and diagnostic implications.

The study looked for an optimal set of genes differentiating between papillary thyroid cancer (PTC) and normal thyroid tissue and assessed the sources of variability in gene expression profiles. The analysis was done by oligonucleotide microarrays (GeneChip HG-U133A) in 50 tissue samples taken intraoperatively from 33 patients (23 PTC patients and 10 patients with other thyroid disease). In the initial group of 16 PTC and 16 normal samples, we assessed the sources of variability in the gene expression profile by singular value decomposition which specified three major patterns of variability. The first and the most distinct mode grouped transcripts differentiating between tumor and normal tissues. Two consecutive modes contained a large proportion of immunity-related genes. To generate a multigene classifier for tumor-normal difference, we used support vector machines-based technique (recursive feature replacement). It included the following 19 genes: DPP4, GJB3, ST14, SERPINA1, LRP4, MET, EVA1, SPUVE, LGALS3, HBB, MKRN2, MRC2, IGSF1, KIAA0830, RXRG, P4HA2, CDH3, IL13RA1, and MTMR4, and correctly discriminated 17 of 18 additional PTC/normal thyroid samples and all 16 samples published in a previous microarray study. Selected novel genes (LRP4, EVA1, TMPRSS4, QPCT, and SLC34A2) were confirmed by Q-PCR. Our results prove that the gene expression signal of PTC is easily detectable even when cancer cells do not prevail over tumor stroma. We indicate and separate the confounding variability related to the immune response. Finally, we propose a potent molecular classifier able to discriminate between PTC and nonmalignant thyroid in more than 90% of investigated samples.

Adolescent↗

[Severe acute pancreatitis--diagnostic and therapeutic strategy].

To establish the optimal diagnosis and therapeutical strategy in severe acute pancreatitis. 94 (56.9%) severe acute pancreatitis (79 males and 15 females, aged between 26 and 81), selected from 165 acute pancreatitis admitted in the last 5 years (2000-2004) were analyzed. The disease was assigned as severe when one or more of the following criteria were present: Ranson score >3 on admission or at 48 hours, APACHE II score >8, visceral failures, Balthazar CT score C, D or E and local complications (infected necrosis, pseudocyst or pancreatic abscess). Medical treatment (aggressive supportive intensive care therapy, minimizing pancreatic secretion and antibiotic therapy) was the first therapeutical step in all cases. 49 (52.1%) patients were operated on: 20 as early surgery imposed by biliary sepsis (16 cases) or by an acute abdomen with uncertain etiology and unfavourable evolution, and 22 as late surgery (at least 12 days after onset), imposed by the presence of the infected pancreatic necrosis, visceral failures or other local complications, the necrosectomy being the main surgical procedure for infected necrosis. 77 (81.9%) cases had a fair evolution. The conservative treatment led to a complete recovery in 37 (37.2%) cases. We registered an overall mortality rate of 12.7% and postoperative mortality rate of 14%; we also registered 5 (10.2%) postoperative complications: 4 pancreatic and 1 colonic fistulae. (1) The treatment of the severe acute pancreatitis must be performed only in the specialized multidisciplinary well equipped centers with very well trained staff. (2) Medical conservative treatment (aggressive supportive intensive care therapy and antibiotic therapy) is the main therapeutical method within the acute phase (first two weeks). (3) Very restrictive surgical indications within the acute phase. (4) Necrosectomy is the main surgical procedure for the infected necrosis.

Abscess↗