Sample records for important differential diagnostic

  1. Recurrence Incidence in Differentiated Thyroid Cancers and the Importance of Diagnostic Iodine-131 Scintigraphy in Clinical Follow-up

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    Filiz Hatipoğlu


    Full Text Available Objective: Differentiated thyroid cancers (DTC are tumors with good prognosis. However, local recurrence or distant metastasis can be observed. In our study, we aimed to investigate the incidence of recurrence and the importance of diagnostic iodine-131 whole body scan (WBS in clinical follow-up in patients with DTC. Methods: The clinical data of 217 patients with DTC who were followed-up more than 3 years were reviewed retrospectively. The incidence of recurrence was investigated in a group of patients who had radioactive iodine (RAI treatment and showed no sign of residual thyroid tissue or metastasis with diagnostic WBS that was performed at 6-12 months after therapy and had a thyroglobulin (Tg level lower than 2 ng/dl. Results: At the time of diagnosis, ten cases had thyroid capsule invasion, 25 cases had extra-thyroid soft tissue invasion, 11 patients showed lymph node metastasis and four patients had distant organ metastasis. One hundred forty-five patients had RAI treatment at ablation dose (75-100 mCi, whereas 35 patients had RAI treatment at metastasis dose (150-200 mCi. Thirty-seven patients with papillary microcarcinoma did not receive RAI treatment. In 12 (%7.5 of the 160 patients who were considered as “successful ablation”, a recurrence was identified. Recurrence was detected by diagnostic WBS in all cases and stimulated Tg level was <2 ng/dL with the exception of the two cases who had distant metastasis. Conclusion: Identification of pathological findings with WBS in patients who developed local recurrence in the absence of elevated Tg highlights the importance of diagnostic WBS in clinical follow-up.

  2. Listeria monocytogenes encephalitis mimicking Herpes Simplex virus encephalitis: the differential diagnostic importance of cerebrospinal fluid lactic acid levels. (United States)

    Cunha, Burke A; Fatehpuria, Ritu; Eisenstein, Lawrence E


    Listeria monocytogenes is a common cause of bacterial meningitis in elderly patients and in those with impaired cellular immunity. The most common central nervous system infection caused by L. monocytogenes is acute bacterial meningitis; meningoencephalitis is uncommon and encephalitis is rare. Early diagnosis of L. monocytogenes meningitis is difficult because only 50% of cerebrospinal fluid (CSF) Gram stains are negative. L. monocytogenes is one of the few central nervous system pathogens associated with red blood cells in the CSF. When L. monocytogenes presents as encephalitis with red blood cells in the CSF, the clinical presentation mimics most closely herpes simplex virus (HSV)-1 encephalitis. Because the therapies for L. monocytogenes and HSV-1 are different, early diagnostic differentiation is clinically important. The CSF lactic acid is the best way to rapidly differentiate between these two entities; the CSF lactic acid level is elevated in L. monocytogenes but is not elevated in HSV-1 encephalitis. The case presented is an elderly man with chronic lymphocytic leukemia who presented with encephalitis. Advanced age and chronic lymphocytic leukemia predispose him to a wide variety of pathogens, but the rapidity and severity of his clinical presentation made L. monocytogenes and HSV-1 encephalitis the most likely diagnostic possibilities. The CSF Gram stain was negative, but the elevated CSF lactic acid levels with encephalitis and red blood cells in the CSF indicated L. monocytogenes as the most likely pathogen. We present a case of L. monocytogenes encephalitis mimicking HSV-1 encephalitis. While receiving ampicillin therapy, the patient remained unresponsive for more than 1 week and then suddenly regained consciousness and recovered without neurologic sequelae.

  3. [Differential diagnostics of hypomelanoses]. (United States)

    Böhm, M


    Hypomelanoses of the skin encompass a wide spectrum of congenital and acquired alterations in melanin pigmentation. These diseases can be localized or universal. The pathobiology of cutaneous hypomelanoses is heterogeneous and includes defects in melanoblast migration from the neural crest to the epidermis, alterations in melanogenesis and melanin transfer to keratinocytes, and destruction of pigment cells by autoimmune and inflammatory processes. Importantly, some congenital forms of universal hypomelanoses are associated with involvement of internal organs (e.g., Hermansky-Pudlack or Chédiak-Higashi syndrome) and require interdisciplinary patient management. In recent years, significant progress has been made in our current understanding of the pathophysiology especially of vitiligo, thus, resulting in promising new treatment strategies. This disease being one of the most common forms of acquired hypomelanoses of the skin can now be treated in a guideline-oriented and evidence-based manner.

  4. Importance of 123I-metaiodobenzylguanidine scintigraphy/single photon emission computed tomography for diagnosis and differential diagnostics of Parkinson syndromes. (United States)

    Jost, Wolfgang H; Del Tredici, Kelly; Landvogt, Christian; Braune, Stefan


    The goal of Parkinson syndrome diagnostics is twofold: early diagnosis on the one hand, and accurate differentiation among idiopathic and atypical Parkinson syndromes on the other. (123)I-metaiodobenzylguanidine scintigraphy is the only method that can distinguish with a high degree of sensitivity and specificity between atypical Parkinson syndromes and Parkinson's disease or dementia with Lewy bodies. Additional advantages are the method's widespread availability and radioactive exposure dose comparable to that for single photon emission computed tomography imaging with much lower costs. Only a single radiotracer study is necessary. (123)I-metaiodobenzylguanidine scintigraphy is an indispensable tool for purposes of differentiating among the various Parkinson syndromes.

  5. A PCR-Based Diagnostic System for Differentiating Two Weevil Species (Coleoptera: Curculionidae) of Economic Importance to the Chilean Citrus Industry. (United States)

    Aguirre, C; Olivares, N; Luppichini, P; Hinrichsen, P


    A PCR-based method was developed to identify Naupactus cervinus (Boheman) and Naupactus xanthographus (Germar), two curculionids affecting the citrus industry in Chile. The quarantine status of these two species depends on the country to which fruits are exported. This identification method was developed because it is not possible to discriminate between these two species at the egg stage. The method is based on the species-specific amplification of sequences of internal transcribed spacers, for which we cloned and sequenced these genome fragments from each species. We designed an identification system based on two duplex-PCR reactions. Each one contains the species-specific primer set and a second generic primer set that amplify a short 18S region common to coleopterans, to avoid false negatives. The marker system is able to differentiate each Naupactus species at any life stage, and with a diagnostic sensitivity to 0.045 ng of genomic DNA. This PCR kit was validated by samples collected from different citrus production areas throughout Chile and showed 100% accuracy in differentiating the two Naupactus species. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email:



    D. Yu. Ovsyannikov


    The lecture is devoted to the problem of differential diagnosis of infectious exanthemas in children. Information about differential-diagnostic sings of infectious and non-infectious exanthemas is present. Differential diagnosis is proposed on the basis of morphological elements identified in objective research. Presents possible infectious and non-infectious causes of rashes which are characterized by different primary (spot, papula, blister, knob, knot, bubble, abscess, bladder) and seconda...


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    D. Yu. Ovsyannikov


    Full Text Available The lecture is devoted to the problem of differential diagnosis of infectious exanthemas in children. Information about differential-diagnostic sings of infectious and non-infectious exanthemas is present. Differential diagnosis is proposed on the basis of morphological elements identified in objective research. Presents possible infectious and non-infectious causes of rashes which are characterized by different primary (spot, papula, blister, knob, knot, bubble, abscess, bladder and secondary (scale, erosion, ulcer morphological elements.

  8. Project management: importance for diagnostic laboratories. (United States)

    Croxatto, A; Greub, G


    The need for diagnostic laboratories to improve both quality and productivity alongside personnel shortages incite laboratory managers to constantly optimize laboratory workflows, organization, and technology. These continuous modifications of the laboratories should be conducted using efficient project and change management approaches to maximize the opportunities for successful completion of the project. This review aims at presenting a general overview of project management with an emphasis on selected critical aspects. Conventional project management tools and models, such as HERMES, described in the literature, associated personal experience, and educational courses on management have been used to illustrate this review. This review presents general guidelines of project management and highlights their importance for microbiology diagnostic laboratories. As an example, some critical aspects of project management will be illustrated with a project of automation, as experienced at the laboratories of bacteriology and hygiene of the University Hospital of Lausanne. It is important to define clearly beforehand the objective of a project, its perimeter, its costs, and its time frame including precise duration estimates of each step. Then, a project management plan including explanations and descriptions on how to manage, execute, and control the project is necessary to continuously monitor the progression of a project to achieve its defined goals. Moreover, a thorough risk analysis with contingency and mitigation measures should be performed at each phase of a project to minimize the impact of project failures. The increasing complexities of modern laboratories mean clinical microbiologists must use several management tools including project and change management to improve the outcome of major projects and activities. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  9. Alcohol dehydrogenase – physiological and diagnostic Importance

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    Magdalena Łaniewska-Dunaj


    Full Text Available Alcohol dehydrogenase (ADH is a polymorphic enzyme, existing in multiple isoenzymes divided into several classes and localized in different organs. ADH plays a significant role in the metabolism of many biologically important substances, catalyzing the oxidation or reduction of a wide spectrum of specific substrates. The best characterized function of ADH is protection against excess of ethanol and some other exogenous xenobiotics and products of lipid peroxidation. The isoenzymes of alcohol dehydrogenase also participate in the metabolism of retinol and serotonin. The total alcohol dehydrogenase activity is significantly higher in cancer tissues than in healthy organs (e.g. liver, stomach, colorectum. The changes in activity of particular ADH isoenzymes in the sera of patients with different cancers (especially of the digestive system seem to be caused by release of these isoenzymes from cancer cells, and may play a potential role as markers of this cancer. The particular isoenzymes of ADH present in the serum may indicate the cancer localization. Alcohol dehydrogenase may also be useful for diagnostics of non-cancerous liver diseases (e.g. viral hepatitis, non-alcoholic cirrhosis.

  10. Proteinuria: The diagnostic strategy based on urine proteins differentiation

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    Stojimirović Biljana B.


    Full Text Available Basal glomerular membrane represents mechanical and electrical barrier for passing of the plasma proteins. Mechanical barrier is composed of cylindrical pores and filtration fissure, and negative layer charge in exterior and interior side of basal glomerular membrane, made of heparan sulphate and sialoglicoproteine, provides certain electrical barrier. Diagnostic strategy based on different serum and urine proteins enables the differentiation of various types of proteinuria. Depending on etiology of proteinuria it can be prerenal, renal and postrenal. By analyzing albumin, armicroglobulin, immunoglobulin G and armacroglobulin, together with total protein in urine, it is possible to detect and differentiate causes of prerenal, renal (glomerular, tubular, glomerulo-tubular and postrenal proteinuria. The adequate and early differentiation of proteinuria type is of an immense diagnostic and therapeutic importance.

  11. Differential diagnostic algorithm for diseases manifested with heart murmurs syndrome. (United States)

    Naumov, Leonid B


    Diagnostic interpretation at auscultation of heart murmurs is accompanied by frequent errors. It creates serious clinical, pedagogical, organizational and social problems. The standard nosological principle of a clinical information description from the diagnosis (a disease name) to the description of symptoms/signs contradicts to real clinical practice from revealing of symptoms through differential diagnostics to a diagnosis establishment. The differential diagnostic algorithm or diagnostic algorithm developed by the author, is based on the opposite syndromic principle of thinking - from the signs to the diagnosis. It completely corresponds to the practical purposes of reliable diagnostics of 35 illnesses, manifested by heart murmurs at a heart auscultation.

  12. Importance of symplasmic communication in cell differentiation. (United States)

    Marzec, Marek; Kurczynska, Ewa


    Symplasmic communication via plasmodesmata (PD) is part of the system of information exchange between plant cells. Molecules that pass through the PD include ions, some hormones, minerals, amino acids, and sugars but also proteins, transcription factors, and different classes of RNA, and as such PD can participate in the coordination of plant growth and development. This review summarizes the current literature on this subject and the role of PD in signal exchange, the importance of symplasmic communication and symplasmic domains in plant cell differentiation, and highlights the future prospective in the exploration of PD functions in plants. Moreover, this review also describes the potential use of barley root epidermis and non-zygotic embryogenesis in study of symplasmic communication during cell differentiation.

  13. Differentiated thyroid carcinoma : diagnostic and therapeutic studies

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    Liu, Ying-ying


    Differentiated thyroid carcinoma (DTC) has favorable prognosis with high cure rate under treatment of thyroidectomy followed by radiotherapy. However, therapeutic efficiency decreases when dedifferentiation occurs. One of the purposes in this study is to use pharmaceuticals intervention to promote t

  14. The size of the thymus: an important immunological diagnostic tool?

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    Jeppesen, Dorthe Lisbeth


    The report on the influence of seasonal factors on thymic size in early life describes a pattern of ultrasonographically measured thymic growth in Gambian infants including the finding of a smaller thymus in the hungry season. These factors raise a number of important questions: Is the size...... of the thymus relevant to its function and could measurement of the thymus be a useful immunological diagnostic tool in the investigation of thymic function in humans with a depressed immune system? Conclusion: Studies using the size of the thymus as an immunological diagnostic tool should be encouraged....

  15. Neonatal cholestasis – differential diagnoses, current diagnostic procedures and treatment

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    Thomas eGötze


    Full Text Available Cholestatic jaundice in early infancy is a complex diagnostic problem. Misdiagnosis of cholestasis as physiologic jaundice delays the identification of severe liver diseases. In the majority of infants it may represent benign cases of breast milk jaundice, but few among them are masked and caused by neonatal cholestasis that requires a prompt diagnosis and treatment. Therefore, a prolonged neonatal jaundice longer than two weeks after birth must always be scrutinized because an early diagnosis is essential for appropriate management. To rapidly identify the cholestatic cases, the conjugated bilirubin needs to be determined in any infant presenting with prolonged jaundice at 14 days of age with or without depigmented stool. Once neonatal cholestasis is confirmed, a systematic approach is the key to reliably achieve the diagnosis in order to promptly initiate the specific, and in many cases, life saving therapy. This strategy is most important to promptly identify and treat infants with biliary atresia, the most common cause of neonatal cholestasis that requires a hepatoportoenterostomy as soon as possible.Here, we provide a detailed work-up approach including initial treatment recommendations and a clinically oriented overview of possible differential diagnoses in order to facilitate an early recognition and a timely diagnosis. This warrants a broad spectrum of diagnostic procedures and investigations including new methods that are described in this review.

  16. CT-diagnosis of optic nerve lesions. Differential diagnostic criteria

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    Unsoeld, R.


    Computed tomograms of 166 optic nerve lesions were analyzed: 97 were mainly orbital and 69 mainly intracranial. The criteria were clinical course, size, density and delineation of the optic nerve shadow, orbital and cerebral soft tissue abnormalities, and bony changes in the optic canal. Characteristic CT features are described of individual disease entities such as optic gliomas, optic nerve sheath meningiomas, neoplastic and inflammatory infiltrations. The differential diagnostic importance of individual CT criteria is evaluated and discussed. Simultaneous visualization of orbital and intracranial soft tissue changes as well as bony changes in the optic canal allow the location and identification of the majority of optic nerve lesions based on the criteria mentioned above, and optic nerve tumors can be differentiated. In 9 patients with optic neuritis due to clinically proven encephalitis and in 17 patients with total optic atrophy, no changes in the size of the optic nerve could be found. CT evaluation of the intraorbital portion of the optic nerve requires special examination techniques. Oblique computer reformations through the optic canal provide excellent visualization of bony changes in the optic canal. The exclusion of intracranial causes of optic nerve lesions requires intravenous injection of contrast material.

  17. [Clinical importance and diagnostic methods of minimal hepatic encephalopathy]. (United States)

    Stawicka, Agnieszka; Zbrzeźniak, Justyna; Świderska, Aleksandra; Kilisińska, Natalia; Świderska, Magdalena; Jaroszewicz, Jerzy; Flisiak, Robert


    Minimal hepatic encephalopathy (MHE) encompasses a number of neuropsychological and neurophysiological disorders in patients suffering from liver cirrhosis, who do not display abnormalities during a medical interview or physical examination. A negative influence of MHE on the quality of life of patients suffering from liver cirrhosis was confirmed, which include retardation of ability of operating motor vehicles and disruption of multiple health-related areas, as well as functioning in the society. The data on frequency of traffic offences and accidents amongst patients diagnosed with MHE in comparison to patients diagnosed with liver cirrhosis without MHE, as well as healthy persons is alarming. Those patients are unaware of their disorder and retardation of their ability to operate vehicles, therefore it is of utmost importance to define this group. The term minimal hepatic encephalopathy (formerly "subclinical" encephalopathy) erroneously suggested the unnecessity of diagnostic and therapeutic procedures in patients with liver cirrhosis. Diagnosing MHE is an important predictive factor for occurrence of overt encephalopathy - more than 50% of patients with this diagnosis develop overt encephalopathy during a period of 30 months after. Early diagnosing MHE gives a chance to implement proper treatment which can be a prevention of overt encephalopathy. Due to continuing lack of clinical research there exist no commonly agreed-upon standards for definition, diagnostics, classification and treatment of hepatic encephalopathy. This article introduces the newest findings regarding the importance of MHE, scientific recommendations and provides detailed descriptions of the most valuable diagnostic methods.

  18. Differential diagnostic radiology of skeletal diseases; Radiologische Differentialdiagnose der Skeletterkrankungen

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    Reiser, M. [ed.] [Klinikum Grosshadern, Muenchen (Germany). Inst. fuer Radiologische Diagnostik; Peters, P.E. [ed.] [Muenster Univ. (Germany). Inst. fuer Klinische Radiologie


    The reference work presents a comprehensive review of the entire spectrum of differential diagnostic radiology of bone diseases. Taking systematic image analysis and localisation, which are the principal criteria of differential diagnosis, as the main line of orientation, the chapters of the book are arranged by diseases and, following a standard pattern common to all chapters, analyse the various syndromes and clinical pictures, giving all essential differential diagnostic aspects ascertained by anamnesis, clinical examination, and augmentative diagnostic evaluation. All chapters conclude with a tabulated list of principal symptoms and diagnostic signs. The great majority of the diagnoses are accompanied by the relevant images, primarily based on X-ray radiography, but all modern imaging methods and their findings are also shown according to their diagnostic applicability and value. (orig./MG). 709 figs., 119 tabs. [Deutsch] Das Referenzwerk gibt eine komplette Uebersicht ueber die gesamte Bandbreite der `Radiologischen Differentialdiagnostik der Skeletterkrankungen`. Ausgehend von der systematischen radiologischen Bildanalyse und der Lokalisation als den wichtigsten differentialdiagnostischen Kriterien werden die einzelnen Krankheitsbilder nach einer einheitlichen Struktur analysiert und alle wesentlichen differentialdiagnostischen Aspekte aus Anamnese, Klinik und weiterfuehrender Diagnostik zusammengestellt. Alle wichtigen Leitsymptome mit den entsprechenden Differentialdiagnosen jeweils in einer Tabelle am Kapitelende wiedergegeben. Die Mehrzahl der Befunde wird durch eine Abbildung dokumentiert. Dabei wird primaer von der konventionellen Roentgendiagnostik ausgegangen, jedoch sind alle modernen bildgebenden Verfahren ihrer Bedeutung entsprechend beruecksichtigt. (orig./MG)

  19. Estimating the Importance of Differential Item Functioning. (United States)

    Rudas, Tamas; Zwick, Rebecca


    The mixture index of fit (T. Rudas et al, 1994) is used to estimate the fraction of a population for which differential item functioning (DIF) occurs, and this approach is compared to the Mantel Haenszel test of DIF. The proposed noniterative procedure provides information about data portions contributing to DIF. (SLD)

  20. Estimating the Importance of Differential Item Functioning. (United States)

    Rudas, Tamas; Zwick, Rebecca


    The mixture index of fit (T. Rudas et al, 1994) is used to estimate the fraction of a population for which differential item functioning (DIF) occurs, and this approach is compared to the Mantel Haenszel test of DIF. The proposed noniterative procedure provides information about data portions contributing to DIF. (SLD)

  1. Importance of enolase in Giardia lamblia differentiation. (United States)

    Castillo-Romero, Araceli; Davids, Barbara J; Lauwaet, Tineke; Gillin, Frances D


    The ability of Giardia to differentiate into cysts which survive in the environment and release the virulent trophozoites after ingestion in the small intestine is essential for transmission and disease. We examined the role of enolase, a glycolytic enzyme, in Giardia differentiation. The sequence of Giardia lamblia enolase (gEno) is most similar to enolases in Homo sapiens and Leishmania mexicana, and shows the conserved catalytic and metal-binding residues. We used an integration vector to stably express wild type and mutant gEno. In trophozoites, wild type gEno localized to the cell membrane, caudal flagella and cytosol. gEno is present on the wall of mature cysts, but not in encystation secretory vesicles (ESV). The expression of gEno with a deletion of residues G167-K169, or mutations H389Q/R390S significantly inhibited excystation while mutation of residue D257K had no effect. These results suggest a role for enolase in regulation of Giardia excystation.

  2. A Diagnostic for Localizing Red Giant Differential Rotation

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    Klion, Hannah


    We present a simple diagnostic that can be used to constrain the location of the differential rotation in red giants with measured mixed mode rotational splittings. Specifically, in red giants with radii $\\sim 4R_\\odot$, the splittings of p-dominated modes (sound wave dominated) relative to those of g-dominated modes (internal gravity wave dominated) are sensitive to how much of the differential rotation resides in the outer convection zone versus the radiative interior of the red giant. An independently measured surface rotation rate significantly aids breaking degeneracies in interpreting the measured splittings. We apply our results to existing observations of red giants, particularly those of Kepler-56, and find that most of the differential rotation resides in the radiative region rather than in the convection zone. This conclusion is consistent with results in the literature from rotational inversions, but our results are insensitive to some of the uncertainties in the inversion process and can be readi...

  3. Pleural mesothelioma in differential diagnostics of a tubercular exudative pleuritis

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    O.M. Raznatovskaya


    Full Text Available Background. Difficulties of differential diagnostics of exudative pleuritis due to pleura mesothelioma and such one of tubercular etiology can take a long time that is the reason of delayed well-timed and correct treatment order. Etiological diagnostics of exudative pleuritis has to be based on an integrated approach taking into account the data of clinical inspection of a patient, a laboratory research of pleural exudate, radial, instrumental, pathomorphological and surgical methods. The aim of our study is to establish the features of diagnosis of exudative pleuritis due to pleura mesothelioma by determining of informativeness and value of applied diagnostic methods for further use for differential diagnostics with exudative pleuritis of tubercular etiology on the cases of own clinical observations. Materials and methods. Four clinical cases of diagnostics of pleura mesothelioma in the patients with exudative pleuritis at Municipal Institution “Zaporizhzhia Regional Antituberculous Clinical Dispensary” were analyzed. Results. Four cases of pleura mesothelioma were diagnosed at Municipal Institution “Zaporizhzhia Regional Antituberculous Clinical Dispensary” within differential diagnostics of exudative pleuritis of obscure origin. In all cases the following similar features of pleura mesothelioma were observed: patients were male; patients complained about dyspnoea at exercise stress, thorax pain (on the side of mesothelioma localization, general weakness, periodic cough; the patients denied tuberculosis contact; the general blood test revealed only lymphopenia against the background of the accelerated ESR; micobacteria of tuberculosis were not revealed at all; steady accumulation of an exudate, despite its systematic evacuation; cytologic research of pleural liquid was characterized by a moderate turbidity, serous (serous and hemorrhagic character, with the specific weight of 1015–1016, rising of protein to 33–66 g/l, positive

  4. The size of the thymus: an important immunological diagnostic tool?

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    Jeppesen, Dorthe Lisbeth


    of the thymus relevant to its function and could measurement of the thymus be a useful immunological diagnostic tool in the investigation of thymic function in humans with a depressed immune system? Conclusion: Studies using the size of the thymus as an immunological diagnostic tool should be encouraged....

  5. Differential diagnostic considerations of desmoid-type fibromatosis. (United States)

    Goldstein, Jeffery A; Cates, Justin M M


    Fibrous and myofibroblastic tumors of soft tissue often present the surgical pathologist with a difficult differential diagnosis because of the number of diagnostic possibilities and morphologic similarities among cytologically bland spindle-cell tumors. Prototypical in this regard is desmoid-type fibromatosis. In a review of 320 surgical specimens diagnosed as desmoid tumor, 94 (29%) were discovered to be misclassified as such. The most common lesions in this series were Gardner fibroma, scar tissue, superficial fibromatosis, nodular fasciitis, myofibroma, and collagenous fibroma. Four sarcomas were also misinterpreted as desmoid-type fibromatosis (3 low-grade fibromyxoid sarcomas and 1 unclassified spindle-cell sarcoma). We take this opportunity to compare and contrast desmoid tumor and several of the soft tissue tumors that should be considered in the differential diagnosis thereof.

  6. [The mode of differential diagnostic of and acute alcoholic gastroenteritis]. (United States)

    Makarov, V K; Makarov, P V


    The study was carried out to develop mode of differential diagnostic of salmonella and acute alcoholic gastroenteritis on the basis of phospholipid specter of blood serum. The indicators of phospholipid fractions of blood serum were analyzed in 50 healthy persons, 50 patients with acute alcoholic gastroenteritis and 50 patients with salmonella gastroenteritis were analyzed. The relative content of following fractions of whole phospholipids were analyzed--total lysophospholipids, sphyngomiyelin, phosphatidcholine, phosphatidyletanolamin. The phospholipid spectrum of blood serum can be applied in differential diagnostic of salmonella gastroenteritis and acute alcoholic gastroenteritis. The disorders of metabolism of lipids under given pathological conditions have a multidirectional character. The salmonella gastroenteritis is characterized by decreasing of relative content of total lysophospholipids and increasing of phosphatidcholine as compared with standard conditions. The acute alcoholic gastroenteritis is characterized by increasing of relative content of total lysophospholipids and phosphatidcholine and decreasing of level of phosphatidcholine. The content of total Iysophospholipids in blood serum is lower on 35% or 30.0 mg% permits diagnosing acute alcoholic gastroenteritis. The content of phosphaltidcholine in blood serum higher than 40% or 50 mg% permits diagnosing salmonella gastroenteritis.

  7. Implementation of HIV and Tuberculosis Diagnostics: The Importance of Context. (United States)

    Dominique, Joyelle K; Ortiz-Osorno, Alberto A; Fitzgibbon, Joseph; Gnanashanmugam, Devasena; Gilpin, Christopher; Tucker, Timothy; Peel, Sheila; Peter, Trevor; Kim, Peter; Smith, Steven


    Novel diagnostics have been widely applied across human immunodeficiency virus (HIV) and tuberculosis prevention and treatment programs. To achieve the greatest impact, HIV and tuberculosis diagnostic programs must carefully plan and implement within the context of a specific healthcare system and the laboratory capacity. A workshop was convened in Cape Town in September 2014. Participants included experts from laboratory and clinical practices, officials from ministries of health, and representatives from industry. The article summarizes best practices, challenges, and lessons learned from implementation experiences across sub-Saharan Africa for (1) building laboratory programs within the context of a healthcare system; (2) utilizing experience of clinicians and healthcare partners in planning and implementing the right diagnostic; and (3) evaluating the effects of new diagnostics on the healthcare system and on patient health outcomes. The successful implementation of HIV and tuberculosis diagnostics in resource-limited settings relies on careful consideration of each specific context. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  8. 75 FR 52505 - Fiscal Year 2011 Veterinary Import/Export Services, Veterinary Diagnostic Services, and Export... (United States)


    ... Animal and Plant Health Inspection Service Fiscal Year 2011 Veterinary Import/Export Services, Veterinary... plasm, organisms, and vectors; for certain veterinary diagnostic services; and for export certification... information on Veterinary Diagnostic program operations, contact Dr. Elizabeth Lautner, Director,...

  9. Desquamative inflammatory vaginitis: differential diagnosis and alternate diagnostic criteria. (United States)

    Bradford, Jennifer; Fischer, Gayle


    To describe alternate diagnostic protocols and describe the differential diagnosis for desquamative inflammatory vaginitis (DIV). One hundred one cases of DIV were audited retrospectively. All patients were seen exclusively by the authors in their private practices using diagnostic criteria applicable to local practice limitations. Other potential etiologies (infection, contact irritant vaginitis, fixed drug eruptions, immunobullous diseases, estrogen hypersensitivity vulvovaginitis, and graft-vs-host disease) were excluded by history, examination, and focused trials of treatment. Historical triggers in the study cohort and a control group of 75 women with lichen planus also drawn from the authors' private practice were compared. Patients were treated with 4 to 6 weeks of topical vaginal antibiotics, 94% with clindamycin, and response to treatment was recorded at subsequent follow-up. All patients were white. Of 101 patients, 57 (56%) had historical triggers, most frequently diarrhea or antibiotic treatment. Of the 75 women in the control group with vaginal lichen planus, 11 had historical triggers (15%, p vaginitis, which were ongoing, were cured when their triggers were finally controlled or cured, leaving 35 patients who required long-term maintenance therapy. Desquamative inflammatory vaginitis seems to be a distinct entity of vaginitis that, in an office setting, can be distinguished from other diagnostic possibilities by careful clinical evaluation and focused trials of treatment. The majority of women responded promptly to intravaginal antibiotics, with approximately 35% of cases requiring maintenance therapy. More than half the cases have an historical trigger. We postulate that DIV occurs when a trigger causes shifts in vaginal homeostasis, resulting in an inflammatory response associated with increased epithelial cell turnover.

  10. Numerical diagnostics of solution blowup in differential equations (United States)

    Belov, A. A.


    New simple and robust methods have been proposed for detecting poles, logarithmic poles, and mixed-type singularities in systems of ordinary differential equations. The methods produce characteristics of these singularities with a posteriori asymptotically precise error estimates. This approach is applicable to an arbitrary parametrization of integral curves, including the arc length parametrization, which is optimal for stiff and ill-conditioned problems. The method can be used to detect solution blowup for a broad class of important nonlinear partial differential equations, since they can be reduced to huge-order systems of ordinary differential equations by applying the method of lines. The method is superior in robustness and simplicity to previously known methods.


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    N. N. Pavlenko


    Full Text Available The problems of timeliness and correctness of diagnostics of bone tumours, as well as therapeutic decision deserve the most careful consideration. The present research concerns the detection of criteria of differential diagnostics of giant-cell tumours, osteocystoma and osteosarcoma (according to the literary data. According to the literature the study of clinical and radiologic diagnostics, allowed to work out differential and diagnostic tables of signs and algorithms of diagnostics of giant-cell tumours, osteocystoma and osteosarcoma. It enabled to detect a therapeutic and diagnostic approach to patients with bone tumours.

  12. Diagnostic and differential diagnostic criteria of lymphoid neoplasms in bone marrow trephine biopsies: a study of 87 cases. (United States)

    Horváth, Emoke; Mezei, T; Pávai, Z; Turcu, M; Demian, Smaranda; Tóth, Erika; Chira, Liliana; Jung, I


    The aim of this study is to present the diagnostic and differential diagnostic criteria of the bone marrow specimen involved by lymphomas based on the histomorphological immunophenotype features and clonality of the tumor cells, patterns of lymphoproliferation and diagnostic pitfalls. BMB material obtained from the right posterior iliac crest was represented from 87 untreated and treated patients with BM involving malignant lymphoma, stained with Hematoxylin-Eosin, Giemsa, Periodic Acid Schiff and Gömöri's Silver. In order to perform immunohistochemistry examination we used a large antibody panel. B-cell clonality was determined in six cases. We found eight reactive lymphoproliferative responses and 79 lymphoid neoplasms of which 45 were diagnosed as de novo lymphoma, the rest of 34 samples being examined for staging. The predominant lymphoma was CLL (30 cases), over followed by DLBCL (18 cases). The most frequent patterns of involvement were the interstitial (29%) and mixed (15%) ones. In eight cases, we found reactive lymphoid aggregates. The B-cell clonality test showed four monoclonal, one oligoclonal and one polyclonal diseases form. Diagnosis of lymphoma versus reactive aggregate has been based on the combination of a lot of antibodies and involvement pattern. Although investigation of gene rearrangement was necessary for the establishment of the correct diagnosis in only 6.9% of cases, it should be emphasized that it is of great importance in disease monitoring.

  13. Diagnostic value of uric acid to differentiate transudates and exudates. (United States)

    Uzun, K; Vural, H; Ozer, F; Imecik, O


    Uric acid is known to be an end product of purine metabolism. Increases in uric acid may be found in clinical conditions associated with tissue hypoxia. We have investigated the value of uric acid to differentiate between a transudate and exudate. In this study, we measured uric acid in the pleural fluid and the serum of 110 patients, 30 women and 80 men with a mean age of 49.5+/-19 years. Light's criteria were used to differentiate between a transudate and exudate. Mean serum uric acid was 496.7+/-153.4 micromol/l in patients with transudates and 291.3+/-143.1 micromol/l in patients with exudates. Mean pleural fluid uric acid was 487.7+/-165 micromol/l in patients with transudates and 279.9+/-142.1 micromol/l in patients with exudates. These data showed that the levels of serum and pleural uric acid were higher in transudates than exudates (p0.05). The specificity and sensitivity of pleural uric acid for diagnosis of transudate effusions were 73% and 80.6%, respectively. The specificity and sensitivity of pleural uric acid for diagnosis of transudate effusions from exudates without malignancy were 71.8% and 91.7%, respectively. The sensitivity and specificity of pleural lactate dehydrogenase for diagnosis of exudates were 82% and 89%; the sensitivity and specificity of pleural fluid/serum lactate dehydrogenase were 85% and 89%; the sensitivity and specificity of pleural fluid/serum protein were 91% and 89%, respectively. Using all three of Light's criteria together, the sensitivity was 91% and its specificity was 94%. Our findings indicate that determination of uric acid in pleural fluid may be of diagnostic value in differential diagnosis of transudates and exudates. The sensitivity of pleural uric acid measurement was higher for exudates without malignancy. However, Light's criteria remain the best means of separating transudates from exudates.

  14. The importance and value of EQA for diagnostic genetic laboratories. (United States)

    Hastings, Ros J; Howell, Rod T


    Quality control in a laboratory setting requires the establishment of effective training, standard operating procedures, internal quality control, validation of tests and external quality assessment (EQA). A structured quality management system subject to regular internal and external audits will minimise the error rate. EQA, therefore, gives assurance, both to patients and referring clinicians, that the diagnostic laboratory is competent to produce results that are reliable and accurate. EQA is educational and aims to improve and validate the overall quality of genetic service to the user. Regular EQA assessment compares laboratory performance against set standards and also allows comparison between laboratories. Sometimes EQA can also help to define good standards (best practice), although this does depend on the type of EQA test. EQA interprets best practice standards (=quality) into a numerical score (=quantity). While international bodies or professional organisations set these standards, EQA is able to assess whether these standards are met, with any omissions resulting in a reduction in the total score. Although EQA has an educational role rather than a punitive role, critical errors affecting clinical management will result in a laboratory receiving a poor performance categorisation. Accurate analysis and interpretation are essential quality parameters that require extensive knowledge of the aetiology of genetic abnormalities/disease and risk factors. Training of staff in interpretation of the results together with a comprehensive means of reporting normal and abnormal genetic results underpins the diagnostic service to the patient. Poor-performing laboratories are, therefore, encouraged to review their internal processes. EQA schemes that have been established for many years have seen improvements in the analytical and reporting content over time, thereby improving the quality of diagnostic service available to patients.

  15. Imported melioidosis in Danish travellers: a diagnostic challenge

    DEFF Research Database (Denmark)

    Badran, Shadia; Pedersen, Thomas Ingemann; Roed, Casper;


    Infections with Burkholderia pseudomallei (melioidosis) are rare events in Scandinavian countries, but the bacterium may be contracted during travel to endemic areas, i.e. Southeast Asia (especially Thailand) and northern Australia. Here, 5 travel-related cases occurring within the last 3 y...... in Denmark are reported, with particular emphasis on diagnostic and therapeutic challenges posed to health staff with little experience in the management of melioidosis. A newly developed B. pseudomallei-specific polymerase chain reaction test was applied and was able to correctly identify all isolates....

  16. X-ray morphology of the eburnated vertebral body - diagnostic and differential diagnostic problems

    Energy Technology Data Exchange (ETDEWEB)

    Krug, B.; Lorenz, R.; Steinbrich, W.


    1. Numerous diseases may become manifest as eburnated vertebral bodies, and hence the X-ray morphological sign of eburnation is an unspecific one. Isolated characteristics such as the involvement of one or several vertebrae, an intact vertebral space, a broadening of the paravertebral accompanying shadow, and the remaining radiological skeletal status enable narrowing down the differential diagnosis, although anamnesis and clinical findings will supply the main pointers. 2. In primary tumorous eburnations radiotherapy or chemotherapy will render an X-ray morphological assessment of therapeutic success impossible. 3. In primary diagnosis of an eburnated vertebral body it is possible to apply sonography. CT and MR as diagnostic tools step by step to narrow down the differential diagnosis by detecting or excluding pathological abdominal processes such as liver or lymphatic node metastases, paravertebral or intraspinal soft-part dense space-occupying growths or bone infiltration, but it will only rarely be possible to classify the phenomenon properly as being caused by a well-defined process, even if CT and MR are employed.

  17. Congenital self-healing reticulohistiocytosis - an important diagnostic challenge

    DEFF Research Database (Denmark)

    Jensen, Marie Louise Slott; Bygum, Anette; Clemmensen, Ole


    , multidisciplinary assessment and follow up are essential. Conclusion:  Our data document how easily the diagnosis congenital self-healing reticulocytosis may be missed and emphasize the importance and value of instant clinical photographing at the neonatal unit and the use of teledermatology whenever congenital...

  18. DNA diagnostics to identify internal feeders (Lepidoptera: Tortricidae) of pome fruits of quarantine importance. (United States)

    Barcenas, N M; Unruh, T R; Neven, L G


    A diagnostic polymerase chain reaction (PCR) method is presented for differentiating among the North American internal apple-feeding pests codling moth, Cydia pomonella (L.); oriental fruit moth, Grapholita molesta (Busck); lesser appleworm, Grapholita prunivora (Walsh); and cherry fruitworm, Grapholita packardi Zeller. An approximately 470-bp fragment of mitochondrial cytochrome oxidase subunit I (COI) was sequenced in three to six specimens of each species. Consistent and diagnostic differences were observed among the species in two regions of COI from which forward and reverse primers were designed to amplify a 112-116-bp segment of the gene. The primer sets were used to selectively amplify DNA from specimens of diverse geographic origin for each corresponding target species. Protocols were adapted for conventional and quantitative PCR, the latter being substantially faster. The method was validated as a decision-making tool for quarantine identifications for Mexico by representatives of their phytosanitary agency (Sanidad Vegetal). The method can facilitate identification of intercepted internal feeding Lepidoptera in apple and pear for many other importing nations.

  19. 76 FR 54193 - Fiscal Year 2012 Veterinary Import/Export, Diagnostic Services, and Export Certification for... (United States)


    ... Animal and Plant Health Inspection Service Fiscal Year 2012 Veterinary Import/Export, Diagnostic Services... Inspection Service, USDA. ACTION: Notice. SUMMARY: This notice pertains to user fees charged for Veterinary..., animal products, birds, germ plasm, organisms, and vectors; for certain veterinary diagnostic...

  20. Importance of GLUT1 in differential diagnosis of vascular anomalies

    Directory of Open Access Journals (Sweden)

    Tiago João da Silva Filho


    Full Text Available Vascular anomalies (VAs include a group of distinct lesions, such as vascular system congenital malformations, as well as benign and malignant vascular tumors. These lesions may present similar clinical and histopathological features, leading to mistaken diagnoses and incorrect treatment choices. It is important that professionals responsible for monitoring the development of VAs conduct precise investigations and use the appropriate terminology. The human glucose transporter protein isoform 1 (GLUT1 has been proposed as a tool to aid in differential diagnosis between different VAs, given that it is a sensitive and specific marker for identification of infantile hemangiomas (HIs in any organ. This article presents a review of the literature on this protein as an effective tool for identification and possible differential diagnosis between several VAs.

  1. Diagnostic features of lung metastases differentiated thyroid cancer

    Directory of Open Access Journals (Sweden)

    T. M. Geliashvili


    Full Text Available Background. The worldwide increasing incidence of thyroid cancer (TC is mainly due to a rise in its major form of differentiated TC (DTC: papillary. Most patients with DTC have a good prognosis; 10-year survival overall rates are as high as 85 %, but not greater than 40 % in a group of patients with distant metastases. At the same time, the lung is the most frequent target for distant metastases, accounting for 70 % of all sites.Objective: to estimate and compare the capabilities of different diagnostic techniques to detect lung metastases of DTC. Materials and methods. The results of diagnosing lung metastases were retrospectively analyzed in 36 patients (33 women and 3 men; mean age 53 years with DTC (29 patients with papillary TC and 7 with follicular TC treated at the department of radiotherapy with systemic therapy, Chelyabinsk Regional Clinical Oncology Center from 2011 to 2014.Results. Chest X-ray could reveal pulmonary metastases in 13 (36 % patients; lung pathology foci were absent in 23 (64 % patients. 131I whole-body scintigraphy (WBS proved to be of informative value in 24 (66.7 % patients, it displayed no increased accumulation of the radiopharmaceutical in the lung of 12 (33.3 % cases. Multislice spiral computed tomography (MSCT of the chest was carried out in 22 (61 % patients; out of them 21 (95.5 % were found to have 1.4-to-20-mm lung cancer foci. 18Fluorodeoxyglucose (18FDG positron emission tomography / computed tomography (PET / CT was performed in 18 (50 % patients, which showed 3–26-mm lung pathology foci in all the patents; out of them 16 (88.9 % were detected to have metastases owing to the CT component of this method. Thus, the highest sensitivity was exhibited by MSCT (95.5 %, 18FDG PET / CT (100 % due to its CT component, and 131I WBS (66.7 %.Conclusion. When lung metastases of DTC are suspected, 1 chest X-ray should be used as a screening test; 2 131I WBS should be performed in all patients; 3 MSCT of the chest is

  2. Differential age-dependent import regulation by signal peptides.

    Directory of Open Access Journals (Sweden)

    Yi-Shan Teng

    Full Text Available Gene-specific, age-dependent regulations are common at the transcriptional and translational levels, while protein transport into organelles is generally thought to be constitutive. Here we report a new level of differential age-dependent regulation and show that chloroplast proteins are divided into three age-selective groups: group I proteins have a higher import efficiency into younger chloroplasts, import of group II proteins is nearly independent of chloroplast age, and group III proteins are preferentially imported into older chloroplasts. The age-selective signal is located within the transit peptide of each protein. A group III protein with its transit peptide replaced by a group I transit peptide failed to complement its own mutation. Two consecutive positive charges define the necessary motif in group III signals for older chloroplast preference. We further show that different members of a gene family often belong to different age-selective groups because of sequence differences in their transit peptides. These results indicate that organelle-targeting signal peptides are part of cells' differential age-dependent regulation networks. The sequence diversity of some organelle-targeting peptides is not a result of the lack of selection pressure but has evolved to mediate regulation.

  3. PRDM proteins: Important players in differentiation and disease

    DEFF Research Database (Denmark)

    Tonnesen, Cathrine Kolster Fog; Galli, Giorgio G; Lund, Anders H


    The PRDM family has recently spawned considerable interest as it has been implicated in fundamental aspects of cellular differentiation and exhibits expanding ties to human diseases. The PRDMs belong to the SET domain family of histone methyltransferases, however, enzymatic activity has been dete...... a more comprehensive understanding of the biological and biochemical functions of this important protein family....... suppressors or drivers of oncogenic processes. The molecular mechanisms have been delineated for only few PRDMs and little is known about functional redundancy within the family. Future studies should identify target genes of PRDM proteins and the protein complexes in which PRDM proteins reside to provide...

  4. Giardia mitosomal protein import machinery differentially recognizes mitochondrial targeting signals. (United States)

    Nyindodo-Ogari, Lilian; Schwartzbach, Steven D; Estraño, Carlos E


    Giardia lamblia mitosomes are believed to be vestigial mitochondria which lack a genome. Similar to higher eukaryotes, mitosomal proteins possess either N-terminal or internal mitosomal targeting sequences. To date, some components of the higher eukaryote archetypal mitochondrial protein import apparatus have been identified and characterized in Giardia mitosomes; therefore, it is expected that mitochondrial signals will be recognized by the mitosomal protein import system. To further determine the level of conservation of the Giardia mitosome protein import apparatus, we expressed mitochondrial proteins from higher eukaryotes in Giardia. These recombinant proteins include Tom20 and Tom22; two components of the mitochondrial protein import machinery. Our results indicate that N-terminal mitochondrial targeting sequence is recognized by the mitosomal protein import machinery; however, interestingly the internal mitochondrial targeting sequences of higher eukaryotes are not recognized by the mitosome. Our results indicate that Giardia mitosome protein transport machinery shows differential recognition of higher eukaryotic mitochondria transfer signals, suggesting a divergence of the transport system in G. lamblia. Therefore, our data support the hypothesis that the protein import machinery in Giardia lamblia mitosome is an incomplete vestigial derivative of mitochondria components.

  5. Non-differential measurement error does not always bias diagnostic likelihood ratios towards the null

    Directory of Open Access Journals (Sweden)

    Fosgate GT


    Full Text Available Abstract Diagnostic test evaluations are susceptible to random and systematic error. Simulated non-differential random error for six different error distributions was evaluated for its effect on measures of diagnostic accuracy for a brucellosis competitive ELISA. Test results were divided into four categories:

  6. Diagnostic algorithm to differentiate lymphoma from inflammation in feline small intestinal biopsy samples. (United States)

    Kiupel, M; Smedley, R C; Pfent, C; Xie, Y; Xue, Y; Wise, A G; DeVaul, J M; Maes, R K


    Differentiating between inflammatory bowel disease (IBD) and small intestinal lymphoma in cats is often difficult, especially when only endoscopic biopsy specimens are available for evaluation. However, a correct diagnosis is imperative for proper treatment and prognosis. A retrospective study was performed using surgical and endoscopic intestinal biopsy specimens from 63 cats with a history of chronic diarrhea or vomiting or weight loss. A diagnosis of lymphoma or inflammation was based on microscopic examination of hematoxylin and eosin (HE)-stained sections alone, HE-stained sections plus results of immunohistochemical labeling (IHC) for CD3e and CD79a, and HE staining, immunophenotyping, and polymerase chain reaction (PCR) results for B and/or T cell clonality. In addition, various histomorphologic parameters were evaluated for significant differences between lymphoma and IBD using Fisher's exact test. The sensitivity and specificity of each parameter in the diagnosis of lymphoma were also determined. Results of Bayesian statistical analysis demonstrated that combining histologic evaluation of small intestinal biopsy specimens with immunophenotyping and analysis of clonality of lymphoid infiltrates results in more accurate differentiation of neoplastic versus inflammatory lymphocytes. Important histologic features that differentiated intestinal lymphoma from IBD included lymphoid infiltration of the intestinal wall beyond the mucosa, epitheliotropism (especially intraepithelial nests and plaques), heterogeneity, and nuclear size of lymphocytes. Based on the results of this study, a stepwise diagnostic algorithm that first uses histologic assessment, followed by immunophenotyping and then PCR to determine clonality of the lymphocytes, was developed to more accurately differentiate between intestinal lymphoma and IBD.

  7. Differential scanning calorimetry as a complementary diagnostic tool for the evaluation of biological samples. (United States)

    Garbett, Nichola C; Brock, Guy N


    Differential scanning calorimetry (DSC) is a tool for measuring the thermal stability profiles of complex molecular interactions in biological fluids. DSC profiles (thermograms) of biofluids provide specific signatures which are being utilized as a new diagnostic approach for characterizing disease but the development of these approaches is still in its infancy. This article evaluates several approaches for the analysis of thermograms which could increase the utility of DSC for clinical application. Thermograms were analyzed using localized thermogram features and principal components (PCs). The performance of these methods was evaluated alongside six models for the classification of a data set comprised of 300 systemic lupus erythematosus (SLE) patients and 300 control subjects obtained from the Lupus Family Registry and Repository (LFRR). Classification performance was substantially higher using the penalized algorithms relative to localized features/PCs alone. The models were grouped into two sets, the first having smoother solution vectors but lower classification accuracies than the second with seemingly noisier solution vectors. Coupling thermogram technology with modern classification algorithms provides a powerful diagnostic approach for analysis of biological samples. The solution vectors from the models may reflect important information from the thermogram profiles for discriminating between clinical groups. DSC thermograms show sensitivity to changes in the bulk plasma proteome that correlate with clinical status. To move this technology towards clinical application the development of new approaches is needed to extract discriminatory parameters from DSC profiles for the comparison and diagnostic classification of patients. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders. (United States)

    Karukivi, Max; Vahlberg, Tero; Horjamo, Kalle; Nevalainen, Minna; Korkeila, Jyrki


    Current categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance. The sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder). The proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant. An elevated severity level of personality disturbance is associated with an

  9. Pulmonary sarcoidosis: An important differential diagnosis in transbronchial lung biopsies

    Directory of Open Access Journals (Sweden)

    Qury S Mahapatra


    Full Text Available Background: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Lungs and lymphatics are the principal sites affected by this disease. The disorder is often not suspected by physicians. Materials and Methods: This was a retrospective study done on 140 transbronchial lung biopsies received for histopathological examination in the Department of Pathology for 1 year in a multispeciality tertiary care hospital, in Delhi. Results: Out of 140 transbronchial lung biopsies studied, 13 cases of sarcoidosis were diagnosed histopathologically. In these patients a clinical, pathological, and radiological corelation was done. And a final diagnosis of sarcoidosis was given after excluding other granulomatous lesions. Conclusion: Transbronchial lung biopsies have become an important tool in the diagnosis of sarcoidosis in present time. Hence sarcoidosis should be considered as a differential diagnosis when dealing with granulomatous lesions in lung biopsies.

  10. Pulmonary sarcoidosis: An important differential diagnosis in transbronchial lung biopsies (United States)

    Mahapatra, Qury S.; Sahai, Kavita; Rathi, K. R.; Singh, Sarvinder; Sharma, Shruti


    Background: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Lungs and lymphatics are the principal sites affected by this disease. The disorder is often not suspected by physicians. Materials and Methods: This was a retrospective study done on 140 transbronchial lung biopsies received for histopathological examination in the Department of Pathology for 1 year in a multispeciality tertiary care hospital, in Delhi. Results: Out of 140 transbronchial lung biopsies studied, 13 cases of sarcoidosis were diagnosed histopathologically. In these patients a clinical, pathological, and radiological corelation was done. And a final diagnosis of sarcoidosis was given after excluding other granulomatous lesions. Conclusion: Transbronchial lung biopsies have become an important tool in the diagnosis of sarcoidosis in present time. Hence sarcoidosis should be considered as a differential diagnosis when dealing with granulomatous lesions in lung biopsies. PMID:24778476

  11. Diagnostic Accuracy of Cerebrospinal Fluid Amyloid-beta Isoforms for Early and Differential Dementia Diagnosis

    NARCIS (Netherlands)

    Struyfs, Hanne; Van Broeck, Bianca; Timmers, Maarten; Fransen, Erik; Sleegers, Kristel; Van Broeckhoven, Christine; De Deyn, Peter P.; Streffer, Johannes R.; Mercken, Marc; Engelborghs, Sebastiaan


    Background: Overlapping cerebrospinal fluid biomarkers (CSF) levels between Alzheimer's disease (AD) and non-AD patients decrease differential diagnostic accuracy of the AD core CSF biomarkers. Amyloid-beta (A beta) isoforms might improve the AD versus non-AD differential diagnosis. Objective: To de

  12. DatSCAN In Differential Diagnostics of Lewy Body Disease. (United States)

    Luzny, Jan; Ivanova, Katerina


    Differential diagnosis between Lewy body disease and Alzheimer´s disease might be difficult because of similarities of clinical symptoms in both neurodegenerative diseases. DatSCAN is a modern functional neuroimmaging method which differentiates between this similar diseases and helps in correct treatment strategy. We report our positive experience with DatSCAN in differentiating Lewy body disease from Alzheimer´s disease. This is a case report of a woman with Lewy body disease, initially diagnosed as Alzheimer´s disease. DatSCAN neuroimmaging method was used in differential diagnosis of dementia. Memory impairment, impaired activities of daily living, sleep and behavioral disturbances were present in our case. Donepezil was well tolerated, but haloperidol administration was followed by development of severe dystonia. DatSCAN showed deficient dopaminergic presynaptic transport in substantia nigra and striatum. This finding is typical for Lewy body disease not for Alzheimer´s disease. DatSCAN neuroimmaging is a suitable method for differentiating Lewy body disease from Alzheimer´s disease. Deficient dopaminergic presynaptic transport in substantia nigra and striatum is typical for Lewy body disease.

  13. Important hemoprotozoan diseases of livestock: Challenges in current diagnostics and therapeutics: An update (United States)

    Maharana, Biswa Ranjan; Tewari, Anup Kumar; Saravanan, Buddhi Chandrasekaran; Sudhakar, Naduvanahalli Rajanna


    Hemoprotozoan parasites pose a serious threat to the livestock population in terms of mortality, reduced milk yield and lowered draft power. Diagnosis of these diseases often poses a challenging task. Needless to say that impact of disease in health and productivity is huge though a fair economic assessment on the quantum of economic loss associated is yet to be worked out from India. The diagnosis of hemoprotozoan infections largely depends on various laboratory-based diagnostic methods as the clinical manifestations are often inconspicuous and non-specific. Traditional diagnostic methods rely on microscopical demonstration of infective stages in blood or tissue fluids. However, it is laborious, lesser sensitive, and cannot differentiate between morphologically similar organisms. Recent development in the technologies has opened new avenues for improvement in the accurate diagnosis of parasitic infections. Serological tests are simple, fast but lack specificity. With advent of molecular techniques, as DNA hybridization assays, polymerase chain reaction and its modifications ensure the detection of infection in the latent phase of the disease. Nucleic acid-based assays are highly sensitive, free from immunocompetence and can differentiate between morphologically similar parasites. With the advent of newer diagnostics complemented with traditional ones will be of huge help for targeted selective treatment with better chemotherapeutic agents. PMID:27284225

  14. Important hemoprotozoan diseases of livestock: Challenges in current diagnostics and therapeutics: An update

    Directory of Open Access Journals (Sweden)

    Biswa Ranjan Maharana


    Full Text Available Hemoprotozoan parasites pose a serious threat to the livestock population in terms of mortality, reduced milk yield and lowered draft power. Diagnosis of these diseases often poses a challenging task. Needless to say that impact of disease in health and productivity is huge though a fair economic assessment on the quantum of economic loss associated is yet to be worked out from India. The diagnosis of hemoprotozoan infections largely depends on various laboratory-based diagnostic methods as the clinical manifestations are often inconspicuous and non-specific. Traditional diagnostic methods rely on microscopical demonstration of infective stages in blood or tissue fluids. However, it is laborious, lesser sensitive, and cannot differentiate between morphologically similar organisms. Recent development in the technologies has opened new avenues for improvement in the accurate diagnosis of parasitic infections. Serological tests are simple, fast but lack specificity. With advent of molecular techniques, as DNA hybridization assays, polymerase chain reaction and its modifications ensure the detection of infection in the latent phase of the disease. Nucleic acid-based assays are highly sensitive, free from immunocompetence and can differentiate between morphologically similar parasites. With the advent of newer diagnostics complemented with traditional ones will be of huge help for targeted selective treatment with better chemotherapeutic agents.

  15. Important hemoprotozoan diseases of livestock: Challenges in current diagnostics and therapeutics: An update. (United States)

    Maharana, Biswa Ranjan; Tewari, Anup Kumar; Saravanan, Buddhi Chandrasekaran; Sudhakar, Naduvanahalli Rajanna


    Hemoprotozoan parasites pose a serious threat to the livestock population in terms of mortality, reduced milk yield and lowered draft power. Diagnosis of these diseases often poses a challenging task. Needless to say that impact of disease in health and productivity is huge though a fair economic assessment on the quantum of economic loss associated is yet to be worked out from India. The diagnosis of hemoprotozoan infections largely depends on various laboratory-based diagnostic methods as the clinical manifestations are often inconspicuous and non-specific. Traditional diagnostic methods rely on microscopical demonstration of infective stages in blood or tissue fluids. However, it is laborious, lesser sensitive, and cannot differentiate between morphologically similar organisms. Recent development in the technologies has opened new avenues for improvement in the accurate diagnosis of parasitic infections. Serological tests are simple, fast but lack specificity. With advent of molecular techniques, as DNA hybridization assays, polymerase chain reaction and its modifications ensure the detection of infection in the latent phase of the disease. Nucleic acid-based assays are highly sensitive, free from immunocompetence and can differentiate between morphologically similar parasites. With the advent of newer diagnostics complemented with traditional ones will be of huge help for targeted selective treatment with better chemotherapeutic agents.

  16. Differential diagnostics of different nosological forms of the temporomandibular joint pain dysfunction syndrome



    Research objective: to carry out differential diagnostics of various nosological forms of a temporal and temporomandibular joint pain dysfunction syndrome. Material and methods. On clinical base of orthopedic odontology chair of SamSMU inspection of 244 patients with temporomandibular joint pain dysfunction syndrome was performed. Diagnostics was carried out according to the special card of inspection which was developed on orthopedic odontology chair of SamSMU and included subjective, object...

  17. Diagnostic value of adenosine deaminase to differentiate exudates and transudates. (United States)

    Jadhav, Ashish Anantrao; Bardapurkar, Jayashree Suhas


    The differentiation of pleural effusions as exudates or transudates is the first step in the diagnosis of pleural effusions. The aim of this study was to evaluate the value of adenosine deaminase (ADA) concentration in the pleural effusions for differentiating exudates from transudates. Sixty indoor patients, admitted to our hospital, having pleural effusions and suffering from varying etiologies were included in this study. According to the final diagnosis, these 60 patients were divided into two groups: exudates (50) and transudates (10). The mean pleural ADA, serum ADA and pleural fluid/serum ADA ratio were significantly (P exudates as compared to transudates. Using a cut-off point of 22 IU/L, the sensitivity and specificity of pleural ADA in the diagnosis of exudates was computed to be 90% and 90% respectively. At a cut-off point 1.28, pleural fluid/serum ADA ratio was found to have sensitivity 84% and specificity 90%, respectively. From this study it is concluded that, ADA is a useful biochemical marker to suggest exudative effusions.

  18. [Systematic teaching of differential diagnostics and information retrieval in medical education--a controlled study]. (United States)

    Renko, Marjo; Soini, Hannu; Rantala, Heikki; Tapiainen, Terhi; Pokka, Tytti; Uhari, Matti


    Teaching of differential diagnostic skills in medical education is often nonsystematic and touched only in a disease-based manner in the context of patient cases. We conducted a controlled study, in which a portion of fifth year students received systematic teaching of differential diagnostics and information retrieval for a period of ten weeks, whereas another portion continued in conventional basic training. We tested the students' problem-solving skills in both groups with a computer-assisted test. Students in the intervention group were more successful in the test and settled on the correct diagnosis more often than students in the control group.

  19. AIDS-associated plasmablastic lymphoma presenting as a poorly differentiated esophageal tumor: A diagnostic dilemma

    Institute of Scientific and Technical Information of China (English)


    Plasmablastic lymphoma (PBL) is a rare form of diffuse large B-cell lymphoma characterized by weak/absent expression of conventional B-cell markers and strong expression of plasma cell markers. It is strongly associated with human immunodeficiency virus (HIV) and Epstein Barr virus infection, and shows an unusual tropism to the oral cavity. Herein we describe a patient with AIDS who presented with weight loss and dysphagia owing to a large gastroesophageal mass. His radiographic and endoscopic findings and long history of cigarette consumption suggested carcinoma. Biopsy demonstrated a poorly differentiated tumor stained negatively to routine lymphoid markers including CD20. However, gene rearrangement studies confirmed a B-cell process and a more detailed immunohistochemical analysis revealed the cells stained positively for CD138 (plasma cell antigen). These findings were diagnostic of PBL. Our report reviews the wide differential diagnosis of PBL and underscores the importance of a broad array of viral and molecular studies needed to establish this diagnosis.

  20. Bearing diagnostics: A method based on differential geometry (United States)

    Tian, Ye; Wang, Zili; Lu, Chen; Wang, Zhipeng


    The structures around bearings are complex, and the working environment is variable. These conditions cause the collected vibration signals to become nonlinear, non-stationary, and chaotic characteristics that make noise reduction, feature extraction, fault diagnosis, and health assessment significantly challenging. Thus, a set of differential geometry-based methods with superiorities in nonlinear analysis is presented in this study. For noise reduction, the Local Projection method is modified by both selecting the neighborhood radius based on empirical mode decomposition and determining noise subspace constrained by neighborhood distribution information. For feature extraction, Hessian locally linear embedding is introduced to acquire manifold features from the manifold topological structures, and singular values of eigenmatrices as well as several specific frequency amplitudes in spectrograms are extracted subsequently to reduce the complexity of the manifold features. For fault diagnosis, information geometry-based support vector machine is applied to classify the fault states. For health assessment, the manifold distance is employed to represent the health information; the Gaussian mixture model is utilized to calculate the confidence values, which directly reflect the health status. Case studies on Lorenz signals and vibration datasets of bearings demonstrate the effectiveness of the proposed methods.

  1. The Differential Diagnostic Values of Cytokine Levels in Pleural Effusions (United States)

    Akarsu, Saadet; Kurt, A. Nese Citak; Dogan, Yasar; Yilmaz, Erdal; Godekmerdan, Ahmet; Aygun, A. Denizmen


    The aim is to examine whether the changes in pleural fluid interleukin (IL)-1β, IL-2, IL-6, and IL-8 levels were significant in differential diagnosis of childhood pleural effusions. IL-1β, IL-2, IL-6, and IL-8 levels in pleural fluids of all 36 patients were measured. The levels of IL-1β, IL-2, IL-6, and IL-8 in pleural fluids were statistically significantly higher in the transudate group compared with those of the exudate group. The levels of IL-1β, IL-6, and IL-8 were also found to be statistically significantly higher in the empyema group compared with both the parapneumonic and the tuberculous pleural effusion groups. The levels of IL-2 and IL-6 were detected to be statistically significantly higher in the tuberculous pleural effusion group in comparison with those of the parapneumonic effusion group. The results showed that pleural fluids IL-1β, IL-2, IL-6, and IL-8 could be used in pleural fluids exudate and transudate distinction. PMID:15770060

  2. [Adrenal tumors: principles of imaging and differential diagnostics]. (United States)

    Degenhart, C


    Adrenal masses are very common and are usually detected incidentally. Less frequently, imaging is performed for the localization of the underlying lesion in the case of endocrine disease. The differentiation between adenomas and non-adenomas is fundamental. Adenomas show a low density on unenhanced computed tomography (CT) and a rapid washout of contrast agents. In magnetic resonance imaging (MRI) adenomas are characterized by a low signal in opposed phase imaging as compared to in phase imaging. According to the literature a density of less than 10 HU in an adrenal mass has a specificity of 98% and a sensitivity of 71% for the presence of an adenoma and MRI is slightly more sensitive. Some adrenal lesions, e.g. cysts or myelolipomas can be diagnosed with high accuracy due to pathognomonic findings. In the majority of cases the synopsis of imaging along with clinical and laboratory findings is necessary for a reliable diagnosis. For the evaluation of an adrenal mass the CT examination should begin with an unenhanced scan, if necessary followed by a washout examination. In the case of MRI in phase and opposed phase imaging are essential components of the examination.

  3. Equilibrium disorders in elderly: diagnostic classification and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Alessandro Castiglione


    Full Text Available Background: Balance is primarily related to the proper functioning of three sensory input: vestibular, visual and proprioceptive. The integration of these different afferences contributes to the proper attitude of the body in static and dynamic conditions. Equilibrium disorders are common among elderly patients and are responsible for falls and fractures, leading sometimes to catastrophic outcomes, representing a serious health and social problem. Approximately one third of elderly patients at home and about 50% of institutionalized, over 75 year-old, suffer from this particular condition, with at least one fall a year and almost 50% of these with recurrent episodes. Females are more affected than males. Attempts to ascertain the underlying cause of unbalance should be done, leading then to specific treatment. Nevertheless, many elderly patients do not have a single disease but rather a multitude of medical conditions which may cause dizziness, imbalance and vertigo: effects of ageing, drugs, cardiovascular and neurological disorders, ocular and orthopaedic diseases. Aim of the study: A literature review was carried out with the intention to offer practical and useful notions for the management and treatment of equilibrium disorders. Discussion: In clinical practice, the main challenge is to distinguish between peripheral and central imbalance disorders. The data collected from history and clinical exams should be integrated with the intent to include the patient in one of the following clinical conditions: vertiginous syndrome, pre-syncope and/or syncope, neurological diseases, other conditions.Conclusions: Following the differential diagnosis, treatment mainly consists in drug administration (antiemetic and vestibular suppressor drugs and vestibular rehabilitation (physiotherapy and vestibular exercises.

  4. [Vocal cord dysfunction. An important differential diagnosis to bronchial asthma]. (United States)

    Kothe, C; Schade, G; Fleischer, S; Hess, M


    Vocal cord dysfunction (VCD) is described as a functional disorder of the vocal folds which leads to an intermittent, inspiratory 'paradoxical' glottal closure. We report on three women with frequent repetitive shortness of breath attacks caused by VCD. This was diagnosed by transnasal videofiberendoscopy, with glottal closure being seen during inspiration. Because of the different etiologies, one of the patients was treated with breathing and speech therapy, another received Omeprazol for laryngopharyngeal reflux, and the third was treated by intralaryngeal botulinum toxin injections. All three patients showed a reduction in attacks. Clinically, VCD seems to mimic asthma. However, with a thorough patient history and diagnostics, especially with transnasal laryngoscopy during a (triggered) attack, a precise diagnosis seems possible.

  5. Importance of differentiating Mycobaterium bovis in tuberculous meningitis

    Directory of Open Access Journals (Sweden)

    Alejandra Gonzàlez-Duarte


    Full Text Available The aim of the article is to describe the principal findings among patients with M.tuberculosis and M. bovis CNS infection. Mycoba - cterium tuberculosis is one of the most common infectious agents that cause death and neurological sequelae around the world. Most of the complications of CNS TB can be attributed to a delay in the diagnosis. Unfortu nately, there are no specific diagnostic tools to support an early diagnosis. Other prognostic factors different from delay in treatment have not been identified. Clinical, radiological and laboratory characteristics were analyzed retrospectively from the medical files of all the patients admitted with the diagnoses of tuberculosis. Of 215 patients admitted with systemic tuberculosis, 64 (30% had a neurological infection. Positive cultures were found in 54 (84% cases, 18 (33% in the CSF and the rest in other fluids or tissues. Adenosin deaminase (ADA enzyme determination was more sensitive than M. tuberculosis PCR in the CSF for supporting an early diagnosis. In addition to a later clinical stage and treatment lag, positive CSF cultures (P=0.001 and the presence of M. bovis (P=0.020 were prognostic factors for a worse outcome. Neither older age, the presence of tuberculomas versus meningeal enhancement, or HIV co-infection, was associated to a worse prognosis. The isolation of M. bovis subspecies was more common that previously reported, and it was associated to the development of parenchymal lesions (P=0.032 when compared to M. tuberculosis. In this study, positive CSF cultures for M. tuberculosis and further identifying M. bovis species were additional prognostic factors for worse outcome. Positive cultures in systemic fluids other than CSF, even when the patient had no obvious systemic manifestations, and ADA determination in the CSF were noteworthy diagnostic tools for the diagnosis.

  6. Introducing new diagnostics into STI control programmes: the importance of programme science. (United States)

    Peeling, Rosanna W; Mabey, David; Ballard, Ronald C


    Many innovative diagnostic technologies will become commercially available over the next 5-10 years. These tests can potentially transform the diagnosis of sexually transmitted infections but their introduction into control programmes can be hampered by health system constraints, and political, cultural, socioeconomic and behavioural factors. We used the introduction of syphilis rapid tests to illustrate the importance of programme science to address the gap between accruing evidence of acceptable test performance and the complexity of programme design, implementation and evaluation of test deployment to address public health needs and improve patient-important outcomes.

  7. The diagnostic performance of perfusion MRI for differentiating glioma recurrence from pseudoprogression (United States)

    Wan, Bing; Wang, Siqi; Tu, Mengqi; Wu, Bo; Han, Ping; Xu, Haibo


    Abstract Background: The purpose of this meta-analysis was to evaluate the diagnostic accuracy of perfusion magnetic resonance imaging (MRI) as a method for differentiating glioma recurrence from pseudoprogression. Methods: The PubMed, Embase, Cochrane Library, and Chinese Biomedical databases were searched comprehensively for relevant studies up to August 3, 2016 according to specific inclusion and exclusion criteria. The quality of the included studies was assessed according to the quality assessment of diagnostic accuracy studies (QUADAS-2). After performing heterogeneity and threshold effect tests, pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated. Publication bias was evaluated visually by a funnel plot and quantitatively using Deek funnel plot asymmetry test. The area under the summary receiver operating characteristic curve was calculated to demonstrate the diagnostic performance of perfusion MRI. Results: Eleven studies covering 416 patients and 418 lesions were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.88 (95% confidence interval [CI] 0.84–0.92), 0.77 (95% CI 0.69–0.84), 3.93 (95% CI 2.83–5.46), 0.16 (95% CI 0.11–0.22), and 27.17 (95% CI 14.96–49.35), respectively. The area under the summary receiver operating characteristic curve was 0.8899. There was no notable publication bias. Sensitivity analysis showed that the meta-analysis results were stable and credible. Conclusion: While perfusion MRI is not the ideal diagnostic method for differentiating glioma recurrence from pseudoprogression, it could improve diagnostic accuracy. Therefore, further research on combining perfusion MRI with other imaging modalities is warranted. PMID:28296759

  8. Pseudoactinomycotic Radiate Granules (PAMRAGs)- An Unusual Differential Diagnosis for Ovarian Neoplasm; A Diagnostic Dilemma. (United States)

    P J, Cicy; P J, Tessy; P, Lekshmidevi; V, Letha; Poothiode, Usha


    Pseudoactinomycotic radiate granules (PAMRAGs) are rarely detected lesions in ovary. Endometrium is the usual site and a detailed search of literature yielded only two cases in the ovary. PAMRAGs must be differentiated from actinomycotic granules which are also strongly associated with the use of intrauterine contraceptive devices (IUCDs). In cases of suppurative oophoritis due to actinomycosis, a proper diagnosis and culture confirmation is mandatory to avoid further complications. This case is reported due to its rarity, unusual clinical presentation and to highlight the importance of special stains in cases of tuboovarian abscess, where PAMRAGs may cause diagnostic dilemma. Our patient was a 50 yr old female admitted with clinical diagnosis of malignant ovarian tumour. After preoperative work up, panhysterectomy, infracolic omentectomy and excision biopsy of the right inguinal lymph node were done. Peroperatively the right ovary was enlarged and adherent to the fallopian tube and pelvic wall. Gross examination revealed a right tuboovarian mass with yellowish areas of necrosis and fibrosis. Histology showed a suppurative granulomatous lesion with spherical granules having club like peripheral projections. A panel of special stains (GMS, GRAMs and AFB) done were negative. Thus, we ruled out actinomycosis and gave a diagnosis of PAMRAG.

  9. Meckel-Gruber syndrome: pathologic manifestations, minimal diagnostic criteria, and differential diagnosis. (United States)

    Alexiev, Borislav A; Lin, Xiaoqing; Sun, Chen-Chih; Brenner, David S


    This article provides an overview of the major pathologic manifestations of Meckel-Gruber syndrome, current knowledge about its pathogenesis, minimal diagnostic criteria, and differential diagnosis. Typical sonographic findings (occipital encephalocele, postaxial polydactyly, and cystic enlargement of the kidneys) allow for diagnosis of most cases before the 14th week of gestation, but the pathologist may encounter clinically unsuspected or atypical cases that require morphologic confirmation. In these cases, a meticulous autopsy is necessary to establish the diagnosis of Meckel-Gruber syndrome.

  10. Mycosis fungoides: an important differential diagnosis for acquired palmoplantar keratoderma. (United States)

    Kim, Janet; Foster, Rachael; Lam, Minh; Kumarasinghe, Sujith Prasad


    Mycosis fungoides is the most common subtype of primary cutaneous lymphoma and has several clinical variants. We report a 74-year-old man presenting with an acquired palmoplantar keratoderma initially diagnosed and treated as psoriasis with suboptimal improvement. Several months later the patient developed patches and plaques that were histologically consistent with mycosis fungoides. These lesions were ameliorated with the treatment of the underlying mycosis fungoides and the palmoplantar keratoderma resolved promptly with radiotherapy. This case highlights the importance of considering mycosis fungoides as an infrequent but serious cause of acquired palmoplantar keratoderma.

  11. Gilbert’s syndrome: clinical features, diagnostics, differential diagnosis and treatment (part 2

    Directory of Open Access Journals (Sweden)

    T.V. Sorokman


    discoloration of the skin (“teinte bilieuse”, especially on the face, hands, and feet without a distinct scleral icterus. Sometimes the development of repeatedly intermittent episodes of jaundice with high bilirubinemia (indirect bilirubin without the evidence of hemolysis (differential diagnostic feature is observed. 2. A tendency to development of pigmented and vascular nevi and xanthelasma of the eyelids, and hyperpigmentation around the eyes; to bradycardia, hypothermia, migraine, postural, intermittent albuminuria or to alimentary glycosuria. 3. An increased tendency to pigmentation under the influence of light, heat, and also chemical and mechanical stimuli. 4. A neuromuscular hyperexcitability. 5. Increased sensitivity to cold. 6. Dyspeptic complaints (pain, nausea, abdominal bloa­ting, diarrhea or constipation. 7. No signs of increased hemolysis (differential diagnostic feature with increasing content in, bilirubin (differential diagnostic feature. 8. The majority of patients have normal liver function tests (differential diagnostic feature also normal bromsulphalein test is also normal (differential diagnostic feature. 9. The biochemical abnormality is not detected by histological methods (differential diagnostic feature .10. Frequently, a family disease of the liver is observed. The differential diagnosis of GS is conducted with all types of hyperbilirubinemias, hemolytic anemias, congenital hepatic cirrhosis, hepatitis, cholecystopathy, atresia of biliary ducts or the small intestine. Medications are used only in severe hyperbilirubinemias and as concomitant therapy in the presence of symptoms of vitamin deficiencies, violations of a motor-evacuation function of the upper digestive tract in the clinical picture and to prevent complications (cholelithiasis.

  12. Multiple sclerosis: imaging, diagnostic criteria and differential diagnosis; Bildgebung, Diagnosekriterien und Differenzialdiagnose der Multiplen Sklerose

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    Harting, I.; Sartor, K. [Abt. Neuroradiologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany); Sellner, J.; Meyding-Lamade, U. [Abt. Neurologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany)


    Multiple sclerosis (MS) is the most common demyelinating inflammatory disease of the central nervous system (CNS), presenting with multifocal, disseminated inflammatory lesions referred to as plaques. Magnetic resonance imaging (MRI) typically depicts multiple, round to oval, circumscript lesions predominantly involving periventricular and subcortical white matter, brainstem and cerebellum. More recent investigations have demonstrated that the macroscopically visible plaques only present the tip of the iceberg: Already early in its course, MS causes neuroaxonal damage and diffusely involves the entire brain parenchyma including normal appearing white matter. These changes are reflected by strongly T{sub 1}w hypointense lesions and atrophy of early onset, by reduction of the neuronal Marker N-acetylaspartate (NAA) on spectroscopy, by a decrease of the magnetization transfer ratio (MTR), by an increased in diffusibility and decreased anisotropy on diffusion-weighted imaging (DWI). MRI imaging is an important tool in the diagnosis of MS by revealing the characteristic spatial and temporal dissemination of the cerebral and spinal manifestations of this disease. Diagnostic criteria increase the diagnostic specificity and allow better differentiation from other diseases with multifocal white matter abnormalities. (orig.) [German] Die multiple sklerose (MS) ist die haeufigste entzuendliche, demyelinisierende Erkrankung des zentralen Nervensystems (ZNS) Sie ist durch multifokale, disseminierte Entzuendungsherde, sogenannte Plaques, in den myelinhaltigen Strukturen des ZNS charakterisiert. In der Magnetresonanztomographie (MRT) sind multiple umschriebene, rundlich-ovale Laesionen der weissen Substanz charakteristisch, die bevorzugt im periventrikulaeren Marklager, an der Mark-Rindengrenze, im Hirnstamm und im Kleinhirn lokalisiert sind. Neuere Untersuchungen zeigen, dass die sichtbaren Entmarkungsherde nur die Spitze des Eisbergs sind: Bereits fruehzeitig verursacht die MS

  13. Diagnostic ability of differential diagnosis in ameloblastoma and odontogenic keratocyst by imaging modalities and observers

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    Gang, Tae In; Huh, Kyung Hoe; Yi, Won Jin; Heo, Min Suk; Lee, Sam Sun; Kim, Jeong Hwa; Moon, Je Woon; Choi, Soon Chul [Seoul National Univ. School of Dentistry, Seoul (Korea, Republic of)


    To evaluate the diagnostic ability in differentiating between ameloblastoma and odontogenic keratocyst according to the imaging modalities and observes. We evaluated thirty-six cases of ameloblastomas and forty-seven cases of odontogenic keratocysts all histologically confirmed. Six oral and maxillofacial radiologists diagnosed the lesions by 3 methods: using panoramic radiograph, using computed tomograph (CT), and using panoramic radiograph and CT. The observers were classified by 3 groups: group 1 had experienced over 10 years in oral and mazilofacial radiologic field, group 2 had experienced for 3-4 years, and group 3 was in the process of residentship. After over 2 weeks, the observers diagnosed them by the same methods. The ROC curve areas except for group 3 were the highest with interpretation using panoramic radiograph and CT, followed by interpretation using CT only, and the lowest with interpretation using panoramic radiograph only. The overall difference was not found in diagnostic ability among groups in using panoramic radiograph only, but there was difference in diagnostic ability of group 1 and 2 vs 3 in using CT only, and combination panoramic radiograph and CT. To differentiate between ameloblastoma and odontogenic keratocyst more accurately, the experienced oral and maxillofacial radiologist should diagnose with combination of panoramic radiograph and CT.

  14. Differential diagnostics of different nosological forms of the temporomandibular joint pain dysfunction syndrome

    Directory of Open Access Journals (Sweden)

    Kameneva L.A.


    Full Text Available Research objective: to carry out differential diagnostics of various nosological forms of a temporal and temporomandibular joint pain dysfunction syndrome. Material and methods. On clinical base of orthopedic odontology chair of SamSMU inspection of 244 patients with temporomandibular joint pain dysfunction syndrome was performed. Diagnostics was carried out according to the special card of inspection which was developed on orthopedic odontology chair of SamSMU and included subjective, objective and special methods of research. As a result of research it is taped: 71 — an occlusal-articulation dysfunctional syndrome, 44 — a neuromuscular dysfunctional syndrome, 76 patients have a hardly set dislocation of intra joint disk and 53 — a habitual dislocation and a subluxation of a temporomandibular joint. We used Yu.A. Petrosov's classification as it displays most precisely the processes happening at pathology of the intra joint relations. Conclusion: On the basis of the obtained data the table of differential diagnostics of various nosological forms of temporomandibular joint pain dysfunction syndrome has been made.

  15. Differential Diagnostics of Pain in the Course of Trigeminal Neuralgia and Temporomandibular Joint Dysfunction (United States)

    Pihut, M.; Szuta, M.; Ferendiuk, E.; Zeńczak-Więckiewicz, D.


    Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest. PMID:24995309

  16. Differential Diagnostics of Pain in the Course of Trigeminal Neuralgia and Temporomandibular Joint Dysfunction

    Directory of Open Access Journals (Sweden)

    M. Pihut


    Full Text Available Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.

  17. Differential diagnostics of pain in the course of trigeminal neuralgia and temporomandibular joint dysfunction. (United States)

    Pihut, M; Szuta, M; Ferendiuk, E; Zeńczak-Więckiewicz, D


    Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.

  18. Differential Item Functioning Assessment in Cognitive Diagnostic Modeling: Application of the Wald Test to Investigate DIF in the DINA Model (United States)

    Hou, Likun; de la Torre, Jimmy; Nandakumar, Ratna


    Analyzing examinees' responses using cognitive diagnostic models (CDMs) has the advantage of providing diagnostic information. To ensure the validity of the results from these models, differential item functioning (DIF) in CDMs needs to be investigated. In this article, the Wald test is proposed to examine DIF in the context of CDMs. This study…

  19. Outcome in patients with differentiated thyroid cancer with negative diagnostic whole-body scanning and detectable stimulated thyroglobulin

    NARCIS (Netherlands)

    van Tol, KM; Jager, PL; de Vries, EGE; Piers, DA; Boezen, HM; Sluiter, WJ; Dullaart, RPF; Links, TP


    Background: Management of patients with differentiated thyroid carcinoma with negative diagnostic radioiodide scanning and increased serum thyroglobulin (Tg) concentrations is a widely debated problem. High-dose iodine-131 treatment of patients who have a negative I-131 diagnostic whole-body scan (W

  20. Diagnostic of the temperature and differential emission measure (DEM based on Hinode/XRT data

    Directory of Open Access Journals (Sweden)

    P. Rudawy


    Full Text Available We discuss here various methodologies and an optimal strategy of the temperature and emission measure diagnostics based on Hinode X-Ray Telescope data. As an example of our results we present the determination of the temperature distribution of the X-rays emitting plasma using a filters ratio method and three various methods of the calculation of the differential emission measure (DEM. We have found that all these methods give results similar to the two filters ratio method. Additionally, all methods of the DEM calculation gave similar solutions. We can state that the majority of the pairs of the Hinode filters allows one to derive the temperature and emission measure in the isothermal plasma approximation using standard diagnostics based on the two filters ratio method. In cases of strong flares one can also expect good conformity of the results obtained using a Withbroe – Sylwester, genetic algorithm and least-squares methods of the DEM evaluation.

  1. Usefulness of acoustic studies on the differential diagnostics of organic and functional dysphonia. (United States)

    Pruszewicz, A; Obrebowski, A; Swidziński, P; Demeńko, G; Wika, T; Wojciechowska, A


    Phoniatric and acoustic examinations were carried out in a group of 30 patients with dysphonia, including 15 with organic type and 15 with functional type. A complex phoniatric assessment offered the possibility to differentiate between these two groups of pathological voices. This was achieved also on the basis of acoustic analysis of the voice by extracting characteristics such as: formant frequency, Fo and its range, percentage of noise in the analysed verbal text, mean and maximum values of jitter. The possibility of differential diagnosis of these two different types of dysphonia in acoustic studies was confirmed by clinical examinations. The acoustic studies presented can be regarded as a new approach to a fast and sufficiently precise method in the screening diagnostics of dysphonia conditioned by growth of the vocal fold mass.

  2. Are complement deficiencies really rare? Overview on prevalence, clinical importance and modern diagnostic approach. (United States)

    Grumach, Anete Sevciovic; Kirschfink, Michael


    Complement deficiencies comprise between 1 and 10% of all primary immunodeficiencies (PIDs) according to national and supranational registries. They are still considered rare and even of less clinical importance. This not only reflects (as in all PIDs) a great lack of awareness among clinicians and general practitioners but is also due to the fact that only few centers worldwide provide a comprehensive laboratory complement analysis. To enable early identification, our aim is to present warning signs for complement deficiencies and recommendations for diagnostic approach. The genetic deficiency of any early component of the classical pathway (C1q, C1r/s, C2, C4) is often associated with autoimmune diseases whereas individuals, deficient of properdin or of the terminal pathway components (C5 to C9), are highly susceptible to meningococcal disease. Deficiency of C1 Inhibitor (hereditary angioedema, HAE) results in episodic angioedema, which in a considerable number of patients with identical symptoms also occurs in factor XII mutations. New clinical entities are now reported indicating disease association with partial complement defects or even certain polymorphisms (factor H, MBL, MASPs). Mutations affecting the regulators factor H, factor I, or CD46 and of C3 and factor B leading to severe dysregulation of the alternative pathway have been associated with renal disorders, such as atypical hemolytic uremic syndrome (aHUS) and - less frequent - with membranoproliferative glomerulonephritis (MPGN). We suggest a multi-stage diagnostic protocol starting based on the recognition of so called warning signs which should aid pediatricians and adult physicians in a timely identification followed by a step-wise complement analysis to characterize the defect at functional, protein and molecular level.

  3. Diagnostic value of serum procalcitonin level in differentiating bacterial from nonbacterial meningitis in children. (United States)

    Umran, Raid M R; Radhi, Nabeel Hashim


    Acute bacterial meningitis in pediatrics remains a serious and potentially lethal disease. Its prognosis is critically dependent on rapid diagnosis and treatment. The use of biological markers, like procalcitonin, has been proposed to facilitate the accuracy of the initial diagnosis of bacterial meningitis. The aim of this study was assessment the diagnostic values of serum procalcitonin (PCT) assay in the diagnosis and differentiation of acute bacterial from non bacterial meningitis. 45 patients with suspicion of meningitis were enrolled in the study and were clinically evaluated and investigated by lumbar punctures for cerebrospinal fluid analysis, C-reactive protein and differential leukocyte count. Patients with clinical and laboratory suggestion of bacterial causes were regarded as bacterial meningitis group (29 patients), and those who were suggestive of nonbacterial causes were regarded as nonbacterial group (16 patients). Serum procalcitonin levels were significantly higher in bacterial meningitis group (637±325 pg/ml) compared with non-bacterial meningitis (380±170 pg/ml); Pdiagnosis of bacterial meningitis. Elevated serum procalcitonin level could be a predictor of bacterial causes of meningitis and is more sensitive and specific than other diagnostic predictors.

  4. A preface on advances in diagnostics for infectious and parasitic diseases: detecting parasites of medical and veterinary importance. (United States)

    Stothard, J Russell; Adams, Emily


    There are many reasons why detection of parasites of medical and veterinary importance is vital and where novel diagnostic and surveillance tools are required. From a medical perspective alone, these originate from a desire for better clinical management and rational use of medications. Diagnosis can be at the individual-level, at close to patient settings in testing a clinical suspicion or at the community-level, perhaps in front of a computer screen, in classification of endemic areas and devising appropriate control interventions. Thus diagnostics for parasitic diseases has a broad remit as parasites are not only tied with their definitive hosts but also in some cases with their vectors/intermediate hosts. Application of current diagnostic tools and decision algorithms in sustaining control programmes, or in elimination settings, can be problematic and even ill-fitting. For example in resource-limited settings, are current diagnostic tools sufficiently robust for operational use at scale or are they confounded by on-the-ground realities; are the diagnostic algorithms underlying public health interventions always understood and well-received within communities which are targeted for control? Within this Special Issue (SI) covering a variety of diseases and diagnostic settings some answers are forthcoming. An important theme, however, throughout the SI is to acknowledge that cross-talk and continuous feedback between development and application of diagnostic tests is crucial if they are to be used effectively and appropriately.

  5. Diagnostic importance of zinc in the clarification of pleural effusions etiology

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    Ranković Boško


    Full Text Available Concentration of zinc in blood serum and effusion was determined in 104 patients with the pleural effusion of different etiology. The importance of zinc concentration in serum and effusion was analyzed, as well as their relation regarding the differential diagnosis of pleural effusion. It was established that the isolated zinc concentrations in serum and pleural effusion could not be used separately either in differing transudates from exudates or in the diagnosis of the pleural diseases. The average value of zinc in the pleural effusion in relation to the serum value in patients with tuberculosis effusion was 1.37, higher than 1 in all patients and was significantly different from the average value of the ratio 0,74 in patients with nonspecific and malignant pleural effusions. The relation of zinc concentration in the effusion and serum higher than 1.0 reliably indicated the presence of tuberculous pleurisy.

  6. Demand Estimation for US Apple Juice Imports: A Restricted Source Differentiated AIDS Model


    Mekonnen, Dawit Kelemework; Fonsah, Esendugue Greg


    Although this paper focuses on apple juice, a restricted version of source differentiated Almost Ideal Demand System (RSDAIDS) was used to examine U.S. import demand for fresh apple, apple juice and other processed apple. Apple imports were differentiated by type and source of origin and the RSDAIDS model was estimated after imposing the general demand restrictions of adding-up, homogeneity and slutsky symmetry. Seasonality and trend variables were also included on the model. The estimation r...

  7. Assessing competition in hospital care markets: the importance of accounting for quality differentiation. (United States)

    Tay, Abigail


    Quality differentiation is especially important in the hospital industry, where the choices of Medicare patients are unaffected by prices. Unlike previous studies that use geographic market concentration to estimate hospital competitiveness, this article emphasizes the importance of quality differentiation in this spatially differentiated market. I estimate a random-coefficients discrete-choice model that predicts patient flow to different hospitals and find that demand responses to both distance and quality are substantial. The estimates suggest that patients do not substitute toward alternative hospitals in proportion to current market shares, implying that geographic market concentration is an inappropriate measure of hospital competitiveness.

  8. Xanthogranulomatous cholecystitis: Diagnostic performance of CT to differentiate from gallbladder cancer

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    Goshima, Satoshi, E-mail: [Department of Radiology, University of Pittsburgh Medical Center, Lothrop St., Pittsburgh, PA 15213 (United States); Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194 (Japan); Chang, Samuel; Wang, Jin Hong [Department of Radiology, University of Pittsburgh School of Medicine, 3362 Fifth Ave., Pittsburgh, PA15213 (United States); Kanematsu, Masayuki [Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194 (Japan); Department of Radiology Services, Gifu University School of Medicine, 1-1- Yanagido, Gifu 501-1194 (Japan); Bae, Kyongtae T. [Department of Radiology, University of Pittsburgh School of Medicine, 3362 Fifth Ave., Pittsburgh, PA15213 (United States); Federle, Michael P. [Department of Radiology, University of Pittsburgh Medical Center, Lothrop St., Pittsburgh, PA 15213 (United States); Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5105 (United States)


    Purpose: To retrospectively evaluate CT findings of xanthogranulomatous cholecystitis (XGC) and to measure diagnostic performance for distinguishing it from gallbladder (GB) cancer. Methods and materials: Our institutional review board approved this retrospective study. Three blinded radiologists, first independently and then in consensus, retrospectively evaluated postcontrast CT images of 35 patients with histopathologically proved XGC and GB cancer, all of whom subsequently had cholecystectomy. These included 18 patients with XGC (13 male, 5 female; age range, 35-84, mean 63 years) and 17 with GB cancer (6 male, 11 female; age range, 45-95, mean 69). Differences in CT findings between XGC and GB cancer and diagnostic performances for each CT finding were calculated. Sensitivity, specificity, and accuracy were calculated for each radiologist and observer performance was also determined by receiver-operating-characteristic curve analysis. Results: Five CT findings showed significant differences between XGC and GB cancer. Sensitivity, specificity, and accuracy of each finding for the differentiation of XGC were 89%, 65%, 77% with diffuse GB wall thickening, 67%, 82%, 74% with a continuous mucosal line, 61%, 71%, 66% with intra-mural hypo-attenuated nodules, 72%, 77%, 74% with absence of macroscopic hepatic invasion, and 67%, 71%, 69% with absence of intra-hepatic bile duct dilatation, respectively. When at least three of these five CT findings were observed in combination, sensitivity, specificity, and accuracy were 83%, 100% and 91%, respectively. Sensitivities, specificities and Az values for the differentiation of XGC from GB cancer were 83%, 88%, 0.94 for reader 1, 78%, 88%, 0.93 for reader 2, and 78%, 82%, 0.84 for reader 3. Conclusions: The combination of three of the five CT findings that are common with XGC can provide excellent accuracy for the differentiation of XGC and GB cancer.

  9. The importance of transmission electron microscopy analysis of spermatozoa: Diagnostic applications and basic research. (United States)

    Moretti, Elena; Sutera, Gaetano; Collodel, Giulia


    This review is aimed at discussing the role of ultrastructural studies on human spermatozoa and evaluating transmission electron microscopy as a diagnostic tool that can complete andrology protocols. It is clear that morphological sperm defects may explain decreased fertilizing potential and acquire particular value in the field of male infertility. Electron microscopy is the best method to identify systematic or monomorphic and non-systematic or polymorphic sperm defects. The systematic defects are characterized by a particular anomaly that affects the vast majority of spermatozoa in a semen sample, whereas a heterogeneous combination of head and tail defects found in variable percentages are typically non-systematic or polymorphic sperm defects. A correct diagnosis of these specific sperm alterations is important for choosing the male infertility's therapy and for deciding to turn to assisted reproduction techniques. Transmission electron microscopy (TEM) also represents a valuable method to explore the in vitro effects of different compounds (for example drugs with potential spermicidal activity) on the morphology of human spermatozoa. Finally, TEM used in combination with immunohistochemical techniques, integrates structural and functional aspects that provide a wide horizon in the understanding of sperm physiology and pathology. transmission electron microscopy: TEM; World Health Organization: WHO; light microscopy: LM; motile sperm organelle morphology examination: MSOME; intracytoplasmic morphologically selected sperm injection: IMSI; intracytoplasmic sperm injection: ICSI; dysplasia of fibrous sheath: DFS; primary ciliary dyskinesia: PCD; outer dense fibers: ODF; assisted reproduction technologies: ART; scanning electron microscopy: SEM; polyvinylpirrolidone: PVP; tert-butylhydroperoxide: TBHP.

  10. Diagnostic Methods of Helicobacter pylori Infection for Epidemiological Studies: Critical Importance of Indirect Test Validation

    Directory of Open Access Journals (Sweden)

    Muhammad Miftahussurur


    Full Text Available Among the methods developed to detect H. pylori infection, determining the gold standard remains debatable, especially for epidemiological studies. Due to the decreasing sensitivity of direct diagnostic tests (histopathology and/or immunohistochemistry [IHC], rapid urease test [RUT], and culture, several indirect tests, including antibody-based tests (serology and urine test, urea breath test (UBT, and stool antigen test (SAT have been developed to diagnose H. pylori infection. Among the indirect tests, UBT and SAT became the best methods to determine active infection. While antibody-based tests, especially serology, are widely available and relatively sensitive, their specificity is low. Guidelines indicated that no single test can be considered as the gold standard for the diagnosis of H. pylori infection and that one should consider the method’s advantages and disadvantages. Based on four epidemiological studies, culture and RUT present a sensitivity of 74.2–90.8% and 83.3–86.9% and a specificity of 97.7–98.8% and 95.1–97.2%, respectively, when using IHC as a gold standard. The sensitivity of serology is quite high, but that of the urine test was lower compared with that of the other methods. Thus, indirect test validation is important although some commercial kits propose universal cut-off values.

  11. Diagnostic utility of epithelial and melanocitic markers with double sequential immunohistochemical staining in differentiating melanoma in situ from invasive melanoma. (United States)

    Parra-Medina, Rafael; Morales, Samuel David


    Identification of melanoma in situ and its distinction from invasive melanoma is important because of its significant impact on morbidity and mortality. However, this interpretation can cause pitfalls in the diagnosis even with the use of immunohistochemistry. The aim of this study is to evaluate the diagnostic utility of epithelial makers (AE1/AE3, CK5/6, and p63) combined with melanocytic markers (HMB-45, S-100, or Melan-A) using dual-color immunohistochemical staining, performed on a single slide by sequentially applying the antibodies. In this study, we show 4 cases in which examination of routine hematoxylin and eosin slides did not allow for clear-cut distinction between in situ and invasive melanoma and highlight the utility of the double-staining method. Therefore, we recommend this double-staining method with melanocytic and epithelial markers as a helpful adjunct to the diagnosis of cases with a differential diagnosis between in situ and invasive melanoma.

  12. A novel differential diagnostic model for multiple primary lung cancer: Differentially-expressed gene analysis of multiple primary lung cancer and intrapulmonary metastasis


    Chen, Dali; Mei, Longyong; Zhou, Yubin; Shen, Cheng; Xu, Huan; NIU, ZHONGXI; Che, Guowei


    The incidence of synchronous multiple primary lung cancer (MPLC) is increasing. However, present diagnostic methods are unable to satisfy the individualized treatment requirements of patients with MPLC. The present study aimed to establish a quantitative mathematical model and analyze its diagnostic value for distinguishing between MPLC and cases of the histologically similar disease, intrapulmonary metastasis (IPM). The sum value of the differential expression ratios of four proteins, namely...

  13. 9 CFR 93.204 - Import permits for poultry and for poultry test specimens for diagnostic purposes; and... (United States)


    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Import permits for poultry and for poultry test specimens for diagnostic purposes; and reservation fees for space at quarantine facilities... SERVICE, DEPARTMENT OF AGRICULTURE EXPORTATION AND IMPORTATION OF ANIMALS (INCLUDING POULTRY) AND...

  14. Importance of shrinkage in empirical bayes estimates for diagnostics: problems and solutions. (United States)

    Savic, Radojka M; Karlsson, Mats O


    Empirical Bayes ("post hoc") estimates (EBEs) of etas provide modelers with diagnostics: the EBEs themselves, individual prediction (IPRED), and residual errors (individual weighted residual (IWRES)). When data are uninformative at the individual level, the EBE distribution will shrink towards zero (eta-shrinkage, quantified as 1-SD(eta (EBE))/omega), IPREDs towards the corresponding observations, and IWRES towards zero (epsilon-shrinkage, quantified as 1-SD(IWRES)). These diagnostics are widely used in pharmacokinetic (PK) pharmacodynamic (PD) modeling; we investigate here their usefulness in the presence of shrinkage. Datasets were simulated from a range of PK PD models, EBEs estimated in non-linear mixed effects modeling based on the true or a misspecified model, and desired diagnostics evaluated both qualitatively and quantitatively. Identified consequences of eta-shrinkage on EBE-based model diagnostics include non-normal and/or asymmetric distribution of EBEs with their mean values ("ETABAR") significantly different from zero, even for a correctly specified model; EBE-EBE correlations and covariate relationships may be masked, falsely induced, or the shape of the true relationship distorted. Consequences of epsilon-shrinkage included low power of IPRED and IWRES to diagnose structural and residual error model misspecification, respectively. EBE-based diagnostics should be interpreted with caution whenever substantial eta- or epsilon-shrinkage exists (usually greater than 20% to 30%). Reporting the magnitude of eta- and epsilon-shrinkage will facilitate the informed use and interpretation of EBE-based diagnostics.

  15. Limited Diagnostic Utility of Plasma Adrenocorticotropic Hormone for Differentiation between Adrenal Cushing Syndrome and Cushing Disease. (United States)

    Hong, A Ram; Kim, Jung Hee; Hong, Eun Shil; Kim, I Kyeong; Park, Kyeong Seon; Ahn, Chang Ho; Kim, Sang Wan; Shin, Chan Soo; Kim, Seong Yeon


    Measurement of the plasma adrenocorticotropic hormone (ACTH) level has been recommended as the first diagnostic test for differentiating between ACTH-independent Cushing syndrome (CS) and ACTH-dependent CS. When plasma ACTH values are inconclusive, a differential diagnosis of CS can be made based upon measurement of the serum dehydroepiandrosterone sulfate (DHEA-S) level and results of the high-dose dexamethasone suppression test (HDST). The aim of this study was to assess the utility of plasma ACTH to differentiate adrenal CS from Cushing' disease (CD) and compare it with that of the HDST results and serum DHEA-S level. We performed a retrospective, multicenter study from January 2000 to May 2012 involving 92 patients with endogenous CS. The levels of plasma ACTH, serum cortisol, 24-hour urine free cortisol (UFC) after the HDST, and serum DHEA-S were measured. Fifty-seven patients had adrenal CS and 35 patients had CD. The area under the curve of plasma ACTH, serum DHEA-S, percentage suppression of serum cortisol, and UFC after HDST were 0.954, 0.841, 0.950, and 0.997, respectively (all P<0.001). The cut-off values for plasma ACTH, percentage suppression of serum cortisol, and UFC after HDST were 5.3 pmol/L, 33.3%, and 61.6%, respectively. The sensitivity and specificity of plasma ACTH measurement were 84.2% and 94.3%, those of serum cortisol were 95.8% and 90.6%, and those of UFC after the HDST were 97.9% and 96.7%, respectively. Significant overlap in plasma ACTH levels was seen between patients with adrenal CS and those with CD. The HDST may be useful in differentiating between these forms of the disease, especially when the plasma ACTH level alone is not conclusive.

  16. Differential scanning calorimetry of gliomas: a new tool in brain cancer diagnostics? (United States)

    Chagovetz, Alexis A; Quinn, Colette; Damarse, Neil; Hansen, Lee D; Chagovetz, Alexander M; Jensen, Randy L


    Thermal stability signatures of complex molecular interactions in biological fluids can be measured using differential scanning calorimetry (DSC). Evaluating the thermal stability of plasma proteomes offers a method of producing a disease-specific "signature" (thermogram) in neoplastic and autoimmune diseases. The authors describe the use of DSC with human brain tumor tissue to create unique thermograms for correlation with histological tumor classification. Primary brain tumors were classified according to the World Health Organization classification. Tumor samples were digested and assayed by a DSC calorimeter. Experimental thermograms were background subtracted and normalized to the total area of transitions to exclude concentration effects. The resulting thermograms were analyzed by applying 2-state, scaled, Gaussian distributions. Differences in glioma-specific signatures are described by using calculated parameters at transitions that are characterized, in the equilibrium approximation, by a melting temperature (Tm), an apparent enthalpy change (ΔH), and a scaling factor related to the relative abundance of the materials denatured in the transition (Aw). Thermogram signatures of glioblastoma multiforme and low-grade astrocytomas were differentiated by calculated values of Aw3 and Tm4, those of glioblastoma multiforme and oligodendrogliomas were differentiated by Aw2, ΔH2, ΔH4, and Tm4, and those of low-grade astrocytomas and oligodendroglioma were differentiated by Aw4. Our preliminary results suggest that solid brain tumors exhibit specific thermogram profiles that are distinguishable among glioma grades. We anticipate that our results will form the conceptual base of a novel diagnostic assay based on tissue thermograms as a complement to currently used histological analysis.

  17. Entropy Diagnostics for Fourth Order Partial Differential Equations in Conservation Form

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    Phil Broadbridge


    Full Text Available The entropy evolution behaviour of a partial differential equation (PDE in conservation form, may be readily discerned from the sign of the local source term of Shannon information density. This can be easily used as a diagnostic tool to predict smoothing and non-smoothing properties, as well as positivity of solutions with conserved mass. The familiar fourth order diffusion equations arising in applications do not have increasing Shannon entropy. However, we obtain a new class of nonlinear fourth order diffusion equations that do indeed have this property. These equations also exhibit smoothing properties and they maintain positivity. The counter-intuitive behaviour of fourth order diffusion, observed to occur or not occur on an apparently ad hoc basis, can be predicted from an easily calculated entropy production rate. This is uniquely defined only after a technical definition of the irreducible source term of a reaction diffusion equation.

  18. Diagnostic value of CD-10 marker in differentiating of papillary thyroid carcinoma from benign thyroid lesions

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    Mojgan Mokhtari


    Full Text Available Background: Using of CD10 in accordance with clinical and histological features of thyroid lesions could be used as both diagnostic and prognostic tool, which consequently influence the management and their prognosis for survival of patients with thyroid neoplasms especially papillary thyroid carcinoma (PTC. The aim of this study was to determine its expression in PTC and different benign thyroid lesions. Materials and Methods: In this descriptive-analytic, cross-sectional study, paraffin-embedded tissues of patients with definitive pathologic diagnosis of different benign thyroid lesions and PTC were retrieved. Immunostained sections of each slides was performed using immunohistochemistry methods and expression of CD10 was compared in two groups of benign thyroid lesions and PTC. Results: From selected cases 134 sections studied in two groups of PTC (n = 67 and benign thyroid lesions (n = 67. CD10 were immunohistochemically positive in 29.9% of PTC cases, but in none of the thyroid benign lesions (0% (P 0.05. Conclusion: The results of the current study indicate that due to the higher expression of CD10 in PTC than benign thyroid lesions it might be used for differentiating mentioned lesions. But for using it as a diagnostic tool further studies with larger sample size and determination of its sensitivity, specificity and cut-off point is necessary.

  19. Using biomarker signature patterns for an mRNA molecular diagnostic of mouse embryonic stem cell differentiation state

    Directory of Open Access Journals (Sweden)

    Zhang Xue W


    Full Text Available Abstract Background The pluripotency and self-renewal capabilities, which define the "stemness" state, of mouse embryonic stem (ES cells, are usually investigated by functional assays or quantitative measurements of the expression levels of known ES cell markers. Strong correlations between these expression levels and functional assays, particularly at the early stage of cell differentiation, have usually not been observed. An effective molecular diagnostic to properly identify the differentiation state of mouse ES cells, prior to further experimentation, is needed. Results A novel molecular pattern recognition procedure has been developed to diagnose the differentiation state of ES cells. This is based on mRNA transcript levels of genes differentially expressed between ES cells and their differentiating progeny. Large publicly available ES cell data sets from various platforms were used to develop and test the diagnostic model. Signature patterns consisting of five gene expression levels achieved high accuracy at determining the cell state (sensitivity and specificity > 97%. Conclusion The effective ES cell state diagnostic scheme described here can be implemented easily to assist researchers in identifying the differentiation state of their cultures. It also provides a step towards standardization of experiments relying on cells being in the stem cell or differentiating state.

  20. Report of a case of primary breast lymphoma highlighting the importance of fine needle aspiration cytology as an initial diagnostic tool

    Directory of Open Access Journals (Sweden)

    Millu F Jain


    Full Text Available Primary non-Hodgkin lymphoma of breast is a rare pathology, representing 0.5% of malignant breast tumors. We report a case of 52 year old female presenting with a large painful mass in left breast with ipsilateral axillary lymph node diagnosed on fine needle aspiration cytology as non-Hodgkin′s lymphoma. Breast lymphoma should be differentiated from other breast malignancies because of the differences in their treatment modalities. When breast lymphoma presents as a lump with axillary node, it clinically mimics breast carcinoma. Ultrasonogram and mammogram shows no characteristic features that can distinguish it from other breast malignancy. In such cases, FNAC becomes an important diagnostic tool that can differentiate PBL from other breast malignancy and avoid unnecessary surgery.

  1. Adjusting for differential-verification bias in diagnostic-accuracy studies: a Bayesian approach. (United States)

    de Groot, Joris A H; Dendukuri, Nandini; Janssen, Kristel J M; Reitsma, Johannes B; Bossuyt, Patrick M M; Moons, Karel G M


    In studies of diagnostic accuracy, the performance of an index test is assessed by verifying its results against those of a reference standard. If verification of index-test results by the preferred reference standard can be performed only in a subset of subjects, an alternative reference test could be given to the remainder. The drawback of this so-called differential-verification design is that the second reference test is often of lesser quality, or defines the target condition in a different way. Incorrectly treating results of the 2 reference standards as equivalent will lead to differential-verification bias. The Bayesian methods presented in this paper use a single model to (1) acknowledge the different nature of the 2 reference standards and (2) make simultaneous inferences about the population prevalence and the sensitivity, specificity, and predictive values of the index test with respect to both reference tests, in relation to latent disease status. We illustrate this approach using data from a study on the accuracy of the elbow extension test for diagnosis of elbow fractures in patients with elbow injury, using either radiography or follow-up as reference standards.

  2. Absence of an important vaccine and diagnostic target in carriage- and disease-related nontypeable Haemophilus influenzae. (United States)

    Smith-Vaughan, Heidi C; Chang, Anne B; Sarovich, Derek S; Marsh, Robyn L; Grimwood, Keith; Leach, Amanda J; Morris, Peter S; Price, Erin P


    Nontypeable Haemophilus influenzae (NTHi)-associated disease is a major health problem globally. Whole-genome sequence analysis identified the absence of hpd genes encoding Haemophilus protein D in 3 of 16 phylogenetically distinct NTHi isolates. This novel finding is of potential clinical significance, as protein D and hpd represent important NTHi vaccine antigen and diagnostic targets, respectively.

  3. 9 CFR 93.304 - Import permits for horses from regions affected with CEM and for horse specimens for diagnostic... (United States)


    ... the origin, history, and health status of the horses; the lack of satisfactory information necessary... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Import permits for horses from regions affected with CEM and for horse specimens for diagnostic purposes; reservation fees for space at quarantine...

  4. Diagnostic accuracy of increased urinary cortisol/cortisone ratio to differentiate ACTH-dependent Cushing's syndrome. (United States)

    Ceccato, Filippo; Trementino, Laura; Barbot, Mattia; Antonelli, Giorgia; Plebani, Mario; Denaro, Luca; Regazzo, Daniela; Rea, Federico; Frigo, Anna Chiara; Concettoni, Carolina; Boscaro, Marco; Arnaldi, Giorgio; Scaroni, Carla


    Differential diagnosis between Cushing's Disease (CD) and Ectopic ACTH Syndrome (EAS) may be a pitfall for endocrinologists. The increasing use in clinical practice of chromatography and mass spectrometry improves the measurement of urinary free cortisol (UFF) and cortisone (UFE). We have recently observed that cortisol to cortisone ratio (FEr) was higher in a small series of EAS; in this study we collected a larger number of ACTH-dependent Cushing's Syndrome (CS) to study the role of FEr to characterize the source of corticotropin secretion. High-pressure liquid chromatography with UV detection (HPLC-UV, n=35) or liquid chromatography-tandem mass spectrometry (LC-MS/MS, n=72) were used to measure UFF, UFE and FEr in 83 patients with CD and 24 with EAS. UFF, UFE and FEr levels were higher in EAS than in CD (UFF: 6671 vs 549 nmol/24 hours; UFE: 2069 vs 464 nmol/24 hours; FEr: 4.13 vs 0.97; all P1.15 (the best ROC-based threshold) was able to distinguish CD from EAS with 75% sensitivity (SE) and 75% specificity (SP), AUC 0.811; results were similar between HPLC-UV (SE 73%, SP 79%, AUC 0.708) and LC-MS/MS (SE 77%, SP 73%, AUC 0.834; P=.727). The diagnostic accuracy of FEr was similar to that of CRH test or high-dose dexamethasone suppression test (respectively P=.171 and P=.683), also combined. Finally, FEr was able to increase the number of correct diagnosis in patients with discordant dynamic tests. Urinary FEr >1.15 was able to suggest EAS, with a diagnostic accuracy similar to that of other dynamic tests proposed to study ACTH-dependent CS. © 2017 John Wiley & Sons Ltd.

  5. Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. (United States)

    Carpenter, Jennifer L; Orth, Robert C; Zhang, Wei; Lopez, Monica E; Mangona, Kate L; Guillerman, R Paul


    Purpose To prospectively evaluate the diagnostic performance of ultrasonography (US) for differentiating perforated from nonperforated pediatric appendicitis and to investigate the association between specific US findings and perforation. Materials and Methods This HIPAA-compliant study had institutional review board approval, and the need for informed consent was waived. All abdominal US studies performed for suspected pediatric appendicitis at one institution from July 1, 2013, to July 9, 2014, were examined prospectively. US studies were reported by using a risk-stratified scoring system (where a score of 1 indicated a normal appendix; a score of 2, an incompletely visualized normal appendix; a score of 3, a nonvisualized appendix; a score of 4, equivocal; a score of 5a, nonperforated appendicitis; and a score of 5b, perforated appendicitis). The diagnostic performance of US studies designated 5a and 5b was calculated. The following US findings were correlated with perforation at multivariate analysis: maximum appendiceal diameter, wall thickness, loss of mural stratification, hyperemia, periappendiceal fat inflammation, periappendiceal fluid, lumen contents, and appendicolith presence. The number of symptomatic days prior to presentation was recorded. Surgical diagnosis and clinical follow-up served as reference standards. Results A total of 577 patients with a diagnosis of appendicitis at US met the study criteria (468 with a score of 5a; 109 with a score of 5b). Appendicitis was correctly identified in 573 (99.3%) of 577 patients. US performance in the detection of perforated appendicitis (5b) was as follows: a sensitivity of 44.0% (80 of 182), a specificity of 93.1% (364 of 391), a positive predictive value of 74.8% (80 of 107), and a negative predictive value of 78.1% (364 of 466). Statistically significant associations with perforated appendicitis were longer duration of symptoms (odds ratio [OR] = 1.46, P appendicitis. Several US findings are

  6. Estimating the Importance of Differential Item Functioning. Program Statistics Research Technical Report No. 95-3. (United States)

    Rudas, Tamas; Zwick, Rebecca

    A method is proposed to assess the importance of differential item functioning (DIF) by estimating the largest possible fraction of the population in which DIF does not occur, or equivalently, the smallest possible portion of the population in which DIF may occur. The approach is based on latent class (C. C. Clogg, 1981) or mixture concepts, and…

  7. Hemoglobinas AS/alfa talassemia: importância diagnóstica Hemoglobins AS/alpha thalassemia: diagnostic importance

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    Renata Tomé-Alves


    , the Sickle Cell beta Thalassemia syndromes, and Hemoglobinopathies in which hemoglobin S is in association with another abnormal hemoglobin, such as hemoglobin S/C. The Sickle Cell trait (hemoglobin AS associated with Alpha Thalassemia presents alterations in the red blood cells morphology, usually absent in the heterozygous for this hemoglobin variant. The interaction between hemoglobin S and alpha Thalassemia has been described as one of the factors responsible for the improvement in the clinical picture of homozygous of hemoglobin S (Sickle Cell Anemia, decreasing the number of episodes of pain. The genetic mechanisms of this influence are evaluated using molecular analyses of the human globin genes. With the objective of verifying the presence of alpha Thalassemia in heterozygous of hemoglobin S, with anemia, sent to the Laboratory of Hemoglobins, Department of Biology, UNESP, São José do Rio Preto, SP, we analyzed 1002 blood samples with Sickle Cell trait, in the period from 1990 to 1998. The samples were picked with EDTA 5% as anticoagulant, after previous authorization of the carriers. Appropriated counseling and management requires definitive diagnosis. For the laboratorial diagnosis the blood samples were submitted to electrophoretic procedures in alkaline and acid pH and cytological evaluation of hemoglobin H. The electrophoretic procedures confirmed the presence of hemoglobin AS. The cytological evaluation evidenced the presence of alpha Thalassemia. Of this total analyzed, 16(1,59% blood samples presented the association between hemoglobin AS and alpha Thalassemia and two individuals belonged of the same family. Our results addressed us to suggest to the routine laboratories, that is important to accomplish the research of alpha Thalassemia among the Sickle Cell trait, with anemia, to verify the interaction with alpha Thalassemia, supplying to the carriers a important information on its hematological profile, genetic pattern of hemoglobinopathies and the

  8. Incidence, differential diagnoses, diagnostic approach and diagnostic value of Coombs´test and erythrocytic osmotic fragility


    Eckmann, Maria


    Anemia is a common laboratory test result in the cat. A classification of different categories of anemia is essential to ensure the correct prognostical evaluation combined with the appro-priate treatment. This study presents an extensive diagnostic approach to 100 feline patients with anemia (hematocrit (hct) below 0,25 l/l) at the Small Animal Clinic, Free University of Berlin. On the basis of those results, different kinds of anemia were classified. In addition to a thorough clinical exami...

  9. Diagnostic and radiological management of cystic pancreatic lesions: Important features for radiologists

    Energy Technology Data Exchange (ETDEWEB)

    Buerke, B., E-mail: [Department of Clinical Radiology, University of Muenster, Muenster (Germany); Domagk, D. [Department of Medicine B, University of Muenster, Muenster (Germany); Heindel, W.; Wessling, J. [Department of Clinical Radiology, University of Muenster, Muenster (Germany)


    Cystic pancreatic neoplasms are often an incidental finding, the frequency of which is increasing. The understanding of such lesions has increased in recent years, but the numerous types of lesions involved can hinder differential diagnosis. They include, in particular, intraductal papillary mucinous neoplasms (IPMN), serous cystic neoplasms (SCN), and mucinous cystic neoplasms (MCN). Knowledge of their histological and radiological structure, as well as distribution in terms of localization, age, and sex, helps to differentiate such tumours from common pancreatic pseudocysts. Several types of cystic pancreatic neoplasms can undergo malignant transformation and, therefore, require differentiated radiological management. This review aims to develop a broader understanding of the pathological and radiological characteristics of cystic pancreatic neoplasms, and provide a guideline for everyday practice based on current concepts in the radiological management of the given lesions.

  10. [Differential diagnosis of imported filariasis by molecular techniques (2006-2009)]. (United States)

    Jiménez, Maribel; González, Luis Miguel; Bailo, Begoña; Blanco, Alejandra; García, Luz; Pérez-González, Francisco; Fuentes, Isabel; Gárate, Teresa


    The last few years has seen an increase in the number of immigrants and travellers from endemic areas where filariasis are mainly caused by Loa loa (L. loa), Mansonella perstans (M. perstans) and Wuchereria bancrofti (W. bancrofti) species. These demographic changes has led to the need for better filariae species-specific molecular diagnostic tests to solve problems, as alternatives to the more time consuming classic parasitology methods. Thus, the objective of the present work was the implementation of optimised molecular protocols (nested-PCR and ITS1-RFLP) developed in our laboratory, for the differential diagnosis of filarial parasites. The results obtained were compared with those obtained using the conventional parasitological methods. A total of 523 samples (517 peripheral blood, 5 adult worms and one vitreous body) were sent to Parasitology Department of the National Microbiology Centre, Carlos II Research Institute (ISCIII), from 47 Health Centres in the Autonomous Regions of Spain, from 2006 to 2009. The samples were studied by the Knott technique, nested-PCR and ITS1-RFLP. The molecular techniques applied on blood samples showed to be more sensitive that Knott's concentration technique in the diagnosis of both L. loa (n=12 versus n=4) and M. perstans (n=57 versus n=25) infections. The nested-PCR and ITS1-RFLP are potential diagnostic tools for daily routine laboratory species-specific and sensitive detection of L. loa and M. perstans filarial species in immigrant population and travellers from endemic areas where these filarial species are co-endemic. Knott's concentration technique was less sensitive than molecular methods and should be carried out as a complementary diagnostic assay. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  11. Lower extremity vasculitis in giant cell arteritis: important differential diagnosis in patients with lower limb claudication. (United States)

    Sigl, Martin; Hsu, Eric; Scheffel, Hans; Haneder, Stefan; Rümenapf, Gerhard; Amendt, Klaus


    Most patients with peripheral arterial disease suffer from arteriosclerosis, the prevalence of which increases with age. In some of these patients, however, the ischemic symptoms are not caused by stenotic arteriosclerosis, but by large vessel giant cell arteritis (LV-GCA), a disease also predominantly affecting patients of the older generation. Identifying large vessel vasculitis is a challenge for all physicians caring for patients with peripheral artery disease. The results of invasive treatment such as bypass surgery and angioplasty of inflammatory vascular lesions differ fundamentally from those of patients with atherosclerosis. Duplex ultrasound is a widely available diagnostic method for examining patients with lower limb claudication and pathological ankle-/toe- brachial index or pulse volume recording with or without exercise. Knowledge of characteristic sonographic findings suspicious about large vessel vasculitis is essential for a differential diagnosis of vasculitis versus atherosclerosis. In addition to clinical and laboratory findings, further imaging techniques, e.g. contrast-enhanced computed tomography, magnetic resonance imaging or a combination of positron emission tomography and computed tomography (PET-CT) can provide information on further vessel involvement and inflammatory activity. The present study focuses on diagnostic imaging of LV-GCA in patients presenting with claudication, illustrated by a series of cases.

  12. Establishing a diagnostic system for detecting Ralstonia solanacearum and genetic differentiation using RAPD molecular markers

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    Edisson Chavarro Mesa


    Full Text Available A polymerase chain reaction-based diagnostic test (PCR has been developed for amplifying a región and obtaining a 292 bp product by using specific 16S rDNA primers for the rapid and precise identification of the causative agent (Ralstonia solanacearum of bacterial withering of potato in asymptomatic tubers. The bacteria was isolated from potato tubers and banana fruit using culturing techniques and immunological and molecular ELISA-NCM and PCR tests, respectively. PCR detected the presence of R. solanacearum on asymptomatic tubers by contrast with ELISA-NCM which did not detect this pathogen. Analysing random amplified polymorphic DNA (RAPD led to differentiating and grouping R. solanacearum by geographical región and bacterial strain, suggesting that differences exist amongst existing collections according to their place of origin, presenting high genetic variability. The results showed that PCR is a sensitive and specific test for detecting R. solanacearum and can therefore be implemented as a method for controlling this pathogen in seed production and certification programmes in áreas free of the disease. The pathogen has been shown to be genetically heterogeneous according to the samples' geographical área thereby hampering control in áreas of Colombia experiencing phytosanitary problems with R. solanacearum in potato crops Key words: bacterial withered, moko, PCR-16S rADN, ELISA-NCM, PCR-RAPD.

  13. Spectrophotometric Method for Differentiation of Human Skin Melanoma. II. Diagnostic Characteristics (United States)

    Petruk, V. G.; Ivanov, A. P.; Kvaternyuk, S. M.; Barunb, V. V.


    Experimental data on the spectral dependences of the optical diffuse reflection coefficient for skin from different people with melanoma or nevus are presented in the form of the probability density of the diffuse reflection coefficient for the corresponding pigmented lesions. We propose a noninvasive technique for differentiating between malignant and benign tumors, based on measuring the diffuse reflection coefficient for a specific patient and comparing the value obtained with a pre-set threshold. If the experimental result is below the threshold, then it is concluded that the person has melanoma; otherwise, no melanoma is present. As an example, we consider the wavelength 870 nm. We determine the risk of malignant transformation of a nevus (its transition to melanoma) for different measured diffuse reflection coefficients. We have studied the errors in the method, its operating characteristics and probability characteristics as the threshold diffuse reflection coefficient is varied. We find that the diagnostic confidence, sensitivity, specificity, and effectiveness (accuracy) parameters are maximum (>0.82) for a threshold of 0.45-0.47. The operating characteristics for the proposed technique exceed the corresponding parameters for other familiar optical approaches to melanoma diagnosis. Its distinguishing feature is operation at only one wavelength, and consequently implementation of the experimental technique is simplified and made less expensive.

  14. Small-Fiber Neuropathy: A Diabetic Microvascular Complication of Special Clinical, Diagnostic, and Prognostic Importance. (United States)

    Körei, A E; Istenes, I; Papanas, N; Kempler, P


    Damage of small nerve fibers may lead to a large variety of clinical symptoms. Small-fiber neuropathy underlies the symptoms of painful diabetic neuropathy, which may decrease quality of life. It also contributes to the poor prognosis of diabetic neuropathy because it plays a key role in the pathogenesis of foot ulceration and autonomic neuropathy. Impairment of small nerve fibers is considered the earliest alteration in the course of diabetic neuropathy. Therefore, assessment of functional and morphological abnormalities of small nerve fibers may enable timely diagnosis. The definition, symptoms, and clinical significance of small-fiber neuropathy are considered in the present review. An apparently more complex interaction between small-fiber impairment and microcirculation is extensively discussed. Diagnostic modalities include morphometric and functional methods. Corneal confocal microscopy and punch skin biopsy are considered gold standards, but noninvasive functional tests are also diagnostically useful. However, in routine clinical practice, small-fiber neuropathy is diagnosed by its typical clinical presentation. Finally, prompt treatment should be initiated following diagnosis.

  15. The MBD4 Gene Plays an Important Role in Porcine Adipocyte Differentiation

    Directory of Open Access Journals (Sweden)

    Lian-Jiang Zhang


    Full Text Available Background: MBD4 (methyl-CpG binding domain protein 4 is an important G: T glycosylase that can identify T-G mismatches. It plays a role in active demethylation through base excision repair. Overexpression of MBD4 gene can cause the demethylation of numerous genes, and the remethylation of MBD4-associated genes can occur when the MBD4 gene is knocked out. To date, the functions and regulatory mechanisms of the MBD4 gene in the differentiation of porcine preadipocytes have not been clearly established. Methods: Subcutaneous fat cells from 1- to 7-day-old Junmu-1 piglets were cultured in vitro, induced to differentiate, and then identified. A real-time fluorescence-based quantitative polymerase chain reaction (PCR analysis was conducted to detect MBD4 messenger RNA (mRNA expression. Cells were treated with MBD4-siRNA (small interfering RNA and induced to differentiate. Changes in the lipid droplets were observed by oil red O staining. Changes in the mRNA and protein expression levels of MBD4 and the adipose differentiation-associated genes C/EBPα (CCAAT-enhancer-binding protein alpha, PPARγ (peroxisome proliferator-activated receptor gamma, and aP2 (adipocyte protein 2 were detected. In addition, the bisulfite sequencing method was used to detect changes in methylation in the promoters of certain genes associated with adipose differentiation. Results: Levels of MBD4 mRNA and protein expression varied with time over the course of the porcine adipocyte differentiation, with the highest levels of this expression observed on day two of the differentiation process. After silencing MBD4 and inducing differentiation, the production of lipid droplets decreased, the mRNA expression levels of C/EBPα, PPARγ, and aP2 were significantly reduced, and DNA methylation modification levels were significantly elevated in the examined promoter regions. Conclusion: The silencing of the MBD4 gene can influence the DNA methylation levels of preadipocyte

  16. The Importance of Alternative Diagnostic Modalities in the Diagnosis of Small Bowel Tumors After a Negative Capsule Endoscopy

    Directory of Open Access Journals (Sweden)

    Iolanda Ribeiro


    We report the case of a patient with overt obscure gastrointestinal bleeding due to a gastrointestinal stromal tumor diagnosed by CT enterography after two negatives capsule endoscopies. This case shows that capsule endoscopy may overlook significant life threatening lesions and highlights the importance of using other diagnostic modalities after a negative capsule endoscopy, especially in patients with a high index of suspicion for small bowel tumoral pathology or persistent/recurrent bleeding.

  17. MiR-378 Plays an Important Role in the Differentiation of Bovine Preadipocytes

    Directory of Open Access Journals (Sweden)

    Si-Yuan Liu


    Full Text Available Background: Adipocyte, the main cellular component of white adipose tissue, plays a vital role in energy balance in higher eukaryotes. In recent years, adipocytes have also been identified as a major endocrine organ involved in immunological responses, vascular diseases, and appetite regulation. In farm animals, fat content and categories are closely correlated with meat quality. MicroRNAs (miRNAs, a class of endogenous single-stranded non-coding RNA molecules, participate in the regulation of adipocyte differentiation and adipogenesis through regulating the transcription or translation of target mRNAs. MiR-378 plays an important role in a number of biological processes, including cell growth, cell differentiation, tumor cell survival and angiogenesis. Methods: In the present study, bioinformatics analysis and dual-luciferase reporter assay were used to identify and validate the target genes of miR-378. In vitro cell transfection, quantitative reverse transcription polymerase chain reaction (RT-qPCR, western blot analysis, Oil Red O staining, and triglyceride content measurement were conducted to analyze the effects of miR-378 on bovine preadipocyte differentiation. Results: MiR-378 was induced during adipocyte differentiation. In the differentiated adipocytes overexpressing miR-378, the volume of lipid droplets was enlarged, and the triglyceride content was increased. Moreover, the mRNA expression levels of the adipocyte differentiation marker genes, peroxisome proliferator-activated receptor gamma (PPARγ and sterol regulatory element-binding protein (SREBP, were significantly elevated in the differentiated, mature adipocytes. In contrast, the mRNA expression level of preadipocyte factor 1 (Pref-1 was markedly reduced. E2F transcription factor 2 (E2F2 and Ras-related nuclear (RAN-binding protein 10 (RANBP10 were the two target genes of miR-378. The mRNA expression levels of E2F2 and RANBP10 did not significantly change in bovine preadipocytes

  18. Neurocysticercosis as an important differential of paradoxical response during antituberculosis therapy in HIV-negative patient

    Directory of Open Access Journals (Sweden)

    Rivonirina Andry Rakotoarivelo


    Full Text Available Neurocysticercosis can simulate a paradoxical response during antituberculosis therapy with neurological ailments. We report the case of a 31 year-old-man, treated for tuberculous meningitis who developed neurological deficit after nine weeks of early antituberculous therapy. The diagnosis of neurocysticercosis was confirmed by CT scan and cerebrospinal fluid analysis. Neurocysticercosis should be sought as an important differential of paradoxical response during antituberculosis therapy.

  19. Taurine transport in human placental trophoblast is important for regulation of cell differentiation and survival. (United States)

    Desforges, M; Parsons, L; Westwood, M; Sibley, C P; Greenwood, S L


    The outer epithelial cell layer of human placenta, the syncytiotrophoblast, is a specialised terminally differentiated multinucleate tissue. It is generated and renewed from underlying cytotrophoblast cells that undergo proliferation, differentiation and fusion with syncytiotrophoblast. Acquisition of fresh cellular components is thought to be balanced by apoptosis and shedding of aged nuclei. This process of trophoblast cell turnover maintains a functional syncytiotrophoblast, capable of sufficient nutrient transfer from mother to foetus. Foetal growth restriction (FGR) is a pregnancy complication associated with aberrant trophoblast turnover and reduced activity of certain amino acid transporters, including the taurine transporter (TauT). Taurine is the most abundant amino acid in human placenta implying an important physiological role within this tissue. Unlike other amino acids, taurine is not incorporated into proteins and in non-placental cell types represents an important osmolyte involved in cell volume regulation, and is also cytoprotective. Here, we investigated the role of taurine in trophoblast turnover using RNA interference to deplete primary human trophoblast cells of TauT and reduce intracellular taurine content. Trophoblast differentiation was compromised in TauT-deficient cells, and susceptibility of these cells to an inflammatory cytokine that is elevated in FGR was increased, evidenced by elevated levels of apoptosis. These data suggest an important role for taurine in trophoblast turnover and cytoprotection.

  20. Diagnostic and Prognostic Value of TSH Levels in Differentiated Thyroid Cancers

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    Mazhar Müslüm Tuna


    Full Text Available Purpose: The frequency of thyroid surgery for suspected malignancy but with a benign result in pathological examination is increasing in recent years. For this reason, additional preoperative markers are needed for increasing the sensitivity for evaluating the preoperative malignancy risk of thyroid nodules. In this study, we aimed to evaluate the diagnostic value of serum TSH levels for determining the differentiated thyroid cancers (DTC and to identify a proper cut-off value if relevant association is present. Material and Method: Our study included 380 patients who underwent thyroidectomy due to nodular goiter in our hospital between 01.01.2012 and 01.06.2013 retrospectively. 201 patients who were diagnosed with DTC constituted the study group, and 179 consecutive patients with a benign pathology result were included as controls. Patients who had overt hyperthyroidism or hypothyroidism and was taken medicines that affect TSH level were excluded. Results: There were no significant differences between the two groups in terms of age, sex, and family history of thyroid disease. Preoperative TSH levels were 1.66 mIU/lt and 1.59 mIU/lt in patients with DTC and controls, respectively (p=0.641. There was no correlation between TSH and tumor size, and no relationship between TSH and capsular invasion, vascular invasion, extrathyroidal invasion and lymph node metastasis. Discussion: In our study, no relationship was found between preoperative TSH level and DTC. In addition, there was no relationship between TSH and bad prognostic parameters. Turk Jem 2014; 1: 1-4

  1. Diagnostic Accuracy of Growth Rate in Differentiating Etiologies of Short Stature in Children

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    Mohammad Reza Alaei


    Full Text Available Background  Short stature is a manifestation of a wide variety of conditions that some of which may be amenable to timely treatment and a suboptimal growth rate may be an early marker pointing to the cause of growth retardation. This study was conducted to evaluate the diagnostic utility of growth rate in differential diagnosis of children with short stature. Materials and Methods All children between the ages of 2 and 18 years who visited in pediatric endocrinology clinic in a five years period were recruited in a prospective cohort study. Children with standing height Results One hundred forty three patients fulfilled the inclusion criteria. Mean follow up period was 14.4±10.9 months. Etiologies of short stature were: constitutional growth delay (CGD 46.9%, familial short stature (FSS 28.7%, hypothyroidism 4.2%, growth hormone deficiency (GHD 4.2% and miscellaneous causes in 16% of patients.  Mean Z- score for children with constitutional growth delay was -2.3±0.69, in familial short stature was -2.3±0.65 and for other condition was -2.7±1.49. There was a meaningful statistical correlation between growth rate and etiology of short stature (P0.05. Conclusion There was significant difference in growth rate between children with constitutional growth delay and familial short stature in comparing to short stature due to endocrine problem and other etiologies. Assessment of growth rate has some utility in diagnosing the etiology of short stature.

  2. Digital capillaroscopy as important tool for early diagnostics of arterial hypertension (United States)

    Gurfinkel, Yu. I.; Sasonko, M. L.; Priezzhev, A. V.


    The study is aimed to determine the digital capillaroscopy possibilities in early diagnostics of an arterial hypertension. A total of 123 adult persons were examined in the study. The first group consisted of 40 patients with prehypertension (BP 130-139/85-89 mm Hg). The second group included 36 patients with 1-2 stage of hypertension (mean systolic BP 152.7±12 mm Hg). Patients in both groups did not receive regular drug therapy. The group of volunteers (n=47) included healthy adults without signs of cardiovascular pathology. The capillary circulation was examined on the nailbed using the optical digital capillaroscope developed by the company "AET", Russia. Diameters of the arterial and venous segments, perivascular zone size, capillary blood velocity, the degree of arterial loops narrowing and the density of the capillary network were estimated. In patients with arterial hypertension and even in patients with prehypertension remodeling and rarefaction of capillaries and the expressed narrowing their arterial loops were manifested. The results of the study revealed the presence of abnormalities of microcirculation parameters in patients of both groups. The capillaries density in both groups of patients was significantly lower than in healthy persons. The significant narrowing of arterial loops was revealed in patients with both arterial hypertension and prehypertension, in comparison with healthy volunteers. Capillary blood velocity did not differ significantly between healthy volunteers group and the group of prehypertensive patients. However in patients with hypertension this parameter was significantly lower in comparison with control group.

  3. [Idiopathic mental retardation--importance of clinical diagnostic scores for case selection]. (United States)

    Caba, Lavinia; Rusu, Cristina; Voloşciuc, M; Butnariu, Lăcrămioara; Braha, Elena; Grămescu, Mihaela; Bujoran, C; Gorduza, E V; Covic, M


    We present a retrospective study aimed to identify the correlation between de Vries clinical score and the detection of chromosomal abnormalities in mentally retarded (MR) children. We have used the score to identify patients who should be tested by karyotyping and subsequently MLPA (multiplex ligation dependent probe amplification) for subtelomeric rearrangements. Our group is formed of 36 children with variable MR associated with other anomalies. 18 children had chromosomal defects, whereas 18 had normal karyotypes. In the first group, total scores varied between 3 and 7. Chromosomal anomalies identified were: numerical (4) and structural (14). Chromosomes involved were: 1, 4, 5, 7, 8, 9, 17, X. Deletions were the most common and correlate with a greater score (> or = 4). Common clinical features were: short stature, microcephaly, nasal, ear and hand anomalies. In the second group the most frequent clinical feature was hand anomaly (61.2%) and cases with a high score have to be further tested (e.g. using MLPA) in order to identify minor defects. In our opinion a high score indicates the karyotype and then a MLPA testing. In conclusion, we present a retrospective study that proves the use of de Vries diagnostic score in the identification of chromosomal abnormalities in MR children.

  4. Importance of nuclear medicine diagnostics in CUP syndrome; Stellenwert der nuklearmedizinischen Diagnostik bei CUP-Syndrom

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    Winter, M.C.; Haberkorn, U.; Kratochwil, C. [Universitaetsklinikum Heidelberg, Abteilung fuer Nuklearmedizin, Heidelberg (Germany)


    The diagnostic work-up in patients with carcinoma of unknown primary (CUP) syndrome is extensive, highly time-consuming and cost-intensive and ultimately often fails to detect a primary site. In this context chest X-ray and computed tomography (CT) have been used as standard imaging modalities in CUP syndrome. Since the introduction of positron emission tomography (PET) evaluation of tumor vitality has become possible. Furthermore, PET-CT hybrid scanners allow the combination of functional and morphological imaging. Several meta-analyses have reported an additional overall detection rate between 24.5 % and 44 % by either PET or PET-CT. Metastatic localization (cervical versus extracervical) did not influence the performance. The sensitivity was usually high (> 80 %) but specificity was moderate ranging from 68 % to 88 % at best. If mentioned, the results obtained by fluorodeoxyglucose (FDG)-PET significantly changed the clinical management in approximately one third of the patients studied. In a direct comparison with PET alone, PET-CT did not depict significantly more primary tumors but was able to reduce false positive findings. To determine the real additional value of PET-CT in the diagnosis of CUP syndrome large prospective studies with more uniform inclusion criteria are needed. Despite the capabilities of FDG-PET-CT there is as yet no evidence that a potentially improved diagnostic algorithm is translated into a better patient outcome. Nevertheless, FDG-PET-CT should be performed in all CUP patients where conventional imaging failed to detect a primary site or the results are equivocal. In CUP patients with cervical lymph node metastases PET-CT should be carried out prior to panendoscopy to reduce the number of false negative biopsies. (orig.) [German] Die Diagnostik bei Carcinoma-of-unkown-primary(CUP)-Patienten ist meist umfangreich, sowohl sehr zeit- als auch kostenintensiv und verlaeuft dennoch haeufig frustran. Roentgenaufnahmen des Thorax und die

  5. Diagnostic performance of combined elastosonography scoring and high-resolution ultrasonography for the differentiation of benign and malignant thyroid nodules

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    Shweel, Mohamed, E-mail: [Radiology Department, El Minia University Hospital, El Minia (Egypt); Mansour, Ehab, E-mail: [Radiology Department, Assiut University Hospitals, Assiut (Egypt)


    Aim: To evaluate the diagnostic performance of the combined use of elstosonography (USE) scoring and high-resolution ultrasonography (HRUS) for the differentiation of benign and malignant thyroid nodule. Patients and methods: Forty-seven consecutive patients with 66 thyroid nodules were enrolled in the present study. Thyroid surgery had been already planned for all the patients. All of them were submitted to high-resolution ultrasonography and elastography scoring at the same sitting. The latter was determined with 5-point scoring method. The examination results were compared against pathological findings as the gold standard of reference. Results: The sensitivity, specificity, accuracy, positive predictive, and negative predictive values of HRUS in the differential diagnosis of thyroid nodules were 92.0%, 72.9%, 60.1%, 95.0%, and 63.1%, respectively, while that of ultrasound elastography scoring were 75.4%, 85.5%, 86.7%, 71.4%, and 90.5%, respectively. Combined use of both US techniques resulted in a higher diagnostic performance as it showed 95.4%, 94.8%, 95.2%, 82.3% and 98.8% sensitivity, specificity, accuracy, positive predictive, and negative predictive values, respectively. Conclusions: The use of combined USE and HRS for the differentiation of benign and malignant thyroid nodules resulted in a high diagnostic performance and a significant statistical difference as compared to HRUS or USE alone (P = 0.003)

  6. Novel multiplex real-time PCR diagnostic assay for identification and differentiation of Mycobacterium tuberculosis, Mycobacterium canettii, and Mycobacterium tuberculosis complex strains. (United States)

    Reddington, Kate; O'Grady, Justin; Dorai-Raj, Siobhan; Maher, Majella; van Soolingen, Dick; Barry, Thomas


    Tuberculosis (TB) in humans is caused by members of the Mycobacterium tuberculosis complex (MTC). Rapid detection of the MTC is necessary for the timely initiation of antibiotic treatment, while differentiation between members of the complex may be important to guide the appropriate antibiotic treatment and provide epidemiological information. In this study, a multiplex real-time PCR diagnostics assay using novel molecular targets was designed to identify the MTC while simultaneously differentiating between M. tuberculosis and M. canettii. The lepA gene was targeted for the detection of members of the MTC, the wbbl1 gene was used for the differentiation of M. tuberculosis and M. canettii from the remainder of the complex, and a unique region of the M. canettii genome, a possible novel region of difference (RD), was targeted for the specific identification of M. canettii. The multiplex real-time PCR assay was tested using 125 bacterial strains (64 MTC isolates, 44 nontuberculosis mycobacteria [NTM], and 17 other bacteria). The assay was determined to be 100% specific for the mycobacteria tested. Limits of detection of 2.2, 2.17, and 0.73 cell equivalents were determined for M. tuberculosis/M. canettii, the MTC, and M. canettii, respectively, using probit regression analysis. Further validation of this diagnostics assay, using clinical samples, should demonstrate its potential for the rapid, accurate, and sensitive diagnosis of TB caused by M. tuberculosis, M. canettii, and the other members of the MTC.

  7. Five-class differential diagnostics of neurodegenerative diseases using random undersampling boosting

    DEFF Research Database (Denmark)

    Tong, Tong; Ledig, Christian; Guerrero, Ricardo


    Differentiating between different types of neurodegenerative diseases is not only crucial in clinical practice when treatment decisions have to be made, but also has a significant potential for the enrichment of clinical trials. The purpose of this study is to develop a classification framework...... for distinguishing the four most common neurodegenerative diseases, including Alzheimer's disease, frontotemporal lobe degeneration, Dementia with Lewy bodies and vascular dementia, as well as patients with subjective memory complaints. Different biomarkers including features from images (volume features, region...... to train classifiers and to handle the class imbalance training problem. Furthermore, a multi-class feature selection method based on sparsity is integrated into the proposed framework to improve the classification performance. It also provides a way for investigating the importance of different features...

  8. Homeodomain-interacting protein kinase 2 plays an important role in normal terminal erythroid differentiation. (United States)

    Hattangadi, Shilpa M; Burke, Karly A; Lodish, Harvey F


    Gene-targeting experiments report that the homeodomain-interacting protein kinases 1 and 2, Hipk1 and Hipk2, are essential but redundant in hematopoietic development because Hipk1/Hipk2 double-deficient animals exhibit severe defects in hematopoiesis and vasculogenesis, whereas the single knockouts do not. These serine-threonine kinases phosphorylate and consequently modify the functions of several important hematopoietic transcription factors and cofactors. Here we show that Hipk2 knockdown alone plays a significant role in terminal fetal liver erythroid differentiation. Hipk1 and Hipk2 are highly induced during primary mouse fetal liver erythropoiesis. Specific knockdown of Hipk2 inhibits terminal erythroid cell proliferation (explained in part by impaired cell-cycle progression as well as increased apoptosis) and terminal enucleation as well as the accumulation of hemoglobin. Hipk2 knockdown also reduces the transcription of many genes involved in proliferation and apoptosis as well as important, erythroid-specific genes involved in hemoglobin biosynthesis, such as alpha-globin and mitoferrin 1, demonstrating that Hipk2 plays an important role in some but not all aspects of normal terminal erythroid differentiation.

  9. Subacute Histoplasmosis with Focal Involvement of the Epiglottis: Importance of Differential Diagnosis

    Directory of Open Access Journals (Sweden)

    F. Ahumada


    Full Text Available Histoplasmosis is an endemic mycosis of the Americas, Africa, and Asia. In Spain, it is the most common imported endemic mycosis appearing in the literature, and its incidence is on the rise. Proper differential diagnosis of the disease must be taken into consideration by otorhinolaryngologists, as the clinical manifestations of histoplasmosis may simulate more prevalent diseases such as cancer or tuberculosis. We present the case of a Spanish patient with focal involvement of the larynx and offer a review of the relevant literature.

  10. Differential diagnostics of the musculoskeletal system in sports medicine; Differenzialdiagnostische Untersuchung in der Sportmedizin des Bewegungsapparats

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    Nehrer, S. [Donau-Universitaet Krems, Department fuer Klinische Medizin und Biotechnologie, Zentrum fuer Regenerative Medizin, Krems (Austria)


    The positive effects of sports on the cardiovascular and musculoskeleal systems are widely accepted. Nevertheless, sports also can cause injury and overuse leading to sport-specific problems, which are often a challenge in diagnosing and treatment. The history of the sport-related injury is crucial for further differential diagnosis. Careful inspection, palpation and functional testing can reveal the possible pathology and lead to an effective strategy in the diagnostic assessment using radiographic tools such as sonography, X-ray and MR imaging (MRI). In muscle and tendon injuries sonography can provide ready to use information concerning muscle tears and tendon ruptures or degenerative lesions. Plain X-rays give a good overview on joint conditions regarding the bone and sometimes have to be completed by focused enlargement of the critical structure, especially in stress fractures and small bone lesions. MRT is the gold standard in the evaluation of interarticular and extra-articular sport-related pathologies, however, an exact clinical diagnosis allows a more effective investigation protocol. Profound knowledge of possible sport-specific injury and overuse patterns is necessary to detect lesions of the musculoskeletal system in active athletes and to use the fitting radiographic strategy for confirmation. The exact diagnosis is the prerequisite for initiating the appropriate treatment and a fast sports medical rehabilitation process. (orig.) [German] Die positive Auswirkung von Sport auf das Herz-Kreislauf-System und den Bewegungsapparat ist weitgehend gesichert. Trotzdem kann es bei der Sportausuebung zu sportspezifischen Problemen kommen, die den Sportarzt bei der Abklaerung dieser Schmerzsyndrome oft vor grosse Herausforderungen stellen. Die Ursache von Sportschaeden und Verletzungen sind einerseits akute Traumata, andererseits aber auch Ueberlastungen oder Kombinationen von beiden. Die Erhebung einer Anamnese unter Beruecksichtigung sportspezifischer Aspekte

  11. [Differential diagnostics of acute inflammatory diseases and tumors of the neck]. (United States)

    Vuĭtsik, N B; Butkevich, A Ts; Kuntsevich, G I; Zemlianoĭ, A B


    The purpose of the investigation was to assess the clinical significance of ultrasonography for differential diagnostics between acute inflammatory and tumorous lesions of the neck. One hundred and eighty-six patients with soft-tissue lesions of the neck aged 18 to 74 (mean age 31.45 +/- 8.39 years), 95 (51%) males and 91 (49%) females were examined. Basing on clinical and ultrasonographic examination, the patients were divided into two groups: 149 or 80% patients with acute inflammatory lesions (Group 1), and 37 or 20% patients with tumorous lesions (Group 2). Thirty-four of the 149 Group 1 patients (22.82%) had lymphadenitis, 30 (20.13%) had soft tissue infiltrates, 13 (8.72%) had abscesses, 19 (12.72%) had phlegmons, 32 (21.48%) had acute inflammatory changes in the major salivary glands, 3 (2.01%) had teratomas with signs of inflammation, and 17 (11.41%) patients had inflammatory changes in the tumors. Of 37 patients with tumorous lesions, 16 (43.2%) had salivary gland tumors, 12 (32.4%) had metastases in the lymphatic nodes, and 9 (24.3%) had neurofibromatosis. Soft tissue ultrasonography was performed using Sonos-5500 and Image-Point ultrasound scanners with 7.5 MHz sensors (Hewlett-Packard, USA), Logio-pro, Uoluson-730 Expert (General Electric, USA), and Premium Edition (ACUSON Antares, Siemens, Germany) with 5 to 13 MHz wide-frequency sensors. Visualization was performed in B-modes using tissue harmonics, color duplex scanning, Sie Scape panoramic visualization, contrast visualization and Sight 4D and 3D-Scape modes. The results of ultrasonography were analyzed taking into account additional methods such as computed and magnetic resonance tomography, intraoperative findings, the results of puncture biopsy, histological, morphological, and bacteriological studies. The study demonstrates that ultrasonography is the method of choice, which is in some cases enough to establish a diagnosis of an acute inflammatory disease or a tumorous formation of various

  12. Emerging phytopathogen Macrophomina phaseolina: biology, economic importance and current diagnostic trends. (United States)

    Kaur, Surinder; Dhillon, Gurpreet Singh; Brar, Satinder Kaur; Vallad, Gary Edward; Chand, Ramesh; Chauhan, Vijay Bahadur


    Macrophomina phaseolina (Tassi) Goid. is an important phytopathogenic fungus, infecting a large number of plant species and surviving for up to 15 years in the soil as a saprophyte. Although considerable research related to the biology and ecology of Macrophomina has been conducted, it continues to cause huge economic losses in many crops. Research is needed to improve the identification and characterization of genetic variability within their epidemiological and pathological niches. Better understanding of the variability within the pathogen population for traits that influence fitness and soil survival will certainly lead to improved management strategies for Macrophomina. In this context, the present review discusses various biological aspects and distribution of M. phaseolina throughout the world and their importance to different plant species. Accurate identification of the fungus has been aided with the use of nucleic acid-based molecular techniques. The development of PCR-based methods for identification and detection of M. phaseolina are highly sensitive and specific. Early diagnosis and accurate detection of pathogens is an essential step in plant disease management as well as quarantine. The progress in the development of various molecular tools used for the detection, identification and characterization of Macrophomina isolates were also discussed.

  13. Diagnostic accuracy of apparent diffusion coefficient and 123I-metaiodobenzylguanidine for differentiation of multiple system atrophy and Parkinson's disease.

    Directory of Open Access Journals (Sweden)

    Atsushi Umemura

    Full Text Available BACKGROUND: It is often hard to differentiate Parkinson's disease (PD and parkinsonian variant of multiple system atrophy (MSA-P, especially in the early stages. Cardiac sympathetic denervation and putaminal rarefaction are specific findings for PD and MSA-P, respectively. PURPOSE: We investigated diagnostic accuracy of putaminal apparent diffusion coefficient (ADC test for MSA-P and (123I-metaiodobenzylguanidine (MIBG scintigram for PD, especially in early-stage patients. METHODS: The referral standard diagnosis of PD and MSA-P were the diagnostic criteria of the United Kingdom Parkinson's Disease Society Brain Bank Criteria and the second consensus criteria, respectively. Based on the referral standard criteria, diagnostic accuracy [area under the receiver-operator characteristic curve (AUC, sensitivity and specificity] of the ADC and MIBG tests was estimated retrospectively. Diagnostic accuracy of these tests performed within 3 years of symptom onset was also investigated. RESULTS: ADC and MIBG tests were performed on 138 patients (20 MSA and 118 PD. AUC was 0.95 and 0.83 for the ADC and MIBG tests, respectively. Sensitivity and specificity were 85.0% and 89.0% for MSA-P diagnosis by ADC test and 67.0% and 80.0% for PD diagnosis by MIBG test. When these tests were restricted to patients with disease duration ≤ 3 years, the sensitivity and specificity were 75.0% and 91.4% for the ADC test (MSA-P diagnosis and 47.7% and 92.3% for the MIBG test (PD diagnosis. CONCLUSIONS: Both tests were useful in differentiating between PD and MSA-P, even in the early stages. In early-stage patients, elevated putaminal ADC was a diagnostic marker for MSA-P. Despite high specificity of the MIBG test, careful neurological history and examinations were required for PD diagnosis because of possible false-negative results.

  14. Occurrence of dermoid cyst in the floor of the mouth: the importance of differential diagnosis in pediatric patients. (United States)

    Puricelli, Edela; Barreiro, Bernardo Ottoni Braga; Quevedo, Alexandre Silva; Ponzoni, Deise


    Lesions in the floor of the mouth can be a challenging diagnosis due to the variety of pathological conditions that might be found in this area. Within a broad range of lesions, attention has to be addressed to those that require specific management, such as a dermoid cyst (DC) and a ranula. Especially in pediatric patients, in whom the failure of diagnosis can postpone the correct treatment and cause sequelae later in life. DC, a developmental anomaly, is managed primarily by surgical resection. On the other hand, ranula is a pseudocyst that may be treated by marsupialization. This article reports a large and painful lesion in the floor of the mouth in a pediatric patient. With a diagnostic hypothesis of ranula, two surgical interventions were performed, but there were recurrences of the lesion. Subsequently, the patient was referred to the Oral and Maxillofacial Surgery Unit for re-evaluation. Computed tomography showed a semi-transparent image suggesting a cystic formation. Another surgical procedure was performed where the lesion was completely removed. Anatomopathological analysis confirmed the diagnosis of DC. The five-year follow-up showed no signs of recurrence. This article indicates that although DC in the floor of the mouth is rare, it should be considered in the differential diagnosis of other diseases in this area. This precaution may be particularly important in the following circumstances: 1) Similar lesions that have different therapeutic approaches and, 2) To prevent future sequelae in pediatric patients.

  15. Wandering spleen in children: a report of 3 cases and a brief literature review underlining the importance of diagnostic imaging

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    Lombardi, Roberta; Menchini, Laura; Corneli, Teresa; Magistrelli, Andrea; Monti, Lidia; Toma, Paolo [Bambino Gesu Pediatric Hospital, Department of Radiology, Rome (Italy); Accinni, Antonella [Bambino Gesu Pediatric Hospital, Department of General and Thoracic Surgery, Rome (Italy)


    Wandering spleen is a rare condition in children that is often caused by loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of children with wandering spleen have splenic torsion as a complication. To provide up-to-date information on the diagnosis, clinical management and diagnostic imaging approaches for wandering spleen in infants and children and to underline the importance of color Doppler US and CT in providing important information for patient management. We report a series of three children with wandering spleen treated at our children's hospital over the last 6 years. All three underwent clinical evaluation, color Doppler US and CT and were surgically treated. We also reviewed 40 articles that included 55 patients younger than 18 years reported in the Medline database from 2002 to 2012. We correlated pathological data with imaging findings. Color Doppler US, the first imaging modality in investigating abdominal symptoms in children with suspected wandering spleen, yielded a diagnostic sensitivity of 54.9%, whereas CT achieved about 71.7%. Radiologic evaluation has a major role in confirming the diagnosis of a suspected wandering spleen and avoiding potentially life-threatening complications requiring immediate surgery. (orig.)

  16. The Diagnostic and Differential Diagnosis Utility of Cerebrospinal Fluid α -Synuclein Levels in Parkinson's Disease: A Meta-Analysis. (United States)

    Zhou, Bo; Wen, Min; Yu, Wen-Feng; Zhang, Chun-Lin; Jiao, Ling


    Several recent studies showed that α-syn might be a potential diagnostic biomarker for PD in human cerebrospinal fluid (CSF), but the results were inconsistent. The purpose of this meta-analysis was to investigate the diagnostic and differential diagnosis efficacy of CSF α-syn in PD. Studies which measured CSF α-syn or α-syn oligomers in patients with PD and met the inclusion criteria were included in the analysis. Results of the meta-analysis indicated that mean concentration of CSF α-syn was significantly lower in PD compared to controls and significantly higher in PD compared to multiple system atrophy (MSA). No significant difference in mean concentration of CSF α-syn was found between PD and dementia with Lewy bodies (DLB). Mean concentration of CSF α-syn was slightly decreased in PD compared to progressive supranuclear palsy (PSP). Mean concentration of CSF α-syn oligomers was significantly higher in PD than control. These results support the findings that CSF α-syn may be a potential diagnostic and differential diagnosis biomarker in PD compared to control and MSA but not DLB. Furthermore, α-syn oligomer may represent a better biomarker for diagnosis of PD.

  17. Transgelin: a potentially useful diagnostic marker differentially expressed in triple-negative and non-triple-negative breast cancers. (United States)

    Rao, Deepthi; Kimler, Bruce F; Nothnick, Warren B; Davis, Marilyn K; Fan, Fang; Tawfik, Ossama


    Triple negative (TN) (estrogen receptor [ER], progesterone receptor [PR] and HER2-) are highly aggressive, rapidly growing, hormone-unresponsive tumors diagnosed at later stage that affect younger women with shorter overall survival. Most TN tumors are of the basal type. For the remainder, identification of target markers for effective treatment strategies remains a challenge. Transgelin (TGLN) is a 22-kd actin-binding protein of the calponin family. It is one of the earliest markers of smooth muscle differentiation. TGLN has been shown to have important biologic activities including regulating muscle fiber contractility, cell migration, and tumor suppression. We examined TGLN expression in the different molecular subtypes of breast cancer. TGLN expression was examined as a function of tumor size, grade, histologic type, lymph node status, patients' age and overall survival, ER, PR, HER2, and Ki-67 in 101 tumors that included 35 luminal A, 28 luminal B, 4 HER2, and 34 TN types. TGLN positivity (defined as 2+ or 3+) was associated with more aggressive tumors (10% of grade I/II tumors were TGLN+ versus 53% of grade III tumors; P < .001), high Ki-67 count, and low ER and PR expression (P < .001) but not with tumor size, age, or lymph node metastasis. TN (n = 34) tumors were 7.7 times more likely to be TGLN+ than non-TN (n = 67) tumors (77% versus 10%, respectively; P < .001). TGLN may be an excellent diagnostic marker of TN tumors and could be useful in stratification of patients. TGLN may also prove a potential target for future treatment strategies.

  18. Mouse rosettes and surface immunoglobulin in small lymphocytic lymphoma. Importance in immunophenotyping and differential diagnosis. (United States)

    Batata, A; Shen, B


    Cell suspensions from lymphoid tissue of 82 small lymphocytic lymphoma (SLL), 8 intermediate lymphocytic lymphoma (ILL), 286 other B-non-Hodgkin's lymphoma (B-NHL), and 248 reactive lymphadenopathy (RLA) cases were analyzed to evaluate the diagnostic significance of mouse-rosette (M-rosette) assay, and surface immunoglobulin clonality (SIg) and level of expression. In SLL, 55 were M-rosette positive (67.07%) and 72 SIg positive (87.8%), with weak fluorescence in 63 and strong fluorescence in 9 cases. Of 10 SIg-negative cases, 9 were M-rosette positive; of 27 M-rosette-negative cases, 26 were SIg positive. Seven of the nine cases with strong fluorescence were M-rosette positive. In other B-NHL, 252 were M-rosette negative (88.11%) and 245 SIg positive (85.66%), with strong fluorescence in 211 and weak fluorescence in 34 cases. Thirty-two of the 34 cases with weak fluorescence were M-rosette negative. Of the RLA cases, 213 were M-rosette negative (85.89%) and 1 SIg positive (0.4%). The study demonstrated the independent expression of M-rosettes and SIg in SLL and their complementary role in diagnosis. It showed that positive results for M-rosettes and weak fluorescence are characteristic of SLL, that M-rosette negativity and strong fluorescence are characteristic of other B-NHL, and that M-rosette negativity and polyclonal SIg are characteristic of RLA. In 26 cases with paired data for CD5, M-rosettes, and SIg, a positive result for M-rosettes was superior to CD5 in differentiating SLL from other B-NHL. Intermediate lymphocytic lymphoma frequently showed weak SIg fluorescence and M-rosette negativity.

  19. Metastatic Renal Cell Carcinoma: The Importance of Immunohistochemistry in Differential Diagnosis

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    Sandra Custódio


    Full Text Available Introduction: Clear cell carcinoma accounts for 75% of all types of renal neoplasms. Approximately one third presents with metastatic disease at diagnosis. Immunohistochemical studies play a significant diagnostic role. Case Report: We report the case of a 48-year-old heavy smoker who presented with productive cough and progressive dyspnea. The study revealed a renal mass and lung alterations compatible with primary tumor of the lung. The patient underwent a right complete nephrectomy. The anatomopathological exam showed clear cell renal carcinoma (pT1bN0Mx. After transthoracic needle aspiration biopsy, the clinical diagnosis was stage IV adenocarcinoma of the lung. Initially, the patient received one cycle of chemotherapy (cisplatin/pemetrexed. Two weeks later, the immunohistochemistry tests revealed a secondary lesion with probable renal origin. Chemotherapy was stopped and the patient was started on sunitinib treatment. After two cycles the disease progressed. A second-line treatment with everolimus was proposed; however, the patient died 2 weeks later due to terminal respiratory insufficiency. Discussion: Clear cell renal cell carcinoma remains one of the great mimickers in pathology. Immunohistochemistry is a valuable tool in the differential diagnosis of lung carcinomas. With the help of thyroid transcription factor 1, it is possible to distinguish a primary lung tumor from a metastasis with a reasonable degree of certainty. The present case report illustrates the challenge of making a definitive and adequate diagnosis. The immunohistochemistry added information that changed the whole treatment strategy. For the best treatment approach, it is fundamental that clinicians await all possible test results, before establishing a treatment plan.

  20. Differential Capacity-Based Modeling for In-Use Battery Diagnostics, Prognostics, and Quality Assurance (United States)


    test and to observe which characteristic feature(s) of the curve changes as a result of performance degradation. A 3.4 Ah NMC 18650 cell was...with corresponding differential capacity curve for a 2.4 Ah NMC 18650 cell. Figure 2. Differential capacity curves comparing data fidelity at...varying charge/discharge rates for a 2.4 Ah NMC 18650 cell. Figure 3. Differential capacity curves comparing data fidelity at varying voltage

  1. Diagnostic accuracy of fibrinogen to differentiate appendicitis from nonspecific abdominal pain in children. (United States)

    Prada-Arias, Marcos; Vázquez, José Luis; Salgado-Barreira, Ángel; Gómez-Veiras, Javier; Montero-Sánchez, Margarita; Fernández-Lorenzo, José Ramón


    The aim of this study was to assess the diagnostic accuracy of the biomarker fibrinogen (FB), along with the more traditional markers white blood cell count (WBC), absolute neutrophil count (ANC), and C-reactive protein (CRP), to discriminate appendicitis from nonspecific abdominal pain (NSAP) in children. We prospectively evaluated all children aged 5 to 15 years admitted for suspected appendicitis at an academic pediatric emergency department during 2 years. Diagnostic accuracy of FB (prothrombin time-derived method), WBC, ANC, and CRP was assessed by the area under the curve (AUC) of the receiver operating characteristic curve. A total of 275 patients were enrolled in the study (143 NSAP, 100 uncomplicated appendicitis, and 32 complicated appendicitis). WBC and ANC had a moderate diagnostic accuracy for appendicitis vs NSAP (WBC: AUC 0.79, ANC: AUC 0.79). FB and CPR had a poor diagnostic accuracy for appendicitis vs NSAP (FB: AUC 0.63, CRP: AUC 0.64) and a good diagnostic accuracy for complicated vs uncomplicated appendicitis (FB: AUC 0.86, CRP: AUC 0.90). All inflammatory markers had a good diagnostic accuracy for complicated appendicitis vs NSAP. WBC and ANC are useful inflammatory markers to discriminate appendicitis from NSAP. FB and CRP are not very useful to discriminate appendicitis from NSAP, but they discriminate properly complicated from uncomplicated appendicitis and NSAP, with a similar diagnostic accuracy. In a child with suspected appendicitis, a plasma FB level (prothrombin time-derived method) >520 mg/dL is associated to an increased likelihood of complicated appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis. (United States)

    Lee, Kwang-Hoon; Choi, Sang-Tae; Lee, Soo-Kyung; Lee, Joo-Hyun; Yoon, Bo-Young


    Septic arthritis and gout are major diseases that should be suspected in patients with acute monoarthritis. These two diseases are clinically similar and often indistinguishable without the help of synovial fluid analysis. Recently, a novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances. This study aimed to determine whether this diagnostic rule could perform well in distinguishing gout from septic arthritis. The diagnostic rule comprises 7 clinical and laboratory variables, each of which is given a specified score. The probability of gout is classified into 3 groups according to the sum of the scores: high (≥ 8), intermediate (> 4 to arthritis (n = 54) based on synovial fluid analysis. The mean sum of scores of acute gout patients was significantly higher than that of those with septic arthritis (8.6 ± 0.2 vs. 3.6 ± 0.32, P arthritis (Eta[η]: 0.776). The prevalence of acute gouty arthritis, as confirmed by the presence of monosodium crystal, was 95.5% (61/64), 57.5% (19/33), and 5.1% (2/39) in high, intermediate and low probability group, respectively. The recently introduced diagnostic rule properly discriminates acute gout from septic arthritis. It may help physicians diagnose gout in cases difficult to be differentiated from septic arthritis.

  3. Five-class differential diagnostics of neurodegenerative diseases using random undersampling boosting. (United States)

    Tong, Tong; Ledig, Christian; Guerrero, Ricardo; Schuh, Andreas; Koikkalainen, Juha; Tolonen, Antti; Rhodius, Hanneke; Barkhof, Frederik; Tijms, Betty; Lemstra, Afina W; Soininen, Hilkka; Remes, Anne M; Waldemar, Gunhild; Hasselbalch, Steen; Mecocci, Patrizia; Baroni, Marta; Lötjönen, Jyrki; Flier, Wiesje van der; Rueckert, Daniel


    Differentiating between different types of neurodegenerative diseases is not only crucial in clinical practice when treatment decisions have to be made, but also has a significant potential for the enrichment of clinical trials. The purpose of this study is to develop a classification framework for distinguishing the four most common neurodegenerative diseases, including Alzheimer's disease, frontotemporal lobe degeneration, Dementia with Lewy bodies and vascular dementia, as well as patients with subjective memory complaints. Different biomarkers including features from images (volume features, region-wise grading features) and non-imaging features (CSF measures) were extracted for each subject. In clinical practice, the prevalence of different dementia types is imbalanced, posing challenges for learning an effective classification model. Therefore, we propose the use of the RUSBoost algorithm in order to train classifiers and to handle the class imbalance training problem. Furthermore, a multi-class feature selection method based on sparsity is integrated into the proposed framework to improve the classification performance. It also provides a way for investigating the importance of different features and regions. Using a dataset of 500 subjects, the proposed framework achieved a high accuracy of 75.2% with a balanced accuracy of 69.3% for the five-class classification using ten-fold cross validation, which is significantly better than the results using support vector machine or random forest, demonstrating the feasibility of the proposed framework to support clinical decision making.

  4. Five-class differential diagnostics of neurodegenerative diseases using random undersampling boosting

    Directory of Open Access Journals (Sweden)

    Tong Tong


    Full Text Available Differentiating between different types of neurodegenerative diseases is not only crucial in clinical practice when treatment decisions have to be made, but also has a significant potential for the enrichment of clinical trials. The purpose of this study is to develop a classification framework for distinguishing the four most common neurodegenerative diseases, including Alzheimer's disease, frontotemporal lobe degeneration, Dementia with Lewy bodies and vascular dementia, as well as patients with subjective memory complaints. Different biomarkers including features from images (volume features, region-wise grading features and non-imaging features (CSF measures were extracted for each subject. In clinical practice, the prevalence of different dementia types is imbalanced, posing challenges for learning an effective classification model. Therefore, we propose the use of the RUSBoost algorithm in order to train classifiers and to handle the class imbalance training problem. Furthermore, a multi-class feature selection method based on sparsity is integrated into the proposed framework to improve the classification performance. It also provides a way for investigating the importance of different features and regions. Using a dataset of 500 subjects, the proposed framework achieved a high accuracy of 75.2% with a balanced accuracy of 69.3% for the five-class classification using ten-fold cross validation, which is significantly better than the results using support vector machine or random forest, demonstrating the feasibility of the proposed framework to support clinical decision making.

  5. Toward First Principle Medical Diagnostics: On the Importance of Disease-Disease and Sign-Sign Interactions

    Directory of Open Access Journals (Sweden)

    Abolfazl Ramezanpour


    Full Text Available A fundamental problem in medicine and biology is to assign states, e.g., healthy or diseased, to cells, organs or individuals. State assignment or making a diagnosis is often a nontrivial and challenging process and, with the advent of omics technologies, the diagnostic challenge is becoming more and more serious. The challenge lies not only in the increasing number of measured properties and dynamics of the system (e.g., cell or human body but also in the co-evolution of multiple states and overlapping properties, and degeneracy of states. We develop, from first principles, a generic rational framework for state assignment in cell biology and medicine, and demonstrate its applicability with a few simple theoretical case studies from medical diagnostics. We show how disease–related statistical information can be used to build a comprehensive model that includes the relevant dependencies between clinical and laboratory findings (signs and diseases. In particular, we include disease-disease and sign–sign interactions and study how one can infer the probability of a disease in a patient with given signs. We perform comparative analysis with simple benchmark models to check the performances of our models. We find that including interactions can significantly change the statistical importance of the signs and diseases. This first principles approach, as we show, facilitates the early diagnosis of disease by taking interactions into accounts, and enables the construction of consensus diagnostic flow charts. Additionally, we envision that our approach will find applications in systems biology, and in particular, in characterizing the phenome via the metabolome, the proteome, the transcriptome, and the genome.

  6. Diagnostic Value of Measurement Specific Gravity by Refractometric and Dipstick Method in Differentiation between Transudate and Exudate in Pleural and Peritoneal Fluid (United States)

    Abdollahi, Alireza; Nozarian, Zohreh


    Background: Accumulation of pleural and peritoneal fluid is seen in some diseases. In order to diagnose the disease and start the treatment, one of the most important actions will be to differentiate between exudates and transudates. The objective of this study was to determine the diagnostic value of measuring the specific gravity of the fluid through refractometer and strip in differentiation of exudates from transudates. Methods: The serum of patients was evaluated for protein, LDH, cholesterol, bilirubin and albumin. The fluid was evaluated for the number of white blood cells, protein, LDH, cholesterol, bilirubin and albumin. Then the fluids were divided into exduate and transudate categories based on Light and Gradient criteria. Finally, the specific gravity of the fluids was measured by refractometer, Erma, Japan and Medi-Test Combi II. The categorized fluids were compared with Gold Standards (final diagnosis) so that the sensitivity and specificity of Light and Gradient criteria in the transudate-exudate differentiation were specified. Results: In comparison with Light criteria, the cut off level of 1022 specific gravity measured by refractometer for pleural effusion has sensitivity, specificity of 92.1%, 68.1%respectively. In evaluation of peritoneal fluid considering cut off point 1023, measured by refractometer has reliable sensitivity 92.4%, specificity 70.4 compared with standard gradient method. Conclusion: Differentiating transudate from exudates by measuring its special gravity by refractometer will have acceptable sensitivity and specificity, and when rapidity is necessary or access to lab equipment is limited, this method could be used. PMID:28855928

  7. Focal Myopericarditis as a Rare but Important Differential Diagnosis of Myocardial Infarction; a Case Series

    Directory of Open Access Journals (Sweden)

    Younes Nozari


    Full Text Available Distinguishing ST-elevation myocardial infarction (STEMI differential diagnoses is more challenging. Myopericarditis is one of these differentials that results from viral involvement of myocardium and pericardium of the heart. Myopericarditis in focal form can mimic acute STEMI in its electrocardiogram (ECG features and elevated cardiac enzymes.Myocarditis patients may face thrombolytic related complications such as intracranial bleeding, myocardial rupture, and hemorrhagic cardiac tamponade. Furthermore, re-administration of streptokinase (a common thrombolytic agent in our country is banned for at least six months of previous administration; however, it can save patients’ lives in emergency conditions such as massive pulmonary embolism. It seems that, when dealing with a young patient presenting to emergency department with acute chest pain and ST segment elevation on ECG, we should consider focal myocarditis as an important but rare differential diagnosis of STEMI. In this report, we describe three cases of focal myocarditis, primarily misdiagnosed as STEMI. Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

  8. [Differential diagnostics of chronic tonsillitis based on the severity of manifestations of tonsillogenic intoxication of the organism]. (United States)

    Pal'chun, V T; Gurov, A V; Aksenova, A V; Guseva, O A


    The objective of the present study was to elucidate the objective diagnostic criteria for the differentiation between various forms of chronic tonsillitis (CT) based on the results of clinical, bacteriological, and serological investigations. A total of 13 patients presenting with various forms of CT were available for the examination. The mathematical analysis of the data thus obtained made it possible to identify the most clinically significant diagnostic criteria allowing to verify the form of CT. It is concluded that their application in the combination with the classification of chronic tonsillitis proposed earlier by B.S. Preobrazhensky and V.T. Pal'chun can be recommended for the choice of the most adequate strategy for the treatment of the patients chronic tonsillitis on an individual basis.

  9. [Practical diagnostics of acid-base disorders: part I: differentiation between respiratory and metabolic disturbances]. (United States)

    Deetjen, P; Lichtwarck-Aschoff, M


    The first part of this overview on diagnostic tools for acid-base disorders focuses on basic knowledge for distinguishing between respiratory and metabolic causes of a particular disturbance. Rather than taking sides in the great transatlantic or traditional-modern debate on the best theoretical model for understanding acid-base physiology, this article tries to extract what is most relevant for everyday clinical practice from the three schools involved in these keen debates: the Copenhagen, the Boston and the Stewart schools. Each school is particularly strong in a specific diagnostic or therapeutic field. Appreciating these various strengths a unifying, simplified algorithm together with an acid-base calculator will be discussed.

  10. Polarization-correlation diagnostics and differentiation of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2 (United States)

    Marchuk, Yu F.; Fediv, O. I.; Ivashchuk, I. O.; Andriychuk, D. R.


    The principles of optical modeling of human bile polycrystalline structure are described. The main types of polycrystalline structures are detailed. It has been proposed and founded the scenarios of formation of bile microscopic images polarization structure in coherent radiation. The results of investigating the interrelation between statistical moments of the 1st-4th order are presented that characterize the coordinate distributions of intensity of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  11. Non-Linear EMG Parameters for Differential and Early Diagnostics of Parkinson's Disease. (United States)

    Meigal, Alexander Y; Rissanen, Saara M; Tarvainen, Mika P; Airaksinen, Olavi; Kankaanpää, Markku; Karjalainen, Pasi A


    The pre-clinical diagnostics is essential for management of Parkinson's disease (PD). Although PD has been studied intensively in the last decades, the pre-clinical indicators of that motor disorder have yet to be established. Several approaches were proposed but the definitive method is still lacking. Here we report on the non-linear characteristics of surface electromyogram (sEMG) and tremor acceleration as a possible diagnostic tool, and, in prospective, as a predictor for PD. Following this approach we calculated such non-linear parameters of sEMG and accelerometer signal as correlation dimension, entropy, and determinism. We found that the non-linear parameters allowed discriminating some 85% of healthy controls from PD patients. Thus, this approach offers considerable potential for developing sEMG-based method for pre-clinical diagnostics of PD. However, non-linear parameters proved to be more reliable for the shaking form of PD, while diagnostics of the rigid form of PD using EMG remains an open question.

  12. Nonlinear EMG parameters for differential and early diagnostics of Parkinson's disease

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    Alexander eMeigal


    Full Text Available The pre-clinical diagnostics is essential for management of Parkinson’s disease (PD. . Although PD has been studied intensively in the last decades, the pre-clinical indicators of that motor disorder have yet to be established. Several approaches were proposed but the definitive method is still lacking. Here we report on the non-linear characteristics of surface electromyogram (sEMG and tremor acceleration as a possible diagnostic tool, and, in prospective, as a predictor for PD. Following this approach we calculated such nonlinear parameters of sEMG and accelerometer signal as correlation dimension, entropy and determinism. We found that the nonlinear parameters allowed discriminating some 85% of healthy controls from PD patients. Thus, this approach offers considerable potential for developing sEMG-based method for pre-clinical diagnostics of PD. However, non-linear parameters proved to be more reliable for the shaking form of PD, while diagnostics of the rigid form of PD using EMG remains an open question.

  13. The diagnostic and prognostic importance of oxidative stress biomarkers and acute phase proteins in Urinary Tract Infection (UTI) in camels. (United States)

    El-Deeb, Wael M; Buczinski, Sébastien


    The present study aimed to investigate the diagnostic and prognostic importance of oxidative stress biomarkers and acute phase proteins in urinary tract infection (UTI) in camels. We describe the clinical, bacteriological and biochemical findings in 89 camels. Blood and urine samples from diseased (n = 74) and control camels (n = 15) were submitted to laboratory investigations. The urine analysis revealed high number of RBCS and pus cells. The concentrations of serum and erythrocytic malondialdehyde (sMDA & eMDA), Haptoglobin (Hp), serum amyloid A (SAA), Ceruloplasmin (Cp), fibrinogen (Fb), albumin, globulin and interleukin 6 (IL-6) were higher in diseased camels when compared to healthy ones. Catalase, super oxide dismutase and glutathione levels were lower in diseased camels when compared with control group. Forty one of 74 camels with UTI were successfully treated. The levels of malondialdehyde, catalase, super oxide dismutase, glutathione, Hp, SAA, Fb, total protein, globulin and IL-6 were associated with the odds of treatment failure. The MDA showed a great sensitivity (Se) and specificity (Sp) in predicting treatment failure (Se 85%/Sp 100%) as well as the SAA (Se 92%/Sp 87%) and globulin levels (Se 85%/Sp 100%) when using the cutoffs that maximizes the sum of Se + Sp. Multivariate logistic regression analysis revealed that two models had a high accuracy to predict failure with the first model including sex, sMDA and Hp as covariates (area under the receiver operating characteristic curve (AUC) = 0.92) and a second model using sex, SAA and Hp (AUC = 0.89). Conclusively, the oxidative stress biomarkers and acute phase proteins could be used as diagnostic and prognostic biomarkers in camel UTI management. Efforts should be forced to investigate such biomarkers in other species with UTI.

  14. Diagnostic differentiation of mild cognitive impairment due to Alzheimer's disease using a hippocampus-dependent test of spatial memory. (United States)

    Moodley, Kuven; Minati, Ludovico; Contarino, Valeria; Prioni, Sara; Wood, Ruth; Cooper, Rebecca; D'Incerti, Ludovico; Tagliavini, Fabrizio; Chan, Dennis


    The hippocampus is one of the earliest brain regions affected in Alzheimer's disease (AD) and tests of hippocampal function have the potential to detect AD in its earliest stages. Given that the hippocampus is critically involved in allocentric spatial memory, this study applied a short test of spatial memory, the 4 Mountains Test (4MT), to determine whether test performance can differentiate mild cognitive impairment (MCI) patients with and without CSF biomarker evidence of underlying AD and whether the test can distinguish patients with MCI and mild AD dementia when applied in different cultural settings. Healthy controls (HC), patients with MCI, and mild AD dementia were recruited from study sites in UK and Italy. Study numbers were: HC (UK 20, Italy 10), MCI (UK 21, Italy 14), and AD (UK 11, Italy 9). Nineteen UK MCI patients were grouped into CSF biomarker-positive (MCI+, n = 10) and biomarker-negative (MCI-, n = 9) subgroups. Behavioral data were correlated with hippocampal volume and cortical thickness of the precuneus and posterior cingulate gyrus. Spatial memory was impaired in both UK and Italy MCI and AD patients. Test performance additionally differentiated between MCI+ and MCI- subgroups (P = 0.001). A 4MT score of ≤8/15 was associated with 100% sensitivity and 90% specificity for detection of early AD (MCI+ and mild AD dementia) in the UK population, and with 100% sensitivity and 50% specificity for detection of MCI and AD in the Italy sample. 4MT performance correlated with hippocampal volume in the UK population and cortical thickness of the precuneus in both study populations. In conclusion, performance on a hippocampus-sensitive test of spatial memory differentiates MCI due to AD with high diagnostic sensitivity and specificity. The observation that similar diagnostic sensitivity was obtained in two separate study populations, allied to the scalability and usability of the test in community memory clinics, supports future application of the 4MT

  15. Diagnostic whole body scan (pre-therapy scan in differentiated thyroid cancer: A single center community hospital experience

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    P Santhanam


    Full Text Available Objective: Diagnostic whole body scan (pre-therapy scan with either I-123 or I-131 (radioactive isotopes of iodine is performed to assess the extent of thyroid cancer especially distant metastasis prior to administering the therapeutic dose of I-131. Our aim of the following study was to determine the utility of the diagnostic pre-therapy scan in the management of differentiated thyroid cancer. Materials and Methods: It was a case-control study carried out by retrospective chart review, of a randomly selected 100 patients with differentiated thyroid cancer who had followed in our community hospital over the course of 1 year. We collected data on multiple variables in the subjects - including age, gender, pre-operative size of the nodules, diagnosis, stage of the malignancy, size of the tumor, multifocality, lymphovascular invasion, dose of radioiodine used for remnant ablation, recurrence rates and persistence rates. Continuous variables were compared using the independent sample Mann-Whitney U-test whereas the Chi-square test was used for nominal variables. Results: The mean dose of radioactive iodine administered was 97.56 (±27.98 in the pre-therapy scan group and it was 97.23 (±32.40 in the control group. There was no difference between the two groups (P - 0.45. There was also no difference in the recurrence rates between the groups (P = 1.0. There was a trend toward a higher degree of persistent cancer in the group that had the pre-therapy scans (P - 0.086. Conclusion: Pre-therapy scan may not affect the dose of radio-iodine I-131 used for remnant ablation of differentiated thyroid cancer and does not influence the recurrence rates. This was especially true with respect to I-131 remnant ablation for low risk tumors.

  16. Circulating thyroid stimulating hormone receptor messenger RNA and differentiated thyroid cancer: A diagnostic meta-analysis (United States)

    Kong, Chao-Yue; Li, Zhan-Ming; Wang, Li-Shun


    Thyroid stimulating hormone receptor messenger RNA (TSHR-mRNA) is over-expressed in thyroid cancer patients, which indicates that TSHR-mRNA is a potential biomarker of thyroid cancer. However, system evaluation for TSHR-mRNA as a diagnostic biomarker of thyroid cancer is deficient. The performance of TSHR-mRNA for thyroid cancer diagnosis was evaluated in this study. Three common international databases as well as a Chinese database were applied for literature researching. Quality assessment of the included literatures was conducted by the QUADAS-2 tool. Totally, 1027 patients from nine studies eligible for the meta-analysis were included in this study. Global sensitivity and specificity for the positivity of TSHR-mRNA in the thyroid cancer diagnosis is 72% and 82%. The value of AUC for this test performance was 0.84. Our meta-analysis suggests that TSHR-mRNA might be a potential biomarker to complete present diagnostic methods for early and precision diagnosis of thyroid cancer. Notably, this findings need validation thorough large-scale clinical studies. PMID:28036261

  17. The Value of Naproxen Test as a Diagnostic Method to Differentiate Cause of Fever

    Directory of Open Access Journals (Sweden)

    Omer Coskun


    Full Text Available Objective: Fever of whatever etiology still remains a perplexing problem to both clinicians and investigators. Increasingly, its role in connective tissue diseases, malignancies and other inflammatory disorders is slowly supplanting the exclusivity of the symptom to just infectious conditions. This study aims to determine the sensitivity of the naproxen test and the diagnostic value in patients with a prolonged febrile illness. Methods: We evaluated twenty patients had been administered the naproxen test. Fever lysis after or within the time frame of drug administration was interpreted as a infectious or an infectious condition. Results: Infectious diseases etiology was detected at 15 patients. 12 and 3 of them responded to naproxen test at the first and second days respectively. Two of non-infectious etiology patients remained unanswered. Conclusion: This study clearly showed that the naproxen test cannot be relied upon to guide diagnostic decision making in patients with fever unknown origin. [TAF Prev Med Bull 2012; 11(6.000: 779-782

  18. [Dissociation (conversion) - malingering - antisocial personality disorder: differential diagnostic reflection on the basis of a case study]. (United States)

    Rothuber, Helfried; Mitterauer, Bernhard


    In this case report we refer to the big challenge of making a diagnosis in a deliberate malingering in the field of mental disorders. We specifically describe the difficulty regarding the differentiation between a conversion disorder and malingering of a serial delinquent. For such a person avoiding criminal persecution is one of the most frequent reason to deceitfully simulate a mental illness. In this field, symptoms of conversion disorders exceed the average; furthermore, a great number of organic-neurological illnesses may appear to be very similar to a conversion disorder or in many cases a neurological disorder can actually be detected in the course of a somatic examination. A further obstacle for the differential diagnosis can be seen in the difficulty to discern it from factitious disorders. However, it is quite possible to discern the deliberate malingering of a mental disorder from a conversion disorder by means of the diligent diagnosis of a competent and experienced doctor/assessor who specialises.

  19. A Case of Bilateral Cystic Partially Differentiated Nephroblastoma vs Cystic Wilms' Tumor: Highlighting a Diagnostic Dilemma. (United States)

    Stout, Thomas E; Au, Jason K; Hicks, J M; Gargollo, Patricio C


    Cystic partially differentiated nephroblastoma (CPDN) is a rare multicystic renal tumor along the spectrum of cystic nephroma and cystic Wilms' tumor. There have only been two previously reported cases of bilateral CPDN in the literature. We present here a case of bilateral CPDN vs cystic Wilms' tumor treated with neoadjuvant and adjuvant chemotherapy in addition to a bilateral partial nephrectomy. We also review the relevant literature regarding CPDN in an effort to aid in diagnosis and management of these rare cystic renal tumors.

  20. Differential interferometric phases at high spectral resolution as a sensitive physical diagnostic of circumstellar disks

    CERN Document Server

    Faes, D M; Rivinius, Th; Štefl, S; Baade, D; de Souza, A Domiciano


    Context. The circumstellar disks ejected by many rapidly rotating B stars (so-called Be stars) offer the rare opportunity of studying the structure and dynamics of gaseous disks at high spectral as well as angular resolution. Aims. This paper explores a newly identified effect in spectro-interferometric phase that can be used for probing the inner regions of gaseous edge-on disks on a scale of a few stellar radii. Methods. The origin of this effect (dubbed central quasi-emission phase signature, CQE-PS) lies in the velocity-dependent line absorption of photospheric radiation by the circumstellar disk. At high spectral and marginal interferometric resolution, photocenter displacements between star and isovelocity regions in the Keplerian disk reveal themselves through small interferometric phase shifts. To investigate the diagnostic potential of this effect, a series of models are presented, based on detailed radiative transfer calculations in a viscous decretion disk. Results. Amplitude and detailed shape of ...

  1. Ways of Sonoelastography Diagnostic Value Improvement in the Differentiation of Thyroid Nodules

    Directory of Open Access Journals (Sweden)

    D A Vasilyev


    Full Text Available Over last ten years, the clinical significance of real-time elastography or sonoelastography (SEG has been widely discussed for the discovery of thyroid cancer. However, there is no works which revealed the relation between parameters of SEG and endocrine status of the patients for improving of diagnostic value of this method; this issue was the aim of our study. 81 patients (20 - benign adenomas and 61 - thyroid cancer (TC: 13 - follicular and 48 - papillary were evaluated prospectively. Mean age was 48.0 ± 16.4 years. It was shown that the blue colour or 4-5 elastotype of SEG was mainly discovered in TC vs adenoma (65.6% vs 20.0% χ2 = 12.61, р = 0.0004. At the same time, the Strain Ratio more than 3.0 was frequently revealed in TC patients vs adenoma (57.4% vs 40.0% but it did not reach level of significance (χ2 = 1,83, р = 0,18. Parameters of the sensitivity, specificity and accuracy were equal 90.2%, 60.0% and 82.7% for SEG, and 96.7%, 40.0% and 82.7% for fine-needle aspiration biopsy (FNAB, respectively. The combination of 38 SEG with FNAB or with body mass index increased specificity of SEG by 65% and 70%, respectively. The combination of SEG with another measures of hormone-metabolic status (glucose level, TSH, thyroglobulin, etc did not improve diagnostic accuracy of SEG. In result, SEG was slightly more specific than FNAB in predicting malignancy of the thyroid nodules. The specificity of SEG could be increased by combination with both FNAB and anthropometry. Further improvement of presurgical diagnosis of TC, especially follicular TC, could be possibly reached via the combination of cytological, hormonal, genetic and instrumental methods, including shear wave elastography.

  2. The Diagnostic Value of B-Mode Sonography in Differentiation of Malignant and Benign Tumors of the Parotid Gland (United States)

    Khalife, Ali; Bakhshaee, Mehdi; Davachi, Behrouz; Mashhadi, Leila; Khazaeni, Kamran


    Introduction: Different imaging modalities are used to evaluate salivary gland diseases, including tumors. Ultrasonography (US) is the preferred method on account of its ease of use, affordability, safety profile, and good tolerance among patients. The aim of this study was to evaluate the role of US in differentiating malignant from benign parotid tumors, in the context of previous controversy in the literature on this subject. Materials and Methods: A cross-sectional study was performed in patients who presented to Qaem Medical Center with parotid masses and who were candidates for parotidectomy between June 2013 and January 2015. Patients were initially referred for a diagnostic US of the parotid. US examinations were performed and sonographic features were reported. The tumors were then classified as benign or malignanton the basis of literature descriptions of the US features of parotid tumors, and were next diagnosed pathologically. The sensitivity, specificity, positive predictive value, and negative predictive value of US for the purpose of differentiating malignant from benign tumors were then calculated. Results: Twenty-eight patients (aged 18–92 years) underwent US of parotid masses. Twenty-three tumors were diagnosed as benign and five were diagnosed as malignant. The final histopathologic examination showed 21 benign and seven malignant tumors. The sensitivity, specificity, positive predictive value, and negative predictive value of US for differentiating malignant from benign tumors were calculated as 57%, 95%, 80%, and 87%, respectively. Conclusion: US has a high specificity in differentiating between malignant and benign tumors. However, fine needle aspiration or core needle biopsy is advocated for an exact diagnosis. PMID:27738606

  3. Statistical analysis of synovial fluid layers phase maps in the diagnostics of development and differentiation of pathological changes severity (United States)

    Kvasniuk, D. I.; Vasyuk, V. L.


    A new method for differential diagnosis of pathological changes of the joints on the basis of synovial fluid was founded. Adduced description scheme and the principles of polarization filtering to determine the coordinate distributions of phase shifts.The optical model of polycrystalline networks of knee joint synovial fluid is suggested. The results of investigating the interrelation between the values of statistical (statistical moments of the 1st-4th order) parameters are presented. They characterize the coordinate distributions of phase shifts between the orthogonal components of the amplitude in the points of laser images of synovial fluid smears and the change in optical anisotropy of this biological object. The diagnostic criteria of knee joint inflammation processes are determined.

  4. Chylothorax in a patient with metastatic Kaposi sarcoma: Differential diagnostic considerations

    Directory of Open Access Journals (Sweden)

    Ryan Alexander, DO


    Full Text Available Kaposi sarcoma (KS is a low-grade mesenchymal tumor involving blood and lymphatic vessels. There are four types, based on clinical presentation: classic, endemic (Africana, iatrogenic (typically, involving renal allograft recipients, and AIDS-associated (epidemic. Kaposi's sarcoma-associated herpes virus infection has been linked along with other factors to the development of KS. The Kaposi's sarcoma-associated herpes virus interacts and encodes for numerous molecular proteins that play a role in the pathogenesis of KS, including latency-associated nuclear antigen, viral G protein-coupled receptor, viral FLICE inhibitory protein, and viral IL-6. KS primarily affects the skin and causes disseminated disease in a variety of organs. Involvement of visceral organs other than the lining of the alimentary tract is extremely rare. While the chylous pleural effusions of KS may resemble other pulmonary diseases (including lymphangioma, lymphangectasis, and lymphangioleiomyomatosis with chylous effusions at thoracic CT, differentiating features may allow for more prompt diagnosis and treatment. The presumptive diagnosis of AIDS-related pulmonary KS is often clinical. A tissue diagnosis is not required to establish the diagnosis of pulmonary KS. There are a variety of causes of chylothorax. The primary finding is a near-water-attenuating pleural effusion. The secondary findings of chylothorax can help differentiate the etiology.

  5. Graduated diagnostics required. Broad spectrum of differential diagnoses; Stufendiagnostik erforderlich. Breites Spektrum an Differentialdiagnosen

    Energy Technology Data Exchange (ETDEWEB)

    Auer, I.O. [Medizinische Klinik Juliusspital, Schwerpunkt Gastroenterologie/Rheumatologie, Wuerzburg (Germany)


    The time lapse between initial symptoms and secured diagnosis of colitis ulcerosa still is 6-8 weeks, in case of M. Crohn even about 30 weeks. A graduated diagnostic approach is required: phase 1 relies on non-invasive methods such as anamnesis, physical examination, examination of stools, blood chemistry and sonography of the abdomen; phase 2 ecompasses endoscopy and radiological techniques, phase 3 computed tomography and MRI for detection of complications. The results of the leucodiagnosis by scintiscanning, for detection of inflammations of and out of the intestine, offer a still inhomogenous picture in terms of sensitivity and specificity. (orig./MG) [Deutsch] Noch immer betraegt die Zeitspanne von den ersten Symptomen bis zur Diagnose bei Colitis ulcerosa 6 bis 8 Wochen, bei M. Crohn sogar etwa 30 Wochen. Eine Stufendiagnostik ist gefordert: Stufe 1 umfasst nicht-invasive Methoden wie Anamnese, koerperliche Untersuchung, Stuhluntersuchung, Blutchemie und Abdomen-Sonographie, Stufe 2 die Endoskopie und radiologische Methoden, Stufe 3 die CT und die MRT zur Erkennung von Komplikationen. Die Ergebnisse der Leukozytenszintigraphie zum Nachweis entzuendlicher Veraenderungen am und ausserhalb des Darms sind hinsichtlich Spezifitaet und Sensitivitaet noch sehr uneinheitlich. (orig./MG)

  6. Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma (United States)

    Rana, Abdul Qayyum; Saeed, Usman; Khan, Osama A.; Qureshi, Abdul Rehman M.; Paul, Dion


    Giant cell arteritis (GCA) or Temporal arteritis (TA) is an autoimmune disease and the most common type of vasculitis in the elderly. It causes inflammation of the medium and large arteries in the upper part of the body. GCA is an under-recognized cause of  head aches in the elderly, especially when it presents itself with atypical features, resulting in delayed or incorrect diagnosis. Since GCA is a treatable condition, an accurate diagnosis is crucial to prevent the most serious complication of CGA, permanent vision loss. The diagnosis can be further complicated as GCA may present with features of other painful neurological conditions. The present case is an 81-year-old woman diagnosed with GCA, who initially presented with features similar to tension-type headache. Due to overlapping features of these conditions, the diagnosis of GCA was delayed, resulting in irreversible vision loss. Although previous research highlights diagnostic dilemmas featuring GCA and other disease states, this case is exclusive in describing a unique dilemma where tension-type headache mimics GCA. PMID:25288850

  7. Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Abdul Qayyum Rana


    Full Text Available Giant cell arteritis (GCA or Temporal arteritis (TA is an autoimmune disease and the most common type of vasculitis in the elderly. It causes inflammation of the medium and large arteries in the upper part of the body. GCA is an under-recognized cause of  head aches in the elderly, especially when it presents itself with atypical features, resulting in delayed or incorrect diagnosis. Since GCA is a treatable condition, an accurate diagnosis is crucial to prevent the most serious complication of CGA, permanent vision loss. The diagnosis can be further complicated as GCA may present with features of other painful neurological conditions. The present case is an 81-year-old woman diagnosed with GCA, who initially presented with features similar to tension-type headache. Due to overlapping features of these conditions, the diagnosis of GCA was delayed, resulting in irreversible vision loss. Although previous research highlights diagnostic dilemmas featuring GCA and other disease states, this case is exclusive in describing a unique dilemma where tension-type headache mimics GCA.

  8. Spinal cord cavities; Differential-diagnostic criteria in magnetic resonance imaging

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    Schubeus, P.; Schoerner, W.; Hosten, N.; Felix, R. (Free University of Berlin, University Clinic Rudolf Virchow, Charlottenburg (Germany). Department of Radiology)

    MRI examinations of 30 patients with idiopathic syringomyelia and 10 patients with cavities associated with an intramedullary neoplasm were evaluated with respect to typical MRI features in both groups. Al tumor-associated cases resembled the idiopathic syringomyelias in some portions of the cavity. At the tumor site, however, tumor-associated cases demonstrated typical findings; the cavities showed abrupt changes of diameter (10/10) and position (8/10) and the surrounding spinal cord demonstrated an uneven thickness (10/10), an increased signal intensity on T2-weighted images (10/10) and pathological contrast enhancement (7/7). Displacement of cerebellar tonsils below the level of the foramen magnum (921/30) and enlargement of the spinal canal (97/29) were characteristic features of idiopathic cases. In conclusion, MRI provides valuable criteria to differentiate between idiopathic and tumor-associated cavities. (author). 19 refs.; 4 figs.; 1 tab.

  9. Importance of clinical examination in diagnostics of Osgood-Schlatter Disease in boys playing soccer or basketball

    Directory of Open Access Journals (Sweden)

    Amela Halilbasic


    Full Text Available Introduction: Osgood–Schlatter disease is an irritation of the patellar tendon at the tibial tubercle. Sports with jumps, running, and repeated contractions of knee extension apparatus are considered to be importantexternal risk-factors which could cause Osgood–Schlatter disease.Objectives of the study are to draw attention to the importance of clinical examination in diagnostics of Osgood–Schlatter disease in boys playing soccer or basketball.Methods: The research included data obtained from 120 boys, average age of 14 years. Examinees were split into two groups, one with young athletes which regularly have soccer or basketball trainings and thesecond one with boys who do not participating in sports. We performed anthropological measurements and clinical examinations of both knees and hips for both groups. For the statistical analysis we used pointbiserialcorrelation coefficient.Results: Based on clinical examination, Osgood–Schlatter disease was diagnosed in 51 examinees (42.5%. In “athletic group” Osgood–Schlatter disease had 31 boys or 52%, comparing with “non-athletic group” wherewe found 20 adolescents with disease (33%. Number of boys with Osgood–Schlatter disease was higher for 19% in “athletic group” comparing with “non-athletic group”. Comparing incidence rate for boys in both groups with diagnosed II and III level of Osgood–Schlatter disease we found that rate is higher in “athletic group” 2.25 times comparing with “non-athletic group”.Conclusions: Clinical examination is critical method in the process of diagnosing Osgood–Schlatter disease especially for identifying II and III level of this disease.

  10. Differentiation between right tubo-ovarian abscess and appendicitis using CT-A diagnostic challenge

    Energy Technology Data Exchange (ETDEWEB)

    Eshed, I., E-mail: [Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel); Halshtok, O. [Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel); Erlich, Z. [Computer Science Department, Open University, Tel Aviv (Israel); Mashiach, R. [Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel); Hertz, M.; Amitai, M.M.; Portnoy, O.; Guranda, L. [Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel); Hiller, N. [Department of Radiology, Hadassah-Hebrew University Medical Center, Mount Scopus (Israel); Apter, S. [Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel)


    Aim: To determine CT features that can potentially differentiate right tubo-ovarian abscess (TOA) from acute appendicitis (AA; including abscess formation). Materials and methods: The abdominal computed tomography (CT) images of 48 patients with right-sided TOA (average age 39.3 {+-} 9.8 years) and 80 patients (average age 53.5 {+-} 19.9 years) with AA (24 with peri-appendicular abscess) were retrospectively evaluated. Two experienced radiologists evaluated 12 CT signs (including enlarged, thickened wall ovary, appendix diameter and wall thickness, peri-appendicular fluid collection, adjacent bowel wall thickening, fat stranding, free fluid, and extraluminal gas) in consensus to categorize the studies as either TOA or AA. The diagnosis and the frequency of each of the signs were correlated with the surgical and clinical outcome. Results: Reviewers classified 92% cases correctly (TOA = 85%, AA = 96.3%), 3% incorrectly (TOA = 6.3%, AA = 1.3%); 5% were equivocal (TOA = 8.3%, AA = 2.5%). In the peri-appendicular abscess group reviewers were correct in 100%. Frequent findings in the TOA group were an abnormal ovary (87.5%), peri-ovarian fat stranding (58.3%), and recto-sigmoid wall thickening (37.5%). An abnormal appendix was observed in 2% of TOA patients. Frequent findings in the AA group were a thickened wall (32.5%) and distended (80%) appendix. Recto-sigmoid wall thickening was less frequent in AA (12.5%). The appendix was not identified in 45.8% of the TOA patients compared to 15% AA. Conclusions: In the presence of a right lower quadrant inflammatory mass, peri-ovarian fat stranding, thickened recto-sigmoid wall, and a normal appearing caecum, in young patients favour the diagnosis of TOA. An unidentified appendix does not contribute to the differentiation between TOA and peri-appendicular abscess.

  11. Metaproteomics analyses as diagnostic tool for differentiation of Escherichia coli strains in outbreaks (United States)

    Jabbour, Rabih E.; Wright, James D.; Deshpande, Samir V.; Wade, Mary; McCubbin, Patrick; Bevilacqua, Vicky


    The secreted proteins of the enterohemorrhagic and enteropathogenic E. coli (EHEC and EPEC) are the most common cause of hemorrhagic colitis, a bloody diarrhea with EHEC infection, which often can lead to life threatening hemolytic-uremic syndrome (HUS).We are employing a metaproteomic approach as an effective and complimentary technique to the current genomic based approaches. This metaproteomic approach will evaluate the secreted proteins associated with pathogenicity and utilize their signatures as differentiation biomarkers between EHEC and EPEC strains. The result showed that the identified tryptic peptides of the secreted proteins extracted from different EHEC and EPEC growths have difference in their amino acids sequences and could potentially utilized as biomarkers for the studied E. coli strains. Analysis of extract from EHEC O104:H4 resulted in identification of a multidrug efflux protein, which belongs to the family of fusion proteins that are responsible of cell transportation. Experimental peptides identified lies in the region of the HlyD haemolysin secretion protein-D that is responsible for transporting the haemolysin A toxin. Moreover, the taxonomic classification of EHEC O104:H4 showed closest match with E. coli E55989, which is in agreement with genomic sequencing studies that were done extensively on the mentioned strain. The taxonomic results showed strain level classification for the studied strains and distinctive separation among the strains. Comparative proteomic calculations showed separation between EHEC O157:H7 and O104:H4 in replicate samples using cluster analysis. There are no reported studies addressing the characterization of secreted proteins in various enhanced growth media and utilizing them as biomarkers for strain differentiation. The results of FY-2012 are promising to pursue further experimentation to statistically validate the results and to further explore the impact of environmental conditions on the nature of the secreted

  12. Cratylia mollis lectin nanoelectrode for differential diagnostic of prostate cancer and benign prostatic hyperplasia based on label-free detection. (United States)

    Silva, Priscila M S; Lima, Amanda L R; Silva, Bárbara V M; Coelho, Luana C B B; Dutra, Rosa F; Correia, Maria T S


    The research for new biomarkers of cancer has studied the role of fetuin glycoprotein on the metastatic disease diagnosis. Cratylia mollis is a lectin with high finity to fetuin, and used here to differentiate prostate cancer and benign prostatic hyperplasia. A label-free electrochemical nanosensor based on assembled carboxylated carbon nanotubes (COOH-CNTs) and poly-L-lysine (PLL) film was developed and applied to serum samples of prostate cancer positive for Gleason score. The electrode analytical response to fetuin in PBS samples, obtained by square wave voltammetry, exhibited a linear range from 0.5 to 25µgmL(-1), with a high correlation coefficient (r=0.994, pprostate cancer patients with known the Gleason score were tested showing a significant statistically correlation. Thus, the lectin nanoelectrode was able to distinguish the degree of staging prostate cancer, providing the diagnostic differentiation of benign and malign hyperplasia. To the best of our knowledge, it is the first biosensor for this application using a lectin.

  13. Surface raw electromyography has a moderate discriminatory capacity for differentiating between healthy individuals and those with TMD: a diagnostic study. (United States)

    Santana-Mora, Urbano; López-Ratón, Mónica; Mora, Maria J; Cadarso-Suárez, Carmen; López-Cedrún, José; Santana-Penín, Urbano


    The use of surface electromyography (sEMG) to identify subjects with chronic temporomandibular disorders (TMD) is controversial. The main objective of this study is to determine the diagnostic accuracy of EMG to differentiate between healthy subjects and those with TMD. This study evaluated 53 individuals with TMD who were referred to the university service and who fulfilled the eligibility criteria during the period of the study. Thirty-eight dental students were also recruited satisfying same eligibility criteria but without TMD. The inclusion criteria were to be fully dentate, have normal occlusion, and be righthanded. The exclusion criteria were periodontal pathology, caries or damaged dental tissues, orthodontic therapy, maxillofacial disease, botulinum A toxin therapy, and psychological disorders. The means of the masseter muscles, right (RM) and left (LM), and temporalis muscles, right (RT) and left (LT), and intraindividual indexes during resting and during clenching were calculated. Raw sEMG activity was used to determine the cutoff points and calculate the diagnostic accuracy of sEMG. The diagnostic accuracy of these variables for a diagnosis of TMD was evaluated by using the Receiver Operating Characteristic (ROC) curve and the area under it (AUC). A new transformed diagnostic variable was obtained by using the Generalized Additive Models (GAM). Optimal cutoff points were obtained where the sensitivity and specificity were similar and by the Youden index. The highest estimated AUC was 0.660 (95% CI 0.605-0.871) corresponding to the rLT variable during rest. When rLT and rACTIVITY (differences divided by sums of temporalis versus masseter muscles) were considered as a linear combination, the AUC increased to 0.742 (95% CI; 0.783-0.934). In conclusion, the raw sEMG evaluation of rest provided moderate sensitivity and specificity to discriminate between healthy individuals and those with TMD. The use of the indexes (mainly assessing the dominance of

  14. SDF-1 and CXCR4 play an important role in adult SVZ lineage cell proliferation and differentiation. (United States)

    Zhu, Chang; Yao, Wen-Long; Tan, Wei; Zhang, Chuan-Han


    Evidence has shown that stromal cell-derived factor (SDF-1/CXCL12) plays an important role in maintaining adult neural progenitor cells (NPCs). SDF-1 is also known to enhance recovery by recruiting NPCs to damaged regions and recent studies have revealed that SDF-1α exhibits pleiotropism, thereby differentially affecting NPC subpopulations. In this study, we investigated the role of SDF-1 in in vitro NPC self-renewal, proliferation and differentiation, following treatment with different concentrations of SDF-1 or a CXCR4 antagonist, AMD3100. We observed that AMD3100 inhibited the formation of primary neurospheres. However, SDF-1 and AMD3100 exhibited no effect on proliferation upon inclusion of growth factors in the media. Following growth factor withdrawal, AMD3100 and SDF-1 treatment resulted in differential effects on NPC proliferation. SDF-1, at a concentration of 500ng/ml, resulted in an increase in the relative proportion of oligodendrocytes following growth factor withdrawal-induced differentiation. Using CXCR4 knockout mice, we observed that SDF-1 affected NPC proliferation in the sub-ventricular zone (SVZ). We also investigated the occurrence of differential CXCR4 expression at different stages during lineage progression. These results clearly indicate that signaling interactions between SDF-1 and CXCR4 play an important role in adult SVZ lineage cell proliferation and differentiation.

  15. Diagnostic Utility of Pleural Effusion and Serum Cholesterol, Lactic Dehydrogenase and Protein Ratios in the Differentiation between Transudates and Exudates

    Directory of Open Access Journals (Sweden)

    Muaz O. Fagere


    Full Text Available This is a descriptive study carried out in Khartoum state hospitals during the period from May 2012 to April 2014. The study aimed to evaluate the diagnostic role of the pleural effusion/serum (CHOL, LDH, and protein ratios in the differentiation between exudate and transudate pleural effusion. As a part of the investigation, 135 serum and pleural effusion samples were collected from patients with accumulated plural effusion. Prior to testing, 5 mL of venous blood and 20 mL of pleural effusion samples were prepared in accordance with specific testing requirements. Exudative pleural effusions were observed in 95 (70.4% samples, of which 64 (67.4% belonged to male patients and 31 (32.6% to females. The calculated means for CHOL, LDH, and protein levels in pleural effusion and serum samples between exudate and transudate effusion showed statistically significant differences with the p-value = 0.000. In distinguishing between exudative and transudate pleural effusion, a high Pearson correlation was observed between CHOL ratio and clinical diagnosis (r = 0.971, as well as between CHOL level in effusion samples and LDH level in serum samples (r = 0.867. Sensitivity, specificity, positive predictive value, and negative predictive value analysis of the parameters in the differentiation between exudate and transudate samples revealed the following values: 97.7% and 100%, 100%, and 95%, respectively, for the CHOL ratio; 86%, 97.4%, 97.4%, and 97%, respectively, for the LDH ratio; and 81.4%, 81.6%, 89.7%, and 70.4%, respectively, for the protein ratio. On the basis of the study findings, it could be concluded that estimation of CHO, LDH, and protein ratios can assist in the differentiation between exudative and transudate pleural effusion and thus patient management. Hence, this approach should be included in routine laboratory analyses of pleural effusions. Nevertheless, additional techniques should be incorporated in the diagnosis of doubtful pleural

  16. Radiolucent rim as a possible diagnostic aid for differentiating jaw lesions

    Energy Technology Data Exchange (ETDEWEB)

    Mortazavi, Hamed; Baharvand, Maryam; Rarahmani, Somayeh; Jafati, Soudeh; Parvaei, Parvin [Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran (Iran, Islamic Republic of)


    In this study, we formulate a new proposal that complements previous classifications in order to assist dental practitioners in performing a differential diagnosis based on patients' radiographs. We used general search engines and specialized databases such as Google Scholar, PubMed, PubMed Central, MedLine Plus, Science Direct, Scopus, and well-recognized textbooks to find relevant studies by using keywords such as 'jaw disease,' 'jaw lesions,' 'radiolucent rim,' 'radiolucent border,' and 'radiolucent halo.' More than 200 articles were found, of which 70 were broadly relevant to the topic. We ultimately included 50 articles that were closely related to the topic of interest. When the relevant data were compiled, the following eight lesions were identified as having a radiolucent rim: periapical cemento-osseous dysplasia, focal cemento-osseous dysplasia, florid cemento-osseous dysplasia, cemento-ossifying fibroma, osteoid osteoma, osteoblastoma, odontoma, and cementoblastoma. We propose a novel subcategory, jaw lesions with a radiolucent rim, which includes eight entities. The implementation of this new category can help improve the diagnoses that dental practitioners make based on patients' radiographs.

  17. Radiolucent rim as a possible diagnostic aid for differentiating jaw lesions (United States)

    Mortazavi, Hamed; Rahmani, Somayeh; Jafari, Soudeh; Parvaei, Parvin


    In this study, we formulate a new proposal that complements previous classifications in order to assist dental practitioners in performing a differential diagnosis based on patients' radiographs. We used general search engines and specialized databases such as Google Scholar, PubMed, PubMed Central, MedLine Plus, Science Direct, Scopus, and well-recognized textbooks to find relevant studies by using keywords such as "jaw disease," "jaw lesions," "radiolucent rim," "radiolucent border," and "radiolucent halo." More than 200 articles were found, of which 70 were broadly relevant to the topic. We ultimately included 50 articles that were closely related to the topic of interest. When the relevant data were compiled, the following eight lesions were identified as having a radiolucent rim: periapical cemento-osseous dysplasia, focal cemento-osseous dysplasia, florid cemento-osseous dysplasia, cemento-ossifying fibroma, osteoid osteoma, osteoblastoma, odontoma, and cementoblastoma. We propose a novel subcategory, jaw lesions with a radiolucent rim, which includes eight entities. The implementation of this new category can help improve the diagnoses that dental practitioners make based on patients' radiographs. PMID:26730374

  18. Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

    Institute of Scientific and Technical Information of China (English)

    Jaap Jacob Kloek; Otto Marinus van Delden; Deha Erdogan; Fibo Jan ten Kate; Erik Anthoni Rauws; Olivier Robert Busch; Dirk Joan Gouma; Thomas Mathijs van Gulik


    AIM: To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures.METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These findings were analyzed to obtain the final diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, group Ⅱ)were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰ vs 60% group Ⅱ, P =0.23). Laboratory findings showed greater elevation of transaminase levels in group I compared to group Ⅱ. The various imaging modalities showed vascular involvement exdusively in the malignant group (36%,P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells.CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy,there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

  19. Comprehensive analysis and differentiated assessment of food safety control systems: a diagnostic instrument

    NARCIS (Netherlands)

    Luning, P.A.; Bango, L.; Kussaga, J.; Rovira, J.; Marcelis, W.J.


    In this article, an instrument is presented to diagnose microbial safety control activities in a food safety management system. The need of such a tool is derived from the importance of microbial safety control and the need for improvement of existing control systems. Careful diagnosis of these syst

  20. High-resolution melting PCR assay, applicable for diagnostics and screening studies, allowing detection and differentiation of several Babesia spp. infecting humans and animals. (United States)

    Rozej-Bielicka, Wioletta; Masny, Aleksander; Golab, Elzbieta


    The goal of the study was to design a single tube PCR test for detection and differentiation of Babesia species in DNA samples obtained from diverse biological materials. A multiplex, single tube PCR test was designed for amplification of approximately 400 bp region of the Babesia 18S rRNA gene. Universal primers were designed to match DNA of multiple Babesia spp. and to have low levels of similarity to DNA sequences of other intracellular protozoa and Babesia hosts. The PCR products amplified from Babesia DNA isolated from human, dog, rodent, deer, and tick samples were subjected to high-resolution melting analysis for Babesia species identification. The designed test allowed detection and differentiation of four Babesia species, three zoonotic (B. microti, B. divergens, B. venatorum) and one that is generally not considered zoonotic-Babesia canis. Both detection and identification of all four species were possible based on the HRM curves of the PCR products in samples obtained from the following: humans, dogs, rodents, and ticks. No cross-reactivity with DNA of Babesia hosts or Plasmodium falciparum and Toxoplasma gondii was observed. The lack of cross-reactivity with P. falciparum DNA might allow using the assay in endemic malaria areas. The designed assay is the first PCR-based test for detection and differentiation of several Babesia spp. of medical and veterinary importance, in a single tube reaction. The results of the study show that the designed assay for Babesia detection and identification could be a practical and inexpensive tool for diagnostics and screening studies of diverse biological materials.

  1. Understanding macrophage differentiation during space flight: The importance of ground-based experiments before space flight. (United States)

    Chapes, Stephen K; Ortega, M Teresa


    In preparation for a space flight on STS-126, two in vitro culture systems were used to investigate macrophage colony stimulating factor-dependent macrophage differentiation from mouse primary bone marrow cells. The patented Techshot Cell Cult Bioreactor and the BioServe Fluid Processing Apparatus (FPA) were operated in different orientations to determine their impact on macrophage growth and differentiation. Bone marrow cell parameters were determined after cells were grown in FPAs incubated at 37°C in vertical or horizontal orientations, and macrophage cell recovery was significantly higher from FPAs that were incubated in the horizontal orientation compared to "vertical" FPAs. Similarly, when bone marrow cells were grown in the Techshot bioreactor, there were significant differences in the numbers of macrophages recovered after 7 days, depending on movement and orientation of the bioreactor. Macrophage recovery was highest when the patented bioreactor was rotated in the horizontal, x-axis plane (merry-go-round fashion) compared to static and vertically, y-axis plane rotated (Ferris wheel fashion) bioreactors. In addition, the expression of F4/80 and other differentiation markers varied depending on whether macrophages differentiated in FPAs or in bioreactors. After 7 days, significant differences in size, granularity and molecule expression were seen even when the same primary bone marrow cells were used to seed the cultures. These data show that culture outcomes are highly dependent on the culture device and device orientation. Moreover, the impact of the culture system needs to be understood in order to interpret space flight data.

  2. Cherubism Gene Sh3bp2 is Important for Optimal Bone Formation, Osteoblast Differentiation and Function (United States)

    Mukherjee, Padma M.; Wang, Chiachien J.; Chen, I-Ping; Jafarov, Toghrul; Olsen, Bjorn R.; Ueki, Yasuyoshi; Reichenberger, Ernst J.


    Introduction Cherubism is a human genetic disorder that causes bilateral symmetrical enlargement of the maxilla and mandible in children. It is caused by mutations in SH3BP2. The exact pathogenesis of the disorder is an area of active research. Sh3bp2 knock-in mice were developed by introducing a Pro416Arg mutation (Pro418Arg in humans) in the mouse genome. The osteoclast phenotype of this mouse model was recently described. Methods We examined the bone phenotype of the cherubism mouse model, the role of Sh3bp2 during bone formation, osteoblast differentiation and osteoblast function. Results We observed delays in early postnatal development of homozygous Sh3bp2KI/KI mice. Sh3bp2KI/KI mice exhibit increased growth plate thickness and significantly decreased trabecular bone thickness and reduced bone mineral density. Histomorphometric and μ-CT analyses reveal bone loss in cranial and appendicular skeleton. Sh3bp2KI/KI mice also exhibit a significant decrease in osteoid formation that indicates a defect in osteoblast function. Calvarial osteoblast cell cultures exhibit a decrease in alkaline phosphatase expression and mineralization suggesting reduced differentiation potential. Gene expression of osteoblast differentiation markers like collagen type-I, alkaline phosphatase and osteocalcin are decreased in osteoblast cultures from Sh3bp2KI/KI mice. Conclusions These data suggest that Sh3bp2 function regulates bone homeostasis not only through osteoclast-specific effects but also through effects on osteoblast differentiation and function. PMID:20691350

  3. Adrenal tumors. Principles of imaging and differential diagnostics; Tumoren der Nebennieren. Prinzipien der Bildgebung und Differenzialdiagnosen

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    Degenhart, C. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Innenstadt, Institut fuer klinische Radiologie, Muenchen (Germany)


    Adrenal masses are very common and are usually detected incidentally. Less frequently, imaging is performed for the localization of the underlying lesion in the case of endocrine disease. The differentiation between adenomas and non-adenomas is fundamental. Adenomas show a low density on unenhanced computed tomography (CT) and a rapid washout of contrast agents. In magnetic resonance imaging (MRI) adenomas are characterized by a low signal in opposed phase imaging as compared to in phase imaging. According to the literature a density of less than 10 HU in an adrenal mass has a specificity of 98 % and a sensitivity of 71 % for the presence of an adenoma and MRI is slightly more sensitive. Some adrenal lesions, e.g. cysts or myelolipomas can be diagnosed with high accuracy due to pathognomonic findings. In the majority of cases the synopsis of imaging along with clinical and laboratory findings is necessary for a reliable diagnosis. For the evaluation of an adrenal mass the CT examination should begin with an unenhanced scan, if necessary followed by a washout examination. In the case of MRI in phase and opposed phase imaging are essential components of the examination. (orig.) [German] Raumforderungen der Nebennieren sind haeufig und werden ueberwiegend inzidentell nachgewiesen. Seltener wird bei einer bereits bekannten endokrinologischen Erkrankung eine radiologische Diagnostik zur Lokalisation eines funktionellen Tumors gezielt durchgefuehrt. Grundlegend ist die Unterscheidung von Adenomen der Nebennieren und nichtadenomatoesen Raumforderungen. Adenome zeigen im Nativ-CT eine niedrige Dichte sowie ein rasches ''wash-out'' in Kontrastmitteluntersuchungen. Im MRT sind Adenome durch ein im Vergleich zur In-phase-Untersuchung niedrigeres Signal in der Opposed-phase-Untersuchung charakterisiert. Der Literatur zufolge spricht eine native Dichte innerhalb einer adrenalen Raumforderung von hoechstens 10 Hounsfield Units (HU) mit 98 % Spezifitaet und 71

  4. Comparison of Diagnostic Performance of US Elastography and Conventional B-mode US in Differentiation of Breast Lesions

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    Kang, Ji Young; Lee, Jin Hwa; Cho, Jin Han; Ha, Dong Ho; Park, Byeong Ho; Choi, Sun Seob [Dept. of Radiology, Dong-A University College of Medicine, Busan (Korea, Republic of); Kim, Eun Kyung [Dept. of Radiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Shin, Su Young [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Byeong Ho [Dept. of Preventive Medicine, Dong-A University College of Medicine, Busan (Korea, Republic of)


    The purpose of this study was to compare the diagnostic performance of ultrasound (US) elastography and conventional B-mode US for discrimination between benign and malignant breast lesions. During a 13-month period, 277 women with 335 sonographically visible breast lesions who were scheduled to undergo biopsy were examined with US elastography. Elastographic findings were classified as benign or malignant based on the area ratio, with 1.00 as the threshold. Findings on conventional B mode US were classified according to the BI-RADS category, as follows: lesions of BIRADS categories 2 and 3 were considered benign, while those in categories 4 and 5 were considered malignant. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and ROC curve analysis for comparison of the diagnostic performance of US elastography and conventional B-mode US. Of the 335 breast lesions, 85 (25.4%) showed malignancy on pathology. Findings on B-mode US showed malignancy in 264 (78.8%) and elastographic findings showed malignancy in 102 (30.4%). The sensitivity, specificity, PPV, NPV, and accuracy of B-mode US and elastography were 98.8%, 28.0%, 31.8%, 98.6%, and 79.4% and 69.4%, 81.2%, 57.8%, 88.8%, and 79.4%, respectively. Elastography showed significantly higher specificity and PPV and lower sensitivity and NPV, compared with B-mode US (p < 0.001). The area under the ROC curve (AUC value) was 0.761 for elastography, and 0.634 for B-mode US (p < 0.001). US elastography can improve specificity and PPV of B-mode US, but with significant sacrifice of sensitivity and NPV. Therefore, US elastography may complement B-mode US for differentiation of breast masses.

  5. Critical Consideration of the "Diagnostic and Statistical Manual": Importance of the Inclusion of Cultural and Contextual Factors (United States)

    Adams, Jennifer R.; Quartiroli, Alessandro


    The authors note that although the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed., text rev.; American Psychiatric Association, 2000) provides a useful tool for assessment and treatment planning, there has been debate over the lack of attention to issues of diversity. The elements of this debate are presented, along with…

  6. Evaluation of the diagnostic performance of platelet-derived indices for the differential diagnosis of thrombocytopenia in pediatrics

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    Nelson Hernando Aponte-Barrios


    Full Text Available Background. Platelet-derived indices have a well-established correlation with the differential diagnosis of thrombocytopenia in adult-based research. These indices include mean platelet volume, platelet distribution width, and platelet-large cell ratio. Objective. To determine the values of platelet-derived indices in a pediatric population with diagnoses of thrombocytopenia and their etiologic correlation. Materials and methods. Analytic observational diagnostic-test study. The population for this analytical study was pediatric patients between 6 months and 18 years of age who had thrombocytopenia (<100x10(9/L. The study period was 18 months long. Results. Of 54 subjects, 18 (33.3% were diagnosed with idiopathic thrombocytopenic purpura, and 36 (66.7% were diagnosed with acute leukemia. Mean age was 7.4 years and 6.8 years for immune thrombocytopenic purpura and acute leukemia, respectively. Mean platelet distribution width values for immune thrombocytopenic purpura and acute leukemia were 15.08 fL and 10.73, respectively. Mean MPV for immune thrombocytopenic purpura and acute leukemia was 11.7 fL and 9.8 fL, respectively. Mean platelet-large cell ratio was 38.26% and 24.97% for idiopathic thrombocytopenic purpura and acute leukemia, respectively. Differences in these three distinct platelet indices between idiopathic thrombocytopenic purpura and acute leukemia were statistically significant (p=0.00. The area under the ROC curve for platelet-derived indices showed that they were adequate for defining the causes of thrombocytopenia. MPV and platelet-large cell ratio had an area under the curve of 0.89 and 0.88, respectively, while platelet size deviation width had an area under the curve of 0.903. Conclusions. Platelet-derived indices could be useful in the initial approach for the differential diagnosis of pediatric patients with thrombocytopenia.

  7. Major histocompatibility complex class I expression can be used as a diagnostic tool to differentiate idiopathic inflammatory myopathies from dystrophies

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    Sundaram C


    Full Text Available Aim: Utility of major histocompatibility complex (MHC Class I antigen immunostaining was studied to differentiate idiopathic inflammatory myopathies from dystrophies. Materials and Methods: Forty muscle biopsies including seven dermatomyositis (DM, six polymyositis (PM, two sporadic inclusion body myositis (sIBM, 20 dystrophies (one Duchenne, three Becker′s, four alpha, one gamma sarcoglycanopathy, nine limb girdle, one myotonic and one fascioscapulohumeral muscular dystrophy and five controls were stained with antibody for MHC Class I antigen (Novocastra clone W6/32 HL 1:100 dilution. Results: Polymyositis and sIBM showed MHC class I antigen positivity along sarcolemma of single and small groups of muscle fibers. The regenerating fibers in the perifascicular area in DM showed intense cytoplasmic positivity of MHC class I antigen. Muscle fibers in all dystrophies except regenerating fibers and control normal muscle were negative for MHC. Capillaries and lymphocytes were positive controls. There were no false positives in the study. Conclusion: MHC Class I immunostaining can be used as a complementary diagnostic tool for the diagnosis of idiopathic inflammatory myopathies.

  8. Differential susceptibility of PCR reactions to inhibitors: an important and unrecognised phenomenon

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    Miller Robert F


    Full Text Available Abstract Background PCR inhibition by nucleic acid extracts is a well known yet poorly described phenomenon. Inhibition assessment generally depends on the assumption that inhibitors affect all PCR reactions to the same extent; i.e. that the reaction of interest and the control reaction are equally susceptible to inhibition. To test this assumption we performed inhibition assessment on DNA extracts from human urine samples, fresh urine and EDTA using different PCR reactions. Results When copurified inhibitors were assessed using two different PCR reactions one reaction appeared to be inhibited whilst the other was not. Further experiments using various concentrations of unextracted urine to inhibit six different PCR reactions revealed that susceptibility to inhibition was highly variable between reactions. Similar results were obtained using EDTA as the PCR inhibitor. We could find no obvious explanation why one reaction should be more susceptible to inhibition than another, although a possible association with amplicon GC content was noted. Conclusion These findings have serious implications for all PCR-based gene expression studies, including the relatively new PCR array method, and for both qualitative and quantitative PCR-based molecular diagnostic assays, suggesting that careful consideration should be given to inhibition compatibility when conducting PCR analyses. We have demonstrated unequivocally that it is not safe to assume that different PCR reactions are equally susceptible to inhibition by substances co-purified in nucleic acid extracts.

  9. Evaluation of the contribution of the importance of neuroimaging for the diagnostics of dementias - comparison to the psychological diagnostics; Evaluation des Beitrages der radiologischen bildgebende Diagnostik bei demenziellen Erkrankungen - ein Vergleich mit der psychologischen Diagnostik

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    Hentschel, F.; Kreis, M.; Damian, M. [Univ. Heidelberg (Germany). Abt. fuer Neuroradiologie; Syren, M. [Univ. Heidelberg (Germany). Gedaechtnisambulanz; Krumm, B. [Univ. Heidelberg (Germany). Abt. fuer Biostatistik


    Objective: While psychology is accepted as a necessary component of the dementia diagnostics, the extended clinical diagnostics with neuroimaging is differently estimated. The goal of the study is the quantification of the individual contribution of the two different methods. Methods: Of 100 patient the diagnosis of entrance, the neurological, the psychological, and the final clinical diagnosis were documented. For both imaging and psychology the sensitivity, specificity, and the positive predictive value were computed. The diagnostic of each method was determined from the change of the final in relation to the initial clinical diagnosis. The neuroradiological investigation took place with MRI, the psychological examination used both usual power and special speed tests. Results: The extended clinical diagnostics led for 26% of the patients to the change of the clinical diagnosis. Imaging and psychology supplied different own but supplementing contributions. In the case of annihilation imaging contributed with 73.3%, psychology with 54.1% to the diagnosis of a neurodegenerative dementia, whereas the contributions to the diagnosis of a vascular dementia were 83.3% and 70.8%, respectively. However psychology diagnosed and quantified the dementia. The contribution of neuroimaging consisted in the differential diagnosis of the dementias organic causes of symptomatic clementias and vascular encephalopathy without dementia but with consequences for a secondary prophylaxis were additional information also. Conclusion: Psychology improves the diagnostic accuracy of dementias. Neuroimaging improves the differential diagnosis of dementias and supplies additional clinically relevant findings. In the qualified diagnostics and differential diagnostics of the dementias both methods are indispensable. (orig.) [German] Ziel: Waehrend die Bedeutung der Psychologie als notwendiger Bestandteil der Demenzdiagnostik akzeptiert ist, wird die erweiterte klinische Diagnostik mit

  10. A lack of genetic basis for biovar differentiation in clinically important Corynebacterium diphtheriae from whole genome sequencing. (United States)

    Sangal, Vartul; Burkovski, Andreas; Hunt, Alison C; Edwards, Becky; Blom, Jochen; Hoskisson, Paul A


    The differentiation of clinically important Corynebacterium diphtheriae into specific biovars is complex and phylogenetically unclear. Comparative genomic analyses of 17 strains indicate that the division of C. diphtheriae into different biovars does not correlate with the variation in the gene content in the relevant metabolic categories that are potentially involved in the biovar discrimination. The biochemical separation is also not supported by phylogenetic analyses, suggesting molecular methods of typing C. diphtheriae strains should be adopted much more widely.

  11. Toscana virus meningo-encephalitis: an important differential diagnosis for elderly travellers returning from Mediterranean countries. (United States)

    Veater, James; Mehedi, Farhan; Cheung, Chee Kay; Nabarro, Laura; Osborne, Jane; Wong, Nicholas; Wiselka, Martin; Tang, Julian W


    Elderly patients have a long list of differentials for causes of acute confusion and altered consciousness levels, including infectious agents. In addition, elderly, retired patients often have more time to travel for tourism, particularly to exotic, warmer locations. Mediterranean countries such as Spain and Italy are popular holiday destinations for British and other tourists, especially during the winter months. However, these warm climates allow insect vectors to proliferate, increasing the risk of exposure to endemic vectorborne viral infections whilst on vacation. Such infections may not be routinely considered by geriatric medical teams. An 87-year old gentleman presented with a three-day history of worsening confusion, lethargy, ataxia, and fevers following a trip to Spain, where he may have sustained a sandfly bite. By the time of admission, he had a reduced GCS, was hallucinating, and was incontinent of urine and faeces, though blood pressure and heart rate were normal. He also appeared hyperaesthetic, and found even capillary blood sugar testing extremely painful. He had no history of cognitive defect or other neurological conditions. He had been previously independently active, with frequent trips to Spain where he maintained a holiday home. He probably sustained a sandfly bite during this most recent trip, whilst cleaning out a shed. Acute and convalescent sera demonstrated IgG antibodies to Toscana virus at extremely high titres of ≥1:10,000 by immunofluorescence assay, though no Toscana virus RNA was detectable in these sera by the time of presentation. Toscana virus should be included in the differential diagnosis of any patients presenting with meningo-encephalitis who have recently returned from a Mediterranean country. Testing for Toscana virus infection is performed by serological testing on acute/convalescent paired sera, and/or a polymerase chain reaction (PCR) assay on blood or cerebrospinal fluid (CSF) if presenting within 5 days of

  12. Using of 199Tl-сhloride and 99mTc-MIBI in indications and differential diagnostics inflammatory and neoplastic processes of musculoskeletal system

    Directory of Open Access Journals (Sweden)

    A. P. Kourazhov


    Full Text Available Potentialities of 199Tl-chloride and 99mTc-MIBI scintigraphy in diagnostics of musculoskeletal system inflammatory and tumor processes were assessed. Nonspecific indications of inflammations and tumors were obtained in 92.6 и 98.5% respectively. Accuracy 199Tl-chloride and 99mTc-MIBI scintigraphy in diagnostics inflammations were 83.7 and 73.2% respectively, tumors were 88.8 и 75.6% respectively. These markers both are available for indications, and 199Tl-chloride for differentiations of them.

  13. Diagnostic Importance of 3D CT Images in Klippel-Feil Syndrome with Multiple Skeletal Anomalies: A Case Report

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    Yuksel, Murvet [Kahramanmaras Sutcu Imam University, Radiology Dept. (Turkey); Karabiber, Hamza [Kahramanmaras Sutcu Imam University Pediatrics Dept. (Turkey); Yuksel, K. Zafer [Kahramanmaras Sutcu Imam University Neuroradiology Dept (Turkey); Parmaksiz, Gonul [Kahramanmaras Sutcu Imam University Pediatrics Dept. (Turkey)


    We present here the case of a 12-year-old boy who had Klippel-Feil syndrome with renal, cardiac and multiple skeletal anomalies, and we show the relevent three-dimensional computed tomography images. Our patient had a triple renal pelvis, mitral valve prolapsus, multiple cervical vertebrae fusions, cervical ribs, hypoplasia of the right thumb, spina bifida of L5, lumbalization at the right side of S1 and a sacral curved defect. In this study, we discuss the atypical clinical features and the diagnostic value of three-dimensional CT for evaluating the skeletal anomalies of the Klippel-Feil syndrome cases.

  14. The importance of input variables to a neural network fault-diagnostic system for nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Lanc, T.L.


    This thesis explores safety enhancement for nuclear power plants. Emergency response systems currently in use depend mainly on automatic systems engaging when certain parameters go beyond a pre-specified safety limit. Often times the operator has little or no opportunity to react since a fast scram signal shuts down the reactor smoothly and efficiently. These accidents are of interest to technical support personnel since examining the conditions that gave rise to these situations help determine causality. In many other cases an automated fault-diagnostic advisor would be a valuable tool in assisting the technicians and operators to determine what just happened and why.

  15. The importance of input variables to a neural network fault-diagnostic system for nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Lanc, T.L.


    This thesis explores safety enhancement for nuclear power plants. Emergency response systems currently in use depend mainly on automatic systems engaging when certain parameters go beyond a pre-specified safety limit. Often times the operator has little or no opportunity to react since a fast scram signal shuts down the reactor smoothly and efficiently. These accidents are of interest to technical support personnel since examining the conditions that gave rise to these situations help determine causality. In many other cases an automated fault-diagnostic advisor would be a valuable tool in assisting the technicians and operators to determine what just happened and why.

  16. An optimized treatment for algorithmic differentiation of an important glaciological fixed-point problem (United States)

    Goldberg, Daniel N.; Krishna Narayanan, Sri Hari; Hascoet, Laurent; Utke, Jean


    We apply an optimized method to the adjoint generation of a time-evolving land ice model through algorithmic differentiation (AD). The optimization involves a special treatment of the fixed-point iteration required to solve the nonlinear stress balance, which differs from a straightforward application of AD software, and leads to smaller memory requirements and in some cases shorter computation times of the adjoint. The optimization is done via implementation of the algorithm of Christianson (1994) for reverse accumulation of fixed-point problems, with the AD tool OpenAD. For test problems, the optimized adjoint is shown to have far lower memory requirements, potentially enabling larger problem sizes on memory-limited machines. In the case of the land ice model, implementation of the algorithm allows further optimization by having the adjoint model solve a sequence of linear systems with identical (as opposed to varying) matrices, greatly improving performance. The methods introduced here will be of value to other efforts applying AD tools to ice models, particularly ones which solve a hybrid shallow ice/shallow shelf approximation to the Stokes equations.

  17. Differential action of medically important Indian BIG FOUR snake venoms on rodent blood coagulation. (United States)

    Hiremath, Vilas; Nanjaraj Urs, A N; Joshi, Vikram; Suvilesh, K N; Savitha, M N; Urs Amog, Prathap; Rudresha, G V; Yariswamy, M; Vishwanath, B S


    Snakebite is a global health problem affecting millions of people. According to WHO, India has the highest mortality and/or morbidity due to snakebite. In spite of commendable research on Indian BIG FOUR venomous species; Naja naja and Bungarus caeruleus (elapid); Daboia russelii and Echis carinatus (viperid), no significant progress has been achieved in terms of diagnosis and management of biting species with appropriate anti-snake venom. Major hurdle is identification of offending species. Present study aims at differentiation of Indian BIG FOUR snake venoms based on their distinguish action on rodent blood coagulation. Assessment of coagulation alterations by elapid venoms showed negligible effect on re-calcification time, prothrombin time, activated partial thromboplastin time and factors assay (I, II, V, VIII and X) both in vitro and in vivo. However, viperid venoms demonstrated significant anticoagulant status due to their remarkable fibrinogen degradation potentials as supported by fibrinogenolytic activity, fibrinogen zymography and rotational thromboelastometry. Though results provide hint on probable alterations of Indian BIG FOUR snake venoms on blood coagulation, the study however needs validation from human victim's samples to ascertain its reliability for identification of biting snake species.

  18. [Importance of laboratory findings in differentiating cranio-cerebral injuries of mild and moderate severity]. (United States)

    Burgman, G P; Iurishchev, E P; Vial'tseva, I N; Ovsiannikova, R P; Smirnova, I V


    The authors discuss the results of clinical and laboratory examination of 191 patients among whom 93 had a mild and 98 a moderately severe cranio-cerebral injury. The dynamics of changes in the cerebrospinal fluid, including the changes in its cell composition, and the changes in the morphological compositions of blood during the post-traumatic period were studied. Different aspects of metabolism characterizing the functional condition of the liver, kidneys and adrenals were studied. The condition of blood coagulation was determined with due account for its rheological properties. The results of the statistical analysis of the material obtained show that in judging the depth of the pathophysiological disturbances and differentiating the mild and moderated degrees of cranio-cerebral injury severity it is advisable to use such laboratory tests as those for disorders of the composition of the cerebrospinal fluid (erythrochromia, hyperproteinochromia, pleocytosis, cytological values) and blood (leukocytosis with a shift of the neutrophils to the left, increased Krebs' index, increased ESR), tests for disorders of carbohydrate and protein metabolism (fructosuria, dysproteinemia), for the degree of intensified blood coagulation activity and tests for abnormalities in the renal function (albuminuria, microhematuria).

  19. Metastatic Renal Cell Carcinoma Presenting as a Paranasal Sinus Mass: The Importance of Differential Diagnosis

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    Massimo Ralli


    Full Text Available Metastases in the paranasal sinuses are rare; renal cell carcinoma is the most common cancer that metastasizes to this region. We present the case of a patient with a 4-month history of a rapidly growing mass of the nasal pyramid following a nasal trauma, associated with spontaneous epistaxis and multiple episodes of hematuria. Cranial CT scan and MRI showed an ethmoid mass extending to the choanal region, the right orbit, and the right frontal sinus with an initial intracranial extension. Patient underwent surgery with a trans-sinusal frontal approach using a bicoronal incision combined with an anterior midfacial degloving; histological exam was compatible with a metastasis of clear cell renal cell carcinoma. Following histological findings, a total body CT scan showed a solitary 6 cm mass in the upper posterior pole of the left kidney identified as the primary tumor. Although rare, metastatic renal cell carcinoma should always be suspected in patients with nasal or paranasal masses, especially if associated with symptoms suggestive of a systemic involvement such as hematuria. A correct early-stage diagnosis of metastatic RCC can considerably improve survival rate in these patients; preoperative differential diagnosis with contrast-enhanced imaging is fundamental for the correct treatment and follow-up strategy.

  20. An important criterion for reliable multi-monochromatic x-ray imager diagnostics and its impact on the reconstructed images

    Institute of Scientific and Technical Information of China (English)

    T.Nagayama; R.C.Mancini; D.Mayes; R.Tommasini; R.Florido


    Temperature and density asymmetry diagnosis is critical to advance inertial confinement fusion(ICF) science. A multimonochromatic x-ray imager, MMI, records the spectral signature from an ICF implosion core with time resolution, 2D spatial resolution and spectral resolution. While narrow-band images and 2D space-resolved spectra from the MMI data constrain the temperature and the density spatial structure of the core, the accuracy of the images and the spectra highly depends on the quality of the MMI data and the processing tools. Here, we synthetically investigate the criterion for reliable MMI diagnostics and its effects on the accuracy of the reconstructed images. The pinhole array tilt determines the object spatial sampling efficiency and the minimum reconstruction width, w. When the spectral width associated with w is significantly narrower than the spectral linewidth, the line images reconstructed from the MMI data become reliable. The MMI setup has to be optimized for every application to meet this criterion for reliable ICF diagnostics.

  1. Crystal arthritides - gout and calcium pyrophosphate arthritis : Part 2: clinical features, diagnosis and differential diagnostics. (United States)

    Schlee, S; Bollheimer, L C; Bertsch, T; Sieber, C C; Härle, P


    arthritis by Gram staining and bacterial culture. Soft tissue ultrasonography is useful to detect affected synovial tissue and monosodium urate crystals within the synovial fluid. Involvement of bone occurs relatively late in the disease so that x‑ray images are not useful in the early stages but might be helpful in differential diagnostics. Dual energy computed tomography (CT) and magnetic resonance imaging (MRI) can be used for certain indications.

  2. Food addiction in a Spanish sample of eating disorders: DSM-5 diagnostic subtype differentiation and validation data. (United States)

    Granero, Roser; Hilker, Ines; Agüera, Zaida; Jiménez-Murcia, Susana; Sauchelli, Sarah; Islam, Mohammed A; Fagundo, Ana B; Sánchez, Isabel; Riesco, Nadine; Dieguez, Carlos; Soriano, José; Salcedo-Sánchez, Cristina; Casanueva, Felipe F; De la Torre, Rafael; Menchón, José M; Gearhardt, Ashley N; Fernández-Aranda, Fernando


    Although the concept of 'food addiction' (FA) has raised growing interest because of evidence for similarities between substance dependence and excessive food intake, there is a lack of studies that explore this construct among the wide spectrum of eating disorders (EDs). Besides providing validation scores of a Spanish version of the Yale FA Scale (YFAS-S), this study examined the prevalence of 'FA' among ED subtypes compared with healthy-eating controls (HCs) and the association between 'FA' scores, eating symptomatology and general psychopathology. A sample of 125 adult women with ED, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders 5 criteria, and 82 healthy-eating women participated in the study. All participants were assessed with the YFAS-S, the ED Inventory-2 and the Symptom Checklist-Revised. Results showed that the internal structure of the one-dimensional solution for the YFAS-S was very good (α = 0.95). The YFAS-S has a good discriminative capacity to differentiate between ED and controls (specificity = 97.6% and sensitivity (Se) = 72.8%; area under receiver operating characteristic curve = 0.90) and a good Se to screen for specific ED subtypes. YFAS-S scores were associated with higher levels of negative affect and depression, higher general psychopathology, more severe eating pathology and greater body mass index. When comparing the prevalence of 'FA' between ED subtypes, the lowest prevalence of 'FA', measured with the YFAS-S, was for the anorexia nervosa (AN) restrictive subtype with 50%, and the highest was for the AN binge-purging subtype (85.7%), followed by bulimia nervosa (81.5%) and binge eating disorder (76.9%). In conclusion, higher YFAS-S scores are associated with bingeing ED-subtype patients and with more eating severity and psychopathology. Although the 'FA' construct is able to differentiate between ED and HC, it needs to be further explored. Copyright © 2014 John Wiley & Sons, Ltd and

  3. The importance of measuring macroprolactin in the differential diagnosis of hyperprolactinemic patients

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    Chih-Chin Lu


    Full Text Available This study investigated the differences in clinical and laboratory features as well as treatment response in 70 outpatients with macroprolactinemia and monomeric hyperprolactinemia treated with dopamine agonists. After precipitation of the patients’ serum samples with poly-ethylene-glycol (PEG, serum prolactin (PRL levels were measured. We also measured serum levels of luteinizing hormone (LH, follicle-stimulating hormone (FSH, estradiol for women and testosterone for men. Clinical symptoms and signs were recorded. All patients received brain magnetic resonance imaging (MRI. After excluding patients with macroadenoma, 66 patients were treated with the dopamine agonist cabergoline. After 1 year, the clinical responses to cabergoline were recorded and PRL levels measured. Of the initial 70 patients with hyperprolactinemia, 15 patients (21.4% were found to have macroprolactinemia, while the rest had monomeric hyperprolactinemia. The two groups did not differ with regard to galactorrhea, menstrual disturbances or impotence. There were no significant group differences in serum LH, FSH, estradiol or testosterone levels. Patients with macroprolactinemia, however, had a significantly lower infertility rate than those with true hyperprolactinemia (6.7% vs. 32.7%, p=0.005. A greater percentage of macroprolactinemic patients had normal MRI pituitary images than those with hyperprolactinemia (73.3% vs. 34.5%, p=0.029. Compared to those with true hyperprolactinemia, patients with macroprolactinemia were found to have no significant changes in clinical features and PRL levels after 1 year of cabergoline therapy (after PEG precipitation, pre- and post-PRL levels: 59.3±100.2 to 13.8±9.5 ng/mL vs. 6.1±5.3 to 5.1±4.3 ng/mL, p=0.002. In conclusion, while macroprolactinemia is a common cause of hyperprolactinemia, many clinical and laboratory features cannot be used reliably to differentiate macroprolactinemia from true hyperprolactinemia. Routine screening

  4. Gravity Plays an Important Role in Muscle Development and the Differentiation of Contractile Protein Phenotype (United States)

    Adams, Gregory A.; Haddad, Fadia; Baldwin, Kenneth M.


    Several muscles in the body exist mainly to work against gravity. Whether gravity is important in the development of these muscles is not known. By examining the basic proteins that compose muscle, questions about the role of gravity in muscle development can be answered. Myosin heavy chains (MHCs) are a family of proteins critically important for muscle contraction. Several types of MHCs exist (e.g., neonatal, slow, fast), and each type is produced by a particular gene. Neonatal MHCs are produced early in life. Slow MHCs are important in antigravity muscles, and fast MHCs are found in fast-twitch power muscles. The gene that is turned on or expressed will determine which MHC is produced. Early in development, antigravity skeletal muscles (muscles that work against gravity) normally produce a combination of the neonatal/embryonic MHCs. The expression of these primitive MHCs is repressed early in development; and the adult slow and fast MHC genes become fully expressed. We tested the hypothesis that weightbearing activity is critical for inducing the normal expression of the slow MHC gene typically expressed in adult antigravity muscles. Also, we hypothesized that thyroid hormone, but not opposition to gravity, is necessary for expressing the adult fast IIb MHC gene essential for high-intensity muscle performance. Groups of normal thyroid and thyroid-deficient neonatal rats were studied after their return from the 16-day Neurolab mission and compared to matched controls. The results suggest: (1) Weightlessness impaired body and limb skeletal muscle growth in both normal and thyroid-deficient animals. Antigravity muscles were impaired more than those used primarily for locomotion andor nonweightbearing activity. (2) Systemic and muscle expression of insulin-like growth factor-I (IGF-I), an important body and tissue growth factor, was depressed in flight animals. (3) Normal slow, type I MHC gene expression was markedly repressed in the normal thyroid flight group. (4

  5. Trombocitopenia em cirurgia cardíaca: importância diagnóstica e prognóstica Thrombocytopenia in cardiac surgery: diagnostic and prognostic importance

    Directory of Open Access Journals (Sweden)

    Ederlon Rezende


    Full Text Available OBJETIVO: Pacientes submetidos à cirurgia cardíaca estão mais propensos a desenvolver plaquetopenia. A trombocitopenia induzida por heparina acomete cerca de 5% dos pacientes. O objetivo foi avaliar a importância clínica da trombocitopenia grave em pacientes no pós-operatório de cirurgia cardíaca. MÉTODOS: Estudo prospectivo observacional que incluiu os pacientes de cirurgia cardíaca com plaquetas 6. A mortalidade na Unidade de Terapia Intensiva (UTI e hospitalar, o tempo de internação, os escores de gravidade e a incidência de tromboses foram comparados em pacientes com escore e" 6 (grupo 1 e 6, em pacientes no pós-operatório de cirurgia cardíaca, está associado a maior incidência de trombose, assim como o maior escore está relacionado à elevada mortalidade hospitalar.OBJECTIVE: Patients undergo to cardiac surgery have more probability to develop thrombocytopenia. The heparin induced thrombocytopenia happens in 5% of the patients. The aim from this study was to evaluate the clinical importance from the severe thrombocytopenia in postoperative cardiac surgical patients. METHODS: It was included cardiac surgical patients with platelets 6 (group 1 and 6, in postoperative cardiac surgical patients, it is associated to higher incidence of thrombosis as well as the greater score is related to higher hospital mortality rate.

  6. Intraspecific taxonomy of plant genetic resources – Important for differentiation of medicinal and aromatic plants?

    Directory of Open Access Journals (Sweden)

    Lohwasser, Ulrike


    Full Text Available Taxonomy of plant genetic resources is an important input in characterising and evaluating cultivated plants and essential for identification and documentation of the diversity of genebank collections. In former times taxonomical determination was based only on morphological characters. Nowadays, new molecular and chemical methods and techniques are available for providing additional information. As examples, investigations of parsley (Petroselinum crispum [Mill.] Nyman, Apiaceae and opium poppy (Papaver somniferum L., Papaveraceae collections of the German genebank are demonstrated. In addition to morphological description, the molecular distance and the phylogenetic relationship of the accessions were performed with molecular marker analysis. Essential oil compound and content for parsley and the content of the five main alkaloids (morphine, codeine, thebaine, noscapine, papaverine for opium poppy were measured with GC (gas chromatography and HPLC (high pressure liquid chromatography, respectively. For parsley the results of the three methods support the existing taxonomy partly, a separation of root and leaf parsley was confirmed. However, the taxonomy of opium poppy should be revised because molecular and chemical data do not verify the morphological results. But nevertheless taxonomy of cultivated plants is an important tool to describe the variability of plant genetic resources.

  7. Differential pollinator effectiveness and importance in a milkweed (Asclepias, Apocynaceae) hybrid zone. (United States)

    Stoepler, Teresa M; Edge, Andrea; Steel, Anna; O'Quinn, Robin L; Fishbein, Mark


    Exceptions to the ideal of complete reproductive isolation between species are commonly encountered in diverse plant, animal, and fungal groups, but often the causative ecological processes are poorly understood. In flowering plants, the outcome of hybridization depends in part on the effectiveness of pollinators in interspecific pollen transport. In the Asclepias exaltata and A. syriaca (Apocynaceae) hybrid zone in Shenandoah National Park, Virginia, extensive introgression has been documented. The objectives of this study were to (1) determine the extent of pollinator overlap among A. exaltata, A. syriaca, and their hybrids and (2) identify the insect taxa responsible for hybridization and introgression. We observed focal plants of parental species and hybrids to measure visitation rate, visit duration, and per-visit pollinia removal and deposition, and we calculated pollinator effectiveness and importance. Visitation rates varied significantly between the 2 yr of the study. Overall, Apis mellifera, Bombus sp., and Epargyreus clarus were the most important pollinators. However, Bombus sp. was the only visitor that was observed to both remove and insert pollinia for both parent species as well as hybrids. We conclude that Bombus may be a key agent of hybridization and introgression in these sympatric milkweed populations, and hybrids are neither preferred nor selected against by pollinators. Thus, we have identified a potential mechanism for how hybrids act as bridges to gene flow between A. exaltata and A. syriaca. These results provide insights into the breakdown of prezygotic isolating mechanisms.

  8. Imaging mammary diagnostics. Diagnostic techniques, archetypical findings, differential diagnostcs and interventions.. 2. rev. and enl. ed.; Bildgebende Mammadiagnostik. Untersuchungstechnik, Befundmuster, Differenzialdiagnose und Interventionen. Kartonierte Sonderausgabe

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    Heywang-Koebrunner, S. [Martin-Luther-Univ., Halle-Wittenberg (Germany). Klinik fuer Diagnostische Radiologie; Schreer, I. (eds.) [Mamma-Zentrum des UK Kiel (Germany). Klinik fuer Geburtshilfe und Gynaekologie


    The book includes the following chapters: I. Methodology: anamnesis and interview; clinical evidence, mammography, sonography, magnetic resonance tomography, new imaging techniques (scintigraphy, PET), transcutaneous biopsy, pre-operative marking; II. phenotypes: normal mammary glands, mastopathics, cysts, benign tumors, inflammatory diseases, in-situ carcinomas, invasive carcinomas, lymphomas, other semi-malign and malign tumors, post-traumatic, post-surgical and post-therapeutic changes, skin changes, male mamma, screening, continuative diagnostics of screening evidence and problem solving for symptomatic patients.

  9. Importance of diazepam administration during electroencephalography in the differential diagnosis of cortical visual loss. (United States)

    Yis, Uluc; Topcu, Yasemin; Bayram, Erhan; Karakaya, Pakize; Cakmakci, Handan; Kurul, Semra Hiz


    A 14-year-old boy presented with acute visual loss due to cortical blindness. Two weeks after the visual symptoms, the patient developed behavioral abnormalities. Brain magnetic resonance imaging (MRI) revealed hyperintense lesions at parieto-occipital lobes on T2-weighted and fluid attenuated inversion recovery images. Sleep and awake electroencephalography (EEG) were normal, but diazepam administration revealed bilateral periodic synchronous complexes occurring every 20 to 30 seconds. Elevated measles antibody titers in cerebrospinal fluid confirmed the diagnosis of subacute sclerosing panencephalitis. We conclude that visual loss due to cortical blindness is an important finding of subacute sclerosing panencephalitis. Diazepam administration during EEG should be a part of investigation in cases with unexplained cortical blindness.

  10. Conditions Promoting Mycorrhizal Parasitism are of Minor Importance for Competitive Interactions in Two Differentially Mycotrophic Species

    Directory of Open Access Journals (Sweden)

    Martina Friede


    Full Text Available Interactions of plants with arbuscular mycorrhizal fungi (AMF may range along a broad continuum from strong mutualism to parasitism, with mycorrhizal benefits received by the plant being determined by climatic and edaphic conditions affecting the balance between carbon costs vs. nutritional benefits. Thus, environmental conditions promoting either parasitism or mutualism can influence the mycorrhizal growth dependency (MGD of a plant and in consequence may play an important role in plant-plant interactions.In a multifactorial field experiment we aimed at disentangling the effects of environmental and edaphic conditions, namely the availability of light, phosphorus and nitrogen, and the implications for competitive interactions between Hieracium pilosella and Corynephorus canescens for the outcome of the AMF symbiosis. Both species were planted in single, intraspecific and interspecific combinations using a target-neighbor approach with six treatments distributed along a gradient simulating conditions for the interaction between plants and AMF ranking from mutualistic to parasitic.Across all treatments we found mycorrhizal association of H. pilosella being consistently mutualistic, while pronounced parasitism was observed in C. canescens, indicating that environmental and edaphic conditions did not markedly affect the cost:benefit ratio of the mycorrhizal symbiosis in both species. Competitive interactions between both species were strongly affected by AMF, with the impact of AMF on competition being modulated by colonization. Biomass in both species was lowest when grown in interspecific competition, with colonization being increased in the less mycotrophic C. canescens, while decreased in the obligate mycotrophic H. pilosella. Although parasitism-promoting conditions negatively affected MGD in C. canescens, these effects were small as compared to growth decreases related to increased colonization levels in this species. Thus, the lack of plant

  11. Neurocysticercosis as an important differential of seizures in pregnancy: two case reports

    Directory of Open Access Journals (Sweden)

    Singhal Suresh K


    Full Text Available Abstract Introduction Seizures in pregnancy usually result from eclampsia, epilepsy or central nervous system disorders. Neurocysticercosis is a rare, but an important, cause of first-time convulsions in pregnancy. Case presentations We report the cases of two Indian women, aged 20 and 24 years old respectively, with neurocysticercosis presenting in the second trimester of pregnancy with convulsions. Both had marginally raised blood pressure with 1+ urine albumin and neither had a past history of convulsions. The neurocysticercosis was diagnosed on magnetic resonance imaging of the head, which showed spherical ring-enhancing lesions in the brain. In one woman, pregnancy was terminated due to spina bifida in the fetus and she was discharged on albendazole and phenytoin. The second woman was put on carbamazepine: she had an emergency Cesarean section at term for fetal distress and delivered a healthy baby. Her postnatal period was uneventful. Conclusion Neurocysticercosis should be considered in pregnant women presenting with seizures which cannot be explained by eclampsia, especially in early pregnancy.

  12. The importance of teacher support: Differential impacts by gender and sexuality. (United States)

    Dessel, Adrienne B; Kulick, Alex; Wernick, Laura J; Sullivan, Daniel


    Teachers play an important role in shaping the experiences of high school students with regard to patterns of heteronormativity and binary gender norms, particularly for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students. A climate survey of high school students (n = 953) in the United States examined the association between students' well-being and their relationships with teachers. The sample was majority white (65.8%) and multiracial (14.1%). Cisgender (cis)-girls (49.6%), cis-boys (41.2%), and trans students (9.2%), as well as heterosexual (78.4%) and LGBQ students (21.6%) were represented. Regression models indicate teachers' use of oppressive language and their intervention in situations of bias and students' trust and comfort with teachers were significantly associated with students' self-esteem. Teachers' use of biased language was directly associated with student self-reported grades. Moderation tests indicate teacher relationships are strongly associated with heterosexual and cisgender students' wellbeing. Recommendations for teacher education and future research are discussed.

  13. Mapping differential elemental accumulation in fish tissues: Importance of fish tissue sampling standardization

    Directory of Open Access Journals (Sweden)

    Jovičić Katarina


    Full Text Available The concentrations of As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se and Zn in the muscle, gills, liver and intestine of the wels catfish (Silurus glanis from the Danube River were analyzed by inductively coupled plasma mass spectrometry (ICP-MS. The aim of the study was to determine whether in complex muscle/skin, gill filament/gill arch, proximal/distal liver and proximal/median/distal intestine samples, particular components differ in concentrations of the analyzed elements. Results indicated that there were no differences in the accumulation of different elements between the proximal and distal liver segments and between the proximal and median intestine sections. Conversely, elemental accumulation patterns in muscle and skin differed significantly. Significant differences were also observed between the gill arch and filaments, as well as between the distal and the two upper intestine sections. Findings indicated the importance of detailed reporting of tissue sampling, i.e. whether the skin was included in the muscle sample, as well as if the gill arch and filaments were analyzed together. Due to a potential bias that can be produced by different muscle/skin or gill arch/filament ratios included in the sample, we strongly recommend that they should not be analyzed together. Results of the present study might be of interest to the scientific community and stakeholders involved in aquatic ecosystem monitoring programs. [Projekat Ministarstva nauke Republike Srbije, br. TR37009 i br. 173045

  14. The Importance of Urine Concentration on the Diagnostic Performance of the Urinalysis for Pediatric Urinary Tract Infection. (United States)

    Chaudhari, Pradip P; Monuteaux, Michael C; Shah, Pinkey; Bachur, Richard G


    The presence of leukocyte esterase by urine dipstick and microscopic pyuria are both indicators of possible urinary tract infection. The effect of urine concentration on the diagnostic performance of the urinalysis for pediatric urinary tract infection has not been studied. Our objective is to determine whether the urinalysis performance for detecting urinary tract infection varies by urine concentration as measured by specific gravity. This was a retrospective cross-sectional study of the urine laboratory results of children younger than 13 years who presented to the emergency department during 68 months and had a paired urinalysis and urine culture obtained. Urinary tract infection was defined as pure growth of a uropathogen at standard culture thresholds. Test characteristics were calculated across 4 specific gravity groups (1.000 to 1.010, 1.011 to 1.020, 1.021 to 1.030, and >1.030). In total, 14,971 cases were studied. Median age was 1.5 years (interquartile range 0.4 to 5.5 years) and 60% were female patients. Prevalence of urinary tract infection was 7.7%. For the presence of leukocyte esterase and a range of pyuria cut points, the positive likelihood ratios decreased with increasing specific gravity. From most dilute to most concentrated urine, the positive likelihood ratio decreased from 12.1 (95% confidence interval [CI] 10.7 to 13.7) to 4.2 (95% CI 3.0 to 5.8) and 9.5 (95% CI 8.6 to 10.6) to 5.5 (95% CI 3.3 to 9.1) at a threshold of greater than or equal to 5 WBCs per high-power field and presence of leukocyte esterase, respectively. The negative likelihood ratios increased with increasing specific gravity for leukocyte esterase and microscopic pyuria. For the detection of pediatric urinary tract infection, the diagnostic performance of both dipstick leukocyte esterase and microscopic pyuria varies by urine concentration, and therefore the specific gravity should be considered when the urinalysis is interpreted. Copyright © 2016 American College of

  15. 9 CFR 93.504 - Import permits for swine and for swine specimens for diagnostic purposes; and reservation fees... (United States)


    ... specimen will be moved only for scientific research or museum display purposes. (Signature of importer... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Import permits for swine and for swine... APHIS. 93.504 Section 93.504 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION...

  16. VEGF-C Is a Thyroid Marker of Malignancy Superior to VEGF-A in the Differential Diagnostics of Thyroid Lesions.

    Directory of Open Access Journals (Sweden)

    Kosma Woliński

    Full Text Available Thyroid nodular goiter is one of the most common medical conditions affecting even over a half of adult population. The risk of malignancy is rather small but noticeable-estimated by numerous studies to be about 3-10%. The definite differentiation between benign and malignant ones is a vital issue in endocrine practice. The aim of the current study was to assess the expression of vascular endothelial growth factor A (VEGF-A and VEGF-C on the mRNA level in FNAB washouts in case of benign and malignant thyroid nodules and to evaluate the diagnostic value of these markers of malignancy.Patients undergoing fine-needle aspiration biopsy (FNAB in our department between January 2013 and May 2014 were included. In case of all patients who gave the written consent, after ultrasonography (US and fine-needle aspiration biopsy (FNAB performed as routine medical procedure the needle was flushed with RNA Later solution, the washouts were frozen in -80 Celsius degrees. Expression of VEGF-A and VEGF-C and GADPH (reference gene was assessed in washouts on the mRNA level using the real-time PCR technique. Probes of patients who underwent subsequent thyroidectomy and were diagnosed with differentiated thyroid cancer (DTC; proved by post-surgical histopathology were analyzed. Similar number of patients with benign cytology were randomly selected to be a control group.Thirty one DTCs and 28 benign thyroid lesions were analyzed. Expression of VEGF-A was insignificantly higher in patients with DTCs (p = 0.13. Expression of VEGF-C was significantly higher in patients with DTC. The relative expression of VEGF-C (in comparison with GAPDH was 0.0049 for DTCs and 0.00070 for benign lesions, medians - 0.0036 and 0.000024 respectively (p<0.0001.Measurement of expression VEGF-C on the mRNA level in washouts from FNAB is more useful than more commonly investigated VEGF-A. Measurement of VEGF-C in FNAB washouts do not allow for fully reliable differentiation of benign and

  17. Rapid detection and differentiation of important Campylobacter spp. in poultry samples by dot blot and PCR. (United States)

    Fontanot, Marco; Iacumin, Lucilla; Cecchini, Francesca; Comi, Giuseppe; Manzano, Marisa


    The detection of Campylobacter, the most commonly reported cause of foodborne gastroenteritis in the European Union, is very important for human health. The most commonly recognised risk factor for infection is the handling and/or consumption of undercooked poultry meat. The methods typically applied to evaluate the presence/absence of Campylobacter in food samples are direct plating and/or enrichment culture based on the Horizontal Method for Detection and Enumeration of Campylobacter spp. (ISO 10272-1B: 2006) and PCR. Molecular methods also allow for the detection of cells that are viable but cannot be cultivated on agar media and that decrease the time required for species identification. The current study proposes the use of two molecular methods for species identification: dot blot and PCR. The dot blot method had a sensitivity of 25 ng for detection of DNA extracted from a pure culture using a digoxigenin-labelled probe for hybridisation; the target DNA was extracted from the enrichment broth at 24 h. PCR was performed using a pair of sensitive and specific primers for the detection of Campylobacter jejuni and Campylobacter coli after 24 h of enrichment in Preston broth. The initial samples were contaminated by 5 × 10 C. jejuni cells/g and 1.5 × 10(2)C. coli cells/g, thus the number of cells present in the enrichment broth at 0 h was 1 or 3 cell/g, respectively.

  18. C-cell-derived calcitonin-free neuroendocrine carcinoma of the thyroid: the diagnostic importance of CGRP immunoreactivity. (United States)

    Nakazawa, Tadao; Cameselle-Teijeiro, José; Vinagre, João; Soares, Paula; Rousseau, Emmanuel; Eloy, Catarina; Sobrinho-Simões, Manuel


    In the thyroid, primary neuroendocrine tumors encompass medullary thyroid carcinoma (MTC) and, rarely, other tumors such as paragangliomas. MTCs are derived from C-cells and express calcitonin and neuroendocrine markers. Besides classic MTC, some reports have documented thyroid neuroendocrine tumors, which show no calcitonin expression and raise difficult diagnostic problems. A 76-year-old man presented with a mass in the left thyroid with neither serological calcitonin elevation nor familial history. A thorough clinico-laboratorial study did not disclose any other mass elsewhere. A left hemithyroidectomy was performed, and the histological examination revealed a neuroendocrine carcinoma resembling a paraganglioma-like MTC displaying unequivocal signs of vascular invasion. Immunohistochemically, the tumor cells showed reactivity for chromogranin A, synaptophysin, thyroid transcription factor-1 (TTF-1), paired box gene 8 (PAX8), cytokeratins (AE1/AE3 and CK8/18), and calcitonin gene-related peptide (CGRP) and negativity for calcitonin, carcinoembryonic antigen, TTF-2, thyroperoxidase, and thyroglobulin. In situ hybridization showed that the tumor cells lacked expression for calcitonin and thyroglobulin mRNA. Genetic analysis did not disclose any RET mutation. A diagnosis of C-cell-derived primary neuroendocrine carcinoma of the thyroid without calcitonin expression was made, and the patient remains free of metastasis or recurrence 18 months after surgery.

  19. Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets. (United States)

    Ellis, D W; Srigley, J


    Key quality parameters in diagnostic pathology include timeliness, accuracy, completeness, conformance with current agreed standards, consistency and clarity in communication. In this review, we argue that with worldwide developments in eHealth and big data, generally, there are two further, often overlooked, parameters if our reports are to be fit for purpose. Firstly, population-level studies have clearly demonstrated the value of providing timely structured reporting data in standardised electronic format as part of system-wide quality improvement programmes. Moreover, when combined with multiple health data sources through eHealth and data linkage, structured pathology reports become central to population-level quality monitoring, benchmarking, interventions and benefit analyses in public health management. Secondly, population-level studies, particularly for benchmarking, require a single agreed international and evidence-based standard to ensure interoperability and comparability. This has been taken for granted in tumour classification and staging for many years, yet international standardisation of cancer datasets is only now underway through the International Collaboration on Cancer Reporting (ICCR). In this review, we present evidence supporting the role of structured pathology reporting in quality improvement for both clinical care and population-level health management. Although this review of available evidence largely relates to structured reporting of cancer, it is clear that the same principles can be applied throughout anatomical pathology generally, as they are elsewhere in the health system.

  20. The diagnostic performance of acoustic radiation force impulse elasticity imaging to differentiate malignant from benign thyroid nodules: Comparison with conventional B- mode sonographic findings

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    Jung, Won Sang; An, Yeong Yi; Ihn, Yon Kwon; Park, Young Ha [Dept. of Radiology, St. Vincent' s Hospital, The Catholic University of Korea, Suwon (Korea, Republic of)


    The purpose of this study was to evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) elasticity imaging. One hundred and twenty-seven thyroid nodules were examined by both ARFI elastography and B-mode sonography. Virtual Touch tissue quantification (VTQ) values of the thyroid nodules were measured. Scoring of B-mode sonographic findings of each thyroid nodules was performed. The sums of these VTQ and the B-mode scores were determined. The comparative diagnostic performances of the VTQ value, the B-mode score, and the combined score were analyzed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each scoring mode were: B-mode score, 84%, 85%, 66%, 94%, and 85%; VTQ, 75%, 91%, 73%, 92%, and 86%; and combined score, 88%, 87%, 70%, 95%, and 88%. The areas under the curves for B-mode, VTQ, and combined score were 0.895, 0.837, and 0.912, respectively. Pairwise comparisons of receiver-operating characteristic curves showed no statistical differences between B-mode and VTQ, and B-mode and combined score. Combined score showed better diagnostic performance than VTQ value (p = 0.0023). ARFI VTQ value is a good diagnostic modality for differentiating malignant thyroid nodules from benign nodules. However, ARFI evaluation is not superior to B-mode sonographic evaluation, but only has a better diagnostic performance when combined with B-mode sonographic findings.

  1. Decreasing cervical cancer mortality in Mexico: effect of Papanicolaou coverage, birthrate, and the importance of diagnostic validity of cytology. (United States)

    Lazcano-Ponce, Eduardo; Palacio-Mejia, Lina Sofía; Allen-Leigh, Betania; Yunes-Diaz, Elsa; Alonso, Patricia; Schiavon, Raffaela; Hernandez-Avila, Mauricio


    The reduction in cervical cancer mortality in developed countries has been attributed to well-organized, population-based prevention and control programs that incorporate screening with the Papanicolaou (Pap) smear. In Mexico, there has been a decrease in cervical cancer mortality, but it is unclear what factors have prompted this reduction. Using data from national indicators, we determined the correlation between cervical cancer mortality rates and Pap coverage, birthrate, and gross national product, using a linear regression model. We determined relative risk of dying of cervical cancer according to place of residence (rural/urban, region) using a Poisson model. We also estimated Pap smear coverage using national survey data and evaluated the validity and reproducibility of Pap smear diagnosis. An increase in Pap coverage (beta= -0.069) and a decrease in birthrate (beta=0.054) correlate with decreasing cervical cancer mortality in Mexico. Self-reported Pap smear rates in the last 12 months vary from 27.4% to 48.1%. Women who live in the central (relative risk, 1.04) and especially the southern (relative risk, 1.47) parts of Mexico have a greater relative risk of dying of cervical cancer than those who live in the north. There is a high incidence of false negatives in cervical cytology laboratories in Mexico; the percentage of false negatives varies from 3.33% to 53.13%. The decrease in cervical cancer mortality observed in Mexico is proportional to increasing Pap coverage and decreasing birthrate. Accreditation of cervical cytology laboratories is needed to improve diagnostic precision.

  2. Diagnostic roles of MUC1 and GLUT1 in differentiating thymic carcinoma from type B3 thymoma. (United States)

    Du, Ms Jun; Shen, Qin; Yin, Honglin; Rao, Qiu; Zhou, Mr Xiaojun


    MUC1 is a transmembrane mucin that has been related to tumor progression and outcome in various malignancies. GLUT1 is a member of the mammalian facilitative glucose transporter (GLUT) family of passive carriers that functions as an energy-independent system for transporting glucose. Both of them are useful markers for the diagnosis, progression, and prognosis of various tumors, especially those that are cancerous. However, the clinical significance of MUC1 and GLUT1 in thymic epithelial tumors remains uncertain due to a lack of quality specimen and studies at sufficient scale, both owing, in part, to the rarity of the tumors. The aim of this article is to study the expression patterns of MUC1 and GLUT1 in thymic carcinoma and type B3 thymoma, and to evaluate their diagnostic value for these two types of tumors via immunohistochemistry. Forty-three patients were included in the study, including twenty-two with thymic carcinoma and twenty-one with type B3 thymoma. Tumor tissue sections were immunohistochemically stained for MUC1 and GLUT1; meanwhile, some tumors were also stained with CKpan, TDT, CD5, and CD117. MUC1 was expressed in a total of 17 cases, with a positive rate of 77.27% (17/22) in thymic carcinoma and 9.52% (2/21) in type B3 thymoma, revealing a significant difference (p<0.0001). A significant difference (p<0.0001) was also shown for GLUT1, where the positive rates for thymic carcinoma and type B3 thymoma were 100% (22/22) and 42.86% (9/21), respectively. The expression of MUC1 was significantly correlated with GLUT1 (p<0.0001). Furthermore, GLUT1 staining sensitivity and specificity for thymic carcinoma were 100% (22/22) and 70.97% (22/31), respectively, while MUC1 staining sensitivity and specificity were 77.27% (17/22) and 89.47% (17/19), respectively. In conclusion, our study shows that MUC1 and GLUT1 staining may play a useful role in differentiating thymic carcinoma from type B3 thymoma, with high sensitivity and specificity. Copyright © 2016

  3. Diagnostic performance of MRI and EUS in the differentiation of benign from malignant pancreatic cyst and cyst communication with the main duct

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    Kim, Jung Hoon, E-mail: [Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehang-no, Chongno-gu, Seoul 110-744 (Korea, Republic of); Eun, Hyo Won, E-mail: [Health Promotion Center, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736 (Korea, Republic of); Park, Hyun-Jeong, E-mail: [Department of Radiology, Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul 140-743 (Korea, Republic of); Hong, Seong Sook, E-mail: [Department of Radiology, Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul 140-743 (Korea, Republic of); Kim, Young Jae, E-mail: [Department of Radiology, Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul 140-743 (Korea, Republic of)


    Purpose: To assess the diagnostic ability of MRI and EUS for differentiating benign from malignant pancreatic cyst focusing on cyst communication with pancreatic duct. Materials and methods: During 44 months, we performed MRI on 65 pancreatic cysts. Among them, 36 patients had confirmed cyst communication with duct by ERCP or surgery and 39 patients underwent EUS. Fifty-one had proven by surgery or aspiration. Among them, 36 had confirmed malignant cysts. Two radiologists independently graded cyst communication with duct and the likelihood of malignancy. When the readers' interpretations differed, third opinion was obtained. They also measured the size of cyst and main duct. The diagnostic performance was analyzed using the ROC curve. The Mann-Whitney U test and {kappa} statistics were used to determine interobserver agreement. Results: The Az of MRI and EUS for determining diagnostic performance regarding the cyst communication with duct, were 0.931 and 0.930, without statistically difference (p = 0.6). Interobserver agreement was excellent ({kappa} = 0.81) on MRI and substantial ({kappa} = 0.69) on EUS. The Az of MRI and EUS for assessing diagnostic performance to differentiate malignant from benign cyst, was 0.902 and 0.923, without statistically difference (p = 0.587). Interobserver agreement was excellent ({kappa} = 0.81) on MRI and moderate ({kappa} = 0.47) on EUS. The mean cyst size (3.98 cm + 2.74: 3.17 cm + 1.26, p = 0.327) and the duct size (5.20 mm + 3.22: 4.39 mm + 4.12, p = 0.227) showed no statistically difference between malignant and benign cysts. Conclusion: MRI and EUS can accurately assess pancreatic cyst communication with duct and are very useful for obtaining a differential diagnosis of malignant cyst versus benign pancreatic cyst.

  4. Diagnostic Dilemma in a Patient with Jaundice: How to Differentiate between Autoimmune Pancreatitis, Primary Sclerosing Cholangitis and Pancreas Carcinoma

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    Matthias Buechter


    Full Text Available A 68-year-old male patient was referred to our institution in May 2011 for a suspected tumor in the pancreatic head with consecutive jaundice. Using magnetic resonance imaging, further differentiation between chronic inflammation and a malignant process was not possible with certainty. Apart from cholestasis, laboratory studies showed increased values for CA 19-9 to 532 U/ml (normal <37 U/ml and hypergammaglobulinemia (immunoglobulin G, IgG of 19.3% (normal 8.0–15.8% with an elevation of the IgG4 subtype to 2,350 mg/l (normal 52–1,250 mg/l. Endoscopic retrograde cholangiopancreatography revealed a prominent stenosis of the distal ductus hepaticus communis caused by pancreatic head swelling and also a bihilar stenosis of the main hepatic bile ducts. Cytology demonstrated inflammatory cells without evidence of malignancy. Under suspicion of autoimmune pancreatitis with IgG4-associated cholangitis, immunosuppressive therapy with steroids and azathioprine was started. Follow-up endoscopic retrograde cholangiopancreatography after 3 months displayed regressive development of the diverse stenoses. Jaundice had disappeared and blood values had returned to normal ranges. Moreover, no tumor of the pancreatic head was present in the magnetic resonance control images. Due to clinical and radiological similarities but a consecutive completely different prognosis and therapy, it is of fundamental importance to differentiate between pancreatic cancer and autoimmune pancreatitis. Especially, determination of serum IgG4 levels and associated bile duct lesions induced by inflammation should clarify the diagnosis of autoimmune pancreatitis and legitimate immunosuppressive therapy.

  5. 9 CFR 93.404 - Import permits for ruminants and for ruminant test specimens for diagnostic purposes; and... (United States)


    ..., or biological specimen will be moved only for scientific research or museum display purposes... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Import permits for ruminants and for... maintained by APHIS. 93.404 Section 93.404 Animals and Animal Products ANIMAL AND PLANT HEALTH...

  6. Expression of ck-19, galectin-3 and hbme-1 in the differentiation of thyroid lesions: systematic review and diagnostic meta-analysis

    Directory of Open Access Journals (Sweden)

    de Matos Leandro


    Full Text Available Abstract Background To distinguish between malignant and benign lesions of the thyroid gland histological demonstration is often required since the fine-needle aspiration biopsy method applied pre-operatively has some limitations. In an attempt to improve diagnostic accuracy, markers using immunocytochemistry and immunohistochemistry techniques have been studied, mainly cytokeratin-19 (CK-19, galectin-3 (Gal-3 and Hector Battifora mesothelial-1 (HBME-1. However, current results remain controversial. The aim of the present article was to establish the diagnostic accuracy of CK-19, Gal-3 and HBME-1 markers, as well as their associations, in the differentiation of malignant and benign thyroid lesions. Methods A systematic review of published articles on MEDLINE and The Cochrane Library was performed. After establishing inclusion and exclusion criteria, 66 articles were selected. The technique of meta-analysis of diagnostic accuracy was employed and global values of sensitivity, specificity, area under the summary ROC curve, and diagnostic odds ratio (dOR were calculated. Results For the immunohistochemistry technique, the positivity of CK-19 for the diagnosis of malignant thyroid lesions demonstrated global sensitivity of 81% and specificity of 73%; for Gal-3, sensitivity of 82% and specificity of 81%; and for HBME-1, sensitivity of 77% and specificity of 83%. The association of the three markers determined sensitivity of 85%, specificity of 97%, and diagnostic odds ratio of 95.1. Similar results were also found for the immunocytochemistry assay. Conclusion This meta-analysis demonstrated that the three immunomarkers studied are accurate in pre- and postoperative diagnosis of benign and malignant thyroid lesions. Nevertheless, the search for other molecular markers must continue in order to enhance this diagnostic accuracy since the results found still show a persistency of false-negative and false-positive tests. Virtual slides Http

  7. Magnetic resonance in the liver. II differential diagnostic of primitive focal lesion. La resonancia magnetica en el higado. II. Diagnostico diferencial de la lesion focal primitiva

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez Hernando, C.; Pastrana Ledesma, M.; Minaya Bernedo, J.; Ramos Gonzalez, L. (Clinica Fuensanta. Madrid (Spain))


    Magnetic resonance (MR) has become a mandatory diagnostic technique for space occupying processes of the liver since it allows the identification of benign processes (cysts, hemangioma focal nodular hyperplasia, regeneration nodules and adenomatous hyperplasia) and malignant processes (hepatoma, intrahepatic cholangiocarcinoma, metastasis, etc.) which, if the situation of the patient so permits, require inmediate surgery. If we add to this the fact that its sensitivity in the detection of focal lesions is greater than that of any other diagnostic technique (including livers deformed by cirrhosis or partial or diffuse fatty infiltrations), it is probably the ideal procedure for the radiological study of the liver. The aim of this work is to record the events that produce primitive expansive processes of the liver and the major points on which the differential diagnosis between them is based. (Author)

  8. Diagnostic accuracy of apparent diffusion coefficient value in differentiating metastatic form benign axillary lymph nodes in cancer breast

    Directory of Open Access Journals (Sweden)

    Ahmed A. Azeem Ismail


    Conclusion: Compared with lymph node size or routine magnetic resonance sequences, DWI and ADC are promising techniques for differentiating metastatic and non metastatic axillary lymph nodes in known breast cancer patients.

  9. Diagnostic Utility of Pleural Effusion and Serum Cholesterol, Lactic Dehydrogenase and Protein Ratios in the Differentiation between Transudates and Exudates

    National Research Council Canada - National Science Library

    O. Fagere, Muaz


    ...) ratios in the differentiation between exudate and transudate pleural effusion. As a part of the investigation, 135 serum and pleural effusion samples were collected from patients with accumulated plural effusion...

  10. Comparison of the diagnostic accuracy of neuropsychological tests in differentiating Alzheimer's disease from mild cognitive impairment: can the montreal cognitive assessment be better than the cambridge cognitive examination? (United States)

    Martinelli, José Eduardo; Cecato, Juliana Francisca; Bartholomeu, Daniel; Montiel, José Maria


    Considering the lack of studies on measures that increase the diagnostic distinction between Alzheimer's disease (AD) and mild cognitive impairment (MCI) and on the role of the Cambridge Cognitive Examination (CAMCOG) in this, our study aims to compare the utility of the CAMCOG, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in helping to differentiate AD from MCI in elderly people with >4 years of schooling. A total of 136 elderly subjects - 39 normal controls as well as 52 AD patients and 45 MCI patients treated at the Institute of Geriatrics and Gerontology, Porto Alegre, Brazil - were assessed using the MMSE, CAMCOG, clock drawing test (CDT), verbal fluency test (VF), Geriatric Depression Scale and Pfeffer Functional Activities Questionnaire. The results obtained by means of a receiver operating characteristic curve showed that the MoCA is a better screening test for differentiating elderly subjects with AD from those with MCI than the CAMCOG and MMSE as well as other tests such as the CDT and VF. The MoCA, more than the CAMCOG and the other tests, was shown to be able to differentiate AD from MCI, although, as Roalf et al. [Alzheimers Dement 2013;9:529-537] pointed out, further studies might lead to measures that will improve this differentiation.

  11. Diagnostic performance of MR imaging findings and quantitative values in the differentiation of seromucinous borderline tumour from endometriosis-related malignant ovarian tumour

    Energy Technology Data Exchange (ETDEWEB)

    Kurata, Yasuhisa; Kido, Aki; Moribata, Yusaku; Kameyama, Kyoko; Himoto, Yuki; Togashi, Kaori [Kyoto University Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto (Japan); Minamiguchi, Sachiko [Kyoto University Graduate School of Medicine, Department of Diagnostic Pathology, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto (Japan); Konishi, Ikuo [Kyoto University Graduate School of Medicine, Department of Gynecology and Obstetrics, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto (Japan)


    To evaluate the diagnostic performance of quantitative values and MRI findings for differentiating seromucinous borderline tumours (SMBTs) from endometriosis-related malignant ovarian tumours (MT). This retrospective study examined 19 lesions from SMBT and 84 lesions from MT. The following quantitative values were evaluated using receiver-operating characteristic analysis: overall and solid portion sizes, fluid signal intensity (SI), degree of contrast-enhancement, and mean and minimum apparent diffusion coefficient (ADC) values of the solid portion. Two radiologists independently evaluated four MRI findings characteristic of SMBT, fluid SI on the T1-weighted image and SI of the solid portion on diffusion-weighted image. The diagnostic values of these findings and interobserver agreement were assessed. For diagnosing SMBT, the mean ADC value of the solid portion showed the greatest area under the curve (0.860) (cut-off value: 1.31 x 10{sup -3} mm{sup 2}/s, sensitivity: 1.00, specificity: 0.61). The T2-weighted image (T2WI) high SI solid portion was the most useful finding, with high specificity and interobserver agreement (sensitivity, 0.58; specificity, 0.95-0.96, kappa = 0.96), followed by T2WI low SI core (sensitivity, 0.48-0.63; specificity, 0.98, kappa = 0.68). Mean ADC values of the solid portion, T2WI high SI solid portion, and T2WI low SI core were useful for differentiating SMBT from MT. (orig.)

  12. Pancreatic neuroendocrine tumour (PNET): Staging accuracy of MDCT and its diagnostic performance for the differentiation of PNET with uncommon CT findings from pancreatic adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Hoon; Lee, Jeong Min; Han, Joon Koo; Choi, Byung-Ihn [Seoul National University Hospital, Department of Radiology, 101 Daehangno, Jongno-gu, Seoul (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul (Korea, Republic of); Eun, Hyo Won [Yonsei University College of Medicine, Department of Radiology, Severance Hospital, Seodaemun-ku, Seoul (Korea, Republic of); Kim, Young Jae [Soonchunhyang University Hospital, Department of Radiology, 657 Hannam-Dong, Youngsan-Ku, Seoul (Korea, Republic of)


    To investigate staging accuracy of multidetector CT (MDCT) for pancreatic neuroendocrine tumour (PNET) and diagnostic performance for differentiation of PNET from pancreatic adenocarcinoma. We included 109 patients with surgically proven PNET (NETG1 = 66, NETG2 = 31, NEC = 12) who underwent MDCT. Two reviewers assessed stage and presence of predefined CT findings. We analysed the relationship between CT findings and tumour grade. Using PNETs with uncommon findings, we also estimated the possibility of PNET or adenocarcinoma. Accuracy for T stage was 85-88 % and N-metastasis was 83-89 %. Common findings included well circumscribed, homogeneously enhanced, hypervascular mass, common in lower grade tumours (p < 0.05). Uncommon findings included ill-defined, heterogeneously enhanced, hypovascular mass and duct dilation, common in higher grade tumours (p < 0.05). Using 31 PNETs with uncommon findings, diagnostic performance for differentiation from adenocarcinoma was 0.760-0.806. Duct dilatation was an independent predictor for adenocarcinoma (Exp(B) = 4.569). PNETs with uncommon findings were associated with significantly worse survival versus PNET with common findings (62.7 vs. 95.7 months, p < 0.001). MDCT is useful for preoperative evaluation of PNET; it not only accurately depicts the tumour stage but also prediction of tumour grade, because uncommon findings were more common in higher grade tumours. (orig.)

  13. Fluorescence In Situ Hybridization for MDM2 Amplification as a Routine Ancillary Diagnostic Tool for Suspected Well-Differentiated and Dedifferentiated Liposarcomas: Experience at a Tertiary Center

    Directory of Open Access Journals (Sweden)

    Khin Thway


    Full Text Available Background. The assessment of MDM2 gene amplification by fluorescence in situ hybridization (FISH has become a routine ancillary tool for diagnosing atypical lipomatous tumor (ALT/well-differentiated liposarcoma and dedifferentiated liposarcoma (WDL/DDL in specialist sarcoma units. We describe our experience of its utility at our tertiary institute. Methods. All routine histology samples in which MDM2 amplification was assessed with FISH over a 2-year period were included, and FISH results were correlated with clinical and histologic findings. Results. 365 samples from 347 patients had FISH for MDM2 gene amplification. 170 were positive (i.e., showed MDM2 gene amplification, 192 were negative, and 3 were technically unsatisfactory. There were 122 histologically benign cases showing a histology:FISH concordance rate of 92.6%, 142 WDL/DDL (concordance 96.5%, and 34 cases histologically equivocal for WDL (concordance 50%. Of 64 spindle cell/pleomorphic neoplasms (in which DDL was a differential diagnosis, 21.9% showed MDM2 amplification. Of the cases with discrepant histology and FISH, all but 3 had diagnoses amended following FISH results. For discrepancies of benign histology but positive FISH, lesions were on average larger, more frequently in “classical” (intra-abdominal or inguinal sites for WDL/DDL and more frequently core biopsies. Discrepancies of malignant histology but negative FISH were smaller, less frequently in “classical” sites but again more frequently core biopsies. Conclusions. FISH has a high correlation rate with histology for cases with firm histologic diagnoses of lipoma or WDL/DDL. It is a useful ancillary diagnostic tool in histologically equivocal cases, particularly in WDL lacking significant histologic atypia or DDL without corresponding WDL component, especially in larger tumors, those from intra-abdominal or inguinal sites or core biopsies. There is a significant group of well-differentiated adipocytic neoplasms

  14. [Differential diagnostic considerations using ICD-10 in chronic back pain with special regard to persistent somatoform pain disorder with somatic and psychological factors (ICD-10 F45.41)]. (United States)

    Wolff, D


    It is often difficult to pass an expert opinion in cases of chronic back pain. This article analyses the differential diagnostic considerations related to coding various causes in line with ICD-10. It emphasises the I importance of making a careful distinction between orthopoedic and psychiatric conditions and disorders. Simultaneous coding of orthopoedic and psychiatric illnesses and disorders based on a distinct cluster of symptoms necessitates an interdisciplinary approach that consistently applies the ICD-10 definitions of mental an behavioural disorders in order to clearly identify the main reason for a functional impairment in the insurance and sociomedical context. Persistant somatoform pain disorder with somatic and psychological factors (ICD-10 F45.41) should be regarded as related to the underlying disease and be used primarily as an additional and descriptive diagnosis.

  15. Diagnostic Value of the CD103+CD4+/CD4+ Ratio to Differentiate Sarcoidosis from Other Causes of Lymphocytic Alveolitis. (United States)

    Bretagne, Lisa; Diatta, Ibrahima-Dina; Faouzi, Mohamed; Nobile, Antoine; Bongiovanni, Massimo; Nicod, Laurent P; Lazor, Romain


    The CD103 integrin is present on CD4+ lymphocytes of the bronchial mucosa, but not on peripheral blood CD4+ lymphocytes. It has been hypothesized that CD4+ lymphocytes in pulmonary sarcoidosis originate from redistribution from the peripheral blood to the lung, and therefore do not bear the CD103 integrin. Some data suggest that a low CD103+ percentage among bronchoalveolar lavage fluid (BALF) CD4+ lymphocytes discriminates between sarcoidosis and other diagnoses. To determine the diagnostic value of BALF CD103+ to identify sarcoidosis among other causes of alveolar lymphocytosis in a large retrospective case series. Among 391 consecutive bronchoalveolar lavages performed at our institution and analyzed by flow cytometry, we identified 207 cases, which were grouped into nine diagnostic categories: sarcoidosis, tuberculosis, non-tuberculous infections, hypersensitivity pneumonitis, non-specific interstitial pneumonia, organizing pneumonia, drug-induced lung diseases, other interstitial lung diseases (ILDs), and other diagnoses. To assess the discriminative value of the CD103+CD4+/CD4+ ratio to distinguish sarcoidosis from other entities, areas under ROC curves (AUC) were calculated. Sarcoidosis patients (n = 53) had significantly lower CD103+CD4+/CD4+ ratios than patients in other diagnostic categories. The AUC was 62% for sarcoidosis compared to all other diagnoses, and 69% for sarcoidosis compared to other ILDs. When combining CD103+CD4+/CD4+ and CD4+/CD8+ ratios, the AUC increased to 76 and 78%, respectively. When applying previously published cut-offs to our population, the AUC varied between 54 and 73%. The CD103+CD4+/CD4+ ratio does not accurately discriminate between sarcoidosis and other causes of lymphocytic alveolitis, neither alone nor in combination with the CD4+/CD8+ ratio, and is not a powerful marker for the diagnosis of sarcoidosis. © 2016 S. Karger AG, Basel.

  16. A Systematic Investigation of Program Differentiation within a Kindergarten Reading Intervention Study: The Importance of Accounting for Implementation across Conditions (United States)

    Civetelli, Christina


    This study examined dimensions of treatment integrity, specifically program differentiation, within the context of a kindergarten reading intervention study. The study explored the relationship between program differentiation and student outcomes. The study was conducted within the context of Project Early Reading Intervention (ERI), a four-year…

  17. Correlation and fractional analysis of synovial fluid microscopic images for diagnostics and differentiation of pathological conditions in joints (United States)

    Kvasniuk, D. I.; Vasyuk, V. L.


    In this paper, was given the basis of the method of spectral Stokes polarimetry of human synovial fluid. The optical model of polycrystalline networks of human knee joint synovial fluid is suggested. The results of investigating the interrelation between the values of statistical (statistical moments of the 1st-4th order), correlation (correlation area, asymmetry coefficient and autocorrelation function excess) and fractal (dispersion of logarithmic dependencies of power spectra) parameters are presented. They characterize spectral distributions of polarization azimuth and ellipticity of the body's electromagnetic radiation and dynamics of change in optical anisotropy of this biological object. The diagnostic criteria of human knee joint inflammation processes are determined.

  18. Cytological diagnostic clues in poorly differentiated squamous cell carcinomas of the breast: Streaming arrangement, necrotic background, nucleolar enlargement and cannibalism of cancer cells. (United States)

    Kinoshita, M; Matsuda, Y; Arai, T; Soejima, Y; Sawabe, M; Honma, N


    Squamous cell carcinoma (SCC) is a rare histological type of breast cancer. The cytological diagnosis of non-keratinising, poorly differentiated SCC is often difficult, and distinguishing it from invasive ductal carcinoma or apocrine carcinoma (AC) is especially challenging. We aimed to define the diagnostic cytological features of poorly differentiated SCC of the breast. We studied the cytological findings of poorly differentiated SCC (n=10) and compared them to those of IDC (n=15) and AC (n=14). The following six cytological features were evaluated: streaming arrangement, nucleolar enlargement, dense nuclei, cannibalism, atypical keratinocytes and necrotic background. SCC exhibited significantly higher frequencies of streaming arrangement (70% vs 6.7%, P=.002), nucleolar enlargement (80% vs 27%, P=.02), and necrotic background (80% vs 36%, P=.002) than invasive ductal carcinoma. The detection of two or three of these features yielded a higher sensitivity (80%) and specificity (93%) for the diagnosis of SCC. Streaming arrangement (70% vs 0%, Pstreaming arrangement, a necrotic background, nucleolar enlargement and cannibalism are useful indicators for the diagnosis of SCC of the breast. As such, greater attention should be paid to these morphological features in daily clinical practice. © 2017 John Wiley & Sons Ltd.

  19. Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH diagnostic accuracy study.

    Directory of Open Access Journals (Sweden)

    James M Mason

    Full Text Available BACKGROUND: The performance of biomarkers for heart failure (HF in older residents in long-term care is poorly understood and has not differentiated between left ventricular systolic dysfunction (LVSD and HF with preserved ejection fraction (HFpEF. METHODS: This is the first diagnostic accuracy study in this population to assess the differential diagnostic performance and acceptability of a range of biomarkers against a clinical diagnosis using portable echocardiography. A total of 405 residents, aged 65-100 years (mean 84.2, in 33 UK long-term care facilities were enrolled between April 2009 and June 2010. RESULTS: For undifferentiated HF, BNP or NT-proBNP were adequate rule-out tests but would miss one in three cases (BNP: sensitivity 67%, NPV 86%, cut-off 115 pg/ml; NT-proBNP: sensitivity 62%, NPV 87%, cut-off 760 pg/ml. Using higher test cut-offs, both biomarkers were more adequate tests of LVSD, but would still miss one in four cases (BNP: sensitivity 76%, NPV 97%, cut-off 145 pg/ml; NT-proBNP: sensitivity 73%, NPV 97%, cut-off 1000 pg/ml. At these thresholds one third of subjects would test positive and require an echocardiogram. Applying a stricter 'rule out' threshold (sensitivity 90%, only one in 10 cases would be missed, but two thirds of subjects would require further investigation. Biomarkers were less useful for HFpEF (BNP: sensitivity 63%, specificity 61%, cut-off 110 pg/ml; NT-proBNP: sensitivity 68%, specificity 56%, cut-off 477 pg/ml. Novel biomarkers (Copeptin, MR-proADM, and MR-proANP and common signs and symptoms had little diagnostic utility. CONCLUSIONS: No test, individually or in combination, adequately balanced case finding and rule-out for heart failure in this population; currently, in-situ echocardiography provides the only adequate diagnostic assessment. TRIAL REGISTRATION: ISRCTN19781227.

  20. A three-long noncoding RNA signature as a diagnostic biomarker for differentiating between triple-negative and non-triple-negative breast cancers (United States)

    Liu, Man; Xing, Lu-Qi; Liu, Yi-Jing


    Abstract Background: Triple-negative breast cancer (TNBC) is an aggressive cancer with unfavorable outcome and it is useful to explore noninvasive biomarkers for its early diagnosis. Here, we identified differentially expressed long noncoding RNAs (lncRNAs) in blood samples of patients with TNBC to assess their diagnostic value. Methods: Differential expression of lncRNAs in plasma of patients with TNBC (n = 25) and non-TNBC (NTNBC; n = 35) and in healthy controls was compared by microarray analysis and validated by real-time PCR. lncRNA expression between plasma and BC tissues was compared using Pearson correlation test. Logit model was used to obtain a new lncRNA-based score. Receiver operating characteristic analysis was performed to assess the diagnostic value of the selected lncRNAs. Results: Microarray data showed that 41 lncRNAs were aberrantly expressed. Among these, antisense noncoding RNA in the INK4 locus (ANRIL), hypoxia inducible factor 1alpha antisense RNA-2 (HIF1A-AS2), and urothelial carcinoma-associated 1 (UCA1) were markedly upregulated in plasma of patients with TNBC compared with patients with NTNBC (P < 0.01). HIF1A-AS2 expression was positively associated with its tissue levels (r = 0.670, P < 0.01). AUC (95% CI) of ANRIL, HIF1A-AS2, and UCA1 was 0.785 (0.660–0.881), 0.739 (0.610–0.844), and 0.817 (0.696–0.905), respectively. TNBCSigLnc-3, a new score obtained using the logit model, showed excellent diagnostic performance, with AUC of 0.934 (0.839–0.982), sensitivity of 76.0%, and specificity of 97.1%. Conclusion: ANRIL, HIF1A-AS2, and UCA1 expression was significantly increased in plasma of patients with TNBC, suggesting their use as TNBC-specific diagnostic biomarkers. PMID:28248879

  1. Diagnostic strategy and differential therapeutic approach for cystic lesions of the pancreas; Diagnostische Strategie und differenzialtherapeutisches Vorgehen bei zystischen Laesionen des Pankreas

    Energy Technology Data Exchange (ETDEWEB)

    Mayer, P.; Klauss, M. [Universitaetsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Tjaden, C. [Universitaetsklinikum Heidelberg, Chirurgie, Heidelberg (Germany)


    Cystic pancreatic lesions (CPL) are diagnosed with increasing frequency. Because up to 60 % of CPL are classified as malignant or premalignant, every CPL should be fully investigated and clarified. Serous CPL with low risk of malignancy must be differentiated from mucinous CPL with relevant potential malignancy (intraductal papillary mucinous neoplasm IPMN) and mucinous cystic neoplasm (MCN) as well as from harmless pseudocysts. Cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) plays a crucial role in the diagnostics of CPL. An algorithm for the differential diagnostic classification of CPL is presented. The connection to the pancreatic duct is the key diagnostic criterion to differentiate IPMN from all other CPL. An exception to this rule is that pseudocysts can also show a connection to the pancreatic duct. A further classification of CPL with no connection to the pancreatic duct can be made by morphological criteria and correlation of the radiological findings with patient age, sex, history and symptoms. Depending on the diagnosis and hence the malignant potential the indications for surgery or watch and wait have to be discussed in an interdisciplinary cooperation. Due to its higher soft tissue contrast MRI is often superior to CT for depiction of CPL morphology. (orig.) [German] Zystische Pankreaslaesionen (ZPL) werden zunehmend haeufiger diagnostiziert. Da bis zu 60 % der ZPL als praemaligne oder maligne einzustufen sind, sollte jede ZPL diagnostisch abgeklaert werden. Seroese ZPL mit geringem Entartungsrisiko (seroes zystische Neoplasien, SZN) muessen von muzinoesen ZPL mit relevantem Malignitaetspotenzial (intraduktale papillaer-muzinoese Neoplasien [IPMN] und muzinoes zystische Neoplasie [MZN]) und harmlosen Pseudozysten unterschieden werden. Die Schnittbildgebung mithilfe der CT und MRT spielt bei der Diagnostik von ZPL eine entscheidende Rolle. Vorgestellt wird ein Algorithmus zur differenzialdiagnostischen

  2. Diffusion weighted imaging for differentiating benign from malignant orbital tumors: Diagnostic performance of the apparent diffusion coefficient based on region of interest selection method

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Xiao Quan; Hu, Hao Hu; Su, Guo Yi; Liu, Hu; Shi, Hai Bin; Wu, Fei Yun [First Affiliated Hospital of Nanjing Medical University, Nanjing (China)


    To evaluate the differences in the apparent diffusion coefficient (ADC) measurements based on three different region of interest (ROI) selection methods, and compare their diagnostic performance in differentiating benign from malignant orbital tumors. Diffusion-weighted imaging data of sixty-four patients with orbital tumors (33 benign and 31 malignant) were retrospectively analyzed. Two readers independently measured the ADC values using three different ROIs selection methods including whole-tumor (WT), single-slice (SS), and reader-defined small sample (RDSS). The differences of ADC values (ADC-ROI{sub WT}, ADC-ROI{sub SS}, and ADC-ROI{sub RDSS}) between benign and malignant group were compared using unpaired t test. Receiver operating characteristic curve was used to determine and compare their diagnostic ability. The ADC measurement time was compared using ANOVA analysis and the measurement reproducibility was assessed using Bland-Altman method and intra-class correlation coefficient (ICC). Malignant group showed significantly lower ADC-ROI{sub WT}, ADC-ROI{sub SS}, and ADC-ROI{sub RDSS} than benign group (all p < 0.05). The areas under the curve showed no significant difference when using ADC-ROI{sub WT}, ADC-ROI{sub SS}, and ADC-ROI{sub RDSS} as differentiating index, respectively (all p > 0.05). The ROI{sub SS} and ROI{sub RDSS} required comparable measurement time (p > 0.05), while significantly shorter than ROI{sub WT} (p < 0.05). The ROI{sub SS} showed the best reproducibility (mean difference ± limits of agreement between two readers were 0.022 [-0.080–0.123] × 10{sup -3} mm{sup 2}/s; ICC, 0.997) among three ROI method. Apparent diffusion coefficient values based on the three different ROI selection methods can help to differentiate benign from malignant orbital tumors. The results of measurement time, reproducibility and diagnostic ability suggest that the ROI{sub SS} method are potentially useful for clinical practice.

  3. Primary Pulmonary Poorly Differentiated Synovial Sarcoma: Transducer-Like Enhancer of Split 1 Immunohistochemistry as A Valuable Diagnostic Aid (United States)

    Kaur, Amulyajit; Tazelaar, Henry Dale; Sahai, Kavita


    Poorly differentiated primary pulmonary synovial sarcomas are rare and challenging for a surgical pathologist to diagnose. Although the demonstration of the tumor specific translocation, t (x; 18)(p11.2;q11.2) or the resultant fusion gene (SYT-SSX) is the gold standard for diagnosis, this test is not always accessible. We report the use of immunohistochemistry, including transducer-like enhancer of split-1 in the diagnosis of one such tumor in a young individual. PMID:24014971

  4. The differential importance of mutations within AmpD in cephalosporin resistance of Enterobacter aerogenes and Enterobacter cloacae. (United States)

    Babouee Flury, Baharak; Ellington, Matthew J; Hopkins, Katie L; Turton, Jane F; Doumith, Michel; Woodford, Neil


    Mechanisms leading to carbapenem and cephalosporin resistance were sought in Enterobacter aerogenes isolates that were highly resistant to carbapenems but had no known carbapenemase. Results were compared with recent work examining carbapenem-resistant Enterobacter cloacae. Eighteen carbapenem-resistant E. aerogenes were screened for known β-lactamase and carbapenemase genes, and novel carbapenemases were sought in whole-genome sequencing (WGS) data of the three most resistant isolates. For all isolates, ampC, ampR, ampD and the porin genes omp35 and omp36 were investigated by Sanger sequencing or from available WGS data. Expression of ampC and porin genes was measured in comparison with cephalosporin- and carbapenem-susceptible control strains by reverse transcriptase PCR, with porin translation also detected by SDS-PAGE. Loss of Omp35, primarily due to decreased transcription (up to 250×), was observed in ertapenem-resistant isolates (MICs ≥ 2 mg/L), whereas meropenem resistance (MICs ≥ 4 mg/L) was observed in those isolates also showing decreased or no production of Omp36. Loss of Omp36 was due to combinations of premature translation termination or reduced transcription. In contrast to E. cloacae, cephalosporin resistance in E. aerogenes was not associated with lesions in AmpD. High-level cefepime resistance (MIC = 32 mg/L) was caused by a novel modification in the H-10 helix of AmpC in one isolate. The differential importance of AmpD lesions in cephalosporin resistance in E. cloacae and E. aerogenes underlines the differences between these contrasting members of the Enterobacter genus. Porin loss resulted in high-level carbapenem resistance with gradual loss of Omp36, which led to high-level meropenem resistance.

  5. Diagnostic usefulness of the oedema-infarct ratio to differentiate acute from chronic myocardial damage using magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Kiyoyasu; Suzuki, Susumu; Kinoshita, Kousuke; Yokouchi, Kazuhiko; Iwata, Hirokazu; Sawada, Ken [Gifu Social Insurance Hospital, Department of Cardiology, Gifu (Japan); Isobe, Satoshi; Ohshima, Satoru; Murohara, Toyoaki [Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya (Japan); Hirai, Makoto [Nagoya University School of Health Sciences, Department of Nursing, Nagoya (Japan)


    To differentiate acute from chronic damage to the myocardium in patients with myocardial infarction (MI) using DE and T2w MR. Short-axis T2w and DE MR images were acquired twice after the onset of MI in 36 patients who successfully underwent emergency coronary revascularisation. The areas of infarct and oedema were measured. The oedema-infarct ratio (O/I) of the left ventricular area was calculated by dividing the oedema by the infarct area. The oedema size on T2w MR was significantly larger than the infarct size on DE MR in the acute phase. Both the oedema size on T2w MR and the infarct size on DE MR in the acute phase were significantly larger than those in the chronic phase. The O/I was significantly greater in the acute phase compared with that in the chronic phase (P < 0.05). An analysis of relative cumulative frequency distributions revealed an O/I of 1.4 as a cut-off value for differentiating acute from chronic myocardial damage with the sensitivity, specificity, and accuracy of 85.1%, 82.7% and 83.9%, respectively. The oedema-infarct ratio may be a useful index in differentiating acute from chronic myocardial damage in patients with MI. (orig.)

  6. Novel multiplex real-time PCR diagnostic assay for identification and differentiation of Mycobacterium tuberculosis, Mycobacterium canettii, and Mycobacterium tuberculosis complex strains.

    NARCIS (Netherlands)

    Reddington, K.; O'Grady, J.; Dorai-Raj, S.; Maher, M.; Soolingen, D. van; Barry, T.


    Tuberculosis (TB) in humans is caused by members of the Mycobacterium tuberculosis complex (MTC). Rapid detection of the MTC is necessary for the timely initiation of antibiotic treatment, while differentiation between members of the complex may be important to guide the appropriate antibiotic treat

  7. Diagnostic accuracy of contrast-enhanced ultrasound for the differential diagnosis of hepatocellular carcinoma: ESCULAP versus CEUS-LI-RADS. (United States)

    Schellhaas, Barbara; Görtz, Ruediger S; Pfeifer, Lukas; Kielisch, Christian; Neurath, Markus F; Strobel, Deike


    A comparison is made of two contrast-enhanced ultrasound (CEUS) algorithms for the diagnosis of hepatocellular carcinoma (HCC) in high-risk patients: Erlanger Synopsis of Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at Risk (ESCULAP) and American College of Radiology Contrast-Enhanced Ultrasound-Liver Imaging Reporting and Data System (ACR-CEUS-LI-RADSv.2016). Focal liver lesions in 100 high-risk patients were assessed using both CEUS algorithms (ESCULAP and CEUS-LI-RADSv.2016) for a direct comparison. Lesions were categorized according to size and contrast enhancement in the arterial, portal venous and late phases.For the definite diagnosis of HCC, categories ESCULAP-4, ESCULAP-Tr and ESCULAP-V and CEUS-LI-RADS-LR-5, LR-Tr and LR-5-V were compared. In addition, CEUS-LI-RADS-category LR-M (definitely/probably malignant, but not specific for HCC) and ESCULAP-category C [intrahepatic cholangiocellular carcinoma (ICC)] were compared.Histology, CE-computed tomography and CE-MRI served as reference standards. The reference standard among 100 lesions included 87 HCCs, six ICCs and seven non-HCC-non-ICC-lesions. For the diagnosis of HCC, the diagnostic accuracy of CEUS was significantly higher with ESCULAP versus CEUS-LI-RADS (94.3%/72.4%; p<0.01). Sensitivity, specificity and positive predictive value (PPV) and negative predictive value for ESCULAP/CEUS-LI-RADS were 94.3%/72.4%; 61.5%/69.2%; 94.3%/94%; and 61.5%/27.3%, respectively.The diagnostic accuracy for ICC (LR-M/ESCULAP-C) was identical with both algorithms (50%), with higher PPV for ESCULAP-C versus LR-M (75 vs. 50%). CEUS-based algorithms contribute toward standardized assessment and reporting of HCC-suspect lesions in high-risk patients. ESCULAP shows significantly higher diagnostic accuracy, sensitivity and negative predictive value with no loss of specificity compared with CEUS-LI-RADS. Both algorithms have an excellent PPV. Arterial hyperenhancement is the key feature for the

  8. Differential diagnostic value of eye movement recording in PSP-parkinsonism, Richardson's syndrome, and idiopathic Parkinson's disease. (United States)

    Pinkhardt, Elmar H; Jürgens, Reinhart; Becker, Wolfgang; Valdarno, Federica; Ludolph, Albert C; Kassubek, Jan


    Vertical gaze palsy is a highly relevant clinical sign in parkinsonian syndromes. As the eponymous sign of progressive supranuclear palsy (PSP), it is one of the core features in the diagnosis of this disease. Recent studies have suggested a further differentiation of PSP in Richardson's syndrome (RS) and PSP-parkinsonism (PSPP). The aim of this study was to search for oculomotor abnormalities in the PSP-P subset of a sample of PSP patients and to compare these findings with those of (i) RS patients, (ii) patients with idiopathic Parkinson's disease (IPD), and (iii) a control group. Twelve cases of RS, 5 cases of PSP-P, and 27 cases of IPD were examined by use of video-oculography (VOG) and compared to 23 healthy normal controls. Both groups of PSP patients (RS, PSP-P) had significantly slower saccades than either IPD patients or controls, whereas no differences in saccadic eye peak velocity were found between the two PSP groups or in the comparison of IPD with controls. RS and PSP-P were also similar to each other with regard to smooth pursuit eye movements (SPEM), with both groups having significantly lower gain than controls (except for downward pursuit); however, SPEM gain exhibited no consistent difference between PSP and IPD. A correlation between eye movement data and clinical data (Hoehn & Yahr scale or disease duration) could not be observed. As PSP-P patients were still in an early stage of the disease when a differentiation from IPD is difficult on clinical grounds, the clear-cut separation between PSP-P and IPD obtained by measuring saccade velocity suggests that VOG could contribute to the early differentiation between these patient groups.

  9. Diagnostic accuracy of PLA2R autoantibodies and glomerular staining for the differentiation of idiopathic and secondary membranous nephropathy: an updated meta-analysis. (United States)

    Dai, Huanzi; Zhang, Huhai; He, Yani


    The diagnostic performance of M-type phospholipase A2 receptor (PLA2R) autoantibodies and PLA2R glomerular staining in discriminating between idiopathic membranous nephropathy (iMN) and secondary membranous nephropathy (sMN) has not been fully evaluated. We conducted an updated meta-analysis to investigate the accuracy and clinical value of serological anti-PLA2R test and histological PLA2R staining for differentiation iMN from sMN. A total of 19 studies involving 1160 patients were included in this meta-analysis. The overall sensitivity, specificity, diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) of serum anti-PLA2R were 0.68 (95% CI, 0.61-074), 0.97 (95% CI, 0.85-1.00), 73.75 (95% CI, 12.56-432.96) and 0.82 (95% CI, 0.78-0.85), respectively, with substantial heterogeneity (I(2) = 86.42%). Subgroup analyses revealed the study design, publication type, study origin, assay method might account for the heterogeneity. Additionally, the overall sensitivity, specificity, DOR and AUROC of glomerular PLA2R staining were 0.78 (95% CI, 0.72-0.83), 0.91 (95% CI, 0.75-0.97), 34.70 (95% CI, 9.93-121.30) and 0.84 (95% CI, 0.81-0.87), respectively, without heterogeneity (I(2) = 0%). Serological anti-PLA2R testing has diagnostic value, but it must be interpreted in context with patient clinical characteristics and histological PLA2R staining in seronegative patients is recommended.

  10. Influence of lesion ratio on diagnostic performance of in-phase/opposed-phase imaging and apparent diffusion coefficient for differentiating acute benign vertebral fractures and metastases

    Institute of Scientific and Technical Information of China (English)

    LIN Fan; LEI Yi; LI Yang-bin


    Background The usefulness of in-phase/opposed-phase imaging and diffusion weighted imaging (DWI) in differentiating benign and neoplastic vertebral fractures has been described. In this study, we aimed to evaluate the influence of the severity of vertebral damage on the diagnostic performance of these two technologies.Methods Totally 59 patients with 68 acute benign vertebral fractures and 43 patients with 79 vertebral metastases were included in this study. The MR protocol included DWls and sagittal in-phase/opposed-phase gradient recalled sequence.The severity of vertebral damage was expressed by lesion ratio (LR, the ratio of lesion area to vertebral area on the slices of largest abnormal signal area in the T1-weighted sequence). Quantitative (signal intensity ratio (SIR) defined as signal intensity (SI) on opposed-phase gradient recalled echo (GRE) images divided by SI on in-phase; apparent diffusion coefficient (ADC) value derived from DWI analysis was performed, the relationships between LR and the measurements of these two technologies were analyzed using linear regression. The covariate-specific receiver operating characteristic (ROC) curves were also fitted to evaluate the influence of LR on the diagnostic performance of ADC and SIR. Results The difference in both SIR and ADC for vertebral metastasis and acute benign vertebral fractures was significant (P 0.05). More severe cases were associated with increased AUC for SIR.Conclusions LR is capable of affecting the diagnostic performances of chemical shift imaging. Thus, when applying these tests to make diagnoses on vertebral fractures, the severity of the vertebral damage should be taken into account.The covariate-specific ROC model is recommended because it substantially improves the ability to avoid bias when evaluating tests.

  11. Rapid on-site evaluation has high diagnostic yield differentiating adenocarcinoma vs squamous cell carcinoma of non-small cell lung carcinoma, not otherwise specified subgroup. (United States)

    Celik, Betul; Khoor, Andras; Bulut, Tangul; Nassar, Aziza


    Our objective was to evaluate the diagnostic yield of rapid on-site evaluation (ROSE) on the differential diagnosis of non-small cell lung carcinoma, not otherwise specified (NSCLC-NOS). Biopsied cases diagnosed as NSCLC-NOS with ROSE during 2004 through 2008 were retrieved. Diagnostic confirmation was done with immunohistochemistry (IHC) involving thyroid transcription factor-1 and p63 immunostains. For the study, 106 cases were available. The final diagnoses rendered were squamous cell carcinoma (SqCC) (n = 39) and adenocarcinoma (AC) (n = 67). Cytologic, histologic, and IHC concordance for these diagnoses occurred in 75 cases (70.8 %), of which 56 (52.8%) were AC and 19 (17.9%) were SqCC. Cytologic, histologic, and IHC discordance was found in 31 cases (29.2%). Of these 31 cases, 11 NSCLC-NOS diagnoses histologically corresponded to 1 SqCC plus 4 ACs, and 4 favor SqCC plus 2 ACs; the former 5 NSCLC-NOS cases classified correctly through cytology, as well as IHC. However, IHC was not available for the latter 6 NSCLC-NOS cases that were also classified correctly through cytology. In addition, only 3 NSCLC-NOS diagnoses cytologically corresponded to 3 favor SqCC histologically, in which IHC was not available, and for 2 cases that both corresponded to favor SqCC and favor AC histologically and cytologically. In the other 15 cases, histology labeled 4 cases NSCLC-NOS and misclassified 2 cases; cytology labeled 1 case NSCLC-NOS and misclassified 13 cases. ROSE has high diagnostic yield over subclassification of NSCLC-NOS. We recommend allocating a cytotechnologist for specimen adequacy and a cytopathologist for cytologic diagnosis.

  12. The utility of biomarkers in differentiating bacterial from non-bacterial lower respiratory tract infection in hospitalized children: difference of the diagnostic performance between acute pneumonia and bronchitis. (United States)

    Hoshina, Takayuki; Nanishi, Etsuro; Kanno, Shunsuke; Nishio, Hisanori; Kusuhara, Koichi; Hara, Toshiro


    The aim of this study is to investigate the utility of several biomarkers in differentiating bacterial community-acquired lower respiratory tract infection (CA-LRTI) from non-bacterial CA-LRTI in children and the difference of their diagnostic performance between pneumonia and bronchitis. A retrospective cohort study composed of 108 pediatric patients hospitalized for CA-LRTI was performed during 2010-2013. Based on the findings of chest X-ray and sputum samples, patients were divided into 4 categories, group of bacterial pneumonia or bronchitis, and non-bacterial (viral or etiology-unknown) pneumonia or bronchitis. Peripheral white blood cell and neutrophil counts, and serum C-reactive protein (CRP) and procalcitonin (PCT) levels were compared among the 4 groups. Finally, 54 patients were the subject of this study. In the patients with pneumonia, serum CRP and PCT levels were significantly elevated in the group of bacterial pneumonia (CRP: p = 0.02, PCT: p = 0.0008). The area under the receiver operating characteristic curve for PCT for distinguishing between bacterial and non-bacterial pneumonia was the largest, and sensitivity, specificity, positive predictive value and negative predictive value of PCT were best among 4 markers. On the other hand, in the patients with bronchitis, neutrophil count was significantly decreased in non-bacterial bronchitis whereas no significant differences of WBC count, CRP level or PCT level were seen. In conclusion, PCT was the most useful marker to differentiate bacterial pneumonia whereas neutrophil count contributed most to the discrimination of bacterial bronchitis. The diagnostic performance of biomarkers may be different between pneumonia and bronchitis. Copyright © 2014. Published by Elsevier Ltd.

  13. Differential diagnosis and diagnostic flow chart of joint hypermobility syndrome/ehlers-danlos syndrome hypermobility type compared to other heritable connective tissue disorders. (United States)

    Colombi, Marina; Dordoni, Chiara; Chiarelli, Nicola; Ritelli, Marco


    Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is an evolving and protean disorder mostly recognized by generalized joint hypermobility and without a defined molecular basis. JHS/EDS-HT also presents with other connective tissue features affecting a variety of structures and organs, such as skin, eye, bone, and internal organs. However, most of these signs are present in variable combinations and severity in many other heritable connective tissue disorders. Accordingly, JHS/EDS-HT is an "exclusion" diagnosis which needs the absence of any consistent feature indicative of other partially overlapping connective tissue disorders. While both Villefranche and Brighton criteria include such an exclusion as a mandatory item, a systematic approach for reaching a stringent clinical diagnosis of JHS/EDS-HT is still lacking. The absence of a consensus on the diagnostic approach to JHS/EDS-HT concerning its clinical boundaries with similar conditions contribute to limit our actual understanding of the pathologic and molecular bases of this disorder. In this review, we revise the differential diagnosis of JHS/EDS-HT with those heritable connective tissue disorders which show a significant overlap with the former and mostly include EDS classic, vascular and kyphoscoliotic types, osteogenesis imperfecta, Marfan syndrome, Loeys-Dietz syndrome, arterial tortuosity syndrome, and lateral meningocele syndrome. A diagnostic flow chart is also offered with the attempt to support the less experienced clinician in stringently recognizing JHS/EDS-HT and stimulate the debate in the scientific community for both management and research purposes.

  14. Diagnostic and interventional radiology

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    Vogl, Thomas J. [Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt am Main (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Reith, Wolfgang [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie; Rummeny, Ernst J. (ed.) [Technische Univ. Muenchen Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Radiologie


    This exceptional book covers all aspects of diagnostic and interventional radiology within one volume, at a level appropriate for the specialist. From the basics through diagnosis to intervention: the reader will find a complete overview of all areas of radiology. The clear, uniform structure, with chapters organized according to organ system, facilitates the rapid retrieval of information. Features include: Presentation of the normal radiological anatomy Classification of the different imaging procedures according to their diagnostic relevance Imaging diagnosis with many reference images Precise description of the interventional options The inclusion of many instructive aids will be of particular value to novices in decision making: Important take home messages and summaries of key radiological findings smooth the path through the jungle of facts Numerous tables on differential diagnosis and typical findings in the most common diseases offer a rapid overview and orientation Diagnostic flow charts outline the sequence of diagnostic evaluation All standard procedures within the field of interventional radiology are presented in a clinically relevant and readily understandable way, with an abundance of illustrations. This is a textbook, atlas, and reference in one: with more than 2500 images for comparison with the reader's own findings. This comprehensive and totally up-to-date book provides a superb overview of everything that the radiology specialist of today needs to know.

  15. Differential neuropsychological patterns of frontal variant frontotemporal dementia and Alzheimer's disease in a study of diagnostic concordance. (United States)

    Giovagnoli, Anna R; Erbetta, Alessandra; Reati, Fabiola; Bugiani, Orso


    Although the pathological hallmarks of Alzheimer's disease (AD) and frontal variant frontotemporal dementia (fvFTD) predict different cognitive patterns, many comparative neuropsychological studies showed no difference in the expected cognitive domains. Inconsistencies in diagnostic criteria, small cohorts of patients, and neuropsychological assessment may account for such findings. Moreover, discrepancies in memory and executive dysfunctions that are expected to distinguish AD and fvFTD may reflect the basic brain organization. Adhering to a strict concordance of clinical and neuroradiological criteria, we compared many patients with AD and fvFTD using a large neuropsychological battery. One hundred and thirty-nine patients with AD (n=89) or fvFTD (n=50) were retrospectively considered in order to verify the diagnostic congruence of clinical and neuroradiological aspects. On this basis, 117 patients with AD (n=77) or fvFTD (n=40) with similar duration and severity of dementia were selected. Ninety-one healthy subjects were also controlled. Mean scores in tests for abstract reasoning, planning, set shifting, initiative, verbal fluency, immediate and episodic memory, constructive, ideomotor and orofacial praxis, selective and divided attention, visuomotor coordination, and visual perception were evaluated. Separate analyses of variance and post hoc Bonferroni tests showed that, with respect to controls, both patient groups were significantly impaired in all neuropsychological tests. Compared to fvFTD patients, AD patients were significantly impaired in episodic memory, selective attention, visual perception, visuomotor coordination, and constructive praxis, whereas no differences were found in executive, intellective, and linguistic abilities between the two patient groups. Logistic regression analyses revealed that episodic memory significantly predicted the diagnosis of AD while no executive deficit was able to predict the diagnosis of fvFTD. To conclude, memory

  16. Diagnostic {sup 131}I whole-body scintigraphy 1 year after thyroablative therapy in patients with differentiated thyroid cancer: correlation of results to the individual risk profile and long-term follow-up

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    Berger, Frank [Ludwig-Maximilians University of Munich, Department of Clinical Radiology, Munich (Germany); Friedrich, Ulla; Knesewitsch, Peter; Hahn, Klaus [Ludwig-Maximilians University of Munich, Department of Nuclear Medicine, Munich (Germany)


    {sup 131}I whole-body scan (WBS) and serum thyroglobulin (TG) are important in detecting thyroid remnants or recurrent disease in patients with differentiated thyroid cancer. Usually, a diagnostic WBS is carried out 6 months after ablation to exclude residual disease. We retrospectively analysed results of a second routine diagnostic WBS and TG measurements at 1 year after thyroablation and correlated these to the risk profile of patients with long-term follow-up. A total of 197 patients were followed up after thyroidectomy and ablative {sup 131}I therapy. Follow-up included clinical examination, radioiodine WBS and thyroid-stimulating hormone (TSH), free thyroxine and TG measurements at 3-6 months and 1 year after ablation. WBS (+) patients received a therapeutic activity of {sup 131}I. The risk profile of patients was defined according to clinical results before the 1-year control. Clinical results at 1 year after ablation were analysed in correlation to the patient risk profile and long-term follow-up data (mean 7.2 years). One year after thyroablation, 95.8% of low-risk patients had no residual disease when diagnostic WBS was carried out using 370 MBq {sup 131}I; 4.2% of low-risk patients had residual disease at this time point. In the high-risk group of this cohort, 54.5% were disease-free 1 year after ablation, but 45.5% demonstrated residual disease. After the 1-year control, 94% of all applied radioiodine therapies were executed in the high-risk group, compared with 6% in the low-risk group (p < 0.01). A second routine WBS 1 year after thyroablation is not indicated in low-risk patients. Risk stratification according to the early clinical course effectively identified patients with higher likelihood of persistent or recurrent disease in the long-term follow-up. (orig.)

  17. Importance of diagnostic laboratory methods of beta hemolytic streptococcus group A in comparison with clinical findings in the diagnosis of streptococcal sore throat and unnecessary antibacterial therapy

    Directory of Open Access Journals (Sweden)

    Peiman Eini


    Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.

  18. Cytomorphologic overlap of differentiated thyroid carcinoma and lung adenocarcinoma and diagnostic value of TTF-1 and TGB on cytologic material. (United States)

    Sathiyamoorthy, Srividya; Maleki, Zahra


    Thyroid carcinomas and lung adenocarcinoma share cytomorphological features yet have different prognoses. Thyroid Transcription Factor-1 (TTF-1) is an immunohistochemical (IHC) marker used to confirm pulmonary and thyroid carcinoma, while Thyroglobulin (TGB) is expressed by thyroid carcinoma. The cytopathology archive of The Johns Hopkins Hospital was searched for cases of lung adenocarcinoma versus thyroid carcinoma with TTF-1 and TGB IHC. Forty-four cases of lung adenocarcinoma (25) and thyroid carcinoma (19) were retrieved. One was metastatic lung adenocarcinoma to the thyroid and three were metastatic papillary thyroid carcinoma (PTC) to the lung. The initial interpretation of two cases from bony lesions was metastatic lung adenocarcinoma. In light of additional clinical information and TGB immunostain, the diagnoses of these two cases changed to metastatic thyroid carcinoma. TTF-1 and TGB is a small immunostain panel that can differentiate lung adenocarcinoma from thyroid carcinoma and prevent misdiagnosis and its consequences. Copyright © 2013 Wiley Periodicals, Inc.

  19. Utility of transperineal and anal ultrasonography in the diagnostics of hidradenitis suppurativa and its differentiation from a rectal fistula. (United States)

    Kołodziejczak, Małgorzata; Sudoł-Szopińska, Iwona; Wilczyńska, Aleksandra; Bierca, Jacek


    The pathogenesis of hidradenitis suppurativa (HS) is not fully understood. There exist several theories, in which mechanical factors, genetic factors, as well as immunological dysfunction of lymphocytes are suspected. Clinically, this entity is frequently mistaken for anal fistula with consequently wrong treatment. We aim to determine the utility of transperineal ultrasound (TPUS) and anal ultrasound (AUS) in the diagnosis of HS and its differentiation from an anal fistula. Retrospective analysis was performed on 51 patients (5 females, 46 males) aged 20-71 years (mean age 47.5), who were operated on in the years 2006-2011 for HS in the area of the anus and perineum, and pre-operatively had been imaged with TPUS and AUS. Sixty-seven operations were analyzed, as 11 patients were operated on more than once due to HS recurrence. In 66 out of 67 cases (98.5%), the pre-operative TPUS and AUS were in accordance with the intraoperative findings. Only in 1 patient was a pilonidal cyst diagnosed intraoperatively. In all 67 patients, the TPUS showed typical fluid-solid changes localized in the subcutaneous adipose tissue. In 6 out of 67 cases of HS (8.9%) AUS showed an anal fistula coexisting with the HS. In 2 cases (2.9%) a skin malignancy coexisting with HS was found. TPUS is an accessible imaging method, which confirms the typical localization of changes of HS, and together with AUS it allows for the proper differentiation of HS from an anal fistula or an abscess.

  20. Effects of pressure ulcer classification system education programme on knowledge and visual differential diagnostic ability of pressure ulcer classification and incontinence-associated dermatitis for clinical nurses in Korea. (United States)

    Lee, Yun Jin; Kim, Jung Yoon


    The objective of this study was to evaluate the effect of pressure ulcer classification system education on clinical nurses' knowledge and visual differential diagnostic ability of pressure ulcer (PU) classification and incontinence-associated dermatitis (IAD). One group pre and post-test was used. A convenience sample of 407 nurses, participating in PU classification education programme of continuing education, were enrolled. The education programme was composed of a 50-minute lecture on PU classification and case-studies. The PU Classification system and IAD knowledge test (PUCS-KT) and visual differential diagnostic ability tool (VDDAT), consisting of 21 photographs including clinical information were used. Paired t-test was performed using SPSS/WIN 20.0. The overall mean difference of PUCS-KT (t = -11·437, P<0·001) and VDDAT (t = -21·113, P<0·001) was significantly increased after PU classification education. Overall understanding of six PU classification and IAD after education programme was increased, but lacked visual differential diagnostic ability regarding Stage III PU, suspected deep tissue injury (SDTI), and Unstageable. Continuous differentiated education based on clinical practice is needed to improve knowledge and visual differential diagnostic ability for PU classification, and comparison experiment study is required to examine effects of education programmes.

  1. Diagnostic performance of conventional MRI parameters and apparent diffusion coefficient values in differentiating between benign and malignant soft-tissue tumours. (United States)

    Song, Y; Yoon, Y C; Chong, Y; Seo, S W; Choi, Y-L; Sohn, I; Kim, M-J


    To compare the abilities of conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) in differentiating between benign and malignant soft-tissue tumours (STT). A total of 123 patients with STT who underwent 3 T MRI, including diffusion-weighted imaging (DWI), were retrospectively analysed using variate conventional MRI parameters, ADCmean and ADCmin. For the all-STT group, the correlation between the malignant STT conventional MRI parameters, except deep compartment involvement, compared to those of benign STT were statistically significant with univariate analysis. Maximum diameter of the tumour (p=0.001; odds ratio [OR], 8.97) and ADCmean (p=0.020; OR, 4.30) were independent factors with multivariate analysis. For the non-myxoid non-haemosiderin STT group, signal heterogeneity on axial T1-weighted imaging (T1WI; p=0.017), ADCmean, and ADCmin (p=0.001, p=0.001), showed significant differences with univariate analysis between malignancy and benignity. Signal heterogeneity in axial T1WI (p=0.025; OR, 12.64) and ADCmean (p=0.004; OR, 33.15) were independent factors with multivariate analysis. ADC values as well as conventional MRI parameters were useful in differentiating between benign and malignant STT. The ADCmean was the most powerful diagnostic parameter in non-myxoid non-haemosiderin STT. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  2. Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and supplementary exams Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

    Directory of Open Access Journals (Sweden)

    Cássio M.C. Bottino

    Full Text Available Abstract In 2005, the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology published recommendations for the diagnosis of Alzheimer's disease These recommendations were updated following a review of evidence retrieved from national and international studies held on PUBMED, SCIELO and LILACS medical databases. The main aims of this review article are as follows: 1 to present the evidence found on Brazilian (LILACS, SCIELO and International (MEDLINE databases from articles published up to May 2011, on the differential diagnosis of these psychiatric disorders and dementia, with special focus on Dementia due to Alzheimer's and vascular dementia, including a review of supplementary exams which may facilitate the diagnostic process; and 2 to propose recommendations for use by clinicians and researchers involved in diagnosing patients with dementia. Differential diagnosis between dementia and other neuropsychiatric disorders should always include assessments for depression, delirium, and use of psychoactive substances, as well as investigate the use of benzodiazepines, anti-epileptics and pattern of alcohol consumption.

  3. The differential diagnostic value of intussusception and volvulus in MSCT%肠套叠与肠扭转的MSCT鉴别诊断价值

    Institute of Scientific and Technical Information of China (English)

    孟世平; 刘地水; 谢斯


    目的回顾性分析肠套叠与肠扭转的64层螺旋CT鉴别诊断价值。方法应用siemens definition AS64螺旋CT行全腹部薄层扫描,结合MPR、CPR、容积再现(VR)等重建图像进行综合分析。结果肠套叠34例,肠扭转3例,术前诊断符合率100%。结论 MSCT结合MPR、CPR等方法对肠套叠与肠扭转的术前鉴别诊断具有重要价值。%Objective To Retrospectively analysis The differential diagnostic value of intussusception and volvulus in MSCT. Methods To apply Siemens definition AS64 CT in the whole abdominal lamellar scanning, comprehensive analysis the reconstructive image of MPR、CPR、VR. Results The rate of preoperative diagnosis coincidence is 100% in 34 cases of intussusception and 3 cases of volvulus. Conclusion It is valuable in preoperative differential diagnosis of intussusception and volvulus that MSCT integrates with MPR, CPR.

  4. Differential diagnostic relevance of high resolution magnetic resonance in patients with possible multiple system atrophy (MSA) - A case report. (United States)

    Baronica, Koraljka Bacić; Ivkić, Goran; Ozretić, David; Milicević, Goran


    Multiple system atrophy (MSA) is sporadic, progressive neurodegenerative disorder characterized clinically by autonomic dysfunction, Parkinsonism (MSA-P), and cerebellar ataxia (MSA-C) in any combination. Parkinsonism is present in the majority of patients (80%). Early in the course of the disease autonomic dysfunctions are present in approximately 40% of patients, while the domination of cerebellar symptoms is present in 20% of all patients. According to second consensus statement on diagnosis of MSA, to make the diagnosis of possible MSA, except Parkinsonism or a cerebellar syndrome, there must be one feature involving autonomic dysfunction plus one other additional that can include findings on history, clinical examination or changes in structural or functional imaging. We present a case of 60-year old male with Parkinsonism and cerebellar symptoms accompanied with signs of autonomic nervous system involvement. Level of autonomic dysfunction was not the level required for the diagnosis of probable MSA. On initially performed 1.5T MRI, the most prominent neurodegenerative feature of brain stem, cerebellum and basal ganglia was atrophy, however features like "hot-cross bun" sign, "slit-like" putaminal rim and middle cerebellar peduncle hyperintensities were detected only after MR imaging on higher resolution (3T) device. Our case points to the possibility that some typical structural changes that can help in diagnostic process may not be clearly visible on 1.5 T MRI devices. In such cases we suggest using 3T MRI device, if feasible, in order to demonstrate findings that may help in establishing the diagnosis of possible MSA.

  5. Postictal MR-changes. A rare and important differential diagnosis; Postiktale MR-Veraenderungen. Eine seltene und wichtige Differenzialdiagnose

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    Hattingen, E.; Raab, P.; Lanfermann, H.; Zanella, F.E.; Weidauer, S. [Johann-Wolfgang-Goethe-Universitaet Frankfurt/Main, Institut fuer Neuroradiologie, Frankfurt (Germany)


    Postictal MR findings are analyzed in the context of MR morphological differential diagnoses. Postictal MRI was performed in 11 patients. The patterns of MR changes and their differential diagnoses were analyzed. Focal accentuation of signal increase in the cortex was found on T2-weighted images in 90% of these cases, pial enhancement in 70% and signal changes of the pulvinar/thalamus in 40%. The most common differential diagnoses were encephalitis, and in tumor patients carcinomatous involvement of the meninges. Postictal MR changes vary widely and are difficult to differentiate from illnesses such as encephalitis and carcinomatosis involving the meninges. Nevertheless, knowledge of the typical pattern of postictal MR findings and the clinical course may help to avoid mistaken diagnoses. (orig.) [German] Postiktale MR-Veraenderungen werden im Kontext ihrer Differenzialdiagnosen analysiert. Elf Patienten wurden postiktal im MRT untersucht. Ausgewertet wurden die MR-tomographischen Befundmuster und ihre Differenzialdiagnosen. Bei 90% der Patienten fanden sich fokale kortikal betonte Signalsteigerungen in der T2-Wichtung, bei 90% Diffusionseinschraenkungen, bei 70% piale Anreicherungen und bei 40% Signalalterationen des Pulvinars/Thalamus. Haeufigste Differenzialdiagnosen waren die Enzephalitis und bei entsprechender Tumoranamnese die Meningeosis carcinomatosa. Postiktale MR-Veraenderungen sind vielgestaltig und nicht immer leicht von Erkrankungen wie insbesondere der Enzephalitis oder der Meningeosis carcinomatosa zu unterscheiden. Dennoch helfen die Kenntnis typischer postiktaler Befallsmuster und der klinische Verlauf, Fehldiagnosen zu vermeiden. (orig.)

  6. Diagnostic vitrectomy for infectious uveitis (United States)

    Jeroudi, Abdallah; Yeh, Steven


    The identification of an infectious or noninfectious uveitis syndrome is important to determine the range of therapeutic and prognostic implications of that disease entity. Diagnostic dilemmas arise with atypical history, atypical clinical presentations, inconclusive diagnostic workup, and persistent or worsened inflammation despite appropriate immunosuppression. More invasive intraocular testing is indicated in these situations particularly in infectious uveitis where a delay in treatment may result in worsening of the patient’s disease and a poor visual outcome. Laboratory analysis of vitreous fluid via diagnostic pars plana vitrectomy is an important technique in the diagnostic armamentarium, but the most important aspects of sample collection include rapid processing, close coordination with an ophthalmic pathology laboratory, and directed testing on this limited collected sample. Culture and staining has utility in bacterial, fungal, and nocardial infection. Polymerase chain reaction (PCR) analysis has shown promising results for bacterial endophthalmitis and infection with mycobacterium tuberculosis whereas PCR testing for viral retinitides and ocular toxoplasmosis has a more established role. Antibody testing is appropriate for toxoplasmosis and toxocariasis, and may be complementary to PCR for viral retinitis. Masquerade syndromes represent neoplastic conditions that clinically appear as infectious or inflammatory conditions and should be considered as part of the differential diagnosis. Diagnostic vitrectomy and chorioretinal biopsy are thus critical tools for the management of patients in whom an infectious etiology of uveitis is suspected. PMID:24613892

  7. Thermal Diagnostics with the Atmospheric Imaging Assembly onboard the Solar Dynamics Observatory: A Validated Method for Differential Emission Measure Inversions

    CERN Document Server

    Cheung, Mark C M; Schrijver, C J; Testa, P; Chen, F; Peter, H; Malanushenko, A


    We present a new method for performing differential emission measure (DEM) inversions on narrow-band EUV images from the Atmospheric Imaging Assembly (AIA) onboard the Solar Dynamics Observatory (SDO). The method yields positive definite DEM solutions by solving a linear program. This method has been validated against a diverse set of thermal models of varying complexity and realism. These include (1) idealized gaussian DEM distributions, (2) 3D models of NOAA Active Region 11158 comprising quasi-steady loop atmospheres in a non-linear force-free field, and (3) thermodynamic models from a fully-compressible, 3D MHD simulation of AR corona formation following magnetic flux emergence. We then present results from the application of the method to AIA observations of Active Region 11158, comparing the region's thermal structure on two successive solar rotations. Additionally, we show how the DEM inversion method can be adapted to simultaneously invert AIA and XRT data, and how supplementing AIA data with the latt...

  8. Several important in vitro improvements in the amplification, differentiation and tracing of fetal liver stem/progenitor cells.

    Directory of Open Access Journals (Sweden)

    Wei-hui Liu

    Full Text Available OBJECTIVE: We previously isolated fetal liver stem/progenitor cells (FLSPCs, but there is an urgent need to properly amplify FLSPCs, effectively induce FLSPCs differentiation, and steadily trace FLSPCs for in vivo therapeutic investigation. METHODS: FLSPCs were maintained in vitro as adherent culture or soft agar culture for large-scale amplification. To direct the differentiation of FLSPCs into hepatocytes, FLSPCs were randomly divided into four groups: control, 1% DMSO-treated, 20 ng/ml HGF-treated and 1% DMSO+20 ng/ml HGF-treated. To trace FLSPCs, the GFP gene was introduced into FLSPCs by liposome-mediated transfection. RESULTS: For amplifying FLSPCs, the soft agar culture were more suitable than the adherent culture, because the soft agar culture obtained more homogeneous cells. These cells were with high nuclear:cytoplasmic ratio, few cell organelles, high expression of CD90.1 and CD49f, and strong alkaline phosphatase staining. For inducing FLSPCs differentiation, treatment with HGF+DMSO was most effective (P<0.05, which was strongly supported by the typical morphological change and the significant decrease of OV-6 positive cells (P<0.01. In addition, the time of indocyanine green elimination, the percentage of glycogen synthetic cells, and the expressions of ALB, G-6-P, CK-8, CK-18 and CYP450-3A1 in HGF+DMSO-treated group were higher than in any other group. For tracing FLSPCs, after the selection of stable FLSPC transfectants, GFP expression continued over successive generations. CONCLUSIONS: FLSPCs can properly self-renew in soft agar culture and effectively differentiate into hepatocyte-like cells by HGF+DMSO induction, and they can be reliably traced by GFP expression.

  9. Diagnostic value of S100B protein in the differential diagnosis of acute vertigo in the emergency department. (United States)

    Kartal, Aslı Gülfer; Yılmaz, Serkan; Yaka, Elif; Pekdemir, Murat; Sarısoy, Hasan Tahsin; Çekmen, Mustafa Baki; Yüksel, Melih


    Vertigo is a common presenting complaint resulting from central or peripheral etiologies. Because central causes may be life-threatening, ascertaining the nature of the vertigo is crucial in the emergency department (ED). With a broad range of potential etiologies, distinguishing central causes from benign peripheral causes is a diagnostic challenge. Cranial magnetic resonance imaging (MRI) is the recommended neuroimaging method when clinical findings are ambiguous. However, MRI scanning for every patient with an uncertain diagnosis may not be efficient or possible. Therefore, to improve ED resource utilization for patients with vertigo, there is a need to identify the subset most likely to have MRI abnormalities. It has previously been shown that S100B protein provides a useful serum marker of stroke, subarachnoid hemorrhage, and traumatic brain injury. This study evaluated whether S100B levels could predict central causes of vertigo as identified by cranial MRI in the ED. This prospective, observational study was conducted with adult patients with acute-onset vertigo (within 6 hours) in the ED of a teaching hospital in Kocaeli, Turkey. Patients with nausea or dizziness complaints without previously known vertigo or cranial pathology, and who agreed to participate in the study, were included. Patients with trauma or with neurologic findings that developed concurrent with their symptoms were excluded. Serum levels of S100B were measured with an electrochemiluminescence immunoassay kit. All subjects underwent cranial MRI. The predictors of positive MRI results were evaluated using logistic regression analysis. Sensitivity and specificity of S100B​ levels for identifying subjects with central causes of vertigo on MRI were calculated with receiver operating characteristic (ROC) curve. Of the 82 subjects included in the study, 48 (58.5%) were female, and the mean (±SD) age was 51 (±16) years. Thirty-one (37.8%) subjects had positive MRI results. Median (with

  10. Diagnósticos diferenciales de la histiocitosis a células de Langerhans The differential diagnostics of Langerhans cell histiocytosis

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    C. N. Chirino


    Full Text Available La histiocitosis a células de Langerhans (HCL debe diferenciarse de las siguientes entidades: eritema tóxico neonatorum (ETN, dermatitis seborreica (DS, foliculitis pustulosa eosinofílica (FPE, incontinencia pigmenti (IP, mastocitosis/urticaria pigmentosa (M/UP, acrodermatitis enteropática (ADE, síndrome de Wiskott-Aldrich (WAS, acropustulosis infantil (API. Además se deben considerar la enfermedad de Rosai- Dorfman (ERD, xantomas diseminados, melanosis pustulosa neonatal (MPN, candidiasis congénita, listeriosis neonatal, herpes simple perinatal y la varicela neonatal. Debido a que los métodos auxiliares de laboratorio no siempre están disponibles o los resultados laboratoriales algunas veces son extemporáneos, y puesto que el médico práctico a menudo necesita tomar decisiones precozmente, es que la epidemiología resulta útil, pues brinda el marco adecuado para ordenar y jerarquizar las sospechas diagnósticas frente a un caso concreto, con un paciente determinado, en un momento específico.The differential diagnostics of Langerhans cell histiocytosis should include the following disorders: erythema toxicum neonatorum, seborrheic dermatitis, eosinophilic pustular folliculitis, incontinentia pigmenti, mastocytosis / urticaria pigmentosa, acrodermatitis enteropathica, Wiskott-Aldrich syndrome, infantile acropustulosis, Rosai- Dorfman disease, xanthoma disseminatum, neonatal pustular melanosis, congenital candidiasis, perinatal listeriosis, perinatal herpes simplex, neonatal varicella. Since the auxiliary methods of lab are not always available, or lab results are sometimes extemporaneous, the physicians often needs to make quick decisions. The epidemiology is useful because it offers the appropriate mark to prioritize the diagnostic in specific cases

  11. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. (United States)

    Ghadri, Jelena R; Cammann, Victoria L; Jurisic, Stjepan; Seifert, Burkhardt; Napp, L Christian; Diekmann, Johanna; Bataiosu, Dana Roxana; D'Ascenzo, Fabrizio; Ding, Katharina J; Sarcon, Annahita; Kazemian, Elycia; Birri, Tanja; Ruschitzka, Frank; Lüscher, Thomas F; Templin, Christian


    Clinical presentation of takotsubo syndrome (TTS) mimics acute coronary syndrome (ACS) and does not allow differentiation. We aimed to develop a clinical score to estimate the probability of TTS and to distinguish TTS from ACS in the acute stage. Patients with TTS were recruited from the International Takotsubo Registry ( and ACS patients from the leading hospital in Zurich. A multiple logistic regression for the presence of TTS was performed in a derivation cohort (TTS, n = 218; ACS, n = 436). The best model was selected and formed a score (InterTAK Diagnostic Score) with seven variables, and each was assigned a score value: female sex 25, emotional trigger 24, physical trigger 13, absence of ST-segment depression (except in lead aVR) 12, psychiatric disorders 11, neurologic disorders 9, and QTc prolongation 6 points. The area under the curve (AUC) for the resulting score was 0.971 [95% confidence interval (CI) 0.96-0.98] and using a cut-off value of 40 score points, sensitivity was 89% and specificity 91%. When patients with a score of ≥50 were diagnosed as TTS, nearly 95% of TTS patients were correctly diagnosed. When patients with a score ≤31 were diagnosed as ACS, ∼95% of ACS patients were diagnosed correctly. The score was subsequently validated in an independent validation cohort (TTS, n = 173; ACS, n = 226), resulting in a score AUC of 0.901 (95% CI 0.87-0.93). The InterTAK Diagnostic Score estimates the probability of the presence of TTS and is able to distinguish TTS from ACS with a high sensitivity and specificity. NCT0194762. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

  12. The importance of quality assurance/quality control of diagnostics to increase the confidence in global foot-and-mouth disease control. (United States)

    De Clercq, K; Goris, N; Barnett, P V; MacKay, D K


    The last decade international trade in animals and animal products was liberated and confidence in this global trade can increase only if appropriate control measures are applied. As foot-and-mouth disease (FMD) diagnostics will play an essential role in this respect, the Food and Agriculture Organization European Commission for the Control of Foot-and-Mouth Disease (EUFMD) co-ordinates, in collaboration with the European Commission, several programmes to increase the quality of FMD diagnostics. A quality assurance (QA) system is deemed essential for laboratories involved in certifying absence of FMDV or antibodies against the virus. Therefore, laboratories are encouraged to validate their diagnostic tests fully and to install a continuous quality control (QC) monitoring system. Knowledge of performance characteristics of diagnostics is essential to interpret results correctly and to calculate sample rates in regional surveillance campaigns. Different aspects of QA/QC of classical and new FMD virological and serological diagnostics are discussed in respect to the EU FMD directive (2003/85/EC). We recommended accepting trade certificates only from laboratories participating in international proficiency testing on a regular basis.

  13. Grb2 Is Important for T Cell Development, Th Cell Differentiation, and Induction of Experimental Autoimmune Encephalomyelitis. (United States)

    Radtke, Daniel; Lacher, Sonja M; Szumilas, Nadine; Sandrock, Lena; Ackermann, Jochen; Nitschke, Lars; Zinser, Elisabeth


    The small adaptor protein growth factor receptor-bound protein 2 (Grb2) modulates and integrates signals from receptors on cellular surfaces in inner signaling pathways. In murine T cells, Grb2 is crucial for amplification of TCR signaling. T cell-specific Grb2(fl/fl) Lckcre(tg) Grb2-deficient mice show reduced T cell numbers due to impaired negative and positive selection. In this study, we found that T cell numbers in Grb2(fl/fl) CD4cre(tg) mice were normal in the thymus and were only slightly affected in the periphery. Ex vivo analysis of CD4(+) Th cell populations revealed an increased amount of Th1 cells within the CD4(+) population of Grb2(fl/fl) CD4cre(tg) mice. Additionally, Grb2-deficient T cells showed a greater potential to differentiate into Th17 cells in vitro. To test whether these changes in Th cell differentiation potential rendered Grb2(fl/fl) CD4cre(tg) mice more prone to inflammatory diseases, we used the murine Th1 cell- and Th17 cell-driven model of experimental autoimmune encephalomyelitis (EAE). In contrast to our expectations, Grb2(fl/fl) CD4cre(tg) mice developed a milder form of EAE. The impaired EAE disease can be explained by the reduced proliferation rate of Grb2-deficient CD4(+) T cells upon stimulation with IL-2 or upon activation by allogeneic dendritic cells, because the activation of T cells by dendritic cells and the subsequent T cell proliferation are known to be crucial factors for the induction of EAE. In summary, Grb2-deficient T cells show defects in T cell development, increased Th1 and Th17 cell differentiation capacities, and impaired proliferation after activation by dendritic cells, which likely reduce the clinical symptoms of EAE.

  14. A novel HRM assay for the simultaneous detection and differentiation of eight poxviruses of medical and veterinary importance (United States)

    Gelaye, Esayas; Mach, Lukas; Kolodziejek, Jolanta; Grabherr, Reingard; Loitsch, Angelika; Achenbach, Jenna E.; Nowotny, Norbert; Diallo, Adama; Lamien, Charles Euloge


    Poxviruses belonging to the Orthopoxvirus, Capripoxvirus and Parapoxvirus genera share common host species and create a challenge for diagnosis. Here, we developed a novel multiplex PCR method for the simultaneous detection and differentiation of eight poxviruses, belonging to three genera: cowpox virus (CPXV) and camelpox virus (CMLV) [genus Orthopoxvirus]; goatpox virus (GTPV), sheeppox virus (SPPV) and lumpy skin disease virus (LSDV) [genus Capripoxvirus]; orf virus (ORFV), pseudocowpox virus (PCPV) and bovine papular stomatitis virus (BPSV) [genus Parapoxvirus]. The assay is based on high-resolution melting curve analysis (HRMCA) of PCR amplicons produced using genus specific primer pairs and dsDNA binding dye. Differences in fragment size and GC content were used as discriminating power. The assay generated three well separated melting regions for each genus and provided additional intra-genus genotyping allowing the differentiation of the eight poxviruses based on amplicon melting temperature. Out of 271 poxviral DNA samples tested: seven CPXV, 25 CMLV, 42 GTPV, 20 SPPV, 120 LSDV, 33 ORFV, 20 PCPV and two BPSV were detected; two samples presented co-infection with CMLV and PCPV. The assay provides a rapid, sensitive, specific and cost-effective method for the detection of pox diseases in a broad range of animal species and humans. PMID:28216667

  15. Importance of fractional exhaled nitric oxide in the differentiation of asthma–COPD overlap syndrome, asthma, and COPD

    Directory of Open Access Journals (Sweden)

    Chen FJ


    Full Text Available Feng-jia Chen,* Xin-yan Huang,* Yang-li Liu, Geng-peng Lin, Can-mao Xie Department of Respiratory Disease, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China *These authors contributed equally to this work Background: Fractional exhaled nitric oxide (FeNO is an easy, sensitive, reproducible, and noninvasive marker of eosinophilic airway inflammation. Accordingly, FeNO is extensively used to diagnose and manage asthma. Patients with COPD who share some of the features of asthma have a condition called asthma–COPD overlap syndrome (ACOS. The feasibility of using FeNO to differentiate ACOS patients from asthma and COPD patients remains unclear. Methods: From February 2013 to May 2016, patients suspected with asthma and COPD through physician’s opinion were subjected to FeNO measurement, pulmonary function test (PFT, and bronchial hyperresponsiveness or bronchodilator test. Patients were divided into asthma alone group, COPD alone group, and ACOS group according to a clinical history, PFT values, and bronchial hyperresponsiveness or bronchodilator test. Receiver operating characteristic (ROC curves were obtained to elucidate the clinical functions of FeNO in diagnosing ACOS. The optimal operating point was also determined. Results: A total of 689 patients were enrolled in this study: 500 had asthma, 132 had COPD, and 57 had ACOS. The FeNO value in patients with ACOS was 27 (21.5 parts per billion (ppb; median [interquartile range], which was significantly higher than that in the COPD group (18 [11] ppb. The area under the ROC curve was estimated to be 0.783 for FeNO. Results also revealed an optimal cutoff value of >22.5 ppb FeNO for differentiating ACOS from COPD patients (sensitivity 70%, specificity 75%.Conclusion: FeNO measurement is an easy, noninvasive, and sensitive method for differentiating ACOS from COPD. This technique is a new perspective for the management of COPD patients. Keywords

  16. Molecular diagnostic tools for detection and differentiation of phytoplasmas based on chaperonin-60 reveal differences in host plant infection patterns.

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    Tim J Dumonceaux

    Full Text Available Phytoplasmas ('Candidatus Phytoplasma' spp. are insect-vectored bacteria that infect a wide variety of plants, including many agriculturally important species. The infections can cause devastating yield losses by inducing morphological changes that dramatically alter inflorescence development. Detection of phytoplasma infection typically utilizes sequences located within the 16S-23S rRNA-encoding locus, and these sequences are necessary for strain identification by currently accepted standards for phytoplasma classification. However, these methods can generate PCR products >1400 bp that are less divergent in sequence than protein-encoding genes, limiting strain resolution in certain cases. We describe a method for accessing the chaperonin-60 (cpn60 gene sequence from a diverse array of 'Ca.Phytoplasma' spp. Two degenerate primer sets were designed based on the known sequence diversity of cpn60 from 'Ca.Phytoplasma' spp. and used to amplify cpn60 gene fragments from various reference samples and infected plant tissues. Forty three cpn60 sequences were thereby determined. The cpn60 PCR-gel electrophoresis method was highly sensitive compared to 16S-23S-targeted PCR-gel electrophoresis. The topology of a phylogenetic tree generated using cpn60 sequences was congruent with that reported for 16S rRNA-encoding genes. The cpn60 sequences were used to design a hybridization array using oligonucleotide-coupled fluorescent microspheres, providing rapid diagnosis and typing of phytoplasma infections. The oligonucleotide-coupled fluorescent microsphere assay revealed samples that were infected simultaneously with two subtypes of phytoplasma. These tools were applied to show that two host plants, Brassica napus and Camelina sativa, displayed different phytoplasma infection patterns.

  17. Clinical implication of F-18 FDG PET/CT for differentiated thyroid cancer in patients with negative diagnostic iodine-123 scan and elevated thyroglobulin

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong-Jang [Department of Nuclear Medicine, Pusan National University Hospital, Busan (Korea, Republic of); Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of)], E-mail:; Lee, Tae Hong [Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of); Department of Radiology, Pusan National University Hospital, Busan (Korea, Republic of); Kim, In-Ju; Kim, Yong-Ki [Department of Nuclear Medicine, Pusan National University Hospital, Busan (Korea, Republic of); Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of)


    This study aims to investigate the usefulness of F-18 FDG PET/CT in differentiated thyroid cancer (DTC) with elevated serum thyroglobulin (Tg) but negative iodine-123 (I-123) scan. Methods: Twenty patients with histopathologically proven DTC, negative diagnostic I-123 scan, and elevated serum Tg levels were prospectively submitted to F-18 FDG PET/CT evaluation. The histopathologic findings consisted of 19 papillary thyroid cancers, 1 follicular thyroid cancer. Results: F-18 FDG PET/CT identified lesions in 18 out of 20 patients, giving a sensitivity of 90%. Thirteen of the 18 patients revealed limited loco-regional disease. Remaining 5 patients showed distant metastases, consisting of 4 patients with lung metastases and 1 patient with bone metastasis. Two patients revealed negative F-18 FDG PET/CT findings. Conclusion: F-18 FDG PET/CT is suitable for the detection and precise localization of loco-regional recurrences and distant metastases of DTC in patients with elevated serum Tg but negative I-123 whole body scan.

  18. Possibility of D2-40 as a diagnostic and tumor differentiation-suggestive marker for some of phosphaturic mesenchymal tumors. (United States)

    Tajima, Shogo; Fukayama, Masashi


    Phosphaturic mesenchymal tumor (PMT) has been established as a tumor that causes tumor-induced osteomalacia (TIO) associated with mesenchymal neoplasm. Its lineage of differentiation has not been elucidated. Previously, the presence of lymphatic vessels inside PMTs has been documented using an anti-podoplanin antibody; the tumor cells of PMTs were reported to not react with it. In this study of 14 cases of PMTs, we used immunohistochemistry of D2-40, a relatively specific lymphatic endothelial marker, to see if they stained PMTs or not, with particular interest in its reaction with microcystic structures containing lymph-like fluid. We report that most of the PMTs (12 out of 14 cases; 86%) were immunostained by D2-40 in their tumor cells; D2-40-positive lymphatic vessels inside the tumor were also observed. We used a proportion score (0-4+), an intensity score (0-3+), and a total score (the sum of the proportion score and the intensity score) to quantitate our results. We report that 50% of cases (7 out of 14 cases) had a total score ≥ 4+; immunostaining of D2-40 in cases with a total score ≥ 4+ was easy to observe at a glance. Most of the tumor cells lining the microcystic structures were immunostained with D2-40. Thus, D2-40 could be a useful diagnostic marker of PMTs and it might also indicate that PMTs take a lymphatic endothelial immunophenotype.

  19. Extraskeletal myxoid chondrosarcoma presenting as an intradural spinal mass: report of a rare clinical presentation with an emphasis on differential diagnostic considerations

    Directory of Open Access Journals (Sweden)

    Priya Rao


    Full Text Available Extraskeletal myxoid chondrosarcoma is a rare soft tissue neoplasm that occurs predominantly in the soft tissues of the lower extremities. Herein we present a case of a 29 year old male who presented with bilateral femoral numbness believed to be the result of prior injury to his back. A magnetic resonance imaging revealed a mass in the T4-T5 epidural space compressing the spinal cord. Laminectomy was performed and the lesion removed piecemeal. The pathology specimen consisted of multiple fragments of dura involved by a myxoid neoplasm with a nodular growth pattern. The tumor cells were arranged in anastomosing cords and strands. Individual tumor cells were small, of uniform size and shape, with small hyperchromatic nuclei and scant eosinophilic cytoplasm. Immunohistochemical stains were performed which showed the tumor cells were diffusely positive for vimentin and focally positive for EMA, S-100 protein and cytokeratin, whereas they were negative for CD34 and CD99. Fluorescence in situ hybridization (FISH studies showed a clonal population of cells with re-arrangement of the EWSR1 locus, confirming the histologic impression of extraskeletal myxoid chondrosarcoma. This is the first report of a case of an extraskeletal myxoid chondrosarcoma arising from the dura, confirmed to have rearrangement of the EWSR1 gene by FISH. There have only been two other cases of dural based extraskeletal myxoid chondrosarcoma reported prior to our case. We also briefly review the published literature and discuss differential diagnostic considerations for this rare tumor.

  20. Importance of P53, Ki-67 expression in the differential diagnosis of benign/malignant phyllodes tumors of the breast

    Directory of Open Access Journals (Sweden)

    Ulku Kucuk


    Full Text Available Background: Conventionally growth pattern, stromal overgrowth, stromal cellularity and stromal mitotic activity are the main parameters in the grading of phyllodes tumors (PTs. Recent studies revealed that both p53 and Ki-67 expressions are correlated with grade of PTs of the breast. Expression of hormone receptors and overexpression/amplification of HER2 has been studied in PTs to discover the roles of these markers as new treatment modalities. Materials and Method: We studied 26 PT cases. Seventeen benign and nine malignant PTs were re-evaluated as regards stromal cellularity mitotic activity, p53/Ki-67 expression rates and the relation between these parameters. Estrogen receptor and progesterone receptor (ER, PR positivity were determined by counting nuclear staining in five high-power fields. Also, the presence of any HER2 staining and staining patterns were documanted. Results: Stromal cellularity, mitotic rate, p53 and Ki-67 expression rates were all correlated with benign and malignant histologic subgroups (P = 0.000-0.001. Ki-67 and p53 expressions were statistically significantly correlated with histologic subgroups, stromal cellularity and mitotic rate (P < 0.005. ER and PR expressions in the epithelial component were not statistically significant between the two groups. HER2 showed different staining patterns in the epithelial component, and there was no staining in the stromal component. Conclusion: Ki-67 and p53 expression rates were statistically significantly correlated with grade of mammary PTs; therefore, they can be used in the determination of tumor grade, especially for the differential diagnosis of benign and malignant tumors. Malignant and benign tumors did not differ significantly in terms of hormone receptor and HER2 expression. HER2 expression showed different patterns in the epithelial component of the PTs.

  1. Differential Transducer for Vehicle Diagnostics. (United States)


    c. Aluminum/Steel Bar 4/# d. GE Ultem 2400 20/# e. Phillips R-4 . 20/# f. Dupont Ryton 10/# g. Carbon-Filled 48/# 2. Cost of Tooling a. Dies 5,000...Table C-i. Summary of Averaged Results Force Collector Sensitivity Material Thickness @100 Psi Applied Cast Alum. 356 .093 in. 7mv/V Ultem 2400 .062...Material Thickness Stress Level @ 100 Psi Aluminum .093 1283 Ultem 2400 .062 2970 Ryton R-4 .082 1671 Rynite 555 .066 2618 Applying the analytical results

  2. SALL4 represents fetal gut differentiation of gastric cancer, and is diagnostically useful in distinguishing hepatoid gastric carcinoma from hepatocellular carcinoma. (United States)

    Ushiku, Tetsuo; Shinozaki, Aya; Shibahara, Junji; Iwasaki, Yoshiaki; Tateishi, Yoko; Funata, Nobuaki; Fukayama, Masashi


    The novel stem cell marker SALL4 has been identified as a diagnostic marker of germ cell tumors, especially yolk sac tumors, in gonadal organs. To clarify the significance of SALL4 as an oncofetal protein, we investigated SALL4 expression by immunohistochemistry in non-neoplastic stomach and gastric carcinoma with particular emphasis on á-fetoprotein (AFP)-producing gastric carcinoma, as AFP-producing gastric carcinoma shares expression of AFP and glypican 3 (GPC3) with yolk sac tumors and hepatic neoplasms. A total of 338 gastric carcinomas, 60 hepatocellular carcinomas, and 48 cholangiocellular carcinomas were studied by immunohistochemistry on tissue microarrays. In addition, more detailed whole tissue section immunohistochemistry was performed on non-neoplastic gastric tissue from 5 adult and 8 fetal specimens, 6 hepatoblastomas, and 31 cases of AFP-producing gastric carcinomas. SALL4 expression was observed in the neofetal stomach in gestational week 9 and disappeared thereafter. It was also identified by tissue microarray study in a fraction of gastric carcinomas (51 of 338, 15%), associated with older age (P=0.0001), male sex (P=0.0033), intestinal-type histology (P=0.0001), and synchronous liver metastasis (P=0.0047). AFP and GPC3 were closely associated with SALL4 expression in gastric carcinoma (both, Pgastric carcinoma with diffuse staining in 24 cases (78%). Diffuse SALL4 expression was observed in the histologic patterns of hepatoid (89%), glandular (57%), and clear cell (39%) AFP-producing gastric carcinoma. In addition, SALL4 expression was completely negative in hepatoblastoma (n=6) and hepatocellular carcinoma (n=60). SALL4 is an oncofetal protein similar to AFP and GPC3, but it represents fetal gut differentiation in gastric carcinoma. SALL4 is a sensitive marker for AFP-producing gastric carcinoma and is especially useful to distinguish hepatoid gastric carcinoma from hepatocellular carcinoma.

  3. Next Generation Sequencing Bulk Segregant Analysis of Potato Support that Differential Flux into the Cholesterol and Stigmasterol Metabolite Pools Is Important for Steroidal Glycoalkaloid Content

    DEFF Research Database (Denmark)

    Kaminski, Kacper Piotr; Sørensen, Kirsten Kørup; Andersen, Mathias Neumann


    content within a diploid potato mapping population (n = 90) that shows a high variation in GA accumulation. The analysis was performed using a novel method based on next generation genome sequencing. A region on chromosome 1 was found to be associated with differential GA content. Within that region......, the elite cultivars primarily used for everyday consumption have very low contents of GAs. Breeding for important agronomical traits, like e.g. pathogen resistance, often requires the use of wild species and a situation where offspring have unacceptable high contents of GAs quite frequently arises....... Knowledge of metabolic pathways leading to the synthesis of GAs, as well as of the genes that are responsible for the observed differences in plant and tuber GA content is only partial. The primary purpose of this study was to identify genomic regions and candidate genes responsible for differential GA...

  4. Functional β-adrenoceptors are important for early muscle regeneration in mice through effects on myoblast proliferation and differentiation.

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    Jarrod E Church

    Full Text Available Muscles can be injured in different ways and the trauma and subsequent loss of function and physical capacity can impact significantly on the lives of patients through physical impairments and compromised quality of life. The relative success of muscle repair after injury will largely determine the extent of functional recovery. Unfortunately, regenerative processes are often slow and incomplete, and so developing novel strategies to enhance muscle regeneration is important. While the capacity to enhance muscle repair by stimulating β2-adrenoceptors (β-ARs using β2-AR agonists (β2-agonists has been demonstrated previously, the exact role β-ARs play in regulating the regenerative process remains unclear. To investigate β-AR-mediated signaling in muscle regeneration after myotoxic damage, we examined the regenerative capacity of tibialis anterior and extensor digitorum longus muscles from mice lacking either β1-AR (β1-KO and/or β2-ARs (β2-KO, testing the hypothesis that muscles from mice lacking the β2-AR would exhibit impaired functional regeneration after damage compared with muscles from β1-KO or β1/β2-AR null (β1/β2-KO KO mice. At 7 days post-injury, regenerating muscles from β1/β2-KO mice produced less force than those of controls but muscles from β1-KO or β2-KO mice did not exhibit any delay in functional restoration. Compared with controls, β1/β2-KO mice exhibited an enhanced inflammatory response to injury, which delayed early muscle regeneration, but an enhanced myoblast proliferation later during regeneration ensured a similar functional recovery (to controls by 14 days post-injury. This apparent redundancy in the β-AR signaling pathway was unexpected and may have important implications for manipulating β-AR signaling to improve the rate, extent and efficacy of muscle regeneration to enhance functional recovery after injury.

  5. Differential proteomic and oxidative profiles unveil dysfunctional protein import to adipocyte mitochondria in obesity-associated aging and diabetes

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    María Gómez-Serrano


    Full Text Available Human age-related diseases, including obesity and type 2 diabetes (T2DM, have long been associated to mitochondrial dysfunction; however, the role for adipose tissue mitochondria in these conditions remains unknown. We have tackled the impact of aging and T2DM on adipocyte mitochondria from obese patients by quantitating not only the corresponding abundance changes of proteins, but also the redox alterations undergone by Cys residues thereof. For that, we have resorted to a high-throughput proteomic approach based on isobaric labeling, liquid chromatography and mass spectrometry. The alterations undergone by the mitochondrial proteome revealed aging- and T2DM-specific hallmarks. Thus, while a global decrease of oxidative phosphorylation (OXPHOS subunits was found in aging, the diabetic patients exhibited a reduction of specific OXPHOS complexes as well as an up-regulation of the anti-oxidant response. Under both conditions, evidence is shown for the first time of a link between increased thiol protein oxidation and decreased protein abundance in adipose tissue mitochondria. This association was stronger in T2DM, where OXPHOS mitochondrial- vs. nuclear-encoded protein modules were found altered, suggesting impaired mitochondrial protein translocation and complex assembly. The marked down-regulation of OXPHOS oxidized proteins and the alteration of oxidized Cys residues related to protein import through the redox-active MIA (Mitochondrial Intermembrane space Assembly pathway support that defects in protein translocation to the mitochondria may be an important underlying mechanism for mitochondrial dysfunction in T2DM and physiological aging. The present draft of redox targets together with the quantification of protein and oxidative changes may help to better understand the role of oxidative stress in both a physiological process like aging and a pathological condition like T2DM.

  6. Identification of forensically important blow fly species (Diptera: Calliphoridae) in China by mitochondrial cytochrome oxidase I gene differentiation

    Institute of Scientific and Technical Information of China (English)

    Qin-Lai Liu; Li Yang; Kun-Lu Wu; Ling-mei Lan; Jiang-Feng Wang; Yao-Qing Chen; Ji-Feng Cai; Yun-Feng Chang; Yan Gu; Ya-Dong Guo; Xing-Hua Wang; Ji-FangWeng; Ming Zhong; Xiang Wang


    Unambiguous and rapid sarcosaphagous insect species identification is an essential requirement for forensic investigations. Although some insect species are difficult to classify morphologically, they can be effectively identified using molecular methods based on similarity with abundant authenticated reference DNA sequences in local databases.However, local databases are still relatively incomplete in China because of the large land area with distinct regional conditions. In this study, 75 forensically important blow flies were collected from 23 locations in 16 Chinese provinces, and a 278-bp segment of the cytochrome oxidase subunit Ⅰ gene of all specimens was successfully sequenced. Phylogenetic analysis of the sequenced segments showed that all Calliphorid specimens were properly assigned into nine species with relatively strong supporting values, thus indicating that the 278-bp cytochrome oxidase subunit one region is suitable for identification of Calliphorid species. The clear difference between intraspecific threshold and interspecific divergence confirmed the potential of this region for Calliphorid species identification,especially for distinguishing between morphologically similar species. Intraspecific geographic variations were observed in Lucilia sericata (Meigen, 1826) and Lucilia caesar (Linnaeus, 1758).

  7. Differential response of rat strains to obesogenic diets underlines the importance of genetic makeup of an individual towards obesity. (United States)

    Mn, Muralidhar; Smvk, Prasad; Battula, Kiran Kumar; Nv, Giridharan; Kalashikam, Rajender Rao


    Obesity, a multifactorial disorder, results from a chronic imbalance of energy intake vs. expenditure. Apart from excessive consumption of high calorie diet, genetic predisposition also seems to be equally important for the development of obesity. However, the role of genetic predisposition in the etiology of obesity has not been clearly delineated. The present study addresses this problem by selecting three rat strains (WNIN, F-344, SD) with different genetic backgrounds and exposing them to high calorie diets. Rat strains were fed HF, HS, and HFS diets and assessed for physical, metabolic, biochemical, inflammatory responses, and mRNA expression. Under these conditions: significant increase in body weight, visceral adiposity, oxidative stress and systemic pro-inflammatory status; the hallmarks of central obesity were noticed only in WNIN. Further, they developed altered glucose and lipid homeostasis by exhibiting insulin resistance, impaired glucose tolerance, dyslipidemia and fatty liver condition. The present study demonstrates that WNIN is more prone to develop obesity and associated co-morbidities under high calorie environment. It thus underlines the cumulative role of genetics (nature) and diet (nurture) towards the development of obesity, which is critical for understanding this epidemic and devising new strategies to control and manage this modern malady.

  8. Importance of B cell co-stimulation in CD4(+) T cell differentiation: X-linked agammaglobulinaemia, a human model. (United States)

    Martini, H; Enright, V; Perro, M; Workman, S; Birmelin, J; Giorda, E; Quinti, I; Lougaris, V; Baronio, M; Warnatz, K; Grimbacher, B


    We were interested in the question of whether the congenital lack of B cells actually had any influence on the development of the T cell compartment in patients with agammaglobulinaemia. Sixteen patients with X-linked agammaglobulinaemia (XLA) due to mutations in Btk, nine patients affected by common variable immune deficiency (CVID) with <2% of peripheral B cells and 20 healthy volunteers were enrolled. The T cell phenotype was determined with FACSCalibur and CellQuest Pro software. Mann-Whitney two-tailed analysis was used for statistical analysis. The CD4 T cell memory compartment was reduced in patients with XLA of all ages. This T cell subset encompasses both CD4(+)CD45RO(+) and CD4(+)CD45RO(+)CXCR5(+) cells and both subsets were decreased significantly when compared to healthy controls: P = 0·001 and P < 0·0001, respectively. This observation was confirmed in patients with CVID who had <2% B cells, suggesting that not the lack of Bruton's tyrosine kinase but the lack of B cells is most probably the cause of the impaired CD4 T cell maturation. We postulate that this defect is a correlate of the observed paucity of germinal centres in XLA. Our results support the importance of the interplay between B and T cells in the germinal centre for the activation of CD4 T cells in humans. © 2011 The Authors. Clinical and Experimental Immunology © 2011 British Society for Immunology.

  9. Single Strand Conformation Polymorphism analysis of PCR-amplified rDNA to differentiate medically important Aspergillus Species

    Directory of Open Access Journals (Sweden)

    K Diba


    Full Text Available "nBackground: Aspergillus species are associated with allergic bronchopulmonary disease, mycotic keratitis, otomycosis, na­sal sinusitis and invasive infection. In this study, we developed a PCR-Single Strand Confomational Polymorphism method to identify the most common Aspergillus species and we showed some advantages of this method comparing a PCR-Restric­tion Fragment Length Polymorphism with our designed restriction enzyme. "nMethods: We selected ITS2, as a short fragment within the rDNA region (length size: 330 bp to be amplified as small size PCR product. We mixed 5 ml of the PCR product with an equal volume of loading buffer and followed by incubation for 5 min at 95º C and quenching in an ice bath. The mixture was applied to a 6%-12% Gradient Poly acryl amide gel to run in a verti­cal electrophoresis, then gel was stained with ethidium bromide and silver nitrate which followed by an ethidium bro­mide staining. "nResults: Our results of restriction digestion showed a fine identification of 7 tested Aspergillus species dur­ing 5-6 hours af­ter an overnight mycelial growth. As our results some of tested Aspergillus species: A. nidulans, A. fisheri, A. quad­ricincta, (A. fumigatus and A. niger as a group and (A. flavus, A. tereus and A. ochraceus as another group, can be dis­criminated. More­over SSCP analysis enabled us to identify above Aspergillus species within 8-12 h after an over night growth without us­ing an expensive restriction enzyme."nConclusion: It is concluded that Single Strand Conformational Polymorphism is a simple and rapid method for identifica­tion of some medically important Aspergillus.

  10. Water deficit alters differentially metabolic pathways affecting important flavor and quality traits in grape berries of Cabernet Sauvignon and Chardonnay

    Directory of Open Access Journals (Sweden)

    Deluc Laurent G


    . Chardonnay berries, which lack any significant anthocyanin content, exhibited increased photoprotection mechanisms under water deficit conditions. Water deficit increased ABA, proline, sugar and anthocyanin concentrations in Cabernet Sauvignon, but not Chardonnay berries, consistent with the hypothesis that ABA enhanced accumulation of these compounds. Water deficit increased the transcript abundance of lipoxygenase and hydroperoxide lyase in fatty metabolism, a pathway known to affect berry and wine aromas. These changes in metabolism have important impacts on berry flavor and quality characteristics. Several of these metabolites are known to contribute to increased human-health benefits.

  11. [The importance of recombinant proteins of West Siberian isolates of Borrelia burgdorferi S.L. for serological diagnostic of ixodic tick borreliosis]. (United States)

    Karavayev, V S; Genina, E S; Ryabchenko, A V; Beklemoschev, A B


    The structural proteins OspC, FlaB, FlaA and DbpB of agent of ixodic tick borreliosis are one of main antigens inducing humoral immunity at initial stages of disease. Owing to it, the task was stated to evaluate antigen activity of recombinant proteins OspC (OscP-Bg), fragment of FlaB (f-FlaB) and DbpB of genospecies B. garinii and OspC (OscC-Ba) of genospecies of B. afzelii of West Siberian isolates of Borrelia Burgdorferi S.L. for their possible application as antigens for serological diagnostic of ixodic tick borreliosis The recombinant proteins OscP-Bg, OscC-Ba, f-FlaB, FlaA and DbpB are analyzed using technique of enzymoimmunoassay to detect ability to bound antibodies of serums of patients with ixodic tick borreliosis with localized and disseminated stage of infection. The difference of their sensitivity as antigens during detection of specific antibodies in blood serum of patients with ixodic tick borreliosis was demonstrated In serum of patients with ixodic tick borreliosis with disseminated stage of infection the level of specific IgM and IgG antibodies reacting with OscP-Bg, OscC-Ba, f-FlaB, FlaA and DbpB is within the limits 15.7-52.6% for IgG. The results of enzymoimmunoassay applied to patients with ixodic tick borreliosis for detection of IgM and IgG in serum demonstrated that OscP-Bg and f-FlaB determined the highest antigen activity with antigens. The study results make it possible to consider these proteins as perspective components for development of immune enzyme test system of diagnostic of ixodic tick borreliosis.

  12. Performance of a new gelled nested PCR test for the diagnosis of imported malaria: comparison with microscopy, rapid diagnostic test, and real-time PCR. (United States)

    Iglesias, Nuria; Subirats, Mercedes; Trevisi, Patricia; Ramírez-Olivencia, Germán; Castán, Pablo; Puente, Sabino; Toro, Carlos


    Microscopy and rapid diagnostic tests (RDTs) are the techniques commonly used for malaria diagnosis but they are usually insensitive at very low levels of parasitemia. Nested PCR is commonly used as a reference technique in the diagnosis of malaria due to its high sensitivity and specificity. However, it is a cumbersome assay only available in reference centers. We evaluated a new nested PCR-based assay, BIOMALAR kit (Biotools B&M Labs, Madrid, Spain) which employs ready-to-use gelled reagents and allows the identification of the main four species of Plasmodium. Blood samples were obtained from patients with clinical suspicion of malaria. A total of 94 subjects were studied. Fifty-two (55.3%) of them were malaria-infected subjects corresponding to 48 cases of Plasmodium falciparum, 1 Plasmodium malariae, 2 Plasmodium vivax, and 1 Plasmodium ovale. The performance of the BIOMALAR test was compared with microscopy, rapid diagnostic test (RDT) (BinaxNOW® Malaria) and real-time quantitative PCR (qPCR). The BIOMALAR test showed a sensitivity of 98.1% (95% confidence interval [CI], 89.7-100), superior to microscopy (82.7% [95% CI, 69.7-91.8]) and RDT (94.2% [95% CI, 84.1-98.8]) and similar to qPCR (100% [95% CI, 93.2-100]). In terms of specificity, the BIOMALAR assay showed the same value as microscopy and qPCR (100% [95% CI, 93.2-100]). Nine subjects were submicroscopic carriers of malaria. The BIOMALAR test identified almost all of them (8/9) in comparison with RDT (6/9) and microscopy (0/9). In conclusion, the BIOMALAR is a PCR-based assay easy to use with an excellent performance and especially useful for diagnosis submicroscopic malaria.

  13. Pre-diagnostic smoking behaviour and poorer prognosis in a German breast cancer patient cohort - Differential effects by tumour subtype, NAT2 status, BMI and alcohol intake. (United States)

    Seibold, Petra; Vrieling, Alina; Heinz, Judith; Obi, Nadia; Sinn, Hans-Peter; Flesch-Janys, Dieter; Chang-Claude, Jenny


    Inconsistent associations of smoking and breast cancer-specific mortality might be explained by subgroups of patients with different susceptibility to harmful effects of smoking. We used a prospective cohort of 3340 postmenopausal breast cancer patients aged 50-74 and diagnosed with invasive tumours 2001-2005 in Germany, with a median follow-up time of 6 years. The effect of pre-diagnostic smoking behaviour on mortality outcomes and risk of recurrence was investigated using delayed entry Cox regression analysis. Differential effects according to N-acetyltransferase (NAT2) status, BMI, alcohol consumption, and tumour subtypes were assessed. Overall, smoking at time of breast cancer diagnosis versus never/former smoking was non-significantly associated with increased breast cancer-specific mortality and risk of recurrence (HR 1.23, 95% CI 0.93-1.64, and HR 1.29, 95% CI 0.95-1.75, respectively). Associations were consistently stronger in NAT2 slow than in fast acetylators for all mortality outcomes. Breast cancer-specific mortality was significantly increased in smokers with NAT2 slow acetylating status (HR 1.77, 95% CI 1.13-2.79) but not in those with fast acetylating status (HR 1.09, 95% CI 0.60-1.98; Pheterogeneity=0.19). Smoking was associated with significantly poorer outcomes for triple negative and luminal A-like tumours (e.g. all-cause mortality: HR 1.93, 95% CI 1.02-3.65, and HR 2.08, 95% CI 1.40-3.10, respectively). Risk of recurrence was significantly increased for women with HER2 positive tumours (HR 3.64, 95% CI 1.22-10.8). There was significant heterogeneity by BMI for non-breast cancer-specific mortality (effects of smoking may be particularly relevant for certain subgroups of breast cancer patients. This may include patients with NAT2 slow acetylation status or with tumour subtypes other than luminal B, such as luminal A tumours who usually have a rather good prognosis. Emphasis on smoking cessation programmes for all cancer patients should be

  14. The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part I: The diagnostic value of the ultrasound B-mode imaging in the differentiation diagnostics of solid, focal lesions in the breast in relation to the pathomorphological verification. (United States)

    Dobruch-Sobczak, Katarzyna


    The aim of this study was to evaluate the diagnostic value of the ultrasound B-mode imaging in the differentiation diagnostics of solid lesions in the breast in relation to the pathomorphological verification. From January to July 2010, 375 ultrasound breast examinations were conducted. The study enrolled 80 women aged 17-83, with 99 solid, focal lesions present in breasts, which were qualified for pathomorphological verification on the basis of the ultrasound examination. All patients underwent: the interview, physical examination, ultrasound examination and sonoelastography. The ultrasound features of the lesions, their vascularization patterns in the Doppler examination as well as the adjacent tissues were determined. Next, the focal lesions were categorized according to the BIRADS-US classification. The obtained results were analyzed statistically. In the group of 80 patients, 99 focal, solid lesions in breasts were visualized, including 39 neoplastic, malignant lesions (group I) and 60 lesions of benign nature (group II). The malignant lesions were often characterized by: greater size, irregular shape (34/39), prevalence of the anteroposterior dimension over the lateral-lateral dimension (22/39), acoustic shadowing (20/39), the margins not well-circumscribed (37/39), spiculated margins (16/39) and the presence of calcifications (14/39). The benign lesions were much more often hyper- and isoechogenic (14/60). In group I the lesions more often demonstrated the features of increased vascularization (29/39) and the presence of irregularly shaped vessels (23/29). This vascularization more often originated in the adjacent tissues. In the surroundings of the malignant neoplastic lesions, the presence of edema (16/39) and skin thickening (6/39) occurred more frequently and the abnormal axillary lymph nodes were more often diagnosed. The lesions of group I were assigned to the following BIRADS categories: BIRADS-US 4 (9 lesions) and BIRADS-US 5 (30 lesions). In group

  15. The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part I: The diagnostic value of the ultrasound B-mode imaging in the differentiation diagnostics of solid, focal lesions in the breast in relation to the pathomorphological verification

    Directory of Open Access Journals (Sweden)

    Katarzyna Dobruch‑Sobczak


    Full Text Available The aim of this study was to evaluate the diagnostic value of the ultrasound B-mode imaging in the differentiation diagnostics of solid lesions in the breast in relation to the pathomorphological verification. From January to July 2010, 375 ultrasound breast examinations were conducted. The study enrolled 80 women aged 17–83, with 99 solid, focal lesions present in breasts, which were qualified for pathomorphological verification on the basis of the ultrasound examination. All patients underwent: the interview, physical examination, ultrasound examination and sonoelastography. The ultrasound features of the lesions, their vascularization patterns in the Doppler examination as well as the adjacent tissues were determined. Next, the focal lesions were categorized according to the BIRADS-US classification. The obtained results were analyzed statistically. In the group of 80 patients, 99 focal, solid lesions in breasts were visualized, including 39 neoplastic, malignant lesions (group I and 60 lesions of benign nature (group II. The malignant lesions were often characterized by: greater size, irregular shape (34/39, prevalence of the anteroposterior dimension over the lateral‑lateral dimension (22/39, acoustic shadowing (20/39, the margins not well-circumscribed (37/39, spiculated margins (16/39 and the presence of calcifications (14/39. The benign lesions were much more often hyper- and isoechogenic (14/60. In group I the lesions more often demonstrated the features of increased vascularization (29/39 and the presence of irregularly shaped vessels (23/29. This vascularization more often originated in the adjacent tissues. In the surroundings of the malignant neoplastic lesions, the presence of edema (16/39 and skin thickening (6/39 occurred more frequently and the abnormal axillary lymph nodes were more often diagnosed. The lesions of group I were assigned to the following BIRADS categories: BIRADS-US 4 (9 lesions and BIRADS-US 5 (30 lesions

  16. [Differential diagnosis "vertigo and dizziness"]. (United States)

    Plontke, S K; Walther, L E


    Vertigo and dizziness are symptoms of interdisciplinary dimension. However, the differentiation and classification of vertigo syndromes also require experience and multidisciplinary knowledge. Since the clinical syndrome is subjective, a detailed analysis of the complaints underlying is required. International disease definitions are an indispensable tool in the differential diagnosis of vertigo syndromes today. With simple diagnostic tools eye movement disorders and nystagmus can be examined and assigned to specific vestibular disorders today. Screening tests (e.g. head impulse test) are now an important instrument in the investigation of patients with vertigo syndromes in case of emergency. With objective diagnostic methods (caloric irrigation, video head impulse test, vestibular evoked myogenic potentials) the degree of functional impairment of the five vestibular receptors can be assessed quantitatively. Furthermore, in vestibulopathies, a receptor and side-specific diagnostic assessment can be performed even with regard to dynamic aspects.

  17. Diagnostic imaging of the breast. Examination techniques, appearances, differential diagnosis and interventiones. 3. compl. rev. ed.; Bildgebende Mammadiagnostik. Untersuchungstechnik, Befundmuster, Differenzialdiagnose und Interventionen

    Energy Technology Data Exchange (ETDEWEB)

    Heywang-Koebrunner, Sylvia H. [Referenzzentrum Mammographie, Muenchen (Germany).; Schreer, Ingrid [Radiologische Allianz, Hamburg (Germany).


    The book on diagnostic imaging of the breast covers the following topics: Part I: Techniques: anamnesis and dialogue, clinical indications, mammography, sonography, nuclear magnetic resonance imaging, new imaging techniques, image clarification and percutaneous breast biopsy, preoperative marking. Part II: Appearance: the normal mamma, benign mamma modifications, cysts, benign tumors, inflammatory diseases, lesions with uncertain biological potential (B3 lesions), in-situ carcinoma, invasive carcinoma. Lymph nodes, other semi-malign and malign tumors, post-traumatic, post-operative and post-therapeutic changes, imaging diagnostics for breast implants, skin changes, the male breast. Part III: Use of imaging breast diagnostics: continuative diagnostics of screening indications and problem solution for the symptomatic patient.

  18. Differentiation of brain abscesses from glioblastomas and metastatic brain tumors: comparisons of diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MR imaging before and after mathematic contrast leakage correction.

    Directory of Open Access Journals (Sweden)

    Cheng Hong Toh

    Full Text Available PURPOSE: To compare the diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MRI before and after mathematic contrast leakage correction in differentiating pyogenic brain abscesses from glioblastomas and/or metastatic brain tumors. MATERIALS AND METHODS: Cerebral blood volume (CBV, leakage-corrected CBV and leakage coefficient K2 were measured in enhancing rims, perifocal edema and contralateral normal appearing white matter (NAWM of 17 abscesses, 19 glioblastomas and 20 metastases, respectively. The CBV and corrected CBV were normalized by dividing the values in the enhancing rims or edema to those of contralateral NAWM. For each study group, a paired t test was used to compare the K2 of the enhancing rims or edema with those of NAWM, as well as between CBV and corrected CBV of the enhancing rims or edema. ANOVA was used to compare CBV, corrected CBV and K2 among three lesion types. The diagnostic performance of CBV and corrected CBV was assessed with receiver operating characteristic (ROC curve analysis. RESULTS: The CBV and correction CBV of enhancing rim were 1.45±1.17 and 1.97±1.01 for abscesses, 3.85±2.19 and 4.39±2.33 for glioblastomas, and 2.39±0.90 and 2.97±0.78 for metastases, respectively. The CBV and corrected CBV in the enhancing rim of abscesses were significantly lower than those of glioblastomas and metastases (P = 0.001 and P = 0.007, respectively. In differentiating abscesses from glioblastomas and metastases, the AUC values of corrected CBV (0.822 were slightly higher than those of CBV (0.792. CONCLUSIONS: Mathematic leakage correction slightly increases the diagnostic performance of CBV in differentiating pyogenic abscesses from necrotic glioblastomas and cystic metastases. Clinically, DSC perfusion MRI may not need mathematic leakage correction in differentiating abscesses from glioblastomas and/or metastases.

  19. Mandibular mass in pediatric patient: A diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    P A Ranadive


    Full Text Available A case of aggressive Juvenile ossifying fibroma in a child has been discussed. The unique appearance of this particular lesion demonstrates a close relationship between aggressive ossifying fibroma and well-differentiated osteogenic sarcoma. The age of the patient and the location of the tumor in the case presented made it mandatory to utilize multiple diagnostic parameters and adjunctive diagnostic help to resolve the dilemma posed by this tumor. Differentiation of ossifying fibroma from other benign and malignant neoplasms as well as fibrous dysplasia is important in correct management of the lesion.

  20. Persistence of intrasellar trigeminal artery and simultaneous pituitary adenoma: description of two cases and their importance for the differential diagnosis of sellar lesions. (United States)

    Machado, Marcio Carlos; Kodaira, Sergio; Musolino, Nina Rosa Castro


    Persistent trigeminal artery (PTA) is the most frequent embryonic communication between the carotid and vertebrobasilar systems. However, hormonal changes or the association of PTA with other sellar lesions, such as pituitary adenomas, are extremely rare. The aim of the present study was to report two patients with intrasellar PTA and simultaneous pituitary adenoma in order to emphasize the importance of differential diagnoses for sellar lesions. Case 1. A female patient, 41 years old, was admitted with a history of chronic headache (> 20 years). Pituitary magnetic resonance imaging (MRI) showed a rounded lesion in the left portion of the pituitary gland suggestive of adenoma (most likely clinically non-functioning adenoma). In addition to this lesion, the MRI demonstrated ecstasy of the right internal carotid artery and imaging suggestive of an intrasellar artery that was subsequently confirmed by an angio-MRI of the cerebral vessels as PTA. Case 2. A female patient, 42 years old, was admitted with a history of amenorrhea and galactorrhea in 1994. Laboratorial investigation revealed hyperprolactinemia. Pituitary MRI showed a small hyposignal area in the anterior portion of pituitary gland suggestive of a microadenoma initiated by a dopaminergic agonist. Upon follow-up, aside from the first lesion, the MRI showed a well delineated rounded lesion inside the pituitary gland, similar to a vessel. Angio-MRI confirmed a left primitive PTA. Failure to recognize these anomalous vessels within the sella might lead to serious complications during transsphenoidal surgery. Therefore, although their occurrence is uncommon, a working knowledge of vascular lesions in the sella turcica or pituitary gland is important for the differential diagnosis of pituitary lesions, especially pituitary adenomas.

  1. 脑多发性硬化的磁敏感加权成像诊断及鉴别诊断价值%The diagnostic and differential diagnostic value of susceptibility weighted imaging in brain multiple sclerosis

    Institute of Scientific and Technical Information of China (English)

    亓敏; 刘强; 史浩


    目的 比较多发性硬化(multiple sclerosis.MS)、脑梗死患者及正常对照组感兴趣区的相位值.探讨其诊断MS的价值.方法 12例MS和20例脑梗死患者均经临床病史和(或)实验室检查证实.对照组选择年龄相匹配的健康志愿者各30例.所有参与者均接受常规MR检查和SWI.结果 正常志愿者感兴趣区的相位值均无显著的性别、侧别差异.其与年龄亦无显著相关,双侧额叶白质相位值低于其他感兴趣区,但无明显统计学差异;与年龄相匹配的正常志愿者组比较.MS组双侧额叶、顶叶、枕叶白质、脑干及小脑白质无病灶区相位值均低于对照组,但只有额叶和枕叶的相位值与对照组比较有明显差异(P<0.05);脑梗死组无病灶区相位值均低于年龄相匹配正常志愿者,但无明显统计学差异;MS组及脑梗死组比较,两组间上述感兴趣区相位值比较亦无明显统计学差异;与脑梗死组比较.MS组病灶区相位值明显降低,配对t检验分析,两组间相位值比较具有统计学差异(P<0.05).此外,12例MS组227个病灶中126个病灶周围伴行静脉.49个病灶内可见静脉穿行.病灶周边为低信号环者56个,20例脑梗死患者病灶区及周围未见明显类似表现.结论 SWI有助于提高对活体多发性硬化和脑梗死病灶病理特征的认识,可以作为二者鉴别诊断的定量补充.在一定程度上指导临床选择治疗方案.%Objective To compare the phase values of susceptibility weighted imaging (SWI) between multiple sclerosis (MS). cerebral infarction and normal control subjects and to explore the diagnostic value of phase values in the patients with MS. Methods Twelve patients with MS. who were confirmed by clinical diagnosis and/or laboratory tests. 20 patients with cerebral infarction and 30 healthy volunteers as control group underwent brain scans using magnetic resonance imaging, which included conventional MR imaging and SW1. Results The

  2. Iodine-123 as a diagnostic imaging agent in differentiated thyroid carcinoma: a comparison with iodine-131 post-treatment scanning and serum thyroglobulin measurement

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    Urhan, Muammer; Dadparvar, Simin; Mavi, Ayse; Houseni, Mohamed; Chamroonrat, Wichana; Alavi, Abass [Department of Medicine University of Pennsylvania Medical Center, Division of Nuclear Medicine, Department of Radiology, Philadelphia, PA (United States); Mandel, Susan J. [Department of Medicine University of Pennsylvania Medical Center, Division of Endocrinology, Diabetes and Metabolism, Philadelphia, PA (United States)


    Using{sup 123}I for diagnostic purposes avoids the risk of stunning for subsequent radioiodine treatment and affords an excellent image quality. In this study we assessed the role of{sup 123}I in comparison with{sup 131}I post-treatment imaging in patients with thyroid cancer. We compared a total of 292{sup 123}I scans with their corresponding post-treatment{sup 131}I images. Patients received a therapeutic dose of{sup 131}I following diagnostic scanning with 50-111 MBq of{sup 123}I. All patients were in a hypothyroid state (>30 {mu}IU/l) before radioiodine administration for either diagnostic or therapeutic purposes. In 228 out of 263 patients with a positive diagnostic scan,{sup 123}I whole-body scan findings were concordant with those of corresponding post-treatment{sup 131}I images (concordance rate 87%). However, there were 44 additional foci of abnormal uptake on post-treatment{sup 131}I scans in 22 discordant cases with no impact on therapeutic management of the patients. In 13 patients, there was at least one new site on post-treatment images that had been missed on pretreatment{sup 123}I images. Twenty-nine patients with a negative diagnostic scan were treated with{sup 131}I owing to a high serum thyroglobulin level (range 11.3-480 ng/ml). Radioiodine uptake sites were seen in eight post-treatment scans. In 21 pairs of whole-body scans, both the pre- and the post-treatment scan were negative (concordance rate 72.4%). {sup 123}I scanning is comparable to high-dose{sup 131}I post-treatment imaging in thyroid carcinoma patients, and {sup 123}I offers excellent image quality as a diagnostic agent. It avoids disadvantages such as stunning before treatment and delivery of a high radiation dose to patients. (orig.)

  3. Physics of Intrinsic and Extrinsic Factors that Cause the Onset of the Deadliest Illness of Mankind and are Important for Diagnostics and Treatment (United States)

    Saxena, Arjun

    One of the most important topic of research in the field of Physics of Behavior is the deadliest illness of mankind which is the group of illnesses called mental illnesses. They are getting attention increasingly worldwide by the medical communities and their respective governments, because of the following fact. It is now well established that these illnesses cause more loss of human lives, destruction of families, businesses and overall economy than all the other illnesses combined. The purpose of this paper is to identify and provide solutions to two fundamental issues of such illnesses which still remain as problems. One is the stigma associated with them because of their name ``mental''. The patients are regarded as less than normal because their illness is only ``mental'' in origin. The second is that it is still not widely recognized that they are caused by medical problems in their ``brain'' which afflict their ``mind''. This paper explains this and gives an improved 3-D model using the physics of intrinsic and extrinsic factors of both ``brain'' and ``mind''. It leads to an important new name, ``BAMI'' (Brain and Mind Illness), which eliminates the stigma and gives quantitative parameters to diagnose the illness and monitor medicines to treat such illnesses.

  4. Diagnostic significance of differential cell count in induced sputum to chronic cough in children%高渗盐水诱导痰细胞学检查在儿童慢性咳嗽诊断中的意义

    Institute of Scientific and Technical Information of China (English)

    钟帼钰; 陈德晖; 罗炜; 陈桥丽; 卢慧敏; 林育能; 潘小安; 吴上志; 赖克方


    evaluating chronic cough in pediatrics (ACCP).The differential cell counts were measured and observed in induced sputum of these children with different causes to chronic cough.Results Sputum induction produced an adequate sample in 175 subjects,the success rate was 88.4%.The side effects including pharynx itching,nausea,cough and dizziness ect were found in 10.1% patients.The causes of 175 children with chronic cough were analyzed.These children were divided into 3 groups base on age.The children of group Ⅰ was 4~6 years (51 cases),group Ⅱ was 7~11 years (66 cases),group Ⅲ was 12~16 years (58 cases).The distribution of causes of chronic cough were no significant differences among group Ⅰ,Ⅱ and Ⅲ ( P >0.05).The differential cell counts in induced sputum were significant differences in each group of different diagnoses (P < 0.05 ). The differential cell counts in induced sputum were significant differences between group of different diagnoses and the healthy controls ( P < 0.05).Conclusions Induced sputum procedure is a safe and effective method.The differential cell count in induced sputum to chronic cough in children has important diagnostic significance.

  5. Differential expression of ANXA6, HSP27, PRDX2, NCF2, and TPM4 during uterine cervix carcinogenesis : diagnostic and prognostic value

    NARCIS (Netherlands)

    Lomnytska, M. I.; Becker, S.; Bodin, I.; Olsson, A.; Hellman, K.; Hellstrom, A-C; Mints, M.; Hellman, U.; Auer, G.; Andersson, S.


    BACKGROUND: Cytology-based diagnostics of squamous cervical cancer (SCC) precursor lesions is subjective and can be improved by objective markers. METHODS: IHC-based analysis of ANXA6, HSP27, peroxiredoxin 2 (PRDX2), NCF2, and tropomyosin 4 (TPM4) during SCC carcinogenesis. RESULTS: Expression of AN

  6. The Eating Disorder Diagnostic Scale: psychometric features within a clinical population and a cut-off point to differentiate clinical patients from healthy controls

    NARCIS (Netherlands)

    Krabbenborg, M.A.M.; Danner, U.N.; Larsen, J.K.; Veer, N. van der; Elburg, A.A. van; Ridder, D.T. de; Evers, C.; Stice, E.; Engels, R.C.E.M.


    The Eating Disorder Diagnostic Scale (EDDS) is a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder. Research has provided evidence of the reliability and validity of this scale in non-clinical populations. Our study is the first to examine the

  7. The Eating Disorder Diagnostic Scale: psychometric features within a clinical population and a cut-off point to differentiate clinical patients from healthy controls

    NARCIS (Netherlands)

    Krabbenborg, M.A.M.; Danner, U.N.; Larsen, J.K.; Veer, N. van der; Elburg, A.A. van; Ridder, D.T. de; Evers, C.; Stice, E.; Engels, R.C.E.M.


    The Eating Disorder Diagnostic Scale (EDDS) is a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder. Research has provided evidence of the reliability and validity of this scale in non-clinical populations. Our study is the first to examine the psych

  8. Epidemiologic aspects of neural tube defects in the United States: changing concepts and their importance for screening and prenatal diagnostic programs

    Energy Technology Data Exchange (ETDEWEB)

    Sever, L.E.; Strassburg, M.A.


    This report considers several major epidemiologic aspects of neural tube defects (NTDs). After examining briefly the approaches and goals of epidemiology the traditional epidemiologic concepts of NTDs are reviewed and new interpretations of the epidemiology of these defects is suggested. Three major topics are addressed: (1) that much of our knowledge of the epidemiology of the NTDs comes from areas or periods of high rates of occurrence and that generalizations based on these data may not be applicable to low incidence situations; (2) that the etiology of these defects is multifactorial, involving interaction between genetic and nongenetic factors which may differ in their relative importance between populations; and (3) that anencephalus and spina bifida may be more epidemiologically and etiologically distinct than is usually appreciated. A final consideration deals with some recent contributions of epidemiology to screening and prenatal diagnosis programs.

  9. [Cytology in uropathological diagnostics]. (United States)

    Gaisa, N T; Lindemann-Docter, K


    Cytology in uropathological diagnostics is mainly performed for oncological purposes. The assessment of malignancy by urothelial cell morphology is therefore decisive; however, cytology is only sensitive enough to detect high-grade tumor cells and the different low-grade tumors cannot be reliably diagnosed. Thus, the four-tier classification system of cytological findings (i.e. negative, atypical cells but significance uncertain, suspicious and positive) refers to high-grade tumor cells only. Furthermore, for valid cytological diagnostics not only the cytological specimen but also clinical information on cystoscopy findings and, if applicable, a biopsy should be evaluated together. In difficult differential diagnostic settings, e.g. differentiation between reactive versus neoplastic atypia or difficult to access lesions in the upper urinary tract, additional fluorescence in situ hybridization of cytological preparations might be helpful. At the moment there are no indications for further immunocytology or additional biomarker tests.

  10. Neuropsychological diagnostics in Ethiopia - challenges and ...

    African Journals Online (AJOL)

    Neuropsychological diagnostics in Ethiopia - challenges and chances among ... Abstract. Background Neuropsychological tests can provide crucial information regarding the consideration of psychiatric differential diagnosis. ... Article Metrics.

  11. Plasma diagnostics discharge parameters and chemistry

    CERN Document Server

    Auciello, Orlando


    Plasma Diagnostics, Volume 1: Discharge Parameters and Chemistry covers seven chapters on the important diagnostic techniques for plasmas and details their use in particular applications. The book discusses optical diagnostic techniques for low pressure plasmas and plasma processing; plasma diagnostics for electrical discharge light sources; as well as Langmuir probes. The text also describes the mass spectroscopy of plasmas, microwave diagnostics, paramagnetic resonance diagnostics, and diagnostics in thermal plasma processing. Electrical engineers, nuclear engineers, microwave engineers, che

  12. Investigation techniques and importance of CT for diagnostics of cardiac valvular diseases; Untersuchungstechniken und Stellenwert der CT bei der Diagnostik von Herzklappenerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Gordic, S.; Alkadhi, H. [Universitaetsspital Zuerich, Institut fuer Diagnostische und Interventionelle Radiologie, Zuerich (Switzerland)


    Cardiac computed tomography (CT) is the first-line modality for coronary assessment. In addition valvular morphology and function can be evaluated. The method of choice for the evaluation of cardiac valves is echocardiography, followed by magnetic resonance imaging. Recent technical improvements and advances in temporal resolution allow a detailed anatomical and functional evaluation of the cardiac valves. Cardiac CT provides an excellent image quality of the aortic and mitral valve thus enabling an evaluation of the morphology. In addition, cardiac CT allows an assessment of aortic valve function with respect to the grading of stenosis and regurgitation. Cardiac CT is not considered the first-line modality for the evaluation of cardiac valves; however, beyond coronary assessment CT provides important information on the morphology and function of cardiac valves. Cardiac CT can be a useful imaging alternative for patients in whom other more commonly used methods, such as echocardiography and magnetic resonance imaging fail to provide the necessary information. (orig.) [German] Die Herz-CT wird in erster Linie anlaesslich einer Koronarabklaerung durchgefuehrt. Sie ist aber auch in der Lage, wichtige Informationen ueber die Morphologie und teilweise auch Herzklappenfunktion zu liefern. Die primaere Modalitaet zur Evaluation der Herzklappen ist die Echokardiographie, gefolgt von der Magnetresonanztomographie. Durch die kontinuierliche technische Weiterentwicklung der CT-Geraete erfolgte eine markante Verbesserung der raeumlichen und zeitlichen Aufloesung, welche fuer die artefaktfreie Darstellung schnell bewegender und kleiner Strukturen, wie etwa der Koronargefaesse und Herzklappen, entscheidend sind. Die CT liefert eine ausgezeichnete Bildqualitaet der Aorten- und Mitralklappe und erlaubt somit eine praezise Beurteilung ihrer Morphologie. Zudem ermoeglicht die CT eine gute Beurteilung der Aortenklappenfunktion mit einer Graduierung von Stenose und Insuffizienz. Die

  13. Differential characters

    CERN Document Server

    Bär, Christian


    Providing a systematic introduction to differential characters as introduced by Cheeger and Simons, this text describes important concepts such as fiber integration, higher dimensional holonomy, transgression, and the product structure in a geometric manner. Differential characters form a model of what is nowadays called differential cohomology, which is the mathematical structure behind the higher gauge theories in physics.  

  14. The diagnostic accuracy of two human epididymis protein 4 (HE4) testing systems in combination with CA125 in the differential diagnosis of ovarian masses


    Lenhard, Miriam; Stieber, Petra; Hertlein, Linda; Kirschenhofer, Angela; Fuerst, Sophie; Mayr, Doris; Nagel, Dorothea; Hofmann, Karin; Krocker, Katja; Burges, Alexander


    Background: Cancer antigen 125 (CA125) is the best known single tumor marker for ovarian cancer (OC). We investigated whether the additional information of the human epididymis protein 4 (HE4) improves diagnostic accuracy. Methods: We retrospectively analyzed preoperative sera of 109 healthy women, 285 patients with benign ovarian masses (cystadenoma: n = 78, leimyoma: n = 66, endometriosis: n = 52, functional ovarian cysts: n = 79, other: n = 10), 16 low malignant potential (LMP) ovarian tum...

  15. Infectious diseases of the brain: imaging and differential diagnosis; Infektioese Hirnerkrankungen: Bildgebung und differenzialdiagnostische Aspekte

    Energy Technology Data Exchange (ETDEWEB)

    Haehnel, S.; Seitz, A. [Abt. Neuroradiologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany); Storch-Hagenlocher, B. [Abt. Neurologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany)


    Infectious diseases of the central nervous system have to be considered in differential diagnosis particularly in immunocompromised persons. Neuro-imaging, specifically advanced techniques such as diffusion weighted MRI and perfusion MRI contribute much to the differentiation of brain infections and for differentiating brain infections from other, for instance, neoplastic diseases. In this review we present the imaging criteria of the most important brains infections in adults and in pediatric patients and discuss differential diagnostic aspects in detail. (orig.)

  16. [Fibrin(ogen degradation product concentration (SFP) as a diagnostic parameter for the differentiation of artifical and essential blood in cerebrospinal fluid]. (United States)

    Hindersin, P; Heidrich, R


    The fibrin(ogen) degradation product concentration is another differential-diagnosis parameter for distinguishing between artificially blood-stained and essentially blood-stained CSF. Determination of the fibrin(ogen) degradation product concentration has been found to be a reliable method of recognizing natively and artificially blood-stained CSF as being different.

  17. Dedifferentiated liposarcoma with "homologous" lipoblastic (pleomorphic liposarcoma-like) differentiation: clinicopathologic and molecular analysis of a series suggesting revised diagnostic criteria. (United States)

    Mariño-Enríquez, Adrián; Fletcher, Christopher D M; Dal Cin, Paola; Hornick, Jason L


    Dedifferentiated liposarcoma (LPS) is a malignant adipocytic neoplasm defined as the transition from well-differentiated LPS to a nonlipogenic sarcoma. Heterologous differentiation is seen in 5% to 10% of dedifferentiated LPS, usually with myogenic or osteo/chondrosarcomatous elements. Adipocytic differentiation in the dedifferentiated component is incompatible with the current definition of dedifferentiated LPS. Pleomorphic LPS is a high-grade sarcoma containing lipoblasts. At least in areas, pleomorphic LPS can be indistinguishable from dedifferentiated LPS, except for the presence of lipoblasts in pleomorphic LPS and well-differentiated LPS areas in dedifferentiated LPS. We evaluated 12 unusual liposarcomas: 11 cases with pleomorphic LPS-like morphology affecting patients with concomitant or previous well-differentiated/dedifferentiated LPS, and 1 case resembling inflammatory "MFH" with scattered lipoblasts. Clinical and histologic features were reviewed. Immunohistochemistry for MDM2 and CDK4 was carried out. Amplification of 12q13 to q15 was studied by FISH analysis of the HMGA2 locus. The tumors arose in the retroperitoneum (7), proximal lower extremity (3), chest wall (1), and neck (1) of 9 males and 3 females (median age 66 y; range 49 to 76). Size ranged from 9 to 32 cm (median 23 cm). In 3 cases, there was an abrupt transition between well-differentiated LPS and sheets of pleomorphic lipoblasts, indistinguishable from pleomorphic LPS. Four cases consisted of otherwise typical dedifferentiated LPS (with adjacent well-differentiated LPS), except for the presence of lipoblasts in the high-grade component. One case contained both nonlipogenic spindle cell areas and an inflammatory "MFH"-like component with numerous admixed lipoblasts. Four cases were composed exclusively of pleomorphic LPS-like areas developing in 1 of the recurrences or metastases of a prior typical dedifferentiated LPS. Two cases also showed heterologous smooth muscle differentiation. MDM2

  18. Target Product Profile for a Diagnostic Assay to Differentiate between Bacterial and Non-Bacterial Infections and Reduce Antimicrobial Overuse in Resource-Limited Settings: An Expert Consensus. (United States)

    Dittrich, Sabine; Tadesse, Birkneh Tilahun; Moussy, Francis; Chua, Arlene; Zorzet, Anna; Tängdén, Thomas; Dolinger, David L; Page, Anne-Laure; Crump, John A; D'Acremont, Valerie; Bassat, Quique; Lubell, Yoel; Newton, Paul N; Heinrich, Norbert; Rodwell, Timothy J; González, Iveth J


    Acute fever is one of the most common presenting symptoms globally. In order to reduce the empiric use of antimicrobial drugs and improve outcomes, it is essential to improve diagnostic capabilities. In the absence of microbiology facilities in low-income settings, an assay to distinguish bacterial from non-bacterial causes would be a critical first step. To ensure that patient and market needs are met, the requirements of such a test should be specified in a target product profile (TPP). To identify minimal/optimal characteristics for a bacterial vs. non-bacterial fever test, experts from academia and international organizations with expertise in infectious diseases, diagnostic test development, laboratory medicine, global health, and health economics were convened. Proposed TPPs were reviewed by this working group, and consensus characteristics were defined. The working group defined non-severely ill, non-malaria infected children as the target population for the desired assay. To provide access to the most patients, the test should be deployable to community health centers and informal health settings, and staff should require 90% and >80% for sensitivity and specificity, respectively. Other key characteristics, to account for the challenging environment at which the test is targeted, included: i) time-to-result targeted and timely efforts by industry partners and academic institutions.


    Directory of Open Access Journals (Sweden)

    Nikolay A. Peev


    Full Text Available Although brain metastases are one of the most frequently diagnosed sequelae of systemic malignancy, their optimal management still is not well defined. In that respect the different diagnostic and therapeutic approaches of BMs patients is an issue for serious discussions. Among the most commonly used diagnostic tools are computed tomography (CT scans, magnetic resonance imaging (MRI scans, single photon emission computed tomography (SPECT and positron emission tomography (PET scans etc. Nowadays the aforementioned diagnostic modalities are usually combined in order to obtain complete diagnostic information important for establishing the optimal treatment. With the present report we try to elaborate on the value of the modern diagnostic tools in differentiating between tumor progressions versus radiation necrosis in irradiated patients with resected brain metastases. Although the present advancement of the modern imaging modalities differentiating between tumor progression versus radiation necrosis is often difficult. Application of the metabolic imaging modalities like SPECT, PET and proton magnetic resonance spectroscopy (1H-MRS contributes for the diagnose but still pathological specimens remain a gold standard for distinguishing tumor from necrosis, because none of the imaging modalities is possible to reliably differentiate necrosis from progression in 100% of the cases.

  20. Diagnostic accuracy of diffusion-weighted imaging with conventional MR imaging for differentiating complex solid and cystic ovarian tumors at 1.5T

    Directory of Open Access Journals (Sweden)

    Zhang Ping


    Full Text Available Abstract Background Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Our study aims to determine the usefulness of apparent diffusion coefficients (ADC for characterizing complex solid and cystic adnexal masses. Methods One-hundred and 91 patients underwent diffusion-weighted (DW magnetic resonance (MR imaging of 202 ovarian masses. The mean ADC value of the solid components was measured and assessed for each ovarian mass. Differences in ADC between ovarian masses were tested using the Student’s t-test. The receiver operating characteristic (ROC was used to assess the ability of ADC to differentiate between benign and malignant complex adnexal masses. Results Eighty-five patients were premenopausal, and 106 were postmenopausal. Seventy-four of the 202 ovarian masses were benign and 128 were malignant. There was a significant difference between the mean ADC values of benign and malignant ovarian masses (p -3 mm2/s may be the optimal one for differentiating between benign and malignant tumors. Conclusions A high signal intensity within the solid component on T2WI was less frequently in benign than in malignant adnexal masses. The combination of DW imaging with ADC value measurements and T2-weighted signal characteristics of solid components is useful for differentiating between benign and malignant ovarian masses.

  1. Diagnostic and Differential Diagnostic Value of MSCT in Inguinal Hernia and Femoral Hernia%MSCT对腹股沟疝及股疝的诊断与鉴别诊断价值探析

    Institute of Scientific and Technical Information of China (English)

    林长安; 李华明; 姜剑榕


    Objective To investigate the multi-slice spiral CT(MSCT)in the diagnosis and differential diagnosis of inguinal hernia and femoral hernia in value.Methods108 cases of inguinal hernia and femoral hernia patients MSCT examinated results.Results108 cases of patients,64 cases of inguinal hernia,30 cases of direct inguinal hernia,14 cases of femoral hernia,hernia diagnosis accuracy rate of 97%,direct hernia diagnosis accurate rate was 93%,femoral hernia diagnosis accuracy rate of 93%.Conclusion MSCT in the diagnosis of inguinal hernia and femoral hernia in accuracy rate is very high.%目的:探讨多层螺旋CT(MSCT)在腹股沟疝及股疝的诊断与鉴别诊断中的价值。方法分析108例腹股沟疝及股疝患者MSCT检查结果。结果108例患者中,腹股沟斜疝64例,直疝30例,股疝14例,斜疝诊断准确率97%,直疝诊断准确率93%,股疝诊断准确率93%。结论 MSCT在诊断腹股沟疝及股疝中准确率非常高。

  2. Diagnostic Efficacy of All Series of Dynamic Contrast Enhanced Breast MR Images Using Gradient Vector Flow (GVF Segmentation and Novel Border Feature Extraction for Differentiation Between Malignant

    Directory of Open Access Journals (Sweden)

    L. Bahreini


    Full Text Available Background/Objective: To discriminate between malignant and benign breast lesions;"nconventionally, the first series of Breast Subtraction Dynamic Contrast-Enhanced Magnetic"nResonance Imaging (BS DCE-MRI images are used for quantitative analysis. In this study, we"ninvestigated whether using all series of these images could provide us with more diagnostic"ninformation."nPatients and Methods: This study included 60 histopathologically proven lesions. The steps of"nthis study were as follows: selecting the regions of interest (ROI, segmentation using Gradient"nVector Flow (GVF snake for the first time, defining new feature sets, using artificial neural network"n(ANN for optimal feature set selection, evaluation using receiver operating characteristic (ROC"nanalysis."nResults: The results showed GVF snake method correctly segmented 95.3% of breast lesion"nborders at the overlap threshold of 0.4. The first classifier which used the optimal feature set"nextracted only from the first series of BS DCE-MRI images achieved an area under the curve"n(AUC of 0.82, specificity of 60% at sensitivity of 81%. The second classifier which used the same"noptimal feature set but was extracted from all five series of these images achieved an AUC of"n0.90, specificity of 79% at sensitivity of 81%."nConclusion: The result of GVF snake segmentation showed that it could make an accurate"nsegmentation in the borders of breast lesions. According to this study, using all five series of BS"nDCE-MRI images could provide us with more diagnostic information about the breast lesion and"ncould improve the performance of breast lesion classifiers in comparison with using the first"nseries alone.

  3. The diagnostic utility of the triple markers Napsin A, TTF-1, and PAX8 in differentiating between primary and metastatic lung carcinomas. (United States)

    El-Maqsoud, Nehad M R Abd; Tawfiek, Ehab Rifat; Abdelmeged, Ayman; Rahman, Mohamed Fathy Abdel; Moustafa, Alaa A E


    Napsin A and thyroid transcription factor-1 (TTF-1) are useful biomarkers for differentiating lung adenocarcinoma from squamous cell carcinoma and also for differentiating primary lung adenocarcinoma from metastatic lung carcinoma. Pair-boxed 8 (PAX8) can help in distinguishing primary lung carcinoma from metastatic carcinomas and help to determine the primary sites of metastatic carcinomas. Immunohistochemistry for Napsin A, TTF-1, and PAX8 were performed on 193 cases of carcinoma: 50 primary lung carcinoma and 143 carcinomas from other sites. Napsin A and TTF-1 were positive in 54, 52 % of lung carcinomas cases, respectively. While in adenocarcinoma cases, their expressions were 86.7 and 83.3 %, respectively. PAX8 was negative in all lung carcinomas. TTF-1 and PAX8 were positive in 93.3 and 96.7 % of thyroid carcinoma cases and in 87.5 and 93.8 % of papillary carcinoma respectively, and both were positive in 100 % of follicular carcinoma. Napsin A was negative in all thyroid carcinomas. Napsin A and PAX8 were positive in 50 and 93.3 % of renal carcinoma cases and in 81.8 and 100 % of papillary carcinoma, 38.5 and 92.3 % of clear cell carcinoma, and 16.7 and 83.3 % of chromophobe carcinoma respectively. TTF-1 was negative in all renal carcinomas. PAX8 was positive in 80 % of ovarian carcinoma cases; 100 and 60 % of serous mucinous carcinomas, respectively. It was also positive in 100 % of endometrial carcinoma. Napsin A and TTF-1 were negative in both ovarian and endometrial carcinomas. Our data demonstrated that combined use of Napsin A, TTF-1, and PAX8 may help in differentiating between primary lung adenocarcinoma and metastatic lung carcinomas.

  4. Functional constraints on SoxE proteins in neural crest development: The importance of differential expression for evolution of protein activity. (United States)

    Lee, Eric M; Yuan, Tian; Ballim, Reyna D; Nguyen, Kristy; Kelsh, Robert N; Medeiros, Daniel M; McCauley, David W


    Vertebrate SoxE genes (Sox8, 9, and 10) are key regulators of neural crest cell (NCC) development. These genes arose by duplication from a single SoxE gene in the vertebrate ancestor. Although SoxE paralogs are coexpressed early in NCC development, later, Sox9 is restricted to skeletogenic lineages in the head, and Sox10 to non-skeletogenic NCC in the trunk and head. When this subfunctionalization evolved and its possible role in the evolution of the neural crest are unknown. Sea lampreys are basal vertebrates that also possess three SoxE genes, while only a single SoxE is present in the cephalochordate amphioxus. In order to address the functional divergence of SoxE genes, and to determine if differences in their biochemical functions may be linked to changes in neural crest developmental potential, we examined the ability of lamprey and amphioxus SoxE genes to regulate differentiation of NCC derivatives in zebrafish colourless (cls) mutants lacking expression of sox10. Our findings suggest that the proto-vertebrate SoxE gene possessed both melanogenic and neurogenic capabilities prior to SoxE gene duplication. Following the agnathan-gnathostome split, lamprey SoxE1 and SoxE3 largely lost their melanogenic and/or enteric neurogenic properties, while gnathostome SoxE paralogs have retained functional conservation. We posit that this difference in protein subfunctionalization is a direct consequence of the independent regulation of SoxE paralog expression between the two lineages. Specifically, we propose that the overlapping expression of gnathostome SoxE paralogs in early neural crest largely constrained the function of gnathostome SoxE proteins. In contrast, the largely non-overlapping expression of lamprey SoxE paralogs allowed them to specialize with regard to their DNA-binding and/or protein interaction properties. Restriction of developmental potential among cranial and trunk neural crest in lampreys may be related to constraints on SoxE activity among

  5. [Imported histoplasmosis]. (United States)

    Stete, Katarina; Kern, Winfried V; Rieg, Siegbert; Serr, Annerose; Maurer, Christian; Tintelnot, Kathrin; Wagner, Dirk


    Infections with Histoplasma capsulatum are rare in Germany, and mostly imported from endemic areas. Infections can present as localized or disseminated diseases in immunocompromised as well as immunocompetent hosts. A travel history may be a major clue for diagnosing histoplasmosis. Diagnostic tools include histology, cultural and molecular detection as well as serology. Here we present four cases of patients diagnosed and treated in Freiburg between 2004 and 2013 that demonstrate the broad range of clinical manifestations of histoplasmosis: an immunocompetent patient with chronic basal meningitis; a patient with HIV infection and fatal disseminated disease; a patient with pulmonary and cutaneous disease and mediastinal and cervical lymphadenopathy; and an immunosuppressed patient with disseminated involvement of lung, bone marrow and adrenal glands.

  6. LLC: critérios diagnósticos, imunofenotipagem e diagnóstico diferencial CLL: diagnostic criteria, immunophenotyping and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Irene Lorand-Metze


    Full Text Available O diagnóstico da LLC é baseado em dados do hemograma e da imunofenotipagem dos linfócitos periféricos: linfocitose acima de 5 (ou 10 x 10(9/L com fenótipo CD19, CD5, CD23 e expressão fraca de imunoglobulinas de superfície monoclonais. A expressão de CD38 ocorre em cerca da metade dos casos e tem relação com o estado não mutado de Ig V. A biópsia de medula só deverá ser realizada antes do tratamento ou quando os dois exames acima não permitirem um diagnóstico definitivo. O diagnóstico diferencial é com os outros linfomas B indolentes, que freqüentemente apresentam células neoplásicas circulantes. Este diagnóstico diferencial é baseado na imunofenotipagem, biópsia de medula ou linfonodo.The diagnosis of CLL is based on the finding of peripheral lymphocytosis of over 5 (or 10 x 10(9/L presenting the CD19, CD5, CD23 phenotype and a weak monoclonal expression of membrane immunoglobulins. The CD38 expression is observed in half of the cases and is correlated with the unmutated status of the Ig V gene. Bone marrow biopsy should only be performed before starting treatment or if necessary for the differential diagnosis with other low-grade lymphomas. This differential diagnosis is based on the morphology of circulating lymphocytes, their immunophenotypes and pattern of bone marrow infiltration.

  7. The combination of urinary IL - 6 and renal biometry as useful diagnostic tools to differentiate acute pyelonephritis from lower urinary tract infection. (United States)

    Azab, Sherif; Zakaria, Mostafa; Raafat, Mona; Seief, Hadeel


    To evaluate the role of renal ultrasound (RUS) and urinary IL-6 in the differentiation between acute pyelonephritis (APN) and lower urinary tract infection (LUTI). This prospective study was carried out at the Pediatric and urology outpatient and inpatient departments of Cairo University Children's Hospital as well as October 6 University Hospital and it included 155 children between one month and fourteen years old with positive culture UTI. Patients were categorized into APN and LUTI based on their clinical features and laboratory parameters. Thirty healthy children, age and sex matched constituted the control group. Children with positive urine cultures were treated with appropriate antibiotics. Before treatment, urinary IL-6 was measured by enzyme immunoassay technique (ELISA), and renal ultrasound (RUS) was done. CRP (C-reactive protein), IL-6 and RUS were repeated on the 14th day of antibiotic treatment to evaluate the changes in their levels in response to treatment. UIL-6 levels were more significantly higher in patients with APN than in patients with LUTI (24.3±19.3pg/mL for APN vs. 7.3±2.7pg/mL in LUTI (95% CI: 2.6-27.4; p20pg/mL and serum CRP >20μg/mL were highly reliable markers of APN. Mean renal volume and mean volume difference between the two kidneys in the APN group were more than that of the LUTI and control groups (Purinary IL-6 levels have a highly dependable role in the differentiation between APN and LUTI especially in places where other investigations are not available and/ or affordable. Copyright© by the International Brazilian Journal of Urology.

  8. Utility of transperineal and anal ultrasonography in the diagnostics of hidradenitis suppurativa and its differentiation from a rectal fistula 

    Directory of Open Access Journals (Sweden)

    Małgorzata Kołodziejczak


    Full Text Available Introduction:The pathogenesis of hidradenitis suppurativa (HS is not fully understood. There exist several theories, in which mechanical factors, genetic factors, as well as immunological dysfunction of lymphocytes are suspected. Clinically, this entity is frequently mistaken for anal fistula with consequently wrong treatment.We aim to determine the utility of transperineal ultrasound (TPUS and anal ultrasound (AUS in the diagnosis of HS and its differentiation from an anal fistula.Material/Methods:Retrospective analysis was performed on 51 patients (5 females, 46 males aged 20–71 years (mean age 47.5, who were operated on in the years 2006–2011 for HS in the area of the anus and perineum, and pre-operatively had been imaged with TPUS and AUS. Sixty-seven operations were analyzed, as 11 patients were operated on more than once due to HS recurrence.Results:In 66 out of 67 cases (98.5� the pre-operative TPUS and AUS were in accordance with the intraoperative findings. Only in 1 patient was a pilonidal cyst diagnosed intraoperatively. In all 67 patients, the TPUS showed typical fluid-solid changes localized in the subcutaneous adipose tissue. In 6 out of 67 cases of HS (8.9�20AUS showed an anal fistula coexisting with the HS. In 2 cases (2.9�20a skin malignancy coexisting with HS was found.Discussion:TPUS is an accessible imaging method, which confirms the typical localization of changes of HS, and together with AUS it allows for the proper differentiation of HS from an anal fistula or an abscess.

  9. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome (United States)


    Introduction Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is characterized by features other than increased pulmonary vascular permeability. Pulmonary vascular permeability combined with increased extravascular lung water content has been considered a quantitative diagnostic criterion of ALI/ARDS. This prospective, multi-institutional, observational study aimed to clarify the clinical pathophysiological features of ALI/ARDS and establish its quantitative diagnostic criteria. Methods The extravascular lung water index (EVLWI) and the pulmonary vascular permeability index (PVPI) were measured using the transpulmonary thermodilution method in 266 patients with PaO2/FiO2 ratio ≤ 300 mmHg and bilateral infiltration on chest radiography, in 23 ICUs of academic tertiary referral hospitals. Pulmonary edema was defined as EVLWI ≥ 10 ml/kg. Three experts retrospectively determined the pathophysiological features of respiratory insufficiency by considering the patients' history, clinical presentation, chest computed tomography and radiography, echocardiography, EVLWI and brain natriuretic peptide level, and the time course of all preceding findings under systemic and respiratory therapy. Results Patients were divided into the following three categories on the basis of the pathophysiological diagnostic differentiation of respiratory insufficiency: ALI/ARDS, cardiogenic edema, and pleural effusion with atelectasis, which were noted in 207 patients, 26 patients, and 33 patients, respectively. EVLWI was greater in ALI/ARDS and cardiogenic edema patients than in patients with pleural effusion with atelectasis (18.5 ± 6.8, 14.4 ± 4.0, and 8.3 ± 2.1, respectively; P edema or pleural effusion with atelectasis patients (3.2 ± 1.4, 2.0 ± 0.8, and 1.6 ± 0.5; P edema patients. A PVPI value of 2.6 to 2.85 provided a definitive diagnosis of ALI/ARDS (specificity, 0.90 to 0.95), and a value < 1.7 ruled out an ALI/ARDS diagnosis (specificity, 0.95). Conclusion

  10. [Advances in the diagnostics of Alzheimer's disease]. (United States)

    Fiedler, U; Wiltfang, J; Peters, N; Benninghoff, J


    Due to the demographic developments, diagnosis and treatment, dementia constitutes an increasing medical challenge and is likely to have an increasing socioeconomic impact. Dementia does not reflect a single disease but encompasses a variety of underlying conditions, heterogeneous clinical courses and therapeutic approaches, among which Alzheimer's disease represents the most common cause. Therefore, a thorough differential diagnosis of dementia is of major importance. To date the current diagnosis of dementia according to ICD-10/DMS-IV is based on clinical criteria. In addition, the concept of mild cognitive impairment comprises early cognitive dysfunction without clinically apparent dementia. Alzheimer's disease is more and more conceptualized as a disease continuum with mild cognitive impairment as an early and manifest dementia as the later stage of the disease. This review gives an overview on the current diagnostic approaches and the proposed revisions of diagnostic and research criteria for Alzheimer's disease.

  11. Diagnostic imaging work-up for disease relapse after radical treatment for prostate cancer: how to differentiate local from systemic disease? The urologist point of view. (United States)

    Schiavina, R; Brunocilla, E; Borghesi, M; Vagnoni, V; Castellucci, P; Nanni, C; Ceci, F; Gacci, M; Martorana, G; Fanti, S


    About 40% of all patients undergoing radical treatment for localized prostate cancer (PCa) develop biochemical relapse (BCR) during lifetime but only 10-20% of them will show clinically detectable recurrences. Prostatic bed, pelvic or retroperitoneal lymph nodes (LN) and bones (especially the spine) are the sites where we must focus our attention in the early phase of PSA relapse. Time to PSA relapse, PSA kinetics, pathological Gleason score and pathological stage are the main factors related to the likelihood of local vs. distant relapse. Before an extensive diagnostic work-up in patients with BCR, is mandatory to understand if there is a therapeutic consequence or not for the patient. Current imaging techniques have some potential but many limits are yet encountered in the diagnosis of disease relapse. Transrectal ultrasound (TRUS) and Multiparametric Magnetic Resonance Imaging (MRI) have low accuracy in the detection of the recurrence. Today, Choline PET/CT may visualize the site of recurrence earlier, with better accuracy than conventional imaging, in a single step and even in the presence of low PSA level. In recent years, the new radiotracer (18)F-FACBC has been proposed as a possible alternative radiopharmaceutical to detect PCa relapse. From a clinical point of view, first clinical studies showed very promising and reproducible results with an improvement in sensitivity is about 20-25% with respect to Choline PET/CT, rendering the FACBC the possible radiotracer of the future for PCa. In conclusion, many improvements have been recently achieved in imaging techniques for PCa restaging, essentially in Nuclear Medicine and MRI, but negative results remain in many cases. Low sensitivity, costs, availability of technologies and confirmation of the results remain the major limitations in most cases.

  12. Diagnostic capabilities of I-131, TI-201, and Tc-99m-MIBI scintigraphy for metastatic differentiated thyroid carcinoma after total thyroidectomy.

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    Full Text Available

    We investigated the diagnostic capabilities of I-131, Tl-201, and Tc-99m-MIBI (hexakis-2-methoxyisobutyl- isonitrile scintigraphy for thyroid cancer metastases after total thyroidectomy over the entire body and for every locus before and after thyroid bed ablation. After total thyroidectomy of thyroid cancer, 36 cases were subjected to I-131 treatment 64 times. They consisted of 17 men and 19 women with 31 papillary carcinomas and 5 follicular carcinomas. Their ages were 22--75(an average of 60.5+/-12.3 years. I-131 scintigraphy(I-131, Tl-201 scintigraphy(Tl-201, and Tc-99m- MIBI scintigraphy (Tc-99m-MIBI were performed. We defined the metastases as those cases in which serum thyroglobulin (Tgincreased significantly or in which we were able to prove the lesions on CT (computed tomography, MRI (magnetic resonance imaging or bone scintigram. Three radiology medical specialists visually evaluated each scintigram and calculated the sensitivity, specificity, and likelihood ratio. For whole-body sensitivity, both Tl-201 and Tc-99m-MIBI were high before ablation and I-131 was high after ablation. Before ablation, the negative likelihood ratio was less than 0.1 for Tl-201 and Tc-99m-MIBI, while the positive likelihood ratio was more than 10 for Tl-201. After ablation, the positive likelihood ratio for I-131, Tl-201, and Tc-99m-MIBI was more than 10. The sensitivity of the mediastinum was appropriate, except for I-131 before ablation, and the sensitivity of the lung before and after ablation was inferior for either tracer. The specificity of the cervix for I-131 before ablation was markedly deteriorated, but it increased after ablation.


    Directory of Open Access Journals (Sweden)

    O. V. Blagova


    Full Text Available PAim. To develop a comprehensive clinical and morphological approach to the nosological diagnosis and treatment of "idiopathic" arrhythmias (IA and the syndrome of dilated cardiomyopathy (DCM.Material and methods. Patients (n=320 with IA (n=190; 117 women, age 45.3±14.8 years and DCM (n=130, 41 women, age 46.9±12.5 years were included in the main group. 51 people (patients with ischemic heart disease; heart valve disease, hypertrophic cardiomyopathy, who underwent open-heart surgery; healthy volunteers were included in the control group. Along with the standard tests evaluation of the level of anti-heart antibodies (185 patients with IA and 122 with DCM, viral serology (166 and 122, multispiral computed tomography (42 and 88, cardiac magnetic resonance imaging (41 and 22, coronary angiography (19 and 54, myocardial biopsy/autopsy (19/0 and 33/9 were performed.Results. According to morphological study infectious-immune myocarditis was found in 78.9% of IA and 66.7% of DCM-patients, arrhythmogenic right ventricular dysplasia in 5.3% and 4.8% of patients, respectively. Other genetic cardiomyopathies, including combination with myocarditis were revealed in other patients. The frequency  of the viral genome detection in the myocardium in IA, DCM and the control group was 17.6%, 66.7% and 77.1%, respectively. However in the control group the incidence of myocarditis and anti-heart antibodies titers were significantly lower, while in the main group a strong correlation between myocarditis and anti-heart antibodies titers was found. The algorithm of noninvasive nosological diagnostics was developed; it allowed to verify diagnosis in 95% of IA patients and 89% DCM patients.Conclusion. Nosological cause of IA and DCM syndrome can be diagnosed in most patients by using an integrated clinical and morphological approach.


    Directory of Open Access Journals (Sweden)

    O. V. Blagova


    Full Text Available PAim. To develop a comprehensive clinical and morphological approach to the nosological diagnosis and treatment of "idiopathic" arrhythmias (IA and the syndrome of dilated cardiomyopathy (DCM.Material and methods. Patients (n=320 with IA (n=190; 117 women, age 45.3±14.8 years and DCM (n=130, 41 women, age 46.9±12.5 years were included in the main group. 51 people (patients with ischemic heart disease; heart valve disease, hypertrophic cardiomyopathy, who underwent open-heart surgery; healthy volunteers were included in the control group. Along with the standard tests evaluation of the level of anti-heart antibodies (185 patients with IA and 122 with DCM, viral serology (166 and 122, multispiral computed tomography (42 and 88, cardiac magnetic resonance imaging (41 and 22, coronary angiography (19 and 54, myocardial biopsy/autopsy (19/0 and 33/9 were performed.Results. According to morphological study infectious-immune myocarditis was found in 78.9% of IA and 66.7% of DCM-patients, arrhythmogenic right ventricular dysplasia in 5.3% and 4.8% of patients, respectively. Other genetic cardiomyopathies, including combination with myocarditis were revealed in other patients. The frequency  of the viral genome detection in the myocardium in IA, DCM and the control group was 17.6%, 66.7% and 77.1%, respectively. However in the control group the incidence of myocarditis and anti-heart antibodies titers were significantly lower, while in the main group a strong correlation between myocarditis and anti-heart antibodies titers was found. The algorithm of noninvasive nosological diagnostics was developed; it allowed to verify diagnosis in 95% of IA patients and 89% DCM patients.Conclusion. Nosological cause of IA and DCM syndrome can be diagnosed in most patients by using an integrated clinical and morphological approach.

  15. Diagnostic examination performance by using microvascular leakage, cerebral blood volume, and blood flow derived from 3-T dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging in the differentiation of glioblastoma multiforme and brain metastasis

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    Server, Andres; Nakstad, Per H. [Oslo University Hospital-Ullevaal, Section of Neuroradiology, Department of Radiology and Nuclear Medicine, Oslo (Norway); University of Oslo, Oslo (Norway); Orheim, Tone E.D. [Oslo University Hospital, Interventional Centre, Oslo (Norway); Graff, Bjoern A. [Oslo University Hospital-Ullevaal, Department of Radiology and Nuclear Medicine, Oslo (Norway); Josefsen, Roger [Oslo University Hospital-Ullevaal, Department of Neurosurgery, Oslo (Norway); Kumar, Theresa [Oslo University Hospital-Ullevaal, Department of Pathology, Oslo (Norway)


    Conventional magnetic resonance (MR) imaging has limited capacity to differentiate between glioblastoma multiforme (GBM) and metastasis. The purposes of this study were: (1) to compare microvascular leakage (MVL), cerebral blood volume (CBV), and blood flow (CBF) in the distinction of metastasis from GBM using dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC-MRI), and (2) to estimate the diagnostic accuracy of perfusion and permeability MR imaging. A prospective study of 61 patients (40 GBMs and 21 metastases) was performed at 3 T using DSC-MRI. Normalized rCBV and rCBF from tumoral (rCBVt, rCBFt), peri-enhancing region (rCBVe, rCBFe), and by dividing the value in the tumor by the value in the peri-enhancing region (rCBVt/e, rCBFt/e), as well as MVL were calculated. Hemodynamic and histopathologic variables were analyzed statistically and Spearman/Pearson correlations. Receiver operating characteristic curve analysis was performed for each of the variables. The rCBVe, rCBFe, and MVL were significantly greater in GBMs compared with those of metastases. The optimal cutoff value for differentiating GBM from metastasis was 0.80 which implies a sensitivity of 95%, a specificity of 92%, a positive predictive value of 86%, and a negative predictive value of 97% for rCBVe ratio. We found a modest correlation between rCBVt and rCBFt ratios. MVL measurements in GBMs are significantly higher than those in metastases. Statistically, both rCBVe, rCBVt/e and rCBFe, rCBFt/e were useful in differentiating between GBMs and metastases, supporting the hypothesis that perfusion MR imaging can detect infiltration of tumor cells in the peri-enhancing region. (orig.)

  16. Diagnostic Value of Diffusion-weighted Imaging and Apparent Diffusion Coefficient Values in the Differentiation of Breast Lesions, Histpathologic Subgroups and Correlatıon with Prognostıc Factors using 3.0 Tesla MR (United States)

    Akın, Yasin; Uğurlu, M. Ümit; Kaya, Handan; Arıbal, Erkin


    Objective The aim of this study was to evaluate the effect of the apparent diffusion coefficient (ADC) and diffusion-weighted imaging in differentiating benign from malignant breast lesions, histopathologic subtypes of breast tumors, and to find a correlation with prognostic factors using 3T MR. Materials and Methods A total of 165 patients aged between 16 and 78 years with 181 histopathologically-verifed breast lesions were enrolled in this study. A 3T MR system and bilateral phased array breast coil was used. Diffusion-weighted imaging was performed with spin echo “echo planar” with “b” values: 50, 400, and 800 seconds/mm2. ADC values were calculated for normal fibroglandular tissue and breast lesions. ADC values of independent groups were compared using Student’s t-test. ROC analysis was used to find a threshold ADC value in the differentiation of lesions. Results The mean ADC values were 1.35±0.16 × 10−3 mm2/s for normal fibroglandular tissue, 1.41±0.24 × 10−3 mm2/s for benign breast lesions and 0.83±0.19 × 10−3 mm2/s for malignant breast lesions. The AUC with ROC analysis was 0.945 and the threshold for ADC was 1.08 × 10−3 mm2/s with a sensitivity and specificity of 92% and 92%, respectively. The threshold value for ADC ratio was 0.9 with 96% sensitivity and 89% specificity. The mean ADC of malignant breast lesions was statistically lower for benign lesions (p<0.01). We found no correlation between the mean ADC values and ER-PR receptor, Her2, and Ki-67 values. Conclusion Diffusion-weighted imaging has high diagnostic value with high sensitivity and specificity in differentiating malignant and benign breast lesions.

  17. Abdome agudo: ruptura espontânea de bexiga como um importante diagnóstico diferencial Acute abdomen: spontaneous bladder rupture as an important differential diagnosis

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Gomes


    Full Text Available A case of spontaneous perforation of the bladder in a diabetic female patient is reported. It is a rare clinical condition, that should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumor in the bladder. A general surgeon should be aware of this possibility in the differential diagnosis of an acute abdomen.

  18. Receptor for advanced glycation end products plays a more important role in cellular survival than in neurite outgrowth during retinoic acid-induced differentiation of neuroblastoma cells. (United States)

    Sajithlal, Gangadharan; Huttunen, Henri; Rauvala, Heikki; Munch, Gerald


    The receptor for advanced glycation end products (RAGE), a member of the immunoglobulin superfamily, is known to interact with amphoterin. This interaction has been proposed to play a role in neurite outgrowth and process elongation during neurodifferentiation. However, there is as yet no direct evidence of the relevance of this pathway to neurodifferentiation under physiological conditions. In this study we have investigated a possible role of RAGE and amphoterin in the retinoic acid-induced differentiation of neuroblastoma cells. The functional inactivation of RAGE by dominant negative and antisense strategies showed that RAGE is not required for process outgrowth or differentiation, although overexpression of RAGE accelerates the elongation of neuritic processes. Using the antisense strategy, amphoterin was shown to be essential for process outgrowth and differentiation, suggesting that amphoterin may interact with other molecules to exert its effect in this context. Interestingly, the survival of the neuroblastoma cells treated with retinoic acid was partly dependent on the expression of RAGE, and inhibition of RAGE function partially blocked the increase in anti-apoptotic protein Bcl-2 following retinoic acid treatment. Based on these results we propose that a combination therapy using RAGE blockers and retinoic acid may prove as a useful approach for chemotherapy for the treatment of neuroblastoma.

  19. Random forest to differentiate dementia with Lewy bodies from Alzheimer's disease. (United States)

    Dauwan, Meenakshi; van der Zande, Jessica J; van Dellen, Edwin; Sommer, Iris E C; Scheltens, Philip; Lemstra, Afina W; Stam, Cornelis J


    The aim of this study was to build a random forest classifier to improve the diagnostic accuracy in differentiating dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) and to quantify the relevance of multimodal diagnostic measures, with a focus on electroencephalography (EEG). A total of 66 DLB, 66 AD patients, and 66 controls were selected from the Amsterdam Dementia Cohort. Quantitative EEG (qEEG) measures were combined with clinical, neuropsychological, visual EEG, neuroimaging, and cerebrospinal fluid data. Variable importance scores were calculated per diagnostic variable. For discrimination between DLB and AD, the diagnostic accuracy of the classifier was 87%. Beta power was identified as the single-most important discriminating variable. qEEG increased the accuracy of the other multimodal diagnostic data with almost 10%. Quantitative EEG has a higher discriminating value than the combination of the other multimodal variables in the differentiation between DLB and AD.

  20. Astrovirus Diagnostics (United States)

    Pérot, Philippe; Lecuit, Marc; Eloit, Marc


    Various methods exist to detect an astrovirus infection. Current methods include electron microscopy (EM), cell culture, immunoassays, polymerase chain reaction (PCR) and various other molecular approaches that can be applied in the context of diagnostic or in surveillance studies. With the advent of metagenomics, novel human astrovirus (HAstV) strains have been found in immunocompromised individuals in association with central nervous system (CNS) infections. This work reviews the past and current methods for astrovirus detection and their uses in both research laboratories and for medical diagnostic purposes. PMID:28085120

  1. [Diagnostics in osteology]. (United States)

    Jakob, F; Genest, F; Seefried, L; Tsourdi, E; Lapa, C; Hofbauer, L C


    Clinical diagnostics in metabolic bone diseases cover a broad spectrum of conventional and state of the art methods ranging from the medical history and clinical examination to molecular imaging. Patient treatment is carried out in an interdisciplinary team due to the multiple interactions of bone with other organ systems. Diagnosis of osteoporosis is supported by high level national guidelines. A paradigm shift concerning the clinical relevance of bone mineral density measurement renders this now to be a strong risk factor rather than a diagnostic parameter, while strengthening the value of other clinical factors for risk assessment. The impact of parameters for muscle mass, structure and function is steadily increasing in all age groups. In order to identify underlying diseases that influence bone metabolism a panel of general laboratory diagnostic parameters is recommended. Markers for bone formation and resorption and specific parameters for the regulation of calcium and phosphate metabolism should be evaluated by specialists because they require diligence in preanalytics and experience in interpretation. Genetic diagnosis is well established for rare bone diseases while diagnostic panels are not yet available for routine diagnostics in polygenetic diseases such as osteoporosis. Conventional radiology is still very important to identify, e. g. fractures, osteolytic and osteoblastic lesions and extraosseous calcifications; however tomography-based methods which combine, e. g. scintigraphy or positron emission technologies with anatomical imaging are of increasing significance. Clinical diagnostics in osteology require profound knowledge and are subject to a dynamic evolution.

  2. The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part II: Diagnostic value of BIRADS-US classification, Tsukuba score and FLR ratio

    Directory of Open Access Journals (Sweden)

    Katarzyna Dobruch-Sobczak


    Full Text Available Sonoelastography is a dynamically developing method of ultrasound examination used to differentiate the character of focal lesions in the breasts. The aim of the Part II of the study is to determine the usefulness of sonoelastography in the differentiation diagnosis of focal breast lesions including the evaluation of the diagnostic value of Tsukuba score and FLR ratio in characterizing solid lesions in the breasts. Furthermore, the paper provides a comparison of classic B-mode imaging and sonoelastography. Material and methods: From January to July 2010 in the Ultrasound Department of the Cancer Centre, The Institute of Maria Skłodowska-Curie, 375 breast ultrasound examinations were conducted. The examined group included patients who in B-mode examinations presented indications for pathological verification. They were 80 women aged between 17 and 83 (mean age was 50 with 99 solid focal lesions in the breasts. All patients underwent: the interview, physical examination, B-mode ultrasound examination and elastography of the mammary glands and axillary fossae. The visualized lesions were evaluated according to BIRADS-US classification and Tsukuba score as well as FLR ratio was calculated. In all cases, the histopathological and/or cytological verification of the tested lesions was obtained. Results: In the group of 80 patients, the examination revealed 39 malignant neoplastic lesions and 60 benign ones. The mean age of women with malignant neoplasms was 55.07 (SD=10.54, and with benign lesions – 46.9 (SD=15.47. In order to identify threshold values that distinguish benign lesions from malignant ones, a comparative analysis of statistical models based on BIRADS-US classification and Tsukuba score was conducted and the cut-off value for FLR was assumed. The sensitivity and specificity values for BIRADS-US 4/5 were 76.92% and 96.67% and for Tsukuba 3/4 – 64.1% and 98.33% respectively. The assumed FLR threshold value to differentiate between

  3. Differential methylation status of IGF2-H19 locus does not affect the fertility of crossbred bulls but some of the CTCF binding sites could be potentially important. (United States)

    Jena, Subas C; Kumar, Sandeep; Rajput, Sandeep; Roy, Bhaskar; Verma, Arpana; Kumaresan, Arumugam; Mohanty, Tushar K; De, Sachinandan; Kumar, Rakesh; Datta, Tirtha K


    Associations between abnormal methylation of spermatozoan DNA with male infertility have been sought in recent years to identify a molecular explanation of differential spermatozoan function. The present work was undertaken to investigate the methylation profile of differentially methylated regions (DMRs) in the IGF2-H19 locus of Bos taurus X Bos indicus crossbred bull spermatozoa. Bulls having more than at least 100 insemination records over a period of 12 years were classified into two groups of five bulls each belonging to low- and high-fertility groups. The IGF2 and H19 DMR sequences in B. indicus cattle were observed to be in absolute homology with B. taurus cattle. The DNA of crossbred bull spermatozoa was isolated, bisulfite treated, and amplified for specific DMR regions using methylation-change-specific primers. The overall degree of methylation at IGF2-H19 DMRs was not found to be significantly different among two groups of bulls. The sixth CTCF binding site (CCCTC) identified in H19 DMR, however, had a significant methylation difference between the high- and low-fertility bulls. It was concluded that alteration of the methylation levels at IGF2-H19 DMRs might not be responsible for the fertility difference of crossbred bulls, although the role played by the specific CTCF binding sites at this locus, which could influence IGF2 expression during spermatogenesis and early embryonic development, deserves further attention.

  4. Spontaneously differentiated GATA6-positive human embryonic stem cells represent an important cellular step in human embryonic development; they are not just an artifact of in vitro culture. (United States)

    Lee, Jun Ho; Hong, Ki Sung; Mantel, Charlie; Broxmeyer, Hal E; Lee, Man Ryul; Kim, Kye-Seong


    In this study, we isolated and characterized spontaneously differentiated human embryonic stem cells (SD-hESCs) found in hESC colonies in comparison to the morphologically premature ESCs in the colonies to investigate the potential role of SD-hESCs in embryogenesis. SD-hESCs were distinguished from undifferentiated hESCs by their higher expression of GATA6, a marker for primitive endoderm and transthyretin, a marker visceral endoderm in embryoid bodies (EBs). SD-hESCs expressed OCT4 and NANOG, markers for pluripotent stem cells, at significantly lower levels than undifferentiated hESCs. EBs derived from isolated SD-hESCs were morphologically distinct from cells directly derived from the undifferentiated hESCs; they contained higher number of cysts compared to EBs from undifferentiated hESC-derived EBs (42% vs. 20%). Furthermore, the extracellular signal molecule, BMP2/4, induced a higher GATA4/6 expression and cystic EB formation than control and noggin-treated EBs. Since cystic formation in EBs play a role in primitive endoderm formation during embryogenesis, the SD-hESC may be a relevant cell type equipped to differentiate into primitive endoderm. Our results suggest that SD-ESCs generated during routine hESC culture are not just an artifact of in vitro culture and these cells could serve as a useful model to study the process of embryogenesis.

  5. miRNA-17 members that target Bmpr2 influence signaling mechanisms important for embryonic stem cell differentiation in vitro and gastrulation in embryos. (United States)

    Larabee, Shannon M; Coia, Heidi; Jones, Shiloh; Cheung, Eric; Gallicano, G Ian


    Body axes and germ layers evolve at gastrulation, and in mammals are driven by many genes; however, what orchestrates the genetic pathways during gastrulation remains elusive. Previously, we presented evidence that microRNA-17 (miRNA-17) family members, miR-17-5p, miR-20a, miR-93, and miR-106a were differentially expressed in mouse embryos and functioned to control differentiation of the stem cell population. Here, we identify function(s) that these miRNAs have during gastrulation. Fluorescent in situ hybridization miRNA probes reveal that these miRNAs are localized at the mid/posterior primitive streak (ps) in distinct populations of primitive ectoderm, mesendoderm, and mesoderm. Seven different miRNA prediction algorithms are identified in silico bone morphogenic protein receptor 2 (Bmpr2) as a target of these miRNAs. Bmpr2 is a member of the TGFβ pathway and invokes stage-specific changes during gastrulation. Recently, Bmpr2 was shown regulating cytoskeletal dynamics, cell movement, and invasion. Our previous and current data led to a hypothesis by which members of the miR-17 family influence gastrulation by suppressing Bmpr2 expression at the primitive streak. This suppression influences fate decisions of cells by affecting genes downstream of BMPR2 as well as mesoderm invasion through regulation of actin dynamics.

  6. Genome-wide study reveals an important role of spontaneous autoimmunity, cardiomyocyte differentiation defect and antiangiogenic activities in gender-specific gene expression in Keshan disease

    Institute of Scientific and Technical Information of China (English)

    He Shulan; Tan Wuhong; Wang Sen; Wu Cuiyan; Wang Pan; Wang Bin; Su Xiaohui


    Background Keshan disease (KD) is an endemic cardiomyopathy in China.The etiology of KD is still under debate and there is no effective approach to preventing and curing this disease.Young women of child-bearing age are the most frequent victims in rural areas.The aim of this study was to determine the differences between molecular pathogenic mechanisms in male and female KD sufferers.Methods We extracted RNA from the peripheral blood mononuclear cells of KD patients (12 women and 4 men) and controls (12 women and 4 men).Then the isolated RNA was amplified,labeled and hybridized to Agilent human 4×44k whole genome microarrays.Gene expression was examined using oligonucleotide microarray analysis.A quantitative polymerase chain reaction assay was also performed to validate our microarray results.Results Among the genes differentially expressed in female KD patients we identified:HLA-DOA,HLA-DRA,and HLA-DQA1 associated with spontaneous autoimmunity; BMP5 and BMP7,involved in cardiomyocyte differentiation defect; and ADAMTS 8,CCL23,and TNFSF15,implicated in anti-angiogenic activities.These genes are involved in the canonical pathways and networks recognized for the female KD sufferers and might be related to the pathogenic mechanism of KD.Conclusion Our results might help to explain the higher susceptibility of women to this disease.

  7. [Acute psychosis as a side effect of efavirenz therapy with metabolic anomalies: an important differential diagnosis of HIV-associated psychoses]. (United States)

    Hinsch, M C; Reichelt, D; Husstedt, I W


    Among patients with human immunodeficiency virus (HIV) infections psychiatric disease poses a particular challenge for caregivers. Neuropsychiatric side effects of efavirenz have been described in up to 40% of patients showing dizziness, insomnia, unusual dreams, mood instability, personality alterations and thought disorders. In immigrants from Africa and South America these side effects may be related to elevated plasma concentrations of efavirenz due to polymorphisms of cytochrome P450 isozymes (especially G516T). Alleles for these polymorphisms are more frequent in African and South American patients. We report a case of a 52-year-old patient from Guinea who was referred to the department of neurology under the diagnosis of HIV-associated neurocognitive disorder (HAND). Since the start of combined antiretroviral therapy (cART) including efavirenz the patient had suffered severe personality alterations, acoustic and visual hallucinations and delusions which led to discrimination and reduced quality of life. Diagnostic procedures including magnetic resonance imaging (MRT) and spinal fluid analysis resulted in normal values and did not explain the disease. After switching to nevirapin instead of efavirenz the psychotic symptoms disappeared within 5 days.

  8. MJO Simulation Diagnostics

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    Waliser, D; Sperber, K; Hendon, H; Kim, D; Maloney, E; Wheeler, M; Weickmann, K; Zhang, C; Donner, L; Gottschalck, J; Higgins, W; Kang, I; Legler, D; Moncrieff, M; Schubert, S; Stern, W; Vitart, F; Wang, B; Wang, W; Woolnough, S


    The Madden-Julian Oscillation (MJO) interacts with, and influences, a wide range of weather and climate phenomena (e.g., monsoons, ENSO, tropical storms, mid-latitude weather), and represents an important, and as yet unexploited, source of predictability at the subseasonal time scale. Despite the important role of the MJO in our climate and weather systems, current global circulation models (GCMs) exhibit considerable shortcomings in representing this phenomenon. These shortcomings have been documented in a number of multi-model comparison studies over the last decade. However, diagnosis of model performance has been challenging, and model progress has been difficult to track, due to the lack of a coherent and standardized set of MJO diagnostics. One of the chief objectives of the US CLIVAR MJO Working Group is the development of observation-based diagnostics for objectively evaluating global model simulations of the MJO in a consistent framework. Motivation for this activity is reviewed, and the intent and justification for a set of diagnostics is provided, along with specification for their calculation, and illustrations of their application. The diagnostics range from relatively simple analyses of variance and correlation, to more sophisticated space-time spectral and empirical orthogonal function analyses. These diagnostic techniques are used to detect MJO signals, to construct composite life-cycles, to identify associations of MJO activity with the mean state, and to describe interannual variability of the MJO.

  9. An important role for adenine, cholera toxin, hydrocortisone and triiodothyronine in the proliferation, self-renewal and differentiation of limbal stem cells in vitro. (United States)

    Yu, Min; Bojic, Sanja; Figueiredo, Gustavo S; Rooney, Paul; de Havilland, Julian; Dickinson, Anne; Figueiredo, Francisco C; Lako, Majlinda


    The cornea is a self-renewing tissue located at the front of the eye. Its transparency is essential for allowing light to focus onto the retina for visual perception. The continuous renewal of corneal epithelium is supported by limbal stem cells (LSCs) which are located in the border region between conjunctiva and cornea known as the limbus. Ex vivo expansion of LSCs has been successfully applied in the last two decades to treat patients with limbal stem cell deficiency (LSCD). Various methods have been used for their expansion, yet the most widely used culture media contains a number of ingredients derived from animal sources which may compromise the safety profile of human LSC transplantation. In this study we sought to understand the role of these components namely adenine, cholera toxin, hydrocortisone and triiodothyronine with the aim of re-defining a safe and GMP compatible minimal media for the ex vivo expansion of LSCs on human amniotic membrane. Our data suggest that all four components play a critical role in maintaining LSC proliferation and promoting LSC self-renewal. However removal of adenine and triiodothyronine had a more profound impact and led to LSC differentiation and loss of viability respectively, suggesting their essential role for ex vivo expansion of LSCs. Replacement of each of the components with GMP-grade reagents resulted in equal growth to non-GMP grade media, however an enhanced differentiation of LSCs was observed, suggesting that additional combinations of GMP grade reagents need to be tested to achieve similar or better level of LSC maintenance in the same manner as the traditional LSC media.

  10. Phlegmonous gastritis: A rare entity as a differential diagnostic of an acute abdomen. Description of a case and a bibliographic review. (United States)

    Rada-Palomino, Arantzazu; Muñoz-Duyos, Arantxa; Pérez-Romero, Noelia; Vargas-Pierola, Harold; Puértolas-Rico, Noelia; Ruiz-Campos, Laura; Espinós-Pérez, Jorge; Veloso-Veloso, Enrique


    Phlegmonous gastritis is a rare bacterial infection of the gastric wall, which progress rapidly. It is characterized by a purulent inflammation that can affect the entire gastrointestinal tract and presents a high mortality rate. We are reporting a case of phlegmonous gastritis in an HIV-seropositive man successfully treated with antibiotics. Moreover, a review of the English andSpanish literature is carried out, from 1980 to the present time.The most frequently involved microorganism is Streptococcus spp. (57 %), but the polimicrobial infection is also frequent (17 %). The most important symptom is the intensive epigastric pain associated with vomits and most cases were diagnosed by CT and/or fibrogastroscopy. There are many existing risk factors described.The main one is the immunesuppression, although in 40 % of the cases no risk factors were identified. The global mortality is 27 % without identifying significant differences between antibiotics and surgical treatment, for that reason it is recommended to initiate antibiotic treatment right from the beginning and postponing surgery for the refractory cases and complications.

  11. Phlegmonous gastritis: a rare entity as a differential diagnostic of an acute abdomen. Description of a case and a bibliographic review

    Directory of Open Access Journals (Sweden)

    Arantzazu Rada-Palomino


    Full Text Available Phlegmonous gastritis is a rare bacterial infection of the gastric wall, which progress rapidly. It is characterized by a purulent inflammation that can affect the entire gastrointestinal tract and presents a high mortality rate. We are reporting a case of phlegmonous gastritis in an HIV-seropositive man successfully treated with antibiotics. Moreover, a review of the English and Spanish literature is carried out, from 1980 to the present time. The most frequently involved microorganism is Streptococcus spp. (57 %, but the polimicrobial infection is also frequent (17 %. The most important symptom is the intensive epigastric pain associated with vomits and most cases were diagnosed by CT and/or fibrogastroscopy. There are many existing risk factors described. The main one is the immunesuppression, although in 40 % of the cases no risk factors were identified. The global mortality is 27 % without identifying significant differences between antibiotics and surgical treatment, for that reason it is recommended to initiate antibiotic treatment right from the beginning and postponing surgery for the refractory cases and complications.

  12. Diagnostic value of 18 FDG-PET/CT for poorly differentiated gastric adenocarcinoma%18 F-脱氧葡萄糖 PET/CT 对低分化胃腺癌的诊断价值

    Institute of Scientific and Technical Information of China (English)

    刘凯; 邹丹丹; 李琼; 贺琦; 刘士远


    Objective The sensitivity and specificity of 18 FDG PET/CT are poor in the diagnosis of gastric cancer .Gastric signet ring cell carcinoma and Mucinous gastric carcinoma is known to have low fluorodeoxyglucose (18FDG) uptake,but not known for poorly differentiated gastric adenocarcinoma .This study was to investigate the value of 18 FDG PET/CT in the diagnosis of poorly differ-entiated gastric adenocarcinoma . Methods We retrospectively analyzed the results of 18 FDG PET/CT of 34 cases of histologically confirmed poorly differentiated gastric adenocarcinoma .We recorded the volume , location , and gastric wall invasion depth , and maxi-mum standardized uptake value ( SUVmax) of the tumors and analyzed the relationship of 18 FDG uptake with the clinicopathologic pa-rameters. Results By 18 FDG-PET/CT, poorly differentiated gastric adenocarcinoma was diagnosed in only 67.6% of the patients (23/34).SUVmax was found to be significantly correlated with age , gastric wall invasion, and tumor size (P0 .05 ) .Logistic regression a-nalysis showed the tumor size to be the sole factor influencing the 18 FDG uptake of poorly differentiated gastric adenocarcinoma ( OR=0.37, 95%CI 0.154-0.920, P=0.03). Conclusion The di-agnostic value of 18 FDG-PET/CT is but limited for poorly differentia-ted gastric adenocarcinoma , and attention should be paid to its false-negative results .%目的:18 F-脱氧葡萄糖(18 F fluorodeoxyglucose ,18 FDG) PET/CT对胃癌的诊断敏感性及特异性不佳。文中旨在探讨18 F PET/CT对低分化胃腺癌的诊断价值。方法回顾性分析第二军医大学附属长征医院2012年4月至2014年7月经手术或胃镜病理证实为低分化胃腺癌的34例患者18 FDG PET/CT征象,记录肿瘤大小、位置、胃壁浸润深度及最大标准摄取值( maximum standardized uptake values , SUVmax)。分析18 FDG摄取阳性与各个临床病理参数关系。结果34例患者低分化胃腺癌诊断阳性率仅为67

  13. Diagnostic Criteria for Pediatric MS

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available Investigators at Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago review the diagnostic criteria for pediatric multiple sclerosis, the differential diagnosis, the 2010 McDonald criteria, and Callen criteria.

  14. [Differential diagnostics of neuroinfections: Lyme disease]. (United States)

    Lobanchenko, O V; Khlyzova, I A; Zholdoshev, K Zh


    In the article the clinical case of development of arthritis is examined for a patient with Laymborreliozom, exposed on territory of Kyrgyzstan. It is well-proven that a chronic flow can flow continuously and with relapses. The compatible clinical and serum criteria of diagnosis of illness are not developed. It is needed to take into account at interpretation of results of tests, that level of antiborrelioznykh antibodies, and frequency of exposure depend on the terms of inspection, beginning of therapy and stage of illness. Along with antibiotikoterapiey nosotropic treatment which consists in setting of nesteroidnykh protivovospalitel'nykh facilities and at a necessity glyukokortikoidov is used. Choice of preparations and dose depend on clinical displays and weight of flow.

  15. Differential diagnosis of hyponatraemia.

    LENUS (Irish Health Repository)

    Thompson, Chris


    The appropriate management of hyponatraemia is reliant on the accurate identification of the underlying cause of the hyponatraemia. In the light of evidence which has shown that the use of a clinical algorithm appears to improve accuracy in the differential diagnosis of hyponatraemia, the European Hyponatraemia Network considered the use of two algorithms. One was developed from a nephrologist\\'s view of hyponatraemia, while the other reflected the approach of an endocrinologist. Both of these algorithms concurred on the importance of assessing effective blood volume status and the measurement of urine sodium concentration in the diagnostic process. To demonstrate the importance of accurate diagnosis to the correct treatment of hyponatraemia, special consideration was given to hyponatraemia in neurosurgical patients. The differentiation between the syndrome of inappropriate antidiuretic hormone secretion (SIADH), acute adrenocorticotropic hormone (ACTH) deficiency, fluid overload and cerebral salt-wasting syndrome was discussed. In patients with SIADH, fluid restriction has been the mainstay of treatment despite the absence of an evidence base for its use. An approach to using fluid restriction to raise serum tonicity in patients with SIADH and to identify patients who are likely to be recalcitrant to fluid restriction was also suggested.

  16. [Novel methods for dementia diagnostics]. (United States)

    Wiltfang, J


    Novel diagnostic methods, such as cerebrospinal fluid-based neurochemical dementia diagnostics (CSF-NDD) and [18F] amyloid positron emission tomography (PET) are meanwhile recommended for specific indications by international guidelines for the improved early and differential diagnostics of multigenic (sporadic) Alzheimer's dementia (AD). In the case of CSF-NDD the German neuropsychiatric guidelines have already been validated on the S3 level of evidence ( and the additional consideration of [18F] amyloid-PET in the current update of the guidelines is to be expected. By means of CSF-NDD and/or [18F] amyloid-PET a predictive diagnosis of incipient (preclinical) AD is also possible for patients at high risk for AD who are in prodromal stages, such as mild cognitive impairment (MCI). As accompanying (secondary) preventive therapy of AD cannot be offered a predictive molecular dementia diagnostics is not recommended by the German neuropsychiatric dementia guidelines ( However, novel diagnostic approaches, which offer molecular positive diagnostics of AD have already gained high relevance in therapy research as they allow promising preventive treatment avenues to be validated directly in the clinical trial. Moreover, future blood-based dementia diagnostics by means of multiplex assays is becoming increasingly more feasible; however, so far corresponding proteomic or epigenetic assays could not be consistently validated in independent studies.

  17. Clinical and morphological approaches to the differential diagnosis of diphtheric colitis

    Directory of Open Access Journals (Sweden)

    V. A. Tsinserling


    Full Text Available Inflammatory bowel diseases is a large group of nosologic forms such as more frequent acute intestinal infection, especially dysentery, chronic inflammatory diseases such as ulcerative colitis and Cron’s disease with lesions of the bowel, antibiotics-associated and ischemic colitis. There are some difficulties in differential diagnostics of inflammatory bowel diseases despite their widespread and tendency to more frequent occurrence. On the one hand, this is largely due to similar clinical picture which is most often presented by diarrhea and abdominal pain of different degree of intensity, and, on the other hand, by the disadvantages of laboratory diagnostics techniques. The article discusses the problem of clinical and morphological aspects of the differential colitis diagnostics with more detailed characteristics of fibrinous colitis of different etiology. The morphological differential diagnostics criteria, as well as a summary table of comparative characteristics of antibiotics-associated pseudomembranous colitis, dysentery, invasive candidiasis of bowel, ulcerative colitis and ischemic colitis have been presented. The importance of an integrated approach to the differential diagnostics of inflammatory bowel diseases, based on the analysis of anamnesis, clinical-laboratory and morphological data is stressed. The algorithm for optimizing of differential diagnostics of inflammatory bowel diseases with recommendations for qualitative morphological examination has been suggested. 

  18. Thyroid diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Scriba, P.C.; Boerner, W.; Emrich, S.; Gutekunst, R.; Herrmann, J.; Horn, K.; Klett, M.; Krueskemper, H.L.; Pfannenstiel, P.; Pickardt, C.R.


    None of the in-vitro and in-vivo methods listed permits on unambiguous diagnosis when applied alone, owing to the fact that similar or even identical findings are obtained for various individual parameters in different thyroid diseases. Further, especially the in-vitro tests are also subject to extrathyroidal effects which may mask the typical findings. The limited and varying specificity and sensitivity of the tests applied, as well as the falsification of results caused by the patients' idiosyncracies and the methodology, make it necessary to interpret and evaluate the in-vivo and in-vitro findings only if the clinical situation (anamnesis and physical examination) is known. For maximum diagnostic quality of the tests, the initial probability of the assumed type of thyroid disease must be increased (formulation of the clinical problem). The concepts of exclusion diagnosis and identification must be distinguished as well as the diagnosis of functional disturbances on the one hand and of thyroid diseases on the other. Both of this requires a qualified, specific and detailed anamnesis and examination procedure, and the clinical examination remains the obligatory basis of clinical diagnostics. In case of inexplicable discrepancies between the clinical manifestations and the findings obtained with specific methods, or between the findings obtained with a specific method, the patient should be referred to an expert institution, or the expert institution should be consulted.

  19. Integrated physiological, biochemical and molecular analysis identifies important traits and mechanisms associated with differential response of rice genotypes to elevated temperature

    Directory of Open Access Journals (Sweden)

    Boghireddy eSailaja


    Full Text Available In changing climate, heat stress caused by high temperature poses a serious threat to rice cultivation. A multiple organizational analysis at physiological, biochemical and molecular level is required to fully understand the impact of elevated temperature in rice. This study was aimed at deciphering the elevated temperature response in eleven popular and mega rice cultivars widely grown in India. Physiological and biochemical traits specifically membrane thermostability (MTS, antioxidants, and photosynthesis were studied at vegetative and reproductive phases which were used to establish a correlation with grain yield under stress. Several useful traits in different genotypes were identified which will be important resource to develop high temperature tolerant rice cultivars. Interestingly, Nagina22 emerged as best performer in terms of yield as well as expression of physiological and biochemical traits at elevated temperature. It showed lesser relative injury, lesser reduction in chlorophyll content, increased super oxide dismutase, catalase and peroxidase activity, lesser reduction in net photosynthetic rate (PN, high transpiration rate (E and other photosynthetic/ fluorescence parameters contributing to least reduction in spikelet fertility and grain yield at elevated temperature. Further, expression of 14 genes including heat shock transcription factors and heat shock proteins was analyzed in Nagina22 (tolerant and Vandana (susceptible at flowering phase, strengthening the fact that N22 performs better at molecular level also during elevated temperature. This study shows that elevated temperature response is complex and involves multiple biological processes which are needed to be characterized to address the challenges of future climate extreme conditions.

  20. [Differential diagnosis of hoarseness]. (United States)

    Voigt-Zimmermann, S; Lampe, K; Arens, C


    Hoarseness can be the leading symptom of dysphonia. In combination with impaired vocal performance and subjective voice-related discomfort, it can represent an individually different handicap for patients and lead to limited participation in social and professional life. Since the reasons for dysphonia may be not only functional but also organic with a potentially poor prognosis, hoarseness must be clarified using differential diagnosis. In addition to the knowledge of possible diseases, pathogenesis, and treatment options for dysphonia, the differential diagnostic approach requires profound knowledge of the various diagnostic methods, and of the interpretation of the results in particular. The etiology of dysphonia is very diverse and rarely monocausal. Therefore, a team-based and interdisciplinary differential diagnostic approach is recommended.

  1. Requirements for ITER diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Young, K.M.


    The development and design of plasma diagnostics for the International Thermonuclear Experimental Reactor (ITER) present a formidable challenge for experimental plasma physicists. The large plasma size, the high central density and temperature and the very high thermal wall loadings provide new challenges for present measurement techniques and lead to a search for new methods. But the physics and control requirements for the long burn phase of the discharge, combined with very limited access to the plasma, constrained by the requirement for radiation shielding of the coils and sharing of access ports with heating and current drive power, remote manipulation, fueling and turn blanket modules, make for very difficult design choices. An initial attempt at these choices has been made by an international team of diagnostic physicists, gathering together in a series of three workshops during the ITER Conceptual Design Activity. This paper is based on that report and provides a summary of its most important points. To provide a background against which to place the diagnostic requirements and design concepts, the ITER device, its most important plasma properties and the proposed experimental program will be described. The specifications for the measurement of the plasma parameters and the proposed diagnostics for these measurements will then be addressed, followed by some examples of the design concepts that have been proposed. As a result of these design studies, it was clear that there were many uncertainties associated with these concepts, particularly because of the nuclear radiation environment, so that a Research and Development Program for diagnostic hardware was established. It will also be briefly summarized.

  2. Rotorcraft Diagnostics (United States)

    Haste, Deepak; Azam, Mohammad; Ghoshal, Sudipto; Monte, James


    Health management (HM) in any engineering systems requires adequate understanding about the system s functioning; a sufficient amount of monitored data; the capability to extract, analyze, and collate information; and the capability to combine understanding and information for HM-related estimation and decision-making. Rotorcraft systems are, in general, highly complex. Obtaining adequate understanding about functioning of such systems is quite difficult, because of the proprietary (restricted access) nature of their designs and dynamic models. Development of an EIM (exact inverse map) solution for rotorcraft requires a process that can overcome the abovementioned difficulties and maximally utilize monitored information for HM facilitation via employing advanced analytic techniques. The goal was to develop a versatile HM solution for rotorcraft for facilitation of the Condition Based Maintenance Plus (CBM+) capabilities. The effort was geared towards developing analytic and reasoning techniques, and proving the ability to embed the required capabilities on a rotorcraft platform, paving the way for implementing the solution on an aircraft-level system for consolidation and reporting. The solution for rotorcraft can he used offboard or embedded directly onto a rotorcraft system. The envisioned solution utilizes available monitored and archived data for real-time fault detection and identification, failure precursor identification, and offline fault detection and diagnostics, health condition forecasting, optimal guided troubleshooting, and maintenance decision support. A variant of the onboard version is a self-contained hardware and software (HW+SW) package that can be embedded on rotorcraft systems. The HM solution comprises components that gather/ingest data and information, perform information/feature extraction, analyze information in conjunction with the dependency/diagnostic model of the target system, facilitate optimal guided troubleshooting, and offer

  3. Diagnostic validity across racial and ethnic groups in the assessment of adolescent DSM-IV disorders. (United States)

    Green, Jennifer Greif; Gruber, Michael J; Kessler, Ronald C; Lin, Julia Y; McLaughlin, Katie A; Sampson, Nancy A; Zaslavsky, Alan M; Alegria, Margarita


    We examine differential validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses assessed by the fully-structured Composite International Diagnostic Interview Version 3.0 (CIDI) among Latino, non-Latino Black, and non-Latino White adolescents in comparison to gold standard diagnoses derived from the Schedule for Affective Disorders and Schizophrenia for School-age Children (K-SADS). Results are based on the National Comorbidity Survey Replication Adolescent Supplement, a national US survey of adolescent mental health. Clinicians re-interviewed 347 adolescent/parent dyads with the K-SADS. Sensitivity and/or specificity of CIDI diagnoses varied significantly by ethnicity/race for four of ten disorders. Modifications to algorithms sometimes reduced bias in prevalence estimates, but at the cost of reducing individual-level concordance. These findings document the importance of assessing fully-structured diagnostic instruments for differential accuracy in ethnic/racial subgroups.

  4. Endoplasmic reticulum (ER stress inducible factor cysteine-rich with EGF-like domains 2 (Creld2 is an important mediator of BMP9-regulated osteogenic differentiation of mesenchymal stem cells.

    Directory of Open Access Journals (Sweden)

    Jiye Zhang

    Full Text Available Mesenchymal stem cells (MSCs are multipotent progenitors that can undergo osteogenic differentiation under proper stimuli. We demonstrated that BMP9 is one of the most osteogenic BMPs. However, the molecular mechanism underlying BMP9-initiated osteogenic signaling in MSCs remains unclear. Through gene expression profiling analysis we identified several candidate mediators of BMP9 osteogenic signaling. Here, we focus on one such signaling mediator and investigate the functional role of cysteine-rich with EGF-like domains 2 (Creld2 in BMP9-initiated osteogenic signaling. Creld2 was originally identified as an ER stress-inducible factor localized in the ER-Golgi apparatus. Our genomewide expression profiling analysis indicates that Creld2 is among the top up-regulated genes in BMP9-stimulated MSCs. We confirm that Creld2 is up-regulated by BMP9 in MSCs. ChIP analysis indicates that Smad1/5/8 directly binds to the Creld2 promoter in a BMP9-dependent fashion. Exogenous expression of Creld2 in MSCs potentiates BMP9-induced early and late osteogenic markers, and matrix mineralization. Conversely, silencing Creld2 expression inhibits BMP9-induced osteogenic differentiation. In vivo stem cell implantation assay reveals that exogenous Creld2 promotes BMP9-induced ectopic bone formation and matrix mineralization, whereas silencing Creld2 expression diminishes BMP9-induced bone formation and matrix mineralization. We further show that Creld2 is localized in ER and the ER stress inducers potentiate BMP9-induced osteogenic differentiation. Our results strongly suggest that Creld2 may be directly regulated by BMP9 and ER stress response may play an important role in regulating osteogenic differentiation.

  5. Differential white cell count by centrifugal microfluidics.

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, Gregory Jon; Tentori, Augusto M.; Schaff, Ulrich Y.


    We present a method for counting white blood cells that is uniquely compatible with centrifugation based microfluidics. Blood is deposited on top of one or more layers of density media within a microfluidic disk. Spinning the disk causes the cell populations within whole blood to settle through the media, reaching an equilibrium based on the density of each cell type. Separation and fluorescence measurement of cell types stained with a DNA dye is demonstrated using this technique. The integrated signal from bands of fluorescent microspheres is shown to be proportional to their initial concentration in suspension. Among the current generation of medical diagnostics are devices based on the principle of centrifuging a CD sized disk functionalized with microfluidics. These portable 'lab on a disk' devices are capable of conducting multiple assays directly from a blood sample, embodied by platforms developed by Gyros, Samsung, and Abaxis. [1,2] However, no centrifugal platform to date includes a differential white blood cell count, which is an important metric complimentary to diagnostic assays. Measuring the differential white blood cell count (the relative fraction of granulocytes, lymphocytes, and monocytes) is a standard medical diagnostic technique useful for identifying sepsis, leukemia, AIDS, radiation exposure, and a host of other conditions that affect the immune system. Several methods exist for measuring the relative white blood cell count including flow cytometry, electrical impedance, and visual identification from a stained drop of blood under a microscope. However, none of these methods is easily incorporated into a centrifugal microfluidic diagnostic platform.

  6. Psychometric properties of the motor diagnostics in the German football talent identification and development programme. (United States)

    HÖner, Oliver; Votteler, Andreas; Schmid, Markus; Schultz, Florian; Roth, Klaus


    The utilisation of motor performance tests for talent identification in youth sports is discussed intensively in talent research. This article examines the reliability, differential stability and validity of the motor diagnostics conducted nationwide by the German football talent identification and development programme and provides reference values for a standardised interpretation of the diagnostics results. Highly selected players (the top 4% of their age groups, U12-U15) took part in the diagnostics at 17 measurement points between spring 2004 and spring 2012 (N = 68,158). The heterogeneous test battery measured speed abilities and football-specific technical skills (sprint, agility, dribbling, ball control, shooting, juggling). For all measurement points, the overall score and the speed tests showed high internal consistency, high test-retest reliability and satisfying differential stability. The diagnostics demonstrated satisfying factorial-related validity with plausible and stable loadings on the two empirical factors "speed" and "technical skills". The score, and the technical skills dribbling and juggling, differentiated the most among players of different performance levels and thus showed the highest criterion-related validity. Satisfactory psychometric properties for the diagnostics are an important prerequisite for a scientifically sound rating of players' actual motor performance and for the future examination of the prognostic validity for success in adulthood.

  7. Diagnostic thoracoscopy

    Directory of Open Access Journals (Sweden)

    Plavec Goran


    Full Text Available Diagnostic thoracoscopy in patients with pleural effusion of unclear origin mostly provides the correct diagnosis. Results from published reports of previous researches are not uniform. In 47 male and 20 female patients with pleural effusion of unknown etiology, after receiving negative results obtained from cytological finding of pleural effusion and percutaneous needle biopsy, thoracoscopy with biopsy of one or both pleurae was performed. Procedure was done in local anesthesia using Stortz rigid thoracoscope. In 37 patients with malignant disease (primary or metastatic diagnosis was confirmed histopathologically in 31 patient (81.12%. In 27 patients with inflammatory pleural disease diagnosis was confirmed histopathologically in 22 patients (81.4%. Among 11 patients with specific pleural effusions, tuberculosis was confirmed in 10 (90.91%. Normal finding in cases of spontaneous pneumothorax and pulmonary embolism was taken as a positive result. Total number of positive findings was 55 (82.10%. In one patient, the third spontaneous pneumothorax was the indication for thoracoscopy, and after numerous bullae were seen during the procedure, talcum powder pleurodesis was done. In four patients low intensity subcutaneous emphysema occurred one day after thoracoscopy. It can be concluded that thoracoscopy in local anesthesia out of the operating room is good and practical method for solving the unclear pleural effusions, with neglectable rate of complications.

  8. Industrial applications of laser diagnostics

    CERN Document Server

    Deguchi, Yoshihiro


    Tighter regulations of harmful substances such as NOx, CO, heavy metals, particles, emissions from commercial plants and automobiles reflect a growing demand for lowering the anthropogenic burdens on the environment. It is equally important to monitor controlling factors to improve the operation of industrial machinery and plants. Among the many methods for doing this, laser diagnostics stands out. Taking a practical approach, Industrial Applications of Laser Diagnostics discusses how to apply laser diagnostics to engines, gas turbines, thermal and chemical plant systems, and disposal faciliti


    Directory of Open Access Journals (Sweden)

    O. A. Antelava


    Full Text Available The lecture considers the problem of rare systemic connective tissue diseases, such as idiopathic inflammatory myopathies (IIMs. It underlines the clinical and immunological heterogeneity of their subtypes, which defines therapeutic tactics and prognosis. The diagnostic criteria for IIMs are given. A differential diagnostic algorithm based on the exclusion of phenotypically similar forms of myopathies of different genesis is proposed. 

  10. Molecular diagnostics of myeloproliferative neoplasms

    DEFF Research Database (Denmark)

    Langabeer, S. E.; Andrikovics, H.; Asp, J.;


    identified. These discoveries have been rapidly incorporated into evolving molecular diagnostic algorithms. Whilst many of these mutations appear to have prognostic implications, establishing MPN diagnosis is of immediate clinical importance with selection, implementation and the continual evaluation...... of the appropriate laboratory methodology to achieve this diagnosis similarly vital. The advantages and limitations of these approaches in identifying and quantitating the common MPN-associated mutations are considered herein with particular regard to their clinical utility. The evolution of molecular diagnostic...

  11. Beef Consumer Preferences in Chile: Importance of Quality Attribute Differentiators on the Purchase Decision Preferencias del Consumidor de Carne de Vacuno en Chile: Importancia de Atributos de Calidad Diferenciadores en la Decisión de Compra

    Directory of Open Access Journals (Sweden)

    Pablo Villalobos


    Full Text Available Agrifood markets worldwide have focused on searching for new quality attribute differentiators, which capture the attention of consumers and meet their needs. The purpose of this research was to determine the importance of a set of quality attribute differentiators associated with a beef cut on the choice behavior of the Chilean consumer. The evaluated differentiating characteristics were: price, origin, production method, and quality assurance. A total of 750 subjects were surveyed in the following cities: Talca, Rancagua, and Santiago. Conjoint analysis was carried out to estimate the impact of the assessed attributes on the purchase decision of the consumers polled. Findings point out that the quality attribute differentiators significantly influence consumer choice behavior, with price being the least important for the majority of consumers polled (21.07% relative importance for the whole sample. In this context, the quality assurance attribute is shown as the most relevant which guides the decision-making process of beef consumers (29.75% relative importance for the whole sample. Even though some limitations are shown within this study, it must be emphasized that the results follow similar trends already described in previous research carried out in other countries. These tendencies should be considered, therefore, to establish differentiation strategy tools when designing a marketing mix focused on the domestic market.Los mercados agroalimentarios a nivel mundial se han focalizado en la búsqueda de nuevos atributos de calidad diferenciadores que capten la atención de los consumidores y satisfagan sus necesidades. El propósito de esta investigación fue determinar la importancia que ejerce un conjunto de atributos de calidad diferenciadores asociados a la carne de vacuno, en la decisión de compra del consumidor chileno. Los atributos evaluados fueron: precio, origen del producto, sistema de producción y aseguramiento de la calidad. Un

  12. Abdominal Wall Desmoid during Pregnancy: Diagnostic Challenges

    Directory of Open Access Journals (Sweden)

    Johnny Awwad


    Full Text Available Background. Desmoids are benign tumors, with local invasive features and no metastatic potential, which have rarely been described to be pregnancy associated. Case. We described the rapid growth of an anterior abdominal wall mass in a 40-year-old pregnant woman. Due to its close proximity to the enlarged uterus, it was misdiagnosed to be a uterine leiomyoma by ultrasound examination. Final tissue diagnosis and radical resection were done at the time of abdominal delivery. Conclusion. Due to the diagnostic limitations of imaging techniques, desmoids should always be considered when the following manifestations are observed in combination: progressive growth of a solitary abdominal wall mass during pregnancy and well-delineated smooth tumor margins demonstrated by imaging techniques. This case emphasizes the importance of entertaining uncommon medical conditions in the differential diagnosis of seemingly common clinical manifestations.

  13. Mesenchymal stem cells: A new diagnostic tool?

    Institute of Scientific and Technical Information of China (English)


    Mesenchymal stem cells (MSCs) are progenitor cellscapable of self-renewal that can differentiate inmultiple tissues and, under specific and standardized culture conditions, expand in vitro with little phenotypicalterations. In recent years, preclinical andclinical studies have focused on MSC analysis andunderstanding the potential use of these cells as atherapy in a wide range of pathologies, and manyapplications have been tested. Clinical trials usingMSCs have been performed (e.g. , for cardiac events,stroke, multiple sclerosis, blood diseases, auto-immunedisorders, ischemia, and articular cartilage and bonepathologies), and for many genetic diseases, thesecells are considered an important resource. Consideringof the biology of MSCs, these cells may also be usefultools for understanding the physiopathology of differentdiseases, and they can be used to develop specificbiomarkers for a broad range of diseases. In thiseditorial, we discuss the literature related to the use ofMSCs for diagnostic applications and we suggest newtechnologies to improve their employment.

  14. The role of diagnostic radiology in pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Elmas, Nevra E-mail:


    Acute pancreatitis is a frequent inflammatory and necrotic process of pancreas and peripancreatic field. To detect the presence of infected or sterile necrotic components and hemorrhage of the pancreatic paranchyma is important for therapeutic approach. Chronic pancreatitis is characterized by irreversible exocrine dysfunction, progressive loss of pancreatic tissue and morphological changes of the pancreatic canal. Imaging modalities play a primary role in the management of both acute and chronic pancreatitis. CT and MR imaging confirm the diagnosis and detect the severity of disease. In chronic pancreatitis, MRCP after Secretin administration, Spiral CT and endoscopic US seems to replace diagnostic ERCP. However differentiation of pseudotumor of chronic pancreatitis from the pancreatic carcinoma is difficult with either imaging modalities.

  15. A PCR-RFLP method for the simultaneous differentiation of three Entamoeba species. (United States)

    Fontecha, Gustavo A; García, Kimberly; Rueda, María Mercedes; Sosa-Ochoa, Wilfredo; Sánchez, Ana Lourdes; Leiva, Byron


    Amoebiasis caused by Entamoeba histolytica continues to be one of the most common parasitic diseases in the developing world. Despite its relevance, due to the lack of accurate diagnostic methods, the true clinical and public health importance of this parasite remains uncertain. The aim of this study was to develop a new diagnostic tool to differentiate E.histolytica from the morphologically undistinguishable E.dispar and E.moshkovskii. We developed a specific, fast and simple PCR-RFLP method that was able to accurately differentiate experimentally-obtained restriction patterns from the three Entamoeba species. This new method could prove useful for clinical and epidemiological purposes.

  16. Integrative Medicine in Clinical Practice:From Pattern Differentiation in Traditional Chinese Medicine to Disease Treatment

    Institute of Scientific and Technical Information of China (English)

    吕爱平; 陈可冀


    Pattern(syndrome) differentiation is the key theory in traditional Chinese medicine(TCM) and the important diagnostic principle for TCM therapy.More and more medical researchers recognize that the combination of disease diagnosis in biomedicine and pattern differentiation in TCM is essential for the clinical practice, and it has been a common practice model in China since it will produce better clinical effects.

  17. [Cluster headache differential diagnosis]. (United States)

    Guégan-Massardier, Evelyne; Laubier, Cécile


    Cluster headache is characterized by disabling stereotyped headache. Early diagnosis allows appropriate treatment, unfortunately diagnostic errors are frequent. The main differential diagnoses are other primary or essential headaches. Migraine, more frequent and whose diagnosis is carried by excess, trigeminal neuralgia or other trigemino-autonomic cephalgia. Vascular or tumoral underlying condition can mimic cluster headache, neck and brain imaging is recommended, ideally MRI.

  18. Differential diagnosis in cases of saddle-like impression of the fundus of the stomach

    Energy Technology Data Exchange (ETDEWEB)

    Hohenberg, G.; Deimer, E.; Schmidmeier, L.


    X-ray examination of the stomach sometimes shows a saddle-like impression of the region of the fundus. This phenomenon is without any clinical importance, but there are many diseases such as hiatal hernia, benign and malignant tumours, inflammatory diseases, and varices which are localised at the fundus. Differential diagnostic problems are discussed.

  19. [Ultrasound diagnostics in ophthalmology (standardized echography): part 2: diseases of the orbit - ultrasound biomicroscopy diagnostics]. (United States)

    Hasenfratz, G; Mardin, C


    Ultrasound diagnostics have been one of the most important noninvasive supplementary diagnostic procedures in ophthalmology for many decades and are indispensable for many intraocular and orbital diseases. When the echography examination and analysis of the echograms obtained are correctly carried out, ultrasound diagnostics are characterized by a high measure of specificity and sensitivity.

  20. Saliva Preservative for Diagnostic Purposes (United States)

    Pierson, Duane L.; Mehta, Satish K.


    Saliva is an important body fluid for diagnostic purposes. Glycoproteins, glucose, steroids, DNA, and other molecules of diagnostic value are found in saliva. It is easier to collect as compared to blood or urine. Unfortunately, saliva also contains large numbers of bacteria that can release enzymes, which can degrade proteins and nucleic acids. These degradative enzymes destroy or reduce saliva s diagnostic value. This innovation describes the formulation of a chemical preservative that prevents microbial growth and inactivates the degradative enzymes. This extends the time that saliva can be stored or transported without losing its diagnostic value. Multiple samples of saliva can be collected if needed without causing discomfort to the subject and it does not require any special facilities to handle after it is collected.

  1. Antibody Arrays Identify Potential Diagnostic Markers of Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Brian J. Peter


    Full Text Available Hepatocellular carcinoma (HCC is the third leading cause of cancer deaths worldwide. Effective treatment of HCC patients is hampered by the lack of sensitive and specific diagnostic markers of HCC. Alpha-fetoprotein (AFP, the currently used HCC marker, misses 30%–50% of HCC patients, who therefore remain undiagnosed and untreated. In order to identify novel diagnostic markers that can be used individually or in combination with AFP, we used an antibody array platform to detect the levels of candidate proteins in the plasma of HCC patients (n = 48 and patients with chronic hepatitis B or C viral infections (n = 19 (both of which are the major risk factors of HCC. We identified 7 proteins that significantly differentiate HCC patients from hepatitis patients (p < 0.05 (AFP, CTNNB, CSF1, SELL, IGFBP6, IL6R, and VCAM1.Importantly, we also identified 8 proteins that significantly differentiate HCC patients with ‘normal’ levels of AFP (<20 ng/ml from hepatitis patients (p < 0.05 (IL1RN, IFNG, CDKN1A, RETN, CXCL14, CTNNB, FGF2, and SELL. These markers are potentially important complementary markers to AFP. Using an independent immunoassay method in an independent group of 23 HCC patients and 22 hepatitis patients, we validated that plasma levels of CTNNB were significantly higher in the HCC group (p = 0.020. In conclusion, we used an antibody array platform to identify potential circulating diagnostic markers of HCC, some of which may be valuable when used in combination with AFP. The clinical utility of these newly identified HCC diagnostic markers needs to be systematically evaluated.

  2. Differential geometry

    CERN Document Server

    Kreyszig, Erwin


    An introductory textbook on the differential geometry of curves and surfaces in three-dimensional Euclidean space, presented in its simplest, most essential form, but with many explanatory details, figures and examples, and in a manner that conveys the theoretical and practical importance of the different concepts, methods and results involved. With problems at the end of each section, and solutions listed at the end of the book. Includes 99 illustrations.

  3. [Diagnostic tools for canine parvovirus infection]. (United States)

    Proksch, A L; Hartmann, K


    Canine parvovirus (CPV) infection is one of the most important and common infectious diseases in dogs, in particular affecting young puppies when maternal antibodies have waned and vaccine-induced antibodies have not yet developed. The mortality rate remains high. Therefore, a rapid and safe diagnostic tool is essential to diagnose the disease to 1) provide intensive care treatment and 2) to identify virus-shedding animals and thus prevent virus spread. Whilst the detection of antibodies against CPV is considered unsuitable to diagnose the disease, there are several different methods to directly detect complete virus, virus antigen or DNA. Additionally, to test in commercial laboratories, rapid in-house tests based on ELISA are available worldwide. The specificity of the ELISA rapid in-house tests is reported to be excellent. However, results on sensitivity vary and high numbers of false-negative results are commonly reported, which potentially leads to misdiagnosis. Polymerase chain reaction (PCR) is a very sensitive and specific diagnostic tool. It also provides the opportunity to differentiate vaccine strains from natural infection when sequencing is performed after PCR.

  4. [Eosinophilia - inflammation, proliferation, reaction. Part 1: diagnostics]. (United States)

    Balke, L; Günther, A; Zeuner, R; Bewig, B


    Eosinophilia presents a challenge to differential diagnostics due to the multitude of possible causes. An initial difficulty is often to distinguish between threatening disease symptoms and relatively harmless secondary reactions. A highly dynamic clinical progression with severe impairment of the vital functions, like breathing, for example, can make swift action necessary. An example of this is known as acute eosinophile pneumonia, which can often only be controlled with the rapid use of high steroid doses. However, a peripheral blood eosinophilia must not lead to an automatic use of steroids before the most important core tests, as this can compromise further diagnostic measures. Furthermore, less dramatic courses require careful handling of an eosinophilia. Various pneumological, infectological, rheumatological or haematological / oncological disease patterns with a prolonged course can develop seriously if they are not recognised in time and treated in a targeted manner. There is no guideline for eosinophile clinical pictures in general. Already the recommendations for a structured diagnosis are scarce and are often concentrated on internist emphases. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Calretinin as a Diagnostic Adjunct for Ameloblastoma

    Directory of Open Access Journals (Sweden)

    Chitra Anandani


    Full Text Available Background. Calretinin is a 29 kDa calcium-binding protein of the EF-hand family which is expressed in a variety of normal and tumorigenic tissues. Its expression in odontogenic epithelium during odontogenesis and in neoplastic odontogenic tissues has been demonstrated. Unicystic ameloblastoma poses a diagnostic challenge, as its histologic presentation can be sometimes mistaken for keratocystic odontogenic tumor (KCOT. This study was performed to assess the usefulness of calretinin as a confirmatory marker for ameloblastic tissue. Methodology. Total of 40 cases: 16 unicystic ameloblastoma, 4 multicystic ameloblastoma, and 20 KCOT, were evaluated immunohistochemically for the presence, localization, distribution, and intensity of calretinin expression. Statistical analysis was done using Chi-square test to intercompare the expression between ameloblastoma and KCOT. Results. Sixteen cases of ameloblastoma (12 unicystic, 4 multicystic showed positive calretinin staining of ameloblastic epithelium and only one case of KCOT was positive for calretinin, with the positivity restricted to the stellate reticulum like epithelium. Intercomparison between two groups revealed statistically significant difference (P=0.000. Conclusion. Calretinin appears to be a specific immunohistochemical marker for neoplastic ameloblastic epithelium and may be an important diagnostic adjunct in the differential diagnosis of ameloblastoma and KCOT.

  6. Diagnostic and differential value for ovarian fibroma by dynamic contrast enhanced MRI%动态增强MRI对卵巢纤维瘤的诊断和鉴别诊断

    Institute of Scientific and Technical Information of China (English)

    吴建国; 谢一平


    Objective To explore the diagnostic and differential value of dynamic contrast enhanced MRI ( DCE-MRI) for ovarian fibroma. Methods Eighteen cases with 19 lesions of ovarian fibromaes proved by surgery and pathology including clinical informations and DCE-MRI data were analyzed retrospectively. Results There were 19 tumours in 18 cases, including 17 cases with single tumour, 1 case with 2 tumours. All lesions showed tumours in pelvic cavity with clear boundary. The maximum diameter of all tumoures was 2.5 ~ 18.0 cm,the mean diameter was (8.78 ±2.17)cm. Twelve tumours were solid,6 were mixed,1 was cystic. The T1WI and T2WI signals of the solid composition were low on unenhanced MR, the signal of cystic composition was low on T1WI and high on T2WI. On DCE-MRI most tumours showed asymmetrical postpone enhancement with slightly to moderate degree. The peak time of intensify and intensified ratio within 208 s was indiscriminate between tumours and iliacus ( P > 0. 05 ) , while different between tumours and myometrium(P <0. 01) . Eight tumours with big size were accompanied with a little hydrops in pelvic cavity ,6 cases with myomaes of uterus,4 cases with cysts of contralateral ovary. Conclusions Ovarian fibroma always shows single solid tumour, with relatively big size and clear boundary. The T1WI and T2WI signals of the solid composition of tumours are low on unenhanced MR, with asymmetrical postpone enhancement with slightly to moderate degree on DCE-MRI.%目的 探讨动态增强MRI对卵巢纤维瘤的诊断和鉴别诊断价值.方法 回顾性分析经手术病理证实的18例(19个)卵巢纤维瘤的动态增强MRI和临床资料.结果 18例共19个肿瘤,17例单发,1例为两侧卵巢发病;均表现为盆腔内境界较清楚肿块;肿瘤最大径2.5~18.0 cm,平均(8.78 ±2.17)cm.表现为实性肿块12个,囊实性肿块6个,囊性肿块1个;平扫肿瘤的实质成分T1WI为较低信号,T2WI为低信号,囊性成分为T1 WI低T2WI高信号.动

  7. Diagnostic features of polycystic ovary syndrome in adolescents (review). (United States)

    Beltadze, K; Barbakadze, L


    The problem of Polycystic Ovary Syndrome (PCOS) is of a special importance due to its connection with not only medical but with psychosocial factors. PCOS is the most common endocrine cause of anovulatory infertility. It is a major factor for the metabolic syndrome, cardiovascular disease, type 2 diabetes mellitus (T2DM). Clinical symptoms of PCOS such as acne, hirsutism, obesity, alopecia represent psychological problem, especially for the adolescents. Many women who have PCOS have the onset of symptoms during adolescence. Early diagnosis and treatment of PCOS are important for preventing of the above mentioned long-term consequences associated with this condition. Adolescent patients often have diagnostic problems because the features of normal puberty are similar with symptoms of PCOS. This article reviews the diagnostic and differential diagnostic characteristics of PCOS in adolescents. In conclusion, consensus statement in adolescent patients is still awaiting. Our data suggest that it may be prudent to define adolescent PCOS according to the Carmina modified Rotterdam criteria. The increase rate of metabolic syndrome in adolescents with PCOS emphasize the importance of regular screening due to the high cardiometabolic disorders risk.

  8. Unusual presentation and inconlusive biopsy render fibroadenoma in two young females a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    D Meerkotter


    Full Text Available Two young non-lactating females presented with acutely painful breast masses. Sonographic features showed mixed echogenic masses. Core biopsy was non-diagnostic in both and surgical excision revealed infarcted fibroadenomas. Although fibroadenomas are common, they do not commonly infarct and only rarely in non-lactating and non-pregnant females. These two cases highlight the clinical and imaging characteristics of this important differential diagnosis.

  9. Neuroimaging differential diagnoses to abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Girard, Nadine [AP-HM Timone 2, Department of Neuroradiology, Marseille cedex 05 (France); Aix Marseille University, UMR CNRS 7339, Marseille (France); Brunel, Herve; Dory-Lautrec, Philippe [AP-HM Timone 2, Department of Neuroradiology, Marseille cedex 05 (France); Chabrol, Brigitte [AP-HM Timone, Department of Pediatric Neurology, Marseille (France)


    Trauma is the most common cause of death in childhood, and abusive head trauma is the most common cause of traumatic death and morbidity in infants younger than 1 year. The main differential diagnosis of abusive head trauma is accidental traumatic brain injury, which is usually witnessed. This paper also discusses more uncommon diagnoses such as congenital and acquired disorders of hemostasis, cerebral arteriovenous malformations and metabolic diseases, all of which are extremely rare. Diagnostic imaging including CT and MRI is very important for the distinction of non-accidental from accidental traumatic injury. (orig.)

  10. Surface primary bone tumors: Systematic approach and differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Mendez Diaz, Cristina; Soler Fernandez, Rafaela; Rodriguez Garcia, Esther; Fernandez Armendariz, Pablo; Diaz Angulo, Carolina [Complejo Hospitalario Universitario A Coruna, Department of Radiology, A Coruna (Spain)


    Surface primary bone tumors may appear similar to their intramedullary counterpart, but because they are rare, they may pose diagnostic challenges when showing different characteristics compared to their intramedullary counterpart. It is important for radiologists to recognize the imaging findings for various uncommon surface primary bone tumors, which may help to reduce the differential diagnosis or to lead to a specific diagnosis. Radiography is typically used for first-line imaging. If necessary, it is followed by CT or MRI for evaluation and characterization of surface bone tumors. The aim of this article is to review the imaging findings and differential diagnosis for surface primary bone tumors. (orig.)

  11. Chronic Meningitis: Simplifying a Diagnostic Challenge. (United States)

    Baldwin, Kelly; Whiting, Chris


    Chronic meningitis can be a diagnostic dilemma for even the most experienced clinician. Many times, the differential diagnosis is broad and encompasses autoimmune, neoplastic, and infectious etiologies. This review will focus on a general approach to chronic meningitis to simplify the diagnostic challenges many clinicians face. The article will also review the most common etiologies of chronic meningitis in some detail including clinical presentation, diagnostic testing, treatment, and outcomes. By using a case-based approach, we will focus on the key elements of clinical presentation and laboratory analysis that will yield the most rapid and accurate diagnosis in these complicated cases.

  12. Neuroleptic malignant syndrome: the diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Ivana Stasevic Karlicic


    Full Text Available Neuroleptic malignant syndrome (NMS is a life-threatening, often fatal idiosyncratic reaction to neuroleptic or other drug therapies that antagonise the central dopaminergic neurotransmission. The clinical presentation of NMS is very heterogeneous. The lack of specific levels of symptom severity in currently used diagnostic criteria dims the diagnosis of NMS. Therefore differential diagnosis is of priority, because NMS is a diagnosis of exclusion. The aim of this paper is to present a complex clinical picture in a patient that after a differential diagnostic exclusion of other medical conditions and intoxications is diagnosed as NMS. Case reports such as these help raise awareness of this clinical issue.

  13. Diagnostic interventions in nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Thrall, J.H.; Swanson, D.P.


    Diagnostic interventions in nuclear medicine may be defined as the coadministration of a nonradioactive drug or application of a physical stimulus or physiologic maneuver to enhance the diagnostic utility of a nuclear medicine test. The rationale for each interventional maneuver follows from the physiology or metabolism of the particular organ or organ system under evaluation. Diagnostic inference is drawn from the pattern of change in the biodistribution of the tracer in response to the intervention-induced change in metabolism or function. In current practice, the most commonly performed interventional maneuvers are aimed at studies of the heart, genitourinary system, hepatobiliary system, and gastrointestinal tract. The single most commonly performed interventional study in the United States is the stress Thallium-201 myocardial perfusion scan aimed at the diagnosis of coronary artery disease. The stress portion of the study is accomplished with dynamic leg exercise on a treadmill and is aimed at increasing myocardial oxygen demands. Areas of myocardium distal to hemodynamically significant lesions in the coronary arteries become ischemic at peak stress due to the inability of the stenotic vessel to respond to the oxygen demand/blood flow needs of the myocardium. Ischemic areas are readily recognized as photopenic defects on scans obtained immediately after exercise, with normalization upon delayed imaging. Diuresis renography is aimed at the differential diagnosis of hydroureteronephrosis. By challenging the urinary tract collecting structures with an augmented urine flow, dilated, unobstructed systems can be differentiated from systems with significant mechanical obstruction. 137 references.

  14. Diagnóstico diferencial de primeiro episódio psicótico: importância da abordagem otimizada nas emergências psiquiátricas Differential diagnosis of first episode psychosis: importance of optimal approach in psychiatric emergencies

    Directory of Open Access Journals (Sweden)

    Cristina Marta Del-Ben


    application of operational diagnostic criteria, the use of scales and structured interviews and a short period of observation, between 24-72 hours. Diagnoses of bipolar disorder, schizophrenia, psychotic depression and delusional disorder developed in the context of emergency have good stability, but not the diagnoses of brief psychotic disorder, schizophreniform disorder and schizoaffective disorder. First episode psychosis can occur in the course of the use of psychoactive substances, with relatively frequent maintenance of psychotic symptoms even after cessation of the use of the substance. The rational use of subsidiary tests may help the differential diagnosis of psychotic episodes due to general medical conditions. CONCLUSION: Diagnoses of first psychotic episode can be adequately performed during psychiatric emergencies, if routines are implemented based on scientific evidence.

  15. Far infrared fusion plasma diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Luhmann, N.C. Jr.; Peebles, W.A.


    Over the last several years, reflectometry has grown in importance as a diagnostic for both steady-state density Profiles as well as for the investigation of density fluctuations and turbulence. As a diagnostic for density profile measurement, it is generally believed to be well understood in the tokamak environment. However, its use as a fluctuation diagnostic is hampered by a lack of quantitative experimental understanding of its wavenumber sensitivity and spatial resolution. Several researchers, have theoretically investigated these questions. However, prior to the UCLA laboratory investigation, no group has experimentally investigated these questions. Because of the reflectometer's importance to the world effort in understanding plasma turbulence and transport, UCLA has, over the last year, made its primary Task IIIA effort the resolution of these questions. UCLA has taken the lead in a quantitative experimental understanding of reflectometer data as applied to the measurement of density fluctuations. In addition to this, work has proceeded on the design, construction, and installation of a reflectometer system on UCLA's CCT tokamak. This effort will allow a comparison between the improved confinement regimes (H-mode) observed on both the DIII-D and CCT machines with the goal of achieving a physics understanding of the phenomena. Preliminary investigation of a new diagnostic technique to measure density profiles as a function of time has been initiated at UCLA. The technique promises to be a valuable addition to the range of available plasma diagnostics. Work on advanced holographic reflectometry technique as applied to fluctuation diagnostics has awaited a better understanding of the reflectometer signal itself as discussed above. Efforts to ensure the transfer of the diagnostic developments have continued with particular attention devoted to the preliminary design of a multichannel FIR interferometer for MST.


    CERN Multimedia

    HR Department


    Green plates, removals and importation of personal effects Please note that, as from 1 April 2009, formalities relating to K and CD special series French vehicle plates (green plates), removals and importation of personal effects into France and Switzerland will be dealt with by GS Department (Building 73/3-014, tel. 73683/74407). Importation and purchase of tax-free vehicles in Switzerland, as well as diplomatic privileges, will continue to be dealt with by the Installation Service of HR Department (Building 33/1-011, tel. 73962). HR and GS Departments

  17. 血清KL-6水平在胰腺癌诊断与鉴别诊断中的价值%Diagnostic and differential value of elevated serum KL-6 levels in pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    赵晓娇; 姚玮艳; 袁耀宗


    Objective To determine the serum KL-6 level in patients with pancreatic carcinoma and investigate its diagnostic value. Methods The data of 53 pancreatic carcinoma (PC) patients; 68 chronic pancreatitis (CP) patients and 51 patients with high risks of pancreatic cancer (HR) with complete follow-up data were studied, and 50 healthy volunteers were used as controls. ELISA was used to measure the serum levels of KL-6, MUC4, and CA50. Radioimmunoassay methods were used to measure the serum CA19-9 levels. The sensitivity and specificity of KL-6 for the diagnosis of PC were determined, and the relationship between its levels and clinicopathologic parameters, patients' outcome were analyzed. Results The serum KL-6 levels were (753±548), (135±93), (105±55) and (99±50) U/ml in PC group, CP group, HR group and control group, and the value in PC group was significantly higher than those in other 3 groups (P 232 U/ml as the cut-off point, the sensitivity and specificity of KL-6 for the diagnosis of PC was 96% and 94%. Using >244 U/ml as the cut-off point, the sensitivity and specificity of KL-6 for the diagnosis of PC was 97% and 91%. The clinical value of KL-6 was higher than those of CA19-9, CASO and MUC4. The serum level of KL-6 was not associated with clinicopathologic parameters. The median survival of patients with serum level of KL-6 =300 U/ml was (9.3 ±1.2) months, which was significantly longer than that in patients with serum level of KL-6 >300 U/ml [ (4.6 ±0.7) months, P =0.006]. Conclusions KL-6 might be a useful serological marker of pancreatic cancer, and it may play a role in the differential diagnosis between pancreatic cancer and chronic pancreatitis.%目的 检测胰腺癌患者血清KL-6水平,探讨其临床诊断价值.方法 收集随访资料完整的53例胰腺癌(PC)、68例慢性胰腺炎(CP)、51例高危人群(high risk person,HR)的血清样本,以50例健康体检者作为对照.用ELISA方法检测血清CA50、MUCA、KL-6

  18. Diagnostic nerve ultrasonography; Diagnostische Nervensonographie

    Energy Technology Data Exchange (ETDEWEB)

    Baeumer, T. [Universitaet zu Luebeck CBBM, Haus 66, Institut fuer Neurogenetik, Luebeck (Germany); Grimm, A. [Universitaetsklinikum Tuebingen, Klinik und Poliklinik fuer Neurologie, Tuebingen (Germany); Schelle, T. [Staedtisches Klinikum Dessau, Neurologische Klinik, Dessau (Germany)


    For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. Using ultrasonography for peripheral nerve diagnostics. With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves. (orig.) [German] Fuer die Diagnostik von Nervenlaesionen ist ein bildgebendes Verfahren zur Darstellung des peripheren Nervs und seiner ihn umgebenden Strukturen fuer eine aetiologische Einordnung erforderlich. Mit der klinisch-neurologischen Untersuchung und Elektrophysiologie ist eine funktionelle Aussage ueber die Nervenlaesion moeglich. In der Standard-MRT-Untersuchung wird der periphere Nerv nur unzureichend gut dargestellt. Die MRT-Neurographie ist ein sehr gutes, aber auch zeit- und ressourcenintensives Verfahren. Nutzung des Ultraschalls fuer die

  19. Differential Equations with Linear Algebra

    CERN Document Server

    Boelkins, Matthew R; Potter, Merle C


    Linearity plays a critical role in the study of elementary differential equations; linear differential equations, especially systems thereof, demonstrate a fundamental application of linear algebra. In Differential Equations with Linear Algebra, we explore this interplay between linear algebra and differential equations and examine introductory and important ideas in each, usually through the lens of important problems that involve differential equations. Written at a sophomore level, the text is accessible to students who have completed multivariable calculus. With a systems-first approach, t

  20. Infective endocarditis: the specific features of its course, the criteria for diagnosis, differential diagnosis (part II

    Directory of Open Access Journals (Sweden)

    B S Belov


    Full Text Available Infective endocarditis (IE is today characterized by polyetiology due to a wide range of pathogens. The paper describes the specific features of the clinical picture of the disease in relation to the etiological agent, which have, in some cases, a crucial role in the choice of empiric antibiotic therapy. Significant clinical polymorphism, obscure symptoms, and monosyndromic onset as guises all enhance the importance of the differential diagnosis of IE, at its early stages in particular. Basic approaches to differentiating IE from the diseases in which differentially diagnostic problems arise to the utmost are outlined.

  1. [The diagnostic algorithm in twin pregnancy]. (United States)

    Ropacka-Lesiak, Mariola; Szaflik, Krzysztof; Breborowicz, Grzegorz H


    This paper presents the diagnostic algorithm in twin pregnancy. The most important sonographic parameters in the assessment of twins have been discussed. Moreover, the most significant complications of twin pregnancy as well as diagnostic possibilities and management, have been also presented and defined.

  2. Diagnostic markers based on a computational model of lipoprotein metabolism

    NARCIS (Netherlands)

    Schalkwijk, D.B. van; Ommen, B. van; Freidig, A.P.; Greef, J. van der; Graaf, A.A. de


    Abstract Background: Dyslipidemia is an important risk factor for cardiovascular disease and type II diabetes. Lipoprotein diagnostics, such as LDL cholesterol and HDL cholesterol, help to diagnose these diseases. Lipoprotein profile measurements could improve lipoprotein diagnostics, but interpreta

  3. Thioaptamer Diagnostic System Project (United States)

    National Aeronautics and Space Administration — AM Biotechnologies (AM) will develop a diagnostic system in response to SBIR Topic X10.01 Reusable Diagnostic Lab Technology that will simultaneously detect and...

  4. Diagnostic Algorithm Benchmarking (United States)

    Poll, Scott


    A poster for the NASA Aviation Safety Program Annual Technical Meeting. It describes empirical benchmarking on diagnostic algorithms using data from the ADAPT Electrical Power System testbed and a diagnostic software framework.

  5. Can attention deficit hyperactivity disorder and fetal alcohol spectrum disorder be differentiated by motor and balance deficits?

    NARCIS (Netherlands)

    Kooistra, Libbe; Ramage, Barbara; Crawford, Susan; Cantell, Marja; Wormsbecker, Shirley; Gibbard, Ben; Kaplan, Bonnie J


    There is an ongoing debate regarding the diagnostic overlap between Attention Deficit Hyperactivity Disorder (ADHD) and Fetal Alcohol Spectrum Disorder (FASD). Differential diagnosis is important because of treatment implications. Children aged 7-10years (47 ADHD, 30 FASD, 39 controls) participated.

  6. Differential geometry

    CERN Document Server

    Ciarlet, Philippe G


    This book gives the basic notions of differential geometry, such as the metric tensor, the Riemann curvature tensor, the fundamental forms of a surface, covariant derivatives, and the fundamental theorem of surface theory in a selfcontained and accessible manner. Although the field is often considered a classical one, it has recently been rejuvenated, thanks to the manifold applications where it plays an essential role. The book presents some important applications to shells, such as the theory of linearly and nonlinearly elastic shells, the implementation of numerical methods for shells, and

  7. Optical diagnostics of intermittent flows

    DEFF Research Database (Denmark)

    Okulov, V.L.; Naumov, I.V.; Sørensen, Jens Nørkær


    The efficiency of combined use of different optical techniques for flow diagnostics is demonstrated with the practically important case of intense swirling flows. It is shown that, when applied separately, commonly used optical measuring techniques, such as laser Doppler anemometry and particle...... image velocimetry, frequently give erroneous results, especially for the transition flow and developed nonstationary flow. However, their combined use in diagnostics of unsteady (intermittent) flows significantly improves both the temporal and spatial resolution of measurements. Such a complex approach...... is for the first time applied for diagnostics of the flow pattern in a closed cylinder with a rotating end face with the aim of studying the changeover from the steady axisymmetric to unsteady asymmetric flow over a wide range of flow parameters. It is found that such a transition is notable for azimuthal...

  8. Molecular diagnostics of neurodegenerative disorders

    Directory of Open Access Journals (Sweden)

    Megha eAgrawal


    Full Text Available Molecular diagnostics provide a powerful method to detect and diagnose various neurological diseases such as Alzheimer’s and Parkinson’s disease. The confirmation of such diagnosis allows early detection and subsequent medical counseling that help specific patients to undergo clinically important drug trials. This provides a medical pathway to have better insight of neurogenesis and eventual cure of the neurodegenerative diseases. In this short review, we present recent advances in molecular diagnostics especially biomarkers and imaging spectroscopy for neurological diseases. We describe advances made in Alzheimer’s disease, Parkinson’s disease, Amyotrophic lateral sclerosis and Huntington’s disease, and finally present a perspective on the future directions to provide a framework for further developments and refinements of molecular diagnostics to combat neurodegenerative disorders.

  9. Audiologic diagnostics of vestibular schwannoma

    Directory of Open Access Journals (Sweden)

    Komazec Zoran


    Full Text Available Introduction Vestibular schwannoma (acoustic neuroma is a rare, but important cause of sensorineural hearing loss. Patients with asymmetric hearing loss, or unilateral tinnitus should be evaluated expeditiously, to prevent further neurological damage. Audiologic diagnostics Audiologic diagnostics represents the basic diagnosis for early detection of vestibular schwannoma. Patients with vestibular schwannomas may present with a variety of clinical features, including retrocochlear pattern of sensorineural hearing loss. Supraliminary audiometry, tympano- metry, stapedius reflex and otoacoustic emissions as well as vestibular response to caloric testing are methods for selection of patients with suspicion of this tumor. Conclusion The golden standard for audiologic diagnostics of vestibular schwannoma is BAEP (Brainstem Auditory Evoked Potentials. Patients with pathological findings of BAEP should undergo MRI of the posterior fossa. Gadolinium-enhanced magnetic resonance imaging is the best and final tool for making a diagnosis of vestibular schwannoma.

  10. Diagnostic randomized controlled trials: the final frontier. (United States)

    Rodger, Marc; Ramsay, Tim; Fergusson, Dean


    Clinicians, patients, governments, third-party payers, and the public take for granted that diagnostic tests are accurate, safe and effective. However, we may be seriously misled if we are relying on robust study design to ensure accurate, safe, and effective diagnostic tests. Properly conducted, randomized controlled trials are the gold standard for assessing the effectiveness and safety of interventions, yet are rarely conducted in the assessment of diagnostic tests. Instead, diagnostic cohort studies are commonly performed to assess the characteristics of a diagnostic test including sensitivity and specificity. While diagnostic cohort studies can inform us about the relative accuracy of an experimental diagnostic intervention compared to a reference standard, they do not inform us about whether the differences in accuracy are clinically important, or the degree of clinical importance (in other words, the impact on patient outcomes). In this commentary we provide the advantages of the diagnostic randomized controlled trial and suggest a greater awareness and uptake in their conduct. Doing so will better ensure that patients are offered diagnostic procedures that will make a clinical difference.

  11. Try to Talk about Enhanced MRI to Differential Diagnosis of Benign and Malignant Breast Diseases is of Great Importance Keyboard Rural%试论增强MRI对乳腺良恶性肿块鉴别诊断的重要性

    Institute of Scientific and Technical Information of China (English)

    李剑; 田园


    目的:探究增强MRI对乳腺良恶性肿块鉴别诊断的重要性。方法回顾性分析该院从2013年6月—2014年10月在放射科进行诊断和MRI扫描的女性患者79例,采用平扫和增强扫描进行临床检验,通过呈像结果配合手术进行治疗。结果通过增强MRI扫描和临床试验,79例患者中,有55例为良性乳腺肿块,占69.6%,有24例为恶性乳腺肿块,占30.4%。结论增强MRI对良性和恶性的乳腺肿块具有一定的意义,它有效减少对人体的伤害,对鉴别和治疗良恶性乳腺肿块具有重要作用。%Objective To explore the MRI to differential diagnosis of benign and malignant breast enhancement is of great importance. Methods A retrospective analysis of our hospital from June 2013 to October 2014 in diagnostic radiology and MRI scans of 79 cases of female patients, clinical inspection by scan and enhanced scan, as well as through treated with surgery. Results Through enhanced MRI scan and clinical trials, 79 cases of patients, 55 cases of benign breast lumps, accounted for 69.6%, 24 cases of malignant breast lumps, accounting for 30.4%. Conclusion Compared with other methods, enhanced MRI for benign and malignant breast tumors have a certain sense, it effectively reduce the harm to human body, to treatment and plays an important role in identification of benign and malignant breast tumors.

  12. I-124 PET/CT to Predict the Outcome of Blind I-131 Treatment in Patients with Biochemical Recurrence of Differentiated Thyroid Cancer : Results of a Multicenter Diagnostic Cohort Study (THYROPET)

    NARCIS (Netherlands)

    Kist, Jakob W.; de Keizer, Bart; van der Vlies, Manfred; Brouwers, Adrienne H.; Huysmans, Dyde A.; van der Zant, Friso M.; Hermsen, Rick; Stokkel, Marcel P. M.; Hoekstra, Otto S.; Vogel, Wouter V.


    Patients with suspected recurrence from differentiated thyroid carcinoma, based on an increased thyroglobulin (Tg) level and negative neck ultrasound (US), pose a clinical dilemma. Because standard imaging has a low yield identifying potential recurrence, blind I-131 treatment is often applied. Howe

  13. Differential diagnosis between ameloblastoma and odontogenic keratocyst using computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kawazu, Toshiyuki; Yoshiura, Kazunori; Yuasa, Kenji; Kanda, Shigenobu; Ohzeki, Satoru; Shinohara, Masanori [Kyushu Univ., Fukuoka (Japan). Faculty of Dentistry; Araki, Kazuyuki; Higuchi, Yoshinori


    Radiographic features of ameloblastoma and odontogenic keratocyst are similar although their biological behaviors are different. Therefore, it is very important to differentiate these lesions before treatment. The aim of this study was to differentiate between the two lesions based on characteristic CT findings. Fifty-three patients diagnosed histopathologically as having ameloblastoma (29 cases) or odontogenic keratocyst (24 cases) and who underwent CT were evaluated radiologically, and some characteristic radiological features to differentiate both lesions were assessed. Ameloblastomas tended to be more than 40 mm in long diameter and 0.5 short/long diameter ratio, whereas odontogenic keratocysts were less than 40 mm and 0.5, respectively (P<0.05: Chi-square test). Buccal expansion of the cortex was seen more often in ameloblastomas than in odontogenic keratocysts (P<0.05: Chi-square test). Together with these features and internal high density structure, which was only seen in odontogenic keratocysts, differential diagnostic criteria between ameloblastomas and odontogenic keratocysts were proposed. Diagnostic accuracy based on these criteria was 84.9%. These results that our criteria to differentiate ameloblastomas from odontogenic keratocysts using CT are clinically useful prior to treatment. (author)

  14. Sensitive Diagnostics for Chemically Reacting Flows

    KAUST Repository

    Farooq, Aamir


    This talk will feature latest diagnostic developments for sensitive detection of gas temperature and important combustion species. Advanced optical strategies, such as intrapulse chirping, wavelength modulation, and cavity ringdown are employed.

  15. A case of pervasive refusal syndrome: a diagnostic conundrum.

    LENUS (Irish Health Repository)

    McNicholas, Fiona


    A case is presented of an 11-year-old girl with pervasive refusal syndrome (PRS) who ultimately recovered acutely and completely after an 18-month paediatric hospitalisation. There was an apparent absence of previously proposed important aetiological factors in PRS, such as family pathology and markedly traumatic or abusive experiences, and her recovery was sudden and complete. The authors consider the differential diagnoses of PRS paying particular attention to the possibility of a conversion disorder or catatonia, given the absence of PRS in the North American literature. Consideration of catatonia is important as it has a diagnostic test and responds rapidly to appropriate treatment, in contrast to conventional treatment for PRS and conversion disorder.

  16. Validation of three early ejaculation diagnostic tools: a composite measure is accurate and more adequate for diagnosis by updated diagnostic criteria.

    Directory of Open Access Journals (Sweden)

    Patrick Jern

    Full Text Available PURPOSE: To validate three early ejaculation diagnostic tools, and propose a new tool for diagnosis in line with proposed changes to diagnostic criteria. Significant changes to diagnostic criteria are expected in the near future. Available screening tools do not necessarily reflect proposed changes. MATERIALS AND METHODS: Data from 148 diagnosed early ejaculation patients (M age = 42.8 and 892 controls (M age = 33.1 years from a population-based sample were used. Participants responded to three different questionnaires (Premature Ejaculation Profile; Premature Ejaculation Diagnostic Tool; Multiple Indicators of Premature Ejaculation. Stopwatch measured ejaculation latency times were collected from a subsample of early ejaculation patients. We used two types of responses to the questionnaires depending on the treatment status of the patients 1 responses regarding the situation before starting pharmacological treatment and 2 responses regarding current situation. Logistic regressions and Receiver Operating Characteristics were used to assess ability of both the instruments and individual items to differentiate between patients and controls. RESULTS: All instruments had very good precision (Areas under the Curve ranging from .93-.98. A new five-item instrument (named CHecklist for Early Ejaculation Symptoms - CHEES consisting of high-performance variables selected from the three instruments had validity (Nagelkerke R (2 range .51-.79 for backwards/forwards logistic regression equal to or slightly better than any individual instrument (i.e., had slightly higher validity statistics, but these differences did not achieve statistical significance. Importantly, however, this instrument was more in line with proposed changes to diagnostic criteria. CONCLUSIONS: All three screening tools had good validity. A new 5-item diagnostic tool (CHEES based on the three instruments had equal or somewhat more favorable validity statistics compared to the other three

  17. [Differential diagnosis of essential adiposity and Cushings syndrome]. (United States)

    Kubel, M; Schwerdtner, U


    On account of the increasing number of patients with essential obesity the delimitation of the Cushing-syndrome is of actual importance. Two observations of hypercortisolism in hyperplasia of the adrenal glands are reported on and the differential-diagnostically important parameters are demonstrated. According to our opinion anamnesis and clinical findings give the possibility of making a diagnosis already on a large scale. Analyses of the hormones and special X-ray examinations only serve for the preoperative ascertainment and localisation of the endocrine defective function. With the help of literary data causes and possibilities of treatment of Cushing's syndrome are entered.

  18. Optical Diagnostics in Medicine (United States)

    Iftimia, Nicusor


    Light has a unique potential for non-invasive tissue diagnosis. The relatively short wavelength of light allows imaging of tissue at the resolution of histopathology. While strong multiple scattering of light in tissue makes attainment of this resolution difficult for thick tissues, most pathology emanates from epithelial surfaces. Therefore, high-resolution diagnosis of many important diseases may be achieved by transmitting light to the surface of interest. The recent fiber-optic implementation of technologies that reject multiple scattering, such as confocal microscopy and optical low coherence interferometry, have brought us one step closer to realizing non-invasive imaging of architectural and cellular features of tissue. Optical coherence tomography (OCT) can produce high-resolution cross-sectional images of biological structures. Clinical OCT studies conducted in the gastrointestinal tract and cardiovascular system have shown that OCT is capable of providing images of the architectural (> 20 µm) microanatomy of a variety of epithelial tissues, including the layered structure of squamous epithelium and arterial vessels. Fine Needle Aspiration- Low Coherence Interferometry (FNA-LCI) is another optical diagnostics technique, which is a suitable solution to increase the effectiveness of the FNA procedures. LCI is capable of measuring depth resolved (axial, z) tissue structure, birefringence, flow (Doppler shift), and spectra at a resolution of several microns. Since LCI systems are fiber-optic based, LCI probes may easily fit within the bore of a fine gauge needle, allowing diagnostic information to be obtained directly from the FNA biopsy site. Fiber optic spectrally encoded confocal microscopy (SECM) is a new confocal microscopy method, which eliminates the need for rapid beam scanning within the optical probe. This advance enables confocal microscopy to be performed through small diameter probes and will allow assessment of internal human tissues in vivo at

  19. Fever and rash in children: important diagnostic considerations. (United States)

    Gurion, R; Sabella, C; Zeft, A S


    The association of fever with illness has been known for years. A febrile child may have rash, and physicians need to know when this symptom combination is a benign versus a pathologic clinical presentation. In other terms, potential etiologies are either infectious or non-infectious. With scrupulous, methodical history taking and careful, serial physical examination, the treating physician will find hints to assess and solidify an appropriate diagnosis, and chose an appropriate treatment.

  20. The diagnostic importance of the bronchoalveolar lavage in lymphocytic alveolitis. (United States)

    Mlika, Mona; Kria, Nourane; Braham, Emna; Chebbi, Chokri; El Mezni, Faouzi


    Multidisciplinary concertation is mandatory in order to assess interstitial pneumonias. The study of the bronchoalveolar lavage helps evoking a diagnosis according to the lavage profile. In lymphocytic alveolitis, immunocytochemistry, or in flux cytometry are necessary in order to identify the different clusters of lymphocytes implicated. Our objective was to evaluate the profile of 31 lymphocytic alveolitis using 2 different techniques which are the immunocytochemistry and the in flow cytometry in order to evaluate the efficacy of each technique and to compare the different results to the final diagnoses. We describe a retrospective study about 31 patients admitted to our hospital in order to explore an interstitial pneumonia between January and July 2014. Bronchial endoscopy and bronchoalveolar lavage were performed in all cases. The sensitivity of the in flow cytometry was estimated to 53% and its specificity reached 33%. On the other hand, the immunocytochemistry presented a specificity of 42.8% and a sensitivity of 42.8%. The final diagnoses retained consisted in sarcoidosis in 12 cases, infectious pneumonia in 10 cases, hypersensitivity pneumonia in 3 cases, cryptogenic pneumonia in 3 cases, idiopathic fibrosis in 2 cases, and adenocarcinoma in 1 case. The relevance of both techniques depends on many factors. They necessitate an available material, well-trained technicians, and experimented pathologists.

  1. Clinical and diagnostic importance of proteinuria: A review

    African Journals Online (AJOL)



    Sep 17, 2008 ... proteins in urine (proteinuria) is a strong indicator of kidney disease. The assessment of ..... production that occurs in multiple myeloma. The re- ... nates in secondary or memory immune response against infectious ... renal disease progression (Eknoyan et al., 2003). Proper ..... ACEI/ATRA therapy.

  2. Integrated diagnostic technique for nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Gofuku, Akio [Graduate School of Natural Science and Technology, Okayama University, Okayama (Japan)


    It is very important to detect and identify small anomalies and component failures for the safe operation of complex and large-scale artifacts such as nuclear power plants. Each diagnostic technique has its own advantages and limitations. These facts inspire us not only to enhance the capability of diagnostic techniques but also to integrate the results of diagnostic subsystems in order to obtain more accurate diagnostic results. The article describes the outline of four diagnostic techniques developed for the condition monitoring of the fast breeder reactor 'Monju'. The techniques are (1) estimation technique of important state variables based on a physical model of the component, (2) a state identification technique by non-linear discrimination function applying SVM (Support Vector Machine), (3) a diagnostic technique applying WT (Wavelet Transformation) to detect changes in the characteristics of measurement signals, and (4) a state identification technique effectively using past cases. In addition, a hybrid diagnostic system in which a final diagnostic result is given by integrating the results from subsystems is introduced, where two sets of values called confidence values and trust values are used. A technique to determine the trust value is investigated under the condition that the confidence value is determined by each subsystem.

  3. Design of a study on suboptimal cognitive acts in the diagnostic process, the effect on patient outcomes and the influence of workload, fatigue and experience of physician

    Directory of Open Access Journals (Sweden)

    van der Wal Gerrit


    Full Text Available Abstract Background Diagnostic error is an important error type since diagnostic adverse events are regularly judged as being preventable and the consequences are considered to be severe. Existing research often focuses on either diagnostic adverse events or on the errors in diagnostic reasoning. Whether and when an incorrect diagnostic process results in adverse outcomes has not been studied extensively. The present paper describes the design of a study that aims to study the relationship between a suboptimal diagnostic process and patient outcomes. In addition, the role of personal and circumstantial factors on the quality of the diagnostic process will be examined. Methods/Design The research questions were addressed using several data sources. First, the differential diagnosis was assessed concurrently to the diagnostic process. Second, the patient records of 248 patients suffering from shortness of breath were reviewed by expert internists in order to reveal suboptimal cognitive acts and (potential consequences for the patient. The suboptimal cognitive acts were discussed with the treating physicians and classified with the taxonomy of unsafe acts. Third, workload, fatigue and work experience were measured during the physicians work. Workload and fatigue were measured during the physicians shift using the NASA tlx questionnaire on a handheld computer. Physicians participating in the study also answered questions about their work experience. Discussion The design used in this study provides insight into the relationship between suboptimal cognitive acts in the diagnostic process and possible consequences for the patient. Suboptimal cognitive acts in the diagnostic process and its causes can be revealed. Additional measurements of workload, fatigue and experience allow examining the influence of these factors on the diagnostic process. In conclusion, the present design provides a method with which insights in weaknesses of the diagnostic

  4. Differential Diagnosis and Treatment of Career Indecision. (United States)

    Fuqua, Dale R.; Hartman, Bruce W.


    Discusses the need for a better diagnostic approach to career indecision. Suggests a model for differential diagnosis and treatment containing three career indecision types or perspectives, i.e., developmental tasks, acute situational reactions, and chronic psychological concerns. Discusses problems of diagnostic measurement. (WAS)

  5. Diagnostic Development on NSTX

    Energy Technology Data Exchange (ETDEWEB)

    A.L. Roquemore; D. Johnson; R. Kaita; et al


    Diagnostics are described which are currently installed or under active development for the newly commissioned NSTX device. The low aspect ratio (R/a less than or equal to 1.3) and low toroidal field (0.1-0.3T) used in this device dictate adaptations in many standard diagnostic techniques. Technical summaries of each diagnostic are given, and adaptations, where significant, are highlighted.

  6. Biomedical photonics handbook biomedical diagnostics

    CERN Document Server

    Vo-Dinh, Tuan


    Shaped by Quantum Theory, Technology, and the Genomics RevolutionThe integration of photonics, electronics, biomaterials, and nanotechnology holds great promise for the future of medicine. This topic has recently experienced an explosive growth due to the noninvasive or minimally invasive nature and the cost-effectiveness of photonic modalities in medical diagnostics and therapy. The second edition of the Biomedical Photonics Handbook presents fundamental developments as well as important applications of biomedical photonics of interest to scientists, engineers, manufacturers, teachers, studen

  7. Diagnostic Value of 11C-Methionine (MET and 18F-Fluorothymidine (FLT Positron Emission Tomography in Recurrent High-Grade Gliomas; Differentiation from Treatment-Induced Tissue Necrosis

    Directory of Open Access Journals (Sweden)

    Takashi Tamiya


    Full Text Available We retrospectively evaluated the usefulness of combined measurement of L-methyl-[11C]methionine (MET and 3'-deoxy-3'-[18F]fluorothymidine (FLT positron emission tomography (PET in the differential diagnosis between recurrent gliomas and necrotic lesions. Twenty-one patients with high-grade glioma, previously treated with surgery and radiotherapy with chemotherapy and first radiological suspicion of recurrence were enrolled. The uptake was assessed by the maximum standardized uptake value (SUVmax and lesion-to-normal tissue count density ratio (L/N ratio. Of the 21 lesions, 15 were diagnosed recurrent gliomas and six were necrotic lesions. The average SUVmax was not significantly different between recurrent gliomas and necrotic lesions on either MET-PET or FLT-PET. The average L/N ratio of recurrent gliomas (3.36 ± 1.06 was significantly higher than that of necrotic lesions (2.18 ± 0.66 on MET-PET (p < 0.01 and the average L/N ratio of recurrent gliomas (7.01 ± 2.26 was also significantly higher than that of necrotic lesions (4.60 ± 1.23 on FLT-PET (p < 0.01. ROC curve analysis showed that the areas under the curves were high but not different between MET- and FLT-PET. PET studies using MET and FLT are useful in the differentiation of recurrent glioma from treatment-induced necrotic lesion. However, there is no complementary information in the differentiation with simultaneous measurements of MET- and FLT-PET.

  8. Diagnostic discrepancies in clinical practice (United States)

    Issa, Victor Sarli; Dinardi, Layara Fernanda Lipari; Pereira, Thiago Vicente; de Almeida, Lyna Kyria Rodrigues; Barbosa, Thaisa Silveira; Benvenutti, Luiz Alberto; Ayub-Ferreira, Silvia Moreira; Bocchi, Edimar Alcides


    Abstract Autopsies are the gold standard for diagnostic accuracy; however, no recent study has analyzed autopsies in heart failure (HF). We reviewed 1241 autopsies (January 2000–May 2005) and selected 232 patients with HF. Clinical and autopsy diagnoses were analyzed and discrepancies categorized according to their importance regarding therapy and prognosis. Mean age was 63.3 ± 15.9 years; 154 (66.4%) patients were male. The causes of death at autopsy were end-stage HF (40.9%), acute myocardial infarction (17.2%), infection (15.9), and pulmonary embolism 36 (15.5). Diagnostic discrepancies occurred in 191 (82.3%) cases; in 56 (24.1%), discrepancies were related to major diagnoses with potential influence on survival or treatment; pulmonary embolism was the cause of death for 24 (42.9%) of these patients. In 35 (15.1%), discrepancies were related to a major diagnosis with equivocal influence on survival or treatment; in 100 (43.1%), discrepancies did not influence survival or treatment. In multivariate analysis, age (OR: 1.03, 95% CI: 1.008–1.052, P = 0.007) and presence of diabetes mellitus (OR: 0.359, 95% CI: 0.168–0.767, P = 0.008) influenced the occurrence discrepancies. Diagnostic discrepancies with a potential impact on prognosis are frequent in HF. These findings warrant reconsideration in diagnostic and therapeutic practices with HF patients. PMID:28121951

  9. [Diagnostic criteria for neuromyelitisoptica spectrum disorders]. (United States)

    Belova, A N; Boiko, A N; Belova, E M


    The review is devoted to revised international diagnostic criteria for neuromyelitisoptica spectrum disorders (NMOSD).Current diagnostic criteria allow NMOSD diagnosis not only for serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG)-seropositive patients but for AQP4-IgG-seronegative patients as well. New criteria are expected to make NMOSD diagnosis earlier and more accurate as well as to facilitate the differentiation with multiple sclerosis. Furthermore, unify international criteria should help to perform comparable epidemiologic studies and clinical trials of new drugs for NMOSD.

  10. A Case of Brucellosis Associated with Histiocytic Necrotizing Lymphadenitis: A Diagnostic Pitfall.

    Directory of Open Access Journals (Sweden)

    Nicole Dalton Wheeler


    Full Text Available Human cases of brucellosis are rare in the United States and difficult to diagnose. We report a case of a young female who underwent a diagnostic investigation of fever of unknown origin, which included a lymph node biopsy. The biopsy was consistent with Kikuchi’s Disease, or histiocytic necrotizing lymphadenitis, an entity where the major differential diagnosis is systemic lupus erythematosus. Interestingly, serologic studies supported the diagnosis of brucellosis. Brucellosis has rarely been associated with histiocytic necrotizing lymphadenitis. This association has never been reported in the United States, thus suggesting that brucellosis should be considered in the differential for histiocytic necrotizing lymphadenitis, along with lupus-like autoimmune disease. As the prognosis and treatment of histiocytic necrotizing lymphadenitis, brucellosis, and systemic lupus erythematosus are distinct, it is important to differentiate these entities. [J Interdiscipl Histopathol 2013; 1(5.000: 274-279

  11. Singular stochastic differential equations

    CERN Document Server

    Cherny, Alexander S


    The authors introduce, in this research monograph on stochastic differential equations, a class of points termed isolated singular points. Stochastic differential equations possessing such points (called singular stochastic differential equations here) arise often in theory and in applications. However, known conditions for the existence and uniqueness of a solution typically fail for such equations. The book concentrates on the study of the existence, the uniqueness, and, what is most important, on the qualitative behaviour of solutions of singular stochastic differential equations. This is done by providing a qualitative classification of isolated singular points, into 48 possible types.

  12. Radiological diagnosis and differential diagnosis of headache; Radiologische Diagnostik und Differenzialdiagnostik bei Kopfschmerzen im Erwachsenenalter

    Energy Technology Data Exchange (ETDEWEB)

    Langner, S.; Kirsch, M. [University Medicine Greifswald (Germany). Inst. for Diagnostic Radiology and Neuroradiology


    Headache is very common and affects almost everyone at some point. It is one of the most common disorders that leads patients to see their physician. All different forms have the nociception via trigeminal nerve fibers in common. Beside the clinical course headaches are classified as either primary or secondary, with the latter having an identifiable structural or biochemical cause. Imaging has a low diagnostic yield in primary headache but play an important role in the differential diagnosis of secondary forms. An overview of different forms of secondary headache is given, outlining diagnostic procedures and the morphologic imaging features of each syndrome.

  13. Comparative analyses of plasma probe diagnostics techniques

    Energy Technology Data Exchange (ETDEWEB)

    Godyak, V. A. [Electrical Engineering and Computer Science Department, University of Michigan, Ann Arbor, Michigan 48109, USA and RF Plasma Consulting, Brookline, Massachusetts 02446 (United States); Alexandrovich, B. M. [Plasma Sensors, Brookline, Massachusetts 02446 (United States)


    The subject of this paper is a comparative analysis of the plasma parameters inferred from the classical Langmuir probe procedure, from different theories of the ion current to the probe, and from measured electron energy distribution function (EEDF) obtained by double differentiation of the probe characteristic. We concluded that the plasma parameters inferred from the classical Langmuir procedure can be subjected to significant inaccuracy due to the non-Maxwellian EEDF, uncertainty of locating the plasma potential, and the arbitrariness of the ion current approximation. The plasma densities derived from the ion part of the probe characteristics diverge by as much as an order of magnitude from the density calculated according to Langmuir procedure or calculated as corresponding integral of the measured EEDF. The electron temperature extracted from the ion part is always subjected to uncertainty. Such inaccuracy is attributed to modification of the EEDF for fast electrons due to inelastic electron collisions, and to deficiencies in the existing ion current theories; i.e., unrealistic assumptions about Maxwellian EEDFs, underestimation of the ion collisions and the ion ambipolar drift, and discounting deformation of the one-dimensional structure of the region perturbed by the probe. We concluded that EEDF measurement is the single reliable probe diagnostics for the basic research and industrial applications of highly non-equilibrium gas discharge plasmas. Examples of EEDF measurements point up importance of examining the probe current derivatives in real time and reiterate significance of the equipment technical characteristics, such as high energy resolution and wide dynamic range.

  14. How to appraise a diagnostic test. (United States)

    Manikandan, Ramanitharan; Dorairajan, Lalgudi N


    Urologists frequently encounter problems in making a clinical diagnosis whose resolution requires the use of diagnostic tests. With an ever increasing choice of investigations being available, the urologist often has to decide which diagnostic test(s) will best resolve the patient's diagnostic problem. In this article, we aim to help the urologist understand how to critically appraise studies on diagnostic tests and make a rational choice. This article presents the guiding principles in scientifically assessing studies on diagnostic tests by proposing a clinical scenario. The authors describe a standardized protocol to assess the validity of the test and its relevance to the clinical problem that can help the urologist in decision making. The three important issues to be considered when evaluating the validity of the study are to identify how the study population was chosen, how the test was performed and whether there is a comparison to the gold standard test so as to confirm or refute the diagnosis. Then, the urologist would need to know the probability of the test in providing the correct diagnosis in an individual patient in order to decide about its utility in solving the diagnostic dilemma. By performing the steps described in this article, the urologist would be able to critically appraise diagnostic studies and draw meaningful conclusions about the investigations in terms of validity, results and its applicability to the patient's problem. This would provide a scientific basis for using diagnostic tests for improving patient care.


    Directory of Open Access Journals (Sweden)

    N. F. Plavunov


    Full Text Available Disease, with exanthema, pose a significant differential diagnostic difficulty for physicians multidisciplinary hospitals and require the consultation of an infectious disease physician. The article highlights the problem of early diagnostics of acute infectious diseases proceeding with exanthema. The analysis of quality of diagnostics of infectious disease on the outcomes of the consultative infectious ambulance team for 2013-2014.

  16. Diagnostics of Nanodusty Plasma (United States)

    Greiner, Franko; Groth, Sebastian; Tadsen, Bejamin; Piel, Alexander


    The diagnostic of nanodusty plasmas, i.e. plasmas including nano-sized dust particles, is a challenging task. For both, the diagnostic of the nanodusty plasma itself, and the in-situ diagnostic of the nanoparticles, no standard diagnostic exist. Nanodust particle size and density can be estimated using light scattering techniques, namely kinetic Mie ellipsometry and extinction measurements. The charge of the nanoparticles can be estimated from the analysis of dust density waves (DDW). Parameters like the electron density, which give information about the plasma itself, may be deduced from the DDW analysis. We present detailed investigations on nanodust in a reactive Argon-Acetylene plasma created in an rf-driven parallel plate reactor at low pressure using the above mentioned portfolio of diagnostic. Funded by DFG under contract SFB TR-24/A2.

  17. A Framework to Debug Diagnostic Matrices (United States)

    Kodal, Anuradha; Robinson, Peter; Patterson-Hine, Ann


    Diagnostics is an important concept in system health and monitoring of space operations. Many of the existing diagnostic algorithms utilize system knowledge in the form of diagnostic matrix (D-matrix, also popularly known as diagnostic dictionary, fault signature matrix or reachability matrix) gleaned from physical models. But, sometimes, this may not be coherent to obtain high diagnostic performance. In such a case, it is important to modify this D-matrix based on knowledge obtained from other sources such as time-series data stream (simulated or maintenance data) within the context of a framework that includes the diagnostic/inference algorithm. A systematic and sequential update procedure, diagnostic modeling evaluator (DME) is proposed to modify D-matrix and wrapper logic considering least expensive solution first. This iterative procedure includes conditions ranging from modifying 0s and 1s in the matrix, or adding/removing the rows (failure sources) columns (tests). We will experiment this framework on datasets from DX challenge 2009.

  18. [Diagnostic imaging of lying]. (United States)

    Lass, Piotr; Sławek, Jarosław; Sitek, Emilia; Szurowska, Edyta; Zimmermann, Agnieszka


    Functional diagnostic imaging has been applied in neuropsychology for more than two decades. Nowadays, the functional magnetic resonance (fMRI) seems to be the most important technique. Brain imaging in lying has been performed and discussed since 2001. There are postulates to use fMRI for forensic purposes, as well as commercially, e.g. testing the loyalty of employees, especially because of the limitations of traditional polygraph in some cases. In USA fMRI is performed in truthfulness/lying assessment by at least two commercial companies. Those applications are a matter of heated debate of practitioners, lawyers and specialists of ethics. The opponents of fMRI use for forensic purposes indicate the lack of common agreement on it and the lack of wide recognition and insufficient standardisation. Therefore it cannot serve as a forensic proof, yet. However, considering the development of MRI and a high failure rate of traditional polygraphy, forensic applications of MRI seem to be highly probable in future.

  19. Diagnostic neuroimaging across diseases (United States)

    Klöppel, Stefan; Abdulkadir, Ahmed; Jack, Clifford R.; Koutsouleris, Nikolaos; Mourao-Miranda, Janaina; Vemuri, Prashanthi


    Fully automated classification algorithms have been successfully applied to diagnose a wide range of neurological and psychiatric diseases. They are sufficiently robust to handle data from different scanners for many applications and in specific cases outperform radiologists. This article provides an overview of current applications taking structural imaging in Alzheimer's Disease and schizophrenia as well as functional imaging to diagnose depression as examples. In this context, we also report studies aiming to predict the future course of the disease and the response to treatment for the individual. This has obvious clinical relevance but is also important for the design of treatment studies that may aim to include a cohort with a predicted fast disease progression to be more sensitive to detect treatment effects. In the second part, we present our own opinions on i) the role these classification methods can play in the clinical setting; ii) where their limitations are at the moment and iii) how those can be overcome. Specifically, we discuss strategies to deal with disease heterogeneity, diagnostic uncertainties, a probabilistic framework for classification and multi-class classification approaches. PMID:22094642

  20. Diagnostic and Prognostic Biomarkers in Melanoma (United States)

    Leininger, Jennifer; Hamby, Carl; Safai, Bijan


    Melanoma is a lethal melanocytic neoplasm. Unfortunately, the histological diagnosis can be difficult at times. Distinguishing ambiguous melanocytic neoplasms that are benign nevi from those that represent true melanoma is important both for treatment and prognosis. Diagnostic biomarkers currently used to assist in the diagnosis of melanoma are usually specific only for melanocytic neoplasms and not necessarily for their ability to metastasize. Traditional prognostic biomarkers include depth of invasion and mitotic count. Newer diagnostic and prognostic biomarkers utilize immunohistochemical staining as well as ribonucleic acid, micro-ribonucleic acid, and deoxyribonucleic acid assays and fluorescence in situ hybridization. Improved diagnostic and prognostic biomarkers are of increasing importance in the treatment of melanoma with the development of newer and more targeted therapies. Herein, the authors review many of the common as well as newer diagnostic and prognostic biomarkers used in melanoma. PMID:25013535



    Slobodanka STOILKOVIC


    Ways of obtaining findings for detection of etiology of impairment and time of the hearing damages;· Methods of diagnostic of hearing difficulties;· Problems that appear in the early diagnostics;· The role and importance of the audiorehabilitator in diagnostic of a child with hearing difficulties;· ”Useful time” and phases of speech development;· The role and benefit of the selective amplification in the treatment of children with hearing difficulties;· Characteristic audiograms for every...


    Directory of Open Access Journals (Sweden)

    Slobodanka STOILKOVIC


    Full Text Available Ways of obtaining findings for detection of etiology of impairment and time of the hearing damages;· Methods of diagnostic of hearing difficulties;· Problems that appear in the early diagnostics;· The role and importance of the audiorehabilitator in diagnostic of a child with hearing difficulties;· ”Useful time” and phases of speech development;· The role and benefit of the selective amplification in the treatment of children with hearing difficulties;· Characteristic audiograms for every group of children with hearing difficulties.

  3. RUNX1 Plays an Important Role in Mediating BMP9-Induced Osteogenic Differentiation of Mesenchymal Stem Cells Line C3H10T1/2, Murine Multi-Lineage Cells Lines C2C12 and MEFs. (United States)

    Ji, Caixia; Liu, Xiaohua; Xu, Li; Yu, Tingting; Dong, Chaoqun; Luo, Jinyong


    As one of the least studied bone morphogenetic proteins (BMPs), BMP9 is highly capable of promoting osteogenic differentiation. However, the underlying mechanism involved remains largely unknown. Recent studies have demonstrated that RUNX1 (runt-related transcription factor 1) is essential in osteoblast/chondrocyte maturation. In this study, we investigated the function of RUNX1 in BMP9-induced osteogenic of murine mesenchymal stem cell line (C3H10T1/2) and murine multi-lineage cell lines (C2C12 and MEFs). Our data showed that BMP9 promoted the endogenous expression of RUNX1 in C3H10T1/2, C2C12 and MEFs. Moreover, RUNX1 was probably a direct target of BMP9/Smad signaling. BMP9-induced osteogenic differentiation was enhanced by overexpression of RUNX1, whereas inhibited by knockdown RUNX1 in C3H10T1/2, C2C12 and MEFs. Further mechanism studies demonstrated that RUNX1 might affect BMP9-induced phosphorylation of Smad1/5/8, but not the phosphorylation of p38 and ERK1/2.Our results suggest that RUNX1 may be an essential modulator in BMP9- induced osteogenic differentiation of MSCs (Mesenchymal stem cells).

  4. Myoblast differentiation of human mesenchymal stem cells on graphene oxide and electrospun graphene oxide-polymer composite fibrous meshes: importance of graphene oxide conductivity and dielectric constant on their biocompatibility. (United States)

    Chaudhuri, Biswadeep; Bhadra, Debabrata; Moroni, Lorenzo; Pramanik, Krishna


    Recently graphene and graphene based composites are emerging as better materials to fabricate scaffolds. Addition of graphene oxide (GO) nanoplatelets (GOnPs) in bioactive polymers was found to enhance its conductivity (σ) and, dielectric permittivity (ϵ) along with biocompatibility. In this paper, human cord blood derived mesenchymal stem cells (CB-hMSCs) were differentiated to skeletal muscle cells (hSkMCs) on spin coated thin GO sheets composed of GOnPs and on electrospun fibrous meshes of GO-PCL (poly-caprolactone) composite. Both substrates exhibited excellent myoblast differentiations and promoted self-alignedmyotubesformation similar to natural orientation. σ, ϵ, microstructural and vibration spectroscopic studies were carried out for the characterizations of GO sheet and the composite scaffolds. Significantly enhanced values of both σ and ϵ of the GO-PCL composite were considered to provide favourable cues for the formation of superior multinucleated myotubes on the electrospun meshes compared to those on thin GO sheets. The present results demonstrated that both substrates might be used as potential candidates for CB-hMSCs differentiation and proliferation for human skeletal muscle tissue regeneration.

  5. Sexually transmitted papillomavirus infections: epidemiology pathogenesis, clinic, morphology, important differential diagnostic aspects, current diagnostic and treatment options Infecções por papilomavírus sexualmente transmitida: epidemiologia, patogênese, clínica, morfologia, aspectos importantes do diagnóstico diferencial, diagnóstico atual e opções de tratamento

    Directory of Open Access Journals (Sweden)

    Georgi Tchernev


    Full Text Available The family of human papilloma viruses (HPV comprises more than 100 genotypes. Approximately 30 of the genotypes are responsible for infections in the human anogenital area. A precisely defined algorithm with the goal of diagnosing and removing HPV for a prolonged or indefinite length of time, as well as to protect the patient from any malignant ransformation, does not currently exist. The identification of HPV strains by PCR or DNA hybridization in lesional tissue provides higher security for the patients. In high-risk patients additional colposcopy, rectoscopy, and rethroscopy/cystoscopy increase the probability of proper diagnosis and the application of a reliable therapeutic strategy. Removal of lesions by means of invasive methods, such as electrodessication, cryosurgery, and/or laser therapy, may be successful and could be combined pre- and postoperatively with the local application of podophyllotoxin, Trichloroacetic acid, 5-fluorouracil epinephrine gel, imiquimod, cidofovir or interferon. The administration of vaccine to young patients prevents to a significant extent the clinical manifestation of the most frequent viral strains, being HPV-6,-11 and -18. The different therapeutic methods must be applied in accordance with the clinical picture, taking into account the patient's general status, the presence of concomitant diseases, as well as the local and systematic compatibility of the side effects of each remedy. The review focuses on the diagnosis and treatment options of sexually transmitted HPV-infections and includes synopsis of the most recent literature regarding new data of epidemiology, pathogenesis, ifferential diagnosis and morphology of HPV infections in humans.A família de papiloma vírus humano (HPV compreende mais de 100 genótipos. Aproximadamente 30 dos genótipos são responsáveis pelas infecções na área anogenital em humanos. Não dispomos no momento de um algoritmo precisamente definido tendo como meta o diagnóstico e a remoção de HPV por períodos de tempo prolongados ou indefinidos, nem para proteção do paciente contra transformação maligna. A identificação das cepas de HPV por PCR ou hibridização de DNA em tecido lesional oferece maior segurança para os pacientes. Em pacientes de alto risco realiza-se ainda colposcopia, rectoscopia e uretroscopia/ cistoscopia, aumentando a probabilidade do diagnóstico correto e a aplicação de estratégia terapêutica confiável. A remoção das lesões por meio de métodos invasivos, como a eletrodissecção, criocirurgia, e/ou terapia com laser, pode ser bem sucedida e combinada no pré e no pós-operatório com a aplicação local de toxina podofílica, ácido tricloroacético, gel de epinefrina 5-fluorouracil, imiquimod, cidofovir ou interferon. A administração da vacina em pacientes jovens é capaz de previnir as manifestações clínicas das cepas virais mais frequentes, que são HPV-6, -11 e -18. Os diferentes métodos terapêuticos devem ser aplicados de acordo com o quadro clínico, levando em consideração o estado de saúde geral do paciente, a presença de doenças concomitantes, assim como a compatibilidade local e sistêmica dos efeitos adversos em cada remédio. A revisão foca o diagnóstico e as opções de tratamento de infecções por HPV sexualmente transmitidas e inclui uma sinopse da literatura mais recente no que diz respeito aos dados de epidemiologia, patogênese, diagnóstico diferencial e morfologia de infecções por HPV em humanos.

  6. Importância e vantagem da citometria de fluxo frente aos testes de triagem no diagnóstico da hemoglobinúria paroxística noturna Importance and advantages of flow cytometry in screening tests for paroxysmal nocturnal hemoglobinuria diagnostic

    Directory of Open Access Journals (Sweden)

    Thaís M. Modesto


    CD55 e CD59 proteins investigation through gel column agglutination were evaluated using flow cytometry, a test useful to detect and measure the PNH clone. Initially, 63 patients evaluated using the Ham's test between January 2003 and December 2004 from the Hemope Foundation were selected. From these, 15 cases were positive for PNH. The inclusion criterion for cytometry evaluation was a positive Ham's test. Thus, four patients were included in the study group. Furthermore, two cases with clinical symptoms of the disease but with negative results for PNH were included in this group. Negative results were explained by the gel test being performed after blood transfusion, giving a suspicion of false negative results. These six cases were submitted to flow cytometry with all cases proving to be positive for the disease as the PNH clone was confirmed, to different degrees, in both erythrocytes and granulocytes. The flow cytometry results proved the limitation of screening tests as well as showing the importance of cytometry in the identification of the intense variations of clone guaranteeing precise diagnosis in previously transfused patients.

  7. Statefinder diagnostic in a torsion cosmology

    CERN Document Server

    Li, Xin-zhou; Xi, Ping


    We apply the statefinder diagnostic to the torsion cosmology, in which an accounting for the accelerated universe is considered in term of a Riemann-Cartan geometry: dynamic scalar torsion. We find that there are some typical characteristic of the evolution of statefinder parameters for the torsion cosmology that can be distinguished from the other cosmological models. Furthermore, we also show that statefinder diagnostic has a direct bearing on the critical points. The statefinder diagnostic divides the torsion parameter $a_1$ into differential ranges, which is in keeping with the requirement of dynamical analysis. In addition, we fit the scalar torsion model to ESSENCE supernovae data and give the best fit values of the model parameters.

  8. Diagnostics in critical conditions

    Directory of Open Access Journals (Sweden)



    Full Text Available The purpose of research: improvement of quality of diagnostics at the patients in a critical condition in intensive care unit. Material and methods. In total have analyzed 1957 medical cards of the patients who have died in ICU»s. At the first stage studied the factors influencing on diagnostics of critically ill patients (medical cards of 1557 patients; at the second stage investigated influence of the diagnostic standards in ICU»s practice on improvement of quality of diag- nostics of critically ill patients (400 medical cards of the patients who have died. Entry criterions were standards and algorithm of diagnostics. Techniques of research: average bed-day in groups, first-day lethality, quantity of the carried out laboratory tests and tool methods of research, level of consciousness of the patients (Glasgow come score, severity of disease by ICU»s patients (APACHE II scores. Results. Quality of diagnostics depend on carried out laboratory tests and tool methods of research, level of consciousness of the patients (Glasgow come score, severity of disease by ICU»s patients (APACHE II score. The conclusion. The laboratory tests and tool methods of research conforming to the standards of diagnostics are necessary for improvement of quality of diagnostics, it is necessary to take into account an altered level of consciousness (Glasgow come score and severity of disease by ICU»s patients (APACHE II scores

  9. [Intrascrotal lipoblastoma in childhood: diagnostic strategies and therapy planning]. (United States)

    Promm, M; Reingruber, B; Rösch, W H


    Based on a case report of an intrascrotal lipoblastoma in childhood, we present the preoperative diagnostic algorithm and the main differential diagnoses in testicular and paratesticular tumors as well as their surgical management. An 8-week-old infant was admitted with a scrotal tumor known since birth. MRI showed a pinnate vessel supply, originating in the left internal iliac artery. The tumor was exposed operatively and could be completely removed. Intrascrotal lipoblastoma are rare. Like most testicular and paratesticular tumors in childhood lipoblastomas are benign. Today ultrasound and Doppler sonography are basic tools for diagnosis and surgical planning in testicular and scrotal tumors in childhood. In some cases MRI can provide additional important information for surgical planning. In contrast to adults testis sparing surgery is favoured in children.

  10. [Current and future diagnostic strategies in venous thromboembolic disease]. (United States)

    Gabriel Botella, F; Labiós Gómez, M; Brasó Aznar, J V; Llavador Ros, G; Bort Martí, J


    Thromboembolic disease (TD), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is the most common acute cardiovascular condition after ischemic cardiopathy and stroke. It is often difficult to diagnose, as it is well-known that half of PE episodes appear are recognized while the patient is still alive and which appear in 30-40% of symptomatic patients. Nonetheless, there are two well-differentiated phases in the diagnosis of TD: the suspicion, and the diagnosis. The first is very important, and is within the competence of any physician. The second can be ratified when carrying out specific tests. We have developed successive steps in the two phases of diagnosis, we critically review the distinct parts currently implicated in the strategic diagnosis of TD. Finally, we analyze the new diagnostic techniques to substitute, possibly, angiography in many cases, and perhaps to include ventilation/perfusion (V/Q) pulmonary gammagraphy, once become generally available.

  11. Cable Diagnostic Focused Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Hartlein, R.A.; Hampton, R.N.


    This report summarizes an extensive effort made to understand how to effectively use the various diagnostic technologies to establish the condition of medium voltage underground cable circuits. These circuits make up an extensive portion of the electric delivery infrastructure in the United States. Much of this infrastructure is old and experiencing unacceptable failure rates. By deploying efficient diagnostic testing programs, electric utilities can replace or repair circuits that are about to fail, providing an optimal approach to improving electric system reliability. This is an intrinsically complex topic. Underground cable systems are not homogeneous. Cable circuits often contain multiple branches with different cable designs and a range of insulation materials. In addition, each insulation material ages differently as a function of time, temperature and operating environment. To complicate matters further, there are a wide variety of diagnostic technologies available for assessing the condition of cable circuits with a diversity of claims about the effectiveness of each approach. As a result, the benefits of deploying cable diagnostic testing programs have been difficult to establish, leading many utilities to avoid the their use altogether. This project was designed to help address these issues. The information provided is the result of a collaborative effort between Georgia Tech NEETRAC staff, Georgia Tech academic faculty, electric utility industry participants, as well as cable system diagnostic testing service providers and test equipment providers. Report topics include: •How cable systems age and fail, •The various technologies available for detecting potential failure sites, •The advantages and disadvantages of different diagnostic technologies, •Different approaches for utilities to employ cable system diagnostics. The primary deliverables of this project are this report, a Cable Diagnostic Handbook (a subset of this report) and an online

  12. Diagnostic Ultrasound in Colorectal Cancer

    DEFF Research Database (Denmark)

    Rafaelsen, Søren Rafael


    SUMMARYBackground and purpose Colorectal cancer is a common disease in Denmark with considerable morbidity and mortality. Although survival in recent years has improved, Denmark still has the lowest 5-year survival compared to the other Nordic countries. The treatment of patients depends on local...... the potential to contribute to the staging of colorectal cancer. The purpose of these studies was to determine the usefulness of ultrasound diagnostics in patients with colorectal cancer.The purpose of the TRUS studies was to compare staging of rectal carcinomas using digital rectal exploration...... with the resulting pathological examination in relation to differentiating benign from malignant polyps and determining tumour stage and lymph node status. In this context we also performed an observer comparison using both TRUS and MRI. Consistency of tumour outgrowth of rectal cancer rated by TRUS and MRI...

  13. Optical tweezers for medical diagnostics. (United States)

    LaFratta, Christopher N


    Laser trapping by optical tweezers makes possible the spectroscopic analysis of single cells. Use of optical tweezers in conjunction with Raman spectroscopy has allowed cells to be identified as either healthy or cancerous. This combined technique is known as laser tweezers Raman spectroscopy (LTRS), or Raman tweezers. The Raman spectra of cells are complex, since the technique probes nucleic acids, proteins, and lipids; but statistical analysis of these spectra makes possible differentiation of different classes of cells. In this article the recent development of LTRS is described along with two illustrative examples for potential application in cancer diagnostics. Techniques to expand the uses of LTRS and to improve the speed of LTRS are also suggested.

  14. [Injury pattern on the hand after slipping onto the blade during a knife attack--a contribution to the differential diagnostic classification of sharp force injuries of the upper extremities]. (United States)

    Tsokos, Michael; Braun, Christian


    Differential diagnosis of injuries caused by accidental slipping of the hand onto the blade of a knife includes self-inflicted injuries (e.g. to simulate an offense) as well as active and passive defense injuries indicative of the involvement of another party. The injury pattern on the hands of five perpetrators who suffered accidental cuts during knife attacks, as seen by the authors during the clinical forensic examination, is presented. The injuries were localized on the ulnar aspect of the thumb facing the index finger, the radial aspect of the index finger facing the thumb and variable sites on the flexor or extensor side of the middle and ring fingers. Especially in those cases in which the injuries of the victim (e.g. involvement of bony structures) and the dominant hand of the perpetrator are known, additional information for the reconstruction of the course of events may be derived from the cut wounds occurring during the knife attack as the hand slipped onto the blade.

  15. A Comparison between Electrochemical Impedance Spectroscopy and Incremental Capacity-Differential Voltage as Li-ion Diagnostic Techniques to Identify and Quantify the Effects of Degradation Modes within Battery Management Systems (United States)

    Pastor-Fernández, Carlos; Uddin, Kotub; Chouchelamane, Gael H.; Widanage, W. Dhammika; Marco, James


    Degradation of Lithium-ion batteries is a complex process that is caused by a variety of mechanisms. For simplicity, ageing mechanisms are often grouped into three degradation modes (DMs): conductivity loss (CL), loss of active material (LAM) and loss of lithium inventory (LLI). State of Health (SoH) is typically the parameter used by the Battery Management System (BMS) to quantify battery degradation based on the decrease in capacity and the increase in resistance. However, the definition of SoH within a BMS does not currently include an indication of the underlying DMs causing the degradation. Previous studies have analysed the effects of the DMs using incremental capacity and differential voltage (IC-DV) and electrochemical impedance spectroscopy (EIS). The aim of this study is to compare IC-DV and EIS on the same data set to evaluate if both techniques provide similar insights into the causes of battery degradation. For an experimental case of parallelized cells aged differently, the effects due to LAM and LLI were found to be the most pertinent, outlining that both techniques are correlated. This approach can be further implemented within a BMS to quantify the causes of battery ageing which would support battery lifetime control strategies and future battery designs.

  16. Melioidosis Diagnostic Workshop, 20131 (United States)

    AuCoin, David; Baccam, Prasith; Baggett, Henry C.; Baird, Rob; Bhengsri, Saithip; Blaney, David D.; Brett, Paul J.; Brooks, Timothy J.G.; Brown, Katherine A.; Chantratita, Narisara; Cheng, Allen C.; Dance, David A.B.; Decuypere, Saskia; Defenbaugh, Dawn; Gee, Jay E.; Houghton, Raymond; Jorakate, Possawat; Lertmemongkolchai, Ganjana; Limmathurotsakul, Direk; Merlin, Toby L.; Mukhopadhyay, Chiranjay; Norton, Robert; Peacock, Sharon J.; Rolim, Dionne B.; Simpson, Andrew J.; Steinmetz, Ivo; Stoddard, Robyn A.; Stokes, Martha M.; Sue, David; Tuanyok, Apichai; Whistler, Toni; Wuthiekanun, Vanaporn; Walke, Henry T.


    Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions. PMID:25626057

  17. Paediatric diagnostic audiology testing in South Africa. (United States)

    Moodley, Selvarani


    With the increased emphasis on the importance of early identification of paediatric hearing loss within developing countries such as South Africa and Nigeria there has been a recognition of the ethical obligation to ensure access to timely diagnostic and intervention services for children identified with hearing loss; regardless of their geographic or socioeconomic status. There are limited studies on diagnosis of paediatric hearing loss in a developing world context. The objective of this study was to determine processes used for diagnosis of paediatric hearing loss in South Africa, across the private and public healthcare sectors, and to profile the age of testing for each component of the diagnostic test battery. Diagnostic audiology testing data of 230 children enrolled in an early intervention programme was analysed to profile the reporting of diagnostic audiology testing as well as diagnostic audiology procedures employed. Results were analysed according to province as well as healthcare sector to compare diagnostic services across regions as well as healthcare sectors. The differences in audiology practice and tests employed with paediatric clients across the regions of Gauteng, Kwazulu Natal and Western Cape indicates that services across regions and across the public and private sector are not equitable. Each region is equally unlikely to complete a full, comprehensive diagnostic evaluation on paediatric clients. The age of testing highlights the increased age of diagnosis of hearing loss. Paediatric diagnostic audiology is a section of Early Hearing Detection and Intervention services that requires attention in terms of the appropriateness of procedures as well as equity of services. Further studies on diagnostic practice and resources in South Africa will provide information on factors that are preventing adherence to international best practice guidelines for paediatric diagnostic audiology. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. The investigation and differential diagnosis of Asperger syndrome in adults. (United States)

    Lehnhardt, Fritz-Georg; Gawronski, Astrid; Pfeiffer, Kathleen; Kockler, Hanna; Schilbach, Leonhard; Vogeley, Kai


    As a result of the increased public interest in autism spectrum disorders (ASD), certain core manifestations of ASD--impaired social interaction and communication, bizarre interests--are now commonly recognized as being typical of autism, not only in children, but in adults as well. More often than before, general practitioners, neurologists, and psychiatrists find themselves being asked whether a patient is suffering from previously unrecognized Asperger syndrome (AS). The prevalence of ASD is estimated at 1%, and the ratio of diagnosed to undiagnosed cases at about 3:2. Little is known about the diagnostic evaluation of AS in adulthood. We selectively searched the Medline database for pertinent literature, paying special attention to diagnostic manuals and to the guideline of the United Kingdom's National Institute for Health and Care Excellence (NICE). Centrally important aspects of the diagnosis of AS include an assessment of the patient's ability to assume the emotional perspectives of others, non-verbal modes of expression, repetitive behavior patterns, and childhood social behavioral history. The autism quotient (AQ) is now established as a simple but nonspecific screening test. Up to 70% of all affected adults have comorbid disturbances, most often depression and anxiety disorders. The differential diagnosis includes personality disorders, anxiety disorders, obsessive-compulsive disorder, and attention deficit-hyperactivity disorder. The diagnostic assessment should proceed in stepwise fashion, starting from simple screening in primary care and then moving on to evaluation of the suspected diagnosis by a mental health care specialist, followed by extensive further investigation in an outpatient clinic specifically devoted to patients with autism spectrum disorders. The diagnostic assessment of autism in adults requires knowledge of the core and accompanying manifestations of autism and of their differential diagnoses. More research is needed for the

  19. Diagnostic validity of basic symptoms. (United States)

    Klosterkötter, J; Ebel, H; Schultze-Lutter, F; Steinmeyer, E M


    Although the Bonn Scale for the Assessment of Basic Symptoms (BSABS) [13] has come into use in several European countries, its diagnostic validity has not yet been sufficiently examined. That is why we have assessed BSABS items on a sample of 243 consecutive admissions to the Department of Psychiatry at the RWTH University, Aachen, and 79 psychologically healthy persons. Then, a cluster analysis was calculated to identify the empirical item-grouping. Five well-interpretable BSABS subsyndromes were found. In addition, uni- and multivariate analyses were computed to evaluate the diagnostic validity of these subsyndromes. We were able to show that every BSABS subsyndrome separates at least schizophrenic, organic mental and affective disorders from personality, neurotic and substance-induced disorders, as well as from psychological health. Furthermore, the subsyndrome "information processing disturbances" differentiates between schizophrenic and organic mental disorders, on the one hand, and affective disorders, on the other, and additionally, the subsyndrome "interpersonal irritation" between schizophrenics and all other persons examined.

  20. New diagnostic criteria for neurocysticercosis: Reliability and validity (United States)

    Fleury, Agnès; Romo, Matthew L.; Abraham, Ronaldo; Fandiño, Jaime; Durán, Juan C.; Cárdenas, Graciela; Moncayo, Jorge; Leite Rodrigues, Cleonísio; San‐Juan, Daniel; Serrano‐Dueñas, Marcos; Takayanagui, Oswaldo; Sander, Josemir W.


    Objective The diagnosis of neurocysticercosis (NCC) remains problematic because of the heterogeneity of its clinical, immunological, and imaging characteristics. Our aim was to develop and assess a new set of diagnostic criteria for NCC, which might allow for the accurate detection of, and differentiation between, parenchymal and extraparenchymal disease. Methods A group of Latin American NCC experts developed by consensus a new set of diagnostic criteria for NCC. A multicenter, retrospective study was then conducted to validate it. The reference standard for diagnosis of active NCC was the disappearance or reduction of cysts after anthelmintic treatment. In total, three pairs of independent neurologists blinded to the diagnosis evaluated 93 cases (with NCC) and 93 controls (without NCC) using the new diagnostic criteria. Mixed‐effects logistic regression models were used to estimate sensitivity and specificity. Results Inter‐rater reliability (kappa) of diagnosis among evaluators was 0.60. For diagnosis of NCC versus no NCC, the new criteria had a sensitivity of 93.2% and specificity of 81.4%. For parenchymal NCC, the new criteria had a sensitivity of 89.8% and specificity of 80.7% and for extraparenchymal NCC, the new criteria had a sensitivity of 65.9% and specificity of 94.9%. Interpretation These criteria have acceptable reliability and validity and could be a new tool for clinicians and researchers. An advantage of the new criteria is that they consider parasite location (ie, parenchymal or extraparenchymal), which is an important factor determining the clinical, immunological, and radiological presentation of the disease, and importantly, its treatment and prognosis. Ann Neurol 2016;80:434–442 PMID:27438337

  1. New diagnostic criteria for neurocysticercosis: Reliability and validity. (United States)

    Carpio, Arturo; Fleury, Agnès; Romo, Matthew L; Abraham, Ronaldo; Fandiño, Jaime; Durán, Juan C; Cárdenas, Graciela; Moncayo, Jorge; Leite Rodrigues, Cleonísio; San-Juan, Daniel; Serrano-Dueñas, Marcos; Takayanagui, Oswaldo; Sander, Josemir W


    The diagnosis of neurocysticercosis (NCC) remains problematic because of the heterogeneity of its clinical, immunological, and imaging characteristics. Our aim was to develop and assess a new set of diagnostic criteria for NCC, which might allow for the accurate detection of, and differentiation between, parenchymal and extraparenchymal disease. A group of Latin American NCC experts developed by consensus a new set of diagnostic criteria for NCC. A multicenter, retrospective study was then conducted to validate it. The reference standard for diagnosis of active NCC was the disappearance or reduction of cysts after anthelmintic treatment. In total, three pairs of independent neurologists blinded to the diagnosis evaluated 93 cases (with NCC) and 93 controls (without NCC) using the new diagnostic criteria. Mixed-effects logistic regression models were used to estimate sensitivity and specificity. Inter-rater reliability (kappa) of diagnosis among evaluators was 0.60. For diagnosis of NCC versus no NCC, the new criteria had a sensitivity of 93.2% and specificity of 81.4%. For parenchymal NCC, the new criteria had a sensitivity of 89.8% and specificity of 80.7% and for extraparenchymal NCC, the new criteria had a sensitivity of 65.9% and specificity of 94.9%. These criteria have acceptable reliability and validity and could be a new tool for clinicians and researchers. An advantage of the new criteria is that they consider parasite location (ie, parenchymal or extraparenchymal), which is an important factor determining the clinical, immunological, and radiological presentation of the disease, and importantly, its treatment and prognosis. Ann Neurol 2016;80:434-442. © 2016 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.

  2. Thioaptamer Diagnostic System Project (United States)

    National Aeronautics and Space Administration — AM Biotechnologies (AM) in partnership with Sandia National Laboratories will develop a Thioaptamer Diagnostic System (TDS) in response to Topic X10.01 Reusable...

  3. Rotorcraft Diagnostics Project (United States)

    National Aeronautics and Space Administration — Under this SBIR program, Ridgetop will introduce the first low-cost, low-power, and lightweight data monitoring solution for rotorcraft diagnostics. The solution is...

  4. National Convective Weather Diagnostic (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Current convective hazards identified by the National Convective Weather Detection algorithm. The National Convective Weather Diagnostic (NCWD) is an automatically...

  5. Prenatal Genetic Diagnostic Tests (United States)

    ... are offered to all pregnant women. What is amniocentesis? Amniocentesis is a diagnostic test. It usually is done ... a very small chance of pregnancy loss with amniocentesis. Leakage of amniotic fluid and slight bleeding can ...

  6. Empirical evaluation of the accuracy of diagnostic criteria for Restless Legs Syndrome. (United States)

    Benes, Heike; von Eye, Alexander; Kohnen, Ralf


    In accordance with the diagnostic criteria of the International Restless Legs Syndrome (RLS) Study Group, the diagnosis of RLS is exclusively based on subjective information. Patients must report an urge to move the legs (and arms) with or without unpleasant sensations which is engendered by rest, relieved by movement, and worse in the evening or at night than during the day (essential criteria). Objective information such as excessive periodic leg movements, positive response to dopaminergic medication, family history of RLS or findings of a neurological examination cannot substitute any of the essential criteria but are considered both supportive for the RLS diagnosis and important for decisions on differential diagnoses. In this article, we report a systematic empirical analysis of the accuracy of diagnostic decisions based on all diagnostic criteria being either "essential" or "non-essential." We re-analyzed data from a validation study for the RLS Diagnostic Index, in which ten items related to diagnostic criteria were compared with an expert diagnosis of RLS (n = 86) and other sleep-related diagnoses (n = 93). The value of individual diagnostic criteria and features of RLS predictive of the expert diagnoses were analyzed with logistic regression models by increasing the set of diagnostic criteria stepwise based on delta-chi(2) tests. The essential diagnostic criteria share a large amount of variance in the prediction of the expert diagnosis. Three of the four essential criteria (urge to move the legs, which is engendered by rest and worse in the evening) almost completely determine the expert diagnosis. However, adding response to dopaminergic medication to the set of the essential criteria increased the effect size in the logistic regression model from 69.4% to 88.4%, indicating a relevant improvement of the accuracy in supporting or excluding the diagnosis of RLS. On the basis of our exploratory empirical analysis we conclude that the accuracy of diagnostic

  7. Optics/Optical Diagnostics Laboratory (United States)

    Federal Laboratory Consortium — The Optics/Optical Diagnostics Laboratory supports graduate instruction in optics, optical and laser diagnostics and electro-optics. The optics laboratory provides...

  8. Infectious spondylitis and its differential diagnosis; Spondylitis und ihre Differenzialdiagnosen

    Energy Technology Data Exchange (ETDEWEB)

    Erlemann, Rainer [Helios St. Johannes Klinik, Duisburg (Germany). Inst. fuer Radiologie; Hoogeveen, Anja [AKH Viersen (Germany)


    Infectious spondylitis can be diagnosed early and reliably by MRI, given that the most important diagnostic criteria are present. These criteria are bone marrow edema adjacent to two contiguous vertebral end plates, disk space of high signal intensity and enhancement of bone adjacent to two contiguous vertebral end plates and of the disk space. If not all of these criteria are present, diagnostic accuracy decreases. Erosive osteochondritis, spondylarthritis, osteoporotic fractures of two contiguous vertebral end plates, active Schmorl's nodes as well as neuropathic spine may mimic an infectious spondylitis. This paper presents typical and atypical morphologic patterns of infectious spondylitis as well as the differentiation criteria from the above mentioned diseases. (orig.)

  9. Wide complex tachycardia in the presence of class I antiarrhythmic agents: a diagnostic challenge. (United States)

    Bhardwaj, Bhaskar; Lazzara, Ralph; Stavrakis, Stavros


    We present two patients with paroxysmal atrial fibrillation on class 1C antiarrhythmic drugs without concomitant atrioventricular (AV) nodal blocking agents who developed atrial flutter with 1:1 AV conduction. Their electrocardiogram revealed wide complex tachycardia with rates >200/minute. Atrial flutter with 1:1 conduction in the presence of class IC antiarrhythmic drugs may present a diagnostic challenge. These cases illustrate the importance of coadministering an AV nodal blocking agent with class IC antiarrhythmic agents in patients with atrial fibrillation. The differential diagnosis of wide complex tachycardia in patients taking class IC agents should include atrial flutter with 1:1 AV conduction.

  10. Fluorescence diagnostics in oncological gynecology (United States)

    Belyaeva, Ludmila A.; Adamyan, Leila V.; Kozachenko, Vladimir P.; Stratonnikov, Alexander A.; Stranadko, Eugene F.; Loschenov, Victor B.


    The method of fluorescent diagnostics (FD) of tumors is a promising tool that may allow to increase sensitivity of tumor detection especially at initial stages. One of the most promising photosensitizers today is 5-aminolevulinic acid (5-ALA) that, actually, is not photosensitizer itself but precursor of protoporphyrin IX (PpIX). This paper deals with cancer diagnostics in gynecology by means of ALA-induced Pp IX laser-fluorescence spectroscopy. The tissue fluorescence spectra in vivo were studied in patients with various pathologies of ovaries, uterine and vulva after 5-aminolevulinic acid administration. It was shown that different pathologies varies in accumulation of Pp IX. Coefficient of fluorescence kf for normal tissue is not high, but exceptions are endometrium and mucous membrane of uterine tubes. Benign tumors of uterus and ovary have low values of kf, but polyps of endometrium exhibit high kf. Optical express-biopsy is important for diagnosis of ovarian cancer and micrometastatic spread. Coefficients of diagnostic contrast were determined for cancer of endometrium, cervical cancer, vulvar cancer.

  11. The diagnostic criteria of pityriasis rosea and Gianotti-Crosti syndrome - a protocol to establish diagnostic criteria of skin diseases. (United States)

    Chuh, A; Zawar, V; Sciallis, G F; Lee, A


    We established and validated diagnostic criteria for pityriasis rosea and Gianotti-Crosti syndrome. In this paper, we compare and contrast both diagnostic criteria to formulate a protocol in establishing diagnostic criteria for other dermatological diseases. The diagnostic criteria are similar in employing clear dividing lines and conjunctions ('and/or') to assure high reliability. Both sets of criteria should be applicable for all ethnic groups. Spontaneous remission is not included, so diagnosis is not delayed while waiting for disease remission. Laboratory investigations are not enlisted, so that the criteria can be used in medical care systems in different parts of the world. The diagnostic criteria are different in that pathognomonic clinical manifestations exist for pityriasis rosea, such as the herald patch and the orientation of lesions along the lines of skin cleavages. These features, however, score low for sensitivity. These specific manifestations are not seen in Gianotti-Crosti syndrome. Such differences led to different categorisation of clinical features. Atypical variants are more common for pityriasis rosea. The diagnostic criteria for pityriasis rosea therefore do not include a list of differential diagnoses, while diagnostic criteria for Gianotti-Crosti syndrome do. Using this comparison, we constructed a protocol to establish diagnostic criteria for other skin diseases. We advocate the need to justify the establishment of diagnostic criteria, that multiple diagnostic criteria for the same disease should be avoided, that diagnostic criteria should be compatible with the disease classification if applicable, and that the scope should be well-delineated with regard to clinical variants. We outline the need for validation studies to assess the criteria-related validity, test-retest intra-clinician reliability, and inter-clinician reliability. We emphasise that the establishment of diagnostic criteria should not be a generic process. We also

  12. Differential manifolds

    CERN Document Server

    Kosinski, Antoni A


    The concepts of differential topology form the center of many mathematical disciplines such as differential geometry and Lie group theory. Differential Manifolds presents to advanced undergraduates and graduate students the systematic study of the topological structure of smooth manifolds. Author Antoni A. Kosinski, Professor Emeritus of Mathematics at Rutgers University, offers an accessible approach to both the h-cobordism theorem and the classification of differential structures on spheres.""How useful it is,"" noted the Bulletin of the American Mathematical Society, ""to have a single, sho

  13. [Abdominal masses in pediatric age; clinical aspects and diagnostic approach in 52 cases (author's transl)]. (United States)

    Perrelli, L; Calisti, A; Molle, P


    A large series of malignant and benign conditions are generally collected under the term of abdominal masses. Their common aspect is the lack, in most of the cases, of peculiar clinical features which may help early differential diagnosis. In many cases the mass is detected late after a long period of vague, aspecific symptoms. 40% of these space occupying lesions of the abdomen are of malignant origin and delayed detection and investigation affect clinical course. Preoperative study of abdominal masses is a problem of primary importance in pediatric surgical practice. A changing attitude is registered towards many diagnostic procedures and the role of largely diffused techniques like angiography is controversial. The introduction of ultrasonography makes in many cases intensive radiologic investigation unwarranted and academic. The Authors discuss the real role and targets of preoperative investigations of abdominal masses and refer on their experience based on 52 cases, to underline some clinical aspects and analyse their diagnostic approach to this pathology.

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

    Directory of Open Access Journals (Sweden)

    Jonathan S. Bleeker


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

  15. Thrombocytosis: Diagnostic Evaluation, Thrombotic Risk Stratification, and Risk-Based Management Strategies (United States)

    Bleeker, Jonathan S.; Hogan, William J.


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

  16. Importance of macroprolactinemia in hyperprolactinemia. (United States)

    Kasum, M; Pavičić-Baldani, D; Stanić, P; Orešković, S; Sarić, J-M; Blajić, J; Juras, J


    occur in patients with conventional symptoms of hyperprolactinemia who cannot be differentiated from patients with true hyperprolactinemia. These symptoms are mainly attributed to excess levels of monomeric prolactin, and this is of concern. The diagnosis of macroprolactinemia is misleading and inappropriate. A multitude of physiological, pharmacological and pathological causes, including stress, prolactinomas, hypothyroidism, renal and hepatic failure, intercostal nerve stimulation and polycystic ovary disease, can contribute to increased levels of monomeric prolactin. It is important for patients with elevated monomeric prolactin levels to undergo routine evaluation to identify the exact pathological state and introduce adequate treatment, regardless of the presence of macroprolactin. In addition, macroprolactinemia occasionally occurs due to macroprolactin associated with pituitary adenomas, with biological activity of macroprolactin comparable with that of monomeric prolactin. In cases when excess macroprolactin occurs with clinical manifestations of hyperprolactinemia, macroprolactinemia should be regarded as a pathological biochemical variant of hyperprolactinemia. An individualized approach to the management of such patients with macroprolactinemia may be necessary, and pituitary imaging, dopamine treatment and prolonged follow-up should be applied.

  17. [Forensic importance of premature craniosynostosis]. (United States)

    Fehlow, P


    In agreement with Canabis craniosynostosis as a little known organic partial factor of sociopathy is demonstrated. A psychic syndrome of the frontal lobe with increased susceptibility in environmental damages is assumed to be basic disorder. In the criminals of the material sexual offenders were preponderating. Associated craniofacial dysplasias are a risk for psychic maldevelopment. The importance of premature craniosynostocis as a biological risk factor, incidence, diagnostic, indication for an operation, also in the meaning of a neurosurgical "Konflikttherapie" (cosmetical indication) are discussed.

  18. The impact of new trends in POCTs for companion diagnostics, non-invasive testing and molecular diagnostics. (United States)

    Huckle, David


    Point-of-care diagnostics have been slowly developing over several decades and have taken on a new importance in current healthcare delivery for both diagnostics and development of new drugs. Molecular diagnostics have become a key driver of technology change and opened up new areas in companion diagnostics for use alongside pharmaceuticals and in new clinical approaches such as non-invasive testing. Future areas involving smartphone and other information technology advances, together with new developments in molecular biology, microfluidics and surface chemistry are adding to advances in the market. The focus for point-of-care tests with molecular diagnostic technologies is focused on advancing effective applications.

  19. Synthetic diagnostics platform for fusion plasmas (invited)

    Energy Technology Data Exchange (ETDEWEB)

    Shi, L., E-mail:; Valeo, E. J.; Tobias, B. J.; Kramer, G. J.; Hausammann, L.; Tang, W. M. [Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540 (United States); Chen, M. [Department of Mechanical and Aerospace Engineering, University of California, Davis, California 95616 (United States)


    A Synthetic Diagnostics Platform (SDP) for fusion plasmas has been developed which provides state of the art synthetic reflectometry, beam emission spectroscopy, and Electron Cyclotron Emission (ECE) diagnostics. Interfaces to the plasma simulation codes GTC, XGC-1, GTS, and M3D-C{sup 1} are provided, enabling detailed validation of these codes. In this paper, we give an overview of SDP’s capabilities, and introduce the synthetic diagnostic modules. A recently developed synthetic ECE Imaging module which self-consistently includes refraction, diffraction, emission, and absorption effects is discussed in detail. Its capabilities are demonstrated on two model plasmas. The importance of synthetic diagnostics in validation is shown by applying the SDP to M3D-C{sup 1} output and comparing it with measurements from an edge harmonic oscillation mode on DIII-D.

  20. Chordoid meningioma: A diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Fouzia Siraj


    Full Text Available Chordoid meningioma (CM, classified as Grade II/atypical meningioma according to the World Health Organization classification, is a rare subtype, which represents only 0.5% of all meningiomas. Morphologically, it can mimic other chondroid and myxoid tumors within the brain and its vicinity thus posing a diagnostic challenge. Accurate diagnosis, therefore, assumes importance as these tumors have an aggressive clinical course and propensity to recur compared to classical meningiomas. Furthermore, the prognosis and treatment strategies vary when compared to tumors with morphological overlap. We present a case of CM in a 14-year-old girl and discuss its clinicopathological and immunohistochemical features.

  1. Diagnostic tools for neuropathic pain

    Directory of Open Access Journals (Sweden)

    CHEN Xiang-jun


    Full Text Available Neuropathic pain (NP is a kind of chronic, severe and persistent pain syndrome. Due to the underlying mechanisms, the treatment for NP differs from that of nociceptive pain. An accurate diagnosis of NP is very important. However, the present diagnostic process which mainly depends on clinical and neurophysiological assessments is quite time-consuming and low efficient. In recent years, various screening tools and drug efficacy assessments for NP have been developed and validated. They become very useful in the diagnosis and treatment of NP, as well as in epidemiological study. These tools are also very useful in elucidating the underlying mechanism of NP.

  2. Ordinary differential equations

    CERN Document Server

    Pontryagin, Lev Semenovich


    Ordinary Differential Equations presents the study of the system of ordinary differential equations and its applications to engineering. The book is designed to serve as a first course in differential equations. Importance is given to the linear equation with constant coefficients; stability theory; use of matrices and linear algebra; and the introduction to the Lyapunov theory. Engineering problems such as the Watt regulator for a steam engine and the vacuum-tube circuit are also presented. Engineers, mathematicians, and engineering students will find the book invaluable.

  3. [Hypernatremia - Diagnostics and therapy]. (United States)

    Arndt, Christian; Wulf, Hinnerk


    Hypernatremia is a common electrolyte disorder that reflects an imbalance in the water balance of the body, often resulting from an increased loss of free water compared to sodium excretion. It is rarely based on excessive sodium intake. The clinical presentation is often characterized by a central nervous system dysfunction (confusion, coma) and pronounced thirst (in awake patients). In addition to medical history, the volume status of the patient and the osmolality of urine are leading in the differential diagnosis. Usually, the treatment of hypernatremia - in addition to addressing the underlying cause - is replacing the (absolute or relative) loss of free water by hypotonic infusions, or in case of diabetes insipidus, by application of Desmopressin (Minirin). As rapid changes in serum sodium concentration may have deleterious consequences (osmotic demyelinsiation syndrome), preexisting hypernatremia (>48h) should not be reduced by more than 8-10 mmol/l/day. Close laboratory controls are important. For acute hypernatremia (< 24 hours), hemodialysis is an effective option to rapidly normalize the serum sodium levels. To avoid a rapid drop in sodium concentration that must also be considered when starting a renal replacement therapy in patients with chronic hypernatremia.

  4. Differential meadows

    NARCIS (Netherlands)

    J.A. Bergstra; A. Ponse


    A meadow is a zero totalised field (0^{-1}=0), and a cancellation meadow is a meadow without proper zero divisors. In this paper we consider differential meadows, i.e., meadows equipped with differentiation operators. We give an equational axiomatization of these operators and thus obtain a finite b

  5. 经直肠超声对前列腺苗勒管囊肿与射精管囊肿的鉴别诊断价值%Differential diagnostic value of transrectal ultrasonography for mullerian cyst and ejaculatory duct cyst

    Institute of Scientific and Technical Information of Chin