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Background: The emergence of metagenomic next-generation sequencing (mNGS) may provide a promising tool for early and comprehensive identification of the causative pathogen in community-acquired pneumonia (CAP). In this study, we aim to further evaluate the etiological diagnostic value of mNGS in suspected CAP. Methods: A total of 555 bronchoalveolar lavage fluid (BALF) samples were collected for pathogen detection by mNGS from 541 patients with suspected CAP. The clinical value was assessed based on infection diagnosis and treatment guidance. The diagnostic performance for pathogen identification by mNGS and sputum culture and for tuberculosis (TB) by mNGS and X-pert MTB/RIF were compared. To evaluate the potential for treatment guidance, we analyzed the treatment regimen of patients with suspected CAP, including imaging changes of lung after empirical antibacterial therapy, intensified regimen, antifungal treatment, and a 1-year follow up for patients with unconfirmed diagnosis and non-improvement imaging after anti-infective treatment and patients with high suspicion of TB or NTM infection who were transferred to the Wuhan Pulmonary Hospital for further diagnosis and even anti-mycobacterium therapy. Results: Of the 516 BALF samples that were analyzed by both mNGS and sputum culture, the positivity rate of mNGS was significantly higher than that of sputum culture (79.1% vs. 11.4%, P = 0.001). A total of 48 samples from patients with confirmed TB were analyzed by both mNGS and X-pert MTB/RIF, and the sensitivity of mNGS for the diagnosis of active TB was significantly lower than that of X-pert MTB/RIF (64.6% vs. 85.4%, P = 0.031). Of the 106 pathogen-negative cases, 48 were ultimately considered non-infectious diseases, with a negative predictive value of 45.3%. Of the 381 pathogen-positive cases, 311 were eventually diagnosed as CAP, with a positive predictive value of 81.6%. A total of 487 patients were included in the evaluation of the therapeutic effect, and 67.1% improved with initial empirical antibiotic treatment. Of the 163 patients in which bacteria were detected, 77.9% improved with antibacterial therapy; of the 85 patients in which fungi were detected, 12.9% achieved remission after antifungal therapy. Conclusions: Overall, mNGS had unique advantages in the detection of suspected CAP pathogens. However, mNGS was not superior to X-pert MTB/RIF for the diagnosis of TB. In addition, mNGS was not necessary as a routine test for all patients admitted with suspected CAP. Furthermore, when fungi are detected by mNGS, antifungal therapy should be cautious. [ABSTRACT FROM AUTHOR]

To investigate the diagnostic value of fractional flow reserve (FFR) of coronary CT angiography (CCTA) in coronary heart disease (CHD) in high altitude environment of plateau. 54 patients who underwent CCTA examination and guidewire measurement of FFR in Qinghai Provincial Cardiovascular and Cerebrovascular Disease Specialized Hospital from January 2022 to May 2023 were selected as the research objects. The data were collected by Flash dual-source spiral CT, CCTA-based FFR (CT-FFR) was simulated calculation by fluid mechanics principle based on CCTA images. FFR as the gold standard, positive predictive value, negative predictive value, sensitivity, accuracy and specificity of CT-FFR in the diagnosis of coronary heart disease and coronary artery lesions were analyzed, the diagnostic efficacy of CT-FFR in coronary heart disease and coronary artery lesions were analyzed by receiver operating characteristic (ROC) curve. The consistency between CT-FFR and FFR were analyzed by Bland-Altman plot. The positive predictive value of CT-FFR in the diagnosis of coronary heart disease was 73.08%, negative predictive value was 89.29%, sensitivity was 86.36%, accuracy was 81.48%, sensitivity was 78.13%. The area under the curve (AUC) of CT-FFR in the diagnosis of coronary heart disease was 0.854, and 95%CI was 0.747~0.962. The positive predictive value of CT-FFR in the diagnosis of coronary artery lesions was 71.05%, negative predictive value was 91.84%, sensitivity was 87.10%, accuracy was 82.76%, sensitivity was 80.36%. The AUC of CT-FFR in the diagnosis of coronary artery lesions was 0.921, and 95%CI was 0.865~0.978. Whether the diagnosis of coronary heart disease or diagnosis of coronary artery lesions, CT-FFR and FFR had good consistency. CT-FFR has high accuracy and sensitivity in the diagnosis of coronary heart disease in high altitude environment, and the detection efficiency is ideal, which has good consistency with FFR. [ABSTRACT FROM AUTHOR]

To investigate the diagnostic value of tuberculosis infection T cell spot test (T-SPOT.TB) combine with serum carbohydrate antigen 125 (CA125) and gamma interferon-inducible protein 10 (IP-10) in pulmonary tuberculosis with diabetes. 480 patients with suspected tuberculosis admitted to Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine from January 2021 to January 2023 were selected and divided into 166 cases in Group A (patients with tuberculosis combined with diabetes mellitus), 214 cases in Group B (patients with simple tuberculosis), and 100 cases in Group C (patients with non-tuberculous mycobacterial infection and non-diabetes mellitus) according to the diagnosis results. All subjects underwent T-SPOT. TB, and serum CA125 and IP-10 levels were detected by enzyme-linked immunosorbent assay. The diagnostic value of T-SPOT.TB combined with serum CA125 and IP-10 levels for pulmonary tuberculosis with diabetes was analyzed by drawing receiver operating characteristic (ROC) curve. The positive rate of T-SPOT.TB in group A was lower than that in group B but higher than that in group C, and the positive rate of T-SPOT. TB in group B was higher than that in group C (P＜0.05). The original values of group A antigen culture filtrate protein 10 (CFP10) and antigen 6kD early secretory antigenic target (ESAT-6) were higher than those in group B and C, and the original values of group B antigen CFP10 and antigen ESAT-6 were higher than those in group C (P＜0.05). Serum CA125 and IP-10 levels were higher in group A than in groups B and C, the serum CA125 and IP-10 levels in group B were higher than those in group C (P＜0.05). ROC curve analysis showed that, the area under the curve (AUC) of T-SPOT.TB, CA125, IP-10, T-SPOT. TB+CA125, T-SPOT.TB+IP-10 and three-term combination in the diagnosis of pulmonary tuberculosis with diabetes mellitus were 0.771, 0.769, 0.779, 0.880, 0.885 and 0.937 respectively; the AUC of three-term combination diagnosis of pulmonary tuberculosis with diabetes mellitus was greater than that of T-SPOT.TB, CA125, IP-10 alone and combination diagnosis. The positive rate of T-SPOT.TB and the levels of serum CA125 and IP-10 increased in patients with pulmonary tuberculosis with diabetes mellitus, T-SPOT. TB combined with serum CA125 and IP-10 could improve the diagnostic value of pulmonary tuberculosis with diabetes mellitus. [ABSTRACT FROM AUTHOR]

To investigate the effect of Suhuang Zhike capsule combined with thymosin in the treatment of elderly patients with COPD complicated with pulmonary infection and its influence on immune function and blood gas indexes. 80 elderly patients treated in hospital were studied. All patients were diagnosed with COPD disease and were complicated with pulmonary infection. The admission time of the patients was distributed from September 2020 to September 2023, and the patients were divided into groups according to different treatment methods, among which 40 patients were divided into matched group and thymosin treatment was added on the basis of conventional symptomatic treatment, and the other 40 patients were divided into observation group and Suhuang Zhike capsule was added on the basis of matched group. Compared the total therapeutic effective rate, inflammatory factors [C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α)] of the two groups, immune function [CD3+, CD4+ /CD8+ , Natural killer cell, NK)], blood gas index [partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen oxygen, PaO2), pH], occurrence of adverse reactions [nausea, vomiting, dizziness, rash, diarrhea]. The total response rate in the observation group was higher than that in the matched group (P<0.05). Post-treatment, the CRP and TNF- α levels in the observation group were significantly lower than those in the matched group (P<0.05). Post-treatment, the levels of CD3+, CD4+ /CD8+, and NK were higher in the observation group than in the matched group (P<0.05). After receiving treatment, the PaCO2 index level in the observation group was lower than that in the matched group (P<0.05), and the level of PaO2 and pH index in the observation group was higher than that in the matched group (P<0.05). The total incidence of adverse reactions such as nausea, vomiting, dizziness, rash and diarrhea in the two groups was 2.50% in the observation group and 7.50% in the matched group. There was no difference in the total incidence of adverse reactions between the two groups (P>0.05). In elderly patients with COPD complicated with pulmonary infection, the addition of Suhuang Zhike capsule on the basis of conventional symptomatic treatment and thymosin treatment can significantly improve the total effective rate of clinical treatment, improve the level of inflammatory factors and blood gas indexes, and enhance immune function, without increasing the risk of adverse reactions [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to investigate the diagnostic values of different musculoskeletal ultrasound (MSUS) signs, serum uric acid (SUA), and their combined detection for gouty arthritis (GA). Patients and methods: In this retrospective study, 70 patients (62 males, 8 females; mean age: 46.1±14.1 years; range, 25 to 86 years) diagnosed with GA (the GA group) between August 2022 and March 2023 and 70 patients (54 females, 16 males; mean age: 49.0±14.1 years; range, 21 to 75 years) diagnosed with rheumatoid arthritis and osteoarthritis during the same period (the non-GA group) were included. The positive rate of MSUS signs and SUA in both groups was recorded to compare the differences. The correlations of MSUS signs and SUA with GA were analyzed using Spearman's rank correlation analysis. The diagnostic values of different MSUS signs, SUA, and their combined detection for GA were analyzed using a receiver operating characteristic, the area under the curve (AUC), sensitivity, specificity, and the Youden index. Results: The positive rate of the double contour (DC) sign (chi-squared [Χ²]=102.935, p<0.001), hyperechoic spots (Χ²=56.395, p<0.001), bone erosions (Χ²=10.080, p<0.001), and SUA (Χ²=41.117, p<0.001) were higher in the GA group than in the non-GA group. The positive rate of the DC sign (rs=0.829, p=0.001), hyperechoic spots (rs=0.631, p<0.001), bone erosion (rs=0.268, p=0.001), and SUA (rs=0.542, p<0.001) were positively correlated with GA. Among the single-indicator measures, the DC sign exhibited the highest diagnostic value (AUC=0.907, sensitivity=81.4%, specificity=100%, p<0.001). Among the combined-indicator measures, the DC sign combined with SUA exhibited the highest diagnostic value (AUC=0.929, sensitivity=91.4%, specificity=94.3%, p<0.001), higher than DC sign detection alone. Conclusion: The DC sign combined with SUA yielded a high diagnostic value and can thus provide a reliable basis for effectively and efficiently diagnosing GA. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the clinical application value of Metagenome Next-Generation Sequencing (mNGS) for pulmonary diffuse exudative lesions. Methods: From January 1, 2014, to November 31, 2021, 136 cases with chest radiologic presentations of pulmonary diffuse exudative lesions admitted to Fujian Provincial Hospital were included in the study; of those, 77 patients underwent mNGS pathogen detection. Based on the pathogen detection outcomes and clinical diagnoses, patients were categorized into an infection group (IG) and a non-infection group (NIG). A comparison was made between the diagnostic efficacy of the mNGS technique and traditional culture methods. Meanwhile, 59 patients clinically identified as having infectious pulmonary diffuse exudative lesions but who did not receive mNGS testing were designated as the non-NGS infection group (non-IG). A retrospective cohort study was conducted on patients in both the IG and non-IG, with a 30-day all-cause mortality endpoint used for follow-up. Outcomes: When compared to conventional culture methods, mNGS demonstrated an approximate 35% increase in sensitivity (80.0% vs 45.5%, P<0.001), without significant disparity in specificity (77.3% vs 95.5%, P=0.185). Under antibiotic exposure, the positivity rate detected by mNGS was notably higher than that by traditional culture methods, indicating that mNGS is less affected by exposure to antibiotics (P<0.05). Within 30 days, the all-cause mortality rate for patients in the IG versus the non-IG was 14.55% and 37.29%, respectively (P<0.05). Following a COX regression analysis to adjust for confounding factors, the analysis revealed that a CURB-65 score =3 points (HR=3.348, P=0.001) and existing cardiovascular disease (HR=2.473, P=0.026) were independent risk factors for these patients. Conversely, mNGS testing (HR=0.368, P=0.017) proved to be an independent protective factor. Conclusion: mNGS technology makes it easier to pinpoint the cause of pulmonary diffuse infectious exudative lesions without much interference from antibiotics, helping doctors spot and diagnose these issues early on, thereby playing a key role in helping them decide the best treatment approach for patients. Such conclusions may have a bias, as the performance of traditional methods might be underestimated due to the absence of complete results from other conventional diagnostic techniques like serological testing and PCR. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical value of echocardiography combined with N-terminal pro-brain natriuretic peptide (NT-proBNP) and long non-coding RNA (1ncRNA) taurine-upregulated gene 1 (TUG1) in elderly patients with hypertension and heart failure with preserved ejection fraction (HFPEF) . Methods: 82 elderly patients with hypertension and HFPEF who were diagnosed and treated in Handan First Hospital from March 2021 to March 2022 were selected as the study group. According to new York Heart Association (NYHA) cardiac function classification, the patients were divided into subgroup A (Ⅰ～Ⅱ) 48 cases and subgroup B (Ⅲ～Ⅳ) 34 cases. In addition, 74 elderly patients with hypertension without HFPEF who were examined during the same period were selected as the control group. The cardiac ultrasound parameters of all subjects were recorded, and their serum NT-proBNP and TUG1 levels were detected. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of ultrasound parameters combined with NT-pro BNP and TUG1 in elderly patients with hypertension and HFPEF, and to evaluate the value of ultrasound parameters in evaluating the severity of elderly patients with hypertension and HFPEF. Results: The left atrial diameter (LAD), serum NT-proBNP and TUG-1 levels in study group were higher than those in control group, and the ratio of early diastolic mitral flow velocity to late diastolic mitral flow velocity (E/A) was lower than that in control group (P＜0.05) . The LAD, NT-proBNP and TUG1 levels in subgroup B were higher than those in subgroup A, and E/A was lower than that in subgroup A (P＜0.05) . The results of ROC curve analysis showed that the area under the curve (AUC), sensitivity and specificity of LAD, E/A combined with serum NT-proBNP and TUG1 in the evaluation of elderly hypertension with HFPEF were 0.876, 0.854 and 0.838, respectively. At the same time, the AUC, sensitivity and specificity of LAD, E/A combined with serum NT-proBNP and TUG1 in evaluating the severity of elderly hypertension with HFPEF were 0.851, 0.853and 0.833, respectively, the combined evaluation efficiency was better than that of each index alone. Conclusion: Cardiac ultrasound parameters, NT-proBNP and TUG-1 have certain clinical value in the diagnosis and evaluation of elderly hypertensive patients with HFPEF, and LAD, E/A parameters combined with serum NT-proBNP and TUG-1 have higher value. [ABSTRACT FROM AUTHOR]

Background: Pleural fluid is one of the common complications of thoracic diseases, and tuberculous pleural effusion (TPE) is the most common cause of pleural effusion in TB-endemic areas and the most common type of exudative pleural effusion in China. In clinical practice, distinguishing TPE from pleural effusion caused by other reasons remains a relatively challenging issue. The objective of present study was to explore the clinical significance of the pleural fluid lactate dehydrogenase/adenosine deaminase ratio (pfLDH/pfADA) in the diagnosis of TPE. Methods: The clinical data of 618 patients with pleural effusion were retrospectively collected, and the patients were divided into 3 groups: the TPE group (412 patients), the parapneumonic pleural effusion (PPE) group (106 patients), and the malignant pleural effusion (MPE) group (100 patients). The differences in the ratios of pleural effusion-related and serology-related indicators were compared among the three groups, and receiver operating characteristic curves were drawn to analyze the sensitivity and specificity of the parameter ratios of different indicators for the diagnosis of TPE. Results: The median serum ADA level was higher in the TPE group (13 U/L) than in the PPE group (10 U/L, P < 0.01) and MPE group (10 U/L, P < 0.001). The median pfADA level in the TPE group was 41 (32, 52) U/L; it was lowest in the MPE group at 9 (7, 12) U/L and highest in the PPE group at 43 (23, 145) U/L. The pfLDH level in the PPE group was 2542 (1109, 6219) U/L, which was significantly higher than that in the TPE group 449 (293, 664) U/L. In the differential diagnosis between TPE and non-TPE, the AUC of pfLDH/pfADA for diagnosing TPE was the highest at 0.946 (0.925, 0.966), with an optimal cutoff value of 23.20, sensitivity of 93.9%, specificity of 87.0%, and Youden index of 0.809. In the differential diagnosis of TPE and PPE, the AUC of pfLDH/pfADA was the highest at 0.964 (0.939, 0.989), with an optimal cutoff value of 24.32, sensitivity of 94.6%, and specificity of 94.4%; this indicated significantly better diagnostic efficacy than that of the single index of pfLDH. In the differential diagnosis between TPE and MPE, the AUC of pfLDH/pfADA was 0.926 (0.896, 0.956), with a sensitivity of 93.4% and specificity of 80.0%; this was not significantly different from the diagnostic efficacy of pfADA. Conclusions: Compared with single biomarkers, pfLDH/pfADA has higher diagnostic value for TPE and can identify patients with TPE early, easily, and economically. [ABSTRACT FROM AUTHOR]

Background: Brain-heart infusion agar supplemented with 4 µg/mL of vancomycin (BHI-V4) was commonly used for the detection of heterogeneous (hVISA) and vancomycin-intermediate Staphylococcus aureus (VISA). However, its diagnostic value remains unclear. This study aims to compare the diagnostic accuracy of BHI-V4 with population analysis profiling with area under the curve (PAP-AUC) in hVISA/VISA. Methods: The protocol of this study was registered in INPLASY (INPLASY2023120069). The PubMed and Cochrane Library databases were searched from inception to October 2023. Review Manager 5.4 was used for data visualization in the quality assessment, and STATA17.0 (MP) was used for statistical analysis. Results: In total, eight publications including 2153 strains were incorporated into the meta-analysis. Significant heterogeneity was evident although a threshold effect was not detected across the eight studies. The summary receiver operating characteristic (SROC) was 0.77 (95% confidence interval [CI], 0.74–0.81). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic score and diagnostic odds ratio were 0.59 (95% CI: 0.46–0.71), 0.96 (95%CI: 0.83–0.99), 14.0 (95% CI, 3.4–57.1), 0.43 (95%CI, 0.32–0.57), 3.48(95%CI, 2.12–4.85) and 32.62 (95%CI, 8.31-128.36), respectively. Conclusion: Our study showed that BHI-V4 had moderate diagnostic accuracy for diagnosing hVISA/VISA. However, more high-quality studies are needed to assess the clinical utility of BHI-V4. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionTo assess the diagnostic value of cervical vascular ultrasound in identifying large arterial lesions in patients with transient ischemic attack (TIA).The current study matched 84 TIA patients (disease group) with 66 healthy controls (control group). The baseline patient profiles and biochemical indices of the patients were analyzed. All patients received color Doppler ultrasonography, and outcome measures of its diagnostic efficiency included plaque status, plaque properties, and the degree of carotid stenosis. The patients in the disease group were assigned to group A (TIA of the internal carotid artery system, n = 40) and group B (TIA of the vertebrobasilar artery system, n = 44), and the plaque distribution of the patients was analyzed.TIA patients had higher rates of diabetes, hypertension, hyperlipidemia, obesity, and smoking compared to controls (p < 0.05). Their serum TC, LDL-C, and FBG levels were significantly elevated, while HDL-C levels were decreased (p < 0.05). TIA patients had more plaques, especially soft plaques, than controls (p < 0.05). They also showed higher rates of moderate to severe carotid stenosis (p < 0.05). TIA involving the internal carotid artery system was associated with a higher risk of plaques at the entrance of the subclavian artery compared to TIA involving the vertebrobasilar artery system (p < 0.05).The diagnostic value of cervical vascular ultrasound in patients with TIA is remarkable, and it provides a reliable monitoring approach as well as an essential screening modality for TIA. The rational use of this technique will markedly benefit the diagnosis, treatment, and prevention of TIA. [ABSTRACT FROM AUTHOR]

Objective: To study Diagnostic value of Cytokeratin 19 fragment (CYFRA21-1), matrix metalloproteinase-3 (MMP-3) and carcinoembryonic antigen (CEA) combined with cytology in malignant pleural effusion. Methods: 100 patients with pleural effusion admitted to our hospital from January 2020 to January 2023 were selected for study, and were divided into experimental group (47 cases with malignant pathological examination results) and control group (53 cases with benign pathological examination results) according to pathological findings. The changes of serum CYFRA21-1, MMP-3, CEA and cytology levels and their diagnostic value were analyzed. Results: The serum levels of CYFRA21-1, MMP-3 and CEA in experimental group were significantly higher than those in control group (P<0.05). The positive rates of CYFRA21-1, MMP-3, CEA and cytology in experimental group were significantly higher than those in control group (P<0.05). The AUC of CYFRA21-1 in the diagnosis of malignant pleural effusion was 0.989, 95%CI was 0.977~1.000. The AUC and 95%CI of MMP-3 in the diagnosis of malignant pleural effusion were 0.979 and 0.964-0.994. The AUC for CEA diagnosis of malignant pleural effusion was 0.982, 95%CI was 0.967~0.997. The AUC and 95%CI for the diagnosis of malignant pleural effusion were 0.823, 0.766~0.879, and the AUC and 95%CI for combined detection were 0.995 and 0.990~1.000, which were significantly different from the area under the curve for single detection. The specificity and accuracy are higher than that of single detection. Conclusion: CYFRA21-1, MMP-3 and CEA combined with cytology can effectively improve the accuracy of diagnosis of malignant pleural effusion, and have high clinical application value. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate the diagnostic potential of Krebs von den Lungen-6 (KL-6) in differentiating between malignant pleural effusion (MPE) induced by non–small cell lung cancer (NSCLC) and benign pleural effusion (BPE). Methods We collected 143 pleural effusion samples from August 2018 to March 2021. The samples included 91 cases of MPE and 52 cases of BPE. The KL-6 and other indicators in pleural effusion were detected. Results The level of pleural effusion KL-6 (pKL-6) in the MPE group was significantly higher than in the BPE group (Mann-Whitney U = 442.500, P =.000). The area under the curve (AUC) of pKL-6/pleural effusion adenosine deaminase (pADA) + pleural effusion carcinoembryonic antigen (pCEA)/pADA (AUC = 0.992) in diagnosing MPE was higher than that of pKL-6 alone (AUC = 0.903), with a sensitivity of 93.26% and specificity of 100%. Conclusion The measurement of pKL-6 can differentiate NSCLC-induced MPE from BPE. Furthermore, the combined detection of pKL-6/pADA and pCEA/pADA can significantly improve the diagnostic efficiency for distinguishing NSCLC-induced MPE. [ABSTRACT FROM AUTHOR]

Le TEP/CT est un examen régulièrement utilisé dans la stratégie diagnostique du syndrome inflammatoire inexpliqué (SII), mais les hypermétabolismes retrouvés ne sont pas toujours concordants avec le diagnostic final. Notre objectif était d'évaluer l'impact clinique et financier de ces faux positifs. Nous avons mené une étude ancillaire sur une précédente cohorte rétrospective du service de médecine interne du centre hospitalier universitaire d'Amiens chez les patients ayant eu un TEP/CT entre octobre 2004 et avril 2017. Les patients étaient inclus si le TEP/CT avait été prescrit pour investiguer un SII. Sur les 763 TEP/CT réalisés, 144 patients satisfaisaient les critères d'inclusion et il était rapporté un taux de faux positifs de 17,4 % (n = 25). Parmi ces 25 patients, les résultats du TEP/CT ont entraîné des investigations complémentaires chez 21 d'entre eux. Les territoires hypermétaboliques les plus fréquemment retrouvés étaient digestifs (n = 12, SUVmax moyen 8 [± 4,33]) et ostéo-articulaires (n = 11, SUVmax moyen 4,33 [± 1,15]). Le coût total des 13 consultations prescrites était de 390 €, le coût total des 40 investigations paracliniques était de 4476€ (essentiellement des endoscopies digestives et de l'imagerie) et le coût total des transports médicaux était de 572€. Le coût total des 35 jours d'hospitalisation nécessaires pour explorer ces faux positifs était estimé à 22 952 €. Chez 23,8 % des patients (n = 5), ces investigations ont fait découvrir fortuitement des lésions tumorales. L'impact économique des investigations prescrites pour étudier les hypermétabolismes faux positifs du TEP/CT ne semble pas négligeable et mériterait une véritable étude prospective médico-économique. PET/CT is regularly used to investigate inflammatory syndrome of unknown origin (IUO), but hypermetabolisms found are not always consistent with the final diagnosis. The objective of the study was to assess the cost attributed to the diagnostic work-up for these false positives. We conducted an ancillary study on a previous retrospective cohort from the internal medicine department at Amiens university hospital in patients who had a PET/CT scan between October 2004 and April 2017. Patients were included if PET/CT had been prescribed to investigate IUO. Among the 763 PET/CT performed, 144 met the inclusion criteria and a false-positive rate of 17.4% (n = 25) was reported. Among these 25 patients, 21 underwent further investigations. The most frequently found hypermetabolic territories were digestive (n = 12, mean SUVmax 8 [±4.33]) and osteoarticular (n = 11, mean SUVmax 4.33 [±1.15]). The total cost of the 13 prescribed consultations was €390, the total cost of the 40 additional tests was €4,476 (mainly digestive endoscopies and radiological tests) and the total cost of medical transport was €572. The total cost of the 35 days of hospitalization specifically required to investigate these false positives was €22,952. In 23.8% (n = 5), these investigations led to the incidental discovery of tumor lesions. The economic impact of false-positive PET/CT results does not appear to be negligible and merits a genuine prospective medico-economic study. [ABSTRACT FROM AUTHOR]

Objective To investigate the predictive value of systemic inflammatory response index (SIRI) for acute ischemic stroke-associated pneumonia of the brain. Methods The baseline data of patients diagnosed with acute ischemic stroke in the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2022 were gathered to calculate the SIRI index. Patients were divided into SAP group (665 cases) and Non-SAP (466 cases) group according to whether SAP occurred within 7 days of stroke onset. Logistic regression was used to analyze the relationship between SIRI index and SAP in patients with acute ischemic stroke-associated pneumonia of the brain, and ROC was used to analyze the predictive value of SIRI for SAP. Results The analysis included 665 patients with acute ischemic stroke whose median age was 67.00 (56.00～76.00) years old, and the incidence of SAP was 29.92%. The age, the incidence of atrial fibrillation, the use rate of acid suppressive drugs, the use rate of indwelling gastric tube, fasting blood glucose, the proportion of moderate and severe patients in the NHISS score, the number of white blood cells, neutrophils, monocytes, and SIRI index in the SAP group were higher than those in the non SAP group (P < 0.05). However, the hemoglobin value and lymphocyte number in SAP group were lower than those in non SAP group (P < 0.05). Logistic regression analysis showed that age, indwelling gastric tube, higher NHISS score group and SIRI index were the risk factors of SAP in patients with acute ischemic stroke. ROC analysis showed that the prediction accuracy of SIRI for patients with acute ischemic stroke-associated pneumonia of the brain was 0.707 (95%CI: 0.662～0.753, P < 0.001). Conclusion SIRI index is correlated with the occurrence of acute ischemic stroke- associated pneumonia and has the predictive value for it. [ABSTRACT FROM AUTHOR]

Background: To explore the variation of serum carcinoem-bryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), and squamous cell carcinoma (SCC) antigen in patients with lung cancer (LC) and their diagnostic value with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Methods: This study examined the diagnostic value of serum tumor marker testing and EBUS-TBNA joint detection for LC in 150 patients with suspected LC. Results: Compared to benign patients, the serum levels of CYFRA21-1, SCC, and CEA in LC were higher (P<0.05). In patients with squamous cell carcinoma (LSCC), small cell lung cancer (SCLC), and lung adenocarcinoma, lung adenocarcinoma had higher serum CEA levels (P<0.05). In comparison, LSCC patients had higher serum SCC and CYFRA21-1 levels (P<0.05). As compared to each index detected alone, the AUC of combined detection of each index to diagnose LC and identify pathological types of LC was elevated. Conclusions: The clinical significance of serum CYFRA21-1, SCC, and CEA conjugated with EBUS-TBNA is demonstrated for diagnostic purposes and identification of LC pathological types. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical value of combined detection of carcinoembryonic antigen(CEA) and CA125 in the diagnosis of non-small cell lung cancer(NSCLC) combined with malignant pleural effusion. Methods: This was retrospective research. Fifty-six NSCLC patients combined with malignant pleural effusion in Baoding No.1 Hospital, China, from January 2020 to January 2022 were recruited as the malignant group, and another 56 NSCLC patients combined with pleural effusion in the same period were recruited as the benign group. Pleural effusion and serum specimens were collected from both groups and their carcinoembryonic antigen (CEA), carbohydrate antigen 125(CA125) and SP70 antigen levels were measured respectively. The differences in index levels between the two groups were compared, and the value of the index in diagnosing NSCLC combined with malignant pleural effusion was analyzed. Results: The positive rates of CEA, CA125 and SP70 antigen in pleural effusion were higher in the malignant group than in the benign group (p>0.05); The positive rates of CEA and CA125 in the malignant group were higher than those in the benign group (p>0.05), with no statistically significant difference between the two groups in the positive rates of SP70 antigen (p>0.05). ROC curve analysis revealed the value of serum CEA and CA12 in the diagnosis of NSCLC combined with malignant pleural effusion, while serum SP70 antigen had no diagnostic value (p>0.05). Conclusion: The combined detection of CEA, CA125 and SP70 antigen boasts a higher diagnostic value for NSCLC-mediated pleural effusion, with higher diagnostic value than the combined detection of serum indexes. [ABSTRACT FROM AUTHOR]

Septic acute kidney injury (AKI) is a common complication in critically ill patients with high morbidity and mortality. This study intends to clarify the clinical value and molecular mechanism of microR-380-3p in septic AKI by recruiting patients with septic AKI and establishing septic AKI cell models. Patients with septic AKI were included and human kidney-2 (HK-2) cells were induced by lipopolysaccharide (LPS) to construct the AKI cell model of sepsis. The expression of microR-380-3p was detected by quantitative realtime RT-PCR (qRT-PCR). The expression of Bax, cleaved caspase 3, Bcl-2, p65, and p-p65 was detected by Western blot. The contents of inflammation and oxidation were determined by commercial kits. Bioinformatics predicted the binding target of microR-380-3p and a dual luciferase reporting system was used to verify the regulatory relationship between microR-380-3p and RAP1B. The concentration of microR-380-3p was elevated in patients with septic AKI and appeared to be a biomarker for these patients. Silenced microR-380-3p reversed the damage of LPS on HK-2 cells via promoting viability, inhibiting apoptosis, inflammation, and oxidation. RAP1B was a target of microR-380-3p and microR-380-3p exerted targeted inhibition of RAP1B expression level. Down-regulation of RAP1B reversed the influence of silenced microR-380-3p on HK-2 cells. MicroR-380-3p/RAP1B participated in activating the NF-κB pathway. MicroR-380-3p down-regulated RAP1B to exacerbate septic AKI, providing a potential therapeutic biomarker for septic AKI. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) is a common systemic inflammatory disease resulting from the activation of trypsinogen by various incentives in ICU. The annual incidence rate is approximately 30 out of 100,000. Some patients may progress to severe acute pancreatitis, with a mortality rate of up to 40%. Therefore, the goal of this article is to explore the key genes for effective diagnosis and treatment of AP. The analysis data for this study were merged from two GEO datasets. 1357 DEGs were used for functional enrichment and cMAP analysis, aiming to reveal the pathogenic genes and potential mechanisms of AP, as well as potential drugs for treating AP. Importantly, the study used LASSO and SVM-RFE machine learning to screen the most likely AP occurrence biomarker for Prdx4 among numerous candidate genes. A receiver operating characteristic of Prdx4 was used to estimate the incidence of AP. The ssGSEA algorithm was employed to investigate immune cell infiltration in AP. The biomarker Prdx4 gene exhibited significant associations with a majority of immune cells and was identified as being expressed in NKT cells, macrophages, granulocytes, and B cells based on single-cell transcriptome data. Finally, we found an increase in Prdx4 expression in the pancreatic tissue of AP mice through immunohistochemistry. After treatment with recombinant Prdx4, the pathological damage to the pancreatic tissue of AP mice was relieved. In conclusion, our study identified Prdx4 as a potential AP hub gene, providing a new target for treatment. [ABSTRACT FROM AUTHOR]

Obejective: To explore the diagnostic and therapeutic effect of ultra-fine bronchoscopic interventional in bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (Allo-HSCT). Methods: Retrospective analysis of clinical data of 2 patients with BOS diagnosed 3 months after transplantation were collected, and the characteristics of diagnosis and therapeutics of BOS were analyzed. Results: The time from Allo-HSCT to diagnosed of BOS in 2 patients in our hospital was within 3 months after transplantation, the clinical manifestations were chest tightness and shortness of breath after activity, and mixed ventilation dysfunction in lung function, Under the direct vision of ultra-fine bronchoscopy, the membrane-like hyperplasia of the lumen orifice of the bronchioles of grade 6 and above in the left and right sides could block the lumen was observed, and the occluded airway could be opened by mechanical expansion or freezing with biopsy forceps, no examination-related complications occurred during and after the operation, the symptoms of the patients were significantly improved compared with the previous ones after treatment, One patient was followed up and the original occluded bronchiole lumen was continuously open after treatment under bronchoscopy. Conclusion: Ultra-fine bronchoscopy can effectively diagnose BOS after Allo-HSCT, and can also open bronchioles through respiratory interventional therapy to improve short-term lung function. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between real-time ultrasound elastography parameters, serum carbohydrate antigen 153 (CA153), insulin growth factor 1 (IGF1), and human epididymal secreted protein 4 (HE4) levels with clinicopathological features of early cervical cancer and their predictive value. Methods: 85 patients with early cervical cancer admitted to our hospital from January 2022 to June 2023 were selected as the cervical cancer group, and another 85 patients with cervical precancerous lesions admitted during the same period were selected as the cervical precancerous lesion group. Both groups underwent real-time ultrasound elastography and serum levels of CA153, IGF1, and HE4 were measured. Explored the relationship between real-time ultrasound imaging, serum CA153, IGF1, and HE4 levels and clinical pathological characteristics of cervical cancer patients. The diagnostic value of real-time ultrasound elastography parameters, serum CA153, IGF1, and HE4 in early cervical cancer patients was analyzed using receiver operating characteristic (ROC). Results: Compared with the cervical precancerous lesion group, the elastic strain ratio and elastic image compression index of the cervical cancer group were significantly increased (P<0.05), and the serum levels of CA153, IGF1 and HE4 were significantly increased (P<0.05). The real-time ultrasound imaging parameters, serum CA153, IGF1 and HE4 levels in patients with FIGO II stage and low differentiation were significantly higher than those in patients with FIGO I stage and medium to high differentiation(P<0. 05). ROC curve showed that the area under the curve (AUC) of elastic strain ratio, elastic image compression index, CA153, IGF1 and HE4 in the diagnosis of early cervical cancer was 0.811, 0.807, 0.760, 0.649 and 0.764, respectively, and the AUC of combined diagnosis was the largest, 0.944. Conclusions: Real-time ultrasound elastography parameters, serum CA153, IGF1 and HE4 are related to the stage and differentiation of early cervical cancer, and have certain clinical value in the diagnosis of early cervical cancer, and the value of combined diagnosis is higher. [ABSTRACT FROM AUTHOR]

There is an urgent need for accurate biomarkers to support timely diagnosis of acute mesenteric ischaemia (AMI) and thereby improve clinical outcomes. With this systematic review, the aim was to substantiate the potential diagnostic value of biomarkers for arterial occlusive AMI. The Pubmed, Embase, and the Cochrane Library electronic databases were searched. A systematic review of the literature has been conducted to define the potential diagnostic value of biomarkers for arterial occlusive AMI. All studies including ≥ 10 patients describing biomarkers for macrovascular occlusive AMI between 1950 and 17 February 2023 were identified within the Pubmed, Embase, and the Cochrane Library electronic databases. There were no restrictions to any particular study design, but letters and editorials were excluded. The QUADAS-2 tool was used for the critical appraisal of quality. The study protocol was registered on Prospero (CRD42021254970). Fifty of 4334 studies were eligible for inclusion in this review. Ninety per cent of studies were of low quality. A total of 60 biomarkers were identified, with 24 in two or more studies and 15 in five or more studies. There was variation in reported units, normal range, and cut off values. Meta-analysis was not possible due to study heterogeneity. Biomarkers currently recommended by the European Journal of Vascular and Endovascular Surgery, European Society for Trauma and Emergency Surgery 2016, and World Society of Emergency Surgery 2017 guidelines also had heterogeneous low quality data for use in the diagnosis of AMI. This systematic review demonstrates high heterogeneity and low quality of the available evidence on biomarkers for arterial occlusive AMI. No clinical conclusions can be drawn on a biomarker or combination of biomarkers for patients suspected of arterial occlusive AMI. Restraint is advised when rejecting or determining AMI solely based on biomarkers. [ABSTRACT FROM AUTHOR]

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Zhan-He Sun,&ast; Cheng-Hong Yu,&ast; Xin Wang Department of Ultrasound, Tongxiang First People’s Hospital, Tongxiang, Zhejiang Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xin Wang, Email xings137@163.comObjective: This study aims to investigate the clinical application value of high-frequency ultrasound technology in diagnosing subcutaneous lipohypertrophy at insulin injection sites in diabetes patients.Methods: All diabetes patients treated in our hospital from January 2022 to January 2023 were selected as the study subjects. The incidence of subcutaneous lipohypertrophy was calculated at the end of the study period. All patients were screened, and those meeting the inclusion criteria were registered, and basic data were collected. Patients were screened for subcutaneous lipohypertrophy using conventional clinical examination (control group) and high-frequency ultrasound technology (study group).Results: The study found that the incidence of subcutaneous lipohypertrophy in diabetes patients receiving insulin injections in our hospital from January 2022 to January 2023 was 80.99%. The average longitudinal diameter of subcutaneous lipohypertrophy in these patients was 11.66 (7.56, 21.44) mm, the transverse diameter was 12.04 (8.96, 18.29) mm, depth was (5.62± 2.17) mm, and the area was 188.79 (76.85, 331.78) mm². The clinical detection rate in the study group was higher than that in the control group (P< 0.05). The quantity of detected sites was greater in the study group compared to the control group (P< 0.05).Conclusion: The incidence of subcutaneous lipohypertrophy in diabetes patients receiving insulin injections is relatively high clinically, and high-frequency ultrasound technology demonstrates significant potential in diagnosis. By providing high-resolution imaging and quantitative data, it effectively improves the clinical detection rate and clarifies symptoms. This technology is likely to become an important auxiliary tool in future diabetes treatment, providing more precise treatment plans for patients.Keywords: high-frequency ultrasound technology, diabetes, insulin injection, subcutaneous lipohypertrophy, diagnostic value

Objective: The aim was to investigate the ability of superb microvascular imaging (SMI) to improve the differential diagnosis of mummified thyroid nodules (MTNs) and papillary thyroid carcinomas (PTCs) using the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Materials and methods: We enrolled 110 cases of MTNs and 110 cases of PTCs confirmed by fine needle aspiration (FNA) or surgery. Conventional ultrasound (US) and the quantity of microvessels detected by SMI were analyzed for all nodules. Thyroid nodules were initially categorized by ACR-TIRADS based on US imaging features and then reclassified based on ACR-TIRADS combined with SMI blood-flow grade (SMI-TIRADS). We compared the diagnostic performances of ACR-TIRADS and SMI-TIRADS by receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results: US-detected margin, shape, and echogenic foci differed between MTNs and PTCs (P < 0.05). The SMI blood-flow grade was significantly greater in PTCs compared with MTNs (Χ2 = 158.78, P < 0.05). There was no significant difference in ACR-TIRADS indicators between MTNs and PTCs (Χ2 = 1.585, P = 0.453); however, reclassification by SMI-TIRADS showed significant differences between the groups (Χ2 = 129.521, P < 0.001). The area under the curve was significantly lower for ACR-TIRADS compared with SMI-TIRADS (0.517 vs 0.887, P < 0.05). SMI-TIRADS had significantly higher diagnostic value for distinguishing MTNs and PTCs than ACR-TIRADS (sensitivity: 91.82% vs 74.55%, P < 0.05; specificity: 84.55% vs 21.82%, P < 0.05; accuracy: 88.18% vs 48.18%, P < 0.05; PPV: 85.59% vs 48.81%, P < 0.05; and NPV: 91.18% vs 46.15%, P < 0.05). Conclusion: The detection of microvascular flow and large vessels in thyroid nodules by SMI resulted in high diagnostic specificity and sensitivity. ACR-TIRADS combined with SMI could effectively distinguish between MTNs and PTCs, to avoid unnecessary FNA or surgical excision.

Abstract Background Triangular fibrocartilage complex (TFCC) injuries commonly manifest as ulnar-sided wrist pain and can be associated with distal radioulnar joint (DRUJ) instability and subsequent wrist functional decline. This study aimed to assess the diagnostic value of MRI compared to wrist arthroscopy in identifying traumatic TFCC injuries and to determine the distribution of different TFCC injury subtypes in a normal clinical setting. Methods The data of 193 patients who underwent both preoperative wrist MRI and wrist arthroscopy were retrospectively reviewed. The analysis focused on the proportion of subtypes and the diagnostic value of MRI in traumatic TFCC injuries, utilizing Palmer’s and Atzei’s classification with wrist arthroscopy considered as the gold standard. Results The most prevalent subtype of TFCC injuries were peripheral injuries (Palmer 1B, 67.9%), followed by combined injuries (Palmer 1 A + 1B, 14%; Palmer 1B + 1D, 8.3%). Compared with wrist arthroscopy, the diagnostic sensitivity, specificity, negative predictive value (NPV), and Kappa value of MRI was as follows: traumatic TFCC tears 0.99 (95% CI: 0.97-1), 0.90 (0.78-0.96), 0.97 (0.87-1), and 0.93; styloid lamina tears 0.93 (0.88-0.96), 0.53 (0.30-0.75), 0.47 (0.26-0.69), and 0.44; and foveal lamina tears 0.85 (0.74-0.92), 0.38 (0.29-0.49), 0.79 (0.65-0.89), and 0.21. Conclusions The diagnostic value of MRI in traumatic TFCC injuries has been confirmed to be almost perfect using Palmer’s classification. In more detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei’s classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy. Radiological associated injuries may offer additional diagnostic value in cases with diagnostic uncertainty.

Abstract Background To explore the diagnostic value of multidetector computed tomography (MDCT) extramural vascular invasion (EMVI) in preoperative N Staging of gastric cancer patients. Methods According to the MR-defined EMVI scoring standard of rectal cancer, we developed a 5-point scale scoring system to evaluate the status of CT-detected extramural vascular invasion(ctEMVI), 0–2 points were ctEMVI-negative status, and 3–4 points were positive status for ctEMVI. Patients were divided into ctEMVI positive group and ctEMVI negative group. The correlation between ctEMVI and clinical features was analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of ctEMVI for pathological metastatic lymph nodes and N staging, The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of pathological N staging using ctEMVI and short-axis diameter were generated and compared. Results The occurrence rate of lymphovascular invasion (LVI) and proportion of tumors with a greatest diameter > 6 cm in the ctEMVI positive group was higher than that in the ctEMVI negative group (P

Objective To investigate the relationship between the expression of Zeste White 10 interactor（ZWINT）and Cyclin-dependent kinase 2（CDK2）and clinicopathological features in breast cancer，and evaluate their pathological diagnostic values in breast cancer. Methods GEPIA database was utilized to analyze the difference in the expression of ZWINT between breast cancer and normal breast tissues and assess the correlation between ZWINT and CDK2 expression in breast cancer. Kaplan-Meier Plotter database was employed to predict the relationship between ZWINT expression and clinical prognosis of breast cancer patients. Paraffin-embedded pathological specimens of 84 cases of breast cancer and paired paracancerous tissues and fresh specimens of 20 cases of breast cancer and paired paracancerous tissues were collected. Quantitative real-time polymerase chain reaction（RT-qPCR）and immunohistochemical staining were used to detect the expression levels of ZWINT and CDK2 mRNA and protein in breast cancer and paracancerous normal breast tissues，to analyze the relationship between ZWINT and CDK2 expression levels and clinicopathological features of breast cancer. Association analysis was used to analyze the correlation between ZWINT and CDK2. Receiver operating characteristic（ROC）curve was delineated to evaluate the values of ZWINT and CDK2 in the pathological diagnosis of breast cancer. Results The results of database analysis showed that ZWINT was highly expressed in breast cancer tissues and there was a positive correlation between the expression of ZWINT and CDK2 in breast cancer（rs = 0.600，P < 0.001）. The expression of ZWINT was closely correlated with clinical prognosis of breast cancer patients（all P < 0.05）. The test results of 84 cases showed that the expression levels of ZWINT and CDK2 mRNA and protein in breast cancer tissues were higher than those in para-carcinoma tissues（both P < 0.05），and high expression was closely correlated with tumor size，tumor stage and lymph node metastasis（all P < 0.05）. Association analysis revealed that the degree of association of Φ and Cramer V coefficient test under symmetric measurements was the same as 0.322（P = 0.003），while the column linkage number was 0.306（P = 0.003）. The expression levels of ZWINT and CDK2 proteins were closely correlated. The areas under the ROC curve of ZWINT and CDK2 were 0.886 and 0.818，which yielded high diagnostic values for breast cancer. Conclusions ZWINT and CDK2 expression levels are closely correlated the occurrence，development and prognosis of breast cancer. Detection of ZWINT and CDK2 contributes to pathological diagnosis of breast cancer.

Background: To investigate the expression levels and diagnostic value of glial cell line-derived neurotrophic factor (GDNF), carcinoembryonic antigen (CEA) and carbohydrate antigen199 (CA199) in patients with colorectal carcinoma (CRC). Methods: 50 CRC patients at our hospital from Feb. 2020 to Feb. 2021 were chosen as the malignant group, another 50 patients with benign colonic diseases were chosen as the benign group, and 50 healthy people who came to our hospital for physical examination during the same period were considered as the control group. Fasting peripheral venous blood was taken from all research subjects in the morning and tested by a fully-automated electrochemiluminometer to determine the GDNF, CEA and CA199 levels. The sensitivity and specificity of the combined detection of the three indexes for CRC were analyzed, and the receiver operating characteristic (ROC) curve was plotted to record the area under the curve (AUC). Results: The malignant group had remarkably higher CEA and CA199 levels (P

Background: Epithelial ovarian cancer (EOC) is among the top 5 causes of cancer-associated death in women. We explored the diagnostic value of 3.0 T magnetic resonance imaging (MRI) combined with carbohydrate antigen 125 (CA125) and human epididymis protein 4 (HE4) on EOC. Methods: Among 380 ovarian space-occupying patients in this retrospective analysis, 344 were included, 59 were excluded, 25 had incomplete clinical data, and 260 were finally included as the subjects. Patients were classified into the EOC (110 patients with EOC) and N-EOC (150 patients without EOC) groups. The levels of interleukin-6 (IL-6), C-reactive protein (CRP), follicle stimulating hormone (FSH), luteinizing hormone (LH), anti-mullerian hormone (AMH), CA125, and HE4 were determined. The apparent diffusion coefficient (ADC) value and the clinical diagnostic value of MRI, CA125, HE4, and their combination were analyzed. Results: There were significant differences in tumor family history, gravidity, parity, IL-6, CRP, FSH, LH, AMH, and ADC value between EOC and N-EOC patients (all p < 0.05). EOC patients exhibited highly-expressed CA125 and HE4 (p < 0.01). CA125/HE4 expression was correlated with the clinicopathological features of EOC, while the ADC value was correlated with the EOC tumor diameter (all p < 0.05). MRI [area under the curve (AUC) = 0.77], CA125 (AUC = 0.85) and HE4 (AUC = 0.90) had certain diagnostic value for EOC (all p < 0.05). Conclusions: The prevalence of EOC in ovarian space-occupying patients with highly-expressed CA125 and HE4 is higher. MRI combined with CA125 and HE4 has high clinical diagnostic value for EOC.

Periapical radiography is a regular radiographic procedure performed by dentists. However, at times, it may not be possible to position the image receptor into a patient’s mouth in an optimized or practical way. For these cases, some dentists advocated the use of extraoral periapical radiography (EOPA). This literature review aimed to review the dental literature on the use of EOPA. In October 2023, PubMed, Web of Science, and Scopus were searched to identify papers that reported on the use of EOPA, supplemented by manual reference tracing and Google Scholar searches. After screening, 18 papers published between 2003 and 2022 were identified, including 14 original articles and 4 reviews. From very limited and conflicting evidence, it was found that root length/working length measurements between EOPA and IOPA did not significantly differ or EOPA showed inferiority. No data were available to compare EOPA with other extraoral modalities such as panoramic radiography. The technique used in EOPA to visualize posterior teeth in the maxilla and mandible varied across studies, such as the vertical angulation of the primary beam, whether mouth should be opened or closed, and whether a holder should be used or not. At the current time, EOPA probably should not be advocated for regular use.

Abstract Bacterial meningitis is a serious complication after neurosurgery and has a high mortality rate. Early diagnosis and timely treatment are crucial or will have disastrous consequences. The classic triad of bacterial meningitis lacks sensitivity and specificity. Therefore, the diagnosis of post-neurosurgical bacterial meningitis relies on cerebrospinal fluid. But traditional cerebrospinal fluid parameters are not completely reliable in diagnosing post-neurosurgical bacterial meningitis. Previous studies have found that CSF lactate concentration is related to bacterial meningitis. But, after the craniocerebral operation, the cerebrospinal fluid of most patients is bloody. Whether red blood cells interfere with diagnosing PNBM based on lactate concentration is limited. In the current study, we further analysis on whether red blood cells interfere with diagnosing PNBM based on lactate concentration. This study aimed to investigate the value of cerebrospinal fluid lactate concentrations in post-neurosurgical bacterial meningitis. A prospective observational study was performed on 62 patients at Kunshan First People’s Hospital’s intensive care unit affiliated with Jiangsu University. We found that erythrocytes do not affect cerebrospinal fluid lactate, and elevated lactate concentrations can be used as a marker for postoperative bacterial meningitis.

Objective·To compare the relationship between sternal cortical thickness ratio and bone mineral density in adult emergency inpatients with chest CT plain scan, and evaluate the diagnostic ability of sternal cortical thickness ratio for osteopenia and osteoporosis.Methods·The bone density was measured by dual energy X-ray absorptiometry (DXA) in hospitalized patients collected in the adult emergency ward of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from November 2020 to October 2022, and the patients were diagnosed as normal bone mass, osteopenia, or osteoporosis according to the bone density. The patients were grouped based on age (>65 years old, ≤65 years old) and osteoporosis status. The sternal cortical thickness ratio measured at the level of tracheal bifurcation in the chest CT scan image of each group was analyzed. Spearman correlation was used to analyze the correlation between the sternal cortical thickness ratio and bone mineral density. The sternal cortical thickness ratio was used to diagnose the osteopenia and the osteoporosis, and the receiver operator characteristic curve (ROC curve) was drawn to obtain the best cut-off value. The diagnostic efficacy of the sternal cortical thickness ratio in the diagnosis of osteopenia and osteoporosis was analyzed.Results·A total of 198 patients were included in the study, including 78 patients with normal bone mass, 66 patients with osteopenia, and 54 patients with osteoporosis. Among patients aged >65 years old (n=115), the proportion of female patients and the age of patients in the osteoporosis group were significantly higher than those in the normal bone mass group (all P0.05). Whether in patients >65 years old or ≤65 years old, the sternal cortical thickness ratio in the normal bone mass group was higher than that in the osteopenia group and the osteoporosis group, and the sternal cortical thickness ratio in the osteopenia group was higher than that in the osteoporosis group (all P65 years old, the diagnostic accuracy rate of male patients in the normal bone mass group was higher than that in the osteopenia group and the osteoporosis group, and the diagnosis misdiagnosis rate in the osteoporosis group was lower than that in the normal bone mass group and the osteopenia group; In patients ≤65 years old, the diagnostic accuracy rate of male patients in the osteoporosis group was higher than that in the normal bone mass group and the osteopenia group, and the diagnosis misdiagnosis rate in the normal bone mass group was lower than that in the osteopenia group and the osteoporosis group.Conclusion·The sternal cortical thickness ratio in both male and female patients is positively correlated with bone mineral density, and the sternal cortical thickness ratio has good diagnostic efficacy for osteopenia and osteoporosis.

ABSTRACT This article aims to study the value of cerebrospinal fluid (CSF) immunoglobulin in differential diagnosis, prediction, and prognosis of tuberculous meningitis (TBM). The clinical data of 65 patients with TBM in our hospital were collected, and 65 patients with cryptococcal meningitis (CM) were enrolled in 1:1 matching. Relevant data were collected for comparison. CSFs IgG [331.51 (164.85, 645.00) vs 129.00 (55.05, 251.00) ng/mL], IgM [22.38 (8.52, 40.18) vs 6.08 (2.19, 23.30) ng/mL], and IgA [64.11 (21.44, 115.48) vs 16.55 (4.76, 30.36) ng/mL] in the TBM group were higher than those in the CM group (P < 0.001). In the TBM group, after 24 weeks of treatment, the CSFs IgG, IgM, and IgA were significantly decreased, and the difference was statistically significant (P < 0.05). The predictive results of CSF immunoglobulin for TBM showed that IgG, IgM, and IgA all had some predictive value for TBM, and the combined predictive value of the three was the highest, with an area under the curve of 0.831 (95% CI: 0.774–0.881). Logistic regression analysis of CSF immunoglobulins and TBM prognosis showed that IgG [odds ratio (OR) = 4.796, 95% confidence interval (CI): 2.575–8.864], IgM (OR = 3.456, 95% CI: 2.757–5.754), and IgA (OR = 4.371, 95% CI: 2.731–5.856) were TBM risk factors for poor prognosis in patients. The levels of IgG, IgM, and IgA in CSF were positively correlated with the severity of cranial magnetic resonance imaging (MRI) in TBM patients (R2 = 0.542, F = 65.392, P < 0.05). CSFs IgG, IgM, and IgA can be used as a routine monitoring index for TBM patients, which has a certain reference value in differential diagnosis and efficacy evaluation.IMPORTANCEIn clinical practice, physicians can determine the physical conditions of patients based on the levels of cerebrospinal fluids (CSFs) IgG, IgM, and IgA. Higher levels of CSFs IgG, IgM, and IgA suggest more possibility of tuberculous meningitis and worse prognosis and magnetic resonance imaging manifestations.

Objectives: Early diagnosis of infectious diseases remains a challenge. This study assessed the diagnostic value of mNGS in infections and explored the effect of various factors on the accuracy of mNGS. Methods: An electronic article search of PubMed, Cochrane Library, and Embase was performed. A total of 85 papers were eligible for inclusion and analysis. Stata 12.0 was used for statistical calculation to evaluate the efficacy of mNGS for the diagnosis of infectious diseases. Results: The AUC of 85 studies was 0.88 (95%CI, 0.85-0.90). The AUC of the clinical comprehensive diagnosis and conventional test groups was 0.92 (95%CI, 0.89-0.94) and 0.82 (95%CI, 0.78-0.85), respectively. The results of subgroup analysis indicated that the PLR and NLR were 12.67 (95%CI, 6.01-26.70) and 0.05 (95%CI, 0.03-0.10), respectively, in arthrosis infections. The PLR was 24.41 (95%CI, 5.70-104.58) in central system infections and the NLR of immunocompromised patients was 0.08 (95%CI, 0.01-0.62). Conclusion: mNGS demonstrated satisfactory diagnostic performance for infections, especially for bone and joint infections and central system infections. Moreover, mNGS also has a high value in the exclusion of infection in immunocompromised patients.

Objective To systematically evaluate the diagnostic value of metagenomic next-generation sequencing(mNGS) for detecting pulmonary infection. Methods PubMed, Embase, Web of Science, the Cochrane Library, CNKI, WanFang, VIP databases were searched for studies according to the criteria of inclusion and exclusion, enrolling literature recorded from database establishment to May 30,2022. Statistical analysis was performed by Meta-Discl. 4, RevMan5. 3 and STATA15.0 software. Results A total of 12 relevant studies were enrolled, including 1 154 patients. The results of meta-analysis showed that the pooled sensitivity was 0.82(95% CI 0.79-0.84, 189.1%), and the pooled specificity was 0.73 (95% CI 0.68 0.78, I² = 85.4%). The heterogeneity in sensitivity and specificity between studies was significant. The area under the curve (AUC) of the total subject operating characteristic curve (SROC) was 0.850, and the Q index was 0. 782. Conclusion The diagnostic performance of mNGS in the clinical application of lung infections is acceptable. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic value of high resolution ultrasound combined with serum homocysteine（HCY),growth differentiation factor 15（GDF-15) and glial fibrillary acidic protein（GFAP) in ischemic cerebral infarction. Methods: 162 patients with ischemic stroke admitted to our hospital from March 2021 to March 2023 were selected as the infarction group, and 138 healthy individuals during the same period were selected as the control group. All subjects underwent high-resolution ultrasound technology to measure carotid artery intima/media thickness（cIT/cMT) and radial artery intima/media thickness（r IT/r MT), and their serum HCY,GDF-15, and GFAP levels were measured using enzyme-linked immunosorbent assay（ELISA), Compared the differences in measurement parameters between two groups. Analyze the diagnostic efficacy of high-resolution ultrasound parameters, serum HCY, GDF-15, and GFAP levels for ischemic stroke by drawing receiver operating characteristic（ROC) curves. Results: The levels of cIT, r IT, serum HCY,GDF-15 and GFAP in infarction group were significantly higher than those in control group（P＜0.05) . There was no significant difference in cMT and r MT between the two groups（P＞0.05) . Compared with diagnosis alone, high resolution ultrasound parameters cIT and r IT combined with serum HCY, GDF-15 and GFAP levels had the highest area under the curve（AUC), Yoden index, sensitivity and specificity in the evaluation of ischemic cerebral infarction. Conclusion: High resolution ultrasound parameters cIT and r IT combined with serum HCY, GDF-15 and GFAP levels have higher diagnostic value for ischemic cerebral infarction, which is helpful to guide the clinical diagnosis of patients with ischemic cerebral infarction. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the diagnostic value of urine lipoarabinomannan (LAM) detection based on chemiluminescence assay for pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) in HIV-negative individuals. Methods: A total of 215 patients and 37 healthy individuals were included according to inclusion and exclusion criteria, including 173 cases of PTB and 42 cases of EPTB. Sputum smears, sputum culture, TB-RNA, GeneXpert, and urine LAM results were obtained from all patients before treatment. Using the composite reference standard as the reference, the diagnostic performance of these methods for PTB and EPTB was evaluated, and the diagnostic performance and cost-effectiveness of different combinations were analyzed. Results: In PTB, LAM exhibited the highest sensitivity (55.49%), followed by GeneXpert (44.51%). In EPTB, LAM also had the highest sensitivity (40.48%), followed by GeneXpert (33.33%). When combined with one method, LAM combined with GeneXpert showed the highest sensitivity for both PTB (68.79%) and EPTB (61.9%). When combined with two methods, culture, GeneXpert, and LAM showed the highest sensitivity for both PTB (73.99%) and EPTB (69.05%). In terms of cost-effectiveness analysis, the price of LAM was significantly lower than that of GeneXpert ($129.82 vs. $275.79 in PTB and 275.79 vs. 502.33 in EPTB). Among all combinations, the combination of LAM and sputum smear had the lowest cost, with prices of $124.94 for PTB and $263.72 for EPTB. Conclusion: Urine LAM detection based on chemiluminescence assay can be used as an adjunct diagnostic tool for PTB and EPTB in HIV-negative individuals. This facilitates expanding the current application of urine LAM from solely HIV-positive populations to the general population. LAM detection can overcome the limitations of obtaining clinical samples, and its ease of sample acquisition will be beneficial for its broader application in a larger scope. For economically better-off areas, we recommend using a combination of LAM + GeneXpert+culture for higher sensitivity; for economically disadvantaged areas, LAM + smear microscopy combination can provide a quick and accurate diagnosis of tuberculosis at a lower cost. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM), a transient disease, may lead to short- or long-term adverse influences on maternal and fetal health. Therefore, its potential functions, mechanisms and related molecular biomarkers must be comprehended for the control, diagnosis and treatment of GDM. Methods: Thedifferentiallyexpressedgenes(DEGs)wereidentified using GSE49524 and GSE87295 associated with GDM from the Gene Expression Omnibus database, followed by function enrichment analysis, protein-protein interactions network construction, hub DEGsmining, diagnostic value evaluation and immune infiltration analysis. Finally, hub DEGs, the strongest related to immune infiltration, were screened as immune-related biomarkers. Results: A hundred and seven DEGs were identified between patients with GDM and healthy individuals. Six hub genes with high diagnostic values, including ALDH1A1, BMP4, EFNB2, MME, PLAUR and SLIT2, were identified. Among these, two immune-related genes (PLAUR and SLIT2) with the highest absolute correlation coefficient were considered immune-related biomarkers in GDM. Conclusion: Our study provides a comprehensive analysis of GDM, which would provide a foundation for the development of diagnosis and treatment of GDM. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical value of transvaginal color Doppler ultrasound combined with serum long non-coding RNA( lncRNA) colorectal related transcript 1(CCAT1) in the diagnosis of epithelial ovarian cancer. Methods: A total of 88patients with epithelial ovarian tumors admitted to our hospital from May 2020 to May 2022 were divided into benign group(n=49) and malignant group(n=39) according to the results of pathological examination. Transvaginal color Doppler ultrasonography and lncRNA CCAT1 detection were performed on all subjects. The receiver operating characteristic curve( ROC) was used to evaluate the value of color doppler ultrasound parameters combined with serum lncRNA CCAT1 in the evaluation of epithelial ovarian cancer and its malignancy. Results: The resistance index(RI) and pulsatility index(PI) in the malignant group were lower than those in the benign group, and the peak systolic blood flow velocity(PSV), end diastolic blood flow velocity(EDV) and serum lncRNA CCAT1 levels were higher than those in the benign group(P＜0.05). In the malignant group, RI and PI in patients with Ⅲ-Ⅳ stage were lower than those in patients with I-Ⅱ stage, and PSV, EDV and serum lncRNA CCAT1 levels were higher than those in patients with stage I-Ⅱ(P＜0.05).ROC analysis showed that the area under the curve(AUC) of RI, PI, PSV, EDV and lncRNA CCAT1 in the combined evaluation of epithelial ovarian cancer was 0.977, and the combined evaluation efficiency was better than that of each index alone. At the same time, the AUC of RI, PI, PSV, EDV and lncRNA CCAT1 combined to evaluate the malignant degree of epithelial ovarian cancer was 0.979,and the combined evaluation efficiency was better than that of each index alone. Conclusion: Transvaginal color Doppler ultrasound combined with serum lncRNA CCAT1 detection has certain evaluation value for epithelial ovarian cancer and its malignancy, and each parameter combined with lncRNA CCAT1 has better evaluation efficiency. [ABSTRACT FROM AUTHOR]

Objective To investigate the expression significance of myoglobin (Myo), growth arrest-specific protein 6 (Gas6), and SRY-related high-mobility group box 9 (SOX9) in patients with acute myocardial infarction (AMI) and evaluate their combined detection value for prognosis assessment after percutaneous coronary intervention (PCI). Methods A total of 166 patients with AMI admitted between January 2020 and June 2021 were included in the study group, and 90 healthy volunteers were recruited as the control group. Serum levels of Myo and Gas6 were measured by enzyme-linked immunosorbent assay, and SOX9 mRNA was detected using the SOX9 mRNA isolation kit. Patients in the study group were divided into MACCE group and non-MACCE group based on the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) during hospitalization. The expression of Myo, Gas6, and SOX9 mRNA was compared between the study and control groups, as well as before and after PCI in AMI patients. Clinical differences between the MACCE and non-MACCE groups were analyzed using univariate/multivariate analysis. The prognostic value of combined Myo, Gas6, and SOX9 mRNA detection for AMI prognosis was assessed. Results Compared with the control group, the study group showed significantly higher levels of Myo and Gas6, and lower expression of SOX9 mRNA (P＜0.05). After PCI, patients in the study group exhibited significantly decreased expression of Myo and Gas6, and increased expression of SOX9 mRNA (P＜0.05). The MACCE group had significantly higher levels of Myo and Gas6 and lower expression of SOX9 mRNA compared to the non-MACCE group (P＜0.05). Logistic regression analysis showed that age, postoperative bleeding, Myo, Gas6, and SOX9 mRNA were independent risk factors affecting the occurrence of MACCE in AMI patients treated with PCI (P＜0.05). The area under the ROC curve for combined assessment of AMI prognosis using Myo, Gas6, and SOX9 mRNA was 0.936, with higher specificity and sensitivity compared to individual detection of Myo, Gas6, and SOX9 mRNA (0.706, 0.696, and 0.711, respectively; Z=2.261, P＜0.05). Conclusion For patients with AMI, higher expression of Myo and Gas6 and lower expression of SOX9 mRNA were observed, and PCI treatment effectively improved the levels of Myo, Gas6, and SOX9 mRNA. Combined detection of these three biomarkers has a significant predictive role for MACCE after PCI, facilitating early diagnosis and treatment decision-making for patients, and warrants clinical application. [ABSTRACT FROM AUTHOR]

BACKGROUND: Strokes are the most common cause of death and the leading cause of acquired disability in adults worldwide. OBJECTIVE: The present study aimed to investigate the value of transcranial Doppler ultrasound (TCD) in the diagnosis of intracranial vascular stenosis in patients with a history of stroke. METHODS: This is a meta-analysis study of diagnostic tests. PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP databases were systematically searched. Diagnostic tests using TCD or transcranial colour Doppler ultrasound (TCCD) for detecting intracranial arterial stenosis in patients with a history of stroke were included, with reference standards of intracranial angiography, computed tomography angiography (CTA), or magnetic resonance angiography. The risk bias map was drawn by Revman v5.3, the sensitivity and specificity forest plot was drawn by Stata v16.0, the receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated. RESULTS: A total of 812 patients with stroke in 12 studies were included in the meta-analysis. The estimated sensitivity of TCD or TCCD for the detection of intracranial vascular stenosis was 0.77–1.00, and the combined sensitivity was 0.96 (95% confidence interval [CI]: 0.88–0.99); the estimated specificity was 0.32–1.00, and the combined specificity was 0.94 (95% CI: 0.82–0.98); the positive likelihood ratio was 15.8 (95% CI: 5.1–48.6); and the negative likelihood ratio was 0.04 (95% CI: 0.01–0.14). The AUC was 0.99 (95% CI: 0.97–0.99). CONCLUSION: Doppler ultrasound has good consistency with conventional methods for the diagnosis of intracranial artery stenosis in patients with a history of stroke. Different reference standards may affect sensitivity and specificity; when CTA was used as the reference standard, the consistency of the TCD in the diagnosis of intracranial artery stenosis in stroke patients was relatively good. [ABSTRACT FROM AUTHOR]

Objective: To discuss the expression levels of mitochondrial autophagy and apoptosis-related genes in peripheral blood mononuclear cells (PBMCs) in the patients with myasthenia gravis (MG), and to clarify its diagnostic value for MG. Methods: The PBMCs from 50 healthy controls (control group) and 50 MG patients (MG group) were collected and extracted. Real-time fluorescence quantitative PCR (RTqPCR) and Western blotting methods were used to detect the expression levels of mitochondrial autophagy factors phosphatase and tensin homolog (PTEN)-induced kinase 1 (PINK1), E3 ubiquitin-protein ligase PARK2 (Parkin), ubiquitin-binding protein p62 (p62), microtubule-associated proteins light chain 3 type Ⅱ (LC3Ⅱ), and apoptotic factors cytochrome C (Cyt-C), B cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax), cysteine-containing aspartic acid protease 3 (caspase 3), and cysteine-containing aspartic acid protease 9 (caspase 9) mRNA and protein. Different cut-off values were set based on the mRNA detection results, and the corresponding sensitivity and specificity at each cut-off value were calculated. The receiver operating characteristic (ROC) curve was drawn. Results: Compared with control group, the expression levels of autophagy factors PINK1, Parkin, and LC3Ⅱ mRNA and protein in the PBMCs in MG group were significantly decreased (P<0. 01), while the expression levels of p62 mRNA and protein were increased (P<0. 05 or P<0. 01). The expression levels of apoptotic factors Cyt-C, Bax, caspase 3, and caspase 9 mRNA and protein were significantly increased (P<0. 05 or P<0. 01), and while the expression levels of Cyt-C mRNA and protein were increased (P<0. 05 or P<0. 01), and the expression levels of Bcl-2 mRNA and protein were significantly decreased (P<0. 01). The ROC curve analysis results showed that the area under the curve (AUC) for PINK1, Parkin, p62, and LC3Ⅱ were 0. 969 6 (95%CI: 0. 943 5- 0. 995 7), 0. 944 0 (95%CI: 0. 904 7-0. 983 3), 0. 855 6 (95%CI: 0. 776 7-0. 934 5), and 0. 908 8 (95%CI: 0. 852 6-0. 965 0) (P<0. 01), respectively, and the sensitivities were 92%, 92%, 78%, and 84%, and the specificities were 88%, 82%, 92%, and 82%, respectively; whereas the AUC for Cyt-C, Bax, Bcl-2, caspase 3, and caspase 9 was 1. 000 (P<0. 01), and the sensitivity and specificity reached 100%. Conclusion: Mitochondrial autophagy disorder and increased apoptosis are found in the PBMCs in the patients with MG, which has a higher guiding value for clinical diagnosis of MG. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic value of non-invasive models for autoimmune cirrhosis with esophagogastric varices (EGV), and to provide the basis for the early diagnosis of autoimmune cirrhosis with EGV. Methods: The retrospective collection of clinical data from 238 patients diagnosed with autoimmune cirrhosis was performed, and the patients divided into EGV group and non-EGV group according to whether complicated with EGV. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (γ-GT), platelet (PLT), AST / PLT index (APRI), fibrosis-4 index (FIB-4), and AST/ALT ratio (AAR) of the patients in both groups were compared and the receiver operating characteristic (ROC) curve was plotted to calculate the area under the curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value to evaluate the diagnostic values of various models for autoimmune cirrhosis with EGV. Results: The levels of APRI, FIB-4, and ALT of the patients in EGV group were significantly higher than those in non-EGV group (P<0. 01), while the levels of PLT and AAR were significantly lower than those in non-EGV group (P<0. 01). In single indicator diagnostic model, ALT had the largest AUC of 0. 645 (95% CI: 0. 580－0. 705, P< 0. 001), the sensitivity was 93. 75%, the specificity was 34. 04%, the positive predictive value was 68. 53%, and the negative predictive value was 78. 05%. In multiple indicator combined models, the combined model of ALT+FIB-4+AAR+PLT had the largest AUC of 0. 787 (95% CI: 0. 730－0. 838, P<0. 001), and the sensitivity was72. 22%, the specificity was 73. 40%, the positive predictive value was 80. 62%, and the negative predictive value was 63. 30%. Compared with ALT and ALT+FIB-4 models, the AUC of the combined models of ALT+FIB-4+AAR, ALT+FIB-4+AAR+PLT, and ALT+FIB4+AAR+PLT+APRI had statistically significant differences (P<0. 05). However, there were no significant differences in AUC among the above three models (P>0. 05). Conclusion: The combined detection of APRI, FIB-4, ALT, PLT, and AAR can improve the early diagnostic efficacy of autoimmune cirrhosis with EGV. [ABSTRACT FROM AUTHOR]

The breathing and suspended inspiration techniques are often used interchangeably for spine X-ray examinations. However, these techniques are not always adequately supported by clinical evidence. This study aimed to determine the two techniques' diagnostic value and adverse image outcomes. A total of 400 participants were examined on a Siemens Ysio Max system and randomized into four examination groups: suspended inspiration or breathing techniques with exposure times of 1, 2, and 3.2 s, respectively. Two consultant radiologists conducted the evaluation of the X-ray images. If disagreement was present, the radiologists collaboratively reviewed the X-ray images until a consensus was reached. The final 394 study population comprised 275 women and 119 men with a mean age of 64 years (range:18–96 years). The proportions of visually sharp reproduction of the endplates and trabecular structures did not differ significantly with regards to differences in exposure times between groups. The breathing technique groups had significantly higher proportions of blurring and motion artifacts (p < 0.001). However, adverse image outcomes (motions artifacts) were significantly lower in the 1-s exposure group. The suspended inspiration and breathing techniques performed equally well regarding visually sharp reproduction. However, the suspended inspiration technique was superior to the breathing technique. regarding adverse image outcomes, although the latter could be improved by using a shorter exposure time. The suspended inspiration and breathing technique appeared to perform at equal diagnostic levels. The suspended inspiration technique should be preferred due to its reduced risk of adverse image outcomes. However, the risk could also be reduced using a short exposure time with the breathing technique. [ABSTRACT FROM AUTHOR]

Sonography is a beneficial imaging modality for detecting elbow fractures in children, considering the lack of radiation exposure and time efficiency. This systematic review aims to determine the diagnostic value and clinical applicability of sonography and each sonographic finding in detecting pediatric elbow fractures. Pubmed, Scopus, and WOS databases were searched for related original articles until February 25, 2023, and data related to diagnostic performance were extracted. We used the Bivariate model and hierarchic summary receiver operating characteristic (HSROC) approach to calculate pooled diagnostic values. Cochrane Q test and I-squared were performed to evaluate heterogeneity. We assessed heterogeneity with meta-regression. Eight studies were included, which involved a total number of 880 patients. According to meta-analysis, sonography demonstrated a pooled sensitivity of 97% (91–99%) and specificity of 90% (80–95%), positive likelihood ratio(LR+) of 9.82 (4.59–20.97), and negative likelihood ratio (LR–) of 0.03 (0.01–0.10). For the sonographic posterior fat pad sign as a sole diagnostic sign, we calculated a Pooled Sensitivity of 80% (70–88%), Specificity of 97% (87–99%), LR+ of 28.8 (6–139.3), and LR– of 0.2 (0.13–0.31). Also, lipohemarthrosis demonstrated a pooled sensitivity of 80% (70–88%), specificity of 97% (87–99%), LR+ of 28.8 (6–139.3), and LR– of 0.2 (0.13–0.31). The sensitivity of detecting fractures with cortical line disruption was significantly higher in studies that utilized a comprehensive technique compared to a conventional technique. Sonography is a valuable diagnostic tool for the assessment of pediatric elbow injuries, and it can be capable of confirmation or exclusion of the diagnosis. [ABSTRACT FROM AUTHOR]

Vascular causes are most commonly associated with sudden sensorineural hearing loss (SSHL). This study was performed to determine the relationship between serum endothelin-1 (ET-1), high-density lipoprotein cholesterol (HDL-C), soluble vascular cell adhesion molecule-1 (sVCAM-1) levels, and the degree of hearing loss in patients with SSHL. Firstly, 60 SSHL patients were admitted to The First Hospital of Shanxi Medical University. In the same period, 60 healthy subjects matching the age and gender of SSHL patients were selected as the control group. Then, serum levels of ET-1, HDL-C, and sVCAM-1 were measured by enzyme-linked immunosorbent assay (ELISA). Next, the relationship between serum levels of ET-1, HDL-C, and sVCAM-1 with clinicopathological factors and their diagnostic and prognostic values were analyzed and evaluated. Serum ET-1 and sVCAM-1 were increased, and HDL-C was decreased in patients with SSHL. Serum ET-1 and sVCAM-1 were higher and HDL-C was lower in patients aged ≥ 45 years, or severe hearing loss patients (P < 0.05). ROC analysis determined that ET-1 (AUC = 0.839), HDL-C (AUC = 0.830), and sVCAM-1 (AUC = 0.865) had excellent diagnostic values. In addition, patients with low levels of ET-1 and sVCAM-1 and high levels of HDL-C had better hearing prognosis (P < 0.05). Abnormal serum ET-1, HDL-C, and sVCAM-1 in patients with SSHL are closely related to age, and degree of hearing loss, and perform diagnostic and prognostic values. [ABSTRACT FROM AUTHOR]

Objective To investigate the diagnostic value of ultrasound parameters combined with peripheral blood indexes in childhood with lymphoma. Methods A total of 123 children with enlarged superficial lymph nodes suspected as lymphoma admitted to this hospital from June 2018 to October 2020 were examined by ultrasound. Among them, 85 children were pathologically diagnosed as lymphoma (the lymphoma group), 38 children were diagnosed as benign lesions (the benign group), and 30 healthy children were collected as the healthy group. The diagnostic value of the ultrasonic parameters such as length to short diameter ratio(L/S), lymphatic hilum and blood flow type were evaluated in children with non-Hodgkin lymphoma. The expression of three immune related genes, CC chemokine receptor 5(CCR5), programmed cell death protein 1(PD-1) and fork head box P3(FOXP3) in peripheral blood of children with lymphoma was analyzed by reverse transcription polymerase chain reaction and the combined diagnostic value of ultrasound parameters combined with three peripheral blood indexes in the childhood lymphoma was analyzed. Results The area under curve (AUC), sensitivity and specificity of L/S, lymphatic hilum and blood flow types in the combined diagnosis of lymphoma were 0. 846.89, 41% and 68, 42% respectively. The relative expression of CCR5.PD-1 and FOXP3 mRNA in peripheral blood of children in lymphoma group was significantly higher than those in healthy group and benign group and the difference was statistically significant (P<0,05), The AUC, sensitivity and specificity of ultrasound parameters combined with peripheral blood CCR5, PD-1 and FOXP3 in the diagnosis of lymphoma were 0.976.97.65% and 92. 11%, respectively. Conclusion Ultrasound parameters(L/S, lymphatic hilum and blood flow type) combined with peripheral blood CCR5, PD-1, and FOXP3 have a very high diagnostic value for lymphoma. [ABSTRACT FROM AUTHOR]

To investigate the relationship between serum hypoxia inducible factor-1α(HIF-1α), carbohydrate responseelement binding protein (ChREBP) and glucose and lipid metabolism, renal function in patients with type 2 diabetic kidney disease(T2DKD) and its diagnostic value. 100 patients with T2DKD who were admitted to our hospital from January 2021 to January2022 were selected as T2DKD group, 100 patients with simple T2DM during the same period were selected as T2DM group, and 100healthy people in our hospital during the same period were selected as control group. Serum HIF-1α, ChREBP and glucose and lipidmetabolism indexes [fasting blood glucose (FBG), postprandial 2hFBG (2hFBG), hemoglobin A1c (HbA1c), homeostasis model assess-ment-insulin resistance index (HOMA-IR), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C)], renal function indexes [urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR)] were detected. The correlation between serum HIF-1α and ChREBP levels and glycolipid metabolism and renal function indexes in T2DKD patients were analyzed by pearson correlation analysis, the diagnostic value of serum HIF-1α and ChREBP levels in T2DKD were analyzed by receiver operating characteristic (ROC) curve. The levels of serum HIF-1α, ChREBP, FBG, 2hFBG,HbA1c, HOMA-IR, TC, TG, LDL-C and UACR in control group, T2DM group and T2DKD group increased in turn, while HDL-C andeGFR decreased in turn (P<0.05). Pearson correlation analysis showed that, serum HIF-1α and ChREBP levels in T2DKD patients were positively correlated with FBG, HbA1 c, HOMA-IR, TC, TG, LDL-C and UACR, and negatively correlated with HDL-C and eGFR(P<0.05). ROC curve analysis showed that, the area under the curve of serum HIF-1α and ChREBP levels alone and combined diagnosis ofT2DKD was 0.784,0.787 and 0.882 respectively, and the area under the curve of combined diagnosis of HIF-1α and ChREBP levels was greater than that of each index alone (P<0.05). The increase of serum HIF-1α and ChREBP levels in T2DKD patients is relate to the disorder of glucose and lipid metabolism and the decrease of renal function, the combination of serum HIF-1α and ChREBP levels has certain value in the diagnosis of T2DKD. [ABSTRACT FROM AUTHOR]