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diagnostic test interpretation

Chuan Zhou, Heang-Ping Chan, Lubomir M Hadjiiski, Aamer Chughtai, Jun Wei, Ella A Kazerooni
PURPOSE: The authors are developing an automated method to identify the best-quality coronary arterial segment from multiple-phase coronary CT angiography (cCTA) acquisitions, which may be used by either interpreting physicians or computer-aided detection systems to optimally and efficiently utilize the diagnostic information available in multiple-phase cCTA for the detection of coronary artery disease. METHODS: After initialization with a manually identified seed point, each coronary artery tree is automatically extracted from multiple cCTA phases using our multiscale coronary artery response enhancement and 3D rolling balloon region growing vessel segmentation and tracking method...
October 2016: Medical Physics
Randall C Edgell, Ahmed E Sarhan, Jazba Soomro, Collin Einertson, Joanna Kemp, Peyman Shirani, Theodore K Malmstrom, Jeroen Coppens
BACKGROUND: Central nervous system vasculitis (CNSV) is a rare disorder, the pathophysiology of which is not fully understood. It involves a combination of inflammation and thrombosis. CNSV is most commonly associated with headache, gradual changes in mental status, and focal neurological symptoms. Diagnosis requires the effective use of history, laboratory testing, imaging, and biopsy. Catheter angiography can be a powerful tool in the diagnosis when common and low-frequency angiographic manifestations of CNSV are considered...
September 2016: Interventional Neurology
Koichi Nagata, Shungo Endo, Tetsuro Honda, Takaaki Yasuda, Michiaki Hirayama, Sho Takahashi, Takashi Kato, Shoichi Horita, Ken Furuya, Kenji Kasai, Hiroshi Matsumoto, Yoshiki Kimura, Kenichi Utano, Hideharu Sugimoto, Hiroyuki Kato, Rieko Yamada, Junta Yamamichi, Takeshi Shimamoto, Yasuji Ryu, Osamu Matsui, Hitoshi Kondo, Ayako Doi, Taro Abe, Hiro-O Yamano, Ken Takeuchi, Hiroyuki Hanai, Yukihisa Saida, Katsuyuki Fukuda, Janne Näppi, Hiroyuki Yoshida
OBJECTIVES: The objective of this study was to assess prospectively the diagnostic accuracy of computer-assisted computed tomographic colonography (CTC) in the detection of polypoid (pedunculated or sessile) and nonpolypoid neoplasms and compare the accuracy between gastroenterologists and radiologists. METHODS: This nationwide multicenter prospective controlled trial recruited 1,257 participants with average or high risk of colorectal cancer at 14 Japanese institutions...
October 25, 2016: American Journal of Gastroenterology
Deepika Savant, Jaya Bajaj, Cecilia Gimenez, Oana C Rafael, Neda Mirzamani, Karen Chau, Melissa Klein, Kasturi Das
BACKGROUND: Urine cytology is the most frequently utilized test to detect urothelial cancer. Secondary bladder neoplasms need to be recognized as this impacts patient management. We report our experience on nonurothelial malignancies (NUM) detected in urine cytology over a 10-year period. METHODS: A 10-year retrospective search for patients with biopsy-proven NUM to the urothelial tract yielded 25 urine samples from 14 patients. Two cytopathologists blinded to the original cytology diagnosis reviewed the cytology and histology slides...
October 24, 2016: Diagnostic Cytopathology
L A Pérula-de Torres, V González-Blanco V, R Luque-Montilla, E Martín-Rioboó, M A Martínez-Adell, J Ruiz-de Castroviejo
INTRODUCTION: Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice and has important prognostic implications. The objective of this study was to demonstrate the validity and the reliability of taking the arterial pulse (TAP) in patients over 65 years for detecting in AF and other rhythm disorders. MATERIALS AND METHODS: A descriptive, observational, multicentre study to validate a diagnostic test within in a controlled clinical trial. SETTING: 39 Primary Care Centres in the Spanish National Health Service...
October 20, 2016: Semergen
Jayita De, Anne P F Wand, Peter I Smerdely, Glenn E Hunt
OBJECTIVE: To measure the diagnostic accuracy of the 4A's test in screening for delirium in geriatric inpatients from culturally diverse backgrounds. METHODS: A prospective study was conducted with patients admitted to the geriatric and orthogeriatric services of a tertiary teaching hospital. Consenting participants aged 65 years and over were screened for delirium with the 4AT by nursing staff within 72 h of admission. The diagnosis of delirium was made separately by expert assessors, responsible for the participant's clinical care, blinded to the 4AT score, within 30 min of the 4AT assessment using the DSM 5 criteria and the Confusion Assessment Method...
October 20, 2016: International Journal of Geriatric Psychiatry
Richard Colling, Daniel Royston, Elizabeth Soilleux
Clonality studies greatly assist in the diagnosis of challenging haematopathology cases. These robust and standardised tests aid the detection of clonal lymphoid populations and may assist in lymphocyte subtyping. In this case report, a gentleman presented with a high-grade transformation of a B cell neoplasm which histologically and immunophenotypically mimicked a T cell anaplastic large-cell lymphoma. With the aid of T cell and B cell receptor clonality studies, it was demonstrated that this tumour was in fact of B cell lineage...
September 2016: Journal of Hematopathology
Giacomo Veronese, Federico Germini, Stella Ingrassia, Ombretta Cutuli, Valeria Donati, Luca Bonacchini, Maura Marcucci, Andrea Fabbri
BACKGROUND: Electrocardiogram (ECG) interpretation is widely performed by emergency physicians. We aimed to determine the accuracy of interpretation of potential ST-segment elevation myocardial infarction (STEMI) ECGs by emergency physicians. METHODS: Thirty-six ECGs resulted in putative STEMI diagnoses were selected. Participants were asked to focus on whether or not the ECG in question met the diagnostic criteria for an acutely blocked coronary artery causing a STEMI...
October 19, 2016: Acute Cardiac Care
Ulrich Wahn
PURPOSE OF REVIEW: Currently, dramatic changes in allergy treatment can be observed in many countries: The availability of monocomponent products with pharmaceutical quality for SLIT is likely to have a strong impact on all immunotherapy practices and the specialty in general. The market for patient-named products with allergenic mixtures can be expected to shrink. Allergists are concerned about the possibility that single-source products for immunotherapy might be insufficient to serve the needs of all 'polyallergic' patients...
October 13, 2016: Current Opinion in Allergy and Clinical Immunology
Gian Paolo Rossi
Primary aldosteronism (PA) involves more than 11% of patients referred to specialized hypertension centers and, therefore, is much more common than commonly held. Moreover, it causes a damage to the heart, blood vessels and kidneys, which translates into a high rate of cardiovascular events, in excess to the degree of blood pressure raise. Along with the notion that a timely diagnosis entails a fundamental step for the choice of an appropriate therapy, which can correct the arterial hypertension and the hypokalemia, this justifies efforts to search for PA in the majority of the patients with hypertension...
September 2016: Journal of Hypertension
Amanda B Weber, Dara V Albert, Han Yin, Timothy Held, Anup Patel
INTRODUCTION: Strategies for diagnosing electrical status epilepticus during slow wave sleep (ESES) vary among interpreting neurologists. Our aim was to evaluate if the spike-wave index (SWI) for the first 100 seconds of sleep is reflective of the SWI when compared to a conventional method. METHODS: We reviewed electroencephalograms (EEGs) from 2005-2011 that were considered diagnostic of ESES based on unspecified methods. The SWI for the first non-rapid eye movement (NREM) sleep cycle (long method) was calculated by two neurophysiologists...
June 13, 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Carina Venter, Kate Maslin, Taraneh Dean, Syed Hasan Arshad
The timing of introduction of solid food on the subsequent development of food allergy is under debate and the role of concurrent breastfeeding is unclear. The aim of the present study was to investigate the role of solid food introduction whilst concurrently breastfeeding on food allergy outcome, with a specific focus on cows' milk allergy. Prospectively collected infant feeding data from a birth cohort were analysed. Participants with histories suggestive of food allergy underwent diagnostic food challenges...
2016: Journal of Nutritional Science
Julie R Taylor, Pamela J Thompson, Jonathan R Genzen, John Hickner, Marisa B Marques
BACKGROUND: The 2015 Institue of Medicine report Improving Diagnosis in Health Care highlighted that diagnostic errors cause patient harm and that improvement in the diagnostic process requires better collaboration among physicians and laboratory professionals. The purpose of this study is to understand why physicians do not contact laboratory professionals when facing diagnostic challenges and identify opportunities for laboratory professionals to become more recognized members of the clinical care team...
October 15, 2016: Laboratory Medicine
Susanne Eigl, Martin Hoenigl, Birgit Spiess, Sven Heldt, Juergen Prattes, Peter Neumeister, Albert Wolfler, Jasmin Rabensteiner, Florian Prueller, Robert Krause, Mark Reinwald, Holger Flick, Dieter Buchheidt, Tobias Boch
In recent years galactomannan antigen testing (GM) and also Aspergillus PCR have become increasingly important for diagnosis of invasive aspergillosis (IA). Whether or not these tests need to be performed with bronchoalveolar lavage fluid (BALF; i.e., primary site of infection), or testing of blood samples is sufficient, remains, however, a matter of debate. We evaluated the diagnostic performance of GM ELISA, and Aspergillus PCR by using BALF samples and blood samples obtained at the same day from a total of 53 immunocompromised patients (16 with probable/proven IA and 37 with no evidence of IA according to the revised EORTC/MSG criteria; 38 patients with hematological malignancies were prospectively enrolled at the Medical University of Graz, Austria, 15 patients with mixed underlying diseases at the Mannheim University Hospital)...
October 14, 2016: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
R Brent Stansfield, Lisa Diponio, Cliff Craig, John Zeller, Edmund Chadd, Joshua Miller, Seetha Monrad
BACKGROUND: Medical students have difficulty performing and interpreting musculoskeletal physical examinations and interpreting the findings. Research has focused on students' knowledge deficits, but there are few direct assessments of students' ability to perform a hypothesis-driven physical examination (HDPE). We developed a novel musculoskeletal Objective Structured Clinical Exam (OSCE) focusing on HDPE skills for disorders of the shoulder, back and knee, and used it to explore medical student diagnostic reasoning...
October 14, 2016: BMC Medical Education
Emily Han-Chung Hsiue, Jih-Hsiang Lee, Chia-Chi Lin, James Chih-Hsin Yang
Gefitinib is recently approved by the US Food and Drug Administration as a first-line treatment for non-small cell lung cancer (NSCLC) patients harboring EGFR mutations. The therascreen® EGFR RGQ PCR Kit is approved as a companion diagnostic to select patients with EGFR exon 19 deletions and L858R mutation for treatment with gefitinib. Areas covered: This article reviews the methods for detecting EGFR mutations, the technology and indication of the therascreen® kit, and the clinical utility of the assay in phase 3 and phase 4 clinical trials...
October 13, 2016: Expert Review of Molecular Diagnostics
Mario Plebani
A body of evidence collected in the last few decades demonstrates that the pre- and post-analytical phases of the testing cycle are more error-prone than the analytical phase. However, the paradigm of errors and quality in laboratory medicine has been questioned, analytical mistakes continuing to be a major cause of adverse clinical outcomes and patient harm. Although the brain-to-brain concept is widely recognized in the community of laboratory professionals, there is lack of clarity concerning the inter-relationship between the different phases of the cycle, interdependence between the pre-analytical phase and analytical quality, and the effect of the post-analytical steps on the quality of ultimate laboratory information...
October 12, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Saroochi Agarwal, Duc T Nguyen, Justin D Lew, Larry D Teeter, Jose-Miguel Yamal, Blanca I Restrepo, Eric L Brown, Susan E Dorman, Edward A Graviss
BACKGROUND: The TSPOT.TB (TSPOT) diagnostic test for latent tuberculosis infection is based on a cell-mediated response to the Mycobacteria tuberculosis antigens, ESAT-6 and/or CFP-10, producing an "interferon-gamma footprint". We investigated the within-sample and within-subject variability of positive TSPOT assays due to the individual assay antigens' reactivity. METHODS: Positive TSPOT assay frequencies due to ESAT-6 or CFP-10 among health care workers (HCWs) at 6-month intervals for 18 months were compared...
September 28, 2016: Tuberculosis
Shanshan Bao, Jonathan I Tamir, Jeffrey L Young, Umar Tariq, Martin Uecker, Peng Lai, Weitian Chen, Michael Lustig, Shreyas S Vasanawala
PURPOSE: To develop and clinically evaluate a pediatric knee magnetic resonance imaging (MRI) technique based on volumetric fast spin-echo (3DFSE) and compare its diagnostic performance, image quality, and imaging time to that of a conventional 2D protocol. MATERIALS AND METHODS: A 3DFSE sequence was modified and combined with a compressed sensing-based reconstruction resolving multiple image contrasts, a technique termed T2 Shuffling (T2 Sh). With Institutional Review Board (IRB) approval, 28 consecutive children referred for 3T knee MRI prospectively underwent a standard clinical knee protocol followed by T2 Sh...
October 11, 2016: Journal of Magnetic Resonance Imaging: JMRI
L Rodriguez, M Sood, C Di Lorenzo, M Saps
BACKGROUND: Over the last few years, the study of the colon and anorectal function has experienced great technical advances that have facilitated the performance of the tests and have allowed a more detailed characterization of reflexes and motor patterns. As a result, we have achieved a much better understanding of the pathophysiology of children with defecation problems. Anorectal and colonic manometry are now commonly used in all major pediatric referral centers as diagnostic tools and to guide the management of children with intractable constipation and fecal incontinence, particularly when a surgical intervention is being considered...
October 9, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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