Utility of serological biomarker’ panels for diagnostic accuracy of interstitial lung diseases

Immunologic Research - Interstitial lung diseases (ILD) are a heterogeneous group of illnesses of known and unknown aetiology. Differential diagnosis among the three disorders is often challenging....     

A six stage approach for the diagnosis of the Alzheimer’s disease based on fMRI data

The aim of this work is to present an automated method that assists in the diagnosis of Alzheimer’s disease and also supports the monitoring of the progression of the disease. The method is based on features extracted from the data acquired during an fMRI experiment. It consists of six stages: (a) preprocessing of fMRI data, (b) modeling of fMRI voxel time series using a Generalized Linear Model, (c) feature extraction from the fMRI data, (d) feature selection, (e) classification using classical and improved variations of the Random Forests algorithm and Support Vector Machines, and (f) conversion of the trees, of the Random Forest, to rules which have physical meaning. The method is evaluated using a dataset of 41 subjects. The results of the proposed method indicate the validity of the method in the diagnosis (accuracy 94%) and monitoring of the Alzheimer’s disease (accuracy 97% and 99%).     

Reevaluation of myoglobin for acute chest pain evaluation: would false-positive results on "first-draw" specimens lead to increased hospital admissions?

Myoglobin is an early marker of cardiac injury, although positive results occur in the absence of cardiac myonecrosis. We studied data for 537 patients admitted to the emergency department with symptoms suggestive of myocardial injury who underwent testing for troponin I (TnI), creatine kinase isoenzyme (CK-MB), and myoglobin at the point of care. Physicians were blinded to the myoglobin results. Myoglobin had a sensitivity of 69.7% and a negative predictive value of 97.4% for the diagnosis of acute coronary syndrome (ACS) on "first-draw" specimens. Receiver operating characteristic curve analysis suggested that myoglobin demonstrated optimal sensitivity for ACS, while TnI had optimal specificity. CK-MB was neither the most specific nor the most sensitive marker. More than 80% of the patients with false-positive myoglobin results were admitted to the hospital. These data invalidate concerns regarding the putative overtreatment effect of false-positive cases owing to myoglobin results. Furthermore, our data suggest that myoglobin is superior to CK-MB as an adjunct to TnI.     

Effect of picrotoxin on organism’s resistance to acute severe hypoxia

Organism’s resistance to acute severe hypoxia (3% O₂) was studied after administration of GABA_A receptor antagonist picrotoxin and adenosine receptor antagonist euphylline (aminophylline) and after neutralization of secondary hypocapnia by adding 7% CO₂ to the hypoxic mixture. Administration of picrotoxin to anesthetized rats increased animal resistance to hypoxia. The resistance to hypoxia decreased after treatment with euphylline. Neutralization of secondary hypocapnia by adding 7% CO₂ to the hypoxic mixture had no effect on animal lifespan. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 2, pp. 136–140, February, 2008     

Can immunohistochemistry replace immunofluorescence in diagnosis of skin bullous diseases?

Autoimmune bullous diseases are distressing and sometimes risky bullous dermatoses characterized by the presence of antibodies focused against disease‐specific target antigens. Recognition of these antibodies using immunofluorescence is used to be the only sure diagnostic method after reviewing the routine histopathological section. Because of many causes that make the using of immunofluorescence difficult, we tried to evaluate the role of immunohistochemistry in diagnosis of these bullous skin diseases; 40 pemphigus cases (30 pemphigus vulgaris and 10 pemphigus foliaceus) and 37 non‐pemphigus cases (35 vesiculobullous skin diseases and 2 normal skin). Skin biopsy was obtained for histopathological diagnosis, immunofluorescence study, and immune‐histochemical studying for IgG4 and C3d expression. IgG4 was positive in almost all cases of pemphigus vulgaris and most of pemphigus foliaceus and bullous pemphigoides, while all other diseases were negative. C3d expression was positive in almost all bullous pemphigoides and pemphigus gestationis cases, while it was negative in almost all other cases. Sensitivity and specificity of both markers increase by using them in combination in diagnosis of such bullous diseases. IgG4 and C3d immunohistochemistry could replace DIF in almost all of our cases, so before doing DIF, reliable immunohistochemical detection of IgG4 and C3d on formalin‐fixed tissue is advised to be done.     

Effectiveness of oncogenetics training on general practitioners’ consultation skills: a randomized controlled trial

PurposeGeneral practitioners are increasingly called upon to deliver genetic services and could play a key role in translating potentially life-saving advancements in oncogenetic technologies to patient care. If general practitioners are to make an effective contribution in this area, their genetics competencies need to be upgraded. The aim of this study was to investigate whether oncogenetics training for general practitioners improves their genetic consultation skills.MethodsIn this pragmatic, blinded, randomized controlled trial, the intervention consisted of a 4-h training (December 2011 and April 2012), covering oncogenetic consultation skills (family history, familial risk assessment, and efficient referral), attitude (medical ethical issues), and clinical knowledge required in primary-care consultations. Outcomes were measured using observation checklists by unannounced standardized patients and self-reported questionnaires.ResultsOf 88 randomized general practitioners who initially agreed to participate, 56 completed all measurements. Key consultation skills significantly and substantially improved; regression coefficients after intervention were equivalent to 0.34 and 0.28 at 3-month follow-up, indicating a moderate effect size. Satisfaction and perceived applicability of newly learned skills were highly scored.ConclusionThe general practitioner–specific training proved to be a feasible, satisfactory, and clinically applicable method to improve oncogenetics consultation skills and could be used as an educational framework to inform future training activities with the ultimate aim of improving medical care.Genet Med16 1, 45–52.     

Baby Boomers’ Adoption of Consumer Health Technologies: Survey on Readiness and Barriers

Background

As they age, baby boomers (born 1946-1964) will have increasing medical needs and are likely to place large demand on health care resources. Consumer health technologies may help stem rising health care needs and costs by improving provider-to-patient communication, health monitoring, and information access and enabling self-care. Research has not explored the degree to which baby boomers are ready for, or are currently embracing, specific consumer health technologies This study explores how baby boomers’ readiness to use various technologies for health purposes compares to other segments of the adult population.

Objective

The goals of the study are to (1) examine what technologies baby boomers are ready to use for health purposes, (2) investigate barriers to baby boomers’ use of technology for health purposes, and (3) understand whether readiness for and barriers to baby boomers’ use of consumer health technologies differ from those of other younger and older consumers.

Methods

Data were collected via a survey offered to a random sample of 3000 subscribers to a large pharmacy benefit management company. Respondents had the option to complete the survey online or by completing a paper-based version of the survey.

Results

Data from 469 respondents (response rate 15.63%) were analyzed, including 258 baby boomers (aged 46-64 years), 72 younger (aged 18-45 years), and 139 older (age >64 years) participants. Baby boomers were found to be similar to the younger age group, but significantly more likely than the older age group to be ready to use 5 technologies for health purposes (health information websites, email, automated call centers, medical video conferencing, and texting). Baby boomers were less ready than the younger age group to adopt podcasts, kiosks, smartphones, blogs, and wikis for health care purposes. However, baby boomers were more likely than older adults to use smartphones and podcasts for health care purposes. Specific adoption barriers vary according to the technology.

Conclusions

Baby boomers have commonalities with and distinctions from both younger and older adults in their readiness to adopt specific consumer health technologies and the barriers they experience to adoption. Baby boomers’ nuances regarding readiness to adopt and the barriers associated with the various forms of consumer health technology should be taken into account by those interested in promoting consumer health technologies use among baby boomers when developing applications, choosing technologies, preparing users for use, and in promotional tactics.     

The effects of ‘‘acute’’ cigarette smoking on cognitive functioning in chronic schizophrenia

Introduction. Visuoconceptual integration was explored as a test of central coherence theory (Frith, 1989). Individuals with autism are thought to have weak central coherence so the prediction was that these individuals would show an impaired ability to integrate visual information. Method. Two groups with autistic disorder were recruited: adults with either autism or Asperger syndrome. All were normally intelligent and were matched with members of the general population of Cambridge. A modified version of the Hooper Visual Organisation Test was used in which line drawings depicting simple objects had been cut into pieces and arranged in a puzzle-like fashion. The participants were required to conceptually integrate the fragments in order to identify the object. A second condition presented just a single piece of an object and participants were required to identify objects from a single piece. Results. Both clinical groups were significantly impaired in their ability to integrate pieces holistically, but they were unimpaired in their ability to identify an object from a single piece. Conclusion. Individuals with an autistic disorder are less able to integrate visual elements. Of the two clinical groups, the autism group had the greater deficit, and it applied to the majority of the group. Possible explanations for the clinical groups' weak central coherence are explored.     

Comparison of six immunohistochemical markers for the histologic diagnosis of neoplasia in Barrett’s esophagus

In esophageal neoplasms, the histopathologic differentiation between Barrett’s esophagus with or without intraepithelial neoplasia and adenocarcinoma is often challenging. Immunohistochemistry might help to differentiate between these lesions. The expression of CDX2, LI-cadherin, mucin 2 (MUC2), blood group 8 (BG8, Lewis^y), claudin-2, and villin was investigated in normal gastroesophageal (n = 23) and in Barrett’s (n = 17) mucosa, in low-grade (n = 12) and high-grade (n = 9) intraepithelial neoplasia (IEN) as well as in esophageal adenocarcinoma (n = 16), using immunohistochemistry. For CDX2 and LI-cadherin, the immunoreactivity score was highest in IEN while for MUC2, BG8, and villin, it dropped gradually from Barrett’s via IEN to adenocarcinoma, and expression of Claudin-2 was only weak and focal in all lesions. The expression of MUC2 and LI-cadherin differed significantly between all examined lesions except between low-grade and high-grade IEN. MUC2 and LI-cadherin are useful immunohistochemical markers for the differentiation between normal glandular mucosa, Barrett’s mucosa, IEN, and invasive carcinoma of the esophagus; however, none of the examined markers was helpful for the differentiation between low-grade and high-grade IEN.     

Muscle abnormalities of the chest in Poland’s syndrome: variations and proposal for a classification

Purposes  

Poland’s syndrome (PS) is a rare congenital malformation, which combines anomalies of the chest and the homolateral upper limb. The purposes of the paper are to study the chest musculoskeletal malformations of the syndrome and propose a classification for the thoracic anomalies through our experience and taking into account the literature.     

Can Computer Meridian Diagnostic be useful in diagnosis and management of diseases?

The need for the development of appropriate guidelines for effective or safe use of antioxidants and herbs has always been a concern, especially for the alternative medicine practices. Computer Meridian Diagnostic (CMD) is one of emerging computer-based diagnostic technologies available to alternative medicine practitioners. However, case report of the agents monitored with CMD is uncommon; and concerted effort to bring this into conventional medical practice is yet to be. This hypothesis builds on an anecdotal observation of anti-stress effect monitored with CMD, with a view to highlight a potential tool that requires expatiation, as well as proof of concept and validation studies for possible integration in conventional and traditional medicine practices for therapeutic monitoring.     

Health practitioners’ recognition and management of postpartum obsessive-compulsive thoughts of infant harm

The postpartum period has been associated with elevated rates of onset of obsessive-compulsive disorder (OCD) among women, with a prevalence of 2–9%. Postpartum OCD is often characterized by recurrent, unwanted, and highly distressing thoughts, images, or impulses of deliberate infant harm. This study investigated health practitioners’ recognition of, and clinical management strategies for, postpartum obsessive-compulsive symptoms (OCS). Ninety-four perinatal health practitioners from a range of disciplines and professional backgrounds completed a survey comprised of a hypothetical case vignette and questions eliciting their responses to a clinical presentation of postpartum infant harming obsessions. Almost 70% of participants did not accurately identify OCS within the case. Furthermore, the majority of practitioners endorsed at least one contraindicated clinical management strategy likely to aggravate postpartum OCS. Accurate recognition of OCS was associated with the selection of fewer contraindicated strategies. Some aspects of practitioner training and experience were associated with correct OCS identification. These findings underscore the need for targeted, interdisciplinary education to improve the detection and management of women experiencing postpartum OCS.

     

2.5 years’ experience of GeneMatcher data-sharing: a powerful tool for identifying new genes responsible for rare diseases

PurposeExome sequencing (ES) powerfully identifies the molecular bases of heterogeneous conditions such as intellectual disability and/or multiple congenital anomalies (ID/MCA). Current ES analysis, combining diagnosis analysis restricted to disease-causing genes reported in OMIM database and subsequent research investigation extended to other genes, indicated causal and candidate genes around 40% and 10%. Nonconclusive results are frequent in such ultrarare conditions that recurrence and genotype-phenotype correlations are limited. International data-sharing permits the gathering of additional patients carrying variants in the same gene to draw definitive conclusions on their implication as disease causing. Several web-based tools have been developed and grouped in Matchmaker Exchange. In this study, we report our current experience as a regional center that has implemented ES as a first-line diagnostic test since 2013, working with a research laboratory devoted to disease gene identification.MethodsWe used GeneMatcher over 2.5 years to share 71 novel candidate genes identified by ES.ResultsMatches occurred in 60/71 candidate genes allowing to confirm the implication of 39% of matched genes as causal and to rule out 6% of them.ConclusionThe introduction of user-friendly gene-matching tools, such as GeneMatcher, appeared to be an essential step for the rapid identification of novel disease genes responsible for ID/MCA.     

Analysis of trajectories of eye,head, and hand movements for early diagnosis of Parkinson’s disease

Relationships between eye, head, and hand movements in patients with stages I–II Parkinson’s disease were studied using an original method. The tests for individual movements in patients and healthy individuals yielded similar results, while coordination test revealed significant differences. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 143, No. 5, pp. 484–486, May, 2007     

Online information on oncologists’ and non-medical practitioners’ websites in Germany: A critical comparison

ObjectiveTo survey websites of oncologists and non-medical practitioners (NMPs) in Germany regarding range of treated symptoms, diagnostic tools and therapies offered to cancer patients as well as the quality of websites.MethodsAnalysis of 98 websites of oncologists and NMPs was conducted between April and July 2018 with a standardized tool.ResultsRange of diagnostic and therapeutic methods was high and differed between both groups. Many NMPs (65.3%) intended to support conventional therapy rather than to treat cancer. Most oncologists (85.7%) did not mention the role of complementary and alternative medicine (CAM). Texts on oncologists’ websites, showed high complexity according to readability analysis using LIX score as opposed to those on NMPs websites that showed medium complexity. Only small difference of quality of websites between both groups could be detected.ConclusionMethods not acknowledged by evidence-based medicine as well as methods at risk for interaction with conventional cancer therapy but also treatment offers with potential benefits for cancer patients were found on NMPs websites.Practice implicationsAs evidence-based CAM methods can be a useful support of cancer treatment, risk of herb drug interactions can be minimized by oncologists offering reasonable CAM.     

Development and validation of an objective assessment scale for chest tube insertion under ‘direct’ and ‘indirect’ rating

Background

There is an increasing need for objective and validated educational concepts. This holds especially true for surgical procedures like chest tube insertion (CTI). Thus, we developed an instrument for objectification of learning successes: the assessment scale based on Objective Structured Assessment of Technical Skill (OSATS) for chest tube insertion, which is evaluated in this study. Primary endpoint was the evaluation of intermethod reliability (IM). Secondary endpoints are ‘indirect’ interrater reliability (IR) and construct validity of the scale (CV).

Methods

Every participant (N =?59) performed a CTI on a porcine thorax. Participants received three ratings (one ‘direct’ on site, two ‘indirect’ via video rating). IM compares ‘direct’ with ‘indirect’ ratings. IR was assessed between ‘indirect’ ratings. CV was investigated by subgroup analysis based on prior experience in CTI for ‘direct’ and ‘indirect’ rating.

Results

We included 59 medical students to our study. IM showed moderate conformity (‘direct’ vs. ‘indirect 1’ ICC?=?0.735, 95% CI: 0.554–0.843; ‘direct’ vs. ‘indirect 2’ ICC?=?0.722, 95% CI 0.533–0.835) and good conformity between ‘direct’ vs. ‘average indirect’ rating (ICC?=?0.764, 95% CI: 0.6–0.86). IR showed good conformity (ICC?=?0.84, 95% CI: 0.707–0.91). CV was proven between subgroups in ‘direct’ (p =?0.037) and ‘indirect’ rating (p =?0.013).

Conclusion

Results for IM suggest equivalence for ‘direct’ and ‘indirect’ ratings, while both IR and CV was demonstrated in both rating methods. Thus, the assessment scale seems a reliable method for rating trainees’ performances ‘directly’ as well as ‘indirectly’. It may help to objectify and facilitate the assessment of training of chest tube insertion.

     

Radiologists’ Usage of Social Media: Results of the RANSOM Survey

The growing use of social media is transforming the way health care professionals (HCPs) are communicating. In this changing environment, it could be useful to outline the usage of social media by radiologists in all its facets and on an international level. The main objective of the RANSOM survey was to investigate how radiologists are using social media and what is their attitude towards them. The second goal was to discern differences in tendencies among American and European radiologists. An international survey was launched on SurveyMonkey (https://www.surveymonkey.com) asking questions about the platforms they prefer, about the advantages, disadvantages, and risks, and about the main incentives and barriers to use social media. A total of 477 radiologists participated in the survey, of which 277 from Europe and 127 from North America. The results show that 85 % of all survey participants are using social media, mostly for a mixture of private and professional reasons. Facebook is the most popular platform for general purposes, whereas LinkedIn and Twitter are more popular for professional usage. The most important reason for not using social media is an unwillingness to mix private and professional matters. Eighty-two percent of all participants are aware of the educational opportunities offered by social media. The survey results underline the need to increase radiologists’ skills in using social media efficiently and safely. There is also a need to create clear guidelines regarding the online and social media presence of radiologists to maximize the potential benefits of engaging with social media.