Rapid and Efficient Enrichment of Snake Venoms from Human Plasma Using a Strong Cation Exchange Tip Column to Improve Snakebite Diagnosis

Snake envenomation is a serious public health issue in many tropical and subtropical countries. Accurate diagnosis and immediate antivenom treatment are critical for effective management. However, the venom concentration in the victims’ plasma is usually low, representing one of the bottlenecks in developing clinically applicable assays for venom detection and snakebite diagnosis. In this study, we attempted to develop a simple method for rapid enrichment of venom proteins from human plasma to facilitate detection. Our experiments showed that several major protein components of both Naja atra (N. atra) and Bungarus multicinctus (B. multicinctus) venoms have higher isoelectric point (pI) values relative to high-abundance human plasma proteins and could be separated via strong cation exchange–high-performance liquid chromatography (SCX-HPLC). Based on this principle, we developed an SCX tip column-based protocol for rapid enrichment of N. atra and B. multicinctus venom proteins from human plasma. Application of liquid chromatography-tandem mass spectrometry (LC-MS/MS) led to the identification of cytotoxin and beta-bungarotoxin as the major proteins enriched by the SCX tip column in each venom sample. The entire process of venom enrichment could be completed within 10–15 min. Combination of this method with our previously developed lateral flow strip assays (rapid test) significantly enhanced the sensitivity of the rapid test, mainly via depletion of the plasma protein background, as well as increase in venom protein concentration. Notably, the SCX tip column-based enrichment method has the potential to efficiently enrich other Elapidae snake venoms containing proteins with higher pI values, thereby facilitating venom detection with other assays. This simple and rapid sample preparation method should aid in improving the clinical utility of diagnostic assays for snakebite.     

Unnecessary diagnostic imaging: a review of the literature on preoperative imaging for boys with undescended testes

Cryptorchidism or undescended testis is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. Ultrasound is commonly ordered for boys with undescended testes prior to referral to a surgical specialist, but its sensitivity and specificity is insufficient to reliably localize non-palpable testes and thus confers unnecessary costs to the patient and the healthcare system. We review the ability of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) to reliably locate undescended testes and emphasize whether diagnostic imaging should change the decision to operate or the surgical approach for boys with cryptorchidism.     

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Despite its long history, there has been very little systematic study of figure skating. Successful skaters and coaches have passed on ideas, traditions, and opinions to their followers with the idea that what once produced good results must be the correct approach. Skaters are significantly shorter, lighter, and leaner than their sedentary counterparts and have a rather low percent body fat. Their cardiovascular fitness levels are 50% to 60% higher than those of sedentary people of the same age, but far less than those of endurance athletes.     

Positive non-invasive tests in the chest pain unit: importance of the clinical profile for estimating the probability of coronary artery disease

We studied 100 consecutive patients with coronary angiography performed after a positive result of a non-invasive test in the chest pain unit. Mean age was 66 years. The percentage of patients without significant coronary artery disease, 1-vessel disease and multivessel disease was 35, 33, and 32%, respectively. The CPU-65 index that combines four clinical variables (comorbidity: diabetes, pain: typical, use of: aspirin, 65 years old or more) was associated with the presence of coronary artery disease, multivessel disease, and coronary revascularization. We conclude that in the chest pain unit, patients with a positive non-invasive test the rate of false positive results, one-vessel disease and multivessel disease is similar. However, important changes in these percentages are seen, according to the clinical profile. The CPU-65 index is useful to determine the pre-test probability of significant coronary artery disease and patients with intermediate scores are the ones that benefit most of non-invasive tests.     

内镜诊断技术在早期胃癌诊断中的研究进展

我国是胃癌高发国家，发病率和病死率均较高。早期发现和诊断可以有效降低胃癌的病死率，从而改善患者的预后。而早期胃癌的发现和诊断高度依赖胃镜的筛查，但传统白光内镜对胃早癌的筛查有一定的局限性。随着科技的快速发展，越来越多新的内镜成像技术应运而生，本文将探讨近年来应用于临床的各种内镜技术在早期胃癌诊断中的应用价值。     

The effect of scan parameters on cone beam CT trabecular bone microstructural measurements of the human mandible

The objective of this study was to investigate the effect of different cone beam CT scan parameters on trabecular bone microstructure measurements. A human mandibular cadaver was scanned using a cone beam CT (3D Accuitomo 170; J.Morita, Kyota, Japan). 20 cone beam CT images were obtained using 5 different fields of view (4×4 cm, 6×6 cm, 8×8 cm, 10×10 cm and 10×5 cm), 2 types of rotation steps (180° and 360°) and 2 scanning resolutions (standard and high). Image analysis software was used to assess the trabecular bone microstructural parameters (number, thickness and spacing). All parameters were measured twice by one trained observer. Intraclass correlation coefficients showed high intraobserver repeatability (intraclass correlation coefficient, 0.95–0.97) in all parameters across all tested scan parameters. Trabecular bone microstructural measurements varied significantly, especially in smaller fields of view (p = 0.001). There was no significant difference in the trabecular parameters when using different resolutions (number, p = 0.988; thickness, p = 0.960; spacing, p = 0.831) and rotation steps (number, p = 1.000; thickness, p = 0.954; spacing, p = 0.759). The scan field of view significantly influences the trabecular bone microstructure measurements. Rotation steps (180° or 360°) and resolution (standard or high) selections are not relevant.     

Rapid Detection of ESBL-Producing Enterobacteriaceae in Blood Cultures

We rapidly identified extended-spectrum β-lactamase (ESBL) producers prospectively among 245 gram-negative bacilli–positive cultured blood specimens using the Rapid ESBL Nordmann/Dortet/Poirel test and direct bacterial identification using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. This combination identified ESBL-producing Enterobacteriaceae within 30 min and had high predictive values.