Adjuncts for the evaluation of potentially malignant disorders in the oral cavity: Diagnostic test accuracy systematic review and meta-analysis—a report of the American Dental Association

Background

Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients’ values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity.

Assessing Bone Type of Implant Recipient Sites by Stereomicroscopic Observation of Bone Core Specimens: A Comparison With the Assessment Using Dental Radiography

Background: The aim of the study is to determine if bone quality evaluation of surgically obtained bone core specimens using a stereomicroscope is reliable for determining bone quality at implant recipient sites. Methods: Bone quality was presurgically assessed in 122 edentulous ridges obtained from 62 patients using periapical radiographs and categorized according to the Lekholm and Zarb classification. During surgery, bone specimens were trephined, and bone types were immediately classified using a stereomicroscope. Microarchitectural characteristics of bone cores were evaluated after being scanned using microcomputed tomography (micro‐CT). Results: Bone types of implant sites categorized from radiography and stereomicroscope had statistically similar distribution but poor interrater agreement. Using micro‐CT, maxillae and mandibles showed significant differences in microarchitectural characteristics of bone cores. Bone volume (BV), total volume (TV), and trabecular thickness (Tb.Th) increased, whereas bone surface density (BS/BV) and open porosity (Po.[Op]) decreased in mandibular bone cores compared with those in maxillary bone cores. Moreover, micro‐CT values of BV/TV and Po.(Op) statistically correlated with bone types assessed by stereomicroscopy, particularly in mandibles (adjusted means of BV/TV of Type 2 to 4 versus Type 1 decreasing from ?9.88%, ?15.09%, ?29.31%; those of Po.(Op) ranged from 9.77%, 15.06%, 29.52% in an upward trend). However, such correlations were not found in maxillae or when bone types were classified using periapical radiographs. Conclusions: Caution is needed when using presurgical periapical radiographs to predict bone quality at implant recipient sites. Surgically preserved bone core specimens, whenever obtainable, might offer additional information to accurately assess bone quality, particularly at mandibular implant sites.     

MDS clinical diagnostic criteria for Parkinson's disease

This document presents the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's disease (PD). The Movement Disorder Society PD Criteria are intended for use in clinical research but also may be used to guide clinical diagnosis. The benchmark for these criteria is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise in PD diagnosis. Although motor abnormalities remain central, increasing recognition has been given to nonmotor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the Movement Disorder Society PD Criteria retain motor parkinsonism as the core feature of the disease, defined as bradykinesia plus rest tremor or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies on three categories of diagnostic features: absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of the PD diagnosis). Two levels of certainty are delineated: clinically established PD (maximizing specificity at the expense of reduced sensitivity) and probable PD (which balances sensitivity and specificity). The Movement Disorder Society criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, the Movement Disorder Society criteria will need continuous revision to accommodate these advances. © 2015 International Parkinson and Movement Disorder Society     

Evaluation of Virus Inactivation by Formaldehyde to Enhance Biosafety of Diagnostic Electron Microscopy

Formaldehyde (FA) fixation of infectious samples is a well-established protocol in diagnostic electron microscopy of viruses. However, published experimental data that demonstrate virus inactivation by these fixation procedures are lacking. Usually, fixation is performed immediately before the sample preparation for microscopy. The fixation procedure should transform viruses in a non–infectious but nonetheless structurally intact form in order to allow a proper diagnosis based on morphology. FA provides an essential advantage in comparison to other disinfectants, because it preserves the ultrastructure of biological material without interfering significantly with the preparation (i.e., the negative staining) and the detection of viruses. To examine the efficiency of FA inactivation, we used Vaccinia virus, Human adenovirus and Murine norovirus as models and treated them with FA under various conditions. Critical parameters for the inactivation efficiency were the temperature, the duration of the FA treatment, and the resistance of the virus in question. Our results show that FA inactivation at low temperature (4 °C) bears a high risk of incomplete inactivation. Higher temperatures (25 °C) are more efficient, although they still require rather long incubation times to fully inactivate a complex and highly robust virus like Vaccinia. A protocol, which applied 2% buffered FA for 60 min and a temperature–shift from 25 to 37 °C after 30 min was efficient for the complete inactivation of all test viruses, and therefore has the potential to improve both biosafety and speed of diagnostic electron microscopy.     

Improved diagnostic yield of neuromuscular disorders applying clinical exome sequencing in patients arising from a consanguineous population

Neuromuscular diseases (NMDs) include a broad range of disorders affecting muscles, nerves and neuromuscular junctions. Their overlapping phenotypes and heterogeneous genetic nature have created challenges in diagnosis which calls for the implementation of massive parallel sequencing as a candidate strategy to increase the diagnostic yield. In this study, total of 45 patients, mostly offspring of consanguineous marriages were examined using whole exome sequencing. Data analysis was performed to identify the most probable pathogenic rare variants in known NMD genes which led to identification of causal variants for 33 out of 45 patients (73.3%) in the following known genes: CAPN3, Col6A1, Col6A3, DMD, DYSF, FHL1, GJB1, ISPD, LAMA2, LMNA, PLEC1, RYR1, SGCA, SGCB, SYNE1, TNNT1 and 22 novel pathogenic variants were detected. Today, the advantage of whole exome sequencing in clinical diagnostic strategies of heterogeneous disorders is clear. In this cohort, a diagnostic yield of 73.3% was achieved which is quite high compared to the overall reported diagnostic yield of 25% to 50%. This could be explained by the consanguineous background of these patients and is another strong advantage of offering clinical exome sequencing in diagnostic laboratories, especially in populations with high rate of consanguinity.     

侵袭性真菌感染分子诊断及病原谱的研究进展

侵袭性真菌感染在近些年的发病率和病死率显著上升,对人类尤其是免疫功能低下患者的健康构成了重大威胁.能够尽早确诊、绘制侵袭性真菌感染病原谱是提高侵袭性真菌感染治愈率、降低病死率的关键.分子生物学技术的进步为侵袭性真菌感染的诊断提供了新的思路,与传统方法相比,分子诊断技术大大缩短了诊断所需时间,同时提高了敏感性和特异性,且操作简便、易于重复.本文对研究较多的分子诊断技术如聚合酶链反应技术、基因测序等以及侵袭性真菌感染病原谱调查进行综述.     

Hepatitis C virus core antigen: A simplified treatment monitoring tool,including for post-treatment relapse

BackgroundSimple, affordable diagnostic tools are essential to facilitate global hepatitis C virus (HCV) elimination efforts.ObjectivesThis study evaluated the clinical performance of core antigen (HCVcAg) assay from plasma samples to monitor HCV treatment efficacy and HCV viral recurrence.Study designPlasma samples from a study of response-guided pegylated-interferon/ribavirin therapy for people who inject drugs with chronic HCV genotype 2/3 infection were assessed for HCV RNA (AmpliPrep/COBAS Taqman assay, Roche) and HCVcAg (ARCHITECT HCV Ag, Abbott Diagnostics) during and after therapy. The sensitivity and specificity of the HCVcAg assay was compared to the HCV RNA assay (gold standard).ResultsA total of 335 samples from 92 enrolled participants were assessed (mean 4 time-points per participant). At baseline, end of treatment response (ETR) and sustained virological response (SVR) visits, the sensitivity of the HCVcAg assay with quantifiable HCV RNA threshold was 94% (95% CI: 88%, 98%), 56% (21%, 86%) and 100%, respectively. The specificity was between 98 to 100% for all time-points assessed. HCVcAg accurately detected all six participants with viral recurrence, demonstrating 100% sensitivity and specificity. One participant with detectable (non-quantifiable) HCV RNA and non-reactive HCVcAg at SVR12 subsequently cleared HCV RNA at SVR24.ConclusionsHCVcAg demonstrated high sensitivity and specificity for detection of pre-treatment and post-treatment viraemia. This study indicates that confirmation of active HCV infection, including recurrent viraemia, by HCVcAg is possible. Reduced on-treatment sensitivity of HCVcAg may be a clinical advantage given the moves toward simplification of monitoring schedules.     

Diagnostic value of serum human epididymis protein 4 and cancer antigen 125 in the patients with ovarian carcinoma: A protocol for systematic review and meta-analysis

Background:Ovarian carcinoma (OC) is considered among the most prevalent triggers of cancer-related deaths in women. Many studies have demonstrated that human epididymis protein 4 (HE-4) as well as cancer antigen 125 (CA-125) are over-expressed in various malignant tumors, such as lung, liver, endometrial, gastric, breast, as well as ovarian cancers. Nonetheless, the overall diagnostic value of serum HE-4, in addition to CA-125 n patients experiencing OC, is still largely undetermined. Therefore, the current study intends to investigate the general diagnostic significance of HE-4 along with CA-125 in patients with OC.Methods:We aim to systematically search retrospective or prospective study for potential eligible studies from electronic databases, such as MEDLINE, EMBASE, Cochrane Library, Web of Science, as well as Chinese National Knowledge Infrastructure. We will relevant articles evaluating the general diagnostic significance of HE-4 and CA-125 in patients with OC from these databases. We will define our search in English and Chinese. Likewise, we will use 2 independent authors to extract the required data, using the Quality Assessment of Diagnostic Accuracy Studies-2 tool to evaluate he procedural quality of all included literature. We will use the appropriate statistical method to complete data analyses.Results:The present study aims to investigate the general diagnostic significance of HE-4 and CA-125 in patients suffering from OC.Conclusion:The present study will systematically summarise current evidence of HE-4 in combination with CA-125 in relation to diagnosing OC.Ethics and dissemination:Ethical approval will not be required.Protocol registration number:DOI 10.17605/OSF.IO/YQPC7 (https://osf.io/yqpc7/).