The diagnostics of prostate cancer are currently based on three pillars: prostate biomarker panel, imaging techniques, and histological verification. This paper presents a diagnostic algorithm that can serve as a "road map": from initial patient stratification to the final decision regarding treatment. The algorithm is based on a review of the current literature combined with our own experience. Diagnostic algorithms are a feature of an advanced healthcare system in which all steps are consciously coordinated and optimized to ensure the proper individualization of the treatment process. The prostate cancer diagnostic algorithm was created using the prostate specific antigen and in particular the Prostate Health Index in the first line of patient stratification. It then continued on the diagnostic pathway via imaging techniques, biopsy, or active surveillance, and then on to the treatment decision itself. In conclusion, the prostate cancer diagnostic algorithm presented here is a functional tool for initial patient stratification, comprehensive staging, and aggressiveness assessment. Above all, emphasis is placed on the use of the Prostate Health Index (PHI) in the first stratification of the patients as a predictor of aggressiveness and clinical stage of prostrate cancer (PCa). The inclusion of PHI in the algorithm significantly increases the accuracy and speed of the diagnostic procedure and allows to choose the optimal pathway just from the beginning. The use of advanced diagnostic techniques allows us to move towards to a more advanced level of cancer care. This diagnostics algorithm has become a standard of care in our hospital. The algorithm is continuously validated and modified based on our results.
BACKGROUND: The identification of implant wear particles and non-implant related particles and the characterization of the inflammatory responses in the periprosthetic neo-synovial membrane, bone, and the synovial-like interface membrane (SLIM) play an important role for the evaluation of clinical outcome, correlation with radiological and implant retrieval studies, and understanding of the biological pathways contributing to implant failures in joint arthroplasty. The purpose of this study is to present a comprehensive histological particle algorithm (HPA) as a practical guide to particle identification at routine light microscopy examination. METHODS: The cases used for particle analysis were selected retrospectively from the archives of two institutions and were representative of the implant wear and non-implant related particle spectrum. All particle categories were described according to their size, shape, colour and properties observed at light microscopy, under polarized light, and after histochemical stains when necessary. A unified range of particle size, defined as a measure of length only, is proposed for the wear particles with five classes for polyethylene (PE) particles and four classes for conventional and corrosion metallic particles and ceramic particles. RESULTS: All implant wear and non-implant related particles were described and illustrated in detail by category. A particle scoring system for the periprosthetic tissue/SLIM is proposed as follows: 1) Wear particle identification at light microscopy with a two-step analysis at low (× 25, × 40, and × 100) and high magnification (× 200 and × 400); 2) Identification of the predominant wear particle type with size determination; 3) The presence of non-implant related endogenous and/or foreign particles. A guide for a comprehensive pathology report is also provided with sections for macroscopic and microscopic description, and diagnosis. CONCLUSIONS: The HPA should be considered a standard for the histological analysis of periprosthetic neo-synovial membrane, bone, and SLIM. It provides a basic, standardized tool for the identification of implant wear and non-implant related particles at routine light microscopy examination and aims at reducing intra-observer and inter-observer variability to provide a common platform for multicentric implant retrieval/radiological/histological studies and valuable data for the risk assessment of implant performance for regional and national implant registries and government agencies.
- Keywords
- Arthroplasty, Ceramic wear particles, Histological particle algorithm, Metallic wear particles, Non-implant related particles, Orthopaedic implant wear particles, Periprosthetic tissue, Polyethylene wear particles, Synovial crystals, Synovial-like interface membrane,
- Publication type
- Journal Article MeSH
BACKGROUND: Despite the established value of genomic testing strategies, practice guidelines for their use do not exist in many indications. OBJECTIVES: We sought to validate a recently introduced scoring algorithm for dystonia, predicting the diagnostic utility of whole-exome sequencing (WES) based on individual phenotypic aspects (age-at-onset, body distribution, presenting comorbidity). METHODS: We prospectively enrolled a set of 209 dystonia-affected families and obtained summary scores (0-5 points) according to the algorithm. Singleton (N = 146), duo (N = 11), and trio (N = 52) WES data were generated to identify genetic diagnoses. RESULTS: Diagnostic yield was highest (51%) among individuals with a summary score of 5, corresponding to a manifestation of early-onset segmental or generalized dystonia with coexisting non-movement disorder-related neurological symptoms. Sensitivity and specificity at the previously suggested threshold for implementation of WES (3 points) was 96% and 52%, with area under the curve of 0.81. CONCLUSIONS: The algorithm is a useful predictive tool and could be integrated into dystonia routine diagnostic protocols. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.
- Keywords
- diagnostic yield, dystonia, exome sequencing, prediction, rare disease, scoring algorithm,
- MeSH
- Algorithms MeSH
- Dystonic Disorders * genetics MeSH
- Dystonia * diagnosis genetics MeSH
- Genetic Testing MeSH
- Humans MeSH
- Parkinson Disease * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Based on current knowledge the criteria for diagnosing nonviability in early intrauterine pregnancy and diagnostic algorithm in pregnancies of unknown location have changed. For either an intrauterine pregnancy of uncertain viability or a pregnancy of unknown location, the consequences of false positive diagnosis of nonviability or false negative diagnosis of ectopic pregnancy may be dire: harming of a potentially normal intrauterine pregnancy or a life-threatening rupture from tubal pregnancy. This review aims to present the most important results of current studies on this topic with their recommendations and to improve patient care reducing the risk of inadvertent harm to potentially normal pregnancies.
PURPOSE: Sarcopenic obesity (SO) as a new diagnostic entity defined by presence of obesity in combination with sarcopenia represents serious health condition negatively affecting quality of life in old age. Despite the rapidly increasing incidence of SO associated with demographic aging, clear diagnostic criteria for SO have not yet been established. We describe here the applicability of the EWGSOP2 and EWGSOP1 diagnostic criteria in identifying sarcopenia and SO and the development of a refinement algorithm for SO detection. METHODS: In total 156 subjects were pre-screened, 126 had a complete dataset and were included, 20.6% (n = 26) were men and 79.4% (n = 100) women, mean age 81 ± 6.3 years in tertiary hospital, Prague, Czech Republic. Testing of physical performance (hand-grip test, 400 m walk test, chair stand test, gait speed), anthropometric measures and SARC-F, SPPB and MNA-SF were used to determine physical, functional, and nutritional status, while muscle mass and fat mass were measured by DXA scans to confirm sarcopenia and SO diagnosis. RESULTS: The prevalence of sarcopenia (BMI adjusted ALM < 0.789 for men, < 0.512 for women) was 26.2% (n = 33), SO in 20.6% (n = 26). 78.8% of all sarcopenic subjects fulfilled the criteria of SO (FM > 27% for men and > 38% for women; waist circumference > 90 cm for men and > 85 cm for women). EWGSOP1 criteria for diagnosing sarcopenia showed better sensitivity of 97.0% than the EWGSOP2 66.7%, while specificity reached 100% for both criteria. According to DXA measurement, EWGSOP1 identified 3.0% cases (1 out of 33) as false negative meanwhile EWGSOP2 identified 33.3% cases as false negative and this difference was statistically significant (McNemar's test, p < 0.001). An algorithm for SO was developed (which uses sex, BMI, height, waist circumference and SPPB) with sensitivity and specificity of 88.5 and 91.0%, respectively. CONCLUSION: High prevalence of obesity among elderly people and rather low sensitivity of current diagnostic criteria for SO call for ongoing research. Broader international consensus for SO diagnostic criteria, screening and diagnosis algorithm are crucial for early detection of SO in older people in clinical practice so that optimal multi-component therapy can be initiated.
- Keywords
- EWGSOP1, EWGSOP2, Modelling, Sarcopenia, Sarcopenic obesity,
- MeSH
- Algorithms MeSH
- Quality of Life MeSH
- Humans MeSH
- Obesity complications diagnosis epidemiology MeSH
- Sarcopenia * diagnosis epidemiology MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Hand Strength physiology MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
INTRODUCTION AND AIM: For a correct assessment of anorectal dysfunction, adequate physical and imaging examinations are required. The aim of our study was to evaluate the use of MRI defecography in patients with anorectal dysfunction. Its comparison with anorectal manometry, standard clinical examination, and patients' subjective perceptions. TYPE OF STUDY: An observational, retrospective analysis. METHODS: Forty patients with symptoms of anorectal dysfunction referred to a colorectal clinic between 9/2022 and 5/2023 participated in the study. All underwent proctological examination, anorectal manometry and MRI defecography. The results of the study were statistically processed with Statistica 12.0 software. RESULTS: The average age of the patients was 55 years. Primary complaints were obstipation in 60% of patients, fecal incontinence in 33%, 1 patient had proctalgia and 2 patients presented for rectal prolapse. On clinical examination, 20% of patients had rectoanal intussusception and 15% had complete rectal prolapse. A total of 36% of patients reported concomitant urinary incontinence. Pelvic floor drop in the anterior compartment was also demonstrated in patients who had physiological internal sphincter function according to anorectal manometry, however, due to the small sample size, only a trend was observed and statistical significance of these differences was not -reached (P = 0.109). Patients without evidence of obstructive defecation syndrome on anorectal manometry had complete rectal emptying on MRI defecography (P = 0.0598). CONCLUSION: Dynamic MRI defecography can identify anatomical and functional abnormalities of the pelvic floor. The main use of the method is in the detection of multi-compartment pathology. Multidisciplinary collaboration is required to interpret the results and establish an accurate diagnosis.
- Keywords
- Incontinence, anorectal dysfunction, dynamic MRI defecography, obstructive defecation syndrome, pelvic floor,
- MeSH
- Algorithms MeSH
- Defecography * methods MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging * MeSH
- Manometry MeSH
- Rectal Diseases * diagnostic imaging physiopathology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
The Internet of Things (IoT) is seen as the most viable solution for real-time monitoring applications. But the faults occurring at the perception layer are prone to misleading the data driven system and consume higher bandwidth and power. Thus, the goal of this effort is to provide an edge deployable sensor-fault detection and identification algorithm to reduce the detection, identification, and repair time, save network bandwidth and decrease the computational stress over the Cloud. Towards this, an integrated algorithm is formulated to detect fault at source and to identify the root cause element(s), based on Random Forest (RF) and Fault Tree Analysis (FTA). The RF classifier is employed to detect the fault, while the FTA is utilized to identify the source. A Methane (CH4) sensing application is used as a case-study to test the proposed system in practice. We used data from a healthy CH4 sensing node, which was injected with different forms of faults, such as sensor module faults, processor module faults and communication module faults, to assess the proposed model's performance. The proposed integrated algorithm provides better algorithm-complexity, execution time and accuracy when compared to FTA or standalone classifiers such as RF, Support Vector Machine (SVM) or K-nearest Neighbor (KNN). Metrics such as Accuracy, True Positive Rate (TPR), Matthews Correlation Coefficient (MCC), False Negative Rate (FNR), Precision and F1-score are used to rank the proposed methodology. From the field experiment, RF produced 97.27% accuracy and outperformed both SVM and KNN. Also, the suggested integrated methodology's experimental findings demonstrated a 27.73% reduced execution time with correct fault-source and less computational resource, compared to traditional FTA-detection methodology.
- Keywords
- Fault Tree Analysis, Methane Sensing, Random Forest, Sensing Edge Device, edge fault detection, sensor faults,
- Publication type
- Journal Article MeSH
Sinonasal carcinomas represent a rare and diverse group of tumors, presenting diagnostic complexities due to their varied histological and molecular features. To ensure accurate differentiation among these malignancies, a systematic and stepwise approach is paramount. Even with the morphological similarities between poorly differentiated (non) keratinizing sinonasal squamous cell carcinoma (SNSCC) and DEK::AFF2 SNSCC, the two lesions are distinguishable using the surrogate immunohistochemical marker AFF2 or molecular testing for DEK::AFF2 mutation. We report a rare case of SMARCB1-retained DEK::AFF2 papillary non-keratinizing SNSCC in a 53-year-old female, who presented with a polypoid mass corresponding to the left middle turbinate. Following the surgical resection of the tumor and locoregional lymph nodes, adjuvant radiotherapy was administered to eradicate any residual cancer cells that may have remained after surgery.
- Keywords
- CSNE pobremente diferenciado no queratinizante, DEK::AFF2 fusion carcinoma, FISH, Fusión de DEK::AFF2 carcinoma, Poorly differentiated non-keratinizing SNSCC, Sinonasal,
- MeSH
- Algorithms MeSH
- Cell Differentiation MeSH
- Nuclear Proteins MeSH
- Middle Aged MeSH
- Humans MeSH
- Lymph Nodes MeSH
- Paranasal Sinus Neoplasms * diagnosis genetics MeSH
- Carcinoma, Squamous Cell * diagnosis genetics MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Names of Substances
- AFF2 protein, human MeSH Browser
- Nuclear Proteins MeSH
PURPOSE OF THE STUDY The aim of the present study was to evaluate the postoperative outcome of patients with pilon tibial fractures with a minimum follow-up of 24 months, treated according to a staged treatment algorithm. MATERIAL AND METHODS In total, 27 patients (mean age 43.6 ± 13 years, range 18-69) with a pilon tibial fracture and a minimum follow-up of 24 months were included in the study. Medical recordings (discharge documents and surgical reports) and radiographic examinations were analyzed. All enrolled patients were invited for a clinical and radiological follow-up examination (ROM, AOFAS hindfoot score, Kellgren score). The mean follow-up time was 44.5 ± 16 months (range 24-82). RESULTS In 21 cases a two-stage operative strategy with initial closed reduction and external fixation was necessary prior to definitive osteosynthesis. Overall, the patients scored 82.1 ± 20 points (range 30-100) in AOFAS hindfoot score, which represents a good clinical outcome. Patients with B-type fractures scored significantly better than those with C-type fractures. Patients with closed pilon tibial fractures reached significantly higher values in the AOFAS hindfoot score than those with open ones. Age and gender did not affect the functional outcome. Total ankle range of motion was 41° ± 10° for B-type fractures (range 20°-55°) and 35° ± 17° (range 0°-60°) for C-type fractures respectively (p > 0.05). Only five patients reached higher scores (Grade III) in Kellgren classification system. DISCUSSION Within the last decades, the therapeutic algorithm of pilon fractures underwent a paradigm shift; a two-stage protocol has prevailed today. However, the initial severity of the fracture in terms of initial absorbed energy, bony comminution and softtissue trauma still affects the outcome. Moreover, the necessity for bone grafting, as an indirect measurement of bone comminution and bone defects, resulted in higher degrees of osteoarthritis in the final follow-up. Higher initial soft-tissue injury also had an impact on the functional outcome of the patients, as patients with closed fractures scored better in AOFAS at the final follow-up. In order to counteract these risk factors and to reduce complications that define the outcome of these severe injuries, clearly defined surgical principles and standardized treatment protocols are needed. CONCLUSIONS The present study confirms the fact that meticulous planning, respect of the soft-tissues and choice of the optimal timepoint for the definitive osteosynthesis and overall treatment according to standardized protocols can optimize the outcome of this severe injury. Key words:pilon, distal tibia fracture, outcome, algorithm.
- MeSH
- Algorithms * MeSH
- Adult MeSH
- Tibial Fractures * surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Follow-Up Studies MeSH
- Radiography MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Fracture Fixation, Internal MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: We aimed to assess the diagnostic utility of the Dimension EXL LOCI High-Sensitivity Troponin I (hs-cTnI-EXL) assay. METHODS: This multicenter study included patients with chest discomfort presenting to the emergency department. Diagnoses were centrally and independently adjudicated by two cardiologists using all available clinical information. Adjudication was performed twice including serial measurements of high-sensitivity cardiac troponin (hs-cTn) I-Architect (primary analysis) and serial measurements of hs-cTnT-Elecsys (secondary analysis) in addition to the clinically used (hs)-cTn. The primary objective was to assess and compare the discriminatory performance of hs-cTnI-EXL, hs-cTnI-Architect and hs-cTnT-Elecsys for acute myocardial infarction (MI). Furthermore, we derived and validated a hs-cTnI-EXL-specific 0/1h-algorithm. RESULTS: Adjudicated MI was the diagnosis in 204/1454 (14%) patients. The area under the receiver operating characteristics curve for hs-cTnI-EXL was 0.94 (95%CI, 0.93-0.96), and comparable to hs-cTnI-Architect (0.95; 95%CI, 0.93-0.96) and hs-cTnT-Elecsys (0.93; 95%CI, 0.91-0.95). In the derivation cohort (n = 813), optimal criteria for rule-out of MI were <9ng/L at presentation (if chest pain onset >3h) or <9ng/L and 0h-1h-change <5ng/L, and for rule-in ≥160ng/L at presentation or 0h-1h-change ≥100ng/L. In the validation cohort (n = 345), these cut-offs ruled-out 56% of patients (negative predictive value 99.5% (95%CI, 97.1-99.9), sensitivity 97.8% (95%CI, 88.7-99.6)), and ruled-in 9% (positive predictive value 83.3% (95%CI, 66.4-92.7), specificity 98.3% (95%CI, 96.1-99.3)). Secondary analyses using adjudication based on hs-cTnT measurements confirmed the findings. CONCLUSIONS: The overall performance of the hs-cTnI-EXL was comparable to best-validated hs-cTnT/I assays and an assay-specific 0/1h-algorithm safely rules out and accurately rules in acute MI. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00470587.
- MeSH
- Biomarkers MeSH
- Myocardial Infarction * diagnosis MeSH
- Humans MeSH
- Prospective Studies MeSH
- ROC Curve MeSH
- Troponin I * MeSH
- Troponin T MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Names of Substances
- Biomarkers MeSH
- Troponin I * MeSH
- Troponin T MeSH
