Developments in the Diagnostic Techniques of Infectious Diseases: Rural and Urban Prospective

Objectives: Diagnostics is the first step for the treatment and eradication of infectious microbial diseases. Due to ever evolving pathogens and emerging new diseases, there is an urgent need to identify suitable diagnostic techniques for better management of each disease. The success rate of specific diagnostic technique in any population depends on various factors including type of the microbial pathogen, availability of resources, technical expertise, disease severity and degree of epidemic of disease in the area. One of the important tasks of the policy makers is to identify and implement suitable diagnostic techniques for specific regions based on their specific requirements. In this review we have discussed various techniques available in the literature and their suitability for the target population based on above mentioned criteria. Methods: Diagnostic techniques evaluation of well documented representative microbial diseases;Tuberculosis (bacterial), Malaria (parasitic) and HIV (viral) were included in the study. Identification and collection of information and data was performed focusing on the diagnostic techniques used from the scientific publications from Pubmed, Science Access, Scopus, EMBASE and several regional databases. WHO and CDC database for Tuberculosis, Malaria and HIV were also included. These techniques were compared with respect to the financial resource availability, expertise and management, functional capacity, pathogen virulence and degree of epidemic in the population. Results and Conclusion: In case of Tuberculosis, ELISA and colorimetric techniques are successful in rural and urban communities with 80% - 90% sensitivity. Genotyping and SNP analysis are useful in drug resistant strains. Parasitic disease Malaria also follows the same trend with diagnostic techniques like RDTs being common in both population with fast results and around 90% sensitivity. STD disease like HIV however shows slight different trends due to urgent need of interference in rural epidemics of the disease. Rapid and sensitive immunotechniques like dipsticks and agglutination with almost 100% sensitivity are used in both rural and urban areas. For the confirmation further tests are done like protein Western and NAAT. Advance techniques could be the option for higher epidemic area, drug resistance and disease research, while rapid techniques would be suitable for low income areas and POC facilities. Therefore, suitability of the diagnostic techniques for better management depends not only on the financial resources and assessment skills of a community but sometimes on the disease itself. We have further discussed the technological improvements for specific settings (rural/urban) based on the past research for better management of diseases, which could be implemented for the understanding of understudied and newly emerging diseases.

Clinical diagnostic advances in intestinal anastomotic techniques:Hand suturing,stapling,and compression devices

The development of intestinal anastomosis techniques,including hand suturing,stapling,and compression anastomoses,has been a significant advancement in surgical practice.These methods aim to prevent leakage and minimize tissue fibrosis,which can lead to stricture formation.The healing process involves various phases:hemostasis and inflammation,proliferation,and remodeling.Mechanical staplers and sutures can cause inflammation and fibrosis due to the release of profibrotic chemokines.Compression anastomosis devices,including those made of nickel-titanium alloy,offer a minimally invasive option for various surgical challenges and have shown safety and efficacy.However,despite advancements,anastomotic techniques are evaluated based on leakage risk,with complications being a primary concern.Newer devices like Magnamosis use magnetic rings for compression anastomosis,demonstrating greater strength and patency compared to stapling.Magnetic technology is also being explored for other medical treatments.While there are promising results,particularly in animal models,the realworld application in humans is limited,and further research is needed to assess their safety and practicality.

Novel diagnostic imaging techniques and applications in anterior uveitis,intermediate uveitis,and scleritis

Uveitis can cause significant visual morbidity and often affects younger adults of working age.Anterior uveitis,or inflammation limited to the anterior chamber(AC),iris,and/or ciliary body comprises the majority of uveitis cases.Current clinical biomarkers and conventional grading scales for intraocular inflammation are mostly subjective and have only a moderate degree of interobserver reliability,and as such they have significant limitations when used in either clinical practice or research related to uveitis.In recent years,novel imaging techniques and applications have emerged that can supplement exam findings to detect subclinical disease,monitor quantitative biomarkers of disease progression or treatment effect,and provide overall a more nuanced understanding of disease entities.The first part of this review discusses automated algorithms for optical coherence tomography(OCT)image processing and analysis as a means to assess and describe intraocular inflammation with higher resolution than that afforded by conventional AC and vitreous cell ordinal grading scales.The second half of the review focuses on anterior segment OCT and OCT angiography(OCTA)in scleritis and iritis,especially with regards to their ability to directly image and characterize the pathologic structures and vasculature underlying these diseases.Finally,we briefly review experimental animal research with promising but more distant human clinical applications,including in vivo molecular microscopy of inflammatory markers and investigation of gold nanoparticles as a potential contrast agent in OCT imaging.Imaging modalities are discussed in the broader context of trends within the field of uveitis towards greater objectivity and quantifiable outcome measures and biomarkers.

Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations

BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography(MDCT)examination of patients with small bowel obstruction(SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques.AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia.METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients' MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence,agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia.RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3(P < 0.01), but the results of the two readers using the same protocol were not different(P > 0.05). Using protocol 3, both readers added multiple postprocessing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1(P < 0.01), but no difference was detected between protocols 2 and 3(P > 0.05). The accuracy, sensitivity,specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia.CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.

Electrical bioimpedance and other techniques for gastric emptying and motility evaluation

The aim of this article is to identify non-invasive, inexpensive, highly sensitive and accurate techniques for evaluating and diagnosing gastric diseases. In the case of the stomach, there are highly sensitive and specific methods for assessing gastric motility and emptying (GME). However, these methods are invasive, expensive and/or not technically feasible for all clinicians and patients. We present a summary of the most relevant international information on non-invasive methods and techniques for clinically evaluating GME. We particularly emphasize the potential of gastric electrical bioimpedance (EBI). EBI was initially used mainly in gastric emptying studies and was essentially abandoned in favor of techniques such as electrogastrography and the gold standard, scintigraphy. The current research evaluating the utility of gastric EBI either combines this technique with other frequently used techniques or uses new methods for gastric EBI signal analysis. In this context, we discuss our results and those of other researchers who have worked with gastric EBI. In this review article, we present the following topics: (1) a description of the oldest methods and procedures for evaluating GME; (2) an explanation of the methods currently used to evaluate gastric activity; and (3) a perspective on the newest trends and techniques in clinical and research GME methods. We conclude that gastric EBI is a highly effective non-invasive, easy to use and inexpensive technique for assessing GME.

Update on diagnostic value of breath test in gastrointestinal and liver diseases

In the field of gastroenterology,breath tests(BTs) are used intermittently as diagnostic tools that allow indirect,non-invasive and relatively less cumbersome evaluation of several disorders by simply quantifying the appearance in exhaled breath of a metabolite of a specific substrate administered.The aim of this review is to have an insight into the principles,methods of analysis and performance parameters of various hydrogen,methane and carbon BTs which are available for diagnosing gastrointestinal disorders such as Helicobacter pylori infection,small intestinal bacterial overgrowth,and carbohydrate malabsorption.Evaluation of gastric emptying is routinely performed by scintigraphy which is however,difficult to perform and not suitable for children and pregnant women,this review has abridged the 13C-octanoic acid test in comparison to scintigraphy and has emphasized on its working protocol and challenges.A new development such as electronic nose test is also highlighted.Moreover we have also explored the limitations and constraints restraining the wide use of these BT.We conclude that breath testing has an enormous potential to be used as a diagnostic modality.In addition it offers distinct advantages over the traditional invasive methods commonly employed.

Enthalpy Probe Technique for Thermal Plasma Diagnostics

The measuring principle and experimental results of the enthalpy probe technique for thermal plasma diagnostics are presented. Its calibration and errors are discussed. Typical results are presented for the system operation in an Ar/H2(5 % H2) plasma arc jet under a reactor chamber pressure of 101.3 kPa. The plasma temperature and velocity profiles are measured. The center temperature and velocity are 6600 K and 850 m/s for plasma power 9 kW at axial location of 17 mm.

Method to Monitor Helicopter Rotor Fault Using Diagnostic Matrix

An efficient method for helicopter rotor fault diagnosis was proposed using diagnostic matrix and its software framework was developed.The diagnostic matrix was extracted by the way of simulating the quantitative models of damaged and undamaged rotor systems.The conflicts were recognized by the virtual symptom sensor based on the dependencies between symptoms and faults.Diagnostic candidates were generated by the Boolean hitting algorithm.The proposed method provides multi-fault real-time diagnostic capability and it is suitable for the synthetic health monitoring of complex systems.

Revision on the Recent Diagnostic Strategies of Fungal Infections

Many invasive fungal diseases have no characteristic signs or symptoms, and may give negative blood cultures;therefore, clinician may decide to start empirical antifungal therapy particularly in high risk patient (e.g., hematopoietic stem cell transplant, solid organ transplant, and AIDS patients). This increases the incidence of appearance of resistant fungal strains to antifungal drugs. Traditional methods for diagnosis such as wet mount examination and microbiological cultures remain the gold standard methods for fungal disease diagnosis. However, they are time-consuming, insensitive, and have a limited impact on clinical decision-making. Significant progress has recently achieved in diagnostic tools of fungal disease. Antigen and antibody based assays, molecular techniques, and MALDI TOF spectrometry technique and nanotechnology offer more rapid, sensitive and accurate results.

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. Accurate anatomical knowledge is necessary in order to administer IM injections. It is possible to gain an adequate understanding of injection site anatomical structures by using ultrasound diagnostic devices. In particular, ultrasonography offers real-time diagnostic data allowing for observation of injection site, subcutaneous tissues, fat layers, muscle membrane, muscles and bones. To deliver the drug accurately into the muscle is essential, to achieve maximum drug efficacy and prevent injection site reactions. Therefore, when administering IM injections to the buttocks area, a suitable injection needle between 23G 25 mm to 21G or 22G 38 mm must be chosen depending on physique and drug characteristics. Needles determined as safe and effective through ultrasonographic evidence are needed such as in the case of a deltoid injection site, in which a 23G 25 mm injection needle is used in the absence of notable obesity. Not only the needle type is essential, but also the IM procedure itself. It is important to stretch the skin, inserting the needle at 90 degree angle to ensure depth of needle insertion to the muscle. Until new con-firmed evidence becomes available, it is necessary to increase the understanding of injection site selection methods, needle insertion depth, needle angle, and established IM injection techniques. The application of ultrasound devices in the development of next-generation techniques for IM injection is promising. Importantly, these techniques provide critical information from a risk management perspective.

Comparison of in Clinic-Based Fecal Microbiome Collection Techniques for Increase in Study Participation and Utilization of Microbiome Analysis

We compared the collection techniques of fecal specimens for DNA extraction and fecal microbiome analysis by utilizing the glove from a standard-of-care digital rectal exam (DRE) and the rectal swab from a pre-prostate biopsy bacterial rectal culture collected in clinical care settings. DNA yield from the swab technique compared to the glove technique yielded similar amounts of DNA (18.1 vs. 13.1 ng/μL, p = 0.06), slightly favoring the swab technique. However, utilizing DNA yield cutoffs of 15 ng/μL (37% vs. 29%, p = 0.18) and 30 ng/μL (15% and 9%, p = 0.16), we identified no differences in yield between the swab versus glove technique, respectively. Absorbance values for overall DNA quality were significantly different in favor of the glove technique (mean 1.6 vs. 2.0, p < 0.001). Using an absorbance value of 1.5 as an indication of DNA quality, only 26% (19/91) met the cutoff value using the swab group compared to 47.3% (53/112) if the glove technique was used (p < 0.001). Similar results occurred for the RNA quality with an absorbance value cutoff of 2.0 (2.2% vs. 30.4%, p < 0.001). To increase sampling feasibility and improve population sampling, gloves used from a DRE may be utilized as a consistent and efficient fecal DNA collection technique for fecal microbiome analysis. DNA yield and quality from the glove technique are comparable to—if not better than—rectal swab collection.

Intelligent Medical Diagnostic System for Hepatitis B

The hepatitis B virus is the most deadly virus,which significantly affects the human liver.The termination of the hepatitis B virus is mandatory and can be done by taking precautions as well as a suitable cure in its introductory stage;otherwise,it will become a severe problem and make a human liver suffer from the most dangerous diseases,such as liver cancer.In this paper,two medical diagnostic systems are developed for the diagnosis of this life-threatening virus.The methodologies used to develop thesemodels are fuzzy logic and the neuro-fuzzy technique.The diverse parameters that assist in the evaluation of performance are also determined by using the observed values from the proposed system for both developedmodels.The classification accuracy of a multilayered fuzzy inference system is 94%.The accuracy with which the developed medical diagnostic system by using Adaptive Network based Fuzzy Interference System(ANFIS)classifies the result corresponding to the given input is 95.55%.The comparison of both developed models on the basis of their performance parameters has been made.It is observed that the neuro-fuzzy technique-based diagnostic system has better accuracy in classifying the infected and non-infected patients as compared to the fuzzy diagnostic system.Furthermore,the performance evaluation concluded that the outcome given by the developed medical diagnostic system by using ANFIS is accurate and correct as compared to the developed fuzzy inference system and also can be used in hospitals for the diagnosis of Hepatitis B disease.In other words,the adaptive neuro-fuzzy inference system has more capability to classify the provided inputs adequately than the fuzzy inference system.

Molecular biology techniques for the surgeon

New technologies are constantly being introduced into the medical and surgical fields. These technologies come in the form of newer medicines, imaging methods and prognostic tools, among others, and allow clinicians to make more rational and informed decisions on the care of their patients. Many of these technologies utilize advanced techniques which are at the forefront of many research fields and represent a transition of bench advances into the clinical realm. This review will highlight four technologies that are at the forefront in the treatment of oncology patients treated by surgeons on a daily basis. Circulating tumor cells, microarray analysis, proteomic studies and rapid sequencing technologies will be highlighted. These technologies will be reviewed and their potential use in the care o surgical patients will be discussed.

Diagnostic Utility of Indigenous Technique of Pleuroscopy in Undiagnosed Cases of Exudative Pleural Effusions

Background and Aims： Since our rural institution has liamted resources we always choose econoamcal options. Recently, indigenous technique of pleuroscopy is gaining popularity due to various advantages. We developed indigenous technique of medical thoracoscopy has been developed and done by using set of patented conduits and fiberoptic bronchoscope （FOB）.Therefore, we have used this technique for undiagnosed pleural effusions. Methods： An observational study was conducted in 79 undiagnosed cases of exudative pleural effusion from June 2016 to Jmmary 2017. Indigenous technique consists of use of fiber optic bronchoscope through various metallic conduits to be used in specified order for medical thoracoscopy. Procedure is done under conscious sedation and conduits are passed one after another in a specified order, through the chest stoma. The visualization of pleural cavity and various procedures were done with FOB （fiberoptic bronchoscope）. Results： Out of the 79 cases, the appearance of pleura showed, inflamed/reddened pleura in 16 （20.2%） cases, thin transparent adhesions in 18 （22.7%）, thin transparent loculations in 16 （20.2%） cases, thick loculations in 6 （7.6%） cases, hard pleural surface in 5 （6.3%）, large nodule/masses in 6 （7.6%）, small amlliary seedlings or sago grain appeoxmlce in 6 （7.6%）, scattered masses or nodules in 5 （6.3%） and, broncho-pleural fistula was observed in 1 （1.2%） case. Histopathological analysis showed chronic inflammation in 34.1% （27）, tubercular lesions in 24.05% （19） of patients. Primary aspergillosis and mesothelioma each has 1 case, and the rest 29.11% （23） were pleural metastasis. Thus, diagnostic yield of pleuroscopy pleural biopsy was 89.9% （71）. Conclusion： Indigenous technique appears to be an efficient and relatively safe procedure with good diagnostic yield in undiagnosed pleural effusions.

分子生物学方法在提高综合医院传染性肺结核发现率中的作用

目的 了解综合医院使用Xpert技术诊断传染性肺结核和耐药肺结核的现状和问题,以便更好地发挥综合医院在肺结核发现中的前哨作用。方法 采用自身前后对照的研究方法,对比分析综合医院使用Xpert检查和未使用Xpert检查患者2组之间的病原学阳性患者比例、利福平耐药肺结核患者发现、肺结核和利福平耐药肺结核患者诊断时间等指标。共有171例肺结核患者纳入本次研究,其中研究组为使用Xpert检查的52例患者,对照组为未使用Xpert检查的119例患者。采用Wilcoxon秩和检验和χ^(2)检验(Fisher精确检验)分析组间差异。结果 研究组中综合医院诊断的病原阳性肺结核比例(41/52,78.85%)明显高于对照组(65/119,54.62%),差异有统计学意义(P<0.05)。研究组中综合医院诊断的疑似病例比例(2/52,3.85%)明显低于对照组(24/119,20.17%)。研究组中肺结核诊断时间为1 d,明显短于对照组(4 d)差异有统计学意义(P<0.05)。研究组共有3例利福平耐药肺结核患者,在综合医院就诊时全部得到明确诊断,利福平耐药诊断时间为1 d;对照组中有1例利福平耐药患者,综合医院未能发现。研究组同时接受痰涂片和Xpert检查的52例患者中,Xpert检出结核分枝杆菌比例(40/52,76.92%)明显高于痰涂片检查(25/52,48.07%),差异有统计学意义(P<0.05)。结论 Xpert技术能够显著提高肺结核病的诊断率、早期发现传染性肺结核和利福平耐药肺结核患者,建议将其纳入医保报销范围,加快在综合医院推广应用。

PCR荧光探针技术对结核分枝杆菌复合群及利福平耐药性检测性能的评价

目的:评价PCR荧光探针技术检测痰液样本中结核分枝杆菌复合群(Mycobacterium tuberculosis complex,MTBC)和利福平耐药性效果,为进一步开展“结核分枝杆菌复合群及利福平耐药核酸检测试剂盒”多中心临床试验提供可行性研究数据。方法:采用前瞻性研究方法,参照入组标准收集2021年12月至2022年8月上海市3家结核病定点医院肺科门诊就诊的205例初诊疑似肺结核患者的3份痰液样本(即时痰、夜间痰、晨痰),分别进行痰涂片、BACTEC MGIT 960(MGIT 960)、GeneXpert MTB/RIF(Xpert)和PCR荧光探针法检测,评价PCR荧光探针法对痰液样本中MTBC及利福平耐药性的检测效能。另对随机选取同期上海市疾病预防控制中心结核病实验室菌株库中保存的96株MTBC临床菌株(包括利福平表型耐药菌株47株和利福平表型敏感菌株49株)分别进行PCR荧光探针法和Xpert检测利福平耐药性,分析两种检测方法对利福平耐药相关基因突变的检出情况。结果:205例疑似肺结核患者中,PCR荧光探针法对MTBC的检出率为22.44%(46/205),与MGIT 960[21.95%(45/205)]、Xpert[20.98%(43/205)]和痰涂片[16.10%(33/205)]的差异均无统计学意义(χ^(2)=0.014,P=0.904;χ^(2)=0.129,P=0.719;χ^(2)=2.650,P=0.104)。以临床诊断为参照标准,PCR荧光探针法、Xpert、MGIT 960和痰涂片检测MTBC的敏感度(95%CI)分别为48.10%(36.93%~59.56%)、48.10%(36.93%~59.56%)、50.63%(39.23%~61.97%)和40.51%(29.79%~52.15%),特异度(95%CI)分别为93.65%(87.47%~97.12%)、96.03%(90.52%~98.53%)、96.03%(90.52%~98.53%)和99.21%(95.01%~99.96%),一致率分别为76.10%(156/205)、77.56%(159/205)、78.54%(161/205)和76.59%(157/205),Kappa值分别为0.453、0.482、0.507和0.446。PCR荧光探针法检测痰液样本中MTBC的涂阴和极低级别阳性样本的检出率[10.73%(19/177)]与Xpert检测结果[8.47%(15/177)]的差异无统计学意义(χ^(2)=0.793,P=0.373)。PCR荧光探针法在检出MTBC的46份样本中同时检出6份样本发生利福平耐药基因突变,突变率为13.04%(6/46);而Xpert在检出MTBC的43份样本中仅同时检出1份样本发生利福平耐药基因突变,突变率为2.33%(1/43)。在96株临床菌株中,两种分子检测方法均检测到56株菌株发生利福平耐药基因突变,除2株探针突变类型不一致外,其他探针突变类型均一致,且多发生在probe E(529~533)和FAM通道(531/533突变)。结论:以临床诊断为参照标准,PCR荧光探针法检测MTBC的效能与MGIT 960、Xpert和痰涂片基本相当,且与Xpert检测MTBC临床菌株的利福平耐药性效果一致,认为PCR荧光探针法不仅是一种等同于Xpert检测功能的新技术,还具有操作简单、价格低于Xpert、真正实现一体化和全封闭等优势。建议在临床推广过程中进一步优化PCR荧光探针法以提高MTBC检出率,并开展多中心临床试验验证研究。

临床医生应重视老年人心脏淀粉样变的诊断与处理

心脏淀粉样变(CA)是淀粉样蛋白错误折叠沉积于心肌细胞外基质所致的心脏疾病。CA好发于老年人,由于症状缺乏特异性且既往被认为是一种罕见病,老年CA患者极易被误诊和漏诊。近年来随着对该病诊断意识的提高及无创性影像学诊断方法的进步,诊断为CA的患者有所增加;治疗CA的药物研究也有重大突破,研发了多种特异性治疗药物。早期治疗可以防止淀粉样蛋白进一步沉积导致的器官损伤,从而改善老年CA患者预后。因此,临床医生应该充分了解老年CA患者的临床特征,重视老年CA的诊断及治疗。

《小儿积滞病诊断标准》的制定研究

目的制定一个框架清晰、指标明确、可操作性强的《小儿积滞病诊断标准》,为中医儿科临床实践和中医药临床评价提供依据。方法基于文献研究法,结合课题组经验,初步制定确立小儿积滞病诊断标准框架和各层面条目;基于共识法(包括德尔菲法、名义小组法)征求专家意见,最终制定形成《小儿积滞病诊断标准》。结果制定了由“病史、病程、诊断指标、需要排除的疾病、诊断条件”5个层面的小儿积滞病诊断标准。结论本研究采用的研究方法得当,保证了内容的全面性和结果的客观性,《小儿积滞病诊断标准》具有科学性、实用性,可供小儿积滞病的临床科研与医疗工作者参考使用。该诊断标准已通过中华中医药学会的审核发布(编号T/CACM1387-2022)。

Concomitant atypical knee gout and seronegative rheumatoid arthritis:A case report

BACKGROUND Gout and seronegative rheumatoid arthritis(SNRA)are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported.Limited information is available regarding the clinical management and prognosis of these combined diseases.CASE SUMMARY A 57-year-old woman with a 20-year history of joint swelling,tenderness,and morning stiffness who was negative for rheumatoid factor and had a normal uric acid level was diagnosed with SNRA.The initial regimen of methotrexate,leflunomide,and celecoxib alleviated her symptoms,except for those associated with the knee.After symptom recurrence after medication cessation,her regimen was updated to include iguratimod,methotrexate,methylprednisolone,and folic acid,but her knee issues persisted.Minimally invasive needle-knife scope therapy revealed proliferating pannus and needle-shaped crystals in the knee,indicating coexistent SNRA and atypical knee gout.After postarthroscopic surgery to remove the synovium and urate crystals,and following a tailored regimen of methotrexate,leflunomide,celecoxib,benzbromarone,and allopurinol,her knee symptoms were significantly alleviated with no recurrence observed over a period of more than one year,indicating successful management of both conditions.CONCLUSION This study reports the case of a patient concurrently afflicted with atypical gout of the knee and SNRA and underscores the significance of minimally invasive joint techniques as effective diagnostic and therapeutic tools in the field of rheumatology and immunology.

二代测序技术在骨关节结核临床诊断中的应用价值

目的:评估二代测序技术(next generation sequencing,NGS)在骨关节结核诊断中的应用价值。方法:采用回顾性研究方法,参照入组标准收集2019年12月至2022年12月河北省胸科医院骨科收治的185例疑似骨关节结核患者临床资料,根据最终临床诊断将患者分为结核组(骨关节结核155例)和非结核组(非骨关节结核30例)。所有患者病灶标本均经手术或穿刺途径获取(包括51份脓液、89份肉芽组织和45份骨组织标本),且均同时送检NGS、BACTEC MGIT 960分枝杆菌液体培养(简称“培养”)及利福平耐药实时荧光定量核酸扩增(GeneXpert MTB/R1F,简称“Xpert”)检测。以最终临床诊断为参照标准,比较3种检测方法诊断骨关节结核的检测效能,并分析3种方法检测脓液、肉芽组织和骨组织标本的阳性检出情况。结果:185例疑似骨关节结核患者中,NGS检测骨关节结核的阳性率[63.24%(117/185)]明显高于Xpert[54.05%(100/185)]和分枝杆菌培养[35.68%(66/185)],差异均有统计学意义(χ^(2)=24.982,P<0.001;χ^(2)=37.934,P<0.001)。以最终临床诊断为参照标准,NGS、Xpert和培养法诊断骨关节结核的敏感度分别为74.84%(116/155)、64.52%(100/155)和42.58%(66/155),特异度分别为96.67%(29/30)、100.00%(30/30)和100.00%(30/30),诊断符合率分别为78.38%(145/185)、70.27%(130/185)和51.89%(96/185),Kappa值分别为0.799、0.590和0.504,AUC(95%CI)值分别为0.867(0.693~0.941)、0.703(0.612~0.784)和0.623(0.529~0.717)。NGS检测脓液的阳性率[80.39%(41/51)]明显高于检测肉芽组织[62.92%(56/89)]和骨组织[44.44%(20/45)],差异均有统计学意义(χ^(2)=4.560,P=0.031;χ^(2)=13.335,P<0.001)。结论:NGS技术可明显提高骨关节结核患者病原学阳性检出率,具有较高的检测效能,并以脓液标本的检测诊断价值最高。