Diagnostic performance of endoscopic classifications for neoplastic lesions in patients with ulcerative colitis:A retrospective casecontrol study

BACKGROUND It is unclear whether the Japan Narrow-Band Imaging Expert Team(JNET)classification and pit pattern classification are applicable for diagnosing neoplastic lesions in patients with ulcerative colitis(UC).AIM To clarify the diagnostic performance of these classifications for neoplastic lesions in patients with UC.METHODS This study was conducted as a single-center,retrospective case-control study.Twenty-one lesions in 19 patients with UC-associated neoplasms(UCAN)and 23 lesions in 22 UC patients with sporadic neoplasms(SN),evaluated by magnifying image-enhanced endoscopy,were retrospectively and separately assessed by six endoscopists(three experts,three non-experts),using the JNET and pit pattern classifications.The results were compared with the pathological diagnoses to evaluate the diagnostic performance.Inter-and intra-observer agreements were calculated.RESULTS In this study,JNET type 2 A and pit pattern typeⅢ/Ⅳwere used as indicators of low-grade dysplasia,JNET type 2 B and pit pattern typeⅥlow irregularity were used as indicators of highgrade dysplasia to shallow submucosal invasive carcinoma,JNET type 3 and pit pattern typeⅥhigh irregularity/VN were used as indicators of deep submucosal invasive carcinoma.In the UCAN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a low positive predictive value(PPV;50.0%and 40.0%,respectively);however,they had a high negative predictive value(NPV;94.7%and 100%,respectively).Conversely,in the SN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a high PPV(100%for both)but a low NPV(63.6%and 77.8%,respectively).In both groups,JNET type 3 and pit pattern typeⅥ-high irregularity/VN showed high specificity.The interobserver agreement of JNET classification and pit pattern classification for UCAN among experts were 0.401 and 0.364,in the same manner for SN,0.666 and 0.597,respectively.The intra-observer agreements of JNET classification and pit pattern classification for UCAN among experts were 0.387,0.454,for SN,0.803 and 0.567,respectively.CONCLUSION The accuracy of endoscopic diagnosis using both classifications was lower for UCAN than for SN.Endoscopic diagnosis of UCAN tended to be underestimated compared with the pathological results.

Diagnostic performance of abbreviated gadoxetic acid-enhanced magnetic resonance protocols with contrast-enhanced computed tomography for detection of colorectal liver metastases

BACKGROUND Although contrast-enhanced magnetic resonance imaging(MRI)using gadoxetic acid has been shown to have higher accuracy,sensitivity,and specificity for the detection and characterization of hepatic metastases compared with other modalities,the long examination time would limit the broad indication.Several abbreviated enhanced MRI(Ab-MRI)protocols without dynamic phases have been proposed to achieve equivalent diagnostic performance for the detection of colorectal liver metastases.However,an optimal protocol has not been established,and no studies have assessed the diagnostic performance of Ab-MRI combined with contrast-enhanced computed tomography(CE-CT),which is the preoperative imaging of colorectal cancer staging in clinical settings,to determine the best therapeutic strategy.AIM To compare the diagnostic performance of two kinds of Ab-MRI protocol with the standard MRI protocol and a combination of the Ab-MRI protocol and CE-CT for the detection of colorectal liver metastases.METHODS Study participants comprised 87 patients(51 males,36 females;mean age,67.2±10.8 years)who had undergone gadoxetic acid-enhanced MRI and CE-CT during the initial work-up for colorectal cancer from 2010 to 2021.Each exam was independently reviewed by two readers in three reading sessions:(1)Only single-shot fast spin echo(FSE)T2-weighted or fat-suppressed-FSE-T2-weighted,diffusion-weighted,and hepatobiliary-phase images(Ab-MRI protocol 1 or 2);(2)all acquired MRI sequences(standard protocol);and(3)a combination of an Ab-MRI protocol(1 or 2)and CE-CT.Diagnostic performance was then statistically analyzed.RESULTS A total of 380 Lesions were analyzed,including 195 metastases(51.4%).Results from the two Ab-MRI protocols were similar.The sensitivity,specificity,and positive and negative predictive values from Ab-MRI were non-inferior to those from standard MRI(P>0.05),while those from the combination of Ab-MRI protocol and CE-CT tended to be higher than those from Ab-MRI alone,although the difference was not significant(P>0.05),and were quite similar to those from standard MRI(P>0.05).CONCLUSION The diagnostic performances of two Ab-MRI protocols were non-inferior to that of the standard protocol.Combining Ab-MRI with CE-CT provided better diagnostic performance than Ab-MRI alone.

Diagnostic Performance of SD Bioline, Accurate, Fortress and Encode Compared to the Mindray CLIA 1200i Test in Volunteer Blood Donors at Kinshasa University Hospital

Background and Purpose: The hepatitis C prevalence rate is among the highest the world. Thus, in the context of transfusion safety, WHO has made it compulsory to screen blood bags by rapid diagnostic orientation tests (TROD) validated in regions that do not have the capacity to use more sophisticated technologies. The purpose of this study is to assess the performance of the TRODs commonly used in Kinshasa. Methods: This was a cross-sectional and analytical study carried out from August 26, 2019 to January 20, 2020 in 200 voluntary blood donors at the University Clinics of Kinshasa (CUK). The detection of anti-HCV antibodies was carried out by Mindray (gold standard) and the SD Bioline, Encode, Fortress and Accurate tests. The diagnostic performance of TRODs was evaluated compared to the Mindray test. Results: Of a total of 200 donors, 112 (56.0%) were male versus 88 (44.0%) female with a sex ratio of 1M: 1F. HCV seroprevalences by Mindray, and other tests were 29.5%, 28.0%, 27.0%, 27.0% and 31.5%, respectively;the Se, Sp, VPP, VPN, SD Bioline, Accurate, Fortress and Encode were 74.6%, 92.9%, 81.5%, 89.7%, respectively;74.6%, 92.9%, 81.5%, 89.7%;74.6%, 91.4%, 78.6%, 89.6%;69.5%, 70.0%, 65.1%, 84.4%. Conclusion: The diagnostic performance of TRODs evaluated in this study does not meet European Union standards (Se = 100%;Sp > 99.5%). The Ministry of Health should promote large-scale validation of TRODs based on World Health Organization guidelines.

Efficacy of ctDNA methylation combined with traditional detection modality to detect liver cancer among high-risk patients:A multicenter diagnostic trial

Objective:Circulating tumor DNA(ctDNA)and alpha-fetoprotein(AFP)plus ultrasound(US)have been considered to have high diagnostic accuracy for cancer detection,however,the efficacy of ctDNA methylation combined with the traditional detection modality of liver cancer has not been tested in a Chinese independent cohort.Methods:The high-risk individuals aged between 35 and 70 years who were diagnosed with liver cirrhosis or had moderate and severe fatty liver were eligible for inclusion.All participants were invited to receive a traditional examination[referring to AFP plus US],and ctDNA methylation,respectively.The sensitivity and specificity of different diagnostic tools were calculated.The logistic regression model was applied to estimate the area under the curve(AUC),which was further validated by 10-fold internal cross-validation.Results:A total of 1,205 individuals were recruited in our study,and 39 participants were diagnosed with liver cancer.The sensitivity of AFP,US,US plus AFP,and the combination of US,AFP,and ctDNA methylation was33.33%,56.41%,66.67%,and 87.18%,respectively.The corresponding specificity of AFP,US,US plus AFP,and the combination of all modalities was 98.20%,99.31%,97.68%,and 97.68%,respectively.The AUCs of AFP,US,US plus AFP,and the combination of AFP,US,and ctDNA methylation were 65.77%,77.86%,82.18%,and92.43%,respectively.The internally validated AUCs of AFP,US,US plus AFP,and the combination of AFP,US,and ctDNA methylation were 67.57%,83.26%,86.54%,and 93.35%,respectively.Conclusions:The ctDNA methylation is a good complementary to AFP and US for the detection of liver cancer.

Circulating Exosomal Lnc RNAs as Novel Diagnostic Predictors of Severity and Sites of White Matter Hyperintensities

Objective Exosomal long noncoding RNAs(lnc RNAs) are the key to diagnosing and treating various diseases. This study aimed to investigate the diagnostic value of plasma exosomal lnc RNAs in white matter hyperintensities(WMH).Methods We used high-throughput sequencing to determine the differential expression(DE) profiles of lnc RNAs in plasma exosomes from WMH patients and controls. The sequencing results were verified in a validation cohort using q RT-PCR. The diagnostic potential of candidate exosomal lnc RNAs was proven by binary logistic analysis and receiver operating characteristic(ROC) curves. The diagnostic value of DE exo-lnc RNAs was determined by the area under the curve(AUC). The WMH group was then divided into subgroups according to the Fazekas scale and white matter lesion site, and the correlation of DE exo-lnc RNAs in the subgroup was evaluated.Results In our results, four DE exo-lnc RNAs were identified, and ROC curve analysis revealed that exolnc_011797 and exo-lnc_004326 exhibited diagnostic efficacy for WMH. Furthermore, WMH subgroup analysis showed exo-lnc_011797 expression was significantly increased in Fazekas 3 patients and was significantly elevated in patients with paraventricular matter hyperintensities.Conclusion Plasma exosomal lnc RNAs have potential diagnostic value in WMH. Moreover, exolnc_011797 is considered to be a predictor of the severity and location of WMH.

Diagnostic accuracy of apparent diffusion coefficient to differentiate intrapancreatic accessory spleen from pancreatic neuroendocrine tumors

BACKGROUND Intrapancreatic accessory spleen(IPAS)shares similar imaging findings with hypervascular pancreatic neuroendocrine tumors(PNETs),which may lead to unnecessary surgery.AIM To investigate and compare the diagnostic performance of absolute apparent diffusion coefficient(ADC)and normalized ADC(lesion-to-spleen ADC ratios)in the differential diagnosis of IPAS from PNETs.METHODS A retrospective study consisting of 29 patients(16 PNET patients vs 13 IPAS patients)who underwent preoperative contrast-enhanced magnetic resonance imaging together with diffusion-weighted imaging/ADC maps between January 2017 and July 2020 was performed.Two independent reviewers measured ADC on all lesions and spleens,and normalized ADC was calculated for further analysis.The receiver operating characteristics analysis was carried out for evaluating the diagnostic performance of both absolute ADC and normalized ADC values in the differential diagnosis between IPAS and PNETs by clarifying sensitivity,specificity,and accuracy.Inter-reader reliability for the two methods was evaluated.RESULTS IPAS had a significantly lower absolute ADC(0.931±0.773×10^(-3)mm^(2)/s vs 1.254±0.219×10^(-3)mm^(2)/s)and normalized ADC value(1.154±0.167 vs 1.591±0.364)compared to PNET.A cutoff value of 1.046×10^(-3)mm^(2)/s for absolute ADC was associated with 81.25%sensitivity,100%specificity,and 89.66%accuracy with an area under the curve of 0.94(95%confidence interval:0.8536-1.000)for the differential diagnosis of IPAS from PNET.Similarly,a cutoff value of 1.342 for normalized ADC was associated with 81.25%sensitivity,92.31%specificity,and 86.21%accuracy with an area under the curve of 0.91(95%confidence interval:0.8080-1.000)for the differential diagnosis of IPAS from PNET.Both methods showed excellent inter-reader reliability with intraclass correlation coefficients for absolute ADC and ADC ratio being 0.968 and 0.976,respectively.CONCLUSION Both absolute ADC and normalized ADC values can facilitate the differentiation between IPAS and PNET.

Prediction of hepatic artery occlusion after liver transplantation by ultrasound characteristics and clinical risk factors

BACKGROUND Hepatic artery occlusion(HAO)after liver transplantation(LT)is a devastating complication,resulting in early graft loss and reduced overall survival.Ultra-sound is an established assessment method for HAO in patients following LT,especially those with complex hepatic artery reconstruction.METHODS We retrospectively analyzed the ultrasound characteristics and the clinic risk factors associated with HAO in 400 adult LT patients who were enrolled and treated at the Third People's Hospital of Shenzhen between November 2016 and July 2022.Fourteen patients diagnosed with acute HAO(A-HAO)by surgery and fifteen diagnosed with chronic HAO(C-HAO)were included.A control group of 33 patients without HAO complications during the same period were randomly selected using a random number table.All patients underwent an ultrasono-graphy examination.Parameters including resistance index(RI),peak systolic velocity(PSV),and portal vein velocity(PVV)were compared across the groups.Additionally,basic clinical data were collected for all patients,including gender,age,primary diagnosis,D-dimer concentration,total operation time,cold ischemia time,hot ischemia time,intraoperative blood loss and transfusion,intraoperative urine volume,infusion,model for end-stage liver disease(MELD)score,and whether complex hepatic artery reconstructions were performed.Furthermore,risk factors influencing HAO formation after LT were analyzed.RESULTS Compared to the non-HAO group,PVV and RI were higher in the A-HAO group,while PSV was lower.Conversely,both PSV and RI were lower in the C-HAO group compared to the non-HAO group.The proportion of patients undergoing complex hepatic artery reconstructions and the gamma-glutamyltransferase(GGT)level before occlusion were significantly higher in the A-HAO group compared to the non-HAO group.However,there were no distinct differences between the two groups in D-dimer,MELD score,pre-occlusion alanine transaminase and aspartate transaminase levels,or intraoperative conditions.CONCLUSION Ultrasound features of the hepatic artery before occlusion are significantly associated with postoperative HAO development.Additionally,complex hepatic artery reconstructions,defined as revascularization of the graft requiring additional anastomosis between donor hepatic arteries,constitute a risk factor for A-HAO.Besides,abnormal pre-occlusion GGT elevation is an important biochemical indicator.Therefore,ultrasound examination serves as an important tool for screening HAO,especially in patients with the identified risk factors.

Imaging Effect and Accuracy Analysis of 64-Slice Spiral CT in the Diagnosis of Coronary Artery Stenosis

Objective:To analyze the imaging effect and accuracy of 64-slice spiral CT in the diagnosis of coronary artery stenosis.Methods:30 patients with suspected coronary heart disease admitted to our hospital from March 2022 to March 2023 were selected.All patients underwent both 64-slice spiral CT and digital subtraction angiography(DSA).DSA is considered the gold standard for diagnosis,so it was used to analyze the diagnostic performance of 64-slice spiral CT.Results:(1)The diagnostic results of digital subtraction angiography and 64-slice spiral CT was analyzed and compared with each other.The 64-slice spiral CT had an accuracy of 96.67%(29/30),a sensitivity 96.55%(28/29),and a specificity of 100.00%(1/1)in diagnosing coronary artery stenosis.(2)There was no significant difference between 64-slice spiral CT and digital subtraction angiography in the positive detection rate of anterior descending artery lesion,the positive detection rate of left main lesion,the positive detection rate of left circumflex artery lesion and the positive detection rate of right coronary artery lesion(P>0.05).(3)There was no significant difference between 64-slice spiral CT examination and DSA examination in identifying mild stenosis,moderate stenosis,and severe stenosis of coronary arteries(P>0.05).Conclusion:64-slice spiral CT examination can accurately determine the degree of occlusion of coronary arteries,which allows for the accurate diagnosis of coronary artery stenosis.

Faecal immunochemical test outside colorectal cancer screening?

Faecal immunochemical tests(FITs)are the most widely colorectal cancer(CRC)diagnostic biomarker available.Many population screening programmes are based on this biomarker,with the goal of reducing CRC mortality.Moreover,in recent years,a large amount of evidence has been produced on the use of FIT to detect CRC in patients with abdominal symptoms in primary healthcare as well as in surveillance after adenoma resection.The aim of this review is to highlight the available evidence on these two topics.We will summarize the evidence on diagnostic yield in symptomatic patients with CRC and significant colonic lesion and the different options to use this(thresholds,brands,number of determinations,prediction models and combinations).We will include recommendations on FIT strategies in primary healthcare proposed by regulatory bodies and scientific societies and their potential effects on healthcare resources and CRC prognosis.Finally,we will show information regarding FIT-based surveillance as an alternative to endoscopic surveillance after high-risk polyp resection.To conclude,due to the coronavirus disease 2019 pandemic,FIT-based strategies have become extremely relevant since they enable a reduction of colonoscopy demand and access to the healthcare system by selecting individuals with the highest risk of CRC.

Associations between CD133,CK19 and G2/M in cirrhotic HCV(genotype-4)patients with or without accompanying tumor

Hepatitis C virus(HCV)-cirrhotic patients have the highest threat of developing hepatocellular carcinoma(HCC)and may be at risk of extra hepatic cancer.The present study was designed to investigate CD133 and CK19 in HCV(genotype-4)-cirrhotic patients with/without HCC or extra hepatic cancer,to assess the degree of their correlation with cell cycle abnormalities and finally to assess the role of their combination as diagnostic tool for discrimination of cirrhotic patients with HCC from those with extra hepatic cancer.The study included 77 HCV-cirrhotic patients and 20 healthy non-disease control group.Patients were categorized histo-pathologically into:24 have only liver cirrhosis,26 with HCC,and 27 patients with extra hepatic cancer.Cell cycle abnormalities,CD133 and CK19 were determined by flow cytometry technique.CD133 and CK19 showed marked elevation in HCC and extra hepatic cancer compared with liver cirrhosis and control subjects(p<0.0001).Positive associations were noted between CK19,CD133 and G2/M.They were gradually increased with progression from liver cirrhosis to HCC.Combination of the three showed the best AUC(0.978)and accuracy(92.5%)for discrimination of HCC from extra hepatic cancer.Combined CD133 with G2/M and CK19 comprises an excellent diagnostic panel for discrimination of HCV-cirrhotic patients with HCC from those with extra hepatic cancer.

Interdialytic 24-Hours Ambulatory Blood Pressure versus Dialysis Unit Blood Pressure for the Diagnosis of Electrocardiographic-Left Ventricular Hypertrophy in Chronic Hemodialysis Black Patients

Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the present study was aimed to assess the diagnostic performance of 24-hours ABPM vs. dialysis unit BPs for the diagnosis of ECG-LVH in steady state chronic hemodialysis black patients. Methods: From March 31 to September 30, 2018, interdialytic ABPM was performed after a mid-week hemodialysis session for 24 hours using a Spacelab 90207 ABPM monitor in the non-access arm in 45 stable chronic hemodialysis black patients (age ≥ 20 years, hemodialysis for at least 3 months and informed consent) attending 3 hemodialysis centers in Kinshasa. Ambulatory BP was recorded every 20 minutes during the day (6 AM to 10 PM) and every 30 minutes during the night (10 PM to 6 AM). ECG-LVH was defined using Cornell product criteria. ROC curve method was used to assess the performance of dialysis unit BPs vs. interdialytic 24-hours ABPM in diagnosing ECG-LVH. P 0.05 defined the level of statistical significance. Results: Whatever the method of BP measurement, all the SBP values were related to ECG-LVH with similar AUC and overlapping 95% CI;however, they were not significantly different from each other. 24-hours interdialytic ambulatory SBP (AUC 0.748;95% CI 0.58 - 0.94) had the highest area under the curve. Conclusion: The present study showed that although all the two BP measurement methods equally detected ECG-LVH, 24-hours ABPM tended to have the highest diagnostic performance.

The Diagnostic performance of galactomannan detection for invasive pulmonary aspergillosis in non-nentropenic hosts

Objective To evaluate the diagnostic performance of galactomannan(GM)detection in serum and BALF for invasive pulmonary aspergillosis(IPA)in non-neutropenic hosts.Methods A prospective study was performed for 1 356 non-neutropenic hosts admitted to the Department of Pulmonary and Critical Care Medicine of

Machine and deep learning-based clinical characteristics and laboratory markers for the prediction of sarcopenia

Background:Sarcopenia is an age-related progressive skeletal muscle disorder involving the loss of muscle mass or strength and physiological function.Efficient and precise AI algorithms may play a significant role in the diagnosis of sarcopenia.In this study,we aimed to develop a machine learning model for sarcopenia diagnosis using clinical characteristics and laboratory indicators of aging cohorts.Methods:We developed models of sarcopenia using the baseline data from the West China Health and Aging Trend(WCHAT)study.For external validation,we used the Xiamen Aging Trend(XMAT)cohort.We compared the support vector machine(SVM),random forest(RF),eXtreme Gradient Boosting(XGB),and Wide and Deep(W&D)models.The area under the receiver operating curve(AUC)and accuracy(ACC)were used to evaluate the diagnostic efficiency of the models.Results:The WCHAT cohort,which included a total of 4057 participants for the training and testing datasets,and the XMAT cohort,which consisted of 553 participants for the external validation dataset,were enrolled in this study.Among the four models,W&D had the best performance(AUC=0.916±0.006,ACC=0.882±0.006),followed by SVM(AUC=0.907±0.004,ACC=0.877±0.006),XGB(AUC=0.877±0.005,ACC=0.868±0.005),and RF(AUC=0.843±0.031,ACC=0.836±0.024)in the training dataset.Meanwhile,in the testing dataset,the diagnostic efficiency of the models from large to small was W&D(AUC=0.881,ACC=0.862),XGB(AUC=0.858,ACC=0.861),RF(AUC=0.843,ACC=0.836),and SVM(AUC=0.829,ACC=0.857).In the external validation dataset,the performance of W&D(AUC=0.970,ACC=0.911)was the best among the four models,followed by RF(AUC=0.830,ACC=0.769),SVM(AUC=0.766,ACC=0.738),and XGB(AUC=0.722,ACC=0.749).Conclusions:The W&D model not only had excellent diagnostic performance for sarcopenia but also showed good economic efficiency and timeliness.It could be widely used in primary health care institutions or developing areas with an aging population.Trial Registration:Chictr.org,ChiCTR 1800018895.