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.

宏基因组二代测序对疑似骨关节结核患者的诊断价值

目的:探讨宏基因组二代测序(metagenomics next-generation sequencing,mNGS)技术在疑似骨关节结核患者中的诊断价值。方法:回顾性分析2019年1月至2023年1月在首都医科大学附属北京胸科医院就诊的疑似骨关节结核患者176例(包括57例骨关节结核患者和119例非结核性骨关节疾病患者),所有研究对象同时行BACTEC MGIT 960液体培养(简称“MGIT 960培养”)、GeneXpert MTB/RIF检测(简称“Xpert”检测)和mNGS检测。分析三种检测方法的阳性预测值、阴性预测值、敏感度及特异度。结果:mNGS检测疑似骨关节结核患者病灶标本结果中,化脓性细菌80例(45.5%)、分枝杆菌73例(41.5%)、真菌22例(12.5%)、放线菌1例(0.6%)。73例分枝杆菌中结核分枝杆菌57例,占32.4%。mNGS、Xpert和MGIT 960培养阳性预测值分别为87.7%(95%CI:77.6%~93.7%)、100.0%(95%CI:93.5%~100.0%)、100.0%(95%CI:89.4%~100.0%),mNGS、Xpert和MGIT 960培养的阴性预测值分别为94.1%(95%CI:88.9%~97.0%)、98.3%(95%CI:93.8%~99.6%)和83.2%(95%CI:78.5%~87.1%)。mNGS与Xpert检测的敏感度分别为87.7%(95%CI:76.3%~94.9%)、96.5%(95%CI:87.9%~99.6%),高于MGIT 960培养[57.9%(95%CI:44.1%~70.9%)]。mNGS、Xpert和MGIT 960培养的特异度分别为94.1%(95%CI:88.3%~97.6%)、100.0%(95%CI:96.9%~100.0%)、100.0%(95%CI:96.9%~100.0%)。结论:mNGS在疑似骨关节结核患者中具有较高的诊断价值。

Development and prospect of near-infrared spectroscopy-assisted schizophrenia diagnosis based on bibliometrics

In this editorial,we comment on the recent article by Fei et al exploring the field of near-infrared spectroscopy(NIRS)research in schizophrenia from a bibliometrics perspective.In recent years,NIRS has shown unique advantages in the auxiliary diagnosis of schizophrenia,and the introduction of bibliometrics has provided a macro perspective for research in this field.Despite the opportunities brought about by these technological developments,remaining challenges require multidi-sciplinary approach to devise a reliable and accurate diagnosis system for schizo-phrenia.Nonetheless,NIRS-assisted technology is expected to contribute to the division of methods for early intervention and treatment of schizophrenia.

基于德尔菲法确定《子宫内膜异位症中西医结合诊疗指南》的临床问题

目的:指南工作组严格遵循指南制定规范,构建《子宫内膜异位症中西医结合诊疗指南》(以下简称“指南”)临床问题,便于指导指南后续工作。方法:在前期文献研究、专家访谈、初步调研的基础上,按照临床问题PICO化构建原则编制专家问卷,通过两轮德尔菲法确定本指南临床问题。结果:两轮德尔菲法分别向34名专家发放问卷,回收率均100%,专家积极系数为100%,权威系数均为0.934,变异系数分别为0%~37%及16%~37%,Kendall协调系数分别为0.177及0.105(均P<0.05)。两轮德尔菲法共有30个临床问题达成共识,经指南工作组专家讨论并将部分临床问题进行合并凝练后,最终纳入9个临床问题。结论:总结了子宫内膜异位症临床当下关注度最高的临床问题,通过两轮德尔菲法调查确定了需要纳入本指南的临床问题,为指南的后续制定工作奠定了良好的基础。

新生儿早发性败血症分子诊断方法新进展

新生儿败血症是一个全球性的健康问题,严重影响新生儿的身体健康及生命安全;在早产儿中,其发病率更高,尤其是出生后72 h内的早发性败血症(EOS)。新生儿EOS的诊断需进行一系列检查,早期和准确的诊断能够及时改善患儿临床结局并减少抗生素的过度使用。目前,EOS诊断的常用生物标志物和传统血培养方法具有一定缺点,因此寻找新的分子诊断方法迫在眉睫。本文总结并比较了新生儿EOS的早期与新型诊断方法,以期为临床提供参考。

对金属构件失效模式诊断技术与方法的探讨

为了提高金属构件的整体应用性能,需要对金属构件的实际情况进行诊断,准确掌握金属构件的具体性能。各种机械装备金属构件诊断分析过程中可能发生失效情况。对失效形式进行分析,掌握金属构件失效的具体原因,并从不同角度出发明确金属构件失效模式诊断技术的应用要点和具体的诊断流程,能够为提高金属构件失效模式诊断效果提供可靠支撑。同时根据分析结果提出金属构件失效模式预防对策是保证金属构件应用效果的重要手段。

锂离子动力电池故障诊断方法探究

新能源汽车在高速发展的同时,其安全问题也日益突出。动力电池作为新能源汽车的重要组成部分,其安全问题也会对新能源汽车的安全造成重大影响,因此,发展动力电池系统的故障诊断技术具有重大意义,力争在故障初级阶段予以处理,为汽车实现安全稳定地运行奠定基础。该文总结了动力电池系统的故障类型和表现形式,并分析了引发故障的原因,然后总结了现有的故障诊断方法。通过分析现有技术,发现在未来针对动力电池故障诊断技术一方面可侧重于发掘新型电池材料,在源头提高电池的性能;另一方面也可通过大数据平台实现对电动汽车的数据实时采集与监控,实现实时监控动力电池状态,为电池故障诊断提供有利条件,同时也可充分预防故障发生导致不良后果。

双源CT冠状动脉造影技术对冠状动脉分支狭窄程度及其临界病变的诊断价值研究

目的:评估双源CT冠状动脉造影技术在冠状动脉分支狭窄程度及其临界病变诊断中的应用价值。方法:选取2023年2月至2024年8月间收治的90例冠心病患者,均接受双源CT冠状动脉造影检查,并以冠脉造影术作为金标准。分析双源CT技术对冠状动脉不同节段狭窄程度和临界病变的诊断效能(灵敏度、特异度等)。结果:双源CT冠状动脉造影技术的诊断效能较佳,诊断一致率、一致性分析Kappa值较好,而且对不同节段血管狭窄程度进行诊断期间应用双源CT冠状动脉造影技术进行干预,提示一致性良好;双源CT冠状动脉造影技术对冠状动脉临界病变诊断获得诊断效能、诊断一致率、一致性分析Kappa值,提示一致性一般(P<0.05)。结论:双源CT冠状动脉造影技术在冠状动脉狭窄及其临界病变的诊断中具有重要临床价值,值得推广。

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.