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Helicobacter pylori (H. pylori) is a spiral microorganism considered as a gram-negative, this organism colonize the microenvironment of gastric for more than 50% of world population. The present study involved 78 patients, 39 of them had a clinical diagnosis of gastric ulcer and the remaining 39 had a clinical diagnosis of gastric cancer. Biopsies were taken from December 2018” until the end of July 2019 and the patients were between 25 and 60 years old. The initial diagnosis of H. pylori was performed by the rapid urease test (RUT). The samples also have been tested for IL-17 gene expression by immunihistochemical techniques. All the samples have been investigated for UreA gene, and the results showed the H.pylori positive in 32 (82%) samples and it was negative in 7 (18%) samples in gastric cancer, whereas the gastric ulcer group showed 29 (75%) negative samples and 10 (25%) positive for H.pylori. Furthermore, the sequencing result of gastric cancer group showed 95% compatibility, while gastric ulcer patients showed 98% compatibility with NCBI. The phylogenetic analysis exhibited the genetic dimension among the samples and the world was 96% and 99% compatibility values.

Artificial intelligence (AI) is having a disruptive and transformative effect on clinical medicine. Prompt clinical diagnosis and imaging are critical for minimizing the morbidity and mortality associated with ischemic strokes. Clinicians must understand the current strengths and limitations of AI to provide optimal patient care. Ischemic stroke is one of the medical fields that have been extensively evaluated by artificial intelligence. Presented herein is a review of artificial intelligence applied to clinical management of stroke, geared toward clinicians. In this review, we explain the basic concept of AI and machine learning. This review is without coding and mathematical details and targets the clinicians involved in stroke management without any computer or mathematics' background. Here the AI application in ischemic stroke is summarized and classified into stroke imaging (automated diagnosis of brain infarction, automated ASPECT score calculation, infarction segmentation), prognosis prediction, and patients' selection for treatment.

Abstract: Nasopharyngeal Carcinoma (NPC), which is associated with latent Epstein-Barr virus infection in most cases, is a unique epithelial malignancy arising from the nasopharyngeal mucosal lining. Accumulating evidence is providing insights into the genetic and molecular aberrations that likely drive nasopharyngeal tumor development and progression. We review recent analyses of microRNAs (miRNAs), including Epstein-Barr virus-encoded miRNAs (EBV-encoded miRNAs) and dysregulated cellular miRNAs, that may be related to the metastasis of nasopharyngeal carcinoma. The studies summarized herein have greatly expanded our knowledge of the molecular biology of NPC involving miRNAs, and they may provide new biological targets for clinical diagnosis and reveal the potential of microRNA therapeutics. However, much remains to be uncovered.

Childhood brucellosis present various non-specific clinical symptoms, and limited laboratory data exist for clinical diagnosis. A better understanding of these clinical and laboratory characteristics can avoid clinical misdiagnosis and mistreatment. In this case-series study, a total of 78 children with confirmed diagnosis of brucellosis were evaluated retrospectively. We observed that the incidence rate was higher in the first two quarters every year. The most common symptom was fever. Osteoarticular involvement was found in 44.87% of the patients. Laboratory tests showed that the values of erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), Hemoglobin(Hb), Neutrophils(NEU), Alanine aminotransfease(ALT) and Ferritin in childhood brucellosis with osteoarticular involvement had significant differences than those without osteoarticular involvement or control group (P

Background: Currently, there are few literature reports on the CT features of pelvic rhabdomyosarcoma, most of which exist in the form of case reports, and some literature reports have suggested that CT features of pelvic rhabdomyosarcoma lack specificity. This study was designed to investigate the CT features of pelvic RMS in children to provide imaging evidence for clinical diagnosis. Methods: We retrospectively reviewed radiographic and clinical data of all paediatric patients with pelvic neoplastic lesions pathologically proven to be malignant in our hospitals from January 2012 through March 2021. The data of the included paediatric patients were divided into two groups according to whether the pathology results indicated RMS. CT features of RMS (n = 37) and non- RMS (n = 91) were compared by two abdominal radiologists. Results: A total of 9 CT features were statistically significant for the diagnosis of pelvic RMS in children (p < 0.05). The sensitivity (range, 0.64-0.74) and specificity (range, 0.86-0.93) of the CT features showing multinodular fusion, surrounding blood vessels, and heterogeneous progressive centripetal enhancement were both relatively high. The CT features indicating lower than muscle density, necrosis, non-calcification and non-haemorrhage exhibited high specificity (range, 0.86-0.97), but the sensitivity (range, 0.32-0.40) was relatively low, while the sensitivity (range, 0.37-0.46) and specificity (range, 0.75-0.83) of other CT features used for diagnosing pelvic RMS, namely, lobulated and lymphatic metastasis, were both relatively low. Conclusion: Pelvic rhabdomyosarcoma in children has its own specific CT features.

3D-printed patient-specific models provide added value for initial clinical diagnosis, preoperative surgical and implant planning and patient and trainee education. 3D spine models are usually designed using CT data, due to the ability to rapidly image osseous structures with high spatial resolution. Combining CT and MRI to derive a composite model of bony and neurological anatomy can potentially provide even more useful information for complex cases. We describe such a case involving an adolescent with a grade V spondylolisthesis in which a composite model was manufactured for preoperative and intraoperative evaluation and guidance. We provide a detailed workflow for creating such models and outline their potential benefit in guiding a multidisciplinary team approach.

Introduction. Significant polymorphism of clinical manifestations of infectious mononucleosis, multisystemic lesions, frequent lack of clear clinical and paraclinical criteria and delayed results of available laboratory tests, and sometimes impossibility of their execution complicate the diagnosis of the disease in prehospital stage and on admission to hospital. Objective of the study: to optimize the diagnosis and treatment of infectious mononucleosis in children by examining current features of the course and analyzing the diagnostic value of clinical and instrumental parameters in the verification of the disease. Materials and methods. On the basis of infectious boxed unit of respiratory infections of Municipal Healthcare Institution «Regional Children’s Hospital» (Chernivtsi), there were examined 65 children with infectious mononucleosis, who were hospitalized in the period of 2014–2015. The first clinical group (I) consisted of 42 children, the final clinical diagnosis of the disease in them was verified on the basis of comprehensive clinical and hematological criteria, the second (II) clinical group included 23 patients with serologically confirmed infectious mononucleosis. In terms of the main clinical signs, the observation groups were not significantly different. Results. It was found that for children with infectious mononucleosis, such clinical features are typical: sudden onset of the disease (in 93.8 %) with fever higher than 37.5 °C (80 %), the presence of exudative tonsillitis (81.6 %), submandibular and cervical lymphadenopathy (in 90.7 %), difficulty in nasal breathing (in 78.4 %), and nasal voice (in 73.8 %). In confirmation of Epstein-Barr virus infectious mononucleosis, phenomena of exudative tonsillitis and lymphadenopathy were highly sensitive (90 and 95 %, respectively), but with a high proportion of false positive results. Conclusion. Thus, given the lack of diagnostic value of clinical-anamnestic and sonographic parameters in identifying Epstein-Barr virus infectious mononucleosis in children, as evidenced by low values of the likelihood ratio and risk indicators, their use is expedient only in the combination.

Purpose This report from VitalSign6 project describes treatment selection, follow-up rates and remission outcomes by initial depression severity using the PCP-FIRST model. Methods This retrospective analysis included 32,106 patients aged ≥12 years screened with the Patient Health Questionnaire 2-item (PHQ-2) from November 2016 to July 2019 across 37 primary care clinics. PHQ-2 positive-screen patients (PHQ-2 ≥ 3) received 9-item PHQ (PHQ-9) and 7-item Generalized Anxiety Disorder scales, clinician assessments, and evaluation for pharmacotherapy management with measurement-based care (MBC). Results Of PHQ-2 screened patients, 18.7% (5994/32,106) were positive and received a PHQ-9. Of 5994 patients with PHQ-9, 2571 received a clinical diagnosis of depression of whom, 333 had none-mild depression (PHQ-9 Conclusions Despite this being a real-world, usual care sample, remission outcomes exceed real world remission rate expectations of 6% in primary care.

VISSER, K., M. Koggel, J. Blaauw, H.J.v.d. Horn, B. Jacobs, and J.v.d. Naalt. Blood based biomarkers of inflammation in mild traumatic brain injury: A systematic review. NEUROSCI BIOBEHAV REV XX(X) XXX-XXX, 2021. – Inflammation is an important secondary physiological response to traumatic brain injury (TBI). Most of the current knowledge on this response is derived from research in moderate and severe TBI. In this systematic review we summarize the literature on clinical studies measuring blood based inflammatory markers following mild traumatic brain injury (mTBI) and identify the value of inflammatory markers as biomarkers. Twenty-three studies were included. This review suggests a distinct systemic inflammatory response following mTBI, quantifiable within 6 hours up to 12 months post-injury. Interleukin-6 is the most promising biomarker for the clinical diagnosis of brain injury while interleukin-10 is a potential candidate for triaging CT scans. The diagnostic and prognostic utility of inflammatory markers may be more fully appreciated as a component of a panel of biomarkers. However, discrepancies in study design, analysis and reporting make it difficult to draw any definite conclusions. For the same reasons, a meta-analysis was not possible. We provide recommendations to follow standardized methodologies to allow for reproducibility of results in future studies.

INTRODUCTION This study aimed to explore the application value of two laboratory tests in the diagnosis of Epstein-Barr virus-associated infectious mononucleosis (EBV-IM) in children. METHODS From January 2018 to December 2020, 166 patients with EBV-IM were included in this study. Two methods were used in the analysis. The results of both tests were compared and analyzed. RESULTS The age of onset of EBV-IM is mainly distributed in the range of 0-6 years, and no difference by gender is observed. The sensitivity and specificity of EBV testing by PCR were 49.4% and 89.8%, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.714 (0.662-0.762). When using the immunofluorescence method to detect EBV antibodies, the two indices with the highest diagnostic efficacy were low-affinity EBV-CA IgG and EBV-CA IgM, and their AUC values were 0.798 (0.751-0.840) and 0.663 (0.609-0.713), respectively. When combining the two indices for testing, the AUC values of EBV-CA IgM + low-affinity EBV-CA IgG, EBV-DNA + EBV-CA IgM, and EBV-DNA + low-affinity EBV-CA IgG were 0.904(0.867-0.933), 0.768 (0.719-0.812) and 0.963 (0.937-0.981), respectively. The diagnostic efficacy of the combined EBV-DNA + EBV-CA IgM + low-affinity EBV-CA IgG test was optimal compared with that of a single index or the combination of two indices, with an AUC of 0.999 (0.986-1.000) (P < 0.05), sensitivity of 100%, and specificity of 89.8%. CONCLUSIONS The combined immunofluorescence and real-time PCR method has high sensitivity and specificity and good application value in the clinical diagnosis of EBV-IM. This article is protected by copyright. All rights reserved.

Background Universal screening for postpartum depression (PPD) remains an unachieved national priority. A tacit screen that requires no additional resources for administration can help to achieve this priority. We examine the predictive utility of using smoking as a tacit screen for PDD. We first establish smoking is a valid proxy for more prominent psychosocial determinants of PPD and is a predictor for PPD. Methods We analyzed PRAMS data (2012-2015; N=134,435). Time of smoking was categorized as nonsmoker, during the prenatal period, the postpartum, or continuously; PPD was assessed using two PHQ-2 style questions. Results Compared to nonsmokers, women who smoked only during the prenatal period (OR: 1.41; 95% CI: 1.06 – 1.86), only during the postpartum (OR: 1.33; 95% CI: 1.18 – 1.49), and continuously throughout both periods (OR: 1.54; 95% CI: 1.41 – 1.69) were more likely to experience PPD. Smoking assessed at a prenatal visit (SN: 0.90, SP: 0.21), postpartum visit (SN: 0.86, SP: 0.25), or assessed at both visits (SN: 0.90, SP: 0.19) performed relatively well as a tacit screen for PPD, performing better among unmarried women (SN: 0.75 – 0.81; SP: 0.29 – 0.36). Limitations In this study, the criterion of positivity used was PRAMS’ adapted version of the PHQ-2. This tacit screen may perform differently relative to a clinical diagnosis. Conclusions Time of smoking predicts risk of PPD and can be used to tacitly screen for PPD with reasonable accuracy without requiring any additional time in settings with limited resources for routine screening of PPD.

The prevalence, morbidity and costs of asthma care have increased worldwide. This study describes the effect and safety of an outpatient medical treatment with traditional medicine for asthma, through a retrospective case series with patients admitted to outpatient consultation from 1995 to 2015 in Cota, Colombia. Analyzing 26 cases with a clinical diagnosis of asthma, during the treatment 34.6% (9/26) did not present episodes of uncontrolled asthma and 61.5% (16/26) were classified as controlled asthma in their last consultation of control. 88.4% (23/26) of the patients reported no adverse reactions and the three reported were mild. The results allow to generate hypotheses about the effectiveness and safety of an outpatient treatment based on the incorporation of resources from traditional medicine. These observations could be explored with experimental studies to determine their long-term effectiveness, safety and low cost.

Background The establishment of a risk-appropriate care approach for pregnant women and newborn infants under the COVID-19 pneumonia is vital to prevent the main pregnancy complications. Objectives and design This study reviewed the vertical transmission (VT) potential of COVID-19 pneumonia in pregnant women. Key-related symptoms and adverse clinical outcomes for mothers and infants before and after childbirth were summarized. Some practical therapies and preventive health solutions were also proposed. Results There was a high susceptibility in pregnant women to COVID-19 infection, especially in the third trimester of pregnancy. The most common symptoms in 22-40-year-old patients infected with COVID-19 were fever (87.6%), cough (52.3%), dyspnea (27.6%), fatigue (22.4%), sore throat (13.5%), malaise (9.4%), and diarrhea (3.4%), respectively. The viral infection led to an increase in preterm labor and cesarean delivery without any intrauterine infection and severe neonatal asphyxia. No infection in the newborn infants was reported despite a high risk of the VT phenomenon. The most important therapies were the reception of antiviral and antibiotic drugs, oxygenation therapy, psychological interventions, and food supplements with health-promoting effects. The best proposed medical strategies to control the COVID-19 infection were bi-monthly screening and following-up the mothers' and fetuses' health, not using the potent broad-spectrum antibiotics and corticosteroids, providing the delivery room with negative pressure for emergency cesarean section, and the immediate isolation of newborns after childbirth without direct breastfeeding. Conclusion Babies with respiratory problems may be born to some mothers with COVID-19, who have weak immune systems. Thus, the virus transmission cycle should be disrupted to prevent adverse maternal and fetal outcomes by integrating individual health guidelines, efficient medical care therapies, and hospital preventive practices.

The availability of electronic health record (EHR)-linked biobank data for research presents opportunities to better understand complex ocular diseases. Developing accurate computable phenotypes for ocular diseases for which gold standard diagnosis includes imaging remains inaccessible in most biobank-linked EHRs. The objective of this study was to develop and validate a computable phenotype to identify primary open-angle glaucoma (POAG) through accessing the Department of Veterans Affairs (VA) Computerized Patient Record System (CPRS) and Million Veteran Program (MVP) biobank. Accessing CPRS clinical ophthalmology data from VA Medical Center Eye Clinic (VAMCEC) patients, we developed and iteratively refined POAG case and control algorithms based on clinical, prescription, and structured diagnosis data (ICD-CM codes). Refinement was performed via detailed chart review, initially at a single VAMCEC (n = 200) and validated at two additional VAMCECs (n = 100 each). Positive and negative predictive values (PPV, NPV) were computed as the proportion of CPRS patients correctly classified with POAG or without POAG, respectively, by the algorithms, validated by ophthalmologists and optometrists with access to gold-standard clinical diagnosis data. The final algorithms performed better than previously reported approaches in assuring the accuracy and reproducibility of POAG classification (PPV >83% and NPV >97%) with consistent performance in Black or African American and in White Veterans. Applied to the MVP to identify cases and controls, genetic analysis of a known POAG-associated locus further validated the algorithms. We conclude that ours is a viable approach to use combined EHR-genetic data to study patients with complex diseases that require imaging confirmation.

Objective: This study aimed to assess the possible role of dermoscopy in the diagnosis of different nail disorders compared with the clinical and histopathological diagnosis. Methods: This study included 104 patients with any nail disorders of both sex and any age. All the patients were subjected to a detailed medical history taken, clinical general examination, clinical and dermoscopic examinations of 20 nails. Potassium hydroxide examination was used to examine all patients with suspicious of onychomycosis. Histopathological evaluation was used to examine of clinically ambiguous nail disorders. Results: The most common nail diseases were onychomycosis (54.81%) followed by nail psoriasis (19.2%), and nail lichen planus (3.8%). Conclusion: Clinical evaluation was an important in diagnosis of different nail diseases. Nail dermoscopy could confirm clinical diagnosis and help in getting an accurate diagnosis of nail diseases and guide in the management of nail diseases by permitting better visualization of nail structure and pathology. Histopathological examination provided the most definitive method in reaching an accurate diagnosis due to it could provide etiologic, diagnostic, and prognostic information. There was good agreement between clinical, dermoscopic, and histopathological examinations for accurate diagnosis of different nail diseases.

Diabetes is the third chronic disease threatening human health after cardiovascular and cerebrovascular diseases and malignant tumors. The latest survey shows that there are as many as 463 million diabetic patients in the world, most of which are type 2 diabetes, and present a state of high incidence. Therefore, preventing and controlling the occurrence of type 2 diabetes is of great strategic significance for protecting human health and saving medical resources. This paper uses the SVM classification technology in data mining to establish a type 2 diabetes risk prediction model based on the SVM classifier, and uses the model to predict the original data of diabetic patients in the endocrinology department of a third-class hospital in Wuhan. Finally, an evaluation tool is used to evaluate the prediction performance and quality of the prediction model. The experimental results show that the prediction model based on the SVM classifier has the advantages of high prediction accuracy, good stability, fast learning speed and good classification effect under complex clinical data sets. It has important guiding significance for assisting the clinical diagnosis and risk prediction of type 2 diabetes.

PURPOSE OF REVIEW: To characterize current concepts in capsular repair and hip instability, and examine findings from biomechanical and clinical studies on hip capsular management strategies as they pertain to hip stability, patient outcomes, and hip arthroscopy failure. Further, we discuss the clinical evaluation and treatment of capsular deficiency. RECENT FINDINGS: There remains debate regarding the optimal capsular management strategies in hip arthroscopy, particularly concerning the necessity of routine capsular repair. A variety of capsulotomy techniques exist and may be used to access the hip joint. Additionally, a wide variety of techniques are employed to repair the hip capsule. Biomechanical evidence supports capsular closure restores hip joint stability to that of the intact, native state. Several clinical studies in both primary and revision hip arthroscopy settings have demonstrated improved pain and functional outcomes in patients who underwent capsular repair or capsular reconstruction. Studies have shown capsular repair may be especially important in patients with ligamentous laxity and hip dysplasia, and in competitive athletes. SUMMARY: Post-surgical hip instability secondary to capsular insufficiency is increasingly recognized as a cause of hip arthroscopy failure. Capsular closure restores native biomechanical stability to the hip joint, and several clinical studies report improved pain and functional outcomes following capsular repair or capsular reconstruction in both the primary and revision hip arthroscopy settings. There remains much to learn regarding capsular hip instability as it relates to optimal capsular management surgical technique, intra-operative capsular management decision-making, clinical diagnosis, and related advanced imaging findings.

Distal symmetrical sensorimotor syndrome is quite common in clinical practice. It is very important to establish the cause of polyneuropathy in time and most accurately. There are about 100 causes of damage to the peripheral nervous system. Recently, increasing attention is paid to instrumental and laboratory research methods, while clinical diagnosis, careful history taking, careful examination can give more than 70 % of the diagnosis. It is very important not to stop searching for a possible etiological factor, even when at first glance the cause is obvious, but clinically there are discrepancies. In the process of finding the causative factors, it is important not to waste time and start treatment as early as possible. For this purpose, drugs can be used that are aimed at universal factors of pathogenesis — free radical oxidation, inflammation, edema, microcirculation disorders., Дистальный симметричный сенсомоторный синдром довольно часто встречается в клинической практике. Очень важно вовремя и наиболее точно установить причину развития полинейропатии. Насчитывается около 100 причин поражения периферической нервной системы. В последнее время все больше внимания уделяется инструментальным и лабораторным методам исследования, тогда как клиническая диагностика, тщательный сбор анамнеза, внимательный ­осмотр могут дать более 70 % диагноза. Очень важно не прекращать поиск возможного этиологического фактора, даже когда на первый взгляд причина очевидна, но клинически наблюдаются несоответствия. В процессе поиска причинных факторов важно не терять время и начать лечение как можно раньше. Для этого подходят препараты, направленные именно на универсальные факторы патогенеза — свободнорадикальное окисление, воспаление, отек, нарушение микроциркуляции., Дистальний симетричний сенсомоторний синдром досить часто зустрічається в клінічній практиці. Дуже важливо вчасно й найбільш точно встановити причину розвитку полінейропатії. Налічується близько 100 причин ураження периферичної нервової системи. Останнім часом усе більше уваги приділяється інструментальним і лабораторним методам дослідження, тоді як клінічна діагностика, ретельний збір анамнезу, уважний огляд можуть дати понад 70 % діагнозу. Дуже важливо не припиняти пошук можливого етіологічного чинника, навіть коли на перший погляд причина очевидна, але клінічно спостерігаються невідповідності. У процесі пошуку причинних факторів важливо не втрачати час і розпочати лікування якомога раніше. Для цього підходять препарати, спрямовані саме на універсальні чинники патогенезу — вільнорадикальне окислення, запалення, набряк, порушення мікроциркуляції.

Atopic dermatitis (AD) is an inflammatory disease of the skin that by evolution has autoimmune characters. The quality of life of patients with AD is an important objective in assessing the evolution and treatment of AD. Severity degrees were appreciated using diagnostic scores (SCORAD). Laboratory examinations come to complete the clinical diagnosis by determining total IgE, specific IgE, IL-31. These parameters allow us to appreciate the allergic component in AD.

The outbreak of coronavirus disease 2019 (COVID‐19) has globally strained medical resources and caused significant mortality. This study was aimed to develop and validate a prediction model based on clinical features to estimate the risk of patients with COVID‐19 at admission progressing to critical patients. Patients admitted to the hospital between January 16, 2020, and March 10, 2020, were retrospectively enrolled, and they were observed for at least 14 days after admission to determine whether they developed into severe pneumonia. According to the clinical symptoms, all patients were divided into four groups: mild, normal, severe, and critical. A total of 390 patients with COVID‐19 pneumonia were identified, including 212 severe patients and 178 nonsevere patients. The least absolute shrinkage and selection operator (LASSO) regression reduced the variables in the model to 6, which are age, number of comorbidities, computed tomography severity score, lymphocyte count, aspartate aminotransferase, and albumin. The area under curve of the model in the training set is 0.898, and the specificity and sensitivity were 89.7% and 75.5%. The prediction model, nomogram might be useful to access the onset of severe and critical illness among COVID‐19 patients at admission, which is instructive for clinical diagnosis.

A vaginal panel assay could improve diagnostic accuracy for vaginitis and facilitate appropriate and timely treatment., OBJECTIVE: To compare the performance of vaginitis diagnosis based on clinical assessment to molecular detection of organisms associated with bacterial vaginosis, vulvovaginal candidiasis, and Trichomonas vaginalis using a vaginal panel assay. METHODS: This cross-sectional diagnostic accuracy study included 489 enrolled participants from five collection sites where those with vaginitis symptoms had a vaginal assay swab collected during their visit and a clinical diagnosis made. The swab was later sent to a separate testing site to perform the vaginal panel assay. Outcome measures include positive, negative, and overall percent agreement (and accompanying 95% CIs) of clinical assessment with the vaginal panel assay. P

Background The aim of the study was to examine the impact of diagnostic status (i.e., having a clinical diagnosis of irritable bowel syndrome (IBS) or being symptomatic but undiagnosed on quality of life (QoL)). We also examined whether the relationships between QoL and variables such as symptom frequency, pain catastrophizing, visceral sensitivity, and psychological distress are moderated by diagnostic status. Methods The online sample comprised 404 participants (Mage = 33.59, SD = 12.43), of which 98 had been diagnosed with IBS and 306 were symptomatic but undiagnosed. Results The findings suggest that even after adjusting for symptom frequency, those diagnosed with IBS experience poorer QoL, relative to those without a diagnosis. Moreover, there was evidence that the relationship between specific QoL domains (namely, sex, food avoidance, and health worry) and psychological variables (namely, pain catastrophizing, and depression) was moderated by diagnostic status. Conclusion The results indicate that diagnostic status in relation to IBS has psychological implications for QoL outcomes distinct from symptom frequency, age, and gender. This highlights a substantial gap in our current understanding of how a diagnosis of IBS can impact the lives of those suffering from IBS symptomology and calls into question the intended purpose of diagnosis.

Objective Within the vascular patient population, there is an increased risk of developing wound complications especially in infrainguinal incisions. There has been increasing interest in using closed incisional negative pressure dressings to decrease the risk of wound complications. To assess the efficacy of these incisional wound dressings, we studied surgical site infections (SSI) and seroma rates of infrainguinal incisions in our vascular patient population. Methods This was a multi-institutional, retrospective study from July 2015 to June 2019. In 2017, our institution began using the Prevena incisional wound system. Wound complication rates were compared with the non-Prevena group before 2017. There were a total of 100 infrainguinal incisions (left and right combined) that received the Prevena wound system and 138 infrainguinal incisions that had not. The primary end point was to assess for wound complication rates, including SSIs and seroma formation. SSIs were graded based on the American College of Surgeons National Surgical Quality Improvement Plan SSI criteria. Seroma formation was diagnosed based on clinical diagnosis, imaging studies (ultrasound examination, computed tomography scan) or needle aspiration of fluid collection. Results This analysis showed a statistically significant decrease in the rate of SSIs in the Prevena group when compared with the non-Prevena group (P = .012). There was no statistical difference between the two groups in the rate of seroma formation (P = .155). Of the 100 incisions that received the Prevena wound system, 1.2% (1/82) had a femoral SSI and 22.0% (4/18) had a popliteal SSI. For seroma formation, 24.4% (20/82) had a femoral seroma and 11.1% (2/18) had a popliteal seroma. Of the 138 incisions that did not have the Prevena wound system, 9.6% (10/104) had a femoral SSI and 8.8% (3/34) had a popliteal SSI. For seroma formation, 24.0% (25/104) had a femoral seroma and 8.8% (3/34) had a popliteal seroma. Comorbid conditions were assessed in the two study groups and there was no statistical significance regarding rates of SSIs between the groups. Conclusions The use of an incisional negative pressure dressing decreases the rate of SSIs in infrainguinal incisions. Regarding the use of these wound systems for seromas, our study did not show a statistically significant decrease in seroma rates.

Objective Cryosurgery is a simple and effective method for treating oral lesions. In this study, cryosurgery was used for vascular lesions such as haemangioma or vascular malformation and the effect was evaluated clinically. Methods The subjects were patients with a clinical diagnosis of vascular lesions in the oral cavity and who chose cryosurgery after an explanation of both surgical excision and cryosurgery. Cryosurgery was performed with a freezing device using liquid nitrogen. No anaesthesia was administered without the patient's wishes. Results Thirteen patients chose cryosurgery. No serious adverse events occurred during or after cryosurgery. In seven cases, the lesions disappeared after cryosurgery alone. Five cases showed reductions in the size of the lesions with several treatment sessions. One case later underwent surgical excision because cryosurgery was not successful. The results of the analysis showed that complete disappearance tended to be difficult and was dependent on the size of the lesion and the length of time it was left untreated. Conclusions This study suggests that cryosurgery is effective, minimally invasive, and safe treatment for vascular lesions in the oral cavity.

Hypertrophic cardiomyopathy (HC) is a common genetic heart disease. However, the number of gene mutation carriers who develop HC and manifest clinical symptoms is not well established. Our objective was to estimate annual prevalence and incidence rates of clinically diagnosed HC in the United States. Data from the HealthCore Integrated Research Database (HIRD) were interrogated for years 2013-2019 to identify patients with ≥1 claim of HC International Classification of Diseases, Clinical Modification Ninth and Tenth Revision diagnosis codes. In 2013, among 16,243,109 patients, 8,526 were identified with HC, yielding an estimated prevalence of clinically diagnosed HC of 0.052% (0.035% for obstructive [oHC], 0.017% for nonobstructive [nHC]). This prevalence yielded an estimated 164,403 patients with clinical diagnosis of HC. For the same year, the incidence of new HC diagnoses was 0.030% (0.020% for oHC, 0.010% for nHC). Over the following 6 years, prevalence and incidence of HC increased by 0.005%/year (p

In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state‐of‐the‐art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.

OBJECTIVE Tuberous sclerosis complex (TSC) is highly associated with autism spectrum disorder (ASD). Objectives of the study were to characterize autistic features in young children with TSC. METHODS Participants included 138 children followed from ages 3 to 36 months with TSC from the Tuberous Sclerosis Complex Autism Center of Excellence Research Network (TACERN), a multicenter, prospective observational study aimed at understanding the underlying mechanisms of ASD in TSC. Developmental and autism-specific assessments were administered, and a clinical diagnosis of ASD was determined for all participants at 36 months. Further analyses were performed on 117 participants with valid autism assessments based on nonverbal mental age greater than 15 months. RESULTS Prevalence of clinical diagnosis of ASD at 36 months was 25%. Nearly all autistic behaviors on the Autism Diagnostic Observation Schedule-2 (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R) were more prevalent in children diagnosed with ASD; however, autism-specific behaviors were also observed in children without ASD. Overall quality of social overtures, facial expressions, and abnormal repetitive interests and behaviors were characteristics most likely to distinguish children with ASD from those without an ASD diagnosis. Participants meeting ADOS-2 criteria but not a clinical ASD diagnosis exhibited intermediate developmental and ADOS-2 scores compared to individuals with and without ASD. INTERPRETATION ASD is highly prevalent in TSC, and many additional individuals with TSC exhibit a broad range of subthreshold autistic behaviors. Our findings reveal a broader autism phenotype that can be identified in young children with TSC, which provides opportunity for early targeted treatments. ANN NEUROL 2021;90:874-886.

Objective To conduct a comprehensive search for evidence with regard to whether central sensitization after an injury can act as a persistent autonomous pain generator after the inducing injury has healed. Methods We searched Medline on PubMed and the Cochrane Library, screening 3,572 abstracts, from which 937 full-text articles were obtained, with 186 of these discarded as irrelevant to the question being posed. The remaining 751 articles were studied for evidence. Results Fourteen publications were judged to provide weak evidence for the hypothesis of central sensitization as a persisting autonomous pain generator, but none addressed the question directly. No strong evidence for the affirmative answer was found. Sixty-one publications were judged to provide weak evidence for a negative answer, and ten were judged to provide strong evidence. Unexpectedly, serious weaknesses were discovered in the literature underpinning the validity of the clinical diagnosis of central sensitization in humans: 1) inappropriate extrapolation, in many publications, of laboratory animal data to humans; 2) failure to demonstrate the absence of peripheral pain generators that might be perpetuating central sensitization; and 3) many factors now shown to confound what is being measured by quantitative sensory testing, conditioned pain modulation, and the Central Sensitization Inventory. Conclusions We found no evidence proving that central sensitization can persist as an autonomous pain generator after the initiating injury has healed. Our review has also shown that the evidential basis for the diagnosis of central sensitization in individual patients is seriously in question.

INTRODUCTION Opioid-induced hyperalgesia (OIH) remains an issue in patients with chronic pain. Multiple cases of OIH in patients with chronic pain exposed to opioids have been reported worldwide. The objective of this systematic review was to summarize the evidence of OIH from clinical reports. METHODS We searched the PubMed, Cochrane, EMBASE, and LILACS databases for case reports and case series of OIH published up to December 2020, with the aim to summarize the evidence for OIH in patients with chronic pain from clinical reports and to discuss issues relevant to the clinical diagnosis and management of OIH. RESULTS We retrieved and reviewed 41 articles describing 72 cases. Clinical features of OIH were observed in patients of both sexes, all ages, and with various types of pain treated with different classes of opioids. OIH was reported at all doses, but most published studies reported a pattern of OIH following treatment with very high daily doses of opioids (median oral morphine equivalent dose of 850 mg). OIH was diagnosed clinically in all cases. Three different strategies for OIH management were described: opioid rotation, opioid cessation, and the use of adjuvant pharmacotherapies. All had statistically similar success rates for OIH treatment: 72%, 57%, and 79%, respectively. The decrease in pain was achieved rapidly (mean: 8 d; range: 1 to 28 d). Adjuvant therapies resulted in the largest decrease in dose. Ketamine and dexmedetomidine were the most widely used adjuvant drugs. CONCLUSION The key finding is that clinical symptoms of OIH can be resolved when this condition is diagnosed and managed.

Chronic enteropathies (CEs) in dogs describe a group of idiopathic disorders characterized by chronic persistent or recurrent gastrointestinal (GI) signs. Three major subgroups of CE can be identified by their response to treatment: Food-responsive disease (FRD), antibiotic-responsive disease (ARD), and steroid-responsive disease (SRD). The clinical diagnosis of CE is made by exclusion of all other possible causes of chronic diarrhea and includes histologic assessment of intestinal biopsies. The process of diagnosing canine CE can therefore be very time-consuming and expensive, and in most cases, does not help to identify dogs that will respond to a specific treatment. The development of novel diagnostic tests for canine CE has therefore focused on the accuracy of such tests to predict treatment responses. In this article, several novel assays that have the potential to become commercially available will be discussed, such as genetic tests, perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), antibodies against transglutaminase/gliadin, antibodies against E coli OmpC/flagellin, and micro RNAs.

Introduction Non-functioning pituitary adenomas (NFPAs) are clinically silent tumors and the second most common pituitary adenoma. Surgery is the mainstay of treatment as there is, as yet, no effective medical treatment. Areas covered We present current knowledge on the clinical diagnosis, histopathological classification, molecular data, and management strategies in NFPA. Expert opinion NFPA is a heterogeneous group of tumors, in respect to their origin and clinical course. In recent years, research on pathology and molecular biology have advanced our knowledge of NFPA pathogenesis. NFPA exhibit, in the majority of cases, an indolent behavior, with satisfactory response to treatment. In aggressive cases, multimodal management is needed; however, even this approach may be insufficient, so the development of new treatments is warranted for better management. In this setting, the understanding of the mechanisms involved in the genesis and progression of NFPA is crucial for the identification and development of directed treatments with higher chances of response.

PURPOSE OF REVIEW The optimal diagnosis and management of dystonic voice disorders are rooted in the nuanced understanding of their phenomenology. Distinguishing between subtypes of vocal dystonia is challenging, not only because the audible and physical presentations of these dystonia's can seem similar, but also because there is a lack of scientific consensus regarding the diagnostic criteria for these conditions. To help improve the clinician's acumen we focus on outlining the classification of the top three neurological voice disorders, notably: spasmodic dysphonia, (2) spasmodic dysphonia with tremor, and essential tremor of the voice. We also provide an algorithmic approach based on current evidence-based literature to guide practitioners through the clinical diagnosis and management of each possible etiology. RECENT FINDINGS Much remains unknown about the subtypes of vocal dystonia, and this gap in our knowledge likely limits our ability to advance clinical management. Still, continued experience evaluating and treating these patients yields refined clinical evaluations and decision making. SUMMARY Improvements in our clinical decision-making can be made by acknowledging that our limited understanding of vocal dystonia may hinder what therapeutic interventions we can offer, yet our ability to accurately diagnose the dystonia is central to providing optimal patient management.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) revised the diagnostic criteria for dissociative identity disorder (DID) to more accurately reflect the symptom profile of DID patients. No study has examined how this change affects clinical diagnosis of DID. The present study examined clinician reports of patient symptoms in relation to DSM-IV-TR and DSM-5 DID diagnostic criteria. Data were analyzed from 169 clinicians who participated in the Treatment of Patients with Dissociative Disorders Network Study with a patient they assigned a DID diagnosis. Clinicians evaluated their patients with respect to DSM-IV-TR and DSM-5 DID diagnostic criteria. Researchers determined a clinician-assigned DID diagnosis as "accurate" when the patient's reported dissociative symptoms matched DSM-IV-TR and/or DSM-5 criteria for DID. Most of the clinicians (95.27%) accurately diagnosed DID. Of those accurately diagnosed, 83.85% of patients met DSM-IV-TR and DSM-5 DID criteria, 9.94% only met DSM-IV-TR DID criteria, and 6.21% only met DSM-5 DID criteria. Further examination of responses suggested that possible idiomatic responses to the negative wording of the DSM-5 exclusionary criteria might have accounted for the DSM-IV-TR appearing to fit for a greater number of cases in this study. Changes in the DSM criteria for DID did not substantially change the frequency or accuracy of assigned DID diagnoses, but the removal of the requirement in DSM-5 that self-states regularly take control of an individual's behavior slightly increased the number of individuals meeting criteria for DID.

BACKGROUND Bradykinesia, dysrhythmia, and decrement in hand movements (HM) are core symptoms of Parkinson's disease (PD). The maximal rate of repetitive rhythm-preserving HM can be a diagnostic tool for PD bradykinesia. OBJECTIVES To improve the clinical diagnosis of bradykinesia by identifying the frequencies at which rhythmic HM become irregular in PD patients compared to healthy age-matched controls. METHOD Forty PD patients and 16 controls were asked to alternately perform left and right hand movements following the rate of a metronome with sound stimulation beginning at 85 beats per minute (BPM) and increasing in increments of 15 BPM up to 355 BPM. The rhythm of the HM for each rate was assessed visually, and the threshold frequency at which the subject could no longer rhythmically continue HM was measured by the metronome. The increasing rates of HM until reaching that threshold were compared between patients with PD and controls. RESULTS The mean rates of a metronome in PD vs. healthy subjects were 173.3 ± 42.0 vs. 248.8 ± 48.5 BPM (p

Circadian rhythm is a periodic change of organism according to the law of external environment, which is manifested in metabolism, cell proliferation, physiology and behavior. In recent years, the role of circadian genes in the occurrence and progression of hematological malignancies have been continuously demonstrated. PER2 is the core component of the circadian rhythm playing an important role in regulating the circadian rhythm of the biological clock. This review summarizes the research progress of PER2 in hematological malignancies, especially leukemia, in order to better understand its role in hematological malignancies, and provide new ideas for clinical diagnosis and treatment.

Objective: Estimates of lead time (LT), i.e., from detection of cancer in asymptomatic persons to manifestations of the disease, can be obtained by follow-up of populations at risk, reviews of the past histories of patients with cancer, estimates of tumor doubling time, and from the ratio between the prevalence of cancer at the first round of screening and its annual incidence on subsequent screening rounds. Aim of this study is to derive the LT of gastric cancer (GC) from published studies. Material and Methods: An overview of longitudinal studies and screening trials of GC; search of the reference sections of the retrieved papers for additional relevant studies; and calculation of the LT derived from these studies. Results: LT was 2.8 – 7.3 years if derived from prospective follow-up studies; 1.0 - 4.0 years if derived from retrospective reviews of the patients' histories before the clinical diagnosis of GC; 5.9 - 8.6 years if derived from tumor doubling time; and 1.8 - 4.3 years if derived from prevalence / /incidence ratios. Conclusions: There is wide variability in estimates of the LT of GC. Since an LT exceeding 6 six years may explain the improved survival of patients with screen-detected GS, the present survey does not obviate the need for randomized clinical trials of the effect of screening on gastric cancer mortality.

Background The clinical diagnosis of multiple system atrophy (MSA) is challenged by overlapping features with Parkinson's disease (PD) and late-onset ataxias. Additional biomarkers are needed to confirm MSA and to advance the understanding of pathophysiology. Positron emission tomography (PET) imaging of the translocator protein (TSPO), expressed by glia cells, has shown elevations in MSA. Objective In this multicenter PET study, we assess the performance of TSPO imaging as a diagnostic marker for MSA. Methods We analyzed [11 C]PBR28 binding to TSPO using imaging data of 66 patients with MSA and 24 patients with PD. Group comparisons were based on regional analysis of parametric images. The diagnostic readout included visual reading of PET images against clinical diagnosis and machine learning analyses. Sensitivity, specificity, and receiver operating curves were used to discriminate MSA from PD and cerebellar from parkinsonian variant MSA. Results We observed a conspicuous pattern of elevated regional [11 C]PBR28 binding to TSPO in MSA as compared with PD, with "hotspots" in the lentiform nucleus and cerebellar white matter. Visual reading discriminated MSA from PD with 100% specificity and 83% sensitivity. The machine learning approach improved sensitivity to 96%. We identified MSA subtype-specific TSPO binding patterns. Conclusions We found a pattern of significantly increased regional glial TSPO binding in patients with MSA. Intriguingly, our data are in line with severe neuroinflammation in MSA. Glia imaging may have potential to support clinical MSA diagnosis and patient stratification in clinical trials on novel drug therapies for an α-synucleinopathy that remains strikingly incurable. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Background Patients with primary biliary cholangitis (PBC) often have comorbid dyslipidemia, and determining the degree of hepatic steatosis can help predict the risk of cardiovascular events in PBC patients. The aim of our study was to analyze the characteristics of lipid distribution and the degree of hepatic steatosis in PBC. Methods We retrospectively analyzed 479 cases of PBC, chronic hepatitis B (CHB), chronic hepatitis C (CHC), non-alcoholic fatty liver disease (NAFLD), and healthy subjects (Normal) diagnosed by liver biopsy or definitive clinical diagnosis. Controlled attenuation parameter (CAP) values were applied to assess the degree of steatosis of the liver, and lipid levels were also compared in the five cohorts. Results We found that among the five groups of subjects, the PBC group had the lowest CAP values (P P = 0.004, P = 0.033, P P = 0.028), ALP (β = − 0.064, P = 0.012), TBA (β = − 0.126, P = 0.020), TG (β = 12.520, P = 0.000), HDL-C (β = − 11.338, P = 0.001) and LDL-C (β = 7.012, P = 0.002) were independent predictors of CAP. Conclusions Among PBC, CHB, CHC, NAFLD and healthy subjects, PBC had the lowest degree of hepatic steatosis and higher HDL-C levels, all of which were found to be protective factors against atherosclerosis and cardiovascular risk and would provide a valuable reference for the risk of developing cardiovascular events in PBC patients.

Актуальність. З початком гібридної війни на Донбасі хімічна терористична загроза в Україні стала реальністю. За таких умов військова дисципліна «токсикологія, радіологія та медичний захист» набула особливої актуальності в підготовці лікарів різних спеціальностей. Мета дослідження: обґрунтувати актуальність післядипломної підготовки лікарів на циклі тематичного вдосконалення «Медичний захист від хімічних агентів під час терористичних атак» в межах навчальної дисципліни «військова токсикологія, радіологія та медичний захист». Матеріали та методи. Проведено аналіз джерел наукової інформації з питань медичного забезпечення при ураженні токсикантами, що застосовуються при сучасних військових конфліктах і терористичних актах. Розглянуто рекомендації Всесвітньої організації охорони здоров’я (ВООЗ), Агентства зі скорочення військової загрози міністерства оборони США, Організації з заборони хімічної зброї, Національного центру біотехнологічної інформації США з цих питань. Застосовані методи дослідження: системного підходу, історичний, бібліосемантичний, контент-аналізу. Результати. Необхідність розширення знань у сфері сучасної військової токсикології для лікарів різних спеціальностей обумовила розробку нової програми тематичного удосконалення за напрямком «Медичний захист від хімічних агентів під час терористичних атак». В умовах гібридної війни медичну допомогу має надавати персонал з високим рівнем підготовки в питаннях медичного сортування, визначення специфічних токсичних синдромів, застосування заходів протихімічного захисту тощо. Однак сьогодні ми стикаємося з багатьма проблемами в цій сфері. Більша частина рекомендованих ВООЗ антидотів відсутня в Україні, тому головний акцент слід зробити на заходи інтенсивної терапії. В даній роботі ми зосередили увагу на основних проблемних питаннях, що можуть виникнути під час лікування постраждалих від різних хімічних агентів (легеневих, кров’яних, нервових, шкірних) в умовах відділень реанімації та інтенсивної терапії звичайних районних і міських лікарень. Висновки. Підвищення обізнаності лікарів про особливості клінічної дії найбільш поширених хімічних агентів є умовою надання своєчасної і ефективної медичної допомоги та збереження здоров’я медичного персоналу, який потенційно наражається на ризик хімічного ураження під час виконання професійної діяльності.

Background This population-based study estimated the health-economic costs of dementia from a societal perspective using nationally representative data from 2015 to 2019 and analysed recent trends in Korea. Methods The prevalence of and mortality due to dementia were calculated using the National Health Insurance claims data and population census. The health-economic burden due to dementia was estimated using a prevalence-based approach, including the number of dementia patients and the number of deaths resulting from dementia during 2015–2019. The health-economic burden was presented separately as the national burden and the burden per capita by summing the direct and indirect costs. Results Between 2015 and 2019, the prevalence of dementia among the elderly aged 65 years or older based on clinical diagnosis increased from 5.9 to 7.3%, with approximately 588000 elderly dementia patients in Korea. The total health-economic cost of dementia increased by about 1.5 times in the last 5 years and was estimated to be about USD 4218 million. Direct costs were 52.0% in 2019, and the proportion has been steadily increasing over the past 5 years; indirect costs accounted for 48.0% of the total burden, mainly from family members and caregivers. The health-economic cost per capita due to dementia was approximately USD 6957. Conclusions The burden of dementia in Korea is expected to considerably increase alongside the elderly population in the future. Health policies addressing the prevention and management of dementia should be prioritised.

Summary The diagnosis of uncomplicated forms of thoracobrachial outlet syndrome (TOS) and brachial plexus stretching syndrome (BPSS) is imprecise due to the lack of clear differentiation between dynamic vascular or neurological compression and brachial plexus stretching without vascular compression. After a review of literature, we propose and describe a simple way for clinical assessment of TOS, BPSS or association of both comprising 1 clinical sign and 2 manoeuvres. This clinical assessment can be performed by the medical doctor, the physiotherapist and the surgeon. The clinical diagnosis is essential because it will dictate the rehabilitation treatment. We propose and describe also a rehabilitation protocol comprising 10 phases with modulation of exercises according to clinical form (TOS, BPSS or association) and/or severity of symptoms. The physiotherapist has a capital role and is the guarantor of the effectiveness of the medical treatment. In France, a training is now available thanks to personal continuous development for diagnosis and treatment of TOS and BPSS. This is essential in order to propose an optimal care to patients.

Early detection of melanoma is important in improving patient survival. The treatment of melanoma is multidisciplinary and begins by obtaining an accurate diagnosis. The mainstays of melanoma diagnosis include examination of the lesion and surrounding areas and an excisional biopsy so that a pathologic diagnosis can be obtained. The pathology results will help guide treatment recommendations, and some information can be used for prognosis. Further workup of the patient may include laboratory studies and imaging for staging and surveillance.

Aim To assess the concordance between variations in Neuropad® results and the those in different diagnostic criteria of Diabetic Peripheral Neuropathy, according to various clinical guidelines. Methods A descriptive observational study was conducted of 111 patients with a confirmed diagnosis of diabetes mellitus. The criteria for inclusion in the study were that patients should be aged 18 years or more and have at least 10 years’ history of diabetes mellitus. Results 73 (65.8%) were male and 38 (34.2%) were female. Their mean age was 57.92 ± 13.24 years (95% CI 55.45–60.38). Healthy Neuropad® findings were obtained for 35 right feet (31.5%) and 31 left feet (27.9%). Conclusion Neuropad® is an effective instrument for detecting macro and microvascular complications such as early-stage neuropathy, although its use should always be accompanied by a clinical examination of the foot.

Parkinson's disease (PD) is the second most common neurodegenerative disorder disease right after Alzheimer's and the most common movement disorder for elderly people. It is characterized as a progressive loss of muscle control, which leads to trembling characterized by uncontrollable shaking, or (tremors) in different parts of the body. In recent years, deep learning (DL) models achieved significant progress in automatic speech recognition, however, limited studies addressed the problem of distinguishing people with PD for further clinical diagnosis. In this paper, an approach for the early detection of patients with PD using speech features was proposed, a recurrent neural network (RNN) with long short-term memory (LSTM) is applied with the batch normalization layer and adaptive moment estimation (ADAM) optimization algorithm used after the network hidden layers to improve the classification performance. The proposed approach is applied with 2 benchmark datasets of speech features for patients with PD and healthy control subjects. The proposed approach achieved an accuracy of 95.8% and MCC=92.04% for the testing dataset. In future work, we aim to increase the voice features that will be worked on and consider using handwriting kinematic features.

Background The clinical diagnosis of pneumonia is usually based on crackles at auscultation, but it is not yet clear what kind of crackles are the characteristic features of pneumonia in children. Lung sound monitoring can be used as a “longtime stethoscope”. Therefore, it was the aim of this pilot study to use a lung sound monitor system to detect crackles and to differentiate between fine and coarse crackles in children with acute pneumonia. The change of crackles during the course of the disease shall be investigated in a follow-up study. Patients and methods Crackles were recorded overnight from 22:00 to 06:00 h in 30 children with radiographically confirmed pneumonia. The data for a total of 28 800 recorded 30-s epochs were audiovisually analysed for fine and coarse crackles. Results Fine crackles and coarse crackles were recognised in every patient with pneumonia, but the number of epochs with and without crackles varied widely among the different patients: fine crackles were detected in 40±22% (mean±sd), coarse crackles in 76±20%. The predominant localisation of crackles as recorded during overnight monitoring was in accordance with the radiographic infiltrates and the classical auscultation in most patients. The distribution of crackles was fairly equal throughout the night. However, there were time periods without any crackle in the single patients so that the diagnosis of pneumonia might be missed at sporadic auscultation. Conclusion Nocturnal monitoring can be beneficial to reliably detect fine and coarse crackles in children with pneumonia., Lung sound monitoring can detect crackles in children with pneumonia and might improve diagnosis https://bit.ly/3CfaCl7

Background: The inguinal hernia is a protrusion of abdominal contents into the inguinal canal through an abdominal wall defect, and the risk of inguinal hernia increases with age. Currently, inguinal hernia repair with a mesh is the mostly common method through surgical procedure. Objective: To compare the outcome of laparoscopic versus open repair for inguinal hernias. Patients and Methods: This prospective comparative study conducted at General Surgery Department, Faculty of Medicine, Zagazig University at the period between January 2021 till July 2021, between open technique (preperitoneal approach, conventional Lichtenstein repair) versus laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) mesh repair of inguinal hernia. 24 patients were randomized into 2 groups by the closed envelop method, 12 patients underwent open repair operation and 12 patients underwent laparoscopic repair operation. The clinical diagnosis of inguinal hernia was based on symptoms and signs elicited during clinical assessment. Results: we found that mean duration of operation in laparoscopic group was longer than open group with significant difference, as regard length of hospital stay there was significant differences between two groups. Return to daily activity (Days) was early among laparoscopic inguinal hernia repair group with mean 1.67±0.49 and range from 1 to 2 days versus 4.58±1.5 with range from 3 to 7 days in open repair for inguinal hernia group, the difference was highly statistically significant. Conclusions: Laparoscopic surgical techniques for inguinal hernia repair (TAPP and TEP) can be carried out with a very low rate of predominantly harmless complications and with an acceptable duration of operation.

SUMMARY OBJECTIVE: The aim of this study was to verify the association among obstructive sleep apnea, functional capacity, and metabolic control. METHODS: This was a cross-sectional study involving individuals of both sexes with clinical diagnosis of diabetes mellitus type 2 who were above 18 years of age. The assessment consisted of a volunteer identification form, a 2-minute step test, and the Stop-Bang questionnaire. In order to assess metabolic control, HbA1c and fasting glucose data were collected from medical records. RESULTS: A total of 100 individuals with diabetes mellitus type 2, of whom 61% were women, were included in this study. According to the Stop-Bang instrument, 26, 57, and 17% of patients had low, intermediate, and high risk of developing OSA, respectively. There was no association between the 2-minute step test and metabolic variables and diabetes mellitus type 2 chronicity with Stop-Bang. CONCLUSIONS: We concluded that there is no association among obstructive sleep apnea measured by means of Stop-Bang instrument, functional capacity measured by means of 2-minute step test, and metabolic variables in individuals with diabetes mellitus type 2.

We investigated the diagnostic value of the tumor marker CA724 in patients with primary gastric cancer. One hundred forty-six patients with primary gastric cancer were selected as the observation group; 89 patients with gastritis treated in the same period were included in the control group 1; 91 patients with healthy physical examination during the same period were included in the control group 2. Electrochemiluminescence immunoassay was used to determine the level of carbohydrate antigen CA724 in each group; the pathological data of the observation group were consulted, and the expression level of tumor marker CA724 under different pathological conditions was analyzed; ROC curve was drawn to evaluate the diagnostic value of CA724 in gastric cancer and gastritis. The level of CA724 in primary gastric cancer patients was significantly correlated with tumor diameter, tumor stage, differentiation type, and lymph node metastasis. The ROC curve was drawn with a CA724 cutoff value of 7.94 U/Ml. The AUC value of CA724 in primary gastric cancer patients was 0.815, with a diagnostic sensitivity of 84.68% and a specificity of 71.95%. In conclusion, CA724 was highly expressed in patients with primary gastric cancer, which can achieve the diagnostic differentiation of gastric cancer and gastritis, and obtain a high diagnostic efficiency, providing a reference basis for clinical diagnosis and treatment.