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Epidemiology and disease characteristics of systemic sclerosis-related pulmonary arterial hypertension: results from a real-life screening programme

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ARTHRITIS RESEARCH & THERAPY 2017年第1期19卷 42-42页

作者： Morrisroe, Kathleen Stevens, Wendy Sahhar, Joanne Rabusa, Candice Nikpour, Mandana Proudman, Susanna Univ Melbourne St Vincents Hosp Melbourne Dept Med 41 Victoria Parade Fitzroy Vic 3065 Australia Univ Melbourne St Vincents Hosp Melbourne Dept Rheumatol 41 Victoria Parade Fitzroy Vic 3065 Australia Univ Melbourne St Vincents Hosp Melbourne Dept Med 41 Victoria Parade Fitzroy Vic 3065 Australia Monash Univ 246 Clayton Rd Clayton Vic 3168 Australia Monash Hlth 246 Clayton Rd Clayton Vic 3168 Australia Royal Adelaide Hosp Rheumatol Unit North Terrace SA 5000 Australia Univ Adelaide Discipline Med Adelaide SA 5000 Australia

Background: Pulmonary arterial hypertension (PAH) is the leading cause of death in systemic sclerosis (SSc). Annual screening with echocardiogram (ECHO) is recommended. We present the methodological aspects of a PAH screening programme in a large Australian SSc cohort, the epidemiology of SSc-PAH in this cohort, and an evaluation of factors influencing physician adherence to PAH screening guidelines. Methods: Patient characteristics and results of PAH screening were determined in all patients enrolled in a SSc longitudinal cohort study. Adherence to PAH screening guidelines was assessed by a survey of Australian rheumatologists. Summary statistics, chi-square tests, univariate and multivariable logistic regression were used to determine the associations of risk factors with PAH. Results: Among 1636 patients with SSc, 194 (11.9%) had PAH proven by right-heart catheter. Of these, 160 were detected by screening. The annual incidence of PAH was 1.4%. Patients with PAH diagnosed on subsequent screens, compared with patients in whom PAH was diagnosed on first screen, were more likely to have diffuse SSc (p = 0.03), be in a better World Health Organisation (WHO) Functional Class at PAH diagnosis (p = 0.01) and have less advanced PAH evidenced by higher mean six-minute walk distance (p = 0.03), lower mean pulmonary arterial pressure (p = 0.009), lower mean pulmonary vascular resistance (p = 0.006) and fewer non-trivial pericardial effusions (p = 0.03). Adherence to annual PAH screening using an ECHO-based algorithm was poor among Australian rheumatologists, with less than half screening their patients with SSc of more than ten years disease duration. Conclusion: PAH is a common complication of SSc. Physician adherence to PAH screening recommendations remains poor. Identifying modifiable barriers to screening may improve adherence and ultimately patient outcomes.

关键词： Systemic sclerosis Scleroderma Pulmonary arterial hypertension screening algorithm

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Prevalence of undiagnosed type 2 diabetes in patients admitted with acute coronary syndrome: the utility of easily reproducible screening methods

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BMC ENDOCRINE DISORDERS 2017年第1期17卷 3-3页

作者： Karamat, Muhammad A. Raja, Umar Y. Manley, Susan E. Jones, Alan Hanif, Wasim Tahrani, Abd A. Birmingham Heartlands Hosp Dept Endocrinol & Diabet Birmingham W Midlands England Queen Elizabeth Hosp Dept Diabet Birmingham W Midlands England Univ Birmingham Inst Metab & Syst Sch Clin & Expt Med Birmingham B15 2TT W Midlands England Queen Elizabeth Hosp Dept Clin Chem Birmingham W Midlands England Birmingham Heartlands Hosp Dept Clin Chem Birmingham W Midlands England Birmingham Hlth Partners Ctr Endocrinol Diabet & Metab Birmingham W Midlands England

Background: Despite the recognition of the importance of diagnosing dysglycaemia in patients with acute coronary syndrome (ACS) there remains a lack of consensus on the best screening modality. Our primary aims were to determine the prevalence of undiagnosed dysglycaemia and to compare the OGTT and HbA1c criteria for diagnosis of T2DM in patients admitted to hospital with ACS at baseline and at 3-months. We also aimed to investigate the role of a screening algorithm and a predictor score to define glucose tolerance in this population. Methods: A prospective study in which patients admitted with ACS to two UK teaching hospitals were assessed at baseline and 3 months follow-up. Results: The prevalence of diabetes at baseline was 20% and 16% based on OGTT and HbA1c criteria respectively. Forty three ( 43) % of the patients with T2DM based on OGTT would have been missed by the HbA1c criteria at baseline. Our screening algorithm identified 87% of patients with T2DM diagnosed with OGTT. Diabetes Predictor score had better sensitivity (> 80%) and negative predictive value (> 90%) compared to HbA1c criteria. Two thirds of participants with IGS and a third with T2DM changed their glycaemic status at 3 months. Conclusions: Only 48% of the patients admitted with ACS had normo-glycaemia based on OGTT. OGTT and HbA1c identified two different populations of patients with dysglycaemia with the HbA1c criteria missing almost half the patients with T2DM based on OGTT. Compared to HbA1c criteria our diabetes algorithm and diabetes predictor score had a better correlation with OGTT criteria.

关键词： Acute Coronary Syndrome Oral Glucose Tolerance Test Impair Glucose Tolerance Impaired Fasting Glucose screening algorithm

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Reactivation of BK polyomavirus after renal transplantation

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NEPHROLOGE 2016年第6期11卷 402-407页

作者： Korth, J. Verheyen, J. Witzke, O. Univ Duisburg Essen Univ Klinikum Essen AoR Klin Nephrol Hufelandstr 55 D-45147 Essen Germany Univ Duisburg Essen Univ Klinikum Essen AoR Inst Virol Essen Germany Univ Duisburg Essen Univ Klinikum Essen AoR Klin Infektiol Essen Germany

Background. Reactivation of the BK polyomavirus(BKPyV) leads to polyomavirusassociated nephropathy (PyVAN) in up to 10% of renal transplantion patients and is associated with transplant failure in up to 50%. The main risk factor for BKPyV reactivation is immunosuppressive therapy due to its immunosuppressive effect and drug-dependent influence on virus replication. So far there is no antiviral causal therapy for PyVAN. Aim. This review article discusses the current diagnostic steps and therapies recommended for BKPyV reactivation after renal transplantation. Conclusion. The possibility for early intervention and prevention of PyVAN progression depends on a thorough screening for BKPyV replication after renal transplantation. Transplant function can be preserved and progression of viral replication can be prevented by early adjustment of the immunosuppressive therapy determined by the viral load.

关键词： BK polyomavirus screening algorithm Polyomavirus-associated nephropathy Reduction of immunosuppression BKV-specific T-cell response

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TREC Based Newborn screening for Severe Combined Immunodeficiency Disease: A Systematic Review

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JOURNAL OF CLINICAL IMMUNOLOGY 2015年第4期35卷 416-430页

作者： van der Spek, Jet Groenwold, Rolf H. H. van der Burg, Mirjam van Montfrans, Joris M. Univ Med Ctr Utrecht Dept Pediat Immunol & Infect Dis NL-3508 AB Utrecht Netherlands Univ Med Ctr Utrecht Julius Ctr Hlth Sci & Primary Care NL-3508 AB Utrecht Netherlands Univ Med Ctr Rotterdam Erasmus MC Dept Immunol Rotterdam Netherlands

Background Newborn screening (NBS) by quantifying T cell receptor excision circles (TRECs) in neonatal dried blood spots (DBS) enables early diagnosis of severe combined immunodeficiency disease (SCID). In recent years, different screening algorithms for TREC based SCID screening were reported. Purpose To systematically review the diagnostic performance of published algorithms for TREC based NBS for SCID. Methods PubMed, EMBASE and the Cochrane Library were systematically searched for case series and prospective cohort studies describing TREC based NBS for SCID. We extracted TREC content and cut-off values, number of retests, repeat DBS and referrals, and type and number of typical SCID and other T cell lymphopenia (TCL) cases. We calculated positive predictive value (PPV), test sensitivity and SCID incidence. Results Thirteen studies were included, re-confirming 89 known SCID cases in case series and reporting 53 new SCID cases in 3.15 million newborns. In case series, the sensitivity for typical SCID was 100 %. In the prospective cohort studies, SCID incidence was similar to 1.7:100,000, re-test rate was 0.20-3.26 %, repeat DBS rate 0.0-0.41 % and referral rate 0.01-1.35 %. PPV within the five largest cohorts was 0.8-11.2 % for SCID and 18.3-81.0 % for TCL. Individual TREC contents in all SCID patients was < 25 TRECs/mu l (except in those evaluated with the New York State assay). Conclusions The sensitivity of TREC based NBS for typical SCID was 100 %. The TREC cut-off score determines the percentage of non-SCID TCL cases detected in newborn screening for TCL. Adapting the screening algorithm for pre-term/ill infants reduces the amount of false positive test results.

关键词： Severe Combined Immunodeficiency T-cell lymphopenia newborn screening T-cell receptor excisions circles screening algorithm systematic review

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Effects of Image Compression and Degradation on an Automatic Diabetic Retinopathy screening algorithm

Effects of Image Compression and Degradation on an Automatic...

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Conference on Medical Imaging 2010 - Computer-Aided Diagnosis

作者： Agurto, C. Barriga, S. Murray, V. Pattichis, M. Soliz, P. VisionQuest Biomed Albuquerque NM 87106 USA Univ New Mexico Dept Elect & Comp Engn Albuquerque NM 87131 USA Univ Iowa Dept Ophthalmol & Visual Sci Iowa City IA 52242 USA

ISBN: (纸本)9780819480255

Diabetic retinopathy (DR) is one of the leading causes of blindness among adult Americans. Automatic methods for detection of the disease have been developed in recent years, most of them addressing the segmentation of bright and red lesions. In this paper we present an automatic DR screening system that does approach the problem through the segmentation of features. The algorithm determines non-diseased retinal images from those with pathology based on textural features obtained using multiscale Amplitude Modulation-Frequency Modulation (AM-FM) decompositions. The decomposition is represented as features that are the inputs to a classifier. The algorithm achieves 0.88 area under the ROC curve (AROC) for a set of 280 images from the MESSIDOR database. The algorithm is then used to analyze the effects of image compression and degradation, which will be present in most actual clinical or screening environments. Results show that the algorithm is insensitive to illumination variations, but high rates of compression and large blurring effects degrade its performance.

关键词： Diabetic retinopathy image compression image degradation screening algorithm

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Efficacy of Advanced Discriminating algorithms for screening on Iron-Deficiency Anemia and β-Thalassemia Trait A Multicenter Evaluation

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AMERICAN JOURNAL OF CLINICAL PATHOLOGY 2012年第2期138卷 300-304页

作者： Schoorl, Margreet Schoorl, Marianne Linssen, Jo Martinez Villanueva, Miriam Velasco NoGuera, Jose A. Hernandez Martinez, Pedro Bartels, Piet C. M. Med Ctr Alkmaar Dept Clin Chem Hematol & Immunol NL-1815 JD Alkmaar Netherlands Sysmex Europe GmbH Norderstedt Germany Hosp Univ Virgen Arrixaca Murcia Spain

For many years, application of RBC indices has been recommended for discriminating between subjects with iron deficiency from those with thalassemia. However, application of the algorithms resulted in only 30% to 40% of subjects being appropriately classified. The aim of the study was to establish the efficacy of algorithms for anemia screening including new hematologic parameters such as percentage of hypochromic and microcytic RBCs and hemoglobin content of reticulocytes. Subjects with iron deficiency anemia (IDA) (n = 142) and subjects with beta-thalassemia (n = 34) were enrolled in a European multicenter study. Apparently healthy subjects were used as a reference group (n = 309). Hemocytometric investigations were performed on a Sysmex XE5000 hematology analyzer. The algorithms for IDA discrimination yielded results for area under the curve, sensitivity, specificity, and positive and negative predictive values of 0.88, 79%, 97%, 74%, and 98%, respectively. The algorithms for beta-thalassemia discrimination revealed similar results (0.86, 74%, 98%, 75%, and 99%, respectively). We conclude that the advanced algorithms, derived from extended RBC parameters provided by the Sysmex XE5000 analyzer, are useful as laboratory anemia screening devices.

关键词： Microcytic anemia screening algorithm Iron-deficiency anemia (IDA) beta-thalassemia %MicroR %HypoHe

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The serological screening of deceased tissue donors within the English Blood Service for infectious agents - a review of current outcomes and a more effective strategy for the future

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VOX SANGUINIS 2010年第3期98卷 e193-e200页

作者： Kitchen, A. D. Gillan, H. L. NHS Blood & Transplant Natl Blood Serv NTMRL London NW9 5BG England NHS Blood & Transplant Tissue Serv Liverpool Merseyside England

Background and Objectives The overall effectiveness of the NHSBT screening programme for infectious agents in deceased tissue donors is examined and evaluated in terms of current outcomes and how to improve upon these outcomes. Materials and Methods The screening results and any subsequent confirmatory results from a total of 1659 samples from NHSBT deceased donors referred to NTMRL for screening for infectious agents were included in the analysis. Results Overall 1566/1659 (94 center dot 4%) of the samples were screen negative. A total of 93 were repeat reactive on screening for one or more of the mandatory markers screened for, of which only 12 (13%) were subsequently confirmed to be positive on confirmatory testing. The majority of the repeat reactive samples were demonstrating non-specific reactivity with the screening assays in use. Conclusion Overall, the NHSBT screening programme for infectious agents in deceased tissue donors is very effective with a relatively low overall loss of donors because of non-specific reactivity. However, unnecessary loss of tissue products is not acceptable, and although this programme compares favourably with the outcomes of other such programmes, the confirmatory results obtained demonstrate both the need and the potential for improving the outcomes. This is particularly important as one donor may donate more than one product, and can be achieved very easily with a change to the screening algorithm followed, using the confirmatory data obtained to support and validate this change. Contents Summary Critical analysis of the NHSBT screening programme for infectious agents in deceased tissue donors and a strategy involving the design and use of a different screening algorithm to improve these outcomes.

关键词： deceased tissue donor non-specific reactivity screening algorithm serological screening tissue product

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Convex Optimization algorithms for Cooperative Localization in Autonomous Underwater Vehicles

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Acta Automatica Sinica 2010年第5期36卷 704-710页

作者： Ming-Yong LIU Wen-Bai LI Xuan PEI College of Marine Northwestern Polytechnical University Xi an 710072 P. R. China

In this paper, a cooperative localization algorithm for autonomous underwater vehicles (AUVs) is proposed. A “parallel” model is adopted to describe the cooperative localization problem instead of the traditional “leader-follower” model, and a linear programming associated with convex optimization method is used to deal with the problem. After an unknown-but-bounded model for sensor noise is assumed, bearing and range measurements can be modeled as linear constraints on the configuration space of the AUVs. Merging these constraints induces a convex polyhedron representing the set of all configurations consistent with the sensor measurements. Estimates for the uncertainty in the position of a single AUV or the relative positions of two or more nodes can then be obtained by projecting this polyhedron onto appropriate subspaces of the configuration space. Two different optimization algorithms are given to recover the uncertainty region according to the number of the AUVs. Simulation results are presented for a typical localization example of the AUV formation. The results show that our positioning method offers a good localization accuracy, although a small number of low-cost sensors are needed for each vehicle, and this validates that it is an economical and practical positioning approach compared with the traditional approach.

关键词： Autonomous underwater vehicle (AUV) convex optimization cooperative localization uncertainty region screening algorithm approximation algorithm

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Data management of a pneumonia screening algorithm in Veterans Affairs Medical Centers

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Journal of Medical Systems 1996年第6期20卷 395-401页

作者： Reed III, James E. Baumann, Margaret Petzel, Robert Weeks Jr., Harry S. West Virginia Medical Institute Charleston WV 25304 United States VA Medical Center West Side Chicago IL 60680 United States University of Illinois College of Medicine Chicago IL 60616 United States VA Medical Center Minneapolis MN 55417 United States

The Veterans Affairs External Peer Review Program (EPRP) reviews patient care episodes in Veterans Affairs Medical Centers (VAMCs) across the United States. This review process uses screening algorithms, followed by peer review, to identify deviations in the care provided by the VAMCs. A schematic model of the case selection, data acquisition at each VAMC, data flow between the VAMCs and the West Virginia Medical Institute (WVMI), data processing at WVMI, and the peer review process are given. A model pneumonia clinical practice guideline was generated by an expert panel of physicians external to the VAMCs. This guideline identifies benchmark criteria that reflect the clinical standards for diagnosing and treating hospitalized pneumonia patients. A screening algorithm was then designed, tested, and implemented to identify deviations in the quality of care delivered by VAMCs to hospitalized pneumonia patients.

关键词： and database management Clinical Practice Guideline peer review screening algorithm

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