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Mukhopadhyay, Partha, Tara Sankar Bag, Amit Kyal, Dipta Prasun Saha, and Noori Khalid. "Oral Hypoglycemic Glibenclamide: Can it be a Substitute to Insulin in the Management of Gestational Diabetes Mellitus? A Comparative Study." Journal of South Asian Federation of Obstetrics and Gynaecology 4, no. 1 (2012): 28–31. http://dx.doi.org/10.5005/jp-journals-10006-1167.
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ABSTRACT Introduction Gestational diabetes is a common medical disorder in pregnancy. So long, it has been usually treated by insulin. Now it has been found that oral glibenclamide can be used instead of insulin with similar glycemic control and without any adverse maternal and fetal effect. Methods A comparative study between oral glibenclamide and insulin for the management of gestational diabetes mellitus (GDM) was conducted. It was a prospective randomized study and patients attending the antenatal clinic were screened with 75 gm oral glucose between 20 to 28 weeks and GDM was diagnosed based on WHO criteria of 2 hours blood glucose ≥140 mg/dl. Women with gestational diabetes were given medical nutritional therapy (MNT) for 2 weeks. Out of this, 60 women did not achieve the target blood glucose. The goal of treatment was maintenance of mean plasma glucose (MPG) of about 105 mg%. For this the fasting plasma glucose should be around 90 mg/dl and postprandial peaks around 120 mg/dl. Patients were randomly assigned to receive glibenclamide (group A, n = 30) or insulin (group B, n = 30). In group A, glibenclamide was given 2.5 mg orally in morning and doses were increased weekly by 2.5 mg up to a maximum of 20 mg and doses >7.5 mg were given in two divided doses. In group B, insulin 0.7 units per kilogram of body weight at admission was given subcutaneously three times daily and increased weekly as necessary. Self monitoring of blood glucose with glucometer was done. Blood glucose was also measured from the laboratory every week. Glycosylated hemoglobin (HbA1c) was measured before initiation of therapy and repeated in the third trimester before confinement. Terminations of pregnancy in both the groups were done between 37 and 38 weeks. The infant birth weight, blood glucose and serum bilirubin were also recorded in all cases. Results The present study showed that the two groups had similar glycemic status (fasting blood sugar in group A was 103.5 ± 14.62 mg/dl and postprandial blood sugar was 184.1 ± 20.46 mg/dl whereas in group B it was109.3 ± 19.63 mg/dl and 194.3 ± 18.47mg/dl) at the time of entry into the study. The two groups also showed similar levels of glycemic control just before confinement (fasting blood sugar in group A was 88.23 ± 6.55 mg/ dl and postprandial blood sugar was 122.7 ± 10.3 mg/dl whereas in group B it was 88.17 ± mg/dl and 128 ± 12.38 mg/dl) and there was no significant statistical difference in the two groups (p > 0.05). The perinatal outcomes in both the groups were also nearly same. There was no significant difference in birth weight, blood sugar level of neonates and complications between the two groups. There was no case of macrosomia in the two groups and the number of infants large for gestational age (LGA) was four in group A and two in group B. Hypoglycemia in newborn was slightly higher in the group A compared to group B (4 and 3 respectively). Conclusion From our study, it is evident that the use of oral agents is a pragmatic alternative to insulin therapy in cases of gestational diabetes because of similar glycemic control, ease of administration and better patient compliance due to noninvasive treatment. How to cite this article Mukhopadhyay P, Bag TS, Kyal A, Saha DP, Khalid N. Oral Hypoglycemic Glibenclamide: Can it be a Substitute to Insulin in the Management of Gestational Diabetes Mellitus? A Comparative Study. J South Asian Feder Obst Gynae 2012;4(1):28-31.
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Malon, Radha S. P., Sahba Sadir, Malarvili Balakrishnan, and Emma P. Córcoles. "Saliva-Based Biosensors: Noninvasive Monitoring Tool for Clinical Diagnostics." BioMed Research International 2014 (2014): 1–20. http://dx.doi.org/10.1155/2014/962903.
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Saliva is increasingly recognised as an attractive diagnostic fluid. The presence of various disease signalling salivary biomarkers that accurately reflect normal and disease states in humans and the sampling benefits compared to blood sampling are some of the reasons for this recognition. This explains the burgeoning research field in assay developments and technological advancements for the detection of various salivary biomarkers to improve clinical diagnosis, management, and treatment. This paper reviews the significance of salivary biomarkers for clinical diagnosis and therapeutic applications, with focus on the technologies and biosensing platforms that have been reported for screening these biomarkers.
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Cheng, Hao-Min, Alan Pearson, Shih-Hsien Sung, Wen-Chung Yu, Chen-Huan Chen, and Jonathan Karnon. "Cost-Effectiveness of Noninvasive Central Blood Pressure Monitoring in the Diagnosis of Hypertension." American Journal of Hypertension 28, no. 5 (November 27, 2014): 604–14. http://dx.doi.org/10.1093/ajh/hpu214.
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Satake, Shuichi, Tatsuo Shimura, Tetsuya Ono, Kenju Shimomura, Seiichi Takenoshita, and Koji Kono. "Noninvasive continuous blood pressure monitoring using microelectromechanical system technology." Blood Pressure Monitoring 24, no. 3 (June 2019): 155–59. http://dx.doi.org/10.1097/mbp.0000000000000380.
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Sasaki, Junichi, Yoshiharu Kikuchi, Takashi Usuda, and Shingo Hori. "Validation of inflationary noninvasive blood pressure monitoring in the emergency room." Blood Pressure Monitoring 20, no. 6 (December 2015): 325–29. http://dx.doi.org/10.1097/mbp.0000000000000145.
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Sartori, Michelangelo, Valentina Benetton, Anna Maria Carraro, Lorenzo A. Cal??, Luisa Macchini, Valter Giantin, Franco Tosato, Achille C. Pessina, and Andrea Semplicini. "Blood pressure in acute ischemic stroke and mortality: a study with noninvasive blood pressure monitoring." Blood Pressure Monitoring 11, no. 4 (August 2006): 199–205. http://dx.doi.org/10.1097/01.mbp.0000209077.23084.93.
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Jin, Michael C., Joseph G. Schroers-Martin, David M. Kurtz, Lieselot Buedts, Mohammad S. Esfahani, Charles Macaulay, Brian Sworder, et al. "Noninvasive Genotyping and Monitoring of Classical Hodgkin Lymphoma." Blood 132, Supplement 1 (November 29, 2018): 2838. http://dx.doi.org/10.1182/blood-2018-99-119140.
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Abstract Introduction: Cell-free DNA (cfDNA) and circulating tumor DNA (ctDNA) have an emerging diagnostic role in multiple malignancies including in lymphomas (Kurtz et al ASH 2017). In classical Hodgkin Lymphoma (cHL), malignant Reed Sternberg (RS) cells are rare, requiring laser capture microdissection from archival tissues or flow sorting from viable tumor cell suspensions for genotyping. We profiled ctDNA in cHL to assess the utility of ctDNA in the noninvasive evaluation of somatic single nucleotide variants (SNVs), somatic copy number alterations (SCNAs), and tumor EBV status. Methods: A total of 53 subjects with HL (29 with early stage and 24 with advanced disease) were studied encompassing a total of 95 blood and tissue samples (72 from Stanford, 23 from UZ Leuven). Plasma samples were sequenced with CAPP-Seq (Newman et al Nat Biotech 2016), using a panel informed by the genotyping of primary tumor biopsies. The genotypes of cHL patients were compared to that of 189 patients with other B-cell malignancies. Given the thoracic distribution of most cHL, we also compared ctDNA levels to that of 55 lung carcinomas. ctDNA levels were calculated as the product of the cfDNA concentration and the mean allelic fraction of somatic mutations. Results: The median pretreatment ctDNA level in cHL was 125 hGE/mL (15 - 5277 hGE/mL), corresponding to a median variant allelic fraction (VAF) of 3.2% (0.3 - 13.9%) (Fig 1A). Pretreatment ctDNA burden was greater in cHL cases than in follicular lymphoma (FL) cases (p = 0.002), but was not significantly different from that of diffuse large B-cell lymphoma (DLBCL) (p = 0.26). Plasma genotyping in cHL and DLBCL also identified similar numbers of SNVs, recovering a median of 108 mutations in cHL and 117 mutations in DLBCL (p = 0.53). In samples with available diagnostic PET/CT, pre-treatment ctDNA levels in cHL were significantly correlated with total metabolic tumor volume (MTV) (Spearman ρ = 0.615, p = 0.006) (Fig 1B), but not with diagnostic PET/CT SUVmax, stage, bulky status (>10 cm), B-symptoms, or presence of extranodal disease. Surprisingly, despite the lower tumor purity of RS cells in cHL tumor masses than that of malignant B-cells in DLBCL, the relationship between ctDNA and PET/CT estimates of disease burden in cHL was highly similar to that of DLBCL. Specifically, cHL and DLBCL were statistically indistinguishable for the ratio between ctDNA levels and MTV (mean ctDNA/MTV of 2.1 vs 1.5 hGE/mL per cm3 tumor, p = 0.38), and both were significantly higher than that of non small cell lung carcinoma (NSCLC) (p < 0.0001) (Fig 1C). In patients with available mid-treatment cfDNA (n = 10), we monitored ctDNA concentrations and observed that circulating tumor burden falls rapidly, with a third of our patients reaching undetectable levels within the first month after start of therapy. PD-L1 copy number gains, previously shown to be prognostic for survival in cHL treated with checkpoint inhibitors, were observed in 42% of cHL patients with ctDNA VAFs above our SCNA limit of detection (1%) and were genotyped significantly more frequently than in other non-PMBCL B-cell malignancies (42% vs 18%, p = 0.005) (Fig 1D). Coding SNVs in the most commonly mutated genes involved STAT6 (24%), SOCS1 (20%), GNA13 (20%), TNFAIP3 (18%), and B2M (16%) while noncoding SNVs in IGK and IGH were more abundant in cHL and DLBCL respectively (Fig 1E). EBV tumor cell presence has previously been shown to be prognostic in cHL (Keegan et al JCO 2005). Prior to therapy, EBV cfDNA constituted a significantly larger fraction of total cfDNA in patients confirmed by EBER ISH to have EBV+ cHL than in either EBER-negative cHL patients or healthy controls (p < 0.0001) (Fig 1F). Conclusions: Levels of ctDNA in cHL are higher than might be expected based on tumor purity, with pre-treatment levels similar to DLBCL and higher than FL. ctDNA allows for reliable noninvasive genotyping of cHL at diagnosis, encompassing coding and non-coding SNVs and additional clinically significant factors such as tumor EBV status and SCNAs. Additional cases are currently being profiled and expanded analyses of genotyping and monitoring will also be presented at the meeting. Disclosures Dührsen: Celgene: Honoraria, Research Funding; AbbVie: Consultancy, Honoraria; Roche: Honoraria, Research Funding; Janssen: Honoraria; Amgen: Research Funding; Gilead: Consultancy, Honoraria. Hüttmann:Roche: Other: Travel expenses; Celgene: Other: Travel expenses. Gaidano:Gilead: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Morphosys: Honoraria; Janssen: Consultancy, Honoraria; Amgen: Consultancy, Honoraria. Westin:Apotex: Membership on an entity's Board of Directors or advisory committees; Celgen: Membership on an entity's Board of Directors or advisory committees; Kite Pharma: Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees. Advani:Regeneron: Research Funding; Kyowa: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Infinity: Research Funding; Pharmacyclics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Millenium: Research Funding; Cell Medica: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Seattle Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board, Research Funding; Agensys: Research Funding; Forty Seven Inc.: Research Funding; Celgene: Research Funding; Janssen: Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Kura: Research Funding; Astra Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Gilead/Kite: Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Autolus: Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board, Research Funding; Celgene: Research Funding; Roche/Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board, Research Funding; Bayer: Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Merck: Research Funding.
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Tsvetkova, Valeriya S., Alexander S. Potapov, Elena L. Semikina, Andrey P. Fisenko, Maksim M. Lokhmatov, Andrey N. Surkov, Anton O. Anushenko, Elena A. Kopyltsova, Tatyana N. Budkina, and Svetlana S. Akulova. "Noninvasive assessment of ulcerative colitis activity in children." Russian Pediatric Journal 24, no. 1 (March 12, 2021): 12–19. http://dx.doi.org/10.46563/1560-9561-2021-24-1-12-19.
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Timely diagnosis and monitoring of ulcerative colitis (UC) in children is extremely relevant. In recent years, much attention has been paid to improving noninvasive UC diagnosis methods, which are available and convenient in the practice of a doctor. In this regard, we analyzed the significance of changes in noninvasive laboratory parameters of sick children with different clinical and endoscopic UC activity. Materials and methods. A prospective analysis of data of 80 patients diagnosed with UC at the age of 1 to 18 years with varying degrees of clinical and endoscopic activity of the disease was performed. Results. Significant changes in the studied laboratory parameters’ levels were revealed depending on the degree of clinical and endoscopic UC activity in children. The changes in fecal calprotectin content, levels of albumin, hemoglobin, and platelets were particularly substantial and informative in the blood of sick children when comparing remission with moderate and high clinical and endoscopic UC activity. A decrease in platelet counts was also found when UC activity increased. Conclusion. The studied laboratory parameters are informative noninvasive markers of UC activity in children. These indices can be used in the diagnosis of UC activity and monitoring of the course of the disease.
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Becker, G., K. Greiner, B. Kaune, J. Winkler, A. Brawanski, M. Warmuth-Metz, and U. Bogdahn. "Diagnosis and Monitoring of Subarachnoid Hemorrhage by Transcranial Color-Coded Real-Time Sonography." Neurosurgery 28, no. 6 (June 1, 1991): 814–20. http://dx.doi.org/10.1227/00006123-199106000-00005.
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Abstract Thirty-six patients with acute spontaneous subarachnoid hemorrhage (26 caused by rupture of an aneurysm) were examined by transcranial color-coded real-time sonography by using a 2.25-MHz ultrasound transducer. In 20 of these 26 patients (76%), the aneurysm could be identified by a characteristic abnormal blood flow pattern within the aneurysm in coronal and axial scanning planes by transcranial color-coded real-time sonography. Blood within the basal cisterns, on top of the tentorium, and within the ventricles and parenchyma was sonographically detected by increased echodensity in 75%. In addition, cerebrospinal fluid circulation disturbances and cerebral vasospasm were detected in two-dimensional B-mode images in 85% and 100%, respectively. In Doppler mode, intravascular blood flow velocity could be quantified. We conclude that transcranial color-coded real-time sonography, a new, noninvasive method for diagnosis and follow-up of patients with subarachnoid hemorrhage, allows detection of the primary vascular lesion and monitoring of complications.
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Qiao, Yue, Zhaohua Gao, Yong Liu, Yan Cheng, Mengxiao Yu, Lingling Zhao, Yixiang Duan, and Yu Liu. "Breath Ketone Testing: A New Biomarker for Diagnosis and Therapeutic Monitoring of Diabetic Ketosis." BioMed Research International 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/869186.
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Background. Acetone,β-hydroxybutyric acid, and acetoacetic acid are three types of ketone body that may be found in the breath, blood, and urine. Detecting altered concentrations of ketones in the breath, blood, and urine is crucial for the diagnosis and treatment of diabetic ketosis. The aim of this study was to evaluate the advantages of different detection methods for ketones, and to establish whether detection of the concentration of ketones in the breath is an effective and practical technique.Methods. We measured the concentrations of acetone in the breath using gas chromatography-mass spectrometry andβ-hydroxybutyrate in fingertip blood collected from 99 patients with diabetes assigned to groups 1 (−), 2 (±), 3 (+), 4 (++), or 5 (+++) according to urinary ketone concentrations.Results. There were strong relationships between fasting blood glucose, age, and diabetic ketosis. Exhaled acetone concentration significantly correlated with concentrations of fasting blood glucose, ketones in the blood and urine, LDL-C, creatinine, and blood urea nitrogen.Conclusions. Breath testing for ketones has a high sensitivity and specificity and appears to be a noninvasive, convenient, and repeatable method for the diagnosis and therapeutic monitoring of diabetic ketosis.
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Goldin, Michael M., Mogely Sh Khubutia, Anatoly K. Evseev, Mark M. Goldin, Alexey V. Pinchuk, Elza I. Pervakova, Yevgeny A. Tarabrin, and Peter J. Hall. "Noninvasive Diagnosis of Dysfunctions in Patients After Organ Transplantation by Monitoring the Redox Potential of Blood Serum." Transplantation 99, no. 6 (June 2015): 1288–92. http://dx.doi.org/10.1097/tp.0000000000000519.
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Doh, Il, Hyun Kyoon Lim, and Bongyoung Ahn. "Development of a simulator for the validation of noninvasive blood pressure-monitoring devices." Blood Pressure Monitoring 21, no. 3 (June 2016): 189–91. http://dx.doi.org/10.1097/mbp.0000000000000174.
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Arshi, Baback, William J. Mack, and Benjamin Emanuel. "Invasive and Noninvasive Multimodal Bedside Monitoring in Subarachnoid Hemorrhage: A Review of Techniques and Available Data." Neurology Research International 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/987934.
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Delayed-cerebral ischemia is a major cause of morbidity and mortality in the setting of aneurysmal subarachnoid hemorrhage. Despite extensive research efforts and a breadth of collective clinical experience, accurate diagnosis of vasospasm remains difficult, and effective treatment options are limited. Classically, diagnosis has focused on imaging assessment of the cerebral vasculature. Recently, invasive and noninvasive bedside techniques designed to characterize relevant hemodynamic and metabolic alterations have gained substantial attention. Such modalities include microdialysis, brain tissue oxygenation, jugular bulb oximetry, thermal diffusion cerebral blood flow, and near-infrared spectroscopy. This paper reviews these modalities and examines data pertinent to the diagnosis and management of cerebral vasospasm.
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Mazzu-Nascimento, Thiago, Ângela Merice de Oliveira Leal, Carlos Alberto Nogueira-de-Almeida, Lucimar Retto da Silva de Avó, Emanuel Carrilho, and Diego Furtado Silva. "Noninvasive Self-monitoring of Blood Glucose at Your Fingertips, Literally!: Smartphone-Based Photoplethysmography." International Journal of Nutrology 13, no. 02 (September 2020): 048–52. http://dx.doi.org/10.1055/s-0040-1716498.
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AbstractDiabetes is a chronic disease and one of the major public health problems worldwide. It is a multifactorial disease, caused by genetic factors and lifestyle habits. Brazil had ∼ 16.8 million individuals living with diabetes in 2019 and is expected to reach 26 million people by 2045. There are global increasing needs for the development of noninvasive diagnostic methods and use of mobile health, mainly in face of the pandemic caused by the coronavirus disease 2019 (COVID-19). For daily glycemic control, diabetic patients use a portable glucometer for glycemic self-monitoring and need to prick their fingertips three or more times a day, generating a huge discomfort throughout their lives. Our goal here is to present a review with very recent emerging studies in the field of noninvasive diagnosis and to emphasize that smartphone-based photoplethysmography (spPPG), powered by artificial intelligence, might be a trend to self-monitor blood glucose levels. In photoplethysmography, a light source travels through the tissue, interacts with the interstitium and with cells and molecules present in the blood. Reflection of light occurs as it passes through the biological tissues and a photodetector can capture these interactions. When using a smartphone, the built-in flashlight is a white light-emitting LED and the camera works as a photodetector. The higher the concentration of circulating glucose, the greater the absorbance and, consequently, the lesser the reflected light intensity will be. Due to these optical phenomena, the signal intensity captured will be inversely proportional to the blood glucose level. Furthermore, we highlight the microvascular changes in the progression of diabetes that can interfere in the signals captured by the photodetector using spPPG, due to the decrease of peripheral blood perfusion, which can be confused with high blood glucose levels. It is necessary to create strategies to filter or reduce the impact of these vascular changes in the blood glucose level analysis. Deep learning strategies can help the machine to solve these challenges, allowing an accurate blood glucose level and interstitial glucose prediction.
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Nardone, Olga Maria, Uday Nagesh Shivaji, Vittoria Ferruzza, Subrata Ghosh, and Marietta Iacucci. "Soluble Blood Markers of Mucosal Healing in Inflammatory Bowel Disease: The Future of Noninvasive Monitoring." Inflammatory Bowel Diseases 26, no. 6 (October 6, 2019): 961–69. http://dx.doi.org/10.1093/ibd/izz226.
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Abstract The traditional management of inflammatory bowel disease (IBD) based on symptom control is not considered valid anymore by most specialists in this field, and a new paradigm called “treat to target” has been introduced. This is based on the assessment of disease activity using objective measures. The identification of noninvasive biomarkers is crucial to diagnosis and monitor IBD because frequent endoscopic examinations are costly and uncomfortable for the patient. In this review, we focus on blood markers that may be able to assess mucosal healing (MH) in IBD and recent advances in this area. Introduction of commercial panel to predict MH opens the way for further developments so that colonoscopy or fecal markers may be avoided in some patients. This may also permit frequent monitoring for therapeutic response and achieve MH. It is a challenging area of research to identify a panel of biomarkers that may reflect inflammation and healing to serve as a surrogate of MH.
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Riley, Leonard E., Guoqing John Chen, and Heath E. Latham. "Comparison of noninvasive blood pressure monitoring with invasive arterial pressure monitoring in medical ICU patients with septic shock." Blood Pressure Monitoring 22, no. 4 (August 2017): 202–7. http://dx.doi.org/10.1097/mbp.0000000000000258.
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Rydosz, Artur. "Sensors for Enhanced Detection of Acetone as a Potential Tool for Noninvasive Diabetes Monitoring." Sensors 18, no. 7 (July 16, 2018): 2298. http://dx.doi.org/10.3390/s18072298.
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Measurement of blood-borne volatile organic compounds (VOCs) occurring in human exhaled breath as a result of metabolic changes or pathological disorders is a promising tool for noninvasive medical diagnosis, such as exhaled acetone measurements in terms of diabetes monitoring. The conventional methods for exhaled breath analysis are based on spectrometry techniques, however, the development of gas sensors has made them more and more attractive from a medical point of view. This review focuses on the latest achievements in gas sensors for exhaled acetone detection. Several different methods and techniques are presented and discussed as well.
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Sipkens, Laura M., Kaij Treskes, Karin Ariese–Beldman, Derk P. Veerman, and Christa Boer. "Application of Nexfin noninvasive beat-to-beat arterial blood pressure monitoring in autonomic function testing." Blood Pressure Monitoring 16, no. 5 (October 2011): 246–51. http://dx.doi.org/10.1097/mbp.0b013e32834b4431.
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Scherer, Florian, David M. Kurtz, Maximilian Diehn, and Ash A. Alizadeh. "High-throughput sequencing for noninvasive disease detection in hematologic malignancies." Blood 130, no. 4 (July 27, 2017): 440–52. http://dx.doi.org/10.1182/blood-2017-03-735639.
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Abstract Noninvasive monitoring of minimal residual disease (MRD) has led to significant advances in personalized management of patients with hematologic malignancies. Improved therapeutic options and prolonged survival have further increased the need for sensitive tumor assessment that can inform treatment decisions and patient outcomes. At diagnosis or relapse of most hematologic neoplasms, malignant cells are often easily accessible in the blood as circulating tumor cells (CTCs), making them ideal targets to noninvasively profile the molecular features of each patient. In other cancer types, CTCs are generally rare and noninvasive molecular detection relies on circulating tumor DNA (ctDNA) shed from tumor deposits into circulation. The ability to precisely detect and quantify CTCs and ctDNA could minimize invasive procedures and improve prediction of clinical outcomes. Technical advances in MRD detection methods in recent years have led to reduced costs and increased sensitivity, specificity, and applicability. Among currently available tests, high-throughput sequencing (HTS)–based approaches are increasingly attractive for noninvasive molecular testing. HTS-based methods can simultaneously identify multiple genetic markers with high sensitivity and specificity without individual optimization. In this review, we present an overview of techniques used for noninvasive molecular disease detection in selected myeloid and lymphoid neoplasms, with a focus on the current and future role of HTS-based assays.
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Indersen, Amitha. "Fetal Intrauterine Transfusion." World Journal of Anemia 1, no. 1 (2017): 27–29. http://dx.doi.org/10.5005/jp-journals-10065-0006.
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ABSTRACT Fetal anemia is a recognizable and treatable condition. It requires identification of the etiology to plan a comprehensive treatment strategy. Fetal blood transfusions help tide over crisis and avert fetal cardiovascular decompensation or deterioration due to the anemia. Based on the cause and the fetal condition, the timing and requirement for transfusion are determined. At present, noninvasive monitoring with fetal middle cerebral arterial Doppler peak systolic velocity is the standard for monitoring and diagnosis of fetal anemia. How to cite this article Indersen A. Fetal Intrauterine Transfusion. World J Anemia 2017;1(1):27-29.
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Wang, Beibei, Juan Du, Zhao Zhu, Zhihong Ma, Songlin Wang, and Zhaochen Shan. "Evaluation of Parotid Salivary Glucose Level for Clinical Diagnosis and Monitoring Type 2 Diabetes Mellitus Patients." BioMed Research International 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/2569707.
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Background. To investigate the relationships among blood glucose, mixed saliva glucose, and parotid glucose in type 2 diabetes patients and to evaluate the diagnostic and monitoring value of salivary gland glucose in patients with type 2 diabetes (type 2DM). Material and Methods. Thirty patients with type 2DM and 30 healthy age- and sex-matched individuals were included in this study. Glucose levels in unstimulated mixed saliva and in unstimulated parotid saliva were measured by the glucose oxidase peroxidase method. Results. The blood glucose and parotid salivary glucose levels in type 2DM patients were significantly higher than those in the controls (P<0.05). The blood glucose, parotid salivary glucose, and mixed salivary glucose were 7.46±1.44 mmol/L, 0.18±0.19 mmol/L, and 3.17×10-2±2.84×10-2 mmol/L, respectively, in the type 2DM group; the corresponding glucose levels in the control group were 5.56±0.71 mmol/L, 7.70×10-2±6.02×10-2 mmol/L, and 3.47×10-2±2.79×10-2 mmol/L. The parotid salivary and blood glucose levels in type 2DM patients were strongly correlated; the linear regression equation for blood glucose and parotid salivary glucose was Y=6.267X+6.360, with r=0.810. However, mixed salivary glucose levels were not significantly different in the type 2 diabetes group compared with the control group. Conclusion. Our results suggest that parotid salivary glucose has potential as a biomarker to monitor type 2DM and as a painless, noninvasive method for the management of type 2DM.
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Parker, Kelly, Olivia Simonson, Kristi Medalen, and Yeong Rhee. "Relationships Between Family History and Self-Reported Diabetes Status and Alzheimer's Disease Warning Signs." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 62. http://dx.doi.org/10.1093/cdn/nzaa040_062.
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Abstract Objectives To determine whether familial history is linked for Alzheimer's disease (AD) and diabetes, and examine if a relationship exists between years since diagnosis and understanding of diabetes management and blood glucose testing. Methods Adults aged fifty and older were asked to complete a survey that included family history of diabetes and AD. The survey asked respondents to self-identify diabetes status, their understanding of diabetes management, and the frequency of their blood sugar monitoring. Surveys were distributed in person and online via social media and email. Data were entered into SPSS 26, and Pearson correlations were run to determine whether a significant relationship was present between the variables of interest. Results There was not a significant relationship between the number of blood relatives with AD and the number of relatives with diabetes (r = 0.140, P = 0.226), but a weak between the total number of relatives with diabetes and self-reported diabetes status (r = 0.278, P = 0.003). While there was not a significant relationship between years since diabetes diagnosis and self-rated understanding of diabetes management (r = 0.197, P = 0.325), there was a strong relationship between years since diagnosis and total number of blood sugar tests taken per week (r = 0.565, P = 0.004). Conclusions The relationship between number of relatives with diabetes and having diabetes oneself is in line with previous research. Additionally, while diabetics monitor their blood sugar more closely as time goes by, Future efforts are needed to inform diabetics about best practices for blood glucose management. Funding Sources None.
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Fernández-Caramés, Tiago, and Paula Fraga-Lamas. "Design of a Fog Computing, Blockchain and IoT-Based Continuous Glucose Monitoring System for Crowdsourcing mHealth." Proceedings 4, no. 1 (November 14, 2018): 37. http://dx.doi.org/10.3390/ecsa-5-05757.
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Diabetes Mellitus, usually called only Diabetes, is a worldwide chronic metabolic disorder that is characterized by abnormal oscillations in blood sugar levels. Such levels should be monitored by diabetes patients, which traditionally have had to take blood samples by finger-pricking, at least between twice and four times a day. Finger-pricking has a number of drawbacks that can be tackled by Continuous Glucose Monitors (CGMs), which are able to determine blood sugar levels throughout the day and not only at specific time instants. In this paper, the design of an IoT CGM-based system is proposed, whose collected blood sugar sample values can be accessed remotely; thus being able to monitor patients, specifically dependent ones (e.g., children, elders, and pregnant women) and warn them in the case where a dangerous situation is detected. In order to create such a system, a fog computing system, based on distributed mobile smart phones, has been devised to collect data from the CGMs. Moreover, the use of a blockchain is proposed, to receive, validate, and store the collected data with the objective of avoiding untrusted sources and, thus, to provide a transparent and trustworthy data source of a population, which can vary in age, ethnicity, psychology, education, self-care, and/or geographic location, in a rapid, flexible, scalable, and low-cost way. These crowdsourced data can enable novel mHealth applications for diagnosis, patient monitoring, or even public health actions, which can help to advance in the control of the disease and raise global awareness on the increasing prevalence of diabetes.
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Mena, Luis J., Vanessa G. Félix, Rodolfo Ostos, Armando J. González, Rafael Martínez-Peláez, Jesus D. Melgarejo, and Gladys E. Maestre. "Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study." JMIR mHealth and uHealth 8, no. 7 (July 20, 2020): e18012. http://dx.doi.org/10.2196/18012.
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Background Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. Objective This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. Methods The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66% women) to test the usability and accuracy of the smartphone-based BP monitor. Results The employed artificial neural network model had good average accuracy (>90%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. Conclusions With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations.
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Stelljes, Matthias, Sven Hermann, Jörn Albring, Gabriele Köhler, Markus Löffler, Christiane Franzius, Christopher Poremba, et al. "Clinical molecular imaging in intestinal graft-versus-host disease: mapping of disease activity, prediction, and monitoring of treatment efficiency by positron emission tomography." Blood 111, no. 5 (March 1, 2008): 2909–18. http://dx.doi.org/10.1182/blood-2007-10-119164.
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Gastrointestinal graft-versus-host disease (GVHD) is a common and potentially life-threatening complication after allogeneic hematopoietic stem-cell transplantation (HSCT). Noninvasive tests for assessment of GVHD activity are desirable but lacking. In the present study, we were able to visualize intestinal GVHD-associated inflammation in an allogeneic murine transplantation model by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in vivo. A predominant localization of intestinal GVHD to the colon was verified by histology and fluorescence reflectance imaging of enhanced green fluorescent protein (EGFP)–expressing donor cells. Colonic infiltration by EGFP+ donor lymphocytes matched increased FDG uptake in PET examinations. These preclinical data were prospectively translated into 30 patients with suspected intestinal GVHD beyond 20 days after transplantation. A total of 14 of 17 patients with a diagnostic histology showed significant FDG uptake of the gut, again predominantly in the colon. No increased FDG uptake was detected in 13 patients without histologic evidence of intestinal GVHD. Our findings indicate that FDG-PET is a sensitive and specific noninvasive imaging technique to assess intestinal GVHD, map its localization, and predict and monitor treatment responsiveness. Novel targeted tracers for PET may provide new insights into the pathophysiology of GVHD and bear the potential to further improve GVHD diagnosis.
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Stabouli, Stella, Euthymia Vargiami, Olga Maliachova, Nikoleta Printza, John Dotis, Maria Kyriazi, Konstantinos O. Papazoglou, and Dimitrios Zafeiriou. "Arterial Stiffness in a Toddler with Neurofibromatosis Type 1 and Refractory Hypertension." Case Reports in Pediatrics 2018 (October 31, 2018): 1–4. http://dx.doi.org/10.1155/2018/5957987.
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Arterial hypertension is a common finding in patients with neurofibromatosis (NF) type 1. Renovascular hypertension due to renal artery stenosis or midaortic syndrome could be the underlying cause. We report the case of a 4-year-old girl with NF type 1 and midaortic syndrome whose changes in blood pressure and pulse wave velocity suggested the evolution of vasculopathy, diagnosis of renovascular hypertension, and provided insights of response to treatment. Hypertension persisted after percutaneous transluminal angioplasty in the abdominal aorta, requiring escalation of antihypertensive treatment, while arterial stiffness demonstrated a mild decrease. Regular assessment of blood pressure using ambulatory blood pressure monitoring and noninvasive assessment of arterial stiffness may enhance the medical care of patients with NF type 1.
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Nemirovsky, Daniel R., Puneet Gupta, Sophia Hu, Raymond Wong, and Avnesh S. Thakor. "Blood Oxygen Level-Dependent (BOLD) MRI in Glomerular Disease." Transplantology 2, no. 2 (April 2, 2021): 109–17. http://dx.doi.org/10.3390/transplantology2020011.
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Renal hypoxia has recently been implicated as a key contributor and indicator of various glomerular diseases. As such, monitoring changes in renal oxygenation in these disorders may provide an early diagnostic advantage that could prevent potential adverse outcomes. Blood oxygen level-dependent magnetic resonance imaging (BOLD MRI) is an emerging noninvasive technique for assessing renal oxygenation in glomerular disease. Although BOLD MRI has produced promising initial results for the use in certain renal pathologies, the use of BOLD imaging in glomerular diseases, including primary and secondary nephrotic and nephritic syndromes, is relatively unexplored. Early BOLD studies on primary nephrotic syndrome, nephrotic syndrome secondary to diabetes mellitus, and nephritic syndrome secondary to systemic lupus erythematosus have shown promising results to support its future clinical utility. In this review, we outline the advancements made in understanding the use of BOLD MRI for the assessment, diagnosis, and screening of these pathologies.
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Laucyte-Cibulskiene, Agne, and Marius Miglinas. "Clinical approach to noninvasive and invasive blood pressure monitoring in end-stage renal disease patients on dialysis." Blood Pressure Monitoring 19, no. 6 (December 2014): 370. http://dx.doi.org/10.1097/mbp.0000000000000070.
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Keum, Do Hee, Su-Kyoung Kim, Jahyun Koo, Geon-Hui Lee, Cheonhoo Jeon, Jee Won Mok, Beom Ho Mun, et al. "Wireless smart contact lens for diabetic diagnosis and therapy." Science Advances 6, no. 17 (April 2020): eaba3252. http://dx.doi.org/10.1126/sciadv.aba3252.
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A smart contact lens can be used as an excellent interface between the human body and an electronic device for wearable healthcare applications. Despite wide investigations of smart contact lenses for diagnostic applications, there has been no report on electrically controlled drug delivery in combination with real-time biometric analysis. Here, we developed smart contact lenses for both continuous glucose monitoring and treatment of diabetic retinopathy. The smart contact lens device, built on a biocompatible polymer, contains ultrathin, flexible electrical circuits and a microcontroller chip for real-time electrochemical biosensing, on-demand controlled drug delivery, wireless power management, and data communication. In diabetic rabbit models, we could measure tear glucose levels to be validated by the conventional invasive blood glucose tests and trigger drugs to be released from reservoirs for treating diabetic retinopathy. Together, we successfully demonstrated the feasibility of smart contact lenses for noninvasive and continuous diabetic diagnosis and diabetic retinopathy therapy.
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Alnaami, Ibrahim, Muzaffer Siddiqui, and Maher Saqqur. "The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound." Case Reports in Medicine 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/894913.
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Background. Vertebrobasilar insufficiency (VBI) is a hemodynamic posterior circulation transient ischemic attack (TIA) caused by intermittent vertebral artery occlusion that is induced by a head rotation or extension. VBI may result from large vessel atherosclerotic disease, dissection, cervical compressive lesions, and subclavian steal phenomenon. Diagnostic transcranial Doppler (TCD) of VBI disease and hemodynamic posterior circulation TCD monitoring in symptomatic positions might prove a useful tool in establishing the diagnosis.Patient and Material/Method. A 50-year-old Caucasian man presented with a one-year history of episodic positional vertigo and ataxic gait that were induced by a neck extension and resolved by an upright position or a neck flexion. Computed tomography angiogram (CTA) and TCD confirmed the presence of VBI where no blood flow was detected through posterior cerebral arteries in the symptomatic position (head extension position).Conclusion. TCD is a promising noninvasive technique that might have a role as a diagnostic test in VBI.
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Leve, Charlotte, Alex Hong, Sandrine Millasseau, Jona Joachim, Cyril Touchard, Joaquim Mateo, José Serrano, Alexandre Mebazaa, Etienne Gayat, and Fabrice Vallee. "Influence of noninvasive central blood pressure devices for afterload monitoring with aortic velocity-pressure Loop in anesthetized patients." Blood Pressure Monitoring 25, no. 4 (May 11, 2020): 184–94. http://dx.doi.org/10.1097/mbp.0000000000000445.
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Ahmed, Imran, Eulalia Balestrieri, and Francesco Lamonaca. "IoMT-based biomedical measurement systems for healthcare monitoring: a review." ACTA IMEKO 10, no. 2 (June 29, 2021): 174. http://dx.doi.org/10.21014/acta_imeko.v10i2.1080.
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<p class="Abstract"><span lang="EN-US">Biomedical measurement systems (BMS) have provided new solutions for healthcare monitoring and the diagnosis of various chronic diseases. With a growing demand for BMS in the field of medical applications, researchers are focusing on advancing these systems, including Internet of Medical Things (IoMT)-based BMS, with the aim of improving bioprocesses, healthcare systems and technologies for biomedical equipment. This paper presents an overview of recent activities towards the development of IoMT-based BMS for various healthcare applications. Different methods and approaches used in the development of these systems are presented and discussed, taking into account some metrological aspects related to the requirement for accuracy, reliability and calibration. The presented IoMT-based BMS are applied to healthcare applications concerning, in particular, heart, brain and blood sugar diseases as well as internal body sound and blood pressure measurements. Finally, the paper provides a discussion about the shortcomings and challenges that need to be addressed along with some possible directions for future research activities.</span></p>
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Sacks, David B., Mark Arnold, George L. Bakris, David E. Bruns, Andrea Rita Horvath, M. Sue Kirkman, Ake Lernmark, Boyd E. Metzger, and David M. Nathan. "Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus." Clinical Chemistry 57, no. 6 (June 1, 2011): e1-e47. http://dx.doi.org/10.1373/clinchem.2010.161596.
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BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A1c (Hb A1c) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
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Cher, Chae Yin, Zi Yi Lim, Daryl Tan, Hae Tha Mya, Wichean Mongkonsritragoon, Min-Han Tan, and Yukti Choudhury. "An ultrasensitive amplicon-based sequencing panel for noninvasive molecular testing of hematological malignancies using blood." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19511-e19511. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19511.
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e19511 Background: Hematological malignancies, especially acute myeloid leukemia, myeloproliferative neoplasms, and myelodysplastic syndromes (MDS), present with distinct genomic alterations relevant to prognosis. Bone marrow (BM) is the primary sample source for genetic testing, but is obtained by an invasive biopsy procedure which carries risk of infection. An alternative non-invasive sample type to profile disease-relevant genomic alterations at diagnosis and subsequently, is desired for clinical decision making. An ultrasensitive sequencing panel was applied to peripheral blood (PB) as an alternative to BM, to demonstrate its utility for disease profiling and monitoring. Methods: A total of 27 pairs of matched PB and BM samples were obtained from patients with hematological malignancies including leukemia (n = 21), lymphoma (n = 4), multiple myeloma (n = 1) and MDS (n = 1). The sequencing panel covers 45 genes commonly mutated in myeloid and lymphoid malignancies. The panel is based on amplicon-sequencing and includes error correction for variant detection with allele frequency (VAF) as low as 0.1%. Optimized bioinformatics pipeline and in-house sequencing noise removal was used for variant selection and clonal analysis. Results: Complete concordance was seen for mutations detected in 23 of 27 patient-matched BM and PB paired samples. The likely cause of discordance in the other 4 pairs is attributable to mutations with low VAF ( < 0.5%). Overall, 91% of detected variants were concordant between PB and BM with strong correlation of VAFs (R = 0.9617). Serial testing trends correlated with stable disease with limited changes in VAFs (n = 2), and successful treatment response with rapidly falling VAFs (n = 5). In particular, 2 patients with FLT3-ITD and BCR-ABL1, respectively, identified at diagnosis had dramatic decrease in VAFs with respective targeted treatment. Conclusions: We report the utility of an ultrasensitive sequencing assay in PB with excellent concordance of mutations with BM, suggesting PB is a reliable alternative source for testing. In serial samples, the assay demonstrated value in treatment selection and response evaluation.
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Gyurászová, Marianna, Radana Gurecká, Janka Bábíčková, and Ľubomíra Tóthová. "Oxidative Stress in the Pathophysiology of Kidney Disease: Implications for Noninvasive Monitoring and Identification of Biomarkers." Oxidative Medicine and Cellular Longevity 2020 (January 28, 2020): 1–11. http://dx.doi.org/10.1155/2020/5478708.
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Kidney disease represents a serious global health problem. One of the main concerns is its late diagnosis, only feasible in a progressed disease state. The lack of a clinical manifestation in the early stages and the fact that the commonly measured parameters of renal function are markedly reduced only during advanced stages of the disease are the main cause. Changes at the molecular level of the kidney tissue occur even before nitrogenous substances, such as creatinine and urea, start to accumulate in the blood. Renal proximal tubules contain a large number of mitochondria and are critical for the energy-demanding process of reabsorption of water and solutes. Mitochondria are the largest producers of oxygen radicals, which, in turn, increase the susceptibility of kidneys to oxidative stress-induced damage. Free radicals and prooxidants produced during acute or chronic kidney injury may further aggravate the course of the disease and play a role in the pathogenesis of subsequent complications. Prevention might be the solution in CKD, but patients are often reluctant to undergo preventive examinations. Noninvasive markers and the possibility to obtain samples at home might help to increase compliance. This review will provide an overview of the possible uses of markers of oxidative status in noninvasive biofluids in patients with renal disease.
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Di, Cao, Yu Jiang, Mao Li, Xu Juan, and Caigang Xu. "Circulating Exosomal microRNA Signature As a Noninvasive Biomarker for Diagnosis of Diffuse Large B-Cell Lymphoma." Blood 132, Supplement 1 (November 29, 2018): 5406. http://dx.doi.org/10.1182/blood-2018-99-115940.
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Abstract Background Diffuse large B-cell lymphoma (DLBCL) is a lymphoproliferative disorder originating in B-lymphocytes, and accounting for about 30% of all non-Hodgkin Lymphoma (NHL) . Since most patients show a lack of apparent symptoms in early stage, they are diagnosed at a late stage and therefore lose the best therapeutic opportunity. An increasing number of studies have indicated indicates that exosomal miRNAs extracted from peripheral blood might be usable as noninvasive biomarkers for the early diagnosis of tumors, therapy response monitoring, and prognosis. Although circulating exosomal miRNA has been studied in many malignant cancers, there are currently no reports examining their use in terms of DLBCL diagnosis. In light of previous research findings, we hypothesized that exosomal miRNA from peripheral blood can work as a candidate for DLBCL diagnosis. Materials and methods Blood samples were collected from 99 newly diagnosed DLBCL patients, 21 natural killer/T-cell lymphoma (NKTCL ) patients and 94 healthy people. NKTCL is another common NHL type which with high incidence in Asia and was chosen as case-control in our study. In the initial of the study, exosomes were extracted and identified by nanoparticle tracking analysis (NTA), Transmission Electron Microscope (TEM) and western blot. Next, Exiqon microarray was performed in 10 DLBCL patients and 5 HCs to determine serum exosomal miRNA profiles, which we called the screening stage. Identified miRNAs were confirmed through testing stage (24 DLBCL patients and 24 HCs) using quantitative reverse transcription polymerase chain reaction (qRT-PCR). According to the criterion that Ct(miRNA)<34,Ct(negative control)>40,fold change >1.5 and two-tailed P<0.05, miRNAs tested in testing stage were further chosen and confirmed through validation stages (65 DLBCL patients and 65 HCs) using qRT-PCR. Next, we carried out ROC (Receiver operating characteristic) curves to assess the performance of identified miRNAs in diagnosis DLBCL. Finally, we test the specificity and sensitivity of the identified miRNA by 21 NKTCL patients. Results Through the three-stage process, five miRNAs, including three high expression (miR-379-5p, miR-135a-3p ,miR-4476) and two low expression (miR-483-3p, miR-451a) were identified between DLBCLs and HCs. the AUCs (area under the curve , AUC)of miR-379-5p, miR-135a-3p, miR-4476, miR-483-3p, and miR-451a in testing stage were 0.757 (95% CI 0.612-0.869), 0.712 (95% CI 0.563-0.833), 0.673 (95%CI 0.522-0.801), 0.674 (95% CI 0.524-0.803), and 0.696 (95% CI 0.544-0.818), respectively, and the AUC of the panel was 0.951 (95% CI0.847-0.993). the AUCs of miR-379-5p, miR-135a-3p, miR-4476, miR-483-3p, and miR-451a in validation stage were 0.731(95% CI 0.646-0.805), 0.616(95% CI 0.527-0.700), 0.660 (95%CI 0.572-0.741), 0.620 (95% CI 0.530-0.703), and 0.648 (95% CI 0.560-0.730), respectively, and the AUC of panel was 0.841 (95% CI 0.767-0.900). When combined the testing and validation stage, revealing AUCs for miR-379-5p, miR-135a-3p, miR-4476, miR-483-3p, and miR-451a were 0.734 (95% CI 0.663-0.798), 0.639 (95% CI 0.564-0.710), 0.661 (95%CI 0.586-0.730), 0.637 (95% CI 0.561-0.707), and 0.663 (95% CI 0.588-0.732),respectively; the AUC of the combined panel was 0.824 (95% CI 0.760-0.877) .The panel also showed good resolving power in distinguishing DLBCL patients from NKTCL patients with the AUC of 0.848(95%CI 0.756-0.902).Moreover,miR-451a showed fairish performance in distinguishing NKTCL and HC, as well as discriminate late stage (IIB-IV) from early stage DLBCL, A tendency for the level of miR-135a-3p to declined gradually with increases in IPI was noted. Conclusions The panel composed by subsets of circulating exosomal miRNAs, including hsa-miR-379-5p, hsa-miR-135a-3p, hsa-miR-4476, hsa-miR-483-3p and hsa-miR-451a,can be used as noninvasive biomarkers for DLBCL diagnosis. Circulating exosomal hsa-miR-379-5p,hsa-miR-135a-3p,hsa-miR-4476 and hsa-miR-451a formed a panel which can be well distinguished DLBCL and NKTCL. Circulating exosomal hsa-miR-451a can be used as noninvasive biomarkers for NKTCL diagnosis. Certain circulating exosoaml miRNAs were related to clinical characteristics, specifically, circulating exosomal hsa-miR-451a was related to stage, while hsa-miR-135a-3p was related to IPI. Disclosures No relevant conflicts of interest to declare.
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Evsyukova, Inna I. "Сerebral oxymetry in neonatology." Pediatrician (St. Petersburg) 8, no. 4 (August 15, 2017): 86–91. http://dx.doi.org/10.17816/ped8486-91.
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The frequency of disturbance the functional development of newborn brain after intrauterine and birth asphyxia determines the necessity the finding objective methods of timely diagnosis the alteration of brain oxygenation for the target therapy. During last years the special attention of investigators was attracted to use for this purpose in newborns the noninvasive, informative and portable method near-infrared spectroscopy (NIRS). Cerebral oxymetry successfully used for estimation brain circulation of the blood and blood volume in the brain vessels with combination constant monitoring blood pressure. This review outlines the basic principles, advantages NIRS technology in clinical studies brain oxygenation in healthy full term and premature newborns and also after asphyxia, vacuum extraction and cesarean section. Monitoring brain oxygenation in newborns which received cooling after heavy asphyxia permits during first 10 hours after birth to prognosis unfavorable outcome or fix the further strategy of treatment cerebral ischemia. Presented clinical use this method for treatment premature newborns with respiratory distress and circulatory insufficiency. It may help to determine the optimal target oxygen saturation. It is alsow useful monitoring during intensive therapy of extremely preterm neonates, due to the risk of impaired cerebral blood flow auto regulation in these patients. Indicated the perspectives of cerebral oxymetry in neonato logy for new diagnostic, treatment and prophylactic perinatal CNS damage.
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Padmasini, N., R. Umamaheswari, R. Kalpana, and Mohamed Yacin Sikkandar. "Comparative Study of Iris and Retinal Images for Early Detection of Diabetic Mellitus." Journal of Medical Imaging and Health Informatics 10, no. 2 (February 1, 2020): 316–25. http://dx.doi.org/10.1166/jmihi.2020.2973.
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The recent increase in the number of diabetic cases due to genetic reasons or sedentary lifestyle, necessitates urgent need for an effective glucose monitoring system. Certainly, periodic glucose level monitoring in the blood will prevent from entering chronic diabetic condition and a noninvasive monitoring tool leads to a simple and automated diagnosis procedure. In this present work, an iridology-based diagnosis of diabetes has been discussed and is compared with a standard retinal imaging modality. Two subject groups, one group of 30 subjects without diabetes, the other group with 20 subjects of controlled diabetes with less than two years duration and 25 subjects with more than two years of uncontrolled diabetes were evaluated. Iris images are acquired using an iriscope and subsequently compared it with that of retinal spectral domain optical coherence tomography (SDOCT) images of the same subjects. The segmentation of the pancreas region in the iris images and the retinal layers in the SDOCT retinal images are performed automatically to predict Diabetic Mellitus (DM). The selected features of the segmented region are given as input to k-Nearest Neighbor, Support Vector Machine and Random Forest classifiers for discriminating diabetic and non-diabetic normal cases. The results showed that iris images are able to reveal the diabetic condition of the subjects even before their retina could reveal the same. However, elaborate extensive studies have to be carried out in order to validate iridology as a best noninvasive tool for detection of diabetes at the early stage itself.
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O'Shannessy, Daniel J., Darren W. Davis, Kenna Anderes, and Elizabeth B. Somers. "Isolation of Circulating Tumor Cells from Multiple Epithelial Cancers with ApoStream® for Detecting (or Monitoring) the Expression of Folate Receptor Alpha." Biomarker Insights 11 (January 2016): BMI.S35075. http://dx.doi.org/10.4137/bmi.s35075.
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This study describes our efforts to further the field of noninvasive diagnostics, specifically in the area of liquid biopsies in oncology. We employed laser scanning cytometry using highly selective antibodies to interrogate circulating tumor cells (CTCs) that were isolated using ApoStream® technology to identify folate receptor alpha (FRα)–positive cells. We demonstrate that FRα+ CTCs can be isolated from patients with metastatic cancers, including NSCLC adenocarcinoma, breast cancer, and ovarian cancer, whereas squamous cell lung cancer and normal healthy controls were devoid of FRα+ CTCs. We believe that the developed methodology will have applications in both the diagnosis and the monitoring of FRα-expressing cancers. Folate receptor alpha (FRα) expression may have utility as a potential diagnostic and therapeutic target in solid tumors. As tissue samples are not always available for patient screening, this study evaluated a noninvasive assay in CTCs from blood samples to detect FRα expression. The presence of FRα+ CTCs enriched using ApoStream® and detected using laser capture cytometry was evaluated in blood samples from cancer patients [NSCLC adenocarcinoma ( n = 14), breast cancer ( n = 20), ovarian cancer ( n = 6), and squamous lung cancer patients ( n = 6)] and healthy subjects ( n = 20). The data demonstrated that FRα+ CTCs were detected in blood from NSCLC adenocarcinoma, breast, and ovarian cancer patients, whereas squamous cell lung cancer patients and normal healthy controls lacked FRα+ CTCs as previously known. We demonstrate that CTCs captured using ApoStream® can be used to detect FRα+ CTCs and may have clinical utility as a real-time liquid biopsy for assessing FRα levels in cancer patients.
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Emaminejad, Sam, Wei Gao, Eric Wu, Zoe A. Davies, Hnin Yin Yin Nyein, Samyuktha Challa, Sean P. Ryan, et al. "Autonomous sweat extraction and analysis applied to cystic fibrosis and glucose monitoring using a fully integrated wearable platform." Proceedings of the National Academy of Sciences 114, no. 18 (April 17, 2017): 4625–30. http://dx.doi.org/10.1073/pnas.1701740114.
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Perspiration-based wearable biosensors facilitate continuous monitoring of individuals’ health states with real-time and molecular-level insight. The inherent inaccessibility of sweat in sedentary individuals in large volume (≥10 µL) for on-demand and in situ analysis has limited our ability to capitalize on this noninvasive and rich source of information. A wearable and miniaturized iontophoresis interface is an excellent solution to overcome this barrier. The iontophoresis process involves delivery of stimulating agonists to the sweat glands with the aid of an electrical current. The challenge remains in devising an iontophoresis interface that can extract sufficient amount of sweat for robust sensing, without electrode corrosion and burning/causing discomfort in subjects. Here, we overcame this challenge through realizing an electrochemically enhanced iontophoresis interface, integrated in a wearable sweat analysis platform. This interface can be programmed to induce sweat with various secretion profiles for real-time analysis, a capability which can be exploited to advance our knowledge of the sweat gland physiology and the secretion process. To demonstrate the clinical value of our platform, human subject studies were performed in the context of the cystic fibrosis diagnosis and preliminary investigation of the blood/sweat glucose correlation. With our platform, we detected the elevated sweat electrolyte content of cystic fibrosis patients compared with that of healthy control subjects. Furthermore, our results indicate that oral glucose consumption in the fasting state is followed by increased glucose levels in both sweat and blood. Our solution opens the possibility for a broad range of noninvasive diagnostic and general population health monitoring applications.
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Chan, KC Allen, Chunming Ding, Ageliki Gerovassili, Sze W. Yeung, Rossa WK Chiu, Tse N. Leung, Tze K. Lau, et al. "Hypermethylated RASSF1A in Maternal Plasma: A Universal Fetal DNA Marker that Improves the Reliability of Noninvasive Prenatal Diagnosis." Clinical Chemistry 52, no. 12 (December 1, 2006): 2211–18. http://dx.doi.org/10.1373/clinchem.2006.074997.
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Abstract Background: We recently demonstrated that the promoter of the RASSF1A gene is hypermethylated in the placenta and hypomethylated in maternal blood cells. This methylation pattern allows the use of methylation-sensitive restriction enzyme digestion for detecting the placental-derived hypermethylated RASSF1A sequences in maternal plasma. Methods: We performed real-time PCR after methylation-sensitive restriction enzyme digestion to detect placental-derived RASSF1A sequences in the plasma of 28 1st-trimester and 43 3rd-trimester pregnant women. We used maternal plasma to perform prenatal fetal rhesus D (RhD) blood group typing for 54 early-gestation RhD-negative women, with hypermethylated RASSF1A as the positive control for fetal DNA detection. Results: Hypermethylated RASSF1A sequences were detectable in the plasma of all 71 pregnant women. The genotype of plasma RASSF1A after enzyme digestion was identical to the fetal genotype in each case, thus confirming its fetal origin. Nineteen of the 54 pregnant women undergoing prenatal fetal RhD genotyping showed undetectable RHD sequences in their plasma DNA samples. The fetal DNA control, RASSF1A, was not detectable in 4 of the 19 women. Subsequent chorionic villus sample analysis revealed that 2 of these 4 women with negative RHD and RASSF1A signals were in fact carrying RhD-positive fetuses. Conclusions: Hypermethylated RASSF1A is a universal marker for fetal DNA and is readily detectable in maternal plasma. When applied to prenatal RhD genotyping, this marker allows the detection of false-negative results caused by low fetal DNA concentrations in maternal plasma. This new marker can also be applied to many other prenatal diagnostic and monitoring scenarios.
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Roy, Dhruvajyoti, David Taggart, Lianghong Zheng, Dan Liu, Gen Li, Mingzhen Li, Kang Zhang, and Richard A. Van Etten. "Epigenetic biomarkers for noninvasive detection of colorectal cancer." Journal of Clinical Oncology 37, no. 8_suppl (March 10, 2019): 45. http://dx.doi.org/10.1200/jco.2019.37.8_suppl.45.
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45 Background: Aberrant DNA hypermethylation is known to be a major mechanism for inactivation of cancer-associated genes, including tumor suppressor genes, in colorectal cancer (CRC) and in other human cancers. Cancer-specific DNA methylation patterns of cell-free DNA (cfDNA) isolated from blood samples is a non-invasive method to obtain representative epigenetic information from solid tumors. In the present study, we identified and validated colorectal cancer-specific methylation markers for diagnosis of the disease with high sensitivity and specificity. We also compared the relative amount of DNA methylation at these target sites in relation to colorectal cancer stage. Methods: For marker validation, a total of 154 samples drawn from 68 subjects diagnosed with colorectal cancer (Stage I to IV), 42 healthy donors, 14 subjects with benign colorectal diseases, and 30 subjects diagnosed with other cancer types (breast, liver and lung cancer: 10 cases each) were obtained for a randomized, blinded study. Cell-free DNA was then extracted from the samples, bisulfite converted, and DNA methylation was quantified by using the IvyGene Platform. Results: By quantifying DNA methylation at the target sites, colorectal cancer samples were differentiated from samples drawn from healthy subjects or subjects with benign disease with an overall sensitivity of 93% (95% CI: 86-99) and specificity of 100% (95% CI: 85-100). All stages (I to IV) of colorectal cancer were identified with sensitivities ranging from 67% to 100%. None of the 30 samples drawn from subjects diagnosed with breast, liver or lung cancers were incorrectly identified as a colorectal cancer by the assay, for a calculated analytical specificity of 100%. Conclusions: These results demonstrate the high diagnostic potential of cfDNA methylation markers isolated from blood for the detection of colorectal cancer. Taken together, these findings establish the utility of methylation biomarkers for the detection of colorectal cancers as early as Stage I. In addition, a quantitative analysis of cfDNA provides an opportunity for non-invasive detection and monitoring of disease.
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Hossain, Shifat, Chowdhury Azimul Haque, and Ki-Doo Kim. "Quantitative Analysis of Different Multi-Wavelength PPG Devices and Methods for Noninvasive In-Vivo Estimation of Glycated Hemoglobin." Applied Sciences 11, no. 15 (July 26, 2021): 6867. http://dx.doi.org/10.3390/app11156867.
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Diabetes is a serious disease affecting the insulin cycle in the human body. Thus, monitoring blood glucose levels and the diagnosis of diabetes in the early stages is very important. Noninvasive in vivo diabetes-diagnosis procedures are very new and require thorough studies to be error-resistant and user-friendly. In this study, we compare two noninvasive procedures (two-wavelength- and three-wavelength-based methods) to estimate glycated hemoglobin (HbA1c) levels in different scenarios and evaluate them with error level calculations. The three-wavelength method, which has more model parameters, results in a more accurate estimation of HbA1c even when the blood oxygenation (SpO2) values change. The HbA1c-estimation error range of the two-wavelength model, due to change in SpO2, is found to be from −1.306% to 0.047%. On the other hand, the HbA1c estimation error for the three-wavelength model is found to be in the magnitude of 10−14% and independent of SpO2. The approximation of SpO2 from the two-wavelength model produces a lower error for the molar concentration based technique (−4% to −1.9% at 70% to 100% of reference SpO2) as compared to the molar absorption coefficient based technique. Additionally, the two-wavelength model is less susceptible to sensor noise levels (max SD of %error, 0.142%), as compared to the three-wavelength model (max SD of %error, 0.317%). Despite having a higher susceptibility to sensor noise, the three-wavelength model can estimate HbA1c values more accurately; this is because it takes the major components of blood into account and thus becomes a more realistic model.
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Sacks, David B., Mark Arnold, George L. Bakris, David E. Bruns, Andrea Rita Horvath, M. Sue Kirkman, Ake Lernmark, Boyd E. Metzger, and David M. Nathan. "Executive Summary: Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus." Clinical Chemistry 57, no. 6 (June 1, 2011): 793–98. http://dx.doi.org/10.1373/clinchem.2011.163634.
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BACKGROUND Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory analysis in patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. A draft of the guidelines was posted on the Internet, and the document was modified in response to comments. The guidelines were reviewed by the joint Evidence-Based Laboratory Medicine Committee of the AACC and the National Academy of Clinical Biochemistry and were accepted after revisions by the Professional Practice Committee and subsequent approval by the Executive Committee of the American Diabetes Association. CONTENT In addition to the long-standing criteria based on measurement of venous plasma glucose, diabetes can be diagnosed by demonstrating increased hemoglobin A1c (Hb A1c) concentrations in the blood. Monitoring of glycemic control is performed by the patients measuring their own plasma or blood glucose with meters and by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Sacks, David B., David E. Bruns, David E. Goldstein, Noel K. Maclaren, Jay M. McDonald, and Marian Parrott. "Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus." Clinical Chemistry 48, no. 3 (March 1, 2002): 436–72. http://dx.doi.org/10.1093/clinchem/48.3.436.
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Abstract Background: Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. Approach: An expert committee drafted evidence-based recommendations for the use of laboratory analysis in patients with diabetes. An external panel of experts reviewed a draft of the guidelines, which were modified in response to the reviewers’ suggestions. A revised draft was posted on the Internet and was presented at the AACC Annual Meeting in July, 2000. The recommendations were modified again in response to oral and written comments. The guidelines were reviewed by the Professional Practice Committee of the American Diabetes Association. Content: Measurement of plasma glucose remains the sole diagnostic criterion for diabetes. Monitoring of glycemic control is performed by the patients, who measure their own plasma or blood glucose with meters, and by laboratory analysis of glycated hemoglobin. The potential roles of noninvasive glucose monitoring, genetic testing, autoantibodies, microalbumin, proinsulin, C-peptide, and other analytes are addressed. Summary: The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are of minimal clinical value at the present time, and measurement of them is not recommended.
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Naeli, Parisa, Fatemeh Yousefi, Younes Ghasemi, Amir Savardashtaki, and Hamed Mirzaei. "The Role of MicroRNAs in Lung Cancer: Implications for Diagnosis and Therapy." Current Molecular Medicine 20, no. 2 (January 14, 2020): 90–101. http://dx.doi.org/10.2174/1566524019666191001113511.
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: Lung cancer is the first cause of cancer death in the world due to its high prevalence, aggressiveness, late diagnosis, lack of effective treatment and poor prognosis. It also shows high rate of recurrence, metastasis and drug resistance. All these problems highlight the urgent needs for developing new strategies using noninvasive biomarkers for early detection, metastasis and recurrence of disease. MicroRNAs (miRNAs) are a class of small noncoding RNAs that regulate gene expression post-transcriptionally. These molecules found to be abnormally expressed in increasing number of human disease conditions including cancer. miRNAs could be detected in body fluids such as blood, serum, urine and sputum, which leads us towards the idea of using them as non-invasive biomarker for cancer detection and monitoring cancer treatment and recurrence. miRNAs are found to be deregulated in lung cancer initiation and progression and could regulate lung cancer cell proliferation and invasion. In this review, we summarized recent progress and discoveries in microRNAs regulatory role in lung cancer initiation and progression. In addition, the role of microRNAs in EGFR signaling pathway regulation is discussed briefly.
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Zahed, Karim, Farzan Sasangohar, Ranjana Mehta, Madhav Erraguntla, and Khalid Qaraqe. "Diabetes Management Experience and the State of Hypoglycemia: National Online Survey Study." JMIR Diabetes 5, no. 2 (June 17, 2020): e17890. http://dx.doi.org/10.2196/17890.
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Background Hypoglycemia, or low blood sugar levels, in people with diabetes can be a serious life-threatening condition, and serious outcomes can be avoided if low levels of blood sugar are proactively detected. Although technologies exist to detect the onset of hypoglycemia, they are invasive or costly or exhibit a high incidence of false alarms. Tremors are commonly reported symptoms of hypoglycemia and may be used to detect hypoglycemic events, yet their onset is not well researched or understood. Objective This study aimed to understand diabetic patients’ perceptions of hypoglycemic tremors, as well as their user experiences with technology to manage diabetes, and expectations from a self-management tool to ultimately inform the design of a noninvasive and cost-effective technology that detects tremors associated with hypoglycemia. Methods A cross-sectional internet panel survey was administered to adult patients with type 1 diabetes using the Qualtrics platform in May 2019. The questions focused on 3 main constructs: (1) perceived experiences of hypoglycemia, (2) experiences and expectations about a diabetes management device and mobile app, and (3) beliefs and attitudes regarding intention to use a diabetes management device. The analysis in this paper focuses on the first two constructs. Nonparametric tests were used to analyze the Likert scale data, with a Mann-Whitney U test, Kruskal-Wallis test, and Games-Howell post hoc test as applicable, for subgroup comparisons to highlight differences in perceived frequency, severity, and noticeability of hypoglycemic tremors across age, gender, years living with diabetes, and physical activity. Results Data from 212 respondents (129 [60.8%] females) revealed statistically significant differences in perceived noticeability of tremors by gender, whereby males noticed their tremors more (P<.001), and age, with the older population reporting lower noticeability than the young and middle age groups (P<.001). Individuals living longer with diabetes noticed their tremors significantly less than those with diabetes for ≤1 year but not in terms of frequency or severity. Additionally, the majority of our participants (150/212, 70.7%) reported experience with diabetes-monitoring devices. Conclusions Our findings support the need for cost-efficient and noninvasive continuous monitoring technologies. Although hypoglycemic tremors were perceived to occur frequently, such tremors were not found to be severe compared with other symptoms such as sweating, which was the highest rated symptom in our study. Using a combination of tremor and galvanic skin response sensors may show promise in detecting the onset of hypoglycemic events.
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Ma, Zhiyao, Marissa Williams, Yuen Yee Cheng, and Wai K. Leung. "Roles of Methylated DNA Biomarkers in Patients with Colorectal Cancer." Disease Markers 2019 (March 3, 2019): 1–8. http://dx.doi.org/10.1155/2019/2673543.
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Colorectal cancer (CRC) is a leading cancer globally; therefore, early diagnosis and surveillance of this cancer are of paramount importance. Current methods of CRC diagnosis rely heavily on endoscopy or radiological imaging. Noninvasive tests including serum detection of the carcinoembryonic antigen (CEA) and faecal occult blood testing (FOBT) are associated with low sensitivity and specificity, especially at early stages. DNA methylation biomarkers have recently been found to have higher accuracy in CRC detection and enhanced prediction of prognosis and chemotherapy response. The most widely studied biomarker in CRC is methylated septin 9 (SEPT9), which is the only FDA-approved methylation-based biomarker for CRC. Apart from SEPT9, other methylated biomarkers including tachykinin-1 (TAC1), somatostatin (SST), and runt-related transcription factor 3 (RUNX3) have been shown to effectively detect CRC in a multitude of sample types. This review will discuss the performances of various methylated biomarkers used for CRC diagnosis and monitoring, when used alone or in combination.
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Yang, Lin, Chao Zhang, Wenbo Liu, Hang Wang, Junying Xia, Benyuan Liu, Xuetao Shi, Xiuzhen Dong, Feng Fu, and Meng Dai. "Real-Time Detection of Hemothorax and Monitoring its Progression in a Piglet Model by Electrical Impedance Tomography: A Feasibility Study." BioMed Research International 2020 (February 28, 2020): 1–13. http://dx.doi.org/10.1155/2020/1357160.
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Hemothorax is a serious medical condition that can be life-threatening if left untreated. Early diagnosis and timely treatment are of great importance to produce favorable outcome. Although currently available diagnostic techniques, e.g., chest radiography, ultrasonography, and CT, can accurately detect hemothorax, delayed hemothorax cannot be identified early because these examinations are often performed on patients until noticeable symptoms manifest. Therefore, for early detection of delayed hemothorax, real-time monitoring by means of a portable and noninvasive imaging technique is needed. In this study, we employed electrical impedance tomography (EIT) to detect the onset of hemothorax in real time on eight piglet hemothorax models. The models were established by injection of 60 ml fresh autologous blood into the pleural cavity, and the subsequent development of hemothorax was monitored continuously. The results showed that EIT was able to sensitively detect hemothorax as small as 10 ml in volume, as well as its location. Also, the development of hemothorax over a range of 10 ml up to 60 ml was well monitored in real time, with a favorable linear relationship between the impedance change in EIT images and the volume of blood injected. These findings demonstrated that EIT has a unique potential for early diagnosis and continuous monitoring of hemothorax in clinical practice, providing medical staff valuable information for prompt identification and treatment of delayed hemothorax.
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Reshetnik, Alexander, Christopher Gohlisch, Michael Abou-Dakn, Markus Tölle, Walter Zidek, and Markus van der Giet. "Validation of noninvasive oscillometric blood pressure 2020 up pressure upper arm blood pressure monitoring technology according to the European Society of Hypertension International Protocol revision 2010." Blood Pressure Monitoring 24, no. 2 (April 2019): 99–101. http://dx.doi.org/10.1097/mbp.0000000000000370.
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