Neopterin, Interleukin-6, Procalcitonin, C-reactive protein and PET-CT staining as markers in infected total knee prosthesis, a retrospective analysis

WOS: 000482218200018PubMed ID: 30423671Diagnosis in prosthetic joint infections is challenging as symptoms are variable, and currently most of the diagnostic tests are non-specific. Normal inflammatory reactions after orthopedic prosthetic surgery may generate false positives, as these tests have high sensitivity, but low specificity. Thus, specific tests, as alpha defensin, are needed to distinguish bacterial infections from reactions to surgical trauma. The aim of this study was to determine the sensitivity and specificity of several diagnostic tools for detecting bacterial infection in prostheses. Between April 2010 and December 2012, we analyzed white blood cell count, erythrocyte sedimentation rate, C-reactive protein, neopterin, interleukin-6, and procalcitonin in 45 patients with prosthetic infection confirmed by positive cultures of joint aspirate and deep tissue biopsy. In addition, these patients underwent PET-CT imaging, in accordance with infection protocols in place at our clinic. The suitability and diagnostic power of these tests were assessed by using Shapiro-Wilk test, Mann-Whitney U test, and ROC curve analysis, and by comparing to 40 age- and gender-matched volunteers who underwent unilateral total knee prosthesis with normal serum indices and without known diseases. Significant differences were observed between infected patients and control volunteers (p < 0.05) for all parameters examined. Highest sensitivity (99%) and specificity (98%) were achieved using a combination of interleukin-6 and C-reactive protein. However, PET-CT imaging had diagnostic accuracy of 93.3%. A combination of interleukin-6 and C-reactive protein also enables accurate diagnosis. PET-CT may be an important imaging modality for detecting prosthesis infection. But, these markers were found neither sensitive nor specific in the diagnosis of periprosthetic infection as alpha defensin

Avaliação de entesopatia em pacientes com fibromialgia por meio do novo índice ultrassonográfico de entesite

OBJETIVO: Determinar a frequência de entesopatia na fibromialgia (FM) utilizando um método de ultrassonografia (US) recém-desenvolvido, o escore Madrid Sonography Enthesitis Index (MASEI). MÉTODOS: Este estudo foi realizado em 38 pacientes com FM consecutivos e 48 controles saudáveis pareados para idade e sexo. Seis sítios de ênteses (tuberosidade do olécrano, polos superior e inferior da patela, tuberosidade tibial, polos superior e inferior do calcâneo) nos dois membros inferiores foram avaliados. Todos os achados da US foram identificados de acordo com o escore MASEI. Os escores de pacientes e controles foram comparados usando-se o teste t de Student e o teste U de Mann-Whitney. A validade foi analisada pela curva receiver operating characteristic (ROC). Valores de P < 0,05 foram considerados significativos. RESULTADOS: O escore total de entesite foi 7,39 ± 4,99 (média ± DP) para os pacientes com FM e 3,7 ± 3,22 para os controles saudáveis (P < 0,001). A curva ROC estabeleceu um escore de US &gt; 3,5 no grupo de FM como o melhor ponto de corte para diferenciar casos de controles. Não houve correlação estatisticamente significativa entre o escore MASEI e a duração da FM, e a localização dos pontos dolorosos. CONCLUSÕES: Erros no diagnóstico de FM são prejudiciais aos pacientes e à comunidade, e a presença de entesopatia entre pacientes com FM é crescente. Sua detecção por meio do escore MASEI pode ser útil para discriminar pacientes com FM, cujos sintomas e sinais são mal definidos, para evitar equívoco de tratamento

Diagnostic and prognostic values of preoperative serum levels of YKL-40, HE-4 and DKK-3 in endometrial cancer

WOS: 000367869100013PubMed ID: 26607777Objective. The objective of this study is to determine the efficiency of YKL-40, HE-4 and DKK-3 levels in early diagnosis of patients with endometrial cancer and in the pre-operative estimation of the prognostic parameters such as stage, grade and the extension of the disease. Methods. In this prospective study, 50 patients diagnosed with endometrial cancer and 50 women as a control group, who applied to Dokuz Eylul University and Ege University Faculties of Medicine, Obstetrics and Gynecology Clinics between May 2011-May 2012 were included. CA125, HE-4, YKL-40 and DKK-3 serum levels were measured by ELISA and compared between two groups. The relation between serum levels and histopathological results, extension of disease and prognostic factors were analyzed. Results. Preoperative serum CA125, HE-4 and YKL-40 levels were significantly higher in endometrial cancer group (p < 0.001). Serum HE-4 levels were significantly higher in advanced stages (p = 0.004). When we examined early stage patients, YKL-40 levels were significantly higher in non-endometrioid histology compared with endometrioid adenocarcinoma (p = 0.022). We also examined the relation between the markers and prognostic factors. Different from other markers, HE-4 levels were significantly higher in endometrial cancer patients who had lymphovascular space involvement, lower uterine segment involvement, endocervical stromal involvement, and deep myometrial invasion. Conclusion. YKL-40 and HE-4 were significantly higher in patients with endometrial cancer. HE-4 seems to be superior to YKL-40 in discriminating early and advanced stages. Additionally, HE4 is significantly correlated with prognostic factors. HE-4 and YKL-40 may be successful in early determination of endometrial cancer and in detection of high risk subsets before surgery

CA125, YKL-40, HE-4 and Mesothelin: a new serum biomarker combination in discrimination of benign and malign epithelial ovarian tumor

Objective: Cancer Antigen 125 (CA125) and Risk of Ovarian Malignancy Algorithm (ROMA) score are used for classification of ovarian masses (benign/malign) in preoperative stage. However, their discrimination capacity are considered insufficient, and greatly effected by histological subtype and menopausal status. This study aimed to investigate diagnostic performance of Human epididymis protein 4 (HE4), Y (tyrosine), K (lysine), and L (leucine)-40 (YKL-40), Mesothelin, Rho GDP dissociation inhibitor beta (LyGDI), CA125 or their combinations in discrimination of benign/malign ovarian diseases in preoperative stage