DNA nanotechnology holds substantial promise for future biomedical engineering and the development of novel therapies and diagnostic assays. The subnanometer‐level addressability of DNA ...nanostructures allows for their precise and tailored modification with numerous chemical and biological entities, which makes them fit to serve as accurate diagnostic tools and multifunctional carriers for targeted drug delivery. The absolute control over shape, size, and function enables the fabrication of tailored and dynamic devices, such as DNA nanorobots that can execute programmed tasks and react to various external stimuli. Even though several studies have demonstrated the successful operation of various biomedical DNA nanostructures both in vitro and in vivo, major obstacles remain on the path to real‐world applications of DNA‐based nanomedicine. Here, we summarize the current status of the field and the main implementations of biomedical DNA nanostructures. In particular, we focus on open challenges and untackled issues and discuss possible solutions.
Although DNA nanotechnology has spawned a broad variety of biomedical nanostructures over the last decade, these DNA nanostructures often suffer from limited stability and considerable immunogenicity. This Review introduces various biomedical applications of DNA nanostructures, describes the challenges imposed on the DNA nanostructures by the physiological environment, and discusses possible solutions to these challenges.
Diagnostic errors receive less attention than medical error though correct diagnosis remains fundamental to a patient seeking health care. Committee by the Institution of Medicine (IOM) of the ...National Academics of Sciences, Engineering, and Medicine identifies five purposes for measuring diagnostic errors.
•A lollipop swab is a simple option for COVID-19 diagnostics.•4 studies show the positives and negatives of lollipop swabs for COVID diagnostics.•Lollipop swabs performed well in patients with acute ...COVID-19 infection.
Common biologic samples used to diagnose COVID-19 include nasopharyngeal, nasal, or oropharyngeal swabs, and salivary samples. The performance characteristics of a sucked “lollipop” swab to detect SARS-CoV-2 virus is assessed in four small sub-studies.
In each sub-study, a flocked swab was sucked for 20 s and submitted for PCR detection of SARS-CoV-2 virus.
Across all studies, 52 of 69 (75.4%) COVID-19 positive participants had positive “lollipop” swabs. Twelve of the 17 COVID-19 positive participants with negative “lollipop” swabs had known corresponding cycle threshold values of >37 from their nasal/nasopharyngeal swabs, an indication of low viral load at time of sampling. In a paired samples sub-study, the sensitivity and specificity of the “lollipop” swabs were 100% and 98%.
“Lollipop” swabs performed satisfactorily especially in individuals with acute infection of COVID-19. “Lollipop” swabs are a simple method of sample collection for detecting SARS-CoV-2 virus and warrants additional consideration.
Whether it's to proactively monitor health, diagnose a condition, or assess how well a particular treatment is working, we all undergo a variety of medical tests throughout our lives. While these ...tests provide valuable information for doctors and patients, they can sometimes carry significant risks, provide ambiguous or incorrect results, or raise more questions than they answer. Contrary to what some may think, medical testing isn't a simple "yes or no" science carried out by computers in a lab-it is a dynamic process that relies heavily on human detective work and interpretation. Medical Tests in Context: Innovations and Insights highlights more than 125 tests performed across a wide range of medical specialties. Each entry in this encyclopedia follows a standardized format that provides readers with information about how, when, and why the test is conducted; the preparation and risks; how results are determined and where errors might occur; and its history. A collection of case studies offers real-world examples of the successes-and shortcomings-of medical testing.
Summary
Due to the lack of diagnostics in primary health care, over 75 % of osteoporotic patients are not diagnosed. A new ultrasound method for primary health care is proposed. Results suggest ...applicability of ultrasound method for osteoporosis diagnostics at primary health care.
Introduction
We lack effective screening and diagnostics of osteoporosis at primary health care. In this study, a new ultrasound (US) method is proposed for osteoporosis diagnostics.
Methods
A total of 572 Caucasian women (age 20 to 91 years) were examined using pulse-echo US measurements in the tibia and radius. This method provides an estimate of bone mineral density (BMD), i.e. density index (DI). Areal BMD measurements at the femoral neck (BMD
neck
) and total hip (BMD
total
) were determined by using axial dual-energy X-ray absorptiometry (DXA) for women older than 50 years of age (
n
= 445, age = 68.8 ± 8.5 years). The osteoporosis thresholds for the DI were determined according to the International Society for Clinical Densitometry (ISCD). Finally, the FRAX questionnaire was completed by 425 participants.
Results
Osteoporosis was diagnosed in individuals with a T-score −2.5 or less in the total hip or femoral neck (
n
= 75). By using the ISCD approach for the DI, only 28.7 % of the subjects were found to require an additional DXA measurement. Our results suggest that combination of US measurement and FRAX in osteoporosis management pathways would decrease the number of DXA measurements to 16 % and the same treatment decisions would be reached at 85.4 % sensitivity and 78.5 % specificity levels.
Conclusions
The present results demonstrate a significant correlation between the ultrasound and DXA measurements at the proximal femur. The thresholds presented here with the application to current osteoporosis management pathways show promise for the technique to significantly decrease the amount of DXA referrals and increase diagnostic coverage; however, these results need to be confirmed in future studies.
Bloodstream infections are associated with considerable morbidity and health care costs. Molecular rapid diagnostic tests (mRDTs) are a promising complement to conventional laboratory methods for the ...diagnosis of bloodstream infections and may reduce the time to effective therapy among patients with bloodstream infections. The concurrent implementation of antimicrobial stewardship programs (ASPs) may reinforce these benefits. The aim of this study was to evaluate the cost-effectivenesses of competing strategies for the diagnosis of bloodstream infection alone or combined with an ASP. To this effect, we constructed a decision-analytic model comparing 12 strategies for the diagnosis of bloodstream infection. The main arms compared the use of mRDT and conventional laboratory methods with or without an ASP. The baseline strategy used as the standard was the use of conventional laboratory methods without an ASP, and our decision-analytic model assessed the cost-effectivenesses of 5 principal strategies: mRDT (with and without an ASP), mRDT with an ASP, mRDT without an ASP, conventional laboratory methods with an ASP, and conventional laboratory methods without an ASP. Furthermore, based on the availability of data in the literature, we assessed the cost-effectivenesses of 7 mRDT subcategories, as follows: PCR with an ASP, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis with an ASP, peptide nucleic acid fluorescent
hybridization (PNA-FISH) with an ASP, a blood culture nanotechnology microarray system for Gram-negative bacteria (BC-GP) with an ASP, a blood culture nanotechnology microarray system for Gram-positive bacteria (BC-GN) with an ASP, PCR without an ASP, and PNA-FISH without an ASP. Our patient population consisted of adult inpatients in U.S. hospitals with suspected bloodstream infection. The time horizon of the model was the projected life expectancy of the patients. In a base-case analysis, cost-effectiveness was determined by calculating the numbers of bloodstream infection deaths averted, the numbers of quality-adjusted life years gained, and incremental cost-effectiveness ratios (ICERs). In a probabilistic analysis, uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. In the base-case analysis, MALDI-TOF analysis with an ASP was the most cost-effective strategy, resulting in savings of $29,205 per quality-adjusted life year and preventing 1 death per 14 patients with suspected bloodstream infection tested compared to conventional laboratory methods without an ASP (ICER, -$29,205/quality-adjusted life year). BC-GN with an ASP (ICER, -$23,587/quality-adjusted life year), PCR with an ASP (ICER, -$19,833/quality-adjusted life year), and PCR without an ASP (ICER, -$21,039/quality-adjusted life year) were other cost-effective options. In the probabilistic analysis, mRDT was dominant and cost-effective in 85.1% of simulations. Importantly, mRDT with an ASP had an 80.0% chance of being cost-effective, while mRDT without an ASP had only a 41.1% chance. In conclusion, our findings suggest that mRDTs are cost-effective for the diagnosis of patients with suspected bloodstream infection and can reduce health care expenditures. Notably, the combination of mRDT and an ASP can result in substantial health care savings.
The increased incidence and the significant health burden associated with carcinoma of the prostate have led to substantial changes in its diagnosis over the past century. Despite technological ...advancements, the management of prostate cancer has become progressively more complex and controversial for both early and late-stage disease. The limitations and potential harms associated with the use of prostate-specific antigen (PSA) as a diagnostic marker have stimulated significant investigation of numerous novel biomarkers that demonstrate varying capacities to detect prostate cancer and can decrease unnecessary biopsies. However, only a few of these markers have been approved for specific clinical settings while the others have not been adequately validated for use. This review systematically and critically assesses ongoing issues and emerging challenges in the current state of prostate cancer diagnostic tools and the need for disruptive next generation tools based on analysis of combinations of these biomarkers to enhance predictive accuracy which will benefit clinical diagnostics and patient welfare.
Accurate, rapid, and multiplexed nucleic acid detection is of great value for applications in biomedicine and agriculture. Here, we demonstrated a one‐step Clustered Regularly Interspaced Short ...Palindromic Repeats (CRISPR) diagnostic method for the digital and multiplexed detection of both single‐stranded (ss) and double‐stranded (ds) DNA on a handheld smartphone device. ssDNA targets exhibited faster reaction kinetics of this single‐step CRISPR–Cas12a assay than dsDNA counterparts. Under optimized conditions, picomolar levels of ssDNA targets can be detected in 96‐well plates by using a benchtop plate reader. The detection sensitivity can be further improved to 5 fM when running the reaction in a microwell‐based digital assay chip. Multiplexed detection of hepatitis B virus and human papillomavirus DNA markers was demonstrated on the smartphone‐based platform. Finally, the one‐step CRISPR–Cas12a assay performed robustly in human serum samples with a recovery rate of ssDNA detection between 96% and 105.6%, suggesting a high potential for clinical diagnostic applications in point‐of‐care settings.
The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to ...correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). This article describes the development of the CAPS for DSM-5 (CAPS-5) and presents the results of an initial psychometric evaluation of CAPS-5 scores in 2 samples of military veterans (Ns = 165 and 207). CAPS-5 diagnosis demonstrated strong interrater reliability (к = .78 to 1.00, depending on the scoring rule) and test-retest reliability (к = .83), as well as strong correspondence with a diagnosis based on the CAPS for DSM-IV (CAPS-IV; к = .84 when optimally calibrated). CAPS-5 total severity score demonstrated high internal consistency (α = .88) and interrater reliability (ICC = .91) and good test-retest reliability (ICC = .78). It also demonstrated good convergent validity with total severity score on the CAPS-IV (r = .83) and PTSD Checklist for DSM-5 (r = .66) and good discriminant validity with measures of anxiety, depression, somatization, functional impairment, psychopathy, and alcohol abuse (rs = .02 to .54). Overall, these results indicate that the CAPS-5 is a psychometrically sound measure of DSM-5 PTSD diagnosis and symptom severity. Importantly, the CAPS-5 strongly corresponds with the CAPS-IV, which suggests that backward compatibility with the CAPS-IV was maintained and that the CAPS-5 provides continuity in evidence-based assessment of PTSD in the transition from DSM-IV to DSM-5 criteria.
Public Significance Statement
This study evaluated the DSM-5 version of the Clinician-Administered PTSD Scale (CAPS-5), a widely used structured interview for posttraumatic stress disorder, in 2 samples of military veterans. Results indicated that the CAPS-5 is psychometrically sound and corresponds closely with the previous DSM-IV version of the CAPS.