Expert review of molecular diagnostics
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Expert Rev. Mol. Diagn. · Jul 2008
ReviewEarly diagnosis of acute kidney injury in critically ill patients.
Acute kidney injury (AKI) is a common and serious problem in critically ill patients. Tests currently used to detect AKI (i.e., serum creatinine, serum urea and various urinary indices) often result in delayed detection of injury--becoming abnormal at 48-72 h after the initial insult. ⋯ The development of novel serum and urinary biomarkers capable of detecting AKI at an earlier phase of illness is therefore vital. This article will review the pitfalls of current conventional testing in kidney injury and discuss the emergence of novel biomarkers with the potential to revolutionize the field of critical care nephrology.
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Expert Rev. Mol. Diagn. · May 2008
ReviewDiagnosis and prognosis of acute pulmonary embolism: focus on serum troponins.
Pulmonary embolism is a common disease associated with high mortality. Death due to pulmonary embolism occurs mainly before hospital admission or in the first hours of the hospital stay. Prompt diagnosis and prognostic stratification and more intensive treatment in patients with estimated high risk for adverse outcomes have the potential to reduce mortality due to pulmonary embolism. ⋯ Serum troponin is rapidly available in the emergency room, and has a critical role in the management of patients with acute coronary syndromes. The role of serum troponin in patients with pulmonary embolism has been explored recently: it seems to be marginal in diagnosis while it can significantly contribute to prognostic stratification. Elevated serum levels of troponins are associated with right ventricular overload and adverse in-hospital outcomes in patients with pulmonary embolism and normal blood pressure.
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Expert Rev. Mol. Diagn. · May 2007
ReviewMultiple biomarkers in molecular oncology. II. Molecular diagnostics applications in breast cancer management.
In recent years, the application of genomic and proteomic technologies to the problem of breast cancer prognosis and the prediction of therapy response have begun to yield encouraging results. Independent studies employing transcriptional profiling of primary breast cancer specimens using DNA microarrays have identified gene expression profiles that correlate with clinical outcome in primary breast biopsy specimens. Recent advances in microarray technology have demonstrated reproducibility, making clinical applications more achievable. ⋯ Furthermore, protein-based immunohistochemistry methods have progressed from using gene clusters and gene expression profiling to smaller subsets of expressed proteins to predict prognosis in early-stage breast cancer. Beyond prognostic applications, DNA microarray-based transcriptional profiling has demonstrated the ability to predict response to chemotherapy in early-stage breast cancer patients. In this review, recent advances in the use of multiple markers for prognosis of disease recurrence in early-stage breast cancer and the prediction of therapy response will be discussed.
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Expert Rev. Mol. Diagn. · Sep 2006
ReviewRapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis.
Group A beta-hemolytic streptococcus (GABHS) is the most common bacterial cause of acute pharyngitis. Clinical criteria alone are not reliable enough to diagnose GABHS pharyngitis. Microbiological-testing is required for correct diagnosis. ⋯ Most of the rapid antigen detection tests that are currently in use have an excellent specificity of greater than 95% and a sensitivity of greater than or equal to 90%. Owing to the high specificity of the rapid antigen detection tests, a positive rapid antigen detection test is accepted as adequate for the diagnosis of GABHS pharyngitis. Conversely, confirmation of a negative antigen detection test with a throat culture result is necessary, unless the physician has ascertained in his/her practice that the sensitivity of the rapid antigen test used is comparable with that of a throat culture.