ABSTRACT
AIM: Faecal markers, such as the faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (FCP), have been increasingly used to exclude colorectal cancer (CRC) and colonic inflammation. However, in those with lower gastrointestinal symptoms there are considerable numbers who have cancer but have a negative FIT test (i.e. false negative), which has impeded its use in clinical practice. We undertook a study of diagnostic accuracy CRC using FIT, FCP and urinary volatile organic compounds (VOCs) in patients with lower gastrointestinal symptoms. METHOD: One thousand and sixteen symptomatic patients with suspected CRC referred by family physicians were recruited prospectively in accordance with national referring protocol. A total of 562 patients who completed colonic investigations, in addition to providing stool for FIT and FCP as well as urine samples for urinary VOC measurements, were included in the final outcome measures. RESULTS: The sensitivity and specificity for CRC using FIT was 0.80 [95% confidence interval (CI) 0.66-0.93] and 0.93 (CI 0.91-0.95), respectively. For urinary VOCs, the sensitivity and specificity for CRC was 0.63 (CI 0.46-0.79) and 0.63 (CI 0.59-0.67), respectively. However, for those who were FIT-negative CRC (i.e. false negatives), the addition of urinary VOCs resulted in a sensitivity of 0.97 (CI 0.90-1.0) and specificity of 0.72 (CI 0.68-0.76). CONCLUSIONS: When applied to the FIT-negative group, urinary VOCs improve CRC detection (sensitivity rises from 0.80 to 0.97), thus showing promise as a second-stage test to complement FIT in the detection of CRC.
Subject(s)
Colorectal Neoplasms/diagnosis , Early Detection of Cancer/methods , Feces/chemistry , Leukocyte L1 Antigen Complex/analysis , Volatile Organic Compounds/urine , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/analysis , Colon , Female , Hemoglobins/analysis , Humans , Male , Middle Aged , Occult Blood , Prospective Studies , Risk Assessment , Sensitivity and Specificity , Single-Blind Method , Symptom Assessment/methodsABSTRACT
The current diagnostic challenge with diagnosing hepatic encephalopathy (HE) is identifying those with minimal HE as opposed to the more clinically apparent covert/overt HE. Rifaximin, is an effective therapy but earlier identification and treatment of HE could prevent liver disease progression and hospitalization. Our pilot study aimed to analyse breath samples of patients with different HE grades, and controls, using a portable electronic (e) nose. 42 patients were enrolled; 22 with HE and 20 controls. Bedside breath samples were captured and analysed using an uvFAIMS machine (portable e-nose). West Haven criteria applied and MELD scores calculated. We classify HE patients from controls with a sensitivity and specificity of 0.88 (0.73-0.95) and 0.68 (0.51-0.81) respectively, AUROC 0.84 (0.75-0.93). Minimal HE was distinguishable from covert/overt HE with sensitivity of 0.79 and specificity of 0.5, AUROC 0.71 (0.57-0.84). This pilot study has highlighted the potential of breathomics to identify VOCs signatures in HE patients for diagnostic purposes. Importantly this was performed utilizing a non-invasive, portable bedside device and holds potential for future early HE diagnosis.
Subject(s)
Breath Tests/methods , Electronic Nose , Hepatic Encephalopathy/diagnosis , Volatile Organic Compounds/analysis , Adult , Aged , Aged, 80 and over , Breath Tests/instrumentation , Disease Progression , Exhalation , Female , Humans , Male , Middle Aged , Pilot Projects , Sensitivity and Specificity , Severity of Illness Index , Young AdultABSTRACT
There is an ever increasing need to develop new tools to aid in the diagnosis and monitoring of human diseases. Such tools will ultimately reduce the cost of healthcare by identifying disease states more quickly and cheaply than current practices. One method showing promise is the analysis of gas-phase biomarkers from human breath, urine, sweat and stool that reflect bodily metabolism. Analysis of these volatiles by GC MS requires specialised infra-structure and staff, making it unsuitable for a clinical setting. Point of care sensor based technologies such as eNoses often suffer from stability and sensitivity issues. Field-Asymmetric Ion Mobility Spectrometry (FAIMS) has potential to fulfil this clinical need. In this paper we review the medical need, the technology, sampling methods and medical evidence thus far. We conclude with reflecting on future developmental steps necessary to bring the device into medical practice.
Subject(s)
Diagnostic Techniques and Procedures , Gases/chemistry , Mass Spectrometry/methods , Diagnostic Techniques and Procedures/instrumentation , Humans , Mass Spectrometry/instrumentationABSTRACT
In two experiments, children were taught a word and then given reminders of that word while reading unfamiliar analogous words. Reminders of the pronunciation of taught words facilitated reading of rime analogous words (e.g. beak-peak) over head analogous words (e.g. beak-bean) in Experiment 1, and onset analogous words (e.g. stilt-stem), over medial analogous words (e.g. stilt-milk) in Experiment 2. Importantly, however, privileged improvement for rime and onset analogous words was not evident in the absence of these concurrent prompts. The findings suggest that the analogy model developed by Goswami (1993) may have limited applicability in naturalistic settings.
