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Percentage of culture confirmation and melting curve analysis reveals false-positive Campylobacter detection in a molecular syndromic panel
No full textSurveillance of enteric organisms can identify outbreaks and support control measures. The BIOFIRE FilmArray Gastrointestinal Panel (FilmArray GI) is the most common culture-independent diagnostic test (CIDT) used in Wisconsin to diagnose enteric infections. State clinical laboratories have raised concerns about inaccurate Campylobacter detection with the FilmArray GI. The Wisconsin State Laboratory of Hygiene (WSLH) evaluated the percentage of positivity and culture confirmations stratified by CIDT for Campylobacter, Salmonella, and STEC from 2018 to 2024. We further analyzed the transport time of Campylobacter specimens and the melt curves of specimens that tested positive by FilmArray GI. Campylobacter, Salmonella, and STEC specimens tested on the FilmArray GI had increases in percentage of positivity compared to those tested on other CIDTs. Salmonella and STEC specimens positive by FilmArray GI, compared to other CIDTs, had no significant culture confirmation differences. However, Campylobacter specimens positive by FilmArray GI had significantly lower culture confirmations than positive specimens from other CIDTs (62% vs. 78%; P \u3c 0.05). Campylobacter culture confirmations were lower for FilmArray GI specimens, compared to other CIDTs, regardless of how many days the specimen spent in transport in 2023. Additionally, we found atypical melt curves among specimens positive by FilmArray GI with cultures that did not grow Campylobacter. Taken together, the higher percentage of positivity, the lower percentage of culture confirmation, and the atypical melt curves suggest that the FilmArray GI might yield false-positive Campylobacter results. These findings emphasize the importance of public health surveillance to identify potential issues with commercially available diagnostic tests.IMPORTANCEEnteric pathogens cause ~9.4 million illnesses annually in the United States. Clinical laboratories rely on culture-independent diagnostic testing platforms (CIDTs) for rapid and accurate diagnosis of enteric pathogens. Campylobacter, Salmonella, and Shiga-toxin-producing Escherichia coli (STEC) are three of the most identified enteric bacterial infections in Wisconsin. The BioFire FilmArray Gastrointestinal panel (FilmArray GI) is currently the most common CIDT used by Wisconsin clinical laboratories to diagnose Campylobacter, Salmonella, and STEC infections. However, the FilmArray GI has had notable issues and recalls in the past. Here, we used public health surveillance data to assess platform performance for these organisms. We analyzed percent positivity and culture confirmations based on testing platforms. Through our analysis, we identified potential false-positive Campylobacter results from the FilmArray GI, which were associated with atypical melt curve profiles on the BioFire platform. Public health surveillance can help identify potential issues with diagnostic platforms
Illinois Masonic Medical Center House Staff, 1994-95
No full textIllinois Masonic Medical Center, Chicago, IL: House staff roster with photos of IMMC residents in 1994-1995 for the specialties of anesthesiology, cardiology, dentistry, emergency medicine, internal medicine, obstetrics and gynecology, pathology, podiatry, radiology, general surgery, transitional year, and family practice.https://institutionalrepository.aah.org/alldocuments/2166/thumbnail.jp
Circulating tumor DNA mutational landscape and dynamics after progression on a CDK4/6 inhibitor in the PACE phase II trial for metastatic HR-positive/HER2-negative breast cancer
No full textBackground: Genomic determinants of response and resistance to endocrine therapy (ET) and cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) beyond progression in hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer are not well characterized. We analyzed serial circulating tumor DNA from the PACE trial in which patients who progressed on ET and CDK4/6i were randomized to fulvestrant, fulvestrant plus palbociclib, or fulvestrant, palbociclib, and avelumab.
Materials and methods: Plasma samples from 200 of 220 PACE participants were collected for circulating tumor DNA analysis using the Guardant360 assay. Samples included baseline (n = 200), cycle 3, day 1 (C3D1; n = 124), and end of treatment (n = 137). The fulvestrant and fulvestrant + palbociclib arms were combined given similar clinical outcomes. The log-rank test was used to test associations between genomic alterations and progression-free survival (PFS).
Results: The most common baseline genomic alterations beyond progression on CDK4/6i plus ET, were mutations in ESR1 (54.0%), TP53 (35.5%), PIK3CA (34.0%), GATA3 (18.5%), and RB1 (10.0%). Among 150 patients treated with fulvestrant or fulvestrant + palbociclib, baseline mutations in TP53, PIK3CA, RB1, and the Y537S ESR1 mutation, were associated with shorter PFS. Mutations within the PI3K and cell cycle pathways were associated with significantly decreased PFS. We also observed increases in the allelic fractions of the ESR1, PIK3CA, and TP53 mutations at progression.
Conclusions: Several mutations within genes and biological pathways are associated with CDK4/6i resistance beyond progression. Additional studies are needed to optimize treatment after resistance to CDK4/6i using genomic biomarkers
Safety of cardioversion without anticoagulation in patients\u27 status post left atrial appendage occlusion: A systematic review and meta-analysis
No full textBackground: Direct current cardioversion (DCCV) is commonly used for rhythm control in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) provides stroke prevention in patients with contraindications to oral anticoagulation (OAC), but the safety of DCCV without periprocedural anticoagulation in this group remains uncertain.
Objective: To evaluate the safety of performing DCCV without systemic anticoagulation in patients with prior LAAO.
Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, ScienceDirect, and the Cochrane Library were searched (January 2010-April 2025). Studies comparing outcomes of patients undergoing DCCV after LAAO, with versus without subsequent anticoagulation, were included. Primary outcomes were thromboembolic events and clinically significant bleeding. Odds ratios (ORs) were calculated using random-effects modeling, with heterogeneity assessed via I2 statistic.
Results: Five observational studies (1697 DCCV procedures; 965 patients receiving post-DCCV anticoagulation) met inclusion criteria. Thromboembolic events occurred in 3.8 % of patients without OAC versus 1.6 % with OAC, with no statistically significant difference (OR 0.48; 95 % CI 0.16-1.43; p = 0.19; I2 = 17 %). Clinically significant bleeding occurred in 4.1 % without OAC and 4.0 % with OAC, also without significant difference (OR 1.22; 95 % CI 0.75-2.00; p = 0.42; I2 = 0 %). Pre-DCCV imaging protocols varied widely among studies.
Conclusions: In selected patients post-LAAO with no device-related thrombus or significant peri-device leak, DCCV without subsequent anticoagulation demonstrated low thromboembolic and bleeding risks. These findings, derived from limited observational data, require confirmation by randomized controlled trials
CAR T therapy in B-cell NHL: A transformative advance, however several clinical and financial challenges remain
No full textExtensive calcification of the ventricular septum in gene-positive (MYBPC3) nonobstructive hypertrophic cardiomyopathy
No full textImages: We present multimodality imaging of ventricular septal calcification.
Case summary: A 38-year-old man with asymptomatic gene-positive hypertrophic cardiomyopathy was found to have extensive dystrophic calcification of the ventricular septum. We hypothesized that the extensive ventricular septal calcification would represent an area of severe myocardial fibrosis, resulting in calcification secondary to postsurgical (septal myectomy) changes.
Take-home message: Calcification of the ventricular septum is a rare finding, not previously described following septal myectomy, that should prompt a comprehensive evaluation and follow-up with multimodality imaging and testing
