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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAlong with a futuristic view, this article presents a technical and historical review of current diagnostic methods for infectious diseases. Topics focus on new testing methods, including nucleic acid sequencing, polymerase chain reaction, and mass spectrometry, and the effects of this technology on healthcare outcomes.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEmerging Therapies\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFeatured Meeting - Specialty page\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELaboratory Techniques\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAlong with a futuristic view, Franklin R. Cockerill, MD, Mayo Clinic, Rochester, Minnesota, USA, presented a technical and historical review of current diagnostic methods for infectious diseases. His presentation focused on new testing methods, including nucleic acid sequencing, polymerase chain reaction (PCR), and mass spectrometry, and the effects of this technology on healthcare outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDr. Cockerill discussed important turning points in diagnostic testing in the last 50 years. At the top of his list were technological advancements for detection and quantification of HIV such as an immunoassay for saliva testing and flow cytometry for detecting and quantitating CD4 cells, the main target of HIV. Flow cytometry allows simultaneous multiparametric analysis of the physical and\/or chemical characteristics of up to thousands of particles per second. Breakthroughs in PCR and sequencing enable the quantification of HIV and the detection of HIV resistance. PCR can amplify a small amount of template DNA (or RNA) into large quantities in a few hours.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EReal-time PCR was number 2 on the list. Instead of being able to detect RNA and DNA at the end point, real time allows this detection while it is occurring. It offers the advantages of having reduced labor requirements (complete automation is now possible) and a high throughput, as well as being inexpensive, sensitive and specific, and fast (minutes instead of days). There is a decreased potential for contamination while allowing for qualitative, quantitative, and mutation analyses. It has recently been used for anthrax identification.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ENumber 3 was real-time PCR\/microarrays, which can be used to identify possible methicillin-resistant \u003Cem\u003EStaphylococcus aureus\u003C\/em\u003E (MRSA) and acute viral epidemics such as SARS.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EMass spectrometry, number 4 on the list, is an analytical technique used to determine masses of particles, and the elemental composition of a sample or molecule, and for elucidating the chemical structures of molecules such as peptides and other chemical compounds. The matrix-assisted laser desorption\/ionization-time of flight (MALDI-TOF) is a protein mass spectrometry that can be used for the identification of microorganisms such as bacteria or fungi (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Species diagnoses by this procedure are much faster, more accurate, and cheaper than other procedures based on immunological or biochemical tests.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/10\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Mass Spectrometry.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1589086368\u0022 data-figure-caption=\u0022Mass Spectrometry.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/10\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/10\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/10\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12890\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EMass Spectrometry.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced courtesy of R. Patel, MD, Mayo Clinic, with permission from F.R. Cockerill, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003ENucleic acid sequencing was number 5. It is being used for detection of HIV resistance mutations, and bacterial and fungal identification. The next-generation genomic sequencing devices will allow for massive parallel sequencing. Their use will include the detection of microbiomes, German Shiga (produces \u003Cem\u003EEscherichia coli\u003C\/em\u003E gastroenteritis and hemolytic-uremic syndrome), and low-frequency HIV quasispecies.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EExcept for flow cytometry, the developers of all of these breakthroughs have been recognized with Nobel Prizes. Such methods have provided considerably faster and more accurate means for diagnosis of pathogens traditionally isolated and identified by cultivation and in some cases have provided the first means for identification and quantification of pathogens, particularly viruses.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ESociety is confronted with a difficult poor economy, diminished basic research funding, a focus on gene discovery\/patents versus technology development\/patents, reimbursement issues, and increasing compliance requirements. However, Dr. Cockerill believes these issues can be overcome. The acute issues are patients\u0027 poor access to medical care, worsening reimbursement that will require improved efficiency and lower-cost diagnostics, and the overutilization of diagnostic services. He sees the recent Supreme Court decision that prevents the patenting of naturally occurring phenomena as having a positive impact on innovation in laboratory medicine; instead of focusing dollars on patenting genes, capital will be directed to the development of new testing platforms (target capture\/enhancement, small molecule detection [phenotypes]) and mobile testing units, the evolving application of basic technology (next-generation sequencing, automation, and compartmentalization), and the advent of informatics as evidence that even bigger breakthroughs will occur in the future.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EConsumer-oriented testing and the possibility of futuristic tricorders, automated and continuous artificial data integration and interpretation, and automated testing algorithms and formularies suggest that there will be new opportunities for healthcare delivery. The ability to miniaturize technology, improvements in specimen preparation and data analysis, smartphone transmission, and devices with minimal energy requirements herald the arrival of tricorders for disease detection. Qualcomm is offering a $10 million prize to the first group who develops such a device. Besides being lightweight and small, the tricorder must have the ability to detect anemia, urinary tract infections, diabetes, strep throat, sleep apnea, melanoma screen, chronic obstructive pulmonary disease, abnormalities in a metabolic panel, hypo- and hyperthyroidism, and the absence of disease.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EPoint-of-patient testing by the patient, miniaturization and portability of standard testing platforms, and integrated reporting transitioning to integrated data interpretation are key features for future patient care. Mayo Clinic has developed a patient self-swabbing procedure for throats that is just as effective as having a physician perform the procedure.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EIncreasing amounts of patient data mean that information integration, informed ordering, and integrated reporting\/interpretation fed into a computer system are areas in need of improvement. Doing so may enable real-time integrated interpretation at the bedside.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EDr. Cockerill stressed the importance of thinking outside the box to meet future needs.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/14\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn9f1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn9f1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}