In a feasibility study using a prototype, lateral-flow test for human papillomavirus type 16, 18, and/or 45 (HPV16/18/45) E6 oncoproteins, 51 of 75 (68%; 95% confidence interval [95% CI] of 56 to 78%) of HPV16/18/45 DNA-positive specimens from women with a diagnosis of CIN3؉ (cervical intraepithelial neoplasia grade 3؉ or cervical cancer) tested positive for HPV16/18/45 E6 oncoprotein. None of 16 (95% CI of 0 to 37%) HPV16/18/45 DNA-positive cervical specimens from women with a negative or CIN1 diagnosis tested positive for HPV16/18/45 E6 oncoprotein.Human papillomavirus (HPV) DNA detection has been proven to be a viable and potentially more effective alternative to Pap testing in both developed countries (3) and developing countries (7), where more than 80% of the almost half million annual cases of cervical cancer occur (5). A new generation of HPV DNA tests that are lower cost, faster, and easier to use are currently being developed (6). Although HPV DNA tests are very sensitive for the diagnosis of cervical precancer and early cancers, their specificity is limited, as they detect both the many benign HPV infections and the less frequent infections linked to clinically important disease.Because elevated expression of E6 and E7 (mRNA and protein) is required for epithelial cell transformation to occur, detecting the E6/E7 proteins represents an attractive, diseasespecific viral biomarker. To examine whether detection of E6 oncoprotein was feasible from cervical specimens and was more specific clinically than detection of HPV DNA, we conducted a pilot study on a convenience sample of cervical swab specimens using a prototype, lateral-flow test for HPV type 16, 18, and/or 45 (HPV16/18/45) E6 oncoproteins (AV Avantage HPV E6 test; Arbor Vita Corporation, Fremont, CA).(i) Specimens. A set of cervical swab specimens linked to histological outcomes were collected using a Dacron swab and stored without buffer or specimen transport medium at less than Ϫ60°C. The specimen set was assembled as a convenience sample from a variety of sources. The first group of specimens consisted of 16 specimens (negative histology) from Planned Parenthood (PPMM, San Jose, CA). The second group consisted of 55 specimens: 1 specimen from a woman with cervical intraepithelial neoplasia grade 1 (CIN1), 14 specimens from women with CIN3, 29 specimens from women with CIN3 or cervical cancer (CIN3ϩ) (The exact diagnosis, CIN3 or cervical cancer, was not provided), and 11 specimens from women with cervical cancer. These specimens were acquired via BioImagene (Cupertino, CA), who obtained the specimens from a clinical trial being conducted in India. The third group of specimens consisted of 89 specimens (8 specimens with negative histology, 28 specimens from women with CIN1, 43 specimens from women with CIN3, and 10 specimens from women with cervical cancers were accumulated by the Program for Appropriate Technology in Health (PATH) as part of ongoing studies of low-cost HPV testing in China (6) and India. Thus, the final set of cervical swab sp...

Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.

Introduction Congestive heart failure and sleep-disordered breathing frequently coexist. Many of these patients are referred for polysomnography(PSG). Left ventricular assist device (LVAD) is increasingly used as a destination therapy or as a bridge to transplant. This can lead to artifacts in EEG and EKG. The artifact can mask pathological waves or over-reading of pathology. We present a case report of a patient who underwent a PSG on LVAD. Report of case(s) Sixty-six-year old male with severe heart failure with reduced ejection fraction (EF) of 15 % presented with snoring and witnessed apnea. The patient was diagnosed with predominant central sleep apnea (92%) but never initiated BPAP/ST due to an unstable heart. He was placed on LVAD (HeartMate III LVAD, oscillatory speed of 5300 rpm/83.3Hz) as the heart status deteriorated. Repeat polysomnography was done for persistent snoring but improved witnessed apneas revealed a newly appearing artifact. EEG showed a diffuse low amplitude,6–7 Hz frequency waves, and a regularly appearing high voltage sharp-peaked wave. The morphology of alpha wave, K wave, spindles, and delta waves could not be appreciated and hence was unable to perform sleep staging. EKG had electrical artifacts. All troubleshooting maneuvers were unsuccessful in eliminating artifacts. The artifact is generated by the impeller rotational speed of LVAD that ranges from 2400 rpm to 10,00 rpm(oscillation frequencies of 40 Hz to 166.7 Hertz,1Hz == 60 rpm). The device’s artificial pulse causes additional minor peaks. EEG artifact can be improved by moving the amplifier away from the heart and repositioning the patient. Adjusting the low-frequency filter can affect the nasal pressure tracing, delta waves, and stage 3 recognition. Reducing the high-frequency filter frequency by 10 from the LVAD oscillation frequency improves the EKG signal. But this may cut off the frequency component of pathologies like left ventricular hypertrophy. Conclusion The LVAD has been increasingly used in the United States. It is important to improve awareness regarding the artifacts among sleep techs and physicians. Unresolved artifacts may lead to missing serious pathologies in EEG and EKG and also can lead to misreading the waves as pathological leading to unnecessary treatment. Support (if any) An image of EEG and EKG

Introduction Dementia with Lewy bodies (DLB) is one of the most common types of degenerative dementia after Alzheimer’s dementia. The core clinical features for diagnosis includes cognitive fluctuations, visual hallucinations, rapid eye movement (REM) sleep behavior disorder (RBD), and parkinsonism. Other symptoms include daytime drowsiness, longer daytime naps, prolonged staring spells, and episodes of disorganized speech. REM behavioral disorder (RBD) is commonly associated with DLB, occurring in 85 percent of individuals, often early in the course of the disease. It can precede the clinical diagnosis of DLB by up to 20 years. Report of case(s) A seventy-six-year-old female with a history of well controlled obstructive sleep apnea was diagnosed with REM behavioral disorder in 2012. She had presented with episodes of screaming, attempt to ambulate during sleep, resulting in injury. Her polysomnogram revealed evidence of REM without atonia and a screaming episode during REM. Her RBD symptoms were controlled with clonazepam and melatonin with less frequency of the RBD episodes. The patient gradually started noticing memory issues and by January 2020 she was diagnosed with dementia and was initiated on Aricept. Within 7 months of diagnosis of dementia, she started reporting vivid hallucinations that were not threatening or violent compared to her violent content of RBD. Physical exam revealed impaired cognitive function and mild intermittent resting tremor of the right hand. The neurological exam was normal including normal tone, strength, and gait. She also reported repeated falls and fractures. The diagnosis of Lewy body dementia was made based on the presence of 2 core clinical features. Conclusion The current management of these conditions is mainly symptomatic. In the evolution of neurodegenerative disorder, RBD precedes other conditions like LBD, parkinsonism, etc. Research suggests that alpha-synuclein neurodegeneration is the common pathology behind these conditions. The understanding that RBD presents at the beginning of the evolution, provides us with a unique opportunity for preemptive treatment to prevent further degeneration in turn preventing the debilitation consequence like dementia, parkinsonism, neuroleptic sensitivity, and dysautonomia. Further research is needed for developing these early interventional strategies. Support (if any) NOne

No abstract