Search Results (37)

If the number of viral hepatitis infections is to be decreased worldwide, and the World Health Organization (WHO) elimination targets are to be achieved by 2030, this requires determining the burden of infection according to the WHO’s test-and-treat approach. In 2014, the introduction of Direct-Acting Antivirals (DAAs) revolutionized the management of Hepatitis C Virus (HCV); another improvement came in 2020, when the use of bulevirtide (BLV) was authorized as a treatment for chronic Hepatitis D Virus (HDV) infection, showing good efficacy. The present observational study was carried out between 2019 and 2024. The diagnosis of viral hepatitis was carried out by routine assays. HDV typing was performed by Sanger sequencing and phylogenetic analysis. Overall, the HCV antibody prevalence was 3.4% in the studied time span, and it was higher in males than in females (59% vs. 41%). In viremic patients, HCV1b (33%) and HCV2a/2c (25%) were the most common subtypes. The overall HCV viremic rate declined in 2022 (2.8%). Unlike HCV, 71.4% of HDV viremic patients were females, and they had a median age of 58 years. The viral load of HDV RNA ranged from 20 IU/mL to 8 million IU/mL. Viral genotypes were classified as HDV1c and HDV1e. In this study, we highlight the prevalence of HCV/HDV infections and their genotype evolution in Southern Italy, underscoring the urgent need to enhance screening and linkage to care. Finally, we quantify the burden of active infections in order to provide data from real-life settings, and we describe the virological status of people living with HCV or HBV/HDV, who may experience significant benefits in terms of liver-related mortality after DAA or BLV treatment. Full article

Introduction: High performance colonoscopy requires the monitoring of an individual’s adenoma detection rate (ADR). The Endocuff (EndoCuff Vision, Olympus America Inc., Center Valley, PA, USA) is an endoscopic distal attachment device that increases surface area exposure during colonoscopy. While studies have shown that Endocuff increased ADR, real-world data is limited on its effectiveness. Methods: The Premiere Health Database was reviewed from 2018 to 2021 to identify patients 50 years of age or older who had a screening colonoscopy. A keyword search for “Endocuff” was used to determine if Endocuff was utilized, and ICD10 codes were analyzed to determine if a polyp was found. Our primary outcome was a polyp detection rate (PDR) for Endocuff-assisted colonoscopy (EAC) and standard colonoscopy (SC). Secondary outcomes included an estimated adenoma detection rate (eADR). Logistic regression modeling was performed to examine the difference in PDR between the EAC and SC groups after controlling for baseline characteristics, insurance type, and provider experience. Results: Gastroenterologists performed 893,560 screening colonoscopies, of which 0.7% were Endocuff-assisted, while surgeons performed 234,962 screening colonoscopies and 0.5% were Endocuff-assisted. PDR was higher with EAC for both gastroenterologists (72.0% vs. 57.4%) and surgeons (55.6% vs. 43.7%), with eADR following similar trends. The odds ratio of polyp detection with vs. without Endocuff was 1.91 for gastroenterologists and 1.62 for surgeons. After adjusting for patient and provider factors, the adjusted odds ratios are 2.01 and 1.61, respectively. Conclusions: While Endocuff utilization remains low, this large study using real-world data demonstrates the ability to improve eADR by over 10% compared to standard colonoscopy. Full article

Cervical cancer remains a major health burden among women in sub-Saharan Africa, where screening is often limited. Persistent high-risk human papillomavirus (HR-HPV) infection is the principal cause, highlighting the need for accurate molecular diagnostics. This cross-sectional study evaluated the analytical performance of one mRNA assay, APTIMA^® HPV assay (APTIMA mRNA), and two DNA-based assays, the Abbott RealTime High Risk HPV assay (Abbott DNA) and Seegene Allplex™ II HPV28 assay (Seegene DNA), in 527 cervical samples from a South African tertiary hospital, focusing on 14 shared HR-HPV genotypes. Seegene DNA yielded the highest detection rate (53.7%), followed by Abbott DNA (48.2%) and APTIMA mRNA (45.2%). APTIMA mRNA showed a strong agreement with Abbott DNA (87.9%, κ = 0.80), 89.9% sensitivity, 91.2% NPV, and the highest accuracy (AUC = 0.8804 vs. 0.8681). The agreement between APTIMA mRNA and Seegene DNA was moderate (83.4%, κ = 0.70), reflecting target differences. Many DNA-positive/mRNA-negative cases likely represent transient infections, though some may be latent with reactivation potential, warranting a follow-up. In resource-constrained settings, prioritizing transcriptionally active infections through mRNA testing may enhance screening efficiency and reduce burden. Scalable, cost-effective assays with strong clinical utility are essential for broadening access and improving cervical cancer prevention. Further studies should assess the integration of mRNA testing into longitudinal screening algorithms. Full article

This study aimed to verify, under real operating conditions, the effectiveness of protective lactic acid bacteria (LAB) culture in counteracting the development of late blowing defects in Valtellina Casera PDO cheese and its impact on product sensory characteristics. Thirty-four LAB isolated from Bitto and Valtellina Casera PDO cheeses were screened for anti-Clostridium activity. Lacticaseibacillus casei VC201 was able to inhibit all the indicator strains through organic acid production. Valtellina Casera PDO cheese-making was performed twice in three dairy farms using a commercial autochthonous starter culture with and without the addition of the protective culture VC201. Cheese was ripened both at 8 °C and 12 °C and analyzed after 70 and 180 days for LAB population, proteolysis, and lipolysis evolution as well as sensory impact. Cheeses with the addition of the VC201 strain showed higher contents of rod-shaped LAB throughout the ripening at both temperatures. The protective culture decreased the production of butyric acid at 70 days, especially at 8 °C (−15.4%), while butyric fermentation was occasionally lightly observed at 12 °C. The sensory profile was favorably impacted by the higher relative proportion of short-chain fatty acids (SCFFAs, C2–C8), which was especially pronounced at 8 °C and persisted for 180-day ripening (23.91% vs. 18.84% at 70 days and 23.84 vs. 21.71 at 180 days of ripening). The temperature and time of ripening had a significant effect on the free fatty acid content of the cheese samples in all three classes (SCFFA, MCFFA, and LCFFA). The cheese made with Lcb. casei VC201 was preferred, according to the sensory evaluation, being perceived as less acidic, less bitter, tastier, and with more intense flavor. Protective cultures can represent a practical way to reduce late blowing defects in Valtellina Casera cheese production while maintaining adherence to its PDO regulatory requirements. Full article

Bovine leukemia virus (BLV) remains a major concern for cattle industries worldwide due to its persistent nature, economic impact, and challenges in control. In this study, we conducted a comprehensive nationwide survey of BLV in Kazakhstan between 2014 and 2024, utilizing serological diagnostics to assess prevalence and characterize viral genotypes (2024). A total of 433,537 serum samples were screened by agar gel immunodiffusion (AGID), revealing an overall seroprevalence of 5.87%, with the highest rates observed in the North Kazakhstan, Kostanay, and East Kazakhstan regions. In 2024, a targeted analysis of 3736 serum and 536 whole blood samples across 17 regions was performed using AGID, ELISA, real-time PCR, and nested PCR. ELISA demonstrated higher sensitivity than AGID (10.4% vs. 8.2%), confirmed by statistical correlation (r = 0.97, p < 0.001) and a Wilcoxon signed-rank test (p = 0.026). Real-time PCR detected BLV DNA in 4.7% of samples, with the highest positivity in the East Kazakhstan and Abai regions, confirming active viral circulation. Validation of a domestically developed AGID diagnostic kit showed full concordance with commercial assays (IDEXX, IDvet), supporting its use in national surveillance programs. These findings highlight the endemic status of BLV in Kazakhstan. Molecular analysis of sequenced isolates revealed the presence of genotype G-7, consistent with strains circulating in neighboring countries. Together, these results underscore the importance of integrated serological and molecular approaches for effective monitoring and control. Full article

Pathogenic variants in the phenylalanine hydroxylase gene can result in phenylalanine (Phe) accumulation leading to phenylketonuria (PKU; OMIM #261600), a metabolic disease diagnosed in newborn screening. Early treatment with a Phe-restricted diet prevents severe mental retardation. Next to several other health complaints, patients with PKU present with low bone mineral density (BMD) more often than the general population. The etiology of the phenotype is not yet fully understood, and current research focuses on improving special medical foods and changes in osteoclasts (OC) and osteoblasts. Analysis of osteoclastic and oxidative stress control gene expression next to the simple number of OC developing from peripheral blood mononucleated cells (PBMCs) in association with dietary compliance and BMD was therefore part of our analysis. PBMCs were obtained from 17 adults with PKU and 17 age- and sex-matched controls on the same day. PBMCs were differentiated into osteoclasts (OC, Trap-positive multi-nucleated cells (≥3 nuclei)) for 14 days by adding human macrophage colony-stimulating factor (MCSF) and receptor activator of NF-κB Ligand (RANKL). Subsequently, quantitative real-time PCR was performed on OC function and oxidative stress control. Data on dietary compliance during the previous 12 months and 5 years and BMD were collected. PBMCs from adults with PKU and controls were differentiated into comparable numbers of OC (PKU: 53 [17–87] vs. controls: 39 [19–52], p = 0.381) without differences in mRNA expression of genes related to OC function and oxidative stress control. Dietary compliance in short-term and mid-term was not associated with OC number or mRNA expression, but CTSK negatively correlated with BMD T-Score in the hips of adults with PKU (Spearman r = −0.518, p = 0.040). Osteoclastogenesis was not changed in adult patients with PKU, nor were most mRNA expressions of OC marker genes or those of oxidative stress control. However, 44% of patients presented with BMD below −1 in their hips, and the OC of these tended to express higher CTSK (above −1: 0.2 [0.2–0.8] vs. below −1: 0.9 [0.6–3.4], p = 0.055). Thus, alternative regulatory mechanisms of OC activity may play a role in the development of low BMD in patients with PKU. Full article

Malaria remains a major public health threat in Cameroon, with an estimated 3 million new cases of Plasmodium spp. infections reported each year. The aim of this study was to assess the occurrence of Plasmodium infections in Cameroon in a group of symptomatic and asymptomatic individuals, residents of the town of Mbalmayo, located in the Central Region of Cameroon. Screening was conducted in December 2024 at the Mbalayo District Hospital. This study involved a total of 93 people aged between 1 and 70 years old, who voluntarily agreed to have their blood samples taken and tested for malaria. As part of this study, the demographic variables of the participants were taken, malaria rapid diagnostic tests (mRDTs) were performed, and blood samples were applied to the Whatman FTA cards for further real-time PCR diagnostics. The occurrence of Plasmodium infections in the residents of Mbalmayo differed depending on the diagnostic method used (30.1% with mRDT vs. 60.2% when RT-PCR assays were performed). A total of 55 malaria cases were found to be caused by P. falciparum, while one case was found to be caused by P. vivax. Nearly half of the study participants exhibited no signs or symptoms of malaria, whereas 35.7% reported fever, 17.9% respiratory symptoms, and 10.7% gastrointestinal symptoms. The prevalence of malaria remains high in populations inhabiting the Central Region in Cameroon. P. falciparum is the dominant species in the region. A considerable proportion of infected individuals are asymptomatic, which supports the finding that asymptomatic carriers play a critical role in disease transmission. The differences between the results depending on the diagnostic method used (mRDT vs. RT-PCR) suggest that there is a need to use a combination of different methods for the identification of malaria, especially in cases of low parasitemia. Full article

Restrictions resulting from the COVID-19 pandemic abruptly reversed the slow decline of the diagnosis and mortality rates of gastric cancer (GC). This scenario highlights the importance of developing cost-effective methods for mass screening and evaluation of treatment response. In this study, we evaluated a non-invasive method based on the circulating methylated cell-free DNA (cfDNA) of Reprimo (RPRM), a tumor suppressor gene associated with the development of GC. Methylated RPRM cfDNA was analyzed in three de-identified cohorts: Cohort 1 comprised 81 participants with GC and 137 healthy donors (HDs); Cohort 2 comprised 27 participants with GC undergoing gastrectomy and/or chemotherapy analyzed at the beginning and after three months of treatment; and Cohort 3 comprised 1105 population-based participants in a secondary prevention program who underwent esophagogastroduodenal (EGD) endoscopy. This cohort includes 180 normal participants, 845 participants with premalignant conditions (692 with chronic atrophic gastritis [AG] and 153 with gastric intestinal metaplasia/low-grade dysplasia [GIM/LGD]), 21 with high-grade dysplasia/early GC [HGD/eGC], and 59 with advanced GC [aGC]). A nested case-control substudy was performed using a combination of methylated RPRM cfDNA and pepsinogens (PG)-I/II ratio. The dense CpG island of the promoter region of the RPRM gene was bisulfite sequenced and analyzed to develop a fluorescence-based real-time PCR assay (MethyLight). This assay allows the determination of the absolute number of copies of methylated RPRM cfDNA. A targeted sequence of PCR amplicon products confirmed the gastric origin of the plasma-isolated samples. In Cohort 1, the mean value of GCs (32,240.00 copies/mL) was higher than that of the HD controls (139.00 copies/mL) (p < 0.0001). After dividing this cohort into training–validation subcohorts, we identified an area under the curve of 0.764 (95% confidence interval (CI) = 0.683–0.845) in the training group. This resulted in a cut-off value of 87.37 copies/mL (sensitivity 70.0% and specificity 80.2%). The validation subcohort predicted a sensitivity of 66.67% and a specificity of 83.33%. In Cohort 2 (monitoring treatment response), RPRM levels significantly decreased in responders (p = 0.0042) compared to non-responders. In Cohort 3 (population-based participants), 18.9% %, 24.1%, 30.7%, 47.0%, and 71.2% of normal, AG, GIM/LGD, HGD/eGC, and aGC participants tested positive for methylated RPRM cfDNA, respectively. Overall sensitivity and specificity in distinguishing normal/premalignant conditions vs. GC were 65.0% (95% CI 53.52% to 75.33%) and 75.9% (95% CI 73.16% to 78.49%), respectively, with an accuracy of 75.11% (95% CI 72.45% to 77.64%). Logistic regression analyses revealed an OR of 1.85 (95% CI 1.11–3.07, p = 0.02) and an odds ratio (OR) of 3.9 (95% CI 1.53–9.93, p = 0.004) for the risk of developing GIM/LGD and HGD/eGC, respectively. The combined methylated RPRM cfDNA and PG-I/II ratio reached a sensitivity of 78.9% (95% CI 54.43% to 93.95%) and specificity of 63.04% (95% CI 52.34% to 72.88%) for detecting HGD/eGC vs. three to six age- and sex-matched participants with premalignant conditions. Our results demonstrate that methylated RPRM cfDNA should be considered a direct biomarker for the non-invasive detection of GC and a predictive biomarker for treatment response. Full article

Traditional screening methods for Mild Cognitive Impairment (MCI) face limitations in accessibility and scalability. To address this, we developed and validated a speech-based automatic screening app implementing three speech–language tasks with user-centered design and server–client architecture. The app integrates automated speech processing and SVM classifiers for MCI detection. Functionality validation included comparison with manual assessment and testing in real-world settings (n = 12), with user engagement evaluated separately (n = 22). The app showed comparable performance with manual assessment (F1 = 0.93 vs. 0.95) and maintained reliability in real-world settings (F1 = 0.86). Task engagement significantly influenced speech patterns: users rating tasks as “most interesting” produced more speech content (p < 0.05), though behavioral observations showed consistent cognitive processing across perception groups. User engagement analysis revealed high technology acceptance (86%) across educational backgrounds, with daily cognitive exercise habits significantly predicting task benefit perception (H = 9.385, p < 0.01). Notably, perceived task difficulty showed no significant correlation with cognitive performance (p = 0.119), suggesting the system’s accessibility to users of varying abilities. While preliminary, the mobile app demonstrated both robust assessment capabilities and sustained user engagement, suggesting the potential viability of widespread cognitive screening in the geriatric population. Full article

The way audiovisuals are perceived is not completely understood. Previous works have shown that attention increases when watching audiovisuals compared with looking at real events, but depending on the editing style, and the interpreter, the understanding of the content may be different. The study of brain asymmetries in this context aims to identify potential lateralizations in audiovisual perception. Previous studies have proven that seeing others grasp objects has a contralateral impact on somatosensory areas (C3 and C4) in the alpha band (8–12 Hz). In this work, we investigated whether brain activity could be asymmetrical in that band when looking at real grasping compared with watching grasping on a screen, and whether media expertise would be a determinant in this regard and presented the same narrative content both through live performance and as a movie to 40 participants (half of them media professionals) while recording their electroencephalography (EEG) activity. We conclude that the asymmetry in the alpha band in the somatosensory cortex is not affected by the medium through which the grasping actions are presented, that is, in reality or on screen. We also conclude that media expertise does not impact this asymmetry. Full article

Carbapenem resistance is a serious public health threat, causing numerous deaths annually primarily due to healthcare-associated infections. To face this menace, surveillance programs in high-risk patients are becoming a widespread practice. Here we report the performance of the combined use of a recently approved commercial multiplex real-time PCR assay (REALQUALITY Carba-Screen kit) with conventional phenotypic screening. In this three-month study, 479 rectal swabs from 309 patients across high-risk units were evaluated by combining the two approaches. Although the molecular assay showed a higher positivity rate than phenotypic screening (7.1% vs. 5%), it should be noted that the molecular method alone would have missed eight carbapenem-resistant isolates, while using only phenotypic screening would not have detected sixteen isolates. This demonstrates the complementary strengths of each method. Our study confirms the need for a combined approach to maximize the possible clinical impact of this kind of screening, ensuring a more comprehensive detection of resistant strains. Full article

Background: The current manuscript’s aim was to determine the human papillomavirus (HPV) genotype-specific prevalence and distribution among individuals, males, and females, of different ages in the region of Apulia, Italy, highlighting the possible variables involved in the carcinogenicity mechanism. In addition, we proposed two hypothetical models of HPV’s molecular dynamics, intending to clarify the impact of prevention and therapeutic strategies, explicitly modeled by recent survey data. Methods: We presented clinical data from 9647 participants tested for either high-risk (HR) or low-risk (LR) HPV at the affiliated Bari Policlinic University Hospital of Bari from 2011 to 2022. HPV DNA detection was performed using nested-polymerase chain reaction (PCR) and multiplex real-time PCR assay. Statistical analysis showed significant associations for all genders and ages and both HR- and LR-HPV types. A major number of significant pairwise associations were detected for the higher-risk types and females and lower-risk types and males. Results: The overall prevalence of HPV was 50.5% (n-4.869) vs. 49.5% (n-4.778) of the study population, of which 74.4% (n-3621) were found to be HPV high-risk (HR-HPV) genotypes and 57.7% (n-2.807) low-risk HPV (LR-HPV) genotypes, of which males were 58% and females 49%; the three most prevalent HR-HPV genotypes were HPV 53 (n707-15%), 16 (n704-14%), and 31 (n589-12%), and for LR-HPV, they were 42 (19%), 6 (16%), and 54 (13%); 56% of patients screened for HPV were ≤ 30 years old, 53% were between 31 and 40 years old, 46% were 41–50 and 51–60 years old, and finally, 44% of subjects were >60 years old. Conclusions: Our study provided comprehensive epidemiological data on HPV prevalence and genotype distribution among 9647 participants, which could serve as a significant reference for clinical practice, and it implied the necessity for more effective screening methods for HPV carcinogenesis covering the use of more specific molecular investigations. Although this is a predominantly descriptive and epidemiological study, the data obtained offer not only a fairly unique trend compared to other studies of different realities and latitudes but also lead us to focus on the HPV infection within two groups of young people and adults and hypothesize the possible involvement of dysbiosis, stem cells, and the retrotransposition mechanism. Full article

Early detection of dyslexia and learning disorders is vital for avoiding a learning disability, as well as supporting dyslexic students by tailoring academic programs to their needs. Several studies have investigated using supervised algorithms to screen dyslexia vs. control subjects; however, the data size and the conditions of data acquisition were their most significant limitation. In the current study, we leverage a large dataset, containing 4243 time series of eye movement records from children across Europe. These datasets were derived from various tests such as saccade, vergence, and reading tasks. Furthermore, our methods were evaluated with realistic test data, including real-life biases such as noise, eye tracking misalignment, and similar pathologies among non-scholar difficulty classes. In addition, we present a novel convolutional neural network architecture, adapted to our time series classification problem, that is intended to generalize on a small annotated dataset and to handle a high-resolution signal (1024 point). Our architecture achieved a precision of 80.20% and a recall of 75.1%, when trained on the vergence dataset, and a precision of 77.2% and a recall of 77.5% when trained on the saccade dataset. Finally, we performed a comparison using our ML approach, a second architecture developed for a similar problem, and two other methods that we investigated that use deep learning algorithms to predict dyslexia. Full article

Background and Objectives: Face recognition is one of the most serious disabilities of patients with age-related macular degeneration (AMD). Our purpose was to study face recognition using a novel method incorporating virtual reality (VR) and eye tracking. Materials and Methods: Eighteen patients with AMD (seven male; median age 83 years; 89% with bilateral advanced AMD) and nineteen healthy controls (five male; median age 68 years) underwent the face recognition test IC FACES (Synthesius, Ljubljna, Slovenia) on a VR headset with built-in eye tracking sensors. Analysis included recognition accuracy, recognition time and fixation patterns. Additionally, a screening test for dementia and imaging with fundus autofluorescence and optical coherence tomography was performed. Results: AMD patients had significantly lower face recognition accuracy (42% vs. 92%; p < 0.001) and longer recognition time (median 4.0 vs. 2.0 s; p < 0.001) in comparison to controls. Both parameters were significantly worse in patients with lower visual acuity. In both groups, eye-tracking data revealed the two classical characteristics of the face recognition process, i.e., fixations clustering mainly in the nose–eyes–mouth triangle and starting observation in the nasal area. Conclusions: The study demonstrates usability of a VR headset with eye tracking for studying visual perception in real-world situations which could be applicable in the design of clinical studies. Full article

Introduction: Lung ultrasound (LUS) is widely used in clinical practice for identifying interstitial lung diseases (ILDs) and assessing their progression. Although high-resolution computed tomography (HRCT) remains the gold standard for evaluating the severity of ILDs, LUS can be performed as a screening method or as a follow-up tool post-HRCT. Minimum training is needed to better identify typical lesions, and the integration of innovative artificial intelligence (AI) automatic algorithms may enhance diagnostic efficiency. Aim: This study aims to assess the effectiveness of a novel AI algorithm in automatic ILD recognition and scoring in comparison to an expert LUS sonographer. The “SensUS Lung” device, equipped with an automatic algorithm, was employed for the automatic recognition of the typical ILD patterns and to calculate an index grading of the interstitial involvement. Methods: We selected 33 Caucasian patients in follow-up for ILDs exhibiting typical HRCT patterns (honeycombing, ground glass, fibrosis). An expert physician evaluated all patients with LUS on twelve segments (six per side). Next, blinded to the previous evaluation, an untrained operator, a non-expert in LUS, performed the exam with the SensUS device equipped with the automatic algorithm (“SensUS Lung”) using the same protocol. Pulmonary functional tests (PFT) and DLCO were conducted for all patients, categorizing them as having reduced or preserved DLCO. The SensUS device indicated different grades of interstitial involvement named Lung Staging that were scored from 0 (absent) to 4 (peak), which was compared to the Lung Ultrasound Score (LUS score) by dividing it by the number of segments evaluated. Statistical analyses were done with Wilcoxon tests for paired values or Mann–Whitney for unpaired samples, and correlations were performed using Spearman analysis; p < 0.05 was considered significant. Results: Lung Staging was non-inferior to LUS score in identifying the risk of ILDs (median SensUS 1 [0–2] vs. LUS 0.67 [0.25–1.54]; p = 0.84). Furthermore, the grade of interstitial pulmonary involvement detected with the SensUS device is directly related to the LUS score (r = 0.607, p = 0.002). Lung Staging values were inversely correlated with forced expiratory volume at first second (FEV1%, r = −0.40, p = 0.027), forced vital capacity (FVC%, r = −0.39, p = 0.03) and forced expiratory flow (FEF) at 25th percentile (FEF25%, r = −0.39, p = 0.02) while results directly correlated with FEF25–75% (r = 0.45, p = 0.04) and FEF75% (r = 0.43, p = 0.01). Finally, in patients with reduced DLCO, the Lung Staging was significantly higher, overlapping the LUS (reduced median 1 [1–2] vs. preserved 0 [0–1], p = 0.001), and overlapping the LUS (reduced median 18 [4–20] vs. preserved 5.5 [2–9], p = 0.035). Conclusions: Our data suggest that the considered AI automatic algorithm may assist non-expert physicians in LUS, resulting in non-inferior-to-expert LUS despite a tendency to overestimate ILD lesions. Therefore, the AI algorithm has the potential to support physicians, particularly non-expert LUS sonographers, in daily clinical practice to monitor patients with ILDs. The adopted device is user-friendly, offering a fully automatic real-time analysis. However, it needs proper training in basic skills. Full article