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Introduction: The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) Key Incident Monitoring and Management EQA Program (KIMMS) aims to monitor the laboratory quality system's pre- and post-analytical phases. The purpose of this paper is to describe the most common incidents from 2024.

Materials and methods: The KIMMS program has four surveys a year, collecting data from the previous three months, with preanalytical and postanalytical incident reporting of 35 incident types. Participants are asked to capture the number of episodes and the number of incidents per quarter of the year.

Results: The four 2024 surveys received an average of 111 responses, with 55,329,998 episodes recorded and 1,496,708 incidents identified. The findings from the 2024 program are that the incident "No specimen received" appears to have the highest 80th percentile across the patient sources. The commonest site of error is the Emergency Department (ED), with an 80th percentile overall.

Conclusions: The KIMMS data provide valuable, regular and reproducible benchmarking data for the pre- and post-analytical phases of the total testing cycle.

Introduction: This study established laboratory and trimester specific indirect reference intervals (RIs) for thyroid stimulating hormone (TSH).

Materials and methods: A retrospective observational study was performed at a tertiary-care laboratory's hospital during 12 months. Between February 2023 and February 2024, TSH results from 2166 women in their first trimester of pregnancy were retrieved. Only outpatients coming from primary care were included in the study. After applying exclusion and outlier criteria, TSH results from 1300 patients were analyzed to establish new RIs using the 2.5th and 97.5th percentiles by the non-parametric percentile method. These RIs were verified by an indirect method analyzing 486 TSH results from a cohort of pregnant women that were extracted from April to June 2024, and a direct prospective study of 28 pregnant women from a primary care center. All TSH tests were measured using a Cobas 8000 e801 system (Roche, Basel, Switzerland).

Results: The TSH RIs were 0.60-4.33 mIU/L. Both verification methods met the requirements of the CLSI guidelines.

Conclusions: The indirect method could be used to establish and verify local RIs for TSH in first trimester pregnant women. This may reduce misclassification of pregnant women undergoing thyroid function tests.

Introduction: Prostate-specific antigen (PSA) can circulate bound to extracellular vesicles (EVs) and its measurement (ev-PSA) can be useful in prostate cancer. Although not designed with that purpose, total PSA assays react with ev-PSA. We evaluated the analytical performance of several total PSA assays in ev-PSA quantification and the impact of ev-PSA on total PSA measurement.

Materials and methods: Extracellular vesicles were isolated from 83 serum samples from prostate cancer patients by size exclusion chromatography or ultracentrifugation. PSA was quantified in serum, EVs, International Standard for PSA 17/100 from the World Health Organization (WHO IS 17/100) and exosomes from lymph node carcinoma of the prostate (LNCaP) cell line, using commercial immunoassays (Elecsys, Atellica, Immulite, Liaison and Kryptor).

Results: Nanoparticle tracking analysis showed that the WHO IS 17/100 contains significantly less EVs than serum (P < 0.001). The sensitivity to detect ev-PSA followed this order: Elecsys ~ Atellica > Immulite > Liaison > Kryptor. Ev-PSA could be detected in all serum samples with Elecsys and Atellica, but not with Immulite (87.8%), Liaison (58.5%) or Kryptor (48.8%). Bland-Altman analysis showed a proportional bias in ev-PSA quantification between Elecsys and other methods. Addition of ev-PSA to serum samples caused a proportional bias in PSA measurement between Elecsys and Immulite methods, with a relationship (r² = 0.99; P < 0.001) between ev-PSA and the difference in total PSA concentration between both methods.

Conclusions: While ev-PSA can be measured using commercial kits, notable differences exist between methods, which could lead to potential discrepancies in serum total PSA results across various assays.

Introduction: Lipoprotein(a) (Lp(a)) is an independent cardiovascular risk factor, primarily determined by genetic factors. This study assessed Lp(a) concentrations in presumably healthy subjects and evaluated its association with age, sex, and cardiometabolic risk factors.

Materials and methods: The study included presumably healthy 1046 adults and 276 children. Laboratory parameters: lipid profile, Lp(a), apolipoprotein B (apoB), glucose, HbA1c, C-reactive protein and creatinine were measured. Contributions of Lp(a)-apoB to apoB (%Lp(a)/apoB) and of Lp(a)-cholesterol to LDL-cholesterol (%Lp(a)-C/LDL-C) were calculated.

Results: Lipoprotein(a) concentrations were significantly higher in adults than in children (P = 0.014) and in women than in girls (P = 0.003), but showed no overall sex differences. In women, Lp(a) was higher after age 50, while in men a slight rise occurred after age 60. Lipid indices %Lp(a)/apoB and %Lp(a)-C/LDL-C declined in men until their 40s and was higher after 50 in both sexes. In a multivariable logistic regression model increased LDL-C concentration was a significant predictor of Lp(a) ≥ 0.30 g/L in women (odds ratio, OR = 1.77; P = 0.021) and children (OR = 2.83; P = 0.009). Boys had twofold higher probability of Lp(a) ≥ 0.30 g/L than girls (OR = 2.17; P = 0.024).

Conclusions: Lipoprotein(a) concentrations increase with age, especially after 50 in women and 60 in men, and are significantly associated with LDL-C. Rising %Lp(a)/apoB and %Lp(a)-C/LDL-C alongside falling apoB and LDL-C suggest greater atherogenicity in older individuals, particularly men. These findings support including Lp(a) in lipid profile for better cardiovascular risk assessment.

Effect size measures are important complements to P values, providing information about the magnitude and practical relevance of research findings. While widely discussed in the context of parametric tests, effect size estimation for nonparametric tests remains less explored. This article reviews standardized effect size measures applicable to four common nonparametric tests: Mann-Whitney, Wilcoxon signed-rank, Kruskal-Wallis, and Friedman. Commonly suggested classifications for these effect sizes are also discussed. This article aims to support researchers in reporting and interpreting effect sizes more effectively in nonparametric contexts.

Introduction: Differentiating between malignant pleural effusion (MPE) and tuberculous pleural effusion (TPE) remains challenging in clinical practice. The cancer ratio plus (CR+), a potential diagnostic tool calculated as serum lactate dehydrogenase/(pleural adenosine deaminase x pleural lymphocyte percentage) has emerged to address this diagnostic challenge. This scoping review maps the available evidence on its diagnostic performance.

Materials and methods: We conducted a systematic search of PubMed, Scopus, and Web of Science databases from inception to April 2025. Eligible studies assessed the accuracy of CR+ in distinguishing MPE from TPE. Data on study design, cut-off values, sensitivity, specificity, area under the curve (AUC), and likelihood ratios were extracted and synthesized narratively.

Results: Six studies comprising 881 patients were included. Reported cut-off values varied widely (5.7 - 41.0), as did sensitivity (74.3 - 97.6%) and specificity (36.6 - 94.1%). Most studies, however, reported good discriminatory power with AUC values generally above 0.80. The highest diagnostic accuracy was observed in one study, which reported a sensitivity of 97.6%, a specificity of 94.1%, and an AUC of 0.86. Differences in cut-off thresholds, study populations, local tuberculosis epidemiology, and laboratory methodology (particularly lymphocyte quantification) likely contributed to this heterogeneity.

Conclusions: The CR+ appears promising as a non-invasive tool using routine parameters for differentiating MPE from TPE, but diagnostic performance varies across settings. The heterogeneity in optimal cut-off values highlights the need for local validation before clinical adoption. Future research should standardize methodology and assess its impact on decision-making and patient outcomes.

Introduction: The hormonal interplay between the mother and the fetal-placental unit may influence the mode of delivery. This study aimed to investigate the association between maternal peripartal serum concentrations of sex hormone-binding globulin (SHBG) and 10 steroid hormones with delivery outcomes.

Materials and methods: This observational study included 171 healthy pregnant women with spontaneous onset of labor: 117 had vaginal delivery and 54 underwent urgent cesarean section (C-section). Serum concentrations of aldosterone, androstenedione, cortisol, cortisone, corticosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone, progesterone, and total testosterone were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS), while free testosterone was calculated. Sex hormone-binding globulin was measured by chemiluminescent microparticle immunoassay. Group differences were tested with the Mann-Whitney U test, and associations with delivery mode were assessed by logistic regression and receiver operating characteristic (ROC) analysis.

Results: Compared with the vaginal delivery group, women who underwent urgent C-section had significantly lower serum concentrations of SHBG, corticosterone, cortisol, aldosterone, progesterone, 17-hydroxyprogesterone, DHEA, DHEAS, and free testosterone (all P < 0.001). In multivariate logistic regression, aldosterone (odds ratio, OR 0.11, 95% CI 0.04 to 0.27, P < 0.001) and DHEAS (OR 0.74, 95% CI 0.58 to 0.94, P = 0.011) were independently associated with delivery mode. ROC analysis showed that aldosterone > 0.9 nmol/L predicted vaginal delivery with AUC 0.874, sensitivity 88%, and specificity 77%.

Conclusions: Low maternal aldosterone concentrations showed the strongest association with urgent C-section, suggesting that aldosterone may play a protective role in successful vaginal delivery.

Dementia represents a rapidly rising global health challenge as a progressive neurodegenerative disease with few options for disease-modifyingtreatments. The present studyaimed to explore the leading phytochemicals from Crocus sativus (saffron) and Matricaria chamomilla (chamomile) and apply AI fragmentation on lead phytochemicals to target the aryl hydrocarbon receptor (AHR), an expertized target for dementia therapy. Bioactive compounds were screened from ISO 3632-2-2010 (E) specified for saffron and GC-MS specified for chamomile. Protein Network mapping, Density Functional Theory, Molecular docking, and molecular dynamics simulations were performed to determine thebinding affinity and interactions stability of key phytochemicals with AHR, such as safranal and bisabolone oxide A. In-silico ADMET predictions of pharmacokinetics and toxicity showed good properties for these molecules. In addition, their structuraland pharmacological properties were optimized to enhance drug-like features by using artificial intelligence (AI) generative model. Collectively, our findings highlight these AI-enhanced phytochemicals as promising AHR modulators with potentially therapeutic activities in pathological pathways that lead toneuroinflammation and oxidative stress involved in the pathogenesis of dementia. They offer an avenue for additional experimental validation and encourage further investigation of these leads as sources of new therapeutic modalities to treat neurodegenerativediseases.

Objectives: The purpose of this study is to establish a model correlating the number of alarms and effective alarms on a monitor, and to use this model to optimise night-time alarm issues in intensive care units in order to reduce alarm fatigue among night shift nurses.

Methods: A retrospective study method was used to track 1,843 samples. Based on partial experimental design analysis, a model for 'alarm frequency' and 'effective alarms' was established for the monitor, which was then optimised using the composite centre factorial (CCF) method. The performance of the model was evaluated using random sampling and night-time model application.

Results: We can model based on three factors: 'APACHE II score,' 'Alarm time period,' and 'Nurse ICU work years.' After using this model, the average number of alarms decreased by 11.86%, and the average proportion of effective alarms increased by 4%.

Conclusions: We can use CCF modeling to manage monitors and help reduce patient and nurse fatigue.

Implications for clinical practice: The number of monitor alarms and effective alarms related to the patient's condition, working time period, and the nurse's experience. We can tailor the management strategy of the monitor based on clinical conditions, reducing the number of night-time alarms while ensuring patient safety, increasing the effectiveness of alarms, and reducing nurse alarm fatigue. The longer the length of service in critical care, the less significant the improvement in monitor alarm performance.

Objectives: In Italy a recent law was approved for providing patients' wishes regarding end of life issues, commonly referred internationally to as "living wills", (Dichiarazione anticipata di trattamento, DAT). Regardless of this official document, advance care planning (ACP) is often used in a palliative care setting to share the treatments to start, to continue, to withdraw, thus preventing the stress on an acute decision. The aim of this study was to assess DAT and ACP in patients with amyotropic lateral sclerosis admitted to home palliative care. Methods: Patients consecutively admitted to speciliazed home palliative care were prospectively assessed. The presence of DAT or ACP was recorded. Results: Sixty-eight patients were enrolled in the period taken into consideration. No patient had drown up DAT, and only one patient provided his ACP prior to home palliative care admission. Along the course of home palliative care care assistance, 30.9% of patients provided their ACP. Discussion: In Italy DAT resulted scarcely widespread, despite an existing law, as no patient officially provided their indication on end of life issues. In addition, ACP was given only after starting specialized home palliative care in less than 1/3 of patients. Home palliative care seems to be a fundamental resource for improving communication and soliciting expression of patients' wishes regarding end of life issues.