Journal of Clinical Laboratory Analysis最新文献

Background: In clinical practice, reference intervals play a pivotal role in interpreting laboratory test results. Yet, when several tests are taken into consideration simultaneously, the traditional univariate intervals might not suffice due to the elevated risk of Type 1 errors.

Methods: This study introduces and evaluates two multivariate reference interval techniques: one based on Mahalanobis distance and the other an adaptation of the multivariate confidence interval (MCI). Using Monte Carlo simulations, we focused our assessments on the interplay between "serum ferritin and transferrin saturation" values.

Results: Upon evaluation, it became evident that the multivariate methods significantly reduced false positives. They presented enhanced accuracy over traditional univariate intervals. Notably, the method involving Mahalanobis distance stood out in terms of efficacy.

Contributions: Beyond presenting novel techniques, our research underscores the importance and potential of using multivariate approaches in clinical lab settings. The findings can guide better medical decision making, ensuring optimized allocation of healthcare resources.

Background: Persistent elevation of aspartate aminotransferase (AST) is commonly indicative of liver injury or disease, but isolated AST elevation without concurrent alanine aminotransferase (ALT) increase is rare and difficult to diagnose. While AST is non-specific and found in various tissues, its isolated elevation is due to less common conditions, such as macro-AST, where AST binds with immunoglobulins creating a high-molecular-weight complex that affects serum activity.

Case description: A 68-year-old female with a history of high-grade serous ovarian cancer (HGSOC) who had persistent isolated AST elevation for several years. Evaluations including physical exams, imaging, and routine liver function tests showed no evidence of hepatic or muscular disease. The polyethylene glycol (PEG) precipitation significantly reduced serum AST activity, confirming the presence of the macro-enzyme form of AST (macro-AST).

Conclusion: This case highlights the rare and novel occurrence of macro-AST in a patient with ovarian cancer. It emphasizes the importance of considering macro-AST in the differential diagnosis of isolated AST elevation, particularly in patients without clear evidence of liver or muscular disease. Recognizing this benign condition can prevent unnecessary diagnostic procedures and anxiety.

Background: Cryoglobulins (CGs) and Cryofibrinogen (CF) are proteins that precipitate at low temperatures. Complex laboratory procedures are necessary to identify them.

Methods: Between December 2022 and December 2023, 1171 patient samples for analysis of CGs and CF were received in the laboratory from different clinical departments with suggestive clinical symptoms and signs of cryoproteinemia and were analyzed using pre-analytical, analytical, and post-analytical procedures.

Results: Cryoproteins were detected in 281 samples (47%); CGs⁺ were found in association with CF⁺ in 74 samples (12.52%); CF⁺ was detected with CGs^- in 119 patients (20.13%); and CGs⁺ were found with CF^- in 88 patients (14.9%).

Conclusions: CGs testing has long been common in laboratories, and the analytical and pre-analytical procedures are well known, in contrast to CF testing, which has only emerged in recent years. Therefore, appropriate procedures are needed for testing both cryoproteins to optimize economic and human resources and reduce laboratory diagnostic times. At last, confirming a clinical suspicion of cryoproteinemia in a short time could improve patient outcomes, allowing suitable therapies to be implemented for vasculitis and related thromboembolic phenomena.

Background: To investigate the association of serum alkaline phosphatase (ALP) with incident metabolic syndrome (MetS) and its components, as well as the influence of sex on this relationship among Iranian adults.

Methods: The multivariable Cox proportional hazards regression models were applied to assess the associations between ALP both as continuous and categorical variables with incident MetS and its components.

Results: Among 831 subjects (467 women) with a mean age of 44.51 years, during a median follow-up of 15.6 years, 597 MetS cases (336 women) occurred. Interaction was found between ALP quartiles and sex (p-value = 0.006). Among women, increasing levels of ALP across the second to fourth quartiles were associated with hazard ratios (HRs) of 1.269, 1.491, and 2.092 for MetS, respectively (p for trend < 0.001). Among men, no association was found between ALP and incident MetS. Among women, the second and fourth quartiles of ALP were associated with incident high triglycerides (TG), with HRs of 1.793 and 1.815, respectively. Moreover, a 1-SD increase in ALP conferred a 17.9% higher risk of low high-density lipoprotein cholesterol (HDL-C). Among men, a 1-SD increase in ALP was associated with an HR of 1.222 for incident high waist circumference (WC) (All p-values < 0.05).

Conclusion: Sex significantly influenced the impact of serum ALP on the incidence of MetS and its components. In women, ALP was a strong harbinger for incident MetS and its dyslipidemia components. However, among men, the increasing value of ALP was associated with incident central obesity but not MetS.

Background: This study tested HIV-1 antibodies in saliva samples (sHIV-1 Ab) collected by the Self-Lollisponge device.

Methods: Blood and saliva from confirmed persons with HIV and HIV-negative controls were analyzed for HIV-1/2 antibodies using the blood-based First Response HIV 1-2.O Card Test. The sampling device containing sHIV-1 Ab was stored at 6°C for 60 days, with intermittent testing on days 2, 5, 10, 20, 30, and 60. Regression analysis was done to assess the relationship between the presence of sHIV-1 Ab and independent variables.

Results: The sensitivity and the specificity of detecting sHIV-1 Ab were 72.9% (95% CI: 63.92%-80.65%) and 100% (95% CI: 92.89%-100.00%), respectively. The presence of opportunistic infections (AOR = 13.1, p < 0.001), having stomatorrhagia (AOR = 4.56, p = 0.0022), and hyperviremia (> 201 copies/mL) (AOR = 4.91, p = 0.0225) heightened sHIV-1 Ab detection. Furthermore, fatigue (AOR = 12.1, p = 0.0024), fever (AOR = 3.5, p = 0.0144), and weight loss (AOR = 10.9, p = 0.0318) increased the odds of having sHIV-1 Ab in persons living with HIV (PLWHIV). sHIV-1 Ab was identified in over 90% of PLWHIV with opportunistic infections (OIs) and stomatorrhagia, OIs and hyperviremia, and stomatorrhagia and hyperviremia. Upon storage for 60 days, the sHIV-1 Ab was detected in all the samples.

Conclusion: Saliva could be an alternative to blood for diagnosing HIV. In addition, the Self-Lollisponge device was found to be user-friendly, acquiescent to all settings, and cheap, and can preserve sHIV-1 Ab for at least 60 days.

Background: Activation of the IL-23/IL-17 cytokine axis could trigger peri-implant bone loss. The aim of this review was to analyze whether in people with peri-implantitis (PI) and peri-implant mucositis (PM) the concentrations of the interleukin-23 and interleukin-17 in peri-implant crevicular fluid (PICF) are elevated compared to people with healthy dental implants (HDI).

Methodology: The protocol of this study was registered in OSF (ID: 10.17605/OSF.IO/U8NBQ) and followed PRISMA guidelines. PECO criteria were used to formulate the research question. A search strategy was performed using PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar until November 15, 2024. A rigorous evaluation was performed, and the JBI tool was used to assess the quality of the cross-sectional and case-control studies.

Results: Fourteen observational studies were included in this study, with a total of 587 participants carrying 601 dental implants. The control group was represented by 252 healthy implants, while the exposure group was represented by 113 implants with PM and 236 implants with peri-implantitis. The age range of the subjects varied from 40.8 to 68.6 years, with a mean age ± standard deviation of 53.9 ± 9.9 years. The concentration of the IL-23/IL-17 cytokine axis and isoforms (IL-17E and IL-17F) was higher in subjects with peri-implant disease compared to the healthy population. Most of the studies (92.8%) showed moderate quality.

Conclusions: The concentrations of cytokines IL-23, IL-17, and IL-17E in PICF were higher in PI-affected dental implants, followed by PM-affected dental implants compared to HDI.

Background: Carbapenem-resistant Enterobacteriaceae (CRE) has increasingly become a global health problem, and the drug resistance and epidemiology of its infection are important for disease prevention and control.

Methods: The CRE isolates detected in the hospital from July 2021 to April 2023 were collected, then the antibiotic sensitivity was detected by an automatic microbial analyzer. Polymerase chain reaction (PCR) was performed to detect carbapenem-resistance genes. The homology and epidemiological characteristics of the strains of Enterobacteriaceae were analyzed by repeated common sequence PCR(ERIC-PCR).

Results: A total of 94 non-repeating CRE isolates were collected mainly from the respiratory tract (67.02%) and urinary tract (22.34%). Among these, 73 strains (77.66%) were carbapenem-resistant Klebsiella pneumoniae (CRKP), while 21 strains (22.34%) were carbapenem-resistant Escherichia coli (CREC). Antibiotic susceptibility testing revealed a low resistance rate to tigecycline (2.13%). Analysis of CRE resistance genes demonstrated that blaKPC accounted for 93.15% of CRKP isolates (68/73), while blaNDM was present in 90.48% of CREC isolates (19/21). In the homology analysis, CRKP isolates were divided into five clusters with C_KP type representing the majority at 80.82% prevalence (59/73). Similarly, CREC could be classified into four clusters with A_EC type being predominant at 80.95% among the isolated strains (17/21). The detection of CRE strains involved multiple departments in two separate wards of this hospital, located approximately 28 km from each other.

Conclusions: CRE infection in this hospital has high homology and wide distribution; it is necessary to strengthen prevention and control measures to control CRE nosocomial infection spread.