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Enzymatic detection of α-hydroxybutyrate, an important marker of insulin resistance, and comparison with LC-MS/MS detection 酶法检测胰岛素抵抗的重要标志物--α-羟丁酸,并与 LC-MS/MS 检测进行比较
IF 1.9 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00398
Beate Steiner , Christian Leitner , David Stadler , Eva-Maria Prugger , Christoph Magnes , Peter L. Herzog

Aim

The metabolite α-hydroxybutyrate (α-HB) is an important marker of insulin resistance and impaired glucose tolerance allowing to identify patients at risk of developing diabetes and related metabolic disorders before any symptoms become apparent. At present, its exact quantification requires mass spectrometry (LC-MS), which is not compatible with routine laboratory use. Accordingly, a simple enzymatic-based method was assessed and its applicability and measuring accuracy compared with LC-MS was investigated.

Methods

Standards, serum, and plasma samples containing α-HB were prepared with routine procedures and their α-HB contents measured with the XpressGT® enzymatic test kit photometrically or with LC-MS and multiple reaction monitoring.

Results

α-HB detection with XpressGT® yielded highly linear calibration curves and 102 % recovery of stocks added to commercial samples. Stability of the analyte in serum and plasma samples prepared with various anti-coagulants was >90 % after 46 h for several widely used preparations and recovery after 3 freeze-thaw cycles was ≥95 % with these anti-coagulants. A direct comparison of 75 samples indicated very good agreement of α-HB levels determined by both methods, 86 % of XpressGT® samples being within ±20 % of LC-MS values and even 93 % within ±20 % considering only samples above 30 μM concentration.

Conclusion

XpressGT®-based detection of α-HB is an easily applicable method which can be used for accurate and reliable quantification of the metabolite in clinical practice. Routine α-HB determination in patients at risk of developing diabetes would allow early establishment of preventive measures or pharmacological intervention reducing the risk for the onset of serious diabetes-related health problems.

目的代谢物α-羟丁酸(α-HB)是胰岛素抵抗和葡萄糖耐量受损的重要标志物,可在症状明显之前识别出有患糖尿病和相关代谢紊乱风险的患者。目前,α-HB 的精确定量需要使用质谱法(LC-MS),这不符合实验室的常规使用要求。方法用常规程序制备含 α-HB 的标准、血清和血浆样品,用 XpressGT® 酶法检测试剂盒光度法或 LC-MS 和多反应监测法测定其 α-HB 含量。在使用各种抗凝剂制备的血清和血浆样品中,分析物在几种广泛使用的制剂中的稳定性在 46 小时后达到 90%,在使用这些抗凝剂进行 3 次冻融循环后的回收率≥95%。对 75 份样本进行的直接比较表明,两种方法测定的 α-HB 含量非常一致,86% 的 XpressGT® 样品在 LC-MS 值的±20%范围内,甚至 93% 在±20%范围内(仅考虑浓度高于 30 μM 的样本)。对有患糖尿病风险的患者进行常规的 α-HB 检测,可以及早制定预防措施或进行药物干预,降低出现严重糖尿病相关健康问题的风险。
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引用次数: 0
Seasonal variation of HbA1c levels in diabetic and non-diabetic patients 糖尿病患者和非糖尿病患者 HbA1c 水平的季节性变化
IF 1.9 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00396
Sana Ahuja , Sugandha Sugandha , Rohit Kumar , Sufian Zaheer , Mukul Singh

Background

Hemoglobin A1c (HbA1c) serves as a pivotal marker for long-term glycemic control. The Diabetes Control and Complications Trial (DCCT) established its relevance, yet gaps exist in understanding potential seasonal variations in HbA1c levels among diabetic patients. The study highlights the need to explore potential seasonal variations in HbA1c levels and their impact on diabetic patients.

Materials and methods

This is an observational study conducted in a tertiary care hospital from January to December 2019, the study analyzed HbA1c levels in 8138 patients. Blood samples were collected using Potassium EDTA-containing vials and processed with an automated analyzer. Seasonal variations were explored using time series analysis.

Results

Mean HbA1c levels peaked during the monsoon (June to September) and were lowest in autumn (October to November). Subgroup analysis revealed differences in patients with HbA1c values below and above 6.5 %. Those with controlled blood sugar showed higher levels in winter (December to February) and monsoon (June to September), while patients with HbA1c values ≥ 6.5 % exhibited significantly lower levels in monsoon (June to September) and autumn (October to November) compared to summer (March to May).

Conclusion

In contrast to global trends, Indian patients demonstrated distinct seasonal variations in HbA1c levels. The highest levels during the monsoon (June to September) may be linked to reduced outdoor activity and dietary changes. The study emphasizes the need for tailored diabetes management considering seasonal influences. Further extensive, longitudinal studies across diverse Indian regions are recommended to comprehensively grasp the impact of seasonal changes on diabetes outcomes.

背景血红蛋白 A1c(HbA1c)是长期血糖控制的关键指标。糖尿病控制与并发症试验(DCCT)确定了其相关性,但在了解糖尿病患者 HbA1c 水平的潜在季节性变化方面仍存在差距。本研究强调了探索 HbA1c 水平潜在季节性变化及其对糖尿病患者影响的必要性。材料和方法这是一项观察性研究,于 2019 年 1 月至 12 月在一家三级医院进行,研究分析了 8138 名患者的 HbA1c 水平。使用含 EDTA 钾的血瓶采集血样,并用自动分析仪进行处理。结果 平均 HbA1c 水平在季风季节(6 月至 9 月)达到峰值,在秋季(10 月至 11 月)最低。亚组分析显示,HbA1c 值低于 6.5 % 和高于 6.5 % 的患者之间存在差异。血糖得到控制的患者在冬季(12 月至次年 2 月)和季风季节(6 月至 9 月)的血糖水平较高,而 HbA1c 值≥ 6.5 % 的患者在季风季节(6 月至 9 月)和秋季(10 月至 11 月)的血糖水平明显低于夏季(3 月至 5 月)。季风季节(6 月至 9 月)的 HbA1c 水平最高,这可能与户外活动减少和饮食变化有关。这项研究强调,有必要考虑季节性影响因素,对糖尿病进行有针对性的管理。建议在印度不同地区进一步开展广泛的纵向研究,以全面掌握季节变化对糖尿病结果的影响。
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引用次数: 0
HPLC and flow cytometry combined approach for HbF analysis in fetomaternal haemorrhage evaluation 采用高效液相色谱法和流式细胞术相结合的方法分析胎儿产妇出血评估中的 HbF
IF 1.9 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00401
Benedetta Peruzzi , Serena Guerrieri , Tiziana Biagioli , Luisa Lanzilao , Sara Pratesi , Sara Bencini , Marinella Statello , Alessia Carraresi , Stefania Stefanelli , Martina Tonelli , Marco Brogi , Manuela Capone , Alessio Mazzoni , Anna Maria Grazia Gelli , Alessandra Fanelli , Roberto Caporale , Francesco Annunziato

Introduction

Recently, a flow cytometric (FC) based test has been developed for detection of circulating fetal cells to replace the less accurate and reproducible Kleihauer-Betke test.

FC test is easier to perform, it can distinguish the origin of fetal cells, but it is expensive and available in highly specialized laboratories. We evaluated the introduction of high-performance liquid chromatography (HPLC) approach as initial screening to identify patients who need an additional FC test to better discriminate the nature of haemoglobin-F (HbF) positive cells.

Methods

Blood samples from 130 pregnant women suspected to have fetomaternal haemorrhage were analysed with HPLC and FC methods. The cut-off for HbF HPLC concentration was calculated. Statistical analyses for the evaluation of HPLC as a screening method were performed. The positivity cut-off of HbF to be used as decision-making value to continue the investigation was calculated.

Results

An excellent agreement (R2 > 0.90) was observed between the percentage of HbF obtained by HPLC and the percentage of fetal cells detected by FC. Results obtained from each assay were compared to define the HPLC threshold below which it is not necessary to continue the investigations, confirming the maternal nature of the HbF positive cells detected. Our study demonstrated that a cut-off of 1.0 % HbF obtained by HPLC was associated with the lowest rate of false negative results in our patient cohort.

Conclusions

This study provides a new FMH investigation approach that possibly leads to a reduction in times and costs of the analysis.

导言最近,一种基于流式细胞术(FC)的检测方法被开发出来,用于检测循环中的胎儿细胞,以取代准确性和可重复性较低的克雷豪尔-贝特克检测方法。FC检测方法更易于操作,可区分胎儿细胞的来源,但其价格昂贵,且只能在高度专业化的实验室中使用。我们评估了采用高效液相色谱法(HPLC)进行初步筛查的方法,以确定哪些患者需要进行额外的 FC 检验,从而更好地鉴别血红蛋白-F(HbF)阳性细胞的性质。计算出 HbF HPLC 浓度的临界值。对高效液相色谱法作为筛查方法的评估进行了统计分析。结果 HPLC 检测到的 HbF 百分比与 FC 检测到的胎儿细胞百分比之间的一致性非常好(R2 > 0.90)。通过比较每种检测方法得出的结果,确定了 HPLC 临界值,低于该临界值则无需继续检测,从而确认了检测到的 HbF 阳性细胞的母体性质。我们的研究表明,在我们的患者队列中,HPLC 检测出的 HbF 临界值为 1.0%,假阴性结果率最低。
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引用次数: 0
The Italian external quality assessment program for Cystic Fibrosis sweat chloride test: CFTR modulators and the impact of a new sweat test report form 意大利囊性纤维化汗液氯化物检测外部质量评估计划:CFTR 调节剂和新汗液检测报告表的影响
IF 1.9 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00403
Natalia Cirilli , Giovanna Floridia , Annalisa Amato , Rita Padoan , Federica Censi , Gianluca Ferrari , Valeria Raia , Giuseppe Castaldo , Ettore Capoluongo , Domenica Taruscio , Marco Salvatore

Background

The advent of CFTR modulators highlighted that the sweat test (ST) for CF can be used also as an outcome measure for the basic defect of CFTR. Despite the technological advances, ST still remains operator-dependent and its execution should be strongly paired with guidelines. In 2022, due to the advent of CFTR modulators, the Italian CF Society introduced a specific ST report. The aim of the present paper is to discuss the impact of this new report in the 2022-23 round of the Italian External Quality Assessment program for ST (I-EQA-SCT).

Methods

The scheme of the I-EQA-SCT is prospective, enrolment is voluntary, the payment of a fee is required and results are shared through a web-facility. Assessment covers analysis, interpretation, and reporting of results. In the 2022-23 round, 2 out of the 3 mock clinical information referred to patients who started modulators.

Results

Fourteen laboratories completed the 2022-23 I-EQA-SCT round. Three of them failed in the interpretation of results from these two mock cases and/or used a wrong report not consistent with the more recent Italian Sweat Test Recommendations.

Conclusions

The overall results obtained from the laboratories involved in the I-EQA-SCT program clearly showed that the laboratories’ qualitative and quantitative performance improved significantly. Results emerged from this round highlighted an issue in the report form used for monitoring patients on CFTR modulator therapy thus stressing the importance of these programs in improving both the performance of lab services and ameliorating the sweat test recommendations.

背景CFTR调节剂的出现突出表明,CF的出汗试验(ST)也可用作CFTR基本缺陷的结果测量。尽管技术不断进步,但出汗试验仍依赖于操作者,其执行应严格遵循相关指南。2022 年,由于 CFTR 调节剂的出现,意大利 CF 协会推出了专门的 ST 报告。本文旨在讨论这一新报告在 2022-23 年度意大利 ST 外部质量评估计划(I-EQA-SCT)中的影响。方法 I-EQA-SCT 计划是前瞻性的,注册是自愿的,需要付费,结果通过网络设施共享。评估包括结果的分析、解释和报告。结果14家实验室完成了2022-23年度的I-EQA-SCT。结论参与I-EQA-SCT项目的实验室所获得的总体结果清楚地表明,实验室的定性和定量能力均有显著提高。这一轮得出的结果突出了用于监测接受 CFTR 调节剂治疗的患者的报告表中存在的一个问题,因此强调了这些计划在提高实验室服务质量和改善汗液检测建议方面的重要性。
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引用次数: 0
Reference intervals of Cyfra21-1 and CEA in healthy adult Han Chinese population 健康成年汉族人群中 Cyfra21-1 和 CEA 的参考区间
IF 1.9 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00409
Lidan Xing , Shuai Zhao , Shichao Gao, Xiaoqian Shi, Yaomeng Huang, Puhuan Bian, Jingna Sun

Objective

This study aimed to establish the reference intervals of Cyfra21-1 and CEA for the local screening populations using a chemiluminescence method.

Methods

A total of 4845 healthy adults and 190 lung cancer patients were included from the First Hospital of Hebei Medical University. The levels of Cyfra21-1 and CEA were measured to establish the local reference intervals.

Results

The upper limit reference intervals for Cyfra21-1 and CEA were determined as 3.19 ng/ml and 3.13 ng/ml, respectively. Notably, both Cyfra21-1 and CEA levels were found to be higher in males than in females. Additionally, both biomarkers showed an increasing trend with age.

In terms of diagnostic efficacy, the receiver operating characteristic (ROC) curve areas for Cyfra21-1, CEA, and their combination in lung cancer were 0.86, 0.73, and 0.91, respectively.

Conclusion

Our study revealed that the reference intervals of Cyfra21-1 and CEA in the local population differed from the established reference intervals. Furthermore, both biomarkers exhibited gender-dependent variations and demonstrated a positive correlation with age. Combining the two biomarkers showed potential for improving the diagnosis rate of lung cancer.

方法 选取河北医科大学第一医院4845名健康成人和190名肺癌患者作为研究对象,采用化学发光法测定Cyfra21-1和CEA的含量,以确定当地筛查人群Cyfra21-1和CEA的参考区间。结果 Cyfra21-1和CEA的参考值上限分别为3.19 ng/ml和3.13 ng/ml。值得注意的是,男性的 Cyfra21-1 和 CEA 水平均高于女性。结论我们的研究表明,本地人群中 Cyfra21-1 和 CEA 的参考区间与既定的参考区间存在差异。此外,这两种生物标志物都表现出性别差异,并与年龄呈正相关。将这两种生物标志物结合起来,有望提高肺癌的诊断率。
{"title":"Reference intervals of Cyfra21-1 and CEA in healthy adult Han Chinese population","authors":"Lidan Xing ,&nbsp;Shuai Zhao ,&nbsp;Shichao Gao,&nbsp;Xiaoqian Shi,&nbsp;Yaomeng Huang,&nbsp;Puhuan Bian,&nbsp;Jingna Sun","doi":"10.1016/j.plabm.2024.e00409","DOIUrl":"https://doi.org/10.1016/j.plabm.2024.e00409","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to establish the reference intervals of Cyfra21-1 and CEA for the local screening populations using a chemiluminescence method.</p></div><div><h3>Methods</h3><p>A total of 4845 healthy adults and 190 lung cancer patients were included from the First Hospital of Hebei Medical University. The levels of Cyfra21-1 and CEA were measured to establish the local reference intervals.</p></div><div><h3>Results</h3><p>The upper limit reference intervals for Cyfra21-1 and CEA were determined as 3.19 ng/ml and 3.13 ng/ml, respectively. Notably, both Cyfra21-1 and CEA levels were found to be higher in males than in females. Additionally, both biomarkers showed an increasing trend with age.</p><p>In terms of diagnostic efficacy, the receiver operating characteristic (ROC) curve areas for Cyfra21-1, CEA, and their combination in lung cancer were 0.86, 0.73, and 0.91, respectively.</p></div><div><h3>Conclusion</h3><p>Our study revealed that the reference intervals of Cyfra21-1 and CEA in the local population differed from the established reference intervals. Furthermore, both biomarkers exhibited gender-dependent variations and demonstrated a positive correlation with age. Combining the two biomarkers showed potential for improving the diagnosis rate of lung cancer.</p></div>","PeriodicalId":20421,"journal":{"name":"Practical Laboratory Medicine","volume":"40 ","pages":"Article e00409"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352551724000556/pdfft?md5=93f0cacdcc571aef9f87336ce0e449d5&pid=1-s2.0-S2352551724000556-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141239036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unified calibration of D-dimer can improve the uniformity of different detection systems 统一校准 D-二聚体可提高不同检测系统的一致性
IF 1.9 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00413
Kun Wang , Xinwei Zang , Wenjie Zhang , Xiangyu Cao , Huiru Zhao , Chunyan Li , Cuiying Liang , Jun Wu

Background

D-dimer at a low level is important evidence for excluding the onset and progression of thrombosis. It is readily detectable and yields rapid results, although significant variability exists among different detection systems. Our study aims to enhance the consistency across various detection systems.

Methods

Twelve detection systems were included in our study. We sought to address this inconsistency by using various calibrators (two supplied by manufacturers and two comprising pooled human plasma diluted with different diluents) to standardize D-dimer measurements. We categorized the data into three groups according to D-dimer concentration levels: low (≤0.5 mg/L), medium (>0.5 mg/L - <3 mg/L), and high (≥3 mg/L). We then analyzed the data focusing on range, consistency, comparability, negative coincidence rate, and false negative rate.

Results

Calibrating with pooled human plasma led to narrower result ranges in the low and medium groups (P < 0.05). In the low group, consistency improved from weak to strong (ICC 0.4–0.7, P﹤0.05), while it remained excellent in the other groups and overall (ICC﹥0.75, P﹤0.05). The percentage of pairwise comparability increased in both the low and high groups. Additionally, there was an increase in the negative coincidence rate.

Conclusion

These findings demonstrate that uniform calibration of D-dimer can significantly enhance the consistency of results across different detection systems.

背景低水平二聚体是排除血栓开始和发展的重要证据。尽管不同的检测系统之间存在很大差异,但二聚体很容易被检测到,而且能快速得出结果。我们的研究旨在提高不同检测系统之间的一致性。为了解决这种不一致性,我们使用了不同的校准物(两种由生产商提供,两种由用不同稀释剂稀释的集合人血浆组成)来标准化 D-二聚体的测量。我们根据 D-二聚体浓度水平将数据分为三组:低(≤0.5 mg/L)、中(0.5 mg/L - 3 mg/L)和高(≥3 mg/L)。然后,我们对数据进行了分析,重点关注范围、一致性、可比性、阴性重合率和假阴性率。结果用集合人血浆校准后,低组和中组的结果范围更窄(P <0.05)。在低组中,一致性由弱变强(ICC 0.4-0.7,P﹤0.05),而在其他组和总体中,一致性仍然很好(ICC﹥0.75,P﹤0.05)。在低分组和高分组中,配对可比性的百分比都有所增加。结论这些研究结果表明,D-二聚体的统一校准可显著提高不同检测系统结果的一致性。
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引用次数: 0
Performance verification and clinical evaluation of the NAP-Fluo Cycler system for detecting five genital tract pathogens based on microfluidic technology 基于微流控技术检测五种生殖道病原体的 NAP-Fluo Cycler 系统的性能验证和临床评估
IF 1.7 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00417
Ye Wang , Qunshan Xu , Jianguo Cai , Lijin Zheng , Weilun Zuo , Jumei Liu , Jiali Cao , Mingxin Lin , Hongli Liu , Huiming Ye

Introduction

Sexually transmitted infections (STIs) are among the most common infectious diseases worldwide, often leading to coinfections. Timely detection of genital tract pathogens in at-risk populations is crucial for preventing STIs. We evaluated the NAP-Fluo Cycler System, an innovative microfluidic nucleic acid detection platform, for its ability to simultaneously identify Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Ureaplasma urealyticum (UU), Mycoplasma genitalium (MG), and Mycoplasma hominis (MH) in urethral or cervical secretions.

Materials and methods

The limits of detection (LODs), repeatability, specificity, and interference resistance of the system were evaluated using standard strains, a panel of 24 pathogens, and seven interferents. We used the system to analyze 302 clinical samples and compared the results with those of five approved commercial reference kits.

Results

The system achieved LODs of 500 IFU/mL, 500 CFU/mL, and 500 CCU/mL for CT, NG, and UU/MG/MH, respectively, demonstrating high stability (coefficient of variation <1.1 %), specificity, and resistance to interference. Among 302 clinical samples, 237 tested positive with single, dual, and triple infection rates of 35.6 %, 16.2 %, and 3.0 %, respectively. The reference kits detected 138 positive samples. The concordance rates with commercial reference kits were 100 % for UU, NG, and MH; 94.85 % for CT; and 80.00 % for MG.

Conclusions

This system offers a streamlined, rapid, and multiplex detection method that reduces testing time and complexity. Although it performs well with pure strains, it has limitations when using clinical samples of CT and MG, suggesting the need for further refinement before its widespread use in the clinic.

导言性传播感染(STI)是全球最常见的传染病之一,常常导致合并感染。在高危人群中及时检测生殖道病原体对预防性传播疾病至关重要。我们评估了创新型微流控核酸检测平台 NAP-Fluo Cycler 系统同时鉴定尿道或宫颈分泌物中沙眼衣原体 (CT)、淋病奈瑟菌 (NG)、解脲支原体 (UU)、生殖支原体 (MG) 和人型支原体 (MH) 的能力。材料与方法使用标准菌株、24 种病原体和 7 种干扰物对该系统的检测限(LOD)、重复性、特异性和抗干扰性进行了评估。结果该系统对 CT、NG 和 UU/MG/MH 的检出限分别为 500 IFU/mL、500 CFU/mL 和 500 CCU/mL,显示出很高的稳定性(变异系数<1.1 %)、特异性和抗干扰性。在 302 份临床样本中,237 份检测结果呈阳性,单感染率、双感染率和三感染率分别为 35.6 %、16.2 % 和 3.0 %。参考试剂盒检测出 138 份阳性样本。UU、NG 和 MH 与商用参考试剂盒的吻合率为 100%;CT 为 94.85%;MG 为 80.00%。虽然该系统在检测纯菌株时表现良好,但在使用 CT 和 MG 临床样本时存在局限性,这表明该系统在广泛应用于临床之前还需要进一步改进。
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引用次数: 0
A genetic condition that spans both extremes of the nutritional spectrum 一种跨越营养范围两个极端的遗传病
IF 1.9 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00405
Lisa M. Johnson

Prader-Willi syndrome (PWS) is a complex genetic disorder caused by lack of expression of genes on the paternally inherited chromosome 15q11.2-q13 region, known as the Prader Willi critical region. Nutritional clinical manifestations change with age and are described in four different phases. The phases span both extremes of the nutritional spectrum, beginning with an infant with poor sucking reflexes and failure to thrive then progressing to an adolescent who may have hyperphagia and be at risk for obesity. The phenotype is likely due to hypothalamic dysfunction due to genetic changes in the Prader Willi critical region. Researchers are examining the pathological mechanisms that determine the disease course.

普拉德-威利综合征(PWS)是一种复杂的遗传性疾病,是由于父方遗传的染色体 15q11.2-q13 区(即普拉德-威利临界区)上的基因缺乏表达所致。营养临床表现会随着年龄的增长而变化,并分为四个不同的阶段。这些分期跨越了营养谱的两个极端,从吸吮反射差、无法茁壮成长的婴儿开始,到可能有多食和肥胖风险的青少年。这种表型很可能是由于普拉德-威利临界区的遗传变化导致下丘脑功能障碍所致。研究人员正在研究决定疾病进程的病理机制。
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引用次数: 0
Beyond the fractures: A comprehensive Comparative analysis of Affordable and Accessible laboratory parameters and their coefficients for prediction and Swift confirmation of pulmonary embolism in high-risk orthopedic patients 骨折之外:全面比较分析高风险骨科患者肺栓塞的可负担和可获得的实验室参数及其预测和 Swift 确认系数
IF 1.9 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00397
Piotr Piech , Mateusz Haratym , Bartosz Borowski , Robert Węgłowski , Grzegorz Staśkiewicz

Background

Pulmonary embolism (PE) poses a significant challenge in diagnosis and treatment, particularly in high-risk patient populations such as those hospitalized for orthopedic reasons. This study explores the predictive and diagnostic potential of laboratory parameters in identifying PE among orthopedic patients.

Objectives

The purpose of this study was to determine whether selected (inexpensive and readily available) laboratory parameters and their coefficients can be used to diagnose pulmonary embolism and whether they are applicable in predicting its occurrence.

Material and methods

Selected laboratory parameters were determined twice in 276 hospitalized orthopedic patients with suspected PE: PLT, MPV, NEU, LYM, D-dimer, troponin I, age-adjusted D-dimer and their coefficients. Depending on the angio-CT results, patients were divided into groups. Selected popular laboratory coefficients were calculated and statistically analyzed. Optimal cutoff points were determined for the above laboratory tests and ROC curves were plotted.

Results

D-dimer/troponin I [p = 0.008], D-dimer [p = 0.001], age-adjusted D-dimer [p = 0.007], NLR/D-dimer [p = 0.005] and PLR [p = 0.021] are statistically significant predictors of PE. D-dimer/troponin I [p < 0.001], troponin I [p = 0.005] and age-adjusted D-dimer [p = 0.001] correlated with the diagnosis of PE after the onset of clinical symptoms.

Conclusions

In the context of orthopedic patients, cost-effective laboratory parameters, particularly the D-dimer/troponin I ratio and age-adjusted D-dimer, exhibit considerable potential in predicting and diagnosing PE. These findings suggest that combining readily available laboratory tests with clinical observation can offer a viable and cost-effective diagnostic alternative, especially in resource-constrained settings. Further studies with larger and diverse patient populations are recommended to validate these results.

背景肺栓塞(PE)给诊断和治疗带来了巨大挑战,尤其是在高危患者人群中,如因骨科原因住院的患者。本研究探讨了实验室参数在识别骨科患者肺栓塞方面的预测和诊断潜力。目的本研究的目的是确定选定的(廉价且容易获得的)实验室参数及其系数是否可用于诊断肺栓塞,以及是否可用于预测肺栓塞的发生。材料和方法对 276 名疑似肺栓塞的住院骨科患者进行了两次选定实验室参数的测定:PLT、MPV、NEU、LYM、D-二聚体、肌钙蛋白 I、年龄调整后的 D-二聚体及其系数。根据血管造影 CT 的结果,将患者分为不同的组别。对选定的常用实验室系数进行计算和统计分析。结果 D-二聚体/肌钙蛋白 I [p = 0.008]、D-二聚体[p = 0.001]、年龄调整后的 D-二聚体[p = 0.007]、NLR/D-二聚体[p = 0.005]和 PLR [p = 0.021]是预测 PE 的有统计学意义的指标。结论 在骨科患者中,具有成本效益的实验室参数,尤其是 D-二聚体/肌钙蛋白 I 比值和年龄调整后的 D-二聚体,在预测和诊断 PE 方面具有相当大的潜力。这些研究结果表明,将现成的实验室检测与临床观察相结合,可提供一种可行且具有成本效益的诊断替代方法,尤其是在资源有限的情况下。为了验证这些结果,建议对更多不同的患者群体进行进一步研究。
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引用次数: 0
Dopamine infusion at typical infusion rates does not cause interference on plasma creatinine assays 以典型输注速度输注多巴胺不会对血浆肌酐测定产生干扰
IF 1.9 Q3 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-05-01 DOI: 10.1016/j.plabm.2024.e00399
Jenny Yeuk Ki Cheng , Shreenidhi Ranganatha Subramaniam , Stephanie C.Y. Yu , L.Y. Lois Choy , Jeffrey Sung Shing Kwok

a) Objectives

Dopamine is known to cause negative interference on enzymatic creatinine measurement. However, its effect on the Jaffe reaction, and its concentration required to interfere with enzymatic reactions, remain uncertain. This study was designed to study the interference of stable dopamine infusion on Jaffe and enzymatic creatinine assays, as well as the effect of dopamine infusion drip arm contamination on both creatinine assays.

b) Design and Methods

For the first part of the study, dopamine was spiked into pooled plasma samples at different concentrations to mimic the scenario of patients on dopamine infusion at an infusion rate between 2 and 20 μg/kg/min. For the second part, dopamine preparation of 2 g/L (same as the preparation used clinically) was mixed with pooled plasma samples at different proportions to mimic drip arm contamination. Creatinine concentrations were measured using Jaffe and enzymatic reactions.

c) Results

The first part showed that creatinine measurements were not interfered by dopamine infusion at an infusion rate between 2 and 20 μg/kg/min. The second part showed that dopamine could negatively interfere with enzymatic creatinine assays, even with minute drip arm contamination. The effect on the Jaffe reaction was less significant.

d) Discussion

Creatinine concentration could be reliably measured by Jaffe or enzymatic reactions if samples are from venous access sites other than the site of dopamine infusion. When dopamine interference on enzymatic creatinine assays is suspected, using the Jaffe reaction to cross-check may provide additional useful information.

a) 目的 多巴胺对酶法肌酐测定有负面干扰。然而,多巴胺对贾菲反应的影响以及干扰酶促反应所需的浓度仍不确定。本研究旨在研究稳定输注多巴胺对杰斐反应和酶法肌酐测定的干扰,以及多巴胺输注点滴臂污染对两种肌酐测定的影响。b) 设计与方法在研究的第一部分,将不同浓度的多巴胺添加到集合血浆样本中,以模拟患者以 2 至 20 μg/kg/min 的输注速度输注多巴胺的情况。在第二部分中,将 2 克/升的多巴胺制剂(与临床使用的制剂相同)按不同比例与集合血浆样本混合,以模拟点滴臂污染的情况。c) 结果第一部分显示,多巴胺输注速度在 2 至 20 μg/kg/min 之间时,肌酐测量不受干扰。第二部分显示,多巴胺会对酶法肌酐测定产生负面干扰,即使在滴注臂污染微小的情况下也是如此。d) 讨论如果样本来自多巴胺输注部位以外的静脉通路,则可以通过贾菲反应或酶反应可靠地测定肌酐浓度。当怀疑酶法肌酐测定受到多巴胺干扰时,使用贾菲反应进行交叉检验可提供更多有用信息。
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Practical Laboratory Medicine
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