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Effects of dabigatran, rivaroxaban, and apixaban on fibrin network permeability, thrombin generation, and fibrinolysis. 达比加群、利伐沙班和阿哌沙班对纤维蛋白网络通透性、凝血酶生成和纤维蛋白溶解的影响。
IF 1.3 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-07-01 Epub Date: 2024-07-02 DOI: 10.1080/00365513.2024.2369993
Viktor Schutz Taune, Michal Zabczyk, Shu He, Anna Ågren, Margareta Blombäck, Håkan Wallén, Mika Skeppholm

Introduction: There are important pharmacological differences between direct oral anticoagulants (DOAC) and a deeper knowledge of how they influence different aspects of hemostasis in patients on treatment is desirable.

Materials and methods: Blood samples from patients on dabigatran (n = 23), rivaroxaban (n = 26), or apixaban (n = 20) were analyzed with a fibrin network permeability assay, a turbidimetric clotting and lysis assay, the calibrated automated thrombogram (CAT), plasma levels of thrombin-antithrombin complex (TAT) and D-dimer, as well as DOAC concentrations, PT-INR and aPTT. As a comparison, we also analyzed samples from 27 patients on treatment with warfarin.

Results: Patients on dabigatran had a more permeable fibrin network, longer lag time (CAT and turbidimetric assay), and lower levels of D-dimer in plasma, compared with patients on rivaroxaban- and apixaban treatment, and a more permeable fibrin network than patients on warfarin. Clot lysis time was slightly longer in patients on dabigatran than in patients on rivaroxaban. Warfarin patients formed a more permeable fibrin network than patients on apixaban, had longer lag time than patients on rivaroxaban (CAT assay), and lower peak thrombin and ETP compared to patients on treatment with both FXa-inhibitors.

Conclusions: Results from this study indicate dabigatran treatment is a more potent anticoagulant than apixaban and rivaroxaban. However, as these results are not supported by clinical data, they are probably more related to the assays used and highlight the difficulty of measuring and comparing the effect of anticoagulants.

简介:直接口服抗凝血剂(DOAC)之间存在着重要的药理差异,因此需要更深入地了解这些药物如何影响患者治疗过程中止血的不同方面:直接口服抗凝药(DOAC)之间存在着重要的药理差异,因此需要更深入地了解这些药物如何影响正在接受治疗的患者止血的不同方面:对服用达比加群(23 例)、利伐沙班(26 例)或阿哌沙班(20 例)患者的血样进行了纤维蛋白网络渗透性测定、浊度凝血和裂解测定、校准自动血栓图(CAT)、血浆凝血酶-抗凝血酶复合物(TAT)和 D-二聚体水平以及 DOAC 浓度、PT-INR 和 aPTT 分析。作为对比,我们还分析了27名接受华法林治疗的患者的样本:与接受利伐沙班和阿哌沙班治疗的患者相比,服用达比加群的患者血浆中纤维蛋白网络的渗透性更强,滞后时间(CAT和浊度测定法)更长,D-二聚体水平更低,而服用华法林的患者血浆中纤维蛋白网络的渗透性更强。服用达比加群的患者血栓溶解时间略长于服用利伐沙班的患者。与服用两种FXa抑制剂的患者相比,服用华法林的患者形成的纤维蛋白网络比服用阿哌沙班的患者更具渗透性,滞后时间比服用利伐沙班(CAT检测)的患者更长,凝血酶峰值和ETP更低:本研究结果表明,达比加群比阿哌沙班和利伐沙班的抗凝效果更好。然而,由于这些结果没有得到临床数据的支持,它们可能更多地与所使用的检测方法有关,并凸显了测量和比较抗凝剂效果的难度。
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引用次数: 0
The diagnostic accuracy of quality control rules. 质量控制规则的诊断准确性。
IF 1.3 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-07-01 Epub Date: 2024-05-28 DOI: 10.1080/00365513.2024.2359085
Arne Åsberg, Bjørn Johan Bolann

Internal quality control in clinical chemistry laboratories are based on analyzing samples of stable control materials among the patient samples. The control results are interpreted by using quality control rules that usually are designed to detect systematic errors. The best rules have a high probability of error detection (Ped), i.e. to detect the maximal allowable (critical) systematic error and a low probability of false rejection (Pfr, false alarm). In this work we show that quality control rules can be represented by points on a ROC curve which appears when Ped is plotted against Pfr and only the control limit is varied. Further, we introduce a new method for choosing the optimal control limit, analogous to choosing the optimal operating point on the ROC curve of a diagnostic test. This decision needs knowledge of the pretest probability of a critical systematic error, the benefit of detecting it when it occurs and the cost of false alarm. The ROC curve analysis showed that if rules based on N = 2 are used, mean rules outperform Westgard rules because the ROC curve of the mean rules was lying above the ROC curves of the Westgard rules. A mean rule also had a lower maximum expected increase in the number of unacceptable patient results reported during the presence of an out-of-control error condition (Max E(NUF)) than comparable Westgard rules.

临床化学实验室的内部质量控制以分析病人样本中的稳定对照材料样本为基础。对照结果通过质量控制规则来解释,这些规则通常是为了检测系统误差而设计的。最佳规则具有较高的错误检测概率(Ped),即检测出最大允许(临界)系统误差,以及较低的错误拒绝概率(Pfr,误报)。在这项工作中,我们证明了质量控制规则可以用 ROC 曲线上的点来表示,当 Ped 与 Pfr 相对应时,ROC 曲线上的点就会出现,并且只改变控制限。此外,我们还介绍了一种选择最佳控制限的新方法,类似于选择诊断测试 ROC 曲线上的最佳操作点。这一决策需要了解临界系统误差的测试前概率、发生误差时检测到误差的收益以及误报的成本。ROC 曲线分析表明,如果使用基于 N = 2 的规则,平均值规则优于 Westgard 规则,因为平均值规则的 ROC 曲线位于 Westgard 规则的 ROC 曲线之上。此外,平均值规则在出现失控错误条件时报告的不可接受的病人结果数量的最大预期增加值(Max E(NUF))也低于同类 Westgard 规则。
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引用次数: 0
Impact of breast cancer neoadjuvant chemotherapy on plasma and urine amino acid profile, plasma proteins and nitrogen metabolism. 乳腺癌新辅助化疗对血浆和尿液氨基酸谱、血浆蛋白和氮代谢的影响
IF 1.3 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-07-01 Epub Date: 2024-06-27 DOI: 10.1080/00365513.2024.2369982
Milan Dastych, Miloš Holánek, Jana Gottwaldová, Zdenka Čermáková, Alena Mikušková

Neoadjuvant chemotherapy (NAC) is the preferred treatment option in locally advanced breast cancer (BC). The administration of NAC is associated with a wide range of adverse effects. This pilot observational prospective study examined the effect of NAC using anthracycline + cyclophosphamide (AC) followed by paclitaxel (PTx) on a portfolio of 22 plasma and urinary amino acids, plasma proteins (albumin, prealbumin, transferrin), and products of nitrogen metabolism (urea, creatinine, uric acid) in plasma and urine. Plasma and 24-h urine samples were obtained from ten patients with early breast cancer (N1-3 N0-2 M0), at the following time points: before the start of NAC and during the AC/PTx treatment period (a total of 8 measurements at three-weekly intervals). Amino acids were analyzed using ion exchange chromatography. There were no significant differences in the measured parameters in plasma and urine between pre-NAC and during AC- and PTx-treatment. No trend was detected. A significant difference in the portfolio of plasma and urinary amino acids was found only in the pre-treatment period compared to the control group. Levels of eight plasma amino acids (8/22) were significantly reduced and those of nine urine amino acids were increased (9/22). Nitrogenous catabolites in plasma and urine were not indicative of increased protein catabolism during the anthracycline and taxane treatment periods. A slightly positive nitrogen balance was accompanied by an average weight gain of 3.3 kg (range 0-6 kg). The AC/PTx treatment regimen did not cause significant changes in the monitored laboratory parameters.

新辅助化疗(NAC)是局部晚期乳腺癌(BC)的首选治疗方案。新辅助化疗与多种不良反应相关。这项试点观察性前瞻性研究考察了使用蒽环类+环磷酰胺(AC)和紫杉醇(PTx)的新辅助化疗对血浆和尿液中的 22 种氨基酸、血浆蛋白(白蛋白、前白蛋白、转铁蛋白)和氮代谢产物(尿素、肌酐、尿酸)的影响。十名早期乳腺癌患者(N1-3 N0-2 M0)在以下时间点采集了血浆和 24 小时尿液样本:开始接受 NAC 治疗前和 AC/PTx 治疗期间(共 8 次测量,每次间隔三周)。氨基酸采用离子交换色谱法进行分析。在 NAC 治疗前、AC 和 PTx 治疗期间,血浆和尿液中的测量参数没有明显差异。未发现任何趋势。只有在治疗前,血浆和尿液中的氨基酸组合与对照组相比有明显差异。八种血浆氨基酸(8/22)的水平显著降低,九种尿液氨基酸(9/22)的水平显著升高。在蒽环类和紫杉类药物治疗期间,血浆和尿液中的含氮代谢物并不表明蛋白质代谢增加。氮平衡略呈正值的同时,平均体重增加了 3.3 千克(范围为 0-6 千克)。AC/PTx 治疗方案并未导致监测到的实验室参数发生显著变化。
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引用次数: 0
Evaluation of a flow cytometry-based method for determination of T-lymphocyte subtypes for quality assessment of cell therapy products. 评估基于流式细胞仪的 T 淋巴细胞亚型测定方法,用于细胞治疗产品的质量评估。
IF 1.3 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-07-01 Epub Date: 2024-07-14 DOI: 10.1080/00365513.2024.2377961
Vladimira Rimac, Ines Bojanić, Nikolina Blažević, Koraljka Gojčeta

Chimeric antigen receptor-T (CAR-T) cell therapy is currently the best-known type of immune effector cells therapy. For CAR T-cell therapy, the determination of CD3+ T cells is necessary for the quality control of fresh leukapheresis product as starting material. The aim was to validate analytical method for quantification of percentage and absolute count of T lymphocyte subtypes (CD3+, CD4+ and CD8+ cells) in fresh apheresis products using single-platform method on flow cytometer BD FACS Canto II. Validation study included determination of precision, trueness (bias), assessment of linearity, carryover, comparison of results obtained with two different protocols on flow cytometer for CD3+ cells determination and stability study. For between-run precision coefficients of variation (CVs) were <20%, as well as bias for all T-lymphocyte subtypes. For within-run precision, CVs were <10%, except for low CD8+ cell (percentage 10.51% and viable absolute count 12.37%). Comparison of results obtained with two different protocols for CD3+ cells determination shows no statistically significant difference. Statistically significant differences between results of the analysis of CD4+ cells in fresh samples and results obtained after storage at 4 °C (p = .004) and at room temperature (p = .018) were found. In conclusion, method for enumeration of T-lymphocyte subtypes can be used in routine work on BD FACS Canto II instrument for quality assessment of fresh cell products collected by leukapheresis procedure.

嵌合抗原受体-T(CAR-T)细胞疗法是目前最著名的免疫效应细胞疗法。对于 CAR T 细胞疗法来说,CD3+ T 细胞的测定对于作为起始材料的新鲜白细胞产品的质量控制是必要的。目的是在 BD FACS Canto II 流式细胞仪上使用单平台方法验证定量新鲜白细胞采集产物中 T 淋巴细胞亚型(CD3+、CD4+ 和 CD8+ 细胞)百分比和绝对计数的分析方法。验证研究包括测定精确度、真实度(偏差)、线性评估、携带、比较两种不同的流式细胞仪测定 CD3+ 细胞的方案所获得的结果以及稳定性研究。结果发现,运行间精密度(CVs)为 p = .004,室温下精密度(CVs)为 p = .018。总之,T淋巴细胞亚型的计数方法可用于 BD FACS Canto II 仪器的常规工作中,以评估通过白细胞清除程序收集的新鲜细胞产品的质量。
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引用次数: 0
Diagnosing sucrase-isomaltase deficiency: a comparison of a 13C-sucrose breath test and a duodenal enzyme assay. 诊断蔗糖酶-异麦芽糖酶缺乏症:13C-蔗糖呼气试验与十二指肠酶测定法的比较。
IF 1.3 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-07-01 Epub Date: 2024-07-10 DOI: 10.1080/00365513.2024.2377960
Hanna Fjeldheim Dale, Milada Hagen, Chirajyoti Deb, Viggo Skar, Jørgen Valeur

Background: Reduced activity of the sucrase-isomaltase (SI) enzyme can cause gastrointestinal symptoms. Biochemical measurement of SI activity in small intestinal biopsies is presently considered the gold standard for the diagnosis of SI deficiency, but this invasive test is not suitable as a routine diagnostic tool.

Aim: To evaluate a 13C-sucrose-breath test (13CSBT) as a diagnostic tool for SI deficiency in an adult population.

Methods: 13CSBT results were compared to sucrase activity measured in duodenal biopsies.

Results: Forty patients with gastrointestinal symptoms were included in the study, 4 of whom had celiac disease and the rest (n = 36) had normal histological findings. Nine patients (22.5%) had low sucrase activity measured using duodenal biopsies. No correlation was observed between enzymatic sucrase activity and the 13CSBT results. The 13CSBT-curves for the celiac patients versus patients with normal duodenal histology demonstrated that the patients with celiac disease were within the lower range of the distribution.

Conclusion: We observed a mismatch between the 13CSBT results and the biochemically measured sucrase activity, suggesting that SI activity is not uniformly distributed throughout the small intestines. This methodological discrepancy should be acknowledged when diagnosing SI deficiency.

背景:蔗糖异麦芽糖酶(SI)活性降低可导致胃肠道症状。目的:评估 13C-蔗糖呼气试验(13CSBT)作为诊断成人 SI 缺乏症的工具的效果。方法:将 13CSBT 结果与十二指肠活检中测得的蔗糖酶活性进行比较:研究共纳入了 40 名有胃肠道症状的患者,其中 4 人患有乳糜泻,其余患者(n = 36)的组织学检查结果正常。九名患者(22.5%)的十二指肠活检结果显示蔗糖酶活性较低。酶促蔗糖酶活性与 13CSBT 结果之间没有相关性。乳糜泻患者与十二指肠组织学正常患者的 13CSBT 曲线显示,乳糜泻患者的分布范围较低:我们观察到 13CSBT 结果与生化测定的蔗糖酶活性不匹配,这表明蔗糖酶活性在整个小肠的分布并不均匀。在诊断 SI 缺乏症时,应认识到这一方法上的差异。
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引用次数: 0
Correction. 更正。
IF 2.1 4区 医学 Q3 Biochemistry, Genetics and Molecular Biology Pub Date : 2024-05-01 Epub Date: 2024-05-31 DOI: 10.1080/00365513.2024.2359217
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引用次数: 0
Clinical and imaging characteristics of patients with cardiac amyloidosis- a single center observational study. 心脏淀粉样变性患者的临床和影像学特征--一项单中心观察性研究。
IF 1.3 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-05-01 Epub Date: 2024-05-06 DOI: 10.1080/00365513.2024.2346908
Andreas Ingebrigtsen, Sahrai Saeed, Terje Hjalmar Larsen, Håkon Reikvam

Amyloidosis is a disease characterized by the deposition of protein fibrils. Cardiac involvement is a significant factor in determining prognosis. This study aimed to examine the clinical profile, outcomes, and long-term mortality rates in patients with transthyretin (ATTR) and amyloid light-chain (AL) amyloidosis. The retrospective cohort study included 94 patients with amyloidosis (69 with AL and 25 with ATTR amyloidosis) diagnosed between 2010 and 2022. The study involved multimodality imaging (ECG, echocardiography and cardiac magnetic resonance (CMR) data and survival analyses. Patients with ATTR amyloidosis were older and had a higher proportion of males compared to those with AL amyloidosis. Cardiac involvement was more prevalent in the ATTR group, including atrial fibrillation (AF), while pleural and pericardial effusion were more frequent in the AL group. Biomarkers such as NT-proBNP and troponin T were significantly elevated in both groups and were associated with all-cause mortality only in univariate analyses. CMR data, especially typical late gadolinium enhancement (LGE) was not associated with increased mortality, while pleural effusion and left atrial dilatation on echocardiography were identified as powerful predictors of mortality. In conclusion, both AL and ATTR amyloidosis exhibited poor outcomes. Cardiac involvement, particularly dilated left atrium and pleural effusion on echocardiography were associated with an increased risk of mortality, while typical LGE on CMR was not.

淀粉样变性是一种以蛋白质纤维沉积为特征的疾病。心脏受累是决定预后的一个重要因素。本研究旨在探讨转甲状腺素(ATTR)和淀粉样轻链(AL)淀粉样变性患者的临床概况、预后和长期死亡率。这项回顾性队列研究纳入了2010年至2022年期间确诊的94名淀粉样变性患者(69名AL患者和25名ATTR淀粉样变性患者)。研究涉及多模态成像(心电图、超声心动图和心脏磁共振)数据和生存分析。与AL淀粉样变性患者相比,ATTR淀粉样变性患者年龄更大,男性比例更高。心脏受累在ATTR组中更为普遍,包括心房颤动(AF),而胸腔积液和心包积液在AL组中更为常见。两组患者的NT-proBNP和肌钙蛋白T等生物标志物均显著升高,仅在单变量分析中与全因死亡率相关。CMR数据,尤其是典型的晚期钆增强(LGE)与死亡率升高无关,而胸腔积液和超声心动图显示的左心房扩张则是预测死亡率的有力指标。总之,AL 和 ATTR 淀粉样变性的预后都很差。心脏受累,尤其是超声心动图显示的左心房扩张和胸腔积液与死亡风险增加有关,而CMR显示的典型LGE则与之无关。
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引用次数: 0
Measurement uncertainty in clinical chemistry: ISO 20914 versus nordtest or intermediate precision versus bias. 临床化学测量的不确定性:ISO 20914 与 nordtest 或中间精度与偏差。
IF 2.1 4区 医学 Q3 Biochemistry, Genetics and Molecular Biology Pub Date : 2024-05-01 Epub Date: 2024-05-14 DOI: 10.1080/00365513.2024.2338738
Nilhan Nurlu, Abdulkadir Cat, Kamil Taha Ucar

Aim: Measuring uncertainty (MU) is crucial to ensure the accuracy and precision of laboratory results. This study compares the ISO 20914 and Nordtest guidelines to analyze the MU values for 20 clinical chemistry analytes over six months.

Methods: The researchers calculated MU components, including within-laboratory reproducibility (Rw), laboratory analytical performance bias (u(bias)), and combined standard uncertainty (uc), based on internal quality control and external quality assessment data. The final expanded uncertainty (U) values were determined by multiplying the combined uncertainty with a coverage factor (k = 2 for 95% Confidence Interval), following each guideline's respective procedures. Clinical chemistry analytes were analyzed on Roche Cobas 6000 c501 auto analyzer (Roche Diagnostics, Mannheim, Germany) and manufacturer's kits were used analysis.

Results: The results show that 11 out of 20 clinical chemistry analytes met the targeted maximum allowable measurement uncertainty (MAU) values when calculated according to ISO 20914 guideline. Also, 11 out of 20 clinical chemistry analytes' MU values met the MAU values with the Nordtest guideline's recommended calculations. However, some tests met the MAU in the ISO 20914 approach but not in the Nordtest guideline, and vice versa.

Conclusions: The study found that intermediate precision (uRw) in the ISO 20914 approach and performance bias (u(bias)) in the Nordtest approach significantly impacted MU values. The research highlights the importance of standardization in MU calculation approaches across clinical laboratories. These findings have implications for patient care and clinical decision-making, emphasizing the importance of selecting appropriate laboratory guidelines for routine use.

目的:测量不确定性(MU)对于确保实验室结果的准确性和精确性至关重要。本研究比较了 ISO 20914 和 Nordtest 准则,分析了 20 种临床化学分析物在六个月内的不确定度值:研究人员根据内部质量控制和外部质量评估数据计算了MU的组成部分,包括实验室内重现性(Rw)、实验室分析性能偏差(u(bias))和综合标准不确定度(uc)。最终的扩展不确定度 (U) 值是按照每份指南各自的程序,将综合不确定度乘以覆盖因子(k = 2,95% 置信区间)确定的。使用罗氏 Cobas 6000 c501 自动分析仪(罗氏诊断公司,德国曼海姆)分析临床化学分析物,并使用制造商提供的试剂盒进行分析:结果表明,根据 ISO 20914 准则计算,20 种临床化学分析物中有 11 种达到了最大允许测量不确定度 (MAU) 的目标值。此外,在 20 个临床化学分析项目中,有 11 个项目的 MU 值符合 Nordtest 指南推荐的 MAU 值。然而,有些检测项目在 ISO 20914 方法中符合 MAU 值,但在 Nordtest 指南中却不符合,反之亦然:研究发现,ISO 20914 方法中的中间精度(uRw)和 Nordtest 方法中的性能偏差(u(bias))对 MAU 值有很大影响。这项研究强调了临床实验室MU计算方法标准化的重要性。这些发现对患者护理和临床决策具有重要意义,强调了选择合适的实验室指南作为常规使用的重要性。
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引用次数: 0
Identification of autoantibodies against PsoP27 in synovial fluid derived from psoriatic arthritis and rheumatoid arthritis patients. 牛皮癣关节炎和类风湿性关节炎患者滑液中针对 PsoP27 的自身抗体的鉴定。
IF 1.3 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-05-01 Epub Date: 2024-05-20 DOI: 10.1080/00365513.2024.2352844
Marina Slobodkin, Ari Polachek, Victoria Furer, Ori Elkayam, Smadar Gertel

PsoP27 is an antigen expressed in psoriatic lesions. It plays an inflammatory role in psoriasis. This study objective was to characterize antibodies (Abs) against PsoP27 in patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Levels of Abs against native and citrullinated PsoP27 in PsA and RA patients' synovial fluid (SF) and sera were determined by ELISA. SF of osteoarthritis (OA) patients and sera of healthy donors were used as controls. Levels of Abs against PsoP27 were correlated with disease activity scores. Abs against native and citrullinated PsoP27 levels in SF of PsA (n = 48; 0.38 ± 0.03 and 0.44 ± 0.04, respectively) and RA (n = 22; 0.57 ± 0.1 and 0.62 ± 0.09, respectively) were significantly higher than in OA patients (n = 23; 0.14 ± 0.01 and 0.15 ± 0.01, respectively) (p < .0001). For both Abs, there were no significant differences between their level in PsA and RA patients. There was no difference in the level of Abs against citrullinated PsoP27 in SF of seronegative versus seropositive RA patients. Levels of Abs against both native and citrullinated PsoP27 in the SF and level of systemic C-reactive protein in PsA correlated positively, while in RA there were no significant correlations with disease activity scores. No differences in level of Abs against PsoP27 were found in the sera of all three study groups. Abs against native and citrullinated PsoP27 are present in PsA and RA SF but not in those of OA patients, suggesting a potential role of those Abs in inflammatory joint diseases.

PsoP27 是一种在银屑病皮损中表达的抗原。它在银屑病中起着炎症作用。本研究旨在确定银屑病关节炎(PsA)和类风湿性关节炎(RA)患者体内针对 PsoP27 的抗体(Abs)的特征。研究采用 ELISA 方法测定了 PsA 和 RA 患者滑液(SF)和血清中针对原生和瓜氨酸化 PsoP27 的抗体水平。骨关节炎(OA)患者的滑液和健康供体的血清作为对照。针对 PsoP27 的抗体水平与疾病活动度评分相关。PsA(n = 48;分别为 0.38 ± 0.03 和 0.44 ± 0.04)和 RA(n = 22;分别为 0.57 ± 0.1 和 0.62 ± 0.09)患者 SF 中针对原生和瓜氨酸化 PsoP27 的 Abs 水平明显高于 OA 患者(n = 23;分别为 0.14 ± 0.01 和 0.15 ± 0.01)(p<0.05)。
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引用次数: 0
Early prediction of sepsis-induced respiratory tract infection using a biomarker-based machine-learning algorithm. 利用基于生物标志物的机器学习算法早期预测败血症诱发的呼吸道感染。
IF 2.1 4区 医学 Q3 Biochemistry, Genetics and Molecular Biology Pub Date : 2024-05-01 Epub Date: 2024-04-29 DOI: 10.1080/00365513.2024.2346914
Mingkuan Su, Haiying Wu, Hongbin Chen, Jianfeng Guo, Zongyun Chen, Jie Qiu, Jiancheng Huang

Early and differential diagnosis of sepsis is essential to avoid unnecessary antibiotic use and further reduce patient morbidity and mortality. Here, we aimed to identify predictors of sepsis and advance a machine-learning strategy to predict sepsis-induced respiratory tract infection (RTI). Patients with sepsis and RTI were selected via retrospective analysis, and essential population characteristics and laboratory parameters were recorded. To improve the performance of the primary model and avoid over-fitting, a recursive feature elimination with cross-validation (RFECV) strategy was used to screen the optimal subset of biomarkers and construct nine machine-learning models based on this subset; the average accuracy, precision, recall, and F1-score were used for evaluation of the models. We identified 430 patients with sepsis and 686 patients with RTI. A total of 39 features were collected, with 23 features identified for initial model construction. Using the RFECV algorithm, we found that the XGBoost classifier, which only needed to include seven biomarkers, demonstrated the best performance among all prediction models, with an average accuracy of 89.24 ± 2.28, while the Ridge classifier, which included 11 biomarkers, had an average accuracy of only 83.87 ± 4.69. The remaining models had prediction accuracies greater than 88%. We developed nine models for predicting sepsis using a strategy that combined RFECV with machine learning. Among these models, the XGBoost classifier, which included seven biomarkers, showed the best performance and highest accuracy for predicting sepsis and may be a promising tool for the timely identification of sepsis.

脓毒症的早期鉴别诊断对于避免不必要的抗生素使用和进一步降低患者发病率和死亡率至关重要。在此,我们旨在确定败血症的预测因素,并推进一种机器学习策略,以预测败血症诱发的呼吸道感染(RTI)。我们通过回顾性分析筛选出脓毒症和 RTI 患者,并记录了基本人群特征和实验室参数。为了提高主要模型的性能并避免过度拟合,我们采用了递归特征消除与交叉验证(RFECV)策略来筛选最佳生物标志物子集,并基于该子集构建了九个机器学习模型;模型的评估采用了平均准确度、精确度、召回率和 F1 分数。我们确定了 430 名败血症患者和 686 名 RTI 患者。共收集了 39 个特征,其中 23 个特征被确定用于构建初始模型。使用 RFECV 算法,我们发现在所有预测模型中,只需包含 7 个生物标记物的 XGBoost 分类器表现最佳,平均准确率为 89.24 ± 2.28,而包含 11 个生物标记物的 Ridge 分类器的平均准确率仅为 83.87 ± 4.69。其余模型的预测准确率均超过 88%。我们采用 RFECV 与机器学习相结合的策略开发了九种预测败血症的模型。在这些模型中,包含 7 个生物标记物的 XGBoost 分类器在预测败血症方面表现最佳,准确率最高,可能是及时识别败血症的一种有前途的工具。
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Scandinavian Journal of Clinical & Laboratory Investigation
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