Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine最新文献

Background: Clinical laboratories play a crucial role in the diagnosis and monitoring of chronic kidney disease. Quantitative measurement of urinary albumin, expressed as the albumin/creatinine ratio (ACR), is the most commonly used biomarker for this purpose. This study evaluates the feasibility of using urinary strips as a screening tool for ACR, compared with conventional biochemical methods. Specifically, we assessed the diagnostic performance of the urinary strip and the potential economic impact of implementing this screening approach.

Materials and methods: This study included 1,257 samples obtained in primary care, with systematic assessment of requests for urinary strip tests and biochemical quantification of urinary albumin and creatinine. Semiquantitative measurements were performed using Unamax autoanalyzer and quantitative determinations were conducted using AU5800 autoanalyzer. Diagnostic indicators for ACR were calculated for different albumin and creatinine levels. Economic effects were analyzed based on the costs of both testing methods.

Results: Results at different cut-off values for albumin and creatinine showed optimal performance at 10 mg/L and above 100 mg/dL, respectively. 666 biochemical quantification tests (53.85% screening) for urinary albumin and creatinine could have been avoided during the study period, resulting in total savings of 522.81€.

Conclusions: The present study supports the use of Unamax autoanalyzer for ACR measurement as a screening tool, avoiding unnecessary quantitative measurement, as well as allowing early identification of patients with pathological albuminuria levels. The economic impact was significant, demonstrating effective optimisation of financial resources and workflow efficiency in clinical laboratories.

Introduction: Printing allowed the scientific revolution. Scientific journals established peer review. AI is driving the next wave of scientific progress. Ethical aspects of AI in publishing are an emerging area of concern.

Key issues: AI tools are used in generating papers. This raises questions about authorship and accountability: who is responsible? If AI contributes, should they be credited as authors? Are researchers accountable for AI-generated content? If AI is involved in writing, this should be disclosed to maintain transparency. Otherwise, there could be concerns about misrepresentation or lack of rigor.

Another consequence is intellectual property: if AI generates portions of a paper, who owns the rights to that work? Frameworks for intellectual property were designed for human creators, so these might be rethought. Many journals require a written statement regarding AI use. AI use in publishing could exacerbate inequality in research access, leading to a divide between well-funded and less-funded institutions. Global inequality in science sharpens: AI might skew research toward countries with more technological resources.

Ai can be used to assist peer review this challenges peer review integrity: relying on AI could undermine the integrity of human oversight. AI does not replace but complements reviewers' expertise. AI-driven tools might lack the nuanced human understanding. Over-reliance on AI could compromise publishing quality.

Conclusion: AI offers possibilities to speed up and to improve scientific publishing, but it is essential to judge and to address the ethical implications. This requires guidelines and rules warranting an honest, transparent and integer approach of publishing.

Background: Preeclampsia (PE) usually presents after 20 weeks of pregnancy with high blood pressure and protein levels in the urine. An imbalance between the body's proinflammatory and anti-inflammatory responses has been suggested to be a key issue in the pathophysiology of the disease. Some important factors, such as soluble fms like tyrosine kinase -1 (sFlt-1), T regulatory cells (Tregs), and Interleukin-10 (IL-10) molecules are thought to be involved as mediators in a systematic response affecting the blood vessel lining. Proteinuria is an essential feature of preeclampsia suggesting the involvement of the kidneys in the disease.

Objective: Our study aimed to explore how Tregs, IL-10 and sFlt-1 correlate with Kidney Injury Molecule-1(KIM-1) protein levels in urine to better understand preeclampsia-induced renal endothelial dysfunction in better way.

Methodology: 36 normal pregnant women and 29 women with preeclampsia were enrolled in this cross-sectional study. Tregs, IL-10, sFlt-1 and KIM-1 levels were analysed and correlated between both the groups.

Results: Our findings revealed that the levels of CD4+FOXP3+ Treg cells and serum IL-10 were much higher and the levels of serum sFlt-1 and urinary KIM-1 were lower in normal pregnant women than in those with preeclampsia. ROC curve showed that serum sFlt-1 was a strong marker for diagnosing preeclampsia with a sensitivity of 93% and specificity of 92%, followed by urinary KIM-1 with a sensitivity of 76% and specificity of 58%, implying at ongoing kidney injury in preeclampsia.

Conclusion: Our study elucidates preeclampsia and supports better biomarker use and treatments, aiming to improve health outcomes for mothers and babies.

Aim: Hepatitis C Virus (HCV) infection promotes insulin resistance, and metabolic dysfunction-associated fatty liver disease (MAFLD). HCV per se leads to impairment in host lipid metabolism and causes a deranged lipid profile. This study aims to analyze the prevalence of MAFLD and determine the levels of lipid profile parameters, surrogate markers of insulin resistance, liver fibrosis, and steatosis in patients with HCV infection.

Methods: This study used data from the Centers for Disease Control - National Health and Nutritional Examination Survey (CDC-NHANES) 2017-2020. Those who tested positive on HCV RNA PCR were included in HCV group (n=89). Propensity score-based age- and gender-matching was done among those tested negative for HCV to select controls (n=89). Homeostatic Model Assessment of Insulin Resistance (HOMAIR), Homeostatic Model Assessment of Beta-cell Function (HOMAB), and the lipid-based insulin resistance markers such as Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), Triglyceride-Glucose Index (TyG) were calculated using the standard formulae.

Results: Serum triglycerides, total cholesterol and low-density lipoprotein cholesterol were significantly lower in HCV. HOMAIR, HOMAB were similar, and the lipid-based insulin resistance markers such as VAI, LAP and TyG index were significantly lower in HCV. FibroScan showed less steatosis, but increased fibrosis in the HCV patients. The surrogate markers of insulin resistance showed a significant association with the presence of MAFLD.

Conclusion: HCV patients showed hypocholesterolemia, hypotriglyceridemia and the levels of lipid-based insulin resistance markers were significantly lower. TyG index showed a strong positive association with the presence of MAFLD. These observations could be due to association between HCV replication and host lipid metabolism.

Objectives: Monocyte Distribution Width (MDW) is the standard deviation of the mean volume of monocytes and may indicate innate immune activation. We investigated the possible association between MDW values and late HIV diagnosis in consecutive patients.

Methods: We retrospectively enrolled newly diagnosed HIV patients admitted to our clinical center. Demographic and clinical characteristics were analyzed.

Results: A total of 97 patients were enrolled. Of these, 63% were late presenters and 43% fulfilled the criteria for advanced HIV disease. Continuous measures showed a significant inverse correlation between CD4 T-cell count and MDW. Multivariate analysis showed that MDW≥21.1 (OR:7.45, 2.13-30.54), HIV viral load >5 log (10) c/mL (OR:3.62, 1.04-13.30), blood lymphocytes<2 x103/μL (OR:14.82, 3.19-111.8) and HIV testing without symptoms (OR:0.21, 0.05-0.82) were independently associated with late presentation. Similarly, adjusted ORs for MDW≥22.5 (OR:4.03, 1.28-13.17), blood lymphocytes<1 x103/μL (OR:9.67, 2.19-57.57), age (OR:1.05, 1.00-1.10) and HIV testing without symptoms (OR:0.16, 0.04-0.52) were significantly associated with advanced HIV disease.

Conclusions: Our results suggest that MDW may be a potential flagging parameter of innate immune activation in HIV infection. Continuous measurements of MDW showed a significant inverse correlation with CD4 T-cell count.Patients with increased MDW values were more likely to be diagnosed late.

Type 2 diabetes mellitus (T2DM) is a multifactorial disorder where platelet-derived mediators, lipid metabolic pathways, and exocytotic proteins intersect to drive β-cell dysfunction. Activated platelets release serotonin, platelet factor 4 (PF4), sphingosine-1-phosphate (S1P), and microvesicles that trigger oxidative and endoplasmic reticulum (ER) stress in pancreatic islets. CD36-mediated lipid uptake and sphingolipid imbalance intensify ceramide-driven mitochondrial damage. These insults converge on exocytotic failure through disruption of DOC2B, a Ca²⁺-sensitive mediator of insulin vesicle fusion. Revisiting this axis clarifies how thromboinflammation and lipotoxicity orchestrate β-cell failure and highlights emerging therapeutic targets for T2DM. This review introduces a novel integrative perspective linking platelet-derived mediators, lipid dysregulation, and DOC2B-mediated exocytotic failure as a unified model of β-cell dysfunction in T2DM.

Background: Lead exposure remains a major health concern in the Asia-Pacific, particularly affecting children. Despite its significance, lead toxicity testing is underutilized because of limited awareness, resources, and policy support. On December 16, 2024, the APFCB C-CP (Asia-Pacific Federation for Clinical Biochemistry and Laboratory Medicine -Communication and Publications Committee) conducted Webcast & eLearning Program Webinar themed as "Protecting Health in Asia-Pacific: Laboratory Advances and Lead Exposure Prevention", aimed to address these issues and acknowledge need based solutions. An online survey was conducted during webinar in real time to assess the current lead-testing practices, common exposure sources, testing challenges, and policy changes.

Methods: A seven-question survey was distributed to webinar participants, covering testing frequency, methodologies, exposure sources, information sources, challenges, and policy needs. A total of 66 professionals attended the session and 22 complete surveys were collected from Nepal, India, Indonesia, Japan, and Australia.

Results: Lead testing was infrequent in the region, with 58.6% of the respondents reporting rare or no testing. Weekly testing has been reported in 20.7% of cases. The most commonly used methodology was point-of-care testing via anodic stripping voltammetry (37.5%) followed by electrothermal atomic absorption spectrometry (25%). Occupational exposure (39.1%) was the leading source of lead poisoning, followed by dietary sources (26.1%) and environmental contamination (21.7%). Academic journals (47.5%) were the primary educational resources. Key challenges included low awareness among healthcare providers (43.5%) and resource shortage (39.1%). The most recommended policy change was to increase government support (61.5%).

Conclusion: In conclusion, lead testing remains infrequent across many settings, with limited routine implementation and heavy reliance on point-of-care methodologies. Occupational exposure emerged as the predominant source of lead poisoning, underscoring the need for targeted interventions. Strengthening government support is identified as the most critical policy change to enhance lead testing and management efforts.

Myocardial infarction (MI) initiates a healing response in which fibroblasts and other cells deposit extracellular matrix to form a stabilizing scar. This scarring is essential for preventing ventricular rupture, yet when excessive or diffuse, it becomes maladaptive: fibrosis stiffens the ventricle, impairs filling, and drives progression to heart failure. Traditional antifibrotic approaches, such as broad TGF-β blockade or collagen cross-linking inhibition, have largely failed because fibroblast activity is required for early scar integrity, while established fibrosis is difficult to reverse. This review highlights endothelial-to-mesenchymal transition (EndMT) as a distinct and underappreciated contributor to post-MI fibrosis. Experimental studies indicate that EndMT supplies 10-30% of fibroblast-like cells, and evidence of EndMT is present in human ischemic cardiomyopathy. Unlike fibroblast-driven repair, EndMT is maladaptive in the adult heart: it promotes fibrosis without enhancing scar strength and reduces endothelial cell numbers, leading to microvascular rarefaction and impaired perfusion. EndMT is regulated by discrete, targetable pathways-including TGF-β/Smad, Notch, Wnt/β-catenin, HIF-1α, and microRNA networks (e.g., miR-21, miR-29)-and exhibits partial reversibility. This opens opportunities for time-limited, pathway-specific interventions during the proliferative phase of healing. Emerging diagnostic tools, such as extracellular volume mapping, fibroblast activation protein PET, collagen peptide assays, and circulating fibrosis-related microRNAs, provide clinical means to detect EndMT activity. By integrating mechanistic insights with advances in molecular imaging and biomarker profiling, this review proposes EndMT-directed, biomarker-guided therapies as a precision strategy to limit maladaptive fibrosis, preserve vascular networks, and improve outcomes after MI.

ISO 15189:2022 introduces key updates to medical laboratory standards, emphasizing risk management, ethics, and technical competence. With the December 2025 deadline for ISO 15189:2012 to 15189:2022 transition nearing, a cross-sectional survey was conducted during the Asia-Pacific Federation of Clinical Biochemistry and Laboratory Medicine webinar on February 21, 2025, to assess readiness. On 303 total responses, awareness was high, with 85% familiar with the revised standard and 92% recognizing its stronger focus on risk management. Most (78%) viewed the transition as highly important, and 82% expected improvements in quality and patient care. Major barriers included financial constraints (65%), insufficient training (72%), and resistance to change (45%). Preparation efforts reported were gap analyses (68%), training programs (75%), and policy updates (70%). While optimism is strong, resource limitations and skills gaps threaten timely adoption. The findings highlight the urgent need for structured training, financial support, and expert guidance to help laboratories, particularly in resource-limited settings, meet the new requirements. Collaboration among laboratories, professional bodies, and regulatory authorities will be crucial to ensure a smooth and effective transition to ISO 15189:2022, enabling more accurate, reliable, and patient-centered diagnostics.

Introduction: Clinical laboratories play a vital role in healthcare but contribute significantly to environmental challenges through high energy consumption, water usage, and waste generation. Pakistan's healthcare sector faces challenges, including limited funding and inadequate awareness of sustainable practices. There is little data on the extent to which clinical laboratories in Pakistan have implemented green practices, making it crucial to assess current efforts and identify barriers to adoption. This study aims to assess the adoption of sustainability and green lab practices in clinical laboratories across Pakistan.

Methods: A cross-sectional survey was conducted by the Chemical Pathology section at Aga Khan University (AKU) using a structured questionnaire. The survey comprised 13 sections to evaluate sustainability practices, covering demographics, current green practices (energy efficiency, water conservation, waste management, etc.), barriers to implementation, environmental and cost impacts, and future goals. It assessed laboratories' existing efforts, challenges, and aspirations for improving sustainability. The survey was distributed via Google Forms to major laboratories across Pakistan via WhatsApp and email. Data was analyzed using Excel (Microsoft Corporation, 2018) software.

Results: A total of 12 laboratories across the country, from the capital Islamabad and all provincial capitals participated in the survey. Key findings include widespread adoption of energy-efficient lighting (75%) and electronic reporting (91.7%), but limited use of water-saving technologies (8.3%) and renewable energy (0%). Barriers like limited resources (58.3%), lack of staff awareness (50%), and financial constraints (41.7%) hindered green practices, though 41.7% reported moderate cost savings. Future goals focused on green certifications (58.3%), recycling programs (50%), and energy-efficient upgrades (41.7%).

Conclusion: Our findings underscore the urgent need for structured sustainability policies, financial incentives, and educational programs to enhance green laboratory practices in Pakistan. While some progress has been made, significant gaps remain in energy efficiency, waste management, and regulatory compliance.