Karl Krupp, Jennifer M Segar, Juan Lewis Fernández-Martínez, Purnima Madhivanan
{"title":"MicroRNAs: Emerging as Highly Promising Biomarkers for Early Breast Cancer Screening.","authors":"Karl Krupp, Jennifer M Segar, Juan Lewis Fernández-Martínez, Purnima Madhivanan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"6 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71491259","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}
Venge P, Xu S, P. C., Eriksson Ak, H. M, Larsson A, Lipcsey M, Bulow S, F. R
Background: A serious consequence of respiratory infections with SARS-CoV-2 is Acute Kidney Injury (AKI). The aim of this study was to evaluate some novel biomarkers measured in plasma for their associations with the outcome of this infection as to AKI and mortality. Methods: Four different HNL (Human Neutrophil Lipocalin) assays were constructed using different antibody configurations, reflecting both neutrophil and epithelial cell activities. TK-1 (Thymidine kinase-1) was measured as a sign of cell destruction and proliferation. For comparison the plasma concentrations of NGAL (Neutrophil Gelatinase Associated Lipocalin), the cytokines IL-6, IL-8 and IFN-γ and of cystatin C, and procalcitonin were also measured. One hundred and three patients with severe respiratory failure admitted to the ICU were sampled for blood at admittance and at day three (n=67) after admittance. Results: Sixty-five percent of the patients developed AKI. The performance of the HNL assay 763/8F was most closely associated to outcome as to AKI and mortality with Area Under the Receiver Operating Characteristics Curve (AUC) of 0.87 and a sensitivity of 80% and a specificity of 88% in COVID-19 patients with and without severe AKI (p<0.0001). TK-1 was significantly related to the development of AKI (p=0.01) and the three cytokines were related to mortality (p=0.004-p<0.001). Conclusion: The HNL variant 763/8F and TK-1 are novel biomarkers that might become useful and novel tools in the management of COVID-19 patients, but likely also in other patients affected by AKI.
{"title":"Plasma Biomarkers Associated to Outcome in Patients with Sars-Cov-2 Infection","authors":"Venge P, Xu S, P. C., Eriksson Ak, H. M, Larsson A, Lipcsey M, Bulow S, F. R","doi":"10.16966/2572-9578.141","DOIUrl":"https://doi.org/10.16966/2572-9578.141","url":null,"abstract":"Background: A serious consequence of respiratory infections with SARS-CoV-2 is Acute Kidney Injury (AKI). The aim of this study was to evaluate some novel biomarkers measured in plasma for their associations with the outcome of this infection as to AKI and mortality. Methods: Four different HNL (Human Neutrophil Lipocalin) assays were constructed using different antibody configurations, reflecting both neutrophil and epithelial cell activities. TK-1 (Thymidine kinase-1) was measured as a sign of cell destruction and proliferation. For comparison the plasma concentrations of NGAL (Neutrophil Gelatinase Associated Lipocalin), the cytokines IL-6, IL-8 and IFN-γ and of cystatin C, and procalcitonin were also measured. One hundred and three patients with severe respiratory failure admitted to the ICU were sampled for blood at admittance and at day three (n=67) after admittance. Results: Sixty-five percent of the patients developed AKI. The performance of the HNL assay 763/8F was most closely associated to outcome as to AKI and mortality with Area Under the Receiver Operating Characteristics Curve (AUC) of 0.87 and a sensitivity of 80% and a specificity of 88% in COVID-19 patients with and without severe AKI (p<0.0001). TK-1 was significantly related to the development of AKI (p=0.01) and the three cytokines were related to mortality (p=0.004-p<0.001). Conclusion: The HNL variant 763/8F and TK-1 are novel biomarkers that might become useful and novel tools in the management of COVID-19 patients, but likely also in other patients affected by AKI.","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67394917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reinfection with COVID-19 is of great importance since it can substantially affect the future of disease control and vaccine development. COVID-19 can present with diverse neurological, as well as respiratory and gastrointestinal symptoms. Here, we present a rare case of COVID-19 reinfection with neurological manifestations. The patient was a healthy 26-year-old male that had experienced first episode of COVID-19 infection with mild respiratory and gastrointestinal symptoms. In his second episode of infection, he presented to the emergency department with vertigo, vomiting, metamorphopsia, blurred vision, headache, and gate disturbance. Based on the clinical data and imaging studies, the patient was diagnosed with benign cerebral edema and intracranial hypertension. Then, he was treated using intravenous/intramuscular corticosteroids in addition to the supplementary therapies. His symptoms dramatically improved during the next 2 days. No important neurologic or systemic adverse events in response to the treatment were noted. This case reveals that infection with COVID-19, despite positive IgG, does not protect the patient from reinfection. Moreover, COVID-19 reinfection can present with benign cerebral edema and intracranial hypertension, in which case, inflammatory suppression therapy should be considered.
{"title":"Benign Cerebral Edema and Increased Intracranial Pressure (ICP) as Manifestations of COVID-19 Reinfection; A Case Report","authors":"Heidary Ah, Elahi R, N. M","doi":"10.16966/2572-9578.138","DOIUrl":"https://doi.org/10.16966/2572-9578.138","url":null,"abstract":"Reinfection with COVID-19 is of great importance since it can substantially affect the future of disease control and vaccine development. COVID-19 can present with diverse neurological, as well as respiratory and gastrointestinal symptoms. Here, we present a rare case of COVID-19 reinfection with neurological manifestations. The patient was a healthy 26-year-old male that had experienced first episode of COVID-19 infection with mild respiratory and gastrointestinal symptoms. In his second episode of infection, he presented to the emergency department with vertigo, vomiting, metamorphopsia, blurred vision, headache, and gate disturbance. Based on the clinical data and imaging studies, the patient was diagnosed with benign cerebral edema and intracranial hypertension. Then, he was treated using intravenous/intramuscular corticosteroids in addition to the supplementary therapies. His symptoms dramatically improved during the next 2 days. No important neurologic or systemic adverse events in response to the treatment were noted. This case reveals that infection with COVID-19, despite positive IgG, does not protect the patient from reinfection. Moreover, COVID-19 reinfection can present with benign cerebral edema and intracranial hypertension, in which case, inflammatory suppression therapy should be considered.","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67394781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: SARS COV-2 pandemic has been a nightmare for medical, political and social systems all over the world, right from the point of initial diagnosis, treatment protocols, anticipated vaccine development and prevention strategies.
{"title":"Serology Testing: The Dark Horse in SARS COV2 Pandemic","authors":"Rajneesh Sareen, Gupta Gn, A. Yadav, S. Saini","doi":"10.16966/2572-9578.136","DOIUrl":"https://doi.org/10.16966/2572-9578.136","url":null,"abstract":"Introduction: SARS COV-2 pandemic has been a nightmare for medical, political and social systems all over the world, right from the point of initial diagnosis, treatment protocols, anticipated vaccine development and prevention strategies.","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67394734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Acne vulgaris is a chronic inflammatory disease that affects the majority of the population at some point in their lifetime. Acne pathogenesis is multifactorial with four primary contributors that play a pivotal role in the formation of acne lesions: inflammation, androgeninduced sebum production, abnormal keratinization, and bacterial colonization. Recent studies have demonstrated the anti-inflammatory, anticarcinogenic, anti-diabetic, and anti-lipid properties of certain Polymethoxylated Flavones (PMF) derivatives.
{"title":"Nobiletin Reduces Lipid Accumulation in Sebocytes and Inhibits PPAR Delta Activation in Epidermal Tissue Models","authors":"E. Fedorova, S. Li, Gusella Gl, A. Mosoian","doi":"10.16966/2572-9578.139","DOIUrl":"https://doi.org/10.16966/2572-9578.139","url":null,"abstract":"Background: Acne vulgaris is a chronic inflammatory disease that affects the majority of the population at some point in their lifetime. Acne pathogenesis is multifactorial with four primary contributors that play a pivotal role in the formation of acne lesions: inflammation, androgeninduced sebum production, abnormal keratinization, and bacterial colonization. Recent studies have demonstrated the anti-inflammatory, anticarcinogenic, anti-diabetic, and anti-lipid properties of certain Polymethoxylated Flavones (PMF) derivatives.","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67394791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Akhtar, Sadaf Haiyat, A. Khan, B. Juneja, T. Khan, S. H. Arif
AML with myelodysplasia related changes is an uncommon type of acute myeloid leukemia. It comprises less than 5% of acute leukemias. According to the recent World Health Organization (WHO-2016) classification, AML cases with ≥ 50% or more erythroid cells and ≥ 20% total myeloblasts should be diagnosed as AML with myelodysplasia-related changes. Morphologic cellular features help to establish the diagnosis. We present a rare case of AML with myelodysplasia related changes in a 35-year-old female who presented with low-grade fever, mild epistaxis, and shortness of breath and diffuse sternal tenderness. The peripheral smear showed features of pancytopenia with 6% blasts along with evidence of hemolysis. Bone marrow examination revealed erythroid hyperplasia with 65% erythroblasts and 24% myeloblasts. Flow cytometry was used for the confirmation of the diagnosis. The patient was administered chemotherapy with Azacitidine 75 mg/m2/day × 7 days in IV infusion along with 2 units of red cell concentrate prophylactically to prevent anemia. Molecular studies are needed to understand better the pathogenesis of AML with myelodysplasiarelated changes and to develop newer diagnostic and prognostic markers.
{"title":"Acute Erythroid Leukemia: A Rare Case Report","authors":"K. Akhtar, Sadaf Haiyat, A. Khan, B. Juneja, T. Khan, S. H. Arif","doi":"10.16966/2572-9578.133","DOIUrl":"https://doi.org/10.16966/2572-9578.133","url":null,"abstract":"AML with myelodysplasia related changes is an uncommon type of acute myeloid leukemia. It comprises less than 5% of acute leukemias. According to the recent World Health Organization (WHO-2016) classification, AML cases with ≥ 50% or more erythroid cells and ≥ 20% total myeloblasts should be diagnosed as AML with myelodysplasia-related changes. Morphologic cellular features help to establish the diagnosis. We present a rare case of AML with myelodysplasia related changes in a 35-year-old female who presented with low-grade fever, mild epistaxis, and shortness of breath and diffuse sternal tenderness. The peripheral smear showed features of pancytopenia with 6% blasts along with evidence of hemolysis. Bone marrow examination revealed erythroid hyperplasia with 65% erythroblasts and 24% myeloblasts. Flow cytometry was used for the confirmation of the diagnosis. The patient was administered chemotherapy with Azacitidine 75 mg/m2/day × 7 days in IV infusion along with 2 units of red cell concentrate prophylactically to prevent anemia. Molecular studies are needed to understand better the pathogenesis of AML with myelodysplasiarelated changes and to develop newer diagnostic and prognostic markers.","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67394702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Managing laboratory test utilization has been a growing problem for the healthcare industry for a long time. With an ever-increasing number of tests, especially in the area of molecular genetics where per test costs are very high, inappropriate utilization is creating a financial burden on healthcare overall. Several large healthcare institutions have made efforts to solve this problem and have developed their own test utilization management approaches. These include, physician education, providing test pricing information, utilizing reminders in Computerized Provider Order Entry (CPOE) systems and/or setting up committees to authorize the use of expensive or complex tests. While these approaches have achieved some minor success in curbing test overutilization and generating cost savings, a robust automated Clinical Laboratory Decision Support System has still been sorely lacking. We present, here, a newly developed Laboratory Decision System, LDSTM as a potential method to address test utilization management in clinical settings. A study of provider and payer use of LDSTM revealed significant improvements in test ordering and management on both sides: a significant reduction in unnecessary tests from the provider’s side and measurable improvement in medical necessity checks from the payer’s side. methods for reducing wasteful testing. A study published by the American College of Physicians (ACP), in 2012, stemming the Tide of over treatment in U.S. Healthcare, explains “the impact of unnecessary tests on healthcare cost totals up to $250 billion a year” [4]. Timely, relevant and actionable data is needed for doctors to accurately order tests, and for labs and other rendering providers to deliver services efficiently and get paid in a timely manner. Further, the rapid growth in molecular and genetic testing (welcomed new tools for diagnosis and disease management) poses a challenge for both healthcare providers and for commercial payers regarding proper utilization of these specialized tests. Given their relatively high cost, inappropriate use of these tests represents an additional financial burden on an already over-taxed healthcare system [2,4,5]. Since laboratory testing provides 70-85% of the objective data upon which physicians base their diagnoses and treatments, laboratory diagnostics has become the single highest-volume medical activity in the U.S., with an estimated 4-5 billion tests performed annually [5]. Inappropriate testing consists of both overand underutilization, which together can dramatically increase healthcare costs. Overutilization refers to tests that are ordered when not clinically indicated, while underutilization refers to tests that are clinically indicated but not ordered. A Harvard Medical School 15Introduction Currently, physicians are challenged by a lack of access to centralized information regarding thousands of available clinical laboratory tests [1]. A study conducted by the Common wealth Fund Survey of Public
长期以来，管理实验室测试的使用一直是医疗保健行业面临的一个日益严重的问题。随着检测数量的不断增加，特别是在每次检测成本非常高的分子遗传学领域，不适当的利用正在给整个医疗保健造成财务负担。一些大型医疗机构已经在努力解决这个问题，并开发了自己的测试利用管理方法。这些措施包括医生教育、提供测试定价信息、在计算机化供应商订单输入(CPOE)系统中使用提醒和/或设立委员会来授权使用昂贵或复杂的测试。虽然这些方法在抑制测试过度使用和产生成本节约方面取得了一些小的成功，但一个强大的自动化临床实验室决策支持系统仍然非常缺乏。我们提出，在这里，一个新开发的实验室决策系统，LDSTM作为一个潜在的方法来解决测试利用管理在临床设置。一项关于提供者和付款人使用LDSTM的研究表明，双方在测试订购和管理方面都有重大改善:提供者方面大幅减少了不必要的测试，付款人方面在医疗必要性检查方面有了可衡量的改善。减少浪费测试的方法。美国医师学会(American College of Physicians, ACP)在2012年发表的一份研究报告中解释说，“不必要的检查对医疗成本的影响每年高达2500亿美元”。该研究遏制了美国医疗保健领域过度治疗的趋势。医生需要及时、相关和可操作的数据，以便准确地安排检查，实验室和其他提供服务的机构也需要这些数据，以便有效地提供服务并及时获得报酬。此外，分子和基因检测(受欢迎的诊断和疾病管理新工具)的快速增长，对医疗保健提供者和商业付款人都提出了如何正确利用这些专门检测的挑战。鉴于其相对较高的成本，这些检测的不当使用对已经负担过重的医疗保健系统构成了额外的经济负担[2,4,5]。由于实验室检测提供了医生诊断和治疗所依据的70-85%的客观数据，因此实验室诊断已成为美国最大规模的医疗活动，估计每年进行40 - 50亿次检测。不适当的检测既包括过度利用，也包括利用不足，两者加起来会大大增加医疗保健成本。过度使用是指在没有临床指征的情况下订购的测试，而使用不足是指临床指征但未订购的测试。目前，医生们面临的挑战是无法获得关于数千种可用临床实验室测试的集中信息。共同财富基金对美国医疗保健系统公众意见的调查显示，医生要求的检查中，超过23%的人以前做过。这种重复增加了护理成本，同时进一步延迟或混淆了患者的诊断和护理[1,2]。2011年，美国疾病控制与预防中心(CDC)研究了医生对实验室适当利用的不确定性。这项研究调查了美国的1768名初级保健医生，结果表明14.7%的医生在选择和订购正确的检查时有不确定性，8.3%的医生在解释检查结果方面有困难。当这些统计数据应用于美国每年超过3亿患者的实验室访问时，不适当的测试顺序和解释每年可能影响2300万患者。这种不适当的测试使用对我们整个医疗保健系统有进一步的下游临床和成本影响。调查还表明，超过四分之三的受访医生表示，咨询专家、查看电子参考资料或专家推荐，有助于减少订购和解释实验室测试的不确定性。由于这些和其他令人信服的原因，支付方，特别是医疗保险，开始要求标准化的做法和Sci Forschen O . c . H . U . B . c . c . c . c . c . c .引用本文:Leblow L, Hamill t, Beqaj SH(2019)在临床环境中使用实验室决策系统作为测试利用管理工具，当前和未来的展望。临床检验医学4(1):dx.doi.org/10.16966/2572-9578.128 2《临床与检验医学开放获取杂志》年度荟萃分析显示，实验室检查的过度使用和不足使用分别占20.6%和44.8%[10]。不适当的检测可能导致不正确或延迟的诊断和治疗，从而对患者的恢复时间和相关成本产生负面影响。 长期以来，管理实验室测试的使用一直是医疗保健行业面临的一个日益严重的问题。随着检测数量的不断增加，特别是在每次检测成本非常高的分子遗传学领域，不适当的利用正在给整个医疗保健造成财务负担。一些大型医疗机构已经在努力解决这个问题，并开发了自己的测试利用管理方法。这些措施包括医生教育、提供测试定价信息、在计算机化供应商订单输入(CPOE)系统中使用提醒和/或设立委员会来授权使用昂贵或复杂的测试。虽然这些方法在抑制测试过度使用和产生成本节约方面取得了一些小的成功，但一个强大的自动化临床实验室决策支持系统仍然非常缺乏。我们提出，在这里，一个新开发的实验室决策系统，LDSTM作为一个潜在的方法来解决测试利用管理在临床设置。一项关于提供者和付款人使用LDSTM的研究表明，双方在测试订购和管理方面都有重大改善:提供者方面大幅减少了不必要的测试，付款人方面在医疗必要性检查方面有了可衡量的改善。减少浪费测试的方法。美国医师学会(American College of Physicians, ACP)在2012年发表的一份研究报告中解释说，“不必要的检查对医疗成本的影响每年高达2500亿美元”。该研究遏制了美国医疗保健领域过度治疗的趋势。医生需要及时、相关和可操作的数据，以便准确地安排检查，实验室和其他提供服务的机构也需要这些数据，以便有效地提供服务并及时获得报酬。此外，分子和基因检测(受欢迎的诊断和疾病管理新工具)的快速增长，对医疗保健提供者和商业付款人都提出了如何正确利用这些专门检测的挑战。鉴于其相对较高的成本，这些检测的不当使用对已经负担过重的医疗保健系统构成了额外的经济负担[2,4,5]。由于实验室检测提供了医生诊断和治疗所依据的70-85%的客观数据，因此实验室诊断已成为美国最大规模的医疗活动，估计每年进行40 - 50亿次检测。不适当的检测既包括过度利用，也包括利用不足，两者加起来会大大增加医疗保健成本。过度使用是指在没有临床指征的情况下订购的测试，而使用不足是指临床指征但未订购的测试。目前，医生们面临的挑战是无法获得关于数千种可用临床实验室测试的集中信息。共同财富基金对美国医疗保健系统公众意见的调查显示，医生要求的检查中，超过23%的人以前做过。这种重复增加了护理成本，同时进一步延迟或混淆了患者的诊断和护理[1,2]。2011年，美国疾病控制与预防中心(CDC)研究了医生对实验室适当利用的不确定性。这项研究调查了美国的1768名初级保健医生，结果表明14.7%的医生在选择和订购正确的检查时有不确定性，8.3%的医生在解释检查结果方面有困难。当这些统计数据应用于美国每年超过3亿患者的实验室访问时，不适当的测试顺序和解释每年可能影响2300万患者。这种不适当的测试使用对我们整个医疗保健系统有进一步的下游临床和成本影响。调查还表明，超过四分之三的受访医生表示，咨询专家、查看电子参考资料或专家推荐，有助于减少订购和解释实验室测试的不确定性。由于这些和其他令人信服的原因，支付方，特别是医疗保险，开始要求标准化的做法和Sci Forschen O . c . H . U . B . c . c . c . c . c . c .引用本文:Leblow L, Hamill t, Beqaj SH(2019)在临床环境中使用实验室决策系统作为测试利用管理工具，当前和未来的展望。临床检验医学4(1):dx.doi.org/10.16966/2572-9578.128 2
{"title":"Use of Laboratory Decision System as a Test Utilization Management Tool in Clinical Settings, Current and Future Perspectives","authors":"L Leblow, T. Hamill, Beqaj Sh","doi":"10.16966/2572-9578.128","DOIUrl":"https://doi.org/10.16966/2572-9578.128","url":null,"abstract":"Managing laboratory test utilization has been a growing problem for the healthcare industry for a long time. With an ever-increasing number of tests, especially in the area of molecular genetics where per test costs are very high, inappropriate utilization is creating a financial burden on healthcare overall. Several large healthcare institutions have made efforts to solve this problem and have developed their own test utilization management approaches. These include, physician education, providing test pricing information, utilizing reminders in Computerized Provider Order Entry (CPOE) systems and/or setting up committees to authorize the use of expensive or complex tests. While these approaches have achieved some minor success in curbing test overutilization and generating cost savings, a robust automated Clinical Laboratory Decision Support System has still been sorely lacking. We present, here, a newly developed Laboratory Decision System, LDSTM as a potential method to address test utilization management in clinical settings. A study of provider and payer use of LDSTM revealed significant improvements in test ordering and management on both sides: a significant reduction in unnecessary tests from the provider’s side and measurable improvement in medical necessity checks from the payer’s side. methods for reducing wasteful testing. A study published by the American College of Physicians (ACP), in 2012, stemming the Tide of over treatment in U.S. Healthcare, explains “the impact of unnecessary tests on healthcare cost totals up to $250 billion a year” [4]. Timely, relevant and actionable data is needed for doctors to accurately order tests, and for labs and other rendering providers to deliver services efficiently and get paid in a timely manner. Further, the rapid growth in molecular and genetic testing (welcomed new tools for diagnosis and disease management) poses a challenge for both healthcare providers and for commercial payers regarding proper utilization of these specialized tests. Given their relatively high cost, inappropriate use of these tests represents an additional financial burden on an already over-taxed healthcare system [2,4,5]. Since laboratory testing provides 70-85% of the objective data upon which physicians base their diagnoses and treatments, laboratory diagnostics has become the single highest-volume medical activity in the U.S., with an estimated 4-5 billion tests performed annually [5]. Inappropriate testing consists of both overand underutilization, which together can dramatically increase healthcare costs. Overutilization refers to tests that are ordered when not clinically indicated, while underutilization refers to tests that are clinically indicated but not ordered. A Harvard Medical School 15Introduction Currently, physicians are challenged by a lack of access to centralized information regarding thousands of available clinical laboratory tests [1]. A study conducted by the Common wealth Fund Survey of Public ","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67394098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parkinson’s disease (PD) is a neurodegenerative disease characterized by loss of dopaminergic neurons in the substantia nigra. Current treatment only helps symptoms, and there is no effective treatment to delay or reverse PD. Scientists have regarded a number of genetic and environmental factors that may lead to developing PD. Lithium has been used for years in psychiatry as an effective mood stabilizer in manic depressive bipolar disorder (BD). This natural element is the most potent inhibitor of the enzyme glycogen synthetase kinase (GSK3) activity. Because of GSK3’s abundance in the body and over expression leading to PD, lithium has been postulated be used as a treatment for numerous neurodegenerative diseases and conditions where GSK3 is over expressed. Lithium has also been shown to be protective to cells against rotenone-induced PD. In contrast cellular based therapy, specifically the use of induced pluripotential stem cells (iPSCs), also pose a promising therapeutic modality for future use in order to more fully understanding the process of PD development.
{"title":"Parkinson’s Disease, Lithium and Stem Cells","authors":"Burckhalter L, Gallicchio Vs","doi":"10.16966/2572-9578.126","DOIUrl":"https://doi.org/10.16966/2572-9578.126","url":null,"abstract":"Parkinson’s disease (PD) is a neurodegenerative disease characterized by loss of dopaminergic neurons in the substantia nigra. Current treatment only helps symptoms, and there is no effective treatment to delay or reverse PD. Scientists have regarded a number of genetic and environmental factors that may lead to developing PD. Lithium has been used for years in psychiatry as an effective mood stabilizer in manic depressive bipolar disorder (BD). This natural element is the most potent inhibitor of the enzyme glycogen synthetase kinase (GSK3) activity. Because of GSK3’s abundance in the body and over expression leading to PD, lithium has been postulated be used as a treatment for numerous neurodegenerative diseases and conditions where GSK3 is over expressed. Lithium has also been shown to be protective to cells against rotenone-induced PD. In contrast cellular based therapy, specifically the use of induced pluripotential stem cells (iPSCs), also pose a promising therapeutic modality for future use in order to more fully understanding the process of PD development.","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67394268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A growing body of scientific literature has been showing the importance of measuring the serum levels of 25-OH Vitamin D (considered to be a reliable indicator of the overall Vitamin D status of a patient). Since the development of the first immuno-assays for 25-OH Vitamin D (over four decades ago), significant improvements have been made in the way 25-OH Vitamin D serum levels are measured. These improvements are, however, still lagging when compared to the exponential demand for Vitamin D testing in clinical settings. Indeed, current 25-OH Vitamin D assays are still slow, have low throughput and are still performed by a limited number of clinical laboratories. In this article, we report on a rapid technique to measure serum 25-OH Vitamin D that uses only two reagents and that can be adapted to virtually any automated spectrophotometric chemistry analyzer. The new technique uses polystyrene (latex) nanoparticles that have been sensitized with Vitamin D-specific antibodies. Extensive performance testing of this new 25-OH Vitamin D assay (namely the Diazyme EZ Vitamin D Assay) has been performed on one of the most common clinical chemistry analyzer (the Beckman AU680). Results show that the assay is sensitive, precise, linear, accurate and fast (throughput over 600 tests per hour). The assay has received approval for clinical use by the US Food and Drug Administration (FDA) and is certified (for accuracy and precision) by the Center for Disease Control and Prevention (CDC).
{"title":"A High Throughput Universal Vitamin D Assay for Automated Chemistry Analyzers","authors":"Saida Fb, C. Yuan","doi":"10.16966/2572-9578.132","DOIUrl":"https://doi.org/10.16966/2572-9578.132","url":null,"abstract":"A growing body of scientific literature has been showing the importance of measuring the serum levels of 25-OH Vitamin D (considered to be a reliable indicator of the overall Vitamin D status of a patient). Since the development of the first immuno-assays for 25-OH Vitamin D (over four decades ago), significant improvements have been made in the way 25-OH Vitamin D serum levels are measured. These improvements are, however, still lagging when compared to the exponential demand for Vitamin D testing in clinical settings. Indeed, current 25-OH Vitamin D assays are still slow, have low throughput and are still performed by a limited number of clinical laboratories. In this article, we report on a rapid technique to measure serum 25-OH Vitamin D that uses only two reagents and that can be adapted to virtually any automated spectrophotometric chemistry analyzer. The new technique uses polystyrene (latex) nanoparticles that have been sensitized with Vitamin D-specific antibodies. Extensive performance testing of this new 25-OH Vitamin D assay (namely the Diazyme EZ Vitamin D Assay) has been performed on one of the most common clinical chemistry analyzer (the Beckman AU680). Results show that the assay is sensitive, precise, linear, accurate and fast (throughput over 600 tests per hour). The assay has received approval for clinical use by the US Food and Drug Administration (FDA) and is certified (for accuracy and precision) by the Center for Disease Control and Prevention (CDC).","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67394685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluation of Lab Request and Report Formats Completeness and its Advantage for Both Health Professionals and Patients in a Health Center, Addis Ababa, Ethiopia","authors":"T. H, Haile B, Siyum B, Mihret G, D. W.","doi":"10.16966/2572-9578.129","DOIUrl":"https://doi.org/10.16966/2572-9578.129","url":null,"abstract":"","PeriodicalId":92069,"journal":{"name":"Journal of clinical and laboratory medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67394201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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