Laboratory medicine最新文献

Introduction: Prenatal lead exposure increases the risk of pregnancy complications and results in fetal neurodevelopmental damage. Despite well-documented risks, most clinicians predominantly rely on risk-based screening rather than on blood lead testing. The study aimed to measure whole blood lead levels (BLLs) in pregnant women from parts of Indiana and explore associations with maternal age, residential zip code, and median household income.

Methods: Remnant whole blood samples submitted for hemoglobin electrophoresis were diluted 250-fold with aqueous diluent, and lead was measured by inductively coupled plasma tandem mass spectrometry. A BLL of 1 μg/dL or greater was classified as elevated in this study, although thresholds set for public health screening are higher.

Results: Among 548 samples analyzed, 37 (6.8%) had a BLL of 1 µg/dL or higher, 2 samples were between 3.5 and 4.9 µg/dL, and 4 samples were 5 µg/dL or higher. We found no association between median household income based on zip code and elevated BLL. Participants were also grouped by age (analysis of variance P < .05), with Tukey honestly significant difference indicating higher mean BLL in participants 40 years of age or older.

Discussion: Nearly 7% of the sampled pregnant population had elevated BLLs, which highlights continued need for surveillance of lead exposure in this vulnerable population.

Introduction: Laboratory immunologists occasionally encounter rare immunofluorescence patterns, such as the centromere protein F (CENP-F)-like pattern, classified as AC-14 by the International Consensus on ANA Patterns (ICAP). The clinical and biological significance of anti-CENP-F antibodies remains unclear, but their presence appears to be related to events involving increased or abnormal cell proliferation, including malignancies.

Methods: This case report describes the diagnostic journey of a patient who presented with clinical manifestations of chronic spontaneous urticaria (CSU), the laboratory report for which indicated the presence of a CENP-F-like (AC-14) antinuclear antibody (ANA) pattern during routine testing for the cause of her symptoms. Concerned by the result, the patient independently searched for information online and discovered a potential association between anti-CENP-F autoantibodies and cancer. This search led to considerable anxiety and prompted her to pursue further medical evaluations to rule out malignancy. The resulting diagnostic pathway involved consultations across several medical disciplines.

Results: This case highlights the complexity of interpreting uncommon ANA patterns and underscores the critical role of the laboratory in such contexts. In particular, it emphasizes that (1) ANA testing should be requested only in well-defined clinical contexts; (2) the CENP-F-like ANA pattern is not diagnostic of malignancy in low-risk patients.

Discussion: Laboratories can play a crucial role in supporting clinicians, providing confirmation of laboratory results, even in the absence of commercial tests for determining the antigenic specificity. We believe that this case exemplifies the importance of correct and careful laboratory reporting, especially in an era where patients frequently engage in self-diagnosis. It also underlines the value of multidisciplinary collaboration in the management of unexpected laboratory results.

Introduction: Against the backdrop of China's diagnosis-related groups/disease intervention packet payment reforms, which mandate cost-effective laboratory management, this study explored a subspecialty-based, multicenter integration model for nonurgent testing projects in independent clinical laboratories. The mounting pressure on health care expenditure control necessitates innovative approaches to enhance laboratory efficiency and reduce costs without compromising quality.

Methods: This research evaluated the impact of integrating testing programs across 4 independent medical laboratories located in cities S, N, H, and L. The integration was conducted on specialized platforms, including flow cytometry, immunoassays, mass spectrometry, and polymer-ase chain reaction. Nonemergent tests with a report turnaround time exceeding 1 day were centralized through cold-chain logistics for intercity sample transfer. Rigorous data collection and analysis methods were employed to compare the efficiency, cost, and quality of preintegration and postintegration performance.

Results: The integration substantially improved testing efficiency (12.11%-71.34%) and reduced costs by 3.70% to 6.25%. Quality metrics demonstrated notable enhancements, with turnaround delay rates decreasing by 0.06% to 0.98% and refund rates decreasing by 0.0% to 0.01%. These improvements were primarily driven by using regional laboratory expertise and implementing artificial intelligence-driven automation technologies for analytical processes.

Discussion: The findings of this study clearly demonstrate that multicenter integration is an effective strategy for optimizing resource allocation and achieving scalable and cost-effective laboratory operations. This subspecialty-based integration approach provides a viable and scalable solution for laboratories in various regions worldwide, enabling them to strike a balance among testing efficiency, quality, and cost-effectiveness. It not only addresses the urgent challenges posed by health care payment reforms but also offers actionable recommendations for the optimization of laboratory layouts in low- and middle-income countries.

Introduction: Acquired bisalbuminemia is an uncommon qualitative albumin abnormality increasingly detected by capillary electrophoresis. It can be associated with several pathologic contexts.

Methods: A retrospective analysis was performed on two cases of bisalbuminemia detected over a 10-year period in the biochemistry-toxicology laboratory of Moulay Ismail Military Hospital in Meknes, Morocco. Clinical, biochemical, electrophoretic, and histologic data were reviewed, with particular emphasis on serum albumin electrophoretic patterns.

Results: Bisalbuminemia was identified in two distinct hepatobiliary contexts: an overlap syndrome between autoimmune hepatitis and primary sclerosing cholangitis and antibiotic exposure in a patient with cholangiocarcinoma. In both cases, the abnormal albumin fraction was temporary and resolved after treating the underlying condition or withdrawing the drug that was causing it.

Discussion: Acquired bisalbuminemia represents a reversible laboratory finding that reflects underlying pathologic or pharmacologic processes. Capillary electrophoresis plays a pivotal role in the detection and follow-up of this condition.

Introduction: Accurate and harmonized antinuclear antibody HEp-2 indirect immunofluorescence (IIF) reporting is essential for reliable communication between laboratories and clinicians. In Türkiye, a national online HEp-2 IIF competency assessment program has been operating since 2018, with 3 runs per year and participation of individual users representing clinical laboratories nationwide. The program evaluates the performance of participants and identifies training and reporting needs.

Methods: Between 2018 and 2025, 21 runs were conducted; the accuracy of competent-level and expert-level fluorescence pattern identification was analyzed. Twenty-six to 64 participants took part in each run. Since 2021, reflex test recommendations have been incorporated.

Results: The competent-level fluorescence patterns most accurately identified were AC-1, AC-3, AC-6/7, AC-8/9/10, AC-11/12, and AC-15/16/17, while AC-0 and AC-2/30 showed less than 80% accuracy in at least 1 run. Among expert-level patterns, accuracy was highest for pattern AC-27 and lowest for pattern AC-29, with low rates for AC-5, AC-6, AC-15, and AC-20. Reflex test recommendations were generally accurate (75.6%-100%).

Discussion: The results revealed good performance for many competent-level nuclear and cytoplasmic patterns and satisfactory reflex test recommendations. Persistent challenges were recognized, however, for patterns AC-29, AC-5, AC-20, and AC-0. Competency self-assessment, combined with collective performance evaluation, may provide insight for the harmonization of HEp-2 IIF reporting and improvement of laboratory-clinician collaboration.

Introduction: Standard triglyceride assays may overestimate true triglyceride concentrations due to endogenous glycerol interference, particularly in type 2 diabetes, where enhanced lipolysis elevates circulating free glycerol. We compared glycerol-blanked and non-blanked triglyceride assays in patients with type 2 diabetes to quantify analytical bias and assess impact on cardiovascular risk indices.

Methods: This cross-sectional study enrolled 200 patients with type 2 diabetes and 200 healthy control individuals. Serum triglyceride levels were measured using glycerol-blanked (Sekisui) and nonblanked (Beckman Coulter) enzymatic assays. Bias assessment, correlation analysis, and impact on atherogenic index of plasma were evaluated.

Results: Median nonblanked triglyceride values were substantially higher than glycerol-blanked triglyceride values in control individuals (129.5 vs 120.95 mg/dL, P = .02) and patients with type 2 diabetes (158.5 vs 136.85 mg/dL, P = .0019). Overestimation was greater in patients (median difference, 16.1 mg/dL) than in control individuals (9.95 mg/dL, P = .0001). Bland-Altman analysis showed higher mean (SD) bias in patients with type 2 diabetes (-21.25 [41.51] mg/dL) than in control individuals (-13.26 [31.26] mg/dL). The triglyceride- glycerol-blanked triglyceride difference correlated with glycated hemoglobin values in individuals with type 2 diabetes (ρ = 0.141, P = .0473).

Discussion: Glycerol-blanked triglyceride assays provide more accurate lipid assessment in type 2 diabetes, improving cardiovascular risk stratification and therapeutic decision-making.

Introduction: Autoimmune bullous diseases (AIBDs) are rare, tissue-specific autoimmune diseases of the skin, and corresponding autoantibodies have been proved to be pathogenic. Recently, we reported that variations in platelet-related parameters may reflect the fluctuations of circulating AIBD-correlated antibody titers during the disease progression of 1 patient with AIBD. The purpose of this article is to further investigate the possible correlation between autoantibody titers and platelet-related parameters in patients with AIBD.

Methods: This study collected data on autoantibody titers and platelet-related parameters from 136 patients with bullous pemphigoid positive for anti-BP180 antibodies, 54 patients with pemphigus foliaceus positive for anti-desmoglein (Dsg) 1 antibody, 55 patients with pemphigus vulgaris positive for both anti-Dsg1 and Dsg3 antibodies, and 16 patients with pemphigus vulgaris positive for anti-Dsg3 antibody alone. Two groups of healthy individuals served as controls.

Results: Comparative analyses revealed clinically significantly elevated platelet-related parameters, such as platelet count and thrombocytocrit, in the autoantibody-positive patient groups relative to control individuals. Correlation analyses demonstrated statistically significant positive associations between autoantibody titers and specific platelet-related parameters.

Discussion: These findings represent the first documented evidence of a positive correlation between autoantibody titers and platelet-related parameters in patients with AIBDs. The data implied that platelets may contribute to the disease pathophysiology and progression of AIBDs.

Introduction: We sought to assess the clinical utility of methylation detection of paired box gene 1 (PAX1) and junctional adhesion molecule 3 (JAM3) in the triage of individuals testing positive for high-risk human papillomavirus (HPV).

Methods: Cervical secretions from 312 high-risk HPV-positive patients were analyzed for dual-gene methylation of PAX1 and JAM3 (PAX1m/JAM3m). Methylation levels were compared across histologically confirmed cervical lesions. Using histopathology as the reference standard, the triage performance of PAX1m/JAM3m was evaluated against cytology and HPV-16/18 genotyping.

Results: Methylation positivity increased in statistical significance with lesion severity (P < .001 for trend). For the detection of cervical intraepithelial neoplasia (CIN) 2 or more severe lesions (CIN2+), PAX1m/JAM3m yielded a sensitivity of 91.8% (95% CI, 84.1%-96.2%), specificity of 90.7% (95% CI, 85.7%-94.1%), and an area under the receiver operating characteristic curve of 0.912 (95% CI, 0.874-0.951), outperforming cytology, HPV-16/18 genotyping, and their combinations. Using PAX1m/JAM3m positivity as a criterion for colposcopy referral, 1 CIN2+ case was detected per 1.22 referrals, reducing the colposcopy referral rate by approximately 19.2% and increasing the CIN2+ detection rate by 39.4% compared with cytology at the atypical squamous cells of undetermined significance threshold.

Discussion: PAX1m/JAM3m levels are strongly associated with cervical lesion severity and represent a promising triage strategy for high-risk HPV-positive individuals.

Introduction: Acute respiratory tract infections remain a major global health concern, and advances in molecular diagnostics have improved viral detection. The clinical interpretation of C-reactive protein (CRP) levels in viral respiratory infections, however, remains insufficiently defined. This study aimed to analyze CRP profiles in patients with respiratory viral infections to clarify their epidemiologic and clinical significance.

Methods: A retrospective analysis was conducted in 7639 respiratory specimens tested by multiplex reverse transcription-polymerase chain reaction between July 2020 and March 2025, with concurrent CRP measurement. C-reactive protein values below 0.5 mg/dL were imputed as 0.25 mg/dL for analysis.

Results: Among the 7639 specimens analyzed, 965 (12.63%) tested positive for respiratory viruses, with a peak observed during the winter-spring season. Viral positivity was slightly higher in women than in men. Children younger than 5 years of age exhibited the highest positivity (54.33%) but lower CRP values, whereas CRP levels increased substantially with age, reaching 12.10 mg/dL in individuals 70 years of age and older. Co-infections (13.2%) were strongly associated with lower CRP levels.

Discussion: Distinct CRP distributions were observed according to age and infection complexity. These findings support the use of CRP as a supplemental marker for interpreting viral respiratory tract infections and identifying atypical inflammatory responses, particularly in co-infections.

Introduction: Cerebrovascular disease (CVD) represents a major global health concern that affects the blood vessels throughout the body and contributes to a considerable burden of mortality and morbidity. The Endothelial Activation and Stress Index (EASIX) has recently emerged as a promising biomarker for predicting many disease complications and outcomes. We aimed to investigate the relationship between EASIX and disease mortality in patients with CVD.

Methods: The present study was conducted in a tertiary emergency department between January 6, 2023, and January 6, 2024, who were diagnosed with CVD. The mortality rate among patients within a 1-month period was analyzed. The EASIX was calculated using lactate dehydrogenase level (U/L) × creatinine level (mg/dL)/platelet count (×109/L). The parameters were then compared in relation to disease morbidity.

Results: Following the exclusion of patients who met the preestablished exclusion criteria, the study included 74 participants. In the 1-month follow-up of 64 patients, no mortality was observed. The median EASIX score was 0.80 (IQR, 0.5-2.2) in the surviving patients, while the median EASIX score was 2.90 (IQR, 1.00-10.55) in the patients who died, indicating a statistically significantly higher score (P < .001).

Discussion: EASIX has the potential to be a prognostic marker for mortality in patients with CVD.