Laboratory Blood Tests Research Articles

Evaluation of AI-Driven LabTest Checker for Diagnostic Accuracy and Safety: Prospective Cohort Study.

In recent years, the implementation of artificial intelligence (AI) in health care is progressively transforming medical fields, with the use of clinical decision support systems (CDSSs) as a notable application. Laboratory tests are vital for accurate diagnoses, but their increasing reliance presents challenges. The need for effective strategies for managing laboratory test interpretation is evident from the millions of monthly searches on test results' significance. As the potential role of CDSSs in laboratory diagnostics gains significance, however, more research is needed to explore this area. The primary objective of our study was to assess the accuracy and safety of LabTest Checker (LTC), a CDSS designed to support medical diagnoses by analyzing both laboratory test results and patients' medical histories. This cohort study embraced a prospective data collection approach. A total of 101 patients aged ≥18 years, in stable condition, and requiring comprehensive diagnosis were enrolled. A panel of blood laboratory tests was conducted for each participant. Participants used LTC for test result interpretation. The accuracy and safety of the tool were assessed by comparing AI-generated suggestions to experienced doctor (consultant) recommendations, which are considered the gold standard. The system achieved a 74.3% accuracy and 100% sensitivity for emergency safety and 92.3% sensitivity for urgent cases. It potentially reduced unnecessary medical visits by 41.6% (42/101) and achieved an 82.9% accuracy in identifying underlying pathologies. This study underscores the transformative potential of AI-based CDSSs in laboratory diagnostics, contributing to enhanced patient care, efficient health care systems, and improved medical outcomes. LTC's performance evaluation highlights the advancements in AI's role in laboratory medicine.

Sex and the Relationship Between Cardiometabolic Risk Factors and Estimated GFR Decline: A Population-Based Cohort Study

Rationale & ObjectiveFemales have a higher prevalence of chronic kidney disease (CKD) than males, but are less likely to be treated with kidney replacement therapy (KRT). We studied the interaction between sex and the association of cardiometabolic risk factors for the decline in kidney function over time. Study DesignA population-based cohort study. Setting & Participants1,127,731 adults living in Wales, UK, within the Secure Anonymised Information Linkage Databank. ExposuresSex and risk factors including age, estimated glomerular filtration rate (eGFR), cardiometabolic conditions, smoking, and socioeconomic deprivation. These risk factors were defined using primary care records. OutcomesThe yearly declines in eGFR and the risk of incident kidney failure defined as long-term KRT and/or sustained eGFR<15mL/min/1.73m2. Analytical ApproachLinear mixed effects models and Cox proportional hazards analysis. ResultsThe average decline in eGFR age ≤73 was equal in males and females. After age 73, eGFR decline was faster in males than females, particularly for males with heart failure (males -1.22 mL/min/1.73m2 per year: 95% confidence interval (CI) -1.25 to -1.20 versus females -0.87mL/min/1.73m2: CI -0.89 to -0.85) and current smokers (males -1.58 mL/min/1.73m2 per year: CI -1.60 to -1.55 versus females -1.27 mL/min/1.73m2: CI -1.29 to -1.25). Socioeconomic deprivation was one of the most impactful risk factors on eGFR decline among females age >73, whereas cardiometabolic risk factors were more important among males. Older females at baseline were less likely to develop incident kidney failure than older males (p-value for age<0.001). LimitationsStudy of people who were almost exclusively White and who had blood laboratory test data. Reliance on creatinine-based eGFR. Albuminuria and body mass index data were incomplete. ConclusionseGFR decline was faster in males than in females especially in the setting of heart failure and smoking. Socioeconomic deprivation was an important risk factor associated with eGFR decline, particularly for females. While further work is required to explore less well-recognised risk factors these findings may inform clinical management strategies of CKD overall and within sex-specific groups.

Diagnostic studies for enterotoxaemia in rabbits

The relevance of this study is highlighted by the occurrence of enterotoxaemia in rabbits, particularly caused by Clostridium perfringens, in the context of industrial rabbit farming. The research aimed to determine the causes of morbidity and increased mortality in young rabbits during the growing period. The study involved a stepwise analysis of feed samples, clinical examination of rabbits reared in an industrial rabbit farm, and laboratory examination of the obtained biological material. Additionally, to establish a diagnosis and provide the farm with appropriate recommendations regarding the maintenance and prevention of rabbit diseases, the health status of the rabbits, the causes of digestive disorders with symptoms of diarrhoea and increased mortality under production conditions were analysed. Clinical, haematological, pathological, microbiological, and statistical research methods were used. In diseased rabbits, an increase in rectal body temperature, symptoms of diarrhoea, and in some animals, seizures were established. Several animals succumbed to the disease. During laboratory blood tests of the rabbits, moderate anaemia was detected, with a decrease in the number of erythrocytes and a reduction in haemoglobin content. There was also a disturbance in the qualitative composition of erythrocytes, including the presence of poikilocytosis and altered erythrocyte forms: acanthocytes, echinocytes, schistocytes, dacryocytes, keratocytes, and drepanocytes. A decrease in the immune status of the rabbits was characterised by a reduction in the total number of leukocytes and lymphocytes in the blood and a low neutrophil-to-lymphocyte ratio. Biochemical analysis of rabbit serum revealed a decrease in glucose levels below the physiological range and an increase in the activity of the enzymes alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase. Results of post-mortem examinations of the deceased rabbits indicated the presence of gas-filled small intestines, with a fluid content and no macroscopic signs of inflammation. The feed provided to the rabbits on the farm was found to contain sulphite-reducing clostridia, specifically Clostridium perfringens. Identifying the causes of morbidity and mortality in rabbits will enable the selection of appropriate methods for preventing deaths within specific farming conditions

Application of the Artificial Intelligence Model for Detection of Electrocardiographic Signs of Coronary Occlusion in Patients with Non ST-Elevation Acute Coronary Syndrome

The aim. This study aimed to determine the effectiveness of the OMI AI deep learning model for the diagnosis of myocardial infarction in patients with non ST-elevation acute coronary syndrome. Materials and methods. This single-center retrospective observational study analyzed the data of 238 patients admitted to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a primary diagnosis of non ST-elevation acute coronary syndrome. The inclusion criteria for the study were: age ≥18 years, symptoms of acute coronary syndrome, at least one 10-second 12-lead electrocardiography on admission, no changes typical of ST-segment elevation myocardial infarction on electrocardiography, and at least one laboratory blood test for biomarkers of myocardial damage. Results. The final analysis included data from 116 patients, 69 (59.5%) men and 47 (40.5%) women aged 43 to 88 years (mean age 67±11 years), of whom 34 were older patients (≥75 years). Of these, 29 (25%) patients were discharged with a diagnosis of acute myocardial infarction, 60 (51.7%) with a diagnosis of unstable angina, and 27 (23.3%) patients with other diagnoses. When analyzing electrocardiographic data by the OMI AI model, true positive results were obtained in 23 cases (19.8%), true negative results in 76 cases (65.5%), false positive results in 11 cases (9.5%), and false negative results in 6 cases (5%). Accordingly, the model’s sensitivity was 67% and specificity was 93%. The positive and negative predictive values for the model under study were 0.793 and 0.874, respectively. The accuracy of the model was 85.34% (95% CI: 77.78% to 90.64%). Conclusions. The use of the artificial intelligence tools has the potential to improve the accuracy of diagnosis of myocardial infarction during hospitalization, accelerate the provision of specialized care and improve prognosis in patients with non ST-elevation acute coronary syndrome.

Left ventricular structure and function following renal sympathetic denervation in patients with HFpEF: an echocardiographic 9-year long-term follow-up.

High blood pressure is a major risk factor for cardiac remodeling and left ventricular hypertrophy, increasing cardiovascular risk and leading to heart failure with preserved ejection fraction (HFpEF). Since renal sympathetic denervation (RDN) reduces blood pressure in the long term, we aimed to investigate the long-term effect of RDN in patients with HFpEF in the present analysis. Patients previously enrolled in a local RDN registry who underwent high-frequency RDN with the use of the Symplicity Flex® renal denervation system between 2011 and 2014 were followed up. The patients were assessed by 24-h ambulatory blood pressure measurement, transthoracic echocardiography, and laboratory tests. We used the echocardiographic and biomarker criteria of the Heart Failure Association (HFA)-PEFF (Pre-test assessment, Echocardiography and Natriuretic Peptide Score, Funkctional testing, and Final aetiology) score to identify patients with HFpEF. Echocardiographic assessment was available for 70 patients at a 9-year long-term follow-up. Of these patients, 21 had HFpEF according to the HFA-PEFF score. We found a significant reduction of the HFA-PEFF score from 5.48 ± 0.51 points at baseline to 4.33 ± 1.53 points at the 9-year follow-up (P < 0.01). This decrease was due to a greater reduction in morphological and biomarker subcategories [from 1.95 ± 0.22 to 1.43 ± 0.51 points (P < 0.01) and from 1.52 ± 0.52 to 0.90 ± 0.63 points (P < 0.01), respectively] than in the functional one. Morphologically, there was a reduction in left ventricular hypertrophy and left atrial dilation. The present analysis suggests that RDN may lead to a regression of the extent of HFpEF beyond a reduction in blood pressure and thus possibly contribute to an improvement in prognosis. More detailed information will be provided by ongoing randomized sham-controlled trials.

In vitro blood sample assessment: investigating correlation of laboratory hemoglobin and spectral properties of dual-energy CT measurements (ρ/Z)

ObjectivesOur study comprised a single-center retrospective in vitro correlation between spectral properties, namely ρ/Z values, derived from scanning blood samples using dual-energy computed tomography (DECT) with the corresponding laboratory hemoglobin/hematocrit (Hb/Hct) levels and assessed the potential in anemia-detection.MethodsDECT of 813 patient blood samples from 465 women and 348 men was conducted using a standardized scan protocol. Electron density relative to water (ρ or rho), effective atomic number (Zeff), and CT attenuation (Hounsfield unit) were measured.ResultsPositive correlation with the Hb/Hct was shown for ρ (r-values 0.37–0.49) and attenuation (r-values 0.59–0.83) while no correlation was observed for Zeff (r-values −0.04 to 0.08). Significant differences in attenuation and ρ values were detected for blood samples with and without anemia in both genders (p value < 0.001) with area under the curve ranging from 0.7 to 0.95. Depending on the respective CT parameters, various cutoff values for CT-based anemia detection could be determined.ConclusionIn summary, our study investigated the correlation between DECT measurements and Hb/Hct levels, emphasizing novel aspects of ρ and Zeff values. Assuming that quantitative changes in the number of hemoglobin proteins might alter the mean Zeff values, the results of our study show that there is no measurable correlation on the atomic level using DECT. We established a positive in vitro correlation between Hb/Hct values and ρ. Nevertheless, attenuation emerged as the most strongly correlated parameter with identifiable cutoff values, highlighting its preference for CT-based anemia detection.Clinical relevance statementBy scanning multiple blood samples with dual-energy CT scans and comparing the measurements with standard laboratory blood tests, we were able to underscore the potential of CT-based anemia detection and its advantages in clinical practice.Key PointsPrior in vivo studies have found a correlation between aortic blood pool and measured hemoglobin and hematocrit.Hemoglobin and hematocrit correlated with electron density relative to water and attenuation but not Zeff.Dual-energy CT has the potential for additional clinical benefits, such as CT-based anemia detection.Graphical

Eruptive Xanthomas – A Case Report with a Review of the Literature

Eruptive xanthomas are most often the result of impaired lipid metabolism. They can be caused by a primary dysregulation in lipid metabolism (familial hyperlipoproteinemias) or by an increase in serum lipids from concomitant diseases (diabetes mellitus, obesity, chronic renal failure, nephrotic syndrome, pancreatitis, hypothyroidism, rarely hyperthyroidism, alcohol abuse, cholestasis or biliary cirrhosis, monoclonal gammopathy, multiple myeloma and leukemia) or from the use of certain medications (beta-blockers, estrogens, retinoids, protease inhibitors, cyclosporine, the antimycotic Miconazole and the antipsychotic Olanzapine (secondary hyperlipoproteinemias). Early diagnosis and adequate therapy of the skin changes and the comorbid underlying disease prevent serious life-threatening complications. A case of a 34-year-old man with papular yellowish lesions on the elbows is presented. The patient has accompanying diseases of diabetes mellitus, alcohol addiction, liver cirrhosis, chronic acute pancreatitis and chronic cholecystitis. The clinical diagnosis of eruptive xanthomas was confirmed by histopathological examination revealing foam cells in the dermis. Laboratory blood tests revealed an accelerated ESR and elevated blood glucose, transaminases, uric acid, total cholesterol, and triglycerides. Hepatoprotective and antidiabetic therapy combined with a dietary regimen improved the patient&amp;apos;s condition and laboratory parameters. A partial reversal of skin lesions occurred. An overview of the epidemiology, etiopathogenesis, clinical picture, laboratory tests, differential diagnosis, dietary regimen, and treatment of eruptive xanthomas are presented.

Improving croup management at a pediatric emergency department

ABSTRACT Objectives Over-testing and over-treatment are common in children with croup at pediatric emergency departments (PED). The objective of the study was to improve care for children with croup. Methods In this quality improvement (QI) initiative, all pediatric residents starting their rotation in the PED attended an informative presentation about croup and were provided reminders throughout their rotation. The primary outcome of this QI initiative was to reduce nebulized epinephrine (NE) use among children with mild croup by 50% over 7 months. The secondary outcome was to reduce X-rays by 50% over 7 months. Other outcomes included the administration of dexamethasone to all children with croup, reduction of antibiotics, laboratory tests, and revisits, and shortening the duration between physical examination to dexamethasone and NE treatments, and the length of stay (LOS) at the PED. Results NE administration to patients with mild croup decreased from 80.2% to 36.3% (p < 0.001). The proportion of children with X-rays decreased from 37.4% to 17.1% (p < 0.001). There was a significant increase in dexamethasone administration, and significant decreases in laboratory blood tests, expanded viral PCR panel tests, and antibiotic prescription among all croup cases (p < 0.001). Revisit rates were not significantly different (p > 0.05). Time to dexamethasone and LOS shortened significantly (p < 0.001). Conclusion With this QI intervention, decreases in the rate of administration of NE to mild croup cases, antibiotic prescription, X-ray, laboratory blood and respiratory PCR panel tests in all croup cases were achieved without an increase in revisits. However, unnecessary NE, antibiotic, and X-ray rates are still high.

INVESTIGATION OF THE EFFICIENCY OF NON-STEROIDAL ANTI-INFLAMMATORY VETERINARY MEDICINAL PRODUCT IN THE COMPLEX TREATMENT OF DISEASES OF THE MUSCULOSKELETAL SYSTEM OF PIGS

The article presents the results of clinical trials of a non-steroidal anti-inflammatory veterinary drug when administered to fattening piglets with clinical signs of musculoskeletal diseases. For the treatment of the diseases, piglets of the experimental (I) and control (II) groups received an antimicrobial drug based on the tetracycline antibiotic. The animals of the experimental group were additionally administered orally with drinking water the test non-steroidal anti-inflammatory drug based on acetylsalicylic, ascorbic and citric acids, in the recommended dosage by the manufacturer. Blood for laboratory tests was selected from piglets before and after the use of drugs. Studies of hematological and biochemical parameters were conducted according to generally accepted methods. The therapeutic efficiecy of the drug and its effect on the morphofunctional state of the body was evaluated by comparing the statistically processed data obtained before and after treatment, as well as in comparison with the indicators of animals of the control group. The analysis of hematological parameters of piglets during the experiment showed a decrease in the number of leukocytes in the animal’s blood after the use of drugs. The normalization of the leukogram was also noted by reducing the relative number of rod-nuclear neutrophils. In particular, this indicator decreased by 17.4% in group I piglets, and by 12% in group II piglets. It is noted that the clinical response to therapy was faster and more pronounced in animals, which used a non-steroidal anti-inflammatory drug in combination with an antimicrobial drug than in piglets, which were treated only by antibiotic. According to the results of biochemical studies, it was found that the content of urea in the serum of animals of both groups before the use of drugs exceeded more than 3 times the upper limit of physiological values for a given age group of piglets. After therapy with the drugs a significant decrease in the urea content in the blood serum of groups 1 and 2 animals was noted by 3.42 and 2.98 times, respectively. It is established that the activity of marker enzymes of the liver physiological state (ALT, AST) in the serum of group I piglets after complex treatment with the studied drugs was slightly reduced and was within the physiological values. In the serum of group II animals, which were treated only with antimicrobial drug, ALT activity increased by 12,0 %, and AST – by 38,6 %, compared to the initial data, and exceeded the limit of physiological values. An increase in the content of iron by 37.4 % in the blood of group I piglets, compared to the period before drug administration, was noted. No adverse reactions and negative phenomena were detected during the use of the test drug, and the drug was well tolerated. According to the clinical condition of the experimental group animals and the results of laboratory tests it was established that the use of non-steroidal anti-inflammatory drugs based on acetylsalicylic, ascorbic and citric acids simultaneously with antimicrobial therapy led to a faster improvement in the state of the musculoskeletal system. Observation during the month of the piglet’s clinical conditions confirmed the safety of the drug in the recommended dosage and method of administration in the combined treatment of inflammatory processes of the musculoskeletal system.

Vitamin D level and low-energy fracture risk in children and adolescents: a population-based case-control study of 45 cases.

The objective of this study is to document the rate of vitamin D deficiency and insufficiency among children with low-energy fractures and compare it to fracture-free control group. We included all children under 15 years presenting to the emergency department with low-energy fractures; controls were children without history of fractures from the outpatient department. Conventional X-ray and laboratory blood tests were performed. Vitamin D deficiency was defined as serum level ≤20 ng/ml, and the mean values were compared through two-sample t -tests. The influence of vitamin D on the fractures was defined using Chi-square test, significance with P -value < 0.05. The relationships between variables and odds of fracture occurrence were examined using logistic regression models. The final sample included 37 cases (30 males, 7 females, 7.4 ± 3.7 years) and 70 control individuals (42 males, 28 females, 7.8 ± 4.6 years) without significant differences regarding age, sex, and month of inclusion. Children with fractures had lower levels of vitamin D (21.87 ± 8.40 ng/ml vs. 25.89 ± 7.62 ng/ml) ( P = 0.01). Vitamin D played a protective role against low-energy fractures (OR, 1.08; 95% CI, 1.01-1.14; P = 0.02), boys showed three times greater fracture risk than girls (OR, 3.00; 95% CI, 1.12-8.07; P = 0.03). Finally, vitamin D deficiency correlated with almost five times increased risk of pediatric low-energy fractures (OR, 4.63; 95% CI, 1.92-11.18; P = 0.001). This is the first MENA study establishing a relation between vitamin D deficiency and low-energy fractures among children and adolescents. The findings show the protective role of vitamin D on the pediatric bone and may help physicians preventing morbidity on children and costs on their families and the socioeconomic health system.

ARTERIAL STIFFNESS ASSOCIATES WITH MALNUTRITION IN HYPERTENSIVE PATIENTS WITH CONCOMITANT CHRONIC PANCREATITIS

Objective: The association between pancreatitis and cardiovascular diseases remains incompletely understood. Malnutrition in chronic pancreatitis may be associated with an increase in arterial stiffness in hypertension. Objective: to evaluate interaction between malnutrition markers and arterial stiffness in patients with hypertension and chronic pancreatitis. Design and method: Methods: 70 non-diabetic patients with 1st degree hypertension with concomitant chronic pancreatitis (median age – 52,4 [43,8;63,7] years) were included in the study. We divided all included patients into two groups: 1st group – 41 patients with malnutrition, 2nd group – 29 patients without malnutrition. Standard laboratory blood tests, haematological parameters, lipid profile, glucose, renal and liver function tests, pancreatic fecal elastase-1, total protein, serum albumin, serum iron, vitamin 25(OH)D, serum zinc and magnesium detection were performed for all patients. The groups were comparable in terms of age, gender structure, functional state of the kidneys. Non-parametric methods were used for statistical data analysis. To determine the prognostic significance, the ROC analysis was performed. Significant differences were considered when the p-value was p&lt;0.001 Results: In patients with a combined course of hypertension and chronic pancreatitis with established malnutrition, an increase in arterial stiffness was significantly more often compared to patients with normal nutritional status - 83% and 62%, respectively (p&lt;0.001). A significantly lower level of brachial artery augmentation index was established by 43% (p&lt;0.001) in the first group. It was established that patients with malnutrition had a significantly higher caritid-femoral pulse wave velocity by 17.5% (p&lt;0.001). Correlations were established between brachial artery augmentation index and serum levels of zinc (R=0.63, p&lt;0.001), magnesium (R=0.66, p&lt;0.001), albumin (R=0.58, p&lt;0.001), vitamin 25(OH)D (R=0.68, p&lt;0.001) in patients with the combined course of hypertension and chronic pancreatitis. ROC analysis revealed that serum zinc level had an excellent diagnostic power for arterial stiffness in hypertensive patients with chronic pancreatitis (AUC = 0.910). Serum albumin had very good diagnostic power for arterial stiffness in hypertensive patients with chronic pancreatitis (AUC = 0.859). Conclusions: Arterial stiffness may be associated with malnutrition in hypertensive patients with concomitant chronic pancreatitis.

MANAGEMENT OF AORTIC OCCLUSION SYNDROME ASSOCIATED TO GRAVES DISEASE

Background :Leriche syndrome or aortoiliac occlusion disease is caused by atherosclerosis and manifests as a constellation of symptoms that include claudication, erectile dysfunction, and the notable absence of femoral pulses. Graves disease (also known as Basedow) is an autoimmune disorder characterized by excessive thyroid hormone production, leading to hyperthyroidism. It often results in symptoms such as weight loss, rapid heart rate, tremors, and an enlarged thyroid gland (goiter).We present a case study detailing a singular occurrence of Leriche syndrome in a patient concurrently diagnosed with Graves disease, emphasizing the intricate nuances encountered in anesthesia management across both surgical procedures. Case presentation: A 53-year-old North African male with history of smoking presented to the ED with critical limb ischemia. The patient exhibited normal vital signs, except for a sinus tachycardia of 140 beats per minute. Initial blood laboratory tests yielded no abnormalities. However, abdominopelvic computed tomography angiography (CTA) revealed an abdominal aortic aneurysm measuring 46mm in diameter and extending over 107mm. This aneurysm was found to be partially thrombosed above the renal arteries, with complete thrombosis noted at the infrarenal level, extending bilaterally to the iliac arteries. The presence of collateral blood vessels supported the diagnosis of Leriche syndrome. Additionally, further investigation into the sinus tachycardia revealed the patients diagnosis of Graves disease, complicating the vascular surgery. After collegial discussion, a two-stage surgical approach was decided upon. Initially, the patient underwent medical treatment using a rapid thyroid hormone blocking protocol to manage the signs of hyperthyroidism. Following achievement of biochemical and clinical euthyroidism, characterized by stable thyroid hormone levels, the first surgery, total thyroidectomy, was performed. Subsequently, a few days later, the patient underwent a bypass surgery. The postoperative course was marked by successful bypass graft surgery, resulting in improved limb function and absence of further complications. The patient was discharged home 10 days after the second surgery. Conclusion : In this case, the challenge lay in managing both conditions while ensuring controlled heart rate and blood pressure to prevent aneurysm rupture, and concurrently administering anticoagulant therapy to prevent thrombus extension. Our findings suggest that in comparable cases, emphasis on thorough physical examination and medical history is crucial, and interdisciplinary collaboration between different specialties enhances patient survival.

Diagnosis, management, and outcomes of parechovirus infections in infants: an overview.

Parechovirus A (PeV-A) infections have been detected with increasing frequency in US infants under 6 months of age, leading to a Centers for Disease Control and Prevention (CDC) health advisory in July 2022. Clinicians are advised to consider PeV-A laboratory testing of blood and cerebrospinal fluid when infants present with unexplained fever, sepsis-like illness, or neurological issues. Clinical laboratories are encouraged to offer in-house molecular testing for PeV-A to avoid diagnostic delays, unnecessary use of antibiotics, and prolonged hospitalization of infants presenting with sepsis-like illness. While data are evolving on potential neurodevelopmental sequelae after PeV-A infant central nervous system infections, most infected infants return to baseline health for age. This review examines the PeV-A literature with a focus on PeV-A3, including aspects of epidemiology, clinical presentations/management, laboratory diagnostics, genotyping, and post-infectious sequelae related to PeV-A infections in infants.

Identifying key risk factors for acute compartment syndrome in tibial diaphysis fracture patients

Acute compartment syndrome (ACS) is a severe orthopedic issue that, if left untreated, can result in lasting nerve and muscle damage or even necessitate amputation. The association between admission laboratory blood test indicators and the occurrence of ACS in patients with tibial diaphysis fractures is currently a subject of debate. The objective of this research was to identify the contributing factors for ACS in individuals suffering from tibial diaphysis fractures. In this retrospective study, we collected data on a total of 705 individuals from our hospital, comprising 86 ACS patients and 619 non-ACS patients with tibial diaphysis fractures. These participants were categorized into two distinct groups: the ACS group and the non-ACS group. Despite the inherent limitations associated with retrospective analyses, such as potential biases in data collection and interpretation, we conducted a comprehensive analysis of demographics, comorbidities, and admission lab results. Our analytical approach included univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis techniques, aiming to mitigate these limitations and provide robust findings. The statistical analysis revealed several predictors of ACS, including gender (p = 0.011, OR = 3.200), crush injuries (p = 0.004, OR = 4.622), lactic dehydrogenase (LDH) levels (p < 0.001, OR = 1.003), and white blood cell (WBC) count (p < 0.001, OR = 1.246). Interestingly, the study also found that certain factors, such as falls on the same level (p = 0.007, OR = 0.334) and cholinesterase (CHE) levels (p < 0.001, OR = 0.721), seem to provide a degree of protection against ACS. In order to better predict ACS, the ROC curve analysis was employed, which determined threshold values for LDH and WBC. The established cut-off points were set at 266.26 U/L for LDH and 11.7 × 109 cells per liter for WBC, respectively. Our research has successfully pinpointed gender, crush injuries, LDH levels, and white blood cell (WBC) count as crucial risk factors for the development of ACS in patients experiencing tibial diaphysis fractures. Furthermore, by establishing the cut-off values for LDH and WBC, we have facilitated a more personalized assessment of ACS risk, enabling clinical doctors to implement targeted early interventions and optimize patient outcomes.

Umbilical Cord Blood as an Alternative to Neonatal Blood for Complete Blood Count: A Comparison Study

ObjectiveTo assess concordance between umbilical cord blood (UCB) and neonatal blood (NB) laboratory test results at birth. Study designThis retrospective study considered very preterm neonates (<32 weeks' gestational age) admitted to a tertiary neonatal intensive care unit from 2012 to 2023. Inclusion criteria required neonates with a complete blood count measured in both UCB and NB drawn within 2 hours after birth. Median hemoglobin (Hb) and hematocrit (Hct) concentrations were compared between UCB (venous samples) and NB (venous, arterial, or capillary samples). ResultsA total of 432 neonates with paired UCB and NB values were included in the study. Hb concentration in UCB was 14.7 g/dL (interquartile range [IQR] 13.5-16.1 g/dL) compared with 14.8 g/dL (IQR 12.6-19.3 g/dL) in venous NB samples, 13.9 g/dL (IQR 12.9-15.3 g/dL) in arterial NB and 18.7 g/dL (IQR 16.6-20.8 g/dL) in capillary NB. The regression equation showed a correction factor of 1.08 for converting Hb values from UCB to venous NB. Median Hct concentration in UCB was 0.45 L/L (IQR: 0.41-0.49 L/L) compared with 0.48 L/L (IQR 0.43-0.54 L/L) in venous NB, 0.42 L/L (IQR 0.38-0.45 L/L) in arterial NB and 0.57 L/L, (IQR 0.51-0.63 L/L) in capillary NB. ConclusionsHb and Hct concentrations measured in UCB are similar to those measured in venous blood in very preterm infants and are valid alternatives for NB tests at birth. Hb and Hct concentrations in arterial and capillary NB are respectively lower and higher compared with UCB measurements.

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach.

The diagnostic approach for patients with tremor is challenging due to the complex and overlapping phenotypes among tremor syndromes. The first step in the evaluation of tremor is to identify the tremulous movement and exclude the tremor mimics. The second step is to classify the tremor syndrome based on the characteristics of tremor from historical clues and focused examination (Axis 1). Comprehensive tremor examinations involve the assessment of tremor in different conditions (rest, action or mixed, position or task-specific), distribution of tremor (upper limb, lower limb, head, jaw), positive signs for functional tremor (FT) if suspected (distractibility, entrainment, co-contraction), and associated neurological signs including parkinsonism, dystonic posture, cerebellar/brainstem signs, neuropathy, and cognitive impairment. A pivotal feature in this step is to determine any distinct feature of a specific isolated or combined tremor syndrome. In this review, we propose an algorithm to assess upper limb tremors. Ancillary testing should be performed if clinical evaluation is unclear. The choice of investigation depends on the types of tremors considered to narrow down the spectrum of etiology (Axis 2). Laboratory blood tests are considered for acute onset and acute worsening of tremors, while structural neuroimaging is indicated in unilateral tremors with acute onset, nonclassical presentations, and a combination of neurological symptoms. Neurophysiological study is an important tool that aids in distinguishing between tremor and myoclonus, etiology of tremor and document specific signs of FT. Treatment is mainly symptomatic based depending on the etiology of the tremor and the patient's disabilities.

ХАРАКТЕРИСТИКА ЭЛЕКТРИЧЕСКОЙ АКТИВНОСТИ ОТДЕЛОВ ЖЕЛУДОЧНО-КИШЕЧНОГО ТРАКТА У ПОЛЬЗОВАТЕЛЕЙ ЭЛЕКТРОННЫХ СИСТЕМ ДОСТАВКИ НИКОТИНА

Introduction. Using electronic nicotine delivery systems has shown a steady growth in recent years, especially among young people. Researchers and professionals are also interested in what consequences the use of such systems may have, but most studies deal with respiratory system. Aim. The aim is to clarify the electrical activity of the gastrointestinal tract parts in users of electronic nicotine delivery systems. Materials and Methods. 35 people of both sexes were examined, divided into two comparable groups: The study group consisted of 17 people regularly using electronic nicotine delivery systems, and the comparator group consisted of 18 practically healthy individuals. All study participants were surveyed using the quality-of-life questionnaire in Gastrointestinal Symptom Rating Scale, clinical laboratory testing of blood and stool was performed, feces were tested for occult blood; and endoscopy, video colonoscopy, and electrogastroenterography were performed. The findings are presented as median (Me), as well as the first and the third quartiles (Q1; Q3). The significance of differences in groups was assessed using the Mann–Whitney test for independent quantitative variables. Differences were considered significant at p≤0.05. Results and Discussion. All individuals examined in the study group had significantly higher scores for gastroenterological symptoms on all syndrome scales of the Gastrointestinal Symptom Rating Scale questionnaire. Disturbances are shown in the electrical activity and frequency of contractions of hollow gastrointestinal organs in individuals using electronic cigarettes. Conclusions. Systematic consumption of nicotine-containing liquids via electronic nicotine delivery systems forms a specific variant of functional gastrointestinal diseases, expressed in electrophysiological disorders of the gastrointestinal tract, which is reflected in clinical symptoms.

The establishment of diseased human whole organ model by normothermic machine perfusion technique: Principle of concept.

The global incidence of liver diseases is rising, yet there remains a dearth of precise research models to mimic these diseases. The use of normothermic machine perfusion (NMP) to study diseased livers recovered from liver transplantation (LT) recipients presents a promising avenue. Accordingly, we have developed a machine perfusion system tailored specifically for the human whole diseased livers and present our experience from the NMP of diseased livers. Six diseased livers recovered from LT recipients with different diagnoses were collected. The diseased livers were connected to the machine perfusion system that circulated tailored perfusate, providing oxygen and nutrients. The pressure and flow of the system were recorded, and blood gas analysis and laboratory tests of perfusate and bile were examined to analyze the function of the diseased livers. Liver tissues before and after NMP were collected for histological analysis. Experiments showed that the system maintained the diseased livers in a physiological state, ensuring stable hemodynamics and a suitable partial pressure of oxygen and carbon dioxide. The results of blood gas analysis and laboratory tests demonstrated a restoration and sustenance of metabolism with minimal damage. Notably, a majority of the diseased livers exhibited bile production continuously, signifying their vivid functional integrity. The pathological characteristics remained stable before and after NMP. We successfully established the machine perfusion system tailored specifically for diseased human whole livers. Through the application of this system, we have developed a novel invitro model that faithfully recapitulates the main features of human liver disease. This model holds immense promise as an advanced disease modeling platform, offering profound insights into liver diseases and potential implications for research and therapeutic development.

Abstract 4951: Integrative multi-omic machine learning model predicts neoadjuvant immunotherapy response using molecular data and deep learning-derived features from digital pathology

Abstract Background: Over the past decade, there has been an exponential accumulation of digital patient data through molecular profiling and digitization of pathology slides. However, integrating this to advance diagnostics and cancer patient care remains a significant challenge. By integrating information from diverse modalities to capture aspects of the tumor microenvironment (TME) and immune landscape, we aim to improve patient stratification for immunotherapy. Methods: We collected data from baseline biopsies from patients with palpable melanoma stage III (n=195) who received neoadjuvant immunotherapy followed by surgical resection of largest lymph node metastasis. The different modalities included clinical information, whole-genome sequencing (WGS), RNAseq, laboratory tests of blood, haematoxylin and eosin (H&amp;E) images, and PDL1 immunohistochemistry (IHC) images. Cell detection and classification models were trained to identify tumor-infiltrating lymphocytes and tumor cells on H&amp;E whole-slide images (WSI), deriving spatial features to quantitatively describe the tumor-immune interaction. Various biomarkers, including tumor mutational burden, BRAF status, expression of inflammatory gene signatures, systemic neutrophil-to-lymphocyte ratio, and tumor-lymphocyte spatial measures, were collectively integrated using machine learning models (random forest, elastic-net regularized logistic regression, CatBoost, support vector machine (SVM), and an ensemble classifier combined from the other models) within a 5x5-fold nested cross-validation scheme to predict pathologic response. Results: Pathologic response to immunotherapy is associated with multi-omics biomarkers which were integrated using machine learning. The ensemble approach showed that when all modalities were combined a higher AUC (AUC=0.69, 0.61-0.77) could be achieved than for the clinical modality alone. RNA plus clinical emerged as the most predictive standalone modality with an AUC of 0.62 (0.50-0.75). The overall highest AUC was achieved using a SVM (AUC=0.72, 0.66-0.82). Conclusions: Immunotherapy efficacy depends on diverse tumor microenvironment components, which were comprehensively assessed through data integration. A multi-omic predictive model holds promise for refining personalized and effective immunotherapy strategies. Citation Format: Lindsay V. Leek, Vanessa Botha, Vipul A. Baxi, Jonas Teuwen, Hugo M. Horlings, Scott D. Chasalow, Joris van de Haar, Lodewyk F. Wessels, Auditi DebRoy, Emile E. Voest. Integrative multi-omic machine learning model predicts neoadjuvant immunotherapy response using molecular data and deep learning-derived features from digital pathology [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4951.

Which low urgent triaged febrile children are suitable for a fast track? An observational European study

BackgroundThe number of paediatric patients visiting the ED with non-urgent problems is increasing, leading to poor patient flow and ED crowding. Fast track aims to improve the efficiency of evaluation...