Laboratory Results Research Articles

Characterization of a 3D prototyping semi-automated filter holder system for RQR radiation qualities

Characterizing radiation measurement systems, such as diagnostic radiology systems for RQR and RQA, is essential for ensuring reliable results in standardized instrument calibration laboratories. Quality control of dosimetry devices, such as patient dose calibrators (PDCs), a reference meter, is crucial for ensuring accurate measurements. This study demonstrates the use of spectrometry and ionization chambers to characterize a set of semi-automated 3D prototyping filter holder systems, developed in a previously project, designed for applications such as Kerma-Area Product (KAP) meter calibration. The set of 3D prototypes were adjusted to a filter wheel and characterized using an X-ray spectrometer, followed by an ionization chamber, according to international standards. The characterization of radiation qualities from 50 to 150 kV in diagnostic radiology was performed using the substitution method: first with an ionization chamber, then with a PDC. The PDC was calibrated for KAP and Air Kerma quantities, considering the conditions of the X-ray system and factors such as temperature, humidity, and pressure. Spectrometric analysis and the use of an ionization chamber were effective in determining these parameters. Spectral characterization allowed for accurate measurements to establish proper quality control, then it is possible to use the PDC calibrated for calibration procedures for KAP meters. Future studies intend to compare these results with computational simulations using the TOPAS Monte Carlo code to validate the calibration method.

Refining the 30-day emergency department visit after initial chemotherapy administration A-PROACCT model.

e23253 Background: This study attempted to address limitations in the A-PROACCT model developed by Stein et al. (JOP, 2023) to predict the rate of acute care events within 30 days (ACE30) of initial chemotherapy administration (ICA). The four most important predictors were drug category (immunotherapy), cancer type (gastrointestinal), age group ( < 40), and BMI category (underweight). Only linear relationships were considered. For patients for whom an ACE30 was predicted by their first and second models, only 0.18 and 0.23 actually had an ACE30, a low positive predictive value (PPV). We attempted to improve the PPV with advanced modeling techniques. Methods: Using Orlando Health data between February of 2012 and April 2021, random sampling was used to split the dataset into training (10,838) and validation (4645). For the training data, resampling was employed to obtain a balanced quota, equal observations followed by an ACE30 and not followed by an ACE30. We included only variables used in Stein (drug category, age group, ED visits and hospitalizations in the prior year, cancer type, insurance category, number of anti-cancer agents, race, and BMI category). Logistic regression with L1-penalty, XGBoost (a non-linear nonparametric tree-based algorithm to account for nonlinear relationships), and artificial neural networks were used to develop and evaluate predictive models. Different sampling methods (bootstrap and SMOTE) as well as cuff-off thresholds for high-risk groups were tested. Results: Based on evaluation with validation data set, the best performing approach was an XGBoost model with SMOTE resampling in the training data. The four most important predictors were ED visits in the prior year, payor category (self-insured), cancer type (genitourinary) and hospitalization in past year. This model reported a PPV of 0.27. Many other combinations of methodologies described above were performed, and the PPV varied between 0.19 to 0.27. Of the 282 ICAs identified as high-risk by the best model, 76 (27.0%) had an ACE30. Of the 4346 ICAs identified as low-risk, 533 (12.3%) had an ACE30. The differences between high risk and low risk ACE30 rates were statistically significant (p < 0.0001). In comparison, using Stein et al. models with our data reported a PPV of 0.27 and 0.25 which are basically at the same level of our best trained model. Conclusions: Using the variables included in A-PROACCT and a variety of machine learning models, advanced sampling methodologies and threshold cut-off limits, the best results were similar to those obtained using basic logistic regression. This suggests improvement in predicting acute care events following chemotherapy administration need to incorporate more extensive multimodal data, such as vital signs, performance status, patient reported outcomes, socioeconomic factors, laboratory and radiology results, remote patient monitoring and wearable device data.

More Biosurfactants and Fewer Synthetic Surfactants to Improve Alkali-Surfactant-Polymer Flooding: Feasibility Study and Large-Scale Field Application

Summary Alkali-surfactant-polymer (ASP) flooding has achieved highly enhanced oil recovery (EOR) in the Daqing Oil Field; however, there are concerns about synthetic surfactants owing to their high cost and difficulty in biodegradation. Cheap biosurfactants conform to human concepts of green circular economy; however, known biosurfactants, as well as their mixtures with alkali, cannot reduce water/oil interfacial tension (IFT) to ultralow values below 0.01 mN/m, which is necessary for ASP flooding to effectively mobilize residual oil. Therefore, we investigate the feasibility of partially replacing synthetic surfactants with biosurfactants rather than completely replacing them to improve ASP flooding. First, through a series of IFT tests, a blend of rhamnolipids (RLs) and alkylbenzene sulfonate (ABS) in a 1:1 mass ratio is determined to be the optimal mixed surfactant and labeled RL/ABS-opt. Second, the interfacial activities, phase behaviors, and wettability alteration capabilities of ASP solutions with RL/ABS-opt are studied. Then, 1.0 wt% NaOH and 0.2 wt% RL/ABS-opt are determined to construct a new ASP system. Subsequently, the waterflooded cores are displaced using the new and the classical ASP systems. Based on the promising experimental results, the new ASP system floods a test block of 56 wells for 3 years. The EOR and surfactant costs are calculated to determine the technical and economic effects. Finally, the concentrations of surfactants before and after activated sludge treatment (AST) are tested by spectrophotometry to verify the biodegradability of RLs better than that of ABS. The laboratory and field results indicate that more biosurfactants and fewer synthetic surfactants could improve ASP flooding to be more environmentally friendly and cost-effective with a higher EOR.

An epidemiological analysis of TB trends in native and migrant populations, New Mexico, 1993-2021.

<sec id="st1"><title>OBJECTIVES</title>To analyze the epidemiological, demographic, clinical, laboratory, radiographic and treatment outcome trends in non-US-born individuals with TB in New Mexico.</sec><sec id="st2"><title>DESIGNS</title>We retrospectively analyzed TB data from New Mexico TB surveillance system from (1993-2021), comparing variables between non-US-born and US-born individuals.</sec><sec id="st3"><title>RESULTS</title>Of the 1,512 TB cases, 876 (56.5%) were non-US-born and 653 (43.3%) were US-born. The incidence rate among non-US-born patients declined from 15.3/100,000 (1993) to 7.8/100,000 (2021) (54.6% reduction), while among US-born patients it declined from 3.3/100,000 (1993) to 0.5/100,000 (2021) (84.8% reduction). The majority of non-US-born individuals were from Mexico (n = 482, 73.5%). Non-US-born were typically younger adults (median age: 54 vs. 61), predominantly male (64.8% vs. 59.4%), less likely to consume excess alcohol and have extrapulmonary TB. However, they were more likely to exhibit resistance to standard TB drugs (P < 0.01). Non-US-born individuals were less likely to die (7.8% vs. 15.4%), but more likely to be lost to follow-up (P < 0.007). Treatment by providers outside the Department of Health was associated with noncompletion (OR 0.18, 95% CI 0.09-0.35; P < 0.001).</sec><sec id="st4"><title>CONCLUSION</title>These results highlight the need for a detailed understanding of the impact of migration on TB epidemiology and the development of tailored interventions to improve treatment outcomes.</sec>.

Reducing the time to chemotherapy start for planned admissions.

e23201 Background: Planned hospital admissions for chemotherapy should be initiated shortly after arrival. Between January 2022 and May 2023, 25.7% of sarcoma patients at Medstar Washington Hospital Center admitted for chemotherapy experienced initiation of chemotherapy delays of more than 6 hours. Delays in chemotherapy initiation can lead to prolonged hospitalization with associated higher costs, increased risk of hospital acquired conditions, and decreased patient satisfaction. Methods: Discussions with team members involved in the initiation of inpatient chemotherapy process identified the following issues contributing to delay: absence of recent lab results, challenges with IV access, missing chemotherapy consent forms, absence of chemotherapy orders, failure to notify team members of patient arrival, lack of dose adjustments based on lab work, and insufficient pharmacy staffing. As our chemotherapy floor policy is to start pre-medications once the chemotherapy is on the unit, we defined the time to chemotherapy start as the time of the first pre-medication minus the time the patient checked in to the hospital’s admissions office. Patients with unforeseen issues such as a new fever on arrival were excluded. We obtained baseline data for sarcoma admissions between January 2022 to May 2023. Two Plan-Do-Study-Act (PDSA) cycles were implemented. The first cycle involved the introduction of a chemotherapy calendar. The second cycle implemented a group email system to finalize all arrangements for the admission. We collected about 3 months of data for each PDSA cycle. Results: Pre-intervention, there were 101 sarcoma admissions with 14.9% of patients starting chemotherapy in &lt; 3 hours while 25.7% took &gt; 6 hours. In the post-intervention data combining both PDSA cycles, 6.8% of patients started chemotherapy in &lt; 3 hours while 43.2% took &gt; 6 hours. As such, the average time to chemotherapy start was increased in post-intervention groups (table 1) despite improvements in many of the common issues. The median time to chemotherapy start based on the number of agents the patient was receiving was 4.98, 6.4, and 7.18 hours respectively for 1, 2, and 3 agents in the post-intervention group. Conclusions: Despite multiple attempts, the median time to chemotherapy start increased in the post-intervention groups. Our interventions targeted many of the barriers except insufficient pharmacy staff. With the median start time increasing based on the number of agents the patient was receiving, it appears that pharmacy mixing and delivery chemotherapy is likely one of the main causes of the delays. Subsequent discussions with the pharmacy team revealed plans to increase staffing as a proactive measure to address this issue. [Table: see text]

Clinical case of pregnancy complicated by thrombotic thrombocytopenic purpura

Background. Thrombotic thrombocytopenic purpura is a rare blood disease characterized by increased thrombogenesis in the microcirculation. One of the most common triggers for the development of this disease is pregnancy. The article describes a case of pregnancy complicated by thrombotic thrombocytopenic purpura.Materials and methods. To assess the clinical case, we used a retrospective analysis of medical documentation: maternity case record, birth history, results of laboratory and instrumental research methods.Results. A 32-year-old patient was admitted to hospital at week 32 of gestation with manifestations of moderate preeclampsia, thrombocytopenia, and moderate anemia. Due to worsening of the condition, the delivery was performed by cesarean section. Subsequently, the mother’s condition did not improve: thrombocytopenia and hyperbilirubinemia progressed; the level of transaminases increased; ADAMTS13 activity was 8 %. Teleconferences were repeatedly held with experts from the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov (Moscow). Complex therapy including extracorporeal methods led to a positive result; the patient was discharged in satisfactory condition under the supervision of a hematologist and obstetrician-gynecologist.Conclusion. Thrombotic thrombocytopenic purpura treatment tactics have its own characteristics; it is necessary to diagnose this pathology in a timely manner to provide qualified medical care and to prevent maternal and perinatal losses.

Immunity against vaccine-preventable diseases among pregnant employees in Germany. A situation analysis before the introduction of the Measles Protection Act

BackgroundImmunization against vaccine-preventable diseases prior to pregnancy is an important measure of primary prevention both for the mother and the unborn child. We analyzed immunity rates against measles, mumps, rubella, varicella, and pertussis in pregnant employees in Germany prior to significant changes in legal conditions in 2020, to provide a basis of comparison for future research. MethodsWe analyzed occupational-medical routine data in three collectives of pregnant women with an occupational risk of infection in the years 2018 and 2019: 1: hospital staff with regular access to an in-house company physician (n = 148); 2: employees in childcare with regular access to external occupational-health services (n = 139); 3: teachers with no regular access to occupational healthcare (n = 285). Immune status was assessed by a physician based on vaccination certificates, laboratory results, and medical documentation on prior infections. We compared immunity rates against measles, rubella, varicella, and pertussis as well as full immunity against all targeted vaccine-preventable diseases. ResultsAltogether, n = 572 pregnant women were included in our study. Of these women, 96.5 % were immune to rubella, 95.8 % to varicella, 88.3 % to measles, 82.7 % to mumps, and 67.8 % to pertussis. Only 56.2 % of the women had full immunity against all targeted vaccine-preventable diseases. Collective 1 showed the highest immunity rates against measles and pertussis as well as the highest rate of full immunity against all targeted vaccine-preventable diseases. The immunity rates against rubella and varicella did not differ significantly between the collectives. With the exception of rubella, the lowest immunity rates during pregnancy were found in Collective 3. ConclusionWe found pregnancy-relevant immunity gaps in all our study groups with significant differences between the collectives. Considering the potentially devastating consequences of infections during pregnancy, all medical professionals and health-policy makers should be involved in an increased effort to improve vaccination rates prior to pregnancy.

Exploring the economic landscape of ureteric stones: impact of age and gender on direct healthcare costs.

To assess whether age or gender affects ureteric stone management costs, in patients presenting to the Emergency Department (ED) with CT proven ureteric stones. A retrospective examination was conducted on patients admitted to the ED who were diagnosed with a ureteric stone through CT scans. Data encompassing clinical, laboratory, and imaging parameters were gathered, alongside information on admissions, ED readmissions, surgical procedures, and the overall treatment cost. Comparative analyses were performed on various cost rates in relation to different stone parameters, patient clinical presentations, laboratory results, and personal histories of urolithiasis. From January 2018 to January 2020, 805 patients underwent abdominal CT scans at a single institution's ED and were diagnosed with ureteric stones. Among them, 773 patients met the inclusion criteria, with 78% (609) being males and 22% (169) females. The mean ages for males and females were 49.4 (SD 14.4) and 51.6 (SD 15.7), respectively (p = 0.08). Treatment costs exhibited a direct relationship with age, amounting to 4,025, 5,116, 6,058, and 9,225 US dollars (USD) in the 18-30, 31-50, 51-70, and over 70 age groups, respectively. Female gender was associated with higher treatment costs, averaging 6,831 USD, compared to 5,450 USD in males (p = 0.03). However, there were no significant differences between genders in terms of the type of surgical procedure (p = 0.4) or hospital stay duration (p = 0.1). Age and gender exerted a significant impact on treatment costs, revealing that advanced age and female gender were both correlated with higher direct treatment costs in the care of ureteric stones.

The remarkable potential of machine learning algorithms in estimating water permeability of concrete incorporating nano natural pozzolana

This paper aims to estimate the permeability of concrete by replacing the laboratory tests with robust machine learning (ML)-based models. For this purpose, the potential of twelve well-known ML techniques was investigated in estimating the water penetration depth (WPD) of nano natural pozzolana (NNP)-reinforced concrete based on 840 data points. The preparation of concrete specimens was based on the different combinations of NNP content, water-to-cement (W/C) ratio, median particle size (MPS) of NNP, and curing time (CT). Comparing the results estimated by the ML models with the laboratory results revealed that the hist-gradient boosting regressor (HGBR) and K-nearest neighbors (KNN) algorithms were the most and least robust models to estimate the WPD of NNP-reinforced concrete, respectively. Both laboratory and ML results showed that the WPD of NNP-reinforced concrete decreased with the increase of the NNP content from 1 to 4%, the decrease of the W/C ratio and the MPS, and the increase of the CT. To further aid in the estimation of concrete’s WPD for engineering challenges, a graphical user interface for the ML-based models was developed. Proposing such a model may be effectively employed in the management of concrete quality.

Digitalizing disease surveillance: experience from Sierra Leone.

The Integrated Disease Surveillance and Response (IDSR) system was adopted by the Sierra Leone Ministry of Health (MOH) in 2008, which was based on paper-based tools for health data recording and reporting from health facilities to the national level. The Sierra Leone MoH introduced the implementation of electronic case-based disease surveillance reporting of immediately notifiable diseases. This study aimed to document and describe the experience of Sierra Leone in transforming her paper-based disease surveillance system into an electronic disease surveillance system. Retrospective mixed methods of qualitative and quantitative data were reviewed. Qualitative data was collected by reviewing surveillance technical reports, epidemiological bulletins, COVID-19, IDSR technical guidelines, Digital Health strategy, and DHIS2 documentation. Content and thematic data analysis were performed for the qualitative data, while Microsoft Excel and DHIS2 platform were used for the quantitative data analysis to document the experience of Sierra Leone in digitalizing its disease surveillance system. In early 2017, a web-based electronic Case-Based Disease Surveillance (eCBDS) for real-time reporting of immediately notifiable diseases and health threats was piloted using the District Health Information System 2 (DHIS2) software. The eCBDS, integrates case profile, laboratory, and final outcome data. All captured data and information are immediately accessible to users with the required credentials. The system can be accessed via a browser or an Android DHIS2 application. By 2021, there was a significant increase in the proportion of immediately notifiable cases reported through the facility-level electronic platform, and more than 80% of the cases reported through the weekly surveillance platform had case-based data in eCBDS. Case-based data from the platform is analyzed and disseminated to stakeholders for public health decision-making. Several outbreaks of Lassa fever, Measles, vaccine-derived Polio, and Anthrax have been tracked in real-time through the eCBDS.

Metro-induced vibration attenuation using rubberized concrete slab track

This paper addresses two important worldwide environmental concerns: disposal of waste tyres and attenuation of trains induced vibration. To this end, use of the waste materials in construction of railway concrete slabs for reduction of train induced vibration is investigated in this research. For this purpose, rubber tyre particles with different dosages were used in the concrete mixtures of test specimens. Extensive laboratory tests were conducted on the rubberized concrete specimens to measure their compressive strength, density and damping of the specimens. The effect of rubberized slab track on attenuation of vibration propagated from slab track was investigated by numerical modeling using results of laboratory tests as the input data. The laboratory results obtained indicate that adding rubber particles to the railway slab causes up to 96% increase in damping ratio (for concrete with 10% rubber). Results of numerical analysis elucidates that the rubberized slab track causes up to 21% reduction of the train induced vibration. By compromising between compressive strength and damping of vibration, it is shown that the optimum amount of crumb rubber in the concrete of railway slabs is 2.5% by which the best performance of the railway slabs is obtained.

Predicting the potentially exacerbation of severe viral pneumonia in hospital by MuLBSTA score joint CD4 + and CD8 +T cell counts: construction and verification of risk warning model

PurposeThis study mainly focuses on the immune function and introduces CD4+, CD8+ T cells and their ratios based on the MuLBSTA score, a previous viral pneumonia mortality risk warning model, to construct an early warning model of severe viral pneumonia risk.MethodsA retrospective single-center observational study was operated from January 2021 to December 2022 at the People's Hospital of Liangjiang New Area, Chongqing, China. A total of 138 patients who met the criteria for viral pneumonia in hospital were selected and their data, including demographic data, comorbidities, laboratory results, CT scans, immunologic and pathogenic tests, treatment regimens, and clinical outcomes, were collected and statistically analyzed.ResultsForty-one patients (29.7%) developed severe or critical illness. A viral pneumonia severe risk warning model was successfully constructed, including eight parameters: age, bacterial coinfection, CD4+, CD4+/CD8+, multiple lung lobe infiltrations, smoking, hypertension, and hospital admission days. The risk score for severe illness in patients was set at 600 points. The model had good predictive performance (AUROC = 0.94397), better than the original MuLBSTA score (AUROC = 0.8241).ConclusionA warning system constructed based on immune function has a good warning effect on the risk of severe conversion in patients with viral pneumonia.

Effect of glucose lymphocyte ratio on prognosis in patients operated with the diagnosis of pancreatic adenocarcinoma

Aims: Pancreatic adenocarcinoma is one of the most aggressive cancers, and predicting prognosis and survival clinically is challenging. Prognostic markers, easily accessible and routinely evaluated in diagnostic tests, are frequently seen in the literature for survival prediction. So far, the glucose lymphocyte ratio (GLR) has emerged as an indicator that can assess both metabolic dysregulation and immune response. In this study, the aim was to assess the impact of GLR on prognosis and survival by following patients diagnosed with pancreatic adenocarcinoma who underwent surgery. Methods: Between January 1, 2016, and April 31, 2021, a totalof 58 patients who underwent Whipple procedure due to pancreatic adenocarcinoma at the Department of General Surgery, Hitit University, were included in the study. Demographic characteristics, tumor features, laboratory results, and survival durations of the patients were collected. GLR was determined as a mortality predictor, and estimated survival times associated with GLR were determined using Kaplan-Meier Survival analysis. The optimal GLR value was determined through ROC analysis. Results: During the postoperative period, the average follow-up time for patients was 11.39 months, with the longest follow-up time being 48 months. During this period, 43 patients (74.14%) were deceased, while 15 patients (25.86%) survived. The mean age and ASA scores of deceased patients were significantly higher compared to survivors (p&lt;0.001 and p&lt;0.001, respectively). Glucose levels were significantly higher in the mortality group compared to the survival group (p=0.008). GLR was notably higher in the mortality group (p=0.170; p=0.703; p=0.429; and p=0.031). The GLR value that best distinguished the two groups was found to be 94.6387 with 93.3% specificity and 95.8% positive predictive value. Crossing this threshold increased the mortality risk approximately 4.27 times within one year and increased the overall mortality risk by approximately 15 times (p=0.014 and p=0.002). The estimated life expectancy for patients below the threshold value was calculated to be an average of 20.996 months, whereas for patients above the threshold value, this expectation was calculated to be an average of 4.427 months (p&lt;0.001). Conclusion: We believe that GLR may be helpful in predicting one-year survival and determining overall survival duration in patients undergoing surgery for pancreatic adenocarcinoma.

Efficacy and safety of Zhishixiaopi decoction in functional dyspepsia: A meta-analysis of randomized controlled trials.

Functional dyspepsia (FD) refers to a group of clinical symptoms caused by gastric and duodenal dysfunction. Which is a chronic functional disorder of the gastrointestinal tract with no cure. Zhishixiaopi decoction (ZSXP) is a type of Chinese herbal prescription that for treating FD. Although some randomized controlled trials (RCTs) report that ZSXP can significantly improve FD clinical symptoms and/or laboratory results, the trial design varies greatly among studies, making it challenging to draw a conclusion of the efficacy of ZSXP in treating FD. A systematic review and a meta-analysis. Mianyang Central Hospital. We conducted a systematic review and a meta-analysis to evaluate the efficacy and safety of ZSXP for treating FD. We developed inclusion and exclusion criteria based on FD diagnosed criteria, interventions to treat FD, and outcomes of these interventions. Search strategies combined disease terms, symptom terms, anatomy terms and intervention terms. Literature search was conducted on eight online databases in English or Chinese, including Medline (via PubMed), Embase (via Ovid), The Cochrane Library, Web of Science, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang Database. The experimental group received oral administration of ZSXP and had a complete treatment process. ZSXP needs to fully contain the key herbal ingredients, regardless of whether the dosage of each herb is consistent with the original prescription. The Control group received monotherapy or combination therapy of other Western medicine and had a complete treatment process. The primary outcomes appraised were Total effective rate (TER), serum levels of Motilin(MOT), Gastrin(GAS) and Somatostatin (SS), Gastric emptying rate (GER) using a Barium meal method (GER(B)) and Gastric half emptying time using an Ultrasonic method (GHET(T1/2)). The Cochrane Bias Risk Tool was used for quality critical appraisal, Review Manager (RevMan) version 5.3 was used for statistical analysis. A total of 21 medium-quality RCTs were included in the meta-analysis. All 21 included studies were conducted and completed in Mainland China from 1998 to 2020. The treatment duration was between two weeks to two months. The meta-analysis suggests that, compared with the Western medicine treatment group, ZSXP treatment was more effective to improving the TER in FD [Odds ratio, OR = 3.54, 95%CI:(2.49, 5.05), Z = 6.99, P<0.00001] without significant increase in adverse events. However, no statistical significance was found between the groups in serum MOT levels [Standard mean difference, SMD = 1.05, 95%CI:(-0.42, 2.53), Z = 1.04, P = 0.16], serum GAS levels [SMD = -0.16, 95%CI:(-1.20, 0.88), Z = 0.31, P = 0.76], serum SS levels [SMD = -0.04, 95%CI:(-1.97, 1.89), Z = 0.04, P = 0.97], GER(B) [SMD = 1.09, 95%CI:(-0.81, 3.00), Z = 1.12, P = 0.26]or GHET(T1/2) [Mean difference, MD = -2.18, 95%CI:(-5.55, 1.19), Z = 1.27, P = 0.20]. The meta-analysis suggests that Zhishixiaopi treatment is a relatively effective and safe traditional Chinese medicine prescription and could be used for functional dyspepsia treatment. Considering the limitations of this study, the conclusion needs to be further confirmed by high-quality, multi-center, and large-sample randomized controlled trials.

Comparison of ChatGPT, Gemini, and Le Chat with physician interpretations of medical laboratory questions from an online health forum.

Laboratory medical reports are often not intuitively comprehensible to non-medical professionals. Given their recent advancements, easier accessibility and remarkable performance on medical licensing exams, patients are therefore likely to turn to artificial intelligence-based chatbots to understand their laboratory results. However, empirical studies assessing the efficacy of these chatbots in responding to real-life patient queries regarding laboratory medicine are scarce. Thus, this investigation included 100 patient inquiries from an online health forum, specifically addressing Complete Blood Count interpretation. The aim was to evaluate the proficiency of three artificial intelligence-based chatbots (ChatGPT, Gemini and Le Chat) against the online responses from certified physicians. The findings revealed that the chatbots' interpretationsof laboratory results were inferior to those from online medical professionals. While the chatbots exhibited a higher degree of empathetic communication, they frequently produced erroneous or overly generalized responses to complex patient questions. The appropriateness of chatbot responses ranged from 51 to 64 %, with 22 to 33 % of responses overestimating patient conditions. A notable positive aspect was the chatbots' consistent inclusion of disclaimers regarding its non-medical nature and recommendations to seek professional medical advice. The chatbots' interpretations of laboratory results from real patient queries highlight a dangerous dichotomy- a perceived trustworthiness potentially obscuring factual inaccuracies. Given the growing inclination towards self-diagnosis using AI platforms, further research and improvement of these chatbots is imperative to increase patients' awareness and avoid future burdens on the healthcare system.

Potential risk factors of pediatric acute respiratory distress syndrome in sepsis

Background Sepsis in children is characterized by a dysregulated host response to infection and life-threatening organ dysfunction. Pediatric acute respiratory distress syndrome (PARDS) is a severe complication of sepsis. Several known risk factors of PARDS are immunodeficiency, obesity, source of infection, and genetic factors. Objective To describe the potential risk factors of PARDS in septic children at Haji Adam Malik General Hospital, Medan, North Sumatera. Methods This descriptive study using eligible medical record data from sepsis patients aged 1 month – 18 years was conducted at Haji Adam Malik General Hospital in 2020–2022. A total sampling method was used for subject selection. Patients’ demographic and clinical characteristics, mechanical ventilation modes and parameters, laboratory results, and outcomes were collected from medical records. Patients were classified as having sepsis with PARDS if Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria of ARDS was met. Results Of 112 pediatric sepsis patients, 33.9% developed PARDS. The mortality rates for PARDS was 73.7%. Of the patients with PARDS, 57.9% had immunodeficiency, 60.5% patients had an intrapulmonary infection, 39.5% had an extrapulmonary infection, and 23.7% of patients had a suspected genetic disorder. In addition, 39.5% had good nutritional status, followed by 21.1% with obese. Conclusion The majority of patients with PARDS have intrapulmonary infection and immunodeficiency. Some of patients with PARDS have suspected genetic disorders and well nourished.

A SARS-CoV-2 minimum data standard to support national serology reporting.

Healthcare laboratory systems produce and capture a vast array of information, yet do not always report all of this to the national infrastructure within the United Kingdom. The global COVID-19 pandemic brought about a much greater need for detailed healthcare data, one such instance being laboratory testing data. The reporting of qualitative laboratory test results (e.g. positive, negative or indeterminate) provides a basic understanding of levels of seropositivity. However, to better understand and interpret seropositivity, how it is determined and other factors that affect its calculation (i.e. levels of antibodies), quantitative laboratory test data are needed. 36 data attributes were collected from 3 NHS laboratories and 29 CO-CONNECT project partner organisations. These were assessed against the need for a minimum dataset to determine data attribute importance. An NHS laboratory feasibility study was undertaken to assess the minimum data standard, together with a literature review of national and international data standards and healthcare reports. A COVID serology minimum data standard (CSMDS) comprising 12 data attributes was created and verified by 3 NHS laboratories to allow national granular reporting of COVID serology results. To support this, a standardised set of vocabulary terms was developed to represent laboratory analyser systems and laboratory information management systems. This paper puts forward a minimum viable standard for COVID-19 serology data attributes to enhance its granularity and augment the national reporting of COVID-19 serology laboratory results, with implications for future pandemics.

The James A. Rand Young Investigator’s Award: Keeping It Simple: Are all Musculoskeletal Infection Society Tests Useful to Diagnose Periprosthetic Joint Infection?

BackgroundCurrent data evaluating the clinical value and cost-effectiveness of advanced diagnostic tests for periprosthetic joint infection (PJI) diagnosis, including alpha-defensin and synovial C-reactive protein (CRP), is conflicting. This study aimed to evaluate the adequacy of preoperative and intraoperative PJI workups without utilizing these tests. MethodsThis retrospective analysis identified all patients who underwent revision total knee or hip arthroplasty (rTKA and rTHA, respectively) for suspected PJI between 2018 and 2020 and had a minimum follow-up of 2 years. Perioperative data and lab results were collected, and cases were dichotomized based on whether they met the 2018 Musculoskeletal Infection Society (MSIS) criteria for PJI. In total, 204 rTKA and 158 rTHA cases suspected of PJI were reviewed. ResultsNearly 100% of the cases were categorized as “infected” for meeting the 2018 MSIS criteria without utilization of alpha-defensin or synovial CRP (rTKA: n = 193, 94.6%; rTHA: n = 156, 98.7%). Most cases were classified as PJI preoperatively by meeting either the major MSIS or the combinational minor MSIS criteria of traditional lab tests (rTKA: n = 177, 86.8%; rTHA: n = 143, 90.5%). A subset of cases was classified as PJI by meeting combinational preoperative and intraoperative MSIS criteria (rTKA: 16, 7.8%; rTHA: 13, 8.2%). Only 3.6% of all cases were considered “inconclusive” using preoperative and intraoperative data. ConclusionsGiven the high rate of cases satisfying PJI criteria during preoperative workup using our available tests, the synovial alpha-defensin and synovial CRP tests may not be necessary in the routine diagnostic workup of PJI. We suggest that the primary PJI workup process should be based on a stepwise algorithmic approach with the most economical testing necessary to determine a diagnosis first. The use of advanced, commercialized, and costly biomarkers should be utilized only when traditional testing is indeterminate.

P.037 Refractory status dystonicus and hypotension after cardiac arrest in a child with AADC deficiency post gene therapy: a case report

Background: Aromatic l-amino acid decarboxylase (AADC) deficiency is a metabolic disorder that causes deficient serotonin, dopamine, and catecholamine synthesis. How children respond to neurological insult post intracranial gene therapy remains underreported. We present a 10 year old girl with profound neurological injury after a brief in-hospital cardiac arrest, secondary to viral infection-induced respiratory failure, 4 years after gene therapy. Methods: Patient’s chart review included brain imaging, clinical notes, laboratory results, and treatment. Results: MRI showed symmetric abnormalities in the basal ganglia, thalami, cortex, and cerebellar hemispheres. CSF analysis showed homovanillic acid 27 nmol/L (reference range 167-563) and 5-hydroxyindoleacetic acid 7 nmol/L (reference range 67-189). She developed generalized dystonia and oculogyric crises which were not seen since before gene therapy. There was poor catecholamine production causing refractory hypotension. She required a one-month stay in ICU for hypotension and status dystonicus. Dystonia was controlled with high doses of 6 agents. Conclusions: We describe a patient with AADC deficiency post gene therapy who experienced disproportionately severe neurological injury and decreased AADC activity after hypoxic neurological insult. There may be unique considerations of dopaminergic neuron integrity, AADC gene promoter sensitivity, and cerebrovascular autoregulation in children with AADC deficiency post gene therapy.

Pulmonary hypertension is associated with increased recurrence of atrial fibrillation post-pulmonary vein isolation: a multicenter study insights

Abstract Background Pulmonary vein isolation (PVI) has become an essential therapeutic approach for managing paroxysmal and persistent atrial fibrillation. Besides the fact its application increases, a substantial proportion of patients will suffer from arrhythmia recurrence. Objectives This study aims to determine the clinical and echocardiographic factors that predict fibrillation recurrence following pulmonary vein isolation. Methods In this prospective, multicenter study carried out across 14 medical centers in Israel, we included a cohort of 1002 patients who underwent pulmonary vein isolation from 2019 to 2022. The study involved an assessment of patients' baseline characteristics, electrocardiographic and echocardiographic data, laboratory results, details of the procedure, and their clinical outcomes. We monitored these clinical outcomes for one year after the ablation procedure, focusing mainly on the recurrence of atrial fibrillation, which was verified using electrocardiographic evidence during the post-blanking period. A multivariable analysis revealed the clinical and echocardiographic predictors for atrial fibrillation recurrence post-PVI. Results Our study evaluated 1002 patients with an average age of 64.4 ±11.3 years, including 37.5% females (376 patients). The cohort predominantly, about two-thirds, had paroxysmal AFIB, with an average arrythmia duration of 4.1 years. Frequent pre-existing conditions included ischemic heart disease in 17.3% and congestive heart failure in 13.8% of the patients. Additionally, diabetes was present in a quarter of the cohort, with 9% having a prior cerebrovascular event. The median LVEF was 60 (IQR 53-60), and the average left atrial diameter was 42.6 mm±8.8. The median pulmonary artery pressure was noted at 31 (IQR 25-38), with 13% of patients exhibiting elevated levels above 45 mmHg. Within the first year after the ablation, 11.7% of patients experienced AFIB recurrence in the post-blanking period. Our multivariate COX analysis established clinical and echocardiographic models for predicting post-PVI AFIB recurrence. Gender was a significant predictor, with women showing a higher recurrence rate (HR 1.85, 95% CI 1.29-2.7, P&amp;lt;0.01), in addition to persistent AFIB and a non-sinus rhythm at the time of the procedure. Echocardiographic predictors of recurrence included a left atrial diameter greater than 40 mm (HR 2.16, 95% CI 1.3-3.6, P&amp;lt;0.01) and pulmonary hypertension, notably when pulmonary artery pressure exceeded 55 mmHg, which correlated with almost a fourfold increase in AFIB recurrence risk within the first-year post-procedure (HR 4.25, 95% CI 1.57-11.5, P&amp;lt;0.01). Conclusions Pulmonary hypertension, especially with pulmonary artery pressure above 55 mmHg, significantly elevates the risk of atrial fibrillation recurrence post-pulmonary vein isolation, underscoring its importance in patient prognosis and management.