Routine Methods Research Articles

Newborn auditory brainstem response and sudden infant death syndrome.

Sudden infant death syndrome (SIDS)-the sudden and unexplained death of a seemingly healthy infant, <1 year old-may be associated with abnormalities in the brain regions that underlie breathing and arousal during sleep. While post-mortem studies suggest abnormalities in SIDS infants' brainstems, there are no studies of these infants' brainstem function before death. One way to assess the function of the brainstem is with auditory brainstem response (ABR), a routine hearing-screening method that noninvasively measures the brainstem's response to sound. We hypothesize that anomalies in newborns' ABR measures may predict SIDS. Indeed, previous studies identified abnormalities in ABR characteristics in small samples of near-miss SIDS infants hospitalized for infant apnea syndrome. However, there is a need to examine the ABRs of infants who died of SIDS. Therefore, in the current study, we propose integrating two secondary datasets to examine newborns' ABRs (N = 156,972), including those who later died of SIDS (n = ~42; .27 out of every 1000 infants), using existing archived records of neonatal ABR results from a sample of newborns born in Florida. We hypothesize that infants who die from SIDS are more likely than non-SIDS infants to have abnormal ABRs as newborns. Understanding the association between SIDS and ABR may facilitate more accurate identification of an infant's risk for SIDS at birth, enabling increased monitoring, which may facilitate interventions and improve survivorship.

The Molecular Mouse System: A New Useful Tool for Guiding Antimicrobial Therapy in Critically Ill Septic Patients.

Bloodstream infections (BSI) caused by multidrug-resistant (MDR) bacteria, pose a major threat for patients, especially for those who are immunosuppressed. Rapid pathogen detection and characterization from positive blood cultures are crucial in the management of patients with BSI to enable an adequate and timely antimicrobial therapy. This study aimed to investigate the potential role of the Molecular Mouse system, a new CE IVD molecular test designed to rapidly detect the causative agents of bacteremia and their resistance determinants, in the management of the therapy in critically ill patients. Agreement between the results of the Molecular Mouse and the conventional routine method was also considered. Overall, 100 positive blood cultures were collected from septic critically ill patients from May 2023 to January 2024 and analyzed with Molecular Mouse and routine protocols. The new instrument consistently agreed with the routine protocols in the case of monomicrobial blood cultures, while some discrepancies were obtained in the polymicrobial samples. Antimicrobial resistance genes were detected in 35 samples, with vanA and CTX-M-1/9 groups being the most frequently detected targets. Therapy was adjusted in 42 critically ill patients confirming the importance of new rapid molecular tests in the management of positive blood cultures, to adjust empirical therapy and use new antibiotics accurately.

Effectiveness of soil remediation intervention in abandoned used lead acid battery (ULAB) recycling sites to reduce lead exposure among the children

Lead (Pb) is a neurotoxin, and children are vulnerable due to their evolving physiology and high-risk behaviours. Soil remediation interventions have proven effective in reducing Pb exposure. The primary objective is to measure the effectiveness of soil remediation at abandoned used lead acid battery (ULAB) recycling sites, nearby household cleaning, and community awareness in reducing blood lead levels (BLLs) in children. Additionally, this study aims to examine associations of Pb exposure with hematological, cardiovascular, renal, immunological, and endocrinological parameters in children aged 0–12 years. This study employs a quasi-experimental design, with abandoned ULAB sites as intervention sites and two control sites in Bangladesh. The intervention includes soil remediation coupled with community education. Data will be collected prior to the intervention and at a 12-month follow-up, including a comprehensive Pb exposure survey and collect environmental, turmeric samples, and blood from the child. Pb concentrations in environmental samples and turmeric samples will be determined using XRF analyser. Child BLL will be measured using Graphite Furnace Atomic Absorption Spectrometry (GF-AAS) and proposed biochemical parameters will be analysed using routine laboratory methods. This study could provide valuable insights for designing targeted interventions in similar settings and mitigating exposure to Pb.

Antimicrobial Susceptibility Patterns of Escherichia coli Isolates from Hospitalized Patients with Different Infections in Isfahan, Iran: Impact on Empiric Antibiotic Therapy in Associated Infections

Background: Escherichia coli is an important cause of urinary tract, bloodstream, and surgical site infections. Objectives: We investigated the organism's antibiotic susceptibility in hospitalized patients under different clinical conditions. Methods: This prospective study was conducted in three referral hospitals located in Isfahan, Iran. Different clinical samples were tested using standard routine microbiological methods to identify E. coli strains and determine their antibiotic susceptibility patterns by the disk diffusion method according to CLSI recommendations. After conducting a clinical investigation, contaminated samples were excluded, and the hospital or community source and infection site were identified. Data on antibiotic susceptibility testing were extracted using WHONET software. Data analysis was then conducted using SPSS Statistics version 18.0. Results: Of 1248 E. coli isolates, 71.9% were from urine, 15.1% from blood, and 7.8% from skin and soft tissue samples. High susceptibility was observed to Imipenem (98%), Meropenem (98.0%), and Amikacin (94.6%); intermediate sensitivity to Gentamicin (68.6%) and Cefepime (51.9%); and low susceptibility to Ceftazidime (46.8%), Ceftriaxone (41.3%), Ciprofloxacin (39.5%), Cefotaxime (39.3%), and Trimethoprim-sulfamethoxazole (32.4%). Conclusions: Antibiotics, including Imipenem, Meropenem, or Amikacin, would be beneficial in the empiric therapy of severe infections where E. coli is the main cause.

Delineation of chicken immune markers in the era of omics and multicolor flow cytometry

Multiparameter flow cytometry is a routine method in immunological studies incorporated in biomedical, veterinary, agricultural, and wildlife research and routinely used in veterinary clinical laboratories. Its use in the diagnostics of poultry diseases is still limited, but due to the continuous expansion of reagents and cost reductions, this may change in the near future. Although the structure and function of the avian immune system show commonalities with mammals, at the molecular level, there is often low homology across species. The cross-reactivity of mammalian immunological reagents is therefore low, but nevertheless, the list of reagents to study chicken immune cells is increasing. Recent improvement in multicolor antibody panels for chicken cells has resulted in more detailed analysis by flow cytometry and has allowed the discovery of novel leukocyte cell subpopulations. In this article, we present an overview of the reagents and guidance needed to perform multicolor flow cytometry using chicken samples and common pitfalls to avoid.

#2009 FGF23 in patients with diabetic kidney disease and atherosclerosis

Abstract Background and Aims Diabetes mellitus (DM) and chronic kidney disease (CKD) are risk factors for vascular atherosclerosis, a pathological process with an important inflammatory component. The coexistence of these conditions in patients with diabetic kidney disease (DKD) has additive effects with worst cardiovascular mortality and morbidity rates when compared to non-diabetic CKD patient on cardiovascular outcomes. Accumulating research has shown that increased levels of bone-derived fibroblast growth factor 23 (FGF23), the major phosphate-regulating hormone, constitute a novel predictor of cardiovascular and all-cause mortality in CKD patients, with potential effects on disorders of glucose metabolism as well. The objective of this comparative study is to determine the differences in FGF23 levels in two groups of patients with CKD, with and without DM, matched by age, sex and renal function, all of them with clinical atherosclerotic disease. We also evaluated the relationships of FGF23 with several inflammatory markers and parameters of glucose metabolism. Method Sixty-six patients with CKD stages 3-4 (33 of them with DM) and diagnosed with peripheral vascular disease were included in the study. Whole blood and serum samples were obtained from all participants. CRP values, neutrophil/lymphocyte (N/L) ratio, HbA1c (%), fasting glucose, and Triglycerides and glucose (TyG) index, among other parameters, were obtained using standardized routine methods. Circulating levels of the intact form of FGF23, tumor necrosis factor (TNF) α, interleukin (IL) 6, and IL10 were determined by ELISA immunoassays in both groups. We also performed gene expression analysis for these three cytokines in peripheral blood cells (PBCs) using qPCR. Results The mean values of eGFR, ACR and phosphate were 37.6 ± 11.2 ml/min/1.73 m2; 294.1 ± 271.2 mg/g; 3.8 ± 0.82 mg/dL; respectively without differences between patients with and without DM The median circulating FGF23 values were higher in the DM group (51.59 [37.73-89.68] vs. 38.1 [33-54.14] pg/mL; p&amp;lt;0.001). Likewise, patients with DM presented higher levels of TNFα both in serum concentration (1.78 [0.72-2.47] vs. 1.28 [1.01-1.88] pg/mL; p&amp;lt;0.01) as in the expression of mRNA in PBCs (2.1 ± 1.26 vs. 1.87 ± 1.16 a.u.; p&amp;lt;0.05). No differences were observed for IL6 and IL10 levels, nor for CRP concentration or N/L ratio. As expected, fasting glucose, HbA1c and TyG index were higher in the group of subjects with DM. FGF23 was inversely correlated with eGFR (r=−0.435, p&amp;lt;0.0001), while it showed a positive association with ACR (r=0.416, p&amp;lt;0.001) and, interestingly, with proinflammatory cytokines including circulating TNFα (r=0.44, p&amp;lt;0.001), circulating IL6 (r=0.27, p=0.04), and TNF mRNA expression in PBCs (r=0.245, p=0.047). Furthermore, circulating FGF23 was also direct and significantly correlated with HbA1c (r=0.34, p&amp;lt;0.01). Conclusion These results suggest that FGF23 levels are higher in DKD than in non-DM CKD patients with similar renal function. DKD patients also had higher levels of the proinflammatory cytokine TNFα. Our results also show positive correlations of FGF23 with the inflammatory cytokines TNFα and IL6, as well as with HbA1c. Previous studies, shown that elevated TNFα and glucose promote FGF23 production, which may help to explain the higher levels of FGF23 in patients with DM Future studies should clarify whether FGF23 is simply a marker of atherosclerosis disease severity or a contributing factor to this complication in CKD.

Pyuria in hospitalized general medical patients without urinary tract infection.

Urine microscopy for detecting pus cells is a common investigation ordered in hospitalized general medical patients as part of routine care. A few previous studies have shown that sterile pyuria is not uncommon in this population. We studied the prevalence of pyuria among patients hospitalized with non-urinary tract infection (UTI) diagnosis in the medical wards. We excluded patients with asymptomatic bacteriuria (ASB). Pyuria was quantified in uncentrifuged urine using the chamber counting method, and ≥ 10 pus cells per mm 3 was considered significant. We also compared this method with the commonly used but less accurate method of counting pus cells/high power field using centrifuged urine (routine method). We studied 196 patients; 113 (57.7%) were males. Most (175[89.3%]) patients were hospitalized for an infection. We found that 18.4% of the study group had sterile pyuria, and it was strongly associated with the presence of concomitant microscopic hematuria (unadjusted odds ratio, 3.74 [1.65 to 8.50]; P=0.002). We found no association of pyuria with female gender, diabetes, acute kidney injury, or current antibiotic use. By routine method, 56 (28.6 %) patients had significant pyuria. In comparison to the chamber counting method, the routine method was 69.4(63-75.8) % sensitive and 80.6(75.1-86.2) % specific. The positive and negative predictive values were 44.6 (37.7- 51.6) % and 92.1 (88.4 - 95.9) %. We concluded that sterile pyuria and microscopic hematuria could be present in a proportion of hospitalized general medical patients without UTI or ASB. Clinical judgment is essential in interpreting the significance of abnormal urinalysis reports.

Impact of Ultrafiltration Profiling Compared to Conventional Methods on Blood Pressure Regulation Among Hemodialysis Patients

Background: Standard hemodialysis sessions pose challenges for patients due to fluctuations in blood pressure. Alternative strategies, such as ultrafiltration profiling, have been proposed as potentially more effective treatments. Objectives: This study aimed to evaluate the effects of ultrafiltration profiling compared to the conventional method on blood pressure regulation among hemodialysis patients. Methods: This study employed a pre-test and post-test design, involving a single group of 30 hemodialysis patients undergoing treatment at Shahid Beheshti Hospital in Hamadan in 2022. The sampling method used was simple random sampling. The intervention consisted of three sessions using the routine method, followed by three sessions utilizing the ultrafiltration profile method, which employed an interval with a negative slope. Demographic and clinical information about the patients was recorded on a checklist. Systolic and diastolic blood pressure measurements were taken before the commencement of hemodialysis, at 1-, 2-, and 3-hour intervals post-treatment initiation, and again 15 minutes after completing hemodialysis. Results: The mean blood pressure changes observed during dialysis stages increased with both methods; however, there was a significant difference between the methods (P &lt; 0.001). Specifically, patients receiving the ultrafiltration profile method experienced significantly lower increases in blood pressure compared to those receiving the routine method. Conclusions: Based on the research results, integrating ultrafiltration profiling into hemodialysis can be regarded as an effective and viable strategy for enhancing blood pressure regulation in patients undergoing hemodialysis treatment. Therefore, it is recommended that this approach be considered in hemodialysis programs as well.

Clinical applications of metagenomic next-generation sequencing in the identification of pathogens in periprosthetic joint infections: a retrospective study

BackgroundThis study aimed to evaluate the application of metagenomic next-generation sequencing (mNGS) technology to identify pathogens in periprosthetic joint infection (PJI).MethodsA retrospective analysis was conducted on 65 patients suspected of having PJI between April 2020 and July 2023. The patients were categorized into PJI (46 patients) and non-PJI (19 patients) groups based on the 2018 International Consensus Meeting criteria. Clinical data were collected, and both conventional bacterial culture and mNGS were performed. The diagnostic performance of the two methods was compared and analyzed.ResultsmNGS exhibited a sensitivity of 89.13%, a specificity of 94.74%, a positive predictive value of 97.62%, a negative predictive value of 78.26%, and an overall diagnostic accuracy of 90.77%. Compared to microbial culture, mNGS demonstrated superior diagnostic sensitivity while maintaining similar specificity. A total of 48 pathogens were successfully identified using mNGS, with Coagulase-negative staphylococci, Streptococci, Staphylococcus aureus, and Cutibacterium acnes being the most common infectious agents. Notably, mNGS was used to identify 17 potential pathogens in 14 culture-negative PJI samples, highlighting its ability to detect rare infectious agents, including Cutibacterium acnes (n = 5), Granulicatella adiacens (n = 1), Mycobacterium tuberculosis complex (n = 1), and Coxiella burnetii (n = 1), among others, which are not detectable by routine culture methods. However, mNGS failed to detect the pathogen in 4 culture-positive PJI patients, indicating its limitations. Among the 46 PJI patients, 27 had positive culture and mNGS results. The results of mNGS were concordant with those of culture at the genus level in 6 patients with PJI and at the species level in 18 patients. Furthermore, the present study revealed a significantly greater proportion of Staphylococcus aureus in the sinus tract group (45.45%) than in the non-sinus tract group (14.29%), indicating the association of this pathogen with sinus formation in PJI (P = 0.03). Additionally, there was no significant difference in the occurrence of polymicrobial infections between the sinus tract group (27.27%) and the non-sinus tract group (33.33%) (P = 0.37).ConclusionsMetagenomic next-generation sequencing can serve as a valuable screening tool in addition to traditional culture methods to improve diagnostic accuracy through optimized culture strategies.

Development and Evaluation of a Multiplex Fluorescence PCR for Salmonella Virulence Genes Analysis

Background: Salmonellosis, a disease caused by Salmonella, is a significant public health concern and economic burden worldwide. The ability of various Salmonella serovars to cause disease is closely linked to the virulence genes they possess. Objectives: The aim of this study was to develop a multiplex fluorescence PCR for detecting ten major virulence genes (ssaR, spvC, pefA, sipA, fimA, sifA, sopE2, sopB, prgH, and stn) in Salmonella. Methods: Primer pairs specific to ten target virulence genes were designed using Primer Premier 5.0 and distributed across two reaction tubes. The multiplex fluorescence PCR was optimized by adjusting one factor at a time. Results: A total of sixty Salmonella strains were analyzed using the newly developed multiplex fluorescence PCR. All strains contained seven or more of the tested virulence genes. The positive rates of virulence genes ssaR, sipA, sopE2, sopB, prgH, and stn were high, each at 100%. The positive rate of sifA was also relatively high at 81.67%. However, the positive rates of spvC at 5% and pefA at 3.33% were relatively low. Conclusions: The newly developed multiplex fluorescence PCR provides a straightforward, cost-effective, and high-throughput solution for detecting virulence genes in Salmonella. It has the potential to become a routine method for analyzing Salmonella virulence genes.

The effect of increased fruit and vegetable consumption on blood pressure and lipids: a pooled analysis of six randomised controlled fruit and vegetable intervention trials.

Increasing fruit and vegetable (FV) consumption is associated with reduced cardiovascular disease risk in observational studies but with little evidence from randomised controlled trials (RCTs). The impact of concurrent pharmacological therapy is unknown. To pool data from six RCTs to examine the effect of increasing FV intake on blood pressure (BP) and lipid profile, also exploring whether effects differed by medication use. Across trials, dietary intake was assessed by diet diaries or histories, lipids by routine biochemical methods and BP by automated monitors. Linear regression provided an estimate of the change in lipid profile or BP associated with a one portion increase in self-reported daily FV intake, with interaction terms fitted for medication use. The pooled sample included a total of 554 participants (308 males and 246 females). Meta-analysis of regression coefficients revealed no significant change in either systolic or diastolic BP per portion FV increase, although there was significant heterogeneity across trials for systolic BP (I2= 73%). Neither adjusting for change in body mass index, nor analysis according to use of anti-hypertensive medication altered the relationship. There was no significant change in lipid profile per portion FV increase, although there was a significant reduction in total cholesterol among those not on lipid-lowering therapy (P < 0.05 after Bonferroni correction). Pooled analysis of six individual FV trials showed no impact of increasing intake on BP or lipids, but there was a total cholesterol-lowering effect in those not on lipid-lowering therapy.

Cell Block: An Unsung Hero

Although present since historic times, cell blocks have still been on a back seat when it comes to diagnostics, despite having immense potential. Cell block preparations made from sedimented cells can be a useful adjunct to routine cytological methods. We, thus, present a case of a 76-year-old female who would have not been treated on time, if a cell block hadn’t been attempted.

LC-HRMS and GC-MS Profiling of Urine Free Cortisol, Cortisone, 6Β-, and 18-Hydroxycortisol for the Evaluation of Glucocorticoid and Mineralocorticoid Disorders.

Urine free cortisol measurements are routinely performed to evaluate hypercortisolism. Despite their analytical inaccuracy, immunoassay-based methods are frequently used. Advances in liquid chromatography-high-resolution mass spectrometry (LC-HRMS) facilitate the incorporation of powerful diagnostic tools into clinical laboratories. In addition to its high analytical specificity and simultaneous analysis of different metabolites, accurate mass measurement allows for untargeted compound identification, which may help to identify clinically relevant metabolites or drugs. The present study aimed to validate a simple routine LC-HRMS method to quantify cortisol, cortisone, 6β-hydroxycortisol, and 18-hydroxycortisol simultaneously in human urine. Additionally, the study also validated a GC-MS method for the same steroids, evaluated their cross-reactivity with commercial cortisol immunoassays, and quantified the 24 h urine excretion in patients under clinical suspicion or follow-up for hypercortisolism. The LC-HRMS method involved liquid-liquid extraction using dichloromethane, micro-LC for chromatographic separation and detection using the accurate masses of the steroids, and simultaneous high-resolution full scan acquisition. The method presented acceptable linearity, precision, and accuracy. Significant interference from 6β-hydroxycortisol and cortisone was demonstrated in the cortisol immunoassays, which impacted their reliability in the follow-up of patients with hypercortisolism and significant changes in these cortisol metabolites (i.e., due to drug-induced changes in CYP3A4 activity). A rapid and accurate routine LC-HRMS method was validated, which is useful for the evaluation of hypercortisolism and other disorders of glucocorticoid and mineralocorticoid metabolism.

Histological Disruptive Effects of Tau-Fluvalinate in Zebrafish (Danio rerio) Testis

Due to the high use of pesticides, undesirable effects are observed in the environment and toxic effects occur in terrestrial and aquatic organisms via pesticide bioaccumulation. Although bioaccumulation levels are low, especially in aquatic ecosystems, toxicological effects on aquatic organisms have been observed. Synthetic pyrethroids are pesticides produced for domestic and agricultural pests and tau-fluvalinate is also a broad-spectrum synthetic pyrethroid. Our study investigated the histopathological effects of zebrafish exposed to tau-fluvalinate at two different doses (8µg/L,16µg/L) on testicular tissue. After 5 days of exposure, testicular tissues were dissected and routine histological methods were applied. Tissues were investigated under a light microscope after they were stained with hematoxylin &amp; eosin. As a result of tau-fluvalinate exposure, deterioration in seminiferous tubule morphology, interstitial fibrosis, vascular congestion, karyorrhexis and hypertrophic spermatogenic cells were detected. Tau-fluvalinate exposure was found to induce apoptosis and cause germ cell deterioration.

Noise and Vibration Generation and Response of Mice (Mus musculus) to Routine Intrafacility Transportation Methods.

Intrafacility transport of mice is an essential function for both laboratory and husbandry personnel. However, transport may induce a stress response that can alter research findings and negatively impact animal welfare. To determine minimally adverse intrafacility transport methods, in-cage noise and vibration exposure during transport on a variety of transport vehicles (hand carrying, stainless steel rack, flatbed cart, metal teacart, plastic teacart, and a cart with pneumatic wheels) were measured. Under-cage and in-cage padding was tested for its ability to decrease noise and vibration on each vehicle. Behavioral (open field test and elevated plus maze) and corticosterone responses of mice were then measured following transport on the most adverse (metal teacart) and least adverse (pneumatic cart) methods of multicage transport. Behavioral measures showed no difference between transported mice and untransported mice in both single- and group-housed settings. Plasma corticosterone was significantly elevated in mice transported on the metal teacart immediately following transport and continued to have elevated trends in circadian peaks during the 48h of sampling. The cart with pneumatic wheels was most effective at reducing noise and vibration, reflected in posttransport corticosterone readings that remained equivalent to those in untransported mice. This study demonstrates that mitigation of noise and vibration during cart transport may decrease the impact of transport on certain stress parameters in mice.

Electronic Real-Time Monitoring Reveals Limited Adherence to Long-Term Opioid Prescriptions in Pain Patients.

Pain management physicians are increasingly focused on limiting prescription opioid abuse, yet existing tools for monitoring adherence have limited accuracy. Medication event monitoring system (MEMS) is an emerging technology for tracking medication usage in real-time but has not been tested in chronic pain patients on long-term opioid regimens. We conducted a pilot clinical trial to investigate the utility of MEMS for monitoring opioid adherence and compared to traditional methods including self-report diaries, urine drug screen (UDS), and physicians' opinions. Opioid-maintained chronic pain patients were recruited from a pain management clinic. Participants (n=28) were randomly assigned to either receive MEMS bottles containing their opioid medication for a 90-day period or to continue using standard medication bottles. MEMS bottles were configured to record and timestamp all bottle openings and the number of pills that were removed from the bottle (via measurement of weight change). Participants who received MEMS demonstrated highly heterogenous dosing patterns, with a substantial number of patients rapidly removing excessive amounts of medication and/or "stockpiling" medication. By comparison, physicians rated all participants as either "totally compliant" or "mostly compliant". UDS results did not reveal any illicit drug use, but 25% of participants (n=7) tested negative for their prescribed opioid metabolite. MEMS data did not correlate with physician-rated adherence (P=0.24) and UDS results (P=0.77). MEMS data consistently revealed greater non-adherence than self-report data (P<0.001). These results highlight the limits in our understanding of naturalistic patterns of daily opioid use in chronic pain patients as well as support the use of MEMS for detecting potential misuse as compared to routine adherence monitoring methods. Future research directions include the need to determine how MEMS could be used to improve patient outcomes, minimize harm, and aid in clinical decision-making. This study was preregistered on ClinicalTrials.gov (NCT03752411).

Comparison between a new point-of-care HbA1c test and a routine laboratory method

Comparison between a new point-of-care HbA1c test and a routine laboratory method

SURVEY ON DETERMINATION OF ALBUMINURIA BY FAMILY PHYSICIANS

Objective: Albuminuria is an established marker of cardiovascular (CV) risk which has a role in pathogenesis of cardio-renal diseases, and it is questioned whether it should also be a therapy target. In all relevant guidelines it is listed as a routine laboratory method for all patients with hypertension and increased CV risk regardless they have diabetes or not. Croatian Hypertension League successfully negotiated with Croatian National Health Insurance company, and since last February determination of albumin-to-creatinine ratio - ACR is reimbursed for all patients with hypertension, and not only hospital specialist, but also family physicians (FP) are allowed to use this method. We announced this important novelty through our newsletters, website and media. The aim was to analyze how this method was implemented by family physicians in regular work. Design and method: A digital structured questionnaire was prepared and placed at the website of the Croatian Hypertension League. Using our regular monthly newsletter, we have invited FP, members of the League to participate in this survey. So far, 135 FP participated (83.7% women) from all parts of Croatia. Results: All physicians believe that determination of ACR is very important. Before this survey, 34% have not heard about this possibility, and from those who were informed 31% have not yet started. The most important reason was incapability of local laboratory (51%) followed by the answer that they have not had proper patient for these analyses (17.8%). When asked whether their laboratory provide them with values of estimated glomerular filtration rate, 51% answered negatively. Conclusions: Croatian Hypertension League made a big step forward enabling determination of ACR for all hypertensive patients by all physicians. However, there are still several gaps which should be eliminated. One is increasing awareness of FP and encouraging them to determine ACR more frequently, and the other one is to convince medical biochemistries to allow regular determination of ACR in all laboratories, but also of reporting eGFR. Survey, like this are very important and could be helpful in reaching final success, and we will use results for evidence-based negotiation with Croatian Biochemistry Chamber.

Chronic diarrhea secondary to intestinal spirochetosis, should we think about it?

Abstract Human intestinal spirochetosis (HIS) is defined as a colonization of the apical membrane of the colonic mucosa and the appendix by spirochetes. It is a very rare finding, being more common in some populations (individuals living in villages and peri-urban environments in developing countries, recent immigrants from developing countries, men who have sex with other men and HIV positive patients), but the spirochete rarely is investigated as human enteric potential microorganism. It is a slow-growing microorganism and has specialized growth requirements, which is why it is not detectable in human fecal samples using routine diagnostic methods. However, it has been histologically identified attached to the colon and rectum in patients with conditions such as chronic diarrhea, rectal bleeding, and/or nonspecific abdominal discomfort. In this article we present the case of a patient with chronic diarrhea secondary to intestinal spirochetosis, highlighting the importance of considering this etiology in the differential diagnosis.

Model discovery approach enables noninvasive measurement of intra-tumoral fluid transport in dynamic MRI.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a routine method to noninvasively quantify perfusion dynamics in tissues. The standard practice for analyzing DCE-MRI data is to fit an ordinary differential equation to each voxel. Recent advances in data science provide an opportunity to move beyond existing methods to obtain more accurate measurements of fluid properties. Here, we developed a localized convolutional function regression that enables simultaneous measurement of interstitial fluid velocity, diffusion, and perfusion in 3D. We validated the method computationally and experimentally, demonstrating accurate measurement of fluid dynamics in situ and in vivo. Applying the method to human MRIs, we observed tissue-specific differences in fluid dynamics, with an increased fluid velocity in breast cancer as compared to brain cancer. Overall, our method represents an improved strategy for studying interstitial flows and interstitial transport in tumors and patients. We expect that our method will contribute to the better understanding of cancer progression and therapeutic response.