Samples For Testing Research Articles

Estimation of undrained shear strength of soft clay during surcharge or vacuum preloading

Preloading using either vacuum or fill surcharge is an effective method for the treatment of very soft saturated clay. The preloading will reduce the water content and increase the shear strength of soil. However, when the soil to be treated is very soft, it is difficult to take soil samples for laboratory tests or carry out in situ tests to determine the soil properties including shear strength. Therefore, there is a need to develop an analytical method to estimate the shear strength during preloading. In this paper, a simple correlation among settlement, water content and undrained shear strength using critical state theory is proposed for saturated soil under one-dimensional loading condition to allow the undrained shear strength variation of the soil to be estimated during preloading without testing. Laboratory model test and field monitoring data are used to verify the validity of this method and the proposed correlation is effective to be used as rough estimations on the undrained shear strength of soft clay.

Compliance of a Tertiary Centre With Molecular Testing Strategies for Lynch Syndrome in Colorectal Cancer.

Introduction Lynch syndrome is one of the most common hereditary cancers associated with germline alterations of DNA mismatch repair genes. Recent advances have shed light on its molecular pathogenesis, leading to the development of various testing strategies. The aim of this study is to evaluate whether all colorectal adenocarcinomas undergo immunohistochemistry (IHC) and microsatellite instability (MSI) testing to identify potential Lynch syndrome patients. Methods This study evaluated the compliance of MSI and IHC testing for Lynch syndrome in a tertiary cancer research centre. All patients undergoing colorectal cancer resectionbetween April 2022 and December 2022were identified from a prospectively maintained register. The histology, MSI, and IHC testing reports for these patients were recorded to check if they were done and reported. Only patients with colorectal adenocarcinoma were included in this study. Results A total of 314 patients had colorectal cancer resections. A total of 301 were included in the study, with a median age of 65 years (IQR = 35-95). Thirteen (4.14%) patients did not have MSI and IHC testing reported on the system. Of these, eight (61.53%) did not have an MSI/IHC testing request, four (30.76%) did not have sufficient specimens to be sent for further testing, one (7.69%) had MSI and IHC testing but the final report was yet to be authorized. Out of the eight who did not have the testing done, three had early polyp cancer and one had a goblet cell adenocarcinoma. Conclusion According to the data, our hospital has a 97.45% compliance with current guidelines, not considering the insufficient sample for testing and the authorization of the final report. A more comprehensive proforma may be needed to provide a feedback loop for further MSI and IHC testing when entering data into the system. Further auditing is required to check the effectiveness of the proforma in achieving complete compliance.

Factors Associated with Medical Care-Seeking and Stool Sample Submission for Diarrheal Illness, FoodNet, United States, 2018-2019.

Laboratory-based surveillance for enteric pathogens causing diarrhea is foundational for monitoring foodborne diseases in the United States. However, diarrheal illnesses are not always confirmed by laboratory testing, so estimates of the true number of illnesses must adjust for underdiagnosis, including underdiagnosis due to ill persons not seeking medical care or submitting a stool sample for laboratory testing. We assessed these factors among persons with an acute diarrheal illness who responded to the most recent Foodborne Diseases Active Surveillance Network (FoodNet) Population Survey (2018-2019). Multiple modes of administration (telephone, web-based) and multiple sampling frames were used to ask survey respondents in English or Spanish about diarrhea and other symptoms experienced in the 30 days before the interview and to ask if they had sought medical care or submitted a stool sample. Of 1018 respondents with an acute diarrheal illness, 22.0% had sought medical care and 4.7% submitted a stool sample. On multivariable analysis, older adults (aged 65 years and over), male respondents, and persons with a household income of ≥$40,000 per annum were significantly more likely to seek medical care, as were respondents reporting cough, fever, vomiting, recent international travel, or duration of diarrhea for ≥3 days. Older adults and persons with five or more loose stools in 24 h who sought medical care were significantly more likely to submit a stool sample. Ill respondents with a concurrent cough were less likely to submit a stool sample. Sociodemographic characteristics, symptoms, and international travel influence whether a patient with an acute diarrheal illness will seek care or submit a stool specimen. Accounting for these factors when analyzing surveillance data will likely produce more precise estimates of the true number of foodborne illnesses.

Prevalence of hypercholesterolemia in the elderly and the very elderly members of the Polish population: results of a national cross-sectional representative survey.

Lipid disorders are the most common cardiovascular risk factor among adult population in Poland. However, there is still insufficient epidemiological data for an ever-growing group of older people. The aim was to describe and analyze the epidemiology of lipid disorders among Polish seniors Patients and methods: The random sample of 4101 participants (M = 2136; W = 1965) aged 65-104, equally distributed in age subgroups (65-69, 70-74, 75-79, 80-84, 85-89, and 90(+)-year-old subjects), participated in a cross-sectional, national survey PolSenior. Anthropometric measurements, blood pressure, and blood samples for tests of lipid profile were obtained. 62.4% of Polish seniors (56.1% of men and 66.3% of women) suffered from hypercholesterolemia. TC level was the highest among 65-69-year-olds, both men (206.0 [201.0-210.9] mg/dL) and women (220.6 [215.6-225.6] mg/dL). Women in each age group had a higher TC concentration than men. Also, in terms of LDL-C, the highest level was found in women aged 65-69 years (131.6 [127.2-136.1] mg/dL) and decreased in older age groups to 120.1 [115.2-125.0] mg/dL in women >90 years of age; similar in men: 121.6 [117.3-125.9] mg/dL in 65-69 y. o. and 106.5 [102.5-110.5] mg/dL in the group over 90 years old. In all the respective age groups, LDL-C was higher in women. In the Polish population among the elderly mean serum TC and LDL-C concentrations are higher in women than in men. The results obtained highlight the importance of lipid disorders as a risk factor also among the elderly Poles.

Gambaran Hasil Pemeriksaan Keton Urin Segera dan Ditunda Metode Dipstik

Laboratory testing is part of a medical process, both from the beginning to the monitoring of diagnostic development, often the urine tested experiences delays due to late delivery of samples or other factors. One element in the urine is the body of ketone (acetoacetate, 3-hydroxybutyrate, and acetone). Acetone includes the classification of ketones with easily evaporating properties due to temperature. Urine ketone is checked by dipstick methods. There's a 10-90% decrease in urine ketone if urine tests are delayed for 2 hours. Of the 30 urine samples with varying results, which are decreasing and increasing but still touch the normal value limit of urine ketone 0.5 mmol/L. Optimal handling and time of urine sampling for urine ketone testing should be observed to maintain medical protocol and ensure more accurate diagnostic results on the public health service network.

A comprehensive epidemiological approach documenting an outbreak of H5N1 highly pathogenic avian influenza virus clade 2.3.4.4b among gulls, terns, and harbor seals in the Northeastern Pacific

Highly pathogenic avian influenza viruses (HPAIV) H5N1 clade 2.3.4.4b continue to have unprecedented global impacts on wild birds and mammals, with especially significant mortality observed in colonial surface-nesting seabirds and in some marine mammal species. In July of 2023 H5N1 HPAIV 2.3.4.4b was detected in Caspian terns nesting on Rat Island, Washington USA. An estimated 1,800–1,900 adult terns populated the breeding colony, based on aerial photographs taken at the start of the outbreak. On a near-weekly basis throughout July and August, we counted and removed carcasses, euthanized moribund birds, and collected swab and tissue samples for diagnostic testing and next-generation sequencing. We directly counted 1,101 dead Caspian tern adults and 520 dead chicks, indicating a minimum 56% loss of the adult colony population and potential impacts to reproductive success. Combining the observed mortality on Rat Island with HPAI-related Caspian tern deaths recorded elsewhere in Washington and Oregon, we estimate that 10–14% of the Pacific Flyway population was lost in the summer of 2023. Comparatively few adult Glaucous-winged gulls (hybrids) nesting on Rat Island died (~3% of the local population), although gull chick mortality was high. Sixteen harbor seals in the immediate or nearby area stranded during the outbreak, and H5N1 HPAIV was detected in brain and/or lung tissue of five seals. These cases are the first known detections of HPAIV in a marine mammal on the Pacific coast of North America. Phylogenetic analyses support the occurrence of at least three independent avian-mammalian virus spillover events (tern or gull to harbor seal). Whole genome sequencing indicated that H5N1 HPAIV may have been introduced to Washington from Caspian terns in Oregon. Ongoing monitoring and surveillance for H5N1 HPAIV in the marine environment is necessary to understand the epidemiology of this virus, assess conservation impacts to susceptible species, and provide support for data-driven management and response actions.

Optimizing task assignment and routing operations with a heterogeneous fleet of unmanned aerial vehicles for emergency healthcare services

This paper studies the optimization of task assignment and pickup and delivery operations using a heterogeneous fleet of unmanned aerial vehicles (UAVs). We specifically address the distribution of emergency medical supplies, including medications, vaccines, and essential medical aid, as well as the collection of biological blood samples for testing and analysis. Unique challenges, such as supply shortages, time windows, and geographical considerations, are explicitly taken into account. The problem is first formulated as a mixed-integer linear programming model aimed at maximizing the total profit derived from the execution of a set of emergency healthcare pickup and delivery tasks. An enhanced Q-learning-based adaptive large neighborhood search (QALNS) is proposed for large-scale benchmark instances. QALNS exhibits a superior performance on benchmark instances. It also improves the quality of the solutions on average by 5.49% and 6.86% compared to the Gurobi solver and a state-of-the-art adaptive large neighborhood search algorithm, respectively. Sensitivity analyses are performed on critical factors contributing to the performance of the QALNS algorithm, such as the learning rate and the discount indicator. Finally, we provide managerial insights on the use of the fleet of UAVs and the design of the network.

The Impact of Next-Generation Sequencing Workflows on Outcomes in Advanced Lung Cancer: A Retrospective Analysis at One Academic Health System.

Broad-based molecular testing with next-generation sequencing (NGS) is now the standard of care in advanced non-small cell lung cancer (NSCLC). Two approaches to molecular testing are (1) reflexive testing at pathologic NSCLC confirmation, often using an in-house molecular panel, and (2) send-out testing to private vendors, ordered by a clinician. This study explored the outcomes with reflex versus send-out testing. A retrospective chart review was conducted of patients diagnosed with de novo stage IV NSCLC in 2019 and 2020 at three hospitals in the same system, one academic hospital (Northwestern Memorial Hospital, or NMH) utilizing reflex, in-house NGS, and two community-based hospitals (Central DuPage Hospital, or CDH, and Delnor, or D) sending out tissue samples for testing. The outcomes assessed were the time from biopsy to results, biopsy to treatment, the incidence of first-line targetable mutations and the use of first-line targeted therapies, and overall survival. In total, 191 patients met the inclusion criteria, 85 at NMH, 106 at CDH + D, and in total, 131 in 2019 and 60 in 2020. The time to results was significantly shorter with reflexive NGS when compared with send-out testing; the time to treatment was also shorter but not statistically significant. At CDH + D, the time to results was significantly shorter with a limited panel than with comprehensive testing, but the time to treatment was similar. NGS testing rates were 95% at NMH and 84.5% at CDH + D (p = 0.009), with 31.0% at NMH receiving 1L targeted therapies versus 20.8% at CDH + D (p = 0.08). In 2019, the median time from biopsy to treatment was 35 days at NMH and 38 days at CDH and Delnor; in 2020, time to treatment was 26 days and 37 days, respectively. Overall survival trended longer in 2020 relative to 2019 independent of site. Reflexive NGS testing is associated with a shorter time to actionable results and higher rates of first-line targetable mutations than send-out testing. In practices with send-out testing, limited panels had slightly faster turnaround times but no difference in time to treatment. If resources allow, reflexive NGS should be considered in healthcare systems for patients with NSCLC.

HIV DNA Levels in Persons Who Acquired HIV in the Setting of Long-Acting Cabotegravir for HIV Prevention: Analysis of Cases from HPTN 083 and 084.

We evaluated HIV DNA levels in individuals who received long-acting cabotegravir (CAB-LA) or tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) pre-exposure prophylaxis in the HPTN 083 and 084 trials and had HIV DNA testing performed to help determine HIV status. HIV DNA testing was performed using peripheral blood mononuclear cell (PBMC) samples collected after a reactive HIV test was obtained at a study site. DNA was quantified using droplet digital PCR (lower limit of detection [LLOD]: 4.09 copies/million PBMCs). Final HIV status and the timing of the first HIV-positive visit were determined by an independent adjudication committee based on HIV test results from real-time site testing and retrospective testing at a centralized laboratory. HIV DNA testing was performed for 133 participants [21 HIV-positive (7 CAB-LA arm, 14 TDF/FTC arm) and 112 HIV-negative; 1-6 tests/person]. For persons with HIV, the time between the first HIV-positive visit and collection of the first sample for DNA testing was a median of 81 days for those receiving CAB-LA (range 41-246) and 11 days for those receiving TDF/FTC (range 3-127). Four (57.1%) of the seven CAB-LA cases with infection had a low initial DNA result [three detected <LLOD; one near the LLOD (4.2 copies/106 PBMCs); in 2/4 cases, the DNA level was still <10 copies/106 PBMCs ≥40 weeks after the first HIV-positive visit. In contrast, only 3/14 (21.4%) of the TDF/FTC cases had a low or negative initial DNA test result (one not detected; two <10 copies/106 PBMCs). In this study, the time between the first HIV-positive visit and the first DNA test was longer in the CAB-LA cases than the TDF/FTC cases. Despite this difference, low or undetectable DNA levels were more frequently observed in the CAB-LA cases. This suggests that CAB-LA exposure may limit seeding of the HIV reservoir in early infection.

Evidence from Europe on implementation, participation and performance of self-collection for cervical cancer screening.

Cervical cancer screening programs reduce the number of cervical cancer cases and deaths, but the success of any screening program is dependent on high participant uptake and coverage and many European countries are observing declining cervical cancer screening coverage to below national targets. Self-collection of vaginal samples for human papillomavirus testing, also termed self-sampling, is one strategy which is being introduced to try to increase screening coverage by removing barriers to participation and it has attracted growing interest and support globally. Informed by peer-reviewed and gray literature, this narrative review starts with a case study from the Netherlands and outlines the self-collection landscape in Europe within the themes of program implementation and relative test performance. It highlights some of the current evidence gaps needed to inform policy decisions on the use of self-collection within screening programs.

Rapid identification of antibiotic residues in bovine kidney using coated blade spray-mass spectrometry.

The use of certain antibiotics in food-producing animals is allowed in Europe following Regulation (EU) 2017/625. However, use could result in antibiotic residues in foodstuffs of animal origin. Maximum residue limits (MRLs) are in place to protect consumers. For monitoring purposes, animal matrices are tested to verify their compliance with these MRLs. Initially, matrices of (slaughtered) food animals are screened, often using a microbiological assay. Faster screening tests for antibiotics would be an advantage for control laboratories. Therefore, the present study describes, for the first time, the use of coated blade spray (CBS) followed by direct mass spectrometry (MS) analysis for the screening of tetracyclines, sulfonamides, quinolones, and macrolides residues from the renal area of intact bovine kidneys. An optimized workflow using two different desorption/ionization solutions per blade allowed screening of target compounds within 1min per sample. The proof-of-principle of the CBS-MS method is validated according to (EU) 2021/808, presenting CCβ screening values of 0.1 × MRL for 43 analytes, 0.5 × MRL for 4 analytes, and 2.5µgkg-1 for the prohibited substance dapsone, respectively. The developed method was successfully applied to seven official control samples of bovine kidneys. One of these samples was found to be positive using the CBS-MS method, which was confirmed as a true positive by LC-MSMS analysis. The developed method demonstrates that CBS devices can directly extract and analyze kidney samples for food safety testing.

Optimal Geometry for Focused Ion Beam-Milled Samples for Direct-Pull Micro-Tensile Testing Performed In Situ in a Scanning Electron Microscope.

A thorough procedure was developed to efficiently manufacture dogbone samples using focused ion beam (FIB) milling for micro-tensile testing. A Bruker PI 89 PicoIndenter, Billerica, MA, USA, was used as a case study, although the analysis and results are applicable to other micro-mechanical testing systems capable of mounting a standard, Ø12.7 mm × Ø3.2 mm pin, scanning electron microscopy (SEM) pin stub (Ted Pella, Redding, CA, USA). Nine dogbones were made from an Fe-45Cu alloy additively manufactured using powder-fed laser-directed energy deposition (DED-LB). Testing showed that fracture was confined to the gauge section for all dogbones and that the fracture mode, ductile vs. brittle, was entirely dependent on the grain orientation relative to the loading direction. The analysis showed that the measured plastic strain to failure can vary from >11% (optimal geometry) to <1% (non-optimal geometry) in micro-tensile testing of high-tensile-strength (>1 GPa) metallic materials. Subsequently, a finite element analysis (FEA) was conducted to identify the improved dogbone geometries. A total of ten thousand dogbone geometries were tested, and their dimensions were defined by a set of four adjustable parameters (corner radius, load surface angle, load surface length, and dogbone head length). The gauge width and gauge length were fixed to 4 µm and 10 µm, respectively. Three-dimensional surface plots of the stress concentration as a function of two parameters were used to identify the optimal ranges of parameter values. The addition of maximum width and length constraints, measuring 25 µm and 30 µm, respectively, allowed us to identify an optimal geometry at load surface angles of 30° and 45°. Their respective dimensions (corner radius, load surface length, and dogbone head length) are, in µm, 12, 6, and 7 and 10, 7, and 7. Testing these two optimal geometries with a range of gauge lengths from 4 to 20 µm showed that smaller gauge lengths only slightly reduced the detrimental stress concentration outside the gauge section. However, smaller gauge lengths will notably improve the FIB surface polishing step as tapering is reduced with smaller dogbone lengths.

Host–microbe interaction-mediated resistance to DSS-induced inflammatory enteritis in sheep

BackgroundThe disease resistance phenotype is closely related to immunomodulatory function and immune tolerance and has far-reaching implications in animal husbandry and human health. Microbes play an important role in the initiation, prevention, and treatment of diseases, but the mechanisms of host–microbiota interactions in disease-resistant phenotypes are poorly understood. In this study, we hope to uncover and explain the role of microbes in intestinal diseases and their mechanisms of action to identify new potential treatments.MethodsFirst, we established the colitis model of DSS in two breeds of sheep and then collected the samples for multi-omics testing including metagenes, metabolome, and transcriptome. Next, we made the fecal bacteria liquid from the four groups of sheep feces collected from H-CON, H-DSS, E-CON, and E-DSS to transplant the fecal bacteria into mice. H-CON feces were transplanted into mice named HH group and H-DSS feces were transplanted into mice named HD group and Roseburia bacteria treatment named HDR groups. E-CON feces were transplanted into mice named EH group and E-DSS feces were transplanted into mice in the ED group and Roseburia bacteria treatment named EDR groups. After successful modeling, samples were taken for multi-omics testing. Finally, colitis mice in HD group and ED group were administrated with Roseburia bacteria, and the treatment effect was evaluated by H&E, PAS, immunohistochemistry, and other experimental methods.ResultsThe difference in disease resistance of sheep to DSS-induced colitis disease is mainly due to the increase in the abundance of Roseburia bacteria and the increase of bile acid secretion in the intestinal tract of Hu sheep in addition to the accumulation of potentially harmful bacteria in the intestine when the disease occurs, which makes the disease resistance of Hu sheep stronger under the same disease conditions. However, the enrichment of harmful microorganisms in East Friesian sheep activated the TNFα signalling pathway, which aggravated the intestinal injury, and then the treatment of FMT mice by culturing Roseburia bacteria found that Roseburia bacteria had a good curative effect on colitis.ConclusionOur study showed that in H-DSS-treated sheep, the intestinal barrier is stabilized with an increase in the abundance of beneficial microorganisms. Our data also suggest that Roseburia bacteria have a protective effect on the intestinal barrier of Hu sheep. Accumulating evidence suggests that host–microbiota interactions are associated with IBD disease progression.2GpPdtDdh9Lk52sebv8JARVideo

Effective Field Sampling of Rectoanal Mucosa-Associated Lymphoid Tissue for Antemortem Chronic Wasting Disease Testing in White-tailed Deer (Odocoileus virginianus).

Chronic wasting disease (CWD) is a fatal prion disease of cervids that has spread across much of North America. Although gold standard CWD diagnostics involve postmortem testing of medial retropharyngeal lymph nodes or obex (brain stem), a key tissue sample for antemortem testing is rectoanal mucosa-associated lymphoid tissue (RAMALT). However, collection of an adequate sample (i.e., enough lymphoid follicles) may be affected by factors such as deer age, repeated sampling, skill of the sampler, and adverse conditions during collection. Here, we document the protocol used to train personnel for RAMALT collection in a large study of free-ranging white-tailed deer (Odocoileus virginianus) in Wisconsin, USA, and determine factors that contributed to the occurrence of inadequate RAMALT samples. Our training protocol included hands-on experience with postmortem tissues, as well as a mentored collection process in the field. Collection of RAMALT under field conditions was highly successful, with 763/806 (94.7%) samples deemed adequate for subsequent testing. Although inadequate samples were rare, they were more likely to occur with older deer and when samples were collected at dusk (i.e., limited ambient lighting). We conclude that RAMALT collection can be highly successful under adverse field conditions, including with technicians with limited prior veterinary experience, and we provide details of our training program to facilitate repeatability in other antemortem CWD testing efforts.

MA08.08 Association of FDG-PET/CT Findings with Sufficient Amount of Tissue Samples for Gene Panel Testing in TBB/TBNA

MA08.08 Association of FDG-PET/CT Findings with Sufficient Amount of Tissue Samples for Gene Panel Testing in TBB/TBNA

Assessing the Feasibility of a Cancer Biomarker Testing Navigator in the Laboratory

Abstract Introduction/Objective Cancer biomarker testing is a crucial component of precision oncology, as it can guide medical treatment decisions with targeted therapies and immune checkpoint inhibitors. However, complex, fragmented, and inefficient operational processes involved in biomarker testing lead to delays, errors, and variability in testing. One potential solution is to introduce a novel role in the pathology laboratory: the cancer biomarker testing navigator (BTN). Methods/Case Report The American Society for Clinical Pathology (ASCP) conducted a mixed-methods project to assess the current state of biomarker testing operations and explore how a BTN may improve biomarker testing processes. ASCP conducted an online survey, focus groups, and worked with two hospital-based cancer centers on a feasibility pilot. Results (if a Case Study enter NA) Survey and focus group insights reveal several operational challenges around the biomarker testing process. 47 completed the survey and 16 participated in the focus groups. Participants report that biomarker test orders may be incorrect or incomplete. 37% of survey respondents experience delays preparing tissue samples for send-out cancer biomarker testing. 42% of survey respondents are unable to track the processing status of send-out tests. Excessive time is required to coordinate and facilitate send-out tests, especially when multiple reference laboratories are used since each has its own portal, requisition form, specimen requirements, etc. 87% agree they would benefit significantly from having a dedicated person to coordinate and manage cancer biomarker tests. The cancer centers that piloted this role found that they could catch and correct defects such as incorrect test ordered, incorrect specimen types marked on the test order, outdated requisition used, etc. The BTN also found instances where the test report was incomplete or had not been uploaded into the EHR. The BTN role could be justified by evaluating metrics such as task efficiency, workplace satisfaction in the lab, and levels of service satisfaction from oncologists. Patient care can be improved by reducing delays in testing and by reviewing other metrics of quality care delivery. Conclusion The BTN role in the laboratory is a novel solution for ensuring the proper collection and triage of pathology samples for biomarker testing. This role could serve as a liaison between the laboratory and ordering clinicians, provide collection and testing guidance, and help with benchmarking and quality measurement initiatives.

Advanced lipid testing in children: a call for pediatric reference intervals

Abstract Introduction Abnormal serum lipid levels in childhood are associated with dyslipidemia and increased risk of cardiovascular disease in adulthood. High prevalence of childhood obesity in the US has increased concerns about the adverse effects of abnormal lipids in children, prompting recommendations for universal lipid screening in adolescents. While specialized analysis of lipoproteins by nuclear magnetic resonance (NMR) has been predominately used in adults with risk factors for CVD, our laboratory also receives pediatric samples for NMR testing, most commonly associated with diagnostic codes for hyperlipidemia and/or abnormal weight gain. Currently adult-based reference ranges for the NMR lipoprotein measurements are used in children. The objective of this pilot study was to compare lipoprotein profiles of healthy adults and children and to assess the impact of reference intervals for children on clinical interpretation of pediatric results. Methods Serum samples were collected from 60 healthy children, ages 1 – 17 years, and 148 healthy adults, ages 19 – 64 years old. NMR lipoprotein analysis was performed using the Axinon lipoFIT by NMR assay on a 600 MHz NMR (Bruker). Statistical analysis was conducted in Excel and GraphPad Prism. Reference intervals (RIs) were determined in EP Evaluator as the central 95% interval. Results The levels of atherogenic low-density lipoprotein particle number (LDL-P) and small LDL-P (sLDL-P) were significantly lower in children compared to adults: 783±222 vs 1212±412 nmol/L and 302±142 vs 498±306 nmol/L, respectively (p&amp;lt;0.00001). Additionally, LDL size (LDL-s) was significantly larger in children than adults (21.23±0.29 vs 21.06±0.44 nm, p=0.006), reflecting prevalence of less dense LDL-P in the former group. Pediatric samples also had lower number of anti-atherogenic high-density lipoprotein particles (HDL-P) compared to adults: 29.4±4.6 vs 33.5±4.6 µmol/L, p&amp;lt;0.00001. The significant differences in the number and size of lipoprotein particles between adults and children implies that currently used adult reference intervals might not be appropriate for evaluating pediatric NMR samples. Therefore, we estimated RIs for our heathy pediatric and adult cohorts and applied these RIs to our retrospective data of 618 samples from children 1-17 years old, which were submitted for NMR lipoprotein testing in recent years. The analysis showed that using the adult RIs, 37% and 27% of pediatric samples would not flag for abnormally elevated LDL-P and sLDL-P, respectively; but they would be flagged based on the RI derived from our pediatric cohort. Moreover, 12% pediatric samples flagged for low HDL-P would have normal HDL-P levels if pediatric RIs are used instead of adult RIs. Conclusions Use of adult reference intervals in children may result in misclassification of lipid status and underestimation or overestimation of dyslipidemia and CVD risk in children. This pilot study highlights the need for pediatric reference intervals to guide interpretation of advanced lipid testing in children.

Molecular Tumor Testing on Colorectal Adenocarcinoma Specimens in a Large Community-Based Healthcare System.

This study aimed to describe the adherence of National Comprehensive Cancer Network guidelines to perform genetic screening for all colorectal cancer (CRC) specimens with molecular tumor testing, eg, immunohistochemical (IHC) testing, in a large community-based healthcare setting. The study also identified trends involving characteristics of CRC, individual reporting physician, and physician location and examined the potential impact of these trends on the performance of molecular tumor testing. This was a retrospective, multi-center study using a centralized pathology database to assess molecular testing on CRC specimens. The primary endpoint was whether tumor testing of a CRC specimen was performed. Secondary endpoints included tumor location within the colon (ie, the right or left side), year of CRC diagnosis, and location of the pathologist within the Advocate Aurora Health (AAH) system. The data were collected from 2016 to 2020. A total of 2469 CRC cases, reviewed by 47 pathologists practicing in five separate hospitals, were identified within the AAH system for the selected five-year time period. IHC testing was performed in 1666 of these specimens (67.5%). There was no statistical difference between CRC sidedness and IHC testing performed (p = 0.9). There were no discernible features or trends for the ordering of IHC testing among different pathologists. Molecular tumor testing for CRC specimens in this large community-based healthcare setting was inconsistent and below the ideal adherence rate of 100%. Secondary findings offered neither explanation nor trends in likelihood to send samples for IHC testing. Education would be beneficial for pathologists and all physicians who care for patients with CRC in community-based health care settings.

A seroprevalence study indicates a high proportion of clinically undiagnosed MPXV infections in men who have sex with men in Berlin, Germany

IntroductionDuring the mpox outbreak in 2022, the highest number of cases in Germany were registered in Berlin, almost all of them in men who have sex with men (MSM). However, the frequency of clinically undiagnosed infections is unknown.MethodsA cross-sectional study was conducted among MSM in Berlin, Germany. Participants were recruited from private practices and community-based checkpoints specialised in HIV and STI care for MSM. They were asked to complete an online questionnaire on socio-demographic data, mpox diagnosis, vaccination history and sexual behaviour, and to provide a blood sample for serological analysis. The samples were tested for antibodies against a range of antigens to distinguish between antibodies induced by mpox infection and MVA vaccination, with pre-immune sera from childhood smallpox vaccination as a confounding factor. Associations of behavioural variables with reported and suspected mpox diagnosis as the outcome were tested using univariable and multivariable logistic regression models.ResultsBetween the 11th April and 1st July 2023, 1,119 participants were recruited in eight private practices and two community-based checkpoints in Berlin. All participants provided a blood sample for serological testing. Information for the online questionnaire was provided by 728 participants; core data on age and mpox history for participants who did not provide questionnaire data were provided by the practices for an additional 218 participants. A previous diagnosis of mpox was reported for/by 70 participants (7.4%). Using a conservative and strict case definition, we serologically identified an additional 91 individuals with suspected undiagnosed mpox infection. Individuals with reported or suspected mpox infections reported more condomless anal sex partners in the past 3 months (OR = 5.93; 95% CI 2.10-18.35 for 5–10 partners; OR = 9.53; 95% CI 2.72–37.54 for > 10 partners) and were more likely to report sexual contact with partners diagnosed with mpox (OR = 2.87; 95% CI 1.39–5.84).ConclusionA substantial proportion of mpox infections were clinically undiagnosed. The number of condomless anal sex partners was strongly associated with both confirmed and suspected undiagnosed mpox infection. Therefore, mpox control measures based on clinical diagnosis of mpox are likely to have limited effectiveness in preventing mpox transmission in outbreak situations because many infections remain unrecognised and undiagnosed.

Association between Visit-to-Visit Ultrafiltration Volume Variability, Vascular Biomarkers and Cardiovascular Parameters in Chronic Hemodialysis Patients

Background. Cardiovascular (CV) diseases are the most common causes of morbidity and mortality in hemodialysis (HD) patients. We studied the effect of high visit-to-visit ultrafiltration (UF) variability on CV abnormalities in HD patients. Methods. Twenty-nine consecutive patients (age: 65.6 ± 10.4 years) were recruited. Samples for routine lab tests were drawn pre-HD for syndecan-1 (SDC-1) and endothelin-1 (ET-1) measurements pre-, mid- and post-HD. Applanation tonometry was performed pre-, mid- and post-HD. Visit-to-visit ultrafiltration volume variability (UVSD) was calculated as the standard deviation of the UF volume/dialysis session in the preceding 12 months. Echocardiography was performed post-HD. Results. Patients were divided into two groups based on the median of UVSD (500 mL). The average UF volume/HD was not different between the groups. Blood pressure (BP) values were similar. Pre-HD cfPWV (10.75 m/s) was lower in the high UVSD group (14.1 m/s, p = 0.03). In the high UVSD group, post-HD cfPWV (13.9 m/s) was higher than the pre-HD cfPWV (p &lt; 0.05). Pre-HD ET-1 was lower in the high UVSD group (8.6 ± 3.9 vs. 10.8 ± 2.7 pg/mL, p &lt; 0.05). Left ventricular end-diastolic diameter (LVEDD) and left ventricular mass index (LVMI) were higher in the high UVSD group (55.7 ± 7.3 vs. 51.0 ± 5.4 mm and 449.9 ± 180.5 vs. 350.3 ± 85.9 g/m², p &lt; 0.005, respectively). Left ventricular ejection fraction (LVEF) was lower in the high UVSD group (53.5 vs. 60, p &lt; 0.05). Conclusions. High UVSD was associated with increased left ventricular hypertrophy and dysfunction and decreased LVEF compared to low visit-to-visit UV variability despite similar UF volumes temporarily compensated by more elastic arteries. The observed abnormalities may increase CV risk.