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1.
Background
The aim of this study was to evaluate the modified Carba NP test to differentiate KPC (Klebsiella pneumoniae carbapenemase)‐ and MBL (metallo‐β‐lactamase)‐producing Klebsiella species.Methods
A total of 508 non‐duplicate clinical isolates of Klebsiella spp. were processed by modified Carba NP and combined disc tests which were further confirmed by conventional polymerase chain reaction (PCR), a gold standard method for statistical analysis.Results
Modified Carba NP test demonstrated 91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 99.8% negative predictive value (NPV) for KPC and 96.7%, 100%, 100%, and 99.5% for MBL detection, respectively.Conclusion
The performance of modified Carba NP test was significantly better than combined disc test, fulfilling the requirement of simple and rapid test for clinical applications.2.
Background
Being able to detect the presence of autoantibodies to interferon (IFN)‐γ in serum is essential for evaluating patients with suspected adult‐onset immunodeficiency (AOID) with unusual intracellular infections. Most reported patients with AOID have been Asian, although the exact prevalence of this illness is unknown. To date, no standard assay exists to detect autoantibodies to IFN‐γ. An easy‐to‐use, low‐cost assay that can be performed in any laboratory would be a valuable tool for clinical management of AOID, as well as better reveal its prevalence.Methods
Our experimental study exploited a dot enzyme‐linked immunosorbent assay (Dot‐ELISA) strip to detect autoantibodies to IFN‐γ. Sera from 66 HIV‐negative patients having autoantibodies to IFN‐γ as determined by indirect ELISA were tested.Results
Dot enzyme‐linked immunosorbent assay was sensitive (100%) and specific (94.5%), with a positive predictive value of 97.6% and a negative predictive value of 100%.Conclusion
This simple method provides prompt qualitative results that can be read visually and used in facilities with limited testing capabilities.3.
Objective
The prevalence of nonalcoholic fatty liver disease (NAFLD) has been rapidly increased, becoming a public health problem worldwide. Our objective was to investigate the association between urine retinol‐binding protein (RBP) and NAFLD in a Chinese population and develop a multivariate logistic regression model for NAFLD prediction.Methods
A total of 317 NAFLD patients and 391 healthy controls were enrolled in this cross‐sectional study based on inclusion and exclusion criteria, from whom fasting urine and blood were collected for further study. Urine RBP level and other parameters were measured and compared between NAFLD subjects and controls.Results
Urine RBP levels (expressed by RBP/creatinine ratio) in NAFLD patients were significantly higher than controls (median 133.1 mg/g vs 110.7 mg/g; P < .001). Urine RBP/creatinine ratio was verified as an independent factor for NAFLD prediction after adjustment in multivariate logistic regression. The area under curve (AUC) of receiver operating characteristic (ROC) was 0.889 with the 95% confidence interval from 0.867 to 0.912.With a cutoff point of 0.215, the sensitivity and specificity of urine RBP/creatinine ratio in NAFLD prediction were 81.1% and 84.5%, respectively.Conclusion
Our results demonstrated that urine RBP/creatinine ratio was an independent risk factor for NAFLD while the predictive model for NAFLD diagnosis is noninvasive with high sensitivity and specificity.4.
Background
Dysfibrinogenemia is a rare coagulation disorder caused by mutations in the fibrinogen gene that results in abnormal fibrinogen function. Dysfibrinogenemia has a wide spectrum of clinical manifestations including asymptomatic(55%), hemorrhage (25%), and thrombosis (20%).Methods
We reported a 30‐year‐old woman with 35 weeks gestation. She was misdiagnosed with hypofibrinogenemia in a local hospital, and then she was treated with fibrinogen concentrate. However, she was diagnosed as dysfibrinogenemia in our hospital base on her low function fibrinogen level (0.55 g/L) and her normal immunologic fibrinogen level (3.80 g/L). This patient had neither bleeding symptom nor thromboembolic event. Her obstetrical history included one normal pregnancy in 2008 with uneventful full‐term delivery.Results
Multidisciplinary experts suggested that there should be no specific intervention in this case because of the patient had no previous episodes of abnormal bleeding or thrombotic. She had an uneventful delivery with no abnormal bleeding symptom or thromboembolic.Conclusion
Dysfibrinogenemia patients without personal or family history of bleeding and thromboembolic events, do not need specific therapeutic intervention.5.
Background
The Moreau score is essential for the diagnosis of B‐cell lymphoproliferative disorders (B‐LPD).Methods
We assessed the consistency of the Moreau score in a series of 138 patients with at least two samples involved by a B‐LPD (316 samples) other than germinal center‐derived malignancies, hairy cell leukemia, and mantle cell lymphomas. Patients with evidence of two distinct B‐LPDs were also excluded.Results
We found 53 inconsistencies in 44 of 138 (32%) patients. FMC7 was the most inconsistent (18 cases) and CD5 the least (5 cases). CD200 was inconsistent in 6 of 67 (9%) cases. The most important predictive factor for the finding of antigenic inconsistencies was sampling of a different anatomic site. Other factors, including number of samples, time between samples, or cytogenetic group, were not predictive. For the most part, these inconsistencies did not appear to be clinically relevant.Conclusion
Inconsistencies in the Moreau score are common, supporting the importance of integrated laboratory diagnosis. However, the practical implications of these antigenic inconsistencies are probably limited.6.
Purpose
Endothelial damages are one of the most important causes of persistent hypertensive complications. The aim of our study was to discuss the relationship between the molecular markers of endothelial damage, thrombomodulin, and complications in hypertension.Methods
A total 132 cases of hypertensive patients, including 13 patients with damage of target organs, were selected as research subjects. And grouping was based on different levels of blood pressure. The blood pressure and thrombomodulin levels were detected among all cases, and their drinking, smoking, and other medical records were tracked.Results
Higher plasma concentration of thrombomodulin was demonstrated in subjects with hypertensive complications compared with without complications [24.5 (18.1,37.55) vs 12.1 (9.1,22.3) TU/mL, P = .001, respectively]. The optimum thrombomodulin cutoff value was determined to be more than 15.5 TU/mL, with a sensitivity of 92.3% and a specificity of 63%. With the increase in blood pressure level, thrombomodulin levels in three groups gradually raised [6.15(5.475,12.75) vs 9.75(7.725,13.35) vs 16.45 (10.125,23.725) TU/mL, P = .007, respectively].Conclusion
With the increase in blood pressure and the occurrence of complications, thrombomodulin showed an increasing trend, which was caused by an increase in the degree of endothelial injury. So, thrombomodulin may serve as a clinically meaningful marker of the progression of hypertension.7.
Background
Cellular and brain metabolism of dopamine can be correlated with a number of neurodegenerative disorders, our study was to explore a simple and efficient method to detect dopamine in real samples.Methods
A new quantum dots (CdTe QDs) could be prepared using the hydrothermal method, the electrochemical biosensor was established by dropping CdTe QDs on the surface of glassy carbon electrode (GCE).Results
The CdTe QDs/GCE exhibited the excellent electrochemical catalytic activity toward dopamine (DA) with good stability and high sensitivity in presence of interfering substances. The detection limit of DA was calculated by differential pulse voltammetry (DPV) as low as 0.3 μmol L−1 with a linear dynamic range of 1 μmol L−1 to 400 μmol L−1.Conclusion
In this paper, the proposed electrochemical biosensor could be effectively used for the direct and rapid detection of DA in human serum and urine samples.8.
Background
Spontaneous bacterial peritonitis (SBP) is frequently occurring infection among patients with liver cirrhosis, defined by polymorphonuclear (PMN) leukocytic count ≥250 cell/mm3 with or without a positive ascitic fluid (AF) bacterial culture . So, this study aimed to investigate the diagnostic value of flow cytometry versus manual counting of ascitic fluid PMNL in cirrhotic patients, with clinical suspicion of SBP.Methods
A hospital‐based cross‐sectional study was carried out on 320 cirrhotic patients with clinical suspicion of SBP . Abdominal paracentesis was performed in all cases for microscopic manual and flow cytometry counting of PMNL. Anti‐HLA‐DR, anti‐CD15, anti‐CD16, and anti‐CD45 monoclonal antibodies were used for flow cytometry method.Results
Flow cytometric PMNL count had 100% sensitivity and specificity, while manual PMNL count had a sensitivity of 65.52% and specificity of 90% with significant difference (P value < .05).Conclusion
Flow cytometry is more reliable rapid method for PMNL counting, than the manual method that is less accurate and time‐consuming in diagnosing clinically suspected SBP.9.
Background
Severe hypertriglyceridemia usually results from a combination of genetic and environmental factors and is most often attributable to mutations in the lipoprotein lipase (LPL) gene.Objectives
The aim of this study was to identify rare mutations in the LPL gene causing severe hypertriglyceridemia.Methods
A Chinese infant who presented classical features of severe hypertriglyceridemia recruited for DNA sequencing of the LPL gene. The pathogenicity grade of the variants was defined based on the prediction of pathogenicity using in silico prediction tools. Review some studies to understand the molecular mechanisms underlying the severe hypertriglyceridemia.Results
We identified a rare mutation in the LPL gene causing severe hypertriglyceridemia: a nucleotide substitution (c.836T>G) resulting in a leucine to arginine substitution at position 279 of the protein (p.Leu279Arg).The pathogenicity of the variant was predicted by in silico analysis using PolyPhen2 and SIFT prediction programs, which indicated that mutation p.Leu279Arg is probably harmful. We have also reviewed published studies concerning the molecular mechanisms underlying severe hypertriglyceridemia. A missense mutation in the 6 exon of the LPL gene is reportedly associated with LPL deficiency.Conclusions
We have here identified a rare pathogenic mutation in the LPL gene in a Chinese infant with severe hypertriglyceridemia.10.
Background
Many studies have revealed that transforming growth factor‐beta (TGF‐β) signals play important roles in maintaining normal status of articular cartilage in human osteoarthritis (OA). However, SMAD3 had inhibitory effect on TGF‐β‐induced chondrocyte maturation.Method
To evaluate the association of SMAD3 genetic variants with the risk of knee OA, we conducted this hospital‐based case‐control study involving 350 knee patients with OA and 400 controls in a Chinese population. Genotyping was performed using a custom‐by‐design 48‐Plex single‐nucleotide polymorphism (SNP) Scan™ Kit.Results
Our results indicate that the GG genotype of rs12901499 could decrease the risk of knee OA compared to AA genotype. However, stratified analyses by sex and age did not obtain positive findings with regard to the association between rs12901499 polymorphism and knee OA risk.Conclusion
In conclusion, SMAD3 rs12901499 polymorphism may be involved in the development of knee OA. Larger studies with more diverse ethnic populations are needed to confirm these results.11.
Background
Mycobacterium tuberculosis (MTB) causes tuberculosis (TB), which is a fatal disease. Cases of drug‐resistant MTB have increased in recent years. In this study, we analyzed 7 sites of MTB DNA sequences, including the rpoB and inhA gene, to investigate the relationship between gene mutations and drug resistance in MTB.Methods
Mycobacterium tuberculosis liquid culture samples (197 specimens from 74 cases) were collected between June 2015 and May 2016 and sequenced. The results were compared with those obtained from antibiotic susceptibility tests.Results
In 65 (87.8%) cases, the antibiotic‐resistant phenotype was consistent with genotyping results, whereas in 9 (12.2%) cases, there was no match. Eight mutations were detected in the rpoB gene, which showed the highest mutation rate. Sequencing results indicated that these mutations were present in 12 cases.Conclusion
Previously published data on antibiotic resistance genes are insufficient for effective prevention of multidrug‐ or extensive drug‐resistant TB. Additional studies are needed to characterize the complement of antibiotic resistance genes in MTB.12.
Background
Inflammation plays an important role in the initiation and progression of acute aortic dissection (AAD). New inflammatory indices derived from full cell blood count and its differential may be associated with increased risk. We evaluated platelet‐lymphocyte (PLR), red cell distribution width (RDW) and RDW/PLT's (platelets) (RPR) in AAD.Methods
We studied 120 consecutive patients with AAD type I admitted for emergency surgery (group I), 121 consecutive patients with aortic aneurysms of the ascending aorta prior to elective repair (group II) and 121 controls (group III), age and sex matched.Results
PLR was significantly higher in group I vs both groups II and III (P < .001). There was an excellent correlation of PLR with neutrophil/lymphocyte ratio (NLR) in all three groups (P < .001 for all). After adjustment for hemoglobin, RDW did not differ but RPR remained significantly higher in group I compared to groups II and III (P < .001). The best cutoff value of PLR to predict dissection was 159 with 53% sensitivity and 86% specificity. No association between PLR, RDW, and RPR and mortality in group I was found.Conclusions
Indices derived from full cell blood count may provide diagnostic information in patients with AAD; whether these indices may contribute to prognosis assessment should be further investigated.13.
Background
In this study, we aimed to identify a simple method for evaluating respiratory function using complete blood count parameters.Methods
The complete blood count parameters, including red blood cell (RBC) count, hemoglobin (Hb) level, lymphocyte (Lym) and platelet (Plt) count, and partial pressure of oxygen (PO2) level, were measured using automated analyzers in patients with chronic obstructive pulmonary disease (COPD), aged subjects, and young subjects (control group). The red cell index (RCI) was calculated using the following equation: (RBC × Hb)/(Lym × Plt); in theory, the RCI is inversely proportional to the respiratory function.Results
We observed a significant relationship between the RCI and PCO2 values, and between the RCI and FEV1/FVC values (P < .05). The RCI in the COPD, and aged subject groups were all significantly higher than that in the control group (P < .05). The cutoff value for normal respiratory function was 2.3. The positive rates for an abnormal increase in RCI were also considerably higher in each observation group than in the control group (P < .05).Conclusion
The RCI can be considered as a simple and effective tool for evaluating respiratory function.14.
Background
Biliary atresia (BA) is a neonatal disease characterized by chronic inflammation of the bile ducts and progressive aggravation of jaundice, but with a poor prognosis and high mortality. The etiology of BA is still uncertain which may be related to gene defect, virus infection, immune disorder, gene polymorphism. As a proinflammatory cytokine, VEGFA gene polymorphism (rs3025039) has been shown to be related to the pathogenesis of BA in Taiwanese population.Methods
We investigated the association between VEGFA gene polymorphism (rs3025039) and BA susceptibility using the largest case‐control cohort, totaling with 506 BA patients and 1473 healthy controls in a Southern Chinese Han population. VEGFA gene polymorphism (rs3025039) was genotyped using the MassARRAY iPLEX Gold system (Sequenom). Odds ratios (OR) and 95% confidence intervals (CIs) were used to access the association between the VEGFA gene polymorphism (rs3025039) and BA risk.Results
No significant association was found between the VEGFA gene polymorphism (rs3025039) and BA risk in the overall analysis.Conclusion
These results suggest that VEGFA gene polymorphism (rs3025039) may not be associated with the risk of BA in the Southern Chinese Han population.15.
Background
To improve the accuracy of the routine methods in laboratory medicine, ion chromatography with a simple sample treatment procedure, which can completely remove the proteins and/or organics in human serum, has been developed for the determination of serum cations.Methods
Chromatographic conditions for the separate and simultaneous determination of K, Na, Ca, and Mg were investigated. Furthermore, various factors influencing the mineralization of human serum, such as the selection and amount of oxidant, were also examined systematically and optimized.Results
The optimized experimental conditions are as follows: 1.0 mL of serum specimen digested with 2 mL nitric acid (120°C) followed by 2 mL hydrogen peroxide (80°C). The specimens were then redissolved and determined by ion chromatography under the optimum eluent concentration of 32 mmol/L methanesulfonic acids. The measurement accuracy and precision are less than 1.0% for all the analytes by analyzing NIST certified reference materials, IFCC‐RELA specimens and serum specimens. The results were also comparable with the reference values obtained by the inductively coupled plasma mass spectrometry (ICP‐MS), which were found to be in good agreement.Conclusions
Ion chromatography with a simple sample treatment procedure for the determination of cations in human serum with high sensitivity and specificity was developed. The proposed method could be recommended as a candidate reference method for the determination of serum cations.16.
Background
Study was performed in order: (i) to assess the comparability of glucose, bilirubin, hemoglobin, leukocyte esterase, and protein; (ii) to assess accuracy of glucose, bilirubin, hemoglobin, leukocyte esterase, and protein; and (iii) to evaluate interference of ascorbic acid on the glucose, bilirubin, hemoglobin, and nitrite determination using 2 different dipsticks: iChem Velocity, Iris Diagnostics and Combur‐10M, Roche Diagnostics.Methods
Random urine specimens were included in the study. Comparability, accuracy, and ascorbic acid interference testing were performed.Results
Obtained results have shown almost perfect agreement for all parameters between 2 dipsticks in samples with negative ascorbic acid. Agreement in samples with positive ascorbic acid was not acceptable for bilirubin, protein, nitrite, and hemoglobin. Accuracy was not acceptable for hemoglobin and leukocyte esterase on both dipsticks. Ascorbic acid interference examination has shown that intensity of interference differs between dipsticks. Ascorbic acid interferes with glucose, hemoglobin, nitrite, and bilirubin at different concentrations causing false‐negative results.Conclusion
Obtained results indicate that it is necessary to determine diagnostic accuracy of used dipstick in order to define purpose of urinalysis. It is very important to choose dipstick with ascorbic acid indicator and to examine ascorbic acid impact on dipstick analytes independently of manufacturer claims.17.
Objective
To explore the role of serum periostin in patients with aneurysmal subarachnoid hemorrhage (aSAH).Method
We conducted a retrospective study and 124 aSAH patients treated in Shenzhen People's hospital during March 1st 2015 to December 30th 2016 were included. Baseline information, neurological status and clinical outcome were recorded. Blood samples on admission were collected and enzyme linked immunosorbent assay (ELISA) kits were used to detect the serum level of periostin. Spearman's Correlation Analysis was used to analyze the correlation between periostin and clinical severity. Receiver operating characteristic (ROC) curve was performed to investigate variables’ prognostic value in patients with aSAH.Results
The average age of patients included was 57.23 years old. Preliminary analysis revealed that serum periostin was significantly correlated with clinical severity. Patients with poor outcome at 12 months had higher level of periostin than patients with good outcome. Multivariate logistic regression analysis showed elevated level of periostin was significantly associated with poor outcome and the AUC was 0.85 for periostin in predicting poor outcome of patient with aSAH.Conclusion
Elevated serum periostin concentrations are significantly associated with clinical severity and poor outcome of aSAH patients, which indicate serum periostin can be used as a prognostic biomarker in patients with aSAH.18.
Shivesh Prakash Shailesh Bihari Zhan Y. Lim Santosh Verghese Hemant Kulkarni Andrew D. Bersten 《Journal of clinical laboratory analysis》2018,32(6)
Background
We tested the hypothesis that the results of the same test performed on point‐of‐care blood gas analysis (BGA) machine and automatic analyzer (AA) machine in central laboratory have high degree of concordance in critical care patients and that the two test methods could be used interchangeably.Methods
We analyzed 9398 matched pairs of BGA and AA results, obtained from 1765 patients. Concentration pairs of the following analytes were assessed: hemoglobin, glucose, sodium, potassium, chloride, and bicarbonate. We determined the agreement using concordance correlation coefficient (CCC) and Bland‐Altman analysis. The difference in results was also assessed against the United States Clinical Laboratory Improvement Amendments (US‐CLIA) 88 rules. The test results were considered to be interchangeable if they were within the US‐CLIA variability criteria and would not alter the clinical management when compared to each other.Results
The median time interval between sampling for BGA and AA in each result pair was 5 minutes. The CCC values ranged from 0.89(95% CI 0.89‐0.90) for chloride to 0.98(95% CI 0.98‐0.99) for hemoglobin. The largest bias was for hemoglobin. The limits of agreement relative to bias were largest for sodium, with 3.4% of readings outside the US‐CLIA variation rule. The number of readings outside the US‐CLIA acceptable variation was highest for glucose (7.1%) followed by hemoglobin (5.9%) and chloride (5.2%).Conclusion
We conclude that there is moderate to substantial concordance between AA and BGA machines on tests performed in critically ill patients. However, the two tests methods cannot be used interchangeably, except for potassium.19.
Background
This study is a retrospective evaluation of patients who were subject to mixing study in our laboratory due to prolonged APTT. The preliminary diagnoses, clinical manifestations, and results of additional ordered tests were reviewed. The study aims to investigate whether repeating APTT test with a different assay prior to performing mixed study in patients with prolonged APTT would be a better alternative algorithmic approach in order to save both time and costs.Methods
We retrospectively evaluated 166 patients (65 females and 101 males) who were subject to mixing study due to isolated prolonged APTT. Additional ordered tests to identify the etiology and clinical findings were reviewed. All patients who had prolonged APTT as a result of testing with Hemosil Synthasil APTT reagent in ACL TOP analyzer were repeated with Stago Cephascreen APTT reagent in STA‐R coagulation analyzer.Results
APTT test was requested preoperatively in 72.2% of cases. Only 6.6% of the cases had history of bleeding. Correction with mixing study was achieved in 122 (73.5%) cases, among which 75 (45%) cases were found to have APTT test results within reference range when tested with Cephascreen reagent. In 44 (26.5%) cases, mixing study did not result in correction. Only 4 cases were confirmed to have lupus anticoagulants (LA), while 4 cases were diagnosed with hemophilia with inhibitors.Conclusion
Prolonged APTT results should always be retested using a different assay prior to mixing study. The clinician and the laboratory specialist should collaborate at the postanalytical phase.20.