Objective:To investigate the significance and value of peripheral blood lymphocyte subset characteristics in patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT) for distinguishing cytomegalovirus (CMV) infection.Methods:This retrospective study gathered data from allo-HSCT patients treated at Beijing Ludaopei Hospital between May 2021 and January 2023. This study included 50 patients in the CMV infection group and 47 patients in the non-CMV infection group. Flow cytometry was used to detect peripheral blood lymphocyte subsets 1 month after the allo-HSCT. The absolute lymphocyte count and their subsets were analyzed to assess their predictive significance in the occurrence of CMV infection. Mamn-whiney U test and χ 2 test were used. Indicators with statistical significance in univariate analysis were further subjected to binary logistic regression analysis and receiver operating characteristic (ROC) curves construction. The generation of survival curves for different outcomes was conducted using the Kaplan-Meier method, and the Log-rank test was applied. A two-sided P-value of<0.05 was considered statistically significant. Results:1. Among patients in the CMV infection group, 22% (11/50) were diagnosed with CMV viremia combined with CMV disease. The maximum CMV viral load in peripheral whole blood in these patients was 1 600 (1 400, 5 800) copies/ml, which was significantly higher than that in patients without confirmed CMV disease 970 (670, 2 300) copies/ml, with a statistically significant difference ( Z=-2.281, P=0.029). 2. The overall survival (OS) at the follow-up endpoint was 80% (40/50) in the CMV infection group and 87.2% (41/47) in the non-CMV infection group. There was no statistically significant difference in OS between the two groups at the follow-up endpoint ( χ2=0.231, P=0.630). 3. In the binary logistic regression model, the number of CD34 cells transfused into the patient, the percentage of CD3+CD38+T cells in CD3+T cells, and the percentage of CD4+CD38+T cells in CD4+lymphocytes were identified as important independent risk factors for infection. The ROC curve analysis demonstrated that the area under the curve (AUC) for these independent risk factors of CMV infection was 0.914 (>0.7, P<0.001), with a decision value of 0.702, a sensitivity of 0.857, and a specificity of 0.844. Conclusion:Followingallo-HSCT, the immune subsets in the CMV infection group exhibited a diminished proportion of T cells and CD4+T cells in comparison to the non-CMV infection group. In terms of T cell differentiation, there was an increase in TEM cells and a decrease in Naive T cells. Additionally, the expression level of the activation marker CD38 on T cells exhibited a high degree of predictive value for the occurrence of CMV infection. Understanding the immune characteristics of post-transplant CMV-infected patients is beneficial for the analysis of their immune reconstitution status, providing valuable insights for clinicians in the diagnosis and treatment of CMV infection after transplantation.
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, and immunotherapy has become a relatively common treatment for NSCLC. The use of biomarkers to screen out people with high benefit from immunotherapy could help to timely grasp the therapeutic information of NSCLC patients and meet the current challenges faced by immunotherapy. Compared with traditional markers such as programmed death-ligand protein 1(PD-L1) expression fraction, circulating biomarkers have the characteristics of non-invasion, convenient collection of materials, and dynamically evaluating the prognosis of patients and observing the efficacy of immunotherapy in the process of immunotherapy, which has a broad application prospect.
Objective:We conducted a real-world multi-center clinical study with a large sample size to comprehensively evaluate the performance of three commercial hepatitis C virus (HCV) core antigen assays. The study aimed to evaluate the performance for their use in HCV infection screening, and to provide clues for further improving the sensitivity and specificity of the assays.Methods:Key performance indicators including the lower limit of detection (LOD), diagnostic sensitivity, and specificity of three HCV antigen assays (the Architect, Laibo, and ChemClin HCV core antigen assays) were evaluated using commercial seroconversion panels reflecting early HCV infection and clinical routine serum samples of outpatients and inpatients from 3 tertiary hospitals from January 2018 to April 2022. Factors that affect the performance indicators were further investigated.Results:The window period for detecting HCV infection with the three antigen assays was equal to or slightly longer than that of the RNA assay, but all are shorter than that of the anti-HCV assay. There was a good linear positive correlation between HCV core antigen and HCV RNA levels in treatment naive patients with hepatitis C ( r=0.90, P<0.01). For the most common genotype 1b strain in China, the LOD of the three HCV assays were equivalent to 531 IU/ml (Architect), 3,698 IU/mL (Laibo), and 4,624 IU/mL (ChemClin) HCV RNA, respectively. Due to the skewed distribution of HCV RNA levels in treatment-naive hepatitis C patients, more than 95% of the patients had viral loads higher than 6 166 IU/ml. Therefore, the three HCV antigens assays still maintained a satisfactory diagnostic sensitivity (94.33%-99.40%). Among 54 immunodeficient patients (leukemia patients) with HCV infection, 9% (5/54) had negative anti-HCV results, while the HCV antigen assays found all these infectors. Through further experiments, we revealed the amino acid polymorphism in the core region of genotype 3 strain impaired the sensitivity of all three HCV antigen assays. In addition, the sensitivity of the two domestic assays was impaired by anti-HCV antibodies in the serum. The specificity of HCV antigen assays for diagnosing hepatitis C is 99.94% to 99.98%. The rheumatoid factors, autoantibodies, and other unknown interference substances can lead to a small number of low level, "false positive" antigen results. Conclusions:HCV core antigen assay may be used as a satisfactory approach of infection screening, especially for the immunodeficient patents. However, the sensitivity and specificity of the assays are influenced by multiple factors, which should be further improved.
Objective:Application study of outcome-based education teaching model in practice teaching Of clinical medical laboratory.Methods:According to the teaching model, A total of 60 interns from the First Affiliated Hospital of the University of South China from June 2021 to May 2022 were selected as the research objects and they were randomly number table method divided into two groups, the traditional teaching group is 30 cases and the OBE group is 30 cases.The Self-regulated Learning Effectiveness Evaluation Scale is used to evaluate the effectiveness of self-regulated learning. The assessment scores (skill operation, case analysis, clinical communication, exit examination,each 50 points) and teaching model satisfaction were compared between the two groups.Results:The results of the two groups were compared to find out the score of the examination ( P>0.05).After practice, the OBE group was significantly better than the traditional teaching group in skill operation test, morphological recognition test, case analysis test aspects ( P<0.05). According to the evaluation of students′ independent learning effectiveness, it can be seen that the OBE group has independent learning ability, self-confidence, ability to acquire knowledge, and logical thinking ability etc. The OBE group scored higher than the traditional teaching group ( P<0.05). There was no significant significance in teachers′ teaching enthusiasm effect score ( P>0.05). Scoring teaching content, teaching difficulties, teaching design, teaching satisfaction etc, the OBE group was significantly higher than the traditional teaching group ( P<0.05). Conclusion:Application study of outcome-based education teaching model in practice teaching of clinical medical laboratory. It can effectively improve the clinical practice and clinical communication ability of students, so as to more effectively improve the social adaptability and post competence of clinical medical laboratory graduates.
Objective:To investigate the clinical and molecular features of patients with CD7 +relapsed or refractory acute myeloid leukemia(r/rAML)and the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods:172 r/rAML patients who underwent allo-HSCT in department of hematology, Aerospace Center Hospital between January 1st 2017 and December 31st 2020 were retrospectively analyzed The patients were were divided into CD7 + group( n=75) and CD7 - group( n=97) according to the expression CD7 in the initial immunophenotype. Mann-Whitney U and Chi-square test were used to compare the clinical data, molecular and cytogenetic characteristics of the two groups of patients. Kaplan-Meier method was used to analyze the median progression-free survival (PFS) and median overall survival (OS) of the two groups of patients, and Cox regression screenthe prognostic factors of the patients. Results:The median follow-up time was 19 months. The recurrence rates were 23.71% and 50.67%, respectively in CD7 - and CD7 + group (χ 2=13.428 P<0.001). In relapsed patients, 86.96 percentage of CD7 - group did not express CD7 while 86.84 percentage of CD7 + group expressed CD7. The median PFS was 25 and 5 months in CD7 - and CD7 + group (χ 2=8.695, P=0.003), and the medianOS was 34 and 15 months in CD7 - and CD7 + group (χ 2=2.579, P=0.108). Univariate analysis showed that the CD7 +group, had the lower rates of morphological remission (χ 2=10.014, P=0.002), molecular remission (χ 2=22.809, P<0.001), and more male patients (χ 2=5.281, P=0.022). The incidence of CEBPA double-site mutation was higher (23.4% vs 8.2%, χ 2=8.180, P=0.004) and the rearrangement of RUNX1::RUNX1T1 was lower(4.0% vs18.6%, χ 2=8.362, P=0.004)in CD7 +group than in CD7 -group. Multivariate analysis showed that pre-transplant tumor load was the only prognostic factor for PFS (HR, 1.600; 95% CI, 1.203 to 2.127; P=0.001) and OS (HR, 1.737; 95% CI, 1.273 to 2.369; P<0.001) in r/r AML patients. Conclusion:CD7 expression is a risk factor for poor prognosis in r/r AML patients, and CD7 expression is stable after relapse. Positive CD7 can be used as a target for immune targeted therapy.
Heart failure with preserved ejection fraction (HFpEF)is a heterogeneous disease, and as a systemic syndrome, it presents different clinical course and prognosis. Currently, HF is not effective in its treatment. For the diagnosis and treatment of HFpEF, at present and in the future, should we focus more on the biomarkers involving the "crosstalk" between organs such as heart-liver-lung-kidney, based on the good application of existing commonly used markers, such as high-sensitivity troponin and BNP/NT-proBNP.
Objective:This study aimed to investigate the predictive value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) trajectory on future major adverse cardiovascular events (MACE) in patients with stable coronary artery disease (SCAD) after percutaneous coronary intervention (PCI).Methods:A retrospective cohort study was conducted on SCAD patients admitted to the Department of Cardiology at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from January 2013 to December 2021. A total of 828 subjects were enrolled, comprising 592 males and 236 females, with an average age of (66.44±11.71) years. SCAD patients post-percutaneous coronary intervention (PCI) were stratified into three NT-proBNP trajectory groups: T1 Low-Low (219 cases), T2 Medium-Low (363 cases), and T3 High-High (246 cases). The median follow-up time was 2.1 years, and the maximum follow-up time was 9 years. The primary clinical endpoint event was MACE. The NT-proBNP concentration in patients′ serum was measured using enzyme-linked fluorescent assay, and different trajectory groups were determined using latent class trajectory modeling. The association between NT-proBNP trajectory and occurrence of MACE in SCAD patients was evaluated using Kaplan-Meier survival curves and multivariable Cox proportional hazards regression models.Results:A total of 67 (8.1%) major adverse cardiovascular events occurred, including 43 cases (5.2%) of all-cause mortality, 13 cases (1.6%) of heart failure death, 9 cases (1.1%) of non-fatal myocardial infarction, and 15 cases (1.8%) of non-fatal stroke. Kaplan-Meier survival curve analysis showed significant differences in survival rates among T1, T2, and T3 groups of SCAD patients for MACE, all-cause mortality, and heart failure death (all P<0.001). In the multivariable Cox regression analysis, the risk of MACE occurrence for patients in the T2 group and T3 group was 1.708 times (95% CI 0.72-4.05) and 3.842 times (95% CI 1.625-9.081) compared to the T1 group, respectively. Moreover, a statistically significant linear trend was observed for the risk of MACE occurrence across trajectory groups ( P<0.001). Conclusions:NT-proBNP trajectory groups after PCI in SCAD patients are strongly associated with the risk of MACE occurrence and can serve as an independent predictor for MACE. Dynamic monitoring of NT-proBNP during follow-up to obtain longitudinal trajectories helps identify high-risk SCAD patients and implement timely effective intervention measures.
Objective:To investigate the relationship between peripheral blood sST2 level and prognosis in patients with heart failure (HFpEF) complicated with hypertension with ejection fraction preservation.Methods:A total of 122 patients with HFpEF hospitalized in Teda International Cardiovascular Hospital and Baoding First Central Hospital from May 5, 2021 to March 9, 2023 were selected. According to whether they were combined with hypertension, they were divided into HFpEF combined with hypertension group (73 cases, 32 males, (67.56±12.06) years old). There were 41 females (70.61±9.95 years old) and 49 males (67.00±11.64 years old) in the HFpEF group alone. There were 24 female patients (70.12±7.49 years old). sST2 levels in peripheral blood were compared between the two groups.HFpEF patients with hypertension were grouped by hypertension grade and prognosis, and the difference of sST2 in different groups was compared. Logistic regression was used for multivariate analysis. ROC curve to evaluate the diagnostic value of sST2 in the poor prognosis of HFpEF patients with hypertension. Patients were followed up regularly and major adverse cardiac events were recorded within 6 months after discharge, including cardiogenic death and heart failure re-hospitalization. The critical value of poor prognosis diagnosed by sST2 was divided into two groups, survival analysis was performed by Kaplan-Meier,and the Log Rank test was performed. Cox regression analysis was performed to determine whether high levels of sST2 were a risk factor for poor prognosis after 6 months of follow-up.Results:There was no significant difference in sST2 in HFpEF combined with hypertension and HFpEF alone ( P>0.05). sST2 was higher in grade 2 and 3 than in grade 1 hypertension (23.83 ng/ml vs. 12.68 ng/ml, Z=-2.778, P=0.005; 22.54 ng/ml vs. 12.68 ng/ml, Z=-2.865, P=0.004); BNP was higher in grade 3 hypertension than in grade 1 hypertension (582.95 pg/ml vs. 154.50 pg/ml, Z=-2.101, P<0.05). sST2 and BNP were higher in the poor prognosis group than in the good prognosis group (30.10 ng/ml vs. 18.95 ng/ml, Z=-2.803; 685.00 pg/ml vs. 347.50 pg/ml, Z=-2.385), all P<0.05. Logistic regression analysis showed that sST2 was a risk factor for poor prognosis ( OR=1.045, P=0.013). The auxiliary diagnostic value of sST2 level in HFpEF patients with hypertension was analyzed by ROC curve (AUC was 0.721, P<0.05). The incidence of cardiac adverse events in sST2>29.12 group was higher than that in sST2≤29.12 group (44.00% vs. 14.58%), and the difference was statistically significant (χ 2=7.657, P=0.006). Kaplan-Meier survival analysis showed that the percentage of patients with no endpoint event in the sST2≤29.12 group was higher than that in the sST2>29.12 group ( P=0.003).Cox regression analysis showed that the risk of endpoint event in sST2>29.12 group was 3.879 times that in sST2≤29.12 group ( OR=3.879, P=0.011). Conclusions:sST2 level can be used as an indicator of poor prognosis in HFpEF patients with hypertension, and can be used to stratify the risk of HFpEF patients. High levels of sST2 are associated with major adverse cardiac events.
Objective:To investigate the influence of DTAS gene mutations (DNMT3A, TET2, ASXL1, SRSF2) on survival of newly diagnosed acute myeloid leukemia (AML) patients.Methods:A retrospective analysis of 163 patients with next-generation sequencing(NGS)data in the hematology Department of Affiliated Hospital of Xuzhou Medical University from January 1, 2018 to October 31, 2021 was performed. Clinical data of patients were collected and analyzed including patient′s height, weight, gender, age, bone marrowblast ratio, induction chemotherapy regimen, transplantation or not, complete blood count, etc. There were 88 males and 75 females with a median age of 48 (4-81) years. According to the next-generation sequencing data, patients with any mutation of the above four genes were divided into the DTAS gene mutation group, and vice versa, they were divides into non-DTAS gene mutation group.The Kaplan-Meier method and Cox proportional risk model were used to analyze survival and prognosis.Results:Among 163 patients, DTAS gene mutation was detected in 50 patients (30.7%), and not in 113patients(69.3%). Among the 50 patients with DTAS genemutations, 8 cases(16%) had≥2 mutations and 42 cases(84%) had any gene mutation in DTAS. In the DTAS gene mutation group, the patients were older, the stratification of the European leukemia network(ELN) was poor, the duration of remission was shorter, the proportion of sever myelosuppression degree was higher (61.8% vs 34.8%) at day28 after induction chemotherapy, and the lymphocyte-monocyte ratio was lower than that of the healthy control group when CR was reached after treatment.The results of K-M survival analysis showed that the overall survival(OS)time ( P=0.003) and event-free survival(EFS) ( P=0.008) time of the DTAS gene mutant were significantly shorter than those of the non-DTAS gene mutated group.The medianOS timein theh DTAS gene mutations was significantly shorter than that in the non-DTAS gene mutated group ( P=0.003, HR=2.041) [21(95% CI 16.63-25.37) months vs 43 (95% CI 33.01-52.99) months].The results of multivariate COX analysis revealed that DTAS gene mutations was an independent risk facror forOS time(HR=2.041, 95% CI: 1.285-3.244, P=0.003) in AML patients. Conclusion:DTAS gene mutation does not affect the hematopoietic recovery time after induction chemotherapy, but the duration of remission is shorter in the DTAS gene mutations group. DTAS gene mutations indicate a poor prognosis, which is an independent risk factor for OS.
Objective:To analyze the correlation between clinical features and prognosis or prognostic risk factors in patients with KMT2A::AFF1 gene positive B-ALL.Methods:Retrospective cohort study was conducted. 167 cases of B-ALL admitted to the Shanghai General Hospital and the Naval Medical University Affiliated First Hospital from April 1, 2011 to July 31, 2022 were divided into groups according to gene types. 22 cases with KMT2A::AFF1 positive B-ALL were enrolled as the experimental group, 54 cases with BCR::ABL gene positive B-ALL as control group 1 and 91 cases with KMT2A::AFF1 and BCR::ABL gene negative B-All as control group 2. The median age of first diagnosis in the experimental group, control group 1 and control group 2 were 43.5(30.5, 56), 43.5(34, 55) and 32(24, 46) respectively. The median white blood cell counts of the three groups were 142.4(25.7, 247.2)×10 9/L, 37.6(15.7, 102.2)×10 9/L and 13.4(4.3, 33.0)×10 9/L, respectively. Allo-HSCT rates in three groups were 45.5%, 72.2% and 72.5% respectively. Using SPSS 26.0 software, the statistical methods of nonparametric rank sum test, chi-square test, Kaplan-Meier and Cox regression were used to analyze and compare the differences in clinical characteristics, chemotherapy and prognosis between the experimental group and the control groups, and to analyze the risk factors and the differences in prognosis of allo-HSCT in the experimental group. Results:The age difference between the experimental group and the control group 2 was significant ( Z=-2.151, P=0.031). The white blood cell count in experimental group was significantly higher than that in control group 1 ( Z=-2.363, P=0.018) and control group 2 ( Z=-4.886, P<0.001). The rate of allo-HSCT in experimental group was lower than that in control group 1(45.5% vs 72.2%, χ 2=4.890, P=0.027) and control group 2 (45.5% vs 72.5%, χ 2=5.897, P=0.015). The remission rates of the patients in three groups after receiving one course of chemotherapy were 60%(12/20), 83.3%(45/54) and 76.6%(69/90); the remission rates after two courses of chemotherapy were 25%(5/20), 7.4%(4/54) and 12.2% (11/90), and the non-remission rates of more than two courses of treatment were 15%(3/20), 9.3%(5/54) and 11.1%(10/90), respectively. The effect of chemotherapy in experimental group was worse than that in control group 1 ( Z=-1.979, P=0.048). There was no significant difference between the three groups in sex, whether the chromosome is a standard-risk karyotype, hemoglobin at the time of initial onset, platelet count and percentage of bone marrow blast cells. The overall survival rate (OS) of experimental group was significantly lower than that of control group 1 and control group 2(23.9% vs 36.7%, χ 2=7.608, P=0.006 and 23.9% vs. 44.8%, χ 2=6.442, P=0.011), and the 3-year recurrence-free survival (RFS) was also lower than that of the other two groups (14.0% vs 57.6%, χ 2=17.823, P<0.001 and 14.0% vs 48.2%, χ 2=16.432, P<0.001). There was a significant difference in the total OS rate between the experimental group and the group without allo-HSCT (45.0% vs 9.2%, χ 2=15.254, P<0.001). Univariate analysis showed that age was the risk factor of RFS in the experimental group, and allo-HSCT therapy was the protective factor of OS. Multivariate analysis showed that allo-HSCT was an independent protective factor for OS in the experimental group. Conclusions:Patients with KMT2A::AFF1 positive B-ALL had higher white blood cells, less sensitivity to chemotherapy and poor prognosis. Age was a risk factor of RFS in KMT2A::AFF1 positive B-ALL, and allo-HSCT could improve the prognosis.
Myocardial remodeling is one of the major pathogenic mechanisms in chronic heart failure, and myocardial fibrosis plays an important role in myocardial remodeling. Myocardial fibrosis is mainly due to the synthesis exceeding degradation of collagen, resulting in the accumulation of collagen. The metabolites produced during the dynamic transformation of collagen synthesis and degradation can indirectly reflect myocardial fibrosis. Due to the complexity of collagen metabolism and the large number of intermediate products, it has not been widely used as a biomarker in clinical practice. We briefly reviewed the process of collagen metabolism and its products, and focused on the clinical value of collagen metabolites (PICP, PIIINP, and MMP) in the diagnosis, risk stratification, and prognostic assessment of heart failure. It provides a reference basis for the wide application of collagen-related biomarkers in heart failure in the future.
The value of peripheral blood cellular immune function detection has received clinical attention in screening beneficiaries of solid tumor immunotherapy, monitoring immune-related adverse events (irAE), and evaluating tumor efficacy and prognosis. In order to assist in the effective selection and interpretation of peripheral blood cellular immune function indicators to further optimize the diagnosis and treatment of solid tumors, the Laboratory Medicine Society of Chinese Medical Association, the Laboratory Medicine Specialist (Technician) Branch of Beijing Medical Doctor Association, the National Cancer Center/National Cancer Regional Medical Center and the National Clinical Research Center of Laboratory Medicine (The First Hospital of China Medical University)organized several well-known experts in relevant fields. The clinical application value of peripheral blood cellular immune function, including deep phenotyping of T-lymphocyte subpopulations, myeloid-derived suppressor cells (MDSC) and cytokines, were fully discussed, and the expert consensus was written. Meanwhile, recommendations and reference directions have been given for laboratory detection indicators and protocols or methods of peripheral blood cellular immune function, aiming to provide help for precise diagnosis and treatment of solid tumor patients.
The arrival of the era of precision medicine has opened a new diagnosis and treatment model for heart failure (HF), and the development of various omics technologies has also promoted the research and clinical application of HF precision phenotype. HF patients are affected by many factors such as gender, age, height, weight, drugs, valvular disease, etc. At the same time, its disease course is long and complex, and different HF types and stages also affect the treatment and prognosis of patients. Therefore, a variety of new biomarkers are urgently needed in clinic to meet the needs of individualized HF diagnosis and treatment. With the latest advances in epigenetics, proteomics, metabolomics and microbiology, it provides a beneficial complementary effect of "addition" for the study of HF individual heterogeneity. The existing application problems and limitations of various types of markers are discussed. For the future, the integration of all personalized omics data offers unlimited potential for precision medicine in patients with HF.
Objective:To investigate the association between CITP/MMP-1 ratio and the severity of Myocardial fibrosis (MF) in patients with Chronic Heart failure (CHF) and its diagnostic and prognostic value in patients with MF.Methods:A retrospective study was conducted to select 110 cases [86 males, (56.60±11.15) years old;24 females, (60.06±12.02) years old] who were hospitalized in the Department of Cardiology, Teda International Cardiovascular Hospital from May 18, 2021 to February 30, 2022 and underwent magnetic magnetic examination. Serum CITP and MMP-1 were detected by enzyme-linked immunoassay and CITP/MMP-1 ratio was calculated. Plasma brain natriuretic peptide (BNP) was detected by automatic chemiluminescence analyzer. Anova and non-parametric test were used to compare the difference of indexes among all groups. Spearman analysis was used to analyze the correlation between serum collagen metabolites and the severity of myocardial fibrosis. Logistic regression analysis was performed for multivariate analysis, and ROC curve was used to evaluate the auxiliary diagnostic value of related indexes. Major adverse cardiac events within 1 year after discharge were recorded, including cardiogenic death, HF rehospitalization, malignant arrhythmia, and myocardial infarction. The risk factors of poor prognosis were analyzed by Cox regression. Patients were divided by the median value of CITP/MMP-1 ratio or the median value of CITP/MMP-1 ratio and BNP. Survival analysis was performed by Kaplan-Meier and Log Rank test was performed.Results:Serum MMP-1 and BNP in LGE (+) group were higher than those in LGE (-) group (1.79 ng/ml > 0.91 ng/ml, Z=-2.924; 503 pg/ml > 367 pg/ml, Z=-1.932; P<0.05); The CITP/MMP-1 ratio in the LGE (+) group was lower than that in the LGE (-) group (3.84 < 10.85, Z=-3.601, P<0.001). MMP-1 in CHF with arrhythmia group was higher than that in CHF group (1.98 ng/ml > 1.25 ng/ml, Z=-2.016), while CITP/MMP-1 ratio was lower than that in CHF group (3.25 < 5.73, Z=-2.751), all P<0.05. CITP/MMP-1 ratio in CHF patients was negatively correlated with the severity of MF ( r=-0.363, P<0.001), and BNP and MMP-1 were positively correlated with the severity of MF ( r=0.267, r=0.264, P<0.05). Serum BNP was positively correlated with collagen metabolite MMP-1 and negatively correlated with CITP/MMP-1 ratio (all P<0.05). Logistic multivariate regression analysis showed that only CITP/MMP-1 was a predictor of myocardial fibrosis, with an OR value of 0.624 ( P=0.005). ROC curve was used to evaluate serum BNP, MMP-1 and CITP/MMP-1 ratio in the diagnosis of myocardial fibrosis in HF patients, with AUC of 0.653, 0.696 and 0.754, respectively. The accuracy of CITP/MMP-1 ratio in diagnosing fibrosis was better than that of BNP by comparing their AUC, and the difference was statistically significant ( Z=-3.808, P<0.001). Cox regression analysis showed that CITP/MMP-1 ≤3.84 was a risk factor for poor prognosis, OR=2.647 ( P=0.009). Kaplan-Meier survival analysis at 1-year follow-up showed that the survival rate of the group with lower CITP/MMP-1 ratio was significantly lower than that of the group with higher CITP/MMP-1 ratio ( P=0.014). The survival rate of CITP/MMP-1 increased and BNP decreased group was higher than that of CITP/MMP-1 decreased and BNP increased group ( P=0.011). Conclusions:The ratio of CITP/MMP-1 can be used as a negative correlation indicator of the degree of cross-linking, which is better than BNP in the evaluation of MF, and has a good auxiliary diagnostic value for myocardial fibrosis in patients with chronic heart failure, and is expected to become a protective indicator for patients with chronic heart failure and be used in clinical evaluation of myocardial fibrosis. CITP/MMP-1 ratio is associated with the incidence of major adverse cardiac events, and CITP/MMP-1 ≤3.84 can be used as a predictor of prognostic adverse cardiovascular events in CHF patients.
Objective:To investigate the application of serum creatinine to prealbumin ratio (Scr/PA) in the diagnosis of patients with heart failure complicated with renal failure.Methods:This was a case-control study. Patients with chronic heart failure and heart failure complicated with renal failure admitted to Dalian Central Hospital from January 5, 2020 to April 23, 2023 were retrospectively analyzed, and Scr/PA was calculated. The general data and laboratory examination indexes of the two groups were compared. According to the data type, t test, Wilcoxon rank sum test and χ 2 test were used for comparison between the two groups. The risk factors of heart failure complicated with renal failure were analyzed by univariate and multivariate logistic regression analysis, and Spearman correlation analysis was used to analyze the correlation between Scr/PA and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and hemoglobin (HGB). ROC curve was used to determine the predictive value of Scr/PA and NT-proBNP for heart failure complicated with renal failure. Results:Compared with the heart failure group, Triglyceride [1.25 (0.94, 1.81) mmol/L vs. 1.07 (0.76, 1.46) mmol/L, Z=-2.159, P=0.031], D-dimer [2.30 (1.53, 4.67) mg/L vs. 1.63 (0.64, 2.96) mg/L, Z=-2.339, P=0.02],NT-proBNP [18 500 (9 575, 30 000) pg/ml vs. 4 865 (1 600, 9 800) pg/ml, Z=-5.637, P<0.001], Scr/PA [0.233 (0.188, 0.351) mg/mg vs 0.064 (0.044, 0.103) mg/mg, Z=-8.197, P<0.001] were higher in heart failure complicated with renal failure group. While albumin [(33.9±5.2) g/L vs. (36.3±4.3) g/L, t=-2.173, P=0.008], estimated glomerular filtration rate[12.86 (7.88, 17.40) ml/(1 min×1.73 m 2) vs. 65.82 (48.66, 86.32) ml/(1 min×1.73 m 2), Z=-9.794, P<0.001], and HGB [(91±24) g/L vs. (123±23) g/L, t=-7.489, P<0.001] were lower. Univariate logistic regression analysis showed that albumin ( OR=0.900, 95% CI 0.830-0.975, P=0.010), HGB ( OR=0.948, 95% CI 0.930-0.966, P<0.001), Scr/PA ( OR=1.639, 95% CI 1.346-1.957, P<0.001) were associated with heart failure complicated with renal failure. Multivariate logistic regression analysis showed that only Scr/PA was an independent risk factor for heart failure complicated with renal failure. The correlation coefficients of Scr/PA with NT-proBNP and HGB were r=0.578 and r=-0.559, respectively (all P<0.001). The area under the AUC curve of Scr/PA and NT-proBNP for predicting heart failure complicated with renal failure was 0.927 (95% CI: 0.881-0.973, P<0.001) and 0.797 (95% CI: 0.717-0.877, P<0.001), respectively. Conclusions:Scr/PA is an independent risk factor for heart failure complicated with renal failure, and it has a good correlation with NT-proBNP and HGB. Scr/PA is superior to NT-proBNP in predicting heart failure complicated with renal failure.
Hypervirulent Klebsiella pneumoniae (hvKP) exhibits a higher propensity for causing severe invasive and disseminated infections compared to classical K. pneumoniae (cKP). Initially reported in East Asia, hvKP infections have rapidly spread worldwide, and certain hvKP isolates have acquired broad drug resistance. The convergence of hypervirulence and multi-drug resistance in K. pneumoniae has emerged as a global public health concern. However, at the time of writing, there lacks a unified standard for the detection procedure and identification method of hvKP. To facilitate the clinical screening, identification, epidemiology, and clinical characteristics studies on this important pathogen, a consensus was reached among domestic experts in the field after extensive reviews. A standardized guideline for identification and differentiation of hvKP infections has been proposed.
The indirect immunofluorescence assay (IFA) is a reference method for detecting antinuclear antibodies (ANA). However, the insufficient standardization of the detection process and the poor consistency of test result reporting are the main challenges faced by clinical laboratories. With the release of ANA patterns nomenclature by the International Consensus on ANA Patterns, the gradual shifting from manual operations to automatic ANA detecting devices and the clinical application of computer-aided diagnosis systems, the clinical laboratories are facing new challenges on the standardized detection and accurate test report. This consensus elaborates and puts forward corresponding opinions of three aspects including before IFA test implementing, examination phase and results report in order to further promote the normalization and standardization in testing and reporting ANA by HEp-2 IFA in China.
Objective:Based on the principle that the aggregation-induced emission (AIE) fluorescent probe 6PD-DPAN could bind and aggregate with bacteria, and the fluorescence intensity could reflect the quantity of bacteria, a new method for rapid, convenient, and accurate bacterial drug sensitivity testing was established, which provided a basis for rapid and accurate clinical drug use.Methods:This was a methodological evaluation study. A total of 107 clinical isolates were collected from Houjie Hospital of Dongguan City from January to December 2022, among which 46 isolates were used for the establishment of the new method, and 61 isolates were used for methodological validation. The minimum inhibitory concentration (MIC) determined by broth microdilution method was used as the gold standard, and three antibacterial drugs, gentamicin, levofloxacin, and cefotaxime, were used as experimental drugs. The AIE plate was incubated for 4 hours, and the fluorescence intensity was measured every half an hour to draw a fluorescence change curve. The MIC results were compared with the CLSI breakpoints to determine the bacteria as sensitive, intermediate, or resistant. To simplify the detection process, the ratio of fluorescence intensity at 4 hours(R) was calculated, and the ROC curve was used to analyze the efficacy of R in determining bacterial growth and establish its cutoff value. The new method was used to determine the MIC of 61 clinical isolates, with broth microdilution method as the gold standard. The basic consistency, categorical consistency, very major errors, and major errors of the new method were analyzed, and the consistency between the two methods was determined by the Kappa test.Results:ROC curve analysis of the R after 4 hours of culture: The cut-off value was 3.0, with both sensitivity and specificity for determining bacterial growth being 100%. The median (interquartile) R for bacterial growth inhibition was 11.1 (8.6, 14.4); the median R-value for bacterial growth was 1.1 (1.0, 1.2). Compared to the gold standard, the newly established method showed 100% (61/61) essential agreement in detecting MICs of 61 clinical isolates, with a categorical agreement of 96.7% (59/61). There were no very major or major errors, and the Kappa value was 0.94, indicating good consistency between the newly established method and the microbroth dilution method.Conclusions:This study successfully established a new method for bacterial drug sensitivity testing based on AIE technology, which could obtain satisfactory results within 5 hours, providing a basis for early precision drug treatment in clinical practice.
Objective:This work aims to analyze the relationship between the 14 weeks′ Infliximab (IFX) treatment trough blood-concentration of IFK and antibodies to infliximab (ATI) concentration and mucosal healing and infusion reactions in the treatment of Crohn disease (CD).Methods:A total number of 119 CD patients who started IFX treatment in DrumTower Hospital affiliated to Nanjing University Medical School from June 2018 to August 2022 were retrospectively included. General data, endoscopic scores, laboratory tests, 14 weeks′ IFX treatment trough concentration and ATI, as well as endoscopic reexamination and clinical responses during follow-up were collected. According to the endoscopic examination results at (32±4) weeks, the two groups′ patients were divided into the mucosal healing group and non-mucosal healing group. The 14 week IFX trough concentration and ATI situation of the two groups were compared. Multiple logistic regression analysis was applied to analyze the risk factors of (32±4) weeks mucosal healing, using (32±4) weeks mucosal healing as the categorical variable, receiver operating curve (ROC) was obtained, and the optimal critical value of 14 week IFX trough concentration was selected.Result:The results of the 14 weeks′ time point indicated that the end-point IFX concentration and baseline albumin concentration in the mucosal healing group ( n=70 cases) were all significantly higher than those in the non-mucosal healing group ( n=49 cases), with values of 5.0 (2.8, 8.7) μg/ml vs 2.2 (0.3, 4.3) μg/ml, (38.7±3.5) g/L vs (36.6±3.8) g/L, respectively. The 14 week effective trough IFX concentration of (32±4) weeks mucosal healing was 2.90 μg/ml, AUC value is 0.704. Multivariate logistic regression analysis showed that 14 week trough IFX concentration≥2.9 μg/ml ( OR=5.369, 95% CI 2.42-11.92) and baseline Alb≥35 g/L ( OR=7.378, 95% CI 2.18-24.99) were significantly correlated with mucosal healing. The positive rate of ATI at 14 weeks′ time-point was 15.1%, and the trough IFX concentration of all the patients with moderate to high concentrations of ATI ( n=21 cases) was<0.4 μg/ml. Twelve patients (10.1%) experienced infusion reactions, and 53 patients (44.5%) had discontinued IFX. Conclusion:The 14 week trough IFX concentration is closely related to (32±4) week endoscopic mucosal healing.
Tumor-associated autoantibodies (TAAS), as cancer biomarkers, have attracted special attention. In recent years, increasing evidence has indicated that TAAS shows an elevated level in the early stage of human malignancies, and examination of TAAS in patients′ clinical specimens has a good predictive value for a variety of cancers′ early diagnosis. The mechanism of TAAS and its clinical application will be introduced, and the advantages and problems of tumor autoantibodies as markers will be expounded in this article.
