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Ying X, Fu W, Zhu L, Sun T, Qi M, Zhou L, Wang Y, Wang J, Su B, Zhang J. Electrochemical Lateral Flow Immunoassay with Built-In Electrodes for Ultrasensitive and Wireless Detection of Inflammatory Biomarkers. Anal Chem 2024. [PMID: 38912708 DOI: 10.1021/acs.analchem.4c01224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Paper-based lateral flow immunoassays (LFIAs) are cost-effective, portable, and simple methods for detection of diverse analytes, which however only provide qualitative or semiquantitative results and lack sufficient sensitivity. A combination of LFIA and electrochemical detection, namely, electrochemical lateral flow immunoassay (eLFIA), enables quantitative detection of analytes with high sensitivity, but the integration of external electrodes makes the system relatively expensive and unstable. Herein, the working, counter, and reference electrodes were prepared directly on the nitrocellulose membrane using screen printing, which remarkably simplified the structure of eLFIA and decreased the cost. Moreover, a horseradish peroxidase (HRP)-based electrochemical signal amplification strategy was used for further increasing the analytical sensitivity. HRP captured on the working electrode can catalyze the oxidation of tetramethylbenzidine (TMB) to form the TMB-TMBox precipitate on the electrode surface, which as an electrochemically active product can output an amplified current for quantification. We demonstrated that the eLFIA could detect low-abundant inflammatory biomarkers in human plasma samples with limits of detection of 0.17 and 0.54 pg mL-1 for interleukin-6 and C-reactive protein, respectively. Finally, a fully portable system was fabricated by integrating eLFIA with a flexible and wireless electrochemical workstation, realizing the point-of-care detection of interleukin-6.
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Affiliation(s)
- Xudong Ying
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, China
| | - Wenxuan Fu
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, China
| | - Lihang Zhu
- Department of Clinical Engineering, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310019, China
| | - Tao Sun
- Department of Laboratory Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310019, China
| | - Min Qi
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, China
| | - Lin Zhou
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, China
| | - Yafeng Wang
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou 310016, China
| | - Jing Wang
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou 310014, China
| | - Bin Su
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, China
| | - Jun Zhang
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou 310016, China
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Ji Kim H, Choi J, Ji Oh E, Lee KN, Yoon Park J, Joon Oh K. Semi-quantitative metalloproteinase-8 rapid test for the prediction of adverse pregnancy outcomes in patients with preterm premature rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2024; 297:65-71. [PMID: 38581887 DOI: 10.1016/j.ejogrb.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/18/2024] [Accepted: 03/30/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE We aimed to determine whether the semi-quantitative metalloproteinase-8 (MMP-8) bedside test is a worthwhile indicator in reflecting the severity of of intra-amniotic inflammation (IAI) and in predicting adverse pregnancy outcomes. STUDY DESIGN This retrospective cohort study comprised 76 singleton-pregnant women admitted to the Seoul National University Bundang Hospital with a diagnosis of preterm premature rupture of membranes (preterm PROM) between 20 weeks 0 days and 33 weeks 6 days of gestation who underwent trans-abdominal amniocentesis to confirm intra-amniotic infection by positive results for aerobic/anaerobic bacteria, fungi, and genital mycoplasma and evaluate lung maturity. The semi-quantitative MMP-8 rapid test kit employs a colourimetric assay to quantify MMP-8 levels in amniotic fluid (AF), expressing results from 0 to 100 percent. Participants were divided into three groups: group 1, including negative MMP-8 test with colour scale of 0 % (negative, n = 17); group 2, including positive MMP-8 test with colour scale < 51 % (weak positive, n = 21); and group 3, including positive MMP-8 test with colour scale of 51 %-100 % (strong positive, n = 38). RESULTS Approximately 78 % (59/76) of the participants showed a positive MMP-8 test result; all culture-proven AF samples (33.3 % [25/75]) yielded positive MMP-8 test, categorizing these patients into either group 2 or group 3. A significant trend was observed where the rate of positive culture-proven samples increased with the progression from group 1 (negative) to group 3 (strong positive). Both white blood cell counts in AF and maternal serum C-reactive protein levels were found to escalate with the progression of test results from negative to strong positive. This progression was associated with an increased risk of spontaneous preterm birth within 48 h, 7 days, and 14 days from amniocentesis and within 34 weeks of gestation. CONCLUSION The more the test results progress from negative to strong positive, the shorter the interval from amniocentesis to delivery becomes, and the higher the risk of intra-amniotic infection, spontaneous preterm delivery, and other perinatal complications. This relationship highlights the critical value of the semi-quantitative MMP-8 rapid test in predicting adverse pregnancy outcomes in patients with preterm PROM.
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Affiliation(s)
- Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jihyun Choi
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun Ji Oh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyong-No Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Pawłowska M, Mila-Kierzenkowska C. Effect of Alpha-1 Antitrypsin and Irisin on Post-Exercise Inflammatory Response: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:205-218. [PMID: 38680225 PMCID: PMC11053258 DOI: 10.30476/ijms.2023.97480.2925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/12/2023] [Accepted: 02/16/2023] [Indexed: 05/01/2024]
Abstract
Physical activity has a positive effect on human health and emotional well-being. However, in both amateur and professional athletes, training poses a risk of acute or chronic injury through repetitive overloading of bones, joints, and muscles. Inflammation can be an adverse effect of intense exercise caused by several factors including oxidative stress. The present narrative review summarizes current knowledge on inflammatory markers induced by physical exercise. Post-exercise recovery may reduce inflammatory responses and is key to effective training and adaptation of muscle tissues to sustained physical exertion.
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Affiliation(s)
- Marta Pawłowska
- Department of Medical Biology and Biochemistry, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Celestyna Mila-Kierzenkowska
- Department of Medical Biology and Biochemistry, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
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Xi D, Garg K, Lambert JS, Rajput-Ray M, Madigan A, Avramovic G, Gilbert L. Scrutinizing Clinical Biomarkers in a Large Cohort of Patients with Lyme Disease and Other Tick-Borne Infections. Microorganisms 2024; 12:380. [PMID: 38399784 PMCID: PMC10893018 DOI: 10.3390/microorganisms12020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Standard clinical markers can improve tick-borne infection (TBI) diagnoses. We investigated immune and other clinical biomarkers in 110 patients clinically diagnosed with TBIs before (T0) and after antibiotic treatment (T2). At T0, both the initial observation group and patients without seroconversion for tick-borne pathogens exhibited notably low percentages and counts of CD3 percentage (CD3%), CD3+ cells, CD8+ suppressors, CD4 percentage (CD4%), and CD4+ helper cells, with the latter group showing reductions in CD3%, CD3+, and CD8+ counts in approximately 15-22% of cases. Following treatment at the T2 follow-up, patients typically experienced enhancements in their previously low CD3%, CD3+ counts, CD4%, and CD4+ counts; however, there was no notable progress in their low CD8+ counts, and a higher number of patients presented with insufficient transferrin levels. Moreover, among those with negative serology for tick-borne infections, there was an improvement in low CD3% and CD3+ counts, which was more pronounced in patients with deficient transferrin amounts. Among those with CD57+ (n = 37) and CD19+ (n = 101) lymphocyte analysis, 59.46% of patients had a low CD57+ count, 14.85% had a low CD19 count, and 36.63% had a low CD19 percentage (CD19%). Similar findings were observed concerning low CD57+, CD19+, and CD19% markers for negative TBI serology patients. Overall, this study demonstrates that routine standard clinical markers could assist in a TBI diagnosis.
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Affiliation(s)
- David Xi
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (D.X.); (J.S.L.); (G.A.)
| | | | - John S. Lambert
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (D.X.); (J.S.L.); (G.A.)
- Infectious Diseases Department, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
- Infectious Diseases Department, The Rotunda Hospital, D01 P5W9 Dublin, Ireland
| | - Minha Rajput-Ray
- Curaidh Clinic: Innovative Solutions for Pain, Chronic Disease and Work Health, Perth PH2 8EH, UK;
| | - Anne Madigan
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (D.X.); (J.S.L.); (G.A.)
| | - Gordana Avramovic
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (D.X.); (J.S.L.); (G.A.)
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Rhim H, Kim M, Gim S, Han JI. Diagnostic value of serum amyloid A in differentiating the inflammatory disorders in wild birds. Front Vet Sci 2024; 11:1284113. [PMID: 38379926 PMCID: PMC10876875 DOI: 10.3389/fvets.2024.1284113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
Rescued wild birds have very high rates of inflammatory diseases; however, there have been limitations in assessing them sensitively. Few studies have examined acute-phase proteins in wild birds. In this study, serum amyloid A (SAA) was evaluated as an inflammatory indicator along with traditional indices such as white blood cell count, albumin, and albumin/globulin ratio. In total, 291 samples from 139 birds of six avian species were analyzed. All samples were divided into four groups (severe, moderate, mild injuries, and clinically healthy) based on clinical examinations and evaluated by group. SAA levels were measured using an anti-chicken SAA ELISA kit and compared with leukocyte counts, albumin concentrations, and albumin/globulin ratios. Differences among groups were evaluated using the Kruskal-Wallis test, followed by a post hoc test using Dunn's multiple comparisons with SPSS V27. Statistical significance was set at a value of p of <0.05. The median concentration and interquartile range (ng/mL) of SAA in each group were 78.10 ng/mL (50.71-109.30), 31.15 ng/mL (19.85-49.24), 9.68 ng/mL (4.71-22.06), and 3.10 ng/mL (1.50-6.00). We observed a significant difference in the mean levels between the groups (p < 0.001), with the same results observed across species. All four indices showed significant differences in mean values between the groups (p < 0.001). In addition, SAA showed rapid changes in periodically collected samples, reflecting either a positive treatment response or the onset of subclinical diseases. SAA can be used to detect inflammatory conditions and asymptomatic disease in wild birds and is helpful in accurately identifying current health status, which is essential for successful treatment and release.
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Affiliation(s)
- Haerin Rhim
- Laboratory of Wildlife Medicine, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Myeongsu Kim
- Laboratory of Wildlife Medicine, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
- Jeonbuk Wildlife Center, Jeonbuk National University, Iksan, Republic of Korea
| | - Seulgi Gim
- Jeonbuk Wildlife Center, Jeonbuk National University, Iksan, Republic of Korea
| | - Jae-Ik Han
- Laboratory of Wildlife Medicine, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
- Jeonbuk Wildlife Center, Jeonbuk National University, Iksan, Republic of Korea
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Öztüzün A, Çeker T, Yılmaz Ç, Aslan M. Inflammatory signal transduction pathways induced by prilocaine toxicity in cultured ARPE-19 cells. J Biochem Mol Toxicol 2023; 37:e23491. [PMID: 37561044 DOI: 10.1002/jbt.23491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023]
Abstract
Prilocaine (PRL) is a common local anesthetic. Despite the successful use of regional anesthesia for intraocular surgery, there are associated side effects that may affect the retina in case of accidental intravitreal injection. This study examined the signal transduction pathways activated by PRL toxicity and determined the protective role of nitric oxide synthase-2 (NOS2) inhibition in cultured human-derived retinal pigment epithelial cells (ARPE-19). Toxicity analysis was performed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay to detect the toxic dose of PRL and protective effectiveness of asperglaucide (ASP), an NOS2 inhibitor. Nuclear factor kappa B p65 (NF-κB p65), phosphorylated NF-κB p65, phospho-protein kinase B (AKT), NOS2, nitrotyrosine, and cleaved caspase-3 protein levels were evaluated by immunofluorescence staining and/or western blot analysis. Interleukin-6 (IL-6) and nitrated protein levels were quantified using an immunoassay, whereas caspase-3 activity and nitrite/nitrate levels were measured using a fluorometric method. A significant increase in NF-κB p65, and phosphorylated NF-κB p65 and AKT levels due to PRL toxicity was observed. Similarly, IL-6, NOS2, nitrite/nitrate, and nitrotyrosine levels were significantly higher in PRL-treated cells than in control cells. Application of ASP to PRL-treated cells reduced NF-κB p65, and phosphorylated NF-κB p65 and AKT to basal levels. IL-6, NOS2, nitrite/nitrate, and nitrotyrosine levels also considerably decreased following ASP treatment in cells experiencing PRL-induced toxicity. Moreover, the caspase-3-dependent apoptotic pathway was not activated. Our results indicate that ASP could ameliorate PRL-induced activation of NF-κB p65 that led to inflammation in cultured ARPE-19 cells.
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Affiliation(s)
- Aleyna Öztüzün
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Tuğçe Çeker
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Çağatay Yılmaz
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mutay Aslan
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Turkey
- Department of Gene and Cell Therapy, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Ali SB, Cecchin A, Lucchesi C, Putty T, Edwards S, Petrou T, Coates P, Ferrante A, Pucar PA, King J, Banovic T. Can C-reactive protein be used as a surrogate marker of IL-6 in a broad array of clinical entities? Biomark Med 2023; 17:1001-1010. [PMID: 38235562 DOI: 10.2217/bmm-2023-0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Background: C-reactive protein (CRP) is commonly performed, whereas cytokine testing is limited to research. Aims: To determine CRP correlation to cytokines IL-6, IL-1β and TNF-α. Results: Consecutive samples (n = 307) were collected over 24 h. Ninety-six patients (31%) had acute infections, and 23 patients (7.5%) had autoimmune or inflammatory disease presentations. A strong correlation between CRP and two IL-6 assays (r = 0.74 and r = 0.71; p < 0.001) was present. CRP did not correlate with IL-1β and TNF-α across the data set. Bacterial infection had a significantly higher CRP and IL-6 (p < 0.001), while only CRP was elevated in inflammatory and autoimmune diseases (p < 0.001). Discussion: CRP may be used as a surrogate marker of IL-6 levels in the routine diagnostic laboratories.
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Affiliation(s)
- Syed B Ali
- Department of Clinical Immunology & Allergy, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
- Department of Immunopathology, Adelaide, 5000, Australia
- School of Medicine & Public Health, University of Adelaide, 5000, Australia
| | - Amelia Cecchin
- Department of Immunopathology, Adelaide, 5000, Australia
| | | | - Trishni Putty
- Department of Immunopathology, SA Pathology Womens' & Childrens' Hospital, Adelaide, 5000, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, 5000, Australia
| | - Tina Petrou
- Department of Biochemistry, Royal Adelaide Hospital, Adelaide, 5000, Australia
| | - Penelope Coates
- Department of Biochemistry, Royal Adelaide Hospital, Adelaide, 5000, Australia
- Department of Biochemistry, SA Pathology, Adelaide, 5000, Australia
| | - Antonio Ferrante
- Department of Immunopathology, SA Pathology Womens' & Childrens' Hospital, Adelaide, 5000, Australia
| | - Phillippa A Pucar
- Department of Clinical Immunology & Allergy, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
- Department of Immunopathology, Adelaide, 5000, Australia
| | - Jovanka King
- Department of Immunopathology, Adelaide, 5000, Australia
- School of Medicine & Public Health, University of Adelaide, 5000, Australia
- Department of Immunopathology, SA Pathology Womens' & Childrens' Hospital, Adelaide, 5000, Australia
| | - Tatjana Banovic
- Department of Clinical Immunology & Allergy, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
- Department of Immunopathology, Adelaide, 5000, Australia
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Sung M, Kim JH, Min HS, Jang S, Hong J, Choi BK, Shin J, Chung KS, Park YR. Three-dimensional label-free morphology of CD8 + T cells as a sepsis biomarker. LIGHT, SCIENCE & APPLICATIONS 2023; 12:265. [PMID: 37932249 PMCID: PMC10628166 DOI: 10.1038/s41377-023-01309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/20/2023] [Accepted: 10/13/2023] [Indexed: 11/08/2023]
Abstract
Sepsis is a dysregulated immune response to infection that leads to organ dysfunction and is associated with a high incidence and mortality rate. The lack of reliable biomarkers for diagnosing and prognosis of sepsis is a major challenge in its management. We aimed to investigate the potential of three-dimensional label-free CD8 + T cell morphology as a biomarker for sepsis. This study included three-time points in the sepsis recovery cohort (N = 8) and healthy controls (N = 20). Morphological features and spatial distribution within cells were compared among the patients' statuses. We developed a deep learning model to predict the diagnosis and prognosis of sepsis using the internal cell morphology. Correlation between the morphological features and clinical indices were analysed. Cell morphological features and spatial distribution differed significantly between patients with sepsis and healthy controls and between the survival and non-survival groups. The model for predicting the diagnosis and prognosis of sepsis showed an area under the receiver operating characteristic curve of nearly 100% with only a few cells, and a strong correlation between the morphological features and clinical indices was observed. Our study highlights the potential of three-dimensional label-free CD8 + T cell morphology as a promising biomarker for sepsis. This approach is rapid, requires a minimum amount of blood samples, and has the potential to provide valuable information for the early diagnosis and prognosis of sepsis.
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Affiliation(s)
- MinDong Sung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyun Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Seok Min
- Tomocube, Inc, 155 Sinseong-ro, Shinsung-dong, Yuseong-gu, Daejeon, Republic of Korea
| | - Sooyoung Jang
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - JaeSeong Hong
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bo Kyu Choi
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - JuHye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Staiano A, Bjerrum L, Llor C, Melbye H, Hopstaken R, Gentile I, Plate A, van Hecke O, Verbakel JY. C-reactive protein point-of-care testing and complementary strategies to improve antibiotic stewardship in children with acute respiratory infections in primary care. Front Pediatr 2023; 11:1221007. [PMID: 37900677 PMCID: PMC10602801 DOI: 10.3389/fped.2023.1221007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
This paper provides the perspective of an international group of experts on the role of C-reactive protein (CRP) point-of-care testing (POCT) and complementary strategies such as enhanced communication skills training and delayed prescribing to improve antibiotic stewardship in the primary care of children presenting with an acute illness episode due to an acute respiratory tract infection (ARTI). To improve antibiotics prescribing decisions, CRP POCT should be considered to complement the clinical assessment of children (6 months to 14 years) presenting with an ARTI in a primary care setting. CRP POCT can help decide whether a serious infection can be ruled out, before deciding on further treatments or management, when clinical assessment is unconclusive. Based on the evidence currently available, a CRP value can be a valuable support for clinical reasoning and facilitate communication with patients and parents, but the clinical assessment should prevail when making a therapy or referral decision. Nearly half of children tested in the primary care setting can be expected to have a CRP value below 20 mg/l, in which case it is strongly suggested to avoid prescribing antibiotics when the clinical assessment supports ruling out a severe infection. For children with CRP values greater than or equal to 20 mg/l, additional measures such as additional diagnostic tests, observation time, re-assessment by a senior decision-maker, and specialty referrals, should be considered.
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Affiliation(s)
- Annamaria Staiano
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Lars Bjerrum
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Carl Llor
- Department of Public Health and Primary Care, University of Southern Denmark, Odense, Denmark
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, The Arctic University of Norway, Tromso, Norway
| | - Rogier Hopstaken
- Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Andreas Plate
- Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland
| | - Oliver van Hecke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jan Y. Verbakel
- NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- EPI-Centre, Department of Public Health and Primary Care, Academisch Centrum Voor Huisartsgeneeskunde, Leuven & NIHR Community Healthcare Medtech and IVD cooperative, Leuven, Belgium
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Ahmad R, Narwaria M, Singh A, Kumar S, Haque M. Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools. Diagnostics (Basel) 2023; 13:2441. [PMID: 37510185 PMCID: PMC10378387 DOI: 10.3390/diagnostics13142441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus and can lead to patient demise if not immediately treated. From the recent literature, the diabetic ketoacidosis mortality rate, depending on age, is 2-5%. Insulin discontinuation and infection remain the two most common triggers for diabetic ketoacidosis. About 50% of cases of ketoacidosis result from bacterial infections like urinary tract infections and pneumonia. It is also important to diagnose the presence of infection in diabetic ketoacidosis patients to prevent the excessive use of antibiotics, which may lead to antibiotic resistance. Although performing bacterial culture is confirmatory for the presence or absence of bacterial infection, the time required to obtain the result is long. At the same time, emergency treatment needs to be started as early as possible. METHODS This narrative review examines various septic markers to identify the appropriate tools for diagnosis and to distinguish between diabetic ketoacidosis with and without infection. Electronic databases were searched using the Google engine with the keywords "Diabetes Mellitus", "Diabetic Ketoacidosis", "Infection with Diabetic Ketoacidosis", "biomarkers for infection in Diabetic Ketoacidosis", "Procalcitonin", "Inflammatory cytokines in DKA", "Lactic acidosis in DKA", and "White blood cell in infection in DKA". RESULTS This narrative review article presents the options for diagnosis and also aims to create awareness regarding the gravity of diabetic ketoacidosis with infection and emphasizes the importance of early diagnosis for appropriate management. Diabetes mellitus is a clinical condition that may lead to several acute and chronic complications. Acute diabetic ketoacidosis is a life-threatening condition in which an excess production of ketone bodies results in acidosis and hypovolemia. Infection is one of the most common triggers of diabetic ketoacidosis. When bacterial infection is present along with diabetic ketoacidosis, the mortality rate is even higher than for patients with diabetic ketoacidosis without infection. The symptoms and biomarkers of diabetic ketoacidosis are similar to that of infection, like fever, C reactive protein, and white blood cell count, since both create an environment of systemic inflammation. It is also essential to distinguish between the presence and absence of bacterial infection to ensure the appropriate use of antibiotics and prevent antimicrobial resistance. A bacterial culture report is confirmatory for the existence of bacterial infection, but this may take up to 24 h. Diagnosis needs to be performed approximately in the emergency room upon admission since there is a need for immediate management. Therefore, researching the possible diagnostic tools for the presence of infection in diabetic ketoacidosis patients is of great importance. Several of such biomarkers have been discussed in this research work.
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Affiliation(s)
- Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka 1230, Bangladesh
| | - Mahendra Narwaria
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, S G Highways, Ahmedabad 380054, India
| | - Arya Singh
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, S G Highways, Ahmedabad 380054, India
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, India
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
- Department of Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, India
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11
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Pan T, Jiang CY, Zhang H, Han XK, Zhang HT, Jiang XY, Chen W, Wang K, Fan FD, Pan J, Zhou Q, Wang CS, Zhang L, Wang DJ. The low-dose colchicine in patients after non-CABG cardiac surgery: a randomized controlled trial. Crit Care 2023; 27:49. [PMID: 36747296 PMCID: PMC9903414 DOI: 10.1186/s13054-023-04341-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recent high-quality trials have shown that the anti-inflammatory effects of colchicine reduce the risk of cardiovascular events in patients suffering post-myocardial infarction and chronic coronary disease. The effect of colchicine in patients undergoing non-coronary artery bypass grafting (non-CABG) with cardiopulmonary bypass remains unclear. We aim to evaluate the effect of colchicine on myocardial protection in patients who underwent non-CABG cardiac surgery. METHOD Patients were randomly assigned to colchicine or placebo groups starting 72 h before scheduled cardiac surgery and for 5 days thereafter (0.5 mg daily).The primary outcome was the level of cardiac troponin T (cTnT) at postoperative 48 h. The secondary outcomes included troponin I (cTnI) and creatine kinase-MB (CK-MB), inflammatory biomarkers (procalcitonin and interleukin-6, etc.), and adverse events (30-day mortality, stroke, ECMO and IABP use, etc.). RESULTS A total of 132 patients underwent non-CAGB cardiac surgery, 11were excluded because of diarrhea (n = 6) and long aortic cross-clamp time > 2 h (n = 5), 59 were assigned to the colchicine group and 62 to the placebo group. Compared with the placebo group, cTnT (median: 0.3 μg/L, IQR 0.2-0.4 μg/L vs. median: 0.4 μg/L, IQR 0.3-0.6 μg/L, P < 0.01), cardiac troponin I (median: 0.9 ng/ml, IQR 0.4-1.7 ng/ml vs. median: 1.3 ng/ml, IQR 0.6-2.3 ng/ml, P = 0.02), CK-MB (median: 1.9 ng/ml, IQR 0.7-3.2 ng/ml vs. median: 4.4 ng/ml, IQR 1.5-8.2 ng/ml, P < 0.01), and interleukin-6 (median: 73.5 pg/ml, IQR 49.6-125.8 pg/ml vs. median: 101 pg/ml, IQR 57.5-164.7 pg/ml, P = 0.048) were significantly reduced in colchicine group at postoperative 48 h. For safety evaluation, the colchicine (n = 65) significantly decreased post-pericardiotomy syndrome (3.08% vs. 17.7%, P < 0.01) and increased the rate of diarrhea (9.23% vs. 0, P = 0.01) compared with the placebo group (n = 62). No significant difference was observed in other adverse events between the two groups. CONCLUSION A short perioperative course of low-dose colchicine was effective to attenuate the postoperative biomarkers of myocardial injury and inflammation, and to decrease the postoperative syndrome compared with the placebo. Trial registration ChiCTR2000040129. Registered 22nd Nov. 2020. This trial was registered before the first participant was enrolled. http://www.chictr.org.cn/showproj.aspx?proj=64370 .
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Affiliation(s)
- Tuo Pan
- grid.428392.60000 0004 1800 1685Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, 210008 Jiangsu China ,grid.412676.00000 0004 1799 0784Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chen-Yu Jiang
- grid.16821.3c0000 0004 0368 8293Department of Cardio-Thoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - He Zhang
- grid.428392.60000 0004 1800 1685Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Xi-Kun Han
- grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard University T H Chan School of Public Health, Boston, MA USA ,grid.38142.3c000000041936754XProgram in Genetic Epidemiology and Statistical Genetics, Harvard University T H Chan School of Public Health, Boston, MA USA
| | - Hai-Tao Zhang
- grid.428392.60000 0004 1800 1685Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Xin-Yi Jiang
- grid.428392.60000 0004 1800 1685Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Wei Chen
- grid.89957.3a0000 0000 9255 8984Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, China
| | - Kuo Wang
- grid.428392.60000 0004 1800 1685Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Clinical College of Xuzhou Medical University, Nanjing, China
| | - Fu-Dong Fan
- grid.412676.00000 0004 1799 0784Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun Pan
- grid.412676.00000 0004 1799 0784Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qing Zhou
- grid.412676.00000 0004 1799 0784Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chuang-Shi Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Mentougou District, Beijing, 102300, China.
| | - Li Zhang
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
| | - Dong-Jin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. .,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China. .,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, China. .,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Clinical College of Xuzhou Medical University, Nanjing, China.
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12
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The effects of selenium supplementation on inflammatory markers in critically ill patients. SN APPLIED SCIENCES 2022; 4:326. [PMID: 36405547 PMCID: PMC9643959 DOI: 10.1007/s42452-022-05208-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract Low serum selenium (Se) levels have been shown in critical illness, which is associated with poor clinical outcomes and a higher mortality rate. Se plays an important role in inflammation and oxidative stress. Since the overproduction of inflammatory cytokines and increased oxidative stress is a major component of critical illnesses, its supplementation has been demonstrated to have promising effects on critically ill patients. This study aims to review the evidence regarding the effects of Se supplementation on inflammatory and oxidative markers in critically ill patients. The literature review highlights alterations of inflammatory markers, including procalcitonin, leukocyte count, albumin, prealbumin, C-reactive protein (CRP), inflammatory cytokines, and cholesterol following Se supplementation in critically ill patients. Besides, the antioxidant properties of Se due to its presence in the structure of several selenoenzymes have been reported. Article highlights Low serum Se level have been shown in critical illness, which is associated with poor clinical outcome and higher mortality rate. Se plays an important role in inflammation and oxidative stress. Se supplementation can have promising effects by alterations of inflammatory markers and its antioxidant properties for critically ill patients.
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Research on point-of-care tests in outpatient care in Germany: A scoping review and definition of relevant endpoints in evaluation studies. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 174:1-10. [PMID: 36055890 DOI: 10.1016/j.zefq.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/14/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The fast turnaround time and user-friendliness of point-of-care tests (POCTs) offer a great potential to improve outpatient health care where clinical decisions have to be made during the physician-patient encounter and time resources are limited. The aim of this scoping review is to describe the extent and nature as well as gaps in German research activities on POCT in outpatient care. In addition, we define research endpoints that should be addressed in the comprehensive evaluation of POCTs targeted for outpatient care. METHODS We performed a scoping review with a systematic literature search in Medline (via PubMed), Scopus, Web of Science, Cochrane library and Google Scholar for German publications on POCT with relevance to German outpatient care published from January 2005 to November 2020. RESULTS Our literature search identified 2,200 unique records. After literature selection 117 articles were included in this scoping review. Just over half of the articles (67/117, 57.3%) were primary research studies with original data, while one third of all the studies (33.3%) were secondary research articles (e.g., review articles). The remaining articles were clinical recommendations / position papers (7/117, 6.0%) and other types of articles (3.4%). The majority of articles focused on POCT use in infectious diseases (44/117, 37.6%), diabetic syndromes (15.4%), cardiac disease (12.0%) or coagulopathies and thrombosis (10.3%), while the remaining articles did not specify the disease (13.7%) or investigated other diseases (11.1%). Similar to international studies, most primary research studies investigated the diagnostic performance of POCT (e.g., sensitivity, specificity). Evidence beyond diagnostic accuracy remains scarce, such as the impact on therapeutic decisions and practice routines, clinical effectiveness, and user perspectives. In line with this, interventional studies (such as RCTs) on the effectiveness of POCT use in German outpatient care are limited. We define six endpoint domains that should be addressed in the evaluation of POCTs targeted for outpatient care: (i) diagnostic performance, (ii) clinical performance, (iii) time and costs, (iv) impact on clinical routines / processes, (v) perspectives of medical professionals and patients, and (vi) broader aspects. CONCLUSION There is considerable research activity on POCTs targeted for use in outpatient care in Germany. Data on their potential benefits beyond diagnostic accuracy is often lacking and should be addressed in future POCT research studies.
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Semitala FC, Chaisson LH, Dowdy DW, Armstrong DT, Opira B, Aman K, Kamya M, Phillips PPJ, Yoon C. Tuberculosis screening improves preventive therapy uptake (TB SCRIPT) trial among people living with HIV in Uganda: a study protocol of an individual randomized controlled trial. Trials 2022; 23:399. [PMID: 35550621 PMCID: PMC9096738 DOI: 10.1186/s13063-022-06371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background People living with HIV (PLHIV) have an increased risk of developing active tuberculosis (TB). To reduce the burden of TB among PLHIV, the World Health Organization (WHO) recommends systematic TB screening followed by (1) confirmatory TB testing for all who screen positive and (2) TB preventive therapy (TPT) for all TPT-eligible PLHIV who screen negative. Symptom-based screening remains the standard of care in most high TB burden settings, including Uganda. Despite having high sensitivity for active TB among antiretroviral-naïve PLHIV, symptom screening has poor specificity; as such, many high-risk PLHIV without active TB are not referred for TPT. C-reactive protein (CRP) is a promising alternative strategy for TB screening that has comparable sensitivity and higher specificity than symptom screening, and was endorsed by WHO in 2021. However, the impact of CRP-based TB screening on TB burden for PLHIV remains unclear. Methods TB SCRIPT (TB Screening Improves Preventive Therapy Uptake) is a phase 3, multi-center, single-blinded, individual (1:1) randomized controlled trial evaluating the effectiveness of CRP-based TB screening on clinical outcomes of PLHIV. The trial aims to compare the effectiveness of a TB screening strategy based on CRP levels using a point-of-care (POC) assay on 2-year TB incidence and all-cause mortality (composite primary trial endpoint) and prevalent TB case detection and uptake of TPT (intermediate outcomes), relative to symptom-based TB screening (current practice). Discussion This study will be critical to improving selection of eligible PLHIV for TPT and helping guide the scale-up and integration of TB screening and TPT activities. This work will enable the field to improve TB screening by removing barriers to TPT initiation among eligible PLHIV, and provide randomized evidence to inform and strengthen WHO guidelines. Trial registration ClinicalTrials.gov NCT04557176. Registered on September 21, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06371-0.
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Affiliation(s)
- Fred C Semitala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda.,Makerere University Joint AIDS Program, Kampala, Uganda
| | - Lelia H Chaisson
- Division of Infectious Diseases, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - David W Dowdy
- Departments of Epidemiology, International Health, and Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Derek T Armstrong
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Bishop Opira
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Moses Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Patrick P J Phillips
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, 1001 Potrero Ave, 5K1, San Francisco, CA, 94110, USA
| | - Christina Yoon
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, 1001 Potrero Ave, 5K1, San Francisco, CA, 94110, USA.
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Ahmad R, Bhatti KM, Ahmed M, Malik KA, Rehman S, Abdulgader A, Kausar A, Canelo R. C-Reactive Protein as a Predictor of Complicated Acute Pancreatitis: Reality or a Myth? Cureus 2021; 13:e19265. [PMID: 34900460 PMCID: PMC8648202 DOI: 10.7759/cureus.19265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction C-reactive protein (CRP) has been reported as a predictor of the severity of acute pancreatitis (AP). However, there is conflicting evidence in the literature. The proposed cut-off values and intervals for best prediction include an absolute value of 150 at 48 hours; an absolute value of 190 at 48 hours; and the interval change in CRP of 90 at 48 hours. The current study assesses the value of CRP at different intervals and cut-offs in predicting complicated acute pancreatitis (CAP) and compares its performance against other available predictors like neutrophil to lymphocyte ratio (NLR); Glasgow scoring system and modified CT severity index (MCTSI). Methods Analysis of prospectively maintained data for index episodes of acute pancreatitis managed in 225 patients over a period of five years (2014-2018) was done. CAP was defined by using revised Atlanta classification and included all the AP patients with local and or systemic complications. It was used as a gold standard. Diagnostic and predictive performance of different biochemical markers and multifactorial scoring systems were determined by analyzing receiving operating curves (ROCs), the area under the curve (AUC), sensitivity, specificity, and predictive values (positive and negative). Results Out of 225 patients, 122 were female while 103 patients were male. CAP developed in 47 patients (20.9%) while 178 (79.1%) patients had mild AP. Overall, in-hospital mortality rate was 1.8% (n=4). ROC analysis demonstrated that CRP at admission had low discriminatory value (AUC= 0.54, p-value=0.74). CRP at 48 hours had AUC of 0.70 (p-value=0.007). At a cut-off of 150, the positive predictive value (PPV) of 150 was 30 %. The PPV of CRP at 48 hours at a cut-off of 190 was 28%. Interval change in CRP at 48 hours greater than 90 had a PPV of 26 %. Further comparison of CRP with other scoring systems like Glasgow scoring system (AUC= 0.65), NL ratio (AUC=0.54), and MCTSI was performed. Among the single predictors, although, NL ratio showed good sensitivity at a cut-off value of 4.7 (87.23%), however, its discriminatory power was negligible (AUC=0.542, p-value=0.513). The overall best performance was achieved by the MCTSI scoring system at a cut-off of 3 (AUC=0.90, sensitivity=83.33 %, specificity=100%, diagnostic accuracy=94.49%). Conclusion CRP measured at admission or at 48 hours has a very limited role in the prediction of CAP. Along with other scoring systems, its negative predictive value should be used to predict cases with mild AP which can help in clinical decision making for early discharge or management of such patients on ambulatory care basis. MCTSI scoring system can be used in cases with high suspicion of CAP.
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Affiliation(s)
- Rami Ahmad
- Colorectal Surgery, Royal Blackburn Hospital, Blackburn, GBR
| | - Khalid M Bhatti
- Surgery, Health Education of England, Northwest Deanery, Blackburn, GBR
| | - Mooyad Ahmed
- Colorectal Surgery, Royal Blackburn Hospital, Blackburn, GBR
| | | | - Shafiq Rehman
- Hepato-Pancreatico-Biliary (HPB) Surgery, Newcastle Freeman Hospital, Newcastle, GBR
| | | | - Ambreen Kausar
- Hepato-Pancreatico-Biliary (HPB) Surgery, Royal Blackburn Hospital, Blackburn, GBR
| | - Ruben Canelo
- Surgery, North Cumbria Integrated Care (NCIC), Carlisle, GBR
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16
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Burtscher B, Manco Urbina PA, Diacci C, Borghi S, Pinti M, Cossarizza A, Salvarani C, Berggren M, Biscarini F, Simon DT, Bortolotti CA. Sensing Inflammation Biomarkers with Electrolyte-Gated Organic Electronic Transistors. Adv Healthc Mater 2021; 10:e2100955. [PMID: 34423579 DOI: 10.1002/adhm.202100955] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/16/2021] [Indexed: 01/08/2023]
Abstract
An overview of cytokine biosensing is provided, with a focus on the opportunities provided by organic electronic platforms for monitoring these inflammation biomarkers which manifest at ultralow concentration levels in physiopathological conditions. Specifically, two of the field's state-of-the-art technologies-organic electrochemical transistors (OECTs) and electrolyte gated organic field effect transistors (EGOFETs)-and their use in sensing cytokines and other proteins associated with inflammation are a particular focus. The overview will include an introduction to current clinical and "gold standard" quantification techniques and their limitations in terms of cost, time, and required infrastructure. A critical review of recent progress with OECT- and EGOFET-based protein biosensors is presented, alongside a discussion onthe future of these technologies in the years and decades ahead. This is especially timely as the world grapples with limited healthcare diagnostics during the Coronavirus disease (COVID-19)pandemic where one of the worst-case scenarios for patients is the "cytokine storm." Clearly, low-cost point-of-care technologies provided by OECTs and EGOFETs can ease the global burden on healthcare systems and support professionals by providing unprecedented wealth of data that can help to monitor disease progression in real time.
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Affiliation(s)
- Bernhard Burtscher
- Laboratory of Organic Electronics Department of Science and Technology Linköping University Norrköping 60174 Sweden
| | | | - Chiara Diacci
- Laboratory of Organic Electronics Department of Science and Technology Linköping University Norrköping 60174 Sweden
| | - Simone Borghi
- Department of Life Sciences University of Modena and Reggio Emilia Via Campi 103 Modena 41125 Italy
| | - Marcello Pinti
- Department of Life Sciences University of Modena and Reggio Emilia Via Campi 103 Modena 41125 Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults University of Modena and Reggio Emilia Via Campi 287 Modena 41125 Italy
| | - Carlo Salvarani
- Rheumatology Unit University of Modena and Reggio Emilia Medical School Azienda Ospedaliero‐Universitaria Policlinico di Modena Modena 41124 Italy
| | - Magnus Berggren
- Laboratory of Organic Electronics Department of Science and Technology Linköping University Norrköping 60174 Sweden
| | - Fabio Biscarini
- Department of Life Sciences University of Modena and Reggio Emilia Via Campi 103 Modena 41125 Italy
- Center for Translation Neurophysiology Istituto Italiano di Tecnologia Via Fossato di Mortara 17–19 Ferrara 44100 Italy
| | - Daniel T. Simon
- Laboratory of Organic Electronics Department of Science and Technology Linköping University Norrköping 60174 Sweden
| | - Carlo A. Bortolotti
- Department of Life Sciences University of Modena and Reggio Emilia Via Campi 103 Modena 41125 Italy
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17
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Sharma A, Tok AIY, Alagappan P, Liedberg B. Point of care testing of sports biomarkers: Potential applications, recent advances and future outlook. Trends Analyt Chem 2021. [DOI: 10.1016/j.trac.2021.116327] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Development of a Point-of-Care System Based on White Light Reflectance Spectroscopy: Application in CRP Determination. BIOSENSORS-BASEL 2021; 11:bios11080268. [PMID: 34436070 PMCID: PMC8394791 DOI: 10.3390/bios11080268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Abstract
The development of methods and miniaturized systems for fast and reliable quantitative determinations at the Point-of-Care is a top challenge and priority in diagnostics. In this work, a compact bench-top system, based on White Light Reflectance Spectroscopy, is introduced and evaluated in an application with high clinical interest, namely the determination of C-Reactive protein (CRP) in human blood samples. The system encompassed all the necessary electronic and optical components for the performance of the assay, while the dedicated software provided the sequence and duration of assay steps, the reagents flow rate, the real-time monitoring of sensor response, and data processing to deliver in short time and accurately the CPR concentration in the sample. The CRP assay included two steps, the first comprising the binding of sample CRP onto the chip immobilized capture antibody and the second the reaction of the surface immunosorbed CRP molecules with the detection antibody. The assay duration was 12 min and the dynamic range was from 0.05 to 200 μg/mL, covering both normal values and acute inflammation incidents. There was an excellent agreement between CRP values determined in human plasma samples using the developed device with those received for the same samples by a standard diagnostic laboratory method.
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19
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Liu L, Han Z, An F, Gong X, Zhao C, Zheng W, Mei L, Zhou Q. Aptamer-based biosensors for the diagnosis of sepsis. J Nanobiotechnology 2021; 19:216. [PMID: 34281552 PMCID: PMC8287673 DOI: 10.1186/s12951-021-00959-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
Sepsis, the syndrome of infection complicated by acute organ dysfunction, is a serious and growing global problem, which not only leads to enormous economic losses but also becomes one of the leading causes of mortality in the intensive care unit. The detection of sepsis-related pathogens and biomarkers in the early stage plays a critical role in selecting appropriate antibiotics or other drugs, thereby preventing the emergence of dangerous phases and saving human lives. There are numerous demerits in conventional detection strategies, such as high cost, low efficiency, as well as lacking of sensitivity and selectivity. Recently, the aptamer-based biosensor is an emerging strategy for reasonable sepsis diagnosis because of its accessibility, rapidity, and stability. In this review, we first introduce the screening of suitable aptamer. Further, recent advances of aptamer-based biosensors in the detection of bacteria and biomarkers for the diagnosis of sepsis are summarized. Finally, the review proposes a brief forecast of challenges and future directions with highly promising aptamer-based biosensors.
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Affiliation(s)
- Lubin Liu
- Institute for Translational Medicine, Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Zeyu Han
- Institute for Translational Medicine, Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Fei An
- Institute for Translational Medicine, Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Xuening Gong
- Institute for Translational Medicine, Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Chenguang Zhao
- Institute for Translational Medicine, Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Weiping Zheng
- Institute for Translational Medicine, Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Li Mei
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Qihui Zhou
- Institute for Translational Medicine, Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China.
- School of Stomatology, Qingdao University, Qingdao, 266003, China.
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Correlation between human health and reactive oxygen species produced in blood: a long-term chemiluminescence and fluorescence analysis. Sci Rep 2021; 11:14545. [PMID: 34267248 PMCID: PMC8282623 DOI: 10.1038/s41598-021-93887-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
The previous slide-glass type system could simultaneously detect reactive and highly reactive oxygen species, i.e., superoxide radicals (O2−·) and hypochlorite ions (OCl−) elicited from leucocytes in sample blood, but had some drawbacks, i.e., signal noise from air-flow stirring, potential biohazard risks, etc. because of open samples placed on a slide glass. We overcame these drawbacks by adopting a fluidic-chip container in a new system, which resulted in higher sensitivity and more stable measurements. Using the new system, we conducted a pilot study on nominally healthy volunteers to find whether or not the monitored activities of leukocytes can distinguish more or less unhealthy conditions from healthy ones. At first, healthy volunteers of both genders and of various ages showed that the fluctuation magnitudes (%) of O2−· and OCl− were nearly similar to each other and to that of the neutrophil count fluctuation. These parameters sometimes exceeded the healthy fluctuation range. By comparing these large fluctuations with the data of an inflammation marker C-reactive protein (CRP), the neutrophil count fluctuation and the timings/symptoms of abnormalities found in questionnaire, we could gain information suggesting the factors causing the large fluctuations. The new system could detect bodily abnormalities earlier than CRP or self-aware symptoms.
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21
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Basak M, Mitra S, Agnihotri SK, Jain A, Vyas A, Bhatt MLB, Sachan R, Sachdev M, Nemade HB, Bandyopadhyay D. Noninvasive Point-of-Care Nanobiosensing of Cervical Cancer as an Auxiliary to Pap-Smear Test. ACS APPLIED BIO MATERIALS 2021; 4:5378-5390. [PMID: 35007017 DOI: 10.1021/acsabm.1c00470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A potential cancer antigen (Ag), protein-phosphatase-1-gamma-2 (PP1γ2), with a restricted expression in testis and sperms has been identified as a biomarker specific to cervical cancer (CaCx). Detection of this cancer biomarker antigen (NCB-Ag) in human urine opens up the possibility of noninvasive detection of CaCx to supplement the dreaded and invasive Pap-smear test. A colorimetric response of an assembly of gold nanoparticles (Au NPs) has been employed for the quantitative, noninvasive, and point-of-care-testing of CaCx in the urine. In order to fabricate the immunosensor, Au NPs of sizes ∼5-20 nm have been chemically modified with a linker, 3,3'-di-thio-di-propionic-acid-di(n-hydroxy-succinimide-ester) (DTSP) to attach the antibody (Ab) specific to the NCB-Ag. Interestingly, the addition of Ag to the composite of Ab-DTSP-Au NPs leads to a significant hypsochromic shift due to a localized surface plasmon resonance phenomenon, which originates from the specific epitope-paratope interaction between the NCB-Ag and Ab-DTSP-Au NPs. The variations in the absorbance and wavelength shift during such attachments of different concentrations of NCB-Ag on the Ab-DTSP-Au NPs composite have been employed as a calibration to identify NCB-Ag in human urine. An in-house prototype has been assembled by integrating a light-emitting diode of a narrow range wavelength in one side of a cuvette in which the reaction has been performed while a sensitive photodetector to the other side to transduce the transmitted signal associated with the loading of NCB-Ag in the Ab-DTSP-Au NPs composite. The proposed immunosensing platform has been tested against other standard proteins to ensure noninterference alongside proving the proof-for-specificity of the NCB detection.
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Affiliation(s)
- Mitali Basak
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Shirsendu Mitra
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Saurabh Kumar Agnihotri
- Endocrinology, Division, CSIR-Central Drug Research Institute Lucknow, Lucknow, Uttar Pradesh 226 031, India
| | - Ankita Jain
- Endocrinology, Division, CSIR-Central Drug Research Institute Lucknow, Lucknow, Uttar Pradesh 226 031, India
| | - Akanksha Vyas
- Endocrinology, Division, CSIR-Central Drug Research Institute Lucknow, Lucknow, Uttar Pradesh 226 031, India
| | | | - Rekha Sachan
- King George's Medical University, Lucknow, Uttar Pradesh 226 003, India
| | - Monika Sachdev
- Endocrinology, Division, CSIR-Central Drug Research Institute Lucknow, Lucknow, Uttar Pradesh 226 031, India
| | - Harshal B Nemade
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Dipankar Bandyopadhyay
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India.,Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
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22
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Hajian R, DeCastro J, Parkinson J, Kane A, Camelo AFR, Chou PP, Yang J, Wong N, Hernandez EDO, Goldsmith B, Conboy I, Aran K. Rapid and Electronic Identification and Quantification of Age-Specific Circulating Exosomes via Biologically Activated Graphene Transistors. Adv Biol (Weinh) 2021; 5:e2000594. [PMID: 33929095 DOI: 10.1002/adbi.202000594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Increasing access to modern clinical practices concomitantly extends lifespan, ironically revealing new classes of degenerative and inflammatory diseases of later years. Here, an electronic graphene field-effect transistor (gFET) is reported, termed EV-chip, for label-free, rapid identification and quantification of exosomes (EV) associated with aging through specific surface markers, CD63 and CD151. Studies suggest that blood-derived exosomes carry specific biomolecules that can be used toward diagnostic applications of age and health. However, to observe improvements in patient outcomes, earlier detection at the point-of-care (POC) is required. Unfortunately, conventional techniques and other electronic-based platforms for exosome sensing are burdensome and inept for the POC distinction of aged blood factors. It is shown that EV-chip can quantitatively detect purified exosomes from plasma, with a limit of detection (LOD) of 2 × 104 particles mL-1 and a limit of quantification (LOQ) of 6 × 104 particles mL-1 . The sensitivity and compact electronics of the EV-chip improves upon previously published electronic biosensors, making it ideal for a physician's office or a simple biological laboratory. The sensitivity, selectivity, and portability of the EV-chip demonstrate the potential of the biosensor as a powerful point-of-care diagnostic and prognostic tool for age-related diseases.
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Affiliation(s)
- Reza Hajian
- Keck Graduate Institute, The Claremont Colleges, Claremont, CA, 91711, USA.,Cardea Bio Inc., 8969 Kenamar Dr. Suite 104, San Diego, CA, 92121, USA
| | - Jonalyn DeCastro
- Keck Graduate Institute, The Claremont Colleges, Claremont, CA, 91711, USA
| | | | - Alex Kane
- Cardea Bio Inc., 8969 Kenamar Dr. Suite 104, San Diego, CA, 92121, USA
| | | | - Peichi Peggy Chou
- Keck Science Department, Pitzer College, The Claremont Colleges, Claremont, CA, 91711, USA
| | - Jielin Yang
- Keck Science Department, Claremont McKenna College, The Claremont Colleges, Claremont, CA, 91711, USA
| | - Nathan Wong
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, 94720, USA
| | | | - Brett Goldsmith
- Cardea Bio Inc., 8969 Kenamar Dr. Suite 104, San Diego, CA, 92121, USA
| | - Irina Conboy
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Kiana Aran
- Keck Graduate Institute, The Claremont Colleges, Claremont, CA, 91711, USA.,Cardea Bio Inc., 8969 Kenamar Dr. Suite 104, San Diego, CA, 92121, USA.,Department of Bioengineering, University of California, Berkeley, Berkeley, CA, 94720, USA
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23
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Ali WA, Bazan NS, Elberry AA, Hussein RRS. A randomized trial to compare procalcitonin and C-reactive protein in assessing severity of sepsis and in guiding antibacterial therapy in Egyptian critically ill patients. Ir J Med Sci 2021; 190:1487-1495. [PMID: 33447966 DOI: 10.1007/s11845-020-02494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/19/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Procalcitonin (PCT) and C-reactive protein (CRP) are the main used biomarkers for sepsis and in guiding antibiotic therapy, although PCT high cost limits its use in developing countries. OBJECTIVE Comparing between PCT and CRP in assessing severity of sepsis and in guiding antibacterial therapy in critically ill patients. METHODS In a prospective randomized study, 60 patients were included from an Egyptian Intensive Care Unit. Patients were divided into CRP and PCT groups. CRP and PCT were measured at baseline and on days 4 and 7. Validity, sensitivity, and specificity of both biomarkers and their correlation with sepsis scores (Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sepsis-related Organ Failure Assessment (SOFA)) were evaluated. Antibacterial continuation at days 4 and 7 was assessed. RESULTS The diagnostic accuracy, specificity, and sensitivity of PCT were higher than CRP (80.79% vs 69.45%, 36% vs 28.7%, 87.6% vs 72.4%, respectively). PCT levels were significantly correlated with APACHE II score (P ≤ 0.0001) and SOFA score (P = 0.005), while CRP levels were not correlated with APACHEII and SOFA scores,(P > 0.05). PCT was associated with less antibacterial exposure (33% stopped their antibiotics on day 4 versus 6% in CRP, P = 0.009). Only 33% continued their antibacterial regimen in PCT group after 7 days versus 83% in CRP group (*P ≤ 0.0001). CONCLUSION PCT is a more accurate diagnostic and prognostic biomarker than CRP in patients with sepsis. PCT significantly shortened patients' exposure to antibacterial therapy and hospital length of stay.
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Affiliation(s)
- Walid A Ali
- Clinical Pharmacy Department, Faculty of Pharmacy, MTI University, Cairo, Egypt
| | - Naglaa S Bazan
- Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt. .,Pharmacy Practice and Clinical Pharmacy Department, Future University in Egypt, Cairo, Egypt.
| | - Ahmed A Elberry
- Clinical Pharmacology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Raghda R S Hussein
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt
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24
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Chen H, Wu S, Zhang X. COVID-19 in China: From epidemiology to treatment (Review). Exp Ther Med 2020; 20:223. [PMID: 33193837 PMCID: PMC7646693 DOI: 10.3892/etm.2020.9353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease caused by the novel coronavirus SARS-CoV-2. It first became prevalent in Wuhan, Hubei, China in December 2019. COVID-19 was initially characterized by pneumonia of unknown etiology, accompanied by fever, dry cough and fatigue. Due to its highly infectious nature it rapidly led to widespread human infection, causing 80,924 confirmed cases and 3,140 mortalities in mainland China as of March 9, 2020. The present review highlights the prevalence of COVID-19 in China, the etiology, pathology, clinical presentation, laboratory and chest imaging tests, and treatment of this disease.
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Affiliation(s)
- Hongtao Chen
- Department of Infectious Diseases, The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong 518020, P.R. China
- Key Laboratory of Pathogenic Microorganisms of Shenzhen, Shenzhen Institute of Respiratory Diseases, Shenzhen, Guangdong 518020, P.R. China
| | - Shipin Wu
- Department of Infectious Diseases, The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Xiaoyong Zhang
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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25
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Mwebe SZ, Yoon C, Asege L, Nakaye M, Katende J, Andama A, Cattamanchi A, Semitala FC. Impact of hematocrit on point-of-care C-reactive protein-based tuberculosis screening among people living with HIV initiating antiretroviral therapy in Uganda. Diagn Microbiol Infect Dis 2020; 99:115281. [PMID: 33453673 DOI: 10.1016/j.diagmicrobio.2020.115281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022]
Abstract
Point-of-care C-reactive protein (POC CRP) testing is a potential tuberculosis (TB) screening tool for people living with HIV (PLHIV). Unlike lab-based assays, POC assays do not routinely adjust CRP levels for hematocrit, potentially resulting in TB screening status misclassification. We compared the diagnostic accuracy of unadjusted and hematocrit-adjusted POC CRP for culture-confirmed TB among PLHIV with CD4 cell-count ≤350 cells/uL initiating antiretroviral therapy (ART) in Uganda. We prospectively enrolled consecutive adults, measured POC CRP (Boditech; normal <8 mg/L), collected two spot sputum specimens for comprehensive TB testing, and extracted pre-ART hematocrit from clinic records. Of the 605 PLHIV included, hematocrit-adjusted POC CRP had similar sensitivity (80% vs 81%, difference +1% [95% CI -3 to +5], P= 0.56) and specificity (71% vs 71%, difference 0% [95% CI -1 to +1], P= 0.56) for culture-confirmed TB, relative to unadjusted POC CRP. When used for TB screening, POC CRP may not require adjustment for hematocrit. However, larger studies may be required if differences close to the clinically meaningful threshold are to be detected.
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Affiliation(s)
- Sandra Z Mwebe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Christina Yoon
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, USA
| | - Lucy Asege
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Martha Nakaye
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jane Katende
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Alfred Andama
- Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, USA
| | - Fred C Semitala
- Infectious Diseases Research Collaboration, Kampala, Uganda; Makerere University Joint AIDS Program (MJAP), Kampala, Uganda; Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
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26
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Ruppert C, Kaiser L, Jacob LJ, Laufer S, Kohl M, Deigner HP. Duplex Shiny app quantification of the sepsis biomarkers C-reactive protein and interleukin-6 in a fast quantum dot labeled lateral flow assay. J Nanobiotechnology 2020; 18:130. [PMID: 32912236 PMCID: PMC7481553 DOI: 10.1186/s12951-020-00688-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/30/2020] [Indexed: 01/09/2023] Open
Abstract
Fast point-of-care (POC) diagnostics represent an unmet medical need and include applications such as lateral flow assays (LFAs) for the diagnosis of sepsis and consequences of cytokine storms and for the treatment of COVID-19 and other systemic, inflammatory events not caused by infection. Because of the complex pathophysiology of sepsis, multiple biomarkers must be analyzed to compensate for the low sensitivity and specificity of single biomarker targets. Conventional LFAs, such as gold nanoparticle dyed assays, are limited to approximately five targets-the maximum number of test lines on an assay. To increase the information obtainable from each test line, we combined green and red emitting quantum dots (QDs) as labels for C-reactive protein (CRP) and interleukin-6 (IL-6) antibodies in an optical duplex immunoassay. CdSe-QDs with sharp and tunable emission bands were used to simultaneously quantify CRP and IL-6 in a single test line, by using a single UV-light source and two suitable emission filters for readout through a widely available BioImager device. For image and data processing, a customized software tool, the MultiFlow-Shiny app was used to accelerate and simplify the readout process. The app software provides advanced tools for image processing, including assisted extraction of line intensities, advanced background correction and an easy workflow for creation and handling of experimental data in quantitative LFAs. The results generated with our MultiFlow-Shiny app were superior to those generated with the popular software ImageJ and resulted in lower detection limits. Our assay is applicable for detecting clinically relevant ranges of both target proteins and therefore may serve as a powerful tool for POC diagnosis of inflammation and infectious events.
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Affiliation(s)
- Christoph Ruppert
- Medical and Life Sciences Faculty, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany.,Institute of Precision Medicine, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany.,Department of Pharmaceutical Chemistry, Pharmaceutical Institute, University of Tuebingen, Auf der Morgenstelle 8, 72076, Tübingen, Germany
| | - Lars Kaiser
- Medical and Life Sciences Faculty, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany.,Institute of Precision Medicine, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany.,Institute of Pharmaceutical Sciences, University of Freiburg, Albertstraße 25, 79104, Freiburg, Germany
| | - Lisa Johanna Jacob
- Medical and Life Sciences Faculty, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany.,Institute of Precision Medicine, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany
| | - Stefan Laufer
- Department of Pharmaceutical Chemistry, Pharmaceutical Institute, University of Tuebingen, Auf der Morgenstelle 8, 72076, Tübingen, Germany
| | - Matthias Kohl
- Medical and Life Sciences Faculty, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany. .,Institute of Precision Medicine, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany.
| | - Hans-Peter Deigner
- Medical and Life Sciences Faculty, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany. .,Institute of Precision Medicine, Furtwangen University, Jakob-Kienzle Str. 17, 78054, Villingen-Schwenningen, Germany. .,EXIM Department, Fraunhofer Institute IZI, Leipzig, Schillingallee 68, 18057, Rostock, Germany. .,Faculty of Science, Tuebingen University, Auf der Morgenstelle 8, 72076, Tübingen, Germany.
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27
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Lin S, Yan YY, Wu YL, Wang MF, Zhu YY, Wang XZ. Development of a novel score for the diagnosis of bacterial infection in patients with acute-on-chronic liver failure. World J Gastroenterol 2020; 26:4857-4865. [PMID: 32921962 PMCID: PMC7459206 DOI: 10.3748/wjg.v26.i32.4857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/18/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The diagnosis of bacterial infection is difficult in patients with acute-on-chronic liver failure (ACLF).
AIM To evaluate the diagnostic accuracy of widely used parameters for bacterial infection in ACLF and to develop a simple scoring system to improve diagnostic efficiency.
METHODS This was a retrospective study. Procalcitonin (PCT), white blood cells (WBC), proportion of neutrophils (N%), and C-reactive protein (CRP) were examined. Logistic regression was used to select variables for the scoring models and receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic value of different indices.
RESULTS This study included 386 patients with ACLF, 169 (43.78%) of whom had bacterial infection on admission. The area under the ROC (AUROC) of PCT, CRP, WBC and N% for the diagnosis of bacterial infection ranged from 0.637 to 0.692, with no significant difference between them. Logistic regression showed that only N%, PCT, and CRP could independently predict infection. A novel scoring system (infection score) comprised of N%, PCT and CRP was developed. The AUROC of the infection score was 0.740, which was significantly higher than that for the other four indices (infection score vs N%, PCT, CRP, and WBC, P = 0.0056, 0.0001, 0.0483 and 0.0008, respectively). The best cutoff point for the infection score was 4 points, with a sensitivity of 78.05%, a specificity of 55.29%, a positive predictive value of 57.91% and a negative predictive value of 76.16%.
CONCLUSION The infection score is a simple and useful tool for discriminating bacterial infection in ACLF.
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Affiliation(s)
- Su Lin
- Department of Gastroenterology, Union Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
| | - Yan-Yan Yan
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Clinical Liver Center, The 180th Hospital of People’s Liberation Army, Quanzhou Fujian Province, 362100, China
| | - Yin-Lian Wu
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
| | - Ming-Fang Wang
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
| | - Yue-Yong Zhu
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
| | - Xiao-Zhong Wang
- Department of Gastroenterology, Union Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
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28
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Zhao D, Yao F, Wang L, Zheng L, Gao Y, Ye J, Guo F, Zhao H, Gao R. A Comparative Study on the Clinical Features of Coronavirus 2019 (COVID-19) Pneumonia With Other Pneumonias. Clin Infect Dis 2020; 71:756-761. [PMID: 32161968 PMCID: PMC7108162 DOI: 10.1093/cid/ciaa247] [Citation(s) in RCA: 288] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background A novel coronavirus (2019-nCoV) has raised world concern since it emerged in Wuhan Hubei China in December, 2019. The infection may result into severe pneumonia with clusters illness onsets. Its impacts on public health make it paramount to clarify the clinical features with other pneumonias. Methods Nineteen 2019-nCoV pneumonia (NCOVID-19) and fifteen other pneumonia patients (NON-NCOVID-19) in out of Hubei places were involved in this study. Both NCOVID-19 and NON-NCOVID-19 patients were confirmed to be infected in throat swabs or/and sputa with or without 2019-nCoV by real-time RT-PCR. We analyzed the demographic, epidemiological, clinical, and radiological features from those patients, and compared the difference between NCOVID-19 and NON-NCOVID-19. Results All patients had a history of exposure to confirmed case of 2019-nCoV or travel to Hubei before illness. The median duration, respectively, was 8 (IQR:6~11) and 5 (IQR:4~11) days from exposure to onset in NCOVID-19 and NON-NCOVID-19. The clinical symptoms were similar between NCOVID-19 and NON-NCOVID-19. The most common symptoms were fever and cough. Fifteen (78.95%) NCOVID-19 but 4 (26.67%) NON-NCOVID-19 patients had bilateral involvement while 17 (89.47%) NCOVID-19 but 1 (6.67%) NON-NCOVID-19 patients had multiple mottling and ground-glass opacity of chest CT images. Compared to NON-NCOVID-19, NCOVID-19 present remarkably more abnormal laboratory tests including AST, ALT, γ-GT, LDH and α-HBDH. Conclusion The 2019-nCoV infection caused similar onsets to other pneumonias. CT scan may be a reliable test for screening NCOVID-19 cases. Liver function damage is more frequent in NCOVID-19 than NON-NCOVID-19 patients. LDH and α-HBDH may be considerable markers for evaluation of NCOVID-19.
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Affiliation(s)
- Dahai Zhao
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Feifei Yao
- Department of Respiratory Medicine, Suzhou Municipal Hospital, Suzhou, Anhui, China
| | - Lijie Wang
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ling Zheng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Yongjun Gao
- NHC Key Laboratory of Biosafety, NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Ye
- Infectious Disease Department, The Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Feng Guo
- Department of Respiratory Medicine, Suzhou Municipal Hospital, Suzhou, Anhui, China
| | - Hui Zhao
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Rongbao Gao
- NHC Key Laboratory of Biosafety, NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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29
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Chen R, Du X, Cui Y, Zhang X, Ge Q, Dong J, Zhao X. Vertical Flow Assay for Inflammatory Biomarkers Based on Nanofluidic Channel Array and SERS Nanotags. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e2002801. [PMID: 32567225 DOI: 10.1002/smll.202002801] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/03/2020] [Indexed: 05/07/2023]
Abstract
There is a great demand for the development of detection assays for inflammation infection diagnosis with high throughput and ultrasensitivity. Herein, a vertical flow assay system with functionalized nanoporous anodic aluminum oxide (AAO) as sensing membrane, and encoded core-shell surface enhanced Raman scattering (SERS) nanotags as labels for multiple inflammatory biomarkers detection is presented. A 2 × 2 test array on the porous AAO is developed and modified with multiple capture antibodies to capture inflammatory biomarkers from samples. Due to the high surface area to volume ratio of the AAO membrane, and its influence on plasmonic coupling, the electromagnetic field of the encoded core-shell SERS nanotags is enhanced. Detection limits of 53.4, 4.72, 48.3, and 7.53 fg mL-1 are realized for C reactive protein, interleukin-6, serum amyloid A, and procalcitonin, respectively, with a linear dynamic range spanning at least five orders of magnitude. In addition, the proposed method also shows acceptable accuracy and repeatability for the detection of clinical samples. Therefore, this approach is expected to be a powerful point of care testing tool for disease diagnosis in facility limited areas.
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Affiliation(s)
- Ruipeng Chen
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
- National Demonstration Center for Experimental Biomedical Engineering Education, Southeast University, Nanjing, 210096, China
- Southeast University Shenzhen Research Institute, Shenzhen, 518000, China
| | - Xin Du
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
| | - Yujun Cui
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
- National Demonstration Center for Experimental Biomedical Engineering Education, Southeast University, Nanjing, 210096, China
- Southeast University Shenzhen Research Institute, Shenzhen, 518000, China
| | - Xieyuan Zhang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
- National Demonstration Center for Experimental Biomedical Engineering Education, Southeast University, Nanjing, 210096, China
- Southeast University Shenzhen Research Institute, Shenzhen, 518000, China
| | - Qinyu Ge
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
- National Demonstration Center for Experimental Biomedical Engineering Education, Southeast University, Nanjing, 210096, China
| | - Jian Dong
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
- National Demonstration Center for Experimental Biomedical Engineering Education, Southeast University, Nanjing, 210096, China
- Southeast University Shenzhen Research Institute, Shenzhen, 518000, China
| | - Xiangwei Zhao
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
- National Demonstration Center for Experimental Biomedical Engineering Education, Southeast University, Nanjing, 210096, China
- Southeast University Shenzhen Research Institute, Shenzhen, 518000, China
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30
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Wang Z, Chen Y, Zhu S, Chen X, Guan J, Yao Y, Wang X, Li Y, Lu F, Gao J, Dong Z. The effects of macrophage‐mediated inflammatory response to the donor site on long‐term retention of a fat graft in the recipient site in a mice model. J Cell Physiol 2020; 235:10012-10023. [DOI: 10.1002/jcp.29816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/30/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Zijue Wang
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Yunzi Chen
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Shengqian Zhu
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Xinyao Chen
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Jingyan Guan
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Yao Yao
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Xinhui Wang
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Ye Li
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Jianhua Gao
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Ziqing Dong
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
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Chen X, Yang Y, Huang M, Liu L, Zhang X, Xu J, Geng S, Han B, Xiao J, Wan Y. Differences between COVID‐19 and suspected then confirmed SARS‐CoV‐2‐negative pneumonia: A retrospective study from a single center. J Med Virol 2020; 92:1572-1579. [PMID: 32237148 DOI: 10.1002/jmv.25810] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Xinyi Chen
- Department of Pathology, Qingdao Central HospitalThe Second Affiliated Hospital of Qingdao University Medical College Qingdao China
| | - Yi Yang
- Department of HematologyChongqing Three Gorges Central Hospital Chongqing China
| | - Min Huang
- Department of Internal Medicine, Baian Branch HospitalChongqing Three Gorges Central Hospital Chongqing China
| | - Lili Liu
- Department of Pathology, Qingdao Central HospitalThe Second Affiliated Hospital of Qingdao University Medical College Qingdao China
| | - Xianxiang Zhang
- Department of EndocrinologyChongqing Three Gorges Central Hospital Chongqing China
| | - Jing Xu
- Department of Pathology, Qingdao Central HospitalThe Second Affiliated Hospital of Qingdao University Medical College Qingdao China
| | - Shaoqing Geng
- Department of Pathology, Qingdao Central HospitalThe Second Affiliated Hospital of Qingdao University Medical College Qingdao China
| | - Bo Han
- The Key Laboratory of Experimental Teratology, Ministry of Education and Department of PathologyShandong University, School of Basic Medical Sciences Jinan China
| | - Jiangfeng Xiao
- Department of LoemologyChongqing Three Gorges Central Hospital Chongqing China
| | - Yanyun Wan
- Department of General Medicine, Baian Branch HospitalChongqing Three Gorges Central Hospital Chongqing China
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Shilpakar R, Paudel BD, Neupane P, Shah A, Acharya B, Dulal S, Wood LA, Shahi R, Khanal U, Poudyal BS. Procalcitonin and C-Reactive Protein As Markers of Bacteremia in Patients With Febrile Neutropenia Who Receive Chemotherapy for Acute Leukemia: A Prospective Study From Nepal. J Glob Oncol 2020; 5:1-6. [PMID: 31526283 PMCID: PMC6872183 DOI: 10.1200/jgo.19.00147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the clinical significance of the biomarkers procalcitonin (PCT) and C-reactive protein (CRP) in patients with febrile neutropenia (FN) undergoing chemotherapy for acute leukemia. METHODS We conducted a prospective, observational study in patients who developed FN while undergoing chemotherapy for acute leukemia. PCT and CRP were obtained in patients who presented with FN. Blood cultures also were obtained. The primary goals were to evaluate the ability of PCT and CRP to predict bacteremia in patients with FN. The secondary goals were to assess the prognostic role of PCT and CRP and to assess the microbiologic profile and culture sensitivity patterns in the study population. RESULTS A total of 124 episodes of FN that involved 67 patients with acute leukemia occurred in the study. PCT was superior to CRP in the prediction of bacteremia. The median PCT level in the bacteremia group was 3.25 ng/mL compared with 0.51 ng/mL in the group without bacteremia (P < .01). The median values of CRP in the bacteremia and without-bacteremia groups were 119.3 mg/L and 94.5 mg/L, respectively (P = .07). There were no differences in median PCT and CRP in patients who died and those who improved. Of the 42 positive cultures, Gram-negative bacteremia was common (86%), and Escherichia coli was the most frequent organism isolated. Carbapenem resistance was seen in 39% of positive cultures. CONCLUSION PCT is an effective biomarker to predict bacteremia in patients with FN undergoing chemotherapy for acute leukemia.
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Affiliation(s)
- Ramila Shilpakar
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | | | | | - Aarati Shah
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Bibek Acharya
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Soniya Dulal
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Lori Anne Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Kortz TB, Nyirenda J, Tembo D, Elfving K, Baltzell K, Bandawe G, Rosenthal PJ, Macfarlane SB, Mandala W, Nyirenda TS. Distinct Biomarker Profiles Distinguish Malawian Children with Malarial and Non-malarial Sepsis. Am J Trop Med Hyg 2020; 101:1424-1433. [PMID: 31595873 DOI: 10.4269/ajtmh.18-0635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Presently, it is difficult to accurately diagnose sepsis, a common cause of childhood death in sub-Saharan Africa, in malaria-endemic areas, given the clinical and pathophysiological overlap between malarial and non-malarial sepsis. Host biomarkers can distinguish sepsis from uncomplicated fever, but are often abnormal in malaria in the absence of sepsis. To identify biomarkers that predict sepsis in a malaria-endemic setting, we retrospectively analyzed data and sera from a case-control study of febrile Malawian children (aged 6-60 months) with and without malaria who presented to a community health center in Blantyre (January-August 2016). We characterized biomarkers for 29 children with uncomplicated malaria without sepsis, 25 without malaria or sepsis, 17 with malaria and sepsis, and 16 without malaria but with sepsis. Sepsis was defined using systemic inflammatory response criteria; biomarkers (interleukin-6 [IL-6], tumor necrosis factor receptor-1, interleukin-1 β [IL-1β], interleukin-10 [IL-10], von Willebrand factor antigen-2, intercellular adhesion molecule-1, and angiopoietin-2 [Ang-2]) were measured with multiplex magnetic bead assays. IL-6, IL-1β, and IL-10 were elevated, and Ang-2 was decreased in children with malaria compared with non-malarial fever. Children with non-malarial sepsis had greatly increased IL-1β compared with the other subgroups. IL-1β best predicted sepsis, with an area under the receiver operating characteristic (AUROC) of 0.71 (95% CI: 0.57-0.85); a combined biomarker-clinical characteristics model improved prediction (AUROC of 0.77, 95% CI: 0.67-0.85). We identified a distinct biomarker profile for non-malarial sepsis and developed a sepsis prediction model. Additional clinical and biological data are necessary to further explore sepsis pathophysiology in malaria-endemic regions.
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Affiliation(s)
- Teresa B Kortz
- Department of Pediatrics, University of California, San Francisco, California.,Institute of Global Health Sciences, University of California, San Francisco, California
| | - James Nyirenda
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Pathology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dumizulu Tembo
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Kristina Elfving
- Department of Infectious Diseases, Institution for Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, University of California, San Francisco, California.,Institute of Global Health Sciences, University of California, San Francisco, California
| | - Gama Bandawe
- Department of Biological Sciences, Malawi University of Science and Technology, Thyolo, Malawi
| | - Philip J Rosenthal
- Department of Medicine, University of California, San Francisco, California
| | - Sarah B Macfarlane
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Wilson Mandala
- Department of Biological Sciences, Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi.,Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Tonney S Nyirenda
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Pathology, College of Medicine, University of Malawi, Blantyre, Malawi
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Deng Y, Qiu T, Patel N, Zhou S, Xue T, Zhang H. Clinical Management of Risk of Radiation Pneumonia with Serum Markers During the Radiotherapy for Patients with Thoracic Malignant Tumors. Cancer Manag Res 2019; 11:10249-10256. [PMID: 31824195 PMCID: PMC6901038 DOI: 10.2147/cmar.s231995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose Risk of radiation pneumonia (RP) could not be effectively detected due to non-specific clinical symptoms in the early stage. The purpose of this investigation was to evaluate serum biomarkers of cytokines interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT) for its early detection in patients with thoracic malignant tumors receiving radiotherapy. Patients and methods The clinical data of 105 patients with thoracic malignant tumors (lung cancer, esophageal carcinoma and mediastinal tumors) treated by radiotherapy were retrospectively analyzed. The patients were divided into RP group and non-RP group according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). The serum level of IL-6 was detected by chemiluminescence, and the level of CRP was measured by nephelometry during radiotherapy. The level of PCT, one of the specific indicators to distinguish infection and non-infectious etiologies, was also detected by chemiluminescence. Results Among 105 patients treated by radiotherapy, 28 developed RP, and the other 77 had no RP. There was no significant difference in the risk of RP between patients’ factors (age, sex, PS score, smoking, tumor type) and treatment factors (chemotherapy, V5, GTV dose). However, chronic obstructive pulmonary disease (COPD), V20 and mean lung dose (MLD) were significantly different between the two groups (χ2 = 4.131, 3.986, 7.830, P < 0.05). Furthermore, PCT levels were also found to have insignificant differences between RP group and non-RP group (P > 0.05). However, there were significant differences between the groups in the levels of IL-6 and CRP (P < 0.05). The IL-6 levels significantly increased earlier than that of conventional CT imaging when patients suffering from RP and peaked at 6 weeks during radiotherapy. CRP had a similar change as IL-6. Single cytokine and combination of IL-6 and CRP possessed a good ability to predict RP with the AUC of IL-6 of 0.89±0.04 (95% CI, 0.80–0.95, P<0.001), CRP of 0.87±0.05 (95% CI, 0.78–0.94, P<0.001), IL-6 + CRP of 0.92 ± 0.03 (95% CI, 0.83–0.97, P < 0.001), respectively. Conclusion The combined detection of serum IL-6, CRP and PCT may be an effectual method for early detection and clinical practice management of risk of RP.
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Affiliation(s)
- Yuxia Deng
- Department of Oncology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Ting Qiu
- Department of Oncology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Nishant Patel
- Department of Oncology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Shi Zhou
- Department of Oncology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Tao Xue
- Department of Cardiothoracic Surgery, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Haijun Zhang
- Department of Oncology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People's Republic of China.,Precision Medical Center, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People's Republic of China
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Paloni JM, Dong XH, Olsen BD. Protein-Polymer Block Copolymer Thin Films for Highly Sensitive Detection of Small Proteins in Biological Fluids. ACS Sens 2019; 4:2869-2878. [PMID: 31702912 DOI: 10.1021/acssensors.9b01020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In nearly all biosensors, sensitivity is greatly reduced for measurements conducted in biological matrices due to nonspecific binding from off-target molecules. One method to overcome this issue is to design a sensor that enables selective size-based uptake of proteins. Herein, a protein-polymer conjugate thin-film biosensor is fabricated that self-assembles into lamellae containing alternating domains of protein and polymer. Analyte is captured in protein regions while polymer domains restrict diffusion of large molecules. Device sensitivity and size-based exclusion properties are probed using two analytes: streptavidin (SA, 52.8 kDa) and monomeric streptavidin (mSA2, 15.6 kDa). Tuning domain spacing by adjusting polymer molecular weight allows the design of films that relatively freely uptake mSA2 and largely restrict SA diffusion. Furthermore, when detecting the smaller mSA2, no reduction in the limit of detection (LOD) is observed when transitioning from detection in the buffer to detection in biological fluids. As a result, LOD measured in fluid samples is reduced by 2 orders of magnitude compared to a traditional surface-immobilized protein monolayer.
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Affiliation(s)
- Justin M. Paloni
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Xue-Hui Dong
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Bradley D. Olsen
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
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Oliveira Perucci L, Pereira Santos TA, Campi Santos P, Ribeiro Teixeira LC, Nessralla Alpoim P, Braga Gomes K, Pires Sousa L, Sant'Ana Dusse LM, Talvani A. Pre-eclampsia is associated with reduced resolvin D1 and maresin 1 to leukotriene B4 ratios in the plasma. Am J Reprod Immunol 2019; 83:e13206. [PMID: 31679164 DOI: 10.1111/aji.13206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/16/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
PROBLEM Omega-3 and omega-6 fatty acids can be endogenously converted into mediators with pro-inflammatory (eg, leukotriene B4/LTB4) or anti-inflammatory/pro-resolving activities (eg, resolvin D1/RvD1 and maresin 1/MaR1). Recent data indicate an imbalance of LTB4 and MaR1 levels in pre-eclampsia (PE), but the relative production of these mediators, including RvD1, and the role of these mediators in the disease pathogenesis remain unclear. Therefore, this study aimed to investigate the plasma levels of LTB4, RvD1, and MaR1 in pregnant women with or without PE and non-pregnant controls and their association with clinical/laboratory parameters of PE women. METHOD OF STUDY LTB4, RvD1, and MaR1 plasma levels were measured by competitive enzyme immunoassay in 19 non-pregnant, 20 normotensive pregnant, and 21 PE women. RESULTS Plasma concentrations of LTB4 were higher and RvD1 were lower in PE women than in normotensive pregnant women, who presented higher levels of LTB4 and similar levels of RvD1 to non-pregnant women. MaR1 levels did not differ among the groups. Pre-eclampsia women had decreased RvD1/LTB4 and MaR1/LTB4 ratios. Considering only the PE group, positive correlations were observed among all the mediators tested, between LTB4 and white blood cell count and between RvD1 and creatinine levels. However, all lipid mediators correlated negatively with body mass index before pregnancy. LTB4 also correlated negatively with maternal age. CONCLUSION Our findings suggest that the PE state results in systemic overproduction of LTB4 in relation to RvD1 and MaR1, and that these lipid mediators may be involved with the disease pathogenesis.
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Affiliation(s)
- Luiza Oliveira Perucci
- Nucleus of Research on Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Talita Adriana Pereira Santos
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Patrícia Campi Santos
- Departament of Microbiology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Lívia Cristina Ribeiro Teixeira
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Patrícia Nessralla Alpoim
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Karina Braga Gomes
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Lirlândia Pires Sousa
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luci Maria Sant'Ana Dusse
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - André Talvani
- Nucleus of Research on Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil.,Departament of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
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Huang Y, Lin C, Luo F, Qiu B, Guo L, Lin Z, Chen G. Ultrasensitive and Portable Assay for Lead(II) Ions by Electronic Balance as a Readout. ACS Sens 2019; 4:2465-2470. [PMID: 31525917 DOI: 10.1021/acssensors.9b01085] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Lead ions (Pb2+) cause harm to human health. Therefore, the development of fast, effective, and convenient sensors for Pb2+ monitoring has received great attention. In this study, a portable method has been proposed for Pb2+ detection using normal electronic balance as a readout. Magnetic bead-catalytic strand is hybridized with platinum nanoparticles (Pt NPs) functioned substrate strand (Pt-Sub) to form double-stranded DNA first. In the presence of Pb2+, the DNAzyme is activated and cleaved at the ribo-adenosine site of the substrate strand and hence causes Pt NPs to be released into the supernatant, which can be easily separated from the Pt-Sub by a magnet. The separated Pt NPs can effectively catalyze the decomposition of H2O2 to produce O2. In a sealed bottle, the pressure inside the bottle is increased by the generation of oxygen so that the water is discharged from the drainage device, and the weight of the water can be easily and precisely measured by a normal electronic balance. The weighting water has a linear relationship with the concentration of Pb2+ in the range of 2.5-100 nM and the detection limit of 0.83 nM (S/N = 3). The proposed method has been applied to detect Pb2+ in water with satisfactory results. Because the electronic balance is one of the most commonly used analytical tools for the laboratory, it is very practical and convenient without the need for expensive instruments and complicated data processing.
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Eckschlager C, Schwenoha K, Roth C, Bogner B, Oostingh GJ. Comparative analysis of high CRP-levels in human blood using point-of-care and laboratory-based methods. Pract Lab Med 2019; 17:e00137. [PMID: 31649989 PMCID: PMC6804588 DOI: 10.1016/j.plabm.2019.e00137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/14/2019] [Accepted: 09/17/2019] [Indexed: 02/03/2023] Open
Abstract
Objectives The use of point-of-care (POC) methods and the measurements of C-reactive protein (CRP) as a diagnostic marker have both increased over the past years. This has led to an increase in POC-methods analysing CRP. High CRP levels are often seen as an indication for the subscription of antibiotics. The quality of POC-systems compared to routine diagnostic measurements for the analysis of CRP is thereby of main importance, since many small practises will use POC-methods. This study compared high-level CRP concentrations (above 100 mg/L) using an i-CHROMATM with 2 routinely used laboratory-based systems (Architect and ABX). Design and Methods: A total of 199 patient samples with a CRP concentration above 100 mg/L were analysed with the i-CHROMATM POC system and the turbidimetric routine methods using the Architect and ABX equipment. Results The results of the i-CHROMATM device showed a significant decrease in the CRP levels compared to those obtained with the Architect and the ABX (i-CHROMATM vs. Architect: y = 0.6792x + 94.701; R2 = 0.4980, i-CHROMATM vs. ABX: y = 0.3674x + 118.05; R2 = 0.3964, Architect vs. ABX: y = 0.7657x + 36.337; R2 = 0.9311). Furthermore, data analysis showed a partition of the i-CHROMATM measurements in two defined clouds, which could not be explained with any of the available sample information. Conclusions This analysis showed the limitations of the i-CHROMATM CRP analyser. In addition, it illustrates the need for strict regulations on the information and output provided by companies regarding the boundaries of novel and existing diagnostic methods.
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Affiliation(s)
- Christiane Eckschlager
- Biomedical Sciences, Salzburg University of Applied Sciences, Urstein Süd 1, 5412, Puch, Salzburg, Austria
| | - Karin Schwenoha
- Biomedical Sciences, Salzburg University of Applied Sciences, Urstein Süd 1, 5412, Puch, Salzburg, Austria
| | - Caroline Roth
- Biomedical Sciences, Salzburg University of Applied Sciences, Urstein Süd 1, 5412, Puch, Salzburg, Austria
| | - Barbara Bogner
- Biomedical Sciences, Salzburg University of Applied Sciences, Urstein Süd 1, 5412, Puch, Salzburg, Austria
| | - Gertie Janneke Oostingh
- Biomedical Sciences, Salzburg University of Applied Sciences, Urstein Süd 1, 5412, Puch, Salzburg, Austria
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Huang D, Lin B, Song Y, Guan Z, Cheng J, Zhu Z, Yang C. Staining Traditional Colloidal Gold Test Strips with Pt Nanoshell Enables Quantitative Point-of-Care Testing with Simple and Portable Pressure Meter Readout. ACS APPLIED MATERIALS & INTERFACES 2019; 11:1800-1806. [PMID: 30571083 DOI: 10.1021/acsami.8b15562] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Traditional immunochromatographic test strips based on colloidal gold are effective devices for portable and low-cost point-of-care (POC) testing. Nevertheless, they still suffer from the limitation of qualitative or semiquantitative tests via naked-eye detection. Replacement of gold with other signal entities, such as magnetic particles or fluorescent particles, requires professional instrumentation to obtain quantitative results. A pressure-based assay with platinum nanoparticles (PtNPs) can provide quantitative results using a portable pressure meter but is also hampered by the long-term instability of PtNPs. Consequently, we developed a Pt-staining method based on test strips to create platinum nanoshells on the surface of colloidal gold. This method not only preserves the original advantages of colloidal gold with easy synthesis and decoration but also introduces PtNPs with excellent catalytic activity as signal labels to achieve sensitive quantitative detection. Myoglobin was tested as a model target, and the limit of detection was 5.47 ng/mL in 20% diluted serum samples, which satisfies the requirements for clinical monitoring of acute myocardial infarction. In addition, the two most common colloidal gold strips available in the marketplace were applied to demonstrate the compatibility of Pt-staining. Taking advantage of low cost, user-friendliness, compatibility, simplicity, and stability, colloidal gold test strips with Pt-staining are expected to satisfy the need for quantitative POC testing of biomarkers, especially in resource-limited regions.
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Affiliation(s)
- Di Huang
- MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, State Key Laboratory of Physical Chemistry of Solid Surfaces, College of Chemistry and Chemical Engineering , Xiamen University , Xiamen 361005 , China
| | - Bingqian Lin
- MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, State Key Laboratory of Physical Chemistry of Solid Surfaces, College of Chemistry and Chemical Engineering , Xiamen University , Xiamen 361005 , China
| | - Yanling Song
- Institute of Molecular Medicine, Renji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai 200127 , China
| | | | - Jie Cheng
- MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, State Key Laboratory of Physical Chemistry of Solid Surfaces, College of Chemistry and Chemical Engineering , Xiamen University , Xiamen 361005 , China
| | - Zhi Zhu
- MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, State Key Laboratory of Physical Chemistry of Solid Surfaces, College of Chemistry and Chemical Engineering , Xiamen University , Xiamen 361005 , China
| | - Chaoyong Yang
- MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, State Key Laboratory of Physical Chemistry of Solid Surfaces, College of Chemistry and Chemical Engineering , Xiamen University , Xiamen 361005 , China
- Institute of Molecular Medicine, Renji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai 200127 , China
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Li Y, Zheng Q, Zou L, Wu J, Guo L, Teng L, Zheng R, Jung LKL, Lu M. Kawasaki disease shock syndrome: clinical characteristics and possible use of IL-6, IL-10 and IFN-γ as biomarkers for early recognition. Pediatr Rheumatol Online J 2019; 17:1. [PMID: 30611297 PMCID: PMC6321686 DOI: 10.1186/s12969-018-0303-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND As an acute febrile and inflammatory disease, Kawasaki disease (KD) could develop Kawasaki disease shock syndrome (KDSS) sometimes. However its pathogenesis was still not well known. This study was to learn more about the clinical features and evaluate the role of cytokines in the pathogenesis of KDSS. METHODS We collected clinical and laboratory data retrospectively for all patients with KDSS(KDSS, n = 27)who were hospitalized at our hospital from Jan 2014 to Oct 2017. For patient with KDSS, we randomly identified 43 patients with KD as control subjects (KD, n = 43). Clinical features, laboratory evaluations were collected. Cytokines IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ in serum were assayed using flow cytometric bead array. RESULTS The patients with KDSS were older age (43.41 ± 31.42 vs 28.81 ± 21.51 months, P < 0.05), longer duration of fever (10.63 ± 5.12 vs 6.98 ± 2.45 days, P < 0.05), higher WBC count, neutrophils, CRP, ESR, PCT and D-dimer, and lower hemoglobin and albumin, more severe hyponatremia and hypokalemia, more refractory to IVIG therapy, more coronary artery abnormalities (CAAs), aseptic meningitis, and longer duration of hospitalization than patients with KD (all P < 0.05). The levels of serum IL-6 [184.1 (27.7-2577.3) vs 54.1 (4-425) pg/ml], IL-10 [42.6 (5-236.7) vs 9.4 (3-94) pg/ml], TNF-α [2.6 (1.0-23.4) vs 2.1 (1-6) pg/ml] and IFN-γ [18.3 (4.5-94.4) vs 6.7 (2-56) pg/ml] in KDSS patients were significant higher than KD patients (all P < 0.05). ROC curves showed that 66.7 pg/ml of IL-6, 20.85 pg/ml of IL-10 and 8.35 pg/ml of IFN-γ had sensitivity and specificity for identifying KDSS as 85.2 and 62.8%; 66.7 and 83.7%; 74.1 and 74.4% respectively. No fatality was recorded in this series. CONCLUSIONS KDSS were characteristic as more cytokine production and prone to developing IVIG non-responsiveness and CAAs. KD patients with IL-6 above 66.7 pg/ml, IL-10 above 20.85 pg/ml, and IFN-γ above 8.35 pg/ml suggested higher risk for KDSS.
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Affiliation(s)
- Yandie Li
- grid.411360.1Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003 China
| | - Qi Zheng
- grid.411360.1Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003 China
| | - Lixia Zou
- grid.411360.1Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003 China
| | - Jianqiang Wu
- grid.411360.1Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003 China
| | - Li Guo
- grid.411360.1Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003 China
| | - Liping Teng
- grid.411360.1Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003 China
| | - Rongjun Zheng
- grid.411360.1Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003 China
| | - Lawrence Kwok Leung Jung
- 0000 0004 0482 1586grid.239560.bDivision of Rheumatology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010 USA
| | - Meiping Lu
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003, China.
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Ryoo SM, Yoo SJ, Kim JS, Yu G, Jung S, Kim YJ, Sohn CH, Kim WY. Factors Predicting Bacterial Infection in Out-of-Hospital Cardiac Arrest Patients Undergoing Targeted Temperature Management. Ther Hypothermia Temp Manag 2018; 9:190-196. [PMID: 30575443 DOI: 10.1089/ther.2018.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The objective of this study was to determine a risk factor for predicting bacterial infection in patients, who survived out-of-hospital cardiac arrest (OHCA), during targeted temperature management (TTM). This prospective registry-based retrospective observational study was conducted from November 2010 to October 2017. We measured several biomarkers such as whole blood cell counts, and levels of C-reactive protein and procalcitonin daily during TTM. The primary outcome was bacterial growth in initial blood or sputum cultures. A total of 116 patients were analyzed in this study. The bacterial growth rate was 32.8% and the procalcitonin levels measured at 24 h from cardiac arrest was significantly higher in the culture-positive group than the culture-negative group (10.6 vs. 2.5 ng/mL, p = 0.017). Area under the receiver operating characteristic curve for procalcitonin obtained after 24 h was 0.727 and the cutoff value was 6.5 ng/mL (odds ratio 9.58 [95% confidential interval, CI 2.21-41.55], p = 0.003). Sensitivity was 71.4% [95% CI 41.9-91.6] and specificity was 79.3% [95% CI 60.3-92.0]. Procalcitonin measured at 24 h from cardiac arrest was associated with bacterial infection in OHCA patients undergoing TTM. Further prospective interventional studies are needed to validate these results.
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Affiliation(s)
- Seung Mok Ryoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Joon Yoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Sung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gina Yu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungmin Jung
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Rigobon AV, Kanagasabai T, Taylor VH. Obesity moderates the complex relationships between inflammation, oxidative stress, sleep quality and depressive symptoms. BMC OBESITY 2018; 5:32. [PMID: 30524737 PMCID: PMC6276225 DOI: 10.1186/s40608-018-0208-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/21/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND The relationship between obesity and depression is complex. This study assessed the impact of body mass index (BMI) on the link between BMI, inflammation, oxidative stress, sleep quality and self-reported depressive symptoms. METHODS We used data from the U.S. National Health and Nutritional Examination Survey 2005-2008 cycles (n = 9133; ≥20y). Depressive symptoms and sleep quality were determined from questionnaires. C-reactive Protein (CRP) was used as a biomarker of inflammation and γ-glutamyltransferase was used to assess oxidative stress. The relationship between depressive symptoms, sleep quality, and biomarkers were assessed with regression models. The moderating effects of BMI and sex were tested. RESULTS BMI was a significant moderator of the relationship between γ-glutamyltransferase and depressive symptoms (p = 0.02), but not CRP or sleep quality. Higher BMI increased odds of depressive symptoms in women (OR (95% CI): 3.92 (1.85-8.30) for BMI ≥25 to < 30 kg/m2; 3.17 (1.53-6.58) for BMI ≥30 to < 35 kg/m2; and 7.38 (2.11-25.76) for BMI ≥35 kg/m2). BMI was also a significant moderator of γ-glutamyltransferase levels in those with vs without depressive symptoms. Those with depressive symptoms had 24% poorer sleep quality compared to those without depressive symptoms after adjusting for inflammation, oxidative stress and other confounders. CONCLUSIONS The link between oxidative stress and depressive symptoms may be particularly relevant for females and people living with obesity. People with depressive symptoms also have a substantial reduction in sleep quality. Thus, research should examine these relationships prospectively to inform and improve the mental health of the adult population in developed countries.
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Affiliation(s)
| | - Thirumagal Kanagasabai
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Valerie H. Taylor
- Women’s College Research Institute, University of Toronto, Toronto, Canada
- Women’s College Hospital, 76 Grenville Street Room E947, Toronto, ON M5S 1B2 Canada
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Lin J, Chen L, Lin J, Wu H, Okunieff P, Wu B, Yang B, Chen J, Lin J, Zhang L. A novel approach for fast detection of sepsis with Gram-negative bacterial infection. Microb Biotechnol 2018; 11:1121-1123. [PMID: 30346117 PMCID: PMC6196396 DOI: 10.1111/1751-7915.13314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/24/2018] [Accepted: 08/26/2018] [Indexed: 01/17/2023] Open
Abstract
Sepsis, a life-threatening systemic infection, requires quick treatment. Gram-negative bacteria (GNB) are the major causative pathogens and their endotoxin can be a surrogate biomarker for diagnosis. We explored a fast identification of GNB by first culturing blood to increase endotoxin levels and then detecting endotoxin by Tachypleus amebocyte lysate (TAL) with kinetic turbidimetric assay (KT-TAL). Heating samples could significantly increase the endotoxin released from GNB; speed and time of centrifugation, and sample dilution could affect the endotoxin results. At a high GNB load, endotoxin was detected 3 h after culture, 6.5 h earlier than the BD BACTEC blood culture system detecting GNB. At a low GNB load, endotoxin was detected at 9 h after culture, 13 h earlier than by the BD BACTEC system. In a sepsis patient with Acinetobacter baumannii, we detected endotoxin at 12 h after culture, while the BD BACTEC system needed 28.5 h for detection, allowing physicians an earlier decision on appropriate treatment.
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Affiliation(s)
- Jingan Lin
- First Affiliated Hospital of Fujian Medical UniversityFuzhou350005China
- Fujian key Lab of Individualized Active ImmunotherapyFuzhou350005China
- Key Lab of Radiation Biology of Fujian Province UniversitiesFuzhou350005China
| | - Long Chen
- First Affiliated Hospital of Fujian Medical UniversityFuzhou350005China
- Fujian key Lab of Individualized Active ImmunotherapyFuzhou350005China
- Key Lab of Radiation Biology of Fujian Province UniversitiesFuzhou350005China
| | - Jiansen Lin
- Xiamen Bioendo Technology Co., Ltd.Xiamen361002China
| | - Haiping Wu
- Xiamen Bioendo Technology Co., Ltd.Xiamen361002China
| | - Paul Okunieff
- Department of Radiation OncologyCollege of MedicineUniversity of FloridaGainesvilleFL32610USA
| | - Bing Wu
- First Affiliated Hospital of Fujian Medical UniversityFuzhou350005China
- Fujian key Lab of Individualized Active ImmunotherapyFuzhou350005China
- Key Lab of Radiation Biology of Fujian Province UniversitiesFuzhou350005China
| | - Bing Yang
- First Affiliated Hospital of Fujian Medical UniversityFuzhou350005China
- Fujian key Lab of Individualized Active ImmunotherapyFuzhou350005China
- Key Lab of Radiation Biology of Fujian Province UniversitiesFuzhou350005China
| | - Jinrong Chen
- First Affiliated Hospital of Fujian Medical UniversityFuzhou350005China
- Fujian key Lab of Individualized Active ImmunotherapyFuzhou350005China
- Key Lab of Radiation Biology of Fujian Province UniversitiesFuzhou350005China
| | - Jianhua Lin
- First Affiliated Hospital of Fujian Medical UniversityFuzhou350005China
- Fujian key Lab of Individualized Active ImmunotherapyFuzhou350005China
- Key Lab of Radiation Biology of Fujian Province UniversitiesFuzhou350005China
| | - Lurong Zhang
- First Affiliated Hospital of Fujian Medical UniversityFuzhou350005China
- Fujian key Lab of Individualized Active ImmunotherapyFuzhou350005China
- Key Lab of Radiation Biology of Fujian Province UniversitiesFuzhou350005China
- Department of Radiation OncologyCollege of MedicineUniversity of FloridaGainesvilleFL32610USA
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Ingram JR, Cawley S, Coulman E, Gregory C, Thomas‐Jones E, Pickles T, Cannings‐John R, Francis NA, Harding K, Hood K, Piguet V. Levels of wound calprotectin and other inflammatory biomarkers aid in deciding which patients with a diabetic foot ulcer need antibiotic therapy (INDUCE study). Diabet Med 2018; 35:255-261. [PMID: 28734103 PMCID: PMC5811820 DOI: 10.1111/dme.13431] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Four inflammatory biomarkers were investigated to develop a composite algorithm for mildly infected diabetic foot ulcers: venous white cell count, C-reactive protein (CRP) and procalcitonin, and a novel wound exudate calprotectin assay. Calprotectin is a marker of neutrophilic inflammation. METHODS In a prospective study, people with uninfected or mildly infected diabetic foot ulcers who had not received oral antibiotics in the preceding 2 weeks were recruited from community podiatry clinics for measurement of inflammatory biomarkers. Antibiotic prescribing decisions were based on clinicians' baseline assessments and participants were reviewed 1 week later; ulcer infection was defined by clinicians' overall impression from their two assessments. RESULTS Some 363 potential participants were screened, of whom 67 were recruited, 29 with mildly infected diabetic foot ulcers and 38 with no infection. One participant withdrew early in each group. Ulcer area was 1.32 cm2 [interquartile range (IQR) 0.32-3.61 cm2 ] in infected ulcers and 0.22 cm2 (IQR 0.09-1.46 cm2 ) in uninfected ulcers. Baseline CRP for mild infection was 9.00 mg/ml and 6.00 mg/ml for uninfected ulcers; most procalcitonin levels were undetectable. Median calprotectin level in infected diabetic foot ulcers was 1437 ng/ml and 879 ng/ml in uninfected diabetic foot ulcers. Area under the receiver operating characteristic curve for a composite algorithm incorporating calprotectin, CRP, white cell count and ulcer area was 0.68 (95% confidence intervals 0.52-0.82), sensitivity 0.64, specificity 0.81. CONCLUSIONS A composite algorithm including CRP, calprotectin, white cell count and ulcer area may help to distinguish uninfected from mildly infected diabetic foot ulcers. Venous procalcitonin is unhelpful for mild diabetic foot ulcer infection.
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Affiliation(s)
- J. R. Ingram
- Division of Infection and ImmunityCardiff UniversityCardiffUK
| | - S. Cawley
- Podiatry DepartmentCardiff and Vale University Health BoardCardiffUK
| | - E. Coulman
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - C. Gregory
- Division of Population MedicineCardiff UniversityCardiffUK
| | - E. Thomas‐Jones
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - T. Pickles
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - R. Cannings‐John
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - N. A. Francis
- Division of Population MedicineCardiff UniversityCardiffUK
| | - K. Harding
- Division of Population MedicineCardiff UniversityCardiffUK
| | - K. Hood
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - V. Piguet
- Division of Infection and ImmunityCardiff UniversityCardiffUK
- Division of DermatologyWomen's College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
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Chaemsaithong P, Romero R, Docheva N, Chaiyasit N, Bhatti G, Pacora P, Hassan SS, Yeo L, Erez O. Comparison of rapid MMP-8 and interleukin-6 point-of-care tests to identify intra-amniotic inflammation/infection and impending preterm delivery in patients with preterm labor and intact membranes . J Matern Fetal Neonatal Med 2018; 31:228-244. [PMID: 28081646 PMCID: PMC5769687 DOI: 10.1080/14767058.2017.1281904] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Among patients presenting with preterm labor and intact membranes, those with intra-amniotic inflammation have adverse obstetrical and neonatal outcomes. The diagnosis of intra-amniotic inflammation can easily be made by detecting an elevated concentration of the cytokine interleukin (IL)-6 or the enzyme neutrophil collagenase, also known as matrix metalloproteinase (MMP)-8. The diagnostic performances of MMP-8 and IL-6 enzyme-linked immunosorbent assay tests are similar. Recently, a rapid test has become available for point-of-care determination of either MMP-8 or IL-6. The objectives of this study were to compare the diagnostic indices and predictive values between the rapid MMP-8 and IL-6 tests for the identification of intra-amniotic inflammation in patients with preterm labor and intact membranes. MATERIALS AND METHODS We performed a retrospective cohort study including 124 women with singleton pregnancies who presented with symptoms of preterm labor and underwent transabdominal amniocentesis for the evaluation of microbial invasion of the amniotic cavity (MIAC). MIAC was defined according to amniotic fluid culture results (aerobic and anaerobic bacteria as well as genital Mycoplasmas). Amniotic fluid white blood cell (WBC) counts were determined using a hemocytometer chamber. An elevated amniotic fluid MMP-8 concentration was assessed using Yoon's MMP-8 Check® (cutoff: 10 ng/mL). An elevated amniotic fluid IL-6 concentration was scored when there was a positive result for the lateral flow-based immunoassay (cutoff: ≥745 pg/mL and ≥1000 pg/mL). In order to objectively compare rapid MMP-8 and rapid IL-6 tests to identify intra-amniotic inflammation, an amniotic fluid WBC count of ≥50 cells/mm3 was used to define intra-amniotic inflammation. RESULTS (1) The rapid tests had the same sensitivity for the detection of intra-amniotic inflammation [85.7% (18/21) for all]; (2) the specificity of the rapid MMP-8 test was higher than that of the rapid IL-6 test (cutoff: 745 pg/mL) for the identification of intra-amniotic inflammation [72.8% (75/103) vs. 64.1% (66/103); p < 0.05]; and (3) there were no differences in the sensitivity and specificity between the rapid MMP-8 test and the rapid IL-6 test (cutoff:1000 pg/mL) in the identification of intra-amniotic inflammation. Of 13 patients with discrepant results between the rapid MMP-8 and rapid IL-6 tests, two had a positive MMP-8 but a negative rapid IL-6 test, and both delivered preterm - one within 24 h, and the other within 10 days - and both had acute histologic chorioamnionitis. On the other hand, there were 11 patients with a positive rapid IL-6 but a negative rapid MMP-8 result: 10 delivered preterm, 3 had acute histologic chorioamnionitis and 1 had subacute chorionitis. CONCLUSION We conclude that the rapid MMP-8 test has a better specificity than the rapid IL-6 (cutoff: 745 pg/mL) assay for the detection of intra-amniotic infection. Moreover, we observed that among patients who were not identified as having intra-amniotic infection or inflammation by the standard cultivation technique and amniotic fluid WBC count, those who had a positive MMP-8 rapid test delivered preterm and had acute histologic chorioamnionitis.
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Affiliation(s)
- Piya Chaemsaithong
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Nikolina Docheva
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Noppadol Chaiyasit
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Percy Pacora
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Abstract
Early diagnosis of sepsis is critical for successful treatment. The clinical value of DcR3 in early diagnosis of sepsis was determined in a dynamic follow-up study. Alterations in plasma levels of DcR3, PCT, CRP, and IL-6 were measured by ELISA and compared among patients with sepsis (n = 134), SIRS (n = 60) and normal adults (n = 50). Correlations and dynamic patterns among the biomarkers, APACHE II scores, clinical outcomes, and pathogens were also examined. Plasma DcR3 was significantly increased in sepsis compared to SIRS and normal adults (median 3.87 vs. 1.28 and 0.17 ng/ml). The elevated DcR3 could be detected in 97.60% sepsis patients 1–2 days prior to the result of blood culture reported. For diagnosis of sepsis, the sensitivity was 97.69% and specificity 98.04%; and for differential diagnosis of sepsis from SIRS, the sensitivity was 90.77% and specificity 98.40%. DcR3 level was positively correlated with severity of sepsis (rs = 0.82). In 41 patients who died of sepsis, DcR3 elevated as early as 1–2 days before blood culture and peaked on day 3 after blood culture performed. In 90% of sepsis patients, the dynamic alteration pattern of DcR3 was identical to that of PCT, while pattern of 10% patients differed in which clinical data was consistent with DcR3. In 13% sepsis patients, while PCT remained normal, DcR3 levels were at a high level. DcR3 levels had no difference among various pathogens infected. DcR3, a new biomarker, will aid in early diagnosis of sepsis and monitoring its outcome, especially when sepsis patients were PCT negative.
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Seshadri P, Manoli K, Schneiderhan-Marra N, Anthes U, Wierzchowiec P, Bonrad K, Di Franco C, Torsi L. Low-picomolar, label-free procalcitonin analytical detection with an electrolyte-gated organic field-effect transistor based electronic immunosensor. Biosens Bioelectron 2017; 104:113-119. [PMID: 29331425 DOI: 10.1016/j.bios.2017.12.041] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/21/2017] [Accepted: 12/24/2017] [Indexed: 02/07/2023]
Abstract
Herein a label-free immunosensor based on electrolyte-gated organic field-effect transistor (EGOFET) was developed for the detection of procalcitonin (PCT), a sepsis marker. Antibodies specific to PCT were immobilized on the poly-3-hexylthiophene (P3HT) organic semiconductor surface through direct physical adsorption followed by a post-treatment with bovine serum albumin (BSA) which served as the blocking agent to prevent non-specific adsorption. Antibodies together with BSA (forming the whole biorecognition layer) served to selectively capture the procalcitonin target analyte. The entire immunosensor fabrication process was fast, requiring overall 45min to be completed before analyte sensing. The EGOFET immunosensor showed excellent electrical properties, comparable to those of bare P3HT based EGOFET confirming reliable biosensing with bio-functional EGOFET immunosensor. The detection limit of the immunosensor was as low as 2.2pM and within a range of clinical relevance. The relative standard deviation of the individual calibration data points, measured on immunosensors fabricated on different chips (reproducibility error) was below 7%. The developed immunosensor showed high selectivity to the PCT analyte which was evident through control experiments. This report of PCT detection is first of its kind among the electronic sensors based on EGOFETs. The developed sensor is versatile and compatible with low-cost fabrication techniques.
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Affiliation(s)
- Preethi Seshadri
- Dipartimento di Chimica - Università degli Studi di Bari "A. Moro", via Orabona, 4, 70125 Bari, Italy
| | - Kyriaki Manoli
- Dipartimento di Chimica - Università degli Studi di Bari "A. Moro", via Orabona, 4, 70125 Bari, Italy
| | - Nicole Schneiderhan-Marra
- Natural and Medical Sciences Institute (NMI) at the University of Tuebingen, Markwiesenstr 55, 72770 Reutlingen, Germany
| | - Uwe Anthes
- Merck KGaA, Frankfurter Str 250, 64271 Darmstadt, Germany
| | | | - Klaus Bonrad
- Merck KGaA, Frankfurter Str 250, 64271 Darmstadt, Germany
| | - Cinzia Di Franco
- CNR - Istituto di Fotonica e Nanotecnologie, Sede di Bari, Italy
| | - Luisa Torsi
- Dipartimento di Chimica - Università degli Studi di Bari "A. Moro", via Orabona, 4, 70125 Bari, Italy; The Faculty of Science and Engineering, Åbo Akademi University, Biskopsgatan 8 Åbo 20500, Turku, Finland.
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Lee JY, Son M, Kang JH, Choi UY. Serum interleukin-6 levels as an indicator of aseptic meningitis among children with enterovirus 71-induced hand, foot and mouth disease. Postgrad Med 2017; 130:258-263. [DOI: 10.1080/00325481.2018.1416257] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Joo Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Minji Son
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ui Yoon Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Pediatrics, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Hackner K, Riegler W, Handzhiev S, Bauer R, Veres J, Speiser M, Meisinger K, Errhalt P. Fever after bronchoscopy: serum procalcitonin enables early diagnosis of post-interventional bacterial infection. BMC Pulm Med 2017; 17:156. [PMID: 29179755 PMCID: PMC5704393 DOI: 10.1186/s12890-017-0508-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/17/2017] [Indexed: 01/14/2023] Open
Abstract
Background The aim of this study was to differentiate unspecific and self-limiting fever after bronchoscopy from fever due to infection by using serum procalcitonin, C-reactive protein and neutrophil count. Furthermore, frequency of fever after bronchoscopy and procedures as possible risk factors were evaluated. Methods Three hundred and fourteen consecutive patients were included. All bronchoscopies were performed using jet-ventilation and general anesthesia. Patients were analyzed according to interventions performed during bronchoscopy and laboratory results. Microbiological assessment was done in patients who developed fever to prove or rule out a bacterial infection. Results Forty-four patients showed fever within 24 h following bronchoscopy (14%). A bacterial infection was proven in 11 patients with fever (3.5%). Procalcitonin, neutrophil count and C-reactive protein were significantly higher in patients with fever after bronchoscopy compared to non-fever patients. To predict bacterial infection in the receiver operating analysis, procalcitonin had the highest area under the curve (0.942; 95% confidence interval [CI], 0.768 to 1.000; p = <0.001), followed by neutrophil count (AUC, 0.804; 95% CI, 0.606 to 0.946; p = 0.005), whereas CRP levels where not statistically significant. Endoscopic airway recanalization was the only intervention that induced fever more frequently than all other interventions (OR 13.629). Conclusions Fever is frequently seen after bronchoscopy and in some cases caused by bacterial infection. Procalcitonin might be useful to distinguish a bacterial infection from unspecific self-limiting fever. Airway recanalization is a procedure that seems to induce fever significantly more often than other bronchoscopic interventions.
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Affiliation(s)
- Klaus Hackner
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria. .,Karl Landsteiner University of Health Science, Krems, Austria.
| | - Waltraud Riegler
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Sabin Handzhiev
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Rosemarie Bauer
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Jan Veres
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Manuela Speiser
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Karin Meisinger
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Peter Errhalt
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
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Yoon C, Semitala FC, Atuhumuza E, Katende J, Mwebe S, Asege L, Armstrong DT, Andama AO, Dowdy DW, Davis JL, Huang L, Kamya M, Cattamanchi A. Point-of-care C-reactive protein-based tuberculosis screening for people living with HIV: a diagnostic accuracy study. THE LANCET. INFECTIOUS DISEASES 2017; 17:1285-1292. [PMID: 28847636 PMCID: PMC5705273 DOI: 10.1016/s1473-3099(17)30488-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/30/2017] [Accepted: 07/18/2017] [Indexed: 01/18/2023]
Abstract
Background Symptom-based screening for tuberculosis (TB) is recommended for all people living with HIV (PLHIV) resulting in unnecessary Xpert MTB/RIF testing for the vast majority of individuals living in TB endemic areas and thus, poor implementation of intensified case finding (ICF) and TB preventive therapy. Novel approaches to TB screening are therefore critical in achieving global targets for TB elimination. Methods In a prospective study of PLHIV with CD4+ T-cell count ≤350 cells/uL initiating antiretroviral therapy (ART) from two HIV/AIDS clinics in Uganda, we evaluated the performance of C-reactive protein (CRP) measured using a rapid and inexpensive point-of-care (POC) assay as a screening tool for active pulmonary TB. Findings Of 1177 HIV-infected adults (median CD4+ T-cell count 168 cells/µL) enrolled, 163 (14%) had culture-confirmed TB. POC CRP had 89% (145/163) sensitivity and 72% (731/1014) specificity for culture-confirmed TB. Compared to the WHO symptom screen, POC CRP had lower sensitivity (difference −7% [95% CI: −12 to −2], p=0.002) but substantially higher specificity (difference +58% [95% CI: +61 to +55], p<0.0001). When Xpert MTB/RIF results were used as the reference standard, sensitivity of POC CRP and the WHO symptom screen were similar (94% [79/84] vs. 99% [83/84]; difference −5% [95% CI: −12 to +2], p=0.10). Interpretation The performance characteristics of CRP support its use as a TB screening test for PLHIV with CD4+ T-cell count ≤350 cells/µL initiating ART. HIV/AIDS programs should consider POC CRP-based TB screening to improve the efficiency of ICF and increase uptake of TB preventive therapy. FUNDING National Institutes of Health; Presidential Emergency Plan for AIDS Relief; University of California, San Francisco, Nina Ireland Program for Lung Health
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Affiliation(s)
- Christina Yoon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - Fred C Semitala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Makerere University Joint AIDS Program, Kampala, Uganda
| | - Elly Atuhumuza
- Makerere University-University of California, San Francisco Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
| | - Jane Katende
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Sandra Mwebe
- Makerere University-University of California, San Francisco Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
| | - Lucy Asege
- Makerere University-University of California, San Francisco Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
| | | | - Alfred O Andama
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Makerere University-University of California, San Francisco Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
| | - David W Dowdy
- Department of Epidemiology, Division of Infectious Disease Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Luke Davis
- School of Medicine, Department of Medicine, Pulmonary, Critical Care, and Sleep Medicine Section, Yale University, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale University, School of Public Health, New Haven, CT, USA
| | - Laurence Huang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Medicine, HIV/AIDS, Infectious Diseases and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Makerere University-University of California, San Francisco Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
| | - Moses Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Makerere University Joint AIDS Program, Kampala, Uganda
| | - Adithya Cattamanchi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Curry International Tuberculosis Center, University of California, San Francisco, Oakland, CA, USA
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