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Marin MJ, van Wijk XMR, Chambliss AB. Advances in sepsis biomarkers. Adv Clin Chem 2024; 119:117-166. [PMID: 38514209 DOI: 10.1016/bs.acc.2024.02.003] [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] [Indexed: 03/23/2024]
Abstract
Sepsis, a dysregulated host immune response to an infectious agent, significantly increases morbidity and mortality for hospitalized patients worldwide. This chapter reviews (1) the basic principles of infectious diseases, pathophysiology and current definition of sepsis, (2) established sepsis biomarkers such lactate, procalcitonin and C-reactive protein, (3) novel, newly regulatory-cleared/approved biomarkers, such as assays that evaluate white blood cell properties and immune response molecules, and (4) emerging biomarkers and biomarker panels to highlight future directions and opportunities in the diagnosis and management of sepsis.
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Affiliation(s)
- Maximo J Marin
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Allison B Chambliss
- Department of Pathology & Laboratory Medicine, University of California Los Angeles, Los Angeles, California, USA
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Pruthviraja D, Nagaraju SC, Mudligiriyappa N, Raisinghani MS, Khan SB, Alkhaldi NA, Malibari AA. Detection of Alzheimer's Disease Based on Cloud-Based Deep Learning Paradigm. Diagnostics (Basel) 2023; 13:2687. [PMID: 37627946 PMCID: PMC10453097 DOI: 10.3390/diagnostics13162687] [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: 06/28/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Deep learning is playing a major role in identifying complicated structure, and it outperforms in term of training and classification tasks in comparison to traditional algorithms. In this work, a local cloud-based solution is developed for classification of Alzheimer's disease (AD) as MRI scans as input modality. The multi-classification is used for AD variety and is classified into four stages. In order to leverage the capabilities of the pre-trained GoogLeNet model, transfer learning is employed. The GoogLeNet model, which is pre-trained for image classification tasks, is fine-tuned for the specific purpose of multi-class AD classification. Through this process, a better accuracy of 98% is achieved. As a result, a local cloud web application for Alzheimer's prediction is developed using the proposed architectures of GoogLeNet. This application enables doctors to remotely check for the presence of AD in patients.
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Affiliation(s)
- Dayananda Pruthviraja
- Department of Information Technology, Manipal Institute of Technology Bengaluru, Manipal Academy of Higher Education, Manipal 576104, India
| | - Sowmyarani C. Nagaraju
- Department of Computer Science and Engineering, R V College of Engineering, Bengaluru 560059, India
| | - Niranjanamurthy Mudligiriyappa
- Department of Artificial Intelligence and Machine Learning, BMS Institute of Technology and Management, Bengaluru 560064, India
| | | | - Surbhi Bhatia Khan
- Department of Data Science, School of Science, Engineering and Environment, University of Salford, Manchester M54WT, UK
| | - Nora A. Alkhaldi
- Department of Computer Science, College of Computer Science and Information Technology, King Faisal University, Al Ahsa 31982, Saudi Arabia
| | - Areej A. Malibari
- Department of Industrial and Systems Engineering, College of Engineering, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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Pupysheva AF, Savelyeva EI, Piskunova VV, Lenyushkina AA, Nikitina IV, Goncharuk OD, Krogh-Jensen OA. Fecal Calprotectin Levels Dynamics in Newborns with High-Risk of Necrotizing Enterocolitis. PEDIATRIC PHARMACOLOGY 2023. [DOI: 10.15690/pf.v20i1.2529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Background. Necrotizing enterocolitis (NEC) is severe gastrointestinal disease in newborns, its early clinical symptoms are nonspecific. Fecal сalprotectin (Cp) is considered as one of the early biomarkers of NEC, thus, its use in newborns is poorly known.Objective. The aim of the study is to evaluate clinical significance of fecal Cp measuring as an early NEC marker in newborns. Methods. The prospective cohort observational study included high-risk newborns (gestational age (GA) ˂ 33 weeks and/or body weight ˂ 1500 g) and moderate risk newborns (GV≥ 33 weeks at suspicion on NEC) of NEC admitted to the neonatal intensive care unit on the 1st day of life. The Cp level was studied via immune colorimetric method on the 3rd and 7th days of life in high-risk children and in all children at NEC manifestation. All patients were divided into 2 main subgroups after the end of the follow-up period: newborns with developed NEC (a) and children without NEC (b). Obtained Cp values were compared between these subgroups.Results. There were no statistically significant differences in Cp levels at the 3rd and 7th days of life in the high-risk group of children with NEC and without NEC. However, it was noted that children without NEC showed a decrease in Cp levels on the 7th day, while children with NEC manifestation, indeed, had increased levels. Cp levels did not differ in the moderate risk group.Conclusion. Single measurement of Cp level in newborns of any GA is uninformative towards the NEC prognosis and diagnosis. However, evaluation of the Cp level dynamics at the 7th day of life compared to the 3rd day of life may be considered as a promising non-invasive method for prognosis of NEC manifestation in premature infants (GA<33 weeks).
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Affiliation(s)
- Anna F. Pupysheva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov
| | | | | | - Anna A. Lenyushkina
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov
| | - Irina V. Nikitina
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov
| | - Olga D. Goncharuk
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov
| | - Olga A. Krogh-Jensen
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov;
Sechenov First Moscow State Medical University
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Ma J, Chen X, Wang X, Liang J, Guo L, Su Y, Hao L, Ren C. The accuracy of soluble urokinase-type plasminogen activator receptor for the diagnosis of neonatal sepsis: a meta-analysis. Front Med (Lausanne) 2023; 10:1169114. [PMID: 37181361 PMCID: PMC10174239 DOI: 10.3389/fmed.2023.1169114] [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: 02/18/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Background Neonatal sepsis is one of the major causes of morbidity and mortality in newborns. However, atypical clinical manifestations and symptoms make the early diagnosis of neonatal sepsis a challenge. Relatively high-serum soluble urokinase-type plasminogen activator receptor (suPAR) has been implicated as a diagnostic biomarker for adult sepsis. Therefore, the meta-analysis is intended to explore the diagnostic value of suPAR for neonatal sepsis. Methods The PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, China Biological Medicine Disk, and Wanfang databases were retrieved from inception to 31 December 2022 to collect diagnostic accuracy studies about suPAR for neonatal sepsis. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in the included studies using the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool. Then, a meta-analysis was performed using Stata 15.0 software. Results A total of six articles involving eight studies were included. The results of the meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.89 [95%CI (0.83-0.93)], 0.94 [95%CI (0.77-0.98)], 14 [95%CI (3.5-55.2)], 0.12 [95%CI (0.08-0.18)], and 117 [95%CI (24-567)], respectively. The area under the curve (AUC) of summary receiver operator characteristic (SROC) curves was 0.92 [95%CI (0.90-0.94)]. Sensitivity analysis confirmed the stability of the results, and publication bias was not observed. Fagan's nomogram results demonstrated the clinical availability of the findings. Conclusion Current evidence suggests that suPAR has potential diagnostic value for neonatal sepsis. Owing to the limited quality of the included studies, more high-quality studies are needed to verify the above conclusion.
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Shastry KA, Vijayakumar V, V MKM, B A M, B N C. Deep Learning Techniques for the Effective Prediction of Alzheimer’s Disease: A Comprehensive Review. Healthcare (Basel) 2022; 10:healthcare10101842. [PMID: 36292289 PMCID: PMC9601959 DOI: 10.3390/healthcare10101842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
“Alzheimer’s disease” (AD) is a neurodegenerative disorder in which the memory shrinks and neurons die. “Dementia” is described as a gradual decline in mental, psychological, and interpersonal qualities that hinders a person’s ability to function autonomously. AD is the most common degenerative brain disease. Among the first signs of AD are missing recent incidents or conversations. “Deep learning” (DL) is a type of “machine learning” (ML) that allows computers to learn by doing, much like people do. DL techniques can attain cutting-edge precision, beating individuals in certain cases. A large quantity of tagged information with multi-layered “neural network” architectures is used to perform analysis. Because significant advancements in computed tomography have resulted in sizable heterogeneous brain signals, the use of DL for the timely identification as well as automatic classification of AD has piqued attention lately. With these considerations in mind, this paper provides an in-depth examination of the various DL approaches and their implementations for the identification and diagnosis of AD. Diverse research challenges are also explored, as well as current methods in the field.
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Affiliation(s)
- K Aditya Shastry
- Department of Information Science and Engineering, Nitte Meenakshi Institute of Technology, Bangalore 560064, India
- Correspondence: (K.A.S.); (V.V.)
| | - V Vijayakumar
- School of Computer Science and Engineering, The University of New South Wales, Sydney, NSW 2052, Australia
- School of NUOVOS, Ajeenkya D Y Patil University, Pune 412105, India
- Swiss School of Business and Management, 1213 Geneva, Switzerland
- Correspondence: (K.A.S.); (V.V.)
| | - Manoj Kumar M V
- Department of Information Science and Engineering, Nitte Meenakshi Institute of Technology, Bangalore 560064, India
| | - Manjunatha B A
- Department of Information Science and Engineering, Nitte Meenakshi Institute of Technology, Bangalore 560064, India
| | - Chandrashekhar B N
- Department of Information Science and Engineering, Nitte Meenakshi Institute of Technology, Bangalore 560064, India
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Liu Y, Zhang Y, Lu Y, Li HT, Yu C. Development and Validation of a Prognostic Nomogram to Predict 30-Day Mortality Risk in Patients with Sepsis-Induced Cardiorenal Syndrome. KIDNEY DISEASES (BASEL, SWITZERLAND) 2022; 8:334-346. [PMID: 36157260 PMCID: PMC9386441 DOI: 10.1159/000524483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/30/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Sepsis-induced cardiorenal syndrome (sepsis-induced CRS) is a devastating medical condition that is frequently associated with a high fatality rate. In this study, we aimed to develop an individualized nomogram that may help clinicians assess 30-day mortality risk in patients diagnosed with sepsis-induced CRS. METHODS A total of 340 patients with sepsis-induced CRS admitted from January 2015 to May 2019 in Shanghai Tongji Hospital were used as a training cohort to develop a nomogram prognostic model. The model was constructed using multivariable logistic analyses and was then externally validated by an independent cohort of 103 patients diagnosed with sepsis-induced CRS from June 2019 to December 2020. The prognostic ability of the nomogram was assessed through discrimination, calibration, and accuracy. RESULTS Five prognostic factors were determined and included in the nomogram: age, Sequential (sepsis-related) Organ Failure Assessment (SOFA) score, vasopressors, baseline serum creatinine, and the rate of change in myoglobin. Our prognostic nomogram showed well-fitted calibration curves and yielded strong discrimination power with the area under the curve of 0.879 and 0.912 in model development and validation, respectively. In addition, the nomogram prognostic model exhibited an evidently higher predictive accuracy than the SOFA score. CONCLUSIONS We developed a prognostic nomogram model for patients with sepsis-induced CRS and externally validated the model in another independent cohort. The nomogram exhibited greater strength in predicting 30-day mortality risk than the SOFA score, which may help clinicians estimate short-term prognosis and modulate therapeutic strategies.
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Affiliation(s)
- Yiguo Liu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingying Zhang
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuqiu Lu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hao Tian Li
- Faculty of Science, University of Western Ontario, London, Ontario, Canada
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Pathak N, Vimal SK, Tandon I, Agrawal L, Hongyi C, Bhattacharyya S. Neurodegenerative Disorders of Alzheimer, Parkinsonism, Amyotrophic Lateral Sclerosis and Multiple Sclerosis: An Early Diagnostic Approach for Precision Treatment. Metab Brain Dis 2022; 37:67-104. [PMID: 34719771 DOI: 10.1007/s11011-021-00800-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/11/2021] [Indexed: 12/21/2022]
Abstract
Neurodegenerative diseases (NDs) are characterised by progressive dysfunction of synapses, neurons, glial cells and their networks. Neurodegenerative diseases can be classified according to primary clinical features (e.g., dementia, parkinsonism, or motor neuron disease), anatomic distribution of neurodegeneration (e.g., frontotemporal degenerations, extrapyramidal disorders, or spinocerebellar degenerations), or principal molecular abnormalities. The most common neurodegenerative disorders are amyloidosis, tauopathies, a-synucleinopathy, and TAR DNA-binding protein 43 (TDP-43) proteopathy. The protein abnormalities in these disorders have abnormal conformational properties along with altered cellular mechanisms, and they exhibit motor deficit, mitochondrial malfunction, dysfunctions in autophagic-lysosomal pathways, synaptic toxicity, and more emerging mechanisms such as the roles of stress granule pathways and liquid-phase transitions. Finally, for each ND, microglial cells have been reported to be implicated in neurodegeneration, in particular, because the microglial responses can shift from neuroprotective to a deleterious role. Growing experimental evidence suggests that abnormal protein conformers act as seed material for oligomerization, spreading from cell to cell through anatomically connected neuronal pathways, which may in part explain the specific anatomical patterns observed in brain autopsy sample. In this review, we mention the human pathology of select neurodegenerative disorders, focusing on how neurodegenerative disorders (i.e., Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis) represent a great healthcare problem worldwide and are becoming prevalent because of the increasing aged population. Despite many studies have focused on their etiopathology, the exact cause of these diseases is still largely unknown and until now with the only available option of symptomatic treatments. In this review, we aim to report the systematic and clinically correlated potential biomarker candidates. Although future studies are necessary for their use in early detection and progression in humans affected by NDs, the promising results obtained by several groups leads us to this idea that biomarkers could be used to design a potential therapeutic approach and preclinical clinical trials for the treatments of NDs.
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Affiliation(s)
- Nishit Pathak
- Department of Pharmaceutical Sciences and Chinese Traditional Medicine, Southwest University, Beibei, Chongqing, 400715, People's Republic of China
| | - Sunil Kumar Vimal
- Department of Pharmaceutical Sciences and Chinese Traditional Medicine, Southwest University, Beibei, Chongqing, 400715, People's Republic of China
| | - Ishi Tandon
- Amity University Jaipur, Rajasthan, Jaipur, Rajasthan, India
| | - Lokesh Agrawal
- Graduate School of Comprehensive Human Sciences, Kansei Behavioural and Brain Sciences, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Cao Hongyi
- Department of Pharmaceutical Sciences and Chinese Traditional Medicine, Southwest University, Beibei, Chongqing, 400715, People's Republic of China
| | - Sanjib Bhattacharyya
- Department of Pharmaceutical Sciences and Chinese Traditional Medicine, Southwest University, Beibei, Chongqing, 400715, People's Republic of China.
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Abstract
Sepsis remains a significant cause of neonatal mortality and morbidity, especially in low- and middle-income countries. Neonatal sepsis presents with nonspecific signs and symptoms that necessitate tests to confirm the diagnosis. Early and accurate diagnosis of infection will improve clinical outcomes and decrease the overuse of antibiotics. Current diagnostic methods rely on conventional culture methods, which is time-consuming, and may delay critical therapeutic decisions. Nonculture-based techniques including molecular methods and mass spectrometry may overcome some of the limitations seen with culture-based techniques. Biomarkers including hematological indices, cell adhesion molecules, interleukins, and acute-phase reactants have been used for the diagnosis of neonatal sepsis. In this review, we examine past and current microbiological techniques, hematological indices, and inflammatory biomarkers that may aid sepsis diagnosis. The search for an ideal biomarker that has adequate diagnostic accuracy early in sepsis is still ongoing. We discuss promising strategies for the future that are being developed and tested that may help us diagnose sepsis early and improve clinical outcomes. IMPACT: Reviews the clinical relevance of currently available diagnostic tests for sepsis. Summarizes the diagnostic accuracy of novel biomarkers for neonatal sepsis. Outlines future strategies including the use of omics technology, personalized medicine, and point of care tests.
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Naga Jyothi VV, Sudhakar B, Kusuma S, Karunakar G, Kanth VK, Prasad MS, Chandra TJ. Role of platelet count and indices in the diagnosis of neonatal sepsis. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2022. [DOI: 10.4103/jdrntruhs.jdrntruhs_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Barekatain B, HasanGhalyaei N, Mohammadizadeh M, Tavakolifard N. Investigation of salivary C-reactive protein and interleukin-18 for the diagnosis of neonatal sepsis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:131. [PMID: 35126594 PMCID: PMC8772511 DOI: 10.4103/jrms.jrms_1256_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/14/2021] [Accepted: 07/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Neonatal sepsis is a leading cause of death in neonates worldwide. The investigation of biomarkers for the early diagnosis of neonatal sepsis is in progress with controversial outcomes. The current report aims to evaluate the values of salivary C-reactive protein (CRP) and interleukin-18 (IL-18) for the diagnosis of neonatal sepsis. MATERIALS AND METHODS In this cross-sectional study, 89 neonates, including 49 neonatal septic case and 40 healthy group admitted at the neonatal intensive care unit, were evaluated. The salivary samples of IL-18 and CRP were measured before the antibiotic therapy initiation, as soon as blood samplings. Sepsis diagnosis was confirmed by the positive blood culture. The diagnostic values of the biomarkers were determined using the receiver operating characteristic curve (ROC curve) analysis. Besides, the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic accuracy were measured. RESULTS Salivary CRP level was remarkably higher in septic case than healthy group (5.2 ± 4.61 vs. 3.5 ± 1.7; P = 0.02), while salivary IL-18 was not different between the groups (0.1 ± 0.29 vs. 0.04 ± 0.19; P = 0.25). The ROC curve for IL-18 showed insignificant values (P = 0.37). The ROC curve of salivary CRP showed area under the curve of 0.63 (95% confidence interval: 0.51-0.74; P = 0.03) with the sensitivity, specificity, PPV, NPV, LR+, LR - and diagnostic accuracy of 44.9% (31.8-58.7), 80% (65.2-89.5), 73.3% (55.5-85.82), 54.2% (41.6-66.3), 60.6% (50.29-70.18), 2.24 (1.57-3.2), and 0.68 (0.63-0.75) at the cutoff of 4.55 ng/L, respectively. CONCLUSION Based on the findings of the current study, salivary CRP can be considered a biomarker for the early diagnosis of neonatal sepsis, while no statistical values for salivary IL-18 were detected. Due to the significance of neonatal sepsis, further evaluations are strongly recommended.
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Affiliation(s)
- Behzad Barekatain
- Department of Pediatrics, Division of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Najmeh HasanGhalyaei
- Neonatologist, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Mohammadizadeh
- Department of Pediatrics, Division of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negah Tavakolifard
- Department of Community and family medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Diagnostic, Prognostic, Predictive, and Monitoring Role of Neutrophil CD11b and Monocyte CD14 in Neonatal Sepsis. DISEASE MARKERS 2021; 2021:4537760. [PMID: 34691286 PMCID: PMC8531823 DOI: 10.1155/2021/4537760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/30/2021] [Accepted: 09/08/2021] [Indexed: 12/21/2022]
Abstract
Background Sepsis is a critical medical condition that requires additional diagnostic considerations. Recently, focus has shifted to the diagnosis of sepsis using new markers to overcome the limitations of traditional laboratory diagnostic modalities. Neutrophil CD11b (nCD11b) and monocyteCD14 (mCD14) cell surface antigens have been shown to be useful in such diagnostic consideration. Aim To investigate the diagnostic, monitoring, prognostic, and predictive roles of nCD11b and mCD14 as sepsis biomarkers in comparison to each other and to traditional laboratory sepsis parameters in order to select the best fit for routine daily use in neonatal intensive care units (NICUs). Subject The study included 188 neonates from Ain Shams University Hospitals' NICUs, who were divided into two groups: the control group (n = 100) and the sepsis group (n = 88). Highly sensitive CRP (hs-CRP), complete blood count (CBC), blood culture, and nCD11b and mCD14 evaluations were all part of the laboratory sepsis evaluation (done by flow cytometry technology). Positive blood culture results (BACT/ALERT system) confirmed the sepsis diagnosis. Twenty-four enrolled sepsis neonates were subjected to follow-up assessments, and they were divided into two groups based on clinical improvement: improved sepsis and sepsis without improvement. In order to predict performance evaluation, the subjected neonates were reclassified according to their outcome into survivors' and nonsurvivors' group. Results Sepsis patients had a significant increase in mCD14 MFI values when compared to controls. With sensitivity 75.4 percent, specificity 71.9 percent, efficacy 73.3 percent, and AUC 0.703, mCD14 MFI at cutoff 9.36 could distinguish the presence of septicemia. Significant increases in both mCD14 MFI and nCD11b MFI (P = 0.001) were observed in the severe sepsis/septic shock group compared to the nonsevere sepsis group. The combined measurement of CD14 MFI at cutoff 9.97 and CD14 percent at cutoff 44.7 percent yielded the best predictive performance. Conclusion Sepsis patients had a significant increase in mCD14 MFI comparable to the controls. mCD14 MFI demonstrated better diagnostic, prognostic, and predictive results than nCD11b. hs-CRP outperformed mCD14 and nCD11b in terms of diagnostic efficacy and AUC. In the monitoring of sepsis patients, both mCD14 and nCD11b produced unsatisfactory results. Currently, the routine use of mCD14 or nCD11b as sepsis biomarkers in neonatal ICUs is not justified.
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Liang X, Wu T, Chen Q, Jiang J, Jiang Y, Ruan Y, Zhang H, Zhang S, Zhang C, Chen P, Lv Y, Xin J, Shi D, Chen X, Li J, Xu Y. Serum proteomics reveals disorder of lipoprotein metabolism in sepsis. Life Sci Alliance 2021; 4:4/10/e202101091. [PMID: 34429344 PMCID: PMC8385306 DOI: 10.26508/lsa.202101091] [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: 04/06/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/26/2022] Open
Abstract
This study illustrated that lipoprotein and lipid metabolism might play a significant role in patients with sepsis and that complement activation was significantly enriched in patients with sepsis-associated encephalopathy. Sepsis is defined as an organ dysfunction syndrome and it has high mortality worldwide. This study analysed the proteome of serum from patients with sepsis to characterize the pathological mechanism and pathways involved in sepsis. A total of 59 patients with sepsis were enrolled for quantitative proteomic analysis. Weighted gene co-expression network analysis (WGCNA) was performed to construct a co-expression network specific to sepsis. Key regulatory modules that were detected were highly correlated with sepsis patients and related to multiple functional groups, including plasma lipoprotein particle remodeling, inflammatory response, and wound healing. Complement activation was significantly associated with sepsis-associated encephalopathy. Triglyceride/cholesterol homeostasis was found to be related to sepsis-associated acute kidney injury. Twelve hub proteins were identified, which might be predictive biomarkers of sepsis. External validation of the hub proteins showed their significantly differential expression in sepsis patients. This study identified that plasma lipoprotein processes played a crucial role in sepsis patients, that complement activation contributed to sepsis-associated encephalopathy, and that triglyceride/cholesterol homeostasis was associated with sepsis-associated acute kidney injury.
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Affiliation(s)
- Xi Liang
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Tianzhou Wu
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Qi Chen
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Jing Jiang
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongpo Jiang
- Department of Intensive Care Unit, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, China
| | - Yanyun Ruan
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Huaping Zhang
- Department of Intensive Care Unit, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Sheng Zhang
- Department of Intensive Care Unit, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, China
| | - Chao Zhang
- Department of Intensive Care Unit, Taizhou Enze Medical Center (Group) Enze Hospital, Taizhou, China
| | - Peng Chen
- Department of Intensive Care Unit, Taizhou Enze Medical Center (Group) Enze Hospital, Taizhou, China
| | - Yuhang Lv
- Department of Intensive Care Unit, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Jiaojiao Xin
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongyan Shi
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Chen
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China .,Institute of Pharmaceutical Biotechnology, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Li
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China .,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yinghe Xu
- Department of Intensive Care Unit, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
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Abd Almonaem ER, Rashad MM, Emam HM, El-Shimi OS. Tracheal aspirate presepsin: a promising biomarker in early onset neonatal pneumonia. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:406-412. [PMID: 34061686 DOI: 10.1080/00365513.2021.1931709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The early recognition and management of early-onset neonatal pneumonia is a challenge facing intensivists. Presepsin is an emerging immunologic and inflammatory biomarker that has been used for early non-culture-based detection of infection. We aimed to clarify the potential of presepsin assessed in tracheal aspirate of newborns to identify pneumonia. This prospective case - control study was conducted on 60 intubated neonates: Thirty neonates with pneumonia diagnosed according to clinical, radiological, and laboratory criteria as pneumonia group and thirty age and sex-matched intubated neonates without pneumonia as a control group. All neonates underwent full clinical evaluation and laboratory investigations. Plasma and tracheal aspirate presepsin was determined on the first day of life. The means of tracheal aspirate and plasma presepsin and CRP (525.55 ± 94.62 pg/mL, 670.95 ± 120.38 pg/mL and 26.4 ± 11.2 mg/L, respectively) were significantly higher in pneumonia group than control group (252.51 ± 104.95 pg/mL, 553.79 ± 117.48 pg/mL, 15.1 ± 3.1 mg/L, respectively) (p < .001 each). Receiver operating characteristic curve analysis for tracheal aspirate and plasma presepsin and CRP levels for the prediction of early-onset neonatal pneumonia was designed. Sensitivity was 86.6, 70 and 56.7%, respectively, while specificity was 90, 73.3, 53.3%, respectively, at a cut-off point of 385 pg/mL, 605 pg/mL and 36 mg/L, respectively [area under the curve (AUC) = 0.97, 0.74 and 0.51, respectively, p < .001, .001 and .44, repectively]. In conclusion, tracheal aspirate presepsin is increased in early-onset neonatal pneumonia and outperformed other plasma biomarkers in diagnosing neonatal pneumonia.
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Affiliation(s)
| | | | | | - Ola Samir El-Shimi
- Clinical Pathology Department, Faculty of Medicine, Benha University, Benha, Egypt
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14
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Hao YX, Yu JL. [Cut-off value of white blood cell count in the diagnosis of early-onset sepsis in neonates]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1159-1163. [PMID: 33172548 PMCID: PMC7666395 DOI: 10.7499/j.issn.1008-8830.2005143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the clinical significance and cut-off value of white blood cell (WBC) count in the diagnosis of early-onset sepsis (EOS) in neonates. METHODS A retrospective analysis was performed on 306 neonates with EOS who were admitted from January 2019 to March 2020. A total of 580 children without infection who were admitted during the same period of time were enrolled as the control group. General status and WBC count were compared between the two groups. The diagnostic value of WBC count was analyzed based on the diagnostic and therapeutic protocol of neonatal sepsis in 2003 (referred to as the 2003 diagnostic and therapeutic protocol) and the expert consensus on the diagnosis and treatment of neonatal sepsis (2019 edition) (referred to as the 2019 expert consensus). RESULTS According to the two different diagnosis and treatment protocols, the statistical analysis showed that WBC count had a relatively positive rate (51.3% and 32.0% respectively) but a relatively high specificity (93.3% and 98.6% respectively). The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve of WBC count in the 2003 diagnostic and therapeutic protocol was larger than that in the 2019 expert consensus (P<0.05). CONCLUSIONS The cut-off value of WBC ≥25×109/L in the 2003 diagnostic and therapeutic protocol is more reasonable in the diagnosis of EOS.
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Affiliation(s)
- Ying-Xia Hao
- Department of Neonatology, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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15
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Clinical Value of Serum Amyloid-A Protein, High-density Lipoprotein Cholesterol and Apolipoprotein-A1 in the Diagnosis and Follow-up of Neonatal Sepsis. Pediatr Infect Dis J 2020; 39:749-755. [PMID: 32251257 DOI: 10.1097/inf.0000000000002682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To evaluate the performance of serum amyloid-A (SAA), high-density lipoprotein cholesterol (HDL-C) and apolipoprotein-A1 (Apo-A1) levels in the identification and monitoring of neonatal sepsis. METHODS This prospective study included 113 full-term septic neonates (postnatal age 4-28 days) admitted to the Special Care Neonatal Unit of a University Hospital from January 1, 2016, to April 30, 2019, and 68 healthy neonates (controls). Blood samples were drawn serially in septic neonates at enrollment and on days 1, 3 and 7, and once in controls, for SAA, HDL-C and Apo-A1 determination. RESULTS At enrollment, SAA levels were significantly higher in septic neonates in comparison with controls (median 50.7 vs. 3.5 mg/L; P < 0.0001); HDL-C and Apo-A1 levels were significantly lower in patients than in controls (P < 0.001 and P < 0.006, respectively). SAA levels were higher in culture-positive compared with culture-negative sepsis (median 202.0 vs. 14.2 mg/L; P < 0.0001). HDL-C and Apo-A1 levels did not differ significantly between culture-positive and culture-negative sepsis. Receiver operating characteristic curve analysis of SAA levels at enrollment resulted in significant areas under the curve (AUC) for detecting sepsis {AUC = 0.929 [95% confidence interval: 0.885-0.973]; P < 0.0001} and also for discriminating between culture-positive and culture-negative sepsis [AUC = 0.933 (95% confidence interval: 0.882-0.984); P < 0.0001]. The combination of HDL-C and Apo-A1 with SAA increased its diagnostic performance. Furthermore, serial SAA levels following enrollment could indicate clinical response in septic neonates. CONCLUSIONS SAA seems to be a useful biomarker for identification and monitoring of neonatal sepsis, and also for discriminating between culture-positive and culture-negative sepsis. HDL-C and Apo-A1 could be used as complementary markers.
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16
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Gilard V, Tebani A, Bekri S, Marret S. Intraventricular Hemorrhage in Very Preterm Infants: A Comprehensive Review. J Clin Med 2020; 9:E2447. [PMID: 32751801 PMCID: PMC7465819 DOI: 10.3390/jcm9082447] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 11/30/2022] Open
Abstract
Germinal matrix-intraventricular-intraparenchymal hemorrhage (GMH-IVH-IPH) is a major complication of very preterm births before 32 weeks of gestation (WG). Despite progress in clinical management, its incidence remains high before 27 WG. In addition, severe complications may occur such as post-hemorrhagic hydrocephalus and/or periventricular intraparenchymal hemorrhage. IVH is strongly associated with subsequent neurodevelopmental disabilities. For this review, an automated literature search and a clustering approach were applied to allow efficient filtering as well as topic clusters identification. We used a programmatic literature search for research articles related to intraventricular hemorrhage in preterms that were published between January 1990 and February 2020. Two queries ((Intraventricular hemorrhage) AND (preterm)) were used in PubMed. This search resulted in 1093 articles. The data manual curation left 368 documents that formed 12 clusters. The presentation and discussion of the clusters provide a comprehensive overview of existing data on the pathogenesis, complications, neuroprotection and biomarkers of GMH-IVH-IPH in very preterm infants. Clinicians should consider that the GMH-IVH-IPH pathogenesis is mainly due to developmental immaturity of the germinal matrix and cerebral autoregulation impairment. New multiomics investigations of intraventricular hemorrhage could foster the development of predictive biomarkers for the benefit of very preterm newborns.
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Affiliation(s)
- Vianney Gilard
- Department of Pediatric Neurosurgery, Rouen University Hospital, 76000 Rouen, France;
- Department of Metabolic Biochemistry, Rouen University Hospital, 76000 Rouen, France;
| | - Abdellah Tebani
- Department of Metabolic Biochemistry, Rouen University Hospital, 76000 Rouen, France;
| | - Soumeya Bekri
- Department of Metabolic Biochemistry, Rouen University Hospital, 76000 Rouen, France;
- Normandie University, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France;
| | - Stéphane Marret
- Normandie University, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France;
- Department of Neonatal Pediatrics, Intensive Care and Neuropediatrics, Rouen University Hospital, 76000 Rouen, France
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17
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Doughty C, O'Driscoll DN, Smith S, O'Currain E, Grant T, O'Hare FM, Culliton M, Watson RWG, O'Neill A, Molloy EJ. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in neonatal sepsis. J Matern Fetal Neonatal Med 2020; 35:2485-2492. [PMID: 32674630 DOI: 10.1080/14767058.2020.1786520] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Efficient and accurate diagnosis of neonatal sepsis is challenging. The potential impact for a reduction in morbidity and mortality as well as antibiotic usage has stimulated the ongoing search for biomarkers of early sepsis. The objective of this pilot study was to quantify the levels of sTREM-1 and correlate with blood cultures and inflammatory markers in neonates evaluated for sepsis. METHODS Neonates with suspected sepsis were enrolled (n = 83; Preterm n = 35; Term n = 48). Routine bloods for sepsis evaluation were included and plasma sTREM-1 levels were quantified by ELISA. RESULTS Term and preterm neonates (n = 83; Preterm n = 35; Term n = 48) were enrolled and 16 neonates had positive blood cultures (preterm n = 15; term n = 1). sTREM-1 levels were not significantly different in infants with culture-positive or culture-negative sepsis (356 ± 218 pg/mL and 385 ± 254 pg/mL respectively). The immature-to-total granulocyte (I/T) ratio showed a significant positive correlation with sTREM-1 in the preterm group with positive blood cultures. Additionally, sTREM-1 showed a positive correlation with CRP in the preterm group with negative blood cultures. CONCLUSIONS sTREM-1 was associated with traditional markers of inflammation (I/T ratio and CRP). However, in this cohort sTREM-1 did not improve the early detection of neonatal culture-positive sepsis.
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Affiliation(s)
- Catherine Doughty
- Department of Biochemistry, National Maternity Hospital, Dublin, Ireland
| | - David N O'Driscoll
- Department of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute; Trinity Research in Childhood Centre, Trinity College, Dublin, Ireland
| | - Sile Smith
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| | - Eoin O'Currain
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| | - Tim Grant
- Centre for Support and Training in Analysis and Research, University College Dublin, Dublin, Ireland
| | - Fiona M O'Hare
- Department of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute; Trinity Research in Childhood Centre, Trinity College, Dublin, Ireland.,Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| | - Marie Culliton
- Department of Biochemistry, National Maternity Hospital, Dublin, Ireland
| | - R William G Watson
- School of Medicine and Medical Sciences, Conway Institute of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Amanda O'Neill
- School of Medicine and Medical Sciences, Conway Institute of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Department of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute; Trinity Research in Childhood Centre, Trinity College, Dublin, Ireland.,Department of Neonatology, National Maternity Hospital, Dublin, Ireland.,Department of Neonatology, Coombe Women and Infants' University Hospital, Dublin, Ireland.,Department of Neonatology, Children's Health Ireland at Crumlin and Tallaght, Dublin, Ireland
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18
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Total antioxidant status as marker of oxidative stress in infants with intrauterine growth restriction. REV ROMANA MED LAB 2020. [DOI: 10.2478/rrlm-2020-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Aim: The aim of this study is to identify correlations between total antioxidant status values of mothers and their infants and compare these values in accordance to the presence or absence of intrauterine growth restriction.
Material and methods: This is a prospective, comparative study performed over a period of 3 years on a number of 52 infants and their mothers. Thirty-six of them had intrauterine growth restriction and 16 were appropriate for their gestational age and were used for comparative purposes. General information regarding the mother, infant and pregnancy were recorded. In addition, total antioxidant status was assessed from blood samples, taken right before delivery from mothers and from the cord blood in infants.
Results: We found significant differences between total antioxidant status both between mothers and neonates with IUGR (intrauterine growth restriction) versus without IUGR (p=0.018, and p<0.001, respectively). In addition, in both groups, there was a significant direct correlation between maternal and neonatal values of serum total antioxidant status (TAS) (p<0.001).
In conclusion, we can say that TAS values, as an important marker of the oxidative status of patients, are correlated with the presence of IUGR and values recorded from blood samples of the mother may be predictive for the oxidative status of the infant, thus of IUGR.
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19
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Siahanidou T, Margeli A, Bourika V, Papassotiriou I. Association of fibroblast growth factor 21 plasma levels with neonatal sepsis: preliminary results. Clin Chem Lab Med 2019; 57:e83-e85. [PMID: 30226205 DOI: 10.1515/cclm-2018-0914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Alexandra Margeli
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Vasiliki Bourika
- Neonatal Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
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20
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Reference ranges of presepsin (soluble CD14 subtype) in term and preterm neonates without infection, in relation to gestational and postnatal age, in the first 28 days of life. Clin Biochem 2019; 77:7-13. [PMID: 31843667 DOI: 10.1016/j.clinbiochem.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the reference ranges of presepsin in term and preterm neonates without infection, with respect to gestational and postnatal age, within the first 28 days of life. METHODS A total of 144 neonates born at 24-42 weeks' gestation, including healthy term and preterm neonates without clinical signs or symptoms of infection, were included in this prospective observational study. Presepsin measurements included cord blood levels and serum levels on postnatal days 1, 3, 5, 7, 14, 21, and 28. RESULTS The presepsin values corresponding to the 10th percentile ranged from 240.8 pg/mL (on day 1) to 129.9 pg/mL (on day 28), whereas those corresponding to the 90th percentile ranged from 725.8 pg/mL (on day 1) to 471.6 pg/mL (on day 28). Significantly higher presepsin levels were observed in cesarean deliveries than in spontaneous deliveries (p: 0.012 to <0.001), in gestational ages ≤ 32 weeks than in gestational ages ≥37 weeks (p: <0.05 to <0.001), and in cases with a maternal history of chorioamnionitis than in those without (p: <0.05 to <0.001). CONCLUSION In conclusion, our findings revealed, for the first time, the reference ranges of presepsin in healthy term and preterm neonates without infection with respect to gestational and postnatal age, sex, and body weight. Presepsin levels within the first 28 days of life seem likely to be affected by the type of delivery, gestational and postnatal age, birth weight, and presence of respiratory distress syndrome or maternal chorioamnionitis.
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21
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Frick MA, Barba I, Fenoy-Alejandre M, López-López P, Baquero-Artigao F, Rodríguez-Molino P, Noguera-Julian A, Nicolás-López M, de la Fuente-Juárez A, Codina-Grau MG, Esperalba Esquerra J, Linde-Sillo Á, Soler-Palacín P. 1H-NMR Urinary Metabolic Profile, A Promising Tool for the Management of Infants with Human Cytomegalovirus-Infection. Metabolites 2019; 9:metabo9120288. [PMID: 31775291 PMCID: PMC6949898 DOI: 10.3390/metabo9120288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 02/07/2023] Open
Abstract
Congenital human cytomegalovirus (HCMV) infection is the most common mother-to-child transmitted infection in the developed world. Certain aspects of its management remain a challenge. Urinary metabolic profiling is a promising tool for use in pediatric conditions. The aim of this study was to investigate the urinary metabolic profile in HCMV-infected infants and controls during acute care hospitalization. Urine samples were collected from 53 patients at five hospitals participating in the Spanish congenital HCMV registry. Thirty-one cases of HCMV infection and 22 uninfected controls were included. Proton nuclear magnetic resonance (1H-NMR) spectra were obtained using NOESYPR1D pulse sequence. The dataset underwent orthogonal projection on latent structures discriminant analysis to identify candidate variables affecting the urinary metabolome: HCMV infection, type of infection, sex, chronological age, gestational age, type of delivery, twins, and diet. Statistically significant discriminative models were obtained only for HCMV infection (p = 0.03) and chronological age (p < 0.01). No significant differences in the metabolomic profile were found between congenital and postnatal HCMV infection. When the HCMV-infected group was analyzed according to chronological age, a statistically significant model was obtained only in the neonatal group (p = 0.01), with the differentiating metabolites being betaine, glycine, alanine, and dimethylamine. Despite the considerable variation in urinary metabolic profiles in a real-life setting, clinical application of metabolomics to the study of HCMV infection seems feasible.
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Affiliation(s)
- Marie Antoinette Frick
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Pediatrics Department, Children’s Hospital, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | | | - Marina Fenoy-Alejandre
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Pediatrics Department, Children’s Hospital, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Pediatrics Department, Children’s Hospital, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
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Platelet to Lymphocyte Ratio in Neonates: A Predictor of Early onset Neonatal Sepsis. Mediterr J Hematol Infect Dis 2019; 11:e2019055. [PMID: 31528321 PMCID: PMC6736225 DOI: 10.4084/mjhid.2019.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/08/2019] [Indexed: 01/17/2023] Open
Abstract
Background Neonatal sepsis (NS) is a common systemic disease that causes morbidity and mortality in newborns. But there is no ideal biomarker that can be used in the early diagnosis of NS. In recent studies, platelet to lymphocyte ratio (PLR) has been reported to play a critical role in the inflammatory process. In this study, we aimed to contribute to the research about whether or not PLR can be used as an early predictor of the diagnosis of NS. Methods This retrospective cohort study was conducted among the newborns born in İzmir Buca Maternity and Pediatric Hospital between March 2015–February 2016. During these twelve months, 611 neonates with Early-Onset Sepsis (EOS) were admitted to our neonatal intensive care unit. One hundred and forty-nine neonates with suspected EOS, 67 neonates with proven EOS and 92 healthy neonates were enrolled in the study. Results Platelet to lymphocyte ratio (PLR) values of the three groups were calculated 56.5 ± 17.8 vs. 62.4± 14.9 vs. 15.3 ± 2.1, respectively. PLR values of suspected or proven EOS group were significantly higher than the control group. PLR has AUC 0.89 to 0.93, the cutoff value of 39.5 to 57.7, the sensitivity of 88.9% to 91.3% and specificity of 94.7% to 97.6%, the positive predictive value of 94.3% to 97.4%, and negative predictive value of 88.6% to 91.8% in suspected and proven sepsis diagnosis. Conclusions Our results suggest that PLR can be used as a parameter in the prediction of neonatal sepsis.
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Wang F, Li W, Wang G, Yu M, Zhong J, Xu C, Li D, Zhou Y. Gas chromatography-mass spectrometry based serum metabolic analysis for premature infants and the relationship with necrotizing enterocolitis: a cross-sectional study. Ital J Pediatr 2019; 45:54. [PMID: 31036043 PMCID: PMC6489265 DOI: 10.1186/s13052-019-0646-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 04/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Preterm birth and feeding are the most important pathogenic factors of neonatal necrotizing enterocolitis (NEC). Metabonomic has been widely used in the diagnosis and treatment of other diseases, but there is no research on the related diseases of premature infants. Compared with full-term infants, the metabolism of preterm infants has its own specificity, so it can easily lead to NEC and other digestive tract inflammatory diseases. Metabonomic may be applied to the diagnosis of preterm related diseases, such as NEC. METHODS The model was established with premature infant serum samples from 19 premature infants in our hospital, which was compared with the full-term infant control group. Serum was analyzed by gas chromatography-mass spectrometry (GC-MS), coupled with the analysis of serum metabolic characteristics. The variable important in projection, P value and Pearson correlation coefficient of samples were analyzed by using SIMCA, SPSS and other multivariate statistical analysis software. RESULTS Compared to the term infants, premature infants had significantly higher levels of luteolin, and lower levels of xylose, O-succinyl-L-homoserine and lauric acid in the serum. There were some correlations among several different metabolites and clinically related indices (albumin, total bilirubin) for premature birth related diseases. CONCLUSIONS There are metabolic alterations in the serum of premature infants, which make contribution to the diagnosis of NEC.
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Affiliation(s)
- Fusheng Wang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041 China
| | - Weizhong Li
- Department of Neonatal, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041 China
| | - Guanghuan Wang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041 China
| | - Menglu Yu
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041 China
| | - Jun Zhong
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041 China
| | - Chenbin Xu
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041 China
| | - Danli Li
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041 China
| | - Yongcui Zhou
- Reproductive Medicine Centre, The First Affiliated Hospital of Shantou University Medical College, Guangdong Province, Shantou, 515041 China
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Serial fecal calprotectin in the prediction of necrotizing enterocolitis in preterm neonates. J Pediatr Surg 2019; 54:455-459. [PMID: 29859621 DOI: 10.1016/j.jpedsurg.2018.04.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate whether serial measurements of fecal calprotectin concentrations enable us to identify infants who will develop NEC prior to development of symptoms. METHODS Prospective matched case-control study including 100 high-risk neonates. High risk includes 1) gestational age (GA) ≤30 weeks, 2) birth-weight (BW) ≤1000 g, 3) GA 30-32 weeks and BW ≤1250 g, 4) born from a mother who received indomethacin for tocolysis. We matched every NEC subject with three controls for birth weight and gestational age. Fecal calprotectin was measured twice a week from day one until five weeks after birth or until NEC development. We analyzed differences in fecal calprotectin between NEC subjects and controls in the week preceding NEC onset and course of fecal calprotectin within subjects who developed NEC. RESULTS Of 100 included patients, ten (median GA 27.5 weeks [24.6-29.4], BW 1010 g [775-1630]) developed NEC. The median calprotectin concentration in all samples combined was 332 μg/g [<40-8230] μg/g feces. There were no differences between NEC subjects and controls, with a wide variation in both groups. In NEC subjects, there was no intraindividual rise in calprotectin before clinical symptoms occurred. CONCLUSIONS There are high concentrations and wide interindividual variations in calprotectin in preterm infants during the first weeks of life. Wide intraindividual variation further precludes the serial use of fecal calprotectin in the early detection or prediction of NEC in high risk infants. LEVEL OF EVIDENCE III.
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Blood culture indications in critically ill neonates: a multicenter prospective cohort study. Eur J Pediatr 2018; 177:1565-1572. [PMID: 30051146 DOI: 10.1007/s00431-018-3203-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 12/29/2022]
Abstract
UNLABELLED Due to potential lethality of healthcare-associated sepsis (HAS), a low threshold for blood culturing and antimicrobial therapy (ABT) initiation is accepted. We assessed variability in the trigger for blood culturing between three neonatal intensive care units. A multicenter prospective cohort study was conducted. In newborns with suspicion of HAS, 10 predefined clinical signs, nosocomial sepsis (NOSEP) score, C-reactive protein, ABT initiation, and risk factors were registered at time of culturing. Outcome was lab-confirmed HAS, defined according to the NeoKISS-criteria. Two hundred ninety-nine suspected HAS episodes were considered in 212 infants, of which 118 had birth-weight ≤ 1500 g; proportion of lab-confirmed HAS per suspected episode was 30/192 (center 1), 28/60 (center 2), and 8/47 (center 3) (p < 0.001). Median C-reactive protein and number of clinical signs at time of culturing differed between centers 1, 2, and 3 (respectively 11 vs. 5 vs. 3 mg/L, p = 0.001; 1 sign [IQR 0-2, center 1] vs. 3 signs [IQR 2-4, centers 2 and 3], p < 0.001). Median NOSEP score at time of culturing was 5 (IQR 3-8, center 1), 5 (IQR 3-9, center 2), and 8 (IQR 5-11, center 3) (p = 0.016). Difference in ABT initiation was noticed (82 vs. 93 vs. 74%, p = 0.05). CONCLUSION Center heterogeneity in sampling practice is substantial. Optimizing sampling practice can be recommended. What is Known: • Blood culture test is a common diagnostic procedure in critically-ill newborns. • A low threshold for sampling and antimicrobial therapy initiation is accepted. What is New: • Variability in blood culture practice was assessed between 3 neonatal intensive care units by the registration of sampling frequencies, clinical indications, and antimicrobial therapy initiation.
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Cikot M, Kasapoglu P, Isiksacan N, Binboga S, Kones O, Gemici E, Kartal B, Alis H. The importance of presepsin value in detection of gastrointestinal anastomotic leak: a pilot study. J Surg Res 2018; 228:100-106. [DOI: 10.1016/j.jss.2018.02.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/14/2018] [Accepted: 02/27/2018] [Indexed: 02/07/2023]
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Aydemir C, Aydemir H, Kokturk F, Kulah C, Mungan AG. The cut-off levels of procalcitonin and C-reactive protein and the kinetics of mean platelet volume in preterm neonates with sepsis. BMC Pediatr 2018; 18:253. [PMID: 30068303 PMCID: PMC6090766 DOI: 10.1186/s12887-018-1236-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Sepsis is a leading cause of morbidity and mortality among newborns. C-reactive protein (CRP) and procalcitonin (PCT) have some limitations in the diagnosis of preterm neonatal sepsis. In this study, the cut-offs of PCT and CRP, and the efficacy of mean platelet volume (MPV) were investigated. Methods We identified key demographic details and compared laboratory values between preterm infants with early onset and late onset neonatal sepsis (EONS/LONS) retrospectively. Blood samples were collected within the first few hours of the onset of clinical sepsis (CRP 1, PCT 1, MPV 1) and were repeated after 24 h (CRP 2, PCT 2, MPV 2). The optimal cut-offs for CRP, PCT and MPV were determined using receiver operating characteristic (ROC) analysis. Furthermore, pairwise comparisons of ROC curves were made to evaluate the performances of these tests. Results In EONS, the cut-off of CRP 1 was 2.6 mg/L, the sensitivity, specificity, PPV and NPV were 80.6, 83.0, 67.5 and 90.7%, respectively (p < 0.001). At a PCT 1 cut-off of 1.1 ng/mL, the sensitivity, specificity, PPV and NPV were 78.6, 81.2, 64.7 and 89.6%, respectively (p < 0.001). The sensitivity, specificity, PPV, and NPV of the CRP 1 cut-off of 3.6 mg/L for LONS were 78.3, 87.4, 74.8, and 89.4%, respectively. At a PCT 1 cut-off of 5.2 ng/mL, the sensitivity, specificity, PPV and NPV were 58.5, 95.5, 86.1, and 82.9% respectively. For proven sepsis, the cut-off of CRP 1 was 7.0 mg/L with a 76.5% sensitivity, 98.2% specificity, 94.9% PPV and 90.5% NPV (p < 0.001). At a PCT 1 cut-off of 1.36 ng/mL, the sensitivity, specificity, PPV and NPV were 90.8, 83.4, 70.6 and 94.4%, respectively (p < 0.001). In each subgroup, other than EONS, the performances of CRP 1 and PCT 1 measurements were found to be statistically higher than MPV 1. CRP 2 cut-off levels of LONS group and proven sepsis group were found to be lower than the initial values. Conclusions Optimal cut-off levels of CRP 1 and PCT 1 may differ in preterm sepsis subgroups. The diagnostic performances of CRP 1 and PCT 1 didn’t differ however, they were more efficacious than MPV.
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Affiliation(s)
- C Aydemir
- Department of Pediatrics, Medical Faculty, Division of Neonatology, Bülent Ecevit University, Zonguldak, Turkey
| | - H Aydemir
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bulent Ecevit University, 67600, Zonguldak, Turkey.
| | - F Kokturk
- Department of Biostatistics, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey
| | - C Kulah
- Department of Microbiology, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey
| | - A G Mungan
- Department of Biochemistry, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey
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Examining the utility of the CD64 index compared with other conventional indices for early diagnosis of neonatal infection. Sci Rep 2018; 8:9994. [PMID: 29968788 PMCID: PMC6030194 DOI: 10.1038/s41598-018-28352-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/20/2018] [Indexed: 02/08/2023] Open
Abstract
As specific clinical manifestations and detection tools for early neonatal infections are lacking, early detection and treatment are ongoing challenges. The present study aimed to investigate the role and clinical significance of the CD64 index in comparison with conventional examination indices (WBC, PCT and CRP) for the early diagnosis of neonatal infection. Of 74 in-patient newborns, non-sepsis (non-specific infection but free of sepsis), sepsis and control [newborns with ABO hemolytic disease of the newborn (ABOHDN) but without infection] groups involved 32, 16 and 26 cases, respectively. Peripheral blood WBC, PCT, CRP and CD64 indices were acquired for all groups. The sepsis group showed significantly higher WBC, PCT and CRP levels than the control group. Compared with the non-sepsis group, the sepsis group demonstrated significant increases in PCT but not in WBC or CRP. Compared with the control group, the non-sepsis and sepsis groups had higher CD64 indices. Combined, compared with the WBC, PCT and CRP indices, the CD64 index is unique in its capacity to diagnose neonatal infections early. The CD64 index combined with other conventional indices may lay a basis for the future early diagnosis and effective treatment of neonatal infections.
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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30
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Holm M, Morken TS, Fichorova RN, VanderVeen DK, Allred EN, Dammann O, Leviton A. Systemic Inflammation-Associated Proteins and Retinopathy of Prematurity in Infants Born Before the 28th Week of Gestation. Invest Ophthalmol Vis Sci 2017; 58:6419-6428. [PMID: 29260199 PMCID: PMC5736326 DOI: 10.1167/iovs.17-21931] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose To assess the association between systemic levels of inflammation-associated proteins and severe retinopathy of prematurity (ROP) in extremely preterm infants. Methods We collected whole blood on filter paper on postnatal days 1, 7, 14, 21, and 28 from 1205 infants born before the 28th week of gestation, and measured the concentrations of 27 inflammation-associated, angiogenic, and neurotrophic proteins. We calculated odds ratios with 95% confidence intervals for the association between top quartile concentrations of each protein and prethreshold ROP. Results During the first three weeks after birth, high concentrations of VEGF-R1, myeloperoxidase (MPO), IL-8, intercellular adhesion molecule (ICAM)-1, matrix metalloproteinase 9, erythropoietin, TNF-α, and basic fibroblast growth factor were associated with an increased risk for prethreshold ROP. On day 28, high levels of serum amyloid A, MPO, IL-6, TNF-α, TNF-R1/-R2, IL-8, and ICAM-1 were associated with an increased risk. Top quartile concentrations of the proinflammatory cytokines TNF-α and IL-6 were associated with increased risks of ROP when levels of neuroprotective proteins and growth factors, including BDNF, insulin-like growth factor 1, IGFBP-1, VEGFR-1 and -2, ANG-1 and PlGF, were not in the top quartile. In contrast, high concentrations of NT-4 and BDNF appeared protective only in infants without elevated inflammatory mediators. Conclusions Systemic inflammation during the first postnatal month was associated with an increased risk of prethreshold ROP. Elevated concentrations of growth factors, angiogenic proteins, and neurotrophins appeared to modulate this risk, and were capable of reducing the risk even in the absence of systemic inflammation.
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Affiliation(s)
- Mari Holm
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tora S Morken
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Raina N Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Deborah K VanderVeen
- Department of Ophthalmology, Children's Hospital Boston, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - Elizabeth N Allred
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States.,Perinatal Epidemiology Unit, Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Alan Leviton
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts, United States
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Sonker M, Knob R, Sahore V, Woolley AT. Integrated electrokinetically driven microfluidic devices with pH-mediated solid-phase extraction coupled to microchip electrophoresis for preterm birth biomarkers. Electrophoresis 2017; 38:1743-1754. [PMID: 28272749 PMCID: PMC5541996 DOI: 10.1002/elps.201700054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 01/06/2023]
Abstract
Integration in microfluidics is important for achieving automation. Sample preconcentration integrated with separation in a microfluidic setup can have a substantial impact on rapid analysis of low-abundance disease biomarkers. Here, we have developed a microfluidic device that uses pH-mediated solid-phase extraction (SPE) for the enrichment and elution of preterm birth (PTB) biomarkers. Furthermore, this SPE module was integrated with microchip electrophoresis for combined enrichment and separation of multiple analytes, including a PTB peptide biomarker (P1). A reversed-phase octyl methacrylate monolith was polymerized as the SPE medium in polyethylene glycol diacrylate modified cyclic olefin copolymer microfluidic channels. Eluent for pH-mediated SPE of PTB biomarkers on the monolith was optimized using different pH values and ionic concentrations. Nearly 50-fold enrichment was observed in single channel SPE devices for a low nanomolar solution of P1, with great elution time reproducibility (<7% RSD). The monolith binding capacity was determined to be 400 pg (0.2 pmol). A mixture of a model peptide (FA) and a PTB biomarker (P1) was extracted, eluted, injected, and then separated by microchip electrophoresis in our integrated device with ∼15-fold enrichment. This device shows important progress towards an integrated electrokinetically operated platform for preconcentration and separation of biomarkers.
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Affiliation(s)
- Mukul Sonker
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT, USA
| | - Radim Knob
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT, USA
| | - Vishal Sahore
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT, USA
| | - Adam T Woolley
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT, USA
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Badr HS, El-Gendy FM, Helwa MA. Serum stromal-derived-factor-1 (CXCL12) and its alpha chemokine receptor (CXCR4) as biomarkers in neonatal sepsis. J Matern Fetal Neonatal Med 2017; 31:2209-2215. [PMID: 28562124 DOI: 10.1080/14767058.2017.1336760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neonatal sepsis remains one of the leading causes of morbidity and mortality both among term and preterm infants. Advances in neonatal care improved survival and reduced complications in preterm infants. Chemokines are chemotactic cytokines that give directional guidance for leukocyte migration during inflammatory process. The chemokine CXCL12 and its receptor CXCR4 are now known to play an important role in inflammatory states. However, its value as a biomarker in neonatal sepsis is unclear. OBJECTIVES To assess the value of measuring the serum levels of alpha-chemokine receptor type 4 (CXCR-4) and stromal-derived-factor-1 (CXCL12) in diagnosis of late onset neonatal sepsis. SUBJECT AND METHODS Serum levels of CXCL12 and CXCR4 were determined in 38 full term neonates, 23 cases of late onset sepsis (13 males and 10 female), and 15 healthy neonates as control (six males and nine females) by ELISA technique and flow-cytometry. RESULTS Serum levels of CXCR4 and CXCL12 were significantly higher in neonates with late onset sepsis compared with the non-septic ones. The sensitivity, the specificity, and the overall accuracy of CXCL12 were 100%. The sensitivity of CXCR4 was 87%; the specificity was 80% and the overall accuracy was 84%. CONCLUSIONS Serum CXCR4 and CXCL12 levels increase significantly in septic neonates and they are valuable marker in diagnosis of neonatal sepsis. Serum concentrations of both chemokines represent promising novel biomarkers for neonatal sepsis.
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Affiliation(s)
- Hassan S Badr
- a Department of Pediatrics , Menoufia University , Shibin El Kom , Egypt
| | - Fady M El-Gendy
- a Department of Pediatrics , Menoufia University , Shibin El Kom , Egypt
| | - Mohamed A Helwa
- b Clinical Pathology, Faculty of Medicine , Menoufia University , Shibin El Kom , Egypt
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Ahn MY, Kim BJ, Kim HJ, Hwang JS, Jung YS, Park KK. Anti-aging effect and gene expression profiling of dung beetle glycosaminoglycan in aged rats. Biomater Res 2017; 21:5. [PMID: 28439422 PMCID: PMC5399430 DOI: 10.1186/s40824-017-0091-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/30/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the anti-aging effect of a newly prepared insect-derived compound, dung beetle glycosaminoglycan (GAG), given intraperitoneally to old SD rats as part of their diet for 1 month. Insect GAG administration was found to be related to a reduction in oxidative damage, hepato-cellular biomarker levels, protein carbonyl content, and malondialdehyde concentration. The anti-aging-related molecular genetic mechanisms of dung beetle GAG are not yet fully elucidated. RESULTS Catharsius molossus (a type of dung beetle) GAG (CaG) possessed anti-aging activities; it reduced the serum level of creatinine kinase, had aortic vasorelaxant activities and cardioprotective actions, and maintained a normal glucose level in treated rats. Microarray analysis was performed with a rat 30 K cDNA clone set array to identify the gene-expression profiles of 14-month-old SD rats treated with dung beetle glycosaminoglycan 5 mg/kg (CaG5) over a 1-month period, which was done to investigate its anti-aging effect as compared to that of either Bombus ignitus (a type of bumblebee) queen GAG 5 mg/kg (IQG5) or chondroitin sulfate 10 mg/kg. CaG5 and IQG5 had marked anti-inflammatory effects, bringing about inhibition of free fatty acid, uric acid, sGPT, IL-1 beta, and CK values. In addition, anticoagulant and antithrombotic effects were seen: the concentration of factor 1 (fibrinogen) was increased in CaG- treated rat plasma. The CaG5-treated rat group, compared to the control, displayed upregulation of 131 genes, including lipocalin 2 (Lbp) and a serine peptidase inhibitor, Kaszal type3 (Spink3), and 64 downregulated genes, including lysyl oxidase (Lox), serine dehydratase (sds), and retinol saturase (Retsat). CONCLUSION Our data suggest that dung beetle glycosaminoglycan may be a helpful treatment for aged rats, which indicates its potential as a therapeutic biomaterial for aging.
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Affiliation(s)
- Mi Young Ahn
- Department of Agricultural Biology, National Academy of Agricultural Science, Rural Development Administration (RDA), Wanju-Gun, 55365 South Korea
| | - Ban Ji Kim
- Department of Agricultural Biology, National Academy of Agricultural Science, Rural Development Administration (RDA), Wanju-Gun, 55365 South Korea
| | - Ha Jeong Kim
- Department of Agricultural Biology, National Academy of Agricultural Science, Rural Development Administration (RDA), Wanju-Gun, 55365 South Korea
| | - Jae Sam Hwang
- Department of Agricultural Biology, National Academy of Agricultural Science, Rural Development Administration (RDA), Wanju-Gun, 55365 South Korea
| | - Yi-Sook Jung
- College of Pharmacy, Ajou University, Suwon, 442-749 South Korea
| | - Kun-Koo Park
- Pharmacogenechips Inc., Chuncheon, 200-160 South Korea
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Torres-Cuevas I, Parra-Llorca A, Sánchez-Illana A, Nuñez-Ramiro A, Kuligowski J, Cháfer-Pericás C, Cernada M, Escobar J, Vento M. Oxygen and oxidative stress in the perinatal period. Redox Biol 2017; 12:674-681. [PMID: 28395175 PMCID: PMC5388914 DOI: 10.1016/j.redox.2017.03.011] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/12/2017] [Accepted: 03/09/2017] [Indexed: 02/08/2023] Open
Abstract
Fetal life evolves in a hypoxic environment. Changes in the oxygen content in utero caused by conditions such as pre-eclampsia or type I diabetes or by oxygen supplementation to the mother lead to increased free radical production and correlate with perinatal outcomes. In the fetal-to-neonatal transition asphyxia is characterized by intermittent periods of hypoxia ischemia that may evolve to hypoxic ischemic encephalopathy associated with neurocognitive, motor, and neurosensorial impairment. Free radicals generated upon reoxygenation may notably increase brain damage. Hence, clinical trials have shown that the use of 100% oxygen given with positive pressure in the airways of the newborn infant during resuscitation causes more oxidative stress than using air, and increases mortality. Preterm infants are endowed with an immature lung and antioxidant system. Clinical stabilization of preterm infants after birth frequently requires positive pressure ventilation with a gas admixture that contains oxygen to achieve a normal heart rate and arterial oxygen saturation. In randomized controlled trials the use high oxygen concentrations (90% to 100%) has caused more oxidative stress and clinical complications that the use of lower oxygen concentrations (30-60%). A correlation between the amount of oxygen received during resuscitation and the level of biomarkers of oxidative stress and clinical outcomes was established. Thus, based on clinical outcomes and analytical results of oxidative stress biomarkers relevant changes were introduced in the resuscitation policies. However, it should be underscored that analysis of oxidative stress biomarkers in biofluids has only been used in experimental and clinical research but not in clinical routine. The complexity of the technical procedures, lack of automation, and cost of these determinations have hindered the routine use of biomarkers in the clinical setting. Overcoming these technical and economical difficulties constitutes a challenge for the immediate future since accurate evaluation of oxidative stress would contribute to improve the quality of care of our neonatal patients.
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Affiliation(s)
- Isabel Torres-Cuevas
- Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Anna Parra-Llorca
- Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Angel Sánchez-Illana
- Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Antonio Nuñez-Ramiro
- Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Julia Kuligowski
- Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Consuelo Cháfer-Pericás
- Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María Cernada
- Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Justo Escobar
- Scientific Department, Sabartech SL, Biopolo Instituto Investigación Sanitaria La Fe, Valencia, Spain
| | - Máximo Vento
- Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
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Kalikstad B, Kultima HG, Andersstuen TK, Klungland A, Isaksson A. Gene expression profiles in preterm infants on continuous long‑term oxygen therapy suggest reduced oxidative stress‑dependent signaling during hypoxia. Mol Med Rep 2017; 15:1513-1526. [PMID: 28259955 PMCID: PMC5364962 DOI: 10.3892/mmr.2017.6185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/01/2016] [Indexed: 01/24/2023] Open
Abstract
Preterm infants are susceptible to neonatal inflammatory/infective diseases requiring drug therapy. The present study hypothesized that mRNA expression in the blood may be modulated by signaling pathways during treatment. The current study aimed to explore changes in global gene expression in the blood from preterm infants with the objective of identifying patterns or pathways of potential relevance to drug therapy. The infants involved were selected based on maternal criteria indicating increased risk for therapeutic intervention. Global mRNA expression was measured in 107 longitudinal whole blood samples using Affymetrix Human-Genome-U133 Plus 2.0-arrays; samples were obtained from 20 preterm infants. Unsupervised clustering revealed a distinct homogeneous gene expression pattern in 13 samples derived from seven infants undergoing continuous oxygen therapy. At these sampling times, all but one of the seven infants exhibited severe drops in peripheral capillary saturation levels below 60%. The infants were reoxygenated with 100% inspired oxygen concentration. The other samples (n=94) represented the infants from the cohort at time points when they did not undergo continuous oxygen therapy. Comparing these two sets of samples identified a distinct gene expression pattern of 5,986 significantly differentially expressed genes, of which 5,167 genes exhibited reduced expression levels during transient hypoxia. This expression pattern was reversed when the infants became stable, i.e., when they were not continuously oxygenated and had no events of hypoxia. To identify signaling pathways involved in gene regulation, the Database for Annotation, Visualization and Integrated Discovery online tool was used. Mitogen-activated protein kinases, which are normally induced by oxidative stress, exhibited reduced gene expression during hypoxia. In addition, nuclear factor erythroid 2-related factor 2-antioxidant response element target genes involved in oxidative stress protection were also expressed at lower levels, suggesting reduced transcription of this pathway. The findings of the present study suggest that oxidative stress-dependent signaling is reduced during hypoxia. Understanding the molecular response in preterm infants during continuous oxygenation may aid in refining therapeutic strategies for oxygen therapy.
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Affiliation(s)
- Betty Kalikstad
- University of Oslo, Institute of Clinical Medicine, Women and Children's Clinic, Rikshospitalet, 0372 Oslo, Norway
| | - Hanna Göransson Kultima
- Department of Medical Sciences, Science for Life Laboratory, Uppsala University, 751 23 Uppsala, Sweden
| | | | - Arne Klungland
- Department of Molecular Biology, Institute of Medical Microbiology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Anders Isaksson
- Department of Medical Sciences, Science for Life Laboratory, Uppsala University, 751 23 Uppsala, Sweden
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Affiliation(s)
- Sascha Meyer
- University Children's Hospital of Saarland, Department of General Pediatrics and Neonatology, Neonatal Intensive Care Unit, Homburg, Germany.
| | - Michael Zemlin
- University Children's Hospital of Saarland, Department of General Pediatrics and Neonatology, Neonatal Intensive Care Unit, Homburg, Germany
| | - Martin Poryo
- University Children's Hospital of Saarland, Department of Pediatric Cardiology, Homburg, Germany
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Tsuji S, Kitatoube A, Kikuchi-Taura A, Oguro E, Shigesaka M, Okita Y, Shimizu T, Nii T, Teshigawara S, Tanaka E, Harada Y, Matsushita M, Hashimoto J, Ohshima S, Takahashi G, Endo S, Saeki Y. Elevated soluble CD14-subtype (PRESEPSIN; P-SEP) levels in rheumatoid arthritis (RA) patients with bacterial infection. Mod Rheumatol 2016; 27:718-720. [PMID: 27785932 DOI: 10.1080/14397595.2016.1246119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Soichiro Tsuji
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Ayako Kitatoube
- b Department of Clinical Research , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan , and
| | - Akie Kikuchi-Taura
- b Department of Clinical Research , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan , and
| | - Eri Oguro
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Minoru Shigesaka
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Yasutaka Okita
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Takashi Shimizu
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Takuro Nii
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Satoru Teshigawara
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Eriko Tanaka
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Yoshinori Harada
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Masato Matsushita
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Jun Hashimoto
- a Department of Rheumatology and Allergology , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan
| | - Shiro Ohshima
- b Department of Clinical Research , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan , and
| | - Gaku Takahashi
- c Department of Critical Care Medicine and Disaster Medicine Medicine , Iwate Medical University , Uchimaru, Morioka , Japan
| | - Shigeatsu Endo
- c Department of Critical Care Medicine and Disaster Medicine Medicine , Iwate Medical University , Uchimaru, Morioka , Japan
| | - Yukihiko Saeki
- b Department of Clinical Research , National Hospital Organization Osaka Minami Medical Center , Kawachinagano, Osaka , Japan , and
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The Treatment of Severe Sepsis in the Pediatric Age. Crit Care Med 2016; 44:1960-2. [DOI: 10.1097/ccm.0000000000001940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jackson F, Georgakopoulou N, Kaluarachchi M, Kyriakides M, Andreas N, Przysiezna N, Hyde MJ, Modi N, Nicholson JK, Wijeyesekera A, Holmes E. Development of a Pipeline for Exploratory Metabolic Profiling of Infant Urine. J Proteome Res 2016; 15:3432-40. [PMID: 27476583 DOI: 10.1021/acs.jproteome.6b00234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Numerous metabolic profiling pipelines have been developed to characterize the composition of human biofluids and tissues, the vast majority of these being for studies in adults. To accommodate limited sample volume and to take into account the compositional differences between adult and infant biofluids, we developed and optimized sample handling and analytical procedures for studying urine from newborns. A robust pipeline for metabolic profiling using NMR spectroscopy was established, encompassing sample collection, preparation, spectroscopic measurement, and computational analysis. Longitudinal samples were collected from five infants from birth until 14 months of age. Methods of extraction and effects of freezing and sample dilution were assessed, and urinary contaminants from breakdown of polymers in a range of diapers and cotton wool balls were identified and compared, including propylene glycol, acrylic acid, and tert-butanol. Finally, assessment of urinary profiles obtained over the first few weeks of life revealed a dramatic change in composition, with concentrations of phenols, amino acids, and betaine altering systematically over the first few months of life. Therefore, neonatal samples require more stringent standardization of experimental design, sample handling, and analysis compared to that of adult samples to accommodate the variability and limited sample volume.
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Affiliation(s)
- Frances Jackson
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London , South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Nancy Georgakopoulou
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London , South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Manuja Kaluarachchi
- Metabometrix Ltd, Bioincubator, Prince Consort Road, South Kensington, London SW7 2AZ, United Kingdom
| | - Michael Kyriakides
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London , South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Nicholas Andreas
- Section of Neonatal Medicine, Department of Medicine, Imperial College London , Chelsea and Westminster Hospital Campus, London SW10 9NH, United Kingdom
| | - Natalia Przysiezna
- Section of Neonatal Medicine, Department of Medicine, Imperial College London , Chelsea and Westminster Hospital Campus, London SW10 9NH, United Kingdom
| | - Matthew J Hyde
- Section of Neonatal Medicine, Department of Medicine, Imperial College London , Chelsea and Westminster Hospital Campus, London SW10 9NH, United Kingdom
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London , Chelsea and Westminster Hospital Campus, London SW10 9NH, United Kingdom
| | - Jeremy K Nicholson
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London , South Kensington Campus, London SW7 2AZ, United Kingdom.,MRC-NIHR National Phenome Centre, Department of Surgery and Cancer, Imperial College London , Hammersmith Hospital Campus, London W12 0NN, United Kingdom
| | - Anisha Wijeyesekera
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London , South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Elaine Holmes
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London , South Kensington Campus, London SW7 2AZ, United Kingdom.,MRC-NIHR National Phenome Centre, Department of Surgery and Cancer, Imperial College London , Hammersmith Hospital Campus, London W12 0NN, United Kingdom
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Brussee JM, Calvier EAM, Krekels EHJ, Välitalo PAJ, Tibboel D, Allegaert K, Knibbe CAJ. Children in clinical trials: towards evidence-based pediatric pharmacotherapy using pharmacokinetic-pharmacodynamic modeling. Expert Rev Clin Pharmacol 2016; 9:1235-44. [PMID: 27269200 DOI: 10.1080/17512433.2016.1198256] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION In pediatric pharmacotherapy, many drugs are still used off-label, and their efficacy and safety is not well characterized. Different efficacy and safety profiles in children of varying ages may be anticipated, due to developmental changes occurring across pediatric life. AREAS COVERED Beside pharmacokinetic (PK) studies, pharmacodynamic (PD) studies are urgently needed. Validated PKPD models can be used to derive optimal dosing regimens for children of different ages, which can be evaluated in a prospective study before implementation in clinical practice. Strategies should be developed to ensure that formularies update their drug dosing guidelines regularly according to the most recent advances in research, allowing for clinicians to integrate these guidelines in daily practice. Expert commentary: We anticipate a trend towards a systems-level approach in pediatric modeling to optimally use the information gained in pediatric trials. For this approach, properly designed clinical PKPD studies will remain the backbone of pediatric research.
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Affiliation(s)
- Janneke M Brussee
- a Division of Pharmacology, Leiden Academic Centre for Drug Research , Leiden University , Leiden , The Netherlands
| | - Elisa A M Calvier
- a Division of Pharmacology, Leiden Academic Centre for Drug Research , Leiden University , Leiden , The Netherlands
| | - Elke H J Krekels
- a Division of Pharmacology, Leiden Academic Centre for Drug Research , Leiden University , Leiden , The Netherlands
| | - Pyry A J Välitalo
- a Division of Pharmacology, Leiden Academic Centre for Drug Research , Leiden University , Leiden , The Netherlands
| | - Dick Tibboel
- b Intensive Care and Department of Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Karel Allegaert
- b Intensive Care and Department of Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands.,c Department of Development and Regeneration , KU Leuven , Leuven , Belgium
| | - Catherijne A J Knibbe
- a Division of Pharmacology, Leiden Academic Centre for Drug Research , Leiden University , Leiden , The Netherlands.,d Department of Clinical Pharmacy , St. Antonius Hospital , Nieuwegein , The Netherlands
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Pugni L, Pietrasanta C, Milani S, Vener C, Ronchi A, Falbo M, Arghittu M, Mosca F. Presepsin (Soluble CD14 Subtype): Reference Ranges of a New Sepsis Marker in Term and Preterm Neonates. PLoS One 2015; 10:e0146020. [PMID: 26720209 PMCID: PMC4697794 DOI: 10.1371/journal.pone.0146020] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 12/12/2015] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Presepsin (soluble CD14 subtype) has been shown to be beneficial as a sepsis marker in adults. Nevertheless, very few data are available in neonates. The aim of the present study was to determine reference ranges of presepsin in term and preterm neonates. METHODS Healthy term neonates and preterm neonates without clinical signs of infection admitted to the Neonatal Unit were consecutively enrolled. Presepsin concentrations in whole blood were measured using a point-of-care assay system located in the Unit. Demographic data, antenatal and perinatal variables commonly affecting C-reactive protein and procalcitonin values were considered. RESULTS Of the 684 neonates enrolled in the study, 484 (70.8%) were born at term and 200 (29.2%) were preterm (24-36 weeks' gestation). In term infants, presepsin median value was 603.5 pg/mL (interquartile range: 466.5-791 pg/mL; 5th and 95th centiles: 315 and 1178 pg/mL respectively). In preterm infants, presepsin median value was slightly higher, equal to 620 pg/mL (interquartile range: 503-864 pg/mL; 5th and 95th centiles: 352 and 1370 pg/mL respectively). The reference ranges of presepsin we determined were much higher than those seen in healthy adults. No correlation between presepsin levels and postnatal age was observed, as well as no significant difference was demonstrated in preterm neonates at different gestational ages. None of the variables analyzed affected presepsin levels at a clinical significant extent. CONCLUSION For the first time, this study provides reference ranges of presepsin in term and preterm neonates. Having reliable reference values is crucial for obtaining an adequate diagnostic accuracy. Based on our results, most variables commonly affecting C-reactive protein and procalcitonin values do not affect presepsin levels, which suggests that presepsin could be an effective sepsis marker. Further investigations in large groups of neonates with sepsis are needed to determine the diagnostic and prognostic value of this biomarker.
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Affiliation(s)
- Lorenza Pugni
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- * E-mail:
| | - Carlo Pietrasanta
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Silvano Milani
- Laboratory “GA Maccacaro”, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudia Vener
- Laboratory “GA Maccacaro”, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Ronchi
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mariella Falbo
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Milena Arghittu
- Microbiology Laboratory, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Offringa M, Davis JM, Turner MA, Ward R, Bax R, Maldonado S, Sinha V, McCune SK, Zajicek A, Benjamin DK, Bucci-Rechtweg C, Nelson RM. Applying Regulatory Science to Develop Safe and Effective Medicines for Neonates: Report of the US Food and Drug Administration First Annual Neonatal Scientific Workshop, October 28–29, 2014. Ther Innov Regul Sci 2015; 49:623-631. [DOI: 10.1177/2168479015597730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Annagür A, Örs R, Altunhan H, Kurban S, Ertuğrul S, Konak M, Uygun SS, Pekcan S, Erbay E, Mehmetoğlu İ. Total antioxidant and total oxidant states, and serum paraoxonase-1 in neonatal sepsis. Pediatr Int 2015; 57:608-13. [PMID: 25488411 DOI: 10.1111/ped.12557] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/27/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Paraoxonase-1 (PON-1) is an enzyme with a glycoprotein structure that depends on calcium and which is located in serum high-density lipoprotein (HDL). The aim of this study was to evaluate PON-1, and oxidant/antioxidant state, before and after treatment for neonatal sepsis, and to determine the usability of PON-1 in neonatal sepsis treatment. METHODS A total of 35 neonatal sepsis patients and 35 healthy controls were included in the study. Activity of PON-1, total oxidant state (TOS) and total antioxidant state (TAS) were measured and oxidative stress index (OSI) was calculated. RESULTS In the neonatal sepsis patients, pre-treatment TAS, TOS and OSI were significantly higher than the post-treatment levels (P < 0.0001, P < 0.0001 and P < 0.0001, respectively), and PON-1 was significantly lower (P < 0.0001). Similarly, pre-treatment TAS, TOS and OSI in the sepsis group were also significantly higher than in the control group (P < 0.0001, P < 0.0001 and P < 0.0001, respectively) and PON-1 was significantly lower (P < 0.0001). Post-treatment TAS in the sepsis group was significantly higher than in the control group (P = 0.009), whereas post-treatment TOS, OSI and PON-1 in the sepsis group were not significantly different to the control group (P = 0.078, P = 0.597 and P = 0.086, respectively). CONCLUSION Low serum PON-1 was found in neonatal sepsis. Serum PON-1 is thought to be a useful biomarker to evaluate the effectiveness of treatment and recovery in neonatal sepsis.
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Affiliation(s)
- Ali Annagür
- Department of Neonatology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Rahmi Örs
- Department of Neonatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Hüseyin Altunhan
- Department of Neonatology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Sevil Kurban
- Department of Clinical Biochemistry, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Sabahattin Ertuğrul
- Department of Neonatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Murat Konak
- Department of Neonatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Saime Sündüz Uygun
- Department of Neonatology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Sevgi Pekcan
- Department of Neonatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ekrem Erbay
- Department of Clinical Biochemistry, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - İdris Mehmetoğlu
- Department of Clinical Biochemistry, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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Neonatal infections due to multi-resistant strains: Epidemiology, current treatment, emerging therapeutic approaches and prevention. Clin Chim Acta 2015; 451:71-7. [PMID: 25749408 DOI: 10.1016/j.cca.2015.02.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 02/19/2015] [Accepted: 02/22/2015] [Indexed: 01/13/2023]
Abstract
Severe infections represent the main cause of neonatal mortality accounting for more than one million neonatal deaths worldwide every year. Antibiotics are the most commonly prescribed medications in neonatal intensive care units. The benefits of antibiotic therapy when indicated are clearly enormous, but the continued and widespread use of antibiotics has generated over the years a strong selective pressure on microorganisms, favoring the emergence of resistant strains. Health agencies worldwide are galvanizing attention toward antibiotic resistance in gram-positive and gram-negative bacteria. Infections in neonatal units due to multidrug and extensively multidrug resistant bacteria are rising and are already seriously challenging antibiotic treatment options. While there is a growing choice of agents against multi-resistant gram-positive bacteria, new options for multi-resistant gram-negative bacteria in the clinical practice have decreased significantly in the last 20 years making the treatment of infections caused by multidrug-resistant pathogens challenging mostly in neonates. Treatment options are currently limited and will be some years before any new treatment for neonates become available for clinical use, if ever. The aim of the review is to highlight the current knowledge on antibiotic resistance in the neonatal population, the possible therapeutic choices, and the prevention strategies to adopt in order to reduce the emergency and spread of resistant strains.
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Abstract
PURPOSE OF REVIEW In newborns, interactions between the host and the microbiome operate synergistically, modulating host immune function and shaping the microbiome. Next generation molecular sequencing methodologies in tandem with modeling complex communities allow insights into the role of the microbiome in health and disease states. Infection-related disease states in which dysbiosis is integral include late-onset sepsis (LOS) and necrotizing enterocolitis (NEC), which still cause deaths and morbidity. Understanding microbiomic interactions may lead to alternative prevention, monitoring or treatment strategies, and modulation of long-term health outcomes especially in the preterm population. Recent studies have advanced understanding of the microbiome in NEC and LOS. RECENT FINDINGS Mechanisms of host-microbiome interaction have been demonstrated. Patterns of microbiomic change in association with NEC and LOS have been observed, with community changes dominated by Proteobacteria and Firmicutes appearing to precede NEC, and very early microbiomic signatures influencing LOS. Data on viral and fungal elements are emerging. SUMMARY Greater understanding of the neonatal bowel microbiome may allow tailored clinical practice and therapeutic intervention. Data handling and interpretation is challenging. Mechanistic studies of clinical interventions that affect the gut microbiome are important next steps.
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Use of early biomarkers in neonatal brain damage and sepsis: state of the art and future perspectives. BIOMED RESEARCH INTERNATIONAL 2015; 2015:253520. [PMID: 25685774 PMCID: PMC4313065 DOI: 10.1155/2015/253520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/11/2014] [Indexed: 12/19/2022]
Abstract
The identification of early noninvasive biochemical markers of disease is a crucial issue of the current scientific research, particularly during the first period of life, since it could provide useful and precocious diagnostic information when clinical and radiological signs are still silent. The ideal biomarker should be practical and sensitive in the precocious identification of at risk patients. An earlier diagnosis may lead to a larger therapeutic window and improve neonatal outcome. Brain damage and sepsis are common causes of severe morbidity with poor outcome and mortality during the perinatal period. A large number of potential biomarkers, including neuroproteins, calcium binding proteins, enzymes, oxidative stress markers, vasoactive agents, and inflammatory mediators, have been so far investigated. The aim of the present review was to provide a brief overview of some of the more commonly investigated biomarkers used in case of neonatal brain damage and sepsis.
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Abstract
Sepsis is defined as an exaggerated, systemic inflammatory response to infection and is a common condition in horses. Systemic inflammatory response syndrome (SIRS) associated with bacterial infection is a hallmark of sepsis. Sepsis in neonatal foals is a common sequela of failure of passive transfer and, in addition to development of SIRS, may be characterised by bacteraemia, pneumonia, enterocolitis, omphalophlebitis, meningoencephalitis or arthritis. Sepsis in mature horses is most commonly observed secondary to gastrointestinal lesions that result in disrupted mucosa and bacterial translocation into circulation (endotoxaemia). Pleuropneumonia and metritis may also cause sepsis in mature horses. Diagnosis of sepsis is based on SIRS criteria as well as suspected or confirmed infection. Due to the relatively low sensitivity of microbial culture and the subjectivity of sepsis scoring, many sepsis biomarkers are being studied for their usefulness in diagnosis and prognostication of sepsis in horses. Treatment of sepsis requires an intensive care approach that includes antimicrobial drug administration, fluid resuscitation and pressure support, and treatment for inflammation, endotoxaemia and coagulopathy. Early recognition of sepsis and prompt antimicrobial drug treatment are critical for a successful outcome. Multiple organ dysfunction syndrome may occur in severe cases of sepsis, with common manifestations including laminitis and coagulopathies. Although prognosis for septic mature horses depends highly on the primary disease process, the overall survival rate in septic neonatal foals ranges from 26 to 86%, with most studies indicating a survival rate of 45-60%.
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Affiliation(s)
- S Taylor
- Veterinary Clinical Sciences Purdue University West Lafayette Indiana USA
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Abstract
Over the past two decades, host-response biomarkers have been extensively used by clinicians for a better understanding of normal biological processes, the complexity and severity of illnesses, or pharmacological responses to therapeutic intervention. A myriad of information can be drawn from the gender, age, dietary intake and the disease history of an individual. These biomarkers may be promising for the complete phenotyping of a cell, tissue or an organism. In neonatology, these molecular markers may help in prediction of disease severity and its outcome, thus allowing personalized interventions. In this Review, existing data in the literature on metabolites in plasma, urine and maternal milk that may offer a unique insight into the host's dynamic behavior in different neonatal conditions will be examined.
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Bhandari V. Effective Biomarkers for Diagnosis of Neonatal Sepsis. J Pediatric Infect Dis Soc 2014; 3:234-45. [PMID: 26625387 DOI: 10.1093/jpids/piu063] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/22/2014] [Indexed: 01/05/2023]
Abstract
Infection in neonates continues to be a global problem with significant morbidity and mortality. The diagnosis of neonatal sepsis is complicated by nonspecific clinical symptomatology, a high-false negative rate, and a delay in obtaining blood culture results. An ideal biomarker needs to have a high degree of accuracy in recognizing the presence or absence of definite infection at an early stage, to guide the initiation and duration of antibiotic therapy. The diagnostic utility of the following biomarkers seems to be most practical in the early (interleukin [IL]-6, IL-8, tumor necrosis factor-alpha, neutrophil CD64), mid (procalcitonin) and late (C-reactive protein) phases of neonatal sepsis. Future research studies to assess reliability of these biomarkers should be (1) adequately powered for sample size and (2) use the gold-standard definition of blood-culture proven pathogen-specific sepsis. Significant advances in diagnostic accuracy of novel biomarkers to allow early, accurate, and cost-effective identification of pathogens responsible for neonatal sepsis is anticipated in the next 5 years.
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Affiliation(s)
- Vineet Bhandari
- Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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50
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Innovative Diagnostik für die pädiatrische Infektiologie. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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