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Chen F, Zhang Y, Wang M, Liu J, Hai W, Liu Y. Chitosan modified graphene field-effect transistor biosensor for ultrasensitive procalcitonin detection. Talanta 2024; 268:125308. [PMID: 37862752 DOI: 10.1016/j.talanta.2023.125308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
Sepsis is a systemic inflammatory response caused by a bacterial infection that often leading to tissue damage, organ failure and death. Procalcitonin (PCT), as a peptide precursor to hormones, is the main biomarker to identification of the sepsis. In this study, a chitosan modified graphene field transistor (CTS-GFET) was established and first time used for PCT ultra-sensitive detection. CTS was functionalized on the GFET channel surface to immobilized anti-PCT by glutaraldehyde. This biosensor exhibited the detection limit as low as 0.82 ag/mL in PBS, which exhibited 3 times enhancement compared with GFET biosensors. The enhancement mechanisms of CTS-GFET were studied by electrical theoretical model. In addition, the CTS-GFET biosensor was successfully applied to quantify the concentration of the PCT in human serum samples, indicating the potential use in clinical application.
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Affiliation(s)
- Furong Chen
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia Minzu University, Tongliao, 028000, People's Republic of China
| | - Ying Zhang
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia Minzu University, Tongliao, 028000, People's Republic of China
| | - Mingxuan Wang
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia Minzu University, Tongliao, 028000, People's Republic of China
| | - Jinghai Liu
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia Minzu University, Tongliao, 028000, People's Republic of China
| | - Wenfeng Hai
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia Minzu University, Tongliao, 028000, People's Republic of China.
| | - Yushuang Liu
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia Minzu University, Tongliao, 028000, People's Republic of China; Key Laboratory of Mongolian Medicine Research and Development Engineering, Ministry of Education, Inner Mongolia Minzu University, Tongliao, 028000, People's Republic of China.
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Loveland PM, Yu JJ, Churilov L, Yassi N, Watson R. Investigation of Inflammation in Lewy Body Dementia: A Systematic Scoping Review. Int J Mol Sci 2023; 24:12116. [PMID: 37569491 PMCID: PMC10418754 DOI: 10.3390/ijms241512116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Inflammatory mechanisms are increasingly recognized as important contributors to the pathogenesis of neurodegenerative diseases, including Lewy body dementia (LBD). Our objectives were to, firstly, review inflammation investigation methods in LBD (dementia with Lewy bodies and Parkinson's disease dementia) and, secondly, identify alterations in inflammatory signals in LBD compared to people without neurodegenerative disease and other neurodegenerative diseases. A systematic scoping review was performed by searching major electronic databases (MEDLINE, Embase, Web of Science, and PSYCHInfo) to identify relevant human studies. Of the 2509 results screened, 80 studies were included. Thirty-six studies analyzed postmortem brain tissue, and 44 investigated living subjects with cerebrospinal fluid, blood, and/or brain imaging assessments. Largely cross-sectional data were available, although two longitudinal clinical studies investigated prodromal Lewy body disease. Investigations were focused on inflammatory immune cell activity (microglia, astrocytes, and lymphocytes) and inflammatory molecules (cytokines, etc.). Results of the included studies identified innate and adaptive immune system contributions to inflammation associated with Lewy body pathology and clinical disease features. Different signals in early and late-stage disease, with possible late immune senescence and dystrophic glial cell populations, were identified. The strength of these associations is limited by the varying methodologies, small study sizes, and cross-sectional nature of the data. Longitudinal studies investigating associations with clinical and other biomarker outcomes are needed to improve understanding of inflammatory activity over the course of LBD. This could identify markers of disease activity and support therapeutic development.
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Affiliation(s)
- Paula M. Loveland
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville 3000, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville 3000, Australia
| | - Jenny J. Yu
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville 3000, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville 3000, Australia
| | - Leonid Churilov
- Department of Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville 3000, Australia
- Melbourne Medical School, University of Melbourne, Parkville 3000, Australia
| | - Nawaf Yassi
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville 3000, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville 3000, Australia
- Department of Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville 3000, Australia
| | - Rosie Watson
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville 3000, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville 3000, Australia
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Zhu K, Chen J, Hu J, Xiong S, Zeng L, Huang X, Xiong Y. Low-sample-consumption and ultrasensitive detection of procalcitonin by boronate affinity recognition-enhanced dynamic light scattering biosensor. Biosens Bioelectron 2022; 200:113914. [PMID: 34973568 DOI: 10.1016/j.bios.2021.113914] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
Accurate determination of procalcitonin (PCT) is highly crucial in bacterial infection diagnosis. Many biosensors previously developed suffer from large sample consumption or lengthy waiting time, which raise difficulties for more vulnerable patients, such as infants, old people, and other critically ill patients. To address this dilemma, we present an innovative boronate affinity recognition (BAR)-enhanced dynamic light scattering (DLS) biosensor to achieve ultrasensitive PCT detection. In this biosensing system, monoclonal antibody-modified magnetic nanoparticles (MNP@mAb) are designed as probes to capture PCT from serum samples and generate DLS signal transduction. Polyvalent phenylboronic acid-labeled bovine serum albumin (BSA@PBA) is used as scaffold to aggregate MNP@mAb and PCT (MNP@mAb-PCT) complex because of the specific interaction of cis-diol-containing PCT with boronic acid ligands on the surface of BSA@PBA. The BAR-enhanced DLS biosensor shows ultrahigh sensitivity to PCT determination due to high binding affinity, with the limit of detection of 0.03 pg/mL. The total detection time of PCT in whole blood or serum is less than 15 min with small sample consumption (about 1 μL) due to the rapid magnetic separation and aggregation of MNP@mAb-PCT triggered by BSA@PBA. In addition, the proposed DLS biosensor exhibits a high specificity for PCT quantitative detection. Therefore, this work provides a promising and versatile strategy for extending DLS biosensor to rapid and ultrasensitive detection of trace PCT for broader patients and more urgent cases.
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Affiliation(s)
- Kang Zhu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China; School of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China
| | - Jing Chen
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China; School of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China
| | - Jiaqi Hu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China; School of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China
| | - Sicheng Xiong
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China; School of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China; Stockbridge School of Agriculture, University of Massachusetts, Amherst, MA 01003, United States.
| | - Lifeng Zeng
- The People's Hospital in Jiangxi Province, Nanchang, Jiangxi, 330006, PR China
| | - Xiaolin Huang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China; School of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China.
| | - Yonghua Xiong
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China; School of Food Science and Technology, Nanchang University, Nanchang, 330047, PR China
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Liu Y, Chen F, Bao L, Hai W. Construction of a non-enzymatic electrochemical sensor based on graphitic carbon nitride nanosheets for sensitive detection of procalcitonin. RSC Adv 2022; 12:22518-22525. [PMID: 36105974 PMCID: PMC9366762 DOI: 10.1039/d2ra03650a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
In this study, we established a label free and ultrasensitive electrochemical sensor based on graphitic nitride nanosheets (g-C3N4 NS) for procalcitonin (PCT) detection. Firstly, an easy-to-prepare and well-conducting g-C3N4 NS was synthesized. Next the g-C3N4 NS was immobilized on the electrode surface by π–π stacking, and further used to anchor the specific recognition peptide (PP). The surface morphology and structure after g-C3N4 NS and PP modification was characterized by X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM) and electrochemistry. The sensing property of this sensor was evaluated by differential pulse voltammetry (DPV) and showed a detection sensitivity with a dynamic range from 0.15 to 11.7 fg mL−1 with a low limit of detection (LOD) of 0.11 fg mL−1. Besides, the electrochemical biosensor was successfully used to detect PCT in human serum samples, and the results suggest its potential use in clinical application. A simple and ultra-sensitive electrochemical biosensor based on graphitic carbon nitride nanosheets (g-C3N4 NS) was developed for the detection of PCT. This sensor presented excellent sensing performance and demonstrates potential for clinical application.![]()
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Affiliation(s)
- Yushuang Liu
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia University for Nationalities, Tongliao 028000, People's Republic of China
| | - Furong Chen
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia University for Nationalities, Tongliao 028000, People's Republic of China
| | - Layue Bao
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia University for Nationalities, Tongliao 028000, People's Republic of China
| | - Wenfeng Hai
- Inner Mongolia Key Laboratory of Carbon Nanomaterials, Nano Innovation Institute (NII), College Chemistry and Materials Science, Inner Mongolia University for Nationalities, Tongliao 028000, People's Republic of China
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Liu P, Li C, Zhang R, Tang Q, Wei J, Lu Y, Shen P. An ultrasensitive electrochemical immunosensor for procalcitonin detection based on the gold nanoparticles-enhanced tyramide signal amplification strategy. Biosens Bioelectron 2019; 126:543-550. [DOI: 10.1016/j.bios.2018.10.048] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/25/2018] [Accepted: 10/20/2018] [Indexed: 12/11/2022]
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Yoon YK, Kim MJ, Yang KS, Ham SY. The role of serum procalcitonin in the differential diagnosis of pneumonia from pulmonary edema among the patients with pulmonary infiltrates on chest radiography. Medicine (Baltimore) 2018; 97:e13348. [PMID: 30461655 PMCID: PMC6393097 DOI: 10.1097/md.0000000000013348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to evaluate the usefulness of serum procalcitonin (PCT) as a diagnostic biomarker for distinguishing pneumonia from pulmonary edema in patients presenting with pulmonary infiltrates on chest radiography.A comparative study was performed retrospectively in a university-affiliated hospital, from May, 2013 to April, 2015. Adult patients (≥18 years) who showed pulmonary infiltrates on chest radiography and had blood tests with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), PCT, and N-terminal pro-b-type natriuretic peptide (NT-proBNP) on admission were included in the study. Clinical parameters collected on admission were compared between the case group (n = 143) with pneumonia and the control group (n = 88) with pulmonary edema alone.During the study period, a total of 1217 patients were identified. Of them, a total of 231 patients were included in analyses based on exclusion criteria. In the multivariate logistic regression analysis, PCT ≥0.25 ng/mL, ESR ≥35 mm/h, CRP ≥18 mg/L, NT-proBNP ≤200 pg/mL, underlying neurologic diseases, fever, sputum, absence of cardiomegaly, and a low Charlson comorbidity index were independently associated with pneumonia. For this model, the sensitivity, specificity, positive predictive value, and negative predictive value in distinguishing between the 2 groups were 90.2%, 79.6%, 87.8%, and 83.3%, respectively, with an area under the curve of 0.93.This study suggests that the practical use of PCT in conjunction with clinical data can be valuable in the differential diagnosis of pulmonary infiltrates and guidance for clinicians to prevent antibiotic misuse.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Medical Center; Seoul, Republic of Korea
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Ceriotti F, Marino I, Motta A, Carobene A. Analytical evaluation of the performances of Diazyme and BRAHMS procalcitonin applied to Roche Cobas in comparison with BRAHMS PCT-sensitive Kryptor. Clin Chem Lab Med 2017; 56:162-169. [PMID: 28809746 DOI: 10.1515/cclm-2017-0159] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/12/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Procalcitonin (PCT) is a recognized marker of sepsis, and its use is expanding to antibiotic stewardship. The aim of this study was the evaluation of two methods: Diazyme PCT on Roche Cobas c702 (PCT-D) and BRAHMS PCT on Roche Cobas e602 analyzers (PCT-BR) in comparison with BRAHMS PCT-sensitive Kryptor (PCT-BK). METHODS Imprecision was assessed at six critical concentrations following the CLSI EP5-A3; limits of detection (LoDs) were checked according to CLSI EP17-A2; linearity was tested, and method comparison was performed on 239 serum samples. RESULTS Overall CVs ranged from 12.58% to 5.97% for PCT-D, from 3.94% to 1.70% for PCT-BR and from 6.57% to 1.90% for PCT-BK. LoDs were 0.143 μg/L, 0.014 μg/L, 0.040 μg/L for PCT-D, PCT-BR and PCT-BK, respectively. The functional assay sensitivity was 0.24 μg/L for PCT-D, 0.045 μg/L for PCT-BK and <0.035 μg/L for PCT-BR. PCT-BR was linear up to 68.7 μg/L, PCT-BK up to 43 μg/L and PCT-D up to 27.2 μg/L. Method comparison: PCT-D=0.6543 PCT-BK+0.014, r=0.8463 (but 0.44 if calculated on 0-5 μg/L range); PCT-BR=0.9125 PCT-BK+0.021, r=0.9917. Cohen's κ ranged from 45.2% at 0.25 μg/L to 57.0% at 2.00 μg/L between PCT-D and PCT-BK, whereas it ranged from 89% to 81.3% between PCT-BR and PCT-BK. CONCLUSIONS The PCT-D performances were significantly different from those of PCT-BR and PCT-BK regarding sensitivity, precision, linearity and agreement at clinical cutoffs. For some patients with serial testing, significantly deviating results were obtained compared to reference. In contrast to Roche PCT assay, it does not seem feasible to use BRAHMS PCT cutoffs for the Diazyme test.
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Hu Y, Yang M, Zhou Y, Ding Y, Xiang Z, Yu L. Establishment of reference intervals for procalcitonin in healthy pregnant women of Chinese population. Clin Biochem 2017; 50:150-154. [DOI: 10.1016/j.clinbiochem.2016.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/04/2016] [Accepted: 10/18/2016] [Indexed: 11/16/2022]
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Procalcitonin: A new biomarker for the cardiologist. Int J Cardiol 2016; 223:390-397. [DOI: 10.1016/j.ijcard.2016.08.204] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 02/04/2023]
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Becker K, Nylén E, Snider R, Müller B, White J. Immunoneutralization of procalcitonin as therapy of sepsis. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/09680519030090061001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prior studies have demonstrated that the prohormone, procalcitonin (ProCT), and its component calcitonin precursors (CTpr) are increased in the serum of septic patients, correlate with the severity of the illness, and persist for relatively long periods of time. Animal studies in septic hamsters have revealed that the administration of ProCT is toxic and that immunoneutralization with IgG that is reactive to this molecule significantly improves survival. A large animal model of a very rapidly lethal polymicrobial sepsis has been developed in the pig in order to measure continuous physiological and metabolic parameters and also to compare the effects in this animal of an immunoneutralization, which is performed late in the course of the disease, to an identical, but early, therapy. Based upon the physiological and metabolic parameters, the late therapy, which was initiated during the fourth hour at a time when pigs were nearly moribund, was found to be as beneficial as early therapy. In both late and early therapy, the only animals to survive at the predetermined time of euthanasia were those which had received immunoneutralization therapy.
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Affiliation(s)
- K.L. Becker
- George Washington University and Veterans Affairs Medical Center, Washington, DC, USA,
| | - E.S. Nylén
- George Washington University and Veterans Affairs Medical Center, Washington, DC, USA
| | - R.H. Snider
- George Washington University and Veterans Affairs Medical Center, Washington, DC, USA
| | | | - J.C. White
- George Washington University and Veterans Affairs Medical Center, Washington, DC, USA
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11
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Landman GWD, Kleefstra N, Groenier KH, Bakker SJL, Groeneveld GH, Bilo HJG, van Hateren KJJ. Inflammation biomarkers and mortality prediction in patients with type 2 diabetes (ZODIAC-27). Atherosclerosis 2016; 250:46-51. [PMID: 27179179 DOI: 10.1016/j.atherosclerosis.2016.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/19/2016] [Accepted: 04/19/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (MR-proADM) are inflammation markers associated with long-term mortality risk. We compared the associations and predictive capacities of CRP, PCT and MR-proADM with cardiovascular and all-cause mortality in patients with type 2 diabetes. METHODS This study included primary care treated patients with type 2 diabetes participating in the ZODIAC cohort study. A total of 1005 out of 1688 patients (60%) had complete baseline variables. Baseline CRP, PCT and MR-proADM were assessed in relation to cardiovascular and all-cause mortality with Cox proportional hazard analyses. Hazard Ratios (HR) were adjusted for age, gender, BMI, smoking, systolic blood pressure, cholesterol-HDL ratio, duration of diabetes, HbA1c, history of cardiovascular diseases, albumin-creatinine ratio and creatinine. Risk prediction capabilities were assessed with Harrell's C statistics and proportion of explained variance (R(2)). RESULTS After a median follow-up of 11 years, 472 (47%) of 1005 patients had died. The likelihood ratio test showed that CRP and MR-proADM significantly improved prediction in cardiovascular mortality [HRs 1.20 (95%CI 1.09-1.33) and 1.56 (95%CI 1.06-2.30)] and in all-cause mortality [HRs 1.10 (95%CI: 1.03-1.18) and 1.31 (95%CI 1.02-1.69)]. Harrell's C values and R(2) measures showed slightly improved discrimination for cardiovascular mortality in patients without macrovascular disease (C: 0.80 to 0.81; R(2): 0.50 to 0.52) and MR-proADM (C: 0.80 to 0.82; R(2): 0.50 to 0.52). CONCLUSIONS CRP and MR-proADM, but not PCT, were independently associated with cardiovascular and all-cause mortality. In patients without macrovascular diseases, CRP and MR-proADM slightly improved discrimination, in absolute sense, of patients at risk for cardiovascular mortality.
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Affiliation(s)
- Gijs W D Landman
- Langerhans Medical Research Institute, Zwolle, The Netherlands; Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands.
| | - Nanne Kleefstra
- Langerhans Medical Research Institute, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas H Groenier
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Research Centre, Isala Hospital, Zwolle, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geert H Groeneveld
- Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Research Centre, Isala Hospital, Zwolle, The Netherlands
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Liu HH, Guo JB, Geng Y, Su L. Procalcitonin: present and future. Ir J Med Sci 2015; 184:597-605. [DOI: 10.1007/s11845-015-1327-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/20/2015] [Indexed: 12/15/2022]
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13
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Sandkovsky U, Kalil AC, Florescu DF. The use and value of procalcitonin in solid organ transplantation. Clin Transplant 2015; 29:689-96. [PMID: 25996831 DOI: 10.1111/ctr.12568] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 01/01/2023]
Abstract
Procalcitonin (PCT) has been increasingly used as a biomarker of bacterial infection and as a tool to guide antimicrobial therapy, especially in lower respiratory tract and bloodstream infections. Despite its increased use, data in patients with solid organ transplants are limited. Even without the presence of infection, PCT increases as a result of surgical procedures during transplantation, implantation of devices, and use of induction immunosuppressive therapy. The risk of infection is also higher in solid organ transplant recipients when compared to the general population. Monitoring PCT in the early post-transplant period seems to be a promising method for early detection of infectious complications. It has been shown that elevated PCT levels after one wk of transplantation are correlated with infectious complications. PCT may be a useful adjunctive biomarker that may improve early identification and guide appropriate treatment of infection or rejection, with the potential to further improve clinical outcomes. The use of serial PCT measurements may be more reliable than single values. It is important to recognize which factors may lead to PCT increases in the post-transplantation period, which in turn will help understand the kinetics and utility of this biomarker in this important patient population.
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Affiliation(s)
- Uriel Sandkovsky
- Division of Infectious Diseases, Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andre C Kalil
- Division of Infectious Diseases, Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA
| | - Diana F Florescu
- Division of Infectious Diseases, Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA.,Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE, USA
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Development of a fluorescent immnunochromatographic assay for the procalcitonin detection of clinical patients in China. Clin Chim Acta 2015; 444:37-42. [DOI: 10.1016/j.cca.2015.01.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/27/2015] [Accepted: 01/27/2015] [Indexed: 01/12/2023]
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15
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Resl M, Vila G, Grimm G, Heinisch B, Riedl M, Dieplinger B, Mueller T, Luger A, Clodi M. Effects of B-type natriuretic peptide on cardiovascular biomarkers in healthy volunteers. J Appl Physiol (1985) 2015; 118:395-9. [DOI: 10.1152/japplphysiol.00101.2014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cardiovascular biomarkers provide independent prognostic information in the assessment of mortality and cardiovascular complications. However, little is known about possible interactions between these biomarkers. In the present study, we evaluated the influence of B-type natriuretic peptide (BNP) on midregional-proadrenomedullin (MR-proADM), C-terminal-proendothelin-1 (CT-proET-1), growth differentiation factor-15 (GDF-15), midregional-proatrial natriuretic peptide (MR-proANP), copeptin, and procalcitonin in healthy volunteers. Ten healthy male subjects (mean age 24 yr) participating in a randomized, placebo-controlled, single-blinded crossover study received placebo or 3.0 pmol·kg−1·min−1human BNP 32 during a continuous infusion lasting for 4 h. Effects of BNP on other cardiovascular biomarkers were assessed. BNP did not change concentrations of MR-proADM, copeptin, CT-proET1, GDF-15, or procalcitonin. In contrast, MR-proANP was significantly decreased during BNP infusion. BNP as an established cardiovascular biomarker did not affect plasma concentrations of other cardiovascular biomarkers in a model of healthy volunteers.
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Affiliation(s)
- M. Resl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine, Konventhospital Barmherzige Brueder, Linz, Austria
| | - G. Vila
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - G. Grimm
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - B. Heinisch
- Department of Internal Medicine III, Division of Gastroenterology, Medical University of Vienna, Vienna, Austria
| | - M. Riedl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - B. Dieplinger
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Linz, Austria; and
| | - T. Mueller
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Linz, Austria; and
| | - A. Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - M. Clodi
- Department of Internal Medicine, Konventhospital Barmherzige Brueder, Linz, Austria
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Schuetz P, Kutz A, Grolimund E, Haubitz S, Demann D, Vögeli A, Hitz F, Christ-Crain M, Thomann R, Falconnier C, Hoess C, Henzen C, Marlowe RJ, Zimmerli W, Mueller B. Excluding infection through procalcitonin testing improves outcomes of congestive heart failure patients presenting with acute respiratory symptoms: results from the randomized ProHOSP trial. Int J Cardiol 2014; 175:464-72. [PMID: 25005339 DOI: 10.1016/j.ijcard.2014.06.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/13/2014] [Accepted: 06/20/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES We sought to determine whether exclusion of infection and antibiotic stewardship with the infection biomarker procalcitonin improves outcomes in congestive heart failure (CHF) patients presenting to emergency departments with respiratory symptoms and suspicion of respiratory infection. METHODS We performed a secondary analysis of patients with a past medical history of CHF formerly included in a Swiss multicenter randomized-controlled trial. The trial compared antibiotic stewardship according to a procalcitonin algorithm or state-of-the-art guidelines (controls). The primary endpoint was a 30-day adverse outcome (death, intensive care unit admission); the secondary endpoints included a 30-day antibiotic exposure. RESULTS In the 110/233 analyzed patients (47.2%) with low initial procalcitonin (<0.25 μg/L), suggesting the absence of systemic bacterial infection, those randomized to procalcitonin guidance (n=50) had a significantly lower adverse outcome rate compared to controls (n=60): 4% vs. 20% (absolute difference -16.0%, 95% confidence interval (CI) -28.4% to -3.6%, P=0.01), and significantly reduced antibiotic exposure [days] (mean 3.7 ± 4.0 vs. 6.5 ± 4.4, difference -2.8 [95% CI, -4.4 to -1.2], P<0.01). When initial procalcitonin was ≥0.25 μg/L, procalcitonin-guided patients had significantly reduced antibiotic exposure due to early stop of therapy without any difference in adverse outcomes (25.8% vs. 24.6%, difference [95% CI] 1.2% [-14.5% to 16.9%, P=0.88]). CONCLUSIONS CHF patients presenting to the emergency department with respiratory symptoms and suspicion for respiratory infection had decreased antibiotic exposure and improved outcomes when procalcitonin measurement was used to exclude bacterial infection and guide antibiotic treatment. These data provide further evidence for the potential harmful effects of antibiotic / fluid treatment when used instead of diuretics and heart failure medication in clinically symptomatic CHF patients without underlying infection.
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Affiliation(s)
- Philipp Schuetz
- University Department of Medicine, Kantonsspital Aarau, Switzerland
| | - Alexander Kutz
- University Department of Medicine, Kantonsspital Aarau, Switzerland.
| | - Eva Grolimund
- University Department of Medicine, Kantonsspital Aarau, Switzerland
| | | | - Désirée Demann
- University Department of Medicine, Kantonsspital Aarau, Switzerland
| | - Alaadin Vögeli
- University Department of Medicine, Kantonsspital Aarau, Switzerland
| | - Fabienne Hitz
- University Department of Medicine, Kantonsspital Aarau, Switzerland
| | - Mirjam Christ-Crain
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Switzerland
| | - Robert Thomann
- Department of Internal Medicine, Bürgerspital Solothurn, Switzerland
| | | | - Claus Hoess
- Department of Internal Medicine, Kantonsspital Münsterlingen, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Kantonsspital Lucerne, Switzerland
| | | | | | - Beat Mueller
- University Department of Medicine, Kantonsspital Aarau, Switzerland
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Sener G, Ozgur E, Rad AY, Uzun L, Say R, Denizli A. Rapid real-time detection of procalcitonin using a microcontact imprinted surface plasmon resonance biosensor. Analyst 2013; 138:6422-8. [DOI: 10.1039/c3an00958k] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Miguel-Bayarri V, Casanoves-Laparra E, Pallás-Beneyto L, Sancho-Chinesta S, Martín-Osorio L, Tormo-Calandín C, Bautista-Rentero D. Prognostic value of the biomarkers procalcitonin, interleukin-6 and C-reactive protein in severe sepsis. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.medine.2012.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schiopu A, Hedblad B, Engström G, Struck J, Morgenthaler NG, Melander O. Plasma procalcitonin and the risk of cardiovascular events and death: a prospective population-based study. J Intern Med 2012; 272:484-91. [PMID: 22530956 DOI: 10.1111/j.1365-2796.2012.02548.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES A number of inflammatory biomarkers such as C-reactive protein (CRP) are independent predictors of cardiovascular risk. The inflammatory biomarker procalcitonin (PCT) has previously been shown to be associated with coronary atherosclerosis and the metabolic syndrome. We evaluated the ability of PCT to predict future cardiovascular events in a population of apparently healthy individuals. DESIGN We measured plasma PCT levels in 3713 subjects with no previous history of cardiovascular disease, randomly selected from the Malmö Diet and Cancer cohort. The correlation between PCT concentration and the incidence of coronary events, stroke and cardiovascular death over a median follow-up period of 13.7 years was studied using a Cox regression analysis corrected for age, sex, CRP level, traditional risk factors and renal function. RESULTS Age and sex were strong determinants of PCT; the concentration of PCT was significantly higher in men than in women. PCT was associated with several of the established cardiovascular risk factors (CRP, hypertension, diabetes and renal function) as determined by multivariate linear regression. Of note, PCT was inversely correlated with HDL and smoking. We found significant correlations between PCT levels, coronary events and cardiovascular death. However, these relationships lost statistical significance when the analysis was corrected for CRP and the traditional risk factors. CONCLUSIONS This is the largest population-based prospective study to demonstrate a positive association between plasma PCT levels and cardiovascular risk in subjects with no previous history of acute cardiovascular events. However, the high degree of covariation between PCT and other cardiovascular risk factors limits the value of PCT as an independent cardiovascular risk predictor.
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Affiliation(s)
- A Schiopu
- Department of Clinical Sciences, Lund University, Skåne University Hospital Malmö, Malmö, Sweden.
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LIMPER MAARTEN, van de STADT LOTTE, BOS WOUTER, de KRUIF MARTIJN, SPEK ARNOLD, WOLBINK GERTJAN, van SCHAARDENBURG DIRKJAN, van GORP ERIC. The Acute-phase Response Is Not Predictive for the Development of Arthritis in Seropositive Arthralgia – A Prospective Cohort Study. J Rheumatol 2012; 39:1914-7. [DOI: 10.3899/jrheum.120586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate whether markers of the acute-phase response in patients presenting with arthralgia and positive anticitrullinated protein antibodies (ACPA) and/or immunoglobulin M rheumatoid factor (IgM-RF) could be predictive for the development of arthritis.Methods.In total, 137 ACPA- and/or IgM-RF-positive patients were included. Patients were followed annually for the development of arthritis, defined as presence of 1 or more swollen joints at clinical examination. High-sensitivity C-reactive protein (hsCRP), procalcitonin (PCT), secretory phospholipase A2 (SPLA2), tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), IL-12p70, IL-10, and interferon-γ (IFN-γ) were measured in baseline serum samples. Gene expression focusing on a predefined panel of genes coding for inflammatory molecules was measured by multiplex ligation-dependent probe amplification.Results.Thirty-five patients (26%) developed arthritis within a median time of 11 months (interquartile range 3.7–18 mo). Circulating levels of cytokines, SPLA2, hsCRP, and PCT were not different between patients with progression to clinical arthritis and those without progression. However, a trend for IL-12p70, TNF-α, IL-10, IL-6, and SPLA2 was observed. No correlation between messenger RNA (mRNA) expression levels of inflammatory genes and progression to arthritis was found. Subgroup analysis of patients with early progression to arthritis showed higher levels of mRNA expression of poly(A)-specific ribonuclease and polycomb complex protein BMI-1 compared to patients without progression to arthritis.Conclusion.Although low-grade inflammation is present before onset of clinical arthritis in large cohorts and can be detected using consecutive measurements, a single measurement of acute-phase reactants seems to have limited value for prediction of development of arthritis in individual patients.
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Prognostic value of the biomarkers procalcitonin, interleukin-6 and C-reactive protein in severe sepsis. Med Intensiva 2012; 36:556-62. [PMID: 22495097 DOI: 10.1016/j.medin.2012.01.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/26/2012] [Accepted: 01/27/2012] [Indexed: 02/01/2023]
Abstract
AIM To determine the prognostic value of the biomarkers procalcitonin, interlukin-6 and C-reactive protein in septic patients. DESIGN A cohort of 81 septic patients. SETTING Critical Care Unit. Dr. Peset Hospital. Valencia (Spain). PATIENTS Divided according to sepsis classification (sepsis, severe sepsis and septic shock), source and two different groups (medical and postsurgical). VARIABLES ANALYZED: Quantitative (procalcitonin, interleukin-6, C-reactive protein, lactate, age, Apache II and SOFA scores upon admission and after 3 and 7 days). Qualitative (ICU mortality, multiorgan failure development and sex). STATISTICAL ANALYSIS Mann-Whitney U-test for the comparison of quantitative variables, χ² test for qualitative variables. Multivariate analysis with mortality and multiorgan failure as dependent variables and the described quantitative parameters as independent variables. ROC curves of the variables found to be significant in the multivariate analysis. RESULTS Septic shock patients showed greater mortality and more frequent multiorgan failure. Comparison of survivors versus deceased patients showed significant differences in Apache II score, interleukin-6 and lactate (p<0.001) upon admission and after 3 and 7 days. Similar findings applied to the comparison of patients with and without multiorgan failure, and on the same days. Procalcitonin only showed differences on days 3 and 7 (p=0.001). In the multivariate analysis with mortality as dependent variable, interleukin-6 proved significant on day 3 (OR 2.6). With multiorgan failure as dependent variable, only the SOFA score showed significance (OR 2.3). The Apache II and interleukin-6 ROC curves corresponding to day 3 showed areas of 0.80 and 0.86, respectively. CONCLUSIONS 1) Interleukin-6 is an inflammatory biomarker with mortality prognostic value. 2) None of the biomarkers proved predictive of multiorgan failure.
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Giannessi D. Multimarker approach for heart failure management: Perspectives and limitations. Pharmacol Res 2011; 64:11-24. [DOI: 10.1016/j.phrs.2011.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/10/2011] [Accepted: 03/20/2011] [Indexed: 12/29/2022]
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Gilbert DN. Procalcitonin as a biomarker in respiratory tract infection. Clin Infect Dis 2011; 52 Suppl 4:S346-50. [PMID: 21460294 DOI: 10.1093/cid/cir050] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Serum procalcitonin (PCT) levels rapidly increase in patients with invasive bacterial disease. PCT levels increase faster than do C-reactive protein levels. Furthermore, a rapid decrease in the PCT level is supporting evidence that the source of the bacterial infection is responding to clinical management. In patients with community-acquired bacterial pneumonia, sequential PCT levels are useful as a guide to shorter courses of antimicrobial therapy. With use of emerging multiplex real-time polymerase chain reaction platforms for the detection of viral and bacterial respiratory pathogens, it should be possible to critically assess whether an elevated serum PCT level is a valid biomarker of invasive bacterial infection.
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Affiliation(s)
- David N Gilbert
- Infectious Diseases and Earle A Chiles Research Institute, Providence Portland Medical Center and Oregon Health and Sciences University, Portland, Oregon 97213, USA.
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Use of plasma procalcitonin levels as an adjunct to clinical microbiology. J Clin Microbiol 2010; 48:2325-9. [PMID: 20421436 DOI: 10.1128/jcm.00655-10] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Procalcitonin (PCT) is synthesized by a large number of tissues and organs in response to invasion by pathogenic bacteria, fungi, and some parasites. Current PCT assays are rapid, specific, and of sufficient sensitivity to detect increases in PCT serum levels within 4 to 6 h of initiation of infection. Clinically, PCT levels may help in decisions regarding the need for empirical antibiotic therapy, "source control" of infection, and duration of antibiotic therapy. The addition of PCT levels to bacterial culture and viral detection results can assist with the separation of colonization and invasion by pathogenic bacteria.
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Kelly D, Khan SQ, Dhillon O, Quinn P, Struck J, Squire IB, Davies JE, Ng LL. Procalcitonin as a prognostic marker in patients with acute myocardial infarction. Biomarkers 2010; 15:325-31. [DOI: 10.3109/13547501003675084] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Kruif MD, Limper M, Gerritsen H, Spek CA, Brandjes DPM, ten Cate H, Bossuyt PM, Reitsma PH, van Gorp ECM. Additional value of procalcitonin for diagnosis of infection in patients with fever at the emergency department. Crit Care Med 2010; 38:457-63. [PMID: 20083920 DOI: 10.1097/ccm.0b013e3181b9ec33] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE First, to determine whether procalcitonin (PCT) significantly adds diagnostic value in terms of sensitivity and specificity to a common set of markers of infection, including C-reactive protein (CRP), at the Emergency Department. Second, to create a simple scoring rule implementing PCT values. Third, to determine and compare associations of CRP and PCT with clinical outcomes. DESIGN The additional diagnostic value of PCT was determined using multiple logistic regression analysis. A score was developed to help distinguish patients with a culture-proven bacterial infection from patients not needing antibiotic treatment using 16 potential clinical and laboratory variables. The prognostic value of CRP and PCT was determined using Spearman's correlation and logistic regression. SETTING Emergency Department of a 310-bed teaching hospital. PATIENTS Patients between 18 and 85 years old presenting with fever to the Emergency Department. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 211 patients were studied (infection confirmed, n = 73; infection likely, n = 58; infection not excluded, n = 46; no infection, n = 34). CRP and chills were the strongest predictors for the diagnosis of bacterial infection. After addition of PCT to these parameters, model fit significantly improved (p = .003). The resulting scoring rule (score = 0.01 * CRP + 2 * chills + 1 * PCT) was characterized by an AUC value of 0.83 (sensitivity 79%; specificity of 71%), which was more accurate than physician judgment or SIRS (systemic inflammatory response syndrome). PCT levels were significantly associated with admission to a special care unit, duration of intravenous antibiotic use, total duration of antibiotic treatment, and length of hospital stay, whereas CRP was related only to the latter two variables. CONCLUSIONS These data suggest that PCT may be a valuable addition to currently used markers of infection for diagnosis of infection and prognosis in patients with fever at the Emergency Department.
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Affiliation(s)
- Martijn D de Kruif
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
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García Moreira V, Prieto García B, Baltar Martín JM, Ortega Suárez F, Alvarez FV. Cell-free DNA as a noninvasive acute rejection marker in renal transplantation. Clin Chem 2009; 55:1958-66. [PMID: 19729469 DOI: 10.1373/clinchem.2009.129072] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute rejection (AR) is a key conditioning factor for long-term graft function and survival in renal transplantation patients. The standard care with creatinine measurements and biopsy upon allograft dysfunction implies that AR is usually detected at advanced stages. Rapid noninvasive biomarkers of rejection are needed to improve the management of these patients. We assessed whether total cell-free DNA (tCF-DNA) and donor-derived cell-free DNA (ddCF-DNA) were useful markers for this purpose, both in plasma and in urine. METHODS Plasma and urine samples from 100 renal transplant recipients were obtained during the first 3 months after transplantation. tCF-DNA and ddCF-DNA were analyzed by quantitative PCR for the HBB (hemoglobin, beta) and the TSPY1 (testis specific protein, Y-linked 1) genes, respectively. We observed 19 episodes of AR, as well as other complications, such as acute tubular necrosis, nephrotoxicity, and infections. RESULTS Plasma tCF-DNA concentrations increased markedly during AR episodes, often before clinical diagnosis, and returned to reference values after antirejection treatment. A cutoff plasma tCF-DNA concentration of 12 000 genome equivalents/mL correctly classified AR and non-AR episodes in 86% of posttransplantation complications (diagnostic sensitivity, 89%; specificity, 85%). Although similar increases were observed during severe posttransplantation infections, use of the combination of plasma tCF-DNA and procalcitonin (PCT), a specific marker of sepsis, significantly improved the diagnostic specificity (to 98%; 95% CI, 92%-100%), with 97% of the episodes being correctly classified. Use of transrenal DNA and ddCF-DNA concentrations did not add relevant information. CONCLUSIONS Given that renal biopsy is the gold standard for detecting AR, analysis of both plasma tCF-DNA and PCT could permit a more selective use of this invasive procedure.
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Affiliation(s)
- Vanessa García Moreira
- Biochemistry Laboratory and Nephrology and Bone Metabolism Unit, Hospital Universitario Central de Asturias, Asturias, Spain
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Struck J, Strebelow M, Tietz S, Alonso C, Morgenthaler NG, van der Hoeven JG, Pickkers P, Bergmann A. Method for the Selective Measurement of Amino-Terminal Variants of Procalcitonin. Clin Chem 2009; 55:1672-9. [DOI: 10.1373/clinchem.2008.123018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract
Background: Procalcitonin (PCT) is an established marker for diagnosing and monitoring bacterial infections. Full-length PCT [116 amino acids that make up procalcitonin (PCT1–116)] can be truncated, leading to des-Ala-Pro-PCT (des-Alanin-Prolin-Procalcitonin; PCT3–116). Current immunoassays for PCT (“total PCT”) use antibodies directed against internal epitopes and are unable to distinguish amino-terminal PCT variants. Here we describe the development of monoclonal antibodies recognizing the amino-termini of PCT1–116 and PCT3–116 and their use in the selective measurement of these PCT species.
Methods: With newly developed monoclonal antibodies against the amino-termini of PCT1–116 and PCT3–116, and an antibody against the katacalcin moiety of PCT, we developed and characterized immunoluminometric assays for the 2 PCT peptides. We comparatively assessed the kinetics of PCT variants in a human endotoxemia model.
Results: Monoclonal antibodies against the amino-termini of PCT1–116 and PCT3–116 showed <1% cross-reactivity with other PCT-related peptides. The sandwich assays for PCT1–116 and PCT3–116 had functional assay sensitivities of 5 and 1.2 pmol/L, respectively, and exhibited recoveries within 20% of expected values. Plasma PCT1–116 was stable for 6 h at 22 °C and 24 h at 4 °C, and PCT3–116 was stable for at least 24 h at both temperatures. During experimental endotoxemia in healthy people, both PCT1–116 and PCT3–116 increased early in parallel with total PCT, but further increases in PCT1–116 were significantly slower than for PCT3–116 (P = 0.0049) and total PCT (P = 0.0024).
Conclusions: The new assays selectively measure PCT1–116 and PCT3–116. Both PCT species increase early during endotoxemia but differ in their kinetics thereafter. The selective measurement of PCT species with different in vivo kinetics may be useful in improving PCT-guided therapies.
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Affiliation(s)
- Joachim Struck
- Research Department, BRAHMS Aktiengesellschaft, Hennigsdorf/Berlin, Germany
| | | | | | - Christine Alonso
- Research Department, BRAHMS Aktiengesellschaft, Hennigsdorf/Berlin, Germany
| | | | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Andreas Bergmann
- Research Department, BRAHMS Aktiengesellschaft, Hennigsdorf/Berlin, Germany
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Plasma Procalcitonin Is an Independent Predictor of Graft Failure Late After Renal Transplantation. Transplantation 2009; 88:279-87. [DOI: 10.1097/tp.0b013e3181ac9ea0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pfäfflin A, Schleicher E. Inflammation markers in point-of-care testing (POCT). Anal Bioanal Chem 2008; 393:1473-80. [PMID: 19104782 DOI: 10.1007/s00216-008-2561-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 12/01/2008] [Accepted: 12/02/2008] [Indexed: 01/13/2023]
Abstract
Inflammation is a central issue in medicine. Inflammatory processes may be local or systemic, acute or chronic, and they may be benign or fatal. In bacterial or viral infections fast and reliable diagnosis is essential for appropriate treatment, e.g. antimicrobial therapy. The time to diagnosis is critical because uncontrolled infections may lead to sepsis with a mortality rate close to 50%. Beside clinical signs, laboratory markers are important in detecting, differentiating, and monitoring inflammation, particularly acute infections. Currently several inflammation markers including leukocyte count and leukocyte differentiation, C-reactive protein (CRP), procalcitonin (PCT), and interleukins (IL) 6 and 8, is available, and potential future serum markers are under development. In this article the clinical use of these markers in routine laboratory and in point-of-care testing is described and the diagnostic value of the four groups of laboratory marker is compared. Current data show that leukocyte count or, better, neutrophil count, CRP, and PCT are well suited to support of rapid diagnosis of inflammation and infections in children and adults whereas measurement of IL-6 and 8 are preferable for detection of sepsis in neonates.
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Affiliation(s)
- Albrecht Pfäfflin
- Department of Internal Medicine IV, Clinical Chemistry Unit, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Clodi M, Vila G, Geyeregger R, Riedl M, Stulnig TM, Struck J, Luger TA, Luger A. Oxytocin alleviates the neuroendocrine and cytokine response to bacterial endotoxin in healthy men. Am J Physiol Endocrinol Metab 2008; 295:E686-91. [PMID: 18593851 DOI: 10.1152/ajpendo.90263.2008] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Oxytocin is a hormone and neurotransmitter found to have anti-inflammatory functions in rodents. Here we used experimental bacterial endotoxinemia to examine the role of exogenous oxytocin administration on innate immune responses in humans. Ten healthy men received, in a randomized, placebo-controlled, crossover design, placebo, oxytocin, LPS, and LPS + oxytocin. Oxytocin treatment resulted in a transient or prolonged reduction of endotoxin-induced increases in plasma ACTH, cortisol, procalcitonin, TNF-alpha, IL-1 receptor antagonist, IL-4, IL-6, macrophage inflammatory protein-1alpha, macrophage inflammatory protein-1beta, monocyte chemoattractant protein-1 (MCP-1), interferon-inducible protein 10, and VEGF. In vitro, oxytocin had no impact on LPS effects in releasing TNF-alpha, IL-6, and MCP-1 in monocytes and peripheral blood mononuclear cells from healthy human donors. In summary, oxytocin decreases the neuroendocrine and cytokine activation caused by bacterial endotoxin in men, possibly due to the pharmacological modulation of the cholinergic anti-inflammatory pathway. Oxytocin might be a candidate for the therapy of inflammatory diseases and conditions associated with high cytokine and VEGF levels.
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Affiliation(s)
- Martin Clodi
- Dept. of Medicine III, Medical Univ. of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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Krämer PM, Gouzy MF, Kess M, Kleinschmidt U, Kremmer E. Development and characterization of new rat monoclonal antibodies for procalcitonin. Anal Bioanal Chem 2008; 392:727-36. [PMID: 18712365 DOI: 10.1007/s00216-008-2321-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 07/18/2008] [Accepted: 07/25/2008] [Indexed: 10/21/2022]
Abstract
The development of selective and sensitive biological recognition elements, e.g., antibodies, for the detection of relevant blood markers is a great challenge in the field of biosensors. In this context, five new rat monoclonal antibodies (mAbs) for procalcitonin (PCT), a marker for bacterial infection and sepsis, were developed and characterized. One mAb, PROC1 3G3, was used as capture antibody. Four mAbs, PROC4 6C6, PROC4 6B2, PROC4 1G3, and PROC4 1D6, were used as detection mAbs, either as Protein G-purified or as biotinylated mAbs. A surface plasmon resonance (SPR) biosensor was used to characterize the antigen-antibody biomolecular interactions. The capture mAb (PROC1 3G3) has an equilibrium dissociation constant (K (D)) of 3.42 x 10(-8) M. All four detection mAbs (PROC4 6C6, PROC4 6B2, PROC4 1G3, and PROC4 1D6) are of high affinity (K (A) = 2.81-6.11 x 10(8) M(-1); K (D) = 1.64-3.56 x 10(-9) M) and have moderate dissociation rate constants (k (d) = 1.70-2.40 x 10(-3) s(-1)). Four different sandwich enzyme-linked immunosorbent assays (ELISAs) with standards of human recombinant (hr) PCT, using PROC1 3G3 as capture mAb and PROC4 mAbs as detection mAbs, respectively, led to highly specific determinations of PCT without cross-reactivities to calcitonin and katacalcin. The lower limits of quantification (LLOQ) for hrPCT (in 40 mM phosphate-buffered saline (PBS), pH 7.6) with these assays ranged from 2.3 to 12.8 microg L(-1). In addition, sandwich ELISAs were set up with biotinylated PROC4 mAbs, and with hrPCT in 4% human serum albumin (diluted 1:10 in 40 mM PBS, including 1:5 (v/v) LowCross Buffer(R)). The LLOQs of these sandwich assays ranged from 4.1 to 6.0 microg L(-1) and were thus much closer together for the different assays. With the latter assay setup (PROC1 3G3 as capture mAb, PROC4 6C6-biotin as detection mAb) a first collection of five serum samples was determined (healthy volunteers, unspiked, and spiked). Recovery rates for the spiked samples ranged from 98.3 to 115.7%. The newly developed anti-PCT mAbs should find broad applications in immunosensors for point-of-care diagnostics of sepsis and systemic inflammation processes.
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Affiliation(s)
- Petra M Krämer
- Institute of Ecological Chemistry, Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany.
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de Kruif MD, Lemaire LC, Giebelen IA, Struck J, Morgenthaler NG, Papassotiriou J, Elliott PJ, van der Poll T. The influence of corticosteroids on the release of novel biomarkers in human endotoxemia. Intensive Care Med 2007; 34:518-22. [PMID: 18080111 PMCID: PMC2244699 DOI: 10.1007/s00134-007-0955-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 10/31/2007] [Indexed: 01/29/2023]
Abstract
Objective Sepsis intervention studies need better patient stratification methods, and one way to realize this is the introduction of stable biomarkers. A set of recently developed novel biomarkers, based upon precursor-fragments of short-lived hormones, was previously shown to be increased during sepsis. However, it is not known whether these biomarkers are influenced by sepsis intervention strategies. Therefore we investigated the markers in a model of human endotoxemia intervened by increasing doses of prednisolone. Design and setting Prospective, open-label study in a specialized clinical research unit of a university hospital. Subjects Thirty-two healthy male volunteers. Interventions Subjects received prednisolone orally at doses of 0, 3, 10 or 30 mg (n = 8 per group) at 2 h before intravenous injection of Escherichia coli lipopolysaccharide (LPS) (4 ng/kg). Blood samples were drawn during 24 h after LPS injection. Measurements and results LPS injection caused an increase in levels of midregional pro-adrenomedullin (MR-proADM), midregional pro-atrial natriuretic peptide (MR-proANP), C-terminal pro-arginine–vasopressin (CT-proAVP) and procalcitonin (PCT). Prednisolone caused a dose dependent inhibition of MR-proADM, MR-proANP and CT-proAVP levels. Conclusions These results show that a set of novel, highly stable sepsis biomarkers was increased during human endotoxemia and was dose-dependently inhibited by corticosteroid pre-treatment.
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Affiliation(s)
- Martijn D de Kruif
- Center for Experimental and Molecular Medicine, Room G2-132, Academic Medical Center, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands.
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Becker KL, Nylén ES, White JC, Müller B, Snider RH. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004; 89:1512-25. [PMID: 15070906 DOI: 10.1210/jc.2002-021444] [Citation(s) in RCA: 348] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- K L Becker
- Veterans Affairs Medical Center and George Washington University, Washington, D.C. 20422, USA.
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Bihan H, Becker KL, Snider RH, Nylen E, Vittaz L, Lauret C, Modigliani E, Moretti JL, Cohen R. Calcitonin precursor levels in human medullary thyroid carcinoma. Thyroid 2003; 13:819-22. [PMID: 14558925 DOI: 10.1089/105072503768499716] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
DESIGN The hormonal serum marker for the presence and course of patients with medullary thyroid cancer (MTC) is the mature calcitonin (CT) peptide. Other CALC-1 gene products such as the 116-amino acid polypeptide prohormone, procalcitonin, as well as its component calcitonin precursors (CTpr) may also be increased in their sera. We performed a study to evaluate the clinical utility of serum levels CTpr in these patients. METHODS Twenty-one patients with MTC (9 males, 12 females; 23-76 years of age) were evaluated. The diagnosis was confirmed by histologic examination, except for 2 (a proven RET mutation plus an abnormal pentagastrin-stimulated CT level). Nine patients had postoperative hypercalcitoninemia and 3 of these died. The specific assay for mature CT was a commercial immunoradiometric assay (hCT-IRMA); the immunoluminometric assay for CTpr (B.R.A.H.M.S Diagnostica, Berlin, Germany) detects intact procalcitonin and the free CT:CT carboxypeptide-1. RESULTS All patients had detectable serum CTpr. These levels considerably exceeded those of mature CT, averaging 7.6-fold greater. CTpr levels correlated positively with mature CT (r = 0.61; p < 0.001). After pentagastrin administration, there was a parallelism of response between the two assays. Whenever there were known metastases, CTpr increased markedly. CONCLUSION This study demonstrates the universal presence of CTpr in the blood of patients with MTC. The measurement of these peptides may offer a new dimension to the clinical evaluation of this malignancy.
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Affiliation(s)
- H Bihan
- Avicenne Hospital, University of Paris XIII, Groupe d'Etudes des Tumeur à Calcitonine, Bobigny, France
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Ammori BJ, Becker KL, Kite P, Snider RH, Nylén ES, White JC, Larvin M, McMahon MJ. Calcitonin precursors in the prediction of severity of acute pancreatitis on the day of admission. Br J Surg 2003; 90:197-204. [PMID: 12555296 DOI: 10.1002/bjs.4036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Calcitonin precursors are sensitive markers of inflammation and infection. The aim of this study was to evaluate the role of plasma calcitonin precursor levels on the day of admission in the prediction of severity of acute pancreatitis, and to compare this with the Acute Physiology And Chronic Health Evaluation (APACHE) II scoring system. METHODS Plasma concentrations of calcitonin precursors were determined on admission in 69 patients with acute pancreatitis. APACHE II scores were calculated on admission. Attacks were classified as mild (n = 55) or severe (n = 14) according to the Atlanta criteria. Plasma calcitonin precursor levels were determined with a sensitive radioimmunoassay. RESULTS On the day of hospital admission, plasma levels of calcitonin precursors were significantly greater in patients with a severe attack compared with levels in those with a mild attack of pancreatitis (median 64 versus 25 fmol/ml; P = 0.014), but the APACHE II scores were no different (median 9 versus 8; P = 0.2). The sensitivity, specificity, positive predictive and negative predictive values, and accuracy for the prediction of severe acute pancreatitis were 67, 89, 57, 93 and 85 per cent respectively for plasma calcitonin precursor levels higher than 48 fmol/ml, and 69, 45, 23, 86 and 50 per cent respectively for an APACHE II score greater than 7. Differences in the specificity and accuracy of the two prognostic indicators were significant (P < 0.001 and P = 0.001 respectively). A plasma calcitonin precursor concentration of more than 160 fmol/ml on admission was highly accurate (94 per cent) in predicting the development of septic complications and death. CONCLUSION The assay of plasma calcitonin precursors on the day of admission to hospital has the potential to provide a more accurate prediction of the severity of acute pancreatitis than the APACHE II scoring system.
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Affiliation(s)
- B J Ammori
- Division of Surgery, University of Leeds and Centre for Digestive Diseases, The General Infirmary, Leeds, UK.
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