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Boutin R, Rolland J, Codet M, Bézier C, Maes N, Kolh P, Equinet L, Thys M, Moutschen M, Lamy PJ, Albert A. Use of hospital big data to optimize and personalize laboratory test interpretation with an application. Clin Chim Acta 2024; 561:119763. [PMID: 38851476 DOI: 10.1016/j.cca.2024.119763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/29/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND AND AIMS In laboratory medicine, test results are generally interpreted with 95% reference intervals but correlations between laboratory tests are usually ignored. We aimed to use hospital big data to optimize and personalize laboratory data interpretation, focusing on platelet count. MATERIAL AND METHODS Laboratory tests were extracted from the hospital database and exploited by an algorithmic stepwise procedure. For any given laboratory test Y, an "optimized and personalized reference population" was defined by keeping only patients whose laboratory values for all Y-correlated tests fell within their own usual reference intervals, and by partitioning groups by individual-specific variables like sex and age category. The method was applied to platelet count. RESULTS Laboratory data were recorded for 28,082 individuals. At the end of the algorithmic process, seven correlated laboratory tests were chosen, resulting in a reference sample of 159 platelet counts. A new 95 % reference interval was constructed [152-334 × 109/L], notably reduced (27.2 %) compared to conventional reference values [150-400 × 109/L]. The reference interval was validated on a sample of 2,129 patients from another downtown laboratory, emphasizing the potential transference of the hospital-derived reference limits. CONCLUSION This method offers new perspectives in laboratory data interpretation, especially in patient screening and longitudinal follow-up.
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Affiliation(s)
- Ronan Boutin
- Bio Logbook, 1 rue Julien Videment, 44200 Nantes, France.
| | - Jakez Rolland
- Bio Logbook, 1 rue Julien Videment, 44200 Nantes, France; Nantes University, École Centrale Nantes, CNRS, LS2N, UMR 6004, 1 Rue de la Noë, 44321 Nantes, France.
| | - Marie Codet
- Bio Logbook, 1 rue Julien Videment, 44200 Nantes, France.
| | - Clément Bézier
- Bio Logbook, 1 rue Julien Videment, 44200 Nantes, France; University of Western Brittany, INSERM, LBAI, UMR1227, 9 Rue Félix le Dantec, 29200 Brest, France.
| | - Nathalie Maes
- Biostatistics and Medico-economic Information Department, University Hospital of Liege, Avenue de l'Hôpital 1, 4000 Liège, Belgium.
| | - Philippe Kolh
- Department of Information Systems Management, University Hospital of Liege, Avenue de l'Hôpital 1, 4000 Liège, Belgium.
| | - Leila Equinet
- Bio Logbook, 1 rue Julien Videment, 44200 Nantes, France.
| | - Marie Thys
- Use of medico-economic data, University Hospital of Liege, Avenue de l'Hôpital 1, 4000 Liège, Belgium.
| | - Michel Moutschen
- Infectious Diseases Department, University Hospital of Liege, Avenue de l'Hôpital 1, 4000 Liège, Belgium.
| | - Pierre-Jean Lamy
- Biopathology and Genetics of Cancers, Institute of Medical Analysis IMAGENOME, INOVIE, 90 rue Nicolas Chedeville, 34075 Montpellier, France; Clinical Research Department, Clinique BeauSoleil, Aesio Santé Méditerranée, 149 Rue de la Taillade, 34070 Montpellier, France.
| | - Adelin Albert
- Biostatistics and Medico-economic Information Department, University Hospital of Liege, Avenue de l'Hôpital 1, 4000 Liège, Belgium; Public Health Department, University of Liege, Avenue de l'Hôpital 1, 4000 Liège, Belgium.
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Hickmott AJ, Cervantes L, Arroyo JP, Brasky K, Bene M, Salmon AB, Phillips KA, Ross CN. Age-related changes in hematological biomarkers in common marmosets. Am J Primatol 2024; 86:e23589. [PMID: 38143428 PMCID: PMC10959687 DOI: 10.1002/ajp.23589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/26/2023]
Abstract
Researchers and veterinarians often use hematology and clinical chemistry to evaluate animal health. These biomarkers are relatively easy to obtain, and understanding how they change across healthy aging is critical to clinical care and diagnostics for these animals. We aimed to evaluate how clinical biomarkers from a chemistry profile and complete blood count (CBC) change with age in common marmosets (Callithrix jacchus). We assessed blood samples collected during routine physical exams at the Southwest National Primate Research Center and the University of Texas Health San Antonio marmoset colonies from November 2020-November 2021. We found that chemistry and CBC profiles varied based on facility, sex, and age. Significant changes in albumin, phosphorus/creatinine ratio, albumin/globulin ratio, amylase, creatinine, lymphocyte percent, hematocrit, granulocytes percent, lymphocytes, hemoglobin, red cell distribution width, and platelet distribution width were all reported with advancing age. Aged individuals also demonstrated evidence for changes in liver, kidney, and immune system function compared with younger individuals. Our results suggest there may be regular changes associated with healthy aging in marmosets that are outside of the range typically considered as normal values for healthy young individuals, indicating the potential need for redefined healthy ranges for clinical biomarkers in aged animals. Identifying animals that exhibit values outside of this defined healthy aging reference will allow more accurate diagnostics and treatments for aging colonies.
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Affiliation(s)
- Alexana J. Hickmott
- Southwest National Primate Research Center, San Antonio, Texas
- Texas Biomedical Research Institute, San Antonio, Texas
| | - Lidia Cervantes
- Southwest National Primate Research Center, San Antonio, Texas
- Texas Biomedical Research Institute, San Antonio, Texas
| | - Juan Pablo Arroyo
- Southwest National Primate Research Center, San Antonio, Texas
- Texas Biomedical Research Institute, San Antonio, Texas
| | - Kathy Brasky
- Southwest National Primate Research Center, San Antonio, Texas
- Texas Biomedical Research Institute, San Antonio, Texas
| | - Michael Bene
- Barshop Institute for Longevity and Aging Studies and Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Adam B. Salmon
- Barshop Institute for Longevity and Aging Studies and Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
- Geriatric Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Kimberley A. Phillips
- Southwest National Primate Research Center, San Antonio, Texas
- Texas Biomedical Research Institute, San Antonio, Texas
- Department of Psychology, Trinity University, San Antonio, Texas
| | - Corinna N. Ross
- Southwest National Primate Research Center, San Antonio, Texas
- Texas Biomedical Research Institute, San Antonio, Texas
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Monaco D, Mariella J, Fusi J, Osman TK, Rauf AA, Probo M. Hematological reference intervals in newborn dromedary calves in the first week after birth: Age and sex-related variations. Res Vet Sci 2024; 169:105172. [PMID: 38340379 DOI: 10.1016/j.rvsc.2024.105172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
The establishment of hematological reference intervals (RIs) is an important tool to assess the health status of animals and to evaluate the impact of diseases at individual and population levels. Nowadays, specific RIs of hematological parameters in newborn dromedary camel calves at birth and during the first week after birth, are lacking. Therefore, RIs for the hematological variables from a complete blood cell count were established in 47 healthy newborn dromedary calves (18 females and 29 males). Blood samples were collected within 2 h after birth (d0), at 24 h (d1), at 3 (d3) and 7 days (d7) after birth, and analyzed within 24 h. The RIs were described based on the 95% confidence interval, and possible differences among mean values due to age (sampling time) and sex were investigated. Statistical analysis showed that age affected all the hematological variables except MCV, MCH, and MCHC, indicating that the adaptational process to the extrauterine life continues for several days after birth; sex affected most of the hematological variables, with higher RBC and PLT count, HGB, PCV, neutrophil population and neutrophil:lymphocyte ratio at d7 in females compared to males. These findings suggest possible sex-based differences in the physiological maturation mechanisms and deserves further investigations. To the best of the authors' knowledge, this is the first report of hematological RIs for newborn dromedary calves at birth up to 7 days of age; the RIs registered in the present study in newborns differ from those reported in adult dromedaries in literature, thus confirming the need for the adoption of separated reference ranges according to age also in the dromedary camel, as previously reported for other species.
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Affiliation(s)
- Davide Monaco
- Department of Veterinary Medicine, University of Bari Aldo Moro, Str. Prov. per Casamassima Km 3, Valenzano, 70010 Bari, Italy
| | - Jole Mariella
- Department of Veterinary Medical Sciences, Università degli Studi di Bologna, Via Tolara di Sopra 50, Ozzano Emilia, 40064 Bologna, Italy
| | - Jasmine Fusi
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, via dell'Università 6, 26900 Lodi, Italy.
| | - Taher Kamal Osman
- Department of Advanced Biotechnology and Research, Salam Veterinary Group, Saudi Arabia
| | - Ahmed Abdel Rauf
- Department of Advanced Biotechnology and Research, Salam Veterinary Group, Saudi Arabia
| | - Monica Probo
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, via dell'Università 6, 26900 Lodi, Italy
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Letelier P, Acuña R, Garrido I, López J, Sanhueza G, Seguel C, Riquelme I, Guzmán N, Hernández AH. Reference intervals of biochemical parameters in Chilean adults. J Med Biochem 2024; 43:133-143. [PMID: 38496020 PMCID: PMC10943462 DOI: 10.5937/jomb0-44156] [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: 05/10/2023] [Accepted: 07/20/2023] [Indexed: 03/19/2024] Open
Abstract
Background Establishing reference intervals (RIs) in clinical laboratories is essential, as these can vary due to inter-individual variability as well as the analytical methods used. The purpose of this study was to determine RIs for markers and ratios biochemical in apparently healthy Chilean adults. Methods A sample of 1,143 data was selected from the Universidad Católica de Temuco, Clinical Laboratory database, La Araucanía Region, Chile, which were analysed by sex. The Tukey's Fences was used to detect outliers and the RIs were established using the non-parametric method.
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Affiliation(s)
- Pablo Letelier
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Laboratorio de investigación en Salud de Precisión, Chile
| | - Rodban Acuña
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Laboratorio de investigación en Salud de Precisión, Chile
| | - Ignacio Garrido
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Laboratorio de investigación en Salud de Precisión, Chile
| | - Jorge López
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Laboratorio de investigación en Salud de Precisión, Chile
| | - Guillermo Sanhueza
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Laboratorio de investigación en Salud de Precisión, Chile
| | - Caren Seguel
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Laboratorio de investigación en Salud de Precisión, Chile
| | - Ismael Riquelme
- Universidad Autónoma de Chile, Faculty of Health Sciences, Institute of Biomedical Sciences, Chile
| | - Neftalí Guzmán
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Laboratorio de investigación en Salud de Precisión, Chile
| | - Alfonso H. Hernández
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Laboratorio de investigación en Salud de Precisión, Chile
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Blatter TU, Witte H, Fasquelle-Lopez J, Theodoros Naka C, Raisaro JL, Leichtle AB. The BioRef Infrastructure, a Framework for Real-Time, Federated, Privacy-Preserving, and Personalized Reference Intervals: Design, Development, and Application. J Med Internet Res 2023; 25:e47254. [PMID: 37851984 PMCID: PMC10620636 DOI: 10.2196/47254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Reference intervals (RIs) for patient test results are in standard use across many medical disciplines, allowing physicians to identify measurements indicating potentially pathological states with relative ease. The process of inferring cohort-specific RIs is, however, often ignored because of the high costs and cumbersome efforts associated with it. Sophisticated analysis tools are required to automatically infer relevant and locally specific RIs directly from routine laboratory data. These tools would effectively connect clinical laboratory databases to physicians and provide personalized target ranges for the respective cohort population. OBJECTIVE This study aims to describe the BioRef infrastructure, a multicentric governance and IT framework for the estimation and assessment of patient group-specific RIs from routine clinical laboratory data using an innovative decentralized data-sharing approach and a sophisticated, clinically oriented graphical user interface for data analysis. METHODS A common governance agreement and interoperability standards have been established, allowing the harmonization of multidimensional laboratory measurements from multiple clinical databases into a unified "big data" resource. International coding systems, such as the International Classification of Diseases, Tenth Revision (ICD-10); unique identifiers for medical devices from the Global Unique Device Identification Database; type identifiers from the Global Medical Device Nomenclature; and a universal transfer logic, such as the Resource Description Framework (RDF), are used to align the routine laboratory data of each data provider for use within the BioRef framework. With a decentralized data-sharing approach, the BioRef data can be evaluated by end users from each cohort site following a strict "no copy, no move" principle, that is, only data aggregates for the intercohort analysis of target ranges are exchanged. RESULTS The TI4Health distributed and secure analytics system was used to implement the proposed federated and privacy-preserving approach and comply with the limitations applied to sensitive patient data. Under the BioRef interoperability consensus, clinical partners enable the computation of RIs via the TI4Health graphical user interface for query without exposing the underlying raw data. The interface was developed for use by physicians and clinical laboratory specialists and allows intuitive and interactive data stratification by patient factors (age, sex, and personal medical history) as well as laboratory analysis determinants (device, analyzer, and test kit identifier). This consolidated effort enables the creation of extremely detailed and patient group-specific queries, allowing the generation of individualized, covariate-adjusted RIs on the fly. CONCLUSIONS With the BioRef-TI4Health infrastructure, a framework for clinical physicians and researchers to define precise RIs immediately in a convenient, privacy-preserving, and reproducible manner has been implemented, promoting a vital part of practicing precision medicine while streamlining compliance and avoiding transfers of raw patient data. This new approach can provide a crucial update on RIs and improve patient care for personalized medicine.
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Affiliation(s)
- Tobias Ueli Blatter
- University Institute of Clinical Chemistry, University Hospital Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Harald Witte
- University Institute of Clinical Chemistry, University Hospital Bern, Bern, Switzerland
| | | | - Christos Theodoros Naka
- University Institute of Clinical Chemistry, University Hospital Bern, Bern, Switzerland
- Laboratory of Biometry, University of Thessaly, Volos, Greece
| | - Jean Louis Raisaro
- Biomedical Data Science Center, University Hospital Lausanne, Lausanne, Switzerland
| | - Alexander Benedikt Leichtle
- University Institute of Clinical Chemistry, University Hospital Bern, Bern, Switzerland
- Center for Artificial Intelligence in Medicine, University of Bern, Bern, Switzerland
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Velev J, LeBien J, Roche-Lima A. Unsupervised machine learning method for indirect estimation of reference intervals for chronic kidney disease in the Puerto Rican population. Sci Rep 2023; 13:17198. [PMID: 37821500 PMCID: PMC10567761 DOI: 10.1038/s41598-023-43830-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
Reference intervals (RIs) for clinical laboratory values are extremely important for diagnostics and treatment of patients. However, the determination of these ranges is costly and time-consuming. As a result, often different unverified RIs are used in practice for the same analyte and the same range is used for all patients despite evidence that the values are gender, age, and ethnicity dependent. Moreover, the abnormal flags are rudimentary, merely indicating if a value is within the RI. At the same time, clinical lab data generated in the everyday medical practice contains a wealth of information, that given the correct methodology, can help determine the RIs for each specific segment of the population, including populations that suffer from health disparities. In this work, we develop unsupervised machine learning methods, based on Gaussian mixtures, to determine RIs of analytes related to chronic kidney disease, using millions of routine lab results for the Puerto Rican population. We show that the measures are both gender and age dependent and we find evidence for normal age-related organ function deterioration and failure. We also show that the joint distribution of measures improves the diagnostic value of the lab results.
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Affiliation(s)
- Julian Velev
- Department of Physics, University of Puerto Rico, San Juan, PR, 00925-2537, USA.
- Abartys Health, San Juan, PR, 00907-3913, USA.
| | - Jack LeBien
- Abartys Health, San Juan, PR, 00907-3913, USA
| | - Abiel Roche-Lima
- Center for Collaborative Research in Health Disparities - CCHRD, RCMI Program, Medical Science Campus, University of Puerto Rico, San Juan, PR, 00936-5067, USA
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Steele CM, Bayley MT, Bohn MK, Higgins V, Peladeau-Pigeon M, Kulasingam V. Reference Values for Videofluoroscopic Measures of Swallowing: An Update. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3804-3824. [PMID: 37669617 PMCID: PMC10713020 DOI: 10.1044/2023_jslhr-23-00246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE It is essential that clinicians have evidence-based benchmarks to support accurate diagnosis and clinical decision making. Recent studies report poor reliability for diagnostic judgments and identifying mechanisms of impairment from videofluoroscopy (VFSS). Establishing VFSS reference values for healthy swallowing would help resolve such discrepancies. Steele et al. (2019) released preliminary reference data for quantitative VFSS measures in healthy adults aged < 60 years. Here, we extend that work to provide reference percentiles for VFSS measures across a larger age span. METHOD Data for 16 VFSS parameters were collected from 78 healthy adults aged 21-82 years (39 male). Participants swallowed three comfortable sips each of thin, slightly, mildly, moderately, and extremely thick barium (20% w/v). VFSS recordings were analyzed in duplicate by trained raters, blind to participant and task, using the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) Method. Reference percentiles (p2.5, 5, 25, 50, 75, 95, and 97.5) were determined as per Clinical and Laboratory Standards Institute EP28-A3c guidelines. RESULTS We present VFSS reference percentile tables, by consistency, for (a) timing parameters (swallow reaction time; the hyoid burst-to-upper esophageal sphincter (UES)-opening interval; UES opening duration; time-to-laryngeal vestibule closure (LVC); and LVC duration) and (b) anatomically scaled pixel-based measures of maximum UES diameter, pharyngeal area at maximum pharyngeal constriction and rest, residue (vallecular, pyriform, other pharyngeal locations, total), and hyoid kinematics (X, Y, XY coordinates of peak position; speed). Clinical decision limits are proposed to demarcate atypical values of potential clinical concern. CONCLUSION These updated reference percentiles and proposed clinical decision limits are intended to support interpretation and reliability for VFSS assessment data. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24043041.
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Affiliation(s)
- Catriona M. Steele
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Canada Research Chair in Swallowing and Food Oral Processing, Canada Research Chairs Secretariat, Ottawa, Ontario
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mary Kathryn Bohn
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Victoria Higgins
- DynaLIFE Medical Labs, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | | | - Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
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Bijelić V, Potter B, Parkin PC, Momoli F, Liebman M, Hamid JS. Paediatric reference intervals and curves for haemoglobin and ferritin: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e073783. [PMID: 37793936 PMCID: PMC10551989 DOI: 10.1136/bmjopen-2023-073783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Reference intervals and reference curves provide clinicians with a point of reference when evaluating patients' laboratory test results. In practical applications, the 2.5th and 97.5th percentiles of healthy reference population are typically used as lower and upper reference limits. Guidelines outlining analytical and methodological steps involved in reference intervals and curves estimation are available and there have been large-scale world-wide initiatives to provide reference intervals and curves for children. However, there is a lack of synthesised evidence regarding the results of such initiatives in general, but specifically in iron-related biomarkers, ferritin (in serum and plasma) and haemoglobin. Objectives of this review are to identify studies that have produced reference intervals and curves for ferritin and haemoglobin in paediatric populations and to synthesise all available evidence. We also aim to quantify heterogeneity across reference intervals and curves and identify and elucidate sources of heterogeneity, including heterogeneity in the methods employed in their development. METHODS AND ANALYSIS Using a comprehensive search strategy, we will identify eligible studies. Following electronic databases will be searched from inception: EMBASE, MEDLINE, SCOPUS and The Cochrane Library. We will also perform grey literature search to capture unpublished reference intervals and curves from healthy cohorts. Two researchers will independently screen retrieved citations against eligibility criteria in two stages, focusing first on titles and abstracts and then on full-text articles. Studies that provide reference intervals and curves for ferritin and haemoglobin for paediatric population will be eligible. Data extraction will include study characteristics, characteristics of reference population, methodological and analytical considerations and estimated reference intervals and curves. We will consider narrative synthesis and quantitative synthesis when appropriate. ETHICS AND DISSEMINATION Ethical approval is not required as data from already published studies will be used. Results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42023399802.
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Affiliation(s)
- Vid Bijelić
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Beth Potter
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Patricia C Parkin
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Franco Momoli
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mira Liebman
- Department of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jemila S Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada
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Miller JJ, Bohn MK, Higgins V, Nichols M, Mohammed-Ali Z, Henderson T, Selvaratnam R, Sepiashvili L, Adeli K. Pediatric reference intervals for endocrine markers in healthy children and adolescents on the Liaison XL (DiaSorin) immunoassay system. Clin Biochem 2023; 120:110644. [PMID: 37673294 DOI: 10.1016/j.clinbiochem.2023.110644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Prominent physiological changes occurring throughout childhood and adolescence necessitate the consideration of age and sex in biomarker interpretation. Critical gaps exist in pediatric reference intervals (RIs) for specialized endocrine markers, despite expected influence of growth and development. The current study aimed to establish and/or verify RIs for six specialized endocrine markers on a specialized immunoassay system. METHODS Samples were collected from healthy children and adolescents (5 to <19 years) and apparently healthy outpatients (0 to <5 years) as part of the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER). Serum samples were analysed for aldosterone, renin (plasma), thyroglobulin, anti-thyroglobulin, growth hormone, and insulin-like growth factor-1 (IGF-1) on the Liaison XL (DiaSorin) immunoassay platform. RIs (2.5th and 97.5th percentiles) were established for aldosterone, renin, thyroglobulin, anti-thyroglobulin, and growth hormone. Manufacturer-recommended pediatric RIs for IGF-1 were verified. RESULTS Age-specific RIs were established for aldosterone, renin, and thyroglobulin, while no age-specific differences were observed for anti-thyroglobulin or growth hormone. IGF-1 was the only endocrine marker studied that demonstrated significant sex-specific differences. Manufacturer-recommended IGF-1 RIs were verified for children aged 6 to <19 years, while those for children aged 0 to <6 years did not verify. CONCLUSIONS This study marks the first time that pediatric RIs for aldosterone and renin were established in the CALIPER cohort and highlights the dynamic changes that occur in water and sodium homeostasis during the first years of life. Overall, these data will assist pediatric clinical laboratories in test result interpretation and improve clinical decision-making for patients tested using Liaison immunoassays.
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Affiliation(s)
- J J Miller
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada
| | - M K Bohn
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - V Higgins
- DynaLIFE Medical Labs, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - M Nichols
- Department of Pathology and Laboratory Medicine, Schulich Medicine and Dentistry, Western University, London, ON, Canada
| | | | - T Henderson
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Selvaratnam
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; Laboratory Medicine Program, Division of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
| | - L Sepiashvili
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Adeli
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada.
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Ireland J, McGowan C. Deciphering reference intervals and clinical decision limits in equine endocrine diagnostic testing. Vet J 2023; 300-302:106037. [PMID: 37832629 DOI: 10.1016/j.tvjl.2023.106037] [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: 06/16/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
Reference intervals (RIs) and clinical decision limits (CDLs) are frequently established to facilitate interpretation of values of endocrine biomarkers in the diagnosis of disease. Despite their commonplace use in clinical decision-making, these concepts can be confused. Comparing a test result with a RI provides an estimation as to whether or not the individual is healthy, whereas comparison with a CDL facilitates identification of individuals with a particular disease state or at greater risk of adverse clinical outcomes. In practice, there will also be a range of results for which the discriminative ability of the test is insufficient to inform a specific diagnostic decision. Including a range of uncertain test results, or 'grey zone', between positive and negative avoids the constraint of a binary decision in classifying an individual with a test value above (or below) a single cut-off value as diseased. This review will detail the application of both RIs and CDLs, including defining the range of uncertain test results, in the context of equine endocrinology.
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Affiliation(s)
- Joanne Ireland
- Department of Equine Clinical Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst, CH64 7TE Cheshire, UK.
| | - Catherine McGowan
- Department of Equine Clinical Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst, CH64 7TE Cheshire, UK
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Valenzano TJ, Smaoui S, Peladeau-Pigeon M, Barbon CEA, Craven BC, Steele CM. Using Reference Values to Identify Profiles of Swallowing Impairment in a Case Series of Individuals With Traumatic Spinal Cord Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:688-700. [PMID: 36812476 PMCID: PMC10171848 DOI: 10.1044/2022_ajslp-22-00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE In this article, we illustrate use of a systematic approach to rating videofluoroscopic swallowing studies (VFSS), the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) method. The method is applied to a clinical case series of individuals with a history of traumatic spinal cord injury (tSCI) requiring surgical intervention using a posterior approach. Previous studies suggest that swallowing is highly variable in this population given heterogeneity in mechanisms, location and extent of injury, and in surgical management approaches. METHOD The case series involved 6 individuals who were at least 1 month postsurgery for management of tSCI. Participants completed a VFSS using a standardized bolus protocol. Each VFSS was blindly rated in duplicate using the ASPEKT method and compared with published reference values. RESULTS The analysis revealed considerable heterogeneity across this clinical sample. Penetration-aspiration scale scores of 3 or higher were not observed in this cohort. Of note, patterns of impairment did emerge, suggesting there are some commonalities across profiles in this population, including the presence of residue associated with poor pharyngeal constriction, reduced upper esophageal opening diameter, and short upper esophageal sphincter opening duration. CONCLUSIONS Although the participants in this clinical sample shared a history of tSCI requiring surgical intervention using a posterior approach, there was great heterogeneity in swallowing profile. Using a systematic method to identify atypical swallowing parameters can guide clinical decision making for determining rehabilitative targets and measuring swallowing outcomes.
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Affiliation(s)
- Teresa J. Valenzano
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sana Smaoui
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Melanie Peladeau-Pigeon
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | - Carly E. A. Barbon
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - B. Cathy Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Division of Physiatry, Department of Medicine, University of Toronto, Ontario, Canada
| | - Catriona M. Steele
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Canada Research Chair (Tier 1) in Swallowing and Food Oral Processing
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Application of the Hoffmann, Bhattacharya, nonparametric test, and Q-Q plot methods for establishing reference intervals from laboratory databases. Clin Biochem 2023; 113:9-16. [PMID: 36587756 DOI: 10.1016/j.clinbiochem.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/05/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Reference intervals (RIs) are vital for interpreting laboratory biomarkers and enabling clinical decision-making. Among various RI-estimation methods, we explored the application value of Hoffmann, Bhattacharya, nonparametric test, and Q-Q plot methods for estimating the RI of urea, creatinine, and uric acid (UA). METHOD This cross-sectional study collected patient data recorded between January 2020 and April 2022 at the Chongqing University Central Hospital Laboratory Information System. The RIs of urea, creatinine, and UA levels were established using the Hoffmann, Bhattacharya, nonparametric, and Q-Q plot methods, and RI differences with different computational methods were verified using the reference change value (RCV%) of biological variability. RESULTS We included 16,474 and 123,570 patients in the physical examination and clinical groups, respectively. In the clinical group, differences in the RI upper limit of analytes with the four methods (excluding the Q-Q plot method) were within the permissible RCV% range; only the nonparametric test produced an RI of urea with the lower limit within the permissible RCV% range. In the physical examination group, the relative RI differences among the four methods (excluding the lower limit of RI obtained using the Q-Q plot) were all within the acceptable RCV% range; the relative deviation of the RI of UA with the four methods was within the acceptable RCV% range (excluding the lower RI limit obtained using the Q-Q plot and nonparametric test). CONCLUSION The Hoffmann and Bhattacharya methods may provide reliable RIs for indirect estimations of urea, creatinine, and UA based on laboratory datasets.
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D'Aurizio F, Kratzsch J, Gruson D, Petranović Ovčariček P, Giovanella L. Free thyroxine measurement in clinical practice: how to optimize indications, analytical procedures, and interpretation criteria while waiting for global standardization. Crit Rev Clin Lab Sci 2023; 60:101-140. [PMID: 36227760 DOI: 10.1080/10408363.2022.2121960] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Thyroid dysfunctions are among the most common endocrine disorders and accurate biochemical testing is needed to confirm or rule out a diagnosis. Notably, true hyperthyroidism and hypothyroidism in the setting of a normal thyroid-stimulating hormone level are highly unlikely, making the assessment of free thyroxine (FT4) inappropriate in most new cases. However, FT4 measurement is integral in both the diagnosis and management of relevant central dysfunctions (central hypothyroidism and central hyperthyroidism) as well as for monitoring therapy in hyperthyroid patients treated with anti-thyroid drugs or radioiodine. In such settings, accurate FT4 quantification is required. Global standardization will improve the comparability of the results across laboratories and allow the development of common clinical decision limits in evidence-based guidelines. The International Federation of Clinical Chemistry and Laboratory Medicine Committee for Standardization of Thyroid Function Tests has undertaken FT4 immunoassay method comparison and recalibration studies and developed a reference measurement procedure that is currently being validated. However, technical and implementation challenges, including the establishment of different clinical decision limits for distinct patient groups, still remain. Accordingly, different assays and reference values cannot be interchanged. Two-way communication between the laboratory and clinical specialists is pivotal to properly select a reliable FT4 assay, establish reference intervals, investigate discordant results, and monitor the analytical and clinical performance of the method over time.
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Affiliation(s)
- Federica D'Aurizio
- Department of Laboratory Medicine, University Hospital of Udine, Udine, Italy
| | - Jürgen Kratzsch
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, University of Leipzig, Leipzig, Germany
| | - Damien Gruson
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine and Thyroid Center, University and University Hospital of Zurich, Zurich, Switzerland
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Saeed M, Waheed U, Wazeer A, Saba N. Do We Need Pakistan-Specific Reference Ranges in Laboratory Medicine? J Lab Physicians 2023. [DOI: 10.1055/s-0042-1760669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Muhammad Saeed
- Department of Pathology, Tehsil Headquarters Hospital, Murree, Pakistan
| | - Usman Waheed
- Peshawar Regional Blood Centre, Provincial Ministry of Health, Khyber Pakhtunkhwa, Pakistan
- Department of Pathology and Transfusion Medicine, Divisional Headquarters Teaching Hospital, Mirpur, Pakistan
| | - Akhlaaq Wazeer
- Department of Pathology and Transfusion Medicine, Divisional Headquarters Teaching Hospital, Mirpur, Pakistan
| | - Noore Saba
- Peshawar Regional Blood Centre, Provincial Ministry of Health, Khyber Pakhtunkhwa, Pakistan
- Department of Pathology and Transfusion Medicine, Divisional Headquarters Teaching Hospital, Mirpur, Pakistan
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Sá ACMGND, Prates EJS, Moreira AD, Aguiar LK, Szwarcwald CL, Malta DC. Intervalos de referência de parâmetros de creatinina e hemoglobina glicosilada para a população adulta brasileira. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.40192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Objetivo: estimar intervalos de referência (IR) de creatinina e hemoglobina glicosilada (HbA1c) na população adulta brasileira. Métodos: estudo transversal, utilizando na base de dados Pesquisa Nacional de Saúde (PNS), entre 2014-2015, composta por 8.952 adultos. Para estabelecer IR, aplicaram-se critérios de exclusão, removeram-se outliers e foi feita estratificação. Após esses procedimentos, a amostra constitui-se de 2.723 adultos para HbA1c e de 2.738 adultos para creatinina. Avaliaram-se diferenças pelos testes Mann Withney e Kruskal Wallis (p≤0,05). Resultados: homens (IR 0,69-1,25; mediana 0,95 mg/dL) apresentaram maiores IR para creatinina que mulheres (IR 0,53-1,05; mediana 0,74 mg/dL) e tiveram maiores valores de limites inferiores (LI) e mediana de HbA1c (sexo masculino: IR: 4,55-5,97; mediana 5,3%; sexo feminino: IR 4,49-5,97; mediana 5,20%) (p ≤ 0,05). Nas mulheres, IR para creatinina foram mais elevados entre 45 a 59 anos (IR: 0,55-1,04; mediana 0,77 mg/dL) e a partir dos 60 anos (IR: 0,54-0,98; mediana 0,77 mg/dL (p ≤ 0,05). Para HbA1c, homens apresentaram IR mais elevados a partir de 60 anos (IR 4,65-6,07; mediana 5,44%) e mulheres a partir de 45 anos (45 a 59 anos: IR 4,61-6,05; mediana 5,40%; e 60 anos ou mais: IR 4,82-6,03; mediana 5,50%) (p ≤ 0,05). Para creatina, foram observados menores LI dos IR e mediana mais proeminente nos adultos de raça/cor branca (IR: 0,56-1,19; mediana 0,85%) em comparação com a parda (IR: 0,55-1,19; mediana 0,84%) (p ≤ 0,05). Conclusão: IR próprios possibilitam desvelar as condições de saúde dos adultos brasileiros e podem subsidiar a identificação adequada de doença renal crônica e diabetes.
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Müller J, Büchsel M, Timme M, App U, Miesbach W, Sachs UJ, Krause M, Scholz U. Reference Intervals in Coagulation Analysis. Hamostaseologie 2022; 42:381-389. [PMID: 36549290 DOI: 10.1055/a-1945-9490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Blood coagulation analysis is characterized by the application of a variety of materials, reagents, and analyzers for the determination of the same parameter, or analyte, by different laboratories worldwide. Accordingly, the application of common reference intervals, that, by definition, would represent a "range of values (of a certain analyte) that is deemed normal for a physiological measurement in healthy persons," is difficult to implement without harmonization of procedures. In fact, assay-specific reference intervals are usually established to allow for the discrimination of normal and abnormal values during evaluation of patient results. While such assay-specific reference intervals are often determined by assay manufacturers and subsequently adopted by customer laboratories, verification of transferred values is still mandatory to confirm applicability on site. The same is true for reference intervals that have been adopted from other laboratories, published information, or determined by indirect data mining approaches. In case transferable reference intervals are not available for a specific assay, a direct recruiting approach may or needs to be applied. In comparison to transferred reference interval verification, however, the direct recruiting approach requires a significantly higher number of well-defined samples to be collected and analyzed. In the present review, we aim to give an overview on the above-mentioned aspects and procedures, also with respect to relevant standards, regulations, guidelines, but also challenges for both, assay manufacturers and coagulation laboratories.
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Affiliation(s)
- Jens Müller
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Martin Büchsel
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Timme
- Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany
| | - Urban App
- Siemens Healthcare GmbH, Eschborn, Germany
| | - Wolfgang Miesbach
- Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Ulrich J Sachs
- Department of Thrombosis and Hemostasis, Giessen University Hospital, Giessen, Germany.,Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Michael Krause
- Center of Hemostasis, MVZ Labor Dr. Reising-Ackermann und Kollegen, Leipzig, Germany
| | - Ute Scholz
- Center of Hemostasis, MVZ Labor Dr. Reising-Ackermann und Kollegen, Leipzig, Germany
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Shieh G. Determining reference ranges and sample sizes in parallel-group studies. PLoS One 2022; 17:e0278447. [PMID: 36449490 PMCID: PMC9710766 DOI: 10.1371/journal.pone.0278447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Reference ranges are widely used to locate the major range of the target probability distribution. When future measurements fall outside the reference range, they are classified as atypical and require further investigation. The fundamental principles and statistical properties of reference ranges are closely related to those of tolerance interval procedures. Existing investigations of reference ranges and tolerance intervals mainly devoted to the primitive cases of one- and paired-sample designs. Although reference ranges hold considerable promise for parallel group designs, the corresponding methodological and computational issues for determining reference limits and sample sizes have not been adequately addressed. METHODS This paper describes a complete collection of one- and two-sided reference ranges for assessing measurement differences in parallel-group studies that assume variance homogeneity. RESULTS The problem of sample size determination for precise reference ranges is also examined under the expected half-width and assurance probability considerations. Unlike the current methods, the suggested sample size criteria explicitly accommodate desired interval width in precise interval estimation. CONCLUSIONS Theoretical examinations and empirical assessments are presented to validate the usefulness of the proposed reference range and sample size procedures. To enhance the usages of the recommended techniques in practical applications, computer programs are developed for efficient calculation and exact analysis. A real data example regarding tablet absorption rate and extent is presented to illustrate the suggested assessments between two drug formulations.
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Affiliation(s)
- Gwowen Shieh
- Department of Management Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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18
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Rostom H, Meng X, Price H, Fry A, Elajnaf T, Humphrey R, Guha N, James T, Kennedy SH, Hannan FM. Protocol for an observational study investigating hormones triggering the onset of sustained lactation: the INSIGHT study. BMJ Open 2022; 12:e062478. [PMID: 36041762 PMCID: PMC9438014 DOI: 10.1136/bmjopen-2022-062478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Lactation is a hormonally controlled process that promotes infant growth and neurodevelopment and reduces the long-term maternal risk of diabetes, cardiovascular disease and breast cancer. Hormones, such as prolactin and progesterone, mediate mammary development during pregnancy and are critical for initiating copious milk secretion within 24-72 hours post partum. However, the hormone concentrations mediating lactation onset are ill defined. METHODS AND ANALYSIS The primary objective of the investigating hormones triggering the onset of sustained lactation study is to establish reference intervals for the circulating hormone concentrations initiating postpartum milk secretion. The study will also assess how maternal factors such as parity, pregnancy comorbidities and complications during labour and delivery, which are known to delay lactation, may affect hormone concentrations. This single-centre observational study will recruit up to 1068 pregnant women over a 3-year period. A baseline blood sample will be obtained at 36 weeks' gestation. Participants will be monitored during postpartum days 1-4. Lactation onset will be reported using a validated breast fullness scale. Blood samples will be collected before and after a breastfeed on up to two occasions per day during postpartum days 1-4. Colostrum, milk and spot urine samples will be obtained on a single occasion. Serum hormone reference intervals will be calculated as mean±1.96 SD, with 90% CIs determined for the upper and lower reference limits. Differences in hormone values between healthy breastfeeding women and those at risk of delayed onset of lactation will be assessed by repeated measures two-way analysis of variance or a mixed linear model. Correlations between serum hormone concentrations and milk composition and volume will provide insights into the endocrine regulation of milk synthesis. ETHICS AND DISSEMINATION Approval for this study had been granted by the East of England-Cambridgeshire and Hertfordshire Research Ethics Committee (REC No. 20/EE/0172), by the Health Research Authority (HRA), and by the Oxford University Hospitals National Health Service Foundation Trust. The findings will be published in high-ranking journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN12667795.
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Affiliation(s)
- Hussam Rostom
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Xin Meng
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Helen Price
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Alexandria Fry
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Taha Elajnaf
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Robert Humphrey
- Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nishan Guha
- Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tim James
- Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen H Kennedy
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Fadil M Hannan
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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Ma L, Zhang B, Luo L, Shi R, Wu Y, Liu Y. Biological variation estimates obtained from Chinese subjects for 32 biochemical measurands in serum. Clin Chem Lab Med 2022; 60:1648-1660. [PMID: 35977427 DOI: 10.1515/cclm-2021-0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 06/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) have established a program of work to make available, and to enable delivery of well characterized data describing the biological variation (BV) of clinically important measurands. Guided by the EFLM work the study presented here delivers BV estimates obtained from Chinese subjects for 32 measurands in serum. METHODS Samples were drawn from 48 healthy volunteers (26 males, 22 females; age range, 21-45 years) for 5 consecutive weeks at Chinese laboratory. Sera were stored at -80 °C before triplicate analysis of all samples on a Cobas 8000 modular analyzer series. Outlier and homogeneity analyses were performed, followed by CV-ANOVA, to determine BV estimates with confidence intervals. RESULTS The within-subject biological variation (CVI) estimates for 30 of the 32 measurands studied, were lower than listed on the EFLM database; the exceptions were alanine aminotransferase (ALT), lipoprotein (a) (LP(a)). Most of the between-subject biological variation (CVG) estimates were lower than the EFLM database entries. CONCLUSIONS This study delivers BV data for a Chinese population to supplement the EFLM BV database. Population differences may have an impact on applications of BV Data.
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Affiliation(s)
- Liming Ma
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Bin Zhang
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Limei Luo
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Rui Shi
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Yonghua Wu
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Yunshuang Liu
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
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Aziz N, Gjertson DW, Mimiaga MJ, Azarkman CD, Soto R, Alexopoulos N, Detels R. Long-term intra- and inter-individual biological variation of serum lipid of HIV-infected and uninfected men participating in the Los Angeles Multi-Center AIDS Cohort Study (MACS). Lipids Health Dis 2022; 21:63. [PMID: 35897032 PMCID: PMC9327155 DOI: 10.1186/s12944-022-01668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND To assess the long-term biological coefficient of variation within individuals (CVI) and between individuals (CVG), effect of aging and cholesterol lowering drugs on blood levels of lipids in HIV-1-infected and -uninfected men. METHODS Bloods were analyzed every six months over 17 years for total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) in 140 HIV-uninfected (38-66 years old) and 90 HIV-treated infected (48-64 years old) white Caucasian men to examine CVI, CVG, and the effect of cholesterol lowering drugs (CLDs) on lipid levels, and estimated changes per year of biomarkers. RESULTS With exception of HDL-C, the long term CVI compared with CVG were higher for serum levels of TC, TGs, and LDL-C in both HIV-1 infected and uninfected men not taking CLDs. Excluding results of TGs in HIV positive men, the CVI compared with CVG were lower for serum levels of TC, HDL-C, and LDL-C in both groups not taking CLDs. There were significant (p < 0.05) differences in the median serum values of lipid biomarkers among 77 HIV negative men taking and 63 not taking CLDs. Also, with exception of HDL, there were significant (p < 0.05) differences in the median values of TC, TGs and LDL-C among 28 HIV positive men taking or not taking CLDs. CONCLUSION Long term CVI and CVG of biomarkers will be useful for monitoring antiviral therapy side effects on lipid profiles in HIV-infected men. CVI of HIV-infected men for TC, TGs, HDL, LDL were higher significantly than CVI of HIV-uninfected men. Interestingly the long term CVI were higher than CVG for the men, who were on CLDs compared to men not on CLDs. The long-term pattern of CVI and CVG of lipid markers in both HIV-infected and uninfected men on CLDs differed from their short-term pattern.
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Affiliation(s)
- Najib Aziz
- grid.19006.3e0000 0000 9632 6718Department of Epidemiology, UCLA, Fielding School of Public Health, Los Angeles, CA 90095-1772 USA
| | - David W. Gjertson
- grid.19006.3e0000 0000 9632 6718Department of Biostatistics, UCLA, Fielding School of Public Health, Los Angeles, CA USA
| | - Matthew J. Mimiaga
- grid.19006.3e0000 0000 9632 6718Department of Epidemiology, UCLA, Fielding School of Public Health, Los Angeles, CA 90095-1772 USA ,grid.19006.3e0000 0000 9632 6718Department of Psychiatry & Biobehavioral Sciences, UCLA, David Geffen School of Medicine, Los Angeles, CA USA
| | - Chantel D. Azarkman
- grid.19006.3e0000 0000 9632 6718Department of Epidemiology, UCLA, Fielding School of Public Health, Los Angeles, CA 90095-1772 USA
| | - Rey Soto
- grid.19006.3e0000 0000 9632 6718Department of Epidemiology, UCLA, Fielding School of Public Health, Los Angeles, CA 90095-1772 USA
| | - Nicole Alexopoulos
- grid.19006.3e0000 0000 9632 6718Department of Epidemiology, UCLA, Fielding School of Public Health, Los Angeles, CA 90095-1772 USA
| | - Roger Detels
- grid.19006.3e0000 0000 9632 6718Department of Epidemiology, UCLA, Fielding School of Public Health, Los Angeles, CA 90095-1772 USA ,grid.19006.3e0000 0000 9632 6718Department of Medicine, UCLA, David Geffen School of Medicine, Los Angeles, CA USA
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Mohammed M, Fiseha M, Belay G, Kindie S, Tsegaye A. Reference Intervals for Common Renal and Liver Function Clinical Chemistry Parameters Among Apparently Healthy Pregnant and Non-pregnant Women in South Wollo Zone, Amhara National Regional State, Northeast Ethiopia. Int J Gen Med 2022; 15:5145-5157. [PMID: 35637704 PMCID: PMC9148174 DOI: 10.2147/ijgm.s363129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Physiological changes during pregnancy cause alterations in concentration of biochemical analytes. Thus, locally established pregnancy-specific reference intervals are important for accurate diagnosis, treatment, and prognosis of diseases. The objective of the study was to establish reference interval for the common renal and liver function clinical chemistry parameters among pregnant and non-pregnant women of South Wollo zone, Ethiopia. Methods A community-based cross-sectional study was conducted on a total of 323 apparently healthy study participants randomly selected from South Wollo zone, Ethiopia, from April to June 2019. Medical history, physical examination and sociodemography were collected by using questionnaire. Liver and renal function clinical chemistry tests were done using A25 Biosystems, clinical chemistry analyzer. After the exclusion of outliers, Kolmogorov–Smirnov test was used to check its normality. The 95% RI with 95% confidence interval was established using the nonparametric method. The significance of differences was evaluated using Mann–Whitney U test. Result There was statistically significant variation between pregnant and non-pregnant women in values of albumin, T. protein, ALP, urea and creatinine, but not for AST, ALT, bilirubin (direct) and bilirubin (total). Reference intervals established for pregnant women includes albumin 26.14–42.87g/L, total protein 48.52–74.71 g/L, AST 2.4–43.6 U/L, ALT 0.94–28.35 U/L, ALP 21.2–337 U/L, bilirubin (direct) 0.03–0.32 mg/dL, bilirubin (total) 0.26–0.94 mg/dL, creatinine 0.29–0.87 mg/dL, urea 7.17–20.82 mg/dL. Albumin: 32.81–47.87, total protein: 56.71–83.9 U/L, AST: 4.2–37.1 U/L, ALT: 2.69–41.18 U/L, ALP: 3.22–278.7 U/L, bilirubin (direct) 0.1–0.51 mg/dL, bilirubin (total) 0.24–1.06 mg/dL, creatinine 0.44–1.00 mg/dL, urea 8.07–27.87 mg/dL for non-pregnant women. Conclusion The study showed marked difference in albumin, total protein, alkaline phosphatase, urea and creatinine. Therefore, physiological adaptations of pregnancy should be considered when interpreting liver and renal function tests in a pregnant woman.
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Affiliation(s)
- Miftah Mohammed
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mesfin Fiseha
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getachew Belay
- Department of Medical laboratory science, College of Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Samuel Kindie
- Department of Medical Laboratory Science, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Science, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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22
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Kramer RM, Sheh A, Toolan CH, Muthupalani S, Carrasco SE, Artim SC, Burns MA, Fox JG. Factors Affecting Hematologic and Serum Biochemical Parameters in Healthy Common Marmosets ( Callithrix jacchus). JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2022; 61:113-131. [PMID: 34996528 DOI: 10.30802/aalas-jaalas-21-000061] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Physiologic changes during development, aging, and pregnancy may affect clinical parameters. Previously available reference values have been based on samples that may include wild and captive marmosets, with little representation of geriatric or pregnant animals. Establishing reference values under various conditions would support better recognition of pathologic conditions in marmosets. One hundred and forty-seven (70 males and 77 females) healthy marmosets from a research colony were included in this study. Exclusion criteria were abnormal physical exam findings at the time of blood sampling, chronic medications, or clinical or pathologic evidence of disease. Reference intervals were calculated for serum chemistry and hematology. Using metadata, samples were classified based on age, sex, colony source and pregnancy status. Multiple tests indicated significant differences with varying effect sizes, indicating that developing reference intervals based on metadata can be useful. Across all the comparisons, medium or large effect sizes were observed most frequently in blood urea nitrogen (BUN), calcium, total protein, alkaline phosphatase (ALP), weight and serum albumin. We report normative clinical pathologic data for captive common marmosets through all life stages and reproductive status. Significant differences were observed in most parameters when stratifying data based on age, sex, colony source, or pregnancy, suggesting that developing reference intervals considering this information is important for clinicians.
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Affiliation(s)
- Robin M Kramer
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA
| | - Alexander Sheh
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA
| | - Carolyn H Toolan
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA
| | | | - Sebastian E Carrasco
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA
| | - Stephen C Artim
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA
| | - Monika A Burns
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA
| | - James G Fox
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA
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23
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Mrosewski I, Dähn T, Hehde J, Kalinowski E, Lindner I, Meyer TM, Olschinsky-Szermer M, Pahl J, Puls M, Sachse K, Switkowski R. Indirectly determined hematology reference intervals for pediatric patients in Berlin and Brandenburg. Clin Chem Lab Med 2021; 60:408-432. [PMID: 34904427 DOI: 10.1515/cclm-2021-0853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Establishing direct reference intervals (RIs) for pediatric patients is a very challenging endeavor. Indirectly determined RIs can address this problem by utilization of existing clinical laboratory databases. In order to provide better laboratory services to the local pediatric population, we established population-specific hematology RIs via data mining. METHODS Our laboratory information system (LIS) was searched for pediatric blood counts of patients aged from 0 days to 18 years, performed from 1st of January 2018 until 31st of March 2021. In total, 27,554 blood counts on our SYSMEX XN-9000 were initially identified. After application of pre-defined exclusion criteria, 18,531 sample sets remained. Age- and sex-specific RIs were established in accordance with International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and Clinical & Laboratory Standards Institute (CLSI) recommendations. RESULTS When compared to pediatric RIs supplied by other authors, the RIs determined specifically for pediatric patients from Berlin and Brandenburg showed several relevant differences, especially with regard to white blood cell counts (WBCs), red blood cell counts (RBCs), red cell distribution widths (RDW) and platelet counts (PLTs) within the distinct age groups. Additionally, alterations to several published age-specific partitions had to be made, while new sex-specific partitions were introduced for WBCs and PLTs. CONCLUSIONS Generic RIs from textbooks, manufacturer information and medical publications - even from nationwide or multicenter studies - commonly used in many laboratories might not reflect the specifics of local patient populations properly. RIs should be tailored to the serviced patient population whenever possible. Careful data mining appears to be suitable for this task.
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Affiliation(s)
- Ingo Mrosewski
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Tobias Dähn
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Jörg Hehde
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Elena Kalinowski
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Ilona Lindner
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Thea Marie Meyer
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | | | - Jana Pahl
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Monika Puls
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Kristin Sachse
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Rafael Switkowski
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
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24
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Bracho FJ. Reference intervals of automated reticulocyte count and immature reticulocyte fraction in a pediatric population. Int J Lab Hematol 2021; 44:461-467. [PMID: 34859588 DOI: 10.1111/ijlh.13776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reticulocytes are erythroid precursors that develop into mature erythrocytes, and they are an important tool to assess erythropoietic activity, as their count indicates the balance between the cells released from the bone marrow, their stage of maturity, and their rate of development into mature erythrocytes. Considering the described biological variability of the absolute reticulocyte count (ARC) and the immature reticulocyte fraction (IRF) and the limited information available on these hematological parameters in children, this study determined the reference intervals (RIs) of these parameters in a healthy pediatric population. METHODS A retrospective, observational, and analytical study was designed to establish RIs for the ARC and the IRF according to age and sex. An indirect sampling method was applied to a mixed database of complete blood counts from children aged 2 months to 18 years, using the truncated maximum likelihood indirect method for reference interval estimation. Percentiles were calculated to obtain bimodal RIs. RESULTS From a total of 190,812 samples, 6,814 were selected. Gender stratification was not necessary for the ARC and the IRF but they required partitioning into six and two age groups, respectively. CONCLUSION This study determined, by an indirect sampling method, RIs for the ARC and the IRF in a pediatric population according to age and sex.
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25
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Jokic A, Rimac V, Vlasic Tanaskovic J, Podolar S, Honovic L, Lenicek Krleza J. The concurrence of the current postanalytical phase management with the national recommendations: a survey of the Working Group for Postanalytics of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb) 2021; 31:030704. [PMID: 34658645 PMCID: PMC8495617 DOI: 10.11613/bm.2021.030704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/01/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction The detection and prevention of errors in the postanalytical phase can be done through the harmonization and standardization of constituent parts of this phase of laboratory work. The aim was to investigate how well the ongoing management of the postanalytical phase corresponds to the document “Post-analytical laboratory work: national recommendations” in Croatian medical biochemistry laboratories (MBLs). Materials and methods All 195 MBLs participating in the national external quality assessment scheme, were invited to undertake a part in a survey. Through 23 questions the participants were asked about management of the reference intervals (RI), delta check, reflex/reflective testing, postanalytical quality indicators and other parts of the postanalytical phase recommended in the national recommendations. The results are presented in numbers and percentages. Results Out of 195 MBLs, 119 participated in the survey, giving a response rate of 61%. Not all of the respondents provided answers to all the questions. Delta check has not been used in 59% (70/118) of the laboratories. Only 22/113 (20%) laboratories use reflex and/or reflective testing. In 53% of the laboratories, critical results were reported within 30 minutes of the confirmation of the results. In 34% (40/118) of the laboratories, turnaround time and reporting of critical results are two most often monitored postanalytical quality indicators. Conclusion The results showed the critical results reporting and monitoring of postanalytical quality indicators are in the line with the recommendations. However, the management of RI verification, the use of delta check and reflex/reflective testing still must be harmonized among Croatian MBLs.
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Affiliation(s)
- Anja Jokic
- Department of Medical Biochemistry, Hematology and Coagulation with Cytology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia.,Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Vladimira Rimac
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jelena Vlasic Tanaskovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Sonja Podolar
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Medical Biochemistry Laboratory, General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Lorena Honovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Jasna Lenicek Krleza
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia
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26
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Pineda-Cortel MRB, Bunag JAA, Mamerto TP, Abulencia MFB. Differential gene expression and network-based analyses of the placental transcriptome reveal distinct potential biomarkers for gestationaldiabetes mellitus. Diabetes Res Clin Pract 2021; 180:109046. [PMID: 34530062 DOI: 10.1016/j.diabres.2021.109046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022]
Abstract
AIMS Gestational diabetes mellitus (GDM) is a common complication during pregnancy affecting the mother and fetus. With the problems encountered with the oral glucose tolerance test (OGTT), we aim to identify potential early biomarkers of GDM. METHODS A cross-sectional study was conducted among 80 pregnant women. Blood samples were collected every trimester, and total RNA was isolated. After quality control and library preparation, next-generation sequencing was performed. Differential expression analysis was done. Enriched Gene Ontology: Biological Processes (GO: BP) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were identified. Gene co-expression networks were constructed. Protein-protein Interaction (PPI) networks were then built from modules significantly correlated with Hemoglobin A1c. Genes with the highest degree of interaction were identified as hub genes. RESULTS IGKV2D-28 and PTPRG were consistently differentially expressed among the three comparisons. Top enriched GO: BP terms and KEGG pathways are linked to immune responses. Orange (r = 0.59, p = 0.02) and purple modules (r = 0.41, p = 0.02) of the GDM cohorts in the first and second trimesters, respectively, significantly correlated with Hemoglobin A1c. HDAC8 of the orange module and MPO and CRISP3 of the purple module were identified as hub genes. CONCLUSIONS In this study, potential biomarkers of GDM were identified, namely, IGKV2D-28, PTPRG, HDAC8, MPO, and CRISP3.
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Affiliation(s)
- Maria Ruth B Pineda-Cortel
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, España Boulevard, 1015 Manila, Philippines; The Graduate School, University of Santo Tomas, España Boulevard, 1015 Manila, Philippines; Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Boulevard, 1015 Manila, Philippines.
| | - Jose Angelo A Bunag
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Boulevard, 1015 Manila, Philippines
| | - Therriz P Mamerto
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Boulevard, 1015 Manila, Philippines; Department of Biochemistry, Faculty of Pharmacy, University of Santo Tomas, España Boulevard, 1015 Manila, Philippines
| | - Miguel Francisco B Abulencia
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Boulevard, 1015 Manila, Philippines
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27
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Zeljkovic A, Csuzdi Balog Z, Dukai E, Vekic J, Jelic-Ivanovic Z, Spasojevic-Kalimanovska V. Indirect reference intervals for haematological parameters in capillary blood of pre-school children. Biochem Med (Zagreb) 2021; 31:010709. [PMID: 33594298 PMCID: PMC7852301 DOI: 10.11613/bm.2021.010709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Indirect estimation of reference intervals (RIs) is straightforward and inexpensive procedure for determination of intra-laboratory RIs. We applied the indirect approach to assess RIs for haematological parameters in capillary blood of pre-school children, using results stored in our laboratory database. Materials and methods We extracted data from laboratory information system, for the results obtained by automatic haematology analyser in capillary blood of 154 boys and 146 girls during pre-school medical examination. Data distribution was tested, and logarithmic transformation was applied if needed. Reference intervals were calculated by the nonparametric percentile method. Results Reference intervals were calculated for: RBC count (4.2-5.4 x1012/L), haemoglobin (114-146 g/L), MCH (25.0-29.4 pg), MCHC (321-368 g/L), RDW-SD (36.1-43.5 fL), WBC count (4.5-12.3 x109/L), neutrophils count (1.7-6.9 x109/L) and percentage (29.0-69.0%), lymphocytes count (1.6-4.4 x109/L) and percentage (21.9-60.7%), PLT (165-459 x109/L), MPV (8.1-11.4 fL) and PDW (9.2-14.4%). Gender specific RIs were calculated for monocytes count (male (M): 0.2-1.6 x109/L; female (F): 0.1-1.4 x109/L) and percentage (M: 2.5-18.3%; F: 1.8-16.7%), haematocrit (M: 0.34-0.42 L/L; F: 0.34-0.43 L/L), MCV (M: 73.4-84.6 fL; F: 75.5-84.2 fL) and RDW (M: 12.1-14.3%; F: 11.7-13.9%), due to observed gender differences in these parameters (P = 0.031, 0.028, 0.020, 0.012 and 0.001; respectively). Estimated RIs markedly varied from the literature based RIs that are used in the laboratory. Conclusions Indirect method employed in this study enables straightforward assessment of RIs in pre-school children. Herein derived RIs differed from the literature-based ones, indicating the need for intra-laboratory determination of RIs for specific populations and sample types.
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Affiliation(s)
- Aleksandra Zeljkovic
- Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | | | - Eva Dukai
- Department of Laboratory Diagnostics, Healthcare Centre Kanjiža, Kanjiža, Serbia
| | - Jelena Vekic
- Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Zorana Jelic-Ivanovic
- Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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28
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Minieri M, Leoni BD, Bellincampi L, Bajo D, Agnoli A, De Angelis AM, Pieri M, Equitani F, Rossi V, Valente F, Pignalosa S, Terrinoni A, Bernardini S. Serum iPTH range in a reference population: From an integrated approach to vitamin D prevalence impact evaluation. Clin Chim Acta 2021; 521:1-8. [PMID: 34111419 DOI: 10.1016/j.cca.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND The iPTH upper reference limit (URL) reported by our laboratory provider (Abbott Laboratories) at Tor Vergata University Hospital was evaluated by internal verification procedures as not representative of our population and resulting as underestimated. In this study, a new reference interval has been investigated and established by comparing a direct and an indirect method based on a statistical reduction from results stored in the laboratory database. METHODS For reference interval calculation from the healthy population, we analyzed a cohort of 100 blood donors (84% males and 16% females) screened with no bone-related and malabsorption diseases. We analyzed a cohort of 495 patients retrieved from more than 800 iPTH results by excluding subjects with pathological measurement for calcium, phosphorus, and creatinine for the reference interval evaluation. Patients with vitamin D results were included in the analysis. Vitamin D sufficiency status during the period from January to September 2020 was also evaluated by investigating 3,050 patients. RESULTS The iPTH reference interval of a healthy blood donor population was measured as 25.2-109.1 pg/mL (2.7-11.6 pmol/L) at 2.5 and 97.5 distribution percentile. The iPTH reference interval from data stored in the laboratory database was 19.3-112.5 pg/mL (2.0-11.9 pmol/L). Furthermore, 60% of the whole population had prevalently insufficient vitamin D concentration (<30 ng/dL; <75 nmol/L). The impact of vitamin D concentration on the iPTH reference interval was measured for insufficient vitamin D (<30 ng/dL; <75 nmol/L) as 15.2-127.7 pg/mL (1.6-13.5 pmol/L), desirable vitamin D (30-40 ng/ml; 75-100 nmol/L) as 25.6-105 pg/mL (2.7-10.7 pmol/L) and optimal vitamin D (>40 ng/ml; >100 nmol/L) as 26.2-89.2 pg/mL (2.8-9.4 pmol/L), respectively. CONCLUSIONS The URL reported in manufacturer datasheets likely refers to a normal population with non-pathological vitamin D levels. On the contrary, the considered population was mostly vitamin D insufficient, resulting in a URL shift. On this basis, we suggest describing in medical reports the iPTH range for vitamin D deficiency for diagnosis of primary hyperparathyroidism even when a specific vitamin D request is lacking. On the other hand, reporting optimal vitamin D-based iPTH reference interval could be clinically relevant in supplemented patients as a marker of treatment efficacy.
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Affiliation(s)
- Marilena Minieri
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy; Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy.
| | | | | | - Daniela Bajo
- Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Alessia Agnoli
- Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
| | | | - Massimo Pieri
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Equitani
- Department of Transfusion Medicine, Santa Maria Goretti Hospital, AUSL Latina, Italy
| | | | | | | | - Alessandro Terrinoni
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy; Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
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29
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Langlois MR, Nordestgaard BG, Langsted A, Chapman MJ, Aakre KM, Baum H, Borén J, Bruckert E, Catapano A, Cobbaert C, Collinson P, Descamps OS, Duff CJ, von Eckardstein A, Hammerer-Lercher A, Kamstrup PR, Kolovou G, Kronenberg F, Mora S, Pulkki K, Remaley AT, Rifai N, Ros E, Stankovic S, Stavljenic-Rukavina A, Sypniewska G, Watts GF, Wiklund O, Laitinen P. Quantifying atherogenic lipoproteins for lipid-lowering strategies: consensus-based recommendations from EAS and EFLM. Clin Chem Lab Med 2021; 58:496-517. [PMID: 31855562 DOI: 10.1515/cclm-2019-1253] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 12/15/2022]
Abstract
The joint consensus panel of the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently addressed present and future challenges in the laboratory diagnostics of atherogenic lipoproteins. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), LDL cholesterol (LDLC), and calculated non-HDLC (=total - HDLC) constitute the primary lipid panel for estimating risk of atherosclerotic cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDLC is the primary target of lipid-lowering therapies. For on-treatment follow-up, LDLC shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations. Lipoprotein(a) [Lp(a)]-cholesterol is part of measured or calculated LDLC and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDLC declines poorly upon statin treatment. Residual risk of ASCVD even under optimal LDL-lowering treatment should be also assessed by non-HDLC or apolipoprotein B (apoB), especially in patients with mild-to-moderate hypertriglyceridemia (2-10 mmol/L). Non-HDLC includes the assessment of remnant lipoprotein cholesterol and shall be reported in all standard lipid panels. Additional apoB measurement can detect elevated LDL particle (LDLP) numbers often unidentified on the basis of LDLC alone. Reference intervals of lipids, lipoproteins, and apolipoproteins are reported for European men and women aged 20-100 years. However, laboratories shall flag abnormal lipid values with reference to therapeutic decision thresholds.
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Affiliation(s)
- Michel R Langlois
- Department of Laboratory Medicine, AZ St-Jan, Ruddershove 10, 8000 Brugge, Belgium.,University of Ghent, Ghent, Belgium
| | - Børge G Nordestgaard
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Langsted
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M John Chapman
- National Institute for Health and Medical Research (INSERM), Paris, France.,Endocrinology-Metabolism Service, Pitié-Salpetriere University Hospital, Paris, France
| | - Kristin M Aakre
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Hannsjörg Baum
- Institute for Laboratory Medicine, Mikrobiologie und Blutdepot, Regionale Kliniken Holding RKH GmbH, Ludwigsburg, Germany
| | - Jan Borén
- Institute of Medicine, Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eric Bruckert
- Department of Endocrinology and Prevention of Cardiovascular Disease, Pitié-Salpetriere University Hospital, Paris, France
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.,IRCCS Multimedica, Milan, Italy
| | - Christa Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Collinson
- Department of Clinical Blood Sciences, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK.,Department of Cardiology, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK
| | - Olivier S Descamps
- Department of Internal Medicine, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium.,Department of Cardiology, UCL Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christopher J Duff
- Department of Clinical Biochemistry, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | | | | | - Pia R Kamstrup
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Genovefa Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Florian Kronenberg
- Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Samia Mora
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Turku and Turku University Hospital, Turku, Finland
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Cardiovascular-Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nader Rifai
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emilio Ros
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, Barcelona, Spain.,Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Sanja Stankovic
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Grazyna Sypniewska
- Department of Laboratory Medicine, Collegium Medicum, NC University, Bydgoszcz, Poland
| | - Gerald F Watts
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Olov Wiklund
- Institute of Medicine, Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Päivi Laitinen
- Department of Clinical Chemistry, HUSLAB, Helsinki University Hospital, Helsinki, Finland
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Hamid JS, Atenafu EG, Borkhoff CM, Birken CS, Maguire JL, Bohn MK, Adeli K, Abdelhaleem M, Parkin PC. Reference intervals for hemoglobin and mean corpuscular volume in an ethnically diverse community sample of Canadian children 2 to 36 months. BMC Pediatr 2021; 21:241. [PMID: 34011305 PMCID: PMC8132375 DOI: 10.1186/s12887-021-02709-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To establish reference intervals for hemoglobin and mean corpuscular volume (MCV) in an ethnically diverse community sample of Canadian children 36 months and younger. Methods We collected blood samples from young children at scheduled primary care health supervision visits at 2 weeks, 2, 4, 6, 9, 12, 15, 18, 24, and 36 months of age. Samples were analyzed on the Sysmex XN-9000 Hematology Analyzer. We followed the Clinical and Laboratory Standards Institute guidelines in our analysis. Data were partitioned by sex and also combined. We considered large age partitions (3 and 6 months) as well as monthly partitions. Reference intervals (lower and upper limits) and 90% confidence intervals were calculated. Results Data from 2106 children were included. The age range was 2 weeks to 36 months, 46% were female, 48% were European and 23% were of mixed ethnicity. For hemoglobin, from 2 to 36 months of age, we found a wide reference interval and the 90% confidence intervals indicated little difference across age groups or according to sex. For MCV, from 2 to 7 months of age there was considerable decrease in the reference interval, which was lowest during the second year of life, followed by a slight increase in the last months of the third year of life. Conclusion These findings suggest adoption of a single hemoglobin reference interval for children 2–36 months of age. Further studies in children under 4 months of age are needed. Trial registration TARGet Kids! cohort is registered at ClinicalTrials.gov. www.clinicaltrials.gov. Identifier: NCT01869530. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02709-w.
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Affiliation(s)
- Jemila S Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Canada
| | - Eshetu G Atenafu
- Biostatistics Department, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Cornelia M Borkhoff
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Catherine S Birken
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Mary Kathryn Bohn
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Mohamed Abdelhaleem
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Haematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Patricia C Parkin
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. .,The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
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Abstract
Abstract
The indirect approach to defining reference intervals operates ‘a posteriori’, on stored laboratory data. It relies on being able to separate healthy and diseased populations using one or both of clinical techniques or statistical techniques. These techniques are also fundamental in a priori, direct reference interval approaches. The clinical techniques rely on using clinical data that is stored either in the electronic health record or within the laboratory database, to exclude patients with possible disease. It depends on the investigators understanding of the data and the pathological impacts on tests. The statistical technique relies on identifying a dominant, apparently healthy, typically Gaussian distribution, which is unaffected by the overlapping populations with higher (or lower) results. It depends on having large databases to give confidence in the extrapolation of the narrow portion of overall distribution representing unaffected individuals. The statistical issues involved can be complex, and can result in unintended bias, particularly when the impacts of disease and the physiological variations in the data are under appreciated.
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Affiliation(s)
- Kenneth A. Sikaris
- Department of Biochemistry , Melbourne Pathology , Collingwood , VIC , Australia
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Canovi S, Vezzani S, Polese A, Frasoldati A, Schiatti C, Preda C, Corradini Zini M, Vitiello A, Foracchia M, Comitini G, Aguzzoli L, Fasano T, Vecchia L. Pregnancy-related reference intervals for serum thyrotropin based on real-life clinical data. Gynecol Endocrinol 2021; 37:113-116. [PMID: 32321333 DOI: 10.1080/09513590.2020.1756251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AIM During pregnancy, thyroid homeostasis is physiologically modified, leading to altered levels of thyrotropin (TSH): hence, the adoption of pregnancy-related, population- and method-specific reference ranges is recommended. This monocentric and retrospective study was conducted to establish local pregnancy-related reference intervals for serum TSH in singleton pregnant women using real-life clinical data. METHODS We included women who measured serum TSH during pregnancy at our Laboratory over six years, excluding pregnant women with current or past history of thyroid disease, pituitary or autoimmune diseases, use of medications known to influence thyroid function, multiple and/or pathological pregnancies, BMI >30 Kg/m2. RESULTS We retrieved a total of 3744 TSH results. Reference limits (90% confidence intervals) for TSH (in mIU/L) are: first trimester 0.09 (0.06-0.12) - 3.16 (3.05-3.29); second trimester 0.25 (0.11-0.30) - 3.55 (3.34-3.73); third trimester 0.42 (0.15-0.48) - 3.93 (3.80-4.08). CONCLUSION In conclusion, real-life clinical data could be used to establish or verify local reference intervals for TSH in pregnant women: this may reduce the risk of misclassification of pregnant women undergoing thyroid function testing.
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Affiliation(s)
- Simone Canovi
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Vezzani
- Struttura complessa di Endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Polese
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Frasoldati
- Struttura complessa di Endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Clara Schiatti
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Preda
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Corradini Zini
- Struttura complessa di Endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Vitiello
- Servizio tecnologie informatiche e telematiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Foracchia
- Servizio tecnologie informatiche e telematiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Comitini
- Ginecologia e Ostetricia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Ginecologia e Ostetricia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Tommaso Fasano
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Vecchia
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Ianni B, McDaniel H, Savilo E, Wade C, Micetic B, Johnson S, Gerkin R. Defining Normal Healthy Term Newborn Automated Hematologic Reference Intervals at 24 Hours of Life. Arch Pathol Lab Med 2021; 145:66-74. [PMID: 33367662 DOI: 10.5858/arpa.2019-0444-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Automated analyzers have advanced the field of clinical hematology, mandating updated complete blood count (CBC) reference intervals (RIs) to be clinically useful. Contemporary newborn CBC RI publications are mostly retrospective, which some authors have cited as one of their cardinal limitations and recommended future prospective studies. OBJECTIVE.— To prospectively establish accurate hematologic RIs for normal healthy term newborns at 24 hours of life given the limitations of the current medical literature. DESIGN.— This prospective study was conducted at an academic tertiary care center, and hematology samples were collected from 120 participants deemed to be normal healthy term newborns. Distributions were assessed for normality and tested for outliers. Reference intervals were values between the 2.5th percentile and 97.5th percentile. RESULTS.— The novel RIs obtained for this study population are as follows: absolute immature granulocyte count, 80/μL to 1700/μL; immature granulocyte percentage, 0.6% to 6.1%; reticulocyte hemoglobin equivalent, 31.7 to 38.4 pg; immature reticulocyte fraction, 35.9% to 52.8%; immature platelet count, 4.73 × 103/μL to 19.72 × 103/μL; and immature platelet fraction, 1.7% to 9.8%. CONCLUSIONS.— This prospective study has defined hematologic RIs for this newborn population, including new advanced clinical parameters from the Sysmex XN-1000 Automated Hematology Analyzer. These RIs are proposed as the new standard and can serve as a strong foundation for continued research to further explore their value in diagnosing and managing morbidities such as sepsis, anemia, and thrombocytopenia.
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Affiliation(s)
- Barbara Ianni
- From the Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona.,University of Arizona College of Medicine - Phoenix.,Neonatal Intensive Care Unit, Banner - University Medical Center Phoenix, Phoenix, Arizona (Ianni)
| | - Holly McDaniel
- Laboratory, Banner Desert and Cardons Children's Medical Centers, Laboratory Sciences of Arizona, Mesa (McDaniel)
| | - Elena Savilo
- Laboratory, Banner - University Medical Center Phoenix, Laboratory Sciences of Arizona, Phoenix (Savilo)
| | - Christine Wade
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Becky Micetic
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Scott Johnson
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Richard Gerkin
- Department of Internal Medicine, Banner - University Medical Center Phoenix, Phoenix, Arizona and University of Arizona College of Medicine - Phoenix (Gerkin)
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Observational Study on Variation of Longitudinal Platelet Counts in Calves over the First 14 Days of Life and Reference Intervals from Cross-Sectional Platelet and Leukocyte Counts in Dairy Calves up to Two Months of Age. Animals (Basel) 2021; 11:ani11020347. [PMID: 33573024 PMCID: PMC7911096 DOI: 10.3390/ani11020347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary To define a healthy animal in an experimental setting or to differentiate and backup a diagnosis in cattle practice, reference intervals (RIs) in haematology diagnostics are necessary. The RIs in calves for blood cell counts, such as platelets and white blood cells, differ from RIs in adult cattle and are not widely studied. Blood results from dairy calves in the Netherlands were used to study the variation in platelet counts in young calves and to calculate an RI for platelet and white blood cell counts. In new-born calves up to six days of age, platelet counts were lower than in calves older than five days. From six days of age until 60 days of age we propose an RI platelet count of 287–1372 × 109/L and for the first 60 days of life an RI for leukocyte count of 4.0–18.9 × 109/L. Abstract Platelet and leukocyte count reference intervals (RIs) for cattle differ by age and while adult RIs are known, RIs for calves are studied less. The aims of this observational study are to evaluate variation of platelet counts of Holstein Friesian calves over the first 14 days of life and to propose RIs for platelet and leukocyte counts of Holstein Friesian calves aged 0–60 days. In a longitudinal study, 19 calves were blood sampled 17 times, in the first 14 days of their lives. Blood was collected in a citrate blood tube and platelet counts were determined. We assessed the course of platelet counts. In a field study, 457 healthy calves were blood sampled once. Blood was collected in an EDTA blood tube and platelet and leukocyte counts were determined. The RIs were calculated by the 2.5 and 97.5 percentiles. Platelet counts started to increase 24 h after birth (mean platelet count 381 × 109/L ± 138 × 109/L) and stabilized after five days (mean platelet count 642 × 109/L ± 265 × 109/L). In calves up to six days of age, platelet counts were lower than in calves older than five days. In conclusion, the RIs of platelet and leukocyte counts in calves were wider in range than the RIs for adult cattle, therefore, calf specific RIs for platelet and leukocyte counts should be used. From 6 until 60 days of age, we propose an RI for platelet counts of 287–1372 × 109/L and for the first 60 days of life an RI for leukocyte counts of 4.0–18.9 × 109/L.
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Hyohdoh Y, Hatakeyama Y, Okuhara Y. A simple method to identify real-world clinical decision intervals of laboratory tests from clinical data. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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36
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Mancopes R, Peladeau-Pigeon M, Barrett E, Guran A, Smaoui S, Pasqualoto AS, Steele CM. Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Chronic Obstructive Pulmonary Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3643-3658. [PMID: 33105085 PMCID: PMC8582841 DOI: 10.1044/2020_jslhr-20-00154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/06/2020] [Accepted: 08/18/2020] [Indexed: 05/26/2023]
Abstract
Purpose Dysphagia is a serious extra pulmonary manifestation of chronic obstructive pulmonary disease (COPD). However, the nature of abnormalities in swallowing physiology in COPD has yet to be clearly established. We explored the frequency of swallowing measures outside the healthy reference range in adults with COPD. Method Participants were 28 adults aged 41-79 years (18 men, 20 women) with stable COPD. Disease severity was classified as GOLD (Global Initiative For Chronic Obstructive Lung Disease) Stages 1 (4%), 2 (25%), 3 (53%), and 4 (18%). Participants underwent a videofluoroscopy and swallowed 20% w/v thin barium in, followed by 20% w/v mildly, moderately, and extremely thick barium prepared with a xanthan gum thickener. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were performed according to the ASPEKT method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). Comparison data for healthy adults aged < 60 years were extracted from an existing data set. Chi-square and Fisher's exact tests compared the frequencies of measures falling < 1 SD/ > 1 SD from mean reference values (or < the first or > the third quartile for skewed parameters). Results Participants with COPD did not display greater frequencies of penetration-aspiration, but they were significantly more likely (p < .05) to display incomplete laryngeal vestibule closure (LVC), longer time-to-LVC, and shorter LVC duration. They also displayed significantly higher frequencies of short upper esophageal sphincter opening, reduced pharyngeal constriction, and pharyngeal residue. Conclusion This analysis reveals differences in swallowing physiology in patients with stable COPD characterized by impaired safety related to the mechanism, timing, and duration of LVC and by impaired swallowing efficiency with increased pharyngeal residue related to poor pharyngeal constriction.
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Affiliation(s)
- Renata Mancopes
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Dysphagia Laboratory, Graduate Program of Human Communication Disorders, Federal University of Santa Maria, Rio Grande do Sul, Brazil
| | - Melanie Peladeau-Pigeon
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Emily Barrett
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Andrea Guran
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Sana Smaoui
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Adriane Schmidt Pasqualoto
- Dysphagia Laboratory, Graduate Program of Human Communication Disorders, Federal University of Santa Maria, Rio Grande do Sul, Brazil
| | - Catriona M. Steele
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Dysphagia Laboratory, Graduate Program of Human Communication Disorders, Federal University of Santa Maria, Rio Grande do Sul, Brazil
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Mosca A, Paleari R, Harteveld CL. A roadmap for the standardization of hemoglobin A 2. Clin Chim Acta 2020; 512:185-190. [PMID: 33181152 DOI: 10.1016/j.cca.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/12/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Standardization of laboratory tests can be a long process, and this is the case with regards to the methods used to measure hemoglobin A2 (HbA2), an important marker for beta-thalassemia and other thalassemic conditions. The IFCC standardization project started in 2004, and it took at least 15 years before developing a reference measurement procedure, defining and producing calibrators and certified reference materials. METHODS A series of steps have to be undertaken in order to promote the standardization in the field, a process involving a number of stakeholders (manufacturers, scientific societies, national health bodies, laboratory professionals, clinicians). In this work we describe some possible process indicators, in order to assure that the standardization will have internal and external validity and be effective for a long time. These indicators concern the inter-method studies, elaboration of External Quality Assessment Schemes, and the evaluation of the yearly distributions of HbA2 measurements collected in selected laboratories. RESULTS Preliminary results are reported concerning the yearly distributions of HbA2, collected in two different locations, and using different analytical methods. Median yearly values were found very constant over the years, but different between methods. On the other side, results obtained on the same specimens using two different techniques, proved that results by capillary electrophoresis in 2 out of the 3 years of observation, were significantly lower than those by HPLC. CONCLUSION In this document we report what has been done so far, and what has to be done to achieve the standardization of the measurement of HbA2 worldwide.
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Affiliation(s)
- Andrea Mosca
- Dip. di Fisiopatologia Medico-Chirurgica e dei Trapianti and Centro per la Riferibilità Metrologica in Medicina di Laboratorio (CIRME), Università degli Studi di Milano, Milano, Italy; Istituto di Tecnologie Biomediche, Consiglio Nazionale delle Ricerche (ITB-CNR), Milano, Italy.
| | - Renata Paleari
- Dip. di Fisiopatologia Medico-Chirurgica e dei Trapianti and Centro per la Riferibilità Metrologica in Medicina di Laboratorio (CIRME), Università degli Studi di Milano, Milano, Italy; Istituto di Tecnologie Biomediche, Consiglio Nazionale delle Ricerche (ITB-CNR), Milano, Italy
| | - Cornelis L Harteveld
- Dept. of Clinical Genetics/LDGA, Leiden University Medical Center, Leiden, the Netherlands
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Hickman PE, Koerbin G, Potter JM, Glasgow N, Cavanaugh JA, Abhayaratna WP, West NP, Glasziou P. Choice of Statistical Tools for Outlier Removal Causes Substantial Changes in Analyte Reference Intervals in Healthy Populations. Clin Chem 2020; 66:1558-1561. [PMID: 34214151 DOI: 10.1093/clinchem/hvaa208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Reference intervals are an important aid in medical practice as they provide clinicians a guide as to whether a patient is healthy or diseased.Outlier results in population studies are removed by any of a variety of statistical measures. We have compared several methods of outlier removal and applied them to a large body of analytes from a large population of healthy persons. METHODS We used the outlier exclusion criteria of Reed-Dixon and Tukey and calculated reference intervals using nonparametric and Harrell-Davis statistical methods and applied them to a total of 36 different analytes. RESULTS Nine of 36 analytes had a greater than 20% difference in the upper reference limit, and for some the difference was 100% or more. CONCLUSIONS For some analytes, great importance is attached to the reference interval. We have shown that different statistical methods for outlier removal can cause large changes to reported reference intervals. So that population studies can be readily compared, common statistical methods should be used for outlier removal.
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Affiliation(s)
- Peter E Hickman
- Australian National University Medical School, Garran, ACT, Australia.,ACT Pathology, Canberra Hospital, Garran, ACT, Australia
| | - Gus Koerbin
- College of Medicine Biology and Environment, Australian National University, Garran, ACT, Australia
| | - Julia M Potter
- Australian National University Medical School, Garran, ACT, Australia.,ACT Pathology, Canberra Hospital, Garran, ACT, Australia
| | - Nicholas Glasgow
- Australian National University Medical School, Garran, ACT, Australia
| | | | - Walter P Abhayaratna
- College of Medicine Biology and Environment, Australian National University, Garran, ACT, Australia
| | - Nic P West
- Griffith University, Brisbane, QLD, Australia
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Ghazizadeh H, Kathryn Bohn M, Ghaffarian Zirak R, Kamel Khodabandeh A, Zare-Feyzabadi R, Saberi-Karimian M, Timar A, Jaberi N, Mohammadi-Bajgiran M, Sharifan P, Tayefi M, Silakhori S, Emamian M, Oladi MR, Esmaily H, Ferns GA, Adeli K, Ghayour-Mobarhan M. Comprehensive laboratory reference intervals for routine biochemical markers and pro-oxidant-antioxidant balance (PAB) in male adults. J Clin Lab Anal 2020; 34:e23470. [PMID: 32986247 PMCID: PMC7676209 DOI: 10.1002/jcla.23470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 01/05/2023] Open
Abstract
Background Reference values of biochemical markers are influenced by various parameters including age, sex, region, and lifestyle. Hence, we aimed to determine age‐ and BMI‐specific reference intervals (RIs) for important clinical biomarkers in a healthy adult male population from northeastern Iran. This is also the first study to investigate reference values for pro‐oxidant‐antioxidant balance (PAB). Methods Seven hundred and twenty (720) healthy men, aged 20‐60 years, were recruited from Sarakhs in the northeast region of Iran. Reference values for lipid profiles (total cholesterol, triglyceride, HDL‐C and LDL‐C), fasting blood glucose, inflammatory factors (hs‐CRP and PAB), minerals (zinc and copper), uric acid, and blood pressure were measured and statistically analyzed to establish accurate age‐ and BMI‐specific RIs in alignment with CLSI Ep28‐A3 guidelines. Results RIs for lipid profiles, inflammatory factors, minerals, and uric acid required no age partitioning with the exception of fasting blood glucose and blood pressure, which demonstrated significantly higher values in subjects aged 50 years and older. Among these biomarkers, only uric acid, blood pressure, and triglycerides demonstrated statistically significant increases in reference value concentrations with increasing BMI. Conclusion In this study, age‐ and BMI‐specific RIs for several biochemical markers were determined in healthy adult Iranian men. Partitioning by age and BMI was only required for a few analytes with most demonstrating no statistically significant changes with these covariates. These data can be useful to monitor various diseases in male adults with varying BMI in this region and others.
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Affiliation(s)
- Hamideh Ghazizadeh
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mary Kathryn Bohn
- Division of Clinical Biochemistry, Pediatric Laboratory Medicine, CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Atieh Kamel Khodabandeh
- Social Determinants of Health Research Center, Mashhad University of Medical sciences, Mashhad, Iran
| | - Reza Zare-Feyzabadi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Saberi-Karimian
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameneh Timar
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghmeh Jaberi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Payam Sharifan
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Tayefi
- Norwegian Center for e-health Research, University hospital of North Norway, Tromsø, Norway
| | - Samaneh Silakhori
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marzieh Emamian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Oladi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Social Determinants of Health Research Center, Mashhad University of Medical sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, UK
| | - Khosrow Adeli
- Division of Clinical Biochemistry, Pediatric Laboratory Medicine, CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
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Sun Q, Yue Y, Tian Y, Wang Q. Establishment of reference intervals for pediatric complete capillary blood counts: A multicenter study in Beijing. Int J Lab Hematol 2020; 42:533-543. [PMID: 32790150 DOI: 10.1111/ijlh.13150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/23/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Qiujin Sun
- Department of Clinical Laboratory Beijing Chaoyang District Maternal and Child Health Care Hospital Beijing China
| | - Yuhong Yue
- Department of Clinical Laboratory Beijing Center for Clinical Laboratories Beijing Chaoyang Hospital Capital Medical University Beijing China
| | - Yu Tian
- Department of Clinical Laboratory Beijing Chaoyang District Maternal and Child Health Care Hospital Beijing China
| | - Qingtao Wang
- Department of Clinical Laboratory Beijing Center for Clinical Laboratories Beijing Chaoyang Hospital Capital Medical University Beijing China
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Steele CM, Peladeau-Pigeon M, Barrett E, Wolkin TS. The Risk of Penetration-Aspiration Related to Residue in the Pharynx. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1608-1617. [PMID: 32598168 PMCID: PMC7893525 DOI: 10.1044/2020_ajslp-20-00042] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 05/04/2023]
Abstract
Purpose Reference data from healthy adults under the age of 60 years suggest that the 75th and 95th percentiles for pharyngeal residue on swallows of thin liquids are 1% and 3%(C2-4)2, respectively. We explored how pharyngeal residue below versus above these values prior to a swallow predicts penetration-aspiration. Method The study involved retrospective analysis of a previous research data set from 305 adults at risk for dysphagia. Participants swallowed six thin boluses and three each of mildly, moderately, and extremely thick barium in videofluoroscopy. Raters measured preswallow residue in %(C2-4)2 units and Penetration-Aspiration Scale (PAS) scores for each swallow. Swallows were classified as (a) "clean baseline" (with no preswallow residue), (b) "clearing" swallows of residue with no new material added, or (c) swallows of "additional material" plus preswallow residue. Frequencies of PAS scores of ≥ 3 were compared across swallow type by consistency according to residue severity (i.e., ≤ vs. > 1%(C2-4)2 and ≤ vs. > 3%(C2-4)2. Results The data set comprised 2,541 clean baseline, 209 clearing, and 1,722 swallows of additional material. On clean baseline swallows, frequencies of PAS scores of ≥ 3 were 5% for thin and mildly thick liquids and 1% for moderately/extremely thick liquids. Compared to clean baseline swallows, the odds of penetration-aspiration on thin liquids increased 4.60-fold above the 1% threshold and 4.20-fold above the 3% threshold (mildly thick: 2.11-fold > 1%(C2-4)2, 2.26-fold > 3%(C2-4)2). PAS scores of ≥ 3 did not occur with clearing swallows of moderately/extremely thick liquids. Lower frequencies of above-threshold preswallow residue were seen for swallows of additional material than for clearing swallows. Compared to clean baseline swallows, the odds of PAS scores of ≥ 3 on swallows of additional material increased ≥ 1.86-fold above the 1% threshold and ≥ 2.15-fold above the 3% threshold, depending on consistency. Conclusion The data suggest that a pharyngeal residue threshold of 1%(C2-4)2 is a meaningful cut-point for delineating increased risk of penetration-aspiration on a subsequent swallow.
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Affiliation(s)
- Catriona M Steele
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Canada
| | - Emily Barrett
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Canada
| | - Talia S Wolkin
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Canada
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Tulloh RMR, Quek FF, Stevenson K, Garratt V, Turner-Cobb JM. Cortisol/cortisone levels and quality of life in individuals with pulmonary arterial hypertension. Pulm Circ 2020; 10:2045894020924325. [PMID: 32523685 PMCID: PMC7235663 DOI: 10.1177/2045894020924325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/13/2020] [Indexed: 11/16/2022] Open
Abstract
Individuals with pulmonary arterial hypertension experience debilitating symptoms and psychological distress which may influence their cortisol regulation. We describe associations between diurnal salivary cortisol/cortisone levels and quality of life in adults with pulmonary arterial hypertension. Findings suggest potential clinical utility of cortisol/cortisone assessment as applied to a pulmonary arterial hypertension population.
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Affiliation(s)
- RMR Tulloh
- Department of Congenital Heart Disease, Bristol Medical School, Bristol, UK
| | - FF Quek
- Department of Congenital Heart Disease, Bristol Medical School, Bristol, UK
| | - K Stevenson
- Department of Biochemistry, University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - V Garratt
- Department of Psychology, University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - JM Turner-Cobb
- Department of Psychology, Bournemouth University, Poole, UK
- JM Turner-Cobb, Department of Psychology, Faculty of Science & Technology, Talbot Campus, Bournemouth University, Poole, Dorset BH12 5BB, UK.
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Delgado JA, Bauça JM, Pastor MI, Barceló A. Use of data mining in the establishment of age-adjusted reference intervals for parathyroid hormone. Clin Chim Acta 2020; 508:217-220. [PMID: 32417213 DOI: 10.1016/j.cca.2020.05.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/23/2020] [Accepted: 05/13/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND-AIM Appropriately defined reference values are of vital importance for the correct interpretation of laboratory results. However, the implementation of in-house reference intervals by traditional methods is rare due to difficulties in the selection of reference individuals, so indirect methods are often alternatively used. Parathyroid hormone (PTH) is a crucial hormone for the metabolism of calcium and phosphorus whose result can lead to erroneous diagnoses and medical actions if adequate reference intervals are not readily available. Our goal was to obtain reference values for adult population for PTH by using data mining. Based on possible new reference intervals, we also aimed to perform a retrospective evaluation of the individuals mistakenly classified. METHODS Retrospective observational study between 2014 and 2019. All requests from individuals aged ≥ 18 years were considered if PTH was requested together with serum creatinine, 25-hydroxyvitamin D, calcium, albumin and phosphate (within their respective reference intervals). PTH was measured on the Cobas e411 platform (Roche). Requests were grouped by age and sex. Differences among partitions were assessed by the Harris-Boyd's test and reference intervals were determined by the non-parametrical calculation of percentiles 2.5 and 97.5. RESULTS A total of 2279 laboratory requests were included. Reference intervals for PTH were seen to be sex-independent, but age-dependent reference intervals were needed: 18-39, 40-59 and >60 years. Based on the reference intervals obtained, up to 20.1% of individuals were misclassified. CONCLUSIONS Appropriateness of PTH reference intervals would lead to a reduction in the number of additional tests and avoid wrong medical actions, thus improving not only patient safety, but also the healthcare system as a whole.
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Affiliation(s)
- Jose Antonio Delgado
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain.
| | - Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain; Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Spain
| | - María I Pastor
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain
| | - Antònia Barceló
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain; Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Spain
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Two-dimensional, M-mode and left atrial velocity echocardiographic measurements in healthy Norwegian-Swedish Coldblooded Trotters. J Vet Cardiol 2020; 29:60-73. [PMID: 32505882 DOI: 10.1016/j.jvc.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The Norwegian-Swedish Coldblooded Trotter (NSCT) is an important breed in Norwegian and Swedish harness racing. In spite of this, little is known about its cardiac measurements and factors that may influence these. The aims of this study were to establish reference intervals (RI) for a series of conventional echocardiographic variables, primarily of the left heart, in NSCTs in race training and to evaluate any effects age, gender, estimated body weight (EBW), number of starts and racing performance may have on these. ANIMALS Sixty-three apparently healthy NSCTs in race training. METHODS Observational study, convenience sampling. All horses were examined unsedated in their normal stabling environment. Auscultatory and echocardiographic examinations were performed. Means, standard deviations, medians and confidence intervals of the RI limits were used to summarize the data. The relationship between selected echocardiographic variables and age, gender, EBW, racing performance and number of starts were explored using linear regression analyses. RESULTS Reference intervals were determined for routinely used echocardiographic variables. Data for left atrial velocity were also obtained. Increasing age, number of starts and money earned significantly increased all cardiac measurements. Males had significantly higher ventricular measurements than females. Great vessel measurements increased with increasing EBW. Horses with faster recorded racing times had generally significantly increased cardiac measurements. Clinically insignificant valvular regurgitation was a common finding, particularly at the tricuspid and pulmonary valves. CONCLUSIONS The RIs described and the factors that may affect these will assist clinicians in interpreting echocardiograms of NSCTs with suspected cardiac disease or poor performance.
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Applying PRO Reference Values to Communicate Clinically Relevant Information at the Point-of-care. Med Care 2020; 57 Suppl 5 Suppl 1:S24-S30. [PMID: 30985593 DOI: 10.1097/mlr.0000000000001113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The inclusion of reference values for common patient-reported outcomes (PROs) measures in clinical care settings provides a clinically relevant context for an individual patient's PRO scores. PRO reference values are currently not reported in clinical care settings. This is a missed opportunity, as clinicians are familiar with the presence and interpretation of reference values, commonly provided alongside laboratory test results. Incorporating PRO reference values into clinical PRO reporting requires: an understanding of the clinical purpose, the availability of an appropriate reference value, and graphical representation. METHODS FOR PRO SCORE INTERPRETATION We present reference value terminology adapted for PROs and discuss important differences between using reference values in the PRO score interpretation compared to other types of clinical measures from clinical chemistry. We outline the basic methodological approaches in obtaining a PRO reference sample and calculating reference intervals. Lastly, we provide recommendations on how to present and use PRO reference values in clinical care settings. DISCUSSION There is a strong, long-standing discipline behind reference value development and application in psychology and medicine, allowing for both providers and patients to understand comparisons and identify what is "out of range." PRO reference values can be communicated in a wide range of ways within clinical care settings and are adaptable as required to different patient populations or clinical care situations. However, a notable adoption barrier is the expense and methodological expertise needed to establish and apply PRO reference values effectively in clinical encounters.
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Waito AA, Plowman EK, Barbon CEA, Peladeau-Pigeon M, Tabor-Gray L, Magennis K, Robison R, Steele CM. A Cross-Sectional, Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:948-962. [PMID: 32310713 PMCID: PMC7242989 DOI: 10.1044/2020_jslhr-19-00051] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/17/2019] [Accepted: 12/11/2019] [Indexed: 05/04/2023]
Abstract
Purpose To date, research characterizing swallowing changes in individuals with amyotrophic lateral sclerosis (ALS) has primarily relied on subjective descriptions. Thus, the degree to which swallowing physiology is altered in ALS, and relationships between such alterations and swallow safety and/or efficiency are not well characterized. This study provides a quantitative representation of swallow physiology, safety, and efficiency in a sample of individuals with ALS, to estimate the degree of difference in comparison to published healthy reference data and identify parameters that pose risk to swallow safety and efficiency. Secondary analyses explored the therapeutic effect of thickened liquids on swallowing safety and efficiency. Method Nineteen adults with a diagnosis of probable-definite ALS (El-Escorial Criteria-Revised) underwent a videofluoroscopic swallowing study, involving up to 15 sips of barium liquid (20% w/v), ranging in thickness from thin to extremely thick. Blinded frame-by-frame videofluoroscopy analysis yielded the following measures: Penetration-Aspiration Scale, number of swallows per bolus, amount of pharyngeal residue, degree of laryngeal vestibule closure (LVC), time-to-LVC, duration of LVC (LVCdur), pharyngeal area at maximum constriction, diameter of upper esophageal sphincter opening, and duration of UES opening (UESOdur). Measures of swallow physiology obtained from thin liquid trials were compared against published healthy reference data using unpaired t tests, chi-squared tests, and Cohen's d effect sizes (adjusted p < .008). Preliminary relationships between parameters of swallowing physiology, safety, and efficiency were explored using nonparametric Cochrane's Q, Friedman's test, and generalized estimating equations (p < .05). Results Compared to healthy reference data, this sample of individuals with ALS displayed a higher proportion of swallows with partial or incomplete LVC (24% vs. < 1%), increased time-to-LVC (d = 1.09), reduced UESwidth (d = 0.59), enlarged pharyngeal area at maximum constriction, prolonged LVCdur (d = 0.64), and prolonged UESOdur (d = 1.34). Unsafe swallowing (i.e., PAS ≥ 3) occurred more frequently when LVC was partial/incomplete or time-to-LVC was prolonged. Pharyngeal residue was associated with larger pharyngeal areas at maximum constriction. Unsafe swallowing occurred less frequently with extremely thick liquids, compared to thin liquids. No significant differences in pharyngeal residue were observed based on liquid thickness. Conclusions Quantitative videofluoroscopic measurements revealed moderate-to-large differences in swallow physiology between this sample of individuals with ALS and healthy reference data. Increased time-to-LVC, noncomplete LVC, and enlarged pharyngeal area at maximum constriction were associated with impaired swallow safety or efficiency. Thickened liquids may mitigate the risk of acute episodes of aspiration in individuals with ALS. Further work is needed to corroborate these preliminary findings and explore how swallowing profiles evolve throughout disease progression.
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Affiliation(s)
- Ashley A. Waito
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | | | - Carly E. A. Barbon
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | - Lauren Tabor-Gray
- Department of Neurology, Holy Cross Hospital, Phil Smith Neuroscience Institute, Fort Lauderdale, FL
| | - Kelby Magennis
- Swallowing Systems Core, University of Florida, Gainesville
| | - Raele Robison
- Swallowing Systems Core, University of Florida, Gainesville
| | - Catriona M. Steele
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
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Krintus M, Braga F, Kozinski M, Borille S, Kubica J, Sypniewska G, Panteghini M. A study of biological and lifestyle factors, including within-subject variation, affecting concentrations of growth differentiation factor 15 in serum. Clin Chem Lab Med 2020; 57:1035-1043. [PMID: 30471215 DOI: 10.1515/cclm-2018-0908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/18/2018] [Indexed: 12/23/2022]
Abstract
Background Growth differentiation factor 15 (GDF-15) is an emerging cardiovascular biomarker, and a fully automated immunoassay has recently become available. The objectives of the study were to identify biological and lifestyle factors affecting serum GDF-15 concentrations and derive robust reference intervals, and to estimate GDF-15 within-subject biological variation and derived indices. Methods A presumably healthy population of 533 questionnaire-screened adults was used to identify the biological and lifestyle determinants of serum GDF-15. Following stringent exclusion criteria, a final group of 173 individuals was selected to establish GDF-15 reference interval. Twenty-six healthy volunteers were enrolled in the biological variation substudy. Results Using a multiple regression model, age, B-type natriuretic peptide and C-reactive protein as well as smoking status were significantly related to serum GDF-15 concentrations. The upper reference limit (URL) for serum GDF-15 concentrations (90% confidence interval [CI]) was 866 ng/L (733-999 ng/L), with no sex-related difference. Although GDF-15 tended to increase with age, the weak dependence of marker from age does not justify age-related URL. The within-subject CV was 6.3% (95% CI, 4.5%-8.5%), with no sex difference in intraindividual variances. The reference change value (RCV) for GDF-15 was 23%, and two are the specimens required to ensure that the mean GDF-15 result is within ±10% of the individual's homeostatic set point. Conclusions By identifying the main factors influencing serum GDF-15 concentrations, we robustly established the URL to be applied in adult population. As intraindividual variation of GDF-15 is relatively low, monitoring longitudinal changes in its concentrations over time using RCV can be a good alternative for interpreting GDF-15 in clinical setting.
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Affiliation(s)
- Magdalena Krintus
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland, Phone: +48 52 585 40 23, Fax: +48 52 585 40 24
| | - Federica Braga
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.,Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Marek Kozinski
- Department of Principles of Clinical Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Simona Borille
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Grazyna Sypniewska
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.,Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
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Lima VP, Velloso M, Pessoa BP, Almeida FD, Ribeiro-Samora GA, Janaudis-Ferreira T. Reference values for the Unsupported Upper Limb Exercise test in healthy adults in Brazil. ACTA ACUST UNITED AC 2020; 46:e20180267. [PMID: 32130343 PMCID: PMC7462672 DOI: 10.1590/1806-3713/e20180267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/01/2019] [Indexed: 01/08/2023]
Abstract
Objective: To establish reference values for the Unsupported Upper Limb EXercise (UULEX) test, which measures peak arm exercise capacity, in healthy adults in Brazil. Methods: This was a cross-sectional study, involving presumably healthy individuals ≥ 30 years of age who completed questionnaires and underwent spirometry. All of the individuals underwent two UULEX tests 30-min apart. The outcome measure was the maximum time (in min) to completion of the test. Results: We included 100 individuals between 30 and 80 years of age. The mean test completion time was 11.99 ± 1.90 min among the women and 12.89 ± 2.15 min among the men (p = 0.03). The test completion time showed statistically significant correlations with age (r = −0.48; p < 0.001), gender (r = 0.28; p = 0.004), body mass index (BMI, r = −0.20; p = 0.05), and height (r = 0.28; p = 0.005). Linear regression analysis showed that the predictors of UULEX completion time were age (p = 0.000), BMI (p = 0.003), and gender (p = 0.019), which collectively explained 30% of the total variability. The mean UULEX completion time was 6% lower for the women than for the men. Conclusions: The present study was able to establish reference values for the UULEX test in healthy adults in Brazil. The values were influenced by age, gender, and BMI.
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Affiliation(s)
- Vanessa Pereira Lima
- . Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM - Diamantina (MG) Brasil.,. Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM - Diamantina (MG) Brasil
| | - Marcelo Velloso
- . Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil.,. Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Bruno Porto Pessoa
- . Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil.,. Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Fabiana Damasceno Almeida
- . Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil.,. Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Giane Amorim Ribeiro-Samora
- . Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil.,. Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Tania Janaudis-Ferreira
- . School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,. Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Center, Montreal, QC, Canada
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Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM. Atherosclerosis 2020; 294:46-61. [DOI: 10.1016/j.atherosclerosis.2019.12.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022]
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