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Grande G, Valletta M, Rizzuto D, Xia X, Qiu C, Orsini N, Dale M, Andersson S, Fredolini C, Winblad B, Laukka EJ, Fratiglioni L, Vetrano DL. Blood-based biomarkers of Alzheimer's disease and incident dementia in the community. Nat Med 2025:10.1038/s41591-025-03605-x. [PMID: 40140622 DOI: 10.1038/s41591-025-03605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 02/21/2025] [Indexed: 03/28/2025]
Abstract
Evidence regarding the clinical validity of blood biomarkers of Alzheimer's disease (AD) in the general population is limited. We estimated the hazard and predictive performance of six AD blood biomarkers for incident all-cause and AD dementia-the ratio of amyloid-β 42 to amyloid-β 40 and levels of tau phosphorylated at T217 (p-tau217), tau phosphorylated at T181 (p-tau181), total tau, neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP)-in a cohort of 2,148 dementia-free older adults from Sweden, who were followed for up to 16 years. In multi-adjusted Cox regression models, elevated baseline levels of p-tau181, p-tau217, NfL, and GFAP were associated with a significantly increased hazard for all-cause and AD dementia, displaying a non-linear dose-response relationship. Elevated concentrations of p-tau181, p-tau217, NfL, and GFAP demonstrated strong predictive performance (area under the curve ranging from 70.9% to 82.6%) for 10-year all-cause and AD dementia, with negative predictive values exceeding 90% but low positive predictive values (PPVs). Combining p-tau217 with NfL or GFAP further improved prediction, with PPVs reaching 43%. Our findings suggest that these biomarkers have the potential to rule out impending dementia in community settings, but they might need to be combined with other biological or clinical markers to be used as screening tools.
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Affiliation(s)
- Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
- Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Martina Valletta
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Xin Xia
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Matilda Dale
- Affinity Proteomics Stockholm, Science for Life Laboratory, Department of Protein Science, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Royal Institute of Technology (KTH), Solna, Sweden
| | - Sarah Andersson
- Affinity Proteomics Stockholm, Science for Life Laboratory, Department of Protein Science, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Royal Institute of Technology (KTH), Solna, Sweden
| | - Claudia Fredolini
- Affinity Proteomics Stockholm, Science for Life Laboratory, Department of Protein Science, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Royal Institute of Technology (KTH), Solna, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
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Tsze DS, Thiele C, Hirschfeld G, Dayan PS. Clinically significant differences in self-reported pain scores in children with headaches. Acad Emerg Med 2024; 31:547-554. [PMID: 38400616 DOI: 10.1111/acem.14879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/05/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Changes in pain scores that represent clinically significant differences in children with headaches are necessary for study design and interpretation of findings reported in studies. We aimed to determine changes in pain scores associated with a minimum clinically significant difference (MCSD), ideal clinically significant difference (ICSD), and patient-perceived adequate analgesia (PPAA) in this population. METHODS We performed a secondary analysis of two prospective studies of children with headaches presenting to an emergency department. Two serial assessments were performed in children aged 6-17 and 4-17 years who self-reported their pain intensity using the Verbal Numerical Rating Scale (VNRS) and Faces Pain Scale-Revised (FPS-R), respectively. Children qualitatively described any endorsed change in pain score; those who received an analgesic were asked if they wanted additional analgesics to decrease their pain intensity. We used receiver operating characteristic curve-based methodology to identify changes in pain scores associated with "a little less" (MCSD) and "much less" (ICSD) pain and patients declining additional analgesics because they experienced adequate analgesia after treatment (PPAA). RESULTS We analyzed 105 children: 63.8% were female and the median (IQR) age was 13 (10-15) years. Ninety-eight children were analyzed for the VNRS and 101 were analyzed for the FPS-R. For the VNRS, raw change and percent reductions in pain scores associated with MCSD, ICSD, and PPAA were 2/10 and 25%, 4/10 and 56%, and 3/10 and 50%, respectively, and for the FPS-R, 2/10 and 25%, 4/10 and 67%, and 4/10 and 60%, respectively. The area under the curve (AUC) associated with a MCSD for both scales ranged from 94% to 98%; the AUC associated with an ICSD or PPAA for both scales ranged from 76% to 83%. CONCLUSIONS We identified changes in pain score associated with patient-centered outcomes in children with headaches suitable for designing trials and assigning clinical significance to changes in pain scores reported in studies.
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Affiliation(s)
- Daniel S Tsze
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Christian Thiele
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Peter S Dayan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Lourenço FR, Oliveira ECD. Nonparametric estimation of measurement uncertainty arising from sampling. Anal Chim Acta 2024; 1305:342597. [PMID: 38677839 DOI: 10.1016/j.aca.2024.342597] [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: 02/19/2024] [Revised: 03/20/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Increasingly, measurement uncertainty has been used by pure and applied analytical chemistry to ensure decision-making in commercial transactions and technical-scientific applications. Until recently, it was considered that measurement uncertainty boiled down to analytical uncertainty; however, over the last two decades, uncertainty arising from sampling has also been considered. However, the second version of the EURACHEM guide, published in 2019, assumes that the frequency distribution is approximately normal or can be normalized through logarithmic transformations, without treating data that deviate from the normality. RESULTS Here, six examples (four from Eurachem guide) were treated by classical ANOVA and submitted to an innovative nonparametric approach for estimating the uncertainty contribution arising from sampling. Based on bootstrapping method, confidence intervals were used to guarantee metrological compatibility between the uncertainty ratios arising from the results of the traditional parametric tests and the unprecedented proposed nonparametric methodology. SIGNIFICANCE AND NOVELTY The present study proposed an innovative methodology for covering this gap in the literature based on nonparametric statistics (NONPANOVA) using the median absolute deviation concepts. Supplementary material based on Excel spreadsheets was developed, assisting users in the statistical treatment of their real examples.
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Affiliation(s)
- Felipe Rebello Lourenço
- Programa de Pós-Graduação em Fármaco e Medicamentos, Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, Brazil
| | - Elcio Cruz de Oliveira
- Postgraduate Programme in Metrology, Pontifical Catholic University of Rio de Janeiro, Marquês de São Vicente Street, 225, Gávea, Rio de Janeiro, RJ, Brazil; Logistics, Land Transportation and Storage, Measurement and Product Inventory Management PETROBRAS S.A., Av. Henrique Valadares 28, 20231-030, Rio de Janeiro, Brazil.
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Wang S, Qiu Y, Zhu F. An updated review of functional ingredients of Manuka honey and their value-added innovations. Food Chem 2024; 440:138060. [PMID: 38211407 DOI: 10.1016/j.foodchem.2023.138060] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024]
Abstract
Manuka honey (MH) is a highly prized natural product from the nectar of Leptospermum scoparium flowers. Increased competition on the global market drives MH product innovations. This review updates comparative and non-comparative studies to highlight nutritional, therapeutic, bioengineering, and cosmetic values of MH. MH is a good source of phenolics and unique chemical compounds, such as methylglyoxal, dihydroxyacetone, leptosperin glyoxal, methylsyringate and leptosin. Based on the evidence from in vitro, in vivo and clinical studies, multifunctional bioactive compounds of MH have exhibited anti-oxidative, anti-inflammatory, immunomodulatory, anti-microbial, and anti-cancer activities. There are controversial topics related to MH, such as MH grading, safety/efficacy, implied benefits, and maximum levels of contaminants concerned. Artificial intelligence can optimize MH studies related to chemical analysis, toxicity prediction, multi-functional mechanism exploration and product innovation.
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Affiliation(s)
- Sunan Wang
- Canadian Food and Wine Institute, Niagara College, 135 Taylor Road, Niagara-on-the-Lake, Ontario L0S 1J0, Canada; School of Chemical Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Yi Qiu
- Division of Engineering Science, Faculty of Applied Science and Engineering, University of Toronto, 35 St. George Street, Toronto, Ontario M5S 1A4, Canada
| | - Fan Zhu
- School of Chemical Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
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