Central role of laboratory medicine in public health and patient care

Clinical laboratories play a vital role in the healthcare system. Objective medical data provided by clinical laboratories supports approximately 60-70% of clinical decisions, however, evidence supporting this claim is poorly documented and laboratories still lack visibility, despite their indisputable impact on patient care and public health. The International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on Outcome Studies in Laboratory Medicine (TF-OSLM) was recently developed to support directed research evaluating the role of laboratory medicine on clinical outcomes. Establishing and documenting this evidence is key to enhance visibility of the field in the eye of the public and other healthcare professionals together with optimizing patient outcomes and health care system operations. In this review, we discuss four areas that exemplify the contribution of laboratory medicine directly to patient care. This includes high-sensitivity cardiac troponin (hs-cTn) and N-terminal pro-B-type natriuretic peptide/B-type natriuretic peptides (NT-proBNP/BNP) for the diagnosis and prognosis of myocardial infarction and heart failure, respectively, and procalcitonin for the management of sepsis and antibiotic stewardship. Emerging markers of traumatic brain injury and the role of laboratory medicine in the fight against the COVID-19 pandemic are discussed along with an introduction to plans of IFCC TF-OSLM.

Systematic literature review of evidence in amyloid light-chain amyloidosis

Introduction: Treatment of amyloid light-chain (AL) amyloidosis, a rare disease with a <5-year lifespan, remains challenging. This systematic literature review (SLR) aimed to evaluate the current evidence base in AL amyloidosis. Methods: Literature searches on clinical, health-related quality of life, economic and resource use evidence were conducted using the Embase, MEDLINE and Cochrane databases as well as gray literature. Results: This SLR yielded 84 unique studies from: five randomized controlled trials; 54 observational studies; 12 health-related quality of life studies, none with utility values; no economic evaluation studies; and 16 resource use studies, none with indirect costs. Conclusion: This SLR highlights a paucity of published literature relating to randomized controlled trials, utility values, economic evaluations and indirect costs in AL amyloidosis.

A geometric snake model for segmentation of medical imagery

In this note, we employ the new geometric active contour models formulated in [25] and [26] for edge detection and segmentation of magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound medical imagery. Our method is based on defining feature-based metrics on a given image which in turn leads to a novel snake paradigm in which the feature of interest may be considered to lie at the bottom of a potential well. Thus, the snake is attracted very quickly and efficiently to the desired feature.

The value of the ejection fraction as a predictor of postoperative cardiac mortality in patients undergoing peripheral vascular surgery

Retrospective evaluation was undertaken in 131 patients who underwent peripheral vascular operations before which a multigated scan had been obtained. The patients were assigned to one of three groups according to their pre-operatively determined ejection fraction; 82 patients had an ejection fraction greater than 55%, in 38 patients the ejection fraction was between 36% and 54% and in 11 patients it was 35% or less. Two cardiac deaths occurred in each of the three groups. Although mortality in the three groups just failed to achieve statistical significance, metanalysis of published reports indicates that significant mortality exists for patients with an ejection fraction of less than 35% compared with those with an ejection fraction of over 55%. In this series, if the ejection fraction was used as the sole indicator, it was not an accurate predictor of peri-operative cardiac mortality. However, when used in conjunction with patient factors, such as cardiac history and status of the resting ECG, it did define a group of patients in whom there was a significant clinical risk of peri-operative cardiac mortality.