Volume 47, Issue 5

The present study was to evaluate the diagnostic accuracy of different types of PCR tests with the aim of determining which one performs best for detecting Helicobacter pylori in stool samples. Related articles were searched from PubMed, Embase, Web of Science databases, Scopus, and Scholar Google. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS - 2) tool and RevMan5.4 software. Pooled sensitivity, specificity, DOR, PLR and NLR for the stool PCR test in detecting H. pylori infection were performed by Stata 15.0 software. Subgroup meta-analysis was performed by Open Meta-analyst software. Ten studies were selected in this study. Stool PCR test had 92.0 % (83.0, 96.0 %) pooled sensitivity, 96.0 % (84.0, 99.0 %) pooled specificity, 296.0 (51.6, 1,696.9) pooled DOR, 26.1 (5.3, 128.7) pooled PLR and 0.09 (0.04, 0.18) NLR in the diagnosis of H. pylori infection, and summary receiver operating characteristic curve (SROC) illustrated an area under the curve (AUC) of 0.98. Subgroup meta-analysis showed rtPCR as having the highest diagnostic accuracy. Our results identify rtPCR as having the highest diagnostic accuracy for the detection of H. pylori in stool samples, and the stool PCR test as a reliable diagnostic tool for H. pylori infection.

Objectives Fourth dose of SARS-CoV-2 vaccination was started from the end of May, 2022 in Japan. However, data on the precise analysis of the side effects after fourth vaccination, remain scarce. Here, we examined the side effects and the levels of SARS-CoV-2 antibody titers in healthy volunteers who underwent BNT162b2 vaccination for the fourth time. Methods Thirty-eight volunteers were assessed for the side effects of the vaccination for the fourth dose, and samples were used for the measurement of SARS-CoV-2 IgG and IgM antibody with chemiluminescent assays. Results We found that the level of IgG at day 504 (average, 117.9 AU/mL [SD 76.9]), was significantly higher than at day 264 (average, 17.3 AU/mL [SD 13.1]), which are 8 months after the third and second vaccination, respectively. The level of IgG was potently increased after fourth vaccination (average, 711.8 AU/mL [SD 361.9]), whereas IgM remained baseline level. Commonly reported side effects in the participants after the fourth dose were similar to those until third dose, such as sore arm/pain (81.0 %), generalized weakness/fatigue (57.1 %) and fever (54.8 %). The number of side effects were significantly decreased with age, and participant with sore arm/pain had higher IgG titer (p=0.0007), whereas participant with lymphadenopathy had lower IgG (p=0.0371). Conclusions The level of IgG was significantly higher in 8 months after the third, compared to the second, vaccination, and it was potently increased after fourth vaccination. The number of side effects were inversely correlated with age. Sore arm/pain and lymphadenopathy may affect IgG titer.

Objectives The purpose of this study was to analyze the role of C-reactive protein/albumin ratio (CRP/ALB) in the diagnosis of complicated appendicitis in adults. Methods A retrospective analysis of 202 patients with acute appendicitis admitted to the Emergency Department of Weifang People’s Hospital between January 2021 and December 2022 was conducted. Patients were classified into complicated appendicitis group (CA) and non-complicated appendicitis group (NCA) based on postoperative pathological diagnosis, and the two groups were compared in terms of preoperative age, gender, white blood cell count (WBCC), C-reactive protein/albumin ratio (CRP/ALB), serum sodium (Na), and fibrinogen (FIB). Results The 202 cases of acute appendicitis in this study, 36.6 % (n=74) were CA. Multivariate logistic regression analysis showed that CPR/ALB (p≤0.001), FIB (p<0.001), and Na (p=0.011) were risk factors for complicated appendicitis. The results of receiver operating characteristic (ROC) analysis, conducted to evaluate the role of CRP/ALB, Na, and FIB in detecting CA, showed that the area under the curve (AUC) of CRP/ALB was 0.871, which was higher than that of FIB and Na. CRP/ALB ratio ≥1.04 was an important indicator for predicting complicated appendicitis, with a sensitivity of 78.2 % and specificity of 84.7 %. Conclusions CRP/ALB ratio can serve as a good indicator for predicting complicated appendicitis.

Objectives Phlebotomy is presumably the most challenging preanalytical aspect in laboratory medicine. In Europe, inpatient phlebotomy is performed by nurses in 45–60 % of cases. We aimed to develop and test a novel phlebotomy assessment tool for nurses. Methods A group of 24 nurses working in a surgical ward was investigated. A three-pronged approach was devised: (1) a standardized knowledge test, (2) three blinded phlebotomy audits, and (3) prospective monitoring of samples sent from the investigated surgical ward for the calculation of preanalytical quality indicators. Results The average knowledge test score was 22.7/31 points (12–31, interquartile range 20.5–25). The average audit score was 14.5/18 points (13.7–14.7, interquartile range 14–15). No statistically significant correlations were found between phlebotomy knowledge (or lack of) and corresponding phlebotomy practices (or errors, respectively). Moreover, there was no statistically significant correlation between individual knowledge scores and audit scores. Several misconceptions about the preanalytical phase were identified, along with common phlebotomy errors. Conclusions Sometimes, nurses do not follow guidelines due to lack of theoretical knowledge. Other times, nurses fail to follow procedures despite having the prerequisite theoretical knowledge. We observed a discordance between theory and practice regarding certain aspects of phlebotomy. The novel multimodal methodology presented here describes an improved assessment tool and a superior alternative to the popular survey studies. This tool may be used to identify specific and recurrent phlebotomy issues and to improve institutional continuing education programs for nurses through targeted training programs.

Objectives BNP is the unique cardiac marker that reflects not as much as the degree of heart muscle damage, but mostly the severity of hemodynamic disorder, which is important in congenital heart disease. The only disadvantage of this marker is the barely studied reference values for children. It is known that the younger the child is, the higher the BNP value will be. By shifting from interpreting the absolute values towards the application of zlog-transformed data in clinical practice, we can overcome the above problems. Methods We performed an age-adjusted zlog transformation of BNP concentration. The age dependence was accounted for by a piecewise linear interpolation of the logarithms of BNP concentration among healthy children in different age groups from the logarithms of age. Results The concentration of BNP was measured in 351 patients (under 1 year old) with various heart diseases. The median age at the time of testing was 52 days [10; 166]; the median weight was 4.1 kg [3.2; 6.2]. The conditions we investigated included almost all known congenital heart diseases, as well as primary cardiac tumors. After the zlog transformation, we eliminated age-dependence, which was proved by comparing BNP concentrations in two groups of patients with univentricular and biventricular hemodynamics. Conclusions BNP in patients with congenital heart disease reflects the severity of hemodynamic disorders, and zlog BNP is an objective, age-independent and clear mechanism that can be used to interpret this cardiac marker.

Objectives To develop a novel diagnostic model combining bilirubin, protein induced by vitamin K absence or antagonist-II (PIVKA-II), and alpha-fetoprotein (AFP) to improve hepatocellular carcinoma (HCC) diagnosis. Methods The serum levels of PIVKA-Ⅱ, AFP, and bilirubin in 718 HCC patients and 2,763 benign liver disease (BLD) patients were measured. A mathematical model was used as the combined diagnostic model (PIVKA-Ⅱ, AFP, and bilirubin: PAB combination) for improving HCC diagnosis. Receiver operating characteristic (ROC) curves were used to analyse the diagnostic value of the individual markers, the PIVKA-II and AFP (PA) combination, and the PAB combination for HCC diagnosis. Results With the increase in bilirubin, the positive predictive value (PPV) of bilirubin in HCC diagnosis decreased (p<0.001) while the negative predictive value (NPV) increased (p<0.001). The areas under the ROC curves (AUCs) of the PAB combination were 0.935 and 0.862 for the diagnosis of HCC and HCC<3.0 cm, respectively, which were significantly higher than those of PIVKA-Ⅱ, AFP, and the PA combination (p<0.001). The AUC values for PIVKA-Ⅱ, AFP, and the PA combination were significantly decreased for the diagnosis of HCC and HCC<3.0 cm when serum levels of PIVKA-Ⅱ≥40 mAU/mL and/or AFP≥20 ng/mL were used for diagnosis, while the AUC value of the PAB combination increased. Conclusions Bilirubin is a superior biomarker for diagnosing HCC and distinguishing HCC from BLD. The combination of bilirubin with PIVKA-Ⅱ and AFP has superior diagnostic value for HCC and early-stage HCC.