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The COVID-19 pandemic has placed healthcare resources around the world under immense pressure. South Africa, given the condition of its healthcare system, is particularly vulnerable. There has been much discussion around rational healthcare utilisation, ranging from diagnostic testing and personal protective equipment to triage and appropriate use of ventilation strategies. There has, however, been little guidance around use of laboratory tests once COVID-19 positive patients have been admitted to hospital. We present a working guide to rational laboratory test use, specifically for COVID-19, among hospitalised patients, including the critically ill. The specific tests, the reasons for testing, their clinical usefulness, timing and frequency are addressed. We also provide a discussion around evidence for the use of these tests from a clinical perspective.

The clinical course of COVID-19 is variable, with clinical manifestation ranging from 81% mild course to 14% severe course along with 5% critical course in patients. The asymptomatic course is reported to potentially range between 20-70% (avg. 33%). A more severe course is seen in the elderly, those with various chronic diseases, and the immunosuppressed, where the case fatality rate is higher in these risk groups. The disease progresses with various symptoms, such as fever, cough, shortness of breath, malaise, myalgia, taste and smell disorders, diarrhea, sore throat, headache and conjunctivitis. The disease begins with shortness of breath, indicative of lung damage, after an average of 7 to 10 days, and progresses in ARDS, sepsis, and septic shock. Some patients quickly enter shortness of breath, while others gradually develop shortness of breath and chest tightness and burning. The risk factors for a poor prognosis are age, comorbidities, and changes in laboratory tests. Secondary bacterial and fungal infections frequently develop in connection with steroids and immunosuppressants, especially in patients followed in the intensive care unit. Frequent complications in hospitalized patients include pneumonia (75%), ARDS (15%), acute renal failure (9%), and acute liver injury (19%). An increased incidence of heart damage is observed, including acute heart failure, arrhythmias, and myocarditis. 10-25% of the patients hospitalized due to COVID-19 present with prothrombotic coagulopathy, resulting in venous and arterial thromboembolic events. The most common extra-pulmonary symptom is neuropsychiatric involvement, frequently accompanied by insomnia, an impediment to remembering, and an altered state of consciousness. During the course of COVID-19, patients undergo some pathological changes (severe lymphopenia, high levels of CRP, D-dimer, ferritin, etc.) depending on the condition and exposure level of the affected systems as shown by various laboratory tests, and the relevant tests are the guiding elements of risk assessment, clinical monitoring, disease severity, and prognosis setting and therapy decision-making processes.

Objectives The present study aimed to develop a clinical decision support tool to assist coronavirus disease 2019 (COVID-19) diagnoses with machine learning (ML) models using routine laboratory test results. Methods We developed ML models using laboratory data (n = 1,391) composed of six clinical chemistry (CC) results, 14 CBC parameter results, and results of a severe acute respiratory syndrome coronavirus 2 real-time reverse transcription–polymerase chain reaction as a gold standard method. Four ML algorithms, including random forest (RF), gradient boosting (XGBoost), support vector machine (SVM), and logistic regression, were used to build eight ML models using CBC and a combination of CC and CBC parameters. Performance evaluation was conducted on the test data set and external validation data set from Brazil. Results The accuracy values of all models ranged from 74% to 91%. The RF model trained from CC and CBC analytes showed the best performance on the present study’s data set (accuracy, 85.3%; sensitivity, 79.6%; specificity, 91.2%). The RF model trained from only CBC parameters detected COVID-19 cases with 82.8% accuracy. The best performance on the external validation data set belonged to the SVM model trained from CC and CBC parameters (accuracy, 91.18%; sensitivity, 100%; specificity, 84.21%). Conclusions ML models presented in this study can be used as clinical decision support tools to contribute to physicians’ clinical judgment for COVID-19 diagnoses.

Qin Wang,* Chenggui Liu,* Jian Xu, Peipei Song, Shuzhe Yang, Qin Zhang Department of Clinical Laboratory, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qin WangDepartment of Clinical Laboratory, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, People’s Republic of ChinaTel +86 28 61866000-6267Email 314306221@qq.comObjective: In order to fight against coronavirus disease 2019 (COVID-19) better and to share our experience as a reference for clinical laboratory departments.Methods: This was a retrospective study conducted in the clinical laboratory department of Chengdu Women’s and Children’s Central Hospital in Chengdu, China, from April 2020 to January 2021. The number of nucleic acid and antibody testing specimens of suspected COVID-19 cases was analyzed. The key points of suspected-case sample processing and detection in the clinical laboratory department were summarized. The laboratory was directly involved in the sample processing and testing of suspected cases, the release of reports, and the transfer of specimens to the fever clinic.Results: The number of COVID-19 nucleic acid test specimens in our laboratory ranged from 102 to 2170 per day, and the number of antibody test specimens ranged from 24 to 391 per day. There were four main considerations in the treatment and detection of suspected-case specimens in the clinical laboratory: biosafety management in clinical laboratory departments, measures to ensure the health of the staff, the eight time points for processing suspected-case samples (turn-around time), and key points for the detection of suspected case specimens.Conclusion: The laboratory developed a protective process for COVID-19 antibody and nucleic acid detection during the pandemic. At present, the detection of COVID-19 antibodies and nucleic acids in the clinical laboratory department is orderly, and there have been no cases of laboratory infection.Keywords: COVID-19, clinical laboratory, laboratory tests

The key metrological issue of substance and energy balance in research engines is the precise determination of the ele-mental composition of the applied fuel and its net calorific value. This makes it possible to calculate the amount of heat brought with the fuel into the combustion chamber, as well as the amount and gas composition of the exhaust. However, to fully assess the energy quality of the fuel used, its ignition properties should also be estimated. They determine the combustion kinetics and, consequently, the course of gas pressure alterations and heat release in the cylinder, which have a direct impact on the indicated power and thermal efficiency of the engine. This article presents the methodology for carrying out this type of laboratory tests and their representative results con-cerning six different low-sulfur marine fuels used to feed marine engines at present. The considerations focus mainly on measurement technology, as well as the measuring apparatus applied today. Additionally some existing metrological difficulties that might be met were shortly described. The laboratory tests in question stand for the first stage of the program of testing a new kind of low-sulfur marine fuels in real operating conditions of a diesel engine, which was carried out at the Department of Ship Power Plants of the Gdańsk University of Technology.

In the case of underground network infrastructure it can be seen that objects functioning in the second technical condition, according to DWA-ATV 143-2, and subjected to rehabilitation with the use of close-fit trenchless technologies are capable of withstanding external loads. The main external load that is taken into account in engineering calculations in the case of conduits in the second technical condition is external groundwater pressure. In order to compare design parameters obtained with the use of various calculation methods, a comparative analysis was conducted in order to determine the values of critical pressure. The calculations were carried out using popular engineering algorithms. In addition, analyses using the Finite Element Method and Abaqus software as a computational tool were carried out for the purpose of verifying laboratory tests. This paper aims to broaden knowledge concerning the possibility of performing control numerical analyses for close-fit liners installed in pipelines that are in the second technical condition according to DWA-ATV 143-2. The analyses were carried out on ten 3D models. The models were parameterized in order to reflect the CIPP samples in the most accurate way. The computational models were built based on assumptions, which are commonly used in this type of scientific analysis, regarding material parameters and their interactions. The direct value of the performed engineering calculations and numerical analyses is the extension of knowledge in the field of strength parameters that are obtained by various material groups of close-fit liners. Comparative analysis of the results of laboratory tests and numerical analyses, and the conclusions that result from them, constitute the basis for the optimization of the design process and the individual approach to issues related to the use of liners that strengthen underground pipelines.

The alterations in the hemostatic balance in COVID‐19 patients are strongly disturbed and contribute to a high prothrombotic status. The high rate of venous thromboembolism in COVID‐19 patients goes along with derangements in coagulation laboratory parameters. Hemostasis testing has an important role in diagnosed COVID‐19 patients. Elevated D‐dimer levels were found to be a crucial laboratory marker in the risk assessment of thrombosis in COVID‐19 patients. The diagnostic approach also includes prothrombin time and platelet count. Fibrinogen might give an indication for worsening coagulopathy. Other markers (activated partial thromboplastin time (aPTT), fibrinolysis parameters, coagulation factors, natural anticoagulants, antiphospholipid antibodies and parameters obtained by thromboelastography or thrombin generation assays) have been described as being deranged. These may help to understand the pathophysiology of thrombosis in COVID‐19 patients but have currently no place in diagnosis or management in COVID‐19 patients. For monitoring the heparin anticoagulant therapy, the anti‐Xa assay is suggested, because the severe acute‐phase reaction (high fibrinogen and high factor VIII) shortens the aPTT.

Laboratory tests are important tools in primary care, but their use is sometimes inappropriate. The aim of this review is to give an overview of interventions applied in primary care to optimize the use of laboratory tests. A search for studies was made in the MEDLINE and EMBASE databases. We also extracted studies from two previous reviews published in 2015. Studies were included if they described application of an intervention aiming to optimize the use of laboratory tests. We also evaluated the overall risk of bias of the studies. We included 24 studies. The interventions were categorized as: education, feedback reports and computerized physician order entry (CPOE) strategies. Most of the studies were classified as medium or high risk of bias while only three studies were evaluated as low risk of bias. The majority of the studies aimed at reducing the number of tests, while four studies investigated interventions aiming to increase the use of specific tests. Despite the studies being heterogeneous, we made results comparable by transforming the results into weighted relative changes in number of tests when necessary. Education changed the number of tests consistently, and these results were supported by the low risk of bias of the papers. Feedback reports have mainly been applied in combination with education, while when used alone the effect was minimal. The use of CPOE strategies seem to produce a marked change in the number of test requests, however the studies were of medium or high risk of bias.

Objective Hepatocellular carcinoma (HCC) development among hepatitis B surface antigen (HBsAg) carriers shows gender disparity, influenced by underlying liver diseases that display variations in laboratory tests. We aimed to construct a risk-stratified HCC prediction model for HBsAg-positive male adults. Methods HBsAg-positive males of 35-69 years old (N=6,153) were included from a multi-center population-based liver cancer screening study. Randomly, three centers were set as training, the other three centers as validation. Within 2 years since initiation, we administrated at least two rounds of HCC screening using B-ultrasonography and α-fetoprotein (AFP). We used logistic regression models to determine potential risk factors, built and examined the operating characteristics of a point-based algorithm for HCC risk prediction. Results With 2 years of follow-up, 302 HCC cases were diagnosed. A male-ABCD algorithm was constructed including participant's age, blood levels of GGT (γ-glutamyl-transpeptidase), counts of platelets, white cells, concentration of DCP (des-γ-carboxy-prothrombin) and AFP, with scores ranging from 0 to 18.3. The area under receiver operating characteristic was 0.91 (0.90-0.93), larger than existing models. At 1.5 points of risk score, 26.10% of the participants in training cohort and 14.94% in validation cohort were recognized at low risk, with sensitivity of identifying HCC remained 100%. At 2.5 points, 46.51% of the participants in training cohort and 33.68% in validation cohort were recognized at low risk with 99.06% and 97.78% of sensitivity, respectively. At 4.5 points, only 20.86% of participants in training cohort and 23.73% in validation cohort were recognized at high risk, with positive prediction value of 22.85% and 12.35%, respectively. Conclusions Male-ABCD algorithm identified individual's risk for HCC occurrence within short term for their HCC precision surveillance.

In December 2019, a novel coronavirus (Covid-19) associated with human to human transmission and severe human infection has been recently reported from the city of Wuhan in China Hubei Province. The first Covid-19 in Turkey comparative findings of their patients can help spread the infection, early diagnosis, treatment and control. This study in Turkey Siirt State Hospital in Covid-19 diagnosed patients and 12 healthy normal consists of 12 patients. Data from electronic medical records were taken retrospectively and patient and control group data were compared statistically. Statistically decreased lymphocyte (1.23 ± 0.66), WBC (5.00 ± 1.50), neutrophil (3.32 ± 1.77), platelets (175.08 ± 44.18) in Covid-19 patients compared to the control group and increased D-Dimer (595.08 ± 185.87), ferritin (236.31 ± 50.36), CRP (12.43 ± 4.31), lactate (1.37 ± 0.39), CK (189.50 ± 63.66) levels, other clinical findings and CT images were found to be compatible with Covid-19. This study is the first comparative study on pandemic Covid-19 in Siirt/Turkey. These prognostic parameters are important for a specific clinical diagnosis, which may contribute to reflect the evolution of CT findings and the severe course of the disease and the worst clinical picture. [Med-Science 2020; 9(4.000): 1008-13]

Background Although frailty has been associated with atypical manifestations of infections, little is known about COVID-19 presentations in hospitalized frail patients. We aimed to investigate the association between age, frailty, and clinical characteristics of COVID-19 in hospitalized middle-aged and older adults. Method Longitudinal observational study comprising 711 patients aged ≥50 years consecutively admitted to a university hospital dedicated to COVID-19 severe cases, between March and May 2020. We reviewed electronic medical records to collect data on demographics, comorbidities, COVID-19 signs/symptoms, and laboratory findings on admission. We defined frailty using the Clinical Frailty Scale (CFS = 1–9; frail ≥5). We also documented in-hospital mortality. We used logistic regressions to explore associations between age, frailty, and COVID-19 signs/symptoms; and between typical symptoms (fever, cough, dyspnea) and mortality. Results Participants had a mean age of 66 ± 11 years, and 43% were female. Overall, 25% were frail, and 37% died. The most common COVID-19 presentations were dyspnea (79%), cough (74%), and fever (62%), but patients aged ≥65 years were less likely to have a co-occurrence of typical symptoms, both in the absence (OR = 0.56; 95% CI = 0.39–0.79) and in the presence of frailty (OR = 0.52; 95% CI = 0.34–0.81). In contrast, older age and frailty were associated with unspecific presentations, including functional decline, acute mental change, and hypotension. After adjusting for age, sex, and frailty, reporting fever was associated with lower odds of mortality (OR = 0.70; 95% CI = 0.50–0.97). Conclusions Atypical COVID-19 presentations are common in frail and older hospitalized patients. Providers should be aware of unspecific disease manifestations during the management and follow-up of this population.

Concrete properties, including its compressive strength, are in general highly nonlinear functions of its components. Concrete mix design methods are basically simulations that require costly and time consuming adjustments in laboratory. A useful support tool based on artificial neural networks, using a multilayer perceptron network, is proposed in this paper as a means to predict compressive strength of concrete mixes. The developed models are useful for reducing the quantity of laboratory tests required for concrete mix design adjustments.

Most of the research done in the literature are based on statistical approaches and used for deriving reference limits based on lab results. As more data are available to the researchers, ML methods are more effectively used by the clinicians and practitioners to reduce cost and provide more accurate diagnoses. This study aims to contribute to the medical laboratory processes by providing an automated method in order to predict the lab results accurately by machine learning from the previous test results. All patient data obtained have been anonymized, and a total of 449,471 test results have been used to build an integrated dataset. A total of 107,646 unique patients’ data has been used. This study aims to predict the value range of the Creatine Kinase tests, which are taken in separate tubes and usually needs more processing time than the other tests do. Using the lab results and the Random Forest Algorithm, this study reports that the outcome of the Creatine Kinase test can be determined with 97% accuracy by using the AST and ALT test values. This is an important achievement for the practitioners and the patients, as this study submits significant reduction in Creating Kinase test evaluation time.

"Published online: 13 Jun 2020", Cracks in rigid pavements are a frequent and critical problem, which needs to be assessed to avoid deterioration and provide comfort and security. Control of damage requires the evaluation of cracks width and depth. Several laboratory tests were used in order to determine the ability of Ground Penetrating Radar (GPR) in the evaluation of damage under different controlled conditions. Those tests were focused in the analysis of different crack dimensions, changing the material inside the fractures and the orientation of the antenna with respect the crack axis. Results showed that the crack width increases hyperbolae amplitude, being the thinnest crack detected with a 2.3 GHz antenna, 2 mm thick. GPR B-scans were compared to images from computational models. Additionally, a field survey provided images according to the lab tests., This research has been partially funded by the Spanish Ministry of Economy and Competitiveness (MINECO) of the Spanish Government and by the European Regional Development Fund (FEDER) of the European Union (UE) through projects referenced as CGL2011-23621 and CGL2015-65913-P (MINECO/FEDER, UE).

Highlights • The novel coronavirus pneumonia patients were frequently encountered in the sixth and seventh decades of life. • Significantly decreased white blood cells, alkaline phosphatase, and d-dimer were observed in novel coronavirus pneumonia patients compared with influenza patients. • the results of lactate dehydrogenase, erythrocyte sedimentation rate and fibrinogen were significantly increased in novel coronavirus pneumonia patients compared with those in influenza patients. • An optimal diagnostic model with moderate value was established based on the combination of eighteen biomarkers from routine laboratory tests to discriminate novel coronavirus pneumonia patients from influenza patients., Background The differential diagnosis between novel coronavirus pneumonia patients (NCPP) and influenza patients (IP) remains a challenge in clinical practice. Methods Between January 2018 and March 2020, 1027 NCPP and 1140 IP were recruited from Tongji hospital. Blood routine examination, biochemical indicators, and coagulation function analysis were performed in all participants simultaneously. Results There was no sex predominance in NCPP. The NCPP were frequently encountered in the sixth and seventh decades of life. The mean age of NCPP (56 ± 16 years) was higher than IP (47 ± 17 years), but without statistical difference. Although most results of routine laboratory tests between NCPP and IP had no significant difference, some laboratory tests showed an obvious change in NCPP. We observed that NCPP had significantly decreased white blood cells, alkaline phosphatase, and d-dimer, compared with IP. However, the results of lactate dehydrogenase, erythrocyte sedimentation rate and fibrinogen were significantly increased in NCPP compared with those in IP. The diagnostic model based on combination of eighteen routine laboratory indicators showed an area under the curve of 0.796 (95% CI, 0.777 to 0.814), with a sensitivity of 46.93% and a specificity of 90.09% when using a cutoff value of 0.598. Conclusions Some routine laboratory results had statistical difference between NCPP and IP. A diagnostic model based on combination of routine laboratory results provides an adjunct approach in the differential diagnosis between NCPP and IP.

Workovers in conditions of increased fracturing is often accompanied by complications even at the stage of well killing operations. During the well killing process, significant gas breakthroughs and fluid loss are observed at this field, which requires significant usage of blocking compositions and increases the well service costs. It is necessary to conduct laboratory studies in order to develop a blocking composition for reliable isolation of highly permeable intervals of formations, which does not adversely affect the reservoir properties of the reservoir and satisfy the safety requirements for work. In this work, the physical, chemical and rheological properties of the carcass and gel forming compositions are studied, which are crosslinked systems prepared on the basis of soluble silicates. Well killing technology involves their sequential injection into the well. The compositions under consideration showed the manufacturability of their use in a wide range of reservoir temperatures, which consists in the possibility of their injection into a typical well and selling into the bottomhole formation zone due to the low viscosity and slowed down crosslinking speed. The use of a destructor allows almost completely eliminating the negative impact of this technology on the filtration characteristics of the bottomhole formation zone after well killing process. The studies carried out in this work showed the effectiveness of the use of blocking polymer compositions, and also opened up new areas for further research, namely, the need for a cycle of laboratory and field tests of the compositions considered, which will allow us to choose and justify the optimal technological and economic parameters of the operation. The results can be applied to increase the well killing efficiency of oil and gas wells in conditions of increased fracturing during well service operations.

The need for monitoring the electrical network parameters is identified to use methods and means to improve power supply reliability and power quality. The article lists the exiting sensors for monitoring electrical parameters and substantiates the necessity of monitoring the parameters at both sides of switching devices. In the paper, there is basic information on the structure, operation and capabilities of the monitoring system for power supply reliability and power quality. A functional electrical circuit of the device for monitoring the number and duration of power outages and voltage deviations is proposed for monitoring the parameters at both sides of switching devices. An algorithm for the device operation has also been developed, which allows detecting the main emergency modes in the consumer's internal network. The article also describes laboratory tests of a prototype of the device for monitoring the number and duration of power outages and voltage deviations, which is based on the Arduino NANO V3 ATmega 328 microprocessor. Web of Science 8 137184 137174

As the coronavirus disease 2019 (COVID-19) pandemic continues to rise and second waves are reported in some countries, serological test kits and strips are being considered to scale up an adequate laboratory response. This study provides an update on the kinetics of humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and performance characteristics of serological protocols (lateral flow assay [LFA], chemiluminescence immunoassay [CLIA] and ELISA) used for evaluations of recent and past SARS-CoV-2 infection. A thorough and comprehensive review of suitable and eligible full-text articles was performed on PubMed, Scopus, Web of Science, Wordometer and medRxiv from 10 January to 16 July 2020. These articles were searched using the Medical Subject Headings terms ‘COVID-19’, ‘Serological assay’, ‘Laboratory Diagnosis’, ‘Performance characteristics’, ‘POCT’, ‘LFA’, ‘CLIA’, ‘ELISA’ and ‘SARS-CoV-2’. Data from original research articles on SARS-CoV-2 antibody detection ≥second day postinfection were included in this study. In total, there were 7938 published articles on humoral immune response and laboratory diagnosis of COVID-19. Of these, 74 were included in this study. The detection, peak and decline period of blood anti-SARS-CoV-2 IgM, IgG and total antibodies for point-of-care testing (POCT), ELISA and CLIA vary widely. The most promising of these assays for POCT detected anti-SARS-CoV-2 at day 3 postinfection and peaked on the 15th day; ELISA products detected anti-SARS-CoV-2 IgM and IgG at days 2 and 6 then peaked on the eighth day; and the most promising CLIA product detected anti-SARS-CoV-2 at day 1 and peaked on the 30th day. The most promising LFA, ELISA and CLIA that had the best performance characteristics were those targeting total SARS-CoV-2 antibodies followed by those targeting anti-SARS-CoV-2 IgG then IgM. Essentially, the CLIA-based SARS-CoV-2 tests had the best performance characteristics, followed by ELISA then POCT. Given the varied performance characteristics of all the serological assays, there is a need to continuously improve their detection thresholds, as well as to monitor and re-evaluate their performances to assure their significance and applicability for COVID-19 clinical and epidemiological purposes.

Baltic Sea Region represents one of the most innovative areas within Europe with dominating SME sector. In order to keep the region and their product developments competitive it is necessary to safeguard access to high-tech labs including test services. This can be realized only through regional networks of universities – business cooperation. The European Union started the project “Test-4-SME” in 2017 to investigate and promote laboratory networks for testing and assessment of electronic products developed by SMEs from BSR. In a BSR wide online survey, the project consortium identified existing gaps in the regional supply of open laboratories together with shortcomings in services, expertise or test equipment, which is needed by SMEs for electronic product or devices testing. The authors take place in the “Test-4-SME” project, conducted the survey and analysed the regional demand together with the availability of labs for SME sector in the BSR. The study focusses on the research question in which BSR regions there exist already university-business networks of open labs for SME and to which extent the offered services meet the regional demand. Therefore, an approach of a gap analysis is used, which is based on primary data gathered in a BSR wide survey together with expert interviews. The results of the study are discussed in the context of the existing literature and recommendations for future improvements are highlighted.

The article presents the information about the usage of artificial neural networks. The automation process of neural networks of the analysed evaluation data results is highlighted. The kinds of MG type artillery fuses are described and the kinds of cartridges’ calibres, in which they are used, are also specified. The way of preparation of databases of test results to computer simulation is described. Building of neural networks determining the main technical parameters and sizes of learning, test and validation sets is characterized. The summary for chosen active neural networks for individual kinds of the analysed MG type artillery fuses is presented. Graphs of learning, values of sensibility indicators and fragments of prediction sheets for the chosen neural networks were shown.

Aim: Dutch national guidelines on follow-up of paediatric celiac disease (CD) are available. The primary aim was to evaluate guideline adherence by paediatricians during follow-up. The secondary aim was to determine the clinical relevance and diagnostic yield of routine laboratory tests suggested by these guidelines. Methods: A retrospective, single-centre, cohort study was performed in paediatric CD patients who visited Tergooi Hospital, the Netherlands, between January 2017 and December 2019, with follow-up of at least twelve months after diagnosis. We analysed guideline adherence, number of outpatient visits and all laboratory data. Results: We included 91 CD children with a median follow-up of 4.0 years (range 1–16 years) and 162 follow-up visits. Strict adherence amongst paediatricians during follow-up was 8.0% (13/162 cases). A total of 1570 laboratory tests were performed of which 45.4% (713/1570) was in strict compliance with the Dutch national guidelines. Clinically relevant deviations were observed in 5.3% of requested laboratory tests. Conclusion: Strict guideless adherence amongst paediatricians in follow-up of paediatric CD was low and the clinical relevance of the suggested routine laboratory tests is limited. This underlines the increasing notion that evidence-based guidelines on follow-up of CD are warranted.

Ersin Sar&inodot;çam,1,2 Ali Do&gbreve;an Dursun,3,4 Gülçin Türkmen Sar&inodot;y&inodot;ld&inodot;z,5,6 Nalan Can,7 Engin Bozkurt,1 U&gbreve;ur Gönüllü,8 Nihal Basay,9 Meral Türkmen,10 Abdülaziz Denli,11 Mustafa Ünlü12 1Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey; 2Department of Cardiology, At&inodot;l&inodot;m University Medical School, Ankara, Turkey; 3Department of Physiology, At&inodot;l&inodot;m University Medical School, Ankara, Turkey; 4Check-up Center, Home Care Services, Medicana International Ankara Hospital, Ankara, Turkey; 5Department of General Surgery, Medicana International Ankara Hospital, Ankara, Turkey; 6Operating Room Services, Vocational School of Health Services, At&inodot;l&inodot;m University, Ankara, Turkey; 7Department of Nuclear Medicine, Medicana International Ankara Hospital, Ankara, Turkey; 8Department of Pulmonary Medicine, At&inodot;l&inodot;m University Medical School, Ankara, Turkey; 9Department of Pulmonary Medicine, Medicana International Ankara Hospital, Ankara, Turkey; 10Department of Internal Medicine, Medicana International Ankara Hospital, Ankara, Turkey; 11Department of Physical Medicine and Rehabilitation, Medicana International Ankara Hospital, Ankara, Turkey; 12Department of Nuclear Medicine, Gazi University Medical School, Ankara, TurkeyCorrespondence: Ersin Sar&inodot;çamDepartment of Cardiology, Medicana International Ankara Hospital, Sö&gbreve;ütözü Cd. 2165. Sokak No: 6, Sö&gbreve;ütözü, Ankara, 06520, TurkeyTel +90 5324066440Fax +90 3122203170Email saricamersin@yahoo.comBackground: In the post-acute COVID-19 syndrome, many patients suffer from palpitations, effort-associated fatigue, and even sudden death. The mechanism of heart involvement in this syndrome is uncertain. The main purpose of the study was to identify possible cardiac involvement causes in patients with post-acute COVID-19 by using biomarkers such as NT-proBNP and nitric oxide (NO) and cardiac imaging modalities.Methods: In this cross-sectional study, a total of 105 participants were included according to the existence of symptoms, and 40 of these participants were asymptomatic patients. The ages of the participants ranged from 20 to 50 years. All patients were healthy before COVID-19. The symptoms were defined as palpitations and/or fatigue association with exercise in post-acute COVID-19 term. The comparison of the two groups was made by using biochemical parameters (NT-proBNP, Troponin I, NO) and imaging techniques (echocardiography, cardiovascular magnetic resonance (CMR) and cardiac positron emission tomography (PET)).Results: The symptomatic patients had higher NT-proBNP levels compared with asymptomatic patients (132.30± 35.15; 76.86± 16.79, respectively; p < 0.001). Interestingly, the symptomatic patients had lower NO levels than asymptomatic patients (9.20± 3.08; 16.15± 6.02, respectively; p < 0.001). Echocardiography and CMR were normal. However, we found regional increased 18F-FDG uptake on cardiac PET to be compatible with myocardial fatigue.Conclusion: We found elevated NT-proNBP levels, low serum NO levels, and increased 18F-FDG uptake on cardiac PET in post-acute COVID syndrome. Cardiac PET could replace or be added to CMR for detecting subtle subacute/chronic myocarditis. The follow-up of patients with post-acute COVID-19 could target the possibility of risk of heart failure.Keywords: post-acute COVID-19, cardiac involvement, laboratory tests, imaging

Cardiac rehabilitation (CR) can improve clinical indicators in patients with cardiovascular diseases. The literature reports a 20% reduction in all-cause mortality and a 27% reduction in heart-disease mortality following CR. Although its clinical efficacy has been established, there is uncertainty whether center-based (CBCR) is more effective than home-based (HBCR) programs in acute and subacute phases. We aimed to verify significant differences in their effectiveness for the improvement of cardiopulmonary function by analyzing cardiopulmonary exercise (CPX) with laboratory tests following both CR programs. A single-center cohort study of 37 patients, recently diagnosed with underlying cardiovascular diseases, underwent CBCR(18) and HBCR(19). CBCR group performed a supervised exercise regimen at the CR center, for 1 hour, 2 to 3 days a week, for a total of 12 to18 weeks. HBCR group completed a self-monitored exercise program at home under the same guidelines as CBCR. Participants were evaluated by CPX with laboratory tests at 1- and 6-month, following the respective programs. There was no statistical significance in clinical characteristics and laboratory findings. Pre–post treatment comparison showed significant improvement in VO2/kg, minute ventilation/carbon dioxide production slope, breathing reserve, tidal volume (VT), heart rate recovery, oxygen consumption per heart rate, low-density lipoprotein (LDL), LDL/HDL ratio, total cholesterol, ejection fraction (EF) (P

Background Little is known about the diagnostic performance of rapid diagnostic tests (RDTs) for passive screening of human African trypanosomiasis (HAT) in Côte d’Ivoire. We determined HAT prevalence among clinical suspects, identified clinical symptoms and signs associated with HAT RDT positivity, and assessed the diagnostic tests’ specificity, positive predictive value and agreement. Methods Clinical suspects were screened with SD Bioline HAT, HAT Sero-K-Set and rHAT Sero-Strip. Seropositives were parasitologically examined, and their dried blood spots tested in trypanolysis, ELISA/Tbg, m18S-qPCR and LAMP. The HAT prevalence in the study population was calculated based on RDT positivity followed by parasitological confirmation. The association between clinical symptoms and signs and RDT positivity was determined using multivariable logistic regression. The tests’ Positive Predictive Value (PPV), specificity and agreement were determined. Results Over 29 months, 3433 clinical suspects were tested. The RDT positivity rate was 2.83%, HAT prevalence 0.06%. Individuals with sleep disturbances (p, Author summary As human African trypanosomiasis (HAT) or sleeping sickness is approaching elimination, case management is progressively transferred from specialized teams to front line health care centres. This approach raises practical questions. What clinical symptoms and signs should trigger HAT testing? What rapid diagnostic tests (RDT) are suitable for screening? Which unconfirmed serological suspects should be examined further? During this study conducted in Côte d’Ivoire, individuals with sleep disturbances, motor disorders, convulsions, severe weight loss, or psychiatric problems were more often positive in RDTs. These symptoms and signs should trigger referral for HAT screening. Our results confirm appropriateness of the existing HAT screening strategy with SD Bioline HAT or HAT Sero-K-Set having specificities of 97.8% and 98.9%. Subsequent tests on dried blood spots from RDT positives were 93.3% to 98.9% specific, and increased the positive predictive value from below 15% up to 67%. For selection of RDT seropositives for additional parasitological examinations, trypanolysis on dried blood spots is suitable, but could be replaced by ELISA, which can be performed locally. The optimal diagnostic test algorithm for Côte d’Ivoire, in terms of cost-effectiveness, remains to be determined.

Background Coagulopathy and following massive bleeding are complications of cardiovascular surgery, particularly occurring after procedures requiring prolonged cardiopulmonary bypass (CPB). Reliable and rapid tests for coagulopathy are desirable for guiding transfusion. Measuring multiple coagulation parameters may prove useful. The purpose of this study is to determine the laboratory parameters predicting massive bleeding. Methods In a prospectively collected cohort of 48 patients undergoing cardiovascular surgery, markers of coagulation and fibrinolysis were measured using automated analyzer and their correlations with bleeding volume were determined. Results Operation time was 318 (107–654) min. CPB time was 181 (58–501) min. Bleeding volume during surgery was 2269 (174–10,607) ml. Number of transfusion units during surgery were packed red blood cells 12 (0–30) units, fresh frozen plasma 12 (0–44) units, platelets 20 (0–60) units and intraoperative autologous blood collection 669 (0–4439) ml. Post-surgery activities of coagulation factors II (FII), FV, FVII, FVIII, FIX, FX, FXI and FXII were decreased. Values of fibrinogen, antithrombin, α2 plasmin inhibitor (α2PI) and FXIII were also decreased. Values of thrombin-antithrombin complex (TAT) were increased. Values of FII, FIX, FXI and α2PI before surgery were negatively correlated with bleeding volume (FII, r = − 0.506: FIX, r = − 0.504: FXI, r = − 0.580; α2PI, r = − 0.418). Level of FIX after surgery was negatively correlated with bleeding volume (r = − 0.445) and level of TAT after surgery was positively correlated with bleeding volume (r = 0.443). Conclusions These results suggest that several clinical and routine laboratory parameters of coagulation were individually associated with bleeding volume during cardiovascular surgery. Determining the patterns of coagulopathy may potentially help guide transfusion during cardiovascular surgery.

Central venous catheterization (CVC) remains a common practice in the emergency setting. Routine flushing 10–20 ml of normal saline to maintain the patency of CVC could affect the accuracy of laboratory tests. Typically, physicians require peripheral vein phlebotomy when more blood sampling is needed. One alternative method, the Pull-push method, could avoid the trauma associated with venipuncture and unnecessary peripheral vein phlebotomy. However, there has been no recent study analyzing the accuracy of blood sampling using this technique. We evaluate laboratory tests' accuracy between blood samples drawn by the Pull-push method from CVC after routine flushing with 10 ml of normal saline versus control. We conducted a diagnostic accuracy study from May to September 2019. After exclusion, 72 patients were eligible for analysis. Promptly after central venous catheterization, we drew blood samples, stored them in blood collecting tubes, and labeled them for the gold standard group. We flushed with 10 ml of normal saline before blood sampling using the Pull-push method's completed three times; then, we drew blood samples again, labeled Pull-push group. We compared the laboratory results between two groups by paired t-test. The accuracies were analyzed based on an allowable error by Clinical Laboratory Improvement Amendments (CLIA) and presented by a modified Bland-Altman plot. The 72 patients were primarily male (n = 47, 65.3%), had a mean age 60.1 ± 14.0 years, and were diagnosed with sepsis (n = 4, 5.6%) or septic shock (n = 65, 90.3%). For almost all the laboratory values, including hemoglobin, hematocrit, white blood cell count, platelet count, blood urea nitrogen, creatinine, sodium, potassium, chloride, bicarbonate, prothrombin time, international normalized ratio, and blood sugar, the accuracy was more than 90% (92.8–98.6%), except aPTT (85.5%) and aPTT ratio (86.7%). Laboratory tests drawn by the Pull-push method could replace peripheral vein phlebotomy to avoid the trauma associated with venipuncture and infection risk., Accuracy; Laboratory tests; Blood specimen collection; Catheterization; Central cenous; Pull-push method.

Purpose.The authors’ goal is to determine the behavior of insulated rail joints with polymer-composite fishplates without glueing in the consideration of dynamic loadings regarding to own laboratory tests. In this paper they introduce the applied measurement opportunities.Methodology.Dynamic (fatigue) bending tests were performed by insulated rail joints assembled with plastic-polymer fishplates. The special laboratory measurements are related to digital picture/video measurement technique and assessment method executed by GOM hardware and software, as well as computer tomography according to laboratory bending tests.Findings.In previous papers the authors published the results of glued-insulated rail joints, in this period they continued their research with the investigation of rail joints with plastic-polymer fishplates without glueing. They tested two different types of rail fishplates made of plastic-polymer material. For the rail joints with fishplates but without glueing, the authors applied special measurement techniques by GOM products (Tritop, Aramis) that enable high precision digital measurement techniques with spectacular visualization results. The computer tomography records ensure the opportunity to be able to receive information about inner crackings and faults of plastic-polymer fishplates, with also high precision measurements. The assessment method has to be developed for these specific measurement methodologies to be able to compare the results and define scientific statements.Originality.Up to now any researcher and research group have been dealing with insulated rail joints with special plastic-polymer fishplates without glueing applied mentioned special techniques, no one determined the exact deterioration process of these joints, as well as the crack growing phenomenon in the cross section of the fishplates.Practical value.The research team of the authors had the possibility to see into the details of glass-fibre reinforced resin bonded plastic fishplates during laboratory tests, as well as they publish timely information in the consideration of their laboratory tests’ results. This result can be applied in railway engineering at all stages: design, construction, maintenance&operation in the future.

Pavement structures, layers, and parameters must meet the strict requirements of applicable standards and regulations. The thickness of layers and the choice of materials depend on the factors involved, i.e., the traffic load and climatic factors (changes in temperature, water, rain, snow); they are also dependent on the geological environment at the road construction site and the parameters and properties of the embankment (the subgrade of the pavement). In some cases, the capacity of the existing transport infrastructure is on the edge of sustainability. The increase in the traffic load and the use of lower-class roads by freight transport, together with insufficient maintenance, has resulted in a deterioration of road conditions, thereby causing many deficiencies and failures. The required serviceability and operational performance of roads can be ensured by the choice of suitable quality materials and technological construction processes. Technologies that are environmentally acceptable and economically efficient should be preferred.

Background: Heart failure is a condition with diverse aetiology and pathogenesis. This is associated with higher rates of comorbidities, such as i.e. hypertension, atrial fibrillation chronic kidney disease, anaemia and iron deficiency. The purpose of this study was to characterise patients hospitalised due to acutely decompensated heart failure, with a particular emphasis on any comorbidities and laboratory test abnormalities. Material and methods: A total of 102 patients aged over 18 years, hospitalised due to acute decompensated heart failure. Thorough medical history (including any concomitant diseases) was obtained from all patients. They also underwent a clinical examination and biochemical tests. Results: The subjects included were mostly men (76.5%) with ischemic aetiology (63.7%). The most common comorbidity was hypertension (66.6%), while hypotension affected only 2% of patients. The most common heart failure subtype was heart failure with reduced ejection fraction (60.8%). The detected blood test abnormalities included elevated cystatin C levels in 94.7%, hyperuricaemia in 75.5%, anaemia in 55.9%, and iron deficiency in 78.3% of patients. Conclusion: Most of acute decompensated heart failure patients suffer from comorbidities with a documented impact on prognosis. Cardiovascular decompensation poses a risk of multi-organ dysfunction and estimating its actual consequences requires a detailed assessment of complex laboratory tests, including levels of creatinine, cystatin C, uric acid, red blood cell parameters and iron metabolism parameters.

Purpose.The authors’ aim is to evaluate more precisely the deterioration process of glued insulated rail joints with polimer-composite and steel fishplates regarding to own laboratory tests.Methodology.The laboratory tests were executed by three-point static and three-point dynamic (fatigue) bending tests’ measurement results related to glued insulated rail joints with fibre-glass reinforced polymer-composite fishplates (brand: APATECH). During the research the static three-point bending tests were performed on rail joints assembled with three different rail profiles (MÁV48, 54E1 (UIC54) and 60E1 (UIC60)) with three specimens, measured on 13 different support bay values before fatigue test, as well as after 3.5 million loading cycles (the degradations process was checked after every 0.5 million cycles) on polymer-composite and steel fishplated rail joints.Findings.The investigation of fiber-glass reinforced and steel fishplated rail joints (three-point static and dynamic bending laboratory tests) are in progress. Considering to them, the mechanical deterioration processes were able to be determined by measurements of deflection values compared to original ones (i.e. before fatigue tests). The differences can be pointed out by analysis of measurement results related to both types of glued insulated rail joints (steel and polymer-composite fishplated ones).Originality.The goal of this research is to investigate the application of this new type of glued insulated rail joint and to determine the ultimate lifetime of the investigated rail joints, e.g. how much time they can be safely held in the railway track without damage. In the international literature no one has investigated this field of glued insulated rail joints.Practical value.The fibre glass reinforced resin-bonded fishplated glued insulated rail joints and ‘control’ steel fishplated glued insulated rail joints were built into railway line (between Kelenföld and Hegyeshalom state border) in Hungary at three different locations. In this article the investigation of deterioration process of glued-insulated rail joints and steel fishplated glued insulated rail joints are demonstrated only by laboratory bending tests.

Antiphospholipid syndrome (APS) is an immune-mediated violation of coagulation, the diagnosis of which requires mandatory laboratory confirmation. Since the clinical manifestations of APS are extremely diverse, various specialists are involved in the diagnostic process – neurology, cardiologists, surgeons, hematologists, endocrinologists, laboratory medicine specialists, etc. So far, it remains an open question what specialist exactly should make the final diagnosis and supervise patient with APS. The experience of a separate diagnostic center shows the distribution of prescriptions and their compliance with the international recommendations. This study also provides data on the frequency of prescribing laboratory tests to confirm APS, which is 1.2% of all coagulation tests. Among the patients with suspected APS on the basis of clinical signs, only 12.2% of the diagnosis was confirmed. Presents the dangers of obtaining false-positive results that should be taken into account when prescribing laboratory tests.

The study was conducted on the basis of the Department of Endocrinology of the National Center for the Protection of Motherhood and Childhood. A study of laboratory studies of metabolic syndrome in children and adolescents revealed significant changes in the main group, compared with the control group. All indicators of lipid, carbohydrate, electrolyte metabolism, as well as liver and kidney function, were higher in children with metabolic syndrome.

Background The overuse of medical tests leads to higher costs, wasting of resources, and the potential for overdiagnosis of disease. This study was designed to determine whether the patients of family doctors who order more routine medical tests are diagnosed with more cancers. Method A retrospective population‐based cross‐sectional study using administrative health care data in Ontario Canada. We investigated the ordering of 23 routine laboratories and imaging tests 2008‐20012 by 6849 Ontario family physicians on their 4.9 million rostered adult patients. We compared physicians’ test utilization and calculated case‐mix adjusted observed to expected (O:E) utilization ratios to categorize physicians as Typical, Higher or Lower testers. Age‐sex standardized rates (cases/10 000 patient years) and Rate Ratios were determined for cancers of the thyroid, prostate, breast, lymphoma, kidney, melanoma, uterus, ovary, lung, esophagus, and pancreas for each tester group. Results There was wide variation in the use of the 23 tests by Ontario physicians. 26% and 24% of physicians were deemed Higher Testers for laboratory and imaging tests, while 41% and 38% were Typical Testers. The patients of higher test users were diagnosed with more cancers of thyroid (laboratory [RR 1.61, 95% CI 1.39‐1.87] and imaging [RR 2.08, 95% CI 0.88‐2.30]) and prostate (laboratory [RR 1.10, 95% CI 1.03‐1.18] and imaging [RR 1.05, 95% CI 1.00‐1.10]). Conclusion There is a wide variation in the ordering of routine and common medical tests among Ontario family doctors. The patients of higher testers were diagnosed with more thyroid and prostate cancers.

Ketosis is a common disease in high producing dairy cows during the early lactation period. Subclinical ketosis (SCK) and periparturient diseases considerably account for economic and welfare losses in dairy cows. Subclinical ketosis poses an increased risk of production-related diseases such as clinical ketosis, displaced abomasum, retained placenta, lameness, mastitis and metritis. Production efficiency decreases (lower milk production, poor fertility, and increased culling rates), which results in economic losses. Increased concentrations of circulating ketone bodies, predominantly ?-hydroxybutyrate (BHB), without the presence of clinical signs of ketosis are considered as SCK. It is characterized by increased levels of ketone bodies in the blood, urine and milk. The gold standard test for ketosis is blood BHB. This ketone body is more stable in blood than acetone or acetoacetate. The most commonly used cut-points for subclinical ketosis are 1.2 mmol/L or 1.4 mmol/L for BHB in the blood. Clinical ketosis generally involves much higher levels of BHB, about 3.0 mmol/L or more. Usually, detection of SCK is carried out by testing ketone body concentrations in blood, urine and milk. A variety of laboratory and cowside tests are available for monitoring ketosis in dairy herds. But no cowside test has perfect sensitivity and specificity compared to blood BHB as the gold standard test. The aim of this review is to overview diagnostic tests for SCK in dairy cows, including laboratory and cowside tests.

Nifurtimox is indicated in Chagas disease but determining its effectiveness in chronic disease is hindered by the length of time needed to demonstrate negative serological conversion. We manually reviewed long-term follow-up data from hospital records of patients with chronic Chagas disease (N = 1,497) in Argentina diagnosed during 1967–1980. All patients were aged ≥18 years at diagnosis and were either treated with nifurtimox (n = 968) or received no antitrypanosomal treatment (n = 529). The primary endpoint was negative seroconversion (the “event”), defined as a change from positive to negative in the serological or parasitological laboratory test used at diagnosis. Time to event was from baseline visit to date of endpoint event or censoring. The effectiveness of nifurtimox versus no treatment was estimated with Cox proportional hazard regression using propensity scores with overlap weights to calculate the hazard ratio and 95% confidence interval. The nifurtimox group was younger than the untreated group (mean, 32.4 vs. 40.3 years), with proportionally fewer females (47.9% vs. 60.1%), and proportionally more of the nifurtimox group than the untreated group had clinical signs and symptoms of Chagas disease at diagnosis (28.9% vs. 14.0%). Median maximum daily dose of nifurtimox was 8.0 mg/kg/day (interquartile range [IQR]: 8.0–9.0) and median treatment duration was 44 days (IQR: 1–90). Median time to event was 2.1 years (IQR: 1.0–4.5) for nifurtimox-treated and 2.4 years (IQR: 1.0–4.2) for untreated patients. Accounting for potential confounders, the estimated hazard ratio (95% confidence interval) for negative seroconversion was 2.22 (1.61–3.07) favoring nifurtimox. Variable treatment regimens and follow-up duration, and an uncommonly high rate of spontaneous negative seroconversion, complicate interpretation of this epidemiological study, but with the longest follow-up and largest cohort analyzed to date it lends weight to the benefit of nifurtimox in adults with chronic Chagas disease. Trial registration: The study protocol was registered at ClinicalTrials.gov: NCT03784391., Author summary Nifurtimox has been a treatment for Chagas disease since the 1970s, is a World Health Organization Essential Medicine, and was recently approved to treat pediatric patients in the USA. Chagas disease is typically transmitted to humans via insect bites and is endemic in parts of Latin America. Symptoms may be mild or absent in the early acute phase of disease and about two-thirds of individuals remain largely asymptomatic in the subsequent chronic phase. However, some chronic patients experience severe cardiac or gastrointestinal effects up to 30 years after infection. Chronic Chagas disease is treatable, but positive serology can persist long after the parasite has been cleared. Studies of the effectiveness of nifurtimox in the chronic phase of the disease have historically been limited by small size or short follow-up duration. From 3,633 patients with Chagas disease identified during review of hospital records in Argentina, we analyzed data retrospectively from 1,497 adults diagnosed with chronic Chagas disease over a 14-year period (1967–1980), looking for negative seroconversion among individuals who received nifurtimox or were untreated. The study had limitations that impact interpretation of the findings: treatment regimens and the amount of time patients were followed both varied, and many untreated patients unexpectedly underwent spontaneous negative seroconversion. However, patients treated with nifurtimox were at least twice as likely to be seronegative as untreated patients, providing supporting evidence for the effectiveness of nifurtimox in adults with chronic Chagas disease.

Objective: This study aimed to identify possible differences between blood culture-negative and blood culture-positive groups of infective endocarditis (IE), and explore the associations between biological parameters and in-hospital mortality. Methods: This was a retrospective study of patients hospitalized for IE between 2007 and 2017. Epidemiological, clinical and paraclinical characteristics, by blood culture-negative and positive groups, were collected. The best predictors of in-hospital mortality based on the receiver-operating characteristic (ROC) analysis and AUC (area under the curve) results were identified. Results: A total of 126 IE patients were included, 54% with negative blood cultures at admission. Overall, the in-hospital mortality was 28.6%, higher in the blood culture-negative than positive group (17.5% vs. 11.1%, p = 0.207). A significant increase in the Model for End-Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) score was observed in the blood culture-negative group (p = 0.004), but no baseline characteristics differed between the groups. The best laboratory predictors of in-hospital death in the total study group were the neutrophil count (AUC = 0.824), white blood cell count (AUC = 0.724) and MELD-XI score (AUC = 0.700). Conclusion: Classic laboratory parameters, such as the white blood cell count and neutrophil count, were associated with in-hospital mortality in infective endocarditis. In addition, MELD-XI was a good predictor of in-hospital death.

Autophagy or auto-phagocytosis is self-phagocytosis of tissues and cellular materials i.e., “self-maintenance.” While phagocytosis normally refers to the innate immune process of white blood cells engulfing foreign bodies such as infectious materials, autophagy is a regulatory phenomenon of dysfunctional cellular components being removed (Kobayashi, 2015). Autophagy is inseparable from inflammation and oxidative stress phenomena (Turkmen, 2017); which are intricately involved in pathophysiology of diabetes mellitus (DM) (Muriach et al., 2014). The relationships between phenomena is shown in Figure 1. Open in a separate window Figure 1 Illustration* of relationship between autophagy and oxidative stress in diabetes mellitus. *This figure illustrates how autophagy is inseparable from inflammation and oxidative stress phenomena. Figure shows that autophagy is caused by (downward arrows), but it also exacerbates (backward arrows), inflammation, and oxidative stress in diabetes.

A local and global finite element analysis of the stringer-floor beam connection of a 19th century riveted railway bridge in Spain made of puddle iron were performed to obtain the maximum principal strains in the riveted connecting angles corresponding to bending moments from train loading on the bridge. Due to the anisotropic nature of puddle iron, the connecting angles were modelled using Hill anisotropic plasticity potential and a parametric study in the local FE model of the connection was performed. A laboratory specimen fabricated with original stringers dismantled from the railway bridge was tested to calibrate the numerical models, so the yield stress ratio that best fitted experimental results was obtained. Based on the method of constant fatigue-life diagram and modified Goodman fatigue failure criterion, it was detected that the connecting angles were prone to fatigue crack initiation, as the combination of mean stress and alternating stress amplitude at the toe of the angle fillet remained outside the infinite fatigue-life region. An innovative strengthening system based on adhesively-bonded carbon-fiber reinforced polymer (CFRP) angles was designed to prevent fatigue crack initiation in the connecting angles of the stringer-floor beam connection. Different CFRP laminate layouts were numerically evaluated and a proper configuration was obtained that reduced both the mean stress and the alternating stress amplitude in the connecting angle to shift from finite fatigue-life region to infinite fatigue-life region in the constant fatigue-life diagram. To validate the effectiveness of the proposed CFRP strengthening method, its application on a second laboratory specimen fabricated with original stringers was evaluated experimentally and compared with numerical results. The research study conducted showed that the use of adhesively-bonded CFRP angles was an effective strengthening system in reducing the stress level in the fillet region of the puddle iron connecting angles (where fatigue cracks are prone to initiate) and consequently could increase fatigue life of the stringer-floor beam connection.

Background The current coronavirus disease 2019 (COVID-19) is a public health emergency. In this study, we aimed to evaluate the risk factors for mortality in severe and critical COVID-19 patients. Methods We performed a retrospective study of patients diagnosed with severe and critical COVID-19 from four hospitals in Wuhan, China, by evaluating the clinical characteristics and laboratory results, and using Cox proportional hazards model to assess the risk factors involved in disease progression. Results In total, 446 patients with COVID-19 were enrolled. The study indicated a high mortality rate (20.2%) in severe and critical COVID-19 patients. At the time of admission, all patients required oxygen therapy, and 52 (12%) required invasive mechanical ventilation, of which 50 (96%) died. The univariate Cox proportional hazards model showed a white blood cell count of more than 10 × 109/L (HR 3.993,95%CI 2.469 to 6.459) that correlated with an increased mortality rate. The multivariable Cox proportional hazards model demonstrated that older age (HR 1.066, 95% CI 1.043 to 1.089) and higher white blood cell count (HR 1.135, 95% CI 1.080 to 1.192) were independent risk factors for determining COVID-19 associated mortality. Conclusions COVID-19 is associated with a significant risk of morbidity and mortality in the population. Older age and higher white blood cell count were found to be independent risk factors for mortality.

Objectives Inborn Errors of Immunity are characterized by infectious conditions and manifestations of immune dysregulation. The diversity of clinical phenotypes can make it difficult to direct the laboratory investigation. This article aims to update the investigation of immunological competence in the context of primary defects of the immune system. Source of data Searches were carried out on Pubmed to review articles published in the last five years, in English, French or Spanish, using the terms “diagnosis” OR “investigation” AND “immunodeficiency” or “primary immunodeficiency” or “inborn errors of immunity” NOT “HIV”. Recent textbook editions have also been consulted. Summary of findings The immune system competence investigation should be started based on clinical phenotypes. Relevant data are: characterization of infectious conditions (location, recurrence, types of infectious agents, response to treatment), age during symptom onset and associated manifestations (growth impairment, allergy, autoimmunity, malignancies, fever and signs of inflammation without the identification of infection or autoimmunity) and family history. These data contribute to the selection of tests to be performed. Conclusions The diagnostic investigation of Inborn Errors of Immunity should be guided by the clinical characterization of patients, aiming to optimize the use of complementary tests. Many diagnoses are attained only through genetic tests, which are not always available. However, the absence of a diagnosis of certainty should never delay the implementation of therapeutic measures that preserve patient life and health.

For the sustainability of lignite and coal mining, engineers need the soils’ appropriate geotechnical characterisation of the excavations. This characterisation relates to the slope stability, the overall area stability, and the sustainable exploitation of mining areas during operational and post-closure eras. This work presents a novel perspective on the soil characterisation of lignite mine excavations. Rather than focusing on one particular mine, a comprehensive geotechnical characterisation provides insights about the soils of related mining areas. Additionally, slope stability representative cases guide soil characterisation and analysis rather than following it. The Greek lignite mines are used as a representative example for the illustration of this framework. Initially, the two typical slope stability scenarios for Greek lignite mines are established: a slope in the presence of a weak zone and a homogeneous slope. The crucial geotechnical parameters are then statistically examined based on an extensive database established from laboratory results of various mines. Focus is on shear strength (friction angle and cohesion), the key to slope stability, and physical properties that can provide the strength through empirical correlations. Many soil layers exhibit a low residual friction angle from 5° to 15°, corresponding to the weak zone. Peak friction angle presents a mean value of 28.4°, and a characteristic value of 25.0°; cohesion presents a wide range with a mean value of 111 kPa and a characteristic value of 84 kPa. Finally, cross-correlations between geotechnical parameters present large scatter, but relations for estimating the residual and the peak friction angle reveal general trends.

This paper presents a modified analytical formula for estimating the static top-to-bottom compressive strength of corrugated board packaging with different perforations. The analytical framework is based here on Heimerl’s assumption with an extension from a single panel to a full box, enhanced with a numerically calculated critical load. In the proposed method, the torsional and shear stiffness of corrugated cardboard, as well as the panel depth-to-width ratio is implemented in the finite element model used for buckling analysis. The new approach is compared with the successful though the simplified McKee formula and is also verified with the experimental results of various packaging designs made of corrugated cardboard. The obtained results indicate that for boxes containing specific perforations, simplified methods give much larger estimation error than the analytical–numerical approach proposed in the article. To the best knowledge of the authors, the influence of the perforations has never been considered before in the analytical or analytical–numerical approach for estimation of the compressive strength of boxes made of corrugated paperboard. The novelty of this paper is to adopt the method presented to include perforation influence on the box compressive strength estimation.

Objective: The epidemiological characteristics of patients with antibody-medicated autoimmune encephalitis in China remain unclear, and a large-scale epidemiological survey is necessary.Methods: A multiple-center retrospective study was performed. We collected 1,047 patients with suspected autoimmune encephalitis and ultimately enrolled 778 defined patients across centers in China. All patients were positive for serum [or cerebrospinal fluid (CSF)] antibodies. Demographic information and clinical data from January 2014 to January 2019 from 22 centers in China were reviewed.Results: A total of 778 patients with autoimmune encephalitis were enrolled in the study. In general, the ratio of males to females was ~1.2:1. The main subtypes of autoimmune encephalitis were NMDAR-AE (61.35%), LGI-1-AE (20.61%), and GABAbR-AE (12.40%). According to the characteristics of age of onset, the incidence of autoimmune encephalitis showed a “double peak” distribution entailing a 20-year-old age group and a 60-year-old age group. We next analyzed the proportion of patients with tumors in this cohort. More specifically, there were 34 patients with tumors and 85 with tumor marker positivity. Relapse occurred in 81 patients within at least 1 year's follow up study: 52 with NMDAR-AE (18.2%); 19 with LGI-1-AE (16.8%); 5 with GABAbR-AE (9%); and 3 with CASPR2-AE.Interpretation: Due to the vast differences in demographic features, the incidence of cancer and the genetic characteristics between the populations in China and Western countries, the demographics, sex distribution, concomitant tumor rate, clinical features, and relapse characteristics associated with autoimmune encephalitis in China shows a similar profile with Western countries with some minor differences.

Laboratory tests are an important component in the diagnostic process. From an analytical point of view, most tests have reached high technical standards resulting in quantitative results with very high precision and accuracy. The challenge for the clinician then is how to interpret those results. It is particularly difficult when different test systems use different scales and arbitrary units for a given biomarker, as is often the case in immunologic testing. For the clinician it is demanding to estimate the predictive value of a diagnostic test result. A solution to this problem that is advocated here is to provide likelihood ratios as a measure of the predictive value of test results. This approach is not only useful to harmonize interpretation between assays and assay platforms but can be employed as well in external quality control programs. However, the concept of likelihood ratios in clinical diagnostics, although not new, is not yet generally accepted and needs further promotion by demonstrating its usefulness. Some 55 years ago, a “technic for the estimation of the predictive value of diagnostic test results in the subject tested when the sensitivity and specificity of the test and the prevalence of the disease in the population are known” was described (1). At that time, the technic was limited to dichotomous, qualitative test results. Later, the approach has been extended to intervals of test results and their likelihood ratio (LR) (2–6). The LR of a diagnostic test result is defined by its likelihood in diseased subjects (sensitivity) versus non-diseased subjects (1-specificity). In the field of autoimmunity, test result interval-specific LRs have been applied for the diagnosis of rheumatoid arthritis (7, 8), vasculitis (9, 10), systemic rheumatic diseases (11–16), inflammatory bowel disease and celiac disease (17–22). It has been realized that expressing results in the form of LRs provides a convenient way to harmonize test results which otherwise would be expressed in various units and provider-defined scales, making it difficult to compare results. This has led to a proposal for harmonization of anti-neutrophil cytoplasmic antibody (ANCA) testing (23, 24), antinuclear antibody testing (25, 26) and autoimmunity tests in general by reporting test result-specific LRs (27, 28). The calculation of LRs of test result intervals has been further extended to arbitrary quantitative test results (29, 30) and applied, for example, for the diagnosis of Alzheimer’s disease (31), ANCA testing (24), antinuclear antibody testing (26) and celiac disease (22). For the clinician, LRs could be a valuable diagnostic measure (32–35). Nevertheless, a wide application of LRs in diagnostic laboratory testing is not observed today. This might have different reasons, such as: a LR is related to a specific diagnosis and, habitually, the clinician does not inform the testing laboratory on the precise diagnostic question. a test might be used for screening purposes resulting in a differential diagnosis. there is a dearth of data on LRs (and consequently laboratories do not report LRs). With regard to the differential diagnosis, it should be noted that LRs for each differential diagnosis are very valuable to estimate the relative weight of possible diagnoses (36, 37). Establishing LRs needs clinical studies to be performed, either by the in vitro diagnostics industry, the laboratories, or a collaboration of both. As this has a cost, reimbursement of laboratory tests should consider the additional clinical value of the diagnostic information given by the LR (38), which is not the case today.

This study applied causal criteria in directed acyclic graphs for handling covariates in associations for prognosis of severe coronavirus disease 2019 (COVID-19) cases. To identify non-specific blood tests and risk factors as predictors of hospitalisation due to COVID-19, one has to exclude noisy predictors by comparing the concordance statistics (area under the curve − AUC) for positive and negative cases of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Predictors with significant AUC at negative stratum should be either controlled for their confounders or eliminated (when confounders are unavailable). Models were classified according to the difference of AUC between strata. The framework was applied to an open database with 5644 patients from Hospital Israelita Albert Einstein in Brazil with SARS-CoV-2 reverse transcription – polymerase chain reaction (RT-PCR) exam. C-reactive protein (CRP) was a noisy predictor: hospitalisation could have happened due to causes other than COVID-19 even when SARS-CoV-2 RT-PCR is positive and CRP is reactive, as most cases are asymptomatic to mild. Candidates of characteristic response from moderate-to-severe inflammation of COVID-19 were: combinations of eosinophils, monocytes and neutrophils, with age as risk factor; and creatinine, as risk factor, sharpens the odds ratio of the model with monocytes, neutrophils and age.

Introduction In 2016, under its new National Adherence Guidelines (AGL), South Africa formalized an existing model of fast-track HIV treatment initiation counselling (FTIC). Rollout of the AGL included an evaluation study at 24 clinics, with staggered AGL implementation. Using routinely collected data extracted as part of the evaluation study, we estimated and compared the costs of HIV care and treatment from the provider’s perspective at the 12 clinics implementing the new, formalized model (AGL-FTIC) to costs at the 12 clinics continuing to implement some earlier, less formalized, model that likely varied across clinics (denoted here as early-FTIC). Methods This was a cost-outcome analysis using standard methods and a composite outcome defined as initiated antiretroviral therapy (ART) within 30 days of treatment eligibility and retained in care at 9 months. Using patient-level, bottom-up resource-utilization data and local unit costs, we estimated patient-level costs of care and treatment in 2017 U.S. dollars over the 9-month evaluation follow-up period for the two models of care. Resource use and costs, disaggregated by antiretroviral medications, laboratory tests, and clinic visits, are reported by model of care and stratified by the composite outcome. Results A total of 350/343 patients in the early-FTIC/AGL-FTIC models of care are included in this analysis. Mean/median costs were similar for both models of care ($135/$153 for early-FTIC, $130/$151 for AGL-FTIC). For the subset achieving the composite outcome, resource use and therefore mean/median costs were similar but slightly higher, reflecting care consistent with treatment guidelines ($163/$166 for early-FTIC, $168/$170 for AGL-FTIC). Not surprisingly, costs for patients not achieving the composite outcome were substantially less, mainly because they only had two or fewer follow-up visits and, therefore, received substantially less ART than patients who achieved the composite outcome. Conclusion The 2016 adherence guidelines clarified expectations for the content and timing of adherence counseling sessions in relation to ART initiation. Because clinics were already initiating patients on ART quickly by 2016, little room existed for the new model of fast-track initiation counseling to reduce the number of pre-ART clinic visits at the study sites and therefore to reduce costs of care and treatment. Trial registration Clinical Trial Number: NCT02536768.

This article presents the characteristic curves of a vertical-axis hydrokinetic tidal turbine of the Darrieus subtype aimed at meeting the electricity demand of port facilities located at harbors and estuaries with low water-speed conditions. The turbine was tested in the water-current flume of the University of Santiago de Compostela for several flow conditions with different water heights and water speeds. Blockage conditions were tested by examining the results from two groups of tests: with and without an accelerator device that restricts the flow around the rotor. The tip speed ratio and the power coefficient were used to characterize the performance of the turbine for each test. Finally, the results for open-field conditions were obtained by applying empirical expressions, which allowed us to assess the performance of the device in estuaries and harbors with known water-flow regimes., This research was funded by PORTOS project co-financed by the Interreg Atlantic Area Programme through the European Regional Development Fund, grant number EAPA_784/2018.

Background The number of websites providing laboratory test information is increasing fast, although the accuracy of reported resources is sometimes questionable. The aim of this study was to assess the quality of online retrievable information by Google Search engine. Methods Considering urinalysis, cholesterol and prostate-specific antigen (PSA) as keywords, the Google Search engine was queried. Using Google Trends, users’ search trends (interest over time) were evaluated in a 5-year period. The first three or 10 retrieved hits were analysed in blind by two reviewers and classified according to the type of owner or publisher and for the quality of the reported Web content. Results The interest over time constantly increased for all the three considered tests. Most of the Web content owners were editorial and/or publishing groups (mean percentage 35.5% and 30.0% for the first three and 10 hits, respectively). Public and health agencies and scientific societies are less represented. Among the first three and 10 hits, cited sources were found to vary from 26.0% to 46.7% of Web page results, whilst for cholesterol, 60% of the retrieved Web contents reported only authors’ signatures. Conclusions Our findings confirm those obtained in other studies in the literature, demonstrating that online Web searches can lead patients to inadequately written or reviewed health information.