rss_2.0Revista Romana de Medicina de Laborator FeedSciendo RSS Feed for Revista Romana de Medicina de Laborator Romana de Medicina de Laborator Feed value of stress myocardial perfusion imaging in combination with computed tomography angiography for coronary slow flow<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: To date, there are few reports on computed tomography angiography (CTA) in combination with stress myocardial perfusion imaging (SMPI) in the diagnosis of coronary slow flow (CSF).</p> <p><bold>Methods</bold>: A total of 62 patients with suspected CSF who were scheduled to undergo CTA, SMPI and coronary angiography (CAG) from June 2019 to June 2021 were selected. With the results of CAG as the gold standard, the value of CTA plus SMPI in the diagnosis of CSF was analyzed.</p> <p><bold>Results</bold>: Of the 62 patients, 52 (83.87%) were diagnosed with CSF by CAG. The results of the Kappa consistency test showed that SMPI alone, CTA alone and SMPI plus CTA had 0.565, 0.396 and 0.881 consistency, respectively, with CAG in the diagnosis of CSF. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SMPI plus CTA in the diagnosis of CSF were 98.08% (51/52), 90.00% (9/10), 96.47% (60/62), 98.08% (51/52), and 90.00% (9/10), respectively, all higher than those of SMPI or CTA alone (P&lt;0.05). The areas under the receiver operating characteristic curves of SMPI alone, CTA alone and SMPI plus CTA in the diagnosis of CSF were 0.754, 0.771 and 0.940, respectively.</p> <p><bold>Conclusion</bold>: CTA and SMPI have high diagnostic values for CSF, and the results of their combination have high consistency with those of CAG.</p> </abstract>ARTICLEtrue of cytotoxicity and apoptotic effects of on the human lung cancer cell lines CaLu-6<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Lung cancer is ranked as the fourth global important cause of cancer related deaths. Despite remarkable advances in drug design, the pharmaceutical industry grapples with significant scientific and financial challenges. While recent strides have been made in the development of chemically synthesized pharmaceutical drugs, nature continues to serve as a primary source of bioactive compounds. The synthesis and assessment of natural herbal remedies have been a focal point of cancer therapy research for many years. The synthesis and evaluation of natural herbal remedies have been a primary research for many years in cancer therapy and the obtained results support the continuous development of novel plant-derived products, mainly because natural herbal remedies have several benefits compared to traditional chemical pharmaceuticals.</p> </sec> <sec><title style='display:none'>Methods</title> <p>This study aims to evaluate the potential cytotoxicity of <italic>Catharanthus roseus</italic> methanolic extract on Human Lung Cancer Cell Lines (CaLu-6). The evaluation was performed using apoptotic and membrane depolarization assays. In addition, the real time gene expression was used for assessing the levels of mRNA.</p> </sec> <sec><title style='display:none'>Results</title> <p>The results demonstrated the possible and positive anticancerous activity of <italic>Catharanthus roseus</italic> methanolic extract compared to the positive control (p&lt;0.05).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Our results support the ongoing exploration of novel plant-derived products for cancer therapy, emphasizing the benefits offered by natural herbal remedies over traditional chemical pharmaceuticals. Further research in this direction could lead to the development of more effective and less toxic treatments for lung cancer.</p> </sec> </abstract>ARTICLEtrue of Systemic Inflammatory Response Index (SIRI) and Systemic Immuno-Inflammation Index (SII) on mortality in heart failure patients<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Heart failure (HF) is a structural and functional disease that affects millions of people worldwide. The role of inflammation has been demonstrated in many diseases. However, the impact of the Systemic Inflammatory Response Index (SIRI) and the Systemic Immuno-Inflammation Index (SII) on mortality in HF patients has not been adequately investigated. Therefore, in this study, we aimed to demonstrate the effect of SIRI and SII on mortality in patients diagnosed with HF.</p> </sec> <sec><title style='display:none'>Methods</title> <p>Our research is a retrospective, single-centre study comprising patients who were diagnosed with HF and presented at the emergency department. We focused on those diagnosed with decompensated HF between January and November 2022. The study recorded the demographic information and hemogram parameters of the patients. The patients’ in-hospital mortality status was recorded and the effect of these parameters on mortality was assessed.</p> </sec> <sec><title style='display:none'>Results</title> <p>We recruited 122 eligible patients for our research study. Patients with mortality exhibited significantly higher median SIRI levels compared to those without mortality (6.07 (1.99-12.23) vs 2.46, p=0.038), and the group with mortality had significantly higher median SII levels compared to the other group (6625.05 (4704.73-7539.51) vs. 982.48 (180.69-1929.45); p&lt;0.001). ROC curves were generated to assess the efficacy of WBC, SIRI, SII, and CRP parameters in discriminating mortality, and it was confirmed that WBC, SIRI, and SII were all statistically significant predictors of mortality. SIRI and SII demonstrated superior diagnostic ability compared with WBC and CRP, as evidenced by their respective AUC values of 0.929 and 0.671, sensitivities of 91.7% and 50%, and specificities of 91% and 94%.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>SIRI and SII can be used as mortality indicators in heart failure patients.</p> </sec> </abstract>ARTICLEtrue the sensitivity of influenza viruses to oseltamivir, in Romania, from 2016 to 2023<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: influenza is an acute viral disease caused by infection of the upper respiratory tract - difficult to control, which affects a large part of the population. Neuraminidase inhibitors (NAIs), such as oseltamivir and zanamivir, are the antiviral drugs utilized in Romania for the treatment of respiratory infections caused by the influenza viruses. The objective of the study is to monitor and analyze influenza viruses circulating in Romania, in terms of their susceptibility to oseltamivir, with the aim of signalling the emergence of viral strains resistant to antivirals.</p> <p><bold>Methods</bold>: The phenotypic method was performed to evaluate the inhibitory effect of oseltamivir on the neuraminidase enzyme activity of influenza viruses. Genotypic methods (SNP-based assays or sequencing of neuraminidase/whole genome) were used for detecting amino acid substitutions associated with influenza antiviral resistance. The study period is from 2016 to 2023.</p> <p><bold>Results</bold>: from the total number of influenza viruses isolated during the period (833 isolated), 670 strains were characterized antigenically and genetically, and the phenotypic susceptibility to antivirals was performed for 245 isolated viral strains. According to WHO criteria categories antiviral susceptibility based on IC50 data, none of the test results indicated reduced or highly reduced inhibition by oseltamivir.</p> <p><bold>Conclusion</bold>: This monitoring, carried out in the National Influenza Center Romania - Cantacuzino NMMIRD, is extremely important to maintain effective flu control and further development of other antiviral agents.</p> </abstract>ARTICLEtrue of expressions of Toll-like receptor 4 and Janus kinase 3 in peripheral blood mononuclear cells with T helper 17 cell/regulatory T cell imbalance in patients with ankylosing spondylitis<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>We aimed to analyze the correlations of the expressions of Toll-like receptor 4 (TLR4) and Janus kinase 3 (JAK3) in peripheral blood mononuclear cells (PBMCs) with T helper 17 cell (Th17)/regulatory T cell (Treg) imbalance in patients with ankylosing spondylitis (AS).</p> </sec> <sec><title style='display:none'>Methods</title> <p>A total of 101 AS patients were enrolled into an AS group. Based on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, they were subdivided into a stable AS (ASS) group (BASDAI score &lt;4 points, n=42) and an active AS (ASA) group (BASDAI score ≥4 points, n=59). Meanwhile, 50 healthy volunteers who received health examination in the same time period were assigned into a healthy control (HC) group. RT-qPCR was performed to determine the mRNA expressions of TLR4 and JAK3 in PBMCs. Enzyme-linked immunosorbent assay was conducted to measure the levels of Th17/Treg-related cytokines [interleukin (IL)-10, IL-17, IL-23, and transforming growth factor-β (TGF-β)] in the serum.</p> </sec> <sec><title style='display:none'>Results</title> <p>The mRNA expressions of TLR4 and JAK3 had positive correlations with IL-17 (r=0.592, 0.542) and IL-23 levels (r=0.529, 0.590) (P 0.05). The levels of TLR4 mRNA, JAK3 mRNA, IL-17, and IL-23 were all correlated with the occurrence of AS (P&lt;0.05). The areas under the receiver operating characteristic curves of TLR4, JAK3, and their combination in PBMCs for predicting the occurrence of AS were 0.912, 0.835, and 0.919, respectively.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>TLR4 combined with JAK3 can effectively predict the occurrence of AS.</p> </sec> </abstract>ARTICLEtrue of routine laboratory markers as short-term outcome indicators in patients with acute ischemic stroke<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Stroke is a disease with high mortality and morbidity. Currently, there are no specific laboratory markers that can replace or improve clinical and radiological diagnosis and prognosis. We evaluated the role of C-reactive protein (CRP), fibrinogen and D-dimer in predicting short-term outcomes in acute ischemic stroke.</p> <p><bold>Methods</bold>: We included 118 acute ischemic stroke patients, admitted within 24 h of onset, mean age 72.73±10.08 years. The severity of the stroke was assessed by the National Institutes of Health Stroke Scale (NIHSS), and for poor outcome (PO) we accepted a severe functional deficit at the end of the hospital stay with NIHSS ≥15, and for good outcome (GO) – NIHSS ≤ 14. In all patients, we monitored the dynamics of CRP, fibrinogen and D-dimer and evaluated their predictive value regarding to the PO and GO of the stroke.</p> <p><bold>Results</bold>: D-dimer had the strongest poor predictive value at admission (p&lt;0.001). Six hours after admission, CRP, D-dimer or both were higher in PO patients (p=0.046, p=0.022 and p=0.006, respectively). At the 24.h, only CRP could be used to predict PO (p&lt;0.001). Elevated CRP, D-dimer or both have been determined as strong indicators of PO with 72 hours of admission (p&lt;0.001, p=0.032 and p=0.001, respectively). Fibrinogen levels were higher 72 hours after admission without a significant relationship with the NIHSS.</p> <p><bold>Conclusion</bold>: Changes in routine biomarkers CRP and D-dimer, but not fibrinogen, can predict short-term stroke prognosis and may be associated with the risk of early neurological deterioration or death during hospital stay.</p> </abstract>ARTICLEtrue role of nitro oxidative factors in metabolic dysfunctions: A link between severe obesity and weight-loss treatment – a narrative review<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Metabolic syndrome (MS) is linked to oxidative stress and intracellular redox imbalance, both triggered by chronic inflammatory conditions. The aim of our research was to figure out if bariatric surgery changes the production of free radicals in obese people. In addition, the relationship between metabolic syndrome(MS) and associated conditions is represented by oxidative stress (OS) and intracellular redox imbalance, both of which are induced by the chronic inflammatory conditions that define MS.</p> <p><bold>Methods</bold>: The literature search was conducted on PubMed, Cochrane Library, and ScienceDirect, using terms related to severe obesity, nitro-oxidative factors, pro-inflammatory status and reactive oxygen species. Six studies were included. We included papers published till 2022, with a concentration on more recent publications (January 2019 to December 2022).</p> <p><bold>Results</bold>: Studies that analyzed the status of the patient after bariatric surgery at 1, 2, 3, 6, 12 months were included in the review, regarding inflammation: CRP levels,IL-6, and regarding oxidative stress: MPO serum activity, blood plasma proteins: dityrosine, kynurenine, glycophore, amyloid and Amadori products, had been found strongly statistically significant decreased at each periodic analyze, the same thing applied to regulatory hormones such as leptin, and due to the fact that these patients have the possibility to keep their weight stable for a longer period, all these factors kept their levels low even 4 years after the intervention.</p> <p><bold>Conclusion</bold>: Bariatric surgery is an efficient and quick solution in increasing the quality of life.</p> </abstract>ARTICLEtrue comprehensive review of Proficiency Testing / Interlaboratory Comparisons Policies of the EA-MLA signatories applicable to medical laboratories<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Proficiency Testing/Interlaboratory Comparisons play an important role that is widely accepted in demonstrating the validity of results of any laboratory and inspection body. To ensure a coherent approach in the field within an economy, accreditation bodies develop specific policies for laboratories and inspection bodies’ participation in proficiency testing/interlaboratory comparisons.</p> </sec> <sec><title style='display:none'>Methods</title> <p>39 Proficiency Testing/Interlaboratory Comparisons policies of accreditation bodies were reviewed for key requirements: initial accreditation, participations of accreditation per accreditation cycle and acceptance criteria of PT/ILC providers.</p> </sec> <sec><title style='display:none'>Results</title> <p>Within the analyzed policies a wide range of approaches was identified especially for the number of participations and acceptance criteria set by different bodies</p> </sec> <sec><title style='display:none'>Conclusions:</title> <p>Even though the analyzed policies belong to accreditation bodies which are signatories of the same regional agreement, there is no harmonized approach with respect to Proficiency Testing/Interlaboratory Comparisons usage in the accreditation process</p> </sec> </abstract>ARTICLEtrue to high-density lipoprotein cholesterol ratio is correlated with baseline anthropometric measurements in patients with obesity but not with weight-loss process after sleeve gastrectomy - An observational cohort study<abstract> <title style='display:none'>Abstract</title> <p><bold>Introductionː</bold> A strong connection between inflammation and obesity was repeatedly described, with the latter defined as a chronic low-degree systemic inflammatory state. This study analyzed the correlations between inflammatory blood indexes and both baseline anthropometric measurements and the weight–loss process after bariatric surgery.</p> <p><bold>Methodsː</bold> An observational study was conducted on patients with obesity admitted for metabolic surgery in a private and a public hospital. The primary endpoints were to establish correlations between baseline inflammatory ratios i.e. neutrophil to lymphocyte (NLR), platelet to lymphocyte (PLR), monocyte to lymphocyte (MLR), monocyte to high-density lipoprotein cholesterol (MHR) ratios, systemic inflammatory index (SII) and anthropometric measurements. Secondary endpoints were to find out if these ratios measured at baseline are predictive factors for weight loss after bariatric surgery.</p> <p><bold>Results</bold>: In the present study, we included 191 patients, mean age 39.1±10,7 and mean BMI 42,2±6,5 kg/m2. There was a positive correlation between MHR and all anthropometric measurements taken at baseline; a direct correlation was also found for MLR in regards to initial weight and waist circumference. No statistical correlations were found between the above-mentioned indexes and the weight loss process (measured as a percentage of excess weight loss - %EWL) at different follow-up timeframes.</p> <p><bold>Conclusionsː</bold> Monocyte to high-density lipoprotein cholesterol ratio (MHR) was positively associated with baseline anthropo-metric measurements in patients with obesity. The above-mentioned inflammatory ratios did not correlate with the weight loss process after bariatric surgery, thus they should not be used as predictors of good postoperative results.</p> </abstract>ARTICLEtrue of four-dimensional computed tomography angiography combined with stromal cell-derived factor-1 for differentiating ruptured intracranial aneurysms and assessing risk of ruptures<abstract> <title style='display:none'>Abstract</title> <p>Background: To analyze the value of four-dimensional computed tomography angiography (4D-CTA) combined with stromal cell-derived factor-1 (SDF-1) for differentiating ruptured intracranial aneurysms and assessing the risk of ruptures.</p> <p>Methods: Fifty patients with unruptured intracranial aneurysms and 50 patients with ruptured ones were included in non-rupture group 1 and rupture group 1, respectively. All patients underwent 4D-CTA and 3D-CTA, and the serum SDF-1 level was detected. Non-rupture group 1 was followed up for 12 months. On this basis, the patients with ruptured aneurysms were included in rupture group 2 and those without ruptured aneurysms were assigned to non-rupture group 2.</p> <p>Results: The AUC values of Wn, AR, L, SR, SDF-1 and their combination for the diagnosis of ruptured intracranial aneurysms were all &gt;0.70, especially their combination. Wn, AR, L, and SR were higher in rupture group 2 than those in non-rupture group 2 (P&lt;0.05). The level of SDF-1 in rupture group 2 [(142.48±11.23) μg/L] was higher than that in non-rupture group 2 [(128.03±10.28) μg/L] (P&lt;0.05). Wn, AR, L, SR, and SDF-1 and their combination all had the AUC values of &gt;0.70 for the prediction of ruptured intracranial aneurysms, especially their combination. The CT values of the internal carotid artery and middle cerebral artery and the CT value and noise of brain parenchyma in 4D-CTA were higher than those in 3D-CTA (P&lt;0.05).</p> <p>Conclusions: 4D-CTA combined with SDF-1 can effectively differentiate ruptured intracranial aneurysms and predict the risk of ruptures.</p> </abstract>ARTICLEtrue EFLM-COLABIOCLI recommendation for venous blood sampling - v 1.1, June 2018<abstract> <title style='display:none'>Abstract</title> <p>Acest document oferă o recomandare comună a Federației Europene de Chimie Clinică și Medicină de Laborator (EFLM), Grupului de lucru pentru faza preanalitică (WG-PRE) și Grupului de lucru din America Latină pentru Faza preanalitică (WG-PRE-LATAM) al Confederației Americii Latine de Biochimie Clinică (COLABIOCLI) pentru recoltarea sângelui venos. Documentul oferă îndrumări asupra cerințelor pentru asigurarea faptului că procedura de recoltare a sângelui este una sigură, centrată pe pacient și oferă îndrumări practice despre cum să fie depășite cu succes potențiale bariere și obstacole în calea difuzării și implementării ei. Publicul țintă pentru această recomandare este personalul medical implicat direct în procesul de recoltare a sângelui. Această recomandare se aplică în cazul utilizării unui sistem închis de recoltare a sângelui și nu oferă recomandări pentru recoltarea sângelui cu seringi și catetere în sistem deschis. Mai mult, acest document nu abordează obținerea consimțământului pacientului, solicitarea testelor, manipularea și transportul probelor și nici recoltarea de la copii și pacienții inconștienți. Procedura recomandată se bazează pe cele mai bune dovezi disponibile. Fiecare pas a fost evaluat folosind un sistem care punctează calitatea dovezilor și puterea recomandării. Procesul de evaluare a fost realizat la mai multe întâlniri față în față implicând aceleași părți interesate menționate anterior. Principalele părți ale acestei recomandări sunt: 1) Proceduri de pre-recoltare, 2) Procedura de recoltare, 3) Proceduri de post-recoltare şi 4) Implementarea. O primă schiță a recomandării a fost transmisă membrilor EFLM pentru consultare publică. A fost invitat și WG-PRE-LATAM pentru a comenta documentul. O versiune revizuită a fost trimisă spre vot tuturor membrilor EFLM și COLABIOCLI și a fost aprobată oficial de 33 dintre cei 40 de membri EFLM și toți membri COLABIOCLI. Încurajăm profesioniștii din toată Europa şi America Latină să adopte şi să implementeze această recomandare pentru a îmbunătăți calitatea practicilor de recoltare a sângelui și creșterea siguranței pacientului și personalului medical.</p> </abstract>ARTICLEtrue peroxidase (TPO) antibodies – Comparative analysis of two automatic methods, ECLIA and CMIA<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Anti-thyroid peroxidase autoantibodies (TPO) is an essential diagnostic tool for autoimmune disorders of the thyroid gland. However, TPO results are not always comparable due to differences between methods. Here, we aimed to investigate the differences between two modern laboratory methods for TPO measurement: electrochemiluminescence (ECLIA) and chemiluminescence microparticle (CMIA) immunoassays.</p> <p><bold>Methods</bold>: A total of 234 serum samples were tested on two methods: Cobas-e601 (ECLIA) and Alinity i (CMIA). TPO results were compared statistically both quantitatively and qualitatively (results were coded as positive/negative, according to ECLIA/CMIA reference ranges.</p> <p><bold>Results</bold>: The precisions of both methods were acceptable compared with the claims of the manufacturer. There was a very strong, but unsatisfactory correlation between the two methods (Pearson r=0.85). Passing-Bablok regression revealed a significant deviation from linearity (Cusum p&lt;0.01) and an unacceptable quantitative relationship: intercept −7.61, slope 1.10. Moreover, a visual analysis of overall and medical decision level-focused Bland-Altman plots confirmed the lack of quantitative agreement. As for the qualitative analysis, the concordance rate between methods was 218/234 (93.1%). The agreement was considered good to very good according to the inter-rater agreement test: weighted Cohen κ = 0.805.</p> <p><bold>Conclusions</bold>: The qualitative agreement between Cobas-e601 (ECLIA) and Alinity i (CMIA) was good, therefore the two methods may be used indiscriminately for initial testing of patients suspected of thyroid gland autoimmune diseases. However, due to poor quantitative agreement, the two methods should not be used interchangeably for monitoring as the results may mislead both physicians and patients, possibly leading to medical errors.</p> </abstract>ARTICLEtrue of shared hub genes in lung cancer and rheumatoid arthritis patients using bioinformatics approaches<abstract> <title style='display:none'>Abstract</title> <p><bold>Objectives</bold>:To identify key genes common to lung cancer and rheumatoid arthritis through WGCNA co-expression network and MCC algorithm analysis.</p> <p><bold>Methods</bold>: Initially, chip data related to lung cancer and rheumatoid arthritis were obtained from the GEO database for data integration and differential analysis, leading to the identification of key differentially expressed genes. Subsequently, WGCNA was utilized to construct a co-expression network, identifying susceptible modules and core genes. Further, common core genes in lung cancer and rheumatoid arthritis were identified through Venn diagrams, assessing their diagnostic accuracy in disease, analyzing differential expression, and constructing a co-expression network. Finally, GO and KEGG enrichment analyses were conducted to understand the functions and pathway enrichment of these core genes, and potential target drugs were predicted.</p> <p><bold>Results</bold>: Six lung cancer-related and three rheumatoid arthritis-related gene co-expression modules were constructed using WGCNA. The Turquoise module was identified as the susceptible module for lung cancer, while the Blue module was for rheumatoid arthritis. A total of 953 genes were included in the lung cancer hub genes, and 152 in the rheumatoid arthritis hub genes. Finally, 92 potential target drugs were predicted through the DGIdb database that may regulate the expression of 11 common hub genes.</p> <p><bold>Conclusion</bold>: We identified 24 common hub genes for lung cancer and rheumatoid arthritis, with the top 6 ranked by the MCC algorithm being FGR, SLA, GZMH, CSF2RB, PRF1, and CCRL2. This study paves the way for further exploration of the common pathogenesis of lung cancer and rheumatoid arthritis. However, further in vivo and in vitro experiments are required for validation and support.</p> </abstract>ARTICLEtrue value of expression of the CXCR4/Akt signaling pathway in the peripheral blood for brain glioma<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: The aim of this study was to investigate the activation of the C-X-C chemokine receptor type 4 (CXCR4)/Akt signaling pathway in the peripheral blood of individuals diagnosed with brain glioma and assess its potential as a predictive marker.</p> <p><bold>Methods</bold>: A study was carried out on 120 patients diagnosed with brain glioma who were admitted between September 2015 and October 2016 (referred to as the brain glioma group). Additionally, a control group consisting of 100 healthy individuals who underwent physical examinations during the same time frame was included. According to the postoperative follow-up results, the patients with brain glioma were divided into death subgroup (n=30) and survival subgroup (n=85). Reverse transcription-polymerase chain reaction was used to identify the presence of molecules associated with the CXCR4/Akt signaling pathway in the peripheral blood samples.</p> <p><bold>Results</bold>: The expressions of the CXCR4/Akt signaling pathway-related molecules differed significantly among tumor World Health Organization (WHO) grades and clinical outcome subgroups (P&lt;0.05). The CXCR4 expression showed a significant correlation with the WHO grade of the tumor, Akt mRNA, E-cadherin, N-cadherin, and vimentin (P&lt;0.05). The prognosis was significantly influenced by the elevated levels of CXCR4/Akt, tumor WHO grade, E-cadherin, N-cadherin, and vimentin, which acted as autonomous risk factors. The prognostic prediction accuracy of CXCR4/Akt was 90.48% for sensitivity and 94.87% for specificity, with a significant area under the receiver operating characteristic curve of 0.908 (P&lt;0.05). Patients with high levels of CXCR4/Akt signaling pathway-related molecules had a considerably lower 5-year survival rate compared to those with low levels (21.08% vs. 46.37%, P&lt;0.05).</p> <p><bold>Conclusions</bold>: The expression of the CXCR4/Akt signaling pathway is significantly up-regulated in the peripheral blood of patients with brain glioma and is closely related to malignant tumor transformation.</p> </abstract>ARTICLEtrue of the S1P pathway in hypoxia-induced cardiovascular failure<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: Vascular failure (VF) and heart failure (HF) are extremely harmful and are the primary causes of hypoxia. Our previous results have shown that the sphingosine-1-phosphate (S1P) pathway was involved in regulating intermittent hypoxia–induced vascular defection, but the clinical role and molecular mechanism of the S1P pathway remain unclear.</p> <p><bold>Methods</bold>: Normalized relative expression values and differentially expressed genes were downloaded in GSE145221 from the Gene Expression Omnibus dataset. WGCNA was used to construct a gene co-expression network. The Spearman correlation matrix was used to identify the top 500 highly correlated genes with the S1P pathway genes. R package clusterProfiler was used to perform Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses on the WGCNA modules. Homer software was utilized to identify regulatory motifs in the promoter and gene body regions of S1P pathway genes. An intermittent hypoxic injury cell model was induced by chronic intermittent hypoxia (CIH). ROS and TUNEL staining and Western blot were used to detect cell apoptosis and reactive oxygen species.</p> <p><bold>Results</bold>: The transcriptional regulatory regions of S1P pathway genes were enriched with hypoxia-inducible factor 1-alpha, which indicated the close connection between the S1P pathway and the CIH process. In vitro, we confirmed that the endothelial cell apoptosis induced by CIH could be reversed by exogenous addition of S1P.</p> <p><bold>Conclusions</bold>: This study elucidated the mechanism of the S1P pathway in regulating cardiovascular injury caused by CIH and provided a new strategy for early intervention in people with cardiovascular dysfunction induced by hypoxia.</p> </abstract>ARTICLEtrue in prophylactic therapy with Emicizumab in patients with hemophilia A: Focus on monitoring tests<abstract> <title style='display:none'>Abstract</title> <p>This study presents a transversal investigation that we performed at Fundeni hospital (Bucharest, Romania) into the therapeutic benefits and efficacy of Emicizumab, a non-factor therapy, in the context of hemophilia A. Ten patients diagnosed with hemophilia A were closely monitored using clinical and laboratory resources during Emicizumab treatment, with an average of 12.8 months. Among these patients, six exhibited anti-factor VIII inhibitors, changing the medical strategy and adding complexity to their clinical profiles. A comprehensive approach was adopted to assess the coagulation status of patients under Emicizumab therapy. The study employed several key coagulation monitoring tools, including thrombin generation time (TGT) and thrombelastography (TEG). These methodologies generated valuable results in evaluating the patients’ coagulation profiles during the treatment regimen. Additionally, traditional coagulation assays were utilized to gain a profound understanding of the overall coagulation dynamics and to evaluate the therapeutic response. During prophylaxis with Emicizumab all patients experienced a reduced number of bleeding events. Moreover, a subset of these patients underwent major surgical procedures (orthopedic joint replacements, cholecystectomy) with successful outcomes. These findings underscore the potential of Emicizumab therapy as an effective option for hemophilia A patients, including those with inhibitors. Our research provides physicians several insights, offering a potential avenue for improved patients’ care and treatment strategies that translate in enhanced quality of life for hemophilia A patients undergoing Emicizumab therapy.</p> </abstract>ARTICLEtrue the pathogenesis, clinical, laboratory diagnosis and treatment of the recent monkeypox virus outbreak<abstract> <title style='display:none'>Abstract</title> <p>Human mpox is a zoonotic disease, caused by the mpox virus (MPXV), that can spread either between animals and humans or humans and humans. In 1970 the first human case of mpox was reported in Zaire, Democratic Republic of the Congo (DRC). Other notable human mpox outbreaks in non-endemic countries were identified in June 2003 in the United States, in July 2021 in Dallas (USA), and the most recent one in May 2022 in Europe in the United Kingdom (UK). During the 2022 outbreak, sexual intercourse was observed to be the most prevalent transmission method, although other means should not be ignored, such as the involvement of respiratory droplets, exposure to surfaces and skin suspected of contamination. In the context of the current mpox outbreak, we consider it important and necessary to correctly identify the virus, use the proper laboratory testing for a correct diagnosis of mpox, understand the means of prophylaxis, and apply the correct treatment, highlighting these facts being the aim of this study.</p> </abstract>ARTICLEtrue of special AT-rich sequence binding protein 2 and chitinase-3-like protein-1 with sensitivity to paclitaxel chemotherapy for gastric cancer<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: Our objective was to examine the associations between special AT-rich sequence binding protein 2 (SATB2) and chitinase-3-like protein-1 (CHI3L1) and the responsiveness to paclitaxel treatment in individuals with gastric cancer.</p> <p><bold>Methods</bold>: From March 2018 to October 2020, our hospital collected gastric cancer samples along with adjacent gastric mucosal tissues located more than 5 cm away from the cancerous margin. These samples were obtained from 90 patients who underwent chemotherapy regimens containing paclitaxel. To assess the rates of positive expression of CHI3L1 and SATB2 in gastric cancer and adjacent tissues, the immunohistochemical streptavidin-peroxidase (SP) technique was utilized.</p> <p><bold>Results</bold>: The positive expression rate of CHI3L1 was higher in gastric cancer tissues compared to adjacent tissues, while the positive expression rate of SATB2 was lower (P&lt;0.05). Risk factors that influenced the positive expression of CHI3L1 in gastric cancer tissues included the level of differentiation, tumor-node-metastasis (TNM) stage, and the presence of lymph node metastasis (OR&gt;1, P&lt;0.05). Additionally, the positive expression of SATB2 was also affected by TNM stage and lymph node metastasis, which were identified as risk factors (OR&gt;1, P&lt;0.05). In gastric cancer tissues, there was a negative correlation observed between the expressions of CHI3L1 and SATB2 (r&lt;0, P&lt;0.05). According to the analysis results of Kendall’s tau-b (K), it was found that the presence of CHI3L1 had an inverse relationship with the responsiveness to paclitaxel-based chemotherapy in gastric cancer (r=-0.498, P=0.000), while SATB2 exhibited a positive correlation with the sensitivity (r=0.513, P=0.000). During the 3-year follow-up after chemotherapy, the survival rate was 55.55% (50/90).</p> <p><bold>Conclusions</bold>: The findings indicate a strong correlation between SATB2 and CHI3L1 with the TNM stage, lymph node metastasis, response to paclitaxel-based chemotherapy, and the overall survival rate of individuals.</p> </abstract>ARTICLEtrue serum tryptophan metabolites in patients with gestational diabetes mellitus<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Although pregnancy is a physiological condition, the secretion of diabetogenic hormones such as growth hormone, corticotropin-releasing hormone, placental lactogen hormone, prolactin and progesterone from the placenta could lead to insulin resistance (IR). In Metabolic Syndrome, obesity and Type1&amp;2 diabetes, a shift in the kynurenine pathway (KP) towards IDO activation is observed. The activation of the IDO leads to the activation of the Aryl hydrocarbon receptor (AhR) and Interleukin-6 (IL-6) also, which may also induce some effects like insulin resistance, β-cell disfunction and increased gluconeogenesis. We hypothesized that the overactivation of IDO and some KP enzymes would be observed in GDM patients, in a similar manner to metabolic syndrome, prediabetes, and diabetes patients.</p> <p><bold>Methods</bold>: 50 patients and 50 controls, who applied to the Endocrinology outpatient clinic of Selcuk University Faculty of Medicine were included. Serum triptophan metabolite levels were measured with liquid chromatography tandem mass spectrometry.</p> <p><bold>Results</bold>: Tryptophan and KYNA values was found to be lower in the patient group diagnosed with GDM (p&lt;0.001 and p&lt;0.001, respectively). The levels of KYN, 3-OH AA, 3-OH-KYN and KTR were significantly higher in the patient group compared to the control group (p=0.008, p&lt;0.001, p=0.05 and p&lt;0.001, respectively).</p> <p><bold>Conclusions</bold>: Understanding the changes that occur in this pathway in GDM patients may provide insight into the development of the disease. Also these tests could be used as supplementary tests in gestational diabetes, which could assist in diagnosis and patient follow-up.</p> </abstract>ARTICLEtrue of levels of high-molecular-weight adiponectin, secreted frizzled-related protein 5 and vascular endothelial growth factor-165 with diabetic retinopathy<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: The pathogenesis of diabetic retinopathy (DR) remains unclear. The aim of the study was to explore the associations of DR with the levels of high-molecular-weight adiponectin (HMW-ADP), secreted frizzled-related protein 5 (SFRP-5) as well as vascular endothelial growth factor-165 (VEGF165).</p> <p><bold>Methods</bold>: Based on the diagnostic criteria for DR, non-DR (NDR), proliferative DR (PDR) plus non-proliferative DR (NPDR) groups were set up for type 2 diabetes mellitus (T2DM) patients (n=180) treated from January 2020 to March 2021. The control group consisted of another 60 healthy subjects undergoing physical examinations. Their clinical data were compared. Receiver operating characteristic curves were plotted to assess the predictive values of HMW-ADP, VEGF165 and SFRP-5 for DR. The predictive efficiency of the established nomogram model was assessed.</p> <p><bold>Results</bold>: The differences in age, fasting plasma glucose (FPG), T2DM duration, triglyceride (TG), hypertension history, high-density lipoprotein cholesterol (HDL-C), glycosylated haemoglobin (HbA1c), serum creatinine (Scr), homeostasis model assessment of insulin resistance (HOMA-IR), urine acid (UA), SFRP-5 HMW-ADP, and VEGF165 were significant between control and DR groups (P&lt;0.05). HMW-ADP, VEGF165 and SFRP-5 had predictive values for DR (AUC&gt;0.7), and the predictive efficiency of their combination was highest. The duration of T2DM, Scr, UA and VEGF165 were independent risk factors for DR, while HMW-ADP and SFRP-5 were protective factors (P&lt;0.05). Preferable discrimination and accuracy together with clinical applicability were obtained for the nomogram prediction model.</p> <p><bold>Conclusions</bold>: The three indicators as a whole have a high predictive value for DR, as potential indicators for the clinical screening of high-risk groups.</p> </abstract>ARTICLEtrue