Novità nel mondo di Medicina di Laboratorio

Low-yield diagnostic testing is common, but machine learning could potentially identify and discourage wasteful testing that may be costly and harmful, researchers say.
Reuters Health Information

This review explores the principles behind and the many uses of thromboelastography and thromboelastometry. How can these diagnostic tests be used in guiding blood product transfusions?
American Journal of Clinical Pathology

The Centers for Medicare & Medicaid Services moves to let more clinicians write progress notes on psychiatric patients and to allow telephone orders for portable X-rays through omnibus rule.
Medscape Medical News

A new trial of autologous mesenchymal stem cells in progressive MS has shown significant benefits vs placebo in several measures of disability.
Medscape Medical News

Metabolic "signatures" in baby teeth can distinguish ADHD from autism as well as cases in which both neurodevelopmental disorders are present, early research suggests.
Medscape Medical News

The recent explosion in our knowledge of the molecular basis of immune regulatory mechanisms has paved the way for rapid developments in immunosuppression, immunotherapy, allergy, autoimmunity, and immunodeficiencies, all of which have impacted the practice of clinical laboratory immunology. The advent of immune checkpoint inhibitors and cell therapies in recent years has led to a surge of interest in clinical immunology. Advancements in lasers, microfluidics, and advanced electronics have resulted in the proliferation of robust and affordable flow cytometry or cell-sorting instruments that can withstand the demands of a clinical lab.

For decades, autoantibody detection has comprised the bulk of clinical laboratory immunology. However, most immune disorders are caused by imbalances in both humoral and cellular immunity. Our knowledge of the immune system has grown exponentially, resulting in new treatment paradigms in immunology. Extensive functional characterization of lymphocyte subsets is routinely carried out in a research laboratories, facilitated by the emergence of high-dimensional analysis technologies for low cell numbers. It will not be long before these approaches enter the diagnostic realm. This chapter outlines emerging trends in laboratory immunology testing with a focus on deep immune profiling or high-dimensional testing modalities.

“With the increasing application of biotechnology to the realm of pharmacology and therapeutics, the types of biological treatments available have significantly expanded. Currently, recombinant proteins, humanized antibodies, or rationally engineered monoclonal antibodies are used on a regular basis in the clinical setting. Moreover, cell-based therapeutics with molecularly rewired antigenic specificities are becoming increasingly common in oncology and are actively being developed for a broad range of diseases. Nonetheless, there has been a significant lag between the development of these technologies and the emergence of assays that can monitor these novel interventions.”

The outcomes of kidney transplantation show a steady improvement with an increasing number of transplantations and decreasing incidence of acute rejection episodes. Successful transplantation begins with a comprehensive immunologic risk assessment and judicious choice of therapeutic agents. In this review, we discuss the trends in transplant immunosuppression practices and outcomes in the United States. We discuss practical testing algorithms for clinical decision making in induction therapy and fine-tuning maintenance immunosuppression. We introduce assessment tools for immune monitoring after transplantation and speculate on future directions in management.

Although the gold standard for diagnosis of immunoglobulin E (IgE)-mediated food allergy is an oral food challenge, clinically relevant biomarkers of IgE sensitization, including serum-specific IgE and skin prick testing, can aid in diagnosis. Clinically useful values have been defined for individual foods. More recently, specific IgE to particular protein components has provided additional diagnostic value. In summary, food allergy diagnostics to evaluate IgE sensitization are clinically useful and continue to evolve to improve evaluation of IgE-mediated food allergies.

Laboratory assays of immune cell function are essential for understanding the type and function of immune defects. These assessments should be performed in conjunction with a detailed history and physical examination, which should guide the evaluation of patients with a suspected immune deficiency. Laboratory assays of immune cell function are critical for assessing and demonstrating the functional impact of genetic mutations. Advances in diagnostic techniques continue to expand the ability of clinicians and researchers to understand the complex immune pathophysiology that underlies these disorders.

The complement system is a critical component of both the innate and adaptive immune systems that augments the function of antibodies and phagocytes. Antigen-antibody immune complexes, lectin binding, and accelerated C3 tick-over can activate this well-coordinated and carefully regulated process. The importance of this system is highlighted by the disorders that arise when complement components or regulators are deficient or dysregulated. This article describes the pathways involved in complement activation and function, the regulation of these various pathways, and the interpretation of laboratory testing performed for the diagnosis of diseases of complement deficiency, exuberant complement activation, and complement dysregulation.

The discovery of antineutrophil cytoplasmic antibodies (ANCA) helped establish ANCA-associated vasculitis as a separate and well-defined clinical entity. Its progressive incorporation into the clinical diagnosis algorithms has made ANCA testing a cornerstone immunoassay embedded in the management of ANCA-associated vasculitis. After its description by indirect immunofluorescence, proteinase-3 and myeloperoxidase were identified as principal ANCA targets. ANCA, and proteinase-3 and myeloperoxidase immunoassessment, have undergone iterative rounds of improvement in sensitivity and specificity. This article traces landmarks in the development of ANCA tests, describes common pitfalls arising during ANCA interpretation, and discusses new technologies to improve the future of ANCA testing.

Accurate diagnosis of inflammatory arthritides remains a challenge because of substantial clinical overlap. To achieve a granular classification for informing clinical decisions, numerous potential serologic biomarkers have been identified. Rheumatologists have settled on rheumatoid factor and anti–citrullinated protein antibodies for the diagnosis of rheumatoid arthritis (RA) based on specificity and sensitivity and their ability to be integrated into clinical algorithms. These biomarkers should be interpreted in their specific clinical context. This article discusses the serologic basis for the diagnosis of RA, how these biomarkers have framed conceptualization of the pathogenesis of RA, and the inherent limitations in their use.

Red blood cell width, routinely available in full blood counts, is associated with likelihood of hip fracture and could offer a good way to identify high risk patients at no cost, say researchers.
Medscape Medical News

If the settlement is ratified, 85,000 union workers will stay on the job in six states and the District of Columbia; the union gets sweetened terms after hard bargaining.
Medscape Medical News

The U.S. Preventive Services Task Force (USPSTF) continues to recommend screening for asymptomatic bacteriuria in pregnant women with urine culture and discourage such screening in nonpregnant adults, based on an updated systematic review of the evidence.
Reuters Health Information

The promise of serum neurofilament light chain to diagnose multiple sclerosis continues to evolve, with new evidence supporting a role in identifying presymptomatic disease.
Medscape Medical News

Multimodal balance training with rhythmic cues improved balance and freezing of gait with persistent benefit in Parkinson's patients, a well-controlled study has shown.
Medscape Medical News

Dr Bishal Gyawali shares what he has learned about empathy and culture in medicine through his experiences of delivering difficult news to cancer patients around the world.
Medscape Oncology