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Diagnostics

Diagnostics is an international, peer-reviewed, open access journal on medical diagnosis published semimonthly online by MDPI.
The British Neuro-Oncology Society (BNOS), the International Society for Infectious Diseases in Obstetrics and Gynaecology (ISIDOG) and the Swiss Union of Laboratory Medicine (SULM) are affiliated with Diagnostics and their members receive a discount on the article processing charges.
Indexed in PubMed | Quartile Ranking JCR - Q1 (Medicine, General and Internal)

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All Articles (18,040)

Antinuclear Antibodies Predict Treatment Escalation and Biologic Switching in Rheumatoid Arthritis

  • Zeynel Abidin Akar,
  • Dilan Yıldırım and
  • Mehmet Çağlayan
  • + 8 authors

Background: Antinuclear antibodies (ANAs) are frequently detected in patients with rheumatoid arthritis (RA); however, their prognostic relevance for predicting treatment escalation and biologic therapy initiation remains incompletely understood. Identifying biomarkers associated with earlier transition to advanced therapies may enhance individualized, treat-to-target disease management. Objectives: We aimed to evaluate the association of ANA status and titer levels with clinical characteristics, treatment trajectories, and time to biologic therapy initiation in patients with RA. Methods: In this retrospective cohort study, 223 patients with RA were stratified according to ANA status (112 ANA-positive, 111 ANA-negative). Baseline demographic data, disease activity (DAS28), and serological markers (RF, anti-CCP) were analyzed. Time to biologic therapy initiation, defined from the date of RA diagnosis to first biologic or targeted synthetic DMARD use, was assessed using Kaplan–Meier survival analysis and Cox proportional hazards regression. Multivariate models adjusted for clinically relevant covariates (age, sex, disease duration, RF, anti-CCP). Within the ANA-positive group, exploratory analyses compared low–moderate (1:80–1:320) and high (>1:320) ANA titers, highlighting potential non-linear effects. Results: Baseline demographic and clinical characteristics were comparable between groups (all p > 0.05). ANA-positive patients more frequently initiated biologic therapy (48.2% vs. 24.3%, p < 0.001) and experienced multiple biologic switches (29.5% vs. 16.2%, p = 0.028). In multivariate analysis, ANA positivity independently predicted earlier biologic therapy initiation (adjusted HR 2.14; 95% CI 1.32–3.46; p = 0.002), whereas RF and anti-CCP status were not significant predictors. Exploratory subgroup analysis revealed the “titer paradox,” whereby high ANA titers (>1:320) were associated with a lower hazard of biologic therapy initiation compared with low–moderate titers (HR 0.24; 95% CI 0.06–0.98; p = 0.048). Conclusions: ANA positivity serves as an independent prognostic marker for earlier biologic therapy initiation in RA, providing incremental information beyond traditional serological markers. The observed non-linear association between ANA titers and treatment escalation underscores the need for cautious interpretation and validation in prospective, mechanistic studies, and highlights the potential value of integrating ANA profiling into personalized treatment strategies.

23 March 2026

Kaplan–Meier Curves for Biologic Therapy Initiation Stratified by ANA Titer Levels. Kaplan–Meier survival curves illustrate the cumulative probability of remaining biologic-free over time in patients stratified by ANA titer groups: low–moderate ANA titer (1:80–1:320; n = 98, solid blue line) and high ANA titer (&gt;1:320; n = 14, dashed red line). Censoring events are indicated by plus signs (+). The log-rank test demonstrates a significant difference between groups (p = 0.017). Multivariate Cox proportional hazards analysis shows that high ANA titer is associated with a decreased hazard of biologic therapy initiation compared to the low–moderate titer group (HR = 0.24, 95% CI: 0.06–0.98, p = 0.048).

Background/Objectives: Post-COVID-19 fibrotic-like lung changes (PC19-FLC), which may represent persistent post-inflammatory abnormalities or early fibrotic remodeling, have emerged as an important long-term pulmonary sequela following SARS-CoV-2 infection. However, the underlying pathogenic mechanisms remain incompletely understood. This study aimed to investigate the potential association between mammalian target of rapamycin (mTOR) activity and the presence of PC19-FLC. Methods: This single-center, cross-sectional study included 70 patients who met the predefined inclusion criteria. Participants were categorized according to the presence or absence of PC19-FLC on chest computed tomography. Demographic, laboratory, and radiological data were collected. Serum mTOR levels were measured using enzyme-linked immunosorbent assay (ELISA). Results: Serum mTOR levels and modified Medical Research Council (mMRC) dyspnea scores were significantly higher in patients with PC19-FLC compared with those without fibrotic-like changes. Receiver operating characteristic (ROC) curve analysis identified a serum mTOR cut-off value of 6.15 ng/mL (sensitivity 83%, specificity 94%) for discriminating patients with PC19-FLC in this cohort. Serum mTOR levels were significantly correlated with forced vital capacity (FVC%), mMRC dyspnea score, and peripheral oxygen saturation (SpO2). Conclusions: Increased serum mTOR levels were associated with the presence of fibrotic-like lung changes after COVID-19 and may help distinguish patients with such CT abnormalities in this cohort. Higher mTOR levels were also associated with greater dyspnea severity, lower lung volumes, and reduced peripheral oxygen saturation. These findings suggest a potential role of mTOR signaling in post-COVID-19 pulmonary sequelae and warrant further investigation in larger, multicenter studies.

23 March 2026

Study flow diagram of patient selection and group allocation. PC-FLC: Post-COVID fibrotic-like lung changes; Control: No fibrotic CT abnormalities.

Acromegalic Uteropathy: Specific Uterine Ultrasound Findings in Female Patients

  • Irina Stanoevich,
  • Aurika Asanova and
  • Natalya Mokrysheva
  • + 8 authors

Background/Objectives: Acromegaly is a systemic connective tissue disease driven by chronic growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess; yet, the female reproductive tract—especially the extracellular matrix (ECM)-rich cervix—has been poorly studied. We aimed to compare uterine and cervical morphology in women with acromegaly versus healthy controls and a gynecologic disease comparator, testing the hypothesis of selective cervical hypertrophy. Methods: We performed a retrospective case–control study of reproductive-age women who underwent pelvic ultrasound: acromegaly (n = 33), healthy controls (n = 45), and adenomyosis without acromegaly (n = 44). Uterine body measurements were obtained by TAUS/TVUS; cervical biometry was performed transvaginally in all cases. Volumes were estimated using the ellipsoid formula, and a uterus-to-cervix (U:C) volume ratio was calculated. Group differences were analyzed with Mann–Whitney tests and Bonferroni correction. Results: A total of 122 women were included. Uterine body length, width, AP size, and volume did not differ between acromegaly and either comparison group (all p-values non-significant). In contrast, cervical length, width, AP thickness, and volume were significantly higher in acromegaly than in healthy controls, with a corresponding reduction in the U:C volume ratio, indicating disproportionate cervical enlargement. Compared with adenomyosis, women with acromegaly again showed larger cervical width, AP thickness, and volume, together with altered U:C indices, whereas cervical length did not differ, suggesting a pattern not explained by nonspecific pelvic pathology. Conclusions: Women with acromegaly demonstrate a distinct uterine phenotype characterized by selective cervical hypertrophy with preserved uterine corpus size—an ECM-centric “acromegalic uteropathy.” This noninvasive morphometric signature may have diagnostic and procedural relevance and warrants confirmation in prospective studies.

23 March 2026

Proposed pathophysiological model of “acromegalic uteropathy” with preferential cervical stromal expansion.

Background/Objectives: Over the last two decades, there has been a substantial change in the understanding of post-traumatic hypopituitarism (PTHP), which is no longer regarded as a marginal phenomenon. Clinical manifestations of pituitary hormone deficiency are frequently nonspecific, with fatigue and cognitive dysfunction predominating. Given that head injuries currently constitute a global burden for healthcare systems, the aim of the present study was to determine whether self-reported post-mild traumatic brain injury (mTBI) symptoms that may indicate hypopituitarism reflect true pituitary insufficiency or are attributable to other hormonal aberrations. The study aimed to assess the relationship between self-reported symptoms of PTHP and hormonal test results following mTBI. Setting: Patients were recruited from a tertiary trauma center Emergency Department (ED) in northern Poland from January 2023 to October 2025. Participants: The participants were adult (18 > y.o.) individuals with mTBI who met the inclusion criteria. Design: This was a prospective cohort study. During their post-head injury admission to the ED, patients had a blood sample taken. The procedure was repeated consecutively after 3, 6 and 12 months. After 6 and 12 months, patients were asked to complete a questionnaire. Methods: Pituitary and thyroid hormones were measured using the chemiluminescence immunoassay method and the heterogenous immunochemiluminescence method. The questionnaire used, Questionnaire for the Assessment of Symptoms of Anterior Pituitary Insufficiency in Patients After Mild Traumatic Brain Injury (mTBI) Hospitalized in the Emergency Department, was designed for the purposes of this study. Results: Self-reported symptoms suggestive of anterior pituitary dysfunction following mTBI were not confirmed by laboratory assessment of pituitary hormones. However, after 6 months, a statistically significant correlation was found between the number of reported symptoms and prolactin levels (ρ = 0.730; p = 0.0013), whereas after 12 months a downward trend in free triiodothyronine (fT3) levels was observed compared with the baseline. Conclusions: Persistent symptoms reported by patients following mTBI at 6 and 12 months, particularly fatigue and impaired concentration, showed statistical associations with prolactin levels at 6 months and lower fT3 levels at 12 months. These findings reflect correlations identified in the statistical analysis and do not support inferences regarding causality or the presence of true PTHP.

23 March 2026

Distribution of patients across different stages of the study.

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Diagnostics - ISSN 2075-4418