Search Results (248)

Background: Wrong blood in tube (WBIT) is a critical pre-analytical error in laboratory medicine in which a blood sample is mislabeled with the wrong patient identity. These errors are often undetected due to the limitations of current detection strategies (e.g., delta checks). Methods: We evaluated Random Forest models for WBIT detection and conducted a detailed analyte importance analysis. In total, 799,721 samples from a German tertiary care center were analyzed and filtered for applicability. Model input features were derived by pairing consecutive same-patient samples for non-WBIT cases, simulating WBIT by pairing samples from different patients, and computing per-analyte first-order differences for each pair. We exhaustively searched all subsets of nine CBC analytes and evaluated models using F1 score, AUC, sensitivity, and PPV. Analyte importance was assessed via SHAP, permutation, and impurity decrease. Results: Models using as few as three analytes (MCV, RDW, MCH) reached F1 scores above 90%, with performance plateauing beyond six analytes. MCV and RDW were consistently top-ranked. Two-dimensional and three-dimensional visualizations revealed interpretable decision boundaries. Conclusions: Findings demonstrate that robust WBIT detection is achievable using a minimal subset of CBC analytes, offering a practical, interpretable, and broadly generalizable ML-based solution suitable for diverse clinical environments. Full article

Background and Objectives: This study aims to evaluate the diagnostic potential of routinely available hematological parameters for acute myocardial infarction (AMI) by employing an Explainable Neural Network (ENN) model that combines high predictive accuracy with interpretability. Materials and Methods: A publicly available dataset comprising 981 individuals (477 AMI patients and 504 controls) was analyzed. A broad set of hematological features—including white blood cell subtypes, red cell indices, and platelet-based markers—was used to train an ENN model. Bootstrap resampling was applied to enhance model generalizability. The model’s performance was assessed using standard classification metrics such as accuracy, sensitivity, specificity, F1-score, and Matthews Correlation Coefficient (MCC). SHapley Additive exPlanations (SHAP) were employed to provide both global and individualized insights into feature contributions. Results: The study analyzed hematological and biochemical parameters of 981 individuals. The explainable neural network (ENN) model demonstrated excellent diagnostic performance, achieving an accuracy of 94.1%, balanced accuracy of 94.2%, F1-score of 93.9%, and MCC of 0.883. The AUC was 0.96, confirming strong discriminative ability. SHAP-based explainability analyses highlighted neutrophils (NEU), white blood cells (WBC), RDW-CV, basophils (BA), and lymphocytes (LY) as the most influential predictors. Individual- and class-level SHAP evaluations revealed that inflammatory and erythrocyte-related parameters played decisive roles in AMI classification, while distributional analyses showed narrower parameter ranges in healthy individuals and greater heterogeneity among patients. Conclusions: The findings suggest that cost-effective, non-invasive blood parameters can be effectively utilized within interpretable AI frameworks to enhance AMI diagnosis. The integration of ENN with SHAP provides a dual benefit of diagnostic power and transparent rationale, facilitating clinician trust and real-world applicability. This scalable, explainable model offers a clinically viable decision-support tool aligned with the principles of precision medicine and ethical AI. Full article

Background/Objectives: Prognostic biomarkers are essential for guiding the clinical management of pulmonary hypertension (PH). This study aimed to assess both established and novel biomarkers—specifically, the red cell distribution width-to-estimated glomerular filtration rate ratio (RGR) and the NT-proBNP-to-albumin ratio (NTAR)—for their ability to predict length of hospital stay (LOS), prolonged LOS (ELOS), in-hospital mortality, and 3-month all-cause mortality in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods: A retrospective analysis was conducted on 275 PH-related hospital regular admissions (148 PAH; 127 CTEPH). Established biomarkers—including serum albumin, neutrophil-to-lymphocyte ratio (NLR), Log NT-proBNP, red cell distribution width (RDW), and estimated glomerular filtration rate (eGFR)—as well as novel indices (RGR, and NTAR) were examined for their relationships with LOS, ELOS, in-hospital mortality, and 3-month all-cause mortality. Spearman correlation, univariate logistic regression, and ROC analyses evaluated biomarker relationships and predictive performance. Results: Serum albumin independently predicted in-hospital and 3-month mortality in PAH, while in CTEPH, it inversely correlated with LOS and strongly predicted prolonged hospitalization and mortality (AUC = 0.833). NLR had limited correlation with LOS but predicted mortality across both groups. RDW correlated weakly with LOS, significantly predicting prolonged hospitalization (threshold > 52.1 fL) in PAH but not in CTEPH. Preserved renal function (eGFR > 60 mL/min/1.73 m²) was inversely associated with LOS in CTEPH patients, suggesting a protective effect. Additionally, reduced eGFR significantly predicted mortality in both PAH (AUC = 0.701; optimal cut-off ≤ 97.4 mL/min/1.73 m²) and CTEPH (AUC = 0.793; optimal cut-off ≤ 59.2 mL/min/1.73 m²) groups. NTAR (AUC = 0.817) outperformed Log NT-proBNP alone in predicting extended hospitalization and mortality, whereas RGR correlated with LOS and predicted in-hospital mortality. Phenotype-specific analysis demonstrated that inflammatory and renal biomarkers had a stronger prognostic impact in CTEPH. Conclusions: Stratification by PH phenotype highlighted the greater prognostic significance of inflammatory and renal indices, particularly in patients with CTEPH. Incorporating NTAR and RGR into clinical workflows may enhance risk stratification and enable more precisely targeted interventions to improve outcomes in pulmonary hypertension. Full article

Pythium schmitthenneri, a soilborne pathogen responsible for root rot in olive trees, poses a significant threat to olive production. Managing this pathogen remains challenging due to its aggressive root colonization and the limited efficacy of conventional control methods. Given the concerns associated with chemical treatments, this study evaluated the resistance of eight olive varieties to P. schmitthenneri-induced root rot under controlled greenhouse conditions by assessing structural and biochemical defense mechanisms. Greenhouse trials revealed that Arbequina, Koroneiki, and Haouziya exhibited strong resistance, with 0% disease severity, while Picholine Marocaine and Picholine Languedoc were highly susceptible, reaching 100% disease severity. Growth parameters varied significantly, with susceptible varieties showing severe reductions in root length (RL), root fresh weight (RFW), and root dry weight (RDW), whereas resistant varieties maintained these parameters unchanged. While shoot length (SL) remained unaffected across all varieties, shoot fresh weight (SFW) and shoot dry weight (SDW) were significantly reduced in susceptible ones. Fourier-transform infrared (FTIR) spectroscopy revealed that resistant varieties maintained stable levels of lignin, cellulose, and polysaccharides, while susceptible ones exhibited extensive cell wall degradation. Additionally, total polyphenol content (TPC) and total flavonoid content (TFC) significantly increased in resistant varieties upon infection, whereas susceptible varieties experienced a substantial decline. These findings highlight the crucial role of structural and biochemical defenses in olive resistance to P. schmitthenneri and suggest that selecting resistant varieties could serve as a sustainable strategy for managing root rot in olive production. Full article

Aging is a complex biological process marked by progressive physiological decline with increasing vulnerability to diseases such as cardiovascular disorders, neurodegenerative conditions, and metabolic syndromes. Identifying reliable biomarkers of aging is essential for assessing biological age, predicting health outcomes, and guiding interventions to promote healthy aging. Among various candidate biomarkers, red blood cells (RBCs) offer a unique and accessible window into the aging process due to their abundance, finite lifespan, and responsiveness to systemic changes. This review examines the potential of RBCs as biomarkers of aging by exploring their age-associated morphological, functional, and biochemical alterations. Age-related reduction in key haematological parameters such as RBC count, haemoglobin concentration, and haematocrit, and increases in mean cell volume (MCV) and red cell distribution width (RDW), reflect underlying shifts in erythropoiesis and cellular turnover. Functional changes include reduced oxygen-carrying capacity, decreased deformability, diminished ATP release, and increased RBC aggregation, all of which may impair both macrocirculatory and microcirculatory flow and tissue oxygenation. Biochemically, aging RBCs exhibit altered membrane lipid and protein composition, reduced membrane fluidity, and diminished antioxidant and enzymatic activity, contributing to cellular senescence and clearance. Despite these promising indicators, challenges persist in establishing RBC parameters as definitive biomarkers of aging. Inter-individual and intra-individual variability and storage-related artifacts complicate their use. In conclusion, RBCs present a compelling, though currently underutilized, avenue for aging biomarker research. Further longitudinal validation and mechanistic research are essential to support the clinical utility of RBC parameters as biomarkers of aging. Full article

Backgrounds: The incidence of gastrointestinal cancers (GICs), though decreased in recent years, still accounts for 35% of all cancer-related mortality. The proper identification of risk factors, early diagnosis, and therapy optimization represent the three cornerstones of GIC treatment. In four-stage diseases, chemotherapy embodies target therapy that may prolong patients’ expectancy when suitably applied. Patients and Methods: There were 133 (82 (62%) male and 51 (38%) female) consecutive patients with a median age of 70 (64–74) years who underwent palliative treatment due to four-stage colorectal cancer (CRC) between 2022 and 2024. The demographic, clinical, and laboratory data and applied chemotherapeutic protocols were evaluated regarding the response to applied therapy, resulting in complete or partial tumor regression. The advancement of the tumor was based on computed tomography (CT) performed before and 6 months after the chemotherapy. Results: The multivariable model revealed red cell distribution width (RDW) from peripheral blood analysis (OR: 0.81, 95% CI: 0.65–1.00, p = 0.049) as a possible predictor for systemic treatment response in colorectal cancer. The receiver operating characteristic curve revealed a predictive value of male sex and RDW prior to systemic therapy, with an area under the curve of 0.672, yielding a sensitivity of 70.0% and specificity of 58.1%. Conclusions: The results of our analysis point out the possible modulatory impact of RDW on six-month systemic therapy in colorectal terminal cancer management. Further studies are required to confirm the presented results. Full article

Atriplex hortensis var. rubra (red orache, RO) is a halotolerant species rich in nutraceutical compounds, which makes it a valuable crop for human nutrition. This plant could also be exploited for phytoremediation of contaminated soil and wastewater, and for saline aquaponics. A root rot disease was observed on hydroponically grown RO plants, caused by Pythium deliense and Pythium Cluster B2a sp. Identification was based on morphology, molecular analysis (ITS and COI), and phylogenetic analysis. We assessed disease severity in plants grown in a growth chamber with nutrient solutions containing different NaCl concentrations (0, 7, and 14 g L⁻¹ NaCl). In vitro growth at different salinity levels and temperatures was also evaluated. Both Pythium species were pathogenic but showed different responses. Pythium deliense was significantly more virulent than Pythium Cluster B2a sp., causing a steady reduction in root dry weight (RDW) of 70% across all salinity levels. Pythium Cluster B2a sp. reduced RDW by 50% at 0 and 7 g L⁻¹ NaCl while no symptoms were observed at 14 g L⁻¹ NaCl. Pythium deliense grew best at 7 and 14 g L⁻¹ NaCl, while Pythium Cluster B2a sp. growth was reduced at 14 g L⁻¹ NaCl. Both pathogens had an optimum temperature of 30 °C. This is the first report of Pythium spp. causing root rot on RO grown hydroponically. The effective use of halophytic crops must consider pathogen occurrence and fitness in saline conditions. Full article

Heavy metals are a major toxicological concern due to their adverse effects on human health, particularly in children exposed to contaminated areas. This study evaluated biomarkers of exposure in 253 children aged 6 to 12 from Magangue, Achi, and Arjona (Bolivar, Colombia), analyzing their relationship with neurotoxicity and hematological markers. The mean Pb concentrations at the study sites were 1.98 µg/g (Magangue) > 1.51 µg/g (Achi) > 1.24 µg/g (Arjona). A similar pattern was observed for Cd concentrations for Magangue (0.39 µg/g) > Achi (0.36 µg/g) > Arjona (0.14 µg/g). In contrast, Se concentrations followed a different trend for Arjona (0.29 µg/g) > Magangue (0.21 µg/g) > Achi (0.16 µg/g). The proportion of Se/Pb molar ratios > 1 was higher in Arjona (3.8%) than in Magangue (0.9%) and Achi (2.0%). For Se/Cd ratios, values > 1 were also more frequent in Arjona (70.7%), exceeding 20% in the other two locations. Significant differences were found among locations in red and white blood cell parameters and platelet indices. Neurotransmitter-related biomarkers, including serotonin, monoamine oxidase A (MAO-A), and acetylcholinesterase levels, also varied by location. Principal component analysis showed that Pb and Cd had high loadings on the same component as PLT, WBC, and RDW, and while Se loaded together with HGB, PDW, MCHC, MCH, and MCV, suggesting distinct hematological patterns associated with each element. Multiple linear regression analysis demonstrated a statistically significant inverse association between hair Pb levels and serotonin concentrations. Although MAO-A and Cd showed negative β coefficients, these associations were not statistically significant after adjustment. These findings highlight the potential impact of toxic element exposure on key hematological and neurochemical parameters in children, suggesting early biological alterations that may compromise health and neurodevelopment. Full article

Background: COVID-19-associated coagulopathy (CAC) is a complex condition, with high rates of thrombosis, high levels of inflammation markers and hypercoagulation (increased levels of fibrinogen and D-Dimer), as well as extensive microthrombosis in the lungs and other organs of the deceased. It resembles, without being identical, other coagulation disorders such as sepsis-DIC (SIC/DIC), hemophagocyte syndrome (HPS) and thrombotic microangiopathy (TMA). Platelets (PLTs), key regulators of thrombosis, inflammation and immunity, are considered an important risk mediator in COVID-19 pathogenesis. Platelet index MPV/PLT ratio is reported in the literature as more specific in the prognosis of platelet-related systemic thrombogenicity. Studies of MPV/PLT ratio with regards to the severity of COVID-19 disease are limited, and there are no references regarding this ratio to the outcome of COVID-19 disease at specific time points of hospitalization. The aim of this study is to evaluate the relationship of COVID-19 mortality with the red cell distribution width–coefficient of variation (RDW-CV), platelets and MPV/PLT ratio parameters. Methods: Values of these parameters in 511 COVID-19 hospitalized patients were recorded (a) on admission, (b) as mean values of the 1st and 2nd week of hospitalization, (c) over the total duration of hospitalization, (d) as nadir and zenith values, and (e) at discharge. Results: As for mortality (survivors vs. deceased), statistical analysis with ROC curves showed that regarding the values of the parameters on admission, only the RDW-CV baseline was of prognostic value. Platelet parameters, absolute number and MPV/PLT ratio had predictive potential for the disease outcome only as 2nd week values. On the contrary, with regards to disease severity (mild/moderate versus severe/critical), only the MPV/PLT ratio on admission can be used for prognosis, and to a moderate degree. On multivariable logistic regression analysis, only the RDW-CV mean hospitalization value (RDW-CV mean) was an independent and prognostic variable for mortality. Regarding disease severity, the MPV/PLT ratio on admission and RDW-CV mean were independent and prognostic variables. Conclusions: RDW-CV, platelets and MPV/PLT ratio hematological parameters could be of predictive value for mortality and severity in COVID-19 disease, depending on the hospitalization timeline. Full article

Background/Objectives: Environmental stressors, including spaceflight and altered gravity, can negatively affect the symbiotic relationship between the gut microbiome and host health. Dietary prebiotics, which alter components of the gut microbiome, show promise as an effective way to mitigate the negative impacts of stressor exposure. It remains unknown, however, if the stress-protective effects of consuming dietary prebiotics will extend to chronic altered-gravity exposure. Methods: Forty female C57BL/6 mice consumed either a control diet or a prebiotic diet containing galactooligosaccharides (GOS) and polydextrose (PDX) for 4 weeks, after which half of the mice were exposed to 3 times the gravitational force of Earth (3g) for an additional 4 weeks. Fecal microbiome samples were collected weekly for 8 weeks, sequenced, and analyzed using 16S rRNA gene sequencing. Terminal physiological endpoints, including immune and red blood cell characteristics, were collected at the end of the study. Results: The results demonstrate that dietary prebiotic consumption altered the gut microbial community structure through changes to β-diversity and multiple genera across time. In addition, consuming dietary prebiotics reduced the neutrophil-to-lymphocyte ratio (NLR) and increased red blood cell distribution width (RDW-CV). Importantly, the prebiotic diet prevented the impacts of altered-gravity on β-diversity and the bloom of problematic genera, such as Clostridium_sensu_stricto_1 and Turicibacter. Furthermore, several prebiotic diet-induced genera-level changes were significantly associated with several host physiological changes induced by 3g exposure. Conclusions: These data demonstrate that the stress-protective potential of consuming dietary prebiotics extends to environmental stressors such as altered gravity, and, potentially, spaceflight. Full article

Background/Objectives: Colorectal cancer (CRC) is one of the major epidemiological oncological confronts with established risk factors, including male sex. Still, CRC is reported among the leading malignancies in the female population. The necessity for possible, easily accessible prognostic factors is required to improve patient outcomes. This study aimed to assess sex-related differences in nine-month four-stage CRC results of palliative systemic therapy. Methods: A total of 67 patients (39 males) with a median age of 70 (64–76) years were referred for first-line palliative chemotherapy due to end-stage colorectal cancer diagnosis. The CRC advancement was evaluated by computed tomography (CT) before and 9 months after chemotherapy. The demographical and clinical characteristics were evaluated for nine-month therapy outcomes, including mortality risk and CT scan results. Results: The nine-month mortality risk in female and male groups was indifferent, reaching 21% (6 patients) and 21% (8 patients), respectively (p = 0.935). Among survivors, therapy response was observed in 6 (21%) female and 20 (51%) male patients (p = 0.056). In multivariable analysis, the male sex (OR: 3.91, 95% CI: 1.09–14.05, p = 0.037) and RDW (OR: 0.61, 95% CI: 0.42–0.88, p = 0.008) were found to be significant for disease response to systemic therapy based on CT scan results. The ROC curve for predictive role yields a sensitivity of 71.1%, specificity of 57.8%, and an area under the curve (AUC) of 0.726. Conclusions: Our analysis points out the possible favorable role of the male sex on nine-month systemic therapy response in palliative CRC. The RDW-CV can be regarded as a possible indicator of chemotherapy response in colorectal cancer. The mortality risk within 9 months of systemic therapy is comparable between males and females. Full article

Background and Objectives: Immunodeficiency associated with aging comorbidities increases the vulnerability of geriatric patients to sepsis. Early recognition and management of sepsis are essential in this population. This study evaluated the relationships between RDW, MPV, and MPV/PLT ratios and mortality in geriatric sepsis patients. Materials and Methods: This retrospective study was conducted between 2020 and 2024 in the Intensive Care Unit of the Department of Anesthesiology and Reanimation at a university hospital. Patients aged ≥ 65 years with a SOFA score of ≥2 were included. Demographic data (sex, age, height, weight, and BMI), hemogram parameters (RDW, MPV, and PLT), blood gas, and biochemical values were analyzed. Furthermore, their comorbidities; site of infection; ICU length of stay; vital signs; and SOFA, APACHE II, and SAPS II scores, recorded within the first 24 h following ICU admission, were evaluated. Statistical analysis was performed using the chi-square test, Student’s t-test, the Mann–Whitney U test, the Monte Carlo exact test, and ROC analysis. A p-value of <0.05 was considered statistically significant. Results: A total of 247 patients were included, with 46.2% (n = 114) classified as non-survivors during the 28-day follow-up period. Among them, 64.9% (n = 74) were male, with a mean age of 78.22 ± 8.53 years. Significant differences were also found in SOFA, APACHE-II, and SAPS-II scores between non-survivors and survivors (SOFA: 7.64 ± 3.16 vs. 6.78 ± 2.78, p = 0.023; APACHE-II: 21.31 ± 6.36 vs. 19.27 ± 5.88, p = 0.009; SAPS-II: 53.15 ± 16.04 vs. 46.93 ± 14.64, p = 0.002). On days 1, 3, and 5, the MPV/PLT ratio demonstrated a statistically significant predictive value for 28-day mortality. The optimal cut-off values were >0.03 on day 1 (AUC: 0.580, 95% CI: 0.516–0.642, sensitivity: 72.81%, specificity: 65.91%, p = 0.027), >0.04 on day 3 (AUC: 0.602, 95% CI: 0.538–0.663, sensitivity: 60.53%, specificity: 60.61%, p = 0.005), and >0.04 on day 5 (AUC: 0.618, 95% CI: 0.554–0.790, sensitivity: 66.14%, specificity: 62.88%, p = 0.001). Conclusions: The MPV and MPV/PLT ratios demonstrated statistically significant but limited predictive value for 28-day mortality in geriatric patients with sepsis. In contrast, the limited prognostic value of RDW may be related to variability in the inflammatory response and other underlying conditions. The correlations found between SOFA, APACHE II, and SAPS II scores highlight their importance in mortality risk prediction. Full article

Background: Prolonged stays in the postoperative intensive care unit (ICU) for patients undergoing heart valve surgery are mainly caused by the development of complications. In turn, with the extension of the ICU stay, there is a risk of developing further serious postoperative complications. The main aim of the present study was to evaluate selected biomarkers in terms of their predictive potential for a prolonged postoperative stay in the ICU. Methods: This prospective study was conducted on a group of patients undergoing heart valve surgery. The primary endpoint was prolonged postoperative intensive care unit stay beyond 3 days (above the median). Logistic regression analysis was used to assess the predictors of the occurrence of the primary endpoint. Results: A total of 631 patients were included in the study. The median stay in the ICU was 3 days (2–5). A total of 265 patients required a prolonged stay in the ICU. In multivariate logistic regression analysis troponin T measured before surgery (p = 0.014), EuroSCORE II operative risk score (p = 0.004), troponin T measured the day after surgery (p = 0.005), preoperative RDW level (p = 0.005) and the presence of preoperative atrial fibrillation (p = 0.002) were independent predictors of the primary endpoint. Conclusions: Patients with elevated troponin T values determined both before the procedure and in the early postoperative period should be given special attention, because this group of patients is burdened with an increased risk of prolonged stay in the postoperative ward, the occurrence of serious postoperative complications and ultimately worse prognosis. Full article

A properly functioning capillary microcirculation is essential for sufficient oxygen and nutrient delivery to the central nervous system. The physical mechanisms governing the transport of red blood cells (RBCs) inside the narrow and irregularly shaped capillary lumen are complex, but understanding them is essential for identifying the root causes of neurological disorders like cerebral ischemia, Alzheimer’s disease, and other neurodegenerative conditions such as concussion and cognitive dysfunction in systemic inflammatory conditions. In this work, we conducted numerical simulations of three-dimensional capillary models, which were acquired ex vivo from a mouse retina, to characterize RBC transport. We show how the spatiotemporal velocity of the RBCs deviates in realistic capillaries and equivalent cylindrical tubes, as well as how this profile is affected by hematocrit and red cell distribution width (RDW). Our results show a previously unprecedented level of RBC velocity fluctuations in capillaries that depends on the geometric features of different confinement regions and a capillary circularity index $\left(I_{cc}\right)$ that represents luminal irregularity. This velocity fluctuation is aggravated by high hematocrit conditions, without any further effect on RDW. These results can provide a better understanding of the underlying mechanisms of pathologically high capillary transit time heterogeneity that results in microcirculatory dysfunction. Full article

Homeopathy is widely used as a complementary therapy, but its effects on the behavior of production animals remain underexplored. This study evaluated the influence of a homeopathic complex on the behavior of castrated male and female piglets in the nursery phase. The experiment lasted 35 days and involved 105 animals. Piglets were allotted to five treatments in a completely randomized block design with seven replicates using three piglets per experimental unit. Tested treatments were: negative control—basal diet without additives; basal diets with 4.5, 6.0, 7.5, and 9.0 kg/ton of the homeopathic complex in the feed. Behavioral tests included open field (OF), novel object (NO), sociability, discriminative learning, judgment bias, and reactivity during weighing (RDW). Vocalizations were lower in females than males during the OF test (p = 0.016). In the RDW test, a trend was identified (p = 0.076): as the level of the homeopathic complex increased, escape attempts decreased in females and increased in males (sex × treatment interaction). Females also showed greater resistance to movement (p = 0.018). Our study suggests that the homeopathic complex does not impact the behavior of castrated male and female nursery piglets. The findings further illustrate that the sex of the animals affects their behavior, with females displaying higher levels of inactivity compared to castrated male piglets. Full article