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Article ; Online: The Utility of a Novel Stacked Microvascular Imaging for Enhanced Detection of Fibrosis in Chronic Liver Diseases.

Miura, Daisuke / Suenaga, Hiromi / Ichihara, Kiyoshi

2024

Abstract: Objective: Ultrasonographic imaging plays a primary role to detect fibrotic changes in patients with chronic liver disease (CLD). To enhance detectability of fibrosis in its early stage, we developed a novel stacked microvascular imaging (SMVI) that ... ...

Abstract	Objective: Ultrasonographic imaging plays a primary role to detect fibrotic changes in patients with chronic liver disease (CLD). To enhance detectability of fibrosis in its early stage, we developed a novel stacked microvascular imaging (SMVI) that enables continuous visualization of fibrotic changes in intrahepatic vessels. Methods: SMVI was produced by accumulating 3-5 seconds of high-definition color images in tilted-scan mode. An SMVI score was devised by quantitating three hallmark vascular changes in liver fibrosis in 0-2 grades (total 0-6): narrowing, caliber irregularity, and tortuosity. To evaluate the clinical utility of the SMVI score, 469 well-defined CLD patients were enrolled and subgrouped by the stage of liver fibrosis defined based on elastography: F0-1Low, F0-1High, F2, F3, and F4. The diagnostic performance of the SMVI score was compared to conventional B-mode liver morphology score and various laboratory test markers of fibrosis. Results: Unlike conventional microvascular imaging that relies on a single image, SMVI enabled an undisrupted view of intrahepatic vessels for easy detection of fibrotic changes. SMVI detected microvascular narrowing in 92% at stage F0-1High. While detection rates for caliber irregularity and tortuosity were low at early stages but increased proportionately in advanced stages. Multiple logistic regression analysis revealed that SMVI score was most accurate in distinguishing F0-1Low from F0-1High cases compared to B-mode or laboratory test scores. Conclusion: SMVI provides enhanced vascular images of liver fibrosis in CLD, especially in its early stage. The SMVI score can be used as a primary tool for determining fibrotic stages in CLD.
Language	English
Publishing date	2024-04-06
Publishing country	England
Document type	Journal Article
ZDB-ID	186150-5
ISSN	1879-291X ; 0301-5629
ISSN (online)	1879-291X
ISSN	0301-5629
DOI	10.1016/j.ultrasmedbio.2024.03.005
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Zs.A 963: Show issues

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Article ; Online: Critical appraisal of two Box-Cox formulae for their utility in determining reference intervals by realistic simulation and extensive real-world data analyses.

Ichihara, Kiyoshi / Yamashita, Teppei / Kataoka, Hiromi / Sato, Shoichi

Computer methods and programs in biomedicine

2023 Volume 242, Page(s) 107820

Abstract: Background: The reference interval (RI) is defined as the central 95 % range of reference values (RVs) from healthy individuals. The ideal method for determining RIs is to transform RV distribution into Gaussian and estimate its 95 % range ... ...

Abstract	Background: The reference interval (RI) is defined as the central 95 % range of reference values (RVs) from healthy individuals. The ideal method for determining RIs is to transform RV distribution into Gaussian and estimate its 95 % range parametrically. One-parameter Box-Cox formula (1pBC) is widely used for correcting skewness (Sk) or kurtosis (Kt) in data distribution. However, 1pBC is not popular for computing RIs due to its unreliability in Gaussian transformation. While its two-parameter version (2pBC) is not used due to a challenge in fitting power (λ) and shift (α) parameters simultaneously. In this study, technical issues in fitting both formulae are assessed, and an alternative algorithm for successful use of 2pBC is proposed. Methods: For fitting 1pBC, optimal λ was determined by stepwise linear search. For 2pBC, optimal [λ, α] combination was pursued in two ways: by grid search of λ and α (2pBCgrid) or by using the grid search but keeping α-range close to the reference distribution (2pBCopt). Their accuracy and precision in determining RIs were compared by generating power-normal distributions simulating RVs of 23 major chemistry analytes. Additionally, their practical utilities were compared by analyzing 776 real-world datasets comprising test results of 25 analytes that were obtained from the global multicenter RV study of IFCC. For comparison, the performance of nonparametric method was evaluated in both settings. Results: For analytes with not-much-skewed distributions, unbiased estimation of RIs was accomplished by all methods. Nevertheless, when reference distributions are located far from zero, λ estimated by1pBC and 2pBCgrid fluctuated widely, which was attributable to virtually flat goodness-of-fit profile for [λ, α]. For highly skewed distributions, 1pBC caused bias in estimating RI and λ due to remotely peaked goodness-of-fit profile. Real-world data analyses revealed that 2pBCopt and 1pBC achieved Gaussian transformation (\|Sk\|<0.1 and \|Kt\|<0.3) in 82.4 % and 66.9 % among 776 datasets, respectively. Fitting bias signified by Kt<-0.4 was more common to 1pBC. The practical utility of 2pBCopt was unbiased prediction of analyte-specific distribution-shape (λ). Whereas nonparametric method gave highly variable RIs for both simulated and real-world datasets. Conclusions: 2pBCopt is suitable for calculating RIs and grasping distribution-shape from the estimated λ.
MeSH term(s)	Humans ; Reference Values ; Computer Simulation ; Normal Distribution ; Bias ; Data Analysis
Language	English
Publishing date	2023-09-19
Publishing country	Ireland
Document type	Multicenter Study ; Journal Article
ZDB-ID	632564-6
ISSN	1872-7565 ; 0169-2607
ISSN (online)	1872-7565
ISSN	0169-2607
DOI	10.1016/j.cmpb.2023.107820
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Zs.B 521: Show issues

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Article ; Online: Establishment of reference intervals for free light chains and immunoglobulins in Saudi population.

Borai, Anwar / Ichihara, Kiyoshi / Tamimi, Waleed / Masaud, Abdulaziz / Sobki, Samia

Clinical chemistry and laboratory medicine

2023 Volume 62, Issue 3, Page(s) 522–529

Abstract: Objectives: Testing of serum-free light chains kappa (κ) and lambda (λ), along with ratio (FLCR) is essential for the diagnosis and management of monoclonal gammopathies. Accurate clinical diagnosis depends upon appropriate local population reference ... ...

Abstract	Objectives: Testing of serum-free light chains kappa (κ) and lambda (λ), along with ratio (FLCR) is essential for the diagnosis and management of monoclonal gammopathies. Accurate clinical diagnosis depends upon appropriate local population reference intervals (RIs). This study examined the Saudi population for serum-free light chains and other immunoglobulins to establish RIs and to explore variations in the test results by using the International Federation for Clinical Chemistry and Laboratory Medicine's global protocol for harmonized implementation of RI study. Methods: A total of 180 healthy Saudi adults were recruited. All serum samples were assayed using the Freelite reagents from the Binding Site. The variation in reference values attributable to sex, age, BMI, and region was calculated by ANOVA as a standard deviation ratio (SDR). The RIs for the FLCR were derived by the parametric method and validated by using samples from patients with hypo- and hypergammaglobulinemia. Results: The new RIs for free κ and FLCR were shifted to a higher side from the manufacturer-adapted RIs. Based on the SDR cutoff value (>0.4), between-sex partition RIs were not required for all analytes except IgM. Validation using patients with hypo- or hypergammaglobulinemia and without multiple myeloma, was all within the new RI. BMI, smoking, and exercise were not relevant sources of variation for any analyte. Conclusions: Locally derived RIs for free light chains and immunoglobulins analytes specific for Saudis were established after careful consideration of various factors. These RIs were more reliable than those provided as guidance by the manufacturer, or from other countries, for appropriate classification and prediction of disease progression for Saudi patients.
MeSH term(s)	Adult ; Humans ; Hypergammaglobulinemia ; Saudi Arabia ; Immunoglobulin Light Chains ; Paraproteinemias ; Reference Values ; Middle Eastern People
Chemical Substances	Immunoglobulin Light Chains
Language	English
Publishing date	2023-10-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1418007-8
ISSN	1437-4331 ; 1434-6621 ; 1437-8523
ISSN (online)	1437-4331
ISSN	1434-6621 ; 1437-8523
DOI	10.1515/cclm-2023-0774
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Zs.A 121: Show issues

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Article ; Online: Statistical considerations for harmonization of the global multicenter study on reference values.

Ichihara, Kiyoshi

Clinica chimica acta; international journal of clinical chemistry

2014 Volume 432, Page(s) 108–118

Abstract: The global multicenter study on reference values coordinated by the Committee on Reference Intervals and Decision Limits (C-RIDL) of the IFCC was launched in December 2011, targeting 45 commonly tested analytes with the following objectives: 1) to derive ...

Abstract	The global multicenter study on reference values coordinated by the Committee on Reference Intervals and Decision Limits (C-RIDL) of the IFCC was launched in December 2011, targeting 45 commonly tested analytes with the following objectives: 1) to derive reference intervals (RIs) country by country using a common protocol, and 2) to explore regionality/ethnicity of reference values by aligning test results among the countries. To achieve these objectives, it is crucial to harmonize 1) the protocol for recruitment and sampling, 2) statistical procedures for deriving the RI, and 3) test results through measurement of a panel of sera in common. For harmonized recruitment, very lenient inclusion/exclusion criteria were adopted in view of differences in interpretation of what constitutes healthiness by different cultures and investigators. This policy may require secondary exclusion of individuals according to the standard of each country at the time of deriving RIs. An iterative optimization procedure, called the latent abnormal values exclusion (LAVE) method, can be applied to automate the process of refining the choice of reference individuals. For global comparison of reference values, test results must be harmonized, based on the among-country, pair-wise linear relationships of test values for the panel. Traceability of reference values can be ensured based on values assigned indirectly to the panel through collaborative measurement of certified reference materials. The validity of the adopted strategies is discussed in this article, based on interim results obtained to date from five countries. Special considerations are made for dissociation of RIs by parametric and nonparametric methods and between-country difference in the effect of body mass index on reference values.
MeSH term(s)	Clinical Laboratory Techniques/standards ; Humans ; Internationality ; Multicenter Studies as Topic/standards ; Multivariate Analysis ; Reference Values ; Statistics as Topic/methods ; Statistics, Nonparametric
Language	English
Publishing date	2014-05-15
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80228-1
ISSN	1873-3492 ; 0009-8981
ISSN (online)	1873-3492
ISSN	0009-8981
DOI	10.1016/j.cca.2014.01.025
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Article ; Online: Biological sources of variations of tartrate-resistant acid phosphatase 5b in a healthy Japanese population.

Kikuchi, Wataru / Ichihara, Kiyoshi / Mori, Kazuo / Shimizu, Yoshihisa

Annals of clinical biochemistry

2021 Volume 58, Issue 4, Page(s) 358–367

Abstract: Background: Tartrate-resistant acid phosphatase 5b (TRACP5b) is a bone resorption marker that is mainly used in clinical management of osteoporosis. For proper interpretations of test results for serum TRACP5b, we explored their biological sources of ... ...

Abstract	Background: Tartrate-resistant acid phosphatase 5b (TRACP5b) is a bone resorption marker that is mainly used in clinical management of osteoporosis. For proper interpretations of test results for serum TRACP5b, we explored their biological sources of variation, esp. age-related changes, and associations with other bone-related markers in healthy Japanese adults. Methods: During the 2009 East-Southeast Asian multicentre study for determination of reference intervals, 72 major laboratory tests were measured by centralized assays in 3541 well-defined healthy volunteers. The current study included 1980 test results in Japanese subjects for five bone-related markers: TRACP5b, bone alkaline phosphatase, intact parathyroid hormone, calcium and inorganic phosphate. Information on sources of variation, including body mass index, smoking habits and ABO-blood group, were obtained from a health status questionnaire. Results: Gender-specific profiles of age-related changes were observed for each parameter. Increased values starting from 40 years of age in females were most prominent for TRACP5b, followed by bone alkaline phosphatase and inorganic phosphate. TRACP5b in males decreased with body mass index, bone alkaline phosphatase and TRACP5b were higher in blood type-O subjects, especially in males. TRACPT5b was closely correlated with bone alkaline phosphatase, and moderately correlated with adjusted calcium and inorganic phosphate, especially in females aged ≥45 years. Reference intervals for each analyte were determined parametrically based on gender and age. Conclusions: This study elucidated sources of variation of TRACP5b and related bone markers in healthy Japanese subjects and demonstrated a specific age profile for each marker. These results are of relevance for better clinical usage and interpretations of serum levels of bone markers.
MeSH term(s)	ABO Blood-Group System ; Adolescent ; Adult ; Age Factors ; Alkaline Phosphatase/blood ; Biomarkers/blood ; Body Mass Index ; Clinical Laboratory Techniques ; Female ; Genetic Variation ; Humans ; Japan ; Male ; Middle Aged ; Parathyroid Hormone/blood ; Reference Values ; Sex Factors ; Smoking ; Tartrate-Resistant Acid Phosphatase/blood ; Young Adult
Chemical Substances	ABO Blood-Group System ; Biomarkers ; Parathyroid Hormone ; Alkaline Phosphatase (EC 3.1.3.1) ; ACP5 protein, human (EC 3.1.3.2) ; Tartrate-Resistant Acid Phosphatase (EC 3.1.3.2)
Language	English
Publishing date	2021-04-07
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	390309-6
ISSN	1758-1001 ; 0004-5632
ISSN (online)	1758-1001
ISSN	0004-5632
DOI	10.1177/00045632211003941
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Zs.A 889: Show issues

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Article ; Online: Elucidation of stability profiles of common chemistry analytes in serum stored at six graded temperatures.

Shimizu, Yoshihisa / Ichihara, Kiyoshi

Clinical chemistry and laboratory medicine

2019 Volume 57, Issue 9, Page(s) 1388–1396

Abstract: Background Many reports address the stability of biochemical analytes in serum. However, studies covering a wide range of storage temperatures are unavailable. Using equipment enabling precise temperature control, we investigated the effect of six ... ...

Abstract	Background Many reports address the stability of biochemical analytes in serum. However, studies covering a wide range of storage temperatures are unavailable. Using equipment enabling precise temperature control, we investigated the effect of six different storage temperatures on serum analytes. Methods Serum specimens from seven healthy volunteers were obtained and divided into multiple aliquots for storage at -30, -20, -10, 0, 4, and 25 °C. On days 1, 3, 7, 14, 28 and 56, the aliquots stored at each temperature were relocated to a deep freezer maintained at -80 °C. On day 60, all aliquots were measured collectively for 13 major chemistry analytes. Results (1) At 25 °C, alanine aminotransferase (ALT), creatine kinase (CK), aspartate aminotransferase (AST) and total bilirubin (TBil) were very unstable especially on day 7 and later. (2) At ≤4 °C, alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), amylase (AMY), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), TBil and complement component-4 (C4) were generally stable and were very stable at 25 °C until day 14. (3) Between -20 and 4 °C, especially at -10 °C, test results of ALT, AST and lactate dehydrogenase (LDH) showed prominent decreases, but their stability was greatly improved at -30 °C. (4) In contrast, the value of complement component-3 (C3) increased at ≥- 20 °C. (5) At -30 °C, test results of all analytes were generally very stable except for ALT and CK, which showed noticeable reductions in activity after 14 days. Conclusions This is the first study to assess the stability of serum analytes at six graded temperatures simultaneously. Each analyte has a unique stability pattern for a range of temperatures.
MeSH term(s)	Alanine Transaminase/analysis ; Alanine Transaminase/blood ; Alkaline Phosphatase/analysis ; Alkaline Phosphatase/blood ; Aspartate Aminotransferases/analysis ; Aspartate Aminotransferases/blood ; Bilirubin/analysis ; Bilirubin/blood ; Blood Preservation/methods ; Blood Specimen Collection/methods ; Chemistry Techniques, Analytical/methods ; Chemistry Techniques, Analytical/standards ; Cholesterol/analysis ; Cholesterol/blood ; Creatine Kinase/analysis ; Creatine Kinase/blood ; L-Lactate Dehydrogenase/analysis ; L-Lactate Dehydrogenase/blood ; Reference Values ; Serum/chemistry ; Temperature ; Time Factors ; Triglycerides/analysis ; Triglycerides/blood ; gamma-Glutamyltransferase/analysis ; gamma-Glutamyltransferase/blood
Chemical Substances	Triglycerides ; Cholesterol (97C5T2UQ7J) ; L-Lactate Dehydrogenase (EC 1.1.1.27) ; gamma-Glutamyltransferase (EC 2.3.2.2) ; Aspartate Aminotransferases (EC 2.6.1.1) ; Alanine Transaminase (EC 2.6.1.2) ; Creatine Kinase (EC 2.7.3.2) ; Alkaline Phosphatase (EC 3.1.3.1) ; Bilirubin (RFM9X3LJ49)
Language	English
Publishing date	2019-03-09
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1418007-8
ISSN	1437-4331 ; 1434-6621 ; 1437-8523
ISSN (online)	1437-4331
ISSN	1434-6621 ; 1437-8523
DOI	10.1515/cclm-2018-1109
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Zs.A 121: Show issues

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Article ; Online: Comparison of reference intervals derived by direct and indirect methods based on compatible datasets obtained in Turkey.

Ozarda, Yesim / Ichihara, Kiyoshi / Jones, Graham / Streichert, Thomas / Ahmadian, Robab

Clinica chimica acta; international journal of clinical chemistry

2021 Volume 520, Page(s) 186–195

Abstract: Background: Indirect derivation of reference intervals (RIs) from the laboratory information system (LIS) has been recently pursued. We aimed at evaluating the accuracy of indirectly predicted RIs compared to the RIs established directly from healthy ... ...

Abstract	Background: Indirect derivation of reference intervals (RIs) from the laboratory information system (LIS) has been recently pursued. We aimed at evaluating the accuracy of indirectly predicted RIs compared to the RIs established directly from healthy subjects in the nationwide RI study in Turkey, targeting 25 major chemistry analytes. Methods: LIS data were retrieved from the laboratory that performed measurements for the direct study. They were cleaned by limiting to outpatients with age 18-65 years, and by allowing only one record per year per patient. Evaluated were four indirect methods of univariate approach: Hoffmann, Bhattacharya, Arzideh, and Wosniok methods. Power transformation of the LIS dataset was performed either using the power (λ) reported by the IFCC global RI study (the first two methods) or using a λ predicted (the last two). Results: Compared to the direct study dataset, the LIS dataset showed a variable degree of alterations in peak location and shape. Consequently, lower-side peak-shifts observed in sodium, albumin, etc. led to lowered RI limits, whereas higher-side peak-shift observed in triglyceride, low-density lipoprotein cholesterol, etc. led to raised RI limits. Overall, 72% (62-81) of the RI limits predicted by indirect methods showed significant biases from direct RIs. However, the biases observed in total cholesterol, lactic dehydrogenase, etc. were attributed to a higher-side age-bias in LIS dataset. After excluding them, the overall proportion of biased RIs was reduced to 47% (38-54). Conclusion: To reduce prediction biases that remained after age adjustment, it is necessary to apply more rigorous data-cleaning before applying indirect methods.
MeSH term(s)	Adolescent ; Adult ; Aged ; Clinical Laboratory Information Systems ; Healthy Volunteers ; Humans ; Middle Aged ; Reference Values ; Turkey ; Young Adult
Language	English
Publishing date	2021-06-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	80228-1
ISSN	1873-3492 ; 0009-8981
ISSN (online)	1873-3492
ISSN	0009-8981
DOI	10.1016/j.cca.2021.05.030
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Article ; Online: Clinical utility of indirect fluorescent assay for IgA class antibodies against Bartonella henselae in serodiagnosis of cat scratch disease in its early stage.

Tsuneoka, Hidehiro / Otsuyama, Ken-Ichiro / Hirano, Akari / Nojima, Junzo / Nishikawa, Jun / Ichihara, Kiyoshi

Diagnostic microbiology and infectious disease

2022 Volume 104, Issue 4, Page(s) 115809

Abstract: The utility of IgA class antibodies for the serodiagnosis of cat scratch disease (CSD) was evaluated by developing an indirect immunofluorescent assay (IFA) using an antigen obtained by co-cultivating Bartonella henselae ATCC 49882 with Vero cells. ... ...

Abstract	The utility of IgA class antibodies for the serodiagnosis of cat scratch disease (CSD) was evaluated by developing an indirect immunofluorescent assay (IFA) using an antigen obtained by co-cultivating Bartonella henselae ATCC 49882 with Vero cells. Served for evaluation were 101 sera from patients serologically confirmed as CSD with IgG-IFA ≥1:256, and 144 sera from patients clinically suspected of CSD but not serologically confirmed. The sensitivity of the newly developed IgA-IFA in detecting the confirmed cases was 57.4% (58/101), and 75.0% in combination with IgM-IFA. As for the non-confirmed cases, IgA-IFA turned 8.3% cases (12/144) positive, 10 of whom were subsequently diagnosed as CSD of early stage from clinical courses and/or by repeated testing. The 12-case gain was regarded as a significant improvement. Hence, the diagnostic rate of early-stage CSD is expected to be increased by routinely performing IgA-IFA in addition to conventional IgG/IgM-IFA.
MeSH term(s)	Chlorocebus aethiops ; Animals ; Cat-Scratch Disease/diagnosis ; Bartonella henselae ; Immunoglobulin A ; Vero Cells ; Antibodies, Bacterial ; Serologic Tests ; Fluorescent Antibody Technique, Indirect ; Immunoglobulin M ; Immunoglobulin G
Chemical Substances	Immunoglobulin A ; Antibodies, Bacterial ; Immunoglobulin M ; Immunoglobulin G
Language	English
Publishing date	2022-09-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	604920-5
ISSN	1879-0070 ; 0732-8893
ISSN (online)	1879-0070
ISSN	0732-8893
DOI	10.1016/j.diagmicrobio.2022.115809
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Zs.A 1845: Show issues

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Article ; Online: Establishment of reference interval for hemoglobin A1C and other hemoglobin subfractions for healthy Saudi adults.

Borai, Anwar / Ichihara, Kiyoshi / Bahijri, Suhad / Alsofyani, Abeer / Elsayid, Mohieldin / Husain, Haitham / Boraie, Sultanah / Sannan, Naif / Kalantan, Ziad / Jan, Majdi / Gassas, Maha / Harbi, Mohammed / Alrowaili, Norah / Almohammadi, Mohammed / Zarif, Hawazen / Qurashi, Mansour

PloS one

2024 Volume 19, Issue 3, Page(s) e0300028

Abstract: Background: The establishment of Reference Intervals (RIs) for Hemoglobin A1C and other hemoglobin subfractions (A1A, A1B, F, LA1C, A0) is of utmost importance in screening, diagnosing, and monitoring diabetes and other hemoglobin abnormalities through ... ...

Abstract	Background: The establishment of Reference Intervals (RIs) for Hemoglobin A1C and other hemoglobin subfractions (A1A, A1B, F, LA1C, A0) is of utmost importance in screening, diagnosing, and monitoring diabetes and other hemoglobin abnormalities through the application of high-pressure liquid chromatography (HPLC) technique. Because there are no locally established RIs for these parameters, it is essential to establish RIs specific to the Saudi population to accurately diagnose and monitor diabetic individuals and identify abnormal levels in hemoglobin subfractions. Methods: As part of the IFCC global multicenter study of laboratory reference values, a cross-sectional study was conducted in Saudi Arabia. The study involved recruiting a total of 381 healthy adult subjects (>18 years, BMI 28.3 ± 6 kg/m2). Blood samples were analyzed for A1C, biochemical and other immunoassay parameters. The need for RIs based on sex, age, and BMI was determined using the standard deviation ratio (SDR) through a 3-level nested ANOVA. Results: Based on the threshold of SDR≥0.4, RIs for A1C and other Hb subfractions were not partitioned by sex or BMI, but partitioned by age (<45 & ≥45 years) for A1C, LA1C, A0 and F. Spearman's correlation between glucose, insulin, and C-peptide showed a positive association with different hemoglobin subtractions of A1B, F, A1C, and LA1C. The RIs were obtained by using the parametric method and the latent abnormal values exclusion (LAVE) principle was applied on A1C. Conclusion: This study established RIs for A1C and other Hb subfractions for healthy adult Saudis. Age was found to be an important source of variation for most of the parameters including A1C. These findings will enhance the understanding and clinical decision-making concerning A1C and other hemoglobin subfractions. The elevated upper limit of RIs for A1C reflects the high prevalence of diabetes in the Saudi population specially in those with increased age.
MeSH term(s)	Adult ; Humans ; Middle Aged ; Glycated Hemoglobin ; Saudi Arabia ; Cross-Sectional Studies ; Hemoglobins ; Reference Values ; Diabetes Mellitus ; Middle Eastern People
Chemical Substances	Glycated Hemoglobin ; Hemoglobins
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0300028
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Article ; Online: Robotic surgery for pelvic organ prolapse with complete bladder eversion.

Ichino, Manabu / Sasaki, Hitomi / Takenaka, Masashi / Ichihara, Keiichiro / Kawai, Akihiro / Fukaya, Kosuke / Zennami, Kenji / Takahara, Kiyoshi / Sumitomo, Makoto / Shiroki, Ryoichi

IJU case reports

2022 Volume 5, Issue 6, Page(s) 484–488

Abstract: Introduction: Pelvic organ prolapse with complete bladder eversion is extremely rare.: Case presentation: An 82-year-old woman was diagnosed with uterine prolapse 3 years ago and underwent occasional urethral catheter placement for difficulty in ... ...

Abstract	Introduction: Pelvic organ prolapse with complete bladder eversion is extremely rare. Case presentation: An 82-year-old woman was diagnosed with uterine prolapse 3 years ago and underwent occasional urethral catheter placement for difficulty in micturition. She presented with vulvar bleeding and prolapsed uterus from the vagina. Pelvic examination revealed uterine prolapse and a 65 × 65-mm red mass ventrally with urinary outflow. Contrast medium leakage from the vulvar mass and guidewire observed on antegrade pyeloureterography indicated pelvic organ prolapse with complete bladder eversion. Manual reduction of the everted bladder, robotic sacrocolpopexy, and bladder neck reconstruction was performed. However, eversion recurred 10 months postoperatively. Subsequently, robotic Burch colposuspension, cystopexy to the rectus fascia, bladder neck reconstruction, colpoclesis, and cystostomy were performed. There was no recurrence postoperatively. Conclusion: Robotic Burch colposuspension, cystopexy to the rectus fascia, bladder neck reconstruction, colpoclesis, and cystostomy were performed for complete bladder eversion.
Language	English
Publishing date	2022-08-12
Publishing country	Australia
Document type	Case Reports
ISSN	2577-171X
ISSN (online)	2577-171X
DOI	10.1002/iju5.12522
Database	MEDical Literature Analysis and Retrieval System OnLINE

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