Critical reviews in clinical laboratory sciences最新文献

{"title":"Pleural fluid biomarkers for the diagnosis and management of malignant pleural effusions: a clinical review.","authors":"Jose Diego Santotoribio","doi":"10.1080/10408363.2025.2559697","DOIUrl":"10.1080/10408363.2025.2559697","url":null,"abstract":"<p><p>Initial pleural fluid analysis is a fundamental step in the evaluation of suspected malignant pleural effusion (MPE). Most MPEs present as exudates, often hemorrhagic, with mononuclear cell predominance. Basic biochemical parameters-glucose, total protein, LDH, ADA, and pH-help distinguish MPE from other causes and offer prognostic information. Low glucose and pH, and elevated LDH, are associated with higher tumor burden and poorer outcomes. Flow cytometry can detect high-fluorescence cells suggestive of malignancy, while additional markers like CRP, cholesterol, amylase, and lipids provide complementary diagnostic value, especially when interpreted alongside tumor markers (TMs). Among TMs in pleural fluid, CEA is the most validated and widely used, showing high specificity for MPE. Others-such as CA 15.3, CYFRA 21-1, CA 125, CA 19.9, NSE, and HE4-offer variable sensitivity and specificity depending on tumor type and clinical context. False positives can occur in benign or inflammatory conditions, emphasizing the need for cautious interpretation. Other cancer biomarkers in pleural fluid-such as VEGF, Apolipoprotein E, calprotectin, endostatin, and homocysteine-may enhance diagnostic and prognostic capabilities. VEGF and endostatin reflect tumor angiogenesis and may also serve as therapeutic targets, while homocysteine shows promise in detecting MPEs not identified by conventional TMs. Multimarker strategies significantly improve diagnostic accuracy. Combinations of two pleural fluid TMs, such as CEA with CA 15.3, or diagnostic models like the MPER score (CEA + homocysteine), have shown excellent performance. Panels with three or more markers, including inflammatory or metabolic biomarkers (ADA, CRP, and %polymorphonuclear leukocytes) further enhance sensitivity and specificity. Molecular analysis in pleural fluid has emerged as a promising approach for the diagnosis of MPE, enabling the detection of mRNA, DNA methylation patterns, lncRNAs, miRNAs, or circulating tumor DNA. Although these biomarkers have demonstrated good diagnostic accuracy, they are not yet implemented in routine clinical practice, and most studies have primarily focused on MPE due to lung cancer. In malignant pleural mesothelioma, where cytology has limited sensitivity, the most extensively investigated markers in pleural fluid are mesothelin and fibulin-3. Among conventional tumor markers, the pleural fluid CYFRA 21-1/CEA ratio has shown high diagnostic accuracy, further enhanced when combined with mesothelin. Pleural fluid fibulin-3 has also been identified as an independent prognostic factor for survival.</p>","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"237-260"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essential amino acids in celiac disease: key roles in immunogenicity, pathogenesis, and therapeutic approaches.","authors":"Sajjad Bakhtiari, Nastaran Asri, Andrea Masotti, Somayeh Jahani-Sherafat, Mostafa Rezaei Tavirani, Mohammad Rostami-Nejad","doi":"10.1080/10408363.2025.2551656","DOIUrl":"10.1080/10408363.2025.2551656","url":null,"abstract":"<p><p>Celiac disease (CD) is a chronic autoimmune disorder triggered by gluten ingestion, causing intestinal damage and systemic complications. Essential amino acids (EAAs) play crucial roles in immune function, intestinal integrity, and metabolic regulation; however, their malabsorption in CD contributes to disease progression. Tryptophan dysregulation may influence mood disorders in CD, while phenylalanine and lysine are linked to immune activation and gluten modification. Methionine impacts antioxidant defense and homocysteine metabolism, and disruptions in both pathways have been observed in CD patients. Branched-chain amino acids (BCAAs), crucial for muscle synthesis, remain deficient even in treated patients, suggesting long-term metabolic effects. Threonine, vital for gut barrier function, has been reported to show increased levels in CD, potentially reflecting altered metabolism and disease progression. Arginine metabolism shifts toward pro-inflammatory nitric oxide production, exacerbating intestinal damage. EAA imbalances may serve as biomarkers for disease activity, severity, and treatment response. Altered plasma and fecal amino acid profiles correlate with disease progression, offering diagnostic and monitoring potential. Addressing EAA deficiencies through targeted supplementation or dietary interventions could enhance intestinal healing, mitigate complications, and improve outcomes beyond a gluten-free diet (GFD). This review examines the interplay between EAAs and CD pathogenesis, highlighting their roles in immune modulation, gut barrier maintenance, systemic metabolic effects, and potential as disease biomarkers.</p>","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"204-219"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data analytics for error detection in clinical laboratories.","authors":"Clarence W Chan","doi":"10.1080/10408363.2025.2555261","DOIUrl":"10.1080/10408363.2025.2555261","url":null,"abstract":"<p><p>Errors inevitably occur in the practice of laboratory medicine. A cornerstone of clinical laboratory quality management is the detection of erroneous results and the assessment of imprecision, bias, and other performance limitations of clinical test methods, particularly those affecting patient care. Errors can arise in each of what has been conventionally regarded as the three key phases of testing: pre-analytical, analytical, and post-analytical. In this review, both the standard concepts and methods of quantifying uncertainty and error are introduced in the context of clinical laboratory operations. Method validation and verification studies are presented as opportunities for preemptive and anticipatory error assessment-before tests are implemented for patient testing. Quality control monitoring is a key internal quality assurance strategy, whereas proficiency testing forms the basis of most external quality assurance initiatives. Data analytic approaches for error detection are reviewed, highlighting quantitative and statistical concepts on which they are based, and emerging machine learning and artificial intelligence algorithms are presented as contemporary tools currently under development for error detection in the clinical laboratory.</p>","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"220-236"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The MicroRNA network in sepsis: from biomarker discovery to novel targeted therapeutic strategies.","authors":"Jianyi Xie, Lingxuan Tang, Wangzheqi Zhang, Changli Wang","doi":"10.1080/10408363.2025.2561071","DOIUrl":"10.1080/10408363.2025.2561071","url":null,"abstract":"<p><p>Sepsis is a life-threatening multiple-organ dysfunction syndrome triggered by infection and mediated by host immune dysregulation. Its complex pathophysiological mechanisms and the lack of effective diagnostic and therapeutic approaches make it a major challenge for the global healthcare system. As key molecules in post-transcriptional gene regulation, microRNAs (miRNAs) play crucial roles in immune dyshomeostasis, inflammatory storms, and organ damage during sepsis, and have emerged as a research focus in this field in recent years. This review summarizes the research progress of miRNAs in sepsis, with a focus on their expression characteristics, regulatory mechanisms, and clinical translational value. miRNAs regulate inflammatory responses by targeting core signaling pathways such as the Toll-like receptor (TLR)/nuclear factor kappa B (NF-κB) pathway. The specific mechanisms include: blocking upstream pathway activation by targeting TLR ligands or adaptor proteins; directly regulating NF-κB subunits to inhibit the transcription of pro-inflammatory genes; modulating negative feedback loops; and interacting with other signaling cascades. Furthermore, certain miRNAs act as both key regulators of immune responses and potential diagnostic/prognostic biomarkers. In terms of organ damage, miRNAs display organ-specific characteristics by working as specific regulatory molecules in sepsis-associated cardiac, hepatic, and cerebral injuries. They affect organ function by targeting pathways such as phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) and Janus kinase/signal transducer and activator of transcription (JAK/STAT). In terms of clinical translational value, miRNAs derived from human serum/plasma have shown significant potential in sepsis diagnosis, treatment guidance, and prognosis prediction. By dissecting the regulatory network of miRNAs in sepsis, this review not only provides a theoretical basis for understanding the complex pathophysiology of sepsis but also identifies key directions for developing miRNA-based precision diagnostic and therapeutic strategies (e.g. combined detection of multiple biomarkers and targeted delivery systems). It is anticipated to offer novel solutions for improving the prognosis of sepsis patients and reducing mortality.</p>","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"261-286"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/10408363.2026.2655071","DOIUrl":"https://doi.org/10.1080/10408363.2026.2655071","url":null,"abstract":"","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"1-8"},"PeriodicalIF":5.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the evidence: a scoping review of the impact of COVID-19 on non-communicable disease care in Sub-Saharan Africa.","authors":"Elsie C Kruger, Aaqilah Fataar, Andre P Kengne, Rajiv T Erasmus, Annalise E Zemlin","doi":"10.1080/10408363.2026.2651301","DOIUrl":"10.1080/10408363.2026.2651301","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Non-communicable diseases (NCDs) are the leading cause of mortality globally and account for a growing proportion of the disease burden in sub-Saharan Africa (SSA), where health systems face significant resource constraints. The COVID-19 pandemic disrupted healthcare delivery globally, raising concerns that interruptions to routine NCD care could lead to higher morbidity and mortality among populations requiring ongoing care. Although evidence of the pandemic's impact on NCD care has been documented in high-income settings, the experience of SSA health systems, which entered the pandemic with preexisting infrastructure and workforce limitations, remains incompletely understood. This scoping review aimed to systematically map the evidence on COVID-19's impact on NCD care in SSA and to identify service adaptations implemented to maintain care continuity during the pandemic. Studies examining the COVID-19 pandemic and disruptions in NCD screening, diagnosis, or monitoring among adults in SSA were identified from four electronic databases: PubMed/Medline, Scopus, EBSCOhost, and Web of Science. The search strategy combined Medical Subject Headings (MeSH) terms and keywords related to geographic location (SSA), exposure (COVID-19 pandemic and related public health measures), and outcomes (screening, diagnosis, and monitoring of NCDs). Inclusion was limited to original research published between March 2020 and December 2023, written in English, French, or German, and reporting observational data on pandemic-related disruptions to NCD care. Two reviewers independently screened titles, abstracts, and full texts, with data extraction conducted using a standardized form capturing study characteristics, NCD types examined, nature of documented disruptions, and reported innovations. Twenty-eight studies were eligible for inclusion across seven countries in SSA, with the majority of evidence originating from South Africa and Ethiopia. Included studies were mainly retrospective and cross-sectional, with some using mixed-methods and time-series designs, and examined various NCDs, including diabetes mellitus, hypertension, and cancers. Sample sizes ranged from fewer than 100 participants to datasets exceeding 9 million records. Due to the heterogeneity of study designs, populations, and outcomes, findings were synthesized narratively. Six major themes emerged: disrupted access to routine care, interruptions to diagnostics and monitoring, medicine supply chain challenges, adoption of remote care models, health equity impacts, and clinical outcome implications. The pandemic was associated with widespread barriers to healthcare access, diagnostic delays, and medication shortages, with the implementation of innovations such as telemedicine and community-based delivery often hindered by technological and resource limitations. COVID-19 significantly disrupted NCD care across SSA, though health systems demonstrated notable capacity for adaptation, emphasizing the ","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"1-13"},"PeriodicalIF":5.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The complex relationship between oxidative stress and aging: new perspectives on similarities and differences.","authors":"Xue-Song Liu, Chenglong Zhu, Haoling Zhang, Wangzheqi Zhang","doi":"10.1080/10408363.2026.2651307","DOIUrl":"https://doi.org/10.1080/10408363.2026.2651307","url":null,"abstract":"<p><p>The association of oxidative stress with aging is considered one of the key theoretical cornerstones in aging research, but accumulating evidence has cast some doubt on the validity of a single \"cumulative oxidative damage\" hypothesis as its mechanism. This review aims to provide a comprehensive and updated overview of the complex interplay between oxidative stress and aging, with a particular focus on their shared mechanisms and context-dependent effects. ROS should not be regarded only as deleterious metabolic waste, but indeed act as pivotal signaling mediators in metabolic, stress, and cell fate regulation within the frame of physiological ranges. In addition, emerging evidence highlights the dual roles of ROS in maintaining cellular homeostasis and mediating stress responses depending on their concentration and spatial distribution. Only when the fine-tuned equilibrium that usually couples ROS production and disposal is perturbed and quality-control activity becomes defective does this signaling network gradually shift from a physiological into a pathological source of stress promoting cellular senescence and tissue malfunction. Aging should thus be considered the outcome of structural derangement in homeostatic regulatory networks caused by chronic stress. This view of the aging process is developed through a discussion of key events comprising oxidative DNA damage, mitochondrial dysfunction, decline in autophagy and lysosomal degradation, as well as senescent cell secretion (SASP), indicating that their reciprocal interactions together define phenotypic features characterizing the aging cell. This network-centric model further mechanistically justifies why peripheral effects of broad-spectrum antioxidant interventions are heterogeneous, and points to rolling back the damage with compensatory quality-control mechanisms and homeostatic regulation as a more effective path toward understanding how to restore homeostasis. These insights may contribute to the development of more precise therapeutic strategies targeting aging-related diseases and improving healthspan. Future research should further clarify the spatiotemporal dynamics of ROS signaling and its integration with cellular stress-response networks. Moreover, elucidating the threshold-dependent and context-specific effects of oxidative signaling may provide a conceptual basis for precision interventions in aging and age-related diseases.</p>","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"1-33"},"PeriodicalIF":5.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance and heterogeneity of validated flow cytometry scores: a systematic review.","authors":"Marc Sorigue","doi":"10.1080/10408363.2026.2651313","DOIUrl":"https://doi.org/10.1080/10408363.2026.2651313","url":null,"abstract":"<p><p>Most flow cytometry diagnostic scores are derived from single-center, retrospective studies, and the reproducibility of their reported performance in validation cohorts remains uncertain. We searched MEDLINE for FC diagnostic scores with at least one validation cohort published in the past 10 years, ultimately focusing on B lymphoid disorders (B-LPD) and myelodysplastic syndrome (MDS) scores, where most validation efforts have been undertaken. Forty-four publications were included: 29 on MDS (10 scores) and 15 on B-LPD (10 scores). Most scores were validated once or twice. For scores with both derivation and validation cohorts, sensitivity and specificity differences ranged from -0.25 to +0.29 (validation minus derivation). Among the three scores with more than five validated cohorts, I² values were consistently high for sensitivity and, in two cases, also for specificity, indicating high heterogeneity. To explain this variability, we systematically reviewed study methods and identified 31 potential sources of heterogeneity, spanning study design, pre-analytical, analytical, and post-analytical factors. In conclusion, few flow cytometry scores have been validated, most only in limited cohorts, and their reported diagnostic performance varies widely. While numerous potential sources of variability can be identified, the small number of available studies prevents reliable quantification of their impact. Published accuracy estimates should therefore not be accepted at face value, and proposed scores should be validated in-house before being adopted into diagnostic practice.</p>","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"1-15"},"PeriodicalIF":5.5,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycation and disease: a systematic review of the analytical methods and applications of advanced glycation end products (AGEs) as biomarkers of disease.","authors":"Dinh Hieu Nguyen, Michael Howsam, Eric Boulanger, Frédéric J Tessier","doi":"10.1080/10408363.2026.2651310","DOIUrl":"https://doi.org/10.1080/10408363.2026.2651310","url":null,"abstract":"<p><p>Over a century since Louis Camille Maillard first described the reaction that bears his name, advanced glycation end products (AGEs) resulting from the advanced stage of the glycation reaction have been widely implicated in the onset and progression of various non-communicable diseases. Although a number of studies on the relationship of AGEs with various diseases have been published, none of them to date has comprehensively and critically assessed the quantification of specific AGEs alongside a description of the analytical methods employed and their clinical relevance as biomarkers. We here provide a review of 116 pertinent articles from the last 10 years and describe the analytical methods, the matrices investigated, and the findings related to specific glycation biomarkers in relation to diagnosis or prognosis of disease-in particular diabetes and its complications, but also cardiovascular and renal diseases, as well as other conditions. Significant trends from the last decade are the diversification of applications beyond diabetes and its complications, an increasing number of innovative, noninvasive approaches to quantifying glycation biomarkers which seek to facilitate large-scale screening and early intervention, and the emergence of approaches combining several markers into a suite of analytes for assessment using Z-scores or machine learning algorithms.</p>","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"1-29"},"PeriodicalIF":5.5,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-regional pro-atrial natriuretic peptide in managing cardiovascular and cerebrovascular diseases.","authors":"Xu-Lei Hao, Gjin Ndrepepa, Wen-Qi Zheng, Zhi-De Hu","doi":"10.1080/10408363.2026.2631481","DOIUrl":"https://doi.org/10.1080/10408363.2026.2631481","url":null,"abstract":"<p><p>Mid-regional pro-atrial natriuretic peptide (MR-proANP), along with B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), is a type of natriuretic peptide hormone that is released by atrial muscle cells upon stress. Previous studies have shown that MR-proANP has high diagnostic accuracy for heart failure (HF) in several clinical settings, and it also helps in the risk stratification of patients with HF. In the general population, elevated MR-proANP levels indicate a high risk of cerebrovascular and cardiovascular diseases, including stroke and atrial fibrillation. In patients with established cardiovascular and cerebrovascular diseases, elevated MR-proANP levels are associated with a poor prognosis. This review summarizes the value and the use of MR-proANP in assessing the risk, diagnosis, and prognosis of patients with cardiovascular and cerebrovascular disease(s).</p>","PeriodicalId":10760,"journal":{"name":"Critical reviews in clinical laboratory sciences","volume":" ","pages":"1-13"},"PeriodicalIF":5.5,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}