Transfusion

BackgroundIn the absence of structured donor registries, social media platforms have become a dominant mechanism for blood donor recruitment in many low-resource settings. However, the implications of this shift for transfusion timeliness and system reliability remain unclear. ObjectiveTo evaluate the impact of social media-sourced donors on transfusion delay, donor reliability, and hemovigilance-related outcomes compared with conventional donor pathways. MethodsThis prospective analytical study included 400 transfusion episodes across tertiary hospitals in Bangladesh. Donor sources were categorized as social media (SM) or conventional (CON). The primary outcome was delay-to-transfusion. Secondary outcomes included donor-related irregularities, documentation completeness, near-miss events, and acute transfusion reactions. Multivariable logistic regression identified predictors of delay [&ge;]4 hours. ResultsSocial media-sourced donors were associated with significantly longer transfusion delays (5.98 vs 2.97 hours; p<0.001). Delay [&ge;]4 hours occurred in 83.6% of SM cases versus 17.6% of CON cases (OR 23.78). Donor-related irregularities were observed in 85% of SM episodes and absent in CON donors. Safety outcomes did not differ significantly between groups. Social media donor sourcing remained the strongest independent predictor of delay (adjusted OR 18.09). ConclusionUnregulated social media-based donor recruitment introduces substantial delays and undermines system reliability without improving access. Integration of digital tools into regulated donor systems is essential to strengthen transfusion timeliness and hemovigilance in resource-limited settings.

iii.Background and ObjectivesThe "Pan-European Transfusion Research InfrAstructure" (PETRA) project was established to advance the use of donor, blood product, and patient datasets in Europe, aiming to benefit both patient and donor health. Here, the initial PETRA objective was to describe the landscape of existing donor and blood establishment (BE) databases. Materials and MethodsAn online survey was circulated to the European Blood Alliances BE members. The survey collected information on the feasibility of accessing donor data, and challenges and possibilities for linking these datasets with information on the associated blood products and transfusion recipients, and donors own health records. ResultsSeventeen BEs across 16 countries completed the survey. The majority could, in principle, link their donor data to product data (13 BEs (76%)) and recipient data (10 BEs (59%)), for research purposes. However, capabilities were limited and in only 29% of the BEs was the donor to recipients linkage an automated process. BEs reported significant challenges to achieve full vein-to-vein linkage, including legal constraints and lack of consent (11 BEs) and resources (10-14 BEs). IT and data issues as well as lack of knowledge and training were cited as obstacles by a minority of BEs. ConclusionWhilst the survey results suggest considerable interest in developing linkages between blood donors, their products, and recipients, many challenges remain due to a variety of obstacles. First steps in working towards a PETRA may be assistance to navigate legal frameworks as well as investing in resources and quality and harmonisation of data collections. iv. HighlightsO_LI17 blood establishments (BEs) in 16 countries responded to a survey on obstacles and opportunities for achieving vein-to-vein datasets. C_LIO_LIIn 59% of the BEs donor-to-recipient links can be established for research improving transfusion outcomes, but only in 29% this is an automated process. C_LIO_LIIn order to work towards a "Pan-European Transfusion Research InfrAstructure" (PETRA), legal frameworks, adequate donor consent and (financial and human) resources are the most common obstacles that require addressing. C_LI

BackgroundFatal insulin intoxication remains difficult to diagnose because insulin undergoes rapid degradation after death, limiting the reliability of direct biochemical measurements. This creates diagnostic uncertainty when objective molecular confirmation of insulin excess are required. We hypothesised that insulin excess induces systemic metabolic alterations that persist beyond insulin degradation and can be captured using postmortem metabolomics in a forensic setting. MethodsHigh-resolution mass spectrometry (HRMS)-based metabolomics was applied to a national cohort comprising 51 fatal insulin intoxications. Orthogonal partial least squares-discriminant analysis (OPLS-DA) models were trained on cases collected between 2017-2022 to identify insulin-associated metabolite features using a shared-and-unique-structures approach. Performance was evaluated using two temporally distinct test sets (2023-2024): a matched validation cohort and a heterogeneous forensic cohort reflecting biological variability. ResultsHere we show that an insulin-associated metabolomic fingerprint comprising 91 features demonstrated reproducible discrimination across independent cohorts. In the matched cohort (n=59, including 14 insulin cases), insulin intoxication classification achieved 100% sensitivity and 73% specificity within the applicability domain. In the heterogeneous cohort (n=154, including 14 insulin cases), 100% sensitivity was maintained with a 72% specificity despite increased biological variability. Univariate analyses demonstrated significant alterations across multiple metabolite classes, including acylcarnitines, fatty acids/lipids, and purine/nucleoside metabolites, with moderate effect sizes, consistent with systemic effects of insulin-induced hypoglycaemia. ConclusionsFatal insulin intoxication is associated with a reproducible metabolomic fingerprint detectable after death. These findings demonstrate that postmortem metabolomics may serve as a complementary decision-support tool when conventional biomarkers are unreliable.

BackgroundNatural killer (NK) cell degranulation is a key immune defense mechanism where exposure to tumor or virus-infected cells triggers the fusion of cytoplasmic granules containing apoptotic proteins, perforin, and granzyme with the cell membrane. This process transiently expresses CD107a on the NK cell surface, and measuring CD107a is a standard method to assess NK cell activity. MethodsWe compared two stimulation protocols differing only in duration (6-hour vs. 18-hour) using K562 target cells to induce NK cell degranulation. Isolated PBMCs without stimulation served as controls to assess spontaneous degranulation. Anti-CD107a-PE antibody was present throughout stimulation in both test and control samples. After stimulation, cells were stained with anti-CD45, anti-CD3, and anti-CD56 and analyzed by flow cytometry. ResultsFor 6 of 7 healthy controls, results from both methods fell within 2 standard deviations. Notably, longer (18-hour) stimulation resulted in lower CD107a expression than the 6-hour assay. Interlaboratory comparisons of two samples showed no significant difference (p>0.05). In a suspected hemophagocytic lymphohistiocytosis (HLH) case, two labs reported similarly reduced CD107a expression (9% and 7%). Inter-day variability was observed in a donor across both time points. The 6-hour assay showed higher sensitivity and specificity than the 18-hour assay. A resting period before ex vivo PBMC assays was found necessary. ConclusionStimulation periods beyond 6 hours are unsuitable for clinical NK degranulation assays. Screening for HLH should include multiple stimulants to improve assay reliability.

Background Venous thromboembolism (VTE) remains a major cause of perioperative morbidity in cranial neurosurgery, yet clinical practice varies widely, and formal guidelines are inconsistent. Understanding internationally sampled neurosurgical practice is essential for informing consensus and future trials. Methods An international, 2-stage cross-sectional, internet-based survey was conducted. Practising neurosurgeons performing elective adult cranial surgery were eligible. Descriptive statistics were used to summarise practice. Responses covered patterns of pre-operative haemostasis decision making, use and timing of mechanical and/or chemical prophylaxis, use of perioperative imaging prior to anticoagulation, and frequency of clinical assessment for VTE. Associations with geographical income status, subspecialty, and years post-certification were statistically tested. Practice heterogeneity was quantified and contextual influence was summarised using mean effect sizes across stratifying variables in order to determine domains of true equipoise. Results Of 585 responses, 456 (78%) met criteria for inclusion: representing 322 units across 78 countries (71% high-income). Thirteen per cent reported no departmental VTE plan; 23% followed no guidelines and 12% used multiple. Routine pre-operative testing almost universally included haemoglobin/platelets/haematocrit, with fibrinogen more common in high-income settings. Compared with high-income country respondents, low- and middle-income respondents reported higher haemoglobin transfusion thresholds (>90 g/dL; p<0.001) and shorter antiplatelet interruption (p[&le;]0.03), and less frequent outpatient VTE assessment (p<0.001). Mechanical prophylaxis was common (TEDs 81%, IPC 62%), typically started pre- or intra-operatively. Among those completing the chemoprophylaxis section (n=310), 57% required a CT or MRI scan before LMWH which was then initiated on average 31.4 hours after surgery. 1% of respondents did not routinely use LMWH. Many clinical decisions demonstrated statistical equipoise ie. high heterogeneity with low contextual influence. Conclusion Peri-operative haemostasis and VTE prophylaxis practices in adult elective cranial neurosurgery vary substantially worldwide, with some decisions reflecting geographical or socioeconomic differences and many others reflecting true clinical equipoise rather than contextual determinants. By mapping contemporary real-world practice across diverse health-system contexts, this study provides a necessary empirical foundation for rational trial design and future guideline development.

Background: External Quality Assurance (EQA) is an essential component of modern laboratory medicine. Current scientific evidence on EQA focuses primarily on the analyses carried out by EQA providers while relatively little research has been conducted in individual clinical laboratories. Methods: In this retrospective single-center observational study in a clinical laboratory, EQA results were analyzed over a period of four years (2021-2024). The evaluation was based on EQA action reports documented in the institutes internal quality management system. Deviations were classified according to department, type of discrepancy, root cause category (analytical, preanalytical, systemic, unidentifiable), and measures taken. Results: A total of 7226 EQA participations were evaluated during the observation period. The overall error rate remained consistently low, ranging between 0.8% and 1.6%, with no significant change over time (p = 0.87). Most deviations occurred in the departments of clinical chemistry and immuno/autoimmune diagnostics (p < 0.001). These were predominantly quantitative discrepancies (false low/false negative or false high/false positive). Root cause analysis showed a clear dominance of analytical causes (p < 0.001), while preanalytical and systemic causes were identified less frequently. In most cases, corrective measures, such as re-analyses, recalibrations, process adjustments, or staff training, were implemented promptly. Hard structural measures, such as changing methods or discontinuing tests, were rarely necessary. Conclusion: In a clinical laboratory, EQA is an important tool for structured error analysis and continuous quality improvement. Consistent processing of deviating EQA results goes hand in hand with stable analytical performance and a low error rate.

BackgroundThe FACE-Q Skin Cancer Module is a condition-specific patient-reported outcome measure for facial skin cancer. While its psychometric properties have been established, normative reference values that enable score interpretation in clinical practice and research are lacking. ObjectiveTo establish normative reference values for the FACE-Q Skin Cancer Module using preoperative patient data and to validate these values by comparison with a demographically matched cohort of healthy partners. MethodsTwo cohorts were analyzed: 287 patients with facial skin cancer (preoperative scores) and 82 healthy partners of skin cancer patients (same-age population without facial skin cancer). Both cohorts completed the Appearance (9 items) and Psychosocial Distress (8 items) scales. Patients additionally completed the Cancer Worry scale (10 items) and Sun Protection scale (5 items). Scores were transformed to a 0-100 scale. Normative values were expressed as percentiles overall and stratified by sex and age group. Group comparisons used independent t-tests, Mann-Whitney U tests, and Cohens d. Internal consistency was assessed with Cronbachs alpha. ResultsPatient and partner cohorts were well matched for age (68.6{+/-}11.9 vs 68.4{+/-}13.0, p=0.902) and sex (46.7% vs 41.5% female, p=0.476). Surprisingly, preoperative facial appearance scores were virtually identical between patients and partners (55.6{+/-}14.0 vs 56.6{+/-}13.6, p=0.590, d=-0.08), as were psychosocial distress scores (14.3{+/-}12.0 vs 14.4{+/-}13.3, p=0.942, d=-0.01). This equivalence held across age groups. A significant sex interaction was identified: female patients scored lower on appearance than female partners (54.3 vs 59.9, p=0.048, d=-0.40), whereas no difference existed among males (56.9 vs 53.1, p=0.168). Internal consistency was excellent in both cohorts (Cronbachs 0.82-0.93). Patients reported marginally higher sun protection behaviors than partners (38.0 vs 33.6, p=0.050). ConclusionsPreoperative FACE-Q Skin Cancer scores in patients are equivalent to those of demographically matched healthy individuals, confirming that these scores serve as valid normative references. The established percentile norms enable clinicians and researchers to interpret individual patient scores in context. The sex-specific difference in appearance scores warrants further investigation.

Plasma cell-free DNA (cfDNA) is a central analyte in liquid biopsy applications spanning prenatal testing, oncology, and epigenomic profiling. To minimize contamination by high-molecular-weight genomic DNA (gDNA) released from nucleated blood cells, standard pre-analytical workflows typically mandate a double-centrifugation protocol prior to cfDNA extraction. This requirement has limited the use of many existing plasma biorepositories that were prepared using only a single low-speed centrifugation step. In this study, we evaluated whether single-spun plasma is sufficient for accurate cfDNA analysis when samples are processed under controlled conditions. Using paired single- and double-spun plasma aliquots derived from the same early-pregnancy maternal blood samples collected in EDTA tubes, we performed whole-genome DNA methylation sequencing and assessed cfDNA integrity across multiple orthogonal dimensions. These included cell-type proportion deconvolution using large and small DNA methylation reference signatures, CpG-level methylation rate estimation with explicit variance modeling, beta-binomial-corrected correlation analyses across libraries, cfDNA fragment length profiling, and genotype-based fetal fraction estimation. Across all analyses, we found no evidence that a second high-speed centrifugation step improved accuracy, reduced technical variability, or enhanced analytical fidelity. Cell-type proportion estimates and CpG-level methylation rates were statistically indistinguishable between single- and double-spun plasma, fragment length distributions were nearly identical, and fetal fraction estimates showed near-perfect concordance. Together, these results demonstrate that a single low-speed centrifugation step is sufficient for high-fidelity cfDNA methylation, fragmentomic, and genotyping analyses. Our findings support the expanded use of legacy single-spun plasma collections for liquid biopsy research and assay development and motivate a re-evaluation of rigid double-centrifugation requirements in cfDNA workflows.

Cryopreservation, or cryonics, is an experimental procedure that preserves individuals at cryogenic temperatures after legal death in the hope of future revival. Although Switzerland hosts Schengen Areas first dedicated cryopreservation facility, public sentiment toward the practice has remained largely unexamined. This exploratory survey of 249 Swiss adults assessed awareness, ethical views, and openness to cryopreservation. Results show broad support for individual autonomy, with most respondents endorsing the right to choose cryopreservation when performed to high medical standards (86.7%) and not supporting legal restrictions (83.5%). While personal interest was in the minority, nearly one in five respondents (20.1%) reported active interest or intent to sign up. Openness to cryopreservation appears driven more by values such as life-extension preference and prior exposure than by demographics. These findings provide the first empirical snapshot of Swiss public opinion on cryopreservation, highlighting a largely permissive public stance and suggesting considerable engagement with the topic.

Per- and polyfluoroalkyl substances (PFAS) are chemicals linked to obesity and metabolic dysfunction, but their role in bariatric surgery remains poorly understood. This prospective pilot study examined correlations between plasma PFAS concentrations, body composition, and glycemic measures in adults undergoing bariatric surgery. Thirty-two patients (91% female; 66% Black; mean age 43 years) were enrolled preoperatively; twenty-two completed follow-up at a mean 8.6 months post-surgery. Three PFAS (PFHxS, PFNA, and PFOS) were quantified by plasma liquid chromatography-mass spectrometry; body composition and insulin sensitivity were assessed by dual-energy X-ray absorptiometry and intravenous glucose tolerance testing. At baseline, higher plasma PFNA and PFOS concentrations tracked with lower total lean mass ({rho}s = -0.46 and -0.48, respectively) and lean mass index ({rho}s = -0.46 and -0.42), and PFNA was inversely correlated with body weight ({rho}s = -0.40). No baseline associations were observed with adiposity or glycemic indices. Postoperatively, PFHxS concentrations decreased (median = -1.103 ng/mL, p < 0.001), whereas PFNA and PFOS did not change. Average PFNA was positively correlated with postoperative changes in HOMA-IR ({rho}s = 0.51) and total lean mass ({rho}s = 0.49). No significant associations were observed for average PFHxS or PFOS. These findings suggest that PFNA and PFOS may be linked to reduced lean tissue at baseline, and that PFNA burden modestly tracks with attenuated metabolic and body composition recovery. In an ANCOVA, baseline PFNA was not significantly associated with postoperative HOMA-IR or total lean mass. Larger, longitudinal studies are needed to clarify how PFAS influence these associations.

ObjectiveThis study evaluates the impact of systemic GLP-1 receptor agonist (GLP-1RA) use on surgical wound healing in high-risk surgical populations, including patients with diabetes, and implications for perioperative planning and healing outcomes. ApproachThis pilot retrospective cohort study compared adult surgery patients with non-healing postoperative wounds by their GLP-1RA use. Outcomes included healing status, time to wound closure, and number of surgical interventions. ResultsThe cohort included 35 non-GLP-1RA users and 16 GLP-1RA users with comparable baseline characteristics, except for significant higher prevalence of venous insufficiency among users. Though median time to closure was similar for all patients, users required fewer surgical interventions and their wounds reached closure in significant difference from non-users. Among patients with diabetes, all GLP-1RA users healed significantly compared to non-users. InnovationThe impact of GLP-1RA therapy on wound healing in high-risk reconstructive and soft-tissue surgery remains poorly defined. This pilot cohort addresses that gap, offering an early signal that GLP-1RA use is associated with improved wound healing and fewer postoperative interventions. These findings may inform perioperative practice by identifying a systemic pharmacologic factor that optimizes surgical outcomes in high-risk populations. ConclusionGLP-1RA use was associated with higher healing rates and fewer interventions, particularly among patients with diabetes. These findings support a beneficial role in surgical wound healing and warrant larger multi-site studies.

BackgroundIn aortic arch surgery, bilateral selective antegrade cerebral perfusion (bSACP) maintains cerebral blood flow during circulatory arrest. bSACP is often delivered using a single pump with a Y-connector, dividing the flow. Current practice has veered towards perfusion of the left common carotid artery by cannula and the right subclavian artery or axillary artery by a vascular graft. Under this configuration, inflow distribution may be sensitive to left-sided cannula resistance, particularly in patients with limited collateral circulation, potentially reducing left-hemispheric pressure and flow despite bSACP. We investigated how cannula design influences perfusion pressure and arterial inflow distribution during bSACP. MethodsFour perfusion cannulas with different flow resistances were characterized using bench measurements (40-200 ml/min) and computational fluid dynamics (CFD). The CFD cannula models were then integrated into patient-specific CFD models of the cerebral circulation from three patients with varying collateral circulation/capacity. Both flow- and pressure-controlled pump strategies were simulated. ResultsBench measurements showed substantial variation in flow resistance between the cannulas, which was accurately reproduced by CFD. For the patient-specific analysis, cannula choice affected perfusion through roughly doubled pressure laterality and halved left-side inflow between the most extreme cannulas. Still, perfusion pressure was kept within recommended levels in two subjects but was low in one. Left-side arterial inflow varied between 70-150 ml/min. ConclusionsWe isolated the effects of cannula design on cerebral pressure and blood inflow distribution during bSACP, highlighting potential pitfalls in patients with limited collateral circulation.

ObjectiveTo analyze the experience of the last six years with ECMO in Uncontrolled Donation after Circulatory Death (uDCD), assessing the clinical and logistical factors that determine donation effectiveness and the viability of retrieved organs, with the nurse perfusionist as the central figure in organ perfusion. MethodsRetrospective observational study of uDCD procedures performed at Hospital Clinic de Barcelona between June 2019 and October 2025. ResultsOf 184 out-of-hospital ECMO-CPR activations, 108 (58.7%) underwent perfusion; 72 donor cases (66.7%) were generated, and 109 kidneys (75.7%) and 3 livers (4.15%) were retrieved. The annual number of uDCD donors was heterogeneous. Compared with non-effective donors, effective donors were significantly younger (48.1 {+/-} 12.4 vs 53.0 {+/-} 10.7 years, p=0.03) and had fewer comorbidities such as hypertension (13.8% vs 33.0%, p=0.018) and diabetes (4.1% vs 16.6%, p=0.027). Although effective donors had a shorter cannulation time (25.6 {+/-} 13.9 vs 29.1 {+/-} 11.9 min, p=0.09), the difference was not statistically significant; however, cardiocompressor time did show a significant difference (58.9 {+/-} 17.7 vs 65.8 {+/-} 18.2 min, p=0.03). ConclusionsuDCD was a useful source of transplantable organs, mainly kidneys (two out of every three perfused patients became donors), in the current context of scarcity of brain-dead donors. Shorter warm ischemia times (cardiocompressor and cannulation times) were significantly associated with more effective organ donation. The multidisciplinary transplant team may benefit from perfusion professionals with expertise in extracorporeal oxygenation therapy.

BackgroundModern natural language tools have potential to improve clinical workflows, but few have been successfully deployed in practice. Here, we present the development, deployment, and evaluation of an AI language tool for generating preliminary clinical sign-outs in a urine drug testing service. MethodsLarge language models (LLMs) were used to extract substance use patterns from 83,553 urine drug test interpretations. We then trained an AI model using these data to predict substance use from qualitative and quantitative urine testing results. Predicted substance use patterns were used to create preliminary clinical sign-out statements, which were then integrated into an existing clinical workflow. Pre- and post-deployment user studies were performed to evaluate model performance and user experience within this workflow. ResultsLLM-based extraction of substance-use patterns was 99.9% accurate, outperforming human labelling. Substance use prediction was similarly accurate, with area under the ROC curve > 0.99 across 33 drug categories. Workflow integration reduced clinical sign-out times by 65s per case (51% efficiency gain), with the greatest benefits seen for less experienced users. ConclusionsAI-based interpretation of urine drug testing was fast and accurate, providing significant efficiency gains to the clinical service. This demonstrates that natural language tool integration can provide substantial clinical benefit, without comprising quality of care.

IntroductionHyperferritinemia is a prognostic marker in critical illness, but its role in postoperative outcomes of pediatric congenital heart defects remains poorly defined, especially in resource-limited settings. This study evaluated early serum ferritin as a predictor of outcomes after congenital heart surgery and its association with the PIM 3 score. MethodsA single-center, prospective cohort study was conducted from April 2023 to October 2024 at a tertiary referral center in southeastern Brazil. Patients aged 29 days to 18 years, of both sexes, admitted to the PICU after congenital heart surgery were included and categorized as cyanotic or acyanotic. Statistical significance was defined as two-sided p < 0.05. ResultsA total of 105 patients were included. Median ferritin was higher in patients with PICU stays < 7 days (183 ng/mL; p = 0.004) and was significantly associated with a PIM 3 score [&ge;] 5% (642 ng/mL; p < 0.006). Cyanotic patients had longer PICU stays (11.0 vs. 7.2 days; p = 0.02), longer use of vasoactive drugs (3.8 vs. 2.6 days; p = 0.01), and accounted for all deaths (p < 0.001). Hemoglobin and hematocrit were also significantly higher in cyanotic patients (14 vs. 13 g/dL and 40% vs. 37%; p < 0.001). ConclusionsSerum ferritin may serve as a marker of secondary outcomes and aid early risk stratification in congenital heart defects patients in the PICU.

Patient-reported outcomes have become standard in facial skin cancer surgery, yet clinicians currently lack validated tools to predict postoperative appearance satisfaction from preoperative patient characteristics. We developed and internally validated a prediction model for appearance satisfaction three months after facial skin cancer reconstruction. A prospective cohort study enrolled 287 patients at a tertiary referral center (2017-2018); 111 patients with complete data were included in the primary analysis. Patients completed the FACE-Q Skin Cancer Module preoperatively and at three months postoperatively. Our multivariable linear regression model incorporated age, sex, comorbidities, smoking status, and baseline appearance satisfaction. The model explained 23.0% of variance in postoperative appearance satisfaction (R2 = 0.23; adjusted R2 = 0.19; p < 0.001). Baseline appearance satisfaction (B = 0.48; 95% CI 0.28-0.68; p < 0.001) and female sex (B = -7.16; 95% CI -12.52 to -1.81; p = 0.009) emerged as independent predictors. Bootstrap resampling (500 iterations) yielded an optimism-corrected R2 of 0.17, supporting acceptable internal validity. Mean appearance satisfaction remained stable from baseline (54.8 +/- 13.8) to three months (57.0 +/- 16.4; p = 0.27). Baseline appearance satisfaction and female sex independently predict postoperative appearance satisfaction following facial skin cancer reconstruction. External validation in independent cohorts is warranted before clinical implementation.

BackgroundFlow virometry (FV) - the application of flow cytometry to viruses - has historically been hindered by the inability of cytometers to detect particles below [~]300 nm in size. However, advances in optics and fluidics have enabled cytometers primarily designed for cells to detect viruses and extracellular vesicles (EVs) through light scatter alone. In 2024, the CytoFLEX nano was released, marketed for the detection of particles as small as 40 nm; however, its performance has yet to be compared to a conventional instrument for FV. MethodsFV was utilized to evaluate performance of the CytoFLEX nano and a conventional flow cytometer (CytoFLEX S). Instrument scatter sensitivity was assessed using NIST beads (40-400 nm), and virus stocks [human immunodeficiency virus (HIV), human coronaviruses (HCoV)-229E and HCoV-OC43]. For fluorescence analysis, HIV virions were stained with PE- and BV421-conjugated antibodies targeting virion incorporated proteins (CD38, CD44), individually and in combination. Finally, HIV stocks were labeled with antibodies against the envelope (Env) glycoprotein and tetraspanins (CD9, CD81) to assess EVs within virus preparations. ResultsCompared to the CytoFLEX S, the CytoFLEX nano exhibited substantially greater scatter sensitivity, reflected by up to 50-fold higher signal-to-noise ratio across NIST-traceable beads and virus samples. This enabled clearer resolution of smaller populations, including bead populations < 70 nm that were undetectable on the CytoFLEX S, as well as improved resolution across all viruses. While both instruments reliably detected stained proteins on HIV virions, the CytoFLEX nano revealed a distinct population of tetraspanin-positive EVs within HIV stocks that was undetected on the CytoFLEX S. Using GFP-tagged HIV, we identified Env+ particles lacking GFP, indicating the presence of Env on EVs. ConclusionsThe CytoFLEX nano exhibited markedly improved scatter sensitivity compared to the CytoFLEX S, improving detection of viruses and enabling detection of EV populations that were undetectable on the conventional instrument. While both platforms performed similarly for surface protein labeling, additional consideration of spectral overlap was needed with the CytoFLEX nano in multicolor experiments. These findings highlight that the complementary strengths of each platform can be utilized to more comprehensively characterize virus and EV populations, providing new opportunities to investigate nanoparticle heterogeneity.

Global shortages of human plasma-derived immunoglobulin G (IgG) remain a major challenge for treating primary immunodeficiencies, especially in low- and middle-income countries. Ensuring virus safety is essential, and nanofiltration provides robust removal of small, non-enveloped viruses. We examined whether removing immunoglobulin A (IgA) and immunoglobulin M (IgM) by anion-exchange chromatography improves the performance of 20-nm nanofiltration applied to small-pool caprylic acid-purified IgG. Cryo-poor plasma was treated with 5% caprylic acid at pH 5.5, concentrated by ultrafiltration, and processed on Fractogel TMAE to deplete IgA and IgM. The IgG flow-through was filtered sequentially through Planova 35N and 20N (or S20N) filters. Direct nanofiltration of caprylic acid-treated IgG with residual IgA and IgM led to rapid membrane clogging and low throughput. Depletion of IgA and IgM increased filtration capacity more than threefold and stabilized flux. Dynamic light scattering confirmed the predominance of monomeric IgG and absence of aggregates after chromatography and nanofiltration. Overall, this process combines two complementary virus reduction steps, caprylic acid treatment and nanofiltration, and provides a practical option for LMICs to convert available domestic plasma into IgG; it could also be adapted to the manufacture of hyperimmune or convalescent IgG preparations.

Abstract Background: ST-elevation myocardial infarction (STEMI) is reported to be a leading cause of mortality worldwide. While cardiac troponins are the gold standard for myocardial injury detection but creatine kinase-MB (CK-MB) and total creatine phosphokinase (CPK) retain prognostic use in resource-limited settings. Objective: To evaluate the prognostic significance of admission CK-MB and CPK levels in STEMI patients and to assess their association with hematological parameters for integrated risk stratification. Methods: This cross-sectional study enrolled 15 consecutive STEMI patients from the Punjab Institute of Cardiology, Lahore, during January 2024. Comprehensive laboratory analysis including cardiac biomarkers (CK-MB, CPK, troponin-I, LDH), complete blood count, renal function, serum electrolytes, and metabolic parameters, was performed on admission. Pearson correlation and comparative statistical analyses were also conducted to assess the relationships between cardiac biomarkers and hematological indices. Results: The cohort includes 15 patients (mean age 50.1 +/- 12.2 years; 73.3% male). Cardiac biomarker elevation was prevalent: CK-MB was elevated in 12/15 (80%), CPK was elevated in 12/15 (80%), with concordant elevation in 11/15 (73.3%), which indicates extensive myocardial necrosis. Troponin-I showed the highest elevation rate at 13/15 (86.7%). Hematological abnormalities included anemia (60%), WBC elevation (53.3%), and RBC reduction (40%). Random glucose averaged 150.80 +/- 63.55 mg/dL, with 66.7% highlighted the hyperglycemia. Remarkably, electrolyte balance was preserved in all of the patients (0% sodium, potassium, and bicarbonate abnormalities), indicating maintained homeostasis. Pearson correlation analysis revealed a significant correlation between CK-MB and CPK (r = 0.615, p = 0.0126), while correlations between cardiac biomarkers and hematological parameters were weak (p > 0.05). Risk stratification identified 53.3% of patients as high-risk who required intensive management. Conclusions: CK-MB and CPK demonstrate significant concordance and retain prognostic value in STEMI patients, particularly in resource-limited settings where troponin access may be constrained. While troponin-I remains the most sensitive biomarker, combined assessment of conventional cardiac enzymes supports reliable evaluation of myocardial injury. Hematological parameters reflect systemic response but show limited correlation with cardiac biomarkers.

This dual-center study evaluated the impact of artificial intelligence (AI) on urine culture turnaround times in Canadian diagnostic laboratories employing full microbiology laboratory automation. Data were collected before and after the implementation of PhenoMATRIX (PM), an AI-based software designed to support culture sorting and result interpretation. In both a low-volume tertiary care hospital and a high-volume community laboratory, PM reduced the time to final culture reporting, with decreases of approximately 1.5 hours and 3.9 hours, respectively. Implementation of PM+, which automatically releases defined results to patient charts, further improved turnaround time. These findings indicate that microbiology laboratories with full laboratory automation can achieve further improvements in turnaround time by integrating AI-culture assessment and results release.