Learning Discriminatory Information for Object Detection on Urine Sediment Image

In clinical practice,the microscopic examination of urine sediment is considered an important in vitro examination with many broad applications.Measuring the amount of each type of urine sediment allows for screening,diagnosis and evaluation of kidney and urinary tract disease,providing insight into the specific type and severity.However,manual urine sediment examination is labor-intensive,time-consuming,and subjective.Traditional machine learning based object detection methods require hand-crafted features for localization and classification,which have poor generalization capabilities and are difficult to quickly and accurately detect the number of urine sediments.Deep learning based object detection methods have the potential to address the challenges mentioned above,but these methods require access to large urine sediment image datasets.Unfortunately,only a limited number of publicly available urine sediment datasets are currently available.To alleviate the lack of urine sediment datasets in medical image analysis,we propose a new dataset named UriSed2K,which contains 2465 high-quality images annotated with expert guidance.Two main challenges are associated with our dataset:a large number of small objects and the occlusion between these small objects.Our manuscript focuses on applying deep learning object detection methods to the urine sediment dataset and addressing the challenges presented by this dataset.Specifically,our goal is to improve the accuracy and efficiency of the detection algorithm and,in doing so,provide medical professionals with an automatic detector that saves time and effort.We propose an improved lightweight one-stage object detection algorithm called Discriminatory-YOLO.The proposed algorithm comprises a local context attention module and a global background suppression module,which aid the detector in distinguishing urine sediment features in the image.The local context attention module captures context information beyond the object region,while the global background suppression module emphasizes objects in uninformative backgrounds.We comprehensively evaluate our method on the UriSed2K dataset,which includes seven categories of urine sediments,such as erythrocytes(red blood cells),leukocytes(white blood cells),epithelial cells,crystals,mycetes,broken erythrocytes,and broken leukocytes,achieving the best average precision(AP)of 95.3%while taking only 10 ms per image.The source code and dataset are available at https://github.com/binghuiwu98/discriminatoryyolov5.

Measurement of very low-molecular weight metabolites by traveling wave ion mobility and its use in human urine samples

The collision cross-sections(CCS)measurement using ion mobility spectrometry(IMS)in combination with mass spectrometry(MS)offers a great opportunity to increase confidence in metabolite identification.However,owing to the lack of sensitivity and resolution,IMS has an analytical challenge in studying the CCS values of very low-molecular-weight metabolites(VLMs250 Da).Here,we describe an analytical method using ultrahigh-performance liquid chromatography(UPLC)coupled to a traveling wave ion mobility-quadrupole-time-of-flight mass spectrometer optimized for the measurement of VLMs in human urine samples.The experimental CCS values,along with mass spectral properties,were reported for the 174 metabolites.The experimental data included the mass-to-charge ratio(m/z),retention time(RT),tandem MS(MS/MS)spectra,and CCS values.Among the studied metabolites,263 traveling wave ion mobility spectrometry(TWIMS)-derived CCS values(TWCCSN2)were reported for the first time,and more than 70%of these were CCS values of VLMs.The TWCCSN2 values were highly repeatable,with inter-day variations of<1%relative standard deviation(RSD).The developed method revealed excellent TWCCSN2 accuracy with a CCS difference(DCCS)within±2%of the reported drift tube IMS(DTIMS)and TWIMS CCS values.The complexity of the urine matrix did not affect the precision of the method,as evidenced by DCCS within±1.92%.According to the Metabolomics Standards Initiative,55 urinary metabolites were identified with a confidence level of 1.Among these 55 metabolites,53(96%)were VLMs.The larger number of confirmed compounds found in this study was a result of the addition of TWCCSN2 values,which clearly increased metabolite identification confidence.

Correlation between glycated hemoglobin A1c,urinary microalbumin,urinary creatinine,β2 microglobulin,retinol binding protein and diabetic retinopathy

BACKGROUND Retinopathy is the most common microvascular disease of type 2 diabetes,and seriously threatens the life,health and quality of life of patients.It is worth noting that the development of diabetic retinopathy(DR)can be hidden,with few symptoms.Therefore,the preliminary screening of diabetic patients should identify DR as soon as possible,delay disease progression,and play a vital role in its diagnosis and treatment.AIM To investigate the correlation between glycated hemoglobin A1c(HbA1c),urinary microalbumin(U-mALB),urinary creatinine(U-CR),mALB/U-CR ratio,β2 microglobulin(β2MG),retinol binding protein(RBP)and DR.METHODS A total of 180 patients with type 2 diabetes mellitus attending the Second People’s Hospital of Hefei from January 2022 to August 2022 were retrospectively enrolled by ophthalmologists.Based on whether they had combined retinopathy and its degree,68 patients with diabetes mellitus without retinopathy(NDR)were assigned to the NDR group,54 patients with non-proliferative DR(NPDR)to the NPDR group,and 58 patients with proliferative DR to the PDR group.General data,and HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR results were collected from the patients and compared among the groups.Pearson's correlation method was used to analyze the correlation between HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR indices,and multiple linear regression was applied to identify the risk factors for DR.Receiver operator characteristic(ROC)curves were also drawn.RESULTS The differences in age,gender,systolic and diastolic blood pressure between the groups were not statistically significantly(P>0.05),but the difference in disease duration was statistically significant(P<0.05).The differences in fasting blood glucose,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,total cholesterol,and triglyceride between the groups were not statistically significant(P>0.05).HbA1c in the PDR group was higher than that in the NPDR and NDR groups(P<0.05).The levels of mALB,β2MG,RBP,mALB/U-CR and UCR in the PDR group were higher than those in the NPDR and NDR groups(P<0.05).Multiple linear regression analysis showed that disease duration,HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR were risk factors for the development of DR.The ROC curve showed that the area under the curve(AUC)for the combination of indices(HbA1c+mALB+mALB/U-CR+U-CR+β2MG+RBP)was 0.958,with a sensitivity of 94.83%and specificity of 96.72%,which was higher than the AUC for single index prediction(P<0.05).CONCLUSION HbA1c,mALB,mALB/U-CR,U-CR,β2MG and RBP can reflect the development of DR and are risk factors affecting PDR,and the combination of these six indices has predictive value for PDR.

Landscape of urine biomarkers for bladder cancer:molecular function,cell-of-origin,and bibliometric trend

Background:The effective management of bladder cancer(BCa)depends on the early diagnosis and surveillance.Previous studies have explored numerous urinary molecules as potential biomarkers of BCa.However,the molecular functions and cell-of-origin profiles of these biomarkers are yet to be elucidated.In this study,we aimed to provide a comprehensive overview of the landscape of urinary biomarker genes for BCa.Methods:We conducted an exhaustive literature search in PubMed,through which 555 biomarker genes were identified.We then analyzed the BCa single-cell atlas to infer the cellular origin of these BCa urine biomarker genes and performed functional enrichment analysis to gain insights into the functional molecular implications of these biomarkers.Results:These genes are involved in tumor proliferation,angiogenesis,cellmigration,and cell death and are predominantly expressed in epithelial and stromal cells.Interestingly,our analysis ofmultiomics tumor data revealed a discordance between tissue and urine in terms of differential methylation and RNA expression,suggesting that biomarker discovery for liquid biopsies should ideally begin with the analysis of bodily fluids rather than relying interest and that test strategies incorporating multiple molecular markers represent an ongoing trend.Conclusions:Collectively,our study has built a landscape of BCa urine biomarker genes,uncovered molecular insights into these biomarkers,and revealed the bibliometric trends in this field,which will contribute to the discovery of novel biomarkers in the future.

Construction of Au@Metal-organic framework for sensitive determination of creatinine in urine

Creatinine level in urine is an important biomarker for renal function diseases,such as renal failure,glomerulonephritis,and chronic nephritis.The Au@MIL-101(Fe)was prepared by in situ growth of Au nanoparticles in MIL-101(Fe)as a selective SERS substrate.The Au@MIL-101(Fe)offers the great local surface plasmon resonance(SPR)effect due to gold nanoparticles aggre-gation inside metal-organic frameworks.The framework structure could enrich trace target samples and drag them into SPR hot spots.The optimal Au@MIL-101(Fe)composite substrate is used for analyzing creatinine in urine and the limit of detection is down to 0.1μmol/L and a linear relationship is ranging from 1μmol/L to 100μmol/L.

Potential effect of Silybum marianum L. and Cistus ladaniferus L.extracts on urine volume, creatinine clearance and renal function

Objective:To investigate the diuretic and renal effects of Silybum marianum L.and Cistus ladaniferus L.in normal rats.Methods:Four groups of rats were used in each experiment.The first group received water,the second group received Cistus ladaniferus L.extract(100 mg/kg b.wt),the third group received Silybum marianum L.extract(100 mg/kg b.wt),and the fourth group received furosemide(10 mg/kg b.wt).Variables including urine volume,plasma and urine sodium,potassium and creatinine,and creatinine clearance were measured.Two experiments were conducted.A single dose of each intervention was used and the variables were measured during 24 h,and the interventions were given daily for a total of 8 d and the variables were measured during various intervals.Results:The single dose of each plant extract increased urine volume at all-time intervals and increased urine sodium and potassium excretion without affecting plasma sodium and potassium(P<0.05).On the day 8 after daily administration,the plant extracts induced a significant diuresis and natriuresis without affecting serum electrolytes(P<0.05),while furosemide caused hypokalemia.Both plant extracts significantly increased creatinine clearance(P<0.05).Conclusions:Silybum marianum L.and Cistus ladaniferus L Increase creatinine clearance and have a significant diuretic effect without affecting serum electrolytes.Silybum marianum L.is more potent than furosemide or Cistus ladaniferus L.

Spot urine protein/creatinine ratio—A quick and accurate method for diagnosis of pre-eclampsia

Objective(s):To assess the diagnostic accuracy of spot urine protein-creatinine (P/C) ratio and its compareson with 24-hour urine proteinuria for predicting eclampsia. Method(s): Spot urine P/C ratio was determined in a mid-stream urine sample, and the 24-hour urine protein was measured. The correlation between the spot P/C ratio and 24-hour urine protein amount was done. Logistic regression analysis and ROC curve analysis have been used to analyse data. Result(s): There was a strong correlation between the spot P/C ratio and 24-hour urine protein excretion (pearson’s correlation coefficient r = 0.71;P < 0.0001). The optimal spot P/C ratio cutoff point was 0.25, for 300 mg/24 h of protein excretion, with sensitivity and specificity of 69% and 75% respectively. Conclusion(s): Spot urine P/C ratio is a quick and reliable tool which can be used as an alternative method for evaluation of proteinuria for diagnosis of pre-eclampsia.

Effect of inflammatory injury and oxidative stress injury on urine microalbumincreatinine and 24 h urine microalbumin in patients with diabetic nephropathy

Objective:To explore the effect of inflammatory injury and oxidative stress injury on urine microalbumin/creatinine (UACR) and 24 h urine microalbumin (24 h UMA) in patients with diabetic nephropathy.Methods: 54 patients with early diabetic nephropathy treated in our hospital between June 2012 and December 2015 were included in early diabetic nephropathy (DN) group and 60 patients with clinical diabetic nephropathy were included in clinical DN group. 50 healthy subjects who received physical examination in our hospital during the same period were included in healthy control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum inflammatory injury index levels;automatic biochemical analyzer was used to determine serum oxidative stress injury index levels;immunoturbidimetry was used to detect 24 h UMA, and UACR level was calculated.Results: Serum interleukin-6 (IL-6), interleukin-18 (IL-18), interleukin-27 (IL-27) and tumor necrosis factor-α (TNF-α) levels of clinical DN group were higher than those of early DN group and healthy control group while IL-10 level was lower than that of early DN group and healthy control group (P<0.05);serum total antioxidant capacity (T-AOC), vitamin C (VitC) and glutathione peroxidase (GSH-Px) levels were lower than those of early DN group and healthy control group while lipid hydrogen peroxide (LHP) and malondialdehyde (MDA) levels were higher than those of early DN group and healthy control group (P<0.05);UACR and 24 h UMA levels were higher than those of early DN group and healthy control group (P<0.05). Spearman correlation analysis showed that UACR and 24 h UMA levels in patients with diabetic nephropathy are directly related to the degree of inflammatory injury and oxidative stress injury.Conclusions: The inflammatory injury and oxidative stress injury directly affect the UACR and 24 h UMA levels in patients with diabetic nephropathy, and are the important determinants for the occurrence and development of disease.

Comparison between different methods of urine collection for estimation of albumin-creatinine ratio in patients with type-2 diabetes mellitus

In patients with diabetes mellitus, urinary albumin-creatinine-ratio (ACR) predicts progressive kidney disease. In order to determine the better urine sample for detecting ACR, we estimated ACR in three modes of urine sample. Two hundred patients of uncontrolled diabetes mellitus with proteinuria irrespective of age and sex were studied for urinary ACR in all the three types of samples over a period of 2 years. The statistical analysis showed that first morning ACR (r = 0.999, p > 0.001) of the subjects was more significantly correlated with their 24 hour urine sample ACR than spot urine (r = 0.995,

Urinary Myeloperoxidase to Creatinine Ratio as a New Marker for Diagnosis of Urinary Tract Infection

Objective To determine whether urinary myeloperoxidase to creatinine ratio(MCR) can serve as a marker for diagnosis of urinary tract infection(UTI).Methods Patients suspected of UTI were consecutively enrolled and further divided into the culture positive and the sterile groups according to urine culture results. Subsequently, MCR, white blood cell(WBC) and bacteria in the urinary samples from patients were detected and compared between the two groups.Results Finally, 253 patients were enrolled including 157 urine culture positive patients and 96 urine culture negative patients(sterile group). After logarithmic transformation in 2 as the base, the MCR, WBC, and bacteria were separately presented as log_2^(MCR), log_2^(WBC)(quantitative), and logbacteria2. The values of log_2^(MCR)(8.6±2.5 vs. 5.4±1.5, t=-12.453, P=0.001), log_2^(WBC)(quantitative)(8.0±2.5 vs. 5.2±1.8, t=-10.332, P=0.001), logbacteria2(11.4±2.5 vs. 8.2±2.8, t=-9.297, P=0.001) and WBC(semi-quantitative) [2(interquartile range 1, 3) vs. 1(interquartile range 0.5, 1), Z=-7.580, P=0.001] showed significant difference between the urine culture positive group and the sterile group. Among the urine culture positive group, the values of log_2^(MCR) of the gram positive and gram negative subgroups were 7.2±2.5 and 9.0±2.4(t=4.016, P=0.001), respectively. The correlation between log_2^(MCR) and log_2^(WBC)(quantitative), log_2^(bacteria), WBC(semi-quantitative) was 0.708(Pearson correlation, P=0.001), 0.381(Pearson correlation, P=0.001), and 0.606(Spearman correlation, P=0.001), respectively.Conclusions MCR is positively correlated with WBC counts and could be ser ved as a promising biomarker for diagnosis of UTI. MCR could be even used for initial inference of infectious bacteria types of UTI.

Effects of Inhabiting and Life Patterns on the UV Spectral Properties of Small Mammalian Herbivores’ Urine

It is well known that avian predators can use prey excretions such as urine and feces to track their prey, and the urine and feces of small mammalian herbivores can reflect ultraviolet (UV) light and emit fluorescent light. There are still some debates as to whether UV visibility of small mammalian herbivores’ urine is used as a hunting cue by avian raptors. Some studies in Europe have demonstrated that diurnal raptors are capable of utilizing these cues to target key prey species. However, researchers in Australia have argued that raptors do not use the UV visibility of urine while hunting. To our knowledge, there are no reports from Asia concerning the ultraviolet spectral characteristics of small mammal herbivores’ urine. This study examined the UV spectral properties of urine from 6 small mammal herbivores species by comparing the UV reflectance and fluorescence spectra of urine from small mammalian herbivores living in plateau meadows, plateau shrubs, open marshland, farmland, and semi-desert grassland in China. In addition, we compared the UV spectral properties of urine from ground-dwelling species of rodents and subterranean species to determine whether ultraviolet visibility of small mammal herbivores’ urine could be used as a visual signal by Asian vole-eating raptors. The results showed that: 1) the SC370 values of urine from four small mammal herbivores species were ordered as plateau pika (plateau meadow) > root voles (plateau bush) > reed voles (swampland) > Brandt’s vole (desert grassland);and 2) UV fluorescence peak intensity and the wavelengths of urine from ground-dwelling species (such as the root vole, plateau pika, or Brandt’s vole) were significantly higher than those of subterranean-dwelling species (mandarin vole and plateau zokor). These results indicate that UV visibility of small mammal herbivores’ urine may act as a visual cue for raptors.

Can the Urine Dipstick Test Be an Alternative in the Screening of Urinary Tract Infections for Inpatients in the Context of a Low-Income Country?

Background: Urinary Tract Infection (UTI), a prevalent bacterial infection in adults, heavily relies on cytobacteriological examination of urine (CBEU) for diagnosis. However, in resource-limited countries, accessibility to CBEU remains hindered by cost and availability. This study aims to assess the utility of the Urinary Dipstick Test (UDT) in diagnosing UTIs among hospitalized patients in the context of limited resources. Methods: A cross-sectional study was conducted from February to May 2019, encompassing hospitalized patients who underwent CBEU at the bacteriology unit of Sour? Sanou University Hospital. UDT and CBEU were concurrently performed, and UDT’s analytical and diagnostic performance was evaluated against CBEU, considered the gold standard. Results: A total of 274 CBEU requests were registered, involving 274 patients (159 males) with a mean age of 45.8 ± 21.3 years (ranging from 1 to 90 years). UTI was confirmed in 90 patients, yielding a frequency of 32.85%. The UTI bacteriological profile was dominated by Enterobacteriaceae (75.23%), primarily Escherichia coli (60.55%). Nitrite and Leukocytes were positive in 54 (19.8%) and 157 (53.6%) of the samples tested. Among patients with confirmed UTI, Nitrite, and Leukocytes were positive in 30 (33%) and 71 (79%) patients respectively. UDT demonstrated variable performance based on nitrite and leukocyte combination: Sensitivity (57%-82%), Specificity (7%-98%), Positive Predictive Value (PPV) (43%-57%), Negative Predictive Value (NPV) (43%-67%). UDT performed slightly better in women (NPV = 88%) and inpatients without urinary catheters (NPV = 75% and PPV = 80%). Conclusion: This study underscores UDT’s potential utility in excluding UTIs among women, younger patients, and inpatients without urinary catheters, albeit with limited confidence. The UDT emerges as a complementary tool for UTI screening, particularly in resource-limited settings.

Diagnosis of an intermediate case of maple syrup urine disease:A case report

BACKGROUND Maple syrup urine disease(MSUD)is an autosomal recessive genetic disorder caused by defects in the catabolism of the branched-chain amino acids(BCAAs).However,the clinical and metabolic screening is limited in identifying all MSUD patients,especially those patients with mild phenotypes or are asymptomatic.This study aims to share the diagnostic experience of an intermediate MSUD case who was missed by metabolic profiling but identified by genetic analysis.CASE SUMMARY This study reports the diagnostic process of a boy with intermediate MSUD.The proband presented with psychomotor retardation and cerebral lesions on magnetic resonance imaging scans at 8 mo of age.Preliminary clinical and metabolic profiling did not support a specific disease.However,whole exome sequencing and subsequent Sanger sequencing at 1 year and 7 mo of age identified bi-allelic pathogenic variants of the BCKDHB gene,confirming the proband as having MSUD with non-classic mild phenotypes.His clinical and laboratory data were retrospectively analyzed.According to his disease course,he was classified into an intermediate form of MSUD.His management was then changed to BCAAs restriction and metabolic monitoring conforming to MSUD.In addition,genetic counseling and prenatal diagnosis were provided to his parents.CONCLUSION Our work provides diagnostic experience of an intermediate MSUD case,suggesting that a genetic analysis is important for ambiguous cases,and alerts clinicians to avoid missing patients with non-classic mild phenotypes of MSUD.

Diagnostic value of matrix metalloproteinases 2, 7 and 9 in urine for early detection of colorectal cancer

BACKGROUND A noninvasive biomarker with high diagnostic performance is urgently needed for the early diagnosis of colorectal cancer(CRC).AIM To evaluate the diagnostic value of matrix metalloproteinases(MMPs)2,7 and 9 in urine for CRC.METHODS Of 59 healthy controls,47 patients with colon polyps and 82 patients with CRC were included in this study.Carcinoembryonic antigen(CEA)in serum and MMP2,MMP7,and MMP9 in urine were detected.The combined diagnostic model of the indicators was established by binary logistic regression.The receiver operating characteristic curve(ROC)of the subjects was used to evaluate the independent and combined diagnostic value of the indicators.RESULTS The MMP2,MMP7,MMP9,and CEA levels in the CRC group differed significantly from levels in the healthy controls(P<0.05).The levels of MMP7,MMP9,and CEA also differed significantly between the CRC group and the colon polyps group(P<0.05).The area under the curve(AUC)distinguishing between the healthy control and the CRC patients using the joint model with CEA,MMP2,MMP7 and MMP9 was 0.977,and the sensitivity and specificity were 95.10%and 91.50%,respectively.For early-stage CRC,the AUC was 0.975,and the sensitivity and specificity were 94.30%and 98.30%,respectively.For advanced stage CRC,the AUC was 0.979,and the sensitivity and specificity were 95.70%and 91.50%,respectively.Using CEA,MMP7 and MMP9 to jointly established a model distinguishing the colorectal polyp group from the CRC group,the AUC was 0.849,and the sensitivity and specificity were 84.10%and 70.20%,respectively.For early-stage CRC,the AUC was 0.818,and the sensitivity and specificity were 76.30%and 72.30%,respectively.For advanced stage CRC,the AUC was 0.875,and the sensitivity and specificity were 81.80%and 72.30%,respectively.CONCLUSION MMP2,MMP7 and MMP 9 may exhibit diagnostic value for the early detection of CRC and may serve as auxiliary diagnostic markers for CRC.

Measurement of serum cystatin C,creatinine clearance and urea micro-albumin as renal function evaluation indicators in cancer patients during chemotherapy with platinum

Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in application due to complicated detection steps.By detecting the expression of serum Cystatin C(Cys C),Ccr and urinary micro-albumin(UMA),this study was designed to analyze and discuss their roles and status in renal function evaluation for cancer patients before and after chemotherapy with platinum.Methods:We retrospectively reviewed 110 patients who receiving platinum-containing protocols or non-platinum-containing ones,and got the expression of Cys C,Ccr(was calculated by Cockcroft-Gault equation) and UMA,then analyzed whether there were differences for Cys C,Ccr and UMA in those patients;for patients with mildly impaired renal function(Ccr between 50-75 mL/min),whether there were differences for Cys C and UMA before and after chemotherapy with platinum.Results:There was statistical significance for Ccr,Cys C and UMA in patients who receiving platinum-containing protocols(85.01 ± 28.40) vs(76.79 ± 26.63) mL/min,(1.49 ± 0.50) vs(1.80 ± 0.84) mg/L and(14.30 ± 9.15) vs(16.90 ± 10.95) mg/L,P = 0.00,0.00 and 0.01),and no statistical significance for those receiving non-platinum-containing ones(89.45 ± 29.69) vs(86.78 ± 27.96) mL/min,(1.51 ± 0.78) vs(1.63 ± 0.73)mg/L and(17.31 ± 10.46) vs(16.59 ± 8.33) mg/L,P = 0.45,0.07 and 0.57);and there were also significant differences for Cys C for patients with mildly impaired renal function before and after chemotherapy(1.68 ± 0.55) vs(2.04 ± 0.68) mg/L,P = 0.03),while no statistical significance for UMA for the same ones(21.11 ± 10.06) vs(21.22 ± 8.81) mg/L,P = 0.93).There were statistical significance both for Cys C and UMA before and after chemotherapy in platinum-containing group,but the AUC for Ccr and Cys C is greater than that for UMA(P < 0.02).Conclusion:Cys C and UMA can both access renal dysfunction early after chemotherapy,but Cys C is more sensitive than UMA in reflecting early renal dysfunction,so Cys C can replace Ccr and become a reliable indicator in the assessment of renal function for cancer patients before and after chemotherapy especially with platinum.

Multivariate Analysis of Female Stress Urinary Incontinence and Establishment of a Prediction Model

Stress urinary incontinence(SUI)is a symptom of uncontrolled urine outflow that affects millions of women worldwide[1].SUI is a significant healthcare issue that affects the quality of life of women across numerous domains,including social activities,physical health,mental well-being,employment,and sexual life.

Urinary Creatinine Concentrations and Its Explanatory Variables in General Chinese Population:Implications for Creatinine Limits and Creatinine Adjustment

Objective The study aimed to analyze the applicability of the World Health Organization’s exclusionary guidelines for Urinary creatinine(Ucr)in the general Chinese population,and to identify Ucr related factors.Methods We conduct a cross-sectional study using baseline data from 21,167 participants in the China National Human Biomonitoring Program.Mixed linear models and restricted cubic splines(RCS)were used to analyze the associations between explanatory variables and Ucr concentration.Results The geometric mean and median concentrations of Ucr in the general Chinese population were 0.90 g/L and 1.01 g/L,respectively.And 9.36%samples were outside 0.3-3.0 g/L,including 7.83%below the lower limit and 1.53%above the upper limit.Middle age,male,obesity,smoking,higher frequency of red meat consumption and chronic kidney disease were associated significantly with higher concentrations of Ucr.Results of the RCS showed Ucr was positively and linearly associated with body mass index,inversely and linearly associated with systolic blood pressure,diastolic blood pressure,triglycerides level,and glomerular filtration rate,and were non-linearly associated with triiodothyronine.Conclusion The age-and gender-specific cut-off values of Ucr that determine the validity of urine samples in the general Chinese population were recommended.To avoid introducing bias into epidemiologic associations,the potential predictors of Ucr observed in the current study should be considered when using Ucr to adjust for variations in urine dilution.

PERINATAL FETAL WELL-BEING MONITORING: A COMPARISON BETWEEN RANDOMIZED URINARY ESTRIOL/CREATININE AND SERUM FREE ESTRIOL DETERMINATION

Randomized urinary and blood samples were obtained from three hundred and ninety-two cases of late pregnancies simultaneously for comparison of the validity in perinatal fetal monitoring. The results of randomized urinary estriol/creatinine （RUE3/C） and serum free estriol （SFE3） tests revealed that Ⅰ. The coefficient of correlation between RUE3/C and SFE3 level were close in either normal or high-risk pregnancies （y=0.1477X+14.2368, r=0.4586, n=170; y=0.1724X+8.6698, r=0.5868, n=222, respectively, P【0.001）; 2.92%cases of the false positive rate of RUE3/C were corrected by SFE3 test. In cases of pregnancy-induced hypertension （PIH） the false positive rate of RUE3/C were highest in comparison with those in cuses of other high-risk pregnancies （53.6%）; 3. The correct rate of SFE3 test in prenatal predication of fetal well-being was significantly higher （95.6%） than that of RUE3/C （87.3%） （X2=17.77, P【0.001）. This paper suggests that RUE3/C can be used as a first line test for perinatal monitoring. When RUE3/C value is lower than normal, SFE3 test should be added to ensure the reliability of perinatal diagnosis, especially in PIH cases. Obviously, to use these two tests for perinatal fetal monitoring simultaneously is better than to use any one test alone.

Prevalence and Antibiotic Resistance of Urinary Tract Pathogens, with Molecular Identification of Klebsiella pneumoniae, Klebsiella oxytoca, and Acinetobacter spp., Using Multiplex Real-Time PCR

Urinary tract infections (UTIs) caused by uropathogens are a significant public health problem, and their treatment primarily relies on antibiotic therapy. However, the increasing global development of antibiotic resistance necessitates updating diagnostic techniques to ensure higher sensitivity and specificity, especially with advancements in science and medicine. This study aimed to evaluate the prevalence of UTIs and antibiotic resistance profiles through urine culture, as well as to identify Klebsiella pneumoniae, Klebsiella oxytoca, and Acinetobacter spp. in urine samples using a molecular approach with multiplex real-time PCR. From May 3 to July 25, 2023, at the Pietro Annigoni Biomolecular Research Center (CERBA) and Saint Camille Hospital of Ouagadougou (HOSCO), 209 urine samples collected from patients with suspected UTIs were analyzed using both urine culture and multiplex real-time PCR. Among the 209 patients, 52.15% were male and 47.85% female, with an average age of 46.87 ± 21.33 years. Urine cultures revealed an overall UTI prevalence of 23.44%, with a prevalence of 8.13% in men versus 15.31% in women (P = 0.023). The bacterial prevalence rates were as follows: Escherichia coli (12.92%), Klebsiella spp. (7.18%), Enterobacter cloacae (1.44%), Staphylococcus aureus (0.96%), and other bacteria. Klebsiella spp. demonstrated 100% resistance to Amoxicillin and Amoxicillin/Clavulanic Acid, while Escherichia coli showed 96.2% and 65.4% resistance to Amoxicillin and Amoxicillin/Clavulanic Acid, respectively. PCR analysis of the target bacteria revealed mono-infection prevalence rates of Klebsiella pneumoniae (10.39%), Klebsiella oxytoca (7.79%), and Acinetobacter spp. (7.79%), along with a co-infection prevalence rate of Klebsiella pneumoniae/Acinetobacter spp. (1.30%). This study demonstrated that PCR, with its high sensitivity and specificity, could effectively distinguish Klebsiella pneumoniae from Klebsiella oxytoca and detect Acinetobacter spp. in less than 24 hours—something urine culture alone could not achieve. The relative ease of automating urine PCR testing, combined with its diagnostic accuracy and rapid turnaround time, makes it a valuable addition to modern medical practice for the laboratory diagnosis of UTIs.

Increased Spot Urinary Protein-to-Creatinine Ratio Can Be a Useful Predictor of Preeclampsia

Objectives: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early diagnosis of preeclampsia is important to help patients with preeclampsia. However, 24-hour urine collection is the gold standard diagnostic method at present. Recently, the spot urinary protein-to-creatinine ratio (P/C ratio) has been used to detect suspected preeclampsia, because it can be used to estimate the amount of 24-hour urinary protein. The aim of this study is to investigate whether an increase in P/C ratio precedes emergence of hypertension among inpatients with preeclampsia. Method: The P/C ratio in normotensive (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) pregnant women was measured during regular prenatal checkups and in inpatients with preeclampsia between April 1, 2013 and March 31, 2014. Results: We included in this study 4074 normotensive pregnant women. The 95th percentile values for the trimester of pregnancy were 0.100, 0.157, and 0.195, respectively. The 95th percentile value for each trimester of pregnancy and gestational age were determined as criterion (Y) and predictive variables (X), respectively. In a simple regression analysis, the regression line was calculated as Y = 0.0035X + 0.0849 (R2 = 0.9913). Twenty-one women were diagnosed with preeclampsia. In 14 patients with preeclampsia, the timing of the increase in P/C ratio to higher than the regression line preceded the emergence of hypertension. Six patients had no data on P/C ratio, and 1 patient had hypertension before the increase in P/C ratio. Conclusions: An increase in P/C ratio to higher than the 95th percentile value can be a useful predictor of preeclampsia.