equine antithymocyte globulin (Thymogam)

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Implementing calculated globulin screening for immunodeficiencies: The benefits and challenges.

Jolles Stephen S, Poli Cecilia C, Rider Nicholas L NL, Negritu Gabriela G et al.

There is a need for pragmatic and cost-effective methodologies to facilitate earlier diagnosis of patients with primary and secondary immunodeficiencies, who often experience diagnostic delays that impact their quality of life, morbidity, and mortality. This review article will consider the utility of calculated globulin (CG) as a simple and unbiased screening tool for immunodeficiencies. We review literature indicating that CG can serve as an inexpensive and routinely performed proxy for immunoglobulin levels due to their established correlation. We also set out a workflow for the implementation of CG into clinical practice and discuss optimal approaches to embedding into laboratory reporting systems, and integration of AI approaches could expedite diagnoses. Finally, we discuss the challenges and pitfalls of CG screening, including the need for established CG cutoffs/action values across different patient age cohorts. Collaboration among biochemistry and immunology laboratories, clinicians, and patient organizations will be required to manage the logistics of effective broader implementation of CG screening into clinical practice.

Development of a machine learning-based noninvasive diagnostic model for liver fibrosis in metabolic-associated steatotic liver disease.

Hui Yixin Y, Zeng Yuping Y, Zhang Mei M

To address the lack of simple tools for assessing fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD), this study develops a machine learning-based diagnostic model to identify patients at high risk of significant fibrosis and advanced fibrosis. Data from biopsy-proven MASLD patients were randomly divided into training and validation sets. Variables were then selected, and models using Logistic, Support Vector Machine, and eXtreme Gradient Boosting (XGBoost) were compared with identify the optimal model. Finally, Shapley Additive Explanations-based interpretability analysis was applied to explain the best-performing model. The DeLong test was applied to compare the new model with the aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) models. The XGBoost models demonstrated robust accuracy. For the significant fibrosis outcome, the model incorporating age, total cholesterol, glycosylated hemoglobin (HbA1c), and albumin/globulin ratio achieved an area under the receiver operating characteristic curve (AUC) of 0.74 in the training set and 0.72 in the testing set. Regarding the advanced fibrosis outcome, the model including age, total cholesterol, HbA1c, platelets, white cell count, and albumin/globulin ratio yielded an AUC of 0.78 in the training set and 0.74 in the testing set. Decision curve analysis curves confirmed clinical utility, and performance surpassed APRI and FIB-4 (P < 0.05). This study developed a novel noninvasive diagnostic model for MASLD using simple and easily accessible variables, which demonstrates superior performance compared with traditional serological models.

Mares with severe equine asthma exhibit a narrower trachea than geldings in a retrospective radiographic study of 189 horses.

Arnaiz Saura Patricia P, Masseau Isabelle I, Lavoie Jean-Pierre JP, Mainguy-Seers Sophie S

To evaluate potential relationships between sex, asthma severity, and tracheal diameter in adult horses through the use of thoracic radiography. This was a retrospective case-control study of horses that underwent thoracic radiography at the Université de Montréal from 2018 through 2024. Horses were classified as control, mild/moderate asthma, or severe asthma (SEA) according to the latest consensus statement on equine asthma. To account for radiographic magnification and body size, standardized ratios of tracheal diameter relative to the fifth thoracic vertebral body length and aortic diameter were calculated. The effects of disease status, sex, and their interaction were analyzed using a 2-way ANOVA and Tukey multiple-comparisons test, with results presented as mean [SD] and 95% confidence intervals (CI) of the difference for significant pairwise comparisons. 189 horses were included. The trachea-to-fifth thoracic vertebral body length ratio differed by disease status, with an interaction between sex and disease, as SEA mares had a lower ratio (0.7 [SD, 0.1]) than SEA geldings (0.8 [SD, 0.1]; 95% CI, 0.03 to 0.2), control mares (0.8 [SD, 0.1]; 95% CI, 0.05 to 0.3), and mild/moderate asthma mares (0.8 [SD, 0.1]; 95% CI, 0.03 to 0.2). The trachea-to-aorta ratio was influenced by disease status as it was lower in SEA horses than in controls. Absolute tracheal diameter was affected by disease status and sex, with an interaction between both factors, with SEA mares exhibiting the narrowest trachea. Tracheal diameter is influenced by both sex and asthma status in horses. Whether this sex-related difference in tracheal diameter influences lung mechanics and exercise capacity remains to be investigated.