A simple and effective screening strategy for early multiple system atrophy diagnosis and α-Synuclein forms in erythrocytes
Bibliographic record
Abstract
Background: Urinary dysfunction is an early manifestation of autonomic dysfunction in Multiple System Atrophy (MSA) and often precedes orthostatic hypotension. This study investigated the diagnostic efficacy of post-void residual (PVR) urine volume in differentiating possible MSA from early-stage Parkinson's disease (PD) and sought to identify a feasible combination of autonomic nervous system indicators for clinical use. The distribution of α-Synuclein (α-Syn) forms in erythrocyte was preliminary explored. Methods: This study included 70 patients with MSA-P, 73 with MSA-C, and 71 with PD. All participants underwent assessments including bladder residual urine ultrasound, the supine-to-standing test (STS), external anal sphincter electromyography (EAS-EMG), brain MRI, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). Receiver operating characteristic (ROC) curves determined the diagnostic value of PVR urine volume and other autonomic indicators for possible MSA. Immunofluorescence staining of α-Syn forms in red blood cells (RBCs) was also performed. Results: < 0.01), with similar differences observed between possible MSA-P/MSA-C and early-stage PD patients. ROC analysis showed that PVR urine volume had diagnostic value in differentiating possible MSA-P (AUC = 0.668, cut-off 24.5 mL) and MSA-C (AUC = 0.759, cut-off 47.5 mL) form early-stage PD patients. ΔSBP at 1 and 3 min also distinguished possible MSA-P (AUC = 0.702, 0.730) and MSA-C (AUC = 0.707, 0.718) from early-stage PD. Combining PVR urine volume and ΔSBP (at 1 and 3 min) further improved diagnostic accuracy, with an AUC of 0.817 (sensitivity 57.1%, specificity 96.8%) for possible MSA-P and an AUC of 0.794 (sensitivity 68.6%, specificity 87.1%) for MSA-C from early-stage PD. On a molecular level, oligo-α-Syn predominantly localized to RBC membrane fractions in MSA patients, while α-Syn pS129 was primarily detected in the RBC cytoplasm of PD patients. Conclusion: Combining PVR urine volume and ΔSBP (at 1 and 3 min) is an easily accessible and effective method for distinguishing possible MSA from early-stage PD. This combination should be considered for routine assessment in Parkinsonism. Distinct α-Syn forms distribution in erythrocytes could be considered as a useful biomarker for differential diagnosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".