bluuebunny/crossref_metadata_2025 huggingface dataset:
Analytical performance and clinical usefulness of a commercially available IRMA kit for measuring atrial natriuretic peptide in patients with heart failure
Authors: Clerico A , Iervasi G , Del Chicca M G , Maffei S , Berti S , Sabatino L , Turchi S , Cazzuola F , Manfredi C , Biagini A
Published: January 2020

We evaluated the analytical characteristics and clinical usefulness of a commercially available IRMA kit for measuring plasma concentrations of atrial natriuretic peptide (ANP) in healthy subjects and in patients with heart failure. The method uses two monoclonal antibodies prepared against sterically remote epitopes of the ANP molecule; the first antibody is coated on the solid-phase beads, and the second is radiolabeled with 125I. Fifty-nine healthy subjects and 77 patients with heart failure were studied. After subjects had rested 20 min in a recumbent position, blood samples were collected from a brachial vein into ice-chilled disposable polypropylene tubes containing aprotinin and EDTA. Plasma samples were immediately separated by centrifugation and stored at -20 degrees C until assay. The working range (CV <15%) was 10-2000 ng/L. The detection limit (2.13 +/- 0.91 ng/L) was similar to those reported for other IRMAs but was much better than those of RIAs. For healthy subjects, the results of this method (18.0 +/- 10.6 ng/L, range 4.7-63 ng/L, median 16.7 ng/L, n = 59) were similar to those generally reported for the most accurate methods, i.e., those using preliminary extraction and chromatographic purification of plasma samples. Measured plasma ANP was significantly associated with the severity of clinical symptoms, i.e., NYHA class (ANOVA, P <0.0001), and with the left ventricular ejection fraction (n = 62, r = 0.618, P <0.0001). Patients with severe heart failure showed greatly increased values (NYHA III-IV: 257.4 +/- 196.6 ng/L, n = 23).
Standardization of assay for cytokeratin-related tumor marker CYFRA21.1 in urine samples
Authors: Dittadi R , Barioli P , Gion M , Mione R , Barichello M , Capitanio G , Cocco G , Cazzolato G , De Biasi F , Praturlon S , Antinozzi R , Gianneo E
Published: January 2020

The determination of tumor markers in urine samples has been proposed as an effective diagnostic tool in bladder cancer. The aim of the present investigation was to validate in urine samples the assay of the CYFRA21.1 cytokeratin-related marker, the serum concentrations of which showed promising diagnostic utility in patients with bladder cancer. First-voided urine samples were collected from patients with different malignancies. CYFRA21.1 was assayed with a commercially available enzyme immunoassay (Boehringer Mannheim). Different centrifugation patterns, the use of different buffers and nonionic detergents, and pH variations were evaluated. We demonstrated that: (a) cells and cell debris contain a large amount of CYFRA21.1 and must be eliminated by centrifugation; (b) storage at -20 degrees C causes amorphous precipitate, which may aspecifically bind CYFRA21.1; (c) the latter behavior may be prevented by diluting fresh urine samples with phosphate buffer with nonionic detergent added; (d) pH variations within the range 4.9-8.2 do not significantly affect CYFRA21.1 assay results. Provided that samples are diluted with buffer containing nonionic detergent, the CYFRA21.1 assay showed good precision and accuracy characteristic in urine samples. We therefore propose a standard protocol for the collection of urine samples for CYFRA21.1 assay. In a preliminary clinical evaluation, CYFRA21.1 concentrations in 16 patients with primary bladder cancer were higher than in healthy subjects. In the urine collected in the follow-up of patients treated for bladder cancer, CYFRA21.1 tended to be higher in relapsed patients than in those without evidence of disease. These preliminary data induced us to extend the clinical trial to establish the actual role of this assay in routine use.
Coated-tube radioimmunoassay for C-telopeptides of type I collagen to assess bone resorption
Authors: Bonde M , Fledelius C , Qvist P , Christiansen C
Published: January 2020

We present a coated-tube RIA that is useful for assessment of bone resorption. The assay uses a monoclonal antibody raised against a linear 8-amino-acid sequence (EKAHDGGR) derived from the C-telopeptides of type I collagen. Within-run and total CVs were 4.4% and 5.3-6.2%, respectively, at concentrations of 1-7 mg/L (n = 4-20). Analytical recovery was 98% +/- 8% and dilution 97% +/- 7%. Values obtained in a group of 36 premenopausal women were 227 +/- 89.6 mg/mol creatinine. In a group of 141 postmenopausal women, the values obtained were 429 +/- 225 mg/mol creatinine, a highly significant increase of 89% (P <0.001) over the premenopausal value. In a double-blind placebo-controlled clinical study of these postmenopausal women receiving five different doses of a bisphosphonate, a significant decrease of RIA-measured C-telopeptide values was seen in all bisphosphonate-treated groups, after just 3 months. Values in urine samples from postmenopausal women assayed with the RIA (gamma) and the CrossLaps(TM) ELISA (x) agreed well: slope = 0.98 (95% confidence interval, 0.94-1.01), intercept = 0.34 (0.25-0.43) mg/L, and Sylx = 0.93 mg/L (n = 678). We conclude that this RIA represents a valuable tool for assessing bone resorption.
Metabolite and matrix interference in phenytoin immunoassays
Authors: Rainey P M , Rogers K E , Roberts W L
Published: January 2020

The major phenytoin metabolite, 5-(p-hydroxyphenyl)-5-phenylhydantoin glucuronide (HPPG), was primarily responsible for the positive bias noted when uremic specimens were assayed with the Abbott TDx Free Phenytoin fluorescence polarization immunoassay. The amount of bias depended on both HPPG and phenytoin concentration, increasing with increases in either concentration. The new Abbott TDx II assays for phenytoin and free phenytoin exhibited no significant cross-reactivity with HPPG and no bias in clinical specimens from uremic patients. Both assays correlated well with Emit-based assays (r >0.98), had CVs of <3.5%, and had minimum detection limits of <0.1 mg/L. Calibration curves were stable for at least 6 weeks. All of the TDx assays cross-reacted with another metabolite, 5-(p-hydroxyphenyl)-5-phenylhydantoin (HPPH), but expected HPPH concentrations are too low to cause a clinically significant bias. The Emit-based phenytoin assay exhibited a significant matrix effect when calibrators were prepared in defibrinated plasma processed to resemble serum.
Isotope dilution--mass spectrometric quantification of specific proteins: model application with apolipoprotein A-I
Authors: Barr J R , Maggio V L , Patterson D G , Cooper G R , Henderson L O , Turner W E , Smith S J , Hannon W H , Needham L L , Sampson E J
Published: January 2020

An enzymatic hydrolysis isotope dilution-mass spectrometric method was developed for reference quantification of specific proteins. The analytical procedure involved measuring a reproducibly hydrolyzed peptide (serving as the primary standard) unique to a specific protein. This new mass spectrometric method was evaluated by assessing the concentration of apolipoprotein (apo) A-I in the European Community Bureau of Reference (BCR) lyophilized Certified Reference Material (CRM 393). We used the method to make 96 measurements (4 replicate analyses of 4 enzymatic digests of 6 vials of BCR-CRM 393), which gave an average total protein mass of 1.048 mg (+/- 1.0% at 99% confidence limits). The total overall analytical CV was 3.95%. The results of this evaluation of our model approach to determine the concentration of a specific protein in a purified preparation demonstrated that our new mass spectrometric method can be used to measure apolipoproteins and other specific proteins without the use of epitopic immunoassay methods.
Results of an international round robin for serum and whole-blood folate
Authors: Gunter E W , Bowman B A , Caudill S P , Twite D B , Adams M J , Sampson E J
Published: January 2020

Because of the increasing significance of folate nutriture to public health, a "round robin" interlaboratory comparison study was conducted to assess differences among methods. Twenty research laboratories participated in a 3-day analysis of six serum and six whole-blood pools. Overall means, SDs, and CVs derived from these results were compared within and across method types. Results reported for serum and whole-blood folate demonstrated overall CVs of 27.6% and 35.7%, respectively, across pools and two- to ninefold differences in concentrations between methods, with the greatest variation occurring at critical low folate concentrations. Although results for serum pools were less variable than those for whole-blood pools, substantial intermethod variation still occurred. The overall results underscore the urgent need for developing and validating reference methods for serum and whole-blood folate and for properly characterized reference materials. For evaluating study or clinical data, method-specific reference ranges (established with clinical confirmation of values for truly folate-deficient individuals) must be used.
Comparative sensitivity of cardiac troponin I and lactate dehydrogenase isoenzymes for diagnosing acute myocardial infarction
Authors: Jaffe A S , Landt Y , Parvin C A , Abendschein D R , Geltman E M , Ladenson J H
Published: January 2020

Criteria for the retrospective diagnosis of acute myocardial infarction rely heavily on increases in lactate dehydrogenase (LD) isoenzymes. However, increases of LD isoenzyme activities are not specific for myocardial injury. Recently, increased concentrations of cardiac troponin I (cTnI) have been shown to be highly specific for myocardial damage and to have sensitivity comparable with that of creatine kinase MB isoenzyme for detecting cardiac injury. Furthermore, increases of cTnI persist in plasma for at least several days. The present study was designed to determine the relative sensitivities of cTnI and LD isoenzymes over time for the diagnosis of infarction. The results indicate that cTnI values are at least as sensitive as LD isoenzymes: 90% of patients with myocardial infarction had above-normal concentrations of cTnI on the 4th day after admission to the coronary care unit. Criteria based on cTnI should improve the accuracy of retrospective diagnoses of acute myocardial infarction.
Use of a rapid HPLC assay for determination of pharmacokinetic parameters of ibuprofen in patients with cystic fibrosis
Authors: Rifai N , Sakamoto M , Law T , Galpchian V , Harris N , Colin A A
Published: January 2020

High doses of ibuprofen have been shown to delay the progression of lung disease without serious adverse effects in patients with cystic fibrosis. To be effective, peak ibuprofen concentration of 50 to 100 mg/L has to be achieved. We developed an HPLC assay to rapidly determine plasma ibuprofen concentration. We used this assay to determine the pharmacokinetics of ibuprofen in patients with cystic fibrosis. The assay possessed linearity up to 500 mg/L, sensitivity to 1 mg/L, average recovery of 98%, and run-to-run precision (n = 23) of 3%. Furthermore, the assay proved to be free of interference from 51 medications. Observed time to peak concentration varied significantly between those receiving ibuprofen tablets (mean + SD, 94 +/- 29 min, n = 16) and syrup (30 +/- 0 min, n = 4) (P < 0.0001). We conclude that the method described here is ideal for therapeutic monitoring of ibuprofen.
Frequency of phenotype-genotype discrepancies at the apolipoprotein E locus in a large population study
Authors: Lahoz C , Osgood D , Wilson P W , Schaefer E J , Ordovas J M
Published: January 2020

Apolipoprotein E (apoE) genotypes were determined in a random subset of 1041 subjects enrolled in the Framingham Offspring Study by using DNA amplification followed by restriction isotyping. The results were compared with the apoE phenotypes previously assessed by isoelectric focusing. Discrepancies in apoE allele assignment were found in 98 subjects (9.4%). Both genotype and phenotype were reassessed in these subjects. Genotype misclassification was observed in 20 subjects, whereas the initial phenotype assignment was modified in 46 subjects. No concordance between apoE phenotype and genotype remained in 32 subjects (3.07%). Both methods resulted in similar apoE allele frequencies. Furthermore, no differences were observed regarding the average allelic effect on total cholesterol, LDL cholesterol, or HDL cholesterol concentrations; however, a significant difference was noted on triglyceride concentrations. Our results indicate that most discrepancies between genotype and phenotype assessment of apoE polymorphism were due to sample mishandling, data entry, and technical difficulties rather than true discordances.
Biological variability in serum vitamin E concentrations: relation to serum lipids
Authors: Maes M , Weeckx S , Wauters A , Neels H , Scharpé S , Verkerk R , Demedts P , Desnyder R
Published: January 2020

The components of biological variation in serum vitamin E in relation to serum cholesterol, triglycerides, high- and low-density lipoprotein cholesterol (HDL-C, LDL-C), apolipoprotein A-I (apo A-I), and apo B were examined in 26 healthy volunteers who had monthly blood samplings during one calendar year. The estimated CVs for vitamin E were: interindividual, 19.9%, and intraindividual, 11.9%; the index of individuality (I-index) was 0.59. The I-indices for all lipid variables were < 0.51. Serum concentrations of vitamin E, cholesterol, triglycerides, HDL-C, LDL-C, and apo B were lower in spring than in the other seasons. The peak-trough differences in the yearly variations, expressed as a percentage of the mean, were for vitamin E 14.5%, cholesterol 16.2%, triglycerides 14.5%, and LDL-C 24.3%. A significant common annual rhythm was expressed in vitamin E or lipid variables and in the changes in ambient temperature the weeks before blood sampling (inverse relations). There were highly significant positive time relations between serum vitamin E and cholesterol, triglycerides, and apo B. Subjects with higher homeostatic setpoints of cholesterol showed higher homeostatic setpoints of vitamin E, triglycerides, LDL-C, and apo B.
Problems and practical considerations in assessing accuracy with NIST SRM 909a: report of defective vials
Authors: De B K , Karr B A , Ghosn S , Copeland B E
Published: January 2020

During an experimental period of 12 months in 1992-1993, while we were comparing the effectiveness of monthly vs quarterly use of the National Institute for Standards and Technology Standard Reference Material (NIST SRM) 909a as an accuracy material for the projected 30-year Fernald Medical Monitoring Program, we encountered three random defective vials with a glucose recovery of less than 30% of the NIST-assigned value. Analysis with five different multichannel instruments confirmed the original finding. Concomitant glucose recovery from adjacent vials was 97%-104%, as determined by using the same instruments, reagents, calibrators, and quality-control criteria on the same days. Recoveries of uric acid and cholesterol were also low (53-75% and 75-80%, respectively) in the three defective vials. Other analytes were unaffected. Studies to identify the cause of the defective vials were carried out with microbiological, electron microscopic, and biochemical techniques. When used for accuracy studies, each vial of NIST SRM 909a should have a concomitant check for glucose recovery to detect whether the vial is defective.
Diagnostic value of various serum antibodies detected by diverse methods in childhood celiac disease
Authors: Sacchetti L , Ferrajolo A , Salerno G , Esposito P , Lofrano M M , Oriani G , Micillo M , Paparo F , Troncone R , Auricchio S , Salvatore F
Published: January 2020

The diagnostic performances of antiendomysium IgA detected on monkey esophagus and human umbilical cord smooth muscle, of antireticulin IgA, and of antigliadin IgA and IgG were calculated in 74 children with celiac disease (CD) or other gastrointestinal disorders. We also compared four methods for gliadin antibody detection. With a diagnostic specificity of 100%, diagnostic sensitivity was 94% for antireticulin IgA, 93% for antiendomysium IgA when detected on human umbilical cord smooth muscle, and 97% when detected on monkey esophagus. The diagnostic sensitivity for gliadin antibody was highest with an ELISA procedure, followed by fluorogenic detection (94% for IgG, 91% for IgA, 97% with IgA and IgG combined). Because of its high diagnostic sensitivity and ease and speed of use, the combined antigliadin IgG and IgA antibody assay is suitable for screening large groups of patients. In IgG- or IgA-positive cases, the more demanding and more specific antiendomysium IgA evaluation is required to confirm suspected CD.
Enzymatic deconjugation of erythrocyte polyglutamyl folates during preparation for folate assay: investigation with reversed-phase liquid chromatography
Authors: Pfeiffer C M , Gregory J F
Published: January 2020

Erythrocyte (RBC) folates occur mainly as 5-methyltetrahydrofolate polyglutamates. Determination of RBC folate concentration requires an initial deconjugation of these polyglutamates. In this study, existing HPLC methods were adapted to investigate the rate and extent of this deconjugation process. The action of endogenous plasma pteroyl-polyglutamate hydrolase activity was strongly affected by the conditions of sample preparation, with pH of the incubation mixture more critical to effective deconjugation than incubation time. Dilution of whole blood with 10 g/L ascorbic acid yielded fast hydrolysis of long-chain polyglutamates, and total conversion to 5-methyltetrahydrofolate monoglutamate occurred after 90 min of incubation at 37 degrees C. In contrast, dilution of whole blood with 10 g/L sodium ascorbate, with up to 90 min of incubation at 37 degrees C, yielded a mixture of polyglutamates of 5-methyltetrahydrofolate (glun = 1-8). As documented by direct HPLC analysis and in concurrent assays with Lactobacillus casei, acidification provided by ascorbic acid can have dramatic effects on the measurement of RBC folates.
Development of human renal function: reference intervals for 10 biochemical markers in fetal urine
Authors: Muller F , Dommergues M , Bussières L , Lortat-Jacob S , Loirat C , Oury J F , Aigrain Y , Niaudet P , Aegerter P , Dumez Y
Published: January 2020

Evaluation of fetal renal function by analysis of fetal urine sampled in utero may improve perinatal care after a prenatal diagnosis of bilateral obstructive uropathy. We provide reference intervals for 10 fetal urinary compounds and examine their variation with gestational age. Forty-one fetuses with bilateral obstructive uropathy (urine sampled between 20 and 38 weeks of gestational age) had normal, healthy values for serum creatinine (< or = 50 mumol/L) at ages 1-2 years. These cases were thus assumed to represent a reasonable approximation to healthy values. Sodium and beta 2-microglobulin concentrations significantly decreased with gestational age; calcium, ammonia, and creatinine significantly increased; glucose, phosphorus, chloride, urea, and total protein concentrations did not vary. Our results provide reference values for prenatal evaluation of fetal renal function and suggest that glomerular filtration of macromolecules and tubular reabsorption of glucose and phosphorus are mature by 20 weeks of gestation, whereas tubular reabsorption of sodium and beta 2-microglobulin increases progressively during the second half of gestation.
Highly sensitive ELISA for soluble Fas in serum: increased soluble Fas in the elderly
Authors: Seishima M , Takemura M , Saito K , Sano H , Minatoguchi S , Fujiwara H , Hachiya T , Noma A
Published: January 2020

We have developed and characterized a highly sensitive ELISA for soluble Fas (sFas) in the serum. The linearity of calibrator range was 0.06-2.00 micrograms/L and the detection limit was 0.01 microgram/L. The average within- and between-run CVs were 3.9% and 3.8%, respectively. The recovery of added sFas to serum was 93-118%. The effects of possible interferences (tryglyceride, hemoglobin, bilirubin) were negligible. We determined serum sFas in 155 healthy subjects, ages 20-69. The mean value of sFas in men (2.50 +/- 0.63 micrograms/L, n = 78) was significantly higher than that in women (2.01 +/- 0.53 micrograms/L, n = 77) (P < 0.001). Furthermore, there was a significant correlation between serum sFas concentration and age (men, r = 0.397, P < 0.001; women, r = 0.569, P < 0.001). Although the concentrations of sFas tended to increase with aging, it remains to be clarified how Fas-mediated apoptosis relates to aging.
Importance of standardization of lipase assays by using appropriate calibrators
Authors: Lessinger J M , Dourson J L , Férard G
Published: January 2020

Comparability of lipase catalytic activities was poor when lipase was determined in 50 patients' specimens by a turbidimetric (Boehringer) and a colorimetric (Sigma) assay. Mean values of results differed by a ratio of 2.39. Optimal common conditions were defined for the titration of lipase activity in two commercial calibrators and in a home-purified preparation of human pancreatic lipase (HPL). When using these titers for each calibrator, comparability was greatly improved (ratio = 1.25). This result indicates that a significant part of between-method discrepancy is due to the lack of a reference method for the titration of lipase calibrators. Intermethod behavior of each material was compared with that of patients' specimens. By using HPL as calibrator, comparability was still dramatically improved (ratio = 1.01). This study shows the importance of the validation of a material for defined routine measurement procedures, before its use as calibrator.
Immunofluorometric assay of prostaglandin D synthase in human tissue extracts and fluids
Authors: Melegos D N , Diamandis E P , Oda H , Urade Y , Hayaishi O
Published: January 2020

A two-site sandwich-type assay for human prostaglandin D (PGD) synthase (beta-trace) was developed with two monoclonal antibodies and using time-resolved fluorometry as the detection technique. The assay is precise (CVs < 10%), accurate, and highly specific for PGD synthase and has a detection limit of 0.05 microgram/L. Using this assay, we measured PGD synthase concentrations in serum, urine, amniotic fluid, cerebrospinal fluid (CSF), seminal plasma, breast cyst fluid, breast discharge fluid, breast milk, and breast tumor extracts. The highest concentrations were found in CSF. We identified proteolytic degradation of PGD synthase in amniotic fluid. Fetal tissues contained various amounts of the enzyme, with the highest values being found in brain and heart. In placental extracts, PGD synthase content was greatest at 11-28 weeks of gestation-in accordance with the concentrations measured in amniotic fluids for this gestational period. We conclude that PGD synthase is ubiquitous and is present in many fluids and tissues of adults and fetuses. This first quantitative and sensitive assay of PGD synthase should facilitate expansion of knowledge on this enzyme and possibly will have applications for diagnosis and monitoring of human diseases.
Biological variation of lipids and lipoproteins in fingerstick blood
Authors: Kafonek S D , Donovan L , Lovejoy K L , Bachorik P S
Published: January 2020

The biological variability of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and calculated low-density lipoprotein cholesterol (LDL-C) was determined in three serial (monthly) capillary and venous specimens from 83 subjects. The analytes were quantified with a desktop analyzer. We saw no differences in the coefficient of biological variability (CVb) between capillary and venous specimens for any analyte (TC, 5.2%; TG, 14.7%; HDL-C, 7.2%; LDL-C, 5.4%). The average analytical variability (CVa) for each analyte, determined in quality-control pools, was; TC, 5.0%; TG, 5.2%; HDL-C, 5.8%; and LDL-C, 7.5%. Compared with standardized laboratory measurements, the desktop analyzer exhibited a significant (P < 0.001) positive bias for all analytes (average bias: TC, 5%; TG, 16%; HDL-C, 6%; and LDL-C, 2.4%). Thus, the biological variation of lipids and lipoproteins was the same in fingerstick and venous samples, and the desktop analyzer showed inherently greater analytical variability.
Immunoreactive elastase I: clinical evaluation of a new noninvasive test of pancreatic function
Authors: Stein J , Jung M , Sziegoleit A , Zeuzem S , Caspary W F , Lembcke B
Published: January 2020

We have evaluated the diagnostic value of the fecal elastase test in comparison with the secretin-pancreozymin test in the diagnosis of exocrine pancreatic insufficiency. Pancreatic elastase was measured immunologically. Immunoreactive elastase activity in spot stools from controls ranged from 136 to 4440 microgram/g; 95% of all values were within 175 to 1500 microgram/g. The elastase assay CVs ranged from 3.3% to 6.3% (intraassay) and from 4.1% to 10.2% (interassay). The output of elastase correlated well with those of amylase, lipase, and trypsin, yielding respective correlation coefficients of 0.83, 0.82, and 0.84 in controls and 0.86, 0.91, and 0.91 in patients with impaired pancreatic function. In contrast to fecal chymotrypsin, the test results were unaffected by pancreatic enzyme replacement therapy. These results indicate that fecal immunoreactive elastase may be recommended as a new, noninvasive tubeless test of pancreatic function.
Rapid competitive PCR determination of relative gene expression in limiting tissue samples
Authors: Jiang Y H , Davidson L A , Lupton J R , Chapkin R S
Published: January 2020

Reverse transcriptase (RT)-PCR is widely used to study gene transcription in many biological systems. Despite the development of a variety of procedures, quantification of RT-PCR products remains difficult, particularly when processing a large number of samples. Therefore, we developed a novel alternative PCR technique that we term "rapid competitive PCR" (RC-PCR), designed to study the relative expression of specific genes in a large number of small tissue biopsies. RC-PCR is characterized by measuring relative gene expression at the mRNA level of two or more samples with a nonradioactive assay based on competitive PCR amplification between identical sequences of internal standard and target cDNA. Only a single reaction tube per sample is used in this technique, and it was validated by comparing RC-PCR of protein kinase C zeta and alpha expression in rat colonic mucosa samples with competitive RT-PCR analysis (requiring 6-8 reaction tubes per sample). We conclude that RC-PCR is a simple, rapid, highly sensitive technique that is capable of detecting less than twofold differences in mRNA expression.
Technical performance evaluation of BM/Hitachi 747-200 serum fructosamine assay
Authors: Lin M J , Hoke C , Ettinger B , Coyne R V
Published: January 2020

The technical performance of serum fructosamine assay as a short-term index of diabetic control was evaluated by using the BM/Hitachi 747-200 Automatic Analyzer (Boehringer Mannheim Corp). Intra- and interassay precisions (CV) were <2%. Linearity was confirmed up to 1000 micromol/L. Lipemia, produced artificially or from hypertriglyceridemia in vivo, did not interfere with measurement of serum fructosamine concentration. However, hemoglobin (Hb) interfered with measurement substantially at concentrations >15.5 micromol/L, and bilirubin interfered substantially at concentrations >68.4 micromol/L. A normal reference range of up to 282 micromol/L (mean +/- 2SD = 242 +/- 40) was derived from results obtained from 228 nondiabetic subjects. In 222 diabetic subjects, serum fructosamine concentration correlated well with fasting glucose concentration (r = 0.74) and with Hb A1c concentration (r = 0.80). This automated fructosamine assay has the advantages of technical simplicity, low cost, and reduced analytical time compared with the Hb A1c method.
Effect of cortisol on percentage of non-sex-hormone-bound steroid: implications for distribution of steroids on binding proteins in serum
Authors: Cooke R R , McIntosh J E , Murray-McIntosh R P
Published: January 2020

We previously observed that in men concentrations of serum testosterone (T) not bound to sex-hormone-binding globulin (n-SHBGT) decreased as concentrations of cortisol increased in early morning. This led us to investigate in vitro the influence of several steroids on protein-bound T. Steroids were added to late-evening sera containing low concentrations of cortisol. Changes were measured in percent T or estradiol not bound to SHBG (%n-SHBGT or %n-SHBGE). Results were compared with computer simulations of a mass action model describing current understanding of steroid binding to serum proteins. In vitro measurements confirmed changes observed in vivo. Cortisol at 600 nmol/L reduced %n-SHBGT to 61% +/- 5% of basal, but this was reversed with cortisol at 2000 nmol/L. Progesterone reduced %n-SHGBT less, and dexamethasone had no effect. Free T rose with added cortisol. Increasing estradiol to 900 nmol/L caused an increase in %n-SHBGT. The %n-SHBGE rose with added cortisol (121% +/- 5% of basal with cortisol at 1000 nmol/L). Simulation predicted all behaviors except the marked initial decrease in %n-SHBGT as cortisol concentrations increased and the absolute values of %n-SHBGT and %n-SHBGE. A possible explanation for the former is that T is displaced from corticosteroid-binding globulin (CBG) by added cortisol, more T is bound to CBG than expected, and T displaced from CBG associates with SHBG rather than albumin. Alternatively, current understanding about steroid binding to serum proteins has other major deficiencies.
Determination of blood lead by electron-capture negative chemical ionization gas chromatography-mass spectrometry
Authors: Baird G S , Fitzgerald R L , Aggarwal S K , Herold D A
Published: January 2020

An electron-capture negative chemical ionization (NCI) gas chromatography-mass spectrometry (GC-MS) method for determination of lead (Pb) in blood samples is described. Extraction of Pb from the sample does not involve hot digestion but is based on treatment at ambient temperature. The blood sample is supplemented with a known amount of internal standard (204Pb) for isotope dilution and is treated with concentrated nitric acid. After adjusting the pH to 7, the Pb is extracted into toluene as the pyrrolidine-dithiocarbamate chelate. Samples are then derivatized with 4- fluorophenylmagnesium bromide to form Pb(FC6H4)4. The use of NCI offers enhanced sensitivity (by 75-fold better than previously used electron ionization), gives good precision and accuracy, and has no observable memory effect. The isotope dilution GCoff methodology typically agreed within 2-3% of expected values for the College of American Pathologists blood Pb specimens and the National Institute of Standards and Technology Standard Reference Material 955a.
Use of flameless atomic absorption spectroscopy in immune cytolysis for nonradioactive determination of killer cell activity
Authors: Borella P , Bargellini A , Salvioli S , Cossarizza A
Published: January 2020

We describe here a novel method to evaluate natural killer (NK) cytolytic activity by use of flameless atomic absorption spectroscopy (GF-AAS). This technique may be adopted for use in laboratories equipped with electrothermal atomic absorption spectrometers. Nonradioactive Cr as Na2CrO4 was used to label target cells (K562), and cell lysis was evaluated by measuring Cr released after 4 h of incubation with the effectors. We selected 520 micrograms/L as the optimal dose for labeling targets, between 12 and 20 h as the optimal incubation time, and 10(4) cells as the optimal target size. Advantages of this method include: (a) exclusion of radioactive tracer, with no risk for workers; (b) limited costs; (c) high sensitivity and reproducibility; (d) possibility to store samples; and (e) better control of Cr used for labeling cells due to well-determined, fixed Cr concentrations in the range of nontoxic and linear cellular uptake. Comparison with data obtained by conventional 51Cr labeling of targets killed by the same effectors was excellent, yielding comparable results and corroborating the method.
Rapid diagnosis of homocystinuria and other hypermethioninemias from newborns' blood spots by tandem mass spectrometry
Authors: Chace D H , Hillman S L , Millington D S , Kahler S G , Adam B W , Levy H L
Published: January 2020

We report a new method for the diagnosis of homocystinuria and other hypermethioninemias from dried blood spots on newborn screening cards, based on isotope-dilution tandem mass spectrometry. The mean concentration of methionine in 909 unaffected newborns was 19 micromol/L (CV 44%). The variability of results was reduced when the concentration of methionine was expressed relative to that of another amino acid in the same specimen. The mean ratio of methionine to leucine plus isoleucine for these same newborn blood spots was 0.16 (CV 25%). In newborn samples from a collection categorized by a Guthrie bacterial inhibition assay as true positive, unaffected, or falsely positive for hypermethioninemias, the ratio of methionine to leucine for each true-positive specimen was at least 2.5 times greater than for respective age-matched unaffected blood specimens. The ratio for falsely positive samples did not differ from that for unaffected blood samples. We predict that the ratio of methionine to leucine plus isoleucine determined by tandem mass spectrometry will successfully detect hypermethioninemias with very low rates for false positives and false negatives.
Detection and identification of 6-methylmercapto-8-hydoxypurine, a major metabolite of 6-mercaptopurine, in plasma during intravenous administration
Authors: Keuzenkamp-Jansen C W , van Baal J M , De Abreu R A , de Jong J G , Zuiderent R , Trijbels J M
Published: January 2020

6-Mercaptopurine, a hypoxanthine antimetabolite, is used in the treatment of acute lymphoblastic leukemia (ALL) in children. Extensively metabolized before it exerts cytotoxic action, it is catabolized into 6-mercapto-2,8-dihydroxypurine (thiouric acid), which is excreted by the kidneys. We describe a metabolite of 6-mercaptopurine, 6-methylmercapto-8-hydroxypurine, whose presence has not been previously reported in plasma. This compound was found in high concentrations in plasma during high-dose 6-mercaptopurine infusions (1300 mg/m2 in 24 h). This previously unknown compound was identified by reversed-phase HPLC with absorbance detection and by gas chromatography-mass spectrometry. The pathways leading to 6-methylmercapto-8-hydroxypurine in vivo are not yet fully understood. In a group of 17 patients treated with four courses of high-dose 6-mercaptopurine infusions according to the ALL-8 treatment protocol of the Dutch Childhood Leukemia Study Group, the steady-state concentrations of 6-methylmercapto-8-hydroxypurine in plasma were one-fifth of the parent drug concentrations, with wide interindividual variation. The formation of high concentrations of 6-methylmercapto-8-hydroxypurine in plasma, especially during the infusion, probably indicates another catabolic pathway of high-dose 6-mercaptopurine, apart from its conversion into thiouric acid.
Delivering clinical laboratory services to intensive care units
Authors: Steffes M W , Gillen J L , Fuhrman S A
Published: January 2020

In response to the pressures of cost reduction, we established and evaluated a carefully integrated program to deliver clinical laboratory services more promptly and efficiently to the intensive care units (ICUs). The new protocol reduced the steps and turnaround time from ordering tests by physicians to reporting results by as much as 80% on all ICUs, permitting significant reductions in personnel (exceeding $400,000 per year). For the surgical ICU there were also fewer blood collections (mean preprotocol: 7.0 per patient per 24 h; mean last 12 months: 6.0; P= 0.002). The volume of blood collected fell from 8.1 to 3.5 mL per collection, primarily following an emphasis on small containers. Consequently, the amount of blood taken from each surgical ICU patient decreased from 56 to 21 mL per 24 h (P <0.001).
VIDAS D-dimer: fast quantitative ELISA for measuring D-dimer in plasma
Authors: Pittet J L , de Moerloose P , Reber G , Durand C , Villard C , Piga N , Rolland D , Comby S , Dupuy G
Published: January 2020

VIDAS D-dimer (bioMérieux) is a new quantitative ELISA for D-dimer determination designed for the VIDAS automated system. The test contains single-dose, ready-to-use reagents and is completed within 35 min. Quantitative results are obtained from a calibration curve stored in the software of the system and expressed as fibrinogen equivalent units. The two-step capture/tag test relies on two complementary monoclonal anti-D-dimer antibodies, the second one being labeled with alkaline phosphatase. The upper limit of the measuring range is 1000 micrograms/L and the lower detection limit is <50 micrograms/L, which is below the lower limit of the reference interval (68-494 micrograms/L). Reproducibility (CV) within and between runs ranges from 5% to 7%. There is no interference from heparin, bilirubin, hemoglobin, fibrinogen degradation products, or plasma turbidity. Comparison with a conventional ELISA (y) gave good correlation (r= 0.91, n= 579) and comparable results (y= 1.35x - 148, S(y/x)= 750), especially for D-dimer concentrations ranging from 0 to 1000 micrograms/L (y= 1.09x - 10.6, r= 0.88, S(y/x)= 170).
Serum prostate-specific antigen measured in children from birth to age 18 years
Authors: Randell E W , Diamandis E P , Ellis G
Published: January 2020

We measured prostate-specific antigen (PSA) in serum from 94 cord- blood samples, from 44 newborns, and from 330 children up to age 18 years, using a highly sensitive "third generation" PSA assay on the IMMULITE (Diagnostic Products Corp.) analyzer. The serum was that remaining after cross-matching for blood transfusion. Most children were hospitalized for special care or surgery. We found detectable concentrations of PSA (> or = 0.003 micrograms/L) in many cord sera and in sera from both male and female neonates. PSA was more frequently detectable in cord and newborn sera from males than from females, but there was considerable overlap in values between the sexes, negating any possible usefulness of PSA for assigning male gender to newborns with ambiguous genitalia. PSA decreased to undetectable concentrations in most prepubertal males and females but became detectable around the age of puberty in males. We speculate that the presence of detectable PSA in cord and newborn sera results from androgenic stimulation of prostatic tissue in males or from stimulation of breast or other tissue by prolactin or progesterone in females.
Relation between number of apolipoprotein(a) kringle 4 repeats and mobility of isoforms in agarose gel: basis for a standardized isoform nomenclature
Authors: Marcovina S M , Hobbs H H , Albers J J
Published: January 2020

The size of apolipoprotein(a) [apo(a)] varies from 187 to 648 kDa because of interallelic differences in the number of kringle 4-encoding sequences in the apo(a) gene. Plasma apo(a) isoform sizes were determined by a high-resolution sodium dodecyl sulfate-agarose gel electrophoretic method, followed by immunoblotting. The relation between the number of apo(a) kringle 4-encoding sequences in the apo(a) gene, as assessed by pulsed-field gel electrophoresis and genomic blotting, and the mobility of apo(a) isoforms in agarose gel was evaluated in 29 individuals who had 48 expressed apo(a) isoforms that contained between 12 and 41 kringle 4 repeats. The log of the kringle number was linearly related to the distance the isoform migrated on the agarose gel (r= 0.999). A nomenclature is proposed to designate apo(a) isoforms by the respective number of kringle 4 repeats.
Measurement of sugar probes in serum: an alternative to urine measurement in intestinal permeability testing
Authors: Fleming S C , Duncan A , Russell R I , Laker M F
Published: January 2020

The percentage dose of lactulose and mannitol excreted in urine after oral ingestion is used as a noninvasive method of assessing small intestinal permeability. The collection of incomplete or inaccurately timed urine samples can lead to errors in estimation of sugar probe molecules. We describe an HPLC method for the simultaneous determination of lactulose and mannitol in serum after oral ingestion of test sugars. We applied the test to healthy volunteers and to subjects undergoing jejunal biopsy for suspected gluten-sensitive enteropathy. The ratio of concentrations of lactulose and mannitol in serum discriminated well between subjects with a normal biopsy and those with villous atrophy, discrimination being best at 90 min postdose. The results agree well with lactulose:mannitol ratios determined in urine (r= 0.88), and the two methods can be used interchangeably. The determination of mannitol and lactulose in serum provides an acceptable alternative to urine collection and may be particularly useful in young children. It also reduces the time spent on the investigation from 5 h to 90 min.
Low-density lipoprotein oxidation, antioxidants, and atherosclerosis: a clinical biochemistry perspective
Authors: Jialal I , Devaraj S
Published: January 2020

Cardiovascular disease is the leading cause of mortality in westernized populations. An increased concentration of plasma low-density lipoprotein (LDL) cholesterol constitutes a major risk factor for atherosclerosis. Several lines of evidence support a role for oxidatively modified LDL in atherosclerosis and for its in vivo existence. Antioxidants have been shown to decrease atherosclerotic lesion formation in animal models and decrease LDL oxidation; the evaluation of LDL oxidation in vivo is therefore very important. However, there is a paucity of methods for direct measurement of LDL oxidation. Of the direct methods currently available, the preferred ones seem to be the measurement of F2-isoprostanes, autoantibodies to epitopes on oxidized LDL, and the assessment of antioxidant status. Of the indirect measures, the most uniformly accepted procedure is examining the oxidative susceptibility of isolated LDL by monitoring conjugated diene formation.
Reference intervals for plasma apolipoprotein A-1 determined with a standardized commercial immunoturbidimetric assay: results from the Framingham Offspring Study
Authors: Contois J , McNamara J R , Lammi-Keefe C , Wilson P W , Massov T , Schaefer E J
Published: January 2020

We have evaluated a commercially available, standardized immunoturbidimetric assay of apolipoprotein (apo) A-I, the major protein constituent of high-density lipoproteins (HDL). We determined the reference ranges of plasma apo A-I concentration for white men and women and related these values to the risk of coronary heart disease (CHD). The mean between-run CV for this assay was 2.9%. As determined with individuals participating cycle 4 of the Framingham Offspring Study, the mean (+/- SD) apo A-I concentration was 13% lower in 1879 men (1.34 +/- 0.23 g/L) than in 1939 women (1.54 +/- 0.28 g/L) (P<0.001). An apo A-I concentration of 1.20 g/L roughly corresponded to the 25th percentile value in men and the 5th percentile in women, and subjects with a concentration below this value were significantly more likely to have CHD than subjects wit a higher concentration (P<0.001).
Assay of prostate-specific antigen from whole blood spotted on filter paper and application to prostate cancer screening
Authors: Hoffman B R , Yu H , Diamandis E P
Published: January 2020

We report the measure of prostate-specific antigen (PSA) from extracts of blood dried on filter paper. Five 3-mm (diameter) paper discs containing approximately 25 microL of dried whole blood were punched from the filter paper and extracted with 500 microL of buffer. Recovery of PSA was > 92%. Imprecision of the filter paper procedure was <10% when corresponding whole-blood concentrations were >0.35 micrograms/L. PSA recovery was unaffected whether blood was applied to the filter as one 85-microL aliquots, two 43-microL aliquots, or three 28-microL aliquots. PSA is contained in the plasma fraction. Variation in hematocrit from 0.61 to 0.31 caused <+/-10% change in filter paper PSA. Regression analysis showed: filter paper PSA = 0.86 whole-blood PSA - 0.02; Sy/x = 0.44. Men (153) without prostate cancer gave a 95th percentile of 4.8 micrograms /L. PSA in filter paper dried blood was stable for >1 month at -20 to 37 degrees C and showed no loss of recovery after being mailed to a hot climate. We conclude that the filter paper procedure can reliably distinguish normal from increased concentrations of PSA and that it could facilitate screening to detect occult prostate cancer in large-scale mail-in programs to centralized laboratories.
Quantitative immunoassay for complexes of prostate-specific antigen with alpha2-macroglobulin
Authors: España F , Sánchez-Cuenca J , Estellés A , Gilabert J , Griffin J H , Heeb M J
Published: January 2020

We have developed two ELISAs for quantifying complexes of prostate-specific antigen (PSA) with alpha2-macroglobulin (alpha2M), using partially purified PSA:alpha2M complex as the calibrator. One ELISA was designed to evaluate )SA:alpha2M complex in fluids containing a huge excess of PSA over the amount of complex (semen-derived fluids), the other for use in fluids containing an excess of alpha2M over PSA (blood plasma). The range of the assays was 2-1000 micrograms/L for PSA complexed to alpha2M; the detection limit was 3 micrograms/: Intra- and interassay CVs were 7-13% and 11-17%, respectively, at complexed PSA concentrations of 6-500 micrograms/L. Seminal fluid from healthy men (n = 60) contained 5.2 +/- 2.6 micrograms/L PSA complexed with alpha2M. Prostatic and seminal vesicle fluids contained 6.5 +/- 2.9 ad 0.3 +/- 0.2 mg/L PSA complexed to alpha2M, respectively. When purified PSA was incubated with citrated plasma, between 45% and 65% of the added PSA was recovered as free PSA, whereas approximately 25% formed complexes with alpha2M, 10% complexed with alpha1-antichymotrypsin, and only 0.1-6% was complexed with protein C inhibitor. Of 30 patients with prostate disease, 20 showed detectable plasma PSA:alpha2M complexes; however, the potential diagnostic significance of this complex requires further investigation.
Diagnostic accuracy of hyaluronan and type III procollagen amino-terminal peptide serum assays as markers of liver fibrosis in chronic viral hepatitis C evaluated by ROC curve analysis
Authors: Guéchot J , Laudat A , Loria A , Serfaty L , Poupon R , Giboudeau J
Published: January 2020

Diagnostic accuracy of two serum markers of liver fibrosis, hyaluronan (HA) and amino-terminal peptide of type III procollagen (P-III-P), was studied in a cohort of 326 untreated patients with chronic viral hepatitis C. Both P-III-P (RIA-gnost P-III-P, Behring Diagnostic) and HA (HA-test, Pharmacia) serum concentrations correlated with the histological grades of liver fibrosis (P < 0.001). Receiver-operating characteristic (ROC) curves showed that serum HA had greater diagnostic performance than P-III-P, both for discriminating patients with extensive liver fibrosis from those with no or mild fibrosis (area under the ROC curves: 0.864 vs 0.691, P <0.001) or for discriminating patients with cirrhosis from those without cirrhosis (area under the ROC curves: 0.924 vs 0.734, P <0.001). At cutoff values of 0.8 kU/L for serum P-III-P and 85 micrograms/L for serum HA, sensitivities were 70.0% and 64.5%, and specificities were 63.4% and 91.2%, respectively, for discriminating patients with extensive liver fibrosis from those with no or mild fibrosis. At the cutoff values of 1.0 kU/L for serum P-III-P and 110 micrograms/L for serum HA, sensitivities were 60.0% and 79.2%, and specificities were 74.0% and 89.4%, respectively, for discriminating patients with liver cirrhosis from those without cirrhosis. We conclude that, because the diagnostic accuracy of serum HA is greater than that of serum P-III-P as a marker of liver fibrosis, serum HA should be preferred when monitoring liver fibrosis in patients with chronic viral hepatitis C.