bluuebunny/crossref_metadata_2025 huggingface dataset:
Analytical and Clinical Evaluation of Creatine Kinase MB Mass Assay by IMx: Comparison with MB Isoenzyme Activity and Serum Myoglobin for Early Diagnosis of Myocardial Infarction
Authors: Van Blerk M , Maes V , Huyghens L , Derde M P , Meert R , Gorus F K
Published: January 2020

We analytically and clinically evaluated Abbott's IMx assay for creatine kinase (CK) isoenzyme MB (CK-MB) in serum. Over a 1-year period, the method was more specific but less precise than catalytic isoenzyme measurements by electrophoresis or immunoinhibition. Sera from different individuals without electrophoretic evidence of CK-MB but containing macro CK type 1 (n = 20), mitochondrial CK (n = 5), or CK-BB (n = 5) were scored as CK-MB negative by the IMx. Likewise, CK-MB-negative by the sera remained so after addition of purified human CK-MM (< or = 7600 U/L) or CK-BB (< or = 8100 U/L). For 39 patients admitted for suspicion of uncomplicated acute myocardial infarction (precordial pain for < or = 4 h), the diagnostic performance of the IMx CK-MB assay on admission and 4 h later was superior to that of total CK activity and compared well with that of CK-MB activity measured by electrophoresis or immunoinhibition. An admission, myoglobin showed a higher diagnostic sensitivity, specificity, and predictive value than did CK-MB and was the most informative test. Diagnostic performance on admission and 4 h later was further improved by considering positivity for myoglobin and for CK-MB by IMx and for the change in each over the first 4 h of hospitalization as criteria. Twelve hours after admission, diagnostic performance was further improved for all CK and CK-MB methods but began to decline for myoglobin.
Oxidation Markedly Reduces Bilirubin Interference in the Jaffé Creatinine Assay
Authors: Rajs G , Mayer M
Published: January 2020

Bilirubin causes underestimation of serum creatinine in the Jaffé alkaline picrate assay. We report an approach for preventing bilirubin interference by pretreating serum samples with peroxidase and H2O2. The dissociation of bilirubin from albumin and its subsequent oxidation markedly reduces the bilirubin interference and enables accurate determination of creatinine concentrations by the Jaffé reaction even in hyperbilirubinemic sera. Within-run CVs were 2.6%, 4.0%, and 3.8% at mean creatinine concentrations of 88, 165, and 349 mumol/L, respectively (n = 20). Day-to-day CVs were 4.0%, 6.3%, and 5.8% for mean creatinine concentrations of 87, 168, and 364 mumol/L, respectively (n = 12). Average recovery of creatinine added to serum in the presence of 600 mumol/L bilirubin was 97% (n = 15). This method requires only small serum volumes (70 microL) and is easily applicable to automated analyzers that can be programmed to add three reagents consecutively.
Interlaboratory Standardization of Measurements of Glycohemoglobins
Authors: Little R R , Wiedmeyer H M , England J D , Wilke A L , Rohlfing C L , Wians F H , Jacobson J M , Zellmer V , Goldstein D E
Published: January 2020

The diversity of methods used to measure glycohemoglobins (GHb) makes it difficult to compare patients' results among laboratories. We reported previously the feasibility of providing comparable results from different assays by use of common calibrators. We here compare results from seven different GHb methods calibrated by use of hemolysates assayed by a precise ion-exchange high-performance liquid-chromatographic (HPLC) method for hemoglobin A1c (HbA1c). Thus, regardless of the GHb species measured by the seven methods, results were referenced to the HbA1c content of the calibrators. Without this calibration, GHb values for single samples varied, e.g., from 4.0% to 8.1% and from 10% to 14.2% in the normal and high ranges, respectively. Calibration decreased between-method variability (single sample ranges of, e.g., 4.8% to 5.4% and 9.4% to 10.2% in the normal and high ranges, respectively) and improved interassay precision. We conclude that this approach to calibration of GHb measurements allows direct comparison of results obtained by different methods and improves precision.
Allelic Amino Acid Substitutions Affect the Conformation and Immunoreactivity of Germ-Cell Alkaline Phosphatase Phenotypes
Authors: Hoylaerts M F , Manes T , Millán J L
Published: January 2020

The gene encoding placental alkaline phosphatase (PLAP) displays a well-documented allelic polymorphism. Likewise, different phenotypes exist for the PLAP-related germ-cell alkaline phosphatase (GCAP). We investigated the extent to which various allelic GCAP positions are critical in determining the enzymatic, structural, and immunological properties of GCAP phenotypes. Three homozygous GCAP phenotypes [JEG3, BeWo, and wild-type (wt) GCAP] were analyzed and compared with a "core" GCAP mutant that contains the seven amino acid substitutions that are consistently different between PLAP and GCAP but are common to the three known allelic GCAP genotypes. Although some substitutions could influence the electrophoretic behavior of the phenotypes, the allelic differences did not affect the kinetic properties of GCAP. However, they did affect the immunoreactivity and conformation of the variants as detected with a panel of 18 epitope-mapped monoclonal antibodies (MAbs) to PLAP. The selective immunoreactivity of the PLAP/GCAP-discriminating MAb C2 was critically dependent on the nature of the allelic residues 133 and 361 in GCAP. Residue 133 was also important for the general stability of the molecule because BeWo and wt GCAP, which have Asn133 and Val133, respectively, instead of Met133, showed a consistently reduced heat stability compared to core GCAP and JEG3. Because the core GCAP mutant consistently shows the characteristics of wt GCAP, its use as an antigen should allow the generation of monoclonal antibodies to GCAP that will not cross-react with PLAP and whose immunoreactivity will only marginally be influenced by allelic GCAP variation.
Kinetic Colorimetric Assay of Lipase in Serum
Authors: Fossati Piero , Ponti Maurizio , Paris Paolo , Berti Giovanni , Tarenghi Giordano
Published: January 2020

We describe a kinetic colorimetric method for assaying lipase (EC 3.1.1.3) activity in serum by using a natural long-chain fatty acid 1,2-diglyceride. In the presence of colipase, deoxycholate, and calcium ions, pancreatic lipase hydrolyzes the clear substrate solution to produce a 2-monoglyceride, which in turn releases glycerol by the action of a 2-monoglyceride lipase. Glycerol is then assayed by a sequence of enzymatic actions (glycerol kinase, glycerol phosphate oxidase, and peroxidase) that produce a violet quinone monoimine dye with peak absorption at 550 nm. The method features zero-order reaction kinetics, provides a simple and rapid assay with an extended dynamic range, is specific and precise, gives results that correlate well (r greater than or equal to 0.99) with those of methods in which emulsified triolein is the substrate, and lends itself readily to automation. For all these reasons, the method seems highly suitable for routine use in clinical laboratories.
α-Glucosidase and Ν-Acetyl-α-D-glucosaminidase Isoenzymes in Serum
Authors: Coma P , Gomez-Chacon L , Garcia-Serrano B , Fernandez E , Ortiz-Apodaca M A
Published: January 2020

Using different conditions for incubation and fluorometry with 4-methylumbelliferylglycosides as substrates, we demonstrated the presence of acid alpha-glucosidase, "renal" alpha-glucosidase, N-acetyl-beta-D-glucosaminidase A, and N-acetyl-beta-D-glucosaminidase B in freshly drawn normal human serum. The acid alpha-glucosidase enzymatic activity was determined at pH 4.0 in 0.1 mol/L Tris reagent, whereas the renal isoenzyme activity was determined at pH 5.6 in presence of 0.05 mol/L turanose reagent. N-Acetyl-beta-D-glucosaminidases A and B were determined by their different behaviors on heating. The corresponding reference intervals for each enzyme were calculated from results for 40 controls: acid alpha-glucosidase (0.024 +/- 0.010 U/L), renal alpha-glucosidase (0.035 +/- 0.012 U/L), N-acetyl-beta-D-glucosaminidase A (10.2 +/- 2.9 U/L), and N-acetyl-beta-D-glucosaminidase B (4.4 +/- 2.1 U/L).
Comparing the Power of Quality-Control Rules to Detect Persistent Increases In Random Error
Authors: Parvin C A
Published: January 2020

This paper continues an investigation into the merits of an alternative approach to the statistical evaluation of quality-control rules. In this report, computer simulation is used to evaluate and compare quality-control rules designed to detect increases in within-run or between-run imprecision. When out-of-control conditions are evaluated in terms of their impact on total analytical imprecision, the error detection ability of a rule depends on the relative magnitudes of the between-run and within-run error components under stable operating conditions. A recently proposed rule based on the F-test, designed to detect increases in between-run imprecision, is shown to have relatively poor performance characteristics. Additionally, several issues are examined that have been difficult to address with the traditional evaluation approach.
Total Urinary Hydroxyproline Determined with Rapid and Simple High-Performance Liquid Chromatography
Authors: Paroni R , De Vecchi E , Fermo I , Arcelloni C , Diomede L , Magni F , Bonini P A
Published: January 2020

A precolumn derivatization method was optimized for rapid and specific analysis of total urinary hydroxyproline by HPLC. After an overnight hydrolysis, urine samples dried and reconstituted with the internal standard cysteic acid (in sodium hydrogen carbonate, pH 9.3) were derivatized with N,N-diethyl-2,4-dinitro-5-fluoroaniline (FDNDEA) at 100 degrees C for 20 min. The DNDEA-hydroxyproline adduct was separated on an Ultrasphere ODS column with a mobile phase of acetate buffer (containing triethylamine, 6 mL/L, pH 4.3) and acetonitrile (80/20, by vol), and was detected at 360 nm. A single run took 18 min with a hydroxyproline retention time of 7.3 min. The assay showed a linear response to hydroxyproline concentrations from 5 to 100 mg/L with a detection limit of 0.8 ng injected, corresponding to 2 mg/L in urine. Mean (SD) analytical recovery was 94.2 (13)% and 104 (9)% at 10 and 50 mg/L, respectively. Within-run and between-run CVs (n = 10) were 3.74% and 4.33%, respectively, for 25 mg/L. Results for samples (n = 50) analyzed by HPLC (y) vs ion-exchange chromatography with postcolumn ninhydrin reaction (x) correlated well: y = 0.98x + 1.02 (r = 0.985, Sxy = 3.13). In another comparison, involving 173 samples, a colorimetric procedure (Hypronosticon, x) gave slightly higher values than the HPLC method (y): y = 0.83x + 2.21 (r = 0.937, Sxy = 4.6).
Low Bias in Assayed Values of Lipoprotein Antigens--Lipoprotein(a) and Apolipoproteins A-I and B--in Midday Postprandial Blood Specimens Compared with Morning Fasting Specimens
Authors: Emancipator K
Published: January 2020

Two-hour postprandial specimens have a -14% proportional bias for lipoprotein(a) [Lp(a)], a -0.035 g/L systematic bias for apolipoprotein (apo) A-I, and a -9% proportional bias for apo B, compared with values in 12-h fasting specimens. Although a physiological hemodilution appears to account for a portion of these biases, other major factors must be implicated for Lp(a) and apo B. Even after dilutional effects are controlled for, assayed values of Lp(a) are 11-13% lower, and assayed values of apo B are 8-9% lower, in postprandial specimens than in fasting specimens. Therefore, the time of collection of a blood sample relative to the last meal can significantly affect assayed values of lipoprotein antigens. Further studies are needed to determine whether these observations result from a physiological sequestering of lipoproteins in the postprandial state or from negative interferences affecting the assays of lipoprotein antigens.
Aspartate Aminotransferase, Alanine Aminotransferase, and Glutathione Transferase in Plasma During and after Sedation by Low-Dose Isoflurane or Midazolam
Authors: Howie A F , Spencer E , Beckett G J
Published: January 2020

To assess the effect of prolonged administration of midazolam or isoflurane on hepatocellular integrity, we measured the concentrations of glutathione transferase (EC 2.5.1.18) B1 subunit and the activities of alanine aminotransferase (ALT; EC 2.6.1.2) and aspartate aminotransferase (AST; EC 2.6.1.1) in 40 patients who required long-term sedation with low-dose midazolam or isoflurane. Blood samples were collected before and 24 h after the start of the sedation and 0, 24, 72, 120, and 172 h after the last dose. ALT and AST activities did not change appreciably, but the glutathione transferase B1 concentration decreased significantly (P less than 0.03) at all times studied. The patients who received isoflurane and those who received midazolam showed no significant differences in any of the enzyme tests. We conclude that long-term sedation with midazolam or isoflurane is unlikely to affect hepatocellular integrity.
Prevalence and Properties of the Intestinal Alkaline Phosphatase Identified in Serum by Cellulose Acetate Electrophoresis
Authors: Griffiths W C , Camara P D , Rosner M , Lev R , Brooks E M
Published: January 2020

We investigated the prevalence and characteristics of intestinal alkaline phosphatase (ALP; EC 3.1.3.1) identified in human serum by cellulose acetate electrophoresis in 8% of fasting serum samples from hospital patients (n = 500) and in 35% of fasting serum samples from patients with diabetes mellitus (n = 106; not differentiated between types 1 and 2). The intestinal ALP electrophoretic band was usually heterogeneous and contained two major subtypes of ALP. Isoelectric focusing of intestinal-ALP-positive serum treated with levamisole and neuraminidase (EC 3.2.1.18) revealed two distinct regions of enzymatic activity that comigrated with ALP extracted from small intestinal and colonic mucosa. Anodic intestinal ALP was resistant to treatment with levamisole and neuraminidase and comigrated with ALP from small intestinal mucosa. The more-cathodic intestinal ALP, which comigrated with ALP from colonic mucosa, was completely inhibited by levamisole and converted by neuraminidase to a species with a more basic pI than that of neuraminidase-digested tissue-nonspecific form. This component of intestinal ALP may be of vascular origin.
Reference Values for Apolipoproteins A-I and B in Healthy Subjects, by Age
Authors: Zunić G , Jelić-Ivanović Z , Spasić S , Stojiljković A , Majkić-Singh N
Published: January 2020

We determined reference values of apolipoproteins A-I (apo A-I) and B (apo B) in serum from a population of 448 healthy subjects (265 men and 183 women, ages 18 to 61 years) by a kinetic immunonephelometric procedure. Frequency distributions of apo A-I were normal, whereas those of apo B were not and yielded asymmetrical curves. Thus, reference intervals for apo A-I were determined as mean +/- 2SD (1.08-1.89 g/L), but a nonparametric method was used for determining reference intervals for apo B (0.60-1.94 g/L). Apo B concentrations were significantly higher (P less than 0.001) in men than in women (0.63-2.01 g/L, mean 1.21 g/L; and 0.54-1.91 g/L, mean 1.08 g/L, respectively). No significant differences for apo A-I between men and women were observed. Concentrations of both proteins increased with age, but apo B increased more than apo A-I. We conclude that not only sex but also the age of the subjects must be considered in interpreting laboratory results for apolipoproteins.
Increased Alpha-Hydroxybutyrate Dehydrogenase in Serum from Children with Measles
Authors: Kano K , Ichimura T
Published: January 2020

For treatment and prognostic evaluation of patients with measles, it is important to determine the source of the increase in serum alpha-hydroxybutyrate dehydrogenase (HBD; EC 1.1.99.6). Here we measured HBD and L-lactate dehydrogenase (LD; 1.1.1.27) activities in the serum of 18 children with measles and in 18 age-matched control patients with bronchopneumonia. HBD and LD activities in the measles patients were significantly higher than those in control subjects (P less than 0.001). The HBD/LD ratio in the measles patients two to three days after the onset of rash was significantly lower than that in control subjects (P less than 0.001). The low HBD/LD ratio was similar to the ratio found in lymphocytes. The number of peripheral lymphocytes decreased markedly after the onset of rash. Our results suggest that increased serum HBD and LD activity is common in measles infection and that the increase originates from the destruction of infected lymphocytes rather than from myocardiac injury.
Certification of Cholesterol Measurements by the National Reference Method Laboratory Network with Routine Clinical Specimens: Effects of Network Laboratory Bias and Imprecision
Authors: Bennett S T , Eckfeldt J H , Belcher J D , Connelly D P
Published: January 2020

The National Reference Method Laboratory Network has initiated a program to certify clinical laboratory cholesterol measurement performance by using routine clinical specimens. Clinical laboratory and reference laboratory measurements of split samples are used to assess whether the clinical laboratory is meeting the Laboratory Standardization Panel's goals for accuracy and precision. We used a computer-based Monte Carlo simulation model of split-sample proficiency testing to evaluate the certification program and, in particular, to analyze the effects of reference laboratory bias and imprecision. Results of our simulations indicate that the accuracy of the certification program is strongly influenced by reference laboratory bias and less influenced by reference laboratory imprecision. The certification program is potentially highly accurate, but unless reference laboratory bias is tightly controlled, the number of classification errors may limit its utility. Moreover, the decision limit of the certification program needs to be higher than the Laboratory Standardization Panel's goal (3.5% instead of 3.0%) to ensure that an acceptably high proportion of well-performing clinical laboratories can become certified.
Patterns of Serological Markers for Cellular Immune Activation in Patients with Dilated Cardiomyopathy and Chronic Myocarditis
Authors: Samsonov M , Fuchs D , Reibnegger G , Belenkov J N , Nassonov E L , Wachter H
Published: January 2020

We determined serum concentrations of neopterin and beta 2-microglobulin, soluble markers of cellular immune activation, in 27 patients with either dilated cardiomyopathy (DCM) or chronic myocarditis. Neopterin and beta 2-microglobulin concentrations were respectively increased in 2 and 5 of 11 patients with DCM and in 11 and 9 of 16 patients with chronic myocarditis. A higher cardiac functional class (according to the New York Heart Association) was associated with greater neopterin and beta 2-microglobulin concentrations. During follow-up of patients, both neopterin and beta 2-microglobulin concentrations in serum correlated with the course of disease. Additionally, correlations were significant between left ventricular functional tests (end-diastolic volume, end-systolic volume, and ejection fraction) and neopterin and beta 2-microglobulin concentrations. We conclude that measurement of neopterin and beta 2-microglobulin are useful to monitor disease development in patients with myocardial inflammation.
High-Performance Liquid Chromatography of 125I-Labeled Mouse Epidermal Growth Factor Radioiodinated by Six Different Methods
Authors: Kienhuis C B , Heuvel J J , Ross H A , Foekens J A , Benraad T J
Published: January 2020

Six different procedures for radioiodination of mouse epidermal growth factor (EGF) all resulted in a heterogeneous 125I-labeled EGF preparation, as analyzed by reversed-phase HPLC. EGF preparations that had been iodinated with Chloramine T, lodogen, or lodo-beads were found mainly to consist of oxidized 125I-labeled EGF moieties. In contrast, the heterogeneous 125I-labeled EGF preparations obtained by using iodine monochloride, Protag-125, or lactoperoxidase-glucose oxidase-coupled beads (Enzymobeads) contained insignificant amounts of oxidized EGF entities. Ligand equivalence analysis (LEA) of distinct HPLC column fractions, obtained after preparative separation of Chloramine T-125I-labeled EGF, showed that the receptor-binding affinity of the tracer in all subfractions was less than the affinity of unlabeled EGF. This implies that HPLC purification of these 125I-labeled EGF preparations does not yield 125I-labeled EGF preparations with ligand equivalence. However, all but one HPLC column fraction of Enzymobeads-125I-labeled EGF showed ligand equivalence. Despite the small amount of the nonequivalent component in the Enzymobeads-labeled tracer, the nonchromatographed 125I-labeled EGF preparation showed ligand equivalence. No significant differences were observed in the maximal binding capacity of the different 125I-labeled EGF preparations.
Enzyme Immunoassay with Synthetic Peptides to Detect Anti-HTLV-I Antibodies
Authors: Yamada K , Kuroda N , Washitani Y , Shiraki H , Maeda Y
Published: January 2020

We developed an enzyme immunoassay (EIA) system to detect antibodies to human T-lymphotropic virus type I (HTLV-I). This system uses chemically synthesized oligopeptides to capture anti-HTLV-I antibodies in serum. The two epitopes of HTLV-I proteins exhibiting the most specific antigen-antibody reaction reside within amino acids 100-130 of p19, a core protein encoded by gag, and amino acids 175-199 of gp46, an envelope glycoprotein encoded by env. This new assay uses synthetic peptides corresponding to these two regions modified by adding two lysine residues at the amino terminal of each peptide to facilitate the binding to the surface of the microtiter plate wells. We compared the performance of our EIA with gelatin-particle-agglutination (PA) and indirect-immunofluorescence (IF) assays, both of which use viral proteins purified from virus-carrying cell cultures. Mass screening by EIA with various synthetic peptides was more accurate than the current confirmatory IF assay.
Apolipoprotein A-Containing Lipoprotein Particles: Physiological Role, Quantification, and Clinical Significance
Authors: Fruchart J C , Ailhaud G
Published: January 2020

High-density lipoprotein (HDL) particles are made up of two major populations of particles, differing in composition and metabolism. Both contain apolipoprotein (apo) A-I but only one contains apo A-II. Lipoprotein particles that contain only apo A-I (LpA-I particles) can increase cellular cholesterol efflux from cultured cells in vitro. LpA-I:A-II particles, however, do not increase cholesterol efflux. LpA-I:A-II can be determined directly with an enzyme-linked differential antibody immunosorbent assay. LpA-I is determined by differential electroimmunoassay: in the presence of a large excess of anti-apo A-II, LpA-I:A-II particles are retained in one peak, whereas LpA-I migrates grates as a second peak. Both lipoprotein forms of apo A-I-containing particles are present mainly in HDL, but the relative proportion of LpA-I is greater in HDL2 than in HDL3. Concentrations of LpA-I in plasma samples from normolipemic subjects average approximately 10% higher in women than in men. The lower apo A-I concentrations in patients with significant coronary artery disease reflect a decrease in the LpA-I particles. Data obtained in octogenarians also support the possibility that LpA-I might represent the anti-atherogenic fraction of HDL. Moreover, the concentration of LpA-I in children of parents with premature coronary heart disease was lower than that of a control group without any family history of this disease. Nutrients and hypolipidemic drugs seem to affect the two kinds of particles differently.
Immunoassays for Quantifying Choriogonadotropin Compared for Assay Performance and Clinical Application
Authors: Witherspoon L R , Shuler S E , Joseph G F , Baird E F , Neely H R , Sonnemaker R E
Published: January 2020

We examined calibration and accuracy, precision, sensitivity, specificity, and "hook" effects for recently revised automated choriogonadotropin (hCG) immunoassay systems (Baxter-Dade Stratus II, Abbott IMx intact hCG and total beta hCG) and compared them with a widely used immunoradiometric assay (Hybritech). We estimated hCG in pregnant women, women with trophoblastic disease, nonpregnant young and menopausal women, normal men, and men with testicular tumors. We found clinically unimportant differences in calibration (all calibrated to the 3rd International Standard). Detection of hCG by all four assays was limited by their responses in serum from nonpregnant women and men. Precision within-run was best for the automated instruments, but all four assays had similar between-run precision. The Hybritech, Stratus, and IMx intact assays are specific for intact hCG. The IMx total beta assay quantifies both free beta subunit and beta subunit present in intact hCG. There is a clinically important hook effect in the Hybritech assay but not the Stratus or IMx assays (to 1.2 x 10(6) int. units/L). Results for pregnant women were similar by all four assays. We measured "hCG" to 8 int. units/L in menopausal women, which weakly correlated with concentrations of lutropin and follitropin and was, in part, explained by crossreactivity. There was no sample-probe carryover in either instrument. We found the IMx diluting module as well as results at the extremes of the IMx calibration curves (less than 10, 800-1200 int. units/L) unreliable but encountered no such problems with the Stratus system. Both automated systems involve batch analyzers with limited throughput but provide hCG concentration estimates much more quickly than the Hybritech assay can.
Limitations of Proficiency Testing Under CLIA '67
Authors: Laessig R H , Ehrmeyer S S , Lanphear B J , Burmeister B J , Hassemer D J
Published: January 2020

Proficiency testing (PT), recognized as a quality-assurance (QA) and quality-improvement tool, also has become the cornerstone of the Health Care Financing Administration's (HCFA) regulatory strategy under the revised Clinical Laboratory Improvement Act of 1967 (CLIA '67) and the proposed Clinical Laboratory Improvement Amendments of 1988 (CLIA '88). Use of PT as a regulatory tool corrupts it for things it can do better. PT as a primary regulatory strategy has severe limitations. We explore the nature of these limitations and their implications for clinical laboratories as they impact on the long-term success of HCFA's approved regulatory PT programs in 1991 and beyond, and CLIA '88 PT, which is to be implemented in 1994.
Review of Actual Proficiency-Testing Performance Under CLIA '67 (March 14, 1990) Rules: Perspective from the First Year's Data
Authors: Lanphear B J , Burmeister B J , Ehrmeyer S S , Laessig R H , Hassemer D J
Published: January 2020

Under the Clinical Laboratory Improvement Act of 1967 the Health Care Financing Administration's proficiency-testing requirement applies to approximately 12,000 hospital, reference, and large-clinic laboratories in the United States. The Wisconsin State Laboratory of Hygiene is approved by the Health Care Financing Administration to provide proficiency testing in all specialties and subspecialties. The focus of the program is to provide highly specialized service and support to a limited number of participants in order to assess intralaboratory performance correctly. We report the findings over the four proficiency-testing events in 1991 for the subspecialty of routine chemistry, which serves approximately 470 participants. Failure rates for individual analytes on single proficiency testing events ranged from 0% to 13%. After four events or one year, if the mandated evaluation criteria and failure rules were strictly applied, as many as 11% of the laboratories could have found themselves involuntarily suspended from offering all routine chemistry testing.
Homocysteine Export from Erythrocytes and Its Implication for Plasma Sampling
Authors: Andersson A , Isaksson A , Hultberg B
Published: January 2020

The concentration of free and total homocysteine in plasma increases in time if blood is stored uncentrifuged after sampling. The increase is temperature dependent and the maximal increase in total plasma homocysteine at 37 degrees C was 3.0 mumol.L-1.h-1. Even at 4 degrees C there is a substantial increase, particularly of free plasma homocysteine. Plasma glutathione, cysteinylglycine, and gamma-glutamylcysteine also show an increase in time if whole blood is stored, whereas cysteine decreases. We show that the erythrocytes are responsible for most of the increase in plasma homocysteine and suggest that homocysteine is derived from adenosylmethionine-dependent protein carboxymethylations in the cells. We conclude that strict sampling conditions are necessary when plasma homocysteine and especially its free fraction are assayed.
Detection of α1-Antitrypsin Z and S Mutations by Polymerase Chain Reaction-Mediated Site-Directed Mutagenesis
Authors: Tazelaar J P , Friedman K J , Kline R S , Guthrie M L , Farber R A
Published: January 2020

alpha 1-Antitrypsin (A1AT) deficiency is a relatively common autosomal recessive disease, resulting most often from a single base pair (1 bp) substitution called the Z mutation. Previous genetic tests for carriers and affected patients have relied on quantitative binding of radioactive probes to an amplified gene product, because the mutation does not occur within a restriction enzyme site. Using polymerase chain reaction (PCR)-mediated site-directed mutagenesis, one can introduce a base substitution near the mutation site, such that an inexpensive restriction enzyme (Taq I) can be used to differentiate normal subjects, carriers, and affected patients. We have applied this method to the detection of the Z mutation and the S mutation, which in heterozygotes with a Z allele may lead to the development of symptoms similar to those in ZZ homozygous subjects.
An Overview of Minimally Invasive Technologies
Authors: Ginsberg B H
Published: January 2020

Self-measurement of blood glucose is an integral part of diabetes mellitus therapy. As many as 65% of diabetic people (4-5 million people) perform some degree of self-monitoring and approximately 20-30% do so frequently. Most patients consider this the most onerous part of their diabetes therapy. It requires obtaining blood, frequently in public, and is usually the most painful part of therapy, being significantly more painful than insulin self-administration. Patients therefore are anxious for a less-invasive method for glucose measurement. Methods exist or are being developed for minimally invasive glucose monitoring, which use body fluids other than blood (e.g., sweat and saliva), subcutaneous tissue, or blood measured less invasively. Sweat and saliva are relatively easily obtained but their glucose concentration lags significantly behind blood glucose. Methods to increase sweating have been developed and seem to increase the timeliness of the sweat glucose measurement. Subcutaneous glucose measurement seems to lag only a few minutes behind blood glucose and may actually be a better measurement of the critical values of glucose concentrations in brain, muscle, and other tissue. Glucose can be measured by noninvasive or minimally invasive methods, such as those making skin or mucous membranes permeable to glucose or those placing a reporter molecule in the subcutaneous tissue. Needle-type sensors have been improved in accuracy, size, and stability and can be placed into the subcutaneous tissue or peripheral veins to monitor blood glucose with miniature instruments.
Less-Invasive Measurement of Tissue Availability of Hormones and Drugs: Diffusion-Sink Sampling
Authors: Wade S E
Published: January 2020

The use of small diffusion-sink sampling devices allows the relatively noninvasive and unobtrusive collection of a specimen that represents, in a precisely interpretable way, the average freely diffusing concentration of an analyte over a biologically relevant period of time. In an orally worn configuration, these sampling devices reject artifacts arising from blood plasma contamination of saliva and provide a time-averaged sample without requiring the subject to adhere to a frequent-sampling schedule. The practical advantages of noninvasiveness are thus combined with a fairly direct method for measuring what seems, in light of our current understanding, most important to know about the relative abundance of the steroid hormones. Whether this specificity of measurement also has practical benefits has yet to be tested.
The Anagen System for Automated Fluorometric Immunoassay
Authors: Clements J A , Forrest G C , Jay R F , Jeffery M , Kemp P M , Kjeldsen N J , Rattle S J , Smith A
Published: January 2020

We describe a new discrete microprocessor-controlled analyzer, the AN2000, which fully automates fluorometric immunoassays by using a magnetic separation of the solid phase and an alkaline phosphatase label. It can operate in random-access or batch mode with a dwell time typically less than 20 min. The analysis rate is 75 samples per hour and the system can hold refrigerated reagents for as many as 20 different analytes. The substrate and wash buffer are common to all analytes. The system can hold as many as 80 samples at once. The operator can select from the menu-driven operator interface any combination of the available analytes to be run for each sample, using either the touch screen or the keyboard. Results are calculated from a stored calibration curve that is stable for greater than or equal to 1 month. The AN2000 is capable of automating most assay formats because the available timings, volumes, incubations, and wash cycles can be used in any combination.
Enzymatic Sample Hydrolysis and HPLC in a Study of Phylloquinone Concentration in Human Milk
Authors: Lambert W E , Vanneste L , De Leenheer A P
Published: January 2020

Phylloquinone (vitamin K) is essential to prevent hemorrhagic diseases in newborns. We were interested in determining the concentration of phylloquinone in human milk and in elucidating the factors that influence that concentration. Human milk contains lipid constituents encapsulated with phylloquinone in the fat globules. To eliminate the lipids, we combined sonication and an enzymatic treatment with lipase to prevent degradation by drastic hydrolysis. Despite the low phylloquinone concentrations and the procedure's complexity (lipase treatment, two HPLC steps, and an on-line thermoinduced postcolumn reduction followed by fluorescence detection), within-day and day-to-day CVs of 5.2% and 5.8% were obtained (n = 8, mean = 1.86 micrograms/L, and n = 7, mean = 1.74 micrograms/L, respectively). The mean concentration of phylloquinone in 126 samples was 1.15 +/- 0.82 micrograms/L (mean +/- SD); no correlation was observed between the vitamin concentration and the postpartum date of collection. There was a positive correlation between phylloquinone concentration and phospholipid and cholesterol content (r = 0.5578 and 0.6020, respectively).
Clostebol-Positive Urine after Consumption of Contaminated Meat
Authors: Debruyckere G , de Sagher R , Van Peteghem C
Published: January 2020

We examined the relationship between the consumption of meat from animals treated with anabolic steroids and the detection of these steroids in the athletes consuming this meat. We proved that clostebol metabolites (e.g., 4-chloro-delta-4-androstene-3 alpha-ol-17-one) in the urine of one of the volunteers involved in a feeding experiment were due to accidental consumption of meat contaminated with clostebol acetate. When two volunteers consumed meat (100 g) containing either 1 or 0.1 mg of clostebol acetate, the same metabolite was found in their urine.
Plasma Selenium Concentrations in Patients with Euthyroid Sick Syndrome
Authors: Van Lente F , Daher R
Published: January 2020

We evaluated plasma selenium concentrations in patients with euthyroid sick syndrome express by low serum triiodothyronine (T3) concentrations. Selenium status in these patients was compared with that found in patients with both untreated and treated hypothyroidism. Selenium concentrations in plasma were significantly lower in hospitalized patients with either euthyroid sick syndrome (0.99 +/- 0.37 mumol/L) or treated hypothyroidism (1.09 +/- 0.25 mumol/L) than in patients with untreated hypothyroidism (1.39 +/- 0.28 mumol/L). However, there was no significant, independent relationship between selenium and the thyroid function indices determined in this study. The strongest association was between serum albumin concentration and either selenium (r = 0.65), T3 (r = 0.58), or the molar ratio of T3 to thyroxine (r = 0.64). The decreased average selenium concentration appears to be associated with the hypercatabolic state of severely ill patients, as indicated by the serum albumin concentration; these patients should be considered for selenium supplementation and their selenium status should be monitored.
Rat Plasma Clearance Rate and Organ Distribution of β-Hexosaminidase Isoenzymes from Human Serum
Authors: Isaksson A , Hultberg B , Jonung T
Published: January 2020

beta-Hexosaminidase (EC 3.2.1.30) is markedly increased in human serum in liver disease, chronic alcoholism, and pregnancy. Knowledge of the clearance rate of plasma/serum beta-hexosaminidase is necessary to evaluate this increase. We studied the plasma clearance of beta-hexosaminidase isoenzymes (purified from human serum and placenta) after their infusion into rat circulation. A recently developed enzyme immunoassay method was used to measure the human beta-hexosaminidase isoenzymes; this method relies on both immunoreactivity and enzyme activity, so intact human isoenzymes were measured. In comparison with the placental isoenzymes (t1/2 less than 2 min), the serum forms showed a considerably slower clearance (t1/2 = 2-4 h). However, desialylation of the serum forms resulted in their rapid clearance (t1/2 less than 2 min). The organ localization of the enzyme eliminated from the circulation was investigated 24 h after infusion. Placental and native serum isoenzymes accumulated mainly in the liver and the spleen. Desialylated serum forms were almost exclusively localized to the liver.
Phenol and p-cresol accumulated in uremic serum measured by HPLC with fluorescence detection
Authors: Niwa T
Published: January 2020

We developed a simple and sensitive high-performance liquid chromatographic (HPLC) method that uses fluorescence as a detector for quantifying serum phenol and p-cresol in uremic patients on hemodialysis. Identification of phenol and p-cresol was confirmed by liquid chromatography/mass spectrometry. Because the HPLC method requires only simple extraction by ethyl acetate and does not require further steps such as derivatization, it is simple and rapid compared with gas chromatography or gas chromatography/mass spectrometry. Concentrations of phenol and p-cresol in uremic serum were significantly (p < 0.01) higher than those in normal serum. Reduction rates of phenol and p-cresol by hemodialysis were lower than those of urea and creatinine, suggesting a protein-binding property of phenol and p-cresol. This method will be useful for monitoring serum phenols in dialyzed patients as an index of hemodialysis adequacy.
Interference of carbamylated and acetylated hemoglobins in assays of glycohemoglobin by HPLC, electrophoresis, affinity chromatography, and enzyme immunoassay
Authors: Weykamp C W , Penders T J , Siebelder C W , Muskiet F A , van der Slik W
Published: January 2020

In vitro-synthesized carbamylated and acetylated hemoglobins interfered in assays of glycohemoglobin by HPLC and electrophoresis but had no effects on results obtained by affinity chromatography and enzyme immunoassay. Correlations between long-term serum urea concentrations and glycohemoglobin percentages revealed that, in vivo, carbamylated hemoglobin equivalent to 0.063% of total hemoglobin is formed for every 1 mmol/L of serum urea. The use of acetylsalicylate, either chronically in small doses (200-300 mg/day) or for 1 week at 2000 mg/day, did not cause significant interference from acetylhemoglobin, formed in vivo. We conclude that interference from carbamylated hemoglobin explains only a small part of existing discrepancies between results of glycohemoglobin assays in current use. The interfering effect of acetylhemoglobin formed in vivo with acetyl-CoA as substrate is as yet unknown.
Assay of D-dimer based on immunofiltration and staining with gold colloids
Authors: Gogstad G O , Dale S , Brosstad F , Brandsnes O , Holtlund J , Mørk E , Gärtner E , Borch S M
Published: January 2020

In this immunofiltration assay of D-dimer in plasma samples, the antigens are captured by a monoclonal antibody on a porous membrane, and labeled with the same antibody conjugated to gold colloids. The assay time is < 2 min, and a color of intensity proportional to the concentration of D-dimer is left on the membrane. The reference range (mean +/- 2 SD) was 0.336 +/- 0.133 mg/L (n = 69). Linearity was found up to 10 mg/L. Comparison with ELISA results (x) for 198 patients' samples demonstrated a linear regression equation of y = 0.99(+/- 0.05)x + 0.68(+/- 0.07) and a mean square error of 0.503. Comparison of visual reading of the color signal (y) vs reflectometric measurements (x) for 220 patients' samples demonstrated a linear regression equation of y = 2.5(+/- 0.06)x -0.22(+/- 0.04) and a mean square error of 0.095. Bilirubin, hemoglobin, fibrinogen, soluble fibrin, and fibrinogen degradation products and freezing/thawing of samples did not interfere. Some interference from rheumatoid factor, heparin, and the presence of cells or large lipid particles was seen. The variance (CV) was 8-12% within run, 10-18% between runs, and 13-20% between persons. The new assay constitutes a rapid and reliable analytical tool combining simplicity equivalent to that of latex tests with analytical information approaching that of ELISA.
Determination of apolipoprotein E genotypes by single-strand conformational polymorphism
Authors: Tsai M Y , Suess P , Schwichtenberg K , Eckfeldt J H , Yuan J , Tuchman M , Hunninghake D
Published: January 2020

We used single-strand conformational polymorphism (SSCP) to determine apolipoprotein E (Apo E) genotypes in 47 individuals. A 295-base-pair (bp) DNA fragment coding for amino acid residues 80-178 of the Apo E protein gave distinct patterns for the three alleles. When we used SSCP to determine the Apo E polymorphism of five individuals whose phenotyping results differed from those of genotyping, the SSCP results agreed with the genotyping results obtained by the PCR-based amplification refractory mutation system (ARMS). Because most of the reported rare alleles of the Apo E gene involve mutations of amino acid residues in positions 120-160, our SSCP method is useful for determining rare as well as common alleles.
Kinetic determination of serum adenosine deaminase
Authors: Oosthuizen H M , Ungerer J P , Bissbort S H
Published: January 2020

A new kinetic method for the determination of serum adenosine deaminase (EC 3.5.4.4) is described, with adenosine as the substrate and nucleoside phosphorylase and xanthine oxidase as the reaction enzymes. Inosine is produced, which is converted to hypoxanthine. The hypoxanthine is oxidized to xanthine, which is further oxidized to uric acid. In these two reactions, blue 2,6-dichlorophenolindophenol is reduced to a colorless compound and the decrease in color is measured spectrophotometrically at 606 nm. The assay was automated by using a Cobas Mira analyzer. The automated assay had a CV of < 7%, and the calibration curve was linear from 10 to 120 U/L. The assay correlates well with an established method, based on detection of liberated NH3 with Berthelot's reaction. The reference interval (mean +/- 2 SD) was 14-34 U/L (mean 24 U/L, n = 84). The enzymatic method described is easily automated and seems to be suitable for the routine determination of adenosine deaminase in serum.
Method for determining reference changes from patients' serial data: example of cardiac enzymes
Authors: Kairisto V , Virtanen A , Uusipaikka E , Voipio-Pulkki L M , Näntö V , Peltola O , Irjala K
Published: January 2020

Changes between serial laboratory test results can be significant, even if none of the individual results exceeds the reference interval. We developed a statistical method for the calculation of reference change limits from routine patients' data for situations in which the majority of the patients can be considered suitable reference subjects. The method was applied to cardiac enzyme data [creatine kinase (CK; EC 2.7.3.2), creatine kinase isoenzyme MB (CK-2), lactate dehydrogenase (LD; EC 1.1.1.28), and lactate dehydrogenase isoenzyme 1 (LD-1)] from 2029 consecutive patients. We used hospital discharge diagnoses to exclude patients with the diagnosis of myocardial infarction or myocarditis, but we also studied the characteristics of the method on unselected patients' data. The reference change limits derived from the diagnosis-selected patient group were as follows (U/L, activity measurements in serum at 37 degrees C according to Scandinavian recommendations): CK from -39 to 27, CK-2 from -8 to 7, LD from -86 to 85, and LD-1 from -19 to 15. Similar limits were obtained by conventional statistical methods from a group of 29 hospitalized patients with no myocardial symptoms. Our results suggest that it is possible to produce clinically applicable reference change limits from routine data.
Models of neoplasia and their diagnostic implications: a historical perspective
Authors: Goldberg D M , Diamandis E P
Published: January 2020

In comparison with normal cells, cancer cells have an enhanced ability to trap both nitrogen and energy; an enhanced operation of the glycolytic and direct oxidative pathways, leading to accumulation of lactate and increased production of NADPH; and a greater content of lysosomal hydrolases. These changes represent a reprogramming of gene expression, which, at its most specific, is accompanied by the reappearance in the cell and ultimately in the body fluids of oncodevelopmental proteins not normally found in mature adult tissues. The most florid stage of this reprogramming leads to the metastatic phenotype, which confers upon the cancer cell the ability to stimulate angiogenesis, invade the bloodstream and lymphatic vessel, and arrest and proliferate in distant tissues. The diagnostic implications of these phenotypic changes are illustrated for cancer of the cervix uteri and cancer of the colon. We also review the classical theories of neoplasia, including the cellular anoxia concept of Warburg, the deletion hypothesis of Potter, and various other mechanisms emphasizing genomic derepression and impaired immunity. The critical steps in chemical carcinogenesis are described, and the Vogelstein-Lane model is presented, emphasizing the stepwise and cumulative genomic changes affecting chromosomes 5q, 17p, 18q, and gene amplification of chromosome 12 as well as genomic instability resulting from reduced DNA methylation. The main consequences of these genomic alterations include overexpression or activation of oncogenes such as c-myc and k-ras, together with mutation or functional inactivation of suppressor genes such as p53. Finally, the implications of these findings for diagnosis and management are illustrated by reference to recent investigations in cancers of the breast, colon, and bladder, in which these genomic alterations can be detected by examination of appropriate cellular material and by detection in serum of antibodies to the p53 gene product.