bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Relation between Reduced, Oxidized, and Protein-Bound Homocysteine and Other Thiol Components in Plasma During Methionine Loading in Healthy Men
Authors: Mansoor M A , Svardal A M , Schneede J , Ueland P M
Published: January 2020

We used a newly developed procedure to determine reduced, oxidized, and protein-bound forms of homocysteine, cysteine, cysteinylglycine, and glutathione to measure the plasma concentrations of these species during methionine loading in six young healthy men with normal fasting concentrations of plasma homocysteine and cysteine. The methionine loading induced a transient increase in total homocysteine, which peaked after approximately 6-8 h. All six subjects showed a concurrent significant increase in reduced homocysteine and cysteine, which peaked 2 h after loading, and a rapid decrease in protein-bound cysteine and cysteinylglycine. The concentration of reduced cysteinylglycine was not altered. Plots of protein-bound cysteine and cysteinylglycine vs total homocysteine formed hysteretic loops, showing a time-dependent relation between these analytes. After the initial decrease, protein-bound cysteine and cysteinylglycine showed a slight, transient increase. From 12 to 24 h after loading, protein-bound cysteine approached preloading concentrations in two subjects and declined further in four subjects. The response pattern was similar for cysteine and cysteinylglycine in each subject. Simple displacement could not account for these effects, which suggests that plasma homocysteine may affect the disposition of other thiols through complex mechanisms. The presence of reduced homocysteine and the dynamic relation that exists between homocysteine, cysteine, and related compounds in plasma should be taken into account when evaluating plasma homocysteine as an indicator or causative agent of human disease.
Temperature Effects on Free-Thyroxine Measurements: Analytical and Clinical Consequences
Authors: van der Sluijs Veer G , Vermes I , Bonte H A , Hoorn R K
Published: January 2020

We compared the analytical and clinical performance of two free-thyroxine (FT4) assays--a solid-phase radioimmunoassay, Spectria, and a time-resolved fluoroimmunoassay, Delfia, both of them two-step methods--with the performance of a direct radioimmunoassay, Nichols, to measure FT4 concentration in equilibrium dialysate of undiluted serum. The three assays showed comparable analytical performance. We tested clinical utility in sera from 135 healthy subjects with and without thyroxine-binding abnormalities and in 61 patients with and without thyroidal illnesses. We found significant differences for FT4 measured by different assays in sera from the same euthyroid patients. To explain the differences, we studied the influence of temperature on performance and calibration. Most important was the neglected fact that the association constant for the binding of thyroxine to thyroxine-binding globulin decreases when the temperature rises from 20 to 37 degrees C, causing a doubling of FT4. The two-step assays, if performed at room temperature without a well-defined calibration, can give misleading FT4 concentrations. This is the case when sera from patients with thyroxine-binding abnormalities are measured against kit standards, made up in normal human sera. If an assay is to reflect the in vivo FT4 concentration at body temperature in all types of samples, it should be performed at body temperature. For practical reasons 37 degrees C is recommended, and reference values should be defined at 37 degrees C. The same might be valid for other free-hormone assays.
Interassay Variability of Immunometric Methods for Thyrotropin in an External Quality Assessment Survey: Evidence that Functional Sensitivity is not Always Adequate for Clinical Decisions
Authors: Pilo A , Zucchelli G C , Malvano R , Clerico A , Iervasi G , Signorini C
Published: January 2020

We investigated the ability of current immunometric methods for thyrotropin (TSH; thyroid-stimulating hormone) to distinguish between low-normal and subnormal hormone concentrations by using the data from an external quality assessment (EQA) survey in 1990. We computed the interassay (between-run) precision profiles from results from 101 laboratories, which used the five most popular kits in the survey; during the control period (one year) each laboratory assayed 4 EQA pools distributed (as hidden replicates) in five occasions. The interassay CV was relatively low (9-13%) for three pools in the normal TSH range (greater than 0.8 milli-int. unit/L) but markedly higher (30-40%, except for one more precise kit) in the subnormal range (0.2 milli-int. unit/L). We calculated the effect of the between-run variability on the diagnostic accuracy (discrimination between normal and subnormal values) for three representative TSH concentrations: 0.2, 0.4, and 0.5 milli-int. unit/L (0.3 milli-int. unit/L was considered the lower normal limit). The three concentrations were reasonably discriminated (P less than or equal to 5%), and only one kit showed a between-run CV less than 18% at 0.2 milli-int. unit/L. For the other four less-precise kits, only the higher TSH value (0.5 milli-int. unit/L) could be classified with an acceptable diagnostic reliability. With the most precise kit, one can distinguish two TSH concentrations in the 0.3-0.5 milli-int. unit/L range that differ by at least 30%; with the other kits, differences greater than 50-60% are needed for reliable discrimination. Thus many laboratories fail to achieve the functional sensitivity of a second-generation assay, even if they use immunometric methods. TSH assays with a better interassay precision in the low concentration range are needed.
Multicenter Technical and Clinical Evaluation of a Fully Automated Enzyme Immunoassay for CA 125
Authors: Kenemans P , Bon G G , Kessler A C , Verstraeten A A , van Kamp G J
Published: January 2020

The technical performance and clinical usefulness of the newly developed Enzymun-Test CA 125 (Boehringer Mannheim) was evaluated in a multicenter study. Sera tested were obtained from healthy control subjects (n = 1003) and from patients with benign conditions (379), ovarian cancer (518), or other malignancies (479). Intra- and interassay variability was low at CA 125 concentrations greater than 100 units/mL. Intra- and interassay CVs were respectively less than or equal to 36% and 23% for the low CA 125 concentrations (less than or equal to 35 units/mL) and less than or equal to 15% and 14% for the medium CA 125 concentrations (36- less than or equal to 100 units/mL). Interlaboratory reproducibility of the Enzymun-Test CA 125 was excellent. A strong linear correlation was observed between Enzymun-Test CA 125 and three of four other commercially available assays of CA 125 in serum. Cutoff values of 35 units/mL in three of these other tests corresponded to Enzymun-Test CA 125 values ranging from 27.0 to 42.1 units/mL. In the fourth test, an enzyme immunoassay, a cutoff of 35 units/mL corresponded to Enzymun-Test values ranging from 64.1 to 77.0 units/mL. Discordant, as yet unexplained, results in which Enzymun-Test values were greater than 65 units/mL and Centocor CA 125 immunoradiometric assay results were less than 35 units/mL were found in 15 of 1003 samples (1.5%) of apparently healthy control subjects. Sensitivity and performance of the Enzymun-Test were very similar to those of the Centocor assay for sera from the patients with various benign disorders or malignant diseases. Given its excellent automated technical performance, this new CA 125 serum assay is feasible for monitoring ovarian cancer patients. Test results are interchangeable with those from other laboratories and, in general, with those obtained by most other CA 125 tests.
Comparison of Plastic vs. Glass Evacuated Serum-Separator (SSTTM) Blood-Drawing Tubes for Common Clinical Chemistry Determinations
Authors: Hill B M , Laessig R H , Koch D D , Hassemer D J
Published: January 2020

We evaluated a plastic evacuated blood-drawing tube containing an integral serum-separating barrier gel, by direct comparison with a glass counterpart. The plastic tube demonstrated no differences when compared for common clinical chemistry analytes with multiple types of instruments and systems. A total of 260 such different combinations were studied with emphasis on tests sensitive to drawing and handling indexes such as lactate dehydrogenase and potassium. A total of six separate blood drawings were tested with no significant differences noted in these tests. The total study included subjective evaluations of the plastic tube's use as a blood-drawing device and objective studies based on quantitative test results from normal and hospitalized patients and use of the primary sampling tubes (both plastic and glass) for 48-h storage.
Pulse Oximetry: Theory and Applications for Noninvasive Monitoring
Authors: Mendelson Y
Published: January 2020

Noninvasive measurement of arterial oxygen saturation (SaO2) by pulse oximetry is widely acknowledged to be one of the most important technological advances in monitoring clinical patients. Pulse oximeters compute SaO2 by measuring differences in the visible and near infrared absorbances of fully oxygenated and deoxygenated arterial blood. Unlike clinical blood gas analyzers, which require a sample of blood from the patient and can provide only intermittent measurement of patient oxygenation, pulse oximeters provide continuous, safe, and instantaneous measurement of blood oxygenation. Here I review the theoretical background behind this advanced technology, instrumentation requirements, practical instrument calibration, common features of commercial pulse oximeters, specific clinical applications, and performance limitations of pulse oximeters.
Development of a Proton Nuclear Magnetic Resonance Spectroscopic Method for Determining Plasma Lipoprotein Concentrations and Subspecies Distributions from a Single, Rapid Measurement
Authors: Otvos J D , Jeyarajah E J , Bennett D W , Krauss R M
Published: January 2020

We are developing a method for quantifying plasma lipoproteins by proton nuclear magnetic resonance (NMR) spectroscopy that offers advantages over existing clinical methods. We showed that the major lipoproteins have distinct NMR properties sufficient to permit their concentrations to be extracted from a computer lineshape analysis of the plasma lipid methyl resonance envelope (Clin Chem 1991; 37:377-86). We have now discovered that the spectra of the subspecies within each lipoprotein class are different enough to influence the composite spectrum of that class and hence the spectrum of whole plasma. By including spectra representative of these subspecies as additional components in the lineshape-fitting analysis, a complete concentration profile of very-low-density, low-density (LDL), and high-density (HDL) lipoproteins plus the subspecies distributions within these classes can be simultaneously generated. A pilot study of 30 plasma samples of widely varied composition demonstrated good agreement between NMR-derived values and lipoprotein lipid concentrations and LDL and HDL subspecies distributions determined by gradient-gel electrophoresis.
Relationship Between Smoking Status and Serum Lipids in a Hyperlipidemic Population and Analysis of Possible Confounding Factors
Authors: Bruckert E , Jacob N , Lamaire L , Truffert J , Percheron F , de Gennes J L
Published: January 2020

The aim of our study was to estimate the potential relationship between smoking behavior and other coronary heart disease risk factors in 250 hyperlipidemic patients. We present data obtained through self-reporting of the number of cigarettes smoked per day, measurements of three tobacco markers, and data on dietary habits and lipid variables. We measured cotinine (by HPLC) and thiocyanate and used a recent colorimetric assay for the indirect evaluation of the nicotine metabolites in a single urine specimen. Mean values of nicotine metabolites, expressed as cotinine equivalents, were 6.7, 39.9, and 79.4 mumol/L, respectively, for nonsmokers, light smokers (7.7 cigarettes per day), and heavy smokers (25.8 cigarettes per day). We found that light smokers have higher concentrations of cotinine and nicotine metabolites in proportion to the number of cigarettes smoked per day than do heavy smokers. Thus, the simple colorimetric assay can accurately evaluate smoking status. Hyperlipidemia and smoking are linked by an intricate network of multiple relations. The concentration of high-density lipoprotein (HDL) cholesterol is lower in heavy smokers, and the concentrations of triglycerides and cholesterol are higher. The 0.11 mmol/L difference in HDL cholesterol between light and heavy smokers is close to the results of previous papers; however, when gender, dietary habits (including alcohol intake), and data on body mass index are included in a multiple regression analysis, there is no longer an association between HDL cholesterol concentrations and smoking status. Therefore, these different dietary habits may be confounding factors that partly explain the pattern of lipid variables.
Multivariate Statistical Modeling: Alternative Approach to Test Evaluation, Applied to Counting Reticulocytes by Flow Cytometry
Authors: Oosterhuis W P , Zwinderman A H , Modderman T A , Dinkelaar R B , van der Helm H J
Published: January 2020

We present a statistical path analysis model for the evaluation of two tests in the absence of a "gold standard" method. This model is applied to the evaluation of flow-cytometric and visual reticulocyte counting by using as the comparison method a combination of three hematological measurements: hemoglobin concentration (HGB), mean cellular volume (MCV), and erythrocyte density width (EDW). We assumed that, in general, a higher reticulocyte count is associated with a lower HGB value and with greater values for MCV and EDW. Applying this assumption and the statistical model, we demonstrated that flow cytometry was superior to visual reticulocyte counting in the low-value range studied. The path analysis model is potentially applicable in other cases where two tests are to be compared, and when no gold standard is available.
Analysis for Fully Oxidized Neopterin in Serum by High-Performance Liquid Chromatography
Authors: Rippin J J
Published: January 2020

Fully oxidized D-neopterin in serum can be measured by HPLC. Serum samples were preincubated with ferric nitrate/EDTA solution to remove any dihydroneopterin, which is unstable and may give spuriously high results because of its conversion to D-neopterin. Pterins were extracted onto solid-phase propylbenzenesulfonic acid minicolumns and eluted with a 1:5 (by vol) mixture of ammonia solution (308 g/L) in acetonitrile. Extracts were evaporated and then reconstituted in mobile phase (50 mL of methanol per liter of 50 mmol/L phosphate buffer, pH 6.2) before injection. Separation was performed with a 25-cm ODS2 column (particle size, 5 microns) at 32 degrees C with fluorescence detection (lambda ex 360 nm, lambda em 440 nm). The between-batch CV was 7.1% and 5.6% for neopterin concentrations of 21.7 and 67.3 nmol/L, respectively. The limit of detection was 0.75 nmol/L, and the mean recovery of the extraction procedure was 90% for neopterin and internal standard. Correlation with a radioimmunoassay (x) gave y = 0.99x + 0.64 (r = 0.970, Sy/x = 2.75). The method allows daily analysis of serum D-neopterin in small batches and is currently used to monitor patients undergoing bone-marrow transplant.
Influence of a Serotonin- and Dopamine-Rich Diet on Platelet Serotonin Content and Urinary Excretion of Biogenic Amines and Their Metabolites
Authors: Kema I P , Schellings A M , Meiborg G , Hoppenbrouwers C J , Muskiet F A
Published: January 2020

Using high-performance liquid chromatography and gas chromatography, we reevaluated the 24-h influence of a serotonin- and dopamine-rich diet on platelet serotonin and serotonin, 5-hydroxyindoleacetic acid (5-HIAA), and major catecholamine metabolites in the urine of 15 healthy adults. Although there were significant responses in urinary free serotonin and catecholamine metabolites, their concentrations did not exceed the upper limits of the reference ranges for any of the participants. For urinary 5-HIAA, pronounced effects were observed within 2-4 h. After 6-8 h, results for 11 participants exceeded the upper limit of the reference range. The median recovery of dietary serotonin as urinary 5-HIAA was 20% and subject to a large range (1-50%). There was no significant change in platelet serotonin. We conclude that, using specific analytical methods, no dietary restrictions need be imposed to diagnose catecholamine (metabolite)-producing tumors. For diagnosis of carcinoids on the basis of urinary 5-HIAA it is appropriate to completely abstain from serotonin-containing foods for greater than or equal to 12 h before testing. Platelet serotonin is a more sensitive marker for carcinoids that produce only small amounts of serotonin, and is unaffected by dietary serotonin.
Rapid and Sensitive Method for Erythropoietin Determination in Serum
Authors: Tanebe M , Teshima S , Hanyu T , Hayashi Y
Published: January 2020

An enzyme-linked immunosorbent assay (ELISA) method for erythropoietin determination has been established by using two kinds of monoclonal antibodies with specific affinities to erythropoietin. Besides being rapid (2.5 h) and sensitive (detection limit 0.3 int. unit/L), the present method gives accurate results and is easy to perform. The method may be clinically applicable for discriminative diagnosis of polycythemia and analyses of various anemic conditions.
Immunonephelometric Assay of Vitamin D-Binding Protein
Authors: Haughton M A , Mason R S
Published: January 2020

An automated immunonephelometric assay was developed to measure vitamin D-binding protein (DBP) in serum. The assay is described for the Behring Nephelometer System, which uses rabbit anti-DBP antiserum and purified human DBP. The detection limit is 0.05 g/L (0.86 mumol/L), and the working range is less than or equal to 1.60 g/L (27.59 mumol/L). Intra- and interassay CVs of 2.0% and 2.8-3.8% compare favorably with alternative methods. When results were compared with those from a immunoradiometric assay, the correlation coefficient was 0.976 (P less than 0.001), and the regression equation [y = 0.866 +/- 0.085x + 0.05 (Syx = 0.042, n = 42)] identified a negative bias. Analysis indicated that both methods appeared to contribute equally to the bias. Although the assay was relatively free from analytical interference, falsely increased values were noted in severely lipemic specimens and in frozen specimens. Interference may be minimized by inclusion of Supplementary Precipitation reagent in a modified assay protocol. The range of concentrations expected in clinical samples was established from normal subjects [0.32-0.46 g/L (5.52-7.93 mumol/L), n = 28], pregnant subjects [0.51-0.70 g/L (8.79-12.07 mumol/L), n = 13], and subjects with liver diseases [0.12-0.33 g/L (2.07-5.69 mumol/L), n = 18].
Screening Cord Blood for Hemoglobinopathies and Thalassemia by HPLC
Authors: van der Dijs F P , van den Berg G A , Schermer J G , Muskiet F D , Landman H , Muskiet F A
Published: January 2020

We evaluated the use of an HPLC method for screening hemoglobins in cord blood. We studied the genotype frequencies of the structural hemoglobin variants HbS and HbC and the synthesis variants alpha- and beta(+)-thalassemia in babies born on Curaçao. During three months, 67.2% of all (748) newborns were screened: 122 (24.3%) had an abnormal hemoglobin pattern, of which 53 (43.4%) had a hemoglobinopathy (HbS or HbC), 64 (52.2%) had alpha-thalassemia (HbBarts greater than 0.5%, corresponding to heterozygous or homozygous alpha-thalassemia-2), and 5 (4.1%) had a hemoglobinopathy plus alpha-thalassemia. None of the newborns with heterozygous HbS and HbC had concomitant beta(+)-thalassemia. The population genotype frequency of heterozygous alpha-thalassemia-2 was calculated to be 30.7%. The data are in excellent agreement with those previously established for the adult population and those available from the black population in the United States and Jamaica. Based on the HPLC results, we estimate that 67.1% of newborns with heterozygous alpha-thalassemia-2 remain undetected. A coincidental finding was a relation between demonstrable alpha-thalassemia and short gestation. Because of its superior separating power and high sensitivity for quantifying relatively low percentages of hemoglobins in the presence of HbF0, the HPLC method was preeminently suitable for screening cord-blood samples.
Immunofixation to Quantify β2-Transferrin in Cerebrospinal Fluid to Detect Leakage of Cerebrospinal Fluid from Skull Injury
Authors: Zaret D L , Morrison N , Gulbranson R , Keren D F
Published: January 2020

beta 2-Transferrin, the desialated form of transferrin normally found only in cerebrospinal fluid (CSF) and aqueous and vitreous humor, is detected by high-resolution immunofixation (IFE). It is not normally found in nasal or aural fluids, saliva, tears, or serum. Detection in nasal fluid has been suggested to document CSF leakage into the nose after skull injury. We measured beta 2-transferrin in 48 samples of CSF. IFE of the CSF was performed on high-resolution agarose gels and stained with Coomassie Blue. beta 2-Transferrin was estimated by quantifying the total transferrin by rate nephelometry and then determining the percentage of transferrin in the beta 2 vs beta 1 region by densitometric scanning of the IFE pattern. We accurately quantified as little beta 2-transferrin as 2.5 mg/L in the CSF samples. The beta 2-transferrin fraction was clearly visible by IFE at concentrations less than 2.5 mg/L, but accurate quantification was difficult. In the samples assayed, the range of beta 2-transferrin was 4.6 +/- 1.9 mg/L. Use of this technique to examine rhinorrhea in a motor-vehicle-accident patient confirmed leakage of CSF into the nasal cavity through a vent in the left olfactory groove.
Recurrent Transient Hyperphosphatasemia of Infancy in an Adult
Authors: Onica D , Torssander J , Waldenlind L
Published: January 2020

We report a case of recurrent transient hyperphosphatasemia in a 29-year-old man with immune deficiency. He had serum alkaline phosphatase (ALP; EC 3.1.3.1) activity 16.9- and 4.8-fold greater than the upper reference limit on two occasions; the activity returned to normal within 2 months on the first and within 1 month on the second. On both occasions we observed the typical electrophoretic pattern for ALP isoenzymes seen in transient hyperphosphatasemia of infancy. We noted no evidence of liver or bone disease. Recognition of the occurrence of transient hyperphosphatasemia of infancy in adults, although rare (it is the fifth case reported), seems as important as in children so that unnecessary extensive investigations are avoided.
Evaluation of silyl-blocked p-nitrophenylmaltoheptaoside as a substrate for alpha-amylase reagents
Authors: Elbin C S , Becks S , Lepp C A
Published: January 2020

We describe a reagent for measuring alpha-amylase (EC 3.2.1.1) activity in serum with use of a thexyldimethylsilyl ether of p-nitrophenyl-alpha-D-maltoheptaoside (SB7) as substrate. This substrate differs from Genzyme's benzylidene-blocked p-nitrophenylmaltoheptaoside substrate (B-PNPG7). The reagent, optimized for the characteristics of the silyl-blocked substrate, contains 4-(2-hydroxyethyl)-1-piperazineethane sulfonate buffer at pH 7.3, alpha-glucosidase (maltase; EC 3.2.1.20), and glucoamylase (EC 3.2.1.3). Comparison with Ciba Corning Diagnostics Corp.'s, amylase reagent with B-PNPG7 as substrate (x) yielded a regression equation of y = 1.20x-2.7 (r = 0.9997). The linear range exceeded amylase concentrations > 2500 U/L and total precision (CV) was 2.3% at an amylase concentration of 112 U/L with the Ciba Corning 550 Express analyzer. Reconstituted reagent is stable for 30 days at 5 degrees C and 7 days at ambient (18-25 degrees C) temperatures.
A robust strategy for screening and confirmation of familial defective apolipoprotein B-100
Authors: Mamotte C D , van Bockxmeer F M
Published: January 2020

The diagnosis of familial defective apolipoprotein B-100 (FDB) has been facilitated by the use of mutagenic polymerase chain reaction (PCR) primers to introduce restriction sites at the FDB gene locus. We describe a two-test strategy for diagnosing FDB that overcomes the potential for error in single-test methods based on such techniques. We introduce an Sau96I restriction site for PCR products of the normal apolipoprotein B allele. Incomplete digestion of the PCR product with Sau96I suggests an FDB heterozygote, although a false-positive result due to nonideal digestion conditions remains a possibility. In such cases we use a second test that introduces an ScaI restriction site in PCR products of the FDB allele. The diagnosis is confirmed if half of this product can be digested with ScaI. Both tests use 0.25 units of Taq polymerase and are robust with respect to annealing temperature (31-58 degrees C) and to Mg2+ concentration (1.0-3.2 mmol/L).
Cyclosporin G and metabolite binding to cyclophilin and a 50-kDa binding protein related to in vitro immunosuppression
Authors: Donnelly J G , Chen Y , Yatscoff R W , Copeland K R , Palaszynski E W , Soldin S J
Published: January 2020

Seven purified metabolites of cyclosporin G (CsG) were studied for binding to cyclophilin and a 50-kDa binding protein (50-kDa BP). The ratios of the metabolite dissociation constants with respect to CsG were compared with in vitro immunosuppression by using the primary mixed lymphocyte suppression assay. The immunosuppressive potency ratio of the parent compounds, both cyclosporin A (CsA) and CsG, compared favorably with the drug dissociation constants for cyclophilin and the 50-kDa BP. Three of the seven metabolites had comparable binding and potency ratios for the 50-kDa BP. In contrast, none of the seven metabolites appreciably bound to cyclophilin in the concentration range tested.
Proficiency test performance as a predictor of accuracy of routine patient testing for theophylline
Authors: Jenny R W , Jackson K Y
Published: January 2020

Proficiency testing (PT) is pivotal in assessing laboratory qualifications for certification and licensure. PT is expected to typify routine assay performance and determine whether the laboratory is producing clinically useful test results. Conventional schemes use mail-distributed test specimens and are often criticized as measuring the best possible laboratory performance, principally because of special practices associated with processing PT specimens. We used on-site proficiency tests and split samples to evaluate the ability of conventional PT schemes to accurately characterize routine laboratory performance. Using 412 assays of theophylline, performed routinely by 200 laboratories and subsequently in a reference laboratory, we found that the predictive value of PT performance in assessing quality of routine testing was high (100% for predicting substandard reliability of routine patient testing and 94% for excluding substandard reliability of patient testing). The imprecision of interlaboratory PT results was equivalent whether testing was observed (hand-carried specimens) or unobserved (mail-distributed specimens). Many methods used for determining theophylline concentration in serum were highly automated, closed, and precise analytical systems. The performance characteristics of these analytical systems are not easily manipulated by the analyst for purposes of improving PT outcome, and PT by use of mail-distributed test specimens is effective for assessing intralaboratory performance.
Breath acetone analyzer: diagnostic tool to monitor dietary fat loss
Authors: Kundu S K , Bruzek J A , Nair R , Judilla A M
Published: January 2020

Acetone, a metabolite of fat catabolism, is produced in excessive amounts in subjects on restricted-calorie weight-loss programs. Breath acetone measurements are useful as a motivational tool during dieting and for monitoring the effectiveness of weight-loss programs. We have developed a simple, easy-to-read method that quantifies the amount of acetone in a defined volume of exhaled breath after trapping the sample in a gas-analyzer column. The concentration of acetone, as measured by the length of a blue color zone in the analyzer column, correlates with results obtained by gas chromatography. Using the breath acetone analyzer to quantify breath acetone concentrations of dieting subjects, we established a correlation between breath acetone concentration and rate of fat loss (slope 52.2 nmol/L per gram per day, intercept 15.3 nmol/L, n = 78, r = 0.81). We also discussed the possibility of using breath acetone in diabetes management.
Double-label time-resolved immunofluorometric assay of prostate-specific antigen and of its complex with alpha 1-antichymotrypsin
Authors: Leinonen J , Lövgren T , Vornanen T , Stenman U H
Published: January 2020

We have developed a procedure for simultaneous immunofluorometric assay (IFMA) of prostate-specific antigen (PSA) and its complex with alpha 1-antichymotrypsin (ACT). A PSA-specific monoclonal antibody, which captures both free PSA and the PSA-ACT complex, was used as solid-phase antibody. Total PSA immunoreactivity was measured with a Eu(3+)-labeled PSA antibody that reacted with both free PSA and PSA-ACT. PSA-ACT was assayed simultaneously with a Sm(3+)-labeled polyclonal ACT antibody as a tracer. As standard we used pooled serum in which most of the PSA occurred as the PSA-ACT complex. The assay range was 0.03-500 micrograms/L for total PSA and 0.16-450 micrograms/L for PSA-ACT. In comparison with the assay for total PSA, assay of the PSA-ACT/PSA ratio improved the clinical specificity for cancer by reducing the number of false-positive results in prostatic hyperplasia.
Enzyme immunoassay, kinetic microparticle immunoassay, radioimmunoassay, and fluorescence polarization immunoassay compared for drugs-of-abuse screening
Authors: Armbruster D A , Schwarzhoff R H , Hubster E C , Liserio M K
Published: January 2020

The newest formulation of the Syva EMIT assay for drugs of abuse, EMIT II, and a new immunoassay, OnLine (Roche), utilizing the kinetic interaction of microparticles in solution (KIMS) methodology, RIA tests, and TDx fluorescence polarization immunoassay (FPIA) procedures were compared for marijuana, cocaine, opiates, and barbiturates. Both EMIT II and OnLine immunoassays were performed with a Hitachi 717 analyzer. Calibration curves, the degree of separation between negative and cutoff calibrators, precision, likelihood of carryover from positive to negative samples, and overall ease and speed of analysis were evaluated. RIA and OnLine detected 99% of gas chromatography/mass spectrometry (GC/MS)-confirmed marijuana samples; TDx, 95%; and EMIT II, 88%. All four immunoassays detected approximately 99% of confirmed cocaine-positive urines. RIA, OnLine, and TDx all detected 100% of opiate-confirmed samples; EMIT II, 97%. Barbiturate assays exhibited the greatest disparity, with OnLine and TDx detecting 100% of confirmed positives; EMIT II, 88%; and RIA, 78%. For a variety of reasons, we prefer the fully automated EMIT II and OnLine assays for high-volume urine testing, in comparison with our laboratory's semiautomated RIA tests and the limited-throughput TDx system. The four immunoassays investigated delivered comparable performance in terms of detection rates for GC/MS-confirmed positives for some drugs but not for others.
Modified assay of prostate-specific antigen with a detection limit < 0.01 microgram/L
Authors: Liedtke R J , Kroon G , Batjer J D
Published: January 2020

We modified the Hybritech Tandem-E prostate-specific antigen (PSA) assay by increasing the sample volume, increasing enzyme-substrate incubation time, and using diethanolamine buffer. Our modified method has a detection limit of 0.009 microgram/L (P < 0.01). The assay curve is linear from 0.01 to 1.0 micrograms/L and has an overall assay time of about 4 h. Linear plots are obtained when the 1.0 micrograms/L standard is diluted with either matrix buffer or serum from men containing PSA < 0.01 microgram/L. Recovery of PSA (0.10 microgram/L) added to serum from men averaged 94%. Interassay CVs were 13%, 7%, and 4% at PSA concentrations of 0.04, 0.07, and 0.30 micrograms/L, respectively (n = 33). This assay should be useful in the detection of early recurrence of prostate cancer after radical prostatectomy.
Chemiluminescent third-generation assay (Amerlite TSH-30) of thyroid-stimulating hormone in serum or plasma assessed
Authors: Wilkinson E , Rae P W , Thomson K J , Toft A D , Spencer C A , Beckett G J
Published: January 2020

We assessed the laboratory performance and clinical utility of a new commercial third-generation assay of thyroid-stimulating hormone (TSH), Amerlite TSH-30. The interassay CV was 6% at TSH concentrations of approximately 0.08 mIU/L, and the analytical and functional detection limits of the assay were 0.005 and 0.0125 mIU/L, respectively. Although the assay recovered approximately 96% of TSH International Reference Preparation (TSH-IRP) 80/558 added to serum samples, the endogenous TSH concentrations in basal samples were significantly lower than those found by using two other TSH assays; bias data obtained from thyroliberin stimulation tests suggested that the negative bias found with TSH-30 may be due to the heterogeneity of TSH in basal samples. TSH-30 completely discriminated hyperthyroid and hypothyroid patients from euthyroid ambulatory patients but also detected TSH (> 0.0125 mIU/L) in 3 of 46 untreated hyperthyroid patients. Compared with two second-generation assays, TSH-30 better discriminated between patients with subnormal TSH due to hyperthyroidism, thyroxine overreplacement, and nonthyroidal illness but there was still significant overlap between results for these groups.
Iron-deficiency anemia and thalassemia trait differentiated by simple hematological tests and serum iron concentrations
Authors: Jiménez C V
Published: January 2020

The diagnostic value of common hematology tests in differentiating between thalassemia trait and iron-deficiency anemia (IDA) was assessed. Serum iron concentration was included in a second stage of the diagnostic model and its predictive contribution was determined. After applying discriminant analysis to the data, minimization of Wilks's lambda (lambda) criterion was used to select the best predictive variables. A training sample of 754 subjects previously classified as either IDA (428) or thalassemia trait (326) was used to determine the classification rule. When serum iron concentrations were included, the model showed a higher predictive capacity than that constructed from hematological variables only (D = 2.342 RBC - 0.079 Hb + 3.627 log[Fe] - 6.459, where D = discriminant score). The sensitivity, specificity, and diagnostic efficiency associated with this model, as assessed on a control sample of 256 patients (137 thalassemia and 119 IDA), were 94.2%, 91.6%, and 93.0%, respectively. This model, when compared with those of other authors, has the highest diagnostic efficiency.
Colorimetric solid-phase minisequencing assay illustrated by detection of alpha 1-antitrypsin Z mutation
Authors: Harju L , Weber T , Alexandrova L , Lukin M , Ranki M , Jalanko A
Published: January 2020

In solid-phase minisequencing, a defined point mutation is detected in microtiter plate-immobilized DNA by a single nucleotide primer extension reaction. We have here developed the method into a colorimetric assay and applied it to the detection of the Z mutation of the alpha 1-antitrypsin gene. We used novel nucleoside triphosphates modified with dinitrophenyl (DNP) hapten, permitting detection by anti-DNP-alkaline phosphatase conjugate, with p-nitrophenyl phosphate as substrate. The Z mutation is detected in two reactions: DNP-labeled dCTP is incorporated when the template is normal, DNP-dUTP when the Z mutation is present. Both modified nucleotides were incorporated with high specificity and with an efficiency similar to that of unmodified nucleotides. The test results are measured by spectrophotometry, yielding quantitative absorbance values. Calculation of the ratio of C to U signal permitted unambiguous distinction of normal homozygous, ZZ homozygous, and ZM heterozygous genotypes. The colorimetric minisequencing assay is rapid, standardized, and automatable, and thus provides an accurate and simple alternative for the analysis of known point mutations.
Kinetic parameters for the cleaved substrate, and enzyme and substrate stability, vary with the phosphoacceptor in alkaline phosphatase catalysis
Authors: Stinson R A
Published: January 2020

Nine different isoenzymes and (or) isoforms of alkaline phosphatase (ALP; EC 3.1.3.1) from human tissue were studied with respect to Km and Vmax values for p-nitrophenyl phosphate (p-NPP) in seven different potential phosphoacceptors/buffers. Generally, the phosphoacceptors/buffers with the lowest affinity for p-NPP (highest Km values) gave the highest Vmax values; for the nine enzyme forms in this study, the mean Km and Vmax values were greatest in 2-(ethylamino) (EAE). The two amino-propanol buffers gave the lowest Km and Vmax values. The phosphoacceptors/buffers N-methyl-D-glucamine (MEG), diethanolamine, and Tris had intermediate Km and Vmax values. Hydrophilic liver ALP retained > 90% of its activity after 24 h at 30 degrees C in both 1.0 and 0.3 mol/L Tris and 2-amino-2-methyl-1,3-propanediol and in 0.3 mol/L MEG. This isoenzyme showed greatest inactivation upon prolonged exposure to 1.0 and 0.3 mol/L EAE, the activity at 24 h being approximately 50-66% of that at zero time. p-NPP underwent the greatest spontaneous degradation, approximately 2.5 times that of baseline levels, in 1 mol/L MEG. There was little degradation in all of the buffers tested at 0.3 mol/L or in Tris, EAE, and 2-amino-2-methyl-1-propanol at 1.0 mol/L.
Intraindividual variation of glycohemoglobin: implications for interpretation and analytical goals
Authors: Phillipou G , Phillips P J
Published: January 2020

Intraindividual variation (CVi) for glycohemoglobin (GHb) was estimated from serial measurements in patients with diabetes in either stable or variable clinical control. GHb determinations were performed by an affinity column procedure with an analytical imprecision of 4.9% (weighted average; GHb 8.2-14.7%). Within the groups of patients, both a short- (28-32 days) and long-term (approximately 85 days) sampling protocol was used. The derived CVi for each category was 4.2% (n = 16, stable, short-term), 7.1% (n = 23, stable, long-term), 5.1% (n = 13, variable, short-term), and 9.8% (n = 21, variable, long-term). The mean GHb within each category was similar (approximately 11%), and there was no statistically significant difference in GHb values between categories. The results establish that the CVi for GHb is affected by both clinical control and the sampling time interval. These findings have important implications for the estimation of significant differences between serial GHb measurements and the setting of appropriate analytical precision goals.
Competitive solid-phase enzyme immunoassay for melatonin in human and rat serum and rat pineal gland
Authors: Yie S M , Johansson E , Brown G M
Published: January 2020

We describe a solid-phase competitive enzyme immunoassay for determination of melatonin in serum. The detection limit of the assay is 1.0 fmol/well. Low cross-reactivity of the antiserum with other indoles, parallel serum extract dilution and melatonin standard curves, good analytical recovery, and within- and between-assay CVs of 6.4-14.4% provide validation of the assay. Linear regression analysis of melatonin concentrations measured with this assay (y) and with a commercial 3H RIA (x) in 88 sera yielded the relation y = 0.62 x - 0.76, Sy/x = 0.03. Values for melatonin in serum samples from healthy subjects are lower during the day than during the night. Melatonin response in rat serum and pineal gland to isoproterenol injection is similar to published RIA data. The analytical procedure is also simple. Thus, the assay should have practical applications in investigation of pineal function in both clinical and basic studies.
Genomic components of carcinogenesis
Authors: Schmandt R , Mills G B
Published: January 2020

Many of the genes encoding growth factors, growth factor receptors, enzymes, and other effector molecules that regulate normal cell growth are designated protooncogenes. Oncogenes, those genes associated with cellular transformation, differ from their protooncogenic progenitors by being mutated, overexpressed, or expressed at inappropriate times or locations in the cell. One of the activities of growth factors is to prime cells to undergo programmed cell death, which is characterized by a series of morphologic changes called apoptosis. In normal cells, specific mediators must be activated or suppressed to bypass programmed cell death. In tumor cells, either the pathways leading to apoptosis are not functional or the mediators that normally "rescue" cells from this fate are overexpressed or constitutively activated. In addition to the biochemical pathways that drive cell division, there are others that limit cell proliferation; these, designated tumor suppressors, anti-oncogenes, or recessive oncogenes, must be inactivated in normal cells to allow passage through the cell cycle and cell proliferation. In contrast to oncogenes, which are overexpressed or activated in tumors, tumor-suppressor genes are frequently inactivated in tumor cells, either by mutation or deletion. Thus, in normal cells a series of checks and balances must be overcome to allow initiation and continuation of cell division. In tumors, these processes are aberrant, resulting in increased rates of cell division, increases in the proportion of cells in the cell cycle, or increased survival of activated cells. Therefore, tumor cells frequently accumulate genomic alterations, which may result in the activation of a particular array of oncogenes, the inactivation of specific tumor-suppressor genes, and the bypassing of programmed cell death. Trials of antitumor agents that act by exploiting the overexpression of oncogenes in tumors and of the biochemical pathways by which they mediate cell proliferation are currently underway.
Screening for cancer: is it cost effective?
Authors: Schwartz M K
Published: January 2020

Screening is defined as the presumptive identification of unrecognized disease or defect by the application of tests, examinations, or other procedures that can be applied rapidly and carried out in the general population or in individuals at high risk. When considering immunochemical or biochemical cancer markers, it might be more appropriate to describe these tests as risk-factor monitors and introduce the concept of two interpretations of these tests: in asymptomatic populations as indicators of probability of cancer, and in patients with previously treated cancer as predictors of recurrence despite initial treatment described as "curative." The successes of screening with alpha-fetoprotein for hepatocellular carcinoma and with catechol metabolites in neuroblastoma are discussed. The major emphasis will be the possible use of CA 125 and prostate-specific antigen (PSA) in risk-factor assessment of ovarian cancer and prostate cancer, respectively. It is important to understand in what context a PSA value > 10 micrograms/L indicates a 67% probability of cancer.
Circadian pharmacodynamics of anticancer therapies
Authors: Hrushesky W J
Published: January 2020

Circadian variation in drug metabolism and tissue sensitivity to drugs affects their activity and toxicity. A growing body of data suggests that therapy may be improved and toxicity reduced by administering antineoplastic agents at carefully selected times of the day. Here I briefly review molecular, cellular, and organismic time-keeping mechanisms as well as cytokinetic, pharmacokinetic, and pharmacodynamic data, which support the predictable and exploitable nonlinear dynamic relation between dose and effect that occurs each day.
Therapeutic drug monitoring in cancer management
Authors: Galpin A J , Evans W E
Published: January 2020

Several anticancer drugs display characteristics that make them suitable candidates for therapeutic drug monitoring (TDM), including substantial pharmacokinetic variability and a narrow therapeutic index. However, concentration-effect relationships (pharmacodynamics) of most antineoplastic agents have not been well defined, thus limiting the widespread clinical application of TDM for cancer chemotherapy. Strategic incorporation of pharmacokinetic studies during phase I-III clinical trials should facilitate the identification of concentration-effect relationships and the definition of clinically useful levels of treatment intensity. We review representative clinical studies that have defined pharmacodynamic relationships for methotrexate, teniposide, etoposide, carboplatin, and mercaptopurine. Given that TDM has impacted positively on the clinical use of many drugs belonging to other therapeutic classes, and that pharmacodynamic correlations have been identified in several recent studies of anticancer drugs, we consider implementation of TDM a rational strategy for optimizing the use of selected antineoplastics.
Serum phospholipases A2 in inflammatory diseases
Authors: Nevalainen T J
Published: January 2020

Phospholipase A2 (EC 3.1.1.4; PLA2) is detected in serum by determination of either the catalytic activity of the enzyme or the concentration of the enzyme protein by immunoassays. The most sensitive methods for determining PLA2 catalytic activity are radiometric assays, with a substrate of synthetic phospholipid (e.g., phosphatidylcholine or phosphatidylethanolamine) containing a 14C- or 3H-labeled fatty acid at the sn-2-position. Membranes of autoclaved Escherichia coli grown in the presence of radioactive oleic acid may also be used as a substrate. The released fatty acids are separated from the unreacted substrate and quantified by liquid scintillation counting. PLA2 catalytic activities are increased in serum in sepsis, acute pancreatitis, peritonitis, multiple injuries, rheumatoid arthritis, and other arthropathies. Immunoassays--radioimmunoassay, enzyme-linked immunosorbent assay, or time-resolved fluoroimmunoassay--are based on the use of either polyclonal or monoclonal antibodies to purified PLA2s. Specific assays have been developed for both pancreatic group I PLA2 (PLA2-I) and nonpancreatic group II PLA2 (PLA2-II). The cellular source of PLA2-I in serum is the pancreatic acinar cell. Increased serum PLA2-I values have been reported in acute pancreatitis, pancreatic cancer, and abdominal trauma. Increased PLA2-II values are found in conditions involving inflammation, e.g., sepsis, infections, acute pancreatitis, various forms of arthritis, cancer, complications of pregnancy, and postoperative states. Good correlations have been found in serum samples between the catalytic activity of PLA2 and the concentration of PLA2-II but not PLA2-I. PLA2-II may represent an acute-phase protein. The cellular source of the PLA2-II in serum is unknown; it is present in large amounts in cartilage and Paneth cells, prostatic gland cells, seminal fluid, lacrimal gland cells, and tears, but cannot be demonstrated by immunohistochemical or immunochemical methods in inflammatory cells.