bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fat Intolerance in Apparently Healthy Individuals with Normal Fasting Lipoproteins Is Associated with Markers of Cardiovascular Risk
Authors: Garcés María Fátima , Guarin Yamil , Carrero Yenny , Stekman Hilda , Hernández Celsy , Núñez María Luisa , Apitz Rafael , Camejo Germán 
Published: July 2018

Abstract

Background
Postprandial increase of triglyceride-rich lipoproteins augments the risk of atherosclerotic cardiovascular disease and all-cause mortality. We explored the hypothesis that a simplified oral fat tolerance test can uncover differences in postprandial triglyceride response associated with potentially atherogenic lipoprotein characteristics, even in a cohort of apparently healthy 31-year-old [mean (SD), 31 (11)] nonobese individuals with normal fasting lipids and lipoproteins.

Methods
We used a fat tolerance test in 96 females and 62 males with blood sampled at 0, 2, and 4 h after a breakfast containing 26.3 g of fats. The postprandial triglyceride response was used to classify the individuals in apparently fat-tolerant and apparently fat-intolerant participants.

Results
The intolerant individuals were found to have at 0 h significantly higher body mass index, plasma triglycerides, remnant cholesterol, VLDL cholesterol, and LDL cholesterol and lower apolipoprotein (apo) AI and HDL cholesterol than the tolerant individuals. More than 70% of the variability (r 2) of the postprandial response in tolerant and intolerant individuals measured as area under the curve or, at a single point at 4 h after the oral fat load, was linearly correlated with 0-h triglycerides (P &lt; 0001). Fasting lipoprotein parameters, proposed to be markers of cardiovascular risk, as the ratios apo B/apo AI, total cholesterol/HDL cholesterol, and triglycerides/HDL cholesterol, were increased in the intolerant individuals.

Conclusions
A simplified oral fat tolerance test, even when used in an apparently healthy, nonobese, normolipidemic cohort, detected that an increased postprandial triglycerides response was associated with augmented lipoprotein markers of increased cardiovascular risk.
Serum α-Hydroxybutyrate: A Candidate Marker of Insulin Resistance Is Associated with Deterioration in Anthropometric Measurements in Individuals with Low Diabetes Risk
Authors: Sarı Hakan , Esen Bennur , Yıldırım Süleyman , Pilten Saadet , Aydın Hasan 
Published: July 2018

Abstract

Background
α-Hydroxybutyrate (α-HB) is a marker of insulin resistance (IR) and lipid oxidation, both of which precede the development of diabetes and cardiovascular disorders. We aimed to analyze the relation of α-HB levels with anthropometric measurements in individuals without metabolic risk factors.

Methods
A total of 82 nonobese individuals [body mass index (BMI) &lt;30 kg/m2] without an accompanying chronic disorder were enrolled into the study. The entire cohort of participants underwent physical examination. Biochemical and hormonal parameters were analyzed. The BMI was calculated as weight/height2 (kg/m2). An ELISA method was used to analyze serum α-HB level. The relation of variables was analyzed by correlation analysis.

Results
The mean age, BMI, body fat ratio, and waist/hip ratio of participants were 36 (9) years, 24.9 (2.2), 39.2 (3.9), and 0.82 (0.06), respectively. The mean fasting glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) levels, total cholesterol, triglyceride, HDL, and LDL levels were 90.7 (5.1) mg/dL, 9.8 (1.5) IU/mL, 2.2 (0.3), 193.2 (32.6) mg/dL, 119.3 (60.3) mg/dL, 54.6 (12.2) mg/dL, and 114.2 (30.4) mg/dL, respectively. Serum α-HB level was significantly correlated with age, BMI, body fat ratio, waist circumference, waist/hip ratio, fasting glucose, insulin, HOMA-IR, HDL, total cholesterol, and triglyceride.

Conclusions
Serum α-HB, a strong marker of insulin resistance, is well correlated with deterioration of anthropometric parameters such as an increase in BMI and body fat distribution in patients with low diabetes risk.
Myocardial Ischemia on Exercise Stress Echocardiography Testing Is Not Associated with Changes in Troponin T Concentrations
Authors: Limkakeng Alexander T , Drake Weiying , Lokhnygina Yuliya , Meyers Harvey P , Shogilev Daniel , Christenson Robert H , Newby L Kristin 
Published: July 2018

Abstract

Background
Some posit that any amount of myocardial ischemia can be detected by high-sensitivity cardiac troponin assays. We hypothesized that patients with myocardial ischemia induced by exercise stress would have significantly higher increases in high-sensitivity cardiac troponin T (hs-cTnT) concentrations than patients without ischemia.

Methods
We prospectively recruited for a biorepository 317 adult patients who presented to an academic hospital emergency department for evaluation possible ischemic symptoms and who were scheduled for exercise echocardiography. Blood samples were obtained before stress testing and 2-h post-testing. For this study, plasma hs-cTnT (Roche Diagnostics) concentrations were determined in a core laboratory blinded to clinical status. Absolute and relative changes between baseline and 2-h post-stress measurements were compared between patients with and without ischemia induced by stress testing.

Results
The median age was 51 (44.0, 60.0) years, 45.9% were male, and 37.8% were African American. In total, 26 patients (8.1%) had myocardial ischemia induced by exercise. Median baseline, 2-h post-stress, and absolute δ concentrations were, respectively, 6.0, 8.0, and 0.2 ng/L for patients with evidence of ischemia; 3.8, 4.6, and 0.0 ng/L for those without; and 3.9, 4.9, and 0.0 ng/L overall. Baseline and 2-h hs-cTnT concentrations were higher among patients with abnormal stress tests (all P ≤0.05), but absolute and relative changes in hs-cTnT concentrations were not significantly different between individuals with ischemia and individuals without.

Conclusions
There was no evidence of change in hs-cTnT values in response to exercise stress testing, regardless of the presence of myocardial ischemia.
Tracking Macroprolactin: Use of an Optimized Polyethylene Glycol Precipitation Method More Compatible with the Requirements and Processes of Automated Core Laboratories
Authors: Favresse Julien , Bastin Pierre , Fillée Catherine , Luyckx Francoise , Maiter Dominique , Gruson Damien 
Published: July 2018

Abstract

Background
Macroprolactin (MPRL) is a large circulating form of a multimeric prolactin currently thought to be biologically inactive. Because of its ability to interfere with prolactin detection in most of the current 2-site immunoassays, the presence of MPRL can lead to inappropriate diagnosis of hyperprolactinemia and unnecessary investigations and treatments. The main objective of our study was to establish an optimized polyethylene glycol (PEG) precipitation method that could be used in automated core laboratory settings.

Methods
The PEG precipitation method adopted in our laboratory (2 min, 19744g) was compared to a standard procedure (30 min, 1500g). We also tested the stability over time (44, 99, and 261 days) of PEG solutions. Post-PEG prolactin concentrations were used for method comparisons, and discrepancies with the classic recovery calculation were also studied.

Results
The higher g-force centrifugation method adopted in our laboratory generated results in agreement with a standard procedure (slope of 1.00, y intercept of −0.8 ng/mL). The PEG solution was stable for at least 261 days (P = 0.72), and the post-PEG reference values as definition of macroprolactinemia revealed a closer association to clinical presentations than the recovery calculation.

Conclusions
We established an optimized PEG precipitation procedure that meets the requirements of core laboratory settings with a more stable PEG solution, less processing samples based on the 30–100 ng/mL screening interval, a lower sample volume, no incubation time, and a higher g-force centrifugation process. Along with post-PEG reference values found in literature, this method could facilitate the widespread introduction of MPRL screening in cases of hyperprolactinemia.
Method Validation of Human Chorionic Gonadotropin and α-Fetoprotein in Cerebrospinal Fluid: Aiding the Diagnosis of Intracranial Germ Cell Tumors
Authors: Shajani-Yi Zahra , Martin Isabella W , Brunelle Abigail A , Cervinski Mark A 
Published: July 2018

Abstract

Background
Our study objective was to validate 2 individual methods to measure α-fetoprotein (AFP) and human chorionic gonadotropin (hCG) in cerebrospinal fluid (CSF) on the Roche cobas® 6000 analyzer. A 3-year retrospective chart review of CSF samples analyzed for AFP and hCG was also conducted.

Methods
Serum samples with high concentrations of AFP or hCG were added to aliquots of pooled CSF. Precision, linearity, detection limit, recovery, carryover, stability, and interference studies of the AFP and hCG+β assays were performed.

Results
Within-day and day-to-day assay imprecision for AFP and hCG assays were &lt;5% at all concentrations tested. The linear range of the AFP assay was established as 1.0–1100 μg/L, and limit of quantification (LOQ) was &lt;1.0 μg/L. The linear range of the hCG assay was established as 1.0–9500 IU/L and LOQ 0.7 IU/L. There was no demonstrable matrix effect, and neither assay was affected by the presence of hemolysis or xanthochromia. AFP in CSF was stable at room and refrigerated temperatures for up to 48 h at concentrations of 19 and 306 μg/L but increased by 24 h at a concentration of 908 μg/L. AFP in CSF was stable frozen (−20 °C) for up to 7 days. hCG in CSF at all concentrations tested was stable at room, refrigerated, and frozen temperatures for up to 7 days.

Conclusions
The Roche cobas 6000 AFP and hCG+β assays accurately quantify AFP and hCG in CSF, facilitating rapid and accurate diagnosis as well as monitoring of intracranial germ cell tumors.
Cholesterol Uptake Capacity: A New Measure of HDL Functionality for Coronary Risk Assessment
Authors: Harada Amane , Toh Ryuji , Murakami Katsuhiro , Kiriyama Maria , Yoshikawa Keiko , Miwa Keiko , Kubo Takuya , Irino Yasuhiro , Mori Kenta , Tanaka Nobuaki , Nishimura Kunihiro , Ishida Tatsuro , Hirata Ken-ichi 
Published: July 2018

Abstract

Background
Recent studies have shown that the cholesterol efflux capacity of HDL is a better predictor of cardiovascular disease (CVD) than HDL cholesterol. However, the standard procedures used for measuring cholesterol efflux capacity involve radioisotope-labeled cholesterol and cultured macrophages. Thus, a simpler method to measure HDL functionality is needed for clinical application.

Methods
We established a cell-free assay system to evaluate the capacity of HDL to accept additional cholesterol, which we named cholesterol “uptake capacity,” using fluorescently labeled cholesterol and an anti-apolipoprotein A1 antibody. We quantified cholesterol uptake capacity of apolipoprotein B (apoB)-depleted serum samples from patients with coronary artery disease who had previously undergone revascularization.

Results
This assay system exhibited high reproducibility (CV &lt;10%) and a short processing time (&lt;6 h). The myeloperoxidase-mediated oxidation of apoB-depleted serum impaired cholesterol uptake capacity. Cholesterol uptake capacity correlated significantly with cholesterol efflux capacity (r 2 = 0.47, n = 30). Furthermore, cholesterol uptake capacity correlated inversely with the requirement for revascularization because of recurrence of coronary lesions in patients with optimal control of LDL cholesterol (P &lt; 0.01, n = 156). A multivariate analysis adjusted for traditional coronary risk factors showed that only cholesterol uptake capacity remained significant (odds ratio, 0.48; 95% CI, 0.29–0.80; P = 0.0048).

Conclusions
Cholesterol uptake capacity assay evaluates the functionality of HDL in a sensitive and high-throughput manner without using radioisotope label and cells. This assay system could be used for the assessment of CVD risk in the clinical settings.
Economics of Pain Management Testing
Authors: Melanson Stacy E F , Petrides Athena K 
Published: July 2018

Abstract

Background
Chronic pain management accounts for a significant portion of health-care costs and has important societal implications, including the increasing availability of prescription narcotics. Urine drug testing (UDT) is an effective tool to monitor adherence to prescription medications and has been recommended by several guidelines. Furthermore, the clinical and technical benefits of UDT using definitive testing methods such as LC-MS/MS are well documented. However, the cost-effectiveness is not well studied.

Content
In this article, we discuss the cost considerations associated with different UDT methodologies, including point-of-care immunoassays, laboratory-based immunoassays, and definitive testing by LC-MS/MS. The costs of reagents, consumables, instrumentation, service, and labor are described, as well as the opportunity each methodology offers in relation to test utilization and clinical cost savings. An overview of how to assess the cost-effectiveness of insourcing definitive testing and how to generate a comprehensive insourcing proposal is provided. Billing options for UDT and the recent changes in current procedural terminology codes are also discussed.

Summary
Given the current health-care environment, additional studies and recommendations that incorporate the cost-effectiveness of definitive testing to monitor compliance in pain management are needed. The decreasing cost of mass spectrometry, the increasing visibility of the value of the laboratory medicine, the new prescriber regulations for opioids, and the push to change reimbursement for definitive UDT will all contribute to the cost-effectiveness of definitive LC-MS/MS to monitor patients with chronic pain.
Clinical Comparison of the NOWDiagnostics' ADEXUSDx Human Chorionic Gonadotropin Point-of-Care Test with the Roche Elecsys hCG + β2 for the Serum Measurement of Human Chorionic Gonadotropin
Authors: Ramos Emilio , Garner Omai B 
Published: July 2018

Abstract

Background
In the emergency and urgent care setting, point-of-care (POC) human chorionic gonadotropin (hCG) testing is a clinical tool used to determine pregnancy status for risk assessment of potentially fetotoxic treatments and procedures in female patients of child-bearing age.

Methods
We reassayed a cohort of remnant blood samples (n = 283; hCG concentrations, &lt;1 mIU/mL to 10–157500 mIU/mL) previously analyzed using a reference laboratory hCG immunoassay (Roche Elecsys) with a novel Food and Drug Administration-cleared rapid hCG POC assay, the NOWDiagnostics' ADEXUSDx™, to assess performance of the rapid test.

Results
We obtained the following characteristics compared with the reference laboratory hCG values at &lt;1 mIU/mL and from 10 to 157500 mIU/mL: sensitivity, 97.6%; specificity, 99.1% (positive predictive value, 99.4%; negative predictive value, 96.6%).

Conclusions
The hCG point-of-care test assayed in this study accurately identified blood samples with hCG levels &gt;10 mIU/mL. Because of its rapid turnaround time and ease of use, further field testing in the clinical setting is warranted.
A Paradigm Shift: Considerations in Prenatal Cell-Free DNA Screening
Authors: Dines Jennifer N , Eckel Ashley M , Cheng Edith Y , Lockwood Christina M 
Published: July 2018

Abstract

Background
Testing to determine the health of a fetus has undergone multiple iterations since the widespread adoption of amniocentesis in the 1970s, including several combinations of ultrasound and/or maternal serum screening. The clinical paradigm for prenatal screening for fetal chromosome aneuploidies was transformed by the introduction of cell-free DNA (cfDNA) screening or noninvasive prenatal screening in 2011.

Content
The clinical performance of cfDNA screening is well-established for the most common autosomal and sex chromosome aneuploidies with a detection rate exceeding 90% for all aneuploidies. One of the most significant advantages of cfDNA screening relative to maternal serum screening is the markedly reduced false-positive rate, which is &lt;0.5%. The clinical implementation of cfDNA screening is discussed at length, including key biological, preanalytical, and analytical factors that affect test performance.

Summary
cfDNA prenatal screening for whole chromosome aneuploidies has become routine in high-risk obstetric populations. There is tremendous interest in expanding cfDNA screening to the general obstetric population. Early studies suggest that routine application of cfDNA screening is both feasible and effective, although significant economic and quality control considerations remain.
Biomarkers for Early Detection of Acute Kidney Injury
Authors: Rizvi Mahrukh S , Kashani Kianoush B 
Published: July 2018

AbstractBackgroundAcute kidney injury (AKI) is common in hospitalized patients and is associated with increased morbidity, mortality, and cost. Currently, AKI is diagnosed after symptoms manifest; available diagnostic tests (e.g., serum creatinine, urine microscopy, urine output) have limited ability to identify subclinical AKI. Because of the lack of treatment strategies, AKI typically is managed with supportive measures. However, strategies exist that may prevent renal insults in critically ill patients; therefore, early recognition of AKI is crucial for minimizing damage propagation.ContentExperimental and clinical studies have identified biomarkers that may facilitate earlier recognition of AKI or even identify patients at risk of AKI. Such biomarkers might aid in earlier implementation of preventive strategies to slow disease progression and potentially improve outcomes. This review describes some of the most promising novel biomarkers of AKI, including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin 18 (lL-18), liver-type fatty-acid-binding protein (L-FABP), insulin-like-growth-factor-binding protein 7 (IGFBP7), and tissue inhibitor of metalloproteinase 2 (TIMP-2).SummaryWe discuss biomarker test characteristics, their strengths and weaknesses, and future directions of their clinical implementation.
Oral Fluid Drug Testing in Pain Management Practice: Factors to Consider Before Choosing the Alternative Biological Matrix
Authors: Lee Dayong 
Published: July 2018

Abstract

Background
As the use of pharmacological agents, particularly opioid analgesics, has increased in the past 2 decades, so have the substance abuse risks, along with the prevalence of overdose deaths, addiction, and illicit drug use. Accordingly, close monitoring of patients to ensure medication compliance and to identify improper drug use becomes a critical task for pain-management practitioners.

Content
Oral fluid is an emerging biological matrix for clinical drug testing. It offers noninvasive, less hazardous, and directly observable sample collection with minimal potential for adulteration. Oral fluid can be collected multiple times in a short period and shows a stronger correlation with blood than urine concentrations. Usability of oral fluid testing had been limited by the sensitivity of analytical methods. The volume of oral fluid samples is typically much smaller than that of urine samples. Furthermore, oral fluid drug concentrations can be 10- to 100-fold lower than urine concentrations depending on analytes. Recent advances in analytical technologies lead to the growing popularity of oral fluid testing and subsequent need for scientific data to aid in interpretation of oral fluid test results.

Summary
This review presents preanalytical, analytical, and postanalytical considerations associated with oral fluid drug testing for those contemplating the implementation of this alternative biological matrix in pain-management practice. Comparison with urine testing, collection procedure, drug stability, available technologies, scope of analysis, and drug disposition are discussed. As with other monitoring tools, oral fluid testing has advantages and limitations. The most important consideration is staying informed to use the testing within its capability.
Antimüllerian Hormone Levels Are Not Altered by Glucose Challenge or a Meal
Authors: Lambert-Messerlian Geralyn M , Straseski Joely A , Eklund Elizabeth E , Palomaki Glenn E , Haddow James E 
Published: July 2018

Abstract

Background
Measurement of antimüllerian hormone (AMH) is used to assess ovarian reserve. Circulating levels of AMH correlate with antral follicle count, with relatively high levels indicating an ample reserve of primary and preantral follicles in the ovary. AMH levels are stable with dilution and freezer storage, and are not altered by hemolysis or menstrual cycle day in young women of reproductive age. We sought to examine whether glucose challenge or food intake modifies AMH levels compared with fasting.

Methods
Residual plasma samples were available from 54 pregnant women under fasting conditions and then 1, 2, and 3 h after ingestion of a 100-g glucose challenge. These samples were collected as part of routine clinical care to identify gestational diabetes (GDM) at 24–28 weeks of gestation. Twelve of these women met criteria for GDM based on an increased glucose level at a minimum of 2 time points. A second set consisted of serum samples collected from 8 nonpregnant women at fasting and 1 h after a meal. Levels of AMH were measured using an ultrasensitive assay (Ansh Labs, Webster, TX). A 2-way ANOVA (sample timing and GDM status) or matched t-test was performed. AMH measurements were subject to a logarithmic transformation before analysis.

Results
Median AMH levels in pregnant women at 1, 2, or 3 h after glucose challenge did not differ compared with AMH levels at fasting or by diagnosis of GDM. Similarly, there was no difference in median AMH levels in nonpregnant women of reproductive age at fasting and after a meal.

Conclusion
AMH levels are not altered by glucose or food intake.
Clinical Use and Monitoring of Antiepileptic Drugs
Authors: Knezevic Claire E , Marzinke Mark A 
Published: July 2018

Abstract

Background
Antiepileptic drugs (AEDs) have been used for the treatment of epilepsy and other neurological disorders since the late 19th century. There are currently several classes of AEDs available for epilepsy management, many of which are also used to treat migraines, bipolar disorder, schizophrenia, depression, and neuropathic pain. Because of their molecular and mechanistic diversity, as well as the potential for drug–drug interactions, AEDs are prescribed and monitored in a highly personalized manner.

Content
This review provides a general overview of the use of AEDs with a focus on the role of therapeutic drug monitoring. Discussed topics include mechanisms of action, guidelines on the clinical applications of AEDs, clinical tests available for AED monitoring, and genetic factors known to affect AED efficacy.

Summary
Implementation of AED therapies is highly individualized, with many patient-specific factors considered for drug and dosage selection. Both therapeutic efficacy and target blood concentrations must be established for each patient to achieve seizure mitigation or cessation. The use of an AED with any additional drug, including other AEDs, requires an evaluation of potential drug–drug interactions. Furthermore, AEDs are commonly used for nonepilepsy indications, often in off-label administration to treat neurological or psychiatric disorders.