22 research outputs found
Effect of different pre-analytical conditions on plasma lactate concentration
Introduction: Plasma lactate is a frequently used and important parameter for medical decision making. To setup a pre-analytical algorithm, we
aimed to investigate the influence of different test tube additives, aliquoting, ice storage and haemolysis on plasma lactate concentrations for possible
sparing critically ill (ICU) patients of additional blood drawing.
Materials and methods: In our study (N = 177), lactate concentration and haemolysis index (HI) were measured in aliquoted (AHP) and unaliquoted
(HP) Li-heparin, NaF/K3EDTA and NaF/KOX plasma, centrifuged within 15 minutes after venipuncture, on Cobas c501 analyzer. Differences
were tested using the Wilcoxon’s test and Passing-Bablok regression. Clinical accuracy of results was assessed in 107 ICU patients based on reference
interval and clinical decision limits.
Results: Lactate concentrations did not differ in NaF/K3EDTA and NaF/KOX plasma (P = 0.855). No clinically significant difference of AHP compared
to NaF/K3EDTA lactate was found (y = 0.13 (0.08 to 0.19) + 1.02 (0.99 to 1.08) x) if samples were aliquoted within 30 minutes after venipuncture. On
contrary, lactate concentrations in HP showed significant proportional difference (y = 0.07 (- 0.12 to 1.24) + 1.37 (1.22 to 1.56) x) and were clinically
incorrect in 14% of patients. Transport in ice bath increases HI in NaF/K3EDTA (P < 0.001), but without influencing lactate results compared to room
temperature (y = 0.03 (- 0.06 to 1.00) + 1.05 (0.99 to 1.11) x).
Conclusions: Lactate determination in HP is unacceptable because of high proportional error and high risk of clinical inaccuracy compared to NaF/
K3EDTA. If pre-analytical conditions are met, AHP, NaF/K3EDTA and NaF/KOX plasma can be used interchangeably. Aliquoted Li-heparin samples alow
measurement of other biochemical tests from a single tube and can spare ICU patients from additional blood drawing. Storage in ice bath provides
no additional stabilization in NaF/K3EDTA tubes
Urinary brain-derived neurotrophic factor and nerve growth factor as noninvasive biomarkers of overactive bladder in children
IntroductionOveractive bladder (OAB) is the most common urinary disorder and the leading cause of functional daytime intermittent urinary incontinence in children. The aim of this study was to determine whether urinary brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) concentrations, normalized to urine creatinine, could be used as biomarkers for diagnosis and treatment monitoring of OAB in children.
Materials and methodsUrine samples of 48 pediatric patients with OAB were collected at the start of anticholinergic therapy (baseline), at follow-up visits (3 and 6 months), and from 48 healthy controls. Urinary BDNF and NGF concentrations were determined by ELISA method (Merck, Darmstadt, Germany) and Luminex method (Thermo Fisher Scientific, Waltham, USA). Differences of frequency between quantifiable analyte concentrations between subject groups were determined using Fisher’s exact test.
ResultsThere was no statistically significant difference between quantifiable analyte concentrations between patients at baseline and the control group for BDNF and NGF by either the ELISA or Luminex method (P = 1.000, P = 0.170, P = 1.000, and P = N/A, respectively). There was a statistically significant difference between quantifiable BDNF by the ELISA method between patients at baseline and complete success follow-up (P = 0.027), while BDNF by Luminex method and NGF by both methods were not statistically significant (P = 0.078, P = 0.519, and P = N/A, respectively).
ConclusionsThis study did not demonstrate that urinary BDNF and NGF concentrations, can be used as biomarkers for diagnosis and therapy monitoring of OAB in children
YKL-40 as a biomarker in various inflammatory diseases: A review
Highlights
YKL-40 is a biomarker for inflammatory diseases’ diagnosis and prediction
YKL-40 concentration increases with age and has variations in healthy population
YKL-40 is convincing in pancreatic/liver disease, arthritis, bronchitis, and sepsis
YKL-40 is debatable in cardiovascular/neurological/renal disease, diabetes, asthma
Future larger studies and age-stratified reference intervals of YKL-40 are needed
YKL-40 or Chitinase-3-Like Protein 1 (CHI3L1) is a highly conserved glycoprotein that binds heparin and chitin in a non-enzymatic manner. It is a member of the chitinase protein family 18, subfamily A, and unlike true chitinases, YKL-40 is a chitinase-like protein without enzymatic activity for chitin. Although its accurate function is yet unknown, the pattern of its expression in the normal and disease states suggests its possible engagement in apoptosis, inflammation and remodeling or degradation of the extracellular matrix. During an inflammatory response, YKL-40 is involved in a complicated interaction between host and bacteria, both promoting and attenuating immune response and potentially being served as an autoantigen in a vicious circle of autoimmunity. Based on its pathophysiology and mechanism of action, the aim of this review was to summarize research on the growing role of YKL-40 as a persuasive biomarker for inflammatory diseases’ early diagnosis, prediction and follow-up (e.g., cardiovascular, gastrointestinal, endocrinological, immunological, musculoskeletal, neurological, respiratory, urinary, infectious) with detailed structural and functional background of YKL-40
Daisy-like crystals: Not just the result of sampling artifact and not only in urine.
peer reviewe
The EC4 European Syllabus for Post-Graduate Training in Clinical Chemistry and Laboratory Medicine: version 4 - 2012
The EC4 European syllabus for post-graduate training in clinical chemistry and laboratory medicine : Version 4-2012
Laboratory medicine’s practitioners across the European
community include medical, scientific and pharmacy trained
specialists whose contributions to health and healthcare is
in the application of diagnostic tests for screening and early
detection of disease, differential diagnosis, monitoring,
management and treatment of patients, and their prognostic
assessment. In submitting a revised common syllabus for
post-graduate education and training across the 27 member
states an expectation is set for harmonised, high quality,
safe practice. In this regard an extended ‘Core knowledge,
skills and competencies’ division embracing all laboratory
medicine disciplines is described. For the first time the syllabus
identifies the competencies required to meet clinical
leadership demands for defining, directing and assuring
the efficiency and effectiveness of laboratory services as
well as expectations in translating knowledge and skills
into ability to practice. In a ‘Specialist knowledge’ division,
the expectations from the individual disciplines of Clinical
Chemistry/Immunology, Haematology/Blood Transfusion,
Microbiology/ Virology, Genetics and In Vitro Fertilisation
are described. Beyond providing a common platform of
knowledge, skills and competency, the syllabus supports the
aims of the European Commission in providing safeguards
to increasing professional mobility across European borders
at a time when demand for highly qualified professionals is
increasing and the labour force is declining. It continues to
act as a guide for the formulation of national programmes
supplemented by the needs of individual country priorities.peer-reviewe
Systemically available bone morphogenetic protein two and seven affect bone metabolism
M1113 Pancreatic Insufficiency in Inflammatory Bowel Disease; Assesment By Fecal Elastase-1
Is D-dimer used according to clinical algorithms in the diagnostic work-up of patients with suspicion of venous thromboembolism? A study in six European countries
WOS: 000376769400001PubMed ID: 27085136Introduction: Clinical algorithms consisting of pre-test probability estimation and D-dimer testing are recommended in diagnostic work-up for suspected venous thromboembolism (VTE). The aim of this study was to explore how physicians working in emergency departments investigated patients suspected to have VTE. Materials and methods: A questionnaire with two case histories related to the diagnosis of suspected pulmonary embolism (PE) (Case A) and deep venous thrombosis (DVT) (Case B) were sent to physicians in six European countries. The physicians were asked to estimate pre-test probability of VTE, and indicate their clinical actions. Results: In total, 487 physicians were included. Sixty percent assessed pre-test probability of PE to be high in Case A, but 7% would still request only D-dimer and 11% would exclude PE if D-dimer was negative, which could be hazardous. Besides imaging, a D-dimer test was requested by 41%, which is a "waste of resources" (extra costs and efforts, no clinical benefit). For Case B, 92% assessed pre-test probability of DVT to be low. Correctly, only D-dimer was requested by 66% of the physicians, while 26% requested imaging, alone or in addition to D-dimer, which is a "waste of resources". Conclusions: These results should encourage scientific societies to improve the dissemination and knowledge of the current recommendations for the diagnosis of VTE. (C) 2016 Elsevier Ltd. All rights reserved.Western Norway Regional Health AuthorityWe would like to thank all the national societies who kindly offered to recruit their member physicians to this study (Norwegian Society of Internal Medicine, Turkish Society of Internal Medicine, Hungarian Society of Emergency Medicine, Croatian Society of Cardiology, Italian Academy of Emergency Medicine Care, all the participating physicians and in addition Thomas H Roraas for statistical support and Silvia Cattaneo (EFLM) for SurveyMonkey support. We also wish to thank Andreas Hillarp and Josep Miquel Bauca for their useful comments on the manuscript and Prof. Philippe DeMoerloose for reviewing the feedback report sent to the responding physicians. AH Kristoffersen has received scholarship from the Western Norway Regional Health Authority
Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments
Letter to the Editors-in-ChiefIntroduction: In patients with suspected venous thromboembolism (VTE), it is recommended to estimate the pre-test probability of VTE, either by experience or by standardized scoring schemes (e.g. Wells or Geneva score), before performing a D-dimer test. Patients with a low probability or unlikely VTE should have D-dimer performed, and if negative, VTE can be excluded, without further investigations, while if positive, the patient should be referred to radiologic imaging to confirm or exclude VTE. Patients with a high pre-test probability or likely VTE should be referred directly to radiologic imaging without D-dimer testing. Thus, to estimate the pre-test probability of VTE before D-dimer testing is of uttermost importance since the
diagnostic algorithm and the interpretation of the D-dimer result is dependent upon this.
Further, the diagnostic accuracy of D-dimer can be expressed by the likelihood ratio (LR). LR is the ratio between the probability of a test result given that VTE is present, and probability of the same test result if VTE is absent. A LR of 1 increases the probability of disease. When clinicians estimate the pre-test probability for VTE, the post-test probability (after D-dimer testing) can be calculated using the LR for D-dimer either for a positive or negative test (i.e. D-dimer above or below the cut-off level, respectively). Probably, most clinicians do not know the LR for D-dimer, but it is indirectly implemented in the above mentioned algorithm for investigating a patient with
suspected VTE. The advice to rule out VTE in a patient if the pre-test probability of VTE is low and the D-dimer is below the cut-off level reflects that the post-test probability of VTE in this case is sufficiently low to rule out VTE (should be< 1-2%). However, if the pre-test probability of VTE is high or likely, a negative D-dimer cannot decrease the post-test probability enough to rule out VTE (the post-test probability will still be about
10%) [4,5]. Therefore, only imaging should be requested when pre-test probability of VTE is high. A positive D-dimer cannot increase post-test
probability of VTE enough to confirm VTE diagnosis in any case, since D-dimer is a non-specific VTE marker and levels can be increased in several
other clinical situations (e.g. infection, inflammation, cancer and pregnancy).
The aims of this survey were 1) to study the relationship between pre-test probabilities estimated by clinicians using two case histories and how
the same clinicians' categorized the patients into low, moderate or high probability of VTE or into unlikely or likely VTE, and 2) to examine the
clinicians' perception of diagnostic accuracy of D-dimer by calculating the LRs based upon their estimated pre- and post-test probabilities.info:eu-repo/semantics/publishedVersio