Showing papers in "Scandinavian Journal of Clinical & Laboratory Investigation in 2007"
TL;DR: Two important issues are focused on, namely the biological and the clinical aspects of thalassaemia, which are now occurring with relatively high frequency in many non‐endemic areas.
Abstract: The thalassaemia syndromes, endemic in the Mediterranean area, the Middle East, the Indian subcontinent, the Far East and in tropical Africa, are the most common hereditary disorders in humans, and millions of people are affected by diseases. Due to a widespread population flow between continents in recent past centuries, the thalassaemias are now occurring with relatively high frequency in many non-endemic areas. In the Nordic countries, homozygous thalassaemia is still relatively rare, and most health-care personnel are not familiar with these diseases. This article focuses on two important issues, namely the biological and the clinical aspects of thalassaemia.
386 citations
TL;DR: There is a strong case for pan‐European collaboration on haemoglobin disorders to share policies, standards and the instruments required to support them, including methods for needs assessment, service standards, education and information strategies and materials, and methods for evaluating service delivery.
Abstract: Objective. As a result of global population movements, haemoglobin disorders (thalassaemias and sickle cell disorders) are increasingly common in the formerly non-indigenous countries of Northern and Western Europe and in the indigenous countries of Southern Europe. This article presents an overview of the changing picture and a method for assessing service needs. Method. Data on country of birth or ethnic origin of residents are adjusted to obtain the estimated proportions of residents and births in non-indigenous groups at risk for haemoglobin disorders in European countries. The results are combined with prevalence data in each country of origin to obtain country prevalence estimates. Service indicators (annual tests or other interventions required to ensure equitable delivery of treatment and prevention) are then derived by country. Results. Haemoglobin disorders now occur at comparable frequency throughout Northern, Western and Southern Europe. Annually, there are more affected conceptions in Northern and Western than in Southern Europe, and sickle cell disorders are more common than thalassaemias. There is growing need for health policy-makers to support motivated professionals working to develop optimal patient care, carrier diagnosis, genetic counselling and access to prenatal diagnosis throughout the Region. Conclusion. There is a strong case for pan-European collaboration on haemoglobin disorders to share policies, standards and the instruments required to support them. These include methods for needs assessment, service standards, education and information strategies and materials, and methods for evaluating service delivery.
147 citations
TL;DR: There was low inter‐laboratory variation between the three laboratories involved in the cystatin C evaluation, and thus all three laboratories can use the same equation for calculating the estimated GFR.
Abstract: OBJECTIVE: Estimation of the glomerular filtration rate (GFR) is essential when evaluating patients with kidney disease and treating patients with drugs eliminated from the circulation by the kidneys. Cystatin C has been shown in several studies to be superior to creatinine in the estimation of GFR. At our hospitals, there is an increasing demand for cystatin C and at present we perform approximately 1500 cystatin C analyses a month. We thus need the assay available 24 h/day and to have it on our routine chemistry instrument to minimize handling time per test and time to reported test results. MATERIAL AND METHODS: We have evaluated a new cystatin C immunoassay from Gentian (Gentian, Moss, Norway) on Architect ci8200 (Abbott Laboratories, Abbott Park, Ill., USA). A prerequisite at our hospital is that cystatin C results are reported as a calculated GFR in mL/min/1.73 m(2), so we also made a comparison with iohexol clearance. RESULTS: The Gentian cystatin C assay showed good agreement with the corresponding assay from Dade Behring (Deerfield, Ill., USA) and good inter-laboratory concordance. The assay has very low total imprecision, good linearity and strong correlation with iohexol clearance (R (2) = 0.956). The equation for the correlation curve is: y = 79.901x(-1.4389). CONCLUSIONS: There was low inter-laboratory variation between the three laboratories involved in the cystatin C evaluation, and thus all three laboratories can use the same equation for calculating the estimated GFR.
93 citations
TL;DR: Since there is a correlation between the plasma level of timolol and several haemodynamic effects – especially HR in the state of elevated β‐adrenergic tonus – the CYP2D6 poor metabolizers may be more prone to bradycardia during treatment with (aqueous) ophthalmic Timolol.
Abstract: Timolol maleate is a non-selective beta-adrenoceptor antagonist currently used mainly as an ocular preparation for the treatment of glaucoma and ocular hypertension. Despite the topical administration, ophthalmic timolol causes systemic adrenergic beta-blocking because of absorption from the eye into the systemic circulation. Gel formulations of ophthalmic timolol have been developed to reduce systemic absorption and adverse effects in comparison with conventional aqueous solution formulations. Timolol is metabolized by the polymorphic cytochrome P450 2D6 enzyme (CYP2D6). The changes in heart rate (HR) are the most striking effects of the systematically absorbed fraction of ophthalmic timolol, with 0.5 % aqueous formulations presenting larger effects than 0.1 % hydrogel formulations, especially during exercise. Plasma levels of ophthalmic timolol correlate with the changes in HR. Neither 0.5 % aqueous nor 0.1 % hydrogel formulations of timolol have exerted noteworthy effects on systolic (SAP) or diastolic (DAP) arterial pressures, probably because of a compensatory increase in systemic vascular resistance due to the attenuation of HR. Ophthalmic timolol does not exert remarkable effects on pulmonary parameter peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1) in non-asthmatic patients. CYP2D6 activity is clearly associated with the pharmacokinetic parameters, particularly when 0.5 % aqueous solution of timolol is used: peak plasma concentration, elimination half-life and area-under-the-curve are highest in CYP2D6 poor metabolizers. Finally, since there is a correlation between the plasma level of timolol and several haemodynamic effects - especially HR in the state of elevated beta-adrenergic tonus - the CYP2D6 poor metabolizers may be more prone to bradycardia during treatment with (aqueous) ophthalmic timolol.
84 citations
TL;DR: The newly developed Lund–Malmö equations for GFR estimation performed better than the MDRDIDMS and Mayo Clinic equations in a Swedish Caucasian sample and inclusion of an LBM term improved performance markedly in certain subgroups.
Abstract: Objective. To evaluate newly developed equations predicting relative glomerular filtration rate (GFR) in adult Swedish Caucasians and to compare with the Modification of Diet in Renal Disease (MDRD) and Mayo Clinic equations using enzymatic and zero‐calibrated plasma creatinine assays. Material and methods. GFR was measured with iohexol clearance adjusted to 1.73 m2. One population sample (n = 436/Lund) was used to derive an equation based on plasma‐creatinine/age/gender, and a second with the addition of lean body mass (LBM). Both equations were validated in a separate sample (n = 414/Malmo). The coefficients of the equations were eventually fine‐tuned using all 850 patients and yielding Lund–Malmo equations without (LM) and with LBM‐term (LMLBM). Their performance was compared with the MDRDCC (conventional creatinine calibration), MDRDIDMS (isotope dilution mass spectroscopy traceable calibration) and Mayo Clinic equations. Results. The Lund equations performed similarly in both samples. In the combined...
83 citations
TL;DR: For clinical problems requiring the analysis of only one or a few elements, the use of FAAS may be sufficient, unless the higher sensitivity of GFAAS is required, whereas for screening of multiple elements the ICP techniques are preferable.
Abstract: Commonly used techniques for trace-element analysis in human biological material are flame atomic absorption spectrometry (FAAS), graphite furnace atomic absorption spectrometry (GFAAS), inductively coupled plasma atomic emission spectrometry (ICP-AES) and inductively coupled plasma mass spectrometry (ICP-MS). Elements that form volatile hydrides, first of all mercury, are analysed by hydride generation techniques. In the absorption techniques the samples are vaporized into free, neutral atoms and illuminated by a light source that emits the atomic spectrum of the element under analysis. The absorbance gives a quantitative measure of the concentration of the element. ICP-AES and ICP-MS are multi-element techniques. In ICP-AES the atoms of the sample are excited by, for example, argon plasma at very high temperatures. The emitted light is directed to a detector, and the optical signals are processed to values for the concentrations of the elements. In ICP-MS a mass spectrometer separates and detects ions produced by the ICP, according to their mass-to-charge ratio. Dilution of biological fluids is commonly needed to reduce the effect of the matrix. Digestion using acids and microwave energy in closed vessels at elevated pressure is often used. Matrix and spectral interferences may cause problems. Precautions should be taken against trace-element contamination during collection, storage and processing of samples. For clinical problems requiring the analysis of only one or a few elements, the use of FAAS may be sufficient, unless the higher sensitivity of GFAAS is required. For screening of multiple elements, however, the ICP techniques are preferable.
83 citations
TL;DR: Observations suggest that cystatin C might be a regulating element in the transformation of monomeric Aβ to larger and perhaps more toxic molecular species in vivo.
Abstract: There are an increasing number of genetic and neuropathological observations to suggest that cystatin C, an extracellular protein produced by all nucleated cells, might play a role in the pathophysiology of sporadic Alzheimer's disease (AD). Recent observations indicate that small and large soluble oligomers of the beta-amyloid protein (Abeta) impair synaptic plasticity and induce neurotoxicity in AD. The objective of the present study was to investigate the influence of cystatin C on the production of such oligomers in vitro. Co-incubation of cystatin C with monomeric Abeta1-42 significantly attenuated the in vitro formation of Abeta oligomers and protofibrils, as determined using electron microscopy (EM), dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting, thioflavin T (ThT) spectrofluorimetry and gel chromatography. However, cystatin C did not dissolve preformed Abeta oligomers. Direct binding of cystatin C to Abeta was demonstrated with the formation of an initial 1:1 molar high-affinity complex. These observations suggest that cystatin C might be a regulating element in the transformation of monomeric Abeta to larger and perhaps more toxic molecular species in vivo.
81 citations
TL;DR: Resistin showed significant BMI‐dependent associations with insulin resistance and factors linked with obesity and inflammation in patients with type 2 diabetes and may represent a link between obesity and insulin resistance via pro‐inflammatory pathways.
Abstract: Objective. Resistin has been linked to obesity, type 2 diabetes, inflammation and atherosclerosis but the results of animal and human studies have been at variance. The purpose of this study was to investigate the potential roles of resistin in patients with type 2 diabetes and to evaluate the correlation between resistin and markers of obesity, inflammation, insulin resistance, metabolic parameters, diabetes control and complications. Material and methods. Fasting resistin, leptin, insulin, glucose, HbA1c, full lipid profile, C‐reactive protein (CRP) (high sensitivity assay) and complete blood count were determined in 135 patients with type 2 diabetes. Univariate regression and multivariate logistic regression analyses were used to relate resistin with indices of obesity, inflammation, insulin resistance (homeostasis model, HOMA), insulin sensitivity, diabetic control, coronary heart disease (CHD) and degree of microalbuminuria. Results. Resistin showed significant (p<0.05) correlations with body mass in...
79 citations
TL;DR: Measurements of fecal MPO, EPX and IL‐1β could be objective complements to endoscopical and histopathological evaluations in the daily care of patients with UC.
Abstract: Objective. A prominent feature of inflammatory bowel disease (IBD) is the presence of inflammatory cells in the gut mucosa, and which contribute to the ongoing inflammatory process. The aim of the study was to evaluate fecal neutrophil, eosinophil, mast cell and macrophage markers in the assessment of disease activity in patients with ulcerative colitis (UC). Methods. Twenty‐eight patients with active UC; 4 with proctitis, 16 with left‐side colitis and 8 with total colitis, were included in the study. Patient history, endoscopy and histopathology were examined and fecal and serum samples were evaluated at inclusion and after 4 and 8 weeks of treatment. Fecal samples were analysed for myeloperoxidase (MPO), eosinophil protein X (EPX), mast cell tryptase, IL‐1β and TNF‐α using immunoassays. Blood samples were analysed for MPO, EPX, C‐reactive protein, orosomucoid and leucocyte counts. Results. Fecal MPO and IL‐1β levels were elevated in all patients at inclusion despite different disease extensions. Strikin...
70 citations
TL;DR: The results indicate an increased filTration of low‐molecular weight molecules during pregnancy, particularly during the first and second trimesters, whereas filtration of 10–30 kDa molecules is decreased in the third but unaltered in the first or second trimeters.
Abstract: Objective. To determine the plasma levels of the renal functional markers creatinine, urate, cystatin C, β2‐microglobulin and β‐trace protein in samples from the first, second, early third and late third trimesters of 398 healthy women with uncomplicated singleton pregnancies. Material and methods. Plasma samples from 58 healthy non‐pregnant women served as controls. The creatinine levels were significantly lower at all time‐points in pregnancy, whereas the urate levels were lower during the first and second trimesters but increased in the late third trimester. The cystatin C, β2‐microglobulin and β‐trace protein levels displayed similar changes with increased levels in the third trimester but unaltered levels during the first and second trimesters. Results. The results indicate an increased filtration of low‐molecular weight molecules during pregnancy, particularly during the first and second trimesters, whereas filtration of 10–30 kDa molecules is decreased in the third but unaltered in the first and se...
68 citations
TL;DR: The circulating protein adiponectin has been the subject of immense interest ever since it was first discovered in the mid‐1990s and is believed to have important anti‐inflammatory and anti‐diabetic effects.
Abstract: The circulating protein adiponectin has been the subject of immense interest ever since it was first discovered in the mid‐1990s The protein is uniquely produced and secreted by mature adipocytes and is believed to have important anti‐inflammatory and anti‐diabetic effects; low levels have been shown to be predictive of future type 2 diabetes and cardiovascular disease This review discusses adiponectin in relation to obesity, inflammation, insulin resistance and atherosclerosis
TL;DR: Although haemoglobinopathy mutations are rarely found in individuals of North European origin, the number of immigrants in the North European countries is steadily increasing and the variety of their ethnic origins poses a problem for screening and accurate diagnosis.
Abstract: The haemoglobin disorders are a group of autosomal recessive disorders characterized by either the reduced synthesis of one or more normal globin chains (the thalassaemias), the synthesis of a structurally abnormal globin chain (the haemoglobin variants) or in a few cases by both phenotypes (the reduced synthesis of a Hb variant, e.g. Hb E). They are the commonest single-gene disorders known and approximately 1000 different mutant alleles have now been characterized at the molecular level. The mutations are regionally specific, with each country having its own unique spectrum of abnormal haemoglobins and thalassaemia mutations, and can occur at high gene frequencies in some ethnic groups [1]. Although haemoglobinopathy mutations are rarely found in individuals of North European origin, the number of immigrants in the North European countries is steadily increasing and the variety of their ethnic origins poses a problem for screening and accurate diagnosis.
TL;DR: The data confirm that rifampicin increases PGP activity, by increasing MDR1 mRNA and Pgp levels, and found that the wild‐type allele of the synonymous polymorphism of MDR 1 position 3435 confers a higher Pgp activity.
Abstract: Objective P‐glycoprotein (Pgp) plays a part in the intestinal uptake of xenobiotics and has been associated with susceptibility to ulcerative colitis The aim of this study was to examine Pgp activity in relation to age, gender, medical treatment (rifampicin or ketoconazole) and the multidrug resistance (MDR1) gene single nucleotide polymorphisms (SNPs) G2677T and C3435T using the model drug digoxin Material and methods Pgp activity was estimated from the pharmacokinetics of orally administered digoxin in blood samples from 32 healthy subjects MDR1 gene expression in duodenal biopsies was monitored by real‐time quantitative RT‐PCR (RQ‐PCR) and Western blot analyses MDR1 SNPs were determined by PCR‐restriction fragment length polymorphism (PCR‐RFLP) The effect of medical treatment was tested by open, randomized, cross‐over treatment with rifampicin and ketoconazole Results Rifampicin treatment resulted in increased Pgp activity, duodenal MDR1 mRNA expression and Pgp detection compared with that in
TL;DR: A narrow concentration range and the ease of measuring the quantitative ELISA support future investigations of plasma α‐synuclein in relation to neurodegenerative diseases.
Abstract: The nerve cell protein alpha-synuclein is important in Parkinson's disease and dementia with Lewy bodies, and its expression levels are directly linked to development of the diseases. Quantification of the plasma level of alpha-synuclein may therefore be important as a biomarker for disease susceptibility. We present a quantitative measurement of alpha-synuclein in the plasma of healthy control subjects in relation to their age using a novel enzyme-linked immunosorbent assay (ELISA). The plasma concentration among the 44 blood donors displayed a median of 5.6 microg/L (range 2.1-19.4 microg/L) with a narrow distribution (25 % and 75 % percentiles, 4.0 and 7.2 microg/L) and there was no correlation with age and gender. This narrow concentration range and the ease of measuring the quantitative ELISA support future investigations of plasma alpha-synuclein in relation to neurodegenerative diseases.
TL;DR: A laparoscopic approach appears to cause less surgical trauma and immunosuppression than open surgery in patients with acute cholecystitis.
Abstract: Objective. Laparoscopic surgery is thought to reduce the postoperative immunologic effects of surgical trauma. The aim of this study is to evaluate the influence of surgical trauma on systemic inflammation and the immune response in acute cholecystitis. Material and methods. Thirty‐three patients with acute calculous cholecystitis were assigned to laparoscopic cholecystectomy (LC, n = 18) or open cholecystectomy (OC, n = 15). Blood samples were obtained preoperatively and on postoperative day 1 (24 h after surgery) and day 3 (72 h after surgery), and blood concentration of C‐reactive protein (CRP), leukocyte subpopulations, as well as levels of tumor necrosis factor‐α (TNF‐α) ex vivo secretion by peripheral blood mononuclear cells (PBMCs) were measured in both groups. Results. Hospitalization was significantly shorter in the LC group than in the OC group (LC group: 3.7±1.2 days versus OC group: 6.3±2.7 days, p = 0.010). There was no postoperative morbidity in the LC group, but two patients in the OC group...
TL;DR: Smoking cessation induced a reduction in ICAM‐1, suggesting a novel mechanism for the rapid reduction in the risk of CVD following smoking cessation.
Abstract: Objective. To prospectively determine the effect of smoking cessation on markers of inflammation and endothelial cell activation. Material and methods: Thirty male and 22 female smokers of >7 cigarettes daily, aged 32–64 years with cardiovascular disease (CVD) or additional risk factors to smoking, participated in a program of smoking cessation with a follow‐up period of 1 year. Cessation was validated by carbon monoxide measurement in expired breath, and 41 of the patients completed the study (17 quitters and 24 non‐quitters). Plasma samples were drawn at baseline and after 1 year, and inflammatory markers were analyzed by enzyme immunoassays. Peripheral blood mononuclear cells (PBMCs) were isolated at baseline and 1 year in 6 quitters and 6 smokers and mRNA levels of interleukin‐8 (IL‐8), tumor necrosis factor α (TNFα) and intercellular adhesion molecule 1 (ICAM‐1) were analyzed by real‐time quantitative RT‐PCR. Results. Our main findings were: (i) While the concentration of soluble (s) ICAM‐1 decreased...
TL;DR: Estimation of glomerular filtration rate (eGFR) is essential in the diagnosis and monitoring of patients with kidney disease and for correct dosage of drugs eliminated from the circulation by the kidneys.
Abstract: Objective. Estimation of glomerular filtration rate (eGFR) is essential in the diagnosis and monitoring of patients with kidney disease and for correct dosage of drugs eliminated from the circulation by the kidneys. Cystatin C has been shown in several studies to be superior to creatinine in estimating eGFR. However, there are few studies on the performance of cystatin C estimated eGFR (eGFRCystC) in patients with advanced kidney disease and low GFR. Material and methods. We measured serum cystatin C, together with serum creatinine, during iohexol clearance in patients with iohexol clearance below 30 mL/min/1.73 m2. The cystatin C values were used to calculate eGFRCystC using the formula eGFR (mL/min/1.73m2) = 79.901*(cystatin C value in mg/L)−1.4389. Results. There was good correlation between eGFRCystC and iohexol clearance (r = 0.88) in patients with iohexol clearance <30 mL/min/1.73 m2 and none of the patients had a difference between eGFRCystC and iohexol clearance exceeding 50 %. The Modification of...
TL;DR: Age affects p‐ADMA in healthy women, but not in men, and high performance liquid chromatography with fluorescence detection established health‐associated reference values for p‐adMA, p‐arginine, p-SDMA and the p‐ arginine/p‐ ADMA and p‐Arginine / p‐SDMA ratios.
Abstract: Objective. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide production. It has been implicated in various pathological processes, especially processes involving the cardiovascular system. Plasma concentration of ADMA (p‐ADMA) has been measured in several studies with different techniques, and a wide range of normal values has been published. With use of high performance liquid chromatography (HPLC) with fluorescence detection, we have established health‐associated reference values for p‐ADMA, p‐arginine, p‐SDMA and the p‐arginine/p‐ADMA and p‐arginine/p‐SDMA ratios. Material and methods. Blood samples were taken from 238 blood donors (112 F and 126 M). HPLC was used to analyse arginine, ADMA and SDMA. Reference values are presented as 2.5 and 97.5 percentiles estimated by the bootstrap method. Results. The reference interval for p‐ADMA is 0.40–0.77 µmol/L for the whole population, 0.41–0.79 µmol/L for men, 0.38–0.73 µmol/L for women 45 years or less, and 0.41–0.84 µmol/L for w...
TL;DR: It is hypothesize that serum ionized levels of calcium (Ca2+) and magnesium (Mg2+) would be altered significantly during certain types of seizures, and was able to show significantly lower Mg2+ and higher ionized Ca2+/Mg 2+ ratios in seizure patients compared with a racially matched control group.
Abstract: Objective. Prior studies have been equivocal about whether or not serum levels of the divalent ions calcium and magnesium are altered during different types of seizures. Magnesium is a potential mo...
TL;DR: Routine use of ADA activity measurement in pleural fluid can obviate the need for a pleural biopsy in the initial diagnostic approach to pleural effusions, while IgA‐ELISA and PCR techniques, potentially more specific tests, need further refinement to improve their accuracy.
Abstract: The diagnosis of pleural tuberculosis (pTB) is difficult, and more sensitive and specific techniques are needed. In the period August 1998 to November 2002, we evaluated 132 patients with a pleural effusion submitted to a thoracentesis and pleural biopsy in a tertiary care hospital in Rio de Janeiro, Brazil. Three tests were performed and compared in the pleural fluid: ADA activity measurement, IgA-ELISA for two combined specific Mycobacterium tuberculosis antigens, and polymerase chain reaction (PCR) for detection of M. tuberculosis DNA. Ninety-five patients (72%) were given a final diagnosis of pTB. Overall histopathologic sensitivity was 77%. The sensitivities of pleural fluid culture and AFB smear were 42% and 1%, respectively. Twenty-one (22%) additional patients had a clinical diagnosis of pTB. Median follow-up time of all TB patients after the completion of antituberculous treatment was 13 months. Sensitivities of ADA, IgA-ELISA and PCR were 91%, 78% and 82%, while specificities were 93%, 96% and 85%, respectively. Only ADA sensitivity was significantly higher than the histopathologic examination (McNemar chi2 test; p = 0.002) and also significantly higher than ELISA (p = 0.049), but not higher than PCR (p = 0.143). We conclude that the routine use of ADA activity measurement in pleural fluid can obviate the need for a pleural biopsy in the initial diagnostic approach to pleural effusions, while IgA-ELISA and PCR techniques, potentially more specific tests, need further refinement to improve their accuracy.
TL;DR: The increase in the serum levels of CA19‐9, CA125 (in males), CYFRA 21‐1, NSE and SCC‐Ag in patients with CKD affects the specificity of these markers in the diagnosis of cancer.
Abstract: Objective. Tumour markers are widely used for monitoring cancer patients and for screening certain tumours. It has recently been shown that the concentrations of some tumour markers are higher in patients with chronic kidney disease (CKD) than in healthy subjects. We analysed the influence of renal function and hemodialysis treatment on the serum levels of CA19‐9, CA125, alpha fetoprotein (AFP), CA15.3, CA72.4, CYFRA 21‐1, neuron‐specific enolase (NSE) and squamous cell carcinoma antigen (SCC‐Ag). Material and methods. 232 non‐dialysis patients with CKD and 37 uraemic patients treated with maintenance hemodialysis were enrolled in this study. The non‐dialysis patients were divided into three groups depending on their creatinine clearance (Ccr) levels: group 1 = Ccr ⩽25 mL/min; group 2 = 25.1–49.9 mL/min; group 3 = Ccr ⩾50 mL/min. For comparison, we chose 37 non‐dialysis patients with similar Ccr, age and same gender as controls. Results. The serum concentrations of CA19‐9, CA125 (male), CYFRA 21‐1, NSE an...
TL;DR: A significant decrease in serum hCG level was found 2–3 weeks before the spontaneous start of labour, which might contribute to increasing the contractility in the uterine muscle and gradually initiate the onset of labour.
Abstract: Objective. Separate reference values were recently established for routine blood samples during last trimester pregnancy. Previously, these were based on blood samples from healthy men or non‐pregnant women. Normal changes in variation in the levels of steroid hormones in the last weeks of pregnancy before delivery are also incompletely investigated. This study of the preterm hormone levels was carried out in the search for events leading to increased contractility that might occur in the predelivery weeks and potentially influence the initiation of delivery. Material and methods. Blood samples during pregnancy weeks 33, 36 and 39 as well as 1–3 h postpartum were collected from pregnant women (19–39 years, mean age 30) with at least one previous pregnancy without hypertension or pre‐eclampsia. All women (n = 135) had had a vaginal delivery and spontaneous start of labour. The blood samples were analysed for serum hCG, oestradiol and progesterone. Postpartum, the values were retrospectively rearranged to c...
TL;DR: Ghrelin was positively associated with hypertension in obese women and this association was inversely influenced by the increase of BMI.
Abstract: Objective. The orexigenic hormone ghrelin induces weight gain by stimulating food intake. Ghrelin has been shown to modulate sympathetic activity, to exert vasodilative effects and to counterreact with leptin on both food intake and blood pressure. Of these two hormones, ghrelin levels are decreased in obesity, whereas leptin levels are increased. In this cross‐sectional study, differences in serum ghrelin and leptin levels were examined in normotensive and hypertensive obese women. Material and methods. Sixty‐one normotensive and hypertensive women were classified according to the body mass indices as follows: (a) 18 healthy subjects with BMI 21.5–27.5 kg/m2; (b) 22 normotensive subjects with BMI 30–47 kg/m2; (c) 21 hypertensive obese subjects (BMI 30–48 kg/m2) with systolic blood pressure ⩾140 mmHg or diastolic blood pressure ⩾90 mmHg. Anthropometric measurements including height, weight, BMI, waist and hip circumferences and blood pressure were recorded. The levels of ghrelin and leptin were determined...
TL;DR: In this article, the reference intervals, variability caused by sampling time, biological variation and stability after repeated freeze-thaw cycles of circulating levels of OPN, OPG, total sRANKL and hsCRP were determined.
Abstract: Objective. Monitoring inflammatory diseases and osteoclastogenesis with osteopontin (OPN), osteoprotegerin (OPG), total soluble receptor activator of nuclear factor kappa B ligand (total sRANKL) and high‐sensitivity C‐reactive protein (hsCRP) has recently attracted increased interest. The purpose of our study was to determine reference intervals, variability caused by sampling time, biological variation and stability after repeated freeze–thaw cycles of circulating levels of OPN, OPG, total sRANKL and hsCRP. Material and methods. Plasma OPN and plasma OPG concentrations were determined with sandwich ELISA; serum total sRANKL concentration was determined using a two‐site sandwich ELISA; and hsCRP was analysed by turbidimetry in 300 Danish blood donors (183 M and 117 F) with a median age of 43 years (range 18–64 years). Variability due to biological variation and sampling time was studied in serial samples from 38 healthy subjects. Results. The 95th percentiles in the donors were 76 µg/L for OPN, 4.2 pmol/L...
TL;DR: Only IL‐6, determined on admission, showed medium diagnostic accuracy, while other laboratory markers showed low diagnostic accuracy for AA in children, and the new laboratory markers do not significantly improve the diagnosis of AA.
Abstract: The aim of the study was to evaluate the diagnostic accuracy of interleukin-6 (IL-6) and lipopolysaccharide-binding protein (LBP) in children with acute appendicitis (AA) and to compare this with the diagnostic accuracy of routinely used C-reactive protein (CRP) and white blood cell (WBC) count Eighty-two consecutive children admitted to our Department because of suspected AA were enrolled in this prospective study and classified into two groups: group 1 (49 children who underwent surgery for AA) and group 2 (33 children with no surgery with diagnosis of non-specific abdominal pain or sonographic mesenteric lymphadenitis) There were no negative appendectomies during the time of the study The patients were further classified into three subgroups: subgroup 1A (43 patients with advanced AA), subgroup 2A (11 patients with mesenteric lymphadenitis) and subgroup 2B (10 patients with non-specific abdominal pain) The perforation rate was 327 % WBC count and serum CRP, IL-6 and LBP were measured on admission Area under receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity and predictive values were evaluated Serum IL-6 and LBP were significantly higher in group 1 than in group 2 The highest AUC for AA was that for IL-6 (0776), followed by WBC count (0684), CRP (0637) and LBP (0635) In conclusion, only IL-6, determined on admission, showed medium diagnostic accuracy, while other laboratory markers showed low diagnostic accuracy for AA in children The new laboratory markers therefore do not significantly improve the diagnosis of AA
TL;DR: The findings demonstrate a significant modification of bone turnover in HHCY rats, which indicates a shift toward bone resorption, which might be a plausible explanation for the relation between H HCY and fracture risk.
Abstract: Objective. To investigate whether experimental hyperhomocysteinemia (HHCY) can induce adverse changes in bone metabolism. Methods. Blood and urine samples were collected from rats fed with a methionine‐enriched diet (HHCY, n = 18) or an isocaloric control diet (control, n = 10) for 12 weeks. Biochemical bone turnover markers (osteocalcin, hydroxyproline, N‐terminal collagen I telopeptides and homocysteine (HCY), folate and vitamin B12) were measured. Whole body bone mineral density (BMD) was assessed by dual energy X‐ray absorptiometry. Results. HCY was significantly higher in HHCY than in control rats (16.2 versus 3.2 µmol/L; p = 0.0006). Bone resorption parameters hydroxyproline (1.60±0.6 versus 0.85±0.4; p<0.05) and N‐terminal collagen I telopeptides (150.8±78 versus 48.1±26 nmol/L BCE; p<0.05) increased, whereas bone formation marker osteocalcin (9.01±3.8 versus 15.07±4.2 ng/mL; p<0.05) decreased in HHCY compared to control rats. The relation N‐terminal collagen I telopeptides/osteocalcin significantl...
TL;DR: The decrease in the OPG/RANKL ratio in girls with AN could partly explain the increase in bone loss that occurs in these patients.
Abstract: Objective. Osteoprotegerin (OPG) and receptor activator of nuclear factor‐κB ligand (RANKL) are key factors in bone remodeling in patients with anorexia nervosa (AN) and osteopenia. The purpose of this study was to investigate basal serum levels of OPG, RANKL and leptin, as well as bone mineral density (BMD) measured by DEXA at lumbar vertebrae L1–L4, and their evolution during one year in two groups of patients with AN. Material and methods. Group I included 10 adolescent girls suffering from malnutrition and secondary amenorrhea with an evolution of more than one year at the beginning of the study who received oral estrogen treatment throughout the follow‐up period. Group II comprised 10 girls with malnutrition and secondary amenorrhea with an evolution of less than one year who received nutritional treatment only. All parameters were compared with those of a control group of 19 healthy, age‐matched girls with normal BMI and regular menstrual cycles. Results. The OPG/RANKL ratio was significantly decrea...
TL;DR: Even when undertaken by relatively inexperienced operators, both ‘within’ and ‘between’ observer repeatability of AIx measurement is very high, which has the potential to be included in the clinical assessment of ambulant patients.
Abstract: Objective. Aortic augmentation index (AIx) measured using applanation tonometry is a non‐invasive indicator of arterial stiffness. The objective of this study was to assess its repeatability when used by nurses with limited experience of the technique. Material and methods. Blood pressure/augmentation index (BP/AIx) was measured 4 times in 20 consecutive ambulant patients (16 male) after they rested supine for 15 min. Two nurses independently and alternately measured BP/AIx using the same equipment (Omron HEM‐757; SphygmoCor with Millar hand‐held tonometer). Nurses were blinded to patient medical records and their colleague's AIx/BP. ‘Within’ and ‘between’ observer differences were assessed using intra‐class correlation coefficients (rI) and 95 % limits of agreement (95 % LoA) derived from Bland‐Altman plots. Results. Mean age was 56 (mean BP 136/79; mean pulse 64). Mean AIx was 24.1 (range 2.8 to 41.0). Both ‘between’ and ‘within’ observer repeatability was very high, with intra‐class correlation coeffic...
TL;DR: Patients with acute severe asthma demonstrated increased MDA levels but no differences in plasma selenium levels or GPx activity, consistent with an adaptive up‐regulation of GPx to protect against oxidative stress.
Abstract: Objective. To investigate plasma glutathione peroxidase concentration, glutathione peroxidase activity, plasma selenium and oxidative stress in acute severe asthma. Material and methods. The study was case‐control in design, with cases presenting to the emergency department with acute severe asthma and controls randomly selected from a larger cross‐sectional study. Plasma malondialdehyde (MDA) was used as a measure of oxidative stress and plasma selenium was measured using ICP‐MS. Glutathione peroxidase (GPx) activity was analysed using a colorimetric GPx assay and plasma GPx level was measured by enzyme‐linked immunosorbent assay (ELISA). Results. Fifteen cases [mean (range) predicted peak expiratory flow rate (PEFR) of 43% (20–69)] and 15 matched controls were recruited. MDA levels (mean±SD) were higher in acute asthma subjects (1.30±0.56 µmol/L) than in controls (0.86±0.53 µmol/L; p<0.05). There were no differences between cases and controls for selenium (99±34 µg/L versus 109±17 µg/L) or for GPx activ...
TL;DR: It is believed that the introduction of standardized routines and regular staff training, combined with an exchange of the existing paper‐based referral management system with an electronic system for managing referrals, could increase safety in the preanalytical process, with positive effects on patient safety.
Abstract: Objective. Most mistakes in laboratory medicine are the result of human error occurring before the blood sample reaches the laboratory. This survey of preanalytical procedures was designed to ident ...