First clinical evaluation of the CELL-DYN 3200 haematology analyser

The respiratory quotient (RQ) reflects the amount of energy derived from carbohydrate as apposed to fat metabolism. To assess the metabolic state of patients with non-insulin-dependent diabetes mellitus, the RQ was measured five times a day (at 09.00, 11.00, 13. 00, 14.00, and 17.00 h) in 20 healthy subjects and 60 diabetic patients. Diabetic patients treated with insulin or sulfonylurea showed significantly higher RQ values than normal subjects and nontreated diabetic patients. Diabetic patients without treatment showed higher glucose levels, and their RQ values were significantly lower than those of treated patients. There was a significant inverse correlation between RQ and blood glucose levels at 11.00 h (r = -0.361, p < 0.01) in diabetic patients, but no significant relation with HbA1c. Treated diabetic patients with a higher body mass index tended to show a higher RQ than those with a lower one (r = -0.269, p = 0.083). Within 1 year, 7 of 13 patients, who had RQ > 1.0, gained more than 3 kg, while only 5 of the remaining 32 treated diabetic patients gained more than 3 kg (p < 0.05). This demonstrates that diabetic patients with a higher RQ tended to gain weight despite the use of insulin or oral hypoglycemia agents. The RQ increased by infusing both insulin and glucose in normal subjects. These results suggest that a high RQ results from excess insulin and excess food. The RQ is a good predictor of weight gain in diabetic patients treated with either insulin or oral hypoglycemic agents.     

European multicentre evaluation of the Super Aution SA-4220 urinalysis analyser

A multicentre evaluation of the urine test strip analyser Super Aution-4220 was carried out in six laboratories. The analytical performance of the instrument with regard to imprecision, linearity, detection limit, drift, carry-over and method comparison was studied. Using the Aution stick 8 test strip the pH, glucose, protein, ketones, bilirubin, blood, urobilinogen and leukocyte esterase were analysed. Specific gravity measurements were performed by refractive index method. Within-run and between-run imprecision determined at three levels of analyte were good. No carry-over was observed. Obtained results were linear through all the described analytical range. No significant drift was detected. Method comparison with some quantitative methods was performed and showed a good correlation with most of the analytes. The study of interferences showed minor interferences by common therapeutic drugs with the measurement of some analytes. During the assessment period of about 6 months no breakdown occurred in any laboratory. The Super Aution urine analyser appeared to be a highly automated analyser of urinary test strips. The operation was simple and the maintenance required only a few minutes a day.     

Multicentre evaluation of a two-step automated enzyme immunoassay of free thyroxine

The two-step enzymatic immunoassay of free thyroxine (IMx FT4, Abbott Laboratories, Chicago, IL) was studied in three centres. The assay involved a fluorimetric measurement and took 45 minutes using a completely automated procedure. The results were compared with those from the free thyroxine two-step radioimmunoassay and with the "calculation" of free thyroxine. The analytical precision was found to be excellent if the analyser was correctly set. The IMx FT4 assay seemed unaffected by increased concentrations of albumin and of non-esterified fatty acids (oleic acid) up to 5 mmol/l. The euthyroid reference interval, defined as that including 95% of 194 control subjects, was 12-21 pmol/l. A limited overlap existed between euthyroid and hyperthyroid patients, but a larger one was seen between the euthyroid and hypothyroid population, the latter including subclinical hypothyroidism. IMx FT4 results agreed well when compared with those from two-step radioimmunoassays. The IMx FT4 technique gave rise to a low percentage of elevated results in patients being treated with heparin, but was undisturbed by autoantibodies to thyroxine and triiodothyronine which were present in one hypothyroid patient.     

Multicentre evaluation of a commercial test for the rapid diagnosis of Clostridium difficile-mediated antibiotic-associated diarrhoea

Although histologic studies of mucin distribution in the peribiliary glands have been conducted, a quantitative study of mucin content in intrahepatic bile ducts has yet to be reported. In an attempt to evaluate the mucin content in stone-containing intrahepatic bile ducts, we conducted a study on 25 surgically resected livers with hepatolithiasis. Specimens from 10 livers without stones served as controls. All specimens were fixed in 10% formalin and sectioned for periodic acid Schiffalcian blue double-stain (PAS-AB; pH 2.5) to evaluate the epithelial mucin content of the intrahepatic bile ducts. The PAS-AB positive area and the total epithelial area were measured with a computerized image analyzer and the PAS-AB index was calculated as the proportion of the PAS-AB positive to the total epithelial area. The histochemical study showed that epithelial cells in both the intramural glands and extramural glands of stone-containing intrahepatic bile ducts stained heavily and homogeneously with PAS-AB, while those of controls stained weakly. The PAS-AB indexes in stone-containing intrahepatic bile ducts were 51.8 +/- 15.88% for mucous cells of intramural glands, 52.86 +/- 9.85% for mucous cells of extramural glands, and 77.29 +/- 21.59% for serous cells of extramural glands. These values were all significantly higher than those of control specimens. However, the PAS-AB index of the epithelial lining in both hepatolithiasis and control specimens were similarly low, indicating the epithelial lining does not secrete much mucous glycoprotein. The results of this study led us to conclude that stone-containing intrahepatic bile ducts contain an abundant amount of mucous glycoprotein, and mucin is secreted from the peribiliary glands, not from the epithelial lining of the bile ducts.     

Evaluation of the portable blood analyser i-STAT]

The purpose of this study was to compare the results of horse blood examinations on a portable blood analysis system, i-STAT SDI, with conventional laboratory equipment and to verify the accuracy and precision. The precision within run was high and the coefficients of variation ranged from 0 to 3.85%. The comparative analysis of patient samples with routine methods showed a very strong positive correlation with correlation coefficients above 0.96 for blood gases, pH, glucose, urea, hemoglobin, hematocrit, sodium and potassium, with the exception of chloride where it was 0.867. The i-STAT system provides a quick and accurate stable-side evaluation of laboratory data in critically ill horses and emergency situations.     

An evaluation of an orientation plus tutoring school-based prevention program.

Some children who transfer into new schools are high-risk candidates for school and later-life difficulties. During transfer, children are faced with the tasks of gaining teacher and peer acceptance, learning school rules, and meeting new academic standards. Children who fail in these tasks are often of low socioeconomic status (SES), show academic lag, and are confronted with multiple life stressors. In this study, 20 schools were randomly assigned to (1) an intervention providing transfer children with an orientation program and tutoring or (2) a control condition. 54 children in Grades 3, 4, and 5 who were assigned to the intervention showed significantly better achievement scores than a group of 52 controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group

OBJECTIVE: To assess the feasibility and impact of introducing the Ottawa ankle rules to a large number of physicians in a wide variety of hospital and community settings over a prolonged period of time. DESIGN: Multicentre before and after controlled clinical trial. SETTING: Emergency departments of eight teaching and community hospitals in Canadian communities (population 10,000 to 3,000,000). SUBJECTS: All 12,777 adults (6288 control, 6489 intervention) seen with acute ankle injuries during two 12 month periods before and after the intervention. INTERVENTION: More than 200 physicians of varying experience were taught to order radiography according to the Ottawa ankle rules. MAIN OUTCOME MEASURES: Referral for ankle and foot radiography. RESULTS: There were significant reductions in use of ankle radiography at all eight hospitals and within a priori subgroups: for all hospitals combined 82.8% control v 60.9% intervention(P < 0.001); for community hospitals 86.7% v 61.7%; (P < 0.001); for teaching hospitals 77.9% v 59.9%; (P < 0.001); for emergency physicians 82.1% v 61.6%; (P < 0.001); for family physicians 84.3% v 60.1%; (P < 0.001); and for housestaff 82.3% v 60.1%; (P < 0.001). Compared with patients without fracture who had radiography during the intervention period those who had no radiography spent less time in the emergency department (54.0 v 86.9 minutes; P < 0.001) and had lower medical charges ($70.20 v $161.60; P < 0.001). There was no difference in the rate of fractures diagnosed after discharge from the emergency department (0.5 v 0.4%). CONCLUSIONS: Introduction of the Ottawa ankle rules proved to be feasible in a large variety of hospital and community settings. Use of the rules over a prolonged period of time by many physicians of varying experience led to a decrease in ankle radiography, waiting times, and costs without an increased rate of missed fractures. The multiphase methodological approach used to develop and implement these rules may be applied to other clinical problems.     

Reassessment of glucose effectiveness and insulin sensitivity from minimal model analysis: a theoretical evaluation of the single-compartment glucose distribution assumption

Minimal model analysis with the frequently sampled intravenous glucose tolerance test provides an effective way to measure two important metabolic parameters in vivo under non-steady-state conditions: glucose effectiveness (SG) and insulin sensitivity (SI). Two questions regarding the validity of SG and SI have recently emerged. First, SG from the minimal model is suspected to be overestimated. Second, the occurrence of SI values indistinguishable from zero ("zero-SI") is not negligible in large clinical studies, and its physiological meaning is uncertain. In this study, we examined the significance of the assumed single-compartment glucose distribution embedded in the minimal model on the estimation of SG and SI. A more accurate two-compartment model was constructed by incorporating insulin action on hepatic glucose output and uptake into a previously validated construction. The two-compartment results were compared with the one-compartment minimal model results. It was shown that the one-compartment assumption contributes to a systematic deviation of SG (slope = 0.54, y-intercept = 0.014 min[-1]; n = 195 simulations). However, SG from the minimal model was linearly correlated to SG determined from the two-compartment model (r = 0.996). The one-compartment assumption also contributed to the occurrence of zero SI values for insulin-resistant subjects. A similar linear relationship was found between SI estimated by both the minimal model and the two-compartment model (slope = 0.58, y-intercept = -0.57 x 10[-4] min[-1] per pU/ml, r = 0.998). In conclusion, SG and SI from the minimal model are not necessarily equivalent to values emanating from the more accurate two-compartment model. However, the very high correlation between one- and two-compartment results suggests that the minimal model-derived SG and SI are dependable indexes of in vivo glucose effectiveness and insulin sensitivity. Minimal model analysis' advantages of simplicity, minimal invasiveness, reasonable reflection of non-steady-state glucose kinetics, and cost-effectiveness could in many cases outweigh the structural bias introduced by the model simplification.     

Introduction of a Vickers M300 analyser into the routine service of a hospital laboratory. 2. Tests, methods, evaluation

A Vickers M300 analyser has been introduced into a busy hospital laboratory; a profile of 13 biochemical tests is currently provided. Analytical performance has been assessed over one year of routine service operation, and mechanical performance has been assessed over two separate three-month periods. At its best, the M300 achieves high standards of precision and accuracy and has the advantage of unrivalled speed. Enzyme assay methods are less satisfactory than the kinetic assays in current use. Random analytical errors occur and are difficult to detect. The restricted facilities of the integral process-control computer are inadequate for effective quality control.     

The use of mass fragmentography in the evaluation of routine methods for glucose determination

A highly specific and accurate mass fragmentographic reference method for determination of serum glucose is described. A fixed amount of hepta-deuterated glucose is added to a fixed amount of serum. The mixture is lyophilized, converted into the penta-trimethylsilyl-methyloxime derivative and subjected to analysis with a combined gas chromatograph - mass spectrometer equipped with a MID-unit (multiple ion detector). The amount of unlabeled glucose was determined from the ratio between recordings at m/e 319 and 323. The two ions used correspond to the base peak in the mass spectrum of derivative of unlabeled and hepta-deuterium labeled glucose, respectively. The relative standard deviation of the method was 1.9%. The method was compared with different enzymatic methods based on the hexokinase reaction and the glucose oxidase reaction. Of the different methods tested, a glucose oxidase method with determination of maximal rate of consumption of oxygen gave results most close to the results of the reference method.     

载流X荧光分析仪的采样测量技术

运用采样测量技术对多个矿浆流道就近取样分析是载流Ｘ荧光分析技术的发展方向，本文详细介绍并评述了国外几个主要生产厂家的采样测量技术。     

Biological evaluation of two anomeric glucose analogues iodinated in position 6

Two anomeric analogues of glucose labelled with 123 iodine in position 6, proposed as tracers of glucose transport in vivo, have been synthesized: alpha- and beta-methyl-6-deoxy-6-iodo-D-glucopyranoside (alpha MDIG and beta MDIG). The aim of this study was to determine whether these molecules interact with the glucose transporter and whether they could be used as tracers of glucose transport in vivo. The biodistribution of alpha MDIG and beta MDIG was studied in the mouse in vivo. To determine if these two anomers enter the cell via the glucose transporter, their uptake was measured in isolated perfused rat hearts, in human erythrocytes in suspension, and in cardiomyocytes of neonatal rat in culture. Both alpha MDIG and beta MDIG had similar repartitions in the mouse: myocardial uptake averaged 7% of the injected dose/g of organ at 2 min postinjection and alpha MDIG competed with D-glucose to enter the cells. Insulin produced a 123% increase of its uptake in isolated perfused rat hearts and a 100% increase in cardiomyocytes of neonatal rat in culture. alpha MDIG uptake was lowered in the presence of glucose transport inhibitors in each experimental model. An interaction between beta MDIG and glucose transporters was observed only in human erythrocytes in suspension. Only alpha MDIG interacts with the glucose transporter, and thus could be used to estimate glucose transport in vivo.     

Automatic dosage of total urinary proteins with centrifugal analyser

Automatic assay of urinary total proteins on a centrifugal analyser. The assay of urinary proteins is achieved opacimetrically after precipitation by trichloracetic acid. The addition of tensio-active agents lates the initiation of precipitation, helps the formation of a microprecipitate thus hold in suspension. The technique is linear from 0 to 2,5 g/l and for every albumin/globulins ratio between pure albumin and pure globulin.     

Retinal thickness variation in the diabetic patient measured by the retinal thickness analyser

BACKGROUND: Acral melanomas are uncommon. Due to the thick overlying stratum corneum, accurate estimation of margins is difficult for minimally pigmented or amelanotic melanomas on the palm or sole. OBJECTIVE: To describe the use of Mohs micrographic surgery using frozen sections and HMB-45 immunostaining in the treatment of a multiply recurrent acral melanoma that had failed both standard surgery and Mohs surgery. METHODS: The melanoma was excised by Mohs technique, and the margins were checked by frozen section and HMB-45 immunostaining. RESULTS: The melanoma was completely excised in 11 stages, resulting in a defect that covered much of the plantar surfaces of the ball of the left foot, great, second, third, fourth, and fifth toes. No recurrence has been noted in 22 months of follow-up. CONCLUSIONS: HMB-45 immunostaining is a very valuable adjunct to examination of surgical margins for melanoma, particularly when combined with such histologic features as clustering of cells, melanocyte position within the epidermis, and cytologic atypia.     

Evaluation and use of a dry chemistry analyser in Antarctica

The Australian National Antarctic Research Expeditions (ANARE) currently operate scientific stations at four remote locations in Antarctica. Each of these stations requires an accurate, easy to use, and flexible biochemical analyser for clinical diagnosis and management. The Ektachem DT60, DTE and DTSC modules were selected and initially assessed during a wintering expedition at the ANARE station on sub-Antarctic Macquarie Island and during an extended scientific voyage to Antarctica. In the initial field assessment, accuracy was assessed by measuring a range of analytes in samples from pathology interlaboratory quality assurance programs. In 90% of the samples tested, analyte recordings were within 2 standard deviations of the mean provided. Kodatrol controls were tested regularly to assess the calibration stability of the machine and to measure within-day and between-day imprecision. Blood was also taken monthly from all expeditioners, analysed, and immediate results of cholesterol and triglyceride compared with results from identical samples frozen and analysed later in Australia. Cholesterol and triglyceride were the analytes chosen as the results obtained could be used as part of a larger study concerning dietary fats and cardiovascular risk factors. Analysis of the results indicated that the Ektachem DT modules satisfied criteria of accuracy and precision. They were relatively economical to use. Maintenance and training were simple and appropriate to the conditions of use. As a result of this favourable assessment, Ektachem machines were obtained for all four of the Australian Antarctic stations and have been in use at those sites for the last six years. Comment is made on experience with these analysers during that time, including discussion of clinical cases in which the availability of such biochemistry has proved useful. Some of the problems encountered are also discussed. It is considered that use of these biochemical analysers has assisted the solo medical practitioner in the isolated Antarctic region.     

The WHO-EURO Multicentre Study: risk of parasuicide and the comparability of the areas under study

The 15 areas under study in the WHO/Euro Multicentre Study on Parasuicide vary considerably with regard to socio-economic factors, culture, life-styles, etc. In this paper, the authors discuss whether the traditional high risk factors for suicidal behavior (such as unemployment, abuse, divorce, etc.) take on different weights depending on local societal and cultural settings. Results from analyzing covariations between various background factors characteristic of the different areas under study and the frequency of attempted suicide showed weak or insignificant correlations, indicating that high-risk factors can only be identified from international pooled data with great care.