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Purpose@#The aim of this study was to analyze the imaging findings and clinical characteristics of extratendinous migration of calcific tendinitis of the shoulder with temporal changes. @*Methods@#Seventy-six patients with extratendinous calcific tendinitis of the shoulder diagnosed by ultrasonography (US) or magnetic resonance imaging (MRI) were enrolled in this retrospective study. Clinical symptoms and imaging findings (on radiography, US, and MRI) of extratendinous calcific tendinitis during an acute painful attack were analyzed. Temporal changes were analyzed in 28 patients before an acute attack and 40 patients after an acute attack. For comparison, 65 patients with intratendinous calcific tendinitis were included. @*Results@#Patients with extratendinous calcific tendinitis had a significantly higher average visual analogue scale (VAS) score (8.8±1.6) than the intratendinous group (6.4±2.2) (P<0.001). The fragmented type (80.5%) was the most common shape on US; sonographic black hole appearance (14.6%) and echogenic fluid (9.8%) were characteristic findings of intrabursal calcifications. In 28 patients with previous radiographs, radiographic type III (78.6%) was dominant and the location of calcific deposits changed (82.1%) during the acute painful attack, which was also perceivable in 12 patients with previous US or MRI. In follow-up radiographs of 40 patients, calcifications shrunk by more than 50% or became invisible in 82.5% of patients, with symptom improvement (VAS score, 8.9±1.5 to 1.9±1.2). Follow-up US and MRI of 16 patients also showed decreased size (56.3%) or disappearance (43.7%) of calcific deposits. @*Conclusion@#Extratendinous calcific tendinitis has distinctive imaging features, the temporal changes of which correlate well with clinical symptoms.
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Background@#This study was conducted to evaluate the analytical performance of the SelexOnTM B-type natriuretic peptide (BNP) assay (Osang Healthcare Inc., Korea), a new rapid lateral flow immunoassay for point of care (POC) testing using whole blood. @*Methods@#The imprecision, linearity, and method comparison of SelexOnTM BNP assay were evaluated. Two commercial BNP assays, the ADVIA Centaur® BNP (Siemens Health Care diagnostics Inc., USA) and the Triage® BNP assays (Alere, USA), were included for method comparison using 100 whole blood samples from patients. The reference interval was verified using 120 residual samples from health examination participants. @*Results@#The SelexOn BNP had total CVs of 20.3%, 13.3%, and 10.3% in BNP concentrations of 89.44 pg/mL, 480.71 pg/mL, and 1,201.84 pg/mL of control materials, respectively. Linearity was observed from 56 pg/mL to 1544 pg/mL. The SelexOn BNP (y) regression equation was y=0.9706x-21.68 with Centaur BNP (x) (r=0.930) and y=0.7600x+0.0506 with Triage BNP (x) (r=0.845), respectively. The predicted mean difference (%) of the SelexOn BNP at the clinical decision levels (100 pg/mL) was up to 25% lower than the two comparative methods. The SelexOn BNP levels were below 50 pg/mL in 114 (95%) of the 120 samples. @*Conclusions@#The SelexOn BNP using EDTA was developed as a POC test for differential diagnosis or treatment monitoring for acute heart failure. However, clinical decision values must be improved to be compatible with other BNP methods.
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BACKGROUND: In Korea, the Korean Laboratory Accreditation Program (KLAP) has set minimum standards for verification of clinical test performance. This verification process is time-consuming and labor-intensive when performed manually. We developed a free, statistical software program for KLAP, using the R language (R Foundation for Statistical Computing, Vienna, Austria). METHODS: We used CLSI guidelines for the algorithm. We built graphic user interfaces, including data input, with Embarcadero Delphi EX4 (Embarcadero Technologies, Inc., Texas, USA). The R Base Package and MCR Package for Method Comparison Regression were used to implement statistical and graphical procedures. RESULTS: Our program LaboStats has six modules: parallel test, linearity, method comparison, precision, reference interval, and cutoff. Data can be entered into the field either manually or by copying and pasting from an MS Excel worksheet. Users can print out precise reports. CONCLUSIONS: LaboStats can be useful for evaluating clinical test performance characteristics and preparing documents requested by KLAP.
Subject(s)
Accreditation , Korea , Mathematical Computing , Methods , TexasABSTRACT
No abstract available.
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BACKGROUND: We evaluated the analytical performance of Wako assays for albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), complement C3 and C4, calcium, creatine kinase (CK), C-reactive protein (CRP), direct bilirubin (DBIL), iron, gamma-glutamyl transferase (GGT), HDL cholesterol (HDLC), inorganic phosphorus (IP), LDL cholesterol (LDLC), total bilirubin (TBIL), total protein (TP), and uric acid (UA), as well as the performance of Sekisui assays for albumin, BUN, calcium, CRP, HDLC, IP, LDLC, TP, and UA by using Hitachi LABOSPECT 008 (Hitachi High-Tech Co., Japan). METHODS: Liquid Assayed Multiqual Control (Bio-Rad Laboratories, USA) and pooled patients' sera were analyzed for 20 days. Wako linearity material (Wako Pure Chemical Industries, Ltd., Japan) and Sysmex Interference Check A Plus kit (Sysmex Co., Japan) were used to test linearity and interference, respectively. Concentrations of the target analytes were measured using Hitachi LABOSPECT 008 in 100 residual patient specimens and compared to those in Pureauto S series reagent (Sekisui Medical, Japan), which were measured using Hitachi 7600 (Hitachi High-Tech Co., Japan). RESULTS: Total coefficients of variation (CVs) for the tested analytes were 0.91-9.26% in Wako and 1.04-7.46% in Sekisui assays. Linearity was demonstrated up to the highest concentration within the analytical range in all the assays except for Wako albumin and Sekisui TP. Wako and Sekisui albumin, BUN, CRP, HDLC, and LDLC assays, and in Wako C3, C4, calcium, and UA assays showed no interference with the test concentrations used. All the tested assays, except for Wako AST, LDLC, and TP, and Sekisui calcium and TP, demonstrated comparability with comparative method for at least one medical decision level. CONCLUSIONS: Our study results showed that the analytical performances of Wako and Sekisui chemistry assays evaluated using Hitachi LABOSPECT 008 had appropriate analytical performance for clinical use.
Subject(s)
Humans , Alanine Transaminase , Aspartate Aminotransferases , Bilirubin , Blood Urea Nitrogen , C-Reactive Protein , Calcium , Chemical Industry , Chemistry Techniques, Analytical , Chemistry, Clinical , Cholesterol, HDL , Cholesterol, LDL , Clinical Chemistry Tests , Complement C3 , Creatine Kinase , Iron , Phosphorus , Transferases , Uric AcidABSTRACT
BACKGROUND: Measurement of HbA1c levels is widely used to diagnose diabetes mellitus and to evaluate and monitor plasma-glucose concentrations over 6-8 weeks. In this study, we evaluated the diagnostic performance of the newly developed latex immunoturbidimetric method by using Autolab HbA1c. METHODS: We analyzed and compared the diagnostic performance of Autolab HbA1c with that of Toshiba 200FR between April 2009 and July 2009. According to guidelines (EP5-A2, EP6-P, EP9-A2) of the clinical and laboratory standards institute (CLSI), we compared linearity, precision and correlation of Autolab HbA1c with those of G7 (Tosoh Corp., Kyoto, Japan) by using high-performance liquid chromatography (HPLC) method. RESULTS: Data obtained using Autolab HbA1c showed good linearity in mixtures of samples with low (3.1%) and high (15.1%) levels of HbA1c (r2 = 0.9997). In the analysis of within-run precision of the samples with HbA1c levels of 5.1% and 12.1%, the SDs were 0.04 and 0.06 and covariances of these samples were 0.8% and 0.5%, respectively. In the Deming regression model, the regression equation was as follows: Autolab HbA1c = 1.0859xTosoh HPLC-0.6957. CONCLUSIONS: In this study, Autolab HbA1c method showed better performance characteristics than Tosoh G7 did. In reference review, there was no interference of variant hemoglobin. The data acquisition time of Autolab HbA1c was lower than that of Tosoh G7. The advantages of Autolab HbA1c are that it can be used as an autoanlyzer in routine chemical analysis, it does not require pre-analytical treatment, and the samples are automatically treated with distilled water for hemolysis.
Subject(s)
Chromatography, High Pressure Liquid , Chromatography, Liquid , Diabetes Mellitus , Hemoglobins , Hemolysis , Latex , Organothiophosphorus Compounds , WaterABSTRACT
BACKGROUND: Accurate measurement of blood glucose concentrations is essential for defining diabetes, and the minimization of ex vivo glycolysis has been recommended. Recent guidelines advocate two kinds of methods for sample collection and processing: either the sodium fluoride (NaF) method or immediate refrigeration using a serum separation tube (SST). We investigated the difference between the two methods in measuring subsequent glucose concentrations using blood specimens from participants recruited for the fourth Korean National Health and Nutrition Examination Survey. METHODS: Paired venous blood samples were collected in an SST and a NaF tube from 1,103 men and women. SST serum was separated within 30 min, including standing for 15 min, and then refrigerated. The NaF samples were refrigerated, but not separated until immediately before analysis. We compared the blood glucose concentrations between the SST (SST glucose) and NaF (NaF glucose) methods. RESULTS: The mean SST glucose was significantly higher than NaF glucose (99.0 mg/dL vs 96.5 mg/dL, P<0.05). NaF glucose showed a negative mean bias of 2.6 mg/dL vs SST glucose but showed high correlation (R=0.9899). There was no significant correlation between the bias of blood glucose concentrations by two methods and the storage time of NaF glucose. CONCLUSIONS: The negative bias associated with the use of NaF tubes may significantly affect the prevalence of diabetes. Serum separation and refrigeration within 30 min after venous sampling is recommended over NaF method, not only to minimize the preanalytical impact on detecting diabetes but also to reduce sample volume and number of tubes.
Subject(s)
Female , Humans , Male , Blood Glucose/analysis , Blood Specimen Collection/methods , Diabetes Mellitus/diagnosis , Glycolysis/drug effects , Nutrition Surveys , Republic of Korea , Sodium Fluoride/pharmacology , Specimen HandlingABSTRACT
BACKGROUND: The HbA1c has been considered to underestimate glucose level in diabetic patients on hemodialysis, therefore, glycated albumin (GA) was recently introduced to assess the glycemic control for those cases. We evaluated the performance of GA assay kit of Lucica GA-L (Asahi Kasei Pharma Co., Japan) and compare it with HbA1c for estimating glucose levels. METHODS: Tests for precision, linearity and interference were performed and reference interval was determined. Thirty eight of non-hemodialysis and seventy of hemodialysis patients were recruited, whose glucose levels of three-, two- and one-month prior to this study were available for calculating weighted means of glucose (WMGs). The correlation coefficients and the slopes of regression equation between WMG and HbA1c or GA were compared between two groups. Multiple linear regression analyses were used to determine significant predictor for HbA1c and GA. RESULTS: Total CV was 2.2% at concentration of 13.7% and 2.8% at 24.6%. The dilution curve between 15.7% and 62.1% was linear. Reference intervals were 10.0% to 16.5% for male and 11.4% to 17.6% for female. The correlation coefficients between WMG and GA were 0.682-0.713 in hemodialysis and 0.640-0.677 in non-hemodialysis. Those between WMG and HbA1c were 0.568-0.625 in hemodialysis and 0.735-0.783 in non-hemodialysis. The slopes of regression equation between GA and WMG in hemodialysis were 0.080-0.090 and 0.130-0.147 in non-hemodialysis. Those between HbA1c and WMG in hemodialysis were 0.012-0.014 and 0.029-0.032 in non-hemodialysis. GA was not influenced by hemodialysis status while HbA1c was. CONCLUSIONS: The claimed performance characteristic of Lucica GA-L were verified. WMG were better reflected by GA rather than HbA1c in patients on hemodialysis.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Blood Glucose/chemistry , Diabetes Mellitus, Type 2/diagnosis , Glycated Hemoglobin/analysis , Reagent Kits, Diagnostic , Renal Dialysis , Reproducibility of Results , Serum Albumin/analysisABSTRACT
BACKGROUND: Therapeutic drug monitoring (TDM) of tacrolimus is essential because of narrow therapeutic range and poor correlation of dose to blood concentration. Affinity Column Mediated Immunometric Assay (ACMIA) does not require a pretreatment steps in measurement of tacrolimus. In this study, we evaluated the performance of tacrolimus assay using ACMIA (Dimension RxL Max, Dade Behring). METHODS: The imprecision, the linearity and the detection limits and the interferences by bilirubin and chyle, and correlation with hematocrit for tacrolimus by ACMIA were evaluated according to Clinical and Laboratory Standards Institute guidelines EP5-A2, EP6-A, EP17-A, EP9-A2, and EP7-A2. Method comparison studies with microparticle enzyme immunoassay (MEIA) (IMx Tacrolimus II, Abbott Laboratories) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) (Waters 2795 Quattromicro API, Micromass) were also performed. RESULTS: The total imprecision for low, middle and high level was 12.8%, 9.0% and 6.7%, respectively. The range of tacrolimus from 3.1 ng/mL to 35.4 ng/mL showed a clinically relevant linearity. The limit of detection and the functional sensitivity were 0.24 ng/mL and 0.72 ng/mL, respectively. Tacrolimus concentration measurement (Tac-CM) with ACMIA did not show significant interferences with bile and chyle and also did not show significant correlation with hematocrit. In comparison study for Tac-CM with MEIA and LC-MS/MS, Tac-CM with ACMIA showed a good correlation with MEIA (r=0.950) and LC-MS/MS (r=0.946). CONCLUSIONS: The imprecision, linearity, detection limits, interference and correlation of Tac-CM with ACMIA were suitable for clinical use. Tac-CM with ACMIA could reduce turn around time and help clinicians to manage transplant patients on immunosuppressant therapy.
Subject(s)
Humans , Bilirubin/chemistry , Chromatography, Affinity , Chyle/chemistry , Drug Monitoring , Immunoassay/methods , Immunosuppressive Agents/blood , Limit of Detection , Reagent Kits, Diagnostic , Reproducibility of Results , Tacrolimus/bloodABSTRACT
BACKGROUND: National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) is the guideline for detection evaluation, and treatment of high blood cholesterol in adults. The risk of coronary heart disease (CHD) is assessed by the presence of CHD risk equivalents and the number of risk factors. LDL-cholesterol is the goal of treatment for hyperlipidemia. Contents: The most common approach for determining LDL-cholesterol level in clinical laboratory is to calculate it based on Friedewald formula. For accurate risk assessment by the calculated LDL-cholesterol, good analytical performances of total cholesterol, HDL-cholesterol and triglyceride are prerequisite. Even if the analytical performance of these three analytes are within the acceptable criteria, pooled imprecision and bias of the calculated LDL-cholesterol could not meet the criteria for LDL-cholesterol. Even under conditions satisfying the requirements of Friedewald formula, the calculated LDL-cholesterol level was lower than the directly measured level and the difference was dependent on the level of triglyceride, LDL-cholesterol and total cholesterol. When evaluatingpatients with hyperlipidemia, Friedewald calculation may underestimate the risk for coronary heart disease which may lead to inappropriate treatment option. CONCLUSIONS: When evaluating patients with hyperlipidemia, direct measurement of LDL-cholesterol appears to be better than Friedewald calculation.
Subject(s)
Adult , Humans , Adenosine Triphosphate , Bias , Cholesterol , Coronary Disease , Hyperlipidemias , Lipoproteins , Risk Assessment , Risk FactorsABSTRACT
BACKGROUND: Additional tests ordered by doctors after checking abnormal routine test results for inpatients are usually delayed for one day or more, which in turn delays diagnostic and therapeutic procedures and prolongs length of stay (LOS) for the patients. We at Department of Laboratory Medicine, Asan Medical Center (AMC), established a "secondary order system for laboratory tests without additional blood sampling" to improve the conventional reflexive tests. METHODS: Oracle 8.0 (Oracle Co., Belmont, CA, USA) was used for data base software and Powerbuilder (Powersoft, Burlington, UK) for client development tool. Specimens subjected to "reflexive tests by doctors without additional blood sampling" were SST tubes for routine chemistry and EDTA for routine hematology requested in the morning of additional requests of the laboratory tests. RESULTS: Programs of registration and request for "reflexive tests by doctors without additional blood sampling" and bar code printing were developed for clinicians to check the routine test results and to order additional tests, if necessary, and for laboratory to perform the requested tests using the same samples used for routine chemistry and hematology tests in the morning. Additionally requested tests were done by finding the SST and EDTA samples, putting newly printed bar code, and processing them as usual. In February 2004, right after introducing reflexive tests by doctors without additional blood sampling, 75 additional requests were made for 50 patients, but they increased gradually up to 1,020 tests for 698 patients in December 2004. In 2005, the monthly average number of tests was 1,035 for 742 patients. CONCLUSIONS: The reflexive tests by doctors without additional blood sampling developed at AMC helped establish a rapid reporting of test results, which in turn reduced LOS related to laboratory. It also increased patient satisfactory indices by reducing repeated blood sampling and would also contribute to the financial health of the hospital.
Subject(s)
Humans , Electronic Data Processing , Chemistry , Edetic Acid , Hematology , Inpatients , Length of Stay , ReflexABSTRACT
BACKGROUND: Preeclampsia is a frequent cause of maternal or fetal morbidity and mortality. There have been many trials to use microalbuminuria as a predictor for preeclampsia, but the usefulness is controversial. Authors have studied the changes in urinary microalbumin excretion during normal pregnancy to help establish a reference interval in which physiologic alteration during pregnancy is reflected. METHODS: During the period from January to April 1999 and from December 1999 to January 2000, urinary albumin and creatinine levels were measured in the 151 spot urine samples from pregnant women visiting Hanyang University Kuri Hospital for prenatal care. They were free of hypertension, proteinuria, and renal diseases at the time of sampling for the medical records. A homemade ELISA and the Cobas Integra 700 were used to measure the urinary albumin and urinary creatinine levels. The analysis of the data was performed as urinary microalbumin/creatinine ratio (ACR). RESULTS: In the 146 urine samples from normotensive pregnant women, urine ACR was 1.36+/-1.72 g/mol (mean+/-standard deviation). The urine ACR was 0.83+/-1.12 g/mol in the first trimester, 1.06+/-1.38 g/mol in the second trimester, and 1.82+/-1.06 g/mol in the third trimester. The urine ACR of the third trimester was significantly different from that of the first or second trimester (3rd vs 1st, P=0.026 and 3rd vs 2nd, P=0.011). CONCLUSIONS: During the course of normal pregnancy, urinary microalbumin excretions increased significantly in the third trimester. It is necessary that the reference interval for urinary microalbumin excretions be established based on gestational weeks.
Subject(s)
Female , Humans , Pregnancy , Creatinine , Enzyme-Linked Immunosorbent Assay , Hypertension , Medical Records , Mortality , Pre-Eclampsia , Pregnancy Trimester, First , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Pregnant Women , Prenatal Care , ProteinuriaABSTRACT
Peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) remains a major problem. Peritonitis due to Cryptococcus neoformans is an unusual complication. A 68-year-old woman on prednisolone for Behcets disease and adrenal insufficiency was admitted with chronic renal failure and CAPD was initiated. During her stay in hospital, she was treated with multiple antibiotics for urinary tract infection and CAPD peritonitis with methicillin resistant Staphylococcus aureus (MRSA). She was deteriorated insidiously and C. neoformans was cultured in the dialysate but not in the blood, urine and stool. After three days, she died. We reviewed 385 organisms isolated from 1,325 peritoneal dialysate specimens between 1990 and 2002. Staphylococcus aureus was most frequently isolated (22.6%). Fungus comprises 10.1% of the isolated organisms.
Subject(s)
Aged , Female , Humans , Adrenal Insufficiency , Anti-Bacterial Agents , Cryptococcus neoformans , Fungi , Kidney Failure, Chronic , Methicillin Resistance , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Prednisolone , Staphylococcus aureus , Urinary Tract InfectionsABSTRACT
This study was conducted to study the changes of cell surface carbohydrates during transdifferentiation of retinal pigment epithelial(RPE)cells. RPE cells were cultured from adult pig eyes. Surface carbohydrates of RPE cells from 1st, 3rd, 5th, 7th and 9th passages were assayed by lectin histochemistry and enzyme immunoassay. Changes in binding affinities to the lectins employed were demonsrated during trasdifferentiation of RPE cell. Whereas binding affinities of ConA, ECL, PNA, WGA, and UEA-I decreased graudally as the number of culture passage increased, binding properties to LCA, STL and DBA fluctuated depending on the number of passages. The results demonstrate changes of surface carbohydrates of RPE cell during trasdifferentiation. We suggest that changes of surface carbohydrates of RPE cell during trasdifferentiation may be close relations with the functional changes during transdifferentiation.
Subject(s)
Adult , Humans , Carbohydrates , Epithelial Cells , Immunoenzyme Techniques , Lectins , RetinaldehydeABSTRACT
The purpose of this study was to investigate the patency rates and the histologic findings of neoendothelialization according to the diameter of polytetrafluoroethylene (PTFE) which is the most widely used synthetic graft for blood vessel. Under the operating microscope, grafts of 3 and 5mm in diameter were implanted in both femoral arteries of ten mongrel dogs by interrupted end-to-end microanastomosis. They were divided into two groups according to the diameter of implanted PTFE (3 and 5mm). Each group had five dogs. The lengths of implanted PTFE were 20mm in both groups. All implanted grafts were 25 urn in fibril length and 0.39mm in wall thickness. Two grafts from one dog were harvested at 1, 2, 4, 8, and 12 weeks after implantation and all PTFE grafts were observed for patency rates. The histologic analysis was performed under a light microscope and scanning electron microscope. In conclusion, PTFE with larger diameter than that of recipient vessel is recommended as the grafts for implantation because PTFE is not as elastic as normal vessel.