Clinical Significance of PLR, NLR, MLR, RPR and CLR in Evaluating Severity of Hyperlipidemic Acute Pancreatitis / 胃肠病学

Background: Peripheral blood test is a routine clinical examination item. Granulocytes and platelets are often used to measure the severity of inflammatory response, and it is worthy to investigate the value of various inflammatory indices ratio for predicting the prognosis of disease. Aims: To compare and analyze the diagnostic efficacy of platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), red blood cell distribution width to platelet ratio (RPR), C-reactive protein to lymphocyte ratio (CLR) and C-reactive protein (CRP) in evaluating the severity of hyperlipidemic acute pancreatitis (HLAP). Methods: The clinical and laboratory data of 104 patients with HLAP from January 2018 to December 2020 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. According to the revised Atlanta classification, HLAP patients were divided into mild HLAP, moderate to severe/severe HLAP. Forty-four healthy subjects during the same period were served as the controls. PLR, NLR, MLR, RPR, CLR and CRP were compared between HLAP group and control group. The ROC curve was used to analyze the diagnostic efficacy of PLR, NLR, MLR, RPR, CLR and CRP for the diagnosis of moderate to severe/severe HLAP. Results: PLR, NLR, MLR, RPR, CLR and CRP were significantly increased in HLAP group than in control group (P<0.05); PLR, NLR, MLR, RPR, CLR and CRP were significantly increased in moderate to severe/severe HLAP group than in mild HLAP group (P<0.05). The cut-off values of PLR, NLR, MLR, RPR, CLR, CRP and combined PLR, NLR, MLR, RPR, CLR were 220.48, 10.95, 0.84, 0.12, 76.66, 87.44 mg/L, 0.37, respectively, the sensitivity for diagnosing moderate to severe/severe HLAP were 0.73, 0.45, 0.47, 0.82, 0.65, 0.65 and 0.88, respectively, the specificity were 0.85, 0.87, 0.90, 0.81, 0.83, 0.83 and 0.85, respectively, AUC were 0.84, 0.65, 0.67, 0.87, 0.77, 0.75 and 0.94, respectively. Conclusions: PLR, NLR, MLR, RPR, CLR and CRP can evaluate the severity of HLAP, and the combined PLR, NLR, MLR, RPR and CLR has higher sensitivity and diagnostic efficacy in the diagnosis of moderate to severe/severe HLAP.

Overview of Prevalence of Syphilis in a Health Facility in Rivers State

Syphilis is one of the sexually transmitted diseases that is prevalent in developing countries and is of public health importance. Among pregnant women, it is reported to cause foetal defects if not treated. This study was thus carried out to determine the prevalence of syphilis among pregnant women visiting a health facility in Rivers State. Records of 482 pregnant women who visited the health facility within January and December 2018 were reviewed after obtaining due consent from the relevant authority. The sensitivity rate of the RPR test was higher than the THPA test, however the THPA has been found to be more specific. A prevalence rate of 2.28% was reported among the samples collected. The women who tested positive had little or no formal education which may have contributed to low knowledge of the disease. Intensive public health awareness on the means of transmission, symptoms, signs and effects of contracting the disease, especially among pregnant womenshould be carried out. Also, robust screening should be carried out at the community level in order to have proper record of the number of persons infected. Rapid test kits that are reliable should be made available also.Original Research Article

Seroprevalence of syphilis in human immunodeficiency virus patients

Background: Syphilis is a sexually transmitted infection caused by, Treponema pallidum. Syphilis facilitates the transmission and acquisition of human immunodeficiency virus (HIV) and causes transient increase in the viral load. Sexually transmitted infections (STI) are 3-5 times more likely to acquire HIV infection, if exposed to the virus through sexual contact. Aim of the study was to estimate the seroprevalence of Syphilis in HIV patients.Methods: A total of 920 blood samples were collected from HIV patients attending ART (Antiretroviral therapy) centre and were tested for Syphilis by using Rapid Plasma Reagin (RPR) and Treponema pallidum Hemagglutination Assay (TPHA). A total of 100 HIV non-reactive individuals were taken as a control group.Results: Out of 920 samples, 102 (11.1%) were positive for Syphilis. Out of 102 Syphilis seropositive patients, males (76.5%) were more commonly affected in age group of 21-40 years. Both RPR and TPHA were reactive in 46% of cases and only TPHA reactive in 53.9% of cases. Out of 100 HIV non-reactive patients, 5% of patients are reactive for Syphilis.Conclusions: In the present study, prevalence of Syphilis was more in HIV patients compared to HIV non-reactive persons. Persons with HIV infection acquired through sexual route should be screened for Syphilis by one nonspecific test along with specific test to confirm the diagnosis. This will help in proper management of the patients having Syphilis and HIV co-infection.

Diagnostic accuracy of RPR, FIB-4, APRI and AAR in liver fibrosis patients with chronic hepatitis B / 中国实用内科杂志

OBJECTIVE: We intended to evaluate the diagnostic efficiency of red cell distribution width to platelet ratio(RPR),and compare it with other three markers of fibrosis-4(FIB-4), aspartate aminotransferase-to-platelet-ratio-index(APRI) and aspartateaminotransferase-to-alanine aminotransferase ratio(AAR) for judging liver fibrosis and fibrosis severity in patients with chronic hepatitis B(CHB). METHODS: who had not received antiviral treatment met the requirements of this cross-sectional study. Hematology,biochemistry, virology testing and liver biopsy were performed. Receiver-operating characteristic curves were constructed and the area under the ROC curve was calculated. RESULTS: The cut-off value for distinguishing F0-1, F2-3 and F4 was 0.079, 0.141 and 0.279,respectively(P<0.001) for RPR; 1.194, 3.703 and 4.383(P<0.001) for FIB-4; 0.384, 0.660 and 1.441, respectively(P<0.001) for APRI; and 0.915, 0.850 and 0.960(P=0.706) for AAR. The sensitivity was 76.09% for RPR, 78.26% for FIB-4, 97.83% for AAR and80.43% for APRI; specificity was 81.48% for RPR, 75.93% for FIB-4, 14.81% for AAR and 80.43% for APRI; the AUROC was 0.787 for RPR, 0.778 for FIB-4, 0.540 for AAR and 0.759 for APRI. The common cut-off value was 0.11, 1.94, 0.60 and 0.59 for RPR, FIB-4, AAR and APRI respectively. CONCLUSION: RPR, FIB-4 and APRI have good efficiency in appraising significant and severe fibrosis in patients with CHB, however RPR is superior to FIB-4 and FIB-4 is superior to APRI, therefore, RPR is a better index in evaluating liver cirrhosis.

Comparison of Auto RPR Plus and Auto TPIM Plus with Mediace RPR and Abbott Syphilis TP for Serologic Diagnosis of Syphilis

BACKGROUND: Serologic testing is considered a standard method for syphilis diagnosis. We compared Auto RPR Plus and Auto TPIM Plus with previously developed assays. METHODS: The precision around the cut-off, linearity, and recovery rate of Auto RPR Plus and Auto TPIM Plus was evaluated using their positive/negative control materials. The results of these two tests were compared with those of Mediace RPR and Abbott Syphilis TP using 431 remnant serum samples collected from people who underwent medical examinations. RESULTS: The within-run precisions (coefficient of variation, CV values) of negative/positive control materials of Auto RPR Plus, Mediace RPR, Auto TPIM Plus and Abbott Syphilis TP were 15.7/2.3%, 20.4/2.3%, -/2.7%, and 8.5/2.3%, respectively; between-run precisions were 67.7/3.3%, 39.1/3.4%, -/4.0%, and 7.0/1.5%, respectively. Auto RPR Plus showed better precision around the cutoff level (1.0 U) compared to Mediace RPR (7.2–7.3% vs. 12.2–14.3%). The CVs of Auto TPIM Plus around the cutoff (10.0 U) were 13.5% at 10.5 U and 6.6% at 12.5 U. Agreement rates between Auto RPR Plus and Mediace RPR and between Auto TPIM Plus and Abbott Syphilis TP were 97.2% and 98.4%, respectively. However, twelve samples showed discrepant results for Auto RPR Plus (−)/Mediace RPR (+) and false-positive Mediace RPR results could not be excluded around the cutoff of 1.0 U. CONCLUSIONS: Auto RPR Plus showing good precision near the cutoff can be used for syphilis screening in health checkups. However, Auto TPIM Plus needs improvement in precision and adjusting the cutoff to be used for syphilis screening.

Comparison of Traditional and Reverse Syphilis Screening Algorithms in Medical Health Checkups

BACKGROUND: The syphilis diagnostic algorithms applied in different countries vary significantly depending on the local syphilis epidemiology and other considerations, including the expected workload, the need for automation in the laboratory and budget factors. This study was performed to investigate the efficacy of traditional and reverse syphilis diagnostic algorithms during general health checkups. METHODS: In total, 1,000 blood specimens were obtained from 908 men and 92 women during their regular health checkups. Traditional screening and reverse screening were applied to the same specimens using automatic rapid plasma regain (RPR) and Treponema pallidum latex agglutination (TPLA) tests, respectively. Specimens that were reverse algorithm (TPLA) reactive, were subjected to a second treponemal test performed by using the chemiluminescent microparticle immunoassay (CMIA). RESULTS: Of the 1,000 specimens tested, 68 (6.8%) were reactive by reverse screening (TPLA) compared with 11 (1.1%) by traditional screening (RPR). The traditional algorithm failed to detect 48 specimens [TPLA(+)/RPR(−)/CMIA(+)]. The median TPLA cutoff index (COI) was higher in CMIA-reactive cases than in CMIA-nonreactive cases (90.5 vs 12.5 U). CONCLUSIONS: The reverse screening algorithm could detect the subjects with possible latent syphilis who were not detected by the traditional algorithm. Those individuals could be provided with opportunities for evaluating syphilis during their health checkups. The COI values of the initial TPLA test may be helpful in excluding false-positive TPLA test results in the reverse algorithm.

Surgical treatment with RPR technique for complex hypertrophic obstructive cardiomyopathy / 上海交通大学学报（医学版）

Objective · To evaluate the surgical outcome of RPR composite technique for complex hypertrophic obstructive cardiomyopathy (HOCM). Methods · From June 2009 to December 2015, 9 complex HOCM patients received RPR procedure. There were 6 males and 3 females with age from 22 to 63 years old and the average age of (43±19) years old. Transthorax echocardiography (TTE) showed systolic anterior motion (SAM) and at least moderate mitral valve regurgitation (MR) in all patients before operations. Transesophageal echocardiography (TEE) was used to evaluate the results of procedures during operation. All the patients had been followed up since one week after operation and examined by TTE. Results · All the patients were discharged without complications. Intraoperative TEE indicated that left ventricular outflow tract pressure gradient (LVOTPG) significantly decreased from (92±14) mmHg before operation to (9±3) mmHg after operation (P<0.01). SAM in all the patients disappeared. One week after operation, TTE demonstrated remarkable reduction in the thickness of ventricular septum, LVOTPG and MR than those before operation (P<0.01). Mean follow-up was 26 months. All the patients became asymptomatic. LVOTPG remained low and MR remained mild. There were no deaths, reoperations, or any other adverse consequences. Conclusion · RPR technique is an effective surgical method to relieve LVOTO and MR of complex HOCM to lead a better life.

Comparison of Automated Treponemal and Nontreponemal Test Algorithms as First-Line Syphilis Screening Assays

BACKGROUND: Automated Mediace Treponema pallidum latex agglutination (TPLA) and Mediace rapid plasma reagin (RPR) assays are used by many laboratories for syphilis diagnosis. This study compared the results of the traditional syphilis screening algorithm and a reverse algorithm using automated Mediace RPR or Mediace TPLA as first-line screening assays in subjects undergoing a health checkup. METHODS: Samples from 24,681 persons were included in this study. We routinely performed Mediace RPR and Mediace TPLA simultaneously. Results were analyzed according to both the traditional algorithm and reverse algorithm. Samples with discordant results on the reverse algorithm (e.g., positive Mediace TPLA, negative Mediace RPR) were tested with Treponema pallidum particle agglutination (TPPA). RESULTS: Among the 24,681 samples, 30 (0.1%) were found positive by traditional screening, and 190 (0.8%) by reverse screening. The identified syphilis rate and overall false-positive rate according to the traditional algorithm were lower than those according to the reverse algorithm (0.07% and 0.05% vs. 0.64% and 0.13%, respectively). A total of 173 discordant samples were tested with TPPA by using the reverse algorithm, of which 140 (80.9%) were TPPA positive. CONCLUSIONS: Despite the increased false-positive results in populations with a low prevalence of syphilis, the reverse algorithm detected 140 samples with treponemal antibody that went undetected by the traditional algorithm. The reverse algorithm using Mediace TPLA as a screening test is more sensitive for the detection of syphilis.

Evaluación de las características funcionales del juego de reactivos VDRL Plus / Evaluation of the functional characteristics of the set of reagents called VDRL Plus

Introducción: la prueba de VDRL (venereal disease research laboratories) es una técnica no treponémica de microfloculación en lámina para la detección cualitativa y semicuantitativa de reaginas plasmáticas. El VDRL Plus es un juego de reactivos que contiene una suspensión antigénica estabilizada (no alcohólica), basada en una mezcla de cardiolipina, colesterol y lecitina en tampón fosfato. Objetivo: determinar un conjunto de parámetros funcionales que caracterizan el desempeño diagnóstico o clínico del juego de reactivo VDRL Plus producido en Centro de Isótopos (CENTIS). Métodos: los parámetros del desempeño diagnóstico evaluados fueron: sensibilidad y especificidad diagnóstica, valores predictivos positivo y negativo, razón de verosimilitud positiva y negativa. Se determinaron además los índices de Youden y de concordancia Kappa. Se emplearon como métodos de referencia TPHA (Treponema pallidum hemagglutination) y RPR (rapid plasma reagin)-carbón producidos en el CENTIS. Se utilizaron muestras de sueros obtenidas en diferentes instituciones de salud de La Habana y el estudio se realizó con dos lotes del producto. Resultados: para los dos lotes evaluados se obtuvieron valores de sensibilidad de 100 porciento y de especificidad diagnóstica de 81 y 84 porciento. Los valores predictivos positivos resultaron de 71 y 75 porciento, y los negativos de 100 porciento. Por su parte, las razones de verosimilitud negativas fueron de 0 porciento y las positivas de 5,3 y 6,3 porciento, para cada lote estudiado. Los índices de Youden obtenidos (0,84 y 0,81) y la concordancia expresada mediante Kappa muestran que existe una adecuada correlación entre los resultados con el método en evaluación y los de referencia. Conclusiones: las características funcionales evaluadas evidencian que el diagnosticador VDRL Plus es apto para el uso previsto y que estas son consistentes entre los lotes estudiados

Introduction: the VDRL test (venereal disease research laboratories) is a no-treponemal slide microaglutination test for the qualitative and semi-quantitative detection of plasma reagins in human serum. The VDRL Plus contains non alcoholic stabilized antigen suspension based in cardiolipin, lecithin and cholesterol in phosphate buffer. Objective: to determine a group of functional parameters in the diagnostic or clinical performance of the VDRL Plus set of reagents produced by the Center of Isotopes (CENTIS). Methods: several parameters, such as, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were evaluated. Likewised, Youden and Kappa indexes were calculated. Two references methods were employed, that is, TPHA (Treponema pallidum hemagglutination) and RPR-Carbon (rapid plasma reagin)-carbon, both from CENTIS. Serum samples were collected from several health centers in Havana city. Two different product batches were evaluated. Results: the sensitivity value for both evaluated batches was 100 percent and the specificity was 81 and 84 percent. The positives predictive values were 71 and 75 percent and negative predictive value was 100 percent. The positive likelihood ration were 5.3 and 6,3 percent respectively and negative likelihood ration was 0 percent for both batches. The Youden indexes obtained (0.84 and 0.81) and Kappa's indexes showed that there was an adequate correlation between the results obtained and the evaluation and reference methods. Conclusions: the evaluated functional characteristics showed that they are consistent among studied batches and that the VDRL Plus assay is suitable for the intended use

Analysis of Positive Results in Mediace Rapid Plasma Reagin and Treponema pallidum Latex Agglutination at a University Hospital / 임상검사와정도관리

BACKGROUND: We analyzed the positive rates of Mediace Rapid Plasma Reagin (RPR) (Sekisui, Japan) and Mediace Treponema pallidum Latex Agglutination (TPLA) (Sekisui) assays. Positive results were compared to those of immunochromatography assay (ICA) and fluorescent treponemal antibody absorption (FTA-ABS) tests. METHODS: We used samples of patients visited at a university hospital from April 2010 to May 2011. The rates of positive results were calculated with 36,343 RPR results and 5,934 TPLA results. In addition, 237 positive samples with Mediace RPR or TPLA were re-tested with ICA and FTA-ABS. Mediace RPR and TPLA tests were performed with Toshiba 200-FR Neo (Toshiba, Japan). RESULTS: The rates of positive results were 0.47% (169/36,343) and 3.52% (209/5,934) with RPR and TPLA, respectively. Among the 237 sera that tested positive with RPR or TPLA, 76 were RPR(+)/TPLA(+), 28 were RPR(+)/TPLA(-), and 133 were RPR(-)/TPLA(+). When compared to the ICA results, 86.84% (66/76) of the RPR(+)/TPLA(+) sera were ICA(+), 3.57% (1/28) of the RPR(+)/TPLA(-) sera were ICA(+), and 54.89% (73/133) of the RPR(-)/TPLA(+) sera were ICA(+). Only 67.11% of the TPLA(+) sera demonstrated positive FTA-ABS results. However, 100% of the TPLA(-) sera yielded negative FTA-ABS results. ICA and FTA-ABS had a 96.59% positive agreement rate and an 80.68% negative agreement rate. CONCLUSIONS: These results demonstrate that Mediace TPLA has a low positive agreement rate with FTA-ABS. Although Mediace RPR and TPLA have advantages associated with automated methods, positive results should be confirmed with other treponemal tests, due to the high false positive rates.

Seroprevalencia de Sífilis en embarazadas Alto Parana-2008

Background: Congenital syphilis is acquired from an infected mother in utero or through the birth canal. With the diagnosis of the disease and the advent of penicillin, it becomes a significant reduction. Nontreponemal serologic evidence as the VDRL (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin) are easy to determined, economic cost, are useful for diagnosis and essential to monitor response to treatment, which needs to the study is quantitative. The aim of this study was to investigate the incidence of syphilis infection in the pregnant population in 6 cities of Alto Paraná, in 2008. Materials and methods: Study retrospective, descriptive cross-sectional. We reviewed the files of maternal and child services private and public, of 7,380 pregnant women who attended the pre-natal control 2,028 serology for syphilis. Results: Of a total of 7,380 chips analyzed, 5,310 were public institutions, where 17% of pregnant women, presented in the medical record VDRL test. In private institutions, of 2,070 pregnant, 54% of them had registered VDRL test. In Ciudad del Este, (capital of Alto Paraná) pregnant women in public institutions were 2,445, of which, only 36% made 4 or more controls during pregnancy, 0.80% tested positive for VDRL test, 7.20% was negative and 92% did not record data, this scenario is repeated in all major cities of the department and the percentage is even lower in public institutions. Conclusion: The situation of pregnant women in Alto Paraná is alarming because it represents a significant and unnecessary risk to the newborn, because they account for many years with appropriate pharmacological and economic weapons to avoid.

La sífilis congénita se adquiere a partir de una madre infectada in útero o por el canal del parto. Con el diagnóstico de la enfermedad y el advenimiento de la penicilina, se torna una reducción significativa. Existen pruebas serológicas no treponémicas como el VDRL (Venereal Disease Research Laboratory) o RPR (Rapid Plasma Reagin) fáciles de realizar, tienen escaso costo económico, son útiles para el diagnóstico y esenciales para controlar la respuesta al tratamiento, para lo cual se necesita que el estudio sea cuantitativo. El objetivo del trabajo consistió en investigar la incidencia de la infección por sífilis, en la población embarazada, en 6 ciudades del Alto Paraná, durante el año 2008. Materiales y métodos: Se realizó un estudio retrospectivo, descriptivo, de corte transversal. Se revisaron los archivos de Servicios materno-infantil privado y público, de 7.380 embarazadas que concurrieron al control pre-natal, donde se registraba la serología para sífilis. Resultados: De un total de 7.380 fichas analizadas, 5.310 fueron de Instituciones Públicas, en donde el 17% de las embarazadas, presentaban en la historia clínica registro de test de VDRL. En Instituciones privadas, de 2.028 embarazadas, el 54% de ellas tenían registrado test de VDRL. En Ciudad del Este, (capital del Alto Paraná) las embarazadas de Instituciones Públicas, fueron 2.445, de las cuales: solo el 36% realizaron 4 o más controles durante la gestación, el 0,80% dio positivo el test para VDRL, el 7,20% dio negativo, y 92 % no registra datos, este panorama se repite en las grandes ciudades del departamento y el porcentaje es menor en Instituciones públicas. Conclusión:La situación de las embarazadas en el Alto Paraná es alarmante ya que supone un riesgo importante e innecesario para el recién nacido, debido a que se cuenta, hace muchos años con las armas farmacológicas adecuadas y económicas para evitarlas.

Comparison of Quantitative Results among Two Automated Rapid Plasma Reagin (RPR) Assays and a Manual RPR Test / 대한진단검사의학회지

BACKGROUND: We compared two automated Rapid Plasma Reagin (RPR) assay kits with a manual RPR assay kit to evaluate the possibility of using the two automated RPR assays as an alternative to the manual RPR assay for a quantitative monitoring. METHODS: One hundred eighty-five samples were analyzed, including 16 sera from patients with primary, secondary, and latent syphilis. Measured RPR unit (R.U.) values of two automated RPR assay kits, Mediace RPR (Sekisui Chemical Co., Ltd, Japan) and HBi Auto RPR (HBI Co., Ltd, Korea), were compared with the RPR titers of Macro-Vue RPR card test (Becton Dickinson BD Microbiology systems, USA). As a confirmatory test, Anti-Treponema pallidum EUROLINE WB (IgG) and Anti-Treponema pallidum EUROLINE WB (IgM) (Euroimmun, Germany) were used. RESULTS: There was a prozone effect with Mediace RPR at RPR titer (card test) of 1:16, but not with HBi Auto RPR. The R.U. values of the two automated RPR assays did not show proportional increase to the RPR titer. Agreement between manual RPR and two automated RPR assay kits, Mediace RPR assay and HBi Auto RPR assay, were 83.8% and 83.2%, respectively. CONCLUSIONS: The two automated RPR assay kits could not be used as an alternative to manual RPR test for quantitative analysis of RPR titer. As Mediace RPR shows a prozone effect at relatively low RPR titer, caution is needed in the interpretation of the measured values.

Evaluation of Automated Architect Syphilis TP as a Diagnostic Laboratory Screening Test for Syphilis / 대한진단검사의학회지

BACKGROUND: The aim of the study was to establish a new syphilis test algorithm using Architect Syphilis TP (Abbott Japan, Japan: AST), a fully automated treponemal antibody test, as a screening test in a university hospital laboratory. We evaluated performance characteristics of AST in various patient groups. METHODS: A total of 1,357 serum samples obtained from patients at a university hospital from June to August, 2008 were categorized into checkup, preoperative, other diseases, diagnosis (clinically suspected of syphilis), and follow up groups. We compared the results of AST with those of RPR (N=1,276) or Treponema pallidum hemagglutination assay (TPHA, N=81). Samples with discrepant results between RPR or TPHA and AST were retested by fluorescent treponemal antibody absorption test (FTA-ABS) and all patients' clinical records were thoroughly reviewed. RESULTS: The positive rate of AST was significantly higher than that of RPR in preoperative and other diseases groups and was the same as that of RPR in diagnosis group. There were no significant differences in check up and follow up groups. The results of AST showed 97.4% (1,243/1,276) and 97.5% (79/81) concordance rates with those of RPR and TPHA, respectively. Among 26 RPR-AST discrepant and FTA-ABS confirmed cases, there were 20 RPR false-negatives, 4 RPR false-positives, 1 AST false-negative, and 1 AST false-positive. CONCLUSIONS: Based on the results and literature review, we established a new syphilis test algorithm using AST as a screening test, which would be helpful for detection of more syphilis patients including latent infections.

Evaluation of Performance and False Positivity of Mediace RPR Test that Uses a Chemistry Autoanalyzer / 대한진단검사의학회지

BACKGROUND: We evaluated the performance and false positive rate of Mediace RPR test (Sekisui, Japan), a newly introduced nontreponemal test using a chemistry autoanalyzer. METHODS: The sensitivity of Mediace RPR test was analyzed using sera from 50 patients with syphilis in different stages (8 primary, 7 secondary, and 35 latent), 14 sera positive with fluorescent treponemal antibody absorption (FTA-ABS) IgM, and 74 sera positive with conventional rapid plasma regain (RPR) card test (Asan, Korea) and also positive with Treponema pallidum hemagglutination (TPHA) test or FTA-ABS IgG test. The specificity was analyzed on 108 healthy blood donors. We also performed RPR card test on 302 sera that had been tested positive with Mediace RPR test and also performed TPHA or FTA-ABS IgG test to analyze the false positive rate of Mediace RPR test. A cutoff value of 0.5 R.U. (RPR unit) was used for Mediace RPR test. RESULTS: Mediace RPR test on syphilitic sera of different stages (primary, secondary, and latent stages) and FTA-ABS IgM positive sera showed a sensitivity of 100%, 100%, 82.9% and 100%, respectively. Among the 74 sera positive with conventional RPR card test and TPHA or FTA-ABS IgG test, 55 were positive with Mediace test. The specificity of Mediace RPR test on blood donors was 97.2%. Among the 302 sera positive with Mediace RPR test, 137 sera (45.4%) were negative by RPR card and TPHA/FTA-ABS IgG tests. CONCLUSIONS: Although the sensitivities of Mediace RPR were good for primary and secondary syphilis, due to its high negative rate of Mediace RPR over the conventional RPR positive samples, further studies are necessary whether it can replace conventional nontreponemal test for screening purpose. Moreover, in view of the high false positive rate, positive results by Mediace RPR test should be confirmed with treponemal tests.

Analysis of Positive Results in Mediace Rapid Plasma Reagin and Treponema pallidum Latex Agglutination as the Automated Syphilis Test / 대한진단검사의학회지

BACKGROUND: We compared the results of automated and quantitative methods for the diagnosis of syphilis, Mediace Rapid Plasma Reagin (RPR) and Mediace Treponema pallidum Latex Agglutination (TPLA) (Sekisui Chemical Co., Ltd, Japan) with those of conventional methods. METHODS: Sera from 3,896 persons who had health checkups between December 2005 and November 2006 were included in the evaluation of positive rates and biological false positives (BFP) for Mediace RPR and TPLA. In addition, 134 patients' sera positive for automated Mediace RPR or TPLA were tested for VDRL and TPHA. Discrepancies between TPLA and TPHA results were confirmed by the RecomBlot Treponemal IgG/IgM (Mikrogen GmbH, Germany). Automated Mediace RPR and TPLA were performed using the Hitachi 7600 chemistry autoanalyzer (Hitachi, Japan). Samples with positive Mediace RPR and negative TPLA results were defined as BFP. RESULTS: Positive rate of automated Mediace RPR was 0.23% (9/3,896). BFP of the Mediace RPR was 0.18%. Positive rate of automated TPLA was 1.62% (37/2,284). Among the 134 patients' sera, 33 (24.6%) showed a discrepancy between conventional VDRL and automated Mediace RPR results: Among 31 Mediace RPR(+)/VDRL(-) sera, 13 were positive and 18 were negative for TPLA. The remaining 2 sera of discrepancy with Mediace RPR(-)/VDRL(+) were all positive for TPLA. There were seven sera that showed a discrepancy between automated TPLA and TPHA results: Two sera with Mediace RPR(+)/TPLA(-)/TPHA(+) showed negative recomBlot Treponemal IgG/IgM results, and among five sera with TPLA(+)/TPHA(-), three demonstrated IgG or IgM by recomBlot Treponemal IgG/IgM. CONCLUSIONS: The results of comparison data demonstrated that automated TPLA results had a high concordance with recomBlot Treponemal IgG/IgM results. Moreover, there are additional advantages of automated methods such as quantitative detection, low infection risk, and no influence by human handling.

Evaluation of IMMUNOTICLES Auto3RPR and Auto3TP for Testing of Syphilis Infection / 임상검사와정도관리

BACKGROUND: The serologic tests for syphilis infection have been performed manually, but the procedures are time-consuming and interpretations may be subjective. Recently, automated assays were developed for rapid and efficient testing for syphilis infection. In this study, we evaluated the performances of IMMUNOTICLES Auto3 RPR and Auto3TP (A&T Corporation, Japan) using latex agglutination turbidimetry method. METHODS: Using 236 serum samples referred for syphilis at Ewha Womans University, Mokdong Hospital, between March 2004 and April 2007, we evaluated precision, linearity, detection limit and compared with the results of manual serologic tests, RPR (RPR card test, ASAN Pharmaceutical, Korea) and TPHA (ASAN-TPHA, ASAN Pharmaceutical). RESULTS: The within-run and between day precisions of Auto3RPR and Auto3TP were from 2.1% to 4.8%. The linearity was good up to 5.0 RU for Auto3RPR and to 250 TU for Auto3TP. Agreement of Auto3RPR with RPR was 65.7% (155/236) and 32.6% of patients (77/236) were RPR positive and Auto3RPR negative. RPR titers were less than 1:8 in 99% of these discrepant samples (76/77) and 65% (50/77) were latent infection and the others were false positive (32%, 27/77). Agreement of Auto3TP with TPHA was 97.1%. CONCLUSIONS: IMMUNOTICLES Auto3RPR and Auto3TP may be useful for rapid and efficient testing for syphilis. However, discrepant results were present in patients with low titer RPR positivity and method of reporting shoud be considered in individual clinical situation. In addition, linear range was not wide and further study is needed for reporting of quantitative results.

Serologic Test for Syphilis by Mediace RPR Test for Chemistry Autoanalyzer / 임상검사와정도관리

BACKGROUND: Mediace RPR test for chemistry autoanalyzer, a nontreponemal serologic test for syphilis, was recently introduced in Korea. We evaluated the performance of Mediace RPR test. METHODS: For the evaluation of precision, within-run and total coefficient variations were analyzed. Two hundred and one sera were tested by Mediace RPR test to investigate the distribution of Mediace RPR titers in healthy subjects. Mediace RPR test was compared with RPR card test using 126 sera. RESULTS: Total coefficient variations for positive control, negative control and pooled sera were 9.1%, 46.6% and 35.3%, respectively. The results of Mediace RPR test in healthy subjects showed 0.44+/-0.28 (mean+/-standard deviation) RPR unit (RU), and the positive rate was 3.5% (7/201). The agreement between Mediace RPR test and RPR card test was 73%. In some of the sera with a result of greater than 4.0 RU, Mediace RPR test showed markedly lower results than that of RPR card quantitative test. CONCLUSION: Mediace RPR test has the advantages that it is useful for screening large number of samples and the results are objective. Mediace RPR test can be used as a quantitative test in sera with low titers. Dilution is needed to determine high titers in sera. Adjusting cutoff for the setting of individual hospital is maybe helpful.

Evaluation of Treponema pallidum antibody test in blood donors / 대한수혈학회지

BACKGROUND: Current serologic tests for Syphilis(STS) in the blood donors are Veneral Disease Reseach Laboratory(VDRL), Rapid Plasma Reagin(RPR) test or Groupamatic Automated Syphilis Test(GAST) using modified VDRL antigen as screening method, and Treponema Pallidum Hemagglutination(TPHA) test as a confirmatory method in Korean Red Cross Blood Centers. This study was carried out to evaluate the usefulness of Enzyme Immunoassay(EIA) as STS in blood donors. METHODS: A total of 11,335 donors s serum samples were tested by RPR and GAST. We analyzed 138 samples including 6 samples of anti-treponema pallidum panel with TPHA and EIA to compare as a confirmatory test. RESULTS: The positive rate of RPR and GAST in 11,335 samples were 0.68%, 0.24%, respectively. Confirmed positive rates by TPHA was 0.26%, and by EIA was 0.27%. False negative results of GAST were 0.11% and 0.13%, respectively according to the results of TPHA and EIA. The agreement between TPHA and EIA was 98.5%(130/132). CONCLUSION: The EIA results were comparable with RPR, GAST and TPHA test. It is considered that EIA method for STS would be alternative one for TPHA as a conformative test because there was excellent agreement between TPHA and EIA method, and EIA method showed almost same results as that of TPHA test.

Effect of compatibility with warming-inside drugs on paeoniflorin in mouse plasma / 中草药

Objective To establish a RP-HPLC method for the determination of the blood concentration of paeoniflorin which was produced by seven kinds of warming-inside drugs (WID) being used with the promoting-blood drugs (PBD) individually and to explore the mechanism of PBD and WID compound prescription. Methods The blood concentration of peaoniflorin in mouse plasma was determined by HPLC after ig seven kinds of WID being compatible with Radix Paeoniae Rubra (RPR) to mice separately. Results Fructus Piperis (FP), Cortex Cinnamoni (CC), Fructus Evodiae (FE), Fructus Foeniculi (FF), and Pericarpium Zanthoxyli (PZ) compound prescription with RPR can increase the blood concentration of paeoniflorin in different degrees (P

Contrast analysis of FTIR fingerprints of Radix Paeoniae Rubra from different areas / 中草药

Object To develop a new method of discriminating the principle components of Radix Paeoniae Rubra (RPR) from different areas, and to find the reason for forming high-quality of RPR in the place of the genuine. Methods Using Foruier transform infrared (FTIR) absorption spectrometry, the characteristic peaks of fingerprint infrared spectra of RPR samples from 18 habitats were recognized and compared. Results Frequency, intensity and shape of infrared absorption spectra were obviously different between wild and cultivated groups of RPR. The infrared absorption peaks of RPR in Duolun, a famous Chinese orthodox drug, were of distinct characteristics. Conclusion FTIR technique is first applied to rapid analysis of principle component of RPR from different areas. So an operable method in the quality control and discrimination of RPR in the place of the genuine is provided.