The performance of saliva test strips for determining ethanol levels, as compared to gas chromatography and breathalyser methods.

We set out to determine the performance of the Testi Technologies enzymatic assay saliva ethanol test strips of three different detection levels: 0 g/L, 0.2 g/L and 0.5 g/L, using as the reference method a gas chromatography analyser (GC). Alcohol levels were measured in 104 volunteers at up to three points in time, using up to three test strips per measurement, while gathering blood samples and breathalyser readings in parallel. The plasma alcohol concentrations (PAC) were determined from the plasma samples using GC. The qualitative results of the test strips were compared to the quantitative results from the reference method, as well as the breathalyser readings, and the amount of true and false positive and true and false negative results were classified using predetermined cut-off levels. The best performing test strips were the 0 g/L and the 0.2 g/L strips. The 0 g/L strips had a sensitivity and specificity of 1.00, as false negatives and false positives were not detected. The 0.2 g/L strips had a sensitivity and specificity [95% confidence interval (CI)] of 0.98 (0.96 - 1.00) and 0.83 (0.62 - 1.00) respectively, an accuracy of 0.97 (0.95 - 0.99), and a diagnostic odds ratio of 205.00 (35.33 - 1189.66). The test strips perform their intended purpose of screening for alcohol consumption well, with their great sensitivity as a defining property compared to other testing methods. For them to be able to be implemented in a clinical setting however, further refinement of the tests' characteristics would be required.

Clinical Diagnostics of Fecal Calprotectin: a Comparative Study of Actim® Calprotectin and LIAISON® Calprotectin.

BACKGROUND: Fecal calprotectin (fCal) is an important surrogate biomarker of chronic inflammatory bowel disease (IBD): Crohn's disease and ulcerative colitis. Non-invasive, immunochromatographic rapid tests are excellent tools for the real-time monitoring of disease activity and reduce the need for invasive and costly colonoscopy procedures. METHODS: In this study the accuracy of fCal detection by the semi-quantitative Actim® Calprotectin and the quantitative automated LIAISON® Calprotectin assay was assessed on a panel of clinical stool samples. RESULTS: Of the 119 fecal samples tested, Actim® Calprotectin agreed on 94 samples (79.0%) with the reference test. Furthermore, of the positive samples detected with LIAISON® Calprotectin, 94.0% were interpreted as positive by Actim® Calprotectin. CONCLUSIONS: Actim® Calprotectin is a rapid test that can be utilized for the initial differentiation between negative and positive samples in an outpatient setting, thus helping to limit more laborious quantitative methods to positive samples.

Sensitive and quantitative detection of cardiac troponin I with upconverting nanoparticle lateral flow test with minimized interference.

Measurement of cardiac troponin I (cTnI) should be feasible for point-of-care testing (POCT) to diagnose acute myocardial infarction (AMI). Lateral flow immunoassays (LFIAs) have been long implemented in POCT and clinical settings. However, sensitivity, matrix effect and quantitation in lateral flow immunoassays (LFIAs) have been major limiting factors. The performance of LFIAs can be improved with upconverting nanoparticle (UCNP) reporters. Here we report a new methodological approach to quantify cTnI using UCNP-LFIA technology with minimized plasma interference. The performance of the developed UCNP-LFIA was evaluated using clinical plasma samples (n = 262). The developed UCNP-LFIA was compared to two reference assays, the Siemens Advia Centaur assay and an in-house well-based cTnI assay. By introducing an anti-IgM scrub line and dried EDTA in the LFIA strip, the detection of cTnI in plasma samples was fully recovered. The UCNP-LFIA was able to quantify cTnI concentrations in patient samples within the range of 30-10,000 ng/L. The LoB and LoD of the UCNP-LFIA were 8.4 ng/L and 30 ng/L. The method comparisons showed good correlation (Spearman's correlation 0.956 and 0.949, p < 0.0001). The developed UCNP-LFIA had LoD suitable for ruling in AMI in patients with elevated cTnI levels and was able to quantify cTnI concentrations in patient samples. The technology has potential to provide simple and rapid assay for POCT in ED setting.

Leptin predicts short-term major adverse cardiac events in patients with coronary artery disease.

INTRODUCTION: Leptin is an adipose tissue-derived hormone associated with cardiovascular risk factors. We examined whether leptin predicts major adverse cardiac events (MACE) in coronary artery disease (CAD) patients. METHODS: Fasting plasma leptin levels were measured in 1327 male and 619 female CAD patients. The patients were followed up for two years. The primary endpoint (MACE) was the composite of a hospitalisation for congestive heart failure (CHF) or a cardiac death. The secondary endpoint was the composite of an acute coronary syndrome (ACS) or a stroke. RESULTS: In regression analysis including established risk variables, high leptin levels were associated with a significantly increased risk of MACE (HR 3.37; 95%CI 1.64-6.90; p = 0.001) and ACS or stroke (HR 1.95; 95%CI 1.29-2.96; p = 0.002). Adding leptin to the risk model for MACE increased the C-index from 0.78 (95%CI 0.71-0.85) to 0.81 (0.74-0.88) and improved classification (NRI 0.36; 95%CI 0.13-0.60; p = 0.002) and discrimination of the patients (IDI 0.016; 95%CI 0.001-0.030; p = 0.031). CONCLUSIONS: High plasma leptin levels predict short-term occurrence of CHF or cardiac death and ACS or stroke in patients with CAD independently of established risk factors. The possible harmful effects of leptin should be thoroughly investigated. Key messages Leptin is a peptide hormone secreted mainly by adipose tissue. It has been associated with several cardiovascular risk factors. High leptin levels predict the short-term occurrence of congestive heart failure or cardiac death and ACS or stroke in patients with CAD independently of established risk factors. The possible detrimental effects of leptin on the cardiovascular system should be thoroughly investigated.

Serum ghrelin and prediction of metabolic parameters in over 20-year follow-up.

Ghrelin is a peptide hormone from the stomach, with an ability to release growth-hormone from the pituitary. Numerous cross-sectional studies indicate that ghrelin also has a role in metabolic abnormalities, such as metabolic syndrome and type 2 diabetes, but evidence for long-term effect is scarce. We investigated, whether ghrelin concentration measured in middle age would predict the development or absence of metabolic disturbances subsequently. Study population consisted of 600 middle-aged persons, and the follow-up time was approximately 21 years. Plasma total ghrelin concentration was measured at the baseline, and divided to tertiles. Numerous anthropometric and other clinical measurements (including blood pressure), and laboratory test were made both at the baseline and at the follow-up. After the follow-up the prevalence of high systolic blood pressure according to MetS IDF-criteria was the lowest in the highest ghrelin tertile, and the highest in the first (p<0.03). When only subjects free of hypertension medication at baseline were considered, subjects belonging to the highest ghrelin tertile developed less new hypertension and high blood pressure according to IDF-criteria as well as medication for it during the follow-up (p<0.05). Although serum insulin levels were negatively correlated to ghrelin levels at both points in time (p<0.001 at baseline and p=0.003 at follow-up), plasma ghrelin concentration did not predict the development of abnormalities in glucose tolerance. The association with ghrelin and metabolic syndrome was lost during the follow-up. In conclusion, our results suggest high ghrelin to be protective against the development of hypertension in the long-term follow-up.

Evaluation of a hand-held blood gas analyzer for rapid determination of blood gases, electrolytes and metabolites in intensive care setting.

BACKGROUND: Intensive care units, operating rooms, emergency departments, and neonatology units need rapid measurements of blood gases, electrolytes, and metabolites. These analyses can be performed in a central laboratory or at the clinic with traditional or compact cassette-type blood gas analyzers such as the epoc blood gas testing system for analyzing whole blood samples at the bedside. In this study, the performance and interchangeability of a hand-held epoc blood gas analyzer was evaluated. METHODS: The analytical performance of the epoc analyzer was evaluated by determining within-and between-run precisions. The accuracy of the epoc analyzer was assessed by comparing patient results from the device with those obtained with the Siemens Rapidlab 1265 and Rapidpoint RP500 and Siemens Dimension Vista and Sysmex XE-2100 analyzers. The following parameters were measured: pH, pCO2, pO2, Hb (calc), Na+, K+, iCa2+, glucose, and lactate. RESULTS: The CV% of the epoc's between-day imprecision for the various parameters varied from 0.4 to 8.6. The within-run imprecision CV% varied from 0.6 to 5.2. The squared regression coefficient (R2) between the epoc and RL1265 varied from 0.94 to 0.99, with the exception of Na+ and Ca2+ (R2≥0.82). The correlation (R2) of Na+ and K+ between epoc and Dimension Vista was 0.73 and 0.89, respectively. The correlation (R2) of Hb between the epoc and the XE-2100 analyzer was 0.94. CONCLUSIONS: With most of the measured blood gas parameters, the epoc analyzer correlated well with reference techniques. The epoc analyzer is suitable for rapid measurement of the blood gases, the electrolytes, and the metabolites in the ICU.

Skeletal troponin I cross-reactivity in different cardiac troponin I assay versions.

OBJECTIVES: To study the skeletal troponin I (skTnI) cross-reactivity of four different commercially available antibodies in four cardiac troponin I (cTnI) research assay versions having the same epitope specificity as evidenced by peptide mapping. DESIGN AND METHODS: The four research assays all use two solid phase antibodies and one detection antibody attached to intrinsically fluorescent nanoparticles. Two alternative antibodies were used for one capture antibody and two for the detector antibody. The assays were evaluated in terms of analytical sensitivity and by determining assay cross-reactivity to skTnI. Additionally, regression analysis was performed by measuring a sample panel (n=101) with all of the four assay versions. RESULTS: A false-positive cTnI concentration of >7000ng/L was measured with one of the assay versions, when serum was spiked with 500,000ng/L skTnI. The corresponding observed cTnI values for the other three assay versions varied from 616ng/L to 727ng/L. Out of the 101 clinical samples assayed, five showed spuriously (3- to 148-fold) elevated cTnI values with the skTnI interference prone assay setup, but not with the other assay versions. According to our investigational skTnI assay, all five samples contained measurable amounts of skTnI (range: 5500-702,000ng/L). CONCLUSIONS: Two out of four cTnI antibodies tested cross-reacted vastly with skTnI but did not cause any notable interference unless paired together. Therefore, skTnI cross-reactivity should be carefully assessed when cTnI assay antibodies claimed to be cTnI specific are selected.

Chimeric recombinant antibody fragments in cardiac troponin I immunoassay.

OBJECTIVES: To introduce a novel nanoparticle-based immunoassay for cardiac troponin I (cTnI) utilizing chimeric antibody fragments and to demonstrate that removal of antibody Fc-part and antibody chimerization decrease matrix related interferences. DESIGN AND METHODS: A sandwich-type immunoassay for cTnI based on recombinant chimeric (mouse variable/human constant) antigen binding (cFab) antibodies and intrinsically fluorescent nanoparticles was developed. To test whether using chimeric antibody fragments helps to avoid matrix related interferences, samples (n=39) with known amounts of triglycerides, bilirubin, rheumatoid factor (RF) or human anti-mouse antibodies (HAMAs) were measured with the novel assay, along with a previously published nanoparticle-based research assay with the same antibody epitopes. RESULTS: The limit of detection (LoD) was 3.30ng/L. Within-laboratory precision for 29ng/L and 2819ng/L cTnI were 13.7% and 15.9%, respectively. Regression analysis with Siemens ADVIA Centaur® yielded a slope (95% confidence intervals) of 0.18 (0.17-1.19) and a y-intercept of 1.94 (-1.28-3.91) ng/L. When compared to a previously published nanoparticle-based assay, the novel assay showed substantially reduced interference in the tested interference prone samples, 15.4 vs. 51.3%. A rheumatoid factor containing sample was decreased from 241ng/L to

Determinants and prognostic value of cardiovascular autonomic function in coronary artery disease patients with and without type 2 diabetes.

OBJECTIVE Cardiovascular autonomic dysfunction is a common finding among patients with coronary artery disease (CAD) and type 2 diabetes (T2D). The reasons and prognostic value of autonomic dysfunction in CAD patients with T2D are not well known. RESEARCH DESIGN AND METHODS We examined the association between heart rate recovery (HRR), 24-h heart rate (HR) variability (SD of normal R-R interval [SDNN]), and HR turbulence (HRT), and echocardiographic parameters, metabolic, inflammatory, and coronary risk variables, exercise capacity, and the presence of T2D among 1,060 patients with CAD (mean age 67 ± 8 years; 69% males; 50% patients with T2D). Second, we investigated how autonomic function predicts a composite end point of cardiovascular death, acute coronary event, stroke, and hospitalization for heart failure during a 2-year follow-up. RESULTS In multiple linear regression model, exercise capacity was a strong predictor of HRR (R = 0.34, P < 0.001), SDNN (R = 0.33, P < 0.001), and HRT (R = 0.13, P = 0.001). In univariate analyses, a composite end point was predicted by reduced HRR (hazard ratio 1.7 [95% CI 1.1-2.6]; P = 0.020), reduced SDNN (2.0 [95% CI 1.2-3.1]; P = 0.005), and blunted HRT (2.1 [1.3-3.4]; P = 0.003) only in patients with T2D. After multivariate adjustment, none of the autonomic markers predicted the end point, but high-sensitivity C-reactive protein (hs-CRP) remained an independent predictor. CONCLUSIONS Cardiovascular autonomic function in CAD patients is associated with several variables, including exercise capacity. Autonomic dysfunction predicts short-term cardiovascular events among CAD patients with T2D, but it is not as strong an independent predictor as hs-CRP.

Serum osteoprotegerin and periodontal destruction in subjects with type 1 diabetes mellitus.

AIM: Besides their role in bone metabolism, receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) are also known to be associated with inflammation. We explored associations between the extent/severity of periodontitis and circulating levels of sRANKL and OPG and their ratio using a cross-sectional study design. SUBJECTS & METHODS: The extent of periodontal inflammation and tissue destruction and the serum levels of sRANKL (pg/ml) and OPG (pg/ml) were determined in 80 subjects with type 1 diabetes mellitus (T1DM). Plaque-, age-, gender-, smoking-, HbA1c- and body mass index-adjusted associations between periodontal parameters and serum sRANKL, OPG and their ratio were studied using multiple linear regression analysis. RESULTS: Adjusted regression analyses of all the subjects indicated a significant positive association between AL ≥ 4 mm and severity of periodontitis and the level of serum OPG. A major drop in the strength and statistical significance of the above association was observed when the analyses included only non-smokers. Serum sRANKL level and sRANKL/OPG ratio were not associated with periodontitis. CONCLUSION: Our observations suggest that serum OPG may be an indicator of periodontal tissue destruction in T1DM.

Rapid and sensitive cardiac troponin I immunoassay based on fluorescent europium(III)-chelate-dyed nanoparticles.

BACKGROUND: Cardiac troponins are the preferred and recommended biomarkers of myocardial infarction. Unfortunately, most of the current commercial assays do not meet the guideline recommendations for sensitivity and low-end precision. Therefore, improvements in their analytical performance are still needed. METHODS: Cardiac troponin I (cTnI) immunoassay was developed. The assay utilized a monoclonal antibody and a F(ab')(2) antibody fragment immobilized onto the microtiter wells for capturing, and a monoclonal antibody covalently conjugated to fluorescent europium(III)-chelate-dyed nanoparticles for detecting. Following a 15-min incubation of the sample and nanoparticle-bioconjugates in the capture wells, cTnI was quantified directly from the washed well surface by time-resolved fluorometry. RESULTS: The limits of detection and quantification were 0.0020 µg/l and 0.012 µg/l, respectively. The response was linear in the measured range of 0.003-9.6 µg/l. The within-run imprecisions were 9.8, 5.1, 7.7 and 5.4%, and the total imprecisions were 13.1, 10.4, 9.0 and 8.7% at cTnI levels of 0.007, 0.051, 0.52 and 2.62 µg/l, respectively. Plasma recoveries of added cTnI were 72-119%. Regression analysis with Innotrac Aio! 2nd generation cTnI assay yielded a slope (95% confidence intervals) of 1.197 (1.141 to 1.253) and y-intercept of 0.216 (-0.128 to 0.561)µg/l (S(yx) = 2.176 µg/l, n = 212, r = 0.945). CONCLUSIONS: The developed immunoassay based on europium(III)-chelate-dyed nanoparticle label allows rapid and sensitive measurement of cTnI.

The interplay between lipoprotein phenotypes, adiponectin, and alcohol consumption.

CONTEXT AND OBJECTIVE: Lipoproteins are involved in the pathophysiology of several metabolic diseases. Here we focus on the interplay between lipoprotein metabolism and adiponectin with the extension of alcohol intake. DESIGN AND SUBJECTS: Eighty-three low-to-moderate and 80 heavy alcohol drinkers were studied. Plasma adiponectin, other biochemical and extensive lipoprotein data were measured. Self-organizing maps were applied to characterize lipoprotein phenotypes and their interrelationships with biochemical measures and alcohol consumption. RESULTS: Alcohol consumption and plasma adiponectin had a strong positive association. Heavy alcohol consumption was associated with decreased low-density lipoprotein cholesterol (LDL-C). Nevertheless, two distinct lipoprotein phenotypes were identified, one with elevated high-density lipoprotein cholesterol (HDL-C) and decreased very-low-density lipoprotein triglycerides (VLDL-TG) together with low prevalence of metabolic syndrome, and the other vice versa. The HDL particles were enlarged in both phenotypes related to the heavy drinkers. The low-to-moderate alcohol drinkers were characterized with high LDL-C and C-enriched LDL particles. CONCLUSIONS: The analyses per se illustrated the multi-faceted and non-linear nature of lipoprotein metabolism. The heavy alcohol drinkers were characterized either by an anti-atherogenic lipoprotein phenotype (with also the highest adiponectin concentrations) or by a phenotype with pro-atherogenic and metabolic syndrome-like features. Clinically this underlines the need to distinguish the differing individual risk for lipid-related metabolic disturbances also in heavy alcohol drinkers.

Serum high-density lipoprotein cholesterol level associated with the extent of periodontal inflammation in type 1 diabetic subjects.

AIM: High-density lipoprotein (HDL) cholesterol is known for its anti-inflammatory and antioxidant activities in protection against cardiovascular diseases. We investigated whether a protective association also exists between serum HDL and periodontal inflammation in type 1 diabetic subjects (T1DM). METHODS: Plaque and periodontal inflammation (bleeding and PD ≥ 4 mm) were examined in 80 subjects with T1DM. The serum levels of glycosylated haemoglobin (HbA1c, %) and HDL (mmol/l) were determined. Adjusted associations between inflammation and serum HDL were analysed using linear regression analysis. To study the linearity of the association, the subjects were categorized into HDL tertiles (I-III). RESULTS: A statistically significant negative association was observed between serum HDL level and the extent of bleeding and PD ≥ 4 mm. Subjects in HDL tertiles II and III (high HDL) presented significantly fewer inflamed sites when compared with the subjects in tertile I (low HDL), whereas no significant difference in the number of inflamed sites was observed between tertiles II and III. CONCLUSIONS: Based on the finding of a negative association between serum HDL and periodontal inflammation, HDL may be considered a marker of susceptibility to periodontal inflammation. A longitudinal study is needed to verify possible causal relationship between serum HDL and inflammation.

Serum interleukin-6 may modulate periodontal inflammation in type 1 diabetic subjects.

AIMS: To evaluate the associations between serum inflammatory biomarkers and periodontal inflammation in subjects with type 1 diabetes mellitus (T1DM). Our hypothesis was that local host responses may be modulated by the serum inflammatory mediators. MATERIAL AND METHODS: Plaque, bleeding on probing and probing pocket depth (PD) were examined in 80 T1DM subjects at the baseline and in 58 subjects 8 weeks after periodontal therapy. The levels of glycosylated haemoglobin, serum interleukin (IL)-6, ultrasensitive C-reactive protein and the lipid profile were measured at the baseline and after therapy. Stratification of the sample separately by smoking and body mass index (BMI) was performed. Adjusted associations between the levels of systemic biomarkers and periodontal parameters were studied using multiple regression models. RESULTS: The level of serum IL-6 was associated with the extent of bleeding and PD≥4 mm at the baseline in non-smokers and in subjects with BMI≤26 kg/m(2). These associations were also evident after periodontal therapy. Subjects with a high after-therapy IL-6 level presented poorer periodontal healing than those with a low level. CONCLUSIONS: The observed associations may be considered to be suggestive of a modulatory effect of IL-6 on host responses in T1DM subjects.

Effects of intracoronary injection of autologous bone marrow-derived stem cells on natriuretic peptides and inflammatory markers in patients with acute ST-elevation myocardial infarction.

BACKGROUND: Intracoronary administration of autologous bone marrow stem cells (BMC) has been shown to result in a subtle improvement of global left ventricular ejection fraction after ST-elevation myocardial infarction (STEMI), but the overall benefits of BMC therapy are still unclear. We studied the influence of intracoronary injections of BMC on levels of natriuretic peptides and inflammatory mediators, which are well established prognostic biomarkers, in patients with STEMI. METHODS: In this randomized, double-blind study, consecutive patients with an acute STEMI treated with thrombolysis followed by PCI 2-6 days after STEMI, were randomly assigned to receive either intracoronary BMC or placebo medium into the infarct-related artery. Blood samples were drawn for biochemical determinations. RESULTS: From baseline to 6 months, there was a significant decrease in the levels of N-terminal probrain natriuretic peptide (NT-proBNP), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) in the whole patient population (P < 0.001 for all). However, no difference was observed between the BMC group (n = 39) and the placebo group (n = 39) in the change of the levels of NT-proANP (median -54 vs. +112 pmol/L), NT-proBNP (-88 vs. -115 pmol/L) or inflammatory markers IL-6 (-3.86 vs. -5.61 pg/mL), hsCRP (-20.29 vs. -22.36 mg/L) and tumor necrosis factor α (-0.12 vs. -0.80 pg/mL) between baseline and 6 months. CONCLUSION: Intracoronary BMC therapy does not appear to exert any significant effects on the secretion of natriuretic peptides or inflammatory biomarkers in STEMI patients.

Feasibility of videoconferencing in lifestyle group counselling.

OBJECTIVES: The rapid increase in the prevalence of type 2 diabetes (T2D) has created an urgent need to develop new practices to prevent and treat it. One possibility is to provide specialists services to remote areas through videoconferencing (VC). Therefore, the aim was to study the feasibility of short-term group counselling by a clinical nutritionist (4 sessions at 1.5-hour each at 2-week intervals from baseline, and the session 5 at 6 months) performed by videoconferencing (VC). STUDY DESIGN: We recruited 74 subjects at high risk of T2D, and compiled 5 VC groups (each group included 5-9 subjects, total n=33) and 6 face-to-face groups (FF, total n=44). The subjects were also asked to participate in a follow-up visit 15 months after the last counselling session. METHODS: Data were collected by a questionnaire (satisfaction with group counselling via videoconferencing), by theme interviews (experiences on group counselling) and by metabolic measures (laboratory tests). RESULTS: Only one of the 74 subjects dropped out during the first 6 months. The proportion of subjects who had received social support from group peers was higher in the videoconferencing group than in the face-to-face groups (p=0.001). The experiences of group counselling transmitted by videoconferencing were positive. Waist circumference decreased significantly at 0 to 6 months of counselling (p<0.01), and was significantly lower at 21 months than at baseline in FF groups (p=0.015). However, no significant differences were observed in most of the measurements between VC and face-to-face groups. CONCLUSIONS: Short-term group counselling by a clinical nutritionist through videoconferencing is a feasible way and a practical model to provide specialists services to remote areas, and thus can be used as an option to diminish inequality related to restricted health care services in sparsely inhabited areas.

The relationships between high-sensitivity C-reactive protein and incident depressed mood among older adults.

Abstract Background. High levels of high-sensitivity C-reactive protein (hs-CRP) are associated with depressed mood, but the causal relationships are not known. Therefore, we examined the relationships between hs-CRP and incident depressed mood among the elderly. Methods. Altogether 764 (69%) individuals out of a representative sample of subjects aged 70 years or older (N = 1113) were screened with the Short Zung Self Rating Depression Scale (SZSRDS), and serum hs-CRP determinations were done at the same time. After a two-and-a-half-year follow-up, the SZSRDS examinations were repeated among those who were free of depressed mood (SZSRDS score >or=28 or use of an anti-depressant drug) at the baseline (N = 404). Analysis of covariance (ANCOVA) and logistic regression were used to analyse the relationship between the baseline hs-CRP (<1, 1 < 3, 3 <10 mg/L) and the follow-up SZSRDS scores (10-40) and depressed mood. Results. Baseline hs-CRP was not associated with an increasing trend in SZSRDS scores and depressed mood in the total study population, but there was a significant gender interaction. Among the men, elevated hs-CRP was associated with an increasing trend in the SZSRDS score and depressed mood. Conclusions. High hs-CRP predicts a higher incident SZSRDS score and depressed mood among older men, suggesting a possible inflammatory etiology for depression.

Determinants of functional recovery after myocardial infarction of patients treated with bone marrow-derived stem cells after thrombolytic therapy.

OBJECTIVE: To assess the determinants of functional recovery in patients with ST-elevation myocardial infarction (STEMI) treated initially with thrombolysis, followed by percutaneous coronary intervention and intracoronary injection of bone marrow-derived stem cells (BMC). DESIGN: A randomised, placebo-controlled, double-blind study (substudy of FINCELL). SETTING: Two tertiary cardiac centres. PARTICIPANTS: 78 patients with STEMI randomly assigned to receive either intracoronary BMC (n=39) or placebo (n=39) into the infarct-related artery. INTERVENTIONS: Thrombolysis a few hours after symptom onset, percutaneous coronary intervention and intracoronary injection of BMC 2-6 days later. MAIN OUTCOME MEASURES: Efficacy of the BMC treatment was assessed by measurement of the change of global left ventricular ejection fraction (LVEF) from baseline to 6 months after STEMI. Various predefined variables (eg, the levels of certain natriuretic peptides and inflammatory cytokines) were analysed as determinants of improvement of LVEF. RESULTS: In the BMC group, the most powerful determinant of the change in LVEF was the baseline LVEF (r=-0.58, p<0.001). Patients with baseline LVEF at or below the median (< or = 62.5%) experienced a more marked improvement in LVEF (+12.7 + or - 12.5 %units, p<0.001) than those above the median (-0.8 + or - 6.3 %units, p=0.10). Elevated N-terminal probrain natriuretic peptide (p<0.001) and N-terminal proatrial natriuretic peptide (p=0.052) levels were also associated with improvement in LVEF in the BMC group but not in the placebo group. CONCLUSIONS: The global LVEF recovers most significantly after intracoronary infusion of BMC in patients with the most severe impairment of LVEF on admission. The baseline levels of natriuretic peptides seem also to be associated with LVEF recovery after BMC treatment. Trial registration ClinicalTrials.gov number, NCT00363324.

Potential preanalytical errors in whole-blood analysis: effect of syringe sample volume on blood gas, electrolyte and lactate values.

BACKGROUND: Arterial blood samples are sensitive to bias because of the physiological properties of blood. Several errors can occur in the preanalytical phase leading to incorrect diagnosis and improper treatment of patients. Collection of a blood specimen, as well as its handling and transport, belong to the key factors to affect the accuracy and good quality of clinical laboratory analysis. METHODS: The aim of this study was to validate the effect of different sample volumes on the blood gas, electrolyte and lactate values using 3 mL Rapidlyte plastic syringes with filter cap and Rapidlab 865 blood gas analyser. Also, the stability of blood gas analyser parameters with different sample volume was studied. RESULTS: No substantial change in blood gas, electrolyte and lactate parameters was found when the results of 3 mL, 1.8 mL sample volumes in the 3 mL syringes were compared. The sample volume of 1.0 mL or 1.5 mL in the 3 mL syringe is not suitable for the measurement of oxygen tension, especially when accurate results of pO(2) and arterial blood is needed for patient's diagnosis. CONCLUSIONS: The minimum sample volume when blood gases, electrolytes and lactate are all measured with the Rapidlab system should be 1.8 mL using 3 mL Rapidlyte plastic syringe with filtercap. According to this study <1.8 mL sample volumes can provide inaccurate results and can impose biases on measurements.