Breath ammonia and trimethylamine allow real-time monitoring of haemodialysis efficacy.

Non-invasive monitoring of breath ammonia and trimethylamine using Selected-ion-flow-tube mass spectroscopy (SIFT-MS) could provide a real-time alternative to current invasive techniques. Breath ammonia and trimethylamine were monitored by SIFT-MS before, during and after haemodialysis in 20 patients. In 15 patients (41 sessions), breath was collected hourly into Tedlar bags and analysed immediately (group A). During multiple dialyses over 8 days, five patients breathed directly into the SIFT-MS analyser every 30 min (group B). Pre- and post-dialysis direct breath concentrations were compared with urea reduction, Kt/V and creatinine concentrations. Dialysis decreased breath ammonia, but a transient increase occurred mid treatment in some patients. Trimethylamine decreased more rapidly than reported previously. Pre-dialysis breath ammonia correlated with pre-dialysis urea in group B (r(2) = 0.71) and with change in urea (group A, r(2) = 0.24; group B, r(2) = 0.74). In group B, ammonia correlated with change in creatinine (r(2) = 0.35), weight (r(2) = 0.52) and Kt/V (r(2) = 0.30). The ammonia reduction ratio correlated with the urea reduction ratio (URR) (r(2) = 0.42) and Kt/V (r(2) = 0.38). Pre-dialysis trimethylamine correlated with Kt/V (r(2) = 0.21), and the trimethylamine reduction ratio with URR (r(2) = 0.49) and Kt/V (r(2) = 0.36). Real-time breath analysis revealed previously unmeasurable differences in clearance kinetics of ammonia and trimethylamine. Breath ammonia is potentially useful in assessment of dialysis efficacy.

Classifying algorithms for SIFT-MS technology and medical diagnosis.

Selected Ion Flow Tube-Mass Spectrometry (SIFT-MS) is an analytical technique for real-time quantification of trace gases in air or breath samples. SIFT-MS system thus offers unique potential for early, rapid detection of disease states. Identification of volatile organic compound (VOC) masses that contribute strongly towards a successful classification clearly highlights potential new biomarkers. A method utilising kernel density estimates is thus presented for classifying unknown samples. It is validated in a simple known case and a clinical setting before-after dialysis. The simple case with nitrogen in Tedlar bags returned a 100% success rate, as expected. The clinical proof-of-concept with seven tests on one patient had an ROC curve area of 0.89. These results validate the method presented and illustrate the emerging clinical potential of this technology.

Classification algorithms for SIFT-MS medical diagnosis.

Selected Ion Flow Tube-Mass Spectrometry (SIFT-MS) is an analytical technique for the real-time quantification of trace gases in air or breath samples. The SIFT-MS system can potentially offer unique capability in the early and rapid detection of a wide variety of diseases, infectious bacteria and patient conditions, by using a classifier to differentiate between control and test groups. By identifying which masses and Volatile Organic Compounds (VOCs) contribute most strongly towards a successful classification, biomarkers for a particular disease state may be discovered. A classification method is presented and validated in a simple study in which saturated nitrogen in tedlar bags was differentiated from dry nitrogen in tedlar bags. Several biomarkers were identified, with the most reliable being N2H(+).H2O, and isotopes and water clusters of H3O(+), as expected. The classifier was then applied in a clinical setting to differentiate between patient breath samples after one and four hours of dialysis treatment. Biomarkers for classification were ammonia, acetaldehyde, ethanol, isoprene and acetone. The model classifies significantly better than random, with an ROC area of 0.89.

Induced cerebral hypothermia reduces post-hypoxic loss of phenotypic striatal neurons in preterm fetal sheep.

Perinatal hypoxic-ischemic injury of the basal ganglia is a significant cause of disability in premature infants. Prolonged, moderate cerebral hypothermia has been shown to be neuroprotective after experimental hypoxia-ischemia; however, it has not been tested in the preterm brain. We therefore examined the effects of severe hypoxia and the potential neuroprotective effects of delayed hypothermia on phenotypic striatal neurons. Preterm (0.7 gestation) fetal sheep received complete umbilical cord occlusion for 25 min followed by cerebral hypothermia (fetal extradural temperature reduced from 39.4+/-0.3 degrees C to 29.5+/-2.6 degrees C) from 90 min to 70 h after the end of occlusion. Hypothermia was associated with a significant overall reduction in striatal neuronal loss compared with normothermia-occlusion fetuses (mean+/-SEM, 5.5+/-1.2% vs. 38.1+/-6.5%, P<0.01). Immunohistochemical studies showed that occlusion resulted in a significant loss of calbindin-28 kd, glutamic acid decarboxylase isoform 67 and neuronal nitric oxide synthase-immunopositive neurons (n=7, P<0.05), but not choline acetyltransferase-positive neurons, compared with sham controls (n=7). Hypothermia (n=7) significantly reduced the loss of calbindin-28 kd and neuronal nitric oxide synthase, but not glutamic acid decarboxylase-immunopositive neurons. In conclusion, delayed, prolonged moderate head cooling was associated with selective protection of particular phenotypic striatal projection neurons after severe hypoxia in the preterm fetus. These findings suggest that head cooling may help reduce basal ganglia injury in some premature babies.

The rapid evaluation of bacterial growth in blood cultures by selected ion flow tube-mass spectrometry (SIFT-MS) and comparison with the BacT/ALERT automated blood culture system.

We compared the performance of the BacT/ALERT automated blood culture system with real-time, quantitative volatile organic compound (VOC) detection by selected ion flow tube-mass spectrometry (SIFT-MS). Blood samples from healthy donors were artificially infected with 5 or 100 CFU of organisms commonly causing bacteremia. Positive results by SIFT-MS analysis of headspace gases were recorded for 53/60 (88.3%) bottles at 8h, and 58/60 (96.6%) bottles at 24 h. We conclude that SIFT-MS is a sensitive method for the detection of microbial VOCs. Furthermore, profiles of the VOCs detected may allow simultaneous identification of infecting organisms.

Diagnosis of aspergillus peritonitis in a renal dialysis patient by PCR and galactomannan detection.

This report describes the use of the polymerase chain reaction (PCR) and galactomannan detection to detect aspergillus in the continuous ambulatory peritoneal dialysis (CAPD) fluid and blood of a patient with multiple myeloma on CAPD and immunosuppressive treatment. Diagnosis of aspergillosis was initially made by conventional culture of CAPD fluid, but the PCR and galactomannan assays also detected aspergillus DNA and antigen in the blood, respectively. This suggests that the PCR and galactomannan assays, previously suggested as useful in the management of invasive fungal infections in neutropenic haematological patients, may be suitable for application to a broad range of clinical situations and sample types.

Effects of task performance and contextual performance on systemic rewards.

Evidence from 2 samples of Air Force mechanics supported the hypothesis that contextual performance affects employees' career advancement and rewards over time. Results of hierarchical regressions controlling for experience showed task performance and contextual performance each predicted systemic rewards. Each facet explained separate variance in promotability ratings over 2 years. In both samples, contextual performance explained separate variance in informal rewards but task performance did not. Task performance explained incremental variance in career advancement 1 year later but contextual performance did not. Analyses using correlations corrected for unreliability suggest these results cannot be attributed to measurement error. Contextual performance still explained separate variance in informal rewards, and task performance explained distinct variance in career advancement a year later.