Sample records for clinical laboratory techniques

  1. An Enzymatic Clinical Chemistry Laboratory Experiment Incorporating an Introduction to Mathematical Method Comparison Techniques (United States)

    Duxbury, Mark


    An enzymatic laboratory experiment based on the analysis of serum is described that is suitable for students of clinical chemistry. The experiment incorporates an introduction to mathematical method-comparison techniques in which three different clinical glucose analysis methods are compared using linear regression and Bland-Altman difference…

  2. Clinical evaluation of analytical variations in serum creatinine measurements: why laboratories should abandon Jaffe techniques

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    Drion Iefke


    Full Text Available Abstract Background Non-equivalence in serum creatinine (SCr measurements across Dutch laboratories and the consequences hereof on chronic kidney disease (CKD staging were examined. Methods National data from the Dutch annual external quality organization of 2009 were used. 144 participating laboratories examined 11 pairs of commutable, value-assigned SCr specimens in the range 52–262 μmol/L, using Jaffe or enzymatic techniques. Regression equations were created for each participating laboratory (by regressing values as measured by participating laboratories on the target values of the samples sent by the external quality organization; area under the curves were examined and used to rank laboratories. The 10th and 90th percentile regression equation were selected for each technique separately. To evaluate the impact of the variability in SCr measurements and its eventual clinical consequences in a real patient population, we used a cohort of 82424 patients aged 19–106 years. The SCr measurements of these 82424 patients were introduced in the 10th and 90th percentile regression equations. The newly calculated SCr values were used to calculate an estimated glomerular filtration rate (eGFR using the 4-variable Isotope Dilution Mass Spectrometry traceable Modification of Diet in Renal Disease formula. Differences in CKD staging were examined, comparing the stratification outcomes for Jaffe and enzymatic SCr techniques. Results Jaffe techniques overestimated SCr: 21%, 12%, 10% for SCr target values 52, 73 and 94 μmol/L, respectively. For enzymatic assay these values were 0%, -1%, -2%, respectively. eGFR using the MDRD formula and SCr measured by Jaffe techniques, staged patients in a lower CKD category. Downgrading to a lower CKD stage occurred in 1-42%, 2-37% and 12–78.9% of patients for the 10th and 90th percentile laboratories respectively in CKD categories 45–60, 60–90 and >90 ml/min/1.73 m2. Using enzymatic techniques, downgrading

  3. Clinical Laboratory Fee Schedule (United States)

    U.S. Department of Health & Human Services — Outpatient clinical laboratory services are paid based on a fee schedule in accordance with Section 1833(h) of the Social Security Act. The clinical laboratory fee...

  4. Reliability of clinical diagnosis and laboratory testing techniques currently used for identification of canine parvovirus enteritis in clinical settings (United States)

    FAZ, Mirna; MARTÍNEZ, José Simón; QUIJANO-HERNÁNDEZ, Israel; FAJARDO, Raúl


    Canine parvovirus type 2 (CPV-2) is the main etiological agent of viral enteritis in dogs. Actually in literature, CPV-2 has been reported with clinical signs that vary from the classical disease, and immunochromatography test and PCR technique have been introduced to veterinary hospitals to confirm CPV-2 diagnosis and other infections. However, the reliability of these techniques has been poorly analyzed. In this study, we evaluated the sensitivity and specificity of veterinary clinical diagnosis, immunochromatography test and PCR technique. Our data indicate that variations in the clinical signs of CPV-2 complicate the gathering of an appropriate diagnosis; and immunochromatography test and PCR technique do not have adequate sensitivity to diagnose positive cases. PMID:27818461

  5. Using Elearning techniques to support problem based learning within a clinical simulation laboratory. (United States)

    Docherty, Charles; Hoy, Derek; Topp, Helena; Trinder, Kathryn


    This paper details the results of the first phase of a project that used eLearning to support students' learning within a simulated environment. The locus was a purpose built Clinical Simulation Laboratory (CSL) where the School's newly adopted philosophy of Problem Based Learning (PBL) was challenged through lecturers reverting to traditional teaching methods. The solution, a student-centred, problem-based approach to the acquisition of clinical skills was developed using learning objects embedded within web pages that substituted for lecturers providing instruction and demonstration. This allowed lecturers to retain their facilitator role, and encouraged students to explore, analyse and make decisions within the safety of a clinical simulation. Learning was enhanced through network communications and reflection on video performances of self and others. Evaluations were positive, students demonstrating increased satisfaction with PBL, improved performance in exams, and increased self-efficacy in the performance of nursing activities. These results indicate that an elearning approach can support PBL in delivering a student centred learning experience.

  6. PCR-based techniques for leprosy diagnosis: from the laboratory to the clinic.

    Directory of Open Access Journals (Sweden)

    Alejandra Nóbrega Martinez


    Full Text Available In leprosy, classic diagnostic tools based on bacillary counts and histopathology have been facing hurdles, especially in distinguishing latent infection from active disease and diagnosing paucibacillary clinical forms. Serological tests and IFN-gamma releasing assays (IGRA that employ humoral and cellular immune parameters, respectively, are also being used, but recent results indicate that quantitative PCR (qPCR is a key technique due to its higher sensitivity and specificity. In fact, advances concerning the structure and function of the Mycobacterium leprae genome led to the development of specific PCR-based gene amplification assays for leprosy diagnosis and monitoring of household contacts. Also, based on the validation of point-of-care technologies for M. tuberculosis DNA detection, it is clear that the same advantages of rapid DNA detection could be observed in respect to leprosy. So far, PCR has proven useful in the determination of transmission routes, M. leprae viability, and drug resistance in leprosy. However, PCR has been ascertained to be especially valuable in diagnosing difficult cases like pure neural leprosy (PNL, paucibacillary (PB, and patients with atypical clinical presentation and histopathological features compatible with leprosy. Also, the detection of M. leprae DNA in different samples of the household contacts of leprosy patients is very promising. Although a positive PCR result is not sufficient to establish a causal relationship with disease outcome, quantitation provided by qPCR is clearly capable of indicating increased risk of developing the disease and could alert clinicians to follow these contacts more closely or even define rules for chemoprophylaxis.

  7. Clinical and Laboratory Diagnosis of Intestinal Tuberculosis

    Directory of Open Access Journals (Sweden)

    Xiao-Chun Shi


    Conclusions: ITB is difficult to diagnose even with modern medical techniques due to its nonspecific clinical and laboratory features. At present, combination of clinical, endoscopic, radiological, and pathological features continues to be the key to the diagnosis of ITB.

  8. Informatics and the clinical laboratory. (United States)

    Jones, Richard G; Johnson, Owen A; Batstone, Gifford


    The nature of pathology services is changing under the combined pressures of increasing workloads, cost constraints and technological advancement. In the face of this, laboratory systems need to meet new demands for data exchange with clinical electronic record systems for test requesting and results reporting. As these needs develop, new challenges are emerging especially with respect to the format and content of the datasets which are being exchanged. If the potential for the inclusion of intelligent systems in both these areas is to be realised, the continued dialogue between clinicians and laboratory information specialists is of paramount importance. Requirements of information technology (IT) in pathology, now extend well beyond the provision of purely analytical data. With the aim of achieving seamless integration of laboratory data into the total clinical pathway, 'Informatics' - the art and science of turning data into useful information - is becoming increasingly important in laboratory medicine. Informatics is a powerful tool in pathology - whether in implementing processes for pathology modernisation, introducing new diagnostic modalities (e.g. proteomics, genomics), providing timely and evidence-based disease management, or enabling best use of limited and often costly resources. Providing appropriate information to empowered and interested patients - which requires critical assessment of the ever-increasing volume of information available - can also benefit greatly from appropriate use of informatics in enhancing self-management of long term conditions. The increasing demands placed on pathology information systems in the context of wider developmental change in healthcare delivery are explored in this review. General trends in medical informatics are reflected in current priorities for laboratory medicine, including the need for unified electronic records, computerised order entry, data security and recovery, and audit. We conclude that there is a

  9. Antiphospholipid syndrome: a clinical and laboratorial challenge

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    Luci Maria Santana Dusse


    Full Text Available Antiphospholipid syndrome (APS is an acquired autoimmune thrombophilia characterized by the presence of a heterogeneous family of antibodies that bind to plasma proteins with affinity for phospholipid surfaces. The two major protein targets of antiphospholipid antibodies are prothrombin and β2-glycoprotein I (β2GPI. APS leads to aprothrombotic state, and it is characterized by the occurrence of arterial, venous or microvascular thrombosis or recurrent fetal loss. The diagnosis of APS is based on a set of clinical criteria and the detection of lupus anticoagulant (LA, anticardiolipin antibodies (ACA or anti-β2GPI in plasma. Although laboratory tests are essential for APS diagnosis, these tests have limitations associated with the robustness, reproducibility and standardization. The standardization of diagnostic tests for detection of APLAs has been a challenge and a variety of results have been obtained using different commercial kits and in-house techniques. An increased sensitivity of the ELISA kits for detection of ACA effectively has contributed to APS diagnosis. However, the lack of specificity associated with a high number of false-positive results is a clinical and laboratorial challenge, since such results may lead to mistaken clinical decisions, such as prescription of oral anticoagulant, leading to the risk of hemorrhaging. Furthermore, clinicians are often unfamiliar with these tests and have difficulty interpreting them, requiring interaction between clinical and laboratory professionals in order to ensure their correct interpretation.

  10. [Clinical laboratory in the 21st century]. (United States)

    Kawai, T


    Alvin Toffler has predicted that the "Third Wave" will be a society which be decentralized, diversified and customized, computer-dependent. Medical care and also clinical laboratory will be revolutionalized in a more or less similar direction to that predicted by him. Laboratory physicians and scientists should try to improve laboratory services, particularly establishment of adequate normal values, common expression of various laboratory results, introduction of medical decision making and recommended guideline for laboratory use in primary health care.

  11. 78 FR 6330 - Clinical Laboratory Improvement Advisory Committee (CLIAC) (United States)


    ... HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory... related to improvement in clinical laboratory quality and laboratory medicine practice and specific... laboratory services; revisions to the standards under which clinical laboratories are regulated; the...

  12. Medical and Clinical Laboratory Technologists and Technicians (United States)

    ... Projected Employment, 2024 Change, 2014-24 Employment by Industry Percent Numeric SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program Clinical laboratory technologists and technicians ...

  13. Graphing techniques for materials laboratory using Excel (United States)

    Kundu, Nikhil K.


    Engineering technology curricula stress hands on training and laboratory practices in most of the technical courses. Laboratory reports should include analytical as well as graphical evaluation of experimental data. Experience shows that many students neither have the mathematical background nor the expertise for graphing. This paper briefly describes the procedure and data obtained from a number of experiments such as spring rate, stress concentration, endurance limit, and column buckling for a variety of materials. Then with a brief introduction to Microsoft Excel the author explains the techniques used for linear regression and logarithmic graphing.

  14. New Laboratory Techniques in Reproductive Medicine

    Directory of Open Access Journals (Sweden)

    Montag M


    Full Text Available Worldwide the routine IVF laboratory still relies on technology and instrumentation which is in principle the same as in the time when IVF started. However, the advances in instrumentation and micro-engineering as well as the increasing knowledge on oocyte and embryo biology will have an impact on how we will perform IVF in the near future. New laboratory techniques will enter the routine in assisted reproduction and lead to a shift in treatment possibilities. This overview summarizes some of the ongoing developments and tries to give a look into the next decade.

  15. Molecular virology in the clinical laboratory. (United States)

    Josko, Deborah


    As one can see by the tests listed at, molecular diagnostic techniques have enabled the laboratory professionals to play an integral role in the identification and quantitation of viral infectious agents. Viral loads can be determined for HIV, HBV, and HCV using a variety of molecular methods such as real-time PCR, TMA, NASBA, and bDNA. Determining the amount of viral particles in a sample can not only monitor the status and progression of the disease, but can also guide recommendations for antiviral therapy. Other assays listed include cytomegalovirus, enterovirus, and human metapneumovirus detection, HPV testing, influenza and respiratory virus panels, and West Nile virus detection in blood donations using a variety of molecular methodologies. The use of molecular methodologies in the detection of viral pathogens has grown at an astounding rate, especially in the past two decades. It is now widely accepted that PCR is the "gold standard" for nucleic acid detection in the clinical laboratory as well as in research facilities. This article only touched on some of the common, widely used assays and platforms used in the identification process. With more and more assays being developed, the cost behind molecular testing has decreased since there are more competitors on the market. At one point, laboratorians may have thought of routine molecular testing as the wave of the future. It is obvious the future is upon us. Molecular diagnostics has become part of the daily, routine workload in most clinical laboratories. The advent of fully automated systems with faster turn around times has given laboratory professionals the tools necessary to report out accurate and sensitive results to clinicians who can ultimately improve patient care and outcomes by rendering a correct and rapid diagnosis.

  16. Automation in the clinical microbiology laboratory. (United States)

    Novak, Susan M; Marlowe, Elizabeth M


    Imagine a clinical microbiology laboratory where a patient's specimens are placed on a conveyor belt and sent on an automation line for processing and plating. Technologists need only log onto a computer to visualize the images of a culture and send to a mass spectrometer for identification. Once a pathogen is identified, the system knows to send the colony for susceptibility testing. This is the future of the clinical microbiology laboratory. This article outlines the operational and staffing challenges facing clinical microbiology laboratories and the evolution of automation that is shaping the way laboratory medicine will be practiced in the future.




  18. Risk Management in the Clinical Laboratory (United States)

    Njoroge, Sarah W


    Clinical laboratory tests play an integral role in medical decision-making and as such must be reliable and accurate. Unfortunately, no laboratory tests or devices are foolproof and errors can occur at pre-analytical, analytical and post-analytical phases of testing. Evaluating possible conditions that could lead to errors and outlining the necessary steps to detect and prevent errors before they cause patient harm is therefore an important part of laboratory testing. This can be achieved through the practice of risk management. EP23-A is a new guideline from the CLSI that introduces risk management principles to the clinical laboratory. This guideline borrows concepts from the manufacturing industry and encourages laboratories to develop risk management plans that address the specific risks inherent to each lab. Once the risks have been identified, the laboratory must implement control processes and continuously monitor and modify them to make certain that risk is maintained at a clinically acceptable level. This review summarizes the principles of risk management in the clinical laboratory and describes various quality control activities employed by the laboratory to achieve the goal of reporting valid, accurate and reliable test results. PMID:24982831

  19. Error tracking in a clinical biochemistry laboratory

    DEFF Research Database (Denmark)

    Szecsi, Pal Bela; Ødum, Lars


    BACKGROUND: We report our results for the systematic recording of all errors in a standard clinical laboratory over a 1-year period. METHODS: Recording was performed using a commercial database program. All individuals in the laboratory were allowed to report errors. The testing processes were cl...

  20. Observations on the 1996 clinical laboratory conferences. (United States)

    Kisner, H J


    The author reviews five trends in the laboratory and diagnostic industries. The five trends are: consolidation of both the diagnostic companies and clinical laboratories (hospital and commercial); pressure to cut costs; robotics; implication of new technology; and the pressure to cut costs by transitioning certain tasks to nontechnical personnel while dealing with an abundant labor supply.

  1. Immunosensors in Clinical Laboratory Diagnostics. (United States)

    Justino, Celine I L; Duarte, Armando C; Rocha-Santos, Teresa A P


    The application of simple, cost-effective, rapid, and accurate diagnostic technologies for detection and identification of cardiac and cancer biomarkers has been a central point in the clinical area. Biosensors have been recognized as efficient alternatives for the diagnostics of various diseases due to their specificity and potential for application on real samples. The role of nanotechnology in the construction of immunological biosensors, that is, immunosensors, has contributed to the improvement of sensitivity, since they are based in the affinity between antibody and antigen. Other analytes than biomarkers such as hormones, pathogenic bacteria, and virus have also been detected by immunosensors for clinical point-of-care applications. In this chapter, we first introduced the various types of immunosensors and discussed their applications in clinical diagnostics over the recent 6 years, mainly as point-of-care technologies for the determination of cardiac and cancer biomarkers, hormones, pathogenic bacteria, and virus. The future perspectives of these devices in the field of clinical diagnostics are also evaluated.

  2. Clinical and Laboratory Diagnosis of Intestinal Tuberculosis

    Institute of Scientific and Technical Information of China (English)

    Xiao-Chun Shi; Li-Fan Zhang; Yue-Qiu Zhang; Xiao-Qing Liu; Gui-Jun Fei


    Background:Tuberculosis (TB) remains a worldwide problem.Intestinal TB (ITB) constitutes a major public health problem in developing countries and has been associated with significant morbidity and mortality.The aim of this study was to characterize the clinical,radiological,endoscopic,and pathological features of ITB and to define the strategy for establishing the diagnosis.Methods:A retrospective study (from January 2000 to June 2015) was carried out in Peking Union Medical College Hospital and all hospitalized cases were diagnosed as ITB during the study period were included.The relevant clinical information,laboratory results,microbiological,and radiological investigations were recorded.Results:Of the 85 cases,61 cases (71.8%) were ranged from 20 to 50 years.The ileocecal region was involved in about 83.5% (71/85) of patients.About 41.2% (35/85) of patients had co-existing extra ITB,especially active pulmonary TB.Abdominal pain (82.4%) was the most common presenting symptom followed by weight loss (72.9%) and fever (64.7%).Both T-cell spot of TB test (T-SPOT.TB) and purified protein derivatives (PPD) tests were performed in 26 patients:20 (76.9%) positive T-SPOT.TB and 13 (50.0%) positive PPD were detected,with a statistical significant difference (P =0.046).Twenty cases (23.5%) were histopathology and/or pathogen confirmed TB;27 cases (31.8%) were diagnosed by clinical manifestation consistent with ITB and evidence of active extra ITB;38 cases (44.7%) were diagnosed by good response to diagnostic anti-TB therapy.Conclusions:ITB is difficult to diagnose even with modem medical techniques due to its nonspecific clinical and laboratory features.At present,combination of clinical,endoscopic,radiological,and pathological features continues to be the key to the diagnosis of ITB.

  3. Teaching Techniques in Clinical Chemistry. (United States)

    Wilson, Diane

    This master's thesis presents several instructional methods and techniques developed for each of eleven topics or subject areas in clinical chemistry: carbohydrate metabolism, lipid metabolism, diagnostic enzymology, endocrinology, toxicology, quality control, electrolytes, acid base balance, hepatic function, nonprotein nitrogenous compounds, and…

  4. Decision support for clinical laboratory capacity planning. (United States)

    van Merode, G G; Hasman, A; Derks, J; Goldschmidt, H M; Schoenmaker, B; Oosten, M


    The design of a decision support system for capacity planning in clinical laboratories is discussed. The DSS supports decisions concerning the following questions: how should the laboratory be divided into job shops (departments/sections), how should staff be assigned to workstations and how should samples be assigned to workstations for testing. The decision support system contains modules for supporting decisions at the overall laboratory level (concerning the division of the laboratory into job shops) and for supporting decisions at the job shop level (assignment of staff to workstations and sample scheduling). Experiments with these modules are described showing both the functionality and the validity.

  5. A quadrant tray and bite registration as an alternative to dual-arch impressions for fixed prosthetics: a clinical and dental laboratory technique. (United States)

    Hammond, Barry D; Myers, Michael L; Haywood, Van B


    To perform fixed prosthodontic procedures, dentists take a full-arch or quadrant impression and articulate the casts. The dual-arch impression technique is a popular quadrant technique for crown fabrication. The technique described in this article, which uses a quadrant impression and separate interocclusal record, offers several advantages over the traditional dual-arch method.

  6. Miniaturization and globalization of clinical laboratory activities. (United States)

    Melo, Murilo R; Clark, Samantha; Barrio, Daniel


    Clinical laboratories provide an invaluable service to millions of people around the world in the form of quality diagnostic care. Within the clinical laboratory industry the impetus for change has come from technological development (miniaturization, nanotechnology, and their collective effect on point-of-care testing; POCT) and the increasingly global nature of laboratory services. Potential technological gains in POCT include: the development of bio-sensors, microarrays, genetics and proteomics testing, and enhanced web connectivity. In globalization, prospective opportunities lie in: medical tourism, the migration of healthcare workers, cross-border delivery of testing, and the establishment of accredited laboratories in previously unexplored markets. Accompanying these impressive opportunities are equally imposing challenges. Difficulty transitioning from research to clinical use, poor infrastructure in developing countries, cultural differences and national barriers to global trade are only a few examples. Dealing with the issues presented by globalization and the impact of developing technology on POCT, and on the clinical laboratory services industry in general, will be a daunting task. Despite such concerns, with appropriate countermeasures it will be possible to address the challenges posed. Future laboratory success will be largely dependent on one's ability to adapt in this perpetually shifting landscape.

  7. [CAP quality management system in clinical laboratory and its issue]. (United States)

    Tazawa, Hiromitsu


    The CAP (College of American Pathologists) was established in 1962 and, at present, CAP-accredited laboratories include about 6000 institutions all over the world, mainly in the U.S. The essential purpose of CAP accreditation is high quality reservation and improvement of clinical laboratory services for patient care, and is based on seven points, listed below. (1) Establishment of a laboratory management program and laboratory techniques to assure accuracy and improve overall quality of laboratory services. (2) Maintenance and improvement of accuracy objectively by centering on a CAP survey. (3) Thoroughness in safety and health administration. (4) Reservation of the performance of laboratory services by personnel and proficiency management. (5) Provision of appropriate information to physicians, and contribution to improved quality of patient care by close communication with physicians (improvement in patient care). (6) Reduction of running costs and personnel costs based on evidence by employing the above-mentioned criteria. (7) Reduction of laboratory error. In the future, accreditation and/or certification by organizations such as CAP, ISO, etc., may become a requirement for providing any clinical laboratory services in Japan. Taking the essence of the CAP and the characteristics of the new international standard, ISO151589, into consideration, it is important to choose the best suited accreditation and/or certification depending of the purpose of clinical laboratory.

  8. Clinical laboratory technologist professional development in Camagüey

    Directory of Open Access Journals (Sweden)

    Mercedes Caridad García González


    Full Text Available The paper describes the results of research aimed at assessing the current conditions related to clinical laboratory technologist professional development. A descriptive cross study covering the period between November 2013 and January 2014 is presented. Several techniques for identifying and hierarchically arranging professional developmental related problems were used to study a sample at the Faculty of Health Technology of the Medical University “Carlos Juan Finlay”. The study involved heads of teaching departments and methodologists of health care technology specialties; moreover a survey and a content test were given graduate clinical laboratory technicians. The authors reached at the conclusion that clinical laboratory technologist professional development is limited and usually underestimate the necessities and interests of these graduates. Likewise, a lack of systematization and integration of the biomedical basic sciences contents and the laboratory diagnosis is noticeable.

  9. Capillary electrophoresis and the clinical laboratory. (United States)

    Jabeen, Rukhsana; Payne, Deborah; Wiktorowicz, John; Mohammad, Amin; Petersen, John


    Over the past 15 years, CE as an analytical tool has shown great promise in replacing many conventional clinical laboratory methods, such as electrophoresis and HPLC. CE's appeal was that it was fast, used very small amounts of sample and reagents, was extremely versatile, and was able to separate large and small analytes, whether neutral or charged. Because of this versatility, numerous methods have been developed for analytes that are of clinical interest. Other than molecular diagnostic and forensic laboratories CE has not been able to make a major impact in the United States. In contrast, in Europe and Japan an increasing number of clinical laboratories are using CE. Now that automated multicapillary instruments are commercially available along with cost-effective test kits, CE may yet be accepted as an instrument that will be routinely used in the clinical laboratories. This review will focus on areas where CE has the potential to have the greatest impact on the clinical laboratory. These include analyses of proteins found in serum and urine, hemoglobin (A1c and variants), carbohydrate-deficient transferrin, forensic and therapeutic drug screening, and molecular diagnostics.

  10. Total quality management in clinical virology laboratories. (United States)

    Tibbets, M W; Gomez, R; Kannangai, R; Sridharan, G


    The diagnostic laboratories in India are progressively promoting higher standards and are moving towards accreditation and international acceptance. Hence, the concept of "Quality" will need to be understood and implemented. Total quality management (TQM) in a laboratory is an integrated program involving all laboratory staff and management. TQM is a framework to operate and it is aiming for integration, consistency, increase in efficiency and a continuous drive for improvement. A well structured clinical virology service will include serology setup, cell culture facility and capacity for molecular diagnosis. The quality of results from the laboratory is significantly influenced by many pre-analytical and post-analytical factors which needed attention. The end goal of the TQM should be to provide the best care possible for the patient.

  11. Polycystic ovary syndrome: clinical and laboratory evaluation


    Marcos Yorghi Khoury; Edmund Chada Baracat; Dolores Perovano Pardini; Mauro Abi Haidar; Eduardo Leme Alves da Motta; Geraldo Rodrigues de Lima


    OBJECTIVE: To evaluate clinically, and with laboratory, tests, women with polycystic ovary syndrome (PCO). PATIENTS: One hundred and twelve women with PCO were studied. METHODS: The following data was recorded: Current age; age at menarche; menstrual irregularity, occurrence of similar cases in the family; fertility, obstetric history; body mass index (BMI); and presence of hirsutism. Serum measurements of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, free testoster...

  12. Projectile Ullage Inspection Technique: Laboratory Demonstration Apparatus. (United States)


    inspection of projectiles was feasible. The mercury manometer was used because it was the only gauge readily available in the laboratory that was...pres- sure. It is suggested that the mercury manometer be replaced by a panel-mounted diaphragm or Bourdon tube gauge. The full-scale pressure range of...When the mercury manometer is used, the volume of the pressure indicator changes linearly with pres- sure (it is assumed that the manometer tube

  13. Verification and validation of diagnostic laboratory tests in clinical virology. (United States)

    Rabenau, Holger F; Kessler, Harald H; Kortenbusch, Marhild; Steinhorst, Andreas; Raggam, Reinhard B; Berger, Annemarie


    This review summarizes major issues of verification and validation procedures and describes minimum requirements for verification and validation of diagnostic assays in clinical virology including instructions for CE/IVD-labeled as well as for self-developed ("home-brewed") tests or test systems. It covers techniques useful for detection of virus specific antibodies, for detection of viral antigens, for detection of viral nucleic acids, and for isolation of viruses on cell cultures in the routine virology laboratory.

  14. 临床微生物实验室细菌分离接种技术的研究进展%Research progress on the bacterial inoculation techniques in clinical microbiology laboratories

    Institute of Scientific and Technical Information of China (English)

    王敬华; 葛平; 陈蓉; 徐蓉; 刘学杰


    近年来,自动化研究方兴未艾,出现了商品化的自动化、半自动化微生物接种仪,如Robobact system全自动微生物分离培养系统、EasySpiral Pro全自动螺旋接种仪以及PREVI Isola自动化微生物接种仪等。然而临床实践表明,目前尚没有比较理想的自动化接种仪,特别是能够准确定量接种的自动化仪器,致使现有商品化自动接种仪在临床实验室难以推广。同时,建立细菌培养定量检验方法,进一步统一和标准化操作程序,已成为临床微生物检验质量控制的发展趋势。基于伯努利原理和流体力学,国内学者设计研发的多通道自动化微生物接种仪,有望建立基于自动化接种技术的细菌培养定量检验方法。现就临床微生物实验室细菌分离接种技术的发展现状、趋势和研究进展进行综述。%In recent years , researches on the bacterial inoculation automation are booming .The commercialized automatic or semi-automatic microbial inoculation instruments are developing , such as, Robobact system , EasySpiral Pro and PREVI Isola.However, the experience of clinical application indicates that no instrument employed is satisfactory , let alone the accurate quantitative inoculation instrument , and they are hard to be popularized in clinical microbiology laboratories.Meanwhile, to develop a new method of accurate quantitative determination and to unify and standardize operating procedure , is the development tendency of quality control .Based on Bernoulli principle and fluid mechanics , a new-type instrument , called the multichannel microbial inoculation instument , is invented by Chinese scholars .It is hopeful to develop a new method for the quantitative determination for microbiology based on automatic technique .In this review, the research and development progress of bacterial inoculation technique in clinical microbiology laboratories are summarized.

  15. Thai clinical laboratory responsible to economic crisis. (United States)

    Sirisali, K; Vattanaviboon, P; Manochiopinij, S; Ananskulwat, W


    Nowadays, Thailand encounters a serious economic crisis. A clear consensus has been made that a cost-saving system must be the important tool. Both private and government organizations are engaged in this situation. We studied the cost-saving in the clinical laboratory. A questionnaire was distributed to 45 hospital laboratories located in Bangkok. Results showed that efforts to control the cost are the essential policy. There was a variety of factors contributing to the cost-saving process. The usage of public utility, non-recycle material and unnecessary utility were reconsidered. Besides, capital cost (wages and salary) personnel incentive are assessed. Forty three of the 45 respondents had attempted to reduce the cost via curtailing the unnecessary electricity. Eliminating the needless usage of telephone-call. water and unnecessary material was also an effective strategy. A reduction of 86.9%, 80 % and 80.0% of the mentioned factors respectively, was reported. An inventory system of the reagent, chemical and supplies was focused. Most of the laboratories have a policy on cost-saving by decreased the storage. Twenty eight of the 45 laboratories considered to purchase the cheaper with similar quality reagents instead. And some one would purchase a bulky pack when it is the best bargain. A specific system "contact reagent with a free rent instrument" has been used widely (33.3%). Finally, a new personnel management system has been chosen. Workload has rearranged and unnecessary extra-hour work was abandoned.

  16. [Excessive spending by misuse of clinical laboratory]. (United States)

    Benítez-Arvizu, Gamaliel; Novelo-Garza, Bárbara; Mendoza-Valdez, Antonia Lorena; Galván-Cervantes, Jorge; Morales-Rojas, Alejandro


    Seventy five percent or more of a diagnosis comes from a proper medical history along with an excellent physical examination. This leaves to the clinical laboratory the function of supporting the findings, determining prognosis, classifying the diseases, monitoring the diseases and, in the minimum of cases, establishing the diagnosis. In recent years there has been a global phenomenon in which the allocation of resources to health care has grown in an excessive way; the Instituto Mexicano del Seguro Social is not an exception with an increase of 29 % from 2009 to 2011; therefore, it is necessary to set containment and reduction without compromising the quality of patient care.

  17. Laboratory research at the clinical trials of Veterinary medicinal Products


    ZHYLA M.I.


    The article analyses the importance of laboratory test methods, namely pathomorfological at conduct of clinical trials. The article focuses on complex laboratory diagnostics at determination of clinical condition of animals, safety and efficacy of tested medicinal product.

  18. Hidden sources of mercury in clinical laboratories. (United States)

    Alvarez-Chavez, C R; Federico-Perez, R A; Gomez-Alvarez, A; Velazquez-Contreras, L E; Perez-Rios, R


    The healthcare sector is an important contributor to mercury (Hg) pollution because of the potential presence of mercury in thermometers, blood pressure cuffs, amalgams, etc. There are also other potential sources of mercury in this sector which are used frequently and in high volumes where the presence of the metal is not obvious and which might be collectively contributing to pollution. For instance, some chemicals used for the clinical diagnosis of illness may contain mercury. The goal of this study was to investigate potential sources of mercury pollution, which originate from clinical laboratory discharges, using an exploratory approach. The focus was on the residue generated during automatic analysis of patients' bodily fluids at a medical center in Hermosillo, Sonora, Mexico. This study shows an overview of what might be happening in the region or the country related to non-obvious sources of mercury in the healthcare sector. The results showed measurable levels of mercury in the residues coming from urine sediment analysis. These amounts do not exceed the maximum allowed by Mexican environmental regulations; nevertheless, the frequency and cumulative volume of residues generated, combined with the potential for persistence and the bioaccumulation of mercury in the environment, warrant attention. The work carried out in this study is being taken as a model for future studies for pollution prevention in the healthcare sector with the goal of measuring mercury emissions to the environment from clinical laboratory wastewater, including identifying sources which--while not obvious--could be important given the frequency and volume of their use in the clinical diagnosis.

  19. Polycystic ovary syndrome: clinical and laboratory evaluation

    Directory of Open Access Journals (Sweden)

    Marcos Yorghi Khoury

    Full Text Available OBJECTIVE: To evaluate clinically, and with laboratory, tests, women with polycystic ovary syndrome (PCO. PATIENTS: One hundred and twelve women with PCO were studied. METHODS: The following data was recorded: Current age; age at menarche; menstrual irregularity, occurrence of similar cases in the family; fertility, obstetric history; body mass index (BMI; and presence of hirsutism. Serum measurements of follicle stimulating hormone (FSH, luteinizing hormone (LH, prolactin, free testosterone, and dehydroepiandrosterone sulfate were taken. RESULTS: All patients presented either oligomenorrhea (31 percent, periods of secondary amenorrhea (9 percent, or both alterations (60 percent. The majority of the patients were infertile (75.6 percent. The LH/FSH ratio was higher than 2:1 in 55 percent of the patients and higher than 3:1 in 26.2 percent. The ultrasonographic aspect of the ovaries was considered to be normal in 31 percent. CONCLUSION: The main clinical feature of the PCO is the irregularity of menses since menarche, and that the laboratory tests would be important to exclude other disorders such as hyperprolactinemia or hyperandrogenemia caused by late-onset congenital adrenal hyperplasia.

  20. Clinical and laboratory features of preleukemia patients

    Institute of Scientific and Technical Information of China (English)

    施均; 邵宗鸿; 陈桂彬; 李克; 刘鸿; 张益枝; 和虹; 赵明峰; 何广胜; 张泓; 储榆林; 郝玉书


    Objective To explore prospective diagnostic criteria for preleukemia.Methods A case control study was done comparing the discrepancies on clinical and laboratory features between patients with preleukemia and those with chronic aplastic anemia (CAA) or atypical paroxysmal nocturnal hemoglubinuria (a-PNH).Results There were eight variables of significance: (1) lymphocytoid micromegakaryocytes in the bone marrow; (2) immature granulocytes in the peripheral blood; (3) ≥2.0% myeloblasts in the bone marrow; (4) positive periodic acid schiff (PAS) stained nucleated erythrocytes; (5) myeloid differentiation index ≥1.8; (6) typical colonal karyotypic abnormalities; (7) negative sister chromatid differentiation; (8) cluster/colony ratio of granulocyte-macrophage colony-forming units (CFU-GM)>4.0. The following criteria were assigned: A: to meet variable one and at least two of the other seven variables and B: to meet at least four of the eight variables. All of the patients with preleukemia met either A or B and none of the patients with CAA or a-PNH did. Conclusions Preleukemia is different from CAA or a-PNH. It has its own clinical and laboratory features, which may be useful for its prospective diagnosis.

  1. Clinical laboratory analytics: Challenges and promise for an emerging discipline

    Directory of Open Access Journals (Sweden)

    Brian H Shirts


    Full Text Available The clinical laboratory is a major source of health care data. Increasingly these data are being integrated with other data to inform health system-wide actions meant to improve diagnostic test utilization, service efficiency, and "meaningful use." The Academy of Clinical Laboratory Physicians and Scientists hosted a satellite meeting on clinical laboratory analytics in conjunction with their annual meeting on May 29, 2014 in San Francisco. There were 80 registrants for the clinical laboratory analytics meeting. The meeting featured short presentations on current trends in clinical laboratory analytics and several panel discussions on data science in laboratory medicine, laboratory data and its role in the larger healthcare system, integrating laboratory analytics, and data sharing for collaborative analytics. One main goal of meeting was to have an open forum of leaders that work with the "big data" clinical laboratories produce. This article summarizes the proceedings of the meeting and content discussed.

  2. Applications of molecular diagnostics techniques in clinical microbiology laboratory%分子诊断技术在临床微生物学检验中的应用

    Institute of Scientific and Technical Information of China (English)

    孙长贵; 成军


    Applications of molecular diagnostics in clinical microbiology laboratory were introduced in the article,including nucleic acid hybridization,nucleic acid amplification,DNA sequencing,gene chips and mass spectrometry.Molecular diagnostic techniques provide major tools for rapid diagnosis of infectious diseases,molecular epidemiology investigation,rapid identification of microbial pathogens and the study of the pathogenicity and antibiotics resistance.The application of these new technologies,as the complement of traditional culture methods,increases sensitivity,accuracy and diagnostic efficiency of assays.%主要介绍分子诊断技术在临床微生物学检验中的应用,内容包括核酸杂交、核酸扩增、DNA测序、基因芯片和质谱技术.分子诊断技术为感染病的快速诊断、分子流行病学调查、微生物的快速鉴定、病原菌的致病性和抗生素的耐受性研究等提供了重要的检测手段.这些新技术的应用,作为传统培养法的补充,提高了检测的灵敏度、准确性和诊断效率.

  3. Realistic modeling of clinical laboratory operation by computer simulation. (United States)

    Vogt, W; Braun, S L; Hanssmann, F; Liebl, F; Berchtold, G; Blaschke, H; Eckert, M; Hoffmann, G E; Klose, S


    An important objective of laboratory management is to adjust the laboratory's capability to the needs of patients' care as well as economy. The consequences of management may be changes in laboratory organization, equipment, or personnel planning. At present only one's individual experience can be used for making such decisions. We have investigated whether the techniques of operations research could be transferred to a clinical laboratory and whether an adequate simulation model of the laboratory could be realized. First we listed and documented the system design and the process flow for each single laboratory request. These input data were linked by the simulation model (programming language SIMSCRIPT II.5). The output data (turnaround times, utilization rates, and analysis of queue length) were validated by comparison with the current performance data obtained by tracking specimen flow. Congruence of the data was excellent (within +/- 4%). In planning experiments we could study the consequences of changes in order entry, staffing, and equipment on turnaround times, utilization, and queue lengths. We conclude that simulation can be a valuable tool for better management decisions.

  4. Supply chain management in the clinical laboratory. (United States)

    McHugh, Thomas M


    Between 15 and 45 percent of a clinical laboratory's operating budget is spent on supplies. Given the size of this expenditure, laboratory managers must pay close attention to the supply chain and develop effective strategies to manage their inventory. Areas that need analysis include the carrying cost of supplies, the cost to generate a purchase order, methods to efficiently count supplies on hand, processes to ensure that lot number items are used before their expiration, and detailed analysis of the inventory. At the University of California-San Francisco Medical Center, we investigated options to manage our inventory and implemented a computerized system. The system required modifications to existing practices, which initially seemed unwieldy. However, after a relatively short learning curve, the improvement to operations has been significant, with a reduction in wasted reagents, fewer staff hours used to count supplies, and the ability to provide prompt analysis of the inventory for audits and discussions with administration. Focusing on the supply chain has allowed us to reduce inventory expenses by approximately 8 percent, reduce waste, given us a more focused understanding of our operations, and provided us with the ability to analyze our inventory easily.

  5. Bringing ayahuasca to the clinical research laboratory. (United States)

    Riba, Jordi; Barbanoj, Manel J


    Since the winter of 1999, the authors and their research team have been conducting clinical studies involving the administration of ayahuasca to healthy volunteers. The rationale for conducting this kind of research is twofold. First, the growing interest of many individuals for traditional indigenous practices involving the ingestion of natural psychotropic drugs such as ayahuasca demands the systematic study of their pharmacological profiles in the target species, i.e., human beings. The complex nature of ayahuasca brews combining a large number of pharmacologically active compounds requires that research be carried out to establish the safety and overall pharmacological profile of these products. Second, the authors believe that the study of psychedelics in general calls for renewed attention. Although the molecular and electrophysiological level effects of these drugs are relatively well characterized, current knowledge of the mechanisms by which these compounds modify the higher order cognitive processes in the way they do is still incomplete, to say the least. The present article describes the development of the research effort carried out at the Autonomous University of Barcelona, commenting on several methodological aspects and reviewing the basic clinical findings. It also describes the research currently underway in our laboratory, and briefly comments on two new studies we plan to undertake in order to further our knowledge of the pharmacology of ayahuasca.

  6. Clinical laboratory analytics: Challenges and promise for an emerging discipline


    Brian H Shirts; Jackson, Brian R.; Baird, Geoffrey S.; Baron, Jason M.; Bryan Clements; Ricky Grisson; Ronald George Hauser; Taylor, Julie R.; Enrique Terrazas; Brad Brimhall


    The clinical laboratory is a major source of health care data. Increasingly these data are being integrated with other data to inform health system-wide actions meant to improve diagnostic test utilization, service efficiency, and "meaningful use." The Academy of Clinical Laboratory Physicians and Scientists hosted a satellite meeting on clinical laboratory analytics in conjunction with their annual meeting on May 29, 2014 in San Francisco. There were 80 registrants for the clinical laborator...

  7. [Laboratory unification: advantages and disadvantages for clinical microbiology]. (United States)

    Andreu, Antonia; Matas, Lurdes


    This article aims to reflect on which areas or tasks of microbiology laboratories could be unified with those of clinical biochemistry, hematology, immunology or pathology laboratories to benefit patients and the health system, as well as the areas that should remain independent since their amalgamation would not only fail to provide a benefit but could even jeopardize the quality of microbiological diagnosis, and consequently patient care. To do this, the distinct analytic phases of diagnosis are analyzed, and the advantages and disadvantages of amalgamation are evaluated in each phase. The pros and cons of the unification of certain areas such as the computer system, occupational risk units, customer service, purchasing logistics, and materials storage, etc, are also discussed. Lastly, the effect of unification on urgent microbiology diagnosis is analyzed. Microbiological diagnosis should be unique. The microbiologist should perform an overall evaluation of the distinct techniques used for a particular patient, both those that involve direct diagnosis (staining, culture, antigen detection techniques or molecular techniques) and indirect diagnosis (antibody detection). Moreover, the microbiology laboratory should be independent, with highly trained technicians and specialists in microbiology that provide added value as experts in infection and as key figures in the process of establishing a correct etiological diagnosis.

  8. 76 FR 5379 - Clinical Laboratory Improvement Advisory Committee (CLIAC) (United States)


    ... HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory..., revisions to the standards under which clinical laboratories are regulated; the impact on medical and laboratory practice of proposed revisions to the standards; and the modification of the standards...

  9. 75 FR 1063 - Clinical Laboratory Improvement Advisory Committee (CLIAC) (United States)


    ... Laboratory Improvement Advisory Committee (CLIAC) In accordance with section 10(a)(2) of the Federal Advisory... under which clinical laboratories are regulated; the impact on medical and laboratory practice of... Testing Workgroup and discussion of the Workgroup's proposals related to good laboratory practices...

  10. New approaches to poliovirus diagnosis using laboratory techniques: memorandum from a WHO meeting.



    Laboratory diagnosis of poliomyelitis is an important part of the WHO initiative for global eradication of poliomyelitis. During the last year, new methods have been developed for the detection of poliovirus in clinical specimens, for intratypic differentiation, for the analysis of poliovirus neurovirulence, and for the detection of poliovirus antibodies. Progress in laboratory techniques for detection of poliovirus antibodies and for characterization of poliovirus isolates has suggested seve...

  11. Clinical and laboratory features of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Andrés Cárdenas


    Full Text Available

    The clinical presentation of hepatocellular carcinoma (HCC differs between patients in developing countries (African and Chinese populations from those in industrialized countries. In industrialized countries, HCC co-exists with symptomatic cirrhosis in 80% of cases and clinical manifestations are usually related to those of the underlying disease. On the other hand, patients from developing countries have HCC and cirrhosis in approximately 40% of cases. Underlying cirrhosis in many cases is not advanced and does not produce any symptoms or associated symptoms are masked by those of the tumor (right upper quadrant pain, mass in the upper abdomen, weight loss and weakness. In a subset of patients, there are no clinical manifestations as HCC may occur in the context of hepatitis B infection without cirrhosis.

    Clinical Manifestations

    In Western countries, nearly 35% percent of patients with HCC are asymptomatic. Some of the most common clinical manifestations include: abdominal pain (53-58% of patients, especially in epigastrium or right upper quadrant, abdominal mass (30%, weight loss, malaise, anorexia, cachexia, jaundice or fever.

    Physical Exam

    Physical findings vary with the stage of disease. The patient may exhibit slight or moderate wasting when first seen. In patients with cirrhosis, typical stigmata of chronic liver disease may be present. In advanced stages of HCC the liver may be enlarged and there is significant tenderness. An arterial bruit may be heard over the liver

  12. [Advanced data analysis and visualization for clinical laboratory]. (United States)

    Inada, Masanori; Yoneyama, Akiko


    This paper describes visualization techniques that help identify hidden structures in clinical laboratory data. The visualization of data is helpful for a rapid and better understanding of the characteristics of data sets. Various charts help the user identify trends in data. Scatter plots help prevent misinterpretations due to invalid data by identifying outliers. The representation of experimental data in figures is always useful for communicating results to others. Currently, flexible methods such as smoothing methods and latent structure analysis are available owing to the presence of advanced hardware and software. Principle component analysis, which is a well-known technique used to reduce multidimensional data sets, can be carried out on a personal computer. These methods could lead to advanced visualization with regard to exploratory data analysis. In this paper, we present 3 examples in order to introduce advanced data analysis. In the first example, a smoothing spline was fitted to a time-series from the control chart which is not in a state of statistical control. The trend line was clearly extracted from the daily measurements of the control samples. In the second example, principal component analysis was used to identify a new diagnostic indicator for Graves' disease. The multi-dimensional data obtained from patients were reduced to lower dimensions, and the principle components thus obtained summarized the variation in the data set. In the final example, a latent structure analysis for a Gaussian mixture model was used to draw complex density functions suitable for actual laboratory data. As a result, 5 clusters were extracted. The mixed density function of these clusters represented the data distribution graphically. The methods used in the above examples make the creation of complicated models for clinical laboratories more simple and flexible.

  13. Laboratory technique for quantitative thermal emissivity measurements of geological samples

    Indian Academy of Sciences (India)

    George Mathew; Archana Nair; T K Gundu Rao; Kanchan Pande


    Thermal infrared spectroscopy is a powerful technique for the compositional analysis of geological materials. The spectral feature in the mid-IR region is diagnostic of the mineralogy and spectral signatures of mixtures of minerals that add linearly, and therefore, can be used as an important tool to determine the mineralogy of rocks in the laboratory and remotely for planetary exploration. The greatest challenge in the emission measurement lies in the measurement of the weak thermal photons emitted from geological materials in a laboratory setup, and accurately records the temperature of the rock sample. The present work pertains to the details of a new Thermal Emission Spectrometer (TES) laboratory that has been developed under the ISRO Planetary Science and Exploration (PLANEX) programme, for emission related mineralogical investigations of planetary surfaces. The focus of the paper is on the acquisition and calibration technique for obtaining emissivity, and the deconvolution procedure to obtain the modal abundances of the thermal emission spectra in the range of 6–25 m using Fourier Transform Infrared (FTIR) spectroscopy. The basic technique is adopted from the work of Ruff et al (1997). This laboratory at the Department of Earth Sciences, IIT-Bombay is currently developing pure end mineral library of mineral particulates (> 65 m), and adding new end members to the existing ASU spectral library. The paper argues the need for considering Lunar Orbiter Thermal Emission Spectrometer (LOTES) for future Indian Moon mission programme (Chandrayan-II) to determine evidences of varied lithologies on the lunar surface.

  14. 42 CFR 414.510 - Laboratory date of service for clinical laboratory and pathology specimens. (United States)


    ... and pathology specimens. 414.510 Section 414.510 Public Health CENTERS FOR MEDICARE & MEDICAID... date of service for clinical laboratory and pathology specimens. The date of service for either a clinical laboratory test or the technical component of physician pathology service is as follows:...

  15. Laboratory automation in clinical bacteriology: what system to choose? (United States)

    Croxatto, A; Prod'hom, G; Faverjon, F; Rochais, Y; Greub, G


    Automation was introduced many years ago in several diagnostic disciplines such as chemistry, haematology and molecular biology. The first laboratory automation system for clinical bacteriology was released in 2006, and it rapidly proved its value by increasing productivity, allowing a continuous increase in sample volumes despite limited budgets and personnel shortages. Today, two major manufacturers, BD Kiestra and Copan, are commercializing partial or complete laboratory automation systems for bacteriology. The laboratory automation systems are rapidly evolving to provide improved hardware and software solutions to optimize laboratory efficiency. However, the complex parameters of the laboratory and automation systems must be considered to determine the best system for each given laboratory. We address several topics on laboratory automation that may help clinical bacteriologists to understand the particularities and operative modalities of the different systems. We present (a) a comparison of the engineering and technical features of the various elements composing the two different automated systems currently available, (b) the system workflows of partial and complete laboratory automation, which define the basis for laboratory reorganization required to optimize system efficiency, (c) the concept of digital imaging and telebacteriology, (d) the connectivity of laboratory automation to the laboratory information system, (e) the general advantages and disadvantages as well as the expected impacts provided by laboratory automation and (f) the laboratory data required to conduct a workflow assessment to determine the best configuration of an automated system for the laboratory activities and specificities.

  16. [Knowledge management system for laboratory work and clinical decision support]. (United States)

    Inada, Masanori; Sato, Mayumi; Yoneyama, Akiko


    This paper discusses a knowledge management system for clinical laboratories. In the clinical laboratory of Toranomon Hospital, we receive about 20 questions relevant to laboratory tests per day from medical doctors or co-medical staff. These questions mostly involve the essence to appropriately accomplish laboratory tests. We have to answer them carefully and suitably because an incorrect answer may cause a medical accident. Up to now, no method has been in place to achieve a rapid response and standardized answers. For this reason, the laboratory staff have responded to various questions based on their individual knowledge. We began to develop a knowledge management system to promote the knowledge of staff working for the laboratory. This system is a type of knowledge base for assisting the work, such as inquiry management, laboratory consultation, process management, and clinical support. It consists of several functions: guiding laboratory test information, managing inquiries from medical staff, reporting results of patient consultation, distributing laboratory staffs notes, and recording guidelines for laboratory medicine. The laboratory test information guide has 2,000 records of medical test information registered in the database with flexible retrieval. The inquiry management tool provides a methos to record all questions, answer easily, and retrieve cases. It helps staff to respond appropriately in a short period of time. The consulting report system treats patients' claims regarding medical tests. The laboratory staffs notes enter a file management system so they can be accessed to aid in clinical support. Knowledge sharing using this function can achieve the transition from individual to organizational learning. Storing guidelines for laboratory medicine will support EBM. Finally, it is expected that this system will support intellectual activity concerning laboratory work and contribute to the practice of knowledge management for clinical work support.

  17. Machine Learning Techniques in Clinical Vision Sciences. (United States)

    Caixinha, Miguel; Nunes, Sandrina


    This review presents and discusses the contribution of machine learning techniques for diagnosis and disease monitoring in the context of clinical vision science. Many ocular diseases leading to blindness can be halted or delayed when detected and treated at its earliest stages. With the recent developments in diagnostic devices, imaging and genomics, new sources of data for early disease detection and patients' management are now available. Machine learning techniques emerged in the biomedical sciences as clinical decision-support techniques to improve sensitivity and specificity of disease detection and monitoring, increasing objectively the clinical decision-making process. This manuscript presents a review in multimodal ocular disease diagnosis and monitoring based on machine learning approaches. In the first section, the technical issues related to the different machine learning approaches will be present. Machine learning techniques are used to automatically recognize complex patterns in a given dataset. These techniques allows creating homogeneous groups (unsupervised learning), or creating a classifier predicting group membership of new cases (supervised learning), when a group label is available for each case. To ensure a good performance of the machine learning techniques in a given dataset, all possible sources of bias should be removed or minimized. For that, the representativeness of the input dataset for the true population should be confirmed, the noise should be removed, the missing data should be treated and the data dimensionally (i.e., the number of parameters/features and the number of cases in the dataset) should be adjusted. The application of machine learning techniques in ocular disease diagnosis and monitoring will be presented and discussed in the second section of this manuscript. To show the clinical benefits of machine learning in clinical vision sciences, several examples will be presented in glaucoma, age-related macular degeneration

  18. Lean-Agile Adaptations in Clinical Laboratory Accredited ISO 15189

    Directory of Open Access Journals (Sweden)

    Carlos Vilaplana Pérez


    Full Text Available It’s introduced Lean techniques in a Clinical Laboratory to improve the operability and the efficiency in continuous processes of analysis, failsafe systems, analysis of areas of value pursuit of zero defects and reduction of waste, and it promote continuous improvement in presented difficulties in adapting to the changing needs of the healthcare environment. Whereas it is necessary to incorporate certification and accreditation, note that the adaptability of the clinical laboratory to the changing needs of physicians in obtaining analytical information is reduced. The application of an agile methodology on analytical systems can provide a line of work that allows the incorporation of planning short work cycles on equips quickly with operational autonomy on the basis of demand and respecting the accreditation requirements and flexibility to ensure adequate performance as the intercomparison of results from the different units analytics, analytical quality and turnaround times. Between 2012 and 2014, a process of analysis and improvement was applied to circuits, a 5 s system, transportation of samples, inventory of reactive and samples, motion of personal and samples, reductions of waiting and delays, overproduction, over processing, and defects of results and reports. At last it seems necessary to apply the Agile methodology to adapt to the evolving necessities in time and the different origins of the samples. It’s have used modular systems where the modules of this study are programmed with immunoassay techniques and it has reduced the operative modules depending on the required activity, ensuring the goals of turnaround times, analytic quality, service, health care continuity, and keeping up with the ISO 15189 accreditation requirements. The results of applying the concept of Lean-Agile to a modular system allows us to reduce the associated costs to the seasonal variation of the health care demand and to adapt the system to the changes on

  19. [ISO 15189 accreditation in clinical microbiology laboratory: general concepts and the status in our laboratory]. (United States)

    Akyar, Işin


    One important trend in the laboratory profession and quality management is the global convergence of laboratory operations. The goal of an accredited medical laboratory is to continue "offering useful laboratory service for diagnosis and treatment of the patients and also aid to the health of the nation". An accredited clinical laboratory is managed by a quality control system, it is competent technically and the laboratory service meets the needs of all its patients and physicians by taking the responsibility of all the medical tests and therapies. For this purpose, ISO 15189 international standard has been prepared by 2003. ISO 15189 standard is originated from the arrangement of ISO 17025 and ISO 9001:2000 standards. Many countries such as England, Germany, France, Canada and Australia have preferred ISO 15189 as their own laboratory accreditation programme, meeting all the requirements of their medical laboratories. The accreditation performance of a clinical microbiology laboratory is mainly based on five essential points; preanalytical, analytical, postanalytical, quality control programmes (internal, external, interlaboratory) and audits (internal, external). In this review article, general concepts on ISO 15189 accreditation standards for the clinical microbiology laboratories have been summarized and the status of a private laboratory (Acibadem LabMed, Istanbul) in Turkey has been discussed.

  20. An investigative graduate laboratory course for teaching modern DNA techniques. (United States)

    de Lencastre, Alexandre; Thomas Torello, A; Keller, Lani C


    This graduate-level DNA methods laboratory course is designed to model a discovery-based research project and engages students in both traditional DNA analysis methods and modern recombinant DNA cloning techniques. In the first part of the course, students clone the Drosophila ortholog of a human disease gene of their choosing using Gateway(®) cloning. In the second part of the course, students examine the expression of their gene of interest in human cell lines by reverse transcription PCR and learn how to analyze data from quantitative reverse transcription PCR (qRT-PCR) experiments. The adaptability of the Gateway(®) cloning system is ideally suited for students to design and create different types of expression constructs to achieve a particular experimental goal (e.g., protein purification, expression in cell culture, and/or subcellular localization), and the genes chosen can be aligned to the research interests of the instructor and/or ongoing research in a department. Student evaluations indicate that the course fostered a genuine excitement for research and in depth knowledge of both the techniques performed and the theory behind them. Our long-term goal is to incorporate this DNA methods laboratory as the foundation for an integrated laboratory sequence for the Master of Science degree program in Molecular and Cellular Biology at Quinnipiac University, where students use the reagents and concepts they developed in this course in subsequent laboratory courses, including a protein methods and cell culture laboratory. © 2017 by The International Union of Biochemistry and Molecular Biology, 2017.

  1. Mentoring for retention and advancement in the multigenerational clinical laboratory. (United States)

    Laudicina, R J


    Retention of recent graduates and other laboratory practitioners in the workplace will play a key role in addressing current and projected shortages of clinical laboratory scientists (CLS) and technicians (CLT). In addition, with overrepresentation of the aging Baby Boomer generation in laboratory supervisory and management positions, it is crucial not only to retain younger practitioners, but to prepare them for assuming these important functions in the future. Mentoring, a practice commonly employed in other professions, is widely considered to be useful in employee retention and career advancement. Mentoring has probably been used in the clinical laboratory profession, but has not been well documented. In the clinical laboratory environment, potential mentors are in the Veteran and Baby Boomer generations, and new practitioners who could benefit from mentoring are in Generation X. Generational differences among these groups may present challenges to the use of mentoring. This article will attempt to provide a better understanding of generational differences and show how mentoring can be applied in the setting of the clinical laboratory in order to increase retention and promote career advancement of younger practitioners. A panel of five laboratory managers provided examples of mentoring strategies. Definitions, benefits, and examples of mentoring are addressed in the accompanying article, "Passing the Torch: Mentoring the Next Generation of Laboratory Professionals".

  2. Medical Service Clinical Laboratory Procedures--Parasitology. (United States)

    Department of the Army, Washington, DC.

    This manual presents techniques for the collection and examination of specimens in the diagnosis of parasitic disease and in field surveys conducted to determine the extent of parasitic infections in human and animal populations. It discusses areas in which parasites are most likely to be found and the relationships of parasites, vectors, and…

  3. Comparison of the Vitek 2 Antifungal Susceptibility System with the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) Broth Microdilution Reference Methods and with the Sensititre YeastOne and Etest Techniques for In Vitro Detection of Antifungal Resistance in Yeast Isolates ▿ ‖ (United States)

    Cuenca-Estrella, Manuel; Gomez-Lopez, Alicia; Alastruey-Izquierdo, Ana; Bernal-Martinez, Leticia; Cuesta, Isabel; Buitrago, Maria J.; Rodriguez-Tudela, Juan L.


    The commercial technique Vitek 2 system for antifungal susceptibility testing of yeast species was evaluated. A collection of 154 clinical yeast isolates, including amphotericin B- and azole-resistant organisms, was tested. Results were compared with those obtained by the reference procedures of both the CLSI and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Two other commercial techniques approved for clinical use, the Etest and the Sensititre YeastOne, were included in the comparative exercise as well. The average essential agreement (EA) between the Vitek 2 system and the reference procedures was >95%, comparable with the average EAs observed between the reference procedures and the Sensititre YeastOne and Etest. The EA values were >97% for Candida spp. and stood at 92% for Cryptococcus neoformans. Intraclass correlation coefficients (ICC) between the commercial techniques and the reference procedures were statistically significant (P < 0.01). Percentages of very major errors were 2.6% between Vitek 2 and the EUCAST technique and 1.6% between Vitek 2 and the CLSI technique. The Vitek 2 MIC results were available after 14 to 18 h of incubation for all Candida spp. (average time to reading, 15.5 h). The Vitek 2 system was shown to be a reliable technique to determine antifungal susceptibility testing of yeast species and a more rapid and easier alternative for clinical laboratories than the procedures developed by either the CLSI or EUCAST. PMID:20220169

  4. [Clinical laboratory approaches to parodontitis treatment optimization]. (United States)

    Soboleva, L A; Shul'diakov, A A; Oseeva, A O; Aleksandrova, E A


    In order to determine cycloferon liniment clinical-pathogenetic efficacy in comprehensive parodontitis therapy examination and treatment of 80 patients was done. It was determined that the cycloferon liniment use in comprehensive treatment of patients with parodontitis let to reduce infectious load in parodontal pockets and local inflammation intensity, to normalize the secretory immunoglobulin level and immune status indices that provided speed up of healing process and reduction relapse frequency.

  5. [Management and accounting solution required in clinical laboratory department in the hospital and the balanced scorecard (BSC)]. (United States)

    Takahashi, Toshiro


    This is to describe required accounting knowledge and the techniques for the clinical laboratory department management level people to operate their division from the viewpoint of management. Especially, the necessity and the efficacy of the BSC implementation in the clinical laboratory department are being explained.

  6. Laboratory aspects of clinically significant rapidly growing mycobacteria

    Directory of Open Access Journals (Sweden)

    R Set


    Full Text Available The pathogenic potential of the rapidly growing mycobacteria (RGM has started being recognized. This is due to more sensitive and specific techniques in the laboratory. The RGM are generally defined as nontuberculous species of mycobacteria that show visible growth on agar media within 7 days. RGM are widely distributed in nature and have been isolated from natural water, tap water, and soil. Several biochemical tests, high performance liquid chromatography, and molecular techniques have been developed for rapid identification of these species. The American Thoracic Society and the Infectious Disease Society of America recommend that RGM should be identified to the species level using a recognized acceptable methodology such as polymerase chain reaction restriction enzyme analysis or biochemical testing and routine susceptibility testing of RGM should include amikacin, imipenem, doxycycline, the fluorinated quinolones, a sulphonamide or trimethoprim-sulphamethoxazole, cefoxitin, clarithromycin, linezolid, and tobramycin. The diseases caused by these organisms have varied manifestations. They have been responsible for a number of healthcare-associated outbreaks and pseudo-outbreaks. For recognition of outbreaks, it is important to be familiar with the causative organisms like RGM which are most frequently involved in healthcare-associated outbreaks and pseudo outbreaks. It is essential to intervene as soon as possible to interrupt this transmission. Large gaps still exist in our knowledge of RGM. Unquestionably more studies are required. Through this review, we wish to emphasize that reporting of RGM from clinical settings along with their sensitivity patterns is an absolute need of the hour.

  7. [Clinical microbiology laboratory and imported parasitic diseases]. (United States)

    Martín-Rabadán, Pablo; Martínez-Ruiz, Rocío; Cuadros, Juan; Cañavate, Carmen


    Imported parasitosis represents an increasingly frequent diagnostic challenge for microbiology laboratories. A surge in immigration and international travel has led to a rise in the number of imported cases of parasitosis, and this trend is expected to continue in the future. The present article addresses this challenge by reviewing recommended diagnostic approaches and tests. Currently, microscopy is always recommended when analysing blood samples for parasites. If malaria is suspected, rapid antigen testing (including at least HRP2 antigen) should also be performed. The work-up for suspected leishmaniasis should include serology, culture, and in selected cases detection of antigen in urine. In suspected Chagas disease, two different serological tests should be performed. PCR for blood protozoa is highly sensitive, although it cannot be used to rule out Chagas disease, since this condition may be present without parasitemia. Accurate diagnosis of intestinal amebiasis usually requires PCR or antigen detection tests. In helminthiasis, traditional microscopy may need to be complemented with other tests, such as agar plate culture for strongyloidiasis, Og4C3 antigen detection for bancroftian filariasis, and antibody detection test for filariasis and schistosomiasis.

  8. Clinical laboratory as an economic model for business performance analysis (United States)

    Buljanović, Vikica; Patajac, Hrvoje; Petrovečki, Mladen


    Aim To perform SWOT (strengths, weaknesses, opportunities, and threats) analysis of a clinical laboratory as an economic model that may be used to improve business performance of laboratories by removing weaknesses, minimizing threats, and using external opportunities and internal strengths. Methods Impact of possible threats to and weaknesses of the Clinical Laboratory at Našice General County Hospital business performance and use of strengths and opportunities to improve operating profit were simulated using models created on the basis of SWOT analysis results. The operating profit as a measure of profitability of the clinical laboratory was defined as total revenue minus total expenses and presented using a profit and loss account. Changes in the input parameters in the profit and loss account for 2008 were determined using opportunities and potential threats, and economic sensitivity analysis was made by using changes in the key parameters. The profit and loss account and economic sensitivity analysis were tools for quantifying the impact of changes in the revenues and expenses on the business operations of clinical laboratory. Results Results of simulation models showed that operational profit of €470 723 in 2008 could be reduced to only €21 542 if all possible threats became a reality and current weaknesses remained the same. Also, operational gain could be increased to €535 804 if laboratory strengths and opportunities were utilized. If both the opportunities and threats became a reality, the operational profit would decrease by €384 465. Conclusion The operational profit of the clinical laboratory could be significantly reduced if all threats became a reality and the current weaknesses remained the same. The operational profit could be increased by utilizing strengths and opportunities as much as possible. This type of modeling may be used to monitor business operations of any clinical laboratory and improve its financial situation by

  9. Antiphospholipid antibody: laboratory, pathogenesis and clinical manifestations

    Directory of Open Access Journals (Sweden)

    T. Ziglioli


    Full Text Available Antiphospholipid antibodies (aPL represent a heterogeneous group of antibodies that recognize various antigenic targets including beta2 glycoprotein I (β2GPI, prothrombin (PT, activated protein C, tissue plasminogen activator, plasmin and annexin A2. The most commonly used tests to detect aPL are: lupus anticoagulant (LAC, a functional coagulation assay, anticardiolipin antibody (aCL and anti-β2GPI antibody (anti-β2GPI, which are enzyme-linked immunoassay (ELISA. Clinically aPL are associated with thrombosis and/or with pregnancy morbidity. Apparently aPL alone are unable to induce thrombotic manifestations, but they increase the risk of vascular events that can occur in the presence of another thrombophilic condition; on the other hand obstetrical manifestations were shown to be associated not only to thrombosis but mainly to a direct antibody effect on the trophoblast.

  10. 1.2.Clinical laboratory diagnosis

    Institute of Scientific and Technical Information of China (English)


    930212 Enzymatic analysis of serum total bileacids and clinical evaluation.WEI Youren (魏有仁),et al.Sino—Japan Friendship Hosp,Bei-jing,100029.CHin J Med Lab Technol 1993;16(1):11—14.An enzymatic colorimetric assay of serum to-tal bile acids (TBA) was reported for the firsttime in China.3 α-hydroxysteroid dehydroge-nase (3α-HSD) had been purified from pseu-domonas testosteroni in the sventies,and hadbeen used as a main enzyme reagent in the enzy-matic analysis of TBA.In this paper,the au-thors introduced a rapid,sensitive colorimetricassay using 3α-HSD,and a couple enzyme 5β-steroid Δ~4 dehydrogenase to imcrease the con-

  11. [View of a Laboratory Physician on the Present and Future of Clinical Laboratories]. (United States)

    Matsuo, Shuji


    It is meaningful to discuss the "present and future of laboratories" for the development of laboratories and education of medical technologists. Laboratory staff must be able to perform urgent high-quality tests and take part in so-called team-based medicine and should be proud of devising systems that efficiently provide laboratory data for all medical staff. On the other hand, there may be staff with a poor sense of professionalism who work no more than is expected and too readily ask firms and commercial laboratories to solve problems. Overwork caused by providing team-based medicine and a decrease in numbers of clinical chemists are concerns. The following are hoped for in the future. Firstly, laboratory staff will become conscious of their own high-level abilities and expand their areas of work, for example, bioscience, proteomics, and reproductive medicine. Secondly, a consultation system for medical staff and patients will be established. Thirdly, clinical research will be advanced, such as investigating unknown pathophysiologies using laboratory data and samples, and developing new methods of measurement. Lastly, it is of overriding importance that staff of laboratory and educational facilities will cooperate with each other to train the next generation. In conclusion, each laboratory should be appreciated, attractive, positive regarding its contribution to society, and show individuality.

  12. 75 FR 12554 - Clinical Laboratory Improvement Advisory Committee: Notice of Charter Renewal (United States)


    ... HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory...-463) of October 6, 1972, that the Clinical Laboratory Improvement Advisory Committee, Centers for..., Clinical Laboratory Improvement Advisory Committee, Centers for Disease Control and Prevention,...

  13. A FMEA clinical laboratory case study: how to make problems and improvements measurable. (United States)

    Capunzo, Mario; Cavallo, Pierpaolo; Boccia, Giovanni; Brunetti, Luigi; Pizzuti, Sante


    The authors have experimented the application of the Failure Mode and Effect Analysis (FMEA) technique in a clinical laboratory. FMEA technique allows: a) to evaluate and measure the hazards of a process malfunction, b) to decide where to execute improvement actions, and c) to measure the outcome of those actions. A small sample of analytes has been studied: there have been determined the causes of the possible malfunctions of the analytical process, calculating the risk probability index (RPI), with a value between 1 and 1,000. Only for the cases of RPI > 400, improvement actions have been implemented that allowed a reduction of RPI values between 25% to 70% with a costs increment of FMEA technique can be applied to the processes of a clinical laboratory, even if of small dimensions, and offers a high potential of improvement. Nevertheless, such activity needs a thorough planning because it is complex, even if the laboratory already operates an ISO 9000 Quality Management System.

  14. Effects of implant angulation, material selection, and impression technique on impression accuracy: a preliminary laboratory study. (United States)

    Rutkunas, Vygandas; Sveikata, Kestutis; Savickas, Raimondas


    The aim of this preliminary laboratory study was to evaluate the effects of 5- and 25-degree implant angulations in simulated clinical casts on an impression's accuracy when using different impression materials and tray selections. A convenience sample of each implant angulation group was selected for both open and closed trays in combination with one polyether and two polyvinyl siloxane impression materials. The influence of material and technique appeared to be significant for both 5- and 25-degree angulations (P impression accuracy. The open-tray technique was more accurate with highly nonaxially oriented implants for the small sample size investigated.

  15. Applications of nuclear techniques for in vivo body composition studies at Brookhaven National Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Cohn, S.H.; Ellis, K.J.; Vartsky, D.; Vaswani, A.N.; Wielopolski, L.


    A series of technical developments and their clinical applications in various nuclear technologies at Brookhaven National Laboratory is described. These include the development of a portable neutron activation facility for measuring cadmium in vivo in kidney and liver, a technique for the measurement of body iron utilizing nuclear resonant scattering of gamma rays, a non-invasive measure of the skeletal levels of lead by an x-ray fluorescence technique, and the development of a pulsed Van de Graaff generator as a source of pulsed neutrons for the measurement of lung silicon. (ACR)

  16. Nuclear and related techniques in parasitology: A laboratory manual

    Energy Technology Data Exchange (ETDEWEB)

    Hayunga, E.G.; Stek, M. Jr. (eds.)


    The course, entitled ''Atomic Energy Applications in Parasitology'', was offered by the Division of Tropical Public Health, Department of Preventive Medicine, and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland. It was an intensive 3-week endeavor during which students attended lectures and acquired practical hands-on experience with the most recent laboratory tools. The course began with an exhaustive introduction to radiation physics, then encompassed a variety of practical applications including irradiation attenuation, radioisotope labeling, tracer techniques and radioimmunoassays. This laboratory manual was written by the faculty in an attempt to document the learning experience of the training course and to provide a detailed description of state-of-the-art technology with up-to-date references. Clearly, the manual has value as a historical document. However, the chapters were written with the explicit intention that they be useful to future investigators who wish to apply these methods to their particular research problem.

  17. Clinical laboratory sciences curriculum redevelopment: an application of change theories. (United States)

    Mundt, Lillian; Vanik, Janet


    The Department of Clinical Laboratory Sciences at Rosalind Franklin University of Medicine and Science (RFUMS) experienced a steady decline in the number of applicants for the Clinical Laboratory Sciences (CLS) Program, even though the department regularly received inquiries from qualified students. The faculty recognized the undergraduate-degreed prospects' desires for both an advanced degree and the procurement of entry-level clinical laboratory knowledge and skills. To address this perceived need, the CLS department developed and implemented a new degree option, the entry-level master's. The new curriculum resulted from a transformational process incorporated into the normal developmental process of curriculum change. This article explores various change theories that were manifested during this transformation process, along with barriers to change and how to overcome them. In addition, the authors demonstrate the need for creation of this entry-level program and provide a curriculum outline.

  18. Laboratory diagnosis of Toxoplasma gondii infection with direct and indirect diagnostic techniques

    Directory of Open Access Journals (Sweden)

    Salvatore Pignanelli


    Full Text Available Background: Toxoplasma gondii infection, common parasitic zoonoses, is an important cause of spontaneous abortion, mental retardation, encephalitis, ocular disease and death worldwide. Today the major diagnostic techniques for the toxoplasmosis are serological assays, but its have many limitations. Aim : The goal in this study is to improve the diagnostic accuracy of T. gondii infection, using direct (Real Time PCR and indirect (IgM, IgA, IgG and IgG avidity diagnostic techniques. Materials and Methods: In the period between 2007 and 2008, 96 non consecutive different clinical samples (38 blood, 40 amniotic fluids, 8 cerebrospinal fluids, 10 vitreous humors and 96 sera have been studied simultaneously through molecular biology and serological techniques. Results: Direct and indirect diagnostic techniques used in this study for laboratory diagnosis of T. gondii infection were always concordant. Conclusions : The high correlation between direct and indirect diagnostic techniques exhibit that serologic techniques are accurate diagnostic assays as screening test in laboratory diagnosis of toxoplasmosis.

  19. Position of immunological techniques in screening in clinical toxicology. (United States)

    George, Steve


    There is a continuing increase in the use of immunological techniques in the field of clinical toxicology. This is primarily due to the rapidity by which analytical results are now required, and can be obtained, following the testing of individuals for drug use. There has recently been an increase in the repertoire of assays now available to testing laboratories (e.g., buprenorphine and heroin metabolite assays), with the techniques themselves becoming increasingly more specific for the drugs and/or metabolites being monitored (e.g., methadone metabolite assays). The near patient testing (NPT), or point-of-care testing (POCT), devices are now several generations forward from their inception, with some tests now approaching the sensitivity and specificity of automated laboratory-based methods. This review has been collated from the literature to illustrate some of the possible reasons for the move towards the increasing use of immunological techniques, and to highlight some of the advantages and disadvantages associated with such drug screening methods. In particular, it has been shown that it is important to determine, monitor and review the knowledge and training of the individual using the technique. In addition, quality control and quality assessment are paramount to ensure the validity of any drug testing being performed. It has also been shown that it is vital to maintain and develop the relationships between the staff performing the testing, the laboratory (if the testing is performed using NPT devices), and the clinicians utilising the results obtained from drug testing. Without these links, interpretive errors could arise which could adversely affect the diagnosis and management of patients.

  20. Contributions of Analytical Chemistry to the Clinical Laboratory. (United States)

    Skogerboe, Kristen J.


    Highlights several analytical techniques that are being used in state-of-the-art clinical labs. Illustrates how other advances in instrumentation may contribute to clinical chemistry in the future. Topics include: biosensors, polarization spectroscopy, chemiluminescence, fluorescence, photothermal deflection, and chromatography in clinical…

  1. Understanding the interface between clinical and laboratory staff

    Directory of Open Access Journals (Sweden)

    Ankie van den Broek


    Full Text Available Background: The interface between clinicians and laboratory staff is where the two meet and work together to provide quality care to their clients (patients. Effectiveness of the interface depends on the way the two groups of professionals relate to and communicate with each other. The number and type of tests requested and the use of the test results for clinical decision making can be influenced by the interface between clinicians and laboratory staff. A model to understand the factors and dynamics around the interface is lacking.Objectives: To propose a new conceptual model to gain insight and analyse factors that influence the laboratory–clinical staff interface.Methods: To develop the conceptual model, a literature study was performed, regulatory guidelines and standards for laboratories were analysed and discussions were held with experts on the topic.Result: A conceptual model and analytical framework provided good guidance in understanding and assessing the organisational and personal factors shaping the interface. The model was based on three elements: (1 the three phases of communication (pre-analytical, analytical and post-analytical; (2 the organisational and personal factors of interaction; and (3 the socio-political, economic and cultural context in which clinicians and laboratory staff operate.Conclusion: Assessment of the interface between clinicians and laboratory workers can be performed in a systematic way. Applying this model will provide information to managers of health institutions and heads of laboratories and clinical departments about what happens when clinicians and laboratory staff interact, thus aiding them in designing strategies to improve this interface. Normal 0 21 false false false NL X-NONE X-NONE

  2. Bioterrorism and the Role of the Clinical Microbiology Laboratory. (United States)

    Wagar, Elizabeth


    Regular review of the management of bioterrorism is essential for maintaining readiness for these sporadically occurring events. This review provides an overview of the history of biological disasters and bioterrorism. I also discuss the recent recategorization of tier 1 agents by the U.S. Department of Health and Human Services, the Laboratory Response Network (LRN), and specific training and readiness processes and programs, such as the College of American Pathologists (CAP) Laboratory Preparedness Exercise (LPX). LPX examined the management of cultivable bacterial vaccine and attenuated strains of tier 1 agents or close mimics. In the LPX program, participating laboratories showed improvement in the level of diagnosis required and referral of isolates to an appropriate reference laboratory. Agents which proved difficult to manage in sentinel laboratories included the more fastidious Gram-negative organisms, especially Francisella tularensis and Burkholderia spp. The recent Ebola hemorrhagic fever epidemic provided a check on LRN safety processes. Specific guidelines and recommendations for laboratory safety and risk assessment in the clinical microbiology are explored so that sentinel laboratories can better prepare for the next biological disaster.

  3. Sweet syndrome: Clinical and Laboratory Findings of 31 Cases

    Directory of Open Access Journals (Sweden)

    Serap Güneş Bilgili


    Full Text Available Background and Design: Sweet syndrome is an inflammatory disease characterized by the abrupt onset of pain, red papules and plaques, fever, neutrophilic leukocytosis, and dermal neutrophilic infiltrate. There are not enough data about Sweet syndrome in Turkey. In this article, we studied clinical, laboratory, histopathological, and epidemiological characteristics of patients, who presented to our clinic, and compared the findings with the literature. Materials and Methods: All patients diagnosed with Sweet syndrome in our clinic between 2005 and 2011 were included in the study. The epidemiological, clinical, and laboratory findings were retrospectively evaluated. Results: A total of 31 patients with Sweet’s syndrome - 24 female (77.4%, 7 male (22.6%; aged 23-82 years – included in the study. The average age of the patients was 48 years. Cutaneous lesions were most frequently localized in the upper extremity. Conjunctivitis was the common systemic manifestation, followed by fever, arthralgia, and myalgia. The most common trigger factor was infections of the upper respiratory tract. In histopathological evaluations of skin biopsies, dense neutrophil infiltration compatible with Sweet syndrome was detected in the dermis. Also, findings of vasculitis were determined in 3 patients. Discussion: The clinical and laboratory findings in our study are mostly similar to those reported in the literature. We found evidence of vasculitis in 10% of cases, therefore, we think the presence of vasculitis does not necessarily rule out the diagnosis of Sweet syndrome

  4. Clinical Mass Spectrometry: Achieving Prominence in Laboratory Medicine

    Energy Technology Data Exchange (ETDEWEB)

    Annesley, Thomas M.; Cooks, Robert G.; Herold, David A.; Hoofnagle, Andrew N.


    Each year the journal Clinical Chemistry publishes a January special issue on a topic that is relevant to the laboratory medicine community. In January 2016 the topic is mass spectrometry, and the issue is entitled “Clinical Mass Spectrometry: Achieving Prominence in Laboratory Medicine”. One popular feature in our issues is a Q&A on a topic, clearly in this case mass spectrometry. The journal is assembling a panel of 5-6 experts from various areas of mass spectrometry ranging from instrument manufacturing to practicing clinical chemists. Dick Smith is one of the scientist requested to participate in this special issue Q&A on Mass Spectrometry. The Q&A Transcript is attached

  5. Walking the bridge: Nursing students' learning in clinical skill laboratories. (United States)

    Ewertsson, Mona; Allvin, Renée; Holmström, Inger K; Blomberg, Karin


    Despite an increasing focus on simulation as a learning strategy in nursing education, there is limited evidence on the transfer of simulated skills into clinical practice. Therefore it's important to increase knowledge of how clinical skills laboratories (CSL) can optimize students' learning for development of professional knowledge and skills, necessary for quality nursing practice and for patient safety. Thus, the aim was to describe nursing students' experiences of learning in the CSL as a preparation for their clinical practice. Interviews with 16 students were analysed with content analysis. An overall theme was identified - walking the bridge - in which the CSL formed a bridge between the university and clinical settings, allowing students to integrate theory and practice and develop a reflective stance. The theme was based on categories: conditions for learning, strategies for learning, tension between learning in the skills laboratory and clinical settings, and development of professional and personal competence. The CSL prepared the students for clinical practice, but a negative tension between learning in CSL and clinical settings was experienced. However, this tension may create reflection. This provides a new perspective that can be used as a pedagogical approach to create opportunities for students to develop their critical thinking.

  6. EM techniques for archaeological laboratory experiments: preliminary results (United States)

    Capozzoli, Luigi; De Martino, Gregory; Giampaolo, Valeria; Raffaele, Luongo; Perciante, Felice; Rizzo, Enzo


    The electromagnetic techniques (EM) are based on the investigation of subsoil geophysical parameters and in the archaeological framework they involve in studying contrasts between the buried cultural structures and the surrounding materials. Unfortunately, the geophysical contrast between archaeological features and surrounding soils sometimes are difficult to define due to problems of sensitivity and resolution both related on the characteristic of the subsoil and the geophysical methods. For this reason an experimental activity has been performed in the Hydrogeosite laboratory addressed on the assessment of the capability of geophysical techniques to detect archeological remains placed in the humid/saturated subsoil. At Hydrogeosite Laboratory of CNR-IMAA, a large scale sand-box is located, consisting on a pool shape structures of 230m3 where archaeological remains have been installed . The remains are relative to a living environment and burial of Roman times (walls, tombs, roads, harbour, etc.) covered by sediments. In order to simulate lacustrine and wetland condition and to simulate extreme events (for example underwater landslide, fast natural erosion coast, etc.) the phreatic level was varied and various acquisitions for the different scenarios were performed. In order to analyze the EM behavior of the buried small archaeological framework, ground penetrating radar (GPR) and electrical resistivity tomographies were performed. With GPR, analysis in time domain and frequency domain were performed and coupled to information obtained through resistivity analysis with the support of numerical simulations used to compare the real data with those modeled. A dense grid was adopted for 400 and 900 MHz e-m acquisitions in both the directions, the maximum depth of investigation was limited and less than 3 meters. The same approach was used for ERT acquisition where different array are employed, in particular 3D configuration was used to carry out a 3D resistivity

  7. [Perspective for clinical laboratory management and its systematization--effects of the systematization of clinical laboratory management]. (United States)

    Ito, S


    There are a large number of ideas concerning the systematization of clinical laboratory management. Therefore many types of laboratory systems have been constructed. As our hospital is not large, we adopted a small scale laboratory system. In introducing it, we expected not only an increase in value-added labor productivity by automating laboratory tests, but also an improvement in technologist's cost awareness. Consequently, new system equipment has itself performed the former in many sections, but not the latter. Improvement in cost awareness was caused by the technologist's routine work in managing reagent and material stocks. We found that this soft-type systematization has been more important than the advanced hard-type system.

  8. Near surface geophysical techniques on subsoil contamination: laboratory experiments (United States)

    Capozzoli, Luigi; Giampaolo, Valeria; Rizzo, Enzo


    Hydrocarbons contamination of soil and groundwater has become a serious environmental problem, because of the increasing number of accidental spills caused by human activities. The starting point of any studies is the reconstruction of the conceptual site model. To make valid predictions about the flow pathways following by hydrocarbons compound is necessary to make a correct reconstruction of their characteristics and the environment in which they move. Near-surface geophysical methods, based on the study of electrical and electromagnetic properties, are proved to be very useful in mapping spatial distribution of the organic contaminants in the subsurface. It is well known, in fact, that electrical properties of the porous media are significantly influenced by hydrocarbons because, when contaminants enter the rock matrix, surface reaction occur between the contaminant and the soil grain surface. The main aim of this work is to investigate the capability of near-surface geophysical methods in mapping and monitoring spatial distribution of contaminants in a controlled setting. A laboratory experiment has been performed at the Hydrogeosite Laboratory of CNR-IMAA (Marsico Nuovo, PZ) where a box-sand has been contaminated by diesel. The used contaminant is a LNAPL, added to the sand through a drilled pipe. Contaminant behaviour and its migration paths have been monitored for one year by Electrical Resistivity measurements. In details, a Cross Borehole Electrical Resistivity Tomography techniques were used to characterize the contamination dynamics after a controlled hydrocarbon spillage occurring in the vadose zone. The approach with cross-borehole resistivity imaging provide a great advantage compared to more conventional surface electrical resistivity tomography, due to the high resolution at high depth (obviously depending on the depth of the well instrumented for the acquisition). This method has been shown to provide good information on the distribution of

  9. Laboratory techniques in plant molecular biology taught with UniformMu insertion alleles of maize (United States)

    An undergraduate course - Laboratory Techniques in Plant Molecular Biology - was organized around our research application of UniformMu insertion alleles to investigate mitochondrial functions in plant reproduction. The course objectives were to develop students’ laboratory, record keeping, bioinfor...

  10. Clinical laboratories, the select agent program, and biological surety (biosurety). (United States)

    Pastel, Ross H; Demmin, Gretchen; Severson, Grant; Torres-Cruz, Rafael; Trevino, Jorge; Kelly, John; Arrison, Jay; Christman, Joy


    The threat of bioterrorism has led to increased concerns over the availability of biological select agents and toxins (BSAT). Congress has implemented several public laws that have led to the development of federal regulations by the Centers for Disease Control and Prevention (CDC) and the US Department of Agriculture. The CDC regulation 42 CFR 73 has a direct impact on all clinical laboratories that may at some time identify BSAT in a clinical specimen. The Department of Defense has imposed a more stringent layer of regulation called biological surety (biosurety) on top of the requirements of 42 CFR 73 for military laboratories that possess BSAT. However,42 CFR 73 falls into the framework of biosurety. Both sets of regulations have four pillars (safety, physical security, agent account-ability, and personnel reliability) that are built on a foundation of training and covered by a roof of management (operations and plans).

  11. Evaluation of Neonatal Hemolytic Jaundice: Clinical and Laboratory Parameters


    Anet Papazovska Cherepnalkovski; Vjekoslav Krzelj; Beti Zafirovska-Ivanovska; Todor Gruev; Josko Markic; Natasa Aluloska; Nikolina Zdraveska; Katica Piperkovska


    BACKGROUND: Neonatal jaundice that occurs in ABO or Rhesus issoimunisation has been recognized as one of the major risk factors for development of severe hyperbilirubinemia and bilirubin neurotoxicity. AIM: Aim of our study was to investigate clinical and laboratory parameters associated with hemolytic jaundice due to Rh and ABO incompatibility and compare results with the group of unspecific jaundice. MATERIAL AND METHODS: One hundred sixty seven (167) neonatal hyperbilirubinemia cas...

  12. Clinical and laboratory characteristics of Achromobacter xylosoxidans infection.



    Achromobacter xylosoxidans was isolated from six patients. The organism causes opportunistic infections in patients who are compromised. A. xylosoxidans is a catalase- and oxidase-positive, motile, gram-negative rod that oxidizes xylose and glucose. The organism exists in a water environment and may be confused with Pseudomonas species. Unlike pseudomonas, achromobacter has peritrichous flagella. The clinical and laboratory characteristics of A. xylosoxidans are presented.

  13. Clinical Laboratory Stressors Used to Study Alcohol–Stress Relationships


    Thomas, Suzanne; Bacon, Amy K.; Sinha, Rajita; Uhart, Magdalena; Adinoff, Bryon


    Understanding the biologic systems that underlie the relationship between stress and alcohol consumption may lead to better prevention efforts and more effective treatments for alcoholism. Clinical laboratory studies offer a unique opportunity to examine these relationships by using a controlled environment to study how an acute stressor affects alcohol drinking and alcohol craving, how individuals in recovery or those at risk for alcoholism may respond differently to stressors relative to co...

  14. Detection of Cryptosporidium and Giardia in clinical laboratories in Europe--a comparative study. (United States)

    Manser, M; Granlund, M; Edwards, H; Saez, A; Petersen, E; Evengard, B; Chiodini, P


    To determine the routine diagnostic methods used and compare the performance in detection of oocysts of Cryptosporidium species and cysts of Giardia intestinalis in faecal samples by European specialist parasitology laboratories and European clinical laboratories. Two sets of seven formalin-preserved faecal samples, one containing cysts of Giardia intestinalis and the other, containing oocysts of Cryptosporidium, were sent to 18 laboratories. Participants were asked to examine the specimens using their routine protocol for detecting these parasites and state the method(s) used. Eighteen laboratories answered the questionnaire. For detection of Giardia, 16 of them used sedimentation/concentration followed by light microscopy. Using this technique the lower limit of detection of Giardia was 17.2 cysts/mL of faeces in the best performing laboratories. Only three of 16 laboratories used fluorescent-conjugated antibody-based microscopy. For detection of Cryptosporidium acid-fast staining was used by 14 of the 17 laboratories that examined the samples. With this technique the lower limit of detection was 976 oocysts/mL of faeces. Fluorescent-conjugated antibody-based microscopy was used by only five of the 17 laboratories. There was variation in the lower limit of detection of cysts of Giardia and oocysts of Cryptosporidium between laboratories using the same basic microscopic methods. Fluorescent-conjugated antibody-based microscopy was not superior to light microscopy under the conditions of this study. There is a need for a larger-scale multi-site comparison of the methods used for the diagnosis of these parasites and the development of a Europe-wide laboratory protocol based upon its findings.

  15. Clinical, laboratorial and radiographic predictors of Bordetella pertussis infection

    Directory of Open Access Journals (Sweden)

    Camila Vieira Bellettini


    Full Text Available OBJECTIVE: To identify clinical, laboratorial and radiographic predictors for Bordetella pertussis infection.METHODS: This was a retrospective study, which analyzed medical records of all patients submitted to a molecular dignosis (qPCR for B. pertussis from September 2011 to January 2013. Clinical and laboratorial data were reviewed, including information about age, sex, signs/symptoms, length of hospitalization, blood cell counts, imaging findings, coinfection with other respiratory pathogens and clinical outcome.RESULTS: 222 cases were revised. Of these, 72.5% had proven pertussis, and 60.9% were under 1 year old. In patients aging up to six months, independent predictors for B. pertussisinfection were (OR 8.0, CI 95% 1.8-36.3; p=0.007 and lymphocyte count >104/µL (OR 10.0, CI 95% 1.8-54.5; p=0.008. No independent predictors of B. pertussisinfection could be determined for patients older than six months. Co-infection was found in 21.4% of patients, of which 72.7% were up to six months of age. Adenovirus was the most common agent (40.9%. In these patients, we were not able to identify any clinical features to detect patients presenting with a respiratory co-infection, even though longer hospital stay was observed in patients with co-infections (12 vs. 6 days; p=0.009.CONCLUSIONS: Cyanosis and lymphocytosis are independent predictors for pertussis in children up to 6 months old.

  16. Correlation between the limit values of laboratory and clinical mycotoxicosis

    Directory of Open Access Journals (Sweden)

    Stojanov Igor M.


    Full Text Available Analysis of feed for the presence of fungi and mycotoxins is a request necessary to meet in order to ensure a healthy and economical production in livestock. These tests are related to legal regulation which prescribes the maximum legislated content (MLC, both for the presence of mycotoxins and the total number of fungi in certain feeds. Health problems that can occur during the production of animals are sometimes caused by the presence of mycotoxins in the feed. Laboratory testing is a good practice to confirm a suspicion, and allows timely treatment of contaminated feed. Potential problems arise under circumstances when there is a clinical outcome of mycotoxicosis and animal and laboratory findings suggest that the obtained values are below the level that is within the MLC. For these reasons, the subject of our research was to investigate the occurrence of mycotoxins and mold in feed, as well as the clinical presentation for animals that were fed with the feed with allowed values of these agents according to the recommended levels. The aim of this paper was to highlight the problems associated with clinical correlation of sick animals and laboratory findings, and suggest their overcoming. In the period of one year, a total of 176 samples of feed (complete mixture for broilers, corn and soy products were examined for the presence of fungi, 106 samples were examined for the presence of mycotoxins and 26 flocks of broilers and turkeys were clinically observed. Standard methods were used for isolation of molds and the ELISA test was used for the detection of mycotoxins. Clinical and pathomorphological observation of the flocks was done to determine the natural indicators of production. Studies indicated a problem because clinical and pathomorphological findings in some cases were not correlated with laboratory findings of molds and mycotoxins in the feed, and in some cases it did not necessarily mean that the animals were healthy. Synergism and

  17. Acute tramadol poisoning and its clinical and laboratory findings (United States)

    Rahimi, Hamid Reza; Soltaninejad, Kambiz; Shadnia, Shahin


    Background: Tramadol is a centrally acting analgesic with opioid and nonopioid properties, which extensively used in the relief of mild to moderate pain. Tramadol poisoning is a common cause of acute pharmaceutical poisoning in Iran. There are a few studies about clinical and laboratory findings related to acute tramadol poisoning. Therefore, the aim of this study was to demonstrate the clinical and laboratory findings in tramadol acute poisoning cases. Materials and Methods: This was a retrospective descriptive study of patients with acute tramadol poisoning who referred to Loghman Hakim Hospital Poison Center during January to April 2012. Data such as patient's age, sex, time of ingestion, ingested dose, cause of poisoning, mean duration of hospitalization, patient's clinical presentations, laboratory findings, therapeutic measures, and patient's outcome have collected in a predesigned checklist. Results: A total of 144 patients including 111 men (77%) and 33 women (23%) with acute tramadol poisoning was included in this study. The mean ingested dose was 1971.2 mg (100-20000 mg). Seizure (47.91%) was the most frequent clinical symptom. Blood gas on admission showed pH (7.3 ± 0.1), PCO2 (49.7 ± 8.6 mmHg) and HCO3− (24.1 ± 3.8 mEq/L), indicating pure acute respiratory acidosis may be occurred in tramadol-intoxicated patients. There were significant differences between tramadol-intoxicated cases with and without a seizure with regard to the time interval between ingestion and admission on hospital, ingested dose and PCO2. Conclusion: Seizure and rise of PCO2 were the most findings in this study. PMID:25535500

  18. [The purpose of clinical laboratory accreditation in transplantation medicine]. (United States)

    Flegar-Mestrić, Zlata; Nazor, Aida; Perkov, Sonja; Surina, Branka; Siftar, Zoran; Ozvald, Ivan; Vidas, Zeljko


    Although transplantation of solid organs has become a more standardized method of treatment, liver transplantation represents an exceptional multidisciplinary clinical procedure requiring understanding of specific pathophysiological changes that occur in the end stage of liver disease. Liver transplantation has been performed at Merkur University Hospital since 1998, with 360 transplantations performed to date. The most common indications are alcohol liver disease, cirrhosis caused by hepatitis B and C virus, hepatocellular carcinoma and cryptogenetic liver cirrhosis. Laboratory tests required for liver transplantation are performed at Department of Clinical Chemistry, Merkur University Hospital, accredited according to ISO 15189 in 2007 for the areas of clinical chemistry, laboratory hematology and coagulation, laboratory immunology-cell immunophenotyping, and molecular diagnosis. The complexity of liver transplant patients requires constant interaction between the anesthesiologist team and clinical laboratory, which has to ensure fast and efficient intraoperative monitoring of biochemical and liver profile: electrolytes and acid-base status, complete blood count, coagulation profile and monitoring of graft function according to the individual patient's health status. Dynamics of intraoperative changes is measured in whole arterial blood samples on a Nova Biomedical Stat Profile Critical Care Xpress mobile acid-base analyzer. Frequent monitoring of ionized calcium and magnesium levels is very important because of citrated blood transfusion and for appropriate therapeutic procedure. During anhepatic stage, there is a progressive increase in lactate level concentration. After reperfusion, a rapid increase in lactate clearance is an excellent indicator of stable graft initial function and its adequate size. During the transplantation procedure, there is usually a biphasic acid-base disturbance characterized by metabolic acidosis and then by metabolic alkalosis. The

  19. Kikuchi-Fujimoto disease: Clinical and laboratory characteristics and outcome

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    P S Rakesh


    Full Text Available Introduction: Kikuchi-Fujimoto disease is an uncommon disorder with worldwide distribution, characterized by fever and benign enlargement of the lymph nodes, primarily affecting young adults. Awareness about this disorder may help prevent misdiagnosis and inappropriate investigations and treatment. The objective of the study was to evaluate the clinical and laboratory characteristics of histopathologically confirmed cases of Kikuchi′s disease from a tertiary care center in southern India. Materials and Methods: Retrospective analysis of all adult patients with histopathologically confirmed Kikuchi′s disease from January 2007 to December 2011 in a 2700-bed teaching hospital in South India was done. The clinical and laboratory characteristics and outcome were analyzed. Results: There were 22 histopathologically confirmed cases of Kikuchi′s disease over the 5-year period of this study. The mean age of the subjects′ was 29.7 years (SD 8.11 and majority were women (Male: female- 1:3.4. Apart from enlarged cervical lymph nodes, prolonged fever was the most common presenting complaint (77.3%. The major laboratory features included anemia (54.5%, increased erythrocyte sedimentation rate (31.8%, elevated alanine aminotransferase (27.2% and elevated lactate dehydrogenase (LDH (31.8%. Conclusion: Even though rare, Kikuchi′s disease should be considered in the differential diagnosis of young individuals, especially women, presenting with lymphadenopathy and prolonged fever. Establishing the diagnosis histopathologically is essential to avoid inappropriate investigations and therapy.

  20. The increasing impact of laboratory medicine on clinical cardiology. (United States)

    Clerico, Aldo


    The practice of cardiology continues to evolve along with a better understanding of the pathophysiology of cardiovascular disease and the development of new therapeutic procedures. Consequently, new demands are being made on the in vitro diagnostics industry to improve the performance of existing cardiac markers and to develop novel markers for new cardiac disease indications. Indeed, in the last 20 years there has been a progressive increase in new laboratory tests for markers of cardiac diseases. Several highly sensitive and/or specific assays for the detection of myocardial ischemic damage as well as some immunoassays for cardiac natriuretic hormones, now considered a reliable marker of myocardial function, have become commercially available. In parallel, a growing number of some novel risk factors, which can be assessed and monitored by laboratory methods, have been added to the classical risk factors for cardiovascular disease. Finally, the recent explosion of genetic analysis may soon place at the clinical cardiologist's disposal many laboratory tests for defining the diagnosis at the molecular level, assessing new risk factors, and better targeting the pharmaceutical approaches in patients with cardiovascular disease. In the present article, after a brief description of the analytical tests included in these four groups, each group's impact on clinical cardiology is discussed in detail.

  1. Liposomal drug delivery system from laboratory to clinic

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    Kshirsagar N


    Full Text Available The main objective of drug delivery systems is to deliver a drug effectively, specifically to the site of action and to achieve greater efficacy and minimise the toxic effects compared to conventional drugs. Amongst various carrier systems, liposomes have generated a great interest because of their versatility. Liposomes are vesicular concentric bilayered structures, which are biocompatible, biodegradable and nonimmumnogenic. They can control the delivery of drugs by targeting the drug to the site of action or by site avoidance drug delivery or by prolonged circulation of drugs. Amphotericin B (Amp B remains the drug of choice in most systemic mycoses and also as a second line treatment for Kala azar. However, its toxic effects often limit its use. Although the liposome delivery system has been tried for several drugs, only a few have been used in patients due to the slow development of necessary large-scale pharmaceutical procedures. This paper reviews the development of the technique for liposomal Amphotericin B (L-Amp-LRC-1, FungisomeTM drug delivery system in our laboratory in collaboration with the department of Biochemistry, Delhi University in India and proving the safety and efficacy of this preparation in clinical practice. It also attempts to compare the efficacy and benefits of our product for Indian patients with those of similar products and it includes facts from the publications that flowed from our work. As compared to conventional Amp B, Fungisome is infused over a much shorter period requiring a smaller volume and no premedication. It was found to be safe in patients who had developed serious unacceptable toxicity with conventional Amp B. In renal transplant patients, Fungisome did not produce any nephrotoxicity. Fungisome is effective in fungal infections resistant to fluconazole, conventional Amp B and in virgin and resistant cases of visceral leishmaniasis. The cost of any drug is of great significance, especially in India

  2. Diets, equipment, and techniques for maintaining crawfish in the laboratory (United States)

    Tarshis, I.B.; Avault, James W.


    One commercial and 4 laboratory prepared extruded, water-stable diets were fed 3 times a week in 1-g portions to juvenile male and female White River crawfish, Procambarus acutus acutus (Girard), for 10 weeks. The. binding material in the laboratory preparation was alginate (Kelgin), whereas that in the commercial preparation was starch. No statistically significant weight differences developed between the groups of crawfish at the end of the 10-week period; all 5 diets were found satisfactory for feeding and maintaining P. acutus acutus in the laboratory, and all test crawfish survived throughout the experimental period. Weight gains were highest in a diet containing 50.5% protein; intermediate in those fed a diet with 46.0% protein; and lowest in those fed diets with 31.7 or 36.3% protein. Crawfish fed the commercial preparation of one of the 46.0% protein diets showed a slightly but not significantly higher weight gain than those fed the laboratory preparation of the diet. In an evaluation of the water stability of 5 commercially prepared animal chow diets and the commercial extruded diet, 2 of the commercial diets disintegrated after one hour exposure in water and the other 3 became bloated after one hour and remained on the surface throughout the 24-hour test. The commercial extruded diet maintained its water stability for the full 24 hours. The commercial preparation of the 46.0% protein diet was successfully used under laboratory conditions for feeding and maintaining the following crawfishes: Cambarellus shufeldtii (Faxon), Cambarus acuminatus Faxon, Orconectes limosus (Rafinesque), O. virilis (Hagen), Procambarus clarkii (Girard), and P. spiculifer (Le conte). In longevity experiments Cambarus diogenes diogenes Girard and Procambarus hinei (Ortmann) now have survived for 8 months on this diet in the laboratory.

  3. Clinical techniques of artificial insemination in dogs. (United States)

    Makloski, Chelsea L


    This article provides an overview of the current breeding techniques used in small animal reproduction today with an emphasis on artificial insemination techniques such as transvaginal and transcervical insemination as well as surgical deposition of semen in the uterus and oviduct. Breeding management and ovulation timing will be mentioned but are discussed in further detail in another article in this issue.

  4. On the improvement of blood sample collection at clinical laboratories (United States)


    Background Blood samples are usually collected daily from different collection points, such hospitals and health centers, and transported to a core laboratory for testing. This paper presents a project to improve the collection routes of two of the largest clinical laboratories in Spain. These routes must be designed in a cost-efficient manner while satisfying two important constraints: (i) two-hour time windows between collection and delivery, and (ii) vehicle capacity. Methods A heuristic method based on a genetic algorithm has been designed to solve the problem of blood sample collection. The user enters the following information for each collection point: postal address, average collecting time, and average demand (in thermal containers). After implementing the algorithm using C programming, this is run and, in few seconds, it obtains optimal (or near-optimal) collection routes that specify the collection sequence for each vehicle. Different scenarios using various types of vehicles have been considered. Unless new collection points are added or problem parameters are changed substantially, routes need to be designed only once. Results The two laboratories in this study previously planned routes manually for 43 and 74 collection points, respectively. These routes were covered by an external carrier company. With the implementation of this algorithm, the number of routes could be reduced from ten to seven in one laboratory and from twelve to nine in the other, which represents significant annual savings in transportation costs. Conclusions The algorithm presented can be easily implemented in other laboratories that face this type of problem, and it is particularly interesting and useful as the number of collection points increases. The method designs blood collection routes with reduced costs that meet the time and capacity constraints of the problem. PMID:24406140

  5. Quality Management Systems in the Clinical Laboratories in Latin America (United States)


    The implementation of management systems in accordance with standards like ISO 9001:2008 (1,2) in the clinical laboratories has conferred and added value of reliability and therefore a very significant input to patient safety. As we know the ISO 9001:2008 (1) a certification standard, and ISO 15189:2012 (2) an accreditation standard, both, at the time have generated institutional memory where they have been implemented, the transformation of culture focused on correct execution, control and following, evidence needed and the importance of register. PMID:27683495

  6. Quality Management Systems in the Clinical Laboratories in Latin America. (United States)

    Garzon, Alba C


    The implementation of management systems in accordance with standards like ISO 9001:2008 (1,2) in the clinical laboratories has conferred and added value of reliability and therefore a very significant input to patient safety. As we know the ISO 9001:2008 (1) a certification standard, and ISO 15189:2012 (2) an accreditation standard, both, at the time have generated institutional memory where they have been implemented, the transformation of culture focused on correct execution, control and following, evidence needed and the importance of register.

  7. Evaluation by Data Mining Techniques of Fluconazole Breakpoints Established by the Clinical and Laboratory Standards Institute (CLSI) and Comparison with Those of the European Committee on Antimicrobial Susceptibility Testing (EUCAST)▿ (United States)

    Cuesta, Isabel; Bielza, Concha; Cuenca-Estrella, Manuel; Larrañaga, Pedro; Rodríguez-Tudela, Juan L.


    The EUCAST and the CLSI have established different breakpoints for fluconazole and Candida spp. However, the reference methodologies employed to obtain the MICs provide similar results. The aim of this work was to apply supervised classification algorithms to analyze the clinical data used by the CLSI to establish fluconazole breakpoints for Candida infections and to compare these data with the results obtained with the data set used to set up EUCAST fluconazole breakpoints, where the MIC for detecting failures was >4 mg/liter, with a sensitivity of 87%, a false-positive rate of 8%, and an area under the receiver operating characteristic (ROC) curve of 0.89. Five supervised classifiers (J48 and CART decision trees, the OneR decision rule, the naïve Bayes classifier, and simple logistic regression) were used to analyze the original cohort of patients (Rex's data set), which was used to establish CLSI breakpoints, and a later cohort of candidemia (Clancy's data set), with which CLSI breakpoints were validated. The target variable was the outcome of the infections, and the predictor variable was the MIC or dose/MIC ratio. For Rex's data set, the MIC detecting failures was >8 mg/liter, and for Clancy's data set, the MIC detecting failures was >4 mg/liter, in close agreement with the EUCAST breakpoint (MIC > 4 mg/liter). The sensitivities, false-positive rates, and areas under the ROC curve obtained by means of CART, the algorithm with the best statistical results, were 52%, 18%, and 0.7, respectively, for Rex's data set and 65%, 6%, and 0.72, respectively, for Clancy's data set. In addition, the correlation between outcome and dose/MIC ratio was analyzed for Clancy's data set, where a dose/MIC ratio of >75 was associated with successes, with a sensitivity of 93%, a false-positive rate of 29%, and an area under the ROC curve of 0.83. This dose/MIC ratio of >75 was identical to that found for the cohorts used by EUCAST to establish their breakpoints (a dose/MIC ratio of

  8. Clinical and laboratory characteristics of women with uterine leiomiyoma

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    Özgür ÖZKUL


    Full Text Available The aim of this study was to compare clinical and laboratory findings of women with or without uterine leiomyoma.Study group consisted of 82 women with uterine leiomyoma and the control group comprised 42 healthy women. Women’s age, gravity, parity, blood groups, pattern of menstrual cycles, complaints at presentation, fertility, ultrasonographical findings, surgical operations and thyroid function tests were evaluated.There were no significant differences in blood group distribution, gravity, parity and thyroid function test results between the patients and the control subjects (P>0.05. A significant difference was found in the complaints at presentation between two groups (P<0.001. Mentrual cycles irregularity was more frequently found in the patients compared with the controls (57.3% vs. 42.9%, respectively, P=0.009. Although no infertile woman was found in the control group, 8.5% of patients were found to have infertility. The sensitivity of ultrasonography was found to be 97.6%. Except for the existence of higher infertility rate and the menstrual cycles irregularities, no significant difference was found in the clinical and laboratory findings between women with or without uterine leiomyoma. Therefore, physical examination and imaging methods are remained as the most important diagnostic tools for uterine leiomyoma.

  9. Socio-demographic, Clinical and Laboratory Features of Rotavirus Gastroenteritis in Children Treated in Pediatric Clinic


    Azemi, Mehmedali; Berisha, Majlinda; Ismaili-Jaha, Vlora; Kolgeci, Selim; Avdiu, Muharrem; Jakupi, Xhevat; Hoxha, Rina; Hoxha-Kamberi, Teuta


    Aim: The aim of work was presentation of several socio-demographic, clinical and laboratory characteristics of gastroenteritis caused by rotavirus. The examinees and methods: The examinees were children under the age of five years treated at the Pediatric Clinic due to acute gastroenteritis caused by rotavirus. Rotavirus is isolated by method chromatographic immunoassay by Cer Test Biotec. Results: From the total number of patients (850) suffering from acute gastroenteritis, feces test on bac...

  10. Clinical Relationships Extraction Techniques from Patient Narratives

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    Wafaa Tawfik Abdel-Moneim


    Full Text Available The Clinical E-Science Framework (CLEF project was used to extract important information from medical texts by building a system for the purpose of clinical research, evidence-based healthcare and genotype-meets-phenotype informatics. The system is divided into two parts, one part concerns with the identification of relationships between clinically important entities in the text. The full parses and domain-specific grammars had been used to apply many approaches to extract the relationship. In the second part of the system, statistical machine learning (ML approaches are applied to extract relationship. A corpus of oncology narratives that hand annotated with clinical relationships can be used to train and test a system that has been designed and implemented by supervised machine learning (ML approaches. Many features can be extracted from these texts that are used to build a model by the classifier. Multiple supervised machine learning algorithms can be applied for relationship extraction. Effects of adding the features, changing the size of the corpus, and changing the type of the algorithm on relationship extraction are examined.

  11. Evaluation of sugarcane laboratory ensiling and analysis techniques

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    André de Faria Pedroso


    Full Text Available The objective was to evaluate the effects of laboratory-silo type and method of silage extract production, respectively, on sugarcane silage fermentation and recovery of fermentation products. Sugarcane was mechanically harvested and ensiled in three different types of laboratory silos (five replicates: 9.7 × 30 cm PVC tubes with tight lids, equipped or unequipped with Bunsen valves, and 20 L plastic buckets with tight lids and Bunsen valves. Three methods were used to produce silage extracts for pH, ethanol, acetic and lactic acids determination: extraction of silage juice by a hydraulic press and production of water extracts using a stomacher or a blender. Total dry matter loss (231 g/kg DM was not affected by silo type. No interactions between silo type and method of silage extract production were observed for ethanol and organic acids contents in the silages. Interaction between silo type and method of silage extract preparation was detected for pH. Silo type affected ethanol content but did not affect lactic and acetic acids concentration in the silages. Dry matter, crude protein, neutral detergent fiber and ash were not affected by silo type. The method used to produce silage extracts affected the recovery of all fermentation products analyzed in the silages. Recovery of ethanol and acetic acid was higher when silage extracts were produced using a blender. For lactic acid recovery, the hydraulic press method was superior to the other two methods. Silage fermentation pattern is not affected by silo type, but the method used to produce silage extracts and some characteristics of silos affect the recovery of volatile fermentation products.

  12. Glycogen storage disease type I: clinical and laboratory profile

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    Berenice L. Santos


    Full Text Available OBJECTIVES: To characterize the clinical, laboratory, and anthropometric profile of a sample of Brazilian patients with glycogen storage disease type I managed at an outpatient referral clinic for inborn errors of metabolism. METHODS: This was a cross-sectional outpatient study based on a convenience sampling strategy. Data on diagnosis, management, anthropometric parameters, and follow-up were assessed. RESULTS: Twenty-one patients were included (median age 10 years, range 1-25 years, all using uncooked cornstarch therapy. Median age at diagnosis was 7 months (range, 1-132 months, and 19 patients underwent liver biopsy for diagnostic confirmation. Overweight, short stature, hepatomegaly, and liver nodules were present in 16 of 21, four of 21, nine of 14, and three of 14 patients, respectively. A correlation was found between height-for-age and BMI-for-age Z-scores (r = 0.561; p = 0.008. CONCLUSIONS: Diagnosis of glycogen storage disease type I is delayed in Brazil. Most patients undergo liver biopsy for diagnostic confirmation, even though the combination of a characteristic clinical presentation and molecular methods can provide a definitive diagnosis in a less invasive manner. Obesity is a side effect of cornstarch therapy, and appears to be associated with growth in these patients.

  13. Review of clinical and laboratory features of human Brucellosis

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    Mantur B


    Full Text Available Infection with Brucella spp. continues to pose a human health risk globally despite strides in eradicating the disease from domestic animals. Brucellosis has been an emerging disease since the discovery of Brucella melitensis by Sir David Bruce in 1887. Although many countries have eradicated B. abortus from cattle, in some areas B. melitensis and B. suis have emerged as causes of this infection in cattle, leading to human infections. Currently B. melitensis remains the principal cause of human brucellosis worldwide including India. The recent isolation of distinct strains of Brucella from marine mammals as well as humans is an indicator of an emerging zoonotic disease. Brucellosis in endemic and non-endemic regions remains a diagnostic puzzle due to misleading non-specific manifestations and increasing unusual presentations. Fewer than 10% of human cases of brucellosis may be clinically recognized and treated or reported. Routine serological surveillance is not practiced even in Brucella - endemic countries and we suggest that this should be a part of laboratory testing coupled with a high index of clinical suspicion to improve the level of case detection. The screening of family members of index cases of acute brucellosis in an endemic area should be undertaken to pick up additional unrecognised cases. Rapid and reliable, sensitive and specific, easy to perform and automated detection systems for Brucella spp. are urgently needed to allow early diagnosis and adequate antibiotic therapy in time to decrease morbidity / mortality. The history of travel to endemic countries along with exposure to animals and exotic foods are usually critical to making the clinical diagnosis. Laboratory testing is indispensable for diagnosis. Therefore alertness of clinician and close collaboration with microbiologist are essential even in endemic areas to correctly diagnose and treat this protean human infection. Existing treatment options, largely based on

  14. [For the improvement of management and assurance in clinical laboratories of education hospitals--from the meeting of clinical laboratory members of public university or college hospitals]. (United States)

    Yoshida, Hiroshi


    Clinical laboratory members, composed of medical doctors, laboratory technologists and office staff from 8 public university or college hospitals and one medical center, have an annual meeting, in which achievements including tested numbers, income, outsourcing ratio, and so on were reported and various agendas from each institution were discussed. The number of agendas for general discussion and in the technologist division has been increasing, which reflects that variables, including management in clinical laboratories, needing solutions have been increasing. Information obtained through discussion could help in the determination of management and the improvement of education and quality assurance in clinical laboratories.

  15. Clinical technique for invasive cervical root resorption

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    Luiz Fernando Machado Silveira


    Full Text Available This clinical case report describes the diagnosis and treatment of an external invasive cervical resorption. A 17-year-old female patient had a confirmed diagnosis of invasive cervical resorption class 4 by cone beam computerized tomography. Although, there was no communication with the root canal, the invasive resorption process was extending into the cervical and middle third of the root. The treatment of the cervical resorption of the lateral incisor interrupted the resorptive process and restored the damaged root surface and the dental functions without any esthetic sequelae. Both the radiographic examination and computed tomography are imperative to reveal the extent of the defect in the differential diagnosis.

  16. [Clinical, laboratory and therapeutics aspects of Sheehan's syndrome]. (United States)

    Soares, Débora Vieira; Conceição, Flávia Lúcia; Vaisman, Mário


    Sheehan's syndrome is characterized by hypopituitarism that occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Nowadays it is not usually seen in developed countries because of the improvements in obstetric care. However, in developing countries it is still frequent and probably one of the most common causes of hypopituitarism. Most patients usually present it months to years later, with a history of failure of postpartum lactation, failure to resume menses and other signs of panhypopituitarism. In mild forms of the disease, patients may remain undetected and do not receive treatment for many years. Early diagnosis and appropriate treatment are important to reduce the morbimortality of the patients with Sheehan's syndrome. The aim of this review is to describe clinical, laboratory and therapeutic aspects of Sheehan's syndrome, including our experience in the replacement of recombinant GH in these patients.

  17. Clinical laboratory stressors used to study alcohol-stress relationships. (United States)

    Thomas, Suzanne; Bacon, Amy K; Sinha, Rajita; Uhart, Magdalena; Adinoff, Bryon


    Understanding the biologic systems that underlie the relationship between stress and alcohol consumption may lead to better prevention efforts and more effective treatments for alcoholism. Clinical laboratory studies offer a unique opportunity to examine these relationships by using a controlled environment to study how an acute stressor affects alcohol drinking and alcohol craving, how individuals in recovery or those at risk for alcoholism may respond differently to stressors relative to control subjects, and how alcohol differentially affects stress reactivity in these groups. This article reviews some of the most common physical, psychological, and pharmacological stressors used in stress-induction studies designed to reveal details about the relationship between stress reactivity and alcohol use and abuse.

  18. Evaluation of clinical and laboratory correlates of sickle leg ulcers. (United States)

    Madu, Anazoeze Jude; Ubesie, Agozie; Madu, Kenechi Anthony; Okwor, Bismarck; Anigbo, Chukwudi


    The exact mechanism for the occurrence of sickle leg ulcers (SLUs) has not been fully explained, although, popular opinion supports a multifactorial etio-pathogenetic process. Leg ulceration in sickle cell is a chronic and debilitating condition which is difficult to treat and may worsen the psychosocial impact of this illness. This study aims to evaluate the laboratory and clinical correlates of SLUs. One hundred sixty-seven patients who had been diagnosed with sickle cell anemia (homozygous S) had their steady-state hemoglobin concentration (Hb), hematocrit, white cell count, platelet count, serum bilirubin, and aspartate transaminase (AST) as well as frequency of crisis per annum evaluated with respect to their relationship to the occurrence of leg ulcers. They were aged 6-53 years (mean age 24.3 years), and prevalence of leg ulcer was found to be 2.75 per 1000 (2.54 per 1000 in females and 2.83 per 1000 in males). The independent sample t-test showed a significant difference in the serum AST levels in those with SLU (p = 0.029), though a positive correlation did not exist. Other predictors of disease severity found to have positive relationship with each other were the AST and total serum bilirubin 0.207 (p = 0.012); Hb and age 0.130 (p = 0.035); Hb and white cell count -0.159 (p = 0.010), white cell count and age -0.113 (p = 0.018). SLUs do not occur in patients with severe disease in sickle cell. The clinical and laboratory indicators of severe sickle cell disease do not correlate positively with the occurrence of SLU. Serum AST may have a relationship with leg ulceration in these patients. Environmental factors most likely play a major part in the etiopathogenesis of leg ulcer and this may require further studies in different sociocultural settings.

  19. Custom software development for use in a clinical laboratory

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    John H Sinard


    Full Text Available In-house software development for use in a clinical laboratory is a controversial issue. Many of the objections raised are based on outdated software development practices, an exaggeration of the risks involved, and an underestimation of the benefits that can be realized. Buy versus build analyses typically do not consider total costs of ownership, and unfortunately decisions are often made by people who are not directly affected by the workflow obstacles or benefits that result from those decisions. We have been developing custom software for clinical use for over a decade, and this article presents our perspective on this practice. A complete analysis of the decision to develop or purchase must ultimately examine how the end result will mesh with the departmental workflow, and custom-developed solutions typically can have the greater positive impact on efficiency and productivity, substantially altering the decision balance sheet. Involving the end-users in preparation of the functional specifications is crucial to the success of the process. A large development team is not needed, and even a single programmer can develop significant solutions. Many of the risks associated with custom development can be mitigated by a well-structured development process, use of open-source tools, and embracing an agile development philosophy. In-house solutions have the significant advantage of being adaptable to changing departmental needs, contributing to efficient and higher quality patient care.

  20. Clinical and laboratory characteristics of children with Kawasaki disease

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    Fatih Akın


    Full Text Available Objective: In this study, we aimed to evaluate clinical and laboratory characteristics of patients with Kawasaki disease (KD in Konya region of Turkey. Methods: The hospital records of patients who were hospitalized with the diagnosis of KD in the Pediatrics Clinics of Konya Training and Research Hospital between May 2010 and June 2012 were reviewed retrospectively. Results: Seven cases were found to have the diagnosis of KD, two of whom were incomplete KD. Oropharynx changes were the most common (100% feature in our patients. Five (71% patients had bulbar conjunctivitis. Three (43% patients had erythema at the site of BCG inoculation. Adenopathy was present in all of our patients with the classical form. A desquamation was observed in one case at the seventh day of fever. No cardiac manifestation was seen. Elevated erythrocyte sedimentation rate and thrombocytosis were present in all patients. All of the patients were received intravenous immunoglobulin in the first ten days of the fever. Conclusion: KD should be considered as a possible diagnosis in any child presenting with prolonged fever. BCG reaction can be attributed as a diagnostic criterion for incomplete form of the disease especially in countries where BCG vaccination is routinely performed. Early treatment is essential to prevent cardiovascular complications.

  1. Clinical and laboratory diagnosis of dengue fever in travelers

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    N. I. Khokhlova


    Full Text Available The paper presents the analysis of clinical and laboratory symptoms in 35 adult patients with denger fever, Novosibirsk residents, which travelled in endemic countries, mostly Tailand. The classic form of the disease was determined in all cases. The moderate form was in 71,5% patients, the severe form was in the rest ones. The diagnosis of dengue was verified by detection of specific immunoglobulin M and in some cases immunoglobulin G and also virus dengue NS1 antigen by immunochromatography. The dominant clinical symptoms in observed patients were fever for 3–8 days (100%, mostly high one (71,4%, asthenia (97,1%, anorexia (100%, myalgia or/and arthralgia (77,1%, exantema (60%, hepatomegaly (62,8%. The gematologic indicators were represented with thrombocytopenia in 91,4% patients (from 167 to 20×109/l и leucopenia in 85,7% patients (from 3,9 to 1,1×109/l. The cytolitic syndrom was revealed in 80% patients with predominance of aspartate aminotransferase activity in early period of the disease. 

  2. Laboratory Generation of Solitary Waves:An Inversion Technique to Improve Available Methods

    Institute of Scientific and Technical Information of China (English)

    A.Romano; M.Guerrini; G.Bellotti; 琚烈红


    Solitary waves are often used in laboratory experiments to study tsunamis propagation and interaction with coasts. However, the experimental shape of the waves may differ from the theoretical one. In this paper, a correction technique aiming at minimizing the discrepancies between the two profiles is presented. Laboratory experiments reveal their effectiveness in correcting the experimental shape of solitary waves, mainly for low nonlinearities.

  3. Acute Viral Hepatitis A – Clinical, Laboratory and Epidemiological Characteristics

    Directory of Open Access Journals (Sweden)

    Melinda HORVAT


    Full Text Available Background and Aims: Infection with hepatitis A virus is still one of the most common causes of hepatitis worldwide. The clinical manifestation of acute hepatitis A (AHA in adults can vary greatly, ranging from asymptomatic infection to severe and fulminant hepatitis. The aim of this study was to describe the demographic, clinical characteristics, laboratory features and hospital outcome of adult patients with AHA over a consecutive period of 4 years within an area from Eastern European country. Methods: Two hundred and two adult patients diagnosed with AHA were retrospective, observational and analytic analized over a period of 4 years. Based on prothrombin time less than 50, the study group was stratified in medium (79.2% and severe forms (20.8%. We investigated the clinical, laboratory and epidemiological features. Statistical analysis were applied to compare the medium and severe forms of AHA. Results: Most patients (72.7% were younger than 40 years. The main symptoms included: dyspepsia (72.07%, jaundice (86.63%, asteno-adynamia (86.72%, and flu-like symptoms (53.46%. The hemorrhagic cutaneous-mucous manifestations (6.93% associated with the severe forms of AHA (OR =12.19, 95%CI -3.59 - 41.3, p =0.001. We found statistically significant differences for PT (p <0.001, INR (p <0.001, TQ (p <0.001, ALAT (p <0.001, ASAT (p <0.001, ALP (p <0.001 and platelets (p =0.009 between severe and medium AHA forms. We found that TQ, INR, ALAT and ASAT have the highest diagnostic values, statistically significant (p <0.05 for severe AHA forms with AUC (0.99, 0.99, 0.72, 0.70 at values of sensitivity (95%, 90.5%, 89%, 95% and specificity (98%, 99%, 88%,94%. Conclusions Medium severity AHA forms were found in most of the study group patients (79.2%. The severe AHA forms were associated with hemorrhagic cutaneous-mucous manifestations (OR =12.19, p =0.001. The univariate analysis proved a negatively statistically significant correlation between IP and ALAT

  4. Different Techniques of MRU: Pitfalls & Clinical Applications

    Directory of Open Access Journals (Sweden)

    H. Nayyeri


    Full Text Available Introduction & Background: Magnetic resonance urography (MRU refers to MR imaging of the urinary col-lecting systems and it provides information roughly analogous to conventional intravenous urography. There are two basic MRU imaging strategies, (1 Static MRU uses T2W scans and rely on the presence of fluid in the pelvicaliceal systems and the ureters; (2 Excretory MRU is performed after administration of IV Gd using a 3D gradient echo sequence. Static MRU is best used for dilated collecting systems and can be employed regardless of renal function. Excretory MRU is usually preferred over static techniques for the demonstration of non-distended ureters; however, it is contraindicated in severely impaired renal function. As MR urograms are often displayed as maximum intensity projections, a low signal intensity ureteral stone surrounded by high signal intensity urine may be obscured on maximum intensity projection images. A prob-lem in static MR urography is the superimposition of fluid-filled structures (i.e. bowel loops, gall bladder and bile ducts, CSF, or any intraabdominal fluid collection on reconstructed images which may create false posi-tive findings or obscure true abnormalities. Non-distended ureters may escape detection on static MR uro-grams, resulting in the incorrect diagnosis of complete ureteral obstruction. Parapelvic cysts may simulate hy-dronephrosis while calyceal diverticulae may simulate simple renal cysts on static MRU. Excretory MR urography is performed in all such cases; however, Gd may create different problems when it becomes too concentrated within the collecting system. Sufficiently concentrated Gd shortens T2 relaxation times to the point that signal loss from T2 relaxation exceeds the T1 shortening effects of the contrast agent. This may result in poor visualization of all or a portion of collecting system on T1W images. Concentrated Gd in the renal collecting system also causes signal loss on T2W images

  5. Current research on cigarette toxicity: critical appraisal in view of clinical laboratory

    Directory of Open Access Journals (Sweden)

    Prajwal Gyawali


    Full Text Available Cigarette smoking has been implicated as a potential risk factor for development and progression of chronic obstructive pulmonary disease (COPD and cardiovascular disease (CVD, including ischemic heart disease. Although, several methods are in existence to measuring cigarette toxicity, evidence regarding adoption of a gold standard technique is still imprecise. In this study, we reviewed articles describing methods of measuring cigarette toxicity in relation to clinical laboratory practice. A critical analysis of the benefits and limitations of each method in relation to low-middle income countries is discussed. [Int J Res Med Sci 2016; 4(6.000: 1785-1793

  6. 78 FR 59704 - Medicare, Medicaid, and CLIA Programs; Clinical Laboratory Improvement Amendments of 1988... (United States)


    ... Laboratory Improvement Amendments of 1988 Exemption of Laboratories Licensed by the State of Washington... requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA) for a period of 6 years. DATES... Laboratory Improvement Amendments of 1988 (CLIA) (Pub. L. 100-578), which was enacted on October 31,...

  7. Obtaining valid laboratory data in clinical trials conducted in resource diverse settings: lessons learned from a microbicide phase III clinical trial.

    Directory of Open Access Journals (Sweden)

    Tania Crucitti

    Full Text Available BACKGROUND: Over the last decade several phase III microbicides trials have been conducted in developing countries. However, laboratories in resource constrained settings do not always have the experience, infrastructure, and the capacity to deliver laboratory data meeting the high standards of clinical trials. This paper describes the design and outcomes of a laboratory quality assurance program which was implemented during a phase III clinical trial evaluating the efficacy of the candidate microbicide Cellulose Sulfate 6% (CS [1]. METHODOLOGY: In order to assess the effectiveness of CS for HIV and STI prevention, a phase III clinical trial was conducted in 5 sites: 3 in Africa and 2 in India. The trial sponsor identified an International Central Reference Laboratory (ICRL, responsible for the design and management of a quality assurance program, which would guarantee the reliability of laboratory data. The ICRL provided advice on the tests, assessed local laboratories, organized trainings, conducted supervision visits, performed re-tests, and prepared control panels. Local laboratories were provided with control panels for HIV rapid tests and Chlamydia trachomatis/Neisseria gonorrhoeae (CT/NG amplification technique. Aliquots from respective control panels were tested by local laboratories and were compared with results obtained at the ICRL. RESULTS: Overall, good results were observed. However, discordances between the ICRL and site laboratories were identified for HIV and CT/NG results. One particular site experienced difficulties with HIV rapid testing shortly after study initiation. At all sites, DNA contamination was identified as a cause of invalid CT/NG results. Both problems were timely detected and solved. Through immediate feedback, guidance and repeated training of laboratory staff, additional inaccuracies were prevented. CONCLUSIONS: Quality control guidelines when applied in field laboratories ensured the reliability and validity

  8. Complement analysis 2016: Clinical indications, laboratory diagnostics and quality control. (United States)

    Prohászka, Zoltán; Nilsson, Bo; Frazer-Abel, Ashley; Kirschfink, Michael


    In recent years, complement analysis of body fluids and biopsies, going far beyond C3 and C4, has significantly enhanced our understanding of the disease process. Such expanded complement analysis allows for a more precise differential diagnosis and for critical monitoring of complement-targeted therapy. These changes are a result of the growing understanding of the involvement of complement in a diverse set of disorders. To appreciate the importance of proper complement analysis, it is important to understand the role it plays in disease. Historically, it was the absence of complement as manifested in severe infection that was noted. Since then complement has been connected to a variety of inflammatory disorders, such as autoimmune diseases and hereditary angioedema. While the role of complement in the rejection of renal grafts has been known longer, the significant impact of complement. In certain nephropathies has now led to the reclassification of some rare kidney diseases and an increased role for complement analysis in diagnosis. Even more unexpected is that complement has also been implicated in neural, ophtalmological and dermatological disorders. With this level of involvement in some varied and impactful health issues proper complement testing is clearly important; however, analysis of the complement system varies widely among laboratories. Except for a few proteins, such as C3 and C4, there are neither well-characterized standard preparations nor calibrated assays available. This is especially true for the inter-laboratory variation of tests which assess classical, alternative, or lectin pathway function. In addition, there is a need for the standardization of the measurement of complement activation products that are so critical in determining whether clinically relevant complement activation has occurred in vivo. Finally, autoantibodies to complement proteins (e.g. anti-C1q), C3 and C4 convertases (C3 and C4 nephritic factor) or to regulatory proteins

  9. Analysis of search in an online clinical laboratory manual. (United States)

    Blechner, Michael; Kish, Joshua; Chadaga, Vivek; Dighe, Anand S


    Online laboratory manuals have developed into an important gateway to the laboratory. Clinicians increasingly expect up-to-date laboratory test information to be readily available online. During the past decade, sophisticated Internet search technology has developed, permitting rapid and accurate retrieval of a wide variety of content. We studied the role of search in an online laboratory manual. We surveyed the utilization of search technology in publicly available online manuals and examined how users interact with the search feature of a laboratory handbook. We show how a laboratory can improve its online handbook through insights gained by collecting information about each user's activity. We also discuss future applications for search-related technologies and the potential role of the online laboratory manual as the primary laboratory information portal.

  10. Application of PCR-based methods for diagnosis of intestinal parasitic infections in the clinical laboratory. (United States)

    Verweij, Jaco J


    For many years PCR- and other DNA-based methods of pathogen detection have been available in most clinical microbiology laboratories; however, until recently these tools were not routinely exploited for the diagnosis of parasitic infections. Laboratories were initially reluctant to implement PCR as incorporation of such assays within the algorithm of tools available for the most accurate diagnosis of a large variety of parasites was unclear. With regard to diagnosis of intestinal parasitic infections, the diversity of parasites that one can expect in most settings is far less than the parasitological textbooks would have you believe, hence developing a simplified diagnostic triage is feasible. Therefore the classical algorithm based on population, patient groups, use of immuno-suppressive drugs, travel history etc. is also applicable to decide when to perform and which additional techniques are to be used, if a multiplex PCR panel is used as a first-line screening diagnostic.

  11. 76 FR 1212 - Joint Biomedical Laboratory Research and Development and Clinical Science Research and... (United States)


    ... AFFAIRS Joint Biomedical Laboratory Research and Development and Clinical Science Research and Development... Eligibility of the Joint Biomedical Laboratory Research and Development and Clinical Science Research and... areas of biomedical, behavioral and clinical science research. The panel meeting will be open to...

  12. 76 FR 79273 - Joint Biomedical Laboratory Research and Development and Clinical Science Research and... (United States)


    ... AFFAIRS Joint Biomedical Laboratory Research and Development and Clinical Science Research and Development... Eligibility of the Joint Biomedical Laboratory Research and Development and Clinical Science Research and... biomedical, behavioral, and clinical science research. The panel meeting will be open to the public...

  13. The Effectiveness of Active and Traditional Teaching Techniques in the Orthopedic Assessment Laboratory (United States)

    Nottingham, Sara; Verscheure, Susan


    Active learning is a teaching methodology with a focus on student-centered learning that engages students in the educational process. This study implemented active learning techniques in an orthopedic assessment laboratory, and the effects of these teaching techniques. Mean scores from written exams, practical exams, and final course evaluations…

  14. 78 FR 44954 - Clinical Laboratory Improvement Advisory Committee (CLIAC) (United States)


    ... ] medicine practice and specific questions related to possible revision of the CLIA standards. Examples... laboratories are regulated; the impact of proposed revisions to the standards on medical and laboratory... laboratory interoperability in health information technology will also be discussed. Agenda items are...

  15. Indirect laryngeal surgery in the clinical voice laboratory: the renewal of a lost art. (United States)

    Hogikyan, N D; Pynnonen, M


    Since the advent of precision instruments and safe techniques for direct laryngoscopic surgery under general anesthesia, indirect laryngeal surgery has become very uncommon. A review of the recent literature finds that few authors advocate indirect surgery under topical anesthesia, and many otolaryngologists dismiss this technique as being either of only historical interest or an idiosyncratic method practiced only by a handful of clinicians. The societal mandate for cost-effective healthcare and the availability of relatively low-cost, high-quality endoscopes and video equipment warrant a renewed and broader interest in this type of surgery. In this article, we review a series of 27 indirect surgical procedures performed under topical anesthesia in the clinical voice laboratory. We discuss the indications, outcomes, advantages, and disadvantages of this surgery, and we present a brief analysis of its cost-effectiveness. We conclude that indirect laryngeal surgery in the clinical voice laboratory is an effective, safe, efficient, and less costly alternative to some procedures routinely performed under general anesthesia.

  16. Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure

    Directory of Open Access Journals (Sweden)

    Ozayr H. Mahomed


    Full Text Available Background: Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes.Objectives: This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management.Methods: A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software.Results: Approximately R35 million South African Rand (10% of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment.Conclusions: Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented.

  17. [External quality assessment in clinical biochemistry laboratories: pilot study in 11 laboratories of Lomé (Togo)]. (United States)

    Kouassi, Kafui; Fétéké, Lochina; Assignon, Selom; Dorkenoo, Ameyo; Napo-Koura, Gado


    This study aims to evaluate the performance of a few biochemistry analysis and make recommendations to the place of the stakeholders. It is a cross-sectional study conducted between the October 1(st), 2012 and the July 31, 2013 bearing on the results of 5 common examinations of clinical biochemistry, provided by 11 laboratories volunteers opening in the public and private sectors. These laboratories have analysed during the 3 cycles, 2 levels (medium and high) of serum concentration of urea, glucose, creatinine and serum aminotransferases. The performance of laboratories have been determined from the acceptable limits corresponding to the limits of total errors, defined by the French Society of Clinical Biology (SFBC). A system of internal quality control is implemented by all laboratories and 45% of them participated in international programs of external quality assessment (EQA). The rate of acceptable results for the entire study was of 69%. There was a significant difference (p<0.002) between the performance of the group of laboratories engaged in a quality approach and the group with default implementation of the quality approach. Also a significant difference was observed between the laboratories of the central level and those of the peripheral level of our health system (p<0.047). The performance of the results provided by the laboratories remains relatively unsatisfactory. It is important that the Ministry of Health put in place a national program of EQA with mandatory participation.

  18. Blood supply to the thoracolumbar spinal cord in the laboratory mouse using corrosion and dissection techniques. (United States)

    Flesarova, Slavka; Mazensky, David; Teleky, Jana; Almasiova, Viera; Holovska, Katarina; Supuka, Peter


    Mice are used frequently as experimental models in the study of ischemic spinal cord injury. The aim of the present study was to describe the arterial blood supply to the thoracolumbar spinal cord in the mouse. The study was carried out on 20 adult mice using the corrosion and dissection technique. Dorsal intercostal arteries were found as branches of the thoracic aorta: as 7 pairs in 80% of cases, as 8 pairs in 15% of cases and as 9 pairs in 5% of cases. The paired lumbar arteries arising from the abdominal aorta were present as 5 pairs in all cases. Along the entire thoracic and lumbar spinal regions, we observed left-sided branches entering the ventral spinal artery in 64.2% and right-sided branches in 35.8% of cases. Along the entire thoracic and lumbar spinal regions, the branches entering the dorsal spinal arteries were left-sided in 60.8% of cases and right-sided in 39.2% of cases. We found some variations in the site of origin of the artery of Adamkiewicz and in the number of dorsal spinal arteries. Documenting the anatomical variations in spinal cord blood supply in the laboratory mouse will aid the planning of future experimental studies and in determining the clinical relevance of such studies.

  19. First-Year Residents' Caring, Medical Knowledge, and Clinical Judgment in Relation to Laboratory Utilization. (United States)

    Yarnold, Paul R.; And Others


    A study of 36 first-year Northwestern University (Illinois) medical residents found that students' medical knowledge was a predictor of increased laboratory test use, that clinical judgment was a predictor of decreased laboratory use, and that level of caring was statistically unrelated to amount of laboratory use. (Author/MSE)

  20. 77 FR 26069 - Joint Biomedical Laboratory Research and Development and Clinical Science Research and... (United States)


    ... AFFAIRS Joint Biomedical Laboratory Research and Development and Clinical Science Research and Development... following three panels of the Joint Biomedical Laboratory Research and Development and Clinical Science... review by the Board involve a wide range of medical specialties within the general areas of...

  1. Current updates on laboratory techniques for the diagnosis of male reproductive failure. (United States)

    Sikka, Suresh C; Hellstrom, Wayne J G


    The incidence of male reproductive failure leading to infertility, whether due to delayed parenthood, environmental issues, genetic factors, drugs, etc., is increasing throughout the world. The diagnosis and prognosis of male subfertility have become a challenge. While the basic semen assessment has been performed for many years, a number of studies question the value of the traditional semen characteristics. This is partly due to inadequate methods and standardization, limited knowledge of technical requirements for quality assurance, and an incomplete understanding of what clinical information a semen assessment can provide. Laboratories currently performing semen and endocrine assessment show great variability. The World Health Organization (WHO) manual for the evaluation of semen has been the core of andrology and fertility evaluation that has helped in further development of this field over many years. These include the physical appearance of the ejaculate, assessments of sperm count, motility, vitality, morphology, and functional aspects of the sperm and semen sample. These tests also include male endocrine profile, biochemical evaluation of the semen, detection of antisperm antibodies in serum, the use of computer-aided sperm analysis (CASA), sperm DNA integrity, and its damage due to oxidative stress. Assisted reproductive techniques (e.g., IVF, ICSI) have shown great success but are too expensive. Further development in this field with newer techniques and extensive training/instructions can improve accuracy and reduce variability, thus maintaining the quality and standards of such an evaluation. There is an urgent need to have standardized training centers and increased awareness in this area of men's health for reproductive success.

  2. Current updates on laboratory techniques for the diagnosis of male reproductive failure

    Directory of Open Access Journals (Sweden)

    Suresh C Sikka


    Full Text Available The incidence of male reproductive failure leading to infertility, whether due to delayed parenthood, environmental issues, genetic factors, drugs, etc., is increasing throughout the world. The diagnosis and prognosis of male subfertility have become a challenge. While the basic semen assessment has been performed for many years, a number of studies question the value of the traditional semen characteristics. This is partly due to inadequate methods and standardization, limited knowledge of technical requirements for quality assurance, and an incomplete understanding of what clinical information a semen assessment can provide. Laboratories currently performing semen and endocrine assessment show great variability. The World Health Organization (WHO manual for the evaluation of semen has been the core of andrology and fertility evaluation that has helped in further development of this field over many years. These include the physical appearance of the ejaculate, assessments of sperm count, motility, vitality, morphology, and functional aspects of the sperm and semen sample. These tests also include male endocrine profile, biochemical evaluation of the semen, detection of antisperm antibodies in serum, the use of computer-aided sperm analysis (CASA, sperm DNA integrity, and its damage due to oxidative stress. Assisted reproductive techniques (e.g., IVF, ICSI have shown great success but are too expensive. Further development in this field with newer techniques and extensive training/instructions can improve accuracy and reduce variability, thus maintaining the quality and standards of such an evaluation. There is an urgent need to have standardized training centers and increased awareness in this area of men′s health for reproductive success.

  3. The path to clinical proteomics research: integration of proteomics, genomics, clinical laboratory and regulatory science. (United States)

    Boja, Emily S; Rodriguez, Henry


    Better biomarkers are urgently needed to cancer detection, diagnosis, and prognosis. While the genomics community is making significant advances in understanding the molecular basis of disease, proteomics will delineate the functional units of a cell, proteins and their intricate interaction network and signaling pathways for the underlying disease. Great progress has been made to characterize thousands of proteins qualitatively and quantitatively in complex biological systems by utilizing multi-dimensional sample fractionation strategies, mass spectrometry and protein microarrays. Comparative/quantitative analysis of high-quality clinical biospecimen (e.g., tissue and biofluids) of human cancer proteome landscape has the potential to reveal protein/peptide biomarkers responsible for this disease by means of their altered levels of expression, post-translational modifications as well as different forms of protein variants. Despite technological advances in proteomics, major hurdles still exist in every step of the biomarker development pipeline. The National Cancer Institute's Clinical Proteomic Technologies for Cancer initiative (NCI-CPTC) has taken a critical step to close the gap between biomarker discovery and qualification by introducing a pre-clinical "verification" stage in the pipeline, partnering with clinical laboratory organizations to develop and implement common standards, and developing regulatory science documents with the US Food and Drug Administration to educate the proteomics community on analytical evaluation requirements for multiplex assays in order to ensure the safety and effectiveness of these tests for their intended use.

  4. The role of the clinical laboratory in the future of health care: lean microbiology. (United States)

    Samuel, Linoj; Novak-Weekley, Susan


    This commentary will introduce lean concepts into the clinical microbiology laboratory. The practice of lean in the clinical microbiology laboratory can remove waste, increase efficiency, and reduce costs. Lean, Six Sigma, and other such management initiatives are useful tools and can provide dividends but must be accompanied by organizational leadership commitment to sustaining the lean culture in the laboratory setting and providing resources and time to work through the process.

  5. The National Market for Medicare Clinical Laboratory Testing (United States)

    U.S. Department of Health & Human Services — Current Medicare payment policy for outpatient laboratory services is outdated. Future reforms, such as competitive bidding, should consider the characteristics of...

  6. Virtual Lab Demonstrations Improve Students’ Mastery of Basic Biology Laboratory Techniques

    Directory of Open Access Journals (Sweden)

    Grace A. Maldarelli


    Full Text Available Biology laboratory classes are designed to teach concepts and techniques through experiential learning. Students who have never performed a technique must be guided through the process, which is often difficult to standardize across multiple lab sections. Visual demonstration of laboratory procedures is a key element in teaching pedagogy. The main goals of the study were to create videos explaining and demonstrating a variety of lab techniques that would serve as teaching tools for undergraduate and graduate lab courses and to assess the impact of these videos on student learning. Demonstrations of individual laboratory procedures were videotaped and then edited with iMovie. Narration for the videos was edited with Audacity. Undergraduate students were surveyed anonymously prior to and following screening to assess the impact of the videos on student lab performance by completion of two Participant Perception Indicator surveys. A total of 203 and 171 students completed the pre- and posttesting surveys, respectively. Statistical analyses were performed to compare student perceptions of knowledge of, confidence in, and experience with the lab techniques before and after viewing the videos. Eleven demonstrations were recorded. Chi-square analysis revealed a significant increase in the number of students reporting increased knowledge of, confidence in, and experience with the lab techniques after viewing the videos. Incorporation of instructional videos as prelaboratory exercises has the potential to standardize techniques and to promote successful experimental outcomes.

  7. Practical way to develop 10-color flow cytometry protocols for the clinical laboratory (United States)

    Tárnok, Attila; Bocsi, Jozsef


    The latest development of commercial routine flow cytometers (FCM) is that they are equipped with three (blue, red, violet) or more lasers and many PMT detectors. Nowadays routine clinical instruments are capable of detecting 10 or more fluorescence colors simultaneously. Thereby, presenting opportunities for getting detailed information on the single cell level for cytomics and systems biology for improve diagnostics and monitoring of patients. The University Leipzig, Germany) recently started a cluster of excellence to study the molecular background of life style and environment associated diseases, enrolling 25000 individuals (LIFE). To this end the most comprehensive FCM protocol has to be developed for this study. We aimed to optimize fluorochrome and antibody combinations to the characteristics of the instrument for successful 10-color FCM. Systematic review of issues related to sampling, preparation, instrument settings, spillover and compensation matrix, reagent performance, and general principles of panel construction was performed. 10-color FCM enables for increased accuracy in cell subpopulation identification, the ability to obtain detailed information from blood specimens, improved laboratory efficiency, and the means to consistently detect major and rare cell populations. Careful attention to details of instrument and reagent performance allows for the development of panels suitable for screening of samples from healthy and diseased donors. The characteristics of this technique are particularly well suited for the analysis of broad human population cohorts and have the potential to reach the everyday practice in a standardized way for the clinical laboratory.

  8. Use of artificial intelligence in analytical systems for the clinical laboratory. (United States)

    Place, J F; Truchaud, A; Ozawa, K; Pardue, H; Schnipelsky, P


    The incorporation of information-processing technology into analytical systems in the form of standard computing software has recently been advanced by the introduction of artificial intelligence (AI), both as expert systems and as neural networks.This paper considers the role of software in system operation, control and automation, and attempts to define intelligence. AI is characterized by its ability to deal with incomplete and imprecise information and to accumulate knowledge. Expert systems, building on standard computing techniques, depend heavily on the domain experts and knowledge engineers that have programmed them to represent the real world. Neural networks are intended to emulate the pattern-recognition and parallel processing capabilities of the human brain and are taught rather than programmed. The future may lie in a combination of the recognition ability of the neural network and the rationalization capability of the expert system.In the second part of the paper, examples are given of applications of AI in stand-alone systems for knowledge engineering and medical diagnosis and in embedded systems for failure detection, image analysis, user interfacing, natural language processing, robotics and machine learning, as related to clinical laboratories.It is concluded that AI constitutes a collective form of intellectual propery, and that there is a need for better documentation, evaluation and regulation of the systems already being used in clinical laboratories.

  9. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in clinical practice

    DEFF Research Database (Denmark)

    Sturgeon, Catharine M; Hoffman, Barry R; Chan, Daniel W


    BACKGROUND: This report presents updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines summarizing quality requirements for the use of tumor markers. METHODS: One subcommittee developed guidelines for analytical quality relevant to serum and tissue-based tumor...

  10. Evaluation of Neonatal Hemolytic Jaundice: Clinical and Laboratory Parameters

    Directory of Open Access Journals (Sweden)

    Anet Papazovska Cherepnalkovski


    CONCLUSIONS: The laboratory profile in ABO/Rh isoimmunisation cases depicts hemolytic mechanism of jaundice. These cases carry a significant risk for early and severe hyperbilirubinemia and are eligible for neurodevelopmental follow-up. Hematological parameters and blood grouping are simple diagnostic methods that assist the etiological diagnosis of neonatal hyperbilirubinemia.

  11. Contentious Conversations: Using Mediation Techniques in Difficult Clinical Ethics Consultations. (United States)

    Fiester, Autumn


    Mediators utilize a wide range of skills in the process of facilitating dialogue and resolving conflicts. Among the most useful techniques for clinical ethics consultants (CECs)-and surely the least discussed-are those employed in acrimonious, hostile conversations between stakeholders. In the context of clinical ethics disputes or other bedside conflicts, good mediation skills can reverse the negative interactions that have prevented the creation of workable treatment plans or ethical consensus. This essay lays out the central framework mediators use in distinguishing positions from interests and describes a set of strategies for managing contentious ethics consultations or working with "difficult" patients, families, or patient-careprovider interactions.

  12. Crown lengthening: basic principles, indications, techniques and clinical case reports. (United States)

    Yeh, Simon; Andreana, Sebastiano


    Sometimes, in order to properly restore teeth, surgical intervention in the form of a crown-lengthening procedure is required. Crown lengthening is a periodontal resective procedure, aimed at removing supporting periodontal structures to gain sound tooth structure above the alveolar crest level. Periodontal health is of paramount importance for all teeth, both sound and restored. For the restorative dentist to utilize crown lengthening, it is important to understand the concept of biologic width, indications, techniques and other principles. This article reviews these basic concepts of clinical crown lengthening and presents four clinical cases utilizing crown lengthening as an integral part of treatments, to restore teeth and their surrounding tissues to health.

  13. Using the Revised Bloom's Taxonomy in the clinical laboratory: thinking skills involved in diagnostic reasoning. (United States)

    Su, Whei Ming; Osisek, Paul J; Starnes, Beth


    Achieving effective transfer of theoretical knowledge to clinical practice requires knowledge of thinking paradigms in relation to specific nursing content. It is a challenge to develop instructional designs for teaching and assessing implicit thought processes involved in clinical reasoning. The authors demonstrate the use of the Revised Bloom's Taxonomy to teach thinking skills involved in diagnostic reasoning in a clinical laboratory.

  14. Customer satisfaction survey with clinical laboratory and phlebotomy services at a tertiary care unit level. (United States)

    Koh, Young Rae; Kim, Shine Young; Kim, In Suk; Chang, Chulhun L; Lee, Eun Yup; Son, Han Chul; Kim, Hyung Hoi


    We performed customer satisfaction surveys for physicians and nurses regarding clinical laboratory services, and for outpatients who used phlebotomy services at a tertiary care unit level to evaluate our clinical laboratory and phlebotomy services. Thus, we wish to share our experiences with the customer satisfaction survey for clinical laboratory and phlebotomy services. Board members of our laboratory designed a study procedure and study population, and developed two types of questionnaire. A satisfaction survey for clinical laboratory services was conducted with 370 physicians and 125 nurses by using an online or paper questionnaire. The satisfaction survey for phlebotomy services was performed with 347 outpatients who received phlebotomy services by using computer-aided interviews. Mean satisfaction scores of physicians and nurses was 58.1, while outpatients' satisfaction score was 70.5. We identified several dissatisfactions with our clinical laboratory and phlebotomy services. First, physicians and nurses were most dissatisfied with the specimen collection and delivery process. Second, physicians and nurses were dissatisfied with phlebotomy services. Third, molecular genetic and cytogenetic tests were found more expensive than other tests. This study is significant in that it describes the first reference survey that offers a survey procedure and questionnaire to assess customer satisfaction with clinical laboratory and phlebotomy services at a tertiary care unit level.

  15. The clinical laboratory in the investigation of hemoglobin disorders


    Lais Pinto de Almeida; Annelise Corrêa Wengerkievicz; Nilceia Maria Viviani; Dulcinéia Martins Albuquerque; Maria Elizabete Mendes; Nairo Massakazu Sumita


    As alterações na síntese da hemoglobina resultam em um grupo de distúrbios hereditários, os quais podem ser classificados como hemoglobina variante, se a alteração tiver origem em uma mutação no gene da hemoglobina, produzindo cadeias anormais, ou como talassemias, se a estrutura é normal, porém a síntese ocorre em quantidade alterada. Este trabalho tem como objetivo descrever a condução do diagnóstico laboratorial de quatro casos de distúrbios da hemoglobina, a fim de ilustrar o papel do lab...

  16. Clinical and laboratory findings in 220 children with recurrent abdominal pain

    NARCIS (Netherlands)

    C. Gijsbers; M.A. Benninga; H.R. Büller


    Aim: To investigate the clinical and laboratory findings in children with recurrent abdominal pain (RAP). Methods: Consecutive patients with RAP (Apley criteria), age 4-16 years, referred to a secondary medical centre were evaluated by a standardized history, physical examination and laboratory test

  17. Clinical, laboratory and electrophysiological features of Morvan's fibrillary chorea. (United States)

    Lee, Will; Day, Timothy J; Williams, David R


    Morvan's Fibrillary Chorea (MFC) is a rare autoimmune disorder causally associated with auto-antibodies directed at the voltage-gated potassium channel (VGKC-Abs). It classically presents with sleep disturbances, neuromyotonia and dysautonomia. We aimed to systematically characterise the features of MFC by describing a patient and reviewing published literature. Case notes of 27 patients with MFC (one from our clinic and 26 from the literature) were reviewed and clinical data were extracted and analysed. We found that MFC mainly affects men (96%) and runs a subacute course over months. Neoplasia (56%), VGKC-Abs positivity (79%) and autoimmunity (41%) are frequent associations. Myokymia, insomnia and hyperhidrosis were almost universally described. Other autonomic features were present in 63% with the most common being cardiovascular and bowel disturbances. Clinical, radiological or electroencephalographical features of limbic encephalitis were present in 19% of patients. Outcome was fair with an overall recovery rate of 78%. All patients with malignancies underwent surgery. Immunotherapies including corticosteroids, intravenous immunoglobulins and plasma exchange were instituted in 22 patients and 19 (86%) responded. Of all symptomatic treatments tried, carbamazepine, phenytoin, sodium valproate, levetiracetam and niaprazine were found to be effective. The broad clinical spectrum of VGKC-Abs diseases can make early recognition of MFC difficult. Myokymia, insomnia and hyperhidrosis are invariably present. There may be abnormalities on cerebrospinal fluid testing and VGKC-Abs can occasionally be absent. Early initiation of immunotherapies and malignancy screening are important to prevent adverse outcomes in a condition that generally responds favourably to treatment.

  18. Pre-analytical phase in clinical chemistry laboratory

    Directory of Open Access Journals (Sweden)

    Neogi SS


    Full Text Available The laboratory testing process is divided into the pre-analytical, analytical and post-analytical phases. For obtaining reliable test results, the prevention and detection of errors at all steps is required. While analytical standards have been developed by recognized quality control criteria, there is a scarcity in the development of standards for the preanalytical phase. This phase is most prone to errors as the steps involved are directly dependent on humans and are out of direct control of the laboratory. Such errors in preanalytical stage often only become apparent in the analytical or post-analytical phase. The development of a pre-analytical quality manual is essential in achieving total quality control. Correct practices and strategies of error prevention can reduce preanalytical errors. This review focuses on prevention of pre-analytical errors that occur while collecting a specimen of blood, urine and cerebrospinal fluid. Most of these can be easily prevented with understanding and education of the personnel involved in and responsible for executing this crucial pre-analytical phase.

  19. MALDI-TOF MS in the clinical microbiology laboratory

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    Marcelo Jenne Mimica


    Full Text Available Traditional methods for microbial identification are often very laborious and time consuming. A new mass spectrometry based technique, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF, has been described as a rapid, practical and low-cost method for this purpose. In this article, primary and possible future applications of this tool are briefly discussed.

  20. 3D roadmap in neuroangiography: technique and clinical interest

    Energy Technology Data Exchange (ETDEWEB)

    Soederman, Michael; Andersson, T. [Karolinska Hospital, Department of Neuroradiology, Stockholm (Sweden); Babic, D.; Homan, R. [Philips Medical Systems, Best (Netherlands)


    We present the first clinical results obtained with a novel technique: the three-dimensional [3D] roadmap. The major difference from the standard 2D digital roadmap technique is that the newly developed 3D roadmap is based on a rotational angiography acquisition technique with the two-dimensional [2D] fluoroscopic image as an overlay. Data required for an accurate superimposition of the previously acquired 3D reconstructed image on the interactively made 2D fluoroscopy image, in real time, are stored in the 3D workstation and constitute the calibration dataset. Both datasets are spatially aligned in real time; thus, the 3D image is accurately superimposed on the 2D fluoroscopic image regardless of any change in C-arm position or magnification. The principal advantage of the described roadmap method is that one contrast injection allows the C-arm to be positioned anywhere in the space and allows alterations in the distance between the x-ray tube and the image intensifier as well as changes in image magnification. In the clinical setting, the 3D roadmap facilitated intravascular neuronavigation with concurrent reduction of procedure time and use of contrast medium. (orig.)

  1. Experimental Psychopathology: From laboratory studies to clinical practice

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    Pierre Philippot


    Full Text Available Recently, David Barlow (2004, a pioneer in the field of anxiety disorders, has proposed that psychologists should abandon the concept of psychotherapy and rather use the one of “psychological treatment”. The provoking idea behind this proposal is that the concept of psychotherapy, relying on the notion of “therapeutic school” should be discarded by professional psychologists because it relies too much on conceptions based on pre-scientific models. Barlow (2004 insists that, today, psychology as an empirical science has gathered sufficient knowledge and know-how to found clinical practice. It is no longer necessary to rely on pre-scientific theories. Further, Barlow’s perspective opens clinical practice to the entire field of psychology, i.e. to the advances accomplished by research on emotion, cognition, learning, development, etc.

  2. Implementation of a companion diagnostic in the clinical laboratory

    DEFF Research Database (Denmark)

    Mancini, Irene; Pinzani, Pamela; Simi, Lisa


    A companion diagnostic test provides information that is essential for the safe and effective use of a corresponding therapeutic product as indicated in the drug instructions. The implementation of a companion diagnostic follows the rules of a molecular test for somatic mutations in a routine...... of mutation under study, the sample to be assayed and its preparation procedure. In addition, the results of a molecular assay require a complex interpretation process of the analytical data as the patient's genotype, the translation of the identified variant into a predicted phenotype and knowledge......, as an example, the BRAF genotype analysis in tumor tissue samples for identification of melanoma patients that can benefit treatment with BRAF inhibitors. The manuscript is focused on the following aspects: i) medical rationale, ii) methodologies of analysis, iii) laboratory performance evaluation and iv...

  3. Neocollagenesis and Neoelastinogenesis: From the Laboratory to the Clinic (United States)

    Mehta-Ambalal, Sujata R


    An internet search was made looking for articles about chemical and physical modalities that are known to induce collagen and elastin formation. Textbooks, independent articles, journals and books on pathology, biochemistry, aesthetic medicine and cosmetic and plastic surgery were used as references. Here, we take a look at various studies, in vitro and in vivo, that lend credence to the products and procedures used in clinical practice to induce neocollagenesis and neoelastinogenesis.

  4. Genetic, Clinical, and Laboratory Markers for DOCK8 Immunodeficiency Syndrome

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    Jeremiah C. Davis


    Full Text Available DOCK8 immunodeficiency syndrome (DIDS is a combined immunodeficiency characterized by recurrent viral infections, severe atopy, and early onset malignancy. Genetic studies revealed large, unique deletions in patients from different families and ethnic backgrounds. Clinical markers of DIDS include atopic dermatitis, allergies, cutaneous viral infections, recurrent respiratory tract infections, and malignancy. Immune assessments showed T cell lymphopenia, hyper-IgE, hypo-IgM, and eosinophilia. The impaired lymphocyte functions in DIDS patients appear central for disease pathogenesis.

  5. Will Regulatory and Financial Considerations Dampen Innovation in the Clinical Microbiology Laboratory? (United States)

    Gilligan, Peter H; Miller, Melissa B


    Over a million prosthetic joints are placed in patients in the United States annually. Of those that fail, 25% will be due to infection, with an estimated cost approaching 1 billion dollars. Despite the clinical and economic importance of these infections, the techniques for their detection are relatively insensitive. An innovative method for detecting these infections by using blood culture bottles (BCB) to culture specimens of periprosthetic tissue (PPT) was described in a recent article [T. N. Peel, et al., mBio 7(1):e01776-15, 2016, doi:10.1128/mBio.01776-15]. There are two potential stumbling blocks to the widespread implementation of this innovation. First, the FDA judges such an application of BCB as an "off-label use" and as such, a laboratory-developed test (LDT). LDTs are coming under greater scrutiny by the FDA and may require extensive, costly validation studies in laboratories that adopt this methodology. Second, the Center for Medicare and Medicaid Services has established a Hospital Acquired Condition Reduction Act under which institutions performing in the lowest quartile forfeit 1% of their Medicare reimbursement. Hospital-acquired infections are an important component of this quality metric. Although prosthetic joint infection (PJI) rates are not currently a hospital quality metric, given their cost and increasing frequency, it is reasonable to expect that they may become one. Will those with financial oversight allow an innovative technique that will require an expensive validation and may put the institution at risk for loss of CMS reimbursement?

  6. The answer of the Bacteriology Laboratory to new clinical needs. Rapid sepsis diagnotics at the Novara hospital

    Directory of Open Access Journals (Sweden)

    Vesselina Kroumova


    Full Text Available Faster microbiological responses are increasingly necessary in modern medicine and the Laboratory of Microbiology must be equipped in this sense. New instrumentation and, above all, a new approach by the Clinical Microbiologist that puts a focus on the real needs of the patient before the microbiological may allow for significantly improving the TAT of these diagnostics. The use of both new methodologies, new tools and revisited old technologies may mean less these days as it was obtained at the Laboratory of Microbiology and Virology of Novara, where the combined use of molecular biology techniques, and mass spectrometry techniques rapid growth have allowed for more than 36 hours to shorten the response time by positivization of blood cultures. Such an approach allows an important support to the clinician with obvious benefits for the patient.

  7. Sesame seed allergy: Clinical manifestations and laboratory investigations

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    Fazlollahi MR.


    Full Text Available Background: Plant-origin foods are among the most important sources of food allergic reactions. An increase in the incidence of sesame seed allergy among children and adults has been reported in recent years. The aim of this preliminary study was to investigate the prevalence, importance and clinical manifestations of sesame allergy among Iranian patients.Methods: In a cross-sectional survey, 250 patients with suspected IgE-mediated food allergies completed a questionnaire and underwent skin prick tests with sesame extract as well as cross-reacting foods (walnut, soya and peanut. Total IgE and sesame-specific IgE levels were measured. Patients with positive skin test reactions and/or IgE specific for sesame without clinical symptoms were considered sensitive to sesame. The patients who also had clinical symptoms with sesame consumption were diagnosed as allergic to sesame.Results: Of the 250 patients enrolled in this study, 129 were male and 121 female, with a mean age of 11.7 years. The most common food allergens were cow's milk, egg, curry, tomato and sesame. Sesame sensitivity was found in 35 patients (14.1%. Only five patients (2% had sesame allergy. Sesame-sensitive patients had a significantly higher frequency of positive prick test to cross-reacting foods when compared to non-sensitized patients (p=0.00. The type of symptom was independent of gender and age of the patients, but urticaria and dermatitis-eczema were significantly more frequent in sensitized patients (p=0.008.Conclusions: This is the first study addressing the prevalence of sesame seed allergy in Iranian population. We found sesame to be a common and important cause of food allergy. The panel of foods recommended for use in diagnostic allergy tests should be adjusted.

  8. Socio-demographic, Clinical and Laboratory Features of Rotavirus Gastroenteritis in Children Treated in Pediatric Clinic (United States)

    Azemi, Mehmedali; Berisha, Majlinda; Ismaili-Jaha, Vlora; Kolgeci, Selim; Avdiu, Muharrem; Jakupi, Xhevat; Hoxha, Rina; Hoxha-Kamberi, Teuta


    Aim: The aim of work was presentation of several socio-demographic, clinical and laboratory characteristics of gastroenteritis caused by rotavirus. The examinees and methods: The examinees were children under the age of five years treated at the Pediatric Clinic due to acute gastroenteritis caused by rotavirus. Rotavirus is isolated by method chromatographic immunoassay by Cer Test Biotec. Results: From the total number of patients (850) suffering from acute gastroenteritis, feces test on bacteria, viruses. protozoa and fungi was positive in 425 (49.76%) cases. From this number the test on bacteria was positive in 248 (58.62%) cases, on viruses it was positive in 165 (39.0%), on protozoa in 9 (2.12%) cases and on fungi only one case. Rotavirus was the most frequent one in viral test, it was isolated in 142 (86.06%) cases, adenoviruses were found in 9 (5.45%) cases and noroviruses in only one case. The same feces sample that contained rotavirus and adenoviruses were isolated in five cases, whereas rotavirus with bacteria was isolated in the same feces sample in five cases. The biggest number of cases 62 (43.66%) were of the age 6-12 months, whereas the smallest number 10 (7.04%) cases were of the age 37-60 months. There were 76 (53.52%) of cases of male gender, from rural areas there were 81 (57.04%) cases and there were 58 (40.80%) cases during the summer period. Among the clinical symptoms the most prominent were diarrhea, vomiting, high temperature, whereas the different degree of dehydration were present in all cases (the most common one was moderate dehydration). The most frequent one was isonatremic dehydration in 91 (64.08%) cases, less frequent one was hypernatremic dehydration in 14 (9.85%) cases. The majority of cases (97.89%) had lower blood pH values, whereas 67 (47.17%) cases had pH values that varied from 7.16 -7.20 (curve peak), normal values were registered in only 3 (2.11%) cases. Urea values were increased in 45 (31.07%) cases (the maximum value

  9. The Frequency of the Accidental Contamination with Laboratory Samples in Yazd Clinical Laboratories’ personnel in 2011

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    Jafari, AA. (PhD


    Full Text Available Background and Objective: laboratory personnel have always accidental exposure to clinical samples, which can cause the transmission of infection. This threat can be prevented and controlled by education for the use of safety instruments. The purpose was to determine the frequency of accidental exposure to laboratory samples among Yazd laboratory personnel in 2011. Material and Methods: This descriptive cross-sectional study was conducted on 100 of Yazd clinical laboratory personnel. The data was collected, using a valid and reliable questioner, via interview and analyzed by means of SPSS software. Results: Eighty-six percent of the subjects reported an experience of accidental exposure to clinical samples, such as blood, serum and urine. The causes were carelessness (41% and work overload (29%. Needle- stick was the most prevalent injury (52% particularly in sampler workers (51% and in their hands (69%. There wasn’t significant relationship between accidental exposure to laboratory samples and the variables such as private and governmental laboratories (p=0.517, kind of employment (p=0.411, record of services (p=0.439 and academic degree (p=0.454. The subjects aged 20-29 (p=0.034 and worked in sampling unit had the highest accidental exposure. Conclusion: based on the results, inexperience of the personnel especially in sampling room, overload at work and ignorance of applying safety instruments are known as the most important reasons for accidental exposure to clinical samples. Keywords: Contamination; accidental Exposure; Infectious agents; laboratory; personnel

  10. [The analytical reliability of clinical laboratory information and role of the standards in its support]. (United States)

    Men'shikov, V V


    The article deals with the factors impacting the reliability of clinical laboratory information. The differences of qualities of laboratory analysis tools produced by various manufacturers are discussed. These characteristics are the causes of discrepancy of the results of laboratory analyses of the same analite. The role of the reference system in supporting the comparability of laboratory analysis results is demonstrated. The project of national standard is presented to regulate the requirements to standards and calibrators for analysis of qualitative and non-metrical characteristics of components of biomaterials.

  11. Excellence in clinical laboratories: the standard ISO 15189:2007

    Directory of Open Access Journals (Sweden)

    Antonio Scipioni


    Full Text Available I laboratori clinici operano in stretto contatto con i pazienti e collaborano direttamente alla loro cura, in modo corresponsabile con i medici e i reparti ospedalieri. L’importanza della loro attività per la salute pubblica rende obbligatoria l’esplicitazione di alcuni punti finora spesso considerati ovvii. Ai pazienti dev’essere infatti garantito che: - i metodi di analisi utilizzati siano stati preliminarmente valutati, per confermare la loro rispondenza agli obiettivi dell’analisi stessa, verificati, per controllarne l’effettiva efficacia e, se necessario, validati per garantire che siano appropriati allo scopo; - il personale che esegue le analisi sia stato adeguatamente formato e quindi tecnicamente competente; - il laboratorio assicuri un’adeguata consulenza allo staff clinico che richiede le analisi, allo scopo di ottenere una sinergia tra il laboratorio e il clinico che ha in cura il paziente, sia nella fase di prelievo di materiale biologico, sia nella fase di interpretazione dei risultati. Tutto ciò è necessario per dimostrare ai pazienti

  12. Percutaneous renal graft biopsy: a clinical, laboratory and pathological analysis

    Directory of Open Access Journals (Sweden)

    Marilda Mazzali


    Full Text Available CONTEXT: Renal allograft biopsies have been used as a good method for monitoring the evolution of kidney transplants for at least 20 years.1 Histological analysis permits differential diagnosis of the causes of allograft dysfunction to be made. OBJECTIVES: To correlate the data of urinalysis and serum creatinine with histological diagnosis of renal graft in a group of renal transplant patients. DESIGN: Accuracy study, retrospective analysis. SETTING: A university terciary referral center. SAMPLE: 339 percutaneous allograft biopsies obtained from 153 patients. Blood and urine samples were obtained before the graft biopsy. MAIN MEASUREMENTS: Laboratory evaluation and hystological analysis (light microscopy, imunofluorescent eletronic microscopy. RESULTS: Most of the biopsies (58.9% were performed during the first month post-transplant. An increase in serum creatinine was associated with acute tubular and/or cortical necrosis. Proteinuria and normal serum creatinine were associated with glomerular lesions. Non-nephrotic range proteinuria and an increase in serum creatinine were associated with chronic rejection. CONCLUSIONS: Evaluation of serum creatinine and urinalysis can be useful in suggesting the histological graft diagnosis.

  13. Development and Use of Challenge Exams for Clinical Laboratory Nursing 2: Part 2 Final Report. (United States)

    Hattstaedt, Mary Jane; Isaac, Margaret M.

    The report describes the development of a set of equivalency tests for students in Nursing 2 who have had prior clinical laboratory training or experience in pediatrics, obstetrics, or geriatrics. For each of the three areas the examination packet includes: the course clinical objectives, the challenge examination objectives, a self-study guide, a…

  14. 78 FR 28292 - Joint Biomedical Laboratory Research and Development and Clinical Science Research and... (United States)


    ... AFFAIRS Joint Biomedical Laboratory Research and Development and Clinical Science Research and Development... areas of biomedical, behavioral and clinical science research. The panel meetings will be open to the... location changes have been made for the following panel meetings of the of the Joint Biomedical...

  15. Nomenclature and basic concepts in automation in the clinical laboratory setting: a practical glossary. (United States)

    Evangelopoulos, Angelos A; Dalamaga, Maria; Panoutsopoulos, Konstantinos; Dima, Kleanthi


    In the early 80s, the word automation was used in the clinical laboratory setting referring only to analyzers. But in late 80s and afterwards, automation found its way into all aspects of the diagnostic process, embracing not only the analytical but also the pre- and post-analytical phase. While laboratories in the eastern world, mainly Japan, paved the way for laboratory automation, US and European laboratories soon realized the benefits and were quick to follow. Clearly, automation and robotics will be a key survival tool in a very competitive and cost-concious healthcare market. What sets automation technology apart from so many other efficiency solutions are the dramatic savings that it brings to the clinical laboratory. Further standardization will assure the success of this revolutionary new technology. One of the main difficulties laboratory managers and personnel must deal with when studying solutions to reengineer a laboratory is familiarizing themselves with the multidisciplinary and technical terminology of this new and exciting field. The present review/glossary aims at giving an overview of the most frequently used terms within the scope of laboratory automation and to put laboratory automation on a sounder linguistic basis.

  16. [Assessment of the quality of laboratory diagnosis of intestinal parasitic diseases by the laboratories participating in the Federal System of External Quality Assessment of Clinical Laboratory Testing]. (United States)

    Malakhov, V N; Dovgalev, A S; Astanina, S Iu; Serdiuk, A P


    In 2010-2013, the quality of microscopic detection of the causative agents ofparasitic diseases in the feces has been assessed by the specialists of the laboratories of the therapeutic-and-prophylactic institutions (TPIs) and Hygiene and Epidemiology Centers, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare, which are participants of the Federal System of External Quality Assessment of Clinical Laboratory Testing. Thirty-two specimens containing 16 species of human helminths and 4 species of enteric protozoa in different combinations were examined. The findings suggest that the quality of microscopic detection of the causative agents of parasitic diseases is low in the laboratories of health care facilities and that the specialists of the laboratories of TPIs and Hygiene and Epidemiology Centers, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare, do not not possess the knowledge and skills necessary to make a laboratory diagnosis of helminths and enteric protozoa. The average detection rates of helminths and protozoa were at a level of 64 and 36%, respectively. The correct results showed that the proportion of helminths and protozoa were 94.5 and 5.5%, respectively. According to the biological and epidemiological classification of helminths, there were higher detection rates for contact group parasites (Enterobius vermicularis and Hymenolepis nana) and geohelminths (Ascaris, Trichuris trichiura, and others). Biohelminths (Opisthorchis, tapeworms, and others) Were detectable slightly worse.

  17. Detection of intestinal protozoa in the clinical laboratory. (United States)

    McHardy, Ian H; Wu, Max; Shimizu-Cohen, Robyn; Couturier, Marc Roger; Humphries, Romney M


    Despite recent advances in diagnostic technology, microscopic examination of stool specimens remains central to the diagnosis of most pathogenic intestinal protozoa. Microscopy is, however, labor-intensive and requires a skilled technologist. New, highly sensitive diagnostic methods have been developed for protozoa endemic to developed countries, including Giardia lamblia (syn. G. intestinalis/G. duodenalis) and Cryptosporidium spp., using technologies that, if expanded, could effectively complement or even replace microscopic approaches. To date, the scope of such novel technologies is limited and may not include common protozoa such as Dientamoeba fragilis, Entamoeba histolytica, or Cyclospora cayetanensis. This minireview describes canonical approaches for the detection of pathogenic intestinal protozoa, while highlighting recent developments and FDA-approved tools for clinical diagnosis of common intestinal protozoa.

  18. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: guide to the Register, version 3-2010

    DEFF Research Database (Denmark)

    McMurray, Janet; Zérah, Simone; Hallworth, Michael;


    In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 12 years, more...... than 2200 specialists in Clinical Chemistry and Laboratory Medicine have joined the Register. In 2007, EC4 merged with the Forum of European Societies of Clinical Chemistry and Laboratory Medicine (FESCC) to form the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC). Two previous...

  19. LabPush: a pilot study of providing remote clinics with laboratory results via short message service (SMS in Swaziland, Africa.

    Directory of Open Access Journals (Sweden)

    Wen-Shan Jian

    Full Text Available BACKGROUND: Turnaround time (TAT is an important indicator of laboratory performance. It is often difficult to achieve fast TAT for blood tests conducted at clinics in developing countries. This is because clinics where the patient is treated are often far away from the laboratory, and transporting blood samples and test results between the two locations creates significant delay. Recent efforts have sought to mitigate this problem by using Short Message Service (SMS to reduce TAT. Studies reporting the impact of this technique have not been published in scientific literature however. In this paper we present a study of LabPush, a system developed to test whether SMS delivery of HIV related laboratory results to clinics could shorten TAT time significantly. METHOD: LapPush was implemented in six clinics of the Kingdom of Swaziland. SMS results were sent out from the laboratory as a supplement to normal transport of paper results. Each clinic was equipped with a mobile phone to receive SMS results. The laboratory that processes the blood tests was equipped with a system for digital input of results, and transmission of results via SMS to the clinics. RESULTS: Laboratory results were received for 1041 different clinical cases. The total number of SMS records received (1032 was higher than that of paper records (965, indicating a higher loss rate for paper records. A statistical comparison of TAT for SMS and paper reports indicates a statistically significant improvement for SMS. Results were more positive for more rural clinics, and an urban clinic with high workload. CONCLUSION: SMS can be used to reduce TAT for blood tests taken at clinics in developing countries. Benefits are likely to be greater at clinics that are further away from laboratories, due to the difficulties this imposes on transport of paper records.

  20. LabPush: A Pilot Study of Providing Remote Clinics with Laboratory Results via Short Message Service (SMS) in Swaziland, Africa (United States)

    Jian, Wen-Shan; Hsu, Min-Huei; Sukati, Hosea; Syed-Abdul, Shabbir; Scholl, Jeremiah; Dube, Nduduzo; Hsu, Chun-Kung; Wu, Tai-jung; Lin, Vera; Chi, Tex; Chang, Peter; Li, Yu-Chuan


    Background Turnaround time (TAT) is an important indicator of laboratory performance. It is often difficult to achieve fast TAT for blood tests conducted at clinics in developing countries. This is because clinics where the patient is treated are often far away from the laboratory, and transporting blood samples and test results between the two locations creates significant delay. Recent efforts have sought to mitigate this problem by using Short Message Service (SMS) to reduce TAT. Studies reporting the impact of this technique have not been published in scientific literature however. In this paper we present a study of LabPush, a system developed to test whether SMS delivery of HIV related laboratory results to clinics could shorten TAT time significantly. Method LapPush was implemented in six clinics of the Kingdom of Swaziland. SMS results were sent out from the laboratory as a supplement to normal transport of paper results. Each clinic was equipped with a mobile phone to receive SMS results. The laboratory that processes the blood tests was equipped with a system for digital input of results, and transmission of results via SMS to the clinics. Results Laboratory results were received for 1041 different clinical cases. The total number of SMS records received (1032) was higher than that of paper records (965), indicating a higher loss rate for paper records. A statistical comparison of TAT for SMS and paper reports indicates a statistically significant improvement for SMS. Results were more positive for more rural clinics, and an urban clinic with high workload. Conclusion SMS can be used to reduce TAT for blood tests taken at clinics in developing countries. Benefits are likely to be greater at clinics that are further away from laboratories, due to the difficulties this imposes on transport of paper records. PMID:23028543

  1. Neurobrucellosis: Clinical and laboratory findings in 22 patients

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    Rasoolinejad M


    Full Text Available Brucellosis is a multisystem disease with diverse clinical presentations and involvement of the nervous system is considered to 5 to be 10% in adult patients and 1% in children. The presentations of neurobrucellosis includes meningoencephalitis, subarachnoid haemorrhage, myelitis, radiculoneuritis, intracerebral and epidural abscess, psychosis and vascular syndrome. Twenty-two patients with neurobrucellosis are described. Ten patients had meningoencephalitis, seven patients had meningitis, three patients had polyradiculopathy and one patient presented with spinal epidural abscess and one patient had brain abscess. Results of an agglutination test for Brucella in serum were positive for all patients (>1:160; eight of 15 patients had positive agglutination test in CSF. Five patients had positive blood cultures, 3 patients had positive bone marrow cultures and 2 of 15 patients had positive CSF cultures. All of cultures were Brucella Mellitensis. Antimicrobial treatment included concurrent administration of Doxycycline, Rifampin and Trimethoprim-Sulfametoxazole. Four patients received Dexamethason concurrently. In conclusion, nervous system involvement is a serious manifestation of brucellosis. As brucellosis is an endemic disease in Iran we suggest that brucellosis be investigated with neurological symptoms and signs.

  2. Sheehan syndrome: clinical and laboratory evaluation of 20 cases. (United States)

    Ozkan, Yusuf; Colak, Ramis


    Sheehan syndrome (SS) or post-partum pituitary necrosis is a pituitary insufficiency secondary to excessive post-partum blood losses. SS is a very significant cause of maternal morbidity and mortality in developing countries although it is a rarity in developed countries in which obstetrical care has been improved. In this study, we reviewed 20 cases retrospectively who were diagnosed as SS in our clinic. The patients aged 40 to 65 years with a mean age of 51.12 +/- 9.44 years (mean +/- SD). Time to make a definitive diagnosis of the disease ranged between 5 and 25 years with a mean of 16.35 +/- 4.74 years. Three of our patient (15%) had a previous diagnosis of SS. Three patients (15%) were referred to emergency service for hypoglycemia, three patients (15%) for hypothyroidism and one patient (5%) for hyponatremia. Dynamic examination of the pituitary revealed GH, Prolactin, FSH, TSH and ACTH insufficiency in all of the patients. One of our patients had a sufficient LH response to LHRH challenge. All of the patients were imaged with pituitary MRI. Eleven patients had empty sella and 9 patients had partial empty sella. SS is still a common problem in our country, especially in rural areas. Considering the duration of disease, important delays occur in diagnosis and treatment of the disease.

  3. [Vasculitic Peripheral Neuropathies: Clinical Features and Diagnostic Laboratory Tests]. (United States)

    Ogata, Katsuhisa


    Vasculitic peripheral neuropathy (VPN) occurs due to ischemic changes of peripheral nerves, resulting from a deficit of vascular blood supply due to damaged vasa nervorum leading to vasculitis. VPN usually manifests as sensorimotor or sensory disturbances accompanied by pain, presenting as a type of multiple mononeuropathy, with a scattered distribution in distal limbs. VPN may also present as a mononeuropathy, distal symmetric polyneuropathy, plexopathy, or radiculopathy. The rapidity of VPN is variable, ranging from days to months, with symptoms occasionally changing with the appearance of new lesions. Careful history taking and neurological examination provides an exact diagnosis. The most common cause of VPN is primary vasculitis predominantly affecting small vessels, including vasa nervorum, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, and polyarteritis nodosa. Similar vasculitic processes can also result from a systemic collagen disorder or secondary vasculitis. Electrophysiological studies and pathological investigation of biopsied peripheral nerves and muscles are important for diagnosis of vasculitis. Serological tests, including ANCA, are useful for diagnosis of vasculitis. Accurate neurological examinations are essential for diagnosis and evaluation of clinical course.

  4. Quality of Control of Clinical-Biochemical Laboratories – Serbian Case

    Directory of Open Access Journals (Sweden)

    Vinko Peric


    Full Text Available In the last 20 years in medical laboratories, numerous activities regarding quality and accreditation system were taken. Approach to this problem in European countries is different, so the task of the Accreditation Work Group of the Confederation of European societies for clinical chemistry (EC 4 to help the efforts to harmonize this issue. External quality control in clinical-chemical laboratories imposed the need for the implementation of quality management system. »Good laboratory practice« and its principles were adopted by nominated bodies, both international and national. In the beginning, the standard ISO 9001 was applied for certification and for accreditation EN 45001 and ISO Guide 25, which are prepared for testing and calibration laboratories. Standard ISO 17025 is the successor of the previous documents and for now it is a reference for mentioned laboratories. Accreditation Work Group of the Confederation of European societies for clinical chemistry (EC 4 made an amendment of the requirements for medical laboratories, which this standard describes. Standard draft ISO 15189 was adopted on February 2003 as a final version with requirements for medical laboratories.

  5. Comparison of three clinical techniques for evaluating joint sounds. (United States)

    Hardison, J D; Okeson, J P


    Two-hundred two consecutive adult patients presenting to the University of Kentucky for general dental care screening were examined for temporomandibular joint sounds by three techniques: (1) lateral pole surface palpation, (2) digital palpation in the external auditory canal, (3) auscultation by a stethoscope. Sixty-nine patients reported joint sounds, but only 32 had sounds diagnosed by auscultation resulting in a 54% false-negative reporting rate. Stethoscopic auscultation was used as the standard to which the other two techniques were compared. The false-negative rate for auditory canal digital palpation was 71% and 77% for lateral pole surface palpation. Surface palpation had only a 2% false-positive incidence while auditory canal digital palpation had a 51% false-positive rate. There was poor agreement between the patients' subjective reporting and clinical exam by any technique. Using stethoscopic auscultation as the standard, both auditory canal and surface palpation had a very high false-negative rate, but only the auditory canal palpation had a poor false-positive incidence. Auditory canal palpation often produces TMJ sounds that are not heard with a stethoscope during normal opening and closure.

  6. [The issues and basic principles of training of physicians of clinical laboratory diagnostics]. (United States)

    Morozova, V T; Naumova, E V


    The article considers the main positions concerning the clinical laboratory diagnostics as an independent clinical specialty and the principles of professional training and improvement of specialists. The basic issues complicating the training and improvement of personnel to be kept in line with actual needs of laboratory service of public health system are discussed. Among them are the availability of laboratory academic sub disciplines demanding a profound special theoretical education and technical skills; the need to account in the process of professional training the variety of forms, sizes and types of laboratory structures in different medical institutions; the need of special training programs for numerous specialists with non-medical basic education. The combination of the present system of postgraduate training of specialists on chairs of state educational organizations with initiative involvement of specialists in various public forms of permanent professional improvement (professional scientific societies meetings, research conferences, internet seminars, etc.) is supported Along with a positive appraisal of the existing system of training in the state educational institutions and corresponding regulation documents, a critique is expressed regarding certain actual documents which improperly limit the administrative functions of physicians of clinical laboratory diagnostics and complicate training of bacteriologists for clinical laboratories.

  7. The Applicability of Lean and Six Sigma Techniques to Clinical and Translational Research (United States)

    Schweikhart, Sharon A.; Dembe, Allard E


    Background Lean and Six Sigma are business management strategies commonly used in production industries to improve process efficiency and quality. During the past decade, these process improvement techniques increasingly have been applied outside of the manufacturing sector, for example, in health care and in software development. This article concerns the potential use of Lean and Six Sigma to improve the processes involved in clinical and translational research. Improving quality, avoiding delays and errors, and speeding up the time to implementation of biomedical discoveries are prime objectives of the NIH Roadmap for Biomedical Research and the NIH Clinical and Translational Science Award (CTSA) program. Methods This article presents a description of the main principles, practices, and methodologies used in Lean and Six Sigma. Available literature involving applications of Lean and Six Sigma to health care, laboratory science, and clinical and translational research is reviewed. Specific issues concerning the use of these techniques in different phases of translational research are identified. Results Examples are provided of Lean and Six Sigma applications that are being planned at a current CTSA site, which could potentially be replicated elsewhere. We describe how different process improvement approaches are best adapted for particularly translational research phases. Conclusions Lean and Six Sigma process improvement methodologies are well suited to help achieve NIH’s goal of making clinical and translational research more efficient and cost-effective, enhancing the quality of the research, and facilitating the successful adoption of biomedical research findings into practice. PMID:19730130

  8. Yeast identification in the clinical microbiology laboratory: phenotypical methods. (United States)

    Freydiere, A M; Guinet, R; Boiron, P


    Emerging yeast pathogens are favoured by increasing numbers of immunocompromised patients and by certain current medical practices. These yeasts differ in their antifungal drug susceptibilities, and rapid species identification is imperative. A large variety of methods have been developed with the aim of facilitating rapid, accurate yeast identification. Significant recent commercial introductions have included species-specific direct enzymatic colour tests, differential chromogenic isolation plates, direct immunological tests, and enhanced manual and automated biochemical and enzymatic panels. Chromogenic isolation media demonstrate better detection rates of yeasts in mixed cultures than traditional media, and allow the direct identification of Candida albicans by means of colony colour. Comparative evaluation of rapid methods for C. albicans identification, including the germ tube test, shows that chromogenic media may be economically advantageous. Accurate tests for single species include the Bichrolatex Albicans and Krusei Color tests, both immunologically based, as well as the Remel Rapid Trehalose Assimilation Broth for C. glabrata. Among broad-spectrum tests, the RapID Yeast Plus system gives same-day identification of clinical yeasts, but performance depends on inoculum density and geographic isolate source. The API 20 C AUX system is considered a reference method, but newer systems such as Auxacolor and Fungichrom are as accurate and are more convenient. Among automated systems, the ID 32 C strip, the Vitek Yeast Biochemical Card and the Vitek 2 ID-YST system correctly identify >93% of common yeasts, but the ID-YST is the most accurate with uncommon yeasts, including C. dubliniensis. Spectroscopic methods such as Fourier transformed-infrared spectroscopy offer potential advantages for the future. Overall, the advantages of rapid yeast identification methods include relative simplicity and low cost. For all rapid methods, meticulous, standardized

  9. Clinical and Laboratory Findings of Patients with Breath Holding Spells

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    Özlem Özdemir


    Full Text Available Aim: The aim of this prospective study was to evaluate the clinical characteristics; physical findings, cardiological, hematological and neurological problems; treatment approaches; and the prognosis of children with breath holding spells.Materials and Method: Seventhy patients were included in this study. All patients were evaluated with detailed history and physical examination. Complete blood count, serum iron and iron binding capacity were studied; cardiological (telecardiography, electrocardiography, if necessary echocardiography and event recorder and neurological investigations (electroencephalography were done during the admission. Patients with iron deficiency anemia and iron deficiency were treated with ferrous sulphate orally. In patients with normal hematological values, no medication was used. After a two-month treatment period patients underwent control hematological evaluation. Frequency of the spells, age of disappearance of spells (defined as 6 months without spells, disappearance ratios between the three groups were compared. Results: The percentage of cyanotic, palloric and mixt type of breath holding spells of 70 patients included in the study were 67.1, 14.3 and 18.6, respectively. It was determined that psychogenic factors played a role in 77.1% of our patients. There were iron deficiency anemia in 39 (55.7%, iron deficiency in 12 (17.2% and normal hematological parameters in 19 (27.1% of 70 patients. The QTc values were normal in all of them. EEG’s were normal in 56 (80%, dysrhythmic in 11 (15.7% and pathologic in (4.3%. There was a positive family history of breath holding spells in 44.3% of those with breath holding spells. Conclusion: We determined that there was a correlation between the iron levels and the frequency of spells. The lower the iron levels the higher the frequency of spells. There was a dramatic decrease of 92% in spells with low doses of iron supplementation especially in the anemic group. (Journal of

  10. PNH revisited: Clinical profile, laboratory diagnosis and follow-up

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    Gupta P


    Full Text Available Background: Paroxysmal nocturnal hemoglobinuria (PNH is characterized by intravascular hemolysis, marrow failure, nocturnal hemoglobinuria and thrombophila. This acquired disease caused by a deficiency of glycosylphosphatidylinositol (GPI anchored proteins on the hematopoietic cells is uncommon in the Indian population. Materials and Methods: Data of patients diagnosed with PNH in the past 1 year were collected. Clinical data (age, gender, various presenting symptoms, treatment information and follow-up data were collected from medical records. Results of relevant diagnostic tests were documented i.e., urine analysis, Ham′s test, sucrose lysis test and sephacryl gel card test (GCT for CD55 and CD59. Results: A total of 5 patients were diagnosed with PNH in the past 1 year. Presenting symptoms were hemolytic anemia (n=4 and bone marrow failure (n=1. A GCT detected CD59 deficiency in all erythrocytes in 4 patients and CD55 deficiency in 2 patients. A weak positive PNH test for CD59 was seen in 1 patient and a weak positive PNH test for CD55 was seen in 3 patients. All patients were negative by sucrose lysis test. Ham′s test was positive in two cases. Patients were treated with prednisolone and/or androgen and 1 patient with aplastic anemia was also given antithymocyte globulin. A total of 4 patients responded with a partial recovery of hematopoiesis and 1 patient showed no recovery. None of the patients received a bone marrow transplant. Conclusion: The study highlights the diagnostic methods and treatment protocols undertaken to evaluate the PNH clone in a developing country where advanced methods like flowcytometry immunophenotyping (FCMI and bone marrow transplants are not routinely available.


    Directory of Open Access Journals (Sweden)



    Full Text Available INTRODUCTION: Malaria is a major health concern across the world and is endemic in our country. It is imperative for us to know the varied manifestations and lab features both classically described and rare features for early detection of this disease and further treatment. This study was undertaken to study the clinical features, lab features and complications of malaria in a tertiary care centre. METHODOLOGY: It is a retrospective study done on 75 cases of confirmed and treated cases of malaria for a period of one year in KIMS hospital, Bangalore. Detailed history examination and lab features of these patients were recorded and analyzed. RESULTS: A total of 75 cases of confirmed malaria were treated during study period of which 57[76%] were males Out of 75 cases 46[61%] had vivax malaria infection, 10[13%] had falciparum infection and 19[26%] had mixed infections of falciparum and vivax. In all 3 groups more number of cases was seen in age group of 18 – 40 years. fever was the major presentation (100% in the patients and Pain abdomen along with fever seen in 15 [20%] patients. Head ache was another predominant complaint in 35[46.6%] On examination Icterus was seen in 11 [14.6%] patients Pallor was seen in 13[17.3%] patients Systolic BP of 2ULN was seen in 9[12%] patients Out of these 6[8%] patients had severe malaria as defined by WHO category of severe malaria. CONCLUSIONS: Being more vigilant and well versed with the varied presentations/lab features of malaria and anticipating complications early, effective treatment can be instituted thus reducing the morbidity and mortality of this endemic disease.

  12. Ultrasound in sports medicine: relevance of emerging techniques to clinical care of athletes. (United States)

    Yim, Eugene Sun; Corrado, Gianmichael


    The applications of ultrasound in managing the clinical care of athletes have been expanding over the past decade. This review provides an analysis of the research that has been published regarding the use of ultrasound in athletes and focuses on how these emerging techniques can impact the clinical management of athletes by sports medicine physicians. Electronic database literature searches were performed using the subject terms 'ultrasound' and 'athletes' from the years 2003 to 2012. The following databases were searched: PubMed, Web of Science, Cochrane Library, CINAHL, and SPORTDiscus™. The search produced 617 articles in total, with a predominance of articles focused on cardiac and musculoskeletal ultrasound. 266 of the studies involved application of ultrasound in evaluating the cardiovascular properties of athletes, and 151 studies involved musculoskeletal ultrasound. Other applications of ultrasound included abdominal, vascular, bone density and volume status. New techniques in echocardiography have made significant contributions to the understanding of the physiological changes that occur in the athlete's heart in response to the haemodynamic stress associated with different types of activity. The likely application of these techniques will be in managing athletes with hypertrophic cardiomyopathy, and the techniques are near ready for application into clinical practice. These techniques are highly specialized, however, and will require referral to dedicated laboratories to influence the clinical management of athletes. Investigation of aortic root pathology and pulmonary vascular haemodynamics are also emerging, but will require additional studies with larger numbers and outcomes analysis to validate their clinical utility. Some of these techniques are relatively simple, and thus hold the potential to enter clinical management in a point-of-care fashion. Musculoskeletal ultrasound has demonstrated a number of diagnostic and therapeutic techniques

  13. Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Hans-Christoph, E-mail: [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany); Johnson, Thorsten [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany)


    Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing. Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as “triple rule out” scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes. This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

  14. Murillo's paintings revealed by spectroscopic techniques and dedicated laboratory-made micro X-ray diffraction. (United States)

    Duran, A; Siguenza, M B; Franquelo, M L; Jimenez de Haro, M C; Justo, A; Perez-Rodriguez, J L


    This paper describes one of the first case studies using micro-diffraction laboratory-made systems to analyse painting cross-sections. Pigments, such as lead white, vermilion, red ochre, red lac, lapis lazuli, smalt, lead tin yellow type I, massicot, ivory black, lamp black and malachite, were detected in cross-sections prepared from six Bartolomé Esteban Murillo paintings by micro-Raman and micro-XRD combined with complementary techniques (optical microscopy, SEM-EDS, and FT-IR). The use of micro-XRD was necessary due to the poor results obtained with conventional XRD. In some cases, pigment identification was only possible by combining results from the different analytical techniques utilised in this study.

  15. Identifying the Clinical Laboratory Tests from Unspecified "Other Lab Test" Data for Secondary Use. (United States)

    Pan, Xuequn; Cimino, James J


    Clinical laboratory results are stored in electronic health records (EHRs) as structured data coded with local or standard terms. However, laboratory tests that are performed at outside laboratories are often simply labeled "outside test" or something similar, with the actual test name in a free-text result or comment field. After being aggregated into clinical data repositories, these ambiguous labels impede the retrieval of specific test results. We present a general multi-step solution that can facilitate the identification, standardization, reconciliation, and transformation of such test results. We applied our approach to data in the NIH Biomedical Translational Research Information System (BTRIS) to identify laboratory tests, map comment values to the LOINC codes that will be incorporated into our Research Entities Dictionary (RED), and develop a reference table that can be used in the EHR data extract-transform-load (ETL) process.

  16. [Akita University Graduate School of Medicine: status of clinical laboratory medicine education]. (United States)

    Ito, Wataru; Chihara, Junichi


    Education in laboratory medicine is important. However, many medical students and doctors cannot understand this importance. This problem may be caused by the unclear character of laboratory medicine in research as well as hospital work, resulting in a lack of staff in the Department of Laboratory Medicine. One of the characters of laboratory medicine is its all-inclusive actions unrestrained by medical specialty. Thus, we tell medical students that the staff of laboratory medicine are suitable members of the infection control team (ICT) and nutrition support team (NST) in lectures. Moreover, we also teach allergy, immunology, infection, and sex-specific medicine, which are some subjects the topics of research. Many students in Akita University recognize that the staff of the Department of Laboratory Medicine are specialists of infection and allergy. On the other hand, young doctors can also receive postgraduate clinical training and conduct research not restricted to allergy and infection. We have a policy whereby the Department of Laboratory Medicine always opens its door widely to everyone including students and doctors. Nine staff joined the Department of Laboratory Medicine of Akita University about ten years, and now, can fully provide students with medical education. To solve some problems regarding education in laboratory medicine, we should promote our roles in medical education as well as in hospitals, and increase the number of staff.

  17. Evaluation of Various Pulse-Decay Laboratory Permeability Measurement Techniques for Highly Stressed Coals (United States)

    Feng, Ruimin; Harpalani, Satya; Pandey, Rohit


    The transient technique for laboratory permeability measurement, proposed by Brace et al. (J Geophys Res 73:2225-2236, 1968) and widely used for conventional gas reservoir rocks, is the preferred method when testing low-permeability rocks in the laboratory. However, Brace et al.'s solution leads to considerable errors since it does not take into account compressive storage and sorption effect when applied to sorptive rocks, such as, coals and shales. To verify the applicability of this solution when used to characterize fluid flow behavior of coal, an in-depth investigation of permeability evolution for flow of helium and methane depletion was conducted for San Juan coals using the pressure pulse-decay method under best replicated in situ conditions. Three permeability solutions, Brace et al.'s (1968), Dicker and Smits's (International meeting on petroleum engineering, Society of Petroleum Engineers, 1988) and Cui et al.'s (Geofluids 9:208-223, 2009), were utilized to establish the permeability trends. Both helium and methane permeability results exhibited very small difference between the Brace et al.'s solution and Dicker and Smits's solution, indicating that the effect of compressive storage is negligible. However, methane permeability enhancement at low pressures due to coal matrix shrinkage resulting from gas desorption can be significant and this was observed in pressure response plots and the estimated permeability values using Cui et al.'s solution only. Therefore, it is recommended that Cui et al.'s solution be employed to correctly include the sorption effect when testing coal permeability using the transient technique. A series of experiments were also carried out to establish the stress-dependent permeability trend under constant effective stress condition, and then quantify the sole contribution of the sorption effect on permeability variation. By comparison with the laboratory data obtained under in situ stress/strain condition, it was verified that

  18. Implementation of External Quality Assessment Scheme in Clinical Chemistry for District Laboratories in Bhutan. (United States)

    Jamtsho, Rixin; Nuchpramool, Wilairat


    External Quality Assessment Scheme (EQAS) involves evaluation of a number of laboratories by an outside agency on the performance of a number of laboratories based on their analytical performance of tests on samples supplied by the external agency. In developing countries, establishment of national EQAS by preparing homemade quality control material is a useful scheme in terms of resources and time to monitor the laboratory performance. The objective of this study is to implement an EQAS to monitor the analytical performance of the district laboratories in Bhutan. Baseline information was collected through questionnaires. Lyophilized human serum including normal and abnormal levels were prepared and distributed to 19 participating laboratories. Nine routine analytes were included for the study. Their results were evaluated using Variance index scores (VIS) and Coefficient of variations (CV) was compared with Clinical Laboratory Improvement Act (CLIA) Proficiency Testing Criteria (PT) for each analyte. There was significant decrease in CV at the end of the study. The percentages of results in acceptable VIS as 'A' were 63, 60, 66, 69, 73 and 74, 75, 76 and 79 % in November 2009-July 2010 respectively. From our results, we concluded that, establishment of EQAS through distribution of home-made quality control material could be the useful scheme to monitor the laboratory performance in clinical chemistry in Bhutan.

  19. Incorporating new materials and techniques into clinical practice. (United States)

    Pitts, N B; Drummond, J; Guggenberger, R; Ferrillo, P; Johnston, S


    This article outlines the subjects presented and discussed at the December 2012 IADR Dental Materials Innovation Workshop held at King's College London. Incorporating new materials and techniques into clinical practice was considered from 4 perspectives: (1) Accelerating the "research to regulatory approval" process was presented with current developments in the United States, with the National Institutes of Health/Food and Drug Administration process as a working example; (2) intellectual property and regulatory requirements were discussed across the well-established US and EU frameworks, as well as the more recently developed procedures across Brazil, Russia, India, and China; (3) the challenges and opportunities of incorporating innovations into dental education were considered with reference to the future needs of both students and faculty; and (4) the key but difficult and unpredictable step of translating such innovations into routine dental practice was then explored. Constructive and far-ranging discussion among the broadly based Workshop participants (from dental research, education, practice, and industry, as well as environmental organizations and the World Health Organization) mapped out key issues for the future. The focus was on facilitating the more timely adoption of improvements in both materials and techniques to improve patient health and health systems, while minimizing environmental impact.

  20. Comparative genomic hybridization: technical development and cytogenetic aspects for routine use in clinical laboratories. (United States)

    Lapierre, J M; Cacheux, V; Da Silva, F; Collot, N; Hervy, N; Wiss, J; Tachdjian, G


    Comparative genomic hybridization (CGH) offers a new global approach for detection of chromosomal material imbalances of the entire genome in a single experiment without cell culture. In this paper, we discuss the technical development and the cytogenetic aspects of CGH in a clinical laboratory. Based only on the visual inspection of CGH metaphase spreads, the correct identification of numerical and structural anomalies are reported. No commercial image analysis software was required in these experiments. We have demonstrated that this new technology can be set up easily for routine use in a clinical cytogenetics laboratory.

  1. New developments of X-ray fluorescence imaging techniques in laboratory (United States)

    Tsuji, Kouichi; Matsuno, Tsuyoshi; Takimoto, Yuki; Yamanashi, Masaki; Kometani, Noritsugu; Sasaki, Yuji C.; Hasegawa, Takeshi; Kato, Shuichi; Yamada, Takashi; Shoji, Takashi; Kawahara, Naoki


    X-ray fluorescence (XRF) analysis is a well-established analytical technique with a long research history. Many applications have been reported in various fields, such as in the environmental, archeological, biological, and forensic sciences as well as in industry. This is because XRF has a unique advantage of being a nondestructive analytical tool with good precision for quantitative analysis. Recent advances in XRF analysis have been realized by the development of new x-ray optics and x-ray detectors. Advanced x-ray focusing optics enables the making of a micro x-ray beam, leading to micro-XRF analysis and XRF imaging. A confocal micro-XRF technique has been applied for the visualization of elemental distributions inside the samples. This technique was applied for liquid samples and for monitoring chemical reactions such as the metal corrosion of steel samples in the NaCl solutions. In addition, a principal component analysis was applied for reducing the background intensity in XRF spectra obtained during XRF mapping, leading to improved spatial resolution of confocal micro-XRF images. In parallel, the authors have proposed a wavelength dispersive XRF (WD-XRF) imaging spectrometer for a fast elemental imaging. A new two dimensional x-ray detector, the Pilatus detector was applied for WD-XRF imaging. Fast XRF imaging in 1 s or even less was demonstrated for Euro coins and industrial samples. In this review paper, these recent advances in laboratory-based XRF imaging, especially in a laboratory setting, will be introduced.

  2. Historical milestones in measurement of HDL-cholesterol: impact on clinical and laboratory practice. (United States)

    Langlois, Michel R; Blaton, Victor H


    High-density lipoprotein cholesterol (HDL-C) comprises a family of particles with differing physicochemical characteristics. Continuing progress in improving HDL-C analysis has originated from two separate fields-one clinical, reflecting increased attention to HDL-C in estimating risk for coronary heart disease (CHD), and the other analytical, reflecting increased emphasis on finding more reliable and cost-effective HDL-C assays. Epidemiologic and prospective studies established the inverse association of HDL-C with CHD risk, a relationship that is consistent with protective mechanisms demonstrated in basic research and animal studies. Atheroprotective and less atheroprotective HDL subpopulations have been described. Guidelines on primary and secondary CHD prevention, which increased the workload in clinical laboratories, have led to a revolution in HDL-C assay technology. Many analytical techniques including ultracentrifugation, electrophoresis, chromatography, and polyanion precipitation methods have been developed to separate and quantify HDL-C and HDL subclasses. More recently developed homogeneous assays enable direct measurement of HDL-C on an automated analyzer, without the need for manual pretreatment to separate non-HDL. Although homogeneous assays show improved accuracy and precision in normal serum, discrepant results exist in samples with atypical lipoprotein characteristics. Hypertriglyceridemia and monoclonal paraproteins are important interfering factors. A novel approach is nuclear magnetic resonance spectroscopy that allows rapid and reliable analysis of lipoprotein subclasses, which may improve the identification of individuals at increased CHD risk. Apolipoprotein A-I, the major protein of HDL, has been proposed as an alternative cardioprotective marker avoiding the analytical limitations of HDL-C.

  3. Measles Outbreak in Macedonia: Epidemiological, Clinical and Laboratory Findings and Identification of Susceptible Cohorts


    Irena T Kondova; Zvonko Milenkovic; Sanja P Marinkovic; Golubinka Bosevska; Gordana Kuzmanovska; Goran Kondov; Sonja Alabakovska; Muller, Claude P.; Hübschen, Judith M


    OBJECTIVES: Despite a 92-99% national vaccination coverage since 2000, the former Yugoslav Republic of Macedonia experienced a large measles outbreak between 2010 and 2011. Here we investigate the characteristics of patients hospitalized during this outbreak at the Clinic of Infectious Diseases in Skopje. METHODS: Epidemiological, clinical and laboratory data of 284 measles patients, including 251 from Skopje (43.80% of the 573 reported cases) and 33 from elsewhere in Macedonia were collected...

  4. Clinical microbiology: Should microbiology be a clinical or a laboratory speciality?

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    Bhattacharya Sanjay


    Full Text Available Clinical microbiology is a specific combination of knowledge, attitude and practice aimed at direct clinical involvement in infectious disease management using the core principles of medical microbiology and clinical medicine. In this article certain areas in microbiology, where a more proactive approach could make a significant difference in clinical outcome has been delineated. The article reiterates the role of a medical microbiologist in a hospital setting. The practices described are the norm in well-organized hospitals. These areas include management of positive blood cultures, management of patients in intensive care units (ICUs, hospital infection control and public health microbiology, development of hospital and community anti-infective policy, organization of clinical-microbiological meetings and provision of emergency out-of-hours service. The implementation of this clinical approach and increased engagement with direct patient care would require changes in existing training structure and working patterns of medical and technical staffs in microbiology.

  5. Clinical symptoms and laboratory findings supporting early diagnosis of Crimean-Congo hemorrhagic fever in Iran. (United States)

    Mostafavi, Ehsan; Pourhossein, Behzad; Chinikar, Sadegh


    Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease, which is usually transmitted to humans by tick bites or contact with blood or other infected tissues of livestock. Patients suffering from CCHF demonstrate an extensive spectrum of clinical symptoms. As it can take considerable time from suspecting the disease in hospital until reaching a definitive diagnosis in the laboratory, understanding the clinical symptoms and laboratory findings of CCHF patients is of paramount importance for clinicians. The data were collected from patients who were referred to the Laboratory of Arboviruses and Viral Hemorrhagic Fevers at the Pasteur institute of Iran with a primary diagnosis of CCHF between 1999 and 2012 and were assessed by molecular and serologic tests. Referred patients were divided into two groups: patients with a CCHF positive result and patients with a CCHF negative result. The laboratory and clinical findings of these two groups were then compared. Two-thousand five hundred thirty-six probable cases of CCHF were referred to the laboratory, of which 871 cases (34.3%) were confirmed to be CCHF. Contact with infected humans and animals increased the CCHF infection risk (P important role in patient survival and the application of the findings of this study can prove helpful as a key for early diagnosis.

  6. Bridging the gap between clinical failure and laboratory fracture strength tests using a fractographic approach

    NARCIS (Netherlands)

    Aboushelib, M.N.; Feilzer, A.J.; Kleverlaan, C.J.


    Objective: The aim of this study was to analyze and to compare the fracture type and the stress at failure of clinically fractured zirconia-based all ceramic restorations with that of morphologically similar replicas tested in a laboratory setup. Methods: Replicas of the same shape and dimensions we

  7. The value of clinical and laboratory diagnostics for chest pain patients at the emergency department

    NARCIS (Netherlands)

    Jellema, Laurens-Jan C.; Backus, Barbra E.; Six, A. Jacob; Braam, Richard; Groenemeijer, Bjorn; van der Zaag-Loonen, Hester J.; Tio, Rene; van Suijlen, Jeroen D. E.


    Background: The focus during the diagnostic process for patients with acute chest pain is to discriminate patients who can be safely discharged from those who are at risk for an acute coronary syndrome (ACS). In this study the diagnostic value of the clinical examination is compared with laboratory

  8. A typology of evidence based practice research heuristics for clinical laboratory science curricula. (United States)

    Leibach, Elizabeth K; Russell, Barbara L


    A typology of EBP research heuristics was defined relative to clinical laboratory science levels of practice. Research skills requisite for CLS baccalaureate level are associated mainly with quality control of analytic processes. Research skills at master's level are associated with pre- and post-analytic investigations, as well. Doctoral level CLS practice portends to utilize research skills facilitating quality investigations at the systems level.

  9. The role of liquid chromatography-tandem mass spectrometry in the clinical laboratory

    NARCIS (Netherlands)

    van den Ouweland, Johannes M. W.; Kema, Ido P.


    Liquid chromatography coupled to mass spectrometry (LC-MS/MS) is increasingly used as a routine methodology in clinical laboratories for the analysis of low molecular weight molecules. The high specificity in combination with high sensitivity and multi-analyte potential makes it an attractive comple

  10. 76 FR 38342 - Medicare Program; Clinical Laboratory Fee Schedule: Signature on Requisition (United States)


    ...; Clinical Laboratory Fee Schedule: Signature on Requisition AGENCY: Centers for Medicare & Medicaid Services... calendar year 2011 Physician Fee Schedule final rule with comment period that requires the signature of a... the prior policy that the signature of a physician or qualified non-physician practitioner is...

  11. Examination of the specific clinical symptoms and laboratory findings of Crimean-Congo hemorrhagic fever

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    Cetin Kilinc


    Interpretation & conclusion: It was inferred that certain clinical symptoms and laboratory findings such as fever, headache, widespread body pain, fatigue, leucopenia, nausea, vomiting, high CK levels, thrombocytopenia, AST/ ALT elevation and elevated LDH levels are highly specific and are required to be considered in the definitive diagnosis of CCHF, particularly in regions where this infection is observed as endemic.

  12. Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings

    DEFF Research Database (Denmark)

    Puhakka, K B; Jurik, A G; Schiøttz-Christensen, Berit


    OBJECTIVE: To compare a new MRI scoring system of the sacroiliac joints (SIJs) in early spondylarthropathy (SpA) with clinical and laboratory parameters. METHODS: Forty-one patients (24 males, 17 females) with a median age of 26 yr and a median duration of inflammatory low back pain of 19 months...

  13. Clinical and laboratory findings of 97 pediatric brucellosis patients in central Turkey. (United States)

    Yoldas, Tamer; Tezer, Hasan; Ozkaya-Parlakay, Aslinur; Sayli, Tulin Revide


    Brucellosis is a disease transmitted to humans by consumption of unpasteurized animal milk, or through direct contact with infected animals. The aim of this study was to evaluate clinical, laboratory findings of pediatric patients with brucellosis. Data of 97 patients diagnosed with brucellosis between January 2000 and December 2010 were evaluated retrospectively.

  14. Soil examination for a forensic trace evidence laboratory--Part 1: Spectroscopic techniques. (United States)

    Woods, Brenda; Lennard, Chris; Kirkbride, K Paul; Robertson, James


    In the past, forensic soil examination was a routine aspect of trace evidence examination in forensic science. However, in Australia, the apparent need for soil examinations has diminished and with it the capability of forensic science laboratories to carry out soil examination has been eroded. In recent years, due to soil examinations contributing to some high profile investigations, interest in soil examinations has been renewed. Routine soil examinations conducted in a forensic science laboratory by trace evidence scientists can be facilitated if the examinations are conducted using the instrumentation routinely used by these examiners. Spectroscopic techniques such as visible microspectrophotometry (MSP) and Attenuated Total Reflectance (ATR) Fourier Transform Infrared spectroscopy (FTIR) are routinely used by trace evidence analysts for the colour and compositional analysis, respectively, of forensic items, including paints, fibres, inks and toners, tapes, adhesives and other miscellaneous examinations. This article presents an examination of the feasibility of using MSP and ATR-FTIR as a first step in the forensic comparison of soils with particular reference to Australian soil samples. This initial study demonstrates MSP and ATR-FTIR can effectively be used as a screening test for the discrimination of "forensic-sized" soil samples prior to submission for more detailed analyses by a soil expert.

  15. Anemia in inflammatory bowel disease: prevalence, differential diagnosis and association with clinical and laboratory variables

    Directory of Open Access Journals (Sweden)

    Rodrigo Andrade Alves

    Full Text Available CONTEXT AND OBJECTIVES:Anemia is the most frequent extraintestinal complication of inflammatory bowel disease. This study aimed to: 1 determine the prevalence of anemia among patients with inflammatory bowel disease; 2 investigate whether routine laboratory markers are useful for diagnosing anemia; and 3 evaluate whether any association exists between anemia and clinical/laboratory variables.DESIGN AND SETTING:Cross-sectional at a federal university.METHODS:44 outpatients with Crohn's disease and 55 with ulcerative colitis were evaluated. Clinical variables (disease activity index, location of disease and pharmacological treatment and laboratory variables (blood count, iron laboratory, vitamin B12 and folic acid were investigated.RESULTS:Anemia and/or iron laboratory disorders were present in 75% of the patients with Crohn's disease and in 78.2% with ulcerative colitis. Anemia was observed in 20.5% of the patients with Crohn's disease and in 23.6% with ulcerative colitis. Iron-deficiency anemia was highly prevalent in patients with Crohn's disease (69.6% and ulcerative colitis (76.7%. Anemia of chronic disease in combination with iron deficiency anemia was present in 3% of the patients with Crohn's disease and in 7% of the patients with ulcerative colitis. There was no association between anemia and disease location. In ulcerative colitis, anemia was associated with the disease activity index.CONCLUSIONS:Most patients present iron laboratory disorders, with or without anemia, mainly due to iron deficiency. The differential diagnosis between the two most prevalent types of anemia was made based on clinical data and routine laboratory tests. In ulcerative colitis, anemia was associated with the disease activity index.

  16. The SIGN nail for knee fusion: technique and clinical results

    Directory of Open Access Journals (Sweden)

    Anderson Duane Ray


    Full Text Available Purpose: Evaluate the efficacy of using the SIGN nail for instrumented knee fusion. Methods: Six consecutive patients (seven knees, three males with an average age of 30.5 years (range, 18–50 years underwent a knee arthrodesis with SIGN nail (mean follow-up 10.7 months; range, 8–14 months. Diagnoses included tuberculosis (two knees, congenital knee dislocation in two knees (one patient, bacterial septic arthritis (one knee, malunited spontaneous fusion (one knee, and severe gout with 90° flexion contracture (one knee. The nail was inserted through an anteromedial entry point on the femur and full weightbearing was permitted immediately. Results: All knees had clinical and radiographic evidence of fusion at final follow-up and none required further surgery. Four of six patients ambulated without assistive device, and all patients reported improved overall physical function. There were no post-operative complications. Conclusion: The technique described utilizing the SIGN nail is both safe and effective for knee arthrodesis and useful for austere environments with limited fluoroscopy and implant options.

  17. New clinical technique for fabrication immediate partial denture

    Directory of Open Access Journals (Sweden)

    Abdulsalam Ali Zwiad


    Full Text Available Immediate partial denture is a choice of treatment due to various cases of teeth extraction such as badly carious teeth, periodontal disease, eruption problems, trauma, and other reasons. Many choices are used to replace the lost teeth; one of these choices is a removable plastic denture in which hot cured acrylic resin should be used to fabricate such denture. Aim of Study: To provide an applicable technique to fabricate an immediate partial denture by reducing and declining the prosthetic steps and some materials in proportional to the conventional method. Clinical Procedures: Maxillary and mandibular stone casts are mounted to a simple articulator and the procedures are explained as step by step to fabricate an immediate partial denture without using the conventional methods and material, just using a small quantity of white cold cure acrylic resin to fabricate the artificial teeth, hot cure acrylic resin for the denture base and mold made of a silicon impression material are used to fabricate an immediate partial denture. Conclusion: The finished immediate partial denture showed a good retention and produced the exact shapes and sizes of the extracted teeth with low cost and less time for a dentist and patient.

  18. WGS Analysis and Interpretation in Clinical and Public Health Microbiology Laboratories: What Are the Requirements and How Do Existing Tools Compare?

    Directory of Open Access Journals (Sweden)

    Kelly L. Wyres


    Full Text Available Recent advances in DNA sequencing technologies have the potential to transform the field of clinical and public health microbiology, and in the last few years numerous case studies have demonstrated successful applications in this context. Among other considerations, a lack of user-friendly data analysis and interpretation tools has been frequently cited as a major barrier to routine use of these techniques. Here we consider the requirements of microbiology laboratories for the analysis, clinical interpretation and management of bacterial whole-genome sequence (WGS data. Then we discuss relevant, existing WGS analysis tools. We highlight many essential and useful features that are represented among existing tools, but find that no single tool fulfils all of the necessary requirements. We conclude that to fully realise the potential of WGS analyses for clinical and public health microbiology laboratories of all scales, we will need to develop tools specifically with the needs of these laboratories in mind.

  19. [Security Management in Clinical Laboratory Departments and Facilities: Current Status and Issues]. (United States)

    Ishida, Haku; Nakamura, Junji; Yoshida, Hiroshi; Koike, Masaru; Inoue, Yuji


    We conducted a questionnaire survey regarding the current activities for protecting patients' privacy and the security of information systems (IS) related to the clinical laboratory departments of university hospitals, certified training facilities for clinical laboratories, and general hospitals in Yamaguchi Prefecture. The response rate was 47% from 215 medical institutions, including three commercial clinical laboratory centers. The results showed that there were some differences in management activities among facilities with respect to continuing education, the documentation or regulation of operational management for paper records, electronic information, remaining samples, genetic testing, and laboratory information for secondary use. They were suggested to be caused by differences in functions between university and general hospitals, differences in the scale of hospitals, or whether or not hospitals have received accreditation or ISO 15189. Regarding the IS, although the majority of facilities had sufficiently employed the access control to IS, there was some room for improvement in the management of special cases such as VIPs and patients with HIV infection. Furthermore, there were issues regarding the login method for computers shared by multiple staff, the showing of the names of personnel in charge of reports, and the risks associated with direct connections to systems and the Internet and the use of portable media such as USB memory sticks. These results indicated that further efforts are necessary for each facility to continue self-assessment and make improvements.

  20. Technique of cultivating limbal derived corneal epithelium on human amniotic membrane for clinical transplantation

    Directory of Open Access Journals (Sweden)

    Fatima A


    Full Text Available Background : The technique of transplantation of cultivated limbal epithelium rather than direct limbal tissue isa novel method of "cell therapy" involved in reconstructing the ocular surface in severe limbal stem celldeficiency [LSCD], caused by chemical burns. Aim : To describe a simple feeder-cell free technique of cultivating limbal epithelium on human amniotic membrane[HAM]. Materials and Methods : The limbal tissues (2 mm were harvested from patients with LSCD. These tissueswere proliferated in vitro on HAM supplemented by human corneal epithelial cell medium and autologousserum. Cultures covering more ?50% area of 2.5x5 cm HAM were considered adequate for clinical use. Thecultured epithelium was characterized by histopathology and immunophenotyping.Results: A total of 542 cultures out of 250 limbal tissues were cultivated in the laboratory from January 2001through July 2005. The culture explants showed that clusters of cells emerging from the edge of the explantsin one-three days formed a complete monolayer within 10-14 days. In 86% of cultures (464 of 542, thegrowth was observed within one-two days. Successful explant cultures were observed in 98.5% (534 of 542cultures with 91% explant cultures showing an area of ?6.25 cm2 (6.25 - 12.5 cm2 range. The cultivatedepithelium was terminated between 10-14 days for clinical transplantation. The problems encountered wereinadequate growth (2 of 542 and contamination (2 of 542. Conclusions : We demonstrate a simple technique of generating a sheet of corneal epithelium from a limbalbiopsy. This new technique could pave the way for a novel form of cell therapy.

  1. [The challenges of standardization in clinical diagnostic laboratories of medical organizations]. (United States)

    Men'shikov, V V


    The generalized data concerning the conditions of application of regulations of national standards in clinical diagnostic laboratories of medical organizations is presented. The primary information was provided by 14 regions of 6 federal administrative okrugs of Russia. The causes of challenges of application of requirements of standards are presented. They are mostly related with insufficient financial support, lacking of manpower, difficulties with reagents supply, inadequate technical maintenance of devices and absence of support of administration of medical organizations. The recommendations are formulated concerning the necessity of publishing the document of Minzdrav of Russia to determine the need in application of standards in laboratory practice.

  2. Clinical and Laboratory evaluation of measleslike rash in children and young adults

    Directory of Open Access Journals (Sweden)

    Stewien Klaus Eberhard


    Full Text Available A clinical and laboratory evaluation of 11 children and young adults with measleslike rash was done during the measles outbreak in the Greater São Paulo Metropolitan area at the end of 1996 and spread over the country during 1997. Measles was laboratory confirmed in 07 patients by specific IgM detection in acute serum specimens using an IgM-capture EIA, by specific IgG seroconversion in serum pairs, and by reverse transcription PCR and virus isolation in peripheral blood lymphocytes. Clinical presentations were not always classic; one of the 07 cases had received measles vaccine and corresponded to modified clinical case of measles. The 4 remaining cases were negative for measles and were diagnosed as exanthem subitum (2 cases, scarlet fever and Kawasaki disease. The present study reinforces the view that clinical features alone are not sufficient for establishing an accurate diagnosis in the post-vaccine era, and a surveillance system based on sensitive laboratory results is needed so that it can confirm IgM-negative measles cases.

  3. Autoverification in a core clinical chemistry laboratory at an academic medical center

    Directory of Open Access Journals (Sweden)

    Matthew D Krasowski


    Full Text Available Background: Autoverification is a process of using computer-based rules to verify clinical laboratory test results without manual intervention. To date, there is little published data on the use of autoverification over the course of years in a clinical laboratory. We describe the evolution and application of autoverification in an academic medical center clinical chemistry core laboratory. Subjects and Methods: At the institution of the study, autoverification developed from rudimentary rules in the laboratory information system (LIS to extensive and sophisticated rules mostly in middleware software. Rules incorporated decisions based on instrument error flags, interference indices, analytical measurement ranges (AMRs, delta checks, dilution protocols, results suggestive of compromised or contaminated specimens, and ′absurd′ (physiologically improbable values. Results: The autoverification rate for tests performed in the core clinical chemistry laboratory has increased over the course of 13 years from 40% to the current overall rate of 99.5%. A high percentage of critical values now autoverify. The highest rates of autoverification occurred with the most frequently ordered tests such as the basic metabolic panel (sodium, potassium, chloride, carbon dioxide, creatinine, blood urea nitrogen, calcium, glucose; 99.6%, albumin (99.8%, and alanine aminotransferase (99.7%. The lowest rates of autoverification occurred with some therapeutic drug levels (gentamicin, lithium, and methotrexate and with serum free light chains (kappa/lambda, mostly due to need for offline dilution and manual filing of results. Rules also caught very rare occurrences such as plasma albumin exceeding total protein (usually indicative of an error such as short sample or bubble that evaded detection and marked discrepancy between total bilirubin and the spectrophotometric icteric index (usually due to interference of the bilirubin assay by immunoglobulin (Ig M monoclonal

  4. Clinical and clinical laboratory correlates in sea otters dying unexpectedly in rehabilitation centers following the Exxon Valdez oil spill (United States)

    Rebar, A.H.; Lipscomb, T.P.; Harris, R.K.; Ballachey, B.E.


    Following the Exxon Valdez oil spill, 347 oiled sea otters (Enhydra lutris) were treated in rehabilitation centers. Of these, 116 died, 94 within 10 days of presentation. Clinical records of 21 otters dying during the first 10 days of rehabilitation were reviewed to define the laboratory abnormalities and clinical syndromes associated with these unexpected deaths. The most common terminal syndrome was shock characterized by hypothermia, lethargy, and often hemorrhagic diarrhea. In heavily and moderately oiled otters, shock developed within 48 hours of initial presentation, whereas in lightly oiled otters shock generally occurred during the second week of captivity. Accompanying laboratory abnormalities included leukopenia with increased numbers of immature neutrophils (degenerative left shift), lymphopenia, anemia, azotemia (primarily prerenal), hyperkalemia, hypoproteinemia/hypoalbuminemia, elevations of serum transaminases, and hypoglycemia. Shock associated with hemorrhagic diarrhea probably occurred either as a direct primary effect of oiling or as an indirect effect secondary to confinement and handling in the rehabilitation centers. Lightly oiled otters were less likely to die from shock than were heavily oiled otters (22% vs. 72%, respectively). Heavily oiled otters developed shock more rapidly and had greater numbers of laboratory abnormalities, suggesting that exposure to oil was an important contributing factor.

  5. Development of an internal dynamic web site to promote quality assurance in a clinical laboratory. (United States)

    Pernet, Pascal; Mario, Nathalie; Vaubourdolle, Michel


    In clinical laboratories, one challenging quality assurance objective is to maintain standardized practices. Meeting this objective entails ensuring information flow, which is necessary to smooth running of the laboratory. To facilitate information flow, we developed an internal quality Web site on our local network. The dynamic generated pages of the site were constructed with EasyPHP v.1.6, a complete freeware package providing PHP dynamic language and databases. The site comprises various sections: general news, specific laboratory units news, documents (quality manual, guidelines, emergency processes), schedules, National Quality Control results, forum, etc. Five to 10 pages are updated each week. This work was facilitated by the use of PHP-written pages and data tables, which enable us to record in real time the operation of our assurance quality project and to improve traceability. This approach could be extended to other aspects of quality management and could help meet the future IS015189 standard requirements.

  6. External quality assessment on detection of hepatitis C virus RNA in clinical laboratories of China

    Institute of Scientific and Technical Information of China (English)

    WANG Lu-nan; ZHANG Rui; SHEN Zi-yu; CHEN Wen-xiang; LI Jin-ming


    Background As with many studies carried out in European countries, a quality assurance program has been established by the National Center for Clinical Laboratories in China (NCCL). The results showed that the external quality assessment significantly improves laboratory performance for quantitative evaluation of hepatitis C virus (HCV) RNA.Methods Serum panels were delivered twice annuatly to the clinical laboratories which performed HCV RNA detection in China. Each panel made up of 5 coded samples. All laboratories were requested to carry out the detection within the required time period and report on testing results which contained qualitative and/or quantitative test findings, reagents used and relevant information about apparatus. All the positive samples were calibrated against the first International Standard for HCV RNA in a collaborative study and the range of comparison target value (TG) designated as ±0.5 log.Results The numbers of laboratories reporting on qualitative testing results for the first and second time external quality assessment were 168 and 167 in the year of 2003 and increased to 209 and 233 in 2007; the numbers of laboratories reporting on quantitative testing results were 134 and 147 in 2003 and rose to 340 and 339 in 2007. Deviation between the mean value for quantitative results at home in 2003 and the target value was above 0.5 log, which was comparatively high.By 2007, the target value was close to the national average except for the low concentrated specimens (103 IU/ml). The percentage of results within the range of GM±0.5 log10 varied from 8.2% to 93.5%. Some laboratories had some difficulties in the exact quantification of the lowest (3.00 log IU/ml) as well as of the highest viral levels (6.37 log IU/ml) values, very near to the limits of the dynamic range of the assays.Conclusions The comparison of these results with the previous study confirms that a regular participation in external quality assessment (EQA) assures the

  7. Sigma metrics in clinical chemistry laboratory – A guide to quality control

    Directory of Open Access Journals (Sweden)

    Usha S. Adiga


    Full Text Available Background: Six sigma is a process of quality measurement and improvement program used in industries. Sigma methodology can be applied wherever an outcome of a process is to be measured. A poor outcome is counted as an error or defect. This is quantified as defects per million (DPM. Six sigma provides a more quantitative frame work for evaluating process performance with evidence for process improvement and describes how many sigma fit within the tolerance limits. Sigma metrics can be used effectively in laboratory services. The present study was undertaken to evaluate the quality of the analytical performance of clinical chemistry laboratory by calculating sigma metrics. Methodology: The study was conducted in the clinical biochemistry laboratory of Karwar Institute of Medical Sciences, Karwar. Sigma metrics of 15 parameters with automated chemistry analyzer, transasia XL 640 were analyzed. The analytes assessed were glucose, urea, creatinine, uric acid, total bilirubin (BT, direct bilirubin (BD, total protein, albumin, SGOT, SGPT, ALP, Total cholesterol, triglycerides, HDL and Calcium. Results: We have sigma values <3 for Urea, ALT, BD, BT, Ca, creatinine (L1 and urea, AST, BD (L2. Sigma lies between 3-6 for Glucose, AST, cholesterol, uric acid, total protein(L1 and ALT, cholesterol, BT, calcium, creatinine and glucose (L2.Sigma was more than 6 for Triglyceride, ALP, HDL, albumin (L1 and TG, uric acid, ALP, HDL, albumin, total protein(L2. Conclusion: Sigma metrics helps to assess analytical methodologies and augment laboratory performance. It acts as a guide for planning quality control strategy. It can be a self assessment tool regarding the functioning of clinical laboratory.

  8. Improvised double-embedding technique of minute biopsies: A mega boon to histopathology laboratory

    Directory of Open Access Journals (Sweden)

    Lokendra Yadav


    Full Text Available Introduction: Optimal orientation of minute mucosal biopsies is essential for a definite diagnosis in gastrointestinal pathology or to visualize neural plexuses in Hirschsprung disease. The problem of minute size of the biopsy and its orientation gets compounded when they are from neonates and mandates exhaustive strip cuts, thus delaying reporting. Aim: A modified agar-paraffin technique is aimed to make tissue embedding efficient and user-friendly by inking mapping biopsies (one or more either fresh or fixed with surgical coloring inks followed by embedding first in agar after orientation and followed thereafter by processing, re-embedding in paraffin wax, sectioning and staining. Results: The tissues in agar paraffin block were found to be well processed, firm, held secure and well preserved. The blocks were easy to cut, with serial sections of thickness 2-3 μ and easy to spread. The colored inks remained permanently on the tissues both in the block as well as on the sections which helped in easy identification of tissues. Agar did not interfere with any stain such as Hematoxylin and Eosin or with histochemical stains, enzyme histochemistry or immunohistochemistry. Inking biopsies and pooling them in a block when obtained from the same patient reduced the number of tissue blocks. Conclusion: The modified agar-paraffin embedding technique is a simple reliable user friendly method that can greatly improve the quality of diagnostic information from minute biopsies by optimal orientation, better quality of sections, faster turnaround time and cost-effectiveness by economizing on the number of paraffin blocks, manpower, chemical reagents and laboratory infrastructure.

  9. Short clinical crowns (SCC) – treatment considerations and techniques


    Sharma, Ashu; G. R. Rahul; Poduval, Soorya T.; Shetty, Karunakar


    When the clinical crowns of teeth are dimensionally inadequate, esthetically and biologically acceptable restoration of these dental units is difficult. Often an acceptable restoration cannot be accomplished without first surgically increasing the length of the existing clinical crowns; therefore, successful management requires an understanding of both the dental and periodontal parameters of treatment. The complications presented by teeth with short clinical crowns demand a comprehensive tre...

  10. Dengue in children: a systematic review of clinical and laboratory factors associated with severity. (United States)

    Wakimoto, Mayumi Duarte; Camacho, Luiz Antonio Bastos; Guaraldo, Lusiele; Damasceno, Luana Santana; Brasil, Patrícia


    Dengue is a potentially life-threatening illness, and children are at higher risk of severity. This review aimed to systematize the identified clinical and laboratory parameters associated with severe dengue in children, as monitoring these signs and fluid-replacement therapy are actually the cornerstones of dengue treatment. Of the 527 studies initially reviewed, 21 were selected as follows: three cohort studies, three case-control studies, 14 cross-sectional studies and one not defined. Eighteen studies were carried out in Asia and three in the Americas. Hepatomegaly, lethargy, abdominal pain, bleeding, hemoconcentration and thrombocytopenia, all referenced as warning signs in the WHO 2009 Guidelines, were the clinical and laboratory parameters independently associated with severity in more than one study. The recognition of these known warning signs associated to severe dengue disease underlines the usefulness of the WHO 2009 classification.

  11. Using the e-Chasqui, web-based information system, to determine laboratory guidelines and data available to clinical staff. (United States)

    Blaya, Joaquin A; Yagui, Martin; Contreras, Carmen C; Palma, Betty; Shin, Sonya S; Yale, Gloria; Suarez, Carmen; Fraser, Hamish S F


    13% of all drug susceptibility tests (DSTs) performed at a public laboratory in Peru were duplicate. To determine reasons for duplicate requests an online survey was implemented in the e-Chasqui laboratory information system. Results showed that 59.6% of tests were ordered because clinical staff was unaware of ordering guidelines or of a previous result. This shows a benefit of using a web-based system and the lack of laboratory information available to clinical staff in Peru.

  12. Microbial contamination of removable prosthodontic appliances from laboratories and impact of clinical storage. (United States)

    Williams, D W; Chamary, N; Lewis, M A O; Milward, P J; McAndrew, R


    Decontamination of dental instruments has recently been the subject of considerable debate. However, little information is available on the potential bacterial colonisation of dental appliances returning from dental laboratories and their need for decontamination. This study investigated the extent and nature of microbial contamination of removable prosthodontic appliances produced at different dental laboratories and stored in two clinical teaching units (CTU 1 and CTU 2) of a dental hospital and school. Forty consecutive dental prosthodontic appliances that were being stored under varying conditions in the two clinical teaching units were selected for study; the appliances having been produced 'in-house' (hospital laboratory) or 'out-of-house' (external commercial laboratory). Two appliances, that were known to have undergone decontamination before storage, were used as controls. Swabs were taken according to a standard protocol and transferred to the microbiological laboratory with bacterial growth expressed as colony forming units (cfu) per cm(2). Microbial sampling yielded growth from 23 (58%) of the 40 appliances studied (CTU 1, n = 22; CTU 2, n = 18), with 38% of these having a high level of contamination (>42,000 cfu/cm(2)). The predominant bacteria isolated were Bacillus spp. (57%), pseudomonads (22%) and staphylococci (13%). Fungi of the genus Candida were detected in 38% of the samples. There was no significant difference in contamination of the appliances in relation to either their place of production or the CTU (p >0.05). However, the level of contamination was significantly higher (p = 0.035) for those appliances stored in plastic bag with fluid (n = 16) compared to those stored on models (n = 19). No growth was recovered from the two appliances that had undergone decontamination before storage. The research showed that appliances received from laboratories are often contaminated and therefore there is a need for routine disinfection of such items

  13. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: guide to the Register, version 3-2010.

    LENUS (Irish Health Repository)

    McMurray, Janet


    In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 12 years, more than 2200 specialists in Clinical Chemistry and Laboratory Medicine have joined the Register. In 2007, EC4 merged with the Forum of European Societies of Clinical Chemistry and Laboratory Medicine (FESCC) to form the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC). Two previous Guides to the Register have been published, one in 1997 and another in 2003. The third version of the Guide is presented in this article and is based on the experience gained and development of the profession since the last revision. Registration is valid for 5 years and the procedure and criteria for re-registration are presented as an Appendix at the end of the article.

  14. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: Code of Conduct, Version 2--2008.

    LENUS (Irish Health Repository)

    McMurray, Janet


    In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 10 years, more than 2000 specialists in Clinical Chemistry and Laboratory Medicine have joined the Register. In 2007, EC4 merged with the Federation of European Societies of Clinical Chemistry and Laboratory Medicine (FESCC) to form the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC). A Code of Conduct was adopted in 2003 and a revised and updated version, taking account particularly of the guidelines of the Conseil Européen des Professions Libérales (CEPLIS) of which EFCC is a member, is presented in this article. The revised version was approved by the EC4 Register Commission and by the EFCC Executive Board in Paris on 6 November, 2008.

  15. Role of the clinical pathology laboratory in the evaluation of endometrial carcinomas for Lynch syndrome. (United States)

    Djordjevic, Bojana; Broaddus, Russell R


    Molecular diagnostic testing of endometrial carcinomas in the pathology laboratory has recently emerged as a key component of the clinical evaluation of Lynch syndrome in many centers. Testing modalities involve immunohistochemical and PCR-based analyses. This article outlines the routine application of these analyses, provides a practical guide for troubleshooting some of the common technical issues related to their performance, and reviews common pitfalls in their interpretation. Discrepancies between tissue testing and genetic testing results are discussed in the context of the current understanding of endometrial cancer biology. The merits of universal versus targeted tissue testing based on clinical patient history and histological tumor appearance are also addressed.

  16. Evaluation of Vitek 2 for identification of yeasts in the clinical laboratory. (United States)

    Meurman, O; Koskensalo, A; Rantakokko-Jalava, K


    The Vitek 2 system was compared with conventional assimilation, fermentation and morphological methods for its ability to identify yeast isolates from among 151 clinical specimens and 16 known type culture or quality control strains. An unequivocal identification was obtained for 155 (92.8%) isolates, with low discrimination for nine (5.4%) and false identification for three (1.8%) isolates. All isolates of Candida albicans, Candida glabrata and Candida krusei were identified correctly. It was concluded that the Vitek 2 system offers an excellent alternative for the identification of yeasts in a clinical laboratory.

  17. Laboratory evaluation of the Beckman Synchron CX3 clinical chemistry analyzer. (United States)

    Peake, M J; Pejakovic, M; White, G H


    In this evaluation of the Beckman Synchron CX3, the multi-analyte clinical chemistry analyzer exhibited high precision, good linearity, and no carryover for each of the eight analytes measured. Results obtained correlated well with those produced by our routine instrumentation (Beckman Astra, Varian atomic absorption spectrophotometer). The instrument can process up to 75 samples per hour (600 tests per hour if all tests available are requested) and, after calibration, can provide urgent results for the complete panel of tests within 2 1/2 min. The performance characteristics of this instrument make it ideal as a routine or a "stat" analyzer for commonly requested tests in the clinical chemistry laboratory.

  18. EFLM WG-Preanalytical phase opinion paper: local validation of blood collection tubes in clinical laboratories. (United States)

    Lippi, Giuseppe; Cornes, Michael P; Grankvist, Kjell; Nybo, Mads; Simundic, Ana-Maria


    The selection or procurement of blood collection devices in healthcare facilities is often an underestimated issue. This is probably due to different factors including the lack of knowledge of policymakers, hospital administrators and even laboratory managers about the importance of preanalytical quality and phlebotomy process, as well as to the absence of reliable guidelines or recommendations on how to precisely assess the quality of blood collection devices around the globe. With the awareness that a gap remains between manufacturers' and local validation of blood collection devices, the Working Group for Preanalytical Phase (WG-PRE) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has drafted a consensus document aimed to provide a set of essential requisites, technical criteria (e.g. presence of physical defects, malfunctioning, safety problems) and clinical issues for supporting laboratory professionals in organization blood collection tubes tenders and validating new devices before local routine implementation. The laboratory professionals should also make sure that the tenders accurately and strictly define the responsibilities for validation experiments and the potential consequences in the case the validation outcome shows that tubes due not fulfill the expectations.

  19. Impact of sonography in gouty arthritis: Comparison with conventional radiography, clinical examination, and laboratory findings

    Energy Technology Data Exchange (ETDEWEB)

    Schueller-Weidekamm, Claudia [Department of Diagnostic Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)]. E-mail:; Schueller, Gerd [Department of Diagnostic Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Aringer, Martin [Department of Rheumatology, Internal Medicine III, Medical University of Vienna (Austria); Weber, Michael [Department of Diagnostic Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Kainberger, Franz [Department of Diagnostic Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)


    Objective: To explore the typical sonographic features of gray-scale and Power Doppler of acute and chronic gouty arthritis in conjunction with radiographic, clinical, and laboratory findings. Materials and methods: All hand, finger, and toe joints of 19 patients with acute and chronic gout were examined with gray-scale and Power Doppler sonography. The number and size of bone changes detected with sonography was compared to radiographic findings. Vascularization of the synovial tissue was scored on Power Doppler (grades 0-3), and was compared with clinical appearance, including swelling, tenderness, and redness (grades 0-3). Results: In acute gout, mild to moderate echogenic periarticular nodules with sonotransmission and hypervascularization of the edematous surrounding soft tissue were found. In chronic gout, tophaceous nodules completely blocked transmission of US wave, leading to strong reflexion and dorsal shadowing in a minority of cases. No significant difference in the detection of large bone changes (>2 mm) was found between sonography and radiography. However, gray-scale sonography was significantly more sensitive in the detection of small bone changes (p < 0.001). Power Doppler scores were statistically significantly higher than clinical examination scores (p < 0.001). Discussion: Sonography is superior to radiographs in evaluating small bone changes. The inflammatory process in joints can be better detected with Power Doppler sonography than with clinical examination. Typical sonographic appearance of acute and in particular of chronic gout might provide clues on gouty arthritis that adds to the information available from conventional radiography, clinical, and laboratory findings.

  20. Assessment of body fatness in childhood obesity: evaluation of laboratory and anthropometric techniques

    Energy Technology Data Exchange (ETDEWEB)

    Bandini, L.G.; Dietz, W.H. Jr.


    The identification of obesity as a pathological diagnosis depends on an accurate assessment of body fatness and a correlation of fatness with pathological consequences. Because total body fat varies with body weight, the proportion of body weight that is fat is probably a more reliable indicator of risk. Among obese children and adolescents, several problems have hindered the development of accurate clinical measures of percent body fat and total body fat. First, the use of direct methods to measure body composition is limited by expense and labor. Second, the relationship between anthropometric indexes and body composition in obese children and adolescents has not been intensively studied. Third, sample sizes of normal weight children have been too small to permit the development of diagnostic criteria. Fourth, the triceps skinfold is less reproducible in overweight subjects. Increases in lean body mass in obese adolescents may confound the use of the body mass index as a measure of adiposity. Current laboratory methods for the measurement of body composition include: (1) underwater weighing, (2) 40K counting, (3) isotopic dilution measures, (4) neutron activation, and (5) electrical impedance. This article examines relationships between those methods and anthropometry in the measurement of fatness in children and adolescents, as well as the difficulties in measuring body fatness and the importance of body fat distribution and its relationship to morbidity in children. Current evidence suggests an association of morbidity and upper segment obesity in adults. Corresponding studies in children and adolescents are yet to be carried out.

  1. Epidemiologival, clinical, pathological and laboratory findings of botulism in cattle in the State of Santa Catarina


    Luciane Orbem Veronezi


    The study was carried out through the epidemiological, clinical, pathological and laboratory findings of botulism in cattle in the state of Santa Catarina, during the period from 1987 to 2008. The data were obtained through information from the files of the Department of Animal Pathology CAV/UDESC and in the properties which the disease continued to occur. In properties with the botulism associated phosphorus deficiency cattle, the animals were kept on native pastures, in most ...

  2. The laboratory of clinical virology in monitoring patients undergoing monoclonal antibody therapy. (United States)

    Cavallo, R


    The relevant efficacy of monoclonal antibodies (mAbs) has resulted in the successful treatment of several diseases, although susceptibility to infections remains a major problem. This review summarizes aspects of the literature regarding viral infections and mAbs, specifically addressing the risk of infection/reactivation, the measures that can reduce this risk, and the role played by the laboratory of clinical virology in monitoring patients undergoing mAb therapy.

  3. The EC4 European syllabus for post-graduate training in clinical chemistry and laboratory medicine

    DEFF Research Database (Denmark)

    Wieringa, Gijsbert; Zerah, Simone; Jansen, Rob


    Laboratory medicine's practitioners across the European community include medical, scientific and pharmacy trained specialists whose contributions to health and healthcare is in the application of diagnostic tests for screening and early detection of disease, differential diagnosis, monitoring...... in translating knowledge and skills into ability to practice. In a 'Specialist knowledge' division, the expectations from the individual disciplines of Clinical Chemistry/Immunology, Haematology/Blood Transfusion, Microbiology/ Virology, Genetics and In Vitro Fertilisation are described. Beyond providing...

  4. MODULAR ANALYTICS: A New Approach to Automation in the Clinical Laboratory


    Horowitz, Gary L.; Zaman, Zahur; Blanckaert, Norbert J. C.; Chan, Daniel W.; Dubois, Jeffrey A.; Golaz, Olivier; Mensi, Noury; Keller, Franz; Stolz, Herbert; Klingler, Karl; Marocchi, Alessandro; Prencipe, Lorenzo; McLawhon, Ronald W.; Nilsen, Olaug L.; Oellerich, Michael


    MODULAR ANALYTICS (Roche Diagnostics) (MODULAR ANALYTICS, Elecsys and Cobas Integra are trademarks of a member of the Roche Group) represents a new approach to automation for the clinical chemistry laboratory. It consists of a control unit, a core unit with a bidirectional multitrack rack transportation system, and three distinct kinds of analytical modules: an ISE module, a P800 module (44 photometric tests, throughput of up to 800 tests/h), and a D2400 module (16 photometric tests, throughp...

  5. Online laboratory evaluation of seeding-machine application by an acoustic technique

    Energy Technology Data Exchange (ETDEWEB)

    Karimi, H.; Navid, H.; Mahmoudi, A.


    Researchers and planter manufacturers have been working closely to develop an automated system for evaluating performance of seeding. In the present study, an innovative use of acoustic signal for laboratory evaluation of seeding-machine application is described. Seed detection technique of the proposed system was based on a rising voltage value that a microphone sensed in each impaction of seeds to a steel plate. Online determining of seed spacing was done with a script which was written in MATLAB software. To evaluate the acoustic system with desired seed spacing, a testing rig was designed. Seeds of wheat, corn and pelleted tomato were used as experimental material. Typical seed patterns were positioned manually on a belt stand with different spacing patterns. When the belt was running, the falling seeds from the end point of the belt impacted to the steel plate, and their acoustic signal was sensed by the microphone. In each impact, data was processed and spacing between the seeds was automatically obtained. Coefficient of determination of gathered data from the belt system and the corresponding seeds spacing measured with the acoustic system in all runs was about 0.98. This strong correlation indicates that the acoustic system worked well in determining the seeds spacing. (Author)

  6. Application of indices Cp and Cpk to improve quality control capability in clinical biochemistry laboratories. (United States)

    Chen, Ming-Shu; Wu, Ming-Hsun; Lin, Chih-Ming


    The traditional criteria for acceptability of analytic quality may not be objective in clinical laboratories. To establish quality control procedures intended to enhance Westgard multi-rules for improving the quality of clinical biochemistry tests, we applied the Cp and Cpk quality-control indices to monitor tolerance fitting and systematic variation of clinical biochemistry test results. Daily quality-control data of a large Taiwanese hospital in 2009 were analyzed. The test items were selected based on an Olympus biochemistry machine and included serum albumin, aspartate aminotransferase, cholesterol, glucose and potassium levels. Cp and Cpk values were calculated for normal and abnormal levels, respectively. The tolerance range was estimated with data from 50 laboratories using the same instruments and reagents. The results showed a monthly trend of variation for the five items under investigation. The index values of glucose were lower than those of the other items, and their values were usually <2. In contrast to the Cp value for cholesterol, Cpk of cholesterol was lower than 2, indicating a systematic error that should be further investigated. This finding suggests a degree of variation or failure to meet specifications that should be corrected. The study indicated that Cp and Cpk could be applied not only for monitoring variations in quality control, but also for revealing inter-laboratory qualitycontrol capability differences.

  7. International Federation of Clinical Chemistry. Use of artificial intelligence in analytical systems for the clinical laboratory. IFCC Committee on Analytical Systems. (United States)

    Place, J F; Truchaud, A; Ozawa, K; Pardue, H; Schnipelsky, P


    The incorporation of information-processing technology into analytical systems in the form of standard computing software has recently been advanced by the introduction of artificial intelligence (AI) both as expert systems and as neural networks. This paper considers the role of software in system operation, control and automation and attempts to define intelligence. AI is characterized by its ability to deal with incomplete and imprecise information and to accumulate knowledge. Expert systems, building on standard computing techniques, depend heavily on the domain experts and knowledge engineers that have programmed them to represent the real world. Neural networks are intended to emulate the pattern-recognition and parallel-processing capabilities of the human brain and are taught rather than programmed. The future may lie in a combination of the recognition ability of the neural network and the rationalization capability of the expert system. In the second part of this paper, examples are given of applications of AI in stand-alone systems for knowledge engineering and medical diagnosis and in embedded systems for failure detection, image analysis, user interfacing, natural language processing, robotics and machine learning, as related to clinical laboratories. It is concluded that AI constitutes a collective form of intellectual property and that there is a need for better documentation, evaluation and regulation of the systems already being used widely in clinical laboratories.

  8. Laboratory-based surveillance in the molecular era: the TYPENED model, a joint data-sharing platform for clinical and public health laboratories. (United States)

    Niesters, H G; Rossen, J W; van der Avoort, H; Baas, D; Benschop, K; Claas, E C; Kroneman, A; van Maarseveen, N; Pas, S; van Pelt, W; Rahamat-Langendoen, J C; Schuurman, R; Vennema, H; Verhoef, L; Wolthers, K; Koopmans, M


    Laboratory-based surveillance, one of the pillars of monitoring infectious disease trends, relies on data produced in clinical and/or public health laboratories. Currently, diagnostic laboratories worldwide submit strains or samples to a relatively small number of reference laboratories for characterisation and typing. However, with the introduction of molecular diagnostic methods and sequencing in most of the larger diagnostic and university hospital centres in high-income countries, the distinction between diagnostic and reference/public health laboratory functions has become less clear-cut. Given these developments, new ways of networking and data sharing are needed. Assuming that clinical and public health laboratories may be able to use the same data for their own purposes when sequence-based testing and typing are used, we explored ways to develop a collaborative approach and a jointly owned database (TYPENED) in the Netherlands. The rationale was that sequence data - whether produced to support clinical care or for surveillance -can be aggregated to meet both needs. Here we describe the development of the TYPENED approach and supporting infrastructure, and the implementation of a pilot laboratory network sharing enterovirus sequences and metadata.

  9. [The clinical immunology laboratory in diagnosis and monitoring of systemic lupus erythematosus and connective tissue diseases]. (United States)

    Sinico, R A; Radice, A


    The laboratory and particularly clinical immunology laboratories have an essential role in diagnosing and monitoring systemic lupus erythematosus (SLE), as well as other connective tissue diseases. The role of the clinical immunology laboratory in these diseases is to confirm or exclude diagnosis, to monitor disease activity, and to identify subgroup of patients. To obtain the best results in terms of diagnostic performance and clinical usefulness, the following recommendations should be fulfilled: anti-nuclear antibodies (ANA) determination by indirect immunofluorescence on Hep-2 cells is an effective screening assay in patients with clinical features of SLE. A negative ANA test makes the diagnosis of SLE unlikely. Anti-dsDNA antibodies are highly specific for SLE and are associated with renal involvement. The method of choice for anti-dsDNA is the Farr assay; however, the necessity of using radioactive materials reduces its applicability. As an alternative, immunofluorescence on Crithidia Luciliae can be used in the diagnostic phase due to its high specificity. The detection of antibodies to extractable nuclear antigens (ENA) and to phospholipids (lupus anticoagulant and anti-cardiolipin antibodies) is useful in identifying subgroups of patients at risk for some clinical manifestations. Anti-dsDNA measurement with a quantitative assay (the Farr assay or ELISA) is currently the best method to monitor disease activity along with complement levels. New assays (anti-C1q and anti-nucleosome antibodies) have been recently proposed for the diagnosis (anti-nucleosome) and monitoring of SLE patients (anti-C1q and anti-nucleosome antibodies), with promising results.

  10. Clinical and Laboratory Presentation of Hairy Cell Leukemia (Hcl and Rate of Response to Cladribine

    Directory of Open Access Journals (Sweden)

    M Forat Yazdi


    Full Text Available Introduction: HCL is a rare malignant condition that is curable if diagnosed early. HCL can present with reduced blood cells and splenomegaly which maybe misdiagnosed with other conditions. The aim of the present study was to determine the frequency of early clinical and laboratory findings as well as the response rate of patients to the standard treatment regimen of Cladribine. Methods: The study was an uncontrolled clinical trial including 25 HCL patients referring to Oncology Clinics of Shahid Sadoughi (Yazd - Iran and Shahid Beheshti (Tehran - Iran between 1999 and 2005. Data was gathered by a pre–designed questionnaire. 21 out of 25 patients were treated with Cladribine and the clinical and laboratory response was assessed. Results: Of the 25 patients studied, 20 patients (80% were male and 5 patients (20% were female. Most of the patients at diagnosis were 55–67 years old and the most common presenting symptom was fatigue and lassitude secondary to anemia. Two patients were asymptomatic and were diagnosed incidentally. Splenomegaly was the main clinical finding which was present in about 80% of the males and all of the females. Accordingly, hairy cells in the peripheral blood smear, leukopenia and anemia were the most common laboratory findings. In contrast to previous results, pancytopenia was found in only 60% of the patients. Response rate was 90% (19 out of 21 of which 61.9% (13 patients and 28.5% (6 patients had complete remission (CR and partial remission (PR, respectively. Conclusion: According to the results, it can be concluded that HCL should be considered as a possible diagnosis in the context of fatigue, splenomegaly and reduced blood cell count. The results of the present study were similar to other similar international studies.

  11. Variability of Creatinine Measurements in Clinical Laboratories: Results from the CRIC Study (United States)

    Joffe, Marshall; Hsu, Chi-yuan; Feldman, Harold I.; Weir, Matthew; Landis, J.R.; Hamm, L. Lee


    across laboratories necessitates calibration of SCr measures to a common standard. Failing to do so may substantially affect study eligibility and clinical interpretations when they are determined by Cr-based estimates of GFR. PMID:20389058

  12. Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults.

    Directory of Open Access Journals (Sweden)

    Vernon J Lee

    Full Text Available BACKGROUND: Dengue and chikungunya are co-circulating vector-borne diseases with substantial overlap in clinical presentations. It is important to differentiate between them during first presentation as their management, especially for dengue hemorrhagic fever (DHF, is different. This study compares their clinical presentation in Singapore adults to derive predictors to assist doctors in diagnostic decision-making. METHODS: We compared 117 patients with chikungunya infection diagnosed with reverse transcription-polymerase chain reaction (RT-PCR with 917 dengue RT-PCR-positive adult patients (including 55 with DHF. We compared dengue fever (DF, DHF, and chikungunya infections by evaluating clinical characteristics of dengue and chikungunya; developing classification tools via multivariate logistic regression models and classification trees of disease etiology using clinical and laboratory factors; and assessing the time course of several clinical variables. FINDINGS: At first presentation to hospital, significantly more chikungunya patients had myalgia or arthralgia, and fewer had a sore throat, cough (for DF, nausea, vomiting, diarrhea, abdominal pain, anorexia or tachycardia than DF or DHF patients. From the decision trees, platelets <118 × 10(9/L was the only distinguishing feature for DF versus chikungunya with an overall correct classification of 89%. For DHF versus chikungunya using platelets <100 × 10(9/L and the presence of bleeding, the overall correct classification was 98%. The time course analysis supported platelet count as the key distinguishing variable. INTERPRETATION: There is substantial overlap in clinical presentation between dengue and chikungunya infections, but simple clinical and laboratory variables can predict these infections at presentation for appropriate management.

  13. Comparison of two measurement techniques for clinical wear

    DEFF Research Database (Denmark)

    Peters, M C; Delong, R; Pintado, M R;


    Clinical wear of restorations is generally evaluated by marginal integrity over time. In this study, both a subjective and an objective method for wear assessment are compared, and the relative advantages and disadvantages of each are considered....

  14. 50th anniversary of Clinical Chemistry and Laboratory Medicine--a historical overview. (United States)

    Körber, Friedrich; Plebani, Mario


    In the early 1960s, Joachim Brugsch, one of the founders of Clinical Chemistry and Laboratory Medicine (CCLM) (then Zeitschrift für Klinische Chemie), had the idea to found a journal in the upcoming field of clinical chemistry. He approached Ernst Schütte, who was associated with the De Gruyter publishing house through another journal, to participate, and Schütte thus became the second founder of this Journal. The aim was to create a vehicle allowing the experts to express their opinions and raise their voices more clearly than they could in a journal that publishes only original experimental papers, a laborious and difficult, but important endeavor, as the profession of clinical chemistry was still in the early stages of development at this time. The first issue of this Journal was published in early 1963, and today, we are proud to celebrate the 50th anniversary of CCLM. This review describes the development of this Journal in light of the political situation of the time when it was founded, the situation of the publisher Walter De Gruyter after the erection of the Berlin Wall, and the development of clinical chemistry, and later on, laboratory medicine as a well-acknowledged discipline and profession.

  15. Measurement of cholesterol and other lipoprotein constituents in the clinical laboratory. (United States)

    Warnick, G R


    Measurements of lipids and lipoproteins in the clinical laboratory have become increasingly important because of their predictive association with cardiovascular diseases, especially coronary artery disease. The US National Institutes of Health-sponsored National Cholesterol Education Program and counterparts in other countries have developed national consensus guidelines for diagnosis and treatment of coronary artery disease which provide risk cut-points and define use of the lipid/lipoprotein analytes in case finding and therapy. Total and low density lipoprotein cholesterol and triglycerides are measured as positive risk factors and high density lipoprotein cholesterol as an inverse risk factor for coronary artery disease. A National Cholesterol Education Program-sponsored expert laboratory panel has developed guidelines for measurements with requisite analytical performance targets for total error and corresponding precision and bias. The US Centers for Disease Control and Prevention have established reference methods for total and high density lipoprotein cholesterol and for triglycerides, with a method for low density lipoprotein cholesterol in development. Standardization programs for research laboratories and a Cholesterol Reference Method Laboratory Network for diagnostic manufacturers and clinical laboratories provide reliable access and documentation of traceability to accepted reference methods. Methods for the lipid/lipoprotein analytes have improved dramatically in recent years and, coupled with improved chemistry analyzer systems and more attention to standardization by manufacturers, offer considerable improvement in analytical performance. Fully automated homogeneous assays for high density lipoprotein cholesterol and newer similar assays for low-density lipoprotein cholesterol have potential for better precision as well as more convenient and cost-effective measurements. Attention to pre-analytical sources of variation is also important in making

  16. [Histological view of ethics in medicine and handling of residual samples in clinical laboratories]. (United States)

    Yoshida, Hiroshi


    One of the important ethical issues in clinical laboratory medicine is whether organs and/or specimens should belong to the examinees. Tracing back to ancient Greece, an episode of the death of Asklepios, killed by Zeus to revive the dead, and the great contribution of Hippocrates to medicine including the vow and ethics of medicine, have been described. In the relationship between doctors and patients, the former had been superior to the latter for more than 2400 years, however, the situation has been changing from that to the same position since 1960th, along with the development of bioethics from medical ethics. For the promotion of bioethics, world medical associations have contributed declarations and continuous discussion. The declarations are based on the avoidance of actions detrimental to the life, health, privacy or dignity of examinees. On the medical use of human organs and specimens in relation to human rights, the mind and the body, discussion has continued, however, a consensus on the details has not been reached. A view on the use of residual samples for methodological study, teaching and research in the clinical laboratory was proposed by the Japanese Society of Laboratory Medicine in 2002. Briefly, it included confidentiality of the laboratory staff, responsibility of the laboratory director, the absence of a necessity to obtain consent for the use of residual samples for methodological study when they are made anonymous or pooled, and the recommendation to obtain a judgement by an ethics committee for research use. The background and discussion for the proposal and the current situation on how to obtain consent from patients in Japan are mentioned.

  17. Clinical Application of Movement-needling Technique: Stiff Neck

    Institute of Scientific and Technical Information of China (English)

    LIU Yan


    @@ Movement-needling Technique, a new acupuncture therapy, is based on traditional acupuncture therapy and anatomical principle, combining acupuncture and movement. Combining disease and syndrome differentiation, and integrating TCM and Western medical diagnosis, this technique is used to treat different diseases mainly with acupuncture,combining some movement in needling. These movements not only boost therapeutic effects of acupuncture, but also add new contents to traditional acupuncture.

  18. Study on fatty liver diagnosed by abdominal ultrasonography and clinical laboratory findings

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jeong Hwa [Cheju Halla College, Cheju (Korea, Republic of)


    The study obtained the following conclusions by making a comparative study on fatty liver diagnosed by abdominal ultrasonography and clinical laboratory findings. I surveyed the value of abdominal ultrasound in 400 patients without clinical symptoms at C Health Clinic Center, Seoul. Compare with blood pressure was high (systolic/diastolic) in 7.5%/4.5% on persons who were diagnosed fatty liver. At the time of the diagnosis, Total cholesterol level was increased in fatty liver patients, HDL-cholesterol level was high in fatty liver patients. And Trigryceride level was increased in fatty liver persons, LDL-cholesterol was high in fatty liver persons. SGOT level was increased in 5.5% on patients who were diagnosed fatty liver, 0% on persons who were normal and SGPT level was high in 29.5% on people who were diagnosed fatty liver, 0% on patients who were diagnosed normal.

  19. 临床免疫学检验的现状与思考%Status quo and reflection of clinical immunology in laboratory medicine

    Institute of Scientific and Technical Information of China (English)

    王兰兰; 欧启水


    免疫学和分子生物学的发展日新月异,为临床免疫学检验带来许多新的启示和思路,在以临床路径管理和个体化医学为主要特点的时代背景下,如何准确把握这些变化,构建完善的临床免疫学检验质量体系、理清免疫学检验的路径并将其融入到临床路径管理中、扎实推进个体化诊断技术的推广和应用、准确评估临床免疫学检验新技术新项目的诊断价值,是值得每一个临床免疫学检验工作者深思的问题,本文对这些领域的现状和思考作一评述.%With the rapid advancement of immunology and molecular biology,many new revelations and ideas were drew for clinical immunology in laboratory medicine.In the current circumstances of application of clinical pathway management and individual medical care,how to accurately grasp these changes to build perfect quality system for clinical immunology laboratory,clarify the immunology laboratory pathway and integrate that into clinical pathway management,make solid progress for the promotion and application of individual diagnosis and evaluate the diagnostic value of new technique and item for clinical immunology laboratory accurately might be worth pondering for every people working in clinical immunology laboratory.In this paper,the status quo and reflection of clinical immunology is reviewed.



    A.D. Sialakouma; Palmer, G A; M. Botsaki; X. Papanikou; N.M. Vaxevanidis


    Biomedical science is a sensitive discipline and presents unique challenges due to its social character, continuous development and competitiveness. The issue of quality management systems and accreditation is gaining increasing interest in this sector. All over Europe, Health Services Units have started to introduce quality management systems and harmonization of criteria for accreditation is of increasing importance. Moreover, clinical laboratories, like the Assisted Reproduction laboratori...

  1. The application of the acoustic emission technique to stone decay by sodium sulphate in laboratory tests

    Directory of Open Access Journals (Sweden)

    Grossi, C. M.


    Full Text Available Acoustic emission was monitored during salt crystallisation cycles in order to study the mechanisms of rock deterioration by sodium sulphate in laboratory tests. Some porous carbonate stones used in Spanish monuments (Cathedral of Oviedo, Murcia and Seo Vella of Lérida were selected for this study. The acoustic emission detected during the different stages of the cycles (immersion, drying and cooling was interpreted to be the result of the salt behaviour inside the stone. The use of this technique has confirmed that this behaviour depends on salt characteristics (solubility, hydration state and polymorphism of anhydrous sodium sulphate and stone porosity and pore network.

    Para determinar los mecanismos de deterioro de las rocas debidos a la acción del sulfato de sodio, se ha registrado la emisión acústica durante ensayos de cristalización de sales en el laboratorio. Para ello, se han seleccionado tres piedras porosas carbonatadas utilizadas como materiales de construcción en monumentos españoles (Catedrales de Oviedo, Murcia y Seo Vella de Lérida. La emisión acústica detectada durante las diferentes etapas de los ciclos (inmersión, secado y enfriamiento se ha interpretado como debida al comportamiento de la sal en el interior de la piedra. Mediante esta técnica se ha confirmado que este comportamiento depende de las características de la sal (solubilidad, diferentes estados de hidratación y el polimorfismo del sulfato de sodio anhidro y de la porosidad y configuración del sistema poroso de las rocas.

  2. Solution-Phase Synthesis of Dipeptides: A Capstone Project That Employs Key Techniques in an Organic Laboratory Course (United States)

    Marchetti, Louis; DeBoef, Brenton


    A contemporary approach to the synthesis and purification of several UV-active dipeptides has been developed for the second-year organic laboratory. This experiment exposes students to the important technique of solution-phase peptide synthesis and allows an instructor to highlight the parallel between what they are accomplishing in the laboratory…

  3. Teaching laboratory rodent research techniques under the tenets of situated learning improves student confidence and promotes collaboration. (United States)

    Whitcomb, Tiffany L; Taylor, Edward W


    A targeted needs assessment at our institution revealed that the online system used to train researchers on performing techniques with animals did not provide opportunities to practice skills, introduce learners to animal care staff, nor satisfactorily support researchers' needs to become comfortable with laboratory animal species. To correct these deficiencies, a series of hands-on training sessions, framed theoretically in situated learning, was developed. This theoretical framework asserts that learning for everyday living (in this case, performing laboratory animal techniques) happens when people interact within the community while using the 'tools at hand' (that is, the instruments and jargon of the field). From this perspective, the students work alongside the instructor as apprentices. The instructor creates increasingly challenging learning opportunities as students work toward independently performing techniques. To test our hypothesis that teaching from this perspective improves comfort levels with laboratory animals and promotes collaborative relationships between animal care and research personnel, a mixed-method design involving online surveys (first survey, n = 45; second survey, n = 35) and semistructured interviews (n = 10) was used. Quantitative results revealed that students became more comfortable with laboratory animals and were more likely to contact animal care personnel due to participating in the training program. The qualitative arm of the study identified specific features of the training program that improved comfort levels for students (seeing then doing, working in small groups, learning within a comfortable environment, and building collegial relationships). These results support teaching rodent research techniques from the practical and theoretical approach of situated learning.

  4. Physics Laboratory Investigation of Vocational High School Field Stone and Concrete Construction Techniques in the Central Java Province (Indonesia) (United States)

    Purwandari, Ristiana Dyah


    The investigation aims in this study were to uncover the observations of infrastructures and physics laboratory in vocational high school for Stone and Concrete Construction Techniques Expertise Field or Teknik Konstruksi Batu dan Beton (TKBB)'s in Purwokerto Central Java Province, mapping the Vocational High School or Sekolah Menengah Kejuruan…

  5. Effectiveness of Student-Generated Video as a Teaching Tool for an Instrumental Technique in the Organic Chemistry Laboratory (United States)

    Jordan, Jeremy T.; Box, Melinda C.; Eguren, Kristen E.; Parker, Thomas A.; Saraldi-Gallardo, Victoria M.; Wolfe, Michael I.; Gallardo-Williams, Maria T.


    Multimedia instruction has been shown to serve as an effective learning aid for chemistry students. In this study, the viability of student-generated video instruction for organic chemistry laboratory techniques and procedure was examined and its effectiveness compared to instruction provided by a teaching assistant (TA) was evaluated. After…

  6. Three cases of CLIPPERS: a serial clinical, laboratory and MRI follow-up study. (United States)

    Kastrup, O; van de Nes, J; Gasser, T; Keyvani, K


    The aim of the study was to further determine the pathophysiology, clinical course, MRI-features and response to therapy of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS), which has recently been proposed as a rare chronic inflammatory central nervous system disorder responsive to immunosuppressive therapy. Three patients with this rare entity underwent serial clinical and bimonthly MRI follow-up over a period of up to 16 months. Extensive laboratory work-up and brain biopsy were performed. Intravenous methylprednisolone or oral dexamethasone was administered as treatment, additionally cyclophosphamide in one patient. Clinically, diplopia, nystagmus, ataxia and facial paresthesia were the cardinal symptoms. Magnetic resonance imaging (MRI) disclosed patchy spot-like gadolinium enhancement in a "salt-and-pepper like appearance" in the pons, midbrain and cerebellum, in two cases with thalamic and in the other with spinal involvement. Brain biopsies demonstrated a predominantly angiocentric but also diffuse infiltration pattern by small mature lymphocytes. Treatment with steroids led to rapid clinical improvement and marked resolution of MRI lesions. As discontinuation of steroids led to clinical relapse, one patient was treated with a further course of steroids and the other with steroids and cyclophosphamide as immunosuppressive therapy. This led to stable remission with only mild clinical residue and normalization of MRI. Extensive laboratory and radiological work-up could not identify any other cause of the disease. Of note, in two cases a marked elevation of IgE in serum was found initially and throughout the course. CLIPPERS seems to be a distinct inflammatory central nervous system disorder. It shows characteristic MRI core features. Extrapontine involvement seems to be frequent. Histologically it is characterised by predominantly angiocentric infiltration by small mature lymphocytes. A pathogenetic

  7. Clinical, laboratory and ultrasonographic findings in Egyptian buffalo (Bubalus bubalis with caecal and colonic dilatation

    Directory of Open Access Journals (Sweden)

    Arafat Khalphallah


    Full Text Available The present study was conducted to describe the clinical, laboratory and ultrasonographic findings of caecal and colonic dilatation in Egyptian buffalo (Bubalus bubalis. A total number of forty buffaloes were included in the study and divided into two groups: control group (n = 20 and diseased group (n = 20. Diseased buffalo were admitted to the Veterinary Teaching Hospital at Assiut University-Egypt. Each of the diseased animals was subjected to clinical, rectal, laboratory and ultrasonographic examinations. Clinically, buffalo with dilated caecum/colon showed reduced appetite, distended right abdomen, abdominal pain and tensed abdomen. Rectal examination indicated empty rectum with the presence of mucus and dilated loop of caecum and/or colon. Buffalo with dilated caecum/colon showed significant (P < 0.05 hypoproteinemia and hypoalbuminemia with significant (P < 0.05 increase in blood serum activities of aspartate aminotransferase (AST and alkaline phosphatase (ALK. Ultrasonographically, the dilated caecum and proximal loop of colon occupied the last right three intercostal space (ICSs particularly their ventral part, intertangled with the liver dorsally in these ICSs. Dilated colon did not hinder the visibility of the liver. The dilated caecum/colon also filled the whole right flank region, with hiding of right kidney, loops and peristaltic movement of the small intestines. The closest wall of the dilated caecum and proximal loop of the colon was imaged as thick semi-circular echogenic line. The furthest wall and contents of dilated caecum/colon were not imaged. In conclusion, buffalo with caecal and/or colonic dilatation have non-specific clinical and laboratory findings; however the affected animals show characteristic ultrasonographic findings.

  8. Time study of clinical and nonclinical workload in pathology and laboratory medicine. (United States)

    Trotter, Martin J; Larsen, Erik T; Tait, Nicholas; Wright, James R


    We describe a detailed, cross-sectional, self-report time study of laboratory physician tasks in a regionalized, multisite academic setting, using custom data collection templates programmed into personal digital assistants (PDAs). The 7-week study was completed by 56 medical and scientific staff (86% participation rate). Participants recorded 12,781 PDA entries of specific tasks completed during the study period. The mean number of entries per worked day per participant was 8.14 (range, 1.96-14.33). Study results demonstrated that professional staff worked, on average, 53.5 hours per week. Percentage work time spent in each activity area was as follows: clinical, direct, 50.6%; administration, 18.5%; clinical, indirect, 9.5%; research, 8.2%; learning/continuing education, 5.3%; teaching, 4.9%; and quality assurance, 3.1%. These percentages varied significantly by laboratory medicine subspecialty and by type of academic appointment. The findings confirm that activities not directly involved with patient care, such as administration, quality assurance, teaching, research, and professional development, typically occupy 40% to 50% of a laboratory physician's time.

  9. Hypereosinophilic syndrome: Clinical, laboratory, and imaging manifestations in patients with hepatic involvement

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gi Beom; Lee, Jong Min; Sung, Yeong Soon; Kang, Duk Sik [Kyungpook Natioanl University College of Medicine, Daegu (Korea, Republic of); Kim, Ok Hwoa [Dongkang general Hospital, Ulsan (Korea, Republic of)


    The hypereosinophilic syndrome (HES) commonly involves liver and spleen but only a few literature has reported the imaging features. In this article, we present the imaging features of the liver and spleen in HES patients together with clinical and laboratory features. This study included 5 HES patients with hepatic involvement. Extensive laboratory tests including multiple hematologic, serologic, parasitological, and immunologic examinations were performed. Imaging studies included CT, ultrasound (US)of upper abdomen and hepatosplenic scintigraphy. All patients were periodically examined by laboratory and imaging studies for 4 to 24 months. The common clinical presentations were weakness, mild fever, and dry cough. All patients revealed leukocytosis with eosinophilia of 40 to 80% and benign eosinophilic hyperplasia of the bone marrow. The percutaneous biopsy of the hepatic focal lesions performed in 2 patients showed numerous benigin eosinophilic infiltrates and one of them revealed combined calibration necrosis of hepatocytes. All cases revealed hepatomegaly with multiple focal lesions on at least on of CT, US, or scintigraphy. These findings completely disappeared in 2 to 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphic studies showed hepatic multifocal lesions with hepatomegaly. Differential diagnosis of these findings should include metastatic disease, lymphoma, leukemia, candidiasis or other opportunistic infections.

  10. Clinical Application and Characteristics of KONG's Scalp Acupuncture and Daoyin Technique

    Institute of Scientific and Technical Information of China (English)

    JIANG Ling-zhen; XIAO Yuan-chun


    @@ Scalp Acupuncture and Daoyin Technique, which are summarized by Dr. KONG in the light of his long-term acupuncture practice, has been considered as one of the clinical diagnostic and treatment programs in Chinese medicine by the State Administration of Traditional Chinese Medicine. In this paper, the characteristics and clinical application of Scalp Acupuncture and Daoyin Technique are presented as follows.

  11. [The manipulation technique and clinical application of kinetic cupping]. (United States)

    Luo, Rong; Liu, Qi; Sun, Dan


    The characteristic of kinetic cupping is explained from treatment principles, manipulation and clinical application. The kinetic cupping is a new particular therapy that combines traditional cupping and kinetic therapy. With cups on the patient, limb action like flexion-extension, adduction-abduction and rotation is made to reinforce clinical effects, which has simple and safe manipulation, obvious efficacy and is well accepted by patient. It has more obvious advantage for pain that was caused by large-area soft tissue injury and discomfort where acupuncture is not appropriate.

  12. Using Clinical Supervision Techniques with Student Art Teachers. (United States)

    Susi, Frank D.


    Contends that the student teaching experience and the cooperating teacher are the most significant aspects of the teacher education process. Describes the features and the implementation of clinical supervision in art education. Concludes that cooperating teachers also benefit as a result of their experiences with student teachers. (CFR)

  13. MALDI-TOF mass spectrometry in the clinical mycology laboratory: identification of fungi and beyond. (United States)

    Posteraro, Brunella; De Carolis, Elena; Vella, Antonietta; Sanguinetti, Maurizio


    MALDI-TOF mass spectrometry (MS) is becoming essential in most clinical microbiology laboratories throughout the world. Its successful use is mainly attributable to the low operational costs, the universality and flexibility of detection, as well as the specificity and speed of analysis. Based on characteristic protein spectra obtained from intact cells - by means of simple, rapid and reproducible preanalytical and analytical protocols - MALDI-TOF MS allows a highly discriminatory identification of yeasts and filamentous fungi starting from colonies. Whenever used early, direct identification of yeasts from positive blood cultures has the potential to greatly shorten turnaround times and to improve laboratory diagnosis of fungemia. More recently, but still at an infancy stage, MALDI-TOF MS is used to perform strain typing and to determine antifungal drug susceptibility. In this article, the authors discuss how the MALDI-TOF MS technology is destined to become a powerful tool for routine mycological diagnostics.

  14. Clinical results of stereotactic hellium-ion radiosurgery of the pituitary gland at Lawrence Berkeley Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Levy, R.P.; Fabrikant, J.I.; Lyman, J.T.; Frankel, K.A.; Phillips, M.H.; Lawrence, J.H.; Tobias, C.A.


    The first therapeutic clinical trial using accelerated heavy-charged particles in humans was performed at Lawrence Berkeley Laboratory (LBL) for the treatment of various endocrine and metabolic disorders of the pituitary gland, and as suppressive therapy for adenohypophyseal hormone-responsive carcinomas and diabetic retinopathy. In acromegaly, Cushing's disease, Nelson's syndrome and prolactin-secreting tumors, the therapeutic goal in the 433 patients treated has been to destroy or inhibit the growth of the pituitary tumor and control hormonal hypersecretion, while preserving a functional rim of tissue with normal hormone-secreting capacity, and minimizing neurologic injury. An additional group of 34 patients was treated for nonsecreting chromophobe adenomas. This paper discusses the methods and results of stereotactic helium-ion radiosurgery of the pituitary gland at Lawrence Berkeley Laboratory. 11 refs.

  15. Physicochemical inactivation of Lassa, Ebola, and Marburg viruses and effect on clinical laboratory analyses

    Energy Technology Data Exchange (ETDEWEB)

    Mitchell, S.W.; McCormick, J.B.


    Clinical specimens from patients infected with Lassa, Ebola, or Marburg virus may present a serious biohazard to laboratory workers. The authors have examined the effects of heat, alteration of pH, and gamma radiation on these viruses in human blood and on the electrolytes, enzymes, and coagulation factors measured in laboratory tests that are important in the care of an infected patient. Heating serum at 60 degrees C for 1 h reduced high titers of these viruses to noninfectious levels without altering the serum levels of glucose, blood urea nitrogen, and electrolytes. Dilution of blood in 3% acetic acid, diluent for a leukocyte count, inactivated all of these viruses. All of the methods tested for viral inactivation markedly altered certain serum proteins, making these methods unsuitable for samples that are to be tested for certain enzyme levels and coagulation factors.

  16. ASVCP quality assurance guidelines: control of preanalytical, analytical, and postanalytical factors for urinalysis, cytology, and clinical chemistry in veterinary laboratories. (United States)

    Gunn-Christie, Rebekah G; Flatland, Bente; Friedrichs, Kristen R; Szladovits, Balazs; Harr, Kendal E; Ruotsalo, Kristiina; Knoll, Joyce S; Wamsley, Heather L; Freeman, Kathy P


    In December 2009, the American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards committee published the updated and peer-reviewed ASVCP Quality Assurance Guidelines on the Society's website. These guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports: (1) general analytical factors for veterinary laboratory performance and comparisons; (2) hematology, hemostasis, and crossmatching; and (3) clinical chemistry, cytology, and urinalysis. This particular report is one of 3 reports and documents recommendations for control of preanalytical, analytical, and postanalytical factors related to urinalysis, cytology, and clinical chemistry in veterinary laboratories and is adapted from sections 1.1 and 2.2 (clinical chemistry), 1.3 and 2.5 (urinalysis), 1.4 and 2.6 (cytology), and 3 (postanalytical factors important in veterinary clinical pathology) of these guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimal guidelines for quality assurance and quality control for veterinary laboratory testing and a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts.

  17. Prosthetic Rehabilitation in Children: An Alternative Clinical Technique

    Directory of Open Access Journals (Sweden)

    Nádia Carolina Teixeira Marques


    Full Text Available Complete and partial removable dentures have been used successfully in numerous patients with oligodontia and/or anodontia. However, there is little information in the literature regarding the principles and guidelines to prosthetic rehabilitation for growing children. This case report describes the management of a young child with oligodontia as well as the treatment planning and the prosthetic rehabilitation technique.

  18. Age of onset influences on clinical and laboratory profile of patients with systemic lupus erythematosus. (United States)

    Sassi, Rafael Hennemann; Hendler, Jordana Vaz; Piccoli, Giovana Fagundes; Gasparin, Andrese Aline; da Silva Chakr, Rafael Mendonça; Brenol, João Carlos Tavares; Monticielo, Odirlei André


    The present study aims to evaluate differences in clinical and laboratory manifestations and medication use in the different ages of disease onset in patients with systemic lupus erythematosus (SLE). This cross-sectional study consisted of 598 SLE patients (550 female and 48 male), who attended the Rheumatology Clinic of the Hospital de Clínicas de Porto Alegre between 2003 and 2015. Demographic, clinical and laboratory data were collected. The patients were classified into three groups according to their ages at disease diagnosis. Mean age of diagnosis was 33.6 ± 14.3 years, and the median (25th-75th percentile) disease duration was 13 (7-20) years. Among the patients studied, 419 (70%) were adult-onset (aSLE), 90 (14.8%) were late-onset (lSLE) and 89 (14.8%) were childhood-onset (cSLE). The female to male ratio was higher in aSLE (18:1) compared to the other groups (p = 0.001). Arthritis was predominantly found in aSLE (78.5%) when compared with lSLE (57.7%) (p drugs.

  19. Direct oral anticoagulants and antiplatelet agents. Clinical relevance and options for laboratory testing. (United States)

    Sibbing, D; Spannagl, M


    Oral anticoagulants and platelet receptor blockers are widely used in clinical practice with the aim of reducing the risk of thrombotic complications in patients with cardiovascular diseases. Their regular intake and adequate antithrombotic action is vital and this is way numerous assays have been developed for laboratory testing and monitoring of these agents. Available assays can be stratified into pharmacokinetic and pharmacodynamic assays. Such assays are increasingly used in clinical routine and their daily use is triggered by the advent of the novel direct oral anticoagulants (DOACs) as an alternative for vitamin K antagonist (VKA) treatment, which are dabigatran, rivaroxaban and apixaban, and by the advent of prasugrel or ticagrelor as an alternative for clopidogrel with regard to platelet P2Y12 receptor inhibition. In this review the most important and most commonly used laboratory assays are summarized as well as their clinical implications with the focus on DOACs as an alternative for VKAs and the different P2Y12 receptor blockers for antiplatelet treatment.

  20. Clinical and laboratory features of systemic sclerosis complicated with localized scleroderma. (United States)

    Toki, Sayaka; Motegi, Sei-ichiro; Yamada, Kazuya; Uchiyama, Akihiko; Kanai, Sahori; Yamanaka, Masayoshi; Ishikawa, Osamu


    Localized scleroderma (LSc) primarily affects skin, whereas systemic sclerosis (SSc) affects skin and various internal organs. LSc and SSc are considered to be basically different diseases, and there is no transition between them. However, LSc and SSc have several common characteristics, including endothelial cell dysfunction, immune activation, and excess fibrosis of the skin, and there exist several SSc cases complicated with LSc during the course of SSc. Clinical and laboratory characteristics of SSc patients with LSc remain unclear. We investigated the clinical and laboratory features of 8 SSc patients with LSc among 220 SSc patients (3.6%). The types of LSc included plaque (5/8), guttate (2/8), and linear type (1/8). All cases were diagnosed as having SSc within 5 years before or after the appearance of LSc. In three cases of SSc with LSc (37.5%), LSc skin lesions preceded clinical symptoms of SSc. Young age, negative antinuclear antibody, and positive anti-RNA polymerase III antibody were significantly prevalent in SSc patients with LSc. The positivity of anticentromere antibody tended to be prevalent in SSc patients without LSc. No significant difference in the frequency of complications, such as interstitial lung disease, reflux esophagitis, and pulmonary artery hypertension, was observed. The awareness of these characteristic of SSc with LSc are essential to establish an early diagnosis and treatment.

  1. Clinical and laboratory signs associated to serious dengue disease in hospitalized children

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    Sheila Moura Pone

    Full Text Available Abstract Objective: To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. Methods: Retrospective cohort of children (19 and negative likelihood ratio <0.6. Pleural effusion and abdominal distension had higher sensitivity (82.6%. History of bleeding (epistaxis, gingival or gastrointestinal bleeding and severe hemorrhage (pulmonary or gastrointestinal bleeding in physical examination were more frequent in serious dengue disease (p < 0.01, but with poor accuracy (positive likelihood ratio = 1.89 and 3.89; negative likelihood ratio = 0.53 and 0.60, respectively. Serum albumin was lower in serious dengue forms (p < 0.01. Despite statistical significance (p < 0.05, both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. Conclusions: Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.

  2. Assessment of noise levels in clinical and laboratory areas of dental teaching institution, Ahmedabad

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    Sujal M Parkar


    Full Text Available Aim: To measure and assess the noise levels produced by different dental equipments. Materials and Methods: Measurement of the noise level was performed in preclinics, clinics, and dental laboratory of different departments of Ahmedabad Dental College and Hospital. The noise levels were determined using a Mini sound meter (CEM USA, which was placed at the dentist′s and laboratory technician′s ear level and at a distance of 1 m from a main noise source. The level of noise was measured in decibel (dB while the instruments were at maximum running speed. Results: In dental laboratory, the nosiest dental equipment was gypsum lathe trimmer with the noise level ranging from 87.36 to 98.3 dB. In preclinical area, the sound produced by low-speed air-rotor ranges from 66.68 to 69.28 dB. In clinical areas, the highest noise produced was by high-speed air-rotor (73.36 to 81.8 dB. The noise created by suction pump when in contact with mucosa was in range from 73.1 to 80.32 dB. The noise levels generated during cutting were significantly higher (P < 0.05 than those of noncutting, which was proved in the course of the measurements. Conclusion: At the end of the study it can be concluded that the sound levels are below that causes damage to the human ear (85 dB. However, dental technicians and other personnel working all day in noisy laboratories could be at risk of Noise-Induced Hearing Loss if they did not choose not to wear ear protection.

  3. Clinical and Laboratory Findings of Lead Hepatotoxicity in the Workers of a Car Battery Manufacturing Factory

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    Bita Dadpour


    Full Text Available Background: Occupational lead poisoning is common in workers of some industries, but lead hepatotoxicity has rarely been reported. Several animal studies have revealed lead induced liver damage but clinical studies concerning the manifestations of lead induced liver toxicity in humans are scares. This study was designed to investigate the clinical manifestations and pathological parameters of hepatic dysfunction and its relationship with blood and urine lead concentrations in a car battery-manufacturing workers. Methods: This cross sectional study was carried out in Mashhad, Iran, during April-June 2011. One hundred and twelve workers underwent blood and urine sampling for determination of lead concentrations and liver function tests. Clinical signs and symptoms of possible lead hepatotoxicity were investigated. Results: Mean (±SD age of the workers was 28.78 (±5.17 yr with a daytime work of 8.67 (±1.41 h and mean work duration of 3.89 (±2.40 yr. Mean blood lead concentration (BLC and urine lead concentration (ULC were 398.95 (±177.41 µg/l and 83.67(±50 μg/l, respectively. We found no correlation between the clinical findings and BLC or ULC. A weak correlation (R: 0.27, P=0.087 between serum alkaline phosphatase concentration and BLC was obtained. No significant relationship was found between other liver function tests and BLC or ULC. Conclusion: We found no specific clinical and laboratory abnormalities of liver in the workers of car battery manufacturer who had chronic lead toxicity. Further investigations with more specific laboratory tests such as LDH5 and gamma glutamyl transferase (GGT as well as novel biomarkers of metal induced hepatotoxicity might be helpful in evaluating lead hepatotoxicity.

  4. Evaluation of clinical and laboratory markers of cardiometabolic risk in overweight and obese children and adolescents

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    Heloísa Marcelina da Cunha Palhares

    Full Text Available OBJECTIVE: This study analyzed the frequency of cardiometabolic risk markers and metabolic syndrome occurrence in overweight and obese children and adolescents. METHODS: The participants included 161 overweight (n=65 and obese (n=96 individuals aged between 5 and 19 years. Clinical markers were assessed (body mass index, body fat percentage, waist circumference, acanthosis, systolic and diastolic blood pressures, laboratory parameters [glucose, insulin, cholesterol (total and fractions and triglyceride levels and homeostasis model assessment of insulin resistance (HOMA-IR index] and leptin and adiponectin levels. The frequency of changes, odds ratios and correlations among markers were determined. Metabolic syndrome was assessed according to International Diabetes Federation criteria. RESULTS: A high frequency of acanthosis (51.6%; increased waist circumference (45.4%, systolic blood pressure / diastolic blood pressure (8.1% / 9.3%, glucose (10%, insulin (36.9% and HOMA-IR (44.3% values; and reduced high-density lipoprotein levels (47.2% were observed. Leptin levels were increased in 95% of obese and in 66% of overweight subjects. Adiponectin was decreased in 29.5% of obese and in 34% of overweight subjects. An odd ratio analysis revealed a greater probability of increased waist circumference (9.0, systolic blood pressure (4.1, triglyceride (2.3 and insulin (2.9 levels and HOMA-IR (3.0 in the obese group than in the overweight group. The clinical and laboratory parameters and leptin levels exhibited significant correlations, whereas adiponectin was negatively correlated with systolic blood pressure. The occurrence rate of metabolic syndrome was 13.6%. CONCLUSIONS: The high frequency of changes in clinical, laboratory and adipokine markers indicates the need for early interventions aimed at preventing cardiometabolic complications in adulthood.

  5. Evaluation of clinical, laboratory, and electrophoretic profiles for diagnosis of malnutrition in hospitalized dogs

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    Andrei Kelliton Fabretti


    Full Text Available Malnutrition is a major factor associated with increased rates of mortality and readmission, longer hospital stays, and greater health care spending. Recognizing malnourished or at-risk animals allows for nutritional intervention and improved prognosis. This study evaluated the association between clinical, laboratory, and electrophoretic variables and the nutritional status (NS of hospitalized dogs in order to generate a profile of the sick dog and to facilitate the diagnosis of malnutrition. We divided 215 dogs into groups according to the severity of the underlying disease and we determined the clinical NS based on the assessment of the body condition score and the muscle mass score. The NS was classified as clinically well nourished, clinical moderate malnutrition, or clinical severe malnutrition. Statistical analyses were conducted by using the chi-square test or Fisher’s exact test; the Kruskal-Wallis test was used for continuous variables. A strong association was found between malnutrition and the severity of the underlying disease. In hospitalized dogs, low body mass index values, anemia, low hemoglobin concentrations, high fibrinogen concentrations, decreased albumin fraction, and increased gamma-globulin fraction (in electrophoresis were associated with malnutrition, reinforcing the classification of poor NS. However, the skin and coat characteristics, the total number of lymphocytes, blood glucose, cholesterol, and total protein concentration were not found to be good predictors of NS.

  6. [Ethical issues in a market dispute between clinical laboratories and a health plan: case report]. (United States)

    Pinheiro, Malone Santos; de Brito, Ana Maria Guedes; Jeraldo, Verônica de Lourdes Sierpe; Pinheiro, Kariny Souza


    In Brazil the private health plans appear as an alternative to the public health assistance. This segment suffered great intensification in the seventies and eighties, culminating in the entry of large insurance company in the scenario of supplementary medicine. Quickly, the service providers associated with these insurance companies, consolidating them in the market and triggering a relationship of dependency. This article analyzed, in the form of a case report, a marketing dispute between clinical laboratories and a health plan, emphasizing the moral and ethical aspects involved in this episode.

  7. MR enterography in children: Principles, technique, and clinical applications

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    Govind B Chavhan


    Full Text Available MR enterography is a constantly advancing technique for assessment of bowel with newer technology and sequences. It is being increasingly used for the assessment of inflammatory bowel disease and has almost replaced barium follow through examinations in many institutions. Its lack of radiation makes it an attractive alternative for bowel evaluation in children. It has been proved to be highly sensitive in the detection of Crohn disease in adults and children. It is also superior to barium studies in showing extra-enteric findings and detecting complications such as fistulas and abscesses. Even though at present it is almost exclusively used for the evaluation of inflammatory bowel disease, it has the potential to be used in other conditions affecting the bowel. The principles, MR enterography technique pertinent to children, and its utility in the assessment of Crohn disease in children are discussed in this review.

  8. Nightmares in crisis: clinical applications of lucid dreaming techniques. (United States)

    Brylowski, A


    A patient in crisis was offered treatment with a major focus on alleviating nightmares using lucid dreaming (dreaming while knowing that one is dreaming). Of sixty-eight non-psychotic patients seen consecutively in a psychiatry emergency room, she was one of 16 (23.5%) found to have a concurrent complaint of nightmares (dream anxiety disorder). The benefits of the skills developed with lucid dreaming extended into areas other than nightmares as the patient entered psychotherapy. The techniques appeared to play a role in the reduction of nightmare frequency, intensity, and distress, and to enhance ego growth and personal development. Further research in lucid dreaming as an adjunctive treatment for patients with nightmares and as a useful technique in psychotherapy is suggested.

  9. Design, data analysis and sampling techniques for clinical research


    Karthik Suresh; Sanjeev V Thomas; Geetha Suresh


    Statistical analysis is an essential technique that enables a medical research practitioner to draw meaningful inference from their data analysis. Improper application of study design and data analysis may render insufficient and improper results and conclusion. Converting a medical problem into a statistical hypothesis with appropriate methodological and logical design and then back-translating the statistical results into relevant medical knowledge is a real challenge. This article explains...

  10. Clinical Study of Acoustic Densitometry Technique in Detecting Atherosclerotic Plaque

    Institute of Scientific and Technical Information of China (English)


    Objective: To investigate the effect of Quyu Xiaoban Capsule (祛瘀消斑, QYXB) on the regressive treatment of atherosclerosis (AS) with acoustic densitometry (AD) technique. Methods: Eighty patients with AS were randomly divided into two groups, trial group was treated with QYXB and conventional medicine, and control group was treated with conventional medicine alone. Normal arterial wall and different types of atherosclerotic plaques were detected with AD technique before treatment and 10 months later. Resuits: The corrected averages in intimal echo intensity (AIIc%) were elevated in both groups but without significant difference, AIIc% of fatty plaques were increased in both groups and the value after treatment was significantly higher than that of pre-treatment in the trial group (68.12±5.54 vs 61.43±5.37, P<0.05).The increment rate of AIIc% in trial group was significantly higher than that in control group (10.9±5.1% vs2.5±5.5%, P<0.05). Conclusion: QYXB can stabilize the atherosclerotic plaque by increasing its acoustic density. Acoustic densitometry technique can differentiate the different histological plaques and monitor the histological changes of plaques during treatment.

  11. Lean Management and Six-Sigma yield big gains in hospital's immediate response laboratory. Quality improvement techniques save more than $400,000. (United States)

    Sunyog, Martha


    DSI Laboratories has used Lean and Six-Sigma methodologies to systematically eliminate waste and reduce variation in its hospital clinical laboratory. The net result was a savings of more than $400,000 in the first year. After mapping its process, the laboratory found that phlebotomists were submitting samples in large batches, which created an early-morning flood of specimens. Switching to single-piece workflow and distributing the workload more evenly allowed DSI to cover the same number of patients with two to three phlebotomists instead of 12. By establishing a more efficient workflow process within the laboratory, a single technologist could quickly move between stations and perform those tests that made up 80% of the work volume. New inventory management techniques reduced both excess inventory and the risk of shortages. Cost savings for the first year were: Reduced overtime spending by 60% ($78,000), Reassigned six phlebotomists for an annual savings of $160,000, 4.5 fewer technologist positions for a savings of $250,000.

  12. Accelerator-based techniques for the support of senior-level undergraduate physics laboratories (United States)

    Williams, J. R.; Clark, J. C.; Isaacs-Smith, T.


    Approximately three years ago, Auburn University replaced its aging Dynamitron accelerator with a new 2MV tandem machine (Pelletron) manufactured by the National Electrostatics Corporation (NEC). This new machine is maintained and operated for the University by Physics Department personnel, and the accelerator supports a wide variety of materials modification/analysis studies. Computer software is available that allows the NEC Pelletron to be operated from a remote location, and an Internet link has been established between the Accelerator Laboratory and the Upper-Level Undergraduate Teaching Laboratory in the Physics Department. Additional software supplied by Canberra Industries has also been used to create a second Internet link that allows live-time data acquisition in the Teaching Laboratory. Our senior-level undergraduates and first-year graduate students perform a number of experiments related to radiation detection and measurement as well as several standard accelerator-based experiments that have been added recently. These laboratory exercises will be described, and the procedures used to establish the Internet links between our Teaching Laboratory and the Accelerator Laboratory will be discussed.

  13. LC-MS/MS analysis of steroids in the clinical laboratory. (United States)

    Keevil, Brian G


    Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a powerful tool that is changing the way we analyse steroids in the clinical laboratory. It is already opening up the field of steroid analysis in endocrinology and is providing new applications for individual steroids and panels of steroids in different clinical conditions. LC-MS/MS is now well-accepted technology and is increasingly being used to replace problematic immunoassay methods because of greater sensitivity and specificity. Improved sample preparation, modern chromatography methods, and sensitive, faster scanning mass spectrometers have all played a role in improving LC-MS/MS. LC-MS/MS is also playing a key role in improving the quality of assays through the development of reference measurement procedures, characterisation of reference materials and multi-site calibration programmes. There is increasing interest in multiplexing steroid assays into panels of diagnostic tests to aid and improve the diagnosis and monitoring of disease.

  14. Laboratory and clinical trials of cocamide diethanolamine lotion against head lice (United States)

    Brunton, Elizabeth R.; Brown, Christine M.


    Context. During the late 1990s, insecticide resistance had rendered a number of treatment products ineffective; some companies saw this as an opportunity to develop alternative types of treatment. We investigated the possibility that a surfactant-based lotion containing 10% cocamide diethanolamine (cocamide DEA) was effective to eliminate head louse infestation. Settings and Design. Initial in vitro testing of the lotion formulation versus laboratory reared body/clothing lice, followed by two randomised, controlled, community-based, assessor blinded, clinical studies. Materials and Methods. Preliminary laboratory tests were performed by exposing lice or louse eggs to the product using a method that mimicked the intended use. Clinical Study 1: Children and adults with confirmed head louse infestation were treated by investigators using a single application of aqueous 10% cocamide DEA lotion applied for 60 min followed by shampooing or a single 1% permethrin creme rinse treatment applied to pre-washed hair for 10 min. Clinical Study 2: Compared two treatment regimens using 10% cocamide DEA lotion that was concentrated by hair drying. A single application left on for 8 h/overnight was compared with two applications 7 days apart of 2 h duration, followed by a shampoo wash. Results. The initial laboratory tests showed a pediculicidal effect for a 60 min application but limited ovicidal effect. A longer application time of 8 h or overnight was found capable of killing all eggs but this differed between batches of test material. Clinical Study 1: Both treatments performed badly with only 3/23 (13%) successful treatments using cocamide DEA and 5/25 (23.8%) using permethrin. Clinical Study 2: The single overnight application of cocamide DEA concentrated by hair drying gave 10/56 (17.9%) successes compared with 19/56 (33.9%) for the 2 h application regimen repeated after 1 week. Intention to treat analysis showed no significant difference (p = 0.0523) between the treatments

  15. Laboratory and clinical trials of cocamide diethanolamine lotion against head lice

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    Ian F. Burgess


    Full Text Available Context. During the late 1990s, insecticide resistance had rendered a number of treatment products ineffective; some companies saw this as an opportunity to develop alternative types of treatment. We investigated the possibility that a surfactant-based lotion containing 10% cocamide diethanolamine (cocamide DEA was effective to eliminate head louse infestation.Settings and Design. Initial in vitro testing of the lotion formulation versus laboratory reared body/clothing lice, followed by two randomised, controlled, community-based, assessor blinded, clinical studies.Materials and Methods. Preliminary laboratory tests were performed by exposing lice or louse eggs to the product using a method that mimicked the intended use. Clinical Study 1: Children and adults with confirmed head louse infestation were treated by investigators using a single application of aqueous 10% cocamide DEA lotion applied for 60 min followed by shampooing or a single 1% permethrin creme rinse treatment applied to pre-washed hair for 10 min. Clinical Study 2: Compared two treatment regimens using 10% cocamide DEA lotion that was concentrated by hair drying. A single application left on for 8 h/overnight was compared with two applications 7 days apart of 2 h duration, followed by a shampoo wash.Results. The initial laboratory tests showed a pediculicidal effect for a 60 min application but limited ovicidal effect. A longer application time of 8 h or overnight was found capable of killing all eggs but this differed between batches of test material. Clinical Study 1: Both treatments performed badly with only 3/23 (13% successful treatments using cocamide DEA and 5/25 (23.8% using permethrin. Clinical Study 2: The single overnight application of cocamide DEA concentrated by hair drying gave 10/56 (17.9% successes compared with 19/56 (33.9% for the 2 h application regimen repeated after 1 week. Intention to treat analysis showed no significant difference (p = 0.0523 between the

  16. Clinical and laboratory characteristics of adolescents with platelet function disorders and heavy menstrual bleeding

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    Amesse Lawrence S


    Full Text Available Abstract Background Platelet function disorders (PFDs have emerged as an important etiology of heavy menstrual bleeding (HMB in adolescents. However, neither clinical nor laboratory data have been methodically analyzed in this population subset. The objective of this study was to evaluate these parameters in order to distinguish characteristics of the disorder that in turn will lead to earlier diagnosis and therapy initiation. Methods Retrospective review of medical records from postmenarcheal adolescents with documented PFDs referred to a hemophilia treatment center and university faculty practices for bleeding diatheses with their clinical and laboratory data evaluated. Results Of 63 teens with documented PFDs, HMB was the most common clinical manifestation of PFD (43; 68.3%. Of these, 37 (86% were diagnosed with PFD either at or after menarche with the diagnosis based on HMB symptoms alone. Only 6 (14% were diagnosed with a PFD prior to menarche, based on associated bleeding, i.e., epistaxis, ecchymosis, and all developed HMB after menstruation onset. Interestingly, 20 girls were diagnosed with a PFD prior to menarche and of these, only 6 (30% went on to develop HMB after pubertal transition, while the majority (14; 70% did not. The average age-at-PFD diagnosis was 14.5yrs, significantly differing from the 10.9yrs average age-at-PFD diagnosis in their counterparts that, after menarche, did not develop HMB (PP P Conclusions Adolescents with PFDs and HMB appear to be clinically distinct from their non-HMB counterparts. This group of girls is characterized by HMB the major bleeding symptom, significantly high incidences of blood group O and the δ-SPD with a PFD diagnosed well after menarche. High false negative standard platelet function study results indicate additional diagnostic strategies, particularly for δ-SPD, should be considered.

  17. Design, data analysis and sampling techniques for clinical research. (United States)

    Suresh, Karthik; Thomas, Sanjeev V; Suresh, Geetha


    Statistical analysis is an essential technique that enables a medical research practitioner to draw meaningful inference from their data analysis. Improper application of study design and data analysis may render insufficient and improper results and conclusion. Converting a medical problem into a statistical hypothesis with appropriate methodological and logical design and then back-translating the statistical results into relevant medical knowledge is a real challenge. This article explains various sampling methods that can be appropriately used in medical research with different scenarios and challenges.

  18. [Role and future aspects of hospital clinical laboratories in medical team approaches]. (United States)

    Suwabe, Akira


    The recent progress in medicine increases the routine works of the physicians or nurses and decreases the chances to obtain the new information on the laboratory medicine. Although the patients desire to know their test results in detail, it is likely to be difficult to obtain them from the physician in charge. Thereby, the quality of the medical services may be deteriorated. In these situations, needs of the medical team approaches in which the medical technologists (MTs) in the hospital laboratories participate are increasing. In Japan, there are a variety of medical team approaches in which MTs are involved. In our university hospital, MTs play important roles in the infection control team (ICT), in the nutrition support team (NST), in the educational class for the patients with diabetes mellitus, in the clinical research center, in the order-made medicine realizing project, in the infertility center and in the laboratory information room. In April 2010, the new payment system for the team approaches such as ICT or NST was established. In the future, the team approaches other than ICT or NST could be chosen for the subjects for the payment if they are recognized as important. The goal of the team approaches is to realize a patient-oriented medicine. MTs can reconfirm that they are working as one of the medical staffs through these team approaches. It is important to always find out a possibility of new team approaches.

  19. Accreditation of medical laboratories in Croatia--experiences of the Institute of Clinical Chemistry, University Hospital "Merkur", Zagreb. (United States)

    Flegar-Mestrić, Zlata; Nazor, Aida; Perkov, Sonja; Surina, Branka; Kardum-Paro, Mirjana Mariana; Siftar, Zoran; Sikirica, Mirjana; Sokolić, Ivica; Ozvald, Ivan; Vidas, Zeljko


    Since 2003 when the international norm for implementation of quality management in medical laboratories (EN ISO 15189, Medical laboratories--Particular requirements for quality and competence) was established and accepted, accreditation has become practical, generally accepted method of quality management and confirmation of technical competence of medical laboratories in the whole world. This norm has been translated into Croatian and accepted by the Croatian Institute for Norms as Croatian norm. Accreditation is carried out on voluntary basis by the Croatian Accreditation Agency that has up to now accredited two clinical medical biochemical laboratories in the Republic of Croatia. Advantages of accredited laboratory lie in its documented management system, constant improvement and training, reliability of test results, establishing users' trust in laboratory services, test results comparability and interlaboratory (international) test results acceptance by adopting the concept of metrological traceability in laboratory medicine.

  20. Epidemiological, clinical and laboratory findings of infectious keratitis at Mansoura Ophthalmic Center, Egypt (United States)

    Badawi, Amani E; Moemen, Dalia; El-Tantawy, Nora L


    AIM To analyze the epidemiological, clinical and laboratory findings of infectious keratitis. METHODS A retrospective study on cases of infective keratitis, attended our institution from Mar. 2013 to Feb. 2015, was done at Mansoura Ophthalmic Center, Egypt. Corneal scrapings were performed and processed for direct microscopy and culture in appropriate media using standard laboratory protocols. RESULTS Out of 245 patients enrolled for study, 247 corneal scrapings were obtained. Ocular trauma was the most common predisposing factor (51.4%), followed by diabetes mellitus (15.1%). Cultures were positive in 110 scraping samples (44.5%): 45.5% samples had pure fungal infection, 40% had pure bacterial infections and 10% had mixed fungal and bacterial growths. Acanthamoeba was detected in 5 (4.5%) samples. The most common fungal pathogen was Aspergillus spp. (41%). The most common bacterial isolates were Staphylococcus aureus (38.2%) and Pseudomonas aeruginosa (21.8%). CONCLUSION Incidence of fungal keratitis is high in our region. Therapeutic approach can initially be based on clinical features and sensitivity/resistance patterns. Microbiological research should direct the antimicrobial treatment. Antibiotic resistance to fluoroquinolones and aminoglycosides is an important consideration. PMID:28149778

  1. Performance of the tutorial function in the Professor of Hematology, specialty: Clinical Laboratory.

    Directory of Open Access Journals (Sweden)

    Oriol Meneses Echemendia


    Full Text Available In the context of the battle of ideas, arises the career, degree in health technology, imposing new challenges to the medical university context, inserting new actors to the teaching - learning process and with them the professor-tutor's figure. For that reason , an evaluative project was developed in the hematology profile in the specialty of clinical laboratory, with the purpose of elaborating a strategy for the improvement of the teaching tutorial, on the base of systematic-structural-functional model; giving answer to the main detected problems. To carry out the study was used a qualitative focus, selecting the integrated paradigm. It was done an investigation action in the seven municipal university headquarters of the county where the process of teaching-learning of the new pedagogic model is developed in the profile. once selecting the scale of priority of the detected difficulties using the interaction and the interdependence among investigator and investigated, the "methodological strategy for the improvement of the teaching tutorial in hematology of clinical laboratory" was designed to propose three strategic actions, valued positively by the expert ones who endorsed the feasibility and effectiveness of their setting in practice to contribute to the improvement of the teaching tutorial in the formation of health technologies.

  2. Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments. (United States)

    Resnick, L; Veren, K; Salahuddin, S Z; Tondreau, S; Markham, P D


    The stability of human T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) under environmental conditions encountered in a clinical or laboratory setting and its inactivation by commonly used chemical disinfectants were investigated. Under our experimental conditions utilizing a highly concentrated viral preparation, virus with an initial infectious titer of approximately 7 log10 tissue culture infectious dose (TCID50) per milliliter can be recovered for more than a week from an aqueous environment held at room temperature (23 to 27 degrees C) or at 36 to 37 degrees C. Virus recovery is reduced at a rate of approximately 1 log10TCID50 per 20 minutes when held at 54 to 56 degrees C. Dried and held at room temperature, HTLV-III/LAV retains infectivity for more than three days with a reduction of approximately 1 log10TCID50 per nine hours. Viral infectivity is undetectable and reduced more than 7 log10TCID50 within one minute with 0.5% sodium hypochlorite, 70% alcohol, or 0.5% nonidet-P40, and within ten minutes with 0.08% quaternary ammonium chloride or with a 1:1 mixture of acetone-alcohol. These results help provide a rational basis to prevent the accidental spread of HTLV-III/LAV in the laboratory or clinical setting.

  3. Molecular-based mycobacterial identification in a clinical laboratory setting: a comparison of two methods.

    LENUS (Irish Health Repository)

    O'Donnell, N


    Many mycobacterial species are pathogenic to humans, with infection occurring worldwide. Infection with Mycobacterium tuberculosis is a well-described global phenomenon, but other mycobacterial species are increasingly shown to be the cause of both pulmonary and extrapulmonary infection and are managed differently from M. tuberculosis infection. Rapid and accurate differentiation of mycobacterial species is, therefore, critical to guide timely and appropriate therapeutic and public health management. This study evaluates two commercially available DNA strip assays, the Genotype Common Mycobacteria (CM) assay (Hain Lifescience, Nehren, Germany) and the Speed-oligo Mycobacteria assay (Vircell, Spain) for their usefulness in a clinical laboratory setting. Both assays were evaluated on 71 clinical mycobacterial isolates, previously identified using Gen-Probe AccuProbe and through a UK mycobacteriology reference laboratory, as well as 29 non-mycobacterial isolates. Concordant results were obtained for 98% of isolates using both assays. The sensitivity was 97% (95% confidence interval [CI]: 93.3-100%) for the CM assay and 98.6% (95% CI: 95.9-100%) for the Speed-oligo assay. Overall, both assays proved to be useful tools for rapid and sensitive mycobacterial species identification, although interpretation of results was easier with the CM assay. Finally, results were available within one day, compared to current identification times which range between seven days and four weeks.

  4. miRNA assays in the clinical laboratory: workflow, detection technologies and automation aspects. (United States)

    Kappel, Andreas; Keller, Andreas


    microRNAs (miRNAs) are short non-coding RNA molecules that regulate gene expression in eukaryotes. Their differential abundance is indicative or even causative for a variety of pathological processes including cancer or cardiovascular disorders. Due to their important biological function, miRNAs represent a promising class of novel biomarkers that may be used to diagnose life-threatening diseases, and to monitor disease progression. Further, they may guide treatment selection or dosage of drugs. miRNAs from blood or derived fractions are particularly interesting candidates for routine laboratory applications, as they can be measured in most clinical laboratories already today. This assures a good accessibility of respective tests. Albeit their great potential, miRNA-based diagnostic tests have not made their way yet into the clinical routine, and hence no standardized workflows have been established to measure miRNAs for patients' benefit. In this review we summarize the detection technologies and workflow options that exist to measure miRNAs, and we describe the advantages and disadvantages of each of these options. Moreover, we also provide a perspective on data analysis aspects that are vital for translation of raw data into actionable diagnostic test results.

  5. Clinical and laboratory description of a series of cases of acute viral myositis

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    Silvana Paula Cardin


    Full Text Available ABSTRACT OBJECTIVE: Describe the clinical and laboratory profile, follow-up, and outcome of a series of cases of acute viral myositis. METHOD: A retrospective analysis of suspected cases under observation in the emergency department was performed, including outpatient follow-up with the recording of respiratory infection and musculoskeletal symptoms, measurement of muscle enzymes, creatine phosphokinase (CPK, lactate dehydrogenase (LDH, transaminases (AST and ALT, blood count, C-reactive protein, and erythrocyte sedimentation rate in the acute phase and during follow-up until normalization. RESULTS: Between 2000 and 2009, 42 suspected cases were identified and 35 (27 boys were included. The median age was 7 years and the diagnosis was reported in 89% in the first emergency visit. The observed respiratory symptoms were cough (31%, rhinorrhea (23%, and fever (63%, with a mean duration of 4.3 days. Musculoskeletal symptoms were localized pain in the calves (80%, limited ambulation (57%, gait abnormality (40%, and muscle weakness in the lower limbs (71%, with a mean duration of 3.6 days. There was significant increase in CPK enzymes (5507 ± 9180 U/L, LDH (827 ± 598 U/L, and AST (199 ± 245 U/L, with a tendency to leukopenia (4590 ± 1420 leukocytes/mm3. The complete recovery of laboratory parameters was observed in 30 days (median, and laboratory and clinical recurrence was documented in one case after 10 months. CONCLUSION: Typical symptoms with increased muscle enzymes after diagnosis of influenza and self-limited course of the disease were the clues to the diagnosis. The increase in muscle enzymes indicate transient myotropic activity related to seasonal influenza, which should be considered, regardless of the viral identification, possibly associated with influenza virus or other respiratory viruses.

  6. Clinical and molecular cytogenetics and gene mapping: principles and techniques. (United States)

    Francke, U


    This article reviews the history of human cytogenetics with respect to technical advances from chromosome banding to molecular cytogenetics. Technologies such as in situ hybridization, chromosome painting, comparative genomic hybridization and interphase cytogenetics and their applications are discussed. The assignments of genes to chromosome regions by somatic cell genetics is illustrated by molecular analyses of somatic cell hybrid panels. The generation of complete physical maps of human chromosomes, by radiation hybrid mapping of sequence-tagged sites and establishment of chromosome-specific yeast artificial chromosome (YAC) banks and clone overlaps (contigs), is exemplified by studies of chromosome 18. The last section outlines the recent and future advances in clinical cytogenetics made possible by progress in molecular genetics.

  7. The Needling Technique and Clinical Application of Point Zhibian

    Institute of Scientific and Technical Information of China (English)



    @@ The Needling Technique The patient is asked to lie in a lateral or prone position. A No. 28 filiform needle of 3 cun is inserted perpendicularly into the point Zhibian (BL 54), with the direction of the needle tip varying according to the different conditions of the diseases. The needle can be directed in three directions, the first along the sciatic nerve; the second pointing to the genitals; and the third pointing to the anus. The reinforcing,reducing, or even needling manipulation can be used,and the needling depth can be deep or superficial.The needling can also be applied in combination with the warm-needle, cupping, and point-injection.


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    A.D. Sialakouma


    Full Text Available Biomedical science is a sensitive discipline and presents unique challenges due to its social character, continuous development and competitiveness. The issue of quality management systems and accreditation is gaining increasing interest in this sector. All over Europe, Health Services Units have started to introduce quality management systems and harmonization of criteria for accreditation is of increasing importance. Moreover, clinical laboratories, like the Assisted Reproduction laboratories and biochemical laboratories are required to apply a Quality Management System in order to ensure their correct, scientific and effective operation. Ultimately, it is a moral obligation for every health care organisation to supply the best possible care for the patient. The specific features and the diversity of clinical laboratories led to the introduction (2003 and, recently to the revision (2007 of the international standard ISO 15189, which is the first international standard developed specifically to address the requirements for accreditation of this type of laboratory. The basic principles for the quality assurance in the clinical laboratories are: x Complete and unambiguous standardized operating procedures. x Complete and unambiguous directives of operation. x Obligatory detailed written documentation, i.e., how each action is done, who will do it, where will this action take place and when. x Suitable scheduling of calibration/control/preventive maintenance of laboratory equipment and recording of each activity. x Distribution of responsibilities among the staff and continuous education and briefing according to current scientific data. x Complete and informed record file keeping. x Continuous improvement which is monitored with the adoption of quantified indicators. x Internal and external audit of all activities. x Troubleshooting. All these principles should be supported by the Management in order that the necessary adaptations should be made

  9. Low-level counting techniques in the underground laboratory `Felsenkeller` in Dresden

    Energy Technology Data Exchange (ETDEWEB)

    Niese, S. [Nuclear Engineering and Analytics Rossendorf, Inc., Dresden (Germany); Koehler, M. [Nuclear Engineering and Analytics Rossendorf, Inc., Dresden (Germany)


    Low radioactivity measurements are characterized by low detection limits. They are mainly determined by the background. The contribution of cosmic rays may be reduced drastically by installation of measurement devices in an underground laboratory. In 1982 we installed a chamber with a shield of ultramafic rock for low-level measurements within a cave of an old brewery named `Felsenkeller`. In this laboratory we used low-level {gamma}-spectrometry for the measurement of neutron activated samples of semiconductor silicon (Niese (1986)), of cosmic induced radioactivity in meteorites, chemically separated long-lived nuclides in low-level wastes, contaminated materials and of environmental samples. (orig./DG)

  10. Application of a mechanobiological simulation technique to stents used clinically. (United States)

    Boyle, Colin J; Lennon, Alex B; Prendergast, Patrick J


    Many cardiovascular diseases are characterised by the restriction of blood flow through arteries. Stents can be expanded within arteries to remove such restrictions; however, tissue in-growth into the stent can lead to restenosis. In order to predict the long-term efficacy of stenting, a mechanobiological model of the arterial tissue reaction to stress is required. In this study, a computational model of arterial tissue response to stenting is applied to three clinically relevant stent designs. We ask the question whether such a mechanobiological model can differentiate between stents used clinically, and we compare these predictions to a purely mechanical analysis. In doing so, we are testing the hypothesis that a mechanobiological model of arterial tissue response to injury could predict the long-term outcomes of stent design. Finite element analysis of the expansion of three different stent types was performed in an idealised, 3D artery. Injury was calculated in the arterial tissue using a remaining-life damage mechanics approach. The inflammatory response to this initial injury was modelled using equations governing variables which represented tissue-degrading species and growth factors. Three levels of inflammation response were modelled to account for inter-patient variability. A lattice-based model of smooth muscle cell behaviour was implemented, treating cells as discrete agents governed by local rules. The simulations predicted differences between stent designs similar to those found in vivo. It showed that the volume of neointima produced could be quantified, providing a quantitative comparison of stents. In contrast, the differences between stents based on stress alone were highly dependent on the choice of comparison criteria. These results show that the choice of stress criteria for stent comparisons is critical. This study shows that mechanobiological modelling may provide a valuable tool in stent design, allowing predictions of their long

  11. Vestibular migraine in children and adolescents: clinical findings and laboratory tests

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    Thyra eLanghagen


    Full Text Available Introduction: Vestibular migraine (VM is the most common cause of episodic vertigo in children. We summarize the clinical findings and of laboratory test results in a cohort of children and adolescents with VM. We discuss the limitations of current classification criteria for dizzy children. Methods: A retrospective chart analysis was performed on 118 children with suspected VM at a tertiary care center. Patients with complaints related to migraine and who presented with vertigo/dizziness were grouped in the following categories: (1 definite vestibular migraine (dVM; (2 probable vestibular migraine (pVM; (3 suspected vestibular migraine (sVM; (4 benign paroxysmal vertigo (BPV; and (5 migraine with/without aura (oM according to the International Classification of Headache Disorders, 3rd edition (beta version. Results: The mean age of all patients was 12±3 years (range 3-18 years, 70 females. 36 patients (30% fulfilled criteria for dVM, 33 (28% for pVM, 34 (29% for sVM, 7 (6% for BPV, and 8 (7% for oM. Somatoform vertigo co-occurred in 27% patients. Episodic syndromes were reported in 8%; the family history of migraine was positive in 65%. Mild central ocular motor signs were found in 24% (most frequently horizontal saccadic pursuit. Laboratory tests showed that about 20% had pathological function of the horizontal vestibulo-ocular reflex, and almost 50% had abnormal postural sway patterns. Conclusion: Patients with definite, probable, and suspected VM do not differ in the frequency of ocular motor, vestibular, or postural abnormalities. VM is the best explanation for their symptoms. It is essential to establish diagnostic criteria in clinical studies. In clinical practice, however, the most reasonable diagnosis should be made in order to begin treatment. Such a procedure also minimizes the fear of the parents and children, reduces the need to interrupt leisure time and school activities, and prevents the development of somatoform vertigo.

  12. Demographic, clinical, and laboratory features of Turkish patients with late onset ankylosing spondylitis

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    Ahmet Karaarslan


    Full Text Available Ankylosing spondylitis (AS is a chronic inflammatory disease, which typically begins in early decades of life with primarily axial joints involvement. This disease rarely affects patients older than 50 years of age. The aim of this study was to compare and evaluate the demographic, clinical, and laboratory features of late onset and early onset AS patients who were followed up in a single rheumatology center. A total of 339 patients who have been diagnosed with AS according to modified New York criteria were included in the study. The patients whose initial symptoms were observed after 50 years of age were accepted as late onset AS. Out of 339 patients, 27 (7.9% were diagnosed as late onset AS and 312 (92.3% patients were evaluated as early onset AS. Of 27 late onset patients, 10 were male and 17 were female. Delay in the diagnosis was 5.8 years for early onset AS, while it was 3.8 years for late onset AS (p = 0.001. Higher levels of acute phase reactants and more methotrexate (MTX use were detected in early onset AS patients compared to late onset AS (p = 0.001, p = 0.007, respectively. Statistically, there was no difference between these two groups, with regard to disease clinical activity indexes, anthropometric measurement parameters, uveitis and peripheral joint involvement. In this study, we showed that early and late onset AS patients may present with different clinical, genetic, and laboratory features. Late onset AS patients are characterized with lower human leukocyte antigen-B27 sequence, less inflammatory sign, delayed diagnosis, and less MTX and anti-tumor necrosis factor alpha drug usage.

  13. Diagnostic clinical and laboratory findings in response to predetermining bacterial pathogen: data from the Meningitis Registry.

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    Maria Karanika

    Full Text Available BACKGROUND: Childhood meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis. METHODOLOGY AND PRINCIPAL FINDINGS: During the 32 year period, 2477 cases of probable bacterial meningitis (BM were collected from the Meningitis Registry (MR. Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta and SPSS (version 15.0-Chicago software. Statistically significant (p or = 15000/microL (OR 2.19 with a PPV of 77.8% (95%CI 40.0-97.2. For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61, age > or = 1 year (OR 2.04, absence of headache (OR 3.01, CSF Glu < 40 mg/dL (OR 3.62 and peripheral WBC < 15,000/microL (OR 1.74 with a PPV of 58.5% (95%CI 42.1-73.7. CONCLUSIONS: The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied.

  14. Clinical and laboratory characteristics of acute community-acquired urinary tract infections in adult hospitalised patients. (United States)

    Piljic, Dilista; Piljic, Dragan; Ahmetagic, Sead; Ljuca, Farid; Porobic Jahic, Humera


    Urinary tract infections (UTI) cause a great number of morbidity and mortality. These infections are serious complications in pregnancy, patients with diabetes, polycystic kidneys disease, sickle cell anaemia, kidney transplant and in patients with functional or structural anomalies of the urinary tract. The aim of this investigation was to determine a dominant causative agents of UTI and some of the clinical and laboratory characteristics of acute community-acquired UTI in adult hospitalised patients. We studied 200 adult patients with acute community-acquired UTI hospitalised in the Clinic for Infectious Diseases Tuzla from January 2006 to December 2007. The patients were divided into two groups: a group of patients with E. coli UTI (147) and a group of patients with non-E. coli UTI (53). In these two groups, the symptoms and signs of illness, blood test and urine analysis results were analysed. Our results have shown that the patients with E. coli UTI frequently had fever higher than 38,5 degrees C (p<0,0001), chills (p=0,0349), headache (p=0,0499), cloudy urine (p<0,0001), proteinuria (p=0,0011) and positive nitrite-test (p=0,0002). The patients with non-E. coli UTI frequently had fever lower than 38,5 degrees C (p<0,0001) and urine specific gravity <1015 (p=0,0012). There was no significant difference in blood test results between patients with E. coli and non-E. coli UTI. These clinical and laboratory findings can lead us to early etiological diagnosis of these UTI before urine culture detection of causative agents, which takes several days. Early etiological diagnosis of the E. coli and non-E. coli UTI is necessary for an urgent administration of appropriate empirical antibiotic treatment. This is very important in prevention of irreversible kidney damage, prolonged treatment, complications, as well as recidives and chronicity of the illness.

  15. Demographic, clinical, and laboratory features of Turkish patients with late onset ankylosing spondylitis. (United States)

    Karaarslan, Ahmet; Yilmaz, Hatice; Aycan, Hakan; Orman, Mehmet; Kobak, Senol


    Ankylosing spondylitis (AS) is a chronic inflammatory disease, which typically begins in early decades of life with primarily axial joints involvement. This disease rarely affects patients older than 50 years of age. The aim of this study was to compare and evaluate the demographic, clinical, and laboratory features of late onset and early onset AS patients who were followed up in a single rheumatology center. A total of 339 patients who have been diagnosed with AS according to modified New York criteria were included in the study. The patients whose initial symptoms were observed after 50 years of age were accepted as late onset AS. Out of 339 patients, 27 (7.9%) were diagnosed as late onset AS and 312 (92.3%) patients were evaluated as early onset AS. Of 27 late onset patients, 10 were male and 17 were female. Delay in the diagnosis was 5.8 years for early onset AS, while it was 3.8 years for late onset AS (p = 0.001). Higher levels of acute phase reactants and more methotrexate (MTX) use were detected in early onset AS patients compared to late onset AS (p = 0.001, p = 0.007, respectively). Statistically, there was no difference between these two groups, with regard to disease clinical activity indexes, anthropometric measurement parameters, uveitis and peripheral joint involvement. In this study, we showed that early and late onset AS patients may present with different clinical, genetic, and laboratory features. Late onset AS patients are characterized with lower human leukocyte antigen-B27 sequence, less inflammatory sign, delayed diagnosis, and less MTX and anti-tumor necrosis factor alpha drug usage.

  16. A Framework for Laboratory Pre-Work Based on the Concepts, Tools and Techniques Questioning Method (United States)

    Huntula, J.; Sharma, M. D.; Johnston, I.; Chitaree, R.


    Learning in the laboratory is different from learning in other contexts because students have to engage with various aspects of the practice of science. They have to use many skills and knowledge in parallel--not only to understand the concepts of physics but also to use the tools and analyse the data. The question arises, how to best guide…

  17. Teaching Protein Purification and Characterization Techniques: A Student-Initiated, Project-Oriented Biochemistry Laboratory Course (United States)

    MacDonald, Gina


    This report describes a biochemistry laboratory that is completely project-oriented. Upper-level biology and chemistry majors work in teams to purify a protein of their choice. After the student groups have completed literature searches, ordered reagents, and made buffers they continue to learn basic protein purification and biochemical techniques…

  18. Stem cell clonality -- theoretical concepts, experimental techniques, and clinical challenges. (United States)

    Glauche, Ingmar; Bystrykh, Leonid; Eaves, Connie; Roeder, Ingo


    Here we report highlights of discussions and results presented at an International Workshop on Concepts and Models of Stem Cell Organization held on July 16th and 17th, 2012 in Dresden, Germany. The goal of the workshop was to undertake a systematic survey of state-of-the-art methods and results of clonality studies of tissue regeneration and maintenance with a particular emphasis on the hematopoietic system. The meeting was the 6th in a series of similar conceptual workshops, termed StemCellMathLab,(2) all of which have had the general objective of using an interdisciplinary approach to discuss specific aspects of stem cell biology. The StemCellMathLab 2012, which was jointly organized by the Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, Dresden University of Technology and the Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, brought together 32 scientists from 8 countries, with scientific backgrounds in medicine, cell biology, virology, physics, computer sciences, bioinformatics and mathematics. The workshop focused on the following questions: (1) How heterogeneous are stem cells and their progeny? and (2) What are the characteristic differences in the clonal dynamics between physiological and pathophysiological situations? In discussing these questions, particular emphasis was placed on (a) the methods for quantifying clones and their dynamics in experimental and clinical settings and (b) general concepts and models for their description. In this workshop summary we start with an introduction to the current state of clonality research and a proposal for clearly defined terminology. Major topics of discussion include clonal heterogeneity in unperturbed tissues, clonal dynamics due to physiological and pathophysiological pressures and conceptual and technical issues of clone quantification. We conclude that an interactive cross-disciplinary approach to research in this

  19. Clinical-Laboratory Parallels in Patients with Demodectic Blepharitis at Cosmecevtic’s Use

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    I. B. Medvedev


    Full Text Available Purpose. To study the influence of the new cosmecevtic — cream «Demazol» on the dynamics of clinical and laboratory parameters (akarogramms with Demodex blepharitis.Patients and methods. There were 56 patients with Demodex blepharitis with symptoms of blepharitis or blepharoconjunctivitis in the study. In all cases, the clinical diagnoses were confirmed by laboratory investigations of epilated lashes. The akarogramms indicated the number of adult mite larvae and eggs of parasites separately for each eye. The cream was applied topically on the eyelids 2 times a day following our instructions, and before this, we provided pretreatment alcohol eucalyptus or sage tincture. The course of treatment was 1.5 months. Alongside this, we conducted drug correction of the status of the tear film via artificial tears eyedrops and therapy of blepharitis or blepharoconjunctivitis withantibiotics, steroids or non-steroidal anti-inflammatory drugs. A controlled laboratory testing for the presence of the mite Demodex folliculorum was undertaken after the course of treatment with cream. Evaluation of the efficacy of the cream was undertaken in accordance with the age of patients (up to 70 groups of patients 70 years and older, and the amount of mites.Results. The cosmetic cream «Demazol» had eliminated all forms of the mite Demodex — adults, larvae and eggs of parasites after 45 days of application. The number of mites after the course was significantly reduced: 5.7 times (by the number of adults; 3.7 times (the number of larvae and 12 times (the number of parasite eggs. Reduction the number of ticks was noted in general by 95% of patients; full or substantial reduction by 62.5%, proving the specific efficacy of «Demazol.» The clinical effect of varying degrees (excluding akarogramm was noted in 49 of 56 patients (87.5%. The percentage of patients with a moderate pronounced effect from the cream was 78.6%. The combination of a pronounced


    Directory of Open Access Journals (Sweden)

    S Afsharpaiman


    Full Text Available "nBrucellosis is not uncommon in children in endemic areas. We described clinical and laboratory features and therapeutic regimens for brucellosis in children under 14 who admitted in the Pediatric Medical Center Hospital, Tehran, Iran from March 1988 until February 2001. The male: female ratio was 2:1. Family history of brucellosis and consumption of un-pasteurized milk and dairy products was positive in 20.4% and 65.9%, respectively. The common clinical findings were arthritis (79.5%, fever (77.4%, anorexia (61.4%, sweating (52.3%, splenomegaly (43.2%, hepatomegaly (34.1% and lymphadenopathy (13.65. Anemia, leukopenia and thrombocytopenia were recorded in 56.8%, 31.8% and 9.1%, respectively. Out of all patients, seropositivity rate for brucellosis was found in 97.7% using serum agglutination test. Culture of blood and bone marrow specimen were positive in 30% and 50% of samples obtained, respectively. Rifampin and co-trimoxazole were the most commonly used combination in 68.1%. The overall relapse rate was 13.6%. Arthritis and fever were the most common clinical findings of brucellosis. Wright test is a very sensitive method to detect brucella infection. Public education and control measures should be applied to prevent the zoonotic and human brucellosis. 

  1. Porphyria cutanea tarda. Clinical features and laboratory findings in 40 patients. (United States)

    Grossman, M E; Bickers, D R; Poh-Fitzpatrick, M B; Deleo, V A; Harber, L C


    Porphyria cutanea tarda is the most common disorder of porphyrin metabolism in the United States and Europe. This report presents the clinical, laboratory and pathologic features of 40 patients with porphyria cutanea tarda. Each patient was followed up for variable times during 1960-76 at the Clinical Research Center and the Dermatology Service of the Columbia-Presbyterian Medical Center; at the New York University Medical Center; or at the Rockefeller University Hospital. Earlier age at onset; diminution of alcohol ingestion as the major etiologic factor; and, an increased incidence in females indicate new environmental influences. The most frequently associated etiologic factor, aside from alcohol intake, was use of estrogens for contraception; postmenopausal syndrome; or treatment of prostatic carcinoma. Cutaneous findings in the patients included bullae (85%); increased skin fragility (75%); facial hypertrichosis (63%); hyperpigmentation (55%); sclerodermoid changes (18%); and, dystrophic calcification with ulceration (8%). Diabetes mellitus was found in 15%; systemic lupus erythematosus in 5%; elevated serum iron level in 62%; and, abnormal liver function test results in 60%. Histologic abnormalities were seen in liver biopsies of 34 patients. Phlebotomy is the treatment of choice. In 32 patients so treated, clinical remissions averaged 30.9 months. 31% (10 patients) had a relapse but additional phlebotomies resulted in 2nd remissions. Chloroquine and plasmaphoresis treatments were also briefly discussed.

  2. [Specific clinical, epidemiological patterns and laboratory diagnostics of enterovirus infection in the Republic of Belarus]. (United States)

    Amvros'eva, T V; Poklonskaia, N V; Bogush, Z F; Kazinets, O N; Germanovich, F A; Fisenko, E G; Titov, L P; Kvacheva, Z B; Bezruchko, A A; Scheslenok, E P


    The clinical and epidemiological patterns as well as the results of the laboratory verification of the outbreak of enterovirus infection (EVI) in Minsk during the period of summer-autumn, 2000, are presented. During this outbreak a variety of clinical forms were observed, the serous meningitis being prevalent (57.5%). Practically simultaneous occurrence of infection on the territory of all administrative districts of the city, the predominant involvement of children aged up to 14 years into the outbreak, a high proportion of simultaneous casualities in the multiple foci. A number of circulating enteroviruses (EV)--ECHO 30, ECHO 6 of three serotypes and Coxsackie B5--were simultaneously isolated from clinical material. EV of the same serotypes were isolated from tap drinking water, and neutralizing antibodies to these serotypes were often detected in the patients blood sera. Infectious EV were also present in samples of bottled water and in water reservoirs used for bathing. The routes of EV transmission and the improvement of EVI control are discussed.

  3. Demographic, clinical, laboratory and treatment characteristics of spondyloarthritis patients with and without acute anterior uveitis

    Directory of Open Access Journals (Sweden)

    Marcelo Gehlen

    Full Text Available CONTEXT AND OBJECTIVE: Acute anterior uveitis is a common extra-articular manifestation in spondyloarthritis patients. The aim of this study was to compare demographic, clinical, laboratory and treatment data among spondyloarthritis patients with and without acute anterior uveitis. DESIGN AND SETTING: This was a cross-sectional analytical study at the Rheumatology Outpatient Clinic of the Evangelical University Hospital, Curitiba, Brazil. METHODS: Spondyloarthritis patients with without acute anterior uveitis were compared regarding demographic data, spondyloarthritis subtype, peripheral arthritis, enthesitis, disease activity, functional index, physical examination, radiological involvement, HLA-B27 and treatment. RESULTS: Presence of acute anterior uveitis was not found to have any relationship with functional index, degree of radiological involvement, peripheral arthritis or enthesitis. Acute anterior uveitis showed a negative association with skin manifestations (P = 0.04 and a trend towards higher disease activity (P = 0.06. CONCLUSION: In the study sample, it could not be shown that AAU had any association with the functional and radiological prognoses. The patients with spondyloarthritis with and without acute anterior uveitis did not differ clinically except for a higher proportion of ankylosing spondylitis and smaller presence of skin involvement in those with uveitis.

  4. A laboratory demonstration of an LQG technique for correcting frozen flow turbulence in adaptive optics systems

    CERN Document Server

    Rudy, Alexander; Srinath, Srikar; Ammons, S Mark; Gavel, Donald


    We present the laboratory verification of a method for re- moving the effects of frozen-flow atmospheric turbulence using a Linear Quadratic Gaussian (LQG) controller, also known as a Kalman Filter. This method, which we term "Predictive Fourier Control," can identify correlated atmospheric motions due to layers of frozen flow turbulence, and can predictively remove the effects of these correlated motions in real-time. Our laboratory verification suggests a factor of 3 improvement in the RMS residual wavefront error and a 10% improvement in measured Strehl of the system. We found that the RMS residual wavefront error was suppressed from 35.0 nm to 11.2 nm due to the use of Predictive Fourier Control, and that the far field Strehl improved from 0.479 to 0.520.


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    D. G. Rekalov


    Full Text Available Rheumatoid arthritis (RA leads not only to a rapid development of disability, but can influence the life of these patients. One-third of patients with rheumatoid arthritis may have signs of disability during the first 3 years of the onset of the disease, while mortality in patients with RA almost two times higher in comparison with the general population. Analysis of recent prospective studies on the progression of the pathological process and predicting of the long-term outcomes in RA clearly indicate the need for clinical evaluation and a comprehensive laboratory and instrumental diagnosis of the disease in the initial manifestations of the most followed by early adequate pathogenetic therapy. The purpose of this survey was to determine modern clinical aspects of diagnosis, the possibility of standard and specialized instrumental examinations in patients with eRA, followed by predicting long-term results. We studied 52 specialized publications on clinical classification and a modern laboratory and diagnostic tests for eRA. This review presents the data of the importance of differentiation of several stages of RA in relation to the time factor. The data on the sensitivity and specificity of the diagnostic classification and clinical criteria of eRA and an algorithm for the identification of the disease were presented. It was shown prognostic value of the main serological markers of RA, and the predictive value for early detection of antibodies to the circulating peptide as a marker of the severity of bone-destructive changes in patients with certain clinical manifestations. Antibodies to the circulating peptide (ACPA can be detected many years before the onset of RA. Study of anti-citrulline mutated vimentin (anti-MCV in patients with eRA can be applied as a marker of activity of the process and the subsequent possibility of use for predicting long-term results. This review presents the major diagnostic errors using standard instrumental

  6. Assessment of clinical and laboratory parameters that reflect inflammatory response and organ function in sepsis

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    Herdiman T. Pohan


    APTT were prolong in severe sepsis and septic shock more than 18.8 and  48 seconds respectively. The d-dimer was also increased mostly in all groups. In conclusions that clinical examinations include level of consciousness, heart rate, mean arterial pressure, temperature and respiration rate and additional laboratory examinations include hamatological, biochemical, blood gas analysis and coagulation  examinations can be used as parameters in diagnosis of sepsis. Some parameters include level of consciousness (Glasgow coma scale, serum creatinine, hemoglobin, platelet count and fibrinogen can differ sepsis according to severity. (Med J Indones 2005; 14: 26-32Keywords: Clinical response, SIRS, sepsis

  7. Anxiety: the importunate companion. Psychoanalytic theory of castration and separation anxieties and implications for clinical technique. (United States)

    Davies, Rosemary


    In this article I consider the implications of our differing psychoanalytic theories of anxiety on clinical technique. Drawing on differentiations between the focus on separation or castration anxiety and the relative neglect of the latter in contemporary writing, I look in detail at two clinical examples of psychoanalysis in borderline young adults to exemplify the issue.(1).

  8. Management of stress and stress-related diseases: Emerging computer-based technologies and the rationale for clinical laboratory assessment


    Ezekiel Uba Nwose; Ross Stuart Richards


    Background : Over the years, the issue of stress management in mental health has been discussed without reference to the clinical laboratory perspectives. Translational research and the vast array of emerging diagnostic technologies in alternative medical practice are now bridging the gap. While it would be scientific arrogance for the clinical practitioner and scientist to ignore the trend, the new technologies seeking clinical acceptability necessarily require expatiation of the scientific ...

  9. Polymyalgia rheumatica (PMR): clinical, laboratory, and immunofluorescence studies in 13 patients. (United States)

    Shintani, Shuzo; Shiigai, Tatsuo; Matsui, Yoshiki


    Thirteen elderly patients with polymyalgia rheumatica (PMR) are presented. The clinical and laboratory findings suggest that many progressive symptoms are due to the non-specific inflammatory changes in various organs of the body, especially in muscles and joints. An immunofluorescence study of muscle biopsy specimens revealed IgG, IgA, and fibrinogen deposits in the perifascicular area of the perimysium. This finding suggests that immune complexes play a role in the pathogenesis of this condition and that the pathophysiology of PMR is an interstitial inflammatory process. We think that the inflammatory findings affecting the interstitial tissue of muscles in the immunofluorescence study are relatively specific to PMR, and will be affected by steroid treatment.

  10. Importance/performance analysis: a tool for service quality control by clinical laboratories. (United States)

    Scammon, D L; Weiss, R


    A study of customer satisfaction with clinical laboratory service is used as the basis for identifying potential improvements in service and more effectively targeting marketing activities to enhance customer satisfaction. Data on customer satisfaction are used to determine the aspects of service most critical to customers, how well the organization is doing in delivery of service, and how consistent service delivery is. Importance-performance analysis is used to highlight areas for future resource reallocation and strategic emphasis. Suggestions include the establishment of performance guidelines for customer contact personnel, the enhancement of timely delivery of reports via electronic transmission (computer and fax), and the development of standardized graphics for request and report forms to facilitate identification of appropriate request forms and guide clients to key items of information on reports.

  11. Clinical and laboratory features of pheochromocytoma in a 52-year-old female patient

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    Otmara Aranguren Barreto


    Full Text Available The article aims to describe the clinical and laboratory features of a female patient suffering from pheochromocytoma. The case is a 52-year-old female patient who presents to our healthcare center with high blood pressure, cold limbs, sweating, jitteriness, and episodes of oppressive chest pain that appear several times per day. She also reports fatigue and a 13-kilogram weight loss. The sonogram revealed a nodular image in the right adrenal gland that had low echogenicity and regular margins measuring 5 mm. The image was confirmed with a contrast-enhanced adrenal CAT scan. Urine vanillylmandelic acid levels were high and an adrenal biopsy confirmed a pheochromocytoma measuring 4.5 x 3.5 x 3 cm.

  12. Comparison of four types of diet using clinical, laboratory and psychological studies. (United States)

    Lockie, A H; Carlson, E; Kipps, M; Thomson, J


    Thirty-seven people of different dietary habits-vegans, ovolactovegetarians, whole-food omnivores and average omnivores-were studied using nine-day weighed food intakes, clinical and laboratory assessments, standard psychology questionnaires, measurements of urinary cortisol and catecholamine levels and questionnaires on life-style and health factors. The vegan diet most clearly approximated current thinking on diet, as expressed in the NACNE Report, but was deficient in vitamin D, riboflavin, and vitamin B12. Cholesterol levels were significantly higher in both diet and serum in all groups compared with the vegans. There was no significant difference in social background, money spent on food, exercise, smoking, stress levels or psychological parameters between groups.

  13. Utility and necessity of repeat testing of critical values in the clinical chemistry laboratory.

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    Aijun Niu

    Full Text Available CONTEXT: Routine repeat testing of critical values is a long-standing practice in many clinical laboratories; however, its usefulness and necessity remain to be empirically established and no regulatory requirements yet exist for verification of the critical value results obtained by repeat analysis. OBJECTIVE: To determine whether repeat testing of critical values is useful and necessary in a clinical chemistry laboratory. METHODS: A total of 601 chemistry critical values (potassium, n = 255; sodium, n = 132; calcium, n = 108; glucose, n = 106 obtained from 72,259 routine clinical chemistry specimens were repeat tested. The absolute value and the percentage of difference between the two testing runs were calculated for each of the four critical values and then compared with the allowable error limit put forth in the College of American Pathologists (CAP. RESULTS: Among the repeat data for the 601 critical values, a total of 24 showed large differences between the initial result and the repeated result which exceeded the CAP limits for allowable error. The number and rates (% of large differences for within and outside the analytical measurement range (AMR were 12 (2.1% and 12 (41.4%, respectively. For the 572 critical values within the AMR for each test category, the mean absolute difference (mmol/L and difference(% between the two testing runs were: potassium, 0.1 mmol/L (2.7%; sodium, 2.1 mmol/L (1.7%; calcium, 0.05 mmol/L (3.0%; glucose, 0.18 mmol/L (2.6%. CONCLUSIONS: When the initial chemistry critical values are within the AMR, repeated testing does not improve accuracy and is therefore unnecessary. When the initial chemistry critical values are outside the AMR, however, the benefit of repeated testing justifies its performance and makes it necessary. Performing repeat clinical testing on a case-by-case, rather than routine, basis can improve patient care by delivering critical values more rapidly while providing savings


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    Full Text Available SUMMARYDuring recent decades, antifungal susceptibility testing has become standardized and nowadays has the same role of the antibacterial susceptibility testing in microbiology laboratories. American and European standards have been developed, as well as equivalent commercial systems which are more appropriate for clinical laboratories. The detection of resistant strains by means of these systems has allowed the study and understanding of the molecular basis and the mechanisms of resistance of fungal species to antifungal agents. In addition, many studies on the correlation of in vitro results with the outcome of patients have been performed, reaching the conclusion that infections caused by resistant strains have worse outcome than those caused by susceptible fungal isolates. These studies have allowed the development of interpretative breakpoints for Candida spp. and Aspergillus spp., the most frequent agents of fungal infections in the world. In summary, antifungal susceptibility tests have become essential tools to guide the treatment of fungal diseases, to know the local and global disease epidemiology, and to identify resistance to antifungals.

  15. Efficacy and safety of far infrared radiation in lymphedema treatment: clinical evaluation and laboratory analysis. (United States)

    Li, Ke; Zhang, Zheng; Liu, Ning Fei; Feng, Shao Qing; Tong, Yun; Zhang, Ju Fang; Constantinides, Joannis; Lazzeri, Davide; Grassetti, Luca; Nicoli, Fabio; Zhang, Yi Xin


    Swelling is the most common symptom of extremities lymphedema. Clinical evaluation and laboratory analysis were conducted after far infrared radiation (FIR) treatment on the main four components of lymphedema: fluid, fat, protein, and hyaluronan. Far infrared radiation is a kind of hyperthermia therapy with several and additional benefits as well as promoting microcirculation flow and improving collateral lymph circumfluence. Although FIR therapy has been applied for several years on thousands of lymphedema patients, there are still few studies that have reported the biological effects of FIR on lymphatic tissue. In this research, we investigate the effects of far infrared rays on the major components of lymphatic tissue. Then, we explore the effectiveness and safety of FIR as a promising treatment modality of lymphedema. A total of 32 patients affected by lymphedema in stage II and III were treated between January 2015 and January 2016 at our department. After therapy, a significant decrease of limb circumference measurements was noted and improving of quality of life was registered. Laboratory examination showed the treatment can also decrease the deposition of fluid, fat, hyaluronan, and protein, improving the swelling condition. We believe FIR treatment could be considered as both an alternative monotherapy and a useful adjunctive to the conservative or surgical lymphedema procedures. Furthermore, the real and significant biological effects of FIR represent possible future applications in wide range of the medical field.

  16. [The quality management in clinical diagnostic laboratory in conditions of the Federal Center of traumatology, orthopedics and endoprosthesis replacement of Minzdrav of Russia (Cheboksary)]. (United States)

    Nikolaev, N S; Nazarova, V V; Dobrovol'skaia, N Iu; Orlova, A V; Pchelova, N N


    The article presents experience of clinical diagnostic laboratory of the Federal Center of traumatology, orthopedics and endoprosthesis replacement of Minzdrav of Russia (Cheboksary) in the area of quality management of medical laboratory services on the basis of evaluation of efficacy and effectiveness of processes. The factors effecting quality of functioning of clinical diagnostic laboratory are indicated. The criteria and indicators of efficacy of work of employees of clinical diagnostic laboratory are presented.

  17. Comprehensive reference ranges for hematology and clinical chemistry laboratory parameters derived from normal Nigerian adults.

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    Timzing Miri-Dashe

    Full Text Available BACKGROUND: Interpretation of laboratory test results with appropriate diagnostic accuracy requires reference or cutoff values. This study is a comprehensive determination of reference values for hematology and clinical chemistry in apparently healthy voluntary non-remunerated blood donors and pregnant women. METHODS AND FINDINGS: Consented clients were clinically screened and counseled before testing for HIV, Hepatitis B, Hepatitis C and Syphilis. Standard national blood donors' questionnaire was administered to consented blood donors. Blood from qualified volunteers was used for measurement of complete hematology and chemistry parameters. Blood samples were analyzed from a total of 383 participants, 124 (32.4% males, 125 (32.6% non-pregnant females and 134 pregnant females (35.2% with a mean age of 31 years. Our results showed that the red blood cells count (RBC, Hemoglobin (HB and Hematocrit (HCT had significant gender difference (p = 0.000 but not for total white blood count (p>0.05 which was only significantly higher in pregnant verses non-pregnant women (p = 0.000. Hemoglobin and Hematocrit values were lower in pregnancy (P = 0.000. Platelets were significantly higher in females than men (p = 0.001 but lower in pregnant women (p =  .001 with marked difference in gestational period. For clinical chemistry parameters, there was no significant difference for sodium, potassium and chloride (p>0.05 but gender difference exists for Bicarbonate (HCO3, Urea nitrogen, Creatinine as well as the lipids (p0.05. CONCLUSIONS: Hematological and Clinical Chemistry reference ranges established in this study showed significant gender differences. Pregnant women also differed from non-pregnant females and during pregnancy. This is the first of such comprehensive study to establish reference values among adult Nigerians and difference observed underscore the need to establish reference values for different populations.

  18. Molecular analysis and association with clinical and laboratory manifestations in children with sickle cell anemia

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    Roberta Faria Camilo-Araújo


    Full Text Available Objectives: To analyze the frequency of βS-globin haplotypes and alpha-thalassemia, and their influence on clinical manifestations and the hematological profile of children with sickle cell anemia. Method: The frequency of βS-globin haplotypes and alpha-thalassemia and any association with clinical and laboratorial manifestations were determined in 117 sickle cell anemia children aged 3–71 months. The confirmation of hemoglobin SS and determination of the haplotypes were achieved by polymerase chain reaction-restriction fragment length polymorphism, and alpha-thalassemia genotyping was by multiplex polymerase chain reaction (single-tube multiplex-polymerase chain reaction. Results: The genotype distribution of haplotypes was 43 (36.7% Central African Republic/Benin, 41 (35.0% Central African Republic/Central African Republic, 20 (17.0% Rare/atypical, and 13 (11.1% Benin/Benin. The frequency of the α3.7 deletion was 1.71% as homozygous (−α3.7/−α3.7 and 11.9% as heterozygous (−α3.7/αα. The only significant association in respect to haplotypes was related to the mean corpuscular volume. The presence of alpha-thalassemia was significantly associated to decreases in mean corpuscular volume, mean corpuscular hemoglobin and reticulocyte count and to an increase in the red blood cell count. There were no significant associations of βS-globin haplotypes and alpha-thalassemia with clinical manifestations. Conclusions: In the study population, the frequency of alpha-thalassemia was similar to published data in Brazil with the Central African Republic haplotype being the most common, followed by the Benin haplotype. βS-globin haplotypes and interaction between alpha-thalassemia and sickle cell anemia did not influence fetal hemoglobin concentrations or the number of clinical manifestations.

  19. Laboratory and clinical tests of a prototype pressure sensor for clincial assessment of prosthetic socket fit. (United States)

    Polliack, A A; Craig, D D; Sieh, R C; Landsberger, S; Mcneal, D R


    Lower limb prosthetic socket fabrication is a highly refined process relying on the prosthetist's skill and experience. Despite their best efforts, patients often return with complications. Additionally, clinical application of technological advances for the quantification of biomechanical factors at the socket interface has not changed in practice. Measuring pressure levels at the stump/socket interface could provide valuable information in the process of prosthetic socket fabrication, fit and modification. This paper presents findings on the performance of a prototype capacitance pressure sensor designed for prosthetic socket use. Bench tests using compressed air were performed to measure accuracy, hysteresis and drift responses in both a flatbed chamber and a custom-modified pressure vessel. For the contoured testing, the sensors were placed on nine sites on a positive trans-tibial stump mould and enveloped with a silicone liner. Additionally, a preliminary clinical evaluation was performed with two trans-tibial amputee subjects at the nine sites during normal ambulation. Bench test results showed that the prototype capacitance sensor performed well in all categories, exhibiting a 2.42% (flatbed) and 9.96% (contoured) accuracy error, a 12.93% (flatbed) and 12.95% (contoured) hysteresis error, and a 4.40% (flatbed) and 6.20% (contoured) drift error. The clinical study showed that after three hours of continual use, no noticeable sensor drift occurred between pre and post-test calibration values. The results from this study were encouraging and the authors hope to conduct further laboratory and clinical trials to assess the influence of shear force and dynamic loading on sensor response.

  20. Analysis of clinical laboratory data by biplot methods using a three-dimensional display: discrimination of renal stone-patients with idiopathic hypercalciuria and primary hyperparathyroidism. (United States)

    Tschöpe, W; Schmidt-Gayk, H; Ritz, E; Weber, E; Berger, J


    The biplot technique is a very useful graphical method to display the relationships between row and column characteristics in two-way tables. This method is applicable as long as the rank-2 approximation explains a large part (e.g. 95%) of the whole variability. However, since in large tables only a rank-3 approximation will yield such a high degree of explanation, a three-dimensional biplot technique has been introduced, using a 3d-screen as a matter of presentation of clinical laboratory data. The value of such a procedure is illustrated using as a clinical example a patient population with recurrent renal stone formation due either to primary hyperparathyroidism or to idiopathic hypercalciuria.

  1. Enzymatic degradation of polygalacturonic acid by Yersinia and Klebsiella species in relation to clinical laboratory procedures. (United States)

    Starr, M P; Chatterjee, A K; Starr, P B; Buchanan, G E


    As scored by several specified plating procedures, clinical and environmental strains of Yersinia enterocolitica, Yersinia pseudotuberculosis, and Klebsiella pneumoniae "Oxytocum" showed detectable, albeit generally weak, ability to digest polygalacturonic (pectic) acid. None of these bacterial strains had the vigorous and rapid pectolytic activity on these polygalacturonic acid-containing media that is typical of soft-rot Erwinia species, although some of the Oxytocum strains came fairly close. Analyses of the pectolytic enzyme contents of the cells and culture supernatants of the Yersinia and Klebsiella species revealed that readily detectable quantities of cell-bound polygalacturonic acid trans-eliminase and hydrolytic polygalacturonase were formed by the Yersinia and Klebsiella species; however, the total units of enzyme activity produced by these bacteria were, in general, lower than were produced by soft-rot Erwinia species. Furthermore, unlike the situation in soft-rot Erwinia cultures, these pectolytic enzymes of Yersinia and Klebsiella species were not excreted rapidly and massively into the growth medium. Cultures of other enterobacteria (Citrobacter species, Enterobacter species, Erwinia amylovora, Erwinia herbicola, Escherichia coli, Proteus species, Salmonella typhimurium, and Serratia marcescens) showed no pectolytic ability whatsoever by any of the plating procedures used and (to the extent they were so examined) produced no pectolytic enzymes detectable either in their cells or culture supernatants. This slow or weak release of pectolytic enzymes by Yersinia and Klebsiella species has a bearing on clinical laboratory procedures suitable for detecting their pectolytic activity; methods adequate for this purpose are detailed.

  2. Corelations between radiological score with clinical and laboratory parameters in rheumatoid arthritis

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    Mihaela Chicu


    Full Text Available Staging in rheumatoid arthritis (RA and evaluating the effectiveness of drug treatment involves the determination of radiological scores (for narrowing and erosions, this being the most specific changes and most commonly found in RA.Matherials and methods: Our study was condacted over a period of 12 months in Medical Rehabilitation Clinic of „Sf. Spiridon” Iasi Hospital, on a group of 40 women patients with RA in various stages of evolution. X-ray examination was done on hands and feet at the beginning and the end of the study period. There were computed radiographic Sharp scores for narrowing and erosions and the total score. Erosions were examined for 16 joints in each hand. For narrowing five joints were evaluated. For accuracy, radiological examination was done on mammography film. Rezults:After calculating Sharp scores - Van der Heide version - I compared them with the levels of clinical (HAQ, NAT, NAD, DAS28, bone densitometry and laboratory (ESR, CRP, rheumatoid factor, IL-1β parameters.Conclusions: The values of radiological scores for narrowing and erosions are directly correlate with DAS28, HAQ, rheumatoid factors levels and IgG values, and indirectly correlated with IL-1β levels.

  3. Measles outbreak in Macedonia: epidemiological, clinical and laboratory findings and identification of susceptible cohorts.

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    Irena T Kondova

    Full Text Available OBJECTIVES: Despite a 92-99% national vaccination coverage since 2000, the former Yugoslav Republic of Macedonia experienced a large measles outbreak between 2010 and 2011. Here we investigate the characteristics of patients hospitalized during this outbreak at the Clinic of Infectious Diseases in Skopje. METHODS: Epidemiological, clinical and laboratory data of 284 measles patients, including 251 from Skopje (43.80% of the 573 reported cases and 33 from elsewhere in Macedonia were collected. RESULTS: The most affected age groups were children up to 4 years of age and adolescents/adults of 15 years and older. Most patients were unvaccinated (n=263, 92.61% and many had non-Macedonian nationalities (n=156, 54.93% or belonged to the Roma ethnicity (n=73, 25.70%. Bronchopneumonia and diarrhea were the most common complications. Eighty-two out of 86 tested patients (95.35% had measles-specific IgM antibodies. The outbreak was caused by the measles variant D4-Hamburg. CONCLUSIONS: The epidemic identified pockets of susceptibles in Skopje and indicated that additional vaccination opportunities in particular for people with non-Macedonian nationality and traveler communities are warranted to ensure efficient measles control in Macedonia. The high attack rate among children of less than 1 year suggests that vaccination before 12 months of age should be considered in high risk settings.

  4. Strongyloidiasis: prevalence, risk factors, clinical and laboratory features among diarrhea patients in Ibadan Nigeria. (United States)

    Dada-Adegbola, H O; Oluwatoba, O A; Bakare, R A


    Strongyloidiasis is a parasitic infection caused by Strongyloides stercoralis. The infection is usually mild or asymptomatic in normal immunocompetent individuals, but could be very severe or even fatal due to hyper infection in individuals who are immunosuppressed. This study aimed at determining the prevalence, risk factors and features of strongyloidiasis among diarrhea patients in Ibadan. This is a descriptive cross-sectional study of diarrhea patients from a teaching hospital, three major government hospitals and one mission hospital in Ibadan. Self administered questionnaire, clinical assessment and laboratory investigations were used to confirm health status and presence of S. stercoralis. Diagnosis was made by microscopic examination of stool in saline preparation and formol-ether concentration. One thousand and ninety patients, (562 (51.6%) males and 528 (48.4%) females) consisting 380 (34.9%) children and 710 (65.1%) adults who had diarrhea were studied. The prevalence rate for the parasite among diarrhea patients was 3.0%. While the risk factor for infection remains contact with contaminated soil, malnutrition, steroid therapy, HIV/AIDS, lymphomas, tuberculosis, and chronic renal failure. Others are maleness, institutionalism and alcoholism. Predominant clinical presentations are abdominal pain, chronic diarrhea, and bloating and weight loss, Strongyloides stercoralis should be considered in diarrhea patients who are either malnourished or immunosuppressed.

  5. Development of a new laboratory technique for high-temperature thermal emission spectroscopy of silicate melts (United States)

    Lee, Rachel J.; Ramsey, Michael S.; King, Penelope L.


    the prevalence of glass and molten silicates in volcanic environments, and the important role of surface emissivity in thermal infrared (TIR) measurements, it is imperative to characterize accurately the spectral features associated with silicate glasses and melts. A microfurnace has been developed specifically for use with a laboratory Fourier transform infrared (FTIR) spectrometer to collect the first in situ TIR emission spectra of actively melting and cooling silicate glasses. The construction, implementation, and calibration of the microfurnace spectrometer system are presented here. Initial testing of the microfurnace is also discussed, which includes acquisition of thermal emission spectra of a quartz powder (unmelted), a melted and cooled oligoclase feldspar, and glassy melt of rhyolitic composition. Unlike a solid material, which may only have bending and stretching vibrations within its molecular structure, a fully molten material will exhibit several more degrees of freedom in structural movement, thus changing its spectral character. Differences in spectral behavior and morphology are observed between a glass in a solid state and its molten counterpart, confirming previous field measurements of lower emissivity upon melting. This laboratory microfurnace system has been designed to quantify the TIR emission spectral behavior of glassy materials in various physical states. Ultimately, it is hoped that the microfurnace data will help improve the ability of field-based, airborne, and spaceborne TIR data to characterize glassy volcanic terranes.

  6. A Practical Introduction to Separation and Purification Techniques for the Beginning Organic Chemistry Laboratory. (United States)

    Leonard, Jack E.


    Describes a sequence of experiments developed at Texas A&M University for use in one-semester and two-semester (nonmajors) organic chemistry courses to teach a maximum number of separation and purification techniques such as distillations, recrystallization, liquid-liquid extraction, and chromatography. (SK)

  7. Emerging Rapid Resistance Testing Methods for Clinical Microbiology Laboratories and Their Potential Impact on Patient Management

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    Hagen Frickmann


    Full Text Available Atypical and multidrug resistance, especially ESBL and carbapenemase expressing Enterobacteriaceae, is globally spreading. Therefore, it becomes increasingly difficult to achieve therapeutic success by calculated antibiotic therapy. Consequently, rapid antibiotic resistance testing is essential. Various molecular and mass spectrometry-based approaches have been introduced in diagnostic microbiology to speed up the providing of reliable resistance data. PCR- and sequencing-based approaches are the most expensive but the most frequently applied modes of testing, suitable for the detection of resistance genes even from primary material. Next generation sequencing, based either on assessment of allelic single nucleotide polymorphisms or on the detection of nonubiquitous resistance mechanisms might allow for sequence-based bacterial resistance testing comparable to viral resistance testing on the long term. Fluorescence in situ hybridization (FISH, based on specific binding of fluorescence-labeled oligonucleotide probes, provides a less expensive molecular bridging technique. It is particularly useful for detection of resistance mechanisms based on mutations in ribosomal RNA. Approaches based on MALDI-TOF-MS, alone or in combination with molecular techniques, like PCR/electrospray ionization MS or minisequencing provide the fastest resistance results from pure colonies or even primary samples with a growing number of protocols. This review details the various approaches of rapid resistance testing, their pros and cons, and their potential use for the diagnostic laboratory.

  8. Tularemia in Children: Evaluation of Clinical, Laboratory and Treatment Outcomes of 15 Tularemia Cases

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    Ekrem Koyuncu


    Full Text Available Introduction: Tularemia is a zoonotic diseases caused by Francisella tularensis. The aim of this study was to evaluate the clinical and laboratory findings of 15 children with the diagnosis of tularemia.Materials and Methods: Fifteen cases admitted with fever, sore throat, lymphadenopathy and a F. tularensis antibody titer of 1/160 and above in the microagglutination test (MAT were evaluated retrospectively. Their sociodemographic characteristics, contact with animals, history of tick bite, duration of complaints, clinical and laboratory findings, treatments and clinical courses were studied.Results: The mean age of patients was 11.5±5.1 (3-17 years and 61.3% were male. Fifty-three percent of the patients were living in rural areas, and had contact with contaminated water. Swelling in the neck (93.3%, sore throat (66.7% and fever (66.7% were the most frequently observed symptoms. Oropharyngeal tularemia (66.7% was predominated. In 27% of the patients LAPs were drained surgically, and in 13.3% of cases they were drained by itself. The mean duration between onset of tularemia symptoms and diagnosis was 53±45.3 (5-150 days. Sixty percent of patients were received beta-lactam-antibiotics before admission. It was noted that 6 patients with suppurative lymph nodes were admitted to hospital within median 61 (20-150 days, while others were admitted within median 35 (5-75 days (p<0.05. Mean leukocyte count was 8558.6±1384.5 (6030-11400/mm3, mean CRP was 5.8±2.9 (1-6.7 mg/dl, and mean ESR was 33.1±28.9 (6-103 mm/h. MAT showed that titers ranged from 1/160 to 1/1280. Gentamicin was given in seven patients (47%, streptomycin in five patients (33%, and doxycycline in 3 patients (20%.Conclusions: Tularemia should to be taken into account in the differential diagnosis in patients having tonsillopharyngitis and cervical lymphadenopathy without response to beta-lactam antibiotics in rural areas. (Journal of Current Pediatrics 2013;11:61-6

  9. Clinical and laboratory aspects of a trichinellosis outbreak in Izmir, Turkey

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    Turk M.


    Full Text Available Epidemiological, clinical and laboratory data were collected during an outbreak of trichinellosis, which occurred in Izmir, Turkey, between January and March 2004. The source of the infection was raw meatballs made with a mixture of uncooked beef and pork. Of 474 persons who were admitted at the Ataturk Training and Research Hospital during this period with a history of raw meatball consumption, the diagnosis of trichinellosis was confirmed for 154 (32.5 %, 87 males and 67 females; mean age 31 years, range 6-67 years. Among persons with a confirmed diagnosis, 79 % had myalgia, 77 % weakness and malaise, 63 % arthralgia, 40 % jaw pain, 68 % fever, 63 % periorbital and/or facial oedema, 49 % oedema at the trunk and limb, 42 % abdominal pain, 40 % nausea and vomiting, 28 % diarrhoea, 23 % subconjunctival haemorrhage, 25 % macular or petechial rash, 4 % subungual haemorrhage, 15 % cardiac complaints and 0.2 % neurological complaints. Nine patients (5.8 % were hospitalised due to severe myalgia (n = 2, high fever (n = 3, neurological manifestations (n = 1, thrombophlebitis (n = 2 and palmar erythema (n = 1. Eosinophilia was present in 88 % of the confirmed cases at the admission. Elevated levels of serum creatine phosphokinase, lactic dehydrogenase and aspartate aminotransferase were detected in 72 %, 70 % and 16 % of the confirmed cases, respectively. The seroconversion occurred in most of the infected people between the 4th and 6th weeks after the infection. All of the confirmed cases were treated with mebendazole. People with severe symptoms were treated also with prednisolone (60 mg/day for three days and those with a moderately severe clinical pattern received a non-steroid anti-inflammatory drug (naproxen sodium, 550 mg/day. All confirmed cases recovered without any clinical sequela.

  10. Clinical and laboratory peculiarities of acute myocardial infarction after chronic tonsillitis

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    Shvarts Y.G.


    Full Text Available Aim: The definition of the relationship of clinical and laboratory features of acute myocardial infarction depending on the suffering of chronic tonsillitis. Materials and methods. The study included 54 patients with acute myocardial infarction suffering for 1-2 days. The collection of the anamnesis, assessment of clinical factors, inspection of the palatine tonsils, clinical and biochemical blood tests have been done. Markers of myocardial necrosis, an electrocardiogram with calculation of a dispersion of interval QT, echocardiogram have been taken into account. Results. 45 of 54 patients reported the symptoms of chronic tonsillitis in their lifetime. At 17 patients the previous diagnosis of chronic tonsillitis has been made, in 6 of them bilateral tonsillectomy was held. All of the patients were divided into 2 groups: 1 with proven chronic tonsillitis (17 patients and 2 — the others (37 patients. At patients with chronic tonsillitis substantially more developed acute heart failure at sick this group glucose of the blood at receipt was higher than in 2 groups (p=0,004, given distinction was independent of presence of diabetes. According to the echocardiography 1 group of patients determined course-diastolic dimensions of the right ventricle increase in comparison with 2 groups (p=0,01. Conclusion. In patients with chronic tonsillitis more severe course of acute myocardial infarction has been determined, which became evident in the relatively high values of blood glucose on admission. The frequent development of congestive heart failure, and increase of the course-diastolic dimensions of the right ventricle have been also revealed.

  11. Prediction of dengue disease severity among pediatric Thai patients using early clinical laboratory indicators.

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    James A Potts

    Full Text Available Dengue virus is endemic in tropical and sub-tropical resource-poor countries. Dengue illness can range from a nonspecific febrile illness to a severe disease, Dengue Shock Syndrome (DSS, in which patients develop circulatory failure. Earlier diagnosis of severe dengue illnesses would have a substantial impact on the allocation of health resources in endemic countries.We compared clinical laboratory findings collected within 72 hours of fever onset from a prospective cohort children presenting to one of two hospitals (one urban and one rural in Thailand. Classification and regression tree analysis was used to develop diagnostic algorithms using different categories of dengue disease severity to distinguish between patients at elevated risk of developing a severe dengue illness and those at low risk. A diagnostic algorithm using WBC count, percent monocytes, platelet count, and hematocrit achieved 97% sensitivity to identify patients who went on to develop DSS while correctly excluding 48% of non-severe cases. Addition of an indicator of severe plasma leakage to the WHO definition led to 99% sensitivity using WBC count, percent neutrophils, AST, platelet count, and age.This study identified two easily applicable diagnostic algorithms using early clinical indicators obtained within the first 72 hours of illness onset. The algorithms have high sensitivity to distinguish patients at elevated risk of developing severe dengue illness from patients at low risk, which included patients with mild dengue and other non-dengue febrile illnesses. Although these algorithms need to be validated in other populations, this study highlights the potential usefulness of specific clinical indicators early in illness.

  12. Evaluation of clinical manifestations and laboratory findings of primary hyperparathyroidism in Imam Hospital (1988-1998

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    Alam Salimi M


    Full Text Available Introduction: Clinical manifestations of primary hyper-para-thyroidism (pHPT had been dramatically changed during last 25 years. Evaluation of changes in clinical findings was the aim of this study. Materials and methods: In a retrospective, descriptive case series, patients' records of all 47 pHPT (44 females, 3 males from 1988 till 1998 were studied. Patients’ clinical presentations, signs and symptoms, laboratory and radiologic findings were reviewed and the results were compared with 34 patients' studied during 1978-1987. Serum Ca>10.5 mg/dl with increased or high normal PTH were the diagnostic criteria of pHPT. Results: Patients’ age range was 11-70 and mean ±SD was 38±16 years, with a female to male ratio of 14:1. 57 percent of the patients had bone pain and muscle weakness, 12 percent were asymptomatic, 10 percent had pathologic fractures, 8 percent had renal stones, 8 percent had symptoms of hypercalcemia, and 2 percent had giant cell lesion. The mean±SD of serum calcium was 11.48±1.16 mg/dl, phosphorus was 2.4±0.6 mg/dl and 24-h urinary Ca was 294±197 mg. Serum PTH was increased from 1.5 to 500 folds. The frequency of single adenoma in right inferior, left inferior, and left superior gland were 43 percent, 30 percent, and 13 percent respectively. Conclusion: In the study 12 percent of patients were asymptomatic whereas there was no asymptomatic case in the previous study. Prevalence of severe bone disease and the interval between onset of symptoms and diagnosis was also reduced. According to this study detection of pHPT in asymptomatic phase remarkably increased.

  13. The combined technique for detection of artifacts in clinical electroencephalograms of sleeping newborns. (United States)

    Schetinin, Vitaly; Schult, Joachim


    In this paper, we describe a new method combining the polynomial neural network and decision tree techniques in order to derive comprehensible classification rules from clinical electroencephalograms (EEGs) recorded from sleeping newborns. These EEGs are heavily corrupted by cardiac, eye movement, muscle, and noise artifacts and, as a consequence, some EEG features are irrelevant to classification problems. Combining the polynomial network and decision tree techniques, we discover comprehensible classification rules while also attempting to keep their classification error down. This technique is shown to out-perform a number of commonly used machine learning technique applied to automatically recognize artifacts in the sleep EEGs.

  14. Estimation of the coefficient of variation from laboratory analysis of split specimens for quality control in clinical trials. (United States)

    Connett, J E; Lee, W W


    An explicit statistical model is proposed for the coefficient of variation for laboratory analyses of constituents of blood, serum, saliva, or other specimens. A method for computing the maximum likelihood estimate of the key parameter is described, and compared with two simpler noniterative estimates. Validity of the model is explored by analysis of data from the central laboratory of a large cooperative clinical trial. Simulation studies are employed to compare the accuracy of the three estimators of the coefficient of variation. For most laboratory measurements for which the model is valid, one of the two noniterative estimates is nearly as accurate and unbiased as the maximum likelihood estimate.

  15. Clinical characteristics and laboratory analyses of acute myeloid leukemia with t(16;21)(p11;q22)


    Zhang, Zhifen; ZOU, JIANWEN; Li, Yuantang; Liu, Zhanfeng; Xu, Rui; TIAN, WENJUN; ZHAO, ZONGCHEN; Sun, Hui; Han, Jingying; Wang, Jia; Zhang, Bingchang; Ju, Ying


    The present study reviewed three patients with acute myeloid leukemia (AML) who had the specific genetic abnormality t(16;21)(p11;q22). To investigate the clinical and laboratory characteristics of AML with t(16;21)(p11;q22) translocation, the similarities and differences of clinical characteristics and laboratory examinations were compared, and a literature review was conducted. According to the French-American-British classification system, patient 1 was M4, patient 2 was M1 and patient 3 w...

  16. Optimized molecular resolution of cross-contamination alerts in clinical mycobacteriology laboratories

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    de Viedma Darío


    Full Text Available Abstract Background The phenomenon of misdiagnosing tuberculosis (TB by laboratory cross-contamination when culturing Mycobacterium tuberculosis (MTB has been widely reported and it has an obvious clinical, therapeutic and social impact. The final confirmation of a cross-contamination event requires the molecular identification of the same MTB strain cultured from both the potential source of the contamination and from the false-positive candidate. The molecular tool usually applied in this context is IS6110-RFLP which takes a long time to provide an answer, usually longer than is acceptable for microbiologists and clinicians to make decisions. Our purpose in this study is to evaluate a novel PCR-based method, MIRU-VNTR as an alternative to assure a rapid and optimized analysis of cross-contamination alerts. Results MIRU-VNTR was prospectively compared with IS6110-RFLP for clarifying 19 alerts of false positivity from other laboratories. MIRU-VNTR highly correlated with IS6110-RFLP, reduced the response time by 27 days and clarified six alerts unresolved by RFLP. Additionally, MIRU-VNTR revealed complex situations such as contamination events involving polyclonal isolates and a false-positive case due to the simultaneous cross-contamination from two independent sources. Conclusion Unlike standard RFLP-based genotyping, MIRU-VNTR i could help reduce the impact of a false positive diagnosis of TB, ii increased the number of events that could be solved and iii revealed the complexity of some cross-contamination events that could not be dissected by IS6110-RFLP.

  17. Clinical and laboratory differences between Epstein-Barr and cytomegalovirus infectious mononucleosis in children

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    Medović Raša


    Full Text Available Introduction. Infective mononucleosis is most commonly caused by Epstein-Barr virus (EBV, and in smaller percentage by cytomegalovirus (CMV. Objective. The aim of this paper was to determine the clinical and laboratory differences between EBV and CMV infectious mononucleosis in children. Methods. Cohort retrospective analytical research was conducted. We used data from medical history in six years period and monitored anamnestic data, frequency of inspection and palpation obtained data during physical examination, several laboratory tests, abdomen ultrasonography examination finding and emergence of disease complications. Statistical processing of data has been performed using SPSS 20. Results. Total number of examined children was 137, out of which 85.4% were with EBV and 14.6% with CMV infection. Affected children were most commonly younger than eight years. Boys were affected more often. There was no difference in frequency of high temperature, sore throat, bad breath, and respiratory symptomatology between examined children. Differences were discovered in frequency of stomachaches, eyelid swelling, skin rash and fatigue. Differences were not proven in the frequency of angina, lymphadenopathy and splenohepatomegaly between the groups. Values of transaminases and lactic dehydrogenases significantly decreased after seven days of hospitalization in both groups. In children with EBV, values of transaminases declined faster than in children with CMV. Anemia and bacterial superinfection of pharynx were most common disease complications. Thrombocytopenia was more common in children with CMV infection. Average duration of hospitalization was 6.7 days. Conclusion. In children with CMV abdominal pain, eyelid swelling, skin rash, fatigue and thrombocytopenia were more common. In children with EBV values of transaminases declined significantly faster.

  18. Effects of ostracism and sex on alcohol consumption in a clinical laboratory setting. (United States)

    Bacon, Amy K; Cranford, Alexi N; Blumenthal, Heidemarie


    Drinking to cope with negative affect is a drinking pattern that leads to problematic alcohol use both in college and after graduation. Despite theory and correlational evidence to this effect, establishing a link between stress and alcohol consumption among college students in the laboratory has yielded both a limited number of studies and, at times, inconsistent results. The present study attempts to resolve these issues through investigating the effects of an ecologically relevant stressor-ostracism-on alcohol consumption in a clinical laboratory setting. Social drinking college students (N = 40; 55% female) completed a 5-min game of Cyberball and were randomly assigned either to be included or excluded in the virtual ball-toss game. The amount (in ml) of beer consumed in a subsequent mock taste test served as our primary dependent variable, with breath alcohol concentration (BrAC) as a secondary dependent variable. Results indicated that excluded participants reported a trend toward an increase in negative affect from pre- to post-Cyberball, and endorsed significantly lower self-esteem, belonging, control, and belief in a meaningful existence compared to included participants. A significant Sex × Condition effect indicated that excluded women consumed less beer than both included women and excluded men, supported by a nonsignificant trend in BrAC. Men did not differ in their consumption of beer as a result of Cyberball condition. Implications of sex and social context on alcohol use are discussed, as well as ostracism as a method for investigating relationships between social stress and alcohol use.

  19. Murillo's paintings revealed by spectroscopic techniques and dedicated laboratory-made micro X-ray diffraction

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    Duran, A., E-mail: [Materials Science Institute of Seville, Avda Americo Vespucio 49, 41092 Seville (Spain); Centre de Recherche et de Restauration des Musees de France (C2RMF-CNRS), Palais du Louvre, 14 quai Francois Mitterrand, 75001 Paris (France); Siguenza, M.B.; Franquelo, M.L.; Haro, M.C. Jimenez de; Justo, A.; Perez-Rodriguez, J.L. [Materials Science Institute of Seville, Avda Americo Vespucio 49, 41092 Seville (Spain)


    This paper describes one of the first case studies using micro-diffraction laboratory-made systems to analyse painting cross-sections. Pigments, such as lead white, vermilion, red ochre, red lac, lapis lazuli, smalt, lead tin yellow type I, massicot, ivory black, lamp black and malachite, were detected in cross-sections prepared from six Bartolome Esteban Murillo paintings by micro-Raman and micro-XRD combined with complementary techniques (optical microscopy, SEM-EDS, and FT-IR). The use of micro-XRD was necessary due to the poor results obtained with conventional XRD. In some cases, pigment identification was only possible by combining results from the different analytical techniques utilised in this study.

  20. [Education required for next generation of clinical laboratory technicians: from perspective of three-year educational institutions]. (United States)

    Sando, Masaru


    Considering the education required for the next generation of clinical laboratory technicians in terms of elements necessary for the technicians, it is generally important for them to be "needed in the medical field", and the three-year educational institutions for training them are expected to nurture technicians who can work with "skills of immediate use." Herein, the phrase "skills of immediate use" does not simply signify knowledge and techniques, but signifies skills including behavior as medical staff. In addition, "growth potential" permitting continuous growth with self-education and aspiration for improvement after gaining employment is of significance. We refer to the "skills of immediate use" and the "growth potential" integrally as "Genba-ryoku(on-site capabilities)", and have striven for improvement in those capabilities as a basic educational policy of our school. In any period, the medical field needs medical staff who can perform greetings, cleaning, etc., as sound practices and who are well-mannered. It is my belief that educational institutions have to fulfill their mission by nurturing medical staff who possess "toughness to work unaided" as well as a "gentle mind."

  1. Fatal dengue hemorrhagic fever in adults: emphasizing the evolutionary pre-fatal clinical and laboratory manifestations.

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    Ing-Kit Lee

    Full Text Available BACKGROUND: A better description of the clinical and laboratory manifestations of fatal patients with dengue hemorrhagic fever (DHF is important in alerting clinicians of severe dengue and improving management. METHODS AND FINDINGS: Of 309 adults with DHF, 10 fatal patients and 299 survivors (controls were retrospectively analyzed. Regarding causes of fatality, massive gastrointestinal (GI bleeding was found in 4 patients, dengue shock syndrome (DSS alone in 2; DSS/subarachnoid hemorrhage, Klebsiella pneumoniae meningitis/bacteremia, ventilator associated pneumonia, and massive GI bleeding/Enterococcus faecalis bacteremia each in one. Fatal patients were found to have significantly higher frequencies of early altered consciousness (≤24 h after hospitalization, hypothermia, GI bleeding/massive GI bleeding, DSS, concurrent bacteremia with/without shock, pulmonary edema, renal/hepatic failure, and subarachnoid hemorrhage. Among those experienced early altered consciousness, massive GI bleeding alone/with uremia/with E. faecalis bacteremia, and K. pneumoniae meningitis/bacteremia were each found in one patient. Significantly higher proportion of bandemia from initial (arrival laboratory data in fatal patients as compared to controls, and higher proportion of pre-fatal leukocytosis and lower pre-fatal platelet count as compared to initial laboratory data of fatal patients were found. Massive GI bleeding (33.3% and bacteremia (25% were the major causes of pre-fatal leukocytosis in the deceased patients; 33.3% of the patients with pre-fatal profound thrombocytopenia (<20,000/µL, and 50% of the patients with pre-fatal prothrombin time (PT prolongation experienced massive GI bleeding. CONCLUSIONS: Our report highlights causes of fatality other than DSS in patients with severe dengue, and suggested hypothermia, leukocytosis and bandemia may be warning signs of severe dengue. Clinicians should be alert to the potential development of massive GI bleeding

  2. Applying Squeezing Technique to Clayrocks: Lessons Learned from Experiments at Mont Terri Rock Laboratory

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    Fernandez, A. M.; Sanchez-Ledesma, D. M.; Tournassat, C.; Melon, A.; Gaucher, E.; Astudillo, E.; Vinsot, A.


    Knowledge of the pore water chemistry in clay rock formations plays an important role in determining radionuclide migration in the context of nuclear waste disposal. Among the different in situ and ex-situ techniques for pore water sampling in clay sediments and soils, squeezing technique dates back 115 years. Although different studies have been performed about the reliability and representativeness of squeezed pore waters, more of them were achieved on high porosity, high water content and unconsolidated clay sediments. A very few of them tackled the analysis of squeezed pore water from low-porosity, low water content and highly consolidated clay rocks. In this work, a specially designed and fabricated one-dimensional compression cell two directional fluid flow was used to extract and analyse the pore water composition of Opalinus Clay core samples from Mont Terri (Switzerland). The reproducibility of the technique is good and no ionic ultrafiltration, chemical fractionation or anion exclusion was found in the range of pressures analysed: 70-200 MPa. Pore waters extracted in this range of pressures do not decrease in concentration, which would indicate a dilution of water by mixing of the free pore water and the outer layers of double layer water (Donnan water). A threshold (safety) squeezing pressure of 175 MPa was established for avoiding membrane effects (ion filtering, anion exclusion, etc.) from clay particles induced by increasing pressures. Besides, the pore waters extracted at these pressures are representative of the Opalinus Clay formation from a direct comparison against in situ collected borehole waters. (Author)

  3. Pharmaco-epidemiological, clinical and laboratory characteristics of drug-induced liver injury in tuberculosis

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    M. V. Koroleva


    Full Text Available Objective: improving the efficiency of pharmacotherapy of drug-induced liver injury in tuberculosis by clarifying pharmaco-epidemiological, clinical and laboratory features.Materials and Methods: A retrospective analysis of primary medical records of 250 patients with pulmonary tuberculosis, patients «Volgograd Regional Clinical TB Dispensary № 1». We evaluated the dynamics of biochemical parameters characterizing the development of hepatic cytolytic syndrome, examined the impact of gender and age on the incidence of liver damage, we investigated the relationship of clinical tuberculosis and chemotherapy regimen with the incidence of drug-induced liver injury, examined the clinical manifestations of liver disease.Results: Drug-induced liver injury as a complication of a specific anti-TB treatment was diagnosed in 67 patients (26,8%. In 170 patients (68,0% showed increase in alanine aminotransferase and asparaginaminotrasferazy. Hepatotoxicity significantly more common in patients with disseminated tuberculosis with the collapse of the lung tissue, smear, and a high degree of disease severity. Risk factors for drug liver damage were female gender and age older than 50 years. Women develop liver disease at an earlier date, and displays it harder than men. The earliest and most informative routine biochemical tests, reflecting the state of the liver in the dynamics are ALT and AST. It was found that the mode of the standard anti-TB treatment determines the type of liver injury: the first, 2a and 3rd modes prevails cytolytic hepatocellular type, with 2b mode – combined (mixed type 4th – type of cholestatic liver damage. It was found that repeated, after the development of hepatotoxic reactions, the appointment of anti-TB drugs without gepatoprotektsii in 94% of patients leads to repeated drug-induced liver damage. Cancel specific therapy against the background of cytolytic syndrome promotes the formation of

  4. [Evaluation of clinical and laboratory findings of adult visceral leishmaniasis cases]. (United States)

    Ural, Serap; Kaptan, Figen; Sezak, Nurbanu; El, Sibel; Örmen, Bahar; Türker, Nesrin; Demirdal, Tuna; Vardar, İlknur; Özkan Çayıröz, Pınar; Çakalağaoğlu, Fulya


    Visceral leishmaniasis (VL, kala-azar) is a zoonotic infection caused by Leishmania species which are transmitted to humans by the bites of infected female phlebotomine sandflies. Leishmania infantum is the responsible species of VL in Aegean, Mediterranean, and Central Anatolia regions of Turkey mainly observed sporadically in pediatric age groups. The aim of this study was to evaluate the clinical and laboratory findings of adult patients with VL who were admitted to our hospital. A total of 10 patients (3 female, 7 male; age range: 18-67 years, mean age: 39.3 ± 16.51) followed in the infectious diseases clinic of the hospital between 2000 and 2013 were evaluated retrospectively. The diagnosis of VL was based on the presence of appropriate clinical and physical examination, as well as biochemical findings, positive serological test results (indirect fluorescent antibody test, and rK39 rapid antigen test) and/or detection of amastigote forms of parasite in the bone marrow aspiration samples. Of the cases three were diagnosed with both bone marrow and serology positivity, five with bone marrow positivity and one of each only with liver biopsy and positive serology result. Time interval from onset of the symptoms until the establishment of the specific clinical diagnosis was ranged from 2 to 12 weeks. The most frequent initial symptoms were fever, fatigue and abdominal distension. None of the patients had immunosupressive conditions such as HIV infection, corticosteroid use, immunosupressive treatment, or transplantation. All the patients were from Aegean region and six were living in rural areas. In all cases, hepatosplenomegaly, increased erythrocyte sedimentation rate, albumin/globulin ratio inversion, anemia, leukopenia and among nine cases trombocytopenia were detected. In one case acute renal failure has been developed before treatment and the patient was admitted to dialysis program. Bacterial superinfection occurred in two cases. Patients were treated with

  5. Technique for the comparison of light spectra from natural and laboratory generated lightning current arcs (United States)

    Mitchard, D.; Clark, D.; Carr, D.; Haddad, A.


    A technique was developed for the comparison of observed emission spectra from lightning current arcs generated through self-breakdown in air and the use of two types of initiation wire, aluminum bronze and nichrome, against previously published spectra of natural lightning events. A spectrograph system was used in which the wavelength of light emitted by the lightning arc was analyzed to derive elemental interactions. A lightning impulse of up to 100 kA was applied to a two hemispherical tungsten electrode configuration which allowed the effect of the lightning current and lightning arc length to be investigated. A natural lightning reference spectrum was reconstructed from literature, and generated lightning spectra were obtained from self-breakdown across a 14.0 mm air gap and triggered along initiation wires of length up to 72.4 mm. A comparison of the spectra showed that the generated lightning arc induced via self-breakdown produced a very similar spectrum to that of natural lightning, with the addition of only a few lines from the tungsten electrodes. A comparison of the results from the aluminum bronze initiation wire showed several more lines, whereas results from the nichrome initiation wire differed greatly across large parts of the spectrum. This work highlights the potential use for spectrographic techniques in the study of lightning interactions with surrounding media and materials, and in natural phenomena such as recently observed ball lightning.

  6. Aspectos clínicos e de laboratório de cães soropositivos para leishmaniose Clinical and laboratorial aspects of seropositive dogs to leishmaniosis

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    D.G. Mattos Jr.


    Full Text Available Leihsmaniasis is a protozoal disease transmitted by dipteran insects. The dog is an important domestic host of both visceral and cutaneous forms of the disease. These forms affects humans in many countries, and it is considered a serious risk for human health. This study reports clinical and laboratorial data from 18 dogs. Nine dogs were positive by indirect immunofluorescence technique and the other nine were negative. The dogs were clinically monitored for 30 days and laboratorial changes were assessed. Three blood samples were collected for hemogram and serum biochemistry at 0, 15, and 30 days. The clinical signs of positive dogs were compatible with the disease, including lymphadenopathy, cutaneous ulcers, hyperthermia, apathy, cachexia and ulcerated mucosa. Marked differences were observed in the blood cell counts and blood biochemistry between positive and negative dogs. In conclusion, blood and biochemistry analyses of positive dogs were not sufficient to diagnose the disease within the period studied. The serologic test associated with the clinical signs are important to confirm the diagnosis.

  7. Prevalence of amyloid deposition in long standing rheumatoid arthritis in Iranian patients by abdominal subcutaneous fat biopsy and assessment of clinical and laboratory characteristics

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    Setarehshenas Roya


    Full Text Available Abstract Background The study was aimed at determining the prevalence of secondary amyloidosis in a group of Iranian patients with Rheumatoid Arthritis (RA, and the assessment of its correlation with the clinical and laboratory findings and data. Method A total number of 220 patients (167 female and 53 male with a minimum five-year history of RA were selected. Congo red staining method was used for staining the specimens obtained by abdominal subcutaneous fat biopsy (ASFB method. All of the specimens were examined for apple-green birefringence under polarized light microscope. Clinical and laboratory characteristics of the patients were assessed. Chi-square test and unpaired student's t-test were run for intergroup comparisons. Results Amyloid deposition test yielded positive results in 15 out of the 220 cases (6.8% examined by the ASFB technique. Thirteen patients were found to have minimal amyloid deposits. Of all the clinically significant cases, 8 (53% presented with proteinuria, and 7 cases (46.6% had severe constipation. Conclusion The prevalence of fat amyloid deposits in Iranian patients with RA is low. In up to half of the study group the deposits were subclinical. Follow up studies are required to determine whether this subclinical amyloidosis can develop into full-blown clinically significant amyloidosis.

  8. Clinical-laboratory characteristics of ANA-positive chronic idiopathic urticaria. (United States)

    Magen, Eli; Waitman, Dan-Andrei; Dickstein, Yoav; Davidovich, Valentina; Kahan, Natan R


    Despite the established association between chronic idiopathic/spontaneous urticaria (CIU) and presence of antinuclear antibodies (ANAs), the prevalence of autoimmune comorbidities in this population has not been analyzed. Here, we aim to identify clinical and laboratory manifestations associated with ANA-positive CIU. ANA-positive patients were identified via electronic data capture from the electronic patient record database of Leumit Health care Services (LHS) of Israel. Patient characteristics, medical histories, and details of diagnostic workup, medical treatment, and follow-up were retrieved by performing a chart review of electronic patient records (EPRs). The prevalence of target diseases among ANA(+) CIU(+), ANA(+) CIU(-), and ANA(-) CIU(+) patients was calculated. A total of 91 ANA(+) CIU(+), 3131 ANA(+) CIU(-), and 478 ANA(-) CIU(+) patients were identified. The ANA(+) CIU(+) group was characterized by higher prevalence of Sjögren's syndrome (SS)-A 52 antibodies (Ab) (7.7% versus 2.4%; p = 0.008), SS-A 60 Ab (11% versus 2.8%; p = ANA(-) CIU(+) group. Additionally, ANA(+) CIU(+) patients were more likely to be diagnosed with thyroid autoimmune diseases, higher C-reactive protein (6.4 ± 10.3 versus 4.1 ± 8.8 mg/L; p = 0.027), and more profound basopenia (0.04 ± 0.09 versus 0.15 ± 0.11 cell/mm(3); p ANA(-) CIU patients. More ANA(+) CIU(+) patients were resistant to four-fold standard licensed doses of antihistamines than ANA(-) CIU(+) patients [11 (12.1%) versus 29 (6.1%); p = 0.046]. ANA-positive CIU is characterized by higher prevalence of SS-A 52, SS-A 60, and SS-B antibodies and poorer clinical response to antihistamine medications.

  9. Clinical feasibility and safety of a novel miniature mobile cardiac catheterization laboratory in diagnosis and treatment for coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    Liang Ming; Han Yaling; Wang Geng; Yao Tianming; Sun Jingyang; Li Fei; Xu Kai


    Background The lack of medical facilities causes delayed diagnosis and treatment of coronary heart disease in remote mountainous area and/or at disaster site.The miniature mobile cardiac catheterization laboratory was developed to be an intervention platform for coronary heart disease diagnosis and treatment by our team.Pre-clinical research indicated that the miniature mobile cardiac catheterization laboratory performed well in the rescue of critical cardiovascular diseases,even ST-segment elevation myocardial infarction.The present study aimed to evaluate the clinical safety and timeliness of the miniature mobile cardiac catheterization laboratory for emergent coronary interventional diagnosis and treatment.Methods X-ray radiation safety and disinfection efficacy in the miniature mobile cardiac catheterization laboratory were tested during working status.Coronary angiography and/or percutaneous coronary intervention were performed in remote mountainous areas on patients who were first diagnosed as having coronary heart disease by senior interventional cardiologists.The percutaneous coronary intervention procedures and results from patients in the miniature mobile cardiac catheterization laboratory were compared with patients who were treated in the hospital catheter lab.Results The X-ray radiation dosages in the miniature mobile cardiac catheterization laboratory were 39.55 μGy/s,247.4 μGy/h,90.3 μGy/h and 39.4 μGy/h which were corresponded to 0 m,1 m,2 m and 3 m away from the tube central of the medium C-arm.And the radiation dosages used in the miniature mobile cardiac catheterization laboratory were less than the corresponding positions in the hospital catheter lab.The numbers of bacteria colonies in the miniature mobile cardiac catheterization laboratory in different environments range from (60±8) cfu/m3 to (120±10) cfu/m3 and met the demands of percutaneous coronary intervention.A total of 17 patients who received angiography in the miniature mobile

  10. Teaching during clinical practice: strategies and techniques used by preceptors in nursing education. (United States)

    Elisabeth, Carlson; Christine, Wann-Hansson; Ewa, Pilhammar


    The preceptor is a nurse who teaches and supports the student and is seen as pivotal to student learning within the clinical setting. Earlier studies have shown that preceptors' pedagogical competence is significant for facilitating learning during clinical practice. However, studies describing pedagogical competence, especially in terms of teaching strategies, seem to be scarce. The aim of this study was to describe which strategies and techniques preceptors use to teach undergraduate nursing students during clinical practice. The study had an ethnographic approach; methods used were participant observations and focus group interviews with nurses who were experienced in precepting undergraduate nursing students. Findings illustrated how preceptors used different strategies and techniques in a continuous process of adjusting, performing and evaluating precepting. Increased knowledge on how the preceptors actually teach student nurses during clinical practice will help facilitate educational programmes for preceptors, which will enhance their pedagogical skills and competences.

  11. Development of criteria for evaluating clinical response in thyroid eye disease using a modified Delphi technique

    DEFF Research Database (Denmark)

    Douglas, Raymond S; Tsirbas, Angelo; Gordon, Mark;


    OBJECTIVE: To identify components of a provisional clinical response index for thyroid eye disease using a modified Delphi technique. METHODS: The International Thyroid Eye Disease Society conducted a structured, 3-round Delphi exercise establishing consensus for a core set of measures for clinical...... exercise, we developed provisional core measures for assessing disease activity and severity in clinical trials of therapies for thyroid eye disease. These measures will be iteratively refined for use in multicenter clinical trials.......% of participants) rated 153 criteria in Delphi 3 (67 criteria were excluded because of redundancy). Criteria with a mean greater than 6 (1 = least appropriate to 9 = most appropriate) were further evaluated by the nominal group technique and provisional core measures were chosen. CONCLUSIONS: Using a Delphi...

  12. Surgical extrusion technique for clinical crown lengthening: report of three cases. (United States)

    Kim, Chang-Sung; Choi, Seong-Ho; Chai, Jung-Kiu; Kim, Chong-Kwan; Cho, Kyoo-Sung


    Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths crown lengthening; it does not induce functional or esthetic deformities, especially in the anterior region.

  13. Characterization of the storage pool of the Neutron Standards Laboratory of CIEMAT, using Monte Carlo techniques

    Energy Technology Data Exchange (ETDEWEB)

    Campo B, X.; Mendez V, R.; Embid S, M. [Centro de Investigaciones Energeticas, Medioambientales y Tecnologicas, Av. Complutense 40, 28040 Madrid (Spain); Vega C, H. R. [Universidad Autonoma de Zacatecas, Unidad Academica de Estudios Nucleares, Cipres No. 10, Fracc. La Penuela, 98060 Zacatecas (Mexico); Sanz G, J., E-mail: [Universidad Nacional de Educacion a Distancia, Escuela Tecnica Superior de Ingenieros Industriales, C. Juan del Rosal 12, 28040 Madrid (Spain)


    Neutron Standards Laboratory of CIEMAT in Spain is a brand new irradiation facility, with {sup 241}Am-Be (185 GBq) and {sup 252}Cf (5 GBq) calibrated neutron sources which are stored in a water pool with a concrete cover. From this storage place an automated system is able to take the selected source and place it in the irradiation position, 4 m over the ground level and in the geometrical center of the Irradiation Room with 9 m (length) x 7.5 m (width) x 8 m (height). For calibration or irradiation purposes, detectors or materials can be placed on a bench but it is possible to use the pool (1.0 m x 1.5 m and more than 1.0 m depth) for long time irradiations in thermal neutron fields. For this reason it is essential to characterize the pool itself in terms of neutron spectrum. In this document, the main features of this facility are presented and the characterization of the storage pool in terms of neutron fluence rate and neutron spectrum has been carried out using simulations with MCNPX-2.7.e code. The MCNPX-2.7.e model has been validated using experimental measurements outside the pool (Bert hold LB6411). Inside the pool, the fluence rate decreases and the spectra is thermalized with the distance to the {sup 252}Cf source. This source predominates and the effect of the {sup 241}Am-Be source in these magnitudes is not shown until positions closer than 20 cm from it. (author)

  14. Laboratory Techniques in Geology: Embedding Analytical Methods into the Undergraduate Curriculum (United States)

    Baedke, S. J.; Johnson, E. A.; Kearns, L. E.; Mazza, S. E.; Gazel, E.


    Paid summer REU experiences successfully engage undergraduate students in research and encourage them to continue to graduate school and scientific careers. However these programs only accommodate a limited number of students due to funding constraints, faculty time commitments, and limited access to needed instrumentation. At JMU, the Department of Geology and Environmental Science has embedded undergraduate research into the curriculum. Each student fulfilling a BS in Geology or a BA in Earth Science completes 3 credits of research, including a 1-credit course on scientific communication, 2 credits of research or internship, followed by a presentation of that research. Our department has successfully acquired many analytical instruments and now has an XRD, SEM/EDS, FTIR, handheld Raman, AA, ion chromatograph, and an IRMS. To give as many students as possible an overview to the scientific uses and operation methods for these instruments, we revived a laboratory methods course that includes theory and practical use of instrumentation at JMU, plus XRF sample preparation and analysis training at Virginia Tech during a 1-day field trip. In addition to practical training, projects included analytical concepts such as evaluating analytical vs. natural uncertainty, determining error on multiple measurements, signal-to-noise ratio, and evaluating data quality. State funding through the 4-VA program helped pay for analytical supplies and support for students to complete research projects over the summer or during the next academic year using instrumentation from the course. This course exemplifies an alternative path to broadening participation in undergraduate research and creating stronger partnerships between PUI's and research universities.

  15. Transcortical selective amygdalohippocampectomy technique through the middle temporal gyrus revisited: An anatomical study laboratory investigation. (United States)

    Bozkurt, Baran; da Silva Centeno, Ricardo; Chaddad-Neto, Feres; da Costa, Marcos Devanir Silva; Goiri, Marcelo Augusto Acosta; Karadag, Ali; Tugcu, Bekir; Ovalioglu, Talat Cem; Tanriover, Necmettin; Kaya, Serdar; Yagmurlu, Kaan; Grande, Andrew


    The anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SelAH) have been used for surgical treatment of mesial temporal lobe epilepsy. We examined the comprehensive white matter tract anatomy of the temporal lobe to gain an insight into the trans-middle temporal gyrus, a lateral approach which has been commonly used. The transmiddle temporal gyrus approach was performed in a stepwise manner on cadaveric human heads to examine the traversing white matter pathways through it and the structures located in the temporal horn. We reviewed the literature to compare the trans-middle temporal gyrus approach with other SelAH techniques based on surgical outcomes. There does not appear to be a significant difference in seizure outcome between SelAH and ATL. However, the SelAH provides a better neuropsychological outcomes than the ATL in selected patients. Each SelAH approach has individual advantages and disadvantages. Based on our anatomical study, in the transcortical amygdalohippocampectomy technique through the middle temporal gyrus the white matter pathways to be encountered. In the temporal horn, the collateral eminence, hippocampus, lateral ventricular sulcus, choroidal fissure, inferior choroidal point, choroid plexus, fimbria of the fornix, and amygdala are exposed. The subpial dissection is performed along the lateral ventricular sulcus from the collateral eminence on lateral side and from the choroidal fissure on medial side by microdissector for en bloc resection of the hippocampus proper. The trans-middle temporal gyrus approach is commonly used in treatment of mesial temporal lobe epilepsy patients. A better anatomical and functional understanding of the structures of the temporal lobe is crucial for safer and more accurate surgery.

  16. Bacterial Adhesion and Surface Roughness for Different Clinical Techniques for Acrylic Polymethyl Methacrylate



    This study sought to assess the effect of different surface finishing and polishing protocols on the surface roughness and bacterial adhesion (S. sanguinis) to polymethyl methacrylates (PMMA). Fifty specimens were divided into 5 groups (n = 10) according to their fabrication method and surface finishing protocol: LP (3 : 1 ratio and laboratory polishing), NF (Nealon technique and finishing), NP (Nealon technique and manual polishing), MF (3 : 1 ratio and manual finishing), and MP (3 : 1 ratio...

  17. Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

    Directory of Open Access Journals (Sweden)

    Luca Masotti


    Full Text Available Luca Masotti1,8, Patrick Ray2, Marc Righini3, Gregoire Le Gal4, Fabio Antonelli5, Giancarlo Landini1, Roberto Cappelli6, Domenico Prisco7, Paola Rottoli81Internal Medicine, Cecina Hospital, Cecina, Italy; 2Department of Emergency Medicine, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie-Paris 6, Paris, France; 3Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland; 4Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France; 5Clinical Chemistry, Cecina Hospital, Cecina, Italy; 6Department of Internal, Cardiovascular and Geriatric Medicine, University of Siena, Siena, Italy; 7Department of Critical Care Medicine, Thrombosis Centre, Careggi Hospital, Florence, Italy; 8Departiment of Clinical Medicine and Immunological Sciences, Division of Respiratory Diseases, University of Siena, Siena, ItalyObjective: Diagnosis of pulmonary embolism (PE remains difficult and is often missed in the elderly due to nonspecific and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more.Materials and Methods: Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE in the title, abstract or text, were reviewed.Results: Dyspnea (range 59%–91.5%, tachypnea (46%–74%, tachycardia (29%–76%, and chest pain (26%–57% represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%–67%; deep vein


    Directory of Open Access Journals (Sweden)

    E. N. Simovanyan


    Full Text Available Adverse course of enterovirus-71 infection (EVI-71 in children, frequent development of the nervous system pathology determine the need for early disease diagnosis. The study included 139 children aged 6 months to 13 years. Modern EVI-71 features is a frequent defeat of children aged from 3 to 7 years, attending organized groups, the priority development of combined moderate severity forms without nervous system pathology. EVI-71 is characterized by cyclical course, appearance in the first two disease days fever, murrain-like, catarrhal, lymphoproliferative syndromes, conjunctivitis, headaches. The second stage of the disease (3— 6 days in 37.9% children accompanied by attaching of meningitis and meningoencephalitis symptoms (common cerebral, meningeal and encephalic syndromes, changes in cerebrospinal fluid. In the EVI-71 diagnosis must be observed epidemiological history, clinical and laboratory parameters, detection of enterovirus-71 and its RNA from feces, oropharyngeal mucus and cerebrospinal fluid. Patients with EVI-71 need for combined treatment, including causal agents and pathogenetic therapy. 

  19. [Clinical laboratory medicine: continuous amelioration with a book of objectives and satisfaction survey]. (United States)

    Reix, Nathalie; Agin, Arnaud; Bahram, Seiamak; Dali-Youcef, Nassim; Grucker, Daniel; Jaulhac, Benoît; Lepiller, Quentin; Lessinger, Jean-Marc; Mauvieux, Laurent; Monier, Laurie; Schramm, Frédéric; Stoll-Keller, Françoise; Vallat, Laurent; Ludes, Bertrand; Candolfi, Ermanno; Filisetti, Denis


    We report in this publication the use of two educational tools, a questionnaire of satisfaction and a training book, to improve the training of students during their internship in clinical laboratory at the "Pôle de biologie des Hôpitaux universitaires de Strasbourg" in France. First, the ongoing training was assessed by the interns with a questionnaire measuring satisfaction. The analysis of this questionnaire identified four key points to improve: 1) define the teaching objectives, 2) organize the training with a schedule, 3) revise certain teaching methods and 4) ensure better integration of the students in the team of medical biologists. After this assessment, we implemented a training book to answer these four points. Indeed, the training book presents the objectives, the schedule of training, and how to validate the educational objectives. A new assessment was performed again using the same methodology. Results showed an improvement in student satisfaction from 74 to 88 %. The questionnaire of satisfaction and the training book are presented in this article. The aim of the assessment of training combined with the training book is to incite the actors of the training (students and teachers) to continually improve the training. The objectives of the Pôle de Biologie are to obtain an 80 % satisfaction rate during the 6 months trainings and to reduce or eliminate dissatisfaction, and finally to ensure the validation by students of 80 to 100 % of their predetermined objectives.

  20. Behaviour of Clinical, Anthropometric and Laboratory Variables in Patients with Metabolic Syndrome

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    Madelaine Hernández Tamayo


    Full Text Available Background: Diagnosing patients with metabolic syndrome is important because of the high prevalence and risk they present. Objective: to determine the behaviour of some clinical, anthropometric and laboratory variables in patients with metabolic syndrome. Methods: A descriptive study was conducted. The sample included 161 patients selected at random in different research stages from a universe including all the patients who attended six different consultations in Urbano Noris municipality, Holguín, from September 2008 to June 2009. Diagnosis was performed according to the ATP-III. Variance analysis and Fisher's exact test in SPSS (α = 0.05 were applied. Results: Patients with metabolic syndrome (n = 103: 63.97% presented values over average weight, height, waist circumference, body mass index, systolic blood pressure, plasma cholesterol, LDL, triglycerides and glucose. Their HDL levels were lower. A significant association between metabolic syndrome and CRP, microalbuminuria, alterations in blood sugar levels and hypertension was proved. Conclusions: The importance of characterizing the metabolic syndrome for future interventions was determined.

  1. Rare hereditary red blood cell enzymopathies associated with hemolytic anemia - pathophysiology, clinical aspects, and laboratory diagnosis. (United States)

    Koralkova, P; van Solinge, W W; van Wijk, R


    Hereditary red blood cell enzymopathies are genetic disorders affecting genes encoding red blood cell enzymes. They cause a specific type of anemia designated hereditary nonspherocytic hemolytic anemia (HNSHA). Enzymopathies affect cellular metabolism, which, in the red cell, mainly consists of anaerobic glycolysis, the hexose monophosphate shunt, glutathione metabolism, and nucleotide metabolism. Enzymopathies are commonly associated with normocytic normochromic hemolytic anemia. In contrast to other hereditary red cell disorders such as membrane disorders or hemoglobinopathies, the morphology of the red blood cell shows no specific abnormalities. Diagnosis is based on detection of reduced specific enzyme activity and molecular characterization of the defect on the DNA level. The most common enzyme disorders are deficiencies of glucose-6-phosphate dehydrogenase (G6PD) and pyruvate kinase (PK). However, there are a number of other enzyme disorders, often much less known, causing HNSHA. These disorders are rare and often underdiagnosed, and the purpose of this review. In this brief review, we provide an overview of clinically relevant enzymes, their function in red cell metabolism, and key aspects of laboratory diagnosis.

  2. Recurrent respiratory disorders in Polish Konik horses - clinical and laboratory findings

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    Niedźwiedź Artur


    Full Text Available The aim of this study was to investigate the causes of chronic respiratory disorders in Polish Konik horses maintained in a stable and pasture, under condition typical for pleasure horses in Poland. The study was conducted on 14 adult horses, consistent with regard to environment and living conditions. The horses were divided into two groups: seven horses not affected by any respiratory problem (control group and seven horses with history of lower airway disease (study group. Clinical and laboratory evaluation, endoscopic examination, bronchoalveolar lavage, tracheal wash, and lung ultrasound were performed in all horses. Median (25th and 75th percentiles for bronchoalveolar lavage fluid differential cell count in control horses was 55.8 (49.8 and 59.1 of macrophages, 41 (38.5 and 45.9 of lymphocytes, and 5.1 (4.1 and 5.3 of neutrophils, whereas in the study group they were 32.8 (25.9 and 35.7 of macrophages, 59.8 (51.3 and 64.8 of lymphocytes, and 38.1 (34.8 and 41.1 of neutrophils. It was concluded that chronic respiratory disorders in Polish Konik horses were probably caused by recurrent airway obstruction.

  3. Identification of rare pathogenic bacteria in a clinical microbiology laboratory: impact of matrix-assisted laser desorption ionization-time of flight mass spectrometry. (United States)

    Seng, Piseth; Abat, Cedric; Rolain, Jean Marc; Colson, Philippe; Lagier, Jean-Christophe; Gouriet, Frédérique; Fournier, Pierre Edouard; Drancourt, Michel; La Scola, Bernard; Raoult, Didier


    During the past 5 years, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) has become a powerful tool for routine identification in many clinical laboratories. We analyzed our 11-year experience in routine identification of clinical isolates (40 months using MALDI-TOF MS and 91 months using conventional phenotypic identification [CPI]). Among the 286,842 clonal isolates, 284,899 isolates of 459 species were identified. The remaining 1,951 isolates were misidentified and required confirmation using a second phenotypic identification for 670 isolates and using a molecular technique for 1,273 isolates of 339 species. MALDI-TOF MS annually identified 112 species, i.e., 36 species/10,000 isolates, compared to 44 species, i.e., 19 species/10,000 isolates, for CPI. Only 50 isolates required second phenotypic identifications during the MALDI-TOF MS period (i.e., 4.5 reidentifications/10,000 isolates) compared with 620 isolates during the CPI period (i.e., 35.2/10,000 isolates). We identified 128 bacterial species rarely reported as human pathogens, including 48 using phenotypic techniques (22 using CPI and 37 using MALDI-TOF MS). Another 75 rare species were identified using molecular methods. MALDI-TOF MS reduced the time required for identification by 55-fold and 169-fold and the cost by 5-fold and 96-fold compared with CPI and gene sequencing, respectively. MALDI-TOF MS was a powerful tool not only for routine bacterial identification but also for identification of rare bacterial species implicated in human infectious diseases. The ability to rapidly identify bacterial species rarely described as pathogens in specific clinical specimens will help us to study the clinical burden resulting from the emergence of these species as human pathogens, and MALDI-TOF MS may be considered an alternative to molecular methods in clinical laboratories.

  4. The Combined Technique for Detection of Artifacts in Clinical Electroencephalograms of Sleeping Newborns


    Schetinin, Vitaly; Schult, Joachim


    In this paper we describe a new method combining the polynomial neural network and decision tree techniques in order to derive comprehensible classification rules from clinical electroencephalograms (EEGs) recorded from sleeping newborns. These EEGs are heavily corrupted by cardiac, eye movement, muscle and noise artifacts and as a consequence some EEG features are irrelevant to classification problems. Combining the polynomial network and decision tree techniques, we discover comprehensible ...

  5. Medical expert systems developed in j.MD, a Java based expert system shell: application in clinical laboratories. (United States)

    Van Hoof, Viviane; Wormek, Arno; Schleutermann, Sylvia; Schumacher, Theo; Lothaire, Olivier; Trendelenburg, Christian


    Growing complexity of diagnostic tests, combined with increased workload, stringent laboratory accreditation demands, continuous shortening of turn-around-time and budget restrictions have forced laboratories to automate most of their iterative tasks. Introduction of artificial intelligence by means of expert systems has gained an important place in this automation process. Different parts of clinical laboratory activity can benefit from their implementation and the present project deals with one aspect, namely the clinical interpretation of diagnostic tests. This paper describes how j.MD, a new Java based expert system shell, was used to reprogram the expert system for interpretation of amylase isoenzyme patterns that has been in use for many years in our laboratory, and that was originally programmed in Pro.MD, a Prolog based expert system shell. One of the most important advantages of the j.MD system is its bidirectional link with the laboratory information system. This project shows how expert systems for the interpretation of complex diagnostic tests that demand specific expertise can become an integrated part of the automated clinical chemistry lab.

  6. The clinical features, laboratory findings, treatment and follow-up results of patients with morphea

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    Nehir Parlak


    Full Text Available Objective: Morphea, also known as localized scleroderma, is a rare skin disease of unknown pathogenesis, characterized by fibrosis in the skin and subcutaneous tissue. In this study, we aim to evaluate the demographic features, clinical characteristics, laboratory findings, and response to treatment in patients diagnosed with morphea. Materials and Methods: The findings of fifty eight patients diagnosed with morphea were retrospectively evaluated between 1995-2011. All patients' clinical symptoms, concomitant diseases, symptoms, immunological features and presence of peripheral eosinophilia were investigated. Treatment methods, response to therapy of 40 patients whose treatment continued for 2-12 months were examined. Fourty nine patients (84.5% were female and 9 patients (15.5% were male of 58 patients who were diagnosed with morphea. The mean age of patients was 42.33±18.44 years (range: 7-75 years. Diagnosis was made histopathologically in all cases. Borrelia antibodies were negative in all patients enrolling the study. Thirty six patients (62.1% had plaque type, 17 patients (29.3% had generalized type, 3 patients (5.2% had mixed type (linear + plaque and 2 patients (3.4% had linear type of morphea. ANA was found to be positive in 12 (26.2% of 46 patients. Considering the relationship between the clinical types of morphea with ANA, 38.5% of plaque type, 53.8% of generalized type, 7.7% of mixed type patients showed ANA positivity. ANA positivity was statistically significant in patients with generalized morphea (p=0.027. Peripheral eosinophilia was detected in one case in whom lesions were generalized (2.1%. Colchicine therapy was given to 23 cases. Complete and partial response rates are 47.8% and 26.1%, respectively. However, 17.4% of patients remained stable and progression was noted in 8.7% of the cases. Conclusion: In conclusion, plaque type morphea is the most common type of morphea. ANA positivity was statistically significant in

  7. Clinical and Laboratory Features, Treatment and Prognosis in Children with Guillian-Barre Syndrome

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    N. A. Suponeva


    Full Text Available A retrospective study of 42 cases of acute flaccid paralysis (AFP in children aged between 7 months and 15 years, registered at the Municipal Clinical Hospital №1 throughout a 7 year period (2007—2014, was performed to investigate the features of pediatric Guillian-Barre Syndrome (GBS. GBS has shown to be the most common cause of AFP in children, with prevalence of 74% of all 31 cases. Clinical manifestations, functional status, laboratory and electrodiagnostic data were evaluated in group of 31 children in order to highlight particular features of childhood GBS in Russia. The highest frequency of GBS was observed in children aged between 1 to 3 with the median 6 [3; 11] years. Boys with GBS outnumbered girls by a 2,1:1 ratio. No seasonal dependence has been observed, with children equally suffering from this disease without a seasonal pattern throughout the year. According to the electrophysiological and clinical data, 24 children were diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (AIDP (77%, 5 with acute motor axonal neuropathy (AMAN (16% and 2 with аcute motor-sensory axonal neuropathy (AMSAN in a total of cases (7%. Several exclusive features of GBS in children for Russia were discovered. The most common initial symptom was limb pain, with the impartial sensory disturbance found only in 13% of the patients observed, 10% of which were paresthesias and the remaining 3% belonging to hypostesias. Children reached the nadir state rapidly, the median time from onset to nadir was 9.5 [6,25; 12,5] days. Cranial nerve dysfunction at nadir was observed in a greater percentage of patients (51% compared to that of 23% cases at the onset, with the facial palsy increasing from 10 to 32% and the bulbar palsy from 12 to 19%. The patients were given intravenous immunoglobulin in various doses: from 0.2 to 1.75 mg/kg per course (0.5 [0.5; 0.8] g/kg and/or plasmapheresis with a median volume of 93 [81; 100] ml/kg per

  8. 78 FR 31560 - Medicare Program; Public Meeting in Calendar Year 2013 for New Clinical Laboratory Test Payment... (United States)


    ... auditorium of the Centers for Medicare & Medicaid Services (CMS), Central Building, 7500 Security Boulevard... [CMS-1451-N] Medicare Program; Public Meeting in Calendar Year 2013 for New Clinical Laboratory Test Payment Determinations AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION:...

  9. Using pathology-specific laboratory profiles in Clinical Pathology to reduce inappropriate test requesting: two completed audit cycles

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    Baricchi Roberto


    Full Text Available Abstract Background Systematic reviews have shown that, although well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy, it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles. Methods Observational study with two cycles of retrospective audit on test request forms, in a primary care setting. Objectives of the study were to develop pathology-specific laboratory profiles and to increase the number of provisional diagnoses on laboratory test request forms. A Multiprofessional Multidisciplinary Inter-hospital Work Team developed pathology-specific laboratory profiles for more effective test requesting. After 8 training sessions that used a combined strategy with multifaceted interventions, the 23 General Practitioners (GPs in the trial district (Castelnovo nè Monti tested the profiles; the 21 GPs in the Puianello district were the control group; all GPs in both districts participated in the trial. All laboratory tests for both healthcare districts are performed at the Laboratory located in the trial district. A baseline and a 1-year audit were performed in both districts on the GPs’ request forms. Results Seven pathology-specific laboratory profiles for outpatients were developed. In the year after the first audit cycle: 1 the number of tests requested in the trial district was distinctly lower than that in the previous year, with a decrease of about 5% (p  Conclusions The first audit cycle showed a significant decrease in the number of tests ordered only in the trial district. The combined strategy used in this study improved the prescriptive compliance of most of the GPs involved. The presence of the clinical pathologist is seen as an added value.

  10. EC4 European Syllabus for Post-Graduate Training in Clinical Chemistry and Laboratory Medicine: version 3 - 2005. (United States)

    Zerah, Simone; McMurray, Janet; Bousquet, Bernard; Baum, Hannsjorg; Beastall, Graham H; Blaton, Vic; Cals, Marie-Josèphe; Duchassaing, Danielle; Gaudeau-Toussaint, Marie-Françoise; Harmoinen, Aimo; Hoffmann, Hans; Jansen, Rob T; Kenny, Desmond; Kohse, Klaus P; Köller, Ursula; Gobert, Jean-Gérard; Linget, Christine; Lund, Erik; Nubile, Giuseppe; Opp, Matthias; Pazzagli, Mario; Pinon, Georges; Queralto, José M; Reguengo, Henrique; Rizos, Demetrios; Szekeres, Thomas; Vidaud, Michel; Wallinder, Hans


    The EC4 Syllabus for Postgraduate Training is the basis for the European Register of Specialists in Clinical Chemistry and Laboratory Medicine. The syllabus: Indicates the level of requirements in postgraduate training to harmonise the postgraduate education in the European Union (EU); Indicates the level of content of national training programmes to obtain adequate knowledge and experience; Is approved by all EU societies for clinical chemistry and laboratory medicine. The syllabus is not primarily meant to be a training guide, but on the basis of the overview given (common minimal programme), national societies should formulate programmes that indicate where knowledge and experience is needed. The main points of this programme are: Indicates the level of requirements in postgraduate training to harmonise the postgraduate education in the European Union (EU); Indicates the level of content of national training programmes to obtain adequate knowledge and experience; Is approved by all EU societies for clinical chemistry and laboratory medicine. Knowledge in biochemistry, haematology, immunology, etc.; Pre-analytical conditions; Evaluation of results; Interpretations (post-analytical phase); Laboratory management; and Quality insurance management. The aim of this version of the syllabus is to be in accordance with the Directive of Professional Qualifications published on 30 September 2005. To prepare the common platforms planned in this directive, the disciplines are divided into four categories: Indicates the level of requirements in postgraduate training to harmonise the postgraduate education in the European Union (EU); Indicates the level of content of national training programmes to obtain adequate knowledge and experience; Is approved by all EU societies for clinical chemistry and laboratory medicine. Knowledge in biochemistry, haematology, immunology, etc.; Pre-analytical conditions; Evaluation of results; Interpretations (post-analytical phase); Laboratory

  11. Antifungal susceptibility of clinical and environmental isolates of Cryptococcus neoformans to four antifungal drugs determined by two techniques. (United States)

    Moraes, E M P; Prímola, N S; Hamdan, Júnia Soares


    A total of 64 Cryptococcus neoformans strains, including clinical and environmental Brazilian isolates var. neoformans and var. gattii, were tested for susceptibility to amphotericin B, 5-flucytosine, fluconazole and itraconazole. The tests were performed according to the recommendations of National Committee of Clinical Laboratory Standards and the method of macrodilution in liquid medium of Shadomy et al. [Manual de Microbiologia Clínica, 4th ed. Buenos Aires: Editorial Medica Panamericana, 1987: 1229-38]. For most drugs there was a significant difference between the readings taken at 24 and 48 h with both methods. When the minimum inhibitory concentrations obtained by the two techniques were compared, significant differences were observed for amphotericin B and fluconazole. Overall, differences in drug susceptibility with respect to the origin of the isolates or the variety of the fungus were not observed. As an exception, the gattii variety exhibited a high resistance rate to amphotericin B when the technique of Shadomy et al. was applied, a fact possibly related to the greater difficulty for treatment of the disease caused by this fungal variety.

  12. Clinical immunology review series: an approach to the use of the immunology laboratory in the diagnosis of clinical allergy. (United States)

    Williams, P; Sewell, W A C; Bunn, C; Pumphrey, R; Read, G; Jolles, S


    In the last 10 years UK immunology laboratories have seen a dramatic increase in the number and range of allergy tests performed. The reasons for this have been an increase in the incidence of immunoglobulin E (IgE)-mediated allergic disease set against a background of greater public awareness and more referrals for assessment. Laboratory testing forms an integral part of a comprehensive allergy service and physicians treating patients with allergic disease need to have an up-to-date knowledge of the range of tests available, their performance parameters and interpretation as well as the accreditation status of the laboratory to which tests are being sent. The aim of this review is to describe the role of the immunology laboratory in the assessment of patients with IgE-mediated allergic disease and provide an up-to-date summary of the tests currently available, their sensitivity, specificity, interpretation and areas of future development.

  13. Laboratory two-dimensional X-ray microdiffraction technique: a support for authentication of an unknown Ghirlandaio painting (United States)

    Bontempi, E.; Benedetti, D.; Massardi, A.; Zacco, A.; Borgese, L.; Depero, L. E.


    Europe has a very rich and diversified cultural heritage of art works, including buildings, monuments and objects of all sizes, involving a great variety of materials. The continuous discovery of new art works opens the problem of their authentication. Advanced analytical techniques can be fundamental to understand the way of life, the culture and the technical and intellectual know-how of the artists. Indeed, the authentication of an art work involves the identification of the used materials, their production techniques and procedures used for the work realization. It is possible to know the origin and provenance of materials, including the location of the natural sources. Advanced analytical techniques also help one to understand degradation processes, corrosion, weathering, and preservation-conservation protocols. In this paper we present a painting attributed to Domenico Ghirlandaio. Ghirlandaio is a well-known artist of fifteenth century who contributes to the apprenticeship of Michelangelo Buonarroti. The study of the pigments used in this painting, which belongs to a private collection, has been supported mainly by means of laboratory two-dimensional X-ray microdiffraction (μXRD2). The possibility to obtain information about not only the phase, but also microstructure allows one to extract interesting consideration and to obtain evidence of the painter’s style and intention.

  14. [Forum on tissue expansion. Expansion of the scalp. Surgical techniques and clinical applications]. (United States)

    Foyatier, J L; Delay, E; Comparin, J P; Latarjet, J; Masson, C L


    Repair of all forms of alopecia is one of the principal applications of scalp expansion. The authors have inserted 400 expansion prostheses, including 20 in the scalp. The surgical technique, choice of material and various types of flaps are described and illustrated by clinical cases of extensive alopecia.

  15. Clinical and laboratory toxicity after intra-arterial radioembolization with (90y-microspheres for unresectable liver metastases.

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    Maarten L J Smits

    Full Text Available OBJECTIVE: To investigate clinical and laboratory toxicity in patients with unresectable liver metastases, treated with yttrium-90 radioembolization ((90Y-RE. METHODS: Patients with liver metastases treated with (90Y-RE, between February 1(st 2009 and March 31(st 2012, were included in this study. Clinical toxicity assessment was based on the reporting in patient's charts. Laboratory investigations at baseline and during a four-month follow-up were used to assess laboratory toxicity according to the Common Terminology Criteria for Adverse Events version 4.02. The occurrence of grade 3-4 laboratory toxicity was stratified according to treatment strategy (whole liver treatment in one session versus sequential sessions. Response assessment was performed at the level of target lesions, whole liver and overall response in accordance with RECIST 1.1 at 3- and 6 months post-treatment. Median time to progression (TTP and overall survival were calculated by Kaplan-Meier analysis. RESULTS: A total of 59 patients, with liver metastases from colorectal cancer (n = 30, neuroendocrine tumors (NET (n = 6 and other primary tumors (n = 23 were included. Clinical toxicity after (90Y-RE treatment was confined to grade 1-2 events, predominantly post-embolization symptoms. No grade 3-4 clinical toxicity was observed, whereas laboratory toxicity grade 3-4 was observed in 38% of patients. Whole liver treatment in one session was not associated with increased laboratory toxicity. Three-months disease control rates for target lesions, whole liver and overall response were 35%, 21% and 19% respectively. Median TTP was 6.2 months for target lesions, 3.3 months for the whole liver and 3.0 months for overall response. Median overall survival was 8.9 months. CONCLUSION: The risk of severe complications or grade 3-4 clinical toxicity in patients with liver metastases of various primary tumors undergoing (90Y-RE is low. In contrast, laboratory toxicity grade 3

  16. [Use of the in vivo microdialysis technique in basic and clinical research]. (United States)

    Nedvídková, J; Nedvídek, J; Koska, J; Ksinantová, L; Vigas, M; Kvetnanský, R; Pacák, K


    Microdialysis is in vivo technique that permits monitoring of local concentrations of metabolites and drugs at specific sites in the body that makes it an attractive tool for the basic and clinical research. Microdialysis entered the experimental studies of the brain, and later also of the peripheral tissues such as adipose and muscle tissues, kidney, lung, eye, skin, and blood. There are several critical factors in the experimental implementations of microdialysis: the probe, the perfusion solution, tissue integrity, and the sensitivity of microdialysate analysis method. When the experimental conditions are optimised to give valid results, microdialysis can provide numerous data from the relatively small number of individual subjects. It can bring about detailed clinical information reflecting free metabolite and drug concentrations in studied tissues and/or in plasma. With the progress of analytical methods, applications and importance of the microdialysis technique in clinical and pharmacokinetic research and diagnostics will increase.

  17. Effect of seasonal variation on adult clinical laboratory parameters in Rwanda, Zambia, and Uganda: implications for HIV biomedical prevention trials.

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    Eugene Ruzagira

    Full Text Available To investigate the effect of seasonal variation on adult clinical laboratory parameters in Rwanda, Zambia, and Uganda and determine its implications for HIV prevention and other clinical trials.Volunteers in a cross-sectional study to establish laboratory reference intervals were asked to return for a seasonal visit after the local season had changed from dry to rainy or vice versa. Volunteers had to be clinically healthy, not pregnant and negative for HIV, Hepatitis B and C, and syphilis infection at both visits. At each visit, blood was taken for measurement of hemoglobin, haematocrit, mean corpuscular volume, red blood cells, platelets, total white blood cells (WBC, neutrophils, lymphocytes, monocytes, eosinophils, basophils, CD4/CD8 T cells, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, direct bilirubin, total bilirubin, total immunoglobulin gamma, total protein, creatinine, total amylase, creatine phosphokinase and lactate dehydrogenase (LDH. Consensus dry season reference intervals were applied to rainy season values (and vice versa and the proportion of 'out-of-range' values determined. Percentage differences between dry and rainy season parameter mean values were estimated.In this cohort of 903 volunteers, less than 10.0% of consensus parameter (except LDH values in one season were "out-of-range" in the other. Twenty-two (22 percent of rainy season LDH values fell outside of the consensus dry season interval with the higher values observed in the rainy season. Variability between consensus seasonal means ranged from 0.0% (total WBC, neutrophils, monocytes, basophils, and direct bilirubin to 40.0% (eosinophils. Within sites, the largest seasonal variations were observed for monocytes (Masaka, 11.5%, LDH (Lusaka, 21.7%, and basophils (Kigali, 22.2%.Seasonality had minimal impact on adult clinical laboratory parameter values in Rwanda, Zambia, and Uganda. Seasonal variation may not be an important factor in the

  18. Musculoskeletal wide detector CT: Principles, techniques and applications in clinical practice and research

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    Gondim Teixeira, Pedro Augusto, E-mail: [Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex (France); Gervaise, Alban [Medical Imaging Department, Legouest Military Instruction Hospital, 27 Avenue de Plantières, BP 90001, 57077 Metz Cedex 3 (France); Louis, Matthias; Lecocq, Sophie; Raymond, Ariane; Aptel, Sabine; Blum, Alain [Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex (France)


    Highlights: • Wide area-detector CT availability is growing steadily. • Advanced techniques such as Dynamic CT, Perfusion CT and dual energy can be used in clinical practice. • Optimal acquisition protocol is needed to increase diagnostic performance and limit dose exposure. • Guidelines for data acquisition and interpretation may increase diagnostic performance and reproducibility. - Abstract: A progressive increase in the detector width in CT scanners has meant that advanced techniques such as dynamic, perfusion and dual-energy CT are now at the radiologist's disposal. Although these techniques may be important for the diagnosis of various musculoskeletal diseases, data acquisition and interpretation can be challenging. This article offers a practical guide for the use of these tools including acquisition protocol, post-processing options and data interpretation based on 7 years of clinical experience in a tertiary university hospital.

  19. Clinical and Laboratory Findings of a Group of Iranian Patients with Oral Lichen Planus

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    Darvishpoor Kakhki H.


    Full Text Available atement of Problem: Lichen planus (LP is a chronic disease that affects skin and mucous membranes. Lesions of oral lichen planus (OLP can persist for a long time. Varying prevalence rates of oral lichen planus have been reported in different parts of the world, while information regarding the epidemiology of this disease in Iran is incomplete.Purpose: This study was designed to evaluate the characteristics of oral lichen planus in a group of Iranian patients and compare the results with similar conducted studies in other populations. Materials and Method: In this descriptive study data were collected from charts of 158 patients In Kerman, Iran (1997-2005 over 8 consecutive years. For each patient, age at presentation, gender, chief complaint, duration of chief compliant, previous treatment, current medications, skin involvement and a complete medical history has been recorded. A number of possible etiologic factors and possible presence of diabetes or liver disease also analyzed. Laboratory evaluations consisted of glucose tolerance test (GTT and liver function tests (LFT. This data were analyzed by SPSS version 12 statistical software. Results: The mean age of study population was 41.16 years. Subjects were predominantly female (65.1%. Liver function tests (LFT were abnormal in 19.6% of cases. Disturbance of glucose metabolism and fasting blood sugar was also higher than normal limit in10.8% and 2.9 % of cases respectively. Atrophic-erosive lesions were found in 17 of the cases. In 50 patients the lesions were exclusively keratotic and in 91 the lesions were atrophic-erosive and keratotic. Most oral lesions were multifocal (88.6%, with the buccal mucosa being the most common location in each clinical form (87.3%. Duration of oral lesions ranged from 0.4 to 20 years with a mean of 1.54 year. Conclusion: This study showed that epidemiological and clinical features of the disease in Kerman are similar to those mentioned in literature. Also, in

  20. Use of bar code labels on collection tubes for specimen management in the clinical laboratory. (United States)

    Tilzer, L L; Jones, R W


    A new generation in specimen handling has arrived with the introduction of bar code readers on medical laboratory equipment. The incorporation of this technology into laboratory information systems offers a streamlining of specimen workflow never before achievable in a laboratory environment. The use of evacuated collection tubes as the primary sampling container on a random-access chemistry analyzer interfaced to a laboratory information system creates a very simplified sampling/analysis system with tremendous advantages. There are significant labor savings, superior service to clinicians, and reduced chances for clerical error.

  1. The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment (United States)

    Braithwaite, Jeffrey; Clay-Williams, Robyn; Vecellio, Elia; Marks, Danielle; Hooper, Tamara; Westbrook, Mary; Westbrook, Johanna; Blakely, Brette; Ludlow, Kristiana


    Objectives To examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these social structures are more a product of inherent characteristics of the individuals or groups comprising the professions, or attributable to a greater extent to workplace factors. Setting Controlled laboratory environment with well-appointed, quiet rooms and video and audio equipment. Participants Clinical professionals (n=133) divided into 35 groups of doctors, nurses and allied health professions, or mixed professions. Interventions Participants engaged in one of three team tasks, and their performance was video-recorded and assessed. Primary and secondary measures Primary: teamwork performance. Secondary, pre-experimental: a bank of personality questionnaires designed to assess participants’ individual differences. Postexperimental: the 16-item Mayo High Performance Teamwork Scale (MHPTS) to measure teamwork skills; this was self-assessed by participants and also by external raters. In addition, external, arm's length blinded observations of the videotapes were conducted. Results At baseline, there were few significant differences between the professions in collective orientation, most of the personality factors, Machiavellianism and conservatism. Teams generally functioned well, with effective relationships, and exhibited little by way of discernible tribal or hierarchical behaviours, and no obvious differences between groups (F (3, 31)=0.94, p=0.43). Conclusions Once clinicians are taken out of the workplace and put in controlled settings, tribalism, hierarchical and stereotype behaviours largely dissolve. It is unwise therefore to attribute these factors to fundamental sociological or psychological differences between individuals in the professions, or aggregated group differences. Workplace cultures are more likely to

  2. Synchrony of clinical and laboratory surveillance for influenza in Hong Kong.

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    Lin Yang

    Full Text Available BACKGROUND: Consultation rates of influenza-like illness (ILI in an outpatient setting have been regarded as a good indicator of influenza virus activity in the community. As ILI-like symptoms may be caused by etiologies other than influenza, and influenza virus activity in the tropics and subtropics is less predictable than in temperate regions, the correlation between of ILI and influenza virus activity in tropical and subtropical regions is less well defined. METHODOLOGY AND PRINCIPAL FINDINGS: In this study, we used wavelet analysis to investigate the relationship between seasonality of influenza virus activity and consultation rates of ILI reported separately by General Out-patient Clinics (GOPC and General Practitioners (GP. During the periods 1998-2000 and 2002-2003, influenza virus activity exhibited both annual and semiannual cycles, with one peak in the winter and another in late spring or early summer. But during 2001 and 2004-2006, only annual cycles could be clearly identified. ILI consultation rates in both GOPC and GP settings share a similar non-stationary seasonal pattern. We found high coherence between ILI in GOPC and influenza virus activity for the annual cycle, but this was only significant (p<0.05 during the periods 1998-1999 and 2002-2006. For the semiannual cycle high coherence (p<0.05 was also found significant during the period 1998-1999 and year 2003 when two peaks of influenza were evident. Similarly, ILI in GP setting is also associated with influenza virus activity for both the annual and semiannual cycles. On average, oscillation of ILI in GP and of ILI in GOPC preceded influenza virus isolation by approximately four and two weeks, respectively. CONCLUSIONS: Our findings suggest that consultation rates of ILI precede the oscillations of laboratory surveillance by at least two weeks and can be used as a predictor for influenza epidemics in Hong Kong. The validity of our model for other tropical regions needs to be

  3. Clinical and laboratory evaluation of thyroid function following total laryngectomy in laryngeal cancer

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    Motasaddi Zarandy M


    Full Text Available Background: Hypothyroidism is a well-documented complication after treatment of laryngeal cancer and is particularly significant among patients undergoing laryngectomy. We investigated the frequency of hypothyroidism in patients treated with total laryngectomy for laryngeal cancer. We also evaluated the effect of neck radiotherapy on thyroid function after total laryngectomy for laryngeal cancer. Methods: In a cross-sectional study, we evaluated 31 patients with laryngeal squamous cell carcinoma (mean age 53.6 years. Among these patients, 14 were treated with surgery only and 17 were treated with surgery plus radiotherapy. Laboratory evaluation included levels of thyroid stimulating hormone (TSH, free T4, free T3, and antithyroid antibodies both preoperatively and postoperatively at the first day, as well as one and six months after surgery. Results: All patients had normal thyroid function before treatment; however, after 6 months, five patients (16.1% were hypothyroid. Of these, three patients (9.6% had subclinical symptoms, including elevated thyroid-stimulating hormone with normal free T4, and two patients (6.5% showed clinical symptoms of hypothyroidism. Radiotherapy and neck dissection were significantly associated with higher incidences of hypothyroidism. Conclusion: Our data suggest that hypothyroidism occurs in a substantial proportion of patients undergoing surgery for laryngeal cancer. The results indicate that thyroid function studies should be routinely performed in the follow-up care of laryngeal cancer patients, especially if radiotherapy and neck dissection were part of the treatment. We suggest that this approach will improve the patient's quality of life and diminish the co-morbidity associated with this kind of surgery.

  4. Contribution of laboratory methods in diagnosing clinically suspected ocular toxoplasmosis in Brazilian patients. (United States)

    Mattos, Cinara C B; Meira, Cristina S; Ferreira, Ana I C; Frederico, Fábio B; Hiramoto, Roberto M; Almeida, Gildásio C; Mattos, Luiz C; Pereira-Chioccola, Vera L


    This prospective study evaluated the value of laboratorial diagnosis in ocular toxoplasmosis analyzing peripheral blood samples from a group of Brazilian patients by immunologic and molecular methods. We analyzed blood samples from 184 immunocompetent patients with ocular disorders divided into 2 groups: Group I, composed of samples from 49 patients with ocular toxoplasmosis diagnosed by clinical features; Group II, samples from 135 patients with other ocular diseases. Samples were assayed by conventional polymerase chain reaction (cnPCR), real-time PCR (qPCR) for Toxoplasma gondii, indirect immunofluorescence reaction (IF), avidity test (crude tachyzoite lysate as antigen), and excreted-secreted tachyzoite proteins as antigen (ESA-ELISA). cnPCR and qPCR profiles were concordant in all samples. Positive PCR was shown in 40.8% of group I patients. The majority of the positive blood samples (75%) were taken from patients with toxoplasmic retinochoroiditis scars, and the others (25%), from patients with retinal exudative lesions. Despite that 86 of the 135 patients from Group II had asymptomatic toxoplasmosis, all DNA blood samples had negative PCR. Concordant results were shown in the data obtained by serologic methods. Around 24% of the patients with ocular toxoplasmosis had high antibody titers determined by ESA-ELISA and IF. Anti-ESA antibodies are shown principally in patients with active infection. Collectively, these data demonstrate the presence of tachyzoites in the blood of patients with chronic infection, supporting the idea of recurrent disease. Circulating parasites in blood of immunocompetent individuals may be associated with the reactivation of the ocular disease.

  5. Reporting incidental findings in genomic scale clinical sequencing--a clinical laboratory perspective: a report of the Association for Molecular Pathology. (United States)

    Hegde, Madhuri; Bale, Sherri; Bayrak-Toydemir, Pinar; Gibson, Jane; Jeng, Linda Jo Bone; Joseph, Loren; Laser, Jordan; Lubin, Ira M; Miller, Christine E; Ross, Lainie F; Rothberg, Paul G; Tanner, Alice K; Vitazka, Patrik; Mao, Rong


    Advances in sequencing technologies have facilitated concurrent testing for many disorders, and the results generated may provide information about a patient's health that is unrelated to the clinical indication, commonly referred to as incidental findings. This is a paradigm shift from traditional genetic testing in which testing and reporting are tailored to a patient's specific clinical condition. Clinical laboratories and physicians are wrestling with this increased complexity in genomic testing and reporting of the incidental findings to patients. An enormous amount of discussion has taken place since the release of a set of recommendations from the American College of Medical Genetics and Genomics. This discussion has largely focused on the content of the incidental findings, but the laboratory perspective and patient autonomy have been overlooked. This report by the Association of Molecular Pathology workgroup discusses the pros and cons of next-generation sequencing technology, potential benefits, and harms for reporting of incidental findings, including the effect on both the laboratory and the patient, and compares those with other areas of medicine. The importance of genetic counseling to preserve patient autonomy is also reviewed. The discussion and recommendations presented by the workgroup underline the need for continued research and discussion among all stakeholders to improve our understanding of the effect of different policies on patients, providers, and laboratories.

  6. Clinical features and pitfalls in the laboratory diagnosis of dengue in travellers

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    Frank Christina


    Full Text Available Abstract Background Several enzyme-linked immunosorbent assay (ELISA-kits are commercially available for the rapid diagnosis of dengue infection, and have demonstrated good sensitivity and specificity in paired serum samples. In practice, however, often only one blood sample is available from febrile travellers returning from dengue endemic areas. Methods To evaluate the diagnostic value of positive dengue antibody-titres performed by a standard ELISA (PanBio IgM- and IgG-ELISA in single serum samples (regarded as "probable infection", 127 positive samples were further analyzed using envelope/membrane IgM-, and nonstructural protein 1 IgM- and IgG-ELISAs, immunofluorescence assays, and real-time reverse transcription polymerase chain reaction assays (RT-PCR. A combination of the test-results served as the diagnostic "gold standard". A total of 1,035 febrile travellers returning from dengue-endemic countries with negative dengue-serology and RT-PCR served as controls to compare clinical and haematological features. Results Overall, only 64 (positive predictive value = 50% of the probable cases were confirmed by additional analysis and 54 (42.5% were confirmed to be "false-positive". Rash was the only clinical feature significantly associated with confirmed dengue fever. The combination of thrombocytopenia and leucopenia was present in 40.4% of confirmed and in 6.1% of false-positive cases. Thus, the positive predictive value for the combination of positive PanBio-ELISA plus the two haematological features was 90.5%. Conclusion The examination of paired serum samples is considered the most reliable serodiagnostic procedure for dengue. However, if only one blood sample is available, a single positive ELISA-result carries a high rate of false-positivity and should be confirmed using a second and more specific diagnostic technique. In the absence of further testing, platelet and white blood cell counts are helpful for the correct interpretation.

  7. The effect of microwave/laboratory light source postcuring technique and wet-aging on microhardness of composite resin

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    Farahnaz Sharafeddin


    Full Text Available Background: Although composite restorations are really valuable for esthetic zones, they have shown less longevity rather than amalgam restorations. Since it may be related to the method used for curing the composite, postcuring could increase the degree of conversion and result in more long-lasting composite restorations. This study was planned to evaluate the effect of two different postcuring techniques on microhardness of indirect composite resin after wet-aging and comparing them with the direct type. Materials and Methods: In this experimental study, 99 composite disk-shaped (6.5 × 2.5 mm specimens of composite (Gradia GC, Japan were prepared in split mold. The indirect composite specimens were postcured by laboratory light source (Labolite LV-III GC Corp, Japan or microwave unit (MC 2002 JR, LG, Korea. Then, the aging procedure was done for 24 h, 30 and 180 days in distilled water. The Vicker′s Hardness test (VHN on surface of specmens was measured by Wolpert microhardness tester and the data were analyzed by the two-way analysis of variance (ANOVA and Tukey′s post hoc tests. (P ≤ 0.05. Results: The statistical analysis revealed that surface microhardness of postcured composite by microwave and laboratory light source was more than that of direct composite ( P = 0.0001 and postcuring by microwave was more effective than postcuring by laboratory light source ( P = 0.004. The 30 days stored composite demonstrated significant decrease of VHN compared with the 24-h stored samples ( P = 0.0001, with a more significant VHN decrease after 180 days of aging ( P = 0.045. Conclusion: Postcuring increased the surface microhardness and aging reduced the surface microhardness of indirect composite.

  8. The use of positive reinforcement training techniques to enhance the care, management, and welfare of primates in the laboratory. (United States)

    Laule, Gail E; Bloomsmith, Mollie A; Schapiro, Steven J


    Handled frequently and subjected to a wide range of medical procedures that may be particularly invasive, nonhuman animals in a laboratory setting have unique needs. To produce the most reliable research results and to protect and enhance the well-being of the animals, it is desirable to perform these procedures with as little stress for the animals as possible. Positive reinforcement training can use targeted activities and procedures to achieve the voluntary cooperation of nonhuman primates. The benefits of such work include diminished stress on the animals, enhanced flexibility and reliability in data collection, and a reduction in the use of anesthesia. Training also provides the means to mitigate social problems, aid in introductions, reduce abnormal behavior, enhance enrichment programs, and increase the safety of attending personnel. This article describes the application of operant conditioning techniques to animal management.

  9. Application of the Ta liner technique to produce Ca beams at INFN-Legnaro National Laboratories (INFN-LNL). (United States)

    Galatà, A; Sattin, M; Manzolaro, M; Martini, D; Facco, A; Tinschert, K; Spaedtke, P; Lang, R; Kulevoy, T


    The ECR ion sources are able to produce a wide variety of highly charged metallic ion beams thanks to the development of different techniques (ovens, sputtering, direct insertion, metal ions from volatile compounds (MIVOC)). In the case of the ovens, the sticking of the hot vapors on the surface of the plasma chamber leads to high material consumption rates. For elements like Ca, a tantalum liner inserted inside the chamber can be used to limit this phenomenon. The modeling of temperature distribution inside the chamber with and without the liner was carried out with COMSOL-multiphysics code. Results of simulation and the comparison with experiments performed at INFN-Legnaro National Laboratories with Ca beams are discussed.

  10. [Extended-spectrum-beta-lactamase-producing Proteus mirabilis: laboratory-based surveillance in cooperation with 12 clinical laboratories in the Kinki Region of Japan]. (United States)

    Nakamura, Tatsuya; Komatsu, Masaru; Shimakawa, Kouichi; Sueyoshi, Noriyuki; Satoh, Kaori; Toyokawa, Masahiro; Nishio, Hisaaki; Wada, Yasunao; Orita, Tamaki; Kofuku, Tomomi; Sakamoto, Masako; Okamoto, Kiyotaka; Akagi, Masahiro; Kinoshita, Shohiro


    We studied 247 strains of Proteus mirabilis collected during the 6 months from November 2003 to April 2004 from 12 clinical laboratories in the Kinki region of Japan for the production of extended-spectrum beta-lactamase (ESBL). Eighteen strains (7.3%) showed MICs for cefpodoxime of > or = 2 microg/mL and 13 strains (5.2%) were positive for the double-disk synergy test. Susceptibility depended on genotype. MICs for cefepime, cefozopran, and cefpirome were high (> or = 8 microg/mL), and that for ceftazidime was low (0.12-0.5 microg/mL). Meropenem showed the lowest MIC (ESBL genotype by the polymerase chain reaction showed that 12 of 13 strains were CTX-M2 types. CTX-M9 was detected in a single laboratory. The clinical background showed 5 strains in urine samples. Twelve of 13 strains were detected in patients with minimal devices use. No symptoms were found in most cases of established syndrome. Analysis of PCR fingerprint profiles of random amplified polymorphic DNA patterns showed that 6 of 7 strains from hospital 1 showed the same pattern, and 5 of 5 strains from hospital 13 showed the same pattern, suggesting the nosocomial spread of P. mirabilis in each hospital.

  11. Towards a green analytical laboratory: microextraction techniques as a useful tool for the monitoring of polluted soils (United States)

    Lopez-Garcia, Ignacio; Viñas, Pilar; Campillo, Natalia; Hernandez Cordoba, Manuel; Perez Sirvent, Carmen


    Microextraction techniques are a valuable tool at the analytical laboratory since they allow sensitive measurements of pollutants to be carried out by means of easily available instrumentation. There is a large number of such procedures involving miniaturized liquid-liquid or liquid-solid extractions with the common denominator of using very low amounts (only a few microliters) or even none of organic solvents. Since minimal amounts of reagents are involved, and the generation of residues is consequently minimized, the approach falls within the concept of Green Analytical Chemistry. This general methodology is useful both for inorganic and organic pollutants. Thus, low amounts of metallic ions can be measured without the need of using ICP-MS since this instrument can be replaced by a simple AAS spectrometer which is commonly present in any laboratory and involves low acquisition and maintenance costs. When dealing with organic pollutants, the microextracts obtained can be introduced into liquid or gas chromatographs equipped with common detectors and there is no need for the most sophisticated and expensive mass spectrometers. This communication reports an overview of the advantages of such a methodology, and gives examples for the determination of some particular contaminants in soil and water samples The authors are grateful to the Comunidad Autonóma de la Región de Murcia , Spain (Fundación Séneca, 19888/GERM/15) for financial support

  12. [Recommendations for implementing the UNE-EN-ISO 15189 quality standard in the clinical microbiology laboratory: bacteriology and serology]. (United States)

    Rojo, María Dolores; Aguiar, Juan Manuel; Cercenado, Emilia; de Ory, Fernando; de la Rosa, Manuel


    The UNE-EN-ISO 15189:2007 standard specifies the management and technical requirements that clinical microbiology laboratories must meet to achieve optimal quality when performing microbiological analyses. With implementation of this standard, a laboratory can receive the accreditation and formal recognition of an authorized body, certifying that it is apt for performing an assay or group of assays. In Spain, laboratories that apply these standards can be accredited by the Entidad Nacional de Acreditación (ENAC, Spanish accreditation body). The purpose of this review is to familiarize clinical microbiology laboratory specialists with the UNE-EN-ISO 15189:2007 standard through a practical approach focussed on bacteriology and serology studies. We briefly define the scope and specify the requisites required for managing the quality of the procedures and processes involved in performing tests on human specimens, for document control, and for management of instruments and equipment, personnel, information systems, supply systems, and external services. Lastly, evaluation approaches are indicated to achieve continuing improvement of the processes carried out and the services the laboratory provides.

  13. Sexually transmitted infections in women: A correlation of clinical and laboratory diagnosis in cases of vaginal discharge syndrome

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    Vidyalaxmi Chauhan


    Full Text Available Aims: This study compares the clinical and laboratory diagnosis of vaginal discharge syndrome. Settings and Design: This cross-sectional study was carried out at the gynaecology outpatient department of a tertiary care hospital in Gujarat, India. Material and Methods: Total of 180 females diagnosed as vaginal discharge or cervicitis based on syndromic approach and were recruited for the study. Their clinical profile was noted and they were investigated for bacterial vaginosis, trichomoniasis, candidiasis, gonorrhoea and chlamydia infection. Results: Lower abdominal pain (35% followed by burning micturition (23.9% were the common associated complaints. Bacterial vaginosis was the most common clinical diagnosis, while trichomoniasis was least common. Upon laboratory investigation, 35.6% of cases of vaginal discharge and 12% of cases of cervicitis tested positive. Percentage of cases confirmed by laboratory investigation was 50, 27.8 and 41.7 for bacterial vaginosis, trichomoniasis and candidiasis respectively. Conclusion: Among all the females diagnosed as vaginal discharge syndrome, a very small percentage actually turned out to be positive upon laboratory testing.

  14. Clinical and Laboratory Findings in Patients with Tramadol Intoxication Referred to Razi Hospital During 2005-06

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    Morteza Rahbar Taromsari


    Full Text Available Introduction: Frequency of Tramadol intoxication is increasing as a result of its useas a drug for suppression of withdrawal symptoms by opioids abusers and its wideaccessibility of this drug. Tramadol intoxication can lead to death and, therefore, earlyidentification of its clinical manifestations is crucial since early detection of theintoxication and its treatment could improve patients' survival This study investigatedthe frequency of clinical and laboratory findings in Tramadol intoxication.Methods: In this cross-sectional study, patients with Tramadol intoxication whoreferred to Razi Hospital in Rasht, Iran, during 2005-06 were examined. Theirmedical records were surveyed for demographic data, past medical history,neurological examination, and routine laboratory tests. All data were statisticallyanalyzed by SPSS software version 14.Result: The majority of the 306 patients (83.3% male were in the age range of 20-40 years and 68.6% of them had been educated up to high school. The mean dose ofingested Tramadol was 746± 453mg (mean± SD. Agitation (25.2% and seizure(20.3% were the most frequent reported symptoms. Among laboratory abnormalities,the most common findings were prolonged PT (18.3% and increased ALT (5.6%.Conclusion: The most common clinical presentation was agitation and the mostcommon laboratory finding was prolonged PT. Of all the patients, 3 cases wereadmitted to ICU. Although Tramadol poisoning might lead to death, there was onlyone death after Tramadol poisoning in the current study.

  15. Whether western normative laboratory values used for clinical diagnosis are applicable to Indian population? An overview on reference interval. (United States)

    Malati, T


    Reference Intervals denote normative values related to laboratory parameters/analytes used by diagnostic centers for clinical diagnosis. International guidelines recommend that every country must establish reference intervals for healthy individuals belonging to a group of homogeneous population. Considering enormous racial and ethnic diversity of Indian population, it is mandatory to establish reference intervals specific to Indian population. The overview on reference interval describes why the national organizations in India need to initiate nationwide efforts to establish its own laboratory standards for apparently healthy reference individuals belonging to our polygenetic, polyethnic, polyracial, multilinguistic and multicultural predominantly rural and appreciable urban Indian population with varied dietary habits.

  16. Using Live Tissue Laboratories to Promote Clinical Reasoning in Doctor of Physical Therapy Students (United States)

    Moore, W. Allen; Noonan, Ann Cassidy


    Recently, the use of animal laboratories has decreased in medical and basic science programs due to lack of trained faculty members, student concerns about animal welfare, and the increased availability of inexpensive alternatives such as computer simulations and videos. Animal laboratories, however, have several advantages over alternative forms…

  17. Sparse Reconstruction Techniques in Magnetic Resonance Imaging: Methods, Applications, and Challenges to Clinical Adoption. (United States)

    Yang, Alice C; Kretzler, Madison; Sudarski, Sonja; Gulani, Vikas; Seiberlich, Nicole


    The family of sparse reconstruction techniques, including the recently introduced compressed sensing framework, has been extensively explored to reduce scan times in magnetic resonance imaging (MRI). While there are many different methods that fall under the general umbrella of sparse reconstructions, they all rely on the idea that a priori information about the sparsity of MR images can be used to reconstruct full images from undersampled data. This review describes the basic ideas behind sparse reconstruction techniques, how they could be applied to improve MRI, and the open challenges to their general adoption in a clinical setting. The fundamental principles underlying different classes of sparse reconstructions techniques are examined, and the requirements that each make on the undersampled data outlined. Applications that could potentially benefit from the accelerations that sparse reconstructions could provide are described, and clinical studies using sparse reconstructions reviewed. Lastly, technical and clinical challenges to widespread implementation of sparse reconstruction techniques, including optimization, reconstruction times, artifact appearance, and comparison with current gold standards, are discussed.

  18. Building Connecticut's clinical biodosimetry laboratory surge capacity to mitigate the health consequences of radiological and nuclear disasters: A collaborative approach between the state biodosimetry laboratory and Connecticut's medical infrastructure

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    Albanese, Joseph [Yale New Haven Health Center for Emergency Preparedness and Disaster Response, New Haven, CT 06510 (United States)], E-mail:; Martens, Kelly [Yale New Haven Health Center for Emergency Preparedness and Disaster Response, New Haven, CT 06510 (United States); Emergency Department, Yale-New Haven Hospital, New Haven, CT (United States); Arnold, Jeffrey L. [Emergency Department, Natividad Medical Center, Salinas, CA (United States); Kelley, Katherine [Connecticut Department of Public Health, Hartford, CT (United States); Kristie, Virginia [Hartford Hospital, Hartford, CT (United States); Forte, Elaine; Schneider, Mark [Yale New Haven Health Center for Emergency Preparedness and Disaster Response, New Haven, CT 06510 (United States); Dainiak, Nicholas [Yale New Haven Health Center for Emergency Preparedness and Disaster Response, New Haven, CT 06510 (United States); Department of Medicine, Bridgeport Hospital, Bridgeport, CT (United States); Yale University School of Medicine, New Haven, CT (United States)


    Biodosimetry, based on the analysis of dicentric chromosomes in circulating mononuclear cells, is considered the 'gold standard' for estimating radiation dose and is used to make informed decisions regarding the medical management of irradiated persons. This paper describes the development of biodosimetry laboratory surge capacity for the health consequences of radiological and nuclear disasters in Connecticut, including: (1) establishment of the Biodosimetry Laboratory for the timely assessment of radiation dosage in biodosimetry specimens; (2) identification of clinical laboratories qualified and willing to process biodosimetry specimens from a large number of victims; (3) training of clinical laboratorians in initial biodosimetry specimen processing; and (4) conducting a functional drill that evaluated the effectiveness of these elements. Descriptive information was obtained from: (1) personal observations; (2) a needs assessment of clinical laboratories in Connecticut; (3) records from a training program of clinical laboratorians in biodosimetry specimen processing that was developed and provided by the Yale New Haven Center for Emergency Preparedness and Disaster Response; and (4) records from a statewide functional drill in biodosimetry specimen processing that was developed and conducted by the State of Connecticut Biodosimetry Laboratory. A needs assessment of clinical laboratories in Connecticut identified 30 of 32 clinical laboratories qualified and willing to perform initial biodosimetry specimen processing. Currently, 79 clinical laboratorians in 19 of these qualified clinical laboratories have been trained in biodosimetry specimen processing. A functional exercise was conducted involving 37 of these trained clinical laboratorians in 18 qualified laboratories as well as the Biodosimetry Laboratory. The average turnaround time for biodosimetry specimen processing in this drill was 199 min. Exercise participants provided feedback which will be

  19. Observational and laboratory studies of optical properties of black and brown carbon particles in the atmosphere using spectroscopic techniques (United States)

    Nakayama, Tomoki; Matsumi, Yutaka


    Light absorption and scattering by aerosols are as an important contributor to radiation balance in the atmosphere. Black carbon (BC) is considered to be the most potent light absorbing material in the visible region of the spectrum, although light absorbing organic carbon (brown carbon or BrC) and mineral dust may also act as sources of significant absorption, especially in the ultraviolet (UV) and shorter visible wavelength regions. The optical properties of such particles depend on wavelength, particle size and shape, morphology, coating, and complex refractive index (or chemical composition), and therefore accurate in situ measurements of the wavelength dependence of the optical properties of particles are needed. Recently, cavity ring-down spectroscopy (CRDS) and photoacoustic spectroscopy (PAS) have been used for the direct measurements of extinction and absorption coefficients of particles suspended in air. We have applied these techniques to the observational studies of optical properties of BC and BrC in an urban site in Japan and to the laboratory studies of optical properties of secondary organic aerosols (SOAs) generated from a variety of biogenic and anthropogenic volatile organic compounds and those of diesel exhaust particles (DEPs). In the presentation, the basic principles of these techniques and the results obtained in our studies and in the recent literatures will be overviewed. References Guo, X. et al., Measurement of the light absorbing properties of diesel exhaust particles using a three-wavelength photoacoustic spectrometer, Atmos. Environ., 94, 428-437 (2014). Nakayama, T. et al., Measurements of aerosol optical properties in central Tokyo during summertime using cavity ring-down spectroscopy: Comparison with conventional techniques, Atmos. Environ., 44, 3034-3042 (2010). Nakayama, T. et al., Laboratory studies on optical properties of secondary organic aerosols generated during the photooxidation of toluene and the ozonolysis of alpha

  20. Performance of ACMG-AMP Variant-Interpretation Guidelines among Nine Laboratories in the Clinical Sequencing Exploratory Research Consortium. (United States)

    Amendola, Laura M; Jarvik, Gail P; Leo, Michael C; McLaughlin, Heather M; Akkari, Yassmine; Amaral, Michelle D; Berg, Jonathan S; Biswas, Sawona; Bowling, Kevin M; Conlin, Laura K; Cooper, Greg M; Dorschner, Michael O; Dulik, Matthew C; Ghazani, Arezou A; Ghosh, Rajarshi; Green, Robert C; Hart, Ragan; Horton, Carrie; Johnston, Jennifer J; Lebo, Matthew S; Milosavljevic, Aleksandar; Ou, Jeffrey; Pak, Christine M; Patel, Ronak Y; Punj, Sumit; Richards, Carolyn Sue; Salama, Joseph; Strande, Natasha T; Yang, Yaping; Plon, Sharon E; Biesecker, Leslie G; Rehm, Heidi L


    Evaluating the pathogenicity of a variant is challenging given the plethora of types of genetic evidence that laboratories consider. Deciding how to weigh each type of evidence is difficult, and standards have been needed. In 2015, the American College of Medical Genetics and Genomics (ACMG) and the Association for Molecular Pathology (AMP) published guidelines for the assessment of variants in genes associated with Mendelian diseases. Nine molecular diagnostic laboratories involved in the Clinical Sequencing Exploratory Research (CSER) consortium piloted these guidelines on 99 variants spanning all categories (pathogenic, likely pathogenic, uncertain significance, likely benign, and benign). Nine variants were distributed to all laboratories, and the remaining 90 were evaluated by three laboratories. The laboratories classified each variant by using both the laboratory's own method and the ACMG-AMP criteria. The agreement between the two methods used within laboratories was high (K-alpha = 0.91) with 79% concordance. However, there was only 34% concordance for either classification system across laboratories. After consensus discussions and detailed review of the ACMG-AMP criteria, concordance increased to 71%. Causes of initial discordance in ACMG-AMP classifications were identified, and recommendations on clarification and increased specification of the ACMG-AMP criteria were made. In summary, although an initial pilot of the ACMG-AMP guidelines did not lead to increased concordance in variant interpretation, comparing variant interpretations to identify differences and having a common framework to facilitate resolution of those differences were beneficial for improving agreement, allowing iterative movement toward increased reporting consistency for variants in genes associated with monogenic disease.

  1. Advanced x-ray spectrometric techniques for characterization of nuclear materials: An overview of recent laboratory activities (United States)

    Misra, N. L.


    Advancements in x-ray spectrometric techniques at different stages have made this technique suitable for characterization of nuclear materials with respect to trace/major element determinations and compositional uniformity studies. The two important features of total reflection x-ray fluorescence spectrometry: 1) requirement of very small amount of sample in ng level 2) multielement analytical capability, in addition to other features, make this technique very much suitable to nuclear materials characterization as most of the nuclear materials are radioactive and the radioactive waste generated and radiation hazards to the operator are minimum when such low amount of sample is used. Similarly advanced features of energy dispersive x-ray fluorescence e.g. better geometry for high flux, reduction in background due to application of radiation filters have made the measurements of samples sealed inside thin alkathene/PVC covers possible with good sensitivity. This approach avoids putting the instrument inside a glove box for measuring radioactive samples and makes the operation/maintenance of the instrument and analysis of the samples possible in easy and fast manner. This approach has been used for major element determinations in mixed uranium-plutonium samples. Similarly μ-XRF with brilliant and micro-focused excitation sources can be used for compositional uniformity study of reactor fuel pellets. A μ-XRF study using synchrotron light source has been made to assess the compositional uniformity of mixed uranium-thorium oxide pellets produced by different processes. This approach is simple as it does not involve any sample preparation and is non-destructive. A brief summary of such activities carried out in our laboratory in past as well as ongoing and planned for the future have been discussed in the present manuscript.


    Institute of Scientific and Technical Information of China (English)

    LIANG Yun-wu; TAN Yuan-sheng; ZHOU Jun


    Objective:To observe the clinical therapeutic effect of Ba-He technique of acupuncture in the treatment of knee osteoarthritis. Methods: A total of 90 cases of knee osteoarthritis were evenly randomized into Ba-He technique group (observation group) and common technique group (control group), with 45 cases in each group. Zusanli (足三里 ST 36), Heding (鹤顶 EX-LE 2) and Dubi (犊鼻 ST 35) were punctured respectively in Ba-He technique and common technique in the two groups. The therapeutic effects of the two groups were compared after one course of treatment (10 sessions) in accordance with Japanese assessment criteria for knee-joint functions. Results: Aftertreatment, among the 74 and 71 affected knees in the observation and control groups, the therapeutic effect was excellent in 42 (56.8%) and 26 (36.6%) knees, fine in 14 (18.9%) and 20 (28.2%), OK in 10 (13.5%) and 11 (15.5%), and poor in 8 (10.8%) and 14 (19.7%) respectively. The therapeutic effect of the observation group was significantly better than that of control group (P<0.01). Conclusion: The Ba-He technique of acupuncture applied to the above-mentioned three acupoints exerted remarkable therapeutic effect for knee osteoarthritis, which is obviously better than that of the common needling technique.

  3. Introduction to Pre-clinical Imaging Techniques; Introduccion a las tecnicas de imagen preclinica

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    Mulero, F.


    Biomedical research poses increasingly complex problems regarding the biochemical processes that take place in living organisms. Just as in clinical research, medical imaging techniques are an excellent tool to study these processes. One of the most outstanding techniques is what is called molecular imaging, the best tool for which is positron emission tomography (PET). PET is capable of monitoring those processes in vivo at a molecular level and it can be used in multiple applications, including the development of new drugs, the study of human disease models in animals, and the characterization of gene expression and phenotype changes caused by genetic manipulation (transgenic and knockout animals). (Author) 5 refs.


    Directory of Open Access Journals (Sweden)

    D. V. Bestaev


    Full Text Available Interstitial lung disease (ILD is a common extra-articular manifestation of rheumatoid arthritis (RA. Objective: to study the associations of the data of high-resolution computed tomography (HRCT and the esti- mate of diffusing lung capacity (DLC with clinical and laboratory parameters in RA patients with and without ILD. Subjects and methods. 79 RA patients fulfilling the 1987 American College of Rheumatology criteria (61 women and 18 men admitted to the Nasonova Research Institute of Rheumatology were included. Results. HRCT revealed signs of ILD in 58 (73% cases. The patients with ILD were divided into three groups: 1 18 (31% patients with ground glass opacities; 2 34 (58.6% patients with fibrosis; 3 6 (10.4% patients with the honeycomb lung. Twenty-one (27% patients with ILD were included in Group 4. In the ILD patients with ground glass opacities, the levels of anti-cyclic citrullinated peptide (ACCP antibodies and rheumatoid factor (RF were much above those in the patients without ILD (240 [166; 410.5], 480 [140; 850.5] and 73 [31; 101], 330,5 [118.5; 604.8], respectively. In the patients with ILD, the concentration of C-reactive protein (CRP (46 [35; 91] was higher than that in those without ILD (24 [18; 31]; p < 0.05. In the ILD patients with ground glass opacities, DLC was considerably below that in those with ILD – 59.2±11.2 and 79.8±12.1% of the normal value, respectively (p < 0.001. Conclusion. The associations found between ACCP antibodies and DLC, DAS28 and DLC may suggest that ACCP antibodies are implicated in the pathogenesis of ILD and the lung is involved in the immunoinflammatory process. The high percent of smokers detected in our investigation confirms the considerable role of smoking in the pathogene- sis of RA-associated ILD. In the RA patients with ILD, ground glass opacities must be an indicator of the activity of an immunopathological process in the lung.

  5. Evaluation of the Etiological, Clinical and Laboratory Findings in Patients with Cerebral Palsy

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    Sebahattin Vurucu


    Full Text Available AIM: In this study we aimed to discuss the etiological risk factors, clinical and laboratory findings of the patients with cerebral palsy (CP according to the literature of knowledges. METHOD: The data including sex, age, social status of families, method of delivery, type of CP, risk factors, comorbidities, brain imaging and electroencephalograpy findings were retrospectively recorded from the patients’ files. RESULTS: A total of 180 patients were included in this study. Of the patients 58.3% were boy, 41.7% were girl, and mean age at diagnosis was 8.98±5.34 months. Of the patients 77.8% had vaginal birth, 22.2% had cesarean birth. The patients who had vaginal birth had statisticaly higher ratio of comorbidity, and lower mean diagnostic age, respectively (respectively p=0,027, p=0,031. Of the patients 88.3% had spastic CP, 10.6% had ataxic-hypotonic CP and 1.2% had other CP types. Of the patients 51,1% had at least one etiological risk factors. Most common etiological risk factors were perianal asfixi (22.7%, prematurity (15.5%, small for gestational age (7.2% and others (18.9%. Of the patients 79.5% had at least one comorbidity. Most common comorbidities were lenguage disabilities (60%, eye abnormalities (56.6%, mental retardation (53.3%, epilepsy (41.1% and others (12.1%. Of the patients 85.6% had at least one brain imaging abnormality. Most common brain imaging abnormalities were cortical atrophy (34.4%, abnormalities of corpus callosum (20%, periventricular leukomalacia (16.6%, encephalomalasia (10.5%, cerebral infarction (10%, hypoxic ischemic encephalopaty (6.6% and others (11.9%. CONCLUSION: Most of the our patients had spastic type CP, comorbidities including lenguage disabilities, eye abnormalities, mental retardation, and epilepsy and brain imaging abnormalities including cortical atrophy, abnormalities of corpus callosum, and periventricular leukomalacia. Therefore we consider that there may be a relationship between brain imaging

  6. Effect of vitamin B/sub 6/ on the neurotoxicity and pharmacology of desmethylmisonidazole and misonidazole: clinical and laboratory studies

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    Coleman, C.N.; Hirst, V.K.; Brown, D.M.; Halsey, J.


    The clinical usefulness of misonidazole (MISO) and desmethylmisonidazole (DMM) is severely limited by neurotoxicity. Based on theoretical considerations and on laboratory data suggesting that pyridoxine (PN) decreased MISO toxicity in mice. The authors attempted to ameliorate the clinical neuropathy of DMM using oral PN. Pharmacokinetic analysis suggested interaction of PN and DMM but no protection against neuropathy was observed. Serial experiments with C3H and BALB/c mice were done using various forms of vitamin B/sub 6/ (PN, pyridoxal, pyridoxal phosphate) administered orally and i.p. No consistent protection was observed. Dexamethasone did not alter MISO toxicity in mice, contrary to the clinical findings. They conclude that vitamin B/sub 6/ is not useful in preventing clinical neurotoxicity of MISO or DMM.

  7. Functions and activities of the Area Committee on Microbiology of the National Committee for Clinical Laboratory Standards. (United States)

    Washington, J A


    The Area Committee on Microbiology of the National Committee for Clinical Laboratory Standards has responsibility for the development of guidelines and standards in the field of clinical microbiology. Through the consensus process, representatives from government, industry, and professional societies have developed standards on antibacterial susceptibility testing (M2, M7, and M11), antimycobacterial susceptibility testing (M24), quality assurance on commercially prepared microbiological culture media (M22), evaluation of production lots of dehydrated Mueller-Hinton agar (M6), and preparation and testing of fetal bovine serum for use as cell culture growth supplement (M25) and guidelines on bactericidal tests (M26), protection of laboratory workers from infections transmitted by blood, body fluids, and tissue (M29), blood film examination for parasites (M15), and development of in vitro susceptibility testing criteria and quality control parameters (M23). PMID:2070343

  8. Validation of antibiotic susceptibility testing guidelines in a routine clinical microbiology laboratory exemplifies general key challenges in setting clinical breakpoints. (United States)

    Hombach, Michael; Courvalin, Patrice; Böttger, Erik C


    This study critically evaluated the new European Committee for Antimicrobial Susceptibility Testing (EUCAST) antibiotic susceptibility testing guidelines on the basis of a large set of disk diffusion diameters determined for clinical isolates. We report several paradigmatic problems that illustrate key issues in the selection of clinical susceptibility breakpoints, which are of general importance not only for EUCAST but for all guidelines systems, i.e., (i) the need for species-specific determinations of clinical breakpoints/epidemiological cutoffs (ECOFFs), (ii) problems arising from pooling data from various sources, and (iii) the importance of the antibiotic disk content for separating non-wild-type and wild-type populations.

  9. Mould routine identification in the clinical laboratory by matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

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    Carole Cassagne

    Full Text Available BACKGROUND: MALDI-TOF MS recently emerged as a valuable identification tool for bacteria and yeasts and revolutionized the daily clinical laboratory routine. But it has not been established for routine mould identification. This study aimed to validate a standardized procedure for MALDI-TOF MS-based mould identification in clinical laboratory. MATERIALS AND METHODS: First, pre-extraction and extraction procedures were optimized. With this standardized procedure, a 143 mould strains reference spectra library was built. Then, the mould isolates cultured from sequential clinical samples were prospectively subjected to this MALDI-TOF MS based-identification assay. MALDI-TOF MS-based identification was considered correct if it was concordant with the phenotypic identification; otherwise, the gold standard was DNA sequence comparison-based identification. RESULTS: The optimized procedure comprised a culture on sabouraud-gentamicin-chloramphenicol agar followed by a chemical extraction of the fungal colonies with formic acid and acetonitril. The identification was done using a reference database built with references from at least four culture replicates. For five months, 197 clinical isolates were analyzed; 20 were excluded because they were not identified at the species level. MALDI-TOF MS-based approach correctly identified 87% (154/177 of the isolates analyzed in a routine clinical laboratory activity. It failed in 12% (21/177, whose species were not represented in the reference library. MALDI-TOF MS-based identification was correct in 154 out of the remaining 156 isolates. One Beauveria bassiana was not identified and one Rhizopus oryzae was misidentified as Mucor circinelloides. CONCLUSIONS: This work's seminal finding is that a standardized procedure can also be used for MALDI-TOF MS-based identification of a wide array of clinically relevant mould species. It thus makes it possible to identify moulds in the routine clinical laboratory setting

  10. Current status of matrix-assisted laser desorption ionisation-time of flight mass spectrometry in the clinical microbiology laboratory. (United States)

    Kok, Jen; Chen, Sharon C A; Dwyer, Dominic E; Iredell, Jonathan R


    The integration of matrix-assisted laser desorption ionisation-time of flight mass spectrometry (MALDI-TOF MS) into many clinical microbiology laboratories has revolutionised routine pathogen identification. MALDI-TOF MS complements and has good potential to replace existing phenotypic identification methods. Results are available in a more clinically relevant timeframe, particularly in bacteraemic septic shock. Novel applications include strain typing and the detection of antimicrobial resistance, but these are not widely used. This review discusses the technical aspects, current applications, and limitations of MALDI-TOF MS.

  11. Clinical laboratory, virologic, and pathologic changes in hamsters experimentally infected with Pirital virus (Arenaviridae): a rodent model of Lassa fever. (United States)

    Sbrana, Elena; Mateo, Rosa I; Xiao, Shu-Yuan; Popov, Vsevolod L; Newman, Patrick C; Tesh, Robert B


    The clinical laboratory, virologic, and pathologic changes occurring in hamsters after infection with Pirital virus (Arenaviridae) are described. Pirital virus infection in the hamsters was characterized by high titered viremia, leukocytosis, coagulopathy, pulmonary hemorrhage and edema, hepatocellular and splenic necrosis, and marked elevation of serum transaminase levels. All of the animals died within 9 days. The clinical and histopathological findings in the Pirital virus-infected hamsters were very similar to those reported in severe human cases of Lassa fever, suggesting that this new animal model could serve as a low-cost and relatively safe alternative for studying the pathogenesis and therapy of Lassa fever.

  12. External Quality Assessment for Detection of Fetal Trisomy 21, 18, and 13 by Massively Parallel Sequencing in Clinical Laboratories. (United States)

    Zhang, Rui; Zhang, Hongyun; Li, Yulong; Han, Yanxi; Xie, Jiehong; Li, Jinming


    An external quality assessment for detection of trisomy 21, 18, and 13 by massively parallel sequencing was implemented by the National Center for Clinical Laboratories of People's Republic of China in 2014. Simulated samples were prepared by mixing fragmented abnormal DNA with plasma from non-pregnant women. The external quality assessment panel, comprising 5 samples from pregnant healthy women, 2 samples with sex chromosome aneuploidies, and 13 samples with different concentrations of fetal fractions positive for trisomy 21, 18, and 13, was then distributed to participating laboratories. In total, 55.6% (47 of 84) of respondents correctly identified each of the samples in the panel. Seventeen false-negative and 87 gray zone results were reported, most [102 of 104 (98.1%)] of which were derived from for trisomy samples with effective fetal fractions trisomy sample generated by BGISEQ-100. Overall, most clinical laboratories detected samples containing effective fetal fractions >4%. Our study shows need for further laboratory training in the management of samples with low fetal fractions. For some assays, precision of Z values needs to be improved.

  13. Management of stress and stress-related diseases: Emerging computer-based technologies and the rationale for clinical laboratory assessment

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    Ezekiel Uba Nwose


    Full Text Available Background : Over the years, the issue of stress management in mental health has been discussed without reference to the clinical laboratory perspectives. Translational research and the vast array of emerging diagnostic technologies in alternative medical practice are now bridging the gap. While it would be scientific arrogance for the clinical practitioner and scientist to ignore the trend, the new technologies seeking clinical acceptability necessarily require expatiation of the scientific aspects of their products. Aims : This commentary builds on a comparative critical review to further our hypothesis that oxidative stress is the biochemical basis of the emerging computer-based diagnostic technologies. Materials & Method : The available information on Computer Meridian Diagnostics, Neuropattern and Virtual Scanning technologies were critically reviewed. The differences and similarities were articulated. Results : The technologies seem different, but have similarities that have not been articulated before. The seemingly different theories are traceable to Russian scientists and are based upon stress-induced adrenal secretions and the associated effect on glucose metabolism. The therapeutic effects of antioxidant nutrition, exercise or relaxation that are inherent in the technologies are highlighted. Conclusion : This commentary furthers explanation of the alterations in antioxidant activities as a result of biofeedback, oxidative stress and/or physiological effects as the biochemical basis of the technologies. The place for antioxidant indices and whole blood viscosity are also highlighted. This provides a rationale for the evaluation of available clinical diagnostic tests both to validate the technologies and as clinical laboratory correlates in stress management.

  14. Clinical characteristics, laboratory identification, and in vitro antifungal susceptibility of Trichomonascus (Candida) ciferrii isolates associated with granular myringitis


    Chan, JFW; Tsang, CC; Yang, J.; Xing, F.; LEUNG, SM; Ngan, AHY; Lau, SKP; Woo, PCY; Yuen, KY


    BACKGROUND: Trichomonascus (Candida) ciferrii is an emerging opportunistic yeast pathogen that has been increasingly recognised in human infections. T. ciferrii has previously been implicated as the cause of tinea pedis, tinea cruris, onchychomycosis, and less commonly, fungaemia. Recently, we diagnosed four unusual cases of T. ciferrii-associated granular myringitis in Chinese patients in Hong Kong and Shenzhen, China. In this study, we report the clinical characteristics, laboratory identif...

  15. Reducing marginal leakage of posterior composite resin restorations: a review of clinical techniques. (United States)

    Cheung, G S


    It has been well established that composite resin restorations have leakage at the margins. The polymerization shrinkage of the material and its inadequate adhesion to the cavity walls are the primary causes. Unlike silver amalgam restorations, which are self-sealing with age, the gap at the composite-to-tooth interface tends to persist and invite postoperative sensitivity, adverse pulp reactions, and the development of recurrent caries. Many techniques or materials have been advocated to improve the clinical adaptation of this material and to reduce marginal leakage. They limit the effect of polymerization shrinkage and/or enhance the bonding of the composite material to the tooth structure. This article reviews the clinical techniques and materials that have been suggested and are presently available to improve the marginal quality of composite resins, with special reference to posterior restorations.

  16. A contemporary perspective on techniques for the clinical assessment of alveolar bone

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    Hausmann, E. (State Univ. of New York, Buffalo (USA))


    Radiographic techniques, traditional ones as well as newer ones under development, for clinically assessing alveolar bone are critically assessed. Traditional intraoral radiography is reexamined, in particular with regard to the accuracy with which the alveolar crest is seen. Evidence is presented for a more accurate representation of the alveolar crest on bitewings rather than periapical films. Application in periodontics of newer radiographic techniques, subtraction radiography, and single and dual photon aborptiometry presently under clinical development are discussed in regard to their potential and limitations. Similarly, radiopharmaceuticals to evaluate the metabolic status of alveolar bone are discussed as well as the potential for using analyses of gingival crevice fluid as a window for assessment of alveolar crest metabolism. 46 references.


    Directory of Open Access Journals (Sweden)



    Full Text Available Breast cancer is the most common cancer in women in both developed and undeveloped countries, and the second most frequent cause of cancer deaths after lung cancer. Although there have been many chemotherapeutic agents like 5-fluorouracil, taxol, tamoxifen, doxorubicin, cisplatin, and camptothecin and hormones are used to treat breast cancer. This review focuses on the causes of breast cancer, latest diagnostic techniques and various molecules under clinical trials for the treatment of breast cancer.

  18. Postoperative pain intensity after using different instrumentation techniques: a randomized clinical study (United States)

    ÇIÇEK, Ersan; KOÇAK, Mustafa Murat; KOÇAK, Sibel; SAĞLAM, Baran Can; TÜRKER, Sevinç Aktemur


    Abstract Postoperative pain is a frequent complication associated with root canal treatment, especially during apical instrumentation of tooth with preexisting periradicular inflammation Objectives The aim of this clinical study was to evaluate the influence of the instrumentation techniques on the incidence and intensity of postoperative pain in single-visit root canal treatment. Material and Methods Ninety patients with single root/canal and non-vital pulps were included. The patients were assigned into 3 groups according to root canal instrumentation technique used; modified step-back, reciprocal, and rotational techniques. Root canal treatment was carried out in a single visit and the severity of postoperative pain was assessed via 4-point pain intensity scale. All the participants were called through the phone at 12, 24 and 48 h to obtain the pain scores. Data were analyzed through the Kruskal–Wallis test. Results There was significant difference between all groups (p<0.05). The modified step-back technique produced postoperative pain significantly lower than the rotational (p=0.018) and reciprocal (p=0.020) techniques. No difference was found between the reciprocal and rotational techniques (p=0.868). Postoperative pain in the first 12 h period (p=0.763) and in the 24 h period (p=0.147) was not significantly different between the groups. However, the difference in the 48 h period was statistically different between the groups (p=0.040). Conclusion All instrumentation techniques caused postoperative pain. The modified step-back technique produced less pain compared to the rotational and reciprocal techniques. PMID:28198972

  19. Left ventricular reconstruction with no-patch technique:early and late clinical outcomes

    Institute of Scientific and Technical Information of China (English)

    HU Sheng-shou; FAN Hong-guang; ZHENG Zhe; FENG Wei; WANG Wei; SONG Yun-hu; WANG Li-qing; YUAN Xin; ZHANG Shi-ju


    Background Few studies have evaluated late clinical outcome of no-patch technique in patients with large left ventricular aneurysms. The objectives of this study were to evaluate a no-patch surgical technique to reconstruct the left ventricle in patients with left ventricular aneurysm and to assess early and late clinical outcomes.Methods In 1995, we began using a no-patch technique in patients with dyskinetic left ventricular aneurysms. A total of 145 patients underwent left ventricular reconstruction with this technique and were followed up for (59±29) months (range,1-127 months). Risk factors for early mortality were analyzed by bivariate analyses. Cox's proportional hazards model was used to calculate risk factors for all-cause mortality and hospital readmission. Kaplan-Meier methodology was used to analyze late survival.Results One week after operation, left ventricular end-diastolic diameter had decreased from (61±8) mm to (55±8)mm, and geometry of the left ventricle was restored to a more normal conical shape. Early mortality was 3% and late mortality 11%. Over a 5-year follow-up period, hospital readmission was 28%. One-, 5-, and 10-year survival estimates were 95% (95% confidence interval (CI) 91%-99%), 86% (95% CI 78%-94%), and 74% (95% CI 60%-88%).Readmission-free survival at 1 and 5 years after operation was 87% (95% CI81%-93%) and 60% (95% CI50%-70%),respectively.Conclusion The no-patch technique for left ventricular reconstruction is an effective and simple procedure that can achieve satisfactory early and late clinical outcomes in patients with left ventricular aneurysms.

  20. Application Anti Microbial Activity Test and Direct Inoculation of Urinary Specimen Test to Increase the Quality of Results and Decrease the Production Cost in Clinical Microbiology Laboratory, Sanglah General Hospital Hospital, Bali-Indonesia

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    Nyoman Sri-Budayanti


    Full Text Available Objective: Urinary tract infection (UTI is the most common bacterial infection in general practice and in hospitals. Fast and accurate urine culture and sensitivity test are needed for adequate therapy. Anti Microbial Activity test (AMA test that is used to detect the presence of antibiotics in urine specimens is not commonly used in clinical microbiology laboratories. Some laboratories are still using indirect inoculation technique using enriched media before inoculating onto the agar media. The aim of this research is to compare results of urinary examination of direct inoculation technique with AMA test with indirect inoculation technique without AMA test.Methods: A number of 210 urine specimens were collected in Clinical Microbiology Laboratory at Sanglah General Hospital within a time period between 16 June until 16 July 2009.Results: Antibiotics were detected in 40% of the urinary specimens; whereas 48.1% showed no evidence of UTI, that is negative AMA test and sterile urinary culture or colony growth < 105 CFU/ml. Only 11.9% of the specimens indicates urinary tract infections. The examination can be completed within 2-3 days which is shorter than indirect inoculation test which require 5-7 days. Direct inoculation technique can reduce the cost of production three-fold the costs require for an indirect inoculation test.Conclusions: Application of AMA test and direct inoculation technique can give results more rapidly, reliable and useful for clinicians. This also decrease the laboratory’s cost of production.

  1. Non-clinical studies in the process of new drug development - Part II: Good laboratory practice, metabolism, pharmacokinetics, safety and dose translation to clinical studies

    Directory of Open Access Journals (Sweden)

    E.L. Andrade

    Full Text Available The process of drug development involves non-clinical and clinical studies. Non-clinical studies are conducted using different protocols including animal studies, which mostly follow the Good Laboratory Practice (GLP regulations. During the early pre-clinical development process, also known as Go/No-Go decision, a drug candidate needs to pass through several steps, such as determination of drug availability (studies on pharmacokinetics, absorption, distribution, metabolism and elimination (ADME and preliminary studies that aim to investigate the candidate safety including genotoxicity, mutagenicity, safety pharmacology and general toxicology. These preliminary studies generally do not need to comply with GLP regulations. These studies aim at investigating the drug safety to obtain the first information about its tolerability in different systems that are relevant for further decisions. There are, however, other studies that should be performed according to GLP standards and are mandatory for the safe exposure to humans, such as repeated dose toxicity, genotoxicity and safety pharmacology. These studies must be conducted before the Investigational New Drug (IND application. The package of non-clinical studies should cover all information needed for the safe transposition of drugs from animals to humans, generally based on the non-observed adverse effect level (NOAEL obtained from general toxicity studies. After IND approval, other GLP experiments for the evaluation of chronic toxicity, reproductive and developmental toxicity, carcinogenicity and genotoxicity, are carried out during the clinical phase of development. However, the necessity of performing such studies depends on the new drug clinical application purpose.

  2. Non-clinical studies in the process of new drug development - Part II: Good laboratory practice, metabolism, pharmacokinetics, safety and dose translation to clinical studies. (United States)

    Andrade, E L; Bento, A F; Cavalli, J; Oliveira, S K; Schwanke, R C; Siqueira, J M; Freitas, C S; Marcon, R; Calixto, J B


    The process of drug development involves non-clinical and clinical studies. Non-clinical studies are conducted using different protocols including animal studies, which mostly follow the Good Laboratory Practice (GLP) regulations. During the early pre-clinical development process, also known as Go/No-Go decision, a drug candidate needs to pass through several steps, such as determination of drug availability (studies on pharmacokinetics), absorption, distribution, metabolism and elimination (ADME) and preliminary studies that aim to investigate the candidate safety including genotoxicity, mutagenicity, safety pharmacology and general toxicology. These preliminary studies generally do not need to comply with GLP regulations. These studies aim at investigating the drug safety to obtain the first information about its tolerability in different systems that are relevant for further decisions. There are, however, other studies that should be performed according to GLP standards and are mandatory for the safe exposure to humans, such as repeated dose toxicity, genotoxicity and safety pharmacology. These studies must be conducted before the Investigational New Drug (IND) application. The package of non-clinical studies should cover all information needed for the safe transposition of drugs from animals to humans, generally based on the non-observed adverse effect level (NOAEL) obtained from general toxicity studies. After IND approval, other GLP experiments for the evaluation of chronic toxicity, reproductive and developmental toxicity, carcinogenicity and genotoxicity, are carried out during the clinical phase of development. However, the necessity of performing such studies depends on the new drug clinical application purpose.

  3. A Simplified Technique for Orientation of a Bone Anchored Auricular Prostheses: a Clinical Report

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    Hussein G. El Charkawi


    Full Text Available Background: A simple technique was presented in this clinical report for orientation of a bone anchored auricular prosthesis.Methods: The proposed technique includes drawing the intact ear on a transparent celluloid paper or radiographic film and flipping it to the opposite side and relating it to the fixed anatomical features on the face of patient.Results: The drawing, by this way provides a simple and easy way to duplicate and transfer the exact size and position of the intact ear to the defect side.Conclusions: This technique provides a simple, safe, inexpensive and time saving yet, an accurate and effective surgical template that orients the craniofacial implants to the confines of the definitive auricular prosthesis. It is indicated for restoration of single missing external ear either in aplasia, injuries and total resection.

  4. Research progress of laboratory diagnostic techniques for Brucella%布鲁杆菌实验室诊断技术研究进展

    Institute of Scientific and Technical Information of China (English)



    布鲁菌病是一种人畜共患传染病,生物种型较多,感染主范围广泛,传播途径多样.对人类致病的主要有羊、牛、猪、犬等4种,呈急性或慢性感染,临床表现为败血、发热性疾病或骨组织、器官系统的局部感染.布鲁菌病的诊断主要以流行病学史、临床表现以及实验检查为依据.因布鲁菌病的临床表现复杂,必须通过实验室分析来确证,诊断可直接进行血培养或通过间接免疫反应对微生物抗原进行检测.布鲁菌病临床表现不一,无症状感染形成抗体常是其特点,因此,当不能直接进行血培养时,血清学检查常发挥重要作用.布鲁杆菌常规细菌培养分离及鉴定耗时,操作杂,存在操作人员面临被布鲁杆菌感染及病菌从实验室扩散的风险.近年来出现的新型免疫学方法和聚合酶链反应(PCR)具有较高的敏感性和特异性.作者将布鲁杆菌实验室诊断检测技术进展做一综述.%Brucellosis is an important zoonosis. There are numerous species of Brucella, which can infect the hosts in various routes of transmission. Brucellosis in humans can be caused by any of the 4 main species (B. abortus, B. melitensis, B. suis and B. ca-nis). This is a disease presenting as acute or chronic infection in humans, and manifesting as a septicaemia febrile illness or localized infection of bone, tissue, or organ systems. Brucellosis diagnosis is primarily based on epidemiological history, clinical manifestations and laboratory examinations. Since the disease presents with a great variety of clinical manifestations the diagnosis must be confirmed by laboratory analyses. The diagnosis can be done directly by isolation of Brucellae from blood cultures, or indirectly by the detection of the immune response against the microbe's antigens. Asymptomatic infection is frequently characterized by antibody formation in people with no history of symptoms consistent with brucellosis. Hence, serological

  5. Clinical and laboratory profile of HIV-positive patients at the moment of diagnosis in Bahia, Brazil

    Directory of Open Access Journals (Sweden)

    Márcia Sampaio Sá


    Full Text Available In Brazil, current trends of the AIDS epidemic include an increase in transmission through heterosexual contact, predominantly from men to women, with more cases of AIDS in women and more children contaminated by vertical transmission. There is also a high proportion of cases in poor people or people living in small towns. HIV-infected patients with high levels of immunodeficiency are frequently hospitalized after their first visit to the clinic due to opportunistic infections, characteristic of advanced disease. This study characterized the clinical and laboratory pattern of AIDS in a sample of patients attended for the first time in the AIDS clinic of the Federal University of Bahia Hospital (HUPES in Salvador, Brazil. We revised medical charts of cases of subjects registered at the outpatient AIDS clinic from January 1997 to December 2003. The demographics, clinical data, and laboratory characteristics were analyzed to determine the degree of immunodeficiency at the time of admission. A total of 377 patients were evaluated (58.6% were male, with a mean sample age of 33.4 years. The most frequent clinical manifestations were asthenia, weight loss, fever, anemia, dermatitis, oral thrush and diarrhea. CDC criteria were not adequate to define the initial cases. After admission to the outpatient clinic, nearly 25% of the patients were hospitalized immediately, indicating delay in the diagnosis. In Bahia, the initial presentation of HIV-infected patients to health care assistance is occurring at a late stage of the disease, when signs and symptoms of immunodeficiency are already established. Efforts are necessary to construct strategies to make an early diagnosis of these patients, improve the quality of care, and guarantee the benefits of antiretroviral therapy, when it is indicated.

  6. The Evaluation and Improvement of Microbial Analysis Methods and Techniques in the Johnson Space Center Microbiology Laboratory (United States)

    St. Pierre, Ashley L.; Smith, Melanie J.; Dunbar, Brandon J.; Ott, C. Mark


    Microbial contamination is a risk to crew health both on the ground and on the International Space Station. The methods and techniques of microbial analysis for surfaces and items on board a spacecraft are an important aspect of ensuring that crew health is not at unnecessary risk. This series of projects seeks to improve and optimize microbial analysis methods, such as the recovery of bacteria from difficult surfaces, and the analysis of long-term bacterial isolate storage techniques. These projects will help the Johnson Space Center Microbiology laboratory be more efficient at identifying and addressing microbial concerns related to spaceflight and on the ground. Fabrics are substantially more problematic for microbial monitoring than steel or glass surfaces, as bacteria tend to get trapped in the fibers. To better understand which microbial sampling method is most efficient, various methods of recovery were attempted, and the processes were revised based on the results. The final phase of testing applied the knowledge gained from the resulting methods to an acoustic blanket that is currently being used on the International Space Station, with future use slated for the Orion spacecraft. In this phase, the sample materials were inoculated with bacterial suspensions, vortexed with phosphate-saline buffer, and the liquid was plated on tryptic soy agar. The results from the test of the acoustic blanket indicate that not only is microbial growth possible on fabric that is treated for moisture-resistance, but also that contamination can occur if aseptic handling procedures are not followed. Interestingly, out of three hundred and ninety (390) plates, only seventeen (17) showed growth (4.36%), and recovery of the Staphylococcus epidermidis used to inoculate the samples only occurred on four (4) of the plates. The growth on the remaining plates was contamination by various microbes, including those commonly found on the skin and in soil. This shows that 2 while bacterial

  7. Pulsed and monoenergetic beams for neutron cross-section measurements using activation and scattering techniques at Triangle Universities Nuclear Laboratory (United States)

    Hutcheson, A.; Angell, C. T.; Becker, J. A.; Boswell, M.; Crowell, A. S.; Dashdorj, D.; Fallin, B.; Fotiades, N.; Howell, C. R.; Karwowski, H. J.; Kelley, J. H.; Kiser, M.; Macri, R. A.; Nelson, R. O.; Pedroni, R. S.; Tonchev, A. P.; Tornow, W.; Vieira, D. J.; Weisel, G. J.; Wilhelmy, J. B.


    In support of the Stewardship Science Academic Alliances initiative, an experimental program has been developed at Triangle Universities Nuclear Laboratory (TUNL) to measure (n,xn) cross-sections with both in-beam and activation techniques with the goal of improving the partial cross-section database for the NNSA Stockpile Stewardship Program. First experimental efforts include excitation function measurements on 235,238U and 241Am using pulsed and monoenergetic neutron beams with En = 5-15 MeV. Neutron-induced partial cross-sections were measured by detecting prompt γ rays from the residual nuclei using various combinations of clover and planar HPGe detectors in the TUNL shielded neutron source area. Complimentary activation measurements using DC neutron beams have also been performed in open geometry in our second target area. The neutron-induced activities were measured in the TUNL low-background counting area. In this presentation, we include detailed information about the irradiation procedures and facilities and preliminary data on first measurements using this capability.

  8. Pulsed and monoenergetic beams for neutron cross-section measurements using activation and scattering techniques at Triangle Universities Nuclear Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Hutcheson, A. [Triangle Universities Nuclear Laboratory, P.O. Box 90308, Durham, NC 27708 (United States)]. E-mail:; Angell, C.T. [Triangle Universities Nuclear Laboratory, P.O. Box 90308, Durham, NC 27708 (United States); Becker, J.A. [Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, CA 94550 (United States); Boswell, M. [Triangle Universities Nuclear Laboratory, P.O. Box 90308, Durham, NC 27708 (United States); Crowell, A.S. [Triangle Universities Nuclear Laboratory, P.O. Box 90308, Durham, NC 27708 (United States); Dashdorj, D. [Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, CA 94550 (United States); Fallin, B. [Triangle Universities Nuclear Laboratory, P.O. Box 90308, Durham, NC 27708 (United States); Fotiades, N. [Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States); Howell, C.R.; Karwowski, H.J.; Kelley, J.H.; Kiser, M. [Triangle Universities Nuclear Laboratory, P.O. Box 90308, Durham, NC 27708 (United States); Macri, R.A. [Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, CA 94550 (United States); Nelson, R.O. [Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States); Pedroni, R.S. [NC A and T State University, 1601 East Market Street, Greensboro, NC 27411 (United States); Tonchev, A.P.; Tornow, W. [Triangle Universities Nuclear Laboratory, P.O. Box 90308, Durham, NC 27708 (United States); Vieira, D.J. [Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States); Weisel, G.J. [Penn State Altoona, 3000 Ivyside Park, Altoona, PA 16601 (United States); Wilhelmy, J.B. [Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States)


    In support of the Stewardship Science Academic Alliances initiative, an experimental program has been developed at Triangle Universities Nuclear Laboratory (TUNL) to measure (n,xn) cross-sections with both in-beam and activation techniques with the goal of improving the partial cross-section database for the NNSA Stockpile Stewardship Program. First experimental efforts include excitation function measurements on {sup 235,238}U and {sup 241}Am using pulsed and monoenergetic neutron beams with E {sub n} = 5-15 MeV. Neutron-induced partial cross-sections were measured by detecting prompt {gamma} rays from the residual nuclei using various combinations of clover and planar HPGe detectors in the TUNL shielded neutron source area. Complimentary activation measurements using DC neutron beams have also been performed in open geometry in our second target area. The neutron-induced activities were measured in the TUNL low-background counting area. In this presentation, we include detailed information about the irradiation procedures and facilities and preliminary data on first measurements using this capability.

  9. The good laboratory practice and good clinical practice requirements for the production of radiopharmaceuticals in clinical research

    NARCIS (Netherlands)

    De Vos, FJ; De Decker, M; Dierckx, RA


    Radiopharmaceuticals account for more than 95% of the group of sterile pharmaceutical products and should therefore be handled and produced with care. Since the introduction of the European directive, all pharmaceuticals used in clinical studies must be prepared under good manufacturing practice (GM

  10. Clinical outcome of root caries restorations using ART and rotary techniques in institutionalized elders

    Directory of Open Access Journals (Sweden)

    Alberto Carlos CRUZ GONZALEZ


    Full Text Available Abstract The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART, in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9% using the conventional technique (p < 0.03. However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.

  11. Designing a clinical skills training laboratory with focus on video for better learning

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein; Toftgård, Rie Castella; Nørgaard, Cita

    of the skills training laboratory was made. The principles included video in different instructional designs: 1. Teacher-produced video podcasts 2. Group work using video 3. Formative assessment using video 4. Practicing skills using video Each principle was described using a template focusing on (a) objectives...

  12. Proposals for the mitigation of the environmental impact of clinical laboratories. (United States)

    Lopez, Joseph B; Badrick, Tony


    Laboratories should be aware of the carbon footprint resulting from their activities and take steps to mitigate it as part of their societal responsibilities. Once committed to a mitigation programme, they should announce an environmental policy, secure the support of senior management, initiate documentation, institute a staff training programme, schedule environmental audits and appoint an environmental manager. Laboratories may aspire to be accredited to one of the standards for environmental management, such as the ISO 14000. As environmental and quality issues are linked, the improvement in the environmental management of an organisation will ultimately lead to improved quality system performance. Indeed, environmental management could conceivably come under overall quality management. Although there will be initial costs, good environmental practices can bring savings. Environmental improvement should be based on the 3R concept to reduce, reuse and recycle. Several policy initiatives may be introduced. These include a green purchasing policy for equipment, laboratory furniture and reagents as well as the management of packaging wastes. There are several ways to reduce energy, water usage and wastage. A reduction of test numbers and collection tubes should be attempted. Paper management involves all aspects of 3R. The recycling of solvents and general wastes should be practised where feasible. The construction new laboratories or renovations to existing ones are opportunities to make them more environmentally-friendly. The advocacy of policies to associates and the inclusion of environmentally-friendly conditions on contractors are integral parts of the programme.

  13. Evaluation of Different Phenotypic Techniques for the Detection of Slime Produced by Bacteria Isolated from Clinical Specimens (United States)

    HRV, Rajkumar; Devaki, Ramakrishna


    Introduction  Microorganisms use various strategies for their survival in both the environment and in humans. Slime production by bacteria is one such mechanism by which microbes colonize on the indwelling prosthetic devices and form biofilms. Infections caused by such microorganisms are difficult to treat as the biofilm acts as a shield and protects microbes against antimicrobial agents. There are several methods for the detection of slime produced by bacteria, and they include both phenotypic and molecular methods. The present study evaluated the Congo red agar/broth method, Christensen’s method, dye elution technique, and the latex agglutination method for the demonstration of slime production by different bacterial clinical isolates. Materials & Methods We collected 151 bacterial clinical isolates (both gram-positive and gram-negative bacteria) from various specimens and tested them for the production of slime both by qualitative and quantitative tests. Congo red agar/broth method, Christensen's method, dye elution technique, and latex agglutination methods were used for detecting the slime or slime-like substance. Results  We found that 103 (68.2%) strains were positive for slime production by Congo red agar/broth method. It was found that 18 (94.7%) strains of Klebsiella pneumoniae, 21 (84.0%) strains of S aureus and 25 (65.7%) strains of coagulase-negative Staphylococci were positive for slime or slime-like substances by Congo red agar/broth method. A total of 41.0% of the strains positive by Christensen's method and 15.2% of the strains by dye elution technique were found to be more adherent organisms and that have the potential to form biofilms. Only the gram-positive organisms showed nonspecific agglutination with latex suspension. Conclusion  Among the various phenotypic methods compared in this study the Congo red agar/broth method is a simple, economical, sensitive, and specific method that can be used by clinical microbiology laboratories

  14. Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI

    Directory of Open Access Journals (Sweden)

    Allan R. Martin


    Conclusions: State-of-the-art spinal cord MRI techniques are emerging with great potential to improve the diagnosis and management of various spinal pathologies, but the current body of evidence has only showed limited clinical utility to date. Among these imaging tools DTI is the most mature, but further work is necessary to standardize and validate its use before it will be adopted in the clinical realm. Large, well-designed studies with a priori hypotheses, standardized acquisition methods, detailed clinical data collection, and robust automated analysis techniques are needed to fully demonstrate the potential of these rapidly evolving techniques.

  15. The EC4 European syllabus for post-graduate training in clinical chemistry and laboratory medicine: version 4--2012. (United States)

    Wieringa, Gijsbert; Zerah, Simone; Jansen, Rob; Simundic, Ana-Maria; Queralto, José; Solnica, Bogdan; Gruson, Damien; Tomberg, Karel; Riittinen, Leena; Baum, Hannsjörg; Brochet, Jean-Philippe; Buhagiar, Gerald; Charilaou, Charis; Grigore, Camelia; Johnsen, Anders H; Kappelmayer, Janos; Majkic-Singh, Nada; Nubile, Giuseppe; O'Mullane, John; Opp, Matthias; Pupure, Silvija; Racek, Jaroslav; Reguengo, Henrique; Rizos, Demetrios; Rogic, Dunja; Špaňár, Július; Štrakl, Greta; Szekeres, Thomas; Tzatchev, Kamen; Vitkus, Dalius; Wallemacq, Pierre; Wallinder, Hans


    Laboratory medicine's practitioners across the European community include medical, scientific and pharmacy trained specialists whose contributions to health and healthcare is in the application of diagnostic tests for screening and early detection of disease, differential diagnosis, monitoring, management and treatment of patients, and their prognostic assessment. In submitting a revised common syllabus for post-graduate education and training across the 27 member states an expectation is set for harmonised, high quality, safe practice. In this regard an extended 'Core knowledge, skills and competencies' division embracing all laboratory medicine disciplines is described. For the first time the syllabus identifies the competencies required to meet clinical leadership demands for defining, directing and assuring the efficiency and effectiveness of laboratory services as well as expectations in translating knowledge and skills into ability to practice. In a 'Specialist knowledge' division, the expectations from the individual disciplines of Clinical Chemistry/Immunology, Haematology/Blood Transfusion, Microbiology/ Virology, Genetics and In Vitro Fertilisation are described. Beyond providing a common platform of knowledge, skills and competency, the syllabus supports the aims of the European Commission in providing safeguards to increasing professional mobility across European borders at a time when demand for highly qualified professionals is increasing and the labour force is declining. It continues to act as a guide for the formulation of national programmes supplemented by the needs of individual country priorities.

  16. Impact of routine real-time PCR testing of imported malaria over 4 years of implementation in a clinical laboratory. (United States)

    Shokoples, Sandra; Mukhi, Shamir N; Scott, Allison N; Yanow, Stephanie K


    In clinical laboratories, diagnosis of imported malaria is commonly performed by microscopy. However, the volume of specimens is generally low and maintaining proficiency in reading blood smears, particularly at the species level, is challenging in this setting. To address this problem, the Provincial Laboratory for Public Health (ProvLab) in Alberta, Canada, implemented real-time PCR for routine confirmation of all smear-positive samples in the province. Here we report our experience over a 4-year period (2008 to 2012) with this new diagnostic algorithm. While detection of Plasmodium falciparum by microscopy alone was accurate, real-time PCR served as an important adjunct to microscopy for the identification of non-falciparum species. In 18% of cases, the result was reported as non-falciparum or the species could not be identified by microscopy alone, and in all cases, the species was resolved by real-time PCR. In another 4% of cases, the species was misidentified by microscopy. To enhance surveillance for malaria, we integrated our demographic, clinical, and laboratory data into a new system developed by the Canadian Network for Public Health Intelligence, called the Malaria System for Online Surveillance (SOS). Using this application, we characterized our patient populations and travel history to identify risk factors associated with malaria infection abroad.

  17. Ovum pick up, intracytoplasmic sperm injection and somatic cell nuclear transfer in cattle, buffalo and horses: from the research laboratory to clinical practice. (United States)

    Galli, Cesare; Duchi, Roberto; Colleoni, Silvia; Lagutina, Irina; Lazzari, Giovanna


    Assisted reproductive techniques developed for cattle in the last 25 years, like ovum pick up (OPU), intracytoplasmic sperm injection (ICSI), and somatic cell nuclear transfer, have been transferred and adapted to buffalo and horses. The successful clinical applications of these techniques require both the clinical skills specific to each animal species and an experienced laboratory team to support the in vitro phase of the work. In cattle, OPU can be considered a consolidated technology that is rapidly outpacing conventional superovulation for embryo transfer. In buffalo, OPU represents the only possibility for embryo production to advance the implementation of embryo-based biotechnologies in that industry, although it is still mainly in the developmental phase. In the horse, OPU is now an established procedure for breeding from infertile and sporting mares throughout the year. It requires ICSI that in the horse, contrary to what happens in cattle and buffalo, is very efficient and the only option because conventional IVF does not work. Somatic cell nuclear transfer is destined to fill a very small niche for generating animals of extremely high commercial value. The efficiency is low, but because normal animals can be generated it is likely that advancing our knowledge in that field might improve the technology and reduce its cost.

  18. Pica associated with iron deficiency or depletion: clinical and laboratory correlates in 262 non-pregnant adult outpatients

    Directory of Open Access Journals (Sweden)

    Barton James C


    Full Text Available Abstract Background There are many descriptions of the association of pica with iron deficiency in adults, but there are few reports in which observations available at diagnosis of iron deficiency were analyzed using multivariable techniques to identify significant predictors of pica. We sought to identify clinical and laboratory correlates of pica in adults with iron deficiency or depletion using univariable and stepwise forward logistic regression analyses. Methods We reviewed charts of 262 non-pregnant adult outpatients (ages ≥18 y who required treatment with intravenous iron dextran. We tabulated their sex, age, race/ethnicity, body mass index, symptoms and causes of iron deficiency or depletion, serum iron and complete blood count measures, and other conditions at diagnosis before intravenous iron dextran was administered. We excluded patients with serum creatinine >133 μmol/L or disorders that could affect erythrocyte or iron measures. Iron deficiency was defined as both SF Results There were 230 women (184 white, 46 black; ages 19-91 y and 32 men (31 white, 1 black; ages 24-81 y. 118 patients (45.0% reported pica; of these, 87.3% reported ice pica (pagophagia. In univariable analyses, patients with pica had lower mean age, black race/ethnicity, and higher prevalences of cardiopulmonary and epithelial manifestations. The prevalence of iron deficiency, with or without anemia, did not differ significantly between patients with and without pica reports. Mean hemoglobin and mean corpuscular volume (MCV were lower and mean red blood cell distribution width (RDW and platelet count were higher in patients with pica. Thrombocytosis occurred only in women and was more prevalent in those with pica (20.4% vs. 8.3%; p = 0.0050. Mean total iron-binding capacity was higher and mean serum ferritin was lower in patients with pica. Nineteen patients developed a second episode of iron deficiency or depletion; concordance of recurrent pica (or absence of

  19. Diversidade clínica e laboratorial no haplótipo bantu da anemia falciforme Clinical and laboratorial diversity in the bantu haplotype of sickle cell anemia

    Directory of Open Access Journals (Sweden)

    Paulo J. M. S. Costa


    Full Text Available Muitos fatores são responsáveis pela diversidade de sintomas nos pacientes de anemia falciforme, entre eles: sexo, idade, haplótipos e nível de hemoglobina fetal. O objetivo deste estudo foi verificar a diversidade clínica e laboratorial dentro do haplótipo bantu. Realizou-se um estudo descritivo onde foram avaliados 18 crianças e adolescentes portadores de anemia falciforme e homozigóticos para o haplótipo bantu, relacionando sexo e idade com as características clínicas e laboratoriais, além de relacioná-las diretamente entre si. As amostras foram do tipo casuais simples. O tamanho da amostra teve uma variação de freqüência para o evento de 30% a 65% e nível de confiança de 99,9%. As análises estatísticas foram realizadas através do programa EPIINFO, versão 6.04b, com erro a de 5%. A faixa etária de 01 a 11 anos teve um maior número de infecções que a faixa de 12 a 19, além de níveis mais altos de hemoglobina fetal. Os valores do hematócrito foram maiores no sexo feminino. Níveis mais elevados de hemoglobina A2 foram relacionados com maior número de infecções, enquanto níveis mais elevados de hemo­globina fetal foram relacionados com maiores valores de hematócrito e menor número de crises álgicas/ano de acompanhamento. O número de transfusões/ano teve correlação positiva com o número de crises álgicas, de infecções e de inter­namentos. Este estudo sugere que há uma diversidade clínica e laboratorial dentro do haplótipo bantu e possivelmente está relacionado com o sexo, a idade e os níveis de hemoglobina fetal e A2 dos pacientes.Several factors have been identified as possibly being responsible for the diversity of sickle cell anemia patients’ symptoms, including gender, age, haplotypes and hemoglobin F levels. The aim of this paper is to verify the clinical and laboratorial diversity of the Bantu haplotype. A descriptive study was performed of eighteen children and adolescents with sickle

  20. Faculty perspectives of the undergraduate laboratory: A survey of faculty goals for the laboratory and comparative analysis of responses using statistical techniques (United States)

    Bruck, Aaron D.

    Qualitative research methods were used in a previous study to discover the goals of faculty members teaching undergraduate laboratories. Assertions about the goals and the unique characteristics of innovative lab programs were developed from categories that emerged from the interviews. The purpose of the present research was to create a survey instrument to measure the prevalence of these themes and faculty goals for undergraduate laboratories with a national sample. This was achieved through a two-stage process that utilized a pilot survey to determine the factor structure and reduce the number of survey items to a manageable size. Once the number of survey questions was reduced, the full survey was given to a national sample of undergraduate laboratory faculty. The 312 responses to the survey were then analyzed using factor analysis. Comparative analyses were conducted using analysis of variance (ANOVA). This dissertation focuses on the processes involved in the creation of this survey and the subsequent analyses of the data the survey produced. The results of these analyses and the implications of this research will also be discussed.

  1. Process improvement with impact in the operational efficiency: a study in the context of a clinical analysis laboratory

    Directory of Open Access Journals (Sweden)

    Gabriel Sperandio Milan


    Full Text Available In an environment of constant change and intense competition, characterized by increasing demands in terms of speed, quality, low cost, flexibility and customer satisfaction, the success of a healthcare organization is its ability to respond appropriately to these requirements by means innovations in its services and processes. In this context, the central objective of the study is identifying an alternative to qualify the Clinical Analysis Laboratory operation from its internal processes. For this, the paper uses process mapping as a basis for analysis and proposition. Therefore, we analyzed the macro process of the Laboratory and identified opportunities for improvement. Moreover, it was proposed the restructuring of the macro process analyzed, presenting the resources needed to implement the proposal as well as the performance indicators and their targets.

  2. 77 FR 64598 - Joint Biomedical Laboratory Research and Development and Clinical Science Research and... (United States)


    ... Hotel. A. Aging and Clinical Geriatrics........ November 28, 2012...... *VA Central Office. Immunology-A.... Endocrinology-A December 10-11, 2012... Sheraton Crystal City Hotel. Surgery December 11, 2012.........

  3. Clinical and Laboratory Findings of Lead Hepatotoxicity in the Workers of a Car Battery Manufacturing Factory


    Bita Dadpour; Reza Afshari; Seyed Reza Mousavi; Sina Kianoush; Mohamad Reza Keramati; Vali Allah Moradi; Mahmood Sadeghi; Faezeh Madani Sani; Mahdi Balali Mood


    Background: Occupational lead poisoning is common in workers of some industries, but lead hepatotoxicity has rarely been reported. Several animal studies have revealed lead induced liver damage but clinical studies concerning the manifestations of lead induced liver toxicity in humans are scares. This study was designed to investigate the clinical manifestations and pathological parameters of hepatic dysfunction and its relationship with blood and urine lead concentrations in a car battery-ma...

  4. Clinical characteristics and laboratory analyses of acute myeloid leukemia with t(16;21)(p11;q22) (United States)



    The present study reviewed three patients with acute myeloid leukemia (AML) who had the specific genetic abnormality t(16;21)(p11;q22). To investigate the clinical and laboratory characteristics of AML with t(16;21)(p11;q22) translocation, the similarities and differences of clinical characteristics and laboratory examinations were compared, and a literature review was conducted. According to the French-American-British classification system, patient 1 was M4, patient 2 was M1 and patient 3 was M2. The cytogenetic aberrations were 46, XY, t(16;21)(p11;q22)/47, idem, +21 for patient 1 and 46, XX, t(16;21)(p11;q22) for patients 2 and 3. Cytophagocytosis and cluster of differentiation 56 antigen expression were found in all three cases. The prognosis was poor in all the cases. AML with t(16;21)(p11;q22) is a specific subtype of AML that exhibits unique characteristics of morphology, immunology, cytogenetics and clinical features, as well as a poor prognosis. Stem cell transplantation may be the first and only choice for treatment. PMID:26137050

  5. Digital management and regulatory submission of medical images from clinical trials: role and benefits of the core laboratory (United States)

    Robbins, William L.; Conklin, James J.


    Medical images (angiography, CT, MRI, nuclear medicine, ultrasound, x ray) play an increasingly important role in the clinical development and regulatory review process for pharmaceuticals and medical devices. Since medical images are increasingly acquired and archived digitally, or are readily digitized from film, they can be visualized, processed and analyzed in a variety of ways using digital image processing and display technology. Moreover, with image-based data management and data visualization tools, medical images can be electronically organized and submitted to the U.S. Food and Drug Administration (FDA) for review. The collection, processing, analysis, archival, and submission of medical images in a digital format versus an analog (film-based) format presents both challenges and opportunities for the clinical and regulatory information management specialist. The medical imaging 'core laboratory' is an important resource for clinical trials and regulatory submissions involving medical imaging data. Use of digital imaging technology within a core laboratory can increase efficiency and decrease overall costs in the image data management and regulatory review process.

  6. [Biofunctional symmetry of individual values of clinic-laboratory indices in patients, suffering severe forms of an acute pancreatitis]. (United States)

    Sipliv'iĭ, V A; Kon', K V; Robak, B I; Evtushenko, A V


    Individual values of clinic-laboratory indices were analyzed in 125 patients, suffering severe forms of an acute pancreatitis (AP). In the early postoperative period there were analyzed 65 indices: clinical analysis of the blood, 24 hematological indices, biochemical analysis of the blood, coagulogram, estimates according to the ASSES, APACHE II, SAPS, SAPS II, SAPS III scales. There was established, that in 83.1% of patients in severe forms of an AP the ratio or the values difference of clinic-laboratory indices in dynamics of postoperative period are depicted according to the "Golden section" rule with deviation no more than 10-15%. In the patients, suffering sterile pancreonecrosis, in comparison with those, suffering infected pancreonecrosis and in the patients with infected pancreonecrosis without retroperitoneal space cellular tissue affection in comparison with patients, suffering infected pancreonecrosis and the retroperitoneal space cellular tissue affection there were more signs, the values ratio or difference of which have deviated from the "Golden section" rule no more than by 5%. While estimating the patients state severity in those, suffering severe forms of AP, using special scales, most precisely the coincidence with a "Golden section" rule was noted, according to scales ASSES and SAPS III. Prognostically unfavorable was a progressive increase of the points sum according to ASSES scale in dynamics of postoperative period.

  7. Integrating clinical and laboratory data in genetic studies of complex phenotypes: a network-based data management system. (United States)

    McMahon, F J; Thomas, C J; Koskela, R J; Breschel, T S; Hightower, T C; Rohrer, N; Savino, C; McInnis, M G; Simpson, S G; DePaulo, J R


    The identification of genes underlying a complex phenotype can be a massive undertaking, and may require a much larger sample size than thought previously. The integration of such large volumes of clinical and laboratory data has become a major challenge. In this paper we describe a network-based data management system designed to address this challenge. Our system offers several advantages. Since the system uses commercial software, it obviates the acquisition, installation, and debugging of privately-available software, and is fully compatible with Windows and other commercial software. The system uses relational database architecture, which offers exceptional flexibility, facilitates complex data queries, and expedites extensive data quality control. The system is particularly designed to integrate clinical and laboratory data efficiently, producing summary reports, pedigrees, and exported files containing both phenotype and genotype data in a virtually unlimited range of formats. We describe a comprehensive system that manages clinical, DNA, cell line, and genotype data, but since the system is modular, researchers can set up only those elements which they need immediately, expanding later as needed.

  8. The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment


    Braithwaite, Jeffrey; Clay-Williams, Robyn; VECELLIO, ELIA; Marks, Danielle; Hooper, Tamara; Westbrook, Mary; Westbrook, Johanna; Blakely, Brette; Ludlow, Kristiana


    Objectives To examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these social structures are more a product of inherent characteristics of the individuals or groups comprising the professions, or attributable to a greater extent to workplace factors. Setting Controlled laboratory environment with well-appointed, quiet rooms ...

  9. Analysis of polyethylene wear of reverse shoulder components: A validated technique and initial clinical results. (United States)

    Lewicki, Kathleen A; Bell, John-Erik; Van Citters, Douglas W


    One of the most prevalent phenomena associated with reverse total shoulder arthroplasty (rTSA) is scapular notching. Current methods examine only the damage to the scapula and no methods are available for quantifying the total wear volume of the polyethylene humeral bearing. Quantifying the polyethylene material loss may provide insight into the mechanism for scapular notching and into the particle dose delivered to the patient. A coordinate measurement machine (CMM) and custom computer algorithms were employed to quantify the volumetric wear of polyethylene humeral bearings. This technique was validated using two never-implanted polyethylene humeral liners with a controlled amount of wear in clinically relevant locations. The technique was determined to be accurate to within 10% of the known value and within 5 mm(3) of the gravimetrically determined values. Following validation, ten retrieved polyethylene humeral liners were analyzed to determine a baseline for future clinical tests. Four of the ten polyethylene humeral liners showed visible and measureable wear volumes ranging from 40 mm(3) to 90 mm(3) total with a maximum wear rate as high as 470 mm(3) /year in one short duration and significantly damaged humeral liner. This validated technique has the potential to relate patient outcomes such as scapular notching grades to polyethylene release into the body. While the total wear volumes are less than reported in literature for cases of osteolysis in knee and hip patients, dosages are well within the osteolytic thresholds that have been suggested, indicating that osteolysis may be a clinical concern in the shoulder. This work provides the basis for future studies that relate volumetric wear to patient outcomes. This article is protected by copyright. All rights reserved.

  10. Clinical evaluation of a two-incision fistula technique for the treatment of oral ranulas. (United States)

    Wang, Shaoyi; Zhang, Zhiyuan; Yang, Chi


    Oral ranulas are caused by extravasation of mucus from the sublingual glands, and the preferred treatment varies. We have developed a two-incision fistula operation for their treatment, and in this clinical study we have evaluated the efficacy and safety of this approach. Twelve patients with oral ranulas confirmed by fine needle aspiration cytology were enrolled and gave their consent to be treated by our new technique. The clinical outcomes and complications were evaluated during a period that ranged from 8-24 months. Nine ranulas became smaller and gradually disappeared, and there were no complications or injury to Wharton's duct. Three ranulas recurred, but disappeared after a second operation. The two-incision fistula operation can be effective and safe as an initial treatment for oral ranulas, and the method may become the preferred management for retention cysts.

  11. General Situation on Clinical Application of Dragon-Tiger Fighting Needling Technique in the Recent Years

    Institute of Scientific and Technical Information of China (English)

    何龙; 袁宜勤; 钟耀东; 何贤发; 黄国琪


    @@ Depending upon the descriptions of the ancient literature, such as Jin Zhen Fu (Odes to Golden Needles, ), the dragon-tiger fighting needling technique has the effects to dredge the meridians, circulate qi, activate blood, stop and remove pain. "Dragon" implies to twist the needle leftward for reinforcing, and "tiger" means to twist the needle rightward for reducing. To twist the needle leftward and rightward alternately is termed "fighting". After the arrival of the needling sensation by inserting the needle to the proper depth, the needle is first twisted leftward with the thumb forward in a method of nine yang numbers, and then twisted backward and rightward with the thumb backward in a method of six yin numbers, in alternation of reinforcing and reducing repeatedly. Therefore, the general information on clinical application of dragon-tiger fighting needling technique in the recent sixteen years is given in the following.

  12. Radiofrequency ablation of chondroblastoma: procedure technique, clinical and MR imaging follow up of four cases

    Energy Technology Data Exchange (ETDEWEB)

    Christie-Large, M.; Evans, N.; Davies, A.M.; James, S.L.J. [Royal Orthopaedic Hospital Foundation Trust, Department of Radiology, Birmingham (United Kingdom)


    The aim of this study is to describe the procedure technique, clinical and imaging outcomes of patients treated with radiofrequency ablation for chondroblastoma. Four patients (female/male, 3:1; mean age, 13 years; age range; 9-16 years) underwent the procedure. All had pre-operative magnetic resonance imaging (MRI) and symptomatic, biopsy-proven chondroblastomas (two proximal femur, two proximal tibia). The lesion size ranged from 1.5 to 2.5 cm in maximal dimension (mean size, 1.8 cm). Bone access was gained with a Bonopty biopsy needle system (mean number of radiofrequency needle placements, 5; mean ablation time, 31 min). Clinical and MRI follow-up was available in all cases (mean, 12.25 months; range, 5-18 months). All patients reported resolution of symptoms at 2-6 weeks post ablation. At their most recent clinical follow-up, three patients remained completely asymptomatic with full return to normal activities and one patient had minor local discomfort (different pain pattern) that was not limiting activity. All four patients' follow-up MRI studies demonstrated resolution of the oedema pattern around the lesion and temporal evolution of the internal signal characteristics with fatty replacement. Radiofrequency ablation for chondroblastoma provides an alternative to surgical curettage, and we have demonstrated both a clinical improvement in symptoms and the follow-up MRI appearances. (orig.)

  13. Pediatric MR elastography of hepatic fibrosis: principles, technique and early clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Binkovitz, Larry A.; Glaser, Kevin J.; Yin, Meng; Ehman, Richard L. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); El-Youssef, Mounif [Mayo Clinic, Pediatric Gastroenterology, Rochester, MN (United States); Binkovitz, Anna K. [Macalaster College, St. Paul, MN (United States)


    Numerous pediatric conditions result in hepatic fibrosis. As treatments develop for the underlying disorders, a non-invasive assessment of liver fibrosis would be beneficial as an adjunct or possible replacement for the traditional gold standard, liver biopsy. Magnetic resonance elastography is a noninvasive imaging technique that has been used successfully in adults for identification and assessment of liver fibrosis. This review describes the basic principles of MR elastography as well as the technical aspects specific to children. Clinical pediatric applications, limitations and areas for future research are described. (orig.)

  14. State-of-the-art MRI techniques in neuroradiology: principles, pitfalls, and clinical applications. (United States)

    Viallon, Magalie; Cuvinciuc, Victor; Delattre, Benedicte; Merlini, Laura; Barnaure-Nachbar, Isabelle; Toso-Patel, Seema; Becker, Minerva; Lovblad, Karl-Olof; Haller, Sven


    This article reviews the most relevant state-of-the-art magnetic resonance (MR) techniques, which are clinically available to investigate brain diseases. MR acquisition techniques addressed include notably diffusion imaging (diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI)) as well as perfusion imaging (dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhanced (DCE)). The underlying models used to process these images are described, as well as the theoretic underpinnings of quantitative diffusion and perfusion MR imaging-based methods. The technical requirements and how they may help to understand, classify, or follow-up neurological pathologies are briefly summarized. Techniques, principles, advantages but also intrinsic limitations, typical artifacts, and alternative solutions developed to overcome them are discussed. In this article, we also review routinely available three-dimensional (3D) techniques in neuro MRI, including state-of-the-art and emerging angiography sequences, and briefly introduce more recently proposed 3D quantitative neuro-anatomy sequences, and new technology, such as multi-slice and multi-transmit imaging.

  15. State-of-the-art MRI techniques in neuroradiology: principles, pitfalls, and clinical applications

    Energy Technology Data Exchange (ETDEWEB)

    Viallon, Magalie [Universite de Lyon, CREATIS, UMR CNRS 5220 - INSERM U1044, INSA de Lyon, Lyon (France); Universite de Lyon-Saint-Etienne, Department of Radiology, Centre Hospitalier Universitaire de Saint-Etienne, Saint Etienne (France); Cuvinciuc, Victor; Barnaure-Nachbar, Isabelle; Lovblad, Karl-Olof; Haller, Sven [University Hospital of Geneva, Department of Neuroradiology, Geneva (Switzerland); Delattre, Benedicte; Toso-Patel, Seema; Becker, Minerva [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland); Merlini, Laura [University Hospital of Geneva, Department of Pediatric Radiology, Geneva (Switzerland)


    This article reviews the most relevant state-of-the-art magnetic resonance (MR) techniques, which are clinically available to investigate brain diseases. MR acquisition techniques addressed include notably diffusion imaging (diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI)) as well as perfusion imaging (dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhanced (DCE)). The underlying models used to process these images are described, as well as the theoretic underpinnings of quantitative diffusion and perfusion MR imaging-based methods. The technical requirements and how they may help to understand, classify, or follow-up neurological pathologies are briefly summarized. Techniques, principles, advantages but also intrinsic limitations, typical artifacts, and alternative solutions developed to overcome them are discussed. In this article, we also review routinely available three-dimensional (3D) techniques in neuro MRI, including state-of-the-art and emerging angiography sequences, and briefly introduce more recently proposed 3D quantitative neuro-anatomy sequences, and new technology, such as multi-slice and multi-transmit imaging. (orig.)

  16. Bacterial Adhesion and Surface Roughness for Different Clinical Techniques for Acrylic Polymethyl Methacrylate

    Directory of Open Access Journals (Sweden)

    Lucas Costa de Medeiros Dantas


    Full Text Available This study sought to assess the effect of different surface finishing and polishing protocols on the surface roughness and bacterial adhesion (S. sanguinis to polymethyl methacrylates (PMMA. Fifty specimens were divided into 5 groups (n=10 according to their fabrication method and surface finishing protocol: LP (3 : 1 ratio and laboratory polishing, NF (Nealon technique and finishing, NP (Nealon technique and manual polishing, MF (3 : 1 ratio and manual finishing, and MP (3 : 1 ratio and manual polishing. For each group, five specimens were submitted to bacterial adhesion tests and analyzed by scanning electron microscopy (SEM. Two additional specimens were subjected to surface topography analysis by SEM and the remaining three specimens were subjected to surface roughness measurements. Data were compared by one-way ANOVA. The mean bacterial counts were as follows: NF, 19.6±3.05; MP, 5.36±2.08; NP, 4.96±1.93; MF, 7.36±2.45; and LP, 1.56±0.62 (CFU. The mean surface roughness values were as follows: NF, 3.23±0.15; MP, 0.52±0.05; NP, 0.60±0.08; MF, 2.69±0.12; and LP, 0.07±0.02 (μm. A reduction in the surface roughness was observed to be directly related to a decrease in bacterial adhesion. It was verified that the laboratory processing of PMMA might decrease the surface roughness and consequently the adhesion of S. sanguinis to this material.

  17. Bacterial Adhesion and Surface Roughness for Different Clinical Techniques for Acrylic Polymethyl Methacrylate. (United States)

    Dantas, Lucas Costa de Medeiros; da Silva-Neto, João Paulo; Dantas, Talita Souza; Naves, Lucas Zago; das Neves, Flávio Domingues; da Mota, Adérito Soares


    This study sought to assess the effect of different surface finishing and polishing protocols on the surface roughness and bacterial adhesion (S. sanguinis) to polymethyl methacrylates (PMMA). Fifty specimens were divided into 5 groups (n = 10) according to their fabrication method and surface finishing protocol: LP (3 : 1 ratio and laboratory polishing), NF (Nealon technique and finishing), NP (Nealon technique and manual polishing), MF (3 : 1 ratio and manual finishing), and MP (3 : 1 ratio and manual polishing). For each group, five specimens were submitted to bacterial adhesion tests and analyzed by scanning electron microscopy (SEM). Two additional specimens were subjected to surface topography analysis by SEM and the remaining three specimens were subjected to surface roughness measurements. Data were compared by one-way ANOVA. The mean bacterial counts were as follows: NF, 19.6 ± 3.05; MP, 5.36 ± 2.08; NP, 4.96 ± 1.93; MF, 7.36 ± 2.45; and LP, 1.56 ± 0.62 (CFU). The mean surface roughness values were as follows: NF, 3.23 ± 0.15; MP, 0.52 ± 0.05; NP, 0.60 ± 0.08; MF, 2.69 ± 0.12; and LP, 0.07 ± 0.02 (μm). A reduction in the surface roughness was observed to be directly related to a decrease in bacterial adhesion. It was verified that the laboratory processing of PMMA might decrease the surface roughness and consequently the adhesion of S. sanguinis to this material.

  18. Comprehensive inter-laboratory calibration of reference materials for delta O-18 versus VSMOW using various on-line high-temperature conversion techniques

    NARCIS (Netherlands)

    Brand, Willi A.; Coplen, Tyler B.; Aerts-Bijma, Anita T.; Böhlke, J.K.; Gehre, Matthias; Geilmann, Heike; Gröning, Manfred; Jansen, Henk G.; Meijer, Harro A. J.; Mroczkowski, Stanley J.; Qi, Haiping; Soergel, Karin; Stuart-Williams, Hilary; Weise, Stephan M.; Werner, Roland A.


    Internationally distributed organic and inorganic oxygen isotopic reference materials have been calibrated by six laboratories carrying out more than 5300 measurements using a variety of high-temperature conversion techniques (HTC)a in an evaluation sponsored by the International Union of Pure and A

  19. Influence of clinical and laboratory variables on faecal antigen ELISA results in dogs with canine parvovirus infection. (United States)

    Proksch, A L; Unterer, S; Speck, S; Truyen, U; Hartmann, K


    False negative faecal canine parvovirus (CPV) antigen ELISA results in dogs with CPV infection are common, but the factors that lead to these false negative results are still unknown. The aim of this study was to investigate whether dogs with a false negative faecal CPV antigen ELISA result have milder clinical signs and laboratory changes, a lower faecal virus load, higher faecal and serum CPV antibody titres and a faster recovery than dogs with a positive result. Eighty dogs with CPV infection, confirmed by the presence of clinical signs and a positive faecal CPV polymerase chain reaction (PCR), were assigned to two groups according to their faecal antigen ELISA result. Time until presentation, severity of symptoms, laboratory parameters, faecal virus load, faecal and serum antibody titres, and CPV sequencing data were compared between both groups. In 38/80 dogs that were hospitalised until recovery, the time to recovery, mortality, and the course of the disease were compared between dogs with positive and negative faecal antigen ELISA results. Of the 80 dogs included, 41 (51.3%) had a false negative faecal antigen ELISA result. ELISA-negative dogs had a significantly shorter time until presentation, lower frequency of defaecation, lower faecal virus load, and higher serum antibody concentrations than ELISA-positive dogs. Laboratory changes, CPV shedding, and outcomes were not associated with faecal antigen ELISA results. In conclusion, low faecal CPV load and antibodies binding to CPV antigen in faeces are likely to be important reasons for false negative faecal antigen ELISA results. Dogs with clinical signs of CPV infection should be retested by faecal PCR.

  20. Field and laboratory comparative evaluation of rapid malaria diagnostic tests versus traditional and molecular techniques in India

    Directory of Open Access Journals (Sweden)

    Bharti Praveen K


    Full Text Available Abstract Background Malaria presents a diagnostic challenge in most tropical countries. Microscopy remains the gold standard for diagnosing malaria infections in clinical practice and research. However, microscopy is labour intensive, requires significant skills and time, which causes therapeutic delays. The objective of obtaining result quickly from the examination of blood samples from patients with suspected malaria is now made possible with the introduction of rapid malaria diagnostic tests (RDTs. Several RDTs are available, which are fast, reliable and simple to use and can detect Plasmodium falciparum and non-falciparum infections or both. A study was conducted in tribal areas of central India to measure the overall performance of several RDTs for diagnosis of P. falciparum and non-falciparum infections in comparison with traditional and molecular techniques. Such data will be used to guide procurement decisions of policy makers and programme managers. Methods Five commercially available RDTs were tested simultaneously in field in parallel with peripheral blood smears in outbreak-affected areas. The evaluation is designed to provide comparative data on the performance of each RDT. In addition, molecular method i.e. polymerase chain reaction (PCR was also carried out to compare all three methods. Results A total of 372 patients with a clinical suspicion of malaria from Bajag Primary Health Centre (PHC of district Dindori and Satanwada PHC of district Shivpuri attending the field clinics of Regional Medical Research Centre were included in the study. The analysis revealed that the First Response Malaria Antigen pLDH/HRP2 combo test was 94.7% sensitive (95% CI 89.5-97.7 and 69.9% specific (95% CI 63.6-75.6 for P. falciparum. However, for non-falciparum infections (Plasmodium vivax the test was 84.2% sensitive (95% CI 72.1-92.5 and 96.5% specific (95% CI 93.8-98.2. The Parascreen represented a good alternative. All other RDTs were relatively

  1. Contemporary concepts for the clinical and laboratory evaluation of systemic lupus erythematosus and "lupus-like" syndromes. (United States)

    Nakamura, R M; Bylund, D J


    Systemic lupus erythematosus (SLE) is a nonorgan-specific autoimmune disease which affects multiple organ systems and is multifactorial in etiology. SLE is the prototypic systemic rheumatic disease with immune dysregulation characterized by (1) polyclonal activation of B-cells and (2) production of a large spectrum of autoantibodies with a marked preference for nuclear and intracellular antigens. The clinical and laboratory manifestations and criteria for classification and diagnosis of systemic lupus erythematosus, lupus-like syndromes, and various subsets of systemic lupus erythematosus, are reviewed. The differential diagnosis of SLE and related diseases is described with correlation of specific intracellular autoantibodies.

  2. Comparative study of accuracy and clinical agreement of the CoaguChek XS portable device versus standard laboratory practice in unexperienced patients. (United States)

    Torreiro, Eduardo G; Fernández, Elizabeth Gómez; Rodríguez, Rosa Mariño; López, Carmen Vázquez; Núñez, Julia Barreal


    The objective of the study was to compare the accuracy and clinical agreement of the CoaguChek XS versus the standard laboratory practice. Forty-one patients on long-term anticoagulation with acenocumarol without previous experience in self-monitoring participated to obtain 218 pairs of data. Several methods for comparative statistics were applied to assess the possible disagreements between techniques as well as a range of previously published criteria of clinical agreement and the very recently described error-grid for INR comparison that we partially modify. The mean age was 52.1 and the indications for oral anticoagulation were prosthetic valves (36.59%), atrial fibrillation (34.15%), venous thromboembolic disease (21.95%) and others (7.31%) with a target range of 2-3 INR units (63.4%) or 2.5-3.5 (36.6%). Analyzing the whole series of data, the Pearsons rho correlation coefficient for precision between methods was 0.95 and the C(b) bias correction factor for accuracy 0.99 with a minimal bias of 0.1 INR units between methods applying the Bland-Altman plot. The linear regression procedure described by Passing and Bablok showed a minimal deviation from the best-fit line and a slope of 0.90. The mean of the absolute relative differences was 7% which is in the "very good" range of agreement. No results were found in the clinically "dangerous" D zone of the error-grids with 99% of data in the clinically irrelevant and low relevant areas A and B. In this study self-management with the CoaguChek XS was clinically safe and reliable.

  3. Correlation between the Lactate Dehydrogenase Levels with Laboratory Variables in the Clinical Severity of Sickle Cell Anemia in Congolese Patients.

    Directory of Open Access Journals (Sweden)

    Tite Minga Mikobi

    Full Text Available Sickle cell anemia is an inflammatory disease and is characterized by chronic hemolysis. We sought to evaluate the association of lactate dehydrogenase levels with specific clinical phenotypes and laboratory variables in patients with sickle cell anemia.The present cross-sectional study was conducted in Sickle Cell Centre of Yolo in Kinshasa, the Democratic Republic of Congo. Two hundred and eleven patients with Sickle Cell Anemia in steady state were recruited. Seventy-four participants with normal Hb (Hb-AA were selected as a control group.The average rates of hemoglobin, hematocrit, and red blood cells tended to be significantly lower in subjects with Hb-SS (p<0.001. The average rates of white blood cells, platelets, reticulocytes and serum LDH were significantly higher in subjects with Hb-SS (p<0.001. The average rates of Hb, HbF, hematocrit and red blood cells of Hb-SS patients with asymptomatic clinical phenotype were significantly higher than those of the two other phenotypes. However, the average rates of white blood cells, platelets, reticulocytes, and LDH of Hb-SS patients with the severe clinical phenotype are higher than those of two other clinical phenotypes. Significant correlations were observed between Hb and white blood cell in severe clinical phenotype (r3 = -0.37 * between Hb and red blood cells in the three phenotypes (r1 = 0.69 * r2 * = 0.69, r3 = 0.83 *, and finally between Hb and reticulocytes in the asymptomatic clinical phenotype and severe clinical phenotype (r1 = -0.50 * r3 = 0.45 *. A significant increase in LDH was observed in patients with leg ulcer, cholelithiasis and aseptic necrosis of the femoral head.The increase in serum LDH is accompanied by changes in hematological parameters. In our midst, serum LDH may be considered as an indicator of the severity of the disease.

  4. Correlation between the Lactate Dehydrogenase Levels with Laboratory Variables in the Clinical Severity of Sickle Cell Anemia in Congolese Patients (United States)

    Mikobi, Tite Minga; Lukusa Tshilobo, Prosper; Aloni, Michel Ntetani; Mvumbi Lelo, Georges; Akilimali, Pierre Zalagile; Muyembe-Tamfum, Jean Jacques; Race, Valérie; Matthijs, Gert; Mbuyi Mwamba, Jean Marie


    Background Sickle cell anemia is an inflammatory disease and is characterized by chronic hemolysis. We sought to evaluate the association of lactate dehydrogenase levels with specific clinical phenotypes and laboratory variables in patients with sickle cell anemia. Methods The present cross-sectional study was conducted in Sickle Cell Centre of Yolo in Kinshasa, the Democratic Republic of Congo. Two hundred and eleven patients with Sickle Cell Anemia in steady state were recruited. Seventy-four participants with normal Hb (Hb-AA) were selected as a control group. Results The average rates of hemoglobin, hematocrit, and red blood cells tended to be significantly lower in subjects with Hb-SS (p<0.001). The average rates of white blood cells, platelets, reticulocytes and serum LDH were significantly higher in subjects with Hb-SS (p<0.001). The average rates of Hb, HbF, hematocrit and red blood cells of Hb-SS patients with asymptomatic clinical phenotype were significantly higher than those of the two other phenotypes. However, the average rates of white blood cells, platelets, reticulocytes, and LDH of Hb-SS patients with the severe clinical phenotype are higher than those of two other clinical phenotypes. Significant correlations were observed between Hb and white blood cell in severe clinical phenotype (r3 = -0.37 *) between Hb and red blood cells in the three phenotypes (r1 = 0.69 * r2 * = 0.69, r3 = 0.83 *), and finally between Hb and reticulocytes in the asymptomatic clinical phenotype and severe clinical phenotype (r1 = -0.50 * r3 = 0.45 *). A significant increase in LDH was observed in patients with leg ulcer, cholelithiasis and aseptic necrosis of the femoral head. Conclusion The increase in serum LDH is accompanied by changes in hematological parameters. In our midst, serum LDH may be considered as an indicator of the severity of the disease. PMID:25946088

  5. Integration of next-generation sequencing in clinical diagnostic molecular pathology laboratories for analysis of solid tumours; an expert opinion on behalf of IQN Path ASBL

    NARCIS (Netherlands)

    Deans, Zandra C; Costa, Jose Luis; Cree, Ian; Dequeker, Els; Edsjö, Anders; Henderson, Shirley; Hummel, Michael; Ligtenberg, Marjolijn Jl; Loddo, Marco; Machado, Jose Carlos; Marchetti, Antonio; Marquis, Katherine; Mason, Joanne; Normanno, Nicola; Rouleau, Etienne; Schuuring, Ed; Snelson, Keeda-Marie; Thunnissen, Erik; Tops, Bastiaan; Williams, Gareth; van Krieken, Han; Hall, Jacqueline A


    The clinical demand for mutation detection within multiple genes from a single tumour sample requires molecular diagnostic laboratories to develop rapid, high-throughput, highly sensitive, accurate and parallel testing within tight budget constraints. To meet this demand, many laboratories employ ne

  6. 77 FR 20489 - Joint Biomedical Laboratory Research and Development and Clinical Science Research and... (United States)


    ... Town Alexandria. Cellular and Molecular June 4, 2012..... *VA Central Office. Medicine. Infectious... May 24, 2012..... Sheraton Suites--Old Science-B. Town Alexandria. Neurobiology-D May 24-25, 2012.... Neurobiology-A June 1, 2012..... Sheraton Suites--Old Town Alexandria. Clinical Application of June 1,...

  7. Augmented Reality M-Learning to Enhance Nursing Skills Acquisition in the Clinical Skills Laboratory (United States)

    Garrett, Bernard M.; Jackson, Cathryn; Wilson, Brian


    Purpose: This paper aims to report on a pilot research project designed to explore if new mobile augmented reality (AR) technologies have the potential to enhance the learning of clinical skills in the lab. Design/methodology/approach: An exploratory action-research-based pilot study was undertaken to explore an initial proof-of-concept design in…

  8. Abdominal and pelvic CT in cases of suspected abuse: can clinical and laboratory findings guide its use?

    Energy Technology Data Exchange (ETDEWEB)

    Trout, Andrew T.; Strouse, Peter J. [University of Michigan Health System, C.S. Mott Children' s Hospital, Department of Radiology, Ann Arbor, MI (United States); Mohr, Bethany A. [University of Michigan Health System, C.S. Mott Children' s Hospital, Department of Pediatrics, Ann Arbor, MI (United States); Khalatbari, S.; Myles, Jamie D. [University of Michigan, Michigan Institute for Clinical and Health Research, Ann Arbor, MI (United States)


    Incomplete history and concern for occult injury in suspected child abuse occasionally results in CT screenings of the abdomen and pelvis. At our institution, we noted that these exams were infrequently positive. To identify clinical or laboratory criteria that may predict intra-abdominal injury and guide the use of abdominal and pelvic CT in this population. This retrospective review involved 68 children older than 36 months who had a CT of the abdomen/pelvis for suspected abuse. CT results and patient charts were reviewed for physical exam and historical and laboratory variables. CTs were positive in 16% of patients (11/68). Hypoactive/absent bowel sounds (P = 0.01, specificity = 94.7%) and AST and ALT values greater than twice normal (P = 0.004 and P = 0.003 respectively, NPV = 93.6%) were significantly associated with positive CTs. Multiple abnormal physical exam or laboratory findings were also significantly associated with positive CTs (P = 0.03 and P = 0.002 respectively, specificity = 91.3% and NPV = 93.6% respectively). CTs of the abdomen and pelvis are infrequently positive in cases of suspected abuse. To reduce radiation exposure, CTs should only be ordered if there are findings indicating that they may be positive. In our population, these findings include absent/hypoactive bowel sounds, LFTs greater than twice normal and {>=}2 abnormal labs or physical exam findings. (orig.)

  9. A review of signal processing techniques for heart sound analysis in clinical diagnosis. (United States)

    Emmanuel, Babatunde S


    This paper presents an overview of approaches to analysis of heart sound signals. The paper reviews the milestones in the development of phonocardiogram (PCG) signal analysis. It describes the various stages involved in