A new method of measuring heparin levels in whole blood by protamine titration using a heparin-responsive electrochemical sensor

OBJECTIVE

To determine the ability of a new electrochemical sensor to determine heparin levels in whole blood and to correlate the heparin levels as determined by this heparin-responsive sensor (HRS) with heparin levels as determined by the Hepcon assay system (Medtronic Hemotec, Parker, CO).

DESIGN

Methods comparison study.

SETTING

A large academic medical center.

INTERVENTIONS

The heparin levels of 162 samples from 24 patients undergoing cardiopulmonary bypass were determined by the HRS system and by the Hepcon system. In 21 samples, heparin levels as measured by anti-Xa activity were determined as well.

MEASUREMENTS AND MAIN RESULTS

HRS-determined values correlated highly with Hepcon-determined values (r = 0.942) and with anti-Xa determined values (r = 0.905). Bias +/- precision comparing the HRS and Hepcon methods was 0.211 +/- 0.478 U/mL.

CONCLUSIONS

HRS determined that whole blood heparin levels correlate well with Hepcon-determined levels. These limited results indicate that further development and testing of this new technology are warranted.

Processing of nutritious, safe and acceptable foods from CELSS candidate crops

A controlled ecological life-support system (CELSS) is required to sustain life for long-duration space missions. The challenge is preparing a wide variety of tasty, familiar, and nutritious foods from CELSS candidate crops under space environmental conditions. Conventional food processing technologies will have to be modified to adapt to the space environment. Extrusion is one of the processes being examined as a means of converting raw plant biomass into familiar foods. A nutrition-improved pasta has been developed using cowpea as a replacement for a portion of the durum semolina. A freeze-drying system that simulates the space conditions has also been developed. Other technologies that would fulfill the requirements of a CELSS will also be addressed.

Teaching microbiology with hypertext: first steps towards a virtual textbook

Computer-assisted learning materials for medical microbiology were developed using hypertext-authoring software (Folio 3.1). Two versions of a text-only introductory tutorial (detailed, read only, and read-write noteform) were then evaluated in a prospective, randomized trial. Evaluation was by pre- and post-exposure multiple choice questions, and by self-administered questionnaire. There was a small difference in outcome between the two groups; the read-write group scoring higher, and students who used either software performed better than those who did not (P = 0.014). Responses to the post-test questionnaires showed that many students regarded the read-only software as an electronic handout, more frequent users requesting the addition of illustrations, self-assessment questions, and greater interactivity. A small group of students made use of the read-write version of the tutorial as a 'virtual textbook' by adding extra material to the starter file. Our experience suggests that the low-cost option of text-only hypermedia produces only modest learning gains for medical undergraduates.

Clinical application of disposable heparin sensors. Blood heparin measurements during open heart surgery

The authors previously reported the development of an ion selective electrode type heparin sensor consisting of a specially formulated polymer membrane doped with tridodecylmethylammonium chloride as the heparin complexing agent. They also demonstrated the feasibility of measuring blood heparin levels by protamine titration, using a disposable copper wire sensor coated with the heparin sensing membrane to probe the titration end point. In this article, the results of further titration studies conducted on 44 clinical whole blood specimens obtained from 8 patients undergoing open heart surgery were reviewed. Samples were taken from patients at four different stages during the bypass surgery: 1) before heparin administration; 2) immediately after heparin administration; 3) within 30 min to 3 hr after heparin administration; and 4) within 30 min after protamine administration. Heparin anticoagulant activity in these samples was monitored by the activated clotting time assay, whereas heparin concentrations were measured by protamine titration using either the Hepcon HMS Titrator (Medtronic HemoTec Inc., Englewood, CO) or the coated wire heparin sensor to determine titration end points. Results indicate that heparin levels determined by the sensor method were in good agreement with those determined by the Hepcon HMS Titrator. When the heparin concentrations estimated by the two methods show significant discrepancy (> 1.0 unit/ml), the sensor method seems to provide more precise values, as verified by an additional chromogenic heparin assay. The overall time required to complete the titration process and heparin measurement with a pre made heparin sensor was less than 3 min. Clinically, the heparin sensor could be used as a safeguard to precisely monitor heparin levels during surgical procedures. Alternatively, the sensor could be used to assess the accurate protamine dose required for full heparin reversal.

Response mechanism of polymer membrane-based potentiometric polyion sensors

The potentiometric response mechanism of a previously reported polymer membrane-based electrode sensitive to the polyanion heparin is established. Based on transport and extraction studies, the heparin response is attributed to a nonequilibrium change in the phase boundary potential at the sample/membrane interface. While true equilibrium polyion response, obtained for low heparin concentrations only after very long equilibration times (> 20 h), yields the expected Nernstian response slope of < 1 mV/decade, the observed large and reproducible EMF response to clinically relevant heparin concentrations (approximately 10(-7) M) during typical measurement periods (2-5 min) is ascribed to a steady-state kinetic process defined by the flux of the polyion both to the surface and into the bulk of the polymer membrane. A model describing this nonequilibrium response is presented. With this model, the uniqueness of the polymer membrane composition (e.g., very low plasticizer content, strictly controlled cationic site concentration, etc.) required to achieve analytically useful heparin response becomes clear. Practical working conditions and limitations of the sensor are discussed. To support the generality of the steady-state model proposed, corresponding EMF response data for a newly developed membrane electrode sensitive to a polycationic protein (protamine) are also presented. It is shown that the protamine-responsive membrane electrode appears to operate via the exact same kinetic mechanism as the heparin sensing system.

A disposable, coated wire heparin sensor

The development of an ion-selective electrode heparin sensor consisting of a specially formulated polymer membrane doped with tridodecylmethylammonium chloride as the heparin complexing agent was recently reported. Because of the simple nature of the membrane technology used, the authors envisioned that the sensor could be configured as a disposable single-use device for rapid clinical or bedside measurement of heparin in a small, discrete sample. To explore this possibility, an inexpensive, disposable heparin sensor was created by dip-coating a copper wire with the specially formulated heparin-sensing polymeric membrane. Coated wire heparin sensors with a broad range of membrane thicknesses, prepared by repeatedly dipping the wire in the membrane solution for various times, were examined. Data show that increasing the membrane thickness of the sensor to a certain degree (more than 10 microns) enhanced the sensor's potentiometric response to heparin, although the time required to achieve 90% of the steady-state potential change was also prolonged. In addition, increasing membrane thickness also magnified the stirring effect on the sensor's response. In undiluted plasma samples, the coated-wire sensor with an optimized membrane thickness yielded a significant (5 to 30 mV) and reproducible response to heparin in a clinically relevant concentration range (0.5 to 12 units/ml, respectively). The clinical utility of the coated wire heparin sensor was shown using the sensor during protamine titration of heparinized plasma to assess the titration end-point. Preliminary results showed that the titration end-points determined by the heparin sensor strongly correlated with those determined by the activated partial thromboplastin time clotting assay. The overall time requirement to complete the titration process using a set of prefabricated coated wire heparin sensors, however, was less than 3 minutes. Further titration studies using undiluted clinical whole blood samples are in progress.

[Determination of magnolol in cortex Magnoliae officinalis and its processed samples by HPLC and studies on ginger-processed principles]

The experimental result of the quantitative determination of magnolol in Cortex Magnoliae Officinalis and its processed samples by HPLC has shown that the stir-fried sample has the highest content of magnolol among all sample and so does the ginger-fried sample among all ginger-processed samples. As a condiment, ginger can increase the content of magnolol to a certain extent, but the quantity used in processing does not affect the content significantly.