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Nivy R, Sutton G, Bruchim Y. Carboxyhemoglobin as a diagnostic and prognostic biomarker of hemolytic anemias in dogs. J Vet Intern Med 2022; 37:110-116. [PMID: 36571460 PMCID: PMC9889617 DOI: 10.1111/jvim.16617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Endogenous production of carbon monoxide during hemoglobin metabolism leads to the formation of carboxyhemoglobin. Carboxyhemoglobin concentration is abnormally high in humans with hemolytic anemia (HA). HYPOTHESIS Measurement of carboxyhemoglobin concentration can discriminate HA from other forms of anemia. ANIMALS Twenty-seven dogs with HA (immune-mediated HA, n = 22; microangiopathic HA, n = 5), 27 dogs with non-HA (kidney disease, n = 14; immune-mediated thrombocytopenia, [n = 6]; miscellaneous, n = 7) and 24 nonanemic control dogs. METHODS Prospective cohort study. Carboxyhemoglobin quantification, a CBC and biochemistry profile were performed upon admission, and survival to hospital discharge and at 30 days were the measured outcomes. Groups were compared by the Mann-Whitney and Kruskal-Wallis tests. Receiver-operator characteristic (ROC) analyses were used to examine the predictive utility of carboxyhemoglobin for the diagnosis of HA in anemic dogs. RESULTS Carboxyhemoglobin (median [interquartile range]) differed between dogs with HA (7.7% [2.5%]) and non-HA (3.6% [1.05]; P < .001) and dogs with HA and nonanemic dogs (3.5% [0.65%]; P < .001). No difference was detected between nonHA and nonanemic dogs. The area under the ROC curve for carboxyhemoglobin as predictor of HA in anemic dogs was 0.997 (95% CI, 0.99-1.00). Three optimal cut-off points were identified, including 5.05%, 4.55% and 4.85%, with corresponding sensitivity/specificity of 92.6%/100%, 100%/92.6% and 96.3%/96.3%, respectively. Neither carboxyhemoglobin nor any of the CBC or chemistry analytes were associated with survival. CONCLUSIONS AND CLINICAL IMPORTANCE Carboxyhemoglobin proved an excellent predictor of HA in dogs and might constitute a useful, ancillary tool for diagnosing and monitoring hemolytic anemias.
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Affiliation(s)
- Ran Nivy
- Ben‐Shemen Specialist Referral CenterBen‐Shemen Youth VillageIsrael,Koret School of Veterinary MedicineThe Hebrew University of JerusalemRehovotIsrael
| | - Gila Sutton
- Koret School of Veterinary MedicineThe Hebrew University of JerusalemRehovotIsrael
| | - Yaron Bruchim
- Ben‐Shemen Specialist Referral CenterBen‐Shemen Youth VillageIsrael
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Tagliaferro T, Cayabyab R, Ramanathan R. Association between blood carboxyhemoglobin level and bronchopulmonary dysplasia in extremely low birthweight infants. J Investig Med 2021; 70:68-72. [PMID: 34493626 DOI: 10.1136/jim-2021-001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/04/2022]
Abstract
Carboxyhemoglobin (CO-Hb) can be endogenously formed in the presence of oxidative stress and may be elevated in inflammatory lung disease. There is lack of evidence of its relationship with the development of bronchopulmonary dysplasia (BPD) in extremely low birthweight (ELBW) infants. The objective of the study is to evaluate the relationship between blood CO-Hb levels in the first 14 days of life (DOL) in ELBW infants and the development of BPD at 36 weeks postmenstrual age (PMA). This is a retrospective cohort study of 58 ELBW infants born at LAC-USC Medical Center between June 2015 and and June 2019 who survived to 36 weeks PMA. CO-Hb values were collected daily from DOL 1 to DOL 14. BPD definition using the recent 2019 NICHD criteria was used. Multivariate logistic regression was performed to determine the association between blood CO-Hb levels and BPD. Receiver operator curve was used to evaluate the ability of the median fraction of inspired oxygen (FiO2) level used at DOL 11-14 in discriminating absent to mild BPD versus moderate to severe BPD. 58 ELBW infants were included in the study. 24 (41%) were diagnosed with moderate to severe BPD, while 34 (59%) were diagnosed with no to mild BPD. Severity of BPD was fairly discriminated by FiO2 at DOL 11-14, but not with CO-Hb levels at any point within the first 14 DOL. The role and mechanism of CO-Hb production in this population need to be further studied.
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Affiliation(s)
- Thea Tagliaferro
- Keck School of Medicine/Pediatrics/Division of Neonatology, USC, Los Angeles, California, USA
| | - Rowena Cayabyab
- Keck School of Medicine/Pediatrics/Division of Neonatology, USC, Los Angeles, California, USA
| | - Rangasamy Ramanathan
- Keck School of Medicine/Pediatrics/Division of Neonatology, USC, Los Angeles, California, USA
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Berger M, Zygmanowski A, Zimmermann S. Differential Inductive Sensing System for Truly Contactless Measuring of Liquids' Electromagnetic Properties in Tubing. SENSORS (BASEL, SWITZERLAND) 2021; 21:5535. [PMID: 34450977 PMCID: PMC8402242 DOI: 10.3390/s21165535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
Certain applications require a contactless measurement to eliminate the risk of sensor-induced sample contamination. Examples can be found in chemical process control, biotechnology or medical technology. For instance, in critically ill patients requiring renal replacement therapy, continuous in-line monitoring of blood conductivity as a measure for sodium should be considered. A differential inductive sensing system based on a differential transformer using a specific flow chamber has already proven suitable for this application. However, since the blood in renal replacement therapy is carried in plastic tubing, a direct measurement through the tubing offers a contactless method. Therefore, in this work we present a differential transformer for measuring directly through electrically non-conductive tubing by winding the tube around the ferrite core of the transformer. Here, the dependence of the winding type and the number of turns of the tubing on the sensitivity has been analyzed by using a mathematical model, simulations and experimental validation. A maximum sensitivity of 364.9 mV/mol/L is measured for radial winding around the core. A longitudinal winding turns out to be less effective with 92.8 mV/mol/L. However, the findings prove the ability to use the differential transformer as a truly contactless sensing system.
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Affiliation(s)
- Marc Berger
- Department of Sensors and Measurement Technology, Institute of Electrical Engineering and Measurement Technology, Leibniz University Hannover, 30167 Hannover, Germany; (A.Z.); (S.Z.)
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Hariri G, Hodjat Panah K, Beneteau-Burnat B, Chaquin M, Mekinian A, Ait-Oufella H. Carboxyhemoglobin, a reliable diagnosis biomarker for hemolysis in intensive care unit: a retrospective study. Crit Care 2021; 25:7. [PMID: 33402152 PMCID: PMC7786981 DOI: 10.1186/s13054-020-03437-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Geoffroy Hariri
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de réanimation médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie, Paris 6, France
| | - Kyann Hodjat Panah
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de réanimation médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Bénédicte Beneteau-Burnat
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de biochimie, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France
| | - Michael Chaquin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'hématologie, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France
| | - Arsene Mekinian
- Sorbonne Université, Université Pierre-et-Marie Curie, Paris 6, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Service de médecine interne, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France
| | - Hafid Ait-Oufella
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de réanimation médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. .,Sorbonne Université, Université Pierre-et-Marie Curie, Paris 6, France. .,Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France.
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5
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Kuster N, Bargnoux AS, Badiou S, Dupuy AM, Piéroni L, Cristol JP. Multilevel qualification of a large set of blood gas analyzers: Which performance goals? Clin Biochem 2019; 74:47-53. [PMID: 31533025 DOI: 10.1016/j.clinbiochem.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/13/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Blood gas analyzers are frequently installed as point of care devices and thus allow rapid decision making. Few data are available regarding analytical performance of large sets of BGA. We aimed at evaluating 22 ABL 90 Flex Plus analyzers intended to be deployed. The evaluation was performed at the device level and at the entire set level to characterize the quality of measurements but also to ensure consistency across the devices deployed in the hospital. METHODS Imprecision and total error were assessed for pH, pCO2, pO2, sodium, potassium, ionized calcium, glucose, lactate and oximetry parameters. Imprecision at the hospital level including between device variability was also evaluated. One of the two analyzers used in the central laboratory was correlated with a GEM Premier 4000 and a Cobas b221 analyzers. Thereafter, we tested sequentially the 20 instruments intended to be deployed in care service in comparison with the reference device. RESULTS Heterogeneity of analytical performance across the different analyzers was low, allowing to consider the whole set as a unique analyzer. The total error was in line with performance goals. Analytical performance of the analyzers was found suitable for use in clinical practice. CONCLUSIONS Our study is an example of the qualification of a set of point and underscores 1)The need for a unified qualification scheme when multiple analyzers are deployed simultaneously 2) analytical performance goals compatible with clinical use and the state of the art for all parameters.
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Affiliation(s)
- Nils Kuster
- Department of Biochemistry and Hormonology, CHU de Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, France
| | - Anne Sophie Bargnoux
- Department of Biochemistry and Hormonology, CHU de Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, France
| | - Stéphanie Badiou
- Department of Biochemistry and Hormonology, CHU de Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, France
| | - Anne-Marie Dupuy
- Department of Biochemistry and Hormonology, CHU de Montpellier, France
| | - Laurence Piéroni
- Department of Biochemistry and Hormonology, CHU de Montpellier, France
| | - Jean Paul Cristol
- Department of Biochemistry and Hormonology, CHU de Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, France.
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Mion MM, Bragato G, Zaninotto M, Alessandroni J, Bernardini S, Plebani M. Analytical performance evaluation of the new GEM® Premier™ 5000 analyzer in comparison to the GEM® Premier™ 4000 and the RapidPoint® 405 systems. Clin Chim Acta 2018; 486:313-319. [DOI: 10.1016/j.cca.2018.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/27/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
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7
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Analytical and pre-analytical performance characteristics of a novel cartridge-type blood gas analyzer for point-of-care and laboratory testing. Clin Biochem 2018; 53:116-126. [PMID: 29339078 DOI: 10.1016/j.clinbiochem.2018.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/19/2017] [Accepted: 01/11/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Point-of-care blood gas test results may benefit therapeutic decision making by their immediate impact on patient care. We evaluated the (pre-)analytical performance of a novel cartridge-type blood gas analyzer, the GEM Premier 5000 (Werfen), for the determination of pH, partial carbon dioxide pressure (pCO2), partial oxygen pressure (pO2), sodium (Na+), potassium (K+), chloride (Cl-), ionized calcium (iCa2+), glucose, lactate, and total hemoglobin (tHb). METHODS Total imprecision was estimated according to the CLSI EP5-A2 protocol. The estimated total error was calculated based on the mean of the range claimed by the manufacturer. Based on the CLSI EP9-A2 evaluation protocol, a method comparison with the Siemens RapidPoint 500 and Abbott i-STAT CG8+ was performed. Obtained data were compared against preset quality specifications. Interference of potential pre-analytical confounders on co-oximetry and electrolyte concentrations were studied. RESULTS The analytical performance was acceptable for all parameters tested. Method comparison demonstrated good agreement to the RapidPoint 500 and i-STAT CG8+, except for some parameters (RapidPoint 500: pCO2, K+, lactate and tHb; i-STAT CG8+: pO2, Na+, iCa2+ and tHb) for which significant differences between analyzers were recorded. No interference of lipemia or methylene blue on CO-oximetry results was found. On the contrary, significant interference for benzalkonium and hemolysis on electrolyte measurements were found, for which the user is notified by an interferent specific flag. CONCLUSION Identification of sample errors from pre-analytical sources, such as interferences and automatic corrective actions, along with the analytical performance, ease of use and low maintenance time of the instrument, makes the evaluated instrument a suitable blood gas analyzer for both POCT and laboratory use.
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Nourse MB, Engel K, Anekal SG, Bailey JA, Bhatta P, Bhave DP, Chandrasekaran S, Chen Y, Chow S, Das U, Galil E, Gong X, Gessert SF, Ha KD, Hu R, Hyland L, Jammalamadaka A, Jayasurya K, Kemp TM, Kim AN, Lee LS, Liu YL, Nguyen A, O'Leary J, Pangarkar CH, Patel PJ, Quon K, Ramachandran PL, Rappaport AR, Roy J, Sapida JF, Sergeev NV, Shee C, Shenoy R, Sivaraman S, Sosa‐Padilla B, Tran L, Trent A, Waggoner TC, Wodziak D, Yuan A, Zhao P, Young DL, Robertson CR, Holmes EA. Engineering of a miniaturized, robotic clinical laboratory. Bioeng Transl Med 2018; 3:58-70. [PMID: 29376134 PMCID: PMC5773944 DOI: 10.1002/btm2.10084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 11/06/2022] Open
Abstract
The ability to perform laboratory testing near the patient and with smaller blood volumes would benefit patients and physicians alike. We describe our design of a miniaturized clinical laboratory system with three components: a hardware platform (ie, the miniLab) that performs preanalytical and analytical processing steps using miniaturized sample manipulation and detection modules, an assay-configurable cartridge that provides consumable materials and assay reagents, and a server that communicates bidirectionally with the miniLab to manage assay-specific protocols and analyze, store, and report results (i.e., the virtual analyzer). The miniLab can detect analytes in blood using multiple methods, including molecular diagnostics, immunoassays, clinical chemistry, and hematology. Analytical performance results show that our qualitative Zika virus assay has a limit of detection of 55 genomic copies/ml. For our anti-herpes simplex virus type 2 immunoglobulin G, lipid panel, and lymphocyte subset panel assays, the miniLab has low imprecision, and method comparison results agree well with those from the United States Food and Drug Administration-cleared devices. With its small footprint and versatility, the miniLab has the potential to provide testing of a range of analytes in decentralized locations.
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Affiliation(s)
| | - Kate Engel
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | | | | | - Pradeep Bhatta
- Computational BiosciencesTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | | | | | - Yutao Chen
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Steven Chow
- EngineeringTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Ushati Das
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Erez Galil
- Computational BiosciencesTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Xinwei Gong
- Computational BiosciencesTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | | | - Kevin D. Ha
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Ran Hu
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Laura Hyland
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | | | - Karthik Jayasurya
- Computational BiosciencesTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Timothy M. Kemp
- Software DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Andrew N. Kim
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Lucie S. Lee
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Yang Lily Liu
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Alphonso Nguyen
- Systems IntegrationTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Jared O'Leary
- Systems IntegrationTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | | | - Paul J. Patel
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Ken Quon
- Software DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | | | | | - Joy Roy
- EngineeringTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | | | | | - Chandan Shee
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Renuka Shenoy
- Computational BiosciencesTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | | | | | - Lorraine Tran
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Amanda Trent
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | | | - Dariusz Wodziak
- Assay DevelopmentTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Amy Yuan
- Systems IntegrationTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Peter Zhao
- EngineeringTheranos, 7373 Gateway BoulevardNewarkCA 94560
| | - Daniel L. Young
- Computational BiosciencesTheranos, 7373 Gateway BoulevardNewarkCA 94560
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Jones B, Till K, King R, Gray M, OʼHara J. Are Habitual Hydration Strategies of Female Rugby League Players Sufficient to Maintain Fluid Balance and Blood Sodium Concentration During Training and Match-Play? A Research Note From the Field. J Strength Cond Res 2016; 30:875-80. [PMID: 26332779 DOI: 10.1519/jsc.0000000000001158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Limited data exist on the hydration status of female athletes, with no data available on female rugby players. The objective of this study was to investigate the habitual hydration status on arrival, sweat loss, fluid intake, sweat Na loss, and blood [Na+] during field training and match-play in 10 international female rugby league players. Urine osmolality on arrival to match-play (382 ± 302 mOsmol·kg(-1)) and training (667 ± 260 mOsmol·kg(-1)) was indicative of euhydration. Players experienced a body mass loss of 0.50 ± 0.45 and 0.56 ± 0.53% during match-play and training, respectively. During match-play, players consumed 1.21 ± 0.43 kg of fluid and had a sweat loss of 1.54 ± 0.48 kg. During training, players consumed 1.07 ± 0.90 kg of fluid, in comparison with 1.25 ± 0.83 kg of sweat loss. Blood [Na+] was well regulated (Δ-0.7 ± 3.4 and Δ-0.4 ± 2.6 mmol·L(-1)), despite sweat [Na+] of 47.8 ± 5.7 and 47.2 ± 6.3 mmol·L(-1) during match-play and training. The findings of this study show mean blood [Na+] that seems to be well regulated despite losses of Na in sweat and electrolyte-free fluid consumption. For the duration of the study, players did not experience a body mass loss (dehydration >2%) indicative of a reduction in exercise performance, thus habitual hydration strategies seem adequate. Practitioners should evaluate the habitual hydration status of athletes to determine whether interventions above habitual strategies are warranted.
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Affiliation(s)
- Ben Jones
- Research Institute Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, West Yorkshire, United Kingdom
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Predicting the Occurrence of Hypotension in Stable Patients With Nonvariceal Upper Gastrointestinal Bleeding: Point-of-Care Lactate Testing. Crit Care Med 2016; 43:2409-15. [PMID: 26468697 DOI: 10.1097/ccm.0000000000001275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES It is difficult to assess risk in normotensive patients with upper gastrointestinal bleeding. The aim of this study was to evaluate whether the initial lactate value can predict the in-hospital occurrence of hypotension in stable patients with acute nonvariceal upper gastrointestinal bleeding. DESIGN Retrospective, observational, single-center study. SETTING Emergency department of a tertiary-care, university-affiliated hospital during a 5-year period. PATIENTS Medical records of 3,489 patients with acute upper gastrointestinal bleeding who were normotensive at presentation to the emergency department. We analyzed the ability of point-of-care testing of lactate at emergency department admission to predict hypotension development (defined as systolic blood pressure <90 mm Hg) within 24 hours after emergency department admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 1,003 patients with acute nonvariceal upper gastrointestinal bleeding, 157 patients experienced hypotension within 24 hours. Lactate was independently associated with hypotension development (odds ratio, 1.6; 95% CI, 1.4-1.7), and the risk of hypotension significantly increased as the lactate increased from 2.5-4.9 mmol/L (odds ratio, 2.2) to 5.0-7.4 mmol/L (odds ratio, 4.0) and to greater than or equal to 7.5 mmol/L (odds ratio, 39.2) (p<0.001). Lactate elevation (≥2.5 mmol/L) was associated with 90% specificity and an 84% negative predictive value for hypotension development. When the lactate levels were greater than 5.0 mmol/L, the specificity and negative predictive value increased to 98% and 87%, respectively. CONCLUSIONS Point-of-care testing of lactate can predict in-hospital occurrence of hypotension in stable patients with acute nonvariceal upper gastrointestinal bleeding. However, subsequently, prospective validate research will be required to clarify this.
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Nicholson G, Mcloughlin G, Bissas A, Ispoglou T. Do the acute biochemical and neuromuscular responses justify the classification of strength- and hypertrophy-type resistance exercise? J Strength Cond Res 2016; 28:3188-99. [PMID: 24832969 DOI: 10.1519/jsc.0000000000000519] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study aimed to examine a wide profile of acute biochemical and neuromuscular responses to strength (STR) and hypertrophy (HYP) resistance exercise (RE). Seven trained men completed an STR workout (4 × 6 repetitions, 85% 1 repetition maximum [1RM], 5-minute rest periods), an HYP workout (4 × 10 repetitions, 70% 1RM, 90-second rest periods), and a control condition (CON) in a randomized crossover design. Peak force (PF), rate of force development (RFD), and muscle activity were quantified before and after exercise during an isometric squat protocol. Blood samples were taken 20, 10, and 0 minutes before and 0, 10, and 60 minutes after exercise to measure the concentration of blood lactate (BL), pH, and a number of electrolytes that were corrected for plasma volume changes. No differences were observed between the workouts for changes in PF, RFD, or muscle activity. Repeated contrasts revealed a greater (p ≤ 0.05) increase in BL concentration and reduction in pH after the HYP protocol than the STR or CON conditions. There were similar but significant (p ≤ 0.05) changes in the concentration of a number of electrolytes after both workouts, and a handful of these changes displayed significant correlations with the PF reductions observed after the HYP condition. Although the STR and HYP workouts were significantly different in terms of intensity, volume, and rest, these differences were only observable in the acid-base responses. The present findings reinforce the need for practitioners to look beyond the classification of RE workouts when aiming to elicit specific physiological responses.
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Affiliation(s)
- Gareth Nicholson
- Carnegie School of Sport, Leeds Metropolitan University, Leeds, United Kingdom
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12
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Kim HJ, Lee HR, Park YS, Kyung SG, Do SH. Assessment of the accuracy and precision of the i-Smart 30 VET Electrolyte Analyzer in dogs, cats, cattle and pigs. Vet Clin Pathol 2015; 44:410-9. [PMID: 25970518 DOI: 10.1111/vcp.12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Performance evaluation of point-of-care (POC) electrolyte analyzers is essential for determining their precision and accuracy in clinical practice. OBJECTIVE The purpose of this study was to validate the i-Smart 30 VET Electrolyte Analyzer for canine, feline, bovine, and porcine samples in comparison with the ion-selective electrolyte analyzer Roche 9180 electrolyte analyzer. METHODS A total of 400 heparinized whole blood samples were collected and analyzed by both instruments for sodium, potassium, and chloride concentrations. Within-run, between-day, and total imprecision were evaluated. Statistical analyses included tests for correlation, regression, bias, and total error. RESULTS The coefficients of variation (CV) of both within-run and between-day imprecisions in the i-Smart 30 VET ranged from 0.4-1.6%. In addition, total CV (0.3-1.7%) and total error (0.7-3.7%) of the i-Smart 30 VET were acceptable according to the ASVCP guidelines (< 5%). The correlation between the i-Smart 30 VET and the Roche 9180 was excellent (r > .98). There was no proportional error according to the regression (slope ranges 0.92-1.00, 95% CI includes 1.00), but a constant error was detected for sodium concentration in dogs (interval = 0.5), cattle (interval = 3.0), and pigs (interval = 4.0), and for chloride concentration in cats (interval = 1.0). Most of the bias was within 95% CI, and the total error range (0.8-3.5%) was acceptable according to ASVCP guidelines. CONCLUSION The i-Smart 30 VET Electrolyte Analyzer provides precise and accurate measurements of sodium, potassium, and chloride concentrations in whole blood samples from dogs, cats, cattle, and pigs.
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Affiliation(s)
- Han-Jun Kim
- Department of Clinical Pathology, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Hye-Rim Lee
- Department of Clinical Pathology, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | | | - Soon-Goo Kyung
- Jangsu Stud Farm, Korea Racing Authority, Jeollabuk-do, Korea
| | - Sun Hee Do
- Department of Clinical Pathology, College of Veterinary Medicine, Konkuk University, Seoul, Korea
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Assessment of Neonatal Hyperbilirubinemia Using GEM Premier 4000 Total Bilirubin Assay. POINT OF CARE 2014. [DOI: 10.1097/poc.0000000000000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kapoor D, Srivastava M, Singh P. Point of care blood gases with electrolytes and lactates in adult emergencies. Int J Crit Illn Inj Sci 2014; 4:216-22. [PMID: 25337483 PMCID: PMC4200547 DOI: 10.4103/2229-5151.141411] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Point-of-care testing (POCT) is one of the formidable concept introduce in the field of critical care settings to deliver decentralized, patient-centric health care to the patients. Rapid provision of blood measurements, particularly blood gases and electrolytes, may translate into improved clinical outcomes. Studies shows that POCT carries advantages of providing reduced therapeutic turnaround time (TTAT), shorter door-to-clinical-decision time, rapid data availability, reduced preanalytic and postanalytic testing errors, self-contained user-friendly instruments, small sample volume requirements, and frequent serial whole-blood testing. However, still there is a noticeable debate that exists among the laboratorians, clinicians, and administrators over concerns regarding analyzer inaccuracy, imprecision and performance (interfering substances), poorly trained non-laboratorians, high cost of tests, operator-dependent quality of testing, and difficulty in integrating test results with hospital information system (HIS). On search of literature using Medline/Pubmed and Embase using the key phrases "ppoint-of-care test," "central laboratory testing," "electrolytes," "blood gas analysis," "lactate," "emergency department," "intensive care unit," we found that POCT of blood gases and selected electrolytes may not entirely replace centralized laboratory testing but may transfigure the clinical practice paradigm of emergency and critical care physicians. We infer that further comprehensive, meaningful and rigorous evaluations are required to determine outcomes which are more quantifiable, closely related to testing events and are associated with effective cost benefits.
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Affiliation(s)
- Dheeraj Kapoor
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Meghana Srivastava
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Pritam Singh
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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Perioperative red blood cell transfusion for patients undergoing elective non-cardiac surgery: an audit at a Chinese tertiary hospital. Transfus Apher Sci 2014; 51:99-103. [PMID: 25189106 DOI: 10.1016/j.transci.2014.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 07/25/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
Abstract
Perioperative blood transfusion still takes a large proportion in inappropriate blood transfusion. As the data are limited in China, we reported a perioperative red blood cell (RBC) transfusion practices in a tertiary hospital in Guangzhou, China. In 2008-2009, patients who underwent elective surgeries receiving RBC transfusions were recorded and the rate of overtransfusion was analyzed. Overtransfusion was defined as discharge hemoglobin (Hb) exceeding 10 g/dL. The median amount of RBC transfused perioperatively was four units in all 2572 patients. The overall rate of overtransfusion was 48.6% and the Department of Neurosurgery had the highest overtransfusion rate. These results are of great use for the future management of blood resource.
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Pecoraro V, Germagnoli L, Banfi G. Point-of-care testing: where is the evidence? A systematic survey. ACTA ACUST UNITED AC 2013; 52:313-24. [PMID: 24038608 DOI: 10.1515/cclm-2013-0386] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/26/2013] [Indexed: 11/15/2022]
Abstract
Abstract
Point-of-care testing (POCT) has had rapid technological development and their use is widespread in clinical laboratories to assure reduction of turn-around-time and rapid patient management in some clinical settings where it is important to make quick decisions. Until now the papers published about the POCT have focused on the reliability of the technology used and their analytical accuracy. We aim to perform a systematic survey of the evidence of POCT efficacy focused on clinical outcomes, selecting POCT denoted special analytes characterized by possible high clinical impact. We searched in Medline and Embase. Two independent reviewers assessed the eligibility, extracted study details and assessed the methodological quality of studies. We analyzed 84 studies for five POCT instruments: neonatal bilirubin, procalcitonin, intra-operative parathyroid hormone, troponin and blood gas analysis. Studies were at high risk of bias. Most of the papers (50%) were studies of correlation between the results obtained by using POCT instruments and those obtained by using laboratory instruments. These data showed a satisfactory correlation between methods when similar analytical reactions were used. Only 13% of the studies evaluated the impact of POCT on clinical practice. POCT decreases the time elapsed for making decisions on patient management but the clinical outcomes have never been adequately evaluated. Our work shows that, although POCT has the potential to provide beneficial patient outcome, further studies may be required, especially for defining its real utility on clinical decision making.
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Affiliation(s)
- Valentina Pecoraro
- Clinical Epidemiologic Unit, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | | | - Giuseppe Banfi
- Clinical Epidemiologic Unit, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
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17
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Bruneel A, Dehoux M, Barnier A, Boutten A. External evaluation of the Dimension Vista 1500® intelligent lab system. J Clin Lab Anal 2013; 26:384-97. [PMID: 23001985 DOI: 10.1002/jcla.21539] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Dimension Vista® analyzer combines four technologies (photometry, nephelometry, V-LYTE® integrated multisensor potentiometry, and LOCI® chemiluminescence) into one high-throughput system. METHODS We assessed analytical performance of assays routinely performed in our emergency laboratory according to the VALTEC protocol, and practicability. RESULTS Precision was good for most parameters. Analytical domain was large and suitable for undiluted analysis in most clinical settings encountered in our hospital. Data were comparable and correlated to our routine analyzers (Roche Modular DP®, Abbott AXSYM®, Siemens Dimension® RxL, and BN ProSpec®). Performance of nephelometric and LOCI modules was excellent. Functional sensitivity of high-sensitivity C-reactive protein and cardiac troponin I were 0.165 mg/l and 0.03 ng/ml, respectively (coefficient of variation; CV < 10%). The influence of interfering substances (i.e., hemoglobin, bilirubin, or lipids) was moderate, and Dimension Vista® specifically alerted for interference according to HIL (hemolysis, icterus, lipemia) indices. Good instrument performance and full functionality (no reagent or sample carryover in the conditions evaluated, effective sample-volume detection, and clot detection) were confirmed. Simulated routine testing demonstrated excellent practicability, throughput, ease of use of software and security. CONCLUSION Performance and practicability of Dimension Vista® are highly suitable for both routine and emergency use. Since no volume detection and thus no warning is available on limited sample racks, pediatric samples require special caution to the Siemens protocol to be analyzed in secured conditions. Our experience in routine practice is also discussed, i.e., the impact of daily workload, "manual" steps resulting from dilutions and pediatric samples, maintenances, flex hydration on instrument's performance on throughput and turnaround time.
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Affiliation(s)
- Arnaud Bruneel
- Laboratoire de Biochimie, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris-AP-HP, Paris, France
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18
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Abstract
Blood gas testing is a commonly ordered test in hospital settings, where the results almost always have the potential to dictate an immediate or urgent response. The preanalytical steps in testing, from choosing the correct tests to ensuring the specimen is introduced into the instrument correctly, must be perfectly coordinated to ensure that the patient receives appropriate and timely therapy in response to the analytical results. While many of the preanalytical steps in blood gas testing are common to all laboratory tests, such as accurate specimen labeling, some are unique to this testing because of the physicochemical properties of the analytes being measured. The common sources of preanalytical variation in blood gas testing are reviewed here.
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Affiliation(s)
- Geoffrey Baird
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
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19
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Helmy MM, Tolner EA, Vanhatalo S, Voipio J, Kaila K. Brain alkalosis causes birth asphyxia seizures, suggesting therapeutic strategy. Ann Neurol 2011; 69:493-500. [PMID: 21337602 DOI: 10.1002/ana.22223] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 07/12/2010] [Accepted: 08/06/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The mechanisms whereby birth asphyxia leads to generation of seizures remain unidentified. To study the possible role of brain pH changes, we used a rodent model that mimics the alterations in systemic CO(2) and O(2) levels during and after intrapartum birth asphyxia. METHODS Neonatal rat pups were exposed for 1 hour to hypercapnia (20% CO(2) in the inhaled gas), hypoxia (9% O(2)), or both (asphyxic conditions). CO(2) levels of 10% and 5% were used for graded restoration of normocapnia. Seizures were characterized behaviorally and utilizing intracranial electroencephalography. Brain pH and oxygen were measured with intracortical microelectrodes, and blood pH, ionized calcium, carbon dioxide, oxygen, and lactate with a clinical device. The impact of the postexposure changes in brain pH on seizure burden was assessed during 2 hours after restoration of normoxia and normocapnia. N-methyl-isobutyl-amiloride, an inhibitor of Na(+) /H(+) exchange, was given intraperitoneally. RESULTS Whereas hypercapnia or hypoxia alone did not result in an appreciable postexposure seizure burden, recovery from asphyxic conditions was followed by a large seizure burden that was tightly paralleled by a rise in brain pH, but no change in brain oxygenation. By graded restoration of normocapnia after asphyxia, the alkaline shift in brain pH and the seizure burden were strongly suppressed. The seizures were virtually blocked by preapplication of N-methyl-isobutyl-amiloride. INTERPRETATION Our data indicate that brain alkalosis after recovery from birth asphyxia plays a key role in the triggering of seizures. We question the current practice of rapid restoration of normocapnia in the immediate postasphyxic period, and suggest a novel therapeutic strategy based on graded restoration of normocapnia.
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Abstract
BACKGROUND Carbon monoxide toxicity in infants and children, like adults, produce nonspecific symptoms with normal vital signs necessitating the serum measurement of carboxyhemoglobin (COHb). In infants, the COHb may be falsely elevated. OBJECTIVES Our goal was to report a case of suspected carbon monoxide toxicity in an infant and the likely cause of the falsely elevated serum COHb. CASE A previously healthy 3-month-old girl presented to the pediatric emergency department (ED) with smoke inhalation from a defective furnace. She was asymptomatic. On examination, she was alert, with Glasgow Coma Scale of 15 and normal vital signs. Cardiorespiratory and neurological examinations were completely normal. Because of concern regarding carbon monoxide poisoning, she was treated with normobaric oxygen therapy. Initial and subsequent serum COHb levels were persistently elevated, despite treatment and the infant appearing clinically well. As such, she had a prolonged stay in the ED. Further investigations found that fetal hemoglobin interferes with the spectrophotometric method used to analyze serum COHb levels. CONCLUSIONS Carboxyhemoglobin serum level, in infants, may be falsely elevated due to the fetal hemoglobin interfering with standard methods of analysis. Knowledge of the false elevation using standard spectrophotometric methods of COHb in clinically well-appearing infants can decrease unnecessary oxygen therapy and monitoring time in the ED.
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An D, Chung HJ, Lee HW, Lee W, Chun S, Min WK. Analytical Performance Evaluation of Glucose Monitoring System Following ISO15197. Ann Lab Med 2009; 29:423-9. [DOI: 10.3343/kjlm.2009.29.5.423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Dongheui An
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hee-Jung Chung
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hye-Won Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Woochang Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sail Chun
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Won-Ki Min
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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22
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:260-77. [PMID: 19390324 DOI: 10.1097/med.0b013e32832c937e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pamidi PV, DeAbreu M, Kim D, Mansouri S. Hydroxocobalamin and cyanocobalamin interference on co-oximetry based hemoglobin measurements. Clin Chim Acta 2009; 401:63-7. [DOI: 10.1016/j.cca.2008.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 11/07/2008] [Accepted: 11/07/2008] [Indexed: 11/16/2022]
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Quantitative Benchtop Analyzers, Estradiol, and Parathyroid Hormone. POINT OF CARE 2008. [DOI: 10.1097/poc.0b013e318183790a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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