Analysis of annual distributions of hemoglobin A2 values as a method to test for HbA2 standardization

BACKGROUND AND AIMS

The monitoring of yearly distributions of HbA2 measured has been indicated as a reliable indicator of worldwide standardization.

MATERIALS AND METHODS

Measurements/year of HbA2 have been collected over three consecutive years in 15 Italian laboratories each using the same analytical method over three years period. HbA2 distributions, cleaned of replicated measurements, were compared by the overlapping area of the raw probability density functions expressed by coefficient eta (η), and by comparing the reference intervals for the central part of each distribution estimated by the indirect method refineR using the R package "refineR".

RESULTS

According to the overlapping areas analysis the distributions/year of the data provided by 4 centers able to perform at least 1000 measurements/year were similar in 2 consecutive years. Moreover, the reference intervals provided by 2 centers using the same analytical methods in two separate locations over the three consecutive years, were very similar. The highest overlap (99.7 %) was observed in one center over two consecutive years. The overlapping areas were very high (93.6-95.7%) in 8 out of 9 inter-comparisons.

CONCLUSION

Despite the limitations of this study the yearly distribution of the HbA2 measured in various centers appears a reliable tool to test HbA2 standardization over different centers using different analytical methods.

Adherence to the Mediterranean diet is inversely associated with metabolic syndrome occurrence: a meta-analysis of observational studies

Diet plays a role in the onset and progression of metabolic disorders, including metabolic syndrome (MetS). We aimed to systematically review and conduct a quantitative meta-analysis of results from observational cross-sectional and prospective cohort studies on adherence to the Mediterranean dietary pattern and risk of MetS. Literature databases including PubMed, SCOPUS and EMBASE were searched from the beginning to May 2016. Eight cross-sectional and four prospective studies were included in this meta-analysis, accounting for a total of 33,847 individuals and 6342 cases of MetS. High adherence to the Mediterranean diet was associated with a risk of MetS (RR: 0.81, 95%CI: 0.71, 0.92). Regarding individual components of the MetS, the inverse associations were significant for waist circumference, blood pressure and low HDL-C levels. In conclusion, adoption of a Mediterranean dietary pattern was associated with lower risk of the MetS and it can be proposed for the primary prevention of the MetS.

Mediterranean meal versus Western meal effects on postprandial ox-LDL, oxidative and inflammatory gene expression in healthy subjects: a randomized controlled trial for nutrigenomic approach in cardiometabolic risk

AIMS

Inflammation and oxidative damage contribute significantly to the development of cardiovascular diseases (CVD). Postprandial oxidative stress and inflammation are characterized by an increased susceptibility of the organism toward oxidative damage after consumption of a meal rich in lipids and/or carbohydrates. Micronutrients modulate immune system and exert a protective action by reducing oxidized low-density lipoprotein (ox-LDL) level. The aim of the present study was to evaluate the postprandial plasma ox-LDL level and the gene expression of 13 genes related to oxidative stress (HOSp) and human inflammasome pathways (HIp), after a tocopherol-enriched Mediterranean meal (TEM), and a Western high-fat meal (HFM). Moreover, Mediterranean Adequacy Index was calculated to define the quality of both meals.

METHODS

We set up a randomized and crossover trial in healthy human volunteers. Ox-LDL level was measured by enzyme-linked immunosorbent assay and the gene expression of 13 genes related to HOSp and HIp by qRT-PCR.

RESULTS

Ox-LDL levels significantly decreased comparing HFM versus TEM (p < 0.05). Percentages of significantly overexpressed genes after each dietary treatment are as follows: (A) baseline versus HFM: 7.69 % HIp and 23.08 % HOSp; (B) baseline versus TEM: 7.69 % HIp and 7.69 % HOSp; (C) HFM versus TEM: 15.38 % HIp and 15.38 % HOSp.

CONCLUSIONS

TEM reduced postprandial risk factors of CVD, such as ox-LDL, and the expression of inflammation and oxidative stress-related genes. Chronic studies on larger population are necessary before definitive conclusions.

TRIAL REGISTRATION

ClinicalTrials.gov Id: NCT01890070.

Total Automation for the Core Laboratory: Improving the Turnaround Time Helps to Reduce the Volume of Ordered STAT Tests

The transition to total automation represents the greatest leap for a clinical laboratory, characterized by a totally new philosophy of process management. We have investigated the impact of total automation on core laboratory efficiency and its effects on the clinical services related to STAT tests. For this purpose, a 47-month retrospective study based on the analysis of 44,212 records of STAT cardiac troponin I (CTNI) tests was performed. The core laboratory reached a new efficiency level 3 months after the implementation of total automation. Median turnaround time (TAT) was reduced by 14.9±1.5 min for the emergency department (p < 0.01), reaching 41.6±1.2 min. In non-emergency departments, median TAT was reduced by 19.8±2.2 min (p < 0.01), reaching 52±1.3 min. There was no change in the volume of ordered STAT CTNI tests by the emergency department (p = 0.811), whereas for non-emergency departments there was a reduction of 115.7±50 monthly requests on average (p = 0.026). The volume of ordered tests decreased only in time frames of the regular shift following the morning round. Thus, total automation significantly improves the core laboratory efficiency in terms of TAT. As a consequence, the volume of STAT tests ordered by hospital departments (except for the emergency department) decreased due to reduced duplicated requests.

Rehabilitation of children after total correction of tetralogy of Fallot

Nine children who had undergone total correction of tetralogy of Fallot were studied with the purpose of observing the physical changes that might be produced by a period of rehabilitation in hospital and comparing these results with those of a control group having the same pathology but which had not followed a protocol for physical activity. Precise criteria were used in the selection of the patients. Careful clinical examinations and exercise tests were conducted before and after the programme, in particular maximal stress testing on the bicycle ergometer and submaximal exercise on the treadmill. The sessions were held three times weekly in a gymnasium over three months, gradually increasing the duration of each session to a maximum of one hour. During the session, heart rate was monitored with a Sport-tester 3000 so as not to exceed 60%, then 70%, of the maximal heart rate recorded during the stress test. Testing at the end of the programme demonstrated an improvement in tolerance under maximal stress in 7 of the 9 patients. As for submaximal performance, 8 out of 9 children covered a greater distance using the same parameters as for initial testing. At the end of the programme, the children all showed increased independence and initiative and more self-confidence in establishing social relations. The programme has proven to be a comprehensive method for safely improving physical fitness in these patients and represents an important starting point for a better future.

[Cycloergometric exercise test in normal children: comparison of an Italian and a North American population]

The need for a more complete protocol for bicycle ergometer exercise testing in children in our country, induced the Authors to apply the F.W. James protocol to healthy Italian children and then compare the results with a study on a similar american sample population. A total of 102 children, 67 males and 35 females, age range 4.4 - 17 years (mean 10.3 yrs), were examined following the F.W. James protocol. The Authors report the anthropometric and ergometric data obtained, the comparison with James' results and the linear correlation coefficients. Normal reference data were obtained. There were no significant differences between the results obtained from the Italian and American groups, and the correlation coefficients were satisfactory. The results will enable us to benefit from a simple and complete protocol which can be applied to healthy and sick children alike in our country.