Mindray BC-6800 haematological analyser: 3D-DIFF scattergram usefulness in infectious mononucleosis diagnosis

INTRODUCTION

3D-DIFF scattergram of the Mindray BC-6800 haematological analyser shows morphological abnormalities and lymphocyte cluster splitting related to the presence of reactive lymphocytes. This study aims to assess whether these cytographic changes are useful in detecting both activated and apoptotic lymphocytes, leading to an improvement in the laboratory diagnostic process of infectious mononucleosis.

METHODS

Two hundred three samples with modified shape and doubled lymphocyte cluster of DIFF scattergram (study group) were divided into two different subgroups: with and, respectively, without serological evidence of ongoing IM. Activated and apoptotic cells in peripheral blood were counted by light microscopy or gating in the instrumental dot plots. Values of apoptotic cells counted by microscopy were compared with those resulting from gating.

RESULTS

Samples with both shape change and doubled lymphocyte cluster had serological profiles according to the diagnosis of ongoing infectious mononucleosis. Blood smears review was positive for reactive lymphocytes in all 112 samples (100%). An underestimation of apoptotic cell count by light microscopy compared with the gating in the instrumental scatterplot was also observed (96 out of 112, 85.7%).

CONCLUSION

The additional lymphocyte cluster was significantly associated with activated and apoptotic lymphocytes in samples with serology suggesting ongoing infectious mononucleosis. Considering the significance of clue for infectious mononucleosis assigned to the apoptotic lymphocytes, a specific flag such as "apoptotic cells?" could be associate with the related cluster. Such a flag could be used for dedicated rules for smears review, thus increasing infectious mononucleosis detection in laboratories that do not usually practise instrumental cytograms observation.

Short preheating at 41°C leads to a red blood cells count comparable to that in RET channel of Sysmex analysers in samples showing cold agglutination

AIMS

The presence of cold agglutinin in blood samples can cause a spontaneous agglutination of red blood cells (RBCs) when low temperature occurs. This phenomenon causes a spurious lowering of RBC count on the automated haematological analysers that are detected by incongruous values (≥370 g/L) of the mean cellular haemoglobi concentration (MCHC). A preheating at 37°C can remove the RBC agglutination generally resulting in a reliable count. It has been reported that the same result can be reached by using the optical reticulocyte (RET) channel of Sysmex analysers where the RBC count is not influenced by the presence of cold agglutinin. This study aims to evaluate these data in a larger population, with regard to environmental conditions on Sysmex analysers. We have also evaluated the influence of different thermal pretreatments on the RBC count.

METHODS

This study was performed on 96 remnants of peripheral blood samples (48 with MCHC in normal range and 48 with MCHC>370 g/L) which have been analysed in different preanalytical conditions on the Sysmex analysers.

RESULTS

A preheating of samples at 41°C for 1 min leads to a reversibility of the cold agglutination comparable to the one observed in the RET channel and yields better results compared with 37°C for 2 hours.

CONCLUSIONS

None of described procedures assure the complete cold agglutination reversibility in every case. Consequently, since the haematological analysers not yet provide reliable parameters to confirm the complete resolution of agglutination, further verification of RBC count accuracy needs to be performed.

Automatic wedge smears preparation may cause traumatic morphological changes in peripheral blood cells

In recent years, several automated analysers that prepare and stain blood smears have been introduced in clinical laboratories. Despite the use of instrumental settings based on physical characteristic of individual samples, traumatic injuries of neutrophil and lymphocytes can be observed. Some samples present a very high percentage of damaged cells, allowing the speculation that a cellular susceptibility may enhance mechanical traumatism. These artefacts can puzzle morphological evaluation in both traditional and digitised microscopy; in addition, unskilled operators can be misled.

Detection of Apoptotic Lymphocytes Through Sysmex XN-1000 As a Diagnostic Marker for Mononucleosis Syndrome

BACKGROUND

The infectious mononucleosis (IM) includes clue elements, apoptotic and atypical lymphocytes. In IM, the evaluation of dot plot provided by Sysmex XN-1000 analyzer revealed a stretched lymphocytic cluster, white cell differential channel (WDF), on cytogram.

METHODS

In this study, we analyzed 698 samples that include 39 IM, 76 chronic lymphoproliferative disorders, 25 nonclonal lymphocytosis, and 40 healthy donors. Five hundred eighteen samples with other diseases or interference were evaluated. The algorithm was validated on 40,000 files that were received from internal database of Sysmex-Dasit.

RESULTS

The analysis of flow cytometry standard (FCS) files in WDF channel and presumed apoptotic lymphocytes counts on side scatter/forward scatter (SSC/FSC) and SSC/SFL (where SFL is side fluorescence) dot plot revealed excellent correlation among apoptotic cells on peripheral blood smear (R(2)  = 0.79 and 0.75). There was a variation of positional parameters in lymphocyte clusters WX, WY, and WZ. If WX-SSC > 500 and WY-SFL > 1,000 and WZ-FSC > 700, specificity equals to 99% and sensitivity equals to 100%. If nucleated red blood cell (NRBC) <0.03 × 10(3) /μl, specificity equals to 100%. In received files, positives were 1% adding the simultaneous presence of a percentage of events in the two gates relating to the apoptotic lymphocytes of 1.2% of WBC.

CONCLUSION

On Sysmex XN-1000, dot-plot observation allowed immediate detection of IM. Meanwhile, an algorithm based on the parameters on these plots can be calculated with excellent performance.

Interleukin-6, soluble interleukin-6 receptor/interleukin-6 complex and insulin resistance in obese children and adolescents

BACKGROUND/AIM

To study the characteristics of interleukin 6 (IL6), soluble form of interleukin 6 receptor (sILR)/IL6 complex in obese children and adolescents and its relationship with insulin resistance (IR).

SUBJECTS AND METHODS

66 obese children and adolescents [34 boys, mean age 10.3 ± 2.9 years, z-score of body mass index (BMI) 4.76 ± 1.36] and 24 non-obese healthy sex- and age-matched controls. Fasting levels of glucose, insulin, IL6, sIL6, sgp130 were measured. IR was assessed by homeostasis model assessment of IR (HOMA-IR).

RESULTS

Obese subjects showed increased levels of insulin and IL-6 and higher HOMA-IR compared to controls (117.67 ± 50.9 vs. 62.42 ± 29.4 pmol/L, 2.73 ± 0.98 vs. 1.07 ± 0.41 pg/ml and 4.03 ± 2.16 vs. 1.83 ± 1.05 for insulin, IL-6 and HOMA-IR, respectively, p < 0.01 in all cases). sIL-6R levels were significantly lower in obese subjects (34.7 ± 14.2 vs. 55.6 ± 15.2 ng/ml in controls, p = 0.005), whereas sgp130 levels were not significantly different. In obese subjects, IL-6 directly correlated with z-score BMI (r = 0.481, p = 0.009) and with waist-to-height ratio (r = 0.494, p = 0.007), while sIL6-R was inversely related to HOMA-IR (r = -0.522, p = 0.002). Insulin resistant subjects showed higher levels of IL6 and lower levels of sIL6R (3.31 ± 0.72 vs. 2.25 ± 0.64 pg/ml, p = 0.020 and 25.3 ± 9.3 vs. 42.5 ± 10.4 ng/ml, p = 0.013, respectively).

CONCLUSIONS

In obese children and adolescents, IR is associated with elevated levels of IL-6 and diminished values of sIL-6R.

Maternal melatonin effects on clock gene expression in a nonhuman primate fetus

In the adult mammal the circadian system, which allows predictive adaptation to daily environmental changes, comprises peripheral oscillators in most tissues, commanded by the suprachiasmatic nucleus (SCN) of the hypothalamus. The external environment of the fetus is provided by its mother. In primates, maternal melatonin is a candidate to entrain fetal circadian rhythms, including the SCN rhythms of metabolic activity. We found in the 90% of gestation capuchin monkey fetus expression of the clock genes Bmal-1, Per-2, Cry-2, and Clock in the SCN, adrenal, pituitary, brown fat, and pineal. Bmal-1, Per-2, and the melatonin 1 receptor (MT1) showed a robust oscillatory expression in SCN and adrenal gland, whereas a circadian rhythm of dehydroepiandrosterone sulphate was found in plasma. Maternal melatonin suppression changed the expression of Bmal-1, Per-2, and MT1 in the fetal SCN. These effects were reversed by maternal melatonin replacement. In contrast, neither maternal melatonin suppression nor its replacement had effects on the expression of Per-2 and Bmal-1 or MT1 in the fetal adrenal gland or the circadian rhythm of fetal plasma dehydroepiandrosterone sulphate. Our data suggest that maternal melatonin is a Zeitgeber for the fetal SCN but probably not for the adrenal gland.

Enumeration of nucleated red blood cells with the ADVIA 2120 Hematology System: an International Multicenter Clinical Trial

The accurate, reproducible, and timely reporting of nucleated red blood cells (NRBC) is an important function of the clinical hematology laboratory. We used 960 samples from 5 worldwide sites to evaluate a new NRBC enumeration method for the ADVIA 2120 Hematology System. The method showed excellent correlation with microscopy (r = 0.93). Sensitivity and specificity for the presence of NRBC for all samples analyzed was 77.3% and 74.6%, respectively. Almost all false negative samples were at NRBC counts <or=10/100 white blood cells (WBC). All false negative samples and the vast majority of the false positive specimens would be identified in clinical practice by routine slide review of flagged results, using existing review criteria. The coefficient of variation of the method was <10% for NRBC counts >10/100 WBC. The NRBC method automatically corrects WBC counts and differential results for the presence of NRBC; the uncorrected counts are available to the user on the run screen. This method allows the enumeration of NRBC with the ADVIA 2120 Hematology System in CBC/DIFF sample mode without need for additional hardware, sample preparation, or reagents.

Classical and new proving methodology: Provings of Plumbum metallicum and Piper methysticum and comparison with a classical proving of Plumbum metallicum

OBJECTIVE

To study the reliability of a proving methodology and the reproducibility of proving symptoms.

METHODS

Two homeopathic medicines and placebo were given, in a double-blind randomized design, to 31 healthy volunteers (13 Piper methysticum 30C, 11 placebo and 7 Plumbum metallicum 30C), 5 drops 4 times daily, until the onset of unbearable symptoms, or at most for 1 week. The primary outcome measure was the number of phrases containing unusual or new symptoms selected by supervisors (SEL) from unstructured diaries and the number of these symptoms (SYM) present in SELs. The secondary outcome measures were the number of symptoms with modalities of both verum groups concordant with symptoms reported in a previous proving of Plumbum 12C. Other parameters evaluated were repeated and crossed symptoms in SELs.

RESULTS

Both medicines showed qualitative and quantitative differences from placebo. Piper: 146 SELs (median: 5), Plumbum: 118 SELs (16), placebo: 48 SELs (2), containing 260 (8), 199 (29) and 58 (2) SYMs, respectively. There was a significant difference from placebo in Plumbum but not in Piper SELs and SYMs (P < 0.05). 31, 24 and 4 'repeated' and 18, 22 and 2 'crossed' symptoms were found in Piper, Plumbum and placebo. 8 and 30 symptoms concordant with the classical proving of Plumbum were found for Piper and Plumbum, corresponding to about 10% and 45% of their total SELs.

CONCLUSIONS

Open diaries, supervision and double-blind placebo are useful methods in homeopathic pathogenetic trials. Estimates of concordance should be introduced in proving methodology.

Eficiência bionutricional de animais da raça Nelore, F1s Valdostana-Nelore e de mestiços de raças européias adaptadas

Foram avaliados cinco grupos genéticos quanto à eficiência bionutricional (índice resultante da primeira função canônica de uma análise bivariada que envolveu ganho de peso e consumo de matéria seca) sendo seis animais da raça Nelore (N), cinco 1/2Romosinuano-1/2Caracu (RSC), quatro 1/2Senepol-1/2Caracu (SEC), quatro 1/2Belmont Red-1/2Caracu (BRC) e sete 1/2Valdostana-1/2Nelore (VAN). Não foi observada diferença significativa no desempenho dos animais mestiços Caracu, cuja média de eficiência bionutricional foi 519,8. O Nelore apresentou a menor eficiência bionutricional, 425,07, e os animais F1 Valdostana-Nelore, 499,30. Tendência semelhante foi observada para o ganho de peso. Os mestiços que envolveram raças européias adaptadas (RSC, SEC, BRC) apresentaram média de ganho de peso de 1,69kg/dia, enquanto os F1s Valdostana-Nelore alcançaram 1,57kg/dia e os da raça Nelore 1,29kg/dia. Não houve diferença no consumo diário de matéria seca entre os grupos genéticos, média de 7,76kg de MS ingerida/dia. Os grupos genéticos apresentaram conversão alimentar semelhante, com média de 4,87kg de MS ingerida/kg de ganho de peso.

The Caenorhabditis elegans RAD51 homolog is transcribed into two alternative mRNAs potentially encoding proteins of different sizes

In prokaryotes, the RecA protein plays a pivotal role in homologous recombination, catalyzing the transfer of a single DNA strand into an homologous molecule. Structural homologs of the bacterial RecA protein, called Rad51, have been found in different eukaryotes (from yeast to man), suggesting a certain level of conservation in recombination pathways among living organisms. We have cloned the homolog of RAD51 in Caenorhabditis elegans. The CeRAD51 gene is transcribed into two alternative mRNAs and potentially codes for two proteins of 395 and 357 amino acids in length, respectively. We discuss the evolutionary implications of these findings.

Sensing of DNA non-homology lowers the initiation of meiotic recombination in yeast

BACKGROUND

Meiotic recombination between homologous chromosomes in the yeast Saccharomyces cerevisiae is initiated by the formation of DNA double-strand breaks (DSBs). The mechanism of DSB formation and the factors that determine their frequency and location have yet to be elucidated. Current studies of meiotic recombination are also concerned with the question of the functional relationship between DSB formation and the other meiotic processes of homology searching, pairing and synapsis of homologues.

RESULTS

To test if DNA identity is required for high levels of DSBs and recombination, we have asked whether small DNA heterologies (140-547 bp) located within the well characterized ARG4 initiator of meiotic recombination, can affect DSB formation and gene conversion events in the ARG4 locus. The present physical and genetic analyses show that some heterologies reduced recombination frequencies without altering DSB formation, whereas others reduced both DSB and gene conversion frequencies.

CONCLUSIONS

These results suggest that DNA heterologies overlapping a recombination initiator impair meiotic gene conversion at two levels. First, some heterologies affect the level of DSB formation, revealing the existence of an anti-initiation process sensing the presence of sequence non-homology between the homologous chromosomes. Second, heterologies can impair the successful processing of the recombination intermediates once DSBs are made. We present a model for interhomologue cross-talks involving chromosomal and DNA/DNA interactions.

The nucleotide mapping of DNA double-strand breaks at the CYS3 initiation site of meiotic recombination in Saccharomyces cerevisiae

Initiation of meiotic recombination in the yeast Saccharomyces cerevisiae occurs by localized DNA double-strand breaks (DSBs) at several locations in the genome, corresponding to hot spots for meiotic gene conversion and crossing over. The meiotic DSBs occur in regions of chromatin that are hypersensitive to nucleases. To gain insight into the molecular mechanism involved in the formation of these DSBs, we have determined their positions at the nucleotide level at the CYS3 hot spot of gene conversion on chromosome I. We found four major new features of these DSBs: (i) sites of DSBs are multiple with varying intensities and spacing within the promoter region of the CYS3 gene; (ii) no consensus sequence can be found at these sites, indicating that the activity involved in DSB formation has little or no sequence specificity; (iii) the breaks are generated by blunt cleavages; and (iv) the 5' ends are modified in rad50S mutant strains, where the processing of these ends is known to be prevented. We present a model for the initiation of meiotic recombination taking into account the implications of these results.

Evaluation of the efficacy of pidotimod in the exacerbations in patients affected with chronic bronchitis

The efficacy and safety of pidotimod ((R)-3-[(S)-(5-oxo-2-pyrrolidinyl)carbonyl]-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6), a new oral synthetic immunostimulating agent, were investigated in a multicentre study, performed in 10 university and hospital centres of pneumophthisiology and respiratory physiopathology, according to a double-blind vs. placebo experimental design. Primary objective of the investigation was to verify the efficacy of pidotimod against infectious exacerbations in patients affected with chronic bronchitis. 181 inpatients or outpatients (117 male, 64 female; mean age: 62.5 years), affected with chronic bronchitis, were enrolled in the study. Pidotimod 800 mg/die or placebo sachets were administered by oral route for 60 consecutive days, followed by a 60-day follow-up period. Clinical observations were performed at baseline (D 0), after 30 (D 30) and 60 (D 60) days of treatment, as well as at the end of the follow-up (D 120). Time and frequency of infectious relapses were considered as the target variable for the evaluation of the efficacy of the drug. Clinical picture, expectoration characteristics, spirometric parameters and laboratory tests were monitored to evaluate patients' conditions. The results indicate that pidotimod is significantly more effective than placebo against infectious relapses in patients suffering from chronic bronchitis. During the first month, 9% of patients treated with pidotimod were affected with an infectious relapse vs. 39.5% of patients treated with placebo (chi 2, p < 0.001). In the second month, infectious episodes were reported by 1.2% of patients treated with the drug vs. 46.1% of patients treated with placebo (chi 2, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of meconium peritonitis]

A case of meconium peritonitis that was diagnosed ultrasonographically in the second trimester is presented. Fetal ascites, intra-abdominal calcification and polyhydramnios were detected on antenatal ultrasonography.

Identification of two divergently transcribed genes centromere-proximal to the ARG4 locus on chromosome VIII of Saccharomyces cerevisiae

We have sequenced a 3296 bp segment of the chromosome VIII adjacent to the 3' end of the ARG4 gene. This segment contains two divergently oriented open reading frames (YSC83 and YSC84). Northern blot analysis showed the presence of transcripts corresponding to these two open reading frames in vegetative cells. Levels of these transcripts increase five to ten-fold during sporulation. These two genes are not essential for vegetative growth or sporulation. Analysis of the putative protein products on the SwissProt database revealed that the C-terminal region of the Ysc84 protein contains a putative SH3 domain.

The Saccharomyces cerevisiae ARG4 initiator of meiotic gene conversion and its associated double-strand DNA breaks can be inhibited by transcriptional interference

In the yeast Saccharomyces cerevisiae, as in other eukaryotes, some regions of the genome have a much higher level of meiotic gene conversion than others. Previous deletion analysis indicated that the sequence necessary for the high level of gene conversion within the ARG4 region defined an initiation site located between positions -316 and -37 [relative to the first base pair (+1) of the ARG4 coding sequence] of the ARG4 promoter. To test whether this sequence is sufficient to promote gene conversion in a novel chromosomal context, we inverted on the chromosome various DNA fragments including the implicated region and the ARG4 coding sequence. Surprisingly, these inversions resulted in the loss of the normal recombination properties and double-strand-break formation associated with this process. By Northern analysis, we found that a transcript traverses the ARG4 initiation site in these inversion mutants but not in the wild type. When transcription through this region was prevented by a transcription terminator, the activity of the initiation site and the formation of double-strand breaks were restored. From these results and from complementary deletion analysis in the normal ARG4 orientation, we conclude that the activity of the ARG4 initiation site requires protection from transcriptional interference.

[Fetal outcome following "accidental" administration of a long-acting DTRP6 GnRh depot preparation during the first trimester of pregnancy]

In the case reported here, an injection of DTRP6 GnRh microcapsules was given in the 5th, 9th and 13th week of a spontaneous unsuspected multiple pregnancy. No deleterious effect of the embryo could be demonstrated at birth or six months later.

[Microalbuminuria after unilateral nephrectomy in humans: study of effects of dietary protein]

Microalbuminuria may be due to increased glomerular capillary pressure. In turn, this increased pressure may be associated to augmented protein intake or reduction of renal mass. 85 normal subjects who had a unilateral nephrectomy were studied. Creatinine clearance, microalbuminuria and blood pressure were measured. Hyperfiltration was evaluated by comparison of creatinine clearance before and after nephrectomy. Protein intake was evaluated by a nutritional questionnaire. Hyperfiltration was estimated as 38% and microalbuminuria was not different in patients submitted to nephrectomy (9.8 micrograms/min) compared to controls (9.7). Microalbuminuria post nephrectomy was not correlated to level of hyperfiltration, protein intake, age, blood pressure or time after surgery. These results suggest that the remaining kidney is able to double the excretion of albumin with a likely increase in glomerular filtration and intracapillary pressure.

[A rare case of echinococcal cyst located in the ovary]

A rare case of echinococcosis ovarian cyst is reported. The diagnostic difficulties this pathology may present, are underlined.

Foreign transcriptional enhancers in yeast. II. Interplay of the polyomavirus transcriptional enhancer and Saccharomyces cerevisiae promoter elements

In this paper, to further analyze the function of the polyoma enhancer in Saccharomyces cerevisiae, we use as reporter-genes derivatives of the yeast HIS3 gene flanked by two types of partially deleted promoters: in one, UAS elements are removed by deletion of sequences upstream of nt -80 (pGM3181) in the second both TATA boxes and UAS elements are removed by deletion of sequences upstream of nt -35 (pGM2809). These constructs have been studied both as free plasmids and after integration at the TRP1 chromosomal locus. We find that in general the polyoma holoenhancer (A + B domains) elicits transcription from the physiological HIS3 RNA start sites when the native TATA boxes are present. In contrast, an altered enhancer B-domain from polyoma mutant Py-B78, although active when inserted downstream of the test-gene or when coupled to a pseudopromoter (Ciaramella et al, accompanying manuscript), does not work properly in concert with the native yeast TATA boxes. We describe experiments that suggest an important role for the foreign enhancer in RNA start-site selection in yeast.

Chloramphenicol inhibition of the bactericidal effect of ampicillin against Haemophilus influenzae

The effects of combinations of ampicillin and chloramphenicol against seven strains of Haemophilus influenzae type b (five beta-lactamase-negative and two beta-lactamase-positive strains) were evaluated by killing-kinetic methods. Growth of strains was assessed in modified Levinthal broth against an inoculum of 10(5) organisms per ml; colony counts were performed immediately and at 6 and 20 h postinoculation. Ampicillin and chloramphenicol were completely bactericidal at 20 h. reducing bacterial densities to 0 colony-forming units per ml at concentrations equivalent to the ampicillin inhibitory concentration and twofold the chloramphenicol inhibitory concentrations. Chloramphenicol at its inhibitory concentration or at one-half of its inhibitory concentration prevented the normally bactericidal activity of ampicillin at 20 h incubation, but not at 6 h.

Meperidine surveillance in an outpatient department: the recognition of misuse and its control

The identification of two patients who were misusing meperidine prescribed in a hospital prompted the establishment of a surveillance system to examine the possible extent of the problem of prescription narcotic abuse. All outpatient prescriptions for meperidine in a six-month period were reviewed and 17 high users were identified who were considered to be at greatest risk of misuse; they received 55% of all meperidine dispensed from the OPD pharmacy. These persons obtained their prescriptions primarily through the emergency room, they rarely saw the same physician twice, and 12 of them carried a diagnosis of sickle cell disease. Among these patients, four cases of definite abuse were identified. Interventions aimed at promoting continuity of care to the high users led to a 66% reduction in meperidine prescribed to this group in the emergency room and to a shift in their care to the clinics. Establishment of a registry for narcotic surveillance is a first toward recognition of outpatient drug abuse. Limiting prescribing privileges to the physician responsible for a patient's long-term care can further decrease this risk.