Free Light Chains κ and λ as New Biomarkers of Selected Diseases

Diagnostic and prognostic markers are necessary to help in patient diagnosis and the prediction of future clinical events or disease progression. As promising biomarkers of selected diseases, the free light chains (FLCs) κ and λ were considered. Measurements of FLCs are currently used in routine diagnostics of, for example, multiple myeloma, and the usefulness of FLCs as biomarkers of monoclonal gammopathies is well understood. Therefore, this review focuses on the studies concerning FLCs as new potential biomarkers of other disorders in which an inflammatory background has been observed. We performed a bibliometric review of studies indexed in MEDLINE to assess the clinical significance of FLCs. Altered levels of FLCs were observed both in diseases strongly connected with inflammation such as viral infections, tick-borne diseases or rheumatic disorders, and disorders that are moderately associated with immune system reactions, e.g., multiple sclerosis, diabetes, cardiovascular disorders and cancers. Increased concentrations of FLCs appear to be a useful prognostic marker in patients with multiple sclerosis or tick-borne encephalitis. Intensive synthesis of FLCs may also reflect the production of specific antibodies against pathogens such as SARS-CoV-2. Moreover, abnormal FLC concentrations might predict the development of diabetic kidney disease in patients with type 2 diabetes. Markedly elevated levels are also associated with increased risk of hospitalization and death in patients with cardiovascular disorders. Additionally, FLCs have been found to be increased in rheumatic diseases and have been related to disease activity. Furthermore, it has been suggested that inhibition of FLCs would reduce the progression of tumorigenesis in breast cancer or colitis-associated colon carcinogenesis. In conclusion, abnormal levels of κ and λ FLCs, as well as the ratio of κ:λ, are usually the result of disturbances in the synthesis of immunoglobulins as an effect of overactive inflammatory reactions. Therefore, it seems that κ and λ FLCs may be significant diagnostic and prognostic biomarkers of selected diseases. Moreover, the inhibition of FLCs appears to be a promising therapeutical target for the treatment of various disorders where inflammation plays an important role in the development or progression of the disease.

Centimeter-Scale PdS2 Ultrathin Films with High Mobility and Broadband Photoresponse

2D materials with mixed crystal phase will lead to the nonuniformity of performance and go against the practical application. Therefore, it is of great significance to develop a valid method to synthesize 2D materials with typical stoichiometry. Here, 2D palladium sulfides with centimeter scale and uniform stoichiometric ratio are synthesized via controlling the sulfurization temperature of palladium thin films. The relationship between sulfurization temperature and products is investigated in depth. Besides, the high-quality 2D PdS₂ films are synthesized via sulfurization at the temperature of 450-550 °C, which would be compatible with back-end-of-line processes in semiconductor industry with considering of process temperature. The PdS₂ films show an n-type semiconducting behavior with high mobility of 10.4 cm² V^-1 s^-1 . The PdS₂ photodetector presents a broadband photoresponse from 450 to 1550 nm. These findings provide a reliable way to synthesizing high-quality and large-area 2D materials with uniform crystal phase. The result suggests that 2D PdS₂ has significant potential in future nanoelectronics and optoelectronic applications.

Determination of cefadroxil in rat plasma and urine using LC-MS/MS and its application to pharmacokinetic and urinary excretion studies

A simple, rapid, and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed and validated for the determination of cefadroxil, a first-generation cephalosporin, in rat plasma and urine. Rat samples were deproteinized with methanol, and then injected into the LC-MS/MS system (electro-spray ionization, positive mode) for quantification. Drugs were separated on a Synergi™ 4 μm Polar-RP 80A column (150 mm × 2.0 mm, 4 μm) with a mixture of 0.1% formic acid and methanol (62:38, v/v) as the mobile phase at 0.2 mL/min. Detection was performed using multiple reaction-monitoring modes at m/z 364.1→208.1 (for cefadroxil) and m/z 368.1→174.2 (for cefaclor, the internal standard). Method was specific and linear over the concentration range of 10-10,000 ng/mL. Validation parameters for cefadroxil, including accuracy, precision, absolute matrix effect, and stability in rat plasma and urine, were acceptable according to the biological method validation guidelines of the FDA (2001) [16]. Cefadroxil levels in plasma up to 1440 min or 480 min and urine up to 96 h were quantifiable following oral and intravenous cefadroxil administrations to rats at a dose of 2mg/kg, each, suggesting that the method is appropriate for routine pharmacokinetic studies including urinary recovery in rats.

Enhancement of Taihu blue algae anaerobic digestion efficiency by natural storage

Taihu blue algae after different storage time from 0 to 60 d were anaerobic fermented to evaluate their digestibility and process stability. Results showed that anaerobic digestion (AD) of blue algae under 15 d natural storage led to the highest CH4 production of 287.6 mL g(-1) VS at inoculum substrate ratio 2.0, demonstrating 36.69% improvement comparing with that from fresh algae. Storage of blue algae led to cell death, microcystins (MCs) release and VS reduction by spontaneous fermentation. However, it also played an important role in removing algal cell wall barrier, pre-hydrolysis and pre-acidification, leading to the improvement in CH4 yield. Closer examination of volatile fatty acids (VFA) variation, VS removal rates and key enzymes change during AD proved short storage time (≤ 15 d) of blue algae had higher efficiencies in biodegradation and methanation. Furthermore, AD presented significant biodegradation potential for MCs released from Taihu blue algae.

When is enough evidence enough? - Using systematic decision analysis and value-of-information analysis to determine the need for further evidence

Decision analysis (DA) and value-of-information (VOI) analysis provide a systematic, quantitative methodological framework that explicitly considers the uncertainty surrounding the currently available evidence to guide healthcare decisions. In medical decision making under uncertainty, there are two fundamental questions: 1) What decision should be made now given the best available evidence (and its uncertainty)?; 2) Subsequent to the current decision and given the magnitude of the remaining uncertainty, should we gather further evidence (i.e., perform additional studies), and if yes, which studies should be undertaken (e.g., efficacy, side effects, quality of life, costs), and what sample sizes are needed? Using the currently best available evidence, VoI analysis focuses on the likelihood of making a wrong decision if the new intervention is adopted. The value of performing further studies and gathering additional evidence is based on the extent to which the additional information will reduce this uncertainty. A quantitative framework allows for the valuation of the additional information that is generated by further research, and considers the decision maker's objectives and resource constraints. Claxton et al. summarise: "Value of information analysis can be used to inform a range of policy questions including whether a new technology should be approved based on existing evidence, whether it should be approved but additional research conducted or whether approval should be withheld until the additional evidence becomes available." [Claxton K. Value of information entry in Encyclopaedia of Health Economics, Elsevier, forthcoming 2014.] The purpose of this tutorial is to introduce the framework of systematic VoI analysis to guide further research. In our tutorial article, we explain the theoretical foundations and practical methods of decision analysis and value-of-information analysis. To illustrate, we use a simple case example of a foot ulcer (e.g., with diabetes) as well as key references from the literature, including examples for the use of the decision-analytic VoI framework by health technology assessment agencies to guide further research. These concepts may guide stakeholders involved or interested in how to determine whether or not and, if so, which additional evidence is needed to make decisions.

Serum free light chains in clinical laboratory diagnostics

Monoclonal free light chains (FLCs) are important disease biomarkers in patients with plasma cell-proliferative disorders. The increasing evidence for clonal diversity and evolution in multiple myeloma highlights the importance of laboratory algorithms that measure both intact immunoglobulins and monoclonal FLCs, at diagnosis and when monitoring response to treatment. A particular focus in the field has been on the utility of serum FLC (sFLC) assays to replace urine electrophoresis for monoclonal FLC measurement. Due to the limited sensitivity and practical constraints of urine analysis, a serum-based algorithm of SPE and sFLC has been adopted by many laboratories as a first line screen in patients with suspected monoclonal gammopathies. This review will discuss the data supporting the use of this simple serum-based algorithm at initial diagnosis, including its utility for the rapid identification of monoclonal FLC in the setting of unexplained acute kidney injury, and provide a comprehensive review of the diagnostic sensitivity of sFLC in patients with multiple myeloma, AL amyloidosis and light chain deposition disease.

A new biomarker--index of cardiac electrophysiological balance (iCEB)--plays an important role in drug-induced cardiac arrhythmias: beyond QT-prolongation and Torsades de Pointes (TdPs)

INTRODUCTION

In the present study, we investigated whether a new biomarker - index of cardiac electrophysiological balance (iCEB=QT/QRS) - could predict drug-induced cardiac arrhythmias (CAs), including ventricular tachycardia/ventricular fibrillation (VT/VF) and Torsades de Pointes (TdPs).

METHODS

The rabbit left ventricular arterially-perfused-wedge was used to investigate whether the simple iCEB measured from the ECG is reflective of the more difficult measurement of λ (effective refractory period×conduction velocity) for predicting CAs induced by a number of drugs.

RESULTS

Dofetilide concentration-dependently increased iCEB and λ, predicting potential risk of drug-induced incidence of early afterdepolarizations (EADs) starting at 0.01μM. Digoxin (1 and 5μM), encainide (5 and 20μM) and propoxyphene (10 and 100μM) markedly reduced both iCEB and λ, predicting their ability to induce non-TdP-like VT/VF. At 10μM, both NS1643 and levcromakalim significantly decreased λ and iCEB, which was preceded with presence of non-TdP-like VT/VF. Isoprenaline (0.05 to 0.5μM) significantly reduced both λ and iCEB, which was associated with a high incidence of non-TdP-like VT/VF in most preparations. Other biomarkers (i.e. transmural dispersion of T-wave and instability of the QT interval) predicted only dofetilide-induced long QT and EADs, but did not predict drug-induced risk of non-TdP-like VT/VF.

DISCUSSION

Our data from 7 reference drugs of known pro-arrhythmic effects suggests that 1) this non-invasive iCEB predicts potential risk of drug-induced CAs beyond long QT and TdP; 2) iCEB is more useful than the current biomarkers (i.e. transmural dispersion and instability) in predicting potential risks for drug-induced non-TdP-like VT/VF.