152 EXPLORATORY ANALYSIS OF TROPONIN AS BIOMARKER OF ACUTE ISCHAEMIC STROKE SUBTYPES IN A GROUP OF PATIENTS RECRUITED TO THE MIND STUDY

Background

Stroke is a major common cause of acquired disability and death worldwide. Atrial dysfunction or cardiomyopathy, defined by the presence of specific serum biomarkers, ECG findings, or echocardiographic findings, increases the risk of atrial fibrillation, which has been implicated as a key risk factor for ischaemic stroke. There is now growing body of evidence which suggests that early positive troponin after ischaemic stroke may be independently associated with a cardiac embolic source. miRNA as Novel Diagnostic biomarker (MiND) is a current Irish-led research study whose aim is to discover a unique highly diagnostic and prognostic biomarker expressed in acute ischaemic stroke.

Methods

Data were retrospectively extracted from patients recruited to the MiND study with confirmed diagnosis of acute ischaemic stroke within 12 hours of symptoms onset having also undergone high-sensitivity troponin testing from July 2019 to November 2021. Stroke subtypes were classified as per ESUS criteria. Statistical analysis was carried out using STATA/SE, version 16.0.

Results

We identified 52 patients who had troponin performed within 12 hours of symptoms onset. Twenty-two patients were identified as having cardioembolic stroke (CE), 17 as non-cardioembolic stroke (NCE) and 13 as Embolic stroke of unknown source (ESUS). The mean age for each group was 77.5 (±9.8), 65.5 (±12.8) and 66.3 (±11.7) years, respectively. The rate of troponin positivity for each group was 55% (12/22), 29% (5/17) and 15% (2/13), respectively. The unadjusted logistic analysis revealed a positive association between CE stroke subtype and elevated troponin (OR 3.94, 95% 1.20-12.98, p = 0.024) and an inverse association between ESUS stroke subtype and elevated troponin (OR 0.24, 95% CI 0.05-1.21, p = 0.083).

Conclusion

Our analysis reveals that early positive troponin after ischaemic stroke is a strong predictor of CE stroke subtype but not of ESUS stroke subtype.

Valvular calcium load assessment for predicting postprocedural paravalvular leakage: a comparison between surgical aortic valve replacement versus transcatheter implantation

Background

Calcification of native aortic valve is a well known variable causing paravalvular leakage (PVL) following transcatheter aortic valve implantation (TAVI). However, there is currently no evidence to support the fact that patients with high calcium load could be better treated with surgical aortic valve replacement (SAVR).

Purpose

To assess the utility of preoperative assessment of valvular calcium load through computed tomography in patients affected by severe aortic valve stenosis undergoing SAVR or TAVI.

Methods

Between June 2016 and June 2018, 109 candidates for isolated SAVR through minimal invasive access underwent preoperative contrast enhanced multidetector computed tomography (MDCT) for the assessment of valve and aortic calcifications. Calcium load was quantitatively measured using a dedicated software in three regions on interest (aortic valve [AV], left ventricular outflow tract [LVOT] and device landing zone [DLZ], which is the sum of the earlier 2). Clinical, echocardiographic, and MDCT variables were collected and compared to a sample population of 107 patients that underwent TAVI (87 transfemoral, 20 transapical) for native aortic valve stenosis in the same period of time, in the same institution. A univariate and multivariate logistic regression analysis were performed on the whole study population to assess risk factors for the onset of postoperative PVL (any grade, defined as ≥ mild) at discharge.

Results

The two study groups were significantly different in terms of age (71.9±5 in SAVR; 81.5±6 in TAVI), gender (36% female in SAVR vs 51% in TAVI), Euroscore II (1.9%±0.8 in SAVR; 4.8%±2.7 in TAVI), annulus perimeter (79.5mm±8.2 in SAVR; 61.8mm±30.5 in TAVI), baseline ejection fraction (57%±8 in SAVR; 51%±12 in TAVI) and severe pulmonary hypertension (2%±13 in SAVR; 26%±44 in TAVI). Calcium load was not different between groups (DLZ 1066 mm3±716 vs 955mm3±639; total calcium in AV 987 mm3±678 vs 879 mm3±601; total calcium in LVOT 78 mm3±130 vs 77 mm3±100). 30-days-mortality was 1.8% in SAVR and 5.6% in TAVI group (p=0.17). At discharge, incidence of all grades PVL was 5.5% in SAVR (0.9% trace, 3.6% mild, 0.9% moderate) and 41% in TAVI group (12.1% trace, 25.2% mild, 3.7% moderate) (p<0.05). On logistic regression on the whole study population, DLZ calcium (OR 1.1, 95% CI 1–1.2 for 100 mm3, p=0.003) and the use of TAVI (OR 24, 95% CI 7.7–78, p<0.001) were identified as independently associated with the onset of PVL.

Conclusions

Aortic valve calcifications are a risk factor for the onset of PVL for both TAVI and SAVR. Nevertheless, the risk increases considerably with the use of TAVI. A deeper anatomical analysis of preoperative MDCT could improve the treatment selection and the outcome of patients affected by aortic valve stenosis.

Funding Acknowledgement

Type of funding source: None

[Risk stratification of emergencies during the COVID-19 pandemic within the emergency department]

BACKGROUND

The COVID-19 pandemic represents a complex challenge for medical staff within emergency departments (ED) of hospitals at all care levels. Beside regular emergency care, rapid detection and isolation of COVID-19 cases are obligatory for prevention of internal viral transmission and efficient medical staff protection.

METHODS

In this study a model of risk stratification for suspected SARS-CoV‑2 and COVID-19 cases was developed on the basis of epidemiologic criteria of the Robert-Koch Institute including five risk categories (RC). The model was implemented in a hospital of basic and regular care level. By combination of risk categories with specific isolation, hygienic and personal protection procedures all areas of the ED were restructured. In a retrospective study all inpatient cases (n = 491) were re-evaluated during a 4-week interval (26 March-26 April 2020).

RESULTS

In the study population 25 SARS-CoV‑2 positive cases (5.2%) were identified. These cases were categorized according to the risk stratification model as follows: RC I-confirmed SARS-CoV‑2 infection 36% (n = 9), RC II-reasonable suspected cases 32% (n = 8), RC III-differential diagnostic cases 12% (n = 3), RC IV-low probability 8% (n = 2) and RC V-no evidence 12% (n = 3). No viral transmission was detected during the whole period within medical staff and patients of the ED.

CONCLUSIONS

Introduction of COVID-19 risk categories within the ED permits central control of important hygienic processes with respect to SARS-CoV‑2 infection probability. By continuous re-evaluation of case definitions local outbreaks can be used to adapt criteria within the risk categories. Risk stratification of COVID-19 cases allows for a strict separation of COVID-19 and non-COVID-19 emergencies and thus ensures effective infection prevention of medical staff and patients.

Modellprojekt zur interdisziplinären universitären Lehre – Studierende der Medizin und der Psychologie lernen erstmals gemeinsam

Eine interdisziplinäre Zusammenarbeit ist in der medizinischen Versorgung chronisch erkrankter Patienten mit komplexen Erkrankungen erforderlich. Vor allem im Bereich der internistischen Rheumatologie ist eine interdisziplinäre Arbeit unerlässlich, um die komplexen somatischen und psychosozialen Aspekte einer chronischen Erkrankung zu berücksichtigen. Dennoch werden die Aspekte der interprofessionellen Arbeit im Studium der Medizin und Psychologie unzureichend thematisiert. Aus diesem Grund wurde ein Modellprojekt zur interdisziplinären universitären Lehre konzipiert, welches beide Fächer miteinander vereint. Die Veranstaltung wurde im Wintersemester 2019/20 erstmalig durchgeführt und stieß bei den Teilnehmer*innen auf positive Resonanz. Das Hauptziel der Veranstaltung ist die Implementierung interprofessioneller Arbeit in die Ausbildung des medizinischen Personals. Zusätzlich konnte das Fach der internistischen Rheumatologie den Studierenden nähergebracht werden.

Non-ambulatory dogs with cervical intervertebral disc herniation: single versus multiple ventral slot decompression

OBJECTIVE

To evaluate the proportion of non-ambulatory dogs with cervical intervertebral disc herniation (IVDH) in a private clinic and to compare signalment and outcome between those that underwent single or multiple ventral slot decompression (VSD).

DESIGN

Retrospective cohort study.

METHODS

After screening 43,378 medical records (January 2010-September 2016), those of 185 dogs with non-ambulatory tetraparesis or tetraplegia along with cervical IVDH that had undergone single (123) or multiple (62) VSD were included in this study. Data on signalment, preoperative neurological status, location of affected intervertebral disc(s), time to ambulation and short-term outcome were compared between single and multiple VSD groups.

RESULTS

The proportion of non-ambulatory dogs with IVDH was 35.3%. The prevalence of non-ambulation was higher in male dogs (0.56%) than in female dogs (0.26%; P < 0.001) and in neutered dogs than in unneutered dogs (0.51% and 0.27%, respectively, P < 0.001). After surgery, 96.2% of the dogs reached ambulatory status. Dogs with multiple IVDH were older than those with single IVDH. Sex, neutering status or size did not affect the outcome or ambulation status postsurgery. The Pekingese was the most commonly affected breed in both groups. There was no difference in the time to reach ambulation and the presence of neurological deficits after surgery between dogs that underwent single and multiple VSD.

CONCLUSIONS

In this cohort, dogs undergoing multiple VSD had a good postoperative outcome, and their short-term functional recovery was equal to that of dogs undergoing single ventral slot compression.

Remodeling of Cancellous and Cortical Canine Bone in Response to Decreased Mechanical Loading

Thirteen pairs of tibiae were excised from adult mongrel dogs following a mean recovery period of 24.2 weeks after unilateral total hip arthroplasty (THA). Prior to euthanasia, peak vertical dynamic load, as a percent of body weight, was determined for each limb at a walking pace. Four contiguous proximal sections and one transverse cortical midshaft section, 5mm thick, were harvested from each tibia. Contact Faxitron radiographs of the sections were quantified, using video digitizing software, to compare mean apparent density measures between the treated (THA) and intact limbs. There was a significant difference in mean apparent density of cancellous bone with the treated limb having a lower apparent density than the intact limb. The mean cortical area at the midshaft was significantly lower and the medullary area significantly higher among tibiae from the treated side, as compared to the contra-lateral tibiae. Resistance to bending and tension at the midshaft of each bone were determined using the second moment of area about cranio-caudal (Ix) and mediolateral (Iy) axes. The mean Iy values for the treated limbs were significantly lower than for the intact limbs. Therefore, measurable adaptive bone remodeling appears to be present in both cancellous and cortical bone in the tibia due to decreased mechanical loading.

Versorgungserfahrungen bipolarer Patienten in Deutschland

Hintergrund: Das übergeordnete Ziel der Erstellung einer S3-Leitlinie zur Diagnostik und Therapie bipolarer Störungen war es, die Versorgung bipolarer Patienten in Deutschland auf einem qualitativ hohen Niveau zu gestalten. Um den aktuellen Versorgungszustand vor Einführung der Leitlinie abbilden und Verbesserungspotenziale aufdecken zu können, wurde eine Befragung von Mitgliedern der beiden die Leitlinie erarbeitenden Gesellschaften durchgeführt. Methoden: Die Befragung wurde von September 2009 bis Februar 2010 mittels Fragebogen durchgeführt. Die meisten Fragen wurden eigens für die Erhebung konzipiert, zusätzlich wurden validierte Instrumente zur Erhebung der aktuellen Stimmungslage und Einschätzung der Lebensqualität verwandt. Ergebnisse: Die Rücklaufquote betrug 40%. Die Dauer vom Auftreten der ersten Symptome bis zur korrekten Diagnosestellung war mit zwölf Jahren, bzw. mit fast neun Jahren bei Patienten mit Diagnosestellung innerhalb der letzten 15 Jahre, sehr lang. Die Mehrheit der befragten Patienten wird regelmäßig im Verlauf von ihrem Arzt betreut. Die Ergebnisse zur Einschätzung der Zufriedenheit mit der Behandlung und Lebensqualität zeigen Verbesserungspotenzial. Schlussfolgerungen: Aus den Ergebnissen geht hervor, dass ein hohes Maß an Engagement der Betroffenen erforderlich war, um eine adäquate Versorgung zu organisieren. Und es zeigten sich in dieser Kohorte weitere Verbesserungspotenziale, die bei „durchschnittlichen” Patienten wahrscheinlich noch größer sind. Für eine Versorgung bipolarer Patienten in Deutschland auf einem qualitativ hohen Niveau müssen vielfältige Initiativen gestärkt werden, wie die Umsetzung entsprechender Leitlinien, die Unterstützung der Patienten bei der Entwicklung einer hohen Selbstkompetenz und der Aktivitäten von Patienten- und Angehörigenorganisationen sowie bei der Realisierung zeitgemäßer Versorgungsmodelle.

Impact of plant growth-promoting rhizobacteria on root colonization potential and life cycle of Rhizophagus irregularis following co-entrapment into alginate beads

AIMS

This study aimed at evaluating the impact of seven plant growth-promoting rhizobacteria (PGPR) on root colonization and life cycle of Rhizophagus irregularis MUCL 41833 when co-entrapped in alginate beads.

METHODS AND RESULTS

Two in vitro experiments were conducted. The first consisted of the immobilization of R. irregularis and seven PGPR isolates into alginate beads to assess the effect of the bacteria on the pre-symbiotic growth of the fungus. In the second experiment, the best performing PGPR from experiment 1 was tested for its ability to promote the symbiotic development of the AMF in potato plantlets from three cultivars. Results showed that only one isolate identified as Pseudomonas plecoglossicida (R-67094) promoted germ tube elongation and hyphal branching of germinated spores during the pre-symbiotic phase of the fungus. This PGPR further promoted the symbiotic development of the AMF in potato plants.

CONCLUSIONS

The co-entrapment of Ps. plecoglossicida R-67094 and R. irregularis MUCL 41833 in alginate beads improved root colonization by the AMF and its further life cycle under the experimental conditions.

SIGNIFICANCE AND IMPACT OF THE STUDY

Co-entrapment of suitable AMF-PGPR combinations within alginate beads may represent an innovative technology that can be fine-tuned for the development of efficient consortia-based bioformulations.

First experience with the new Sorin Crown PRT bioprosthetic aortic valve: early postoperative outcome and hemodynamic performance in 90 patients

AIM

The Crown PRT (The Phospholipid Reduction Treatment) is a new stent bovine bioprosthesis for aortic valve replacement (AVR). Aim of this paper is to report the postoperative clinical and hemodynamic results after ninety consecutive implants.

METHODS

After receiving CE mark in July 2014, two European university centers implanted the new Crown PRT (Sorin Group, Burnaby, Canada) for the first time. Up to now, ninety patients underwent aortic valve replacement, in isolated or combined procedures, for aortic stenosis or insufficiency. Intraoperative transesophageal echocardiogram was used to assess the prosthesis's function. In hospital outcomes and echocardiographic parameters were recorded.

RESULTS

Age and Log Euroscore were 71.8±7.9 years and 10.2%±4.5 respectively. In-hospital mortality for isolated AVR was 0%; one patient died after a multiple procedure (overall 30-days mortality 1.1%). No adverse device effects were recorded. Intensive Care Unit stay was 2±5.8 days. At discharge, echocardiogram showed no paravalvular leaks and normal postoperative gradients.

CONCLUSION

Our starting results showed that the Crown PRT is safe and reliable, with excellent hemodynamic performance. Further clinical results with a larger population and long term follow-up are needed to assess the versatility and the durability of this new device.

Femtosecond all-optical synchronization of an X-ray free-electron laser

Many advanced applications of X-ray free-electron lasers require pulse durations and time resolutions of only a few femtoseconds. To generate these pulses and to apply them in time-resolved experiments, synchronization techniques that can simultaneously lock all independent components, including all accelerator modules and all external optical lasers, to better than the delivered free-electron laser pulse duration, are needed. Here we achieve all-optical synchronization at the soft X-ray free-electron laser FLASH and demonstrate facility-wide timing to better than 30 fs r.m.s. for 90 fs X-ray photon pulses. Crucially, our analysis indicates that the performance of this optical synchronization is limited primarily by the free-electron laser pulse duration, and should naturally scale to the sub-10 femtosecond level with shorter X-ray pulses.

Few-femtosecond synchronization at free-electron lasers is key for nearly all experimental applications, stable operation and future light source development. Here, Schulz et al. demonstrate all-optical synchronization of the soft X-ray FEL FLASH to better than 30 fs and illustrate a pathway to sub-10 fs.

[Nellix® endovascular aneurysm sealing (EVAS) - a new technology for endovascular management of infrarenal aortic aneurysms]

BACKGROUND

Recently used endografts for envascular aneurysm repair (EVAR) exclude the pathology by fixation at both the proximal and distal landing zone. Due to endoleaks and migration EVAR is associated with a relevant rate of secondary interventions. The Nellix® system (Endologix Inc., CA, USA) was developed to seal the complete aneurysm using a polymer filling, therefore stabilising endograft-position and reducing the rate of endoleaks and reinterventions. The present contribution introduces the method, describes the technique of implantation and presents the first clinical results. Material und Methods: The Nellix system consists of two balloon-expandable stent grafts made of a cobalt-chromium composition, surrounded with ePTFE and the so-called endobags. During the implantation each endobag is filled with a non-biodegradable polymer, sealing the aneurysm lumina including the proximal and distal landing zone. Hence, lumbar arteries will be sealed to reduce the probability of a type II endoleak.

RESULTS

Longterm durability as well as the structural integrity of the Nellix system has been proven over 4 years in sheep experiments. The technical success in a multicentre, prospective registry was 94% without the appearance of severe adverse events (migration, occlusion, secondary endoleak).

CONCLUSION

EVAS is a new and different concept of endovascular AAA repair. Recent clinical data of the Nellix system are promising showing a high technical success rate while the need for secondary intervention is low. Further studies in larger cohorts are needed.

[Services for the early recognition of psychoses and bipolar disorders in Germany: inventory survey study]

BACKGROUND

In order to successfully implement early recognition and intervention services in psychiatry, it is crucial to improve the attention to and recognition of severe mental disorders and to establish low threshold services that are available at short notice for diagnostic and treatment procedures.

MATERIAL AND METHODS

For this inventory survey study, questionnaires regarding the presence and type of early recognition services for psychoses and bipolar disorders were sent separately to German psychiatric hospitals by mail in September and October 2012. Additionally, an internet search and telephone inquiries as well as an alignment of responses from the two surveys and with network lists from published and ongoing early recognition studies were performed.

RESULTS

Response rates in the psychosis and bipolar disorder surveys were 21 % (51/246) and 36 % (91/255), respectively. Three quarters of participating institutions reported at least an interest in creating an early recognition service for psychoses and one half for bipolar disorders. Overall, 26 institutions were identified that already offer early recognition of psychoses and 18 of bipolar disorders. Of these 16 are low threshold early recognition centres with direct access at short notice for first-episode patients and person from at-risk groups and separate specific public relations work. Of these early recognition centres five have a separate and easy to find homepage available; in an additional 15 institutions the specific websites are part of the institutions homepage.

CONCLUSION

Despite widespread interest and the increasingly recognized importance of early recognition and intervention services in psychiatry, there is currently no nationwide coverage with early recognition services for severe mental disorders in Germany. Public relations and information activities are not (yet) sufficiently provided to reach affected persons and their environment. Common standards are (still) missing and interdisciplinary models are sparse. To correct these shortcomings, amongst other factors, acquisition of sufficient funding for such services is required.

Alleviation of chronic venous leg ulcers with a hand-held dielectric barrier discharge plasma generator (PlasmaDerm(®) VU-2010): results of a monocentric, two-armed, open, prospective, randomized and controlled trial (NCT01415622)

BACKGROUND

Cold atmospheric plasma (CAP, i.e. ionized air) is an innovating promising tool in reducing bacteria.

OBJECTIVE

We conducted the first clinical trial with the novel PlasmaDerm® VU-2010 device to assess safety and, as secondary endpoints, efficacy and applicability of 45 s/cm(2) cold atmospheric plasma as add-on therapy against chronic venous leg ulcers.

METHODS

From April 2011 to April 2012, 14 patients were randomized to receive standardized modern wound care (n = 7) or plasma in addition to standard care (n = 7) 3× per week for 8 weeks. The ulcer size was determined weekly (Visitrak® , photodocumentation). Bacterial load (bacterial swabs, contact agar plates) and pain during and between treatments (visual analogue scales) were assessed. Patients and doctors rated the applicability of plasma (questionnaires).

RESULTS

The plasma treatment was safe with 2 SAEs and 77 AEs approximately equally distributed among both groups (P = 0.77 and P = 1.0, Fisher's exact test). Two AEs probably related to plasma. Plasma treatment resulted in a significant reduction in lesional bacterial load (P = 0.04, Wilcoxon signed-rank test). A more than 50% ulcer size reduction was noted in 5/7 and 4/7 patients in the standard and plasma groups, respectively, and a greater size reduction occurred in the plasma group (plasma -5.3 cm(2) , standard: -3.4 cm(2) ) (non-significant, P = 0.42, log-rank test). The only ulcer that closed after 7 weeks received plasma. Patients in the plasma group quoted less pain compared to the control group. The plasma applicability was not rated inferior to standard wound care (P = 0.94, Wilcoxon-Mann-Whitney test). Physicians would recommend (P = 0.06, Wilcoxon-Mann-Whitney test) or repeat (P = 0.08, Wilcoxon-Mann-Whitney test) plasma treatment by trend.

CONCLUSION

Cold atmospheric plasma displays favourable antibacterial effects. We demonstrated that plasma treatment with the PlasmaDerm® VU-2010 device is safe and effective in patients with chronic venous leg ulcers. Thus, larger controlled trials and the development of devices with larger application surfaces are warranted.

Enhanced anti-tumour effects of Vinca alkaloids given separately from cytostatic therapies

BACKGROUND AND PURPOSE

In polychemotherapy protocols, that is for treatment of neuroblastoma and Ewing sarcoma, Vinca alkaloids and cell cycle-arresting drugs are usually administered on the same day. Here we studied whether this combination enables the optimal antitumour effects of Vinca alkaloids to be manifested.

EXPERIMENTAL APPROACH

Vinca alkaloids were tested in a preclinical mouse model in vivo and in vitro in combination with cell cycle-arresting drugs. Signalling pathways were characterized using RNA interference.

KEY RESULTS

In vitro, knockdown of cyclins significantly inhibited vincristine-induced cell death indicating, in accordance with previous findings, Vinca alkaloids require active cell cycling and M-phase transition for induction of cell death. In contrast, anthracyclines, irradiation and dexamethasone arrested the cell cycle and acted like cytostatic drugs. The combination of Vinca alkaloids with cytostatic therapeutics resulted in diminished cell death in 31 of 36 (86%) tumour cell lines. In a preclinical tumour model, anthracyclines significantly inhibited the antitumour effect of Vinca alkaloids in vivo. Antitumour effects of Vinca alkaloids in the presence of cytostatic drugs were restored by caffeine, which maintained active cell cycling, or by knockdown of p53, which prevented drug-induced cell cycle arrest. Therapeutically most important, optimal antitumour effects were obtained in vivo upon separating the application of Vinca alkaloids from cytostatic therapeutics.

CONCLUSION AND IMPLICATIONS

Clinical trials are required to prove whether Vinca alkaloids act more efficiently in cancer patients if they are applied uncoupled from cytostatic therapies. On a conceptual level, our data suggest the implementation of polychemotherapy protocols based on molecular mechanisms of drug-drug interactions.

LINKED ARTICLE

This article is commented on by Solary, pp 1555-1557 of this issue. To view this commentary visit http://dx.doi.org/10.1111/bph.12101.

Sternal wound dehiscence from intense coughing in a cardiac surgery patient: could it be prevented?

This case report is on a obese patient who underwent a coronary artery bypass. The immediate postoperative phase, on the 8th day, was characterized by sternal dehiscence with diastasis, from intense coughing. At present, for obese patients there are not any guidelines aimed to prevent the sternal diastasis. The use of a sternum support vest after median sternotomy could be a valuable tool in the postoperative care of our patients, in order to avoid chest wall hyperexpansion and to prevent sternal wound dehiscence and diastasis.

European proficiency study with control serum for the tumor marker CA 19-9 measured on different test systems

BACKGROUND

Reliable and precise CA 19-9 testing is required for the long-term follow-up of patients with pancreatic carcinoma during therapy. The aim of this longitudinal proficiency study was to evaluate the comparability, linearity, and precision of CA 19-9 determinations performed in different laboratories using currently available test systems under routine conditions.

METHODS

During the one year study period, 15 laboratories applied 7 different tests and included a liquid BIOREF control serum with pancreatic carcinoma derived CA 19-9 in their routine testing and quality control procedures. The results were collected centrally and evaluated statistically.

RESULTS

The comparability of CA 19-9 results is limited especially when different tests are used, albeit, some tests show a good correlation: The CA 19-9 values obtained by different laboratories using different test systems vary up to a factor of 2. The precision of CA 19-9 determinations was acceptable in most laboratories with coefficients of variation ranging between very low 3.2% and high 17.8%. The imprecision was slightly increased when automatic dilution procedures of the analysers were used.

CONCLUSIONS

The comparability of CA 19-9 test results must be improved. The precision is acceptable in most cases. In order to monitor key performance parameters, every laboratory should participate in external quality assessment schemes and should perform a routine internal quality control with a control serum independent from the test kit manufacturer.