A case of IgA multiple myeloma: Nutritional perspective in diagnostic testing

A 64-year-old security guard and longstanding known hypertensive presented with hypertensive heart disease (HHD), weight loss, an enlarged prostate, and a spontaneously fractured rib. Malignancy of the prostate with possible metastases to the ribs was strongly suspected. Biochemical profiling revealed a paraprotein. Other biochemical and hematological correlates that were on hand before serum protein electrophoresis were rather atypical. Paraprotein studies by immunofixation revealed IgA myelomatosis. Unlike previous reports from Caucasians there was normocalcaemia, normal protein level, microcytic hypochromia, low MCHC, cholesterol level at the lower limit of the reference range and normal urea level (in the face of markedly raised creatinine level). Nutritional modulation of the classical laboratory features of this disease may account for the fairly atypical laboratory picture. The need to appreciate the influence of nutritional status on the laboratory (especially biochemical) features of a disease and thus interpretation of diagnostic tests appears of exceptional current importance, given the widening gap in socioeconomic status and the level of poverty between the resource poor and developed countries from which the classical, clinical and laboratory features of most diseases were first described. This case report reminds of the need not only to recognize theoretically the impact of nutritional status on the laboratory characteristics of a disease but of the practical application of the nutritional perspective in the interpretation of diagnostic investigations, especially in nutritionally disadvantaged communities.     

Clinical usefulness of alterations in sialic acid,sialyl transferase and sialoproteins in breast cancer

Sialic acid, the end moieties of the carbohydrate chains are biologically important and essential for functions of glycoconjugates and are reported to be altered in cancer patients. Two hundred and twenty five breast cancer (BC) patients, 100 patients with benign breast disease (BBD) and 100 healthy females (controls) were enrolled for the study. Eight hundred and twenty four follow-up samples of 225 breast carcinoma patients were also evaluated. The association of sialic acid forms, sialyltransferase and α-2–6 sialoproteins levels with presence and extent as well as prognosis of breast carcinoma was studied. Serum sialic acid forms and sialyltransferase revealed significantly elevated levels among untreated breast cancer patients as compared to the controls, patients with BBD as well as cancer patients in remission. Non-responders showed comparable levels of the markers with those found in breast cancer patients at the time of diagnosis. Higher levels of sialic acid forms at diagnosis were associated with poor prognosis. A positive correlation between serum levels of different forms of sialic acids and extent of malignant disease was observed. The changes in serum proteins with terminal α-2–6 sialic acid correlated well with alterations in the levels of sialic acid forms and sialyltransferase. Malignant tissues showed elevated levels of sialic acid and sialyltransferase as compared to surrounding normal tissues. The results suggested potential utility of these markers in evaluation of clinical outcome.     

Effects of vanadate supplementation on high fat-diet and diabetes-induced metabolic changes in liver

Normal and streptozotocin-induced diabetic rats were fed the control high starch-diet or a high fatdiet supplemented with or without sodium orthovanadate (1.5 mg/g diet) for six weeks. Plasma glucose, insulin and triacylglycerol levels and the activities of hepatic glycogen synthase, phosphorylase, glucose-6-phosphate dehydrogenase, malic enzyme, and ATP-citrate lyase were measured in these eight groups of rats. The high fat-diet increased the levels of insulin (P<0.05) and triacylglycerol (P<0.01) in plasma and decreased the activities (P<0.001) of phosphorylase (active from and total) and the lipogenic enzymes. Vanadate supplementation led to significant (P<0.001) decreases in the elevated insulin and triacylglycerol levels whereas the enzyme activities remained unaffected. Diabetes and fat diet in combination caused 3.7-fold increases in plasma glucose and triacylglycerol levels and vanadate decreased them by 58% and 74% respectively. Vanadate improved the activities of hepatic glycogen metabolizing and lipogenic enzymes in diabetic rats when they were fed on control starch-diet but not with high fat-diet. This study shows that vanadate normalizes hyperinsulinemia and hypertriglyceridemia but not the defective hepatic glycogen metabolism in high fat-fed rats.     

The correlation between pertinence and rate of citation duplication in multidatabase searches.

The rate of citation duplication was examined in three databases: MEDLINE, BIOSIS, and LIFE SCIENCES COLLECTION. Duplicate citations were found to be more pertinent than unique citations. The duplicate citations came from a highly compact literature, while those from a single database were very widely scattered. The pertinent duplicated citations were more likely to be retrieved in searches that had more terms overall, had a higher percentage of thesaurus terms, and had terms which appeared in both title and abstract. These results suggest that the rate of duplication of citations in multidatabase searches may be used to rank output according to probable pertinence.     

Troponin T and Heart Type Fatty Acid Binding Protein (h-Fabp) as Biomarkers in Patients Presenting with Chest Pain

Acute coronary syndrome (ACS) is a term for a range of clinical signs and symptoms suggestive of myocardial ischemia. It results in functional and structural changes and ultimately releasing protein from injured cardiomyocytes. These cardiac markers play a major role in diagnosis and prognosis of ACS. This study aims to assess the efficacy of heart type fatty acid binding protein (h-FABP) as a marker for ACS along with the routinely used hs-TropT. In our observational study, plasma h-FABP (cut-off 6.32 ng/ml) and routinely done hs-Trop T (cutoff 0.1 and 0.014 ng/ml) were estimated by immunometric laboratory assays in 88 patients with acute chest pain. Based on the clinical and laboratory test findings the patients were grouped into ACS (n = 41) and non-ACS (n = 47). The diagnostic sensitivity, specificity, NPV, PPV and ROC curve at 95 % CI were determined. Sensitivity of hs-TropT (0.1 ng/ml), hs-TropT (0.014 ng/ml) and h-FABP were 53, 86 and 78 % respectively and specificity for the same were 98, 73 and 70 % respectively. Sensitivity, specificity and NPV calculated for a cut-off combination of hs-TropT 0.014 ng/ml and h-FABP was 100, 51 and 100 % respectively. These results were substantiated by ROC analysis. Measurement of plasma h-FABP and hs-TropT together on admission appears to be more precise predictor of ACS rather than either hs-Trop T or h-FABP.     

The effect of extremely high glucose concentrations on 21 routine chemistry and thyroid Abbott assays: interference study

Introduction

Extremely high glucose concentrations have been shown to interfere with creatinine assays especially with Jaffe method in peritoneal dialysate. Because diabetes is the fastest growing chronic disease in the world, laboratories study with varying glucose concentrations. We investigated whether different levels of glucose spiked in serum interfere with 21 routine chemistry and thyroid assays at glucose concentrations between 17-51 mmol/L.

Materials and methods

Baseline (group I) serum pool with glucose concentration of 5.55 (5.44-5.61) mmol/L was prepared from patient sera. Spiking with 20% dextrose solution, sample groups were obtained with glucose concentrations: 17.09, 34.52, and 50.95 mmol/L (group II, III, IV, respectively). Total of 21 biochemistry analytes and thyroid tests were studied on Abbott c8000 and i2000sr with commercial reagents. Bias from baseline value was checked statistically and clinically.

Results

Creatinine increased significantly by 8.74%, 31.66%, 55.31% at groups II, III, IV, respectively with P values of < 0.001. At the median glucose concentration of 50.95 mmol/L, calcium, albumin, chloride and FT4 biased significantly clinically (-0.85%, 1.63%, 0.65%, 7.4% with P values 0.138, 0.214, 0.004, < 0.001, respectively). Remaining assays were free of interference.

Conclusion

Among the numerous biochemical parameters studied, only a few parameters are affected by dramatically increased glucose concentration. The creatinine measurements obtained in human sera with the Jaffe alkaline method at high glucose concentrations should be interpreted with caution. Other tests that were affected with extremely high glucose concentrations were calcium, albumin, chloride and FT4, hence results should be taken into consideration in patients with poor diabetic control.Key words: assay interference, glucose interference, preanalytical phase, creatinine, Jaffe kinetic assay, thyroid function tests     

Using Research Based Assessment Tools in Professional Development in Current Electricity

We present a practical way of adapting and using four research-based assessments for different purposes in an electricity and magnetism course for K-8 science teachers. The course is designed to accomplish conceptual change toward accepted scientific conceptions as well as introducing teachers to materials and activities appropriate for their classrooms. Our data support that using the research-based tests to identify alternative conceptions and discuss test results with teachers is a promising way to use the knowledge of alternative conceptions in professional development. We also identify some mismatches between the research of conceptual change and its use in programs of professional development.

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基于最短路径的停车场内部诱导系统设计方法研究

从图论的角度讨论了静态最优路径的算法及其复杂度,在此基础上对停车诱导功能需求进行研究,提出了停车场内部诱导系统的设计思路和方法.     

Longitudinal study of preadolescent sport self-concept and performance: reciprocal effects and causal ordering

Do preadolescent sport self-concepts influence subsequent sport performance? Longitudinal data (Grades 3, 4, and 6) for young boys and girls (N= 1,135; mean age = 9.67) were used to test reciprocal effects model (REM) predictions that sport self-concept is both a cause and a consequence of sport accomplishments. Controlling prior sport performance (performance-based measures and teacher assessments), prior sport self-concept had positive effects on subsequent sport performance in both Grade 4 and Grade 6 and for both boys and girls. Coupled with previous REM studies of adolescents in the academic domain, this first test for preadolescents in the sport domain supports the generalizability of REM predictions over gender, self-concept domain, preadolescent ages, and the transition from primary to secondary school.