Incorrect order of draw could be mitigate the patient safety: a phlebotomy management case report

Procedures involving phlebotomy are critical for obtaining diagnostic blood specimens and represent a well known and recognized problem, probably among the most important issues in laboratory medicine. The aim of this report is to show spurious hyperkalemia and hypocalcemia due to inadequate phlebotomy procedure. The diagnostic blood specimens were collected from a male outpatient 45 years old, with no clinical complaints. The tubes drawing order were as follows: i) clot activator and gel separator (serum vacuum tube), ii) K₃EDTA, iii) a needleless blood gas dedicated-syringe with 80 I.U. lithium heparin, directly connected to the vacuum tube holder system. The laboratory testing results from serum vacuum tube and dedicated syringe were 4.8 and 8.5 mmol/L for potassium, 2.36 and 1.48 mmol/L for total calcium, respectively. Moreover 0.15 mmol/L of free calcium was observed in dedicated syringe. A new blood collection was performed without K₃EDTA tube. Different results were found for potassium (4.7 and 4.5 mmol/L) and total calcium (2.37 and 2.38 mmol/L) from serum vacuum tube and dedicated syringe, respectively. Also free calcium showed different concentration (1.21 mmol/L) in this new sample when compared with the first blood specimen. Based on this case we do not encourage the laboratory managers training the phlebotomists to insert the dedicated syringes in needle-holder system at the end of all vacuum tubes. To avoid double vein puncture the dedicated syringe for free calcium determination should be inserted immediately after serum tubes before EDTA vacuum tubes.     

Critical review and meta-analysis of spurious hemolysis in blood samples collected from intravenous catheters

Background:

A number of preanalytical activities strongly influence sample quality, especially those related to sample collection. Since blood drawing through intravenous catheters is reported as a potential source of erythrocyte injury, we performed a critical review and meta-analysis about the risk of catheter-related hemolysis.

Materials and methods:

We performed a systematic search on PubMed, Web of Science and Scopus to estimate the risk of spurious hemolysis in blood samples collected from intravenous catheters. A meta-analysis with calculation of Odds ratio (OR) and Relative risk (RR) along with 95% Confidence interval (95% CI) was carried out using random effect mode.

Results:

Fifteen articles including 17 studies were finally selected. The total number of patients was 14,796 in 13 studies assessing catheter and evacuated tubes versus straight needle and evacuated tubes, and 1251 in 4 studies assessing catheter and evacuated tubes versus catheter and manual aspiration. A significant risk of hemolysis was found in studies assessing catheter and evacuated tubes versus straight needle and evacuated tubes (random effect OR 3.4; 95% CI = 2.9–3.9 and random effect RR 1.07; 95% CI = 1.06–1.08), as well as in studies assessing catheter and evacuated tubes versus catheter and manual aspiration of blood (OR 3.7; 95% CI = 2.7–5.1 and RR 1.32; 95% CI = 1.24–1.40).

Conclusions:

Sample collection through intravenous catheters is associated with significant higher risk of spurious hemolysis as compared with standard blood drawn by straight needle, and this risk is further amplified when intravenous catheter are associated with primary evacuated blood tubes as compared with manual aspiration.     

Glycogen phosphorylase isoenzyme BB in the diagnosis of acute myocardial infarction: a meta-analysis

Background

Early diagnosis is crucial for management of patients with suspected acute myocardial infarction (AMI). Among innovative and promising biomarkers, the recent interest raised on glycogen phosphorylase isoenzyme BB (GPBB) has prompted us to perform a meta-analysis of published studies.

Materials and methods:

A systematic electronic search was carried out on PubMed, Web of Science and Google Scholar, with no date restriction, to retrieve all articles that have investigated the early diagnostic performance of GPBB in patients with suspected AMI, and directly reported or allowed calculation of sensitivity and specificity. A meta-analysis of the reported sensitivity and specificity of each study and pooled area under the curve (AUC) was then performed by random effect approach. Heterogeneity was assessed by I-square statistics.

Results:

Eight studies were finally selected for analysis (941 subjects; 506 cases and 435 controls), with a high heterogeneity (I-squared, 86.3%). The resulting pooled estimates and 95% confidence interval were 0.854 (0.801–0.891) for sensitivity, 0.767 (0.713–0.815) for specificity, 0.826 (0.774–0.870) for negative predictive value, 0.802 (0.754–0.844) for positive predictive value, and 0.754 (0.602–0.907) for AUC. In those studies that have simultaneously assessed GPBB and a troponin immunoassay, the combination of these biomarkers did not significantly improve the performance of troponin alone.

Conclusion:

GPBB does not meet the current requirements for an efficient diagnosis of AMI when used as a stand-alone test, whereas its combination with troponin merits further investigation in larger trials.     

Numerical modelling of the structural behaviour of Buti’s bell tower

The paper describes the numerical techniques implemented in the finite-element code NOSA for structural analysis of masonry constructions. The code is then applied to the analysis of “Buti’s bell tower”, a medieval structure located on the Pisa mountains, under two different conditions: firstly, with the structure subjected to its own weight alone, and then while subjected to both its own weight and a horizontal load, which models an earthquake. The displacement and stress fields, as well as the distribution of cracking have been calculated with NOSA, and the numerical results analysed and compared to the actual distribution of fractures in the tower.     

Acquisition of reading and written spelling in a transparent orthography: Two non parallel processes?

Reading and written spelling skills for words and non-words of varying length and orthographic complexity were investigated in normal Italian first and second graders. The regularity and transparency of the mapping between letters and phonemes make Italian orthography an unlikely candidate for discrepancies between reading and spelling to emerge. This notwithstanding, the results showed that reading accuracy is significantly better than spelling. The difference is particularly striking in first graders, but it is still evident in 2nd graders, though most strongly on non-words. The data show that reading and written spelling are non parallel processes and that the developmental asynchrony reflects a partial structural independence of the two systems.     

International patent disputes: Evidence from oppositions at the European Patent Office

The impact of the geographical origin of patents on the probability of an opposition being filed and a patent being revoked has been examined in this paper, after accounting for patent value indicators and industry specificities. The study is based on a dataset of approximately 450,000 EPO granted patents and 24,000 patent opposition cases in the years 2000–2008. We find that patents with a first priority in the US are less likely to be challenged, although they are relatively more likely to be revoked than patents with a priority in a member country of the European Patent Convention. Patents from Japan have less probability of being opposed and are less likely to be revoked than the other countries. A disaggregation of the European countries has revealed that patents with a German priority have a higher or similar likelihood of being opposed than patents from the other countries, with the exceptions of The Netherlands and Denmark.     

Energy balance of locomotion with pedal-driven watercraft

Abstract

In this study, we examined the mechanics and energetics of locomotion with a paddle-wheel boat and a water bike. Power output ([Wdot] _tot) was measured directly on the water bike by means of an instrumented chain-ring. The simultaneous assessment of oxygen uptake ([Vdot]O₂) allowed the computation of the “overall” efficiency of locomotion (η _o = [Wdot] _tot / [Vdot]O₂). Mean η _o was 0.27 (s = 0.02), which was unaffected by the speed, and was assumed to be the same for the two boats as both are semi-recumbent bicycles. For the paddle-wheel boat, [Wdot] _tot was then obtained from η _o and measures of [Vdot]O₂. The power to overcome (passive) drag was calculated as [Wdot] _d = D · v (where D is the force measured by means of a load cell when towing the boats at given speeds). Propelling efficiency was calculated as η _p = [Wdot] _d / [Wdot] _tot, which was lower with the paddle-wheel boat (mean 0.35, s = 0.01) than with the water bike (mean 0.57, s = 0.01). The observed differences in η _p and [Wdot] _d explain why at the highest speed tested (～3 m · s^?1), the energy required to cover a unit distance with the water bike is similar to that required to move the paddle-wheel boat at 1.3 m · s^?1.     

Environmental conditions,air pollutants,and airway cells in runners: A longitudinal field study

Abstract

Runners have increased numbers of neutrophils in the airways at rest and after exercise compared with sedentary individuals. The aim of this study was to determine whether Mediterranean seasonal changes in temperature, humidity or airborne pollutants affect the airway cells of runners training outdoors in an urban environment. In nine male amateur runners, cell composition, apoptosis, and inflammatory mediators were measured in induced sputum collected at rest (baseline) and the morning after races held in the fall (21 km), winter (12 km), and summer (10 km). Concentrations of air pollutants were below the alert threshold at all times. Neutrophil differential counts tended to increase after all races (P = 0.055). Apoptosis of neutrophils increased with ozone (P < 0.005) and particulate matter <10 μm (PM₁₀) (P < 0.05) exposure. Bronchial epithelial cell counts were low at all times and weakly correlated with ozone and PM₁₀ concentrations. Apoptotic bronchial epithelial cells increased after all races (P < 0.05). Inflammatory mediators in induced sputum were low at baseline and after the races, and correlated with neutrophil differential counts only at rest. In conclusion, apoptosis of airway cells in runners appears to be affected by both exercise and environmental conditions. Apoptosis of neutrophils increased with exposure to environmental pollutants while apoptosis of bronchial epithelial cells increased after intense exercise. Since no relationship was observed between neutrophil counts and inflammatory mediators 20 h after races, airways inflammation at this time point appears blunted in healthy runners and little affected by exposure to mild seasonal changes and airborne pollutants.     

Physiology in the Journal of Sports Sciences

Abstract

Doping in sports is commonplace. The prevention of harm to the athlete, the guarantee of fair play, and a level playing field for all competitors are the basis of the current anti-doping strategies. As healthcare systems are forced to allocate increasing resources to prevent and treat the prevailing pathologies worldwide, funding for anti-doping campaigns will necessarily be restricted. Ideally, additional resources should be devoted to increasing the number of athletes tested, the panels of tests used, and the frequency of out-of-competition controls. Since doping prevention cannot be considered a priority for most healthcare systems, such an approach is unaffordable and an alternative framework should be devised, focused primarily on harm reduction rather than fair play. The identification of abnormal deviations from reference values, regardless of pathological or artificial causes, would allow the athlete to be followed and tested using conventional laboratory tests, which are affordable to governments and healthcare systems and available to clinical laboratories. Although this strategy would not detect cheating, it would safeguard athletes' health.