Cardiac indexes, cardiac damage biomarkers and energy expenditure in professional cyclists during the Giro d'Italia 3-weeks stage race

Introduction

The study of cardiac response to strenuous and continuous exercise is crucial to understanding the physiology of endurance. N-terminal proB-type natriuretic peptide (NT-proBNP) is a potential marker for monitoring myocardial wall stress, and troponins (TnT and TnI) are widely used in the diagnosis of cardiac ischemia and infarction. Strenuous exercise may generate transitory ischemia, myocardial stress, and diastolic left ventricular dysfunction, inducing the increased production of both these biomarkers. We measured changes in NT-proBNP and TnT in elite cyclists during a 3-week stage race, a model of strenuous exercise.

Materials and methods:

The study population was 9 professional cyclists participating in the 2011 Giro d’Italia. Pre-analytical and analytical phases scrupulously followed official recommendations. Anthropometric data, net energy expenditure and cardiac indexes (rate, diastolic and systolic blood pressure) were recorded. Blood samples were drawn pre-race (day −1) and at days 12 and 22; NT-proBNP and highly sensitive-troponin (Hs-TnT) concentrations were assayed and corrected for plasma volume changes.

Results:

Body-mass index decreased and energy expenditure increased by 52% during the race. NT-proBNP concentrations increased [day −1: 23.52 ng/L (9.67–34.33); day 12: 63.46 ng/L (22.15–93.31); P = 0.039; day 22: 89.26 ng/L (34.66–129.78) vs. day −1; P < 0.001] and correlated with heart rate (r = −0.51; P = 0.006), systolic pressure (r = 0.39; P = 0.046) and energy expenditure (r = 0.70; P < 0.001). TnT concentrations did not vary, but a widened TnT amplitude distribution was observed.

Conclusions:

Increases in NT-proBNP correlated with higher energy expenditure over a 3-week cycling stage race, possibly indicating myocardial stress.     

Impact of the phlebotomy training based on CLSI/NCCLS H03-A6 - procedures for the collection of diagnostic blood specimens by venipuncture.

Introduction:

The activities involving phlebotomy, a critical task for obtaining diagnostic blood samples, are poorly studied as regards the major sources of errors and the procedures related to laboratory quality control. The aim of this study was to verify the compliance with CLSI documents of clinical laboratories from South America and to assess whether teaching phlebotomists to follow the exact procedure for blood collection by venipuncture from CLSI/NCCLS H03-A6 - Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture might improve the quality of the process.

Materials and methods:

A survey was sent by mail to 3674 laboratories from South America to verify the use of CLSI documents. Thirty skilled phlebotomists were trained with the CLSI H03-A6 document to perform venipuncture procedures for a period of 20 consecutive working days. The overall performances of the phlebotomists were further compared before and after the training program.

Results:

2622 from 2781 laboratories that did answer our survey used CLSI documents to standardize their procedures and process. The phlebotomists’ training for 20 days before our evaluation completely eliminated non-conformity procedures for: i) incorrect friction of the forearm, during the cleaning of the venipuncture site to ease vein location; ii) incorrect sequence of vacuum tubes collection; and iii) inadequate mixing of the blood in primary vacuum tubes containing anticoagulants or clot activators. Unfortunately the CLSI H03-A6 document does not caution against both unsuitable tourniquet application time (i.e., for more than one minute) and inappropriate request to clench the fist repeatedly. These inadequate procedures were observed for all phlebotomists.

Conclusion:

We showed that strict observance of the CLSI H03-A6 document can remarkably improve quality, although the various steps for collecting diagnostic blood specimens are not a gold standard, since they may still permit errors. Tourniquet application time and forearm clench should be verified by all quality laboratory managers in the services. Moreover, the procedure for collecting blood specimens should be revised to eliminate this source of laboratory variability and safeguard the quality.     

Hierarchical web resources retrieval by exploiting Fuzzy Formal Concept Analysis

In recent years, knowledge structuring is assuming important roles in several real world applications such as decision support, cooperative problem solving, e-commerce, Semantic Web and, even in planning systems. Ontologies play an important role in supporting automated processes to access information and are at the core of new strategies for the development of knowledge-based systems. Yet, developing an ontology is a time-consuming task which often needs an accurate domain expertise to tackle structural and logical difficulties in the definition of concepts as well as conceivable relationships. This work presents an ontology-based retrieval approach, that supports data organization and visualization and provides a friendly navigation model. It exploits the fuzzy extension of the Formal Concept Analysis theory to elicit conceptualizations from datasets and generate a hierarchy-based representation of extracted knowledge. An intuitive graphical interface provides a multi-facets view of the built ontology. Through a transparent query-based retrieval, final users navigate across concepts, relations and population.     

pH controlled staining of CD4+ and CD19+ cells within functionalized microfluidic channel

Herein proposed is a simple system to realize hands-free labeling and simultaneous detection of two human cell lines within a microfluidic device. This system was realized by novel covalent immobilization of pH-responsive poly(methacrylic acid) microgels onto the inner glass surface of an assembled polydimethylsiloxane/glass microfluidic channel. Afterwards, selected thiophene labeled monoclonal antibodies, specific for recognition of CD4 antigens on T helper/inducer cells and CD19 antigens on B lymphocytes cell lines, were encapsulated in their active state by the immobilized microgels. When the lymphocytes suspension, containing the two target subpopulations, was flowed through the microchannel, the physiological pH of the cellular suspension induced the release of the labeled antibodies from the microgels and thus the selective cellular staining. The selective pH-triggered staining of the CD4- and CD19-positive cells was investigated in this preliminary experimental study by laser scanning confocal microscopy. This approach represents an interesting and versatile tool to realize cellular staining in a defined module of lab-on-a-chip devices for subsequent detection and counting.     

Comparison of Freelite and N-Latex serum free light chain assays: a critical review

IntroductionThe measurement of serum free light chain (FLC) represents a fundamental aspect on the assessment of patients with monoclonal gammopathies (MG). Different analytical methods for FLC have become available with the possibility to obtain different value with a substantial impact on the assessment of patients with MG. This study aimed to evaluate FLC results obtained with two different assays and how the difference value obtained can impact in the patient’s assessment.Materials and methodsNinety-three patient serum samples that underwent analysis for FLC with two different methods, Serum Freelite (The Binding Site, Birmingham, UK) and N-Latex FLC (Siemens, Marburg, Germany), were included in this retrospective study. Statistical analysis was performed to evaluate correlation, difference, and the grade of concordance between the results obtained with the two methods.ResultsSignificant statistical differences between the results obtained from the two methods were found (P < 0.05). A good correlation was found (0.99 for κ FLC, 0.95 for λ FLC, and 0.94 for the κ/λ ratio, respectively). We found a weighted kappa value of 0.65 for κ/λ ratio, 0.65 for λ FLC and 0.90 for κ FLC. A positive bias found with the Bland-Altman plot mirrors overestimation of κ FLC and κ/λ ratio with Freelite compared to N-Latex, whilst a negative bias underscores underestimation of λ FLC by Freelite compared to N-Latex.ConclusionAlthough in general the concordance between Freelite and N-Latex appears satisfactory, several discrepancies could be evidenced and consequently the two assays are not interchangeable.     

A new method to estimate a first-order plus time delay model from step response

In this paper an identification method to estimate the parameters of a first-order plus time delay model is proposed. Such a method directly obtains these parameters using a new linear regression equation. No iterations in calculation are needed. Moreover, a simple true/false criterion to establish if the hypothesis on the process type is correct can be easily derived. The proposed method shows an acceptable robustness to disturbances and measurement noise as it is confirmed by several simulated experiments.     

Stretching of DNA confined in nanochannels with charged walls

There is currently a growing interest in control of stretching of DNA inside nanoconfined regions due to the possibility to analyze and manipulate single biomolecules for applications such as DNA mapping and barcoding, which are based on stretching the DNA in a linear fashion. In the present work, we couple Finite Element Methods and Monte Carlo simulations in order to study the conformation of DNA molecules confined in nanofluidic channels with neutral and charged walls. We find that the electrostatic forces become more and more important when lowering the ionic strength of the solution. The influence of the nanochannel cross section geometry is also studied by evaluating the DNA elongation in square, rectangular, and triangular channels. We demonstrate that coupling electrostatically interacting walls with a triangular geometry is an efficient way to stretch DNA molecules at the scale of hundreds of nanometers. The paper reports experimental observations of λ-DNA molecules in poly(dimethylsiloxane) nanochannels filled with solutions of different ionic strength. The results are in good agreement with the theoretical predictions, confirming the crucial role of the electrostatic repulsion of the constraining walls on the molecule stretching.     

Physical activity - an important preanalytical variable

The concentration of several biochemical and hematological biomarkers is strongly influenced by a number of preanalytical variables. Several lines of evidence attest that short, middle, and long-term exercise, as well as the relative intensity of physical effort (from mild to strenuous), may influence a broad array of laboratory variables. The amount of extracellular release and clearance from blood of most of these biomarkers is markedly influenced by the biological characteristics of the molecule(s), level of training, type, intensity and duration of exercise, and time of recovery after training. It is hence noteworthy that test results that fall outside the conventional reference ranges in athletes not only may reflect the presence of a given disease, but may frequently mirror an adaptation to regular training or changes that have occurred during and/or following strenuous exercise, and which should be clearly acknowledged to prevent misinterpretation of laboratory data. The aim of this narrative review is to provide an update about the most significant changes of some biochemical and hematological biomarkers in response to physical exercise, for appropriate interpretation of these changes in the context of physically active subjects.     

Metabolic optimisation of the basketball free throw

The free throw (FT) is a fundamental basketball skill used frequently during a match. Most of actual play occurs at about 85% of maximum heart rate (HR). Metabolic intensity, through fatigue, may influence a technically skilled move as the FT is. Twenty-eight under 17 basketball players were studied while shooting FTs on a regular indoor basketball court. We investigated FT accuracy in young male basketball players shooting at three different HRs: at rest, at 50% and at 80% of maximum experimentally obtained HR value. We found no significant FT percentage difference between rest and 50% of the maximum HR (FT percentage about 80%; P > 0.05). Differently, at 80% of the maximum HR the FT percentage decreased significantly by more than 20% (P < 0.001) down to about 60%. No preliminary warm-up is needed before entering game for the FT accuracy. Furthermore, we speculate that time-consuming, cooling-off routines usually performed by shooters before each FT may be functional to improve its accuracy.     

Repeated sprint ability in young basketball players: one vs. two changes of direction (Part 1)

The present study aimed to compare the changes of direction on repeated sprint ability (RSA) vs. intensive repeated sprint ability (IRSA) protocols in basketball. Eighteen young male basketball players performed on RSA [10 × 30-m (15 + 15-m, one change of direction)] and IRSA [10 × 30-m (10 + 10 + 10-m, two changes of direction)]. A correlation matrix between RSA, IRSA, “squat jump (SJ)–countermovement jump (CMJ)”, footstep analysis and total distance in Yo-Yo intermittent recovery level 1 was performed. The best time, worst time, total time and the number of footsteps were significantly smaller in the RSA test compared to IRSA test (P < 0.001), even though they were significantly correlated with each other (r > 0.80, P < 0.05). Blood lactate level and fatigue index did not show any difference between tests. The sensibility of the two tests assessed by the Bland–Altman analysis revealed a small bias (<1.5%) for almost all variables. Moreover, almost all time variables of the two tests were significantly correlated with the SJ (r > 0.478, P < 0.05), CMJ (r > 0.515, P < 0.05) and Yo-Yo (r > 0.489, P < 0.05) performances. The IRSA provided a reliable method for assessing specific sprint ability (with 10-m legs for IRSA ~2.3 s vs. 15 m for RSA ~3 s) with a closer link to basketball game’s actions (~2 s). Besides, IRSA could be an appropriate choice for assessing both RSA and changes of direction capacities in basketball players.